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.

Objective:To investigate the clinical characteristics of non-typhoidal Salmonella（NTS）enteritis in children and the drug resistance of NTS strains.Methods:The clinical data of 138 children who were hospitalized in Children's Hospital Affiliated to Xi'an Jiaotong University from 2022 to 2023 with diarrhea as the main complaint and NTS detected in stool culture were analyzed retrospectively, and the clinical characteristics and drug resistance were summarized.Results:Among 138 children with NTS enteritis，89 were males and 49 were females，with a male-to-female sex ratio of 1.81∶1 and an average age of 1.9（1.0,3.6）years，with a high incidence rate in June,July and August.Seventeen（12.31%）cases had a history of suspected unclean diet before illness.All the children had diarrhea symptoms with changes in fecal frequency and character，including 74 cases of pus and bloody stool，119 cases of mucus stool，and 70 cases of watery stool.One hundred and twenty-five（90.57%）cases had fever.Among 138 cases of fecal culture,there were 47 (34.05%) strains of Salmonella typhimurium,36(26.09%) strains of Salmonella enteritidis,and 55(39.85%) strains of other serotypes of Salmonella .One hundred and twenty-two（88.40%）NTS strains were resistant to more than one antimicrobial agent，and 29（21.01 %）were multi-drug resistant.The resistance rates to ampicillin，ampicillin/sulbactam，ceftriaxone，trimethoprim/sulfamethazole，ceftazidime，cefepime and piperacillin/tazobactam were 73.91%，71.01%，29.71%，29.71%，23.19%，11.59%，and 3.62%，respectively.All strains were sensitive to carbapenem antibiotics（meropenem，imipenem，and ertapenem）.The drug resistance rates of Salmonella typhimurium to ceftazidime and trimethoprim/sulfamethoxazole were higher than those of Salmonella enteritidis（38.30% vs 8.33%），the difference was statistically significant ( P < 0.05). Conclusion:Infants and young children are the high-incidence group of NTS enteritis，with the peak incidence period being from June to August each year，manifested by mucus-pus-blood stools, abdominal pain, vomiting，fever and other symptoms.Reasonable selection of antibiotics in time according to the local epidemic strains,changes of antimicrobial resistance and the results of drug sensitivity test of strains can effectively resist infection and reduce the production of drug-resistant beads.

Objective:To assess the value of chromosomal microarray analysis (CMA) for the detection of low-level mosaicisms in amniotic fluid samples, and to retrospectively analyze the rare cases of mosaicisms.Methods:Chromosomal karyotype of the fetus was determined by G-banding analysis of cultured amniotic fluid cells. CMA was used to detect copy number variation of fetal chromosomes, and fluorescence in situ hybridization (FISH) was used to determine the proportion of fetal chromosomal mosaicisms in uncultured amniotic fluid cells. Results:Among 825 prenatal samples, 4 cases of true fetal mosaicisms were detected, which yielded an incidence of 0.48%. Two cases were sex chromosomal mosaicisms, and two were autosomal mosaicisms, which involved chromosomes 8 and 9, respectively. All cases were verified by G-banding analysis of cultured amniotic fluid cells, CMA, and/or FISH.Conclusion:CMA has a great value for detecting low-level mosaicisms in amniotic fluid samples, though the positive results need to be verified by other techniques and should be interpreted with caution. The review of rare cases can provide a basis for prenatal genetic counseling.

