Idiopathic thrombocytopenic purpura (ITP),also called immune thrombocytopenia more frequently by the international,is the most common acquired hemorrhagic disease characterized by thrombocytopenia,presence of anti-platelet antibody in the plasma,with increased or normal megakaryocytes with abnormal maturation.About 70％ of 1TP patients recover spontaneously within 6 months,while a small proportion of patients will transform to persistent,chronic or refractory idiopathic thrombocytopenic purpura.New immunosuppressive agents and thrombopoietin for the treatment of children with refractory ITP have been developed.Dramaric progresses in the diagnostis,severity assessment and treatment of refractory ITP have been made recently,which is comprehensively illustrated in this review.

Objective To explore the glucose and liplid metabolism changes of pregnant rats and the birth weight of their offsprings due to pregnancy malnutrition,including overnutrition and undernutrition.Methods Thirty pregnant Wistar rats were randomly divided into three groups on the day of conception,the high-fat-diet group,normal control group and 50％ food-restricted diet group.Increase of body weight and serum level of triglycerides,high-density lipoprotein,low-density lipoprotein,oral glucose tolerance test (OGTT) and insulin release test(IRT) levels during pregnancy were measured.The birth weight of offsprings was recorded within 12 h after birth.One-way ANOVA,LSD or Dunnett T3,and Chi-square test were applied for statistical analysis.Results The body weight at late pregnancy and the level of triglycerides and low-density lipoprotein were significantly increased in the high-fat-diet rats compared to normal control ones [(1.68±0.13) mmol/L vs (0.78±0.08) mmol/L,(0.57±0.04) mmol/L vs (0.35±0.07) mmol/L; both P＜0.01].While the level of high-density lipoprotein of high-fat-diet rats was lower than that of the normal control rats [(0.56±0.06) mmol/L vs (1.09±0.08) mmol/L,P＜0.05].The level of triglycerides,low density lipoprotein and high density lipoprotein in 50％ food restricted group [(0.47±0.06) mmol/L,(0.21±0.06) mmol/L and (0.42±0.05) mmol/L] were lower than the control group (all P＜0.05).Impaired glucose tolerance,abnormal OGTT and IRT results were found in both high-fat-diet and 50％ foodrestricted diet rats.The fasting plasma glucose level in high-fat-diet group was significantly increased in late pregnancy compared to the control [(6.63±0.53) mmol/L vs (4.90±0.26) mmol/L,P＜0.05],while there was no significant difference between rats in 50％ food-restricted diet [(4.18±0.26) mmol/L]and control group (P＞0.05).There was no statistical difference in fasting serum insulin level among the three groups.The average birth weight was significantly increased in high-fat-diet rats than in the control group [(6.14±0.31) g vs (5.73±0.26) g,P＜0.05],and the incidence of macrosomic newborn rats in the high-fat-diet group was also higher than that of the control group [19.2 ％ (19/99)vs 7.84％(8/102),P＜0.05].The birth weight of offspring in 50％ food-restricted diet group was decreased with their average birth weight of (4.54±0.23) g,which was lower than that of the control group (P＜0.05).The incidence of macrosomic [13.40％ (11/76)] and low birth weight newborn rats [15.90％ (13/76) vs 3.92％(4/102)] in food-restricted diet group were both higher than in the control group (P＜0.05); and smaller number of offsprings was obtained than the control group (76 vs 102,P＜0.05),the number of offsprings in high-fat-diet group was 99,which was less than the control group without statistical difference (P＞0.05).Conclusions Pregnancy malnutrition,including overnutrition and undernutrition,may affect the lipid metabolism and glucose tolerance of pregnant rats,leading to insulin resistance,and may also contribute to the abnormal birth weight of the offspring,including macrosomia and low birth weight.

Atrial fibrillation ( AF) is the most common sustained arrhythmia in clinical practice and it is associated with an in-creased thromboembolism risk , due mainly to embolism from the left atrial appendage ( LAA) .Percutaneous left atrial appendage clo-sure ( PLAAC) provides a valid alternative to oral anticoagulation ( OAC) mainly in patients who cannot tolerate this therapy due to a high bleeding risk .Recent studies showed PLAAC can substantially reduce stroke incidence .This article reviews the safety and efficacy of PLAAC preventing thromboembolism by retrospectively analyzing related studies of PLAAC .

Abstract Psychological stress is a significant contributing factor for the decline in male sperm quality. In terms of the psychological mechanism, the decline of sperm quality due to psychological stress is associated with increased perceived stress and different coping strategies. External sources of stress can elevate stress perception, then affect sperm quality, while coping strategies may modulate the impact of stress perception on sperm quality. In terms of the physiological mechanism, psychological stress disrupts the normal functioning of the sympathoadrenal system, hypothalamic-pituitary-adrenal axis and hypothalamic-pituitary-gonadal axis, leading to disturbances in the essential endocrine environment for sperm production. This review synthesizes the psychological and physiological mechanisms through which psychological stress influences male sperm quality, providing insights into the prevention and treatment of male infertility.

Objective To guarantee the quality of measurenents with the radon-thoron discriminative detectors of our laboratory.Methods LD-P radon-thoron discriminative detector participated in the international intercomparison for integrating radon/thoron detectors organized by National Institute of Radiological Science (NIRS,Japan).Detectors were sent to NIRS for exposure.Radon intercomparison was conducted with radon chamber providing three levels of exposure:low,medium and high levels.Thoron intercomparison was carried out at thoron chamber,which also provided three levels of exposure:low,medium and high levels.Detectors were posted back to our laboratory for etching and analysis after exposure.Then the measured values were submitted to NIRS.Finally the reference values were informed of us.Results The relative percent difference (RPD) between the measured value and the reference value for radon was-13.8％,-14.4％ and-17.1％ at low,medium and high levels respectively,and that of thoron were-14.4％,8.9％ and-3.2％ at three levels respectively.Conclusions Both radon and thoron measurement of our detectors rank asCategory Ⅰ in the 4th international intercomparisons for integrating radon/thoron detectors with the NIRS radon/thoron chambers.

