本文探讨临床药师对口服靶向药物的非小细胞肺癌患者开展药学服务的要点,以案例为依据,通过查阅药品说明书、指南及文献等,分析药学服务的内容和方向。临床药师在安全性评估、剂量调整、个体化治疗方案选择、用药教育和健康宣教等方面为患者和临床医生提供专业、全面的药学服务。临床药师通过全程参与患者的治疗过程,指导患者正确用药、优化治疗方案,利用专业优势解决临床实际问题,提升药学服务质量的同时体现了药师的职业价值。

To explore the key points of pharmaceutical care for non-small cell lung cancer patients with oral targeted drugs．Based on clinical cases,the content and direction of pharmaceutical care were analyzed with drug instructions,guidelines and literature．Clinical pharmacists provided professional and comprehensive pharmaceutical services for patients and clinicians in safety assessment,dose adjustment,individualized treatment plan selection,medication education and health education．Clinical pharmacists participate in the whole treatment process,guide patients to use drugs correctly,optimize treatment plans,use professional advantages to solve clinical practical problems,improve the quality of pharmaceutical care and reflect the professional value of pharmacists．

目的 通过分析奥氮平的群体药代动力学研究,探讨影响奥氮平药动学参数的因素,为临床制定个体化给药方案提供依据。方法 在中国知网、万方、维普、迈特思创、PubMed和Embase等中英文数据库,以“奥氮平”“群体药代动力学”“模型”“非线性混合效应模型”及“olanzapine pamoate”“olanzapine”“population pharmacokinetic”“pharmacokinetic model”“nonlinear mixed effect”“NONMEM”为检索策略,检索建库至2023年5月所有关于奥氮平群体药代动力学的研究。结果 共纳入14篇奥氮平的群体药代动力学研究,大多数研究将奥氮平的药代动力学描述为一个单室模型。成人群体药代动力学模型群体典型值吸收速率常数：（0.3~2.85）/h;表观分布清除率：（10.4~25.4）L/h;表观分布容积：（223~2 390）L。儿童青少年模型群体典型值吸收速率常数：（0.142~0.758）/h;表观分布清除率：（13.6~16.8）L/h;表观分布容积：（322~899）L。年龄、体质量、性别、种族、吸烟状况、合并用药是影响奥氮平药动学参数的显著协变量。结论 奥氮平药动学参数估计值存在差异且有不同程度的个体间变异,未来应侧重于对特殊人群的研究。有必要对先前发表的模型进行外部验证,以便更准地的描述模型的适用性。

Objective By analyzing the population pharmacokinetics of olanzapine,the factors affecting the pharmacokinetic parameters of olanzapine were discussed,so as to provide a basis for the clinical formulation of individualized dosing regimens．Methods In Chinese and English databases such as CNKI,Wanfang,Wipro database,FMRS,PubMed and Embase,all studies on population pharmacokinetics of olanzapine from the establishment of the database to May 2023 were searched with “olanzapine pamoate”“olanzapine”,“population pharmacokinetics”,“pharmacokinetic model”,“nonlinear mixed-effect” and “NONMEM” as key words．Results A total of 14 population pharmacokinetic studies of olanzapine were included．Most studies described the pharmacokinetics of olanzapine as a single-chamber model．Adult pharmacokinetic model population typical values absorption rate constant was（0.3-2.85）/h;apparent distribution clearance was（10.4-25.4）L/h;apparent volume of distribution was（223-2390）L．absorption rate constants of the population of children and adolescents was（0.142-0.758）/h,apparent distribution clearance was（13.6-16.8）L/h,apparent volume of distribution was（322-899）L．Age,weight,gender,ethnicity,smoking status and concomitant medication were significant covariates affecting the pharmacokinetic parameters of olanzapine．Conclusions Estimates of pharmacokinetic parameters of olanzapine vary and have varying degrees of inter-individual variation．In the future,research should focus on special populations．Externally validation of previously published models should also be performed to more accurately describe the applicability of the models．

