OBJECTIVE To evaluate the effect of clinical pharmacists participating in the treatment of chronic heart failure （CHF） based on the clinical pharmacy pathway （CPP）. METHODS Totally 226 CHF patients recruited from August 24th， 2024 to March 14th， 2025， were divided into an observation group and a control group based on the random number table method， with 113 cases in each group. All patients were treated with conventional therapy. The observation group was additionally given CPP management （including pharmaceutical care during hospitalization， the formulation of individualized discharge medication regimens， and pharmaceutical follow-up after discharge）. The cardiac function parameters at admission， at discharge， at 3 and 6 months after discharge， drug use at 6 months after discharge， economic indicators， as well as the readmission rate and mortality rate at 6 months after discharge were compared between the two groups. Morisky Medication Adherence Scale-8 Items （MMAS-8）， Somatic Self-rating Scale （SSS） and Patient Health Questionnaire-9 （PHQ-9） scores were compared at admission， at discharge and at 3 and 6 months after discharge. RESULTS Six months after discharge， 24 patients dropped out. Eventually， 104 patients in the observation group and 98 patients in the control group completed the study. Compared with at admission， New York Heart Association （NYHA） cardiac functional classification， left ventricular ejection fraction （LVEF） and N -terminal pro-B-type natriuretic peptide （NT-proBNP） of both groups of patients at discharge as well as at 3 and 6 months after discharge were significantly improved； moreover， the improvements at 3 and 6 months after discharge were significantly better than those at discharge. Meanwhile， the above indexes （except for NYHA cardiac functional classification at discharge， NT-proBNP and NYHA cardiac functional classification at 3 months after discharge） of the observation group at discharge， at 3 and 6 months after discharge were significantly better than the control group （ P ＜0.05）. The utilization rates of angiotensin converting enzyme inhibitor （ACEI）/angiotensin Ⅱ receptor blocker （ARB）/angiotensin receptor neprilysin inhibitor （ARNI）， the proportion of β-blockers reaching the target dose， the utilization rate of sodium-glucose linked transporter 2 inhibitor （SGLT2i）， and the proportion of SGLT2i reaching the target dose in the observation group were significantly higher than the control group （ P ＜0.05）， and the proportion of drugs and readmission rate were significantly lower than the control group （ P ＜0.05）. Compared with at admission， MMAS-8 scores of the patients in the observation group at discharge， at 3 and 6 months after discharge were significantly increased， while SSS and PHQ-9 scores were significantly lowered （ P ＜0.05）. And all the above scores gradually decreas ed with the extension of discharge time （ P ＜0.05）. CONCLUSIONS Clinical pharmacists can utilize CPP to significantly improve patients’ cardiac function， medication adherence， somatic symptoms and depression. Additionally， they can significantly improve the utilization rates of ACEI/ARB/ARNI and SGLT2i， as well as the proportion of target doses of β-blockers and SGLT2i， while simultaneously reducing readmission rates.

AIM:To investigate the protective ef-fect of osthole(Ost)on APAP-induced liver injury in mice and its molecular mechanism.METHODS:We established the APAP-induced liver injury model in mice,and Ost was used to intervene.The expres-sion of AST,ALT,SOD,ROS,MDA,LDH,GSH-PX in mice plasma were detected by biochemical meth-od.HE staining was used to observe the changes of liver tissue structure.Immunofluorescence assay was used to detect the expression of Tif1γ and Smad4 in liver tissue.The mRNA expression of IL-1β,IL-6,TNF-α,Smad4,and Tif1γ were detected by qRT-PCR.Western blot was applied to assess the protein expression of Smad2/3 and pSmad2/3 in liver tissue.RESULTS:Compared with the control group,the liver structure destruction and hepato-cyte death was increased,ALT,AST,ROS,MDA and LDH were increased,while SOD and GSH-PX were decreased,and the mRNA expressions of IL-1β,IL-6 and TNF-α were increased in the model group.Compared with the model group,the Ost interven-tion group had improved liver structure and de-creased liver cell death;decreased ALT,AST,ROS,MDA and LDH,increased SOD and GSH-PX,and de-creased expression of IL-1β,IL-6 and TNF-α mRNA.Compared with the control group,liver tissues of model mice showed increased expression of pS-mad2/3,Smad4 protein and Smad4 mRNA,and de-creased Tif1γ protein and mRNA.Compared with the model group,the liver tissues of the Ost inter-vention group showed decreased expression of pS-mad2/3,Smad4 protein and Smad4 mRNA,and in-creased expression of Tif1γ protein and mRNA.CONCLUSION:Ost can improve liver function,re-duce oxidative stress and inflammatory reaction,and protect hepatocyte damage induced by APAP in mice,which may be related to the up-regulation of Tif1γ and inhibition of TGF-β1/Smad signaling pathway.

