BACKGROUND:With the development of unilateral biportal endoscopic technology,endoscopic lumbar fusion surgery has become an increasingly popular development trend in spinal surgery.Unilateral biportal endoscopic transforaminal lumbar interbody fusion shows significant advantages for preserving paravertebral muscle and reducing intraoperative bleeding in spinal stenosis and lumbar spondylolisthesis in the lumbar spine with degenerative changes.OBJECTIVE:To compare the effects of unilateral biportal endoscopic lumbar interbody fusion and traditional open transluminal lumbar interbody fusion on paraspinal muscles.METHODS:A retrospective analysis was conducted on the clinical data of 60 patients who visited the Department of Spine Surgery,Second Affiliated Hospital of Soochow University from October 2019 to November 2022 and underwent single segment unilateral decompression fusion.They were divided into two groups according to different surgical procedures.Group A received unilateral biportal endoscopic lumbar interbody fusion.Group B received traditional open transluminal lumbar interbody fusion.All patients underwent magnetic resonance imaging examination before and 3 months after surgery.Basic patient information,last follow-up time,magnetic resonance imaging images,visual analog scale scores for lower back and leg pain,and Oswestry Disability Index were collected.RESULTS AND CONCLUSION:(1)Three months after surgery,the cross-sectional area of the bilateral multifidus muscle in group A was significantly larger than that of group B(P＜0.05),and the degree of fat infiltration was lower(P＜0.01).(2)There was no significant difference in the cross-sectional area and degree of fat infiltration of bilateral erector spinae muscles between the two groups 3 months after surgery(P＞0.05).(3)It is concluded that unilateral biportal endoscopic lumbar interbody fusion is more effective than traditional open transluminal lumbar interbody fusion in protecting multifidus muscle,reducing multifidus muscle atrophy and fat infiltration.Both surgical methods did not have a significant impact on the erector spine muscle.

BACKGROUND:With the development of unilateral biportal endoscopic technology,endoscopic lumbar fusion surgery has become an increasingly popular development trend in spinal surgery.Unilateral biportal endoscopic transforaminal lumbar interbody fusion shows significant advantages for preserving paravertebral muscle and reducing intraoperative bleeding in spinal stenosis and lumbar spondylolisthesis in the lumbar spine with degenerative changes.OBJECTIVE:To compare the effects of unilateral biportal endoscopic lumbar interbody fusion and traditional open transluminal lumbar interbody fusion on paraspinal muscles.METHODS:A retrospective analysis was conducted on the clinical data of 60 patients who visited the Department of Spine Surgery,Second Affiliated Hospital of Soochow University from October 2019 to November 2022 and underwent single segment unilateral decompression fusion.They were divided into two groups according to different surgical procedures.Group A received unilateral biportal endoscopic lumbar interbody fusion.Group B received traditional open transluminal lumbar interbody fusion.All patients underwent magnetic resonance imaging examination before and 3 months after surgery.Basic patient information,last follow-up time,magnetic resonance imaging images,visual analog scale scores for lower back and leg pain,and Oswestry Disability Index were collected.RESULTS AND CONCLUSION:(1)Three months after surgery,the cross-sectional area of the bilateral multifidus muscle in group A was significantly larger than that of group B(P＜0.05),and the degree of fat infiltration was lower(P＜0.01).(2)There was no significant difference in the cross-sectional area and degree of fat infiltration of bilateral erector spinae muscles between the two groups 3 months after surgery(P＞0.05).(3)It is concluded that unilateral biportal endoscopic lumbar interbody fusion is more effective than traditional open transluminal lumbar interbody fusion in protecting multifidus muscle,reducing multifidus muscle atrophy and fat infiltration.Both surgical methods did not have a significant impact on the erector spine muscle.

OBJECTIVE To investigate the marketing status， general characteristics， and time trends of rare disease drugs in China. METHODS Based on 121 kinds of rare diseases included in the First Batch of Rare Disease Catalog， the names and marketing approval information of corresponding drugs with indications were obtained from the databases of the Center for Drug Evaluation， National Medical Products Administration and Yaozhi.com， and the relevant characteristic variables were extracted for descriptive statistical analysis. RESULTS As of December 31， 2022， only 32 of 121 rare diseases have therapeutic drugs available for treatment on the market in China， and 79 rare disease drugs have been approved. Among them， 46.84% of the drugs are domestic drugs， 88.61% of the drugs are approved for use in both adults and children； 67.09% are chemicals and 59.49% are injections. According to the ATC classification， Category A （digestive system drugs） is the most， accounting for 20.25%. The number of rare disease drugs on the market each year is the highest in 2021， with an overall upward trend from 2018 to 2021 and a downward trend in 2022. Among rare disease drugs on the market each year， according to the ATC classification， the number of Category L （antineoplastics and immune inhibitors） will be the largest in 2021， being 5. By dosage form， oral medicines were marketed in the largest number in 2022， and injectable medicines in 2021. CONCLUSIONS In recent years， the number of approved rare disease drugs in China has been continuously increasing， but it is still far from meeting the needs of patients， and there is still a lack of domestically approved rare disease drugs. We should further accelerate the research and development of rare disease drugs， and promote the import and replication of rare disease drugs.

