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.

Objective To establish a simplified simulation method of rocking-chair archwire(RCA),explore the biomechanical effect of RCA during anterior teeth retraction with sliding mechanics,and provide guidance for clinical treatment.Methods A standard 0.019 in×0.025 in(0.483 mm×0.635 mm)labial archwire was imported into ANSYS software and preloaded spring was used to simulate RCA at different angles to achieve parameterized modeling.A three-dimensional(3D)finite element model with labial straight wire appliance,teeth,periodontium and maxillary bone was established to analyze the displacement and force of anterior/posterior teeth under 1.5 N intra-arch traction combined with RCA at different angles.Results Preloading forces of 1.5,3,4.5,and 6 N in spring induced angles of approximately 5°,10°,15°,and 20° for RCA,demonstrating the flexibility and convenience of the parameterized modeling method.During intra-arch traction with increased angle of RCA,lingual crown displacement of the middle incisor gradually decreased,while the lateral incisor and canine showed decreased crown tipping and increased lingual root displacement;when the RCA angle was 20°,the lateral incisor and canine achieved almost bodily retraction.Meanwhile,premolars showed an extrusion tendency,while molars demonstrated distal crown tipping and intrusion tendency.As the RCA angle increased from 0° to 20°,intrusive force on the anterior teeth increased,and the moment-force ratio(M/F)at bracket level increased from 0 to near 9 mm.Conclusions RCA can effectively control the moving pattern of the maxillary anterior teeth and prevent their over-erection and extrusion during retraction with sliding mechanics.During intra-arch traction with rigid stainless steel archwire,theoretically RCA of 20° has sufficient torque control on the anterior teeth to achieve their en-masse retraction.

Objective To establish a simplified simulation method of rocking-chair archwire(RCA),explore the biomechanical effect of RCA during anterior teeth retraction with sliding mechanics,and provide guidance for clinical treatment.Methods A standard 0.019 in×0.025 in(0.483 mm×0.635 mm)labial archwire was imported into ANSYS software and preloaded spring was used to simulate RCA at different angles to achieve parameterized modeling.A three-dimensional(3D)finite element model with labial straight wire appliance,teeth,periodontium and maxillary bone was established to analyze the displacement and force of anterior/posterior teeth under 1.5 N intra-arch traction combined with RCA at different angles.Results Preloading forces of 1.5,3,4.5,and 6 N in spring induced angles of approximately 5°,10°,15°,and 20° for RCA,demonstrating the flexibility and convenience of the parameterized modeling method.During intra-arch traction with increased angle of RCA,lingual crown displacement of the middle incisor gradually decreased,while the lateral incisor and canine showed decreased crown tipping and increased lingual root displacement;when the RCA angle was 20°,the lateral incisor and canine achieved almost bodily retraction.Meanwhile,premolars showed an extrusion tendency,while molars demonstrated distal crown tipping and intrusion tendency.As the RCA angle increased from 0° to 20°,intrusive force on the anterior teeth increased,and the moment-force ratio(M/F)at bracket level increased from 0 to near 9 mm.Conclusions RCA can effectively control the moving pattern of the maxillary anterior teeth and prevent their over-erection and extrusion during retraction with sliding mechanics.During intra-arch traction with rigid stainless steel archwire,theoretically RCA of 20° has sufficient torque control on the anterior teeth to achieve their en-masse retraction.

