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 revise the quality standards for pharmaceutical excipients such as medicinal brown sugar.Methods:This article combines the production and application of medicinal brown sugar,and refers to the requirements of GB/T35885-2018 brown sugar,the fourth general rules of the Chinese Pharmacopoeia 2020 edition,and other relevant requirements,and conducts research on its characteristics,identification,inspection,and assay.Results:A quality standard for medicinal brown sugar was established,and 10 batches of samples were tested according to the proposed quality standard.Conclusion:The establishment of this standard will provide quality assurance for the application of brown sugar in the pharmaceutical field.

Objective:To establish and evaluate a confirmation method for hepatitis B surface antigen(HBsAg)based on chemiluminescent immunoassay and neutralization test.Methods:①Detection procedure of the confirmation method:Initially,optimal concentration of neutralizing antibody was determined through a preliminary trial.During the confirmation of HBsAg,in the detection cups and control cups already containing test serum,neutralizing antibody and pre-test four items(hepatitis B serological markers,HCV antibody,syphilis spiral body antibody,HIV antibody)negative serum were added in a 1∶1 ratio(100 μl∶100 μl),respectively.After thorough mixing,the mixture was incubated at 37℃for 30 min,and the pre-treated serum was tested using the Siemens Atellica IM HBsAg detection program.②Reliability evaluation of the confirmation method:Coincidence rate of the confirmation method results and the Siemens confirmation reagent test results for 64 serum samples with different concentrations of HBsAg reactivity was compared and analyzed.③Determination of the diagnostic value and positive judgment value of the confirmation method:Taking the Siemens confirmation reagent test results for 64 HBsAg reactive serum samples as"the gold standard",neutralization rate of the confirmation method test results was statistically analyzed using ROC curve.Results:①In the preliminary trial,when the concentration of HBsAb was≥1 285.12 mU/ml,neutralization rate of the test results was>50%,and the neutralization rate was increased with the concentra-tion of HBsAb.After the same concentration of HBsAb neutralized different concentrations of HBsAg,trend of the neutralization rate change was not significant.②Coincidence rate of the two methods was 100.00%.③Area under the curve(AUC)was 0.993 4,the pos-itive judgment value was neutralization rate≥47.93%,with a sensitivity of 98.15%and specificity of 100.00%.Conclusion:This de-tection method is simple,easy-to-use,cost-effective,and has high diagnostic value,suitable for confirming HBsAg at different con-centrations.

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 investigate whether Yiqicongming Decoction(YCD)can alleviate dry eye syndrome in rats.Methods Thirty-six male SD rats at 6 weeks of age were divided into blank group,model group,positive group,YCD high-dose group,YCD medium-dose group,and YCD low-dose group,with six rats in each group.The rats underwent iris,tear secretion volume,and corneal epithelial damage scoring assessments.Conjunctival tissue was stained with PAS,and the activity of superoxide dismutase(SOD)and the content of malondialdehyde(MDA)were detected using the en-zyme-linked immunosorbent assay(ELISA).The level of reactive oxygen species(ROS)was measured by flow cytometry.Western blot was used to detect the protein expression of nuclear factor erythroid 2-related factor 2(Nrf2)and hymeoxyge-nase-1(HO-1)in corneal tissues.Results Compared with the blank group,the number of goblet cells in the conjuncti-va,corneal epithelial injury score,MDA content and ROS level in the model group were significantly increased at all time points(all P＜0.05).The tear secretion volume of rats decreased on days 3,7,and 14,and the number of conjunctival goblet cells and SOD activity also decreased(all P＜0.05).Compared with the model group,the conjunctival score,corne-al epithelial injury score,MDA content,and ROS level in the positive control group and high-,medium-,and low-dose YCD groups were significantly reduced(all P＜0.05),while SOD activity and protein expression levels of Nrf2 and HO-1 in rats on day 14 were significantly increased(all P＜0.05).Compared with the high-dose YCD group,the conjunctival score,corneal epithelial injury score,and ROS level in the low-and medium-dose YCD groups were significantly increased(all P＜0.05),while SOD activity and protein expression levels of Nrf2 and HO-1 on day 14 were significantly decreased(all P＜0.05).On day 14,the tear secretion volume and the number of goblet cells in the conjunctiva of rats administered a low dose of Yiqi Congming Decoction both decreased(all P＜0.05).Compared with the medium-dose YCD group,the conjunc-tival score,corneal epithelial injury score and ROS level in the low-dose YCD group were significantly increased(all P＜0.05),while the tear secretion volume and protein expression levels of Nrf2 and HO-1 on day 14 were significantly de-creased(all P＜0.05).Conclusion YCD can increase tear secretion,alleviate iris and corneal epithelial damage,acti-vate Nrf2/HO-1 pathway,regulate oxidative stress,and alleviate dry eye syndrome.

