OBJECTIVE To summarize the current status of position training for clinical pharmacists in China and provide references for the continuous optimization of such training programs.METHODS SinoMed,CNKI,VIP and Wanfang Data were electronically searched to collect position training of clinical pharmacists studies from the inception until November 5th 2024.After data extraction and quality evaluation,descriptive analysis was performed on the results of the included studies.RESULTS&CONCLUSIONS A total of 68 pieces of relevant literature were included in the study.Among them,50 studies reported on training content,49 involved the allocation of teaching resources in the bases,48 addressed training methods,and 39 focused on training evaluation;only 2 studies mentioned faculty development.There were notable variations in the clinical pharmacist training programs across different bases,particularly in the allocation of teaching resources,such as the composition of the teaching team and the utilization of auxiliary teaching tools.Additionally,differences existed in training approaches,such as those employing a single method versus a blended approach.Conversely,the core training content of each base generally revolved around clinical pharmacy practice,demonstrating a degree of consistency.Moreover,the overall emphasis on teacher training and assessment tended to be obviously insufficient.Each base can focus on enhancing the competence of clinical pharmacists by allocating teaching resources,selecting training methods,improving training content,and using evaluation tools,to further enhance the quality of clinical pharmacist training.

Alcoholic steatohepatitis (ASH) is a liver disease characterized by steatosis, inflammation, and necrosis of the liver tissue as a result of excessive alcohol consumption. Pregnane X receptor (PXR) is a xenobiotic nuclear receptor best known for its function in the transcriptional regulation of drug metabolism and disposition. Clinical reports suggested that the antibiotic rifampicin, a potent human PXR activator, is a contraindication in alcoholics, but the mechanism was unclear. In this study, we showed that the hepatic expression of fatty acid binding protein 4 (FABP4) was uniquely elevated in ASH patients and a mouse model of ASH. Pharmacological inhibiting FABP4 attenuated ASH in mice. Furthermore, treatment of mice with the mouse PXR agonist pregnenolon-16α-carbonitrile (PCN) induced the hepatic and circulating levels of FABP4 and exacerbated ASH in a PXR-dependent manner. Our mechanism study established FABP4 as a transcriptional target of PXR. Treatment with andrographolide, a natural compound and dual inhibitor of PXR and FABP4, alleviated mice from ASH. In summary, our results showed that the PXR-FABP4 gene regulatory axis plays an important role in the progression of ASH, which may have accounted for the contraindication of rifampicin in patients of alcoholic liver disease. Pharmacological inhibition of PXR and/or FABP4 may have its promise in the clinical management of ASH.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is the endoscopic modality of choice for the treatment of biliary and pancreatic diseases. However, patients with cirrhosis, particularly those with decompensated cirrhosis, are believed to be at increased risk for complications associated with ERCP. There is a paucity of literature describing the outcomes of ERCP for patients with cirrhosis. This study aimed to investigate the outcomes of ERCP for cirrhosis patients, especially adverse events, and evaluated its safety and efficacy. METHODS: We performed a multicenter, retrospective study of all patients at Beijing Friendship Hospital affiliated to Capital Medical University, Xijing Hospital affiliated to Air Force Military Medical University, Beijing Youan Hospital affiliated to Capital Medical University, and the Fifth Medical Center of the People's Liberation Army General Hospital from June 2003 to August 2019. The adverse events of inpatient ERCP for patients with ( n  = 182) and without liver cirrhosis (controls; n  = 385) were compared. RESULTS: A total of 567 patients underwent ERCP between January 2003 and December 2019 were enrolled in this study. Compared to patients without cirrhosis, patients with cirrhosis were at higher risk for postoperative complications (odds ratio [OR], 4.172; 95% confidence interval [CI], 1.232-7.031; P  < 0.001) such as postoperative pancreatitis (OR, 2.026; 95% CI, 1.002-4.378; P  = 0.001) and cholangitis (OR, 3.903; 95% CI, 1.001-10.038; P  = 0.036). The main indications for ERCP for patients with cirrhosis in this study included choledocholithiasis (101 cases; 55.5%), benign bile duct strictures (46 cases; 25.3%), and malignant bile duct strictures (28 cases; 15.4%). Among them, 23 patients (12.6%) underwent balloon dilation and 79 patients (43.4%) underwent sphincterotomy. Of the patients with cirrhosis, delayed bleeding occurred in ten patients (5.5%), postoperative pancreatitis occurred in 80 patients (44.0%), and postoperative cholangitis occurred in 25 patients (13.7%). An additional multivariate analysis showed that the total bilirubin (TBIL) level (OR, 4.58; 95% CI, 2.37-6.70) and Child-Pugh score of C (OR, 3.11; 95% CI, 1.04-5.37) were risk factors for postoperative complications in patients with cirrhosis. CONCLUSIONS Compared with the general population of patients undergoing ERCP, patients with cirrhosis were more prone to postoperative pancreatitis and cholangitis. TBIL levels and Child-Pugh scores were risk factors for postoperative complications in patients with cirrhosis.
Humans ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects* ; Retrospective Studies ; Constriction, Pathologic ; Risk Factors ; Liver Cirrhosis/complications* ; Pancreatitis/etiology* ; Postoperative Complications/epidemiology* ; Cholangitis

