OBJECTIVE To formulate Guidelines for the standardized implementation of pharmacist-managed clinics （ 2026 edition ） in response to the challenges faced by such clinics in China， including uneven development， large discrepancies in service specifications， insufficient patient awareness， and limited medical insurance coverage. METHODS Led by the Pharmaceutical Affairs Professional Committee of the Chinese Hospital Association， the Evidence-based Pharmacy Professional Committee of the Chinese Pharmaceutical Association， and the Hospital Pharmacy Professional Committee of the Cross-strait Medical and Health Exchange Association， a total of 19 domestic hospital pharmacy experts were organized. Through a systematic review of national policies and literature research， current practical experience was summarized. Consensus on the contents of the guidelines was reached after in-depth discussions. RESULTS &CONCLUSIONS The guidelines covered five sections： definition and connotation of pharmacist-managed clinics， establishment requirements， implementation and management， post competency， and practical research. Firstly， the definition and connotation included three operational forms of pharmacist-managed clinics （independent mode， physician-pharmacist joint mode， and online pharmacist-managed clinic mode） and classified service modes （specialty-specific， drug-specific， and disease-specific pharmacist-managed clinics）. The establishment requirements were further refined， covering system construction （pharmaceutical service management system， quality control and assessment mechanism）， personnel qualifications （professional credentials， continuing education and professional training， etc）， service recipients， as well as service venues and facilities. Subsequently， the implementation and management of pharmacist-managed clinics were proposed， involving service procedures， intervention measures， documentation and records， patient education and follow-up， humanistic care， as well as risk management and quality control. Finally， post competency encompassed the competency requirements for pharmacists providing services in pharmacist-managed clinics， as well as the suggestions on teaching methods； practical research encouraged the conduct of high-quality pharmaceutical practice in the setting of pharmacist-managed clinics. The guidelines provide valuable guidance for the standardized implementation of pharmacist-managed clinics in China in terms of establishment， management， teaching， and research， fill the guideline gap in this field， and can promote the high-quality development of pharmacist-managed clinics.

AIM: To explore the clinical therapeutic effect of teprotumumab combined with glucocorticoid pulse therapy for thyroid-associated ophthalmopathy(TAO), and its impacts on thyroid function, levels of inflammatory factors, and adverse reactions in patients. METHODS: Active TAO patients admitted to the Ophthalmology Department were enrolled and randomly divide into the steroid group and the combined group. Then the steroid group was treated with glucocorticoid pulse therapy, while the combined group was combined with intravenous infusion of teprotumumab on the basis of the steroid group. The clinical therapeutic effect, the CAS, OSDI, M-C-TAO-QOL scores, ocular sign indicators(fissure width, proptosis), levels of inflammatory factors(TNF-α, CRP, IL-17), thyroid function(TSH, FT3, FT4)before and after treatment, and occurrence of adverse reactions were compared between two groups.RESULTS:Totally 96 TAO patients(192 eyes)were included, with 48 cases(96 eyes)in each group. In the combined group, there were 17 males and 31 females, with an average age of 51.85±3.53 y; in the steroid group, there were 14 males and 34 females, with an average age of 51.26±3.84 y. The total effective rate of the combined group(94%)was higher than that of the steroid group(79%)(P<0.05). After treatment, the CAS score, OSDI score, fissure width, proptosis, levels of TNF-α, CRP, and IL-17 in the combined group were all lower than those in the steroid group, and the M-C-TAO-QOL score was higher than that in the steroid group(P<0.05). However, there was no difference in thyroid function indicators and adverse reactions between two groups after treatment(P>0.05). CONCLUSION: The combination of teprotumumab and glucocorticoid pulse therapy for TAO has a prominent therapeutic effect. Meantime, it can more effectively control ocular inflammation, improve ocular signs and quality of life of patients, and has no obvious adverse effect on thyroid function, with controllable safety.

