OBJECTIVE To provide standardized guidance for the homogenization construction and management of pharmaceutical care in urban medical groups. METHODS This consensus was jointly initiated by the Therapeutic Drug Monitoring Professional Committee of the Chinese Pharmacological Society and the Expert Committee on Precision Clinical Medication of the Guangdong Pharmaceutical Association. Led by Guangzhou Red Cross Hospital， a drafting group of 7 members and an expert group of 36 members were organized. The outline of the Expert Consensus on Homogeneous Construction and Management of Pharmaceutical Care in Urban Medical Groups （hereinafter referred to as the “Consensus”） was discussed and finalized using the nominal group technique， and a preliminary draft was formed. The Delphi method was used for online c orrespondence review， and 12 external experts were invited for evaluation. After analyzing and revising expert opinions， the final Consensus was formed. RESULTS &CONCLUSIONS This Consensus defines the position setting and appointment procedures for the chief pharmacist， and establishes a three-tier professional guidance network of “chief pharmacist-regional/specialist pharmacist-pharmaceutical liaison of member institutions”. It formulates unified management standards for the drug supply catalog， establishes a full-process homogenization mechanism for prescription review， prescription commentation and comprehensive pharmaceutical care， and specifies the core functions and performance requirements of the prescription review system. It also supports by long-term mechanisms including cost allocation and performance assessment. This consensus can serve as a systematic reference for the homogeneous construction and management of pharmaceutical care systems in urban medical groups.

ObjectiveTo analyze the epidemiological and etiological characteristics of a cluster of human metapneumovirus (HMPV) infection in a kindergarten in Gongshu District of Hangzhou City in May 2024, and to provide reference for the prevention and control of similar outbreaks. MethodsAn on-site investigation was conducted using an epidemiological case investigation form. Throat swab specimens collected from cases were screened for 13 respiratory pathogens using real-time fluorescent polymerase chain reaction (PCR). For HMPV nucleic acid positive specimens, the F gene of HMPV was used as the target gene for amplification and sequencing. The sequencing results were then compared with sequences in GenBank database to determine the virus subtypes and perform phylogenetic analyses. ResultsThe outbreak occurred in a kindergarter junior class with a total of 28 preschoolers and 3 teachers and childcare workers. A total of 11 cases (10 preschoolers and 1 teacher) were identified, including 8 male cases and 3 female cases. Clinical manifestations included fever in all 11 cases (100.00%), cough in 8 cases (72.72%), catarrhal symptoms in 4 cases (36.36%), and headache in 3 cases (27.27%). All symptoms were mild, and no severe cases were observed. A total of 11 throat swab samples were collected. Real-time fluorescent PCR test results showed that 3 samples were positive for HMPV nucleic acid, 2 samples were positive for both HMPV and Streptococcus pneumoniae, and 1 sample was positive for both HMPV and rhinovirus. The sequences of the 6 HMPV nucleic acid positive specimens were amplified and analyzed using specific primers, and all were determined to be HMPV subtype A2b. The F gene fragment sequence showed the highest similarity to PV081665.1/Brazil/2024 (99.65%), and also exhibited high similarity to PP683455.1/Indonesia/2021 (99.48%), PV016275.1/Beijing/2024 (99.31%), and PV052230.1/USA/2024 (99.13%). ConclusionThis cluster of acute respiratory tract infection was caused by HMPV subtype A2b, with co-infection of rhinovirus and Streptococcus pneumoniae. The F gene fragment sequences of the HMPV in this outbreak were highly homologous to those of the A2b strains isolated from Brazil, Beijing, Indonesia, and the the United States.

