OBJECTIVE To provide reference for improving the pre-prescription review system and reducing the occurrence of medication error by analyzing the drug-related problems （DRPs） in the pre-prescription review orders of pediatric outpatient clinics using the Pharmaceutical Care Network Europe （PCNE） classification system. METHODS The data of pre-prescription review orders were retrospectively collected from outpatient department of Shanghai Children’s Medical Center， Shanghai Jiao Tong University School of Medicine from July 2022 to June 2023； DRPs in the pre-prescription review orders were classified and summarized by using the PCNE classification system （version 9.1）， and then analyzed in terms of types and causes of issues， and the acceptance of interventions. RESULTS A total of 66 017 DRPs orders were included， involving 41 165 patients. The proportion of DRPs orders in children aged ≤5 years old was the highest （58.25%）， followed by children aged 6-12 years old （33.52%）； the department with the highest proportion of DRPs was internal medicine of pediatrics department （71.41%）； the department with the highest incidence of DRPs was thoracic surgery department （9.73%）； top three drug categories of DRPs orders were systemic anti- infective drugs （25.26%）， Chinese patent medicines （24.74%） and respiratory drugs （22.38%）. Referring to PCNE classification system， the types of DRPs mainly focused on treatment safety （64.86%）； the reasons of DRPs orders mainly focused on dose selection （82.09%）， of which 41.26% were due to excessive drug dosage； 92.13% of interventions could be accepted and fully executed by doctors. CONCLUSIONS DRPs orders identified by the pre-prescription review system can be effectively analyzed by using PCNE classification system. Pharmacists should focus on medication use in children aged ≤5 years old， update and develop personalized prescription review rules timely， and meet the rational needs of clinical medication for children.

Objective: To reveal the therapeutic effects of moxibustion in collagen-induced arthritis (CIA) rat models using the combined analysis of plasma and synovial membrane lipidomic profiling and to enhance the understanding of how moxibustion affects lipid metabolism in rheumatoid arthritis (RA). Methods: A total of 32 male Sprague-Dawley (SD) rats were randomly assigned to four groups: control, moxibustion control (MC), model, and moxibustion model (MM) groups, with 8 rats in each group. CIA was induced in SD rats by two immunizations. The paw volume was measured before the induction of CIA. Following induction, after assessing paw volume and arthritis index (AI) scores, the MC and MM groups received treatment at bilateral Shenshu (BL23) and Zusanli (ST36) acupoints for 10 min per acupoint. The intervention included three treatment courses, each spanning 6 d and followed by a 1-d interval. Paw volume and AI scores were assessed after each treatment course. After the completion of the three treatment courses, serum, plasma, synovial tissue, and ankle joint samples were collected. Enzyme-linked immunosorbent assay (ELISA) was employed to quantify the levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α in serum. Hematoxylin and eosin (HE) staining was performed for histopathological examination of the ankle joint tissues. Meanwhile, ultra-high-performance liquid chromatography coupled with Q-Exactive Orbitrap mass spectrometry (UHPLC-Q-Exactive Orbitrap MS) was utilized to analyze the plasma and synovial tissue samples. In addition, multivariate statistical analysis was performed to identify differential lipid metabolites, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was applied to explore metabolic pathways modulated by moxibustion therapy. Results: No significant difference in hind paw volume and AI scores was observed among the groups (P > 0.05). After CIA induction, model group showed increased hind paw volume and AI scores compared with control group (P < 0.05), which were significantly reduced after moxibustion treatment in MM group compared with model group (P < 0.05). The levels of IL-6 and TNF-α were significantly higher in model and MM groups compared with control group (P < 0.05), but were lower in MM group than those in model group (P < 0.05). Histopathological analysis showed improved cartilage and reduced inflammation in MM group. A total of 33 differential lipid metabolites in the plasma and 24 in the synovial membranes of CIA rat models were identified when compared with control group. Among these lipid metabolites, 31 in the plasma and all 24 in the synovial membranes were regulated by moxibustion treatment. Pathological analysis revealed upregulation of diacylglycerol (DG) and fatty acid (FA) levels, alongside downregulation of lysophosphatidylcholine (LPC), phosphatidylcholine (PC), and phosphatidylethanolamine (PE). Under physiological conditions, the treatment specifically reduced LPC and PC levels. Pathway enrichment analysis revealed that moxibustion predominantly affected α-linolenic acid, glycerophospholipid, and sphingolipid metabolism under pathological conditions. Under physiological conditions, the regulation was centered around α-linolenic acid and glycerophospholipid metabolism. Conclusion The RA rat models exhibited significant lipid metabolic disturbances. Moxibustion alleviated paw swelling, reduced AI scores, modulated inflammatory cytokine levels, and partially corrected the altered levels of multiple lipid metabolites. The potential metabolic pathways implicated in the regulation of lipid metabolism under both physiological and pathological conditions include α-linolenic acid, glycerophospholipid, and sphingolipid metabolism.