Objective To translate the Urinary Incontinence Awareness and Attitude Scale(URINAS)and test its reliability and validity.Methods The Chinese version of the URINAS was developed by Brislin's translation model for translation,back translation,cultural adaptation,and pilot investigation.A convenience sampling method was used to select 384 urinary incontinence patients who visited a tertiary hospital in Nanchang,Jiangxi Province from June 2024 to October 2024 for investigation,in order to evaluate the reliability and validity of the scale.Results The Chinese version of the URINAS consisted of 5 dimensions with 26 entries.The Cronbach's alpha coefficient of this scale was 0.843;the folded half reliability was 0.917;the retest reliability was 0.852.The content validity of the scale at the level of the entries ranged from 0.846 to 1.000,and that at the level of the scale was 0.979.A total of 5 metrics were extracted by exploratory factor analysis,and the cumulative variance contribution rate of 74.286％.The results of the validation factor analysis showed a chi-square/degree of freedom of 2.268,a root mean square error of approximation of 0.064,a standardized fit index of 0.916,a Tucker-Lewis index of 0.923,a comparative fit index of 0.906,and a goodness-of-fit index of 0.922.Conclusion The URINAS has good reliability and validity,and can better reflect the level of patients' cognition and attitude towards urinary incontinence,thus providing theoretical basis for the development of corresponding intervention programs for such patients.

Objective To analyze the distribution and drug resistance patterns of pathogenic bacteria in bile and blood cultures obtained from patients with biliary stones accompanied by acute biliary tract infection,to evaluate the clinical appropriate-ness of antibiotic use based on drug sensitivity results,and to provide evidence for empirical antibiotic treatment in such patients.Methods The clinical data of 161 patients with biliary calculi complicated by acute biliary tract infection who were admitted to the First People's Hospital of Neijiang from 2017 to 2023 were retrospectively analyzed.The results of microbial culture,drug sensitivity analysis,and patient characteristics were assessed to evaluate the appropriateness of clinical antimicrobial therapy.Results Among the 161 patients with positive cultures,212 strains of pathogenic bacteria were detected.The predominant patho-gens were Escherichia coli,Klebsiella pneumoniae subspecies,and Enterococcus faecium.Age and underlying diseases significantly affected the distribution of Escherichia coli and Klebsiella pneumoniae subspecies.Within the gram-negative bacterial group,Esche-richia coli and Klebsiella pneumoniae subspecies exhibited higher drug resistance to commonly used broad-spectrum penicillin,third-generation cephalosporin and quinolones but lower resistance rates to piperacillin and tazobactam;furthermore,elderly indi-viduals aged ≥65 years showed higher resistance rates to ceftriaxone than those under age 65 while people with drug exposure history had higher ceftazidime resistance rates that were statistically significant.In contrast to Enterococcus faecalis which displayed low antimicrobial resistance rates for most drugs tested in this study,Enterococcus faecium demonstrated high levels of antibiotic resistance;however,both Enterococcus faecalis and Enterococcus faecium exhibited zero-resistance rates against vancomycin and tigecycline although this may be attributed to their small sample size in our study cohort.Finally,we found that empirical anti-in-fective drugs,as well as target anti-infective drugs,were not prescribed rationally among these patients due mainly to inappropriate combinations of antibiotics or incorrect dosages.Conclusions The predominant pathogens in patients with acute biliary tract infection are gram-negative bacteria,Gram-positive bacteria,and fungi;however,the potential involvement of anaerobic bacteria should not be overlooked.Vancomycin exhibits sensitivity against gram-positive bacteria,yet the overall rationality of antibiotic usage remains suboptimal.Enhanced clinical testing for pathogenic microorganisms is imperative in the management of biliary stones accompanied by acute biliary tract infection.In contrast,clinical pharmacists should provide comprehensive training on anti-infective drugs to clinicians to facilitate their judicious selection of antibiotics based on drug sensitivity results and prevent the e-mergence of multidrug-resistant bacteria.

