OBJECTIVE To summarize the implementation experiences of the China Hospital Association’s Clinical Pharmacist Instructor Training Program Reform， and to evaluate the effectiveness of the reform， thus continuously enhancing the quality and standards of clinical pharmacist instructor training. METHODS The study drew on project evaluation methodologies to summarize the main characteristics of the comprehensive system and new model for clinical pharmacist instructor training established through the reform by literature review. The “learning assessment” and “reaction assessment” were conducted by using Kirkpatrick’s four-level model of evaluation in order to evaluate the effectiveness of the clinical pharmacist instructor training reform through statistically processing and analyzing the performance data and teaching evaluation data of the instructor participants. Based on problem and trend analysis， the future development directions were anticipated for the reform of clinical pharmacist instructor training. RESULTS & CONCLUSIONS The latest round of clinical pharmacist instructor training reform initiated by the Chinese Hospital Association had initially established a four-pronged training system encompassing “recruitment， training， assessment， and management”. It had also forged a training 。 model “oriented towards enhancing clinical teaching competency， with practical learning and skill-based assessment conducted on clinical teaching sites as its core”. Following a period of over three years of gradual reform， the new training system and model became increasingly mature. In both 2023 and 2024， the participants achieved relatively high average total scores in their initial completion assessments [with scores of （84.05± 5.83） and （85.82±4.35） points， respectively]. They also reported a strong sense of gain from the training reform [with self- perceived gain scores of （4.80±0.44） and （4.85±0.39） points， respectively]. The operation and implementation effects of the reform were generally satisfactory. In the future， clinical pharmacist instructor training reforms should continue to address the issues remaining from the current phase， while aligning with global trends in pharmacy education and industry development. Additionally， sustained exploration and practice will be carried out around the core objective of “enhancing clinical teaching competence”.

Zearalenone(ZEN)is a mycotoxin that extensively contaminates food and feed,posing a significant threat to public health.However,the mechanisms behind ZEN-induced intestinal immunotoxicity remain unclear.In this study,Sprague-Dawley(SD)rats were exposed to ZEN at a dosage of 5 mg/kg/day b.w.for a duration of 14 days.The results demonstrated that ZEN exposure led to notable pathological alterations and immunosup-pression within the intestine.Furthermore,ZEN exposure caused a significant reduction in the levels of apolipoprotein E(ApoE)and liver X receptor(LXR)(P＜0.05).Conversely,it upregulated the levels of myeloid-derived suppressor cells(MDSCs)markers(P＜0.05)and decreased the presence of 27-hydroxycholesterol(27-HC)in the intestine(P＜0.05).It was observed that ApoE or LXR agonists were able to mitigate the immunosuppressive effects induced by ZEN.Additionally,a bioinformatics analysis highlighted that the downregulation of ApoE might elevate the susceptibility to colorectal,breast,and lung cancers.These find-ings underscore the crucial role of the 27-HC/LXR/ApoE axis disruption in ZEN-induced MDSCs proliferation and subsequent inhibition of T lymphocyte activation within the rat intestine.Notably,ApoE may emerge as a pivotal target linking ZEN exposure to cancer development.

Objective:To develop an intervention program for symptom clusters in children with acute lymphoblastic leukemia (ALL) during the consolidation and reinforcement phase based on symptom management theory from a sociopsychological perspective.Methods:An initial draft of the intervention program for symptom clusters in children with ALL during the consolidation and reinforcement phase was prepared through literature review and group discussions. Purposeful sampling was used to select 20 experts as respondents for a Delphi method consultation. After two rounds of expert consultations, adjustments and improvements were made to the relevant indicators, resulting in the final version of the intervention program.Results:The effective response rates for the two rounds of expert consultations were 80% (16/20) and 100% (20/20), respectively. The authority coefficients for the experts were 0.816 and 0.838, while the Kendall's coordination coefficients were 0.207 and 0.397 ( P<0.01 for both rounds). The final intervention program comprised 3 primary items, 7 secondary items, and 27 tertiary items. Conclusions:The intervention program for symptom clusters in children with ALL during the consolidation and reinforcement phase, developed from a sociopsychological perspective, demonstrates scientific validity, reliability, and feasibility. It can offer guidance and reference for symptom management in children with ALL.

