OBJECTIVE To optimize the prescription pre-review system in our hospital and evaluate its application effects. METHODS Aiming at the problems of imperfect rule base and high false positive rate in the early operation of the system， optimization measures were taken， including improving the content of the rule base， adjusting the interception level and prompt mode， refining the working model of prescription review pharmacists， and strengthening clinical communication. A retrospective cohort study was conducted， with prescription data from June to December 2023 （before optimization） as the control group and June to December 2024 （after optimization） as the observation group. Through inter group comparative analysis， the actual effect of optimizing the prescription pre-approval system was evaluated. RESULTS The prescription qualified rate increased from （82.51± 4.04）% before optimization to （90.98±1.55）% after optimization； the false positive rate decreased from （20.87±1.64）% before optimization to （7.41±2.04）% after optimization. The monthly range of prescription qualified rate narrowed from 10.24% to 4.11%， and the coefficient of variation decreased from 4.92% to 1.73%. The monthly range of false positive rate slightly increased from 4.40% to 5.34%， the coefficient of variation rose from 8.32% to 26.18%. CONCLUSIONS Through multi-dimensional optimizations of the prescription pre-review system in our hospital， its prescription review efficiency has been significantly enhanced， the quality of prescriptions has steadily improved， and the accuracy of reviews has notably improved.

