Non-alcoholic fatty liver disease (NAFLD) has become a new health issue in the world due co its increasing incidence rate,and in particular,nonalcoholic steatohepatitis is progressive and has poor prognosis.Therefore,there is an argent need to search for the methods for the prevention of disease progression and treatment.Bile acid,as an important metabolite and signal molecule,can adjust the metabolism of lipids and carbohydrates and energy balance inside and outside the liver.Bile acid interacts with is receptors,such as the farnesoid X receptor and Takeda G-protein coupled receptor 5,bile acid transporter,and gut microbiota and is involved in the pathogenesis of NAFLD and nonalcoholic steatohepatitis at different levels.This article summarizes the research advances in the pathogenesis of bile acid-related NAFLD and related pharmacotherapy.

Objective To evaluate the clinical effect of one-stage posterior-anterior approach surgery for patients with cervical fracture and dislocation combined with locked facet.Methods A retrospective review was conducted on 21 cases of cervical dislocation and fracture combined with locked facet treated by one-stage posterior-anterior approach surgery between April 2011 and December 2012.There were 16 males and 5 females at age ranging from 23 to 61 years (mean,38.3 years).Posterior unlocking reduction by partial facetectomy and lateral mass screw fixation was performed,followed by anterior decompression,internal fixation and interbody fusion by titanium meshes.Outpatient or telephone follow-up was performed to evaluate bone fusion and recovery of neurologic function.Results Mean operation time was 140 minutes (130-210 minutes) and mean blood loss was 340 ml (range,150-600 ml).All incisions got primary healing with no operation-correlated complications.Five patients complicated with severe lung infection after surgery and one died of respiratory failure two week later.Titanium meshes achieved bone fusion within 3-9 months (mean,6 months) after surgery.At a mean follow-up of 17 months (range,12-30 months),there was no implant breakage and mesh displacement or collapse.According to the American Spinal Injury Association (ASIA) score,preoperative neurologic deficit restored by mean one grade at final follow-up.Conclusion One-stage posterior-anterior approach surgery is an ideal choice for cervical fracture and dislocation combined with locked facet,for it provides unlocking reduction,canal decompression,and rigid reconstruction of the anterior-posterior column.

[ABSTRACT]AIM:ToestablishandevaluateahyperbilirubinemiaandkernicterusmodelinneonatalSDrats. METHODS:Three-day-old SD rats were randomly divided to 7 experimental groups by litter and body weight , and were in-traperitoneally injected with physiological saline (control group), and 6.25μg/g (T1), 12.5μg/g (T2), 25μg/g (T3), 50μg/g (T4), 100μg/g (T5) and 200μg/g (T6) bilirubin, respectively, twice every day for 3 d.All rats were photo-graphed , weighed and killed 12 h after the last injection .The contents of the stomach were drawn and weighed , and the index was calculated .The liver/body weight ratio was determined , the total and unconjugated bilirubin in the serum and total bili-rubin in the brain were calculated , and the contents of ATP and water in the brain were measured .HE and Nissl staining were used to observe the pathological changes .RESULTS:Along with the increase in bilirubin , gradual exacerbation of the general performance of the rats , and yellowish discoloration of the skin and mucous membranes were observed .The degree of the activity gradually reduced , and the weight gain was suppressed .The weight of T6 group showed negative growth , and the 72 h mortality rate was close to 100%.The mortality rate in T4 and T5 groups continued to rise 1 week after injection .Com-pared with control group , the weight of stomach contents and stomach content index in T 3~T5 groups significantly decreased (P<0.01).The liver/body weight ratio in T5 group was significantly higher (P<0.05).The concentrations of serum total and unconjugated bilirubin and brain bilirubin levels in T 1~T5 groups were gradually increased , while the brain water con-tent had no difference among groups .The brain ATP content in T1~T5 groups increased at the beginning and reached its peak in T3 group, but compared with control group , that in T4 group and T5 group significantly reduced (P<0.05).HE re-sults showed that , with the increase in bilirubin concentration , the number of the neurons in the cerebral cortex of the rats de-creased.In T4 group and T5 group, the neuronal structural disorder , cell swelling, nuclear pyknosis, fragmentation and dis-solution, increase in non-homogeneous structure of the material dyed red , and disappearance of nuclear staining were ob-served.Nissl staining showed that , compared with control group , in T1 group and T2 group, the cortical neurons became smaller, Nissl bodies decreased , and cytoplasmic staining changed little .The cortical neuronal tigroid body color became light gradually, neuron cells become small , and Nissl bodies decreased obviously in T 3, T4 and T5 groups.The T4 and T5 rat ce-rebral cortical neurons dissolved or even disappeared .CONCLUSION:Newborn 3-day-old SD rats receiving intraperitoneal injection of bilirubin at doses of 12.5, 25, 50 and 100μg/g, 2 times a day, can induce hyperbilirubinemia , and 50 and 100μg/g can cause bilirubin encephalopathy .

