OBJECTIVE To establish a Chinese drug-related problem （DRP） classification system applicable to pharmacist-led pharmaceutical care in China， providing pharmacists with an effective and practical tool for pharmaceutical care. METHODS A multi-stage process was employed to construct the DRP classification system， including literature review and analysis， comparison of existing classification systems， refinement of classification items and framework development， two rounds of standard case validation， expert discussion， and system revision. The Fleiss′ kappa test was used to calculate the consistency coefficient κ， assessing the reliability of pharmacists participating in evaluating the classification system. An electronic questionnaire comprising six items was employed to evaluate the system’s applicability. RESULTS The constructed Chinese DRP classification system comprised six sections [problem（including potential problems）， DRP evaluation， cause （including possible causes of potential problems）， intervention， acceptance of intervention and DRP status]， with 24 primary codes and 96 secondary codes. In the first round of case validation， κ values exceeded 0.4 for all sections except “intervention” and “DRP status”. In the second round， κ values exceeded 0.4 for all sections. In the applicability evaluation of the classification system， positive ratings （“strongly agree” or “agree”） exceeded 85% for all items. Specifically， positive ratings for“the classification system can provide appropriate category selection”，“ the classification system is comprehensive”，“ the classification system is convenient to use” and “the classification system is highly satisfactory” exceeded 92%. CONCLUSIONS The Chinese DRP classification system developed demonstrates both high reliability and applicability， providing an effective and practical classification tool for pharmacists in China to conduct pharmaceutical care.

OBJECTIVE:To assess the efficacy and safety of acupuncture in treating postmenopausal osteoporosis.METHODS:Clinical randomized controlled trials on acupuncture for postmenopausal osteoporosis were retrieved from databases including CNKI,VIP,WanFang,China Biomedical Literature Service System,Web of Science,PubMed,Embase,and Cochrane Library.The search period was from the inception of the database to July 23,2024.The quality of evidence and risk of bias of the included studies were assessed using the GRADEprofiler and the revised Cochrane risk-of-bias tool for randomized trials(RoB 2.0).Meta-analysis was performed using StataSE 15 and TSA 0.9.5,along with heterogeneity analysis,sensitivity analysis,subgroup analysis,publication bias analysis,trim-and-fill analysis,and trial sequential analysis.RESULTS:The study included 19 randomized controlled trials involving a total of 1 464 patients.(1)The meta-analysis revealed that compared with conventional therapies,acupuncture significantly increased the total effective rate(RR=1.25,95％confidence interval[1.19,1.32],P＜0.001),lumbar spine L2-L4 bone mineral density(mean difference=0.08,95％confidence interval[0.05,0.11],P＜0.001),and estrogen levels(standard mean difference=0.55,95％confidence interval[0.30,0.81],P＜0.001).Additionally,acupuncture increased bone mineral density and gonadotropin levels in the femoral neck,greater trochanter,and Ward's triangle,reduced visual analogue scale scores,and improved bone metabolism without significantly increasing the incidence of adverse events.(2)Subgroup analysis of the main outcome indicators showed no significant difference between the treatment and control groups when the body mass index was greater than 23.9 kg/m2 and the total treatment duration was 6 months.All other treatment subgroups were significantly superior to the control group.(3)Publication bias analysis indicated a significant risk of publication bias in the overall efficacy;however,a trim-and-fill analysis showed that this risk did not significantly impact the reliability of the conclusions.Publication bias analysis showed no significant risk of publication bias in the bone mineral density values of lumbar spine L2-L4 and estradiol levels.(4)The sequential analysis of the trial further confirmed that acupuncture significantly increased the overall effective rate,bone mineral density values at the lumbar spine L1-L4,and estradiol levels.CONCLUSION:Acupuncture is an effective and safe treatment for postmenopausal osteoporosis.More rigorously designed and high-quality studies are needed in the future to verify this conclusion.

Objective Explore the clinical and molecular genetic characteristics of children with epilepsy as the first symptom caused by mutations in the ATPase Na+/K+transporting subunit alpha-3(ATP1A3)gene.Methods Clinical data of 853 epilepsy patients who visited the Department of Pediatric Neurology at Northwest Women's and Children's Hospital from November 2021 to December 2023 were retrospectively collected.Among them,3 cases were diagnosed with ATP1A3 gene mutations.Next-generation sequencing(NGS)techniques was used to perform whole exome sequencing analysis on serum samples from ATP1A3 gene mutation patients,and Sanger sequencing method was used for mutation verification.Results The ATP1A3 gene mutation sites in three patients were c.2401(exo n17)G>A,c.1103C>T and c.2542+1G>A,all of which presented with epilepsy as the initial symptom,mainly manifested as seizures and loss of consciousness.Imaging examination shows no abnormalities or slight widening of the subarachnoid space in both frontal and temporal regions,with background slow waves appearing in the electroencephalogram.Seizure were relieved after treatment with antiepileptic drugs.Conclusion The heterozygous mutations c.1103C>T and c.2542+1G>A at the ATP1A3 gene locus are novel pathogenic variations in epilepsy,and further confirm that the c.2401(exon17)G>A heterozygous mutation can cause epilepsy symptoms in patients.The clinical phenotype of ATP1A3 gene mutation includes typical alternating hemiplegia and muscle tone disorders,as well as seizures and developmental delay.

