Objective To explore continuous renal replacement therapy(CRRT) machine for plasma exchange in critical disease in children.Methods Retrospective study of 8 patients(8 month to 14 years,mean 5.7 years) and 32 plasma exchange treatments,after(adowble) lumen catheter inserted into the subclayian venous,using the Baxter BM25 machine with commercially available plasma filters.Results Five patients(3 ABO-incompatibility in bone marrow transplantation,1 thrombotic thrombocytopaenic purpura TTP,1 sepsis) gained full recovery.One systemic lupus erythematosus(SLE) and 1 sepsis experienced moderate improvement while 1 case of acute disseminated encephalomyelitis failed PE treatment.The average total exchange volume was 80-100 mL/kg,achieved at a blood flow rate of 5-10 mL/(kg?min) and a turnover rate of 60-120 mL/(kg?h) over a 3-hours duration.Thirty-one PE treatments were finished smoothly,one of which experienced the serious complication involving plasma filter.Conclusion Plasma exchange therapy is a safe and effective procedure for severe autoimmune abnormalities and pathogen removal in children.

Adult ; Choanal Atresia ; etiology ; therapy ; Constriction, Pathologic ; etiology ; Humans ; Male ; Nasopharyngeal Diseases ; etiology ; therapy ; Otorhinolaryngologic Surgical Procedures ; adverse effects ; Palate ; surgery ; Postoperative Complications ; therapy ; Uvula ; surgery

Objective To explore the effects of peripheral stem cell transplantation on extremely severe bone marrow form of acute radiation sickness.Methods One patient was radiated aecidently with the radiation dosage of 9～15 Gy and diagnosed as extremely severe bone marrow form of acute radiation sickness.Pretreatment was performed at 4th day after the accident and 3 days later,HLA- matched allogeneic stem cell transplantation on the patient was performed.Graft versus host disease (GVHD) was prevented with cyclosporin A (CsA) and mycophenolate mofetil (MMF).Results The haematopoiesis was recovered at 9th day after transplantation.At 11th day after transplantation, WBCs were increased to 14.74?10~9/L and returned to the normal levels subsequently,number of platelets risen to 51?10~9/L and hemaglobin was over 80 g/L.TRS-PCR and blood type dynamic detection testified that the donor's cells were stably implanted,the chromosome aberration and micro- nuclei disappeared after transplantation,and the patient's blood type changed into the donor's at 27th day after transplantation.But the radiation injury were still getting worse complicated with multiple infections,At 68th day after transplantation (75 days after the accident),the patient was died of mul- tiple organs failure.Conclusion Extremely severe bone marrow form of ARS can achieve hematopoie- sis recovery by allogeneic stem cell transplantation,but only hematopoiesis recovery can not cure the immunodefficiency and the radiation injury of the whole body.

Objective To explore the regularity and characteristics of violence-related injury. Method Data from the injury surveillance in the Emergency Medicine department of Nan-shan hospital was used in this study. Data of all injured patients, who admitied to the emergency department between 1 January 2004 to 31 November 2005, was analysed. Results During the study period, 25376 injured patients were collected and 12280 (48.4%) were violence-related injury patients. The male to female ratio was 2.4: 1. Most of patients were aged 15～44 years old, accouting for 79.9%. The majority of the violence-related patients were wonters, accounting for 59%, most injuries were open wounds and occurred in working places, injuries occurred most during 13 pm to 18 pm. Conclusions Analysis of data from the violence injury surveillance in emergency department can be an aid for the depiction of the overall severe injury profile in area and, in this way, it will be essential for the implementation of properly preventive and controlling measures, despite some limitation. It is urgent to explore and develop an violence injury surveillance system to cope China's milieu.

