OBJECTIVE To investigate the effectiveness of resident clinical pharmacist-led medication therapy management （MTM） model in geriatric cardiology departments， and provide reference for optimizing resident pharmaceutical services. METHODS A retrospective cohort study was conducted， incorporating data from inpatients admitted to the Department of Cardiovascular Medicine in the Geriatric Medical Center of our hospital during March to August 2023 （conventional group， n＝ 903） and the same period in 2024 （MTM group， n＝963）. The conventional group received only standard pharmaceutical services （including prospective prescription review and retrospective order evaluation）， while the MTM group received additional resident clinical pharmacist-led interventions-such as medication reconciliation， personalized therapeutic drug monitoring （TDM）， standardized intravenous infusion management， and a four-stage closed-loop monitoring process-based on conventional care. The effectiveness of the MTM model was evaluated by comparing the primary outcome measures （e.g.， intravenous infusion rate， TDM target attainment rate） and secondary outcome measures [e.g.， incidence of drug-drug interactions （DDIs）， incidence of grade 3 or higher acute kidney injury， average length of hospital stay， cholesterol， and medication cost per capita] between the two groups. RESULTS Compared with the conventional group， in terms of primary outcome indexes： both the overall intravenous infusion rate and the use rate of acid-suppressive injection were significantly lowered in the MTM group （P＜0.05）； serum concentration target attainment rates for digoxin and vancomycin were increased significantly （P＜0.05）. For secondary outcome indexes， the MTM group exhibited significant decreases in the work incidence of grade 3 or higher acute kidney injury， the incidence of DDIs， the rate of patients leaving the hospital against medical advice， alanine amino-transferase， aspartate transferase and the per capita total medication cost （P＜0.05）. Additionally， there was a notable increase in the creatinine， estimated glomerular filtration rate and a significant shortening of the per capita length of hospital stay （P＜0.05）. CONCLUSIONS The resident clinical pharmacist-led MTM model can significantly optimize medication therapy processes， enhance medication safety and cost-effectiveness， thus playing a positive role in promoting rational drug use and improving patient outcomes.

Objective To explore the differences of lipid metabolites in tongue coating between ischemic stroke patients and healthy people,thus to screen out the potential biomarkers for tongue coating of ischemic stroke patients.Methods Twenty patients confirmed as ischemic stroke were selected as the observation group,and another 20 controls receiving healthy medical checkup at the same period were selected as the control group.All of them were aged between 40 and 80 years.Using ultra-high performance liquid chromatography-mass spectrometry(UHPLC-MS)technology,and by combined with the statistical methods of principal component analysis(PCA)and partial least squares discriminant analysis(PLS-DA),non-targeted lipid metabolomics study was performed on tongue coating samples of the observation group and the control group.According to the criteria that the VIP value in the orthogonal signal correction-based orthogonal partial least squares discriminant analysis(OPLS-DA)model was greater than 1 and the P value of the Wilcoxon rank test was less than 0.05,lipid metabolites with significant differences were screened and determined.Results Differential lipid metabolites exist in ischemic stroke patients(observation group)and healthy people(control group),and a total of 14 lipid metabolites were identified,and they were free fatty acids,ceramide,sphingomyelin,cardiolipin,lecithin,etc.Of the 14 lipid metabolites,4 were down-regulated and 10 were up-regulated,and the differences were statistically significant(P＜0.05).Conclusion There exist differential lipid metabolites in tongue coating of patients with ischemic stroke and the healthy controls,and these different lipid metabolites are expected to become potential biomarkers for ischemic stroke.

