This article presents a case study of a patient who visited the Geriatric Department of Peking Union Medical College Hospital due to "palpitations, shortness of breath for more than 2 years, limb weakness for 6 months, edema, and nocturnal dyspnea for 2 months". The patient exhibited decreased muscle strength in the limbs and involvement of swallowing and respiratory muscles, alongside complications of heart failure and various arrhythmias which were predominantly atrial. Laboratory tests revealed the presence of multiple autoantibodies and notably anti-mitochondrial antibodies. Following a comprehensive multidisciplinary evaluation, the patient was diagnosed with anti-mitochondrial antibody-associated inflammatory myopathy. Treatment involved a combination of glucocorticoids and immunosuppressants, along with resistance exercises for muscle strength and rehabilitation training for lung function, resulting in significant improvement of clinical symptoms. The case underscores the importance of collaborative multidisciplinary approaches in diagnosing and treating rare diseases in elderly patients, where careful consideration of clinical manifestations and subtle abnormal clinical data can lead to effective interventions.

The writing of pharmacist-managed clinics documents （hereinafter referred to as “outpatient medication record”） is a necessary part of pharmacist-managed clinics service. Outpatient medication record is an important carrier to reflect the quality of pharmacist-managed clinics service. The Chinese Hospital Association Pharmaceutical Specialized Committee was entrusted by the Pharmaceutical Administration Department of the National Health Commission to lead the formulation of the Guidelines for the Pharmacist-managed Clinics Service and Document Writing and Usage （Reference） （hereinafter referred to as Guidelines） according to the compilation method of group standards and the technical route of “documentation combing→framework establishment→draft writing→opinion collection→Guidelines formation”. The Guidelines standardizes the basic requirements of pharmacist-managed clinics record management and the basic content of record， and provides a general template and two specialized templates including pregnant and lactating pharmacist-managed clinics record template and cough and asthma pharmacist-managed clinics record template， which provides a reference for medical institutions to write pharmacist-managed clinics record. This paper introduces the formulation process of Guidelines and analyzes the key contents of Guidelines， which is helpful for the application practice of Guidelines and further improves the quality of pharmacist-managed clinics work.

ObjectiveTo investigate the processing technology of calcined Haematitum based on the concept of quality by design（QbD） and to assess its health risk. MethodsTaking whole iron content， Fe²⁺ dissolution content and looseness as critical quality attributes（CQAs）， and calcination temperature， calcination time， spreading thickness and particle size as critical process parameters（CPPs） determined by the failure mode and effect analysis（FMEA）， the processing technology of calcined Haematitum was optimized by orthogonal test combined with analytic hierarchy process-criteria importance through intercriteria correlation（AHP-CRITIC） hybrid weighting method. The contents of heavy metals and harmful elements were determined by inductively coupled plasma mass spectrometry， and the health risk assessment was carried out by daily exposure（EXP）， target hazard quotient（THQ） and lifetime cancer risk（LCR）， and the theoretical value of the maximum limit was deduced. ResultsThe optimal processing technology for calcined Haematitum was calcination at 650 ℃， calcination time of 1 h， particle size of 0.2-0.5 cm， spreading thickness of 1 cm， and vinegar quenching for 1 time［Haematitum-vinegar（10：3）］. The contents of 5 heavy metals and harmful elements in 13 batches of calcined Haematitum were all decreased with reductions of up to 5-fold. The cumulative THQ of 2 batches of samples was>1， while the cumulative THQ of all batches of Haematitum was>1. The LCR of As in 1 batches of Haematitum was 1×10^-6-1×10^-4， and the LCR of the rest was<1×10^-6， and the LCRs of calcined Haematitum were all<1×10^-6， indicating that the carcinogenic risk of calcined Haematitum was low， but special attention should still be paid to Haematitum medicinal materials. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg were formulated as 1 014， 25， 17， 27， 7 mg·kg^-1. ConclusionThe optimized processing technology of calcined Haematitum is stable and feasible， and the contents of heavy metals and harmful elements are reduced after processing. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg are formulated to provide a scientific basis for the formulation of standards for the limits of harmful elements in Haematitum.

