To further standardize the technical links of the whole-process therapeutic drug monitoring， promote the standardization of the technical methods， and enhance the scientific and clinical guidance value of the monitoring results， the Guidelines for the Technical Management of Therapeutic Drug Monitoring were jointly drafted by the Division of Therapeutic Drug Monitoring， Chinese Pharmacological Society， and the Division of Clinical Evaluation of Drug， Chinese Pharmacists Association. The guideline development Committee will standardize the guideline development process in accordance with relevant methodological requirements， such as the latest definition of Institution of Medicine （IOM） about clinical practice guideline， World Health Organization （WHO） handbook， and Appraisal of Guidelines for Research and Evaluation （AGREE Ⅱ）， and follow the Reporting Items for Practice Guidelines in Healthcare （RIGHT）. The Guidelines for the Technical Management of Therapeutic Drug Monitoring have been registered in the “Practice guideline REgistration for transPAREncy” （PREPARE）， in the version of “original version”， classification of “standard guide”， and registration code of “PREPARE-2023CN646”. This plan mainly reports the background， research content， application scope， formulation methods and technical routes of the guideline， so as to provide basis and guarantee for scientific， standardized， objective， feasible and high-quality guideline formulation.
OBJECTIVE To explore the effects of Yinao Fujian Formula （YNFJ） on the middle cerebral artery occlusion （MCAO） model rats and lipopolysaccharide （LPS）-induced BV2 cells through the polarization of microglia and the AMP-activated protein kinase （AMPK）/Nucleotide binding oligomerization domain-like receptor protein 3 （NLRP3） inflammasome pathway. METHODS High-performance liquid chromatography （HPLC） analysis was used to identify the chemical compositions of YNFJ. Zea-Longa score and balance beam walking experiment were used to evaluate the effect of YNFJ on the degree of nerve defect in MCAO rats. Enzyme-linked immunosorbent assay （ELISA） kits were used to detect interleukin-1β （IL-1β）， IL-6 and tumor necrosis factor-α （TNF-α） levels. Immunofluorescence was used to observe fluorescence intensities of Caspase1 and NLRP3 in microglia. Flow cytometry was used to detect the fluorescence intensities of CD32 and CD206 in BV2 cells. Expression levels of TNF-α， IL-6， IL-10 and TGF-β in BV2 cells were detected by reverse transcription-quantitative real-time polymerase chain reaction （RT-qPCR）. Western blot was used to detect the protein expressions of Iba 1， Caspase 1 and NLRP3 in brain tissue. RESULTS HPLC results showed that the similarity of YNFJ in 10 batches was between 97%-99%， indicating that YNFJ had good stability. In the MCAO model， YNFJ significantly improved the Zea-Longa and balance beam walking test scores. YNFJ treatment significantly downregulated Iba1， reduced IL-6 and IL-1β and TNF-α levels， increased CD206 expression and decreased iNOS expression. In addition， YNFJ significantly downregulated NLRP3， Cleaved Caspase 1 and IL-1β. In LPS-induced BV2 cells， YNFJ treatment significantly increased the expression levels of CD206， IL-10， and TGF-β， but decreased CD32， TNF-α， and IL-6 levels. YNFJ treatment significantly downregulated NLRP3， ASC， Cleaved Caspase 1， IL-18， IL-1β and cleaved GSDMD， but upregulated p-AMPK in LPS-induced BV2 cells. Compound C， an AMPK inhibitor， significantly inhibited the regulatory effect of YNFJ on LPS-induced BV2 cells. CONCLUSION YNFJ effectively protects the ischemic stroke injury by affecting the microglial remodel process from M1 to M2 and regulating the AMPK/NLRP3 inflammasome pathway.
