ObjectiveTo investigate the value of preoperative dual-layer spectral detector CT （DLCT） parameters in predicting lymph node metastasis （LNM） of non-functional pancreatic neuroendocrine neoplasms （NF-pNENs）. MethodsA retrospective study was conducted on patients with pathologically confirmed NF-pNENs who underwent preoperative contrast-enhanced DLCT examination between September 2019 and July 2024. Regions of interest （ROIs） were manually delineated on three representative slices of the solid component of the lesion， and the mean values were recorded. Conventional CT parameters， monochromatic energy images （40 keV， 70 keV， 100 keV）， iodine concentration maps， and effective atomic number （Z_eff） maps in the pancreatic parenchymal phase and portal venous phase were acquired. A total of 34 parameters， including clinical characteristics， imaging features， conventional CT and DLCT quantitative parameters， were analyzed. Intergroup differences were compared between the LNM and non-LNM groups. Independent predictive factors were screened using logistic regression and least absolute shrinkage and selection operator （LASSO） regression. Receiver operating characteristic （ROC） curves were generated for each predictive model， and the area under the curve （AUC） was calculated to evaluate the predictive efficacy. ResultsA total of 82 patients with NF-pNENs were enrolled， including 37 males and 45 females， with a mean age of 49.7±14.7 years. Thirty patients were performed with LNM and 52 were with non-LNM. After univariate logistic regression， LASSO regression and multivariate stepwise logistic regression analyses， body mass index （BMI）， organ invasion， normalized CT value in the portal venous phase （nCTv） and normalized iodine concentration in the portal venous phase （nICv） were identified as independent predictive factors. The AUCs of the clinical-radiological qualitative model （BMI+organ invasion）， conventional CT model （nCTv）， DLCT model （nICv） and comprehensive model （organ invasion+nICv） were 0.815 （0.719， 0.910）， 0.750 （0.642， 0.858）， 0.829 （0.733， 0.925） and 0.865 （0.879， 0.953）， respectively. The comprehensive model combining clinical-radiological and DLCT characteristics exhibited superior predictive performance. ConclusionDLCT parameters are more effective than conventional CT parameters in predicting LNM in NF-pNENs， enabling non-invasive preoperative prediction and assisting clinical decision-making.

ObjectiveTo investigate the value of preoperative dual-layer spectral detector CT （DLCT） parameters in predicting lymph node metastasis （LNM） of non-functional pancreatic neuroendocrine neoplasms （NF-pNENs）. MethodsA retrospective study was conducted on patients with pathologically confirmed NF-pNENs who underwent preoperative contrast-enhanced DLCT examination between September 2019 and July 2024. Regions of interest （ROIs） were manually delineated on three representative slices of the solid component of the lesion， and the mean values were recorded. Conventional CT parameters， monochromatic energy images （40 keV， 70 keV， 100 keV）， iodine concentration maps， and effective atomic number （Z_eff） maps in the pancreatic parenchymal phase and portal venous phase were acquired. A total of 34 parameters， including clinical characteristics， imaging features， conventional CT and DLCT quantitative parameters， were analyzed. Intergroup differences were compared between the LNM and non-LNM groups. Independent predictive factors were screened using logistic regression and least absolute shrinkage and selection operator （LASSO） regression. Receiver operating characteristic （ROC） curves were generated for each predictive model， and the area under the curve （AUC） was calculated to evaluate the predictive efficacy. ResultsA total of 82 patients with NF-pNENs were enrolled， including 37 males and 45 females， with a mean age of 49.7±14.7 years. Thirty patients were performed with LNM and 52 were with non-LNM. After univariate logistic regression， LASSO regression and multivariate stepwise logistic regression analyses， body mass index （BMI）， organ invasion， normalized CT value in the portal venous phase （nCTv） and normalized iodine concentration in the portal venous phase （nICv） were identified as independent predictive factors. The AUCs of the clinical-radiological qualitative model （BMI+organ invasion）， conventional CT model （nCTv）， DLCT model （nICv） and comprehensive model （organ invasion+nICv） were 0.815 （0.719， 0.910）， 0.750 （0.642， 0.858）， 0.829 （0.733， 0.925） and 0.865 （0.879， 0.953）， respectively. The comprehensive model combining clinical-radiological and DLCT characteristics exhibited superior predictive performance. ConclusionDLCT parameters are more effective than conventional CT parameters in predicting LNM in NF-pNENs， enabling non-invasive preoperative prediction and assisting clinical decision-making.

