Twice-daily plasma exchange for patients with refractory thrombotic thrombocytopenic purpura: the experience of the Oklahoma Registry, 1989 through 2006

BACKGROUND: Twice-daily plasma exchange has been used for patients with thrombotic thrombocytopenic purpura (TTP) who are unresponsive to treatment with daily plasma exchange for many years but with no clear evidence of effectiveness. STUDY DESIGN AND METHODS: The 18 years' experience of The Oklahoma TTP-HUS (hemolytic-uremic syndrome) Registry, 1989 through 2006, with twice-daily plasma exchange for 31 episodes of TTP in 28 patients is reported. A definite response to twice-daily plasma exchange was defined a priori as a platelet (PLT) count increase after twice-daily plasma exchange on two separate occasions during the treatment of a single episode of TTP, with no change of other treatments. A possible response was defined as a PLT count increase after initiation of twice-daily plasma exchange only once with or without change of other treatments. RESULTS: A definite response to twice-daily plasma exchange occurred in 3 episodes (three patients), 27 episodes had a possible response, and 1 episode had no response. The three patients with a definite response had ADAMTS13 activities of 5, 6, and 12 percent and all had an inhibitor; the patient with no response was subsequently determined to have Rocky Mountain spotted fever. CONCLUSION: Twice-daily plasma exchange was typically considered in acutely ill patients who had initially responded but then severe thrombocytopenia recurred, often with new neurologic abnormalities, while continuing daily plasma exchange. In three patients, twice-daily plasma exchange appeared to be beneficial. In most patients, a benefit of twice-daily plasma exchange could not be clearly documented because other treatments were initiated or intensified.     

骨肉瘤非手术治疗新进展

目的探寻较好的治疗骨肉瘤方法。方法学习文献资料,综合对比分析各治疗方法的疗效优势。结果高位截肢、关节离断已不再是骨肉瘤首选治疗方法,以化疗为中心多学科联合的综合治疗＋个体化治疗为首选治疗方法。在化疗中,以介入化疗（化学药物动脉灌注＋栓塞）在提高临床控制率方面最具优越性。结论在骨肉瘤的治疗中,提倡推广以化疗为中心的综合治疗＋个体化首选治疗方案,在化疗中,提倡推广介入化疗的给药方法。     

床旁超声在同期胰肾联合移植治疗I型糖尿病术后的检查思路与探讨

目的总结床旁超声在胰肾联合移植（SPK）术后的应用,并就超声扫查思路、超声参考参数及术后并发症等方面做相关探讨。 方法回顾性分析2009年7月至2020年12月于北京朝阳医院行胰肾联合移植术后超声评估的I型糖尿病患者计6位,记为1~6,分析总结其血管重建术式、胰腺动静脉的血流动力学参数、并发症等情况。 结果6位患者中4位患者术后出现胰肾免疫排斥反应,胰腺内动脉的血流阻力指数均升高,阻力指数（RI）为0.74_~0.87,峰值流速（PSV）为87~90 cm/s;另2位患者胰腺动脉RI分别为0.69、0.72;且该4位患者移植胰腺与移植肾脏均同期出现并发症;6位患者的回流静脉吻合方式均为经体循环回流,其中1例患者为供体门静脉与受体的髂外静脉端侧吻合,另5例为供体的门静脉与受体的下腔静脉端侧吻合;该6位患者血管重建的方式均为“Y”型血管吻合,供肾的肾动脉与供体的髂内动脉吻合、供体的腹主动脉袖片（包含腹腔干与肠系膜上动脉）与供体的髂外动脉吻合、供体的髂总动脉与受体的髂外动脉的端侧吻合。 结论床旁超声在对胰肾联合移植术后器官功能评估中有较大的临床应用价值,重建的血管是扫查要点,超声医师的诊断思路需要与外术的具体操作密切结合。     

胆道引流术后荧光腹腔镜手术治疗胆囊结石的临床疗效

背景与目的:腹腔镜胆囊切除术(LC)中经胆道直接注射吲哚菁绿(ICG)行荧光胆管显影,有即刻显影及零肝脏背景荧光的优势,在复杂LC中有更好的效果.本研究旨在探讨经皮经肝胆囊穿刺引流术(PTGBD)或经内镜鼻胆管引流术(ENBD)术后行荧光LC的临床效果.方法:选取2019年1月-2021年4月120例行LC的胆囊结石患...     

