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 study the protein expression of maspin in the HCC and its correlation with AFP,and to discuss its clincal significance.Methods:the protein expressions of maspin and AFP in the normal liver tissue(NT),paratumor tissue(PT)and liver tumor tissue(TT)were detected with immunohistoch-emistry and their area densities were measured.A total of30 patients with HCC and 30 patients without HCC in our Department of Hepatobiliary Surgery were as samples from March,2004 to December,2005.Results:(1)The area densities(AD)of maspin protein in the NT,PT and TT were 20 712.48?1 826.28,7 347.40?441.16,85.68?19.81 respectively,but the area densities of AFP protein were 66.00?10.70,7 005.04?335.69,13 094.00?516.32 respectively;the comparion of two was P

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 construct the expression vector maspin /Pcr2.1 in order to provide the evidence for the inhibitory effect of maspin gene on growth,metastasis and invasion of hepatocellular carcinoma(HCC) and to discuss its mechnism.Methods:The full length of maspin gene was cloned,and the expression vector PCR2.1 was digested by Hind111/XbaI,then the maspin gene and the PCR2.1 vector were ligated with T4 DNA ligase to be recombinant vector.The recombinant vector maspin/PCR2.1 was transfected into humman hcc MHCC-97 cell line,and the expressive changes of maspin gene were detected.Results:The recombinant plasmid was amplified in the E.coli.JM109.After the identification of redigesting by HindIII/XbaI and sequencing,the reconstructive plasmid was confirmed to contain the correct and full nucleotide sequence of maspin gene,and the mRNA and protein level of maspin gene were up-regulated in hcc MHCC-97 cell.Conclusion:The expression vector maspin/PCR2.1 is constructed successfully and can be expressed in eukaryotic cells.

In view of the increased incidences of cardiac arrest outside hospital year by year and younger tendency of the patients,foreign medical education practice showed that school-age children accepting cardiopulmonary resuscitation (CPR) skill training will benefit most from this survival skill in the future.This article elaborated on the meaning and methods of promoting CPR training in primary and middle school based on the present situation of CPR in order to promote its further development.

Objective To study metabolism of glucose and lipidin patients with hyperandrogenism and analyze the risk of their cardiovascular disease.Methods Object of study:firstly,choosed 118 cases of women of reproductive age from April 2013 to July 2014.Then detected their serum Testosterone (T),Estradiol (E2),fasting plasma Glucose (FPG),fasting plasma insu-lin (FINS),triglycerides (TG),total cholesterol (TC),high-density lipoprotein cholesterol (HDL-C),low-density lipopro-tein cholesterol (LDL-C),lipoprotein (a),body mass index (BMI).Finally,divided them into different groups and analyzed the results using SOSS19.0 software and two independent samples t-test statistical method.Results BMI,T,FPG,HOMA-IR and TG were significantly more higher (P <0.05)in the group of hyperandr-ogenism than in the group of normal con-trol.However,E2,TC,HDL-C,LDL-C and LP(a)had no significant difference (P >0.05)in statistics between the group of hyperandrogenism and the group of normal control.Hyperandr-ogenism group was divided into PCOS group and non-PCOS group according to etiology.In those two groups,BMI,T,E2,FPG,HOMA-IR,TG,TC,HDL-C,LDL-C and LP(a)had no significant difference in statistics (P >0.05).According to the definition of obesity adults in china,78 patients with hyperan-drogenism were divided into 2 group,one with BMI normal (BMI<24 kg/m2 )and the other group with overweight and obe-sity (BMI≥24 kg/m2 ).In group with overweight and obesity,BMI,T,FPG,HOMA-IR,TG,TC,LDL-C and LP (a)were significantly higher than the group with BMI normal (P <0.05),moreover,HDL-C was significantly lower than the group normal (P <0.05).E2 had no significant difference in statistics between the two groups (P >0.05).Conclusion Investiga-tion of the relation between hyp-erandrogenism and metabolism of glucose and lipid,can not only practically guide life style and drug therapy,but also prevent cardio-vascular disease.