Objective To evaluate the efficacy of arthroscopic double row suture technique combined with knotless suture bridge technique in repairing medium and large rotator cuff tears.Methods 92 medium and large rotator cuff tears patients from January 2018 to October 2022 were randomly divided into two groups with 46 cases in each group.The observation group was administrated with arthroscopic double row suture combined with knotless suture bridge technique,while the control group was treated with arthroscopic single row suture combined with knotless suture bridge technique.The two groups were compared before and 3,6,and 12 months after surgery in terms of intermediate,medial and lateral T2 values of supraspinatus tendons,shoulder joint range of motion,and the scores on related scales[Constant-Murley scale,University of California,Los Angeles(UCLA)shoulder joint grading system,visual analogue scale(VAS)score],as well as the acromion-humeral head distance(A-H distance).And the joint stiffness and rotator cuff tears were collected from the two groups within 12 months after the operation.Results At 3,6 and 12 months after surgery,the intermediate,medial and lateral T2 values of supraspinatus tendons in both groups were gradually decreased,and were significantly lower than those before surgery,the differences were statistically significant(P<0.05),and the intermediate,medial and lateral T2 values of supraspinatus tendons at each time point in the observation group were significantly lower than those in the control group,the differences were statistically significant(P<0.05);At 3,6,and 12 months after surgery,the anterior flexion range of motion,lateral rotation range of motion,and A-H head distance of both groups were seeing a gradual increase,and the values were significantly higher than those before the treatment,the differences were statistically significant(P<0.05).The anterior flexion range of motion,lateral rotation range of motion and A-H head distance at each time point in the observation group were significantly greater than those in the control group,the differences were statistically significant(P<0.05);At 3,6,and 12 months after surgery,the Constant-Murley and UCLA scales of both groups were seeing a gradual increase,and the values were significantly higher than those before the treatment,the differences were statistically significant(P<0.05),and The Constant-Murley and UCLA scales of the observation group at each time point were significantly higher than those of the control group,the differences were statistically significant(P<0.05);At 3,6,and 12 months after surgery,the VAS score in both groups was lower than that before operation,the difference was statistically significant(P<0.05),the VAS score of the observation group at 3 months after surgery was significantly lower than that of the control group,the difference was statistically significant(P<0.05);12 months after surgery,the incidence of joint stiffness and rotator cuff retear in observation group were 2.17%and 0.00%,significantly lower than those in control group(17.39%and 13.04%),the differences were statistically significant(P<0.05).Conclusion The application of arthroscopic double row suture combined with knotless suture bridge technique can effectively promote postoperative rotator cuff tissue healing,improve the range of motion,function of the shoulder joint and A-H head distance,relieve shoulder pain and greatly reduce the occurrence of postoperative rotator cuff tear and joint stiffness compared with arthroscopic single row suture combined with knotless suture bridge technique.It is worthy clinical application.

Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective To investigate the clinical feasibility and safety of endoscopic ultrasonography(EUS)combined with modified endoscopic mucosal resection(EMR)in the treatment of rectal neuroendo-crine tumors(RNETs).Methods A total of 48 patients diagnosed with RNETs by colonoscopy in the depart-ment of gastroenterology in this hospital from December 2021 to June 2023 were selected as the study objects.Patients were randomly divided into the study group(EUS combined with modified EMR,n=16),the control 1 group(traditional EMR,n=16)and the control 2 group[endoscopic submucosal dissection(ESD),n=16].The operation time,R0 resection rate and postoperative complications of each group were observed.Endoscop-ic ultrasonography was followed up 3 and 6 months after surgery to determine whether there was any recur-rence.Results The operative time of the study group[(17.813±0.379)min]was significantly shorter than that of the control 2 group[(36.250±3.296)min],the difference was statistically significant(P＜0.05),but compared with the control 1 group[(16.375±1.996)min],there was no significant difference(P＞0.05).The incidence of complications in the study group(6.2％)was significantly lower than that in the control 2 group(37.5％),the difference was statistically significant(P＜0.05).while the incidence of complications in the study group was not significantly higher than that in the control 1 group(12.5％,P＞0.05).R0 removal rate in the study group(93.8％)was significantly higher than that in the control 1 group(62.5％)and the control 2 group(75.0％),the difference was statistically significant(P＜0.05).Conclusion EUS combined with modified EMR has more advantages than EMR and ESD in the treatment of RNETs,and has certain fea-sibility and safety,which is convenient for clinical application.

