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.

ObjectiveTo explore the mechanisms of Yangjing Tongluo prescription （YJTL） in the treatment of intrauterine adhesion （IUA） from the perspective of oxidative stress mediated by the Kelch-like ECH-associated protein 1/nuclear factor erythroid 2-related factor 2/heme oxygenase-1 （Keap1/Nrf2/HO-1） signaling pathway. MethodsA total of 48 rats with normal estrous cycles were selected and randomly divided into a normal group （n=8） and a modeling group （n=40）. An IUA rat model was established using a dual-injury method combining surgical curettage and infection. Eight rats were randomly selected from the modeling group for a pilot experiment to confirm successful model establishment. After successful modeling， the remaining 32 rats were randomly divided into a model group， a low-dose YJTL group （YJTL-L）， a high-dose YJTL group （YJTL-H）， and a Progynova group. Rats in the normal and model groups were administered purified water （15 mL·kg^-1） by gavage daily， while rats in the YJTL-L， YJTL-H， and Progynova groups received YJTL at doses of 6.43 and 12.86 g·kg^-1 and Progynova at 2.06 × 10^-4 g·kg^-1， respectively， for 14 consecutive days. The general condition， uterine morphology， and uterine index of the rats were monitored. Histopathological changes in uterine tissue were observed using hematoxylin-eosin （HE） staining. Serum levels of reactive oxygen species （ROS） and glutathione peroxidase （GSH-Px） were measured by enzyme-linked immunosorbent assay （ELISA）. Protein expression levels of Keap1， Nrf2， and HO-1 in endometrial tissue were detected by Western blot. Immunofluorescence （IF） was used to assess the distribution of Nrf2 and HO-1， as well as the expression of Nrf2 in the cytoplasm and nucleus. ResultsCompared with the normal group， rats in the model group exhibited poor mental status and reduced mobility， markedly edematous and tortuous uterine morphology， decreased gland number， and inflammatory reactions in the endometrium， along with an increased uterine organ index （P<0.05）. Serum ROS levels were significantly increased （P<0.05）， while serum GSH-Px levels were significantly decreased （P<0.05）. In endometrial tissue， Keap1 protein expression was increased （P<0.05）， whereas Nrf2 and HO-1 protein expression was decreased. Mild nuclear translocation of Nrf2 was observed， accompanied by increased relative fluorescence intensity of nuclear Nrf2 and decreased relative fluorescence intensity of cytoplasmic HO-1. Compared with the model group， all treatment groups showed varying degrees of improvement in the above symptoms and pathological changes. Serum ROS levels were reduced （P<0.05）， serum GSH-Px levels were increased （P<0.05）， Keap1 protein expression in endometrial tissue was decreased， and Nrf2 and HO-1 protein expression was increased in a dose-dependent manner （P<0.05）. Notably， significant nuclear translocation of Nrf2 was observed， with correspondingly increased relative fluorescence intensity of nuclear Nrf2 and enhanced relative fluorescence intensity of cytoplasmic HO-1. ConclusionYJTL may enhance antioxidant capacity and repair oxidative damage to the endometrial basal layer by regulating the Keap1/Nrf2/HO-1 signaling pathway.

