Objective To investigate the etiology and clinical characteristics of pregnancy-emerged thrombocytopenia.Methods A retrospective analysis was conducted on clinical data of 159 pregnancies with thrombocytopenia,who were admitted to Peking University People's Hospital from January 2000 to January 2010.All the patients recruited in this study had no history of blood or immune system disease before pregnancy,and thrombocytopenia was the predominate clinical manifestation during pregnancy,with platelet counts less than 100 × 109/L at least twice during pregnancy.The thrombocytopenia should not be induced by drugs,viral infections,preeclampsia or hemolysis,elevated liver enzymes,and low platelets syndrome (HELLP).All cases were followed up.The general condition,the onset time of thrombocytopenia,platelet changes,accompany symptoms,maternal and perinatal outcomes as well as follow-up conditions were compared based on the etiology.Results ( 1 ) Etiology:among the 159 cases,101 (63.5％) were diagnosed gestational thrombocytopenia (GT) ;43 ( 27.0％ ) were idiopathic thrombocytopenic purpura(ITP) ;9 ( 5.7％ ) were blood system diseases,including 4 cases of megaloblastic anemia( MA ),2 cases of aplastic anaemia (AA),and 3 cases of myelodysplastic syndrome(MDS).Six cases (3.8％)were diagnosed immune system diseases,including 3 cases of systemic lupus erythematosus ( SLE),2 cases of antiphospholipid syndrome (APS),and 1 case of Evans syndrome.(2)Maternal and perinatal outcomes:pregnancy induced hypertension was diagnosed in 21 cases ( 13.2％ ),abnormal glucose metabolism in 13 cases ( 8.2％ ),anemia in 44 cases ( 27.7％ ) and preterm delivery in 18 cases ( 11.3％ ).Twenty-nine cases ( 18.2％ ) were treated with corticosteroids or gamma globulin during pregnancy.The average gestational week was 38 weeks.Fifty-five cases ( 34.6％ ) underwent vaginal delivery,104 cases ( 65.4％ ) received cesarean section.Postpartum hemorrhage was observed in 34 cases (21.4％),and puerperal infection happened in 2 eases ( 1.3％ ).No maternal death was found.In a total of 160 fetuses (including twins),there were 157 live births.Three cases of fetal death and 2 cases of early neonatal deaths were observed.Fetal growth restriction was observed in 4 cases,and neonatal thrombocytopenia was seen in 6 cases.No intracranial hemorrhage was detected.(3)The onset time of thrombocytopenia:among the 159 cases,29 cases ( 18.2％ ),67 cases (42.1％ ),63 cases (43.6％) of thrombocytopenia were detected in the first,second and third trimester,respectively.There was a significant difference of the onset time of thrombocytopenia between GT and ITP groups( P ＜ 0.05 ).Patients with GT tended to have a later onset of thrombocytopenia,which mainly happened in the second and third trimester,while patients with ITP tended to happen in the first and second trimester.(4)The degree of thrombocytopenia:the cases with the minimum platelets level of (51 - 100) × 109/L,(31 - 50) × 109/L,( 10 - 30) × 109/L,＜ 10 × 109/L during pregnancy were 75 (47.2％ ),39 (24.5％ ),31 ( 19.5％ ),14( 8.8％ ) respectively.There was a significant difference between GT and ITP groups in the lowest platelets level (P ＜ 0.01 ).(5)Thrombocytopenia accompany with anemia:among the 159 cases,there were 44 cases (27.7％ ) accompanied with anemia.The proportion was 9.9％ ( 10/101 ) in GT group,58.1％ (25/43) in ITP group,with significant difference(P ＜0.01 ).Anemia was also found in 5 cases in blood system disease group (5/9),and 1 case in immune system disease group (Evans syndrome,1/6).Pancytopenia was observed in 2 cases with ITP (4.7％,2/43 ) and 3 cases with blood system disease ( AA:1 cases,MA:2 cases,3/9).(6) The recovery of the platelets counts postpartum:the postpartum follow-up periods were 7 months to 10 years.Patients recovered within 1 week,6 weeks,6 months postpartum were 66 cases ( 41.5％ ),43 cases ( 27.0％ ),17 cases ( 10.7％ ) respectively.The platelets counts did not recover within 6 months postpartum in 33 cases(45.7％ ).Conclusions GT is the leading cause of pregnancy-emerged thrombocytopenia followed by ITP.There are significant differences between GT and ITP in the onset time of thrombocytopenia,the lowest platelets level,the proportion of anemia accompanied and the postpartum recovery.Other etiologies including immune and blood system diseases are rare.The relevant examinations should be taken for etiology and differential diagnosis.

