Objective To conduct a single-center retrospective analysis on the distribution characteristics and prevalence of idiopathic membranous nephropathy (IMN) patients diagnosed with pathology for the past 16 years,to investigate diagnostic and differential diagnostic value of serum antiphospholipase A2 receptor antibodies (PLA2R-Ab),and to evaluate the correlation between PLA2R-Ab and clinical disease activity.Methods (1) 6996 biopsy-proven primary glomerular nephropathy (PGN) patients,including 1567 IMN cases,admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2000 to December 2015 were involved.Demographics and pathological type were gathered from all patients.(2) 433 cases receiving renal biopsy and testing PLA2R-Ab from June 2015 to December 2015 were involved,with their clinical and laboratorial data being collected.During the period patients' follow-up time,therapeutic schedule and laboratory results were recorded.Results (1) IMN accounted for 22.4％ of primary glomerular disease,and patients above 40 years old accounted for more than 60％ of the IMN.(2) The sensitivity and specificity of serological PLA2R-Ab were 58.1％(95％CI 47.0％-68.5％) and 98.6％(95％CI 95.6％-99.6％) respectively.PLA2R-Ab positive rate was affected by immunosuppression therapy.(3) The PLA2R-Ab titers wasn't correlated with 24-hour urinary protein (r=-0.017,P=0.887),serum albumin (r=-0.072,P=0.549) and urinary red blood cell count (r=-0.030,P=0.802).There was no difference between PLA2R-Ab positive positive and PLA2R-Ab negative on proportion of IMN pathological stage Ⅰ-Ⅱ (P ＞ 0.05).Thirteen cases of patients with PLA2R-Ab positive were all prescribed glucocorticoid combined with immunosuppressant.After (2.21± 1.09) months,the decrease of PLA2R-Ab titers was in accordance with 24-hour urinary protein quantity descending and serum albumin ascending (P ＜ 0.05).Condusions The incidence of IMN increase year by year,especially in the mid-aged and the elderly.Serum PLA2R-Ab correlates not with IMN pathological stage,but with the development of IMN.Monitoring PLA2R-Ab titers individually may access the efficiency of treatment.

Objective To investigate the relationship between cognitive function and emotional status in functional constipation patients.Methods Thirty-five functional constipation patients (the functional constipation group) and 24 healthy controls (the HCs) were enrolled in an event-related potential (ERP),behavior and electroeneephalogram study while performing an oddball auditory task.Response time,accuracy,latency and P300 amplitude were compared between the two groups.The Hamilton depression rating scale (HAMD-17),Hamilton anxiety scale (HAMA),symptom check list-90 (SCL-90) and Eysenck personality questionnaire (EPQ) were administered prior to the oddball task.Results The average HAMD-17,HAM A and SCL-90 (the somatization,obsessive-compulsive disorder,depression,anxiety and psychosis dimensions) scores of the functional constipation group differed significantly from those of the HCs.The intro-extraversion and neurosis dimensions of the EPQ were also significantly different.There was no significant difference in response time or latency between the two groups.The ERP results showed that the P300 amplitudes at the F3 and F7 sites were significantly different between the functional constipation group and the HCs.But there was no significant difference in P300 latencies at F3 or F7 between the two groups.Conclusions The findings suggest that patients with functional constipation are more susceptible to depression and anxiety,as well as somatization,obsessive-compulsive tendencies and other neurotic personality characteristics.Patients may employ psychological defense mechanisms to avoid the depression and anxiety.The ERP results imply there may be the implicit cognitive dysfunction with emotion in patients with functional constipation.

Objective To investigate the clinical characteristics of patients with polymyositis(PM) and dermatomyositis (DM), and compare the differences of PM/DM to help the understanding of clinical diagnosis and treatment. Methods One hundred and forty-five hospitalized PM/DM patients from Department of Rheumatology of the First Affiliated Hospital of Xiˊan Jiaotong University were collected from May 2008 to December 2014, and the clinical manifestations, muscle enzymes, electromyogram, muscle biopsy, treatment outcome were retrospectively analyzed. Mann-Whitney U test and χ2 test were used for statistical analysis. Results The most common initial symptom of PM was muscle weakness, accounted for 51.2%, while rash was the initial presentation in most DM patients(43.1%). The incidence of interstitial lung disease (ILD) (62.7% vs 39.5%, χ2=11.009, P=0.001), and the elevation of CRP (48.9% vs 26.8%, χ2=10.272, P=0.001) were all higher in DM than PM, while the elevation of level of CK (85.4% vs 61.8%, U=-2.668, P=0.008) and CKMB (82.9%vs 41.2%, U=-3.303, P=0.001) were more common in PM compared with DM. The pathological study showed degeneration of muscle fiber, connective tissue hyperplasia in most PM patients, and perimysium atrophy, vacuoles degeneration, muscle bundles, perivascular inflammatory cell infiltration were observed in most DM patients. During the follow-up, the clinical remission rate was 57.5%, the relapse rate and the mortality rate was 7.5%and 31.1%respectively. The mortality rate was higher in DM than PM (34.6% vs 21.4%, χ2=4.861, P=0.027). Infection and tumors were the major causes of death, and the lung was the most common site of infection. Conclusion Differences in the clinical features, muscle enzymes, CRP level, pathology and the mortality rate between PM and DM are evident, while ILD, infection and the higher mortality rate are more common in DM than in PM.

