Spine is a common site of metastasis in patients with malignant tumors, and tumor metastasis to the spine can lead to pain, pathological fractures, and nerve compression. In order to optimize the diagnosis and management of patients with spinal metastases and metastatic spinal cord compression (MSCC), the National Institute for Health and Care Excellence (NICE) in the UK proposed the first diagnostic and treatment guidelines for patients with MSCC (or at risk of MSCC) in 2008. In recent years, with the rapid advancement of spinal surgery and radiotherapy technology, the standardized process of MSCC diagnosis and treatment urgently needs to be updated. In 2023, NICE launched new guidelines for spinal metastases and MSCC. Based on a thorough study of the guidelines, this article discusses and interprets pain management, corticosteroid treatment, application of bisphosphonates and denosumab, tools for assessing spinal stability and prognosis, radiation therapy, surgical timing and approach, etc., providing reference for clinical diagnosis and treatment in China.
ObjectiveTo investigate the role of Peptidase domain containing associated with muscle regeneration 1 (PAMR1) in the proliferation, migration, and prognosis of hepatocellular carcinoma (HCC) through cellular experiments and clinical sample validation. Methods① Bioinformatics analysis was performed on datasets from the GEO public database to identify and screen for key genes, ultimately selecting PAMR1 for further study. Findings were validated using data from the TCGA database and six primary HCC surgical specimens prospectively obtained from the Army Characteristic Medical Center of Army Medical University from February 2024 to June 2024. ② PAMR1-overexpressing cell lines were established using HCC cell lines Huh7 and Lm3. Cells were transfected with either the recombinant plasmid pcDNA3.1(+)-PAMR1 as overexpression group or the empty vector pcDNA3.1(+) as negative control group. The effects of PAMR1 on HCC cell proliferation and migration were assessed using the Cell Counting Kit-8 (CCK-8) assay and wound healing assay, respectively. ③ Pathological specimens and clinical data were retrospectively collected from 61 patients with primary HCC who underwent surgical resection at the Army Characteristic Medical Center of Army Medical University between May 2019 and April 2020. The impact of PAMR1 expression on disease-free survival was evaluated. Results① PAMR1 was identified as a candidate gene through GEO database screening and was found to be downregulated in HCC tissues based on both TCGA data and the six HCC surgical specimens. ② The CCK-8 assay revealed that cell proliferation was significantly inhibited in the PAMR1 overexpression group compared to the negative control group (P<0.05). Similarly, the wound healing assay demonstrated reduced migratory capability in PAMR1 overexpression group (P<0.05). ③ Multivariate cox proportional hazards regression analysis of patient data indicated that high PAMR1 expression serves as an independent protective factor for disease-free survival in HCC (HR= 0.335, P=0.026). ConclusionPAMR1 serves as a crucial gene in HCC, high PAMR1 expression can significantly suppressing tumor cell proliferation and migration and indicates a favorable prognosis.
Objective To systematically review the effect of discontinuous warfarin on the risk of postoperative bleeding complications after tooth extractions. Methods PubMed, EMbase, The Cochrane Library (Issue 9, 2016), CNKI, VIP, WanFang Data, China Food and Drug Administration and the ADR supervision system of FDA were electronically searched to collect randomized controlled trials (RCTs) and cohort studies about the effect of discontinuous warfarin on risk of postoperative bleeding complications after tooth extractions in patients until September 30th, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 8 studies were included, involving 3 RCTs and 5 cohort studies. The results of meta-analysis showed that: there was no significant difference between the discontinuous or reduced warfarin group and the continuous warfarin group (RCTs: RR=0.86, 95%CI 0.49 to 1.51,P=0.60; cohort studies: RR=0.67, 95%CI 0.45 to 1.01,P=0.06). Conclusions Current evidence indicates that there is no statistically significant correlation between whether discontinuous warfarin and the risk of postoperative bleeding complications after tooth extractions. Due to the limited quantity and quality of included studies, the above conclusions are needed to be further verified by more high quality studies.
Objective
To analyze the causes of drug dispensing errors and reduce the error rate through scientific precautions, and improve the quality of pharmaceutical service.
Methods
According to the PDCA cycle, existing problems were found in dispensing between January and June 2013, and the causes were analyzed. Then, from July 2013, strategies were developed to decrease the dispensing error rate. The variation trend of dispensing error rate from January 2013 to June 2017 were observed.
Result
The dispensing error rate decreased since the beginning of PDCA cycle, from 0.042‰ (the first quarter of 2013) to 0.003‰ (the second quarter of 2017).
Conclusion
The PDCA cycle is an effective intervention to detect the errors during drug delivery in inpatient pharmacy, which could improve the quality of pharmaceutical service and insure the patients’ safety.
