In the context of aging population, the issue of polypharmacy among elderly patients with mental disorders has become increasingly prominent.Cognitive decline and depressive symptoms render these patients more vulnerable to medication-related risks, while poorly managed physical illnesses further complicate their treatment.To address these challenges, this paper proposes a series of management strategies that emphasize the critical role of pharmacists in conducting medication reviews.A comprehensive assessment of drug risks, benefits, and patient adherence is essential.The proposed strategies not only require careful consideration of patients' clinical needs and individual preferences but also highlight the importance of multidisciplinary team collaboration to reach a consensus on medication therapy.The use of clinical decision support systems as an auxiliary tool is recommended to enhance the scientific rigor of medication decision-making.Furthermore, pharmacists can optimize medication regimens through scientifically validated methods and promote patient or family involvement in self-management to improve acceptance and adherence to treatment adjustments.

Objective:To investigate the status of psychological distress, self-compassion, and self-management behaviors among patients with type 2 diabetes mellitus (T2DM), and explore the mediating role of self-compassion in the relationship between diabetes distress and self-management behaviors, and to provide a theoretical basis for the psychological intervention of patients with T2DM.Methods:A convenience sampling method was adopted to select 221 patients with T2DM hospitalized in the Department of Endocrinology and Metabolism, the First Hospital of China Medical University from November 2023 to April 2024. The General Information Form, the Diabetes Distress Scale-17, the Self-Compassion Scale and the Summary of Diabetes Self-Care Activity were utilized for investigation. A structural equation model was constructed with AMOS 24.0 to analyze the relationships among psychological distress, self-compassion, and self-management behaviors, and the mediating effect of self-compassion was tested using the Bootstrap method.Results:A total of 221 patients with T2DM were included, including 138 males and 83 females, aged (54.52 ±10.42) years old. The total score of psychological distress of patients with T2DM was (34.55 ± 18.82) points, the total score of self-compassion was (94.22 ± 26.04) points, and the total score of self-management behavior was (40.81 ± 22.64) points. Psychological distress in T2DM patients was significantly negatively correlated with both self-compassion ( r=-0.850, P<0.01) and self-management behaviors ( r=-0.736, P<0.01). In contrast, self-compassion was significantly positively correlated with self-management behaviors ( r=0.743, P<0.01). Self-compassion partially mediated the relationship between diabetes-related psychological distress and self-management behaviors, with a mediation effect size of -0.456. Conclusions:Psychological distress among T2DM patients is at a moderate level, and their self-management behaviors require urgent improvement. Psychological distress not only directly impacts self-management behaviors but also indirectly influences them through self-compassion. Healthcare professionals should prioritize enhancing patients′ self-compassion levels to mitigate the negative effects of psychological distress on their health behaviors.

In the context of aging population, the issue of polypharmacy among elderly patients with mental disorders has become increasingly prominent.Cognitive decline and depressive symptoms render these patients more vulnerable to medication-related risks, while poorly managed physical illnesses further complicate their treatment.To address these challenges, this paper proposes a series of management strategies that emphasize the critical role of pharmacists in conducting medication reviews.A comprehensive assessment of drug risks, benefits, and patient adherence is essential.The proposed strategies not only require careful consideration of patients' clinical needs and individual preferences but also highlight the importance of multidisciplinary team collaboration to reach a consensus on medication therapy.The use of clinical decision support systems as an auxiliary tool is recommended to enhance the scientific rigor of medication decision-making.Furthermore, pharmacists can optimize medication regimens through scientifically validated methods and promote patient or family involvement in self-management to improve acceptance and adherence to treatment adjustments.

Objective:To investigate the status of psychological distress, self-compassion, and self-management behaviors among patients with type 2 diabetes mellitus (T2DM), and explore the mediating role of self-compassion in the relationship between diabetes distress and self-management behaviors, and to provide a theoretical basis for the psychological intervention of patients with T2DM.Methods:A convenience sampling method was adopted to select 221 patients with T2DM hospitalized in the Department of Endocrinology and Metabolism, the First Hospital of China Medical University from November 2023 to April 2024. The General Information Form, the Diabetes Distress Scale-17, the Self-Compassion Scale and the Summary of Diabetes Self-Care Activity were utilized for investigation. A structural equation model was constructed with AMOS 24.0 to analyze the relationships among psychological distress, self-compassion, and self-management behaviors, and the mediating effect of self-compassion was tested using the Bootstrap method.Results:A total of 221 patients with T2DM were included, including 138 males and 83 females, aged (54.52 ±10.42) years old. The total score of psychological distress of patients with T2DM was (34.55 ± 18.82) points, the total score of self-compassion was (94.22 ± 26.04) points, and the total score of self-management behavior was (40.81 ± 22.64) points. Psychological distress in T2DM patients was significantly negatively correlated with both self-compassion ( r=-0.850, P<0.01) and self-management behaviors ( r=-0.736, P<0.01). In contrast, self-compassion was significantly positively correlated with self-management behaviors ( r=0.743, P<0.01). Self-compassion partially mediated the relationship between diabetes-related psychological distress and self-management behaviors, with a mediation effect size of -0.456. Conclusions:Psychological distress among T2DM patients is at a moderate level, and their self-management behaviors require urgent improvement. Psychological distress not only directly impacts self-management behaviors but also indirectly influences them through self-compassion. Healthcare professionals should prioritize enhancing patients′ self-compassion levels to mitigate the negative effects of psychological distress on their health behaviors.

