1.Phase Change and Quantity-quality Transfer Analysis of Medicinal Materials, Decoction Pieces and Standard Decoction of Haliotidis Concha (Haliotis discus hannai)
Zhihan YANG ; Jingwei ZHOU ; Weichao WANG ; Yu HUANG ; Chuang LUO ; Lian YANG ; Chenyu ZHONG ; Hongping CHEN ; Fu WANG ; Yuan HU ; Youping LIU ; Shilin CHEN ; Lin CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(13):206-214
ObjectiveTo explore the quantity-quality transfer process of medicinal materials, decoction pieces and standard decoction of Haliotidis Concha(Haliotis discus hannai) by analyzing the physical phase and compositional changes, so as to provide references for the effective control of its quality. MethodsA total of 20 batches of Haliotidis Concha(H. discus hannai) from different habitats were collected and prepared into corresponding calcined products and standard decoction, and the content of CaCO3 of the three samples were determined and the extract yield and transfer rate of CaCO3 were calculated. The changes in elemental composition and their relative contents were investigated by X-ray fluorescence spectrometry(XRF), X-ray diffraction(XRD) was used to study the changes in the phase compositions of the three samples and to establish their respective XRD specific chromatogram. Fourier transform infrared spectrometry(FTIR) was used to study the changes in the chemical composition and content changes of the three samples and to establish their respective FTIR specific chromatogram, while combining hierarchical cluster analysis(HCA), principal component analysis(PCA) and orthogonal partial least squares-discriminant analysis(OPLS-DA) to find the common and differential characteristics, in order to explore the quantity-quality transfer relationship in the preparation process of standard decoction of Haliotidis Concha(H. discus hannai). ResultsThe CaCO3 contents of the 20 batches of medicinal materials, decoction pieces and standard decoction of Haliotidis Concha(H. discus hannai) were 93.87%-98.95%, 96.02%-99.97% and 38.29%-51.96%, respectively, and the extract yield of standard decoction was 1.71%-2.37%, and the CaCO3 transfer rate of decoction pieces-standard decoction was 0.68%-1.27%. XRF results showed that the elemental species and their relative contents contained in Haliotidis Concha and its calcined products had a high degree of similarity, and although there was no obvious difference in the elemental species contained in decoction pieces and standard decoction, the difference in the relative contents was obvious, which was mainly reflected in the decrease of the relative content of element Ca and the increase of the relative content of element Na. XRD results showed that Haliotidis Concha mainly contained CaCO3 of aragonite and calcite, while calcined Haliotidis Concha only contained CaCO3 of calcite, and standard decoction mainly contained CaCO3 of calcite and Na2CO3 of natrite. FTIR results showed that there were internal vibrations of O-H, C-H, C=O, HCO3- and CO32- groups in Haliotidis Concha, while O-H, HCO3- and CO32- groups existed in the calcined products and standard decoction. ConclusionThe changes of Haliotidis Concha and calcined Haliotidis Concha are mainly the increase of CaCO3 content, the transformation of CaCO3 aragonite crystal form to calcite crystal form and the absence of organic components after calcination, and the changes of calcined products and standard decoction are mainly the decrease of CaCO3 content and the increase of Na2CO3 relative content. The method established in the study is applicable to the quality control of the shellfish medicines-decoction pieces- standard decoction, which provides a new idea for the study of quality control of dispensing granules of shellfish medicines.
