Children, as a special group, have received public attention. Although a series of policies have been released in recent years to ensure the safety of children's medication, there are still problems such as fewer suitable varieties of drugs and irrational use of medication, which require scientific and reasonable policies on children's medication to promote their development.

To quantitatively evaluate China's pediatric drug policy texts and provide reference for the formulation and improvement of future pediatric drug policies.

Based on the text mining method, 23 pediatric drug policy documents issued at the national level from 2014 to 2023 were processed, the policy modeling consistency (PMC) index model of pediatric drug policy was constructed, and the quantitative evaluation and analysis of China's 23 pediatric drug policies were carried out through 10 primary variables and 41 secondary variables.

The mean value of PMC index of the 23 policies on pediatric drug was 5.65, and the mean value of PMC depression index was 4.35, including 1 excellent-grade policy, 17 good-grade policies and 5 qualified-grade policies, and there were no perfect-grade policies and bad policies. 23 medication policies for children scored high on policy tools and policy receptors and low on publishing organizations and policy timeliness.

China's pediatric drug policy is generally at a good level, and can be further improved in terms of policy timeliness, issuing organization and policy content.

With the accelerated population aging, the number of elderly patients with chronic diseases is growingly elevated. Adherence to medication regimens is pivotal for the health outcomes of chronic diseases. Existing research mainly analyzed influencing factors for medication adherence and the outcome of medication adherence by interventions. A single analysis of medication adherence from the aspect of medication experience is one-sided.

To understand the current situations of medication experience and medication adherence in elderly patients with chronic diseases, and to explore the influence of medication experience at multiple dimensions on medication adherence, thus proposing countermeasures to improve medication adherence in elderly patients with chronic diseases.

From September 2023 to December 2023, a total of 2 432 residents of three cities in Shandong Province were selected by stratified random sampling according to the economic level and social development. Elderly patients (>60 years of age) with chronic diseases and long-term medications were screened according to the inclusion and exclusion criteria. A self-designed Medication Experience Scale, consisting of 7 dimensions and 28 items was used to investigate the medication experience. A Chinese version of 4-item Medication Adherence Scale was used to investigate the medication adherence. Current status of patients' medication experience and medication adherence were described. Multiple linear regression was performed to analyze the dimensions of medication experience that greatly influenced medication adherence.

A total of 2 432 questionnaires were distributed in this survey, and 2 415 were retrieved. After excluding samples with missing data on the main variables, a total of 1 544 samples were included in this study. The mean score of medication experience of elderly patients with chronic diseases was (4.31±0.39) point, with the highest score in the dimension of life influenced by medication (4.72±0.58) points, and lowest in the dimension of convenience (3.86±0.49) points. The mean score of medication adherence in elderly patients with chronic diseases was (3.48±0.62) points. A total of 698 (45.2%) patients were identified as a poor adherence. The most common cause for non-adherence was 'forgetting to take medication' (77.1%, 538/698). Medication adherence scores were significantly lower in female elderly, or elderly patients with two or more chronic diseases than those of counterparts (P<0.05). The results of multivariate linear regression showed that medication adherence was worse in female elderly patients (β=-0.056) and elderly patients with two or more chronic diseases (β=-0.053) (P<0.05). Among the dimensions of the Medication Experience Scale, the dimensions of effectiveness (β=0.083), and affordability (β=0.135) positively predicted patients' medication adherence (P<0.05) .

The proportion of elderly patients with poor medication adherence to chronic diseases in Shandong Province is 45.2%, among whom, female patients and elderly patients with two or more chronic diseases have a worse medication adherence. The effectiveness and affordability dimensions of the medication experience are positive predictors of medication adherence. Relevant departments should focus on continuously reducing the price of chronic disease medicines, and doctors should strengthen the pharmacy guidance service provided to female patients and elderly patients with two or more chronic diseases.

Cardiometabolic multimorbidity (CMM) was one of the most common comorbidity aggregation patterns in different regions and populations, with a high risk of mortality. However, studies on the clinical and medication characteristics of CMM were limited.

To study the clinical characteristics and medication patterns of patients with CMM in the real world, and provide reference basis for the prevention and management of CMM.

Outpatient patients who were diagnosed with CMM in the hospital information system (HIS) of the First Affiliated Hospital of Ningbo University from January 2023 to June 2023 were selected. Basic prescription information was collected and analyzed using frequency analysis and association rule analysis methods.

A total of 7 059 patients with CMM were included, of which 3 960 (56.1%) were male and 3 099 (43.9%) were female, with an age range of 18 to 97 years and a mean age of (58.1±13.7) years. The results showed that 3 910 patients with less than 5 types of medication, accounting for 55.4%; 2 740 patients with 5-9 types of medication, accounting for 38.8%; and 409 patients with more than 10 types of medication, accounting for 5.8%. Hypertension, dyslipidemia, and diabetes were the core diseases of CMM. Among the comorbidities of cardiovascular metabolic diseases, chronic gastritis, renal insufficiency, and hyperuricemia were more common. In the prescription of patients with CMM, statins, calcium channel blockers (CCB), angiotensin receptor blockers (ARB), metformin, and sodium-dependent glucose transporters 2 inhibitors (SGLT2i) were the core medications.

Our findings suggest chronic gastritis, renal insufficiency, and hyperuricemia are more common diseases in patients with CMM. Screening and prevention should be strengthened and treatment strategies should be adjusted. In the CMM drug prescription, lipid-lowering, antihypertensive, and hypoglycemic drugs are the core drugs used.

The incidence of acute poisoning caused by commonly used clinical drugs has been increasing annually, yet specific antidotes are lacking for most drug poisonings. Blood purification plays a crucial role in the treatment of acute poisoning. However, there are currently no unified recommendations in China regarding its application in cases of acute poisoning from commonly used clinical drugs. This consensus centers on pharmacokinetics, summarizing and outlining the strategies for applying blood purification in the treatment of acute poisoning caused by these drugs. Its aim is to assist clinicians in improving their understanding of pharmacokinetic parameters and the corresponding blood purification methods, so that they can select the appropriate blood purification technique and develop suitable treatment plans based on the pharmacokinetic characteristics of the drug involved. Ultimately, this seeks to improve outcomes in treating patients with acute poisoning from commonly used clinical drugs.

Primary care physicians in community settings face numerous challenges when making medication decisions for patients with multimorbidity. Enhancing their decision-making capabilities through training is an important way to address these challenges. However, there is a dearth of in-depth research on the training needs of primary care physicians in the context of medication decision-making for multimorbidity.

This study aims to explore the challenge physicians encountered in medication decision-making for patients with multimorbidity and their needs for training content and modalities, providing a reference for designing the training courses for the abilities enhancement.

From October 5th to December 21st in 2023, physicians from community health care centers in Hangzhou, Ningbo, Jiaxing, Shenzhen, and Shanghai were recruited for in-depth interviews following the principle of purposive sampling and maximum variation, which focus on the content and formats of training to enhance medication decision-making abilities. Two researchers transcribed and coded the interviews independently, and content analysis was performed on the interview data.

A total of 20 Physicians completed the interviews and 15 were females, mean age were (38.5±3.0) years. Based on the challenges faced by primary care physicians in the medication decision-making for multimorbidity, the training should cover four aspects: evaluation of medication therapy, rational selection of medication, doctor-patient communication and shared decision-making, medication education and follow-up. In terms of training form, primary care physicians are willing to accept flexible and multiple teaching approaches, and prefer case-based training that aligns with community health needs.

Primary care physicians have clear training needs of medication decision-making for patients with multimorbidity. The results of this study provide a theoretical reference for the development of training courses, which adapt to the working environment and actual requirements of primary care physicians.

Multimorbidity refers to an individual suffering from two or more chronic diseases simultaneously. Patients with multimorbidity refers often require the concurrent use of multiple medications, posing a challenge to community general practitioners in making scientific medication decisions. This paper analyzes the reasons and influencing factors that lead to the dilemmas in medication decision-making for patients with multimorbidity in the community. It also proposes a dynamic and comprehensive decision-making framework known as the Medication Decision-making for Multimorbidity Framework (MDMF). The framework consists of five stages in the process of community general practitioners treating patients with multimorbidity, which include "Health problems review""Comprehensive medication assessment""Shared decision-making""Medication therapy recording", and "Follow-up arrangement". The MDMF facilitates the development of individualized medication therapy for patients with multimorbidity by community general practitioners, but it also places certain demands on their capabilities. Therefore, it is recommended to provide training for community general practitioners centered on the MDMF, offer decision-making support, and implement reasonable incentives and supervision measures. This is expected to promote primary care institutions to provide patient-centered medication therapy, enhance its safety and efficacy, and alleviate the treatment burden on patients.

Currently, the treatment of refractory epilepsy (RE) in children is still a difficult point in epilepsy treatment. In China, pirenzapine (PER) is still a new drug for treating RE in children, and there is currently a lack of recommendations for adding PER to the treatment of RE in children. And in Chinese reports, the sample size of RE patients treated with PER is relatively small. Therefore, the efficacy of PER for pediatric RE, especially for young children with RE, still needs to be further studied with a large sample size.

To explore the efficacy, possible indications, adverse reactions, and tolerability of PER addition therapy for RE in children.

A self-control and retrospective analysis was conducted on children with RE aged 0-18 who were treated at the Women and Children's Hospital, Qingdao University from January 2022 to January 2023. The frequency of seizures at different observation points before and after the addition of PER treatment was compared, and the effective rate of PER was evaluated. Adverse drug reactions and drug retention rates were recorded, and the clinical characteristics of the effective and ineffective groups of PER were analyzed.

A total of 192 study subjects were included. After adding PER treatment, the effective rates at 12, 24, and 36 weeks were 56.3% (108/192), 62.1% (113/182), and 69.7% (122/175), respectively, and the seizure free rates were 19.3% (37/192), 21.4% (39/182), and 24.6% (43/175). The incidence of adverse reactions was 16.1% (31/192), mainly including dizziness, irritability, weakness, and drowsiness. The last follow-up drug retention rate was 91.1% (175/192). There was a statistically significant difference in the onset age, duration of anti-epileptic treatment, type of origin, seizure form, frequency of seizures before the addition of PER, number of combined anti-epileptic drugs (ASMs), and ketogenic diet/surgical treatment between patients with RE who received continuous medication for 12 weeks (P<0.05). In addition, 178 children underwent EEG examination, and 167 children underwent cranial magnetic resonance imaging examination. There was a statistically significant difference in the electroencephalogram (EEG) and head magnetic resonance imaging (MRI) results between patients who received effective and ineffective treatment. In the results of electroencephalogram examination, the effective rate of discharge in the anterior (anterior, middle, temporal anterior, and middle) part of the brain was higher (P<0.05) ; In the results of cranial imaging examination, the normal group had a higher effective rate, followed by children with mainly white matter damage.

