Objective To analyze the epidemiological changes, clinical features and disease patterns of 10-year renal biopsy series in our center and to compare the changes of pathological diagnosis spectrum of renal biopsy, so as to explore the trend of epidemiological characteristics of renal biopsy across ten years. Methods From January 2007 to December 2016, 1 786 patients (aged ≥18 years) undergoing percutaneous renal biopsy were involved and divided into 3 period groups according to the date of biopsy, earlier group (2007-2010), mid-term group (201 1-2013) and recent group (2014-2016). The patients were also divided into 3 age groups (15-39 years, 40-64 years and ≥65 years). The clinical and pathological data of all patients were collected, and than statistical analysis was performed by SPSS 18. 0 software. Results A total of 1 786 cases with complete clinical data were enrolled, of which 973 were male and 813 were female, with a median age of 42 years (range 15-88 years). There were 1 548 patients with primary glomerular disease, with IgA nephropathy (IgAN) being the most common one, accounting for 29.1% (520/1 786), 17.3% (309/1 786) having minimal change disease (MOD), and 17.0%(304/1 786) having membranous nephropathy (MN). Totally 238 patients had secondary renal disease, of which lupus nephritis was the most common one, accounting for 3.4% (61/1 786), followed by diabetic nephropathy (2.9%, 51/1786) and Henoch-Schönlein purpura nephritis (2.2% 39/1 786). There were no significant differences in gender or age between three period groups. Compared with the earlier group (66/684, 9. 6%), the proportions of MN in the midrtem group (90/547, 16.5%) and the recent group (148/555, 26.7%) were significantly increased (P<0.01). Nephritis syndrome (NS; 45.5%, 812/1786) was the most frequent clinical manifestation in all cases, followed by nephrotic syndrome (688/1786, 38.5%). The most common clinical manifestation in patients suffered from NS was MCD in 15-39 years group and MN in 40-64 years group and ≥65 years group. Meanwhile, the most common diagnosis for patients suffered from nephritis syndrome was IgAN in 15-39 years group and 40-64 years group, but was MN in ≥65 years group. Conclusion IgAN remains the most common glomerulopathy in our study. However, the prevalence of MN has grown quickly in recent years. IgAN is the main diagnosis for young and middle aged patients with nephritis syndrome, while the MN is the main for middle aged and elderly patients with NS.

Objective To study the clinicopathological features of membranous nephropathy(MN) with ANCA-associated crescentic glomerulonephritis (ANCA-associated CGN). Methods 79 cases diagnosed as MN with ANCA associated CGN were selected from the whole English and Chinese literatures and a similar case was from our hospital. Total 80 casess were included in this study to summarize the clinicopathological features, treatment and prognosis. Results 44 male and 36 female patients were included. The average age was 56. 8±13. 1 years and the average disease onset period was 3. 2±3. 6 months. In 95% cases, MN and ANCA associated CGN occurred simultaneously. 93. 8% patients presented renal dysfunction onset of the disease, the common clinical manifestation were nephrotic syndrome with rapidly progressive glomerulonephritis. All patients were serum ANCA positive and 88. 2% cases were MPO-ANCA positive. The average 24h proteinuria was 5. 27±4. 3g and SCr was 420. 7±307μmol/L. Renal biopsy showed crescent formation and GBM thicken. Immunofluorescence showed IgG and C3 deposits were positive. Prednisone combined with CTX could improve the prognosis. 62. 7% cases reached relieve remission. Conclusions The coexistence of ANCA associated CGN and MN was rare. The pathogenesis of this condition is still unclear. Immunosuppressive therapy might improve the outcome.

