Derived from healthy human blood， human albumin is widely applied for treating critically and seriously ill patients. However， inappropriate off-label and irrational use of human albumin has remained prevalent， resulting in significant wasting of valuable drug resources. Currently， there is an acute dearth of authoritative guidelines or consensus on clinical application management of human albumin in China. To address this wide gap， a multidisciplinary panel of experts， under the auspices of Committee of Hospital Pharmacy of Chinese Pharmaceutical Association， has collaborated on developing a comprehensive consensus for standardizing management measures and providing guidance for rational utilization of human albumin. This consensus focused upon eight major aspects of clinical application management， including supply management， formulating clinical application standards， management of off-label drug use， training in rational usage， management of prescription sessions， prescription review processes， informatization management and patient education regarding medication usage.

Osteoporosis has been the most prevalent bone disease. It is characterized clinically by systemic low bone mass and microstructural damage to bone tissue， resulting in heightened vulnerability to fractures due to greater bone fragility. With a rapid aging of society， the prevalence of osteoporosis has markedly spiked. However， its public awareness， diagnostic rate and treatment level remain low. Osteoporotic fractures carry severe consequences， particularly among elders， leading to disability and even death. Consequently， osteoporosis and associated fractures have emerged as critical public health issues in China. Anti-osteoporosis agents may be divided into anti-resorptives， anabolics of stimulating bone formation and dual-acting drugs. Based upon the latest clinical trials and drug application status for osteoporosis， a multidisciplinary panel of experts assembled by Hospital Pharmacy Committee of Chinese Pharmaceutical Association has collaborated to develop this consensus for standardizing rational drug dosing for improved patient outcomes and satisfactions.

Glucokinase agonist dorzagliatin is a new oral antidiabetic drug independently developed in China， which provides a new drug option for type 2 diabetic patients newly diagnosed or poorly controlled with metformin. In order to standardize the clinical application of dorzagliatin and deepen the understanding of medical workers on the patient choice， usage and dosage， drug interactions， and adverse reactions， led by Beijing Hospital， the National Center for Gerontology， Geriatric Pharmacy Professional Committee of China Medical Education Association， and Hospital Pharmacy Professional Committee of Chinese Pharmaceutical Association organized relevant clinical medicine， pharmacy and evidence-based experts to develop the consensus after three rounds of expert opinion collection and thorough discussion by using the Delphi method based on evidence-based evidence and clinical practice. A total of 9 recommendations were formulated， which will provide reference for the rational use of dorzagliatin in clinical practice.

The use of hemostatic drugs during peri-operative period is an important measure to reduce blood loss and promote postoperative rehabilitation. Meanwhile， the improper use of hemostatic drugs may increase the risk of thromboembolic disease and disseminated intravascular coagulation. This consensus is aim to regulate the rational use of hemostatic drugs during peri-operative period. Based on the latest evidence of evidence-based medicine and suggestions from pharmaceutical and clinical experts， this consensus states the mechanism， clinical application suggestions and pharmaceutical care of commonly used non-blood hemostatic drugs during peri-operative period， which doesn’t contain blood products. The purpose of this work is to provide reference for clinicians and surgical pharmacists to rationally use hemostatic drugs during peri-operative period.

In recent years， with a rapid development of subcutaneous drug delivery techniques， more and more antineoplastic monoclonal antibodies of existing intravenous agents have been approved for subcutaneous dosing. Pharmaceutical manufacturing， pharmacokinetic characteristics， clinical efficacy and safety， clinical rational use and pharmaceutical management of innovative subcutaneous antineoplastic drugs have attracted growing attention. However， there is still a global lack of normative guidance for innovative subcutaneous antineoplastic drugs. Therefore， Hospital Pharmacy Specialty Committee of Chinese Pharmaceutical Association organized domestic experts to propose the definition of innovative subcutaneous preparations of antineoplastic drugs based upon existing resources of evidence-based medicine and clinical drug dosing experiences. Recommendations were offered on unique characteristics， clinical rational use， pharmaceutical management and care of innovative subcutaneous antineoplastic drugs.

With the highest global disease burden， atopic dermatitis （AD） is a chronic inflammatory skin disease requiring positive treatment and long-term management. In the past， topical corticosteroids （TCS）， topical calcineurin inhibitors （TCI） and systemic immunosuppressants acted as major treatments for AD. Due to patient concerns of adverse reactions of TCS and traditional immunosuppressants， as well as uneven medical levels among different regions， clinical therapy of AD， especially systemic therapy of moderate-to-severe AD， often faces the problems of delayed initiation and poor patient compliance. Recently targeted drugs such as biologics and Janus kinase （JAK） inhibitors have been successively approved and systemic therapy for AD has gradually improved. However， due to relatively limited clinical application experiences of these drugs， drug selection， drug timing， tapering and withdrawing， adverse reaction management and other issues have brought new challenges to clinical therapy. With the introduction of the concept of “treat-to-target”， AD therapy has emphasizes primary patient needs， guidance of therapy goal and individualized management. Therefore therapeutic drug dosing and patient compliance management have become important factors affecting the “treat-to-target”. And pharmaceutical care plays a growingly prominent role in the management of AD therapeutic drugs. This consensus was intended to standardize drug use in AD management， summarize key points of pharmaceutical care， ensure drug safety and improve patient medication compliance， thereby improving the therapy outcomes and promoting the quality of AD therapy management in China.

As a polymer material with a three-dimensional network structure， hydrogel has excellent properties of hydrophilicity， flexibility and swelling. Also it has decent biocompatibility and degradability. Therefore hydrogels have great potential applications in such biomedical fields as drug delivery and tissue scaffolds. Summarizing the latest domestic and foreign literatures， this review introduced different types of hydrogels responsive to temperature， pH， redox， enzyme， electricity and multiple factors. The applications of hydrogels in biomedicine included tissue engineering， drug carrier， dressing， sensor and 3D cell culture.