Minor stroke is a common subtype of acute ischemic stroke， primarily defined by a National Institutes of Health Stroke Scale score ≤3 or ≤5. Despite mild clinical symptoms， it carries a risk of early deterioration， and its intravenous thrombolysis strategy has long been controversial. This article systematically summarizes the results of key randomized controlled trials in recent years， which found that although non-inferiority has been confirmed among thrombolytic agents such as alteplase， tenecteplase， and prourokinase， none of these have shown superior functional improvement in the treatment of minor stroke compared with dual antiplatelet therapy or aspirin monotherapy， and they carry safety risks such as symptomatic intracranial hemorrhage. Subgroup analyses suggested potential benefits for patients with a National Institutes of Health Stroke Scale score>3， disabling symptoms， or the large artery atherosclerosis subtype， but the evidence is inconsistent. The limited net benefit of thrombolysis is primarily attributed to heterogeneous definitions， a generally favorable natural prognosis， and the offsetting effect of bleeding risks. Future studies should focus on unifying definitions， leveraging multimodal imaging for precise patient selection， optimizing drug regimens， and ultimately achieving precise stratification and individualized thrombolytic interventions for minor stroke.

Objective To evaluate the clinical value and safety of double nylon rope purse string suture closing the postoperative wounds of the treatment of endoscopic full thickness resection(EFR)for gastric submucosal tumors(SMT).Methods We retrospectively analyzed the clinical data of 104 patients with gastric SMT originating from the muscularis propria,from June 2020 to March 2023.According to different suture methods,they were divided into single nylon rope purse string suture group(48 cases)and double nylon rope purse string suture group(56 cases).The patients'operative,postoperative,and long-term follow-up conditions were evaluated.Results All tumors were completely resected under endoscopic guidance.The terms of lesion diameter in double nylon rope purse string suture group was bigger than that in single nylon rope purse string suture group,there was statistically significant difference between the two groups(P=0.040).In the single nylon rope purse string suture group,postoperative perforation occurred in 1 case,low fever occurred in 4 cases,and mild pain in the upper abdomen occurred in 6 cases,in the double nylon rope purse string suture group,there was no postoperative perforation,5 patients had low fever,and 6 patients had mild pain in the upper abdomen,there was no significant difference in postoperative complications between the two groups(P＞0.05).No postoperative cases were transferred to gastrointestinal surgery,and all patients were discharged smoothly.After 3 months,7 cases in the single nylon rope purse string suture group had titanium clips and/or nylon rope residue,while 18 cases in the double nylon rope purse string suture group still had titanium clips and/or nylon rope residue,and the difference between the two groups was statistically significant(P=0.037).Conclusion Compared with single nylon rope purse string suture,double nylon rope purse string suture can effectively close the postoperative wounds following gastric SMT with EFR(≥3 cm).

Objective:To conduct a comparative analysis of the oxygen depletion and oxygen effect of FLASH irradiation and conventional irradiation by direct measurement of oxygen content.Methods:The oxygen content in different tissues and organs of mice was measured using a phosphorescent probe. A subcutaneous xenograft tumor model in mice was established, to receive electron-beam irradiation at different doses and dose rates. The oxygen depletion of tumor and normal tissue was analyzed, and tumor control was evaluated. The oxygen depletion of conventional irradiation and FLASH irradiation was further analyzed using an in vitro model. The survival fraction (SF) of normal cells after conventional irradiation and FLASH irradiation was calculated using colony formation assay under different partial pressures of oxygen, and the data were fitted to the oxygen enhancement ratio (OER) curve. Results:The mean oxygen content of subcutaneous xenograft tumor in mice was 1.28%, suggesting hypoxia. The mean oxygen content of normal tissue ranged from 3.51% to 6.53%, suggesting physioxia. In animal experiments, oxygen depletion was not observed during conventional irradiation. High-dose-rate (20 Gy/s) and ultra-high-dose-rate (FLASH, 40 Gy/s) irradiation produced oxygen depletion. During FLASH irradiation, with the increase of oxygen content, the oxygen depletion was 0.1-0.2 mm Hg/Gy for tumor tissue and 0.19-0.21 mm Hg/Gy for skin tissue, which tended to stabilize. FLASH irradiation maintained equivalent tumor control compared to conventional irradiation. The tumoricidal effect was significantly enhanced with the increase of oxygen content in the tissue ( t=3.46, P<0.01). In in vitro experiments, the mean oxygen depletion rate was about 0.16 mm Hg/Gy for conventional irradiation and 0.16-0.18 mm Hg/Gy for FLASH irradiation, which did not change significantly with the increase of oxygen content. FLASH irradiation was associated with an oxygen effect. When the partial pressure of oxygen decreased from physioxia to hypoxia, the OER value significantly reduced. Conclusions:Normal tissues and organs are in physioxia, which exhibits a lower oxygen content than that in the air. FLASH irradiation can consume a proportion of oxygen, producing an oxygen effect. When oxygen content decreases, the oxygen depletion rate slows down after FLASH irradiation.

