OBJECTIVE To summarize the implementation experiences of the China Hospital Association’s Clinical Pharmacist Instructor Training Program Reform， and to evaluate the effectiveness of the reform， thus continuously enhancing the quality and standards of clinical pharmacist instructor training. METHODS The study drew on project evaluation methodologies to summarize the main characteristics of the comprehensive system and new model for clinical pharmacist instructor training established through the reform by literature review. The “learning assessment” and “reaction assessment” were conducted by using Kirkpatrick’s four-level model of evaluation in order to evaluate the effectiveness of the clinical pharmacist instructor training reform through statistically processing and analyzing the performance data and teaching evaluation data of the instructor participants. Based on problem and trend analysis， the future development directions were anticipated for the reform of clinical pharmacist instructor training. RESULTS & CONCLUSIONS The latest round of clinical pharmacist instructor training reform initiated by the Chinese Hospital Association had initially established a four-pronged training system encompassing “recruitment， training， assessment， and management”. It had also forged a training 。 model “oriented towards enhancing clinical teaching competency， with practical learning and skill-based assessment conducted on clinical teaching sites as its core”. Following a period of over three years of gradual reform， the new training system and model became increasingly mature. In both 2023 and 2024， the participants achieved relatively high average total scores in their initial completion assessments [with scores of （84.05± 5.83） and （85.82±4.35） points， respectively]. They also reported a strong sense of gain from the training reform [with self- perceived gain scores of （4.80±0.44） and （4.85±0.39） points， respectively]. The operation and implementation effects of the reform were generally satisfactory. In the future， clinical pharmacist instructor training reforms should continue to address the issues remaining from the current phase， while aligning with global trends in pharmacy education and industry development. Additionally， sustained exploration and practice will be carried out around the core objective of “enhancing clinical teaching competence”.

Objective:To investigate the structural changes in the spinal cord in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) and their relationship with clinical disability.Methods:This study was cross-sectional. A retrospective analysis of clinical and imaging data from 124 patients with MS (MS group), 101 patients with aquaporin-4 antibody-positive NMOSD (NMOSD group), and 110 healthy controls (HC group) from seven medical centers were conducted from January 2018 to October 2021. All subjects underwent 3D T 1WI, and the upper cervical spinal cord cross-sectional area (MUCCA) was segmented and measured. All patients completed the expanded disability status scale (EDSS) assessments at baseline and during follow-up, as well as the baseline 25-foot walk test (T25FW) and the nine-hole peg test (NHPT). Patients were classified into EDSS progression and non-progression groups based on follow-up EDSS scores. Comparisons of MUCCA among the three groups were conducted using analysis of covariance, controlling for age and sex as covariates. Pairwise comparisons between groups were performed using the HSD test. Univariate linear regression and logistic models were employed to identify candidate predictors of baseline clinical disability status or EDSS progression in the MS and NMOSD groups. L1 regularized multivariable linear regression analysis was used to determine independent predictors of baseline clinical disability status or EDSS progression. Independent predictors were then combined to establish a logistic regression model, and the model′s performance in predicting EDSS progression was evaluated using receiver operating characteristic analysis and the area under the curve (AUC). Results:A total of 144 patients completed follow-up EDSS assessments, with a follow-up duration of 3.30 (1.10, 6.42) years, including 82 patients in the MS group and 62 patients in the NMOSD group. Controlling for sex and age as covariates, the overall difference in MUCCA among the MS, NMOSD, and HC groups was statistically significant ( P=0.001). The MUCCA in the MS group was lower than that in the HC group, with a significant difference ( t=-2.54, P=0.007); the MUCCA in the NMOSD group was also lower than that in the HC group, with a significant difference ( t=-2.80, P=0.002). However, the difference in MUCCA between the MS and NMOSD groups was not statistically significant ( t=-0.40, P=0.882). In the MS group, MUCCA was an independent predictor of baseline EDSS score (β=-0.03), baseline T25FW score (β=-0.09), and baseline NHPT score (β=-0.30). In the NMOSD group, MUCCA (β=-0.08), age (β=0.06), and baseline EDSS score (β=-0.43) were independent predictors of EDSS progression, and the logistic regression model incorporating these three factors predicted EDSS progression with an AUC of 0.82. Conclusions:Significant spinal cord atrophy occurs in patients with both MS and NMOSD. Atrophy of the upper cervical spinal cord can predict the degree of disability in MS patients and the progression of clinical disability in NMOSD patients.

