Objective:To compare the difference of serum levels of M-phospholipaseA2 receptor ( PLA2R) antibodies in patients with idiopathic membranous nephropathy(IMN) detected by two different methods and evaluate the diagnostic value of two methods. Methods:Patients diagnosed as membranous nephropathy and other diseases with biopsy-proven from december 2014 to october 2015 in Shengjing Hospital of China Medical University were enrolled and devided into IMN group and non-IMN group. The serum levels of anti-PLA2R antibody were detected by both indirect immunofluorescence assay(IFA) and enzyme linked immunosorbent assay(ELISA). Results:The sensitivity of IFA and ELISA in IMN were 71. 3% and 68. 5%,and the specificities of two methods were the same as 100%. The area under ROC curves of anti-PLA2R antibody for IMN diagnosis were 0. 860 and 0. 839. The diagnostic value of IFA and ELISA was no statistically significant differences in IMN ( P>0. 05 ) , and the consistency of two methods was better (κ=0. 876). The IMN patients of positive anti-PLA2R antibody be susceptible to the low level of serum albumin (P<0. 05). The higher levels of PLA2R antibody were linked with the worse hypoproteinemia and the higher rate of nephrotic-range proteinuria in IMN patients. Conclusion:Two methods of detecting sera PLA2R antibody have higher sensitivity and specificity,so the sera anti-PLA2R antibody was a better biomarker in the diagnosis of idiopathic membranous nephropathy.

Objective To explore the imaging typing of skull eosinophilic granuloma( SEG) in children,and the clinical significance of this typing system was determined. Methods The clinical and radiological data of 32 cases of SEG confirmed by pathology in the past six years were retrospectively reviewed. According to the imaging findings,which included the size and shape of the granuloma,and the degree of skull destruction,SEGs were divided into four types:typeⅠ( subtle granumoma) ,typeⅡ( exteriorly convex granuloma) ,typeⅢ( biconvex granuloma) and typeⅣ(multiple granulomas and destructions). The imaging features of different types of SEG were analyzed,and the signif-icance of imaging typing was explored combining with the clinical manifestations,treatment programs and prognosis. Results Three cases (9. 4%) were included in typeⅠ,in which,the granuloma was not obvious and the skull destruction was confined in the diploe and outer plate. In type Ⅱ (21 cases,65. 6%),the imaging features included an obvious exteriorly convex mass and complete skull destruction of in-side and outside panels. Granuloma remove and destructed skull repair were performed in all cases,in which 15 were followed up and no re-currence was found. The imaging features of type Ⅲ (5 cases,15. 6%) were biconvex mass which broke through the inner plate and op-pressed the dura and cerebral parenchyma. Therapy program included not only surgical excision of the lesion but also repair of skull and dura. Three cases were followed up and no recurrence was found. Type Ⅳ (3 cases,9. 4%) showed multiple skull destructions and granulomas of various sizes. Chemotherapy and surgery treatment,poor prognosis and ease recurrence were characterized by this type. Conclusion we put forward a imaging typing method for SEGs. This typing system is helpful in guiding clinical protocols and prognosis of SEGs in children.

Objective To investigate the concentrations of serum N-terminal brain natriuretic peptide (NT-pm BNP) and high-sensitivity C-reactive protein (hs-CRP) of acute exacerbation of chronic obstrnctive pulmonary disease(AECOPD) patients treated by bi-level positive airway pressure(BiPAP) for with respiratory failure.Methods A total of 100 respiratory failure in patients with AECOPD were divided into study group and control group,and 50 cases of each group.Patients in study group were received the conventional treatment(anti infection,diastolic bronchial,cough and phlegm and oxygen therapy) combined with BiPAP therapy,while in control group were received the conventional treatment.Blood samples were drawn at beginning and 3 d later.Serum hs-CRP and NT-pro BNP levels were determined,and the expenses and duration of hospitalization of two groups were compared.Result After treatment,the level of serum NT-pro BNP in study group and control group were (105.79 ± 4.56) ng/L and (113.33 ± 3.26) ng/L,and the difference was statistically signifi cant (t =3.03,P ＜ 0.05).The serum hs-CRP levels were (10.83 ± 16.35) mg/L and (26.39 ± 26.87) mg/L in study and control group,and the differences were statistically significant (t =-3.44,P ＜ 0.05).The expenses and duration of hospitalization in study group were both less than those in control group((11.15 ± 1.86) d vs.(12.78±2.25) d;(6 659.11 ±1 609.49) yuan vs.(8 031.31 ±1 449.79) yuan;t=-3.87,-4.38;P ＜0.05).Conclusion Early BiPAP therapy in AECOPD patients with respiratory failure in patients is showed that NT-pro BNP and hs-CRP levels faster decrease and disease is recovery remission,which suggests that NTpro BNP or BNP for AECOPD patients and respiratory failure condition monitoring,clinical efficacy have some clinical value.