Thoracolumbar trauma, including fractures, dislocations and spinal cord injuries, often result from high-energy injuries such as traffic accidents and falls from heights. It not only causes severe pain and restricted movement for patients, but also leads to neurological damage and even permanent disability. Currently, the diagnosis and treatment of thoracolumbar trauma are faced with many problems, such as possible missed diagnosis and misdiagnosis, lack of individualized and standardized treatment plans, and lack of objective and quantitative metrics for postoperative assessment. Artificial intelligence (AI) technology offers innovative ideas to these problems. Among them, the core AI technology such as machine learning (ML), deep learning (DL), computer vision, and robotics has demonstrated outstanding capabilities in medical image analysis, clinical decision support, etc., which can significantly improve the diagnostic precision, surgical planning efficiency, and postoperative management level of thoracolumbar trauma. At present, application of AI technology in cross-modal data integration, clinical decision support, and long-term efficacy prediction in the field of thoracolumbar trauma remains to be systematically sorted out. To this end, the authors reviewed the research progress of AI technology in the diagnosis, treatment, and postoperative management of thoracolumbar trauma, providing a reference for a wide application of AI technology in the management of thoracolumbar trauma.

OBJECTIVE To explore the effect of Shiquan Dabu Decoction combined with vacuum sealing drainage(VSD)on treatment of the Gustilo Ⅲ open fracture patients with postoperative chronic refractory wound(CRW)infection and observe the changes of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)/Caspase-1/interleukin-1β(IL-1β)signaling pathways.METHODS A total of 82 Gustilo Ⅲ open fracture patients with postoperative CRW infection who were treated in Shandong Wendeng Orthopedic Hospital from Jan.2020 to Oct.2023 were randomly divided into the sodium chloride irrigation group(the conventional debridement,VSD plus 0.9％sodium chloride injection irrigation)and the Shiquan Dabu Decoction irrigation group(the conventional debridement,VSD plus Shiquan Dabu Decoction irrigation),with 41 cases in each group.Both groups were trea-ted for 14 days and were followed up for 1 month.The indexes were observed and compared between the two groups.RESULTS The total effective rate of clinical treatment of the Shiquan Dabu Decoction irrigation group was higher than that of the sodium chloride irrigation group after the treatment for 14 days(P＜0.05).The average healing time of wound and length of hospital stay were shorter in the Shiquan Dabu Decoction irrigation group than in the sodium chloride irrigation group(P＜0.05).The scores of wound pain,exudation,edema and granulation and the expression levels of NLRP3 mRNA,Caspase-1 mRNA and IL-1β mRNA were lower after the treatment for 14 days than before the treatment,and the above indexes of the Shiquan Dabu Decoction irrigation group were lower than those of the sodium chloride irrigation group(P＜0.05).There were no significant differences in the levels of serum bone morphogenetic protein-2(BMP-2),insulin growth factor-1(IGF-1),tartrate-resistant acid phosphatase 5b(TRACP5b),bone gla protein(BGP),bone-specific alkaline phosphatase(BALP)and total procol-lagen type Ⅰ N-terminal propeptide[PINP]between before the treatment and after the treatment for 14 days or be-tween the two groups.CONCLUSIONS The Gustilo Ⅲ open fracture patients with postoperative CRW infection show the down-regulated expression levels of NLRP3/Caspase-1/IL-1β signaling pathways after the treatment with Shiquan Dabu Decoction combined with VSD,which may relieve the wound pain,exudation and edema and promote the wound healing.It can achieve remarkable curative effect without affecting the bone metabolism indexes.

