Bibliometric analysis of drug package insert adaptation for the elderly based on Web of Science / 中国药房

OBJECTIVE To explore the hotspots of aging adaptation of drug package inserts， and to provide evidence for the development of aging adaptation of drug package inserts in China. METHODS The relevant English literature on drug package inserts for the elderly published from 2012 to 2022 was retrieved from Web of Science Core Collection； bibliometric analysis was performed by using VOSviewer and CiteSpace software， to explore research hotspots in this field， and summarize obstacles and solutions for the development of this field. RESULTS & CONCLUSIONS This study collected a total of 335 literature related to the aging adaption of drug package inserts， from 819 research institutions in 51 countries （regions）， involving 2 174 authors. The research development of drug package insert adaptation for the elderly has slowed down in the past decade， and developed countries such as the United States and Japan dominate this field. Authors such as Wolf from Northwestern University in the United States， have the largest number of publications（12 literature）. The research focuses in this field include the risk management of medication for the elderly， the updating of medication information for the elderly in drug package inserts， and the understanding and compliance of the elderly with drug package inserts and their influencing factors. The solutions to related obstacles in the development of aging adaption in drug package inserts include improving the visibility and readability of drug package inserts， filling in the information on elderly medication in drug package inserts， and so on. China can learn from the experiences and methods of other countries， conduct investigations into the influencing factors of elderly package inserts and pharmacokinetic studies based on the characteristics of the Chinese population， and improve the safety of medication for elderly patients in multiple dimensions.

Efficacy of modified prostate tip separation technique combined with laparoscopic radical prostatectomy based on propensity score matching / 现代泌尿外科杂志

【Objective】 To explore the efficacy of modified prostate tip separation technique combined with laparoscopic radical prostatectomy based on propensity score matching (PSM) in the treatment of prostate cancer. 【Methods】 A total of 74 prostate cancer patients treated during Jan.2019 and Dec.2022 with modified prostate tip separation technique combined with laparoscopic radical prostatectomy were included in the combined group, and another 63 prostate cancer patients treated during the same period with laparoscopic radical prostatectomy were selected as the control group. Altogether 58 pairs of patients were matched with PSM. The perioperative indicators, incidence of complications, urinary control function and sexual function before and one month after surgery between the two groups after matching were compared. 【Results】 There were no statistically significant differences in general data between the two groups (P>0.05). One month after operation, the scores of the International Urinary Incontinence Questionnaire (ICIQ-SF) and International Erectile Function Questionnaire (IIEF-5) in both groups decreased, while the Expanded Prostate Cancer Index Composite (EPIC-UIN) and International Prostate Symptom Score (IPSS) in both groups increased (P<0.05). The scores of ICIQ-SF [(9.02±1.98) vs. (11.38±2.04)] and IPSS [(19.67±4.19) vs. (21.68±4.23)] were lower in the combined group than in the control group (P<0.05), while the scores of EPIC-UIN [(70.49±6.82) vs. (63.34±6.48)] and IIEF-5 [(18.17±1.73) vs. (16.72±1.58)] were higher in the combined group than in the control group (P<0.05). Compared with the control group, the combined group had shorter catheter retention time [(7.38±1.97) d vs. (5.11±1.82) d] and hospital stay [(13.18±2.23) d vs. (11.74±2.09) d], lower incidence of complications (22.41% vs. 6.90%), and higher positive rate of incision margin (8.62% vs. 20.69%) (P<0.05). 【Conclusion】 PSM can balance the differences between groups. The modified prostate tip separation technique combined with laparoscopic radical prostatectomy can improve the urinary control function, have little impact on sexual function, and cause fewer postoperative complications. However, the risk of positive incision margin is high, and further modification is needed to achieve the best therapeutic effects.

Visualization analysis of the therapy of recurrent high-grade gliomas based on CiteSpace / 中国药房

OBJECTIVE To analyze the hotspots， progress and frontiers of the therapy of recurrent high-grade gliomas， and to provide a reference for the research in this field. METHODS The relevant literature were retrieved from the Web of Science and CNKI during Jan. 1st， 2005-Mar. 14th， 2022. CiteSpace 6.1.R3 software was used to quantitatively analyze the countries， authors， institutions and keywords of the included literature to form visual network maps and generate data. RESULTS A total of 1 019 English papers and 308 Chinese papers were included. The number of international publications kept growing and the number of domestic publications remained stable. Institutions and authors cooperated extensively. The United States featured a large centrality （0.38） and the largest number of publications （442）， with major research institutions such as the University of California San Francisco， University Texas MD Anderson Cancer Center， Dana-Farber Cancer Institute， and important researchers such as Wen， Cloughesy， Reardon， and so on. Domestic research groups were relatively fixed and closed. Internationally， the mechanism of tumorigenesis and drug resistance were the focus of basic research， while there was less basic research in China. Radiotherapy， chemotherapy， targeted therapy and combination therapy were studied the most internationally. Immunotherapy and photodynamic therapy were emerging therapies in recent years. In China， temozolomide and radiotherapy were the main research directions. CONCLUSIONS International attention and investment in the treatment of recurrent high-grade glioma are increasing. The United States has a high influence in this field. Currently， radiotherapy， traditional chemotherapeutic agents and bevacizumab are still the main treatment for recurrent high-grade glioma. Novel therapeutic approaches， including immunotherapy and photodynamic therapy， warrant more attempts and research.

