Objective:To analyze the clinical characteristics of patients with spontaneous splenorenal shunt (SSRS) in liver cirrhosis, and to compare the effects and prognosis of different treatments.Methods:The data of cirrhotic patients with SSRS at the First Affiliated Hospital of Zhengzhou University between 2016-2022 were retrospectively analyzed.Patients were divided into Group A receiving conservative treatment, Group B by simple embolization, Group C undergoing TIPS combined with embolization, and Group D given liver transplantation. Life status, liver function changes, incidences of adverse events, and survival between groups were compared.Results:SSRS diameter was positively correlated with blood ammonia ( R=0.478) and negatively correlated with portal vein diameter ( R=-0.301). SSRS diameter is a protective factor for gastrointestinal hemorrhage and ascites and a risk factor for hepatic encephalopathy; Blood ammonia decreased and prothrombin time prolonged after treatment in group A ( P<0.05), blood ammonia decreased and albumin increased in group B ( P<0.05). Hemoglobin and bilirubin increased in group C ( P<0.05), blood ammonia and bilirubin decreased and platelets and albumin increased in group D ( P<0.05); Survival analysis showed that the prognosis of groups A and C was related to liver function, and the survival rate of group D was the highest of all ( P<0.05). Conclusions:SSRS embolization is safe and effective, and liver transplantation improves patient survival. Individualized treatment should be selected based on patient symptoms, liver function, and shunt diameter.

Objective:To investigate the computed tomography(CT)and magnetic resonance imaging(MRI)features of retroperitoneal ded-ifferentiated liposarcoma(DDL),and improve the understanding of DDL and the accuracy of preoperative diagnosis.Methods:Clinical and imaging features of 25 patients with retroperitoneal DDL from Tianjin Medical University Cancer Institute&Hospital,confirmed by patho-logy from January 2012 to June 2022,were retrospectively analyzed.Results:Among 25 cases of retroperitoneal DDL,19 and 6 had single and multiple tumors,respectively and 10 and 15 were oval and irregular shaped tumors,respectively.Most lesions had unclear boundaries,with 15 cases invading the surrounding tissues and organs.Small vessel shadows were visible in 15 cases,while calcifications or ossifications were observed in 7 cases,and cystic necrosis was observed in only 3 cases.Enhanced scanning exhibits a centripetal and progressive con-tinuous augmentation characteristic defined as"slow in and slow out."According to its manifestations in CT and MRI,it can be divided into two types:type I(soft tissue mass type),where the tumor has a soft tissue component with no fat content(14 cases);and type Ⅱ(fat con-taining),where the tumors exhibit both soft tissue and adipose components,most of which are clearly defined and rarely present in a mosa-ic shape.In abnormal fat areas,cord-like fibrous septa can be seen.Among them,the intratumoral fat composition<50%was Ⅱa type(10 cases).Intratumor fat composition≥50%was type Ⅱb(1 case).Conclusions:Combined with imaging classification,a comprehensive ana-lysis of the CT and MRI imaging characteristics of retroperitoneal DDL is of great value for its preoperative qualitative diagnosis.