A 57-year-old female patient with small cell lung cancer was treated with serplulimab (100 mg by intravenous infusion on the first day, 21 days as a cycle). After the 10th cycle of treatment, the patient suddenly presented drowsiness, shortness of breath, dry mouth, nausea, vomiting, fatigue and other symptoms. Laboratory tests showed fasting blood glucose 38.9 mmol/L, glycosylated hemoglobin 7.9%, serum C peptide 0.2 μg/L, pH value 7.05, anion gap 31 mmol/L, anti-islet cell antibody 36 kU/L, anti-glutamic acid decarboxylase antibody 131 kU/L, urine ketone body (+++). The patient was diagnosed with fulminant type 1 diabetic ketoacidosis, which was considered to be related to serplulimab. The drug was stopped, and insulin, rehydration, correction of acid-base imbalance, and other treatments were given. After 3 days, the patient′s consciousness returned to normal. After 12 days, her breathing was stable, dry mouth, nausea, vomiting and other symptoms were relieved. Laboratory tests showed random blood glucose 13.6 mmol/L, pH value 7.44, anion gap 6 mmol/L, and urine ketone body negative. After 26 days, her random blood glucose was controlled at 10.0-12.0 mmol/L.

Objective Explore the clinical and molecular genetic characteristics of children with epilepsy as the first symptom caused by mutations in the ATPase Na+/K+transporting subunit alpha-3(ATP1A3)gene.Methods Clinical data of 853 epilepsy patients who visited the Department of Pediatric Neurology at Northwest Women's and Children's Hospital from November 2021 to December 2023 were retrospectively collected.Among them,3 cases were diagnosed with ATP1A3 gene mutations.Next-generation sequencing(NGS)techniques was used to perform whole exome sequencing analysis on serum samples from ATP1A3 gene mutation patients,and Sanger sequencing method was used for mutation verification.Results The ATP1A3 gene mutation sites in three patients were c.2401(exo n17)G>A,c.1103C>T and c.2542+1G>A,all of which presented with epilepsy as the initial symptom,mainly manifested as seizures and loss of consciousness.Imaging examination shows no abnormalities or slight widening of the subarachnoid space in both frontal and temporal regions,with background slow waves appearing in the electroencephalogram.Seizure were relieved after treatment with antiepileptic drugs.Conclusion The heterozygous mutations c.1103C>T and c.2542+1G>A at the ATP1A3 gene locus are novel pathogenic variations in epilepsy,and further confirm that the c.2401(exon17)G>A heterozygous mutation can cause epilepsy symptoms in patients.The clinical phenotype of ATP1A3 gene mutation includes typical alternating hemiplegia and muscle tone disorders,as well as seizures and developmental delay.

Objective:To analyze the epidemiological characteristics of cases involving monkey injuries at medical institutions surrounding Qianlingshan Park in Guiyang City, and to provide a reference basis for preventive measures to reduce monkey injuries and standardized post-exposure treatment.Methods:A retrospective cross-sectional study was conducted, collecting 1 900 cases of monkey-induced injuries in Qianlingshan Park treated at the outpatient clinic of Guizhou Provincial Center for Disease Control and Prevention and the Department of Surgery at Qianling Hospital, Guiyang City, from 2021 to 2024. Statistical analysis was performed using Pearson′s chi-square test.Results:Total of 1 900 cases of monkey-related injuries in Qianlingshan Park were collected from 2021 to 2024. The exposure time distribution exhibited significant seasonality, with 48.58% of cases occurring during July and August, totaling 923 cases, indicating a peak in the summer. There were 774 male patients and 1 126 female patients, with a ratio of 1∶1.45.and significant differences were observed between different age groups and genders (χ2=195.00, P<0.001), with the highest number of cases occurring in the 0-9 and 20-29 age groups, accounting for 22.05%(419 cases) and 21.79%(414 cases), respectively. The upper limbs were the most common injury site, accounting for 50.84% of the total cases(966 cases in total), with significant differences between gender and injury location (χ2=22.00, P<0.001), Among females, the proportion of injuries to the upper and lower limbs (30.11% and 16.47%, respectively) was higher than that among males (20.74% and 8.63%, respectively). The majority of injuries were classified as Grade Ⅲ, making up 57.38% of cases(1 069 cases in total). Self-treatment after exposure was the most common approach(60.44%), with significant differences observed between wound severity and treatment method (χ2=6.90, P=0.032), Patients with Grade Ⅱ and Grade Ⅲ wounds were more likely to choose self-management (26.84% and 33.23%, respectively) than outpatient management (15.14% and 24.15%). Approximately 98.05% (1 863 cases) of monkey-injured patients had received rabies vaccinations. Conclusions:This study analyzes monkey-related injuries in Qianlingshan Park from 2021 to 2024, clarifying the temporal distribution of injuries, demographic characteristics, injury sites, and treatment methods. The findings provide references for optimizing human-monkey conflict management and the prevention and control of zoonotic diseases in urban ecological parks.

