Antibacterial drug resistance is a severe challenge for the treatment of bacterial infectious diseases worldwide, especially in the treatment of ultra broad extended-spectrum β-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae and drug-resistant Pseudomonas aeruginosa infected. In 2023, the Infectious Diseases Society of America provided guidance on the treatment of the three drug-resistant bacterial infections mentioned above based on updated evidence-based evidence. Based on the guidance and recommendations in domestic guidelines, this article reviewed the treatment for the three drug-resistant bacterial infections mentioned above, in order to provide clinical reference for the control and treatment of related diseases in China.

Sjögren's syndrome(SS) is an autoimmune disease involving exocrine glands of the whole body. It is characterized by the infiltration of lymphocytes into exocrine glands such as salivary glands and lacrimal glands, resulting in insufficient secretion of the glands. The clinical manifestations are mainly dry mouth and dry eyes, and can also invade the respiratory system and digestive system, thus affecting the quality of life of patients and even life-threatening. The pathogenesis of SS is not yet clear. At present, symptomatic treatment is the main treatment. This article reviewed related drugs in recent years, aiming to provide some reference for clinical practice.

This paper reviewed the system design and reform experience of health insurance and payment system in Chinese Taiwan from the aspects of the health insurance system and health insurance payment system, also provided references for the reform of medical and health system in Chinese mainland, including building a multi-channel financing system, continuously promoting the reform of medical insurance payment methods, introducing third-party institutions to formulate budget and payment standards, and strengthening medical service supervision and construction of information standardization.

Diabetic nephropathy(DN) is the main factor leading to end-stage renal disease, but the types and effects of current therapeutic drugs are limited. Mineralocorticoid receptor antagonist(MRA) has certain renal protection effect in patients with DN, and its mechanism may be related to inhibiting inflammation, reducing renal fibrosis and improving oxidative stress imbalance. This article further summarized the effects of MRA on DN, in order to provide some reference for clinical diagnosis and treatment.

Zuranolone is a new neuroactive steroid drug, which acts on the positive allosteric modulation of γ-aminobutyric acid type A receptor, and is expected to become a new treatment for depression. The results of phase Ⅲ clinical trials showed that zuranolone could rapidly improve depressive symptoms with the treatment of oral administration once a day for 2 weeks, and the overall tolerance was good. This article reviewed the pharmacological action, pharmacokinetics, safety and clinical research progress in zuranolone.

Objective To evaluate the bioequivalence, skin adhesion, irritation and safety of test preparation and reference preparation of 5% lidocaine gel patch on the skin of healthy volunteers under topical application condition. Methods A single-center, randomized, open-label, single-dose, two-cycle, two-sequence, two-crossover trial was designed. Thirty healthy subjects were randomly divided into RT group and TR group, subjects in RT group were treated with the reference preparation in the first cycle, and test preparation in the second cycle. Subjects in the TR group were treated with the test preparation in the first cycle, and reference preparation in the second cycle. The cleaning period was 3 days, 3 patches each time and continuous application for 12 h. The internal standard method and statistical method were used to calculate the main pharmacokinetic parameters, and the bioequivalence, adhesion and skin irritation of the two formulations were analyzed. Results The 90% confidence interval for the geometric mean ratio of plasma peak concentration of the test preparation and the reference preparation, the area under the blood concentration-time curve from 0 to the time t that can be accurately measured, and the area under the blood concentration-time curve from 0 to infinite time were all 80.00% to 125.00%. The adhesive force of the two formulations were completely consistent among all subjects at all time points. There was no statistically significant difference in skin irritation between the test preparation and the reference preparation(P＞0.05). Conclusion The test preparation was bioequivalent to the reference preparation, with good safety, and the test preparation was not inferior to the reference preparation in adhesive force, and there was no difference in skin irritation.

Now there is growing evidence supporting the association between hypertension and tumors, and the two diseases have some common epidemiological and pathophysiological characteristics. Although antineoplastic drugs greatly improve survival rate of cancer patients, they increase the risk of cardiovascular disease including cardiac disease, thrombotic disease and hypertension. Studies have confirmed that a variety of antineoplastic drugs can cause or worsen hypertension, which in turn is an associated risk factor for certain cancers (e.g., renal cell carcinoma, colorectal cancer). In addition, drug interactions and some other adjuvant drugs in tumor therapy also have the potential to elevate the risk of hypertension. In January 2023, the American Heart Association published a scientific statement on cancer therapyrelated hypertension, which aims to elucidate the epidemiology of antineoplastic drugs, the possible mechanisms that cause hypertension, and the diagnosis and management of hypertension due to cancer therapy drugs, and to identify important issues that need to be addressed and to provide recommendations and guidance. This article interpreted this scientific statement and provides a reference for the clinical diagnosis and treatment of cancer therapy-related hypertension in China.

