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

The complications of extracorporeal membrane oxygenation ( ECMO ) include technical relevance complications and physical relevance complications. The former mainly includes dysfunction of oxygenation,cannula-related problems,technical relevance hemolysis,blood clots of oxygenator or rest of the circuit. The latter includes hemorrhage and embolism,culture-confirmed infection,renal failure and neurologic complications. One of the most reported complications of ECMO is hemorrhage. It′s important for reducing mortality and improving prognosis through stricting with the indications of ECMO,strengthening team cooper-ation,closely clinical monitoring and early identifying complications. In this paper,we introduced complica-tions of ECMO as well as how to prevent and treat it.

Malnutrition occurs as a result of inadequate nutrient intake,malabsorption and altered me-tabolism in pediatric liver failure. Malnutrition may be associated with a poor outcome. The current evidence indicates that the provision of adjunctive nutritional support ( parenteral nutrition or enteral nutrition or nutri-tional supplements) to patients with a variety of liver diseases. It may be reasonable to start enteral nutrition in 5 to 7 days in acute liver failure or hepatic coma. According to individualized appropriate nutritional evalu-ation,the metabolic demand,to provide appropriate nutritional support in pediatric liver failure.

Biological antagonism was found to be only one aspeet When we Study the interactions among the microbial populations in and on the human beings. We examined the following strains of the resident flora isolated from the human healthy skin, including propionibacterium acnes (A14-1), Staphylococcus epidermidis (F65), and a number of the common dermal pathogenic micro-organisms such as staphylococcus aurcns. Ps. acruginosa snd E. coli, for their antagonistic interactions in vitro. The following results were obtained, they revealed obvious antagonism After 48h of contact in vitro antagonistic interaction to appear, and after 72h antagonism displayed obviously. On the other hand, P. acnes (A14-1) and S. epidermidis (F65) showed no antagonisim, they behaved commesaly, such commensality seemed to be important for the autoperification of the human normal skin surfaces resulting in dermal microeubiosis of the human beings.We examined the members of the transient microbial flora of the healthy human skin Lactobacterium (ad3), Bifidobacterium (Bf1) and some common pathogenic bacteria in antagonistic experiments in vitro, and discovered that they showed micropopulations appeared to be of great value to the maintenance of good health to their host.

AIM:To investigate the effects of five drugs which were usually used simultaneously with aza- thioprine(AZA)in patients with kidney transplantation: ciclosporin,hydrocortisone,nifedipine,captopril and al- lopurinol on erythrocyte thiopurine methyltransferase (TPMT)activity.METHODS:The erythrocyte TPMT activity of healthy volunteers was measured by high-per- formance liquid chromatography(HPLC).Sixteen volun- teers were chosen,in which 8 cases with intermediate TPMT activity and others with normal TPMT activity.The mean inhibition ratio of each drug concentration and the mean IC_(50)values of the inhibitors were determined.RE- SULTS:Ciclosporin,hydrocortisone,captopril and allo- purinol had nearly no impacts on TPMT activity.Nifedip- ine highly inhibited TPMT activity in vitro,the mean IC_(50)value in intermediate TPMT activity group was(24?17)?g/mL and in normal TPMT activity group was(12?10)?g/mL.CONCLUSION:The co-administration of nifedipine and thiopurines may lead to drug interactions.

Objective: To approach the mechanisms of prevention and treatment of diabetic microangiopathy(DMAP) by observing the effect of acupoint catgut embedding therapy(ACET) and complex prescription in TCM(CPTCM) on blood vessel endothelial function and insulin sensitivity(ISI).Methods: To establish model rats by abdominal cavity injecting alloxan.After being treated respectively with ACET,CPTCM for 16 weeks,plasma endothelins(ET),serum nitric oxide(NO),urinary albumin excretion(UAE),ISI were detected.Results: Compared with normal control group,the content of ET and UAE in model group increased,but ISI and NO decreased remarkably.After being treated,ET and UAE decreased remarkably,NO and ISI increased notably(P

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.

Objective To evaluate the therapeutic efficacy of percutaneous transhepatic portal vein catheterization and thrombolysis on acute superior mesenteric vein thrombosis.Methods The treatment and therapeutic efficacy of 7 cases of acute superior mesenteric vein thrombosis underwent percutaneous transhepatic portal vein catheterization and thrombolysis under ultrasound guidance from August 2005 to April 2009 were analyzed.Results All the patients succeeded in portal vein catheterization and no bile leakage or abdominal bleeding occurred during the procedure.The clinical symptoms such as abdominal pain,abdominal distension,and passing bloody stool relieved were relieved and liquid diet began at postoperative of day 2-5.Emergency operation was done in one case and there was no intestinal fistula.The angiography after the operation showed that the majority of thrombosis were cleared and the blood of portal vein and superior mesenteric vein flowed smoothly.During the follow-up of 3 months to 3 years,all the patients’ status maintained well and no recurrence occurred.Conclusion Treatment of acute superior mesenteric vein thrombosis by percutaneous transhepatic portal vein thrombolysis is safe and effective.