OBJECTIVE To formulate Guidelines for the standardized implementation of pharmacist-managed clinics （ 2026 edition ） in response to the challenges faced by such clinics in China， including uneven development， large discrepancies in service specifications， insufficient patient awareness， and limited medical insurance coverage. METHODS Led by the Pharmaceutical Affairs Professional Committee of the Chinese Hospital Association， the Evidence-based Pharmacy Professional Committee of the Chinese Pharmaceutical Association， and the Hospital Pharmacy Professional Committee of the Cross-strait Medical and Health Exchange Association， a total of 19 domestic hospital pharmacy experts were organized. Through a systematic review of national policies and literature research， current practical experience was summarized. Consensus on the contents of the guidelines was reached after in-depth discussions. RESULTS &CONCLUSIONS The guidelines covered five sections： definition and connotation of pharmacist-managed clinics， establishment requirements， implementation and management， post competency， and practical research. Firstly， the definition and connotation included three operational forms of pharmacist-managed clinics （independent mode， physician-pharmacist joint mode， and online pharmacist-managed clinic mode） and classified service modes （specialty-specific， drug-specific， and disease-specific pharmacist-managed clinics）. The establishment requirements were further refined， covering system construction （pharmaceutical service management system， quality control and assessment mechanism）， personnel qualifications （professional credentials， continuing education and professional training， etc）， service recipients， as well as service venues and facilities. Subsequently， the implementation and management of pharmacist-managed clinics were proposed， involving service procedures， intervention measures， documentation and records， patient education and follow-up， humanistic care， as well as risk management and quality control. Finally， post competency encompassed the competency requirements for pharmacists providing services in pharmacist-managed clinics， as well as the suggestions on teaching methods； practical research encouraged the conduct of high-quality pharmaceutical practice in the setting of pharmacist-managed clinics. The guidelines provide valuable guidance for the standardized implementation of pharmacist-managed clinics in China in terms of establishment， management， teaching， and research， fill the guideline gap in this field， and can promote the high-quality development of pharmacist-managed clinics.

Objective To explore the predictive efficacy of several multimodal MRI-based machine learning models for the promoter methylation states of O6-methylguanine-DNA methyltransferase(MGMT)of glioblastoma muliforme(GBM)patients in terms of the GBM heterogeneity and the complexity of the tumor microenvironment.Methods Firstly,the multimodal MRI images of 317 GBM patients from The University of Pennsylvania Glioblastoma(UPENN-GBM)dataset were pre-processed,with four sequences involved in including T1-weighted imaging(T1WI)sequence,T1-weighted contrast-enhanced imaging(T1CE)sequence,T2-weighted imaging(T2WI)sequence and fluid-attenuated inversion recovery(FLAIR)sequence,and the radiomics features were extracted for two regions of interest(ROIs)such as the tumor core region and the tumor edema region.Secondly,the data of the 317 GBM patients were randomly divided into a training set(254 cases)and a test set(63 cases),which underwent normalization with Z-scores and feature selection and dimensionality reduction with Lasso regression.Finally,three models were established respectively with particle swarm optimization-support vector machine(PSO-SVM),C-support vector classification(C-SVC)and adaptive boosting(adaptive boosting(Adaboost)algorithms,and the predictive efficacy of the three models for glioblastoma multiforme MGMT promoter methylation states were evaluated in terms of accuracy and AUC.Results The Adaboost model based on T2WI sequence and radiomics features of the tumor core region had the highest predictive efficacy with accuracy and AUC values of 67％and 0.74,respectively,higher than those of other combinations of sequences,models and regions of interest.Conclusion The multimodal MRI-based machine learning models can be used for the prediction of glioblastoma multiforme MGMT promoter methylation states,which provides powerful support for personalized treatment and prognostic assessment of GBM.[Chinese Medical Equipment Journal,2025,46(6):7-13]