AIM:To assess the influence of preoperative lacrimal passage probing and dilation on the therapeutic effectiveness of nasolacrimal silicone intubation in cases of incomplete primary acquired nasolacrimal duct obstruction(PANDO).METHODS: A retrospective case-control clinical study was conducted. The study included patients with incomplete PANDO who underwent nasolacrimal silicone intubation at the hospital between October 2022 and October 2024. Participants were categorized into two groups based on their receipt of nasolacrimal duct probing and dilation prior to intubation. Group A consisted of patients who had undergone one or more sessions of nasolacrimal duct probing and dilation before nasolacrimal silicone intubation, while Group B included patients who did not receive nasolacrimal duct probing and dilation before intubation. All patients had their nasolacrimal silicone tubes removed 3 mo postoperatively and were monitored for 6 mo following tube removal to evaluate surgical success rates.RESULTS: A total of 136 patients(152 eyes)completed the six-month follow-up period. The overall surgical success rate for both groups was 72.4%(110/152 eyes).Group A included 22 males and 36 females, mean age 58.09±11.07 y, and achieved a success rate of 82.8%(53/64 eyes), while Group B included 27 males and 51 females, mean age 59.35±8.84 y and attained a success rate of 64.8%(57/88 eyes). The difference in surgical success rates between the two groups was statistically significant(P=0.014). Furthermore, Group A achieved a complete success rate of 67.2%(43/64 eyes), compared to 47.7%(42/88 eyes)in Group B, with this difference also reaching statistical significance(P=0.017). No serious postoperative complications were observed in either group.CONCLUSION: Nasolacrimal silicone intubation is a safe and effective intervention for incomplete PANDO, with preoperative nasolacrimal duct probing and dilation potentially enhancing therapeutic outcomes.

Cucurbitacin B has been demonstrated to exhibit significant antitumor activity against various types of tumors. Its antiproliferative effects were mediated through the regulation of multiple signaling pathways， including the Janus kinase 2/signal transducer and activator of transcription 3 （STAT3） pathway， the phosphoinositide 3-kinase/protein kinase B pathway， and the mitogen-activated protein kinase pathway. Diverse forms of cell death were induced by modulating the expression of proteins such as B-cell lymphoma-2-associated X protein， Notch signaling components， iron uptake regulatory proteins， and gasdermin D. Genetic effects were exerted through upregulation of phosphorylated histone H2AX expression and suppression the expression of oncogenes. Furthermore， the tumor immune microenvironment was modulated， angiogenesis and migration/invasion were inhibited， and tumor drug resistance was ameliorated via targeting of the STAT3 site， inhibition of vascular endothelial growth factor receptor 2， and downregulation of P-glycoprotein. However， the oral bioavailability of cucurbitacin B has been found to be low； therefore， various strategies， including the development of derivatives and prodrugs， construction of nano-drug delivery systems， and fabrication of molecular probes， have been employed to improve its utilization efficiency and safety. In the future， more in-depth mechanistic investigations and clinical trials are still required to provide a theoretical basis for novel drug development and clinical application of this compound.