[Objective]To sort out and summarize the theory of nourishing Yin of ZHU Danxi and ZHANG Jingyue,and discuss the similarities and differences of two doctors'understanding of Yin deficiency and the treatment method of nourishing Yin.[Methods]Through the research method of documentics,this paper carefully studies the contents related to"Yin deficiency"in the major works of ZHU Danxi and ZHANG Jingyue,as well as relevant literature reports and analyzes the similarities and differences of the theory of nourishing Yin,classification of Yin deficiency and the treatment method of nourishing Yin between them.[Results]ZHU Danxi's treatment of Yin deficiency syndrome was based on the theory of"an excess of Yang with deficiency of Yin""ministerial fire(Xianghuo)".He took the hyperactivity of ministerial fire as the main pathogenesis of Yin deficiency syndrome.In the treatment method,he paid attention to reducing fire,and made good use of the bitter and cold products such as Anemarrhenae Rhizoma(Zhimu)and Cortex Phellodendri(Huangbai),and paid equal attention to nourishing Yin and reducing fire.ZHANG Jingyue,on the basis of the theory that"Yin and Yang are one"and"true Yin was the foundation of Yang Qi",believed that the deficiency of true Yin can lead to Yin deficiency and Yang deficiency,and proposed that Yin deficiency had two aspects:water deficiency in Yin and fire deficiency in Yin.In the treatment method,nourishing true Yin by the sweet and warm medicines such as Radix Rehmanniae Preparata(Shudihuang)was emphasized,and Yin Yang mutual aid was advocated.[Conclusion]Whether it is the thought of nourishing Yin or the specific treatment and prescription,ZHANG Jingyue inherited and made a breakthrough on ZHU Danxi.He further improved the theory of nourishing Yin and the theory of warm-recuperation in traditional Chinese medicine,and created a series of prescriptions based on nourishing true Yin.It is of great significance to study the similarities and differences of their thought,theory,clinical symptoms and treatment for sorting out the development context of the treatment method of nourishing Yin.

Objective:To explore the effectiveness of blood glucose monitoring at different frequencies on the control of blood glucose in overweight/obese prediabetes population on the basis of health education, and to provide a basis for blood glucose monitoring and management in prediabetes population.Methods:A randomized controlled study was used. 90 prediabetes patients from the Physical Examination Center/Endocrine Clinic/Endocrine Ward of the First Affiliated Hospital of China Medical University from January to March 2021 were selected by continuous sampling method, and were randomly divided into the group A, B and C by lottery method, with 30 patients in each group, and the study period was 12 months. Group A, B and C received unified health education guidance at enrollment, 6-month follow-up, and 12-month follow-up. Group A underwent blood glucose monitoring every 6 months, group B underwent blood glucose monitoring every 3 months, group C underwent blood glucose monitoring every month. Recorded and compared the levels of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2-hour post-load blood glucose (2 hPG), and body mass index (BMI) of three groups at the time points of enrollment, 6-month follow-up, and 12-month follow-up.Results:There were 15 males and 15 females in the group A, 14 males and 16 females in the group B, 12 males and 18 females in the group C. The ages in the group A, B and C were (48.37 ± 10.80), (49.20 ± 9.25) and (44.77 ± 12.28) years old respectively. At the time point of 12-month follow-up, the HbA1c in the group A, B and C were (6.01 ± 0.36)%, (5.82 ± 0.35)% and (5.64 ± 0.27)%, the difference was significant ( F=9.72, P<0.05); the FPG in the group A, B and C were (5.64 ± 0.88), (5.05 ± 0.53) and (4.98 ± 0.48)mmol/L, the difference was significant ( F=9.23, P<0.05); the 2 hPG in the group A, B and C were (9.38 ± 1.23), (8.23 ± 0.72) and (7.71 ± 0.86) mmol/L, the difference was significant ( F=23.89, P<0.05); the BMI in the group A, B and C were (28.52 ± 4.24), (27.02 ± 2.67) and (25.56 ± 1.34) kg/m 2, the difference was significant ( F=7.37, P<0.05). Conclusions:On the basis of health education, compared with the routine blood glucose monitoring once every six months, blood glucose monitoring once every three months and once every month can improve the blood glucose control and BMI level of overweight/obese young and middle-aged people with prediabetes, and provide a basis for seeking an effective and economic blood glucose monitoring mode in clinical practice.

