OBJECTIVE To construct the “school-enterprise-community” linkage community pharmaceutical care mode based on the WeChat mini program， upgrade the content and mode of community pharmaceutical care， and improve the quality of healthy life of the residents. METHODS Focusing on the pharmaceutical care needs of community residents， by integrating school， enterprise and community pharmaceutical resources， the WeChat mini program of “drug enjoying health” was created and the “online+offline” community pharmaceutical care mode was built. Using classified random sampling， mini program users were randomly selected as the observation group， and offline pair-assisted community residents as the control group. The intervention effects of the two groups were compared around the three aspects of medication health knowledge mastery， medication compliance and medication behavior. RESULTS The “drug enjoying health” mini program consisted of four modules：“ drug for health”，“ drug for warmth”，“ drug for safety”， and “personal information”. The “school-enterprise-community” linkage community pharmaceutical care mode based on the “drug enjoying health” mini program began to be applied in July 2022， with 6 185 users， 2 732 recovery records of expired drugs， 941 times of pharmaceutical care， and 3 354 consultation orders. After the intervention， the qualified rate of medication health knowledge mastery， complete compliance rate， and the correct rate of medication behavior in the observation group increased from 33.53% to 76.87%， 20.23% to 46.26%， and 49.71% to 89.80%， respectively； the proportion of the increase after the intervention was higher than that of the control group （P＜0.05）. CONCLUSIONS This mode has effectively improved the quality of community pharmaceutical care， improves the health awareness of community residents in drug use， and promotes the standardization， rationalization and safety of residents’ drug use.

Objective:To observe the feelings of listening to music and the importance of music in the daily life of post-lingual deaf adults with cochlear implants, and to explore the relevant influencing factors.Methods:This was a cross-sectional survey study. From January 2021 to August 2021,the Music-Related Quality of Life Scale was used to evaluate the music needs and music experiences of 63 post-lingual deaf adults who met the inclusion criteria, including 27 males and 36 females, aged (40.7±12.3) years, at the time of surgery (36.8±13.1) years, and with a preoperative hearing aid ineffective time of (3.9±5.8) years. Indicators analyzed included age, duration of ineffective preoperative hearing aid wear, preoperative music preference, duration of postoperative cochlear implant use, current hearing aid modality, and auditory rehabilitation outcomes. Whether the six factors mentioned above constituted an influence on the subjects′ music listening was investigated using SPSS 25.0 statistical software.Results:All of the observations in the scale were correlated with a single factor. The two sub-dimensions of music experience section were related to the effect of auditory rehabilitation. In the importance section, the effect of auditory rehabilitation was the influential factor of the dimension of "participation importance", and the preoperative enjoyment of music was the relevant influential factor of the dimension of "perceived importance". There was a significant difference between the groups when they were grouped by the above factors ( P value<0.05), while there was no statistically significance between the groups when they were grouped by other factors ( P value>0.05). Conclusions:Post-lingual deaf adults show the need and attempt to listen to music after cochlear implantation. The effectiveness of auditory rehabilitation and the degree of music preference preoperatively are two important factors that influence music listening in implant recipients. Once the level of auditory communication has been restored to a certain degree, it is important to pay more attention to the needs of music for implant recipients and train them in time, especially for those with music preferences preoperatively.