雌二醇对大鼠凳下腺GnRH,GH生成的影响

目的 研究雌二醇（estradiol17β,E2)对颌下腺促性腺激素释放激素（gonadotropin relesaing hormoe GnRH)和生长激素（growth factor,GH)生成的影响。方法 采用免疫组织化学的ABC法。结果 雌二醇促进颌下腺GnRH的生成而对GH的产生有抑制作用。结论 雌二醇可能对颌下腺GnRH和GH的合成起重要的调节作用。     

喉科擒拿法概述

目的:发掘整理喉科绝技擒拿法的相关资料,探讨该法在当代临床的应用前景。方法:通过搜集文献资料中有关喉科擒拿法的内容,特别是中医五官科奠基人干祖望教授的"擎拿"技艺,探讨喉科擒拿法的基本操作手法及其分类,以及练功注意事项。结果:喉科擒拿法是中医喉科的一门绝技,不仅在急救时有奇效,在治疗咽喉急性肿痛时也大有用武之地,操作简便,见效快。结论:喉科擒拿法具有浓郁的中医传统特色,是一门濒临失传的中医五官科绝技,值得发掘推广。     

重组人粒细胞集落刺激因子生产质量控制方法的研究

利用凝胶图像光密度分析系统和高效液相色谱双向综合检测方法对重组人粒细胞集落刺激因子的生产及纯化过程进行质量跟踪监控，使目标产品含量控制在＞98％；产品批间差异＜0.15，保证了纯化质量。     

体外静脉转流对猪原位肝移植术的血流动力学及生化影响

目的:在体外静脉静脉转流下行猪原位肝移植术观察其血流动力学及血气电解质变化情况。-,方法:选健康猪12头,体重±,静脉复合麻醉。经右颈内静脉及颈动脉插管后连接测压仪,监测血流动力学变化;右颈动脉抽血监25.502.10kg测血气及电解质。无肝期行体外静脉静脉转流。-结果:无肝期和新肝期早期显著下降。体外静脉转流中血气指标以MAP,BEHCO3及血钙变化显著。结论:无肝期体外静脉静脉转流有助于血流动力学的稳定,但在无肝期和新肝期早期仍有显著-变化;术中血气及电解质变化不容轻视。     

Redescription of <Emphasis Type="Italic">Trypanosoma siniperca</Emphasis> Chang 1964 from freshwater fish of China based on morphological and molecular data

During the parasite fauna investigation within 2005, the freshwater fish trypanosome Trypanosoma siniperca Chang 1964 was isolated from the blood of Mandarin carp (Siniperca chuatsi) from Niushan Lake, Hubei Province, central China. Blood trypomastigotes were observed only, and the density of infection was low. Light microscopy examinations of this material made it possible to study in detail the morphology of this parasite and redescribe it according to current standards. T. siniperca is characterized also on the molecular level using the sequences of SSU rRNA gene. Phylogenetic analyses based on these sequences allowed clearer phylogenetic relationships to be established with other fish trypanosomes sequenced to date.     

组织工程心脏瓣膜支架制备方法研究

目的：探讨去垢剂、胰蛋白酶对于猪主动脉瓣膜去细胞过程的影响，研究心脏瓣膜组织工程生物支架的最佳制备方法。方法：将新鲜猪主动脉瓣膜用氯化钠、十二烷基硫酸钠、曲拉通和胰蛋白酶等处理，去除内皮细胞和间质细胞，常规苏木精伊红和Masson染色，电子扫描显微镜检查，评价效果。结果：NaCl—SDS对瓣膜超微结构损伤小，但去细胞不彻底，胰蛋白酶法去细胞彻底，对结构损害大，曲拉通法能有效去除细胞成分，对瓣膜结构损伤小。结论：曲拉通法是一种有效去细胞的方法。