OBJECTIVE To ensure the safety of patients’ drug use and control the risk of medical insurance expenditure by upgrading the pre-prescription review system to conduct pre-review on prescriptions from internet hospitals and external prescriptions， as well as to review the payment methods of drugs （including in-hospital and external drug dispensing）. METHODS The data interfaces of prescriptions from internet hospitals and external prescriptions were integrated to achieve real-time rational drug use intervention. Additionally， an intelligent review project for payment method was added to precisely intervene in the medical insurance payment methods of drugs. The effect of the system upgrade was evaluated by comparing the qualification rates of prescriptions from internet hospitals and external prescriptions and the suspected amounts of drug violations from January to April 2025 （before the system upgrade） and May to August 2025 （after the system upgrade）. RESULTS After the upgrade of the pre-prescription review system， the qualification rates of prescriptions from internet hospitals and external prescriptions increased by 3.5% [95% confidence interval （CI）＝0.3%-6.7%， P ＝0.037 ] ； the suspected amounts of drug violations decreased to 52.9% of the pre-upgrade level （95%CI＝31.6%-88.5%， P ＝0.026）， and the average monthly sequential decrease was 29.5% （95%CI＝12.2%-43.4%， P ＝0.012）. Moreover， the addition of the intelligent review project for payment methods promoted the management of off-label drug use in our hospital. After the upgrade， a total of 79 filling valid applications for off-label drug use were received and archived. CONCLUSIONS The upgrade of the pre-prescription review system effectively improves the review qualification rates of prescriptions from internet hospitals and external prescriptions and the accuracy of medical insurance payment for drugs， and strengthens the supervision of off-label drug use， achieving dual guarantees of clinical rationality and medical insurance compliance.

OBJECTIVE To develop a pharmacist-led intervention model for reducing drug-related medical insurance claim denial risks， so as to provide practical references for healthcare institutions in fulfilling their primary responsibility for medical insurance fund supervision. METHODS A risk matrix method was employed by the pharmacists to assess the risks associated with drug‑related medical insurance claim rejections in our hospital during 2024. Intervention measures were developed targeting high‑risk factors (including inappropriate indications for medical insurance coverage, exceeding the covered treatment course, and inappropriateness of gender and age) from three dimensions, namely organizational structure, technical prevention and control, and closed‑loop management. Changes in drug‑related claim rejection data were compared between 2024 (pre‑intervention) and 2025 (post‑intervention), and the interception effect of the pre‑prescription review system was evaluated after the intervention. RESULTS After the intervention, the total amount of drug‑related medical insurance claim rejections in our hospital was reduced by 57.24% compared with that before the intervention, and the number of rejected items decreased from 10 108 to 2 892. Specifically, the number of rejected items due to inappropriate indications, exceeded treatment course, inappropriate gender, and inappropriate age was reduced by 70.94%, 74.26%, 83.86%, and 96.70%, respectively. Throughout the year following the intervention, a total of 5.605 yuan million in outpatient prescription drug amounts and 4.683 million yuan in inpatient medication order amounts that did not meet the insurance‑limited payment requirements were intercepted by the pre‑prescription review system. The proportion of drug‑related claim rejection amount to the total medical service claim rejection amount of our hospital decreased to 19.7%. CONCLUSIONS The pharmacist-led multi-department collaborative， technical prevention and control， and dynamic optimization integrated full-process intervention model is highly operable and has significant practical effects. It has important promotion value in reducing drug-related medical insurance claim denial risks.

