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.

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

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.

Objective To investigate the effect of Shenmai injection on severe acute pancreatitis (SAP)-associated lung injury and the possible mechanism in rats. Methods The animals were randomly divided into three groups: sham operation group (sham group, n = 10), severe acute pancreatitis (SAP group, n = 10) and Shenmai injection treatment group (SM group, n = 10). The rat model of SAP was induced by injection of 5% sodium taurocholate to the pancreatic duct. The rats in SM group were given Shenmai injection (8 mL/kg) via tail vein 10 min before sodium taurocholate injecting. 24 h after the model was made, 1 mL blood was drawn for serum amylase detection. Left lung tissues and pancreatic tissues were harvested for pathology and immunohistochemistry. Right lung tissue was homogenated for detection of myeloperoxidase (MPO) activity and levels of malondialdehyde(MDA), tumor necrosis factory (TNF-«) and interleukin-lp (IL-lp). Results There were no obvious damages to pancreas and lung in the sham group. While in the SAP group, the plasma amylase was greatly increased, the pancreatic lobular structures were severely damaged, and the pulmonary alveoli were destroyed with inflammatory cell infiltration. The MPO activity, MDA, TNF-«, and IL-lp levels in the SAP lung tissues were significantly increased compared with those in the sham group (P<0. 01). ICAM-1 and caspase-3 were strongly positive in the lung tissues of SAP group. These parameters in the SM group were improved compared with those in the SAP group. Conclusion Shenmai injection has a protective effect on SAP-associated lung injury, and the mechanism may be related to the inhibition of apoptosis and reduction of oxygen free radical and inflammatory content.

Objective To investigate the effect of miR-214 on the invasive capacity of esophageal squamous carcinoma cell line Eca109, and to explore the possible molecular mechanism. Methods We prepared miR-214 double-stranded mimic and transfected it into Eca109 cells with Lipofectamine 2000. Eca109 cells transfected with nonsense miRNA mimics were taken as control. The expression of mature miR-214 was determined by qPCR. The capacity of cell invasion was determined by Matrigel-coated Transwell assay. E-cadherin protein expression and the percentage of E-cadherin positive cells were examined by Western blotting analysis and flow cytometry, respectively. Results The expression level of mature miR-214 in the miR-214 mimic transfection group was significantly higher than that in the control group 48 h after transfection (P<0.01). Eca109 cells transfected with miR-214 mimic showed a significantly lower cell invasive capacity compared to that of cells transfected with control miRNA mimic (P<0.05). Moreover, E-cadherin protein expression and the ratio of E-cadherin positive cells in miR-214 mimic transfection group were both significantly lower than those in the control group (P<0.05). Conclusion Our data suggest that miR-214 may inhibit the invasive capacity of esophageal squamous carcinoma cells by repressing the epithelial-mesenchymal transition.

Objective To investigate pathogens, antibiotics sensitivity and prognosis of dialysis-associated polymicrobial peritonitis, so as to provide evidence for prevention and treatment of polymicrobial peritonitis. Methods A total of 151 peritoneal peritonitis episodes in 81 patients, who received dialysis in our department between January 2008 and September 2010, were analyzed in the present study. The causative pathogens, antibiotics sensitivity and prognosis of polymicrobial peritonitis were retrospectively reviewed in these patients. Results Pathogenic culture of effluent peritoneal dialysate was positive in 98(64. 9%) of the 151 peritoneal peritonitis episodes, and 20(13. 2%) epidoses were polymicrobial peritonitis. The organisms isolated from the effluent peritoneal dialysate included mixed Gram-positive and Gram-negative organisms (30%), mixed Gram-positive and fungi (30%), mixed Gram-negative and fungi (15%), pure Gram-positive organisms (15%), pure Gram-negative organisms infection (5%), and pure fungi (5%). The sensitive rates of Gram-positive organisms in the polymicrobial peritonitis were 100% to vancomycin, 61% to cefazolin sodium, and 52% to levofloxacin; and those of Gram-negative organisms were 100% to meropenem, 100% to cefoperazone-sulbactam, 70% to gentamycin, and 60% to ceftazidime. Fifteen (75%) of the 20 polymicrobial peritonitis episodes were cured and continuously received peritoneal dialysis. One (5%) patient died and 4 (20%) were converted to permanent hemodialysis. Conclusion Polymicrobial peritonitis in our group has been mainly caused by mixed infection of Gram-positive and Gram-negative organisms, mixed infection of Gram-positive organisms and fungi. The Gram-positive organisms are sensitive to vancomycin, and Gram-negative organisms are sensitive to meropenem and cefoperazone-sulbactam. Earlier catheter removal is necessary for fungal peritonitis or refractory peritonitis.

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.