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 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 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.

The optimal condition of double-paper synergy test in the detection of bacteria producing extended-spectrum β-lactamase (ESBLS) was studied. In 244 isolates of Enteric bacilli，Klebsiella pneumonia，Enteric cloacae，there were 49 ESBLS-producing strains with the positive rate being 19.67 %. Five ESBLS-producing strains were detected in Pseudomonas maltophilla. One ESBLS-producing strains was detected in Pseudomonas aeruginose，Enteric aerogenes and Citrobacter，respectively. The optimal substrates of double-paper synergy test were cefotaxime，aztreonam and cefepime，and the interspace was 25 mm. This method was still a simple，economical and appropriate method in the detection of ESBLS-producing isolates.

The complications of extracorporeal membrane oxygenation ( ECMO ) include technical relevance complications and physical relevance complications. The former mainly includes dysfunction of oxygenation,cannula-related problems,technical relevance hemolysis,blood clots of oxygenator or rest of the circuit. The latter includes hemorrhage and embolism,culture-confirmed infection,renal failure and neurologic complications. One of the most reported complications of ECMO is hemorrhage. It′s important for reducing mortality and improving prognosis through stricting with the indications of ECMO,strengthening team cooper-ation,closely clinical monitoring and early identifying complications. In this paper,we introduced complica-tions of ECMO as well as how to prevent and treat it.

OBJECTIVE:To provide reference for structure adjustment of medical industry. METHODS:The existing problems of medical industrial structure and urgency of structure adjustment were analyzed by retrieving related literatures and society survey. Based on the scientific outlook on development,the principle and points to which should be paid attention were put forward and suggestion was also given. RESULTS & CONCLUSIONS:It is necessary to adjust medical industrial structure. The measures should be conducted such as improving concentration ratio of medical remarket,optimizing industrial policy,accelerating merge and recombination of enterprises and promoting the growth of concentrated enterprises.

Malnutrition occurs as a result of inadequate nutrient intake,malabsorption and altered me-tabolism in pediatric liver failure. Malnutrition may be associated with a poor outcome. The current evidence indicates that the provision of adjunctive nutritional support ( parenteral nutrition or enteral nutrition or nutri-tional supplements) to patients with a variety of liver diseases. It may be reasonable to start enteral nutrition in 5 to 7 days in acute liver failure or hepatic coma. According to individualized appropriate nutritional evalu-ation,the metabolic demand,to provide appropriate nutritional support in pediatric liver failure.

Humans ; Medicine, Chinese Traditional ; Translating

Objective:To detect the chlamydia psittaci DNA in patients with ocular adnexal lymphomas,and find out the relationship between chlamydia psittaci infection and ocular adnexal lymphomas.Methods:Tissue samples from 36 patients with ocular adnexal lymphomas were collected,as well as samples from patients with benign lymph disease and patients with eye trauma as controls.Chlamydia psittaci DNA were detected by PCR.Results:The chlamydia psittaci DNA positive rates in patients with ocular adnexal lymphomas,benign lymph diseases and ocular trauma organizations were 47.2%,5.0%,0.0%(?2 = 24.578,P=0.000 1),respectively.The DNA positive rates in patients withⅠ A period were 52.0%,36.4% of Ⅱ A period(?2 =0.749,P=0.387).5,8-year survival rates of all the cases were 90.1%,78.5%,which were the same in Chlamydia psittaci DNA positive group and negative group(?2 = 0.163,P= 0.687).Conclusion:The incidence of ocular adnexal lymphomas may be related with Chlamydia psittaci infection.But there is no evidence of the relationship with Chlamydia psittaci infection and of the ocular adnexal lymphomas stage and prognosis.

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.