OBJECTIVE To investigate the clinical efficacy of integrating pharmacists into family health teams （FHTs） for long-term medication therapeutical management （MTM） in stroke patients， and empirically evaluate the service model. METHODS A pharmacist team， jointly established by clinical and community pharmacists from the Affiliated Suzhou Hospital of Nanjing Medical University （hereinafter referred to as “our hospital”）， developed a pharmacist-supported MTM model integrated into FHTs. Using a prospective randomized controlled design， 170 stroke patients discharged from our hospital （July 2022-December 2023） and enrolled in FHTs at Suzhou Runda Community Hospital were randomly divided into trial group （88 cases） and control group （82 cases） according to random number table. The control group received routine FHTs care （without pharmacist involvement in the team collaboration）， while the trial group xhz8405@126.com received 12-month MTM services supported by pharmacists via an information platform. These services specifically included innovative interventions such as personalized medication regimen optimization based on the MTM framework， dynamic medication adherence management， medication safety monitoring， a home medication assessment system， and distinctive service offerings. Outcomes of the 2 grousp were compared before and after intervention， involving medication adherence （adherence rate， adherence score）， compliance rates for stroke recurrence risk factors [blood pressure， low-density lipoprotein cholesterol （LDL-C）]， and incidence of adverse drug reactions （ADR）. RESULTS After 12 months， the trial group exhibited significantly higher medication adherence rates， improved adherence scores， higher compliance rates for blood pressure and LDL-C targets compared to the control group （P＜0.05）. The incidence of ADR in the trial group （4.55%） was significantly lower than that in the control group （8.11%）， though the difference was not statistically significant （P＞ 0.05）. CONCLUSIONS Pharmacist involvement in FHTs to deliver MTM services significantly enhances medication adherence and optimizes risk factor for stroke recurrence， offering practical evidence for advancing pharmaceutical care in chronic disease management under the family doctor system.

The pathogenic mechanisms underlying neuroimmune disorders associated with anti-glutamic acid decarboxylase (GAD) antibodies remain incompletely elucidated. This article systematically reviews the immunopathological mechanisms of this disease. In humoral immunity, anti-GAD antibodies target intracellular antigens and induce neuronal dysfunction, yet the mechanisms of antibody penetration across cell membranes remain undefined, and validated animal models confirming their pathogenicity are lacking. In cellular immunity, histopathological studies demonstrate T-lymphocyte infiltration in the central nervous system (CNS) of patients, while GAD antigen-specific T cells have been detected in peripheral blood and cerebrospinal fluid. However, the antigen specificity of CNS-infiltrating T cells and their potential association with GAD reactivity remain unclarified. Additionally, the CNS migration routes, functional phenotypes of these T cells, and their synergistic interplay with humoral immune responses require further investigation. Future research should focus on: (1) resolving the transmembrane mechanisms of anti-GAD antibodies; (2) defining the CNS trafficking pathways and functional roles of GAD antigen-specific T cells; (3) establishing reliable animal models to recapitulate disease-specific immune cascades. Elucidating these mechanisms will advance the development of precise diagnostic and therapeutic strategies.

Organophosphorus pesticide(OP)is one of the most widely used pesticides in the world with the largest dosage.Acute organophosphorus pesticide poisoning(AOPP)is a common clinical disease,and AOPP accounts for 20%-50%of poisoning cases in China every year,with case fatality rate of 3%-40%.Bromophos(BDF)is a long-acting anticoagulant rodenticide,which inhibits vitamin K epoxide reductase and interferes with the synthesis of coagulation factorsⅡ,Ⅶ,Ⅸ and Ⅹ,leading to coagulation dysfunction.This article discusses the multidisciplinary diagnosis and treatment(MDT)process of a patient with combined poisoning of dichlorvos and bromadiolone.The article explores blood purification,management of coagulation abnormalities,secondary infection,atropinization and altered consciousnes in patients with organophosphorus poisoning and anticoagulant rodenticide compound poisoning,with the aim of providing clinicians with references for early diagnosis and treatment.

Objective To analyze the factors affecting patients with active tuberculosis(ATB)combined with acute pulmonary thromboembolism(APTE),in order to intervene the progression of the patients'disease early and improve the prognosis.Methods A total of 121 patients with ATB were studied.Forty-one cases with APTE diagnosed by CT pulmonary arteriography(CTPA)were in the ATB+APTE group,and 80 patients with ATB were in the ATB group.The general data of the two groups were collected and analyzed,including the differences in TB lesion sites and drug resistance,clinical manifestations and first laboratory indexes after admission.The influencing factors of ATB patients with concurrent APTE were analyzed by multifactorial Logistic regression,and continuous indexes with significant differences were selected,and the subjects'work characteristics(ROC)curves were plotted to assess the predictive value.Results Compared with the ATB group,patients in the ATB+APTE group were older,and Padua scores were higher,red blood cell distribution width(RDW),neutrophil-to-lymphocyte ratio(NLR),D-dimer were higher,the proportion of cough and expectoration increased and levels of partial pressure of carbon dioxide,hemoglobin(Hb),and albumin were lower(P＜0.05).Multifactorial Logistic regression analysis showed that higher Padua score,RDW and D-dimer were risk factors for patients with ATB combined with APTE,and the predicted area under the curve(AUC)for ATB combined with APTE were 0.657(95%CI:0.549-0.764)and 0.889(95%CI:0.827-0.951)for RDW and D-dimer,respectively.Conclusion In patients with ATB,the risk of combined APTE is increased with increased frequency of sputum and elevated Padua score,RDW and D-dimer,alerting to the development of APTE events.

