OBJECTIVE To explore optimization pathways for the drug traceability code management model in outpatient pharmacy workflows， providing practical evidence for enhancing the efficiency of pharmaceutical service. METHODS Taking the outpatient pharmacy of the First Affiliated Hospital of Sun Yat-sen University as the research subject， a comprehensive drug traceability system was established through three key interventions： upgrading the information system architecture [including integration of the hospital information system （HIS） with the traceability platform]， workflow optimization （reorganizing the inventory-dispensing-verification tripartite process）， and designing a dual-mode traceability data collection mechanism （primary data capture at dispensing stations and supplementary capture at verification stations）. Operational efficiency differences before and after implementation were analyzed using the medical insurance data and service timeliness metrics in September 2024. RESULTS After the implementation of drug traceability code management， in terms of data collection: Mode Ⅰ （verification-stage capture） uploaded 26 144 records， while Mode Ⅲ （inventory-as-sales capture） uploaded 443 061 records， totaling 469 205 entries； in terms of time efficiency： average drug dispensing time increased from 28.74 s to 43.37 s （enhanced by 51%）. Through dynamic staffing adjustments， patient wait time only extended from 8.04 min to 8.67 min （enhanced by 8%）. CONCLUSIONS Drug traceability code management can be effectively implemented via a “system reconstruction-process reengineering-human-machine collaboration” trinity strategy， leveraging informatization （e.g.， dual-mode data capture） to offset manual operation delays， which validates the feasibility of balancing national traceability demands with service efficiency in outpatient pharmacies.

Randomized controlled trial (RCT) are considered the "gold standard" for evaluating the causal effects of interventions on outcome measures. However, due to high research costs and ethical constraints, conducting RCT in clinical practice, especially in the surgical field, faces numerous challenges such as difficulties in subject recruitment, implementation of blinding, and standardization of interventions. In such cases, using real-world data to perform causal inference under the framework of target trial emulation (TTE), based on the principles of RCT design, helps to identify and reduce biases arising from design flaws in traditional observational studies, such as immortal time bias, confounding, selection bias, or collider bias. This approach can produce high-quality evidence comparable to that of RCT, thereby enhancing the clinical guidance value of real-world data studies. However, TTE has limitations, such as the inability to completely eliminate confounding, high quality requirements for source data, and the current lack of reporting standards. Therefore, researchers should be fully aware of these limitations to avoid making incorrect causal inferences. This article intends to provide an overview of the TTE framework, implementation points, application scope, application cases, and advantages and disadvantages of the framework.

Objective:To investigate the influence of COX-2 expression in hepatocellular carcinoma (HCC) on the infiltration and immune response of conventional type 1 dendritic cells (cDC1).Methods:Clinicopathological data from 111 HCC patients undergoing radical hepatectomy at Peking University People's Hospital from Jan 2016 to Jun 2017 were retrospectively analyzed. Immunofluorescence staining was employed to evaluate the cDC1 infiltration and COX-2 expression in tumor tissues. Patients were divided into two groups based on cDC1 infiltration: cDC1 enrichment and cDC1 depletion, and the correlation between COX-2 expression and cDC1 infiltration was analyzed. Single-cell sequencing of HCC tumor tissues was used to further investigate the correlation between PTGS2, the encoding gene of COX-2, and cDC1 infiltration. Hematopoietic stem cells (HSC) were utilized for in vitro generation of cDC1. HSC-derived cDC1s were sorted by FACS and cocultured with HCC cell line SNU423. Celecoxib, a selective COX-2 inhibitor, was used to suppress the COX-2 expression in HCC cell line SNU423. The functions of cDC1 were explored by FITC-dextran uptake assay, flow cytometry, and Luminex multiplex cytokine assay. Results:COX-2 expression was significantly higher in the cDC1 depletion group ( n=73) compared to the cDC1 enrichment group ( n=38) ( P=0.004 2). Patients with higher PTGS2 expression had significantly lower proportion of cDC1. Increased cDC1 infiltration in the HCC tumor microenvironment correlated with improved patient overall survival rates ( P=0.037) and disease-free survival rates ( P=0.048). Results from FITC-dextran uptake assay, flow cytometry, and Luminex assay indicated that cDC1 co-cultured with HCC showed significantly reduced antigen uptake function, co-stimulatory molecule expression, and cytokine secretion, but partially abrogated with celecoxib treatment. Conclusions:The intratumoral infiltration of cDC1 is positively correlated with favorable prognosis in HCC patients. Elevated COX-2 expression in HCC impedes the intratumoral accumulation of cDC1 and compromises their immune response capabilities. COX-2 inhibitors hold promise for enhancing cDC1 function in HCC.