Objective:To explore the clinical application value of third-generation sequencing technology in preimplantation genetic testing (PGT) of an ATR-X syndrome pedigree with chromosomal microduplication.Methods:The study selected a pedigree with a suspected ATR-X syndrome child at Assisted Reproductive Center of Jiangxi Maternal and Child Health Hospital in October 2022. After chromosome copy number variation sequencing (CNV Seq) detection, it was found that the female carried a 550 kb heterozygous microrepeat with unclear clinical significance in the Xq21.1 region, which involved partial sequences of the ATRX gene. The third generation long read sequencing technology was used to detect the female genome sequence, determine the physical location of the insertion of the above repeat into the genome, clarify the pathogenicity of the repeat, and obtain a single nucleotide polymorphism (SNP) haplotype linked to the above micro repeat inheritance. After the couple's full informed consent, PGT was performed to assist pregnancy. One haploid embryo without pathogenic microduplication was selected for transfer. To verify the consistency with PGT test results, amniocentesis prenatal diagnosis was performed in the second trimester after successful pregnancy, and the fetus was followed up after birth. Results:The results of the third generation long read sequencing and Sanger sequencing verification showed that the Xq21.1 microrepeat carried by the female was inserted into the genome chrX: 76804463-76804464 (GRCh37/hg19), which is an intra tandem repeat of the ATRX gene, and it is predicted that it may cause damage to the normal function of the ATRX protein. After one cycle of PGT treatment, 27 oocytes were obtained and 13 blastocysts were successfully developed after intracytoplasmic sperm injection (ICSI). Through genetic testing, it was found that two blastocysts were haploid embryos without carrying the aforementioned pathogenic microduplication. After thawing and transferring one of the blastocysts, the pregnancy was achieved, and the prenatal diagnosis results of amniocentesis in the second trimester were consistent with the PGT results. In November 2023, at 39 +5 weeks of pregnancy, a female live baby was delivered by natural delivery, and she is in good health. Conclusion:The third-generation sequencing technology has significant advantages in PGT detection of clinically ambiguous microreplicates with functional deficiency due to its long read length characteristics. It can not only determine the location of microreplicates inserted into the genome and determine their pathogenicity, but also obtain SNP haplotypes that are linked to the target mutation, thus preparing for subsequent embryo detection.

Objective:To explore the clinical application value of third-generation sequencing technology in preimplantation genetic testing (PGT) of an ATR-X syndrome pedigree with chromosomal microduplication.Methods:The study selected a pedigree with a suspected ATR-X syndrome child at Assisted Reproductive Center of Jiangxi Maternal and Child Health Hospital in October 2022. After chromosome copy number variation sequencing (CNV Seq) detection, it was found that the female carried a 550 kb heterozygous microrepeat with unclear clinical significance in the Xq21.1 region, which involved partial sequences of the ATRX gene. The third generation long read sequencing technology was used to detect the female genome sequence, determine the physical location of the insertion of the above repeat into the genome, clarify the pathogenicity of the repeat, and obtain a single nucleotide polymorphism (SNP) haplotype linked to the above micro repeat inheritance. After the couple's full informed consent, PGT was performed to assist pregnancy. One haploid embryo without pathogenic microduplication was selected for transfer. To verify the consistency with PGT test results, amniocentesis prenatal diagnosis was performed in the second trimester after successful pregnancy, and the fetus was followed up after birth. Results:The results of the third generation long read sequencing and Sanger sequencing verification showed that the Xq21.1 microrepeat carried by the female was inserted into the genome chrX: 76804463-76804464 (GRCh37/hg19), which is an intra tandem repeat of the ATRX gene, and it is predicted that it may cause damage to the normal function of the ATRX protein. After one cycle of PGT treatment, 27 oocytes were obtained and 13 blastocysts were successfully developed after intracytoplasmic sperm injection (ICSI). Through genetic testing, it was found that two blastocysts were haploid embryos without carrying the aforementioned pathogenic microduplication. After thawing and transferring one of the blastocysts, the pregnancy was achieved, and the prenatal diagnosis results of amniocentesis in the second trimester were consistent with the PGT results. In November 2023, at 39 +5 weeks of pregnancy, a female live baby was delivered by natural delivery, and she is in good health. Conclusion:The third-generation sequencing technology has significant advantages in PGT detection of clinically ambiguous microreplicates with functional deficiency due to its long read length characteristics. It can not only determine the location of microreplicates inserted into the genome and determine their pathogenicity, but also obtain SNP haplotypes that are linked to the target mutation, thus preparing for subsequent embryo detection.

