Objective To investigate the executive condition of Enhanced Recovery After Surgery(ERAS)measures among the hospitalized surgical patients in secondary and tertiary medical institutions of Chongqing City.Methods Using a multicenter cross-sectional survey approach,patients undergoing elective surgeries admitted and treated in 40 member units under the Chongqing Anesthesiology and Perioperative Medicine Specialized Alliance from July 11 to 30,2024 were selected as the survey subjects.Adherence to and completion of ERAS measures were calculated.Factors influencing measures with low completion rates were analyzed.Results A total of 2 100 questionnaires were issued,1 708 effective questionnaires were recovered with an effective recovery rate of 81.33％.Among them,there were 1 017 questionnaires in the tertiary medi-cal institutions and 691 questionnaires in the secondary medical institutions.The age of 1 708 patients ranged from 19-78 years old with a median age of 52 years old.Females were dominant.The proportion of patients from gastrointestinal surgery and those with secondary school education or above was high.Hypertension and diabetes were the main complication types.The surgical grade was concentrated at grades Ⅲ and Ⅳ.The ASA grading was concentrated at the grade Ⅰ/Ⅱ.The NYHA heart function grade was mainly the grade Ⅰ/Ⅱ.The ERAS measures compliance rate ranged from 36.36％to 95.45％,averaged 73.47％.The compliance rate of ERAS measures in the tertiary hospitals was higher than that in the secondary hospitals(75.82％vs.70.01％),and the difference was statistically significant(P<0.05).The average completion rate of ERAS measures was 74.08％.The top three in the completion rate were preoperative education(95.78％),preven-tive antibiotics and skin preparation(92.62％),and preoperative interview and evaluation(88.58％).The completion rates of Prehabilitation(55.27％)and preoperative fasting(57.67％)urgently needed to be in-creased.The completion rate of other measures was lower than 60％.Conclusion The compliance rate of ERAS measures needs to be increased,moreover there are significant differences among various hospitals.Fu-ture practices should focus on two measures:preoperative pre-rehabilitation exercises and preoperative oral intake of carbohydrates.

Objective:To analyze relevant factors influencing severe acute radiation enteritis (SARE) during total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC). To identify specific prediction indicators of the occurrence and progression of radiation enteritis by investigating the effect relationships between radiation enteritis and multidimensional factors.Methods:A total of 92 patients with rectal adenocarcinoma who received total neoadjuvant therapy at the First Affiliated Hospital of Soochow University from January 2020 to September 2023 were enrolled in this study. Their relevant information was collected, encompassing clinical nutritional indicators, dynamic changes in hematological parameters, systemic inflammatory indicators, and the occurrence of adverse reactions. Then, risk factors associated with radiation enteritis were determined using logistic regression analysis. Based on independent risk factors, a nomogram model for risk prediction was constructed.Results:Univariate analysis revealed significant correlations of the SARE occurrence with certain nutritional indicators, local tumor measurement data, and laboratory parameters. Multivariate regression analysis further identified the independent risk factors for SARE occurrence, including albumin reduction >26.5% before vs. after treatment ( OR = 5.010, 95% CI: 1.766-14.154, P = 0.010), rectual tenesmus rating of Grade 1-3 ( OR = 3.639, 95% CI: 1.425-9.300, P = 0.024), and elevated disease activity index (DAI) score ( OR ≈ 7.683 per 1-point increase, 95% CI: 1.105-53.410, P = 0.039). The prediction model constructed based on these factors demonstrated high prediction efficiency (AUC = 0.841; 95% CI: 0.749-0.934). Conclusions:The nomogram model constructed using albumin reduction, rectal tenesmus rating, and DAI score can provide accurate, simple, and low-cost risk prediction of radiation enteritis during TNT for LARC patients. This model facilitates the early clinical identification of high-risk patients, providing a basis for implementing personalized adjustments to radiotherapy regimens and enhancing nutritional interventions.

