OBJECTIVE To explore and establish a full-cycle management model for drug traceability codes that aligns with national policy requirements and the practical needs of healthcare institutions， thereby enhancing the refinement of drug management and the level of medication safety. METHODS A tripartite strategy integrating “hardware deployment， system transformation， and process re-engineering” was adopted. This involved the introduction of intelligent identification devices （personal digital assistant， high-definition industrial reader）， the modification of the hospital information system interface， and the re-engineering of workflows （drug warehousing， dispensing and distribution， drug withdrawal， uploading to the insurance platform） to achieve comprehensive， informatized collection and association of drug traceability codes throughout all stages. RESULTS A full-cycle management model for drug traceability codes was successfully established， realizing the goals of making drugs “traceable to their source， trackable in their distribution， and accountable in their responsibility”. The patient waiting time for medication dispensing before and after the implementation was [3.08（1.67，5.58）] min and [3.28（1.77，5.98）] min， respectively. Among them， the patient waiting time under the pre-preparation mode was [3.60（2.13，6.35）] min and [3.50（2.03，6.30）] min， respectively； the patient waiting time under the real-time mode was [2.05（0.83，4.03）] min and [2.78（1.18，5.38）] min， respectively； the number of dispensing errors was 3， 0， respectively； the staffing of relevant positions had not been increased. CONCLUSIONS The drug traceability code management model constructed from a full-cycle perspective effectively meets national policy requirements. It provides data support for refined hospital management and offers solid technical and procedural safeguards for ensuring patient medication safety and strengthening medical insurance fund supervision， demonstrating practical value.

Metastatic dissemination is the major cause of death from breast-cancer (BC). Fusobacterium nucleatum (F.n) is widely enriched in BC and has recently been identified as one of the high-risk factors for promoting BC metastasis. Here, with an experimental model, we demonstrated that intratumoral F.n induced BC aggressiveness by transcriptionally activating Epithelial-mesenchymal transition-associated genes. Therefore, the F.n may be a potential target to prevent metastasis. Given the fact that cancer-associated fibroblasts (CAFs) are abundant in BC and located near blood vessels, we report an optogenetic system that drives CAF to in situ produce human antibacterial peptide LL37, with the characteristics of biosafety and freely intercellular trafficking, for depleting intratumoral F.n, leading to a 72.1% reduction in lung metastatic nodules number without affecting the balance of the systemic flora. Notably, mild photothermal treatment was found that could normalize CAF, contributing to synergistically inhibiting BC metastasis. In addition, the system can also simultaneously encode a gene of TNF-related apoptosis-inducing ligand to suppress the primary tumor. Together, our study highlights the potential of local elimination of tumor pathogenic bacteria to prevent BC metastasis.

Objective:To study the application effect of perioperative management based on enhanced recovery after surgery(ERAS)philosophy in the robot-assisted surgery for thoracolumbar fracture.Methods:This was a prospective random control trial(RCT).A total of 80 patients with thoracolumbar fracture admitted to Jiangsu Provincial People's Hospital from January 2020 to January 2025 were selected.They were divided into control group and ERAS group according to random number method,with 40 cases in each group.All of them adopted robot-assisted surgery for thoracolumbar fracture as the main therapeutic scheme.After surgery,the control group adopted routine perioperative management,and the ERAS group adopted perioperative management based on the ERAS philosophy.The postoperative recovery time of physiological function(the time for removing urinary catheter,time for eating,time for exhaling,time for getting out of bed,and length of hospital stay)between two groups were compared.The self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were applied to assess the levels of anxiety and depression of the patients in two groups before surgery and at the 1st d,5th d and 7th d after surgery.In addition,the pain score of visual analogue scale(VAS),the incidence of postoperative complication,the scores of psychological state before and at the 7th day after surgery,and patient's satisfaction for diagnosis and treatment during the length of hospital stay as the evaluation of Nursing Scale for Nursing Staff(NSNS)before discharge were compared between the two groups.Results:The time for removing urinary catheter,time for eating,time for exhaling,time for getting out of bed,and length of hospital stay of ERAS group were shorter than those of control group,and the differences were significant(t=3.508,9.171,5.423,10.983,6.675,P<0.05).Before surgery,there were not significant differences in VAS score,SAS score and SDS score between the two groups(P>0.05).The VAS scores at the 1st d,5th d and 7th d after surgery in ERAS group were significantly lower than those in control group(t=5.433,5.882,5.060,P<0.05).At the 7th d after surgery,the scores of SAS and SDS in ERAS group significantly decreased,which were significantly lower than those in control group(t=14.327,13.390,P<0.05).The incidence of postoperative complications in ERAS group was 7.50%(3/40),which was lower than 32.50%(13/40)in control group(x2=7.812,P<0.05).Satisfaction of patients in ERAS group was 95.00%,which was significantly higher than 77.50%in control group(x2=5.165,P<0.05).Conclusion:The perioperative management based on ERAS philosophy can contribute to promote the recovery of postoperatively physiological function,and relieve postoperative pain,and improve postoperatively negative emotional state,and reduce the incidence of postoperative complications,and enhance patient's satisfaction.