The overall effective rate and retention rate of PER addition therapy for RE in children are high, with mild adverse reactions and good drug tolerance. It is more effective for children with RE who have a late onset age, seizures in the form of motor seizures, focal origin, short course of anti-epileptic treatment, fewer combination medications, and less frequency of seizures. In electroencephalography, patients with normal discharge in the anterior (anterior, middle, anterior temporal, and middle temporal) of the brain and normal results in cranial magnetic resonance imaging have a higher effective rate.

Statins are the cornerstone of lipid-lowering therapy and moderate-dose statin therapy is the preferred treatment strategy for lipid management in the Chinese population. Despite the widely recognized efficacy of statins in reducing cholesterol levels and preventing cardiovascular diseases, there are significant differences in treatment responses among patients from different ethnic groups.

To explore the differences in therapeutic efficacy between Han and Uyghur patients under moderate-dose statin therapy to guide the formulation of individualized treatment plans.

A total of 780 patients diagnosed with atherosclerotic cardiovascular disease (ASCVD) by coronary angiography at the First Affiliated Hospital of Xinjiang Medical University's Cardiac Center from 2012 to 2022 were included in the study. Baseline data and laboratory examination results of the patients were collected.

A total of 780 ASCVD patients were included, with 408 Han and 372 Uyghur patients. The mean age and gender composition of the two groups were statistically significant (P<0.05). Prior to statin therapy, Han patients had higher levels of total bilirubin (Tbil), albumin (ALB), glycated hemoglobin (HbA_1c), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), and proportions of hypertriglyceridemia and hypercholesterolemia compared to Uyghur patients. Conversely, Han patients had lower levels of alanine aminotransferase (ALT), hypoalphalipoproteinemia, hypoapolipoproteinemia A1, and hyperlipoproteinemia a compared to Uyghur patients (P<0.05). After statin therapy, Han patients had higher levels of Tbil, aspartate aminotransferase, ALB, HbA_1c, HDL-C, ApoA1, and lower levels of ALT, TC, low-density lipoprotein cholesterol (LDL-C), ApoB, hypoalphalipoproteinemia, hypoapolipoproteinemia A1, and hyperapolipoproteinemia B compared to Uyghur patients (P<0.05). After medium-dose statin therapy, the reduction levels of TC, HDL-C, LDL-C, and ApoB in Han patients were higher than those in Uyghurs (P<0.05) ; the reduction levels of TC, LDL-C, and ApoB were higher in Han patients than those in Uyghurs, and the increase level of HDL-C was lower in Han patients than those in Uyghurs (P<0.05). Patients were categorized into sensitive group (n=124), resistant group (n=104), and Intermediate group (n=552) based on the reduction in LDL-C. The resistant group consisted of 42 Han and 62 Uyghur patients, the sensitive group of 78 Han and 46 Uyghur patients, and the intermediate group of 288 Han and 264 Uyghur patients. The distribution of ethnicities among the three groups was statistically significant (χ²=11.511, P=0.030) .

Han patients showed a significantly better lipid-lowering effect following moderate-dose statin therapy compared to Uyghur patients. Uyghur patients may require more frequent monitoring of lipid levels and consideration of increased statin dosage or early combination with other lipid-lowering drugs to improve therapeutic efficacy.

In recent years, the number of diabetics in China ranks first in the world. While recommending metformin as the first-line hypoglycemic drug, the Chinese Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 edition) emphasize "patient-centere" and select appropriate second-line hypoglycemic agents for combination administration according to the clinical characteristics and preferences of patients. Because there are great differences in the prevalence rate and life behavior of type 2 diabetes between the north and the south of China, whether there is a difference in the second-line drug preference of patients with type 2 diabetes between the two places remains to be further demonstrated.

To analyze the difference of second-line drug preference among patients with type 2 diabetes mellitus in North and South China, and to provide empirical evidence for clinical and health management decision-making.

The study adopts a Discrete Choice Experimental design, Mixed Logit Model was used to analyze drug preference of patients with type 2 diabetes in the north and south of China based on Multi-stage random cluster sampling and convenient sampling, from October 2021 to January 2022.

In this study, 1 443 questionnaires were distributed, and 1 388 were valid, with an effective recovery rate of 96.19%. Logit model analysis showed that the effect of blood sugar control, the risk of hypoglycemia, the risk of gastrointestinal side effects, whether the cardiovascular system can be protected, the way of taking drugs and the out-of-pocket cost/month were the influencing factors of the second-line drug preference of southern patients (P<0.05). Patients with type 2 diabetes in South China prefer to take oral second-line hypoglycemic drugs with 0 yuan, no risk of gastrointestinal side effects, strong blood sugar control effect, no risk of hypoglycemia events, and can protect the cardiovascular system (P<0.05). When the risk of gastrointestinal side effects changes from high to no risk, patients in South China are willing to pay 408.06 yuan per month. The effect of blood sugar control, the risk of hypoglycemia, the risk of gastrointestinal side effects, whether the cardiovascular system can be protected, the way of taking medicine, out-of-pocket expenses/month, and the change of body mass within half a year are the influencing factors of the preference for second-line medication in northern patients (P<0.05). The patients with type 2 diabetes in the north prefer the second-line hypoglycemic drugs with 0 yuan, strong blood sugar control effect, no risk of hypoglycemia events, cardiovascular protection and no risk of gastrointestinal reaction, taking orally and reducing body weight by 2.0 kg within six months (P<0.05). When the blood sugar control effect is weak and changed to strong, the patients in the north are willing to pay 435.98 yuan per month.

In addition to out-of-pocket expenses/month, patients with type 2 diabetes in the south pay more attention to gastrointestinal side effects, while patients with type 2 diabetes in the north pay more attention to the effect of blood sugar control. There are differences in second-line medication preferences between the two places. Regional differences provide a basis for individualized treatment of patients with type 2 diabetes mellitus. Clinical diagnosis and treatment should be "patient-centere" and pay attention to individual preference differences.

Comorbid insomnia and sleep apnea is a highly prevalent disorder characterized by both insomnia and sleep apnea, leading to more severe impairment of daytime function and quality of life than in patients with either insomnia or obstructive sleep apnea (OSA) alone. Non-benzodiazepine drugs (NBZDs) are frontline medications for insomnia treatment, as they can improve insomnia symptoms and enhance sleep quality. However, they are not recommended for OSA treatment due to their potential to increase the apnea-hypopnea index (AHI) and worsen the severity of sleep-disordered breathing. Currently, the therapeutic effects of NBZDs on COMISA are not well-established and require further investigation. Therefore, this article adopts a systematic review approach to compile relevant literature on the use of NBZDs in patients with OSA and COMISA, analyzing the impact of NBZDs on various indicators such as AHI, oxygen desaturation index, and sleep quality. It evaluates the clinical efficacy and safety of medications including zopiclone, eszopiclone, zolpidem, and zaleplon in the treatment of COMISA, aiming to provide guidance on the rational use of NBZDs for these patients.

Diabetes is an important health problem due to its high prevalence and associated disability and mortality. Research evidence provides effective information for improving patient health outcomes. Decision aids can help patients obtain evidence and increase physician-patient interaction.

To obtain patients' preferences for anti-diabetic drugs and develop an evidence-based decision aid to achieve the integration of evidence, patient values, and decision settings, thus facilitating patient-centered evidence-based decision making.

Several literature databases, like PubMed, Web of Science Core Collection, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), VIP Chinese Science Journals Database, and Wanfang Data were searched to determine the value assessment dimensions and attributes of anti-diabetic drugs. The time limit for literature search is from the establishment of the database to December 31, 2022. The questionnaires for investigating patients' preferences for anti-diabetic drugs were designed using the best-worst scaling method. Then, the empirical study to explore preferences was carried out in five hospitals in Jiangsu Province. Based on the analysis of patients' preferences, an evidence-based decision aid was developed using techniques including Vue + Element UI, Spring Boot, Spring Security, Java, etc.

The most important five attributes in patient decisions were incidence of macrovascular complications, length of extended life years, change of health-related quality of life, incidence of microvascular complications, and control of HbA_1c. The evidence-based decision aid provides a structured summary of evidence on the comparative effectiveness, comparative safety, convenience, and affordability of new anti-diabetic drugs. The multi-attribute value assessment module of new anti-diabetic drugs is the core element of the decision aid, supporting patients' evidence-based assessment of the drugs' value.

Evidence-based decision aid integrates research evidence of new anti-diabetic drugs, patients' preferences and values, and helps realize shared decision-making between physicians and patients.

Drug-induced liver injury is one of the most common adverse drug reactions, and atorvastatin is one of the widely used statin lipid-lowering drugs in clinical practice, which is susceptible to hepatic injury. Currently, there is limited research data on the clinical characteristics of liver injury induced by atorvastatin.

To investigate the clinical characteristics of liver injury induced by atorvastatin, so as to improve clinicians' understanding of liver injury induced by atorvastation.

The patients who were hospitalized and treated with atorvastatin in the First Affiliated Hospital of Guangxi Medical University from January 2012 to August 2022, developed liver injury and were evaluated as liver injury induced by atorvastation based on Roussel Uclaf Causality Assessment Method were selected, and analyzed on clinical characteristics.

A total of 84 cases of liver injury induced by atorvastation were diagnosed by Causality Assessment Method. The patients with liver injury induced by atorvastation were more male (72.6%), with an average age of (60.2±11.5) years, and all of them were comorbid with the underlying diseases (100.0%) ; two cases (2.4%) reached moderate liver injury, and the cure or improvement rate after treatment reached 100.0%. According to the stage of the disease, the main manifestation was an acute course (100.0%) ; according to the damaged target cells, the mixed type was the most frequent (60.7%), followed by the cholestasis type (26.2%) and the hepatocyte type (11.9%). The statistical results showed that 78.6% of the patients with liver injury occurred within 3 months after taking atorvastation and predominantly in the 1st to 2nd week; and 81.0% of the patients developed liver injuryat 80 defined daily dose (DDD) of cumulative atorvastation.

Liver injury induced by atorvastation occurs mostly in male, middle-aged and elderly patients patients with underlying diseases, mostly have mild liver injury and good prognosis, and the clinical types were mostly mixed type and cholestasis type. Liver injury occurs mainly within 3 months and the occurrence of liver injury induced by atorvastation was dose-dependent.

With the acceleration of population aging, the problem of multi-drug comorbidity among the elderly is serious, and community health service centers have become an important way for the elderly to obtain various health services. However, the management of medication for elderly patients in primary health care institutions is still in a weak state.

To explore the influence of the rational medication management model on patients' knowledge, belief and behavior of medication in the community elderly, and to provide a realistic basis for improving the medication behavior of the elderly.