OBJECTIVE To evaluate the advantages and hazards of denosumab vs. zoledronic acid （ZA） in bone protection for breast cancer and provide evidence-based proof for clinical decision-making. METHODS Health technology assessment （HTA） related websites， including PubMed， WanFang， Cochrane Library and CNKI， were systematically searched. The systematic review/Meta-analysis and pharmacoeconomic evaluation on denosumab and ZA for modified bone therapy in breast cancer were included. According to the inclusion and exclusion criteria， two reviewers independently identified the literature， extracted the data and assessed the quality of the included studies， and then performed qualitative description and comparison of the results. RESULTS Six systematic review/Meta and five pharmacoeconomic evaluation were included. Compared with ZA， denosumab was more effective in delaying the time of first occurrence and recurrence of skeletal-related events （SREs）， reducing the incidence of SREs， and preventing pain in breast cancer with bone metastases. Denosumab reduced the fracture rates in postmenopausal breast cancer treated with aromatase inhibitors， while ZA did not show the effect. Compared with ZA， the adverse effects of denosumab were less severe inedema， pyrexia， renal failure and bone pain. However， denosumab may promote the occurrence of osteonecrosis of jaw. Denosumab may have more cost-effectiveness advantages than ZA in domestic and international medical settings. CONCLUSION Compared with ZA， denosumab is safer， more effective and more economical in bone care of breast cancer.

Multidrug-resistant Pseudomonas aeruginosa has become one of the common pathogens of nosocomial infections. It can simultaneously develop resistance to common antibiotics through multiple resistance mechanisms. Increasing treatment difficulties and patient mortality significantly， it has become a global public health challenge. This review focused upon the epidemiological features and risk factors of Pseudomonas aeruginosa infection， the resistance characteristics to commonly used antibiotics and analyzes the sensitivity criteria and clinical applications of new antibiotics against multidrug-resistant Pseudomonas aeruginosa including ceftolozane/tazobactam， ceftazidime/avibactam， imipenem-cilastatin/relebactam and cefiderocol. It may provide references for clinical applications.

OBJECTIVE To explore the inhibitory effects and mechanisms of Sanwu Huangqin Decoction （SWHD） on acute inflammation based upon zebrafish inflammatory models. METHODS CuSO₄ immersion， tail transection and lipopolysaccharide （LPS） yolk injection zebrafish models were set up for evaluating the acute anti-inflammatory effects of SWHD. Zebrafish larvae were divided into four groups of control， model， positive （10 μg·mL^–1 dexamethasone） and SWHD treatment （100/200/300 μg·mL^–1）. Aggregation of neutrophils in injured area of zebrafish was observed by fluorescence. In LPS-induced inflammation model， hematoxylin-eosin （HE） stain was utilized for observing the changes in the number of inflammatory cells in zebrafish. Quantitative reverse-transcription polymerase chain reaction （qRT-PCR） was employed for measuring the transcript mRNA levels of inflammation-related genes and lactate kit for detecting lactate concentration in zebrafish. RESULTS As compared with model group， SWHD dosing blunted abnormal neutrophil recruitment to inflamed sites. The survival rate of LPS-induced zebrafish was significantly elevated after dosing of SWHD. Significantly elevated lactate level， up-regulated mRNA expressions of lactate dehydrogenase A （LDHA） and interleukin-10 （IL-10） and down-regulated mRNA expressions of NF-κB， IL-6 and TNF-α were also observed. CONCLUSION SWHD may effectively suppress neutrophil aggregation to alleviate acute inflammatory process through regulating the LDHA-mediated NF-κB signaling pathway.

OBJECTIVE To evaluate the comprehensive clinical value of domestic and imported montelukast sodium （MS） in the treatment of children with asthma. METHODS Six dimensions of safety， effectiveness， economy， suitability， accessibility and innovation， expert consultation and literature survey were employed for determining the clinical comprehensive evaluation index system. Delphi method and analytic hierarchy process were utilized for screening the index system and determine the weights of all indices. Evidence collection proceeded through literature researches， real world researches and questionnaire surveying. Experts were invited to score MS according to evidence sets. Total score of clinical comprehensive evaluation of two drugs was calculated by the weights of indices. RESULTS A comprehensive clinical evaluation index system of MS was established， including 6 primary indices （safety， effectiveness， suitability， accessibility， economy & innovation）， 14 secondary indices and 32 tertiary indices. Total score of MS centrally purchased domestically was 8.12 points and total score of imported original drug was 8.03 points. The scores of safety， effectiveness and innovation of imported original research drugs were slightly higher than those of pooled drugs. And the scores of economy， accessibility and suitability of pooled drugs were slightly higher than those of imported original research drugs. CONCLUSION The comprehensive clinical value of MS centrally purchased domestically for treating pediatric asthma is superior to that of imported original drugs.

OBJECTIVE To systematically review the short/long-term economic evaluations of Semaglutide Injection. METHODS The databases of PubMed， Embase， Web of Science， Cochrane Library， EBM Reviews-Health Technology Assessment， EBM Reviews-NHS Economic Evaluation Database， China National Knowledge Infrastructure （CNKI）， Wanfang， VIP and ISPOR were searched from inception until December 1， 2023. Two researchers independently screened reports， extracted raw data and evaluated qualities. RESULTS A total of 38 articles were included. From the perspective of research countries， Semaglutide Injection was economically advantageous compared to other GLP-1 receptor agonists （e.g. dulaglutide， exenatide ER & liraglutide） and insulin glargine. When compared with SGLT-2 inhibitors （empagliflozin & canagliflozin）， Semaglutide Injection demonstrated superior long-term economic benefits. CONCLUSION Further economic studies based upon real-world data of Chinese populations are required for providing decision-making references for stakeholders.

