OBJECTIVE:To fathom American pharmaceutical benefit managers(PBMs).METHODS:The development of PBMs in America was reviewed and the role they played in American pharmaceutical management was analyzed.RESULTS:PBMs,whose strength was increasing,did play a role in curbing the increase of drug expenses though their place was still somewhat controversial.CONCLUSION:PBMs in American sets a good example for other countries including China to follow.

Objective:To analyze DNA methylation sites related to fibrosis and autophagy in human hepatic stellate cells (LX-2 cells) induced by sodium arsenite (NaAsO 2), and to screen specific methylation genes related to fibrosis and autophagy. Methods:Genome-wide DNA detection was performed using Illumina Infinium Methylation EPIC BeadChips (850K methylation chip) to derive differential methylation sites in LX-2 cells (control group) and the fibrosis and autophagy models of LX-2 cells induced by NaAsO 2(low, medium and high dose groups: the final concentrations were 5, 10, 15 μmol/L NaAsO 2, respectively, after 48 h intervention). Gene ontology (GO) function enrichment analysis and Kyoto encyclopedia of genes and genomes (KEGG) signaling pathway enrichment analysis were used to explore gene function. Results:The model of cell fibrosis and autophagy was established successfully in high dose group. The results of 850K methylation chip detection showed that there were 25 817 significant different methylation sites between the high dose group and the control group, including 12 083 hypermethylation sites and 13 734 hypomethylation sites. GO function enrichment analysis showed that the molecular functions of differentially methylated genes mainly included protein binding, ion binding, catalytic activity, enzyme binding. KEGG signaling pathway enrichment analysis showed that the pathways involved in differentially methylated genes mainly included metabolic pathway, cancer pathway, phosphatidylinositol-3-kinase-protein kinase B (PI3K-Akt) signaling pathway, endocytosis, and mitogen activated protein kinase (MAPK) signaling pathway. In the promoter region, 11 and 29 differentially methylated genes related to fibrosis and autophagy were screened, respectively.Conclusions:A large number of differential methylation sites exist in the process of NaAsO 2 induced fibrosis and autophagy of LX-2 cells. Specific methylation genes related to fibrosis and autophagy are screened out.

Ambient air pollution has become a widespread global public health problem. As one of the main components of ambient air pollution, fine particulate matter (PM_2.5), with its small diameter and large surface area, can carry a variety of toxic substances and enter the blood circulation directly through the blood-air barrier, damaging various tissues and organs of human body. Studies have shown that PM_2.5 exposure during pregnancy can disrupt the mother's and child's thyroid function. Since the fetal thyroid gland does not begin to develop until around the sixth week of pregnancy, the fetal thyroid hormone is almost entirely dependent on the mother during early stages of pregnancy, and maternal thyroid hormone level play a crucial role in the growth and development of fetus. When a mother is exposed to PM_2.5 during pregnancy, placenta, the "bridge" between mother and fetus, is also affected to some extent, including changes in placental iodine uptake and oxidative stress, inflammation, and DNA methylation in placental tissue. Exposure to PM_2.5 during pregnancy also alters maternal thyroid hormone level and normal placental function, which can have a detrimental effect on pregnancy outcomes, such as preterm birth, low birth weight, and neurological abnormalities. This paper reviewed the effects of PM_2.5 exposure during different trimesters on maternal and infant thyroid function, placental function, and pregnancy outcomes, aiming to provide more accurate protection of maternal and fetal health.

BackgroundSchizophrenia and the use of antipsychotic medications are identified to be the likely contributors to the development of metabolic syndrome （MS） and cardiovascular disease， and jeopardize the prognosis of schizophrenia. Therefore， effectively preventing or reducing the risk of developing MS in patients with schizophrenia is critical. ObjectiveTo explore the efficacy of aripiprazole combined with olanzapine for male schizophrenia patients and its effect on MS， so as to provide a certain reference for the selection of antipsychotic drugs for schizophrenia patients. MethodsMale patients （n=80） who were hospitalized in The Third People's Hospital of Meizhou from February to June 2023 and fulfilling the International Classification of Diseases， tenth edition （ICD-10） diagnostic criteria for the schizophrenia were enrolled， and grouped using random number table method， each with 40 cases. Study group was treated with aripiprazole combined with olanzapine， while control group was given aripiprazole monotherapy. The treatment lasted for 6 continuous weeks in both groups. At the baseline， Positive and Negative Symptom Scale （PANSS） score， MS-related indices ［fasting plasma glucose （FPG）， hemoglobin A1c （HbA1c）， body mass index （BMI）， waist-to-hip ratio （WHR）， lipid profile］， S100 calcium-binding protein B （S100B） and high sensitivity C-reactive protein （hs-CRP） were recorded. Then the PANSS scores at the end of the 2^nd， 4^th and 6^th week of treatment， the Clinical Global Impression （CGI） scores at the end of the 2^nd and 6^th week of treatment， as well as the MS-related indices， S100B， hs-CRP， Treatment Emergent Symptom Scale （TESS） score and Rating Scale for Extrapyramidal Side Effects （RSESE） score at the end of the 6^th week of treatment were recorded in all participants. ResultsAnalysis on PANSS score revealed a significant group effect， time effect and group×time interaction effect （F=18.092， 634.780， 2.917， P<0.05 or 0.01）. Analysis on CGI score revealed a significant group effect and time effect （F=20.492， 99.190， P<0.01）. At the end of the 6^th week of treatment， study group detected lower serum concentrations of HbA1c and triglyceride （TG） compared with control group （t=-3.495， -3.293， P<0.05）. The post-treatment hs-CRP level was lower in study group than that in control group （t=-3.916， P<0.05）. Study group scored lower on TESS compared with control group （t=-4.684， P<0.01）. ConclusionAripiprazole combined with olanzapine can effectively alleviate psychotic states in male schizophrenia patients， and the combination therapy yields less impact on MS-related indices than olanzapine monotherapy. ［Funded by Meizhou Science and Technology Plan Project （number， 2022B116）］