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.

BACKGROUND: Lung cancer is the first leading cause of morbidity and mortality among the malignant tumors, which has become a hot issue in current research. Clinically, lung cancer is divided into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) according to the pathological types. NSCLC includes adenocarcinoma, squamous cell carcinoma and other types of lung cancer, accounting for about 80% of all lung cancer. Venous thromboembolism (VTE) includes deep venous thrombosis (DVT) and pulmonary embolism (PE), which is a recognized complication in lung cancer patients with higher morbidity and mortality. The aim of this study is to determine the incidence of DVT and reveal the risk factors for DVT in the postoperative patients with lung cancer. METHODS: We collected 83 postoperative patients with lung cancer admitted to the Department of Lung Cancer Surgery, Tianjin Medical University General Hospital from December 2021 to December 2022. All these patients were examined by color Doppler ultrasound of lower extremity vein upon admission and after operation to analyze the incidence of DVT. In order to explore the possible risk factors for DVT in these patients, we further analyzed the correlations between DVT and their clinical features. At the same time, the changes of coagulation function and platelet were monitored to investigate the value of blood coagulation in the patients with DVT. RESULTS: DVT occurred in 25 patients after lung cancer operation, and the incidence rate of DVT was 30.1%. Further analysis found that the incidences of postoperative lower limb DVT were higher in lung cancer patients of stage III+IV or over 60 years of age (P=0.031, P=0.028). D-Dimer level in patients with thrombosis was significantly higher than that in non-thrombus patients on the 1st, the 3rd, and the 5th day after operation (P<0.05), and there was no significant difference in platelets and fibrinogen (FIB) (P>0.05). CONCLUSIONS The overall incidence of DVT in our center after lung cancer patients operation was 30.1%. Late-stage and older postpatients were more likely to develop DVT, and these patients with higher D-Dimer values should be considered the possibility of VTE events.
Humans ; Middle Aged ; Aged ; Lung Neoplasms/surgery* ; Incidence ; Carcinoma, Non-Small-Cell Lung ; Venous Thromboembolism ; Venous Thrombosis/etiology*

Background: and Purpose By measuring a newly defined parameter, the carotid–cerebral pulse wave velocity (ccPWV), this study aimed to determine the association of intracranial artery calcification (IAC) with arterial stiffness as reflected by the pulse wave velocity between the carotid and middle cerebral arteries using transcranial Doppler sonography in patients with acute stroke. Methods: We recruited 146 patients with ischemic stroke from our stroke center. Computed tomography of the head was used to assess the presence and severity of IAC. Arterial stiffness was evaluated using ccPWV. Data are presented as quartiles of ccPWV. A multivariable logistic regression model was used to assess the independent relationship between ccPWV and IAC. Results: The IAC prevalence increased with the ccPWV quartile, being 54%, 76%, 83%, and 89% for quartiles 1, 2, 3, and 4, respectively (p<0.001) as did IAC scores, with median [interquartile range] values of 0 [0–2], 3 [2–4], 4 [2–5], and 5 [4–6], respectively (p<0.001). After additionally adjusting for age and hypertension, a significant correlation was only found between quartiles 3 and 4 of ccPWV and IAC scores. The odds ratio (95% confidence interval) for the IAC scores was 1.78 (1.28–2.50) (p=0.001) in quartile 4 of ccPWV and 1.45 (1.07–1.95) (p=0.015) in quartile 3 compared with quartile 1. Conclusions We found that in patients with acute ischemic stroke, ccPWV was positively related to the degree of IAC. Future longitudinal cohort studies may help to identify the potential role of IAC in the progression of cerebral arterial stiffness.

Objective:To investigate the prognostic value of serum levels of miR-134 and miR-146b in elderly patients with acute ischemic stroke(AIS).Methods:A total of 162 elderly patients with AIS admitted to the Third People's Hospital of Haikou from January 2017 to October 2019 were enrolled.According to modified Rankin Scale(mRS)scores, they were divided into the good prognosis group(n=98, mRS score≤2)and the poor prognosis group(n=64, mRS score>2). Based on the National Institutes of Health Stroke Scale(NIHSS), patients were divide into the mild group(n=46, NIHSS score<5), moderate group(n=75, 5≤NIHSS score≤20), and severe group(n=41, NIHSS score>20). Real-time fluorescence quantitative PCR was used to detect serum levels of miR-134 and miR-146b in each group.Multivariate logistic regression was used to analyze risk factors for poor prognosis in elderly patients with AIS.The receiver operating characteristic(ROC)curve was used to analyze the value of serum miR-134 and miR-146b levels in predicting poor prognosis of elderly patients with AIS.Pearson correlation was used to analyze the correlations of serum levels of miR-134 and miR-146b with NIHSS and mRS scores in elderly patients with AIS.Results:Serum levels of miR-134(3.26±1.13 vs.0.85±0.38)and miR-146b(2.27±0.93 vs.0.56±0.21)were higher in the AIS group than in the control group( t=14.360 and 12.527, P<0.01). Serum levels of miR-134(4.35±1.46 vs.2.28±0.85)and miR-146b(3.07±1.04 vs.1.51±0.66)were higher in the poor prognosis group than in the good prognosis group( t=13.520 and 11.242, P<0.01). Serum levels of miR-134 and miR-146b in the severe group were higher than in the moderate and mild groups( t=10.815 and 9.462, P<0.01), and they were also higher in the moderate group than in the mild group( t=13.627, 11.611, P<0.01). Multivariate Logistic regression analysis showed that serum miR-134( OR=2.470, 95% CI: 1.603-4.927)and miR-146b( OR=1.914, 95% CI: 1.350-3.406)were risk factors for poor prognosis in elderly AIS patients( P<0.05). The ROC curve analysis showed that the optimal cut-off values of serum miR-134 and miR-146b to predict poor prognosis in elderly AIS patients were 3.84 and 2.68, respectively.The area under the ROC curve(AUC)of combined serum miR-134 and miR-146b(0.926, 95% CI: 0.865-0.987)for the prediction of poor prognosis was higher than that of either marker alone, with a sensitivity and specificity of 92.4% and 86.2%, respectively.The correlation analysis showed that serum levels of miR-134 and miR-146b were positively correlated with NIHSS and mRS scores in elderly AIS patients( r=0.806, 0.871, 0.785 and 0.842, all P<0.01). Conclusions:Increased serum miR-134 and miR-146b levels are correlated with the severity of neurological impairment and prognosis in elderly patients with AIS.Serum miR-134 and miR-146b levels together have a high value in predicting poor prognosis in elderly AIS patients.

