OBJECTIVE To provide technical support for improving recognition rate of adverse drug events （ADEs） related to traditional Chinese medicine （TCM） formula granules and decoction pieces among inpatient patients. METHODS By referencing the global trigger tool （GTT） whitepaper， literature on adverse reactions to TCM， and expert review opinions， ADE trigger items for TCM formula granules and decoction pieces used in the inpatients were established. GTT was applied to analyze ADEs in inpatients who had used TCM formula granules and decoction pieces in our hospital from August 2013 to August 2023， utilizing the Chinese Hospital Pharmacovigilance System. The effectiveness of GTT and the characteristics of these ADEs were analyzed. RESULTS A total of forty-eight triggers were established， including thirty-two laboratory test indexes， thirteen clinical symptoms， and three antidotes. Among the 1 682 patients included， GTT identified 652 potential ADEs， 284 true positive ADEs，with a trigger rate of 38.76% and a positive predictive value of 43.56%. After review by the auditor， 278 cases of ADEs were finally confirmed， with an incidence rate of 16.53%， significantly higher than the number of spontaneously reported ADEs during the same period （0）. The 278 cases of ADEs were mostly grade 1 （223 cases）， mainly involving hepatobiliary system， gastrointestinal system， blood- lymphatic system， etc；a total of 219 types of TCMs are involved，and the top five suspected TCMs used at a frequency higher than 1% were Poria cocos， Codonopsis pilosula， Atractylodes macrocephala， fried Glycyrrhiza uralensis， and Scutellaria baicalensis. CONCLUSIONS The established GTT can improve the recognition rate of ADEs for hospitalized patients using traditional Chinese medicine formula granules and decoction pieces.

Objective To analyze the evaluation value of regulatory T cells(Treg),helper T cells(Th17)and Treg/Th17 changes on the morbidity and severity of viral myocarditis(VMC)patients,and further analyze the influencing factors of morbidity and severity of VMC patients.Methods Press 1∶1 The research objects were screened according to the matching principle.140 VMC patients admitted to Dingzhou People's Hospital from Janu-ary 2022 to January 2024 were selected as the observation group,and the severity of the disease was determined according to the left ventricular ejection fraction(LVEF)and serum troponin(cTnI)levels.According to the severity of the disease,the observation group was divided into a mild group(n=79)and a moderately severe group(n=61).In addition,140 healthy people in the same period were selected as the control group.All patients were followed up for one year.According to the Treg/Th17 cutoff value in the receiver operating characteristic(ROC)curve,the patients were grouped based on the expression levels of the indicators into the Treg/Th17 high-expression group(107 patients)and the Treg/Th17 low-expression group(30 patients).The levels of Treg,Th17,Treg/Th17 and baseline data were compared between the control group and the observation group.The levels of Treg,Th17,Treg/Th17 and baseline data were compared between the mild group and the moderate-severe group.The diagnostic value of the combined detection of Treg,Th17,Treg/Th17 alone and in a parallel mode for the onset and severity of the disease in patients with VMC was analyzed using the ROC curve.Multivariate Logistic regression was used to analyze the influencing factors of the onset and severity of VMC.Results During the study period,4 cases were shed in the observation group,including the study period,4 cases dropped out and 136 cases were included in the observation group,and 3 cases dropped out and 137 cases were included in the control group.Compared with the control group,Treg and Treg/Th17 in the observation group were significantly lower,and Th17 was significantly higher(P<0.05).Th17 was the risk factor affecting the incidence of VMC patients(OR=2.547,2.698),Treg and Treg/Th17 were the protective factors affecting the incidence of VMC patients(OR=0.507,0.519).The area under the curve(AUC),sensitivity and specificity of Treg,Th17 and Treg/Th17 combination in the diagnosis of VMC were higher than those of single detection.Delong's test confirmed that the AUC of the combined detection(0.893)was significantly greater than that of the individual detections of Treg(0.664,Z=7.042),Th17(0.696,Z=6.033),and Treg/Th17(0.721,Z=5.691)(P<0.05).Compared with the mild group,Treg and Treg/Th17 in the moderate and severe group were significantly lower,and Th17 was significantly higher(P<0.05).Treg and Treg/Th17 were the independent protective factors affecting the severity of VMC patients(OR=0.547,0.419),and Th17 was the independent risk factor affecting the severity of VMC patients(OR=2.554)(P<0.05).The AUC,sensitivity and specificity of Treg,Th17 and Treg/Th17 combination in detecting the severity of VMC patients were higher than those of single detection(P<0.05).During the 1-year follow-up,a total of 36 patients with VMC died.The 1-year survival rate and OS of patients with high expression of Treg/Th17 were higher than those of patients with low expression of Treg/Th17(P<0.05).Conclusion During the onset and progression of VMC,there is an imbalance in Treg/Th17 cytokines.Treg/Th17 can serve as an important indicator for detecting the deterioration of the condition in VMC patients at an early stage.Clinically,the combined detection scheme of Treg,Th17,and Treg/Th17 can be used as a reference for clinical assessment of the onset diagnosis and disease progression of VMC patients.