OBJECTIVE To control the quality of drugs and establish microbial limit test methods for four antibacterial liquid preparations including diphenhydramine hydrochloride， clobetasol propionate and lincomycin hydrochloride liniment， compound clobetasol propionate liniment， glacial acetic acid paint and concentrated compound benzoic acid paint. METHODS The bacteriostatic effect of the tested solution was eliminated by plate method and membrane filtration method， and the recovery tests of the total number of aerobic bacteria， fungi and yeast were carried out. The control bacteria were verified by medium dilution method and membrane filtration method. RESULTS The recoveries of the total aerobic microbial count and the total yeast and mold count for all kinds of testing strains were 0.5–2.0. In the method validations， Pseudomonas aeruginosa and Staphylococcus aureus were detected， and no control bacteria were detected out in the negative control group. CONCLUSION It is proved that the method is scientific and feasible， and the results are accurate and reliable. It is suitable for the quality control of the 4 liquid pharmaceutical preparations， which can objectively reflect the contamination status of microorganisms in drugs.

OBJECTIVE To explore the safety differences of baloxavir marboxil and oseltamivir to provide references for post-marketing research and clinical rational drug use. METHODS The adverse events of baloxavir marboxil and oseltamivir reported in FDA Adverse Event Reporting System （FAERS） from quarter Ⅰ of 2019 to quarter Ⅲ of 2022 were retrieved with reporting odd ratio （ROR） and Bayesian confidence propagation neural network （BCPNN）. Results ADE signals of baloxavir marboxil and oseltamivir involved multiple systems. Different from the signals of congenital familial genetic disorder， reproductive system and breast diseases unique to oseltamivir， baloxavir marboxil as a primary suspect drug has unique signals of kidney and urinary system diseases. In system organ class （SOC） with signals for both drugs， obvious differences existed in AED signal intensity in psychiatric diseases， pregnancy/puerperium/perinatal conditions， ocular organ diseases and various nervous system diseases. Baloxavir marboxil reported the most number of no adverse event signals while oseltamivir yielded the most number of vomiting signals. Conclusion ADE signals obtained in this study are consistent with the existing common ADRs in package insert. However， significant differences exist in system organs and signal intensity of pregnancy/postpartum/perinatal conditions， congenital familial genetic diseases， ocular organ diseases， kidney and urinary system diseases. For population at a high risk of ADE as mentioned above， this study provides references for individualized drug selections and ensuring clinical safety and rational drug use.

OBJECTIVE To compare the consistency of transdermal effect of 5% minoxidil solution test product versus reference product. METHODS Bama miniature pig skin was utilized as a material for transdermal penetration and vertical modified Franz diffusion cell for determining the penetration of minoxidil solution. Liquid chromatography/tandem mass spectrometry （LC-MS/MS） was employed for determining the relationship between total amount of drug permeation in receiving solution and retention of drug in skin with time. RESULTS Test and reference products in skin for 24 h cumulative permeation were （49 721±29 707） and （45 372±23 755） ng·cm^–2； Average permeation rates were （2 352±1 309） and （2 182±1 080） ng·cm^–2·h^–1； 24 h skin retention （218 276±137 675） and （188 040±49 523） ng·g^–1；Average permeation rates of test and reference products at a cumulative permeation of about half total permeation （12 h） were （2 172±1 330） and （1 947±1 037） ng·cm^–2·h^–1. CONCLUSION Degree and rate of transdermal penetration of 5% minoxidil solution test/reference formulation fulfill the consistency requirements for topical formulations. And drug retention characteristics of minoxidil solution are similar in Bama miniature pig skin.

Objective To explore whether or not Changji’an Formula （CJAF） treats diarrhea-predominant irritable bowel syndrome （IBS-D） through interfering with tryptophan metabolism and its downstream NMDAR1/ERK/BDNF signaling pathway. Methods Twenty-four Sprague-Dawley （SD） male rats were randomized into 4 groups of normal， model， CJAF （16.74 g·kg^–1） and pinaverium bromide （18 mg·kg^–1） （n=6 each）. Three-factor method was employed for establishing a rat model of IBS-D. After successful modeling， CJAF was dosed by gavage once daily for 2 weeks. Finally the rats were sacrificed for tissue harvesting. The model was evaluated by drying method to determine the water content of feces， abdominal wall withdrawal reflex for assessing the visceral sensitivity， determination of sugar-water preference and hematoxylin-eosin （HE） stain. The plasma content of tryptophan metabolite was determined by LC-MS. Quantitative polymerase chain reaction （q-PCR） was utilized for detecting the mRNA expressions of NMDAR1， CREB1 and BDNF. Western blot was utilized for detecting the protein expressions of IDO1， NMDAR1， ERK1/2， pERK， CREB1 and BDNF. And immunofluorescence was employed for detecting the expression of IDO1. Enzyme-linked immunosorbent assay （ELISA） was used for determining the expression of IFN-γ. Results As compared with model group， CJAF and Pinaverium Bromide groups had lower fecal water content， lower AWR score and higher sugar-water preference value （P<0.05）. Plasma levels of TRP and KA spiked， the levels of Kyn and QA declined and the expression of IFN-γ was down-regulated （P<0.05）. And mRNA/protein expressions of IDO1， NMDAR1， pERK， CREB1 and BDNF dropped in colon （P<0.05）. Conclusion CJAF may improve the symptoms of pain and diarrhea in IBS-D model rats， Its mechanism is probably correlated with the regulation of tryptophan-kynurenine metabolism， an inhibition of IDO1 expression and the regulation of NMDAR1/ERK/BDNF signaling pathway.

Lung cancer is characterized by high mortality， poor prognosis and low 5-year survival rate. At present， the comprehensive treatment based on chemotherapy is the main treatment for non-small cell lung cancer （NSCLC）. According to the stage and the type of lung cancer， patients received comprehensive treatment including surgery， radiotherapy， chemotherapy and targeted therapy. However， the not significance of early symptom， the huge difference of individuals， the resistance of radiotherapy and chemotherapy limited the diagnosis and treatment， which caused harmful effects to patients. Metabolomics plays an increasingly important role in exploring tumor biomarkers， evaluating overall metabolic changes， and studying pathogenesis. This paper mainly reviewed the research progress of biomarkers for the prognosis effect evaluation of lung cancer treatment based on metabolomics technology， so as to provide an important theoretical basis for the individualized precision treatment of lung cancer and help clinical patients to maximize the treatment benefits.

