refer to the cases with pression caused by both posterior and anterior matters, the posterior-anterior surgery is better.

Objective To explore the clinical effect of blood purification combined with fasudil in elderly cardiac surgery patients with postoperative acute kidney injury.Methods Fifty elderly cardiac surgery patients with postoperative acute kidney injury were divided into control group and study group by random digit table method with 25 cases each.The 2 groups were treated with routine drug and blood purification,the study group was additionally given fasudil injection 30 mg + 0.9％ sodium chloride injection 50 ml vein pumping,1 time/12 h,for 7 d.The urine volume,urine N-acetyl-β-D-glucosaminidase (NAG),urine γ-glutamyl transpeptidase (γ-GTP),urine α 1-microglobulin (α 1-MG),serum creatinine (SCr),blood urea nitrogen (BUN) and creatinine clearance rate (CCr) were observed,and the acute physiology and chronic health evaluation (APACHE) Ⅱ score was computed.Results There were no statistical differences in the indexes before treatment between the 2 groups (P＞ 0.05).The urine volume after treatment 3,5,7 d in study group was more than that in control group [(38.72 ± 2.68) ml/h vs.(31.68 ± 2.52) ml/h,(47.24 ±3.73) ml/h vs.(40.24 ± 2.52) ml/h、(63.80 ± 2.50) ml/h vs.(56.60 ± 3.30) ml/h],urine NAG,urine α 1-MG,urine γ-GTP,SCr and BUN were lower than those in control group [NAG:(25.05 ±5.44) U/L vs.(28.04 ± 5.21) U/L,(24.06 ± 3.43) U/L vs.(27.23 ± 6.43) U/L,(22.08 ± 3.25) U/L vs.(26.23 ± 4.41) U/L; α 1-MG:(24.05 ± 3.65) mg/L vs.(26.74 ± 6.74) mg/L,(22.98 ± 3.58) mg/L vs.(25.57 ± 3.58) mg/L,(20.95 ± 3.78) mg/L vs.(25.48 ± 3.45) mg/L; γ-GTP:(8.2 ± 0.4) U/L vs.(10.8 ± 3.8) U/L,(7.3 ± 0.2)U/L vs.(10.5 ± 2.5) U/L,(6.5 ± 1.4) U/L vs.(9.7 ± 2.6) U/L; SCr:(206.52 ± 6.72) μ mol/L vs.(255.16 ±6.75) μmol/L,(182.98 ±6.26) μmol/L vs.(252.23 ±9.53) μmol/L,(33.25 ±7.95) μmol/L vs.(170.75 ± 7.94) μ mol/L; BU N:(19.61 ± 3.23) mmol/L vs.(20.25 ± 3.25) mmol/L,(16.76 ± 2.06) mmol/L vs.(18.32 ± 4.84) mmol/L,(12.28 ± 2.26) mmol/L vs.(14.27 ± 4.54) mmol/L],CCr was higher than that in control group [(18.66 ± 3.89) ml/min vs.(13.28 ± 3.25) ml/min,(27.76 ± 4.36) ml/min vs.(16.23 ± 4.18)ml/min,(33.79 ± 5.58) ml/min vs.(22.12 ± 4.65) ml/min],there were statistical differences (P ＜ 0.05).The APACHE Ⅱ score before treatment and after treatment 5,7 d in control group were (32.20 ±4.51),(26.38 ±5.28) and (21.43 ±4.22) scores,in study group were (33.05 ±3.82),(22.15 ±3.42) and (13.25 ± 2.15) scores.There was no statistical difference in the APACHE Ⅱ score before treatment (P ＞ 0.05),the APACHE Ⅱ score after treatment was improved,furthermore APACHE Ⅱ score after treatment 5,7 d in study group were better than those in control group,there were statistical differences (P ＜ 0.05).Conclusions The treatment effect of blood purification combined with fasudil is remarkable in elderly cardiac surgery patients with postoperative acute kidney injury.At the same time,it has high security and very important clinical significance.