Objective To establish a real-time quantitative PCR (RT-PCR) preliminary screening method for rapid detection of Brucella.Methods Based on the nucleotide sequence encoding Brucella's outer membrane proteins omp10 and omp31,four primers and probes of omp10,omp10-1,omp31 and omp31-1 were designed.The primers and probes were used to detect 19 strains of 6 categories of Brucella DNA of known organisms,10 strains of Brucella DNA that were isolated from Yuxi of Yunnan.And 224 negative Brucella DNA,including 35 strains of Bartonella DNA,103 strains of the Lord Komori enterocolitis DNA (including 4 parts of O ∶ 3 and 9 parts of O ∶ 9) and 86 samples of hybrids bacteria DNA.Then the specificity of primers and probes were evaluated based on the test results.Results The DNA of 19 standard Brucella strains could be amplified by omp10 and omp10-1,and the peak time and amplification curve of omp10 is better than omp10-1,and the DNA of negative control strains could not be amplified by omp10.The DNA of 16 standard Brucella strains could be amplified by omp31-1.The DNA of standard Brucella strains could not be amplified by omp31.The average Ct values of 10 strains of Brucella DNA which were isolated from Yuxi of Yunnan that were detected by omp10,omp10-1 and omp31-1 respectively were 19.87,19.14 and 17.52.Conclusion Omp10 has strong specificity and only specific for Brucella,so it can be used for rapid detection of Brucella.

Objective: To investigate whether plague phages were present in the indicator animals of plague foci in Yunnan Province, and to explore their epidemiological significance. Methods: Anus swabs were collected from indicator animals (dogs or cats) of the 41 plague affected villages in 26 towns of 10 cities (counties, districts) of Yunnan plague foci from November of 2015 to March of 2018. The Yersinia pestis phages were isolated by plague vaccine strain EV76. The isolation of plague phages from different plague foci, the isolation of plague phages from different canine species (cats), the polymorphism of plaque and the host spectrum of phages were analyzed. Results: A total of 1 014 indicator animals (1 003 dogs and 11 cats) were studied, and 102 of plague phages were isolated. In the 10 cities (counties, districts), plague phages were only not isolated from Lancang County, and the plague phages were isolated from the other 9 cities (counties, districts). The separation rates from high to low were as follows: Yiliang County (21.00%, 21/100), Menghai County (19.23%, 25/130), Yuanjiang County (11.63%, 10/86), Midu County (11.50%, 13/113), Wenshan County (10.10%, 10/99), Mile Country (7.07%, 7/99), Lianghe County (6.67%, 7/105), Baoshan Longyang District (4.90%, 5/102) and Gengma County (3.81%, 4/105). Of the 102 plague phages, 75 were isolated from the native dogs (Chinese pastoral dogs, 9.32%, 75/805), 20 from the pug dogs (13.70%, 20/146), 5 from the wolf dogs (17.24%, 5/29), 1 from Samoye (1/4) and 1 from Alaska dog (1/2). The plaque of the phage was divided by five appearance of complete lysis (the plate was clear), large (2.5-4.0 mm), big (1.5-< 2.5 mm), middle (0.5-< 1.5 mm) and small (< 0.5 mm). The representative phages were all of the Myoviridae family. Most of the phages could lysis the strains of Yersinia pestis, and some phages could lysis Shigella and type 5 Yersinia pseudotuberculosis (PST5). Conclusion The plague phages are present in the plague foci of Yunnan, and the phages are polymorphic.

Objective:To study the effect of exendin-4 on weight reduction in normal rats after long-term subcutaneous injection.Methods:40 Wistar rats aged 6-8 weeks were randomly divided into four groups and were injected subcutaneously with 0,1,5,25 ?g/kg exendin-4 for 26 weeks.Body weight,food intake,cholesterol,triglyceride,kidney fat pad weight and diameter of adipocytes were measured.Results:Body weight,kidney fat pad weight and serum tricyleride in 25?g/kg group were significantly lower than that in control group(P