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.

Huangqintang， with its accurate efficacy， is a classic formula specialized in treating dysentery recommended and promoted by medical experts from successive generations， and it was included in the Catalogue of Ancient Classic Prescriptions （the Second Batch， Han Chinese medicine prescriptions） published by the National Administration of Traditional Chinses Medicine （TCM） in 2023. The method of bibliometrics was applied in this study to conduct textual research on the classic formula Huangqintang and provide a literature reference for the development of modern preparations of Huangqintang. A total of 2 026 pieces of ancient literature were searched with "Huangqintang" as the key word， and 23 pieces of effective data were selected， involving 15 ancient TCM books. The historic evolution， composition， dosage， origin， processing methods， preparation and decocting methods， efficiency， and application of Huangqintang were carefully reviewed. The results showed that Huangqintang was first recorded in the Treatise on Febrile Diseases written by ZHANG Zhongjing. It has the effect of clearing heat， stopping dysentery， regulating the middle， and downbearing counterflow and has become one of the classic formulas widely used in clinical practice. Because of its accurate efficacy， medical experts from later generations have modified it from its original composition. Though many prescriptions have different names， it is the manifestation of physicians' inheritance and development of the thought of ZHANG Zhongjing. Ancient literature showed this prescription had wide indications yet centered on digestive system diseases such as dysentery and abdominal pain. Modern applications of Huangqintang involve digestive， respiratory， ophthalmology and otolaryngology， gynecological， skin， musculoskeletal system， and connective tissue， and this prescription has great potential in treating ulcerative colitis， diarrhea， acute enteritis， and damp-heat dysentery. Through a systematic textual excavation and review of the ancient literature about Huangqintang， the paper has confirmed its key information， so as to provide a scientific basis for the clinical application and new drug development of classic formulas.

The classic formula Fangji Fulingtang is from ZHANG Zhongjing's Synopsis of the Golden Chamber in the Eastern Han dynasty. It is composed of Stephaniae Tetrandrae Radix， Astragali Radix， Cinnamomi Ramulus， Poria， and Glycyrrhizae Radix et Rhizoma， with the effects of reinforcing Qi and invigorating spleen， warming Yang and promoting urination. By a review of ancient medical books， this paper summarizes the composition， original plants， processing， dosage， decocting methods， indications and other key information of Fangji Fulingtang， aiming to provide a literature basis for the research， development， and clinical application of preparations based on this formula. Synonyms of Fangji Fulingtang exist in ancient medical books， while the formula composition in the Synopsis of the Golden Chamber is more widespread and far-reaching. In this formula， Stephaniae Tetrandrae Radix， Astragali Radix， Cinnamomi Ramulus， Poria， and Glycyrrhizae Radix et Rhizoma are the dried root of Stephania tetrandra， the dried root of Astragalus embranaceus var. mongholicus， the dried shoot of Cinnamomum cassia， the dried sclerotium of Poria cocos， and the dried root and rhizome of Glycyrrhiza uralensis， respectively. Fangji Fulingtang is mainly produced into powder， with the dosage and decocting method used in the past dynasties basically following the original formula. Each bag is composed of Stephaniae Tetrandrae Radix 13.80 g， Astragali Radix 13.80 g， Cinnamomi Ramulus 13.80 g， Poria 27.60 g， and Glycyrrhizae Radix et Rhizoma 9.20 g. The raw materials are purified， decocted in water from 1 200 mL to 400 mL， and the decoction should be taken warm， 3 times a day. Fangji Fulingtang was originally designed for treating skin edema， and then it was used to treat impediment in the Qing dynasty. In modern times， it is mostly used to treat musculoskeletal and connective tissue diseases and circulatory system diseases， demonstrating definite effects on various types of edema and heart failure. This paper clarifies the inheritance of Fangji Fulingtang and reveals its key information （attached to the end of this paper）， aiming to provide a theoretical basis for the development of preparations based on this formula.

