Objective To explore the application effect of a standardized management method based on failure mode and effect analysis （FMEA） in optimizing the whole-process quality control system of the intravenous admixture service （PIVAS）. Methods The quality control management system of the PIVAS was optimized by establishing six quality control groups led by the head nurse, with full participation of pharmacy, nursing, and logistical staff, ensuring comprehensive coverage and traceability of all quality control links. Each group conducted risk priority number （RPN） scoring for potential failure modes in their respective quality control processes, and targeted improvement measures were formulated based on the scoring results. The RPN values of failure modes and quality control-related evaluation indicators before and after implementation were compared to achieve closed-loop management. Results After one year of management, the RPN values of the six major failure modes significantly decreased compared to those before implementation （P<0.05）. The compounding error rate dropped to 0.13%, the dispensing error rate decreased to 0.95%, the compounding efficiency increased to 98%, the delivery time was shortened by 0.45 h per batch, the intervention rate for irrational prescriptions rose to 94.87%, satisfaction improved to 96.78%, and the participation rate of quality control personnel reached 95.36% （P<0.05）. Conclusion FMEA-based identification of potential failure modes in the whole-process quality control system of the IVAS, combined with risk quantification and targeted interventions, significantly reduced high-risk failure modes, improved compounding accuracy and efficiency, and ensured the safety of clinical intravenous medication and the effectiveness of healthcare quality management.

Objective To explore the application effect of a standardized management method based on failure mode and effect analysis （FMEA） in optimizing the whole-process quality control system of the intravenous admixture service （PIVAS）. Methods The quality control management system of the PIVAS was optimized by establishing six quality control groups led by the head nurse, with full participation of pharmacy, nursing, and logistical staff, ensuring comprehensive coverage and traceability of all quality control links. Each group conducted risk priority number （RPN） scoring for potential failure modes in their respective quality control processes, and targeted improvement measures were formulated based on the scoring results. The RPN values of failure modes and quality control-related evaluation indicators before and after implementation were compared to achieve closed-loop management. Results After one year of management, the RPN values of the six major failure modes significantly decreased compared to those before implementation （P<0.05）. The compounding error rate dropped to 0.13%, the dispensing error rate decreased to 0.95%, the compounding efficiency increased to 98%, the delivery time was shortened by 0.45 h per batch, the intervention rate for irrational prescriptions rose to 94.87%, satisfaction improved to 96.78%, and the participation rate of quality control personnel reached 95.36% （P<0.05）. Conclusion FMEA-based identification of potential failure modes in the whole-process quality control system of the IVAS, combined with risk quantification and targeted interventions, significantly reduced high-risk failure modes, improved compounding accuracy and efficiency, and ensured the safety of clinical intravenous medication and the effectiveness of healthcare quality management.

Objective:To explore the association between postoperative radiotherapy for bladder cancer and the risk of second primary rectal cancer.Methods:Eligible 75 120 patients with bladder cancer from the Surveillance, Epidemiology, and End Result database (SEER) of the National Cancer Institute (NCI) (1975-2017) were enrolled in this study. The second primary cancers referred to rectal cancers patients suffered after more than five years post-treatment for bladder cancer, and the cumulative incidence was estimated using Fine-Gray competing risk regression. The relative risk (RR) of rectal cancer in patients treated with or without radiotherapy (the RT group or the NRT group) was evaluated using Poisson regression.Results:Among the 75 120 patients, 70 045 (92.4%) were Caucasian, with a median age of 65.8 years (54-74 years). A total of 2 236 (3%) received postoperative radiotherapy, while 72 884 (97%) received surgery alone. The 30-year follow-up revealed a cumulative incidence of rectal cancer of 0.93% in the RT group and 0.43% in the NRT group ( P = 0.004). The competing risk regression analysis identified a significant association between radiotherapy and rectal cancer ( HR: 1.86; 95% CI 1.26-2.74, P < 0.009). Furthermore, the RR of radiotherapy-associated rectal cancer significantly increased as the diagnosis occurred earlier (1975-1985 vs. 1985-1994: RR 2.59; 95% CI 1.20-4.86, P < 0.001), and a lower age at the time of radiotherapy was associated with a higher probability of second primary tumors (≤50-year old vs. > 50 year old : RR 7.89, 95% CI 2.97-21.30, P < 0.001). As calculated using the Poisson distribution, the RR of second rectal tumors was higher in the RT group ( RR: 2.20, 95% CI 1.45-3.18, P < 0.001), even after adjusting the date of diagnosis ( RR: 1.77, 95% CI 1.17-2.57, P = 0.009). Conclusions:An increased risk of rectal cancer following bladder cancer radiotherapy necessitates aggressive follow-ups for the purpose of early detecting second primary rectal cancer associated with bladder cancer radiotherapy.

