ObjectiveTo observe the clinical efficacy of Shentong Zhuyutang combined with Dilongtang in the treatment of lumbar disc herniation （LDH） with Qi stagnation and blood stasis syndrome， and its effect on nucleus pulposus reabsorption and immune-inflammatory factors， exploring its therapeutic mechanism from the perspective of reabsorption. MethodsA total of 120 patients with LDH from the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine， treated between June 2020 and January 2023， were randomly divided into the control group （52 cases， with 8 dropouts） and the observation group （49 cases， with 11 dropouts） according to a random number table. The control group received routine treatment， while the observation group was treated with Shentong Zhuyutang combined with Dilongtang in addition to routine treatment. Visual Analogue Scale （VAS）， Oswestry Disability Index （ODI）， Japanese Orthopaedic Association （JOA） score， and traditional Chinese medicine （TCM） syndrome score were measured before treatment and after 3 courses of treatment. Venous blood samples were collected for the determination of serological indexes. MR examination was performed during the 6-month follow-up to calculate the absorption rate. ResultsAfter treatment， both groups showed significant reductions in VAS， ODI， TCM syndrome score， serum tumor necrosis factor （TNF）-α， matrix metalloproteinase （MMP）-9， and vascular endothelial growth factor （VEGF） levels， and a significant increase in JOA score compared with pre-treatment values （P<0.05）. Compared with the control group， the observation group showed significantly lower VAS， ODI， TCM syndrome score， serum TNF-α， MMP-9， and VEGF levels， and a significantly higher JOA score （P<0.05）. The proportion of nucleus pulposus reabsorption in the observation group was 57.14% （28/49）， significantly higher than 21.15% （11/52） in the control group （χ²=6.161， P<0.05）. ConclusionShentong Zhuyutang combined with Dilongtang can effectively relieve pain， improve lumbar function， and alleviate TCM clinical symptoms in LDH patients with Qi stagnation and blood stasis syndrome. Imaging findings suggest that the treatment promotes the reabsorption of nucleus pulposus protrusion， while laboratory testing shows reduced serum levels of TNF-α， MMP-9， and VEGF， which contribute to the rehabilitation of patients.

Objective To understand the epidemiological and genotypic characteristics of norovirus (NoV) in Jingzhou area，and to design primers and probes covering the variant genomes in the NoV gene library. Methods A total of 556 fecal samples were collected from suspected NoV patients from the First People's Hospital of Jingzhou from January 2022 to May 2023. The positive rate of NoV nucleic acid in fecal samples was detected by commercial kits. The differences in positive rates among different seasons and five age groups were statistically analyzed. Primers covering the NoV variant genome were designed to genotype some positive specimens. Results The detection rate of NoV nucleic acid in the tested samples was 30.04% (167/556). The detection rate in spring and winter was higher than that in summer and autumn (χ²=20.411，P<0.01). There were statistical differences in the positive rates among the five age groups of <1 year, 1-5 years, 6-10 years, 11-19 years, and >19 years (χ²=17.192，P<0.01), and the positive rate in young children (1~5 years old) was the highest (39.29%, 88/224). In addition, all the positive samples were NoV GII. Conclusion The epidemic situation of NoV is serious in winter and spring in Jingzhou area, with a high infection rate in young children (1-5 years old), and NoV GII is the main prevalent genotype. The primers designed in this study can be used for genotyping of NoV GI and GII.

Hyperkalemia is one of the common ion metabolism disorders in clinical practice. Hyperkalemia is defined as serum potassium higher than 5.0 mmol/L according to the guidelines at home and abroad. Acute severe hyperkalemia can cause serious consequences, such as flaccid paralysis, fatal arrhythmia, and even cardiac arrest. The use of renin-angiotensin- aldosterone system inhibitors, β-blockers and diuretics, low-sodium and high-potassium diets, and the presence of related comorbidities increase the occurrence of hyperkalemia. Hyperkalemia risk exist in all clinical departments, but there is a lack of a standardization in the management of multi- department cooperation in hospital. Therefore, a number of domestic nephrology and cardiology department experts have discussed a management model for multi-department cooperation in hyperkalemia, formulating the management standard on hospital evaluation, early warning, diagnosis and treatment, and process. This can promote each department to more effectively participate in nosocomial hyperkalemia diagnosis and treatment, as well as the long-term management of chronic hyperkalemia, improving the quality of hyperkalemia management in hospital.

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.

