OBJECTIVE To formulate Guidelines for the standardized implementation of pharmacist-managed clinics （ 2026 edition ） in response to the challenges faced by such clinics in China， including uneven development， large discrepancies in service specifications， insufficient patient awareness， and limited medical insurance coverage. METHODS Led by the Pharmaceutical Affairs Professional Committee of the Chinese Hospital Association， the Evidence-based Pharmacy Professional Committee of the Chinese Pharmaceutical Association， and the Hospital Pharmacy Professional Committee of the Cross-strait Medical and Health Exchange Association， a total of 19 domestic hospital pharmacy experts were organized. Through a systematic review of national policies and literature research， current practical experience was summarized. Consensus on the contents of the guidelines was reached after in-depth discussions. RESULTS &CONCLUSIONS The guidelines covered five sections： definition and connotation of pharmacist-managed clinics， establishment requirements， implementation and management， post competency， and practical research. Firstly， the definition and connotation included three operational forms of pharmacist-managed clinics （independent mode， physician-pharmacist joint mode， and online pharmacist-managed clinic mode） and classified service modes （specialty-specific， drug-specific， and disease-specific pharmacist-managed clinics）. The establishment requirements were further refined， covering system construction （pharmaceutical service management system， quality control and assessment mechanism）， personnel qualifications （professional credentials， continuing education and professional training， etc）， service recipients， as well as service venues and facilities. Subsequently， the implementation and management of pharmacist-managed clinics were proposed， involving service procedures， intervention measures， documentation and records， patient education and follow-up， humanistic care， as well as risk management and quality control. Finally， post competency encompassed the competency requirements for pharmacists providing services in pharmacist-managed clinics， as well as the suggestions on teaching methods； practical research encouraged the conduct of high-quality pharmaceutical practice in the setting of pharmacist-managed clinics. The guidelines provide valuable guidance for the standardized implementation of pharmacist-managed clinics in China in terms of establishment， management， teaching， and research， fill the guideline gap in this field， and can promote the high-quality development of pharmacist-managed clinics.

OBJECTIVE To evaluate the cost-effectiveness of lecanemab for early Alzheimer disease （AD） from a whole-society perspective. METHODS Based on data from the Clarity AD study， a global multicenter， randomized， double-blind， placebo-controlled study of lecanemab for early AD， a Markov model was developed according to the disease progression of AD， with a monthly cycle and a time horizon extending to 99% patient mortality. Quality-adjusted life year （QALY） and incremental cost-effectiveness ratio （ICER） were used as outcome indicators， with a willingness-to-pay （WTP） threshold set at twice China’s per capita gross domestic product （GDP） for 2025 （199 330.00 yuan/QALY）. The model simulated the cost-effectiveness of lecanemab plus standard of care （SoC） versus placebo plus SoC for early AD. One-way sensitivity analysis， probabilistic sensitivity analysis， and scenario analysis were employed to test the robustness of the results. RESULTS Compared with placebo plus SoC， the ICER for lecanemab plus SoC was 4 364 711.54 yuan/QALY. One-way sensitivity analysis showed that the hazard ratio for disease progression， the price of lecanemab， body weight， the monthly progression probability of mild cognitive impairment， and the discount rate were key parameters affecting model robustness. Results of the probabilistic sensitivity analysis showed that the probability of lecanemab being cost-effective was 0 at the current WTP threshold. Scenario analysis indicated that a price reduction of at least 94.88% would be required for lecanemab to fall below the WTP threshold. CONCLUSIONS At the current WTP threshold， lecanemab plus SoC is not cost-effective compared with placebo plus SoC for early AD.

OBJECTIVE To evaluate the cost-effectiveness of lecanemab for early Alzheimer disease （AD） from a whole-society perspective. METHODS Based on data from the Clarity AD study， a global multicenter， randomized， double-blind， placebo-controlled study of lecanemab for early AD， a Markov model was developed according to the disease progression of AD， with a monthly cycle and a time horizon extending to 99% patient mortality. Quality-adjusted life year （QALY） and incremental cost-effectiveness ratio （ICER） were used as outcome indicators， with a willingness-to-pay （WTP） threshold set at twice China’s per capita gross domestic product （GDP） for 2025 （199 330.00 yuan/QALY）. The model simulated the cost-effectiveness of lecanemab plus standard of care （SoC） versus placebo plus SoC for early AD. One-way sensitivity analysis， probabilistic sensitivity analysis， and scenario analysis were employed to test the robustness of the results. RESULTS Compared with placebo plus SoC， the ICER for lecanemab plus SoC was 4 364 711.54 yuan/QALY. One-way sensitivity analysis showed that the hazard ratio for disease progression， the price of lecanemab， body weight， the monthly progression probability of mild cognitive impairment， and the discount rate were key parameters affecting model robustness. Results of the probabilistic sensitivity analysis showed that the probability of lecanemab being cost-effective was 0 at the current WTP threshold. Scenario analysis indicated that a price reduction of at least 94.88% would be required for lecanemab to fall below the WTP threshold. CONCLUSIONS At the current WTP threshold， lecanemab plus SoC is not cost-effective compared with placebo plus SoC for early AD.

