Objective To retrospectively explore the diagnosis and treatment of severe immune thrombocytopenia(SIT)induced by programmed death-1(PD-1)monoclonal antibody.Methods Three patients with SIT caused by PD-1 monoclonal antibody treatment at Putuo District People's Hospital,Zhoushan City,Zhejiang Province from March 2020 to October 2022 were selected,and the diagnosis and treatment process and disease outcome were analyzed.Results All three patients were diagnosed with malignant tumors after postoperative pathological examination,and SIT was induced after PD-1 monoclonal antibody treatment,of which one patient died,and two patients improved after the treatment.Conclusion PD-1 induced SIT often occurs after 12 weeks,and clinical diagnosis can be confirmed by combining patients'medication history,platelet antibodies,and bone marrow examination.In terms of treatment,combination therapy such as ordered reduction of hormones,thrombopoietin,and platelet receptor agonists can promote the recovery of the patient.In addition,if necessary,CD20 monoclonal antibody therapy can be applied to antagonize platelet antibodies.

Objective:The therapeutic effect of less polar ginsenosides on rats with rheumatoid arthritis was studied, and the metabolic pathway that produce anti-inflammatory effect of less polar ginsenosides was identified.Methods:Rats were randomly divided into the control group, the model group, methotrexate treatment group, and high dose, medium dose, and low dose less polar ginsenosides groups. After 30 days of oral administration, less polar ginsenosides reduced the disease activity significantly in rats with rheumatoid arthritis. Blood and ankle synovial tissue metabolisms were measured by ultra performance liquid chromatography (UPLC) tandem mass spectrometry (MS) to explore the mechanism of less polar ginsenosides.The resulting data were subjected to principal component analysis and orthogonal partial least squares discriminant analysis(OPLS-DA).Results:Compared with the model group, erythrocyte sedimentation rate and RF decreased significantly in the high dose of less polar ginsenosides ( P<0.01). Metabolomics showed that R2X and R2Y of serum OPLS-DA were 0.626 and 0.904 respectively. The R2X and R2Y of synovial OPLS-DA were 0.429 and 0.689 respectively. Major differential metabolites were identified in the model group of rats, including arachidonic acid, valine, linoleic acid, and guanine nucleoside, etc. The main differential metabolites were identified in rats in the high dose group of less polar ginsenosides, including linoleic acid, betaine, eicosapentaenoic acid, alanine, methionine sulfoxide, isoleucine, etc. Conclusion:The metabolic spectrum has shown that inflammation is associated with linoleic acid metabolism, valine, leucine and isoleucine degradation, arachidonic acid metabolism. Less polar ginsenosides regulatethe linolenic acid metabolism, methionine metabolism and glucose alanine cycle.

The elbow is more susceptible to motion loss than other joints after trauma,and elbow stiffness leads to functional impairment in the upper limb and interferes with daily activities.Open arthrolysis is the most common and classical treatment for post-traumatic elbow stiffness.In this paper,we review the treatment protocols like preoperative clinical evaluation,arthrolysis strategies and postoperative rehabilitation program for post-traumatic elbow stiffness,discuss relevant issues and assess their prospects.

Objective To observe and analyze the change state of serum inflammatory mediators of patients with secondary septic shock after chemotherapy for acute leukemia .Methods 56 patients with secondary septic shock after chemotherapy for acute leukemiawere were selected as the group A,56 patients without secondary septic shock after chemotherapy for acute leukemia were selected as the group B ,56 healthy persons of the same age were selected as the group C,then the serum inflammatory mediators levels of three groups were detected and compared,and the serum indexes of group A with different severity degree of shock were compared, then the detection results of group A and group B with different types ( lymphocytic leukemia and nonlymphocytic leukemia)were compared.Results The serum inflammatory mediators levels, including TNF-α, IL-4, IL-6, IL-10 and other inflammatory factors, including PGE2 , sICAM-1, sVCAM-1 and sCD44, there were group A >group B >group C, severe shock >moderate shock>mild shock ( all P<0.05 ) .The above serum inflammatory mediators and other inflammatory factors levels of different types in group A were higher than those in group B, and the above mediators in lymphocytic leukemia of group A and group B were higher than those in nonlymphocytic leukemia (all P<0.05).Conclusion The serum inflammatory mediators of patients with secondary septic shock after chemotherapy for acute leukemia show higher expression state,and the influence of shock degree and leukemia types for the expression are great.

Oral and maxillofacial development is the course that the oral students first learn, and their mastery directly influences the study of other courses that follow. The application of mind mapping in the teaching of the development of oral maxillofacial region can make the temporal and spatial features of oral and maxillofacial development in the form of visual presentation, help students build development mode of thinking, stimulate students' interest in learning, improve the quality of teaching of oral histopathology, and promote the new teaching concept in oral pathology teaching.