OBJECTIVE：To investigate the clini cal features of thrombocytopenia induced by antidepressants ，and to provide reference for the rational use of clinical drugs. METHODS ：Retrieved from CNKI ，Wanfang database ，VIP，PubMed and Web of Science，during Jan. 1st in 1985 to Aug. 31st in 2020，case reports about antidepressants-induced thrombocytopenia was collected and analyzed descriptively in terms of demographic characteristics ，medication，clinical manifestations ，treatment and outcome. RESULTS：A total of 17 literatures were retrieved ，and 19 patients were included ，involving 10 male and 9 female，aged from 5 to 95 years old ，with an average of （48±24）years old. Nine kinds of drugs were involved ，including 4 cases of escitalopram ，3 cases of citalopram ，3 cases of fluoxetine ，3 cases of mirtazapine ，2 cases of amitriptyline ，1 case of sertraline ，1 case of paroxetine，1 case of mianserin and 1 case of imipramine. There were 9 cases of single drug and 10 cases of drug combination. All 19 patients suffered from thrombocytopenia at 3 d-10 years after medication ，14 of them had hemorrhage tendency. Main clinical manifestations included mucocutaneous hemorrhage ，gingival bleeding ，black stool ，hematochezia，vaginal bleeding ，ocular hemorrhage，alveolar hemorrhage. No bleeding was found in 5 cases. After drug withdrawal/changing drugs and other symptomatic treatment， platelet count of 19 patients recovered to normal ， and bleeding symptoms disappeared. CONCLUSIONS ： Thrombocytopenia caused by antidepressants has no obvious clinical features and is not easy to be found ，but it may lead to severe； bleeding symptoms if it is not found in time. The changes of platelet count should be closely monitored in clinical application of such drugs to ensure the safety of drug use.

Objective To detect the anti-citrullinated alpha-enolase peptide 1 (CEP-1) antibody in rheumatoid arthritis (RA). Methods One hundred and twenty-nine patients with RA were enrolled randomly. Thirty-one patients with primary Sj?gren's syndrome (pSS), 32 patients with systemic lupus erythematosus (SLE), 32 patients with osteoarthritis (OA), and 106 healthy controls (HC) were include into this study. Anti-CEP-1 antibody was detected by enzyme-linked immunosorbent assay (ELISA). The correlations between serum anti-CEP-1 antibody and clinical features, disease activities,laboratory tests or Sharp scores of RA patients were evaluated. Mann-Whitney U test and χ2 test were used for statistical analysis. Results ①Anti-CEP-1 antibodies were positive in 64.3%(83/129) of RA patients, 22.6%(7/32) of pSS patients, 12.5%(4/32) of SLE patients, none of OA patients (0/32) or healthy controls. The positivity of anti-CEP-1 antibody was significantly higher than those in pSS ( χ2=17.7), SLE ( χ2=25.7), OA ( χ2=42.5), and healthy controls ( χ2=102.6) (P<0.01, respectively). The specificity of anti-CEP-1 antibody in RA was 94.5%. ②In patients without anti-citrullinated protein/peptide autoantibodies (ACPA), rheumatoid factor (RF) or the patients without ACPA and RF, the positive rate of anti-CEP-1 antibody was 30.3%(10/33), 41.9%(18/43) and 22.7%(5/22), respectively. ③Compared with patients without anti-CEP-1 antibodies, patients with anti-CEP-1 anti-bodies had higher rates of joint deformity, bone erosion and high disease activities (P<0.05, respectively). ④ Higher rate of interstitial lung disease (ILD) was found in RA patients with anti-CEP-1 antibody (19.3% vs 4.3%, χ2=5.494, P<0.05). ⑤The patients with anti-CEP-1 anti-body had higher rates of elevated erythrocyte sedimentation rate (ESR) ( χ2=6.543) and decreased serum albumin ( χ2=6.59), compared to patients without anti-CEP-1 antibody (P<0.05, respectively). Conclusion Anti-CEP-1 antibody has high sensitivity and specificity for RA diagnosis. Combination of anti-CEP-1 antibody with other RA antibodies might improve the early diagnosis of RA. Anti-CEP-1 antibody is significantly associated with joint damage, disease activity and pulmonary interstitial fibrosis.