Objective To observe the changes of inflammatory factors and clinical parameters on septic patients with hemoperfusion,and to discuss the application of hemoperfusion on sepsis. Methods 43 patients with sepsis were divided into treatment group and control group randomly. In the treatment group,the patients received conventional treatment and hemoperfusion together,which performed every 24 hours,continuously for 3 times when they arrived in ICU in the first hour. The concentrations of TNF-α,IL-6,IL-10 and PAF were dynamically detected before hemoperfusion,after 24 hours,48 hours and 72 hours in treatment group. The concentrations of TNF-α,IL-6,IL-10 and PAF were compared between the two groups after 72 hours. So did the clinical parameters as WBC count,CRP,PCT and blood lactate acid. Results The concentrations of TNF-α,IL-6, IL-10 and PAF were increased significantly in the early stage of sepsis,and were decreased obviously after hemoperfusion(P < 0.01). After 72 hours treatment,the concentrations of TNF-α,IL-6 and PAF were decreased rapidly,so did the level of CRP,PCT and blood lactate acid. There were significant differences between the two groups(P < 0.05). ConclusionHemoperfusion could remove the inflammatory factor of septic patients and improve the clinical symptoms of them.

ObjectiveTo evaluate the feasibility, safety and the long-termoutcomes of laparoscopy-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC).MethodsWe retrospectively analyzed the clinical and follow-up data of 346 cases after LADG from January 2004 to June 2009, compared with 313 cases after conventional open distal gastrectomy (ODG) for advanced gastric cancer at the same period at our hospital. The surgical safety, postoperative complications, survival rate, and the recurrence and metastasis of cancer were compared.ResultsThere was no significant difference at the average time of LADG and ODG procedures (211 ± 56) min vs.(204 ±41 ) min, but blood loss during operation and length of incision in LADG group were significantly less than in the ODG group. The proximal and distal length were, respectively, (6. 3 ± 2. 0) cm and (5. 7 ± 1.7 ) cm in LADG group and (6. 3 ±2. 1 ) cm and (5.6 ± 1.6) cm in ODG group, the difference was not significant. The number of lymph node dissections was also similar: (33 ± 13) in LADG group and (33 ± 16) in ODG group. The incidence of postoperative complications in LADG group was significantly lower than that in ODG group ( 6. 7％ vs.13. 1％, P ＜ 0. 05). During the follow-up period of 6-72 months (average 37 months), the 1-, 3-and 5-year survival rates were, respectively, 87. 2％, 57. 2％ and 50. 3％ in LADG group and 87. 1％, 54. 1％and 49. 2％ in ODG group, the difference was not significant. The differences in recurrence and metastasis between the two groups were not statistically significant.ConclsionLaparoscopy-assisted gastrectomy for advanced gastric cancer is not significantly different with open surgery in postoperative survival rate or recurrence. It is less traumatic and of fewer complications.

Objective To study the effect of procyanidin on neural cell apoptosis and the expression of Caspase-3 of cerebral ische-mia reperfusion(I/R) injury in rats. Methods 40 rats were randomly divided into 4 groups, which were sham operated group, I/R group, low dose procyanidin treated group and high dose procyanidin treated group. The focal middle cerebral artery occlusion (MCAO) model was made by suture-occluded method. After MCAO for 90min following 24h of reperfusion, neural cell apoptosis and the expression of caspase-3 was investigated with TUNEL and immunohistochemistry. HE staining and Trc staining was also used. Result Compared with sham opera-ted group, neural cell apoptosis rate and the expression of caspase-3 were increased at the 24th hour of reperfusion in the ischemic territory(P < 0.05) . Compared with I/R group, low and high dose procyanidin treated group reduced expression of caspase-3 and neural cell apopto-sis rate in a dose-dependent manor (P <0.05). The change of ischemic impairment in procyanidin treated group was less than that of I/R group, and the change of high dose procyanidin treated group was less than that of low dose procyanidin treated group. Compared with that of I/R group, cerebral infarction volume of procyanidin treated group was decreased in a dose-dependent manor (P < 0.05). Conclusion Procyanidin may reduce cerebral ischemia-reperfusion injure by reducing expression of caspase-3 and neural cell apoptosis.

