Morita therapy has been bom for more than 100 years.Inpatient Morita therapy is highly oper-able and easy to master.It can improve many refractory neuroses through four-stage treatment.But more neuroses are treated in outpatient clinics,and Morita therapy cannot be used in hospitalized patients.Therefore,the formula-tion of expert opinions on outpatient operations is particularly important.This paper is based on domestic and for-eign references,and after many discussions by domestic Morita therapy experts,and then drew up the first version of the expert opinions on operation of outpatient Morita therapy.Meanwhile the operation rule of Morita therapy in three stages of outpatient treatment was formulated:in the etiological analysis stage,under the theoretical guidance of Morita therapy,analyze the pathogenic factors,to improve treatment compliance and reduce resistance;during the operating stage,guide patients to engage in constructive and meaningful actions,realizing the achievement of letting nature take its course principle;in the cultivating character and enriching life stage,pay attention to positive infor-mation,expanding the scope and content of actions,improving the ability to adapt to complex life,and preventing recurrence caused by insufficient abilities.It will lay a foundation for the promotion of Morita therapy in domestic outpatient clinics,so that more patients with neurosis and other psychological diseases could receive characteristic Morita therapy treatment in outpatient clinics.

Objective:To evaluate the clinical efficacy of Jianpi Bushen Zhixie Recipe combined with conventional western medicine therapy in the treatment of diabetic diarrhea patients with spleen and kidney yang-deficiency syndrome.Methods:According to the random number table method, 62 patients with diabetic diarrhea with spleen and kidney yang-deficiency syndrome from June 2019 to June 2021 in Shunyi Hospital of Beijing Traditional Chinese Medicine Hospital, who met the inclusion criteria, were divided into two groups, with 31 in each group. The control group was treated with standardized hypoglycemic and mecobalamin treatment, while the treatment group was treated with Jianpi Bushen Zhixie Recipe on the basis of the control group. Both groups were treated for 2 weeks and followed up for 2 weeks. Before and after treatment, TCM syndrome scores and Bristol Stool Form Scale (BSFS) scores were performed before and after treatment. The Health Related Quality of Life Scale (SF-36) was used to evaluate the quality of life of patients. The number of bowel movements and adverse reactions during treatment were recorded before and after treatment, and followed up for 2 weeks to observe the disease recurrence rate.Results:The total effective rate was 93.55% (29/31) in the treatment group and 74.19% (23/31) in the control group, with a statistically significant difference between both groups ( χ2=5.44, P=0.020). After treatment, the number of bowel movements in the treatment group [(1.02±0.23) times/d vs. (2.35±0.45) times/d, t=14.65] was significantly lower than that of the control group ( P<0.01); the BSFS scores (1.93±0.43 vs. 3.23±0.43, t=11.87) and TCM syndrome score (0.93±0.25 vs. 1.95±0.36, t=12.96) in the treatment group were significantly lower than those in the control group ( P<0.01); the SF-36 score (92.32±2.99 vs. 86.23±3.12, t=7.85) in the treatment group was significantly higher than that of the control group ( P<0.01). No gastrointestinal adverse events were found in both groups during treatment. During the follow-up period, there were 4 cases (4/23) of recurrence in the control group after treatment, and no recurrence in the treatment group. There was a statistically significant difference in the recurrence rate between the two groups ( χ2=4.28, P=0.039). Conclusion:The Jianpi Bushen Zhixie Recipe combined with conventional western medicine can improve symptoms and quality of life of patients with diabetic diarrhea with spleen and kidney yang-deficiency syndrome, reduce adverse reactions and recurrence rate.

