Post-hepatitis cirrhosis (PHC),which results from either hepatitis B virus (HBV) or hepatitis C virus (HCV) infection,and its associated with hemodynamic changes may cause the spleen to become functionally hyperactive-a condition known as hypersplenism.Hypersplenism is associated with anemia,leukopenia,thrombocytopenia and splenomegaly.There are several effective methods to treat hypersplenism with the development of medical technology and the main purpose is the remission of hypersplenism,reducing the portal hypertension and decreasing the risk of hemorrhage.However,complete splenectomy or partial treatment of the hyperactive spleen is still controversial all over the world.This may be caused by the lack of the knowledge on the pathophysiological characteristics and clinical significance of treating hypersplenism.This review is a comprehensive discussion on the recent research which investigates hypersplenism caused by PHC.

Objective To study the relationship between the clinical imaging manifestations and the judgement of benign and malignant of solitary pulmonary nodules (SPN) .Methods A retrospective analysis of 146 patients with SPN which confirmed by pathological diagnosis .According to SPN diameter all SPN were divided into three groups ,the number of SPN which diameter smal-ler than 0 .8 cm were 16 case ,> 0 .8 - 1 .5 cm were 41 cases ,> 1 .5 - 3 .0 cm were 89 cases .Collect patients′ age ,sex ,smoking his-tory ,clinical symptoms and imaging data ,and analyze its relationship with pathological results .Results All the 146 patients were pathological diagnosis ,benign in 52 cases (35 .6% ) ,malignant in 94 cases (64 .4% ) .As the diameter increases ,the malignant rate increased .There was statistical significance in benign and malignant lesions with smoking history and clinical symptoms (P< 0 . 05) .Whether SPN boundary is clear ,have lobulation ,burr ,pleural indentation syndrome and vessel convergence in benign and ma-lignant lesions were statistically significant (P< 0 .05) .Conclusion The feature size and imaging performance of SPN has important reference value for the judgement of benign and malignant .The positive intervention to SPN have great significance on improve sur -vival rate of lung cancer .

Objective To observe the effect of Sini decoction on inflammatory response and immune function in septic rats and to discuss its possible mechanism.Methods 66 Sprague-Dawley (SD) rats were randomly divided into normal control group (n=6),model group (n=30),and Sini decoction group (n=30).Septic model was reproduced by intraperitoneal injection of lipopolysaccharide (LPS,5 mg/kg).After the reproduction of sepsis,rats in Sini decoction group received Sini decoction (5 g/kg) by gavage,while those in model group were given equal dose of normal saline in the same way.Rats in normal control group did not receive any treatment.Blood was collected via eye sockets at 2,12,24,48,72 hours after LPS administration,then the rats were sacrificed.The concentrations of inflammatory mediators,such as interleukin (IL-1,IL-6,IL-10),tumor necrosis factor-α (TNF-α),and the expression level of monocyte human leukocyte antigen-DR (HLA-DR) were determined with enzyme linked immunosorbent assay (ELISA),and the pathological changes in intestinal mucosa were observed under electron microscope.Results The concentration of IL-1 (ng/L) at 2 hours in model group was gradually increased and peaked at 48 hours (4.07 ± 0.10),and then gradually decreased,while the IL-1 level in Sini decoction group peaked at 12 hours (2.98 ± 0.12) followed by a gradual decrease.IL-6 (ng/L) in model and Sini decoction groups peaked twice at 12 hours (91.39 ± 1.55,73.00 ± 2.38) and 48 hours (82.51 ± 1.49,64.68 ± 1.68) respectively.IL-10 (ng/L) in model group gradually decreased after peaking at 2 hours (86.66 ± 6.12),and that in Sini decoction decreased at 12 hours (71.61 ± 2.35) followed by an increasing tendency,and approached normal level at 48 hours (109.09 ±4.77 vs.124.01 ± 7.89,P＞0.05).TNF-α (ng/L) in model group was gradually increased and peaked at 48 hours (83.37 ±3.79),and that in Sini decoction peaked at 12 hours (48.52 ± 1.21),and decreased to normal level at 72 hours (18.59 ± 1.97 vs.15.50 ± 2.68,P＞0.05).During the course of the experiment,as compared with those of the model group,level of IL-1,IL-6,and TNF-α were significantly lower at all time points in Sini decoction group,and IL-10was significantly higher.The expression level of HLA-DR (μg/L) in model and Sini decoction groups peaked at 2 hours (4.86 ± 0.15,4.85 ± 0.17),and then gradually lowered.HLA-DR expression μg/L) at 48 hours and 72 hours in Sini decoction group was significantly lower than that in model group (48 hours:4.21 ± 0.12 vs.2.74 ± 0.16,72 hours:3.80 ± 0.09 vs.2.27 ± 0.12,both P＜0.01).Pathological study of intestinal mucosa showed that the intestinal mucosa were infiltrated significandy by inflammatory cells,and villi were damaged severely in both model group and Sini decoction group at 2 hours after LPS challenge.Infiltration of inflammatory cells in Sini decoction group was less intense after 12 hours,and the intestine villi repair was more obvious compared with model group.Conclusion Sini decoction could regulate systemic inflammatory response,and promote the repair of intestinal mucosa,the intestinal function and the immune status of septic rats.