Objective This study was performed to explore the use of intramuscular low-dose Zoletil(1.5 mg/kg)combined with isoflurane inhalation for tracheal intubation in miniature pigs while preserving spontaneous respiration by determining the 50％and 95％minimum alveolar concentrations effective inhaled(MAC EI50 and MAC EI95).The goal was to establish a safe anesthetic method for tracheal intubation in miniature pigs in which intubation is difficult.Methods Forty-four Bama miniature pigs underwent general anesthesia.Following sedation with an intramuscular injection of sufentanil,anesthetic induction was performed using mask inhalation of isoflurane with monitoring of the heart rate,blood pressure,respiration,body temperature,oxygen saturation,end-tidal carbon dioxide concentration,and end-tidal isoflurane concentration.The initial end-tidal isoflurane concentration was set at 2.0％.The tracheal intubation conditions and outcomes were evaluated using Cooper's scoring system,and the dose-response relationship was calculated using Dixon's up-and-down method.Probit regression was employed to calculate the MAC EI50 and MAC EI95 along with their 95％confidence intervals(CI).Results In tracheal intubation using direct laryngoscopy with induction by low-dose sufentanil combined with isoflurane inhalation in miniature pigs,the MAC EI50 was 3.10％(95％CI,2.79％～3.56％)and the MAC EI95 was 3.77％(95％CI,3.41％～6.42％).With proper monitoring and airway management planning in place,alveolar isoflurane concentrations ranging from 3.10％to 3.75％were able to maintain stable vital signs in the miniature pigs.Conclusions The use of Zoletil combined with isoflurane inhalation for tracheal intubation in miniature pigs,aimed at preserving spontaneous breathing,is a preferable and safe anesthetic method for oral airway management in miniature pigs with significant potential for widespread application.

Objective To understand the bioinformatics of human ribosomal protein L22(RPL22)gene,prokary-otic expression and purification of human RPL22 recombinant protein,synthesis of human RPL22(labeled as agent M)in vitro,study the effects of agent M on proliferation,cycle and apoptosis of NSCLC A549 cells,and to analyze the effect of combination chemotherapy with M and cisplatin(DDP).Methods RPL22 bioinformatics was ana-lyzed.RPL22 gene was cloned by PCR,the single chain oligonucleotide was designed and synthesized to obtain the target gene,and connect the pET-28α vector.The pET-28α-RPL22 recombinant plasmid was constructed,and the receptive cell DH5α of Escherichia coli was transformed.The expression of recombinant protein RPL22 was analyzed by SDS-PAGE and Western blot.The semi-inhibitory rate(IC50)of M and DDP in A549 cells and the effect of M on the proliferation of A549 cells were detected by CCK-8.The effect of agent M on apoptosis and cycle of A549 cells was detected by flow cytometry.qPCR and Western blot assays were used to detect M and DDP on phosphati-dylinositol-3-kinase/protein kinase B(PI3K/AKT)and adenosine 5'-monophosphate activation of protein kinase/mammalian target of rapamycin(AMPK/mTOR)signaling pathway,respectively.Results RPL22 protein was an unstable and hydrophilic protein.The recombinant protein was dissolved and purified to obtain high concentration of recombinant protein.In A549 cells,the IC50 of reagent M was 400 μg/L,and the IC50 of DDP was 10 μmol/L,and the concentration of reagent M was inversely proportional to the cell activity.The inhibitory effect of reagent M(200 μg/L)combined with DDP(2.5 μmol/L)was similar to that of DDP(10 μmol/L)alone.Reagent M could induce G2 cell cycle arrest and promote apoptosis,and might be involved in the regulation of PI3 K/AKT and AMPK/mTOR pathways.Conclusion The recombinant RPL22 protein is cloned and expressed successfully.

