Objective To summarize a case of latent autoimmune diabetes in adults(LADA)who received medication therapy management(MTM)of pharmaceutical outpatient service,and to provide reference for the treatment of similar diseases.Methods The physician recommended a 61-year-old male patient with LADA to the pharmacy clinic on March 27,2023.The pharmacists provided MTM services for the patient through pharmacy inquiry,medication evaluation,medication reconciliation,medication education,and pharmacy follow-up,return visit or pharmacy follow-up for the patient once a week,and established the patient MTM archives.Results Through fifteen MTM services for over three months,including eight visits to the pharmaceuti-cal outpatient clinic and follow-up seven times.On July 10,2023,the atherosclerotic cardiovascular disease(ASCVD)monitoring indicators,such as fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),blood pressure,heart rate,low density lipo-protein cholesterol(LDL-C),and homocysteine(HCY),reduced from 7.17 mmol·L-1,6.8％,140-150/90-100 mmHg,80-90 times·min-1,2.15 mmol·L-1,16.30 μmol·L-1 to 6.06 mmol·L-1,6.1％,120-130/70-80 mmHg,60-70 times·min-1,1.63 mmol·L-1,8.67 μmol·L-1 after MTM services.The ASCVD monitoring indicators were effectively controlled.After thirty-two weeks,the re-examination of the patient's fasting C-P level remained stable,there was no significant decline in pancreas islet function,and cardiac ultrasound showed that cardiac function had a certain improvement.Conclusion By providing MTM serv-ices and reconciliation the medication regimen for the patient with LADA,the ASCVD monitoring indicators such as blood glu-cose,blood pressure,blood lipids,heart rate,and homocysteine were controlled to meet the standards,effectively protecting the pancreatic β-cell and target organs functions of the patient,and significantly improving his health management level.

Objective To provide a reference for medication therapy management(MTM)of diabetic patients complicated with abnormal blood pressure fluctuation.Methods A 71-year-old female diabetic patient with combined hypertension and abnormal blood pressure fluctuations was referred by the doctor to the pharmacy clinic.The pharmacists provided MTM services through pharmacy inquiry,medication evaluation,medication reconciliation,drug use education,and pharmacy follow-up.They reconciliated the medication regimen based on plasma glucose levels and dynamic blood pressure rhythms.Results Through twelve times MTM services for fourteen weeks,the atherosclerotic cardiovascular disease(ASCVD)risk factors,including morning peak blood pressure,fasting plasma glucose(FPG),plasma glucose two hours post breakfast(P2h PG)and glycosylated hemoglobin(HbA1c),reduced from 163/115 mmHg,7.54 mmol·L-1,12.87 mmol·L-1 and 7.2%before MTM to 137/84 mmHg,6.42 mmol·L-1,8.79 mmol·L-1 and 6.4%after MTM services,and the trough blood pressure post breakfast raised from 86/64mmHg to 115/76 mmHg.The patient's plasma glucose and blood pressure were effectively managed and controlled,and the abnormal non-spoon-shaped hypertension rhythm changed to the normal spoon-shaped diurnal blood pressure rhythm,and the patient's dizziness symptoms disappeared after breakfast.Conclusion The hospital develops pharmacy clinics,where pharmacists provide MTM services for patients with chronic diseases such as hypertension and diabetes,promote clinical rational drug use,and improve the level of patient health management.

