OBJECTIVE To summarize the implementation experiences of the China Hospital Association’s Clinical Pharmacist Instructor Training Program Reform， and to evaluate the effectiveness of the reform， thus continuously enhancing the quality and standards of clinical pharmacist instructor training. METHODS The study drew on project evaluation methodologies to summarize the main characteristics of the comprehensive system and new model for clinical pharmacist instructor training established through the reform by literature review. The “learning assessment” and “reaction assessment” were conducted by using Kirkpatrick’s four-level model of evaluation in order to evaluate the effectiveness of the clinical pharmacist instructor training reform through statistically processing and analyzing the performance data and teaching evaluation data of the instructor participants. Based on problem and trend analysis， the future development directions were anticipated for the reform of clinical pharmacist instructor training. RESULTS & CONCLUSIONS The latest round of clinical pharmacist instructor training reform initiated by the Chinese Hospital Association had initially established a four-pronged training system encompassing “recruitment， training， assessment， and management”. It had also forged a training 。 model “oriented towards enhancing clinical teaching competency， with practical learning and skill-based assessment conducted on clinical teaching sites as its core”. Following a period of over three years of gradual reform， the new training system and model became increasingly mature. In both 2023 and 2024， the participants achieved relatively high average total scores in their initial completion assessments [with scores of （84.05± 5.83） and （85.82±4.35） points， respectively]. They also reported a strong sense of gain from the training reform [with self- perceived gain scores of （4.80±0.44） and （4.85±0.39） points， respectively]. The operation and implementation effects of the reform were generally satisfactory. In the future， clinical pharmacist instructor training reforms should continue to address the issues remaining from the current phase， while aligning with global trends in pharmacy education and industry development. Additionally， sustained exploration and practice will be carried out around the core objective of “enhancing clinical teaching competence”.

Artemisia argyi (A. argyi), a plant with a longstanding history as a raw material for traditional medicine and functional diets in Asia, has been used traditionally to bathe and soak feet for its disinfectant and itch-relieving properties. Despite its widespread use, scientific evidence validating the antifungal efficacy of A. argyi water extract (AAWE) against dermatophytes, particularly Trichophyton rubrum, Trichophyton mentagrophytes, and Microsporum gypseum, remains limited. This study aimed to substantiate the scientific basis of the folkloric use of A. argyi by evaluating the antifungal effects and the underlying molecular mechanisms of its active subfraction against dermatophytes. The results indicated that AAWE exhibited excellent antifungal effects against the three aforementioned dermatophyte species. The subfraction AAWE6, isolated using D101 macroporous resin, emerged as the most potent subfraction. The minimum inhibitory concentrations (MICs) of AAWE6 against T. rubrum, M. gypseum, and T. mentagrophytes were 312.5, 312.5, and 625 μg·mL^-1, respectively. Transmission electron microscopy (TEM) results and assays of enzymes linked to cell wall integrity and cell membrane function indicated that AAWE6 could penetrate the external protective barrier of T. rubrum, creating breaches ("small holes"), and disrupt the internal mitochondrial structure ("granary"). Furthermore, transcriptome data, quantitative real-time PCR (RT-qPCR), and biochemical assays corroborated the severe disruption of mitochondrial function, evidenced by inhibited tricarboxylic acid (TCA) cycle and energy metabolism. Additionally, chemical characterization and molecular docking analyses identified flavonoids, primarily eupatilin (131.16 ± 4.52 mg·g^-1) and jaceosidin (4.17 ± 0.18 mg·g^-1), as the active components of AAWE6. In conclusion, the subfraction AAWE6 from A. argyi exerts antifungal effects against dermatophytes by disrupting mitochondrial morphology and function. This research validates the traditional use of A. argyi and provides scientific support for its anti-dermatophytic applications, as recognized in the Chinese patent (No. ZL202111161301.9).
Antifungal Agents/chemistry* ; Arthrodermataceae ; Artemisia/chemistry* ; Molecular Docking Simulation ; Mitochondria ; Microbial Sensitivity Tests

