OBJECTIVE To investigate and analyze the current situation， demand， driving and hindering factors of prescription circulation in China， thus providing references for promoting prescription circulation. METHODS An online questionnaire survey was conducted on the current situation and demand of prescription circulation by convenient sampling based on the network member hospital of Chinese Medical Economic Information. RESULTS A total of 3 826 questionnaires were collected and 3 823 were valid. 43.81% of the respondents had used prescription circulation. 76.62% of respondents knew the prescription circulation. Most of the respondents used prescription circulation services 1-3 times in the past year （1 168 respondents）； 859 respondents had experienced a drug change at a social pharmacy. The circulating prescriptions were mainly chronic disease drugs. 920 respondents used prescription circulation mode to buy cold medications against fever， cough and analgesia. “Previous usage of a prescription circulation” was the primary way to spread the concept of prescription circulation. Most of the respondents had the demand （2 189 respondents， 57.26%） and willingness （2 469 respondents， 64.58%） of prescription circulation. 3 218 respondents were willing to transfer prescriptions to “social pharmacies designated by medical insurance”. The largest demand （1 465 respondents） was the use of prescription circulation to buy cold medications against fever， cough and analgesia. The most important driving factor was “saving time in hospital queues to pick up drugs”. The main hindering factors to offline prescription circulation was respondents’ concern that the supervision of pharmacies was not as strong as that of hospitals， while the main hindering factors to online prescription circulation was lack of medication guidance services. Occupation （whether it is a medical practitioner） significantly affected the awareness， use， and demand of respondents for prescription circulation. CONCLUSION The awareness rate， utilization rate and demand of prescription circulation in China are increasing. However， there is a gap between the standardization and ability level of pharmaceutical care in social pharmacies and the needs of patients. The payment of medical insurance， the supervision of drugs in the field of circulation and the safety of drug distribution are important factors influencing the development of prescription circulation.
OBJECTIVE The explore the effects of Jianpi-Zishen Formula on differentially expressed serum metabolites and metabolic pathways in MRL/lpr mice with systemic lupus erythematosus mice （SLE）. METHODS Twelve MRL/lpr mice with SLE were randomly divided into model group， and traditional Chinese medicine （TCM） group， and 6 C57BL/6 mice were as the control group. Through LC-MS/MS， differentially expressed serum metabolites of Jianpi-Zishen Formula responsible for treating SLE were identified through the principal component analysis （PCA）， partial least squares discriminant analysis （PLS-DA） and orthogonal partial least squares discriminant analysis （OPLS-DA）， with the criteria of variable importance projection （VIP） >1， P<0.05 in the t test and fold change （FC） ≥ 1.5 or ≤0.5. Online databases， including the HMDB， Massbank， LipidMaps， mzcloud， Kyoto Encyclopedia of Genes and Genomes （KEGG） and the self-built standard library of metabolism （Suzhou Panomix Biomedical Tech Co.， Ltd.） were used for identification. MetaboAnalyst software package was used for functional pathway enrichment and topology analysis of the screened differentially expressed metabolites. The enriched pathways were visualized using the KEGG Mapper tool to display the differentially expressed metabolites and pathways. RESULTS A total of 338 metabolites were detected. Compared with the normal group， there were 33 differentially expressed metabolites between the model group and the normal group， with 22 up-regulated and 11 down-regulated metabolites. A total of 31 differentially expressed metabolites were found between the model group and the TCM group， involving 18 up-regulated and 13 down-regulated metabolites. After treatment with Jianpi-Zishen Formula， the contents of differentially expressed metabolites， including the 3-hydroxy-2-aminobenzoic acid， sphingosine 1-phosphate and myristic acid were significantly up-regulated， and raffinose and ethyl 4-acetylbutyrate were significantly down-regulated. KEGG enrichment analysis showed 49 metabolic pathways with significant differences， and the top five pathways were cell burial， pentose phosphate pathway， melanin production， galactose metabolism， and Fcγ receptor-mediated phagocytosis. CONCLUSION The therapeutic effects of the Jianpi-Zishen Formula in treating SLE may be associated with significant alterations in metabolites like 3-hydroxy-2-aminobenzoic acid， sphingosine-1-phosphate， myristic acid， raffinose， and ethyl 4-acetylbutyrate. These metabolites are involved in the regulation of metabolic pathways， including efferocytosis， the pentose phosphate pathway， melanogenesis， galactose metabolism， and Fcγ receptor-mediated phagocytosis.