目的 检测微小RNA（miR）在人黑色素瘤中的表达情况,研究miR-412通过抑制性别确定区Y框转录因子6（SOX6）的表达影响黑色素瘤细胞增殖及侵袭能力的变化。方法 癌症基因组图谱（TCGA）数据库分析发现miR-412在黑色素瘤中异常表达,为研究其表达与肿瘤的相关性,采用Transwell小室,非锚定独立生长实验分析miR-412对黑色素瘤细胞增殖及侵袭能力的影响。软件预测SOX6可能为其靶向基因,采用荧光素酶报告分析及Western blot实验检测SOX6与miR-412的靶向调节情况。结果 TCGA数据库分析黑色素瘤组织中miR-412表达水平高于正常对照组,表达越高,生存时间越短。Transwell小室,非锚定独立生长实验显示miR-412过表达后促进细胞增殖及侵袭能力,而下调miR-412后抑制黑色素瘤细胞增殖及侵袭能力;通过靶点预测miR-412结合SOX6基因3’-非翻译区（UTR）,导致SOX6蛋白因miR-412表达增高而下调;同时在miR-412下调的细胞中抑制SOX6表达可恢复黑色素瘤细胞的增殖及侵袭能力。结论 miR-412过表达后促进黑色素瘤细胞增殖及侵袭能力,反之则抑制黑色素瘤细胞增殖及侵袭能力。 miR-412通过靶向调控SOX6影响黑色素瘤细胞增殖及侵袭,提示miR-412在黑色素瘤的发病过程中起重要作用,是潜在的治疗靶点。

Objective To assess the expression of miR-412 in human melanoma and investigate how miR-412 modulates melanoma cell proliferation and invasive capacity by inhibiting SRY-Box Transcription Factor 6,（SOX6） expression．Methods Analysis of the TCGA（The Cancer Genome Atlas）database identified aberrant miR-412 expression in melanoma．To explore its relevance to tumorigenesis,we conducted Transwell chamber and non-adherent independent growth assays to examine the effects of miR-412 on melanoma cell proliferation and invasion．Software predictions highlighted SOX6 as a potential target gene．We performed luciferase reporter assays and Western blot experiments to elucidate the regulatory interactions between SOX6 and miR-412．Results TCGA database analysis revealed significantly elevated miR-412 expression levels in melanoma tissues compared to the normal control group．Moreover,higher miR-412 expression correlated with shorter survival times．Functional assays using Transwell chambers and non-adherent independent growth assays demonstrated that overexpressing miR-412 enhanced cell proliferation and invasive capabilities．Conversely,reducing miR-412 expression restrained these attributes in melanoma cells． Target prediction analysis indicated that miR-412 binds to the 3’-UTR region of SOX6,resulting in decreased SOX6 protein levels due to increased miR-412 expression．Intriguingly,inhibiting SOX6 expression concurrently amplified the proliferation and invasive potential of melanoma cells,which was initially dampened by miR-412 downregulation．Conclusions Elevated miR-412 expression augments melanoma cell proliferation and invasive capabilities,while its suppression diminishes these traits．Through its targeted regulation of SOX6,miR-412 exerts a significant influence on melanoma cell proliferation and invasion．These findings underscore the pivotal role of miR-412 in melanoma pathogenesis and underscore its potential as a promising therapeutic target．

目的 探讨综合呼吸康复训练对老年慢性阻塞性肺疾病急性期（AECOPD）患者的临床症状、生活质量、活动能力、肺功能、肺康复依从性的影响。方法 纳入70 例AECOPD 患者,随机数字分为对照组（n=35）和干预组（n=35）,对照组在常规治疗基础上予缩唇腹式呼吸功能锻炼,干预组在常规治疗基础上进行综合呼吸康复训练,干预前后采用慢性阻塞性肺疾病评估测试（CAT）调查问卷、改良版英国医学研究委员会呼吸问卷（mMRC）、肺功能第一秒用力呼气容积（FEV1）预计值进行评估。结果 对照组呼吸康复训练前后CAT评分、mMRC量表呼吸困难评级比较差异均有统计学意义（t=16.781,t=8.103,均P<0.001）;干预组呼吸康复训练前后CAT评分、mMRC呼吸困难评级比较差异也均有统计学意义（t=24.035,t=15.938,均P<0.001）;干预组患者的CAT评分、mMRC量表呼吸困难评级较对照组下降明显。结论 综合呼吸康复训练能有效改善 AECOPD 患者临床症状、增强患者活动能力、提高生活质量、提高肺康复依从性。