Objective To investigate the perinatal outcomes of pregnancies complicated with varying degrees of thrombocytopenia.Methods Clinical data of 305 pregnant women with thrombocytopenia,who admitted to Peking University People's Hospital from January 1,2000 to January 31,2010 were retrospectively analyzed.The etiological diagnosis of them were gestational thrombocytopenia (GT),idiopathic thrombocytopenic purpura (ITP) or undetermined.The patients were divided into 4 groups according to the minimal level of platelets in pregnancy ( platelets count was lower than 100 ×109/L at least twice) : groupⅠ,(50-100) ×109/L (n=101) ; group Ⅱ,(30-50) × 109/L (n = 85); group Ⅲ,(10-30) × 109/L (n = 87); group Ⅳ,< 10 × 109/L (n = 32).Demographic data such as pregnancy complications,treatment,neonates and follow-up results of the patients in each group were compared with ANOVA,Spearman rank correlation analysis,Chirsquare test and Chi-square trend test in SPSS 17.0.Results Medical complications in pregnancy of these patients included hypertensive disorder complicating (n = 35,11.48%) and abnormal glucose metabolism (n=23,7.54%),no difference was found in the incidence of these diseases among the four groups.There were 68 patients complicated with anemia (22.30%),40 preterm delivery (13.11%),60 postpartum hemorrhage (19.67%); there were significant differences in the incidence among the four groups (P＜0.05),the incidence increased with the aggravation of thrombocytopenia (P＜0.05).There were 2 cases of puerperal infection (0.66%),no maternal deaths.Fifty-one patients (16.72%) accepted treatment of corticosteroids or Gamma globulin during pregnancy.There were 116 cases (38.03%) of vaginal delivery and 189 cases (61.97%) of cesarean section.The postpartum bleeding amount within 24 hours increased with the aggravation of thrombocytopenia.Two hundred and eleven (69.18%) patients were followed up and platelet count regained normal,among which 152 cases recovered within six months after delivery.The recovery rates were 90.59% (77/85),82.36% (42/51),46.16% (24/52) and 39.13% (9/23) from group Ⅰ to group Ⅳ,as declined with the aggravation of thrombocytopenia in pregnancy ( x2trend = 42.616,Ptrend =0.000).Among the 306 perinatal fetuses,neonatal outcomes included 301 live births,5 fetal deaths,4 early neonatal deaths,4 low birth-weight infants after term birth,1 intracranial hemorrhage and 18 (5.98%) neonatal thrombocytopenia cases.Incidence of neonatal thrombocytopenia increased with the aggravation of maternal thrombocytopenia.Sixteen cases of neonatal thrombocytopenia recovered at 3-8 weeks after birth,but two cases did not recover within three years during followed up.Conclusions The perinatal outcomes are different in pregnancies complicated with varying degrees of thrombocytopenia.As thrombocytopenia in pregnancy become worse,the risk of anemia,premature delivery,postpartum hemorrhage and neonatal thrombocytopenia increases.While,perinatal outcomes may be better under close perinatal care.

Objective:The main purpose of this research is an experiment on the application of a comfort nursing model to a stem cell collection of peripheral blood procedure.Methods: The comparison method has been applied in this research. 178 cases have been selected as a whole research group. Then 88 cases are the observed group who will adopt the comfortable nursing model and 90 cases are the control group who will adopt the normal model.Results: The result of the comparison method shows that the observed group has lower mental pressure during the stem cell collection progress. Furthermore, the satisfaction feedback of the observed group is 90.9% but the control group is 67.8%.Conclusion: This research found that the application of the comfortable nursing modeling in stem cell collection of peripheral blood will ensure the collection process is completed smoothly. More importantly, an improvement was made in medical treatment quality and patient satisfaction.