OBJECTIVE To investigate the pharmacokinetics and pharmacodynamics of ropivacaine at different concentrations in patients undergoing thoracoscopic lobectomy with serratus anterior plane block （SAPB）. METHODS This study included 30 patients who underwent thoracoscopic lung resection. Ultrasound-guided SAPB was performed using ropivacaine at an equidose （3 mg·kg–1） but varying concentrations. The patients were divided into the 0.25% group， 0.5% group， and 0.75% group based on the concentrations of ropivacaine. Each group consisted of 10 cases. Blood samples were collected at each time point after the administration of ropivacaine， and its concentration was determined by liquid chromatography with tandem mass spectrometry （LC-MS/MS）. The time of SAPB and the onset of analgesia were recorded. The numeric rating scale （NRS） scores for pain at rest and during activity were recorded in the resuscitation unit， 24 h and 48 h postoperatively. Adverse events within 48 h postoperatively， such as nausea and vomiting， abnormal blood pressure， arrhythmia and neurotoxicity were recorded. RESULTS As the concentration of ropivacaine increased， the maximum concentration （Cmax）， half-life （t1/2）， and area under the curve （AUC） of ropivacaine in patients also increased. Cmax in the 0.75% group was significantly higher than that of the 0.25% group （P<0.05）， but there were no significant differences in other pharmacokinetic parameters and analgesic onset time among all groups. The NRS scores at rest and during activity at various postoperative time points were significantly lower in the 0.5% and 0.75% groups compared to the 0.25% group （P<0.05）. No significant differences were observed in the incidence of adverse events of abnormal blood pressure and arrhythmia among the three groups. Only 2 cases of postoperative nausea and vomiting were reported in the 0.5% group. CONCLUSION There are significant differences in the pharmacokinetics of different concentrations of ropivacaine applied to SAPB in patients undergoing thoracoscopic lobectomy. The analgesic efficacy of 0.5% and 0.75% ropivacaine is better than 0.25%.
OBJECTIVE To establish a high performance liquid chromatography tandem-mass spectrometry （HPLC-MS/MS） method for simultaneous quantification of busulfan and phenytoin in children’s trace plasma， thus applying to the therapeutic drug monitoring in children with hematopoietic stem cell transplantation. METHODS Children’s plasma samples were processed by methanol precipitation of proteins. Then， proteins were separated using the Phenomenex Kinetex® EVO C18 column （30 mm× 2.1 mm， 2.6 μm）. The mobile phase was 2 mmol·L–1 ammonium acetate and 0.1% formic acid and acetonitrile （A）， and 2 mmol·L–1 ammonium acetate and 0.1% formic acid （B） with gradient elution. The mass spectrometry detection was performed in positive ion mode with electrospray ion source and multiple reaction monitoring scanning. The monitoring ion pairs were as follows： busulfan for m/z 264.0→151.1， phenytoin for m/z 253.1→182.1， and stable isotope internal standards were used for quantification. RESULTS The analytes showed good linearity in the range of 20-2 560 ng·mL–1 busulfan （r=0.999 4）， and 0.4-51.2 μg·mL–1 phenytoin （r=0.995 8）. The accuracy， precision， stability and matrix effect could meet the requirements. Then， the established and validated method was successfully applied to monitor the plasma concentrations of 3 children who were administrated with busulfan and phenytoin before hematopoietic stem cell transplantation treatment. CONCLUSION The method is simple and rapid， and can be accurately quantified with only a small amount of plasma. It can be used for clinical therapeutic drug monitoring in children receiving hematopoietic stem cell transplantation.