Objective:To investigate the clinical and endoscopic characteristics of patients with autoimmune gastritis (AIG).Methods:From January 1, 2013 to December 31, 2023, 73 AIG patients who visited Peking Union Medical College Hospital were retrospectively enrolled. The clinical data of all the patients were analyzed, including gender, age, symptoms, laboratory examination results (such as serum hemoglobin, vitamin B 12, serum iron, gastrin, anti-parietal cell antibody (APCA), anti-intrinsic factor antibody (AIFA), Helicobacter pylori ( HP) infection status; the indicators were judged based on the normal reference value), and endoscopic and histopathological examination results. Descriptive statistical methods were used for statistical analysis. Results:Among the 73 AIG patients, there were 27 males (37.0%) and 46 females (63.0%), with a median age of 57 years old (ranged from 25 to 85 years old). Among the 73 AIG patients, 68 patients received APCA test, with a positivity rate of 88.2% (60/68); 67 patients took the AIFA test, with a positivity rate of 52.2%(35/67); 62 patients underwent both APCA and AIFA tests, of which 22 patients (35.5%) showed double positive. Serum level of vitamin B 12 was detected in 59 patients, and decreased in 27 cases (median level: 0.100 ng/L, mean level: 0.102 ng/L). Gastrin level was detected in 58 patients, and increased in 55 cases (median level: 0.930 ng/L, mean level: 1.203 ng/L). The levels of serum iron and ferritin were tested in 52 patients, the level of serum iron of 5 cases decreased, and the level of ferritin of 17 cases decreased (median level: 780.0 and 26.0 μg/L, mean level: 807.8 and 76.0 ng/L, respectively).Among the 73 AIG patients, the urea breath test was performed in 12 patients, and the result was positive in 6 cases. Endoscopic rapid urease test was performed in 69 patients, and the result was positive in 11 cases (15.9%). Regular blood analysis was performed in 71 patients, 24 cases (33.8%) were diagnosed with anemia, the median age of patients with anemia was 55 years old, and male-to-female ratio was 1∶5. There were 6 cases of iron-deficiency anemia and 5 cases of pernicious anemia. The endoscopic examination results of 73 patients indicated that 65 cases (89.0%) with mucosal atrophy under endoscopy, including 47 cases (64.4%) with mucosal atrophy in the gastric fundus and body, and 18 cases (24.7%) with whole gastric atrophy, more obviously in the gastric body. The pathological examination results showed type Ⅰ gastric neuroendocrine tumor(g-NET) in 35 cases (47.9%). Conclusions:The early clinical symptoms of AIG patients are nonspecific, often present with anemia and vitamin B 12 deficiency. Close monitoring of serological markers including APCA, AIFA and gastrin is essential. For patients diagnosed or suspected with AIG, intervals of endoscopic surveillance should be shortened to prevent the genesis and development of neoplasms such as g-NET.

Objective:To investigate the clinical and endoscopic characteristics of patients with autoimmune gastritis (AIG).Methods:From January 1, 2013 to December 31, 2023, 73 AIG patients who visited Peking Union Medical College Hospital were retrospectively enrolled. The clinical data of all the patients were analyzed, including gender, age, symptoms, laboratory examination results (such as serum hemoglobin, vitamin B 12, serum iron, gastrin, anti-parietal cell antibody (APCA), anti-intrinsic factor antibody (AIFA), Helicobacter pylori ( HP) infection status; the indicators were judged based on the normal reference value), and endoscopic and histopathological examination results. Descriptive statistical methods were used for statistical analysis. Results:Among the 73 AIG patients, there were 27 males (37.0%) and 46 females (63.0%), with a median age of 57 years old (ranged from 25 to 85 years old). Among the 73 AIG patients, 68 patients received APCA test, with a positivity rate of 88.2% (60/68); 67 patients took the AIFA test, with a positivity rate of 52.2%(35/67); 62 patients underwent both APCA and AIFA tests, of which 22 patients (35.5%) showed double positive. Serum level of vitamin B 12 was detected in 59 patients, and decreased in 27 cases (median level: 0.100 ng/L, mean level: 0.102 ng/L). Gastrin level was detected in 58 patients, and increased in 55 cases (median level: 0.930 ng/L, mean level: 1.203 ng/L). The levels of serum iron and ferritin were tested in 52 patients, the level of serum iron of 5 cases decreased, and the level of ferritin of 17 cases decreased (median level: 780.0 and 26.0 μg/L, mean level: 807.8 and 76.0 ng/L, respectively).Among the 73 AIG patients, the urea breath test was performed in 12 patients, and the result was positive in 6 cases. Endoscopic rapid urease test was performed in 69 patients, and the result was positive in 11 cases (15.9%). Regular blood analysis was performed in 71 patients, 24 cases (33.8%) were diagnosed with anemia, the median age of patients with anemia was 55 years old, and male-to-female ratio was 1∶5. There were 6 cases of iron-deficiency anemia and 5 cases of pernicious anemia. The endoscopic examination results of 73 patients indicated that 65 cases (89.0%) with mucosal atrophy under endoscopy, including 47 cases (64.4%) with mucosal atrophy in the gastric fundus and body, and 18 cases (24.7%) with whole gastric atrophy, more obviously in the gastric body. The pathological examination results showed type Ⅰ gastric neuroendocrine tumor(g-NET) in 35 cases (47.9%). Conclusions:The early clinical symptoms of AIG patients are nonspecific, often present with anemia and vitamin B 12 deficiency. Close monitoring of serological markers including APCA, AIFA and gastrin is essential. For patients diagnosed or suspected with AIG, intervals of endoscopic surveillance should be shortened to prevent the genesis and development of neoplasms such as g-NET.

