Background and Aims:Sleeve gastrectomy(SG)has become the most widely performed bariatric procedure worldwide,but postoperative gastroesophageal reflux disease(GERD)remains a major concern.This multicenter study aimed to identify independent risk factors associated with GERD after SG to guide preoperative assessment and intraoperative management.Methods:Clinical data of 672 patients who underwent SG between January 2020 and December 2022 in six bariatric centers and completed a 12-month follow-up were retrospectively analyzed.Demographic characteristics,esophagogastric junction(EGJ)integrity graded by the AFS system,operative parameters,and postoperative outcomes were compared between patients with and without GERD.Multivariate logistic regression was used to identify predictors of postoperative GERD.Results:The overall incidence of GERD after SG was 24.7%(166/672).Multivariate analysis revealed that a preoperative BMI>35 kg/m2(OR=1.68,P=0.033),EGJ integrity AFS grade>2(OR=2.90,P=0.006),and preoperative reflux symptoms(OR=2.44,P=0.030)were independent risk factors for GERD.A staple line more than 1 cm from the angle of His(OR=0.45,P<0.001)and a bougie size>36 Fr(OR=0.08,P=0.001)were protective factors.Conclusion:High BMI,impaired EGJ integrity,and preoperative reflux symptoms significantly increase the risk of GERD after SG,whereas adequate preservation of the His angle and appropriate bougie calibration may reduce it.Comprehensive preoperative EGJ assessment and standardized surgical techniques are essential for minimizing postoperative reflux.

Background and Aims:Sleeve gastrectomy(SG)has become the most widely performed bariatric procedure worldwide,but postoperative gastroesophageal reflux disease(GERD)remains a major concern.This multicenter study aimed to identify independent risk factors associated with GERD after SG to guide preoperative assessment and intraoperative management.Methods:Clinical data of 672 patients who underwent SG between January 2020 and December 2022 in six bariatric centers and completed a 12-month follow-up were retrospectively analyzed.Demographic characteristics,esophagogastric junction(EGJ)integrity graded by the AFS system,operative parameters,and postoperative outcomes were compared between patients with and without GERD.Multivariate logistic regression was used to identify predictors of postoperative GERD.Results:The overall incidence of GERD after SG was 24.7%(166/672).Multivariate analysis revealed that a preoperative BMI>35 kg/m2(OR=1.68,P=0.033),EGJ integrity AFS grade>2(OR=2.90,P=0.006),and preoperative reflux symptoms(OR=2.44,P=0.030)were independent risk factors for GERD.A staple line more than 1 cm from the angle of His(OR=0.45,P<0.001)and a bougie size>36 Fr(OR=0.08,P=0.001)were protective factors.Conclusion:High BMI,impaired EGJ integrity,and preoperative reflux symptoms significantly increase the risk of GERD after SG,whereas adequate preservation of the His angle and appropriate bougie calibration may reduce it.Comprehensive preoperative EGJ assessment and standardized surgical techniques are essential for minimizing postoperative reflux.

