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.

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.

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.

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 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 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 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.

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 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.

As one of sodium-glucose cotransporter 2 inhibitors （SGLT2i）， dagliflozin was the first SGLT2i agent approved for treating type 2 diabetes mellitus （T2DM） in EU in 2012 and later in China in 2017. In addition to its definite hypoglycemic effect， it has demonstrated promising efficacies for heart failure and chronic kidney disease in China. With its widespread clinical applications， many adverse reactions have been reported. Acute pancreatitis was mentioned in a foreign report. Only one case of acute liver injury was reported globally. Here we described one case of acute pancreatitis and acute liver injury caused by dagliflozin.

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.

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 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.

A 65-year-old male patient was diagnosed with malignant tumor in right lung complicated with lymph node metastasis in lung hilum and abdomen， bone metastasis and secondary malignant tumor of adrenal gland. In March 2021， two cycles of immunochemotherapy were dosed in the regimen of pembrolizumab （200 mg）， pemetrexed disodium for injection （800 mg） and carboplatin injection （500 mg）. Since liver function manifested as Grade 4 immune hepatotoxicity， pembrolizumab was terminated and liver function gradually normalized after dosing of glucocorticoid and hepatoprotective drugs. In May 2022， three cycles of immunochemotherapy were offered in the regimen of pembrolizumab （200 mg） and pemetrexed disodium for injection （800 mg）. Liver function manifested as Grade 2 immune hepatotoxicity. After dosing of glucocorticoid and hepatoprotective drugs， liver function gradually normalized.

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.

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.

OBJECTIVE To summarize pharmaceutical care researches published in top medical journals to provide references for pharmacists to carry out researches of pharmaceutical care. METHODS PubMed database was searched by journal and contents of pharmaceutical care as search terms. Pharmaceutical care researches published in top four medical journals from January 1， 2000 to August 21， 2023 were extracted. RESULTS A total of 18 articles were included， among which 9 articles were published in BMJ， 5 in JAMA， 3 in LANCET and 1 in NEJM. The participants， study design， contents of pharmaceutical care and outcome parameters were analyzed. CONCLUSION Pharmaceutical care researches published in top medical journals have outstanding characteristics in terms of population representation， targeted intervention measures， diversity of settings， appropriateness of epidemiological study design and rationality of outcome parameters. It may provide practical references for planning researches in pharmacy practice in China and offering high-quality pharmaceutical care.

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 extraction technology of the ancient formula Shangdangshen Ointment （SO）， and to evaluate its effect on mouse immune function. METHODS Independent variables included extraction frequency， the amount of water added， and extraction time， and evaluation parameters included the content of lobetyolin， and the comprehensive score of the ointment yield. The weight coefficient of each evaluation index was determined by the composite entropy weight of analytic hierarchy process （AHP）-index weight determination method （CRITIC）. Box-Behnken response surface method was to identify the optimal extraction technology of SO. An immunosuppressive mouse model was established by intraperitoneal injection of cyclophosphamide， followed by oral gavage of Lentinan and SO for 30 days. The body weight， organ index of immune organs， and serum immune factors （interleukin IL-2， IL-4） were detected， and the intestinal pathology of mice was observed by hematoxylin and eosin （H&E） staining. RESULTS The optimal extraction process for SO was three extractions （1 h， 0.5 h and 0.5 h， respectively） by adding 10-fold， 8-fold and 6-fold， respectively. Compared with the blank group， mouse in the model group had significantly decreased body weight and thymus index， increased spleen index and serum immune factors （all P<0.01）， and seriously damaged structure of small intestine. Model mice treated with SO had significantly increased body weight and thymus index （P<0.01）， and decreased spleen index and serum immune factors （P<0.05）. The impaired structure of small intestinal tissue was significantly alleviated. CONCLUSION Based on the Box-Behnken response surface methodology， the optimized extraction process of SO has the advantages of strong operability， high extraction rate， energy saving and good reproducibility. SO can significantly improve the immune function of immunocompromised mice induced by cyclophosphamide.

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.

Amomum kravanh has a long history of medicinal use in China. Containing volatile oils， flavonoids， diarylheptane and other chemical components， A. kravanh has pharmacological functions of renohepatic protection and anti-tumor. Here chemical compositions and pharmacological effects of A. kravanh were reviewed and Q-Markers of A. kravanh were predicted from the aspects of plant genealogy， specificity of chemical components， correlation between components， traditional medicinal properties， compound compatibility， chemical composition measurability and different origins. It was preliminarily predicted that 1，8-eucalyptol， β-pinene， α-pinene， α-terpineol， α-caryophyllene， α-cubebene and eugenol could be used as Q-Markers for A. kravanh， providing rationales for optimizing the quality standards of A. kravanh.

