OBJECTIVE To identify and analyze adverse drug event （ADE） signals associated with tirzepatide based on the FDA Adverse Event Reporting System （FAERS） database， providing a reference for clinical medication safety. METHODS ADE reports from January 1， 2022， to June 30， 2024， with tirzepatide as the primary suspected drug， were extracted from the FAERS database. Medical Dictionary for Regulatory Activities was used to systematically categorize the selected system organ class （SOC） and preferred term of ADE. Signal mining and analysis were performed using the reporting odds ratio method and the proportional reporting ratio method. RESULTS A total of 39 229 ADE reports related to tirzepatide were obtained， including 3 934 severe ADE reports （10.03%）. The majority of severe ADE reports were related to hospitalization or prolonged hospitalization （3.82%）， involving 131 positive ADE signals. Among the reports with documented patient gender and age， 26 195 were female （66.77%）， 7 869 were male （20.06%）， and the majority of patients were aged 18-64 years （54.26%）. The top three most frequently reported ADE were injection site pain， nausea， and injection site hemorrhage. Strong ADE signals not mentioned in the tirzepatide instruction included injection site coldness， starvation ketoacidosis， injection site hemorrhage， hunger， elevated adrenaline， injection site skin cracking， binge eating， skin laxity， intestinal sepsis， lack of satiety， and dysesthesia. Subgroup analysis for patient’s gender and age showed differences in the proportion of ADE reports across different SOC. Male patients or those aged≥65 years had a higher risk of gastrointestinal system disorders compared to female patients or those aged ＜65 years. CONCLUSIONS In clinical use of tirzepatide， in addition to monitoring ADE listed in the instruction， attention should also be paid to ADE not mentioned in the instruction， such as injection site coldness， starvation ketoacidosis， injection site hemorrhage， elevated adrenaline， and intestinal sepsis， to ensure patient safety.

OBJECTIVE To evaluate the efficacy， safety and cost-effectiveness of tirzepatide for diabetes mellitus type 2 （T2DM） and long-term weight management， and provide evidence-based basis for clinical drug treatment and health insurance policy formulation. METHODS Computer searches were conducted in Embase， PubMed， the Cochrane Library， CNKI and health technology assessment （HTA） official website from their inception to October 1st 2024 to collect HTA report， systematic review/ meta-analysis and pharmacoeconomic study on tirzepatide for the treatment of T2DM or for weight management. After data extraction and quality evaluation， descriptive analysis was performed on the research results. RESULTS Totally 18 papers were included， including 14 systematic reviews/meta-analyses and 4 pharmacoeconomics studies， and no HTA report was retrieved. In terms of efficacy， most results showed that the tirzepatide 10 mg and 15 mg were significantly better than other glucagon-like peptide-1 （GLP-1） receptor agonists in reducing glycosylated hemoglobin， body weight， and waist circumference （P＜0.05）. In terms of safety， compared with other GLP-1 receptor agonists， tirzepatide did not increase the incidence of gastrointestinal-related adverse events （AE）， the incidence of AE of grade ≥3， or the incidence of severe hypoglycemia （P＞0.05）. However， tirzepatide 15 mg may significantly increased the incidence of hypoglycemia and the rate of discontinuation due to adverse reactions （P＜ 0.05）. In terms of cost-effectiveness， based on the background of foreign pharmacoeconomic studies， tirzepatide was more cost- effective compared to semaglutide and liraglutide in the treatment of T2DM or for weight management. CONCLUSIONS Tirzepatide at doses of 10 mg and 15 mg has good efficacy and safety for the treatment of T2DM and for long-term weight management. However， when using the 15 mg dose of tirzepatide， close monitoring is required due to the risk of hypoglycemia and discontinuation due to adverse reactions it may pose. Based on pharmacoeconomic studies conducted abroad results， tirzepatide exhibits economic advantages.

OBJECTIVE To investigate the current situation of pharmaceutical management in compact medical consortium of Guangdong province， and to provide decision-making basis for promoting the high-quality construction and sustainable development of the provincial medical consortium. METHODS A self-designed questionnaire was used to select 50 compact medical consortiums in Guangdong province. The survey was answered by the heads of the pharmacy department of the general hospitals. The survey covered the basic scale of the consortium， the appointment of chief pharmacists， the implementation of pharmaceutical management and pharmaceutical care homogenization within the consortium， the difficulties in promoting the homogenization， and the expected provincial support. Descriptive statistical analysis was performed on the survey results. RESULTS A total of 50 questionnaires were collected， and the effective recovery rate was 100%. There were 16 chief pharmacists （32.00%） in charge of the pharmacy department of the general hospital in the medical consortium. Thirty-seven medical consortiums （74.00%） had established a drug supply support system within the consortium， 35 medical consortiums （70.00%） had carried out pharmaceutical management and coordination work within the medical consortium， 23 medical consortiums （46.00%） had established a clinical medication guidance system， 25 medical consortiums chenwenying2016@163.com （50.00%） had established a bidirectional communication mechanism， and only 8 medical consortiums （16.00%） had developed new models of pharmaceutical care. At present， the difficulties in promoting the homogenization of pharmaceutical management and pharmaceutical care within the medical consortium were mainly found in three aspects： the wide gap in management level of each member unit， the lack and uneven level of pharmaceutical personnel， and insufficient policy support and implementation. Most medical consortiums hoped that relevant departments could promote the homogenization of pharmaceutical work by holding special training courses or special supervision. CONCLUSIONS At present， the compact medical consortium in Guangdong province has achieved initial results in the implementation of the chief pharmacist system， the homogenization of pharmaceutical management and pharmaceutical care. However， it is still necessary to improve the coverage of chief pharmacist appointments in the medical consortium， implement the homogenization of pharmaceutical management， and accelerate the homogenization process of pharmaceutical care.