2.Phase Change and Quantity-quality Transfer Analysis of Medicinal Materials, Decoction Pieces and Standard Decoction of Haliotidis Concha (Haliotis discus hannai)
Zhihan YANG ; Jingwei ZHOU ; Weichao WANG ; Yu HUANG ; Chuang LUO ; Lian YANG ; Chenyu ZHONG ; Hongping CHEN ; Fu WANG ; Yuan HU ; Youping LIU ; Shilin CHEN ; Lin CHEN
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(13):206-214
ObjectiveTo explore the quantity-quality transfer process of medicinal materials, decoction pieces and standard decoction of Haliotidis Concha(Haliotis discus hannai) by analyzing the physical phase and compositional changes, so as to provide references for the effective control of its quality. MethodsA total of 20 batches of Haliotidis Concha(H. discus hannai) from different habitats were collected and prepared into corresponding calcined products and standard decoction, and the content of CaCO3 of the three samples were determined and the extract yield and transfer rate of CaCO3 were calculated. The changes in elemental composition and their relative contents were investigated by X-ray fluorescence spectrometry(XRF), X-ray diffraction(XRD) was used to study the changes in the phase compositions of the three samples and to establish their respective XRD specific chromatogram. Fourier transform infrared spectrometry(FTIR) was used to study the changes in the chemical composition and content changes of the three samples and to establish their respective FTIR specific chromatogram, while combining hierarchical cluster analysis(HCA), principal component analysis(PCA) and orthogonal partial least squares-discriminant analysis(OPLS-DA) to find the common and differential characteristics, in order to explore the quantity-quality transfer relationship in the preparation process of standard decoction of Haliotidis Concha(H. discus hannai). ResultsThe CaCO3 contents of the 20 batches of medicinal materials, decoction pieces and standard decoction of Haliotidis Concha(H. discus hannai) were 93.87%-98.95%, 96.02%-99.97% and 38.29%-51.96%, respectively, and the extract yield of standard decoction was 1.71%-2.37%, and the CaCO3 transfer rate of decoction pieces-standard decoction was 0.68%-1.27%. XRF results showed that the elemental species and their relative contents contained in Haliotidis Concha and its calcined products had a high degree of similarity, and although there was no obvious difference in the elemental species contained in decoction pieces and standard decoction, the difference in the relative contents was obvious, which was mainly reflected in the decrease of the relative content of element Ca and the increase of the relative content of element Na. XRD results showed that Haliotidis Concha mainly contained CaCO3 of aragonite and calcite, while calcined Haliotidis Concha only contained CaCO3 of calcite, and standard decoction mainly contained CaCO3 of calcite and Na2CO3 of natrite. FTIR results showed that there were internal vibrations of O-H, C-H, C=O, HCO3- and CO32- groups in Haliotidis Concha, while O-H, HCO3- and CO32- groups existed in the calcined products and standard decoction. ConclusionThe changes of Haliotidis Concha and calcined Haliotidis Concha are mainly the increase of CaCO3 content, the transformation of CaCO3 aragonite crystal form to calcite crystal form and the absence of organic components after calcination, and the changes of calcined products and standard decoction are mainly the decrease of CaCO3 content and the increase of Na2CO3 relative content. The method established in the study is applicable to the quality control of the shellfish medicines-decoction pieces- standard decoction, which provides a new idea for the study of quality control of dispensing granules of shellfish medicines.
3.Efficacy and safety of tislelizumab in the treatment of advanced non-small cell lung cancer:a meta-analysis
Yanxue WANG ; Xiaotong LIAN ; Ziying LIANG ; Xinyi GUO ; Qiuyi YUAN ; Jinni WANG ; Yixuan QIN ; Xiaolian DING ; Gang LIANG
China Pharmacy 2025;36(19):2454-2459
OBJECTIVE To systematically evaluate the efficacy and safety of tislelizumab in the treatment of advanced non- small cell lung cancer (NSCLC). METHODS Computerized searches were conducted in PubMed, Embase, the Cochrane Library, CNKI, Wanfang and other Chinese and English databases to collect randomized controlled trials (RCTs) on tislelizumab for advanced NSCLC. The search period was from the establishment of the databases to December 2024. After strictly screening the literature, extracting data and conducting quality evaluations in accordance with the inclusion and exclusion criteria, a meta-analysis was performed using RevMan 5.3 and Stata 16.0 software. RESULTS A total of 18 RCTs involving 2 337 patients were included, with 1 283 in the experimental group and 1 054 in the control group. The meta-analysis results showed that the objective response rate [RR=1.61, 95%CI (1.48, 1.75), P<0.000 01], disease control rate [RR=1.21, 95%CI (1.13, 1.29), P<0.000 01], progression free survival [HR=0.55, 95%CI (0.45, 0.66), P<0.000 01], and overall survival [HR=0.78, 95%CI(0.62, 0.97), P=0.03] were significantly better in the experimental group than in the control group. There was no statistically significant difference in the incidence of adverse reactions between the two groups [RR=1.00, 95%CI (0.73, 1.37), P=1.00]; among the common adverse reactions, only the incidence of liver function impairment was significantly higher in the experimental group than in the control group [RR=1.30, 95%CI (1.10, 1.54), P<0.01]. CONCLUSIONS Tislelizumab in combination with chemotherapy or targeted drugs significantly improves the efficacy in patients with advanced NSCLC without increasing the risk of adverse reactions overall. However, liver function should be closely monitored during treatment.
