Layered anatomy is a both ancient and novel conception, which is derived from topographic anatomy.Topographic anatomy and phylembryogenesis are basic academic knowledges of layered anatomy.With the development of laparoscopic surgery and robotic surgery, less bleeding, more meticulous dissection, faster postoperative recovery and lower recurrence rate are required in surgical operation, because of which layered anatomy is mentioned and valued again.Organs in abdominal cavity are composed of different layered tissues,between them are loose connective tissues which are poor in vessels.Layered anatomy in surgical operation can avoid the en bloc dissection of organs, which not only reach total lesion dissection, but also avoid hurting surrounded normal tissues, showing the best surgical results.

Objective To assess the outcomes of chronic hepatitis B (CHB) infection following immunosuppressant and corticosteroid treatment in patients with rheumatic disuses.Methods The medical records of patients with positive HBsAg and rheumatic diseases from 1 Jan 2004 to 31 Dec 2007 were retros pectively reviewed and analyzed for the types of rheumatic diseases,hepatitis B seroiogies,name and dosage of immunosuppressive agents used,anti-viral therapies and outcomes of CHB infection.Results Twenty one patients were included.There were 14 female and 7 male patients.The mean age of all patients was (45±16)years.All patients were positive for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (HbcAb),and had alanine aminotransferase (ALT) less than 60 U/L except one patient with dermatomyositis.Twelve(57%) patients treated with immunosuppressant only.Among them,rheumatoid arthritis (75%) was the most commonly diagnosed rheumatic diseases.These patients were treated with methotrexate (no more than 10 mg per week) or leflunomide ( 10 mg/d),combined with suffasalazine or hydroxychloroquine.Three patients received antivirus drugs because of the elevation of HBV-DNA.During the follow-up period (7 to 47 months with a median of 25 months),four (33%) developed ALT elevation,but none had developed HBV reactivation.Nine (43%) patients were treated with prednisolone and /or immunosuppressants.Among them,5 (56%)patients were diagnosed as systemic lupus erythematosus,others were adult onset of Still's disease and dermatomyositis,and 3 patients had elevation of HBV-DNA copies.These patients were treated with predni-soione (0.8～1.2 mg·kg-1·d-1) only or combined with immunosuppressants (methotrexate or cyclophosphamide),and all patients received antivirus drugs.During the follow-up period (3 to 50 months with a median of 13 months),two developed ALT elevation,but none had developed HBV reactivation.Conclusion In patients with rheumatic disease complicated with chronic HBV infection,methotrexate (no more than 10 mg per week) and leflunomide (10 rag/d) may be safe for patients with negative HBV-DNA.Prednisolone and immunosuppressants (methotrexate or cyclophosphamide) may be used safely with prophylactic antivims drugs.

This study was to identify the clinical features of myositis complicated with primary Sj(o)gren's syndrome (pSS). A total of 202 patients with pSS were investigated. Myositis was diagnosed according to the clinical findings, muscle enzyme levels, electromyographic results, and muscle biopsy, and compared with 15 polymyositis (PM) patients. Myositis was identified in 4 of 202 pSS patients (2.0%). They developed myositis 5 to 20 years after the onset of SS. Two patients showed no myalgia and muscular weakness. Creative kinase (CK) was increased from 480 to 2702 IU/L. Anti-Jo-1 antibody was negative. All patients responded well to prednisone and had a median serum CK decrease by 48.9%. No patients had myositis recurrence. Compared with the PM group, the percentage of myalgia, peak of CK, descending rate of CK, and positive rate of anti-Jo-1 antibody were all significantly different. Myositis with Sj(o)gren's syndrome is not common, show relatively moderate symptoms, and respond well to prednisone.

