OBJECTIVE To investigate a dynamic monitoring of drug consumption （DMDC） model based on the seasonal Mann-Kendall trend test， aiming to provide scientific evidence for the efficient and macroscopic monitoring of drug use. METHODS A monitoring list of key outpatient drugs was established based on the top 20% of drugs ranked by sales volume in the outpatient pharmacy in October 2024. A DMDC model based on the Mann-Kendall trend test was constructed using the monthly usage data of key outpatient drugs from November 2021 to October 2024， aiming to eliminate the impact of seasonal fluctuations and analyze the temporal trends in drug consumption. Taking mucolytic expectorants， triazole derivatives for dermatophytosis， and single-agent hydroxymethylglutaryl coenzyme A （HMG-CoA） reductase inhibitors as examples， the monitoring effectiveness of the DMDC model was demonstrated， and its performance was compared with that achieved by the traditional sequential growth rate ranking method. RESULTS A total of 215 drug varieties were included in the monitoring list， and DMDC models were successfully established for all of them. Among these， 119 showed a significant increasing trend （P＜0.05， S′＞0）. The model successfully monitored the monthly consumption of mucolytic expectorants， triazole derivatives for dermatophytosis， and single- agent HMG-CoA reductase inhibitors. The precision and recall rates of the DMDC model for identifying abnormal drug use were 60.7% and 85.0%， respectively， both significantly higher than those of the sequential growth rate ranking method （8.3% and 15.0%， respectively） （χ2＝20.114， P＜0.001； χ2＝19.600， P＜0.001）. CONCLUSIONS DMDC model based on the seasonal Mann-Kendall trend test can effectively identify long-term trends in drug consumption， eliminate seasonal interference， enhance monitoring accuracy and management efficiency， and is suitable for the dynamic monitoring of drug consumption.

OBJECTIVE To provide scientific evidence and practical references for refined antimicrobial stewardship in multi- branch medical institutions. METHODS Data of antibiotic use density （AUD） of inpatients as well as physician-level case mix index （CMI） were collected from the Liji Road main campus and Panlongcheng branch campus of our hospital from August 2023 to March 2026. The two-factor decomposition method was adopted to decompose total AUD variation into a level effect and structural effect. Grey relational analysis （GRA） was performed to quantify the correlation degree between ward CMI， physician CMI and physician AUD， so as to identify wards and physicians requiring targeted key intervention in different campuses. A refined antimicrobial management framework for multi-branch hospitals was constructed and implemented based on the above analytical results. An interrupted time series （ITS） model incorporating seasonal dummy variables was applied. The research period was divided into pre-intervention stage （August 2023 to March 2024） and post-intervention stage （April 2024 to March 2026）. The temporal changing trends of AUD in two campuses were compared to evaluate management efficacy. RESULTS Driving factors for AUD variation presented significant heterogeneity between the two campuses. AUD variation in the main campus was dominated by level effect， while AUD variation in the branch campus was jointly affected by structural effect and level effect. The grey relational degrees of ward CMI and physician CMI with physician AUD were 0.901 and 0.882， respectively. After refined management implementation， AUD decreased by 7.48 DDDs/（100 bed·days） and 20.54 DDDs/（100 bed·days） in the main campus and branch campus， respectively； the rising trends of AUD in both campuses reversed to declining trends after intervention. CONCLUSIONS Driving factors of AUD variation under the multi-branch hospital model show obvious inter-campus heterogeneity. CMI is highly correlated with AUD. The refined management system developed via AUD attribution decomposition and CMI correlation analysis matches the differentiated clinical characteristics of multi- branch hospitals and effectively improves the precision of antimicrobial stewardship.

Objective To investigate alteration in brain gray matter volume in kidney transplant recipients(KTRs)and its correlation with post-traumatic stress symptoms(PTSS)in KTRs so as to provide neuro-imaging evidence for early detection and intervention of PTSS in KTRs.Methods Forty-six KTRs and 46 age-,sex-,and education-matched heath control(HCs)underwent brain MRI scanning with 3D T1-weighted structural images.Voxel-based morphometry(VBM)was applied to compare the gray matter volume between the two groups.For regions with significant differences in gray matter volume between KTRs and HCs,we analyzed the correlations with the Impact of Event Scale-Revised(IES-R)scores,which assess the severity of PTSS.Results Compared to HCs,KTRs showed significant reductions in gray matter volume in the bilateral precentral gyrus,middle frontal gyrus,supplementary motor area,medial paracingulate gyrus,and bilateral middle temporal gyrus(all P＜0.05,TFCE-FWE correction).The gray matter volume of the left middle frontal gyrus in KTRs was negatively correlated with their IES-R scores(r=-0.235,P=0.022).Conclusion KTRs exhibit abnormal gray matter volume,and the gray matter volume of the left middle frontal gyrus is correlated with the severity of PTSS.