OBJECTIVE To investigate the intervention effect and mechanism of Shaoyao Gancao Decoction （SGD） on rats with muscle spasm after spinal cord injury （SCI） by regulating plasma exosomal miR-125b-5p and inhibiting the expressions of inflammatory factors interleukin 6 （IL-6） and interleukin 16 （IL-16）. METHODS The effective components of SGD were extracted and determined. A SCI model was established in 65 sprague dawley （SD） rats， and they were randomly divided into the model control group， SGD group， and positive control group， with 15 rats in each group. Rats were subjected to oral gavage of deionized water， SGD， and baclofen in the three groups， respectively. On 14 days of oral gavage， the Basso， Beattie and Bresnahan locomotor rating scale （BBB） score was graded. Plasma exosomes were extracted in the model control group and SGD group， and miRNAs with the regulatory effects on IL-6 and IL-16 were screened and validated by real-time quantitative polymerase chain reaction （RT-qPCR）. Dual-luciferase reporter assay was conducted to validate the correlation of the screened plasma exosomal miRNA with IL-6 and IL-16. Primary neurons of SCI rats were cultured in vitro and identified. After treatment of SGD and knockdown of miR-125b-5p， expression levels of IL-6 and IL-16 were examined. In addition， SCI rats treated with SGD or overexpression of miR-125b-5p were harvested to measure the expression levels of IL-6 and IL-16 by Western blot. RESULTS A total of 53 active ingredients in SGD were identified， with glycyrrhizic acid and paeoniflorin having the highest contents. The BBB score in SCI rats indicated the presence of functional impairment， but improved by oral gavage of baclofen or SGD. Western blot results showed upregulation of IL-6 and IL-16 in the model control group. The morphology and markers of plasma exosomes under transmission electron microscopy （TEM） were all positive. The screened miR-125b-5p had a regulatory effect on IL-6 and IL-16， which was overexpressed in the SGD group. Dual-luciferase reporter assay confirmed that miR-125b-5p could directly regulate IL-6 and IL-16. In vitro cultured primary neurons of SCI rats， SGD treatment significantly upregulated plasma exosomal miR-125b-5p and downregulated IL-6 and IL-16 in the spinal cord after SCI. CONCLUSION SGD actively intervenes SCI by upregulating plasma exosomal miR-125b-5p and downregulating IL-6 and IL-16.
OBJECTIVE To investigate the effects of Scutellaria baicalensis polysaccharides on the gut microbiota and endogenous metabolites in rats with chronic obstructive pulmonary disease （COPD）， and to explore the mechanism of Scutellaria baicalensis polysaccharides in treating lung diseases. METHODS The COPD model in rats was created by exposure to cigarette smoking， and the therapeutic effect of Scutellariabaicalensis polysaccharides was evaluated through examining lung function， histopathology， inflammation and tight junction protein levels in lung tissue， as well as changes in vascular remodeling factors. Using 16S rRNA sequencing and ultra-high-performance liquid chromatography-tandem mass spectrometry （UPLC-MS/MS）， changes in rat gut microbiota and metabolites were detected. Spearman correlation analysis was performed to identify the relationship between gut microbiota and metabolomics in COPD rats. RESULTS Compared with the model group， Scutellariabaicalensis polysaccharides significantly improved lung function in COPD rats （P<0.05）， and alleviated lung， intestinal， and tracheal tissue damages， reduced vascular remodeling and airway remodeling， and decreased mRNA levels of IL-6 and TNF-α （P<0.01）， but increased mRNA levels of Claudin and Occludin （P<0.01）. The 16S rRNA sequencing results showed that Scutellaria baicalensis polysaccharides could significantly increase the abundances of Treponema， Lactobacillus， Muriaculaceae， and Romboutsia （P<0.01）. Fecal metabolomics results showed that Scutellariabaicalensis polysaccharides alleviated lung diseases by affecting phenylalanine metabolism and the biosynthesis pathways of phenylalanine， tyrosine， and tryptophan. Spearman correlation analysis showed that the abundance of UCG-005 was negatively correlated with the levels of metabolites tryptophan and indoleline. CONCLUSION Scutellaria bacalensis polysaccharide relieves COPD by regulating the intestinal microbiota composition and phenylalanine metabolism， as well as the phenylalanine， tyrosine and tryptophan biosynthesis pathways.
