Health Personnel ; psychology ; Humans ; Love ; Rare Diseases ; therapy

Evans syndrome is a rare autoimmune disease.Clinical presentation are the different degrees of bleeding and hemolysis,similar to immune thrombocytopenia and autoimmune hemolytic anemia.The treatments are divided into first-line therapy,second-line therapy and third-line therapy,including corticosteroids,intravenous immunoglobulin; immunosuppressive agents,splenectomy; haemopoietic stem cell transplantation,romiplostim and so on.The treatment of refractory Evans syndrome is difficult.Immunosuppressive agents and haemopoietic stem cell transplantation are effective.This review focuses on recent developments in the treatment of Evans syndrome.

Objective To study the changes of the humoral immune parameters in patients after infusion of irradiated platelets and the correlation with platelet transfusion refractoriness(PTR).Methods 126 patients with malignant blood diseases of transfusion in our hospital by more than twice were randomly divided into observation group and control group by randomized single-blind allocation method.The observation group was treated with transfusion note γ irradiated platelets,and the control group was treated with infusion ordinary way of apheresis platelets.Before and after transfusion,the changes of vivo complement(C3,CA),immune globulin (IgG,IgM,IgA),C-reactive protein (CRP) and circulating immune complexes(CIC) were detected andplatelet transfusion efficiency and the correlation between changes of immune parameters and the occurrence of invalid infusion.Results The infusion of platelets in patients of C3,C4,IgG,IgM and CIC of the control group were significantly higher than the observation group(all P ＜0.05).There was no significant changes in IgA of the two groups,but the CRP had the high trends.The infusion efficiency of the observation group was 87.3％,which was significantly higher than that of the control group(61.9％)(χ2 =8.92,P ＜ 0.05),blood transfusion after the PTR immune parameters in patients with C3,C4,IgG,IgM,CRP,CIC significantly higher than before,the difference was statistically significant(all P ＜0.05).Conclusion The bodyimmune parameters with PTR is closely related to humoral immune parameters,and the infusion of γirradiated platelets alleviate to some extent,further improve clinical infusion effective rate.

Sepsis in premature is a major cause of morbidity and mortality.The definition of neonatal sepsis is complicated by the frequent presence of noninfectious conditions that resemble those of sepsis,especially in very low-birth-weight preterm infants.Although growth of an organism from a sterile site is the gold standard for definitive diagnosis,the positive rate is low.Therefore,assessment of history,risk factors,sepsis screening scores in combination with diagnostic tests are used to identify neonates who are more likely to be infected.Methods studied to prevent infection include improved hand hygiene,early feedings,immune globulin administration,prophylactic antimicrobial administration.It improves prognosis for early diagnosis and antibiotic administration.

Objective To study the relationship between the change of resting electrocardiogram ST-T in chronic stable coronary atherosclerotic heart disease(CAD) and left ventricle enjection fraction(LVEF).To know the significance that the change of ST-T may predict the function of left ventricle.Methods 80 patients with CAD in our c ardaic department were analyzed retrospectively,40 patients with the change of ST-T (positive group) and 40 patients without the change of ST-T(negative group) were analyzed the outcome of LVEF and the extent of coronary lesion.Results The LVEF of positive group was lower than negative group obviously,the comparision between both groups had statistical significance (t =6.125,P =0.000).In the electrocardiogram positive group,the number of the patients who had 2 and more than 2 branches lesion was more than negative group,the comparision between both groups had statistical significance(x2 =9.683,P =0.008).Conclusion The change of ST-T may predict the function of left ventricle of patients with chronic stable coronary atherosclerotic heart disease,the relationship may be connected with the degree of coronary lesion.

Objective To investigate the clinical significance of the serum levels of sICAM-1,ET,MCP-1 and APN in patients with acute cerebral infarction(ACI).Methods 120 patients with ACI were selected and divided into different groups according to the size of infarction and clinical neurologic impairment degree score.The serum levels of sICAM-1,ET,MCP-1 and APN were detected by enzyme-linked immunosorbent assay.A healthy control group which approximately matched the experimental group included 30 persons.Results The serum sICAM-1,ET and MCP-1 levels in the patients with ACI were significantly higher than those in the healthy groups (all P ＜ 0.05).The serum levels of sICAM-1,ET and MCP-1 were increased steply with the volume of infarction and the clinical neurologic impairment degree score,the differences between the groups was significant (all P ＜ 0.05).The serum APN levels.In the patients with ACI were significantly lower than that in the healthy groups (P ＜ 0.05).The serum levels of APN were decreased steply with the volume of infarction and the clinical neurologic impairment degree score,the differences between the groups were significant (all P ＜ 0.05).Conclusion The sICAM-1,ET,MCP-1 and APN may play an important role in the pathogenesis of ACI.The serum levels of sICAM-1,ET,MCP-1 and APN are closely correlated with the clinical neurologic impairment degree score and the volume of infarction,which may be of great value in predicting acute cerebral infarction and the severity of cerebral infarction.

Recombinant human growth hormone (rhGH) has been widely used in clinical treatment of growth hormone deficiency(GHD),and has achieved satisfactory effect.Growth hormone (GH) can stimulate liver cells to produce insulin-like growth actor(IGF-1) which mediated GH growth promoting effect.The majority of IGF-1 combine with insulin like growth factor binding protein 3.IGF-I promotes cell mitotic and inhibit cell apoptosis,in recent years,some scholars have reported that there is a certain relationship between IGF-1 and tumor occurrence and development,and thus leading to the attention to the efficacy and safety of rhGH treatment.