OBJECTIVE To investigate the marketing status， general characteristics， and time trends of rare disease drugs in China. METHODS Based on 121 kinds of rare diseases included in the First Batch of Rare Disease Catalog， the names and marketing approval information of corresponding drugs with indications were obtained from the databases of the Center for Drug Evaluation， National Medical Products Administration and Yaozhi.com， and the relevant characteristic variables were extracted for descriptive statistical analysis. RESULTS As of December 31， 2022， only 32 of 121 rare diseases have therapeutic drugs available for treatment on the market in China， and 79 rare disease drugs have been approved. Among them， 46.84% of the drugs are domestic drugs， 88.61% of the drugs are approved for use in both adults and children； 67.09% are chemicals and 59.49% are injections. According to the ATC classification， Category A （digestive system drugs） is the most， accounting for 20.25%. The number of rare disease drugs on the market each year is the highest in 2021， with an overall upward trend from 2018 to 2021 and a downward trend in 2022. Among rare disease drugs on the market each year， according to the ATC classification， the number of Category L （antineoplastics and immune inhibitors） will be the largest in 2021， being 5. By dosage form， oral medicines were marketed in the largest number in 2022， and injectable medicines in 2021. CONCLUSIONS In recent years， the number of approved rare disease drugs in China has been continuously increasing， but it is still far from meeting the needs of patients， and there is still a lack of domestically approved rare disease drugs. We should further accelerate the research and development of rare disease drugs， and promote the import and replication of rare disease drugs.

OBJECTIVE：To preliminarily investigate the improveme nt effects and mechanism of Mongolian medicine Saorilao-4 decoction on specific pulmonary fibrosis model rats. METHODS ：Male SD rats were randomly divided into normal control group ，model group ，positive control group （pirfenidone，0.163 g/kg）and Saorilao- 4 decoction low ，medium and high dose groups （0.899，1.798，3.596 g/kg），8 rats in each group. Except for normal control group ，other groups were given 6 mg/mL bleomycin intratracheally at 5 mg/kg once to induce the specific pulmonary fibrosis model. From the first day after modeling ， normal control group and model group were given normal saline intragastrically ，other groups were given corresponding drugs intragastrically，once a day ，10 mL/kg，for 4 weeks. During the experimental period ，the general condition of the rats in each group was observed and the body mass was weighed. Twenty-four h after last medication ，the appearance morphology of rat l ung in each group were observed. The morphological characteristics of lung tissues were observed by HE and Masson staining. ELISA was adopted to determine the activity of SOD and the content of MDA in serum ，the contents of hydroxyproline （HYP），IL-1β，IL-6，hyaluronidase（HA），laminin（LN）precollagen type Ⅲ（PC-Ⅲ）and collagen type Ⅳ（Col-Ⅳ）in lung tissue. RT-PCR was used to determine the mRNA 发。E-mail：bwf007007@sina.com expression of TGF-β 1，Smad3 and Smad 7 in lung tissue. RESULTS：Compared with model group ，the activity ，hair and diet of the rats in each dose group of Saorilao- 4 decoction and positive control group were significant ly improved ，and the body mass after the last administration was significantly increased ； the pathological change of lung and pulmonary fibrosis were significantly improved ，and the activity of SOD in serum was increased significantly. Serum content of MDA （except for Saorilao- 4 decoction medium dose group ），the contents of HYP （except for Saorilao- 4 decoction high dose group ），IL-1β，IL-6，HA，LN，PC-Ⅲ，Col-Ⅳ（except for Saorilao- 4 decoction high dose group）as well as mRNA expression of TGF-β1 and Smad 3 in lung tissue were significantly decreased ；mRNA expression of Smad 7 was significantly increased （P＜0.05 or P＜0.01）. CONCLUSIONS ：Saorilao-4 decoction can significantly improve the lung pathological changes ，delay and reverse the progression of pulmonary fibrosis in specific pulmonary fibrosis model rats ，the mechanism of which may be related to the inhibition of inflammatory response ， improvement of lipid peroxidation ， down-regulation of TGF-β1 and Smad 3 mRNA expression ，and up-regulation of Smad 7 mRNA expression.