ObjectiveTo observe the clinical efficacy of acupuncture combined with bloodletting and cupping in the treatment of chronic spontaneous urticaria（CSU） and to explore its potential mechanisms of action. MethodsSeventy CSU patients were randomly divided into loratadine group and acupuncture + bloodletting group， with 35 patients in each group. The loratadine group received oral loratadine tablets， 10 mg once daily in the evening. The acupuncture + bloodletting group received acupuncture at Zhongwan （CV 12）， Guanyuan （CV 4）， Tianshu （ST 25）， Zusanli （ST 36）， Sanyinjiao （SP 6）， Xuehai （SP 10）， Quchi （LI 11）， Hegu （LI 4）， Taichong （LR 3）， Baihui （GV 20）， and Shenting （GV 24）， once daily，along with bloodletting and cupping at Dazhui （GV 14） and Geshu （BL 17）， every other day. Both groups were treated for 4 weeks. The 7-day urticaria activity score（UAS7） was assessed before and after the treatment， and levels of serum immunoglobulin E （IgE）， interleukin-4 （IL-4）， interleukin-5 （IL-5）， eosinophil cationic protein （ECP）， plasma tissue factor （TF）， activated factor Ⅶ （FⅦa）， prothrombin fragment 1+2 （F1+2）， D-dimer （D-D） and complement component 5a （C5a） were detected. ResultsA total of 65 patients were included in the final analysis， 32 in the loratadine group and 33 in the acupuncture + bloodletting group. Before treatment， there was no significant difference in UAS7 score， serum IgE， IL-4， IL-5， ECP levels， or plasma TF， FⅦa， F1+2， D-D， C5a levels between groups （P＞ 0.05）. After treatment， both groups showed significant reductions in UAS7 score， serum IgE， IL-4， IL-5， and plasma TF， FⅦa， F1+2， D-D， and C5a levels compared to those before treatment （P＜0.01）. However， after treatment， there was no significant difference in UAS7 score and serum ECP， IgE， IL-4， IL-5 levels between groups （P＞0.05）. The acupuncture + bloodletting group showed lower plasma TF， FⅦa， F1+2， D-D and C5a levels compared to the loratadine group （P＜0.05 or P＜0.01）. ConclusionAcupuncture combined with bloodletting and cupping can effectively improve the skin symptoms of CSU patients and reduce the levels of inflammatory factors. The potential mechanism of action may involve the regulation of the coagulation-complement-mast cell activation axis， thereby inhibiting mast cell degranulation.

Objective:To explore the predictive value of the combined application of total prostate-specific antigen (TPSA), vascular endothelial growth factor A (VEGF-A), and interleukin (IL) in predicting postoperative biochemical recurrence in patients with prostate cancer.Methods:This study adopted a retrospective cohort research method. 202 male prostate cancer patients who visited Xi′an Gaoxin Hospital from April 2021 to January 2024 were selected as the research subjects. The age of the patients was 68(64, 71) years, and their postoperative conditions were classified into the non-recurrence group ( n=144) and the biochemical recurrence group ( n=58). The general clinical data and serumological test indicators SA, free prostate-specific antigen (FPSA), VEGF-A, IL-6, IL-17] were detected and compared between the two groups. Quantitative data with normal distribution were expressed as mean±standard deviation, and the comparison between groups was performed using the independent sample t-test; non-normal distribution quantitative data were expressed as M( Q1, Q3), and the comparison between groups was performed using the Mann-Whitney U test. The comparison between groups of count data was performed using the chi-square test. Through Spearman correlation analysis and multivariate Logistic regression analysis, the risk factors for biochemical recurrence after surgery in prostate cancer patients were screened out, and the efficacy of the combined prediction model based on TPSA, VEGF-A, and IL-17 was evaluated by receiver operating characteristic (ROC) curve, decision curve (DCA), and calibration curve. Results:The average tumor diameter, proportion of positive surgical margins, proportion of seminal vesicle invasion, and proportion of patients with Gleason score 3-5 in the biochemical recurrence group were significantly higher than those in the non-recurrence group ( P<0.05). The serumological indicators TPSA, VEGF-A, IL-6, IL-17 in the biochemical recurrence group were 44.28 (42.37, 48.57) ng/mL, (28.24±3.99) ng/mL, (39.14±2.95) ng/L and (66.64±6.04) pg/mL; those in the non-recurrence group were 41.25 (36.61, 43.56) ng/mL, (23.52±3.75) ng/mL, (37.19±4.19) ng/L, and (57.31±6.63) pg/mL. The biochemical recurrence group was higher than the non-recurrence group, and the difference was statistically significant ( P<0.05). Spearman correlation analysis and Logistic regression analysis found that TPSA, VEGF-A, and IL-17 were risk factors for biochemical recurrence after surgery in prostate cancer patients ( P<0.05); the DCA curve and calibration curve indicated that the combined prediction model based on TPSA, VEGF-A, and IL-17 had good accuracy (Hosmer-Lemeshow P=0.421), and the ROC curve suggested that the efficacy of the above indicators combined for predicting biochemical recurrence after surgery in prostate cancer patients was higher [AUC (95% CI)=0.899 (0.832-0.966)], and higher than the independent predictive efficacy of each indicator. Conclusion:Continuous monitoring of serum TPSA, VEGF-A, and IL-17 levels can effectively predict the risk of postoperative recurrence in prostate cancer patients and also provide biological markers for preventing disease recurrence.

