In autoimmune thrombocytopenic purpura (AITP) specific autoantibodies bind platelet GP via their Fab fragments. Both splenic CD5+ B and CD5- B cells produce platelet glycoprotein-specific antibodies. There is limited number of antigenic determinants, and the GP-specific autoantibodies are derived from a restricted number of B-cell clones in chronic AITP. Blocking co-stimulatory signals could induce platelet-specific T cell anergy. MMF could be used as a second line agent for the treatment of steroid-resistant AITP. Detection of plasma thrombopoietin levels play an important role in the differentiation of thrombocytopenic states caused by platelet destruction or due to bone marrow hypoplasia. Endogenous TPO level is also important on the differential diagnosis of ET and RT. Quinine- or heparin-dependent antibodies could induce thrombocytopenia. PCR-SSP is useful for the genotyping of the platelet-specific alloantigen HPA. Biotinylated platelets have an impaired response to agonists as evidenced by in vitro platelet aggregation tests.
Antigens, Human Platelet ; immunology ; Blood Platelets ; immunology ; Heparin ; adverse effects ; Humans ; Platelet Membrane Glycoproteins ; immunology ; Purpura, Thrombocytopenic, Idiopathic ; etiology ; immunology ; Thrombopoietin ; blood

Adult ; Humans ; Purpura, Thrombocytopenic, Idiopathic ; diagnosis ; therapy

Objective To evaluate the value of proton magnetic resonance spectroscopy(~1H-MRS))and diffusion tensor imaging(DTI)in minimal hepatic encephalopathy(MHE).Methods Twenty-nine with cirrhosis(15 cases with MHE diagnosed according to number-connection test A and digital symbol test and 14 age-matched controls underwent ~1H-MRS and DTI examinations.~1H-MRS of left basal ganglia were acquired using STEAM sequences.Peak area of each metabolite,including NAA,Cr,Cho,mIns and Glx and their ratios to Cr were measured,respectively.Fractional anisotropy(FA),mean diffusivity(MD)were calculated in deep gray matter nuclei and mainly white matter regions in both cerebral hemispheres.The MD and FA values from different regions in different groups were compared.Results NAA/Cr and Glx/Cr levels showed no significant difference among the groups(P＞0.05).Ratios of mIns/Cr and Cho/Cr showed no differences in MHE group compared to controls(P＞0.05),whereas were significantly different in MHE and cirrhosis without MHE(P＜0.05).The MD values from different regions had a significant difference among various groups(P＜0.05),and there were no significant changes in FA among the groups(P＞0.05).Significantly increased MD was found in five regions of brain in MHE and only caudate nuclei in cirrhosis without MHE compared to controls.Conclusion Patients with MHE have abnormal metabolite changes in basal ganglia;the increase in MD with no concomitant changes in FA in cirrhosis with MHE that indicates the presence of reversible interstitial brain edema.MRS and DTI may be sensitive tests for detecting MHE.

BACKGROUND:Animal models can be used to study specific scientific problems of intervertebral disc biology.Model of disc degeneration is mainly used to resolve the relevant disease mechanisms and scientific and security issues of the treatment.OBJECTIVE:To summarize currently used experimental animal models of intervertebral disc degeneration study,and to dynamically observe and confirm the pathological process of disc degeneration based on disc imaging,morphology,biomechanics and bi(o)chemicel changes.METHODS:Using "intervertebral disc degeneration,animal models,in vivo,in vitro" in English as the search words,Cochrane Library (No.1 2009),Cochrane Library Database of Controlled Clinical Trials (No.1 2009),MEDLINE from 1990 to March 2009,EMbase from 1990 to March 2009,Current Controlled Trials,and the National Research Register were retrieved.Literature was limited to English language.The disc imaging,morphology,biomechanical end biochemical composition and other indicators,as well as the pathological process of disc degeneration served as the evaluation indices.The articles related to the intervertebral disc cell culture models,the whole disc tissue culture model,mechanical model,injury model,biological model,genetically modified models,spontaneous models were included.The repetitive researches and those unrelated to animal models of intervertebral disc degeneration were excluded.RESULTS AND CONCLUSION:The establishment of a reliable animal model can provide favorable conditions for studying the pathogenesis of intervertebral disc degeneration,at the same time,provides a good experimental vehicle for various researches about the repair treatment of intervertebral disc degeneration.Animal models of intervertebral disc degeneration can be divided into two categories:in vitro models and in vivo models of disc degeneration and repair.The former can be assigned into disc cell culture models and whole disc tissue culture model;the latter is assigned into mechanical models,injury models,biological models,genetically modified models,spontaneous models and so on.The above models are commonly used in the study of the occurring mechanism of disc degeneration,as well as the feasibility and effectiveness of a variety of treatments.However,there is still no generally accepted animal models as an ideal disc degeneration model,various types of models reported have their own advantages and disadvantages.