Objective To investigate clinical significance of positive antineutrophil cytoplasmic antibodies (ANCA) in diagnosis for vasculitis or other diseases. Methods From January 2005 to December 2008, 104 patients with positive ANCA detected by enzyme-linked immunosorbent assay (ELISA) in People's Hospital of Peking University were randomly selected and their clinical features and diagnoses were analyzed retrospectively. Results Among 104 ANCA-positive patients, 22 were diagnosed as vasculitis and 13 as ANCA-associated vasculitis, and 82 (78. 8% )were diagnosed as non-vasculitis including 40 of connective diseases such as systematic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and 42 of non-connective diseases with the most common of ulcerative colitis. According to the results of ANCA tests by ELISA, ANCA-positive patients could be divided into those with proteinase 3 (PR3)-positive and myeloperoxideaso (MPO)-positive. More organs were involved in MPO-positive patients (n =48 ) than that in PR3-positive ones ( n = 49), and more frequent involvement of the kidneys and less frequent involvement of the gastrointestinal tract in MPO-positive than those in PR3-positive ones (P < 0. 01 ). As compared to those with non-vasculitis, more organs (2. 28 organs vs. 3.55 organs in average) were involved in patients with vasculitis (P <0. 01 ) and more frequent involvement of the upper or lower respiratory tracts and the kidneys in vasculitis patients ( P <0. 01 or <0. 05, respectively). Elevated leukocyte count and accelerated erythrocyte sedimentation rate (ESR) were also more common in vasculitis patients than those in non-vasculitis ones (P <0. 01 and P <0. 05, respectively). Positive ANCA combined with number of organs involved, clinical manifestations and other laboratory findings, its positive predictive value (PPV) in diagnosis for vasculitis can be improved. Conclusions Spectrum of disease in patients with positive ANCA was varied. Diagnostic value of positive ANCA in diagnosis for vasculitis can be improved if combined with comprehensive analysis of their clinical features and laboratory examinations.

With the development of molecular diagnostic techniques, the study for the etiology of leukemia has been entering the era of the molecular biology.Molecular techniques for leukemia diagnosis, prognosis and individualized therapy are used widely, becoming one of the necessary routine tests for patients with leukemia. So far, molecular techniques for leukemiaincluding cytogenetic diagnosis, molecular genetics, molecular diagnostics based on PCR, mutation detection, as well as a variety of next-generation sequencing, have played an important role in the diagnosis of leukemia, minimal residual disease monitoring, prognosis and targeted therapy.

Objective To establish the method of anti-cell membrane associated DNA (mDNA) antibody detection, to evalute its sensitivity and specificity in systemic lupus erythematosus (SLE), and to analyze the relationship between anti-mDNA antibody and the clinical features of SLE. Methods Indirect immunofluorescence assay was used to measure anti-mDNA antibodies in sera of 207 SLE patients, 167 patients with other rheumatic diseases and 82 healthy controls. Using indirect immunofluorescence to detect the expression of mDNA with positive standard serum samples on nine cultured cell lines and pre-treated cells by DNAse, RNAse or trypsin. Results Of the serum samples, 73.3% SLE and 5.4% other rheumatic diseases were positive for anti-mDNA, but negative in 82 blood donors (P0.05). This study also proved that mDNA was expressed on B and T lymphocytes, the strongest staining was expressed on Raji cell line. The mDNA molecule was confirmed by pattern extinction on the cells pre-treated with DNAse but not RNAse or trypsin. Conclusion Anti-mDNA antibody is one of the most valuable marker in the diagnosis of SLE. Anti-mDNA antibody is valuable in diagnosis of SLE with negative anti-dsDNA, Sm, DNP, AHA and AnuA antibodies; but it has no significant with relationship the disease activity of SLE.

Objective To investigate the prevalence of human papillomavirus(HPV)infections in women with uterine cervical cancer in Wenzhou.Methods Exfoliated cells samples of cervix uteri were collected from 198 patients with cervical cancer. Flow-through hybridization technique was used to detect HPV and its genotypes.The relationship of HPV infection with cervical cancer stage,histological type and differentiation degree were analyzed.The prevalence of HPV infections in patients with different cervical diseases was observed.SPSS 13.0 was used for statistical analysis.Results In 198 patients with cervical cancer,HPV infection was occunrred in 147 (74.24%), of whom 101patients were superinfected (51.01%),and 129 patients(65.15%)were infected with the high-risk HPVs,which were significantly higher than those in cervicitis and cervical dysplasia(x2 = 28.28,65.34 and 95.22,P ＜ 0.01).HPV positive rate was not correlated with clinical stages,differentiation degree of cervical cancer(x2 = 0.475 and 0.969,P＞0.05).HPV positive rates in squamous cancer and adenocarcinoma had no statistical difference (x2 =0.582,P＞0.05).The logistic regression analysis showed that HPV 16/58 infection and age over 40might increase the risk of carcinogenesis of the cervix.Conclusion sHPV infection and superinfection are popular in women with cervix cancer in Wenzhou.HPV16/58 infection and age over 40 years are the risk factors of cervical cancer.

