Objective: To investigate the value of decreased carbohydrate antigen 19-9(CA19-9) kinetics in predicting short-term outcomes and determining prognosis among advanced biliary or pancreatic cancer patients receiving first-or second-line therapy in the real world. Methods : Eighty-nine patients were retrospectively collected with advanced biliary or pancreatic cancer, especially on the CA19-9 dynamics and decline rates at different time points. This study evaluated the association of CA19-9 changes with clinicopathological features, short-term response to antitumor therapy, and survival outcomes. Results : The enrolled patients recorded baseline CA19-9 levels ranging from 1.20 to 65 706.40 U/ml, with a median of 303.11 U/ml. There was no statistical correlation between baseline CA19-9 levels and gender, age, body mass index, primary tumor site, hepatic metastases, pulmonary metastases, lymph node metastases, peritoneal metastases, performance status, treatment lines, and combinations of drug types. Baseline CA19-9 levels were not associated with systemic immunoinflammatory index, prognostic nutritional index, and total bilirubin. A 25% or 50% decrease in CA19-9 after 2-3 therapy courses indicated short-term efficacy in reaching tumor objective remission or disease control. Both combinations of multiple drug types and a 25% decline in CA19-9 after one course of treatment were independent prognostic factors that affected the longer progression-free survival of patients receiving first or second line of treatment. Conclusion Decreased CA19-9 kinetics has specific values in predicting the efficacy and prognosis of advanced biliary or pancreatic cancer.

Objective:To investigate the clinical and radiological differences in treating single-level cervical spondylosis using the Zero-profile interbody fusion cage (Zero-PVA) versus the titanium plate interbody fusion cage in anterior cervical discectomy and fusion (ACDF) and to analyze the correlation between clinical outcomes and radiological parameters.Methods:this retrospective study collected data from patients with cervical spondylosis who underwent single-level ACDF surgery at the First Affiliated Hospital of Kunming Medical University between January 2019 and June 2022. A total of 70 patients (32 males and 38 females) with an average age of 51.34 ± 8.62 years (range: 29 to 77 years) were included. Based on the type of interbody fusion device used, patients were divided into two groups: the cage-plate construct (CP) group (35 patients; average age: 51.51 ± 10.02 years, range: 29 to 77 years) and the zero-profile interbody fusion device with variable angle (ZP) group (35 patients; average age: 51.17±7.11 years, range: 38 to 68 years). Preoperative, one-week postoperative, and final follow-up (≥6 months postoperative) data were collected for visual analogue scale (VAS) scores, neck disability index (NDI) scores, and Japanese Orthopaedic Association (JOA) scores. Radiological parameters assessed included surgical segment intervertebral disc height, cervical lordosis angle, surgical segment Cobb angle, T 1 slope (T 1S), and C 2-C 7 sagittal vertical axis (C 2-C 7 SVA). Additional evaluations included Bazaz dysphagia ratings at one week and final follow-up, Odom surgical outcome ratings at final follow-up, fusion grades, adjacent vertebral ectopic ossification grades, and adjacent segment degeneration. Patients were further classified into a symptom relief group and an incomplete symptom relief group based on Odom ratings. Logistic regression analysis was performed to examine the correlation between radiological parameters and postoperative outcomes. Statistical methods such as ROC curves, Youden index, product index, and Euclidean index were used to determine optimal cut-off values for radiological parameters affecting postoperative outcomes. Results:There were no statistically significant differences between the two groups in terms of gender, age, follow-up duration, surgical segment, or classification ( P>0.05), confirming comparability. At both one-week post-operation and final follow-up, VAS, NDI, and JOA scores showed no significant differences between the groups ( P>0.05). However, the incidence of dysphagia in the CP group was 49% at one week post-operation and 20% at final follow-up, significantly higher than that in the ZP group (14% at one week and 0 at final follow-up; P<0.05). The intervertebral space height in the CP group was 9.16±0.84 mm at one week post-operation and 8.19±1.11 mm at final follow-up, which was significantly higher than in the ZP group (8.22±1.23 mm at one week and 7.57±1.14 mm at final follow-up; P<0.05). The surgical segment Cobb angle in the CP group at final follow-up (7.34°±4.21°) was significantly greater than in the ZP group (4.63°±4.32°; t=2.661, P=0.010). Regarding heterotopic ossification (HO) of the superior vertebral body, in the CP group, 27 cases were grade 0, 7 cases were grade 1, and 1 case was grade 2. In the ZP group, 34 cases were grade 0 and 1 case was grade 1, with a statistically significant difference between the groups (χ 2=6.128, P=0.028). Binary logistic regression analysis revealed that a reduction in intervertebral space height of ≥0.63 mm at one week post-operation and final follow-up ( OR=2.913, P=0.021) and a heterotopic ossification grade of ≥1 ( OR=5.178, P=0.042) were correlated with incomplete symptom relief after single-level ACDF surgery. Conclusions:Both Zero-PVA and titanium plate interbody fusion devices demonstrated favorable clinical outcomes in single-level ACDF surgery. However, a reduction in intervertebral space height and heterotopic ossification of the superior vertebral body may be risk factors for incomplete symptom relief following single-level ACDF.