Objective To investigate the role of Dicentrine in regulating lipopolysaccharide(LPS)-induced inflammatory responses in RAW264.7 macrophages and its underlying mechanisms.Methods RAW264.7 macropha-ges were cultured and pretreated with different concentrations of Dicentrine(250,500,1 000 μmol/L).An inflam-matory response model was established using LPS stimulation(model group),with a control group receiving no treatment.Cytotoxicity of Dicentrine was evaluated by MTT assay.Nitric oxide(NO)levels in cell culture supernatants were measured using the Griess method.Fluorescence microscopy was employed to observe in-tracellular reactive oxygen species(ROS)accumulation and apoptosis.Finally,mRNA expression levels of in-flammatory cytokines including IL-1β,IL-6,inducible nitric oxide synthase(iNOS),and tumor necrosis factor-α(TNF-α)were analyzed by qPCR.Results MTT assay results indicated that Dicentrine exhibited no cyto-toxic effects at concentrations below 1 000 μmol/L.Griess method and fluorescence microscopy showed signif-icantly elevated NO and ROS levels in the model group compared to the control group(P<0.05).Compared with the model group,the 250,500,and 1 000 μmol/L Dicentrine groups demonstrated significantly reduced NO and ROS levels(P<0.05).qPCR analysis revealed significantly increased mRNA expression of IL-1β,IL-6,iNOS,and TNF-α in the model group versus the control group(P<0.05).Compared with the model group,the 250,500,and 1 000 μmol/L Dicentrine groups showed significantly decreased mRNA expression of IL-1β,IL-6,iNOS,and TNF-α(P<0.05).Conclusion Dicentrine regulates macrophage apoptosis,thereby ef-fectively inhibiting LPS-induced inflammatory responses in macrophages.

Objective To investigate the status and influencing factors of psychological distress associated with weight loss among young and middle-aged adults with obesity,so as to provide a theoretical basis for developing personalized interventions and improving psychological well-being.Methods A convenience sampling method was used to select young and middle-aged obese patients who visited the weight management clinic of a Grade A tertiary hospital in Jiangxi Province from October 2024 to May 2025.Data were collected using a general information questionnaire,the distress thermometer,the perceived social support scale,the brief illness perception questionnaire,and the simplified coping style questionnaire.Binary logistic regression was applied to identify factors influencing psychological distress.Results A total of 204 valid questionnaires were collected.The detection rate of significant psychological distress was 58.82%(120 cases).Regarding weight loss methods,32.84%of participants opted for medication.The top five issues reported on the psychological distress problem list were:appearance/body image,work/studies,lack of time/energy to care for elderly parents or children,bathing/dressing,and relationship with a partner.Binary logistic regression indicated that age,body mass index,waist circumference,history of chronic disease,perceived social support,illness perception,and negative coping style were significant influencing factors of psychological distress(P﹤0.05).Conclusions The rate of significant psychological distress is relatively high among young and middle-aged obese patients and is influenced by multiple factors.Medical staff may develop personalized interventions based on these factors to reduce the incidence of psychological distress.

Objective To explore the clinical value of mini-incision combined with balloon dilatation under the guidance of miniprobe echoendoscope in the treatment of refractory benign esophageal stenosis.Methods From October 2019 to October 2023,30 cases of esophageal early cancer with esophageal scar stenosis after endoscopic submucosal dissection(ESD)were selected and randomly divided into study group(miniprobe echoendoscope guided small incision+balloon dilatation,15 cases)and control group[esophageal radial incision(ERI),15 cases],EUS in the study group judged the hierarchical structure of esophageal wall before operation,and excluded those with esophageal cancer recurrence and submucosal invasive growth.According to miniprobe echoendoscope,the length of scar segment and the scope of scar ring lumen were defined,and the location and length of pre-incision were defined,and then balloon was used to expand step by step.The short-term postoperative complications,Stooler dysphagia scale score and restenosis rate of the two groups were observed,and the feasibility,safety and efficacy were evaluated.Results The incidence of short-term postoperative complications 6.7％in the study group was significantly lower than that 46.7％in the control group,the difference was statistically significant(P＜0.05),and the Stooler dysphagia scale score were(1.133±0.990)and(1.600±0.737)in the study group at 1 and 2 months after operation with significantly lower than those(2.067±1.033)and(2.467±0.915)in the control group,the differences were statistically significant(P＜0.05).Two months after operation,the restenosis rate was 13.3％,which was significantly lower than that 46.7％of the control group,the difference was statistically significant(P＜0.05),and the scar thickness under miniprobe echoendoscope(2.113±0.887)mm was significantly thinner than that(3.353±1.468)mm of the control group,the difference was statistically significant(P＜0.05).Conclusion Preoperative miniprobe echoendoscope evaluation,can accurately locate lesions,endoscopic mini-incision combined with balloon mechanical expansion are safe and effective,with less pain and fewer postoperative complication.