Objective To explore the association between physical activity levels and metabolic dysfunction-associated fatty liver disease(MAFLD)and the modifying effects of different types of obesity.Methods A cross-sectional study was conducted on 19925 participants recruited from the Chengdu sub-cohort of the Southwest China Natural Population Cohort.The participants were recruited between 2018 and 2019.The association between physical activity and MAFLD prevalence was examined using the inverse probability weighting(IPW)method based on the generalized propensity score(GPS).The odds ratios(OR)and the 95％confidence interval(CI)for moderate and vigorous physical activity were calculated using the mild physical activity group as a reference.A restricted cubic spline function was used to model the exposure-response relationship between physical activity and MAFLD risk.The potential modifying effects of obesity types on the association between physical activity and MAFLD were evaluated in male and female populations.Results The prevalence of MAFLD was 17.30％.Compared to those engaging in mild physical activity,individuals participating in vigorous and moderate physical activities had a lower risk of MAFLD,with OR(95％CI)being 0.76(0.67,0.86)and 0.85(0.76,0.94),respectively.The exposure-response relationship showed a nonlinear association between physical activity and MAFLD risks(Pnonlinearity=0.005).The protective effect of physical activity against MAFLD was observed when physical activity reached approximately 20 METs-h/d.However,when physical activity exceeded 70 METs-h/d,no significant effect on MAFLD risk was observed.Among the female population,obesity type significantly modified the association between physical activity and MAFLD(P＜0.05).In females with central obesity,the protective effect of physical activity on MAFLD showed a threshold effect,with the lowest disease risk observed at approximately 25 METs-h/d.However,physical activity exceeding 37.5 METs-h/d showed no statistically significant association with MAFLD risk.In contrast,for females with peripheral obesity,high levels of physical activity had limited effects on reducing MAFLD risks.Conclusion Moderate physical activity can significantly reduce the risk of MAFLD,and the obesity types can modify this association.It is recommended that individuals engage in approximately 20-70 METs-h/d of physical activity.For females with central obesity,physical activity should not exceed 37.5 METs-h/d,while for females with peripheral obesity,it should not exceed 30 METs-h/d.

Objective To investigate the association between 8 insulin resistance(IR)surrogate markers and incident atherosclerotic cardiovascular disease(ASCVD)in population with cardiovascular-kidney-metabolic syndrome(CKM)of stages 0-3,and to identify the surrogate marker with the best predictive performance.Methods A study was conducted on 20121 community residents classified as CKM stages 0-3 from the Chengdu cohort of the China Multi-Ethic Cohort.A Cox proportional hazards model was used to calculate hazard ratios(HRs)between each IR surrogate marker and incident ASCVD.Cubic spline regression was employed to explore the dose-response relationships between these markers and incident ASCVD.The relative relationships between different markers and incident ASCVD were examined through the ratio of HRs(RHRs).Time-dependent area under the receiver operating characteristic curve(TDAUC)and Uno's C-statistic were calculated to compare the predictive performance of each marker for incident ASCVD.Based on the PREVENT equation components and the 8 surrogate markers under analysis,random forest feature selection was used to determine the contribution of each marker to accurate prediction.Results During a follow-up period of82 741.93 person-years,1447 incident cases of ASCVD were recorded,with an incidence density of 17.49 per 1000 person-years.Association analyses indicated that the triglyceride to high-density lipoprotein cholesterol ratio(TG/HDL)and the TyG/(TG/HDL)index were not associated with incident ASCVD(P＞0.05).The TyG index combined with obesity measurement parameters emerged as a reliable predictor of ASCVD incidence.The most promising indicator,TyG index with waist-to-height ratio(TyG_WHtR),exhibited an inverted J-shaped association with incident ASCVD(P for nonlinearity=0.045;TDAUC=0.640;C=0.634),while the TyG index with body mass index(TyG_BMI),waist circumference(TyG_WC),and waist-to-hip ratio(TyG_WHR)showed positive linear associations(all P for trend＜0.05),with relatively lower predictive performance(C=0.564,0.588,and 0.598,respectively).Although both the TyG index and the metabolic score for insulin resistance(METS-IR)were associated with increased ASCVD risk(TyG:Q2 vs.Q1,HR=1.23 and Q4 vs.Q1,HR=1.24;METS-IR:P for non-linearity=0.045),they exhibited poor predictive performance for incident ASCVD.Conclusion The TyG index combined with obesity measurement parameters is an ideal IR surrogate marker for predicting incident ASCVD in populations with stages 0-3 CKM.Monitoring these markers will facilitate the prevention and control of cardiovascular diseases in CKM populations.

