Objective The current study was to investigate the clinical and pathological features of macroscopic hematuria associated acute kideny injury (MH-AKI) in patients with IgA nephropathy (IgAN) and its associated prognostic factors.Methods We performed an analysis on the clinical and pathological features of biopsy-proven IgAN patients diagnosed during 2004 to August of 2007,who had experienced MH associated AKI.The patients enrolled in the study were followed up.The renal lesions were evaluated with Katafuchi pathological scores of IgAN.Results 5 patients with IgAN had experienced at least one episode of MH-AKI,accounting for 1.3% of IgAN diagnosed during the same period and 13.5% of IgAN patients with macroscopic hematuria.High proportion of tubules filled with red blood cell casts and tubular injury were demonstrated in all biopsy specimens.Renal function of 3 patients completely recovered within 14 days.One patient (patient 4) got quick recovery in the first month of the disease but completely recovered 418 days later.The other patients only had an incomplete recovery during the 20-month follow-up.The incompletely recovered one had relatively an older age,longer persistence of MH,more sclerotic glomeruli and a more severe tubule-interstitial damage.Conclusion AKI is commonly seen during episodes of MH in patients with IgAN.Not all patients with MH-AKI showed a complete recovery.Age,duration of MH,proportion of glomerular sclerosis and the severity of tubular necrosis might be the risk factors of an incomplete recovery of renal function.

Epilepsy is a common nervous system seizure disease in children,20%-30% of them is intractable epilepsy.The pathogenesis of intractable epilepsy in children is not yet identify.Some research think that this may be associated with resistance of a variety of diffe-rent mechanisms of antiepileptic drug and abnormalities of multidrug resistance gene expression.The most investigation of multidrug transpor-ter is P-glycoprotein,multidrug resistance-associated protein.They are present in cell membrane and belong to adenosine triphosphate-dependent membrane transport protein.Studies have showed that over-expression of multidrug transporter in temporal lobe brain tissue of patients with refractory epilepsy and animal model of chronic epilepsy reduce the concentration of therapeutic drug in cells.They result in resis-tance by releasing the energy and transferring large amounts of anti-epileptic drugs to exterior of brain capillary endothelial cells in way of active transport.The relationship between multidrug transporter′s structure,distribution,functions and drug-resistant epilepsy are reviewed.

Objective To study the value of endoscopic management of thyroid disease through periareola approach. Methods From Nov. 2008 to Feb. 2010, 20 cases were treated by endoscopic throidectomy using bilateral areola three-hole method. The chest skin and platysma were separated and CO2 (6 - 8mmHg pressure)was inflowed to establish the operative space. Thyroid tissues were cut and separated by harmonic scaple. Recurrent laryngeal nerve, superior laryngeal nerve and parathyroid gland were preserved. Results Operations were successfully completed using endoscope, among which there were 1 case of thyroid cyst resection, 5 cases of thyroid adenoma resection, 8 cases of thyroid unilateral partial resection, 3 cases of thyroid bilateral partial resection and 3 cases of thyroid sub-total resection. The average operation time was (100. 0 ± 30. 5) min. Blood loss was (70. 0 ± 15. 0) ml. 1 case of neck skin burns and 3 cases of subcutaneous hydrops appeared. No convertion occured. Conclusion Endoscopic thyroidectomy through periareolar approach is a safe minimal invasive surgical procedure with excellent cosmetic results.

OBJECTIVETo observe differences of immediate effect of twirling reinforcing-reducing manipulation at head acupoints on muscle force in patients with acute ischemic stroke.

METHODSA total of 126 patients who met the inclusive criteria were randomly divided into a twirling reinforcing group, a mild reinforcing-reducing group and a twirling reducing group, 42 cases in each one. The lines between Baihui (GV 20) and bilateral Taiyang (EX-HN 5) were selected and treated with successive insertion of three needles. The twirling reinforcing method was used in the twirling reinforcing group, and mild reinforcing-reducing method was used in the mild reinforcing- reducing group, and twirling reducing method was used in the twirling reducing group. Each needle was manipulated for 1 min, which was repeated once every 10 min. The needles were retained for 30 min. Muscle force was evaluated immediately after treatment.