Objective: To evaluate the relationship between the offset of a laser-assisted flap using the WaveLight FS200 femtosecond laser and the clinical results after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). Methods: In this prospective cohort study, 125 patients who underwent FS-LASIK for myopia by WaveLight FS200 femtosecond laser from June 2017 to July 2018 at the Tungwah Ophthalmic Center were divided into two groups according to the offset of the corneal flap from the pupil center: the no-offset group (57 eyes) and the certain-offset group (68 eyes); the baseline data, including age, sex, uncorrected visual acuity(UCVA), spherical degree, and central corneal thickness were matched in the two groups.UCVA, residual astigmatism, spherical degree, corneal curvature and aberration were observed 1 week and 1 month after surgery.The study protocol was approved by the Ethics Committee of Tungwah Hospital of Sun Yat-Sen University (No.2017DHLL004). Written informed consent was obtained from each subject prior to entering the study cohort. Results: UCVA, corneal curvature, spherical degree, spherical and corneal aberration between the two groups were not significantly different (all at P>0.05). One week after surgery, the residual astigmatism was ≤-0.50 D in 50 eyes (87.7%, 50/57)and >-0.50 D in 7 eyes (12.3%, 7/57) in the no-offset group; the residual astigmatism was ≤-0.50 D in 50 eyes (73.5%, 50/68) and >-0.50 D in 18 eyes (26.5%, 18/68) in the no-offset group.The residual astigmatism between the two groups 1 week after surgery was significantly different (χ²=3.902, P=0.048), and there was no significant difference in residual astigmatism 1 month after surgery (χ²=2.031, P=0.068). The trefoil of the no-offset group was statistically less than of the certain-offset group at 1 week and 1 month after surgery (0.05[0.04, 0.08]vs.0.06[0.04, 0.10]; 0.05[0.03, 0.07]vs.0.06[0.05, 0.09])(Z=-2.245, P=0.022; Z=-2.370, P=0.018). The spherical aberration and coma were not significantly different between the two groups at 1 week and 1 month after surgery (both at P>0.05). Conclusions The offset from femtosecond laser-assisted flap by WaveLight FS200 has no effect on long-term visual acuity or residual astigmatism.Some patients may have different visual experiences because of the residual astigmatism and higher order aberration during the early postoperative stage.

OBJECTIVE：To in vestigate the effects of dexmedetomidine （Dex）on SIRT 1/Akt/GSK3β/β-catenin signaling pathway in cerebral injury of sepsis model rats ，and explore the mechanism of its protecitve effect on cerebral injury. METHODS ： A total of 80 male SD rats were randomly divided into sham operation group （Sham group ），sepsis group （CLP group ），CLP+Dex group（10 μg/kg Dex），CLP+Dex+Sirtinol group （10 μg/kg Dex+2 μL/100 g SIRT 1 inhibitor sirtinol ），with 20 mice in each group. Two hours before modeling ，CLP+Dex+Sirtinol group was injected with sirtinol via lateral ventricle. Sepsis model was induced by cecal ligation and perforation in each group （in sham group ，only operation was performed but no ligation was performed）. At 0，3，6 h after modeling ，CLP+Dex group and CLP+Dex+Sirtinol group were given Dex （10 μg/kg） intraperitoneally，Sham group and CLP group were given constant volume of normal saline intraperitoneally. Cerebral tissue water content，Evans blue （EB）content，apoptosis in cerebral cortex ，the levels of IL- 1β and TNF-α in cerebral tissue as well as the protein expression of SIRT 1，p-Akt，p-GSK3β and β-catenin in hippocampus were detected 24 h after last medication. RESULTS ： Compared with Sham group ，cerebral tissue water content ，EB content ，the number of apoptotic cells in cerebral cortex as well as the levels of IL- 1β and TNF-α in cerebral tissue were increased significantly（P＜0.05），while the protein expression of SIRT 1， p-Akt，p-GSK3β and β-catenin in hippocampus were decreased significantly （P＜0.05）. Compared with CLP group ，cerebral tissue water content ，EB content ，the number of apoptotic cells in cerebral cortex as well as the levels of IL- 1β and TNF-α in cerebral tissue were decreased significantly in CLP+Dex group （P＜0.05），while the protein expression of SIRT 1，p-Akt，p-GSK3β and β-catenin in hippocampus were increased significantly （P＜0.05）. Sirtinol could significantly reverse the above-mentioned cerebral protection and factor regulation effects of Dex （P＜0.05）. CONCLUSIONS ：Dex can protect the cerebral tissue of sepsis model rats，which may play an anti-inflammatory and anti-apoptotic role by activating SIRT 1/Akt/GSK3β/β-catenin signaling pathway ，so as to reduce cerebral edema ，protect blood-brain barrier and reduce cerebral injury.