Objective:To revise the quality standards for pharmaceutical excipients such as medicinal brown sugar.Methods:This article combines the production and application of medicinal brown sugar,and refers to the requirements of GB/T35885-2018 brown sugar,the fourth general rules of the Chinese Pharmacopoeia 2020 edition,and other relevant requirements,and conducts research on its characteristics,identification,inspection,and assay.Results:A quality standard for medicinal brown sugar was established,and 10 batches of samples were tested according to the proposed quality standard.Conclusion:The establishment of this standard will provide quality assurance for the application of brown sugar in the pharmaceutical field.

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 establish and evaluate a confirmation method for hepatitis B surface antigen(HBsAg)based on chemiluminescent immunoassay and neutralization test.Methods:①Detection procedure of the confirmation method:Initially,optimal concentration of neutralizing antibody was determined through a preliminary trial.During the confirmation of HBsAg,in the detection cups and control cups already containing test serum,neutralizing antibody and pre-test four items(hepatitis B serological markers,HCV antibody,syphilis spiral body antibody,HIV antibody)negative serum were added in a 1∶1 ratio(100 μl∶100 μl),respectively.After thorough mixing,the mixture was incubated at 37℃for 30 min,and the pre-treated serum was tested using the Siemens Atellica IM HBsAg detection program.②Reliability evaluation of the confirmation method:Coincidence rate of the confirmation method results and the Siemens confirmation reagent test results for 64 serum samples with different concentrations of HBsAg reactivity was compared and analyzed.③Determination of the diagnostic value and positive judgment value of the confirmation method:Taking the Siemens confirmation reagent test results for 64 HBsAg reactive serum samples as"the gold standard",neutralization rate of the confirmation method test results was statistically analyzed using ROC curve.Results:①In the preliminary trial,when the concentration of HBsAb was≥1 285.12 mU/ml,neutralization rate of the test results was>50%,and the neutralization rate was increased with the concentra-tion of HBsAb.After the same concentration of HBsAb neutralized different concentrations of HBsAg,trend of the neutralization rate change was not significant.②Coincidence rate of the two methods was 100.00%.③Area under the curve(AUC)was 0.993 4,the pos-itive judgment value was neutralization rate≥47.93%,with a sensitivity of 98.15%and specificity of 100.00%.Conclusion:This de-tection method is simple,easy-to-use,cost-effective,and has high diagnostic value,suitable for confirming HBsAg at different con-centrations.