Objective To investigate the risk factors for early postoperative cognitive function in the patients with peritoneal surface malignancies after cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy(CRS-HIPEC).Methods Fifty-one patients(21 men and 30 women), ranged from 25 to 65 years,42-80 kg,ASA Ⅰ-Ⅲ,undergoing CRS-HIPEC under combined intrave-nous-inhalational anesthesia,were studied.Patients were assigned into postoperative cognitive dys-function (POCD)group or non-POCD group according to their performances of visual verbal learning test,concept shifting task,letter-digit coding test and stroop color-word test 1 day before operation and 7 days after operation.Years of education,medical history,duration of operation,intraoperative blood loss,frequency of cardiovascular events,amount of fluid infused per hour and VAS scores were recorded.Venous blood samples were taken at five time points:before surgery(T0 ),30 minutes after the beginning of the procedure(T1 ),30 minutes after the beginning of HIPEC(T2 ),at the end of the surgery(T3 )and 24 hours after the surgery(T4 ),to determine the concentration of serum amyloid A (SAA).pH,PaCO 2, Hb,blood glucose were recorded at T0-T2.Then the data was statistically analyzed.Results According to the diagnostic criteria,twenty patients developed POCD 20 (39.2%). There were significant differences between POCD and non-POCD groups on age,gender, pre-operative complications and the origin of tumor(P <0.05).The concentration of SAA increased from T2 and reached the peak at T4 ,and SAA concentration for patients in POCD group was higher than that for patients in non-POCD group(P <0.05).Compared with non-POCD group,the levels of blood glucose were significantly increased in POCD group at T2 (P <0.05).Conclusion CRS-HIPEC resul-ted in exaggerated and prolonged inflammatory response.Advanced age,female,diabetes,hyperten-sion,peritoneal carcinomatosis from ovarian cancer and endometrial cancer are associated with early POCD in the patients undergoing CRS-HIPEC.

Objective To investigate the characteristic immunophenotype of B cell chronic lymphoid leukemia in china. Method Single and multiparameter flow cytometry were used to analysis 163 cases of B cell chronic lymphoid leukemia. Results 71.8%(117/163) of cases co-expressed CD5 and B cell markers. The patients were classified into category of B cell chronic lymphocytic leukemia(B-CLL), hairy cell leukemia(HCL) and other B-cell lymphoproliferative disorders(LPDs) by using the scoring system that was recommended by world health organization (WHO). The B-CLL typically display the composite phenotypes: CD5+,CD23+,CD20+,CD19+,HLA-DR+,but the CD22,CD11c,CD25 and FMC7 were variable present in some B-CLL cases.CD103 seems the most specific marker for HCL.To differentiate diagnosis of atypical B-CLL with B-prolymphocytic leukemia(B-PLL) or mantle cell lymphoma(MCL), one must not rely exclusively on immunophenotypic dates, cytogenetic or molecular biology detection would be helpful. The index of froward scatter( FSC) and antigens expression of tumor B cells could be calculated by dividing the relevant value of residual normal T cell within same sample as internal control, so the cell size and the intensity of antigen expression could be comparable each other and quantitative between different investigations. Conclusion immunophenotypic analysis is an extremely useful adjunct in the diagnosis of chronic lymphoid leukemia.

Objective:A questionnaire for the compliance with moxibustion was designed based on the 4-item Morisky scale, and the reliability and validity of the questionnaire was investigated.Methods:A modified Morisky scale was designed based on the 4-item Morisky scale for the compliance with moxibustion, and 146 patients having received moxibustion for over 2 weeks were investigated using this scale to evaluate their compliance with moxibustion; the internal equity and the construct validity of the scale were statistically analyzed.Results:The analysis of reliability showed that in item of internal consistency, the Cronbach's α was 0.72 and the split-half coefficient was 0.71, the correlation coefficients between the 4 component scores and the total score ranged 0.67-0.80, and the between-component correlation coefficients ranged 0.24-0.56; the exploratory factor analysis (EFA) totally extracted 1 common factor, and the explicable variation was 55.02%, and the loads of the 4 items were respectively 0.82, 0.81, 0.74 and 0.58.Conclusion:The reliability and validity of the modified Morisky scale for the compliance with moxibustion are acceptable, while several items need further modification and improvement in the expression and content.