Objective:To investigate the efficacy and safety of venlafaxine and fluoxetine for somatic pain symptoms in postmenopausal depression patients.Methods:In an 8-week randomized controlled study, 184 postmenopausal depression patients who met the study criteria were randomly assigned into the venlafaxine group (90 cases) and the fluoxetine group (94 cases). 172 patients were divided into full analysis set(FAS) and 184 patients were divided into safety set (SS).The efficacy was assessed by the Visual Analogue Scale (VAS), Clinical Global Impression-Severity (CGI-S), and HAMD 24 at baseline, 1-week, 2-week, 4-week, 6-week and 8 weeks treatment. Mixed-effect model repeated measure (MMRM), paired sample t test and independent sample t test were used to compare the efficacy between the two groups. Results:(1) MMRM analysis showed that the main effect of VAS scores between groups was statistically significant, venlafaxine group was significantly lower than the fluoxetine group ( F=6.89, P=0.001).(2) The anxiety/somatization scores and CGI-S scores at 1-week, 2-week, 4-week, 6-week and 8 weeks treatment were significantly lower than baseline（all P<0.05) in both groups. The anxiety/somatization scores of the venlafaxine group were statistically lower than the fluoxetine group at 1-week, 2-week, 4-week, 6-week and 8 weeks treatment ( t=-2.66, 2.21, -3.52, -4.10, -3.14, all P<0.05). The CGI-S scores of venlafaxine group were lower than fluoxetine group at 4-week, 6-week and 8 weeks treatment( t=-2.73, -2.08, -2.17, all P<0.05). (3)There was no significant difference in the incidence of adverse reaction between the two groups (χ 2=0.61, P=0.434). Conclusion:Venlafaxine is more effective in the treatment of somatic pain symptoms in postmenopausal depression than fluoxetine.

Objective:To investigate the efficacy and safety of venlafaxine and fluoxetine for somatic pain symptoms in postmenopausal depression patients.Methods:In an 8-week randomized controlled study, 184 postmenopausal depression patients who met the study criteria were randomly assigned into the venlafaxine group (90 cases) and the fluoxetine group (94 cases). 172 patients were divided into full analysis set(FAS) and 184 patients were divided into safety set (SS).The efficacy was assessed by the Visual Analogue Scale (VAS), Clinical Global Impression-Severity (CGI-S), and HAMD 24 at baseline, 1-week, 2-week, 4-week, 6-week and 8 weeks treatment. Mixed-effect model repeated measure (MMRM), paired sample t test and independent sample t test were used to compare the efficacy between the two groups. Results:(1) MMRM analysis showed that the main effect of VAS scores between groups was statistically significant, venlafaxine group was significantly lower than the fluoxetine group ( F=6.89, P=0.001).(2) The anxiety/somatization scores and CGI-S scores at 1-week, 2-week, 4-week, 6-week and 8 weeks treatment were significantly lower than baseline（all P<0.05) in both groups. The anxiety/somatization scores of the venlafaxine group were statistically lower than the fluoxetine group at 1-week, 2-week, 4-week, 6-week and 8 weeks treatment ( t=-2.66, 2.21, -3.52, -4.10, -3.14, all P<0.05). The CGI-S scores of venlafaxine group were lower than fluoxetine group at 4-week, 6-week and 8 weeks treatment( t=-2.73, -2.08, -2.17, all P<0.05). (3)There was no significant difference in the incidence of adverse reaction between the two groups (χ 2=0.61, P=0.434). Conclusion:Venlafaxine is more effective in the treatment of somatic pain symptoms in postmenopausal depression than fluoxetine.