Objective To summarize a case of latent autoimmune diabetes in adults(LADA)who received medication therapy management(MTM)of pharmaceutical outpatient service,and to provide reference for the treatment of similar diseases.Methods The physician recommended a 61-year-old male patient with LADA to the pharmacy clinic on March 27,2023.The pharmacists provided MTM services for the patient through pharmacy inquiry,medication evaluation,medication reconciliation,medication education,and pharmacy follow-up,return visit or pharmacy follow-up for the patient once a week,and established the patient MTM archives.Results Through fifteen MTM services for over three months,including eight visits to the pharmaceuti-cal outpatient clinic and follow-up seven times.On July 10,2023,the atherosclerotic cardiovascular disease(ASCVD)monitoring indicators,such as fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),blood pressure,heart rate,low density lipo-protein cholesterol(LDL-C),and homocysteine(HCY),reduced from 7.17 mmol·L-1,6.8％,140-150/90-100 mmHg,80-90 times·min-1,2.15 mmol·L-1,16.30 μmol·L-1 to 6.06 mmol·L-1,6.1％,120-130/70-80 mmHg,60-70 times·min-1,1.63 mmol·L-1,8.67 μmol·L-1 after MTM services.The ASCVD monitoring indicators were effectively controlled.After thirty-two weeks,the re-examination of the patient's fasting C-P level remained stable,there was no significant decline in pancreas islet function,and cardiac ultrasound showed that cardiac function had a certain improvement.Conclusion By providing MTM serv-ices and reconciliation the medication regimen for the patient with LADA,the ASCVD monitoring indicators such as blood glu-cose,blood pressure,blood lipids,heart rate,and homocysteine were controlled to meet the standards,effectively protecting the pancreatic β-cell and target organs functions of the patient,and significantly improving his health management level.

Objective To provide a reference for medication therapy management(MTM)of diabetic patients complicated with abnormal blood pressure fluctuation.Methods A 71-year-old female diabetic patient with combined hypertension and abnormal blood pressure fluctuations was referred by the doctor to the pharmacy clinic.The pharmacists provided MTM services through pharmacy inquiry,medication evaluation,medication reconciliation,drug use education,and pharmacy follow-up.They reconciliated the medication regimen based on plasma glucose levels and dynamic blood pressure rhythms.Results Through twelve times MTM services for fourteen weeks,the atherosclerotic cardiovascular disease(ASCVD)risk factors,including morning peak blood pressure,fasting plasma glucose(FPG),plasma glucose two hours post breakfast(P2h PG)and glycosylated hemoglobin(HbA1c),reduced from 163/115 mmHg,7.54 mmol·L-1,12.87 mmol·L-1 and 7.2%before MTM to 137/84 mmHg,6.42 mmol·L-1,8.79 mmol·L-1 and 6.4%after MTM services,and the trough blood pressure post breakfast raised from 86/64mmHg to 115/76 mmHg.The patient's plasma glucose and blood pressure were effectively managed and controlled,and the abnormal non-spoon-shaped hypertension rhythm changed to the normal spoon-shaped diurnal blood pressure rhythm,and the patient's dizziness symptoms disappeared after breakfast.Conclusion The hospital develops pharmacy clinics,where pharmacists provide MTM services for patients with chronic diseases such as hypertension and diabetes,promote clinical rational drug use,and improve the level of patient health management.

OBJECTIVE To provide reference for medication therapy management （MTM） of diabetic patients complicated with cardiovascular disease. METHODS A 63-year-old male diabetic patient who suffered from temporary headache every morning after percutaneous coronary intervention （PCI） visited the neurology department of our hospital， and then was recommended to the pharmaceutical outpatient department. The pharmacists thought that the patient’s symptoms of headache， severe constipation and hyperuricemia were more likely induced by the medication used. The pharmacists further found that his atherosclerotic cardiovascular disease （ASCVD） influencing factors such as blood pressure， heart rate， blood glucose and blood lipids did not reach standard. The pharmacists provided MTM services for the patient through pharmacy inquiry and adverse drug reactions judgement， medication evaluation， medication reconciliation， medication education and pharmacy follow-up. RESULTS Through fifteen MTM services for thirteen weeks， the pharmacists reconciliated and optimized the medication therapy plan， discontinued the use of Isosorbide mononitrate sustained-release tablets， Nifedipine controlled-release tablets， and Indapamide tablets， which caused adverse drug reactions； the number of drugs was adjusted from fifteen to seven， and the symptom of headache disappeared； severe constipation had also been significantly improved， and hyperuricemia dropped to normal range. The ASCVD influencing factors of blood pressure， heart rate， fasting plasma glucose， glycosylated hemoglobin， low-density lipoprotein cholesterol and uric acid were reduced from ＞140/90 mmHg（1 mmHg＝0.133 kPa）， 70-80 beats per minute， 7.71 mmol/L， 7.2%， 2.13 mmol/L and 494 μmol/L before MTM services to ＜130/80 mmHg， 55-60 beats per minute， 6.22 mmol/L， 6.3%， 1.55 mmol/L and 348 μmol/L after MTM services. CONCLUSIONS The pharmacists providing MTM services to the patients can improve their quality of life and therapeutic efficacy， reduce medication risks， and enhance the level of rational drug use in hospitals and pharmaceutical service capabilities.

