1.Efficacy of mFOLFOX7 regimen systemic chemotherapy combined with camrelizumab and apatinib for hepatocellular carcinoma with Vp4 portal vain tumor thrombus
Linhui PENG ; Tao CHEN ; Yunxiuxiu XU ; Jie WANG ; Jie CHEN ; Yong LI ; Pinbo HUANG ; Guoping ZHONG ; Xi CHEN ; Congting YE ; Yajin CHEN
Chinese Journal of Digestive Surgery 2024;23(2):265-271
Objective:To investigate the efficacy of mFOLFOX7 regimen systemic chemo-therapy combined with camrelizumab and apatinib for hepatocellular carcinoma (HCC) with Vp4 portal vain tumor thrombus (PVTT).Methods:The single-arm, open, exploratory clinical study was conducted. The clinicopathological data of 15 HCC patients with Vp4 PVTT who were admitted to the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from April 2021 to October 2023 were collected. There were 14 males and 1 female, aged 48(range, 33-67)years. All patients underwent treatment with mFOLFOX7 regimen combined with camrelizumab and apatinib. Observa-tion indicators: (1) clinical efficacy; (2) survival of patients. Measurement data with skewed distribution were represented as M(rang), and count data were described as absolute numbers or percentages. Results:(1) Clinical efficacy. All 15 patients underwent treatment with mFOLFOX7 regimen combined with camrelizumab and apatinib. According to the response evaluation criteria in solid tumors version 1.1, the ratio of objective response, ratio of complete response, ratio of partial response, ratio of disease control, median progression free survival time and median total survival time of the 15 patients were 10/15, 1/15, 9/15, 15/15, not reached and not reached. The median progression free survival time and median total survival time were both >9 months. According to the modified response evaluation criteria in solid tumors, the ratio of objective response, ratio of complete response, ratio of partial response, ratio of disease control, median progression free survival time and median total survival time of the 15 patients were 12/15, 6/15, 6/15, 15/15, not reached and not reached. The median progression free survival time and median total survival time were both >9 months. Of the 15 patients, 7 cases were successfully treated with conversion therapy with the surgical conversion rate as 7/15, and all of them achieved R 0 resection. The other 6 cases were failed in conversion therapy, and there were 2 cases still undergoing conversion therapy. Of the 7 patients with successful conver-sion therapy, 5 cases achieved complete pathological remission, 1 case achieved major pathological remission with 90% of tumor tissue necrosis, and 1 case achieved complete remission through imaging examination, but new liver lesions appeared in multiple locations during further observation which were surgically removed. Results of histopathology examination on the patient confirmed multiple liver metastases. The proportion of treatment-associated adverse reactions in 15 patients was 13/15, with 7/15 having ≥grade 3 adverse reactions, including diarrhea (3/15), neutropenia (2/15), thrombo-cytopenia (2/15), and elevated aspartate aminotransferase (2/15). One patient may experience ≥1 adverse reaction. All patients were improved after symptomatic treatment. (2) Survival of patients. All 15 patients were followed up for 13.0(range, 2.0-31.0)months. During the follow-up period, 3 patients died. One case died of upper gastrointestinal bleeding after achieving partial remission, with a survival time of 7.5 months. One case died of multiple liver metastases of tumor, with tumors accounting for over 70% volume of liver and a survival time of 9.5 months. One case with multiple liver tumors and bilateral lung metastasis died due to disease progression after achieving partial remission, with a survival time of 13.5 months. The postoperative follow-up time for 7 patients undergoing surgical treatment was 14.0(range, 2.0-25.0)months. Of the 7 patients, 1 case experien-ced tumor recurrence 20.0 months after surgery, and 6 cases had no recurrence at last time of the follow-up (3 cases completed treatment and entered follow-up observation). The longest survival time was 31.0 months. Conclusion:The mFOLFOX7 regimen systemic chemotherapy combined with camrelizumab and apatinib for HCC with Vp4 PVTT is safe and feasible.