OBJECTIVE To establish a comprehensive evaluation system for lipid-lowering drugs aligned with the clinical reality of Liaoning province， and to assess the commonly used lipid-lowering drugs in medical institutions within Liaoning province. METHODS A comprehensive evaluation system for lipid-lowering drugs of Liaoning province was established using literature analysis and the Delphi expert consultation method. A calculation method of “indicator weighted score” to “step-by-step aggregation” to “percentile standardization” was employed to enable horizontal comparison of 49 commonly used lipid-lowering drugs. RESULTS This study successfully established a comprehensive clinical evaluation system for lipid-lowering drugs of Liaoning province， comprising 7 first-level indicators， 35 second-level indicators， and 116 scoring criteria. Among the first-level indicators， effectiveness （23%） had the highest weight， followed sequentially by safety （22%）， innovativeness （15%）， economy （13%）， suitability （13%）， accessibility （10%）， and other attributes （4%）. Among the 49 evaluated lipid-lowering drugs， the top 10 in overall score were all statins， with rosuvastatin calcium tablet B having the highest total score of 79.22. Inclisiran sodium injection had a total score of 57.14， performed outstandingly in safety （16.27） and innovativeness （11.27）. CONCLUSIONS This study established a relatively comprehensive and detailed clinical evaluation system for lipid-lowering drugs of Liaoning province. Statins remain the cornerstone of lipid management. Most patients can primarily choose drugs like rosuvastatin tablet B， while PCSK9 inhibitors and fixed-dose combinations can be considered for patients with conventional treatment failure or statin intolerance.

Objective:To evaluate the influence of midface (nasal base and zygomatic bone) morphological changes on the overall perception of lip prominence from different perspectives.Methods:From February to March 2024, 212 volunteers were recruited in Fujian Province as study subjects and divided into three groups: orthodontists [65 participants, 28 males and 37 females, aged (31.3±6.9) years], orthodontic patients [72 participants, 24 males and 48 females, aged (27.6±5.7) years], and healthy adults [75 participants, 37 males and 38 females, aged (25.6±4.4) years]. Three-dimensional facial modeling software was used to generate facial models, which were sculpted using three-dimensional model sculpting software to simulate different nasal base, zygomatic bone, and upper lip prominence conditions. A total of 15 facial models were generated, divided into five groups (three models per group): Group A (normal nasolabial angle, normal nasal base, normal upper lip); Group B (increased nasolabial angle, normal nasal base, flattened upper lip); Group C (decreased nasolabial angle, normal nasal base, protruded upper lip); Group D (increased nasolabial angle, protruded nasal base, normal upper lip); Group E (decreased nasolabial angle, recessed nasal base, normal upper lip). Models 1, 2, and 3 in each group had normal, protruded, and flattened zygomatic bones, respectively (with Model 1 in Group A as the initial model). Forty-five-degree and ninety-degree profile images of the models were captured (30 images in total) and compiled into a questionnaire. Participants in the three study groups were selected as the most attractive and least attractive facial appearances based on the questionnaire and ratings of the lip prominence of the 45° and 90° profile images (0-10 points, where 0=very flat, 5=normal, and 10=very prominent). A one-sample t-test was used to compare the difference between model ratings and the median score of 5. Results:Among the 30 images, the proportion of lip prominence ratings deviating from the median score of 5 was the highest among orthodontists [83% (25/30)], followed by orthodontic patients [67% (20/30)], and lowest among healthy adults [53% (16/30)]. At the 90° profile view, the scores given by orthodontists, orthodontic patients, and healthy adults for the initial model (5.07±0.79, 5.00±1.03, and 4.95±1.07, respectively) showed no statistically significant difference from 5 ( t=0.65, P=0.521; t=0.00, P=1.000; t=-0.42, P=0.673). At the 45° profile view, the scores given by orthodontists, orthodontic patients, and healthy adults for the initial model (5.42±0.98, 5.40±1.15, and 5.35±1.45, respectively) were significantly higher than 5 ( t=3.30, P=0.002; t=2.98, P=0.004; t=2.11, P=0.038). At both 90° and 45° profile views, orthodontists, orthodontic patients, and healthy adults all rated the lip prominence of Model 1 in Group E (nasal base recession) significantly higher than 5 (all P<0.05). In Group E (nasal base recession model), changes in zygomatic prominence led to alterations in the overall lip prominence ratings by orthodontists and orthodontic patients, with significant differences among Models 1, 2, and 3 (all P<0.05). In the most attractive facial appearance evaluation, Model 1 of Group D had the highest frequency percentage in both the 90° profile and 45° profile views [90°: 19.8% (42/212); 45°: 22.6% (48/212)]. Conclusions:Orthodontists had the highest sensitivity to changes in lip prominence. The observation angle influenced the perception of lip prominence changes, and variations in zygomatic and nasal base prominence could shift lip prominence evaluations. A slightly larger nasolabial angle, protruded nasal base, and normal zygomatic bone configuration were perceived as the most attractive.

