This paper aims to review the current understanding and advances in knowledge of thyroid eye disease(TED)with a focus on Asian population. TED can significantly impact quality of life, and has devastating consequences, including facial disfigurement and vision loss. Recent findings revealed a novel targeted therapy against TED, including teprotumumab, a human monoclonal antibody that inhibits the insulin-like growth factor-1 receptor. Teprotumumab was found to reverse the disease process in patients with active, moderate-to-severe TED. A randomized clinical trial of this drug compared to placebo showed significant improvement in clinical activity score, proptosis, subjective diplopia, and quality of life at 4 months follow-up in the treatment group. In this paper, we review the current epidemiology, pathophysiology, and advances in management of TED.

Objective: To assess the role of T cell immunoglobulin and mucin domain-containing protein 3 (TIM-3) in regulation of interleukin (IL) -12 secretion by CD14⁺ peripheral blood monocytes from patients with psoriasis vulgaris. Methods: From November 2017 to March 2018, a total of 47 patients with psoriasis vulgaris (psoriasis group) and 19 healthy volunteers (control group) were enrolled from Shanxi Provincial People′s Hospital. Peripheral blood mononuclear cells (PBMC) were isolated, and stimulated with Toll-like receptor (TLR) ligands. TIM-3 expression and IL-12 secretion by CD14⁺ monocytes were measured by flow cytometry. After blockade of TIM-3 pathway by anti-TIM-3 neutralizing antibody, changes in the downstream signaling pathway molecules in and IL-12 secretion by CD14⁺ monocytes were investigated. Two independent samples t-test was used for comparison between two groups, and Pearson correlation test for correlation analysis. Results: Under the unstimulated condition, the level of IL-12 secreted by CD14⁺ monocytes was very low, and the proportion of CD14⁺ TIM-3⁺ cells was significantly higher in the psoriasis group (12.20% ± 2.83%) than in the control group (9.91% ± 1.77%, t = 3.270, P = 0.001 7) . After the stimulation with TLR ligands, the proportion of CD14⁺ IL-12⁺ cells was significantly lower in the psoriasis group (13.49% ± 2.80%) than in the control group (28.97% ± 8.97%, t = 10.71, P < 0.000 1) , but the proportion of CD14⁺TIM-3⁺ cells was still higher in the psoriasis group (6.80% ± 1.11%) than in the control group (4.85% ± 1.37%, t = 6.064, P < 0.000 1) . The proportion of CD14⁺TIM-3⁺ cells was negatively correlated with that of CD14⁺ IL-12⁺ cells in both the control group and psoriasis group (r = -0.473, -0.371 respectively, both P < 0.05) . The TIM-3 pathway blockade could induce the decrease of suppressor of cytokine signaling 1 in CD14⁺ monocytes, increase the phosphorylation of signaling transducers and activators of transcription 1, and promote IL-12 secretion by CD14⁺ monocytes induced by keratinocytes isolated from psoriatic skin lesions. Conclusion TIM-3 plays a crucial role in the negative regulation of CD14⁺ monocyte-induced innate immune response in psoriasis.

AIM:To observe and analyze the effect of non-mydriatic fundus photography in screening diabetic retinopathy(DR), so as to provide the basis for clinical screening.

METHODS:In our hospital from December 2016 to November 2017, 120 patients(240 eyes)was diagnosed as diabetes(DM), which were treated as the subjects of observation. By the same operator with non-mydriatic fundus photography, fundus photography and 7 range fundus fluorescein angiography(FFA)after mydriasis were taken. Taking the international clinical classification of diabetic retinopathy(DR)as the standard, the above three examinations were review, grade and record by the same physician by blind method. The fundus fluorescein angiography as the gold standard, the other two results were compared to detect the sensitivity, specificity, Youden index, Kappa value of the two for DR with different grade.

RESULTS: There was 70.0% eyes diagnosed as diabetic retinopathy after screened by fundus angiography, 66.7% by post-mydriatic fundus photography, 65.0% by non-mydriatic fundus photography. The grading results of diabetic retinopathy screened by different methods were basically consistent, with no significant difference(P>0.05). When screening for diabetic retinopathy of different degrees, the sensitivity and specificity of the non-mydriatic group were 92.9% and 90.3%, respectively. There was no significant difference between the results of the non-mydriatic group and the non-mydriatic group. Compared with the gold standard group(FFA), the Youden index(83.14%)was close to 1, with high reliability; Kappa=0.81, and the validation was consistent. When screening for moderately nonproliferative diabetic retinopathy, the sensitivity and specificity of non-mydriatic fundus photography were 90.6% and 95.5%; there was no significant difference between the results of non-mydriatic and the results of fundus photography after mydriasis. Compared to the gold standard group, the Youden index was 86.09%, the reliability is high, Kappa=0.86, and the test was consistency.

CONCLUSION:Non-mydriatic fundus photography can be used as a simple and accurate method for screening diabetic retinopathy. It is simple and easy to carry out without risk. It is easy to train specialist technicians for multi-point operation. With the help of today's convenient network, the image is transmitted to an experienced ophthalmologist for reading and diagnosis, which is convenient and fast, so that the patient can be diagnosed and treated nearby, which has positive significance for the society.