Objective The epidemiological characteristics and risk factors of infection of non-tuberculous mycobacterial (NTM) by elderly bronchiectasis patients in Huai 'an area were analyzed, and the theoretical basis for prevention of NTM infection by elderly bronchiectasis patients in Huai 'an area was provided. Methods Among the 371 elderly patients with bronchiectasis admitted to our hospital from January 2020 to June 2022 were selected and divided into control group and NTM group according to whether they had NTM or not. The NTM strains were isolated and identified. Clinical data of patients were collected from the medical record system. Independent risk factors of NTM infection in elderly patients with ramus were analyzed by univariate analysis and logistic regression, including gender, age, previous smoking status, number of ramus, pulmonary cavities, hypoproteinemia, and CD4+T cell level. Results A total of 108 cases NTM infection (29.11%) among the 371 patients with branch enlargement. There was no statistical significance in cough, phlegm, hemoptysis and fever between the two groups (P>0.05). The proportion of chest tightness and shortness in NTM group was significantly higher than that in control group (P<0.05). Six mycobacterium species were isolated from 108 patients with NTM infection, including 57 intracellular, 22 abscess, 14 avium, 7 Kansas, 5 terrapin and 3 flavus. There were significant differences in age, sex, smoking history, place of residence, number of brandished lobes, hypoproteinemia, pulmonary cavities, and number of CD4+T lymphocytes between the two groups (P<0.05). Multivariate logistic regression analysis showed that smoking history >20 years (OR=1.692), number of branchial dilated lobe ≥5 (OR=2.671) and thin-walled cavity (OR=2.458) were independent risk factors for NTM infection in elderly patients with branchial dilated lobe (P<0.05). Conclusion Elderly patients with bronchiectasis in Huai 'an area have a high risk of NTM infection, which are mainly Mycobacterium intracellular and mycobacterium abscess. The main risk factors are the number of bronchiectasis lung ≥5, smoking history >20 years, and thin-walled cavity. Patients should actively quit smoking, improve the body immunity, and prevent NTM infection in patients with bronchiectasis.

OBJECTIVE To interpret Teacher Training Syllabus for Clinical Pharmacist Training Program （2023 edition） （hereinafter referred as to the “new syllabus”）， and to provide reference and guidance for promoting the implementation of the new syllabus and realizing the quality-improving goal of the reform of the clinical pharmacist teacher training program initiated by China Hospital Association. METHODS From the perspective of the management and based on the position of the designer， the new syllabus was interpreted from four aspects： the background of its compilation and release， the process of its compilation and its characteristics， the key improvements of the program and the points for attention about its subsequent implementation. RESULTS & CONCLUSIONS The development and release of the new syllabus provide a “construction blueprint” for the reform of the clinical pharmacist teacher training program of the China Hospital Association. The whole process of compiling the new syllabus is characterized by four basic features： theory-led， goal-oriented， research-based， and synergistic. Compared with the previous syllabus， in addition to the adjustment of the text structure，the new syllabus presents more complete and clearer competence requirements for clinical teaching competence in terms of training objectives； in terms of training content， it further structures the group of task items， pays attention to the 育。E-mail：zhenjiancun@163.com sequential planning and time arrangement of items， and puts forward both quantitative and qualitative refinement requirements for each specific training task；in terms of training methods， it emphasizes the interaction of lecturing， demonstrating and guiding， and the progression of observation， operation and reflection， with the intention of guiding teacher trainees to “learn how to teach by teaching”. In the subsequent implementation of the new syllabus， it is necessary for the teacher training bases to attach great importance to the guarantee of training conditions and process quality management， and to organize the teacher training team to do a good job in the two training programs of “clinical pharmacist training” and “clinical pharmacist teacher training”. Based on further improving the connection between the two training programs， the teacher training team should continue to explore the scientific model of clinical pharmacist teacher training oriented by clinical teaching competence.

