Objective:To explore the clinical efficacy of chemoembolization with doxorubicin-infused gelatin sponge microparticles in the amelioration of arterioportal shunting (APS) in patients afflicted with hepatocellular carcinoma (HCC).Methods:A retrospective investigation was conducted on 9 HCC patients admitted between January 2020 and December 2022 with concomitant moderate-to-severe APS who underwent GSM-transarterial chemoembolization (TACE). Hepatic artery digital subtraction angiography (DSA) was employed to ascertain the magnitude of improvement in arteriovenous shunts, utilization of modified response evaluation criteria in solid tumors facilitated the appraisal of short-term clinical outcomes. Follow-up records documented survival duration, along with quantitative parameters such as the longest diameter of tumor lesions and serum alpha-fetoprotein (AFP) levels before and after treatment. The Wilcoxon rank-sum test was utilized to compare the differences of these quantitative parameters before and after treatment.Results:The APS amelioration rates were 100% and 88.9% at immediate and recent postoperatively, respectively. The oncological response rate was 77.8% (7/9), and the complete necrosis rate was 22.2% (2/9) at three months postoperatively, the 1-year survival rate was 100%. Following treatment, a significant reduction was observed in the tumor′s longitudinal diameter [4.32(3.88,6.63)cm] and serum AFP levels [13.50 (7.55, 29.60) μg/L], compared to the pre-treatment values of the tumor′s longitudinal diameter [5.20(4.58,8.57)cm] and serum AFP levels [524.30 (320.65, 1 046.15) μg/L] ( P<0.05 for all). Conclusion:Doxorubicin-infused GSM-TACE is both feasible and efficacious in the first treatment of HCC concomitant with APS and represents a better clinical alternative.

OBJECTIVE: To explore the safety and effectiveness of one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation in the treatment of ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture. METHODS: A clinical data of 20 patients with ankylosing spondylitis kyphosis combined with acute thoracolumbar spine fracture, who were treated with one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation between April 2016 and January 2022, was retrospectively analyzed. Among them, 16 cases were male and 4 cases were female; their ages ranged from 32 to 68 years, with an average of 45.9 years. The causes of injury included 10 cases of sprain, 8 cases of fall, and 2 cases of falling from height. The time from injury to operation ranged from 1 to 12 days, with an average of 7.1 days. The injured segment was T ₁₁ in 2 cases, T ₁₂ in 2 cases, L ₁ in 6 cases, and L ₂ in 10 cases. X-ray film and CT showed that the patients had characteristic imaging manifestations of ankylosing spondylitis, and the fracture lines were involved in the anterior, middle, and posterior columns and accompanied by different degrees of kyphosis and vertebral compression; and MRI showed that 12 patients had different degrees of nerve injuries. The operation time, intraoperative bleeding, intra- and post-operative complications were recorded. The visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the low back pain and quality of life, and the American spinal cord injury association (ASIA) classification was used to evaluate the neurological function. X-ray films were taken, and local Cobb angle (LCA) and sagittal vertical axis (SVA) were measured to evaluate the correction of the kyphosis. RESULTS: All operations were successfully completed and the operation time ranged from 127 to 254 minutes (mean, 176.3 minutes). The amount of intraoperative bleeding ranged from 400 to 950 mL (mean, 722.5 mL). One case of dural sac tear occurred during operation, and no cerebrospinal fluid leakage occurred after repair, and the rest of the patients did not suffer from neurological and vascular injuries, cerebrospinal fluid leakage, and other related complications during operation. All incisions healed by first intention without infection or fat liquefaction. All patients were followed up 8-16 months (mean, 12.5 months). The VAS score, ODI, LCA, and SVA at 3 days after operation and last follow-up significantly improved when compared with those before operation ( P<0.05), and the difference between 3 days after operation and last follow-up was not significant ( P>0.05). The ASIA grading of neurological function at last follow-up also significantly improved when compared with that before operation ( P<0.05), including 17 cases of grade E and 3 cases of grade D. At last follow-up, all bone grafts achieved bone fusion, and no complications such as loosening, breaking of internal fixation, and pseudoarthrosis occurred. CONCLUSION One-stage posterior eggshell osteotomy and long-segment pedicle screw fixation is an effective surgical procedure for ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture. It can significantly relieve patients' clinical symptoms and to some extent, alleviate the local kyphotic deformity.
Humans ; Male ; Female ; Animals ; Adult ; Middle Aged ; Aged ; Spinal Fractures/surgery* ; Pedicle Screws ; Spondylitis, Ankylosing/surgery* ; Quality of Life ; Retrospective Studies ; Egg Shell/injuries* ; Thoracic Vertebrae/injuries* ; Lumbar Vertebrae/injuries* ; Kyphosis/surgery* ; Osteotomy ; Fracture Fixation, Internal/methods* ; Fractures, Compression/surgery* ; Treatment Outcome