ObjectiveTo investigate the processing technology of calcined Haematitum based on the concept of quality by design（QbD） and to assess its health risk. MethodsTaking whole iron content， Fe²⁺ dissolution content and looseness as critical quality attributes（CQAs）， and calcination temperature， calcination time， spreading thickness and particle size as critical process parameters（CPPs） determined by the failure mode and effect analysis（FMEA）， the processing technology of calcined Haematitum was optimized by orthogonal test combined with analytic hierarchy process-criteria importance through intercriteria correlation（AHP-CRITIC） hybrid weighting method. The contents of heavy metals and harmful elements were determined by inductively coupled plasma mass spectrometry， and the health risk assessment was carried out by daily exposure（EXP）， target hazard quotient（THQ） and lifetime cancer risk（LCR）， and the theoretical value of the maximum limit was deduced. ResultsThe optimal processing technology for calcined Haematitum was calcination at 650 ℃， calcination time of 1 h， particle size of 0.2-0.5 cm， spreading thickness of 1 cm， and vinegar quenching for 1 time［Haematitum-vinegar（10：3）］. The contents of 5 heavy metals and harmful elements in 13 batches of calcined Haematitum were all decreased with reductions of up to 5-fold. The cumulative THQ of 2 batches of samples was>1， while the cumulative THQ of all batches of Haematitum was>1. The LCR of As in 1 batches of Haematitum was 1×10^-6-1×10^-4， and the LCR of the rest was<1×10^-6， and the LCRs of calcined Haematitum were all<1×10^-6， indicating that the carcinogenic risk of calcined Haematitum was low， but special attention should still be paid to Haematitum medicinal materials. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg were formulated as 1 014， 25， 17， 27， 7 mg·kg^-1. ConclusionThe optimized processing technology of calcined Haematitum is stable and feasible， and the contents of heavy metals and harmful elements are reduced after processing. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg are formulated to provide a scientific basis for the formulation of standards for the limits of harmful elements in Haematitum.

Lymphoma is a highly heterogeneous malignancy characterized by complex molecular regulatory mechanisms that result in significant differences in aggressiveness and prognosis across its subtypes.Gene copy number alteration(CNA)analysis,an emerging technology,has become a pivotal tool in the precision re-search and management of lymphoma.By detecting DNA deletions,amplifications,and chromosomal copy number changes,CNA analysis addresses the limitations of traditional cytogenetic techniques,enhances the ac-curacy of subtype classification,and aids in evaluating tumor heterogeneity and disease progression.This re-view provides a comprehensive summary of CNA detection methods and their applications in lymphoma,with a focus on recent advancements in the field.It offers a comparative analysis of CNA detection techniques and discusses their role in precision diagnosis,subtype classification,monitoring disease progression,predicting therapeutic resistance,and assessing prognosis.Additionally,the review explores the potential applications of CNA analysis in uncovering molecular regulatory mechanisms,optimizing therapeutic strategies,and impro-ving patient survival outcomes.

Objective To investigate the efficacy of combined prediction of postpartum hypertension using 24-h urinary protein quantification(24-hUP),hematocrit and plasma albumin difference(HCT-ALB),and brain natriuretic peptide(BNP)in patients with severe preeclampsia at the end of pregnancy.Methods A retrospective study was conducted using cluster sampling to select 540 patients with severe preeclampsia from the University City Hospital affiliated to Chongqing Medical University between January 2018 and December 2022.Patients were divided into a hypertension group(n=98)and a non-hypertension group(n=442)based on the occurrence of postpartum hypertension.Clinical data[age,body mass index(BMI),maternal type,abortion history,family history of hypertension,smoking history,total cholesterol(TC),triglyceride(TG),fasting blood glucose(FBG),systolic blood pressure(SBP),diastolic blood pressure(DBP)]and levels of 24-hour urinary protein excretion(UP),hematocrit-albumin(HCT-ALB),and BNP in the third trimester of pregnancy were compared between the two groups to analyze the predictive value of these indicators for postpartum hypertension.Results The levels of BMI,family history of hypertension,TC,TG,FBG,SBP and DBP in hypertensive group were higher than those in non-hypertensive group[(25.63±1.37)kg/m2 vs(23.05±1.23)kg/m2,70.41%vs 30.54%].(5.32±1.14)mmol/L vs(3.91±0.95)mmol/L,(3.48±0.82)mmol/L vs(1.66±0.43)mmol/L,(7.24±1.60)mmol/L vs(4.83±1.22)mmol/L,(148.27±13.29)mmHg vs(127.65±10.71)mmHg,(92.36±5.17)mmHg vs(84.20±4.35)mmHg],the difference was statistically significant(P<0.05).The levels of urinary protein,HCT,HCT-ALB and BNP at 24 h at the end of pregnancy in hypertension group were also higher than those in non-hypertension group[(7.82±2.18)g/24 h vs(6.15±1.26)g/24 h,(34.22±3.15)%vs(32.80±1.77)%].(6.19±2.01)vs(3.46±0.90),(646.43±170.59)pg/mL vs(523.81±134.62)pg/mL],while ALB level was lower than that of the non-hypertension group[(28.03±1.13)g/L vs(29.34±1.44)g/L],with statistically significant differences(P<0.05).There was a positive correlation between 24-hUP,HCT,HCT-ALB,BNP and SBP,DBP,while ALB was negatively correlated with SBP and DBP,the difference was statistically significant(P<0.05).24-hUP,HCT-ALB and BNP at the end of pregnancy were independent risk factors for postpartum hypertension,with a combined prediction AUC of 0.930(95%CI:0.905～0.950),a Jordon index of 0.719,sensitivity of 85.71%,the specificity of 86.20%.The AUC of the combined prediction was significantly greater than that of each individual predictor,with statistically significant differences(P<0.05).Conclusion 24-hUP,HCT-ALB,and BNP at the end of pregnancy are independent risk factors for postpartum hypertension.Their combined predictive efficacy is significantly superior to that of individual indicators and can be used as an optimal clinical method for predicting whether patients with severe preeclampsia will develop postpartum hypertension.