Chimeric antigen receptor-modified T(CAR-T)cell therapy,as a new type of cellular immunotherapy,has shown good clinical efficacy in the treatment of malignant hematological tumors,especially B-cell acute lympho-blastic leukemia.However,there are problems such as antigen loss and immune evasion in single-target selection,so multi-target therapy strategies are gradually gaining attention.Multi-target CAR-T can effectively avoid antigen escape caused by a single target by targeting multiple tumor-associated antigens at the same time,reduce the risk of recurrence,and is expected to improve the therapeutic effect.This paper primarily discusses the structural types of multi-target CAR-T cell therapy and its clinical trial applications in the treatment of B-cell acute lymphoblastic leu-kemia(B-ALL),aiming to provide future references for the treatment of B-ALL.

Objective To analyze the characteristics and risk factors associated with postoperative deep vein thrombosis(DVT)of the lower extremities in patients undergoing surgery for lumbar degenerative diseases.Methods A retrospective analysis was conducted on clinical data from 298 patients who were hospitalized for lumbar degenerative diseases and underwent lumbar spine surgery treatment in the First Affiliated Hospital of Nanchang University from October 1,2022 to April 15,2023.Patients were divided into DVT group(n=71)and non-DVT group(n=227)according to whether DVT of the lower limbs occurred within 1 week postoperatively.The incidence and distribution characteristics of postoperative DVT were analyzed.Univariate and binary logistic regression analyses were performed to identify risk factors for DVT,and receiver operating characteristic(ROC)curves were used to determine cut-off values for relevant risk factors.Results A total of 298 patients were included,among whom 159 were males(53.4%)and 139 were females(46.6%),with an average age of(64.5±9.8)years.DVT occurred in 71 patients,and the incidence of lower extremity DVT was 23.8%.In the DVT group,there were 49 cases(69.0%)of intermuscular vein thrombosis,and 22 cases of other types of thrombosis(7 cases of peroneal vein thrombosis,4 cases of posterior tibial vein thrombosis,3 cases of common femoral vein thrombosis,1 case of anterior tibial vein thrombosis,and 7 cases of multiple thrombosis);58 cases(81.7%)had DVT in one lower extremity,and 13 cases(18.3%)had DVT in both lower extremities.Univariate analysis results showed that age,body mass index(BMI),length of hospital stay,history of hypertension,operative time,and intraoperative blood loss were associated with the occurrence of lower extremity DVT after surgery for lumbar degenerative diseases(P<0.05).Binary logistic regression analysis results indicated that older age(OR=1.079,P<0.01),higher BMI(OR=1.130,P=0.01),history of hypertension(OR=2.992,P<0.01),and larger intraoperative blood loss(OR=1.002,P=0.03)were independent risk factors for the occurrence of lower extremity DVT.ROC curve analysis demonstrated that patients with age>58.5 years,BMI>24.01 kg/m2,history of hypertension,and intraoperative blood loss>550 ml had a significantly increased risk of postoperative lower limb DVT.Conclusions The incidence of lower extremity DVT after surgery for lumbar degenerative disease is high,and intermuscular venous thrombosis is more common.Older age,higher BMI,history of hypertension,and larger intraoperative blood loss are independent risk factors for the occurrence of lower extremity DVT after surgery.