A single factor duplicate test was designed to investigate whether bovine recombinded resistin impacts the expression of pyruvate carboxylase (PC) mRNA and the activity of PC in vitro culture bovine hepatocyte.Bovine recombinded resistin was added to the media with 0,25,50,100,200 and 400 ng/L.Abundance of PC mRNA in bovine hepatocyte,which was cultured with bovine recombinded resistin for 12 hours,was determined by real-time fluorescence quantitative RT-PCR,and activity of PC was determined by colourimetry.The results showed that bovine recombinded resistin could downregulate the expression of PC mRNA and the activity of PC in vitro culture bovine hepatocyte.

Objective To explore the relationship between big-five personality,and public mood of volunteers,and to find out the moderator effect of justice sensitivity.Methods A total of 1 022 volunteers were investigated.The Big-Five Inventory (BFI),Public Mood Scale (PMS),Justice Sensitivity Inventory (JSI) were applied to all subjects.Results The average score was (19.77±4.49) for extraversion,(26.69± 4.13) for agreeableness,(23.33±5.37) for conscientiousness,(12.49±4.91) for neuroticism,(24.95±5.44)for openness,(8.78±3.23) for positive public mood,(3.46±3.06) for negative public mood and correlated with (26.85± 10.55) for observer sensitivity.The extraversion,agreeableness,conscientiousness and openness were correlated with positive public mood(β=0.31,P＜0.01;β=0.25,P＜0.01;β=0.29,P＜0.01;β=0.26,P＜0.0 1),and negatively correlated with public mood (β=-0.14,P＜0.01;β=-0.29,P＜0.01;β=-0.20,P＜0.01;β=-0.08,P＜0.01).Neuroticism was negatively correlated with positive public mood (β=-0.27,P＜0.01),and positively correlated with negative public mood (β=0.31,P＜0.01).The interaction effect of agreeableness and observer sensitivity negatively correlated with positive public mood,negative public mood (β=-0.09,P＜0.01;β=-0.07,P＜0.05).The interaction effect of neuroticism and observer sensitivity was positively correlated with positive public mood (β=0.08,P＜0.01).Conclusion Observer sensitivity plays a regulative role between big-five personality and mental health,and can slow the negative impact of low agreeableness to positive public mood,strengthen the impact of low agreeableness to negative public mood,and slow the negative impact of high neuroticism to positive public mood.

Objective To evaluate the effect of dexmnedetomidine pretreatment on apoptosis in hippocampal neurons of rats undergoing one-lung ventilation (OLV).Methods Ninety adult male SpragueDawley rats,aged 10-11 months,weighing 260-300 g,were divided into 3 groups (n=30 each) using a random number table:two-lung ventilation (TLV) group,group OLV and dexmedetomidine pretreatment group (group D).Dexmedetomidine 25 μg/kg was injected intraperitoneally at 45 min before OLV in group D.After tracheal intubation,the animals were ventilated in volume-controlled mode.OLV was performed for 90 mnin followed by 30 min of TLV in OLV and D groups.TLV was performed for 120 min in group TLV.On 1,3 and 7 days after ventilation,6 rats in each group were selected,and Morris water maze test was carried out to evaluate the cognitive function.The swimming speed,time of staying at the target quadrant,and frequency of crossing the platform quadrant were recorded.Six rats in each group were selected immediately after ventilation and sacrificed,the hippocampi were removed for detection of cell apoptosis,and the apoptosis index was calculated.Immediately after ventilation and on 1,3 and 7 days after ventilation,6 rats in each group were selected and sacrificed,and the hippocampi were removed for determination of phosphorylated extracellular signal-regulated kinase 1/2 (pERK1/2),phosphorylated cyclic adenosine monophosphate response element-binding protein (pCREB),Bcl-2 and Bax expression.The ratio of Bcl-2 expression to Bax expression (Bcl-2/Bax ratio) was calculated.Results Compared with group TLV,the time of staying at the target quadrant was significantly shortened,the frequency of crossing the platform quadrant was decreased,the apoptosis index was increased,the expression of pERK1,pERK2,pCREB and Bcl-2 was down-regulated,the expression of Bax was up-regulated,and Bcl-2/Bax ratio was decreased in group OLV (P＜0.05 or 0.01).Compared with group OLV,the time of staying at the target quadrant was significantly prolonged,the frequency of crossing the platform quadrant was increased,the apoptosis index was decreased,the expression of pERK1,pERK2,pCREB and Bcl-2 was up-regulated,the expression of Bax was down-regulated,and Bcl-2/Bax ratio was increased in group D (P＜0.05 or 0.01).Conclusion Dexmedetomidine pretreatment decreases apoptosis in hippocampal neurons through activating ERK/CREB signaling pathway,thus reducing cognitive dysfunction of rats undergoing OLV.

