Objective To explore the clinical value of inflammatory prognostic index combined with dual-source CT perfusion imaging in predicting early response of hepatocellular carcinoma(HCC)after transcatheter hepatic artery chemoembolization(TACE).Methods A total of 25 patients with HCC,who met the inclusion criteria and received initial TACE at the First Affiliated Hospital of Dali University of China from November 2022 to November 2023,were prospectively collected.CT perfusion scan was performed before TACE as well as in 30-40 days after TACE,and blood routine and blood biochemical data were collected.The modified Response Evaluation Criteria in Solid Tumors(mRECIST)was used to evaluate postoperative enhanced CT manifestations.Patients obtaining complete remission(CR)or partial remission(PR)were classified as effective group(n=14),and patients obtaining stable disease(SD)or progression disease(PD)were classified as ineffective group(n=11).The differences in CT perfusion imaging parameters and inflammatory parameters between the two groups were analyzed,and the predictive values of preoperative CT perfusion imaging parameters and inflammatory parameters for postoperative early response of HCC were evaluated.The cutoff value was taken at the maximum Youden index.Univariate analysis and multivariate analysis were used to analyze the effect of CT perfusion imaging parameters,inflammatory parameters and clinical features on the prognosis.The nomogram prediction model was constructed by using R software.Results The post-TACE arterial liver perfusion(ALP),hepatic perfusion index(HPI),blood flow(BF)and blood volume(BV)were significantly lower than their pre-TACE values(all P＜0.05).Afer TACE portal vein perfusion(PVP)was obviously higher than that before operation(P＜0.05).No statistically significant differences in the mean transit time(MTT),flow extraction product(FED),C-reactive protein(CRP),albumin(ALB),neutrophil/lymphocyte ratio(NLR)and inflammatory prognosis index(IPI)existed between the pre-TACE values and post-TACE values(all P＞0.05).The pre-TACE ALP,BF and FED in the effective group were significantly higher than those in the ineffective group,while the pre-TACE CRP and IPI in the effective group were remarkably lower than those in the ineffective group(P＜0.05).There were no statistically significant differences in pre-TACE PVP,HPI,MTT,BV,ALB and NLR between the effective group and the ineffective group before(all P＞0.05).In the effective group,the pre-TACE ALP,HPI,BF,BV and FED were obviously higher than their post-TACE values(all P＜0.05)preoperative PVP was significantly lower than postoperation(P＜0.05),while no statistically significant differences in MTT,CRP,ALB,NLR and IPI existed between the pre-TACE values and the post-TACE values(all P＞0.05).In the ineffective group,the pre-TACE HPI was prominently higher than the post-TACE value(P＜0.05),while no statistically significant differences in ALP,PVP,BF,BV,MTT,FED,ALB,CRP,NLR and IPI existed between the pre-TACE values and the post-TACE values(all P＞0.05).The pre-TACE ALP,BF,BV,FED,CRP and IPI had high predictive values in judging early response of HCC after TACE(all P＜0.05),the AUC values were 0.831,0.779,0.740,0.753,0.779 and 0.805 respectively,and the optimal cutoffs were 33.280 mL/100 mL min,61.860 mL/100 mL min,5.885 mL/100 mL,29.725 mL/100 mL min,30.465 mg/L,1.885 respectively.ALP combined with CRP had the highest predictive value for post-TACE early response of HCC,with an AUC of 0.968(95％CI:0.906-1.000,P＜0.05),ALP combined with IPI could significantly improve the predictive value,with an AUC of 0.961(95％CI:0.894-1.000,P＜0.05),with the sensitivity and specificity being 0.929 and 0.909 respectively.Multivariate analysis showed that pre-TACE ALP and CRP were the independent influencing factors for post-TACE early response of HCC(P＜0.05).The nomogram prediction model constructed based on the pre-TACE ALP and CRP could effectively predict the post-TACE early response of HCC,and the AUC value was 0.968(95％CI:0.908-1.000).Conclusion ALP and CRP can be used to predict the post-TACE early response of HCC,and the combination use of ALP and CRP can significantly improve the predictive value.

