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.

OBJECTIVE: To promote rational drug use in the clinic. METHODS: 275 ADR case reports collected by ADR monitoring center of Yaan city from 2005 to 2007 were classified and analyzed statistically. RESULTS:The occurrence of ADR induced by Chinese materia medica preparations through Ⅳin 2005 accounted for 80.4% of the total(56 cases).The occurrence of ADR induced by Chinese materia medica preparations through Ⅳ in 2006 accounted for 79.8% of the total(113 cases).The occurrence of ADR induced by Chinese materia medica preparations through Ⅳ in 2007 accounted for 75.5% of the total(106 cases).The Chinese medicinal injection was the chief dosage form causing ADR. CONCLUSION: Timely reporting of Chinese materia medica preparations-induced ADRs, strengthened monitoring and research of which may help to reduce and avoid the ADRs incidence induced by Chinese materia medica preparations and ensure patients' medication safety.

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.

The separation and analysis of hematoporphyrin photosensitizers PSD-001, photocarcinorin,photofrin II and other HPD preparations in comparison with authentic samples protoporphyrin (PP), 3-(8)-(1-hydroxyethyl) -8-(3-)-vinyldeuteroporphyrin ( HVD)and hematoporphyrin(HP) using thin layer chromatography(TLC) under different conditions are described here.It has been shown that there are 3 and 2 main spots in PSD-001 and photocarcinorin by common TLC, but 8-9 spots by high performance TLC.It has been found by comparison with authentic HP,HVD and PP that the amount of PP in PSD-001 or photocarcinorin is less than 3% and HVD,about 2.5% and 6.3% respectively,the HP content of photocarcinorin is much lower than other photosensitizers mentioned above and there is not any component near the origin spot.The Rf of one of the major components of photocarcinorin is 0.65.This component seems to be hardly found in other photosensitizers.These suggest that photocarcinorin is a new photosensitizing agent differing from HPD and photofrin II.

Objective To review the progression of molecular biological mechanism on chondronecrosis in cartilage with Kashin-Beck disease (KBD) so as to promote the research work for pathogenesis of KBD. Methods The document analysis was used to compare the status quo of domestic and abroad research on KBD and osteoarthrosis. Results An aggregation in pedigrees with KBD was found, and an excessive chondrocyte apoptosis and de-differentiation was observed in cartilage from KBD patients except for chondronecrosis in deep zone. In contrast to osteoarthrosis, short tandem repeat, collagen gene in cartilage and gene chip were little known in KBD. Conclusion The pathogenesis of KBD should be further studied using modern biotechonology, such as short tandem repeat, cartilage collagen gene and gene chip.

Objective:To evaluate the application of Quantitative tissue velocity imaging(QTVI) in assessing the left ventricular (LV) systolic function in Children with dilated cardiomyopathy(DCM).Methods:Fifteen consecutive children with DCM were included in the present study,who were divided into group A(with light heart failure) and group B(with moderate and severe heart failure).Twelve children without any cardiac diseases were as controls.The dynamic tri-plane QTVI images of apical four-chamber,LV two-chamber and LV long-axis views were acquired simultaneously and the myocardial velocity curves in basal and middle segments were analyzed.Results:(1)The peak systolic velocity (Vs)redueed generally in group A and B compared with that in controls,especially in group B(P0.05).(2)There were forty-two segments with the velocity of postsystolie shortening(PSS) more than that of the systole in DCM group,among which thirty segments(71.43%)were from group B,and twelve segrnents(28.57%)from group A. Analyzed with strain,twenty-one segments (50.00%)were actively shortened and eleven segments (26.19%)were paradoxical motion.Conclusion:QTVI can assess LV systolic function accurately in Children with DCM.