Relation between dynamic changes of platelet counts and 30-day mortality in severely burned patients

Thrombocytopenia is a common event in severely burned patients and associated with adverse outcome. The underlying relationship between the dynamic changes of platelet counts and mortality has not been well defined. We performed a 6-year retrospective chart of adult patients with a burn index of 50 or greater admitted to two burn centers and collected data on patient demographics, laboratory results, and patient outcomes. The mean daily increase in the platelet count (?PC/?t) from day 3 to day 10 was calculated, and 30-day mortality was determined. For the study, 141 survivors and 65 nonsurvivors were enrolled. The sequential changes in PCs presented a biphasic pattern after admission, with a slump to the nadir during the first 3 days and a subsequent recovery. With respect to 30-day mortality, compared with the AUC of APACHE-Ⅱ score (0.841), no significant difference was noted between ΔPC/ΔT and APACHE-Ⅱ score (p = 0.0648). The ΔPC/ΔT associated with the best discrimination between survivors and nonsurvivors was 20.57 × 10⁹/L due to the cutoff with optimal Youden index (0.453). By multiple logistic regression, ΔPC/ΔT ＜ 20.57 × 10⁹/L was one of the prognostic predictors of 30-day mortality. Furthermore, Kaplan–Meier estimates of hospital survival according to the size of ΔPC/ΔT revealed that a blunted increase with ΔPC/ΔT ＜ 20.57 × 10⁹/L was associated with increased 30-day mortality. A blunted daily increase in PCs, especially ΔPC/ΔT < 20.57 × 10⁹/L, is associated with increased 30-day mortality, which provides prognostic information for mortality risk assessment in severely burned patients.     

5种天然植物提取物清除自由基和茶多酚抗辐射作用研究

目的 探讨天然植物提取物清除自由基及抗辐射损伤能力,为筛选有效的电离辐射防护剂提供实验依据.方法 对维生素C(VC)和5种天然植物提取物清除羟自由基和氧自由基的能力进行比较,根据实验结果选择茶多酚(TP)单独和联合VC作用评价抗辐射功能.动物实验设对照组、辐照组、TP组(2.5、25和250mg/kg),TP+VC组(2.5+2.5、25+25、250+75mg/kg);存活实验小鼠以6.0Gyγ射线照射,白细胞计数实验以3.5Gy γ射线照射.结果 VC和5种天然植物提取物清除羟自由基的能力依次为VC、TP、大蒜素、刺五加苷、螺旋藻、枸杞多糖,清除氧自由基的能力依次为VC、TP、大蒜素、螺旋藻、刺五加苷、枸杞多糖.6.0Gy γ射线照射后,存活率由高至低依次为对照组、TP高剂量、TP低剂量、TP中剂量、TP+VC中剂量、辐照组、TP+VC低剂量、TP+VC高剂量;3.5Gy γ射线照射后,各个给药组对照射后小鼠周围血白细胞计数均有明显影响.结论 大剂量γ射线照射后,小鼠的存活率和白细胞数目均下降;一定质量浓度的TP可明显提高小鼠的存活率,TP可能是通过清除自由基来达到抗辐射损伤作用.     

156例手足口病患儿脑脊液检验结果分析

目的:探讨手足口病(HFMD)患儿脑脊液有核细胞计数和生化检验结果的特点及其相互关系。方法:分析156例HFMD患儿的脑脊液有核细胞计数和生化检验数据。结果:HFMD患儿的脑脊液有核细胞计数升高者占82.0%,有核细胞计数升高的HFMD患儿脑脊液蛋白质和葡萄糖高于有核细胞计数正常者(P<0.05),两者之间氯离子相比差别无统计学意义。结论:对HFMD患儿进行脑脊液检验有利于对病情进行准确的判断和采取及时有效地治疗措施,对预后判断也有意义。     

衡阳市市售凉拌菜的卫生微生物质量监测

目的:了解衡阳市凉拌菜的总体微生物污染状况。方法:在2010年9月-2010年12月从超市、菜市场以及路边小摊采集各种凉拌菜,按照《食品微生物学检验》GB 4789-2010的方法检测。各指标参照国家标准GB 2726-2005进行结果评价。结果:共检测400份凉拌菜1,60份样品菌落总数超标1,76份样品大肠菌群数超标6,6份检出沙门菌;90份检出金黄色葡萄球菌;24份检出志贺菌。5种类型凉拌菜中,以豆制品的污染率最高。结论:本市凉拌菜的微生物污染较为严重。     

新生儿溶血病凝血功能变化的研究

目的 探讨新生儿溶血病凝血功能的变化及其临床意义.方法 以新生儿溶血病(溶血病组)、非溶血性高胆红素血症(非溶血病组)患儿各60例为研究对象,同期出生的60例正常足月儿为对照组.测定各组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板计数.结果 溶血病组PT、APTT明显高于非溶血病组[(28.79±4.21)s比(18.98±241)s和(58.52±313)s比(47.26±5.81)s],且两组明显高于对照组[(13.81±1.83)s和(38.10±3.00)s],差异有统计学意义(P<0.05),而血小板计数比较差异无统计学意义(P>0.05).结论 新生儿溶血病有出血倾向,与血小板计数无关,而与PT、APTT延长有关,溶血程度越重,PT、APTT升高越明显.PT、APTT可作为新生儿溶血病患儿凝血功能检测的指标和疗效评价指标.

