OBJECTIVE:To observe the clinical efficacy and safety of ezetimibe combined with simvastatin in the treatment of membranous nephropathy complicated with hyperlipidemia. METHODS:90 patients with membranous nephropathy complicated with hyperlipidemia were randomly divided into observation group and control group,45 cases in each group. All patients received health guidance,low-fat diet,and the drugs without interfere with regulating lipid,hepatoprotective and lipid metabolism were for-bid. Control group was orally given 20 mg Simvastatin tablet,qd;observation group was additionally given 10 mg Ezetimibe tab-let,qd. They were treated for 8 weeks. Clinical efficacy was observed,lipid levels [total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C)],aspartate aminotransferase (AST),ala-nine aminotransferase(ALT),urinary protein quatitation,creatine kinase(CK)before and 2,4,8 weeks after treatment,and the incidence of adverse reactions were compared. RESULTS:Total effective rates of membranous nephropathy and hyperlipidemia were 95.56% and 93.30% in observation group,which were significantly higher than 73.33% and 75.56% in control graup,with statistical significance (P<0.05) .There were no significant differences in TG,HDL-C and LDL-C levels before and 2,4,8 weeks after treatment,and TC level before and 2,4 weeks after treatment between 2 groups (P>0.05);after 8 weeks of treat-ment,TC level in observation group was significantly lower than control group,the differences were statistically significant (P<0.05). Compared with control group,there were no significant differences in AST,ALT,urinary protein quatitation and CK level between 2 groups before and 2,4,8 weeks after treatment(P>0.05). And there was no significant difference in the incidence of adverse reactions between 2 groups(P>0.05). CONCLUSIONS:Ezetimibe shows similar clinical efficacy with simvastatin in the treatment of membranous nephropathy complicated with hyperlipidemia,it can effectively reduce TC level,with good safety.

Objective To evaluate the clinical value of three-dimensional power Doppler ultrasound (3D PDUS) in diagnosing cervical cancers.Methods 162 patients with cervical lesions were enrolled.All the cases were confirmed by autopsy or surgery.Vascularization index (VI),flow index (FI) and vascularization flow index(VFI) were all measured and compared.The pathological findings was taken as golden standard.ROC curve was used to find the best cut-off value.Results 3D PDUS indices of benign and malignant lesions were statistically different (P ＜0.0001).The best cut-off value of VI was 4.63 using ROC curves,the area under the curve (AUC) was 0.94,the sensitivity and specificity were 89.10％ and 86.30％,respectively.The best cut-off value of FI was 34.39 using ROC curves,AUC was 0.76,the sensitivity and specificity were 73.40％ and 76.70％,respectively.The best cut-off value of VFI was 1.60 using ROC curves,AUC was 0.93,the sensitivity and specificity were 87.50 ％ and 86.30 ％,respectively.Conclusions 3D PDUS was a new and noninvasive way for the clinical to differentiate benign and malignant cervical lesions.

With the advent of Twenty-First century, more and more genome-wide association studies (GWAS) showed that idiosyncratic adverse drug reactions (ADRs) were closely related with human leukocyte antigen (HLA) alleles, such as the associations of abacavir-HLA-B*5701, allopurinol-HLA-B*5801, and carbamazepine-HLA-B*1502, etc. To explore the mechanisms of these idiosyncratic drug reactions, hapten hypothesis, danger signal hypothesis, pharmacological interaction (P-I) concept and autoimmune mechanism are proposed. In this paper, recent GWAS studies on the HLA-mediated adverse drug reactions and underlying mechanism are reviewed in detail.

There are still differences in the surgical treatment of children with pulmonary atresia(PA-VSD) with ventricular septal defect. The high rate of postoperative complications and reoperation intervention is still a problem that plagues surgeons. There are few reports on the understanding of the anatomy and physiological functions of MAPCAs. This article systematically reviews and analyzes domestic and foreign literature, and reviews the anatomical classification, surgical management strategies and related complications of PA-VSD patients.