Objective To evaluate the clinical efficacy of transjugular intrahepatic portosystem shunt (TIPS) and gastric coronary vein embolization (GCVE) in the treatment of patients with cirrhosis,portal hypertension and upper gastrointestinal bleeding.Methods From Jan 2014 to May 2017 72 patients were enrolled and divided into the TIPS group (36 cases,receiving TIPS) and TIPS + E group (36 cases,byTIPS+GCVE).Results Portal vein diameter (1.21 ±0.08)cm vs.(1.26 ±0.09)cm,portal pressure (23.9 ± 2.1) cmH2O vs.(25.1 ± 2.2) cmH2O and congestion index (0.06 ± 0.03) cm/s vs.(0.08 ±0.03) after 1 month of treatment in TIPS + E group was significantly lower than the TIPS group,and the portal vein velocity was significantly higher than that of the TIPS group (42 ± 6) cm/s vs.(38 ± 7) cm/s,t =2.491,2.367,2.828,t =2.343,all P ＜ 0.05.The Child-Pugh score in the TIPS + E group was significantly lower than that in the TIPS group (7.9 ± 1.4) vs.8.6 ± 1.6,t =2.074,P =0.042).There was no statisticall different difference in postoperative hepatic encephalopathy in the two groups (17％ vs.11％,x2 =0.465,P =0.496).The one-year rebleeding rates in the TIPS group and the TIPS + E group were 14％ and 3％,respectively.The risk of rebleeding in the TIPS + E group was significantly lower than that in the TIPS group (HR =0.218,P =0.041).The one-year access obstruction rates in the TIPS group and the TIPS + E group were 17％ and 14％,respectively.(P =0.679).The all-cause mortality rates of the TIPS group and the TIPS + E group were 8％ and 3％,respectively,showing no statistically (P =0.299).Conclusions TIPS + GCVE therapy in the treatment of portal hypertensive upper gastrointestinal bleeding effectively reduces the risk of rebleeding.

Objective: To investigate the modulation role of Gas6 in silica-induced inflammatory effect on human macrophages. Methods: Differentiated THP-1 macrophages were exposed to different concentrations of silica for 6 h and 24 h. Additionally, silica-activated macrophages were treated with different concentrations of recombine human Gas6 and Gas6 antibody respectively. Cell viabilities were determined by CCK-8 kit. Expression levels of Gas6 and inflammatory cytokines (TNF-α, IL-1β and IL-6) were measured by ELISA assay kits. Results: Silica particles induced clear dose-dependent decreases of cell viability and Gas6 expression at both 6 h and 24 h. The cell viability of 24 h is lower than 6 h at the same concentration of silica (P<0.05). Furthermore, silica activated macrophages treated with Gas6 antibody induced significant decreases of Gas6 both at 6 h and 24 h (P<0.05). After pretreated with various concentrations of Gas6 antibody, silica induced higher expressions of inflammatory cytokines (TNF-α, IL-1β, IL-6) in dose-dependent manners at two time points. Addition of exoge-nous Gas6 significantly suppressed silica-induced inflammatory cytokines concentrations mentioned above in the cell culture supernatants in clear dose-dependent manners. Conclusion Exogenous Gas6 could inhibit the secre-tion of inflammatory cytokines in macrophages, while the block of Gas6 might enhance this inflammation.

BACKGROUND: Glaucoma is a kind of eye disease that can cause irreversible blindness which is characterized by visual field loss. Clinical research shows that the optic nerve head has changed before the visual field loss. The morphological changes of the optic nerve head have become the key to determine the early diagnosis of glaucoma and disease development. So it has important significance for us to study the morphological changes of the tissues of optic nerve head under the high intraocular pressure.
OBJECTIVE: To establish three-dimensional finite element model of optic nerve head which includes choroid, retina and lamina cribrosa, and analyze the thickness of the optic nerve head under the acute high intraocular pressure.
METHODS: (1) We chose healthy cats without refractive media and other eye diseases. The tomographic sequence images of the optic nerve head of a cat were obtained with the intraocular pressure of the normal value by using enhanced depth imaging spectral-domain optical coherence tomography. (2) The three-dimensional model of the retina, choroid and lamina cribrosa was obtained. Three-dimensional model of optic nerve head was established by assembling the model of the retina, the choroid and the lamina cribrosa. The thickness of the retina, choroid and lamina cribrosa was analyzed under different intraocular pressures by using the method of finite element analysis. (3) Animal model of acute ocular hypertension was established by methods of anterior chamber perfusion. The tomographic sequence images of the optic nerve head of a cat were obtained with different intraocular pressures by using enhanced depth imaging spectral-domain optical coherence tomography. Then, we measured the thickness changes of the choroid, retina and lamina cribrosa under different intraocular pressures, and compared with the results of finite element analysis.
RESULTS AND CONCLUSION: The thickness of the choroid, retina and lamina cribrosa trended to be thin, and the cup dish ratio of optic nerve head increased gradual y with the increased intraocular pressures. Regarding to the thickness changes of the choroid, retina and lamina cribrosa, the trend of experimental measurement results was consistent with finite element calculation results. Hence, it is feasible to analyze morphological changes of every fundus tissue under high intraocular pressure using the tomographic sequence images obtained by optical coherence tomography. We can predict the morphological changes of the optic nerve head tissue by finite element analysis, which has certain guiding significance in determining the progression of glaucoma.