Objective To investigate the effects of single i.v. subanesthetic dose of ketamine on heart rate, blood pressure and oxygen saturation for antidepressant treatment. Methods Patients with severe depressive disorder were randomized to ketamine group (n=13) and control group (n=14). Ketamine group received ketamine (0.5mg/kg) single injection whereas control group received saline single injection. Escitalopram (10 mg/d) were orally administered for 4 weeks simultaneously. Comparisons were made on the heart rate, blood pressure and oxygen saturation at baseline, 40 min, 100 min, and 280 min after injection between the two groups. Results The main effects of time but not group were significant for all parameters including heart rate, systolic blood pressure and diastolic blood pressure, (P＜0.05). Interaction of time×group was significant (P＜0.05). All parameters including heart rate (F=16.85, P＜0.01), systolic blood pressure (F=15.82, P＜0.01) and diastolic blood pressure (F=8.63, P＜0.01) with time were significant in ketamine group. The heart rate, systolic blood pressure and diastolic blood pressure in ketamine group were significantly higher at 40 min than at other time points (P＜0.05), while were no significant difference among other time points (P＞0.05). There was no statistical significance of main effect of time, group and interaction of time×group in oxygen saturation between the two groups (P＞0.05). Conclusion Single subanesthetic dose ketamine intravenous drip for antidepressant therapy may cause a transient increase in heart rate and blood pressure.

Objective To investigate the prevalence and characters of residual physical symptoms in Chinese depressive patients after acute treatment and the influence on the quality of life and social function.Methods In the multi-centers cross-sectional study,1 503 adult depressive outpatients,from 11 hospitals,who had been treated by antidepressants for 8-12 weeks with significant improvement of at least 50％ by Self-rating Visual Analog Scale were involved.The group with residual physical symptoms could be differentiated by Brief 16-Item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16) ＞5,while the QIDS-SR16 of remission group was ≤5.The QIDS-SR16,Patient Health Questionnaire-15 (PHQ-15),Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) and Sheehan Disability Scale (SDS) were used to assess the depressive symptoms,physical symptoms and social function.Results 49.8％ (748/1 503) patients had residual physical symptoms (PHQ-15＞4).The most common physical symptoms (PHQ-15≥1) were feeling tired or having low energy (56.3％,846/1 503),trouble sleeping (50.6％,760/1 503),headache(43.6％,655 / 1 503),constipation,loose stools or diarrhea(41.3％,620/1 503),feeling heart pound or race (37.6％,565/1 503),dizziness (34.0％,511/ 1 503),nausea,gas or indigestion (33.6％,505/1 503),etc.The 75.7％ (555/733) of the physical symptoms (PHQ-15＞4) in residual group was significantly higher than the 25.1％ (193/770;x2=385.38,P＜0.01) in remission group.The differences on social function (t=2.77-10.47) and life quality (t=3.04-11.41) between two groups were significant (P＜0.01).Generalized linear regression analysis showed that gender (female),present history of first episode were related to better social function,and the factors related to both social function and quality of life included residual depressive symptoms,residual physical symptoms of different severity,comorbid medical conditions,age,duration of antidepressant treatment for this episode.Conclusion The rate of residual physical symptoms is higher in patients with major depression who responded to acute phase treatment.The more severe the residual physical symptoms,the worse the quality of life and social function.It suggests that physical symptoms be focused in order to achieve clinical recovery.

Objective To explore the detection rate and clinical characteristics of multiple somatic symptoms among adult outpatients in cardiology,neurology and GI clinics.Methods The general demographic data and disease-related information of 1 497 patients in Beijing Chaoyang Hospital,Beijing Anzhen Hospital and Beijing Tongren Hospital were collected through continuous inquiry and screening.Physical symptoms and depressive symptoms were assessed by Patient Health Questionnaire-15 (PHQ-15) and Patient Health Questionnaire-9 (PHQ-9).The patients were divided into multiple somatic symptoms group (SOM+group,PHQ-15≥10) and non-multiple somatic symptoms group (SOM-group,PHQ-15＜10).The detection rate of multiple somatic symptoms was calculated.Partial correlation analysis was used to analyze the correlation of PHQ-15 with the demographic,course of disease,cumulative number of visits,and the total score of PHQ-9.Results The overall detection rate of multiple somatic symptoms was 32.67％ (489/1 497)in the three hospitals,and the highest was found in the department of digestive medicine (37.74％,191/506).There were significant differences in gender (x2=36.85,P＜0.01),working status (x2=19.78,P＜0.01),visiting department (x2=9.64,P＜0.01),first visiting/repeated visiting (x2=6.67,P＜0.01),and the total score of PHQ-9 (x2=231.52,P＜0.01).The detection rate of female patients was higher than that of male patients.The detection rates of retired patients and patients who had no daily stable work were higher than patients who had daily stable work.The detection rate of re-visited patients was higher than that of first-visited patients.The illness duration (r=0.07,P＜0.05,Bonferroni correction) and the total score of PHQ-9 (r=0.66,P＜0.05,Bonferroni correction) were positively correlated with the severity of somatic symptoms measured by PHQ-15.Conclusions The detection rate of multiple somatic symptoms was high in general hospitals,especially highest in digestive outpatient clinics,and significantly higher in female,retired,unemployed,re-visited and patients who have depressive symptoms.Depressive symptoms and the illness duration were positively correlated with the severity of somatic symptoms.