Objective To compare the clinical efficacy of pentoxifylline and Xuesaitong in the treatment of acute cerebral infarction(ACI). Methods A total of 160 patients with ACI hospitalized in department of neurology, Tongling municipal hospital from July 2020 to July 2022 were selected as the research objects. They were divided into observation group and control group, with 80 cases in each group. The observation group was given pentoxifylline on the basis of conventional treatment, and the control group was given Xuesaitong on the basis of conventional treatment. National Institute of Health stroke scale(NIHSS) and mini-mental state examination(MMSE) were used to evaluate the degree of neurological impairment and cognitive function. The clinical efficacy, changes of plasma fibrinogen(FIB) and hypersensitivity C-reaction protein(hs-CRP) levels before and after treatment were compared between the two groups, and the adverse reactions were observed. Results The effective rate of observation group was higher than that of control group(86.25% vs 71.25%, P＜ 0.05). After treatment, the MMSE scores of both groups increased compared to before treatment(P＜0.05), while the NIHSS score and FIB level decreased compared to before treatment(P＜0.05), and the improvements of the observation group were better than those of the control group(P＜0.05). The incidence of progressive cerebral infarction in the observation group was lower than that in the control group(P＜0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞0.05). Conclusion Pentoxifylline has better clinical efficacy than Xuesaitong in the treatment of ACI, which can effectively improve neurological deficits symptoms and cognitive function, and reduce the levels of plasma FIB and hs-CRP, and it is rather safe.

The deterioration of chronic heart failure(CHF) not only reduces the quality of life of patients, increases the risk of hospitalization and death, but also imposes a heavy burden on healthcare resources. In order to better manage CHF, the Heart Failure Association of the European Society of Cardiology has developed a new clinical consensus statement in 2023, updating the definition, clinical characteristics, management, and prevention of CHF deterioration. The consensus highlights the importance of diuretics, and intravenous, oral or combined diuretics should be selected depending on the severity of the patient. It also emphasizes the importance of early and rapid administration of guideline recommended medical therapies to prevent first deterioration and repeated exacerbations of heart failure. In order to relieve the medical pressure and meet the needs of patients for timely treatment, it is recommended to carry out hierarchical diagnosis and treatment for patients, mild to moderate patients in emergency or outpatient treatment, severe patients need to choose hospital treatment. This article provided a brief interpretation of the relevant content in order to provide reference for the clinical management of CHF.

Multiple myeloma(MM) is a hematologic tumor resulting from the malignant proliferation of monoclonal plasma cells in the bone marrow. In recent years, the extensive application of proteasome inhibitor(PI), immunomodulators and autologous or allogeneic stem cell transplantation have significantly improved the remission rate, survival rate and prognosis of MM patients. Bortezomib(BTZ) is a PI, which is effective in the treatment of MM in clinical practice. This article reviewed the progress of BTZ-based treatment of MM, aiming to provide some reference for clinical use.

Diabetic nephropathy(DN) is one of the common microvascular complications of diabetes mellitus and the main cause of end-stage renal disease. In recent years, traditional Chinese medicine has certain advantages in reducing proteinuria, protecting renal function and delaying the progression of DN. Clinically, DN is usually treated by syndrome differentiation and type treatment, traditional prescription and Chinese patent medicine, and the effect is remarkable. This article reviewed the recent progress of randomized controlled studies in the treatment of DN with traditional Chinese medicine in accordance with the requirements of evidence-based medicine, in order to provide some reference for its prevention and treatment.

Objective To explore the effects of Relinqing granules combined with cefodizime sodium in the treatment of male gonorrhea. Methods A total of 80 male patients with gonorrhea from January 2018 to December 2020 were selected, grouped according to random number table method. There were 40 cases in the control group(treated with cefodizime sodium) and 40 cases in the observation group(treated with cefodizime sodium combined with Relinqing granules), and compare clinical efficacy between the two groups. Results The total effective rate of the observation group was higher than that of the control group(100.00% vs 80.00%), and the difference was statistically significant(P＜0.05). The positive rates of gonococci in the observation group on D3 and D8 were 37.35% and 2.50%, respectively, lower than the 62.50% and 22.50% in the control group. After treatment, the levels of interleukin(IL)-10, IL-6 and tumor necrosis factor-α in both groups were decreased, and the levels of observation group were lower than those of the control group(P＜0.05). After treatment, the quality of life scores of both groups of patients were improved, and these indicators of observation group were higher than those of the control group(P＜0.05). During the treatment period, there was no statistically significant difference in adverse reactions between the observation group(2.50%) and the control group(7.50%). The incidence of gonorrhea complications in the observation group(2.5%) was lower than that in the control group(25.00%)(P＜0.05). Conclusion After the treatment of male gonorrhea patients with Relinqing granules, the positive rate of gonococci was significantly reduced, the serum inflammatory factors and quality of life of the patients were also significantly improved, and the treatment was safe. It had an effective prevention effect on the occurrence of complications, with significant clinical application value.