Objective:To evaluate the influence of midface (nasal base and zygomatic bone) morphological changes on the overall perception of lip prominence from different perspectives.Methods:From February to March 2024, 212 volunteers were recruited in Fujian Province as study subjects and divided into three groups: orthodontists [65 participants, 28 males and 37 females, aged (31.3±6.9) years], orthodontic patients [72 participants, 24 males and 48 females, aged (27.6±5.7) years], and healthy adults [75 participants, 37 males and 38 females, aged (25.6±4.4) years]. Three-dimensional facial modeling software was used to generate facial models, which were sculpted using three-dimensional model sculpting software to simulate different nasal base, zygomatic bone, and upper lip prominence conditions. A total of 15 facial models were generated, divided into five groups (three models per group): Group A (normal nasolabial angle, normal nasal base, normal upper lip); Group B (increased nasolabial angle, normal nasal base, flattened upper lip); Group C (decreased nasolabial angle, normal nasal base, protruded upper lip); Group D (increased nasolabial angle, protruded nasal base, normal upper lip); Group E (decreased nasolabial angle, recessed nasal base, normal upper lip). Models 1, 2, and 3 in each group had normal, protruded, and flattened zygomatic bones, respectively (with Model 1 in Group A as the initial model). Forty-five-degree and ninety-degree profile images of the models were captured (30 images in total) and compiled into a questionnaire. Participants in the three study groups were selected as the most attractive and least attractive facial appearances based on the questionnaire and ratings of the lip prominence of the 45° and 90° profile images (0-10 points, where 0=very flat, 5=normal, and 10=very prominent). A one-sample t-test was used to compare the difference between model ratings and the median score of 5. Results:Among the 30 images, the proportion of lip prominence ratings deviating from the median score of 5 was the highest among orthodontists [83% (25/30)], followed by orthodontic patients [67% (20/30)], and lowest among healthy adults [53% (16/30)]. At the 90° profile view, the scores given by orthodontists, orthodontic patients, and healthy adults for the initial model (5.07±0.79, 5.00±1.03, and 4.95±1.07, respectively) showed no statistically significant difference from 5 ( t=0.65, P=0.521; t=0.00, P=1.000; t=-0.42, P=0.673). At the 45° profile view, the scores given by orthodontists, orthodontic patients, and healthy adults for the initial model (5.42±0.98, 5.40±1.15, and 5.35±1.45, respectively) were significantly higher than 5 ( t=3.30, P=0.002; t=2.98, P=0.004; t=2.11, P=0.038). At both 90° and 45° profile views, orthodontists, orthodontic patients, and healthy adults all rated the lip prominence of Model 1 in Group E (nasal base recession) significantly higher than 5 (all P<0.05). In Group E (nasal base recession model), changes in zygomatic prominence led to alterations in the overall lip prominence ratings by orthodontists and orthodontic patients, with significant differences among Models 1, 2, and 3 (all P<0.05). In the most attractive facial appearance evaluation, Model 1 of Group D had the highest frequency percentage in both the 90° profile and 45° profile views [90°: 19.8% (42/212); 45°: 22.6% (48/212)]. Conclusions:Orthodontists had the highest sensitivity to changes in lip prominence. The observation angle influenced the perception of lip prominence changes, and variations in zygomatic and nasal base prominence could shift lip prominence evaluations. A slightly larger nasolabial angle, protruded nasal base, and normal zygomatic bone configuration were perceived as the most attractive.

