Objective To investigate the clinical efficacy of laparoscopic splenectomy (LS) for immune thrombocytopenic purpura (ITP).Methods The clinical data of 84 patients with ITP who underwent LS at the First Affiliated Hospital of Chongqing Medical University from January 2007 to January 2014 were retrospectively analyzed.The potential prognosing indexes (gender,age,course of diseas,preoperative response to steroid,preoperative PLT,operation time,volume of intraoperative blood loss and postoperative PLT peak within 7 days) were collected and analyzed.The evaluation of surgical efficacy was done according to the American Society of Hematology 2011 evidence-based practice guideline for ITP.The complete response and partial response were defined as effective and no response as void.All of the patients were followed up by outpatient examination and telephone interview till December 2014,the follow-up information included platelet count,bleeding performance,presence of long-term complications and postoperative recurrence,etc.Measurement data with normal distribution were presented as x ± s,and skew distribution data were described as M (range).The postoperative long-term effective rate was analyzed by Kaplan-Meier method.The univariate analysis and multivariate analysis were done using the chi-square test and Logistic regression model,respectively.Results The operation time of 84 patients was (154 ±40)minutes with a median volume of intraoperative blood loss as 200 mL (10-1 000 mL).Lienculus was detected in 11 patients and resected.Seven patients had complications and recovered after symptomatic and supportive treatment.There was no perioperative death.Among the 84 patients who were followed up for an average follow-up time of 51 months (12-96 months),45 patients had complete response,18 patients had partial response and 21 had no response,without serious spontaneous visceral and intracranial hemorrhage.Eighteen partial-response patients underwent symptomatic medical therapy and 21 no-response patients took orally prednisolone,among which 13 had PLT ＞ 30 × 109/L stably.During the follow-up,only one complete-response patient died of lung cancer with systemic metastasis at 2 years after surgery.Four patients had pneumonia,1 noresponse female patient had pyothorax repeatedly for a long time,and they all recovered after symptomatic and supportive treatments.There were no serious complications and overwhelming postsplenectomy infection in other patients.The 1-,3-,5-,7-year effective rates were 82.1％,77.6％,72.5％ and 67.9％,respectively.Univariate analysis showed that preoperative response to steroid,preoperative PLT and postoperative PLT peak within 7 days were related factors affecting long-term effecacy of patients with ITP (x2=5.600,6.006,21.733,P ＜ 0.05),but gender,age,course of disease,operation time and volume of intraoperative blood loss were not related factors affecting long-term effecacy of patients with ITP (x2=0.018,2.684,0.000,0.064,0.397,P ＞ 0.05).Multivariate analysis showed that preoperative response to steroid and postoperative PLT peak within 7 days ≥300 × 109/L were independent protective factors affecting long-term efficacy (OR =5.426,19.454,95％ confidence interval:1.220-24.129,4.704-80.449,P ＜ 0.05).Conclusions LS is safe and feasible for the treatment of ITP with a high long-term effective rate.Preoperative response to steroid and postoperative PLT peak within 7 days may be the predictors of LS for ITP.

Objective To summarize and analyze the effect of mannitol combined with Xueshuantong on the treatment of early swelling and pain in patients with tibial and fibula fracture. Methods In Huzhou central hospital from June 2014 to January 2017, 100 cases with early swelling and pain with tibia and fibula fractur were divided into the observation group (50 cases) and the control group (50 cases). The control group were given routine mannitol combined with Xueshuantong treatment and routine nursingcare, at this basis, the observation group were received nursing intervention. The effect of the treatment and nursing in the two groups were compared. Results The total effective rate, nursing service satisfaction and the VAS score after treatment between the two groups were statistically significant (P<0.05). Conclusion The treatment of mannitol combined with Xueshuantong and strengthening clinical nursing intervention is helpful to improve the therapeutic effect and alleviate the pain of the patients with early swelling and pain with tibia and fibula fracture.

Objective To observe the effect of sanfukechuangao acupoint application on changes of interleukin-18 (IL-18), eosinophils (EOS) and pulmonary pathology in asthma model of guinea pigs, and its underlying mechanism thereof. Methods A total of 60 guinea pigs were randomized into normal control group, asthma model group, acupoint-application 1 h group, acupoint-application 3 h group, acupoint-application 6 h group and dexamethasone group. Asthma model was established by intraperitoneal injection of 10%ovalbumin (OVA,1 mL) and forced inhalation of atomized 2%OVA. Skin preparation and external application of Chinese medicinal herbs were made on back of guinea pigs, and Feishu,Xinshu,Geshuwere selected in acupuncture points). Levels of IL-18 and EOS were detected by immunohistochemisty method. Results Compared with model group,the levels of IL-18 and EOS were significantly decreased, the pathological changes were significantly reduced in three acupoint-application groups. The effectiveness of acupoint-application 3 h group was the best in three groups. Conclusion Sanfukechuangao acupoint application can influence the levels of IL-18 and EOS effectively, and relieve phlegmonosis injuries in pulmonary tissue of asthma model of guinea pig.