2.Signal interference between drugs and metabolites in LC-ESI-MS quantitative analysis and its evaluation strategy
Jiang FULIN ; Liu JINGYU ; Li YAGANG ; Lu ZIHAN ; Liu QIAN ; Xing YUNHUI ; Zhu JANSHON ; Huang MIN ; Zhong GUOPING
Journal of Pharmaceutical Analysis 2024;14(7):1024-1034
Liquid chromatography-electrospray ionization tandem mass spectrometry(LC-ESI-MS)is a widely utilized technique for in vivo pharmaceutical analysis.Ionization interference within electrospray ion source,occurring between drugs and metabolites,can lead to signal variations,potentially compromising quantitative accuracy.Currently,method validation often overlooks this type of signal interference,which may result in systematic errors in quantitative results without matrix-matched calibration.In this study,we conducted an investigation using ten different groups of drugs and their corresponding me-tabolites across three LC-ESI-MS systems to assess the prevalence of signal interference.Such in-terferences can potentially cause or enhance nonlinearity in the calibration curves of drugs and metabolites,thereby altering the relationship between analyte response and concentration for quanti-fication.Finally,we established an evaluation scheme through a step-by-step dilution assay and employed three resolution methods:chromatographic separation,dilution,and stable labeled isotope internal standards correction.The above strategies were integrated into the method establishment process to improve quantitative accuracy.
3.Determination and difference analysis of bile acid active constituents of artificial bezoar in Babao jingfeng powder from different manufacturers
Qi ZHONG ; Weikang CHEN ; Guoping ZHOU ; Yanmei LIU ; Dehong LIU ; Jing LI
China Pharmacy 2023;34(20):2502-2506
OBJECTIVE To establish the method for determination of bile acid active constituents (cholic acid, hyodeoxycholic acid and sodium taurocholate) in Babao jingfeng powder, and to compare the differences of 3 constituents in Babao jingfeng powder from different manufacturers. METHODS UPLC-MS method was adopted to determine the contents of cholic acid, hyodeoxycholic acid and sodium taurocholate in 9 batches of Babao jingfeng powder from 3 manufacturers. The separation was performed on a Phenomenex Luna® C18 column with mobile phase consisted of acetonitrile-water (gradient elution) at a flow rate of 0.5 mL/min. The column temperature was 40 ℃ and the sample size was 2 μL. MS system was operated in a negative ion single quadrupole mode, and the m/z of cholic acid, hyodeoxycholic acid and sodium taurocholate were 407.2, 392.2 and 514.2, respectively. With the contents of three components as the index, cluster analysis and principle component analysis were performed on 9 batches of samples. RESULTS The linear ranges of cholic acid, hyodeoxycholic acid and sodium taurocholate were 5.48- 548.40, 5.38-538.40, 4.74-474.05 ng/mL, respectively (r≥ 0.999 3). RSDs of precision, repeatability and stability tests(24 h) were all lower than or equal to 3.7% (n=6), and the average recoveries were 103.3%, 103.3% and 101.6% with RSDs of 3.3%, 3.4%, 4.2% (n=6), respectively. The contentsof cholic acid ranged 0.702-1.711 mg/g, those of deoxycholic acid ranged 0.599-2.049 mg/g, and those of sodium taurocholate ranged 0.664-1.752 mg/g in 9 batches of samples. The average content of 3 components in samples from manufacturer A was high, and the difference between batches was the smallest; the average content of 3 components from manufacturer C was the lowest, and the difference between batches was large. Cluster analysis could basically distinguish samples from different manufacturers; cluster analysis was conducted by using the comprehensive score of principal components as an indicator, the results of which were basically consistent with those of cluster analysis for content. CONCLUSIONS The method is established successfully for the content determination of the 3 bile acid active constituents of artificial bezoar in Babao jingfeng powder. The contents of 3 components in Babao jingfeng powder from 3 manufacturers are significantly different.