Objective To analyze and compare the clinical efficacy of dexmedetomidine and remifentanil combined with propofol in painless induced abortion, and the effects of T cytokines, vital signs, and sexual hallucinations. Methods A total of 100 early pregnancy pregnant women who underwent painless induced abortion in our hospital from December 2018 to December 2020 were selected and divided into control group(dexmedetomidine＋propofol) and study group(remifentanil＋ propofol) according to random number method, with 50 cases in each group. Anesthesia induction time, anesthesia effect, recovery time and discharge time of the two groups were observed. Serum interleukin(IL)-1β, IL-10, mean arterial pressure(MAP), heart rate(HR), pulse oxygen saturation(SpO2) changes and the incidence of sexual hallucinations were also observed. Results MAP and HR of the two groups after induction, during operation and after operation were lower than those before operation, and MAP and HR of the study group were higher than those of the control group at all periods(P＜ 0.05). The difference of IL-1β and IL-10 levels in the study group before and after anesthesia was significantly lower than those in the control group(P＜0.05). Compared with the control group, the incidence of sexual hallucinations in the study group was significantly lower after anesthesia(14% vs 36%). Anesthesia induction time[(122.08±21.49)s vs (82.92±11.41)s], recovery time[(3.58±1.05)min vs (3.08±1.03)min] and discharge time[(31.34±5.57)min vs (28.12± 4.75)min] were significantly shortened. The total effective rate of anesthesia was significantly improved(80% vs 98%, P＜ 0.05). Compared with the control group, serum IL-1β level was significantly decreased[(0.31±0.07)ng/ml vs (0.23± 0.06)ng/ml] and serum IL-10 level was significantly increased[(36.41±12.34)pg/ml vs (44.96±11.02)pg/ml] after anesthesia. Conclusion The combination of remifentanil and propofol has better anesthetic effect than dexmedetomidine and propofol. The intraoperative vital signs are more stable, the inflammatory reaction is lighter, and the incidence of sexual hallucination is lower.

Sotagliflozin is a drug with dual inhibitory effects on sodium-dependent glucose transporters(SGLT) 1 and 2. Inhibition of SGLT1 can inhibit glucose and galactose absorption in the digestive tract, and inhibition of SLGT2 can reduce glucose reabsorption in the renal tubules. Sotagliflozin has been shown to be effective in the treatment of type 2 diabetes mellitus. In recent years, it has shown great potential in cardiovascular diseases. Soglitazone can reduce adverse cardiovascular events in type 2 diabetes patients with cardiovascular risk factors. This article summarized the research on the application of sotagliflozin in diabetes mellitus complicated with cardiovascular diseases at home and abroad in recent years, in order to provide guidance for the further application of sotagliflozin in cardiovascular diseases.

抗菌药耐药是一个日益严重的全球性公共卫生问题，若不采取紧急行动，则会进入“后抗菌药时代”。但由于抗菌药 领域相对较低的投资回报率，新型抗菌药的研发面临着技术、监管、临床及资金等重大挑战。传统的价值评估框架没有考虑 抗菌药的特殊性，存在被低估的风险，有必要开展医保报销模式改革。文章梳理了抗菌药的传播价值、多样性价值、安心价 值、赋能价值、抗菌谱价值及新颖机制价值的内涵及英国、美国、德国、法国、瑞典在抗菌药创新支付中的先进经验，期望 为开发出基于我国国情的抗菌药社会价值评估维度和医保决策中的抗菌药创新支付方案提供政策参考，进而促进抗菌药的合 理使用，推动新型抗菌药的研发。

In 2022, the American College of Chest Physicians(ACCP) released the guidelines for the perioperative management of antithrombotic therapy. The guidelines mainly put forward antithrombotic recommendations for four clinical situations. Patients receiving vitamin K antagonists, heparin bridging, direct oral anticoagulants, antiplatelet drugs requiring surgery or invasive procedures, and perioperative laboratory testing were advised. This article compared with previous versions of the ACCP guidelines for perioperative antithrombotic therapy, and made a comprehensive interpretation of the guidelines combined with Shanghai Expert Consensus On Perioperative Management of Antithrombotic Patients Accepting Non-Cardiac Surgery(2021 Edition) and Chinese Guidelines for the Prevention and Treatment of Thrombotic Diseases, in order to provide references for the clinical application of antithrombotic drugs in perioperative period.

