Objective To explore the application effect of medication therapy management(MTM)services on the treatment of childhood asthma.Methods A total of 107 children aged 5-11 with asthma who visited the Cough and Asthma Pharmacy Clinic of Hebei General Hospital from July to December 2022 were selected,and randomly divided into the control group(50 cases)and the intervention group(52 cases).The control group of children only received single inhalation medication education services at the first visit.The intervention group received standardized MTM services throughout the entire process.The economic,clinical and human outcomes(ECHO)model was used to analyze the differences between the two groups of children in economic(medication costs,cost-effectiveness ratio),clinical(ACT score,correct rate of inhaled preparation,number of asthma attacks)and humanistic(EQ-5D-5L utility value,Morisky medication compliance,patient satisfaction)results before the intervention,3 months after the intervention,and 6 months after the intervention,evaluate the application effect of MTM services in children with asthma.Results Compared with the control group,there was no significant difference between the two groups before the intervention.After the intervention,the children in the intervention group showed statistically significant differences in economic,clinical,and humanistic outcomes(P<0.05).Conclusions The MTM service led by pharmacists can benefit children with asthma from multiple dimensions such as economy,clinical practice,and humanities.This not only enables long-term effective control of asthma in children,but also enhances pharmacist pharmacy specialist service capabilities.

OBJECTIVE To systematically evaluate the effectiveness of different treatment regimens as first-line treatment for metastatic urothelial carcinoma （UC） using a network meta-analysis （NMA） approach. METHODS Electronic databases including PubMed， the Cochrane Library， Embase， Wanfang Data， CNKI， and VIP were searched for randomized controlled clinical trials （RCTs） on first-line treatment for metastatic UC from January 1， 2010 to January 31， 2024. After literature screening and data extraction， a risk of bias assessment of included studies was conducted. R software （version 4.3.2） was used to perform the NMA. RESULTS A total of 11 RCTs involving 14 treatment interventions were included. No significant differences were noted in objective response rate among groups， with the combination of pembrolizumab， gemcitabine and cisplatin having the highest probability of ranking first. Regarding progression-free survival （PFS） and overall survival （OS）， no significant differences were observed among groups， while enfortumab vedotin combined with pembrolizumab showed a trend towards better PFS extension compared to gemcitabine combined with cisplatin [HR＝0.45， 95%CI（0.20，1.06）， P＝0.049]， and it had the highest probability of ranking first in both PFS and OS. CONCLUSIONS The combination of enfortumab vedotin and pembrolizumab may have an advantage in prolonging survival in the first-line treatments for metastatic UC.

OBJECTIVE To provide reference for constructing scientific and reasonable pharmaceutical service mode for hospitalized patients with chronic airway diseases. METHODS From October 2023 to March 2024， 250 patients with chronic obstructive pulmonary disease and acute exacerbation of asthma who were hospitalized in the respiratory department of Hebei General Hospital and received pharmaceutical care （PC） were randomly divided into control group （125 cases） and observation group （125 cases）. The control group received general pharmaceutical services throughout their hospitalization， while the observation group received standardized and graded pharmaceutical services throughout their hospitalization. The differences in clinical value indicators， humanistic value indicators， and quality management indicators were compared among different PC service models. RESULTS Among clinical value evaluation indicators， the observation group had better achievement rate of disease treatment goals， correct use score of inhalation devices， the incidence of adverse drug reactions， and the number of drug-related problems solved than the control group （P＜0.05）. Among the humanistic evaluation indicators， compared with the control group， the observation group had better medication compliance scores， pharmacist intervention success rates， and patient satisfaction scores （P＜0.05）. Among quality management evaluation indicators， the proportion of drug costs， the proportion of intravenous medication， the use rate of antibiotics， the intensity of antibiotic use， and the number of pharmaceutical services in the observation group were significantly better than the control group （P＜0.05）. CONCLUSIONS Standardized and graded pharmaceutical care services have improved the efficiency of pharmacists and service effectiveness， making it a new pharmaceutical service model worth promoting.