Objective To analyze the values of serum Delta-like protein 4(DLL4)and cAMP response element-binding protein(CREB)levels in predicting microvascular injury of patients with different stages of diabetic retinopathy(DR).Methods Eighty diabetic patients from February 2020 to February 2023 were selected as research objects,and they were divided into no DR group(n=37),non-proliferative DR group(n=19)and proliferative DR group(n=24)according to different stages of DR;serum DLL4 and CREB levels in the blood were detected,and the FACS Count flow cytometry was used to detect levels of endothelial progenitor cells(EPC),circulating endothelial cells(CEC)and circulating progenitor cells(CPC)in patients.Results The levels of DLL4 and CREB in the blood of proliferative DR group were the highest,while the levels of DLL4 and CREB in the no DR group were the lowest,and the differences were statistically significant(P＜0.05);different stages of DR were significantly positively correlated with the levels of DLL4 and CREB(P＜0.05);the high levels of DLL4 and CREB in the blood of diabetic patients were the independent risk factors affecting staging of DR(P＜0.05).The levels of EPC and CPC in the blood of proliferative DR group were the lowest,while the level of CEC was the highest;in the no DR group,the levels of EPC and CPC were the highest,while the level of CEC was the lowest,and the differences were statistically signifi-cant(P＜0.05);the levels of DLL4 and CREB were significantly negatively correlated with EPC and CPC levels(P＜0.05),while the levels of DLL4 and CREB were significantly positively corre-lated with CEC level(P＜0.05);the area under the curve(AUC)of both DLL4 and CREB in pre-dicting microvascular injury in DR patients was greater than 0.85.Conclusion As the staging of DR increases,the levels of serum DLL4 and CREB show a significant upward trend,and DLL4 and CREB have higher predictive values for microvascular injury.

Objective To analyze the values of serum Delta-like protein 4(DLL4)and cAMP response element-binding protein(CREB)levels in predicting microvascular injury of patients with different stages of diabetic retinopathy(DR).Methods Eighty diabetic patients from February 2020 to February 2023 were selected as research objects,and they were divided into no DR group(n=37),non-proliferative DR group(n=19)and proliferative DR group(n=24)according to different stages of DR;serum DLL4 and CREB levels in the blood were detected,and the FACS Count flow cytometry was used to detect levels of endothelial progenitor cells(EPC),circulating endothelial cells(CEC)and circulating progenitor cells(CPC)in patients.Results The levels of DLL4 and CREB in the blood of proliferative DR group were the highest,while the levels of DLL4 and CREB in the no DR group were the lowest,and the differences were statistically significant(P＜0.05);different stages of DR were significantly positively correlated with the levels of DLL4 and CREB(P＜0.05);the high levels of DLL4 and CREB in the blood of diabetic patients were the independent risk factors affecting staging of DR(P＜0.05).The levels of EPC and CPC in the blood of proliferative DR group were the lowest,while the level of CEC was the highest;in the no DR group,the levels of EPC and CPC were the highest,while the level of CEC was the lowest,and the differences were statistically signifi-cant(P＜0.05);the levels of DLL4 and CREB were significantly negatively correlated with EPC and CPC levels(P＜0.05),while the levels of DLL4 and CREB were significantly positively corre-lated with CEC level(P＜0.05);the area under the curve(AUC)of both DLL4 and CREB in pre-dicting microvascular injury in DR patients was greater than 0.85.Conclusion As the staging of DR increases,the levels of serum DLL4 and CREB show a significant upward trend,and DLL4 and CREB have higher predictive values for microvascular injury.