Objective To establish a medication error prevention system based on similarity algorithms and providing technical references for a comprehensive management of drugs at outpatient pharmacies. Methods Similarity algorithms were utilized for detecting text and image similarities of seemingly similar drugs and establishing a database of similar drugs. Root cause analysis was conducted for examining the fundamental causes of errors in seemingly similar drugs， ultimately constructing a comprehensive medication error prevention system for outpatient pharmacy drug management. Results A total of 708 645 pairs of similarities were successfully detected among 1 191 types of drugs， A database of similar drugs was constructed with 145 types of sound-alike drugs and 87 types of look-alike drugs. Based upon the database of similar drugs and key factors identified through root cause analysis， an error prevention system was constructed with four core modules of prescription， dispensing ticket printing， label & location and drug dispensing verification. Preliminary application results showed a significant decrease in medication error data after implementation （P<0.05）. Conclusion This study has successfully established a medication error prevention system based upon similarity algorithms， providing a solid foundation for researches and practical applications of computer similarity algorithms in the field of hospital pharmacy. It also offers new insights into the role of informatic pharmacists integrating computational theories into hospital drug management systems.

Chronic heart failure （CHF） is an end-stage manifestation of various heart diseases with a high prevalence and a poor prognosis. In recent years， with a rapid emergence of new drugs and evidence-based medical evidence， the therapeutic concepts of heart failure drug are constantly updated. This review focused upon CHF classification， novel drugs and evolving conceptions of heart failure to provide references for a proper management of CHF.

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 explore the occurrences and risk factors of drug-induced liver injury （DILI） caused by azivudine tablets for corona virus disease 2019 （COVID-19） in real world and provide references for safe clinical dosing. METHODS From November 30， 2022 to January 26， 2023， medical records were retrospectively reviewed for 294 hospitalized patients taking azivudine tablets for COVID-19. Age， gender， weight， dosage， course of treatment， co-medication， liver function parameters and adverse reactions of causing liver injuries were recorded. Basic characteristics of azvudine DILI were examined. They were assigned into two groups of non-DILI and DILI. The inter-group differences of basic characteristics and medications were compared and the influencing factors of azivudine-induced DILI further discussed. RESULTS Among them， 17 cases （5.78%） developed DILI. In clinical classification of DILI， the types were hepatocyte injury （n=4）， cholestasis （n=6） and mixed （n=7）. Regarding DILI causality assessment， the likelihood was extreme （n=1）， quite （n=12） and possible （n=4）. As for DILI severity， the grade was Ⅰ （mild， n=10）， Ⅱ （moderate， n=5） and unknown （n=2）. As for occurrence time of DILI， average treatment duration of azvudine was （7.6±3.7） days and occurrence time of DILI （6.4±3.9） days post-dosing. Number of co-medications， hypoproteinemia and critical illness were significant influencing factors for the development of DILI （P<0.05）. CONCLUSION DILI induced by azivudine for COVID-19 is a common clinical adverse reaction. Most adverse reactions are mild or moderate in severity. The overall safety and tolerability of azivudine are decent in clinical practices. The pathological status of patients should be evaluated prior to clinical dosing. For individuals with hypoproteinemia and/or critically illness， azivudine should be carefully dosed after comprehensive evaluations. During dosing， the number of co-medications should be minimized， especially interacting co-medications should be avoided to avoid the occurrence of DILI.

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.

Elevated low-density lipoprotein cholesterol （LDL-C） is a significant risk factor for atherosclerotic cardiovascular disease （ASCVD）. In recent lipid management guidelines， LDL-C has been recommended as a primary target for lipid-lowering therapy in most countries or regions. And target levels are based upon risk stratification. Extensive evidence indicates that statins could effectively decrease the incidence of cardiovascular events in ASCVD patients through a marked reduction of serum LDL-C level. However， the current rate of LDL-C target attaining in high-risk ASCVD populations remains low， indicating numerous unmet needs in lipid-lowering therapy. To address this challenge， researchers have identified several LDL-C-targeting drugs with potentially innovative mechanisms of action. These include proprotein convertase subtilisin/kexin type 9 （PCSK9） inhibitors （e.g. monoclonal antibodies of evolocumab， alirocumab and torcetrapib， as well as small interfering RNA molecule of inclisiran）， ATP-citrate lyase inhibitor （e.g. bempedoic acid） and angiopoietin-like protein 3 inhibitor （e.g. evinacumab）. Additionally many emerging LDL-C-targeting drugs are currently under evaluations. Focusing upon clinical pharmacology and cardiovascular benefits of these drugs， this review summarized the evidence-based management protocols of innovative LDL-C-targeting therapies.

