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.

Current curriculum provision and teaching patterns of computer science in medical school has been far behind the requirements of clinical and research works, which restricted the develop-ment of medical talents to a large extent. According to the experiences of teaching practice,Department of Computer Science in Chongqing Medical University launched reform on medical computer science from aspects of teaching practice,curriculum provision,teaching methods and evaluation methods. Computer courses were opened according to students' computer knowledge and the profession. Task-based teaching and comprehensive evaluation methods were employed in order to improve the teaching quality.

Building a systematic public welfare evaluation index system for public hospitals is key to scientific evaluation of the public welfare positioning of public hospitals and enhancing their public benefit orientation,along with references for government decision making on macro health policies.The indexes were screened and pinpointed in two rounds of Delphi expert consultations,and index weights were determined with the variation coefficient method,initially building a public welfare performance evaluation index system for such hospitals,including eight class-1 indexes and 20 class-2 indexes.Outcomes of the system prove that the public welfare performance indexes of the two hospitals evaluated rise year by year from 2008 to 2010.

Objective To explore the value of high frequency and color doppler ultrasonography on diagnosis of deep venous thrombus in lower extremitiy.Method 32 cases with lower extremitiy deep venous thrombi diagnosed by angiography were further examined by CDFI,36 healthy cases were randomly selected as the normal group (NOR).Results High frequency and CDFI displayed the venous image in normal lower limbs rapidly and clearly as well as the echographic features of different shapes and types of the obstructed vessels.Conclusion High frequency and CDFI as a non-invasive and realtime method is better than angiography in diagnosis of the disease.

The article summarizes the questions of clinical practicing in obstetrics and gynecology through clinical teaching in person,and find out some measures to improve teaching quality of clinical practicing.

Objective To investigate changes of CD~+_4CD~+_ 25 regulatory T cells (CD~+_4CD~+_ 25 Treg) and forkhead/winged helix transcription factor(Foxp3) mRNA in peripheral blood mononuclear cells (PBMCs) from patients with asthma, so as to elucidate the possible roles of CD~+_4CD~+_ 25 Treg in the development of asthma. Methods The peripheral blood samples were collected from 29 healthy controls (normal control group) and 78 patients with asthma which included 30 patients in exacerbation group, 25 patients in persistent group, and 23 patients in remission group. By using flow cytometry and RT-PCR, the CD~+_4CD~+_ 25 Treg ratio and Foxp3 mRNA in PBMCs were detected. Results The CD~+_4CD~+_ 25 Treg ratio and Foxp3 mRNA in PBMCs of exacerbation and persistent group were lower than that of remission group and normal control group (P0.05). Compared with persistent group, exacerbation group had lower CD~+_4CD~+_ 25 Treg ratio and Foxp3 mRNA (P

Objective To examine the distribution of Malassezia species in follicular contents and perifollicular superficial skin in patients with Malassezia folliculitis and search for its causative agent. Methods A total of 120 patients with Malassezia folliculitis were investigated. Follicular lesions at three different anatomic sites were selected in each patient. Perifolliclar superficial skin specimens were taken by sterile adhesive tape, and the follicular contents of the same follicle were taken by sterile haemostatic forceps. The above specimens were cultured respectively on media containing rapeseed oil. The isolated colonies were identified by their physiological and morphological characteristics. Results Out of 319 isolates obtained from the perifollicular superficial skin, 247 isolates (77.43%) were identified as M. sympodialis, 40 isolates (12.54%) as M. furfur, 27 isolates(8.46%) as M. globosa and 5 isolates(1.57%) as M. obtusa. Out of 314 isolates obtained from follicular contents, 252 isdates(80.25%) were identified as M. globosa, 57 isolates(18.15%) as M. sympodialis, 4 isolates(1.27%) as M. furfur, and 1 isolate(0.32%) as M. obtusa. There was statistical difference in species distribution between the follicular contents and the perifolliclar superficial skin (P

The changes of CD4(+)CD25(+) regulatory T cells (CD4(+)CD25(+) Treg) and Foxp3 mRNA in peripheral blood mononuclear cells (PBMCs) from patients with asthma were investigated in order to elucidate the possible roles of CD4(+)CD25(+) Treg in the development of asthma. The peripheral blood samples were collected from 29 healthy controls (normal control group) and 78 patients with asthma which included 30 patients in exacerbation group, 25 patients in persistent group, and 23 patients in remission group. By using flow cytometry and RT-PCR, the CD4(+)CD25(+) Treg ratio and Foxp3 mRNA in PBMCs were detected. The CD4(+)CD25(+) Treg ratio and Foxp3 mRNA in PBMCs of exacerbation and persistent groups were lower than that of remission and normal control group (P<0.05). Although the CD4(+)CD25(+) Treg ratio and Foxp3 mRNA of remission group also lower than that of normal control group, there was no significant difference between them (P>0.05). As compared with persistent group, exacerbation group had lower CD4(+)CD25(+) Treg ratio and Foxp3 mRNA (P<0.05). It was indicated that the decrease of CD4(+)CD25(+) Treg ratio and its function in PBMCs may be responsible for pathogenesis of asthma.

Objective To study the changes of serum and tissue soluble intercellular adhesion molecule(sICAM)-1 in colorectal cancer patients and their clinical significance. Methods Serum level of sICAM-1 was detected by the double antibody sandwich enzyme-linked immunosorbent assay method in 44 patients with colorectal cancer before and after operation, 28 patients with intestinal polyps and 30 controls.Simultaneously, tissue level of sICAM-1 was measured in the patients of colorectal cancer and intestinal polyps. Results The serum sICAM-1 level in colorectal cancer patients[ (693.22±276.25) mg/L]was significantly higher than that in the intestinal polyps patients [(61.99±27.39) mg/L]and healthy controls[(59.28±27.55) mg/L]. The tissue sICAM-1 level in the colorectal cancer [(706.92±286.09)mg/L ]was significantly higher than that in the intestinal polyps patients[ (63.06±27.06) mg/L,P<0.01 ]. The serum and tissue levels of sICAM-1 in Dukes C-D stages of the colorectal cancer showed significantly higher than those in Dukes A-B stages (P<0.01 ). The level of sICAM-1 declined remarkably after one month of radical operation. Conversely, it decreased illegibly after palliative operation. Conclusion Dynamic alterations of serum and tissue sICAM-1 level may be used as indicators of diagnosis, choice of operative method and judgment of prognosis in patients with colorectal cancer.

Objective To evaluate the risk factors for the postoperative acute renal failure requiring dialysis (ARF-D)after heart valve surgery. Methods Adult patients (age≤18 years) underwent valve surgery with preoperative serum creatinine ＜300 μmol/L were included between January 2005 and December 2008. Fifty patients developed ARF-D within 30 days postoperatively (ARF-D group). While random 220 patients had the same operation without ARF-D served as the control group. Univariate analysis and multivariable logistic regression were used to identify risk factors of ARF-D after valve surgery.Results The incidence of ARF-D was 1.78%, and the early mortality rate was 65.5%. Multivariate analysis identified the following independent risk factors of ARF-D: age, previous cardiac surgery, preoperative serum creatinine, NYHA class Ⅳ,and low cardiac output syndrome. ARF-D group had a longer hospital stay and ICU stay than that of the control group ( P ＜0.001 ). Conclusion Conclusion ARF-D had a higher mortality rate and longer hospital stay following heart valve surgery.Age, previous cardiac surgery, preoperative serum creatinine, NYHA class Ⅳ, and low cardiac output syndrome were the independent risk factors of ARF-D after heart valve surgery.