OBJECTIVE To establish a method for simultaneous determination of 7 anti-tumor drugs(irinotecan,capecitabine,paclitaxel,docetaxel,tamoxifen,letrozole and methotrexate)in human plasma and apply it to the clinic.METHODS After precipitating with a methanol-acetonitrile mixture(1∶1,V/V)containing 0.1%formic acid,liquid chromatography-tandem mass spectrometry(LC-MS/MS)was used to determine the plasma concentration,using deuterium isotopes of each analyte as internal standards.The chromatography was performed on the Agilent Eclipse Plus C18 column with a gradient elution of water(containing 0.1%formic acid+0.04%5 mmol/L ammonium formate)as mobile phase A and acetonitrile(containing 0.1%formic acid)as mobile phase B.The flow rate was 0.6 mL/min,and the column temperature was set at 40℃.The sample size was 10 μL,and the analysis lasted for 5.5 min.Electrospray ionization was used in positive and negative ion mode,and multiple reaction monitoring mode was used.The ion pairs used for quantitative analysis were m/z 587.1→167.1(irinotecan),m/z 360.1→244.1(capecitabine),m/z 876.4→308.0(paclitaxel),m/z 830.3→304.2(docetaxel),m/z 372.1→129.1(tamoxifen),m/z 284.1→242.1(letrozole),and m/z 455.0→ 308.0(methotrexate).A total of 97 patients with malignant tumors in our hospital were selected to measure the plasma concentrations of 7 anti-tumor drugs using the above method.RESULTS The linear ranges of irinotecan,capecitabine,paclitaxel,docetaxel,tamoxifen,letrozole and methotrexate were 2-1 000 ng/mL(r=0.994 3),20-10 000 ng/mL(r=0.997 5),2-1 000 ng/mL(r=0.997 9),1-500 ng/mL(r=0.995 8),1-500 ng/mL(r=0.995 2),1-500 ng/mL(r=0.996 4),10-5 000(r=0.997 7),respectively.The quantitative lower limits were 2,20,2,1,1,1 and 10 ng/mL;RSDs of intra-assay precision were 0.08%-14.86%(n=6).RSDs of inter-batch precision were 1.51%-11.55%(n=3),and the accuracies were 89.17%-114.93%(n=6).The matrix effects ranged from 89.89%-119.74%(n=6).RSDs of the stability tests were 1.98%-14.88%(n=6).The results of clinical application showed,the average plasma concentrations of irinotecan,capecitabine,paclitaxel and docetaxel were 704.09,909.40,36.45,150.43 ng/mL,respectively.The values of the coefficient of variation were 25.24%,62.65%,122.69%,and 92.27%.CONCLUSIONS The established LC-MS/MS method is simple and rapid,and can be used for the simultaneous determination of 7 commonly used anti-tumor drugs in the plasma of patients with malignancy.

ObjectiveTo establish a rapid screening method for influenza virus neuraminidase（NA） inhibitors sourced from Chinese medicines based on fluorescence detection. MethodThe method was constructed based on the principle that after the reaction of the test sample and a certain amount of NA， the activity of some NA will be inhibited by the test sample， and the NA that is still active after the addition of the substrate can generate fluorescence at a specific wavelength when combined with the fluorescent substrate， and the inhibition rate of the test sample on NA was calculated according to the measured fluorescence intensity， so as to evaluate the in vitro inhibitory activity of the test sample on NA. A total of 49 high-purity chemical components from 12 Chinese medicines were used to evaluate the in vitro anti-NA activity by the established method. The theoretical calculated values of binding energy and inhibition constant after docking between the NA protein receptor and the test sample were used to prove the accuracy of the experimental results. The established method was applied to detect the in vitro NA inhibitory activity of different batches of Banlangen granules and Kangbingdu granules， so as to evaluate the quality consistency among different batches of samples. ResultThe methodological examination results showed that the method had good accuracy and repeatability. The screening results of 49 components showed that 22 of them had strong in vitro inhibitory activity against NA than peramivir ［half inhibitory concentration（IC₅₀） was 131.2 μmol·L^-1］， such as schaftoside， isoorientin， chebulinic acid， menthone and isoschaftoside. The inhibitory activity of the remaining 27 components was weaker than that of peramivir. The molecular docking results showed that the theoretical calculation results of binding energies and inhibition constants of most compounds were basically consistent with the experimental results. The test results of the inhibitory activity of 12 batches of Banlangen granules on NA showed that the quality consistency among samples A1， A2， B2， C1， C2， E2 and F2 was good. The analysis results of the inhibitory activity of 9 batches of Kangbingdu granules produced by the same manufacturer on NA showed that the inhibitory rates of samples K1 to K9 were 37.68%， 36.18%， 31.37%， 33.98%， 40.36%， 33.76%， 40.69%， 41.08%， 40.06% when the concentration of 0.02 g·mL^-1， and the average inhibitory rate was 37.24%. ConclusionIn this paper， we successfully established an analytical method that can be used to rapidly evaluate whether Chinese medicines （derived from chemical components of traditional Chinese medicine or proprietary Chinese medicines） have in vitro anti-NA activity， which can be a powerful supplement to the existing screening methods for influenza virus NA inhibitors. And this method was used to screen 22 compounds from 12 Chinese medicines with good in vitro inhibitory activity against NA， which can provide candidate compounds for the development of anti-influenza small molecule drugs.

