Objective To study the clinical effect of tacrolimus combined with small dose of prednisolone in treatment of IgA nephropathy.Methods 84 cases with IgA nephropathy were randomly divided into study group and the control group in accordance with the digital table method.The control group was given simple hormone treatment, while the study group was treated with tacrolimus combined with small dose of prednisolone.The clinical efficacy and safety were compared between the two groups.Results The treatment effective rate (100.00%)and complete remis-sion rate (73.81%)of the study group were significantly higher than those in the control group (76.19%, 23.81%),and the differences were statistically significant (χ2 =21.01,11.35,P <0.05 ).After treatment,24h urinary protein level was significantly decreased compared with before treatment.24h urinary protein level[(0.54 ± 0.41)g/L]of the study group was significantly lower than the control group[(1.06 ±0.62)g/L],and the difference was statistically significant (t =4.01,4.58,3.87,all P <0.05).In addition,before and after treatment,the serum creatinine,blood sugar,white blood cells,cereal third transaminase,SBP and DBP levels between two groups had no significant differences (P >0.05).When patients lighter (Lee's Ⅱ level),the team for complete response rate was significantly higher than the control group,and the difference was statistically significant (χ2 =5.01,P <0.05 ). However,with the aggravation of pathological damage (Lee),the effective rate and complete remission rate of the study group and the control group showed a downward trend.The effective rate and complete remission rate of the study group were higher than those in the control group,but the differences were not statistically significant (χ2 =1.03,2.11,1.20,1.20,all P >0.05).The incidence rate of adverse reactions in the study group (19.05%)was not significantly different from that of the control group (16.67%)(χ2 =0.08,P >0.05 ).Conclusion Tacrolimus combined with small dose hormone for the treatment of IgA nephropathy has high clinical value,it can significantly reduce the level of IgA nephropathy 24h nephropathy,and adverse reactions.

AIM: To study the expression of MDM2 and muta nt-type P53 proteins in primary hepatocellular carcinoma(HCC). METHODS: Using immunohistochemical staining method(SP),the expression of mutant-t ype P53 and MDM2 proteins was examined in 55 cases of HCC,23 cases of correspond ing paracancerous tissues and 10 cases of normal hepatic tissues. RESULT S: The frequencies of MDM2 and P53 positive expression in HCC were 17/55 (30 9%) and 23/55 (41 8%), respectively. There was both positive expression of MDM2 and mutant-type P53 in 11 cases (20%) with HCC. Expression of MDM2 showed a significantly positive correlation with expression of mutant-type P53 (r=0 310,P

Objective:To assess effect of detection of plasma N terminal pro brain natriuretic peptide (NT‐proBNP) and serum cystatin C (Cys C) combined Global Registry of Acute Coronary Events (GRACE) score on heart func‐tion and prognosis in patients with acute coronary syndrome (ACS) .Methods :According to GRACE score ,a total of 136 ACS patients were divided into low risk group (n=29) ,intermediate risk group (n=39) and high risk group (n=68) .Serum Cys C level and plasma NT‐proBNP level were measured in all groups .Incidence rate of major ad‐verse cardiovascular events (MACE) within three and six months was counted .Results:Among ACS patients ,com‐pared with low risk group ,there were significant rise in levels of NT‐proBNP [ (165.80 ± 51.62) ng/L vs .(193.13 ± 74.64) ng/L vs .(985.45 ± 152.69) ng/L] and Cys C [ (0.83 ± 0.38) mg/L vs .(0.9 ± 0.25) mg/L vs .(1.23 ± 0.23) mg/L] ,left ventricular end‐diastolic diameter [six months: (50 ± 3) mm vs .(55 ± 3) mm vs .(59 ± 5) mm] ,significant reduction in left ventricular ejection fraction [LVEF ,six months: (55 ± 7)% vs .(49 ± 5)% vs . (40 ± 7)% ] ,and significant rise in incidence rate of MACE (six months:2.94% vs .9.55% vs .30.88% ) ,and a‐bove indexes in high risk group were significantly higher than those of intermediate risk group except LVEF signifi‐cantly reduced , P<0.05 or <0.01 ;Pearson correlation analysis indicated that NT‐proBNP and Cys C levels were positively correlated with GRACE score (r=0.72 , P<0.05 ; r=0.65 , P<0.05) respectively .Conclusion:NT‐proBNP and Cys C level detection combined GRACE score could exactly response heart function and prognosis .

