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 explore the change characteristics of platelet derived growth factor BB (PDGF-BB),transforming growth factor beta 1 (TGF-beta 1),and alkaline fibroblast factor (bFGF) of the wound exudates after the hysteroscopy adhesion separation technique.Methods Thirty two cases of intrauterine adhesions patients were selected who received the hysteroscopy adhesion separation technique from June 2014-June 2015 as the observation group,and 24 cases of hysteroscopy septum resection patients during the same period as the control group.PDGF-BB,TGF-beta 1,and bFGF of the wound exudates were measured with enzyme-linked immunosobent assay (ELISA) method at the postoperative 3,6,9,12,24,48,72 h.Results At the postoperative 3,6,9 and 12 h:PDGF-BB level of the observation group was (2.73 ± 0.72) ng/ml,(3.69 ± 0.74) ng/ml,(5.78 ± 0.82) ng/ml,and (5.94 ± 0.85) ng/ml,respectively;TGF-β1 level was (3.63 ±0.57) ng/ml,(9.89 ±0.95) ng/ml,(8.24 ±0.82) ng/ml,and (7.64 ±0.75) ng/ml,respectively;bFGF level was (20.23 ± 2.35) ng/ml,(92.46 ± 23.96) ng/ml,(387.84 ±76.63)ng/ml,and (1178.53 ± 127.95)ng/ml,respectively.PDGF-BB level of the control group was (2.52 ± 0.53) ng/ml,(2.63 ± 0.55) ng/ml,(4.72 ± 0.67) ng/ml,and (4.52 ± 0.61) ng/ml,respectively;TGF-β1 level was (3.07 ±0.59)ng/ml,(7.43 ±0.67) ng/ml,(5.43 ±0.57) ng/ml,and (4.68 ±O.77)ng/ml,respectively;bFGF level was (18.25 ±2.46) ng/ml,(81.49 ±20.18) ng/ml,(237.06 ±53.97) ng/ml,and (747.02 ± 107.73) ng/ml,respectively.The PDGF-BB,TGF-beta 1,and bFGF levels of two groups at the postoperative 3,6,9 h were risen quickly,and continued to the 72 h after surgery,the peak concentration of three indices of the observation group were higher than the control group,the difference had statistical significance (P ＜ 0.05).Conclusions The levels of PDGF-BB,TGF-beta 1,and bFGF of the wound exudates were obviously increased after the hysteroscopy adhesion separation technique.

Objective To observe the curative effect of acupoint injection combined with miscarriage prevention and anti -vomit recipe on hyperemesis gravidarum.Methods 88 patients with hyperemesis gravidarum in our hospital from February 2013 to February 2014 were selected and randomly divided into the control group and treatment group with 44 cases in each.The control group was given conventional western medicine therapy;and the treatment group was given acupoint injection combined with miscarriage pre-vention and anti-vomit recipe additionally.The two groups were compared in terms of the time of vomit stopping, treatment duration of hyperemesis gravidarum, number of people with normal dieting after treatment, number of people with normal electrolyte level, fre-quency of daily vomiting, curative effect of hyperemesis gravidarum, ketone levels before and after treatment and carbon dioxide com-bining power indicators of the two groups.Results The time of vomiting stopping and treatment duration of hyperemesis gravidarum of the treatment group were significantly shorter than those of the control group; the ketone values before and after treatment of the treatment group improved significantly compared with the control group; the number of people with normal dieting after treatment and normal electrolyte level of the treatment group was significantly larger than that of the control group .The average frequency of vomit of the treatment group was significantly smaller than that of the control group; and the curative effect of hyperemesis gravidarum of the treatment group was significantly better than the control group (p<0.05).Conclusion Acupoint injection combined with miscar-riage prevention and anti-vomit recipe in the treatment of patients with hyperemesis gravidarum is clinically effective and is worthy of clinical application and promotion.

Objective To analyze the surgical treatment choice of hepatolithiasis and its curative effect. Methods The clinical data of 120 patients with hepatolithiasis admitted in our hospital were randomly selected and retrospectively analyzed. 43 cases were undergone cho-ledocholithotomy, 37 cases were given merotomy of live, 31 cases were given hepatic duct plasty and choledochojejunostomy, and 9 cases were performed fiber choledochoscope lithotomy. Results All the 120 cases were followed-up from 1 year to 10 years. The postoperative re-sidual stone rate, good rate, and occurrence rate of complications were respectively:42. 23%, 78. 69%, 9. 23% in group of choledocho-lithotomy;8. 05%, 95. 93%, 18. 09% in group of merotomy of live;13. 33%, 87. 33%, 21. 32% in group of hepatic duct plasty and cho-ledochojejunostomy;31. 98%, 78. 04%, 15. 69% in group of fiber choledochoscope lithotomy. The total residual stone rate was 24. 17%, the total good rate was 85. 83%, and the occurrence rate of complications was 15. 83%. Conclusion Choose the suitable operation method according to medical history of patients is the the key to reduce the residual stone rate and the occurrence rate of complications, thus elevating therapeutic efficacy of hepatolithiasis.

Multiple myeloma (MM) is a heterogeneous disease with certain cytogenetic abnormalities [1q21 gains,t(4;14),del 17p] associated with worse outcome.The extensive use of thalidomide,lenalidomide and bortezomib has dramatically improved the outcome for patients with MM and some cytogenetic abnormalities.It is also widely proved that bortezomib can partly overcome the harmful affects of t (4;14).However,till now,there are many controversies about the effects of some novel agents worked on certain cytogenetic abnormalities.In this review,the effects of novel agents in cytogenetic abnormalities were summaried to provide new information on clinical treatment of this disease.