Objective To compare the efficacies of esmolol and urapidial in improving brain beat during microvascular decompression surgery for hemifacial spasm. Methods A total of 226 patients scheduled for microvascular decompression surgery received general anesthesia with controlled blood pressure, with the mean arterial blood pressure (MAP) being 55-65 mmHg (1 mmHg=0. 133 kPa) and the bispectral index being 40-60. Thirty-two of the 226 patients who developed brain beat were randomly assigned to 3 groups; groupA (esmolol, n = 11), B (urapidial, n=11) and C (isotonic NaCl, n=10), receiving intravenous injection of esmolol 10 mg, urapidial 5 mg and isotonic NaCl 2 mL, respectively. Theheart rate (HR), mean arterial pressure (MAP) and cardiac output (CO) at T0 (before injection), T1 (1 min after injection), T2 (5 min after injection), T3 (10 min after injection), T4 (30 min after injection), operating time under microscope, and improvement of brain beat were observed. Results There were no significant differences in HR, MAP or CO at T0 time between the three groups. HR and CO were significantly decreased in group A compared with those in group C at all time points(P<0. 01); MAP values were similar between group A and group C. HR, MAP and CO were similar at different time points in group C. The improvement rate of group A was significantly higher than those of group B and group C(P<0. 01). The operating time under microscope in group A was (18±4) min, which was significantly shorter than those in group B ([28 ± 6] min) and group C ([29 ±5] min). Conclusion Esmolol can notably improve the brain beat during microvascular decompression surgery for hemifacial spasm.

Malignant biliary obstruction (MBO) leads to obstructive jaundice as a result of bile excretion disorder, which may cause complications such as cholangitis, sepsis, hepatic failure and even life-threatening. Biliary drainage is an effective mean to relieve symptoms and improve patients'quality of life. At present, endoscopic retrograde cholangiopancreatography (ERCP) is the first-line palliative treatment for MBO patients without surgical opportunity. In recent years, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been gradually accepted as an alternative to percutaneous transhepatic biliary drainage (PTBD) in MBO with failed ERCP. The available evidence suggests that EUS-BD might even replace ERCP as the first-line procedure in patients with malignant distal biliary obstruction by experienced surgeons. This paper reviews the research progresses of EUS-BD in MBO.

China is a country with high incidence of gastrointestinal (GI) cancer. Gastric cancer, esophageal cancer and colon cancer seriously threaten the health of people, and leads to heavy medical burdens. This review discusses the current screening protocol of GI cancer and pancreatic cancer. It also interprets the relevant policies issued by the state in recent years, and evaluates the effects of new technologies such as serum pepsinogen combined with gastrin in detecting gastric cancer, fecal and blood gene detection for colon cancer, and "serum liquid biopsy" of pancreatic cancer for early cancer screening. We also point out the difficulties and challenges in cancer screening at early stage, and the significance of promoting early cancer screening to reduce the mortality of GI cancer in China.

Objective To explore the feasibility and repeatability of Surgimap software in measurement of Cobb angle of adolescent idiopathic scoliosis (AIS). Methods Four surgeons (1 associate chief physician and 3 residents) measured the coronal main curve Cobb angle and sagittal parameters (thoracic kyphosis [TK], thoracolumbar kyphosis [TLK] and lumbar lordosis [LL]) of 67 AIS patients using Surgimap software and traditional measurement method on standard standing position X-ray images before operation. The measurement time of the two methods was recorded and compared. The reliability analysis was performed for the measurement results of 4 surgeons, and the repeatability analysis was performed for 2 measurement results of 3 residents. Results The coronal main curve Cobb angles measured by Surgimap software and traditional measurement method were 49.4°±8.2° and 41.4°±15.6°, respectively, and the absolute average difference between the two methods was 8.29°±4.36°. The measurement time of Surgimap software and traditional measurement method was (5.2±0.7) min and (8.8±1.5) min, respectively, with the absolute average difference being (3.6±0.9) min, and the difference was significant (t= 2.57, P<0.01). The reliability analysis showed that the coronal main curve Cobb angle, TK, TLK and LL measured by 4 surgeons using Surgimap software had excellent or good consistency (intraclass correlation coefficient [ICC]= 0.972, 0.924, 0.875, 0.962). Repeatability analysis showed that the coronal main curve Cobb angle, TK, TLK and LL measured by 3 residents had excellent or good consistency using Surgimap software (ICC ranged from 0.875 to 0.984). Conclusion Surgimap software is superior to the traditional method in measuring Cobb angle, and has the advantages of high efficiency, short learning curve and unified data derivation.

