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OBJECTIVE@#To investigate the influencing factors on prognosis of adult patients with chronic primary immune thrombocytopeuia (ITP) after rituximab treatment and predictive value of platelet (Plt) count.@*METHODS@#Clinical data of 52 adult patients with chronic primary ITP treated with rituximab from January 2012 to December 2016 were retrospectively analyzed, including 32 patients for failed in treatment as group A and 20 patients for succeeded in treatment as group B. The independent risk factors influencing the clinical efficacy of rituximab were analyzed. The influence of CD41 megakaryocyte count in bone marrow diagnosed for first time on the response rate of patients with 1-year followed-up were observed, and the Plt count were calculated to predict the clinical efficacy index and the best cut-off point.@*RESULTS@#The CD41 megakaryocyte count in bone marrow for first time treatment in group B were significantly higher than that in group A (P＜0.05). Multivariate Logistic regression analysis showed that the number of CD41 megakaryocytes in bone marrow＜150 at first diagnosis was the independent risk factor influencing the clinical efficacy of rituximab (OR=5.40，95%CI：1.82-15.66，P=0.00). The response rate of 1-year followed-up in patients with CD41 megakaryocyte count ≥150 at first diagnosis was significantly higher than that of CD41 megakaryocyte count ＜150 (P＜0.05). The Plt count level in group B was significantly lower than that in group A at the 3rd, 14th, 21th, 30th, 60th, 90th, 180th, 270th and 360th days after first treatment with rituximab (P＜0.05). ROC curve analysis showed that the best cut-off point for Plt count was 50×10/L and AUC was 0.68 at the 14th day after first treatment with rituximab (95%CI: 0.57-0.78, P=0.00). The predictive sensitivity and specificity of clinical efficacy in adult patients with chronic primary ITP treated with rituximab were separately 48.73% and 87.58%, and the AUC in 30th and 60th day after rituximab treatment were separately 0.74 (95%CI: 0.64-0.87, P=0.00), 0.93 (95%CI：0.82-0.98，P=0.00).@*CONCLUSION@#Adult patients with chronic primary ITP may possess long-term remission after rituximab treatment, but the prognosis is poor for patients with bone marrow megakaryocyte count ＜150. The Plt counts in 14th, 30th and 60th days after rituximab treatment can effectively predict the long-term clinical efficacy and guide the formulation of treatment plans.

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Objective To study the effects of taking clopidogrel on relevant indicators of platelet aggregation function in 138 cases acute coronary syndrome (ACS) .Methods The platelet function analyzer and flow cytometry were adopted to detect the ADP‐induced platelet aggregation rate ,P selectin and activated GP Ⅱ b/ Ⅲ before medication and on 7 d after taking clopidogrel . Results The platelet aggregation rate after taking clopidogrel for 7 continuous d was decreased significantly (P<0 .01);the P se‐lectin level and activated GP Ⅱ b/ Ⅲ a expressed on platelet surface were significantly reduced (P<0 .01) as well .Conclusion Taking clopidogrel could reduce the platelet aggregation significantly in the patients with ACS and has the effect for inhibiting the platelet aggregation .

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Objective To observe the curative effect of low molecular heparin for treating secondary high coagulation state in the patients with nephrotic syndrome(NS) .Methods Total 87 cases of NS in our hospital were divided into the conventional treat‐ment group (n=42) and the low molecular heparin treatment group (n=45) .The routine treatment group was given the prednisone treatment and the low molecular heparin treatment group was treated by low molecular heparin combined with prednisone .The re‐lated indicators of blood coagulation before and after treatment were detected and the clinical curative effects in two groups were an‐alyzed .Results The coagulation related indicators in the conventional treatment group had no statistically significant difference be‐tween before and after treatment (P>0 .05) ,the prothrombin time(PT) and activated partial thrombin time(APTT) after treat‐ment in the low molecular heparin treatment group were significantly extended compared with before treatment ,while the concen‐trations of D‐dimer and fibrinogen were significantly decreased and the concentration of antithrombin Ⅲ was markedly increased compared with before treatment ,showing statistically significant differences between the two groups (P<0 .05);the patients of the low molecular heparin group patients had no bleeding after treatment .Conclusion Low molecular heparin combined with predni‐sone can reduce the secondary high condensation state in NS without bleeding and has a significantly clinical effect .

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<p><b>BACKGROUND AND OBJECTIVE</b>125I seed implantation treatment of pulmonary metastases, often because of complicated structure of the chest, was considered as restricted areas. The aim of this study is to evaluate the effectiveness of CT guided radioactive 125I seed implantation in treating lung metastatic tumors.</p><p><b>METHODS</b>Totally 115 metastatic masses were found in 30 patients with CT guiding. 125I seeds were implanted into lung metastatic masses. The approach of implantation was determined according to the location of the lesions (hilar masses, peripheral masses and masses covered by skeletal thorax). The therapeutic effects were evaluated by CT.</p><p><b>RESULTS</b>Uniform distribution were achieved by single puncture in 84.3% of patients. The rest patients (15.7%) were received replanting. The follow-up period was 6-24 months (mean 14.6). Among 115 lesions in 30 cases, complete response (CR) was achieved in 80 nodes, partial response (PR) in 20 nodes, No change (NC) in 8 nodes and progressive disease (PD) in 7 nodes. The total response rate was 86.9%. The one-year local control rate were 93.9% (108/115). No severe perioperative complications occurred.</p><p><b>CONCLUSION</b>CT guided radioactive seed 125I implantation is a safe and effective procedure in treating multiple lung metastatic tumor with minimal invasion.</p>

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