Organophosphorus pesticide(OP)is one of the most widely used pesticides in the world with the largest dosage.Acute organophosphorus pesticide poisoning(AOPP)is a common clinical disease,and AOPP accounts for 20%-50%of poisoning cases in China every year,with case fatality rate of 3%-40%.Bromophos(BDF)is a long-acting anticoagulant rodenticide,which inhibits vitamin K epoxide reductase and interferes with the synthesis of coagulation factorsⅡ,Ⅶ,Ⅸ and Ⅹ,leading to coagulation dysfunction.This article discusses the multidisciplinary diagnosis and treatment(MDT)process of a patient with combined poisoning of dichlorvos and bromadiolone.The article explores blood purification,management of coagulation abnormalities,secondary infection,atropinization and altered consciousnes in patients with organophosphorus poisoning and anticoagulant rodenticide compound poisoning,with the aim of providing clinicians with references for early diagnosis and treatment.

Objective To analyze the factors affecting patients with active tuberculosis(ATB)combined with acute pulmonary thromboembolism(APTE),in order to intervene the progression of the patients'disease early and improve the prognosis.Methods A total of 121 patients with ATB were studied.Forty-one cases with APTE diagnosed by CT pulmonary arteriography(CTPA)were in the ATB+APTE group,and 80 patients with ATB were in the ATB group.The general data of the two groups were collected and analyzed,including the differences in TB lesion sites and drug resistance,clinical manifestations and first laboratory indexes after admission.The influencing factors of ATB patients with concurrent APTE were analyzed by multifactorial Logistic regression,and continuous indexes with significant differences were selected,and the subjects'work characteristics(ROC)curves were plotted to assess the predictive value.Results Compared with the ATB group,patients in the ATB+APTE group were older,and Padua scores were higher,red blood cell distribution width(RDW),neutrophil-to-lymphocyte ratio(NLR),D-dimer were higher,the proportion of cough and expectoration increased and levels of partial pressure of carbon dioxide,hemoglobin(Hb),and albumin were lower(P＜0.05).Multifactorial Logistic regression analysis showed that higher Padua score,RDW and D-dimer were risk factors for patients with ATB combined with APTE,and the predicted area under the curve(AUC)for ATB combined with APTE were 0.657(95%CI:0.549-0.764)and 0.889(95%CI:0.827-0.951)for RDW and D-dimer,respectively.Conclusion In patients with ATB,the risk of combined APTE is increased with increased frequency of sputum and elevated Padua score,RDW and D-dimer,alerting to the development of APTE events.

The pathogenic mechanisms underlying neuroimmune disorders associated with anti-glutamic acid decarboxylase (GAD) antibodies remain incompletely elucidated. This article systematically reviews the immunopathological mechanisms of this disease. In humoral immunity, anti-GAD antibodies target intracellular antigens and induce neuronal dysfunction, yet the mechanisms of antibody penetration across cell membranes remain undefined, and validated animal models confirming their pathogenicity are lacking. In cellular immunity, histopathological studies demonstrate T-lymphocyte infiltration in the central nervous system (CNS) of patients, while GAD antigen-specific T cells have been detected in peripheral blood and cerebrospinal fluid. However, the antigen specificity of CNS-infiltrating T cells and their potential association with GAD reactivity remain unclarified. Additionally, the CNS migration routes, functional phenotypes of these T cells, and their synergistic interplay with humoral immune responses require further investigation. Future research should focus on: (1) resolving the transmembrane mechanisms of anti-GAD antibodies; (2) defining the CNS trafficking pathways and functional roles of GAD antigen-specific T cells; (3) establishing reliable animal models to recapitulate disease-specific immune cascades. Elucidating these mechanisms will advance the development of precise diagnostic and therapeutic strategies.