Background::Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by complex and various clinical manifestations. The study aimed to analyze clinical features and cerebral magnetic resonance imaging (MRI) changes of hyperintense white matter (WM) lesions in SLE patients.Methods::This was a retrospective study based on a consecutive cohort of 1191 SLE patients; 273 patients for whom cerebral MRI data were available were enrolled to assess hyperintense WM lesions associated with SLE. Patients were assigned to two groups, ie, with or without hyperintense WM lesions. The MRI assessment showed that the hyperintense WM lesions could be classified into three categories: type A, periventricular hyperintense WM lesions; type B, subcortical hyperintense WM lesions; and type C, multiple discrete hyperintense WM lesions. The clinical and MRI characteristics were analyzed. Factors related to hyperintense WM lesions were identified by multivariate logistic regression analysis.Results::Among the 273 SLE patients with available cerebral MRI scans, 35.9% (98/273) had hyperintense WM lesions associated with SLE. The proportions of types A, B, and C were 54.1% (53/98), 11.2% (11/98), and 92.9% (91/98), respectively. Fifty-one percents of the patients showed an overlap of two or three types. Type C was the most common subgroup to be combined with other types. Compared with those without hyperintense WM lesions, the patients with hyperintense WM lesions were associated with neuropsychiatric SLE (NPSLE), lupus nephritis (LN), hypertension, and hyperuricemia ( P = 0.002, P = 0.018, P = 0.045, and P = 0.036, respectively). Significantly higher rates of polyserous effusions and cardiac involvement were found in the patients with hyperintense WM lesions ( P = 0.029 and P = 0.027, respectively), and these patients were more likely to present with disease damage ( P < 0.001). In addition, the patients with hyperintense WM lesions exhibited a higher frequency of proteinuria ( P = 0.009) and higher levels of CD8 + T cells ( P = 0.005). In the multivariate logistic analysis, hyperuricemia and higher CD8 + T cells percentages were significantly correlated with hyperintense WM lesions in SLE patients ( P= 0.019; OR 2.129, 95% confidence interval [CI] 1.313-4.006 and P < 0.001; OR 1.056, 95% CI 1.023-1.098, respectively). Conclusions::Hyperintense WM lesions are common in SLE patients and significantly associated with systemic involvement, including NPSLE, LN, polyserous effusions, cardiac involvement, and disease damage. Hyperuricemia and a higher number of CD8 + T cells were independent factors associated with hyperintense WM lesions in SLE.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Objective:To explore the feasibility of CT angiography (CTA) in investigating vascular dilatation of anterior choroidal artery (AChA) and posterior communicating artery (PComA) in patients with Moyamoya syndrome (MMS).Methods:From July 2017 to July 2018, the clinical and imaging data of MMS patients with brain CTA and DSA performed were analyzed retrospectively. According to DSA results, 71 MMS patients were divided into unilateral MMS group (20 cases, 20 hemispheres) and bilateral MMS group (51 cases, 102 hemispheres). There were 20 cases in unilateral MMS group, 10 males and 10 females, with an average age of (45±9) years; 51 cases in bilateral MMS group, 24 males and 27 females, with an average age of (44±12) years. The hemispheres were divided into dilated group and non-dilated group according to the dilatation of AChA or PComA. Kappa analysis was used to evaluate the consistency of two inspection methods to judge the expansion of AChA. The lumen diameters of PComA, P1 and P2 segments of posterior cerebral artery were measured on CTA images, and the ratio of PComA/P1 and PComA/P2 were calculated. The repeatability of CTA measures was evaluated by intra-group correlation coefficient. Independent sample t-test was used to compare CTA measurement results between PComA dilated group and non-dilated group, and ROC curve was drawn to calculate the best threshold for diagnosis of PComA expansion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CTA measures were calculated. Results:The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CTA diagnosis of AChA expansion inunilateral MMS were all 100.00%. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CTA diagnosis of AChA expansionin bilateral MMS were 90.00%, 93.90%, 93.14%, 78.26% and 97.47%. Compared with DSA, there was no significant difference in the diagnostic performance of AChA expansion between single and bilateral MMS diagnosed by CTA ( P>0.05). The two methods had strong consistency (Kappa value was 1.00 and 0.79 respectively, P<0.01). A total of 46 patients (69 cerebral hemispheres) were included in the evaluation of PComA. PComA/P1 (1.09±0.41) and PComA/P2 (0.86±0.13) in the dilated group were significantly higher than those in the non-dilated group (0.71±0.21 for PComA/P1 and 0.75±0.23 for PComA/P2). The differences were statistically significant ( t=-4.59, -2.50, P<0.05). The best threshold in diagnosing PComA expansion was 0.87 (PComA/P1) and 0.76 (PComA/P2), and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 84.62%, 83.33%, 84.06%, 86.84%, 80.65% and 79.49%, 60.00%, 71.01%, 72.09% and 69.23%, respectively. Compared with DSA, the Kappa value of CTA measures in diagnosis of PComA expansion was 0.68 (PComA/P1) and 0.40 (PComA/P2), respectively, and the difference was statistically significant ( P<0.05). Conclusions:CTA has a strong consistency with DSA in evaluating the AChA expansion in MMS. When the PComA/P1 ratio on CTA is greater than 0.87, it can be used as the diagnosis criterion for PComA expansion.

Objective To study the clinical char acteristics and outcome of two lymphoma patients mimicking Beh?et's disease. Methods Lymphoma was diagnosed in two patients mimicking Beh?et's disease referred to our Department in 2015. A search on published similar cases in Chinese database and the Pubmed was also performed and then analyzed. Results Eight patients were indentified in this pooled analysis, six of which were non-Hodgkin lymphoma (NHL). All of the eight cases presented with cutaneous lesion, seven cases with fever, seven cases with oral ulceration and six cases with orogenital ulceration, respectively. Ocular involvement was present in four of the eight cases, two were with a positive pathergy test. Among feverish patients, six were moderate or high fever, four were high fever, one was low-grade fever. Neutropenia was found in four patients, and lymphocytoponia in four of five patients with detailed data. All patients fulfilled the 2014 International Criteria for Beh?et's Disease (ICBD) with an average score of (5.8 ±1.5), ranging from 4 to 8. Survival period ranged from one month to 36 months, with an average of 8 months. Conclusion For patients diagnosed as Beh?et's disease are finally diagnosed as lymphoma. For patients with Beh?et's disease present-ation but also present with mediate to high fever, atypical deepseated ulcer, neutropenia or lymphocytoponia, malignancy especially lymphoma should be investigated.