Branch atheromatous disease(BAD) refers to cerebral infarction that occurs at the opening or bifurcation of the perforating artery and is caused by the stenosis or occlusion of the lumen of the perforating artery due to atherosclerosis. Since BAD was proposed,it has attracted wide attention due to its characteristic imaging manifestations and clinical features of early neurological deterioration. However,since it is unable to visualize the perforating artery on conventional imaging,it is difficult to clarify and unify the diagnostic criteria and therapeutic strategies for BAD. The application of high-resolution magnetic resonance and high-field magnetic resonance can help to display the hemodynamics and luminal plaques of the perforating artery,which will provide assistance for the development of more high-level BAD studies. This article reviews the epidemiology,clinical and imaging manifestations,diagnostic criteria,and treatment of BAD,so as to improve the early identification of this disease among clinicians and provide a reference for the diagnosis and treatment of this diseases.

This paper reports the diagnosis and treatment of a pregnant woman complicated with myotonic dystrophy (DM) type 1(DM1). The pregnant woman complained of occasional dull pain in the precardiac region accompanied by night sweats in the first trimester and a mild increase in myocardial enzymes was observed. Symptoms were improved after oral medication followed by no regular reexamination. While in the third trimester, abnormal myocardial enzyme, liver enzyme, and urinary protein were found and echocardiography and abdomen ultrasound suggested multiple organic lesions involving the heart and spleen. A girl was born through cesarean section at 36 +5 weeks of gestation due to maternal heart failure, with Apgar scores of 10 at 1 and 5 minutes. The patient developed acute respiratory failure, ventricular bigeminy, and diarrhea after surgery. Neurology consultation found incomplete buried eyelids in both eyes, weak bulging cheeks, and weak upper extremity muscle strength. Muscle biopsy confirmed the diagnosis of DM and genetic testing showed abnormal amplification of non-coding region [CTG] n in myotonic dystrophy protein kinase gene in chromosome 19q13.3, which indicated DM1. The mother recovered well at nine months postpartum. Further genetic analysis of pedigree and offspring is recommended.

OBJECTIVE To introduce the construction of undergraduate specialty of clinical pharmacy based on the concept of outcome-based education （OBE），and to provide new idea and enlightenment for the construction of undergraduate specialty of clinical pharmacy in Chinese universities. METHODS Through the establishment and construction of training objectives and graduation requirements ，teaching reform was designed and implemented ，and the construction of teaching support system and teaching quality assurance system were completed. RESULTS The clinical pharmacy department of our university established the training direction of clinical pharmacy talents under the guidance of post competence ，including clarifying the training needs of undergraduate talents based on the overall requirements of national undergraduate education ；defining the social and industrial needs of clinical pharmacy talents based on the normative documents or concepts of clinical pharmacy ；clarifying the post and ability needs of clinical pharmacy talents based on the investigation of graduates and clinical pharmacists ；clarifying the development needs of clinical pharmacy based on the current situation and trends at home and abroad ；forming characteristic training objectives combined with the regional characteristics and school positioning ， so as to construct training objectives and graduation requirements. The OBE concept was introduced into the undergraduate teaching reform of clinical pharmacy ；the pharmacy talent training direction were established under the guidance of post competence ；the training system was designed by reverse design method；a training mode of both innovation and practical ability was built so as to promote teaching reform ，strengthen the construction of grass-roots teaching organizations and teaching staff ， and improve the construction of teaching quality assurance system. CONCLUSIONS The undergraduate training mode of clinical pharmacy specialty based on the concept of OBE is helpful to improve students ’personal comprehensive quality and professional knowledge and skills. The established undergraduate training model of clinical pharmacy specialty is in line with the modern educational concept and social needs ，and provides theoretical basis and practical experience for the training mode of clinical pharmacy professionals.