Background::While type 2 diabetes mellitus (T2DM) is considered a putative causal risk factor for coronary artery disease (CAD), the intrinsic link underlying T2DM and CAD is not fully understood. We aimed to highlight the importance of integrated care targeting both diseases by investigating the phenotypic and genetic relationships between T2DM and CAD.Methods::We evaluated phenotypic associations using data from the United Kingdom Biobank ( N = 472,050). We investigated genetic relationships by leveraging genomic data conducted in European ancestry for T2DM, with and without adjustment for body mass index (BMI) (T2DM: Ncase/ Ncontrol = 74,124/824,006; T2DM adjusted for BMI [T2DM adjBMI]: Ncase/ Ncontrol = 50,409/523,897) and for CAD ( Ncase/ Ncontrol = 181,522/984,168). We performed additional analyses using genomic data conducted in multiancestry individuals for T2DM ( Ncase/ Ncontrol = 180,834/1,159,055). Results::Observational analysis suggested a bidirectional relationship between T2DM and CAD (T2DM→CAD: hazard ratio [HR] = 2.12, 95% confidence interval [CI]: 2.01–2.24; CAD→T2DM: HR = 1.72, 95% CI: 1.63–1.81). A positive overall genetic correlation between T2DM and CAD was observed ( rg = 0.39, P = 1.43 × 10 -75), which was largely independent of BMI (T2DM adjBMI–CAD: rg = 0.31, P = 1.20 × 10 –36). This was corroborated by six local signals, among which 9p21.3 showed the strongest genetic correlation. Cross-trait meta-analysis replicated 101 previously reported loci and discovered six novel pleiotropic loci. Mendelian randomization analysis supported a bidirectional causal relationship (T2DM→CAD: odds ratio [OR] = 1.13, 95% CI: 1.11-1.16; CAD→T2DM: OR = 1.12, 95% CI: 1.07-1.18), which was confirmed in multiancestry individuals (T2DM→CAD: OR = 1.13, 95% CI: 1.10-1.16; CAD→T2DM: OR = 1.08, 95% CI: 1.04-1.13). This bidirectional relationship was significantly mediated by systolic blood pressure and intake of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, with mediation proportions of 54.1% (95% CI: 24.9-83.4%) and 90.4% (95% CI: 29.3-151.5%), respectively. Conclusion::Our observational and genetic analyses demonstrated an intrinsic bidirectional relationship between T2DM and CAD and clarified the biological mechanisms underlying this relationship.

[Objective]To summarize the research and understanding on the role of inflammatory factors in the onset of type-2 diabetes(T2DM)at home and abroad,the correlation between damp-heat syndrome and inflammation in T2DM,and the experience of traditional Chinese medicine(TCM)in treating T2DM from damp-heat syndrome,so as to provide new ideas for the treatment of T2DM.[Methods]Reviewing relevant information on T2DM,reading relevant literature,summarizing the research results on the role of inflammatory factors in the pathogenesis of T2DM at home and abroad,summarizing the correlation between damp-heat syndrome and inflammation in TCM,and summarizing the experience of treating T2DM from the perspective of damp-heat in TCM.[Results]The onset of T2DM is closely related to inflammatory factors,inflammatory factors such as tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)in the serum of T2DM patients are higher than normal levels.The role of inflammatory factors in the pathogenesis of T2DM includes hindering normal tyrosine phosphorylation in the insulin receptor substrate(IRS),accelerating the dissociation and degradation of IRS and phosphatidylinositol 3-kinases(PI3K),affecting downstream PI3K phosphorylation,interfering with insulin signaling through the pathway,and triggering insulin resistance(IR);promoting nuclear factor-κB(NF-κB)activation continuously exacerbates the inflammatory state through a positive feedback mechanism,promoting IR;directly or indirectly causing pancreatic islets β cellular destruction and decreasing insulin secretion function.TCM syndrome differentiation of T2DM patients is mostly characterized by damp-heat syndrome,the levels of IL-6 and hypersensitive-C reactive protein(hs-CRP)in T2DM damp heat syndrome are higher.Lipid metabolism disorders,IR and inflammation are more severe.There is a strong correlation between T2DM damp-heat syndrome and the inflammatory state of the body.TCM can reduce the level of inflammatory factors in the body by using various TCM formulas and single drugs to treat T2DM damp-heat syndrome.[Conclusion]There is a correlation among T2DM,inflammation and damp-heat syndrome.T2DM mostly belongs to damp-heat syndrome.The use of TCM formulas for clearing heat and removing dampness and single drugs is effective in treating T2DM damp-heat syndrome,which is a new approach to treat T2DM from the perspective of damp-heat theory.

Anti-seizure medications (ASMs) are the main therapy for epilepsy.There are many kinds of ASMs with complex mechanism of action, so it is difficult for pharmacists to examine prescriptions.This paper put forward some suggestions on the indications, dosage forms/routes of administration, appropriateness of usage and dosage, combined medication and drug interaction, long-term prescription review, individual differences in pathophysiology of children, and drug selection when complicated with common epilepsy, for the reference of doctors and pharmacists.

