Medication literacy directly impacts the safety of drug therapy and clinical outcomes.Patients with low medication literacy demonstrate poorer medication adherence,higher medication risks,and inferior disease control outcomes.Chronic disease patients face significant medication safety hazards due to multimorbidity and polypharmacy.Accurately assessing medication literacy can quantify individual medication capabilities and promote safe medication management.This paper reviews the structure,methods,applicable population,current applications,advantages,and limitations of medication literacy assessment tools for chronic disease patients,both domestically and internationally.The aim is to provide references for developing and applying medication literacy assessment tools for patients in China,offering a basis for scientifically evaluating medication literacy levels and formulating medication safety intervention strategies.

Objective To develop an effective intervention strategy to improve medication adherence among chronic disease patients.Methods Based on the behavior change wheel theory and integrating literature analysis,questionnaire surveys,clinical practice experience,the initial draft of the intervention strategies was developed.The intervention strategies were revised and refined through two rounds of Delphi expert consultation.Results The effective response rates for the two rounds of expert consultation questionnaires were 95%and 100%,respectively.The expert authority coefficient was 0.91.The Kendall's coefficient of concordance for the importance of the first and second rounds of expert consultation was 0.224 and 0.202,while the Kendall's coefficient of concordance for feasibility was 0.172 in the second round of expert consultation.The differences were statistically significant(P﹤0.05).The coefficient of variation of entries was 0.00-0.23.Based on the experts'feedback,adjustments were made to several items,resulting in a final intervention strategy that includes 3 primary indicators,9 secondary indicators and 41 intervention measures.Conclusion This strategy demonstrates a high level of scientific rigor and practicality,making it applicable in clinical settings to enhance medication adherence among chronic disease patients effectively,thus providing robust support for patient management.

Objective:To investigate the role of ferroptosis in renal cell injury induced by diquat (DQ) .Methods:From January to October 2022, human renal tubular epithelial (HK-2) cells were treated with DQ for 48 h, and different doses of ferroptosis inhibitors [deferoxamine (DFO), Fer-1] were added, and cells were harvested 24 h later. The experiment was divided into 6 groups ( n=6) : control group, DQ group (60 μmol/L), 20 μmol/L DFO (DFO-H) group, 10 μmol/L DFO (DFO-L) group, 5 μmol/L Fer-1 (Fer-1-H) group, 0.5 μmol/L Fer-1 (Fer-1-L) group. From December 2022 to June 2023, male C57bl/6 mice were selected to establish the animal model, and the experimental group was divided into 4 groups ( n=6) : control group, DQ group (25 mg/kg), DFO group (100 mg/kg) and Fer-1 group (2.5 μmol/kg). The changes of renal tissue were detected by HE staining. The fluorescence probe of ferrous ions was used to detect the change of iron ions in cells, and the colorimetric determination of total iron and ferrous ions in mouse kidney tissues was performed. Reverse transcription real-time quantitative polymerase chain reaction (qRT-PCR) and Western blotting were used to detect mRNA and protein expression changes related to ferroptosis signaling pathway. TUNEL staining was used to detect apoptosis. Enzyme-linked immunosorbent assay (ELISA) was used to detect the changes of antioxidant-related proteins and oxidative stress-related products. Differences among groups were analyzed by one-way analysis of variance. Results:In vitro test, compared with the control group, the iron ion level of HK-2 cells in DQ group was increased, the mRNA and protein expression levels of glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11) and ferritin heavy chain (FTH) were decreased, the mRNA and protein expression levels of transferrin receptor 1 (TFR1) and divalent metal transporter 1 (DMT1) were increased, and the apoptosis level was significantly increased ( P<0.05). The expression levels of glutathione (GSH) and super oxide dismutase (SOD) in HK-2 cells in DQ group were significantly lower than those in control group ( P<0.05), and the expression levels of malondialdehyde (MDA) and reactive oxygen species (ROS) were significantly higher than those in control group ( P<0.05). Compared with DQ group, iron ion levels in HK-2 cells in the intervention groups of DFO and Fer-1 at different doses were decreased ( P<0.001), and GPX4, SLC7A11 and FTH mRNA and protein expression levels were increased, and the mRNA and protein expression levels of TFR1 and DMT1 were decreased in DFO-H and DFO-L groups ( P<0.05). The apoptosis levels in the intervention groups of DFO and Fer-1 at different doses were decreased compared with DQ group ( P<0.001), the expression levels of GSH and SOD were higher than those in DQ group ( P<0.05), and the expression levels of ROS were lower than those in DQ group ( P<0.05). In vivo, HE staining showed that the renal tissue of DQ group mice had obvious renal tubular epithelial cell injury with inflammatory cell infiltration. Compared with DQ group, DFO group and Fer-1 group had less damage of renal tubular epithelial cells and less inflammatory cell infiltration. Compared with the control group, the total iron content and ferrous iron content in kidney tissue of mice in DQ group were increased, the mRNA and protein expression levels of GPX4, SLC7A11 and FTH were decreased, the mRNA and protein expression levels of TFR1 and DMT1 were increased, and the apoptosis level was increased in DQ group ( P<0.05). The levels of GSH and SOD in DQ group were lower than those in control group, while the levels of MDA and ROS in DQ group were higher than those in control group ( P<0.05). Compared with DQ group, the total iron content and ferrous iron content in DFO group, and ferrous iron content in Fer-1 group were decreased ( P<0.001), the mRNA and protein expression levels of GPX4, SLC7A11 and FTH in kidney tissues of mice in DFO group and Fer-1 group were increased ( P<0.05), and the mRNA and protein expression levels of TFR1 and DMT1 were decreased ( P<0.05). The level of apoptosis in DFO group and Fer-1 group was lower than that in DQ group ( P<0.001). Compared with DQ group, the expression levels of GSH in kidney tissues, and the expression levels of SOD in serum and kidney tissues in DFO group were increased ( P<0.05), and the expression levels of GSH and SOD in serum and kidney tissues in Fer-1 group were increased ( P<0.05). The expression levels of MDA and ROS in serum and kidney tissues of DFO group and Fer-1 group were lower than those of DQ group ( P<0.05) . Conclusion:Ferroptosis may be involved in renal cell injury induced by DQ poisoning, and ferroptosis inhibitor may alleviate DQ-induced renal injury by inhibiting ferroptosis.