Objectives:To understand the awareness of HIV pre-exposure prophylaxis and post-exposure prophylaxis (PrEP/PEP) and related factors among female sex workers (FSWs) in Zhejiang Province to provide a reference for promoting PrEP/PEP.Methods:From April to July 2023, a questionnaire survey was conducted at the surveillance posts of prostitutes in 17 counties (cities and districts) in Zhejiang Province. The sample size of each post was at least 400 FSWs, and the information on social demography, sexual behavior, AIDS knowledge, prevention services, and detection were collected.Results:A total of 6 899 FSWs were surveyed. Most of them were ≥30 years old (57.7%), had secondary school education or below (61.8%), and had worked locally for ≥12 months (52.6%). The prevalence of HIV PrEP and PEP awareness among FSWs was 52.0% (3 589/6 899) and 58.6% (4 045/6 899), respectively. Multivariate logistic regression analysis showed that the negative related factors of awareness of PrEP/PEP among FSWs included age ≥30 years, local working time <6 months, and condom use during commercial sex in the last 1 month. The positive related factors of awareness of PrEP/PEP among FSWs included marital status was married or cohabiting, aware of HIV/AIDS knowledge, working in medium or high-end venues, finding clients primarily online in the past 6 months, receiving HIV prevention services in the past year, and having self-tested for HIV in the past year.Conclusions:The overall awareness of PrEP/PEP was relatively low among FSWs in Zhejiang Province. Efforts should be made to strengthen the publicity and education of PrEP/PEP, especially for those who are older and more mobile and working in low-end venues, combined with HIV prevention services to increase the use of PrEP/PEP.

The NOD-like receptor protein 3 (NLRP3) inflammasome is essential in innate immune-mediated inflammation, with its overactivation implicated in various autoinflammatory, metabolic, and neurodegenerative diseases. Pharmacological inhibition of NLRP3 offers a promising treatment strategy for inflammatory conditions, although no medications targeting the NLRP3 inflammasome are currently available. This study demonstrates that clioquinol (CQ), a clinical drug with chelating properties, effectively inhibits NLRP3 activation, resulting in reduced cytokine secretion and cell pyroptosis in both human and mouse macrophages, with a half maximal inhibitory concentration (IC₅₀) of 0.478 μM. Additionally, CQ mitigates experimental acute peritonitis, gouty arthritis, sepsis, and colitis by lowering serum levels of interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α). Mechanistically, CQ covalently binds to Arginine 335 (R335) in the NACHT domain, inhibiting NLRP3 inflammasome assembly and blocking the interaction between NLRP3 and its component protein. Collectively, this study identifies CQ as an effective natural NLRP3 inhibitor and a potential therapeutic agent for NLRP3-driven diseases.

OBJECTIVE:To assess the efficacy and safety of acupuncture in treating postmenopausal osteoporosis.METHODS:Clinical randomized controlled trials on acupuncture for postmenopausal osteoporosis were retrieved from databases including CNKI,VIP,WanFang,China Biomedical Literature Service System,Web of Science,PubMed,Embase,and Cochrane Library.The search period was from the inception of the database to July 23,2024.The quality of evidence and risk of bias of the included studies were assessed using the GRADEprofiler and the revised Cochrane risk-of-bias tool for randomized trials(RoB 2.0).Meta-analysis was performed using StataSE 15 and TSA 0.9.5,along with heterogeneity analysis,sensitivity analysis,subgroup analysis,publication bias analysis,trim-and-fill analysis,and trial sequential analysis.RESULTS:The study included 19 randomized controlled trials involving a total of 1 464 patients.(1)The meta-analysis revealed that compared with conventional therapies,acupuncture significantly increased the total effective rate(RR=1.25,95％confidence interval[1.19,1.32],P＜0.001),lumbar spine L2-L4 bone mineral density(mean difference=0.08,95％confidence interval[0.05,0.11],P＜0.001),and estrogen levels(standard mean difference=0.55,95％confidence interval[0.30,0.81],P＜0.001).Additionally,acupuncture increased bone mineral density and gonadotropin levels in the femoral neck,greater trochanter,and Ward's triangle,reduced visual analogue scale scores,and improved bone metabolism without significantly increasing the incidence of adverse events.(2)Subgroup analysis of the main outcome indicators showed no significant difference between the treatment and control groups when the body mass index was greater than 23.9 kg/m2 and the total treatment duration was 6 months.All other treatment subgroups were significantly superior to the control group.(3)Publication bias analysis indicated a significant risk of publication bias in the overall efficacy;however,a trim-and-fill analysis showed that this risk did not significantly impact the reliability of the conclusions.Publication bias analysis showed no significant risk of publication bias in the bone mineral density values of lumbar spine L2-L4 and estradiol levels.(4)The sequential analysis of the trial further confirmed that acupuncture significantly increased the overall effective rate,bone mineral density values at the lumbar spine L1-L4,and estradiol levels.CONCLUSION:Acupuncture is an effective and safe treatment for postmenopausal osteoporosis.More rigorously designed and high-quality studies are needed in the future to verify this conclusion.