Objective:To compare the clinical efficacy and safety of intra-articular platelet rich plasma combined with hyaluronic acid and platelet rich plasma alone in the treatment of knee osteoarthritis.Methods:The relevant literatures published between January 2010 and December 2021 on the randomized control study of intra-articular injection of platelet rich plasma and hyaluronic acid and injection of platelet rich plasma only in the treatment of knee osteoarthritis were searched. The bias risk of all the literatures included in the study was evaluated by Revman 5.3 software, and the data were processed and analyzed by Stata 16.0 software. The standardized mean difference ( SMD) was calculated for the difference of efficacy indexes, and the difference was compared by t- test. The odds ratio ( OR) was calculated for the difference of safety in-dex, and the difference was compared by t- test. Results:①A total of 7 relevant research literatures were in-cluded, all of which were in English. ②A total of 675 patients were included in the study, of which 330 patients were treated with intra-articular injection of platelet rich plasma and hyaluronic acid, and 345 patients were treated with intra-articular injection of platelet rich plasma only. ③The VAS scores of patients with platelet rich plasma and hyaluronic acid injection combined with injection and platelet rich plasma injection alone were compared. After 1 and 3 months of injection, the VAS scores of patients with platelet rich plasma combined with hyaluronic acid injection were compared with those of patients with platelet rich plasma injection only. There was no significant difference[ SMD(95% CI)=-0.02(-0.30, 0.27), t=-0.12, P=0.902; SMD(95% CI)=-0.40(-0.80, 0.00), t=-1.97, P=0.051]. After 6 months of injection, the VAS scores of patients with combined injection of platelet rich plasma and hyaluronic acid were significantly lower than those of patients with injection of platelet rich plasma only, and the difference was statistically significant [ SMD(95% CI)=-0.33 (-0.55, -0.11), t=-2.98, P=0.012]. ④The WOMAC scores of patients with combined injection of platelet rich plasma, hyaluronic acid and platelet rich plasma only were compared. After 12 months of treatment, the WOMAC scores of patients with combined injection of platelet rich plasma and hyaluronic acid were significantly higher than those of patients with PRP only, and the difference was statistically significant [ SMD(95% CI)=-0.30(-0.58, -0.03), t=-2.14, P=0.033]. ⑤The incidence of adverse events of platelet rich plasma combined with hyaluronic acid was lower than that of platelet rich plasma only [ OR(95% CI)=0.55(0.33, 0.93), P=0.021]. Conclusion:Compared with intra-articular injection of platelet rich plasma only, the short-term clinical efficacy of combined injection of platelet rich plasma and hyaluronic acid is equivalent to that of injection of platelet rich plasma only, but the long-term clinical efficacy is significantly better, and the safety of combined injection of platelet rich plasma and hyaluronic acid is significantly better.

BackgroundDepression is a kind of disease with relatively high suicide risk， which seriously affects the quality of life of patients and their families， and brings a great burden to society. Antidepressants in western medicine are effective， but the improvement of depressive symptoms is relatively limited by single use， and the combination of two antidepressants may increase the risk of adverse reactions in patients. The rational use of Chinese patent medicine and western medicine may play a complementary role， and the safety of Chinese patent medicine is high. ObjectiveTo explore the early clinical efficacy of fluoxetine combined with Shugan Jieyu capsule in the treatment of depression， and to compare the differences in efficacy， safety and influence on heart rate variability between fluoxetine combined with Shugan Jieyu capsule and fluoxetine alone， so as to provide references for clinical medication of depression patients. MethodsFrom December 2015 to June 2016， 64 patients who met the diagnostic criteria of depression in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） who were hospitalized in the Second Affiliated Hospital of Xinxiang Medical University were selected as the research objects， and were randomly divided into the combined medication group and the fluoxetine group with 32 patients in each group. Patients in both groups were treated with fluoxetine， while patients in the combined medication group were treated with Shugan Jieyu capsule on this basis. Patients in both groups were assessed with Hamilton Depression Scale-24 item （HAMD-24）， Hamilton Anxiety Scale （HAMA） and Heart Rate Variability （HRV） before treatment， and were assessed with HAMD-24 and Treatment Emergent Symptom Scale （TESS） at the end of the 2^nd， 4^th and 6^th week of treatment， and HRV was analyzed again at the end of the 6^th week of treatment. ResultsThe study ultimately included 60 patients with depression， with 30 cases in the combination therapy group and 30 cases in the fluoxetine group. At the end of the 2^nd， 4^th and 6^th week of treatment， the HAMD-24 score of the combined drug group was lower than that of the fluoxetine group （t=-2.677， -3.960， -4.432， P<0.05 or 0.01）. Compared with before treatment， the 24-hour mean standard deviation of normal RR intervals （SDNN）， normal low frequency （nLF） and normal high frequency （nHF） in the combined treatment group were higher at the end of the 6^th week （t=-73.970， -31.878， -38.721， P<0.01）， but significant lower in LF/HF （t=3.525， P<0.01）. At the end of the 6^th week of treatment， the total effective rate of the combined treatment group was higher than that of fluoxetine group， and the difference was statistically significant （86.67% vs. 70.00%， χ²=18.764， P<0.01）. At the 2^nd， 4^th and 6^th week of treatment， there was no significant difference in the number of adverse reactions between the two groups （P>0.05）. ConclusionCompared with fluoxetine alone， Shugan Jieyu capsule combined with fluoxetine may be better in clinical efficacy and improvement of heart rate variability in patients with depression， without increasing adverse reactions.