ObjectiveTo explore the mechanisms associated with Mahoniae Caulis alkaloids （MA） in ameliorating depression by network pharmacology， molecular docking， and animal experiments. MethodsThe component targets of MA were obtained through Swiss Target Prediction and TCMIP database. The depression targets were collected through TCMIP， Genecards， HPO， DrugBank and OMIM database. The depression targets were collected through TCMIP， Genecards， HPO， DrugBank and OMIM database. Protein-protein interaction （PPI） network was constructed by protein interaction analysis （STRING） database. Gene ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） analyses were performed through Bioinformatics （DAVID） database. The docking of components and targets was performed by AGFR. The mouse model of depression was established by intraperitoneal injection of corticosterone （CORT） once a day for 35 consecutive days. Sixty mice were randomly allocated into control （0.9% normal saline）， model （CORT， 20 mg·kg^-1）， positive control （fluoxetine hydrochloride， 3.6 mg·kg^-1）， and MA （10， 5， and 2.5 mg·kg^-1） groups. Each group was administrated with corresponding medicine or normal saline once a day for 28 consecutive days. The depression-like behavior of mice was observed. The pathological changes of prefrontal cortex in mice were observed by hematoxylin-eosin staining. Terminal deoxynucleotidyl dUTP transferase nick end labeling （TUNEL） was employed to observe the apoptosis of neurons in the prefrontal cortex. Enzyme-linked immunosorbent assay was employed to assess the serum levels of brain-derived neurotrophic factor （BDNF）， dopamine （DA）， 5-hydroxytryptamine （5-HT）， and norepinephrine （NE） in mice. The mRNA levels of cyclic adenosine monophosphate （cAMP） pathway-related factors and inflammatory factors were determined by Real-time PCR. Western blot was employed to determine the expression of cAMP pathway-related factors and connexin 43 （Cx43）. ResultsA total of 434 component targets and 545 depression targets were obtained， including 84 common targets， among which 10 core targets were screened out. GO analysis predicted 34 biological processes， 15 cell components， and 11 molecular functions. The KEGG pathways were mainly related to gap junction and cAMP signaling pathway. The core components had good binding affinity with the core targets. The results of animal experiments showed that compared with the control group， CORT prolonged the immobility time of mice in forced swimming and tail suspension tests （P<0.01）， lowered the serum levels of NE， BDNF， and 5-HT （P<0.05）， up-regulated the mRNA levels of nuclear factor-κB （NF-κB） and interleukin-6 （IL-6） in the brain tissue （P<0.05）， and down-regulated the mRNA levels of cyclic adenosine monophosphate effector binding protein （CREB） and BDNF （P<0.05） and the protein levels of protein kinase （PRKACA）， phosphorylation （p）-CREB/CREB， BDNF， and Cx43 （P<0.05） in the brain tissue. Compared with the model group， high-dose MA reduced the immobility time of mice in forced swimming （P<0.05） and tail suspension （P<0.01） tests， raised the serum levels of NE， BDNF， and 5-HT （P<0.01）， down-regulated the mRNA level of NF-κB （P<0.01）， and up-regulated the mRNA level of BDNF （P<0.01） and protein levels of PRKACA， p-CREB/CREB， BDNF， and Cx43 （P<0.05）. ConclusionMA alleviates the CORT-induced depressive behavior of mice. It may play an antidepressant role by regulating cAMP signaling pathway and gap junction pathway， improving synaptic plasticity and gap junction function， and reducing neuroinflammation.