OBJECTIVE To visualize the intelligent construction and development of PIVAS in China over the last two decades by CiteSpace software. METHODS The relevant articles on the development of PIVAS intelligence were retrieved from the databases of China National Knowledge Infrastructure （CNKI）， Wanfang and VIP. NoteExpress and CiteSpace software suites were utilized for visualizing the number of publications， authors， institutions and keywords. RESULTS A total of 121 articles were included and the largest number of articles appeared in 2021 （23 articles）. And 241 keywords were counted and 12 clusters were formed for keyword analysis. Top 5 keywords were pharmacy intravenous admixture service， information， automation， centralized intravenous drug dispensing center and intelligence. According to the statistics of the publishing institutions of PIVAS intelligent construction， Hebei General Hospital and First Affiliated Hospital of Soochow University submitted the largest number of publications （6 articles）. Among 350 authors， Pang Guoxun had the largest number of publications （7 articles）. Among 60 statistical journals， China Pharmacy and Straits Pharmacy predominated （12 articles）. According to the statistics of applying intelligent construction in PIVAS in China， use of intelligent equipment could significantly minimize deployment errors and improve work efficiency. And its application outcomes were excellent. CONCLUSION The intelligent development of PIVAS in China has been rapid. Employing information management and automation equipment for constructing an intelligent service platform， it can significantly boost work efficiency， optimize workflows and effectively promote the innovation of pharmaceutical services. It represents a future direction of the construction and development of PIVAS at modern medical institutions.

OBJECTIVE To investigate the influencing factors of meropenem-related thrombocytopenia in patients with pulmonary infection and their predictive value. METHODS In a retrospective case-control study， the clinical data of patients treated with meropenem for pulmonary infection in a Grade-A tertiary hospital from January 2018 to December 2021 were searched and screened by the Chinese Hospital Pharmacovigilance System （CHPS）. Unifactorial and multivariate logistic regression were used to analyze the influencing factors of meropenem-related thrombocytopenia. RESULTS Totally 625 patients were selected in the study， including 73 with meropenem-related thrombocytopenia. Unifactorial analysis showed that age， hypertension， coronary heart disease， baseline platelet value， serum creatinine value and respectively combined with quinolones， cephalosporins， penicillins and linezolid were significantly correlated with thrombocytopenia （P<0.05）. Multivariate logistic regression analysis showed that hypertension （OR=1.811， 95%CI： 1.029–3.188）， baseline platelet value （OR=0.988， 95%CI： 0.983–0.993）， and combined use of cephalosporins （OR=2.998， 95%CI： 1.573–5.711） or penicillin （OR=2.703， 95%CI： 1.317–5.548） were independent risk factors for the development of meropenem-related thrombocytopenia in patients with pulmonary infection. CONCLUSION Hypertension， baseline platelet value， and combined use of cephalosporins or penicillins are important factors affecting meropenem-related thrombocytopenia in patients with pulmonary infection. Combined multivariate analysis can effectively evaluate and predict the risk of meropenem-related thrombocytopenia in patients with pulmonary infection.

Gene therapy has demonstrated great therapeutic potentials for such major refractory diseases as malignant tumors， infectious， autoimmune and rare disease， etc. Gene delivery vectors are essential for a successful implementation of gene therapy. Polythylenimine （PEI） is a widely studied cationic gene delivery vector， showing stable and efficient gene transfection in numerous cell lines and transfection conditions. PEI25k is regarded as a "gold standard" for gene transfection. Although PEI has broad application prospects in the field of gene delivery， there are still urgent problems to be tackled， including low transfection efficiency in vivo， high cytotoxicity， low targeting capability and lysosomal degradation of loaded gene. This review summarized the latest advances of designing novel polyethylenimine-based nanosystems for gene therapy， including high molecular weight linear PEI， PEI modified with polysaccharides， hydrophilic polymers or dextran， crosslinked low molecular weight branched PEI， PEI-based inorganic nanoparticles and co-delivery vectors of drug/gene based upon PEI. It was intended to provide theoretical rationales for further constructing gene delivery carriers with high efficiency and low toxicity.

Vericiguat has been approved in the United States， Japan， European Union and China. It is indicated for heart failure （HF） with reduced ejection fraction （＜45%）. Here pharmaceutical characteristics and clinical trial results of vericiguat were summarized. This review focused upon the latest applications of vericiguat for HF based upon clinical trial criteria in real world. It provided references for proper managements of HR.

OBJECTIVE To construct a prediction model based on machine learning algorithm for predicting the prognosis of aneurysmal subarachnoid hemorrhage（aSAH）. METHODS A total of 326 patients with aSAH treated in Tianjin Huanhu Hospital from October 2020 to September 2021 were reviewed. According to the ratio of 7∶3， all the data were randomly divided into training set （to construct the prediction model） and test set （to evaluate the prediction model）. SMOTE was used to deal with the imbalance data. Least absolute shrinkage and selection operator （Lasso） analysis was used to select the optimal variables. Logistic regression （LR）， BP neural network， K near neighbor （KNN）， random forest （RF）， decision tree （DT）， support vector machine （SVM）， naive Bayes （NB） and XGBoost algorithm based on machine learning were used to construct the predictive model. RESULTS Eleven optimal features were obtained by Lasso regression. The accuracy of LR， BP neural network， KNN， RF， DT， SVM， NB and XGBoost model were 0.847， 0.847， 0.816， 0.867， 0.806， 0.827， 0.745 and 0.816， and AUC were 0.784， 0.794， 0.646， 0.821， 0.499， 0.765， 0.737 and 0.676， respectively. CONCLUSION Machine learning models are relatively more effective in predicting aSAH prognosis， and the RF model exhibits the best performance.