OBJECTIVE To investigate the role of Compound Chaijin Jieyu Formula in promoting melatonin secretion in depression rats combined with insomnia by improving autophagy. METHODS Rats were randomly divided into eight groups based on a sucrose consumption test： the control group， chronic unpredictable stress model （CUMS） group， sleep deprivation （SD） group， CUMS+SD group， melatonin combined with venlafaxine （CUMS+SD+Ven+Mel） group， and low-dose， medium-dose， and high-dose Compound Chaijin Jieyu Formula groups. Various detection methods were employed to investigate the effects of Compound ChaiJin JieYu Formula on depressive-like behavior， sleep patterns， pineal melatonin secretion， central oxidative stress responses， neuroinflammation， autophagic damage， ultrastructural changes in mitochondrial autophagosomes in rat pineal gland and the AMP-activated protein kinase （AMPK）/forkhead box O3a （FOXO3a） signaling pathway. RESULTS In the CUMS+SD group， the levels of corticotropin-releasing hormone （CRH）， adrenocorticotropic hormone （ACTH）， cortisol （CORT）， reactive oxygen species （ROS）， nucleotide-binding oligomerization domain-like receptor protein 3 （NLRP3）， and cysteinyl aspartate-specific proteinase 3 （Caspase-3） were significantly elevated in peripheral blood and cerebrospinal fluid. In contrast， the levels of 5-hydroxytryptamine （5-HT） and melatonin in the pineal gland were significantly reduced. Meanwhile， the expressions of autophagy-related protein 4 （ATG4）， and tight junction proteins Claudin and Occludin was significantly reduced in the rat pineal gland， which inhibited the AMPK/FOXO3a signaling pathway and accompanied pineal mitochondrial autophagy damage. Compound Chaijin Jieyu Formula at varying doses significantly increased melatonin levels in the pineal gland while reducing the levels of CRH， ACTH， CORT， ROS， NLRP3， Caspase-3， and 5-HT， thereby ameliorating central oxidative stress and neuroinflammation. After the intervention of Compound Chaijin Jieyu Formula， the protein expressions of ATG4， Claudin， and Occludin proteins were significantly upregulated， which activated autophagy through the AMPK/FOXO3a signaling pathway and improved autophagy damage in pineal mitochondria. CONCLUSION Compound Chaijin Jieyu Formula alleviates the symptoms of depression combined with insomnia by improving the pineal autophagy injury and promoting melatonin secretion in CUMS+SD rats via regulating the AMPK/FOXO3a pathway.
OBJECTIVE To investigate the mechanism of Poria cocos against metabolic-associated fatty liver disease （MAFLD）. METHODS Using the random allocation method， male sprague-dawley （SD） rats were divided into normal group， model group， fenofibrate group， alcohol extract of Poria cocos （PCE） group， and residue after alcohol and water extraction of Poria cocos （PCZ） group. MAFLD was induced in the rats via a high-fat diet regimen， followed by a 12-week period of daily gavage administration of the respective drug interventions. After 12 weeks， the animals were sacrificed. Total cholesterol （TC）， triglyceride （TG）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， high-density lipoprotein cholesterol （HDL-C） and low-density lipoprotein cholesterol （LDL-C） levels in serum and liver， as well as organ index were measured. Oil red O and hematoxylin-eosin （H&E） staining were used to observe liver tissue morphology. Metabolites in the urine， serum， liver and hepatic mitochondria were analyzed by ultra-performance liquid chromatography-mass spectrometry （UPLC/MS）. Principal component analysis was used to establish the metabolic profiles of rats. Partial least squares discrimination analysis， t-test and variable important in projection were used to screen differential metabolites， which were identified by human metabolome database and METLIN databases. MetaboAnalyst and Kyoto Encyclopedia of Genes and Genomes databases were used to enrich metabolic pathways and constructed metabolic networks. RESULTS PCE treatment significantly improved liver histopathological abnormalities， reduced intrahepatic lipid droplet accumulation， and TG and ALT in serum and liver， but significantly increased HDL-C level in the liver. PCZ treatment significantly reduced the liver index， improved liver histopathological abnormalities， and reduced intrahepatic lipid droplet accumulation and TC， TG and ALT in serum and liver tissues. PCE significantly regulated 218 metabolites in serum， urine， liver and liver mitochondria， which mainly involved six pathways， including amino acid metabolism （taurine， hypotaurine， arginine， proline， cysteine， methionine， and tyrosine metabolism， and phenylalanine， tyrosine and tryptophan biosynthesis） and carbohydrate metabolism （pentose and glucuronate interconversions）. PCZ significantly regulated 165 metabolites in serum， liver and liver mitochondria， which mainly involved five pathways， including amino acid metabolism （phenylalanine， tyrosine and tryptophan biosynthesis， and tyrosine， phenylalanine， and glutathione metabolism）， lipid metabolism （glycerophospholipid metabolism） and carbohydrate metabolism （amino sugar and nucleotide sugar metabolism）. CONCLUSION PCZ and PCE alleviate lipid metabolism disorders in MAFLD rats. PCE regulates 218 metabolites related with six metabolic pathways， while PCE regulates 165 metabolites related with five metabolic pathways.