Objective:To observe the inhibiting effects of manual acupuncture(MA)on bladder cell apoptosis in rats with diabetic neurogenic bladder(DNB)based on the protein and mRNA expression of B-cell lymphoma-leukemia(Bcl)-2,Bcl-2-associated X(Bax)protein,caspase-3,and the protein expression of α-smooth muscle actin(α-SMA),transforming growth factor(TGF)-β in the bladder tissue. Methods:A DNB rat model was established via intraperitoneal injection of streptozotocin(STZ).The rats were randomly divided into a control group,a model group,and an MA group,with 10 rats in each group.For the MA group,MA was applied after modeling.The body mass,fasting blood glucose(FBG),bladder wet weight,and bladder histomorphology were observed.Protein and mRNA expression levels of Bcl-2,Bax,and caspase-3 and the protein expression of α-SMA and TGF-β in the bladder tissue were determined.The apoptotic index of bladder cells was also evaluated. Results:After STZ injection,compared with the control group,the model group and the MA group both showed higher FBG from week 3 and lower body mass from week 9(P<0.05),and had a larger bladder wet weight(P<0.05).Compared with the model group,the MA group showed a smaller bladder wet weight(P<0.05).The histopathological evaluation indicated that MA improved muscle fiber alignment and detrusor cell compensatory hypertrophy in the bladder tissue.In addition,compared with the control group,the apoptotic index increased significantly in the model group and the MA group(P<0.05);the protein and mRNA expression levels of Bax and caspase-3 and the protein expression level of TGF-β in the bladder tissue in the model group and the MA group increased significantly(P<0.05),while the protein and mRNA expression levels of Bcl-2 and the protein expression level of α-SMA in the bladder tissue decreased significantly(P<0.05).Compared with the model group,the apoptotic index of the MA group decreased significantly(P<0.05);the protein and mRNA expression levels of Bax and caspase-3 and the protein expression level of TGF-β in the bladder tissue decreased significantly(P<0.05),while the protein and mRNA expression levels of Bcl-2 and the protein expression level of α-SMA in the bladder tissue increased significantly(P<0.05). Conclusion:MA can protect the bladder by inhibiting the excessive apoptosis of bladder cells,which may be related to the down-regulation of Bax and caspase-3 proteins and mRNAs and TGF-β protein expression,and the up-regulation of Bcl-2 protein and mRNA and α-SMA protein expression.

bstract: Objective To elucidate the distribution characteristics of mosquito species and the population genetic diversity of important mosquito species in the Wuyi Mountain Nature Reserve, with the aim of providing a scientific basis for the prevention and control of mosquito-borne diseases in the region. Methods Within Wuyi Mountain Nature Reserve 2022- 2023, 16 sampling sites were selected, where larvae were collected using the pipette method and adult mosquitoes were collected using the mosquito trap lamp method. Mosquito species identification was accomplished by integrating morphological characteristics and molecular identification techniques based on CO Ⅰ and CO Ⅱ gene sequences. Software tools such as ClustalX, DnaSP v5.0, and Network v4.6.1.0 were utilized to analyze the genetic differentiation (Fst), gene flow (Nm) among populations of Aedes japonicus, Aedes albopictus and Armigeres subalbatus. Results The mosquito specimens collected from the Wuyi Mountain Nature Reserve were identified as 30 species belonging to 8 genera within the Culicidae family. Among them, there were 10 species of Aedes, 13 species of Culex, 1 species each of Armigeres, Orthopodomyia, Uranotaenia, Tripyeroides, and Anopheles, and 2 species of Toxorhynchites. Analysis of the genetic structure of important mosquito populations showed that the haplotype diversity index (Hd) of Ae. japonicus was 0.994 7, with a generally moderate degree of differentiation between populations and a higher degree of genetic differentiation between populations 6 and 12; Aedeslbopictus had a haplotype diversity index of 0.634 0, with significant genetic differentiation between populations 1 and 2 compared to other groups; Armigeres subalbatus had a haplotype diversity index of 0.703 3, with substantial genetic differentiation and limited gene flow between population 2 and populations 3, 4, 6, and 7. Conclusions The mosquito species are rich in Wuyi Mountain Nature Reserve. A comprehensive survey of the composition and distribution of mosquito populations was carried out, and the characteristics of the population genetic structure of the important species of Ae. japonicus, Ae. Albopictus, and Ar. subalbatus populations were analyzed, providing valuable scientific data reference for local mosquito-borne ecological research and disease prevention and control.

