OBJECTIVE To investigate the clinical efficacy of integrating pharmacists into family health teams （FHTs） for long-term medication therapeutical management （MTM） in stroke patients， and empirically evaluate the service model. METHODS A pharmacist team， jointly established by clinical and community pharmacists from the Affiliated Suzhou Hospital of Nanjing Medical University （hereinafter referred to as “our hospital”）， developed a pharmacist-supported MTM model integrated into FHTs. Using a prospective randomized controlled design， 170 stroke patients discharged from our hospital （July 2022-December 2023） and enrolled in FHTs at Suzhou Runda Community Hospital were randomly divided into trial group （88 cases） and control group （82 cases） according to random number table. The control group received routine FHTs care （without pharmacist involvement in the team collaboration）， while the trial group xhz8405@126.com received 12-month MTM services supported by pharmacists via an information platform. These services specifically included innovative interventions such as personalized medication regimen optimization based on the MTM framework， dynamic medication adherence management， medication safety monitoring， a home medication assessment system， and distinctive service offerings. Outcomes of the 2 grousp were compared before and after intervention， involving medication adherence （adherence rate， adherence score）， compliance rates for stroke recurrence risk factors [blood pressure， low-density lipoprotein cholesterol （LDL-C）]， and incidence of adverse drug reactions （ADR）. RESULTS After 12 months， the trial group exhibited significantly higher medication adherence rates， improved adherence scores， higher compliance rates for blood pressure and LDL-C targets compared to the control group （P＜0.05）. The incidence of ADR in the trial group （4.55%） was significantly lower than that in the control group （8.11%）， though the difference was not statistically significant （P＞ 0.05）. CONCLUSIONS Pharmacist involvement in FHTs to deliver MTM services significantly enhances medication adherence and optimizes risk factor for stroke recurrence， offering practical evidence for advancing pharmaceutical care in chronic disease management under the family doctor system.

Organophosphorus pesticide(OP)is one of the most widely used pesticides in the world with the largest dosage.Acute organophosphorus pesticide poisoning(AOPP)is a common clinical disease,and AOPP accounts for 20%-50%of poisoning cases in China every year,with case fatality rate of 3%-40%.Bromophos(BDF)is a long-acting anticoagulant rodenticide,which inhibits vitamin K epoxide reductase and interferes with the synthesis of coagulation factorsⅡ,Ⅶ,Ⅸ and Ⅹ,leading to coagulation dysfunction.This article discusses the multidisciplinary diagnosis and treatment(MDT)process of a patient with combined poisoning of dichlorvos and bromadiolone.The article explores blood purification,management of coagulation abnormalities,secondary infection,atropinization and altered consciousnes in patients with organophosphorus poisoning and anticoagulant rodenticide compound poisoning,with the aim of providing clinicians with references for early diagnosis and treatment.

The pathogenic mechanisms underlying neuroimmune disorders associated with anti-glutamic acid decarboxylase (GAD) antibodies remain incompletely elucidated. This article systematically reviews the immunopathological mechanisms of this disease. In humoral immunity, anti-GAD antibodies target intracellular antigens and induce neuronal dysfunction, yet the mechanisms of antibody penetration across cell membranes remain undefined, and validated animal models confirming their pathogenicity are lacking. In cellular immunity, histopathological studies demonstrate T-lymphocyte infiltration in the central nervous system (CNS) of patients, while GAD antigen-specific T cells have been detected in peripheral blood and cerebrospinal fluid. However, the antigen specificity of CNS-infiltrating T cells and their potential association with GAD reactivity remain unclarified. Additionally, the CNS migration routes, functional phenotypes of these T cells, and their synergistic interplay with humoral immune responses require further investigation. Future research should focus on: (1) resolving the transmembrane mechanisms of anti-GAD antibodies; (2) defining the CNS trafficking pathways and functional roles of GAD antigen-specific T cells; (3) establishing reliable animal models to recapitulate disease-specific immune cascades. Elucidating these mechanisms will advance the development of precise diagnostic and therapeutic strategies.