OBJECTIVE To investigate the inhibitory mechanism of chlorogenic acid （CHA） against Trichophyton mentagrophytes based on transcriptomics and proteomics. METHODS The minimum inhibitory concentration （MIC） and minimum bactericidal concentration （MBC） of CHA against Trichophyton mentagrophytes were determined by broth microdilution method and plate recovery method， respectively. Transcriptomics and proteomics were used to analyze differentially expressed genes/proteins （DEGs/DEPs） between the control group and the CHA group， and Gene Ontology function and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis were performed. RT-qPCR was employed to validate the DEGs. RESULTS The MIC and MBC values of CHA against Trichophyton mentagrophytes were 250 μg·mL–1 and 500 μg·mL–1， respectively. A total of 181 DEGs were screened by transcriptomics， including 128 down-regulated and 53 up-regulated ones. DEGs were mainly enriched in pathways related to nucleic acid regulation， proton transfer ATPase activity， oxidoreductase activity and synaptic vesicle cycle. A total of 212 DEPs were screened by proteomics， of which 107 were down-regulated and 105 were up-regulated. DEGs were mainly enriched in translation pathway， protein folding and oxidative phosphorylation pathways. RT-qPCR consistently verified DEGs with the trend of transcriptomics， indicating that the sequencing results were highly reliable. CONCLUSION CHA may affect intracellular nucleic acid repair and energy metabolism by regulating nucleic acid metabolism and metalloproteinase expression， and then inhibit Trichophyton mentagrophytes.
OBJECTIVE To investigate the effect of ginsenoside Rg1 on exosomal miRNAs of dendritic cells （DCs）， and to analyze the mechanism of action of ginsenoside Rg1 in ameliorating chronic obstructive pulmonary disease （COPD）. METHODS DCs were induced in vitro and divided into immature DCs （imDCs） and Rg1-induced imDCs （Rg1-imDCs）. Exosomes of imDCs and Rg1-imDCs were extracted and characterized by differential ultra-high-speed centrifugation combined with ultrafiltration. Differentially expressed exosomal miRNAs were identified by the Agilent portfolio of microarray analysis， subjected to bioinformatic analyses， and validated by RT-qPCR. The mechanism of exosomal miRNAs of Rg1-imDCs in COPD via regulating the PI3K/AKT signaling pathway was explored. RESULTS The average particle size of the extracted exosomes was （127.80±3.16） nm， with a polydispersity index （PDI） of 0.27±0.01. The exosomes exhibited a “cup-shaped” dual-membrane structure， and the marker proteins CD81， Alix， and TSG101 were positively expressed. A total of 78 differentially expressed exosomal miRNAs were identified between imDCs and Rg1-imDCs. Bioinformatic data showed that ginsenoside Rg1 was primarily enriched in the cellular components and biological functions of cell membrane， cytoplasm， nucleus and protein binding. It also affected the PI3K/AKT signaling pathway， MAPK signaling pathway， Ras signaling pathway， axon guidance， and focal adhesion. MiR-695 was the top 1 upregulated exosomal miRNA in Rg1-imDCs， whose target gene was closely related to the PI3K/AKT pathway. RT-qPCR results verified that miR-695 was significantly upregulated in the Rg1-imDCs than imDCs （P<0.01）. In vitro experiments further demonstrated that overexpression of miR-695 significantly inhibited the protein expressions of PI3K and AKT1（P<0.05）. CONCLUSION Ginsenoside Rg1 influences the biological processes and signaling pathways in COPD by altering exosomal miRNAs of imDCs， which relies on upregulating miR-695 and inhibiting the PI3K/AKT signaling pathway.
