OBJECTIVE To establish a “BRAND” pharmaceutical care model for advanced non-small cell lung cancer （NSCLC） patients with positive driver genes， providing theoretical and practical references for the clinical implementation of precise and individualized oncology pharmaceutical care. METHODS One hundred patients admitted to the department of pulmonary and critical care medicine in our hospital from January 2023 to May 2024 were collected meeting the inclusion and exclusion criteria. Patients were randomly divided into control group and intervention group， with 50 patients in each group. The control group received routine pharmaceutical care， while the intervention group received pharmaceutical care under the “BRAND” model （collecting patients’ basic information， reviewing disease treatment-related information， conducting precise medication assessments， formulating individualized pharmaceutical care plans for the next steps， and implementing medication guidance and follow-up management）. The study was conducted in a 3-week cycle for a total of 4 cycles. The medication compliance， quality of life， laboratory test indicators， incidence of drug-related adverse events and satisfaction of patients in both groups were compared before and after the intervention to evaluate the effects. RESULTS After 12 weeks of intervention， compared with the control group， the medication compliance， cognitive function， social function and satisfaction of patients in the intervention group were improved significantly （ P ＜0.05）； the severity of fatigue and constipation and the incidence of drug-related adverse events were significantly reduced （ P ＜0.05）， and there was no statistically significant difference in laboratory test indicators （ P ＞0.05）. CONCLUSIONS The “BRAND” pharmaceutical care model can effectively improve the medication compliance of patients with advanced NSCLC with positive driver genes and improve their quality of life. This study can provide a feasible path for clinical pharmacists to carry out standardized and high-quality pharmaceutical care.

Objective To explore the characteristics of the interaction between nirmatrelvir/ritonavir or ritonavir and tacrolimus,and to provide a reference for the safe clinical use of these medication.Methods Case reports related to the combination of nirmatrelvir/ritonavir,ritonavir,and tacrolimus were retrieved from PubMed,Embase,CNKI,Wanfang,and VIP databases up to June 2023.Statistical analysis was conducted on baseline blood concentration,baseline creatinine,tacrolimus dosage,nirmatrelvir/ritonavir usage,and tacrolimus blood concentration under the combination of medication.Results A total of 10 patients,who used nirmatrelvir/ritonavir and tacrolimus were identified from 9 articles,including 5 males and 5 females,the minimum age of 14 years old and the maximum age of 76 years old,average age(47.5±20.1)years.Among these patients,6 cases had kidney transplantation,3 cases had heart transplantation,and 1 case had lung transplantation.Six literature articles on the combination of ritonavir and tacrolimus were included,with a total of 6 cases,including 4 males and 2 females,aged 52 to 58 years,with an average age of(54.5±2.5)years.There were 3 cases of kidney transplantation with HIV,1 case of kidney transplantation with HCV,1 case of liver transplantation with HIV,1 case of orthotopic heart transplantation with HIV.Nirmatrelvir/ritonavir significantly increased tacrolimus concentration,and the extent of increase vary depending on the medication situation.The highest increase was 35.8 fold,while the remaining increases ranged from 2.7 to 14.0 fold,the average was 10.7 fold.All 10 patients experienced varying degrees of creatinine elevation,including two cases of toxic metabolic encephalopathy and one case of liver damage due to rifampicin rescue.Four patients were rescued by phenytoin sodium,and two were rescued by rifampicin.All patients recovered well after clinical treatment.The combination of ritonavir and tacrolimus can also lead to varying degrees of increase in tacrolimus concentration.Conclusions Ritonavir significantly increases the blood concentration of tacrolimus.After discontinuation of nirmatrelvir/ritonavir,tacrolimus concentration should be monitored to guide the dose adjustments for safe reactivation.

Objective To explore the characteristics of the interaction between nirmatrelvir/ritonavir or ritonavir and tacrolimus,and to provide a reference for the safe clinical use of these medication.Methods Case reports related to the combination of nirmatrelvir/ritonavir,ritonavir,and tacrolimus were retrieved from PubMed,Embase,CNKI,Wanfang,and VIP databases up to June 2023.Statistical analysis was conducted on baseline blood concentration,baseline creatinine,tacrolimus dosage,nirmatrelvir/ritonavir usage,and tacrolimus blood concentration under the combination of medication.Results A total of 10 patients,who used nirmatrelvir/ritonavir and tacrolimus were identified from 9 articles,including 5 males and 5 females,the minimum age of 14 years old and the maximum age of 76 years old,average age(47.5±20.1)years.Among these patients,6 cases had kidney transplantation,3 cases had heart transplantation,and 1 case had lung transplantation.Six literature articles on the combination of ritonavir and tacrolimus were included,with a total of 6 cases,including 4 males and 2 females,aged 52 to 58 years,with an average age of(54.5±2.5)years.There were 3 cases of kidney transplantation with HIV,1 case of kidney transplantation with HCV,1 case of liver transplantation with HIV,1 case of orthotopic heart transplantation with HIV.Nirmatrelvir/ritonavir significantly increased tacrolimus concentration,and the extent of increase vary depending on the medication situation.The highest increase was 35.8 fold,while the remaining increases ranged from 2.7 to 14.0 fold,the average was 10.7 fold.All 10 patients experienced varying degrees of creatinine elevation,including two cases of toxic metabolic encephalopathy and one case of liver damage due to rifampicin rescue.Four patients were rescued by phenytoin sodium,and two were rescued by rifampicin.All patients recovered well after clinical treatment.The combination of ritonavir and tacrolimus can also lead to varying degrees of increase in tacrolimus concentration.Conclusions Ritonavir significantly increases the blood concentration of tacrolimus.After discontinuation of nirmatrelvir/ritonavir,tacrolimus concentration should be monitored to guide the dose adjustments for safe reactivation.

