Objective:To summarize long-term clinical follow-up results of segment instability between the upper instrumented vertebra (UIV) and the adjacent upper vertebra (UIV+1) and to establish the optimal timing for surgery for UIV+1.Methods:A retrospective analysis was conducted on 265 patients with lumbar degenerative diseases who underwent transforaminal lumbar interbody fusion (TLIF) surgery at the Department of Spinal Surgery, Zhongda Hospital, from January 2014 to December 2018. The cohort included 119 male and 146 female patients, with an average age of 64.93 years (range: 32-86 years). Preoperative dynamic imaging measured sagittal angulation (SA) and sagittal translation (ST) of the UIV+1/UIV segment. Patients with SA>10° or ST>2 mm were categorized into the unstable group, further divided into the unstable non-fusion group and the unstable fusion group based on whether UIV+1 expansion fusion was performed. The remaining patients were classified into the stable group. Imaging indicators, Visual Analogue Scale (VAS) scores, Oswestry disability index (ODI) scores, and Japanese Orthopaedic Association (JOA) scores were compared among the groups, with JOA improvement rates calculated to assess clinical efficacy. Pearson correlation coefficient analysis was employed to examine correlations between preoperative imaging indicators and final follow-up JOA improvement rates. Receiver Operating Characteristic (ROC) curves and the maximum Youden index were utilized to determine thresholds for preoperative SA and ST.Results:The follow-up duration for all patients was 73.53±12.92 months (range: 61-108 months). The stable group (124 cases) included 61 males and 63 females, aged 64.31±9.83 years (range: 44-82 years). The unstable non-fusion group (59 cases) included 22 males and 37 females, aged 65.76±11.01 years (range: 32-86 years). The unstable fusion group (82 cases) included 36 males and 46 females, aged 65.26±8.68 years (range: 47-80 years). At the last follow-up, the unstable non-fusion group exhibited ΔSA 0.90°±1.97° and ΔST 0.77±1.27 mm, both significantly higher than the stable group's ΔSA 0.25°±1.57° and ΔST 0.34±0.34 mm ( t=3.564, P<0.001; t=2.311, P=0.022). Clinical improvements were lower in the unstable non-fusion group compared to the other two groups: VAS (2.28±0.83), ODI (5.91%±3.46%), JOA (24.11±1.78), with a JOA improvement rate of 60%. The stable group showed VAS (1.51±0.69), ODI (3.71%±1.75%), JOA (27.33±1.91), with a JOA improvement rate of 83%. The unstable fusion group had VAS (1.46±0.83), ODI (3.46%±1.81%), JOA (26.48±1.66), with a JOA improvement rate of 78%. These differences were statistically significant ( F=32.117, P<0.001; F=24.827, P<0.001; F=92.658, P<0.001; F=93.341, P<0.001). The JOA improvement rate was negatively correlated with preoperative SA ( r=-0.363, P<0.001) to a low extent, and with preoperative ST ( r=-0.596, P<0.001) to a moderate extent. ROC curve analysis determined the preoperative SA threshold as 11.5° and the preoperative ST threshold as 1.85 mm. Conclusion:Pre-existing instability of the responsible segment UIV and UIV+1 (SA>10° or ST>2 mm) may worsen during long-term follow-up after TLIF. When preoperative SA exceeds 11.5° and ST exceeds 1.85 mm between UIV and UIV+1, performing an extended fusion involving UIV+1 can ensure surgical efficacy over long-term follow-up.

With an aging population, the incidence of osteoporotic vertebral fractures (OVFs) is on the rise, posing new challenges for developing personalized treatment strategies. For patients who do not respond to conservative treatment, percutaneous vertebroplasty or percutaneous kyphoplasty (PVP/PKP) remains the preferred surgical option due to its minimal invasiveness and rapid recovery time. However, progressive local kyphosis (PLK) is one of the most severe complications following PVP/PKP, with an incidence rate of 1.5%-25.8%. PLK often presents with recurring thoracic and lower back pain, and in severe cases, spinal stenosis, causing symptoms like numbness and pain in the lower limbs. The severity of PLK varies, and treatments can range from conservative management and bone cement reinforcement to internal fixation or osteotomy. Current studies suggest that re-fracture of the affected vertebra, intervertebral disc degeneration, and osteonecrosis may be underlying mechanisms. These conditions shift the axial load forward, promoting postoperative PLK, which tends to progress over time. Postoperative PLK is closely associated with patient characteristics, fracture details, surgical factors, and post-surgery osteoporosis management. 1) The severity of osteoporosis, as indicated by the T-score from bone mineral density testing, can help predict postoperative PLK. While factors like age and gender influence osteoporosis severity, no direct relationship has been established between these factors and PLK. 2) Thoracolumbar fractures, old nonunion fractures, endplate fractures, or severe preoperative compression changes with kyphosis can increase PLK risk. Surgical factors, including the use of balloons or implants and the distribution of bone cement, also play a role. Personalized treatment plans should be developed based on the patient's general condition and imaging results to ensure adequate bone cement diffusion, as enhanced integration can reduce PLK risk. 3) Postoperative anti-osteoporosis therapy is also crucial; long-term therapy, particularly with teriparatide, can prevent PLK. Recognizing the related risk factors and establishing predictive models can help clinicians tailor treatments. Machine learning models, utilizing big data, are particularly adept at handling complex interrelated risk factors and may provide a powerful tool for personalized treatment in the future.

