Objective To investigate the impact of pharmaceutical services provided by clinical pharmacists on rational drug use and cost control in hepatobiliary surgery under the Diagnosis Related Groups(DRGs)payment model,aming to provide evidence for improving the rationality of drug therapy and saving medical costs.Methods Patients classified under DRGs disease codes HB15,HB13,and HB11 from November 2022 to April 2024 were selected as study subjects.A total of 195 patients were included,with 106 in the intervention group and 89 in the control group.The intervention group received multidimensional clinical pharmaceutical services in addition to the standard care provided to the control group.The rational drug use rate,medication costs,total hospitalization expenses,and length of hospital stay were observed between the two groups.A cost-benefit analysis was employed to evaluate the economic impact of providing pharmaceutical services to hepatobiliary surgical patients.The cost indicator was the clinical pharmacy services cost,and the benefit indicators were the reductions in total hospitalization expenses and medication costs.The benefit-cost ratio(B/C)was calculated,and sensitivity analysis was performed.Results The intervention group showed significantly higher rational use rates of prophylactic antimicrobial agents(drug selection:83.96％vs.46.07％,P＜0.01;treatment duration:84.91％vs.56.18％,P＜0.01)and parenteral nutrition drugs(97.17％vs.73.03％,P＜0.01)compared to the control group.Additionally,the intervention group had significantly reduced the length of hospital stay,total hospitalization expenses,medication costs,and insurance over-expenditure compared to the control group(P＜0.05).Furthermore,clinical pharmacist intervention led to a reduction in medication costs by 4 320.05(2 555.00,5 088.25)yuan(CNY)and total hospitalization expenses by 8 891.12(5 135.05,10 074.03)yuan(CNY).The B/C ratios were 14.24(8.42,16.77)and 29.30(16.92,33.20),respectively,indicating economic efficiency.Sensitivity analysis supported these results.Conclusion Under the DRGs payment model,clinical pharmaceutical services guided by drug therapy pathways contribute to improving rational drug use in hepatobiliary surgery and provide clear economic benefits,playing a positive role in reducing medical costs.

Objective To investigate the therapeutic efficacy of artesunate(AS)on polycystic ovary syndrome(PCOS)in mice and explore the potential mechanism primarily.Methods Twenty-five female C57BL/6J mice were randomly divided into Control group,model group(PCOS group),low-and high-dose AS groups(AS15 and AS30 groups)and metformin group(Met group).In addition to the Control group,the mouse model of PCOS was established by subcutaneous injection of dehydroepiandrosterone(DHEA,60 mg/kg)following by a high-fat diet for 21 d.After modeling,AS of 15 and 30 mg/kg was intraperitoneally injected into the mice of the AS 15 and AS30 groups,respectively,and 200 mg/kg Met was given to those of the Met group by gavage,once per day,for 6 weeks.ELISA was used to detect serum testosterone(T),fasting insulin(FINS),luteinizing hormone(LH)and follicle-stimulating hormone(FSH),and the LH/FSH ratio was calculated.The levels of fasting blood glucose(FBG),triglyceride(TG)and total cholesterol(TC)were detected by automatic biochemical analyzer,and the homeostasis model assessment of insulin resistance(HOMA-IR)was calculated.The estrous cycle was observed,and HE staining was performed for pathological changes in the ovary and uterus.Immunofluorescence assay was employed to measure the expression of p-eIF2α,ATF4 and CHOP in the ovarian tissue.After steroidogenic human granulosa-like tumor cell line KGN were exposed to 100 μmol/L DHEA to simulate the hyperandrogen environment of PCOS,and then treated with 5 and 10 μg/mL AS for 24 h,the protein levels of endoplasmic reticulum stress signaling pathway was detected by Western blotting.Results Compared with the Control group,the PCOS mice had disturbed estrous cycle,polycystic changes in the ovaries,and significantly increased serum T level and LH/FSH ratio(P＜0.05),and obviously elevated HOMA-IR,TC and TG levels in terms of metabolism(P＜0.01).The expression levels of p-eIF2α,ATF4 and CHOP were notably up-regulated in the ovarian granulosa cells of PCOS mice and KGN cells after DHEA exposure(P＜0.05).Additionally,AS treatment attenuated the pathological changes of ovary and uterine expression,decreased the serum T level and the LH/FSH ratio(P＜0.05),and reduced HOMA-IR,TC and TG levels(P＜0.05)when compared with the PCOS mice.Moreover,the expression levels of p-eIF2α,ATF4 and CHOP were significantly down-regulated after AS treatment in both ovarian granulosa cells of PCOS mice and KGN cells(P＜0.05).Conclusion AS significantly improves glycolipid metabolic disorder and reproductive dysfunction in PCOS mice,which may be associated with its suppressing endoplasmic reticulum stress by inhibiting the PERK/eIF2α/ATF4/CHOP pathway.