From September to December 2021, two community health centers in Jinshan District, Shanghai were selected as the sample source, elderly patients with chronic disease comorbidity with contracted general practitioner were studied. The contracted elderly patients from one of the community health service centers were randomly selected as the intervention group (n=223), and the contracted elderly patients from another community health service center were selected as the control group (n=198). Baseline matching between groups was performed using a propensity matching score (PSM) in a 1∶1 ratio. Patients in the control group adopted the conventional chronic disease management plan, patients in the intervention group were medication-integrated and instructed to use the Health Care Handbook of Medication for the Elderly and split pill boxes during medication administration, implementing a rational drug use management mode of the elderly in community. The patients' medication knowledge, belief and behavior scores and standardized medication use behaviors at enrollment and after 3 months of follow-up were recorded, and changes before and after the intervention were analyzed.

After PSM, a total of 141 pairs were successfully matched, and the difference between the basic situation of the intervention group and the control group after matching was not statistically significant (P>0.05). After the intervention, the difference between the patients' knowledge of rational medication, belief, medication adherence score, and the development of standardized medication habits in the intervention group was statistically significant compared with the pre-intervention situation (P<0.05). After the intervention, the patient's knowledge of rational medication use, belief, and medication adherence scoreswere higher than those of the control group in the intervention group. Knowledge of rational medication, belief, and medication adherence scorewere higher than those in the control group, and the difference was statistically significant (P<0.05). After the intervention, the proportion of patients in the intervention group who established the habit of reminding medication, placed medication in a conspicuous location, and involved family members to assist with medication reminders, used split pill boxes, and recorded medication notes were higher than those in the control group. The difference was statistically significant (P<0.05) .

The rational medication management model for the elderly in the community can help strengthen the family doctor team services, enhance the patients' knowledge and belief in rational medication use, and improve the patients' adherence and standardization of medication use behavior.

Atrial fibrillation (AF) is the most common arrhythmia in cardiovascular disease, and it often coexists and interacts with sick sinus syndrome. In the past, pacemaker implantation combined with antiarrhythmic drugs was preferred for symptomatic atrial fibrillation with long interval treatment. However, in recent years, more and more studies have shown that compared with pacemaker implantation, radiofrequency ablation can reduce the hospitalization rate related to tachycardia, effectively control atrial fibrillation, and improve patient prognosis and hospitalization rate of heart failure. However, some patients present intrinsic sinus node dysfunction (SND), and SND may progress and worsen in some patients with atrial fibrillation. Therefore, the first-line treatment strategy for patients with atrial fibrillation with long interval remains controversial. This article reviews the selection of long-term intermittent treatment strategies for atrial fibrillation.

Drug-induced liver injury is the third major liver disease, following viral hepatitis and fatty liver disease. Timely diagnosis and effective treatment are crucial in halting disease progression and improving cure rates. Kuhuang preparation has been widely used in treating acute and chronic hepatitis stemming from various causes, particularly in patients manifesting jaundice, demonstrating clear clinical efficacy and safety. Nonetheless, there remains a dearth of evidence-based medical data concerning the efficacy and safety of hepatoprotective measures in patients with acute drug-induced liver injury.

To evaluate the efficacy and safety of Kuhuang injection sequential Kuhuang granules in the treatment of drug-induced liver injury.

Using a randomized, positive-controlled, non-inferiority trial design, 93 patients diagnosed with acute drug-induced liver injury at Beijing Youan Hospital, Capital Medical University, between November 2021 and September 2023 were selected. These patients were allocated through single-center randomization, with 49 cases assigned to the experimental group and 44 cases to the control group. After receiving conventional hepatoprotective therapy for 4 weeks, the experimental group and the control group were treated with Kuhuang injection/ adenosylmethionine butanedisulfonate for injection for 2 weeks, followed by Kuhuang granules/enteric-coated tablets of adenosylmethionine butanedisulfonate for another 2 weeks. The efficacy rates of jaundice regression, as well as changes in key liver function parameters [alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), total bilirubin (TBIL), total bile acid (TBA) ] at baseline, 2 weeks, and 4 weeks of treatment, along with their normalization rates, were compared between the two groups.

A total of 4 patients fell off during treatment, including 3 patients in the experimental group and 1 patient in the control group. Following 2 and 4 weeks of treatment, there was no significant difference observed in the efficient rate of jaundice regression between the two groups (P>0.05). Similarly, no significant differences were detected in the levels of ALT, AST, ALP, GGT, TBIL, and TBA between the two groups at the 2-week and 4-week marks of treatment (P>0.05). Additionally, there were no notable variations in the recurrence rates of ALT, AST, ALP, GGT, TBIL, and TBA between the two groups following 2 and 4 weeks of treatment (P>0.05) .

Kuhuang Injection Sequential Kuhuang Granules has definite efficacy and good safety in the treatment of drug-induced liver injury, and is not inferior to adenosylmethionine butyldisulfonate for injection sequential enteric-coated tablets of adenosylmethionine butanedisulfonate.

Pharmacotherapy is the cornerstone of primary and secondary prevention of atherosclerotic cardiovascular diseases (ASCVD), but the values and preferences of community patients for pharmacotherapy remain unclear.

To understand the values and preferences surrounding pharmacotherapy among community patients at risk of or undergoing treatment for ASCVD, which would help clarify the individualized treatment burden and provide patient-centered clinical practice.

This study employed a sequential exploratory mixed-methods design. Firstly, we recruited eligible patients in West China Hospital of Sichuan University and Yulin Community Health Service Center in Wuhou District, Chengdu City from November 2021 to January 2022. for a focus group discussion, aiming to collect qualitative insights into their experience, values, and preferences for medication use. The software MAXQDA 2020 was used to support qualitative data analysis, and Colaizzi's seven-step approach was further used to identify themes. After completing the qualitative phase, a questionnaire was designed based on the emergent themes to further quantitatively analyze the values and preferences regarding pharmacotherapy.

Four themes emerged from the qualitative data, including knowledge and use of medications, barriers of medication use, facilitators of medication use, and need for medical services. A total of 186 valid questionnaires were collected in the quantitative study (response rate of 93.5%). The quantitative data showed a commonality in missed dose and confirmed the existence of social stigma and treatment burden in this group of participants. Although preferences in medication use were highly heterogeneous, participants generally preferred taking fewer medications with less frequency, and were less likely to use injectable medications.

The study suggests that it may be appropriate to increase the use of compound preparations, and make treatment plans in accordance with patients' daily lives and work to reduce the treatment burden of pharmacotherapy. In addition, we should be active in managing the misconceptions and improper practices in pharmacotherapy in order to improve patients' medication adherence.

Adenomyosis (AM) is a common and difficult gynecological disease, but its specific mechanism has not been fully elucidated. Traditional Chinese Medicine (TCM) has certain advantages in the treatment of AM, preliminary studies have shown that Guilou compound-releasing intrauterine system can significantly reduce the proliferation and invasion ability of endometrial cells in rats with AM model.

To investigate the effect of Guilou compound on the migration and invasion of human adenomyosis derived cells (AMDC), and study its effect on Rho/ROCK signaling pathway.

The experiment was completed from October 2021 to April 2023 in Central Laboratory of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine. The CCK-8 assay was used to detect AMDC cell viability and screen the optimal drug concentration. AMDC were treated with Guilou compound (50 and 100 mg/L), and the cell migration viability was detected by scratch assay, and cell invasion ability was detected by Transwell assay. The expression of RhoA, RhoB, RhoC, ROCK1, and ROCK2 at protein and mRNA levels was detected by Western Blotting/RT-qPCR assay. In the Rescue experiment, AMDC were treated with agonist U-46619 (1 μmol/L) and Guilou compound (100 mg/L), and the protein expression of RhoA, RhoB, RhoC, ROCK1, and ROCK2 was detected by Western Blotting.

Compared with the control group, the survival rate of AMDC treated with 100 mg/L mass concentration of Guilou compound was not significantly decreased (P>0.05), which was the optimal drug concentration without affecting the cell viability, 50 and 100 mg/L mass concentrations of Guilou compound were selected for subsequent experiments. Compared with the control group, the migration and invasion ability of AMDC in the Guilou compound (50 mg/L, 100 mg/L) group was significantly inhibited (P<0.001), the protein and mRNA expression levels of RhoA, RhoC, ROCK1, and ROCK2 were significantly down-regulated (P<0.001), while the protein expression of RhoA, RhoC, ROCK1 and ROCK2 in the U-46619 1 μmol/L group were significantly up-regulated (P<0.001). Compared with the U-46619 1 μmol/L group, the protein expression of RhoA, RhoC, ROCK1, and ROCK2 in the U-46619 (1 μmol/L) combined with Guilou compound (100 mg/L) group was significantly down-regulated (P<0.001). There was no significant difference in protein and mRNA expression levels of RhoB in the control group and Guilou compound (50 mg/L, 100 mg/L) group (P>0.05) .

Guilou compound can effectively inhibit the migration and invasion ability of AMDC with the optimal drug concentration of 100 mg/L that does not affect the cell viability, Guilou compound can reverse the up-regulation of U-46619 on the protein expression of RhoA, RhoC, ROCK1 and ROCK2, thus inhibiting the the continuous progression of ectopic lesions of AM, which may be closely related to the regulation of Rho/ROCK pathway.

Cerebral infarction is a disorder of blood supply to the local brain tissue area caused by various causes. Tongnao Decoction is approved and used in Jiangsu Province Hospital of Chinese Medicine for the treatment of cerebral infarction. However, the specific mechanisms underlying its action remain unclear.

To explain the mechanism of Tongnao Decoction in the treatment of cerebral infarction through network pharmacology and clinical trails.

From January 2019 to June 2020, a total of 199 patients with cerebral infarction admitted to Jiangsu Province Hospital of Chinese Medicine were included in the clinical study. and divided into the control group (97 cases) and experimental group (102 cases) according to the method of random number table. Both groups received standardized treatment for stable cerebral infarction, and the experimental group was treated with Tongnao Decoction. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the degree of functional impairment caused by stroke, and the modified Rankin Scale (mRS) was used to assess the recovery of neurological function for both groups before treatment and at 2 weeks of treatment. The chemical compounds of Tongnao Decoction were screened from TCMSP and literature, and those with bioavailability (OB) ≥30% and drug-like properties (DL) ≥0.18 requirements were selected to find the active ingredient of the prescription. OMIM and GeneCards databases were used to analyze the molecular targets of Tongnao Decoction for the treatment of cerebral infarction. After screening the common targets, Cytoscape software, String database were used to plot the network of compounds and target proteins, construct protein-protein interaction (PPI) network, gene ontology (GO) function, and Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway enrichment analysis, respectively. Molecular docking experiments were finally performed to identify the main active ingredients of Tongnao Decoction for the treatment of cerebral infarction.

