The reduction of peripheral blood cells is a common and serious complication in hepatic cirrhosis portal hypertension patients with splenomegaly, and severely affects the prognosis.Its reasons include hypersplenism and non-hypersplenism factors.We should correctly understand these two factors.Hypersplenism factors is common, and non-hypersplenism factors, including the toxic effects of virus on the bone marrow, liver cirrhosis, hepatosis, immunodeficiency, the toxic effects of drugs, dystrophia, the destruction of platelets in blood circulation and hemorrhage.Etiological treatment and liver transplantation is the main treatment.Now, treatment of the reduction of peripheral blood cells has become an important topic.In this paper, the causes and treatments of peripheral blood cytopenias, which were caused by non-hypersplenism factors in the patients of liver cirrhosis and portal hypertension, were reviewed.

Background Dry eye is a common disease worldwide.Cyclosporine A(CsA) is provided to be a immunosuppressive agent and is effective on dry eye.But in China,0.05％ CsA is not yet applied in dry eye treatment.Objective This study was to evaluate the efficacy and safety of 0.05％ CsA eye drops in the treatment of dry eye.Methods This was a randomized,double-blind,vehicle-controlled parallel group study.Forty eyes of 40 patients with moderate to severe dry eye were randomly divided into two groups,with the corresponding treatment of 0.05％ CsA eye drops or the vehicle emulsion.The patients in both the groups received non-preserved artificial tear.Symptoms and signs were observed before administration,(7±1),(28±2),(56±3),and (84±3) days and also 14 days after withdrawal.The clinical effective rate was considered as the primary outcome.The subjective assessment of the patients including total symptom scores and ocular surface disease index (OSDI) scores,Schirmer Ⅰ test (S Ⅰ t) with topical anaesthesia,tear film breakup time (BUT),rose Bengal and fluorescein staining scores were evaluated.The safety profile was evaluated by adverse events,visual acuity and ocular tolerance.Results At the end of this trial,the ocular symptoms scores,conjunctival hyperemia,BUT,S Ⅰ t and keratoconjunctiva staining scores of the two groups had statistically significant difference.The total effective rate of 0.05％ CsA treatment group was 75％ (15/20) and vehicle group was 25％ (5/20).There was a statistically significant difference between groups (P =0.000),and the 95％ confidence interval (C1) of the difference value of total effectiveness between the two groups was 30.80％-53.75％.At the end of this trial,there was no statistically significant difference in visual acuity distribution (P =0.890).No obvious discomfort was found in the patients received 0.05％ CsA eye drops.There were no adverse events during the follow-up duration.Conclusions 0.05％ CsA ophthalmic emulsion is an effective and safe treatment for dry eyes.

Forty two resident general practitioners (GPs) attending obstetrics and gynecology course in Beijing Hospital were divided into trial group and control group with 21 in each group. The 2-hour study content uterine fibroids was taught by the same teacher. For control group the traditional classroom teaching mode was used, while for the trial group the WeChat-based flipped classroom model was used. The teaching effectiveness was evaluated by means of paper examination, critical examination and questionnaire survey. The average scores and the clinical reasoning scores of trial were significantly higher than those of control group [(90.5±3.4) vs. (82.5±4.2) points and (94.5±1.5) vs. (84.5±2.0) points; t=4.28, P<0.05 and t=5.01, P<0.05, respectively]. Compared with the control group, the trial group presented more learning interest, higher learning efficiency and self-learning ability; and also the ability of expression and communication was improved, the ability of teamwork and the ability of analyzing and solving problems was enhanced more markedly in trial group (all P<0.05). The result indicates that WeChat-based flipped classroom teaching model can improve the learning efficiency in general practice residency training.

Objective To study the role of risk factors associated with hemodynamics in patients with intracranial artery stenosis.Methods Eighteen patients with local stenosis of middle cerebral artery were recruited in this study retrospectively.According to patients′clinical symptoms and magnetic resonance imaging findings, they were divided into the symptomatic group (n=13) and the asymptomatic group (n=5).Wall shear stress ( WSS) , oscillatory shear index ( OSI) , velocity and pressure of the stenotic artery wall were compared between the two groups after reconstructing 3-dimentional model of hemodynamics.Then related risk factors of hemodynamics were analyzed in symptomatic intracranial atherosclerotic stenosis.Results There were no statistically significant differences between the two groups in the parameters such as age, sex, degree of artery stenosis, mean arterial pressure and some medical histories of hypertension and diabetes.The results showed obvious changes of hemodynamics in local artery stenosis.The WSS(78.69(68.15,117.65) Pa vs 39.34(22.76,60.54) Pa,U=4,P=0.003), pressure of the stenotic artery wall (1 815.14(1 242.44,4 398.84) Pa vs 735.55(361.17,1 528.78) Pa,U =7,P=0.010)and velocity of the local stenosis(3.87(2.58, 4.52) m/s vs 2.31(1.38,3.12) m/s,U=12,P=0.046) in the symptomatic group were much higher than those in the asymptomatic group; however, there were no significant differences between the two groups in OSI.Conclusions Hemodynamic features do exist in local intracranial atherosclerotic stenosis.The WSS, wall pressure and velocity of the local stenosis may be vital risk factors associated with symptomatic intracranial atherosclerotic stenosis.