Objective:To investigate the role of ferroptosis in renal cell injury induced by diquat (DQ) .Methods:From January to October 2022, human renal tubular epithelial (HK-2) cells were treated with DQ for 48 h, and different doses of ferroptosis inhibitors [deferoxamine (DFO), Fer-1] were added, and cells were harvested 24 h later. The experiment was divided into 6 groups ( n=6) : control group, DQ group (60 μmol/L), 20 μmol/L DFO (DFO-H) group, 10 μmol/L DFO (DFO-L) group, 5 μmol/L Fer-1 (Fer-1-H) group, 0.5 μmol/L Fer-1 (Fer-1-L) group. From December 2022 to June 2023, male C57bl/6 mice were selected to establish the animal model, and the experimental group was divided into 4 groups ( n=6) : control group, DQ group (25 mg/kg), DFO group (100 mg/kg) and Fer-1 group (2.5 μmol/kg). The changes of renal tissue were detected by HE staining. The fluorescence probe of ferrous ions was used to detect the change of iron ions in cells, and the colorimetric determination of total iron and ferrous ions in mouse kidney tissues was performed. Reverse transcription real-time quantitative polymerase chain reaction (qRT-PCR) and Western blotting were used to detect mRNA and protein expression changes related to ferroptosis signaling pathway. TUNEL staining was used to detect apoptosis. Enzyme-linked immunosorbent assay (ELISA) was used to detect the changes of antioxidant-related proteins and oxidative stress-related products. Differences among groups were analyzed by one-way analysis of variance. Results:In vitro test, compared with the control group, the iron ion level of HK-2 cells in DQ group was increased, the mRNA and protein expression levels of glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11) and ferritin heavy chain (FTH) were decreased, the mRNA and protein expression levels of transferrin receptor 1 (TFR1) and divalent metal transporter 1 (DMT1) were increased, and the apoptosis level was significantly increased ( P<0.05). The expression levels of glutathione (GSH) and super oxide dismutase (SOD) in HK-2 cells in DQ group were significantly lower than those in control group ( P<0.05), and the expression levels of malondialdehyde (MDA) and reactive oxygen species (ROS) were significantly higher than those in control group ( P<0.05). Compared with DQ group, iron ion levels in HK-2 cells in the intervention groups of DFO and Fer-1 at different doses were decreased ( P<0.001), and GPX4, SLC7A11 and FTH mRNA and protein expression levels were increased, and the mRNA and protein expression levels of TFR1 and DMT1 were decreased in DFO-H and DFO-L groups ( P<0.05). The apoptosis levels in the intervention groups of DFO and Fer-1 at different doses were decreased compared with DQ group ( P<0.001), the expression levels of GSH and SOD were higher than those in DQ group ( P<0.05), and the expression levels of ROS were lower than those in DQ group ( P<0.05). In vivo, HE staining showed that the renal tissue of DQ group mice had obvious renal tubular epithelial cell injury with inflammatory cell infiltration. Compared with DQ group, DFO group and Fer-1 group had less damage of renal tubular epithelial cells and less inflammatory cell infiltration. Compared with the control group, the total iron content and ferrous iron content in kidney tissue of mice in DQ group were increased, the mRNA and protein expression levels of GPX4, SLC7A11 and FTH were decreased, the mRNA and protein expression levels of TFR1 and DMT1 were increased, and the apoptosis level was increased in DQ group ( P<0.05). The levels of GSH and SOD in DQ group were lower than those in control group, while the levels of MDA and ROS in DQ group were higher than those in control group ( P<0.05). Compared with DQ group, the total iron content and ferrous iron content in DFO group, and ferrous iron content in Fer-1 group were decreased ( P<0.001), the mRNA and protein expression levels of GPX4, SLC7A11 and FTH in kidney tissues of mice in DFO group and Fer-1 group were increased ( P<0.05), and the mRNA and protein expression levels of TFR1 and DMT1 were decreased ( P<0.05). The level of apoptosis in DFO group and Fer-1 group was lower than that in DQ group ( P<0.001). Compared with DQ group, the expression levels of GSH in kidney tissues, and the expression levels of SOD in serum and kidney tissues in DFO group were increased ( P<0.05), and the expression levels of GSH and SOD in serum and kidney tissues in Fer-1 group were increased ( P<0.05). The expression levels of MDA and ROS in serum and kidney tissues of DFO group and Fer-1 group were lower than those of DQ group ( P<0.05) . Conclusion:Ferroptosis may be involved in renal cell injury induced by DQ poisoning, and ferroptosis inhibitor may alleviate DQ-induced renal injury by inhibiting ferroptosis.