The research status and common methods of the Four Tantras are summarized by bibliographic methods.The"philosophy,biology,society,geography,psychology and medicine"model of Tibetan medicine inheritance innovation in the Four Tantras was used to explore the historical necessity of interdisciplinary integration of the Four Tantras.It combines the latest technology and methods at the forefront of systems science,philosophical science,psychological science,astronomy,biological science,geographic science,ecological science,medical science,as well as modern biotechnology and digital technology into the innovation of Tibetan medical heritage.It is also put forward the idea of multidisciplinary intersection and large integration research of the Four Tantras and Tibetan medicine,as well as a new paradigm of systematic Tibetan medicine research that reflects a systemic and holistic view.The culture,theoretical basis and scientific connotation of Tibetan medicine contained in the Four Tantras are preliminarily clarified,which provides basic ideas for the inheritance and innovation of Tibetan medicine.

Objective:To evaluate the long-term oncological outcomes of partial nephrectomy(PN)in patients with renal cell carcinoma(RCC)who were clinically staged as clinical T1(cT1)preoperatively but upstaged to pathological T3a(pT3a)after surgery.Methods:A total of 427 RCC patients postopera-tively diagnosed as pT3aN0M0 at Peking University Third Hospital from February 2013 to December 2022 were retrospectively reviewed.Among them,33 cT1 patients upstaged to pT3a RCC received PN(PN group),while 394 non-upstaged pT3a RCC patients underwent radical nephrectomy(RN,RN group).Propensity score matching was performed at a 1∶1 ratio based on baseline characteristics.The Kaplan-Meier method was used to assess overall survival(OS),cancer-specific survival(CSS),and disease-free survival(DFS),with Log-rank tests and Cox regression models for multivariate analysis.Results:Before matching,the PN group(n=33)had significantly higher rates of perirenal fat invasion(PFI,45.5％vs.15.2％)and segmental renal vein involvement(42.4％vs.20.8％),but lower rates of renal sinus invasion(RSI,21.2％vs.73.6％)and renal vein tumor thrombus(0％vs.15.2％)compared with the RN group(n=394,all P＜0.05).After matching,baseline characteristics were comparable between the PN group(n=33)and RN group(n=33).No significant differences were observed in operative time,blood loss,mean hospital stay,complication rate,positive margin rate,or conversion to open surgery between the two groups(P＞0.05).However,the PN group showed significantly higher estimated glomerular filtration rate(eGFR)postoperatively[76.9(55.4,87.3)mL/(min·1.73 m2)vs.61.7(56.8,73.5)mL/(min·1.73 m2),P＜0.05],indicating better renal function preserva-tion.No significant differences were found in OS,CSS,or DFS between the groups(P＞0.05).Multi-variate ana-lysis identified renal vein invasion(RVI),higher Fuhrman grades(Ⅲ-Ⅳ),and sarcoma-toid differentiation as independent risk factors for DFS and CSS in the pT3a RCC patients(P＜0.05).Conclusion:For cT1 RCC patients upstaged to pT3a,PN preserves renal function more effectively while achieving com-parable oncological outcomes to RN.RVI,higher Fuhrmann grade,and sarcomatoid differentiation are independent risk factors for pT3N0M0 RCC patients.