Objective To investigate the prevalence and characters of residual physical symptoms in Chinese depressive patients after acute treatment and the influence on the quality of life and social function.Methods In the multi-centers cross-sectional study,1 503 adult depressive outpatients,from 11 hospitals,who had been treated by antidepressants for 8-12 weeks with significant improvement of at least 50％ by Self-rating Visual Analog Scale were involved.The group with residual physical symptoms could be differentiated by Brief 16-Item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16) ＞5,while the QIDS-SR16 of remission group was ≤5.The QIDS-SR16,Patient Health Questionnaire-15 (PHQ-15),Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) and Sheehan Disability Scale (SDS) were used to assess the depressive symptoms,physical symptoms and social function.Results 49.8％ (748/1 503) patients had residual physical symptoms (PHQ-15＞4).The most common physical symptoms (PHQ-15≥1) were feeling tired or having low energy (56.3％,846/1 503),trouble sleeping (50.6％,760/1 503),headache(43.6％,655 / 1 503),constipation,loose stools or diarrhea(41.3％,620/1 503),feeling heart pound or race (37.6％,565/1 503),dizziness (34.0％,511/ 1 503),nausea,gas or indigestion (33.6％,505/1 503),etc.The 75.7％ (555/733) of the physical symptoms (PHQ-15＞4) in residual group was significantly higher than the 25.1％ (193/770;x2=385.38,P＜0.01) in remission group.The differences on social function (t=2.77-10.47) and life quality (t=3.04-11.41) between two groups were significant (P＜0.01).Generalized linear regression analysis showed that gender (female),present history of first episode were related to better social function,and the factors related to both social function and quality of life included residual depressive symptoms,residual physical symptoms of different severity,comorbid medical conditions,age,duration of antidepressant treatment for this episode.Conclusion The rate of residual physical symptoms is higher in patients with major depression who responded to acute phase treatment.The more severe the residual physical symptoms,the worse the quality of life and social function.It suggests that physical symptoms be focused in order to achieve clinical recovery.

Objective To explore the detection rate and clinical characteristics of multiple somatic symptoms among adult outpatients in cardiology,neurology and GI clinics.Methods The general demographic data and disease-related information of 1 497 patients in Beijing Chaoyang Hospital,Beijing Anzhen Hospital and Beijing Tongren Hospital were collected through continuous inquiry and screening.Physical symptoms and depressive symptoms were assessed by Patient Health Questionnaire-15 (PHQ-15) and Patient Health Questionnaire-9 (PHQ-9).The patients were divided into multiple somatic symptoms group (SOM+group,PHQ-15≥10) and non-multiple somatic symptoms group (SOM-group,PHQ-15＜10).The detection rate of multiple somatic symptoms was calculated.Partial correlation analysis was used to analyze the correlation of PHQ-15 with the demographic,course of disease,cumulative number of visits,and the total score of PHQ-9.Results The overall detection rate of multiple somatic symptoms was 32.67％ (489/1 497)in the three hospitals,and the highest was found in the department of digestive medicine (37.74％,191/506).There were significant differences in gender (x2=36.85,P＜0.01),working status (x2=19.78,P＜0.01),visiting department (x2=9.64,P＜0.01),first visiting/repeated visiting (x2=6.67,P＜0.01),and the total score of PHQ-9 (x2=231.52,P＜0.01).The detection rate of female patients was higher than that of male patients.The detection rates of retired patients and patients who had no daily stable work were higher than patients who had daily stable work.The detection rate of re-visited patients was higher than that of first-visited patients.The illness duration (r=0.07,P＜0.05,Bonferroni correction) and the total score of PHQ-9 (r=0.66,P＜0.05,Bonferroni correction) were positively correlated with the severity of somatic symptoms measured by PHQ-15.Conclusions The detection rate of multiple somatic symptoms was high in general hospitals,especially highest in digestive outpatient clinics,and significantly higher in female,retired,unemployed,re-visited and patients who have depressive symptoms.Depressive symptoms and the illness duration were positively correlated with the severity of somatic symptoms.