Metabolic Disease Management Guideline for National Metabolic Management Center(2nd edition) / 中华内分泌代谢杂志

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.

Percutaneous kyphoplasty through transverse pedicle approach for osteoporotic vertebral compression fractures / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of percutaneous kyphoplasty (PKP) through the transverse process-pedicle approach (TPPA) by comparing with PKP through the conventional transpedicle approach (CTA).Methods:A retrospective study was conducted to analyze the data of 101 patients with single-segment osteoporotic vertebral compression fracture (OVCF) who had been treated at Department of Spine Surgery, The Fourth Hospital of Wuhan from August 2020 to August 2021. There were 31 males and 70 females, with an age of (70.3±7.6) years. Their T values of bone mineral density averaged (-3.0±0.3). They were divided into a TPPA group of 52 cases in which PKP was performed through the TPPA and a CTA group of 49 cases in which PKP was performed through the CTA. The clinical efficacy was evaluated by comparing the 2 groups in terms of operation time, frequency of intraoperative fluoroscopy, excellent to good rate of bone cement distribution, rate of bone cement leakage, refractures, and visual analogue scale (VAS), Oswestry disability index (ODI) and Beck index at preoperation, 24 hours, 3 months and 6 months postoperation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). All the patients were followed up for (9.8±1.5) months. Operations were completed successfully in all patients with no complications like nerve injury or pedicle fracture. There were no significant differences in operation time, frequency of intraoperative fluoroscopy or rate of bone cement leakage between the 2 groups ( P>0.05). In the TPPA group, the excellent to good rate of bone cement distribution [92.3% (48/52)] was significantly higher than that in the CTA group [61.2% (30/49)], the VAS score [3.0 (2.0, 4.0)] and ODI (57.2±4.6) at 24 hours postoperation were significantly lower than those in the CTA group [4.0 (3.0, 4.0) and 59.2±5.3] ( P<0.05). There were no significant differences in VAS or ODI between the 2 groups at preoperation, 3 months or 6 months postoperation ( P>0.05). The VAS and ODI improved steadily within each group, showing significant differences between every 2 time points ( P<0.05). The Beck indexes [0.81 (0.69, 0.86) and 0.76 (0.67, 0.81)] at 24 hours and 6 months postoperation in the TPPA group were significantly higher than those in the CTA group [0.75 (0.71, 0.79) and 0.72 (0.68, 0.77)] ( P<0.05). The Beck indexes at 24 hours and 6 months postoperation improved significantly in all patients compared with the preoperative values ( P<0.05). Conclusions:In the treatment of OVCF with PKP, the TPPA shows the same surgical safety as CTA does, but leads to better cement distribution, better pain relief at immediate postoperation and an advantage in restoring and maintaining the height of the injured vertebral body.

Efficacy of O-arm combined with CT three-dimensional navigation system assisted versus manual screw placement in the treatment of lower cervical fracture and dislocation / 中华创伤杂志