Objective To investigate the clinical effect of intravenous iron dextran peritoneal dialysis patients with renal anemia.Methods Fifty cases of peritoneal dialysis patients with renal anemia in the Shenzhen Hospital of Peking University from Jan.2010 to Jun.2014 were randomly divided into control group and the observation group,and 25 cases in each group.Patients in observation group were given intravenous iron dextran at dose of 100 mg/time,and 3 times/week.Patients in control group were given ferrous succinate at dose of 200 mg/times orally,and 3 times/day.Both treatment period was eight weeks.Changes in clinical symptoms and treatment of the two groups of patients were recorded.Results Ater eight weeks treatment,the levels of hemoglobin(Hb),red blood cell count (RBC),hematocrit (Hct),reticulocyte count (Ret),total iron binding capacity(TS) and serum iron(SF) in two groups were significantly better than before treatment (P＜0.05 or P ＜0.01).The levels of Hb,RBC,Hct,Ret,TS and SF in observation group after treatment were (91.6± 13.8) g/L,(3.4± 0.4) × 109/L,0.31 ± 0.04,(1.7 ± 0.6) ％,(38.9 ± 6.7) ％ and (525.9 ± 81.4) μg/L,significantly better than those of control group((79.6 ± 13.9) g/L,(3.0±0.7) × 109/L,0.27±0.06,(1.4 ±0.6) ％,(28.1 ±8.4)％ and (377.2 ± 107.2) μg/L),and the differences were statistically significant (P ＜0.05).Total effective rate of observation group were 80％(20/25) and 76％(19/25) in the control group.The difference was not statistically significant(x2 =4.364,P＞0.05).Adverse reactions in observed group was 4％ (1/25) and 8％ (2/25) in control group (x2 =4.895,P ＞ 0.05).Conclusion The therapy of intravenous iron dextran on peritoneal dialysis patients with renal anemia can effectively improve the clinical symptoms,and supply iron for the patient.

Objective:To evaluate the clinical effects of the key-way attachment in fixed restoration of mandibular first and second molar deletion.Methods:A 1 -5-year follow-up study was conducted on 1 6 patients with the reconstruction of mandibular first and second molar deletion.The key-way attachment was used as a connector in the fixed partial denture,with the third molar and 2 sec-ond premolars as the abutments.Results:During 5-year follow-up,1 3 of the fixed partial denture were good-looking,stable and functioning.The abutments were stable,without endodontic and periodontal disease.No absorption of alveolar bone was observed by X-ray examination.3 cases were failure.Bleeding on probing of third molar was observed in 1 patient 1 year after restoration.1 re-tainer of a denture on the third molar was loosing 1 .5 years after restoration.1 patient had dental caries on the third molar 5 years af-ter restoration.Conclusion:The key-way attachment as a connector is useful in fixed partial denture in patients with mandibular first and second molar deletion.

Myeloproliferative neoplasms (MPN) are a group of diseases with malignant cloning in hematopoietic stem / progenitor cells. The main clinical feature is excessive proliferation of one or more lineage of myeloid cells, which cause increasing count of erythrocytes, granulocytes and platelets in peripheral blood.Arterio-venous thrombosis and complications are responsible for the mortality of MPN. Low molecular weight heparin (LMWH) is a kind of anticoagulant that commonly used for its safety and validity. It can improve the hyperviscosity of blood , affect platelets, and interact with leukocytes and endothelial cells, by which can reduce cells aggregation. LMWH can effectively play an active role of anticoagulant in high-platelet plasma. All of these provides a theoretical basis to its availability in MPN.

Objective:To evaluate the application of Quantitative tissue velocity imaging(QTVI) in assessing the left ventricular (LV) systolic function in Children with dilated cardiomyopathy(DCM).Methods:Fifteen consecutive children with DCM were included in the present study,who were divided into group A(with light heart failure) and group B(with moderate and severe heart failure).Twelve children without any cardiac diseases were as controls.The dynamic tri-plane QTVI images of apical four-chamber,LV two-chamber and LV long-axis views were acquired simultaneously and the myocardial velocity curves in basal and middle segments were analyzed.Results:(1)The peak systolic velocity (Vs)redueed generally in group A and B compared with that in controls,especially in group B(P0.05).(2)There were forty-two segments with the velocity of postsystolie shortening(PSS) more than that of the systole in DCM group,among which thirty segments(71.43%)were from group B,and twelve segrnents(28.57%)from group A. Analyzed with strain,twenty-one segments (50.00%)were actively shortened and eleven segments (26.19%)were paradoxical motion.Conclusion:QTVI can assess LV systolic function accurately in Children with DCM.

Objective To review the progression of molecular biological mechanism on chondronecrosis in cartilage with Kashin-Beck disease (KBD) so as to promote the research work for pathogenesis of KBD. Methods The document analysis was used to compare the status quo of domestic and abroad research on KBD and osteoarthrosis. Results An aggregation in pedigrees with KBD was found, and an excessive chondrocyte apoptosis and de-differentiation was observed in cartilage from KBD patients except for chondronecrosis in deep zone. In contrast to osteoarthrosis, short tandem repeat, collagen gene in cartilage and gene chip were little known in KBD. Conclusion The pathogenesis of KBD should be further studied using modern biotechonology, such as short tandem repeat, cartilage collagen gene and gene chip.