OBJECTIVE To explore the effect of Coptis chinensis polysaccharide （CCPs） on alleviating renal injury by inhibiting epithelial mesenchymal transformation （EMT） and pyroptosis of renal tubular epithelial cell in diabetic nephropathy （DN） mice. METHODS Db/db mice were divided into the model group， low-dose and high-dose CCPs groups （200 mg·kg–1 and 400 mg·kg–1） and englipzin group （10 mg·kg–1）， and db/m mice were included in the normal group， with 10 mice in each group. The intervention lasted for 12 weeks. Biochemical indicators， such as blood urea nitrogen （BUN）， serum creatinine （SCr）， 24 h urinary total protein quantification （24 h-UTP）， cystatin C （CysC） and N-acetyl-β-D-glucose （NAG） were detected. Pathological morphology of renal tissue was observed by hematoxylin-eosin （H&E） and Masson’s trichrome staining， so as to evaluate the effect of CCPs on alleviating renal injury. The mRNA expressions of EMT markers， such as fibronectin （FN）， α-smooth muscle actin （α-SMA） and E-cadherin （E-Cad） in renal tissue were detected by real-time qPCR. Proinflammatory factors related to pyroptosis， such as interleukin-1β （IL-1β）， IL-6 and IL-18 in serum and renal tissue were detected by enzyme-linked immunosorbent assay （ELISA）. Proteins expressions related to pyroptosis， such as NOD-like receptor protein 3 （NLRP3）， apoptosis-associated spot-like protein （ASC） and Caspase-1 in renal tissue were detected by Western blot. RESULTS Compared with model groups， mice in the low-dose and high-dose CCPs groups had significantly lower BUN， SCr， 24 h-UTP， CysC and NAG （P<0.01）， alleviated pathological morphology of renal tissue， downregulated mRNA levels of FN and α-SMA （P<0.05， P<0.01）， and upregulated mRNA level of E-Cad （P<0.01）. In addition to the IL-6 level in mosque renal tissue of low-dose CCPs group （P>0.05）， contents of IL-1β， IL-6 and IL-18 in serum and renal tissue were significantly reduced in other groups （P<0.05， P<0.01）. Protein levels of NLRP3， ASC and Caspase-1 in mice renal tissue of low-dose and high-dose CCPs groups were significantly downregulated （P<0.05， P<0.01）. CONCLUSION CCPs can inhibit the EMT and pyroptosis of renal tubular epithelial cell in DN mice， which may be a potential mechanism of alleviating renal injury.