Objective To observe the clinical effects of early use of neuromuscular blocking agents (NMBA) in patients with severe sepsis and acute respiratory distress syndrome (ARDS).Methods A prospective study was conducted.96 patients with severe sepsis and ARDS admitted from July 2012 to September 2013 to intensive care unit (ICU) of Liuzhou People's Hospital in Guangxi Zhuang Autonomous Region were enrolled and divided into severe ARDS group (n=48) and moderate ARDS group (n=48) according to the Berlin definition of ARDS.Then patients in each group were randomly divided into treatment group (n =24) and control group (n=24).All patients with diagnosis in accordance with the 2008 international septic shock and severe sepsis treatment guidelines were provided with comprehensive treatment and mechanical ventilation on the basis of analgesia and sedation.The patients in treatment group were given a loading dose of vecuronium during mechanical ventilation,started with 0.l mg/kg up to 0.05 mg ·kg 1 ·h 1 for continuous intravenous infusion for 24-48 hours.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA),arterial oxygenation index (PaOfFiO2),central venous oxygen saturation (ScvO2),arterial blood lactate (Lac),C-reactive protein (CRP) levels of two groups were compared before treatment and 48 hours after treatment,and 21-day mortality rate was finally compared.Results In moderate or severe ARDS group,there were no statistically significant difference in APACHE Ⅱ score,SOFA score,PaO2/FiO2,ScvO2,Lac and CRP before treatment between two groups.APACHE Ⅱ score,SOFA score,PaO2/FiO2,ScvO2,and Lac 48 hours after treatment were significantly improved in severe ARDS group compared with control group [APACHE Ⅱ score:16.58 ± 2.41 vs.19.79 ± 3.52,t=3.679,P=0.010; SOFA score:12.04 ± 2.17 vs.14.75 ±3.26,t=3.385,P=0.010; PaO2/FiO2 (mmHg,1 mmHg=0.133 kPa):159.31 ±22.57 vs.131.81 ± 34.93,t=3.239,P=0.020; ScyO2:0.673 ± 0.068 vs.0.572 ± 0.142,t=3.137,P=0.030; Lac (mmol/L):3.10 ± 1.01 vs.4.39 ± 1.72,t=3.161,P=0.030],while the value of CRP (mg/L) showed no significant difference (180.91 ±37.14 vs.174.66 ± 38.46,t=0.572,P=0.570).21-day mortality in treatment group was significantly lower than that in control group [20.8％ (5/24) vs.50.0％ (12/24),x2=4.463,P=0.035].In moderate ARDS group,each of the above clinical parameters were improved in both groups expect for CRP at 48 hours after treatment,but the indexes showed no statistically significant difference between two groups (all P＞0.05).21-day mortality rate in the treatment group was slightly lower than that in the control group which showed no statistically significant difference [16.7％ (4/24) vs.25.0％(6/24),x2=0.505,P=0.477].Conclusion The early use of NMBA treatment of patients with severe sepsis and severe ARDS cannot only improve the severity but also reduce 21-day mortality.

Objective To explore the feasibility and value of MRI examination in colorectal carcinoma. Methods Thirty-eight patients with clinically suspected colorectal carcinoma were included in this study and all of them underwent MRI examination. About 300- 1 000 ml water was administered transrectally before scanning. Axial plain scan, three-planar enhanced scan and hydrography were performed, respectively. Results In 38 patients, 31 cases were pathologically proved as colorectal carcinoma. The main MRI findings were: intraluminal soft tissue mass (n=5), irregular thickening of colorectal wall and partial or circumferential stenosis of colorectal lumen (n=26). The tumors were all demonstrated as medium signal intensity on T 1-weighted images. Thirty of 31 cases showed slightly hyperintensity and one was conspicuous high signal intensity on T 2-weighted images. Marked enhancement was demonstrated in all foci. Focal low signal structures were presented in the pericolorectal fat on precontrast T 1-weighted SE sequence in 5 cases. Smooth margins were revealed in 12 cases and irregular and/or nodular margins of peripheral wall in 19 cases. Colorectal hydrography showed that there were intraluminal irregular filling defects (n=14), and that "cuff sign" or "sawn-off sign" was demonstrated in the distal end of tumor and its proximal part couldn't be seen (n=10). Thirty of 31 patients with pathologically proved colorectal carcinoma and 4 of 7 patients with non-colorectal carcinoma were correctly identified by MRI. The sensitivity, specificity, and accuracy were 96.8%, 57.1%, and 89.5%, respectively. The accuracy of MRI in T staging was 83.9% (26/31). The accuracy in T1-2, T3, and T4 staging was 75.0% (9/12), 88.2% (15/17), and 100% (2/2), respectively. Conclusion MRI could clearly show the longitudinal and horizontal invasion of colorectal carcinoma as a whole. It could accurately determine the invasive depth of local lesions. Barium enema examination may be partially replaced by colorectal hydrography with MIP reconstruction. It is of directorial value in clinical treatment.

