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.

BACKGROUND: Blood platelet is active commonly appeared in both acute and recovery stages in ischemic cerebral apoplexy. Cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) are closely correlated with the blood platelet function.OBJECTIVE: To observe the therapeutic effects of compound danshen drop on clinical prevention and treatment of transient cerebral ischemic attack (TIA) and the influence on serum cAMP and cGMP.DESIGN: Randomized control experiment.SETTING: Department of Neurology of Binzhou Medical College affiliatedHospitalPARTICIPANTS: Totally 180 TIA patients participated in the experiment in volunteer in the clinic of Neurological Department of Affiliated Hospital of Binzhou Medical College from September 2000 to April 2001. Based on randomized number scale, 3 groups were divided according to dosages of compound danshen drop. In 10 drops/d group, there were 60 cases, of which 35 cases were male and 25 cases female, aged varied from 50 to 70 years, averagely (54.3±7.2) years old. In 20 drops/d group, there were 60 cases, of which, 32 cases were male and 28 cases female, aged varied from 49 to 62 years, averagely (55.7±5.1) years old. In 30 drops/d group, there were 60 cases, of which, 33 cases were male and 27 cases female, aged varied from 52 to 69 years, averagely (54.9±5.5) years old.METHODS: In 10 drops/d group, the drug was given once per day, 10drops each time. In 20 drops/d group, the drug was given twice per day,10 drops each time. In 30 drops/d group, the drug was given three times per day, 10 drops each time. Four weeks after medication, 3 mL blood was collected from each patient in the morning. With radioimmunoassay, the contents of cAMP and cGMP in serum were determined. Each case was tions, gem bleeding, epistaxis, subcutaneous bleeding, mouth numbness,headache, dizziness, etc.tack: In 10 drops/d group, there were 1 case in internal carotid arterial system, 2 cases in vertebral arterial system, 1 case of cerebral infarction and 2 cases of myocardial infarction. In 20 drops/d group, it was 2, 2 and 1 cases successively and in 30 drops/d group, it was 1, 2, 1 cases succesgroup: There were 1, 2 and 4 cases of harmful accident and side effects in three groups successively, of which, peripheral numbness of mouth 1 case in 10 drops/d group, 1 case of either peripheral numbness of mouth or headache in 20 drops/d group, gastrointestinal reaction 1 case, peripheral numbness of mouth 2 cases and dizziness 1 case in 30 drops/d group.There was no gem bleeding, epistaxis and subcutaneous bleeding, and no patient was withdrawn the treatment due to above-mentioned side effects.With comparison among groups, significant difference was not indicated The contents of cAMP were (21.22±3.94), (22.5±3.67), (23.1±7.7) ng/Land cGMP were (3.67±1.18), (4.74±2.12), (4.6±0.7) ng/L successively in three groups (P ＞ 0.05).CONCLUSION: During second-grade prevention of TIA, compound danshen drop presents definite therapeutic effects, which is basically same in comparison of dosages. Simultaneously, no remarkable side effects appear.

Objective To investigate the correlation between the quantitative results,the semi-quantitative scores from ultrasound elastography and the distribution of myofibroblasts (MFS)in breast tumor,and to analyze the value of quantitative results and the semi-quantitative score from ultrasound elastography in the diagnosis of breast tumor.Methods Thirty eight patients with breast lesions underwent ultrasound elasticity examinations,tissue dispersion quantitative analysis technique was used to assess the 11 characteristic quantities and the corresponding strain ratios in all lesions,and the score of ultrasonic elastography was evaluated.38 cases were divided into benign and malignant group according to pathological diagnosis results.The expression levels of CD34 andα-SMA protein in breast tissue were examined by immunohistochemistry.The distribution patterns of MFS in breast tumor were analyzed. The correlation between the quantitative results, the semi-quantitative scores from ultrasound elastography and the distribution of MFS in breast tumor was studied.Results The expression level of CD34 in malignant group was significantly higher than that in benign group, while the expression level of α-SMA was significantly higher than that in benign group;the differences in the expression levels of CD34 andα-SMA between benign and malignant breast tumor patients were statistically significant (P < 0.01 ).The masses observed in malignant group by elastography were shown in blue,while most of the masses in benign group were shown in green.There were statistically significant differences between two groups in elastography scores (P < 0.05 ). There was a anegative correlation between the CD34 expression in tumor tissue and the score of ultrasound elastography (r=-0.423 7,P =0.027 3).There was a negative correlation between the CD34 expression and the score of ultrasound elastography (r=-0.423 7,P =0.027 3),while the positive correlation was found between theα-SMA expression and the score of ultrasound elastography (r=0.397 0,P =0.014 2).The CD34 expression was significantly correlated with the average relative strain value,entropy,area ratio of low-strain region,kurtosis, skewness and inverse difference moment (P <0.05).Among the 11 characteristics,CD34 was positively correlated with the average relative strain value (r=0.385 6,P =0.016 8)and entropy (r=0.380 5,P =0.018 5);CD34 was negatively correlated with area ratio of low-strain region (r = - 0.351 7,P = 0.030 4),kurtosis (r =-0.427 7,P =0.007 4),skewness (r=-0.394 6,P =0.014 2),inverse difference moment (r = -0.344 3, P =0.034 3),angular second moment (r = - 0.484 9,P = 0.002 0)and strain ration (r = - 0.379 0,P =0.047 5);CD34 was not correlated with standard deviation,complexity and contrast (P > 0.05).The α-SMA espression was positively correlated with kurtosis (r = 0.356 9,P = 0.027 8),skewness (r = 0.323 0,P =0.047 9),area ratio of low-strain region (r=0.382 0,P =0.021 6)and strain ratio (r=0.403 3,P =0.012 0). Conclusion The features and its scores of ultrasound elastography are correlated with the distribution of MFS in breast tumor,suggesting that the ultrasound elastography is very informative and helpful in the diagnosis of breast tumor.

