OBJECTIVE To provide references for ensuring the safety of prescription preparation， dispensing， and use of parenteral nutrition solution， as well as for expanding the scope of pharmaceutical services provided by pharmacists in the Pharmacy Intravenous Admixture Services （PIVAS）. METHODS Under the guidance of PIVAS pharmacists， the rules for reviewing medical orders of parenteral nutrition in the PIVAS system and the information displayed on the infusion labels of finished parenteral nutrition solutions were refined. The process management of dispensing parenteral nutrition solution was strengthened， and detailed quality control and inspection rules were formulated. Additionally， Clinical Safety Monitoring Form for Finished Parenteral Nutrition Infusions was designed to conduct clinical monitoring and inspections for abnormalities in the finished infusions， infusion operations， and complications that may arise during the use of finished parenteral nutrition infusions. The implementation effects of the aforementioned optimization/inspection measures were evaluated by comparing data on the efficiency of medical order review for parenteral nutrition， the rate of irrational medical orders， the compliance rate of vascular access selection and infusion rate standardization， the rate of dispensing error， as well as the abnormalities occurring during clinical use， before and after the optimization/inspection initiatives were put into place. RESULTS The optimized prescription review system achieved automatic review of medical orders for parenteral nutrition， enhancing the efficiency of order review. The average time taken to review one parenteral nutrition medical order was reduced from approximately 1 minute to 10 seconds. The irrational rate of parenteral nutrition orders decreased by 31.87%. The dispensing error rate of parenteral nutrition decreased by 56.55%. The standard rate of vascular access selection and standard rate of infusion speed were increased by 13.29% and 3.54%， respectively. The PIVAS pharmacists identified and intervened in 5 abnormal cases out of 298 cases examined for use of parenteral nutrition solutions. CONCLUSIONS By optimizing the prescription review system， improving labeling information， and strengthening quality control inspections during both preparation and administration processes， PIVAS pharmacists have enhanced the safety of compounded parenteral nutrition solutions. This initiative has expanded the scope and depth of pharmaceutical care provided by dispensing pharmacists.

Between PFO and ischemic stroke has been confirmed， and the concept of PFO-AS was officially established in 2020. Contradictory embolism is considered the main pathogenesis of PFO-AS. Fibrinogen， a coagulation factor mainly synthesized by the liver， is closely related to thrombosis and is also an important risk factor for occurrence and recurrence of ischemic stroke， Its level is closely related to polymorphism of fibrinogen promoter. Currently analyzed fibrinogen β（FGβ） there more than 10，which HindⅢ（β-148C/T） gene polymorphism in the FGβ gene promoter region is closely related to plasma fibrinogen level and ischemic stroke. Therefore， a better understanding of genetic variation and susceptibility gene may be one of the best methods to help us prevent，diagnose，treat and improve the prognosis of stroke in the early stages.

Sjögren's syndrome （SS）， a disorder of immune system， is one of the dominant diseases treated by traditional Chinese medicine （TCM）. China Association of Chinese Medicine organized experts in the field of TCM and western medicine rheumatology and pharmacology to discuss the advantages and optimal regimens of TCM for the treatment of SS. The experts generally agreed on the low early diagnosis rate of SS and the lack of targeted therapeutic drugs. In addition， autoimmune abnormality is the key factor in the occurrence of SS and deficiency of both Qi and Yin is the core pathogenesis. SS has unique tongue manifestations， which is expected to allow for the early diagnosis and treatment with integrated traditional Chinese and western medicine. TCM has advantages in treating SS in terms of alleviating clinical symptoms and systemic involvement， individualized treatment， relieving sleep and mood disorders， preventing the occurrence in the early stage， and enhancing the effectiveness and reducing toxicity in the treatment by integrated TCM and western medicine. In general， TCM has advantages in different stages of SS. Internal and external use of TCM， acupuncture， and acupotome are all available options. The optimal regimens should be determined on the basis of pattern identification， stage of disease， and the advantages of TCM. Clinical characteristics and biomarkers of SS should be studied to classify patients， so as to design precision evidence-based TCM regimens for SS. On the basis of unique tongue manifestations of SS， models for early diagnosis and poor prognosis identification of SS should also be established to achieve early prevention and treatment and to improve the prognosis. In the future， we should vigorously carry out high-quality evidence-based medical research on the treatment of SS by TCM and integrated traditional Chinese and western medicine and develop relevant guidelines to optimize and standardize current diagnosis and treatment， thereby laying a basis for clarifying and explaining the advantages of TCM in treating SS.