Objective:To compare the clinical efficacy and safety of intra-articular injection of platelet rich plasma and hyaluronic acid in the treatment of knee osteoarthritis.Methods:The relevant literatures including the randomized control study of intra-articular injection of platelet rich plasma and hyaluronic acid in the treatment of knee osteoarthritis published from January 2010 to December 2021 were searched. The bias risk of the included literatures was evaluated by Revman 5.3 software, and the data were processed and analyzed by Stata 16.0 software. The weighted mean difference ( WMD) was calculated for the difference ofefficacy indexes, and the difference was compared by t-test. The odds ratio ( OR) was calculated for the difference of safety index, and the difference was compared by t-test. Results:① A total of 10 literatures were included, all of which were in English. ② A total of 921 patients were included in the study, of which 479 patients were treated with intra-articular injection of platelet rich plasma and 442 patients were treated with intra-articular injection of hyaluronic acid. ③ Comparing the VAS scores of platelet rich plasma injection and hyaluronic acid injection, the visual analogue scale (VAS) scores of platelet rich plasma injection patients were significantly lower than those of hyaluronic acid injection patients after 6 and 12 months of injection treatment, and the difference was statistically significant [ WMD(95% CI)=-0.66(-1.25, -0.77), P=0.029; WMD(95% CI)= -0.90(-1.51, -0.29), P=0.004]. ④ The specific performance was that the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score of patients injected with platelet rich plasma after 6 and 12 months of injection treatment was significantly lower than that of patients injected with hyaluronic acid [ WMD(95% CI)=-0.76(-1.06, 0.45), P<0.001; WMD(95% CI)=-1.35(-2.05, -0.65), P<0.01]; After 3, 6 and 12 months of injection treatment, the WOMAC stiffness score of patients injected with platelet rich plasma was significantly lower than that of patients injected with hyaluronic acid [( WMD(95% CI)=-0.37(-0.66, -0.08), P=0.011; WMD(95% CI)=-0.30(-0.57, -0.04), P=0.023; WMD(95% CI)=-0.62(-0.92, -0.33), P<0.001]; After 3, 6 and 12 months of injection treatment, the WOMAC function score of patients injected with platelet rich plasma was significantly lower than that of patients injected with hyaluronic acid [ WMD(95% CI)=-1.90 (-2.53, -1.27), P<0.001; WMD(95% CI)=-5.77(-9.20, -2.34), P=0.001; WMD(95% CI)=-5.72(-8.62, -2.82), P<0.001]. ⑤There was no significant difference in the incidence of adverse events between the two intra-articular injection methods [ OR(95% CI)=1.28(0.68, 2.42), P=0.440]. Conclusion:Compared with intra-articular injection of hyaluronic acid, the short-term clinical efficacy of injection of platelet rich plasma is equivalent to that of injection of hyaluronic acid, but the long-term clinical efficacy is better, and the safety of the two methods is similiar.