Objective To investigate the effects of comprehensive respiratory rehabilitation training on clinical symptoms,quality of life,activity ability,lung function and compliance of elderly patients with acute exacerbation of obstructive pulmonary disease（AECOPD）．Methods Seventy patients with AECOPD were included and randomly divided into control group（n=35）and intervention group（n=35）．The control group was given routine treatment and respiratory muscle function exercise．The intervention group was given routine treatment and comprehensive respiratory rehabilitation training．COPD Assessment Test（CAT）,modified Medical Research Council Scale（mMRC）and FEV1 predicted value of lung function were used to evaluate before and after intervention．Results In the control group,differences of CAT score and mMRC score were significant（t=16.781,t=8.103,P<0.001）before and after respiratory rehabilitation training．In the intervention group,the CAT score before and after respiratory rehabilitation training showed a 0.01 level of significance（t=24.035,P<0.001）,and the mMRC score before and after training showed a 0.01 level of significance（t=15.938,P<0.001）．There were significant differences between control group and intervention group（P<0.01）．Compared with the control group,CAT score and mMRC score were significantly lower in the intervention group．Conclusions Comprehensive respiratory rehabilitation training can effectively improve the clinical symptoms of AECOPD patients,enhance the activity ability of patients,improve the quality of life,and improve the compliance of patients to perform pulmonary rehabilitation．

肝癌患者因食欲降低、进食减少导致不同程度的营养不良,引发厌食症,甚至恶病质,严重影响患者生存质量。食欲评估是降低营养风险的基础,医护人员可通过食欲症状的评估调整患者饮食及营养指导措施,以改善患者营养状态,提高生存质量。该文对食欲的评估工具、方法及干预在肝癌营养不良患者中的应用现状进行阐述,为肝癌患者的食欲干预提供科学依据。

Hepatocellular carcinoma patients suffer from different degrees of malnutrition due to decreased appetite and eating,which triggers anorexia and even cachexia,seriously affecting the quality of patient survival．Appetite assessment is the basis for reducing nutritional risk,and healthcare professionals can adjust patients’ diet and nutritional guidance measures through the assessment of appetite symptoms in order to improve patients’ nutritional status and survival quality．In this paper,the current status of the assessment tools,methods and interventions of appetite in malnutrition patients with hepatocellular carcinoma are described to provide a scientific basis for appetite interventions．

药物递送系统对于各类疾病意义非凡,但传统药物载体面临细胞毒性强、组织相容性低、半衰期短和靶向性弱等诸多挑战。血小板及其相关衍生物作为新型药物载体具有更为显著的优势。由于血小板自身的生理特点,以及在肿瘤、心血管疾病、血栓性疾病、感染等多种疾病中发挥的病理生理作用,血小板能够弥补传统药物载体的缺陷,具有极大的临床转化意义。该文总结了血小板相关药物递送系统目前的研究进展,以期为新型药物载体研究提供参考。

Drug delivery systems are important for various diseases,but conventional therapeutic drug have many shortcomings,such as high cytotoxicity,low histocompatibility,short half-life and weak targeting．Platelets and their derivatives have more significant advantages as novel drug carriers．Platelets play an important role in the pathophysiology of a wide range of diseases including oncology,cardiovascular diseases,thrombosis and infection．In this paper,we summarized the current research progress of platelet-related drug delivery systems to provide a reference for the research of novel drug delivery systems．

价值医疗下公立医院需转变运营管理模式,建设专门运营管理部门对满足外部政策要求和改善内部运营管理十分必要。通过梳理公立医院开展运营管理的主要任务,确定公立医院专门运营管理部门的职责,设计与承担职责相适应的组织架构,保证专门运营管理部门的职能充分发挥。

Public hospitals need to change the operation management mode under value-based healthcare．It is necessary to build a special operation management department to meet the requirements of external policies and improve internal operation management．By sorting out the operation and management tasks of public hospitals,the responsibilities of the operation management department are determined,and the organizational structure suitable for the responsibilities is designed,so that the construction of specialized operation management department can be effectively implemented．