4.Construction and analysis of a predictive model for chemotherapy response of patients with colorectal cancer based on tissue chip technology
Linghua CONG ; Guoping ZHONG ; Zuguo YUAN ; Ying REN ; Gun CHEN ; Laifu FANG ; Ping LI
Chinese Journal of Endocrine Surgery 2023;17(3):307-311
Objective:To explore the prediction model of tissue chip technology for the chemotherapy response of patients with colorectal cancer.Methods:217 patients with colorectal cancer who had received standardized chemotherapy in the Affiliated People’s Hospital of Ningbo University from Jan. 2017 to Dec. 2019 were prospectively selected. The patients were randomly divided into training set (152 cases) and test set (65 cases) according to the ratio of 7:3, and were followed up for 6 months. The clinical data of the patients in the training set were compared, the expression levels of Ang-2, caspase-3 and CD147 in the patients were analyzed by tissue microarray technology, and the related factors affecting the responsiveness of colorectal cancer chemotherapy were analyzed by the Logistic regression model. R software was used based on the training set. A nomogram prediction model was built and model performance on the test set was evaluated.Results:One case was excluded from the training center, and 151 cases were finally included, including 93 cases in the chemotherapy response group and 58 cases in the chemotherapy response group. The tumor diameter, serum carcinoembryonic antigen, caspase3, Ang2 expression level, and the proportion of clinical stage IV in the poor chemotherapy group were significantly higher than those in the good chemotherapy group (all P<0.05) ; Logistic regression showed tumor diameter ( OR=2.394), serum carcinoembryonic antigen ( OR=1.878), caspase-3 ( OR=4.261), Ang-2 expression level ( OR=5.457), and clinical stage IV ( OR=5.954) were independent risk factors for adverse drug reactions in patients with colorectal cancer (all P<0.05). The consistency index (C-index) for predicting the factors related to adverse chemotherapy reactions in patients with colorectal cancer was 0.915. External verification showed that the sensitivity was 86.96%, the specificity was 92.50%, and the accuracy was 90.48% (42/65) . Conclusion:The expression levels of Ang-2 and caspase-3 are correlated with the responsiveness of colorectal cancer to chemotherapy, and can be used as predictive indicators to evaluate the responsiveness of colorectal cancer to chemotherapy.
5.A comparative study of the effects of citrate and heparin anticoagulation on coagulation function and efficacy in children with septic shock undergoing continuous blood purification
Xiaoming ZHONG ; Shasha LUO ; Ruihua REN ; Jie LAI ; Guoping DENG ; Huifang ZHU
Chinese Critical Care Medicine 2023;35(8):856-859
Objective:To compare the effects of citrate and heparin anticoagulation on coagulation function and efficacy in children with septic shock undergoing continuous blood purification (CBP), and to provide guidance for CBP anticoagulation in children with septic shock.Methods:A case control study was conducted. Thirty-seven children with septic shock admitted to the pediatric intensive care unit (PICU) of the First Affiliated Hospital of Gannan Medical University from July 2019 to September 2022 were enrolled as the research subjects. The patients were divided into citrate local anticoagulation group and heparin systemic anticoagulation group according to different anticoagulation methods. The baseline data, the level of coagulation indicators [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fib), D-dimer] before treatment and 1 day after weaning from CBP, serum inflammatory mediators [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), hypersensitivity C-reactive protein (hs-CRP), procalcitonin (PCT)], bleeding complications during CBP and 7-day mortality were collected.Results:A total of 37 cases were enrolled finally, including 17 cases with citric acid local anticoagulation and 20 cases with heparin systemic anticoagulation. There was no statistically significant difference in general data such as gender, age, and body weight of children between the two groups. There were no statistically significant differences in baseline levels of coagulation indicators and inflammatory mediators before treatment of children between the two groups. One day after weaning from CBP, both groups showed varying degrees of improvement in coagulation indicators compared with those before treatment. Compared with before treatment, the PT of the heparin systemic anticoagulation group was significantly shortened after 1 day of weaning (s: 11.82±2.05 vs. 13.64±2.54), APTT and TT were significantly prolonged [APTT (s): 51.54±12.69 vs. 35.53±10.79, TT (s): 21.95±4.74 vs. 19.30±3.33], D-dimer level was significantly reduced (mg/L: 1.92±1.58 