Objective:To construct a quality evaluation index system for postoperative rehabilitation in children with developmental dislocation of the hip (DDH) .Methods:From August to November 2021, a quality evaluation index system for postoperative rehabilitation in children with DDH was established through literature review, group discussion, and Delphi expert consultation. The analytic hierarchy process was used to determine the weights of various indicators. The positive coefficient of experts was expressed by the effective response rate of the questionnaire. The authority level of experts was represented by the authority coefficient ( Cr) , which was determined by the expert judgment coefficient ( Ca) and the expert familiarity level ( Cs) . The degree of coordination of expert opinions was represented by the Kendall harmony coefficient (Kendall's W) . The degree of concentration of expert opinions was represented by the average score of importance assignment, coefficient of variation, and full score rate. Results:The effective response rates of the two rounds of expert consultation questionnaires were 90.00% and 100.00%, respectively. The Cr of experts in two rounds were 0.785 and 0.815, and the Kendall harmony coefficients were 0.098-0.193 and 0.147-0.212 ( P<0.05) . In the second round of expert consultation, the average scores of importance assignment for all levels of indicators were≥4.0, with coefficients of variation of 0-0.24 and a full score rate of ≥50%. The final quality evaluation index system for postoperative rehabilitation in children with DDH included 3 first-level indicators, 9 second-level indicators, and 37 third-level indicators. In the consistency test results of each indicator at all levels, all of the CI were <0.001, and all of the CR were<0.001. Conclusions:The construction process of the quality evaluation index system for postoperative rehabilitation in children with DDH is scientific, and the weight distribution of the indicators is reasonable, which can be used as an effective tool for evaluating the postoperative rehabilitation quality of DDH children.

Objective:To determine the best age cutoff value of Barthel Index in the assessment of children's activities of daily living based on the scores of children's activities of daily living at different ages and the expert consensus.Methods:From December 5, 2019 to March 31, 2020, 186 children with elective surgery who were admitted to the Stomatology Department of Anhui Provincial Children's Hospital were selected as the study subject by convenience sampling. The General Information Questionnaire and Barthel Index were used to evaluate the activities of daily living of children.According to children's age, children were divided into infant group 1 (12-17 months) ( n=25), infant group 2 (18-35 months) ( n=49), preschool group (36-71 months) ( n=54), and school age group (≥ 6 years) ( n=54). The differences of children's activities of daily living in different age groups were compared. A total of 186 questionnaires were distributed, and 182 valid questionnaires were recovered, with avalid recovery rate of 97.85% (182/186). From January 7 to 14, 2020, 8 nursing experts and 2 medical experts were selected by purposive sampling.After two rounds of face-to-face expert meetings, consensus was reached on the best age cutoff value for children's activities of daily living evaluation according to the children's neuropsychiatric development progress. Results:Among children in infant group 1, 96.00% (24/25) were severely dependent and 4.00% (1/25) were moderately dependent.Among children in infant group 2, 61.22% (30/49) were severely dependent, 36.73% (18/49) were moderately dependent, and 2.04% (1/49) were lightly dependent. Among children in preschool group, 20.37% (11/54) were moderately dependent, 77.78% (42/54) were lightly dependent, and 1.85% (1/54) were completely self-care. In the school age group, 27.78% (15/54) of the children were lightly dependent and 72.22% (39/54) were completely self-care. The scores of activities of daily living in different age groups were statistically significant ( P<0.01). Through face-to-face expert meeting, the best age cutoff value for children's activities of daily living assessment was determined to be ≥ 3 years old. Conclusions:Based on the scores of children of different ages and the expert consensus, it is recommended that children ≥ 3 years old use the Barthel Index to evaluate their activities of daily living as one of the bases for establishing the nursing grade.

Chemical constituents from the air dried parts of Cichorium glandulosum were studied. The chemical constituents of C. glandulosum were separated and purified by means of silica gel, Sephadex-LH 20, ODS column chromatography and semi-preparative high performance liquid chromatography. The structure was elucidated by physicochemical characteristics and spectral data. One new flavonoid glycoside was isolated from C. glandulosum, and identified as quercetin-3-O-［6″-O-(3-ethoxy-1, 3-dioxopropyl)］-β-D-glucopyranoside(1).