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.

Self-healing hydrogel is a novel type of material with reticular structure and self-healing capability. On the one hand， this material has intrinsic self-healing and realizes its self-healing property of structural fracture and reconnection through dynamic chemical bonding. On the other hand， hydrogels are dynamic， self-regulating and biocompatible， making them promising drug delivery vehicles. This review summarized the latest researches of self-healing hydrogels in the field of drug delivery. Also application prospects and research directions of drug-loading systems based upon self-healing hydrogels in pharmacy were discussed.

OBJECTIVE Through questionnaire survey， understand the current status and influencing factors of home medication safety for urban elders in Shandong Province and provide references for pharmacists providing home pharmaceutical care. METHODS Pharmacists provided home pharmaceutical care for elders and completed a questionnaire survey to obtain basic profiles and managed family medicine chest and drug safety. Binary logistic regression or multiple linear regression was utilized for examining the influencing factors of drug safety. RESULTS A total of 294 valid questionnaires， covering families of elders in 14 cities in Shandong Province， were obtained finally. The prevalence of multiple chronic conditions in urban elders was 61.22% and 27.21% of urban elders received polypharmacy treatment. There were still many problems of family medicine chest， such as non-classification， similar drugs and lacking package. And 70.07% of elders had poor medication compliance. Binary Logistic regression indicated that education level was an influencing factor of medication compliance. Medication literacy and common sense， including medication cognition and behavior， were rated as good. The results of multiple linear regression revealed that the influencing factors of score of medication cognition and behavior were education level and monthly income. CONCLUSION Due to the existence of multiple chronic conditions， dosing of various drugs， poor management of family medicine chest and low medication compliance have elevated， the risks of home medication for elders. It is necessary to provide home pharmaceutical care for elders.

OBJECTIVE Vonoprazan is a novel potassium competitive acid blocker. Due to its novelty， its long-term safety and adverse events still need to be further confirmed. METHODS From 2015 to 2023， the relevant adverse event reports were searched and extracted through the FDA Adverse Event Reporting System （FAERS） and the Japanese Adverse Drug Event Reporting System （JADER） and the adverse event system was classified using the Medical Dictionary for Regularly Activities terminology set. Data processing and analysis of drug-related reports were performed by reporting odds ratio （ROR） and proportional reporting ratio （PRR）. RESULTS In the analysis of preferred terms， the important signals in the FAERS database were deficiency of luteinizing hormone （ROR=2 066.06，PRR=2 065.82）， gallbladder torsion （ROR=2 065.94， PRR=2 065.82） and esophageal anastomosis （ROR=1 377.37， PRR=1 377.21）. The important signal orders of JADER database were as follows： elevated blood gastrin （ROR=1 535.76， PRR=1 525.05）， gastrinoma （ROR=930.27， PRR=928.29） and duodenal polyps （ROR=398.20， PRR=397.84）. In the analysis of system organ classification， the important signals of FAERS database were arranged in the following order： endocrine disorders （ROR=5.36， PRR=5.31）， hepatobiliary disorders （ROR=5.14， PRR=4.98） and blood/lymphatic system disorders （ROR=2.96， PRR 2.87）. The important signals of JADER database were ranked as follows： social circumstances （ROR=4.54， PRR=4.53）， pregnancy， puerperium & perinatal conditions （ROR=3.81， PRR=3.81） and skin/subcutaneous tissue disorders （ROR=3.16， PRR=3.15）. CONCLUSION The signal mining results based upon FAERS and JADER databases suggest that pharmacists should pay greater attention to the risk of venolazone related adverse events. And clinical medication monitoring should be strengthened for minimizing the impact of adverse reactions on patient prognosis and quality-of-life.