Objective To explore the age-related biological properties of bone-derived mesenchymal stem cells(BMSCs)from mice of different age groups and their osteogenic differentiation induced by bone morphogenetic protein 2(BMP2).Methods Eight C57BL/6J mice were divided into a young group(4 weeks old,weighing 10～15 g,n=4)and an old group(12 months old,weighing 20～25 g,n=4),with half male and half female.MSCs were extracted from the whole bones of the 2 groups of mice.After the obtained cells were identified with flow cytometry for the surface markers,β-galactosidase staining was employed to compare the senescence level of BMSCs,MTT and EdU incorporation assays were conducted to compare the proliferation and self-renewal abilities of between the 2 groups.Western blotting was employed to analyze the expression of CyclinD1 and P21 in BMSCs.Then ALP staining,Alizarin Red staining and RT-qPCR were used to evaluate the osteogenic differentiation ability of the cells.RNA sequencing was performed to compare the differential gene expression in BMP2-induced BMSCs.Lastly,the sequencing results were re-confirmed by using flow cytometry.Results Flow cytometry showed that the sorted and cultured mouse BMSCs met the criteria for MSCs.The results of β-galactosidase staining indicated that the senescence level of BMSCs in the old group was significantly higher than that in the young group(P＜0.05).MTT and EdU doping experiments revealed that the cell viability and proliferation ability of BMSCs were significantly lower in the old group than the young group(P＜0.05).Western blotting displayed that the expression level of cell cycle protein CyclinD1 was lower,whereas that of cell cycle inhibitory factor P21 was significantly higher in the BMSCs from the old group than the cells from the young group(P＜0.05).ALP/Alizarin Red staining and RT-qPCR demonstrated that the BMSCs from the young group had stronger osteogenic differentiation capacity after BMP2 treatment when compared the cells of the old group(P＜0.05).RNA sequencing results displayed that the changing profile of CD51 expression was in opposite trends in the young and old BMSCs after BMP2 treatment.Finally,flow cytometry revealed that the percentage of CD51+cells within the CD45-cells was significantly higher in the young group than the old group.Conclusion The decrease in the percentage of CD51+cells among CD45-cells in aged BMSCs is closely associated with their decreased responsiveness to BMP2-induced osteogenic differentiation.

Objective This study aimed to develop an experimental animal platform for evaluating the feasibility and safety of intelligent acupuncture robots and to lay the foundation for further research.Methods Six 2-month-old Guangxi Bama miniature pigs were used as experimental subjects for acupuncture verification after anesthesia.First,manual acupuncture verification was carried out.Six acupoints were selected for each experimental animal and the needles were left for 20 min after the lifting,inserting,and twisting manipulation.Before and after controls were included.The experiment was carried out for 28 days,and each experiment was conducted once every 2 days for a total of 10 times.After verification of manual acupuncture,a point 10 mm from each of the six selected acupoints was selected,with a total of 12 points,and acupuncture operations were carried out on the experimental animals using the intelligent acupuncture module of the acupuncture robot at different frequencies and angles,to further verify the stability and feasibility of the animal platform.Results Routine safety-related blood indicators and blood biochemistry indicators after the procedure were normal and stable compared with those before the procedure.The average heart rate of the animals was 124 beats/min,the average blood pressure was 87/36 mmHg,and the average body temperature of was 36℃at a room temperature of 25℃,with no significant change in body temperature during and after the experiment.On the basis of this experimental platform,acupuncture manipulation using the intelligent acupuncture module of the acupuncture robot was completed successfully,with no abnormalities related to acupuncture such as bending,breaking,or stagnation of needles during the experimental process,and the experimental animals showed no obvious abnormalities.Conclusions This study established a stable experimental animal platform for evaluating the feasibility and safety of acupuncture carried out by intelligent acupuncture robots,based on the existing experimental method of miniature pigs.These result lay a foundation for further research related to the use of intelligent acupuncture robots.