Objective: To analyze the influence of stress and psychological resilience on the dietary behavior of middle school students so as to privide a basis for the development of policies and interventions aimed at improving middle school students dietary behavior. Methods: A total of 8 874 middle school students in Shanghai were surveyed using stratified cluster random sampling method from November 2019 to January 2020. The questionnaire included general information, dietary behavior, Perceived Stress Scale (PSS-10) and Connor-Davidson Resilience Scale (CD-RISC-10). Factor analysis was used to analyze the dietary behavior model. Logistic regression model was used to explore the correlation between stress, psychological resilience and dietary behavior in adolescents. Besides, a structural equation model was established to analyze the mediating effect of psychological resilience on stress and dietary behavior. Results: The total score of psychological resilience among middle school students was (27.99±9.83), and the total score of stress was (25.56±7.06). Factor analysis categorized dietary behavior into two types: the high energy dietary behavior and balanced dietary behavior. High energy dietary behavior exhibited statistically significant differences across genders and schooling stage ( χ 2=41.37, 204.03), while balanced dietary behavior showed statistically significant differences across schooling stage and socioeconomic status ( χ 2=130.23, 96.53) (all P <0.01). Logistic regression analysis showed that adolescents with moderate and high stress levels had an increased risks of high energy dietary behavior ( OR=1.25, 95%CI =1.12-1.39; OR=1.58, 95% CI = 1.39-1.79) and a reduced likelihood of reduced balanced dietary behavior ( OR=0.73, 95%CI =0.65-0.81; OR=0.53, 95%CI =0.47-0.60); adolescents with high levels of psychological resilience had a decreased risk of highenergy dietary behavior ( OR= 0.73 , 95%CI =0.65-0.83), and those with moderate and high resilience levels showed improved balanced dietary behavior ( OR= 1.45 , 95%CI =1.29-1.62; OR=2.50, 95%CI =2.21-2.84) (all P <0.01). The mediating effect of psychological resilience between stress and high energy dietary behavior or balanced dietary behavior accounted for 15.61% and 56.10% of the total effects, respectively. Conclusions Stress and psychological resilience are the influencing factors of dietary behavior in middle school students. Psychological resilience have a partial mediating effect between stress and high energy dietary behavior or balanced dietary behavior.

ObjectiveThis study aimed to evaluate the clinical efficacy of Ruyi Zhenbaowan（RYZBW）in the treatment of initial and early knee osteoarthritis （KOA） through a prospective multicenter，randomized，double-blind，and placebo-parallel controlled trial. MethodFrom October 13^th， 2021 to December 25^th， 2021， 240 KOA subjects meeting the acceptance criteria were enrolled in 15 sub-centers including Wangjing Hospital， Chinese Academy of Chinese Medical Sciences， and they were randomly divided into observation group and control group， with 120 cases in each group. The intervention measures for the observation group were RYZBW + health education， and the intervention measures for the control group were RYZBW placebo + health education. The intervention period in both groups was four weeks， and they were followed up for four weeks after the intervention. The primary outcome measure was the total score of Western Ontario and McMaster University Osteoarthritis Index score （WOMAC score）， and the secondary outcome measures were the response rate of visual scale （VAS） pain score， WOMAC sub item scores （joint pain， joint stiffness， and joint function）， quality of life （SF-12） score， and traditional Chinese medicine （TCM） syndrome score. Result（1） Efficacy evaluation. The marginal model results showed that the observation group was better than the control group in improving the WOMAC total score and WOMAC pain score in the treatment of KOA with RYZBW， and the difference was statistically significant （P<0.05）. There was no significant difference between the two groups in improving VAS score response rate， WOMAC function score， WOMAC stiffness score， SF12-PCS （quality of life-physical health） score， SF12-MCS （quality of life-mental health） score， and TCM syndrome score. （2） Subgroup analysis. ① In terms of VAS score response rate， the response rate of the observation group was higher than that of the control group for subjects with baseline VAS score of （4， 5］， and the difference was statistically significant （P<0.05）. ② In terms of TCM syndrome score， for subjects aged ［56， 60］ and ［61， 65］， the decrease in total TCM syndrome score in the observation group was better than that in the control group， and the difference was statistically significant （P<0.05）. ConclusionTibetan medicine RYZBW has good clinical efficacy in improving WOMAC total score， VAS score response rate， WOMAC pain score， WOMAC function score， and TCM syndrome score for patients with initial and early KOA， which can fill the lack of Tibetan medicine RYZBW in the treatment of KOA and make a demonstration study for the inheritance and development of ethnic medicine.