OBJECTIVE To explore the efficacy， safety and economy of different ratios of domestic piperacillin tazobactam （PT） for complicated urinary tract infection （cUTI） to provide references for clinical rational drug use and proper health decision-making. METHODS This was a multi-center retrospective cohort study at 9 tertiary general hospitals in Guizhou Province. Between January 2020 and December 2022， cUTI patients received different ratios of PT as exposure factors. Confounding factors such as age， nationality， co-morbidity and therapeutic duration were controlled by propensity score matching （PSM）. Efficacy， safety and economy of two groups of PT were evaluated. RESULTS Among 881 eligible cUTI patients， two groups of PT （8∶1， n=796） and PT （4∶1， n=85） were assigned. After PSM， 231 cases were successfully matched and divided into two groups of observation （n=161） and control （n=70）. And all variables were matched evenly （P>0.05）. Clinical efficacy of PT （8∶1） was better than that of PT （4∶1） with statistically significant difference （P=0.009）. No significant inter-group difference existed in adverse reactions （P=0.605）. Total therapeutic expense of PT （8∶1） was lower than that of PT （4∶1）. There was statistically significant difference （P<0.001）. CONCLUSION PT （8∶1） and PT （4∶1） have comparable safety for cUTI. However， piperacillin tazobactam （8∶1） is more efficacious and economical.

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.

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 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 systematically evaluate the risk of virus and/or symptom rebound after Nirmatrelvir/Ritonavir （NMV/r） treatment in patients with coronavirus disease 2019 （COVID-19）. METHODS From January 1， 2018 to November 2， 2023， the databases of PubMed， Embase， Cochrane Library， Clinical Trials， Wanfang and China National Knowledge Infrastructure （CNKI） were searched for the related literature of COVID-19 rebound in patients treated with NMV/r （observation group） and molnupiravir or no antiviral drugs （control group）. After information collection and quality evaluation， meta-analysis was performed by STATA 12.0 software. RESULTS A total of 12 cohort studies and 1 randomized controlled trial were included. Rate of viral rebound， symptom rebound， viral and/or symptom rebound after NMV/r treatment were 4.72%， 3.75% and 7.24%， respectively. Meta-analysis results revealed no significant differences in viral rebound ［OR=1.46， 95%CI（0.91， 2.33）， P=0.116］， symptom rebound ［OR=0.85， 95%CI（0.58， 1.25）， P=0.093］ and virus and/or symptom rebound ［OR=0.76， 95%CI（0.37， 1.55）， P=0.452］ between NMV/r and control groups. Subgroup analysis indicated that symptom rebound rate was significantly lower in NMV/r group than that in molnupiravir group ［OR=0.67， 95%CI（0.48， 0.92）， P=0.015］. It was comparable to that in group without antiviral drugs ［OR=1.43， 95%CI（0.45， 4.57）， P=0.684］. CONCLUSION COVID-19 rebound may appear in patients treated with NMV/r， molnupiravir and no antiviral drugs. The risk of COVID-19 rebound does not differ between NMV/r group and group without antiviral drugs. Symptom rebound rate of NMV/r is lower than that of molnupiravir and viral rebound rate is similar between them. However， due to the limitations of the included studies， these results should be further verified by more large-sample clinical trials.

OBJECTIVE To systematically evaluate the pharmacoeconomic researches on durvalumab as a first-line treatment for extensive-stage small cell lung cancer （ES-SCLC） so as to optimize clinical treatment plans， improve health decisions and provide references for subsequent pharmacoeconomic researches. METHODS A systematic review was conducted by accessing the databases of PubMed， Embase， Cochrane Library， Web of Science， China National Knowledge Infrastructure （CNKI）， SinoMed， VIP and WANFANG DATA. And the relevant literature items were up to March 2024. The qualities of included studies were assessed by the CHEERS 2022 checklist and followed by a descriptive summary analysis. RESULTS Ten studies of high overall quality were included. All were model-based cost-effectiveness analyses from the perspectives of health system and payers. Utility values were derived from prior researches and expenses focused upon direct medical costs. Survival data were projected by standard parametric and risk-adjusted models. Durvalumab plus chemotherapy （etoposide plus platinum） failed to demonstrate cost-effectiveness over chemotherapy alone or atezolizumab plus chemotherapy. However， in ES-SCLC patients with brain metastases or receiving patient assistance， durvalumab plus chemotherapy was economically favorable and more cost-effective than atezolizumab plus chemotherapy and yet not over chemotherapy alone. As compared with such checkpoint inhibitors as pembrolizumab and ipilimumab， durvalumab offered a significant cost-effectiveness advantage. CONCLUSION This study has preliminarily clarified the economic viability of durvalumab as compared with other drug dosing regimens. Future researches should utilize head-to-head trial data or real-world data to provide further evidence for treating ES-SCLC.