An ordered mesoporous silica ( OMS ) was synthesized through hydrothermal process. The synthesized material was characterized by different techniques such as X-ray diffraction, nitrogen adsorption-desorption and transmission electron microscope. The electrochemical characteristics of the OMS modified carbon paste electrode ( OMS/CPE ) were investigated by using cyclic voltammetry and electrochemical impedance spectroscopy. Compared with bare carbon paste electrode ( CPE ) , the OMS/CPE exhibited a larger electrode surface and a faster electron-transfer rate. Electrochemical behaviors and kinetic properties of L-tryptophan ( L-Trp) at the OMS/CPE in the presence of sodium dodecylsulphate ( SDS) were studied. The results showed that the voltammetric response of L-Trp at OMS/CPE was improved due to the synergistic effect of OMS and SDS. The electrochemical oxidation of L-Trp at OMS/CPE in the presence of SDS was an irreversible process involved two electrons and two protons, and the electrode process was controlled by the adsorption step. Some parameters such as SDS concentration, accumulation time, accumulation potential and pH were optimized. Under optimal conditions, the oxidation peak current was linearly proportional to L-Trp concentration in the range of 8. 0×10-8 to 4. 0×10-6 mol/L, with a detection limit of 7. 0×10-8 mol/L (S/N=3 ) . The proposed method was applied for the determination of L-Trp in oral liquid with the recoveries of 99 . 6%-102 . 6%.

Objective To assess whether asymmetric spin echo version of echo planar imaging (ASE EPI) sequence can reflect cerebral oxygen metabolism by means of the changes in oxygen extraction fraction values before and after surgical operations in the canine model of ischimia. Methods A total of 12 healthy crossbreed dogs were enrolled in this study. All canines underwent cerebral MR imaging including coronal T2WI, DWI, MRA, ASE EPI and 3D PCASL. The bilateral carotid arteries (CA) were separated by surgical operations. The bilateral CA were ligated in 6 dogs, and the other 6 dogs had embolization in ligated bilateral CA. The cerebral MR imaging with the above protocol was repeated at 1 hour after surgical operation for each dog. All dogs were executed when they finished the MR examinations. Then the whole brains of the dogs were taken out for cutting coronal sections and 2, 3, 5-triphenyltetrazolium chloride (TTC) staining. The ASE EPI data were processed by the Functool software in the workstation to generate OEF maps. For measuring the OEF values before and 1 hour after surgical operations, one and the same region of interest (ROI) was respectively placed in the left and right hemispheres on the OEF maps for each dog. 3D PCASL data were processed by the Functool software in the workstation to yield CBF maps. The method for measuring the CBF values before and 1 hour after surgical operations on CBF maps was same as that for measuring on OEF maps. The changes of measurements before and after surgical operations were compared between the dogs with ligated bilateral CA and the dogs with embolization in ligated bilateral CA by using an independent samples t test. The measurements before and after surgical operations were respectively compared in the dogs with ligated bilateral CA and the dogs with embolization in ligated bilateral CA by using a paired t-test. The cutting slices with TTC staining were analysed for determining ischimia. Results The CBF values of the dogs with ligated bilateral CA were (59.81±23.59) and (38.56± 12.98) ml/(min · 100 g) before and after surgical operations, respectively. The CBF values of the dogs with embolization in ligated bilateral CA were (58.94±18.35) and (28.01±11.41) ml/(min·100 g) before and after surgical operations, respectively. The CBF values were significantly lower before surgical operations than after surgical operations in the dogs with ligated bilateral CA and the dogs with embolization in ligated bilateral CA, respectively (t=8.92 and 13.42, respectively; P=0.00, respectively). The CBF values were decreased more significantly in the dogs with embolization in ligated bilateral CA than in the dogs with ligated bilateral CA (t=2.92, P=0.00). The OEF values of the dogs with ligated bilateral CA were 0.29±0.02 and 0.32 ± 0.06 before and after surgical operations, respectively. The OEF values of the dogs with embolization in ligated bilateral CA were 0.29 ± 0.02 and 0.35 ± 0.06 before and after surgical operations, respectively. The OEF values were significantly higher before surgical operations than after surgical operations in the dogs with ligated bilateral CA and the dogs with embolization in ligated bilateral CA, respectively (t=-7.21 and-4.43, respectively;P=0.00, respectively). The OEF values were increased more significantly in the dogs with embolization in ligated bilateral CA than in the dogs with ligated bilateral CA (t=2.18, P=0.03). The pathological results showed that the dogs with embolization in ligated bilateral CA had swollen cortex with focal infarction which was matched with the hyperintensity areas on the OEF and DWI images. However, the dogs with ligated bilateral CA only had swollen cortex whereas didn't have focal infarction. Conclusions ASE EPI sequence can reliably reflect cerebral oxygen metabolism in ischemia. This sequence has an important role for assessing hemodynamic state in patients with cerebral vascular diseases.