OBJECTIVE: To review the clinical research progress of spinal epidural lipomatosis (SEL). METHODS: The clinical studies on SEL at home and abroad in recent years were extensively reviewed, and the pathogenesis, clinical and imaging manifestations, and treatment status of SEL were summarized and analyzed. RESULTS: SEL is a disease characterized by compression of the spinal cord and nerve roots due to abnormal accumulation of epidural adipose tissue in the spinal canal. Its prevalence and diagnosis rate are low and the pathogenesis is not fully understood. MRI is the most sensitive and specific diagnostic test for SEL. Surgical decompression and removal of excess adipose tissue are the only options for patients with acute SEL or those who have failed conservative management, and conservative management should be considered for other patients. CONCLUSION SEL is a rare disease and related research still needs to be improved. In the future, high-quality, multi-center and large-sample studies will be of great significance for evaluating the choice of treatment methods and effectiveness of SEL patients.
Humans ; Decompression, Surgical/methods* ; Epidural Space/surgery* ; Lipomatosis/surgery* ; Magnetic Resonance Imaging ; Spinal Cord Diseases/surgery*

Ex vivo culture-amplified mesenchymal stem cells (MSCs) have been studied because of their capacity for healing tissue injury. MSC transplantation is a valid approach for promoting the repair of damaged tissues and replacement of lost cells or to safeguard surviving cells, but currently the efficiency of MSC transplantation is constrained by the extensive loss of MSCs during the short post-transplantation period. Hence, strategies to increase the efficacy of MSC treatment are urgently needed. Iron overload, reactive oxygen species deposition, and decreased antioxidant capacity suppress the proliferation and regeneration of MSCs, thereby hastening cell death. Notably, oxidative stress (OS) and deficient antioxidant defense induced by iron overload can result in ferroptosis. Ferroptosis may inhibit cell survival after MSC transplantation, thereby reducing clinical efficacy. In this review, we explore the role of ferroptosis in MSC performance. Given that little research has focused on ferroptosis in transplanted MSCs, further study is urgently needed to enhance the in vivo implantation, function, and duration of MSCs.
Humans ; Antioxidants/metabolism* ; Ferroptosis ; Mesenchymal Stem Cell Transplantation ; Mesenchymal Stem Cells ; Iron Overload/metabolism*

OBJECTIVE To excavate and evaluate β-blockers associated with acute renal failure（ARF）signal. METHODS Using the report odds ratio （ROR）method and Bayesian confidence interval progressive neural network （BCPNN）method，signal detection and analysis were performed for 4 kinds of β-blockers（metoprolol，bisoprolol，atenolol，nebivolol）associated with ARF Δ 基金项目：重庆市临床药学重点专科建设项目 （No.渝卫办发 in FDA adverse event reporting system （FAERS）from the two 〔2020〕68号）；重庆医科大学未来医学青年创新团队发展支持计划项 dimensions of Standard International Dictionary of Medical 目（No.W0081） Terms （MedDRA） analysis query （SMQ） term set and ＊药师，硕士研究生。研究方向：药物警戒。电话：023-68485161。 preferred term （PT） level terms. When the two methods E-mail：2020121624@stu.cqmu.edu.cn detected positive signals at the same time ，it indicated that # 通信作者：主任药师，硕士生导师。研究方向：临床药学、药物警 suspicious signals were detected. RESULTS Totally 14 328 戒。电话：023-63625666。E-mail：jiayuntaomail@hospital.cqmu.edu.cn ARF reports of 4 kinds of β-blockers were retrieved within the ·1380· China Pharmacy 2022Vol. 33 No. 11 中国药房 2022年第33卷第11期 narrow sense of “acute renal failure ”in SMQ term set ，of which men （6 964）were more than women （6 206）. The age of patients was mainly concentrated in the middle-aged and elderly （≥45 years old ），and serious adverse events accounted for 77.23％. The results of signal retrieval based on SMQ term set showed that ROR values and 95％ confidence intervals of metoprolol ，bisoprolol， atenolol and nebivolol detected by ROR method were 2.58（2.51，2.65），5.30（5.14，5.47），2.80（2.69，2.91）and 3.28（3.04， 3.53）respectively. The signal components （IC）detected by BCPNN method and the lower limit of IC were 1.29（1.25），2.26 （2.22），1.42（1.36）and 1.64（1.53）respectively，suggesting suspicious signals were detected in these four kinds of β-blockers associated ARF. The results of signal detection based on PT level terms showed that 37 positive signals were detected by ROR method，38 positive signals were detected by BCPNN method ，and 36 suspicious signals were detected by the two methods at the same time. For each drug ，12 suspicious signals of metoprolol were detected at the same time ，9 suspicious signals of bisoprolol and atenolol were detected at the same time ，and 6 suspicious signals of nebivolol were detected at the same time ；the number and type of signals were different among the 4 kinds of drug. CONCLUSIONS Four kinds of β-blockers may cause ARF. Compared with metoprolol and atenolol ，bisoprolol and nebivolol have strong statistical correlation with ARF ，suggesting that medical personnel should pay attention to the possible renal related adverse reactions of these drugs in the process of clinical use.