After treatment, the scores of NIHSS and mRS in the experimental group were lower than those in the control group (P<0.05). Finally, 60 active ingredients of Tongnao Decoction were obtained, including 147 potential targets, 5 167 disease-related targets, and 121 intersection targets of drugs and diseases. The enrichment analysis of KEGG signaling pathway obtained prostate cancer, neuroactive ligand-receptor interaction, IL-17 signaling pathway, prolactin signaling pathway, PI3K-Akt signaling pathway, calcium signaling pathway, etc. Molecular docking showed that β-sitosterol, kastricol and carotene, the main active ingredients of Tongnao Decoction in the treatment of stroke, had good binding properties to the core protein androgen receptor (AR) .

Tongnao Decoction may play a role in treating cerebral infarction by activating AR. IL-17 signaling pathway, PI3K-Akt signaling pathway and prolactin signaling pathway are potential mechanisms as well.

Dapagliflozin is an effective drug for the treatment of type 2 diabetes mellitus (T2DM), which can also reduce the risk of nephropathy progression, decrease urinary protein and protect the heart. However, whether dapagliflozin can reduce the incidence of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in T2DM patients remain unclear.

To investigate the impact of dapagliflozin on the incidence of CIN in patients with T2DM underwent PCI.

According to the principle of 1∶1 propensity matching based on the use of dapagliflozin, a total of 484 T2DM patients who underwent PCI in the Department of Cardiology, Tianjin Chest Hospital from 2021 to 2023 were retrospectively consecutively enrolled in the study, of which 242 cases were in the dapagliflozin group and 242 cases were in the control group. The pre-PCI clinical data of the two groups were collected and compared, and the renal functions of the two groups were recorded before PCI, 48 hours after PCI and 1 week after PCI, including blood urea nitrogen (BUN), serum creatinine (Scr), creatinine clearance rate (Ccr), cystatin C (Cys-C), β2- microglobulin (β2-MG), and neutrophil gelatinase associated apolipoprotein (NGAL). The primary study endpoint was the incidence of CIN, and the secondary study endpoint was the change in renal function during the perioperative period of PCI. Multivariate Logistic regression was used to analyze the effect of dapagliflozin on the incidence of CIN after PCI in patients with T2DM.

The incidence of CIN in patients in the dapagliflozin group was 6.2% lower than that in patients in the control group (12.0%). The difference was statistically significant (χ²=4.900, P=0.039). The CIN risk score and B-type natriuretic peptide of patients in the dapagliflozin group were higher than those in the control group (P<0.05). There was no statistically significant difference in BUN, Scr, Ccr, Cys-C, β2-MG, and NGAL levels between 2 groups before and 1 week after PCI (P>0.05). At 48 hours after PCI, the levels of Cys-C, β2-MG, and NGAL in the dapagliflozin group were lower than those in the control group (P<0.05). Multivariate Logistic regression analysis showed that high CIN risk score (OR=1.213, 95%CI=1.085-1.358, P=0.001) and B-type natriuretic peptide levels (OR=3.940, 95%CI=1.479-10.494, P=0.006) were independent risk factors for CIN after PCI in patients with T2DM, and the use of dapagliflozin (OR=0.338, 95%CI=0.159-0.717, P=0.005) was an independent protective factor for the development of CIN after PCI in patients with T2DM.

The use of dapagliflozin is an independent protective factor against the development of CIN after PCI in patients with T2DM, and dapagliflozin does not increase the risk of developing acute kidney injury after PCI in patients with T2DM and may reduce the incidence of CIN.

Rheumatoid arthritis interstitial lung disease (RA-ILD) is one of the most common complications of rheumatoid arthritis (RA) that severely impairs the quality of life and survival. Zang Bi Formula (ZBF) is mostly used in clinical practice for patients with recurrent occurrence of RA. However, its mechanism of action and efficacy in RA-ILD still remain unclear. Objective To investigate the therapeutic possibilities and potential mechanisms of the ZBF on RA and RA-ILD.

To investigate the therapeutic possibilities and potential mechanisms of the ZBF on RA and RA-ILD.

From January 2022 to March 2023, a total of 14 tumor necrosis factor alpha-transgenic (TNF-Tg) mice were randomly divided into Saline group and ZBF group, with 7 mice in each group. At the same time, 7 wild-type (WT) mice in the same litter were randomly selected as the control group (WT group). Intragastric administration of ZBF 1.4 g/mL with 0.2 mL per time was given to mice of ZBF group once a day, and those in the WT group and Saline group were given an equal amount of normal saline via intragastric administration. After the intervention for 8 weeks, hematoxylin&eosin (H&E) staining of mouse ankle tissues was performed to observe the inflammatory cell area. Alcian blue-orange and tartrate-resistant acid phosphatase (TRAP) staining was performed to observe the cartilage area and bone area ratio, as well as the osteoclast area, respectively. The area proportion of inflammatory cells, fibrosis and T-cell/B-cell proportion in mouse lung tissues were observed by H&E staining, Masson staining and immunofluorescence staining, respectively.

Mice in the Saline group had significantly increased inflammatory cell infiltration, synovial hyperplasia, and ankle tissue destruction. Inflammation of the ankle joint was alleviated in the ZBF group. The proportion of inflammatory cells in the Saline group was significantly higher than that of the ZBF group and WT group, which was significantly higher in the ZBF group than that of the WT group (P<0.05). Mice in the Saline group had significant damages to the sagittal plane of the talus of the ankle joint and bone erosion. Bone damages of the ankle joint and erosion were significantly alleviated in ZBF group, showing a gradually cleared boundary of the sagittal plane of the talus and increased bone mass. The proportions of cartilage area and bone area in the Saline group were significantly lower than those of ZBF group and WT group, which were significantly lower in the ZBF group than those of WT group (P<0.05). Mice in the Saline group presented massive infiltration of red-stained osteoclasts in the ankle joint, which was significantly alleviated in mice of ZBF group. The area of osteoclasts in the ZBF group was significantly smaller than that of the Saline group (P<0.05). Mice in the Saline group had mild-to-moderate inflammatory cell infiltration diffusely around the pulmonary interstitium, blood vessels and bronchi, thickening of the walls of the middle and small arteries, reduced alveolar intervals and obvious damages to lung tissues. Inflammatory cells infiltrated in the pulmonary interstitium surrounding tissues of the trachea and blood vessels were reduced and the boundary of the lungs were cleared in mice of ZBF group, presenting an improved lung structure. The proportion of inflammatory cells area in the Saline group was significantly higher than that of the ZBF group and WT group, which was significantly higher in the ZBF group than that of the WT group (P<0.05). Mice in the Saline group had significantly enlarged areas of blue collagen fibers around blood vessels and trachea and thickening of the alveolar or bronchial walls. Mice in the ZBF group had reduced areas of blue collagen fibers around blood vessels and trachea and improved lung structure. Pulmonary fibrosis scores of the lung were significantly higher in the Saline group than those of ZBF group and WT group, which were significantly higher in the ZBF group than those of WT group (P<0.05). T lymphocytes cells and B lymphocytes cells increased significantly in mouse lung tissue of the Saline group, and most of them surrounded the pulmonary blood vessels and bronchi, forming a follicle-like structure lacking a germinal center. The follicle-like structures were less observed in mouse lungs of the ZBF group. The area proportions of B lymphocytes cells and T lymphocytes cells in the Saline group were significantly higher than those of the ZBF group and WT group, which were significantly higher in the ZBF group than those of WT group (P<0.05) .

ZBF not only reduced ankle injury in TNF-Tg mice, but also improved their lungs inflammation and fibrosis, reducing the numbers of B lymphocytes cells and CD₃⁺ T lymphocytes cells in lung tissue.

The potential risks of long-term use of proton pump inhibitor (PPI) and the potentially inappropriate medication are gradually being taken into account, and PPI deprescribing has been widely recognised, but the situation of long-term use of PPI and the willingness to deprescribing of PPI among the community residents in our country are not yet clear.

To understand the current situation of long-term PPI use and PPI deprescribing among community residents, explore its influencing factors and propose improvement measures.

From April 2018 to January 2020, a survey was conducted among 389 residents of the Shichahai Community Health Service Center in Xicheng District, Beijing, who had been taking proton pump inhibitors (PPIs) chronically. Data on participants' demographics, PPI usage patterns, concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or antiplatelet agents, presence of comorbid chronic diseases, medication quantities, potential for PPI deprescribing, and polypharmacy status were collected via the community electronic health information system and telephone-administered questionnaires. Subsequently, between June and December 2020, telephone interviews were conducted with 92 residents still using PPIs long-term to assess their perceptions regarding prolonged PPI use and attitudes toward deprescribing. Multivariate Logistic regression analysis was employed to identify factors influencing the continuous PPI use exceeding six months among those deemed eligible for deprescribing.

After excluding individuals who declined to participate, could not be reached, or had not taken PPIs continuously, the final study population consisted of 318 residents who were chronically using PPIs. The mean age of long-term PPI residents was (63.9±12.5) years, 61.0% were female, the mean number of types of comorbid chronic diseases was (3.3±1.4) , and the mean number of medications was (6.1±3.3) , and the majority of the residents were able to carry out PPI deprescribing (231, 72.6%) . The prescribing indications for PPIs to prevent nonsteroidal anti-inflammatory drugs (NSAIDs) and antiplatelet drugs for gastrointestinal damage were the most frequent (202, 63.5%) . Multifactorial Logistic regression analysis showed that residents' age and number of medications were influential factors for taking PPIs continuously for >6 months[OR=1.044, 95%CI (1.016-1.073) ; OR=1.175, 95%CI (1.009-1.376) , P<0.05]. Residents who were still taking PPIs chronically between June and December 2020 and were available to carry out deprescribing was available for a total of 92 residents, 82.6% of respondents were aware of the indications for medication use, 70.7% (65/92) of respondents were unaware of the potential risks of long-term PPI use, 71.7% (66/92) were willing to deprescribe PPI with the help of their GP, and the main concern about deprescribing was recurring symptoms.

Long-term PPI residents in community health services are older and predominantly female, with a high proportion of multiple medication use; attention should be paid to the use of PPI medication by residents who are older and use a larger number of medications, and there is a need to strengthen the education on the potential risks of long-term use of PPIs, and long-term PPI users have a positive attitude towards PPI deprescribing, and there is a need to strengthen the management of long-term use of PPIs.

Chronic atrophic gastritis (CAG) with intestinal metaplasia (IM) is an independent risk factor for gastric cancer. Long-term inflammation and oxidative stress response stimulate the physical and mental state of patients. Under the modern medical model, proton pump inhibitors and gastric mucosal protective agents are increasingly unable to meet the high drug resistance of patients. It is urgent to seek effective new Chinese medicine treatments and multiple methods to treat CAG and IM.

To evaluate the clinical efficacy and safety of modified Piwei Peiyuan Decoction combined with acupuncture in the treatment of CAG with IM.