vs. 4.94±3.94), with statistically significant differences (all P < 0.05). While in the citrate local anticoagulation group, only APTT was significantly prolonged after treatment compared with that before treatment (s: 49.28±10.32 vs. 34.34±10.32, P < 0.05). There were no statistically significant differences in other coagulation indicators compared with before treatment. Compared with the citric acid local anticoagulation group, the PT of the heparin systemic anticoagulation group was significantly shortened after treatment (s: 11.82±2.05 vs. 13.61±3.05, P < 0.05), and the D-dimer level was significantly reduced (mg/L: 1.92±1.58 vs. 3.77±2.38, P < 0.01). The levels of inflammatory mediators in both groups were significantly reduced 1 day after CBP weaning compared with those before treatment [citric acid local anticoagulation group: hs-CRP (mg/L) was 12.53±5.44 vs. 22.65±7.27, PCT (μg/L) was 1.86±1.20 vs. 3.30±2.34, IL-6 (ng/L) was 148.48±34.83 vs. 202.32±48.62, TNF-α (ng/L) was 21.38±7.71 vs. 55.14±15.07; heparin systemic anticoagulation group: hs-CRP (mg/L) was 11.82±4.93 vs. 21.62±8.35, PCT (μg/L) was 1.90±1.08 vs. 3.18±1.97, IL-6 (ng/L) was 143.81±33.41 vs. 194.02±46.89, TNF-α (ng/L) was 22.44±8.17 vs. 56.17±16.92, all P < 0.05]. However, there was no statistically significant difference between the two groups (all P > 0.05). There was no statistically significant difference in bleeding complication during CBP and 7-day mortality in children between the citrate local anticoagulation group and the heparin systemic anticoagulation group (5.9% vs. 30.0%, 17.6% vs. 20.0%, both P > 0.05). Conclusions:Heparin for systemic anticoagulation and regional citrate anticoagulation can significantly reduce the levels of IL-6, TNF-α, hs-CRP and PCT in children with septic shock, and relieve inflammatory storm. Compared with citric acid local anticoagulation, heparin systemic anticoagulation can shorten the PT and reduce the level of D-dimer in children with septic shock, which may benefit in the prevention and treatment of disseminated intravascular coagulation (DIC).
6.Pharmacokinetics of sugammadex in reversal of rocuronium-induced muscle relaxant residual in infants and young children undergoing daytime surgery
Hao LUO ; Yao LIU ; Junxiang HUANG ; Yanping GUAN ; Cheng FAN ; Guoping ZHONG ; Xingrong SONG ; Bilian LI
Chinese Journal of Anesthesiology 2023;43(8):966-971
Objective:To investigate the pharmacokinetics of sugammadex in reversal of rocuronium-induced muscle relaxant residual in infants and young children undergoing daytime surgery.Methods:One hundred and four pediatric patients of either sex, aged 3-36 months, of American Society of Anesthesiologists Physical Status classification Ⅱ, with body mass index of 18.5-28.0 kg/m 2, diagnosed with oblique inguinal hernia and/or hydrocele, scheduled for laparoscopic high ligation of hernia sac and/or high ligation of sphingoid surgery, were included in the study. Intraoperative neuromuscle relaxation was assessed by transdermal stimulation of the ulnar nerve in the wrist using a TOF Guard monitor. Rocuronium 0.9 mg/kg, propofol 3 mg/kg, and sufentanyl 0.5 μg/kg were intravenously injected for anesthesia induction, and propofol 6-8 mg·kg -1·h -1 was intravenously infused to maintain anesthesia. The pediatric patients were divided into Ⅰgroup and Ⅱ group according to the degree of postoperative neuromuscular block. In group Ⅰ, sugammadex 2 mg/kg was intravenously injected when TOF returned to T 2 recurrence. In group Ⅱ, sugammadex 4 mg/kg was intravenously injected when the single stimulation count was 1 or 2 after tetanic stimulation. At 2 and 10 min after rocuronium administration, at the end of operation, 2 and 10 min after sugammadex administration, and when the children met the standard of leaving the resuscitation room, venous blood samples were collected for determination of plasma concentrations of rocuronium and sugammadex using ultra-high performance liquid chromatography-mass spectrometry. Pharmacokinetic parameters were determined using the Pheonix WinNonlin software. The onset of rocuronium and time for recovery of TOF ratio to 90% were recorded. Results:The pharmacokinetics of sugammadex was fitted to the nonlinear mixed-effect satrioventricular model.There was no significant difference in the peak concentration, area under the drug concentration-time curve, elimination half-life, apparent clearance, apparent volume of distribution, mean retention time, and time for TOF ratio returning to 90% between the two groups ( P> 0.05). Conclusions:The pharmacokinetics of sugammadex in reversal of rocuronium-induced muscle relaxant residual is fitted to a nonlinear mixed-effect satrioventricular model, and sugammadex 2 and 4 mg/kg have similar pharmacokinetics in infants and young children undergoing daytime surgery.