Crystal power/epoxy resin composite was made with refined crystal power as filling material in different composition. The shearing strength and coefficient of thermal expansion of the crystal powder/epoxy resin composite was studied. The sectional morphology was observed under a scanning electron microscope. The results of the study indicate that the shearing strength of crystal powder/epoxy resin composite is improved while the coefficient of thermal expansion decreases with increase of the amount of crystal powder, and a well-proportioned three-dimensional structure is obtained. The augmentation of shearing strength exhibits no linear relationship to the amount of crystal powder, and there is an optimal amount for crystal powder filling. The coefficient of thermal expansion is decreased with increase of crystal powder filling, and three-dimensional structure optimization exhibits the' similar inflexion.

Objective To explore the generalization effect of a semantic navigation strategy(SNS)on naming in patients with aphasia.Methods Fourteen patients with aphasia were randomly divided into an SNS group (n =7)and an unrelated semantic(US)group(n =7).One hundred and twenty-two words chosen from Chinese word association norms were used in this study.The presentation sequence of words was generated automatically with network analysis techniques for the SNS group and randomly without network analysis techniques for the US group.After baseline tests using the western aphasia battery(WAB)and the mini-mental status examination(MMSE),all patients received language training once a day for 10 consecutive days.The amount of correct responses was recorded every day in order to draw the learning curve.The generalization effect was evaluated with 46 untrained items before and after training with all patients.Results The average learning curve of the SNS group was steeper than that of the US group.Correct responses on trained items were significantly more frequent in the SNS group than in the US group after the 6th day of training.After 10 days the frequency of correct responses on untrained items in the SNS group was significantly higher than it had been before training,and higher than the frequency after training in the US group.The frequency of no response on untrained items in the SNS group had declined,and it had declined more than in the US group.Conclusion A semantic navigation strategy may promote significant generalization while improving the learning curve in naming among patients with aphasia.

Objective To synthesize a quantum dot (QD) to recognize glioma cells for imaging and photodynamic therapy. Methods By one-pot aqueous approach, near infrared-emitting CdTe was produced. After detection of its physicochemical characterizations, RGD was conjugated. Emission images were observed with confocal microscopy. To test its toxicity, CdTe-RGD with various concentrations was separately added into U251 and 3T3 cells for incubation in dark circulation. To test its photodynamic effect, U251 and 3T3 cells were then irradiated for 5 ~ 60 min using 632.8 nm laser. Results The QD (Φ = 3.75 nm, PL peak wavelength =700 nm, PLQY=20%) achieved was a spherical crystal with excellent monodispersity. Under confocal microscope , U251 cells were visualized but 3T3 cells not. In dark circulation, the survival rates of both U251 and 3T3 cells were above 85%. After laser irradiation, the survival rate of U251 cells decreased to (37 ± 1.6)%with the increasing of irradiation time and CdTe-RGD concentration. Conclusion With good physicochemical characterization and low toxicity, CdTe-RGD could be applied in biomedical imaging and photodynamic therapy of gliomas.

AIM: To evaluate relationship between dosing schedules and safety of voriconazole by analyzing the monitoring results of voriconazole in patients with liver dysfunction, and to provide reference for the clinical individualized medication. METHODS: The blood concentration and safety information of voriconazole in patients with liver dysfunction was searched in PubMed, Cochrane Library, Wanfang, Weipu, and Chinese Journal Full-text Database from the establishment of the databases to December 2019, the dosing schedule and safety range of voriconazole for patients with liver dysfunction was analyzed. RESULTS: A total of 10 literatures were selected, 5 of which were multi-sample retrospective studies and 1 of which was prospective study, and the remaining 4 were case reports. In Child-Pugh grade C liver dysfunction, a maintenance dose of 100 mg q12h is more secure. The incidence of adverse reactions of voriconazole is generally within 7 days. When the target trough concentration is less than 5 mg/L or 5.3 mg/L, the incidence of adverse reactions is still high. The main adverse reactions include neurotoxicity, hallucinations, visual disturbances, gastrointestinal reactions and rash. CONCLUSION: The dose of voriconazole in patients with liver dysfunction should be reduced, and the drug concentration should be monitored in a timely manner. It is recommended that on the basis of ensuring the efficacy, trough concentration can be further reduced to reduce the occurrence of adverse reactions in patients with liver dysfunction.