Objective:To investigate the role of aging-related genes(ARGs)in the prognosis of lung squamous cell carcinoma(LUSC)and establish a novel prognostic prediction model.Methods:Transcriptomic data and clinical information of LUSC patients were obtained from TCGA,combined with ARGs from Aging Atlas.Key genes were screened through differential expression analysis,survival analysis,and Cox regression to construct a prognostic model.Model performance was validated in clinical subgroups,and biological pathway enrichment(GSEA)and immune microenvironment analyses were performed.Results:Five ARGs(ERFFI1,MDH1,SENP2,SNAI1,TP63)were identified to build the model.Significant survival differences were observed between high-and low-risk groups(P＜0.001),with 1-,3-,and 5-year AUC values of 0.610,0.668,and 0.665,respectively.The risk score was an independent prognostic factor(HR=11.261,95％CI:3.654-34.701,P＜0.001)and showed predictive efficacy in both early-stage(Ⅰ-Ⅱ,P=0.022)and advanced-stage(Ⅲ-Ⅳ,P=0.004)patients.GSEA revealed significant enrichment of Alzheimer's disease(P=0.003)and cell adhesion pathways(P=0.008)in high-risk groups.SNAI1 correlated positively with M1/M2 macrophage infiltration(r=0.45,P＜0.001),MDH1 associated with 12 immune cell types(|r|＞0.3,P＜0.05),and the risk score linked to CD8+T cells(r=0.38)and M2 macrophages(r=0.32)(both P＜0.001).Twenty-three immune checkpoints(e.g.,TNFRSF14,CD200R1)were differentially expressed between groups and survival-related(P＜0.05).High-risk patients exhibited elevated TIDE scores(P＜0.001),indicating enhanced immune suppression.Conclusion:This model provides a novel tool for LUSC prognosis assessment,but further clinical validation is required.

Objectives:To describe the use of antihypertensive, antidiabetic and lipid-lowering drugs, and evaluate the effects on blood pressure, blood glucose and blood lipids controls required by Chinese Guideline on the Primary Prevention of Cardiovascular Diseases (the guideline) in a community-based cohort of individuals at high risk for cardiovascular disease. To analyze the association of the uses of antihypertensive, antidiabetic and lipid-lowering drugs, and the comprehensive control of blood pressure, blood glucose and blood lipids with cardiovascular disease. Methods:From the CHinese Electronic health Records Research in Yinzhou (CHERRY), those who were at high risk for cardiovascular disease and aged 40-75 years as of January 1, 2013 in in Yinzhou District of Ningbo, Zhejiang Province were selected as study subjects. The information about their antihypertensive, antidiabetic, and lipid-lowering drug uses between 2013 and 2015 was collected, and blood pressure, blood glucose, and blood lipid measurements were conducted during the follow-up. The study constructed two kinds of comprehensive scores: the comprehensive medication score based on the guideline requirement for the treatment of hypertension, diabetes and hyperlipidemia, dividing the study participants into the compliancy group and non-compliancy group; and the comprehensive control score based on the guideline requirement for blood pressure, blood glucose, and blood lipids control, dividing the study participants into better control group, moderate control group, and poor control group. Cox proportional hazards regression model was used to analyze the association of the comprehensive medication score and comprehensive control score with cardiovascular disease. The incidence data of cardiovascular disease were collected from January 1, 2015 (baseline time) to August 31, 2020 (follow up end time).Results:A total of 79 734 participants at high risk for cardiovascular disease were included in the study, in whom 68.4%, 27.4%, and 4.2% had 1, 2, or 3 cardiometabolic conditions (hypertension, diabetes, or hyperlipidemia), respectively. In the participants with hypertension, diabetes, and hyperlipidemia from 2013 to 2015, the proportions of those who had two years of medication compliancy records were 66.0%, 67.4%, and 13.9%, respectively. In the hypertension patients, 59.2% had better blood pressure control, in the diabetes patients, 28.7% had better blood glucose control, and in the patients with hyperlipidemia, 27.4% had better blood lipid control. After a median follow-up of 5.66 years, 4 088 cardiovascular disease cases or deaths occurred. After multivariate adjustment, compared with the non-compliancy group, the compliancy group had lower risk for cardiovascular disease ( HR=0.91, 95% CI: 0.85-0.96). Compared with the better control group, the poor control group had an increased risk for cardiovascular disease ( HR=1.67, 95% CI: 1.53-1.81). In the moderate control group, the risk increased significantly in the diabetes patients ( HR=1.29, 95% CI: 1.07-1.56), while no additional risk for cardiovascular disease was observed in non-diabetes patients ( HR=1.06, 95% CI: 0.97-1.16). Conclusions:Compliancy to the medication required by the guideline is associated with lower risk for cardiovascular disease. However, it is still necessary to improve the medication compliancy in people at high risk in primary prevention, especially in the patients with hyperlipidemia, due to their low taking rate of lipid-lowering drugs. Additionally, as the requirement of the guideline becomes more stringent, the management of disease has met more challenges. Notably, diabetes patients who have not met the guideline requirement are at high risk for cardiovascular disease, to whom the disease management should be strengthened.