Objective To provide a home care pharmacy for a patient with severe heart failure and diuretic resistance,and to provide a reference for healthcare pharmacists to carry out home care pharmacy practice.Methods As part of the family physician team,clinical pharmacists performed home care pharmacy practice on a patient with severe heart failure and diuretic re-sistance.This involved providing an assessment of medication regimen,medication reorganization,medication education,medication counseling,popularization of medical knowledge,management of the home medicine box,and guidance on a healthy lifestyle.Mean-while,online and offline methods were adopted to conduct regular follow-up visits to the patient.Results The patient's medica-tion adherence was dramatically improved,the symptoms of heart failure were improved,and no adverse reactions occurred.Con-clusion Clinical pharmacists' home care pharmacy practice contributes to improving patients' diseases,reducing the risk of ad-verse drug reactions and potential medication errors,and promoting safe and rational drug use for patients.

Drug quality problems seriously threaten the life and health of patients,drug quality problems handling is an important part of pharmaceutical management in medical institutions,and strengthening the management of drug quality problems in medical institutions can provide a strong guarantee for drug safety of patients.This standard was compiled by the Pharmaceutical Affairs Commission of the Chinese Hospital Association,and the process included problems identification,framework development,manuscript writing,opinions gathering,expert argumentation and deliberation,and standards development.The standard regulates the basic requirements,coping strategies,quality control and continuous improvement of drug quality problems handling in medical institutions.This article elaborates on the methods and contents of formulating standards for drug quality problems handling,to pro-vide reference and inspiration for medical institutions to carry out drug quality problems handling.

Objective To provide a home care pharmacy for a patient with severe heart failure and diuretic resistance,and to provide a reference for healthcare pharmacists to carry out home care pharmacy practice.Methods As part of the family physician team,clinical pharmacists performed home care pharmacy practice on a patient with severe heart failure and diuretic re-sistance.This involved providing an assessment of medication regimen,medication reorganization,medication education,medication counseling,popularization of medical knowledge,management of the home medicine box,and guidance on a healthy lifestyle.Mean-while,online and offline methods were adopted to conduct regular follow-up visits to the patient.Results The patient's medica-tion adherence was dramatically improved,the symptoms of heart failure were improved,and no adverse reactions occurred.Con-clusion Clinical pharmacists' home care pharmacy practice contributes to improving patients' diseases,reducing the risk of ad-verse drug reactions and potential medication errors,and promoting safe and rational drug use for patients.

Drug quality problems seriously threaten the life and health of patients,drug quality problems handling is an important part of pharmaceutical management in medical institutions,and strengthening the management of drug quality problems in medical institutions can provide a strong guarantee for drug safety of patients.This standard was compiled by the Pharmaceutical Affairs Commission of the Chinese Hospital Association,and the process included problems identification,framework development,manuscript writing,opinions gathering,expert argumentation and deliberation,and standards development.The standard regulates the basic requirements,coping strategies,quality control and continuous improvement of drug quality problems handling in medical institutions.This article elaborates on the methods and contents of formulating standards for drug quality problems handling,to pro-vide reference and inspiration for medical institutions to carry out drug quality problems handling.

OBJECTIVE:To provide reference for promoting smoothly implementation of deprescribing. METHODS:A total of 335 elderly patients with chronic disease were randomly selected from 4 communities and 9 village clinic of a Chongqing community health service center. Questionnaire survey was conducted about general information of respondents,disease and drug use condition and attitude to deprescribing by using Australian Patients'Attitudes Towards Deprescribing questionnaire as reference. The results of questionnaire survey were analyzed statistically. The cognitive function was assessed by Hastgawa Dementia Scale. The degree of weakness was evaluated by Chinese edition of Edmonton Frail Scale. The quality of life was evaluated by Chinese edition of European Five Dimensional Health (EQ-5D) Scale. RESULTS:Totally 311 valid questionnaires were obtained,with effective recovery rate of 92.8％. Overall,311 participants were recruited,with a median age of 70 years,5 types of median disease (hypertension was most common) and 5 types of median medication (mainly calcium channel blocker and non-insulin hypoglycemic agent);54.7％(170 cases)participants took multiple drugs. The attitudes towards deprescribing were that 39.5％ of respondents believed that they took too many drugs;73.9％ had a desire to reduce their drugs;83.6％ reported that they would be willing to reduce drugs if their doctor said it was possible. The patients taking multiple drugs preferred to use less drugs (P=0.001) and reduce current drugs (P=0.001),and were more willing to reduce drug cost by reducing drug use;they were also more worried about drug side effects than those without taking multiple drugs (P=0.005). CONCLUSIONS:The phenomenon of elderly chronic diseases patients with multiple diseases and multiple drug use are popular in community. It is necessary to simpilfy prescription. Most elderly patients would like to reduce their medications if doctors say it is possible;the patients with multiple drug use are more willing to simplify prescription than those without multiple drug use.