Objective To explore the protective effect and possible mechanism of modified Shenqi Dihuang Decoction on podocytes in db/db mice based on ROS/NLRP3/GSDMD signaling pathway.Methods Fifty 8-week-old male db/db mice(SPF grade)were randomly divided into the model group,losartan group and TCM low-,medium-and high-dosage groups,with 10 mice in each group.Ten heterozygous db/m mice served as the blank group.Interventions were administered respectively for 12 weeks.The body mass,random blood glucose,serum creatinine,blood urea nitrogen and 24 h urinary protein content were detected,HE,PAS,PASM,Masson and Sirius red staining was used to observe the morphology of renal tissue,transmission electron microscopy was used to observe the ultrastructure of renal tissue,fluorescent probes were used to observe the release of ROS in renal tissue,immunofluorescence staining was used to detect the expression of Nephrin,NLRP3,Cleaved Caspase-1 and GSDMD-N in renal tissue,and Western blot was used to detect the expression of NLRP3,Cleaved Caspase-1,GSDMD-N,IL-1β,IL-18,Nephrin,Podocin,PODXL,WT-1 and Desmin proteins.Results Compared with the blank group,the body mass and random blood glucose of the model group mice significantly increased(P<0.05),and the contents of serum creatinine,blood urea nitrogen and 24 h urinary protein were significantly increased(P<0.05);glomerular hypertrophy,dilation of renal glomeruli and tubules,thickening of basement membrane,matrix proliferation in mesangial area,abnormal deposition of collagen fibers in renal interstitium,accompanied by damage to renal tubular epithelial structure and focal glomerulosclerosis,significant increase in type Ⅰ collagen deposition,extensive fusion of podocyte processes,and scattered electron dense material in the basement membrane or subepithelial layer;the ROS content in renal tissue significantly increased(P<0.05),and the protein expression of NLRP3,Cleaved Caspase-1,GSDMD-N,IL-1β,IL-18 and Desmin significantly increased(P<0.05),the protein expression of Nephrin,Podocin,PODXL and WT1 significantly decreased(P<0.05).Compared with the model group,the body mass and random blood glucose of mice in each dosage of TCM group were relatively stable,the contents of serum creatinine,blood urea nitrogen and 24 h urinary protein decreased;the pathological damage to renal tissue was reduced,the ultrastructure of podocytes was improved,and the density of podocytes increased;the ROS content decreased,and the protein expression of NLRP3,Cleaved Caspase-1,GSDMD-N,IL-1β,IL-18 and Desmin decreased,while the protein expression of Nephrin,Podocin,WT1 and PODXL increased.With the dosage of modified Shenqi Dihuang Decoction increased,the improvement effect gradually strengthened,and the differences in TCM high-dose group was statistically significant(P<0.05).Conclusion Modified Shenqi Dihuang Decoction can protects podocytes in db/db mice,potentially by modulating the ROS/NLRP3/GSDMD signaling pathway.

Objective Magnetic resonance angiography(MRA)offers a non-invasive and radiation-free advantage in detecting and diagnosing intracranial artery stenosis;however,it is associated with high equipment costs.Transcranial color-coded Duplex ultrasound(TCCD)combined with contrast-enhanced ultrasound(CEUS)presents advantages such as non-invasiveness,real-time dynamic monitoring,and low cost.Nevertheless,there were no reports comparing the sensitivity,specificity,diagnostic agreement with MRA,or health economic evaluation of TCCD combined with CEUS for detecting major intracranial artery stenosis.Methods From April 2023 to August 2024,a total of 55 patients suspected of having intracranial artery stenosis or occlusion were recruited at Beijing Tiantan Hospital,Capital Medical University.Both TCCD combined with CEUS and MRA were performed to evaluate the degree of stenosis in the terminal segment of the internal carotid artery,M1 and M2 segments of the middle cerebral artery,A1 and A2 segments of the anterior cerebral artery,P1 and P2 segments of the posterior cerebral artery,and the V4 segment of the vertebral artery.Intracranial artery stenosis was categorized into three groups:normal/mild,moderate,and severe/occlusion.Sensitivity,specificity,and consistency between the two methods were calculated.The Wilcoxon signed-rank test was used to compare the differences in examination costs and diagnostic time.Results Fifty-five high-risk patients(110 cerebral hemispheres in total)with suspected cerebrovascular stenosis were included(median age:46 years;69.0%male).TCCD combined with CEUS and MRA were performed simultaneously.TCCD combined with CEUS showed high sensitivity and specificity in diagnosing intracranial artery stenosis,with good consistency compared to MRA.The highest diagnostic consistency was observed in the M2 segment(Kappa=0.704)and A2 segment(Kappa=0.650),while the M1 segment showed moderate consistency(Kappa=0.569).The average cost of TCCD combined with CEUS was 240 CNY with a diagnostic duration of 21 min,compared to 722 CNY and 287 min for MRA(P<0.001,effect sizer=0.89-0.91).Conclusion Compared to MRA,TCCD combined with CEUS demonstrates higher consistency in screening for stenosis in the M2 segment of the middle cerebral artery and the A2 segment of the anterior cerebral artery.It is also more cost-effective.However,MRA has advantages in assessing deep intracranial vessels.A synergistic use of both methods can optimize the allocation of diagnostic resources for intracranial artery stenosis.It is recommended that primary healthcare institutions adopt TCCD as the initial screening tool,and,with standardized training and technical upgrades,combine it with CEUS.Complex cases should be referred for detailed evaluation by using MRA.