Severe acute pancreatitis is a common critical emergency in the digestive system. It is difficult to treat in clinic and has high mortality. According to the new Atlanta classification standard proposed in 2012, the treatment of acute pancreatitis mainly focused on early indentification, maintenance of organ function, anti-inflammatory response, intestinal function maintenance and other measures, so as to improve the success rate of the treatment. As more patients with severe acute pancreatitis have successfully crossed the acute phase, the prevention and treatment of subsequent complications of acute pancreatitis have been increasingly valued. To focus on the “secondary attack” of acute pancreatitis, it is necessary to carry out clinical research on the subsequent complications such as the accumulation of peripancreatic fluid, infectious necrosis, and vascular complications, and to reduce the mortality. This is a change in the focus of acute pancreatitis treatment and a further extension of the concept of multidisciplinary collaboration in acute pancreatitis.

Objective To investigate the risk factors influencing the recurrence of calcium oxalate kidney stone. Methods The clinical data of patients with calcium oxalate kidney stone were collected; they were hospitalized in Changhai Hospital, Navy Medical University (Second Military Medical University) from Sep. 2015 to Dec. 2015. The patients were divided into the first-time calcium oxalate stone group (first-time group) and the recurrent of calcium oxalate stone group (recurrent group) according to the stone histories. The concentrations of clusterin in serum and urine, and the concentrations of serum interleukin (IL)-1β, IL-2 and IL-6 in the two groups were detected by ELISA. The independent risk factors influencing the recurrence of calcium oxalate kidney stones were analyzed by univariate and multivariate logistic regression analysis. Results Thirty-six patients were included in each group. Univariate analysis showed that there were no significant differences in age, gender, body mass index (BMI), estimated glomerular filtration rate (eGFR), maximum stone diameter or the concentrations of serum clusterin, IL-1β, IL-2 and IL-6 between the two groups (all P0.05). The concentration of urinary clusterin in the recurrent group was significantly lower than that in the first-time group ([44.35±15.44] ng/mL vs [56.76±16.80] ng/mL, t=–3.262, P0.05). Multivariate logistic regression analysis showed that urinary clusterin concentration (OR=0.939, 95% CI 0.900-0.979, P0.05) was an independent risk factor influencing the recurrent of calcium oxalate kidney stone. Conclusion The concentration of urinary clusterin is decreased in patients with recurrence of calcium oxalate stone compared the first-time stone patients, suggesting that the clusterin in urine may be closely related to the recurrence of stones.

Small bowel endoscopy (enteroscopy) is an important technique for diagnosis and treatment of small intestinal diseases. This review summarizes the updated points of the 2018 edition of the Chinese Guideline for Clinical Application of Enteroscopy. It expounds the contents of the guideline from four aspects: indications and contraindications of enteroscopy, the role of enteroscopy in the diagnosis process of small intestinal diseases, the operation skills of enteroscopy, and the expansion of the therapy field of enteroscopy. The current guideline also included many native clinical evidences, which is of great significance in guiding the clinical practice of enteroscopy in China.

Acute pancreatitis (AP) is the most common severe disease of digestive system, with high morbidity and mortality. In 2019, the latest version of guidelines for the management of acute pancreatitis (Shenyang, 2019) was launched. Starting from the etiology and classification of AP, the guidelines proposed 30 statements on the diagnosis and treatment of AP. The guideline fully reflected the level of evidence and consensus level of experts and provided suggestions for the clinical management of AP in the future. This review summarizes the key points of updating the guidelines, focusing on the classification principle of AP, the change of etiology, the unification of diagnostic name, the strategy of fluid resuscitation and antibiotic use to strenthen the understanding of the guidelines for better clinical practice.