Objective To explore the predictive value of two models based on machine learning algorithms in predicting the initial and subsequent doses of tacrolimus in kidney transplant recipients. Methods A retrospective analysis was conducted on the medical records of 1 013 Chinese kidney transplant recipients at the First Affiliated Hospital of Sun Yat-sen University from January 2015 to April 2019, focusing on the initial and subsequent doses in kidney transplant recipients. Thirty-three variables were collected for the initial dose, and twenty-six variables for the subsequent dose. A genetic algorithm combined with a random-restart hill-climbing algorithm was used to determine a small number of key clinical variables through majority voting, and variables with Lasso regression coefficients less than the optimal variable coefficient threshold were further eliminated. The selected clinical variables were input into a cascaded deep forest (CDF) and TabNet deep neural network for analysis and comparison based on structured tabular data, and the leave-one-subject-out method was used for validation. Results A total of 613 recipients were included in the training set, and 116 recipients were in the external validation set. In the initial dose algorithm of tacrolimus, the clinical variables ultimately included target concentration, time from surgery to target concentration, body weight, gender, type of surgery, time from surgery to first dose, WuZhi capsule, calcium channel blocker, creatinine, hemoglobin and CYP3A5. In the subsequent dose algorithm, the clinical variables ultimately included target concentration, time from surgery to target concentration, WuZhi capsule, creatinine, alanine aminotransferase, aspartate aminotransferase, previous dose, previous dose concentration and time from surgery to previous concentration. Based on the above variables, the TabNet model showed better predictive performance than the CDF model: in the initial dose prediction, the accuracy of the predicted dose within ±20% of the actual dose was 0.801, and the fitting index R² was 0.436; in the subsequent dose prediction, the corresponding accuracy and R² were 0.939 and 0.902, respectively. The results of feature contribution showed that CYP3A5 and target concentration contributed the most to the prediction of initial dose, while previous dose and its corresponding concentration had the greatest impact on subsequent dose prediction. In addition, the results of independent external validation were also satisfactory. Conclusions The optimized TabNet predictive model may provide important reference for drug dose prediction based on machine learning algorithms in clinical practice.

Objective To construct and implement a swallowing disorder assessment and management program for tracheal intubated patients after extubation based on the 4R crisis management theory,providing standardized and scientific interventions for oral feeding.Methods Utilizing the expert meeting method with the 4R crisis management theory framework,a swallowing disorder assessment and management program was developed for post-extubation tracheal intubated patients.A convenience sampling method was employed to select patients with tracheal intubations treated from July to December 2023 in the emergency ICU,central ICU,and cardiovascular surgery ICU of a tertiary hospital in Zhejiang Province.The patients treated from October to December were assigned to an experimental group(n=68),while those treated from July to September were designated as a control group(n=58).The experimental group received the 4R crisis management-based intervention,whereas the control group received standard ICU assessment and management.Outcomes indicators included the incidence of post-extubation swallowing disorders,time to first oral intake,incidence of aspiration during initial feeding,nasogastric and nasointestinal tube placement duration,incidence of aspiration pneumonia during hospitalization,re-intubation rates,ICU readmission rates,ICU stay duration,and total hospitalization days.Results Of the initially recruited subjects,68 in the experimental group and 54 in the control group were included in the final analysis.After the intervention,the experimental group exhibited significantly lower rates of post-extubation swallowing disorders,shorter time to first liquid oral intake,aspiration incidence during first feeding,shorter durations of nasogastric and nasointestinal tube placement,aspiration pneumonia,ICU readmission compared to the control group(P＜0.05).No significant differences were observed between the groups in time to first regular oral intake,re-intubation rates(P＞0.05).Conclusion The risk management program for dysphagia following tracheal extubation based on the 4R crisis management theory is scientifically robust and safe,offering a valuable reference for clinical assessments and management of swallowing and eating post-extubation in tracheal intubated patients.

Objective:To explore the psychological experience of reproductive concerns in female patients of childbearing age with systemic lupus erythematosus (SLE), and to provide evidence for formulating targeted intervention measures.Methods:From April to May 2024, phenomenological research methods of qualitative study and purposive sampling were used to conduct semi-structured interviews with 13 female SLE patients of childbearing age who were outpatient or hospitalized in the Third Affiliated Hospital of Southern Medical University. Colaizzi′s seven-step method was used for data analysis.Results:A total of 13 female patients of childbearing age with SLE were interviewed, aged 21-36 (27.08 ± 3.88) years. Six themes were identified: concerns about fertility, concerns about one′s own health, concerns about the safety of the offspring, concerns about unmet fertility information, the need for positive emotional transmission, negative psychological experience caused by childbearing related problems ( inferiority and depression caused by difficulty in maintaining intimate relationships, anxiety and guilt caused by reproductive pressure, pain and panic caused by failure reproductive experience, and restlessness and anxiety caused by the burden of reproductive costs).Conclusions:Female patients of childbearing age with SLE have many concerns about fertility issues. Medical staff should pay attention to the psychological experience related to fertility among female patients of childbearing age with SLE, and give targeted scientific and effective intervention to alleviate the negative psychological experience of patients with reproductive.