Cassiae Semen is a substance with both edible and medicinal uses approved by the National Health Administration， and it is widely used in health food products in China. In this study， an information database of Cassiae Semen-based health food products was constructed， and the common patterns of functional claims， major raw materials， and dosage forms were analyzed. The Apriori algorithm and network method were used to analyze the association rules of high-frequency ingredients with the three major functional claims： Maintaining blood lipid （cholesterol/triglyceride） level， controlling fat， and relaxing bowel. Secondly， based on the positioning and regulatory requirements of health food and the recent research progress in Cassiae Semen， this paper analyzed the problems in technology review and product development from safety， function claim， and quality controllability. Finally， suggestions were put forward to promote the inheritance and carry forward China's traditional healthcare culture and the achievement of the Healthy China Initiative. These suggestions included classifying and optimizing the access management of health food， innovating the traditional healthcare function claims， and strengthening the quality system construction and information disclosure of post-marketing evaluation.

High-altitude regions,characterized by their elevated altitude,are subject to a complex set of environmental conditions including intense ultraviolet radiation,low oxygen levels,low temperatures,and low humidity.These distinctive environmental features lead to unique dietary patterns,lifestyles,and physiological adaptations.Notably,individuals who have just moved into high-altitude areas and those who live there on a long-term basis undergo specific adaptive adjustments in glucose metabolism.Typically,newcomers experience transient elevations in blood glucose levels,which gradually decline after prolonged residence at high altitudes to levels even lower than those found at low altitudes.In general,current findings of observational studies generally suggest a decreased risk of diabetes mellitus among populations inhabiting high-altitude regions.However,the glucose metabolism varies among populations from different high-altitude regions across the world,which indicates that the reshaping of glucose metabolism induced by high altitudes is a complicated phenomenon.This article provides an overview of the impact of various components of high-altitude environment,characteristic lifestyle factors,and socioeconomic development levels on glucose metabolism and the related diseases and the potential mechanisms involved.The aim is to offer valuable insights for researchers investigating glucose metabolism in high-altitude settings.

In response to the Opinions of the CPC Central Committee and the State Council on Promoting the Inheritance， Innovation， and Development of traditional Chinese medicine（TCM） and the spirit of the National Conference on TCM， Chinese Association of Chinese Medicine organized experts in Otorhinolaryngology Head and Neck Surgery of traditional Chinese and western medicine to discuss the clinical advantages of TCM and integrated traditional Chinese and western medicine in the treatment of allergic rhinitis （AR） and they reached a basic consensus. In recent years， the prevalence of AR has been on the rise， threatening the quality of life of patients and giving rise to a heavy burden to both the patients and the society. AR is resulted from immune imbalance rather than reduced immunity or hyperimmunity， and the imbalance is similar to the Yin-yang disharmony in TCM. In the treatment of this disease， western medicine features rapid onset. However， it is cost-intensive and causes severe surgical trauma， and the recurrence is common. TCM boasts diverse methods for AR， which can be used in all stages of this disease. It has advantages in controlling symptoms such as nasal congestion， runny nose， or dysosmia in the attack stage， preventing recurrence in the remission stage， and treating refractory AR or steroid-resistant AR. In particular， acupuncture enjoys a reputation in treatment of AR， which has been supported by evidence-based medicine and recommended by guidelines. While treating local symptoms of AR， TCM regulates the psychosomatic conditions， which facilitates chronic disease management and long-term follow-up. We should integrate the advantages of TCM and western medicine， give full play to the unique nonnegligible and irreplaceable advantages of TCM， formulate a comprehensive diagnosis and treatment scheme for learning and promotion， and summarize the research outcomes to promote the theoretical innovation of TCM on AR from the perspective of integrated traditional Chinese and western medicine.