Objectives:To observe the anatomical location and mechanism of axis ring fractures (ARF) using 3-D CT scans, and propose a new classification for such fractures.Methods:By reviewing prospectively maintained database collecting ARF from 7 medical centers in China, 202 patients were included in this study. According to anatomical location, ARFs were classified into axis arthrosis fracture (AAF) and axis bony damage (ABD). The axis ring was divided into anterior, middle, and posterior rings, based on the border of the pars interarticularis (or pedicle) of axis. According to the features of ARF and previous study, a new classification was proposed based on the anatomical features of different fracture patterns, which was divided into three types and six subtypes (A1, A2, B1, B2, C1 and C2). The incidence of AAF and ABD and their distribution in different location of axis ring and the new classification, were observed.Results:In 202 patients with ARF, 501 anatomical structures were involved. 288 AAFs were found in 178 patients (288/501, 57%), while 213 ABDs were found in 149 patients (213/501, 43%). In anterior ring, 304 structures (304/501, 61%) were involved in injury, with 225 AAF and 79 ABD. In middle ring, 99 structures (99/501, 20%) were involved in injury, and all of them were ABD. In posterior ring, 98 structures (98/501, 19%) were involved in injury, with 63 AAF and 35 ABD. The anterior ring injuries (61%) were more common than middle (20%) or posterior ring (19%). In anterior ring, AAF (84%) were morecommon than ABD (16%); In middle ring, all the injuries were ABD; In posterior ring, AAFs (64%) were more common than ABD (36%). Type A fractures were featured with pedicle fractures and were identified in 30 patients (30/202, 15%). Type A1 fractures were bilateral pedicle fracture lines symmetrically or asymmetrically and identified in 12 (6%) patients; Type A2 fractures were pedicle fracture lineson one side and inferior articular facet injuries or lamina fractures on the otherside and identified in 18 (9%) patients. Type B fractures were featured with superior articular facet injuries or posterior wall of C2 body fractures on one side and identified in 136 patients (67%). Type B1 fractures were superior articular facet injuries or posterior wall of C2 body fractures on one side and pedicle fracture on the other side and identified in 57 (28%) patients; Type B2 fractures were superior articular facet injuries or posterior wall of C2 body fractures on one side and inferior articular facet injuries or lamina fractures on the otherside and identified in 79 (39%) patients. Type C fractures were featured with bilateral superior articular facet injuries or posterior wall of C2 body fractures and identified in 36 patients (18%). Type C1 fractures were bilateral superior articular facet injuries or posterior wall of C2 body fractures symmetrically and identified in 22 (11%) patients; Type C2 fractures were bilateral superior articular facet injuries or posterior wall of C2 body fractures asymmetrically and identified in 14 (7%) patients.Conclusion:ARF could occur in different anatomical locations, and most of these fractures were caused by hyperextension and axial load on superior articular facet on one or two sides. The new CT classification of ARF with three types and six subtypes might provide all fracture patterns, which could be useful for the choice of proper diagnosis and treatment for such fractures.

Objective To explore the efficiency of the ABC-HOME in the rapid identification and assessment of potential donors.Methods We developed a submit system and a rapid assessment method of ABC-HOME for potential donors at 2013.They were on trial in service area hospitals of Guangzou General Hospital Organ Procurement Organization (GHOPO) from February,2015.We reviewed medical records of potential donors occurring in the intensive unit at 2014,from February to December 2015 and 2016,respectively.We examined data on the number of potential donors,actual donors and beds of ICU,and calculated the number of potential donors and actual donors per bed per year.The reasons for donation failure were analyzed.Results 19,38 and 50 organ donations were realized in 243,474 and 513 potential donors in 2014,from February 2015 to December 2015 and 2016,respectively.The growth rate of organ donation and the number of actual donors per bed per year was 95.0%,8.2% and 0.45,0.89 and 0.96,respectively.The conversion rate in these potential donors was 8.92% from February 2015 to December 2016.The reasons for donation failure included the family and social factors,doctor-patient relationship and communication factor and illness condition of donors' factors.Conclusion ABC-HOME is a convenient assessment method for potential donors,which can help to promote the identification of potential donors and to increase the number of potential donor information.