Objective To analyze the development and implementation of nutritional drug treatment pathways abroad,and to provide insights for the establishment of similar pathways in China.Methods A search was conducted in international literature and guideline databases for studies on nutritional therapy pathways up until December 1st,2024.The search focused on aspects such as pathway development methods,the composition of development teams,and implementation outcomes.Results A total of 29 relevant articles were identified,including 12 clinical practice guidelines and 17 research papers.The guidelines were all issued by the European Society for Clinical Nutrition and Metabolism,while the research papers showed significant heterogeneity,spanning multiple countries,regions,and medical conditions,primarily from developed countries in Europe and North America.The analysis reveals that nutritional therapy pathways typically include components such as nutritional assessment,formulation of nutritional plans,integration with other drug therapies,development of follow-up plans,pathway implementation teams,and the reassessment and updating of pathways.Conclusions China can benefit from the practices of developed countries,particularly those in Europe and North America.Key recommendations include the establishment of multidisciplinary teams,the promotion of a tiered treatment model,and the involvement of medical associations in forming expert groups to develop and implement nutritional drug treatment pathways,thereby enhancing the quality of nutritional treatment in China.

Objective To develop a method of pulsed direct current electrospray ionization mass spectrometry(pulsed-dc-ESI-MS)for rapid detection of 4 kinds of amphetamines in saliva.Methods Saliva samples were adjusted to optimal pH using NaOH,followed by protein precipitation with anhydrous magnesium sulfate and liquid-liquid extraction with ethyl acetate.The supernatant was then analyzed via pulsed-dc-ESI-MS.Results The limits of detection were 0.01～0.5 ng/mL and the limits of quantitative were 1.0～5.0 ng/mL.In addition,in the concentration range,4 amphetamines have good linear relationships,the correlation coefficients(R2)were all greater than 0.999,the recoveries of 97.21%～104.70%and the relative standard deviations(RSDs)were less than 10%.Conclusion The method has the advantages of simple operation,fast detection,high sensitivity,selectivity and good stability.It can be used for on-site rapid detection of amphetamines in saliva.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Objective To investigate the impact of pharmaceutical services provided by clinical pharmacists on rational drug use and cost control in hepatobiliary surgery under the Diagnosis Related Groups(DRGs)payment model,aming to provide evidence for improving the rationality of drug therapy and saving medical costs.Methods Patients classified under DRGs disease codes HB15,HB13,and HB11 from November 2022 to April 2024 were selected as study subjects.A total of 195 patients were included,with 106 in the intervention group and 89 in the control group.The intervention group received multidimensional clinical pharmaceutical services in addition to the standard care provided to the control group.The rational drug use rate,medication costs,total hospitalization expenses,and length of hospital stay were observed between the two groups.A cost-benefit analysis was employed to evaluate the economic impact of providing pharmaceutical services to hepatobiliary surgical patients.The cost indicator was the clinical pharmacy services cost,and the benefit indicators were the reductions in total hospitalization expenses and medication costs.The benefit-cost ratio(B/C)was calculated,and sensitivity analysis was performed.Results The intervention group showed significantly higher rational use rates of prophylactic antimicrobial agents(drug selection:83.96％vs.46.07％,P＜0.01;treatment duration:84.91％vs.56.18％,P＜0.01)and parenteral nutrition drugs(97.17％vs.73.03％,P＜0.01)compared to the control group.Additionally,the intervention group had significantly reduced the length of hospital stay,total hospitalization expenses,medication costs,and insurance over-expenditure compared to the control group(P＜0.05).Furthermore,clinical pharmacist intervention led to a reduction in medication costs by 4 320.05(2 555.00,5 088.25)yuan(CNY)and total hospitalization expenses by 8 891.12(5 135.05,10 074.03)yuan(CNY).The B/C ratios were 14.24(8.42,16.77)and 29.30(16.92,33.20),respectively,indicating economic efficiency.Sensitivity analysis supported these results.Conclusion Under the DRGs payment model,clinical pharmaceutical services guided by drug therapy pathways contribute to improving rational drug use in hepatobiliary surgery and provide clear economic benefits,playing a positive role in reducing medical costs.