Objective:To evaluate the safety and effectiveness of fuzuloparib for the treatment of ovarian epithelial cancer patients in the real world setting.Methods:A retrospective analysis was conducted on the baseline data of 4 620 ovarian cancer patients who had received fuzuloparib monotherapy or combination therapy. Another 224 ovarian cancer patients who were willing to receive fuzuloparib monotherapy or combination therapy were prospectively enrolled, and their baseline characteristics, drug effectiveness, and safety data were analyzed.Results:(1) Among the 4 620 patients in the retrospective cohort, the median age of patients was 60 years; tumor types: 89.8% (4 149/4 620) had ovarian cancer. Among patients with clearly documented information, the vast majority had a histological type of serous carcinoma (82.9%, 3 770/4 546) and International Federation of Gynecology and Obstetrics (FIGO) staging of Ⅲ-Ⅳ (90.9%, 1 537/1 691). (2) Among the 224 patients in the prospective cohort, the median age of patients was 57 years; tumor types: 83.9% (188/224) had ovarian cancer. Among patients with clearly documented records, the predominant pathologic type was serous carcinoma (91.9%, 193/210), and FIGO stage was Ⅲ-Ⅳ in 79.9% (139/174). (3) Among the 224 prospective patients: 84 patients received first-line fluzoparib maintenance therapy, 92 patients received fluzoparib maintenance therapy after platinum-sensitive recurrence, 23 patients received direct fluzoparib treatment after platinum-sensitive recurrence, 19 patients received direct fluzoparib treatment after platinum-resistant recurrence. The median follow-up durations were 8.5, 8.7, 7.9, and 6.7 months, respectively. The median durations of fluzoparib treatment were 6.7, 4.8, 3.1, and 1.9 months, respectively. The median progression-free survival (PFS) times were not reached during follow-up, 12.6 months, not reached during follow-up, and 4.8 months, respectively. The 1-year PFS rates were 84.1%, 55.0%, 69.8%, and 45.5%, respectively. The remaining 6 patients received other fluzoparib regimens. (4) Among the 224 patients in the prospective dataset, 205 had safety data recorded. Of these, 127 patients (62.0%, 127/205) experienced treatment-related adverse events, with common events including anemia (24.4%, 50/205), thrombocytopenia (21.0%, 43/205), and leukopenia (19.5%, 40/205). Among the 205 patients, 43 (21.0%, 43/205) experienced grade 3 or higher treatment-related adverse events, with common events including anemia (8.3%, 17/205) and thrombocytopenia (8.3%, 17/205).Conclusions:The effectiveness of fuzuloparib in clinical application is generally consistent with other drugs in the same class, with good safety. This study provids new clinical evidence for the treatment of ovarian cancer with fuzuloparib.