OBJECTIVE To investigate the correlation of virulence factors carriage， expression and virulence of carbapenem-resistant Pseudomonas aeruginosa （CRPA） type Ⅲ secretion system （T3SS） with drug resistance in clinical isolates and molecular epidemiologic patterns. METHODS Forty-five strains of CRPA isolated from The First Affiliated Hospital of Hebei North University from April 2022 to February 2023 were collected. Drug sensitivity testing was performed using the micro-broth dilution method. The presence of four T3SS virulence factors （exoU， exoY， exoS， exoT） and β-lactamase genes in the T3SS of CRPA strains， as well as strain typing （ST） of the CRPA strains were determined using second-generation high-throughput sequencing. The virulence level of the strains was assessed using the Galleria mellonella virulence test. The relative expression levels of virulence factors were detected by quantitative reverse-transcription polymerase chain reaction （qRT-PCR）. RESULTS The results showed that the highest detection rate of T3SS virulence factors was exoT （100%）， followed by exoS and exoY （88.9% for both）， and exoU （11.1%）. Eighteen β-lactamase genes were detected， dominated by blaPDC-374， blaOXA-101， blaOXA-847， blaPER-1 and blaOXA-50. The study identified 22 ST phenotypes， with ST244 as the most prevalent one （31.1%）. In the Galleria mellonella virulence test， five strains showed a high virulence， 25 strains showed a medium virulence， and 15 strains showed a low virulence. There were significant differences in resistance rates of CRPA strains with different virulence levels to piperacillin/tazobactam， levofloxacin， and amikacin （P<0.05）. qRT-PCR showed a correlation between the strain virulence level and the expression levels of virulence genes. CONCLUSION The virulence genotypes of clinically isolated CRPA strains in our hospital are mainly exoY+/exoS+/exoT+/exoU-， showing a higher resistance to aztreonam， meropenem and levofloxacin. Polymyxin B is an effective drug against most isolates. Strains of type ST244 that produce blaOXA-101 and blaPER-1 enzymes， are locally spread to be highly concerned. All four virulence factors carried and expressed in T3SS are associated with strain virulence levels and antibiotic resistance.
OBJECTIVE To establish a method for rapid detection and identification of the various compounds in Petroselinum crispum （Mill.） Fuss fruits by the ultra-performance liquid chromatography-Q Exactive Orbitrap mass spectrometry （UPLC-QE-Orbitrap-MS）. METHODS The data were collected by UPLC-QE-Orbitrap-MS using an electrospray ionization source in the mode of simultaneous positive and negative ion acquisition. The raw data were analyzed using Progenesis QI v3.0 software. Characteristic peaks based on the exact mass number， secondary fragmentation， and isotopic distributions of the compounds were structurally identified by the TCM specimen database LuMet-TCM and Herb database. RESULTS One hundred and ninety-five compounds were identified from fruits of Petroselinum crispum （Mill.） Fuss， including 67 phenylpropanoids， 38 terpenoids， 27 flavonoids， 12 phenolic compounds， 12 carboxylic acids and their derivatives， 11 alkaloids， 9 sugars and their glycosides， 1 amino acid and peptide compounds， and 18 other compounds. CONCLUSION UPLC-QE-Orbitrap-MS can quickly identify the components in fruits of Petroselinum crispum （Mill.） Fuss. This study provides reliable data for quality control and scientific reference for further comprehensive utilization of resources and product development.
OBJECTIVE To evaluate the cost-effectiveness of tislelizumab combined with first-line chemotherapy for treating advanced or metastatic esophageal squamous cell carcinomas （ESCC） from the perspective of Chinese health system. METHODS The Markov model was constructed for cost-effectiveness analysis. The research time limit was 10 years， and the model period was 3 weeks. The clinical data were derived from the phase Ⅲ clinical trial RATIONALE-306. The cost data were derived from the http://yaozhi.com， the medical insurance bureau and the published literatures. The utility data were derived from the literatures. The incremental cost-effectiveness ratio （ICER） was compared with the willingness to pay threshold to determine the economy of this scheme， and the results were subjected to sensitivity analysis and scenario analysis. RESULTS In the total population， and programmed death ligand-1 tumor area positivity score （PD-L1 TAP）≥10% and PD-L1 TAP<10% subgroups， the ICERs of tislelizumab combined with chemotherapy versus chemotherapy were 113 990.29 yuan/quality-adjusted life year （QALY）， 134 581.6 yuan/QALY and 137 115.24 yuan/QALY， respectively， which were lower than 3 times of per capita gross domestic product in China in 2023， showing an economical efficiency. Sensitivity analysis results showed that the model results were stable. The results of scenario analysis showed that in the context of different research time limits and different utility values， tislelizumab combined with chemotherapy was more economical than chemotherapy alone. CONCLUSION Compared with chemotherapy alone， the first-line treatment of advanced or metastatic ESCC with tislelizumab combined with chemotherapy is economical.