Objective To compare the expressions of Beclin 1 and its 11 interacting proteins in subcutaneous fat and visceral fat,and to observe the expressions of these genes in 3T3-L1 adipocytes differentiation process.Methods In 3T3-L1 adipocytes,cells were harvested at day 0,2,4,6,8 in differentiation process,and then proteins or mRNAs were obtained and followed with Western blot and realtime PCR.Mice tissue proteins or mRNAs were detected with Western blot and realtime PCR.Results In 3T3-L1 adipocytes differentiation process,expressions of LC3,Beclin 1,and TNFAIP3 continued to rise,expression of BIRC5 was high to low,FEZ1 continued at a low level.In mice,expressions of LC3,Beclin 1,YWHAQ,FEZI,BAD,WAC,TNFAIP3,and GOPC in visceral fat were significantly higher than those in subcutaneous fat,while expression of SLAMF1was higher in subcutaneous fat.Conclusion Autophagy plays an important role in 3T3-L1 differentiation process and may be tissue-specific in visceral fat and subcutaneous fat.

Objective To investigate the morphological changes of the head,body and tail of the hippocampus in patients with Alzheimer's disease (AD).Methods Totally 30 AD (AD group),30 mild cognition impairment (MCI) patients (MCI group) and 30 normal old persons (normal control group) underwent brain MR scan.Based on the MR images,the head,body and tail of the hippocampus were segmented and the volume was measured.The difference of the volume in total,head,body and tail of hippocampus in AD group,MCI group and normal control group were compared.The correlation between hippocampal volume and the scores of neurological assessment scale was analyzed.Results The left total,head,body and tail volume were greater than those of the right side in 3 groups (all P＜0.05).For the comparison of total volume of left and right sides among the 3 groups,AD group was less than normal control group (both P＜0.01) and MCI group (both P＜0.05),MCI group was less than normal control group (both P＜0.05).Compared with the normal control group,the head,body and tail volume of hippocampus of both sides were decreased in AD group (all P＜0.05) and the volume of left head,body and right head of hippocampus in MCI group were decreased (all P＜0.05).Both sides hippocampus's head and body volume of AD group were less than those of MCI group (both P＜0.05).The scores of minimum mental state examination (MMSE) were positively correlated with the total and the head,body,tail volume of bilateral hippocampus.Except volume of left tail,there were negative correlations between the scores of activities of daily living (ADL),clinical dementia rating (CDR) and the volume of total and head,body,tail of bilateral hippocampus,which were positively correlated with Montreal cognitive assessment (MoCA) score.Conclusion The volume of bilateral hippocampus was significantly reduced in AD patients.The head of hippocampal volume was significantly reduced and the body and tail was not obvious.

Objective To assess whether FICE or IC is more effective at detecting colonic diseases.Method We searched PubMed, CINAHL, CQVIP and the Cochrane Library databases for relevant papers published between January 2008 and August 2013 using the following keywords: lfexible spectral imaging color enhancement, indigo carmine, colonoscope, colonic lesions, colon tumor and chromoendoscopy. We included eight articles, and all data were subdivided for analysis.Results We used odds ratios (OR^s) with 95 % conifdence intervals (CIs) to assess correlations between the detection methods and detection rates. The detection rates did not signiifcantly differ between FICE and IC for colonic tumor lesions (OR^ = 0.90, 95 % CI: 0.76~1.08,P = 0.255), non-tumor lesions (OR^ = 1.09, 95 % CI: 0.92~1.30,P = 0.302), adenomas (OR^ = 0.87, 95 % CI: 0.72~1.07,P = 0.188), non-neoplastic polyps (OR^ = 0.84, 95 % CI: 0.67~1.06,P = 0.146), lfat lesions (OR^ = 0.87, 95 % CI: 0.71~1.08,P = 0.203), protruded lesions (OR^= 1.23, 95 % CI: 0.93 ~ 1.64,P = 0.153), right colon lesions (OR^ = 0.83, 95 % CI: 0.60 ~ 1.14,P =0.251), transverse colon lesions (OR^ = 0.71, 95 % CI: 0.48~1.05,P = 0.086), or left colon lesions (OR^ = 1.35, 95 % CI: 1.01 ~ 1.80,P = 0.045).Conclusions There were no signiifcant differences in the rate of colonic lesion detection between FICE and IC except the left colon. Therefore, providers should choose a suitable inspection method based on the resources of the hospital.

Objective:The purpose of our study was to assess the clinical value of ultrasound in the diagnosis of retroaortic left renal vein (RLRV) behind abdominal aorta.Methods:The ultrasound images of patients with RLRV diagnosed by ultrasound in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from 2013 to 2018 were retrospectively analyzed. The general information, clinical symptoms, ultrasound images and other clinical data of the patients were collected and analyzed.Results:RLRV was detected in 16(0.46%) cases of the 3 519 patients from 2013 to 2018 using ultrasonography, and the male to female ratio was 11 to 5. All patients presented with hematuria, including 7 patients with other symptoms, such as left flank pain. Ultrasound were firstly performed in all patients. Of the 16 patients, 15(93.75%) cases were of complete retroaortic type Ⅰ, including 13(81.25%) cases with left renal vein compression and 2(12.5%) cases with complete retroaortic type without left renal vein compression. In 16 cases, 1 case (6.25%) was type Ⅲ, with compression of both branches.Conclusions:Ultrasound may be the preferred method for the left renal vein examination when a clinical suspicion of Nutcracker syndrome is required. Ultrasound can clearly show the left renal vein in most patients, to determine whether the left renal vein is mutated or compressed. Ultrasound has the highest sensitivity for detecting the type Ⅰ, which is not easy to misdiagnose. However, type Ⅲ is easy to misdiagnosis. Whereas the type Ⅱ and type Ⅳ is difficult to detect using ultrasound, which may be related to the limitations of ultrasound imaging.

Brown-Sequard Syndrome ; etiology ; Cervical Vertebrae ; Humans ; Intervertebral Disc Displacement ; complications ; surgery ; Male ; Middle Aged

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