ObjectiveTo compare the efficacy of sodium morrhuate versus lauromacrogol in the treatment of hepatic cyst. MethodsSeventy-four patients with hepatic cyst who were admitted to our hospital from January 2009 to May 2013 were enrolled as subjects and divided into two groups. After the cystic fluid was drained by percutaneous liver biopsy, sodium morrhuate solution was injected into the cystic cavity for adhesion and sclerosis in 46 patients in group A, and lauromacrogol solution was injected in 28 patients in group B. The incidence rates of pain in patients during and after surgery were compared between the two groups. The follow-up comparison of hepatic cyst recurrence rates within one year after surgery was performed between the two groups. Between-group comparison was performed by χ2 test. ResultsFive patients (10.87%) in group A and two patients (7.14%) in group B had recurrence within one year after treatment. There was no significant difference in recurrence rate between the two groups (χ2=0.283, P＞0.05). The incidence of pain in group A was significantly higher than that in group B (χ2=5.258, P＜0.05). ConclusionWith the same efficacy as sodium morrhuate in the treatment of hepatic cyst, lauromacrogol can be routinely used as a sclerosing agent due to its mild side effects.

Neonatal neutropenia is classified into early-onset and late-onset neutropenia. Causes of neutropenia include decreased production, increased destruction, margination in the microvascular endothelium, sequestration in the spleen, or a combination of mechanisms. Neutropenia often accompanied by an increased risk of bacterial infection, and sometimes it may be a hint of some rare severe diseases. In this article, we review advances in classification, pathogenesis, diagnosis and treatment of neonatal neutropenia.

Objective To explore the mediating effect of social support on the relationship between negative emotion and coping style in human immunodeficiency virus (HIV)-infected pregnant women. Methods A total of 202 HIV-infected pregnant women were enrolledby a convenient sampling method in this study. Participants completed questionnaires including social support rating scale (SSRS), knowledge, attitudes and practices scale for preventing mother-to-child transmission of human immunodeficiency virus (KAPS-PMTCT), selPrating anxiety scale (SAS), selrating depression scale (SDS), Berger HIV stigma scale (BHSS), and simplified coping style questionnaire (SCSQ). The relationships of these variables were analyzed by Pearson correlation analysis and structure equation modeling analysis. Results The correlations between negative emotion, social support and coping style were all significant. Social support was negatively correlated with negative emotion (P<0. 05) and negative coping style (P<0. 01), and was positively correlated with positive coping style (P<0. 01). Negative emotion was weakly negatively correlatedwith positive coping style (P < 0. 07), and was strongly positively correlated with negative coping style (P<0. 01). Structure equation modeling analysis showed that negative emotion indirectly affected the coping style of HIV-infected pregnant women mainly through the mediating effect of social support (x2/df=1. 835, foodness of ht index [GFI]=0. 975, adjusted goodness of ft index [AGFI]=0. 961, normed bt index [NFI]=0. 950, incremental bt index [IFI]=0. 938, comparative bt index [CFI] =0. 981, parsimony comparative fit index [PCFI]=0. 452, root mean square error approximation [RMSEA]=0.064), with the total amount of mediating effect of the positive coping style and negative coping style being -0.273 and 0.522, respectively. Conclusion Social support is an important mediator between negative emotion and coping style in HIV-infected pregnant women.

Objective::To observe the clinical efficacy of Dahuang Zhuyu decoction for oral administration and enema on severe acute pancreatitis with syndromes of blood stasis and toxin and its effect on serum inflammatory factors. Method::Sixty eight patients with severe acute pancreatitis with syndromes of blood stasis and toxin who were admitted in Henan Provincial People's Hospital from September 2017 to December 2018 were randomly divided into treatment group (34 cases) and control group (34 cases). The control group was treated with western medicine. The treatment group was treated with Dahuang Zhuyu decoction for oral administattion and enema in addition to the therapy of the control group. Both groups were treated for 7 days. Before and after treatment, abdominal pain, bloating, nausea and vomiting were scored separately, serum amylase (AMS), lipase (LPS), interleukin-6 (IL-6), interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α) were detected, and abdominal pain disappearance time, bloating disappearance time and exhaust recovery time were recorded. Result::After treatment, the abdominal pain score, abdominal distension score, nausea and vomiting score, serum AMS, LPS, IL-6 and TNF-α were lower than those before treatment (P<0.05), and those in treatment group was lower than those in control group (P<0.05). After treatment, IL-10 level in both groups was higher than those before treatment (P<0.05), and that in treatment group was higher than that in control group (P<0.05). The disappearance time of abdominal pain, the disappearance time of abdominal distension and the recovery time of exhaust were shorter in treatment group than in control group (P<0.05). The total effective rate of the treatment group was higher than that of the control group (P<0.05). Conclusion::Dahuang Zhuyu decoction for oral administration and enema for severe acute pancreatitis with syndromes of blood stasis and toxin can alleviate clinical symptoms, reduce amylase and lipase levels, inhibit the expression of pro-inflammatory factors, promote the expression of anti-inflammatory factors, restore intestinal function, and improve clinical efficacy.