Medication literacy directly impacts the safety of drug therapy and clinical outcomes.Patients with low medication literacy demonstrate poorer medication adherence,higher medication risks,and inferior disease control outcomes.Chronic disease patients face significant medication safety hazards due to multimorbidity and polypharmacy.Accurately assessing medication literacy can quantify individual medication capabilities and promote safe medication management.This paper reviews the structure,methods,applicable population,current applications,advantages,and limitations of medication literacy assessment tools for chronic disease patients,both domestically and internationally.The aim is to provide references for developing and applying medication literacy assessment tools for patients in China,offering a basis for scientifically evaluating medication literacy levels and formulating medication safety intervention strategies.

Objective To develop an effective intervention strategy to improve medication adherence among chronic disease patients.Methods Based on the behavior change wheel theory and integrating literature analysis,questionnaire surveys,clinical practice experience,the initial draft of the intervention strategies was developed.The intervention strategies were revised and refined through two rounds of Delphi expert consultation.Results The effective response rates for the two rounds of expert consultation questionnaires were 95%and 100%,respectively.The expert authority coefficient was 0.91.The Kendall's coefficient of concordance for the importance of the first and second rounds of expert consultation was 0.224 and 0.202,while the Kendall's coefficient of concordance for feasibility was 0.172 in the second round of expert consultation.The differences were statistically significant(P﹤0.05).The coefficient of variation of entries was 0.00-0.23.Based on the experts'feedback,adjustments were made to several items,resulting in a final intervention strategy that includes 3 primary indicators,9 secondary indicators and 41 intervention measures.Conclusion This strategy demonstrates a high level of scientific rigor and practicality,making it applicable in clinical settings to enhance medication adherence among chronic disease patients effectively,thus providing robust support for patient management.