Objective:To observe the effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO)combined with prone position ventilation (PPV) on oxygenation index (PaO 2/FiO 2), respiratory compliance (Crs) and vasoactive inotropic score (VIS) in severe acute respiratory distress syndrome (ARDS) patients. Methods:Eighteen patients with severe ARDS requiring VV-ECMO support in Liuzhou People's Hospital from June 2018 to April 2020 were selected for retrospective analysis, and 8 patients among of these cases received PPV after VV-ECMO. The differences in PaO 2/FiO 2, VIS and Crs before and 1, 2 or 3 days after treatment were compared between VV-ECMO group and VV-ECMO combined with PPV group, as well as the differences in these indices before PPV and 2 hours after PPV daily in VV-ECMO combined with PPV group. The incidence of adverse events in two groups were also observed. Results:Before treatment, there was no significant difference in PaO 2/FiO 2, Crs between two groups. Over time, PaO 2/FiO 2 and Crs increased and VIS decreased in both groups. Compared with before treatment, there were statistically significant differences in PaO 2/FiO 2 and VIS from 1 day after treatment [PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): VV-ECMO group was 197.75±39.80 vs. 75.57±7.44, VV-ECMO combined with PPV group was 255.20±31.92 vs. 68.24±11.64; VIS: VV-ECMO group was 5.51±3.72 vs. 10.20±7.10, VV-ECMO combined with PPV group was 6.73±3.32 vs. 14.50±2.48, all P < 0.05], up to 3 days after treatment [PaO 2/FiO 2 (mmHg): VV-ECMO group was 231.96±32.76 vs. 75.57±7.44, VV-ECMO combined with PPV group was 285.61±19.40 vs. 68.24±11.64; VIS: VV-ECMO group was 2.26±1.90 vs. 10.20±7.10, VV-ECMO combined with PPV group was 2.13±1.55 vs. 14.50±2.48, all P < 0.05], and the PaO 2/FiO 2 1 day and 3 days after treatment in VV-ECMO combined with PPV group were significantly higher than those in VV-ECMO group (mmHg: after 1 day of treatment was 255.20±31.92 vs. 197.75±39.80, after 3 days of treatment was 285.61±19.40 vs. 231.96±32.76, both P < 0.05). Before treatment, Crs of VV-ECMO combined with PPV group was significantly lower than that of VV-ECMO group (mL/cmH 2O: 17.91±0.82 vs. 20.54±1.26, P < 0.05). From 1 day after treatment, the Crs in VV-ECMO combined with PPV group was significantly higher than that before treatment (mL/cmH 2O: 21.20±1.50 vs. 17.91±0.82), the peak value was (24.93±2.18) mL/cmH 2O on 3 days after treatment, however, there was no significant difference between the two groups (all P > 0.05). In VV-ECMO combined with PPV group, compared with before PPV treatment, the PaO 2/FiO 2 and Crs of 2 hours after PPV treatment in 1, 2 and 3 days were significantly rose, and it reached the highest level in 3 days [PaO 2/FiO 2(mmHg): 285.61±19.40 vs. 189.91±28.34, Crs (mL/cmH 2O): 24.93±2.18 vs. 23.35±1.45, both P < 0.05]; the VIS was only increased in 2 hours after PPV treatment on the first day than before (6.73±3.32 vs. 6.38±3.22, P < 0.05). There were no related serious adverse events happened after PPV treatment. Conclusions:The combination of PPV during VV-ECMO could further increase PaO 2/FiO 2, improve hypoxemia and implement further protective lung ventilation to reduce the potential hazards during mechanical ventilation. In addition, no serious adverse events were observed in this study, suggesting PPV is safe during VV-ECMO.