Objective:To investigate the intervention effect of exercise rehabilitation based on constructivism teaching mode on pelvic girdle pain (PGP) in pregnant women in late pregnancy, and to provide guidance for improving the pregnancy experience of PGP pregnant women.Methods:A quasi-experimental study was conduced, from November 2023 to February 2024, using convenience sampling method to select late pregnant women with PGP who had been filed and had regular obstetric checkups in the Second Hospital of Shandong University as the study subjects, they were randomly divided into intervention group (granted exercise rehabilitation based on the constructivism teaching model) and control group (granted exercise rehabilitation based on the traditional teaching model) according to the random number table method. Compare the pain scores and teaching effectiveness of pregnant women before and after the intervention in the two groups.Results:The final number of the two groups were 50 in each group, aged (32.38 ± 3.93) years in the intervention group; aged (31.34 ± 3.19) years in the control group. After the intervention, the pain scores of pregnant women in the intervention group (1.48 ± 1.26) scores were significantly lower than those in the control group (2.96 ± 1.42) scores, and the difference was statistically significant ( t = -5.45, P<0.05). The scores of the evaluation of the teaching effect memory problem scores, movement mastery scores, and classroom evaluations were (7.96 ± 1.30) scores, (13. 96 ± 0.88) scores, (27.54 ± 3.08) scores in the intervention group, which were significantly higher than those in the control group (5.80 ± 1.29) scores, (8.48 ± 1.82) scores, (16.24 ± 3.80) scores, the differences were statistically significant ( t = 8.30, 19.16, 16.31, all P<0.05). Conclusions:Based on the constructivism teaching model, exercise rehabilitation for pregnant women with PGP in late pregnancy can effectively alleviate their pelvic girdle pain, and the teaching effect is better than the traditional teaching model, which has the potential to be promoted and applied in the teaching of obstetric maternity schools.

Objective:To evaluate the safety and oncological outcomes of robot-assisted laparoscopic inferior vena cava(IVC)segmental resection in renal tumor with IVC tumor thrombus(IVCTT).Methods:Clinical data from renal tumor patients undergoing robot-assisted laparoscopic IVC segmental resection at Peking University Third Hospital from Jan.2021 to Feb.2025 were retrospectively analyzed.Data collection included baseline demographics,tumor characteristics,perioperative parameters,and follow-up outcomes.Surgical records and pathological reports were retrieved from the electronic medical record system.Continuous variables were presented as median(P25,P75),and categorical variables as frequency(percentage).Results:Forty-four patients were enrolled.The cohort comprised 31 malesand 13 females,with a median age of 62(55,68)years.Right-sided tumors were observed in 39 cases and left-sided in 5 cases.Median tumor diameter was 8.1(6.1,10.1)cm.Mayo classifications included grade Ⅱ(n=37),Ⅲ(n=6),and Ⅳ(n=1).Neoadjuvant therapy was administered to 23 patients.Seventeen patients were complicated by IVC bland thrombus.Median operative time was 224.0(167.3,303.8)min,with intraoperative blood loss of 500.0(300.0,850.0)mL.Transfusion was administered to 19 patients,with a median blood transfusion of 800.0(400.0,1 200.0)mL.Postoperative complica-tions occurred in 25 cases(56.8％),classified as Clavien-Dindo grade Ⅰ(n=8)and grade Ⅱ(n=17).Procedure-specific complications included deep vein thrombosis(n=6),transfusion-requiring ane-mia(n=5),lower extremity edema(n=2),and pulmonary embolism(n=2),with no procedure-related mortality.Median postoperative serum creatinine was 116.0(86.5,157.5)μmnol/L.Pathological examination identified clear cell renal cell carcinoma as the predominant subtype,observed in 34 cases(77.3％).Pathological staging revealed T3b(n=12),T3c(n=29),and T4(n=3)disease,with nodal involvement(N1)in 8 cases and distant metastasis(M1)in 17.At a median follow-up of 10 months(range:1-49 months),cancer-specific mortality occurred in 3 patients,while 1 succumbed to other causes.Disease progression included pulmonary metastasis(n=5),hepatic metastasis(n=4),and local recurrence(n=4).Adjuvant therapy regimens comprised targeted-immunotherapy combina-tions(n=9)and targeted monotherapy(n=18).Conclusion:Robot-assisted laparoscopic I VC seg-mental resection achieves precise thrombus removal with confirmed short-term efficacy in renal tumor with IVCTT,though vigilance against vascular complications remains critical.