Targeting T-cell is a strategy to control allogeneic response disorders, such as acute graft-versus-host disease (GVHD) which is an important cause of therapy-failure after allogeneic hematopoietic cell transplants. Free fatty acid receptor-4 (FFAR4) is a regulator of obesity but its role in T-cell and allogeneic reactions is unknown. Here, we found knockout of Ffar4 in donor T-cells in a mouse allograft model increased acute GVHD whereas the natural FFAR4 ligands and the synthetic FFAR4 agonists decreased it. FFAR4 agonist-mediated anti-acute GVHD effects depended on FFAR4-expression in donor T-cells. The FFAR4 agonist CpdA suppressed donor T-cell-mediated alloreaction by activating an aryl hydrocarbon receptor (AhR) pathway. CpdA recruited β-Arrestin2 to FFAR4 which facilitated nuclear translocation of AhR and upregulation of IL-22. The CpdA-mediated anti-acute GVHD effect was absent in mice receiving Ahr-knockout or Il22-knockout T-cells. Recipient-expressing Ffar4 was also important for the anti-acute GVHD effect of CpdA which inhibited activation of antigen presenting cells. Importantly, CpdA decreased acute GVHD in obese mice, an effect also depended on Ffar4-expression in donor T-cells and recipients. Our study shows the immunoregulatory effect of FFAR4 in T-cell, and targeting FFAR4 might be a relative option for controlling allogeneic reactions in obese patients.

Echocardiography is an important imaging technique in mithal valve transcatheter edge-to-edge repair (TEER). During the operation, mitral leaflets capture and clamping have the highest requirements for ultrasound image quality and should be performed under the guidance of high-quality commissural view. However, standard commissural view cannot be obtained in some patients due to cardiac enlargement, transposition or limited esophageal acoustic window. In this condition, the optimal view can be obtained by Multivue technology. This paper reports a male patient aged 67 years with successful mitral valve TEER under the real-time guidance of Multivue technology, and summarizes the key points of this technology.

Objective To explore the correlations of evaluations of right heart function parameters in patients with Ebstein anomaly(EA)using echocardiography and cardiac MRI.Methods Data of transthoracic echocardiography and cardiac MRI in 32 patients with EA confirmed by operation were retrospectively analyzed.The correlations of cardiac cavity size,right ventricular function and strain parameters obtained using echocardiography and the functional right ventricular(fRV)ejection fraction(EF)measured using MRI were explored.Results MRI fRV-EF in 32 cases of EA was(23.20± 7.61)％.Among echocardiographic parameters in 32 cases of EA,fractional area change(FAC)of fRV(r=0.347,P=0.015)was slightly,while global longitudinal strain(GLS)of fRV(r=0.801,P＜0.001)was highly positively correlated with MRI fRV-EF,respectively,whereas atrialized right ventricle(aRV)area/fRV area(r=-0.730,P=0.007)was highly negatively,aRV area/left ventricular area(r=-0.450,P=0.042)and right ventricular anterior-posterior diameter(r=-0.650,P=0.022)were both moderately negatively correlated with MRI fRV-EF.Both the left ventricular eccentricity index(r=-0.347,P=0.049)and Glasgow outcome scale extended(r=-0.336,P=0.024)obtained with echocardiography were slightly negatively correlated MRI fRV-EF.Conclusion Right heart function parameters in EA patients obtained with echocardiography were correlated with those of MRI fRV-GLS,among which aRV area/fRV area were highly positively correlated with MRI fRV-EF,hence having great value for evaluating right heart function in EA patients.