7.Myocardial protective effect of Yangxin dingji capsule on diabetic cardiomyopathy model golden hamsters
Yi ZHONG ; Gang LIU ; Guoping MA ; Baozhu DING ; Xiaoxia LI ; Haoying LIU ; Wenjie LIANG
China Pharmacy 2022;33(13):1573-1580
OBJECTIVE To explore t he protective mechanism of Yangxin dingji capsules on the cardiomyocytes of diabetic cardiomyopathy(DCM)model golden hamsters. METHODS In this study ,golden hamsters were divided into control group (n= 10,no modeling ,no drug administration ),model group (n=9,modeling,no drug administration ),TCM high-dose group [ n=8, modeling,Yangxin dingji capsules 2 g/(kg·d)],TCM low-dose group [ n=8,modeling,Yangxin dingji capsules 1 g/(kg·d)] and empagliflozin group [ n=9,positive control ,modeling,10 mg/(kg·d)]. All the golden hamsters were gavaged continuously for 8 weeks. The general conditions of golden hamsters were observed during the experiment. Blood glucose ,total cholesterol (TC)and creatine kinase MB (CK-MB),ejection fraction (EF),fractional shortening (FS),interleukin 1β(IL-1β)and transforming growth factor β1(TGF-β1)were detected ;the histopathological changes of myocardium were observed. mRNA and protein expression of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),caspase-1,aspirin D (GSDMD),nuclear factor κB (NF-κB)and IL- 1β were detected and observed;DNA damage in myocardial was detected. RESULTS Compared with control group,the blood glucose ,TC,CK-MB,serum IL- 1β,TGF-β1 levels,the mRNA expressions and positive protein expression of NLRP 3,caspase-1,GSDMD,NF-κ B and IL-1 β and protein expression of GSDMD in golden hamsters were significantly increased in model group (P<0.05 or P<0.01) EF and FS were significantly decreased (P<0.01);the fibers of myocardial cells was disordered , and the blue-stained collagen fibers between the myocardium increased ; DNA damaged positive cells in myocardial tiss ue of gold hamsters increased significantly. Compared with model group,the above indexes of administration groups were reversed to varying degrees ;the gap of myocardial cells were clear ,and the fibers disorder was improved ;the DNA damaged positive cells in the myocardial tissue were reduced to varying degrees. CONCLUSIONS Yangxin dingji capsule can inhibit the cardiomyocyte pyroptosis and relieve the inflammatory injury of DCM in DCM model golden hamsters by regulating the NLRP 3/caspase-1/GSDMD signaling pathway ,so as to protect the cardiomyocytes.