Objective To investigate the inhibition effects of chitooligosaccharides on the production of pro-angiogenesis factors of estradiol(E2) induced human MCF-7 cells.Methods The cell survival rate was demonstrated by MTT assay at 24 and 48 hours;and the mRNA level of some pro-angiogenesis factors such as MMP-9,TIMP-1,2 and VEGF were investigated by RT-PCR.Results There was no significant effect of chitooligosaccharides on proliferation of human MCF-7cells;but when induced by E_2,MMP-9 was significantly down-regulated by chitooligosaccharides.Conclusion Chitooligosaccharides had potent inhibition effects on the mRNA production of MMP-9 of human MCF-7 cells.

OBJECTIVE To explore the into clinical features and nursing measures for neonates with ventilator-associated pneumonia(VAP).METHODS Totally 74 newborns were hospitalized and received ventilating treatment during 2003-2007.RESULTS Thirty out of 74 baby patients have been found out VAP,whose occurring rate was 41.9% and death rate was 14.3%.Its main original bacteria are G-bacteria,covering 82.2% of all bacteria.CONCLUSIONS While we are carrying out ventilating treatment,we must pay much attention to VAP occurance,useing antibiotic correctly and rationally,strengthen ventilator′s air passage management,follow aseptic technique strictly,and shorten the time of ventilator so as to raise the success rate of the ventilating treatment.

Although the prevalence of Kashin-Beck disease (KBD) has decreased greatly since its discovery,the etiology and pathogenesis of the disease have always been one of the mysteries of the medical world.Facing the difficult situation in obtaining human samples of cartilage tissues and chondrocytes from such as KBD children,we should pay great attention to the spontaneous and induced animal models,and establish the disease model for KBD research using modern molecular biology techniques such as induced pluripotent stem cells,to reproduce the developing process of epiphyseal cartilage,growth plate cartilage and articular cartilage in KBD children,and to verify the high-risk environmental causing factors and specific biological mechanism of the cartilage necrosis and to develop targeted therapeutic drugs for KBD and to enhance the prevention and control levels of the disease.

The premise of teachers' specialization is the potential protection of teachers' rights.Teacher's rights,in the sense of law,embody the original rights and vocational rights.When the two are in trouble,the course lying on the legislative Issues can be relied on to protect the teacher's rights.

To solve the problems of the clinical education for adult undergraduates,the author analyzed thoroughly the characteristics of the adult students and their learning needs.Then the author brought forward some thoughts on the reformation of clinical education for adult undergraduates: define a special goal for the medical education of adults;foster the persons qualified to teach;found the new teaching methods to make the greatest benefits of teaching and learning.

Abstract: The theory of formulas corresponding to syndromes is a relatively mature and integrated method contained in the classics of traditional Chinese medicine (TCM) for diagnosing and treatment of diseases. The development of the theory mainly includes three stages, i.e. prototype stage before Han Dynasty, sublimation stage of late Eastern Han Dynasty and the following improving stage. People recorded what they saw and heard of during their medical activities in prototype stage. In sublimation stage, Treatise on Febrile Diseases written by Zhang Zhong-jing found out the relationship of structure-fixed prescriptions used more often with symptoms and signs. Doctors after Han Dynasty repeated and verified the truth of classical prescriptions and the theory of formulas corresponding to syndromes. They also developed and improved the theory. Based on clinical experience, and classics, it was enriched, advanced and improved by doctors after then. It could provide reference for clinical treatment through systematically hackling the theories.

Eight new diaryltriazine derivatives containing 4-allylamino and 4-azido substitutes guided by molecular docking have been designed and synthesized based on our previous work.The evaluation of HIV inhibitory activity demonstrated that all compounds were potent against HIV-1 replication.The most active compound 7c exhibited activity against HIV-1 (IC50=0.034 μmol·L-1,SI=6475)and the double mutant strain (IC50=9.39 μmol·L-1)in the micromolar range, which was more potent than nevirapine.