A 66-year-old female patient self-administered Jingyaokang capsules (a compound preparation of traditional Chinese medicines, 3 capsules thrice daily orally) due to lumbar pain. The patient developed oliguria and edema of bilateral lower limbs after 3 doses of medication on the same day. The laboratory tests showed WBC 7.3×10 9/L, neutrophil percentage 0.70, blood urea 12.7 mmol/L, blood crea- tinine 179 μmol/L, and blood uric acid 461 μmol/L. The kidney function tests 15 days ago showed no abnormalities in the patient. Acute kidney injury caused by Jingyaokang capsules was considered. The drug was stopped and symptomatic treatments including torasemide and maintenance of fluid balance were given. The patient′s urine output gradually increased. Five days later, the patient′s edema of bilateral lower limbs disappeared, and her blood urea and creatinine decreased to normal range. The acute kidney injury in the patient may be related to strychni semen component in the Jingyaokang capsules.

A 66-year-old female patient self-administered Jingyaokang capsules (a compound preparation of traditional Chinese medicines, 3 capsules thrice daily orally) due to lumbar pain. The patient developed oliguria and edema of bilateral lower limbs after 3 doses of medication on the same day. The laboratory tests showed WBC 7.3×10 9/L, neutrophil percentage 0.70, blood urea 12.7 mmol/L, blood crea- tinine 179 μmol/L, and blood uric acid 461 μmol/L. The kidney function tests 15 days ago showed no abnormalities in the patient. Acute kidney injury caused by Jingyaokang capsules was considered. The drug was stopped and symptomatic treatments including torasemide and maintenance of fluid balance were given. The patient′s urine output gradually increased. Five days later, the patient′s edema of bilateral lower limbs disappeared, and her blood urea and creatinine decreased to normal range. The acute kidney injury in the patient may be related to strychni semen component in the Jingyaokang capsules.

Osteoporosis （OP） is a skeletal metabolic disease characterized by bone loss and destruction of bone microstructure. Changes in estrogen levels are not the only pathogenic factors for the occurrence and development of OP. MicroRNA （miRNA） plays an important regulatory role in cells. The complementary sequences of miRNA and targeted mRNA combine to inhibit the expression of targeted mRNA through post-transcriptional regulation， forming a complex regulatory network. Research suggests that miRNA is closely related to the occurrence and development of various diseases， including inflammatory diseases， metabolic diseases， and cancer. Targeted mRNA participates in post-transcriptional gene expression regulation in OP， mainly regulating the balance among bone construction， bone resorption， and osteoblast differentiation. Therefore， miRNA-based gene therapy is a rapidly developing disease treatment strategy. Traditional Chinese medicine can improve bone metabolism by intervening in miRNA differential expression to target and regulate osteogenic/osteoclast differentiation. This article summarized the targeting effects of miRNAs in physiological and developmental processes such as bone cell proliferation， differentiation， survival， and apoptosis， reviewed and classified their mechanisms of action and targets， and sorted out the current treatment methods of traditional Chinese medicine for preventing and treating OP and drugs that exert bone protective functions through miRNAs. This review is expected to provide theoretical reference and research guidance for future research on OP treatment by regulating miRNA.