4.Umbrella review of Chinese patent medicines in treatment of hypertension.
Meng-Meng WANG ; Xiang-Jia LUAN ; Rui MA ; Lian-Xin WANG ; Yuan-Hui HU
China Journal of Chinese Materia Medica 2025;50(12):3452-3473
Hypertension is a major risk factor for cardiovascular diseases. Controlling blood pressure can reduce the incidence of cardiovascular events and mortality. The patients with hypertension are mainly treated with antihypertensive drugs. For the patients who can't achieve the target blood pressure with a single drug, comprehensive treatment strategies become particularly important. Chinese patent medicines are prepared by modern extraction and processing technology based on the basic theory of traditional Chinese medicine(TCM). Due to the stable antihypertensive effect, target organ protection, and synergistic effect with western medicine, Chinese patent medicines are becoming one of the effective options for the treatment of hypertension. At present, there are many systematic reviews on the treatment of hypertension with Chinese patent medicines, which makes it difficult for health policy makers and health service providers to choose the best evidence for the treatment. Umbrella review can integrate multiple systematic reviews to comprehensively assess the quality of evidence and potential bias, thereby providing high-quality evidence-based medicine basis for formulating clinical guidelines and optimizing treatment strategies. In this study, the systematic reviews/Meta-analysis of Chinese patent medicines in the treatment of essential hypertension were systematically searched. Sixty-nine articles were included for the umbrella review. Literature information was extracted, and the corrected covered area(CCA) was calculated to quantitatively evaluate the overlap degree of original studies in systematic reviews/Meta-analysis. The risk of bias in systematic reviews(ROBIS) tool and Cochrane RoB tool 2.0 were used to assess the risk of bias of the included studies. A Measure Tool to Assess Systematic Reviews 2(AMSTAR 2) was used to evaluate the methodological quality of systematic reviews/Meta-analysis. The quality of evidence was evaluated based on the Grade of Recommendations Assessment, Development and Evaluation(GRADE). The results showed that the Chinese patent medicines in the categories of treating wind, resolving stasis, and reinforcing healthy Qi were effective in lowering blood pressure. The Chinese patent medicines for resolving stasis combined with conventional treatment can lower blood pressure and the levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, and total cholesterol in the treatment of hypertension complicated with coronary heart disease and hypertension complicated with left ventricular hypertrophy. Moreover, the combined therapy can recover the interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass index, left ventricular end diastolic diameter, and left ventricular ejection fraction in the case of left ventricular hypertrophy. The Chinese patent medicines for resolving stasis and for replenishing Qi and restoring pulse can be used in combination with conventional treatment for hypertension complicated with arrhythmia, which can lower blood pressure while improving the outcome indicators such as the P-wave dispersion of arrhythmia, left atrial diameter, ejection fraction, heart rate, and recurrence time. Due to the heterogeneity, the efficacy evidence obtained by the umbrella review needs to be further verified through precise clinical studies and long-term follow-up.
Hypertension/physiopathology*
;
Humans
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Drugs, Chinese Herbal/therapeutic use*
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Antihypertensive Agents/therapeutic use*
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Nonprescription Drugs/therapeutic use*
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Blood Pressure/drug effects*
5.Research progress of vacuum compression molding technology in pharmaceutical fields
Yixuan WANG ; Xin CHEN ; Lian HE ; Congcong ZHANG ; Peiya SHEN ; Yuan GAO ; Jianjun ZHANG
Journal of China Pharmaceutical University 2025;56(5):654-660
Vacuum compression molding (VCM) is a novel technology supporting the research and development of pharmaceutical solid dispersions. It is widely applied due to its precision and convenience in sample preparation. This technology integrates the principles of heating, melting, cooling, and vacuum compression to transform solid powders into shaped solids directly. By selecting different molds, temperatures, and pressures, researchers can prepare samples with diverse characteristics. This paper presents an overview of the equipment composition and working principles of VCM technology, demonstrating its distinct advantages in the formulation screening process of amorphous solid dispersions through comparative analysis with hot melt extrusion using case studies, and introduces its applications in the development of drug delivery systems and rheological characterization analysis, with a perspective on the future development of its functions.