Objective:To explore the application prospect of "education cloud platform + dual track" teaching in continuing medical education of thoracic surgery.Methods:A total of 100 trainees who participated in continuing medical education in thoracic surgery department in Air Force Medical University were randomly divided into experimental group and control group, with 50 students in each group. The experimental group adopted "education cloud platform + dual-track" teaching, and the control group adopted dual-track teaching. At the end of the study, an examination of theoretical knowledge and practical operation would be conducted; at the same time, an anonymous questionnaire survey would be used to evaluate the satisfaction of the two teaching modes. SPSS 20.0 was used for t test and chi-square test. Results:There was no statistically significant difference between the two groups in basic theoretical performance. The professional theoretical performance [(28.6±3.7) points] and operational theory performance [(34.9±4.7) points] of the experimental group were higher than those of the control group, with significant differences ( P<0.05). The experimental group performed better than the control group in five practical operation assessments: basic operation of thoracoscopy, basic operation of opening and closing the chest, operation of vascular isolation and suture, operation of esophageal anastomosis and operation of tracheal anastomosis, with statistical differences ( P<0.05). The satisfaction with teaching of experimental group was significantly higher than that of the control group ( P<0.05). Conclusion:"Education cloud platform + dual track" teaching can effectively ensure the teaching progress of problem-based learning (PBL) and team-based learning (TBL), improve students' learning effect, and has high promotion and application value.

Objective: To investigate the effects of treatment of hernia sac stump in laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) on postoperative seroma. Methods: The prospective study was conducted. The clinical data of 128 male patients with primary indirect inguinal hernia who were admitted to Fujian Medical University Union Hospital from October 2017 to March 2019 were selected. Patients were divided into two groups by random number method. Patients in experimental group had hernia sac stump sutured and fixed at the lower margin of rectus abdominis after transection of hernia sac in TAPP, and patients in control group had hernia sac stump free in the abdominal cavity after dissection and transection of hernia sac in TAPP. Observation indicators: (1) surgical situations; (2) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect the incidence of postoperative seroma, incision infection, chronic pain, and hernia recurrence up to June 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using the Mann-Whitney U test. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test. Results: A total of 128 male patients were screened for eligibility, including 60 patients in the experimental group and 68 patients in the control group. The 128 patients were aged from 47 to 74 years, with an average age of 61 years. (1) Surgical situations: operation time and hospital expenses were (102±34)minutes and (12 813±2 390)yuan for the experimental group, and (97±30)minutes and (12 125±2 205)yuan for the control group, respectively, showing no significant difference between the two groups (t=0.907, 1.685, P>0.05). (2) Follow-up: all the 128 patients received follow-up. There were 8 cases of seroma in both the experimental group and the control group, with no significant difference between the two groups (χ²=0.072, P>0.05). The extraction volume of patients with seroma was 20 mL (range, 4-31 mL) in the experimental group, and 43 mL (range, 23-98 mL) in the control group, showing a significant difference between the two groups (Z=-2.013, P<0.05). There was no incision infection, chronic pain or hernia recurrence in 3 months after operation in patients with seroma of either experimental group or control group. Conclusions During TAPP, suture and fixation of the hernia sac stump to the lower edge of rectus abdominis and free hernia sac stump in the abdominal cavity after dissection and transection of hernia sac can effectively repair indirect inguinal hernia. The former method can reduce the extraction volume of seroma after operation.

Cervical cancer is one of the most common gynecological malignancies which seriously threatens the health of women. How to further expand the scope of screening and improve the sensitivity and specificity of screening and optimize screening programs are the key points of cancer prevention and treatment. At present,the screening methods that are commonly used at home and abroad include cervical smear cytology, human papillomavirus ( HPV) detection,molecular biology detection and genetic genetic testing. Cervical smear cytology has high specificity and low sensitivity,the sensitivity of HPV detection is high,but the specificity is low,and the molecular biological detection and genetic testing has high specificity and high sensitivity,but due to the lack of large quantities of clinical samples,and the higher detection cost,they are still in the test study stage.

Objective: To discuss the methods, skills and experiences of dividing the neck of pancreas in laparoscopic pancreaticoduodenectomy(LPD). Methods: The clinical data of 58 patients with periampullary tumors who received LPD at the Union Hospital of Fujian Medical University from December 2014 to January 2017 were retrospectively analyzed.There were 26 males and 32 females, ranged from 18 to 65 years, with a mean age of (46±12)years. Results: All of the 58 patients underwent operation smoothly.Three cases underwent open anastomosis via an auxiliary incision after the total resection of specimen laparoscopically, due to the early learning curve of LPD.Two cases transformed into open operation as a result of tumor vascular invasion to portal vein(PV) or superior mesenteric vein(SMV). Fifty-three cases underwent laparoscopic or laparoscopic combined with robotic pancreaticoduodenectomy completely.Forty-two cases ligated gastroduodenal artery(GDA), fully penetrated the interspace between rear of pancreatic neck and SMV, suspended the pancreas and then divided the neck of pancreas from inferior to superior. Thirteen cases fully dissected the interspace between rear of pancreatic neck and SMV, divided the neck of pancreas from inferior to superior and then ligated GDA.Three cases ligated GDA, dissected PV and SMV at the superior and inferior margin of the neck of pancreas separately, and then divided pancreas from anterior to posterior.Mean time of dividing pancreas was (34.9±9.7)minutes, mean volume of blood loss while dividing pancreas was (30.1±8.2)ml.The main postoperative complications included pancreatic fistula(7 cases, Biochemical leak 2 cases, B grade 3 cases, C grade 2 cases), biliary fistula(3 cases), gastric fistula(1 case), delayed gastric emptying(1 case, C grade), abdominal infection(5 cases), hepatic failure (1 case), intra-abdominal hemorrhage(2 cases), reoperation(2 cases). One case died at the perioperative period while others recovered.The mean duration of postoperative stay was (14.2±5.1)days. Conclusions Dividing the neck of pancreas is one of the most important steps in LPD, which deserved sufficient attention.At the meantime, a suitable method of dividing the neck of pancreas should be chosen according to intraoperative exploration and preoperative imageological examinations.