Objective To analyze the factors affecting patients with active tuberculosis(ATB)combined with acute pulmonary thromboembolism(APTE),in order to intervene the progression of the patients'disease early and improve the prognosis.Methods A total of 121 patients with ATB were studied.Forty-one cases with APTE diagnosed by CT pulmonary arteriography(CTPA)were in the ATB+APTE group,and 80 patients with ATB were in the ATB group.The general data of the two groups were collected and analyzed,including the differences in TB lesion sites and drug resistance,clinical manifestations and first laboratory indexes after admission.The influencing factors of ATB patients with concurrent APTE were analyzed by multifactorial Logistic regression,and continuous indexes with significant differences were selected,and the subjects'work characteristics(ROC)curves were plotted to assess the predictive value.Results Compared with the ATB group,patients in the ATB+APTE group were older,and Padua scores were higher,red blood cell distribution width(RDW),neutrophil-to-lymphocyte ratio(NLR),D-dimer were higher,the proportion of cough and expectoration increased and levels of partial pressure of carbon dioxide,hemoglobin(Hb),and albumin were lower(P＜0.05).Multifactorial Logistic regression analysis showed that higher Padua score,RDW and D-dimer were risk factors for patients with ATB combined with APTE,and the predicted area under the curve(AUC)for ATB combined with APTE were 0.657(95%CI:0.549-0.764)and 0.889(95%CI:0.827-0.951)for RDW and D-dimer,respectively.Conclusion In patients with ATB,the risk of combined APTE is increased with increased frequency of sputum and elevated Padua score,RDW and D-dimer,alerting to the development of APTE events.

Organophosphorus pesticide(OP)is one of the most widely used pesticides in the world with the largest dosage.Acute organophosphorus pesticide poisoning(AOPP)is a common clinical disease,and AOPP accounts for 20%-50%of poisoning cases in China every year,with case fatality rate of 3%-40%.Bromophos(BDF)is a long-acting anticoagulant rodenticide,which inhibits vitamin K epoxide reductase and interferes with the synthesis of coagulation factorsⅡ,Ⅶ,Ⅸ and Ⅹ,leading to coagulation dysfunction.This article discusses the multidisciplinary diagnosis and treatment(MDT)process of a patient with combined poisoning of dichlorvos and bromadiolone.The article explores blood purification,management of coagulation abnormalities,secondary infection,atropinization and altered consciousnes in patients with organophosphorus poisoning and anticoagulant rodenticide compound poisoning,with the aim of providing clinicians with references for early diagnosis and treatment.

Objective To analyze the factors affecting patients with active tuberculosis(ATB)combined with acute pulmonary thromboembolism(APTE),in order to intervene the progression of the patients'disease early and improve the prognosis.Methods A total of 121 patients with ATB were studied.Forty-one cases with APTE diagnosed by CT pulmonary arteriography(CTPA)were in the ATB+APTE group,and 80 patients with ATB were in the ATB group.The general data of the two groups were collected and analyzed,including the differences in TB lesion sites and drug resistance,clinical manifestations and first laboratory indexes after admission.The influencing factors of ATB patients with concurrent APTE were analyzed by multifactorial Logistic regression,and continuous indexes with significant differences were selected,and the subjects'work characteristics(ROC)curves were plotted to assess the predictive value.Results Compared with the ATB group,patients in the ATB+APTE group were older,and Padua scores were higher,red blood cell distribution width(RDW),neutrophil-to-lymphocyte ratio(NLR),D-dimer were higher,the proportion of cough and expectoration increased and levels of partial pressure of carbon dioxide,hemoglobin(Hb),and albumin were lower(P＜0.05).Multifactorial Logistic regression analysis showed that higher Padua score,RDW and D-dimer were risk factors for patients with ATB combined with APTE,and the predicted area under the curve(AUC)for ATB combined with APTE were 0.657(95%CI:0.549-0.764)and 0.889(95%CI:0.827-0.951)for RDW and D-dimer,respectively.Conclusion In patients with ATB,the risk of combined APTE is increased with increased frequency of sputum and elevated Padua score,RDW and D-dimer,alerting to the development of APTE events.