From January 2022 to September 2023, 202 patients with CAG and IM diagnosed by gastroscopy and pathological examination in the Department of Spleen and Stomach, the Center for Preventive Treatment of Disease, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine and the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine were selected. The patients were divided into control group (n=67), treatment group A (n=68) and treatment group B (n=67) by random number table method. All patients participated in 6 weeks of treatment: (1) Control group: aluminum magnesium suspension combined with folic acid tablets (3 times/d) ; (2) Treatment group A: to add and subtract syndrome types of Piwei Peiyuan Decoction (2 times/d) ; (3) Treatment group B: Piwei Peiyuan Decoction (the same as group A) combined with acupuncture (1 time/d), with Zusanli, Liangqiu, Gongsun, Neiguan, Zhongwan as the main points, according to the syndrome type selection of acupoints. Before and 6 weeks after treatment, OLGA, OLGIM staging, gastric mucosal pathological efficacy, gastric mucosal pathological score, clinical symptom score, PRO scale score, drug-related adverse events (AE) and adverse drug reactions (ADR) were recorded.

A total of 192 patients completed the 6-week course of treatment (62 in the control group, 66 in the treatment group A, and 64 in the treatment group B). The effective rate of the control group was 48.39% (30/62), the effective rate of the treatment group A was 69.70% (46/66), and the effective rate of the treatment group B was 71.88% (46/64). There was a statistically significant difference in the effective rate among the three groups (χ²=9.144, P=0.01). After treatment, the gastric mucosal pathological score, clinical symptom score and PRO scale score in the three groups were lower than those in the same group before treatment (P<0.05). Pathological score of gastric mucosa: the scores of chronic inflammation, atrophy and IM in treatment group A and treatment group B were lower than those in control group, and the scores of active inflammation and dysplasia were higher than those in control group (P<0.05). Clinical symptom score: the scores of epigastric fullness and epigastric pain in treatment group A and treatment group B were lower than those in control group (P<0.05). The PRO scale score: the treatment group A and the treatment group B were lower than the control group in acid reflux, dyspepsia, defecation, psychological state, systemic symptoms and total score (P<0.05). There was no significant difference in the incidence of AE and ADR among the three groups (P>0.05) .

The overall clinical efficacy of Piwei Peiyuan Decoction combined with acupuncture is better than that of aluminum magnesium suspension combined with folic acid tablets, which is better than that of traditional antacids and gastric mucosal protective agents.

As the aging population continues to increase, there has been a rise in the prevalence of multimorbidity in the elderly. The adherence to medication regimens by elderly patients with multimorbidity significantly impacts the effectiveness of chronic disease management.

This study analyses the factors that impact medication adherence among the elderly with multimorbidity in Guangdong province. This study aims to provide a foundation for the management of multimorbidity in this population.

A multi-stage stratified cluster random sampling method was used to survey a population of 998 multimorbid patients aged 60 years and above in Guangdong province from October 2022 to March 2023. Medication adherence was the dependent variable, while patient sex, age, marital status, living conditions, education level, personal annual income, family encouragement for medication adherence, family doctor support, number of diseases, disease awareness, medication awareness, BMI, smoking and alcohol consumption were considered as independent variables. Multivariate Logistic regression analysis was used to identify the factors influencing medication adherence among elderly patients with multimorbidity in Guangdong province.

A total of 1 000 questionnaires were distributed and 998 valid questionnaires were collected, with a valid recovery rate of 99.8%. Among the 998 cases of elderly patients with multimorbidity in Guangdong province, there were 719 cases (72.0%) with good adherence to medication and 279 cases (28.0%) with poor medication adherence; there were 512 cases (51.3%) of males and 486 cases (48.7%) of females. The results of multivariate Logistic regression analysis showed that: education level (high school/secondary school: OR=0.298, 95%CI=0.117-0.762; college and above: OR=0.325, 95%CI=0.127-0.831), personal annual income (>30 000 to 50 000 yuan: OR=7.694, 95%CI=2.071-28.582; >50 000 to 100 000 yuan: OR=12.408, 95%CI=3.229-47.686; >100 000 to 200 000 yuan: OR=4.893, 95%CI=1.174-20.397), and frequency of family members' supervision of medication taking (occasionally: OR=1.842, 95%CI=1.222-2.779), family doctor's help (slightly helpful: OR=2.537, 95%CI=1.531-4.205), understanding of the condition (mostly understood: OR=3.015, 95%CI=1.948-4.667; better understood: OR=3.510, 95%CI=1.955-6.300; some/no understanding: OR=3.469, 95%CI=1.338-8.994), medication concern (mostly concerned: OR=4.928, 95%CI=3.336-7.278; more concerned: OR=3.670, 95%CI=1.915-7.033; somewhat concerned/unconcerned: OR=8.560, 95%CI=2.497-29.339), BMI (too low: OR=2.303, 95%CI=1.154-4.598; overweight/obese: OR=0.598, 95%CI=0.390-0.915), and alcohol consumption (OR=1.959, 95%CI=1.270-3.022) were the influencing factors of medication adherence among elderly patients with multimorbidity in Guangdong province (P<0.05) .

The elderly patients with multimorbidity in Guangdong province had better medication adherence, at 72.0%. Medication adherence was poorer among the elderly patients with multimorbidity in Guangdong province who were high-income earners, occasionally urged to take medication by their family members, slightly assisted by their family doctors, had a low understanding of their condition, paid little attention to the use of medication, had a low BMI, and drank alcohol. All parties in society should join hands to take multiple measures to improve the medication adherence of elderly patients with multimorbidity in all aspects, strengthen the integrated management of multimorbidity, and promote the health of elderly patients.

Ulcerative colitis (UC) is a persistent immune-mediated inflammatory bowel disease characterized by chronic relapses and remissions. The management of UC remains a subject of contention, particularly as approximately half of the patients experience a complex disease progression marked by chronic activity or frequent recurrence of common UC symptoms, significantly impacting their quality of life.

The current landscape presents a growing array of treatment modalities for UC. This study aims to systematically compare the relative efficacy and safety of biologics and small molecule drugs in treating patients with UC.

Two independent researchers meticulously conducted a search for randomized controlled trials involving biologics and small molecule drugs for UC. The search encompassed PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Data, and VIP. The intervention group involved either biologics or small molecule drugs, while the control group received a placebo. The quality of the included studies was assessed using the Cochrane Risk of Bias tool and RevMan 5.4. Paired analyses and network meta-analyses were conducted using R Studio. The surface under the cumulative ranking curve (SUCRA) was employed to rank the included drugs based on each outcome indicator, providing a comparative assessment of the clinical efficacy of diverse treatments for UC.

A total of 25 studies including 9 546 patients with ulcerative colitis and 10 intervention regimens (Filgotinib 100 mg, Filgotinib 200 mg, Upadacitinib, Tofacitinib, Etrolizumab, Adalimumab, Vedolizumab, Golimumab 50 mg, Golimumab 100 mg, Infliximab). The results of SUCRA probability ranking of clinical remission effect of each drug showed that Upadacitinib (94.1%) >Vedolizumab (85.1%) >Tofacitinib (74.3%) >Infliximab (72.7%) >Filgotinib 200 mg (51.5%) >Golimumab 100 mg (44.3%) >Golimumab 50 mg (39.3%) >Etrolizumab (38.9%) >Adalimumab (29.8%) >Filgotinib 100 mg (18.7%) >Placebo (0.7%). The results of SUCRA probability ranking of the effect of each drug on clinical response showed that Upadacitinib (98.4%) >Infliximab (84.4%) >Tofacitinib (67.2%) >Vedolizumab (58.4%) >Golimumab 50 mg (53.3%) >Adalimumab (34.6%) >Golimumab 100 mg (30.1%) >Placebo (0.4%). The results of SUCRA probability ranking of the effect of each drug on endoscopic remission showed that Upadacitinib (98.7%) >Tofacitinib (68.6%) >Filgotinib 200 mg (59.6%) >Adalimumab (55.2%) >Etrolizumab (46.0%) >Vedolizumab (45.9%) >Filgotinib 100 mg (23.4%) >Placebo (2.2%). The results of SUCRA probability ranking of the effect of each drug on mucosal healing showed that Upadacitinib (99.7%) >Tofacitinib (77.2%) >Infliximab (65.2%) >Golimumab 50 mg (46.4%) >Vedolizumab (44.4%) >Adalimumab (33.8%) >Golimumab 100 mg (31.9%) >Placebo (1.0%). The results of the SUCRA probability ranking of the risk of adverse events for each drug showed that Golimumab 100 mg (96.7%) >Golimumab 50 mg (92.1%) >Placebo (68.7%) >Tofacitinib (60.8%) >Adalimumab (60.7%) >Etrolizumab (47.2%) >Upadacitinib (42.2%) >Vedolizumab (41.3%) >Infliximab (27.0%) >Filgotinib 200 mg (6.6%) >Filgotinib 100 mg (6.2%) .

Upadacitinib demonstrated optimal efficacy in clinical response, clinical remission, mucosal healing, and endoscopic remission, and Filgotinib 100 mg demonstrating safer outcomes in terms of adverse events.

Depression is a common psychiatric disorder with limited treatment options. Deep transcranial magnetic stimulation (dTMS), as a new non-invasive neuromodulation technique, has been utilized in the treatment of major depressive disorder (MDD), but there is less evidence from clinical studies.

To explore the clinical efficacy of dTMS combined with escitalopram oxalate (Esc) in the treatment of depression, and provide further reliable data reference for dTMS in the treatment of depression patients.

A total of 73 patients with depression who attended Department of Psychiatry, Affiliated Hospital of Guizhou Medical University from December 2021 to January 2023 were selected as the study subjects and divided into the control group (n=35) and combined treatment group (n=38) according to the random number table. Patients in the control group were given Esc ( 10 mg per day in the first week and 20 mg per day from the second week for 2 consecutive weeks). The combined treatment group received the treatment of dTMS (left DLPFC as the stimulation target, 18 Hz, 120%MT, 1 980 times per day for 2 weeks, 10 times in total) based on the same treatment for the control group. The depressive symptoms and cognitive improvement of patients in the two groups were evaluated before and after the two weeks of treatments by Hamilton depression scale (HAMD), Beck Scale for Suicide Ideation (BSS), Montreal Cognitive Assessment Scale (MoCA) and the mean oxygenated hemoglobin (oxy-Hb) concentration in the prefrontal cortex measured by functional near-infrared spectroscopy (fNIRS) based on the verbal fluency text (VFT) task.

The actual completion of the trial was 30 cases in the control group and 31 cases in the combined treatment group. After treatment, the HAMD and BSS scores of the combined treatment group were lower than those of the control group, and the MoCA score was higher than that of the control group (P<0.05). After treatment, the HAMD and BSS scores of patients in the two groups were lower than those before treatment, and the MoCA score was higher than that before treatment (P<0.05). There was no significant activation of the prefrontal cortex after treatment in both groups. The improvement of depression symptoms and cognitive function in the combined treatment group was better than that in the control group.