Objective:To investigate the structural changes in the spinal cord in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) and their relationship with clinical disability.Methods:This study was cross-sectional. A retrospective analysis of clinical and imaging data from 124 patients with MS (MS group), 101 patients with aquaporin-4 antibody-positive NMOSD (NMOSD group), and 110 healthy controls (HC group) from seven medical centers were conducted from January 2018 to October 2021. All subjects underwent 3D T 1WI, and the upper cervical spinal cord cross-sectional area (MUCCA) was segmented and measured. All patients completed the expanded disability status scale (EDSS) assessments at baseline and during follow-up, as well as the baseline 25-foot walk test (T25FW) and the nine-hole peg test (NHPT). Patients were classified into EDSS progression and non-progression groups based on follow-up EDSS scores. Comparisons of MUCCA among the three groups were conducted using analysis of covariance, controlling for age and sex as covariates. Pairwise comparisons between groups were performed using the HSD test. Univariate linear regression and logistic models were employed to identify candidate predictors of baseline clinical disability status or EDSS progression in the MS and NMOSD groups. L1 regularized multivariable linear regression analysis was used to determine independent predictors of baseline clinical disability status or EDSS progression. Independent predictors were then combined to establish a logistic regression model, and the model′s performance in predicting EDSS progression was evaluated using receiver operating characteristic analysis and the area under the curve (AUC). Results:A total of 144 patients completed follow-up EDSS assessments, with a follow-up duration of 3.30 (1.10, 6.42) years, including 82 patients in the MS group and 62 patients in the NMOSD group. Controlling for sex and age as covariates, the overall difference in MUCCA among the MS, NMOSD, and HC groups was statistically significant ( P=0.001). The MUCCA in the MS group was lower than that in the HC group, with a significant difference ( t=-2.54, P=0.007); the MUCCA in the NMOSD group was also lower than that in the HC group, with a significant difference ( t=-2.80, P=0.002). However, the difference in MUCCA between the MS and NMOSD groups was not statistically significant ( t=-0.40, P=0.882). In the MS group, MUCCA was an independent predictor of baseline EDSS score (β=-0.03), baseline T25FW score (β=-0.09), and baseline NHPT score (β=-0.30). In the NMOSD group, MUCCA (β=-0.08), age (β=0.06), and baseline EDSS score (β=-0.43) were independent predictors of EDSS progression, and the logistic regression model incorporating these three factors predicted EDSS progression with an AUC of 0.82. Conclusions:Significant spinal cord atrophy occurs in patients with both MS and NMOSD. Atrophy of the upper cervical spinal cord can predict the degree of disability in MS patients and the progression of clinical disability in NMOSD patients.

Objective:To estimate the lung cancer disease burden of residents caused by indoor radon exposure in living rooms in China, and to provide scientific basis for improving radon prevention and control policies and measures.Methods:Based on the data from the national indoor radon monitoring survey, the study of lung cancer caused by indoor radon, and the basic data such as population and smoking, the attributable burden of disease calculation method was used to estimate the disease burden of lung cancer caused by indoor radon in China.Results:In 2018, it was estimated that the years of life lost due to premature death (YLL), years of life lost due to health disability (YLD) and disability-adjusted life years (DALY) due to indoor radon exposure were 5.109 3 million, 0.052 6 million and 5.161 9 million, respectively. DALY was highest in the 50-54 age group. The disease burden of indoor radon-induced lung cancer in smoking men was more than 9 times that of smoking women, and the disease burden of lung cancer in non-smoking women was more than 5 times that of non-smoking men. Smoking is closely related to the disease burden of indoor radon-induced lung cancer.Conclusions:Indoor radon exposure is a major environmental risk factor associated with lung cancer burden in China. The health hazards of indoor radon require more attention and improved policy measures to address this challenge.

