OBJECTIVE To establish drug utilization evaluation （DUE） criteria for pyrotinib to promote its appropriate application in clinical practice. METHODS Based on the label of Pyrotinib maleate tablets， with relevant guiding principles and diagnostic and treatment guidelines as the evaluation basis， DUE criteria for pyrotinib were determined through the Delphi method. Attribute hierarchical model （AHM） and entropy weight method （EWM） were used to combine and assign weights to each indicator within the DUE criteria. Additionally， the weighted technique for order preference by similarity to an ideal solution （TOPSIS） method was applied to perform rationality evaluation of medication in archived medical records from Hainan Provincial Tumor Hospital and Hainan Western Central Hospital regarding the use of pyrotinib from November 2019 to November 2023. RESULTS The established DUE criteria for pyrotinib included 4 primary indicators （prescription authority， indications for use， medication process， and medication outcomes） and 11 secondary indicators. The secondary indicators with higher weights were the route of administration and dosage （0.257） and indications in the label （0.241）. Among the 88 archived cases included， there were 28 cases of inappropriate medication （31.82%）， 43 cases of generally appropriate medication （48.86%）， and 17 cases of appropriate medication （19.32%）. The main issues related to inappropriate medication involved off-label use （42.05%） and inappropriate routes of administration and dosage （43.18%）. CONCLUSIONS DUE criteria for pyrotinib established using the AHM-EWM-weighted TOPSIS method is highly operational and results in quantifiable evaluation outcomes. The overall rationality of the use of pyrotinib in the above hospitals remains to be improved， and there are some issues， like the off-label use，and inappropriate routes of administration and dosage being liaoyylyy@163.com unreasonable.

Objective To investigate the mechanism of chronic intermittent hypoxia (CIH)-induced renal injury and the protection of metallothionein (MT).Methods 8-10 weeks old male MT-1 transgenic (MT-TG) mice (n=12) and the wide type (WT) mice (n=12) were randomly divided into two groups respectively,Air mimic control(Ctrl) group (n=6) and CIH group (n=6).The period of chronic intermittent hypoxia was continued for 8 weeks.The CIH paradigm consisted of 20.9％ O2 and 8％ O2 fraction of inspiration O2 (FiO2) alternation cycles (30 episodes per hour) with 20 seconds at the nadir FiO2 for 12 hours/day during daylight.The nadir hemoglobin oxygen saturations mainly ranged from 60％ to 70％.Urine,blood,kidney were collected at the end of study respectively.Histopathology,Western blotting and colorimetric method for related target were performed respectively.Results In WT mice,renal fibrosis,the expression of connective tissue growth factor (CTGF),type-1 plasminogen activator inhibitor (PAI-1),hypoxia-inducible factor 1α (HIF-1α),transforming growth factor β1 (TGF-β1),phosphorylated Smad2 and the MDA content were significantly increased by CIH (P ＜ 0.01).In WT mice,the expression of MT detected by using Western blotting was significantly decreased by CIH (P ＜ 0.01).However,in MT-TG mice,above-mentioned indicators showed no significant difference between CIH and Ctrl group.Conclusions Oxidative stresses is the main mechanism of CIH-induced renal injury.The possible molecular mechanism of CIH-induced renal injury is that CIH increases the expression of HIF-1α in kidney tissue,then activate the TGF-β1-Smad2 signaling pathway and lead to the renal fibrosis.The protection of MT on CIH-induced renal injury may be via its antioxidant effect.

Objective:To investigate the effects of serum sICAM-1 and sVCAM-1 in renal allograft recipients with infection, acute rejection and CsA-induced nephrotoxicity for the clinical significance of early diagnosis and differential diagnosis.Methods:The sequential monitoring of serum sICAM-1 and sVCAM-1 were conducted by ELISA technique in 86 patients before and after renal transplantation.Results:The levels of serum sICAM-1 and sVCAM-1 increased in the first three day posttransplantation, decreased and stabilized after one to two weeks,increased one to three days prior to the clinical diagnosis in acute rejection and decreased with effective treatment,increased in infection and had no significant difference in CsA-induced nephrotoxicity.Conclusion:Sequential monitoring of serum sICAM-1 and sVCAM-1 of renal allograft recipients can be used to estimate the function of graft,as markers of the early diagnosis and differential diagnosis of acute rejection.

Objective:To investigate the effect of anti-CD25 monoclonal antibody in preventing acute rejection after renal transplantation.Methods:71 patients were randomly divided into two groups;treatment gourp( n =26)and control group( n =45).The treatment group received anti-CD25 monoclonal antibody twice before and after renal transplantation.The occurrence of rejection postoperation and renal function and T lymphocyte subtypes were sequentially monitored.Results:The occurrence of aute rejection in treatment group in 1,3,6 and 12 months after renal transplantation was 7.7% ,19.2%,23.1% and 30.8%,while it was 15.6%,28.9%,35.6% and 46.7% in control group.There was significant difference between the two groups( P0.05 ).Conclusion:It suggests that anti-CD25 monoclonal antibody reduce the occurrence of acute rejection and have no influence on T lymphocyte subtypes.