A 40-year-old female patient took Rukuaixiao granules 10 g thrice daily orally by herself due to breast pain and nodules. After about 1 and a half months of medication, the patient developed intermittent right upper abdominal distension and pain, dark yellow urine, accompanied by fatigue, aversion to greasy food, nausea, vomiting, etc. After 2 and a half months of medication, the above symptoms worsened. Laboratory tests showed total bilirubin (TBil) 98.8 mmol/L, direct bilirubin (DBil) 51.5 mmol/L, alanine aminotransferase(ALT) 962 U/L, aspartate aminotransferase (AST) 1 213 U/L, γ-Glutamyltransferase(GGT) 196 U/L, and alkaline phosphatase (ALP) 124 U/L. The liver injury caused by Rukuaixiao granules were considered. Then the drug was discontinued and treatments such as glutathione, hepatocyte growth-promoting factor, tiopronin, Jiangmeiling(降酶灵), silymarin, and ursodeoxycholic acid were given. After 10 days of treatments, the patient′s symptoms were gradually improved; after 13 days, the patient′s digestive symptoms disappeared. Laboratory tests showed TBil 20.5 mmol/L, DBil 6.2 mmol/L, ALT 43 U/L, AST 58 U/L, GGT 53 U/L, and ALP 60 U/L. Glutathione, hepatocyte growth-promoting factor, and tiopronin were discontinued, and Jiangmeiling, silymarin, and ursodeoxycholic acid were continued to be taken for 2 weeks. Six weeks later, the patient′s liver function returned to normal. The patient′s liver injury was most likely related to the Fructus toosendan in Rukuaixiao granules.

A 40-year-old female patient took Rukuaixiao granules 10 g thrice daily orally by herself due to breast pain and nodules. After about 1 and a half months of medication, the patient developed intermittent right upper abdominal distension and pain, dark yellow urine, accompanied by fatigue, aversion to greasy food, nausea, vomiting, etc. After 2 and a half months of medication, the above symptoms worsened. Laboratory tests showed total bilirubin (TBil) 98.8 mmol/L, direct bilirubin (DBil) 51.5 mmol/L, alanine aminotransferase(ALT) 962 U/L, aspartate aminotransferase (AST) 1 213 U/L, γ-Glutamyltransferase(GGT) 196 U/L, and alkaline phosphatase (ALP) 124 U/L. The liver injury caused by Rukuaixiao granules were considered. Then the drug was discontinued and treatments such as glutathione, hepatocyte growth-promoting factor, tiopronin, Jiangmeiling(降酶灵), silymarin, and ursodeoxycholic acid were given. After 10 days of treatments, the patient′s symptoms were gradually improved; after 13 days, the patient′s digestive symptoms disappeared. Laboratory tests showed TBil 20.5 mmol/L, DBil 6.2 mmol/L, ALT 43 U/L, AST 58 U/L, GGT 53 U/L, and ALP 60 U/L. Glutathione, hepatocyte growth-promoting factor, and tiopronin were discontinued, and Jiangmeiling, silymarin, and ursodeoxycholic acid were continued to be taken for 2 weeks. Six weeks later, the patient′s liver function returned to normal. The patient′s liver injury was most likely related to the Fructus toosendan in Rukuaixiao granules.

A 2-year-old boy with hydrocele of spermatic cord received an IV infusion of ketorolac tromethamine injection 7 mg after laparoscopic high ligation of bilateral sheath to relieve pain. About 17 hours after the medication, the boy developed gross hematuria. Ultrasonic examination showed blood clots in the bladder. Routine urine analysis showed urine occult blood (++), red blood cells >50 cells per high-power field in urine microscopy, and protein (+++). The boy did not use other drugs in the same period, and hematuria related to ketorolac tromethamine injection was considered. The boy received IV infusions of etamsylate injection 0.5 g once daily and then ceftriaxone sodium for injection 0.5 g once daily successively. After 6 days of treatments, the boy′s gross hematuria disappeared. Routine urine analysis showed urine occult blood (+++), 3 red blood cells per high-power field in urine microscopy, and urine protein (+++). Eleven days later, the re-analysis showed urine occult blood (+), none red blood cell per high-power field in urine microscopy, and urine protein (++). One month later, the re-analysis showed urine occult blood ( -) and urine protein ( -).