Objective:To explore the effect of nursing interventions based on systematic concept in elderly patients with type 2 diabetes.Methods:From May 2018 to August 2019, 120 elderly patients with type 2 diabetes in Hangzhou Red Cross Hospital were selected by convenience sampling. The patients were randomly divided into observation group and control group with 60 cases each. Patients in each group were given nursing interventions based on systematic concept and routine nursing respectively. The anxiety, depression, benefit finding and coping modes of the two groups were compared before and after the intervention.Results:Before the intervention, there was no statistical difference between the two groups in the scores of anxiety, depression, benefit finding and behavior pattern ( P>0.05) . After intervention, the scores of anxiety and depression in the two groups decreased, and the scores in the observation group were lower than those in the control group, with statistically significant differences ( P<0.05) . After the intervention, the scores of benefit finding of the two groups increased, and that of the observation group was higher than that of the control group, and the differences were statistically significant ( P<0.05) . After intervention, the scores of confronting of the two groups increased, and that of observation group was higher than that of the control group, and the differences were statistically significant ( P<0.05) . After intervention, the scores of avoidance and resignation in the two groups decreased, and the scores in the observation group were lower than those in the control group, with statistically significant differences ( P<0.05) . Conclusions:Systematic concept nursing can reduce the anxiety and depression of elderly patients with type 2 diabetes, improve the benefit finding, increase the sense of benefit, and urge patients to adopt a positive coping style to deal with the disease.

Objective:To analyze the value of minute ventilation to carbon dioxide production slope (VE/VCO 2 slope) combined with peak systolic blood pressure (SBP) in predicting prognosis for patients with chronic heart failure (CHF). Methods:A total of 170 patients with CHF who visited the Cardiac Rehabilitation Center of Tongji Hospital Affiliated to Tongji University and completed cardiopulmonary exercise test from March 2007 to December 2018 were enrolled in the study. The clinical data, cardiopulmonary exercise testing results and follow-up information of patients were collected to explore the predictors of all-cause mortality in patients with CHF.Results:The median follow-up time was 647 (182-1 764) days. All-cause death occurred in 34 patients. Compared with surviving patients, the proportion of diabetes and angiotensin-converting enzyme inhibitor/angiotensin Ⅱ receptor blocker (ACEI/ARB) use in fatal patients was significantly higher ( P<0.01). The VE/VCO 2 slope and peak SBP*VE/VCO 2 in the fatal patients were significantly higher, and the peak oxygen consumption (peak VO 2) was lower than those in the surviving patients ( P<0.01). The areas under the receiver operating characteristic curve (AUC) of VE/VCO 2 slope and peak SBP*VE/VCO 2 in predicting all-cause mortality in patients with CHF were 0.648 ( P=0.008) and 0.681 ( P=0.001), respectively; the optimal thresholds were >40.95 ( P=0.008) and > 5 423.50 mmHg (1 mmHg=0.133 kPa, P=0.006), the sensitivity was 0.559 and 0.588, and the specificity was 0.728 and 0.735, respectively. Multivariate Cox regression analysis showed that after adjusting for age, gender, diabetes and ACEI/ARB use, VE/VCO 2 slope ( HR=2.12, P=0.036) and peak SBP*VE/VCO 2 ( HR=2.42, P=0.016) were independent risk factors for all-cause mortality in patients with CHF. Conclusion:Compared to the traditional index VE/VCO 2 slope, a novel index peak SBP* VE/VCO 2 provides a relatively better predictive value for all-cause death of CHF patients.

Objective:To observe the clinical characteristics and guideline compliance of chronic obstructive pulmonary disease (COPD) patients with initial triple therapy in real-life world.Methods:This study is a cross-sectional study. The subjects of the study were COPD patients admitted to 13 hospitals in Hunan Province and Guangxi Zhuang Autonomous Region from December 2016 to December 2021. The initial treatment was triple inhaled drugs. The data collected included gender, age, diagnosis, body mass index (BMI), history of acute exacerbation (AE) in the past year, pulmonary function, COPD Assessment Test (CAT) score, modified British Medical Research Council Dyspnea Questionnaire (mMRC), inhaled drugs and other indicators. The characteristics and differences of COPD patients before and after 2020 were analyzed.Results:7 184 patients with COPD were enrolled in this study, including 2 409 COPD patients treated with initial triple therapy, accounting for 33.5%(2 409/7 184). Taking January 1st, 2020 as the cut-off point, 1 825 COPD patients (75.8%) received initial treatment with triple inhaled drugs before 2020 and 584 patients (24.2%) after 2020 were included in this study. Compared with COPD patients before 2020, the COPD patients after 2020 had higher FEV 1% [(40.9±15.5 )% vs (39.3±15.5)%, P=0.040], lower CAT [(15.8±6.5)point vs (17.5±6.2)point, P<0.001], less AE in the past year [1(0, 2)times vs 1(0, 2)times, P=0.001] and higher rate of non-AE [255(43.7%) vs 581(37.1%), P=0.006]. In addition, before 2020, patients with COPD were mainly treated with open triple drugs (1 825/1 825, 100%); after 2020, 306 patients (52.4%) received open triple inhaled drugs, and 278 patients (47.6%) received closed triple inhaled drugs. Conclusions:In real-life world, most of patients with COPD treated with triple therapy have severe lung function, obvious symptoms and high risk of acute exacerbation. The real-world prescribing of triple therapy in patients with COPD does not always reflect recommendations in guidelines and strategies, and overtreatment is common. After 2020, prescribing triple therapy for COPD patients is more positive and worse consistency with guideline.