Objective:To compare the clinical efficacies of O-arm combined with CT three-dimensional navigation system assisted screw placement versus manual screw placement in treating lower cervical fracture and dislocation.Methods:A retrospective cohort study was used to analyze the clinical data of 41 patients with lower cervical fracture and dislocation, who were treated in Honghui Hospital, Xi′an Jiaotong University from May 2021 to February 2022. The patients included 26 males and 15 females, aged 31.5-48.6 years [(41.5±15.0)years]. The injured segments were C 3 in 3 patients, C 4 in 12, C 5 in 13, C 6 in 10 and C 7 in 3. Nineteen patients were treated with cervical pedicle screws by O-shaped arm combined with CT three-dimensional navigation system (navigation group, 76 screws) and 22 by bare hands (traditional group, 88 screws). The total operation time, effective operation time, single nail placement time, single screw correction times, screw distance from anterior cortex, intraoperative blood loss, intraoperative fluoroscopic radiation dose, incision length and length of hospital stay were compared between the two groups, and the height of intervertebral space, Cobb angle, interbody slip distance and American Spinal injury Association (ASIA) grade were compared before operation and at 3 days after operation. Visual analogue score (VAS), Japanese Orthopedic Association (JOA) score, and neck dysfunction index (NDI) were evaluated before operation, at 3 days, 3 months after operation and at the last follow-up. Accuracy of screw placement and incidence of complications (adjacent facet joint invasion, infection, screw loosening) were detected as well. Results:All the patients were followed up for 11.1-13.9 months [(12.5±1.4)months]. The total operation time, intraoperative blood loss, intraoperative fluoroscopic radiation dose and incision length in the navigation group were more or longer than those in the traditional group (all P<0.05). The effective operation time, single nail placement time, single nail correction times and screw distance from anterior cortex in the navigation group were markedly less or smaller than those in the traditional group (all P<0.05). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). There were significant improvements in the height of intervertebral space, Cobb angle and interbody slip distance between the two groups at 3 days after operation (all P<0.05). There was no significant difference in the height of intervertebral space, Cobb angle, interbody slip distance or ASIA grade between the two groups before operation or at 3 days after operation (all P>0.05). Compared with pre-operation, the VAS, JOA score and NDI were significantly improved in both groups at 3 days, 3 months after operation and at the last follow-up (all P<0.05), with further improvement with time. There was no significant difference in VAS between the two groups before operation or at 3 months after operation (all P>0.05), but it was markedly lower in the navigation group compared with the traditional group at 3 days after operation and at the last follow-up (all P<0.05). There were no significant differences in JOA score or NDI between the two groups before operation or at 3 days and 3 months after operation (all P>0.05), but both were lower in the navigation group compared with the traditional group at the last follow-up (all P<0.05). The accuracies of placement of grade 0 and grade 0+1 screws were 92.0% (70/76) and 96.6% (73/76) in the navigation group, respectively, which were markedly higher than 88.7% (78/88) and 93.5% (82/88) in the traditional group (all P<0.05). The rates of adjacent facet joint invasion of A, B, and C degrees were 71.2% (54/76), 28.8% (22/76) and 0% (0/76) in the navigation group, respectively, while the invasion rates were 60.5% (53/88), 32.3% (28/88) and 7.3% (7/88) in the traditional group ( P<0.05). No screw loosening was noted in the navigation group, but the screw loosening rate was 9.1% (8/88) in the traditional group ( P<0.01). Conclusion:Compared with manual screw placement, O-arm combined with CT three-dimensional navigation system assisted screw placement for lower cervical fracture and dislocation has the advantages of shorter effective operation time, quicker screw placement, stronger screw holding force, better cervical stability, slighter postoperative pain, higher screw placement accuracy, and lower facet joint invasion and screw loosening rates.

Predictive value of HACOR score on the clinical outcome of non-invasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease with pulmonary encephalopathy / 中华危重病急救医学

Objective:To explore the predictive value of HACOR score [heart rate (H), acidosis (A), consciousness (C), oxygenation (O), and respiratory rate (R)] on the clinical outcome of non-invasive positive pressure ventilation in patients with pulmonary encephalopathy due to chronic obstructive pulmonary disease (COPD).Methods:A prospective study was conducted. The patients with COPD combined with pulmonary encephalopathy who were admitted to Henan Provincial People's Hospital from January 1, 2017 to June 1, 2021 and initially received non-invasive positive pressure ventilation were enrolled. Besides non-invasive positive pressure ventilation, standard medical treatments were delivered to these patients according to guidelines. The need for endotracheal intubation was judged as failure of non-invasive ventilation treatment. Early failure was defined as the need for endotracheal intubation within 48 hours of treatment, and late failure was defined as the need for endotracheal intubation 48 hours and later. The HACOR score at different time points after non-invasive ventilation, the length of intensive care unit (ICU) stay, the total length of hospital stay, and the clinical outcome were recorded. The above indexes of patients with non-invasive ventilation were compared between successful and failed groups. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive effect of HACOR score on the failure of non-invasive positive pressure ventilation in the treatment of COPD with pulmonary encephalopathy.Results:A total of 630 patients were evaluated, and 51 patients were enrolled, including 42 males (82.35%) and 9 females (17.65%), with a median age of 70.0 (62.0, 78.0) years old. Among the 51 patients, 36 patients (70.59%) were successfully treated with non-invasive ventilation and discharged from the hospital eventually, and 15 patients (29.41%) failed and switched to invasive ventilation, of which 10 patients (19.61%) were defined early failure, 5 patients (9.80%) were late failure. The length of ICU and the total length of hospital stay of the non-invasive ventilation successful group were significantly longer than those of the non-invasive ventilation failure group [length of ICU stay (days): 13.0 (10.0, 16.0) vs. 5.0 (3.0, 8.0), total length of hospital stay (days): 23.0 (12.0, 28.0) vs. 12.0 (9.0, 15.0), both P < 0.01]. The HACOR score of patients at 1-2 hours in the non-invasive ventilation failure group was significantly higher than that in the successful group [10.47 (6.00, 16.00) vs. 6.00 (3.25, 8.00), P < 0.05]. However, there was no significant difference in HACOR score before non-invasive ventilation and at 3-6 hours between the two groups. The ROC curve showed that the area under the ROC curve (AUC) of 1-2 hour HACOR score after non-invasive ventilation for predicting non-invasive ventilation failure in COPD patients with pulmonary encephalopathy was 0.686, and the 95% confidence interval (95% CI) was 0.504-0.868. When the best cut-off value was 10.50, the sensitivity was 60.03%, the specificity was 86.10%, positive predictive value was 91.23%, and negative predictive value was 47.21%. Conclusions:Non-invasive positive pressure ventilation could prevent 70.59% of COPD patients with pulmonary encephalopathy from intubation. HACOR score was valuable to predict non-invasive positive pressure ventilation failure in pulmonary encephalopathy patients due to COPD.