ObjectiveTo investigate effect of conducting training of autism spectrum disorder （ASD） early screening skill on improving the ability to early identify ASD of medical staffs in primary care hospitals. MethodsIn September 2021， the training of ASD early screening skills was carried out for medical staffs from 20 primary care hospitals in Chengdu. After training， the training effect was evaluated. The numbers of referrals from primary care hospitals to superior hospitals， confirmed ASD as well as their average diagnostic age of children with ASD before and after training were used as evaluation indicators. ResultsAfter training， the number of children with suspected ASD referred by primary care hospitals was more than that before training ［（16.65±11.60） vs. （3.40±2.23）， t=5.431， P<0.01］， the number of children diagnosed with ASD was more than that before training［（6.85±4.93） vs. （2.45±1.67）， t=4.171， P<0.01］， and the differences were statistically significant. As for the diagnosed age of ASD children， after training， the average age was lower than that before training ［（34.95±11.67） vs. （42.2±14.64）， t=-2.553， P=0.019］. ConclusionTraining of ASD early screening skills for medical staffs in primary care hospitals may help to improve their ability to early screening ASD children.

OBJECTIVE: To investigate the characteristics and regularity of ADR induced by antineoplastic drugs and provide reference for safe drug use in clinic. METHODS: ADR reports induced by antineoplastic drugs reported by 108 hospitals during Jan. 2009-Dec. 2016 were collected from PLA ADR Monitoring Center. ADR reports were analyzed respectively in respects of types of ADR reports, patients ' gender and age, administration route, occurrence time, types of antineoplastic drug, the situation of patients suffering tumor, systems/organs involved in ADR, clinical manifestations, outcome, etc. RESULTS: Among 15 183 ADR reports, there were 462 cases of new ADR and 2 873 cases of severe ADR; there were 8 039 male (52. 95％) and 7 144 female (47. 05％). The proportion of severe ADR in female (20. 00％) was significantly higher than male (17. 96％), with statistical significance (P=0. 001). ADR was mainly induced by intravenous administration (90. 53％), and mainly occurred 2-＜7 d after medication (23. 00％). Top 3 drug categories in the list of ADR were platinum antineoplastic drugs (25. 63％), plant-derived antineoplastic drugs and its derivative (24. 42％) and anti-metabolism drugs (18. 50％). Male patients mainly suffered from lung cancer, colorectal cancer and gastric cancer; female patients mainly suffered from breast cancer, lung cancer and colorectal cancer. Systems/organs involved in ADR were gastrointestinal system, hematological system and systemic damage. Main clinical manifestations were nausea, vomiting, myelosuppression, skin rash and fever. Totally 92. 57％ of ADR cases were cured and recovered after treatment, and 5 cases died. CONCLUSIONS: Antineoplastic drugs have high incidence of ADR with serious damage. Clinic should strengthen the monitoring of key population and key drugs so as to reduce the occurrence of ADR.