RESULTS(1) Muscle force of upper limb: after acupuncture, the muscle force of proximal and remote ends were all improved significantly in three groups (all P < 0.05), which was more obvious in proximal end (all P < 0.05). The improvement of the muscle force of proximal end in the twirling reinforcing group was superior to those in the mild reinforcing-reducing group and twirling reducing group (both P < 0.05); the differences of the muscle force of remote end were not significant among three groups (all P > 0.05). (2) Muscle force of lower limb: after acupuncture, the muscle force of proximal and remote ends was all improved significantly in the three groups (all P < 0.05). The improvement of the muscle force of proximal end was superior to that of remote end in the twirling reinforcing group and mild reinforcing-reducing group (both P < 0.05).

CONCLUSIONThe twirling reinforcing manipulation at head acupoints is superior to mild reinforcing-reducing and twirling reducing manipulation for muscle force in patients with acute ischemic stroke, which is more significant in proximal end of limbs.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Ischemia ; therapy ; Lower Extremity ; physiopathology ; Male ; Middle Aged ; Stroke ; physiopathology ; therapy ; Treatment Outcome ; Upper Extremity ; physiopathology

Objective To establish a UV spectrophotometry method and an HPLC method respectively for the determination of the total content of coumarin and contents of four main constituents of coumarin in Fraxini Cortex extract.Methods UV spectrophotometry was used for the determination of the content of total coumarin in Fraxini Cortex extract. The reference substance was Aesculin, and the maximum ultraviolet absorption wavelength was 334 nm. The HPLC method was used to determine the contents of Aesculin, Fraxin, Aesculetin and Fraxetin in Fraxini Cortex extract, using gradient elution with acetonitrile-phosphate solution (0.01%) as mobile phase on Agilent ZORBAX SB-C18 chromatographic column (4.6 mm × 250 mm, 5μm) at room temperature.Results For the UV method, the linear range of the mass concentration of Aesculin was 5.76-23.04μg/mL (r=0.999 9), and the average recovery was 100.6% (RSD=1.8%). For the HPLC method, the linear ranges of the mass of Aesculin, Fraxin, Aesculetin and Fraxetin were 0.055 0-3.850 0μg (r=0.9997), 0.053 9-3.773 0μg (r=0.999 8), 0.060 0-0.660 0μg (r=0.999 9), and 0.056 2-0.618 2μg (r=0.999 9), respectively, and the average recoveries were 96.97% (RSD=1.26%), 100.80% (RSD=2.22%), 99.04% (RSD=2.47%), and 98.77% (RSD=1.94%), respectively.Conclusion Both of the two methods are simple, accurate and reliable, and can be used for the quality control of total coumarin and the main constituents of coumarin in Fraxini Cortex extract.

Objective To investigate the immediate effect of twirling reinforcing manipulation, twirling reducing manipulation and mild reinforcing-reducing manipulation on motor functions for patients with acute ischemic stroke. Methods Totally 116 patients with ischemic stroke were randomly divided into twirling reinforcing manipulation group (TRFM, n=39), mild reinforcing-reducing manipulation group (TRRM, n=37), and twirling reducing manipulation group (TRDM, n=40) by stratified blocked randomization. Each group was treated in Baihui-Taiyang acupoint area accordingly with twirling reinforcing manipulation, mild reinforcing-reducing manipulation and twirling reducing manipulation once. The operation time for each needle was 1 minute. Interval time between every 2 needles was 10 minutes, and each needle was retained for 30 minutes. Neurological deficit score (NDS) and simplified Fugl-Meyer assessment (FMA) were evaluated before and immediate time, 1 h, 2 h and 3 h after treatment. Results FMA in TRFM was higher than that of TRDM and TRRM at immediate time, 1 h and 2 h after treatment (P<0.05), but there was no difference at 3 h after treatment (P>0.05). DNS in TRFM decreased sharply at immediate time, 1 h, 2 h and 3 h compared with TRDM and TRRM (P<0.05). The statistical analysis showed no significant difference between TRDM and TRRM at all time points (P>0.05). Conclusion TRFM has an advantage over TRDM and TRRM in immediate effect of motor functions for patients with acute ischemic stroke.