Objective To investigate the effects of Shechuangzi San on Th1/Th2 immune function in eczema rats and analyze its mechanisms in treating eczema.Methods Fifty SD rats were randomly divided into blank group,model group,Shechuangzi San high dose group,Shechuangzi San low dose group,and Bingbaiye liquid group,with 10 rats in each group.The rat eczema model was established using 2,4-dinitrochlorobenzene.The blank group and model group were topically treated with 0.9%saline,the Shechuangzi San high dose group was topically treated with a decoction of Shechuangzi San at a concentration of 2.32 g·mL-1,and the low dose group was topically treated with a decoction of Shechuangzi San at a concentration of 1.16 g·mL-1.And the Bingbaiye liquid group was topically treated with the original liquid of Bingbaiye,once in the morning and once in the evening,for a total of 14 days.After the last administration,the skin lesions on the rats'backs were observed and the skin lesion scores were evaluated.The pathological changes of eczema lesions were observed by HE staining,and semi-quantitatively scored.ELISA method was used to detect the levels of IFN-γ,IL-4,IL-18,and IL-33 in rat serum.Flow cytometry was used to determine the Th1/Th2 ratio in the serum.Results Compared to the blank group,the rat skin lesion score in the model group was significantly increased(P<0.05),with a series of skin lesions including edema,erythema,scaling,lichenification appearing on the back.Pathological sections showed excessive keratosis,thickening of cuticular layer,edema of epidermis sponge,infiltration of a large number of inflammatory cells in epidermis,and the semi-quantitative score of skin lesions was significantly increased(P<0.05).Serum levels of IL-4,IL-18,and IL-33 were significantly increased(P<0.05),while the level of IFN-γ was significantly decreased(P<0.05).Serum Th1/Th2 ratio decreased(P<0.05).Compared to the model group,the rat skin lesions in the Shechuangzi San high and low dose groups and the Bingbaiye liquid group were significantly improved(P<0.05),Pathological sections showed that the structure of epidermis was restored to normal,the cuticle became thinner,the spongy edema of epidermis disappeared,epidermal inflammatory cells disappeared,and the semi-quantitative score of skin lesions decreased(P<0.05).Serum levels of IL-4,IL-18,and IL-33 were decreased(P<0.05),while the level of IFN-γ was increased(P<0.05),serum Th1/Th2 ratio increased significantly(P<0.05).and the therapeutic effect of the Shechuangzi San high and low dose groups was superior to that of the Bingbaiye liquid group(P<0.05).Conclusion Shechuangzi San can effectively improve the skin lesions of rats with eczema,repair the pathological damage of skin lesions,and reduce the levels of inflammatory factors.Its mechanism may be related to the inhibition of secretion of inflammatory factors such as IL-4,IL-18,and IL-33,promotion of IFN-γ release,and restoration of Th1/Th2 imbalance.

Objective To explore the differences of bone age of radius,ulna,metacarpophalangeal and carpal bones in children with different physiques.Methods Radiographs of children's wrists aged between 4 and 12 years were collected.The bone age of radius,ulna,metacarpophalangeal,and carpal bones were assessed using the Chinese Children's Bone Age Score,and the difference between the two bone ages(the former minus the latter)was recorded.According to gender,age,and physical grouping,the physical group was divided into normal and abnormal groups.The abnormal group was further divided into thin,overweight,and obese groups.A comparative analysis was conducted to determine the differences in bone age between normal and abnormal groups for both males and females at all ages.Results A total of 3 028 children were included,and the differences between the two bone age results for normal boys aged 7-12 years and normal girls aged 5-12 years were not statistically significant(P＞0.05).In boys,there was no significant difference in bone age between the normal group and the thin group(P＞0.05),the difference in bone age between the normal and thin groups at the age of 5-6 years was greater than that between the overweight and obese groups,and the difference was statistically significant(P＜0.05),the difference in bone age between the normal group at 11-12 years and the thin group at 11 years was smaller than that between the overweight and obese groups(P＜0.05).The difference in bone age was smaller in the normal group than in the thin group at 6 years of age for girls(P＜0.05),and larger in the thin group than in the overweight and obese groups at 5 to 6 years old(P＜0.05).Conclusion The difference in bone age between the TW-C RUS series and TW-C C series bone age values is influenced by the child's gender,physique,and age.The difference in bone age between the majority of normal children and the thin group is not statistically significant,but differed from the overweight and obese groups at some ages,most are the overweight and obese boys.

