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 provide standardized guidance for the rational clinical use of antibody-based drugs for the treatment of myasthenia gravis， and to enhance the evidence-based system of guidelines and consensus in this field. METHODS The consensus expert team consisted of 71 multidisciplinary experts from 28 provinces/autonomous regions/municipalities directly under the Central Government. Evidence was systematically retrieved through multiple databases， drug package inserts， and official websites of international and national health administrative authorities， drug regulatory agencies， healthcare security departments， and related industry associations， up to April 30， 2025. Evidence was graded according to the 2014 version of JBI pre-grading system for evidence from intervention studies. Based on full consideration of the current best evidence and multidisciplinary expert experience， the expert consensus recommendations were formulated using a modified Delphi method. RESULTS The Evidence-based expert consensus on the clinical application and pharmaceutical management of antibody-based drugs for the treatment of myasthenia gravis standardized the key points of whole-process pharmaceutical management for four antibody-based drugs approved for marketing in the mainland of China for the treatment of myasthenia gravis （efgartigimod alfa， efgartigimod alfa/hyaluronidase， eculizumab， and rozanolixizumab）. It formulated 37 expert consensus recommendations covering nine pharmaceutical management aspects： drug suitability selection， medication in special populations， administration methods， drug storage， therapeutic drug monitoring and pharmacogenetic testing， immunization management， drug interactions， pharmaceutical care， and off-label drug use. CONCLUSIONS Based on the current best evidence and multidisciplinary expert experience， this consensus establishes a whole-process management framework for antibody-based drugs for the treatment of myasthenia gravis， from clinical application to pharmaceutical management. It provides a scientific basis for the rational and precise use of these drugs in clinical practice， effectively promotes the enhancement of pharmaceutical management efficiency， and helps improve the overall therapeutic benefits for patients.

OBJECTIVE To compare the similarities and differences of the two methods in analyzing the use of opioids in third grade class A medical institutions and provide a reference for the management of opioids in medical institutions. METHODS Two methods， Defined Daily Dose （DDD） and Oral Morphine Equivalent （OME）， were used to count the opioid prescription data of five comprehensive medical institutions of third grade class A （named H1-H5） in Shanxi province in 2020， calculate consumption sum of opioid， annual per capita consumption sum， patient cost burden and drug consumption sum ratio， compare the index results presented by the two analysis methods， and explore the application scenarios of the advantages of each of the two evaluation methods. RESULTS The ranking of consumption sum of opioid and patient cost burden calculated by the two methods was the same in the five sample medical institutions， but the ranking of per capita consumption sum was different. Taking the 5 medical institutions as a whole， the top 4 rankings of consumption sum ratio for each species of opioid compared by both methods were the same， i. e. remifentanil＞sufentanil＞oxycodone＞morphine. The ratio of remifentanil was close to 50%. When comparing the ranking of consumption sum ratio in each medical institution， the ranking calculated by the two methods was different for those medical institutions except for H1 medical institutions. The consumption sum ratio of fentanyl calculated by DDD method was significantly higher than that of OME method； whereas consumption sum ratio of remifentanil calculated by OME method was significantly higher than that of DDD method. Perioperative patients had the highest consumption sum ratio， about 50%. The consumption sum ratio of critically ill patients in H3 jwsydey@163.com medical institutions and inpatient patients with cancer pain and other patients in H5 medical institutions calculated by DDD method was significantly higher than that by OME method. There were differences in the order of cost burden of different types of patients calculated by two methods. CONCLUSIONS DDD method can accurately reflect the dosage of opioid drugs and facilitate the monitoring and management of the dosage； OME method can more reflect the analgesic effect and compare the cost burden of patients.

Lactic acid bacteria and cellulose degrading bacteria play an important role in fermentation process of silage, because they can prevent the rancidity and increase the nutritive value of silage. But the propagation of lactic acid bacteria will inhibit the activity of cellulose degrading bacteria in the silage fermentation system. This problem can be solved by releasing lactic acid bacteria and cellulose degrading bacteria in different time. Therefore, we immobilized lactic acid bacteria as a microbial agent for sustained release. Firstly, the optimal balling concentration of the composite immobilized carrier and composite immobilized carrier were obtained by immobilization of blank balls and corncob adsorbed Lactobacillus plantarum S1 respectively. The best immobilization condition of L. plantarum S1 was obtained by comparing the immobilized rate and balling effect of two kinds of balls, which were embedded by sodium alginate (SA), CMC-Na and embedded-crosslinked by SA, CMC-Na, polyvinyl alcohol (PVA). The results showed that the best balling concentration was achieved by using 6% PVA+0.4% SA+0.3% CMC-Na for embedding-crosslinking and 1.2% SA+0.5% CMC-Na for direct embedding respectively. In addition, comparing with the mechanical strength and embedding rate of five kinds of immobilization process, the best immobilized process was obtained by adding of the mixture of immobilized carriers (1.2%SA+ 0.5%CMC-Na) and corncob adsorbed L. plantarum S1 slowly into 4% CaCl₂ for 24 hours. The corncob adsorption and SA embedding methodology can effectively increase the embedding efficiency of Lactobacillus plantarum S1.