Objective To investigate the clinical effect of flupentixol and melitracen tablets combined with macrogol 4000 powders on treatment of irritable bowel syndrome with constipation (IBS-C) in elderly patients. Methods Fifty paients aged from 65 to 95 years with IBS-C were randomly divided into 2 groups: control group (23 patients) and treatment group (27 patients). The patients in treatment group received flupentixol and melitracen tablets (1 tablets, once a day) combined with macrogol 4000 powders (1 bag/time, 2 times a day) , while the patients in control group received macrogol 4000 powders alone. The treatment period was 4 weeks. The curative effect, the scores of self-rating depression scale (SDS) and self-rating anxiety scale (SAS) and adverse reaction were compared between two groups. Results At the improvement of depressive symptoms, the effective rate in treatment group and control group was 88.9%(24/27) and 39.1%(9/23), and there was significant difference (P<0.01). At the improvement of anxiety symptoms, the effective rate in treatment group and control group was 74.1%(20/27) and 26.1%(6/23), and there was significant difference (P<0.01). The total effective rate in treatment group and control group was 88.9%(24/27) and 65.2%(15/24), and there was significant difference (P<0.05). Conclusions Flupentixol and melitracen tablets combined with macrogol 4000 powders on treatment of aged IBS-C patients have more distinguished therapeutic effect in improving constipation symptoms, stools times, anxiety and depression.

AIM To investigate the effects of tetracycline on the expression of adhesive molecules E selectin and intercellular adhesion molecule 1 (ICAM 1) on human umbilical vein endothelial cells (HUVECs) stimulated by tumor necrosis factor alpha (TNF ?) or lipopolysaccharide (LPS). METHODS HUVECs were activated by TNF ? (0 5～50 ?g?L 1 ) or LPS (0 5～50 mg?L -1 ). Tetracycline (10 -6 ～10 -4 mol?L -1 ) was used to incubate HUVECs for 1 h before stimulation with TNF ? ( 1 ?g?L -1 ) or LPS ( 5 mg?L -1 ) and co incubate HUVECs with TNF ? or LPS for 4 h or 18 h. The expression of adhesive molecules on HUVECs was measured by a cellular enzyme linked immunoabsorbent assay (Cell ELISA) method. RESULTS After stimulation of HUVECs with TNF ? or LPS for 4 h induced E selectin expression, and exposure HUVECs to TNF ? or LPS for 18 h increased constitutive expression of ICAM 1 compared with control group ( P

Objective To evaluate the accuracy of the soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and lipopolysaccharide binding protein (LBP) as diagnostic indices for neonatal serious bacterial infections (SBI). Methods A total of 171 newborns were enrolled in the study, and were classiifed into SBI group (including early-onset and late-onset), non-SBI group according to clinical manifestations, laboratory examinations and the time of disease onset. Serum sTREM-1, LBP and C-reactive protein (CRP) levels were measured. Receiver operator characteristic curve (ROC) was drawn, and the area under curve (AUC) was calculated. Each index was evaluated for the diagnostic value of neonatal SBI. Results The sTREM-1 and LBP levels were signiifcantly higher in SBI group than those in non-SBI group (P=0.000). The AUC of ROC for sTREM-1, LBP and CRP in early-onset SBI was 0.888, 0.839 and 0.706, respectively. The AUC of ROC for sTREM-1, LBP and CRP in late-onset SBI was 0.860, 0.865 and 0.705, respectively. Conclusions Both sTREM-1 and LBP are useful for the diag-nosis of neonatal SBI.

BACKGROUND:The appropriate choice of orthoses based on hemiplegic patient’s condition can improve motor function recovery in stroke patients.
OBJECTIVE:To review the motor function recovery of stroke patients with hemiplegia wearing different types of orthoses.
METHODS:Application of different types of orthoses in hemiplegic patients was reviewed through access to literature, as wel as effects of a variety of orthoses on the recovery of motor functions in hemiplegic patients.
RESULTS AND CONCLUSION:Orthoses can reduce limb muscle tension and muscle spasms, and improve motor function and overal daily living skil s in stroke patients with hemiplegia, which play a variety of roles, including stable support, fixed protection, correction of deformity and functional compensation. However, the long-term therapeutic effect of orthoses cannot be verified because of fewer cases, shorter time for therapeutic observation, and the lack of long-term fol ow-up. It is necessary to perform long-term fol ow-up for the verification of long-term efficacy of orthoses. Meanwhile, the appropriate timing for removal of orthoses needs further study.