Objective:To investigate the causes and management strategies of anesthetic complications during percutaneous spinal endoscopic surgery under local anesthesia.Methods:A total of 16 800 patients (8 625 males and 8 175 females) who underwent percutaneous spinal endoscopic surgery under local anesthesia (including intravenous basic anesthesia) in Tianjin Hospital, Shandong Public Health Clinical Center and Hebei General Hospital from February 2012 to February 2023 were retrospectively analyzed. The average age was 45.3±21.6 years (range, 12-84 years). There were 220 cases of posterior cervical keyhole endoscopic surgery, 50 cases of thoracic transforaminal endoscopic surgery, 70 cases of thoracic posterior interlaminar endoscopic surgery, 11 670 cases of lumbar transforaminal endoscopic surgery, and 4 790 cases of lumbar posterior interlaminar endoscopic surgery. The occurrence time, clinical manifestations, management of intraoperative anesthesia complications were recorded, as well as surgical segments, puncture sites, complication symptoms, signs, outcome and prognosis.Results:All patients received percutaneous water-mediated uniaxial spinal endoscopic surgery under local anesthesia. There were 9 patients experienced anesthesia complications, including 6 cases of epidural diffusion of anesthetics and 3 cases of anesthetics mistakenly entering the subarachnoid space. There were 4 males and 5 females, aged 48.4±18.2 years (range, 28-84 years). There were 1 case of T 12L 1 disc herniation, 1 case of C 5-6 disc herniation, 3 cases of L 4-5 disc herniation and 4 cases of L 5S 1 disc herniation. Surgical segments and procedures: 1 case of C 5-6 posterior Keyhole endoscopic surgery, 1 case of T 12L 1 transforaminal endoscopic surgery, 2 cases of L 4-5 transforaminal endoscopic surgery, 1 case of L 4-5 interlaminar endoscopic surgery, and 4 cases of L 5S 1 interlaminar endoscopic surgery. Anesthesia complications all appeared 5-10 min after injection of local anesthetics, with symptoms of decreased oxygen saturation, decreased blood pressure, altered consciousness, and sensory and motor dysfunction of limbs. 6 patients with epidural diffusion of anesthetics recovered completely after symptomatic treatment in 5 cases, and 1 case was left with foot drop. Three patients with anesthetics mistakenly entering the subarachnoid space were immediately converted to the supine position, of which one recovered by mask oxygenation; 1 patient improved after emergency tracheal intubation, rehydration, and application of vasoconstrictive medications; and 1 patient developed multiple complications such as multiorgan failure, rhabdomyolysis, and sepsis after tracheal intubation, and recovered at 3 months after surgery with symptomatic treatment. Conclusions:Epidural diffusion and entering into subarachnoid space of anesthetics are serious complications of local anesthesia in percutaneous spinal endoscopic surgery. In addition to sensory and motor dysfunction of the limbs, the functions of the respiratory and circulatory systems can also be affected. It is necessary to be alert to the occurrence of anesthesia-related complications during operation and early identification and treatment.

Primary hyperparathyroidism(PHPT) is a relatively common endocrine disorder in clinical practice. While the diagnosis and characterization of this condition are straightforward, cases with negative 99Tc m-methoxyisobutylisonitrile( 99Tc m-MIBI) imaging often complicates lesion localization, posing a clinical challenge in determining whether surgical intervention is warranted. This paper presents two cases of PHPT with negative 99Tc m-MIBI imaging, both diagnosed with papillary thyroid carcinoma(PTC). Following bilateral neck exploration, the surgeons successfully localized and excised the hyperparathyroid lesions and provided appropriate treatment for PTC. Postoperative follow-up indicated favorable recovery in both patients. This article aims to dive deeply into the necessity of surgical intervention and enhance clinical management of these cases.

Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) induced by anti-thyroid drugs has been reported occasionally, but methimazole-induced AAV is not as frequently reported. This case report described a 54-year-old male who developed AAV and multiple organ failure after more than 20 days of methimazole treatment. After timely discontinuation of the disease-causing drug methimazole, the patient received methylprednisolone shock, cyclophosphamide immunosuppression, renal replacement therapy, and other supportive treatments, and the disease was alleviated without recurrence.

Objective To investigate the changes and clinical significance of synovial fluid Asporin level in patients with tem-poromandibular joint disorders(TMD).Methods A total of 48 TMD patients who were treated in our hospital from January 2021 to December 2023 due to irritant pain and mouth opening limitation were randomly selected as the observation group,and 48 healthy vol-unteers were selected as the control group.The synovial fluid Asporin levels of the two groups were detected by enzyme-linked immu-nosorbent assay(ELISA).The difference of synovial fluid Asporin levels between the two groups was compared.The correlation be-tween the synovial fluid Asporin levels and the clinical symptoms of TMD was analyzed.Results The synovial fluid Asporin level in the experimental group was significantly higher than that in the control group(P＜0.05).The synovial fluid Asporin level was positively correlated with the pain degree of TMD patients(Rs=0.825,P＜0.001),negatively correlated with the degree of mouth opening(Rs=-0.945,P＜0.001).Conclusion The level of Asporin in synovial fluid of TMD patients was significantly increased.The level of As-porin in synovial fluid of TMD patients is correlated with the clinical symptoms of TMD,which provides a basis for the diagnosis and evaluation of TMD.

Objective To investigate the guiding value and safety of three tracers in identifying sentinel lymph nodes(SLN)for lymph node dissection during radical surgery for early-stage cervical cancer.Methods A total of 114 patients with early-stage cervical cancer from January 2021 to No-vember 2022 were selected as the study subjects.They were randomly divided into methylene blue group,nano-carbon group,and indocyanine green(ICG)group according to the random number ta-ble method,with 38 cases in each group.All three groups underwent radical surgery.The methylene blue group used methylene blue for SLN identification during surgery,the nano-carbon group used nano-carbon,and the ICG group used ICG fluorescence imaging.The SLN identification status and surgery-related indicators were compared among the three groups.Trauma indicators[serum cortisol(Cor),epinephrine(E),adrenocorticotropic hormone(ACTH),and C-reactive protein(CRP)]were compared among the three groups before surgery and on 1,3,and 7 d after surgery.Tumor markers[carcinoembryonic antigen(CEA),alpha-fetoprotein(AFP),carbohydrate antigen 125(CA125),and carbohydrate antigen 199(CA199)]were compared among the three groups before surgery and 3 months after surgery.The complication rates and recurrence rates were also compared among the three groups.Results The tracing time in the ICG group was shorter than that in the nano-carbon and methylene blue groups,and the tracing time in the nano-carbon group was shorter than that in the methylene blue group(P＜0.05).In terms of the success rate and number of identified SLN,the nano-carbon group was higher than the ICG and methylene blue groups,and the ICG group was higher than the methylene blue group(P＜0.05).Regarding the SLN resection time,the nano-car-bon group had the shortest time,and the methylene blue group had the longest time,with a statisti-cally significant difference(P＜0.05).The serum levels of CEA,AFP,CA125,and CA199 in the three groups decreased significantly 3 months after surgery compared with those before surgery(P＜0.05).The within-group effects of one-way repeated-measures analysis of variance showed that the serum levels of Cor,E,ACTH,and CRP in the three groups increased first and then decreased on 1,3,and 7 d,with statistically significant differences(P＜0.05).There was no statistically signif-icant difference in the complication rates among the three groups(P＞0.05).During the 1-year fol-low-up,2 patients were lost during follow-up in the nano-carbon group,1 in the ICG group,and 2 in the methylene blue group.No recurrence was found in any of the three groups.Conclusion Among the three tracers,ICG has the shortest time for tracing SLN during radical surgery for early-stage cer-vical cancer.Nano-carbon exhibits relatively high application value compared with the other two tracers,and it guides the scope of lymph node dissection and demonstrates certain safety.