Objective:To explore the expression changes of N6-methyladenosine (m6A)-related proteins in the hippocampus of mice with post traumatic stress disorder (PTSD)-like behavior and the therapeutic effects of sertraline hydrochloride.Methods:Male C57BL/6J mice aged 4-6 weeks were selected to establish a PTSD model using a single prolonged stress and foot shock stimulation. A total of 24 mice were randomly divided into the control group, model group, and sertraline group using a random number table, with 8 mice in each group. Mice in the sertraline group were intraperitoneally injected with sertraline hydrochloride (15 mg/kg, once daily) 24 h after PTSD modelling, continuing for 14 days. Mice in the control group and model group were injected with an equal volume of 0.9% NaCl solution (once daily, for 14 days). The anxiety, despair, and learning and memory functions of the mice were assessed using the open field test, Y-maze test, and forced swimming test. Western blot was performed to measure the protein expression levels of methyltransferase-like protein 3 (METTL3), fat mass and obesity-associated gene (FTO), ALKB homolog 5 (ALKBH5), Wilms tumour 1 associating protein (WTAP), and methyltransferase-like protein 14 (METTL14) in the hippocampus. Immunofluorescence was used to detect the expression levels of METTL3, FTO, and ALKBH5 in the hippocampus. Statistical analysis was performed using SPSS 26.0 and GraphPad Prism 9.0.Comparisons between two groups were conducted using independent samples t-test, while comparisons among three groups were performed using one-way analysis of variance (ANOVA) or Kruskal-Wallis H test, followed by pairwise comparisons using LSD test. Results:(1) Behavioral results showed that the total distance travelled in the central area ( F=9.231, P<0.05) and the time spent in the central area ( H=8.045, P<0.05) showed statistically significant differences among the control, model, and sertraline groups. Mice in the control and sertraline groups travelled a greater distance((332.68±121.17)cm, (248.56±40.21)cm) and spent more time(24.98(23.08, 26.71)s, 22.52(18.86, 26.20)s) in the central area than those in the model group((131.66±84.90)cm, 9.14(6.56, 18.53)s) (all P<0.05). In the forced swimming test, the number of resting episodes ( F=16.882, P<0.05) and the duration of rest ( H=12.285, P<0.05) differed significantly among the three groups. Mice in the control group ((19.14±8.30) counts, 30.21 (18.98, 52.62) s) and the sertraline group ((17.63±8.14) counts, 25.90 (16.78, 37.56) s) had fewer resting episodes and shorter resting durations compared to those in the model group ((37.75±6.47) counts, 83.37 (64.62, 124.42) s) (all P<0.05). The percentage of alternations in the Y-maze experiment showed significant statistical differences among the three groups( F=6.844, P<0.05). Mice in the control group ((51.33±11.49)%) and the sertraline group ((48.24±3.10)%) exhibited a higher percentage of alternations than that in the model group ((36.70±8.15)%) ( P<0.05). (2) Western blot results showed that the protein expression levels of METTL3, FTO, and ALKBH5 in the hippocampal tissue of the three groups showed significant differences ( F=10.263, 9.010, 6.950, all P<0.05). The METTL3 and FTO protein expression levels in the hippocampus in the control group (0.85±0.07, 0.86±0.04) and the sertraline group (0.93±0.06, 0.95±0.13) were higher than those in the model group (0.74±0.02, 0.68±0.04) (all P<0.05). However, the ALKBH5 protein expression levels in the control group (0.93±0.08) and the sertraline group (0.87±0.13) were lower than that in the model group (1.13±0.04) (both P<0.05). (3) Immunofluorescence results showed that the expression levels of METTL3, FTO, and ALKBH5 proteins in the hippocampal tissue of the three groups showed significant statistical differences ( F=37.912, 62.659, 54.417, all P<0.05). The expression levels of METTL3 and FTO in the hippocampus in the control group (14.03±0.32, 13.85±0.28) and the sertraline group (17.94±0.29, 10.52±0.66) were higher than those in the model group (11.67±1.48, 8.70±0.68) (all P<0.05). The expression levels of ALKBH5 in the control group (12.94±0.38) and the sertraline group (13.30±0.93) were lower than that in the model group (19.24±1.03) (both P<0.05). Conclusion:The expression of m6A-related proteins in the hippocampus of PTSD-like mice is altered. Sertraline treatment can significantly regulate the expression of these proteins and improve anxiety, despair, and learning and memory impairments in the PTSD-like mice.

Objective To achieve non-invasive and precise prediction of mean arterial pressure(MAP)based on a fully convolutional neural network(FCNN).Methods A high-precision blood pressure data acquisition system compliant with international metrological standards was used in conjunction with the'gold standard'auscultation method to collect blood pressure and pulse waveform data from patients.True MAP values were derived via Gaussian fitting of pulse waveform data,constructing a traceable dataset.The FCNN was applied to this dataset to develop a novel MAP prediction method.Additionally,the predictive accuracy of the FCNN was compared with linear regression and conventional empirical formulas.Results The mean squared errors(MSE)for MAP prediction using the FCNN,linear regression,and empirical formulas were 19.76,21.40,and 30.97,respectively.The coefficients of determination(R2)were 0.90,0.89,and 0.84,and the prediction accuracies were 0.90,0.89,and 0.85,respectively.Conclusions By using systolic blood pressure,diastolic blood pressure,age,and arm circumference as input parameters,the FCNN-based MAP prediction method significantly reduces the bias of empirical formulas.This approach not only improves the accuracy of hemodynamic boundary condition acquisition but also contributes to refining the metrological traceability system of non-invasive blood pressure measurement.