Objective:To explore the clinicopathological characteristics and prognosis of pancreatic gastrointestinal interstitial tumors(pGISTs).Methods:Three cases of pGISTs diagnosed in the Affiliated Tumor Hospital of Guangxi Medical University from August 2015 to October 2019 were analyzed retrospectively. Relevant literatures at home and abroad were searched and reviewed through PubMed, China knowledge Network, Wanfang and VIP databases. The sex, age, tumor size, tumor location, cystic or solid tumor, mode of treatment, mitosis, gene mutation, survival status and survival time were recorded, and the correlation between tumor cystic-solid characteristics and clinicopathological parameters was analyzed. Kaplan-Meier′s method was used to calculate the overall survival (OS) rate and disease-free survival (DFS) rate. Univariate and multivariate Cox regression models were used to analyze the independent risk factors affecting the prognosis of pGISTs.Results:In this group, 3 cases were combined with 71 cases reported in the literature, and a total of 74 cases of pGISTs were included. Among them, 36 cases were male and 38 were female, the age of onset was 55(19-84) years, and the diameter of the tumor was 8 cm(2-35 cm). The tumor location of 71 patients was recorded by literature; 30 cases (42.3%) were located in the head of the pancreas. The solid-cystic characteristics of tumor in 63 patients were recorded by literature, and 33 cases (52.4%) were solid. The mode of treatment of 74 patients was recorded, and 60 cases (81.1%) underwent radical resection. The mitosis figures of 59 patients were recorded, and 33 cases (55.9%) were <5/50 high power field of vision (HPF). The gene mutation of 14 patients was recorded, and 11 cases (78.6%) were c-kit exon gene mutation. Correlation analysis showed that the cystic-solid characteristics of the tumor were significantly correlated with tumor location, tumor diameter and mitosis figures, but not with age, sex, histological type, Ki-67 index and modification National Institutes of Health(mNIH) classification. The 5-year OS rate of 51 patients after radical resection was 88.8%, and the 5-year DFS rate was 60.3%. The 1-year OS rate of patients receiving palliative treatment was 51.9%, and the 1-year fatality rate was 33.3%. Univariate Cox regression analysis showed that male ( P=0.083), mitosis figures >5/50 HPF ( P=0.008)and CD 34 negative ( P=0.055)were risk factors for postoperative recurrence of pGISTs, while multivariate Cox regression analysis showed that mitosis figures >5/50 HPF ( P=0.023)was an independent risk factor for the prognosis of pGISTs. Kaplan-Meier survival analysis showed that patients with mitosis figures ≤5/50 HPF had a higher survival rate ( P=0.0003), but there was no significant difference on prognosis between patients with 10/50 HPF and >10/50 HPF( P=0.3075). Conclusions:pGISTs usually occured in the head of pancreas, and the tumor volume was usually found to be large. The main treatment was radical operation, and the main mutation type was exon mutation of c-kit gene. Nuclear fission image figures >5/50HPF was an independent risk factor for postoperative recurrence.

Primary liver cancer is one of the most common malignant tumors in the world, and hepatocellular carcinoma accounts for the majority of liver cancer. Hepatectomy is one of the most important treatment methods, but the high postoperative recurrence rate is the leading cause of treatment failure, which seriously reduces the long-term survival rate and reduces quality of life. Therefore, preventing the recurrence of liver cancer is an important part of treatment. At present, there is no standard program for the treatment of hepatocellular carcinoma to prevent recurrence after surgery, most of the treatment programs include transarterial chemoembolization, antiviral therapy, traditional Chinese medicine treatment, targeted therapy, immunity therapy, etc., which has certain clinical significance in preventing recurrence. This paper reviewed the research progress on preventing recurrence of hepatocellular carcinoma after surgery, which may provide guidance for the clinical study.