Gorham-Stout disease(GSD)is a sporadic chronic disease characterized by progressive bone dissolution,absorption,and disappearance along with lymphatic vessel infiltration in bone-marrow cavities.Although the osteolytic mechanism of GSD has been widely studied,the cause of lymphatic hyperplasia in GSD is rarely investigated.In this study,by comparing the RNA expression profile of osteoclasts(OCs)with that of OC precursors(OCPs)by RNA sequencing,we identified a new factor,semaphorin 3A(Sema3A),which is an osteoprotective factor involved in the lymphatic expansion of GSD.Compared to OCPs,OCs enhanced the growth,migration,and tube formation of lymphatic endothelial cells(LECs),in which the expression of Sema3A is low compared to that in OCPs.In the presence of recombinant Sema3A,the growth,migration,and tube formation of LECs were inhibited,further confirming the inhibitory effect of Sema3A on LECs in vitro.Using an LEC-induced GSD mouse model,the effect of Sema3A was examined by injecting lentivirus-expressing Sema3A into the tibiae in vivo.We found that the overexpression of Sema3A in tibiae suppressed the expansion of LECs and alleviated bone loss,whereas the injection of lentivirus expressing Sema3A short hairpin RNA(shRNA)into the tibiae caused GSD-like phenotypes.Histological staining further demonstrated that OCs decreased and osteocalcin increased after Sema3A lentiviral treatment,compared with the control.Based on the above results,we propose that reduced Sema3A in OCs is one of the mechanisms contributing to the pathogeneses of GSD and that expressing Sema3A represents a new approach for the treatment of GSD.

ObjectiveTo explore the relationships between internet gaming disorder (IGD), interpersonal needs, loneliness, and depression in adolescents through the construction of a chain mediation model, to clarify the underlying mechanisms of these associations, and to provid a theoretical basis for depression prevention and intervention. MethodsBased on the data of the 7th Population Census, using convenient sampling method 1 106 adolescents aged between 10‒19 years in South China (176), North China (147), Central China (332), and East China (451) were selected to conduct a cross-sectional survey, with a ratio of 1∶1∶1.5∶2.5. The survey was conducted with a questionnaire consisting of general information (sex, age, grade, parents’ education level), the Chinese version of the IGDS9-SF, the INQ-15, the short-form of the ULS-8 and the PHQ-9 were used to evaluate the depression status of adolescents. Spearman correlation analysis was used to explore the correlation between the variables. A multiple-mediator model was constructed using IBM SPSS Statistics 22.0 PROCESS to examine the mediating effects of interpersonal needs and loneliness on the relationship between IGD and depression. The significance of the chain mediating effect was tested using the Bootstrap method. ResultsOverall, 39.06% (432/1 106) adolescents experienced depression. The incidence of depression among adolescents with smoking and without smoking was 62.50% and 38.36%, respectively. Similarly, the incidence of depression among adolescents with alcohol consuming and without alcohol consuming was 61.94% and 35.94%, respectively. There were statistically significant differences between IGD, interpersonal needs, loneliness, and depression (P<0.01). The chain mediation model demonstrated a good fit, and the bootstrap test showed that the 95%CI of each mediation path did not include 0, indicating significant mediation effects. The overall effect was 0.337. The direct effect of IGD on depression was significant (effect value=0.138, 95%CI:0.102-0.173, P<0.001). The mediation effects included three paths: ① IGD →interpersonal needs → depression (effect value=0.073, P<0.05), accounting for 21.47% of the total effect;② IGD→ loneliness → depression (effect value=0.093, P<0.05), accounting for 27.35%; and ③ IGD → interpersonal needs → loneliness → depression (effect value=0.036, P<0.05), accounting for 10.59%. ConclusionInterpersonal needs and loneliness independently and jointly mediate the relationship between IGD and depression among adolescents. To reduce depression and improve mental health in this population, measures should be taken to prevent and intervene in IGD, address adolescents’ social and emotional needs, enhance satisfaction of interpersonal needs, and reduce loneliness.