Objective To investigate whether Yiqicongming Decoction(YCD)can alleviate dry eye syndrome in rats.Methods Thirty-six male SD rats at 6 weeks of age were divided into blank group,model group,positive group,YCD high-dose group,YCD medium-dose group,and YCD low-dose group,with six rats in each group.The rats underwent iris,tear secretion volume,and corneal epithelial damage scoring assessments.Conjunctival tissue was stained with PAS,and the activity of superoxide dismutase(SOD)and the content of malondialdehyde(MDA)were detected using the en-zyme-linked immunosorbent assay(ELISA).The level of reactive oxygen species(ROS)was measured by flow cytometry.Western blot was used to detect the protein expression of nuclear factor erythroid 2-related factor 2(Nrf2)and hymeoxyge-nase-1(HO-1)in corneal tissues.Results Compared with the blank group,the number of goblet cells in the conjuncti-va,corneal epithelial injury score,MDA content and ROS level in the model group were significantly increased at all time points(all P＜0.05).The tear secretion volume of rats decreased on days 3,7,and 14,and the number of conjunctival goblet cells and SOD activity also decreased(all P＜0.05).Compared with the model group,the conjunctival score,corne-al epithelial injury score,MDA content,and ROS level in the positive control group and high-,medium-,and low-dose YCD groups were significantly reduced(all P＜0.05),while SOD activity and protein expression levels of Nrf2 and HO-1 in rats on day 14 were significantly increased(all P＜0.05).Compared with the high-dose YCD group,the conjunctival score,corneal epithelial injury score,and ROS level in the low-and medium-dose YCD groups were significantly increased(all P＜0.05),while SOD activity and protein expression levels of Nrf2 and HO-1 on day 14 were significantly decreased(all P＜0.05).On day 14,the tear secretion volume and the number of goblet cells in the conjunctiva of rats administered a low dose of Yiqi Congming Decoction both decreased(all P＜0.05).Compared with the medium-dose YCD group,the conjunc-tival score,corneal epithelial injury score and ROS level in the low-dose YCD group were significantly increased(all P＜0.05),while the tear secretion volume and protein expression levels of Nrf2 and HO-1 on day 14 were significantly de-creased(all P＜0.05).Conclusion YCD can increase tear secretion,alleviate iris and corneal epithelial damage,acti-vate Nrf2/HO-1 pathway,regulate oxidative stress,and alleviate dry eye syndrome.

Objective:To analyze the safety of reduced clinical target volume (CTV) irradiation of suspicious positive lymph nodes in IIa region in patients with N 0-N 1 nasopharyngeal carcinoma (NPC) and the protective effect of submandibular gland and long-term resting dry mouth, and to explore the diagnostic value of multimodal imaging for suspicious cervical lymph nodes. Methods:Clinical data of T 0-4N 0-1M 0 stage NPC patients admitted to Jiangsu Cancer Hospital from July 2015 to April 2017 were retrospectively analyzed. Clinical, radiation therapy planning, multimodal imaging and other relevant data were collected. All patients were treated with an optimized regimen of IMRT with a prophylactic radiation dose of 50.4 Gy (named as CTV50) for IIa region. Imaging characteristics and treatment response of suspicious lymph nodes were monitored by MRI, MRI-DWI, PET-CT and repeated enhanced positioning CT, etc. The dosimetry of the submandibular gland between optimized and standard dose plans (CTV50 vs. CTV60) was compared by paired t-test. The long-term dry mouth degree of the patients was evaluated using advanced radiation injury from Radiation Therapy Oncology Group (RTOG), Jiangsu Cancer Hospital Multi-dimensional Dry Mouth Evaluation Scale and summated xerostomia inventory (SXI). The difference of dry mouth degree was analyzed by rank-sum test. Results:A total of 106 patients were included in this study, including 149 cervical lymph node negative sides, 73 sides of which had ≤3 recognizable lymph nodes, and 76 of which were>3 in Ⅱa region. Among patients with N 1 stage, 63 patients underwent contralateral single neck area optimization, and 43 patients (N 0 stage and N 1 stage patients with retropharyngeal lymph node metastasis) underwent double-neck area optimization. A total of 109 suspicious lymph nodes with a short diameter of >5 mm were found on the largest cross section, of which 105 had clear portal structure. The ratio of long to short diameter was ≥1.5 in 93 cases, and the maximum standardized uptake value (SUV max) in PET-CT was ≥2.5 in 76 cases. No lymph node recurrence was found in the CTV optimized area. There was no significant difference in the average dose of GTV in tumor target area after optimization ( P>0.05), and the D mean and V 39 Gy in submandibular gland were significantly lower than those in unoptimized plan (both P<0.01). There was no significant difference in long-term dry mouth and resting dry mouth between patients with unilateral and bilateral optimization of submandibular gland (both P>0.05). Conclusions:The optimal program of CTV50 reduction irradiation in Ⅱa area of N 0-N 1 NPC patients is safe and effective. The submandibular gland has obvious dosimetric advantages, and patients have a good subjective response to resting dry mouth. The multimodal imaging tools such as enhanced CT, MRI-DWI and PET-CT should be performed to deliver individual evaluation and treatment for suspicious lymph nodes.