Objective To find a reasonable frequency range of pure tone source signal and to propose a prelim-inary normal value determination range for sonotubometry for eustachian tube function assessment.Methods A to-tal of 31 healthy adults were enrolled in this study.Step pure tone line spectrum signals with an interval of 100 Hz on the frequency band of 3-6 kHz were used as sound sources for sonotubometry.Results The results showed that 8 frequency points of 3.5 kHz,4.3 kHz,4.35 kHz,4.5 kHz,4.65 kHz,4.8 kHz,5.0 kHz and 5.15 kHz were suitable frequency points for pure tone signal.The line spectrum data at these 8 frequency points were summarized and statistically analyzed,and 95％confidence interval of LVc value was calculated,that was,95％LVc value was greater than 5.5 dB,and 6 dB was set as the LVc threshold after integer.Conclusion In this study,a pure tone line spectrum sound source frequency suitable for sonotubometry was found,and the amplitude change of sound pressure level over 6 dB within about 0.5-1 second before and after swallowing action of the sound source signal can be used as an effective indicator of eustachian tube opening.

Objective:To analyze the clinical features, imaging features and diagnosis and treatment process of a female pelvic epithelioid inflammatory myofibroblastic sarcoma (EIMS) with peritoneal metastasis, so as to improve the clinical understanding and diagnostic ability of the disease and avoid misdiagnosis and missed diagnosis.Methods:The clinical data of a female patient with pelvic EIMS combined with peritoneal metastasis in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Results:The triad examination of the patient involved an irregular solid mass in the pelvic cavity about 8.0 cm×9.0 cm in size. Laboratory examination revealed human epididymal protein 4(HE4)154.00 pmol/L. The ultrasonography showed multiple low-echo masses in deep pelvic cavity with unclear boundary and uneven internal echo, and color doppler flow imaging (CDFI) showed abundant internal blood flow signals. Enhanced CT showed uneven and obvious enhancement of the lesion. Pathological examination showed the infiltration of inflammatory cells in the mucous interstitial background. The tumor cells were round and epithelioid, with large nuclei, deep staining and obvious nucleolus. Immunohistochemistry showed anaplastic lymphoma kinase (ALK) positive, and molecular pathology fluorescence in situ hybridization showed ALK gene amplification (positive). Combined with pathological, immunohistochemical and genetic tests, EIMS was diagnosed. Conclusions:EIMS should be considered when there are single or multiple solid or cystic nodules or masses in the pelvic cavity with obvious enhancement, invasive growth and peritoneal implantation metastasis, and the correct diagnosis can be made according to the pathological findings, immunohistochemistry and genetic test results.

Multiple myeloma (MM) is a malignant disease characterized by clonal plasma cell proliferation, with metabolic reprogramming. Abnormal metabolism of amino acids, glucose, lipids and nucleotides plays a crucial role in various pathological processes in MM, such as proliferation, metastasis, immune escaping and drug resistance. This review summarized the application of metabolomics technology in identifying biomarkers for MM and targeting related metabolic pathways. The objective is to guide further investigations into the metabolic mechanisms underlying MM and encourage innovation in clinical diagnosis and treatment strategies for this disease.

Objective To develop a risk prediction model for ischemic stroke in symptomatic intracranial atherosclerotic stenosis(ICAS)patients based on high-resolution magnetic resonance imaging(HR-MRI)and arterial spin labeling(ASL)imaging.Methods A total of 142 patients were included and divided into acute ischemic stroke(AIS)and transient ischemic attack(TIA)groups based on stroke occurrence.Clinical risk factors,plaque characteristics,and arterial transit artifact(ATA)presence on ASL images were compared between the two groups.Multivariate logistic regression analysis was performed,incorporating clinical risk factors,plaque characteristics,and double post labeling delay(PLD)ATA presence.The predictive value of different models was compared using receiver operating characteristic(ROC)curve and DeLong tests.Results Hypertension,positive lumen remodeling,plaque enhance-ment rate,1.5 s-ATA presence,and 2.5 s-ATA presence were independent risk factors for AIS(P＜0.05).The combination of HR-MRI and ASL imaging predicted AIS most effectively[area under the curve(AUC)=0.908;95％ confidence interval(CI)0.862-0.954].No significant difference was found between the prediction performances of HR-MRI and ASL(95％CI-0.041-0.082,Z=0.659,P=0.509).Conclusion ASL is more convenient than HR-MRI for predicting ischemic stroke in ICAS patients.A model combining plaque characteristics and ATA presence effectively predicts AIS occurrence.

Multiple myeloma (MM) is a malignant disease characterized by clonal plasma cell proliferation, with metabolic reprogramming. Abnormal metabolism of amino acids, glucose, lipids and nucleotides plays a crucial role in various pathological processes in MM, such as proliferation, metastasis, immune escaping and drug resistance. This review summarized the application of metabolomics technology in identifying biomarkers for MM and targeting related metabolic pathways. The objective is to guide further investigations into the metabolic mechanisms underlying MM and encourage innovation in clinical diagnosis and treatment strategies for this disease.