OBJECTIVE To provide a reference for the early diagnosis， drug treatment and medication monitoring for patients with Lemierre’s syndrome. METHODS The doctors confirmed the diagnosis of the patient as having Lemierre’s syndrome based on the patient’s condition and the results of metagenomic next-generation sequencing （mNGS）， and the clinical pharmacists participated in the treatment process of the patient. During the treatment process， the clinical pharmacists suggested using piperacillin sodium and tazobactam sodium combined with metronidazole for anti-infective treatment against Fusobacterium necrophorum infection； clinical pharmacists recommend anticoagulant treatment with Enoxaparin sodium injection for left internal jugular vein thrombophlebitis. RESULTS The doctors accepted the suggestion of the clinical pharmacists， and the patient’s condition improved after treatment and was allowed to be discharged with medication. CONCLUSIONS By interpreting the results of mNGS， combined with the patient’s condition， the clinical pharmacists assist doctors in formulating individualized anti-infective and anticoagulant plans for the patient and provide medication monitoring， ensuring the safety and effectiveness of the patient’s medication.

This article reported the comprehensive management of an extremely preterm infant with severe bronchopulmonary dysplasia. The patient born at 26 +6 gestational weeks was transferred to Children's Hospital of Fudan University due to invasive mechanical ventilation dependence at 61 d after birth and was diagnosed with severe bronchopulmonary dysplasia. A comprehensive treatment plan was adopted, including appropriate fluid restriction, improving nutrition, glucocorticoid administration, using antibiotics against Ureaplasma urealyticum infection to reduce pulmonary parenchymal lesions and alleviating pulmonary hypertension. The preterm infant was successfully extubated to non-invasive ventilation and subsequently weaned to a high-flow nasal cannula. Then, the patient was discharged at 372 d after birth (correct gestational age nine months and six days). At the 3-month follow-up after discharge, the patient remained on high-flow oxygen, but with lower flow and concentration of oxygen. Moreover, the growth, development and lung images were significantly improved. Follow-up to correct gestational age one year and 11 months, the child was not on oxygen any more, but on rehabilitation due to language and motor development retardation.

Objective To investigate the clinical effect of hemorrhoid elimination agent made by our hospital for the treatment of constipation, blood in stool, pain in defecation, anal burning sensation and abdominal distension after hemorrhoids surgery. Methods A number of 120 patients from January 2017 to June 2019 undergo hemorrhoid surgery in the department of anorectal surgery in our hospital were enrolled in the study. The patients were divided into the experimental group and the control group by the random digit table. The experimental group took hemorrhoid elimination agent orally, and the control group took paraffin oil orally. The two groups were compared in terms of the clinical efficacy, symptom and sign scores before and after treatment and adverse reactions. Results The total clinical effective rate of patients in the experimental group was 95%，and the total effective rate in the control group was 81.6% . Compared withpre-treatment, the fecal character score in the experimental group was significantly improved after treatment, and the incidence of hematochezia was significantly reduced after treatment (P<0.05). There was no significant difference in fecal character score and incidence of hematochezia before and after treatment in the control group(P>0.05). After treatment, the score of symptoms and signs in the experimental group was significantly lower than that in the control group (P<0.05). The incidence of hematocele in the experimental group was 5 %，while that in the control group was 21.67%，with significant difference between them(P<0.05). Conclusion With obvious effect and high safety, hemorrhoid elimination agent can effectively relieve constipation and hemostasis after hemorrhoidectomy, which is worthy of promotion in clinic.