Objective To summarize the experiences and protocol of extracorporeal membrane oxygenation (ECMO) technique in donors with brain death and unexpected cardiac arrest.Method We described here the organ donation of one case of brain death complicated with hemodynamic instability and cardiac arrest,and the corresponding recovery of the receptor liver.A 50-year old female developed brain death due to brain aneurysmal hemorrhage.He was given two kinds of high-dose vasopressor,but hemodynarnic instability was not improved.After ECMO support,the hemodynamics turned to stable,but unexpected cardiac arrest happened.The total operating time of ECMO was 5 h,including 4 h after cardiac arrest.The liver was transplanted into a 65-year old female with hepatocellular carcinoma (diagnosed by Hangzhou Criteria) by classic orthotopic liver transplantation with end-to-end anastomosis.Result One liver and two kidneys were obtained successfully,and all the receptors recovered uneventfully.The post-operative ALT and AST levels reached the peak at 169 U/L and 365 U/L respectively,and returned to normal two weeks later.Conclusion ECMO can be used to support brain death complicated with hemodynamic instability and unexpected cardiac arrest.It can save precious time for organ donation,and preserve the function of liver and kidney as well.

Objective To study the diagnosis and treatment of non-anastomotic biliary stricture (NABS) after liver transplantation.Methods The clinical data of 403 patients who underwent liver transplantation in the past 10 years in our department were analyzed retrospectively,compared different methods to find out the most appropriate method in the diagnosis and management of NABS.Results NABS occurred in 13 out of 403 patients (3.2％),almost the same incidence as in patients who received DCD donor livers (4.16％,2/48).The clinical signs of NABS were frequent cholangitis and high TBil,r-GT and AKP (P ＜0.01).All these cases were finally diagnosed by cholangiography and they could be classified into 3 types:hepatic bile duct stricture (4 patients,type Ⅰ),multiple extrahepatic and intrahepatic biliary strictures (7 patients,type Ⅱ),intrahepatic biliary strictures (2 patients,type Ⅲ).NABS were mainly treated by interventional therapy,Roux-en-Y anastomosis and retransplantation in our centre.All type Ⅰ patients were successfully managed with interventional therapy/ERCP and Roux-en-Y anastomosis,but 44.4％ (4/9) of type Ⅱ and Ⅲ patients required retransplantation.The TBIL,r-GT and AKP decreased significantly in 12 patients (P ＜ 0.05) and the total curative rate of NABS was 92.3％ (12/13) with one patient who died after retransplantation.Conclusions Cholangiography was an effective way to diagnose NABS which is common among patients after liver transplantation.Interventional therapy/ERCP,Roux-en-Y anastomosis and retransplantation were our 3 ways to treat this problem.We proceeded from easy to difficult and chose a suitable way to deal with NABS according to the different types of biliary stricture from cholangiography.Type Ⅰ patients had much better prognosis than Type Ⅱ and Ⅲ patients who should receive retransplantation if interventional therapy/ERCP failed.

Objective To investigate the application and clinical value of donation after citizens death (DCD) in salvage liver transplantation (SLT).Method The clinical data of 12 recipients who underwent SLT from DCD of 12 donors at the Guangzhou General Hospital of Guangzhou Military Area from October 2010 to December 2013 were retrospectively analyzed.Of the donors,there was one case of type of China-Ⅰ,2 cases of the type of China-Ⅱ and 9 cases of the type of China-Ⅲ.Extracorporeal membrane oxygenation (ECMO) was applied to donation after brain and cardiac death to avoid warm ischemia.Of the recipients,6 met the Milan criteria,3 UCSF(The University of California,San Francisco) criteria and 3 Hangzhou criteria respectively.Orthotopic liver transplantation was performed on recipients.Eleven recipients received end-to-end anastomosis of the bile duct and followed up regularly.Result Liver transplantation was successfully performed on all recipients.No mortality during operation,no recovering delay and non-function of the transplanted liver occurred.Postoperative complications occurred in 4 cases,2 patients died,and 2 patients recovered and discharged after the second surgery.Ten recipients had a long-term survival.Two cases of hepatocellular carcinoma (HCC) recurrence were still alive after active treatment.The longest survival time was 42 months.All of them had no long-term complications such as biliary stricture.Conclusion The role and status of SLT in the treatment of HCC has become increasingly,and there will be more and more use of DCD donor in SLT.To ensure the DCD donors safely and effectively applied in SLT,we should grasp the characteristics of SLT,choose the appropriate DCD donor according to recipients,and rationally use the ECMO to protect the graft quality.