Research advances in transcatheter arterial chemoembolization combined with targeted agents or anti-PD-1/PD-L1 monoclonal antibody in treatment of patients with unresectable hepatocellular carcinoma / 临床肝胆病杂志

Transcatheter arterial chemoembolization (TACE) is recommended by domestic and international guidelines for the treatment of patients with unresectable hepatocellular carcinoma (uHCC), and it is one of the most common treatment methods for patients with uHCC. The chemotherapy drugs commonly used in TACE for HCC include epirubicin, cisplatin, and fluorouracil, while it is still unclear which chemotherapy drug has a better clinical effect. This article summarizes the studies of different TACE regimens using different chemotherapy drugs in the treatment of patients with uHCC in the recent five years. TACE combined with sorafenib can significantly improve the survival of patients with advanced HCC and has been recommended for the treatment of such patients by Chinese Society of Clinical Oncology guidelines, and the efficacy of TACE combined with other tyrosine kinase inhibitors (TKI) has become a research hotspot. Studies have shown that compared with TACE combined with sorafenib in the treatment of patients with advanced HCC, TACE combined with lenvatinib can achieve a significantly longer progression-free survival time and a tendency of increase in median overall survival time. However, due to the variation of target receptors or downstream signals, resistance to molecular-targeted agents is still a challenging problem. TKI combined with immune checkpoint inhibitors may be a promising strategy for the treatment of patients with uHCC. Some studies suggest that triple therapy using TACE combined with TKIs and anti-PD-1/PD-L1 monoclonal antibody has better efficacy in improving the survival of patients with uHCC. This article reviews the studies of the efficacy and safety of TACE combined with targeted agents and TACE combined with anti-PD-1/PD-L1 monoclonal antibody in the treatment of patients with uHCC in the recent five years.

Exploration on Determination and Quantity Transfer of Index Components in Benchmark Samples of Erdongtang / 中国实验方剂学杂志

ObjectiveTo establish the determination for index components in benchmark samples of Erdongtang， and clarify the content and transfer rate rages of index components in 15 batches of benchmark samples， and to explore the quantity transfer of index components of decoction pieces to benchmark samples. MethodFifteen batches of benchmark samples were prepared， the contents of mangiferin， baicalin and glycyrrhizic acid were determined by high performance liquid chromatography （HPLC）-diode array detector （DAD）， the mobile phase was acetonitrile （A）-0.1% formic acid aqueous solution （B） for gradient elution （0-10 min， 10%-17%A； 10-25 min， 17%-19%A； 25-28 min， 19%-25%A； 28-45 min， 25%-33%A； 45-46 min， 33%-45%A； 46-60 min， 45%-55%A）， detection wavelength was set at 254 nm. Contents of timosaponin BⅡ and the sum of protoneodioscin and protodioscin were determined by HPLC-evaporative light scattering detector （ELSD）， the mobile phase was acetonitrile （A）-water （B） for gradient elution （0-20 min， 24%A； 20-25 min， 24%-27%A； 25-33 min， 27%-28%A； 33-36 min， 28%-90%A； 36-41 min， 90%-24%A）. ResultThe methodological verification of the established method was good， which could be used for determination of five index components in benchmark samples. The content ranges of mangiferin， baicalin， glycyrrhizic acid， timosaponin BⅡ， and the sum of protoneodioscin and protodioscin in 15 batches of benchmark samples of Erdongtang were 0.14%-0.23%， 2.40%-3.37%， 0.07%-0.44%， 0.43%-0.95%， and 0.15%-0.47%， the transfer rate ranges of them were 33.90%-52.15%， 84.46%-105.61%， 22.59%-93.86%， 38.07%-61.43%， and 53.28%-96.11%， respectively. ConclusionThe consistencies of transfer rate of mangiferin， baicalin， timosaponin BⅡ and the sum of protoneodioscin and protodioscin （except glycyrrhizic acid） between decoction pieces and benchmark samples of Erdongtang are good， indicates that the transfer rates of 4 index components are stable during the preparation process of benchmark samples， which can provide data support for research and development of the compound preparation of this formula.