Background::Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized immune-mediated disorder that can affect almost any organ in the human body. IgG4-RD can be categorized into proliferative and fibrotic subtypes based on patients’ clinicopathological characteristics. This study aimed to compare the clinical manifestations, laboratory findings, and treatment outcomes of IgG4-RD among different subtypes.Methods::We prospectively enrolled 622 patients with newly diagnosed IgG4-RD at Peking Union Medical College Hospital from March 2011 to August 2021. The patients were divided into three groups according to their clinicopathological characteristics: proliferative, fibrotic, and mixed subtypes. We compared demographic features, clinical manifestations, organ involvement, laboratory tests, and treatment agents across three subtypes. We then assessed the differences in treatment outcomes among 448 patients receiving glucocorticoids alone or in combination with immunosuppressants. Moreover, risk factors of relapse were revealed by applying the univariate and multivariate Cox regression analysis.Results::We classified the 622 patients into three groups consisting of 470 proliferative patients, 55 fibrotic patients, and 97 mixed patients, respectively. We found that gender distribution, age, disease duration, and frequency of allergy history were significantly different among subgroups. In terms of organ involvement, submandibular and lacrimal glands were frequently involved in the proliferative subtype, while retroperitoneum was the most commonly involved site in both fibrotic subtype and mixed subtype. The comparison of laboratory tests revealed that eosinophils ( P = 0.010), total IgE ( P = 0.006), high-sensitivity C-reactive protein ( P <0.001), erythrocyte sedimentation rate ( P <0.001), complement C4 ( P <0.001), IgG ( P = 0.001), IgG1 (P <0.001), IgG4 (P <0.001), and IgA ( P <0.001), at baseline were significantly different among three subtypes. Compared with proliferative and mixed subtypes, the fibrotic subtype showed the lowest rate of relapse (log-rank P = 0.014). Conclusions::Our study revealed the differences in demographic characteristics, clinical manifestations, organ involvement, laboratory tests, treatment agents, and outcomes across proliferative, fibrotic, and mixed subtypes in the retrospective cohort study. Given significant differences in relapse-free survival among the three subtypes, treatment regimens, and follow-up frequency should be considered separately according to different subtypes.Trial Registration::ClinicalTrials. gov, NCT01670695.

By identifying and analyzing the problems and difficulties in the implementation process of student stratification, goal stratification, practice stratification, and assessment stratification in standardized residency training, this article proposes to fully leverage the main role of professional bases in hierarchical and progressive teaching for standardized residency training and strengthen the specific responsibilities of professional base teaching groups in discussing hierarchical and progressive teaching plans, evaluation standards, and assessments. It is also necessary to scientifically implement student stratification, achieve consistent stratification goals, strengthen the training of hierarchical and progressive teaching concepts and teaching abilities for teachers, enhance the ability for homogeneous and hierarchical evaluation, and develop countermeasures that combine stage training goal process evaluation with dynamic personalized teaching by mentors, so as to provide a useful reference for further promoting the reform of standardized residency training using a hierarchical and progressive teaching model.

Objective:To retrieve and evaluate the best evidence on the assessment and management of constipation in Parkinson's disease (PD) patients and provide clinical practitioners with evidence-based guidelines for effectively managing constipation in this patient group.Methods:A comprehensive literature search was conducted in databases including UpToDate, BMJ Best Practice, Cochrane Library, Joanna Briggs Institute Evidence-Based Healthcare Center, CINAHL, Medline, PubMed, National Institute for Health and Care Excellence, Evidence-Based Medicine database, Ovid, China National Knowledge Infrastructure, Wanfang Database, SinoMed, Chinese Guidelines Network, World Health Organization website, and various national PD, neurology, and gastroenterology associations' websites. The search covered literature from December 2018 to December 2023. The methodological quality of the retrieved literature was assessed, and relevant evidence was extracted and summarized.Results:A total of 12 articles were included: one clinical decision-making article, four clinical guidelines, three systematic reviews, and four expert consensus. Fifteen pieces of evidence were summarized from four aspects: screening and assessment, non-pharmacological interventions, pharmacological interventions, and health education.Conclusions:This study summarized the best evidence for the assessment and management of constipation in PD patients from various dimensions and provided evidence-based guidelines for clinical practitioners.