Advanced gastric cancer is usually dealt with D2 radical dissection. There are different opinions as to whether it is necessary to perform D3 radical lymphadenectomy.Some scholars thought that properly enlarged radical dissection can improve long-term outcomes for the treatment of advanced gastric cancer.In recent years,laparoscopic D1 and D2 radical dissection of gastric cancer could be carried out in many hospitals.However,the technique and related skills for performing D3 radical lymphadeneetomy through laparoscope remains to be explored.Based on our previous experiences,D3 radical lymphadeneetomy using artery suspension method and medial-to-lateral approach for advanced gastric cancer is proved to be safe and feasihle.

OBJECTIVE To investigate the HIV infections states in tumor patients for clinical diagnosis,treatment and to prevent HIV infection in the tumor hospital.METHODS The result of HIV detection in tumor patients from Dec 2000 to Aug 2006 was analyzed by the review statistics analysis.RESULTS Totally 48 101 tumor paients were detected,and the number of tumor patients with positive HIV antibody result was 51(0.106%).Among the positive patients there were 21 cases with blood transfusion history,14 cases with blood donating experience,2 cases with both these two kinds of experiences and 14 cases without the two kinds of experiences.Their rate was separately 41.0%,27.5%,4.0% and 27.5%.Most of the HIV positive patients had no clinical synptoms.CONCLUSIONS The HIV positive rate of patients with blood transfusion or blood donating is significantly higher than the patients without these experiences.The routine detection for the HIV before the operation,blood transfusion or other traumatic detection is very necessary.

The operation path, lymph node dissection and reconstruction of the alimentary tract are the three most technical difficulties of laparoscopy-assisted gastrectomy. The essential difference between laparoscopy-assisted gastrectomy and open gastrectomy is the operation path. Based on our clinical experience, we investigated reasonable paths for laparoscopyassisted gastrectomy. Patients were placed in a supine position with their legs apart, and the operator stood on the left side of the patient. Five trocars were placed in the abdominal wall in a curved line. The operation was carried out in the order of greater gastric curvature, the lower region of the pylorus and antrum,the upper region of the pancreas, omentum minus, cardia, and arcuate diaphragm. From May 2004 to April 2010, we successfully carried out 761 laparoscopy-assisted gastrectomies with satisfactory outcomes.

Objective:To compare the safety and efficacy of continuous transversus abdominis plane (CTAP) block and patient-controlled intravenous analgesia (PCIA) in abdominal surgery postoperatively.Methods:PubMed, Embase, Web of Science, CNKI and other English and Chinese databases were searched since their establishment to February 2021 with "continuous/modified, transversus/transverse abdominis plane block, TAP block, patient controlled analgesia, patient-controlled analgesia, patient controlled intravenous analgesia, patient-controlled intravenous analgesia, PCA/PCIA/IV-PCA" as the search keywords. According to the analgesia treatment methods, patients were divided into continuous transversus abdominis plane block group (CTAP group) and patient-controlled intravenous analgesia group (PCIA group). Review Manager 5.4 software was used to conduct a Meta-analysis on outcome indicators such as postoperative nausea and (or) vomiting (PONV), dizziness, pain score and recovery status after abdominal surgery. Risk ratio ( RR) was calculated for counting data, Mean ± SD was calculated for measurement data. Heterogeneity was measured by I2, and related data were analyzed by using either a fixed effects model or a random effects model. Results:(1) The results of literature search: A total of 6 randomized controlled trials, including 2 published in English and 4 published in Chinese were analyzed, involving 479 patients. The results of the Meta-analysis: Compared with PCIA, CTAP block had lower incidence of PONV ( RR=0.22, 95% CI: 0.08-0.62, P<0.01), lower incidence of dizziness ( RR=0.27, 95% CI: 0.09-0.79, P=0.02), lower pain scores on movement at 24 h ( MD=-0.75, 95% CI: -1.42--0.08, P=0.03) and 48 h ( MD=-0.68, 95% CI: -1.05--0.31, P<0.001) postoperatively, and earlier time of first mobilization ( MD=-0.49, 95% CI: -0.69--0.30, P<0.001) and first exhaust ( MD=-10.47, 95% CI: -13.53--7.41, P<0.001), with statistically significant differences. However, there were no statistically significant differences in pain scores at rest at 24 h ( MD=-0.25, 95% CI: -0.57-0.08, P=0.14) and 48 h ( MD=-0.15, 95% CI: -0.39-0.09, P=0.22) postoperatively and postoperative length of hospital stay ( MD=-1.01, 95% CI: -2.28-0.26, P=0.12). Conclusion:CTAP block is a relatively safe and effective analgesic method, and it′s more consistent with the concept of enhanced recovery after surgery (ERAS) and can be recommended as an alternative method of PCIA.