The classic formula Fangji Fulingtang is from ZHANG Zhongjing's Synopsis of the Golden Chamber in the Eastern Han dynasty. It is composed of Stephaniae Tetrandrae Radix， Astragali Radix， Cinnamomi Ramulus， Poria， and Glycyrrhizae Radix et Rhizoma， with the effects of reinforcing Qi and invigorating spleen， warming Yang and promoting urination. By a review of ancient medical books， this paper summarizes the composition， original plants， processing， dosage， decocting methods， indications and other key information of Fangji Fulingtang， aiming to provide a literature basis for the research， development， and clinical application of preparations based on this formula. Synonyms of Fangji Fulingtang exist in ancient medical books， while the formula composition in the Synopsis of the Golden Chamber is more widespread and far-reaching. In this formula， Stephaniae Tetrandrae Radix， Astragali Radix， Cinnamomi Ramulus， Poria， and Glycyrrhizae Radix et Rhizoma are the dried root of Stephania tetrandra， the dried root of Astragalus embranaceus var. mongholicus， the dried shoot of Cinnamomum cassia， the dried sclerotium of Poria cocos， and the dried root and rhizome of Glycyrrhiza uralensis， respectively. Fangji Fulingtang is mainly produced into powder， with the dosage and decocting method used in the past dynasties basically following the original formula. Each bag is composed of Stephaniae Tetrandrae Radix 13.80 g， Astragali Radix 13.80 g， Cinnamomi Ramulus 13.80 g， Poria 27.60 g， and Glycyrrhizae Radix et Rhizoma 9.20 g. The raw materials are purified， decocted in water from 1 200 mL to 400 mL， and the decoction should be taken warm， 3 times a day. Fangji Fulingtang was originally designed for treating skin edema， and then it was used to treat impediment in the Qing dynasty. In modern times， it is mostly used to treat musculoskeletal and connective tissue diseases and circulatory system diseases， demonstrating definite effects on various types of edema and heart failure. This paper clarifies the inheritance of Fangji Fulingtang and reveals its key information （attached to the end of this paper）， aiming to provide a theoretical basis for the development of preparations based on this formula.

OBJECTIVE: To observe the therapeutic effect of electroacupuncture (EA) in improving early enteral nutrition tolerance in patients with acute pancreatitis (AP) under the concept of accelerated rehabilitation, and to explore the related mechanism based on the changes in autonomic nerve characteristics. METHODS: A total of 42 patients with AP were randomized into an observation group (21 cases, 1 case dropped out) and a control group (21 cases, 1 case dropped out). The control group received standard basic treatment for AP. On the basis of the treatment in the control group, EA was applied in the observation group, bilateral Zusanli (ST36), Yixian point (Extra), Tianshu (ST25), Neiguan (PC6) and Zhongwan (CV12) were selected as the main points, and the supplementary points were selected according to syndrome differentiation. Ipsilateral Zusanli (ST36) and Yixian point (Extra) were connected to EA, using discontinuous wave, in frequency of 2 Hz, 30 min a time, once a day for 6 continuous days. The enteral nutrition tolerance score was observed before treatment and after 3 and 5 days of treatment; the visual analogue scale (VAS) score for abdominal pain was observed before treatment and after 3 days of treatment; the time of reaching the feeding goal and hospital stay was recorded; the levels of C-reactive protein (CRP) and amylase were measured before treatment and after 5 days of treatment; the heart rate variability (HRV) indexes (standard deviation of NN intervals [SDNN], average standard deviation of NN intervals [SDANN], root mean square of successive NN interval differences [rMSSD], low frequency [LF] and high frequency [HF], ratio of low frequency to high frequency [LF/HF]) were monitored in the two groups. RESULTS: After 3 and 5 days of treatment, the enteral nutrition tolerance scores were decreased compared with those before treatment in both groups (P<0.01), the reductions in the observation group were larger than those in the control group (P<0.01). After 3 days of treatment, the VAS scores for abdominal pain were decreased compared with those before treatment in both groups (P<0.01), the reduction in the observation group was larger than that in the control group (P<0.01). The time of reaching the feeding goal and hospital stay in the observation group was shorter than that in the control group (P<0.05). After 5 days of treatment, the CRP and amylase levels were decreased compared with those before treatment in both groups (P<0.01), the reduction of CRP level in the observation group was larger than that in the control group (P<0.01). In the observation group, SDNN, SDANN and LF/HF were lower than those in the control group (P<0.05, P<0.01), while rMSSD was higher than that in the control group (P<0.01). SDNN, SDANN and LF/HF were positively correlated with the enteral nutrition tolerance scores after 3 and 5 days of treatment (P<0.05), while rMSSD was negatively correlated with the enteral nutrition tolerance scores after 3 and 5 days of treatment (P<0.01). CONCLUSION Electroacupuncture can improve enteral nutrition tolerance in patients with AP by regulating autonomic nervous function, alleviating the inflammation, promoting accelerated recovery, and reducing the length of hospital stay.
Humans ; Electroacupuncture ; Male ; Female ; Enteral Nutrition ; Middle Aged ; Adult ; Pancreatitis/physiopathology* ; Aged ; Acupuncture Points ; Young Adult ; Acute Disease/therapy* ; Autonomic Pathways/physiopathology*

