Objective To investigate the clinical efficacy of unilateral small incision Quadrant channel assisted MIS?TLIF unilateral pedicle screw fixation system in the treatment of degenerative lumbar disease. Methods From January 2011 to December 2013,a total of 56 cases with low back and leg pain were selected in the People′s Hospital of Dongguan,including 25 cases with lumbar disc herniation,18 cases with lumbar tube stenosis,10 cases with discogenic low back pain,2 cases of recurrence after posterior lumbar spine surgery,1 case of recurrence after transforaminal endoscopic surgery. Unilateral pedicle screw fixation was performed in the treatment of MIS?TLIF with expandable pipeline system. VAS and Oswestry dysfunction index scoring system( ODI) were used to evaluate of pain and functional recovery in patients with preoperative and postoperative pain and functional recovery,the Suk method was used to observe the bone graft fusion. Results There were 5 cases of non operative side waist back pain after operation,and the waist circumference and anti?inflammatory pain relief were improved after treatment. One case of postoperative subcutaneous fat liquefaction, was cured by dressing change. One patient with recurrence of MED intraoperatie cerebrospinal fluid leakage,was cured after treatment by the bed,dehydration and others. Other complications such as infection,screw loosening, nerve root injury and other complications had no found. After 1 month,the VAS score from preoperative ( 6. 82 ±0. 92) points fell to (1. 95±0. 55) points,ODI score from preoperative (35. 21±2. 73) points fell to (10. 05 ±1. 72) points, significantly improved compared with the preoperative, the differences were statistically significant( t=36. 775,65. 858,P<0. 05) ,based on the fusion of Suk judgment method,2 cases of patients with possible fusion,the rest were fusion. Conclusion Unilateral small incision under the quadrant assisted MIS?TILF unilateral pedicle nail stick system has obvious advantages in treatment of degenerative lumbar spine disease,as long as we choose to suitable cases and most patients can obtain satisfactory results.

ObjectiveTo study the Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL)of the elderly and explore its clinical characteristics. MethodsThe clinical manifestation,laboratory examination and treatment of two cases of EBV positive DLBCL of elderly were lescribed.Results EBV positive DLBCL of elderly onset was often between 70-79 years,usually presented with lymphadenopathy and may be extranodal,may present with massive splenomegaly,secondary immune hemolytic anemia and often had B symptom.Pathologically,this disease was characterized by a proliferation of atypical large B cells with rich reactive cells,especially T cell.ConclusionImmunohistochemically,the tumor cells of EBV positive DLBCL of elderly present with CD20 or CD79a,EBV-encoded small RNA (EBER) positive.This disease has aggressive clinical course,a poor response to standard treatment.Rituximab may be effective in a short periods,but the long effect is limited.Overall survival is short.The cause of death is mainly respiratory failure due to factor infection.

Objective:To investigate the radiotherapy discipline construction and existing problems in non-public hospitals in Zhejiang province and put forward suggestions for improvement.Methods:In 2022, on-site inspection and investigation were carried out in 14 non-public hospitals in Zhejiang province, including equipment configuration and source, discipline setting, personnel qualification and professional experience, academic leaders and admission of patients, etc. Results:For 14 non-public hospitals in Zhejiang province, 19 treatment equipment, 15 positioning equipment and 77 quality control equipment were equipped, and a total of 249 radiotherapy practitioners were employed. A total of 4 224 patients were admitted throught 2022.Conclusion:Multiple problems exist in non-public radiotherapy hospitals in Zhejiang province, such as unscientific discipline setting, fewer professionals, lack of personnel training, unclear management mode, unqualified qualification of partial radiotherapy doctors, and insufficient refinement of clinical quality management, which need to be further improved.

OBJECTIVE To mine adverse drug event （ADE） signals related to the pulmonary arterial hypertension （PAH） therapeutic drug macitentan， and to provide reference for safe clinical medication. METHODS Macitentan-related ADE reports were collected from the US FDA Adverse Event Reporting System （FAERS） database from the fourth quarter of 2013 to the third quarter of 2023. Data mining was conducted by using the reporting odds ratio （ROR） method and the comprehensive standard method established by the UK Medicines and Healthcare Products Regulatory Agency （referred to as “MHRA method”） under the proportional imbalance approach. According to the systemic organ class （SOC） and preferred term （PT） stated in 26.0 edition of Medical Dictionary of Regulatory Activities， standardized coding of ADE names was performed， followed by the analysis of time to onset （TTO） and the Weibull shape parameter （WSP） test. RESULTS Overall， a total of 26 079 ADE reports were identified with macitentan as the primary suspect drug. These reports predominantly involved female patients （73.25%） and were concentrated in the age range of 18 to 65 years （42.39%）. The majority of reports originated from the US （84.42%）， with hospitalization or prolonged hospital stays （59.82%） being the most common in severe treatment outcome. A total of 269 ADE positive signals related to macitentan were identified. Among these， hypothyroidism， ADE related to renal injury such as the increase of serum creatinine and blood urea nitrogen， and ADE related to psychiatric disorders like apathy and despair were not included in the drug label. TTO analysis indicated that the majority of macitentan-related ADE signals occurred between 0-30 days after initial treatment （492 reports， 21.52%） and over 360 days （411 reports， 17.98%）. The results of WSP test showed that most of the top 20 reported ADE signals conformed to the characteristics of an early failure curve. CONCLUSIONS When clinically using macitentan in patients with PAH， attention should be given not only to the adverse reactions mentioned on the drug label but also to thyroid dysfunction， kidney dysfunction and mental disorder-related ADEs.

OBJECTIVE To provide reference for rational clinical use of mepolizumab. METHODS The reporting odds ratio method and Bayesian confidence propagation neural network method were used to conduct signal mining and analysis of adverse drug event （ADE） reports related to mepolizumab in the United States Food and Drug Administration Adverse Event Reporting System from the first quarter of 2016 to the third quarter of 2022. RESULTS A total of 57 501 ADE reports were extracted with mepolizumab as the primary suspect drug， involving 16 358 patients. Among these reports， the proportion of males （23.51%） was lower than females （50.48%）. The reporting countries were primarily the United States （51.91%） and Canada （29.94%）. Consumers （71.18%） constituted the main reporting population. A total of 172 ADE-positive signals were identified， mainly involving 13 system organ classes such as the respiratory， thoracic and mediastinal disorders （41.63%）， as well as infectious and parasitic diseases （14.16%）. There were 60 high-risk signals， including 15 that were explicitly mentioned or related to adverse reactions in the drug instructions of mepolizumab and 45 signals （such as asthmatic crisis， sputum discoloured， purulent sputum， sleep disorder due to a general medical condition） were newly identified high-risk signals. Among them， 11 high-risk signals exhibited gender or age differences. CONCLUSIONS When clinically using mepolizumab， in addition to the adverse reactions mentioned in the drug instruction， special attention should also be given to changes in the nature of sputum， painful respiration， and sleep disorders.