OBJECTIVE To validate the rationality of increasing the reference interval of plasma amisulpride （320-600 ng·mL-1） in real clinical applications for treating schizophrenia by analyzing the efficacy score and adverse events via the clinical global impression （CGI） and the Therapeutic Drug Monitoring （TDM） data at discharge. METHODS TDM results and dose adjustments of amisulpride in schizophrenia patients from January 2022 to December 2023 in The Affiliated Brain Hospital of Guangzhou Medical University were retrospectively analyzed. Plasma concentrations of amisulpride and TDM results at discharge before and after adjustments were compared. RESULTS TDM data of 430 patients （103 cases of withdrawal during the treatment， and 327 cases of discharged with medication） were included. Among them， 269 schizophrenia patients had the plasma amisulpride concentration of （390.17±246.01） ng·mL-1 recorded in the TDM data at discharge， with only 40.52% of the plasma concentration concentrated in the therapeutic reference range （100-320 ng·mL–1） recommended by the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie （AGNP）. 76.21% of patients had the plasma amisulpride concentration ranged at 100-600 ng·mL–1. After medication adjustment， 70 cases showed a significant increase of 14.29% in TDM within the range of 320-600 ng·mL–1， with the increase group （n=35） having the greatest increase of 28.57% in the >320 ng·mL–1 range and the decrease group （n=34） having the greatest decrease of 29.41% in the >600 ng·mL–1 range. CONCLUSION In real-world clinical applications， plasma amisulpride concentration ranged 320-600 ng·mL–1 is efficacy and safe. Our data further validate the rationale for the reference range of 100-600 ng·mL–1 of plasma amisulpride concentrations for treating schizophrenia.
OBJECTIVE To evaluate the influence of polypharmacy on hospitalization resource in elderly patients with hypertension， coronary heart disease， cerebrovascular disease， or diabetes mellitus. METHODS We conducted a retrospective cohort study using data from the Beijing health insurance database from July to September 2017. The study included adults aged 65 years and above who have been diagnosed with one of hypertension， coronary heart disease， cerebrovascular disease， or diabetes mellitus on the initial admission. Polypharmacy was defined as the concurrent use of five or more medications at enrollment. Multiple regression analyses were performed to assess the association between polypharmacy and the utilization of hospitalization resources （risks of hospitalization， inpatient medication costs， and length of hospital stay）. RESULTS A total of 405 608 patients were enrolled in the study， including 291 671 （71.91%） with hypertension， 220 363 （54.33%） with coronary heart disease， 95 101 （23.45%） with cerebrovascular disease， and 133 070 （32.81%） with diabetes mellitus. After adjusting for variants， the use of polypharmacy was not associated with an increased risk of hospitalization （OR 1.09， 95% CI 0.95-1.26， P=0.23）， increased inpatient medication costs （marginal change 16 897.15， 95% CI 15 324.38-18 629.47 yuan， P=0.97）， nor prolonged length of hospital stay （marginal change 3.98 days， 95%CI 3.68-4.30 days， P=0.79）. CONCLUSION Polypharmacy does not contribute to an increased hospitalization resource utilization in elderly patients with hypertension， coronary heart disease， cerebrovascular disease， or diabetes mellitus. These results have important implications for policymakers and healthcare providers to evaluate the impact of polypharmacy on the care of elderly patients comprehensively.