Objective To investigate the application value of perioperative enhanced recovery after surgery (ERAS) combined with laparoscopic common bile duct exploration (LCBDE) in the treatment of choledocholithiasis.Methods The clinical data of 84 patients with choledocholithiasis who were admitted to the Yijishan Hospital from January 2011 to December 2013 were prospectively analyzed.A single-blind,randomized,controlled study was performed in the 75 patients who were allocated into the control group and the enhanced recovery after surgery group (ERAS group) based on a random number table.All the patients underwent LCBDE,the patients in the control group received conventional perioperative management and the patients in the ERAS group received perioperative management according to enhanced recovery rehabilitation program.All the patients were followed up by outpatient interview till postoperative month 6.The clinical features,liver function and residual stones in the patients were observed.The operation time,postoperative complications,postoperative intestinal function recovery,duration of hospital stay and hospital expenses in the two groups were compared.Measurement data with normal distribution were presented as x ± s.Comparison between groups were evaluated with an independant sample t test.Count data were analyzed using the chi-square test.Results All the 75 eligible patients undergoing successful operation were randomly divided into the control group (35 patients) and the ERAS group (40 patients).The operation time and volume of intraoperative blood loss in the control group and the ERAS group were (185 ±46)minutes and (124 ±28)mL,(178 ±37) minutes and (114 ±32)mL,respectively,with no significant difference (t =0.729,1.431,P ＞ 0.05).There were 12,14 and 10 patients in the control group and 5,6 and 4 patients in the ERAS group with postoperative incision pain,vomit and infection,showing a significant difference (x2=5.054,5.966,4.241,P ＜ 0.05).The level of white blood cell,alanine aminotrausferase and direct bilirubin in the control group and in the ERAS group were (11.4 ± 3.5) × 109/L,(128 ± 33)U/L,(38 ±14) μmol/L and (10.6 ± 3.0) × 109/L,(135 ± 35) U/L,(44 ± 16) μmol/L at postoperative day 1,compared with (7.8 ±2.9) × 109/L,(48 ± 14) U/L,(21 ± 8) μmol/L and (6.9 ±2.1) × 109/L,(43 ± 13) U/L,(20 ±7) μmol/L in the 2 groups at postoperative day 4,respectively,showing no significant difference between the 2 groups (t =1.018,-0.872,-1.767,1.553,1.836,1.044,P ＞ 0.05).The postoperative first flatus day,time of food intake,time of postoperative infusion and duration of hospital stay were (42 ± 13)hour,(45 ±14) hours,(6.8 ±2.3)days and (11.3 ±4.5)days in the control group,and (35± 11)hours,(19 ±7)hours,(4.2 ± 1.8) days and (9.6 ± 2.4) days in the ERAS group,with a significant difference between the 2 groups (t =2.741,10.524,5.485,2.077,P ＜ 0.05).The total hospital expenses was (18 729 ± 3 127) yuan in the control group,which was significantly greater than (16 981 ±2 756) yuan in the ERAS group (t =2.574,P ＜ 0.05).The liver function of all the patients was recovered at the postoperative month 1.Four patients with residual stones in the 2 groups were detected by T-tube cholangiography,and were cured by removal of gallstones by choledochoscopy.There were no complications of the abdominal pain,jaundice and fever in all the patients till the end of follow-up.Conclusion ERAS combined with LCBDE for the treatment of choledocholithiasis is safe and feasible,with the advantages of low morbidity,quick recovery,short duration of hospital stay and less hospital expenses.

SUMMARY We analyzed the clinicopathological characteristics of one patient with Rhupus syndrome as-sociated nephropathy in Peking University People ’s Hospital, and reviewed the related literature .The pa-tient was a middle aged female .She developed rheumatoid arthritis first , and then manifested mild sys-temic lupus erythematosus together with positive anti-neutrophil cytoplasmic antibodies ( ANCA ) and cryoglobulinemia several years later .The renal biopsy was performed and manifested as lupus nephritis . The transmission electron microscopy revealed cryoglobulinemia associated renal damage .This report shows that the clinicopathological characteristics in patients with Rhupus syndrome associated nephropathy are complicated .The renal pathology can be used as a diagnostic tool .

Thanks to the three decades of reform and opening up,hospitals in China have made tremendous achievements in their development,yet facing new ehallenges as well.to address these challenges,there is an urgent need for these hospitals to further their reform under the guideline of the scientific concept of development.This will help them strengthen their hospital culture,quality control,technology,human resources development,and their leadership,in order to achieve a better and faster growth,better serving the role to build a harmonious socialist society.

Biomarkers ; blood ; Biopsy, Needle ; utilization ; Hepatitis C ; complications ; Humans ; Liver ; pathology ; Liver Cirrhosis ; diagnosis ; pathology