Objective:To investigate the role of aging-related genes(ARGs)in the prognosis of lung squamous cell carcinoma(LUSC)and establish a novel prognostic prediction model.Methods:Transcriptomic data and clinical information of LUSC patients were obtained from TCGA,combined with ARGs from Aging Atlas.Key genes were screened through differential expression analysis,survival analysis,and Cox regression to construct a prognostic model.Model performance was validated in clinical subgroups,and biological pathway enrichment(GSEA)and immune microenvironment analyses were performed.Results:Five ARGs(ERFFI1,MDH1,SENP2,SNAI1,TP63)were identified to build the model.Significant survival differences were observed between high-and low-risk groups(P＜0.001),with 1-,3-,and 5-year AUC values of 0.610,0.668,and 0.665,respectively.The risk score was an independent prognostic factor(HR=11.261,95％CI:3.654-34.701,P＜0.001)and showed predictive efficacy in both early-stage(Ⅰ-Ⅱ,P=0.022)and advanced-stage(Ⅲ-Ⅳ,P=0.004)patients.GSEA revealed significant enrichment of Alzheimer's disease(P=0.003)and cell adhesion pathways(P=0.008)in high-risk groups.SNAI1 correlated positively with M1/M2 macrophage infiltration(r=0.45,P＜0.001),MDH1 associated with 12 immune cell types(|r|＞0.3,P＜0.05),and the risk score linked to CD8+T cells(r=0.38)and M2 macrophages(r=0.32)(both P＜0.001).Twenty-three immune checkpoints(e.g.,TNFRSF14,CD200R1)were differentially expressed between groups and survival-related(P＜0.05).High-risk patients exhibited elevated TIDE scores(P＜0.001),indicating enhanced immune suppression.Conclusion:This model provides a novel tool for LUSC prognosis assessment,but further clinical validation is required.

[Purpose]To analyze the trend of prostate cancer mortality in China from 2011 to 2020,and to predict the prostate cancer mortality trend from 2021 to 2030.[Methods]The data were collected from the National Mortality Surveillance System(NMSS)from 2011 to 2020,the burden of prostate cancer in China from 2011 to 2020 were analyzed by the number of deaths,age-standardized mortality rate(ASMR),years of life lost(YLL)and age-standardized YLL rate.Joinpoint regression model was used to calculate the average annual percentage change(AAPC)to describe the trend of change.The Bayesian age-period-cohort model was used to predict the mor-tality rate of prostate cancer from 2021 to 2030 and estimate the number of deaths of prostate can-cer in the future.Decomposition analysis was carried out to explore the potential drivers of changes of mortality.[Results]The number of prostate cancer deaths in China in 2020 was 30 805 with an ASMR of 5.56/105.The ASMR for prostate cancer in urban and rural areas was 6.56/105 and 4.84/105,respectively.From 2011 to 2020,the number of prostate cancer deaths,ASMR and age-standardized YLL rate of prostate cancer in China showed an upward trend,AAPC was 5.4％(95％CI:4.7％～6.1％),1.5％(95％CI:1.4％～1.6％)and 1.1％(95％CI:1.1％～1.2％),respective-ly.The ASMR of prostate cancer was higher in the eastern region than those in the central and western regions.Prostate cancer deaths increased in both urban and rural areas among people aged 60 years old and above.In 2030,it is predicted the ASMR of prostate cancer would increase to 5.74/105.Population aging,changes in age-specific mortality rates,and natural population growth accounted for 24.75％,2.77％,and 7.45％of the changes in total deaths of prostate can-cer,respectively.[Conclusion]The burden of prostate cancer is increasing in China.Targeted measures should be implemented in high-risk areas and high-risk groups to effectively reduce the disease burden caused by prostate cancer.