Objective:To explore the expression changes of N6-methyladenosine (m6A)-related proteins in the hippocampus of mice with post traumatic stress disorder (PTSD)-like behavior and the therapeutic effects of sertraline hydrochloride.Methods:Male C57BL/6J mice aged 4-6 weeks were selected to establish a PTSD model using a single prolonged stress and foot shock stimulation. A total of 24 mice were randomly divided into the control group, model group, and sertraline group using a random number table, with 8 mice in each group. Mice in the sertraline group were intraperitoneally injected with sertraline hydrochloride (15 mg/kg, once daily) 24 h after PTSD modelling, continuing for 14 days. Mice in the control group and model group were injected with an equal volume of 0.9% NaCl solution (once daily, for 14 days). The anxiety, despair, and learning and memory functions of the mice were assessed using the open field test, Y-maze test, and forced swimming test. Western blot was performed to measure the protein expression levels of methyltransferase-like protein 3 (METTL3), fat mass and obesity-associated gene (FTO), ALKB homolog 5 (ALKBH5), Wilms tumour 1 associating protein (WTAP), and methyltransferase-like protein 14 (METTL14) in the hippocampus. Immunofluorescence was used to detect the expression levels of METTL3, FTO, and ALKBH5 in the hippocampus. Statistical analysis was performed using SPSS 26.0 and GraphPad Prism 9.0.Comparisons between two groups were conducted using independent samples t-test, while comparisons among three groups were performed using one-way analysis of variance (ANOVA) or Kruskal-Wallis H test, followed by pairwise comparisons using LSD test. Results:(1) Behavioral results showed that the total distance travelled in the central area ( F=9.231, P<0.05) and the time spent in the central area ( H=8.045, P<0.05) showed statistically significant differences among the control, model, and sertraline groups. Mice in the control and sertraline groups travelled a greater distance((332.68±121.17)cm, (248.56±40.21)cm) and spent more time(24.98(23.08, 26.71)s, 22.52(18.86, 26.20)s) in the central area than those in the model group((131.66±84.90)cm, 9.14(6.56, 18.53)s) (all P<0.05). In the forced swimming test, the number of resting episodes ( F=16.882, P<0.05) and the duration of rest ( H=12.285, P<0.05) differed significantly among the three groups. Mice in the control group ((19.14±8.30) counts, 30.21 (18.98, 52.62) s) and the sertraline group ((17.63±8.14) counts, 25.90 (16.78, 37.56) s) had fewer resting episodes and shorter resting durations compared to those in the model group ((37.75±6.47) counts, 83.37 (64.62, 124.42) s) (all P<0.05). The percentage of alternations in the Y-maze experiment showed significant statistical differences among the three groups( F=6.844, P<0.05). Mice in the control group ((51.33±11.49)%) and the sertraline group ((48.24±3.10)%) exhibited a higher percentage of alternations than that in the model group ((36.70±8.15)%) ( P<0.05). (2) Western blot results showed that the protein expression levels of METTL3, FTO, and ALKBH5 in the hippocampal tissue of the three groups showed significant differences ( F=10.263, 9.010, 6.950, all P<0.05). The METTL3 and FTO protein expression levels in the hippocampus in the control group (0.85±0.07, 0.86±0.04) and the sertraline group (0.93±0.06, 0.95±0.13) were higher than those in the model group (0.74±0.02, 0.68±0.04) (all P<0.05). However, the ALKBH5 protein expression levels in the control group (0.93±0.08) and the sertraline group (0.87±0.13) were lower than that in the model group (1.13±0.04) (both P<0.05). (3) Immunofluorescence results showed that the expression levels of METTL3, FTO, and ALKBH5 proteins in the hippocampal tissue of the three groups showed significant statistical differences ( F=37.912, 62.659, 54.417, all P<0.05). The expression levels of METTL3 and FTO in the hippocampus in the control group (14.03±0.32, 13.85±0.28) and the sertraline group (17.94±0.29, 10.52±0.66) were higher than those in the model group (11.67±1.48, 8.70±0.68) (all P<0.05). The expression levels of ALKBH5 in the control group (12.94±0.38) and the sertraline group (13.30±0.93) were lower than that in the model group (19.24±1.03) (both P<0.05). Conclusion:The expression of m6A-related proteins in the hippocampus of PTSD-like mice is altered. Sertraline treatment can significantly regulate the expression of these proteins and improve anxiety, despair, and learning and memory impairments in the PTSD-like mice.