Pharmacoeconomic evaluation of Qili qiangxin capsule in the treatment of chronic heart failure / 中国药房

OBJECT IVE To evaluate the efficacy ，safety and cost-effectiveness of Qili qiangxin capsule in the treatment of chronic heart failure ，and provide reference for drug selection and evaluation in relevant institutions. METHODS Meta-analysis was performed to investigate clinical efficacy and safety of Qili qiangxin capsule combined with routine treatment （combined treatment group）versus routine treatment （routine treatment group ）in the treatment of chronic heart failure. From the perspective of Chinese health care system ，a decision tree model was constructed. The time horizon of the model was 1 year. The effective rate obtained by meta-analysis was taken as the effect parameter ，and the total cost was calculated by drug cost and hospitalization cost ，to evaluate the cost-effectiveness of combined treatment versus routine treatment in the treatment of chronic heart failure. Subgroup analysis was carried out according to the course of treatment and literature quality ，and one-way sensitivity analysis and probability sensitivity analysis were adopted to check the robustness of basic analysis results. RESULTS Total of 72 literatures involving 9 575 patients were included in meta-analysis. Results of meta-analysis showed that effective rate ，left ventricular ejection fraction ， N-terminal fragment of the prohomone brain-type natriuretic peptide and 6 minute walking distance in combined treatment group were all better than those of routine treatment group ， while its safety was similar to routine therapy. The results of cost-effectiveness analysis showed that the cost of combined therapy was 1 867 yuan higher than that of routine therapy ，patients could get 0.016 QALYs more ，and the incremental cost-effectiveness ratio （ICER）was 117 861 yuan/QALY. If only high-quality literature were included for meta-analysis and the effectiveness parameters were obtained ，the ICERs of the combined therapy versus routine therapy were 102 162 yuan/QALY（based on all high-quality literature ）and 72 354 yuan/QALY（based on high-quality literature with treatment course of 24 weeks）. The results of the probability sensitivity analysis showed that taking twice China ’s per capita gross domestic product in 2020 as the willingness to pay threshold ，the probability of cost-effectiveness for Qili qiangxin capsule combined with routine therapy was 67.1％ . CONCLUSIONS Compared with routine therapy ，Qili qiangxin capsule combined with routine therapy has better clinical efficacy ，equivalent safety and cost-effective.

Risk factors for cement displacement after percutaneous vertebral augmentation for osteoporotic vertebral compression fracture / 中华创伤杂志

Objective:To explore the risk factors of cement displacement after percutaneous vertebral augmentation in patients with osteoporotic vertebral compression fracture (OVCF).Methods:A case-control analysis was made on clinical data of 1 538 patients with OVCF admitted to Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2016 to June 2021. There were 377 males and 1 161 females, aged from 45-115 years [(71.7±10.8)years]. Percutaneous vertebroplasty (PVP) or percutaneous vertebroplasty (PKP) was performed. Patients were divided into cement displacement group ( n=78) and cement non-displacement group ( n=1 460) according to the radiographic outcomes. Factors related to cement displacement were analyzed by univariate analysis, including age, gender, body mass index (BMI), preoperative bone mineral density, underlying diseases, involved vertebral segments, surgical methods, surgical approaches, cement leakage (anterior edge), viscosity of cement, dispersion ratio of cement, degree of cement interweaving, sagittal position of cement, targeted location of cement, distance from cement to upper and lower endplates and duration of brace wearing. Independent risk factors for bone cement displacement were identified by multivariate Logistic regression analysis. Results:Univariate analysis showed that bone cement displacement was significantly correlated with BMI, preoperative bone mineral density, involved vertebral segments, operation methods, cement leakage (anterior edge), viscosity of cement, dispersion ratio of cement, degree of cement interweaving, sagittal position of cement, targeted location of cement, distance from cement to upper and lower endplates and duration of brace wearing (all P<0.05), but there was no correlation with gender, age, underlying diseases or surgicales approach (all P>0.05). Multivariate Logistic analysis showed that the preoperative bone mineral density ( OR=2.45, 95% CI 1.81-7.50, P<0.01), operation methods ( OR=4.56, 95% CI 1.86-8.44, P<0.01), cement leakage (anterior edge) ( OR=5.77, 95% CI 2.85-9.20, P<0.01), viscosity of cement ( OR=7.36, 95% CI 1.01-1.77, P<0.01), dispersion ratio of cement ( OR=6.84, 95% CI 1.69-13.39, P<0.01), degree of cement interweaving ( OR=8.97, 95% CI 2.29- 14.97, P<0.01), sagittal position of cement ( OR=6.39, 95% CI 1.06-9.47, P<0.01), targeted location of cement ( OR=7.93, 95% CI 1.64-11.84, P<0.01), distance from cement to upper and lower endplates ( OR=6.78, 95% CI 1.84-6.96, P<0.01) and duration of brace wearing ( OR=9.55, 95% CI 2.26- 9.38, P<0.01) were significantly correlated with bone cement displacement after percutaneous vertebral augmentation. Conclusion:Low bone mineral density preoperatively, PKP, cement leakage into the vertebral anterior edge, low viscosity of cement, small dispersion ratio of cement, small degree of cement interweaving, cement filling in the anterior 1/3 and anterior middle 2/3 of the vertebral body in sagittal plane, non-targeted injection of cement, long distance from cement to upper and lower endplates and short duration of brace wearing are independent risk factors of cement displacement after percutaneous vertebral augmentation for OVCF.