This study aimed to clarify the appropriate disease coding for coronary heart disease(CHD)and procedure coding for coronary stent implantation through an in-depth analysis of the I20-I25 classification for ischemic heart disease in the International Classification of Diseases,Tenth Revision(ICD-10),and the 36.06-36.07 procedure codes for coronary stents in the International Classification of Diseases,Ninth Revision,Clinical Modification(ICD-9-CM-3),2011 revision.Representative cases from a tertiary general hospital were analyzed to illustrate and validate accurate coding practices.Based on coding guidelines and case analyses,a set of correct codes for CHD and coronary stent procedures was compiled.This work provides guidelines for standardizing medical information documentation and provides a reference for medical insurance payment reform in CHD patients undergoing coronary stent implantation.

Objective:To investigate the clinical and radiological differences in treating single-level cervical spondylosis using the Zero-profile interbody fusion cage (Zero-PVA) versus the titanium plate interbody fusion cage in anterior cervical discectomy and fusion (ACDF) and to analyze the correlation between clinical outcomes and radiological parameters.Methods:this retrospective study collected data from patients with cervical spondylosis who underwent single-level ACDF surgery at the First Affiliated Hospital of Kunming Medical University between January 2019 and June 2022. A total of 70 patients (32 males and 38 females) with an average age of 51.34 ± 8.62 years (range: 29 to 77 years) were included. Based on the type of interbody fusion device used, patients were divided into two groups: the cage-plate construct (CP) group (35 patients; average age: 51.51 ± 10.02 years, range: 29 to 77 years) and the zero-profile interbody fusion device with variable angle (ZP) group (35 patients; average age: 51.17±7.11 years, range: 38 to 68 years). Preoperative, one-week postoperative, and final follow-up (≥6 months postoperative) data were collected for visual analogue scale (VAS) scores, neck disability index (NDI) scores, and Japanese Orthopaedic Association (JOA) scores. Radiological parameters assessed included surgical segment intervertebral disc height, cervical lordosis angle, surgical segment Cobb angle, T 1 slope (T 1S), and C 2-C 7 sagittal vertical axis (C 2-C 7 SVA). Additional evaluations included Bazaz dysphagia ratings at one week and final follow-up, Odom surgical outcome ratings at final follow-up, fusion grades, adjacent vertebral ectopic ossification grades, and adjacent segment degeneration. Patients were further classified into a symptom relief group and an incomplete symptom relief group based on Odom ratings. Logistic regression analysis was performed to examine the correlation between radiological parameters and postoperative outcomes. Statistical methods such as ROC curves, Youden index, product index, and Euclidean index were used to determine optimal cut-off values for radiological parameters affecting postoperative outcomes. Results:There were no statistically significant differences between the two groups in terms of gender, age, follow-up duration, surgical segment, or classification ( P>0.05), confirming comparability. At both one-week post-operation and final follow-up, VAS, NDI, and JOA scores showed no significant differences between the groups ( P>0.05). However, the incidence of dysphagia in the CP group was 49% at one week post-operation and 20% at final follow-up, significantly higher than that in the ZP group (14% at one week and 0 at final follow-up; P<0.05). The intervertebral space height in the CP group was 9.16±0.84 mm at one week post-operation and 8.19±1.11 mm at final follow-up, which was significantly higher than in the ZP group (8.22±1.23 mm at one week and 7.57±1.14 mm at final follow-up; P<0.05). The surgical segment Cobb angle in the CP group at final follow-up (7.34°±4.21°) was significantly greater than in the ZP group (4.63°±4.32°; t=2.661, P=0.010). Regarding heterotopic ossification (HO) of the superior vertebral body, in the CP group, 27 cases were grade 0, 7 cases were grade 1, and 1 case was grade 2. In the ZP group, 34 cases were grade 0 and 1 case was grade 1, with a statistically significant difference between the groups (χ 2=6.128, P=0.028). Binary logistic regression analysis revealed that a reduction in intervertebral space height of ≥0.63 mm at one week post-operation and final follow-up ( OR=2.913, P=0.021) and a heterotopic ossification grade of ≥1 ( OR=5.178, P=0.042) were correlated with incomplete symptom relief after single-level ACDF surgery. Conclusions:Both Zero-PVA and titanium plate interbody fusion devices demonstrated favorable clinical outcomes in single-level ACDF surgery. However, a reduction in intervertebral space height and heterotopic ossification of the superior vertebral body may be risk factors for incomplete symptom relief following single-level ACDF.