OBJECTIVE To investigate the efficacy and potential mechanism of urolithin A （UA） in the treatment of renal fibrosis induced by unilateral ureteral obstruction （UUO） based on network pharmacology， molecular docking and animal experiment. METHODS Network pharmacology techniques were used to analyze the mechanism of improving renal fibrosis action of UA. Auto Dock Tool software was used to perform molecular docking of UA with key targets to improve renal fibrosis. UUO was used to establish a rat renal fibrosis model. The regulatory effect of UA on renal fibrosis marker proteins was verified by immunohistochemical staining of fibronectin and collagen Ⅰ. The regulatory effects of UA on p-Akt1 and Akt1 were examined by immunofluorescence staining and Western blot. The effects of UA on the expression of PI3K and p-PI3K upstream， and GSK3β and p-GSK3β downstream of Akt1 were examined by Western blot. RESULTS A total of 21 core targets were obtained by screening through network pharmacology techniques. Through PPI network topology analysis， GO biological function annotation and KEGG pathway enrichment analysis， it was found that UA could play a role in the treatment of renal fibrosis through signal pathways such as PI3K-Akt， p53 and key core targets such as Akt1， CCND1， CDK4， EGFR， CDK2， ERBB2， CDK6， GSK3B， BCL2L1， PTK2， ESR1 and PTGS2. Akt1 was the key target with the highest node degree in the PPI network study. Molecular docking further verified the high docking affinity of UA and Akt1. Animal experiments showed that UA could significantly reduce the expression of fibronectin and collagen Ⅰ in UUO rats （P＜0.01）， and inhibit the expression of p-Akt1 （P＜0.01）， as well as inhibited the phosphorylation of PI3K upstream and GSK3β downstream of Akt1 （P＜0.01）. CONCLUSION UA can effectively alleviate renal fibrosis by inhibiting PI3K/Akt1/GSK3β signal pathway， and effectively reduce the expression of fibronectin and collagen Ⅰ in rat kidney， which provide scientific basis for further study of UA in the treatment of renal fibrosis.

Drug-induced hypersensitivity syndrome （DIHS） is an under-recognized and potentially life-threatening hypersensitivity reaction. One patient successively presented with fever， rash， lymphadenopathy and elevated liver enzymes after a 10-day regimen of piperacillin tazobactam and moxifloxacin. Improvements occurred after a discontinuation of all previous medications and systemic corticosteroid therapy. For patients presenting with skin rash and systemic abnormalities after medications， physicians should consider a possible diagnosis of DIHS and adopt aggressive measures.

OBJECTIVE Under the background of the transformation of hospital pharmacy in the country， we should explore innovative pharmaceutical care models， open up communication channels between patients and pharmacists at home， and ensure the safety of patients’ medication. METHODS Based upon existing problems in the current domestic pharmaceutical care model and the improvement of the level of pharmaceutical care， combined with the characteristics of hospital disease treatment， transformation direction of pharmaceutical care was sought. Taking “Internet +” pharmaceutical care as the starting point， this paper explores the service mode， service content， service accuracy and other aspects to establish the new intelligent interactive pharmaceutical care model. RESULTS After inputting drug information through the intelligent interactive service platform， an independently encrypted two-dimensional code for each drug can be generated. Patients do not need to pay attention to any APP， just scan the two-dimensional code above the medicine box to view the basic information of the medicine box at any time （usage and dosage， precautions， common adverse reactions， etc.）， and if there is any medication problem， they can solve it by themselves through the preset common problems in the two-dimensional code or consult the pharmacist at any time. During the three years of online service from 2020 to 2022， this model has provided a total of 241 262 drug information inquiries for patients， answered 2 912 patient consultations， and obtained 172 adverse drug reaction feedbacks， and the number of inquiries in 2022 is 261% higher than in 2020. CONCLUSION This innovative intelligent interactive pharmaceutical care model extends professional pharmaceutical care to patients， builds a bridge of communication between patients and pharmacists， and truly brings pharmacists home under the premise of ensuring patients’ medication safety.

Inpatient pharmacy care at medical institutions is pharmaceutical service provided by qualified pharmacists to ensure the safety of inpatient medications and optimal treatment outcomes. To strengthen the managements of inpatient pharmacy care at medical institutions and ensure the qualities of pharmaceutical services， the compilation team for Standardized Pharmacy Care for Healthcare Facilities in Hubei Province has formulated this protocol under the guidance of Hubei Clinical Pharmacist Educational Center in accordance with the relevant laws， regulations and rules. This standardized protocol is applicable to medical institutions providing inpatient pharmacy consultations in Hubei Province.

Objective To elucidate the mechanism of Guizhi Shaoyao Zhimu Decoction （GSZD） on autophagy in a rat model of rheumatoid arthritis （RA） through regulating the signaling axis of PI3K/AKT/mTOR. Methods Sixty rats were randomized into six groups of normal， model， GSZD low/medium/high-dose and rapamycin. Except for normal group， the other groups were subcutaneously injected with bovine type Ⅱ collagen protein for establishing a RA model. The corresponding drugs were dosed for 4 weeks. Footpad thickness was measured and arthritis index （AI） scored regularly. Four weeks later， synovial tissues of rat knee joint were harvested. The pathological changes of synovial tissues were observed after hematoxylin-eosin （HE） stain. Ultrastructural changes of synovial cell were observed by transmission electron microscopy. The expressions of Beclin1， LC3， p62， PI3K， AKT and mTOR mRNAs and proteins were detected by quantitative real-time polymerase chain reaction （qRT-PCR） and Western blot. Results GSZD could effectively alleviate footpad thickness and AI score in RA rats. The results of transmission electron microscopy indicated that synoviocytes had lower autophagy while the number of autolysosomes and autophagosomes jumped after GSZD dosing. The results of qRT-PCR and Western blot indicated that， as compared with normal group， the expressions of Beclin1 mRNA and protein， LC3 mRNA and LC3II/LC3I were down-regulated in synovial tissues （P<0.01） while the expressions of p62， PI3K， AKT， mTOR mRNAs and proteins rose sharply in model group （P<0.01）. As compared with model group， the expressions of Beclin1mRNA and protein， LC3mRNA and LC3II/LC3I spiked markedly in synovial tissues （P<0.01， P<0.05） while the expressions of p62， PI3K， AKT， mTOR mRNAs and proteins dropped in GSZD high-dose and rapamycin groups （P<0.05， P<0.01）. Conclusion GSZD could attenuate footpad thickness and pathomorphism of RA rats. And its therapeutic mechanism may be correlated with a down-regulation of PI3K/AKT/mTOR pathway and an acceleration of autophagy.