Objective To construct a culture system of endometrial organoids for infertility induced by non-immune or immune factors,and to compare the immune cytokines between them.Methods The samples were collected from infertility patients undergoing hysteroscopy in Department of Reproductive Medicine Center of The First Affiliated Hospital of Naval Medical University(Second Military Medical University).Endometrial tissues were obtained from patients with infertility caused by non-immune factors(n=3)and patients with repeated implantation failure(RIF)(n=5).The tissues were embedded in matrix glue for 3D culture after washing,digestion,re-suspension and plate attachment.The growth of endometrial organoids of the 2 groups was observed under inverted microscope;the expression of estrogen receptor,keratin and E-cadherin,which were specific endometrial markers,was detected by immunofluorescence staining;and the cytokines of the 2 groups were determined by enzyme-linked immunosorbent assay(ELISA)and the differences of cytokines between the 2 groups were observed.Results During the process of in vitro culture of endometrial organoids,the volume of organoids and the number of cells gradually increased.After 7-10 d of culture,the volume of organoids reached a stable state,and the shape gradually became a perfect circle.At the same time,the number of organoids from the infertility patients caused by non-immune factors was more than that from the infertility patients caused by RIF.Immunofluorescence staining showed the expression of endometrial related marker proteins estrogen receptor,keratin and E-cadherin,indicating the successful construction of endometrial organoids.ELISA results showed that the levels of interferon(IFN)-γ,interleukin(IL)-10,tumor necrosis factor(TNF)-α,IL-4 and TNF-α/IL-4 ratio between the 2 groups were significantly different(P＜0.05 or P＜0.01).There were no significant differences in the levels of TGF-β1 or IL-17,the ratios of IL-17/TGF-β1,IFN-γ/IL-10 or TNF-α/IL-10(all P＞0.05).Conclusion Endometrial organoids with proliferative ability from patients with non-immune infertility and RIF have been successfully cultured in vitro,which provides a new model for the basic research of immune infertility.

Objective:To investigate the feasibility and clinical diagnostic value of rapid arterial spin labeling (ASL) imaging in brain glioma.Methods:Patients with glioma admitted to Beijing Tiantan Hospital, Capital Medical University from May 2021 to December 2022 were prospectively enrolled. All patients received MR rapid ASL (scan time: 1 min) and conventional ASL (scan time: 4 min 30 s), where the cerebral blood flow (CBF) perfusion maps were obtained. The qualitative analysis of CBF signal intensity and quantitative analysis of average CBF values from both tumor solid and edema regions were conducted by two radiologists independently. Kappa test and intraclass correlation coefficient ( ICC) were used to analyze the consistency of qualitative and quantitative results, respectively. Results:A total of 30 patients with brain glioma were included. The 2 physicians used rapid ASL to determine low perfusion, isoperfusion, and hyperperfusion in the tumor area in 1, 6, 23 cases and 0, 5, and 25 cases, respectively; and used conventional ASL to determine low perfusion, isoperfusion, and hyperperfusion in the tumor area in 0, 9, and 21 cases, respectively. The results of qualitative analysis of rapid ASL and conventional ASL were highly consistent within and between groups ( Kappa was 0.830 and 0.850 respectively). The results of quantitative analysis of rapid ASL and conventional ASL were highly consistent within and between groups ( ICC 0.940—0.994). Conclusion:Rapid ASL with shorter scanning time could be applied in assessing tissue perfusion in brain glioma and contribute to the clinical diagnosis of gliomas.

Objective:To estimate the lung cancer disease burden of residents caused by indoor radon exposure in living rooms in China, and to provide scientific basis for improving radon prevention and control policies and measures.Methods:Based on the data from the national indoor radon monitoring survey, the study of lung cancer caused by indoor radon, and the basic data such as population and smoking, the attributable burden of disease calculation method was used to estimate the disease burden of lung cancer caused by indoor radon in China.Results:In 2018, it was estimated that the years of life lost due to premature death (YLL), years of life lost due to health disability (YLD) and disability-adjusted life years (DALY) due to indoor radon exposure were 5.109 3 million, 0.052 6 million and 5.161 9 million, respectively. DALY was highest in the 50-54 age group. The disease burden of indoor radon-induced lung cancer in smoking men was more than 9 times that of smoking women, and the disease burden of lung cancer in non-smoking women was more than 5 times that of non-smoking men. Smoking is closely related to the disease burden of indoor radon-induced lung cancer.Conclusions:Indoor radon exposure is a major environmental risk factor associated with lung cancer burden in China. The health hazards of indoor radon require more attention and improved policy measures to address this challenge.