Objective:To investigate the correlation between polymorphisms of serine hydroxymethyltransferase1 gene and the adverse reactions of high-dose methotrexate (HD-MTX) in children with acute lymphoblastic leukemia (ALL). Methods:A total of 51 patients with ALL were treated with HD-MTX, and clinical manifestations after HD-MTX treatment were evaluated retrospectively. cD-NA was obtained from mRNA. The polymorphisms of SHMT1 gene containing rs1979277, rs3783, rs1979276, and rs12952556 sites were tested by denaturing gradient gel electrophoresis and direct sequencing. Effects of SHMT1 gene polymorphisms on HD-MTX ad-verse reactions were evaluated. Results:Severe adverse reactions in ALL patients treated with HD-MTX appeared to be mainly neutro-penia and hepatoadverse reactions. The frequency distributions of rs3783 (C>G), rs1979276 (C>T), rs12952556 (A>G), and rs1979277 (C>T) were the same. The polymorphisms of rs1979277 showed no correlation with neutropenia (P>0.05) but rs1979277 CT and TT genotypes were correlated with hepatoadverse reactions (CT: OR=0.129, 95% CI: 0.020 to 0.817, P=0.03; TT: OR=0.103, 95% CI:0.017 to 0.620, P=0.013). Conclusion: No correlation was found between the combination of rs1979277, rs3783, rs1979276, rs12952556, and neutropenia, but one or more of these loci may reduce the risk of hepatoadverse reactions.

AIM: To observe the clinical efficacy and safety of vincamine sustained release capsules on non- arteritic anterior ischemic optic neuropathy ( NAION) . · METHODS: Patients who were diagnosed with monocular onset NAION in acute stage from January to September 2015 were divided into two groups. Routine treatment such as steroid pulse therapy and neurotrophic treatment were given to all the patients. Vincamine was added to the treatment group patients with 30mg twice a day for 3mo. The best corrected visual acuity ( BCVA), mean deviation ( MD) of visual field, retinal nerve fiber layer ( RNFL ) , ganglion cell complex ( GCC ) , pattern visual evoked potential ( PVEP ) and OCT results were analyzed before and after the treatment. ·RESULTS:Totally 42 eyes of 42 patients were enrolled in our study. There were 27 patients in the treatment group, aged from 33 to 79 years old, the average value was 55. 55± 11. 83 years old. The control group has 15 patients, aged from 40 to 70 years old, the average value was 55. 71 ± 10. 06 years old. There were no statistical differences between the two groups in the baseline. After 3mo of the treatment, MD value of the two groups were lower compared with the baseline, the difference was statistically significant in the treatment and control group respectively (t= 2. 342, 2. 692; P = 0. 027, 0. 041). The difference of PVEP amplitude and potential of the two groups before and after the treatment were not statistically significant. The thickness of retinal nerve fiber layer and the ganglion cell complex were all lower than the baseline, and the difference was statistically significant (P<0. 001). The treatment of the two groups were both effective, the treatment group has better treatment effect than the control group. Adverse events related to the treatment of vincamine had not been found. ·CONCLUSION:Vincamine is helpful in the treatment of non-arteritic anterior ischemic optic neuropathy.

Objective To observe the effectiveness of dexmedetomidine on postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy.Methods Seventy patients (17 males,53 females,aged 20-65 years,ASA grade Ⅰ or Ⅱ) undergoing laparoscopic cholecystectomy were randomized to receive either dexmedetomidine (group R,n=35) or dexamethasone (group D,n=35).The patients in the group R received 0.5 μg/kg bolus dose and maintenance dose at the rate of 0.5 μg·kg-1·h-1 of dexmedetomidine before intubation.The patients in the group D received 8 mg dexamethasone before intubation.The BP and HR were recorded at the following points: on arrival in the operating room (T1),before intubation (T2),5 minutes after intubation (T3),5 minutes after the beginning of the operation (T4),30 minutes after the beginning of the operation (T5),at the end of operation (T6) and 5 minutes after extubation (T7).The inhaling concentration of sevoflurane,extubation time,operation time and anesthesia time were recorded.The incidence of nausea and vomiting were recorded at 8,24,48 hours after operation.Results The incidence of nausea and vomiting at each point were similar between two groups.The HR at T2-T7 in group D was significantly lower.But MAP was similar between two groups.Conclusion 0.5 μg/kg bolus dose and maintenance dose at the rate of 0.5 μg·kg-1·h-1 of dexmedetomidine reduced the incidence of PONV in patients undergoing laparoscopic cholecystectomy,similar to dexamethasone.