Discussion on Particle Size of Powders and Decocted Powders in Famous Classical Formulas / 中国实验方剂学杂志

Objective:Powders and decocted powders account for about 1/3 in the Catalogue of Ancient Famous Classical Formulas （the First Batch）， and have a very important position. Determination of preparation technology and particle size in the pulverization process is the key step in the research and development of powders and decocted powders following the original methods. However， there are many terms describing the preparation technology and particle size of powders and decocted powders in ancient Chinese medical books， and the parameters are not clear. Due to the lack of unified basis of particle size， the existing research results have not formed a uniform consensus. Based on ancient textual researches and experimental results， this article discusses the particle size of decocted powders and powders. Method:Through textual researches of the preparation technology and particle size of powders and decocted powders and powder classification in the 2020 edition of Chinese Pharmacopoeia， the specifications of pulverized particle size were suggested. In addition， Xiebaisan and Danggui Buxuetang were taken as examples to investigate the influence of different particle sizes （4， 10， 24 mesh） on the preparation process of decocted powders and the obtained decoction. Result:The particle size of 4 mesh was equivalent to that of ancient as big as hemp bean. The contents of index components in Xiebaisan and Danggui Buxuetang with particle size of 4 mesh were higher than that of 10 mesh and 24 mesh， but the particle size of 50 mesh was too fine to be filtered. Conclusion:The suggested particle sizes of powders and decocted powders are recommended as Cumo is the power through 10-mesh sieve， Mo is the power through 24-mesh sieve， Ximo is the power through 80-mesh sieve， as big as hemp bean is the power through 4-mesh sieve and not through 10-mesh sieve.

Identification of Decoction Pieces and Standard Decoction of Ophiopogonis Radix and Liriopes Radix by TLC / 中国实验方剂学杂志

Objective:There were 92 kinds of compound preparations containing Ophiopogonis Radix in the 2015 edition of Chinese Pharmacopoeia， but there was no effective method to identify these compound preparations. Because Ophiopogonis Radix and Liriopes Radix are similar in appearance， it is easy to be confused in application. The aim of this study was to set up a thin layer chromatography （TLC） to identify compound preparations containing Ophiopogonis Radix and distinguish Ophiopogonis Radix and Liriopes Radix in the forms of decoction pieces and standard decoction. Method:In this study， decoction pieces of Ophiopogonis Radix and Liriopes Radix were collected and separately prepared as standard decoction. TLC was used to qualitatively identify decoction pieces and standard decoction of Ophiopogonis Radix and Liriopes Radix， and compound preparations containing Ophiopogonis Radix. In the TLC， the lower solution of chloroform-methanol-water （65∶35∶10） was selected as the developing agent and 10% sulfuric acid ethanol solution as the chromogenic agent. Result:The resolution of this TLC was good. Decoction pieces， standard decoction and preparations of Ophiopogonis Radix had the same characteristic strips， which were two bright white fluorescent strips under ultraviolet lamp （365 nm）. But these two characteristic strips were not existed in the TLC of decoction pieces and standard decoction of Liriopes Radix. The corresponding components of both of these two strips were identified as mixture containing saponins by LC-MSn， including ophiopogonin Ra， Tb， ophiopogonin D'， borneol glycoside， ophiopogonin C and Liriope muscari baily saponins C. Conclusion:The established TLC method， which has significant advantages such as high specificity and sensitivity， can be applied to the characteristic identification of decoction pieces and standard decoction of Ophiopogonis Radix， the identification of compound preparations containing Ophiopogonis Radix， and the distinction of Ophiopogonis Radix and Liriopes Radix， thus serving as an effective method to qualitatively identify Ophiopogonis Radix and its compound preparations.