Objective:To investigate the bidirectional causal relationship between schizophrenia and suicide or intentional self-harm using a Mendelian randomization (MR) approach.Methods:Using pooled data from a large-scale genome-wide association study, genetic loci that were independent of each other and associated with schizophrenia and suicide or intentional self-harm in populations of European ancestry were selected as instrumental variables. The data for schizophrenia included 76 755 patients with schizophrenia and 243 649 controls. Data for suicide or intentional self-harm included 1 058 patients with suicide or intentional self-harm and 307 942 controls. The inverse variance weighting (IVW) and weighted median methods of MR analysis were used to explore the bidirectional causality of schizophrenia and suicide or intentional self-harm using the ratio of ratios ( OR) as an evaluation index. Heterogeneity between individual single nucleotide polymorphism (SNP) was assessed by Cochran′s Q test. Mendelian randomization polymorphism residuals and outliers (MR-PRESSO) were used to detect SNP outliers, and MR-Egger regression tests were performed to examine the horizontal pleiotropy of SNPs. A "leave-one-out" sensitivity analysis was performed to test whether the MR study was influenced by individual SNPs. Results:The IVW approach showed that schizophrenia increased the risk of suicide or intentional self-harm ( OR=1.297, 95% CI=1.154-1.457, P<0.001). In addition, the above relationship was confirmed in the weighted median ( OR=1.232, 95% CI=1.038-1.461, P=0.017). Conversely, suicide or intentional self-harm was not causally associated with schizophrenia ( OR=0.969, 95% CI=0.927—1.012, P=0.157), again confirmed by the weighted median method. The Cochran′s Q test, MR-PRESSO and MR-Egger regression tests did not show heterogeneity or horizontal pleiotropy between instrumental variables. The "leave-one-out" sensitivity analysis confirmed that no single SNP had a disproportionate effect on the overall outcome. Conclusion:Schizophrenia is significantly and causally associated with an increased risk of suicide or intentional self-harm.

Objective:To investigate the bidirectional causal relationship between schizophrenia and suicide or intentional self-harm using a Mendelian randomization (MR) approach.Methods:Using pooled data from a large-scale genome-wide association study, genetic loci that were independent of each other and associated with schizophrenia and suicide or intentional self-harm in populations of European ancestry were selected as instrumental variables. The data for schizophrenia included 76 755 patients with schizophrenia and 243 649 controls. Data for suicide or intentional self-harm included 1 058 patients with suicide or intentional self-harm and 307 942 controls. The inverse variance weighting (IVW) and weighted median methods of MR analysis were used to explore the bidirectional causality of schizophrenia and suicide or intentional self-harm using the ratio of ratios ( OR) as an evaluation index. Heterogeneity between individual single nucleotide polymorphism (SNP) was assessed by Cochran′s Q test. Mendelian randomization polymorphism residuals and outliers (MR-PRESSO) were used to detect SNP outliers, and MR-Egger regression tests were performed to examine the horizontal pleiotropy of SNPs. A "leave-one-out" sensitivity analysis was performed to test whether the MR study was influenced by individual SNPs. Results:The IVW approach showed that schizophrenia increased the risk of suicide or intentional self-harm ( OR=1.297, 95% CI=1.154-1.457, P<0.001). In addition, the above relationship was confirmed in the weighted median ( OR=1.232, 95% CI=1.038-1.461, P=0.017). Conversely, suicide or intentional self-harm was not causally associated with schizophrenia ( OR=0.969, 95% CI=0.927—1.012, P=0.157), again confirmed by the weighted median method. The Cochran′s Q test, MR-PRESSO and MR-Egger regression tests did not show heterogeneity or horizontal pleiotropy between instrumental variables. The "leave-one-out" sensitivity analysis confirmed that no single SNP had a disproportionate effect on the overall outcome. Conclusion:Schizophrenia is significantly and causally associated with an increased risk of suicide or intentional self-harm.