OBJECTIVE To observe the effect of ethanol on the pyroptosis in the insulin resistance （IR） of liver cells， and to explore of the intervention effect of salidroside （SAL）. METHODS An in vitro IR model was established by high-glucose induction in human hepatocyte cell line HepG2. IR-induced HepG2 cells were treated with ethanol at varying concentrations and SAL. Cell proliferation/viability was determined by CCK-8 assay. Pyroptotic bodies were observed under a microscope. The level of reactive oxygen species （ROS） in cells was detected by the dichlorofluorescein diacetate （DCFH-DA） probe. The protein expressions of insulin signal Akt/glycogen synthase kinase 3β （GSK3β）， pyroptotic signal nod-like receptor protein 3 （NLRP3）/gasdermin D （GSDMD） in cells were detected by Western blot. Cells were then interfered with AMP-activated protein kinase （AMPK） inhibitor Compound C （CC）， and the above indicators and the level of AMPK activation were detected to explore the mechanism of SAL. RESULTS The phosphorylation level of Akt/GSK3β in IR-induced HepG2 cells was downregulated， accompanied by increased number of pyroptotic bodies， increased ROS levels， and increased protein levels of NLRP3/GSDMD. Compared with IR-induced HepG2 cells， ethanol exposure dose-dependently aggravated the above changes， but dose-dependently improved by SAL. The role of SAL in alleviating ethanol exposure-induced changes was reversed by CC. CONCLUSION Ethanol exposure can accelerate the pyroptosis of IR-induced liver cells， which can be reversed by SAL in an AMPK-dependent way.
OBJECTIVE To evaluate the bioequivalence of the test preparation （T） and the reference preparation （R） of single-dose oral vardenafil hydrochloride tablets under fasting and fed conditions in healthy volunteers. METHODS A randomized， open-ended， single-dose， two-cycle， double-cross bioequivalence trial design was adopted， and 44 subjects were enrolled in the fasting group and 62 subjects were enrolled in the postprandial group. One tablet of the T and R of single-dose oral vardenafil hydrochloride was taken in the fasting or fed condition each cycle， and venous blood was collected as required. Liquid chromatography with tandem mass spectrometry （LC-MS/MS） was used to determine the plasma concentration of vardenafil， and pharmacokinetic parameters were calculated using Phoenix WinNonlin 8.1 and SAS 9.4 software for bioequivalence evaluation． RESULTS One subject withdrew from the fasting trial due to an adverse event and 43 subjects completed the trial； one subject withdrew voluntarily from the postprandial trial and 61 subjects completed the trial. The t1/2 for the fasting single-dose oral T and R was （3.847±1.431） h and （4.110±1.515） h； the median Tmax was （0.856±0.553） h and （0.766±0.351） h； the Cmax was （30.995±17.449） ng·mL–1 and （31.319±17.010） ng·mL–1； the AUC0-t was （90.778±58.293） h·ng·mL–1 and （90.917±65.530） h·ng·mL–1； and the AUC0-∞ was （94.364±61.688） h·ng·mL–1 and （94.502±70.142） h·ng·mL–1， respectively. The statistical results of the 90% confidence intervals （CI） of the main pharmacokinetic parameters Cmax， AUC0-t and AUC0-∞ of the subjectswere 89.96%-109.82%， 94.30%-108.35% and 94.66%-108.38%， respectively， all of which were within the range of 80.00%-125.00%. The t1/2 of single-dose oral administration of T and R in the postprandial trial was （3.996±1.240） h and （4.107±1.272） h； the median Tmax was （1.880±1.267） h and （1.761±0.962） h； the Cmax was （19.769±10.736） ng·mL–1 and （20.736±15.362） ng·mL–1； the AUC0-t was （82.698±46.894） h·ng·mL–1 and （84.491±51.709） h·ng·mL–1； and the AUC0-∞ was （85.731±48.827） h·ng·mL–1 and （87.506±54.130） h·ng·mL–1， respectively. The 90% CIs of Cmax， AUC0-t and AUC0-∞ were 89.59%-108.36%， 94.10%-104.25% and 94.40%-104.15%， respectively， which were in the range of 80.00%-125.00%. CONCLUSION In the fasting and fed state， single-dose oral administration of T and R of vardenafil hydrochloride tablets have good bioequivalence.
