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.

Humans ; Medicine, Chinese Traditional ; Translating

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.

Objective:To explore the biological effect of maspin on VEGF(vascular endothelial growth factor,VEGF)in hepatocarcinoma cell MHCC-97 and discuss its significance.Methods:Maspin/pEFIRES-N expressing plasmid was constructed .The changes of maspin and VEGF in the levels of mRNA and protein in hepatocarcinoma cell MHCC-97 before and after the transfection and recombination were detected by RT-PCR and Western blotting.Results:The maspin/pEFIRES-N plasmid was constructed successfully,and was stably transferred into MHCC-97 cell.The expressions of maspin mRNA and protein increased in hepatocarcinoma cell MHCC-97 after the transfection of maspin/pEFIRES-N plasmid,while the expressions of VEGF mRNA and protein decreased ,as compared with those after the transfection of pEFIRES-N plasmid(P

Objective:To assess the clinical efficacy of the ventilator treatment of non-invasive mechanical ventilation in the elderly patients with chronic obstructive pulmonary disease(COPD) with respiratory failure.Methods:Collected 61 cases from elderly COPD patients with respiratory failure in our hospital,A total of 24 cases for using ventilator-non-invasive mechanical ventilation was the treatment group,A total of 37 cases for not use was the control group,The two groups were similar to medical treatment,Treatment group to the ventilator treatment of non-invasivemechanical ventilation.Results:The outcome of ventilator-non-invasive mechanical ventilation group,20 cases of good tolerance,Only two cases can not be tolerated.After the treatment arterial partial pressure of oxygen(PaO2) and carbon dioxide partial pressure(PaCO2) significantly improved than that before treatment(P0.05);the ventilator-barotrauma or the ventilator-associated pneumonia did not occur.Conclusion:The nasal(facial) mask respirator non-invasive mechanical ventilation is a safety and effective method to treatment of the elderly COPD patients with respiratory failure.

AIM: To explore the appearent partition coefficient of flavonoids from Hawthorn leaf in phospholids complex. METHODS: With the aid of the shake-flask method,The contents of rhamnosylvitexin,rutin and quercetin were determined by HPLC and apparent partition coefficient in the system of n-octyl alcohol and water of each ingredient in the physical mixture of Hawthorn leaf flavonoids and phospholipids,Hawthorn leaf flavonoids and its phospholipids complex were calculated respectively. RESULTS: Apparent partition coefficient of rhamnosylvitexin and rutin and quercetin in phospholipids complex were enhanced comparing with both in Hawthorn leaf flavonoids and the physical mixture of Hawthorn leaf flavonoids and phospholipids. CONCLUSION: Phospholipid complex may be an effective carrier to elevate the oral bioavailability of total flavonoids from effective fraction of Hawthorn leaf.

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 evaluate alteration of sexual function and defecation after hysterectomy with two different operation techniques. Methods: Total hysterectomy was performed in 31 patients(groupA) ,and inlrafascial hysterectomy was carried out in 31 patients. Alterations of sexual function and defecation after operation were investigated by using a questionnaire. Results : The incidence of anxiety and depression during intercourse was 50. 8% ; 45% of patients complained of decreased libido and decreased quality of coitus. There existed no signficant difference between group Aand B. The defecation habit was altered in 45% of cases. The incidence in group A was higher than in group B. Conclusion :The hysterectomy led to alteration of sexual function . It was necessary to give guidance of sexual surgery technique and intrafascial hysterectomy was a better choice.

Objective:To investigate the abnormity of arterioles in gallbladder and its relation with gallbladder hypomotility in patients with gallstone and diabetes mellitus.Methods:30 patients with simple gallstone and 30 patients with gallstone accompanied with diabetes mellitus were analyzed.Their gallbladder emptying function was measured with B ultrasound before operation.After operation,the arterioles of gallbladder rinsed with PAS reagent in photos were analyzed in tubular area and stereo system with BEIHANG CM-2000B biological and medical photo system.Results:The gallbladder volumes of fasting(V 0),two hours after eating(V 2) increased (59.3?0.6 vs 37.9?5.4,44.7?6.6 vs 14.3?4.9 respectively),whilethe ejective volume of bile(EV) and the ejective rate of gallbladder two hours after eating[GBEF 2 (%)] decreased in patients with diabetes mellitus(14.5?7.1 vs 23.4?9.3,24.9?12.7 vs 61.5?8.5,respectively).In patients with gallstone and diabetes mellitus,the area ratio of arterioles wall to whole arterioles in cross section was significantly higher than in the patients with simple gallstone(0.81 ?0.09 vs 0.58?0.15, P 0.05).Conclusion:The emptying function is significantly impaired in patients with gallstone and diabetes mellitus.The sedimentation of PAS positive material in the wall of arterioles lead to the stenosis of arterioles,and it is probably the cause for gallbladder hypomotility.

[Objective]To summarize febrile disease syndrome and treatment characteristics in“Common Treatise of Febrile Diseases”of Yu Genchu, add new meanings to the research of the doctrine of febrile disease. [Methods] Through col ating febrile disease contents in“Common Treatise of Febrile Diseases”to analyse and discuss. [Results] The name of febrile disease appears rarely in“Common Treatise of Febrile Diseases”,but the contents of the book contain febrile disease,such as febrile disease diagnosis,treatment and aftercare. [Conclusion]The name of “typhoid fever”is throughout the whole book,but as a scholar of younger age,we should know it is generalized “typhoid fever”, which is the name of seasonal exogenous disease.The book explains the original idea of Zhongjing and integrates with the theories of the doctors of febrile diseases, reflecting Yu Genchu ’s academic idea of cold-warm combination and initiating the research of Shao Pai Shang Han.