OBJECTIVE To detect and evaluate the signals of amlodipine and lercanidipine -induced adverse drug events （ADE）. METHODS All ADE reports about “amlodipine”and“lercanidipine”were searched from FAERS database during Jan . 1st，2004 to Sept . 30th，2021. Reported odds ratio and Bayesian confidence propagation neural network were used to detect ADE signals. The moderately strong signals and strong signals in key systems were selected for analysis . RESULTS From FAERS database，249 657 and 10 558 reports were extracted with amlodipine and lercanidipine as suspect drugs ，respectively. In this study，62 and 58 signals related to amlodipine and lercanidipine were detected respectively . At the same time ，moderately strong signals of peripheral edema ， hypotension， orthostatic hypotension and hypovolemic shock were detected in the twodrugs，all of which were common adverse reactions of the two drugs. The special ADEs detected in this study were as follows： in the respiratory system ， chest and mediastinaldisease system ，strong signals of non -cardiogenic pulmonary edema were detected for amlodipine ，and strong signals of dyspnea at rest for lercanidipine ；in gastrointestinal diseases ，strong signals of gingival hypertrophy were detected only for amlodipine；in skin and subcutaneous tissue disease system ，moderately strong signals related to “vasculitis”were detected for both drugs，moderately strong signals related to linear IgA disease were detected for amlodipine ，and moderately strong signals related to bullous dermatitis were detected for lercanidipine ；in the renal and urinary system disease system ，the signals of acute renal injury were detected for both drugs （amlodipine was detected as a moderately strong signal ，and lecardipine was detected as a strong signal ）； in the mental system ，moderately strong signals related to suicide were detected for amlodipine . Both hypotension and acute renal injury ranked in the top two in the number of reports of the two drugs . The time scan results of the information component （IC）of this study showed that the IC values of non -cardiogenic pulmonary edema and suicide completion signals of amlodipine increased from 0.76，－0.49 to 4.48 and 1.95 respectively，and the confidence intervals narrowed from （－0.44，1.97），（－1.01，0.03）to （4.24，4.72）and（1.90，2.01）respectively during 2004 to 2021，suggesting that the signals kept stable . CONCLUSIONS The risks of peripheral edema ，hypotension，arrhythmia，pulmonary edema ，gingival hyperplasia ，skin related ADE ，acute renal injury ， depression and suicide should be alert when using amlodipine and lercanidipine in clinic .

ObjectiveTo investigate the current situation of personality traits and job satisfaction of pediatric therapists in Jiangsu province, and to explore the correlation between them and the related factors of job satisfaction. MethodsFrom June, 2021 to February, 2022, random cluster sampling method was adopted after field investigating several pediatric hospitals and institutions in Jiangsu. Online questionnaires were sent out to pediatric therapists in different settings in eleven cities in Jiangsu. The questionnaires included Minnesota Satisfaction Questionnaire (MSQ), Eysenck Personality Questionnaire-Revised Short Scale for Chinese (EPQ-RSC) and self-made scale of demographic characteristics and working status. ResultsAll of the questionaires were taken back, in which 165 were valid (83.33%). Among the three dimensions of psychoticism, extraversion and neuroticism, the intermediate type accounted for 66.06%, 38.79% and 40.00%, respectively. The overall satisfaction of job was (3.80±0.55), the internal satisfaction was (3.88±0.53), and the external satisfaction was (3.59±0.69). There was significant difference in the satisfaction among different types of work institution, monthly incomes, levels of parental support and neuroticism (P < 0.05). Multiple linear regression showed that the internal satisfaction and overall satisfaction were related with neuroticism, monthly income and parental support (P < 0.05), while external satisfaction was related with the neuroticism and parental support (P < 0.05). The level of neuroticism was negatively correlated with the internal satisfaction, the external satisfaction and overall satisfaction (|r| > 0.337, P < 0.001), and the level of extraversion was postively correlated with the external satisfaction (r = 0.155, P < 0.05). ConclusionThe job satisfaction of pediatric therapists is fine in Jiangsu, and is ralated with the level of neuroticism, the monthly income and the level of parental support. The levels of neuroticism and extraversion correlate with the job satisfaction.