Objective: To establish a method for determining the molecular weight and molecular weight distribution of Poly(Lactide-co-Glycolide Acid) (PLGA) using Size Exclusion Chromatography-Refractive Index-Multiangle Laser Light Scattering (SEC-RI-MALLS) and Size Exclusion Chromatography-Refractive Index (SEC-RID), and to compare the results obtained from these two methods.
Methods: For SEC-RI-MALLS, tetrahydrofuran was used as the mobile phase, Shodex GPC KF-803L was employed as the chromatographic column with a flow rate of 1 mL·min^-1, column temperature at 30 ℃, and an injection volume of 100 μL. For SEC-RID, tetrahydrofuran was also used as the mobile phase, Agilent PLgel 5 μm MIXD-D was used as the chromatographic column with a flow rate of 1 mL·min^-1, column temperature at 30 ℃, differential detector temperature at 35 ℃, and an injection volume of 20 μL. The molecular weight and molecular weight distribution were calculated using Agilent’s GPC software. The newly established methods were validated methodologically, and the molecular weight and molecular weight distribution of 13 batches of samples were determined.
Results: The precision, accuracy, stability, and repeatability tests for SEC-RI-MALLS showed RSD values of 1.35%, 1.58%, 1.53%, and 1.26%, respectively. The SEC-RID method exhibited good linearity (r=0.999 9), with RSD values for precision, accuracy, stability, and repeatability tests (n=6) of 2.05%, 1.62%, 1.30%, and 2.97%, respectively. The results obtained from SEC-RI-MALLS were lower than those from SEC-RID, and the molecular weight distribution coefficient was smaller, but the results from the paired T-test performed with the value measured by SEC-RID method and the value measured by SEC-RI-MALLS method multiplied a conversion coefficient of 1.5 showed no significant difference between the two methods.
Conclusion: Both methods are stable and reliable, and can be used for the determination of PLGA molecular weight and molecular weight distribution based on the specific situations.

Objective To systematically review the risk factors for liver injury in breast cancer patients after chemotherapy.Methods PubMed,Cochrane Library,Embase,Web of Science,CNKI,SinoMed,WanFang Data and VIP databases were electronically searched to collect studies on the influential factors of liver injury in breast cancer patients from inception to March 31,2024.Two reviewers independently screened the literature,extracted data and evaluated the risk of bias of the included studies.Meta-analysis was performed by using RevMan 5.3 software.Results A total of 15 studies involving 6,486 patients were included.The results of Meta-analysis showed that hepatitis B virus infection[OR=2.41,95％CI(1.52,3.82),P＜0.001],lymph node metastasis[OR=1.27,95％CI(1.05,1.55),P=0.02],hyperlipidemia[OR=1.58,95％CI(1.13,2.20)P=0.007],liver metastasis[OR=3.19,95％CI(2.11,4.84),P＜0.001],tumor node metastasis(TNM)stage Ⅲ to Ⅳ[OR=1.49,95％CI(1.17,1.90),P＜0.001],were risk factors for liver injury after breast cancer chemotherapy.Compared with other chemotherapy agents/regimens,the use of fluorouracil[OR=0.58,95％CI(0.42,0.80),P＜0.001],cyclophosphamide[OR=0.65,95％CI(0.47,0.89),P=0.008],AC regimen[OR=0.38,95％CI(0.22,0.66),P＜0.00 1]and neoadjuvant chemotherapy[OR=0.61,95％CI(0.43,0.88),P=0.007]were associated with a lower risk of liver injury,the use of paclitaxel drugs[OR=2.85,95％CI(2.31,3.52),P＜0.001],intensive regimen[OR=3.48,95％CI(2.15,5.62),P＜0.001],TAC regimen[OR=2.42,95％CI(1.38,4.24),P=0.002]increased the risk of liver injury.Tumor TNM stage I[OR=0.63,95％CI(0.51,0.78),P=0.001]were protective factors for liver injury after chemotherapy in breast cancer patients.Conclusion The current evidence shows that multiple factors influence the incidence of liver injury after breast cancer chemotherapy.Medical staff can formulate targeted chemotherapy programs according to the influencing factors and clinical characteristics to reduce the risk of liver injury after chemotherapy.