Objective To investigate the associations between 21 metals in fine particulate matter (PM2.5) and their corresponding concentrations in urine in the general population.Methods Between April and May 2011,this panel study enrolled 120 residents using random sampling approach in Wuhan communities which contained 3 035 subjects.Participants were aged 18 to 80 years and had lived in the sampling buildings for at least 5 years.Data from basic questionnaires,physical examinations,and morning blood and urine samples under fasting conditions were collected.Participants with missing data were excluded.Finally,83 particpants included.Participants were instructed to use personal air samplers to continuously monitor PM2.5 for 24 h.The following 21 metals were measured in PM2.5 and urine by inductively coupled plasma mass spectrometry:aluminum,titanium,vanadium,chromium,manganese,cobalt,nickel,copper,zinc,arsenic,selenium,rubidium,strontium,molybdenum,cadmium,tin,antimony,barium,tungsten,thallium and lead.The associations between PM2.5 metals and urinary metals were investigated using generalized linear regression models.Results The age of the study population was (51.5±6.3)years.After adjusting for age,sex,smoking status,BMI,education and income,elevated urinary chromium was significantly associated with increased chromium concentrations in personal PM2.5.The least square means (standard deviation) of urinary chromium in participants classified as having low exposure (＜12.491 ng/m3),intermediate exposure (12.491-32.388 ng/m3) and high exposure (＞32.388 ng/m3) were (-1.334±0.756),(-1.114±0.813) and (-0.718±0.645) μg/mmol creatinine,respectively (P=0.009).However,the association between urinary and personal PM chromium was not observed after additionally adjusting for false discovery rate (P＞0.05).Furthermore,the results demonstrated that other metals in PM2.5 were not related to their corresponding concentrations in urine of subjects.Conclusion Urinary concentrations of metals did not reflect human exposure to metals in air,and may not be appropriate as an index to assess personal exposure to metals in particulate matter.

Objective To investigate the associations between 21 metals in fine particulate matter (PM2.5) and their corresponding concentrations in urine in the general population.Methods Between April and May 2011,this panel study enrolled 120 residents using random sampling approach in Wuhan communities which contained 3 035 subjects.Participants were aged 18 to 80 years and had lived in the sampling buildings for at least 5 years.Data from basic questionnaires,physical examinations,and morning blood and urine samples under fasting conditions were collected.Participants with missing data were excluded.Finally,83 particpants included.Participants were instructed to use personal air samplers to continuously monitor PM2.5 for 24 h.The following 21 metals were measured in PM2.5 and urine by inductively coupled plasma mass spectrometry:aluminum,titanium,vanadium,chromium,manganese,cobalt,nickel,copper,zinc,arsenic,selenium,rubidium,strontium,molybdenum,cadmium,tin,antimony,barium,tungsten,thallium and lead.The associations between PM2.5 metals and urinary metals were investigated using generalized linear regression models.Results The age of the study population was (51.5±6.3)years.After adjusting for age,sex,smoking status,BMI,education and income,elevated urinary chromium was significantly associated with increased chromium concentrations in personal PM2.5.The least square means (standard deviation) of urinary chromium in participants classified as having low exposure (＜12.491 ng/m3),intermediate exposure (12.491-32.388 ng/m3) and high exposure (＞32.388 ng/m3) were (-1.334±0.756),(-1.114±0.813) and (-0.718±0.645) μg/mmol creatinine,respectively (P=0.009).However,the association between urinary and personal PM chromium was not observed after additionally adjusting for false discovery rate (P＞0.05).Furthermore,the results demonstrated that other metals in PM2.5 were not related to their corresponding concentrations in urine of subjects.Conclusion Urinary concentrations of metals did not reflect human exposure to metals in air,and may not be appropriate as an index to assess personal exposure to metals in particulate matter.

Breast malignant lymphoma refers to occur in the breast malignant tumor of the lymphoid tissue.Breast malignant lymphoma which belongs to outside of lymph tissue malignant tumor can be divided into two categories:one category is the secondary breast lymphoma (SBL),another kind is the primary malignant lymphoma of the breast (PBL).Because the rate of PBL was low and the difficulty of preoperative diagnosis,illness development is rapid and high malignant degree,we should improve the attention of clinicians.Based on the discussion of primary breast lymphoma pathological changes,histological types,clinical manifestations,this article focuses on the progress of diagnosis and treatment of the PBL.