OBJECTIVE：To provide reference for constructing and improving the pharmacovigilance signal management sys - tem in China by comparing signal management system among the European Union （EU），the United States （U. S. ）and Japan. METHODS：Literature analysis method was used to systematically compare the similarities and differences on definitions ，sources， detection methods and management process of pharmacovigilance signals among EU ，U. S. and Japan. Some suggestions were put forward for pharmacovigilance management in China. RESULTS & CONCLUSIONS ：Regulatory authorities of the EU ，U. S. and Japan did not have a uniform definition on signals ；EU drug administration adopted the definition of the eighth working group of Council for International Organizations of Medical Sciences ，FDA adopted its own definition ，while the Japanese regulatory agency had no clear definition. Currently ，post-marketing surveillance still relied mainly on spontaneous reporting systems ；EU，U. S. and Japan had carried out the signal detection based on the spontaneous reporting system ；EU mainly adopted the proportional reporting ratio method ，U. S. mainly adopts the multiple gamma Poisson Shrinker ，and Japan mainly adopted the reporting ratio method. EU had special guidelines for signal management process ，while the U. S. and Japan did not. It is recommended to accelerate the deve- lopment of the legal and regulatory framework on pharmacovigilance in China ，draw up guidelines on pharmacovigilance practices ， strengthen the active ADR surveillance and promote the application of data mining techniques in signal detection field ，for accelerat - ing the standardization and internationalization of China ’s pharmacovigilance work.

Objective: To investigate clinical characteristics and treatment of phytophotodermatitis due to ingesting Chenopodium album. Methods: This study included 11 patients with phytophotodermatitis caused by ingesting Chenopodium album collected from Department of Dermatology, Affiliated Hospital of Jining Medical University from 2013 to 2017. The patients′ general information, clinical manifestations, laboratory test results, treatment and prognosis were retrospectively analyzed. Results: All the 11 patients were female, and their age ranged from 45 to 62 years. They all had a history of ingesting Chenopodium album and exposing to sunlight within 1 - 2 days prior to the disease onset. Clinical manifestations included symmetrically distributed, painful and pruritic, nonpitting, swelling erythema on the face and back of both hands and at sunexposed sites of forearms, with a tense and bright surface. Increased white blood cell counts were observed in 6 patients, and increased eosinophil counts in 1. All of the 11 patients were treated with systemic methylprednisolone, loratadine, ebastine, spironolactone, furosemide and omeprazole as well as topical agents, 2 also received human immunoglobulin treatment, and 3 were also treated with oral ibuprofen and codeine for painful lesions. Ten patients received obvious improvement and were discharged after 7 - 10 days of treatment, and no pigmentation or scars were observed after 1-year follow-up. Skin necrosis occurred on the back of both hands in 1 patient after 7-day treatment, and scars remained in the patient after follow-up of half a year. Conclusions Chenopodium album-induced phytophotodermatitis commonly manifests as swelling erythema on the exposed body sites. After confirmed diagnosis, Chenopodium album ingestation and sunlight exposure should be avoided, and timely antianaphylactic treatment should be considered to effectively control the disease.

Liver metastasis is one of the main causes of death in patients with colorectal cancer. About 15%-25% of patients with colorectal cancer have synchronous liver metastasis at the initial diagnosis. With the development of new evidence and concept of surgery, there is a improvement in the understanding of the surgical treatment, transformation treatment, criteria of surgical resectability and prognosis of patients with colorectal liver metastasis (CRLM). Based on latest progress, specialized multi-disciplinary team decides the best individualized treatment strategy. This paper reviews the current situation and progress of CRLM.

Liver metastasis is one of the main causes of death in patients with colorectal cancer. About 15%-25% of patients with colorectal cancer have synchronous liver metastasis at the initial diagnosis. With the development of new evidence and concept of surgery, there is a improvement in the understanding of the surgical treatment, transformation treatment, criteria of surgical resectability and prognosis of patients with colorectal liver metastasis (CRLM). Based on latest progress, specialized multi-disciplinary team decides the best individualized treatment strategy. This paper reviews the current situation and progress of CRLM.