Objective: To evaluate color velocity imaging-quantitative method (CVI-Q) in estimating cerebral hemodynamic change in patients with cerebral infarction. Methods: The carotids of 60 normal people and 40 cerebral infarction patients were detected by CVI-Q. We observed endangium thickness and atheromatous plaques,and measured the diameter (d), peak velocity(Vmax), resistance index(RI) and blood flow volume(Q) of the common carotid arteries. Results: In cerebral infarction group there were 75% cases with endangium thickening to different degrees, 45% cases with atheromatous plaques and 71% plaques in carotid enlargement section or bifurcation. The data measured in 2 groups were compared: (1)The d value in cerebral infarction cases increased than that in normal（P<0.05 or P<0.01）; (2)The Vmax reduced in cerebral infarction cases(P<0.05); (3)The RI increased in cerebral infarction cases (P<0.05 or P< 0.01); (4) The Q value reduced in cerebral infarction cases (P<0.01). Conclusion: CVI-Q can be used for detecting cerebral hemodynamic changes and provide quantitative indexes for clinicians to estimate ischemia degree and treatment in cerebral infarction patients.

OBJECTIVETo investigate the effect of compound Danshen Dripping Pill (DSP) on carotid arterial intima-media thickness (IMT) in patients with type 2 diabetes mellitus (T2DM).

METHODSOne hundred and thirty T2DM patients were assigned to four groups, 32 in the Group A, the control group treated with blood glucose (BG) and blood pressure (BP) controlling; 32 in the Group B, with BG, BP and blood lipid (BL) controlling, 32 in Group C with BG, BP, BL controlling and vitamin E administration, and 34 in Group D with BG, BP, BL controlling and DSP administration. Patients in Group D were subdivided by Chinese medicine syndrome differentiation into four types, 8 of Yin-deficiency with flourishing heat type (YDFH), 5 of both qi-yin deficient type (BQYD), 8 of both yin-yang deficient type (BYYD) and 13 of blood-stasis and qi-stagnant type (BSQS). Fasting blood glucose (FBG), BP and BL in patients were observed periodically, and IMT in them were measured by ultrasonography before treatment, as well as at the end of the 1st, 3rd, and 5th year of treatment to dynamically observe the changes of IMT and condition of plaque formation, and analyze the relation between them with FBG, BP and BL.

RESULTSThe 5-year follow-up was performed in 105 patients. In the observation period, level of total cholesterol (TC) showed a decreasing trend and level of high density cholesterol (HDL-C) showed an increasing trend in all the 4 groups, the improvements in Group C and D were slightly better than those in Group B, while significantly superior to those in Group A; the changes of FBG and glycosylated hemoglobin (HbAlc) were insignificant in the 4 groups. IMT and numbers of atheroma plaque increased gradually in all groups in the observation period, however, the changes in Group D were lesser than those in other groups, showing significant difference (P < 0.01). It was showed that the increasing of cervical carotid IMT in T2DM patients was correlated with levels of HbAlc, HDL-C, LDL-C, triglyceride and TC, especially in Group D.

CONCLUSIONDSP might delay the occurrence and development of diabetic macro-vascular disease.

Carotid Arteries ; pathology ; Carotid Intima-Media Thickness ; Diabetes Mellitus, Type 2 ; drug therapy ; pathology ; Diabetic Angiopathies ; pathology ; prevention & control ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Salvia miltiorrhiza ; chemistry ; Tunica Intima ; pathology ; Tunica Media ; pathology

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.