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Objective To explore the clinical effect of detection of serum procalcitonin (PCT), C-reactive protein (CRP)and white blood cell (wBC)on diagnosis and treatment of severe pneumonia in children.Methods A total of 189 cases of pediatric patients with pneumonia including 51 severe pneumonia cases (severe pneumonia group)and 138 common pneumonia cases (common pneumonia group)treated from Mar 2014 to Dec 2014 and 30 healthy cases (control group)were enrolled,and the level of PCT,CRP and wBC of all cases were detected.Results The levels of PCT before treatment in severe pneumonia group,common pneumonia group,and control group were 1.12(0.44 ~3.07)ng /ml,0.14 (0.09 ~0.26) ng /ml and 0.03(0.01 ~0.06)ng /ml respectively,and there were significant differences among three groups (P ﹤0.05,respectively).The levels of CRP before treatment in severe pneumonia group,common pneumonia group,and control group were 82.2(25.9 ~120.3 )mg /L,10.8 (5.3 ~23.9)mg /L and 3.2 (2.1 ~6.9) mg /L respectively,and there were significant differences among three groups (P ﹤0.05,respectively).The counts of wBC before treatment in severe pneumonia group,common pneumonia group,and control group were 10.1 (9.1 ~14.1 )×109 /L,8.8(6.8 ~1 1.7)×109 /L and 6.2(4.8 ~7.9)×109 /L respectively,and there was significant difference only between severe pneumonia group and control group (P ﹤0.05 ).The level of PCT and CRP significantly decreased in severe pneumonia group after one week of treatment[PCT:0.15(0.09 ~0.24)ng /ml,CRP:9.9(3.6 ~19.0)mg /L](P ﹤0.05),but there was no significant differ-ence of wBC counts in severe pneumonia group between after and before treatment[8.5(6.3 ~9.8)×109 /L vs.10.1 (9.1 ~14.1 )×109 /L](t =1.312,P =0.205 ).After two days of anti-inflammatory treatment in severe pneumonia group,serum PCT dropped to 44% of the level before treatment,and smoothly dropped to nearly 10% of the basic value every two days.Serum PCT was correlated with serum CRP in children with pneumonia(R2 =0.550 4,P ﹤0.05).Conclusion The combined detection of PCT and CRP could provide important guidance for the differential diagnosis,treatment and prognosis for severe pneumonia in children.

Objective To explore the therapeutic efficacy of three different treatment regimens for conservative treatment of ec‐topic pregnancy(EP) .Methods Clinical data of 198 cases of patients with EP who were conservatively treated in this hospital from June 2012 to June 2014 were retrospectively analysed .All patients were divided into group A (39 cases) ,group B(92 cases) and group C(67 cases) ,which were treated with single‐dose of methotrexate(MTX) ,MTX combined with mifepristone and multiple‐dose of MTX respectively .The curative rate and time for human chorionic gonadotropin beta‐subunit(β‐HCG) dropping to normal were observed and recorded .Results The total curative rates in three groups were statistically different (P<0 .05) ,additionally , group C had the highest curative rate(86 .57% ) ,followed by group B with 84 .78% and group A with 66 .67% .In the three groups , for patients with serum level of β‐HCG 1 500-3 000 mIU/mL or >3 000 mIU/mL ,the curative rates were statistically different (P<0 .05) .Conclusion Single‐dose of MTX has relative low curative rate .It is recommend to use combination regimens or multi‐ple‐dose of MTX regimens ,and for patients with high level of β‐HCG multiple‐dose of MTX regimens might be the best choice .