Objective : To explore the effect of esketamine on anxiety-depressive-like behavior in mice and its rela- tionship with inflammation． Methods : SPF grade healthy adult male C57BL/6J mice，weighing 20 －24 g，were used in the exprement．The random number table method was used to divide into 5 groups (n = 8) : control group ( Con group) ，esketamine group (ESK group) ，model group ( LPS group) ，model + esketamine prevention group (LPS + ESK1 group) and model + esketamine treatment group ( LPS + ESK2 group) ．An inflammation-induced anxiety-depression model was prepared by intraperitoneal injection of LPS 0. 83 mg / kg．The ESK group was injec- ted with esketamine 10 mg / kg ; LPS group was injected with LPS 0. 83 mg / kg ; LPS + ESK1 group was injected with LPS 0. 83 mg / kg before 24 hours intraperitoneal injection of esketamine 10 mg / kg ; and the LPS + ESK2 group was injected with LPS 0. 83 mg / kg and 30 minutes later with esketamine 10 mg / kg．24 h after intraperitoneal injec- tion of LPS，the anxiety-depression-like behaviors of mice were measured using behavioral experiments．At the end of behavioral experiments，the spleen was taken immediately ; hippocampal tissues were taken and enzyme-linked immunosorbent assay (ELISA) was used to detect the contents of interleukin-1 β (IL-1 β) ，tumor necrosis factor al- pha (TNF-α) and interleukin 6 (IL-6) and neuronal pathological changes in hippocampal tissues were observed by HE staining. Results : Compared with the Con group，mice in the LPS group showed increased anxiety and depres- sion-like behavior (P＜0. 05) ，increased spleen weight / body weight (P ＜0. 05 ) ，increased hippocampal tissue concentrations of IL-1 β , TNF-α and IL-6 (P＜0. 05) ，and increased neuronal degeneration necrosis，there was no statistically significant difference in these indicators in the ESK group compared with the Con group．Compared with the LPS group，mice in the LPS + ESK1 and LPS + ESK2 groups showed reduced anxiety-depression-like behavior (P＜0. 05) ，decreased splenic weight / body weight (P ＜0. 05) ，hippocampal tissue IL-1 β , TNF-α , IL- 6 con- centrations were reduced (P＜0. 05) ，and neuronal degeneration necrosis was reduced．Compared with the LPS + ESK1 group，the LPS + ESK2 group showed an increase in the distance travelled in the central area of the open field experiment and the distance into the open arm of the elevated cross maze experiment (P＜0. 05) ，a decrease in IL-6 and TNF-α concentrations (P＜0. 05) ，and a reduction in the degree of neuronal damage． Conclusion Esketamine ameliorates LPS-induced anxiety-depression-like behavior and neuronal damage in mice by a mechanism that may be related to reduced inflammation.