Objective To analyze the clinical typing, pathological classisfication, and prognosis of primary IgA nephropathy (IgAN).Methods Clinical typing, pathological classisfication and relationship between clinical manifestations and pathological features of 220 cases with IgAN were analyzed in 10 years.Results IgA nephropathy occupied 42.9％ (220/512) of all the patients received renal biopsy at the corresponding time.Asymptomatic abnormal urinalysis was the most common clinical manifestation(39.0％ (86/ 220)), followed by hypertension (17.7％ (39/220)) and recurrent macroscopic hematuria (15.4％ (34/220)).Grade Ⅲ pathological change(29.5％ (65/220)) was the most co mmon,followed by grade Ⅱ (27.3％ (60/ 220)) and grade Ⅳ (18.2％), Grade Ⅰ/Ⅴ were relatively less ((11.4％ (25/220), 13.6％ (30/220)).No correlation could be found between types of deposited immune complex and pathological lesion extent(x2=4.87, P＞0.05).The clinical manifestations were significantly correlated with the severity of glomerular lesions (x2 =13.14,P＜0.05).During the follow-up for 106 patients (mean duration of 23 months), 90 patients(84.9％) had normal renal function and 75 patients(70.8％) had decreased excretion of protein in urine (＜1 g/24 h).Conclusion The clinical typing of primary IgA is correlated with pathological changes.The prognosis of IgA is markedly correlation with the pathological lesion degree.Renal functions will be improved if the different treatments were given according to the different renal pathological features.

Objective To evaluate the effects and security of single or combined sufentanil application on sedation and analgesia for mechanically ventilated patients in intensive care unit(ICU).Method A total of 160 ICU patients with mechanical ventilation were randomly allocated into four groups:sufentanil group,sufentanil plus midazolam group,sufentanil plus dexmedetomidine group and fentanyl group.Facial pain scale(FPS),Ramsay score and vital signs were employed to assess the effects of different therapies on organ functions and adverse reactions.Result After the treatment,FPS in all groups were significantly decreased and maintained around 3 points.Ramsay scores were significantly increased(P <0.001)and the score in group given sufentanil combined with midazolam or dexmedetomidine at the time points of30 min,1 h,6 h were even higher.Compared with the preoperative data,indicators of lung function(PaCO2and blood lactic acid),liver function(AST)and renal function(Cr)were decreased in all groups(P <0.05).Respiratory rate in the fentanyl group was significantly higher than the others.Total consumption ofsufentanil in group with combined sufentanil application was significantly lower.No significant differencesin adverse reactions were noticed among the groups(P >0.05).Conclusion For mechanically ventilatedpatients,sufentanil has efficient sedative and analgesic effects with less physiological interference and severe adverse reactions.Combined application is beneficial in decreasing total sufentanil consumption andinhibition to respiratory system,which is worthy of being spread.

The authors expound the idea and service priorities of terminal care, making it clear that pain control and emotional support of relatives after the death of the patient are the major content of terminal care at present. They suggest that nursing in terminal care be implemented according to the situation of our country. Firstly, institutions for terminal care need to be established. Secondly, education of patients, their relatives and medical workers themselves regarding death ought to be strengthened. Thirdly, training in knowledge and skills of consolation should be conducted among nurses. And fourthly, nurses should be encouraged to cultivate noble moral sentiments, enhance training in clinical skills, receive education in psychology, and master nursing skills in psychology so as to do a good job of terminal care.

The animal models of calcium oxalate stones induced by hyperoxaluria, hypercalciuria and lack of vitamin were summaried, and effects of different inhibitors and Chinese traditional medicines on the formation of calculi in animals were discussed.

AIM: To analyze the characteristics of internal fixation implantation therapy for comminuted patella fracture. METHODS: A computer-based search of Pubmed database and Chinese Journal Full-text Database was undertaken, and the quotations of each literature were checked after the primary screening. Inclusion criteria: the papers about the application of internal fixation materials in comminuted patella fracture, those published in authority journals within recent five years were preferred. Exclusion criteria: repeated study or Meta analysis. RESULTS: Internal fixation approach differs as the fracture type. Tension band fixation is generally accepted to treat transverse patella fracture. Kirschner wire plus tension band fixation are inferior to transverse fixation, but in comminuted fracture it can induce more complications; despite of wide application, nickel titanium patella fixator is unsuitable for comminuted fractures due to its hypersensibility and carcinogenicity; silk or steel wire loop fixation fits various comminuted fractures, but metal cerclage is predisposed to induce infection and breakage because of insufficient fixation force. CONCLUSION: There is no common way for comminuted patella fracture therapy. Further researches on material and method which can cure all kinds of comminuted patella fracture are still needed.