The combination of dTMS and Esc can improve the depressive symptoms and cognitive function better than Esc treatment alone in depression patients.

The treatment of coronary microvascular disease (CMVD) has always been the focus of non-coronary obstructive ischemic heart disease. Adenosine injection and adenosine disodium triphosphate (ATP) injection, which are common clinical loading drugs to determine coronary flow reserve (CFR) and evaluate CMVD, are related but significantly different. ATP is the precursor of adenosine, with low price and similar vasodilatory mechanism to adenosine, and is often substituted for adenosine in clinical practice, but its potential adverse effects are ignored.

To compare the incidence of adverse reactions in the assessment of coronary microvascular disease by adenosine load and adenosine disodium triphosphate load.

A total of 170 patients who visited the Department of Cardiology of Shaanxi Provincial People's Hospital for typical angina pectoris and underwent coronarography/Coronary CT angiography (CTA) to determine the residual stenosis diameter of each branch coronary artery <50% during June 2019 to July 2020 were selected and divided into the adenosine group (n=88) and ATP group (n=82) based on random number table method. CFR was determined by adenosine injection loading in the adenosine group and by ATP loading in the ATP group. Blood pressure, heart rate, scanning time and adverse reactions of patients were recorded during the detection process.

The incidence of adverse reactions of chest tightness [61.0% (50/82) vs 20.4% (18/88) ], dizziness [72.0% (59/82) vs 31.8% (28/88) ], headache [68.3% (56/82) vs 11.4% (10/88) ], gastrointestinal discomfort [13.4% (11/82) vs 4.5% (4/88) ], palpitation [69.5% (57/82) vs 5.7% (5/88) ], shortness of breath [40.2% (33/82) vs 2.3% (2/88) ], profuse sweating [28.0% (23/82) vs 3.4% (3/88) ], hot flush [19.5% (16/82) vs 2.3% (2/88) ] and facial flushing [13.4% (11/82) vs 4.5% (4/88) ] in patients in the ATP group were higher than those in the adenosine group (P<0.05). There was no significant difference in the incidence of neuroticism, tinnitus, dry throat and neck discomfort between the two groups (P>0.05) .

Compared with ATP loading, adenosine loading has a lower incidence of adverse reactions determine CFR.

The heterogeneity of myelodysplastic syndromes (MDS) is strong, with poor efficacy of existing therapeutic regimens and large individual differences in patient prognosis. B-cell lymphomato-2 (Bcl-2) protein is highly expressed in patients with myeloid tumors, which has been proved by previous to be associated with disease progression, chemotherapy resistance, and shortened overall survival. The Bcl-2 inhibitor Veneckla (VEN) is approved for elderly patients with newly diagnosed acute myeloid leukemia (AML) who are not eligible for intensive therapy, and there is less data on its use in MDS patients. The difference in Bcl-2 expression in MDS patients and its correlation with the efficacy and prognosis of VEN therapy haven't been reported.

To analyse the expression of Bcl-2 protein in MDS patients and assess its correlation with the efficacy and prognosis of VEN treatment.

The clinical data of 71 patients with MDS admitted to Sichuan Academy of Medical Sciences·Sichuan Provincial People's Hospital from July 2018 to December 2022 were retrospectively analyzed. Baseline data of patients including gender, age, blood routine, blood biochemistry, bone marrow hemocytology, flow cytometry, chromosome karyotype, myeloid gene mutation, fusion gene mutation and MDS-EB typing were collected. The expression of Bcl-2 protein was detected by immunohistochemical staining. According to the modified International Prognostic Score System (IPSS-R), the patients were divided into 5 risk levels of very low risk (0 case), low risk (1 case), medium risk (7 cases), high risk (40 cases) and very high risk (23 cases). Patients with bone marrow Bcl-2 positivity≥10% were defined as Bcl-2 positive and<10% as Bcl-2 negative. Patients were divided into the positive group (n=38) and negative group (n=33). Of 63 patients with high-risk and very high-risk MDS, 38 were treated and evaluated for efficacy, including 28 patients who received VEN combined with azacitidine (VA combination regimen) and 10 patients who received hypomethylated drugs (HMA, including azacitidine or decitabine) as monotherapy. The patients were followed up until 2022-12-30. Kaplan-Meier curve was plotted to analyze the overall survival time (OS) of different patients, and Log-rank test was used for comparison. Univariate Cox regression model was used to analyze the influencing factors of patients' OS.

The proportions of fusion gene mutation and nuclear myeloid phosphoprotein 1 (NPM1) gene mutation in the positive group were higher than those in the negative group, and the difference was statistically significant (P<0.05). Of the 10 patients who received HMA monotherapy, 1 was Bcl-2 negative and 9 were Bcl-2 positive, after 14 days of treatment, 4 of them (40.0%) achieved composite complete response (CR/mCR). Of the 28 patients receiving the VA combination regimen, 12 were Bcl-2 negative and 16 were Bcl-2 positive, and after 14 days of treatment, 20 (71.4%) patients receiving the VA combination regimen achieved CR/mCR. There was no significant difference in CR/mCR ratio between the two treatment regimens (P=0.087). The median overall survival time (mOS) for patients with VA combination therapy was 6.9 months, with a mOS of 2.9 months for Bcl-2 negative patients and 7.4 months for Bcl-2 positive patients. There was no significant difference in survival rate between Bcl-2 positive patients and Bcl-2 negative patients (χ²=2.075, P=0.150). The mOS of Bcl-2 positive patients receiving HMA monotherapy was 4.3 months, and there was no significant difference in the survival rate comparing with Bcl-2 positive patients receiving VA combination regimen (χ²=0.824, P=0.364). Univariate Cox regression model analysis showed that age, Bcl-2 protein expression, mutant gene number, chromosome karyotype, MDS-EB typing, IPSS-R risk, and efficacy were not the influencing factors for OS in patients treated with VA combination regimen (P>0.05) .

Bcl-2 protein contributes to MDS fusion gene mutation and myeloid gene mutation; Bcl-2 positive expression was not associated with the survival of MDS patients. There was no difference in survival rate between Bcl-2 positive and Bcl-2 negative patients who received the VA combination regimen.

Differentiated thyroid carcinoma (DTC) with distant metastasis generally forecasts a poor prognosis. Timely diagnosis and effective treatment of distant metastasis are pivotal and challenging in clinical practice. Serum thyroglobulin (Tg) is a marker for monitoring tumor residue or recurrence/metastasis post-surgery and post-¹³¹I therapy in DTC. Thyroglobulin antibodies (TgAb) are autoantibodies against Tg that can potentially interfere with Tg measurement. Presently, literature on ¹³¹I treatment of TgAb positive DTC with distant metastasis is sparse.

To investigate the efficacy of ¹³¹I therapy in TgAb positive DTC with distant metastasis.

A retrospective analysis was conducted on clinical data of 189 DTC patients treated with ¹³¹I from January 2017 to January 2022 at the People's Hospital of Zhengzhou University. Pre-treatment and follow-up measurements of thyroid-stimulating hormone (TSH), Tg, and TgAb were collected. Patients were categorized into TgAb positive (29 cases) and TgAb negative (160 cases) groups. The efficacy of ¹³¹I therapy was evaluated. Serum thyroid hormones and routine blood tests were conducted 6-8 weeks post-¹³¹I therapy, followed by biannual or annual follow-ups including serum thyroid hormones, Tg, TSH, TgAb, thyroid peroxidase antibodies (TPOAb), neck ultrasound, and CT scans of metastatic sites.

Statistical significance (P<0.05) was observed in the comparison of distant metastatic sites, TPOAb, and pre-first ¹³¹I therapy TgAb levels between the TgAb positive and negative groups. In the TgAb positive group, disease was controlled in 14 patients (48.2%), while 15 patients (51.8%) showed disease progression; in the TgAb negative group, 127 patients (79.4%) showed disease control and 33 patients (20.6%) showed progression. The rate of disease progression in the TgAb positive group was significantly higher than in the TgAb negative group (χ²=7.148, P=0.008) .

The rate of disease progression in serum TgAb positive DTC with distant metastasis is significantly higher than in TgAb negative patients; differences in metastatic sites, TPOAb, and pre-first ¹³¹I therapy TgAb levels were observed between the groups.

In recent years, the symptoms of perimenopausal hearing loss (PMS-HL) have received widespread attention, but there is no targeted treatment. Zuoci pill has been used clinically for a hundred years, but there is no relevant research on the treatment of PMS-HL with this drug.

To explore the mechanism and therapeutic targets of Zuoci pill on PMS-HL through further validation of animal experiments based on the network pharmacology and molecular docking technology.

The active components and action targets of Zuoci pill were obtained through TCMSP and Uniprot databases, and the protein targets of PMS-HL were obtained through GeneCards, OMIM, TTD, DrugBank, and PharmGKB databases according to the composition of Zuoci pill from inception to February 2023, the intersection was taken to screen the potential therapeutic targets of Zuoci pill for the treatment of PMS-HL, and the "drug-active ingredient-target" interaction network diagram was constructed. The protein interaction analysis function of the String database was utilized to screen core targets. The Metascape database was used for enrichment analysis of the function of the proteins and pathways. Molecular docking of the core proteins was performed using Autodock and Pymol software to determine the binding capacity between key active ingredients and core targets. The menopausal animal model was established from September 2022 to January 2023, including Sham operation group (SHAM) group, ovariectomized (OVX) group, and Zuoci pill (ZCW) group, and serum level of the key protein interleukin 1β (IL-1β) was detected and statistically analyzed using SPSS 26.0.

There were 90 active components, 226 potential protein targets, 2 481 PMS-HL related targets, and 150 Zuoci pill and PMS-HL intersection targets for the compounds in the Zuoci pill formula. A total of 183 items for biological process, 103 items for molecular function, and 103 items for cellular components were obtained in the Gene Ontology (GO) function. The top three Kyoto Encyclopedia of Genes and Genomes (KEGG) were cancer pathways, lipid and atherosclerotic lesion pathway, and receptor activation pathway for chemical carcinogenesis. Molecular docking showed that the main active ingredients of Zuoci pill in treating PMS-HL were quercetin, kaempferol, stigmasterol, β- Sitosterol, isorhamnetin, diosgenin, tetrahydrostilbene and kaempferone; the active components of Zuoci pill can bind to the core target proteins of serine/threonine kinase 1 (AKT1), cellular tumor antigen p53 (TP53), interleukin 6 (IL-6), vascular endothelial growth factor (VEGFA), cystatinase 3 (CASP3), IL-1β, epidermal growth factor receptor (EGFR), and estrogen receptor 1 (ESR1) stably. Comparison of serum IL-1β level among the three groups of rats showed statistically significant difference (F=11.73, P<0.001) .