Objective:To identify the risk factors for acute graft-versus-host disease (aGVHD) in patients with acute myeloid leukemia (AML) undergoing haploidentical hematopoietic stem cell transplantation (HID-HSCT) .Methods:A total of 141 AML patients who underwent HID-HSCT at the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, from January 2020 to July 2021 were included. The cumulative incidence of aGVHD was analyzed using the Fine-Gray competing risk model, with relapse and death as competing events, to compare differences between groups. Potential risk factors were evaluated by univariable and multivariable Cox proportional hazards regression analyses to determine their independent effects on aGVHD.Results:Among the 141 patients, 86 (61.0%) were male and 55 (39.0%) were female, with a median age at transplantation of 34 years. Within 100 days post-transplant, 59 patients developed grade Ⅱ-Ⅳ aGVHD, whereas 86 patients experienced no or grade Ⅰ aGVHD (the grade 0-Ⅰ aGVHD group) . Survival analysis showed that the 3-year overall survival was 68.7% (95% CI: 57.7%-81.9%) in the grade Ⅱ-Ⅳ aGVHD group, compared with 78.8% (95% CI: 70.4%-88.3%) in the grade 0 - Ⅰ aGVHD group, with the difference not being statistically significant ( P=0.190) . Univariable analysis identified donor age ( P=0.020, HR=1.020, 95% CI: 1.000-1.040) and the female donor-male recipient sex combination ( P=0.033, HR=1.980, 95% CI: 1.160-3.380) as risk factors for grade Ⅱ-Ⅳ aGVHD. Multivariable analysis confirmed that donor age ( P=0.005, HR=1.026, 95% CI: 1.008-1.047) and the female donor-male recipient sex combination ( P=0.002, HR=2.339, 95% CI: 1.354-4.037) were independent risk factors for aGVHD. Patients receiving grafts from donors aged >45 years had a significantly higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD compared with those receiving grafts from donors ≤45 years [54.7% (95% CI: 42.3%-67.0%) vs 31.6% (95% CI: 21.0%-42.1%) , P=0.006]. Similarly, patients with the female donor-male recipient sex combination had a higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD than those with other sex combinations [56.8% (95% CI: 40.4%-73.1%) vs 36.9% (95% CI: 27.5%-46.3%) , P=0.015]. Conclusion:Older donor age and the female donor-male recipient sex combination remain independent risk factors for aGVHD in patients with AML undergoing HID-HSCT.