8.Degeneration of paraspinal muscles in degenerative lumbar scoliosis and its correlation with lumbar kyphosis
Zexiang ZHONG ; Fangcai LI ; Ning ZHANG ; Zuijia YING ; Sheng ZHENG ; Guoping XU
Chinese Journal of Orthopaedics 2022;42(7):445-454
Objective:To investigate the changes of paraspinal muscles in patients with degenerative lumbar scoliosis (DLS) and its correlation with lumbar kyphosis.Methods:The clinical data of 67 female patients with degenerative lumbar scoliosis, with an average of 65.4±5.6 years old (rang 52-83 years old), were retrospectively analyzed. There were 35 patients of DLS with lumbar degenerative kyphosis (LDK) in the DLS+LDK group, with an average of 64.60±5.40 years old (rang 52-75 years old), and 32 patients of lumbar scoliosis without lumbar kyphosis in the DLS group, with an average of 66.22±5.8 years old (rang 55-83 years old). The cross-sectional area (CSA) and the percentage of fat infiltration area (FIA%) of erector spinae and multifidus muscles of the 5 intervertebral disc levels (from L 1-2 to L 5S 1) were measured by MRI using Image J software (ver. 1.51 k, National Institutes of Health, USA). The curve direction, Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) were evaluated and recordedin both groups using an anteroposterior radiograph in the standing position, and the correlation between the changes of paraspinal muscles and these factors was analyzed. Results:The TLK, LL, and SVA values of the DLS+LDK group (11.85°±7.89°, -9.35°±8.70° and 70.16±76.94 mm) were higher than those of the DLS group (7.47°±5.06°, -26.46°±10.26° and 39.45±38.18mm) ( t=2.73, P=0.008; t=7.38, P<0.001; t=2.10, P=0.041). The TK, PI, and SS values of the DLS+LDK group (16.36°±13.52°, 42.49°±11.70° and 11.89°±10.03°) were lower than those of the DLS group (23.60°±10.23°, 49.38°±11.92° and 21.21°±8.28°) ( t=2.45, P=0.017; t=2.38, P=0.020; t=4.13, P<0.001). The differences of Cobb and PT were not statistically significant between the two groups. The cross-sectional areas of L 1-2, L 2-3, L 3-4 intervertebral disc levels of erector spinae of the DLS+LDK group (1 328.36±339.16 mm 2, 1 331.98±305.76 mm 2 and 12 53.58±275.86 mm 2) were lower than those of the DLS group (1 564.16±312.68 mm 2, 1 574.80±325.92 mm 2 and 1 427.18±278.82 mm 2) ( t=0.40, P=0.004; t=0.81, P=0.002; t=0.306, P=0.013). The cross-sectional areas of L 1-2, L 2-3, L 3-4, L 4-5 intervertebral disc levels of multifidus muscles of the DLS+LDK group (225.07±59.80 mm 2, 228.38±87.44 mm 2, 436.40±117.99 mm 2 and 666.55±184.13 mm 2) were lower than those of the DLS group (264.28±44.27 mm 2, 384.85±75.52 mm 2, 576.10±109.92 mm 2 and 801.52±145.83 mm 2) ( t=0.21, P=0.004; t=0.42, P<0.001; t=0.52, P<0.001; t=0.37, P=0.002). The differences of FIA% of erector spinae and multifidus muscles at all lumbar spine levels were not statistically significant between the two groups. The cross-sectional areas of L 1-2, L 2-3, L 3-4 intervertebral disc levels of erector spinae and L 1-2, L 2-3, L 3-4, L 4-5 intervertebral disc levels of multifidus muscles of the two groups were negatively correlated with LL values ( r=-0.37, P=0.002; r=-0.34, P=0.005; r=-0.21, P=0.049; r=-0.34, P=0.005; r=-0.61, P<0.001; r=-0.65, P<0.001; r=-0.55, P<0.001), and positively correlated with SS ( r=0.42, P<0.001; r=0.37, P=0.002; r=0.27, P=0.027; r=0.38, P=0.001; r=0.53, P<0.001; r=0.46, P<0.001; r=0.42, P<0.001). The cross-sectional areas of L 3-4 intervertebral disc levels of erector spinae and L 1-2, L 2-3 intervertebral disc levels of multifidus muscles of the two groups were positively correlated with PI ( r=0.25, P=0.039; r=0.33, P=0.006; r=0.35, P=0.004). There was no correlation between the FIA% of erector spinae and multifidus muscles at all lumbar spine levels and the sagittal and pelvic parameters in both groups. Conclusion:Paravertebral muscle atrophy is more obvious in patients with degenerative lumbar scoliosis with lumbar kyphosis, which may be related to the reduce of lumbar lordosis and sacral slope. Patients with lumbar scoliosis with a smaller PI are more likely to experience paravertebral atrophy and increased loss of lumbar lordosis, and ultimately leading to lumbar kyphosis.