The development trend, countries, institutions, co-authors, and subjects in MEDLINE-covered papers were analyzed by Excel, Ucinet and SciMAT respectively in order to understand the current situation in studies on precision medicine, which showed that precision medicine is in a rapid development stage, the impact power of pa-pers on precision medicine published in United States of America is high, the source journals published in United States of America are the core journals in precision medicine, the academic level of papers on precision medicine published in United States of America is high. Co-authors analysis showed that the co-authors network is of the small world effect. Subject evolution analysis revealed that the subjects involved in studies on precision medicine are increasingly rich with genomics, drug treatment and oncology accounted a large proportion. Analysis of the evo-lution in genomics, drug treatment and oncology displayed that the subjects involved in studies on precision medi-cine have experienced macro-stage, micro-stage, and combined macro- and micro-stage.

Objective To study the application of citation frequency, relative impact power and social network analysis in evaluation of scientific papers. Methods A total of 37919 papers onfemale fertility maintenance published in 2006-2015 were evaluated by citation frequency, relative impact power and social network analysis, respectively. Their coincidence and correlativity, and the effect of citation structure on the papers sequenced according to their citation frequency, relative impact power and social network were analyzed. Results The local citation frequency could measure the publication time of papers and the effect on their sequence. Conclusion Global citation frequency can measure the effect width and depth of papers, intermediary centrality can help to find the core papers, and ap-proximate centrality can help to measure the early published papers.

Objective To explore the level of angiopoietin‐like protein 4 (ANGPTL4) in patients with early chronic kidney disease (CKD ) in diabetes and the influence of pioglitazone on the level. Methods 92healthypeoplewithnormalglucosetolerancewereselectedasthecontrols(NCgroup).89 newly diagnosed T2DM were selected (T2DM group ). 90 cases of CKD group were divided into pioglitazone (PGZ) and glimepiride (GLI) treated subgroups ,45 cases in each subgroup. After treatment , serum ANGPTL4 levels were observed in CKD group. Results There were significant differences in serum ANGPTL4 levels among NC ,T2DM and CKD groups [(34.8 ± 4.75) vs (31.1 ± 3.65) vs (27.1 ± 3.52)ng/ml ,P<0.05 or P<0.01]. ANGPTL4 level was positively correlated with SOD ,TG (r=0.635 , 0.526 ,P< 0.05 or P< 0.01) ,and negatively correlated with BMI ,FPG ,HbA1c ,hsC‐RP ,UAlb/Cr , VEGF ,FIns ,HOMA‐IR (r= -0.502 ,-0.624 ,-0.542 ,-0.520 ,-0.538 ,-0.566 ,-0.576 ,-0.509 ,P< 0.05 or P < 0.01 ). In PGZ subgroup after treatment ,ANGPTL4 levels were significantly increased and UAlb/Cr significantly decreased [(31.51 ± 3.87 ) vs (27.60 ± 3.58 )ng/ml ,P < 0.05 ;(88.50 ± 8.90 ) vs (116.20 ± 10.30 )mg/24 h ,P < 0.01 ]. In GLI subgroup after treatment ,there were no significant difference in FPG and HbA1 c as compared with PGZ subgroup but ANGPTL4 levels have no significant differences after treatment ,and UAlb/Cr decreased [(27.20 ± 3.54 ) vs (26.60 ± 3.48 )ng/ml ,P > 0.05 ;(99.70 ± 12.80 ) vs (122.40 ± 13.10 )mg/24 h ,P < 0.05]. HbA1 c ,FIns ,UAlb/Cr were the independent related factors influencing ANGPTL4 of CKD patients. Conclusion Serum ANGPTL4 has a lower level in CKD patients. PGZ is effective in treating CKD. This role is associated with the increase of serum ANGPTL4.