Carcinoma, Hepatocellular ; surgery ; therapy ; Catheter Ablation ; Combined Modality Therapy ; Humans ; Liver Neoplasms ; surgery ; therapy

Objective To discuss the effectiveness of the second surgical procedure of adjacent segment degeneration after the first spinal fusion.Method 35 patients who had been performed spinal fusion in our hospital or had symptoms recurred or aggravated after 12 ～ 114 (42 ±35) months of the prior surgery were enrolled in this study.A second surgery was performed and intraoperative the intradiscal pressure of adjacent segments of degeneration and normal segments was measured.The VAS score systems were compared among prior surgery,3 months later and 2 years after the second surgery.Result The intradiscal pressure of adjacent segments after the cervical vertebra and lumbar vertebra fusion were [ (15 ± 4.6)cmH2O,(23 ±5.2)cmH2O],much higher than normal segments [ (3 ±2.3)cmH2O,(8 ±4.1)cmH2O](P ＜0.01).The VAS score systems of 3 months later and 2 years after the second surgery were [ (2.9 ±0.7),(2.0 ± 0.6) ],which were dramatically lower than the prior (7.8 ± 1.2) (P ＜ 0.01).In 12 ～ 46(31 ± 12) months of follow-up after the second procedure,X-ray and MRI showed that fusion segments reached nearly bone fusion,well decompressed and without nerve compression or other complications.Conclusion If recurrence of symptoms after spinal fusion were caused by adjacent segment degeneration,reoperation would guarantee good clinical outcome.

Recent research based on various animal models has shown the neuroprotective effects of erythropoietin (EPO). However, few studies have examined such effects of EPO in the clinic. In this study we enrolled patients with spinal cord ischemia-reperfusion (I-R) injury to investigate the clinical application of EPO and methylprednisolone (MP) for the neuroprotection against spinal cord I-R injury. Retrospective analysis of 63 cases of spinal cord I-R injury was performed. The Frankel neurological performance scale was used to evaluate the neurological function after spinal cord injury (SCI), including 12 cases of scale B, 30 cases of scale C, and 21 cases of scale D. These cases were divided into 2 groups: group A (27 cases) got treatment with both EPO and MP; group B (36 cases) got treatment with MP only. The neurological function of patients after treatment was evaluated by American Spinal Cord Injury Association (ASIA) index score, and activity of daily living (ADL) of the patients was also recorded. All patients got follow-up and the follow-up period ranged from 24 to 39 months (mean 26 months). There was no significance difference in neurological function between groups A and B before the treatment (P>0.05). However, the neurological function and ADL scores were significantly improved 1 week, 1 year or 2 years after the treatment compared to those before the treatment (P<0.05), and the improvement was more significant in group A than in group B (P<0.05). It is suggested that the clinical application of EPO and MP provides the neuroprotection against spinal cord I-R injury.

Humans ; Liver Neoplasms ; diagnosis ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed

At present, the classification, nomenclature, and definition of carcinoma of the bile ducts are controversial. Moreover, there is no uniformity between China and aboard, which has brought confusion to clinical practice. It needs to clarify regarding tumor naming principles, anatomical location, tumor origin, pathological classification, biological characteristics, clinical manifestations, treatment methods, etc. Additionally, the WHO tumor classification, UICC staging, ICD disease classification, relevant Chinese regulations, EASL, AJCC staging, and NCCN guidelines were also needed to be referred. After investigating the above-mentioned latest authoritative literature, based on the existing problems, combined with clinical practice in China, the author reevaluated the definition, classification, and nomenclature of cholangiocarcinoma, and proposes updated suggestions. Hoping to standardize and unify clinical practice for classification and nomenclature of cholangiocarcinoma in China.
Bile Duct Neoplasms/pathology* ; Bile Ducts/pathology* ; Bile Ducts, Intrahepatic/pathology* ; China ; Cholangiocarcinoma/pathology* ; Humans ; Neoplasm Staging ; Prognosis

OBJECTIVE To provide technical support for improving recognition rate of adverse drug events （ADEs） related to traditional Chinese medicine （TCM） formula granules and decoction pieces among inpatient patients. METHODS By referencing the global trigger tool （GTT） whitepaper， literature on adverse reactions to TCM， and expert review opinions， ADE trigger items for TCM formula granules and decoction pieces used in the inpatients were established. GTT was applied to analyze ADEs in inpatients who had used TCM formula granules and decoction pieces in our hospital from August 2013 to August 2023， utilizing the Chinese Hospital Pharmacovigilance System. The effectiveness of GTT and the characteristics of these ADEs were analyzed. RESULTS A total of forty-eight triggers were established， including thirty-two laboratory test indexes， thirteen clinical symptoms， and three antidotes. Among the 1 682 patients included， GTT identified 652 potential ADEs， 284 true positive ADEs，with a trigger rate of 38.76% and a positive predictive value of 43.56%. After review by the auditor， 278 cases of ADEs were finally confirmed， with an incidence rate of 16.53%， significantly higher than the number of spontaneously reported ADEs during the same period （0）. The 278 cases of ADEs were mostly grade 1 （223 cases）， mainly involving hepatobiliary system， gastrointestinal system， blood- lymphatic system， etc；a total of 219 types of TCMs are involved，and the top five suspected TCMs used at a frequency higher than 1% were Poria cocos， Codonopsis pilosula， Atractylodes macrocephala， fried Glycyrrhiza uralensis， and Scutellaria baicalensis. CONCLUSIONS The established GTT can improve the recognition rate of ADEs for hospitalized patients using traditional Chinese medicine formula granules and decoction pieces.