Objective To analyze the clinical features of Weber-Christian disease (WCD) and to make a review of the literature for early diagnosis and treatment.Methods The clinical features of an atypical WCD patient who had been misdiagnosed as polymyositis were analyzed.Results WCD was characterized by subcutaneous nodules and systemic symptoms.Repeating physical examination and biopsy in time were important if the nodules were not obvious.Conclusion WCD is often misdiagnosed because of the complicated clinical manifestations.Carefully physical examination and timely biopsy are help for early diagnosis.

Objective To study the prevalence of thyroid diseases in systemic lupus erythematosus (SLE) patients and to analyze the prevalence of subclinical hypothyroidism (SCH) with lupus nephritis (LN).Methods A total of 813 hospitalized SLE patients were retrospectively analyzed.The demographic,clinical and biochemical data were collected.The prevalence of different thyroid diseases was calculated.Among all patients,83 patients with SCH and 562 patients without any thyroid diseases were recruited according to thyroid hormone,thyroid stimulating hormone (TSH) and anti-thyroid antibodies levels.Case control study was performed to explore the potential risk factors for SCH in SLE.T test,Mann-Whitney U test,x2 test and Logistic regression analysis were used for statistical analysis.Results Among the 813 patients,13 (1.6％) had clinical hypothyroidism,83(10.2％) had SCH,13 (1.6％) had central hypothyroidism,27(3.3％) had autoimmunethyroid disease (AITD),10 (1.2％) had hyperthyroidism,95 (11.7％) had euthyroid sick syndrome (ESS) and 11 (1.4％) had nodules.SCH was more frequent in patients with LN (13.7％,50/366) than those without LN [7.4％(33/447),x2=8.654,P＜0.01].Meanwhile,prevalence of LN was also significantly higher in SCH group in case control study [60.2％(50/83) vs 42.9％(241/562),x2=8.800,P＜0.01].Besides,SLE patients with SCH had more severe proteinuria,hypoalbuminemia,and hyperlipidemia,which were complications of LN.In addition,the SCH group presented significantly higher anti-dsDNA antibody positive rate [50.6％(42/83) vs 33.7％(212/562),x2=5.026,P＜0.01].In Logistic regression models,24-hour urine protein and serum creatinine was retained as independent correlated factors with SCH after adjusted for demographic variables,risk factors,and other potential confounders.The presence of SCH was associated with increased 24-hour urine protein levels,occurring in 10.4％ of subjects with 24-hour urine protein ≤ 150 mg,11.9％ with 24-hour urine protein 150.1-1 500 mg,17.2％ with 24-hour urine protein 1 500.1-3 500 mg,and d24.4％ with 24-hour urine protein ＞3 500 mg (P＜0.05 for trend).In addition,when eGFR ≥30 ml·min-1· 1.73 m-2,the prevalence of SCH was increased as eGFR decreased:occurring in 12.8％ with eGFR ≥90 ml·min-1· 1.73 m-2,12.6％ with eGFR 60-89.9 ml·min-1· 1.73 m-2 and 20.0％ with eGFR 30-59.9 ml ·min-1· 1.73 m-2.Conclusion Thyroid diseases are common in SLE patients,and SCH is closely related with LN and disease activity.

Objective To explore the accuracy and clinical application of Pyrosequencing for detection of drug resistant relevant mutation in the polymerase gene of Hepatitis B virus (HBV).Methods Compared with Sanger sequencing,the accuracy and sensitivity of Pyrosequencing were assessed.Pyrosequencing was used to determine the serum of 1164 patients with chronic Hepatitis B and its results were analyzed.Results The sensitivity of Pyrosequencing was 1 × 103 KIU/L,the same as Sanger sequencing.But Pyrosequencing was more stable and specific than Sanger sequencing to detect low rate of mutation with over 10％ mutation.The mutations couldn't be detected in 248 patients with chronic Hepatitis B,but positive results occurred in 919 patients,among them,61.5 ％ without mutation,38.5 ％ with mutation (including 47.5％ of the single locus mutation and 52.5％ of the combined mutation).Other sites had different degree of mutations except the sites of rtI169T and rtA194T; the main mutation sites in patients with chronic Hepatitis B were rtM204V/I (32.1％),rtL180M (19.8％),rtA181V/T (6.7％) and rtN236T (5.3％),in which fractional mutation had high ratio in the sites of rtA181V/T (6.7％) and rtN236T (5.3％).Conclusions Pyrosequencing has good sensitivity,specificity and accuracy and can early detect the drug resistant relevant mutation in the polymerase gene of HBV,which is suitable for monitoring patients with chronic Hepatitis B for the treatment of nucleoside analogues (acid).The different sites and frequencies of mutations may be associated with different habits of doctors for using different anti-HBV drugs.