Objective To analyze the development and implementation of nutritional drug treatment pathways abroad,and to provide insights for the establishment of similar pathways in China.Methods A search was conducted in international literature and guideline databases for studies on nutritional therapy pathways up until December 1st,2024.The search focused on aspects such as pathway development methods,the composition of development teams,and implementation outcomes.Results A total of 29 relevant articles were identified,including 12 clinical practice guidelines and 17 research papers.The guidelines were all issued by the European Society for Clinical Nutrition and Metabolism,while the research papers showed significant heterogeneity,spanning multiple countries,regions,and medical conditions,primarily from developed countries in Europe and North America.The analysis reveals that nutritional therapy pathways typically include components such as nutritional assessment,formulation of nutritional plans,integration with other drug therapies,development of follow-up plans,pathway implementation teams,and the reassessment and updating of pathways.Conclusions China can benefit from the practices of developed countries,particularly those in Europe and North America.Key recommendations include the establishment of multidisciplinary teams,the promotion of a tiered treatment model,and the involvement of medical associations in forming expert groups to develop and implement nutritional drug treatment pathways,thereby enhancing the quality of nutritional treatment in China.

Objective To develop a method of pulsed direct current electrospray ionization mass spectrometry(pulsed-dc-ESI-MS)for rapid detection of 4 kinds of amphetamines in saliva.Methods Saliva samples were adjusted to optimal pH using NaOH,followed by protein precipitation with anhydrous magnesium sulfate and liquid-liquid extraction with ethyl acetate.The supernatant was then analyzed via pulsed-dc-ESI-MS.Results The limits of detection were 0.01～0.5 ng/mL and the limits of quantitative were 1.0～5.0 ng/mL.In addition,in the concentration range,4 amphetamines have good linear relationships,the correlation coefficients(R2)were all greater than 0.999,the recoveries of 97.21%～104.70%and the relative standard deviations(RSDs)were less than 10%.Conclusion The method has the advantages of simple operation,fast detection,high sensitivity,selectivity and good stability.It can be used for on-site rapid detection of amphetamines in saliva.

Objective To retrospectively analyze the periprocedural and postprocedural antithrombotic therapy regimens for patients undergoing percutaneous left atrial appendage closure(PLAAC)at Nanjing Drum Tower Hospital(hereinafter referred to as"the hospital")and their association with prognosis,and to provide a basis for antithrombotic therapy in clinical practice for such patients.Methods We systematically collected medical records of non-valvular atrial fibrillation patients underwent PLAAC treatment from January 2018 to January 2022 at our hospital.We recorded basic patient information,preoperative left atrial appendage(LAA)thrombus screening,and antithrombotic regimens,and analyzed the incidence of bleeding and thrombotic events during the periprocedural period and up to 12 months postprocedure.Results A total of 96 patients underwent PLAAC,with 86 included in the final analysis.Eight patients had LAA thrombus detected by transesophageal echocardiography before the procedure,and all thrombi resolved after one month of extended antithrombotic therapy.There was one bleeding event in the continuous anticoagulation group during the periprocedural period,while no bleeding events occurred in the interrupted anticoagulation group.Within one year postprocedure,11 patients(18.0%)in the continuous anticoagulation group and 4 patients(16.0%)in the interrupted anticoagulation group experienced bleeding events.All patients adhered to anticoagulant therapy as prescribed for the first three months postprocedure;between three to six months postprocedure,33.7%of patients received dual antiplatelet therapy(DAPT),and 29.1%discontinued therapy;between six to twelve months,47.7%of patients received single antiplatelet therapy(SAPT)and 48.8%discontinued therapy.During the one-year follow-up,there was one case each of device-related thrombus,ischemic stroke,and cerebral hemorrhage,indicating a low overall incidence of adverse events.Conclusion In the real-world setting,the individualized antithrombotic regimens provided by physicians at the hospital,both periprocedurally and postprocedurally,were reasonable and consistent with guidelines.However,poor medication adherence was a significant issue among patients.It is recommended that clinical pharmacists actively engage in pharmacotherapy monitoring and enhance medication education to improve medication adherence.