Objective To explore the clinical values of holter among different types of pacemaker postoperations .Methods Selected 120 patients undergoing pacemaker implantation from November 2013 to October 2014 ,who also received holter examina-tion after operation .The sensing and pacing dysfunction and pacemaker associated arrhythmia were analyzed according to their hol-ter results .Results In the DDD group ,the detection rate of the ventricular premature contraction ,the atrial premature contraction , the paroxysmal atrial tachycardia ,the paroxysmal atrial fibrillation and the paroxysmal supraventricular tachycardia were 38 .9% , 44 .4% ,8 .3% ,2 .8% and 2 .8% ,respectively .In the DDD group ,the detection rate of the sensing and pacing dysfunction and pace-maker associated arrhythmia was 69 .4% ,which was significantly higher ( P < 0 .05) than that in the VVI group (42 .5% ) ,the VVIR group(30 .0% ) ,the DDDR group(31 .3% ) and the AAI group(25 .0% ) ,respectively .In the VVI group ,the positive rate of the ventricular premature contraction ,the atrial premature contraction ,the paroxysmal atrial tachycardia ,the paroxysmal atrial fi-brillation and the paroxysmal supraventricular tachycardia were 37 .5% ,42 .5% ,10 .0% ,17 .5% and 2 .5% ,respectively .In the VVIR group ,the appearance rate of the ventricular premature contraction ,the atrial premature contraction and the paroxysmal atrial tachycardia were 25 .0% ,25 .0% and 5 .0% ,respectively .In the DDDR group ,the detectable rate of the ventricular premature con-traction ,the atrial premature contraction ,the paroxysmal atrial tachycardia and the paroxysmal atrial fibrillation were 31 .3% , 25 .0% ,12 .5% and 12 .5% ,respectively .Finally ,in the AAI group ,the detection rate of the ventricular premature contraction and the atrial premature contraction were 25 .0% each .Conclusion The clinical application of holter can evaluate the working states of different types of pacemakers ,and can monitor the sensing ,the pacing dysfunction and the pacemaker associated arrhythmia .

Objective To explore the quality control method of leucodepleted red cell concentrate (LDRC) preparation ,to choice an optimal processing , in order to raise the quality of LDRC,so as to ensure the efficiency and safty for the preparation application.Methods 62 bag red cells concentrates suspensin(each 150ml,preparation from 200ml whole blood) were investigated.By linear regression multianalyzed the effects of some factors on efficiency for removal of leukocytes from red cell concentrates.Free hemoglobin value(n=8) was detected before and after leukodepleted filtration.1% samples were tested and bacterial cultured,and observed the clinical adverse effects after LDRC tranfusion.Results ⑴The plasma and platelet in red cell contentrate before filtration,the time of filtration had influence significantly on the result of leukocyte depletion.⑵The percentage of leukodepleted red cell in which residual leukocyte less than 5?10 6/unit and 1?10 6/unit were 100% and 46.9%. The percentage of leukodepleted red cell in which the leukocyte removal efficiency more than 2log(99%)and 3log(99.9%) were 100% and 56.1% .After controlling the time of filtration,the percentage of leukodepleted red cell in which residual leukocyte less than 1?10 6/unit was up from 46.9% to 90.91% and the percentage of leukodepleted red cell in which the leukocyte removal efficiency more than 3log(99.9%)/bag was up from 56.1% to 78.1%.⑶Red blood cell recovery rate was (90.48?4.73)%. There was no significant change of free hemoglublin before and after filtration.⑷No bacteria were detected by germiculture.⑸Evident side effects was no seen after transfusion.Conclusions During the course of removal of leukocytes from red cell concentrates by filtration, the sustained quality control is necessary for improving the quality of leukodepleted red cell.So enforcing aseptic manipulation rigorously and controlling the components of blood,the time of blood storage and filtration appropriately are quite important.

