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.

Medical students participating in chnieal medical early is one of the good ways to cultivate students'all-around qualities From freshman year medical students begin to enter chnical medical service system and make clinical practice in spare time,They are also trained to link theory with practice to caltivate clinical thinking ability,strengthen its humanistic care idea and doctor-patient communication ability so that medical students will know the sacred profession of being adatov and from the idea of sewing patients work of the sacred doctor,set up'professional service to patients'concept.

Objective To evaluate the effect of intraoperative mechanical ventilation on alveolar gas exchange in patients with type 2 diabetes mellitus.Methods Thirty ASA Ⅰor Ⅱpatients with type 2 diabetes mellitus aged 46-64 yr weighing 47-78 kg undergoing total gastrectomy under general anesthesia were divided into 2groups according to preoperative glycolated hemoglobin level(HbA1c)(n=15 each):group B HbA1c/Hb=6.6%-10.4%and group C HbA1c/Hb＞10.4%.Another 15 non-diabetic patients with comparable demographic data were included in this study as control group(group A).Radial artery and right internal jugular vein were cannulated.The patients were intubated after induction of anesthesia and mechanically ventilated(VT 8 ml/kg,RR 12-lected from artery before induction of anesthesia(To,baseline)and at 30,60,90 and 120 min of mechanical ventilation(T1-4)for blood gas analysis and determination of plasma SOD activity and MDA,'TNF-α,IL-6,IL-10 concentrations.PA-aDO2 was calculated.Results PA-aDO2 was significantly increased during mechanical ventilation at T1-4 as compared with the baseline at T0 in diabetic patients and were significantly higher than in non-diabetic patients.The plasma SOD activity was significantly decreased at T1-4 as compared with the baseline at T0 in diabetic patients and was significantly lower than in non-diabetic patients.While the plasma MDA,TNF-α,IL-6 and IL-10concentrations were significantly increased at T1-4 compared with the baseline at T0 in diabetic patients and were significantly higher than in non-diabetic patients.The PA-aDO2,plasma MDA,TNF-α,IL-6 and IL-10 concentrations were significantly higher and plasma SOD activity lower in gorup C than in group B.Conclusion Intraoperative mechanical ventilation can decrease alveolar gas exchange by inducing inflammatory response in patients with type 2 diabetes mellitus.The changes are correlated with severity of diabetes.

The transport of critical neonates has a high mortality. To reduce the mortality, it is very important to determine the transport indications in advance. Additionally, the neonatal transport is also based on the industrial training, the transport team combined by a variety of profession, the uniform and standard transport equipment and so on. Therefore, this article mainly reviews the education training, team, equipment, indications, the latest skill, air transport and so on.

The virus of hand, foot and mouth disease(HFMD) damages nerve system.Brainstem is the main site and has some specific receptors.Severe HFMD has a high mortality.The main causes of death are cardiopulmonary and brain failure, so it is very important that risk factors of severe HFMD are timely judged and treated. Pulmonary edema of severe HFMD is mainly caused by neurological damage. At present, although it has still no standardized treatment scheme, the diagnosis and treatment for different stages have a significant effect.

Eight new diaryltriazine derivatives containing 4-allylamino and 4-azido substitutes guided by molecular docking have been designed and synthesized based on our previous work.The evaluation of HIV inhibitory activity demonstrated that all compounds were potent against HIV-1 replication.The most active compound 7c exhibited activity against HIV-1 (IC50=0.034 μmol·L-1,SI=6475)and the double mutant strain (IC50=9.39 μmol·L-1)in the micromolar range, which was more potent than nevirapine.

The optimal condition of double-paper synergy test in the detection of bacteria producing extended-spectrum β-lactamase (ESBLS) was studied. In 244 isolates of Enteric bacilli，Klebsiella pneumonia，Enteric cloacae，there were 49 ESBLS-producing strains with the positive rate being 19.67 %. Five ESBLS-producing strains were detected in Pseudomonas maltophilla. One ESBLS-producing strains was detected in Pseudomonas aeruginose，Enteric aerogenes and Citrobacter，respectively. The optimal substrates of double-paper synergy test were cefotaxime，aztreonam and cefepime，and the interspace was 25 mm. This method was still a simple，economical and appropriate method in the detection of ESBLS-producing isolates.

Intrauterine growth restriction is a common perinatal complication of major harm to the fetus. In recent years, immunological mechanism has been found in the pathogenesis of intrauterine growth restricition. Abnormal immune mechanism may be the developmental programming of ways to affect the fetal immune function, as well as extrauterine.

Multiple myeloma (MM) is a heterogeneous disease with certain cytogenetic abnormalities [1q21 gains,t(4;14),del 17p] associated with worse outcome.The extensive use of thalidomide,lenalidomide and bortezomib has dramatically improved the outcome for patients with MM and some cytogenetic abnormalities.It is also widely proved that bortezomib can partly overcome the harmful affects of t (4;14).However,till now,there are many controversies about the effects of some novel agents worked on certain cytogenetic abnormalities.In this review,the effects of novel agents in cytogenetic abnormalities were summaried to provide new information on clinical treatment of this disease.

Myeloproliferative neoplasms (MPN) are a group of diseases with malignant cloning in hematopoietic stem / progenitor cells. The main clinical feature is excessive proliferation of one or more lineage of myeloid cells, which cause increasing count of erythrocytes, granulocytes and platelets in peripheral blood.Arterio-venous thrombosis and complications are responsible for the mortality of MPN. Low molecular weight heparin (LMWH) is a kind of anticoagulant that commonly used for its safety and validity. It can improve the hyperviscosity of blood , affect platelets, and interact with leukocytes and endothelial cells, by which can reduce cells aggregation. LMWH can effectively play an active role of anticoagulant in high-platelet plasma. All of these provides a theoretical basis to its availability in MPN.