Analysis on Quality Evaluation Methods of Asparagi Radix Decoction Pieces and Its Standard Decoction / 中国实验方剂学杂志

Objective:To establish the quality evaluation methods of Asparagi Radix decoction pieces and its standard decoction. Method:Ten batches of Asparagi Radix standard decoction were prepared. High performance liquid chromatography-evaporative light scattering detection method (HPLC-ELSD) was established for the determination of protodioscin and protoneodioscin in Asparagi Radix decoction pieces and its standard decoction, and the fingerprint detection of Asparagi Radix decoction pieces with acetonitrile-water as mobile phase for gradient elution. UHPLC-LTQ-Orbitrap-MS/MS was used to identify ten main common peaks in the fingerprint with acetonitrile-0.1% formic acid solution as mobile phase for gradient elution, electrospray ionization (ESI) and positive and negative ion mode scanning were employed, the detection range was m/z 100-1 400. Result:The total content of protodioscin and protoneodioscin in Asparagi Radix decoction pieces was 0.41%-0.72%, and their total content in Asparagi Radix standard decoction was 0.33%-0.59%, the transfer rate of these two components was 73.6%-98.3%. The dry extract yield of the standard decoction was 59.0%-73.0%, and its pH was 4.9-5.6. There were 10 common peaks in the fingerprint, and all of them were saponins, including protoneodioscin, protodioscin, aspacochioside A and its isomer, methyl protodioscin, asparagoside F, (25R)-26-O-β-D-glucopyranosyl-furostan-5, 20-diene-3β, 26-diol-3-O-[α-L-rhamnopyranosyl (1→2)]-[β-D-glucopyranosyl (1→4)-α-L-rhamnopyranosyl (1→4)]-β-D-glucopyranoside, 26-O-β-D-glucopyranosyl-furostan-20 (22)-ene-3β, 26-diol-3-O-[α-L-rhamnopyranosyl (1→2)]-[α-L-rhamnopyranosyl (1→4)]-β-D-glucopyranoside, pseudodiosgenin, aspacochioside C. Conclusion:In this paper, the quality evaluation methods of Asparagi Radix decoction pieces and its standard decoction are established, and these methods are stable and feasible, which can provide reference for the quality control of pharmaceutical preparations containing Asparagi Radix.

Research Strategies for Quality Standards of Famous Classical Formula Based on Standard Decoction (Material Reference) / 中国实验方剂学杂志

The inheritance of traditional clinical value of famous classical formulae is an important direction for the development of traditional Chinese medicine industry.Compared with the previous research and development of new drugs, the management requirement of " material reference" was introduced into the famous classical formulae research, which is used as the reference of process optimization and quality control.The characteristics of compound preparation of famous classical formulae are also reflected in the core concept of " quality inheritance of classics" in the road of industrial development.How to implement the above requirements and concepts into product development and industrial production? There are many specific common problems to be solved in practical research.How to effectively establish the " material reference" of famous classical formulae of different dosage forms? How to use " material reference" to guide the process optimization of compound preparation of famous classical formulae? How to determine the daily dose of famous classical formulae? How to take effective measures in the selection of raw material to reduce quality fluctuation range? This paper discusses the key issues such as production process and quality evaluation from the following aspects.Firstly, the management regulations and research and development guidelines are analyzed, and the specific implementation methods are given.Then, the possible problems in the Requirements for Declaration Documents (Draft for Opinions) are pointed out, and relevant suggestions are given.Finally, based on the research experience of standard decoction and famous classical formulae in the laboratory, an example is given to provide reference for the development of compound preparation of famous classical formulae.

Status and influencing factors of outpatient and inpatient service utilization among empty-nest aging population in China / 中华医院管理杂志

Objective:To examine the status quo and influencing factors of outpatient and inpatient service utilization among empty-nest aging population in China and to provide reference for future research.Methods:A total of 3 918 empty-nest elderlies aged 60 and above were extracted from the database of China Health and Retirement Longitudinal Study which was conducted in 2015. Multivariate logistic regression was performed to analyze the influencing factors of outpatient and inpatient services utilization.Results:The four-week outpatient visit rate and the one-year hospitalization rate in empty-nest aging population was 20.80% and 18.20% respectively. Multivariate logistic regression analysis indicated that age, chronic diseases, self-rated health status, depression status and social activities were the factors influencing the four-week outpatient visit rate. Age, chronic disease, self-rated health status, activity of daily living, economic support from children and medical insurance were the factors influencing the one-year hospitalization rate.Conclusions:The four-week outpatient visit rate of empty-nest aging population in China was slightly lower than that of elderlies at large, the one-year hospitalization rate of empty-nest aging population was higher than that of elderlies at large, and the level of medical utilities by empty-nest aging population may be insufficient and its influencing factors are generally complicated, calling for further study.