Objective:To investigate the status of depression and physiological, psychological and social factors among people with type 2 diabetes(T2DM), as well as the mediating effects of illness perception and diabetes distress on glycemic control and depression.Methods:A total of 511 patients with type 2 diabetes were recruited and investigated using general demographic questionnaire, self-rating depression scale(SDS), brief illness perception questionnaire(BIPQ) and diabetes distress scale(DDS). Body mass index (BMI) and hemoglobin a1c (HbA1c) were detected in laboratory.Results:The mean score of SDS was (57.48±9.94). The distribution of depression condition were 138(27.0%)without depression, 179(35%)with mild depression, 174(34.1%)with moderate depression and 20(3.9%)with severe depression.SDS score was significantly positively correlated with poor glycemic control ( r=0.157, P<0.01), illness perception( r=0.359, P<0.01) and four dimensions of diabetes distress( r=0.177-0.354, P<0.01). Partially mediating effect of illness perception( B=0.216, 95% CI=0.112-0.372) was found in glycemic control and depression, the proportion of effect was 25.9%.The chain mediating effect ( B=0.086, 95% CI=0.042-0.149) of illness perception and diabetes distress was also found between glycemic control and depression, whose indirect effect size was 10.3%. Conclusion:Glycemic control is significantly related with depression.Illness perception and diabetes distress are partly mediating the effect between glycemic control and depression.

Objective:To systematically evaluate cardiotoxicity of programmed cell death 1 receptor (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors.Methods:Clinical trials of PD-1/PD-L1 inhibitor alone or in combination with other treatments for tumors were collected by searching related databases at home and abroad (up to March 2, 2019). The methodological quality of studies was evaluated using the internationally accepted Cochrane collaboration′s risk of bias assessment tool. A meta-analysis was performed using RevMan 5.3 software to compare the incidences of cardiotoxicity between PD-1/PD-L1 inhibitors (trial group) and placebo or other antineoplastic agents(control group).Results:A total of 10 randomized controlled trials (RCTs) were enrolled, 9 of which were about PD-1 inhibitor alone or in combination with other antineoplastic agents, and 1 of which was about PD-L1 inhibitor monotherapy. There were a total of 5 291 patients, including 3 022 in the trial group and 2 269 in the control group. Evaluation of the methodological quality for studies showed that 4 RCTs were at high risk of bias and the other 6 were at low risk of bias. The meta-analysis showed that the incidence of cardiotoxicity in the trial group was significantly higher than that in the control group, and the difference was statistically significant[1.13% (34/3 022) vs. 0.22% (5/2 269), RR=2.38, 95 %CI: 1.19 -4.78, P=0.01]. Conclusion:PD-1/PD-L1 inhibitors have the risk of causing heart related adverse events, which should be paid attention to in clinical application.

Objective:To explore the clinical and pathological characteristics of heomlytic-uremic syndrome (HUS) induced by gemcitabine.Methods:The relevant databases abroad were searched up to November 12, 2018. Case reports and clinical research papers about HUS induced by gemcitabine were collected. The patient′s general situation, use of gemcitabine, symptoms of HUS, relevant laboratory test results, renal biopsy results, time from medication to HUS onset, and the treatments and outcomes of HUS were recorded. The clinical and pathological characteristics of HUS induced by gemcitabine were analyzed by descriptive statistical method.Results:A total of 61 patients were enrolled in the study, including 22 males and 35 females with 4 unknown gender. The age of patients ranged from 25 to 81 years. The primary diseases included pancreatic cancer in 22 cases, lung cancer in 18 cases, cholangiocarcinoma in 7 cases, mammary cancer in 5 cases, ovarian cancer in 4 cases, non-Hodgkin′s lymphoma in 2 cases, soft tissue sarcoma in 1 case, bladder cancer in 1 case, and kidney cancer in 1 case. HUS occurred in 2-34 months after the first application of gemcitabine, and the median time was 6 months. The cumulative dose of gemcitabine was 4 000-99 540 mg/m 2 when HUS occurred, and the median cumulative dose was 19 100 mg/m 2. Of the 61 patients, 54 patients developed HUS symptoms, including hypertension (43 cases, 79.6%), peripheral edema (31 cases, 57.4%), and dyspnea (20 cases, 37.0%), and 7 patients were asymptomatic. There were different degrees of increase in serum creatinine and lactate dehydrogenase and decrease in platelet and hemoglobin in 61 patients. Fifteen patients performed renal biopsy and the thrombotic microangiopathy were found in all cases. Gemcitabine were stopped after the occurrence of HUS in all patients, and therapies such as symptomatic treatments, plasmapheresis, hemodialysis, symptomatic treatments+plasmapheresis, symptomatic treatments+glucocorticoid, or rituximab or ikuzumab treatment on the basis of above-mentioned therapy were given. Of the 61 patients, HUS was improved in 34 (55.7%) cases, but 27 patients (44.3%) died within 1-65 months after the occurrence of HUS, of which 13 cases (21.3%) died of HUS. Conclusions:The main clinical manifestations of HUS caused by gemcitabine are hypertension, peripheral edema, and dyspnea. A few patients may be asymptomatic, but all develop abnormal laboratory indicators related to toxuria and hemolysis. The main pathological changes in the kidney are thrombotic microangiopathy. The prognosis of HUS is poor. Severe cases can lead to death.