Ulcerative colitis （UC） is a chronic recurrent inflammatory bowel disease which primarily affects the colonic mucosa. The UC patients mainly present diarrhea， abdominal pain， tenesmus， and mucous bloody stools， and even malnutrition and systemic symptoms in severe cases， with rising incidence， which has a significant impact on the health and quality of life of patients. The pathogenesis of UC is not clear， and the Western medical therapies include sulfasalazine， glucocorticoids， and immunosuppressants， which， however， have side effects and unsatisfactory effects. Chinese medicine with high safety， mild adverse reactions， and a multi-component， multi-target， and multi-pathway treatment manner has garnering increasing attention. Therefore， finding the Chinese medicine to treat UC has become a hot spot. Glycyrrhizae Radix et Rhizoma is one of the commonly used Chinese herbal medicines， with the effects of tonifying spleen and reinforcing qi， clearing heat and detoxifying， dispelling phlegm and relieving cough， relieving pain， and harmonizing medicines. Glycyrrhizae Radix et Rhizoma mainly contains glycyrrhizic acid， glycyrrhetinic acid， diammonium glycyrrhizinate and other active ingredients. Modern pharmacological studies have shown that Glycyrrhizae Radix et Rhizoma has anti-inflammatory， antioxidant， antimicrobial， and immunomodulatory activities. According to statistics， Glycyrrhizae Radix et Rhizoma is among the top three Chinese herbal medicines for the treatment of UC. The recent years have witnessed progress in the treatment of UC with Glycyrrhizae Radix et Rhizoma and the related prescriptions. The present study summarized the mechanisms underlying the anti-inflammatory， immunomodulatory， intestinal flora-regulating， cell apoptosis-inducing， and oxidative stress-reducing effects of the key chemical constituents （glycyrrhetinic acid， diammonium glycyrrhizinate， polysaccharide， glycyrrhetinic acid， and isoglycyrrhizin） and compound prescriptions of Glycyrrhizae Radix et Rhizoma. The findings provide a solid foundation for further development and clinical application of Glycyrrhizae Radix et Rhizoma.

With accumulating dysregulated circular RNAs(circRNAs)in pathological processes,the regulatory functions of circRNAs,especially circRNAs as microRNA(miRNA)sponges and their interactions with RNA-binding proteins(RBPs),have been widely validated.However,the collected information on experimentally validated circRNA-disease associations is only preliminary.Therefore,an updated CircR2Disease database providing a comprehensive resource and web tool to clarify the relationships between circRNAs and diseases in diverse species is necessary.Here,we present an updated CircR2Disease v2.0 with the increased number of circRNA-disease associations and novel characteristics.CircR2Disease v2.0 provides more than 5-fold experimentally validated circRNA-disease associations compared to its previous version.This version includes 4201 entries between 3077 circRNAs and 312 disease subtypes.Secondly,the information of circRNA-miRNA,circRNA-miRNA-target,and circRNA-RBP interactions has been manually collected for various diseases.Thirdly,the gene symbols of circRNAs and disease name IDs can be linked with various nomenclature databases.Detailed descriptions such as samples and journals have also been integrated into the updated version.Thus,CircR2Disease v2.0 can serve as a platform for users to systematically investigate the roles of dysregulated circRNAs in various diseases and further explore the posttranscriptional regulatory function in diseases.Finally,we propose a computational method named circDis based on the graph convolutional network(GCN)and gradient boosting decision tree(GBDT)to illustrate the applications of the CircR2Disease v2.0 database.

We integrate the precision medicine into the training process of breast surgery postgraduates. Besides the traditional training, we emphasize the idea of precision medicine and provide precision medicine lessons. We also carry out multidisciplinary precision-medicine teaching ward-rounds, and take use of AI system to assist clinical decision making, so as to stimulate the subjective initiative of the postgraduates, and strengthen the training of clinical practical capabilities. Our experience has showed that applying the precision medicine mode to the training of breast surgery postgraduates is more conducive to strengthening their clinical capabilities and overall quality.

Objective:To investigate the current status of doctor-patient communication of pediatric residents, and to explore the specific demand of communication skills training in clinical practice.Methods:A self-made questionnaire was conducted to investigate 77 residents taking standardized residency training of pediatrics in Beijing Children's Hospital training base, including basic information, self-satisfaction of communication ability and the needs of doctor-patient communication courses, etc. SPSS 22.0 statistical software was used for data processing and analysis.Results:In terms of the doctor-patient communication ability, the results showed that the satisfaction degree of pediatric resident surgeons was higher than that of pediatric resident physicians (78.9% vs. 58.5%, P=0.108) and the satisfaction degree of high-seniority residents was higher than that of low-seniority residents (78.6% vs. 62.5%, P=0.330; 78.6% vs. 58.9%, P=0.278). Besides, the importance of communication objectives and the degree of difficulty were sorted in order, and the top three were family members, superior and children for importance, and family members, children and nurses for difficulty, respectively. The main reasons of difficult communication included heavy work (41.6%) and lack of communication skills (46.7%), with no statistical difference between different majors and seniorities ( P >0.05). More than 80% residents agreed that effective doctor-patient communication could promote the clinical work. The lower of seniority, the higher demands for the class time allocation and teaching frequency of doctor-patient communication training courses. Conclusion:Pediatric residents have a good cognition of medical doctor-patient communication. There are some obvious communication problems in pediatric physicians and low-seniority pediatric residents. Therefore, it's necessary to adjust courses according to different majors and seniorities, so as to improve the training quality, thereby promoting the clinical work and reform of medical education.