Progress of hematopoietic stem cell transplantation in treatment of peripheral T-cell lymphoma / 白血病·淋巴瘤

Peripheral T-cell lymphoma (PTCL) is a group of highly heterogeneous rare malignant lymphoproliferative diseases, and PTCL patients have low therapeutic efficacy rate and poor prognosis after conventional comprehensive treatments. Hematopoietic stem cell transplantation (HSCT) can improve the survival of PTCL patients, and previous studies showed that patients with a definite diagnosis should receive high-dose chemotherapy combined with autologous-HSCT (auto-HSCT) in the first remission. In recent years, a consensus on the role of auto-HSCT as the first-line consolidation therapy for PTCL patients has not been reached so far. Allogeneic-HSCT is an effective option for relapsed and refractory patients with PTCL, while auto-HSCT has unfavorable efficacies. This paper reviews the research progress of HSCT in treatment of PTCL.

Cost accounting of hospital pharmaceutical service based on job analysis / 中华医院管理杂志

With the full implementation of the separation policy of medicine in China, the circulation of drugs in hospitals no longer produces direct economic value, but turns into the operating cost in the process of providing medical services. The research on the cost calculation of hospital pharmaceutical service can not only help the hospital to strengthen the internal cost management, but also provide the basis for the government policy compensation. This paper constructed a model of pharmaceutical service cost calculation based on job analysis, and produced basic pharmaceutical and advanced pharmaceutical service cost based on the data of a sample hospital.

Analysis of the Marketing Approval of Pediatric Drugs in the United States and Its Enlightenment to Pedia tric Drug Use Guarantee in China / 中国药房

OBJECTIVE：To provide sugge stions for improving the variety of pediatric drugs and ensuring the safety of pediatric drug use in China. METHODS ：The historical evolution of laws and regulations on the marketing approval of pediatric drugs in the United States and the implementation results of relevant policies were summarized. Combined with the current situation of the development of pediatric drugs in China ，some suggestions were put forward to ensure the accessibility and safety of pediatric drug use in China. RESULTS & CONCLUSIONS ：Since 1994，the United States had issued a series of laws and regulations to encourage the development of pediatric drugs. At present ，the marketing approval of pediatric drugs were mainly based on the two laws of Best Pediatric Drug Act（BPCA）and Pediatric Research Equality Act （PREA）. From 1998 to 2019，the amount of supplements of pediatric drug information in drug instructions of the United States showed a fluctuating growth. As of April 2020，854 kinds of drugs had been modified in pediatric instructions ，792 of which had been carried out post marketing pediatric clinical research ，and the problem of incomplete pediatric instructions had also been greatly improved. At present ，China’s policies on pediatric drugs mainly included encouraging R&D innovation ，giving priority to review and approval ，and strengthening R&D technical guidance. Although certain achievements had been made ，there were still some problems ，such as imperfect policies and regulations ，and great difficulties carrying out pediatric drug clinical trials. It is suggested that our country should draw lessons from the American regulations on pediatric drugs ，pediatric research and the catalogue of pediatric drugs ，and establish a system and catalogue of ped iatric drug use suitable for China ’s national conditions ，so as to improve the effectiveness ，safety and accessibilityof pediatric drugs.