Objective To investigate the common initial clinical presentations of primary Sj(o)gren's syndrome (pSS) with pulmonary complications,and to explore the differences between patients with extraglandular manifestations at disease onset (EGM) and those with glandular manifestations at disease onset (GM).Methods A total of 1 341 hospitalized SS patients from 2003 to 2012 were retrospectively reviewed.Of them,102 hospitalized patients with pSS'associated lung disease were analyzed and included.Case control study was performed to explore the differences between the EGM group and the GM group.Results Fifty-one percent of patients were presented with EGM at onset,with significantly shorter disease duration [36 (12,156) m vs 102 (48,159) m,x2=-2.41,P=0.016].Although the mean diagnose time was similiar,only 4％ of the EGM group could be confirmed the pSS diagnose at onset,which was significantly less frequently than that of the GM group (34％,22=15.29,P＜0.01).Case control study revealed that hyperglobulinemia,elevated RF titers and anti-SSA and/or anti-SSB test positive were less predominant in the EGM group [IgG 16(12,21) g/L vs 21 (15,28) g/L,x2=-2.15,P=0.032;22 (20,171) U/ml vs 104 (20,238) U/ml,x2=-l.98,P=0.048;33％ vs 72％,x2=15.78,P＜0.01].The predicted value of TLC and FVC were lower [(87±23)％ vs (97±20)％,x2=-1.96,P=0.050;(8±28)％ vs (100±27)％,x2=-1.70,P=0.089] and HRCT score was higher in EMG group [12(88,15) vs 8(5,13),x2=-1.82,P=0.070].Conclusion EMG at onset is the common initial manifestation of pSS'associated lung involvement.Pulmonary complication is more progressively and severe than those with MG at onset.Anti'SSA positive,elevated RF titer and hyperglobulinemia are not predominant for patients with EMG at onset.

Objective To explore the clinical efficacy of ebridement and suturing combined with double vacuum sealing drainage (VSD) technology for the treatment of pressure ulcer. Methods Totally 32 patients of pressure ulcer (from July 2011 to October 2015) re-ceived debridement and suturing after infection control. Then F14 silicone ventricular drainage tube was placed in the wound for drainage while VSD was placed outside the wound. Both tubes inside and outside wound were connected to the central vacuum (20~40 kPa). Three days after the drainage,F14 silicone ventricular drainage tube was removed,and VSD material outside wound was replaced to continuous vacu-um treatment for another 3 to 4 days. Results All of 32 cases were healed up without hematoma,dead space and flap margin necrosis,inclu-ding 4 cases of poor healing,which were healed after active dressing. Conclusion Small area of the pressure ulcer can be closed up by de-bridement and suturing combined with double VSD technology,which is a simple operation with little injury and high clinical application value.

Objective To evaluate the cosmetic outcomes of nasal aesthetic sub-unit principle. Methods From May 2007 to March 2015,19 patients with traumatic soft tissue defects of nose had a Single-stage reconstruction with suitable reconstructive method. Full-thick-ness skin transplantation was performed in 1 case,forehead nasal flap in 1 case,bilobed flaps in 2 cases,nasolabial flaps in 9 cases,a folded nasolabial flap in 2 cases,free auricular composite flap in 1 case,the temporal flap pedicled with the orbicular oculi muscle in 3 cases. All pa-tients were followed up for 5~27 months,evaluation items were recorded and analyzed. Results Skin transplantation and local flap were all survived. But 1 case with nasolabial flap infected was healing by second intention,the rest were primary healing,free auricular composite flap was gloomy,and it became normal 5 months after operation. The radian and the curve of the folded nasolabial flap to repair the nasal alar area were slightly poor. Condusion Good aesthetic effets come from nasal aesthetic sub-unit principle in Single-stage soft tissue reconstruction of a traumatic nasal defects.