BACKGROUND:After the internal fixation of cannulated screws in femoral neck fractures,because the affected limb is often unable to bear weight in the short term and the implants with high stiffness have a stress shielding effect on the fracture end,it is easy to cause osteoporosis of the affected limb and changes in the biomechanical distribution of the proximal femur,the incidence of osteonecrosis of the femoral head is high after surgery.At present,few studies have been conducted on the biomechanical effects of osteoporosis at the proximal end of the femur occurring after femoral neck fracture surgery on femoral neck fracture treated with cannulated screws. OBJECTIVE:Using finite element analysis,to investigate the biomechanical effects of osteoporosis occurring after femoral neck fracture surgery on femoral neck fracture treated with cannulated screws and explore the role of biomechanical factors in osteonecrosis of the femoral head. METHODS:Based on the obtained CT scan data of the femur in a patient with a femoral neck fracture,a proximal femoral model for internal fixation for femoral neck fracture was established by Mimics 19.0,3-Matic,UG 11.0,Hypermesh 14.0,and Abaqus software.One finite element model of the proximal femur without osteoporosis and three finite element models of the proximal femur with osteoporosis were analyzed using Abaqus software.The stress,contact pressure,displacement peak and cloud map under different components of the four models were measured and analyzed,and the internal stress changes and distribution of the femoral head were compared and analyzed. RESULTS AND CONCLUSION:The stresses and contact pressures of the femoral head and lower anterior cannulated screws varied more with the degree of osteoporosis.The peak displacement of the four models increased slowly with the degree of osteoporosis.By one-way analysis of variance,there was no significant effect of the degree of osteoporosis on the peak stress,contact pressure,and displacement of the different components.The internal stress distribution of the femoral head changed with the degree of osteoporosis.Changes in the biomechanical environment of the proximal femur have an important impact on osteonecrosis of the femoral head.

Objective To investigate the biomechanical effects of lateral wedge insole(LWI)on internal tissues of the foot and ankle(including foot bones,joints,and ligaments).Methods A three-dimensional finite element model of the foot-insole-ground was developed and validated,and the plantar pressure distributions,contact pressures on joints,and peak stresses on metatarsals and major ligaments in barefoot model and insole intervention models at three key gait instants were explored.Results The 5° LWI model reduced the peak plantar pressure by 65.8％compared to the barefoot model.Insole interventions decreased the peak contact pressure at the cuneonavicular joint,but increased the peak contact pressure at the subtalar joint and peak stress at the 4th and 5th metatarsals.Conclusions This study quantitatively assesses the biomechanical effects of LWI on various parts of the foot and ankle,and suggests a design that can appropriately reduce the inclination angle of LWI at the 4th and 5th metatarsals.