Objective To study the efficacy and adverse reactions of different kinds of antibiotics in the treatment of patients with acute leukemia after chemotherapy.Methods 112 cases with acute leukemia after chemo-therapy and infected were selected as the research subjects,and were randomly divided into the study group and the control group,56 cases in each group,Two groups of patients were intravenously injected amikacin sulfate,control group was intravenously injected ceftazidime and study group was given cefepime,two groups of patients were treated for 7 days.The clinical efficacy,the defervescence time,C -reactive protein (CRP)level,peripheral blood neutro-philic granulocyte (ANA)distribution levels and adverse reactions were observed.Results In the control group,the total effective rate was 83.9%,which of the study group was 94.6%,the difference between the two groups was statis-tically significant (χ2 =4.92,P =0.02).The normal rate of ANC in the study group was significantly higher than the control group (χ2 =6.62,P =0.01).The average defervescence time of the control group was (3.9 ±0.8)d,which of the study group was (2.6 ±0.8)d,there was significant difference between the two groups (t =8.44,P =0.00);CRP level of the study group after treatment was (21.18 ±4.07)mg/L,which was significantly lower than (37.27 ± 5.32)mg/L of the control group,with significant difference between the two groups (t =7.71,P =0.00).The incidence rate of adverse reaction of study group was 5.3%,which was significantly lower than 19.6% in the controlgroup,with significant difference between the two groups (χ2 =5.22,P =0.02).Conclusion Cefepime in the treat-ment of acute leukemia chemotherapy after infection has significant curative effect,can improve patients'neutral granu-locyte number and adverse reactions are mild,it is worthy of popularization in clinical.

Objective To explore the thyroid function changes of episodes period and remissions period in children with primary nephrotic syndrome (NS).Methods The urinary protein quantitation and serum albumin,total cholesterol,thyroid hormone level [total triiodothyronine (TT3),total thyroxine (TT4),free triiodothyronine (FT3),free thyroxine (FT4) and thyroid stimulating hormone (TSH)] of episodes period and remissions period in 15 children with primary NS were retrospectively analyzed.Results There were statistical differences in urinary protein quantitation and serum albumin,total cholesterol in children with NS between episodes period and remissions period (P ＜ 0.05).The TT3,TT4,FT3,FT4 in episodes period were significantly lower than those in remissions period [(0.6 ± 0.3) μ g/L vs.(1.3 ± 0.3) μ g/L,(40.0 ± 23.0)μ g/L vs.(68.0 ± 15.0) μ g/L,(1.6 ± 0.3) pmol/L vs.(3.3 ± 0.3) pmol/L,(8.6 ± 2.5) pmol/L vs.(12.2 ± 2.0) pmol/L],TSH was significantly higher than that in remissions period [(5.6 ± 2.1) mU/L vs.(2.5 ± 1.1) mU/L],there were statistical differences (P ＜ 0.05).Conclusions Thyroid function of episodes period in children with primary NS is decreased temporarily,associated with heavy proteinuria leads to thyroid hormone missing from urine.Detecting thyroid function plays an important role in estimating the state and guiding the treatment of primary NS.

Objective To examine the application effect of intelligent simulator(SimMan) in comprehensive skill training among doctors and nurses.Methods Totally 168 doctors and nurses were chosen as the training object,6 people (4 doctors and 2 nurses) formed a work team.Comprehensive training course was in accordance with 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care science.Real clinical situation was designed by using the third generation SimMan of Norway laerdal company.Trainees were administered two tests before and after training,in which there were two parts containing specialized operation ability and non-technical ability.Overall qualification rate,average mark and treatment time of qualified teams were compared before and after the training.SPSS 16.0 software was used to analyze the data and P ＜0.05 signifies statistically significance.Results Overall qualification rate,average mark and treatment time of qualified teams were 71.43％,(84.70 ± 3.15),and (449.25 ± 77.0) s respectively before training while 100％,(93.55 ± 3.86) and (323.71 ± 42.26) s after training.There were significant differences in results of two groups before and after training (P =0.002,0.000,0.000).Conclusions Application of the third generation intelligent simulator (SimMan) in comprehensive training will obviously improve training effectiveness and cultivate the non-technical ability.