OBJECTIVE To study the effect of hordenine on melanin synjournal process in B16 cells and its mechanism of action. METHODS Western blot was used to detect the expression of TYR， TRP1 and TRP2 in B16 cells after the treatment with hordenine （50，100，200 μmol·L^–1） to determine the impact on the melanin synjournal process. After PKA agonist treatment， the correlation between the effect of hordenine on melanin synjournal process in B16 cells and cAMP/PKA/CREB/MITF signaling pathways. RESULTS Hordenine （ 50，100，200 μmol·L^–1） could inhibit the protein expression of cAMP， PKA， p-CREB and MITF in melanoma B16 cells group， thus inhibiting TYR， TRP1 and TRP2 expression during melanin synjournal process. CONCLUSION Hordenine can inhibit melanin synjournal process in B16 cells， and the mechanism may be related to inhibiting cAMP/PKA/CREB/MITF signaling pathways.

OBJECTIVE To explore the curative efficacy of dexzopiclone assisted oryzanol tablets on anxiety insomnia and its influences on neurotransmitters in perimenopausal women. METHODS Between January 2020 and January 2023， 202 perimenopausal women hospitalized at Hengshui People's Hospital were recruited. They were assigned into two groups of control （dexzopiclone tablets） and observation （dexzopiclone tablets plus oryzanol tablets）. Before and after treatment， sleep quality and anxiety status of subjects were evaluated by Pittsburgh sleep quality index （PSQI） and Hamilton anxiety scale （HAMA）. The serum levels of 5-hydroxytryptamine （5-HT）， γ-aminobutyric acid （GABA）， noadrenaline （NE）， dopamine （DA）， brain-derived neurotrophic factor （BDNF）， neurotrophic factor 3 （NT-3）， nerve growth factor （NGF）， follicle-stimulating hormone （FSH）， luteinizing hormone （LH） and estradiol （E2） were detected. Adverse reactions were statistically compared. RESULTS After treatment， points of PSQI/HAMA were significantly lower in observation group than those in control group （P<0.05）. As compared with control group， sleep quality was significantly better and anxiety degree significantly milder in observation group （P<0.05）. The levels of 5-HT， GABA， BDNF， NT-3， NGF and E2 were significantly higher in observation group than those in control group while the levels of NE， DA， FSH and LH significantly lower than those in control group （P<0.05）. No significant inter-group difference existed in the incidence of adverse reactions （P>0.05）. CONCLUSION Dexzopiclone plus oryzanol tablets may improve anxiety insomnia in perimenopausal women.

Clinical pharmacists participated in the treatment of blood flow infection of Pichia ohmeri in a patient of esophageal cancer. In light of underlying diseases， clinical symptoms and laboratory tests， antibiotics and pharmaceutical care were provided.Pichia ohmeri was detected in peripheral and catheter blood samples. Voriconazole and amphotericin B were recommended by clinical pharmacists. After amphotericin B dosing， patient status improved markedly and the result of blood culture turned negative， laying the foundations for subsequent anti-neoplastic treatment.Amphotericin B is an optimal drug for catheter-associated bloodstream infections caused by Pichia ohmeri. Clinical pharmacists actively participating in the treatment of rare fungal bloodstream infection may enhance the treatment benefits of patients.

OBJECTIVE To optimize the maintenance dosing regimen of amisulpride in schizophrenics using Monte Carlo simulations （MCs）. METHODS Based upon the published population pharmacokinetic （PPK） data of amisulpride in schizophrenics， using MCs to predict its steady-state plasma concentration （C_ss） and its recommended blood concentration reference range of 100-600 ng·mL^–1 under different dosage regimens. Probability of target attainment （PTA） was applied along with monitoring clinical blood drug concentrations for verification. RESULTS When amisulpride was 350-400 mg qd， 150-300 mg bid and 100-200 mg tid， PTA value of C_ss was >90% in the range of 100-600 ng·mL^–1. At a daily dose ≥1 050 mg， C_ss was likely to surpass 600 ng·mL^–1 （simulation probability ≥75.61%）. Blood concentration of amisulpride at a conventional dose in 24 samples was 48.10-1 032.03 ng·mL^–1 with an average value of （466.64±284.10） ng·mL^–1. CONCLUSION MCs may predict C_ss of amisulpride in Chinese schizophrenics. According to clinical treatment， it is reasonable to set the reference concentration range of amisulpride at 100-600 ng·mL^–1 under a conventional dose.

Objective To explore the treatment of oral vancomycin for skin adverse reaction caused by Clostridium difficile infection. Methods Domestic and foreign databases were searched from the inceptions until July 2023. The relevant literatures were retrieved and the related data extracted for descriptive statistical analysis. Results A total of 15 patients were recruited， including 9 males and 6 females. All of them had an indication of antibiotic use and vancomycin was prescribed for C. difficile infection. In terms of age， there were 2 children and 8 patients were 65 years and above. Five cases developed kidney injury. Oral dose of vancomycin was ≥500 mg·d^–1 （n=11）. Skin adverse reactions included red man syndrome， maculopapular rash and linear IgA bullous dermatosis. Blood concentration of vancomycin was （0.1–28.7） mg·mL^–1（n=5）. In terms of adverse reaction management， drug was discontinued （n=14） and antihistamines offered （n=12）. For 4 cases on anti-C. difficile regimen， fedamycin （n=1） and metronidazole （n=3） were prescribed. All of them had varying degrees of improvements and 2 cases died from underlying diseases. Conclusion During the treatment of C. difficile infection， oral vancomycin may be absorbed throughout body and leads to rash. Greater attention should be paid to high-risk groups.