The pathogenic mechanisms underlying neuroimmune disorders associated with anti-glutamic acid decarboxylase (GAD) antibodies remain incompletely elucidated. This article systematically reviews the immunopathological mechanisms of this disease. In humoral immunity, anti-GAD antibodies target intracellular antigens and induce neuronal dysfunction, yet the mechanisms of antibody penetration across cell membranes remain undefined, and validated animal models confirming their pathogenicity are lacking. In cellular immunity, histopathological studies demonstrate T-lymphocyte infiltration in the central nervous system (CNS) of patients, while GAD antigen-specific T cells have been detected in peripheral blood and cerebrospinal fluid. However, the antigen specificity of CNS-infiltrating T cells and their potential association with GAD reactivity remain unclarified. Additionally, the CNS migration routes, functional phenotypes of these T cells, and their synergistic interplay with humoral immune responses require further investigation. Future research should focus on: (1) resolving the transmembrane mechanisms of anti-GAD antibodies; (2) defining the CNS trafficking pathways and functional roles of GAD antigen-specific T cells; (3) establishing reliable animal models to recapitulate disease-specific immune cascades. Elucidating these mechanisms will advance the development of precise diagnostic and therapeutic strategies.

ObjectiveTo explore the syndrome elements and evolving patterns of patients with hepatitis B virus-related acute on chronic liver failure （HBV-ACLF） at different stages. MethodsClinical information of 1,058 hospitalized HBV-ACLF patients， including 618 in the early stage， 355 in the middle stage， and 85 in the late stage， were collected from 18 clinical centers across 12 regions nationwide from January 1， 2012 to February 28， 2015. The “Hepatitis B-related Chronic and Acute Liver Failure Chinese Medicine Clinical Questionnaire” were designed to investigate the basic information of the patients， like the four diagnostic information （including symptoms， tongue， pulse） of traditional Chinese medicine （TCM）， and to count the frequency of the appearance of the four diagnostic information. Factor analysis and cluster analysis were employed to determine and statistically analyze the syndrome elements and patterns of HBV-ACLF patients at different stages. ResultsThere were 76 four diagnostic information from 1058 HBV-ACLF patients， and 53 four diagnostic information with a frequency of occurrence ≥ 5% were used as factor analysis entries， including 36 symptom information， 12 tongue information， and 5 pulse information. Four types of TCM patterns were identified in HBV-ACLF， which were liver-gallbladder damp-heat pattern， qi deficiency and blood stasis pattern， liver-kidney yin deficiency pattern， and spleen-kidney yang-deficiency pattern. In the early stage， heat （39.4%， 359/912） and dampness （27.5%， 251/912） were most common， and the pattern of the disease was dominated by liver-gallbladder damp-heat pattern （74.6%， 461/618）； in the middle stage， dampness （30.2%， 187/619） and blood stasis （20.7%， 128/619） were most common， and the patterns of the disease were dominated by liver-gallbladder damp-heat pattern （53.2%， 189/355）， and qi deficiency and blood stasis pattern （27.6%， 98/355）； and in the late stage， the pattern of the disease was dominated by qi deficiency （26.3%， 40/152） and yin deficiency （20.4%， 31/152）， and the patterns were dominated by qi deficiency and blood stasis pattern （36.5%， 31/85）， and liver-gallbladder damp-heat pattern （25.9%， 22/85）. ConclusionThere are significant differences in the distribution of syndrome elements and patterns at different stages of HBV-ACLF， presenting an overall trend of evolving patterns as "from excess to deficiency， transforming from excess to deficiency"， which is damp-heat → blood stasis → qi-blood yin-yang deficiency.