Objective To compare the effects of aspirin and clopidogrel on platelet aggregation function by TEG,and to study the antiplatelet agents tailored therapy of Thrombelastography(TEG)in treatment of cerebral infarc-tion patients.Methods 100 patients with acute cerebral infarction were included in two groups:aspirin group and clopidogrel group.The inhibitory rates of AA and ADP receptor pathway in platelets were detected by TEG.The effect of inhibitory rates in group aspirin and clopidogrel was compared with nerve function and the recurrence rate of stroke. Results The inhibitory rates of group aspirin (85.23 ±21.98)% was higher than group clopidogrel (47.31 ± 22.37)% (t =7.340,P =0.005).The patients with which the inhibitory rates showed goodby TEG in group aspirin and clopidogrel got better neurological recovery,and the patients showed goodby TEG in group aspirin got lower stroke recurrence rate within 1 year(χ2 =4.460,P =0.035;χ2 =7.232,P =0.007).Conclusion TEG had guided the antiplatelet individual therapy for cerebral infarction patients,and can be used to predict and confirm the efficacy of antiplatelet drug.

Objective:To systematically evaluate the effectiveness and safety of intra-articular in-jection of mesenchymal stem cells (MSCs) and hyaluronic acid (HA) in the treatment of knee osteoarthritis.Methods:The relevant literatures published in both English and Chinese were systematically searched in PubMed, Embase, Wanfang database, China Knowledge Network (CNKI), SinoMed database and other data-bases from inception to May 2020. Two researchers independently extracted data and evaluated the included literature. Risk assessment of literature bias was carried out. RevMan 5.3 software was used for Meta analysis, and the combined sensitivity were calculated.Results:Finally, 13 references were included, including a total of 726 patients with knee osteoarthritis. Meta-analysis results showed that compared with the HA group, the Western Ontario and McMaster University Osteopathic Index Total Score (WOMAC) [ MD=-10.92, 95% CI (-16.87, -4.96), P<0.01], the visual analogue scale (VAS) score [ MD=-1.70, 95% CI(-2.44, -0.95), P<0.01], and the knee joint Lequesne index score of MSCs group all decreased significantly [ MD=-13.78, 95% CI (-15.03,-12.52), P<0.01]. Furthermore, there was no significant difference in the incidence of adverse events (AEs) between the two groups [ RR=1.11, 95% CI(0.90, 1.37), P=0.33]. However, American Knee Association Score (AKS score) [ MD=-10.15, 95% CI(-22.33, 2.03), P=0.10] and whole-organ magnetic resonance imaging score (WORMS) [ MD=-3.93, 95% CI(-11.60, 3.75), P=0.32] were not statistically significant ( P>0.05). Conclusion:Compared with intra-articular injection of HA, intra-articular injection of MSCs can significantly improve the symptoms and dysfunction, and has favorable clinical tolerability and safety, suggesting that MSCs is expected to bea new treatment for knee osteoarthritis.