Objective:To develop and validate a predictive model for massive hemorrhage during brain tumor resection in pediatric patients.Methods:A retrospective analysis was performed on the clinical data from pediatric patients who underwent elective brain tumor resection under general anesthesia at the Women and Children′s Medical Center Affiliated to Guangzhou Medical University from December 2016 to October 2023. The patients were randomly divided into model group and internal validation group in a ratio of 8∶2. Pediatric patients who underwent elective brain tumor resection under general anesthesia at Qilu Hospital of Shandong University from January 2021 to July 2024 were selected and served as external validation group. Relevant characteristic variables were screened through Lasso regression. A multivariate logistic regression was used to develop the model and plot the nomogram for intraoperative massive hemorrhage. The performance of the model was evaluated using the area under the receiver operating characteristic curve and calibration curve.Results:Through Lasso regression and multivariate logistic regression analyses, 11 independent influencing factors were identified: age ( OR=0.323, 95% confidence interval [ CI]: 0.280-0.374, P<0.001), weight ( OR=0.164, 95% CI: 0.135-0.199, P<0.001), activated partial thromboplastin time ( OR=1.133, 95% CI: 1.036-1.239, P=0.006), thrombin time ( OR=1.141, 95% CI: 1.048-1.243, P=0.002), red blood cell count ( OR=0.941, 95% CI: 0.888-0.996, P=0.035), hemoglobin concentration ( OR=0.873, 95% CI: 0.822-0.926, P<0.001), platelet count ( OR=1.062, 95% CI: 1.001-1.127, P=0.048), maximum tumor diameter ( OR=2.384, 95% CI: 2.241-2.536, P<0.001), tumor invasiveness ( OR=2.376, 95% CI: 2.071-2.726, P<0.001), hydrocephalus ( OR=2.409, 95% CI: 2.139-2.713, P<0.001), and centered midline structure ( OR=0.509, 95% CI: 0.465-0.557, P<0.001). Based on this, a nomogram prediction model was established. The receiver operating characteristic curve showed that the area under the curve of this model in predicting the risk of massive hemorrhage during brain tumor resection was 0.936 (95% CI: 0.90-0.959) in model group, 0.863 (95% CI: 0.744-0.948) in internal validation group, and 0.855 (95% CI: 0.726-0.955) in external validation group. The calibration curve indicated good model consistency, and the Hosmer-Lemeshow goodness-of-fit test result showed a P value of 0.979 ( P>0.05). Conclusions:Age, body weight, activated partial thromboplastin time, thrombin time, red blood cell count, hemoglobin concentration, platelet count, maximum tumor diameter, tumor invasiveness, hydrocephalus and midline structure are independent influencing factors for major bleeding during brain tumor resection in pediatric patients, and the prediction model established based on this histogram has high accuracy.

Objective By using intravoxel incoherent motion(IVIM)double exponential model liver multi-b value diffusion-weighted imaging(DWI)scanning technique to analyze the lesion's IVIM parameters before and after interventional treatment of hepatocellular carcinoma(HCC)with conventional transcatheter arterial chemoembolization(TACE)combined with CalliSpheres drug-loaded microspheres(DEB-TACE),based on which to quantitatively evaluate the efficacy of interventional therapy for HCC.Methods A total of 40 HCC patients,who were admitted to the Department of Interventional Therapy of Anqing Municipal Hospital of China from June 2022 to November 2023 to receive DEB-T ACE,were enrolled in this study.Routine MR examination,DWI and IVIM-DWI scan were performed before and at 1,3 and 6 months after treatment,and a total of 40 interest lesions were selected.The ADC value,perfusion fraction(f),pure diffusion coefficient(D),and perfusion-related diffusion coefficient(D*)of each lesion were analyzed.The receiver operating characteristic(ROC)curve was drawn to analyze the prognosis assessment value of IVIM-DWI parameters.Results After DEB-TACE treatment,the ADC value and D value were increased,and the f value was decreased when compared with their preoperative values,the differences were statistically significant(all P＜0.01).The ADC value and D value in the patients of effective group were remarkably higher than those in the patients of ineffective group,the differences were statistically significant(both P＜0.01);the f value in the patients of effective group was slightly lower than that in the patients of ineffective group,and the difference was statistically significant(P＜0.05).The areas under ROC curve of ADC value,D value and f value for evaluating efficacy were 0.762,0.877,and 0.708 respectively.The area under the curve for the joint assessment of the three parameters was 0.928,with the highest efficacy.Conclusion IVIM-DWI can quantitatively determine the microperfusion and activity of HCC lesions before and after interventional DEB-TACE treatment,and it can also evaluate the curative efficacy of interventional therapy for HCC as well as the outcome of HCC lesions.