Objective:To investigate the effects of overexpression of Nkx2.5 gene on the anti apoptotic ability of bone marrow mesenchymal stem cells (BMSCs) and cardiac function after myocardial infarction.Methods:A cell ischemia model was established by culturing cells under oxygen glucose deprivation/reoxygenat (OGD/R) conditions. The experiment was divided into four groups: bone marrow mesenchymal stem cells cultured under normal conditions (BMSC group), BMSC group cultured under glucose and oxygen deprivation (BMSC+OGD/R group), overexpressed empty vector BMSC group cultured under glucose and oxygen deprivation(BMSC NC+OGD/R group), and overexpressed Nkx2.5 BMSC group cultured under glucose and oxygen deprivation (BMSC Nkx2.5+OGD/R group). The apoptosis rate of BMSCs in each group was detected via flow cytometry, and BMSC protein was extracted. The expression of caspase-3 and pro-caspase-3, caspase-8 and pro-caspase-8, caspase-9, and cytochrome C protein and expression of Nkx2.5 in the BMSCs of each group were detected by Western blot to determine the anti-apoptotic pathway in vitro. The model of myocardial infarction in mice was established by ligating the left anterior descending branch of coronary artery. The experiment was divided into five groups: sham surgery group, myocardial infarction untreated group, myocardial infarction tail vein injection of BMSC group, myocardial infarction tail vein injection of BMSC empty body group, myocardial infarction tail vein injection of BMSC overexpression Nkx2.5 group. The changes of cardiac function in mice were evaluated by echocardiography. Normal distribution econometric data were compared between groups using convenient analysis, and pairwise comparisons were conducted using LSD-t test. Results:The apoptosis rate of the BMSC+OGD/R group (12.98±1.24)% was higher than that of the BMSC group (7.82±0.42)%, and the difference was statistically significant ( P<0.001). The apoptosis rate of the BMSC NKx2.5+OGD/R group (11.26±0.22)% was lower than that of the BMSC+OGD/R group (12.98±1.24)% and the BMSC NC+OGD/R group (13.14±0.70)%, with statistically significant differences ( P<0.05). Compared to BMSC group ((0.36±0.08), (1.13±0.04), (0.36±0.06), (1.12±0.13), (1.23±0.08), (0.60±0.05), (0.67±0.14)), BMSC+OGD/R group ((1.05±0.10), (0.62±0.04), (1.07±0.09), (0.57±0.07), (0.55±0.08), (1.25±0.09), (0.71±0.04)) and BMSC NC+OGD/R group ((1.16±0.16), (0.64±0.06), (1.19±0.16), (0.56±0.06), (0.50±0.06), (1.28±0.06), (0.73±0.04)), the expression of Caspase-3 (0.72±0.08) and pro-caspase-3(0.89±0.09), Caspase-8 (0.63±0.08) and pro-caspase-8(0.85±0.12), Caspase-9 (0.87±0.09), cytochrome C (0.91±0.10), and Nkx2.5 (1.54±0.16) in BMSC Nkx2.5+OGD/R group was statistically significant (all P<0.05). In vivo experiments showed that the heart ejection fraction (29.05±7.07)% of mice treated with BMSC Nkx2.5 after myocardial infarction was significantly improved compared to the BMSC group (16.57±2.09)% and BMSC NC group (18.08±3.27)% (all P<0.05). Conclusion:BMSC Nkx2.5 may enhance the anti-apoptosis ability of BMSCs and improve cardiac function after myocardial infarction by inhibiting the death receptor pathway and the mitochondrial signal pathway .