OBJECTIVE To analyze the incidence of immune-associated pneumonia caused by tislelizumab to provide a pharmaceutical supervision for clinical pharmacists on immune-associated pneumonia occurring in actual clinical treatment of tislelizumab. METHODS The databases of PubMed， Elsevier Science Direct， SpringerLink， Wiley Online Library， China National Knowledge Infrastructure （CNKI） and Wanfang were searched for immune-associated pneumonia induced by tislelizumab were searched as of June 2023. RESULTS A total of 12 cases of pneumonia induced by tislelizumab were included. There were 11 males and 1 female with a mean age of 61 years. Time of onset of pneumonia predominated at 1-6 months after an initial drug dosing. The major clinical manifestations included dyspnea， cough and fever and imaging feature was ground-glass opacity. Nine patients were cured after symptomatic treatment. Four patients were retreated with tislelizumab and two relapsed. CONCLUSION Clinical symptoms and lung imaging characteristics of patients with immune-related pneumonia should be closely monitored during a treatment of tislelizumab by clinical pharmacists. And the pharmaceutical care should be strengthened to ensure the safety of drug dosing.

Inflammatory bowel disease （IBD） is a chronic inflammatory disease of intestinal tract with an elusive etiology. Its clinical course is influenced by a large variety of environmental， genetic， immunologic and microbiologic factors. Currently IBD has outstanding problems of high expenses， many adverse reactions from long-term use of therapeutic drugs and treatment intolerance. There is an urgent need for formulating novel therapeutic options. Recent studies have demonstrated that hypoglycemic agent sodium-glucose cotransporter-2 inhibitor （SGLT2i） could delay the progression of IBD through glucose-dependent and independent pathways. It was capable of attenuating inflammatory responses， ameliorating innate immune responses， antagonizing oxidative stress， arresting apoptosis， enhancing autophagy induction and regulating intestinal microbiota imbalance in IBD.

Objective To explore the therapeutic effects and mechanism of Pulsatilla Decoction on Vulvovaginal candidiasis （VVC） based upon network pharmacology and animal experiments. Methods The active ingredients and corresponding targets of Pulsatilla Decoction were collected through literature reviews and searching the database of TCMSP. Gene Cards was applied for obtaining the potential targets related to VVC and Cytoscape 3.6.0 for constructing the network of “drug active components-targets-pathways”. And the database of String was utilized for constructing a protein interaction network. Gene ontology （GO） enrichment analysis and Kyoto Encyclopedia of Genes and Genomes （KEGG） were performed by the platform of DAVID. Molecular docking was performed with AutoDock software. Specific pathogen free Kunming （SPF-KM） mice were randomized into six groups of normal， model， low/medium/high-dose Pulsatilla Decoction and fluconazole. VVC model was established through an inoculation of Candida albicans. All groups were continuously dosed for 14 days. Fungal quantities in vaginal lavage fluid were determined by Gram stain and plate counting. Hematoxylin-eosin （HE） stain was utilized for observing the morphology of vaginal tissue. Enzyme-linked immunosorbent assay （ELISA） was employed for detecting the serum contents of IL-17， IL-23 and IL-1β. The expressions of core regulatory factors， including TNF-α， STAT3， HSP90， ESR and key regulator ROR-γT protein in IL-23/IL-17 axis were measured by Western blot. Results Through network pharmacology screening， the core components identified for treating VVC included anemoside B4， dihydroniloticin， obacunone， β-sitosterol and berberine. Additionally， 18 key target proteins and 75 pathways were identified as crucial for therapeutic effects for VVC. As compared with model group， a treatment of Pulsatilla Decoction could significantly lower both fungal burden in vagina and serum levels of IL-17， IL-23 and IL-1β. Moreover， the protein expression levels of TNF-α， STAT3， HSP90， ESR and ROR-γT dropped in vaginal tissue （P<0.05）. Conclusion Pulsatilla Decoction exerts its therapeutic effects on VVC through modulating the targets of STAT3 and TNF-α and regulating the axis of IL-23/IL-17.

OBJECTIVE To evaluate the cost-effectiveness of camrelizumab， sintilimab and toripalimab for advanced non-small cell lung cancer （NSCLC） based upon real-world study data. METHODS From March 2019 to February 2023， 149 patients with locally advanced and advanced NSCLC on camrelizumab， sintilimab and toripalimab were retrospectively reviewed at General Hospital of Southern Theater Command. Inverse probability of treatment weighting （IPTW） method was utilized for eliminating intergroup confounding factors. A partitioned survival model was established for evaluating the cost-effectiveness of three domestic PD-1 inhibitors for locally advanced and advanced NSCLC based upon progression-free survival （PFS）， overall survival （OS） and the incidence of adverse reactions of three groups after IPTW. Incremental cost-effectiveness ratio was calculated. RESULTS After IPTW data processing， no difference existed in mPFS （8.20 vs. 14.80 vs. 14.80 month） or mOS （non-attained vs. 22.70 month vs. non-attained） among three groups. Adverse reactions with an incidence of >5% and grade≥Ⅲ for either drug included anemia， leucopenia， neutropenia and thrombocytopenia. As compared with sintilimab， camrelizumab and toripalimab increased clinical benefit by 0.50 and 1.00 QALYs. However， additional costs for boosting the clinical benefit by 1 QALY were divided into ￥495 151.83 and ￥440 095.05. Toripalimab required an input of ￥384 563.57 for each additional QALY of benefit as compared with camrelizumab. Regardless of whether not willingness-to-pay （WTP） threshold was set at 3 folds per capita gross domestic product （￥257 000/QALY） or 3 folds Guangdong's per capita GDP （￥305 400/QALY）， camrelizumab and toripalimab were no cost-effectiveness as compared with sintilimab and toripalimab was no cost-effectiveness as compared with camrelizumab. CONCLUSION In terms of economy， sintilimab is the most cost effective followed by camrelizumab and toripalimab.