Investigation on post classification and personnel qualification of pharmaceutical care in hospitals / 中华医院管理杂志

Objective:To understand the evaluation of 90 pharmaceutical service posts by pharmacists in hospitals, so as to provide basis for rational allocation of pharmaceutical personnel in hospitals.Methods:A questionnaire survey was conducted among 2 582 hospital pharmacists in 31 provinces from August 2019 to April 2020. The survey contents included post classification, staffing qualification and scores related to drug safety.Results:Among the 90 pharmaceutical posts investigated, there were 39 posts with a safety correlation score of 5(the highest score), 36 with 4 and 15 with 3. There were 41 posts in advanced pharmaceutical care and 49 posts in basic pharmaceutical care. The minimum qualifications required was 21 posts with pharmacy related college degree or assistant pharmacist, 61 posts with pharmacy related or clinical pharmacy bachelor degree or pharmacist title, and 8 posts with higher qualification. Advanced pharmaceutical care posts had high drug safety relevance scores and high personnel qualification requirements, mainly involving drug treatment, scientific research and comprehensive management posts.Conclusions:Pharmacists with different qualifications should be allocated according to different levels of pharmaceutical care projects, which can reasonably allocate limited human resources and make the best of their talents.

Investigation and precautions of SARS-CoV-2 infection among healthcare workers in Emergency Center / 中华急诊医学杂志

Objective:To analyze the causes of SARS-CoV-2 nosocomial infection among healthcare workers (HCWs) and explore the effective precaution strategies in Emergency Center.Methods:The data of SARS-CoV-2 infected HCWs from January 5 to March 2, 2020 were retrospectively analyzed and compared under different conditions in Emergency Center of Zhongnan Hospital of Wuhan University.Results:Totally 13 SARS-CoV-2 infected HCWs (12 confirmed cases and 1 suspected case) were included in this study. The overall infection rate was 17.8% (13/73). The infection rates in outpatient/rescue room, isolation observation room and isolationin patient ward were 11.8% (4/34), 20.0% (3/15), 25% (6/24), respectively. The infection rate of physician was 13.0% (3/23), and the infection rate of nurse was 20.0% (10/50). All the infected HCWs had the definite exposure with confirmed or suspected COVID-19 patients. One asymptomatic cases were identified by laboratory findings of SARS-CoV-2 infection screening. There was no new confirmed SARS-CoV-2 infected HCWs after February 5, 2020. All the infected HCWs were cured.Conclusions:Under the epidemic of COVID-19, HCWs of Emergency Center have a high risk of occupational exposure and infection, especially for staffs working in COVID-19 isolation units. Scientific prevention and control management can effectively reduce the risk of SARS-CoV-2 infections and ensure the occupational safety for HCWs in Emergency Center.

Discussion on improving the service value of pharmacists in China based on the pharmaceutical classification service mode at home and abroad / 中华医院管理杂志

By comparing the proportion of hospital pharmaceutical functions and work contents of different levels of pharmaceutical professionals at home and abroad, the authors divided pharmaceutical care in medical institutions into basic pharmaceutical care based on drug management and advanced pharmaceutical care based on drug treatment. Different pharmaceutical service levels created different pharmaceutical service values. Pharmaceutical classification service can stimulate the work potential of pharmaceutical professionals at all levels, improve the service level of pharmacists, and provide basis for the better distribution of medical costs in China.

Literature Analysis of Domestic and Foreign Drug Use in Pregnancy Period Based on CiteSpace / 中国药房

OBJECTIVE：To provide reference for improving safe drug use in pregnant women. METHODS ：Retrieved from as domestic and foreign literature retrieval platforms as CNKI and Web of Science ，the literatures about drug use in pregnancy period were collected and analyzed by using the literature analysis function provided by the retrieval platform and CiteSpace 5.5R2 software. The collected data of annual volume ，author，organization，keyword co-occurrence and literature co-citation analysis of domestic and foreign literatures are visualized ，and the research focus was analyzed. RESULTS ：A total of 38 946 foreign literatures and 698 domestic literatures were included ，and domestic literatures were less than foreign literatures ；the literature volume on pregnancy drug use were increasing year by year at abroad，but the volume of domestic literatures fluctuates greatly and increased slowly. Foreign institutions and scholars worked closely together ，and built a close cooperation network ，especially in the United States. However ，the author team of domestic research was relatively scattered as a whole ，and the cooperation between researchers was less ，so a large cooperation team had not yet been formed. The most frequently cited literatures in the world were randomized controlled studies and large-scale cohort studies，the keyword “Risk”appears most frequently ，indicating that it focuses on the effects of pregnancy medication on pregnancy outcomes and offspring. The effects of antiepileptic drugs ，antidepressants and opioids used in pregnancy on pregnancy outcomes and child development were currently a research hotspot abroad. However ，there was a lack of large-scale sample and high-quality clinical research in China ，high-frequently keywords in domestic literatures indude “fetus”“hypertension in pregnancy ”etc.，which focused on the treatment of combined diseases in pregnancy and paid little attention to the long-term effects of medication in pregnancy. CONCLUSIONS：More and more attention had been paid to the study of drug use in pregnancy period. Domestic research needs to seize the international cooperation communication ，learns from the excellent experience of foreign research team ，and establishes domestic specific pregnancy medication research team. Relevant departments should introduce measures as soon as possible ，support medical institutions and drug production and developmententerprises to do a good job in the registration of pregnancy medication，establish the database of pregnancy medication inChina as soon as possible ，and improve the medication safety of pregnant patients.