Objective To explore the effect of interest induction combined with integrated healthcare nursing on improvements of mental health and prognosis in children with lobar pneumonia.Methods A total of 126 children diagnosed as lobar pneumonia in the Hebei Children's Hospital from October 2023 to October 2024 were selected as research objects and randomly divided into study group(n=63)and control group(n=63).The control group received conventional nursing interven-tions,while the study group received the interest induction combined with integrated healthcare nursing model.The time for improvement of clinical symptoms,psychological scores,therapeutic compliance,and the occurrence of complications were compared between the two groups.Results The resolution time for fever,obvious alleviation time for cough,relief time for shortness of breath,and disappear-ance time for moist rales in the study group were significantly shorter than those in the control group(P＜0.05).After the intervention,the scores of the Multidimensional Anxiety Scale for Children(MASC-C)and the Child Behavior Checklist(CBCL)in both groups were significantly lower than those before the intervention,and the scores in the study group were significantly lower than those in the control group(P＜0.05).The compliance scores of the study group in terms of taking medication on time,functional exercise,dietary adjustment,and self-monitoring dimensions were all significantly higher than those of the control group(P＜0.05).In the study group,there was 1 case of atelecta-sis and 1 case of pneumothorax,with a total complication rate of 3.17％(2/63);there was 1 case of pleural effusion,1 case of atelectasis,and 2 cases of pneumothorax in the control group,with a total complication rate of 6.35％(4/63).There was no significant difference in the total complica-tion rate between the two groups(x2=0.700,P＞0.05).Conclusion The interest induction combined with integrated healthcare nursing model can improve therapeutic compliance,shorten the time for improvement of clinical symptoms,and enhance the mental health of children.

Objective:To investigate the effects of botulinum toxin A (BTX-A) injection on ocular surface in patients with blepharospasm and dry eye.Methods:In this prospective study, 56 patients (83 eyes) with essential blepharospasm who were treated with BTX-A in the Department of Ophthalmology of Jiaxing Hospital of Traditional Chinese Medicine from April 2020 to January 2022 were included. The patients were divided into blepharospasm with dry eye group (group A, 50 eyes) and simple blepharospasm group (group B, 33 eyes) according to whether they were accompanied by dry eye. The Oculus Keratograph was used to evaluate tear meniscus height (TMH), tear break-up time (BUT), ocular bulbar redness, and corneal fluorescein staining. The OPD-Scan III analyzer was used to measure the corneal surface regularity index. The Ocular Surface Disease Index and meibomian gland analysis were performed to diagnose dry eye before treatment. Paired t-tests and Wilcoxon signed-rank tests were conducted to analyze the data. In patients with unilateral conditions, the ocular surface data of the affected and healthy eyes were compared before treatment. The severity of blepharospasm was evaluated in both groups before treatment and 1 week after treatment. Results:Among the 56 patients, 57.1% (32/56) were diagnosed with dry eye. One week after BTX-A injection treatment, both groups demonstrated varying degrees of improvement in their conditions. In patients with unilateral blepharospasm, pre-treatment ocular surface examinations indicated that the affected eye had a lower tear BUT of (6.67 ± 3.86) seconds and a lower TMH of (0.18 ± 0.07) mm compared with the healthy eye, which showed (10.20 ± 5.95) seconds for BUT and (0.20 ± 0.05) mm for TMH ( t = -3.94, -2.44, both P < 0.05). Additionally, the ocular bulbar redness value was significantly higher in the affected eye [(1.75 ± 0.38)] than in the healthy eye [(1.65 ± 0.47), t = 2.16, P < 0.05]. After treatment, both groups exhibited significant increases in BUT and TMH compared with their pre-treatment values ( t = -6.27, -4.21, -2.56, -3.12, all P < 0.05). Furthermore, both groups showed significant decreases in ocular bulbar redness values compared with pre-treatment values ( t = 3.04, 3.32, both P < 0.05). In group A, the corneal fluorescein staining score post-treatment was significantly lower than the pre-treatment value ( Z = 2.10, P < 0.05). However, in group B, the FL score did not show a significant difference between pre-treatment and post-treatment. ( Z = 0.03, P > 0.05). There were also no significant differences in the surface regularity index between the two groups both before and after treatment ( t = 1.35, 0.65, both P > 0.05). Conclusions:Blepharospasm can affect the stability of the tear film on the ocular surface, and BTX-A injection can help relieve dry eye caused by essential blepharospasm.