Objective: To determine the clinical efficacy and feasibility of multiple special formed titanium mesh cages (TMCs) to treat lumbo-sacral spinal tuberculosis via posterior approach. Methods: From July, 2007 to June, 2013, 25 patients with lumbo-sacral spinal tuberculosis underwent one-stage posterior debridement, internal if xation, and interbody fusion using multiple special formed titanium meshes. We compared the parameters as follow: the pre- and post-operative American Spinal Injury Association (ASIA) score, lumbo-sacral angle, the height of intervertebral space, visual analogue scale (VAS), and erythrocyte sedimentation rate (ESR), and observedoperation time, intraoperative blood loss, and time of bone gratf fusion. Results: Operation time ranged from 90 to 180 min, (128±24) min in average. Blood loss in the operation ranged from 100 to 800 mL, (310±125) mL in average. hTe patients were followed up for 24 to 59 months, (43±7) months in average. One patient delayed healing of wound. ASIA score was improved in a certain degree in patients with neurological dysfunctions. hTe lumbo-sacral angle and the height of intervertebral space in the post-operation were signiifcantly higher than those in the pre-operation (P<0.001). VAS was reduced obviously atfer 2 weeks of operation. hTe ESR recovered to the normal level 6 months atfer operation in all the patients. Solid fusion was achieved within 4 to 8 months, 6 months in average. No sinus tract, cerebrospinal meningitis, tuberculosis recurrence and titanium mesh subsidence were found. Conclusion: For lumbo-sacral tuberculosis, multiple special formed titanium mesh cages via posterior approach is safe and effective, which is good to the stability in spine reconstruction.

BACKGROUND:Transforaminal endoscopic discectomy needs to dissociate the ligamentum flavum, and if
combined with the continuous dilator and working channel, it can keep the intact ligamentum flavum no matter how smal the incision may be (even 3-5 mm).
OBJECTIVE:To present the technique of interlaminar endoscopic lumbar discectomy with ligamentum flavum splitting.
METHODS:We performed operations on 16 male and 14 female patients by interlaminar endoscopic lumbar
discectomy with ligamentum flavum splitting. The average age of the patients in the study was (48±15) years. The chief complaint before surgery was radiculopathy confined to one leg. The anatomic operative level was L 3-4 in
one case, L 4-5 in 13 cases and L 5-S 1 in 16 cases. The ruptured disc migrated superiorly in four cases and
inferiorly in seven cases, and intraoperative electromyo-graphic monitoring was performed in al surgeries. The
ligamentum flavum was split, and after withdrawing the working channel, the ligamentum flavum could reset itself. RESULTS AND CONCLUSION:The total operation time was 20-40 minutes, and the fol ow-up period was
(149±108) days. There were no abnormal signals on the intraoperative electromyography in any cases, and the reported symptoms were immediately improved in al patients after the operation. Fol ow-up magneticresonance imaging showed a disappearance of the ruptured disc without defect in the ligamentum flavum. There were no operation-associated complications in al the patients. Interlaminar endoscopic lumbar discectomy with
ligamentum flavum splitting is a feasible approach.

Objective To investigate the complications of three-dimensional correction surgery for scoliosis and the corresponding prevention and treatment strategies.Methods From December 2004 to June 2011,727 cases of scoliosis were treated by three-dimensional correction system.There were 245 males and 482 females,aged from 3 to 62 years (average,18.2 years).Coronal Cobb angles ranged from 32° to 142° (average,87.6°),and sagittal Cobb angles ranged from-10° to 75° (average,45°).Results All patients were followed up for 12 to 90 months (average,62.5 months).All patients underwent surgery safely.The coronal correction rate ranged from 55％ to 98％ (average,85.2％),and the sagittal correction rate ranged from 35％ to 67％ (average,47.5％).There were no major complications such as death and nerve injury,but occurrences of other minor complications were 113 times in 102 cases.There were 26 cases of instrumentation-related complication,including 5 cases of pedicle screw loosening,5 cases of broken screw,8 cases of broken rod,3 cases of hook loosening,and 5 cases of pedicle fracture; 14 cases of them occurred early after correction surgery for adult scoliosis.There were 65 cases of correction-related complication,including 36 cases of junctional kyphosis (21 cases of proximal junctional kyphosis,11 cases of which were neuromuscular scoliosis; 15 cases of distal junctional kyphosis,including 4 cases of Marfan syndrome with scoliosis and 6 cases of neuromuscular scoliosis),22 cases of adding-on phenomenon,and 7 cases of flat back.Internal medicine complications included 6 cases of superior mesenteric artery syndrome and 7 cases of pulmonary complications.Operation-related complications included 4 cases of pressure sore and 5 cases of wound infection.Conclusion Accurate procedures of diagnosis and surgery for scoliosis are the key to decrease and prevent the complications.For adult scoliosis,enough instrumentation should be placed at the apical segments to decrease instrumentation-related complications.For neuromuscular scoliosis and Marfan syndrome with scoliosis,appropriate extension of fusion segment can effectively decrease junctional kyphosis.