Objective To observe the effects of Yiqi Huoxue Prescription in regulating METTL3/HAND2/TGF-β1 signaling axis on rats with qi deficiency and blood stasis syndrome of coronary heart disease.Methods Totally 48 male SD rats were randomly divided into sham-operation group,model group,Yiqi Huoxue Prescription group and Western medicine(isosorbide mononitrate)group,with 12 rats in each group.Except for the sham-operation group,the animal models of coronary heart disease with qi deficiency and blood stasis syndrome were prepared by the method of ligation of the left anterior descending branch of coronary artery combined with swimming exhaustion.After modeling,Yiqi Huoxue Prescription group and the Western medicine group were gavaged for 28 d.The general conditions of the rats were observed,and electrocardiograms and echocardiograms were collected to detect the cardiac function of the rats,blood rheology was used to detect the degree of blood stasis,HE staining was used to observe the morphology of myocardial tissue,immunohistochemistry was used to detect the expression of METTL3,TGF-β1,Smad2 and Smad3 in myocardial tissue,RT-PCR and Western blot were used to detect the expression of METTL3,HAND2,TGF-β1,Smad2 and Smad3 mRNA and protein in myocardial tissue.Results Compared with the sham-operation group,the model group rats showed symptoms of qi deficiency such as mental lethargy,slow movement,drowsiness,and decreased body mass,significant elevation of ST segment on electrocardiogram,the left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)decreased(P＜0.01),the left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular end diastolic diameter(LVEDd)and left ventricular end systolic diameter(LVEDs)increased(P＜0.01),the red blood cell aggregation index,Carcasson viscosity and whole blood viscosity increased(P＜0.01);with enlargement and necrosis of myocardial cells,disordered arrangement of myocardial fibers,and infiltration of inflammatory cells into myocardial tissue,the mRNA and protein expressions of METTL3,TGF-β1,Smad2 and Smad3 in myocardial tissue increased(P＜0.05,P＜0.01),while the mRNA and protein expression of HAND2 decreased(P＜0.01).Compared with the model group,the Yiqi Huoxue Prescription group and the Western medicine group showed significant improvement in the mental state of rats,significant ST segment regression on electrocardiogram,LVEF and LVFS increased(P＜0.01),LVEDV,LVESV,LVEDd and LVEDs decreased(P＜0.05,P＜0.01),with red blood cell aggregation index,Carcasson viscosity and whole blood viscosity decreased(P＜0.01);the arrangement of myocardial fibers was neat,the structure and morphology of myocardial cells were improved,the infiltration of inflammatory cells was reduced,the mRNA and protein expressions of METTL3,TGF-β1,Smad2 and Smad3 in myocardial tissue decreased(P＜0.05,P＜0.01),and the mRNA and protein expression of HAND2 increased(P＜0.05,P＜0.01).Conclusion Yiqi Huoxue Prescription can alleviate the pathological damage of myocardial tissue in rats with coronary heart disease of qi deficiency and blood stasis syndrome,improve heart function and inhibit inflammatory response.Its mechanism may be related to the regulation of the METTL3/HAND2/TGF-β1 signaling axis.

Objective:To investigate the clinical characteristics and independent risk factors of severe disease in patients with anti-nuclear matrix protein (NXP) 2 antibody-positive juvenile dermatomyositis (JDM).Methods:A retrospective cohort study was conducted, including 219 anti-NXP2 antibody-positive JDM patients admitted to 23 children′s hospitals across China from July 2011 to July 2023. Patients were classified into severe and non-severe groups based on classification criteria for severe dermatomyositis. Demographic characteristics, clinical manifestations, and laboratory parameters were compared between the 2 groups using independent sample t-test, Mann-Whitney U test, or χ2 test. Univariate and multivariate Logistic regression analyses were performed to identify risk factors for severe disease. The receiver operating characteristic curve was employed to calculate optimal cut-off values. Results:Among the 219 patients, 108 were male and 111 were female, with an age at onset of 6.3 (3.5, 9.4) years. The severe group comprised 69 patients, and the non-severe group 150 patients. The severe group had significantly higher rates of fever, heliotrope rash, subcutaneous edema, periorbital edema, anti-Ro52 antibody positivity, as well as elevated levels of ferritin-to-albumin ratio (FAR), creatine kinase (CK), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) (all P<0.05). Multivariate analysis identified anti-Ro52 antibody positivity ( OR=13.26, 95% CI 1.37-128.29) and elevated FAR ( OR=1.90, 95% CI 1.09-2.31) as independent risk factors for severe anti-NXP2 antibody-positive JDM (both P<0.05). Receiver operating characteristic curve analysis revealed that a FAR cutoff value of 6.82 predicted severe disease with an area under the curve of 0.87 (95% CI 0.81-0.94, P<0.001), sensitivity of 0.85, and specificity of 0.70. All patients received glucocorticoid therapy, and the severe group received higher proportions of steroid pulse therapy, cyclophosphamide, mycophenolate mofetil, intravenous immunoglobulin, biologics, and adjuvant treatments compared to the non-severe group (all P<0.05). In terms of outcomes, 2 patients (2.9%) in the severe group died (due to neurological involvement and intestinal perforation, respectively), while the remaining patients achieved complete clinical response or remission. All patients in the non-severe group achieved remission. Conclusions:The primary clinical features of anti-NXP2 antibody-positive JDM included fever, heliotrope rash, subcutaneous edema, periorbital edema, anti-Ro52 antibody positivity, and elevated levels of CK, AST, LDH, and FAR. Furthermore, anti-Ro52 antibody positivity and a FAR>6.82 were identified as independent risk factors.