6.Chemical constituents from Ganoderma angustisporum and their α-glucosidase inhibitory activities
Ya-Qin HUO ; Yu-Xi WANG ; Yu-Lian WEI ; Yi-Xuan ZHANG ; Hai-Sheng YUAN
Chinese Traditional Patent Medicine 2024;46(1):132-137
AIM To study the chemical constituents from Ganoderma angustisporum J.H.Xing,B.K.Cui&Y.C.Dai and their α-glucosidase inhibitory activities.METHODS The ethyl acetate extract from G.angustisporum was isolated and purified by silica gel,ODS,TLC and HPLC,then the structures of obtained compounds were identified by physicochemical properties and spectral data.pNPG method was used to evaluate their α-glucosidase inhibitory activities.RESULTS Seven compounds were isolated and identified as N-acetyl-L-phenylalanine ethyl ester(1),N-acetyl-L-phenylalanine methyl ester(2),4-hydroxy-17R-methylincisterol(3),6,8-di-O-methylaverufin(4),aversin(5),methyl 2-(4-hydroxyphenyl)aceate(6),5-toluene-1,3-diol(7).Compounds 1-2,4-7 showed inhibitory activities of α-glucosidase with IC50 values being(33.80±0.47),(45.45±7.95),(48.80±5.86),(39.48±2.82),(41.47±6.68),(55.38±10.12)μmol/L,and compound 1 showed good inhibitory activity.CONCLUSION Compound 1 is a new natural product.Compounds 2-7 are isolated from genus Ganoderma for the first time.Compounds 1-2,4-7 have α-glucosidase inhibitory activities.
7.Treatment of Traditional Chinese Medicine for Diabetic Peripheral Neuropathy Based on Mitochondrial Quality Control: A Review
Susu HUANG ; Hanyu LIU ; Xueru WANG ; Jiushu YUAN ; Lian DU
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(1):255-263
Diabetic peripheral neuropathy(DPN) is a neurodegenerative disease of diabetes mellitus involving peripheral nervous system damage, which is characterized by axonal degenerative necrosis, Schwann cell apoptosis and demyelination of nerve myelin sheath as the main pathological features, this disease is highly prevalent and is a major cause of disability in diabetic patients. Currently, the pathogenesis of DPN may be related to oxidative stress, inflammatory response, metabolic abnormality, and microcirculation disorder. The treatment of DPN in modern medicine mainly starts from controlling blood glucose, nourishing nerves and improving microcirculation, which can only alleviate the clinical symptoms of patients, and it is difficult to fundamentally improve the pathological damage of peripheral nerves. Mitochondrial quality control refers to the physiological mechanisms that can maintain the morphology and functional homeostasis of mitochondria, including mitochondrial biogenesis, mitochondrial dynamics, mitochondrial oxidative stress and mitochondrial autophagy, and abnormal changes of which may cause damage to peripheral nerves. After reviewing the literature, it was found that traditional Chinese medicine(TCM) can improve the low level of mitochondrial biogenesis in DPN, maintain the balance of mitochondrial dynamics, inhibit mitochondrial oxidative stress and mitochondrial autophagy, and delay apoptosis of Schwann cells and neural axon damage, which has obvious effects on the treatment of DPN. With the deepening of research, mitochondrial quality control may become one of the potential targets for the research of new anti-DPN drugs, therefore, this paper summarized the research progress of TCM in treating DPN based on four aspects of mitochondrial quality control, with the aim of providing a theoretical research basis for the discovery of new drugs.