BACKGROUND:Cognitive impairment is the most common complication after stroke,and its severity is closely related to the patient's prognosis.The prognosis of patients can be significantly improved if the severity of their cognitive impairment is recognized and targeted early.OBJECTIVE:To initially explore potential biomarkers affecting the progression of post-stroke cognitive impairment,thereby providing a richer and unique reference for the study of their pathophysiological mechanisms.METHODS:Using ultra performance liquid chromatography-mass spectrometry,non-targeted metabolomics analysis was conducted on serum samples from patients with mild and moderate post-stroke cognitive impairment to identify differential metabolites between the two groups.To further validate the diagnostic efficacy of the differential metabolites,the receiver operating characteristic curve analysis was used to evaluate their accuracy and sensitivity in distinguishing disease severity.In addition,pathway analysis was conducted on the differential metabolites.RESULTS AND CONCLUSION:(1)There were significant differences in metabolic profiles between patients with mild and moderate post-stroke cognitive impairment,and 9 differential metabolites were screened by the receiver operating characteristic curve.(2)Differential metabolite pathway analysis revealed that the metabolic pathways affecting disease progression in patients with mild-to-moderate post-stroke cognitive impairment included tryptophan metabolism,D-amino acid metabolism,biotin metabolism,retinol metabolism,aminoacyl-tRNA biosynthesis,lysine degradation,protein digestion and uptake,pyrimidine metabolism,cysteine and methionine metabolism,ABC transporter proteins,amino acid biosynthesis,and 2-oxocarboxylic acid metabolism.To conclude,9 potential biomarkers affecting disease progression in patients with mild-to-moderate post-stroke cognitive impairment have been identified,involving 12 metabolic pathways including tryptophan metabolism,D-amino acid metabolism and retinol metabolism.

OBJECTIVE To establish a closed-loop management system for the whole-process traceability of outpatient drugs based on internet of things(IoT)and blockchain technology,and evaluate its implementation effects.METHODS A closed-loop management system for the whole-process traceability of outpatient drugs covering the entire drug lifecycle was designed using drug traceability codes integrated with IoT and blockchain technology.System effectiveness was evaluated from three dimensions:work efficiency,medication management quality and data safety by comparing indicators such as the acceptance time of incoming drugs and the number of collected drug traceability codes before the system implementation(October to December 2024)and after the system implementation(January to March 2025).RESULTS A closed-loop management system for the whole-process traceability of outpatient drugs,centered around the drug traceability code management system,was successfully established.The acceptance time for incoming drugs was shortened from(4.65±0.26)h before implementation to(0.34±0.08)h after implementation(P＜0.05).The number of collected drug traceability codes increased from 419 018 to 1 236 522,and the coverage rate of traceability codes rose from 28.36%to 89.88%(P＜0.05).The time pharmacists spent on drug expiry management per week decreased from(128.40±19.20)min to(0.56±0.13)min(P＜0.05),and the dispensing time for a single prescription(excluding a part of injections and repackaged drugs)was reduced from(143.25±17.67)s to(15.24±10.08)s(P＜0.05).The time for drug return was reduced from 129.90(122.32,137.00)s to 104.36(89.91,117.33)s(P＜0.05);the number of drug dispensing errors decreased from 2 cases to 0 cases.After the system was launched,there were no data security incidents in our outpatient pharmacy.CONCLUSIONS The constructed closed-loop management system for the whole-process traceability of outpatient drugs can significantly enhance drug traceability accuracy and drug management quality,improve pharmacist work efficiency,and reduce drug management risks,thus providing a feasible solution for the digital transformation of hospital pharmaceutical services.

Background/Aims: Dexamethasone (DEX) is a widely used exogenous therapeutic glucocorticoid in clinical settings. Its long-term use leads to many side effects. However, its effect on metabolic disorders in individuals on a high-fat diet (HFD) remains poorly understood. Methods: In this study, HFD-fed mice were intraperitoneally injected with DEX 2.5 mg/kg/day for 30 days. Lipid metabolism, adipocyte proliferation, and inflammation were assayed using typical approaches. Results: DEX increased the epididymal fat index and epididymal adipocyte size in HFD-fed mice. The number of epididymal adipocytes with diameters > 70 μm accounted for 0.5% of the cells in the control group, 30% of the cells in the DEX group, 19% of the cells in the HFD group, and 38% of all the cells in the D+H group. Adipocyte proliferation in the D+H group was inhibited by DEX treatment. Adipocyte enlargement in the D+H group was associated with increased the lipid accumulation but not the adipocyte proliferation. In contrast, the liver triglyceride and total cholesterol levels and their metabolism were downregulated by the same treatment, indicating the therapeutic potential of DEX for nonalcoholic fatty liver disease. Conclusions DEX synergizes with HFD to promote lipid deposition in adipose tissues. A high risk of obesity development in patients receiving HFD and DEX treatment is suggested.