Objective:To establish autoverification rules for coagulation tests in multicenter cooperative units, in order to reduce workload for manual review of suspected results and shorten turnaround time (TAT) of test reports, while ensure the accuracy of results.Methods:A total of 14 394 blood samples were collected from fourteen hospitals during December 2019 to March 2020. These samples included: Rules Establishment Group 11 230 cases, including 1 182 cases for Delta check rules; Rules Validation Group 3 164 cases, including 487cases for Delta check; Clinical Application Trial Group 77 269 cases. Samples were analyzed for coagulation tests using Sysmex CS series automatic coagulation analyzers, and the clinical information, instrument parameters, test results, clinical diagnosis, medication history of anticoagulant and other relative results such as HCT, TG, TBIL, DBIL were summarized; on the basis of historical data, the 2.5 and 97.5 percentile of all data arranged from low to high were initially accumulated; on the basis of clinical suggestions, critical values and specific drug use as well as relative guidelines, autoverification rules and limits were established.The rules were then input into middleware, in which Stage I/Stage II validation was done. Positive coincidence, negative coincidence, false negative, false positive, autoverification pass rate, passing accuracy (coincidence of autoverification and manual verification) were calculated. Autoverification rules underwent trial application in coagulation results reports.Results:(1) The autoverification algorisms involve 33 rules regarding PT/INR, APTT, FBG, D-dimer, FDP,Delta check, reaction curve and sample abnormalities; (2)Autoverification Establishment Group showed autoverification pass rate was 68.42% (7 684/11 230), the false negative rate was 0%(0/11230), coincidence of autoverification and manual verification was 98.51%(11 063/11 230), in which positive coincidence and negative coincidence were respectively 30.09% (3 379/11 230) and 68.42%(7 684/11 230); Autoverification Validation Group showed autoverification pass rate was 60.37%(1 910/3 164), the false negative rate was 0%(0/11 230), coincidence of autoverification and manual verification was 97.79%(3 094/3 164), in which positive coincidence and negative coincidence were respectively 37.42%(1 184/3 164) and 60.37%(1 910/3 164); (3) Trialed implementation of these autoverification rules on 77 269 coagulation samples showed that the average TAT shortened by 8.5 min-83.1 min.Conclusions:This study established 33 autoverification rules in coagulation tests. Validation showedthese rules could ensure test quality while shortening TAT and lighten manual workload.

Rational drug use and patient medication safety have always been key to pharmaceutical management.The authors introduced the practice of informationization management of rational drug use in the medical alliance of Luohu Hospital Group.The main measures refer to building an informationization platform for drug purchasing and supply management, dispensing management, medication intervention and medication guidance.This practice can realize closed-loop drug management, achieving full-range supervision and traceability for drugs and higher patient drug use safety.

Objective To study the changes and characteristics of TPO -Ab and TG-Ab in type 2 diaetic patients and provide new ideas for the diagnosis of diabetes.Methods From January 2014 to January 2017,160 samples in General Hospital of Taiyuan Iron&Steel (Group) Co.Ltd were selected,80 healthy people and 80 patients with type 2 diabetes,fasting venous 5 mL blood was obtained in the morning ,then electrochemical luminescence method was used to test TPO-Ab and TG-Ab contents.The diabetic patients were divided into four groups :TPO-Ab normal group,TPO-Ab elevation group,TG-Ab normal group,TG-Ab elevation group.The blood glucose,age and gender of the four groups were compared.Results Compared with the control group ,the proportions of increased TPO -Ab and TG-Ab in diabetic patients were 11.25%and 2.5%respectively,the difference was statistically significant (χ2＝4.86,P＜0.05).In type 2 diabetic patients,the blood glucose value of the normal TPO -Ab group was (6.67 ± 1.53)mmol/L,which in the TPO -Ab elevation group was (7.87 ±1.24) mmol/L,the difference was statistically significant (t＝2.94,P＜0.05).The blood glucose of the normal TG -Ab group was (6.75 ±1.34)mmol/L,which in the TG-Ab elevation group was (7.04 ±1.25)mmol/L,the difference was statistically significant (t＝2.82,P＜0.05).TPO-Ab and TG-Ab elevation had no obvious relation with age ,gender.The age of the normal TPO -Ab group was (62.1 ±6.3)years,which in the TPO-Ab elevation group was (63.0 ±4.9)years,there was no statisti- cally significant difference (t＝1.37,P＞0.05).The age of the normal TG -Ab group was (62.8 ±7.1)years,which in the TG-Ab elevation group was (61.6 ±2.7)years,the difference was not statistically significant (t＝1.27,P＞0.05).In male patients,TPO-Ab normal accounted for 84.09%,TPO-Ab rise accounted for 15.91%.In female patients,TPO-Ab normal accounted for 86.11%,TPO-Ab rise accounted for 13.89%,there was no statistically significant difference (χ2＝1.20,P＞0.05).In male patients,TG-Ab normal accounted for 97.73%,TG-Ab rise accounted for 2.27%, in female patients, TG -Ab normal accounted for 97.22%, TG -Ab rise accounted for 2.78%,there was no statistically significant difference (χ2＝0.97,P＞0.05).Conclusion TPO-Ab and TG-Ab in type 2 diabetes patients are higher than healthy people.The increase of TPO -Ab and TG -Ab is positively correlated with blood glucose level.The increase of TPO-Ab and TG-Ab is not correlated with age and gender.

Problems such as frequent medical disputes and lack of mutual trust between doctors and patients re -quire us to pay more attention to the medical professionals ' moral ethics practice .By means of deepening the un-derstanding of medical professionals ' moral psychology , it expected to promote medical ethics education and medi-cal management smoothly , meanwhile , alleviate medical disputes .This paper analyzed medical professionals ' com-ments on the Selfie in Operating Room Incident using a qualitative study .By analyzing their moral psychology be-hind these comments , it depicted three mental representations of medical professionals ' ethics practice , namely conflict,responsibility and concerns .