This study aimed to clarify the appropriate disease coding for coronary heart disease(CHD)and procedure coding for coronary stent implantation through an in-depth analysis of the I20-I25 classification for ischemic heart disease in the International Classification of Diseases,Tenth Revision(ICD-10),and the 36.06-36.07 procedure codes for coronary stents in the International Classification of Diseases,Ninth Revision,Clinical Modification(ICD-9-CM-3),2011 revision.Representative cases from a tertiary general hospital were analyzed to illustrate and validate accurate coding practices.Based on coding guidelines and case analyses,a set of correct codes for CHD and coronary stent procedures was compiled.This work provides guidelines for standardizing medical information documentation and provides a reference for medical insurance payment reform in CHD patients undergoing coronary stent implantation.

Myelodysplastic syndrome (MDS) is a malignant hematologic tumor, which is currently difficult to cure. The theory of Xuanfu was proposed by Liu Wansu, which is unique in the clinical evidence of Chinese medicine and is less frequently applied to hematological diseases. The application of Xuanfu theory in myelodysplastic syndrome provides new ideas for the treatment of the disease. The abnormal flow of Qi, blood and fluids caused by the occlusion of the Xuanfu is the cause of toxic stasis obstruction, which is the pathogenesis of toxic stasis obstruction. Thus, the method of dispersion of Bone from Xuanfu, the external treatment of Xuanfu, and regulation of liver qi and Xuanfu help to return to normal of opening and closing function of Xuanfu, and release toxic stasis. In this paper, we analyzed the evidence of toxin-stasis obstruction in myelodysplastic syndrome from the theory of Xuanfu, aiming to provide a feasible theoretical basis for clinical treatment of the disease.

Objective:To explore the feasibility of contrast-enhanced ultrasound in assessing the degree of transplant renal artery stenosis(TRAS)and evaluate its diagnostic efficacy of severe TRAS.Methods:From February 2013 to February 2022, clinical and follow-up data are retrospectively reviewed for 23 TRAS recipients.A definite diagnosis is made by magnetic resonance angiography (MRA, 2 cases)or digital subtraction angiography(DSA, 21 cases). They are assigned into two groups of mild-moderate stenosis(5 cases)and severe stenosis(18 cases)according to the diameter reduction rate of transplanted renal artery detected by DSA/MRA.Another 32 recipients of stable renal function are selected as controls.All contrast-enhanced ultrasonic images are quantitatively processed with SonoLiver.The following quantitative parameters are obtained, including rising time of interlobular artery(RTi), rising time of cortex(RTc), rising time of medulla(RTm), time to peak of interlobular artery(TTPi), time to peak of cortex(TTPc)and time to peak of medulla(TTPm). The differences of contrast-enhanced ultrasonic quantitative parameters are compared among three groups.And their diagnostic efficacies are calculated in the diagnosis of severe TRAS.Results:As compared with those in normal group, RTi, RTc, TTPi and TTPc are significantly longer in mild-moderate stenosis group(all P<0.05); Meanwhile, RTi, RTc, RTm, TTPi, TTPc and TTPm are significantly longer in severe stenosis group than those in normal group(all P<0.05); Comparing mild-moderate stenosis and severe stenosis groups, only RTm is significantly different between two groups( P<0.05). Among all the above parameters, RTc has the highest diagnostic efficacy in the diagnosis of severe TRAS(AUC=0.848)with a sensitivity of 72.22%, a specificity of 86.49% and an accuracy of 81.82%. Conclusions:The quantitative parameters of contrast-enhanced ultrasound offer aid in assessing the degree of TRAS.And RTc is the most valuable in the diagnosis of severe TRAS.