8.A multicenter study on effect of delayed chemotherapy on prognosis of Burkitt lymphoma in children
Li SONG ; Ling JIN ; Yonghong ZHANG ; Xiaomei YANG ; Yanlong DUAN ; Mincui ZHENG ; Xiaowen ZHAI ; Ying LIU ; Wei LIU ; Ansheng LIU ; Xiaojun YUAN ; Yunpeng DAI ; Leping ZHANG ; Jian WANG ; Lirong SUN ; Rong LIU ; Baoxi ZHANG ; Lian JIANG ; Huixia WEI ; Kailan CHEN ; Runming JIN ; Xige WANG ; Haixia ZHOU ; Hongmei WANG ; Shushuan ZHUANG ; Chunju ZHOU ; Zifen GAO ; Xiao MU ; Kaihui ZHANG ; Fu LI
Chinese Journal of Pediatrics 2024;62(10):941-948
Objective:To analyze the factors affecting delayed chemotherapy in children with Burkitt lymphoma (BL) and their influence on prognosis.Methods:Retrospective cohort study. Clinical data of 591 children aged ≤18 years with BL from May 2017 to December 2022 in China Net Childhood Lymphoma (CNCL) was collected. The patients were treated according to the protocol CNCL-BL-2017. According to the clinical characteristics, therapeutic regimen was divided into group A, group B and group C .Based on whether the total chemotherapy time was delayed, patients were divided into two groups: the delayed chemotherapy group and the non-delayed chemotherapy group. Based on the total delayed time of chemotherapy, patients in group C were divided into non-delayed chemotherapy group, 1-7 days delayed group and more than 7 days delayed group. Relationships between delayed chemotherapy and gender, age, tumor lysis syndrome before chemotherapy, bone marrow involvement, disease group (B/C group), serum lactate dehydrogenase (LDH) > 4 times than normal, grade Ⅲ-Ⅳ myelosuppression after chemotherapy, minimal residual disease in the interim assessment, and severe infection (including severe pneumonia, sepsis, meningitis, chickenpox, etc.) were analyzed. Logistic analysis was used to identify the relevant factors. Kaplan-Meier method was used to analyze the patients' survival information. Log-Rank was used for comparison between groups.Results:Among 591 patients, 504 were males and 87 were females, the follow-up time was 34.8 (18.6,50.1) months. The 3-year overall survival (OS) rate was (92.5±1.1)%,and the 3-year event-free survival (EFS) rate was (90.5±1.2)%. Seventy-three (12.4%) patients were in delayed chemotherapy group and 518 (87.6%) patients were in non-delayed chemotherapy group. The reasons for chemotherapy delay included 72 cases (98.6%) of severe infection, 65 cases (89.0%) of bone marrow suppression, 35 cases (47.9%) of organ dysfunction, 22 cases (30.1%) of tumor lysis syndrome,etc. There were 7 cases of chemotherapy delay in group B, which were seen in COPADM (vincristine+cyclophosphamide+prednisone+daunorubicin+methotrexate+intrathecal injection,4 cases) and CYM (methotrexate+cytarabine+intrathecal injection,3 cases) stages. There were 66 cases of chemotherapy delay in group C, which were common in COPADM (28 cases) and CYVE 1 (low dose cytarabine+high dose cytarabine+etoposide+methotrexate, 12 cases) stages. Multinomial Logistic regression analysis showed that the age over 10 years old ( OR=0.54,95% CI 0.30-0.93), tumor lysis syndrome before chemotherapy ( OR=0.48,95% CI 0.27-0.84) and grade Ⅲ-Ⅳ myelosuppression after chemotherapy ( OR=0.55,95% CI 0.33-0.91)were independent risk factors for chemotherapy delay.The 3-year OS rate and the 3-year EFS rate of children with Burkitt lymphoma in the delayed chemotherapy group were lower than those in the non-delayed chemotherapy group ((79.4±4.9)% vs. (94.2±1.1)%, (80.2±4.8)% vs. (92.0±1.2)%,both P<0.05). The 3-year OS rate of the group C with chemotherapy delay >7 days (42 cases) was lower than that of the group with chemotherapy delay of 1-7 days (22 cases) and the non-delay group (399 cases) ((76.7±6.9)% vs. (81.8±8.2)% vs. (92.7±1.3)%, P=0.002).The 3-year OS rate of the chemotherapy delay group (9 cases) in the COP (vincristine+cyclophosphamide+prednisone) phase was lower than that of the non-chemotherapy delay group (454 cases) ((66.7±15.7)% vs. (91.3±1.4)%, P=0.005). Similarly, the 3-year OS rate of the chemotherapy delay group (11 cases) in the COPADM1 phase was lower than that of the non-chemotherapy delay group (452 cases) ((63.6±14.5)% vs. (91.5±1.3)%, P=0.001). Conclusions:The delayed chemotherapy was related to the age over 10 years old, tumor lysis syndrome before chemotherapy and grade Ⅲ-Ⅳ myelosuppression after chemotherapy in pediatric BL. There is a significant relationship between delayed chemotherapy and prognosis of BL in children.