ObjectiveTo investigate the levels of serum antibodies against novel coronavirus （SARS-CoV-2） in healthcare workers after one month of natural infection， to explore the influencing factors and their correlations with the levels of antibodies， and to provide reference for strengthening the protection of healthcare workers and preventive intervention in Pudong New Area in Shanghai. MethodsVenous blood samples were collected from 1 102 medical staff in Pudong hospitals one month after infection. The serum levels of new coronavirus specific antibodies IgM， IgG and neutralizing antibodies were detected by chemiluminescent immunoassay. The information of gender， age， position， infection severity， vaccination， basic diseases and use of immunosuppressants were obtained by questionnaire to explore the influencing factors and their correlation with the antibody level. ResultsOne month after natural infection， 99.00% （1 091/1 102） of the subjects were found to be positive for IgG antibody against the new coronavirus， 17.79% （196/1 102） of the subjects were IgM antibody positive， and 99.00% （1 091/1 102） of the samples were positive for the neutralizing antibody. The level of antibody might be influenced by the severity of infection， the time of the last dose of vaccination， and the long-term use of immunosuppressants. The more severe the disease， the stronger the neutralizing antibody response. The antibody level in the people who received the final dose of vaccine within 6 months was higher than that of the people who received the vaccine 6 months ago， and the difference was statistically significant. The antibody levels were low in the subjects who received long-term immunosuppressants. ConclusionThe specific IgM， IgG and neutralizing antibody were found， one month after infection， in the medical workers in Pudong New Area， Shanghai， and the antibody titers were high， which had a good protective effect. The antibody level of the people who were vaccinated within 6 months was higher， it is recommended that people who receive the last vacination more than 6 months should be re-vaccinated with the booster vaccine， to improve the autoimmunity against the novel coronavirus.

Objective:To study the distribution of TCM constitutions in maintenance hemodialysis (MHD) patients.Methods:This is a multicenter cross-sectional study. The general clinical data, dialysis-related parameters and physical and chemical examination data of MHD patients from 6 dialysis centers in Sichuan were collected. At the same time, DS01-A tongue and facial pulse information collection system was used for TCM constitution discrimination.Results:A total of 232 MHD patients were enrolled , and 417 kinds of TCM constitutions were detected, including 59 patients (25.43%) with moderate constitution and 173 patients (74.57%) with biased constitution. Phlegm-dampness was the most common type of solid constitution 47 patients (20.26%). The most common deficiency constitution was qi deficiency 86 patients (37.07%). There were certain differences in the physical distribution of patients with different gender, age, dialysis age, BMI, and whether they had diabetes, hypertension or anemia.Conclusions:The TCM constitutions of MHD patients are mainly biased constitution. Gender, age, BMI, diabetes or hypertension have a certain impact on the distribution of TCM constitutions. At the same time, different constitutions may have an impact on the anemia of MHD patients. The intervention of TCM constitutions on MHD patients may be beneficial to the prognosis of MHD patients.

OBJECTIVE To assess the clinical profile,prognosis,and risk factors of extrapulmonary metastasis in adenoid cystic carcinoma patients.METHODS A retrospective analysis was conducted on 126 patients diagnosed with adenoid cystic carcinoma at Beijing Tongren Hospital between January 2002 and December 2020.Of these patients,21 cases had metastases outside the lungs as their initial site of metastasis,while 105 cases had lungs as the initial site of distant metastasis.In addition,clinical data of patients diagnosed with adenoid cystic carcinoma from the Surveillance,Epidemiology,and End Results(SEER)database in the United States from 2010 to 2019 were analyzed for prognosis.RESULTS Univariate analysis showed that factors such as N stage,neurological symptoms,pathological subtype,grading,Ki67,neural invasion,and p63 status were associated with extrapulmonary metastasis(χ2=5.385,9.888,20.485,15.579,8.711,5.476,5.280;all P values<0.05).Multivariate logistic regression analysis indicated that N stage,pathological grading,and neurological symptoms were correlated with an increased risk of extrapulmonary metastasis.Survival analysis indicated lower cumulative survival and progression-free survival rates in the initial extrapulmonary metastasis group(both P values<0.05).CONCLUSION The initial metastasis site in adenoid cystic carcinoma is associated with multiple factors including N stage,pathological grading,and neurological symptoms.Patients displaying a solid subtype and those accompanied by high-grade transformation are more prone to extrapulmonary metastasis.Patients with extrapulmonary metastasis as their initial diagnosis typically exhibit poorer prognosis.