Objective: To compare the short-term clinical outcomes and cost differences of robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP). Methods: The retrospective descriptive study was adopted.The clinical data of 158 patients underwent minimally invasive distal pancreatectomy who were admitted to Fujian Medical University Union Hospital between January 2016 and July 2018 were collected.A 1∶1 matched propensity score (PSM) analysis was performed for the RDP group and the LDP group.Observed indexes included operative time, blood loss, spleen-preserving rate, postoperative hospital stay, morbidity, incidence of pancreatic fistula and hospital costs. T test or rank sum test was used to compare measurement data, χ² test or Fisher exact test was used to compare count data. Results: A well-balanced cohort of 41 patients was analyzed.There were 14 males and 27 females in the RDP group, aged (45.2±16.4)years. There were 15 males and 26 females in the LDP group, aged (47.4±14.9) years.The operation time was (209.7±52.9) minutes for the RDP group and (186.5±56.7) minutes for the LDP group (P=0.073). Median blood loss was less in RDP (50(15-175)ml) compared with LDP (100(50-350)ml) (Z=-2.689, P=0.007). Thirty-eight cases of non-malignant diseases were observed in each group and spleen-preserving rate was higher in RDP (76.3%) compared to LDP(44.7%) (χ²=7.930, P=0.005).Postoperative hospital stay was similar in the RDP group and the LDP group (RDP: 9.4 days vs. LDP: 10.6 days; P=0.372). The overall morbidity and incidence of pancreatic fistula major complication rates (RDP: 12.2% vs. LDP: 14.6%, P=0.746; RDP: 7.3% vs. LDP: 9.8%, P=1.000) were similar.Total cost of RDP group was higher than that of LDP group ((80 563.7±10 641.8) yuan vs. (57 792.8±8 943.0) yuan, t=4.515, P<0.01). Conclusions Both RDP and LDP are safe and feasible procedures. RDP is more expensive, but RDP is associated with significantly less blood loss and higher spleen-preserving rate, which is more suitable for the non-malignant diseases of pancreatic body and tail with an expectation of splenic preservation.

Objective To investigate the mechanism of rapamycin inhibiting the differentiation and proliferation of newborn porcine pancreatic adult stem cells, and to explore the therapeutic methods that may effectively reduce the side effects of rapamycin. Method Porcine NPCCs were treated with rapamycin alone or in combination with IGF-Ⅱ, and the caspase-3 and [ 3 H ]-thymidine uptake assays were performed to detect apoptosis and proliferation. The expression of insulin, PDX-1, NeuroD/Beta2, and Foxo1, a downstream transcription factor of IGF-Ⅱ, were analyzed by RT-PCR and Western blot to evaluate the differentiation ability of pancreatic adult stem cells. Results The NPCCs treated with rapamycin inhibited the proliferation ofβ-cells, increased apoptosis, reduced insulin secretion, inhibited the expression of PDX-1 and NeuroD/Beta2, and decreased the expression of IGF-Ⅱ. Foxo1 expression and induction of Foxo1 from the cytoplasm to the nucleus of the ectopic. The combined treatment of rapamycin and IGF-Ⅱcan reduce the side effects of rapamycin, inhibit the decrease ofβ-cell number and insulin content, repair the expression of insulin, PDX-1, NeuroD/Beta2, inhibit Foxo1 expression and intracellular ectopic. Conclusion Aberrant expression of IGF-Ⅱ and Foxol genes is the key inducing factor of rapamycin inhibiting the proliferation and differentiation of NPCCs, and IGF-Ⅱtreatment can effectively reduce the side effects of rapamycin on NPCCs differentiation.