Objective:To observe the clinical effects of Zuoyu üo. 1(ZY1)in the prevention of concomitant concurrent complica-tions after operation for anorectal diseases. Methods:164 patients who had received operation for anorectal diseases were randomly di-vided into 2 groups. Patients in the treatment group were treated with sitz baths in ZY1 and the conventional wound dressing method. Patients in the control group were treated with sitz baths in warm water and the conventional wound dressing method. Results:The effi-ciency rate of the treatment group was significantly higher than that of the control group(53. 57% vs. 27. 5%,P<0. 05),as well as the total effectiveness(95. 23% vs. 88. 75%,P<0. 05). The comparison showed that better curative effects existed in the treatment group on distress,bleeding,and edema ratings and wound healing time. Conclusion:Sitz bath in ZY1 after operation for anorectal dis-eases reduces complications and shortens the wound healing time without any side effect. It is thus extensively promising in clinical ap-plications.

ObjectiveTo investigate the cause,diagnosis and treatment measures of neonatal pneumothorax.MethodsThe clinical data of 98 cases with neonatal pneumothorax in our hospital from Mar 2005 to Mar 2010 were reviewed retrospectively.ResultsThere were 27 premature neonates and 71 full-term neonates in the 98 cases.Ten cases were spontaneous pneumothorax and 88 cases were non spontaneous pneumothorax.After the treatnent of primary disease,pleural aspiration,chest drainage and mechanical ventilation,88 cases were cured,8 cases were improved and 2 cases died.ConclusionNeonatal pneumothorax is related with cesarean section,improper use of endotracheal intubation,meconium aspiration,premature hyaline membrane disease using pulmonary surfactant and ventilator therapy.Most pneumothorax is due to lung disease.The prevention of preterm birth and asphyxia can reduce the incidence of neonatal pneumothorax.

Objective To study the protective earth requirement for touched metal parts of medical electrical equipment to improve the manufacturer's understanding on national standards.Methods The isolation methods for the touched metal parts in national standards were studied,and the principle of protective earth combined with insulation separating was analyzed.The characteristics of the second isolation method was discussed,and the respiratory system structure and electroshock protection of the anaesthetic machine were taken as examples.Results The touched metal parts with no measures for grounding,double isolation or reinforced insulation was determined by structure detection to meet the requirements of national standards in case basic insulation ceased to be effective and the parts were uncharged.Conclusion The necessities to girt the touched metal parts with measures for grounding,double isolation or reinforced insulation should depend on the understanding on national standards and electrical construction of the equipment under test by structure detection.

ABSTRACT:Objective To a rare case of double primary cancer (hepatocellular carcinoma with gallbladder)to guide clinical application.Methods and Results We reported one case of primary hepatocellular carcinoma and gallbladder.A male patient,54 years old,had main complaints of intermittent right upper quadrant pain for 4 days. The abdominal CT of the local county hospital showed gallstones,gallbladder with liver infiltration.And then he went to the First Affiliated Hospital of Xi’an Jiaotong University for further treatment.Laboratory examination revealed:HBsAg(+),HBcAb(+),alpha-fetoprotein (AFP)> 60 500 ng/mL,carcinoembryonic antigen (CEA) 5.25 ng/mL.Abdominal CT showed hilar slightly stronger light echo groups:liver cancer or gallbladder cancer? Hepatic artery and portal vein CT imaging (CTA+CTV)examination showed the malignant tumor shadow in the inside of the left hepatic lobe huge,uneven thickening of the gallbladder wall,suspected liver disease with gallbladder infringement or gallbladder disease with liver infringement. With the preoperative preliminary consideration of primary liver cancer with infiltration of the gallbladder,we chose the operation as the resection of segment Ⅳ b and Ⅴ of the liver,cholecystectomy and T tube drainage.Pathological examination postoperative showed the bulky liver carcinoma grade Ⅲ and the poorly differentiated adenocarcinoma of gallbladder.A month later,abdominal CT showed the tumor spread intrahepatic,prompting the poor prognosis.Conclusion The two which are not continuous,which is the standard of double primary cancer,are not suitable for all double primary cancers.This case provides useful experience for future similar diagnosis and treatment of disease,and also helps us with timely and accurate identification of “metastatic”or “primary”,which is the key point for clinicians to give patients an effective treatment.