AIM:To analyze the Pharmaceutical Care Network Europe(PCNE)classification system used for evaluating the drug related problems(DRPs)of tacrolimus concentration fluctuations in kidney transplant recipients.METHODS:Kidney transplant recipients were selected as the study subjects,who experienced fluctuations in tacrolim-us blood concentrations and clinical pharmacist in-tervention during outpatient follow-up.PCNE(9.0)classification system was used to evaluate the DRPs of tacrolimus.And the DRP problems,causes,inter-vention plans,acceptance and status were ana-lyzed.RESULTS:A total of 700 kidney transplant re-cipients were enrolled from July 2019 to December 2021,and 1014 DRPs were found.The problems of DRPs included the occurrence of adverse drug events(P2.1,60.16％)and poor treatment out-comes(P1.2,39.84％);The main reasons included dosage selection(C3,43％),others(C9,38.4％),and drug selection(C1,9.41％);Clinical pharmacists ac-tively intervened at the recipient level(I2,98.92％)and drug level(I3,1.08％);The acceptance rate of the intervention plan(A1.1+A1.3)reached 98.62％,and the complete implementation rate(A1.1)reached 72.09％;79.29％of DPRs were fully or par-tially resolved(O1.1 and O2.1).CONCLUSION:Clini-cal pharmacists can use PCNE to evaluate tacrolim-us therapeutic drug monitoring(TDM)related DRPs,help standardize TDM pharmaceutical ser-vice models,standardize TDM abnormal result in-terpretation and intervention workflows,and pro-mote safe and rational drug utilization.

AIM:In this study,bioinformatics tech-nology was used to explore the differentially ex-pressed genes in antibody-mediated rejection after renal transplantation,and to screen out the possi-ble mechanisms and potential therapeutic targets of AMR-related miRNAs after renal transplantation,in order to provide new idea for the targeted thera-py of AMR after transplantation.METHODS:The dataset GSE115816 was downloaded from the GEO database,and the differential expression of miR-NAs in stable renal transplantation(SGF)group and the antibody-mediated rejection(AMR)group after renal transplantation was analyzed online by using DESeq 2R software.TargetScan software predicted the related targets of miRNAs,and the differential-ly expressed genes(DEGs)were analyzed through through gene ontology(GO)enrichment analysis and Kyoto gene and genome encyclopedia(KEGG)enrichment analysis,then key genes were screened by String database and Cytoscape,and finally veri-fied by TargetScan online analysis.RESULTS:A total of 10 differentially expressed miRNAs were identi-fied in the AMR group by comparison with the SGF group,with the most significant difference in ex-pression of miR-144-5p.A total of 143 miR-144-5p related targets were predicted by Targetscan soft-ware.GO analysis showed that DEGs were mainly involved in angiogenesis,synaptic signaling,and transcriptional co-activator regulation.KEGG analy-sis showed that DEGs were mainly enriched in the thyroid hormone signaling pathway,human papillo-mavirus infection,and PI3K-AKT signaling pathway.The 10 Hug genes were screened by PPI network.Based on the 6 algorithms in cytoHubba,5 key genes were obtained by taking the intersection of the top 10 Hug genes of each algorithm,which were NCOA2,NCOA1,FOXO1,PAX3,and PPARGC1A.After the literature review,we found that FoxO1 plays an essential role in immune sys-tem diseases and kidney diseases.In our study,we chose FoxO1 as a potential target protein for miR-144-5p.Finally,TargetScan online analysis showed that miR-144-5p has a targeted binding site with the 3'UTR region of FoxO1.CONCLUSION:MiR-144-5p plays an important role in AMR after Kidney transplantation.MiR-144-5p targeting FoxO1 may be a potential therapeutic target and prognostic biomarker for AMR.

AIM:To analyze the Pharmaceutical Care Network Europe(PCNE)classification system used for evaluating the drug related problems(DRPs)of tacrolimus concentration fluctuations in kidney transplant recipients.METHODS:Kidney transplant recipients were selected as the study subjects,who experienced fluctuations in tacrolim-us blood concentrations and clinical pharmacist in-tervention during outpatient follow-up.PCNE(9.0)classification system was used to evaluate the DRPs of tacrolimus.And the DRP problems,causes,inter-vention plans,acceptance and status were ana-lyzed.RESULTS:A total of 700 kidney transplant re-cipients were enrolled from July 2019 to December 2021,and 1014 DRPs were found.The problems of DRPs included the occurrence of adverse drug events(P2.1,60.16％)and poor treatment out-comes(P1.2,39.84％);The main reasons included dosage selection(C3,43％),others(C9,38.4％),and drug selection(C1,9.41％);Clinical pharmacists ac-tively intervened at the recipient level(I2,98.92％)and drug level(I3,1.08％);The acceptance rate of the intervention plan(A1.1+A1.3)reached 98.62％,and the complete implementation rate(A1.1)reached 72.09％;79.29％of DPRs were fully or par-tially resolved(O1.1 and O2.1).CONCLUSION:Clini-cal pharmacists can use PCNE to evaluate tacrolim-us therapeutic drug monitoring(TDM)related DRPs,help standardize TDM pharmaceutical ser-vice models,standardize TDM abnormal result in-terpretation and intervention workflows,and pro-mote safe and rational drug utilization.