Background/Aims: Dexamethasone (DEX) is a widely used exogenous therapeutic glucocorticoid in clinical settings. Its long-term use leads to many side effects. However, its effect on metabolic disorders in individuals on a high-fat diet (HFD) remains poorly understood. Methods: In this study, HFD-fed mice were intraperitoneally injected with DEX 2.5 mg/kg/day for 30 days. Lipid metabolism, adipocyte proliferation, and inflammation were assayed using typical approaches. Results: DEX increased the epididymal fat index and epididymal adipocyte size in HFD-fed mice. The number of epididymal adipocytes with diameters > 70 μm accounted for 0.5% of the cells in the control group, 30% of the cells in the DEX group, 19% of the cells in the HFD group, and 38% of all the cells in the D+H group. Adipocyte proliferation in the D+H group was inhibited by DEX treatment. Adipocyte enlargement in the D+H group was associated with increased the lipid accumulation but not the adipocyte proliferation. In contrast, the liver triglyceride and total cholesterol levels and their metabolism were downregulated by the same treatment, indicating the therapeutic potential of DEX for nonalcoholic fatty liver disease. Conclusions DEX synergizes with HFD to promote lipid deposition in adipose tissues. A high risk of obesity development in patients receiving HFD and DEX treatment is suggested.

Objective:To identify the risk factors for acute graft-versus-host disease (aGVHD) in patients with acute myeloid leukemia (AML) undergoing haploidentical hematopoietic stem cell transplantation (HID-HSCT) .Methods:A total of 141 AML patients who underwent HID-HSCT at the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, from January 2020 to July 2021 were included. The cumulative incidence of aGVHD was analyzed using the Fine-Gray competing risk model, with relapse and death as competing events, to compare differences between groups. Potential risk factors were evaluated by univariable and multivariable Cox proportional hazards regression analyses to determine their independent effects on aGVHD.Results:Among the 141 patients, 86 (61.0%) were male and 55 (39.0%) were female, with a median age at transplantation of 34 years. Within 100 days post-transplant, 59 patients developed grade Ⅱ-Ⅳ aGVHD, whereas 86 patients experienced no or grade Ⅰ aGVHD (the grade 0-Ⅰ aGVHD group) . Survival analysis showed that the 3-year overall survival was 68.7% (95% CI: 57.7%-81.9%) in the grade Ⅱ-Ⅳ aGVHD group, compared with 78.8% (95% CI: 70.4%-88.3%) in the grade 0 - Ⅰ aGVHD group, with the difference not being statistically significant ( P=0.190) . Univariable analysis identified donor age ( P=0.020, HR=1.020, 95% CI: 1.000-1.040) and the female donor-male recipient sex combination ( P=0.033, HR=1.980, 95% CI: 1.160-3.380) as risk factors for grade Ⅱ-Ⅳ aGVHD. Multivariable analysis confirmed that donor age ( P=0.005, HR=1.026, 95% CI: 1.008-1.047) and the female donor-male recipient sex combination ( P=0.002, HR=2.339, 95% CI: 1.354-4.037) were independent risk factors for aGVHD. Patients receiving grafts from donors aged >45 years had a significantly higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD compared with those receiving grafts from donors ≤45 years [54.7% (95% CI: 42.3%-67.0%) vs 31.6% (95% CI: 21.0%-42.1%) , P=0.006]. Similarly, patients with the female donor-male recipient sex combination had a higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD than those with other sex combinations [56.8% (95% CI: 40.4%-73.1%) vs 36.9% (95% CI: 27.5%-46.3%) , P=0.015]. Conclusion:Older donor age and the female donor-male recipient sex combination remain independent risk factors for aGVHD in patients with AML undergoing HID-HSCT.