目的 分析PDCA管理法在医院药事管理中的应用效果。方法 将我院2 000批药品设置为研究对象,样本纳入的起始、截止时间分别为2022年1月、2022年12月,依据时间对纳入样本开展组别划分,将2022年1月—6月1 000批药品设置为PDCA管理前研究对象,期间接受常规药品管理;将2022年7月—12月1 000批药品设置为PDCA循环法管理后研究对象。对比PDCA管理前后药品不良事件发生率及药事管理质量评分。结果 PDCA循环法管理后药学差错事件发生率低于PDCA循环法管理前,分别为0.30%、1.90%,对比差异有统计学意义（P<0.05）;PDCA循环法管理后建立药品质量监控体系、药品调剂制度、抗肿瘤药物分级管理方案和处方管理、临床药师参与四个维度评分较PDCA循环法管理前均有明显提升,分别为18.15±1.83、18.15±1.64、18.22±1.67、18.07±1.84,管理前后评分对比差异具有统计学意义（P<0.05）。结论 医院药事管理采用PDCA管理法可提升药事管理质量,降低药品不良事件发生率,值得应用。

Objective To analyze the application effect of PDCA cycle method in hospital pharmaceutical management．Methods A total of 2 000 batches of drugs in our hospital were included as research objects,the inclusion start and end of samples were January 2022 and December 2022．The included samples were divided into groups according to the time,1 000 batches of drugs from January 2022 to June 2022 were included as research objects before PDCA management,during which they were subjected to routine drug management．1 000 batches of drugs from July 2022 to December 2022 were included as the research objects under management by PDCA cycle method．The incidence of adverse drug events and the quality score of drug administration before and after PDCA administration were compared．Results The incidence of pharmaceutical error events after PDCA cycle management was lower than that before PDCA cycle management,which were 0.30% and 1.90%,respectively,and the differences were statistically significant（P<0.05）．After PDCA cycle management,the scores of establishment of drug quality control system（18.15±1.83）,drug dispensing system（18.15±1.64）,anti-tumor drug grading management scheme and prescription management（18.22±1.67）,clinical pharmacist participation（18.07±1.84）were significantly improved compared with those before PDCA cycle management,and the difference between scores before and after PDCA cycle management was statistically significant（P<0.05）．Conclusions PDCA cycle can improve the quality of pharmaceutical management and reduce the incidence of adverse drug events,which is worthy of application．

目的 分析国产帕利哌酮缓释片治疗稳定期精神分裂症的疗效与安全性。方法 采用随机数字表法将驻马店市第二人民医院2021年10月—2023年10月收治的108例稳定期精神分裂症患者分为对照组（服用原研帕利哌酮缓释片）与观察组（服用国产帕利哌酮缓释片）,每组各54例,以阳性与阴性症状量表（PANSS）评分变化为疗效衡量指标,以不良反应发生率及药物副反应量表（TESS）评分变化为安全性衡量指标。结果 治疗后,两组PANSS评分均比治疗前降低,组内不同时间点评分差异有统计学意义（t=22.147、4.513、3.431、21.369、3.927、3.601,P值分别为<0.001、<0.001、0.001、<0.001、<0.001、<0.001）,但组间不同时间点评分比较差异无统计学意义（t=0.281、0.043、0.150,P=0.779、0.966、0.881）;观察组不良反应发生率（14.81%）与对照组（12.96%）比较差异无统计学意义（χ²=0.090,P=0.765）;两组TESS评分接近,不良反应皆轻微（t=0.185,P=0.856）。结论 国产帕利哌酮缓释片治疗稳定期精神分裂症患者可促进症状改善,且不良反应轻微,疗效及安全性与原研制剂相当。