Objective:To analyze the iodine nutrition status of pregnant women in Weihai City before and after (2022, 2023) the iodine deficiency disorders (IDD) intervention, evaluate the effectiveness of intervention measures, and provide a scientific basis for adjusting IDD prevention strategies in the city.Methods:In May 2023, the intervention action of IDD was carried out for pregnent women in Weihai City. In April 2022 and December 2023, respectively, a cross-sectional survey method was conducted in four districts (cities) of Weihai City. Each district (city) was divided into five areas (east, west, south, north, and central) each year, and one township (street) was selected from each areas. At least 20 pregnant women were selected from each township (street) as survey subjects, and their household salt samples and random urine samples were collected to measure salt iodine and urinary iodine concentrations, and to compare the test results.Results:A total of 922 household salt samples were tested, including 530 iodized salt samples and 469 qualified iodized salt samples. The median salt iodine was 24.00 mg/kg. The coverage rate of iodized salt, the qualified rate of iodized salt, and the consumption rate of qualified iodized salt were 57.48%, 88.49%, and 50.87%, respectively. No significant difference was observed in medians salt iodine between 2022 (24.26 mg/kg) and 2023 (24.00 mg/kg, Z = - 1.58, P = 0.113). However, the coverage rate of iodized salt and the consumption rate of qualified iodized salt in 2023 werehigher than those in 2022 [73.72% (373/506) vs 37.74% (157/416), 65.22% (330/506) vs 33.41% (139/416), χ 2 = 120.90, 92.40, P < 0.001]. A total of 922 urine samples were collected from pregnant women, with a median urinary iodine of 135.90 μg/L. The median urinary iodine of pregnant women in 2022 was 113.55 μg/L. There was a statistically significant difference in medians urinary iodine among different regions ( H = 27.91, P < 0.001). The median urinary iodine of pregnant women in 2023 was 153.00 μg/L. There was no statistically significant difference in medians urinary iodine among different regions ( H = 3.33, P = 0.343). The medians urinary iodine of pregnant women in Huancui District, Wendeng District, and Rushan City in 2023 (156.60, 155.00, 140.85 μg/L) were higher than those in 2022 (93.60, 110.00, 110.70 μg/L), and the differences were statistically significant ( Z = - 5.44, - 4.92, - 5.99, P < 0.001). The median urinary iodine of pregnant women in Weihai City in 2023 showed a statistically significant difference compared to 2022 ( Z = - 7.62, P < 0.001). Conclusions:The IDD intervention measures in Weihai City have achieved good results, and the coverage of iodized salt, the consumption rate of qualified iodized salt, and the iodine nutrition level of pregnant women have improved. We should continue to implement intervention measures, improve the iodine nutrition level of key populations, and maintain a sustained elimination of IDD.