OBJECTIVETo explore the preventive effect of Yougui drink on femoral head necrosis in rats under micro CT.

METHODSTwenty-five SD rats were divided into steroid hormone group (group A, 10 rats ), Yougui drink group (group B,10 rats) and normal group (group C,5 rats)with random number table. Endotoxin were injected into abdominal cavity of rats in group A and B for 2 days, methylprednisolone sodium succinate were injected by gluteus for twice a week continued for 6 weeks; group B were gavaged by Yougui drink (veryday for 8 weeks; group C did not do any processing. All rats were killed on the 10th weeks,m icro CT were used to scan femoral head in vitro and preventive effect of Yougui drink (n femoral head necrosis in rats.

RESULTSThere was statistical significance in BMD, BV/TV, Tb.N, Tb, Th, Thb, Sp, BS/TV and DA but no significance in SMI between group A and B. Comparison between A and C, there was significant meaning in BMD, BV/TV, Tb.N, Tb, Th, Tb, Sp, BS/TV, DA and SMI.

CONCLUSIONYougui drink on femoral head necrosis in rats under micro CT has preventive effect from BMD BV/TV, Tb.N, Tb, Th, Tb, Sp, BS/TV and DA.

Animals ; Apoptosis ; Bone Density ; Drugs, Chinese Herbal ; therapeutic use ; Femur Head Necrosis ; diagnostic imaging ; pathology ; prevention & control ; Rats ; Rats, Sprague-Dawley ; X-Ray Microtomography ; methods

OBJECTIVETo investigate the therapeutic effect of facial artery perforator flap for the soft tissue defects at nose, lip and cheek.

METHODSThe facial artery perforator adjacent to the defect was identified by Doppler ultrasonography. The perforator flap was designed according to the defect location, size and shape. The subcutaneous tissue around the perforator was kept as much as possible to protect the venous drainage.

RESULTSFrom Oct. 2012 to Oct.2013, 26 cases were treated with facial artery perforator flaps, with 9 cases of nasal defects, 10 cases of lip defects and 7 cases of buccal defects. The defects size ranged from 1.5 cm x 2.0 cm to 3.0 cm x 3.0 cm and the flaps size ranged from 2.0 cm x 2.5 cm to 3.5 cm x 3. 5 cm. Superficial necrosis(3mm in width) happened at the end of one flap. All the other 25 flaps survived completely. 16 cases were followed up for 3 months to 2 years with no relapse and satisfactory cosmetic and functional results were achieved.

CONCLUSIONSBoth cosmetic and functional effect can be achieved with facial artery perforator flap for defects at nose, lip and cheek.

Arteries ; Cheek ; surgery ; Graft Survival ; Humans ; Lip ; surgery ; Nose ; surgery ; Perforator Flap ; blood supply ; transplantation ; Rhinoplasty ; methods