A 2-year-old boy with hydrocele of spermatic cord received an IV infusion of ketorolac tromethamine injection 7 mg after laparoscopic high ligation of bilateral sheath to relieve pain. About 17 hours after the medication, the boy developed gross hematuria. Ultrasonic examination showed blood clots in the bladder. Routine urine analysis showed urine occult blood (++), red blood cells >50 cells per high-power field in urine microscopy, and protein (+++). The boy did not use other drugs in the same period, and hematuria related to ketorolac tromethamine injection was considered. The boy received IV infusions of etamsylate injection 0.5 g once daily and then ceftriaxone sodium for injection 0.5 g once daily successively. After 6 days of treatments, the boy′s gross hematuria disappeared. Routine urine analysis showed urine occult blood (+++), 3 red blood cells per high-power field in urine microscopy, and urine protein (+++). Eleven days later, the re-analysis showed urine occult blood (+), none red blood cell per high-power field in urine microscopy, and urine protein (++). One month later, the re-analysis showed urine occult blood ( -) and urine protein ( -).

OBJECTIVE： To investigate the current situation of medication safety in 24 public medical institutions（referred to as “hospital”） from Linyi city and the differences in medication safety between urban and rural areas. METHODS： ISMP self-assessment scale [including 10 key elements （Ⅰ-Ⅹ，such as “Ⅰ patient’s information” “Ⅱ drug information”）， 20 key characteristics and 270 evaluation projects] developed by Institute of Safe Medication Practices was used to investigate 24 hospitals in Linyi city. The implementation rates of 10 key elements in urban and rural hospitals were analyzed statistically， and the top 10 evaluation projects were listed for the key elements with the lowest implementation rate. The key elements and top 10 evaluation projects with the largest difference in the implementation rate were compared between urban and rural hospitals. Radar maps were used for comparison and analysis intuitively. RESULTS： A total of 24 hospitals were surveyed， including 12 in urban and 12 in rural areas； there were significant differences in the implementation rate of 10 key factors among 24 hospitals； the elements with the highest implementation rate were “Ⅶ environmental factors， workflow and staffing pattern”（56.55％）；the elements with the lowest implementation rate was “Ⅱ drug information” （26.77％）. Among 33 evaluation projects of “Ⅱ drug information”， the implementation rate of No. 36 project （12.50％， related to opioids） was the lowest. Among the implementation rates of 10 key elements in 12 urban hospitals and 12 rural hospitals， the key elements with the greatest difference was “Ⅳ drug label， packaging and naming” （differing by 44.44％，59.72％ vs. 15.28％）； Among“Ⅸ patient education”evaluation project with the greatest gap， there was the greatest difference in No. 199 project （related to patients’ active participation in medication， 58.33％ in urban， 4.17％ in rural）. CONCLUSIONS： The results of medication safety investigation in 24 hospitals from Linyi city show that all the item in each hospital needs to be improved expecially in the implementation of “Ⅱ drug information”. Rural hospitals should strengthen medication education for patients.

A 58-year-old female patient took orlistat 0.12 g orally once daily by herself due to obesity.After 13 months,she developed fatigue and anorexia.Laboratory tests showed alanine aminotransferase(ALT) 1 603 U/L,aspartate aminotransferase(AST) 1 265 U/L,alkaline phosphatase (ALP) 310 U/L,direct bilirubin(DBil) 8.4 μmol/L,and indirect bilirubin(IBil) 13.4 μmol/L.She was diagnosed with liver injury.Orlistat was discontinued,considering its relationship with the liver injury.And an Ⅳ infusion of diammonium glycyrrhizinate 150 mg (added to 250 ml of glucose injection) once daily was given.Two days later,the diammonium glycyrrhizinate was replaced by Ⅳ infusion of magnesium isoglycyrrhizinate 100 mg (added to 100 ml of 0.9％ sodium chloride injection) once daily because that the symptoms did not relieve.After 6 days of treatment with magnesium isoglycyrrhizinate,the patient's symptoms relieved and she had ALT 124 U/L,AST 73 U/L,ALP 73 U/L,DBil 3.1 μmol/L,and IBil 7.3 μmol/L.After 1 month,liver function tests showed ALT 30 U/L,AST 57 U/L,ALP 93 U/L,DBil 3.0 μmol/L,and IBil 11.8 μmol/L.