BACKGROUND:Accurate reduction of ankle fractures under direct vision has become a common understanding among foot and ankle surgeons.How to fully expose free or compressed fragments of the posterior ankle remains one of the most challenging problems. OBJECTIVE:To explore the clinical efficiency of the para-Achilles tendon approach in exposing and repositioning the posterior malleolus sandwich fracture. METHODS:A retrospective study was made for 26 patients with posterior malleolus sandwich fracture treated with open reduction and internal fixation via para-Achilles tendon approach from January to December 2020 in The Second People's Hospital of Dalian.21 of 26 cases were managed with the lateral approach of Achilles tendon and 5 cases were managed with the medial approach of Achilles tendon.There were 19 males and 7 females,with the age of 24-69 years,averagely 38.6 years.The operation time and postoperative complications were recorded.The fracture reduction condition was evaluated by Burwell-Charnley imaging standard.Before operation,3 months after operation and last follow-up,visual analog scale score,ankle plantar flexion and dorsiflexion and American Orthopedic Foot&Ankle Society Ankle Hind Score were used to evaluate the treatment effect. RESULTS AND CONCLUSION:(1)All 26 patients were followed up for an average of 14.6 months(range 13-18 months).The operation time was 52-85 minutes(average 64.2 minutes).(2)Part of the skin edge of the lateral malleolus incision was necrotic in one patient and healed completely after a dressing change.Incision healing of the other patients was in one stage.(3)Through Burwell-Charnley imaging standard,anatomical reductions were obtained in 24 of 26,and good reductions were in 2 of 26,with an excellent and good rate of 100%.(4)At the last follow-up,the visual analog scale score(1.19±0.40)was significantly lower than the preoperative score(6.81±0.80)(P<0.01).Ankle plantar flexion(33.5±5.02)° and ankle plantar back stretch(17.23±0.99)° were significantly increased compared with preoperative data(14.58±2.50)° and(5.81±1.02)°(P<0.01).American Orthopedic Foot&Ankle Society Ankle Hind Score was improved to(89.31±3.62)points compared to preoperative(46.00±5.45)points(P<0.01).The results were excellent in 23 patients and good in 3 patients,with an excellent and good rate of 100%.(5)It is concluded that the open reduction and internal fixation via the para-Achilles tendon approach for the treatment of posterior malleolus sandwich fracture were efficient with decreased operation time,satisfying fracture reduction,fewer complications,satisfactory motion range,and functional recovery.

Objective To investigate the application effect of fiberoptic bronchoscopy and alveolar lavage therapy in the diagnosis and treatment of recurrent wheezing diseases in children. Methods A total of 151 children with recurrent wheezing diseases were enrolled, and divided into control group (n=84) and study group (n=67) based on different diagnostic and therapeutic methods. The control group received conventional diagnosis and treatment, while the study group underwent fiberoptic bronchoscopy combined with alveolar lavage therapy. The time to resolution of symptoms and length of hospital stay were compared between the two groups. Additionally, lung function [forced expiratory volume in 1 second (FEV₁), FEV₁/forced vital capacity (FEV₁/FVC) and peak expiratory flow (PEF)], exhaled nitric oxide (FeNO), serum inflammatory mediator levels [C-reactive protein (CRP), procalcitonin (PCT) and white blood cell (WBC) count] and clinical efficacy were compared. Results The absence time of wheezing and pulmonary rales and hospital stay in the study group were significantly shorter than those in the control group (P < 0.05). After treatment, FEV₁, FEV₁/FVC and PEF in two groups were significantly higher than before treatment, and the study group was significantly higher than the control group (P < 0.05). After treatment, FeNO, CRP, PCT and WBC in two groups were significantly lower than before treatment, and the study group was significantly lower than the control group (P < 0.05). The total effective rate of the study group was 94.03%, which was significantly higher than 77.38% of the control group (P < 0.05). Conclusion Fiberoptic bronchoscopy and alveolar lavage are effective in the diagnosis and treatment of recurrent asthmatic diseases in children, which can effectively relieve symptoms, shorten hospital stay, and improve lung function, FeNO and serum inflammatory mediators.