Objective:To investigate the efficacy of cementless long-stem total hip arthroplasty (THA) in the treatment of end-stage osteonecrosis of the femoral head (ONFH) combined with ipsilateral subtrochanteric femoral fractures.Methods:A retrospective case series study was conducted on 18 patients with end-stage ONFH combined with ipsilateral subtrochanteric fractures who were admitted to the 940th Hospital of the Joint Logistics Support Force of the PLA from January 2016 to June 2023, including 8 males (8 hips) and 10 females (10 hips), aged 56-79 years [(69.4±7.0)years]. All the patients had Association Research Circulation Osseous (ARCO) stage IV ONFH combined with ipsilateral subtrochanteric fracture (Seinsheimer types II-IV). Parameters recorded included operation duration, intraoperative blood loss, length of hospital stay, time to partial weight-bearing, and time to full weight-bearing. Vertical offset and leg length discrepancy (LLD) were compared preoperatively and at 1 week postoperatively. Visual analogue scale (VAS) score, hip range of motion (flexion, abduction), and Harris hip score (HHS) were compared preoperatively, at 1 week, 3 months postoperatively, and at the last follow-up. Perioperative complications were observed.Results:All the patients were followed up for 12-70 months [(36.4±16.2)months]. Operation duration was (116.4±18.1)minutes. Intraoperative blood loss was (334.4±121.3)ml. The length of hospital stay was 13.0(10.0, 16.3)days. The time to partial weight-bearing was 5.0(3.0, 7.0)days, with time to full weight-bearing for 5.0(4.0, 5.3)weeks. At 1 week postoperatively, the vertical offset [(58.9±4.1)mm] was significantly increased compared to that preoperatively [(49.3±3.3)mm] ( P<0.01), while the LLD [(4.2±3.1)mm] was significantly reduced compared to that preoperatively [(16.2±5.8)mm] ( P<0.01). At 1 week, 3 months postoperatively and at the last follow-up, the VAS scores [3.0(2.0, 3.3)points, 2.0(1.0, 2.0)points, and 1.0(0.0, 2.0)points] were significantly lower than that preoperatively [6.0(5.0, 6.3)points], and decreased with the passage of follow-up time ( P<0.01); the hip flexion angles [(50.4±6.5)°, (94.3±6.4)°, and (104.7±7.4)°] and hip abduction angles [(21.5±4.4)°, (34.9±4.5)°, and (42.9±4.9)°] were lower than those preoperatively [(32.9±6.4)° and (13.4±4.9)°], and decreased with the passage of follow-up time ( P<0.01); the HHS [(58.1±4.9)points, (83.1±2.9)points, and (90.7±2.6)points] were higher than that preoperatively [(33.4±4.4)points], and increased with the passage of follow-up time ( P<0.01). At the last follow-up, 5 patients were rated as excellent, 11 as good, and 2 as fair according to the HHS criteria, with an overall excellent and good rate of 89%. No perioperative complications were observed, including neurovascular injury, secondary fracture, or infection. One patient developed partial deep vein thrombosis of the lower extremity (the popliteal vein) at 2 weeks after surgery, which recovered completely following treatment with a standard oral administration of rivaroxaban, etc. At the last follow-up, no evidence of malunion, prosthesis loosening, subsidence, or dislocation was observed. Conclusion:The use of cementless long-stem THA in the treatment of end-stage ONFH combined with ipsilateral subtrochanteric fractures has advantages of small trauma, early weight-bearing, early pain relief, improved joint motion and function, and few complications.