Objective:To summarise and analyse the experience in the diagnosis and management of abdominal aortic endograft infection in recent years.Methods:Retrospectively summarised and analysed the general data, clinical presentation, laboratory and imaging findings, causative organisms and treatment choices of 14 patients with abdominal aortic endograft infection treated in Beijing Friendship Hospital, Capital Medical University, from January 2018 to June 2024, and analysed the prognosis of the patients and the risk factors associated with prognosis.Results:Positive bacterial cultures were 10 out of 14 patients. One non-operatively treated patient died of infectious toxic shock. Thirteen surgically treated patients underwent axillary-bifemoral artery bypass, removal of the infected stent, and closure of the aortic stump. Four of the 13 cases had combined aortoenteric fistula, 3 cases underwent one-stage enterocutaneous fistula repair, 1 case only fistula drainage, 3 cases of gastrojejunal anastomosis, all of them underwent gastric or jejunal nutrient tube implantation. Two of the 13 patients had combined the infection foci spread to the renal artery openings. To save the kidney, intraoperative left kidney autologous renal transplantation was performed in 1 case, and autologous saphenous vein reconstruction from celiac trunk artery-left renal artery and superior mesenteric artery-right renal artery was performed in the other case. All 14 patients were retrospectively summarised and followed up in August 2024, with 5 deaths in the early postoperative period (< 3 months), 3 deaths in the mid- to long-term period (≥3 months), and 5 survivors, with a median follow-up time of 2 years (1-5 years) for surviving patients. Among the 13 operated patients, 4 cases were combined with aortoenteric fistula, and 3 cases died in the early postoperative period; 4 cases of abdominal aortic infection foci involving renal artery openings, 2 cases of early postoperative death; 4 cases with pleural effusion, 4 cases died in the early postoperative period; 2 cases of combined creatinine elevation, 2 cases of early postoperative death; 2 cases of postoperative infection of artificial blood vessels.Conclusions:Abdominal aortic endograft infection are aggressive. The risk of early death is increased in patients who are elderly, in poor general condition, with aortoenteric fistula or with pre-existing cardiac, pulmonary, hepatic and renal insufficiency, but surgery based on adequate anti-infective therapy remains an effective means of saving the patient′s life.

Objective To identify factors associated with gastrointestinal heat retention in preschool children,and to provide a foundational understanding for future clinical investigations. Methods A case-control study was performed,which involved children from kindergartens in the Longgang District of Shenzhen City,Guangdong Province,from May to July 2021. Using the Children's Gastrointestinal Heat Retention Diagnostic Self-assessment Scale,subjects were allocated into a case group (children diagnosed with gastrointestinal heat retention) and a control group (children without this condition). An online survey was used to collect data on dietary behaviors,caregivers' feeding behaviors,early antibiotic use,daily routines,and birth conditions. SPSS 27.0 software was used to facilitate precise sociodemographic matching and paired logistic regression analysis to explore the association between gastrointestinal heat retention and the above factors. Results From the analysis of 51,252 matched cases,the study found that several factors contributed to an increased risk of gastrointestinal heat retention. These factors included reduced food intake compared to peers,reports of picky eating by caregivers,distractions during meals,pronounced dietary preferences,disinterest in food,meal durations ≥ 25 min,reluctance to sample new foods,consistent refusal of specific food types for over one month,irregular meal locations,coercive feeding practices,use of micronutrient supplements,allowing children too much freedom in food choice,persuading children to eat,infrequent encouragement to experiment with new foods,early antibiotic introduction,inadequate sleep,and premature birth (P<0.05). In contrast,exclusive breastfeeding in the first six months,engagement in moderate to massive physical activity,and regular napping patterns were associated with a reduced risk of gastrointestinal heat retention (P<0.05). Conclusion The suboptimal dietary habits,improper feeding practices,insufficient physical activity,inadequate sleep,and premature antibiotic exposure may be significant risk factors for gastrointestinal heat retention. Future research dedicated to unraveling the cause of gastrointestinal heat retention should prioritize these elements.

Objective To investigate the effect of mesenchymal stem cells(MSCs)combined with immunosuppressants(IS)on immune rejection in a rat model of liver transplantation.Methods F344 rats were divided into Normal group(without any intervention),PS group(injected with an equal volume of normal saline),MSC group(injected with MSC),IS group(injected with IS),and MSC+IS group(injected with MSC and IS),with 8 rats in each group.For all rats except those in the Normal group,the Kamada's double-cuff method was used to establish a model of orthotopic liver transplantation,without reconstruction of the hepatic artery.HE staining and Masson staining were performed for rat liver tissue,and the degree of liver fibrosis was analyzed;immunohistochemical experiments were used to measure the infiltration of T cells and NK cells,and immunofluorescence assay was used to analyze macrophage M2 polarization.A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups.The Kaplan-Meier method was used to plot survival curves,and the log-rank test was used for survival analysis.Results Compared with the PS group,the MSC+IS group had a significantly prolonged survival time(P＜0.01),and the MSC group,the IS group,and the MSC+IS group had a significant improvement in the histological structure of the liver and a significant reduction in the degree of liver fibrosis(all P＜0.000 1),as well as a significant reduction in the infiltration of NK and T cells(all P＜0.000 1)and a significant increase in the degree of macrophage M2 polarization(all P＜0.000 1).The MSC+IS group had a significantly better effect than the MSC group and the IS group.Conclusion MSCs combined with IS can improve liver histopathology,reduce inflammatory cell infiltration,promote macrophage M2 polarization,and exert an immunosuppressive effect in rats after liver transplantation.