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.

0.05). CONCLUSION:3M Ketac Molar ultrahard glass ionomer cement is a good substitute for silver amalgam as the filling material for dental cavities,for not only can it repair dental facial defects,but also make teeth good-looking and prevent dental caries.

Objective To analyze and investigate the thyroid hormone levels in the patients with coronary heart disease(CHD) . Methods The levels of thyroid hormones were detected by the immunochemiluminescence method in 108 cases of CHD in the car‐diology department of our hospital and 50 healthy controls from July 2012 to October 2014 .The detection results of various indica‐tors were analyzed by using the SPSS19 .0 software and two independent samples t -test .Results In 108 cases of CHD ,11 cases were thyroid dysfunction ,including 3 cases of hyperthyroidism ,5 cases of hypothyroidism ,1 case of subclinical hyperthyroidism and 2 cases of subclinical hypothyroidism .The FT3 level in two CHD groups was significantly lower than that in the control group ,the difference was statistically significant (P< 0 .05) ,although the FT4 level was decreased somewhat ,but the difference compared with the control group was not statistically significant (P>0 .05);the FT3 level in the CHD heart failure group was lower than that in the CHD non-heart failure group ,the difference was statistically significant (P<0 .05) ,the difference in the FT4 level had no statistically significant difference (P> 0 .05);the TSH level in the CHD group was similar to the that in the control group ,the difference was not statistically significance (P>0 .05) .No difference in thyroid hormone levels was observed between male and fe‐male CHD patients (P>0 .05) .Conclusion Monitoring in the change of thyroid hormone levels in the patients with CHD can effec‐tively reflect the severity of illness and conduces to observe the clinical efficacy .

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.

Medical students participating in chnieal medical early is one of the good ways to cultivate students'all-around qualities From freshman year medical students begin to enter chnical medical service system and make clinical practice in spare time,They are also trained to link theory with practice to caltivate clinical thinking ability,strengthen its humanistic care idea and doctor-patient communication ability so that medical students will know the sacred profession of being adatov and from the idea of sewing patients work of the sacred doctor,set up'professional service to patients'concept.

Objective To evaluate the effect of intraoperative mechanical ventilation on alveolar gas exchange in patients with type 2 diabetes mellitus.Methods Thirty ASA Ⅰor Ⅱpatients with type 2 diabetes mellitus aged 46-64 yr weighing 47-78 kg undergoing total gastrectomy under general anesthesia were divided into 2groups according to preoperative glycolated hemoglobin level(HbA1c)(n=15 each):group B HbA1c/Hb=6.6%-10.4%and group C HbA1c/Hb＞10.4%.Another 15 non-diabetic patients with comparable demographic data were included in this study as control group(group A).Radial artery and right internal jugular vein were cannulated.The patients were intubated after induction of anesthesia and mechanically ventilated(VT 8 ml/kg,RR 12-lected from artery before induction of anesthesia(To,baseline)and at 30,60,90 and 120 min of mechanical ventilation(T1-4)for blood gas analysis and determination of plasma SOD activity and MDA,'TNF-α,IL-6,IL-10 concentrations.PA-aDO2 was calculated.Results PA-aDO2 was significantly increased during mechanical ventilation at T1-4 as compared with the baseline at T0 in diabetic patients and were significantly higher than in non-diabetic patients.The plasma SOD activity was significantly decreased at T1-4 as compared with the baseline at T0 in diabetic patients and was significantly lower than in non-diabetic patients.While the plasma MDA,TNF-α,IL-6 and IL-10concentrations were significantly increased at T1-4 compared with the baseline at T0 in diabetic patients and were significantly higher than in non-diabetic patients.The PA-aDO2,plasma MDA,TNF-α,IL-6 and IL-10 concentrations were significantly higher and plasma SOD activity lower in gorup C than in group B.Conclusion Intraoperative mechanical ventilation can decrease alveolar gas exchange by inducing inflammatory response in patients with type 2 diabetes mellitus.The changes are correlated with severity of diabetes.

Objective Seek countermeasures against the debt risk in universities. Methods Taking the debts of Kunming Chenggong universities construction as an example, analyze the reasons and countermeasures for the debts of universities in Yunnan province. Results Due to the enrollment expansion policy, the higher education in Yunnan province has been transformed from the elite education into mass education. The universities in Kunming have gained unprecedented development opportunities,especially with the completion of the Kunming Chenggong University Town. However, loan funds for the new campus construction mostly came from banks. So,the huge debt stress from banks has been brought with the development of the universities. Conclusion The sustainable development of universities requires the moderate debt. The government, universities and society need to work together to control the scale of debt effectively and avoid the debt crisis.

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.