Headache is a common neurological disorder. Among them, primary headache is more common, and seriously affects the quality of life of patients. This article tracked the progress on western medicine treatment of primary headache, combined the unique understanding of traditional Chinese medicine(TCM) on the diagnosis and treatment of headache, expounded the clinical advantages of TCM and western medicine in the treatment of headache, and looked forward to the development prospects of integrative TCM and western medicine in the treatment of headache.

Objective To investigate the effects of acetyl-L-carnitine and mecobalamine on pain, nerve conduction velocity in patients with diabetic peripheral neuropathy(DPN). Methods A total of 80 DPN patients admitted to our hospital from January 2021 to November 2022 were selected and divided into observation group(conventional treatment＋acetyl-Lcarnitine) and control group(conventional treatment＋mecobalamine) according to random number table method, 40 cases in each group, all of which were treated for 3 months. Pain relief, visual analogue scale(VAS) score, blood glucose, sensory nerve conduction velocity(SNCV) of median nerve and common peroneal nerve, motor nerve conduction velocity(MNCV) changes and adverse reactions were compared between the two groups. Results The total effective rate of pain relief in observation group was higher than that in control group(P＜0.05). VAS score of observation group was lower than that of control group(P＜0.05). There was no significant difference in SNCV and MNCV between the median nerve and common peroneal nerve between the two groups(P＞0.05). Conclusion Acetyl-L-carnitine and mecobalamine have similar effects in improving nerve conduction velocity in DPN patients, and acetyl-L-carnitine has better effects in relieving pain, and has high clinical application value.

Objective To investigate the effect of mollugin on the biological behavior of human hepatocellular carcinoma cells and its mechanism. Methods HepG2 cells were divided into control group, low, medium and high concentration of mollugin(40, 60 and 80 mmol/L) group, SN50(36 μmol/L) group and high concentration of mollugin(80 mmol/L)＋ LPS(2.5 μmol/L) group. Cell counting kit-8 assay, clonal formation assay, flow cytometry and Transwell staining were used to detect the proliferation, apoptosis, invasion and migration of HepG2 cells. Western blotting was used to detect the protein expression in HepG2 cells. Results Compared with the control group, the cell proliferation inhibition rate, apoptosis rate, rabbit anti-Caspase-3(Caspase-3), B-cell lymphoma 2 associated X protein(Bax), inhibitor of nuclear factor-κB (IκB-α) and Bax/B-cell lymphoma 2 (Bcl-2) in the low, medium, and high concentration of mollugin groups and SN50 group were increased (P＜0.05). The number of clone cells, invasion and migration cells, Bcl-2, matrix metalloproteinase (MMP)- 2, MMP-9, nuclear factor(NF)-κB and p-IκB-α were all decreased (P＜0.05). Compared with the high concentration of mollugin group, the cell proliferation inhibition rate, apoptosis rate, Caspase-3, Bax, IκB-α and Bax/Bcl-2 in high concentration of mollugin＋LPS group were decreased, the number of cloned cells, invasive and migratory cells, and the expression of MMP-2, MMP-9, NF-κB, Bcl-2 and p-IκB-α were all increased(P＜0.05). Conclusion Mollugin may inhibit cell proliferation, invasion, migration and promote apoptosis of HepG2 cells by inhibiting NF-κB pathway, which is expected to become a targeted drug for the treatment of liver cancer.

Psoriasis is a common chronic, recurrent and inffammatory disease in dermatology, and the exact etiology of psoriasis has not been completely understood. Genetic and environmental factors are important factors that induce or aggravate psoriasis, among which tobacco smoking and alcohol drinking are common controllable risk factors. Studies have shown that the tobacco smoking rate of psoriasis patients is higher than that of general population. Tobacco smoking may affect the occurrence and the progress of psoriasis by enhancing the expression of psoriasis-related genes and activating psoriasis-related signaling pathways, thus increasing the risk of psoriasis and leading to the exacerbation of the condition of psoriasis patients. However, whether tobacco smoking affects the treatment effect of psoriasis patients remains controversial, and more clinical studies are needed to conffrm the impact of tobacco smoking and cessation on the treatment effect of psoriasis patients. Epidemiological investigation shows that the alcohol drinking rate of psoriasis patients is higher than that of general population. Existing research evidence suggests that alcohol drinking may have adverse effects on the occurrence and the progress of psoriasis by affecting psoriasis-related susceptibility genes, affecting the proliferation and differentiation of keratinocytes and inducing abnormal activation of immune cells. At the same time, alcohol drinking may weaken the therapeutic response of psoriasis, making the treatment less effective. However, there is no unified conclusion on the relationship between alcohol drinking and the occurrence and severity of psoriasis. So more studies are needed to explore the association between alcohol drinking and psoriasis.