9.Diffusion weighted imaging for assessment of efficacy and volume response after uterine artery embolization of uterine fibroids
Jinxiang XIA ; Song WANG ; Ping CUI ; Hu LIAN ; Hui WU ; Xing ZHONG ; Ye YUAN ; Ruokun WANG ; Mao SHENG
Journal of Practical Radiology 2024;40(11):1833-1836
Objective To observe the clinical and symptomatic improvement three months after uterine artery embolization(UAE),and to analyze the value of apparent diffusion coefficient(ADC)in MR diffusion weighted imaging(DWI)in assessing the response of fibroids volume after UAE.Methods A total of 40 patients with uterine fibroids were included.The volume changes of fibroids,clinical and symptomatic improvement before and after treatment were recorded,and the efficacy of UAE was comprehensively analyzed.All patients underwent MR DWI before UAE and were evaluated at three months postoperatively by outpatient MR follow-up,with fibroids vol-ume and ADC quantitative measurements were performed to compare the changes in ADC values of fibroids preoperatively and post-operatively at each b value.Pearson correlation analysis was performed to analyze the correlation between baseline ADC values and postoperative fibroids volume reduction.Regression analysis was performed to assess the relationship between ADC and fibroids volume reduction after UAE.And the receiver operating characteristic(ROC)curve were plotted to analyze the predictive value of ADC values for evaluating fibroids volume reduction of more than 30%after UAE.Results The patients'clinical symptoms was improved in the three months after surgery,the volume of fibroids was significantly reduced,and the life quality was improved,the difference was sta-tistically significant(P<0.05).There was no significant effect on ovarian function,hormone levels did not change significantly com-pared to before surgery,with no statistical significance(P>0.05).When b=50,1 000 s/mm2,the changes in ADC values before and after uterine fibroids treatment were not significant,with no statistical significance(P>0.05).However,the changes in ADC values before and after uterine fibroids treatment were significant when b=800 s/mm2 and the difference was statistically significant(P<0.05).Under the condition of b=800 s/mm2,Pearson correlation analysis showed ADC value had a positive correlation with postoperative uterine fibroids volume reduction rate(r=0.45,P<0.05),and the area under the curve(AUC)for ADC value to predict the reduction rate of uterine fibroids volume by more than 30%after UAE was 0.787.The cut-off value was 1.143 × 10-3 mm2/s,with sensitivity and specificity of 0.793 and 0.818,respectively.Conclusion UAE is more effective in treating uterine fibroids.The baseline ADC value of uterine fibroids correlated significantly with the volume reduction after UAE.The ADC value can be used to assess the volume response after UAE.
10.Establish and evaluate effectiveness of three-tier review rules for parenteral nutrition prescriptions
Peng XING ; Li-Li WANG ; Li-Yuan TAO ; Jian-Ping LIU ; Lian-Zhen CHEN
Parenteral & Enteral Nutrition 2024;31(5):275-279
Objective:To establish a three-tier review rule for parenteral nutrition orders by pharmacists,improve the qualification rate of parenteral nutrition orders,and promote the rational and standardized use of parenteral nutrition.Method:Pharmacists from different positions participate in a manual review intervention model for parenteral nutrition orders at three-tier review,establishing standardized and simplified parenteral nutrition review rules to reduce review difficulty and improve review efficiency.Result:After implementation,the qualified rate for parenteral nutrition orders increased from 71.09%to 95.59%,with a qualified rate of 100%for an industrial multi-cavity bag.The simplicity of parenteral nutrition components,cation concentration,carbohydrate-to-lipid ratio,non-protein calorie-to-nitrogen ratio and route of administration have been significantly improved.Conclusion:The involvement of pharmacists in the three-tier review of parenteral nutrition can reduce the risk of single-tier review,promote collaboration between pharmacists in different roles,improve the accuracy and efficiency of review,and reduce the risk of inappropriate use of parenteral nutrition.

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