Objective To investigate the correlation of fasting plasma glucose (FPG) in early period of pregnancy and abnormal glucose metabolism during gestation period.Methods Two hundred and seventy-seven women with single pregnancy and non-propregnant diabetes mellitus were selected.FPG,fasting insulin,insulin resistance index were detected in early period of pregnancy ( ＜19 weeks).One hundred g oral glucose tolerant test (OGTT) was taken during 24-36 weeks.According to OGTT,patients were divided into gestational impaired glucose tolerance (GIGT) group (24 cases),gestational diabetes mellitus(GDM) group(23 cases),OGTT 1 h higher blood glucose (HG-1) group (26 cases) and normal group (204 cases).Results FPG,fasting insulin and insulin resistance index of GDM group and HG-1 group were obviously higher than those of normal group [( 4.58 ± 0.36 ),( 4.58 ± 0.38) mmol/L vs.( 4.20 ±0.33) mmol/L,(9.4 ± 1.1),(9.3 ±2.1) U/L vs.(7.0 ± 2.1) U/L,2.0 ± 0.4,2.0 ± 0.3 vs.1.3 ± 0.4,P＜ 0.05].FPG of GIGT group [(4.45 ±0.36) mmol/L] was higher than that of normal group (P ＜0.05).After controlled age,body mass index,family history of type-2 diabetes mellitus and sport exercises,the relative risk degree of blood glucose metabolism had correlation with FPG,fasting insulin and insulin resistance index in early period of pregnancy (P ＜ 0.05).Conclusion FPG,fasting insulin and insulin resistance index in early period of pregnancy can predict abnormal glucose metabolism.

BACKGROUND:About 50% patients with coronary heart disease have no symptoms of cardiac disease before the first onset of myocardial infarction. Therefore, it is of great importance to make early and accurate detection of coronary heart disease and myocardial ischemia.OBJECTIVE: To measure the time of heart repolarization with magnetocardiography and probe into the role of non-invasive magnetocardiographic examination in evaluating cardiac function in patients with coronary heart disease.DESIGN: Case-control observation.SETTING: Department of Cardiology of Philippustift Hospital, Essen,GermanyPARTICIPANTS: Totally 52 patients hospitalized for suspected coronary heart disease in the Department of Cardiology of Philippustift Hospital(Essen, Germany) between March 1998 and December 2002 were recruited,and another 10 patients diagnosed as old myocardial infarction were set as myocardial infarction group. Informed consents were obtained from the patients. Totally 32 healthy volunteers aged above 40 years old were recruited as the control group.METHODS: All the patients received the following examinations: physical and laboratory examinations, rest and stress electrocardiography(ECG), echocardiography, coronary artery angiography and magnetocardiography(MCG) examination. The control group received only rest ECG and MCG examination. The values of QT dispersion with ECG and MCG were compared between the patients and healthy controls. The diagnostic criteria for coronary heart disease: stenosis of one coronary artery ≥ 75% according to coronary artery angiography; index of repolarization time of the heart was measured with MCG QT dispersion and MCG dispersion coincidence (the mean of probe signal and QT dispersion of peripheral probe in each MCG).MAIN OUTCOME MEASURES: ECG QT dispersion, MCG QT dispersion as well as coincidence index of QT dispersion of the observed subjects in each group.RESULTS: The 52 patients with suspected coronary heart disease,10 with myocardial infarction, and 32 healthy controls all entered the result analysis. The patients with suspected coronary disease were divided into 2 groups: group with coronary heart disease (n=27) and group without coronary heart disease (n=25). [1] Comparison of ECG QT dispersion: there was no significant difference among the groups(P ＞ 0.05). [2] Comparison of MCG QT dispersion: MCG QT dispersion in myocardial infarction group was significantly higher than that in control group [81.3±21.5, 52.4±13.6 (F=13.113, P ＜ 0.05)]. [3]Comparison of coincidence index of QT dispersion: Coincidence index of QT dispersion in myocardial infarction group and coronary heart disease group was both significantly higher than that in control group [15.6±4.2, 14.9±4.1, 10.2±2.7 (F=2.403, 3.332, P ＜ 0.01)].CONCLUSION: Compared with ECG, MCG can better reflect changes in the repolarization process of patients with coronary heart disease,and coincidence index of dispersion is superior to QT dispersion. This is because MCG is more sensitive to tangential currents presented at the precardial region when myocardial ischemia and infarction occur.

Objective To observe the effect of gastroscopy injection of norepinephrine combined with routine triple therapy on peptic ulcer with gastrointestinal bleeding. Methods 84 cases of gastroscopy upper gastrointestinal bleeding caused by peptic ulcer patients were randomly divided into two groups, the control group 42 cases;the observation group 42 cases, the observation group was guven endoscopic injection of norepinephrine combined conventional triple therapy,the control group was given conventional triple therapy with hemostatic therapy. Efficiency and adverse reactions were observed in patients. Results In the observation group,36 csses was significantly effective,5 cases was effective,1 case was not effective,the total effective rate was 97.6%. In the control group,21 cases was significantly effective, 16 cases was effective ,5 cases was not effective,the total effective rate was 88. 1% ,the difference of the total effective rate between the two groups was significant( x2 =5. 137, P ＜ 0. 05 ). There was no serious adverse reactions in the two groups. Conclusion Endoscopic injection of norepinephrine and routine triple therapy in treatment of gastrointestinal hemorrhage of peptic ulcer was significantly better than conventional medical treatment alone.