Objective:To analyze the efficacy and safety of curcumin in the treatment of knee osteoarthritis.Methods:The randomized controlled trials of curcumin in the treatment of knee osteoarthritis published from January 2011 to August 2021 were retrieved. The bias risk of the included literatures was evaluated by Revman 5.3 software, and the efficacy related indexes and the incidence of adverse events were analyzed by Stata 16.0 software. The weighted mean difference ( WMD) was calculated for the difference of efficacy indexes, the odds ratio ( OR) was calculated for the difference of safety indexes, the difference was compared by t test. Results:① A total of 9 relevant literatures were included, all of which were in English. ② A total of 724 patients were included in the study, of which 383 were treated with curcumin capsules and 341 were treated with placebo. ③ The visual analogue scale/score (VAS) of patients treated with oral curcumin at 3-4, 6 and 8 weeks were significantly lower than those of patients treated with oral placebo, the differences were statistically significant [weighted mean difference ( WMD)=-1.09, 95% CI (-1.44, -0.73), P<0.001; WMD=-1.52, 95% CI (-2.35, -0.69), P<0.001; WMD=-1.20, 95% CI(-1.71, -0.69), P<0.001]. ④ The western Ontario and McMaster universities osteoarthritis index (WOMAC) scores of patients treated with oral curcumin for 3-4 and 6-8 weeks were significantly lower than those of patients treated with oral placebo, and the differences were statistically significant [ WMD=-7.96, 95% CI(-14.89, -1.04), P=0.020; WMD=-15.34, 95% CI(-20.51, -10.18), P<0.001]. Specifically, the WOMAC pain and stiffness scores of patients treated with oral curcumin for 6-8 weeks were significantly lower than those of patients treated with oral placebo, and the differences were statistically significant [ WMD=-2.16, 95% CI(-3.69, -0.63), P=0.010; WMD=-1.00, 95% CI (-1.54, -0.46), P<0.001]. The WOMAC joint function scores of patients treated with oral curcumin for 3-4 and 6-8 weeks were significantly lower than those of patients treated with oral placebo, the difference was statistically significant [ WMD=-3.21, 95% CI(-4.51, -1.92), P<0.001; WMD=-7.07, 95% CI(-11.19, -2.94), P<0.001]. ⑤ There was no significant difference in the incidence of adverse events between oral curcumin and placebo [ OR=1.19, 95% P(0.74, 1.90), P=0.478]. Conclusion:Compared with placebo, oral curcumin can significantly alleviate the pain, stiffness and joint function of patients with knee osteoarthritis, and its safety is similar to placebo.

Objective: To understand the exposure to second hand smoking (SHS) and associated factors among middle school students in Beijing, and to provide data support for tobacco control. Methods: The two stage stratified cluster random sampling method were used to select 10 532 students from 370 classes in 48 junior middle schools, 34 senior high schools and 14 vocational high schools in 16 districts of Beijing. The national unified paper questionnaire was used to collect the information. Results: During the past 7 days, 71.5% (95% CI =70.2%-72.7%) of students reported exposure to SHS. The proportion of exposure was highest (60.3%) in outdoor public places, followed by indoor public places (48.9%), at home (34.1%), and public transport (19.1%). About 31.6% of students reported people smoking in the campus in the past 30 days. Risk factors of SHS exposure included one or more parents was smoker( OR =2.62), friends who smoked( OR =2.13), received education on tobacco hazards in school( OR = 0.74 ), and senior high school( OR =0.68-0.73)( P <0.05). Conclusion High exposure to second hand smoking among middle school students in Beijing is common. Implementation of the regulations and the publicity of tobacco hazards and tobacco control in schools should be strengthened. Smoke free household should be advocated, and middle school students, especially junior middle school students, should be protected from the harm of SHS.

The purpose of this paper is to optimize the course construction and teaching process of psychopharmacology， and analyze the problems in the course of teaching and assessment of psychopharmacology from many aspects. This article is to deeply excavate the space for improvement， and enrich the teaching links by using existing conditions， technology and personnel to enhance the teaching effect and improve the teaching quality， so as to provide references for the reform of similar course teaching.