Objective:To analyze the clinical characteristics and treatments of adverse reactions and anaphylaxis induced by cisatracurium besylate, and provide reference for medication safety in clinic.Methods:Adverse reaction reports of cisatracurium besylate in database of Shandong Provincial Center for Adverse Drug Reaction Monitoring between January 1, 2008 and April 18, 2023 were collected and analyzed retrospectively. The adverse reaction terminology was standardized using the preferred terms and system organ class (SOC) in the Medical Dictionary for Regulatory Activities 25.1. The cases of anaphylaxis were selected and graded. The characteristics of all anaphylaxis and treatments of anaphylaxis of grade Ⅱ-Ⅳ were analyzed. Results:A total of 163 adverse reaction reports were included for analysis, involving 201 preferred terms. The top 3 SOCs involved were mainly skin and subcutaneous tissue disorders (133 cases, 66.17%), vascular disorders (14 cases, 6.96%), and immune system disorders(14 cases, 6.96%). One hundred and forty-five patients (89.0%) experienced anaphylaxis, mainly within 10 minutes after medication (115 cases, 79.3%). Of them, 37 (25.5%) patients had anaphylaxis of grade Ⅱ-Ⅳ. The most common initial symptom was circulation system symptoms (19 cases, 51.4%), followed by skin or mucosal signs (12 cases, 32.4%). The main therapeutic drugs included glucocorticoids (27 cases, 73.0%), adrenaline (17 cases, 45.9%), and other vasopressors other than adrenaline (19 cases, 51.4%). All patients showed improvement or recovery in symptoms after treatments.Conclusions:The anaphylaxis caused by cisatracurium besylate mainly occurred within 10 minutes after medication and have a good prognosis. For anaphylaxis classified as grade Ⅱ-Ⅳ, the acute phase treatment drugs mainly include glucocorticoids, adrenaline, and other vasopressors other than adrenaline.

Objective:To analyze the clinical characteristics and treatments of adverse reactions and anaphylaxis induced by cisatracurium besylate, and provide reference for medication safety in clinic.Methods:Adverse reaction reports of cisatracurium besylate in database of Shandong Provincial Center for Adverse Drug Reaction Monitoring between January 1, 2008 and April 18, 2023 were collected and analyzed retrospectively. The adverse reaction terminology was standardized using the preferred terms and system organ class (SOC) in the Medical Dictionary for Regulatory Activities 25.1. The cases of anaphylaxis were selected and graded. The characteristics of all anaphylaxis and treatments of anaphylaxis of grade Ⅱ-Ⅳ were analyzed. Results:A total of 163 adverse reaction reports were included for analysis, involving 201 preferred terms. The top 3 SOCs involved were mainly skin and subcutaneous tissue disorders (133 cases, 66.17%), vascular disorders (14 cases, 6.96%), and immune system disorders(14 cases, 6.96%). One hundred and forty-five patients (89.0%) experienced anaphylaxis, mainly within 10 minutes after medication (115 cases, 79.3%). Of them, 37 (25.5%) patients had anaphylaxis of grade Ⅱ-Ⅳ. The most common initial symptom was circulation system symptoms (19 cases, 51.4%), followed by skin or mucosal signs (12 cases, 32.4%). The main therapeutic drugs included glucocorticoids (27 cases, 73.0%), adrenaline (17 cases, 45.9%), and other vasopressors other than adrenaline (19 cases, 51.4%). All patients showed improvement or recovery in symptoms after treatments.Conclusions:The anaphylaxis caused by cisatracurium besylate mainly occurred within 10 minutes after medication and have a good prognosis. For anaphylaxis classified as grade Ⅱ-Ⅳ, the acute phase treatment drugs mainly include glucocorticoids, adrenaline, and other vasopressors other than adrenaline.