9.Effect of psoas major intramuscular block therapy on the early complications related to the multi-segmental crenel lumbar interbody fusion
Zexiang ZHONG ; Fangcai LI ; Qixin CHEN ; Weishan CHEN ; Zhiwei WANG ; Linwei CHEN ; Guoping XU ; Yuanqing SHEN
Chinese Journal of Orthopaedics 2021;41(13):825-833
Objective:To explore the clinical effect of the application of intraoperative psoas major intramuscular block therapy on the complications related to the approach after multi-segmental crenel lumbar interbody fusion (CLIF).Methods:All of 68 degenerative lumbar scoliosis patients who had received multi-segmental crenel lumbar interbody fusion during January 2020 and June 2020 were retrospectively reviewed. Patients were divided into two groups according to whether the psoas major muscle was treated with block therapy during the operation. The psoas muscle inblock group were filled with gel sponge infiltrated with a mixture of Betamethasone and lidocaine for local block therapy before closing the incision while that in the control group were not filled with gel sponge. There were 33 patients in the control group, 7 males and 26 females with an average of 65.8±7.1 years old (range: 54-81 years old); 35 cases in the block group, 9 males and 26 females with an average of 68.0±6.5 years old (range: 54-85 years old). The complications related to the approach (mainly includes pain, numbness in the front of the thigh, as well as psoas major, quadriceps muscle strength) were recorded respectively 1 day, 1 week, 1 month and 3 months after surgery. The main indicators of outcome including visual analog scale (VAS) of pain, the visual analog scale (VAS) of numbness, muscle strength of psoas major and quadriceps femoris, and the incidence of complications related to the approach were compared between the two groups of patients at different time points after surgery. The clinical outcomes were assessed using the Oswestry disability index (ODI), VAS for low back pain. The radiological outcome was evaluated with Cobb angles and sagittal balance parameters (sagittal vertical axis, SVA).Results:There were no significant differences in age, gender, body mass index (BMI), number of fusion segments, operation time, and intraoperative blood loss between the two groups. The incidence of approach-related complications was 17.1% in the block group and 39.4% in the control group, with statistically significant difference between the two groups ( χ2=4.177, P=0.041). The incidence of postoperative pain, numbness in the front of the thighs, and muscle strength of psoas major in the block group (11.4%, 14.3%) were lower than those in the control group (33.3%, 36.4%) ( χ2=4.740, P=0.029; χ2=4.416, P=0.036). And for numbness in the front of thigh, the block group (14.3) was lower than control group (21.2%), but no significant difference was shown between two groups ( χ2=0.561, P=0.454). However, there was no quadriceps weakness in either group. The VAS scores of painof the block group were lower than those of the control group at 1 day, 1 week, and 1 month after surgery, and the difference was statistically significant ( t=2.220, P=0.031; t=2.235, P=0.031; t=2.086, P=0.044). The difference at 3 months was not statistically significant ( t=0.385, P=0.701). The muscle strength of psoas major of the block group, meanwhile, was higher than those of the control group on the 1day and 1 week after surgery, the difference was statistically significant as well ( t=2.208, P=0.032; t=2.171, P=0.034). The difference at 1 and 3 months was not statistically significant ( t=0.923, P=0.359; t=1.437, P=0.160). No statistically significant differences were found in VAS scores of numbness at 1 day, 1 week, 1 month, and 3 months after surgery. Postoperative low back pain and lumbar spine function were significantly improved in both groups, and there was no statistical significance between the two groups. Coronal Cobb angle and sagittal balance were significantly improved in both groups after surgery, and there was no statistical significance between the two groups. Conclusion:Psoas major intramuscular block therapy can reduce the incidence of early postoperative complications of multi-segmental CLIF. Furthermore, it was found to be effective to alleviate anterior thigh pain within 1 month, and improve psoas major muscle weakness within 1 week.
10.Enlightenment and reference of training and certification mode of radiation therapist in the United States
Jiping LIU ; Junliang XU ; Yin ZHANG ; Renming ZHONG ; Guoping SHAN ; Wei CHEN
Chinese Journal of Radiation Oncology 2021;30(5):429-433
The training program of radiation therapists in the United States has been established early, and the mode of training, qualification and continuing education are relatively complete. Literature review was conducted at home and abroad and United States Department of Labor, American Registry of Radiologic Technologists, American Society of Radiologic Technologists as well as Joint Review Committee on Education in Radiologic Technology websites were reviewed. The training mode, qualification, work content, continuing education and employment situation of American radiotherapists were analyzed, aiming to provide some reference and enlightenment for the establishment of a new model for the training of professional radiologists suitable for the national conditions of China Mainland.

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