ObjectiveTo explore the mechanisms associated with Mahoniae Caulis alkaloids （MA） in ameliorating depression by network pharmacology， molecular docking， and animal experiments. MethodsThe component targets of MA were obtained through Swiss Target Prediction and TCMIP database. The depression targets were collected through TCMIP， Genecards， HPO， DrugBank and OMIM database. The depression targets were collected through TCMIP， Genecards， HPO， DrugBank and OMIM database. Protein-protein interaction （PPI） network was constructed by protein interaction analysis （STRING） database. Gene ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） analyses were performed through Bioinformatics （DAVID） database. The docking of components and targets was performed by AGFR. The mouse model of depression was established by intraperitoneal injection of corticosterone （CORT） once a day for 35 consecutive days. Sixty mice were randomly allocated into control （0.9% normal saline）， model （CORT， 20 mg·kg^-1）， positive control （fluoxetine hydrochloride， 3.6 mg·kg^-1）， and MA （10， 5， and 2.5 mg·kg^-1） groups. Each group was administrated with corresponding medicine or normal saline once a day for 28 consecutive days. The depression-like behavior of mice was observed. The pathological changes of prefrontal cortex in mice were observed by hematoxylin-eosin staining. Terminal deoxynucleotidyl dUTP transferase nick end labeling （TUNEL） was employed to observe the apoptosis of neurons in the prefrontal cortex. Enzyme-linked immunosorbent assay was employed to assess the serum levels of brain-derived neurotrophic factor （BDNF）， dopamine （DA）， 5-hydroxytryptamine （5-HT）， and norepinephrine （NE） in mice. The mRNA levels of cyclic adenosine monophosphate （cAMP） pathway-related factors and inflammatory factors were determined by Real-time PCR. Western blot was employed to determine the expression of cAMP pathway-related factors and connexin 43 （Cx43）. ResultsA total of 434 component targets and 545 depression targets were obtained， including 84 common targets， among which 10 core targets were screened out. GO analysis predicted 34 biological processes， 15 cell components， and 11 molecular functions. The KEGG pathways were mainly related to gap junction and cAMP signaling pathway. The core components had good binding affinity with the core targets. The results of animal experiments showed that compared with the control group， CORT prolonged the immobility time of mice in forced swimming and tail suspension tests （P<0.01）， lowered the serum levels of NE， BDNF， and 5-HT （P<0.05）， up-regulated the mRNA levels of nuclear factor-κB （NF-κB） and interleukin-6 （IL-6） in the brain tissue （P<0.05）， and down-regulated the mRNA levels of cyclic adenosine monophosphate effector binding protein （CREB） and BDNF （P<0.05） and the protein levels of protein kinase （PRKACA）， phosphorylation （p）-CREB/CREB， BDNF， and Cx43 （P<0.05） in the brain tissue. Compared with the model group， high-dose MA reduced the immobility time of mice in forced swimming （P<0.05） and tail suspension （P<0.01） tests， raised the serum levels of NE， BDNF， and 5-HT （P<0.01）， down-regulated the mRNA level of NF-κB （P<0.01）， and up-regulated the mRNA level of BDNF （P<0.01） and protein levels of PRKACA， p-CREB/CREB， BDNF， and Cx43 （P<0.05）. ConclusionMA alleviates the CORT-induced depressive behavior of mice. It may play an antidepressant role by regulating cAMP signaling pathway and gap junction pathway， improving synaptic plasticity and gap junction function， and reducing neuroinflammation.

Objective:To systematically review the current registered clinical study schemes in China regarding the combination of TCM and targeted drug therapy for lung cancer; To analyze their strengths and weaknesses; To provide reference for future study.Methods:Chinese Clinical Trial Registry for clinical study schemes combining TCM with targeted drug therapy for lung cancer treatment was retrieved from the inception to July 10, 2024. The general characteristics, study types, intervention measures, and outcome indicators of existing schemes were systematically summarized and analyzed.Results:A total of 15 studies were included, with the earliest study registered in 2013. Registration locations were concentrated in Shanghai, Guangdong, Tianjin, and Zhejiang. Among them, 9 studies received funding from local, national finance, or hospitals; 13 studies passed ethical review, and 12 included informed consent. The design schemes included 10 randomized controlled studies, 1 cohort study, 1 interventional single-arm study, and 3 observational studies. 6 studies had a sample size smaller than 100 cases, and most were single-center trials. Intervention measures primarily involved the combination of Chinese patent medicine or TCM with targeted drugs, with evaluation indicators mainly focusing on clinical symptoms and laboratory indicators. The setting of outcome indicators lacked a unified standard.Conclusions:Since 2013, clinical studies combining TCM with targeted drug therapy for lung cancer have been relatively methodologically sound but face challenges such as small sample sizes and a certain degree of regional concentration, leading to relatively insufficient representativeness. The future direction for improvement lies in multi-center, large-sample, and well-designed clinical trials. It is also necessary to establish a standardized and normalized system for evaluating outcomes. Integrating basic research to clarify the mechanisms of TCM can provide a theoretical basis for the combination of TCM and targeted drugs, which is conducive to enhancing the rigor and scientific nature of clinical trial design and promoting the formation of high-level evidence-based medicine.