Objective:To develop and validate a predictive model for massive hemorrhage during brain tumor resection in pediatric patients.Methods:A retrospective analysis was performed on the clinical data from pediatric patients who underwent elective brain tumor resection under general anesthesia at the Women and Children′s Medical Center Affiliated to Guangzhou Medical University from December 2016 to October 2023. The patients were randomly divided into model group and internal validation group in a ratio of 8∶2. Pediatric patients who underwent elective brain tumor resection under general anesthesia at Qilu Hospital of Shandong University from January 2021 to July 2024 were selected and served as external validation group. Relevant characteristic variables were screened through Lasso regression. A multivariate logistic regression was used to develop the model and plot the nomogram for intraoperative massive hemorrhage. The performance of the model was evaluated using the area under the receiver operating characteristic curve and calibration curve.Results:Through Lasso regression and multivariate logistic regression analyses, 11 independent influencing factors were identified: age ( OR=0.323, 95% confidence interval [ CI]: 0.280-0.374, P<0.001), weight ( OR=0.164, 95% CI: 0.135-0.199, P<0.001), activated partial thromboplastin time ( OR=1.133, 95% CI: 1.036-1.239, P=0.006), thrombin time ( OR=1.141, 95% CI: 1.048-1.243, P=0.002), red blood cell count ( OR=0.941, 95% CI: 0.888-0.996, P=0.035), hemoglobin concentration ( OR=0.873, 95% CI: 0.822-0.926, P<0.001), platelet count ( OR=1.062, 95% CI: 1.001-1.127, P=0.048), maximum tumor diameter ( OR=2.384, 95% CI: 2.241-2.536, P<0.001), tumor invasiveness ( OR=2.376, 95% CI: 2.071-2.726, P<0.001), hydrocephalus ( OR=2.409, 95% CI: 2.139-2.713, P<0.001), and centered midline structure ( OR=0.509, 95% CI: 0.465-0.557, P<0.001). Based on this, a nomogram prediction model was established. The receiver operating characteristic curve showed that the area under the curve of this model in predicting the risk of massive hemorrhage during brain tumor resection was 0.936 (95% CI: 0.90-0.959) in model group, 0.863 (95% CI: 0.744-0.948) in internal validation group, and 0.855 (95% CI: 0.726-0.955) in external validation group. The calibration curve indicated good model consistency, and the Hosmer-Lemeshow goodness-of-fit test result showed a P value of 0.979 ( P>0.05). Conclusions:Age, body weight, activated partial thromboplastin time, thrombin time, red blood cell count, hemoglobin concentration, platelet count, maximum tumor diameter, tumor invasiveness, hydrocephalus and midline structure are independent influencing factors for major bleeding during brain tumor resection in pediatric patients, and the prediction model established based on this histogram has high accuracy.

Objective:To establish a mass spectrometry method for the determination of characteristic peptides of Galli Gigerii Endothelium Corneum that can identify the authenticity of Galli Gigerii Endothelium Corneum as well as its preparations; To evaluate their quality.Methods:Ultra performance chromatography-electrospray tandem mass spectrometry (UPLC-MS/MS) with the mode of multiple reaction monitoring quantification (MRM) was employed to monitor the ion pairs of m/z 379.21(charge: +2)→571.36, m/z 379.21(charge: +2)→385.26, m/z 785.41(charge: +2)→941.51 and m/z 785.41(charge: +2)→245.08, in order to detect the Galli Gigerii Endothelium Corneum crude drug and its preparations. Results:Chicken specific peptide I and chicken specific peptide Ⅱ could be detected in the 18 batches of Galli Gigerii Endothelium Corneum from different regions, their corresponding extractions and 4 batches of prescription preparations, while the chicken specific peptides were not detected in the 8 batches of endothelium corneums from ducks, geese and pigeons.Conclusions:The method established in this study can effectively supplement the deficiencies in standards of Galli Gigerii Endothelium Corneum and its decoction pieces, improve the quality control standard, and provide a reference for the safety and effectiveness of Galli Gigerii Endothelium Corneum in clinical medication.