The 90 active ingredients in Zuoci pill, such as quercetin, act on 226 potential proteins such as AKT1 to regulate the antioxidant stress of tissues and cells, metabolism of blood lipids and glucose, and anti-tumor pathway, directly or indirectly protect the perimenopausal hearing function, IL-1β may be one of the key target proteins.

Tiaozhong Yiqi Soup was first used to treat gastrointestinal diseases caused by spleen deficiency and dampness stagnation. Years of experience in treating slow transit constipation (STC) in the elderly through the addition or subtraction of this formula has been found can treat elderly slow transit constipation.

To evaluate the clinical effect of Tiaozhong Yiqi Soup on elderly Qi deficiency type STC and intestinal motility.

A total of 100 cases of Qi deficiency type STC patients were selected from the Proctology Department and the Prevention and Treatment Center of Traditional Chinese Medicine Hospital of Yinchuan City from May 2022 to April 2023, and randomly divided into the observation group of 50 cases and control group of 50 cases using a 1∶1 randomized numerical table method. The observation group was orally treated with Tiaozhong Yiqi Soup decoction, the control group of 50 patients was orally treated with Prukapril Succinate Tablets, each group was treated for 4 weeks. The score of weekly Complete Spontaneous Bowel Movement (CSBM), traditional Chinese medicine (TCM) syndrome score, clinical symptom score, exclusion rates of markers at 48 and 72 hours before and after 4 weeks of treatment were recorded and compared, gastrointestinal hormone levels were detected and the occurrence of adverse reactions was observed. Follow up for 3 months to observe the recurrence of constipation in both groups of patients.

After 4 weeks of treatment, the weekly CSBM score, TCM syndrome score, and clinical symptom score of the observation group were lower than those of the control group (P<0.05), and the exclusion rates of markers at 48 and 72 hours were significantly higher than those of the control group (P<0.05). The serum 5-HT, VIP, and SS of the observation group were lower than those of the control group, while the GAS higher than the control group, with statistical significant difference (P<0.05). The total clinical effective rate of the observation group was higher than that of the control group after 4 weeks of treatment (χ²=4.031, P=0.046). Following up for 3 months, the recurrence rate of the observation group was higher than that of the control group, and the difference was statistically significant (χ²=5.134, P=0.023). In the course of the study, 2 cases in the observation group developed abdominal distension after taking Tiaozhong Yiqi Soup, while 4 cases in the control group developed dry mouth, nausea, dizziness, and other symptoms after taking Prukapril Succinate Tablets orally, all of which were not treated symptomatically, and the symptoms disappeared on their own after the termination of the trial.

Self formulated Tiaozhong Yiqi Soup can improve TCM syndrome, weekly CSBM, and clinical symptoms in elderly STC patients, regulate gastrointestinal neurohormone levels, promote gastrointestinal motility, with a low clinical recurrence rate, which is worthy of clinical promotion.

Steriod-induced osteonecrosis of femoral head (SIONFH) cystic degeneration have a "double-edged sword" effect. The method of activating blood and dredging collate is effective in the treatment of early SIONFH, but its regulatory effect on bone resorption/angiogenesis/osteogenic protein in cystic degeneration remains unclear.

To investigate the effect of activating blood and dredging collate method on serum bone resorption/angiogenesis/osteogenic protein in patients with cystic degeneration of SIONFH.

Sixty patients with SIONFH admitted to the Hip Joint Research Center of Guangzhou University of Traditional Chinese Medicine from January 2019 to January 2021 were included as the study subjects and divided into the control group and treatment group according to random number table method, with 30 cases in each group. Another 30 volunteers with normal physical examination in hospital at the same period and no history of hormone use were selected as the normal group. The treatment group was treated with Huoxuetongluo capsule (2 g/time, 3 times/day) and calcium carbonate (600 mg/time, 1 time/day), the control group was treated with the same amount of calcium carbonate, and the course of treatment of both groups was 12 months, simultaneously limiting weight-bearing on the affected limb. Fasting serum was collected, and the expression levels of nuclear factor κB receptor activating factor ligand (RANKL), platelet-derived growth factor-BB (PDGF-BB), vascular endothelial growth factor A (VEGFA), osteoprotegerin (OPG) and cadherin-associated protein (CTNNB1) in serum were detected by enzyme-linked immunosorbent assay. The patients were followed up twice at the 6th and 12th month after discharge, and the collapse of femoral head was defined as the end event. Hip pain visual analogue score (VAS), hip function (Harris) score and necrotic area score were used to evaluate the efficacy.

Baseline RANKL, PDGF-BB, OPG and CTNNB1 levels were compared among the three groups, and the differences were statistically significant (P<0.05). The results of intergroup comparison showed that RANKL and PDGF-BB in the control group and treatment group were higher than those in the normal group, while OPG and CTNNB1 were lower than those in the normal group, the difference was statistically significant (P<0.05). Repeated measurement ANOVA results showed that time and group had interaction effects on RANKL, PDGF-BB, VEGFA, OPG and CTNNB1 levels (P<0.05), time and group had significant main effect on RANKL, PDGF-BB, VEGFA, OPG and CTNNB1 levels (P<0.05). The level of RANKL in the treatment group was higher than that in the control group at the 6th month, the level of PDGF-BB in the treatment group was higher than that in the control group at the 12th month, and the levels of VEGFA, OPG and CTNNB1 were higher than those in the control group at the 6th and 12th months (P<0.05). At the 12 months after treatment, the hip VAS and necrotic area score of the treatment group were lower than those of the control group, and the hip Harris score was higher than that of the control group (P<0.05). The results of intragroup comparison showed that at 12 months after treatment, hip VAS and necrotic area score in the treatment group were lower than those before treatment, and hip Harris score was higher than that before treatment (P<0.05) ; hip VAS and hip Harris score in the control group were higher than those before treatment (P<0.05) .

Activating blood and dredging collate method can up-regulate the protein expression levels of RANKL, PDGF-BB, VEGFA, OPG and CTNNB1 in patients with SIONFH, effectively promote bone repair and improve clinical symptoms of SIONFH patients. It is hypothesized that this drug can promote the bone repair of cystic degeneration through the "bone resorption/angiogenesis/osteogenesis" repair network.

Cardiovascular disease (CVD) is one of the leading causes of death worldwide. In April 2022, the U.S. Preventive Services Task Force (USPSTF) updated and published recommendations on aspirin use to prevent CVD based on the latest evidence-based research results. The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults aged 60 years and above. The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one based on shared decision-making between clinicians and patients about the potential benefits and harms. This paper aims to interpret the latest recommendations in the context of China's actual situation, providing a reference on aspirin use to prevent CVD in China.

Cardiovascular disease (CVD) is the leading cause of death. It is well known that statins can reduce the risk of CVD and CVD-related death through lipid-lowering, anti-inflammatory, and plaque-stabilizing effects. In August 2022, the U.S. Preventive Services Task Force (USPSTF) conducted an updated recommendations statement on statins for primary prevention of CVD based on new evidence on the benefits and potential harms of statins in reducing CVD morbidity/mortality and all-cause mortality. The USPSTF recommends statins for the primary prevention of CVD for adults aged 40 to 75 years with 1 or more CVD risk factors and an estimated 10-year CVD risk of 10% or greater (B recommendation). The USPSTF recommends that clinicians selectively offer statins for the primary prevention of CVD in adults aged 40 to 75 years who have 1 or more of CVD risk factors and an estimated 10-year CVD risk of 7.5% to less than 10% (C recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using statins for primary prevention of CVD events and mortality in adults aged 76 years and above (I statement). This article interprets the latest recommendations in the context of China to provide reference for the use of statins for the primary prevention of CVD in China.

Elderly patients with type 2 diabetes mellitus often face the problems of multimorbidity and multiple medications, and these conditions often lead to irrational or inappropriate medication use, significantly affecting patient outcomes and quality of life, making early and effective medication decisions particularly important. As an important supplement to medication support information, decision support tools, including electronic health record-based systems, mobile applications, online health platforms, etc., provide personalized, evidence-based medical information to help patients understand medication regimens, assist patients and healthcare professionals in making more rational medication decisions, enhance the appropriateness and safety of medication, and reduce the risk of drug interactions, thereby improving the overall treatment of patients and reducing the risk of drug interactions. The application of medication management in elderly patients with type 2 diabetes mellitus has made significant progress, thus improving the overall outcome and quality of life of patients. This article summarizes the current situation of medication use in elderly patients with type 2 diabetes mellitus, the influencing factors, types, application methods and their roles of decision aids, aiming to provide reference for the development of medication decision aids for this population in China.

Multiple myeloma is a highly heterogeneous disease. Super-aged patients with multiple myeloma are a special group. There is a lack of evidence-based medical basis in the treatment decision and general evaluation of them, and there is also some controversy in the assessment of frailty.

To explore the clinical features and the influencing factors of survival and prognosis in newly diagnosed super-aged multiple myeloma (MM) patients with the bortezomib based regimen and to evaluate the best assessment model for the general status of patients with MM.

The clinical data of newly diagnosed super-aged patients with MM in Beijing Chao-yang Hospital, Capital Medical University from November 2013 to January 2023 were retrospectively analyzed. Survival follow-up was conducted through the medical record system of Beijing Chao-Yang Hospital, Capital Medical University until April 1, 2023, with the end points of this study of overall survival (OS) and progression-free survival (PFS) . The patients were divided into the two-drug treatment group (n=18) and three-drug treatment group (n=11) , and the clinical and genetic characteristics of the two groups were compared. The Geriatric Assessment System (GA) score, UK Myeloma Research Alliance Risk Profie (MRP) score, and Mayo score were used to evaluate the frailty status and treatment efficacy. Survival curves of OS and PFS in MM patients were plotted using the Kaplan-Meier method. Log-rank test was used to compare the survival curves of different influencing factors. Multivariate Cox hazard risk regression analysis was used to explore the influencing factors of OS and PFS in MM patients.

The median PFS was 8.70 (1.90-43.87) months and the median OS was 17.23 (2.00-72.83) months. A total of 21 (72.41%) patients experienced disease progression (PD) or relapse, and 12 (41.38%) patients died by the final follow-up. The objective remission rate (ORR) for first-line treatment was 82.76% (24/29) , the partial remission (PR) rate was 51.72% (15/29) , the very good partial remission (VGPR) rate was 24.14% (7/29) , and the complete remission (CR) rate was 6.90% (2/29) . There was no significant difference in CR rate, VGPR rate, PR rate and ORR between the two groups of newly diagnosed super-aged MM patients (P>0.05) . Multivariate Cox hazard risk regression analysis showed that MRP debilitation (HR=0.213, 95%CI=0.049-0.924, P=0.039) , elevated serum corrected calcium (HR=0.153, 95%CI=0.041-0.570, P=0.005) and maintenance therapy (HR=4.301, 95%CI=1.219-15.169, P=0.023) were independent influencing factors of PFS in newly diagnosed super-aged MM patients, while maintenance treatment (HR=4.372, 95%CI=1.049-18.221, P=0.043) was an independent influencing factor for OS in newly diagnosed super-aged MM patients.