Objective To analyse the treatment,clinical features and prognosis of chronic lymphocytic thyroiditis combined with thyroid cancer.Methods Retrospectively analysed 40 cases with chronic lymphocytic thyroiditis combined with thyroid cancer,admitted to the Department of General Surgery of the First Affiliated Hospital of Dalian Medical University from November 2002 to April 2011.All the 40 patients were female.Results Ultrasound diagnosis or suspected diagnosis of chronic lymphocytic thyroiditis was made in 2 patients.Eleven patients underwent CT examination,and 2 patients were found with thyroid adenoma,1 patient found with thyroid cancer and lymph node metastasis,3 patients with chronic lymphocytic thyroiditis.Forty patients underwent surgical treatment,pathological results of 39 patients showed chronic lymphocytic thyroiditis with thyroid papillary carcinoma,1 patient was medullary thyroid carcinoma combined with chronic lymphocytic thyroiditis.Forty patients were administrated levothyroxine tablets.Thirty-six patients were followed up,4 patients were lost,1 relapsed,the others were in stable condition.Conclusions Preoperative diagnosis is difficult for chronic lymphocytic thyoiditis combined with thyroid cancer,which needs through the thyroid antibody tests,imaging examinations and intraoperative,postoperative pathologic examination and other means of comprehensive application.The method of definitive diagnosis for CLT combined with TC is intraoperative,postoperative pathologic diagnosis.The main pathological type is papillary thyroid carcinoma,which small papillary carcinoma occupies a large proportion.Surgery is the main treatment for CLT combined with TC.

Mitochondrial aldehyde dehydrogenase(ALDH2),one of the isoforms of aldehyde dehydrogenase,has multiple enzymatic functions including the activity of dehydrogenase and esterase.The metabolisms of ethanol,amino acids,biogenic amine,vitamin or steroid in the body produce various substances of aldehyde.With the help of co-factor NAD(P)+,ALDH2 can convert aldehydes into corresponding carboxylic acid,which plays a key role in reducing toxic effects of aldehydes on the body.It does not need co-factor when ALDH2 works as esterase.It can convert carboxylic ester or other acids into corresponding carboxylic acids or alcohols.Recently,it has been shown that the decrease of ALDH2 activity exacerbates multiple factors(such as ethanol,ischemia)-induced myocardial injury and accelerates the development of nitroglycerin tolerance.Therefore,the development of specific agonists of ALDH2 may provide a novel approach to the therapy and prevention of heart diseases.

Concepts and techniques of spinal fusion as a therapeutic modality may date back to the origins of spinal surgery. Spinal fusion has been considered as the standard treatment of progressive deformities,including instability,scoliosis and trauma. In this study,we shall attempt to define and review the bone graft materials,progress on the operative techniques,postoperative complications and related therapy,the latest dynamic fixation,and minimally invasive technique to lumbar spine fusion.

Objective To investigate the clinical efficacy and safety of alteplase thrombolysis in the treatment of patients with acute ischemic stroke.Methods 42 patients with acute ischemic stroke were randomly divided into the control group and the study group.1 8 cases in the control group were treated by urokinase thrombolysis, and 24 cases in the study group were treated by alteplase thrombolysis.The clinical efficacy and safety were compared between the two groups.Results The total effective rate of the study group(91 .7%)was higher than that of the con-trol group(77.8%),and the difference was statistically significant(χ2 =9.7,P <0.01 ).Compared with the control group,the total vascular patency rate was higher,the difference was statistically significant(χ2 =97.6,P <0.01 ).The NIHSS score was lower in the two groups after treatment(t =1 0.1 58,1 5.962,all P <0.05),and that in the study group was more lower,the difference between the two groups was statistically significant(t =1 0.564,P <0.05 ). Conclusion Alteplase thrombolysis in the treatment of acute ischemic stroke patients,thrombolytic therapy for patients,in the use of drugs within the time window patients can get good clinical curative effect,no more than drug use the most extensive restrictions rarely cause patients with intracranial hemorrhage,and being suitable for populari-zation and application.

The level of clinical practice skills in medical students is one of the most important markers to evaluate themedical educational quality. We have designed a new integrative assessing scheme which chiefly evaluates the practicalskills, that is: clinical skills account for 50%, oral test of professional knowledge accounts for 20% ,case analysis 20%,medical history writing 5%, and medical ethics and work discipline 5%. Through the nearly two years' implement,theproject greatly accelerates the cultivation of clinical practice abilities in medical students, enormously promotes thestudents' initiative and consciousness in clinical practice training, and roundly improves the teaching quality of clinicalpractice.