Objective: To evaluate diagnostic value of three noninvasive examinations for coronary heart disease (CHD).Methods:A total of 500 subjects, who were suspected of CHD, first received diagnostic coronary angiography (CAG) and hospitalized in our department from May 2014 to May 2015, were selected.According to CAG results, they were divided into non-CHD control group (n=106), single vessel coronary disease group (n=199), double-vessel coronary disease group (n=95) and multi-vessel coronary disease group (n=100, ≥three vessel disease).Besides CAG, all subjects accomplished one of following examinations at least: (1) 24h dynamic ECG (Holter);(2) real-time three-dimensional echocardiography(RT-3DE);(3) radionuclide myocardial perfusion imaging (RMPI).Sensitivity, specificity and accuracy of these three examinations in diagnosing CHD were evaluated.Results: With CAG as the gold standard, compared with Holter and RT-3DE, there were significant rise in sensitivity(68.4%, 69.0% vs.92.9%), specificity (62.9%, 81.4% vs.88.5%) and accuracy (67.1%, 71.2% vs.91.9%) of RMPI (P<0.01 all), only specificity of RT-3DE was significantly higher than that of Holter, P=0.019.Conclusion:Noninvasive examination can be used as important method diagnosing CHD, which are important measures for noninvasive diagnosing and assessing CHD.Accuracy, sensitivity and specificity of RMPI are high, which is worth extending.

AIM: To detect the expression of cytoplasmic inhibitor of apoptosis protein 2 (c-IAP2) and growth arrest-specific gene 1 (GAS1) in Hodgkin's lymphoma (HL) and anaplastic large cell lymphoma (ALCL) and to investigate the role of two genes in the pathogenesis of HL and ALCL.METHODS: HE staining,the antibodies CD30,CD15,CD45RO and CD20 were used to screen the cases of HL and ALCL from 288 cases of lymphoma. The clarified HL and ALCL were subjected for immunohistochemical staining by SP and ABC methods to analyze the expression of c-IAP2 and GAS1. RESULTS: ①The positive rate of c-IAP2 in HL was 25/26(96.1%) while that in ALCL was 6/19(31.6%),there presented statistic significance between HL and ALCL groups( P

AIM: To observe the effect of partial liquid ventilation with perfluorocarbon on gas exchange, hemodynamics and lung histological change in the piglets with surfactant depletion-induced acute lung injury. METHODS: 12 piglets were treated by lung lavage to a partial pressure of oxygen in arterial blood (PaO 2) below 100 mmHg for one hour and randomly divided into gas ventilation group (control group) and partial liquid ventilation (PLV) group, in PLV group, piglets received PFC (FC3280) intratracheally at doses of 15 mL/kg. The parameters of gas exchange and hemodynamics were measured before lung lavage, after lung lavage when the acute lung injury (ALI) was established, and 1 hour, 2 hours after ALI. Animals underwent euthanasia at the end of the study, lung histologic analysis followed. RESULTS: Surfactant depletion by lung lavage induced a stable acute lung injury.Gas exchange increased markedly in the animals that underwent PLV, less hemodynamic damage was observed in PLV group compared with the animals in GV group. Lung histologic analysis demonstrated a less lung damage, including atelectasis, neutrophil excudation, intra-alveolar hemorrhage and interstitial edema in PLV group compared with control group. CONCLUSION: In piglets with surfactant depletion-induced acute lung injury, partial liquid ventilation with perfluorocarbon can improve the gas exchange with less adverse hemodynamic effect and less lung injury compared with conventional gas ventilation.

AIM: This study is based on the result of the study in HL and ALCL employing gene chip technique, in which writer found that there was distinctly different expression of caspase-4 between HL and ALCL cell lines at the level of mRNA. From the point of view, we try to identify at the level of protein whether there is different expression of this gene in HL and ALCL tissues as well. METHODS: HE staining, the monoclonal antibodies CD30 (BerH2), CD15 (C3D-1), CD20 (L26) and CD45RO (UCHL1) were used for selecting the cases of HL and ALCL. Specific high affinitive anti-caspase-4 polyclonal antibody was used by immunohistochemical staining to analyze the expression of caspase-4 in 18 cases of HL and 15 cases of ALCL. RESULTS: The expression of caspase-4 demonstrated a strong positive staining in all ALCL cases (15/15,100%), whereas negative in 16 HL cases (88 8%), while other two cases were weakly stained (11 2%), showing a distinct difference (P