Objective To investigate the effect of fructose-1,6-diphosphate (FDP) pretreatment on myocardial connexin 43 (Cx43) in a rat model of acute myocardial ischemia.Methods Thirty-six male Sprague Dawley rats (aged 8-12 weeks and weighing 220-280 g) were randomly divided into three groups (n =12 each):sham operation group (group S),ischemia group (group Ⅰ) and FDP + ischemia group (group F).The animals were anesthetized with intraperitoneal injection of 10％ chloral hydrate 40 mg/100 g,then tracheostomized and mechanically ventilated.Acute myocardial ischemia was induced by occlusion of the left anterior descending coronary artery for 30 minutes.Myocardial ischemia was verified by elevation of the S-T segment on echocardiogram (EGG).In group F,FDP 100 mg/kg was injected intravenously 10 minutes before ischemia.The hearts were removed after 30 minutes of myocardial ischemia.The myocardial infarct size (IS) and area at risk (AAR) were measured and the IS/AAR ratio was calculated.The expression of myocardial Cx43 protein was determined by immunohistochemestry and analysis of mean optical density.Results The severities of arrhythmia were significantly higher in groups F and I than in group S,while lower in group F than in group Ⅰ (P＜ 0.05).The IS/AAR ratio was significantly lower in group F than in group Ⅰ.The myocardial Cx43 protein expression was down-regulated in group Ⅰ and group F as compared with group S,and was significantly lower in group Ⅰ than in group F.Conclusion FDP pretreatment can protect myocardium against acute ischemia by up-regulation of myocardial Cx43 expression.

Objective To observe the safety and effectiveness of inductive chemotheray with lobaplatin plus 5-Fu (LF regimen) and concurrent chemoradiotherapy with lobaplatin for local-regionally advanced nasopharyngeal carcinoma (NPC) patients,and investigate the appropriate lobaplatin dose for the concurrent chemoradiotherapy.Methods Newly diagnosed local-regionally advanced NPC patients signed informed consent.The inductive chemotherapy was lobaplatin 30 mg/m2 + 5-Fu 4 g/m2 civ 120 h for 2 cycles every 21 days,then concurrent lobaplatin chemoradiotherapy was conducted.The initial lobaplatin dose for concurrent chemoradiotherapy was 50 mg/m2 with at least 3 cases in every dose level.If 2 of 3 patients presented dose-limiting toxicity (DLT),5 mg/m2 dose decreased for the next level until maximal tolerant dose (MTD) reached.The tumor response was evaluated after inductive chemotherapy,at the end of the chemoradiotherapy,3 months after chemoradiotherapy and 6 months after chemoradiotherapy.Results From Dec 2011 to Apr 2012,11 patients were enrolled in this study.After 2 courses of inductive chemoradiotherapy,CR,PR and SD were observed in 1,8 and 2 patients,respectively.At the end of the chemoradiotherapy and 3 months after chemoradiotherapy,CR and PR were observed in 10 and 1 patients,respectively.Six months after the chemoradiotherapy,all patients were CR.For the patients(3 in each arm) received 50 mg/m2 or 45 mg/m2 lobapaltin concurrent chemoradiotherapy,2 patients in each arm presented DLT.For the 5 patients received 40 mg/m2 lobapaltin concurrent chemoradiotherapy,no patients presented DLT.40 mg/m2 was suggested as the MTD.Inhibition of platelet was the major DLT.Conclusion Inductive chemotherapy with LF regimen and concurrent chemoradiotherapy with lobaplatin is safe and effective for local-regionally advanced NPC patients and the MTD of lobaplatin for the concurrent chemoradiotherapy is 40 mg/m2.Further clinical trial with large sample is expected.

Objective To analyze the changes of splenic volume and blood flow detected by ultrasonography in men having been migra-ted in high-altitude area for 10 years and to explore the relationship between the splenic blood flow and volume. Methods Men migrating to high-altitude area for 10 years,male indigenous Tibetan and healthy men from planitia with 55 cases in each were involved. Ultrasonography was performed to measure the length,width and thickness of spleen to calculate the volume,and color Doppler flow imaging was applied to measure the diameter of splenic artery and the mean flow velocity to calculate the blood flow volume. The differences among groups were com-pared and the relationship between the blood flow and the volume was analyzed. Results The blood flow and the volume of spleen in men migrating to high-altitude area were higher than those in male indigenous Tibetan and healthy men from planitia (P<0. 01),and the blood flow was positively correlated with the splenic volume (r=0. 828,P<0. 01). Conclusion The splenic volume and blood flow are increased in men when have been migrated in high-altitude area for 10 years and ultrasonography is of great importance in detecting the pathophysiologic changes in high-altitude area in our country.