Objective To examine the effect of metformin on serum thyrotropin (TSH) level in diabetic patients with subclinical hypothyroidism (SCH).Methods The long-term effects of metformin on thyroid axis hormones were assessed in 55 diabetic patients with primary SCH who were untreated with L-T4(study group),as well as in 31 diabetic patients with normal thyroid function (control group).According to using metformin or not,patients of study group were divided into the metformin group (group 1,n =28),and the non-metformin group(group 2,n =27).Serum TSH levels were compared between baseline and follow-up in patients receiving metformin treatment.Results After 30 weeks of metformin administration,a significant TSH decrease(t =2.91,P ＜ 0.05) was observed in group 1 [from(6.98 ± 1.92) to(2.44 ± 0.61) mIU/L].After stopping metformin therapy,the level of TSH at 52 weeks fol low-up was back to the baseline level [(6.99 ± 1.76) mIU/L,P ＞ 0.05].There was no significant difference in TSH level between baseline and after 30 weeks follow-up in group 2[(6.01 ± 1.63) mIU/L vs(6.21 ± 1.71) mIU/L,P ＞0.05].At the end of 30 weeks follow-up,no significant differences were found in body mass index and thyroid func tion in both metformin group and non-metformin group.In control group,metformin administration for 30 weeks had no effect on TSH level(P ＞ 0.05).Conclusion Metformin administration influences TSH without change of FT4 level in type 2 diabetic patients with primary SCH.

Objective To study the prevalence of thyroid diseases in systemic lupus erythematosus (SLE) patients and to analyze the prevalence of subclinical hypothyroidism (SCH) with lupus nephritis (LN).Methods A total of 813 hospitalized SLE patients were retrospectively analyzed.The demographic,clinical and biochemical data were collected.The prevalence of different thyroid diseases was calculated.Among all patients,83 patients with SCH and 562 patients without any thyroid diseases were recruited according to thyroid hormone,thyroid stimulating hormone (TSH) and anti-thyroid antibodies levels.Case control study was performed to explore the potential risk factors for SCH in SLE.T test,Mann-Whitney U test,x2 test and Logistic regression analysis were used for statistical analysis.Results Among the 813 patients,13 (1.6％) had clinical hypothyroidism,83(10.2％) had SCH,13 (1.6％) had central hypothyroidism,27(3.3％) had autoimmunethyroid disease (AITD),10 (1.2％) had hyperthyroidism,95 (11.7％) had euthyroid sick syndrome (ESS) and 11 (1.4％) had nodules.SCH was more frequent in patients with LN (13.7％,50/366) than those without LN [7.4％(33/447),x2=8.654,P＜0.01].Meanwhile,prevalence of LN was also significantly higher in SCH group in case control study [60.2％(50/83) vs 42.9％(241/562),x2=8.800,P＜0.01].Besides,SLE patients with SCH had more severe proteinuria,hypoalbuminemia,and hyperlipidemia,which were complications of LN.In addition,the SCH group presented significantly higher anti-dsDNA antibody positive rate [50.6％(42/83) vs 33.7％(212/562),x2=5.026,P＜0.01].In Logistic regression models,24-hour urine protein and serum creatinine was retained as independent correlated factors with SCH after adjusted for demographic variables,risk factors,and other potential confounders.The presence of SCH was associated with increased 24-hour urine protein levels,occurring in 10.4％ of subjects with 24-hour urine protein ≤ 150 mg,11.9％ with 24-hour urine protein 150.1-1 500 mg,17.2％ with 24-hour urine protein 1 500.1-3 500 mg,and d24.4％ with 24-hour urine protein ＞3 500 mg (P＜0.05 for trend).In addition,when eGFR ≥30 ml·min-1· 1.73 m-2,the prevalence of SCH was increased as eGFR decreased:occurring in 12.8％ with eGFR ≥90 ml·min-1· 1.73 m-2,12.6％ with eGFR 60-89.9 ml·min-1· 1.73 m-2 and 20.0％ with eGFR 30-59.9 ml ·min-1· 1.73 m-2.Conclusion Thyroid diseases are common in SLE patients,and SCH is closely related with LN and disease activity.