Case Reports of Two Patients with Pregnancy-associated Breast Cancer and Related Literature Review / 中国药房

OBJECTIVE：To provide reference for the early diagnosis and selection of treatment regimens of pregnancy- associated breast cancer （PABC）. METHODS ：The disease characteristics ，treatment process and prognosis of 2 cases of PABC were analyzed in our hospital. The relevant literature published from Jan. 1986 to Apr. 2019 in PubMed database was retrieved. The case reports that the title ，keywords or abstracts involved “Breast cancer and pregnancy ”“Pregnancy-associated breast cancer ” “Breast cancer during pregnancy ”“Breast carcinoma during pregnancy ”“Case reports ”were included. Cases which didn ’t meet the definition of PABC were excluded. The general information ，tumor clinical characteristics ，drug treatment plan ，maternal/fetal prognosis and other information of patients were extracted for summary and descriptive statistical analysis. RESULTS & CONCLUSIONS：Two patients were both diagnosed during lactation. The prognosis was good after neoadjuvant chemotherapy and surgical resection. A total of 36 case reports were obtained through literature search and screening ，as well asclinical data of 45 patients（39 diagnosed during pregnancy and 6 diagnosed during lactation ）.Neoadjuvant chemotherapy AC regimen （doxorubicin+ cyclophosphamide）was used in 35.0％（14/40）of cases after excluding the cases without relevant information ；elective caesarean section was performed in 59.5％（22/37）of cases ，37.8％（14/37）of cases were delivered ，and 1 case chose to terminate pregnancy；survival rate of patients was 80.8％（21/26），and the average weight of newborns was 2 407 g（1 015-3 830 g）. Six patients each received taxanes during pregnancy and 9 patients during postpartum. The determination of chemotherapy for PABC should comprehensively consider a variety of factors. It is necessary to comprehensively weigh the benefit risks of the mother and child，try to avoid chemotherapy in early pregnancy ，and especially consider the impact of chemotherapy on the fetus. The chemotherapy regimen is still dominated by anthracyclines. Based on this ，an individualized regimen is formulated and close monitoring should be performed when using paclitaxel.

Bacterial expression of 183-227aa region of HER3 extracellular domain I and preparation and identification of its polyclonal antibodies / 南方医科大学学报

OBJECTIVE@#To prepare the recombinant peptide MVF-HER3 I composed of the 183-227aa peptide segment of human epidermal growth factor receptor 3 (HER3 I) and the measles virus protein 288-302 peptide segment (MVF), and prepare polyclonal antibodies (PcAb) against this recombinant peptide.@*METHODS@#The MVF-HER3 I gene was synthesized chemically and subcloned into pET21b or pET32a plasmid containing Thioredoxin (Trx) tag gene. The recombinant plasmids were identified by endonuclease digestion. MVF-HER3 I was expressed in BL21(DE3) cells under an optimal bacterial expression condition. The fusion protein Trx-MVF-HER3 I was purified using nickel ion affinity chromatography, and the purified protein was digested by enterokinase to remove Trx tag. The digested mixture underwent further nickel ion affinity chromatography to obtain purified MVF-HER3 I. The purified MVF-HER3 I was used to immunize SD rats subcutaneously for preparing anti-MVF-HER3 I PcAb. The titer of PcAb was determined using ELISA. The bindings of anti-MVF-HER3 I PcAb to MVF-HER3 I, native HER3 and MCF7 cells were analyzed using immunoblotting, immunoprecipitation and laser confocal microscopy. The growth inhibition effect of the antibodies on MCF7 cells cultured in the absence or presence of NRG was assessed using sulforhodamine B.@*RESULTS@#The recombinant peptide gene could not be expressed alone, but could be efficiently expressed after fusion with Trx gene under optimized conditions. The fusion peptide MVF-HER3 I was successfully prepared from Trx-MVF-HER3 I. The anti-MVF-HER3 I PcAb, with a titer reaching 1: 512 000, specifically bound to MVF-HER3 I, recognized native HER3 and bound to the membrane of MCF7 cells. The obtained PcAb could dose-dependently inhibit the growth of MCF7 cells irrespective of the presence or absence of NRG.@*CONCLUSIONS@#We successfully obtained the recombinant peptide MVF-HER3 I and prepared its PcAb, which can facilitate further functional analysis of HER3 signaling pathway.