Objective:To systematically evaluate cardiotoxicity of programmed cell death 1 receptor (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors.Methods:Clinical trials of PD-1/PD-L1 inhibitor alone or in combination with other treatments for tumors were collected by searching related databases at home and abroad (up to March 2, 2019). The methodological quality of studies was evaluated using the internationally accepted Cochrane collaboration′s risk of bias assessment tool. A meta-analysis was performed using RevMan 5.3 software to compare the incidences of cardiotoxicity between PD-1/PD-L1 inhibitors (trial group) and placebo or other antineoplastic agents(control group).Results:A total of 10 randomized controlled trials (RCTs) were enrolled, 9 of which were about PD-1 inhibitor alone or in combination with other antineoplastic agents, and 1 of which was about PD-L1 inhibitor monotherapy. There were a total of 5 291 patients, including 3 022 in the trial group and 2 269 in the control group. Evaluation of the methodological quality for studies showed that 4 RCTs were at high risk of bias and the other 6 were at low risk of bias. The meta-analysis showed that the incidence of cardiotoxicity in the trial group was significantly higher than that in the control group, and the difference was statistically significant[1.13% (34/3 022) vs. 0.22% (5/2 269), RR=2.38, 95 %CI: 1.19 -4.78, P=0.01]. Conclusion:PD-1/PD-L1 inhibitors have the risk of causing heart related adverse events, which should be paid attention to in clinical application.

Objective:To explore the clinical and pathological characteristics of heomlytic-uremic syndrome (HUS) induced by gemcitabine.Methods:The relevant databases abroad were searched up to November 12, 2018. Case reports and clinical research papers about HUS induced by gemcitabine were collected. The patient′s general situation, use of gemcitabine, symptoms of HUS, relevant laboratory test results, renal biopsy results, time from medication to HUS onset, and the treatments and outcomes of HUS were recorded. The clinical and pathological characteristics of HUS induced by gemcitabine were analyzed by descriptive statistical method.Results:A total of 61 patients were enrolled in the study, including 22 males and 35 females with 4 unknown gender. The age of patients ranged from 25 to 81 years. The primary diseases included pancreatic cancer in 22 cases, lung cancer in 18 cases, cholangiocarcinoma in 7 cases, mammary cancer in 5 cases, ovarian cancer in 4 cases, non-Hodgkin′s lymphoma in 2 cases, soft tissue sarcoma in 1 case, bladder cancer in 1 case, and kidney cancer in 1 case. HUS occurred in 2-34 months after the first application of gemcitabine, and the median time was 6 months. The cumulative dose of gemcitabine was 4 000-99 540 mg/m 2 when HUS occurred, and the median cumulative dose was 19 100 mg/m 2. Of the 61 patients, 54 patients developed HUS symptoms, including hypertension (43 cases, 79.6%), peripheral edema (31 cases, 57.4%), and dyspnea (20 cases, 37.0%), and 7 patients were asymptomatic. There were different degrees of increase in serum creatinine and lactate dehydrogenase and decrease in platelet and hemoglobin in 61 patients. Fifteen patients performed renal biopsy and the thrombotic microangiopathy were found in all cases. Gemcitabine were stopped after the occurrence of HUS in all patients, and therapies such as symptomatic treatments, plasmapheresis, hemodialysis, symptomatic treatments+plasmapheresis, symptomatic treatments+glucocorticoid, or rituximab or ikuzumab treatment on the basis of above-mentioned therapy were given. Of the 61 patients, HUS was improved in 34 (55.7%) cases, but 27 patients (44.3%) died within 1-65 months after the occurrence of HUS, of which 13 cases (21.3%) died of HUS. Conclusions:The main clinical manifestations of HUS caused by gemcitabine are hypertension, peripheral edema, and dyspnea. A few patients may be asymptomatic, but all develop abnormal laboratory indicators related to toxuria and hemolysis. The main pathological changes in the kidney are thrombotic microangiopathy. The prognosis of HUS is poor. Severe cases can lead to death.