Objective:To explore the application effect of new whole-course closed sputum specimen collection technology in intensive care unit patients.Methods:From April 2020 to January 2022, the convenient sampling was used to select 442 ICU mechanical ventilation patients admitted to 6 hospitals in Jiaxing City as the research objects. According to the order of admission time, the patients were divided into the control group ( n=221) and the experimental group ( n=221) . The control group adopted the traditional open sputum specimen collection technology, while the experimental group adopted the new whole-course closed sputum specimen collection technology. The heart rate, the incidence of hypooxygen saturation and the incidence of sputum spatter were compared between the two groups after sputum sample sampling. Results:The incidences of hypooxygen saturation and sputum spatter in the experimental group were lower than those in the control group, and the differences were statistically significant ( P<0.01) . Conclusions:The new whole-course closed sputum specimen collection technology can effectively stabilize the oxygen saturation of ICU patients in the process of sputum specimen collection, reduce the incidence of sputum spatter and promote the safety of both patients and medical staff, which is worthy of clinical promotion and application.

BACKGROUND: Epidermal growth factor receptor (EGFR) is the gene with the highest mutation rate in non-small cell lung cancer (NSCLC) patients, and the accurate evaluation of its mutational status can facilitate patients receiving targeted drug therapy and thereby prolong patients' survival. The gene testing platform has adequacy requirements for the specimen quality in order to obtain accurate examination results. It has been reported that the number and proportion of tumor cells in samples will affect the detection rate of EGFR gene mutation. The present study aims to analyze the relationship between the quality of small biopsy specimens of NSCLC and the mutation rate of EGFR gene with amplification refractory mutation system (ARSM) test. METHODS: After collecting the clinical characteristics of 299 cases small biopsy of lung adenocarcinoma, DNA concentration of the specimens and the mutational status of EGFR gene, the number and proportion of tumor cells in HE stained sections evaluated using light microscopy, the relationship between specimen quality and the mutation rate of EGFR gene were analyzed. RESULTS: The mutation rates of EGFR for the groups with tumor cell number ≤500 and >500 were 40.7% (11/27) and 43.8% (119/272) respectively, without significant difference (P=0.764). The mutation rates for the groups with DNA concentration ≤20.4 ng/μL and >20.4 ng/μL were 42.7% (64/150) and 44.3% (66/149) respectively, without significant difference (P=0.776). The mutation rates for the groups with tumor cells proportion ≤30% and >30% were 29.4% (20/68) and 47.6% (110/231) respectively, demonstrating significant difference (P=0.008). Multivariate Logistic analysis showed that male, thyroid transcription factor-1 (TTF-1) negative, smoking history and tumor cell proportion less than 30% were main factors that contributes to the low detection rate of EGFR gene mutation. CONCLUSIONS After meeting the minimum requirements for detection, the EGFR mutation rate is affected by the proportion of tumor cells in the sample. Therefore, it is necessary to re-evaluate the tumor cell proportion in the last section after the genetic test section. For samples with lower tumor cell proportion, enriching tumor cells through microdissection and other methods is recommended for a more accurate detection result. For specimens that cannot be enriched with tumor cells, circulating tumor DNA (ctDNA) test can be performed as a supplement. If the result is still negative, another biopsy should be considered to obtain enough tumor specimens for molecular testing.