Objective To analyze the efficacy and safety of domestic paliperidone sustained-release tablets in the treatment of stable schizophrenia．Methods A total of 108 patients with stable schizophrenia admitted to Zhumadian Second People's Hospital from October 2021 to October 2023 were divided into control group（taking the original paliperidone sustained-release tablet）and observation group（taking domestic paliperidone sustained-release tablet）by random number table method,with 54 cases in each group．The change of Positive and Negative Symptom Scale（PANSS）was used as the efficacy measure,and the change of incidence of adverse reactions and Treatment Emergent Symptom Scale（TESS） score was used as the safety measure．Results After treatment,PANSS scores in both groups were lower than before treatment,and the differences in scores at different time points in the groups were statistically significant（t=22.147,4.513,3.431,21.369,3.927,3.601,the P values were<0.001,<0.001,0.001,<0.001,<0.001,<0.001,respectively）．However,there was no significant difference in scores at different time points between the groups（t=0.281,0.043,0.150,P=0.779,0.966,0.881）．There was no significant difference in the incidence of adverse reactions between observation group（14.81%）and control group（12.96%）（χ²=0.090,P=0.765）．TESS scores were similar between the two groups,and adverse reactions were mild（t=0.185,P=0.856）．Conclusions The domestic paliperidone sustained-release tablets can improve the symptoms of stable schizophrenia patients,and the side effects are slight,and the efficacy and safety are comparable to the original agent．

目的 探讨俯卧位通气在脓毒症合并急性肺损伤患儿的应用效果。方法 选取泉州市儿童医院2020年9月—2023年9月收治的72例脓毒症合并急性肺损伤患儿,应用抽签法将其分为观察组与对照组,均为36例。对照组患儿实施常规仰卧位机械通气与对应护理,观察组患儿在常规护理基础上增加俯卧位通气与对应护理。对比两组患儿机械通气时间,干预前和干预3 d后气道平台压和心率水平,动脉血二氧化碳分压（PaCO₂）、动脉血氧分压（PaO₂）,并计算动脉血氧分压与吸入气中的氧浓度分数比值（PaO₂/FiO₂）,评价两组患儿预后及不良事件发生情况。结果 观察组机械通气时间明显低于对照组（P<0.05）,干预后两组患儿气道平台压、心率均降低,且观察组低于对照组（P<0.05）;干预后两组患儿PaO₂/FiO₂、PaO₂水平升高,观察组高于对照组,PaCO₂降低,观察组低于对照组（P<0.05）;干预后两组患儿全身性感染相关性器官功能衰竭评分（SOFA）、急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）评分均降低,观察组低于对照组（P<0.05）;两组患儿呼吸机管路折管、管路滑脱、压力性损伤等不良事件发生率对比差异无统计学意义（P>0.05）。结论 俯卧位通气在脓毒症合并急性肺损伤患儿的应用效果显著,可降低患儿气道平台压及心率,缩短机械通气时间,改善患儿通气功能,有助提升预后水平。

Objective To explore the application effect of prone position ventilation in children with sepsis complicated with acute lung injury．Methods From September 2020 to September 2023,72 children with sepsis and acute lung injury admitted to Quanzhou Children's Hospital were selected and divided into observation group and control group by drawing lots,both with 36 cases．The children in the control group received routine supine mechanical ventilation and corresponding nursing,and the children in the observation group added prone ventilation and corresponding nursing on the basis of routine nursing．By comparing the duration of mechanical ventilation,airway plateau pressure and heart rate level,PaCO₂,PaO₂,PaO₂/FiO₂,the prognosis and occurrence of adverse events in the two groups were evaluated．Results The mechanical ventilation time in the observation group was significantly shorter than that in the control group（P<0.05）．After intervention,the airway plateau pressure and heart rate levels of the two groups of children decreased,and the observation group was lower than the control group（P<0.05）．After the intervention,the levels of PaO₂/FiO₂ and PaO₂ in the two groups of children increased,with the observation group higher than the control group,while the level of PaCO₂ was lower,with the observation group lower than the control group（P<0.05）．After the intervention,the SOFA and APACHE II scores of the two groups of children decreased,and the observation group was lower than the control group（P<0.05）．There was no difference in the incidence of adverse events such as ventilator tube folding,tube slip and pressure injury between the two groups（P>0.05）．Conclusions The application of prone position ventilation in children with sepsis combined with acute lung injury has a significant effect,which can reduce airway plateau pressure,lower heart rate,shorten mechanical ventilation time,improve ventilation function,and assist in improving prognosis．