Objective To evaluate the promotional effectiveness of different TCM appropriate technology packages; To provide a scientific basis for improving the technology package. Methods 8 assessment indexes, including input costs, the number of experts, the number of people with senior professional post, the number of grassroots people under the guidance of experts, the number of training hours, the number of people receiving training, evaluating rate and the number of users were selected. TOPSIS method was used to evaluate the promotional effectiveness of five kinds of TCM packages in grassroots. Results The Ci values for appropriate technology packages were 0.76 for pains in neck, shoulder, waist and lower extremities, 0.49 for gynecological diseases, 0.44 for infantile diarrhea, 0.66 for chronic gastropathy, and 0.00 for tumors. Conclusion The effectiveness of promotion of TCM appropriate technology packages from high to low is pains in neck, shoulder, waist and lower extremities package, chronic gastropathy package, gynecological diseases package, infantile diarrhea package, tumors package.

Objective To investigate the experience of family caregivers in nursing perioperative patients undergoing permanent cardiac pacemaker. Methods Twenty-five family caregivers taking care of the patients undergoing permanent cardiac pacemaker participated in the non-structural study. Data were analyzed by phenomenological procedure. Result The factors by category analysis includes fear, anxiety and uneasiness due to preoperative lack of relevant knowledge and postoperative lack of caring experience, lowered health level of the caregivers, strong demand for health education and lack of confidence in home care. Conclusions The family caregivers′ experience varies with different phases in perioperative period. Nurses should provide personalized services to enhance the continuity of home care so as to enhance the care quality.

In this paper, the patent of traditional medicines of type-2 diabetes mellitus before 2014 were searched, totally 1 229 patent family information were obtained. The patent information including developing trends, geographic distribution, competitive agencies, technical focus, herbs preferences and so on were analyzed. China is in a leader position on the number of applying patent of using traditional medicine to treat type-2 diabetes mellitus, and the main applications were research institutes, universities and pharmaceutical enterprises. Although the views and theo-ries on treatment of type-2 diabetes mellitus are variety and abound, the most frequently used traditional medicines are tonics and heat-clearing. This article reflected the history, clinical treatment way, developments, application of the diabetes traditional drugs after a meta-analysis,efforts to guide a better understanding and further research.

Objective To explore the clinical value of color Doppler ultrasonography in the diagnosis of uterine carcinosarcoma (UCS).Methods The clinical data and ultrasonographic manifestations of 63 cases of UCS proved by operation and pathology in Obstetrics and Gynecology Hospital of Fudan University from January 2003 to December 2014 were retrospectively analyzed.The clinical features and characteristics of ultrasound images in UCS were summarized and classified according to their ultrasonographic features.Results It mostly occurred in postmenopausal women (77.8％).The average age of the 63 patients of UCS was (57.7 ± 11.5) years old.The most common symptoms of UCS were postmenopauseal vaginal bleeding (57.1％),menstrual disorders (20.6％),vaginal discharge (11.1％),uterine mass or thickened endometrium (11.1％).Tumor marker CA125 was evaluated in 36 women and found to be elevated in 15 women (41.7％),60％ of which (9/15) was less than 200 U/mL.Six cases (16.7％) of relative higher level of serum CA125 (＞ 200 U/mL) were at advanced stage or with malignant ovarian tumors.The sonographic findings of UCS had three types:Uterine cavity type (71.4％),endometrium type (14.3％),and myometrium type (14.3％).The ultrasonographic characteristics of uterine cavity type and myometrium type were fuzzy boundary,irregular shape,and internal uneven echo.Color doppler flow image showed rich blood signals and low resistance index (0.55 + 0.11) of the surrounding and internal artery of the lesions.The large volume of lesion was the characteristic of myometrium type.Conclusions UCS is a very aggressive and extremely rare tumor with the symptoms of postmenopauseal vaginal bleeding,menstrual disorders,vaginal discharge,et al.There are three types of sonographic findings of UCS:uterine cavity type,endometrium type and myometrium type.To strengthen the understanding of UCS and combined with clinical manifestations,the transvaginal color Doppler ultrasound was helpful to early detection,early diagnosis and making the appropriate treatment.

Objective To investigate the levels and distribution of radon concentrations in groundwater in some representative cities in China,and estimate the effective dose from inhaled radon released from domestic groundwater.Methods A total of 12 cities in 7 provinces (municipalities) were selected,including Beijing,Inner Mongolia,Ningxia,Shaanxi,Henan,Liaoning and Heilongjiang.In total,73 water samples from groundwater supply were taken.Radon concentrations in water samples were determined by using a continuous radon monitor with air-water exchanger.Results The average radon content in groundwater for drinking was 11.8 Bq/L in 12 cities in 7 provinces,ranging from 1.0 to 63.8 Bq/L.The radon concentrations in 37％ water samples exceeded 1 1.1 Bq/L,the safe limit recommended for drinking water by the United States Environmental Protection Agency (EPA).The radon contents in all of the water samples was lower than the reference level 100 Bq/L recommended by World Health Organization (WHO).The average annual effective dose arising from inhaled radon released from groundwater was 29 μSv (2.4 to 160 μSv).Conclusions Generally,the effective dose from inhaled radon released from groundwater is negligibly low.However,in some areas dominated by granite bedrock,the dose contribution from radon released from groundwater to residents should be routinely monitored.