Objective: To investigate the prevalence of adolescents dietary behavior in Shanghai, and to explore emotional influence on dietary behavior. Methods: A total of 7 456 students from 10 junior and 6 senior high schools in Shanghai were selected to participate in the questionnaire survey with the stratified random cluster sampling method. The survey included general information, eating behavior, PHQ-2 and GAD-7. Results: During the past week, the proportion of adolescents in Shanghai reported consumption of sugar sweetened beverages, sweet desserts, frequent fried food and fast food (≥4 times/week) were 13.26%, 16.90%, 6.99 % and 13.01%, respectively. The proportion of students reported consumption of fruits, vegetables, milk and breakfast every day were 56.96%, 73.00%, 65.03% and 76.11%, respectively. There were significant differences by sex and educational stages(both P <0.05). Adolescents with depression or anxiety have a higher incidence of unhealthy eating behaviors than those without depression or anxiety( P <0.01). After adjusting for gender, school, accommodation, grades, pocket money and social class, depression and anxiety increase the risk of various unhealthy eating behaviors in adolescents( P <0.05). Compared with those without anxiety, the risks of sugar sweetened beverages consumption (≥1 time/d) among adolescents with mild and moderate to severe anxiety were 1.42 times (95% CI =1.20-1.67) and 2.51 times (95% CI =2.09-3.01), the risks of insufficient fruits consumption (<1 time/d) were 1.30 times (95% CI =1.16-1.45) and 1.28 times (95% CI =1.11-1.47), the risks of insufficient vegetable consumption (<1 time/d) were 1.35 times (95% CI =1.20-1.52) and 1.41 times(95% CI =1.21-1.65), the risks of insufficient milk consumption (<1 time/d) were 1.29 times (95% CI =1.15-1.44) and 1.20 times(95% CI =1.04-1.39), and the risks of breakfast skipping were 1.75 times (95% CI =1.54-1.99) and 2.97 times (95% CI =2.55-3.46) among adolescents with mild and moderate to severe anxiety. Conclusion The proportion of unhealthy eating behaviors among adolescents in Shanghai is still high. Early education and intervention for students eating behaviors should be carried out, and attention should be paid to the occurrence of adolescents negative emotions, so as to reduce the risk of unhealthy eating behaviors among adolescents through the promotion of mental health.

Objective To evaluate the clinical efficacy of gemcitabine plus cisplatin (GP) regimen and paclitaxel plus cisplatin (TP) regimen in the treatment of recurrent or metastatic nasopharyngeal carcinoma.Methods One hundred and thirty patients with recurrent or metastatic nasopharyngeal carcinoma of Qinhuangdao Harbor Hospital,Hebei Province between September 2012 and December 2017 were chosen,and were divided into GP group (68 cases) and TP group (62 cases)according to the selection of treatment.GP group was treated with GP regimen,and TP group was treated with TP regimen.The clinical efficacy and adverse reactions of the two groups were observed,and the serum epithelial cadherin (SE-CAD) and platelet-derived growth factor (PDGF-BB) were measured before and after chemotherapy.Results There was no significant difference in short-term efficacy between GP group and TP group (P＞0.05),and the total effective rates were 88.24％ (60/68) and 79.03％ (49/62) respectively;1 month after treatment,SE-CAD in GP group and TP group were (2.57 ± 0.81) and (2.50 ± 0.96) g/L,PDGF-BB were (102.22 ± 31.18) and (110.15 ± 37.21) ng/L,and the difference was not statistically significant (P＞0.05);progression-free survival (PFS) in GP group and TP group were 13 and 12 months,and overall survival (OS) were 17 and 16 months,and the difference was not statistically significant (P＞0.05);there were no significant difference in leucopenia,hemoglobin,thrombocytopenia and abnormal liver and kidney function between GP group and TP group (P＞0.05);the incidence of gastrointestinal reactions in GP group was 16.18％ (11/68),which was significantly lower than that in TP group was 38.71％(24/62),and the difference was statistically significant (P＜0.01).Conclusions GP and TP regimens are effective in the treatment of recurrent or metastatic nasopharyngeal carcinoma.There is no significant difference in SE-CAD and PDGF-BB levels between the two regimens after treatment,but GP regimen has a lower incidence of gastrointestinal reactions.

Objective To study the effect of intercellular adhesion of tumor cells on immune response of human body. Methods A tumor growth-cellular immune feedback model was developed based on cellular Potts model (CPM) to simulate the progression of tumor cells and the cellular immune feedback system, and the influence of adhesion between tumor cells on the immune system was analyzed. Results Under the condition of tumor intercellular adhesion with normal intensity, tumor cells could escape when the immune system was weak and be eliminated when the immune system was strong. Under the condition of tumor intercellular adhesion with low intensity, tumor cells could escape when the immune system was weak, while exhibited behavior of oscillation and could not be eliminated when the immune system was strong. Conclusions Higher adhesion between tumor cells inhibited escape of tumor cells from the immune system, while lower adhesion between tumor cells could effectively help the tumor escape killing from the immune system. When the tumor was extremely spread, the immune system could not completely eliminate tumor cells.