Objective:To analyze the current development status and spatial distribution characteristics of traditional Chinese medicine (TCM) hospitals in China, predict the changing trends of the number of TCM hospitals, the number of beds, and the number of physicians, and provide references for the development of TCM hospitals and the formulation of related policies.Methods:From the official websites of the National Bureau of Statistics and the State Administration of Traditional Chinese Medicine, the total population and number of TCM hospitals of 31 provinces (excluding China′s Hong Kong, Macao, and Taiwan) in China from 2013 to 2022 were included, as well as the number of beds and practicing (assistant) physicians in TCM hospitals from 2013 to 2021. The grey prediction model was applied to predict the changing trends of the number of TCM hospitals, beds and physicians. Using the global Moran′s I index in spatial autocorrelation analysis, the distribution of TCM hospitals per 10 000 people in China was analyzed by spatial correlation analysis, and local G coefficient was analyzed by local hot spots.Results:From 2013 to 2027, the number of TCM hospitals, beds and practicing (assistant) TCM physicians in China all showed an increasing trend year by year. The number of TCM hospitals per 10 000 people in China showed a spatial correlation between 2013 and 2022 ( P<0.05). The hot spots of TCM hospitals were mainly concentrated in North China and Northeast China, while the cold spots were mainly concentrated in southeast coastal areas and Northwest China. Conclusions:The number of TCM hospitals in China is increasing year by year, but it is necessary to control the reasonable increase and avoid blind expansion. It is necessary to formulate regional policies of TCM hospitals according to local conditions and pay attention to the individuation of policies. Focus on hot and cold areas to promote balanced development of TCM hospitals.

Objective:To characterize the epidemiology of respiratory syndrome across healthcare facilities of different types and tiers in Beijing City, to compare pathogen-testing modalities and their associations with adverse outcomes, and to identify key factors associated with progression to severe illness, thereby informing regional prevention, control, and clinical optimization.Methods:The multicenter observational cohort study was performed using outpatient and emergency department data from five sentinel hospitals in Beijing (Beijing Xiaotangshan Hospital, Beijing Chaoyang District Shuangqiao Hospital, Beijing Haidian Hospital, Beijing You′an Hospital, Capital Medical University (Beijing You′an Hospital), and Beijing Ditan Hospital, Capital Medical University (Beijing Ditan Hospital)) from October 1st, 2023 to April 9th, 2025. Dual-target (two-plex) and triple-target (three-plex) respiratory specimens were collected. Demographic characteristics, visit information, pathogen-testing modalities and results were collected, and the epidemiologic features of patients who progressed to severe illness between the influenza high-incidence season (December to May) and the non-influenza season (June to November) were compared. Categorical variables were analyzed using the chi-square test. Multivariable logistic regression was used to estimate associations between covariates and risk of progression to severe illness.Results:Among the 192 131 cases, patients visited at Beijing You′an Hospital were concentrated in the 16 to 44 year age group, accounting for 66.79%(32 532/48 708). Beijing Xiaotangshan Hospital had a broad age distribution, with older adults comprising up to 22.35% (885/3 960). Of the 47 349 respiratory specimens across the five hospitals, Beijing You′an Hospital had the highest positivity rate for dual-target testing (46.76%(1 585/3 390)), while Beijing Haidian Hospital conducted the largest number of this tests ( n=12 514). For triple-target testing, Beijing You′an Hospital again had the highest positivity rate (45.03%(2 835/6 296)), whereas Beijing Ditan Hospital tested the most specimens ( n=12 011; positivity rate was 29.73%(3 571/12 011)). The influenza season within the same period (November 2023 to January 2024) exhibited a bimodal pattern, with alternating circulation of influenza viruses and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Among 32 744 outpatients/emergency patients who progressed to severe illness, significant seasonal differences were observed by sex, age, comorbidity status, and infection type ( χ2=6.60, 189.24, 32.71 and 189.99, respectively; all P<0.05). After adjustment for sex, age group, comorbidities, and infection type, testing modality remained significantly associated with risk of progression (dual-target testing, odds ratio ( OR)=0.116, 95% confidence interval ( CI) 0.111 to 0.122, P<0.001); no testing, OR=0.063, 95% CI 0.060 to 0.065, P<0.001). Conclusions:The epidemiological pattern of respiratory pathogens undergo significant changes after October 2023, which is characterized by alternating waves of influenza viruses and SARS-CoV-2 with pronounced seasonality and diversity. Substantial inter-hospital differences are observed in testing modalities and positivity rates. Risk of progression to severe illness varies significantly by sex, age, comorbidity burden, and infection type, and is closely associated with the testing modality. These findings support strengthening multiplex pathogen testing and targeted surveillance of high-risk groups to improve early identification and precise control of febrile-respiratory syndromes.