OBJECTIVE To develop and refine rules pertaining to traditional Chinese patent medicines within the prescription review system to promote the rational and canonical utilization of these medicines among specific populations. METHODS The refined medication rules of traditional Chinese patent medicines among special populations were established through the instructions of package insert， recent medication guidelines and expert consensuses. Adding functions and optimizing the rules of preapproval system concerning rational medication prescriptions were implemented for ensuring the rational， safe and effective use of medication. The interception rate of prescription audit and the distribution of audit types were counted after establishing refined rules of traditional Chinese patent medicines among special populations. By continuously optimizing audit rules， additionally， adding pop-up window tips and other functions， clinical pharmacists could improve the qualification rate of prescription regarding traditional Chinese patent medicines among special outpatients and standardize clinical rational drug use. RESULTS The audit of refined rules pertaining to traditional Chinese patent medicines among special populations could detect such errors as inappropriate use， incorrect dose and improper dosing route， prohibited use， caution and avoidance use， allergic drug use， drug interactions and repeated drug use. Audit interception rate was valued at 4.45% and the success rate of audit relatively high at 94.83%. There is a significant difference in the audit accuracy rate before and after refining rules of traditional Chinese patent medicines among special populations （P<0.01）. CONCLUSION The refined rules of traditional Chinese patent medicines have facilitated an effective implementation of prescription reviews at specialist hospitals and standardized the rational utilization of Chinese patent medicines among special populations.

OBJECTIVE To explore the attenuation mechanism of vinegar through the metabolomic study on liver of rats in physiological state treated with Euphorbia kansui before and after processing. METHODS Twenty-four SPF SD rats were randomly divided into blank group， E. kansui group and vinegar stir-fried E. kansui group with 8 rats in each group. The blank group was given 0.5% carboxymethylcellulose sodium （CMC-Na） by gavage， and the E. kansui group and vinegar stir-fried E. kansui group were given the corresponding test solution for 20 days. The livers were collected on the 20th day. Rat liver samples were analyzed by ultra-high performance liquid chromatography-quadrupole-orbital trap high resolution mass spectrometry （UPLC-Q-Exactive-MS）. The data were processed by Compound Discoverer 3.0 software， and HMDB and other databases were searched. The differential metabolites were analyzed by principal component analysis （PCA）， orthogonal partial least squares-discriminant analysis （OPLS-DA）， and MetaboAnalyst to analyze the significant enrichment pathways of the obtained differential metabolites. RESULTS In the end， 28 differential metabolites with biological significance were found between the E. kansui group and the blank group， 18 metabolites were found with significant differences between the vinegar stir-fried E. kansui group and the blank group， and there were 13 metabolites in the intersection. CONCLUSION By increasing the levels of taurodeoxycholic acid and stearylcarnitine in liver， fermented vinegar can reduce the potential risk of early brain injury and type 2 diabetes. It can promote the regulation of immune function by increasing the level of glycocholic acid in liver. It can promote neurovascular remodeling and functional recovery after ischemic stroke by increasing the level of 20-hydroxyeicosaptaenoic acid in liver. By increasing the levels of 3-hydroxybutyric acid and oleo ethanolamine in liver， it shows anti-tumor， anti-oxidation and neuroprotection effects. The metabolic pathways involved in its attenuated mechanism are arachidonic acid metabolism， primary bile acid biosynthesis， ketone body synthesis and degradation， taurine and hypotaurine metabolism.

OBJECTIVE To analyze the clinical symptoms and evolution process of red man syndrome （RMS） caused by vancomycin after cardiovascular surgery， and provide diagnostic and therapeutic basis for clinical treatment. METHODS Retrospective analysis was made on 18 patients with RMS treated with vancomycin for anti-infection after cardiovascular surgery in Cardiothoracic Surgery Department of Nanjing Drum Tower Hospital from March 2016 to August 2022. The disease type， symptoms and evolution， vancomycin dose and blood concentration were analyzed， and the treatment methods and clinical outcomes of all the patients were recorded. RESULTS Among the 18 patients， 17 were with infective endocarditis and aortic dissection. The incidence of RMS was related to the high concentration of vancomycin and the use of domestic vancomycin. In the early stage， two patients died due to edema and bleeding of digestive tract and airway mucosa， and the rest were cured and discharged after treatment. CONCLUSION RMS is a common complication of vancomycin anti-infection after cardiovascular surgery. We should pay attention to the selection of pure preparations and monitoring of blood drug concentration. Early occurrence of maculopapules requires drug withdrawal and hormone intervention to prevent dragging to angioneurotic edema， leading to respiratory obstruction and gastrointestinal bleeding， resulting in poor prognosis.

OBJECTIVE To explore the current awareness and service needs of pediatric patients’ families towards pharmacist-managed clinics （PMCs）， and to provide reference for the establishment and continuous improvement of pediatric PMCs. METHODS A questionnaire survey was conducted on the "Questionnaire Star" platform， targeting families of pediatric outpatients at a tertiary grade A hospital. The survey was designed based on previous publications and practical experience. SPSS 27.0 software was used for the statistical analysis of the results. RESULTS A total of 531 valid questionnaires were collected. In terms of the awareness and willingness towards pediatric PMC， more than half of the families （52.54%） were unaware of PMC， and the vast majority （94.35%） had never experienced a PMC visit. However， most families （85.31%） considered it （very） necessary to establish pediatric PMCs. The majority of families （75.89%） were （very） willing to visit a PMC if referred by a physician. In terms of service needs， most families wished to receive specific instructions on how to use medications （88.14%） at pediatric PMCs， along with information on adverse drug reactions （78.91%）， dosage （77.21%） and course of treatment（75.33%）. The drug categories with the highest demand included： antipyretics （75.8%）， antiallergics （73.4%）， cough suppressants （68.1%）， hormonal drugs （64.2%）， and anti-infective drugs （58.0%）. Most of the families responded that appointment should be made through medical platforms with a certain service fee（60.83%） and they preferred face-to-face verbal communication with pharmacists （84.75%）. CONCLUSION There is a low level of awareness among family members of pediatric patients about pediatric PMCs， but there is a consensus on the necessity of establishing pediatric PMCs. The families have expressed their expected service forms and contents. Pediatric PMCs should further improve the service model and process based on service need to enhance the pediatric patients' medication adherence and satisfaction in the future.