OBJECTIVE To investigate the effects of tranexamic acid on perioperative blood loss and safety in total knee arthroplasty （TKA）. METHODS A retrospective analysis was conducted on 1，026 patients who underwent unilateral TKA in the Second Affiliated Hospital of Soochow University from October 1， 2020 to December 31， 2022. These patients were divided into three groups according to the usage of tranexamic acid： 1 g intravenous infusion group， 2 g intravenous infusion group， and combined group （1 g intravenous infusion + 1 g local intra-articular injection）. Intraoperative blood loss， postoperative drainage volume， perioperative total blood loss， changes of hemoglobin and hematocrit levels before and after operation， blood transfusion rate and incidence of postoperative thrombosis were compared among the three groups. RESULTS Compared to the other two groups， intravenous infusion of 2 g tranexamic acid significantly reduced intraoperative bleeding， total perioperative blood loss， maximum decrease in hemoglobin， and maximum decrease in hematocrit （P<0.05）. There was no significant difference in postoperative drainage volume between the intravenous infusion groups and the combined group. There were no significant differences in the rate of blood transfusion， the incidence of postoperative deep venous thrombosis and postoperative intramuscular thrombosis between the intravenous infusion groups and the combined group. The combined treatment of 1 g intravenous infusion + 1 g local intra-articular injection significantly shortened the length of hospital stay （P<0.05）. CONCLUSION Intraoperative intravenous infusion of 2 g tranexamic acid during TKA can effectively reduce the total perioperative and intraoperative blood loss without increasing the risk of postoperative thrombosis， showing a good safety.
OBJECTIVE To understand the occurrence of potentially clinically significant drug-drug interactions （pcsDDIs） in elderly inpatients and the factors affecting them， thus providing an important basis for the clinical drug safety in elderly patients. METHODS Discharged elderly patients （≥65 years old） in the electronic medical records system of Huaibei People’s Hospital from May 1， 2022， to May 20， 2022 were retrieved. The occurrence of pcsDDIs was assessed by the inpatient medical orders based on the International Consensus List of pcsDDIs in Older People. Risk factors for pcsDDIs were analyzed by logistic regression. RESULTS A total of 856 elderly patients with a median age of 74 years were included， of whom 413 （48.2%） had at least 1 pcsDDI. A concomitant use of more than 2 potassium-protecting drugs （24.4%） was the dominant pcsDDI. There were 19 single factors affecting pcsDDIs， and multifactorial logistic regression revealed that history of drug allergy， total number of discharge diagnoses， age-corrected Charlson comorbidity index （aCCI）， comorbid cerebral infarction， comorbid hypertension， comorbid myocardial infarction， comorbid coronary artery disease， comorbid cardiac insufficiency， comorbid atrial fibrillation， number of Western medication varieties， and use of biologics were the risk factors. CONCLUSION The incidence of pcsDDIs in the medication of hospitalized elderly patients is high. The risk of drug interactions should be highlighted to strengthen the monitoring of the rational use of medication in elderly patients， and optimize medical resources.
OBJECTIVE To investigate the risk factors of hepatitis B virus （HBV） reactivation following transarterial chemoembolization （TACE） combined with targeted immunotherapy in patients with hepatocellular carcinomas （HCC）. Additionally， to observe the impact of HBV reactivation on relevant clinical indicators. METHODS Clinical data from HCC patients who underwent TACE combined with targeted immunotherapy were collected between January 1， 2022， and December 31， 2023. The correlation of gender， age， preoperative serum alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total bilirubin （TBIL）， albumin （ALB）， prothrombin time （PT）， Alpha-fetoprotein（AFP） and HBV-DNA levels with HBV reactivation was analyzed. Additionally， we explored the effect of HBV reactivation on these clinical indicators. RESULTS Among the 129 HCC patients treated with TACE and targeted immunotherapy， 26 （20.2%） experienced HBV reactivation. A significant difference in HBV-DNA levels was observed between the reactivated and non-reactivated groups （P<0.05）. Notably， an HBV-DNA level of less than 1 000 copies was identified as a protective factor against HBV reactivation in HCC patients treated with TACE and targeted immunotherapy （P<0.05）. Additionally， there were significant differences in the changes in ΔAST and ΔALB levels between the reactivated and non-reactivated groups （P<0.05）， while no significant differences were observed in the changes in ΔALT， ΔTBIL， and ΔPT （P>0.05）. CONCLUSION TACE combined with targeted immunotherapy can lead to HBV reactivation in patients with HBV-related HCC， particularly in those with high preoperative HBV-DNA levels. Sex， age， ALT， AST， TBIL， ALB， and AFP do not show significant correlations with HBV reactivation following the combined treatment. Patients experiencing HBV reactivation exhibit increased AST levels and decreased ALB levels， with a high preoperative HBV-DNA load identified as a major risk factor for HBV reactivation after treatment.