OBJECTIVE： To systematically evaluate the effects of Shenqi fuzheng injection combined with conventional chemotherapy on the immune function of patients with advanced non-small cell lung cancer （NSCLC）， and provide evidence-based reference for clinical medication. METHODS： Retrieved from Cochrane Library， PubMed， Medline， Embase， CNKI， Wanfang database， VIP and CBM， Shenqi fuzheng injection combined with conventional chemotherapy （trial group） versus conventional therapy （control group） for advanced NSCLC were collected. After literature screening， data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0 risk evaluation tool， Meta-analysis was performed by using Rev Man 5.3 statistical software. RESULTS： A total of 16 literatures were included， involving 1 324 cases. Results of Meta-analysis showed that there were no statistical significance in the difference of objective remission rate （ORR） [RR＝1.14， 95％CI（0.91，1.43）， P＝0.25] and the level of  CD8+ [MD＝－1.26，95％CI（－4.10， 1.59），P＝0.39] between 2 groups. The levels of CD3+ [MD＝17.48， 95％CI（13.40， 21.56）， P＜0.000 01 ]， CD4+[MD＝12.26， 95％CI（8.39 16.13）， P＜0.000 01]， CD4+/CD8+ [MD＝0.33，95％CI（0.27， 0.39），P＜0.000 01] and the percentage of NK cells [MD＝9.33， 95％CI（5.72， 12.94）， P＜0.000 01] in trial group were significantly higher than control group. Results of subgroup analysis for medication duration of Shenqi fuzheng injection showed that after 1-14 d treatment of Shenqi fuzheng injection， the levels of CD3+ [MD＝17.11， 95％CI（12.37 ，23.17），P＜0.000 01]， CD4+[MD＝13.28，95％CI（8.33， 18.23），P＜0.000 01]， CD4+/CD8+[MD＝0.36，95％CI（0.28，0.43），P＜0.000 01] and the percentage of NK cells [MD＝12.06，95％CI（7.52，16.61），P＜0.000 1] in trial group were significantly higher than control group. After 21 d treatment of Shenqi fuzheng injection， the levels of CD3+[MD＝14.88， 95％CI（7.51，22.26），P＜0.000 01]， CD4+[MD＝10.56，95％CI（5.57，15.56），P＜0.000 01]， CD8+[MD＝3.02， 95％CI（1.80， 4.23），P＜0.000 01]， CD4+/CD8+[MD＝0.29，95％CI（0.23， 0.35），P＜0.000 01] and the percentage of NK cells [MD＝5.58，95％CI（2.49， 8.67），P＝0.000 4] in trial group were significantly higher than control group. There was no statistical significance in the level of CD8+ between 2 groups after 7-14 d treatment of Shenqi fuzheng injection [MD＝－4.26，95％CI（－12.60， 4.09），P＝0.32]. The incidence of leukopenia， nausea and vomiting， and renal dysfunction in trial group were significantly lower than control group. There was no statistical significance in the incidence of hemoglobin decreased and thrombocytopenia between 2 groups. The results of publication bias showed that there was a greater possibility of publication bias in this study. CONCLUSIONS： Shenqi fuzheng injection combined with conventional chemotherapy may improve the immune function of patients with advanced NSCLC and improve the safety after chemotherapy. But more large-scale， milltiple-center and high-quality RCT are needed to validate this conclusion.

A 25-year-old male patient with epithelioid hemangioendothelioma received periodic chemotherapy with gemcitabine 1600 mg (on day 1 and 8 of each chemotherapy cycle)and docetaxel 110 mg (on day 8 of each chemotherapy cycle)and the chemotherapy cycle was 21 days. The patient developed fever on day 7 after the first IV infusion of gemcitabine in the third chemotherapy cycle and then the following infusions of this cycle was abandoned. Thirty days later,he was hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine to undergo the fourth chemotherapy cycle. On day 4 after hospitalization,the patient developed urinary incontinence and 900 ml of soy sauce-colored liquid was drained by catheter. Laboratory tests showed red blood cell count 2. 19 × 1012 / L,hemoglobin 63 g/ L, and platelet 257 × 109 / L. The patient was diagnosed as hemolytic-uremic syndrome due to gemcitabine. The patient′s condition improved after Ⅳ infusions of alprostadil injection,reduced glutathione for injection,and suspended red blood cells for 6 days.