Objective:To investigate the value of generative adversarial networks-based PET image reconstruction in improving the quality of low-dose 18F-FDG PET images and lesion detection in pediatric patients. Methods:Retrospective analysis of 61 PET images of children (38 males, 23 females, age (4.0±3.5) years) who underwent 18F-FDG total-body PET/CT imaging in Beijing Friendship Hospital, Capital Medical University from August 2021 to December 2021 was performed. The low-dose images (30 s, 20 s, 10 s) of all children extracted by list mode were input into the generative adversarial networks for deep learning (DL) reconstruction to obtain the corresponding simulated standard full-dose images (DL-30 s, DL-20 s, DL-10 s). The semi-quantitative parameters of the liver blood pool and primary lesion of standard full-dose 120 s, 30 s, 20 s, 10 s, DL-30 s, DL-20 s, and DL-10 s images were measured. The target-to-background ratio (TBR), contrast-to-noise ratio (CNR), and CV were calculated. The 5-point Likert scale was used for subjective scoring of image quality, and the detective abilities for positive lesions of each groups were compared. The sensitivities and positive predictive values of positive lesions detection were calculated. Mann-Whitney U test and Kruskal-Wallis rank sum test and χ2 test were used for data analyses. Results:CNR of the 30 s, 20 s, and 10 s groups were lower than those of DL-30 s, DL-20 s, and DL-10 s groups, respectively ( z values: -3.58, -3.20, -3.65, all P<0.05). Score of DL-10 s group was significantly lower than those of 120 s, DL-30 s and DL-20 s groups (4(3, 4), 5(4, 5), 4(4, 5), 4(4, 5); H=97.70, P<0.001). There were no significant differences in TBR, CNR, CV, SUV max and SUV mean of lesions and liver blood pool in 120 s, DL-30 s, DL-20 s, and DL-10 s groups ( H values: 0.00-6.76, all P>0.05). The sensitivities of positive lesion detection in DL-30 s, DL-20 s, and DL-10 s groups were 97.83%(225/230), 96.96%(223/230), 95.65%(220/230), respectively, and the positive predictive values were 96.57%(225/233), 93.70%(223/238), 84.94%(220/259), respectively. The positive predictive value in DL-10 s group was lower than those in DL-30 s and DL-20 s groups ( χ2=23.51, P<0.001). There were more false-positive and false-negative lesions detected by DL-10 s group than those of DL-30 s and DL-20 s groups in different sites. Conclusion:Based on the generative adversarial networks, the image quality of DL-20 s group is high and can meet the clinical diagnostic requirements.

A 78-year-old female patient with hypertension (196/93 mmHg) received a slow IV infusion of urapidil injection 100 mg diluted into 250 ml of 0.9% sodium chloride injection to reduce blood pressure. The infusion rate was controlled at 40 drops/min. If the blood pressure dropped to the target value, the drug would be stopped temporarily. The blood pressure dropped to 152/70 mmHg when urapidil injection was intravenously infused for 40 min (about 80 ml). Then the drug was stopped temporarily. The nurse on duty did not introduce the patient′s condition and the use of urapidil to the nurse who would take turn on duty. The successive nurse did not check the doctor′s order and mistakenly infused the remained urapidil 170 ml within 60 min (60 drops/min). Five minutes later, the patient developed dizziness, fatigue, and severe vomiting, and the blood pressure dropped to 136/66 mmHg. Rehydration treatment was given immediately. About 2 hours later, the patient′s blood pressure increased to 158/76 mmHg and the symptoms were relieved.