There is no significant difference in the efficacy and prognostic impact of two-drug or three-drug Bortezomib based treatment. Serum corrected calcium elevation and maintenance therapy are independent prognostic factors for survival. MRP score can be used to assess the prognosis of newly diagnosed super-aged MM patients.

Chimeric antigen receptor (CAR) -T cell immunotherapy has achieved good therapeutic effect in multiple myeloma (MM) , and the most common target is B cell maturation antigen (BCMA) . The disadvantage of single target CAR-T cell immunotherapy is that it can lead to disease resistance and recurrence, which may be related to antigen escape. Therefore, the dual-targeted CAR-T cell therapy for refractory-relapsed multiple myeloma (RRMM) has been improved and developed, but there is still a lack of systematic clinical analysis in this field.

A meta-analysis was conducted on the efficacy and safety of dual-targeted CAR-T cell therapy for RRMM patients.

PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, and VIP were searched for single-group rate studies on dual-targeted CAR-T cell therapy in patients with RRMM from inception to 2023-02-06. The data were extracted for collection by 2 investigators using a self-designed form and the quality of literature was evaluated using the methodological index for non-randomized studies (MINORS) . The data analysis was conducted using RStudio software.

A total of 9 clinical studies, involving 200 RRMM patients who had previously received multi-line therapy were included in the study. Dual-targeted CAR-T cell therapy can be mainly divided into four categories based on different targets of BCMA/CD₁₉, BCMA/CD₃₈, BCMA/TACI, and BCMA/CS1, of which the BCMA+CD₁₉ target is more studied. Dual-targeted CAR-T cell therapy also can be divided into four categories of bispecific categories, combined/sequential infusion of two different CAR-T cells, bicistronic or cotransduction according to the different forms of infusion. Meta-analysis showed that the overall response rate (ORR) of dual-targeted CAR-T cells for RRMM was 90.0% (95%CI=0.849-0.943) , and the complete response rate (CRR) was 54.6% (95%CI=0.416-0.673) , the negative rate of minimal residual disease (MRD) was 75.6% (95%CI=0.489-0.952) , the ORR of extramedullary diseases (EMD) was 55.1% (95%CI=0.234-0.851) , the recurrence rate at the last follow-up was 29.7% (95%CI=0.141-0.454) , and the survival rate was 75.6% (95%CI=0.554-0.915) . The incidence of grade 3 to 4 cytokine release syndrome (CRS) was 16.4% (95%CI=0.094-0.245) , and the incidence of immune effector cell-associated neurotoxicity syndrome (ICANS) was 4.0% (95%CI=0-0.120) . Sensitivity analysis suggested stable results. The results of Egger's test indicated a potential bias risk for ORR (P=0.03) and overall response rate of EMD (P=0.02) . Meanwhile, no publication bias was suggested for CRR (P=0.53) , MRD negative rate (P=0.79) , recurrence rate at the last follow-up (P=0.71) , survival rate (P=0.98) , incidence of grade 3-4 CRS (P=0.90) , and incidence of ICANS (P=0.30) .

Dual-targeted CAR-T cell therapy for RRMM has shown favorable efficacy and safety, and multicenter, large-sample, and longer follow-up studies are needed to further evaluate its efficacy and safety.

Schizophrenia could affect the social and occupational functions of patients in the long term. Community-based mental health services and management models promote mental health by improving accessibility, acceptability, affordability, practicality and scalability. In the community management model, long-acting injectable antipsychotic agents are one of the main strategies for the treatment of schizophrenia, but there is a lack of relevant evidence. This paper systematically and comprehensively discussed the benefits of long-acting injectable antipsychotic agents in patients with schizophrenia, including effectiveness and safety, compliance, attitude to use, social function recovery and community rehabilitation. The results of this study showed that long-acting injectable antipsychotic agents can exert superior efficacy than oral drugs in the community rehabilitation of schizophrenia patients under different community management modes, not only reflected in the disease recurrence rate and readmission rate, but also in the recovery of social functioning and the reduction of accident rate and other aspects of excellent performance. However, the overall prescription rate of long-acting injectable antipsychotic agents is still low in China. The main reasons include insufficient information sharing between medical institutions and communities in primary level, low community medical services and treatment rate, low follow-up rate of patients, and less community psychiatric rehabilitation. This study can provide some references for the community treatment of schizophrenia patients in China, explore more community treatment programs, and improve the treatment effect and quality of life of schizophrenia patients in China.

There is a high prevalence of polypharmacy among elderly patients with severe situation. There is an urgent need for more comprehensive and objective tools to assess the benefits and risks of medication use in patients to ensure maximum length of life and quality of life for patients.

To translate the Patient-reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) Scale into Chinese and evaluate its reliability and validity among elderly patients with polypharmacy.

With the authorization of the original author, Brislin's translation model of forward-back translation, cultural adaptation, and cognitive interviews were used to develop a test draft of the Chinese version of the PROMPT-QoL. Elderly patients with polypharmacy who visited outpatient clinics, received health checkups and took medicine at community health centers of Gongyuan street, Beishan street and Henan street, Yanji Hospital and Yanbian University Hospital from June to August in 2022 were selected as the survey respondents. Item analysis was conducted using the item-dimension correlation analysis and the critical ratio (CR). The content validity of the scale was evaluated using the item-level content validity index (I-CVI), universal agreement scale-level CVI (S-CVI/UA) and average scale-level CVI (S-CVI/AVE). Structural validity was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency tests (Cronbach's alpha coefficient) and the split-half coefficient were used to assess reliability.

A total of 590 patients were investigated and 564 valid data were recovered, with a recovery rate of 95.8%. Among them, 234 data were applied to the item analysis and EFA in the first stage, and 330 data were applied to the CFA in the second stage. The correlation coefficients between the scores of each item and the scores of each dimension ranged from 0.504~0.915 (P<0.01), and the CR value of each item was >3.0 (P<0.05). The I-CVI ranged from 0.89 to 1.00, the S-CVI/UA was 0.91>0.80, and the S-CVI/Ave was 0.99>0.90. A total of 8 common factors were extracted from EFA, which were basically consistent with the results of the source questionnaire, among which item G34 had a loading of <0.40 on the common factor to which it belonged, so this item was deleted. CFA was performed on the remaining 41 items as follows: χ²/df=2.160, goodness of fit index (GFI) =0.791, normed fit index (NFI) =0.848, incremental fit index (IFI) =0.912, comparative fit idex (CFI) =0.911, Tucker-Lewis index (TLI) =0.902, root mean square error of approximation (RMSEA) =0.059. In the reliability test, Cronbach's α coefficient for the scale was 0.839, Cronbach's α coefficient for each dimension ranged from 0.823 to 0.955, and the split-half coefficient of each dimension ranged from 0.815 to 0.957.

The Chinese version of the PROMPT-QoL scale has good reliability and validity, and can be applied to evaluate the pharmaceutical therapy-related quality of life of elderly patients with polypharmacy in China.

Patient medication safety has become a global priority in healthcare, and patients play an important role in promoting their own medication safety.

To develop a Self-assessment Scale for the Ability of Outpatients with Chronic Diseases to Participate in Medication Safety based on the Delphi method and provide objective criteria for assessing and promoting their abilities to participate in medication safety.

A literature review and semi-structured interviews were used to formulate the initial entries of scale for the ability of outpatients with chronic diseases to participate in medication safety. According to the study objectives, 28 experts from Beijing, Shanghai, Guangdong, Tianjin, Zhejiang, and Inner Mongolia participated in two rounds of correspondence using the Delphi method, and were asked to rate their familiarity and judgement basis of the dimensions, and the importance and feasibility of the items were rated using a five-point Likert scale. The first round of expert correspondence was conducted from 30 September to 12 October 2021, and the second round was conducted from 5 to 15 November 2021. Final items of the scale were determined through an expert panel discussion. The questionnaire recovery rate was calculated as a reflection of expert motivation; the degree of authority of the correspondence results was measured using the authority coefficient; the degree of coordination of expert opinions was evaluated using the coefficient of variation and the coordination coefficient Kendall's W. The arithmetic mean of importance and feasibility scores≥3.5 and coefficient of variation<0.25 were used as the initial reference for items selection, the adjustments of the items were decided after the thorough discussions among the members of research team and the expert panel combining with the opinions of experts.

In both rounds of correspondence, 28 questionnaires were sent out and 28 questionnaires were returned, with a positive coefficient of 100% and the expert authority coefficient of 0.877. The expert coordination coefficient Kendall's W of the importance and the feasibility of items in the second round of correspondence increased compared to the first round of correspondence. The mean importance scores of items in the two rounds of the consultation ranged from 3.964 to 4.964 and 4.321 to 5.000, with coefficients of variation from 0.038 to 0.211 and 0 to 0.168. The mean feasibility scores of the items in the two rounds of the consultation ranged from 3.964 to 4.821 and 4.036 to 4.893, with coefficients of variation from 0.081 to 0.265 and 0.064 to 0.186, respectively. The final Self-assessment Scale for the Ability of Outpatients with Chronic Diseases to Participate in Medication Safety was determined after two rounds of expert correspondence and an expert panel discussion, including 4 dimensions of medication knowledge, medication belief, participation in medication decision-making, and medication self-management, with 33 items.

A Self-assessment Scale for the Ability of Outpatients with Chronic Diseases to Participate in Medication Safety containing four dimensions of medication knowledge, medication belief, participation in medication decision-making, and medication self-management, with 33 items, was constructed in the study, which can assess the ability of outpatients with chronic diseases to participate in medication safety and provide a reference for developing appropriate measures to promote patient participation in the medication process and improve medication safety.

Type 2 diabetes mellitus (T2DM) is one of the common chronic diseases among the elderly. Persistent hyperglycemia damages blood vessels throughout the body, affecting organs and tissues such as heart, kidneys, eyes, and nerves, leading to various complications. Atherosclerotic cardiovascular diseases (ASCVD) are the main cause of death in T2DM patients. Such patients need comprehensive treatment such as glucose-lowering, lipid-regulation, antihypertensive, antiplatelet, and urinary protein-lowering treatments. Polypharmacy plays a good role in disease control in older adults with multiple comorbidities, but it also poses a number of problems such as potential drug interactions and adverse drug reactions if applied in an irrational and unscientific manner. This paper analyses the management of polypharmacy in elderly T2DM patients combined with ASCVD, with a particular emphasis on the interactions among hypoglycemic, antihypertensive, lipid-regulating, and antiplatelet medications, as well as precautions, so as to improve the rationality, safety and standardization of medication under the premise of ensuring the efficacy of medication, reduce the occurrence of adverse reactions and provide reference for clinicians in the use of drugs.