OBJECTIVETo establish osteoblast apoptosis model induced by gingipains, and to examine the expression of pro-apoptotic protein Bcl-2 interacting mediator (Bim), Bcl-2 associated X protein (Bax) and Bcl-2 antagonist/killer (Bak).

METHODSGingipain and gingipain acticity were extracted and measured. Mouse osteoblast cell line MC3T3-E1 cells were cultured in the presence of 0.453, 0.906, 1.812 U/L gingipains for 0, 16, 24 and 48 h. Apoptosis was examined by 4',6-diamidino-2-phenylindole (DAPI) staining or annexin V/propidine iodide (PI) staining.Protein expression of Bim, Bax and Bak was determined by Western blotting after osteoblasts were cultured with 1.812 U/L gingipain for 0, 4, 8, 16, 24 and 48 h. Osteoblasts were cultured with 1.812 U/L gingipain which had been inhibited with N-alpha-tosyl L-lysyl-chlorom ethylketone (TLCK). Western blotting was used to detect Bim expression and DAPI staining to measure apoptosis.

RESULTSArginine-specific proteinases (Rgp) activity was (18.11 ± 2.11) U/L and specific proteinases (Kgp) was (1.02 ± 0.25) U/L. Percentage of osteoblast apoptosis induced by 1.812 U/L gingipain rose to (6.31 ± 0.37)% after 16 h, and reached (11.20 ± 0.35)% at 24 h and (10.80 ± 0.46)% after 48 h with DAPI staining. Annexin V/PI staining supported the result from DAPI staining.Bim protein level increased during osteoblast apoptosis, the relative fold rose to (0.31 ± 0.03) after 4 h (about 2 fold compared to control), peaking at 24 h (0.57 ± 0.05, 3-4 fold compared to control). Proteinase inhibitor TLCK effectively blocked the activity of gingipain and inhibited up-regulation of Bim induced by gingipains from (0.58 ± 0.04) to (0.14 ± 0.03). The percentage of osteoblast apoptosis decreased from (11.20 ± 0.35)% to (4.31 ± 0.38)% in the presence of TLCK. Expression of Bax remained unchanged when cells were cultured with or without gingipains. Bak was under the detectable level in MC3T3-E1.

CONCLUSIONS1.812 U/L gingipains induced osteoblast apoptosis. Protein expression of Bim was up-regulated during cell apoptosis and was down-regulated when gingipain inhibited with TLCK, suggesting that Bim was involved in osteoblast apoptosis induced by gingipain. Inhibition of Bim protein expression protected osteoblast from apoptosis.

Adhesins, Bacterial ; pharmacology ; Animals ; Apoptosis ; drug effects ; Apoptosis Regulatory Proteins ; metabolism ; Bcl-2-Like Protein 11 ; Cell Line ; Cysteine Endopeptidases ; pharmacology ; Humans ; MCF-7 Cells ; Membrane Proteins ; metabolism ; Mice ; Osteoblasts ; cytology ; metabolism ; Proto-Oncogene Proteins ; metabolism ; Tosyllysine Chloromethyl Ketone ; pharmacology ; bcl-2 Homologous Antagonist-Killer Protein ; metabolism ; bcl-2-Associated X Protein ; metabolism

Tacrolimus and cyclosporine are both calcineurin inhibitors ( CNI) that widely used for immunosuppression and have the characteristics of great intra-and inter-variabilities in phar-macokinetics and pharmacodynamics.CNI undergoes extensive first-pass metabolism and is substrate for cytochrome P450 (CYP) 3A4, CYP3A5 and P-glycoprotein in intestine and liver.'Hie functions of the enzyme and transporter are determined by complex interactions including gene polymorphisms, induction or inhibition of drugs and endogenous substances ( such as inflam-matory factors).This review summarizes the clinical determinants of CNI treatment variability, including food intake, diarrhea and other intestinal diseases, anemia, hypoproteinemia, hyperlipidemia, liver and kidney disease and combination medications.The underlying mechanisms are also discussed.