OBJECTIVE To evaluate the effect of medication routes for postoperative intracranial infections under the national essential drug and centralized procurement policies， so as to provide references for the promotion of medication routes. METHODS The medical records of 298 patients diagnosed with postoperative intracranial infection and admitted to the Neurosurgery Department in The First Affiliated Hospital of Guangxi Medical University from August 2021 to September 2023 were collected. The patients were divided into two groups according to postoperative intracranial infection alone （simple infection group） and postoperative intracranial infection combined with other infections （co-infection group）. SPSS24.0 software was used for data analysis. The use of antibiotics， average length of stay， average hospitalization costs and other indicators were compared before and after the implementation of medication routes. RESULTS A total of 96 patients were included in the simple infection group and 202 patients were included in the co-infection group. After the implementation of medication routes， the average number of antibacterial drugs in the two groups significantly decreased to 2.75 and 4.04， respectively（P<0.05）. The proportion of national essential drugs increased to 48.76% and 58.68%； and the proportion of centrally purchased drugs increased to 35.44% and 65.69%， respectively. The proportion of the frequency of first-line recommended drugs for intracranial infection increased， such as vancomycin and meropenem. The top 5 most frequently used essential drugs/centrally purchased drugs in the simple infection group and the top 15 in the co-infection group were basically the same before and after the implementation of medication routes. Vancomycin was the dominant non-essential drug/centrally purchased drug in the two groups before and after the implementation of medication routes. There were no significant differences in the consumption of antibiotics and defined daily doses of antibiotics in the sample wards before and after the implementation of medication routes. After the of medication routes， the average length of hospital stay was 17.57 days in the simple infection group （P＞0.05） and 22.29 days in the co-infection group （P<0.05）. The total hospitalization cost of the simple infection group decreased by 14.70% （P＞0.05）， and the drug cost and antibacterial drug cost decreased by 32.14% and 28.02% （P<0.05）， respectively. The total hospitalization cost， drug cost and antibacterial drug cost of the co-infection group significantly decreased by 17.38%， 34.10% and 42.90% respectively （P<0.05）. CONCLUSION Clinical medication routes have achieved remarkable results in standardizing medication regimens， controlling medical costs， and alleviating economic burden of patients.
OBJECTIVE To summarize and analyze the refined construction and practical experience of pediatric pharmacy clinic using the medicine referral collaboration model in the Peking University Third Hospital， and to provide references for the similar type of clinics. METHODS The medicine referral collaboration model was constructed to improve the hardware and software conditions of the pediatric pharmacy clinic and the refined pharmacy service model. We collected data from patients attending the clinic， pharmacy outpatient service data， and assessed the effect of inhalation device patient education and service satisfaction. RESULTS One year after the opening of the pediatric pharmacy clinic in our hospital， a total of 700 children and their families visited the clinic， with an average of 58 visits per month. A total of 19 physician conducted referrals. Totally 296 （42.29%） cases completed the charge for pharmacist services. The median duration of visit was 11 minutes， with 13 mins in medical visit with special device education， and 8 minutes without education. Totally 79 （11.83%） cases completed repeated visits. The predominant disease was respiratory， and the most frequent teaching was about the use of inhalation devices. After visiting the pediatric pharmacy clinic， the error rate of using the device was significantly reduced， and the number of teachings on expiration， inhalation and breath-holding was significantly reduced （P<0.05）. Healthcare professionals and families of the children satisfied the services provided by the pediatric pharmacy clinic. CONCLUSION The pediatric pharmacy clinic of our hospital has adopted the collaborative model of medicine referral and constructed a more complete pharmacy service process and refined service content， which is effective and provides a useful reference for the construction of the similar type of clinic. In the future， we will gradually build the service guidelines and pathways of pediatric subspecialty pharmacy clinic， improve the informationization level to ensure the efficiency of consultation， and promote the high-quality development of pediatric pharmacy clinic.