OBJECTIVE Using CiteSpace 6.2.R6， the bibliometric and visualization analysis of phytoestrogens was conducted to summarize the current status and hot trends of phytoestrogens research， and to provide references for the subsequent in-depth research and clinical application of phytoestrogens. METHODS Relevant literatures published between 2000 and 2024 were searched in the China National Knowledge Infrastructure （CNKI）， VIP， WanFang Data （Wanfang）， Web of Science （WoS） and PubMed databases. NoteExpress software was used to screen the literatures and CiteSpace version 6.2.R6 software was applied to visualize and analyze the authors and institutional keywords. RESULTS The final analysis included 1 168 Chinese-language publications and 899 English-language articles. Professor Niu Jianzhao published the greatest number of Chinese-language publications about phytoestrogens， and Dr Alessandra Bitto emerged as the leading contributor in the English-language publications. Analysis of the international collaboration network revealed a dominant role of China in phytoestrogen research. Institutional contributions revealed that Beijing University of Chinese Medicine and the Hong Kong Polytechnic University were the most productive institutions for Chinese-language and English-language publications， respectively. Co-occurrence and cluster analyses of keywords in both language corpora revealed three main research areas： characterisation of chemical composition， evaluation of pharmacological activity and mechanistic investigation of phytoestrogens. CONCLUSION At present， research on phytoestrogens focuses mainly on their chemical composition， pharmacological effects， clinical applications， etc. It is necessary to develop and excavate the new active ingredients of phytoestrogens， and to conduct more comprehensive， in-depth and multi-dimensional research on the specific mechanisms and pathways of their estrogenic effects， in order to lay the foundation for subsequent comprehensive development and use in the clinic.
OBJECTIVE To investigate the risk of acute kidney injury （AKI） associated with vancomycin （VAN） combined with piperacillin-tazobactam and other β-lactam antibiotics in the Chinese population. METHODS A retrospective study was conducted on all patients treated with VAN at Nanjing Drum Tower Hospital from 2013 to 2019. Patients were grouped based on the β-lactam antibiotic they received as concomitant therapy. Multivariate logistic regression was used to assess the risk of drug-induced acute kidney injury （DIAKI）， and survival analysis was performed in patients with severe （grade 3 or 4 events） DIAKI. RESULTS The study involved 5 308 VAN-treated patients， with 1 871 treated with a monotherapy， 1 848 treated in a combination of carbapenems， 922 with cephalosporins or cephamycins， 363 with cefoperazone-sulbactam， and 304 with piperacillin-tazobactam （VPT）. The highest incidence of any-grade DIAKI （6.9%） and AKI （19.4%） in the VPT group. VPT regimen significantly increased the risk of DIAKI （OR： 1.774， 95% CI： 1.044-3.013， P=0.034）. Chronic kidney disease （CKD） and VAN trough concentration ≥20 mg·mL–1 were identified as risk factors for DIAKI， whereas the absence of β-lactam combination therapy was a protective factor. The cumulative incidence was significantly higher in those receiving cefoperazone-sulbactam （P=0.041）， but the multivariate Cox regression model indicated that various drug regimens did not significantly increase the cumulative incidence of severe DIAKI. Multi-infections and VAN trough concentration ≥20 mg·mL–1 were identified as risk factors for severe DIAKI. CONCLUSION While VPT is a risk factor for DIAKI when VAN combined with β-lactam drugs， it does not significantly elevate the cumulative risk for severe DIAKI events. In addition， multi-infections， CKD， and VAN trough concentration of ≥20 mg·mL–1 are risk factors for DIAKI.