Objective:To explore the application of clinical nursing pathway (CNP) standardized management in children with primary vesicoureteral reflux (VUR) undergoning Politano-Leadbetter operation for.Methods:From January 2016 to December 2018, we selected 69 children with VUR from the First Affiliated Hospital of Zhengzhou University. Children all underwent modified Politano-Leadbetter operation and were divided into CNP group ( n=39) and control group ( n=30) with the method of random number table. Control group carried out routine clinical nursing management, while CNP group implemented CNP standardized management. We compared the general operation situation, hospitalization, improvement of reflux level and incidence of postoperative complications among children between two groups. Results:There were no intestinal and important vascular injury events during operation in both groups, and there was no significant difference in the operation time, intraoperative blood loss and postoperative hematuria duration between the two groups ( P>0.05) . However, the length of hospitalization, hospitalization costs and incidence of postoperative complications in CNP group were lower than those in control group; the improvement rate of reflux of CNP group was higher than that of control group; the differences were statistically significant ( P<0.05) . Conclusions:For VUR children with Politano-Leadbetter operation, CNP standardized management is more conducive to postoperative recovery of children than routine nursing management, and it can obtain better therapeutic benefits and reduce the risk of postoperative complications to a certain extent.

Objective To analyze the role of telehealth?based dialysis registration systems in real?time and dynamic reflection of renal anemia in hemodialysis (HD) patients, and discuss the prospect of its application in dialysis registration management. Methods The Red China project was to build up a dialysis registration system based on the WeChat mobile terminal platform. Demographic and baseline laboratory parameters such as age, gender, primary disease, dialysis age, creatinine were recorded in this system. Hemoglobin (Hb) level was monthly recorded. The platform generated Hb statistics report for each HD center monthly, including the detection rate, target rate and the distribution level of Hb, and released it to physicians through the WeChat terminal of mobile phone. After that, physicians could change the treatment of anemia individually on basis of this report. Here the demographic and baseline laboratory parameters, the detection rate, target rate, the average level and the distribution of Hb from June 2015 to October 2017 after the project launched were analyzed. Results From June 2015 to October 2017, 8392 maintenance HD patients from 28 HD centers in Shanghai were enrolled, of whom 5059(60.3％) were male.The average rate age was (60.5 ± 13.7) years old. Baseline average Hb was (108.3±16.0) g/L. Baseline detection rate and target rate were 54.2％and 47.5％, respectively. After 28 months follow?up, the detection rate of Hb increased from 54.2％ to 73.6％ (P<0.001), the target rate of Hb increased from 47.5％ to 56.1％ (P<0.001), and the level of average Hb rose from (108.3±16.0) g/L to (110.7±16.0) g/L. The difference between average Hb in two consecutive months was less than 1.3 g/L. Conclusions The telehealth?based dialysis registration system can timely report the anemia situation of HD patients, which may improve the awareness rate of anemia, the degree of attention and the compliance of anemia monitoring, so as to improve the detection rate and target rate of Hb and reduce the fluctuation of Hb, which helps to maintain the HD patients to correct anemia in a timely, stable and long?term way. The telehealth?based dialysis registration system, as an improved mode of dialysis registration is a promising way for long?term management of renal anemia in dialysis patients.

Objective To investigate the effect of preventive nursing on infection of patients with continuous renal replacement therapy (CRRT).Methods A total of 45 patients with CRRT treatment in our department were selected as observation group,given prevention nursing for infection,another 40 CRRT patients during the same period were selected as control group,given routine nursing.The changes of clinical correlated index,APACHE score and the rates of infection and mortality,hospitalization time of two groups were compared.Results The levels of BUN,SCr and CRP after the treatment in the observation group were lower than that in the control group,and the differences were statistically significant (P ＜ 0.05).The APACHE Ⅱ score,the infection rate after treatment in the observation group were lower,and the hospitalization time was shorter than that in the control group,the differences were statistically significant (P ＜ 0.05).Conclusion Preventive nursing can prevent the occurrence of infection in patients with CRRT,promote the improvement of clinical indexes and shorten the hospitalization time of patients.