Objective:To evaluate the long-term oncological outcomes of partial nephrectomy(PN)in patients with renal cell carcinoma(RCC)who were clinically staged as clinical T1(cT1)preoperatively but upstaged to pathological T3a(pT3a)after surgery.Methods:A total of 427 RCC patients postopera-tively diagnosed as pT3aN0M0 at Peking University Third Hospital from February 2013 to December 2022 were retrospectively reviewed.Among them,33 cT1 patients upstaged to pT3a RCC received PN(PN group),while 394 non-upstaged pT3a RCC patients underwent radical nephrectomy(RN,RN group).Propensity score matching was performed at a 1∶1 ratio based on baseline characteristics.The Kaplan-Meier method was used to assess overall survival(OS),cancer-specific survival(CSS),and disease-free survival(DFS),with Log-rank tests and Cox regression models for multivariate analysis.Results:Before matching,the PN group(n=33)had significantly higher rates of perirenal fat invasion(PFI,45.5％vs.15.2％)and segmental renal vein involvement(42.4％vs.20.8％),but lower rates of renal sinus invasion(RSI,21.2％vs.73.6％)and renal vein tumor thrombus(0％vs.15.2％)compared with the RN group(n=394,all P＜0.05).After matching,baseline characteristics were comparable between the PN group(n=33)and RN group(n=33).No significant differences were observed in operative time,blood loss,mean hospital stay,complication rate,positive margin rate,or conversion to open surgery between the two groups(P＞0.05).However,the PN group showed significantly higher estimated glomerular filtration rate(eGFR)postoperatively[76.9(55.4,87.3)mL/(min·1.73 m2)vs.61.7(56.8,73.5)mL/(min·1.73 m2),P＜0.05],indicating better renal function preserva-tion.No significant differences were found in OS,CSS,or DFS between the groups(P＞0.05).Multi-variate ana-lysis identified renal vein invasion(RVI),higher Fuhrman grades(Ⅲ-Ⅳ),and sarcoma-toid differentiation as independent risk factors for DFS and CSS in the pT3a RCC patients(P＜0.05).Conclusion:For cT1 RCC patients upstaged to pT3a,PN preserves renal function more effectively while achieving com-parable oncological outcomes to RN.RVI,higher Fuhrmann grade,and sarcomatoid differentiation are independent risk factors for pT3N0M0 RCC patients.

Objective To explore the predictive value of the preoperative C-reactive protein-albumin-lymphocyte ratio(CALLY index)for short-term prognosis in patients undergoing radical gastrectomy.Methods The clinical data of 228 gastric cancer patients who underwent radical gastrectomy were retrospectively analyzed.Based on follow-up results,patients were divided into the good prognosis group(n=205)and the poor prognosis group(n=23).The differences in clinical characteristics and laboratory test results between the two groups were compared.Cox proportional hazards regression model was used to analyze the impact of CALLY index on poor prognosis in patients.The receiver operating characteristic(ROC)curve was used to determine the clinical value and optimal cutoff value of CALLY index in predicting poor prognosis of patients.Kaplan-Meier method was used to analyze the difference in disease-free survival(DFS)between patients with different CALLY index levels.Results After a follow-up of 3 to 53 months(median follow-up of 36 months),23 patients developed poor prognosis(including 3 deaths and 20 recurrences or metastases).Compared with the good prognosis group,tumors in the poor prognosis group were larger,the proportion of poorly differentiated tumors was higher and white blood cell count(WBC),neutrophil count(NEU),C-reactive protein(CRP)were higher,and lymphocyte(LYM),albumin(ALB),prealbumin,total cholesterol(TC)and CALLY indexl were lower.Multivariate Cox regression analysis showed that the elevated CALLY index(HR=0.306,95%CI:0.102-0.921,P=0.035)was an independent protective factor for poor prognosis,while larger tumors and poorly differentiated tumors were independent risk factors for poor prognosis.ROC curve analysis showed that the area under the curve for predicting poor prognosis in gastric cancer patients undergoing radical gastrectomy was 0.862(95%CI:0.810-0.904),with a sensitivity of 95.65%,specificity of 69.76%,and an optimal cutoff value of 2.21.Kaplan-Meier analysis showed that patients with a CALLY index>2.21 had a longer disease-free survival than those with a CALLY index≤2.21(mean DFS:48 months vs.42 months,Log-rank χ2=4.123,P=0.042).Conclusion The preoperative CALLY index is a simple,effective and easily accessible predictor for predicting short-term prognosis in patients undergoing radical gastrectomy.A high CALLY index indicates a better prognosis of patient.

Medication reconciliation plays a key role in improving patient medication safety,reducing inappropriate polypharmacy,and promoting the high-quality development of pharmaceutical services.Compared to advanced international guidelines,China's medication reconciliation service standards have deficiencies in areas such as definition and process design,and multidisciplinary team building.There is a need to establish a comprehensive medication reconciliation effect evaluation index system,develop pharmacist-led multidisciplinary teams,promote the advancement of artificial intelligence and big data technologies,and strengthen outpatient and community medication reconciliation coverage,thereby contributing to the high-quality development of pharmaceutical services in China.