Objective To evaluate the effects of roxatidine acetate hydrochloride for injection (roxatidine)on liver and kidney function and analyze the related risk factors. Methods The electric medical records of the hospitalized patients who received roxatidine during January 1st,2016 to December 31st,2016 in Chinese PLA General Hospital were monitored by the autonomic monitoring system which was researched and developed by ourselves. The adverse drug reactions (ADR)were re-evaluated for the alarmed cases from the autonomic monitoring system by clinical pharmacists. The incidence rates of liver and kidney injury were calculated. The risk factors and the independent risk factors of liver and kidney injury due to roxatidine were confirmed by univariate and multivariate logistic regression analysis. Results Data of a total of 9284 patients who come from 34 clinical departments (Department of Urinary Surgery,Orthopedics, and Cardiac Surgery,etc. )were collected. Of the 9284 patients,5308 (57. 2％)were male,3976 (42. 8％)were female. The dosage of roxatidine was 75 mg twice daily and the route of medication was intravenous infusion. The time of medication was 1-39 days and the median time was 3 (1,5)days. Totally 8268 patients were enrolled into the monitoring for roxatidine related liver injury. Eighty-six patients (1. 0％)were judged to have liver injury,all the relevant evaluations were " possible",the degrees of liver injuries were mild. The 86 patients′ average age was (59 ± 13)years,average body mass index (BMI)was (24. 6 ± 3. 3)kg/ m2 ,average time of medication was (8. 1 ± 4. 1)days. Of 86 patients,52 (60. 5％) were combined with ceftriaxone sodium. The results of univariate logistic regression analysis showed that age, time of medication,and combination with ceftriaxone sodium were the risk factors of liver injury due to roxatidine. The results of multivariate logistic regression analysis showed that > 65 years (OR = 1. 57,95％CI:0. 99-2. 43),> 3 days of medication time (OR = 14. 14,95％ CI:6. 99-33. 81),and combination use of ceftriaxone sodium (OR = 2. 31,95％ CI:1. 50-3. 60)were the independent risk factors of liver injury due to roxatidine. Nine thousand two hundred and eighty-four patients enrolled into the monitoring of roxatidine related kidney injury. Twenty-six patients (0. 3％)were judged as kidney injury,all the relevance evaluations were " possible",the degrees of kidney injuries were mild. The 26 patients′ average age was (59 ± 15)years,average BMI was (22. 0 ± 6. 2)kg/ m2 ,average time of medication was (7. 5 ± 6. 1) days. Of 26 patients,8 patients (30. 8％)suffered from hepatobiliary diseases meanwhile. The results of univariate logistic regression analysis showed that the time of medication and suffering from hepatobiliary diseases were the risk factors of kidney injury due to roxatidine. The result of multivariate logistic regression analysis showed that > 3 days of medication time (OR = 3. 57,95％ CI:1. 56-9. 16)was the independent risk factor of kidney injury due to roxatidine. Conclusions The incidence rates of liver and kidney injuries due to roxatidine are lower. Roxatidine is safe in clinical medication. > 65 years, > 3 days of medication time,and combination use of ceftriaxone sodium are the independent risk factors of liver injury due to roxatidine. > 3 days of medication time is the independent risk factor of kidney injury due to roxatidine.

Objective To evaluate the effects of roxatidine acetate hydrochloride for injection (roxatidine)on liver and kidney function and analyze the related risk factors. Methods The electric medical records of the hospitalized patients who received roxatidine during January 1st,2016 to December 31st,2016 in Chinese PLA General Hospital were monitored by the autonomic monitoring system which was researched and developed by ourselves. The adverse drug reactions (ADR)were re-evaluated for the alarmed cases from the autonomic monitoring system by clinical pharmacists. The incidence rates of liver and kidney injury were calculated. The risk factors and the independent risk factors of liver and kidney injury due to roxatidine were confirmed by univariate and multivariate logistic regression analysis. Results Data of a total of 9284 patients who come from 34 clinical departments (Department of Urinary Surgery,Orthopedics, and Cardiac Surgery,etc. )were collected. Of the 9284 patients,5308 (57. 2％)were male,3976 (42. 