Objective To observe and compare the resistance changes of ciprofloxacin (CIP), levofloxacin (LEV), norfloxacin (NOR) to Pseudomonas aeruginosa (PA), and choose the drug which had the best curative effect for PA from the drugs mentioned above.Methods Seven strain of non-repetitive PA which had sensitiveness to ciprofloxacin (CIP), levofloxacin (LEV), norfloxacin (NOR) and the same minimal inhibitory concentration (MIC) of the three drugs were co-cultured with CIP, LEV, NOR in concentrations of 0.5, 1.0, 2.0, and 4.0 times of MIC for evoked drug resistance, respectively.The MIC of CIP, LEV, and NOR to PA which evoked drug resistance by 3 kinds of concentration were detected by the methods of Epsilometer Test and Two-fold Agar Dilution.Results The MIC value of CIP to PA after evoking by 3 concentrations increased from 0.09 μg/ml before evoking to 0.25-16.00 μg/ml.The MIC after evoking was 3 to 178 times that before evoking.The MIC value of NOR to PA after evoking increased from 0.50 μg/ml before evoking to 2.00-64.00 μg/ml.The MIC after evoking was 4 to 128 times that before evoking.The MIC value of LEV to PA after evoking by 3 concentrations increased from 0.50 μg/ml before evoking to 2.00-32.00 μg/ml.The MIC after evoking was 2 to 64 times that before evoking.The differences of MIC of CIP to PA after evoking by different concentrations of CIP, NOR and LEV were not statistically significant (all P>0.05).The MIC value of NOR to PA after evoking by 4.0×MIC CIP was higher than that of evoking by 0.5×MIC CIP (P=0.006).The MIC value of NOR to PA after evoking by 4.0×MIC LEV was higher than that evoked by 1.0×MIC LEP (P=0.006).The MIC value of LEV to PA after evoking by 4.0×MIC CIP was higher than that of evoking by 0.5×MIC CIP (P=0.006).The MIC value of LEV to PA after evoking by 4.0×MIC NOR and LEV were higher than those evoked by 0.5×MIC NOR and LEV (all P=0.007).Conclusion PA can be evoked to develop resistance to different degrees after co-culturing with different concentrations of CIP, LEV, and NOR.The change of resistance of CIP to PA is the least among the three drugs mentioned above.It is suggested that CIP is still one of the best fluoroquinolones for the treatment of PA infection.

Objective To observe and compare the resistance changes of ciprofloxacin (CIP), levofloxacin (LEV), norfloxacin (NOR) to Pseudomonas aeruginosa (PA), and choose the drug which had the best curative effect for PA from the drugs mentioned above.Methods Seven strain of non-repetitive PA which had sensitiveness to ciprofloxacin (CIP), levofloxacin (LEV), norfloxacin (NOR) and the same minimal inhibitory concentration (MIC) of the three drugs were co-cultured with CIP, LEV, NOR in concentrations of 0.5, 1.0, 2.0, and 4.0 times of MIC for evoked drug resistance, respectively.The MIC of CIP, LEV, and NOR to PA which evoked drug resistance by 3 kinds of concentration were detected by the methods of Epsilometer Test and Two-fold Agar Dilution.Results The MIC value of CIP to PA after evoking by 3 concentrations increased from 0.09 μg/ml before evoking to 0.25-16.00 μg/ml.The MIC after evoking was 3 to 178 times that before evoking.The MIC value of NOR to PA after evoking increased from 0.50 μg/ml before evoking to 2.00-64.00 μg/ml.The MIC after evoking was 4 to 128 times that before evoking.The MIC value of LEV to PA after evoking by 3 concentrations increased from 0.50 μg/ml before evoking to 2.00-32.00 μg/ml.The MIC after evoking was 2 to 64 times that before evoking.The differences of MIC of CIP to PA after evoking by different concentrations of CIP, NOR and LEV were not statistically significant (all P>0.05).The MIC value of NOR to PA after evoking by 4.0×MIC CIP was higher than that of evoking by 0.5×MIC CIP (P=0.006).The MIC value of NOR to PA after evoking by 4.0×MIC LEV was higher than that evoked by 1.0×MIC LEP (P=0.006).The MIC value of LEV to PA after evoking by 4.0×MIC CIP was higher than that of evoking by 0.5×MIC CIP (P=0.006).The MIC value of LEV to PA after evoking by 4.0×MIC NOR and LEV were higher than those evoked by 0.5×MIC NOR and LEV (all P=0.007).Conclusion PA can be evoked to develop resistance to different degrees after co-culturing with different concentrations of CIP, LEV, and NOR.The change of resistance of CIP to PA is the least among the three drugs mentioned above.It is suggested that CIP is still one of the best fluoroquinolones for the treatment of PA infection.

Seven meroterpenoids and five small-molecular precursors were isolated from Penicillium sp., an endophytic fungus from Dysosma versipellis. The structures of new compounds, 11beta-acetoxyisoaustinone (1) and isoberkedienolactone (2) were elucidated based on analysis of the spectral data, and the absolute configuration of 2 was established by TDDFT ECD calculation with satisfactory match to its experimental ECD data. Meroterpenoids originated tetraketide and pentaketide precursors, resepectively, were found to be simultaneously produced in specific fungus of Penicillium species. These compounds showed weak cytotoxicity in vitro against HCT-116, HepG2, BGC-823, NCI-H1650, and A2780 cell lines with IC 50 > 10 micromol x L(-1).