OBJECTIVE To evaluate the clinical efficacy and safety of ivabradine in the treatment of chronic heart failure in patients with end-stage renal disease （ESRD）. METHODS A total of 82 ESRD patients with chronic heart failure who visited the Cardiovascular Department of the Second Affiliated Hospital of Guangzhou Medical University from January 2022 to December 2023 were included. They were divided into the observation group （ivabradine， n=40） and control group（conventional therapy， n=42）. Heart rate， brain natriuretic peptide （BNP）， and echocardiographic indicators such as left ventricular ejection fraction （LVEF）， fractional shortening （FS）， left ventricular end-diastolic diameter （LVEDD） and left ventricular end-systolic diameter （LVESD） were compared between the two groups. Multivariate ordinal logistic regression analysis was used to interpret the effective factors. RESULTS The observation group had significantly higher LVEF， and FS， and lower heart rate， BNP， LVEDD and LVESD after treatment than the control group （P<0.05）. The observation group also had significantly higher total effective rate （82.5% vs.14.3%， P<0.01） and numbers of increased dosage of beta blockers （62.5% vs. 21.4%， P<0.01）， and lower readmission rate of heart failure （25.0% vs. 64.3%， P<0.01） than the control group. Multivariate ordered logistic regression analysis showed that the use of ivabradine and LVEF were the independent factor affecting efficacy （OR=14.078， 95%CI： 3.565-55.602； OR=1.061， 95%CI： 1.006-1.120， respectively）. The incidence of hyperkalemia in the observation group after treatment was significantly lower than that of the control group （2.5% vs. 19.0%， P<0.05）. CONCLUSION Ivabradine can effectively reduce heart rate， inhibit myocardial remodeling， and improve cardiac function in ESRD patients with chronic heart failure. Close attention should be paid to the risk of renal function deterioration， hyperkalemia， and atrial fibrillation during treatment.
OBJECTIVE To establish a multidisciplinary pharmaceutical care team （MPCT） model led by resident pharmacists and to explore its role in pharmaceutical services for hospitalized patients in the nephrology department. METHODS The qualifications and professional composition of the MPCT team members were identified， and a MPCT team， startup standards and operating procedures were established. The MPCT model was carried out among hospitalized patients in the nephrology department. The Lean Management tool Six Sigma was used to improve the quality of lean projects in the MPCT model process. A performance evaluation team was created to assess the performance of MPCT team members， in order to form a virtuous loop of management mode. RESULTS We established a work model with resident pharmacists as the core and multidisciplinary clinical pharmacist teams as support. Based on the difficulty of disease and drug treatment， resident pharmacists invited relevant professional clinical pharmacists to participate in pharmaceutical monitoring. After implementing the MPCT model， the number of MPCTs initiated by resident pharmacists was 108， the average response time of MPCT pharmacists was 5.5 hours， and the problem-solving rate was 97.2%； The qualified rate of medical orders increased by 4.3 percentage points compared to the previous value （before the model was carried out）， the average length of hospital stay was shortened by 0.6 days， the average cost of medication per visit reduced by 340.1 yuan， the proportion of medication decreased by 1.7 percentage points， and the success rate of intervention increased by 5.2 percentage points； The satisfaction rate within the hospital increased to 97.7 points， and the patient satisfaction rate increased to 98.3%. CONCLUSION The MPCT model can expand the service scope of specialized resident pharmacists， improve the service level of clinical pharmacists， and promote it to resident pharmacists in other chronic disease.