Objective:To establish the acute symptomatic osteoporotic thoracolumbar fracture (ASOTLF) classification system, and to examine the reliability and evaluate the effect of clinical application.Methods:A retrospective case series study was conducted to analyze the clinical data of 1 293 patients with osteoporotic thoracolumbar fracture(OTLF) admitted to Honghui Hospital from January 2016 to December 2018. There were 514 males and 779 females, aged 57-90 years [(71.4±6.3)years]. The T value of bone mass density was -5.0--2.5 SD [(-3.1±-0.4)SD]. According to the clinical symptoms a and fracture morphology, OTLF was divided into 4 types, namely type I(I occult fracture), type II(compressed fracture), type III (burst fracture) and type IV(unstable fracture). The type II was subdivided into three subtypes (type IIA, IIB, IIC), and the Type III into two subtypes (type IIIA, IIIB). of all patients, 75 patients (5.8%) were with type I, 500 (38.7%) with type II A, 134 (10.4%) with type IIB, 97 (7.5%) with type IIC, 442 (34.2%) with type IIIA, 27(2.1%) with type IIIB and 18 (1.4%) with type IV. After testing the validity of the classification, different treatment methods were utilized according to the classification, including percutaneous vertebroplasty (PVP) for Type I, PVP after postural reduction for Type II, percutaneous kyphoplasty (PKP) for Type IIIA, posterior reduction and decompression, bone graft fusion and bone cement-augmented screw fixation for Type IIIB, and posterior reduction, bone graft fusion and bone cement-augmented screw fixation for Type IV. The visual analog score (VAS), Oswestry disability index (ODI), Frankel grade of spinal cord injury, local Cobb Angle, and vertebral body angle (vertebral body angle) were recorded in all patients and in each type of patients before surgery, at 1 month after surgery and at the last follow-up. The neurological function recovery and complications were also recorded.Results:The patients were followed up for 24-43 months [(29.9±5.1)months]. A total of 3 000 assessments in two rounds were conducted by three observers. The overall κ value of inter-observer credibility was 0.83, and the overall κ value of intra-observer credibility was 0.88. The VAS and ODI of all patients were (5.8±0.7)points and 72.5±6.6 before surgery, (1.8±0.6)points and 25.0±6.3 at 1 month after surgery, and (1.5±0.6)points and 19.5±6.2 at the last follow-up, respectively (all P<0.05). The Cobb angle and vertebral body angle of all patients were (13.0±9.1)° and (8.0±4.6)° before surgery, (7.9±5.2)° and (4.6±2.9)° at 1 month after surgery, and (9.1±6.0)° and (5.8±3.0)° at the last follow-up, respectively (all P<0.05). At the last follow-up, VAS, ODI, Cobb Angle and VBA of each type of patients were significantly improved compared with those before surgery (all P<0.05). The spinal cord compression symptoms were found 1 patient with type IV and 5 patients with type IIIB preoperatively. At the last follow-up, neurological function improved from grade C to grade E in 1 patient and from grade D to grade E in 5 patients ( P<0.05). The lower limb radiation pain or numbness in 3 patients with type IV and 22 patients with type III preoperatively were fully recovered after surgical treatment at the last follow-up except for three patients. Conclusions:The ASOTLF classification is established and has high consistency and reliability. The classification-oriented treatment strategy has achieved a relatively satisfactory effect, indicating that the classification has a certain guiding significance for treatment of OTLF.

Objective:To evaluate the effect of job-transfer training for psychiatrists in Henan province in 2018 and to compare them with the results of 2016.Methods:Data of the trainees were collected through questionnaires in 2017 and 2019 respectively. The influencing factors of knowledge and skills were determined by Multiple linear regression analysis; baseline data, training intention, training feedback and the proficiency of knowledge and skills were compared by independent sample t test and chi-square test. Results:The overall satisfaction rate for training was 98.3%, and the overall mastery rate of training knowledge and skills was 59.2% in year 2018. Compared with 2016, the willingness to participate in training, the satisfaction rate, the recognition degree of " 1+ 10+ 1" training mode, the degree of mastery and practical application of training knowledge and skills increased( P<0.05). There were statistically significant differences in the distribution of the primary reasons for participating in the training, factors hindering their participation in the training, and the causes for their failure to fully apply their learning to practice( P<0.01). The results showed that scope of practice, title, intention, and interest in psychiatry was related to the mastery of training knowledge and skills( P<0.05). Conclusions:The effect of training in 2018 is better than 2016, and the degree of mastery and practical application of training knowledge and skills should be increased.