Objective To determine the application effect of esketamine pretreatment in laparoscopic high ligation of hernia sac in children.Methods A total of 70 children who received laparoscopic high ligation of hernia sac under general anesthesia were selected and divided into the control group and the observation group according to the random number table method,with 35 cases in each group.The control group received conventional general anesthesia,while the observation group was intravenously injected with 0.5 mg/kg of esketamine 15 minutes before the induction of general anesthesia.The preoperative anxiety score,respiratory mechanics indexes,lung injury status,anesthesia recovery,and adverse reactions during the awakening period were compared between the two groups.Results The anxiety scores of the observation group 10 minutes before anesthesia and immediately before anesthesia were significantly lower than those of the control group(P<0.05).The peak airway pressure and mean airway pressure of the observation group 30 minutes after establishing pneumoperitoneum and at the end of the operation were significantly lower than those of the control group(P<0.05).The levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)at the end of the operation in the observation group were significantly lower than those in the control group(P<0.05).There was no statistically significant difference in the time of spontaneous breathing recovery,time to regain consciousness,tracheal extubation time,or post-anesthesia care unit(PACU)stay time between the two groups(P>0.05).The incidence of adverse reactions during the anesthetic awakening period in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Esketamine pretreatment can significantly alleviate preoperative separation anxiety for children undergoing laparoscopic high ligation of hernia sac,reduce lung injury,and decrease airway pressure,which is beneficial to lung protection and postoperative anesthetic recovery,and has few adverse reactions.

Numerous studies on the formation and consolidation of memory have shown that memory processes are characterized by phase-dependent and dynamic regulation. Memory retrieval, as the only representation of memory content and an active form of memory processing that induces memory reconsolidation, has attracted increasing attention in recent years. Although the molecular mechanisms specific to memory retrieval-induced reconsolidation have been gradually revealed, an understanding of the time-dependent regulatory mechanisms of this process is still lacking. In this study, we applied a transcriptome analysis of memory retrieval at different time points in the recent memory stage. Differential expression analysis and Short Time-series Expression Miner (STEM) depicting temporal gene expression patterns indicated that most differential gene expression occurred at 48 h, and the STEM cluster showing the greatest transcriptional upregulation at 48 h demonstrated the most significant difference. We then screened the differentially-expressed genes associated with that met the expression patterns of those cluster-identified genes that have been reported to be involved in learning and memory processes in addition to dipeptidyl peptidase 9 (DPP9). Further quantitative polymerase chain reaction verification and pharmacological intervention suggested that DPP9 is involved in 48-h fear memory retrieval and viral vector-mediated overexpression of DPP9 countered the 48-h retrieval-induced attenuation of fear memory. Taken together, our findings suggest that temporal gene expression patterns are induced by recent memory retrieval and provide hitherto undocumented evidence of the role of DPP9 in the retrieval-induced reconsolidation of fear memory.
Animals ; Fear/physiology* ; Male ; Dipeptidyl-Peptidases and Tripeptidyl-Peptidases/genetics* ; Memory Consolidation/physiology* ; Time Factors ; Mental Recall/drug effects* ; Mice ; Gene Expression Profiling

Apical microsurgery is accurate and minimally invasive, produces few complications, and has a success rate of more than 90%. However, due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists, many clinical problems remain to be overcome. The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus. This document specifies the indications, contraindications, preoperative preparations, operational procedures, complication prevention measures, and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.
Microsurgery/standards* ; Humans ; Apicoectomy ; Contraindications, Procedure ; Tooth Apex/diagnostic imaging* ; Postoperative Complications/prevention & control* ; Consensus ; Treatment Outcome