Objective To explore the interaction and compatibility optimization of esketamine combined with oxycodone in postoperative analgesia after cesarean section.Methods A total of 138 postpartum women who received cesarean section in Zhejiang Provincial Hospital of Chinese Medicine from April 2021 to October 2022 were selected as the study subjects.The initial compatibility concentration of target-controll infusion of esketamine and oxycodone was selected,and the pain disappearance time(TLOP)of patients after anesthesia,who visual analogue scale(VAS)scores＜3 was observed.The target-controlled infusion concentrations of esketamine and oxycodone were adjusted according to bispectral index(BIS),mean arterial pressure(MAP)and heart rate(HR)during operation,and BIS 42-65,MAP＞60 mmHg and HR＞50 times/min were maintained.The pain recovery time(TROP)from esketamine and oxycodone infusion to VAS score＞3 was recorded.The median effective dose(ED50)of each group of drugs at BIS50 was calculated by point-slope method.The pharmacodynamic interaction of esketamine and oxycodone in postoperative analgesia after cesarean section was analyzed by response surface model,and the optimal compatible concentration range was calculated.Results When the BIS value was 50,ED50 of esketamine combined with oxycodone deviated from the addition line without statistical significance(P＞0.05).The compound drug effect(compound point SP)fell to the left of the addition line,indicating that the analgesic effect of the two drugs was synergistic.The response surface model showed that esketamine and oxycodone had a significant synergistic effect on the body motor response and circulation response during postoperative analgesia in patients undergoing cesarean section.The optimal compatible concentration range was as follows:when the concentration of oxycodone was 2 mg/mL,0.38-0.80 mg/kg esketamine was used;when the concentration of oxycodone was 3 mg/mL,0.30-0.70 mg/kg esketamine was used;when the concentration of oxycodone was 4 mg/mL,0.23-0.46 mg/kg esketamine was used;when the concentration of oxycodone was 5 mg/mL,0.18-0.37 mg/kg esketamine was used;when the concentration of oxycodone was 6 mg/mL,0.20 mg/kg esketamine was used.Conclusion The target-controlled infusion of esketamine and oxycodone target controlled infusion has a synergistic effect in postoperative analgesia after cesarean section.The combination of different pharmacodynamic responses creates the optimal dosage range of esketamine and oxycodone,which can provide patients with good analgesia effect and fewer adverse reactions within the optimal concentration range.

Objective    To explore the natural changes of procalcitonin (PCT) in the early period after pediatric cardiac surgery with cardiopulmonary bypass (CPB). Methods    A prospective and observational study was done on patients below 3 years of age, who underwent cardiac surgery involving CPB, with the risk adjustment of congenital heart surgery (RACHS) score of 2 to 5 and free from active preoperative infection or inflammatory disease. Blood samples for measurement of PCT, C-reactive protein (CRP) and white blood cell (WBC) were taken before surgery and daily for 7 days in postoperative period. Infections and complications within 7 days after operation were investigated. According to the presence or absence of infection and complications within 7 days after operation, the enrolled children were divided into an infection+complications group, a simple infection group, a simple complication group, and a normal group. Results     Finally, 429 children with PICU stay≥ 4 days were enrolled, including 268 males and 161 females, with a median age of 8.0 (0.7, 26.0) months. There were 145 children in the simple infection group, 38 children in the simple complication group, 230 children in the normal group and 16 children in the infection+complications group. The levels of PCT, CRP and WBC were significantly higher after CPB. CRP and WBC peaked on the second postoperative day (POD) and remained higher than normal until POD7. PCT peaked on POD1 and would generally decrease to normal on POD5 if without infection and complications. Age, body weight, RACHS scores, the duration of CPB and aortic cross-clamping time were correlated with PCT level. There was a statistical difference in PCT concentration between the simple infection group and the normal group on POD 3-7 (P<0.01) and a statistical difference between the simple complication group and the normal group on POD 1-7 (P<0.01). A statistical difference was found between the simple infection group and the simple complication group in PCT on POD 1-5 (P<0.05). Conclusion    WBC, CRP and PCT significantly increase after CPB in pediatric cardiac surgery patients. The factors influencing PCT concentration include age, weight, RACHS scores, CPB and aortic cross-clamping time, infection and complications.

