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.

Humans ; Medicine, Chinese Traditional ; Translating

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.

Objective To analyze the surgical treatment choice of hepatolithiasis and its curative effect. Methods The clinical data of 120 patients with hepatolithiasis admitted in our hospital were randomly selected and retrospectively analyzed. 43 cases were undergone cho-ledocholithotomy, 37 cases were given merotomy of live, 31 cases were given hepatic duct plasty and choledochojejunostomy, and 9 cases were performed fiber choledochoscope lithotomy. Results All the 120 cases were followed-up from 1 year to 10 years. The postoperative re-sidual stone rate, good rate, and occurrence rate of complications were respectively:42. 23%, 78. 69%, 9. 23% in group of choledocho-lithotomy;8. 05%, 95. 93%, 18. 09% in group of merotomy of live;13. 33%, 87. 33%, 21. 32% in group of hepatic duct plasty and cho-ledochojejunostomy;31. 98%, 78. 04%, 15. 69% in group of fiber choledochoscope lithotomy. The total residual stone rate was 24. 17%, the total good rate was 85. 83%, and the occurrence rate of complications was 15. 83%. Conclusion Choose the suitable operation method according to medical history of patients is the the key to reduce the residual stone rate and the occurrence rate of complications, thus elevating therapeutic efficacy of hepatolithiasis.

Objective Seek countermeasures against the debt risk in universities. Methods Taking the debts of Kunming Chenggong universities construction as an example, analyze the reasons and countermeasures for the debts of universities in Yunnan province. Results Due to the enrollment expansion policy, the higher education in Yunnan province has been transformed from the elite education into mass education. The universities in Kunming have gained unprecedented development opportunities,especially with the completion of the Kunming Chenggong University Town. However, loan funds for the new campus construction mostly came from banks. So,the huge debt stress from banks has been brought with the development of the universities. Conclusion The sustainable development of universities requires the moderate debt. The government, universities and society need to work together to control the scale of debt effectively and avoid the debt crisis.

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.

As a mature tool for estimating tissue dosimetry,physiologically based pharmacokinetic (PBPK) models are being used to simulate the process from an external chemical exposure to an internal exposure at a target site,for supporting quantitative predictions of risks to human health. This paper reviewed these models from three aspects: the general steps of model construction,the criteria of model evaluation,the use of model in risk assessment and taking xylene as an example particularly described the third aspect.

Kashin-Beck disease(KBD) is an endemic and deforming osteochondropathy and its etiology remains unclear up to now.The prevalence of the disease is the severest in the western China and the effective methods for prevention and cure still need further study.This article summarized the progression and problems to be investigated for three main hypotheses of KBD by reviewing literature published at home and abroad.Integrating with his own research work and his team members,the author suggested that excessive apoptosis and dedifferentiation of chondrocytes besides classic chondrocytic necrosis in KBD growth plate and articular cartilage,differences of gene expression profiles in cartilage and peripheral blood mononuclear cells,proteomic markers and short tandem repeat polymorphism in KBD patients were significantly different from those of the healthy subjects from both KBD-areas and non KBD-areas,and those of osteoarthritis patients.The important objectives in the future are to understand ① the gene and proteomic markers for chondrocytic necrosis in KBD,② environmental factors that cause the damage to KBD chondrocytes,③ the way it selectively impairs chondrocytes in the deep zone of growth and joint cartilage by interacting with susceptible gene related to KBD,and ④ effective intervention methods.