Objective To explore the effect of tumor necrosis faction-α(TNF-α)gene rs1799964 and C-reactive protein(CRP)gene rs2794521 polymorphism and their interaction on the therapeutic effect of dagliaglozin in patients with heart failure.Meth-ods 98 patients with HF who received treatment in Chengdu Wenjiang District People's Hospital from January 2021 to October 2023 were retrospectively selected for the study.According to the different therapeutic effects,the patients were divided into effective group(n=61)and ineffective group(n=37).The laboratory indexes of the effective group and the ineffective group were compared.The polymorphism,genotype and allele distribution of TNF-α gene(rs1799964)and CRP gene(rs2794521)were analyzed.Multiple regression model was used to analyze the risk factors affecting the efficacy of dagaglizin in the treatment of HF.The association between TNF-α gene(rs1799964)and CRP gene(rs2794521)and cardiac function index was analyzed.To analyze the interaction between TNF-α polymorphism(rs1799964)and CRP polymorphism(rs2794521)on the efficacy of daglipzin in the treatment of HF.Results The frequencies of CC genotype,CT genotype and C allele of TNF-α gene(rs1799964)in ineffective group were 24.32%(9/37),54.05%(20/37)and 51.35%(38/74),respectively,which were higher than those in effective group 11.48%(7/61),40.98%(25/61)and 31.97%(39/122),the differences were statistically significant(χ2=7.284,7.256,7213,all P<0.05).The frequencies of CC genotype and C allele of CRP gene(rs2794521)in ineffective group were 24.32%(9/37)and 47.30%(35/74),respectively,which were higher than those in effective group 6.56%(4/61)and 28.69%(35/122),and the differences were statistically significant(χ2=7.578,6.947,all P<0.05).In the dominant mode and in the cumula-tive mode in the association between TNF-α gene(rs1799964)and CRP gene(rs2794521)was statistically significant(all P<0.05).TNF-α gene(rs1799964)CC genotype(β=1.134,95%CI:1.028～1.964),CRP gene(rs2794521)CT genotype(β=1.357,95%CI:1.239～2.154),CC genotype(β=2.017,95%CI:1.674～4.231)were independent risk factors for the efficacy of daglipzin in treating HF(all P<0.05).The association differences between TNF-α gene(rs1799964)and CRP gene(rs2794521)polymorphism and left ventricular end-systolic dimension(LVESd),left ventricular end diastolic dimension(LVEDd),left ventric-ular ejection fractions(LVEF)and stroke volume(SV)in additive and dominant models were statistically significant(all P<0.05).There were multiplicative and additive interactions between TNF-α gene(rs1799964)genotype CC and CRP gene(rs2794521)genotype CC(all P<0.05).Conclusion The TNF-α gene(rs1799964)genotype CC and CRP gene(rs2794521)genotype CC have a multiplicity and additional interaction,and the risk of daglaglizin in treating heart failure is higher when these two factors coexist.