Objective:To analyze the association between thrombocytopenia and clinical manifestations in patients with antiphospholipid syndrome (APS), and the significance of adding thrombocytopenia to the classification criteria of APS.Methods:One hundred and sixty one APS patients admitted to Peking University People's Hospital from January 2003 to August 2017 were retrospectively analyzed. Clinical and laboratory data were compared between patients with and without thrombocytopenia. Chi-square test, Fisher's exact test and t test were used for statistical analysis. Results:Among 161 APS patients, 48 patients (29.8%) were primary APS and 113 patients (70.2%) were secondary APS. Ninety-one patients (56.5%) experienced thrombocytopenia, while 62 patients (38.5%) had thrombocytopenia as the initial symptom. Among primary APS patients, compared with patients without thrombocytopenia, the prevalence of thrombosis was significantly lower in patients with thrombocytopenia (40.0% vs 69.6%, χ2=4.218, P=0.040), especially venous thrombosis (20.0% vs 47.8%, χ2=4.174, P=0.041). Among secondary APS patients, compared with patients without thrombocyt-openia, the prevalence of thrombosis, arterial thrombosis (21.2% vs 42.6%, χ2=5.944, P=0.015) and venous thrombosis (22.7% vs 51.1%, χ2=9.753, P=0.002) was significantly lower in patients with thrombocytopenia (43.9% vs 80.9%, χ2=15.496, P<0.01). As for laboratory findings, primary APS patients with thrombocytopenia showed a higher proportion of positive aCL findings (80.0% vs 52.2%, χ2=4.174, P=0.041), while secondary APS patients with thrombocytopenia experienced more leukopenia (25.8% vs 10.6%, χ2=4.002, P=0.045), lower complement C3 levels (78.7% vs 44.4%, χ2=13.205, P<0.01) and complement C4 levels (74.6% vs 46.7%, χ2=8.485, P=0.004). The proportion of patients fulfilling 1988, 1989, 1999 and 2006 APS classification criteria in our cohort was 88.2%, 87.0%, 64.0% and 70.8%, respectively. Inclusion of thrombocytopenia into 2006 criteria improved the proportion to 96.3%. Conclusion:The prevalence of thrombosis in APS patients with thrombocytopenia is significantly low. Thrombocytopenia is an important clinical manifestation of APS which can improve the diagnostic accuracy of APS.

Alcoholic liver disease is a common chronic liver disease. Inflammatory pathways in the immune microenvironment of the liver play important roles in the development and progression of alcoholic liver disease, providing potential targets for therapeutic interventions. This review focused on the pathophysiology of alcoholic liver disease, changes in the immune microenvironment including immune cells and inflammatory mediators, and advances in targeted therapy.

Objective    To investigate the timing and clinical efficacy of diaphragmatic plication in the treatment of diaphragmatic paralysis after congenital heart disease (CHD) operation. Methods    From January 2013 to February 2019, 30 children with CHD who were treated in Fuwai Hospital were collected, including 17 males and 13 females with a median age of 19.5 (3, 72) months. There were 6 patients with bilateral diaphragmatic paralysis (bilateral group) and 24 patients with unilateral diaphragmatic paralysis (unilateral group). The clinical data of the two groups were compared. Results    Among the 6 bilateral diaphragmatic paralysis patients, 2 underwent bilateral diaphragmatic plication, and the other 4 patients continued their off-line exercise after unilateral diaphragmatic plication. Patients in the unilateral group had shorter ventilator use time (266.77±338.34 h vs. 995.33±622.29 h, P=0.001) and total ICU stay time (33.21±23.97 d vs. 67.33±28.54 d, P=0.008) than those in the bilateral group. One patient died in the bilateral group, and there was no statistical difference between the two groups (P=0.363). There was no statistical difference in the ICU stay time after diaphragm plication between the two groups (11.68±10.28 d vs. 29.83±27.73 d, P>0.05). Conclusion    Diaphragmatic plication is an effective treatment for diaphragmatic paralysis after CHD operation once the conservative treatment failed. The prognosis of bilateral diaphragmatic paralysis is worse than that of unilateral diaphragmatic paralysis. Strict control of indications for surgery is beneficial to the early recovery of patients.