OBJECTIVE To explore the regularity and characteristics of medical damage liability related to adverse drug reaction （ADR） and provide references for clinical rational use of drugs. METHODS From January 2011 to January 2023， medical damage liability disputes cases caused by ADR were retrieved from the legal-document database of China Judgements Online. And a strategy was formulated for comprehensive prevention and prescription review. RESULTS A total of 356 judgments were retrieved and 201 included as judgment documents. Top three categories of ADR-causing drugs were antibiotics （n=65， 32.34%）， nervous system agents （n=31， 15.42%） and traditional Chinese medicines （n=23， 11.44%）. Approximately one-third of case courts ruled that physicians committed medical faults due to ADR and shouldered 60%-100% of compensation liability. The judgments highlighted such major issues as lax prescription indications， inadequate risk assessment， suboptimal prevention & monitoring practices and insufficient adherence to notification obligations. CONCLUSION Medical institutions should strengthen and further improve ADR monitoring and management system. It is imperative to emphasize rational drug use and medication monitoring and make full use of prescription review systems to mitigate ADR occurrences， harness the expertise of pharmacists in enhancing prescription reviews and pharmaceutical services， minimize harm and related medication disputes caused by ADR and safeguard legitimate rights and interests of both physicians and patients.

OBJECTIVE To employ the FDA Adverse Event Reporting System （FAERS） to obtain the adverse drug event （ADE） information of ecucizumab and assess its safety for provide references for rational drug dosing. METHODS Through OpenVigil 2.1 website for extracting the raw data of FAERS database until March 2023， ADE reports of ecucizumab were selected. Reporting odds ratio （ROR） and proportional reporting ratio （PRR） were utilized as signal detection parameters for setting the corresponding threshold conditions for statistical analysis and systematic classification of ADEs. RESULTS A total of 25840 ADE reports of eculizumab were collected with 471 valid signals. And 27 system organ classes （SOCs） included systemic diseases and administration site reactions， various examinations， infections and invasive diseases. Top three signal intensities were lower total complement activity， extravascular hemolysis and hemoglobinuria. Among the reported patients， age distribution was primarily between 18 and 59 years （11.00%） with a higher proportion of females （42.96% vs. 31.33%） than males. Moreover， several novel ADEs were identified， such as eyelid ptosis， cholelithiasis， splenomegaly and Budd-Chiari syndrome. CONCLUSION During dosing of eculizumab， greater attention should be paid to females with a high incidence of ADEs. Physicians stay on a high vigilance for infection-associated ADEs and some new occurrences.

OBJECTIVE To elucidate the characteristics and outcomes of liver function abnormalities in patients taking tigecycline and detect the trends in liver function abnormalities before reaching the diagnostic criteria for drug-induced liver injury （DILI） METHODS For this retrospective study， the relevant clinical data of 585 adult inpatients were collected through an electronic medical record system. Tigecycline was dosed for 72 h or more between January 1， 2018 and January 1， 2020， medical data were complete and other causes of hepatic function abnormality excluded. The liver function parameters of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， alkaline phosphatase （ALP） and total bilirubin （TB） were analyzed. The dynamic changes in the incidence and severity grading of abnormalities of each parameter was assessed. Binary Logistic regression analysis was employed for determining independent risk factors associated with liver function abnormalities. RESULTS As compared with baseline values， initial and peak abnormalities values of various liver function parameters spiked markedly. Gender was identified as an independent risk factor for abnormal ALT （OR=0.507， P=0.001） or AST （OR=0.657， P=0.034）. High maintenance dose （100 mg bid） and prolonged duration （>14 days） were independent risk factors for abnormal ALT/AST/ALP （P<0.01 for all parameters）. Furthermore， prolonged duration （>14 days）（OR=1.699， P=0.017）， surgery （OR=1.819， P=0.001） and baseline TB value beyond upper limit of normal （OR=4.079， P<0.001） were independent risk factors for abnormal TB. CONCLUSION Clinicians should closely monitor liver function and pay greater attention to abnormal parameters of liver function after tigecycline therapy. This approach is conducive to detecting trends of liver injury and preventing further deterioration of liver function.