A 78-year-old female patient with atrial fibrillation developed tarry stools after regularly taking dronedarone, metoprolol, and rivaroxaban for 3 months. The patient stopped using rivaroxaban by herself for 7 days, and her black stools was gradually improved. After taking rivaroxaban again for 1 month, black stools appeared again, accompanied by fatigue, dizziness, and amaurosis fugax. Her blood pressure was 90/50 mmHg, heart rate was 80 beats/min, and hemoglobin was 55 g/L. Rivaroxaban was discontinued again and supportive treatments such as soft food, acid suppression, fluid replacement, and blood transfusion were given. After 3 days of treatments, the symptoms of fatigue were improved significantly, and no amaurosis recurred when sitting up. Hemoglobin was 75 g/L. After 6 days of treatments, the patient discharged formed yellow soft stools. After excluding gastrointestinal tumors through gastroscopy and tumor marker examination, it was considered that the interaction of dronedarone and rivaroxaban caused the increase of rivaroxaban plasma concentration, which resulted in gastrointestinal bleeding in the patient. The patient′s anticoagulant medication was changed to dabigatran etexilate, and no gastrointestinal bleeding occurred.

A 78-year-old female patient with atrial fibrillation developed tarry stools after regularly taking dronedarone, metoprolol, and rivaroxaban for 3 months. The patient stopped using rivaroxaban by herself for 7 days, and her black stools was gradually improved. After taking rivaroxaban again for 1 month, black stools appeared again, accompanied by fatigue, dizziness, and amaurosis fugax. Her blood pressure was 90/50 mmHg, heart rate was 80 beats/min, and hemoglobin was 55 g/L. Rivaroxaban was discontinued again and supportive treatments such as soft food, acid suppression, fluid replacement, and blood transfusion were given. After 3 days of treatments, the symptoms of fatigue were improved significantly, and no amaurosis recurred when sitting up. Hemoglobin was 75 g/L. After 6 days of treatments, the patient discharged formed yellow soft stools. After excluding gastrointestinal tumors through gastroscopy and tumor marker examination, it was considered that the interaction of dronedarone and rivaroxaban caused the increase of rivaroxaban plasma concentration, which resulted in gastrointestinal bleeding in the patient. The patient′s anticoagulant medication was changed to dabigatran etexilate, and no gastrointestinal bleeding occurred.

Objective To inve stigate in vestigate the effects of splenectomy on the expression of the PTEN gene in liver fibrosis of rats induced by biliary tract obstruction.Methods The liver fibrosis model was induced by bile duct ligation.Rats were randomly divided into 3 groups.Group A had bile duct ligation + splenectomy (BDL + SPL,45 rats),group B had bile duct ligation + spleen sham operation (BDL + SSP,45 rats),and group C had sham bile duct ligation + spleen sham operation (SBDL + SSP,45 rats).Liver tissue samples from each group were taken in weeks 1,3,and 5.HE and Sirius staining displayed the degree of liver fibrosis.Western-blot,real-time PCR,and immunohistochemistry SP measured the expression of α-smooth muscle actin (α-SMA) together with the expression of PTEN mRNA and PTEN protein.The relevance was also tested in this study.Results As time increased,liver fibrosis gradually occurred in group A and B,and the degree of liver fibrosis was more serious in group B than in group A.The expression volume of PTEN mRNA and PTEN protein in group A was higher than that in group B (P ＜ 0.05),while the expression volume of α-SMA was the opposite (P ＜ 0.05).The expression volume of PTEN mRNA and PTEN protein were negatively correlated to α-SMA (r =-0.86,P ＜ 0.05).Conclusion In the rat liver fibrosis model,splenectomy up-regulated the expression of the PTEN gene and reduced the secretion of α-SMA,thereby delaying the progression of liver fibrosis.