OBJECTIVE To establish a platform for a precision dosing of vancomycin in the laboratory using clinical decision support system （CDSS） and hospital information system （HIS） information-based data capture. METHODS A retrospective analysis was conducted to determine the trough concentration results of patients who received vancomycin and adjusted the regimen in Beijing Tsinghua Changgung Hospital from September 2020 to December 2023. Multiple clinical decision support systems based on vancomycin C0 after drug administration and the level of AUC0-24 h prediction calculation were evaluated. A terminal CDSS was selected based on the prediction effect， and the final data source was determined. A one-click query of HIS-based personalized information data was established to predict the C0 after adjusting medication for different patient vancomycin and realize individualized medication scheme for clinical references. RESULTS A total of 157 critically ill patients were enrolled， and 230 cases of therapeutic drug monitoring （TDM） were monitored. The accuracy of predicting C0 was： JPKD>V system>Smart Dose>VCM-TDM； the correlation coefficient between the predicted AUC0-24 h and the measured vancomycin C0 was： JPKD>VCM-TDM>Smart Dose. Based on HIS system， the individual information module of the vancomycin was established， thus achieving the one-click data capture for individual patient vancomycin information on doctor workstations， nursing workstations， and pharmacist workstations. Patient-specific information was fed into the JPKD software to estimate vancomycin C0 and AUC0-24 h predictions， and individualized dosing was provided based on custom features. CONCLUSION The JPKD system is better for predicting vancomycin C0 and AUC0-24 h after adjusting the dosing regimen. Based on the HIS system of our hospital， we improved the custom module and applied the JPKD software， adjustment of vancomycin TDM-assisted individualized medication regimen can significantly improve efficacy and has good value for promotion and application in medical institutions.
Liver fibrosis is a pathophysiological process of liver damage caused by various pathogenic factors， which is characterized by the accumulation of extracellular matrix （ECM）. The abnormal elevation of reactive oxygen species （ROS） in the liver is an important trigger for liver fibrosis. Due to the limited antioxidant activity and adverse reactions， the traditional antioxidant drugs have not obtained clinically satisfactory anti-hepatic fibrosis effects. With ongoing advancements in nanotechnology and nanomedicine， the antioxidant nanomaterials that exhibit liver-targeting effect， high antioxidant properties， and superior biocompatibility are being increasingly utilized to treat liver fibrosis. This paper reviewed the antioxidant capacity and mechanism of antioxidant nanomaterials/carriers， such as liposomes， polymer nanoparticles， fullerene carbon nanomaterials， and nanozymes （metal nanozymes， metal oxide nanozymes， hybrid nanozymes）， providing a new direction in the clinical research of alleviating or even reversing liver fibrosis.
The active ingredients of traditional Chinese medicine （TCM） have anti-tumor activities in different types of tumors， with less toxic side effects. However， most of the active ingredients of TCM have low solubility， poor in vivo stability， fast metabolism， and low targeting efficiency， severely limiting their clinical application. Liposome-loaded active ingredients of TCM are an effective drug delivery strategy. This review summarized the effects of some typical types of active ingredients in TCM on various tumors， and focused upon the research progress of liposomes in improving the targeting effect， pharmacokinetic characteristics， and tumor microenvironmental response to drug release through surface modification to improve targeting， as well as their combined administration， and combined treatment strategies to improve the anti-tumor effects. The application prospects of liposome-loaded active ingredients of TCM were discussed.
Cyclin-dependent kinase （CDK） 4/6 inhibitor combined with endocrine therapy is the first-line treatment for hormone receptor-positive breast cancer. Myelosuppression， diarrhea， and liver function injury are the most common adverse effects of CDK4/6 inhibitors， while kidney injury-related adverse effects have been rarely reported. In this study， a rare adverse reaction of acute kidney injury was reported in a breast cancer patient treated with abemaciclib. Clinical pharmacists carried out pharmaceutical care， analyzed the causes of kidney injury by referring to literatures at home and abroad， and participated in the adjustment of the patient's medication regimen according to the guidelines， aiming to provide references for clinical medication safety.