Objective To study the clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with agitation thrombolysis in treatment of acute portal vein thrombosis (PVT) in patients with liver cirrhosis.Methods The clinical data of 37 cirrhotic patients with acute PVT treated from January 2014 to December 2017 at the First Affiliated Hospital of Henan University of Science and Technology was analyzed.There were 20 males and 17 females with age ranging from 29 to 71 years.The patients were divided into the combined group (n =15) and the anticoagulation group (n =22).The combined group was treated with TIPS combined with agitation thrombolysis anticoagulation.The anticoagulation group was treated with anticoagulation.The changes in liver function and hemodynamics of portal vein of the two group were compared.Follow-up studies included postoperative portal vein patency,bleeding and survival rates of patients.Results The postoperative portal vein pressure and maximum burden of PVT in the combined group were significantly lower than those before operation,and the portal vein maximum blood volume and flow velocity of portal vein were significantly higher than those before operation (all P ＜ 0.05).At 2 weeks,6 months and 12 months after operation,the maximum burden of PVT of the combined group was (13.9 ±5.4)％,(16.1 ±5.5)％ and (13.8 ±6.2)％,respectively,which was significantly lower than that of the anticoagulant group (84.1±31.3)％,(85.9±27.6)％ and (88.2±39.5)％ (all P＜0.05).At 2 weeks,6 months and 12 months after operation,the flow velocity of portal vein of the combined group was (21.6 ± 5.7) cm/s,(16.1 ± 6.3) crn/s and (17.6 ± 4.9) cm/s,respectively,which was significantly higher than that of the anticoagulation group (9.7 ± 4.6) cm/s,(8.1 ± 4.3) cm/s and (8.2 ± 3.5) cm/s (all P ＜ 0.05).After operation,3 patients in the combined group developed recurrence of portal vein thrombosis,while the remaining patients had smooth blood flow in the portal vein and shunt.In the anticoagulation group,only 3 patients had unobstructed portal vein blood flow.The cumulative rate of no gastrointes tinal bleeding in the combined group was significantly better than the anticoagulant group.The cumulative survival rate of the combined group was also significantly better than the anticoagulation group (P ＜ 0.05).Conclusion TIPS combined with agitation thrombolysis was more effective than the traditional anticoagulant therapy in treatment of acute portal vein thrombosis in cirrhotic patients.

Objective: To investigate the impact of perioperative allogeneic red blood cells transfusion on the early recurrence of patients with hepatocellular carcinoma (HCC) after liver resection. Methods: Retrospective analysis was made on 999 patients who underwent surgical resection for HCC, and these patients were divided into two groups according to whether or not received perioperative allogeneic red blood cells transfusion. Differences between groups were balanced using propensity score matching (PSM). The Kaplan-Meier method was used for comparing the differences in early recurrence (within 2 years) between the two groups and the multivariate COX analysis regression was used to identify independent risk factors for early recurrence. Result: There were 100 patients in red cell transfusion group and 899 patients in non-red cell transfusion group. After PSM, 85 pairs of patients were successfully matched, and there was no significant difference in baseline data between groups. Before PSM, the early recurrence rate of the red blood cell group was significantly higher than that of the non-red blood cell group (P<0.05). However, there was no significant difference in early recurrence rates between the two groups after PSM (P=0.346). Multivariate analysis showed that perioperative allogeneic red blood cells transfusion was not an independent risk factor of early recurrence for patients with HCC after liver resection (P=0.153). Conclusion Perioperative allogeneic red blood cells transfusion has no impact on the early recurrence of patients with HCC after liver resection.

Objective The objective of this study was to investigate the effect of depression on serum levels of C-reactive protein(CRP)and high-sensitivity C-reactive protein(hs-CRP),and prognosis in liver cancer patients. Methods A total of 251 patients with liver cancer undergoing hepatectomy were enrolled. The hospital anxiety and depression scale( HADS-D) and 9-item patients health questionnaire(PHQ9) were assessed for depression before 3 days for surgery. Patients were divided into depression group(n=95)and non-depression group(n=156) according to the scores. Preoperative serum levels of CRP,hs-CRP,ALT and AST were measured and compared between the depression and non-depression groups. Survival analysis Kaplan-Meier method was used to compare the disease-free survival(DFS)and total survival(OS)between the two groups. Results The serum levels of CRP, hs-CRP,ALT and AST in the depression group were significantly higher than those in the non-depression group(P<0. 05). The follow-up of 3. 5-year showed that 164 patients(65 in depression group and 99 in non-depression group)had recurrence or metas-tasis and 47 patients(22 in depression group and 25 in non-depression group) died. The DFS and OS in the depression group were significantly lower than those in the non-depression group(P< 0. 05). Cox multiple regression analysis showed that liver function grading,BCLC staging and depression were independent risk factors for the prognosis of liver cancer. Spearman correlation analysis showed that patients′degree of depression was positively correlated with serum levels of CRP and hs-CRP(P<0. 05),DFS and OS were negatively correlated with serum levels of CRP and hs-CRP(P<0. 05). Conclusion Depression may mediate elevated serum levels of CRP and hs-CRP,maintain inflammatory response in patients,lead to increased liver function damage,elevate levels of ALT and AST,and thus adversely affect the prognosis of patients with liver cancer.