Objective:To explore the value of endorectal echodefecography（EDF）in the evaluation of functional anorectal disorders（FAD）.Methods:A total of 67 patients clinically diagnosed with FAD who underwent EDF at the Sixth Affiliated Hospital of Sun Yat-Sen University from September 2021 to August 2024 were retrospectively collected. EDF was performed using a combination of transrectal and transperineal scans. XRD was used as the reference standard.Results:The diagnostic accuracy，sensitivity，specificity，positive predictive value，and negative predictive value of EDF for common FADs were as follows：for rectocele，85.1%，84.6%，85.4%，78.6%，and 89.7%；for rectal intussusception，79.1%，50.0%，93.3%，78.6%，and 79.2%；for external rectal prolapse，94.0%，71.4%，100%，100%，and 93.0%；for anismus，82.1%，66.7%，82.8%，15.4%，and 98.1%；for perineal descent，65.7%，54.2%，72.1%，52.0%，and 52.0%.Conclusions:EDF is valuable for evaluating FAD，especially for external rectal prolapse and rectocele. It can serve as an effective complement to XRD and provide a non-invasive and safe imaging method for FAD diagnosis.

Objective:To analyze the epidemiological characteristics and injury patterns of eye trauma in children and adolescents in China.Methods:A multicenter cross-sectional, retrospective, observational study. Based on the Chinese Eye Trauma Registry database, 189 patients (189 eyes) aged 0-18 years (13.4%, 189/1 412) of 1 412 patients (1 435 eyes) with eye trauma who were hospitalized from January to December 2023 were included in the study. Patients were recruited from 23 tertiary general hospitals or ophthalmology specialty hospitals located in 17 provincial-level administrative regions across six major geographical areas in China (North China, East China, South China, Central China, Northwest China, and Southwest China). The analysis focused on population characteristics, epidemiological features, injury patterns, and visual outcomes of children from different geographical regions and age groups. Among the 189 eyes, 95 eyes underwent secondary surgery. A total of 23 eyes were excluded due to non-cooperation during examination, no light perception, or only light perception. Ultimately, 72 eyes were included in the statistical analysis. Of these, 36 eyes had follow-up data and were used to observe postoperative visual outcomes.Results:Among 189 patients, 143 were males (75.7%, 143/189) and 46 were females (24.3%, 46/189). Age 8.73 (1-18) years old. The gender composition of all age groups was mainly male. The geographical distribution showed that East China had the largest number of cases, 55 (29.1%, 55/189). There were 70 cases (37.0%, 70/189) in 7-10 years old. The type analysis of eye trauma showed that in 189 eyes, mechanical ocular trauma accounted for 130 eyes, of which 105 (80.8%, 105/130) eyes had open globe injuries and 25 (19.2%, 25/130) eyes had closed globe injuries. 122 eyes received emergency surgery within 24 h after injury (accounts for 83.6% of emergency surgical cases, 122/146). In 36 eyes with complete follow-up data, the initial visual acuity distribution was: blind 23 eyes (63.9%), low visual acuity 6 eyes (16.7%), visual acuity ≥0.3 in 7 eyes (19.4%). At the last follow-up, visual acuity improved in 12 eyes (33.3%) with blindness, 8 eyes (22.2%) with low visual acuity, and 16 eyes (44.4%) with visual acuity ≥ 0.3. The final visual outcome showed that the disability rate was 22.2% (8/36) and the blindness rate was 33.3% (12/36).Conclusions:Children and adolescents account for 13.4% of the hospitalized patients with eye trauma in the same period, and there is a significant gender difference (male accounted for 75.7%). There are obvious age-specific distribution rules in the causes, locations and clinical features of eye trauma in children and adolescents of different ages.