Approach to the patient with pancytopenia secondary to panhypopituitarism after craniopharyngioma surgery / 中华内分泌代谢杂志

Craniopharyngioma is the most common benign intracranial tumor in children. The major post-operative complication is dysfunction of pituitary, which can result in many complicate clinical manifestations with hormonal deficiencies. Normochromic anemia has been reported as a common hematologic abnormality. However, pancytopenia is rarely reported so far. Here we describe a 21-year-old inpatient with the main complaint of nasal bleeding, who accepted craniopharyngioma surgery 9 years ago. Laboratory tests showed pancytopenia secondary to panhypopituitarism. This paper aims to increasing the awareness of this disease and accumulating clinical experiences for the clinicians.

A comparative study of induction chemotherapy with or without autologous hematopoietic stem cell transplantation in the treatment of newly diagnosed young medium/high risk diffuse large B cell lymphoma patients / 中华血液学杂志

Objective@#To compare the efficacy of induction chemotherapy with or without autologous hematopoietic stem cell transplantation (auto-HSCT) for newly diagnosed young diffuse large B cell lymphoma (DLBCL) patients.@*Methods@#The retrospective study was performed in 90 cases of young patients (≤60 years) with newly diagnosed DLBCL and an age-adjusted International Prognostic Index (aa-IPI) score of 2 or 3. All of them were treated with R-CHOP (32 cases, rituximab combined with CHOP), dose-intensive regimens (DA-EPOCH, Hyper CVAD/MA or ESHAP) combined with or without rituximab (25 cases), and consolidated with up-front auto-HSCT (33 cases), respectively. The efficacy and the potential predictors were evaluated.@*Results@#①The median age of 90 patients was 43 (18-60) years old. The median follow-up time was 42 (3-110) months. ②The 5-year progression-free survival (PFS) for R-CHOP group, dose-intensive chemotherapy group and auto-HSCT group were (33.5±10.7) %, (55.3±10.1) % and (65.8±13.6) % (P=0.012), the 5-year overall survival (OS) were (49.7±9.0) %, (61.6±10.2) % and (78.6±7.8) % (P=0.035), respectively. There was no significant difference in 5-years PFS and OS between the R-CHOP group and dose-intensive chemotherapy group (P=0.519, P=0.437) compared with that of the dose-intensive chemotherapy group, auto-HSCT group has higher 5-year PFS (P=0.042). ③ When stratified with IPI score, the high-risk group treated with auto-HSCT (26 cases) showed similar 5-years PFS and 5-years OS to those in the low-risk group with chemotherapy alone (12 cases were in R-CHOP group and 8 cases were in dose-intensive chemotherapy group) [5-years PFS were (62.3 ±14.3)%, (58.3 ±18.6)% and (51.4±18.7)%, respectively, P=0.686; 5-years OS were (69.2±13.9)%, (62.5±15.5)% and (58.3±18.6)%, respectively, P=0.592]. ④However, the high-risk group treated with auto-HSCT (26 cases) showed superior 5-years PFS (P=0.002) and 5-years OS (P=0.019) compared to the high-risk group with chemotherapy alone (20 cases were in R-CHOP group and 17 cases were in dose-intensive chemotherapy group) [5-years PFS were (62.3±14.3)%, (41.1±13.5)% and (21.9±11.6)%, respectively; 5-years OS were (69.2±13.9)%, (51.5%±14.0)% and (35.4±13.6)%, respectively]. ⑤In the univariate analysis, as a whole, patients diagnosed with GCB subtype had higher 3-years PFS (P=0.022) and 3-years OS (P=0.037) compared to non-GCB subtype patients; in subgroup analysis, patients diagnosed with GCB subtype had higher 3-years PFS and 3-years OS compared to non-GCB subtype both in R-CHOP group (P=0.030, P=0.041) and dose-intensive chemotherapy group (P=0.044, P=0.047), but not in auto-HSCT group (P=0.199, P=0.093). ⑥In the multivariate analysis, different molecular classification (GCB/non-GCB) was an independent predictor for PFS and OS both in R-CHOP group [HR=0.274 (95% CI 0.094-0.800), P=0.018; HR=0.408 (95% CI 0.164-1.015), P=0.045] and dose-intensive chemotherapy group [HR=0.423 (95% CI 0.043-1.152), P=0.048; HR=5.758 (95% CI 0.882-6.592), P=0.035]. However, there was no significant difference in PFS and OS for auto-HSCT group between GCB/non-GCB patients.@*Conclusion@#Induction chemotherapy followed by up-front auto-HSCT has significant effect on efficacy for young and untreated patients with high risk DLBCL. Combined with induction chemotherapy followed by up-front auto-HSCT could improve the prognosis of non-GCB patients.