Abstract：

Objective To investigate the clinical significance and coagulation function changes in newborn hemolytic disease. Method The newborn hemolytic disease ( 60 cases, hemolytic disease group ), non-hemolytic hyperbilirubinemia (60 cases, non-hemolytic hyperbilirubinemia group) and normal newborn (60 cases,control group) were selected as the study subjects, the prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured, and the blood platelet count at the same time was detected. Results PT and APTT in hemolytic disease group were higher than those in non-hemolytic hyperbilirubinemia group[(28.79 ?.21) s vs. (18.98?.41) s and (58.52?.13) s vs. (47.26?.81) s], and they were apparently higher than those in control group [(13.81 ?1.83) s and (38.10 ?3.00) s], the difference had statistic significance (P<0.05). There was no statistic significance to detect the blood platelet count (P> 0.05). Conclusions The newborn hemolytic disease has the bleeding tendency, and the bleeding tendency has no relationship with the quantity of the blood platelet, but relates to the extension of PT and APTT. The more serious the case is, the more obvious the PT and APTT rise. PT and APTT can be as the detection index and evaluating effect of the newborn hemolytic disease coagulation function.     

腹腔镜脾切除术治疗免疫性血小板减少性紫癜——单个教学医院经验

Background  High anatomic location, fragility, and generous blood supply of the spleen makes laparoscopic splenectomy (LS) difficult to master, and few patients need splenectomy for benign disorders. The aim of this research was to assess operative outcomes and hematological results of a large series of patients treated with LS for chronic immune thrombocytopenic purpura (ITP) and to determine which clinical variables predict favorable hematological outcome.

Methods  LS was successfully performed for 154 patients with chronic ITP from September 1999 to April 2009 at the First Affiliated Hospital of Sun Yat-sen University. Operative outcomes were assessed retrospectively. Long-term follow-up data were obtained from outpatient medical records and phone interviews. Clinical and laboratory variables (including gender, age, disease duration before surgery, previous response to steroids, preoperative platelet count, and postoperative peak platelet count) were evaluated by univariate analysis to identify potential predictors of hematological outcome. Multivariate Logistic regression model was used to determine independent predictors of hematological outcome.

Results  One patient died from subphrenic abscess and postoperative sepsis. The overall major morbidity rate was 8.4%. None of the patients required a second surgery for complications. Of the 127 patients available for a mean follow-up of 43.6 months (range 9–114 months), the overall initial response (i.e., at two months after LS) and long-term response to LS were achieved in 89.0% and 80.3%, respectively. Five patients (3.9%) developed pneumonia 3–35 months after LS. Univariate analysis showed a significant difference in mean age between responders (29.1 years) and nonresponders (38.8 years; P <0.05). Patients who responded to steroid therapy had better hematological outcome than those who did not respond (P <0.05). Compared to nonresponders, responders to LS had a significantly higher postoperative peak platelet count (404×10⁹/L versus 213×10⁹/L, P <0.001). Multivariate Logistic regression analysis identified postoperative peak platelet count as the only independent predictor of favorable response to LS ( P <0.001).

Conclusions  LS is a safe and effective treatment for chronic ITP. Postoperative peak platelet count may serve as a major predictor of long-term response.

     

Multi-central Clinical Research into Treating 80 Cases of Chronic Thrombocytopenia with Qi-supplementing and Yin-nourishing Therapy and Western Medicine

Objective: To probe the effects of qi-supplementing and yin-nourishing therapy (blood-increasing decoction and blood generating powder) on chronic thrombocytopenia. Methods: Two hundred patients with chronic thrombocytopenia were randomly divided into control (n=100) and test groups (n = 100) with Amino-polypeptide as a basic treatment for both. Test group patients consumed a blood-increasing decoction and blood-generating powder for 1-3 months. Improvements in platelet counts and TCM syndrome were observed...     

小剂量米非司酮对女性生殖/内分泌系统的影响

目的探讨小剂量米非司酮对女性生殖/内分泌系统的影响。方法选取子宫腺肌病患者31例,服用米非司酮4个月。检测用药前后血雌二醇（estradiol,E2）、促卵泡素（Follicle-stimulating hormone,FSH）、谷丙转氨酶（glutamic-pyruvic transaminase,GPT）、肌酐（creatinine,Cr）及用药前后卵巢体积、子宫体积及子宫内膜增殖细胞核抗原（proliferation cell nuclear antigen,PCNA）指数。结果治疗后E2水平[（131.68±40.31）pmol/L]较治疗前E2水平[（255.90±152.61）pmol/L]明显下降,差异有统计学意义（P〈0.05）;治疗前后FSH水平差异无统计学意义（P〉0.05）。②卵巢体积[（10.68±0.24）cm3]及子宫体积[（64.20±1.04）cm3]均小于治疗前[（14.25±0.51）cm3、（81.42±1.01）cm3],差异有统计学意义（P〈0.05）。③治疗后内膜转化率为33.3%,部分内膜发生增生过长;治疗前后内膜PCNA指数差异无统计学意义（P〉0.05）。④治疗前后血GPT、Cr差异无统计学意义（P〉0.05）。结论小剂量米非司酮对垂体具有雌激素样的负反馈作用;同时通过抗雌激素样作用直接作用于卵巢,使卵巢激素缺乏周期性变化而出现闭经,并伴随卵巢、子宫缩小及更年期症状;还对子宫内膜具有微弱的雌激素样作用。     

赣州地区 Sysmex XE-2100自动血细胞分析和白细胞分类的复检规则探讨

目的:通过对实验数据进行分析,在国内专家提出的适合中国人群使用的Sysmex XE-2100自动血细胞分析和白细胞涂片复检规则的基础上,提出适合于赣州地区人群使用的XE-2100血细胞涂片复检规则.方法:采用XE-2100五分群全自动血细胞分析仪,随机检测患者标本1 820份,同时将血液涂片染色后做显微镜检查,按照国内...