The role of hypoxia-related molecules in the pathogenesis of osteoarthritis / 中华创伤骨科杂志

Osteoarthritis is one of the most common chronic diseases in orthopedics.With increasing populations of aging and obese people,its incidence has risen year by year and become a major public health problem.The hallmark of osteoarthritis is cartilage destruction,the main cause of which is degradation of extracellular matrix by catabolic enzymes and death of chondrocytes caused by apoptosis or autophagy.Articular cartilage is a hypoxic environment because it lacks blood supply and the joint cavity is relatively closed.A hypoxic environment induces chondrocytes to produce a series of hypoxia-related molecules which can regulate the expression of catabolic enzymes,autophagy and apoptosis of chondrocytes for osteoarthritis.This paper aims to review recent reports on the relationship between hypoxic-related molecules and pathogenesis of osteoarthritis and discuss the role of hypoxia-related molecules in the pathogenesis of osteoarthritis.

Research Progress on Pharmacodynamic Material Basis and Quality Control of Danggui Buxue Tang / 中国实验方剂学杂志

Danggui Buxue Tang(DBT) is a famous classical formula of traditional Chinese medicine(TCM) for invigorating Qi and activating blood circulation.It is composed of Angelicae Sinensis Radix and Astragali Radix.It has the effect of enriching blood,invigorating Qi and regulating immunity,and has a high application value in clinical treatment.Because of its definite curative effect and simple compatibility,it has become a hot spot in the research field of TCM.This paper summarized and analyzed the research status of DBT from the pharmacological action,pharmacodynamic material basis,pharmacokinetics,quality control,compatibility and decoction process,so as to provide reference for the development of DBT and formulating its quality standard.

Some thoughts on health food formulated with traditional Chinese medicine / 中国中药杂志

The health food industry is an important support for the big health industry and the strategy of healthy China. The Chinese medicine prescription health food has exceeded 60% of the total declared health food. However,the main basis for its function evaluation,the Technical Specification for Inspection and Evaluation of Health Food,was abolished in 2018,and 27 of them were based on modern medical and nutritional theories. Quantitative efficacy evaluation methods in western pharmacology are short of function claims and function evaluation methods reflecting the characteristics of traditional Chinese medicine,which could affect the health food industry to a certain extent. Therefore,the establishment of the evaluation mechanism of Chinese medicine prescription health food which conforms to the positioning of health food and the theory of traditional Chinese medicine is helpful for the healthy development of health food industry. In this paper,this problem was explained from five aspects. First,how to differentiate the positioning of Chinese medicine prescription health food from ordinary food and medicine,and how to embody the characteristics of Chinese medicine. Secondly,the relationship between traditional Chinese medicine prescription health food and Chinese patent medicine. Thirdly,how to scientifically and reasonably determine the raw materials of traditional Chinese medicine prescription health food. Fourthly,how to explain the function claim of traditional Chinese medicine prescription health food,and how to evaluate its function scientifically and reasonably. Fifthly,the functional evaluation of Chinese herbal medicine prescription health food is connected with other national scientific and technological strategies. In this paper,a preliminary analysis of the Chinese medicine prescription health food was conducted from the above five aspects,and some personal views and suggestions were put forward,hoping to provide reference for the competent authorities and researchers.

Current situation and research strategy of quality control of health food containing Chinese materia medica / 中国中药杂志

Health food containing Chinese materia medica has many advantages in health preservation and reducing the risk of disease occurrence,which meets people's demands for " great health" and " preventive treatment of disease". However,due to its complex ingredients,diverse quality of raw materials,as well as the vagueness and lack of integrity for existing quality standards,chaos is caused in the health food market,which restricts its healthy development and also poses new challenges to the quality control of healthy food. At present,the total component content or single component content is determined in most functional/marker component examinations. Safety and microbial detection methods fail to cover the contamination range of the raw materials of Chinese materia medica.Therefore,it is impossible to meet the purpose of ensuring authenticity,safety and efficacy. In recent years,a lot of Chinese materia medica extracts have been used as raw materials for food products,but many extracts lack standards. The author believes that the quality control of health food containing Chinese materia medicas should start with the quality control of Chinese materia medica extracts. In this way,product quality is controlled from source to ensure product consistency; secondly,the overall quality control should be strengthened to ensure the authenticity of the products; the scope of safety inspection shall be expanded to fundamentally ensure the safety of products. At the same time,we should strengthen the quality control of whole process and strengthen the overall quality control of raw materials to produce health food of high quality.