OBJECTIVE To explore the impact of multidisciplinary team （MDT） care involving resident pharmacists on the 10-year risk score of atherosclerotic cardiovascular disease （ASCVD） in patients with diabetes mellitus. METHODS Retrospective analysis of 460 non-ASCVD patients with diabetes mellitus admitted twice or more from January 2020 to December 2023 was conducted， including 186 patients receiving MDT care （MDT group） participated by resident pharmacists， and 274 patients receiving routine care （control group）. Propensity score matching analysis was used to balance two groups of bias， and 109 pairs were successfully matched. The changes in ASCVD risk scores， the proportion of patients reaching LDL-C goal， hemoglobin A1c （HbA1c）， the rate of taking statins among high-risk populations and smoking cessation rate were compared to evaluate the effectiveness. RESULTS There was a significant difference in ASCVD score change between the MDT and control groups ［0.00 （-4.60， 3.40） vs. 1.40 （-1.20， 4.50）， P=0.022］. The proportion of patients reaching LDL-C goal in the MDT group was significantly higher than that of the control group （78.9% vs.21.1%， P=0.002）.HbA1C was significantly lower than that in the control group （P<0.01）. The rate of taking statins among high-risk groups was significantly higher than the control group （62.5% vs.12.9%， P<0.01）. There was no significant difference in smoking cessation rates. CONCLUSION The MDT involving resident pharmacists can delay the increase of the risk score of ASCVD in diabetes.
OBJECTIVE To explore the concept， measurement and current status of medication literacy （ML） among Chinese residents. METHODS This study involved 30 001 eligible participants from a national survey conducted in China in 2023. Potential profiling of the ML level of Chinese residents was performed based on the Medication Literacy Scale. Regional and demographic differences were explored through the Chi-square test. RESULTS Latent profile analysis showed that ML was categorized into high level （13.3%）， medium-to-high level （46.4%）， low-to-medium level （27.2%）， and low level （13.1%）. There was a high percentage of residents with medium-to-high ML level and above in Xinjiang Uygur Autonomous Region， Macao Special Administrative Region， Shandong Province， Zhejiang Province， Jiangsu Province， Yunnan Province and Shanghai. There was a significant distribution of ML among different categories of residents classified by gender， age， body mass index （BMI）， ethnicity， religious beliefs， place of residence， health insurance status， per capita monthly income， chronic diseases， marital status， occupational status， education level， family type， and drinking and smoking status （P<0.05）. CONCLUSION There are significant differences in ML among residents of different regions and demographic characteristics. Improving ML requires a whole-of-society approach in which the ecosystem around the target population is brought together to promote safe， effective， economical， and appropriate drug treatment.
Estrogen has been used in protective therapy for neurodegenerative diseases， but its clinical application is constrained due to the associated carcinogenic risk. Icariin， the primary bioactive compound found in the Epimedium， has been scientifically demonstrated to exhibit estrogenic properties. It can regulate the estrogen levels or the signal transduction of estrogen receptors， with low toxicity and mild adverse effects. It has shown good neuroprotective effects on neurological diseases like Alzheimer’s disease， major depressive disorder， multiple sclerosis， and Parkinson’s disease. This article presented a comprehensive review of recent research on the estrogen-like neuroprotective effects of icariin in the nervous system， thus providing references for the development of new drugs for nervous system diseases.