OBJECTIVE To interpret Teacher Training Syllabus for Clinical Pharmacist Training Program （2023 edition） （hereinafter referred as to the “new syllabus”）， and to provide reference and guidance for promoting the implementation of the new syllabus and realizing the quality-improving goal of the reform of the clinical pharmacist teacher training program initiated by China Hospital Association. METHODS From the perspective of the management and based on the position of the designer， the new syllabus was interpreted from four aspects： the background of its compilation and release， the process of its compilation and its characteristics， the key improvements of the program and the points for attention about its subsequent implementation. RESULTS & CONCLUSIONS The development and release of the new syllabus provide a “construction blueprint” for the reform of the clinical pharmacist teacher training program of the China Hospital Association. The whole process of compiling the new syllabus is characterized by four basic features： theory-led， goal-oriented， research-based， and synergistic. Compared with the previous syllabus， in addition to the adjustment of the text structure，the new syllabus presents more complete and clearer competence requirements for clinical teaching competence in terms of training objectives； in terms of training content， it further structures the group of task items， pays attention to the 育。E-mail：zhenjiancun@163.com sequential planning and time arrangement of items， and puts forward both quantitative and qualitative refinement requirements for each specific training task；in terms of training methods， it emphasizes the interaction of lecturing， demonstrating and guiding， and the progression of observation， operation and reflection， with the intention of guiding teacher trainees to “learn how to teach by teaching”. In the subsequent implementation of the new syllabus， it is necessary for the teacher training bases to attach great importance to the guarantee of training conditions and process quality management， and to organize the teacher training team to do a good job in the two training programs of “clinical pharmacist training” and “clinical pharmacist teacher training”. Based on further improving the connection between the two training programs， the teacher training team should continue to explore the scientific model of clinical pharmacist teacher training oriented by clinical teaching competence.

Objective:To observe the clinical features of eyes in children with methylmalonic acidemia (MMA).Methods:A retrospective clinical case study. From June 2019 to June 2022, 13 children with MMA visited on the Department of Ophthalmology of Henan Children's Hospital were included in the study. The anterior segment and fundus were examined under surface or general anesthesia. Best corrected visual acuity (BCVA) and refraction were performed in 9 cases; fluorescein fundus angiography (FFA) was performed in 3 cases; flash electroretinogram (FERG) was performed in 6 cases; flash visual evoked potential (FVEP) was detected in 6 cases; optical coherence tomography (OCT) was performed in 3 cases.Results:Among the 13 pediatric patients with methylmalonic acidemia, 6 cases were male and 7 cases were female. The average age at first visit was 45 months. All cases suffered from hyperhomocysteinemia; 9 cases were with epilepsy; 2 cases were with infantile spasms; 11 cases were with stunting, 13 cases were with repeated pulmonary infection during growth period; 4 cases were with hydrocephalus; 1 cases was with hypertension and renal insufficiency. Genetic dectection results of 8 cases were recorded, MMACHC:c.609G>A:p.W203* mutation site was found in all cases. One case was accompanied by corneal ulcer. There were 10 cases with nystagmus, 4 cases with macular degeneration, 3 cases with hyperopic refractive error and esotropia. Nine cases underwent BCVA examination, BCVA was light perception-0.6. In OCT, 2 cases of 3 cases showed retinal thinning and photoreceptor cell layer atrophy in the macular area. In FFA, 2 cases of 3 cases showed circular transparent fluorescence in the macular area. Five cases of 6 cases who with FVEP had different degrees of P100 peak time delay and decreased amplitude, and 4 cases of 6 cases with FERG had decrease of a and b wave in light and dark adaptation. Conclusions:The clinical phenotypes of eyes in children with MMA are various and the severity was different; most of them are accompanied by nystagmus, and the fundus lesions are common in the characteristic bovine eye like macular region. Those with macular disease have severe visual impairment.

Bone regeneration remains a great clinical challenge. Low intensity near-infrared (NIR) light showed strong potential to promote tissue regeneration, offering a promising strategy for bone defect regeneration. However, the effect and underlying mechanism of NIR on bone regeneration remain unclear. We demonstrated that bone regeneration in the rat skull defect model was significantly accelerated with low-intensity NIR stimulation. In vitro studies showed that NIR stimulation could promote the osteoblast differentiation in bone mesenchymal stem cells (BMSCs) and MC3T3-E1 cells, which was associated with increased ubiquitination of the core circadian clock protein Cryptochrome 1 (CRY1) in the nucleus. We found that the reduction of CRY1 induced by NIR light activated the bone morphogenetic protein (BMP) signaling pathways, promoting SMAD1/5/9 phosphorylation and increasing the expression levels of Runx2 and Osterix. NIR light treatment may act through sodium voltage-gated channel Scn4a, which may be a potential responder of NIR light to accelerate bone regeneration. Together, these findings suggest that low-intensity NIR light may promote in situ bone regeneration in a CRY1-dependent manner, providing a novel, efficient and non-invasive strategy to promote bone regeneration for clinical bone defects.
Animals ; Rats ; Bone Morphogenetic Protein 2/metabolism* ; Bone Regeneration ; Cell Differentiation ; Circadian Clocks ; Cryptochromes/metabolism* ; Osteoblasts/metabolism* ; Osteogenesis ; Transcription Factors/metabolism*