Objective To investigate the clinical efficacy of artificial dura mater and epidermal growth factor in the repair of tympanic membrane perforation after endoscopic tympanic membrane repair.Methods 58 patients with tympanic membrane perforation were randomly divided into two groups,29 cases in each.Group A was repaired with gelatin sponge,group B was repaired with artificial dura mater and epidermal growth factor.The tympanic membrane healing was reviewed every month,and the pure tone audiometry was reviewed after 3 months.Results The success rate of repair in group A was 34.48%(10/29),and that in group B was 75.86%(22/29).The difference was statistically significant(P<0.05).The air-bone gap in group A was improved by(7.32±2.68)dB HL,and that in group B was improved by(21.77±4.65)dB HL.The difference was statistically significant(P<0.05).Conclusion Artificial dura mater is a suitable tympanic membrane regeneration scaffold.Epidermal growth factor can promote the healing of tympanic membrane perforation.The combination of the two is a feasible treatment for tympanic membrane repair.

To analyze the disease group structure and its trends in key departments of large public hospitals using diagnosis related group (DRG) data, explore the key points of intervention and optimization of disease groups in departments, and further promote the rational allocation of department resources.

Objective To investigate the correlation between tongue and pulse indicators and the out-come of live birth in patients undergoing frozen-thawed embryo transfer(FET),as well as the association between these indicators and patients'endocrine parameters. Methods This study was conducted at Reproductive Medicine Center,Shuguang Hospital Af-filiated to Shanghai University of Traditional Chinese Medicine,Shanghai,China,from March 8,2021 to January 5,2022.Patients undergoing FET were divided into live birth and non-live birth groups according to their live birth outcome.The differences between the endocrine pa-rameters[basic follicle stimulating hormone(b FSH),basic luteinizing hormone(b LH),basic estradiol(b E2),basic progesterone(b P),basal endometrial thickness,follicle stimulating hormone(FSH)on endometrial transition day,luteinizing hormone(LH)on endometrial transition day,estradiol(E2)on endometrial transition day,progesterone(P)on endometrial transition day,and endometrial thickness on endometrial transition day]and the tongue and pulse indicators[tongue body(TB)-L,TB-a,TB-b,tongue coating(TC)-L,TC-a,TC-b,perAll,perPart,h1,h4,h5,t1,h1/t1,and h4/h1]of patients in the two groups were analyzed,with the correlation between these variables analyzed as well using Spearman's correlation coefficient.Multivariate logistic regression was employed to identify the influential factors in the live birth prediction models across various datasets,including Model 1 consisting of endocrine indica-tors only,Model 2 solely consisting of tongue and pulse indicators,and Model 3 consisting of both tongue,pulse,and endocrine indicators,as well as to evaluate efficacy of the models de-rived from different datasets. Results This study included 78 patients in live birth group and 144 patients in non-live birth group.Compared with non-live birth group,live birth group exhibited higher levels of TB-L(P=0.01)and TB-a(P=0.04),while demonstrated lower levels of b FSH(P=0.01),perAll(P=0.04),and h4/h1(P=0.03).The Spearman's correlation coefficient analysis revealed statisti-cally significant correlation(P<0.05)between TB-L,TB-b,TC-L,TC-b,perAll,perPart,h4,h5,t1,h1/t1 and b FSH,b LH,basal endometrial thickness,LH on endometrial transition day,E2 on endometrial transition day,P on endometrial transition day,and endometrial thickness on endometrial transition day in live birth group.The multivariate logistic regression analysis showed that the prediction Model 3 for live birth outcome[area under the curve(AUC):0.917,95%confidence interval(CI):0.863-0.971,P<0.001]surpassed the Model 1(AUC:0.698,95%CI:0.593-0.803,P=0.001),or the Model 2(AUC:0.790,95%CI:0.699-0.880,P<0.001).The regression equations for the live birth outcomes,integrating tongue and pulse indicators with endocrine parameters,included the following measures:FSH on endometrial transition day[odds ratio(OR):0.523,P=0.025],LH on endometrial transition day(OR:1.277,P=0.029),TB-L(OR:2.401,P=0.001),perPart(OR:1.018,P=0.013),h1(OR:0.065,P=0.021),t1(OR:4.354,P=0.024),and h4/h1(OR:0.018,P=0.016). Conclusion In infertility patients undergoing FET,there exists a correlation between tongue and pulse indicators and endocrine parameters.The corporation of tongue and pulse indica-tors significantly improved the predictive capability of the model for live birth outcomes.Specifically,tongue and pulse indicators such as TB-L,perPart,h1,t1,and h4/h1 exhibited a discernible correlation with the ultimate live birth outcomes.