8％)were female. The dosage of roxatidine was 75 mg twice daily and the route of medication was intravenous infusion. The time of medication was 1-39 days and the median time was 3 (1,5)days. Totally 8268 patients were enrolled into the monitoring for roxatidine related liver injury. Eighty-six patients (1. 0％)were judged to have liver injury,all the relevant evaluations were " possible",the degrees of liver injuries were mild. The 86 patients′ average age was (59 ± 13)years,average body mass index (BMI)was (24. 6 ± 3. 3)kg/ m2 ,average time of medication was (8. 1 ± 4. 1)days. Of 86 patients,52 (60. 5％) were combined with ceftriaxone sodium. The results of univariate logistic regression analysis showed that age, time of medication,and combination with ceftriaxone sodium were the risk factors of liver injury due to roxatidine. The results of multivariate logistic regression analysis showed that > 65 years (OR = 1. 57,95％CI:0. 99-2. 43),> 3 days of medication time (OR = 14. 14,95％ CI:6. 99-33. 81),and combination use of ceftriaxone sodium (OR = 2. 31,95％ CI:1. 50-3. 60)were the independent risk factors of liver injury due to roxatidine. Nine thousand two hundred and eighty-four patients enrolled into the monitoring of roxatidine related kidney injury. Twenty-six patients (0. 3％)were judged as kidney injury,all the relevance evaluations were " possible",the degrees of kidney injuries were mild. The 26 patients′ average age was (59 ± 15)years,average BMI was (22. 0 ± 6. 2)kg/ m2 ,average time of medication was (7. 5 ± 6. 1) days. Of 26 patients,8 patients (30. 8％)suffered from hepatobiliary diseases meanwhile. The results of univariate logistic regression analysis showed that the time of medication and suffering from hepatobiliary diseases were the risk factors of kidney injury due to roxatidine. The result of multivariate logistic regression analysis showed that > 3 days of medication time (OR = 3. 57,95％ CI:1. 56-9. 16)was the independent risk factor of kidney injury due to roxatidine. Conclusions The incidence rates of liver and kidney injuries due to roxatidine are lower. Roxatidine is safe in clinical medication. > 65 years, > 3 days of medication time,and combination use of ceftriaxone sodium are the independent risk factors of liver injury due to roxatidine. > 3 days of medication time is the independent risk factor of kidney injury due to roxatidine.

Objective To explore the correlations of intracranial pressure (ICP) with changes of neuron specific enolase (NSE),D-Dimer (D-D) and C-reactive protein (CRP) levels in patients with severe traumatic brain injury.Methods A serial of 35 patients with severe traumatic brain injury,admitted to our hospital from January 2012 to January 2014,were chosen as experimental group,and 20 healthy subjects performed physical examination in our Physical Examination Center at the same period were as controls.ICP monitoring was performed in these 35 patients.The patents were divided into two groups according to ICP:severely elevated ICP group (＞40 mmHg) and moderately elevated ICP group (20-40 mmHg).The NSE,D-D and CRP levels were measured,and these data were compared with those from the control group.The correlations of ICP with changes of NSE,D-D and CRP levels were analyzed.Results The levels of NSE,D-D and CRP in the severely elevated ICP group and moderately elevated ICP group were obviously higher than those in the control group ([12.11 ±2.35] lg/L,[0.39±0.61] mg/L,[3.72±0.69] mg/L) (P＜0.05).The levels ofNSE,D-D and CRP in the severely elevated ICP group ([104.08±7.90] μg/L,[1.55±0.26] mg/L,[47.66±8.60] mg/L) were also obviously higher than those in the moderately elevated ICP group ([61.89±30.35] μg/L,[0.93±0.32] mg/L,[30.87±9.84] mg/L)(P＜0.05).Significant positive correlations were noted between ICP and changes ofNSE,D-D and CRP levels in the patient group (regression equation:ICP=18.598+0.256 NSE [t=7.200,P=0.000],ICP=10.779+23.955D-D [t=10.29,P=0.000],ICP=9.932+0.771 CRP [t=8.423,P=0.000]).Multivariant stepwise regression analysis indicated the closest correlation between ICP and D-D (multiple correlation coefficient=0.873,coefficient of determination=0.762,F=105.917,P=0.000).Conclusions Significant positive correlations can be noted between ICP and changes of NSE,D-D and CRP levels,and the closest correlation is between ICP and D-D in patients with severe traumatic brain injury.The combined application of ICP and NSE,D-D and CRP levels can promote the diagnosis and treatment of severe traumatic brain injury patients.