Short-Term Clinical Response of DEB-TACE Combined with Apatinib on Patient with Intermediate-advanced Hepatocellular Carcinoma / 中山大学学报(医学科学版)

@#【Objective】To evaluate the safety and effects of transcatheter arterial chemoembolization using Drug-eluted beads（DEB-TACE）plus apatinib in patients with hepatocellular carcinoma（HCC）.【Methods】A retrospective analysis was performed，which included 11 HCC patients treated with DEB- TACE and followed by a target therapy of apatinib（500 mg QD）in our clinical research center. Radiograph evaluation and tumor biomarker，alpha- fetoprotein（AFP）， were recorded before the procedure and during the follow-up of the first cycle after 4~8 weeks. Adverse events induced by apatinib were recorded. 【Results】 According to the response evaluation criteria in solid tumors （RECIST），modified response evaluation criteria in solid tumors （mRECIST） and European Association for the study of the liver （EASL） criteria，the objective response rate （ORR） was 36.4% ，63.6% ，72.7% respectively，and the disease control rate（DCR）was 90.7% ，72.7% ，81.8% respectively. AFP levels were 44 251.7 μg/L which significantly decreased after the procedure ，compared to 366 336 μ g/L ，the levels before the treatment. Four reversible grade III adverse events were recorded and no grade IV adverse events found in these cases. 【Conclusion】According to the short-term treatment response and safety，DEB- TACE combined with apatinib could be considered as a promising treatment for intermediate and advanced stage hepatoma.

Efficacy of suprapatellar versus infrapatellar approach in tibial intramedullary nail fixation for tibial fracture:a systematic review and meta-analysis / 中华创伤杂志

Objective To investigate the efficacy of suprapatellar versus infrapatellar approach in tibial intramedullary nail fixation for tibial fracture. Methods Clinical trials that evaluated suprapatellar approach and infrapatellar approach for tibia intramedullary nailing fixation were searched in PubMed, EMBASE, Cochrane Central Register of Controlled Trials ( CENTRAL ) , Chinese Biology Medicine ( CBM) , Wanfang, Weipu and CNKI databases. Methodological qualities of the included studies were assessed using the Cochrane Collaboration tool and Newcastle-Ottawa Scale. Sensitivity analyses were performed to determine whether overall results were reliable. Publication bias was detected using Begg's test and Egger's test. Lysholm score, reoperation rate, Hospital for Special Surgery ( HSS ) score, operation time, intraoperative blood loss and hospital stay were selected to evaluate the clinical effect of suprapatellar approach and infrapatellar approach in tibial intramedullary nail fixation for tibial fracture. Results Two randomized controlled trials and six case-controlled studies involving 787 patients were included in the analysis. Sensitivity analyses indicated that the results were statistically significant. No significant publication bias was detected by Begg's test or Egger's test. Our meta-analysis indicated that suprapatellar approach had significantly higher Lysholm score ( MD=1. 04, 95％CI 0. 82 -1. 26, P<0. 05, I2 =10. 5％) and HSS score ( MD =0. 97, 95％CI 0. 65 -1. 30, P <0. 05, I2 =0 ) than infrapatellar approach ( P <0. 05 ) . Additionally, there were no statistical differences between the two procedures in reoperation rate, operation time, intraoperative blood loss and hospital stay (P>0. 05). Conclusion Compared with infrapatellar approach, suprapatellar approach in intramedullary nail fixation for tibial fracture can better relieve the pain, keep stability and motion of the knee joint and promote function recovery of knee joint.