Objective To investigate the clinical application and efficacy of DNA immune absorption in patients with lupus interstitial pneumonia.Methods to collect randomized 18 patients with lupus patients with pneumonia were enrolled in the study and randomly divided into immunoadsorption group and traditional CTX treatment group,in order to observe the ESR,CRP,ANA quantitative monitoring at different time,pulmonary function test (diffusing capacity of the lung for carbon monoxide,DLCO),6 min walking distance,procalcitonin (PCT).The difference between groups was statistically analyzed and the effect of DNA immunization was discussed.Results There were significant differences between immunoadsorption group and control group in ESR at the different time points before and after the treatment (Fgroup =7.841,P＜0.05;Fcross =6.512,P ＜0.05;Finteraction =10.421,P＜0.05),CRP(Fgroup =6.995,P＜0.05;Fcross=5.847,P＜0.05;Finteraction =8.847,P＜ 0.05) and ANA quantitative monitoring (FgrouP =12.336,P ＜ 0.05;Fcross =11.214,P ＜ 0.05;Finteraction =15.847,P＜0.05).At 1 and 2 weeks after treatment,CRP and ESR of the immunoadsorption group began to decrease,and the difference was statistically significant compared with those before treatment (P ＜0.05),while the difference between the control group and the treatment group was statistically significant after 4 weeks (P＜0.05).After 2 weeks of treatment,there was a significant difference in ANA quantitative monitoring between the immunoadsorption group,compared with that before treatment.There was a significant difference between the control group before treatment and the 6 months after treatment (P＜0.05).There was a significant difference between the immunoadsorption group and the control group in pulmonary function test (FgrouP =6.222,P＜ 0.05:Fcross =7.154,P＜ 0.05:Finteraction =8.527,P ＜ 0.05),6 min walking distance (FgrouP =8.669,P＜ 0.05;Fcross =7.154,P ＜ 0.05;Finteraction =11.547,P＜ 0.05) and PCT (FgrouP =5.621,P ＜0.05;Fcross =4.125,P ＜ 0.05;Finteraction =7.554,P ＜ 0.05.The pulmonary function and 6 min walking distance of 2-week treatment in the immunoadsorption group.There showed a significant difference compared with that before treatment.The difference between the control group after 4 weeks of treatment and that before treatment was statistically significant (P=＜0.05).There was a significant difference between the 2 weeks PCT treatment in the immunoadsorption group and that before treatment (P＜0.05).There was a significant difference between the control group after 3 months of treatment and before treatment (P ＜ 0.05).Conclusion The treatment of lupus interstitial pneumonia in traditional regimens is ineffective,and the efficacy of DNA is better than that of conventional regimens,and reduces the risk of infection.

Objective To investigate the safety and efficacy of three column osteotomy (3-CO) procedures through previous spinal fusion site for the revision surgical treatment in severe spinal deformity patients.Methods From Oct.2010 to May 2014 in our hospital,a total of 12 severe spinal deformity patients underwent 3-CO for the revision surgical treatment.There were 7 males and 5 females with the average age of (21.8±3.8) years,ranging from 18 to 30 years.The mean time from the initial operation to the revision surgery was (10.2±4.8) years (ranging from 3 to 17 years).The reasons for revision were:curve progression in 7 patients,neurologic deficit in 2 cases,implant failure in 1 patient and pseudarthrosis in 2 patients.The coronal parameters including major Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL-CSVL),and the sagittal parameters including global kyphosis curve and sagittal vertical axis (SVA) were measured pre-operatively,post-operatively and at last followup,respectively.The operation time,intraoperative blood loss and complications were recorded.The paired t test was used to evaluate the difference among pre-revision,post-revision and last follow-up.Results The average operation time was (451.7±83.1) min (range,320-600 min) and the average blood loss was (4 016.7± 1 080.0) ml (range,2 700-6 000 ml).The average follow-up time after revision operation was (35.4±9.8) months (range,24-49 months).The coronal Cobb angles of pre-revision and post-revision were 83.8°±23.3°and 34.6°± 13.7°.The average correction rate was 60.1％ ±8.8％.At last follow-up,the average coronal Cobb angle was 34.9°±13.8°,there was no significant loss of correction.The pre-revision and post-revision values of global kyphosis were 99.1°±13.3°and 38.7°±7.8° with a mean correction rate of 60.8％ ±6.7％.At the last follow-up,the average global kyphosis was 39.3°±7.5°and no loss of correction was found.For the C7PL-CSVL and SVA,pre-revision (30.3± 17.1) mm and (40.1±31.1) mm were corrected to (14.3 ±7.6) mm and (19.1± 12.3) mm immediately after revision operation,respectively.At final follow-up,the average C7PL-CSVL and SVA were(14.1 ± 7.6) mm and (19.6± 12.1) mm,the correction was well maintained.Obviously,two patient's neurological status improved from Frankel C before revision surgery to Frankel E.Complications were encountered in five patients (41.7％),including SEP signal changed in 1 patient (8.3％),transient neurologic deficit after revision surgery in 1 patient (8.3％),cerebrospinal fluid leak in 1 patient (8.3％),and pleural effusion in 2 patients (16.7％).During the follow-up time,there was no patient experienced pseudarthrosis,implant failure,infection or significant loss of correction.Conclusion Based on results of this study,it was concluded that 3-CO procedures through previous spinal fusion sites could obtain satisfactory and safety results in severe spinal deformity revision surgery.However,it is a technique-demanding procedure with more blood loss,longer operative time and higher risk of perioperative complications.