Objective To study the diagnostic value of the morphological changes to deep fascia in distinguishing between benign and malignant soft-tissue tumors in lower limbs using 3.0 T MRI. Methods MR images of 40 consecutive patients with 41 pathologically proven soft-tissue tumors of the lower limbs were retrospectively reviewed by two radiologists. Lesions were divided into four groups according to their predominant location with respect to the deep fascia: (1)Subcutaneous lesions superficial to the deep fascia (n=7). (2) Lesions located beneath the deep fascia (n=8). (3) Lesions in the interspaces of the deep fascia investment (n=10). (4) Intramuscular lesions (n=16). The relationship between tumors and the deep fascia and the morphology changes of deep fascia were analyzed. Lesions of groups (1) (2) were considered as superficial lesions, while lesions of group (3) (4) were considered as deeper lesions. The size differences between those had intact deep fascia and those had destructed deep fascia in superficial lesions and in deeper lesions were evaluated by using Mann-Whitney U test, respectively. P values < 0. 05 were considered statistically significant. Results The deep fascial structures were intact in all of the 16 pathologically proven benign lesions. In 23 of the 25 malignant lesions, there was destruction of the deep fascia with the signs of displacement/disruption of the deep fascia and penetrating growth in (1) (2), and displacement/distruption of intermuscular septum as well as involvement of interspaces of the deep fascial investment and loss of integrity of the fascial/muscular planes in (3) (4). Only 2 malignant lesions demonstrate intact deep fascia. In superficial lesions [(1) (2)] , the maximum size were (5.0±3.8) cm (Median ± Interquartile Range) in those had intact deep fascia, and (5.7±6.90) cm in those had destruction signs (T=47.5, P >0.05). In deeper lesions [(3) (4)] the maximum size were (4.6±1.9) cm of those had intact deep fascia, and (13.6±6.5) cm of those had destruction signs (T= 62.5, P <0.01). Distinguish malignant from benign lesions on the signs of destructed deep fascia, the sensitivity, specificity and accuracy were 92.0% (23/25), 100% (16/16), and 95. 1% (39/,41), respectively. Conclusions Tumor involvements and disruption of the deep fascial structures visualized by 3.0 T MR imaging may be of utility in differentiating malignant from benign soft-tissue tumors.

AIM To study the effect of genistein (GST), a protein tyrosine kinases inhibitor, on L-type calcium channel currents (Iba,L or Ica,L, dependent on permeating ion used) in freshly dispersed colon smooth muscle cells from guinea-pig. METHODS Single colon smooth muscle cells were enzymatically dissociated from guinea-pig. L-type calcium currents were measured by conventional whole-cell patch-clamp techniques. RESULTS The peak amplitudes of Iba,L elicited to 10 mV test potential from a holding potential of -80 mV, were reversibly and dose-dependently reduced by GST (10-100 μmol·L-1) with an IC50 value of (39.9±3.6)μmol·L-1. Bath application of GST shifted the steady-state inactivation curves of Iba,L in a hyperpolarized direction (about 10 mV, P＜0.01) without altering their slopes. The peak amplitudes of Iba,L were also inhibited but to a less extent by daidzein, an inactive analogue of GST. Sodium orthovanadate 1 mmol·L-1, a potent inhibitor of protein tyrosine phosphatases, blocked GST-induced inhibition of Ica,L. CONCLUSION GST can block L-type calcium channel activity in guinea-pig colon smooth muscle cells via tyrosine kinase pathway.

OBJECTIVE:To study the effect of long-term follow-up of Valsartan and amlodipine tablets(Ⅰ)on blood pressure control and renal protection of patients with refractory hypertension. METHODS:120 patients with refractory hypertension were di-vided into control group and observation group according to the patients’wishes,with 60 cases in each group. All patients accepted the triple therapy of amlodipine+valsartan+hydrochlorothiazide and life-style intervention;at the time of discharge from hospital, the blood pressure was well controlled. After discharge from hospital,control group was given amlodipine;observation group was given Valsartan and amlodipine tablet (Ⅰ) orally,1 tablet each time,qd,and dose increasing according to blood pressure,with maximal dose no more than 2 tablets. With 18 months of follow-up,blood pressure and renal function indexes of 2 groups were ob-served at different time points,and blood pressure control rate and the rate of renal function injury were also observed at the last follow-up;the occurrence of ADR was observed. RESULTS:2 cases and 3 cases were follow-up loss in observation group and con-trol group,respectively. With 12 and 18 months of follow-up,24 h systolic pressure,24 h diastolic pressure and 24 h urine protein of 2 groups increased significantly while creatinine clearance rate decreased significantly compared with before discharge;but the in-dexes of observation group was better than that of control group,with statistical significance(P<0.05). At last follow-up,the rate of blood pressure in observation group was significantly higher than in control group(84.5% vs. 52.6%),the rate of renal function injury was significantly lower than control group(8.6% vs. 24.6%),with statistical significance(P<0.05). There was no statisti-cal significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Valsartan amlodipine tablet(Ⅰ)has obvi-ous advantages in long-term follow-up of blood pressure control of patients with refractory hypertension. It can significantly reduce the incidence of renal function injury with good safety.