Novel therapeutic approaches targeting key genes and regulatory molecules of hepatocellular carcinoma (HCC) have gradually been carried out in clinical practice. Hypoxia-inducible factor (HIF), as a critical factor for hepatocellular carcinoma cells to adapt to the hypoxic microenvironment, mediates changes in the transcription of many genes. HIF has a wide range of target genes and can promote metabolic reprogramming, angiogenesis, invasion and metastasis, and immune escape of cancer cells by regulating various signaling pathways. Hypoxia-inducible factor 1α (HIF-1α), as the main member of the HIF family, can provide new ideas and insights for exploring potential targets for HCC treatment.

OBJECTIVE To explore the hotspots of aging adaptation of drug package inserts， and to provide evidence for the development of aging adaptation of drug package inserts in China. METHODS The relevant English literature on drug package inserts for the elderly published from 2012 to 2022 was retrieved from Web of Science Core Collection； bibliometric analysis was performed by using VOSviewer and CiteSpace software， to explore research hotspots in this field， and summarize obstacles and solutions for the development of this field. RESULTS & CONCLUSIONS This study collected a total of 335 literature related to the aging adaption of drug package inserts， from 819 research institutions in 51 countries （regions）， involving 2 174 authors. The research development of drug package insert adaptation for the elderly has slowed down in the past decade， and developed countries such as the United States and Japan dominate this field. Authors such as Wolf from Northwestern University in the United States， have the largest number of publications（12 literature）. The research focuses in this field include the risk management of medication for the elderly， the updating of medication information for the elderly in drug package inserts， and the understanding and compliance of the elderly with drug package inserts and their influencing factors. The solutions to related obstacles in the development of aging adaption in drug package inserts include improving the visibility and readability of drug package inserts， filling in the information on elderly medication in drug package inserts， and so on. China can learn from the experiences and methods of other countries， conduct investigations into the influencing factors of elderly package inserts and pharmacokinetic studies based on the characteristics of the Chinese population， and improve the safety of medication for elderly patients in multiple dimensions.

Objective To analyze the differences in aging-related information between Chinese and American drug instruction for common chronic disease in the elderly,and to propose policy recommendations for the aging-related drug instruction in China.Methods Ten common chronic disease treatment drugs for elderly patients were selected,and through the random sampling method,the drug manuals of one domestic manufacturer were randomly selected for each drug by the random number method,and one American drug manual was selected as a sample from the dailymed website,and the information related to elderly people in the various items of the drug manuals was statistically analyzed by using Excel for comparative analysis.The average reading level of the patient version of the U.S.drug instructions was calculated using the Readability Formulas Scoring System;the readability of the Chinese drug instructions was assessed by the Health Education Text Material Suitability Scale.Results Compared with the U.S.drug instruction,the drug instruction for common chronic diseases of the elderly in China were updated less frequently and at a slower pace;the drug instruction with information on medication for elderly patients were fewer than those of the U.S.drug instruction,and the content of the drug instruction was not well documented;and the drug instruction were poorly readable,which was not conducive to the comprehension of the elderly patients.Conclusion China is in urgent need of reforming the aging of drug instructions,and it is recommended that,for chronic disease medications for elderly patients,we should increase the number of clinical trials conducted on the elderly,improve and complete the drug information for the elderly in the drug instructions,and produce"drug instructions for elderly patients"that are suitable for the elderly to read and understand.

Objective To explore the current status of medication literacy among urban elderly patients with chronic diseases in Anhui Province,aiming to reveal the factors influencing their medication literacy,and to propose targeted measures for improvement.Methods This research involved 381 participants aged 60 and above.It was conducted in Anhui province between December,2022 and January,2023,with data collected through face-to-face interviews by pharmacists.Single-factor analysis and ordinal multi-class logistic regression analysis were conducted to determine factors affecting medication literacy.Results Medication literacy cognition and medication literacy behavior were rated as good among urban older adults in Anhui province of the 294 valid questionnaires.Those who did not understood package insert exhibited significantly lower medication literacy behavior than those who fully understood[estimate=-1.224,95%CI=(-2.130,-0.317),P<0.01].Elderly patients with chronic diseases faced issues such as an inability to read or understand drug instructions in the investigation.90.48%of elderly patients with chronic diseases never heard or seldom heard of medication guidance services.Conclusion Medication literacy among urban elderly patients with chronic diseases is generally good in Anhui province.The ability to understood drug instructions significantly influenced the medication literacy of urban elderly patients with chronic diseases.Modifying the drug instructions to meet the reading needs of the elderly patients with chronic diseases and developing pharmaceutical care could effectively enhance rational drug use among this demographic.