Quality evaluation of Rhei Radix et Rhizoma decoction / 中国中药杂志

Decoction of single medicinal herb is a reference for the standardization of different dosage forms of Chinese medicine and it provides a new direction for solving the problems existing in the quality of Chinese medicinal granules such as no uniform dosage form and no clear quality standard. In this paper, the quality evaluation method of standard decoction of rhubarb was established to provide reference for the quality control of common dosage forms such as clinical decoction and formula granule. 10 batches of representative Rhei Radix et Rhizoma were collected to establish UPLC fingerprints were established. The chemical structures of main peaks were identified with ultra-performance liquid chromatography with quadrupole-time-of-flight mass spectrometry (UPLC-Q-TOF-MS) and the main components in the decoction were Anthraquinones. The extraction ratio of the standard decoction was (28.1±3.8)% and the transfer rate was (19.9±6.3)%. The method for the quality evaluation of standard decoction of Rhei Radix et Rhizoma was established in this study, providing reference for the quality control method of terminal products from decoction of Rhei Radix et Rhizoma.

Quality evaluation of medicinal herb decoction--Forsythiae Fructus / 中国中药杂志

To establish the quality control methods for the standard decoction of Forsythiae Fructus. Twelve batches of representative Forsythiae Fructus were collected to prepare standard decoction of Forsythiae Fructus, and then the parameters such as extraction ratio, transfer rate of the index components and pH value of the solution were calculated to evaluate the stability of the process. The simultaneous determination method of target components and fingerprint method were established, and ultra performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) was used to identify the main common peaks in the fingerprint to clarify the main chemical constituents in the decoction. The similarities of the fingerprints of standard decoction of Forsythiae Fructus were more than 0.9. The average extraction ratio of the standard decoction of Forsythiae Fructus was (15.53±6.27)%, and the transfer rate of forsythiaside A was(38.0±10.2)%. The method for evaluating the quality of standard decoction of Forsythiae Fructus was presented, providing reference for the quality control of products stemmed from the water extract of Forsythiae Fructus, with high similarity and uniform quality.

ROCCIPI Analysis of Tianchang County's New Rural Cooperative Global Per Capita Budget Reform in the County's Healthcare Alliance / 中国医院管理

Based on the literature research and ROCCIPI framework,the paper analyzes Tianchang County's New Rural Cooperative global per capita budget reform under the context of the county's healthcare alliance from the perspectives of the policy content,opportunity of development,motivation,process and capacity and the cognition of stakeholders in relevant.In addition,the dissection of the factors and conditions,as well as the latent problems and the corresponding recommendations of the reform,is put forward.

Study on evaluation framework of integrated health care system / 中国卫生政策研究

Objective:The aim of this study is to establish an evaluation framework for an integrated health care service system,which provides evidence for the further construction of the evaluation index system. Methods:A sys-tematic review,thematic system and expert consultation were synthetically used to screen,construct and improve the evaluation framework of the integrated health care service system. Results:The results of this study show that the fi-nalized evaluation framework of the integrated health care system contains 4 first-level indexes which include system integration,organizational integration,professional integration and service integration; and 25 corresponding second level indictors. Conclusions:The evaluation framework of the integrated health care service system constructed in this study has a strong effectiveness and suitability, which lays a good foundation for further development of the corre-sponding evaluation index system.

Phosphorylcholine Oligomer-Grafted Graphene Oxide for the Transcatheter Arterial Chemoembolization of Liver Cancer / 中山大学学报(医学科学版)