Objective:To explore the relationship between lipid accumulation product (LAP) and disease activity, nutritional status in patients with Crohn disease (CD).Methods:The clinical data of 74 patients with CD in the Affiliated Hospital of Yangzhou University from July 2020 to June 2021 were retrospectively analyzed. The patients were divided into active group (32 cases) and remission group (42 cases) according to simplified Crohn disease activity index (CDAI). The general clinical data, laboratory examination results and body fat indexes were recorded, body fat indexes including body mass index (BMI), waist circumference, waist-to-height ratio, LAP and nutritional risk screening 2002 (NRS2002) score. Spearman method was used for correlation analysis; the receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of LAP in predicting the disease activity and nutritional status in patients with CD.Results:The proportion of males, body weight, hemoglobin, albumin, total cholesterol, triglyceride and high-density lipoprotein cholesterol in active group were significantly lower than those in remission group: 46.9% (15/32) vs. 71.4% (30/42), (53.58 ± 8.13) kg vs. (61.05 ± 9.38) kg, (109.94 ± 23.70) g/L vs. (134.19 ± 18.03) g/L, (34.01 ± 5.71) g/L vs. (39.15 ± 4.27) g/L, (3.23 ± 0.68) mmol/L vs. (3.66 ± 0.74) mmol/L, (1.12 ± 0.36) mmol/L vs. (1.34 ± 0.55) mmol/L and (0.91 ± 0.23) mmol/L vs. (1.04 ± 0.33) mmol/L, the nutritional risk rate, platelet count, C-reactive protein and erythrocyte sedimentation rate were significantly higher than those in remission group: 68.8% (22/32) vs. 19.0% (8/42), (317.97 ± 130.19) ×10 9/L vs. (194.00 ± 51.91) × 10 9/L, 14.15 (6.15, 41.35) mg/L vs. 1.51 (0.22, 5.58) mg/L and 40.00 (20.50, 64.25) mm/1 h vs. 9.00 (3.00, 20.00) mm/1 h, and there were statistical differences ( P<0.01 or <0.05); there were no statistical difference in age, height, total protein and low-density lipoprotein cholesterol between the two groups ( P>0.05). The BMI, waist circumference, waist-to-height ratio and LAP in active group were significantly lower than those in remission group: 19.46 (17.70, 21.45) kg/m 2 vs. 21.08 (18.87, 23.12) kg/m 2, (72.51 ± 5.92) cm vs. (77.67 ± 7.27) cm, 0.44 ± 0.03 vs. 0.46 ± 0.04, 13.42 (5.07, 17.72) cm·mmol/L vs. 15.49 (9.37, 31.71) cm·mmol/L, the NRS2002 was significantly higher than that in remission group: 3.00 (1.00, 3.75) scores vs. 1.00 (0, 2.00) scores, and there were statistical differences ( P<0.01 or <0.05). Spearman correlation analysis result showed that LAP was positively correlated with BMI, waist circumference and waist-to-height ratio ( r = 0.701, 0.766 and 0.829; P<0.01); LAP was negatively correlated with NRS2002 score, platelet count and erythrocyte sedimentation rate ( r =- 0.609, - 0.249 and - 0.243; P<0.01 or<0.05). ROC curve analysis result showed that the areas under the curve of LAP predicting disease remission and nutritional status improvement in patients with CD were 0.645 and 0.832 (95% CI 0.520 to 0.770 and 0.739 to 0.925), the best cut-off values were 20.89 and 12.86 cm·mmol/L, the sensitivities were 45.2% and 81.8%, and the specificities were 87.5% and 73.3%. Conclusions:LAP has good predictive value for disease remission and nutritional status improvement in patients with CD.

Objective:To establish a supportive and effective management mode of scientific research project application, promote the capacity building of scientific research in the hospital.Methods:Retrospective analysis was conducted on the national and provincial scientific research projects of Xinhua Hospital Affiliated to Shanghai Jiaotong University Medical School from 2010 to 2019, and the practical effect of " point to point" management mode of scientific research project application was evaluated.Results:The funding rate of Xinhua Hospital, especially national scientific research projects and provincial talents projects, was greatly improved by adoption of the multi-dimensional " point to point" management mode of scientific research project application. The number of national scientific research projects increased from 34 (26.02 million) in 2010 to 72 (51.0851 million) in 2019.The number of provincial talents projects increased from 5 (1.05 million) in 2010 to 26 (6.5 million) in 2019.Conclusions:The " point to point" management mode of scientific research project application plays an important role in promoting the overall funding rate. Enhancement of comprehensive capacity of hospital scientific research can be achieved by further improvement of this management mode, early initiation and arrangement of funding application depending on the " close partner" entity, emphasizing scientific research talents cultivation.