Objective:Comparing the effect of different doses of simvastatin in lowering the serum lipid.Methods:79 patients were randomized into group A and group B,and were given simvastatin 10 mg*d-1 (group A) and 20 mg*d-1 (group B),respectively for a total of 8 weeks.Results:Comparing with baseline,in group A,TC,TG,LDL-C were decreased by 23.4%,20.0% and 30.7%,respectively (P＜0.01); HDL-C was increased by 17.5%.The content of serum TC,TG and LDL-C was decreased to the normal range in 12.8%,28.2% and 15.4% of the patients in group A.For the group B,TC,TG,LDL-C were decreased by 32.7%,22.8% and 42.8%,respectively (P＜0.01); HDL-C was increased by 13.7%.The content of serum TC,TG and LDL-C was decreased to the normal range in 65.0%,57.5% and 65.0% of the group B patients.Conclusion:Oral intake of 20 mg of simvastatin once a day can effectively reduce the serum lipid.The patients can well tolerate and no obvious side effect was observed in our study.

Objective To investigate the clinical efficacy of ligation of intersphincteric fistula tract (LIFT) for the treatment of high anal fistula.Methods The clinical data of 77 patients with high anal fistula who were admitted to the Puren Hospital and Chaoyang Hospital from January 2011 to June 2012 were retrospectively analyzed.All the patients were treated using the LIFT method (LIFT group,37 patients) or fistulectomy + threaddrawing therapy (thread-drawing group,40 patients).The operation time,healing time,time and severity of postoperative pain,recurrence and anal sphincter dysfunction were compared between the 2 groups.The measurement data,the count data and the rank data were analyzed using the t test,chi-square test,and the rank sum test,respectively.Results The operation time of the LIFT group and the thread-drawing group were (21.4 ± 2.0) minutes and (20.6 ± 1.9) minutes,with no significant difference between the 2 groups (t =1.911,P ＞ 0.05).In the LIFT group,17 patients felt low-grade pain,no patient felt medium-grade or severe pain.In the thread-drawing group,7 patients felt low-grade pain,14 patients felt medium-grade pain,19 patients felt severe pain.The duration of postoperative pain in the LIFT group and the thread-drawing group were (3.0 ± 1.3) days and (14.1 ± 1.5)days,respectively.The severity and duration of postoperative pain of the LIFT group were significant lower and shorter than those of the thread-drawing group (u =-7.189,t =34.534,P ＜ 0.05).The healing time,anal scar area and anal sphincter function score were (26.0 ± 1.9) days,(1.24 ± 0.20) cm2 and 1 in the LIFT group,and (40.7 ± 2.8) days,(2.64 ± 0.25) cm2 and 4 in the thread-drawing group,with no significant difference between the 2 groups (t =26.574,26.868,Z =-7.513,P ＜ 0.05).The effective rate of the 2 treatment methods were 100％.The cure rate and recurrence rate were 51.4％ (19/37) and 5.4％ (2/37) in the LIFT group,and 42.5％ (17/40) and 2.5％ (1/40) in the thread-drawing group.There were no significant differences in the cure rate and recurrence rate between the 2 groups (x2=0.605,0.433,P ＞ 0.05).Conclusion LIFF method has higher cure rate for high anal fistula with short time of postoperative pain and healing,good anal sphincter function and low recurrence rate.

Objective To learn the policy outcomes of the management of category-B large medical instruments deployed in Beijing.Methods Call into play the data from the surveys made in 2005,2007 and 2010 on the five types of category-B large medical instruments deployed in the city.Summarize and analyze the outcomes of such instruments in terms of their total configuration volume,and the growth,distribution and use.Results From 2005 to 2010,CT scored the fastest growth of these five types of instruments,with 48 units deployed; SPECT was the lowest,with 8 units deployed.Conclusion The volume growth,instruments distribution,and use efficiency of such instruments in Beijing are rationally evolving,which proves that the deployment and management of category-B large medical instruments is compliant with conditions of the city.