[Objective]To investigate the safety and efficacy of phosphorylcholine oligomer grafted graphene oxide as a drug carrier for transcatheter arterial chemoembolization in the treatment of liver cancer.[Methods]Doxorubicin loaded folic acid labeled phosphorylcholine oligomer grafted graphene oxide(DOX@GO-PCn-FA)was prepared. Graphene ox-ide(GO)and DOX@GO-PCn-FA were injected intravenously via marginal ear vein in New Zealand white rabbits respec-tively to assess their safety and biodistribution for intravenous administration.Ten male New Zealand rabbits were used to establishe the VX2 liver cancer model and the tumor characteristics were confirmed by dynamic contrast enhanced CT scan.Catheter was inserted via femoral artery and advanced into hepatic lobar or segmental artery.Digital subtraction angi-ography(DSA)was performed to validate the tumor feeding vessels.DOX@GO-PCn-FA was injected through the cathe-ter to carry out selective transcatheter arterial chemoembolization(TACE). Dynamic enhanced CT scan and pathological examinations of major tissues and organs were implemented 7 days post TACE to evaluate the efficacy of embolization effect of DOX@GO-PCn-FA against liver tumor as well as the biodistribution and safety.[Results]Intravenous injection of GO resulted in significant thrombosis and pulmonary embolism whereas DOX@GO-PCn-FA of same dosage did not. DOX@GO-PCn-FA was capable of effectively diminishing the blood supply of liver tumors when applied in TACE. Pathologic exploration revealed that DOX@ GO-PCn-FA mainly deposited in the tumor,and no obvious complications were observed.[Conclusions]GO-PCn presented superior biocompatibility and exerted effective chemoembolization against liver cancer.

Clinical outcome of bone cement-augmented pedicle screw fixation for thoracolumbar refractures after percutaneous kyphoplasty / 中华创伤杂志

Objective To investigate the clinical therapeutic effects of bone cement-augmented pedicle screw fixation for cement vertebrae refractures with lower limb neurological symptoms after percutaneous kyphoplasty (PKP) in elderly patients with osteoporotic thoracolumbar compression fractures.Methods A total of 123 elderly patients with osteoporotic thoracolumbar compression fractures underwent PKP from December 2013 to December 2016 were retrospectively analyzed by case series study.Twelve patients had vertebral refracture with compression of the spinal cord or cauda equina which resulted in lumbosacral and leg pain,numbness and disability of ambulation and there were five males and seven females,with age of (69.2 ± 7.1) years.Injured vertebrae was located at T12 in five cases,at L1 in five and at L2 in two.Bone cement-augmented pedicle screw fixation through a standard posterior approach was utilized to treat all the 12 patients.Visual analogue scale (VAS),Oswestry disability index (ODI),anterior vertebral height compression ratio,and kyphotic angle at the preoperative time,one week postoperatively and last follow-up were recorded and compared.Intraoperative and postoperative complications were also recorded.Results The mean duration of follow-up in all the patients was 26.7 months (range,12-36 months).Intraoperative nerve injury,dural tear,leakage of bone cement,bone cement toxicity reaction,and pulmonary embolism were not observed during the surgery.The postoperative radiographs for all the 12 patients showed that the bone cement was distributed in cancellous bone and around the screw appropriately where there was no cement leakage out of the vertebral body or pedicle.Compared with preoperative scores,the average low back pain VAS,leg pain VAS and ODI at postoperative one week were improved by (2.2 ± 0.7) points,(2.2 ± 0.4) points and (33.2 ± 8.9) points,respectively (P ＜ 0.01).Anterior vertebral height compression ratio was decreased from preoperative (71.5 ± 11.7) ％ to (18.7 ± 10.3) ％ at postoperative one week (P ＜ 0.01).The mean kyphotic angle was corrected from preoperative (28.3 ± 7.6) ° to (7.1 ± 2.3) ° at postoperative one week (P ＜ 0.01).The symptoms of lumbar pain,and numbness and weakness of lower limbs were improved significantly.There was no statistically significant difference of all the parameters between the last follow-up evaluation and one week post-operatively (P ＞ 0.05).Conclusion For elderly patients with spinal cord or cauda equina nerve compression symptoms after PKP for osteoporotic thoracolumbar compression fractures,the usage of posterior approach bone cement-augmented pedicle screw fixation can effectively correct kyphosis,relieve neurological symptoms and restore spinal stability.

Analysis on the Practice of Health Care Alliance Reform in Tianchang County of Anhui / 中国卫生经济

The health care alliance in county was the vertical integration of medical service system,which was conductive to improve the overall efficiency of the county medical service,achieve tiered health care system,optimize regional health resources and enhance the capacity of primary health care services.It took Tianchang County,Anhui as a case study.It investigated and analyzed how the local took measures to carry out the health care alliance reform in organization structure,interest distribution,health human resources construction,information construction,division and coordination mechanism,medical service pattern,etc.,so as to provide references for implementing county medical alliance reform in other regions.