Objective:To analyze the statuses of CD8 + T cell exhaustion in patients with human immunodeficiency virus (HIV) infection, Mycobacterium tuberculosis (MTB) infection and co-infection. Methods:A total of 87 patients infected with HIV and/or MTB in Wuxi Fifth People′s Hospital and Taicang First People′s Hospital from August 2019 to January 2020 were enrolled, including 18 cases of HIV infection, 34 cases of active tuberculosis (ATB), 19 cases of latent tuberculosis infection (LTB), seven cases of HIV coinfected with ATB, and nine cases of HIV coinfected with LTB. Another 11 healthy controls were also included. The peripheral blood of all subjects was collected for cell surface staining and intracellular cytokine staining, and flow cytometry was used to detect the expressions of activation molecules including CD62 ligand, CD44 and CD127, the transcription factor like eomesodermin (EOMES), T cell factor 1 (TCF-1), T-box expressed in T cells (T-bet), B lymphocyte-induced maturation protein 1 (Blimp-1), inhibitory receptors including programmed death-1 (PD-1) and T-cell immunoglobulin and mucin domain 3 (Tim-3) on CD8 + T cells. Mann-Whitney U test was used for statistical analysis. Results:The mean fluorescence intensities (MFIs) of the activation molecules CD62 ligand and CD44 in the HIV group were lower than those in the healthy control group, while the inhibitory receptor Tim-3 was higher than that in the healthy control group. The differences were all statistically significant ( U=31.00, 1.00 and 0.00, respectively, all P<0.010). The MFIs of CD62 ligand and CD44 in HIV coinfected with LTB group were lower than those in LTB group, while PD-1 and Tim-3 were higher than those in LTB group. The differences were all statistically significant ( U=4.00, 26.00, 6.00 and 3.00, respectively, all P<0.010). The MFIs of CD62 ligand, CD44 and CD127 in HIV coinfected with ATB group were lower than those in ATB group, while PD-1 and Tim-3 were higher than those in ATB group. The differences were all statistically significant ( U=9.00, 40.00, 45.50, 28.00 and 7.00, respectively, all P<0.010). The proportion of terminal effector CD8 + T cells in the HIV group was higher than that in the healthy control group, while the proportion of central memory CD8 + T cells was lower than that in the healthy control group. The differences were both statistically significant ( U=15.00 and 33.00, respectively, both P<0.010). The proportion of terminal effector CD8 + T cells in the HIV coinfected with LTB group was higher than the LTB group, while the proportion of central memory CD8 + T cells was lower than that in the LTB group. The differences were both statistically significant ( U=7.00 and 20.00, respectively, both P<0.010). The proportion of terminal effector CD8 + T cells in the HIV coinfected with ATB group was higher than that in ATB group, while the proportion of central memory CD8 + T cells was lower than that in ATB group. The differences were statistically significant (both U=7.00, P<0.001). The expression level of PD-1 + Tim-3 + T cells in HIV group was higher than that in healthy control group, that in HIV coinfected with LTB group was higher than that in LTB group, and that in HIV coinfected with ATB group was higher than that in ATB group. The differences were all statistically significant ( U=21.00, 6.00 and 5.50, respectively, all P<0.001). The MFI of transcription factors EOMES and TCF-1 in HIV coinfected with LTB group were lower than those in HIV group, while the MFI of T-bet was higher than that in HIV group. The differences were all statistically significant ( U=3.00, 4.00 and 9.00, respectively, all P<0.001). The MFI of EOMES and TCF-1 in HIV coinfected with ATB group were lower than those in HIV group, while the MFI of T-bet and Blimp-1 were higher than those in the HIV group. The differences were all statistically significant ( U=11.00, 14.00, 7.00 and 22.00, respectively, all P<0.050). Conclusions:MTB co-infected with HIV patients present lower immune function and a higher degree of CD8 + T cell exhaustion. In addition, HIV patients co-infected with LTB and ATB have a higher degree of CD8 + T cell exhaustion than HIV infected patients.

OBJECTIVE:To discuss the application of rational drug use software system in drug dispensing in outpatient depart-ment of our hospital. METHODS:The application of rational drug use software system (included clinical decision support soft-ware,drug dispensing software and drug management software) in prescribing (warning in advance),dispensing (intervention in the event)and the prescription review(the post review)in outpatient department of our hospital were all introduced. Outpatient pre-scription checking and intervention were collected from our hospital after the application of rational drug use software system to evaluate the effect of the software system. RESULTS & CONCLUSIONS:Rational drug use software system is adopted to realize scientific,convenient and express monitoring and management of prescription drug use in advance,in the course and afterwards. A total of 721 507 outpatient prescriptions were checked in our hospital from Jan. to May in 2015;0.17‰prescriptions were intercept-ed by system warning;system pointed out and pharmacists had checked 23.25% prescriptions;the rate of qualified prescription was more than 99.96%. After pharmacists intervention,various types of irrational prescriptions decreased significantly (P<0.01). It is suggested that pharmacists should make full use of information system,at the same time,optimize and improve the system through active exploration so as to improve rational drug use.