Objective To explore the effect of tumor necrosis faction-α(TNF-α)gene rs1799964 and C-reactive protein(CRP)gene rs2794521 polymorphism and their interaction on the therapeutic effect of dagliaglozin in patients with heart failure.Meth-ods 98 patients with HF who received treatment in Chengdu Wenjiang District People's Hospital from January 2021 to October 2023 were retrospectively selected for the study.According to the different therapeutic effects,the patients were divided into effective group(n=61)and ineffective group(n=37).The laboratory indexes of the effective group and the ineffective group were compared.The polymorphism,genotype and allele distribution of TNF-α gene(rs1799964)and CRP gene(rs2794521)were analyzed.Multiple regression model was used to analyze the risk factors affecting the efficacy of dagaglizin in the treatment of HF.The association between TNF-α gene(rs1799964)and CRP gene(rs2794521)and cardiac function index was analyzed.To analyze the interaction between TNF-α polymorphism(rs1799964)and CRP polymorphism(rs2794521)on the efficacy of daglipzin in the treatment of HF.Results The frequencies of CC genotype,CT genotype and C allele of TNF-α gene(rs1799964)in ineffective group were 24.32%(9/37),54.05%(20/37)and 51.35%(38/74),respectively,which were higher than those in effective group 11.48%(7/61),40.98%(25/61)and 31.97%(39/122),the differences were statistically significant(χ2=7.284,7.256,7213,all P<0.05).The frequencies of CC genotype and C allele of CRP gene(rs2794521)in ineffective group were 24.32%(9/37)and 47.30%(35/74),respectively,which were higher than those in effective group 6.56%(4/61)and 28.69%(35/122),and the differences were statistically significant(χ2=7.578,6.947,all P<0.05).In the dominant mode and in the cumula-tive mode in the association between TNF-α gene(rs1799964)and CRP gene(rs2794521)was statistically significant(all P<0.05).TNF-α gene(rs1799964)CC genotype(β=1.134,95%CI:1.028～1.964),CRP gene(rs2794521)CT genotype(β=1.357,95%CI:1.239～2.154),CC genotype(β=2.017,95%CI:1.674～4.231)were independent risk factors for the efficacy of daglipzin in treating HF(all P<0.05).The association differences between TNF-α gene(rs1799964)and CRP gene(rs2794521)polymorphism and left ventricular end-systolic dimension(LVESd),left ventricular end diastolic dimension(LVEDd),left ventric-ular ejection fractions(LVEF)and stroke volume(SV)in additive and dominant models were statistically significant(all P<0.05).There were multiplicative and additive interactions between TNF-α gene(rs1799964)genotype CC and CRP gene(rs2794521)genotype CC(all P<0.05).Conclusion The TNF-α gene(rs1799964)genotype CC and CRP gene(rs2794521)genotype CC have a multiplicity and additional interaction,and the risk of daglaglizin in treating heart failure is higher when these two factors coexist.

Objective:To analyze relevant factors influencing severe acute radiation enteritis (SARE) during total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC). To identify specific prediction indicators of the occurrence and progression of radiation enteritis by investigating the effect relationships between radiation enteritis and multidimensional factors.Methods:A total of 92 patients with rectal adenocarcinoma who received total neoadjuvant therapy at the First Affiliated Hospital of Soochow University from January 2020 to September 2023 were enrolled in this study. Their relevant information was collected, encompassing clinical nutritional indicators, dynamic changes in hematological parameters, systemic inflammatory indicators, and the occurrence of adverse reactions. Then, risk factors associated with radiation enteritis were determined using logistic regression analysis. Based on independent risk factors, a nomogram model for risk prediction was constructed.Results:Univariate analysis revealed significant correlations of the SARE occurrence with certain nutritional indicators, local tumor measurement data, and laboratory parameters. Multivariate regression analysis further identified the independent risk factors for SARE occurrence, including albumin reduction >26.5% before vs. after treatment ( OR = 5.010, 95% CI: 1.766-14.154, P = 0.010), rectual tenesmus rating of Grade 1-3 ( OR = 3.639, 95% CI: 1.425-9.300, P = 0.024), and elevated disease activity index (DAI) score ( OR ≈ 7.683 per 1-point increase, 95% CI: 1.105-53.410, P = 0.039). The prediction model constructed based on these factors demonstrated high prediction efficiency (AUC = 0.841; 95% CI: 0.749-0.934). Conclusions:The nomogram model constructed using albumin reduction, rectal tenesmus rating, and DAI score can provide accurate, simple, and low-cost risk prediction of radiation enteritis during TNT for LARC patients. This model facilitates the early clinical identification of high-risk patients, providing a basis for implementing personalized adjustments to radiotherapy regimens and enhancing nutritional interventions.