Bariatric and metabolic surgery is an effective treatment for obesity and metabolic syndrome with definite results. In recent years, bariatric and metabolic surgery has developed rapidly, and the surgical indications and procedures have gradually matured. At the same time, the complications have also been widely discussed, including those specific to bariatric metabolic surgery and the risks common to gastrointestinal surgery, of which gastrointestinal leak is one of the most important and serious complications, which can be life-threatening in severe cases. This paper will review the mechanisms, clinical manifestations, diagnostic strategies, prevention, and treatment advances related to gastrointestinal leak after bariatric metabolic surgery based on the two major procedures that cause gastrointestinal leak, namely, staple line leak after laparoscopic sleeve gastrectomy and gastrojejunostomy leak after laparoscopic Roux-en-Y gastric bypass.

Objective To investigate the ED50 and ED9 5 of subarachnoid 0.375% bupivacaine in elderly patients undergoing elective total hip arthroplasty (THA ) in high altitude area. Methods Twenty-three elderly patients,aged 73-99 years old,ASA Ⅱ or Ⅲ,selected for total hip ar-throplasty (THA)under combined spinal-epidural (CSE)anesthesia were enrolled in this study and predose of 3.0 mg,0.375% (m/v)bupivacaine administered in subarachnoid,following dosage in-creased by ratio of 0.8.Calculate the ED50 and ED9 5 of subarachnoid 0.375% bupivacaine and 95%CI.Results Twenty of 23 underwent the test completely.The ED50 (95%CI)and ED9 5 (95%CI)of 0.375% (m/v)bupivacaine were 4.81 mg (3.98-5.81 )and 7.29 mg (6.03-8.81 ),respectively. Conclusion Subarachnoid 0.375% bupivacaine (7.5 mg)can be used effectively and safely in elderly patients undergoing total hip arthroplasty in high altitudes area.

Objective　To diagnose the pre-symptomatic cases of Chinese Wilson's disease(WD) and detect the potential carriers by using fluorescence PCR technique. Methods　Screening the high frequency spot Arg778Leu of WD gene mutation in 66 Chinese WD patients, 55 healthy family members and 30 controls, and selecting 3 random samples (2 from WD patients, 1 from controls) for DNA sequencing to testify the accuracy of fluorescence PCR. Results　Among 66 Chinese WD cases, 5 were found homozygous for mutation of Arg778Leu and 21 were compound heterozygous; the gene mutation rate was totally 39.4%.Out of 55 healthy family members, 12 were found heterozygous, and it was confirmed that 11 of these 12 individuals were WD gene carriers but not pre-symptomatic patients. The results of direct DNA sequencing consisted with those results detected by fluorescence PCR. Conclusion　The Arg778Leu mutation in exon 8 is the high frequency spot of Chinese Wilson's disease gene. Fluorescence PCR analysis is a rapid, accurate gene diagnostic method and demonstrates a high detecting rate.