The European Society of Cardiology (ESC) released the "2024 ESC guidelines for the management of elevated blood pressure and hypertension" on August 30, 2024. This guideline updates the 2018 "Guidelines for the management of arterial hypertension." One notable update is the introduction of the concept of "elevated blood pressure" (120-139/70-89 mm Hg). Additionally, a new systolic blood pressure target range of 120-129 mm Hg has been proposed for most patients receiving antihypertensive treatment. The guideline also includes numerous additions or revisions in areas such as non-pharmacological interventions and device-based treatments for hypertension. This article interprets the guideline's recommendations on definition and classification of elevated blood pressure and hypertension, and cardiovascular disease risk assessment, diagnosing hypertension and investigating underlying causes, preventing and treating elevated blood pressure and hypertension. We provide a comparison interpretation with the 2018 "Guidelines for the management of arterial hypertension" and the "2017 ACC/AHA guideline on the prevention, detection, evaluation, and management of high blood pressure in adults."

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder and its symptoms are subject to the composition of the gut microbiota. However, it is not yet clear how probiotics relieve IBS, and there is no well-acknowledged standards concerning the clinical application of probiotics. This systematic review was conducted on the literature published from January 2020 to December 2023 and included 12 randomized controlled trials on probiotics in the treatment of IBS. Compared with placebo, the probiotic preparations improved the overall efficacy in IBS patients and was also well tolerated, suggesting the potential of probiotics in IBS management. Nevertheless, different probiotic strains, dosages, combinations, and dosing schedules may affect the outcomes. In the future, large-scale, multi-center, long-term follow-up studies are still needed to clarify the effective strains and methods of use and to promote the use of probiotics in the treatment of IBS.

Objective:To explore dynamic changes of CD4+T lymphocytes in peripheral blood of patients with bronchial asthma at different periods and its correlation with control level.Methods:A total of 108 patients with bronchial asthma who received medical treatment in Beijing Jishuitan Hospital,Capital Medical University from September 2020 to October 2022 were selected as study objects,and CD4+T level in peripheral blood of patients with asthma at different periods were compared.According to control level,patients were divided into control group(n=68)and uncontrolled group(n=40).Factors affecting control level of patients with bronchial asthma were analyzed,and prediction model of column graph was constructed and evaluated.Results:CD4+T level in periph-eral blood of patients with acute attack of bronchial asthma was significantly lower than that in chronic duration stage and clinical control stage,CD8+T and CD3+T levels were significantly higher than that in chronic duration stage and clinical control stage(P<0.05).Allergic rhinitis,smoking history,acute respiratory tract infection and residential air pollution were uncontrolled risk factors of patients with bronchial asthma,CD4+T and regular use of inhaled corticosteroids were protective factors(P<0.05).The above indexes were used to construct a line chart model.After internal verification(Bootstrap resamplage 1 000 times),it was found that AUC of this model was 0.845(95%CI:0.734～0.885),sensitivity and specificity were 85.7%and 88.6%,respectively.Conclusion:CD4+T lymphocytes in peripheral blood of patients with acute asthma are significantly lower than patients with chronic asthma and healthy people.Allergic rhinitis,smoking history,acute respiratory tract infection and residential air pollution are uncontrolled risk factors of patients with bronchial asthma,CD4+T and regular use of inhaled corticosteroids are protective factors.

To verify whether the two B-cell epitopes Pep1 and Pep4 in the FAdV-4 WZ fiber can be used as candidate epitopes for multivalent epitope vaccines,epitopes Pep1 and Pep4 were tandemly linked with the chicken infectious bronchitis virus strain M41 S1 protein gene in different patterns,and a recombinant fusion plasmid was constructed and expressed in E.coli BL21(DE3).It was confirmed by Western blot and ELISA tests that all four expressed fusion proteins reacted specific-ally with anti-M41 whole virus serum and WZ strain anti-Fiber 2-knob protein serum.After purifi-cation and immunization of BALB/c mice,specific antibodies against the peptide epitopes were de-tected in mouse sera.The results showed that the Pep4 epitope induced a stronger immune re-sponse than the Pep1 epitope.When Pep1 was connected with the amino and carboxyl termini of the fusion protein,respectively,both resulted in the production of the same level of anti-Pep1 anti-bodies in the immunized animals,whereas when Pep4 was connected with the carboxyl terminus of the fusion protein,the immunized animals produced a higher level of anti-Pep4-specific antibodies.This research indicates that the B cell epitopes Pep1 and Pep4 of the reactive WZ strain Fiber 2,when conjugated with proteins to form fusion proteins,can enhance the immunogenicity of Pep1 and Pep4 without affecting the antigenicity of the carrier protein.This study provides technical support and serves as a reference for the design and development of a multivalent epitope vaccine for FAdV-4.