In recent years, China has carried out in-depth clinical trial supervision reform and established a clinical trial management system that is in line with international standards. However, a minority from the United States and other western countries still take the news reports voluntarily disclosed by Chinese media on the self-inspection & verification of clinical trials in 2016 as the basis, ignoring the achievements of China’s drug regulatory reform, questioning the quality of existing pharmaceutical clinical trials in China, which has a negative affect the internationalization development of China’s pharmaceutical innovation. This paper conducted an in-depth study on the work of launching background of the self-inspection & verification of clinical trial data in 2015 and the relevant data in the 2017 summary report, revealed the actual situation of the work at that time, analyzed the policy background behind the problems, and put forward policy recommendations to continue to optimize the management of pharmaceutical clinical trials.

Objective To investigate the effects of kaempferol on ferroptosis in trophoblast cells induced by high glucose by regulating nuclear factor erythroid-2 related factor(Nrf)2/solute carrier family 7 member(SLC7A)11/glutathione peroxidase(GPX)4 signaling pathway. Methods Human chorionic trophoblast cells HTR-8/SVneo were cultured in vitro and divided into control group, model group(25 mmol/L glucose), kaempferol group, ML385(Nrf2 inhibitor) group, kaempferol＋ML385 group. Cell counting kit-8 was used to detect the cell survival rate. Flow cytometry was used to detect the apoptosis rate. Enzyme linked immunosorbent assay was used to detect the levels of lactate dehydrogenase(LDH), interleukin(IL)-6, IL-18, and tumor necrosis factor(TNF)-α. The biochemical method was used to detect the antioxidant factors superoxide dismutase(SOD), catalase(CAT), glutathione(GSH), malondialdehyde(MDA), iron content and relative levels of reactive oxygen species(ROS). Western blot was used to detect the expression of Nrf2/SLC7A11/GPX4 signalrelated proteins in HTR-8/SVneo cells of each group. Results Kaempferol can increase the cell survival rate, SOD, CAT, GSH levels and the protein expressions of Nrf2, SLC7A11 and GPX4, reduce LDH release, apoptosis rate, IL-6, IL-18, TNF-α, MDA, ROS levels and iron content, and inhibit the ferroptosis of trophoblast cells induced by high glucose. ML385 can enhance the ferroptosis of trophoblast cells induced by high glucose, and weaken the inhibitory effect of kaempferol on the ferroptosis of trophoblast cells induced by high glucose. Conclusion Kaempferol may inhibit high glucose-induced inflammation and lipid peroxidation in trophoblast cells by activating Nrf2/SLC7A11/GPX4 signaling pathway, and alleviate ferroptosis.

Objective To systematically evaluate the efficacy and safety of enteral nutrition preparations containing ω-3 polyunsaturated fatty acids or standard enteral nutrition preparations in patients with upper gastrointestinal cancer during the perioperative period, and to provide reference for clinical rational drug use. Methods Pubmed, EMbase, the Cochrane Library, CNKI, and Wanfang databases were searched for relevant literature. The search time limit was from the establishment of the database to June 1, 2022. Two researchers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Stata16.0 software was used for meta-analysis. Results A total of 38 randomized controlled trials were included. The results of meta-analysis showed that compared with the standard enteral nutrition, enteral nutrition preparations containing ω-3 polyunsaturated fatty acids were more effective in reducing the infectious complications(relative risk＝0.75, P＜0.001), improving immune and inflammation-related indicators, albumin, and reducing the length of hospital stay(weighted mean differenc＝-2.321, P＜0.05). Conclusion Enteral nutrition preparations containing ω-3 polyunsaturated fatty acids have advantages in efficacy and safety in postoperative nutritional therapy for upper gastrointestinal cancer, and can be used as the preferred clinical drug. Limited by the quantity and quality of the included studies, the above conclusions need to be verified by more high-quality studies.

In recent years, the review and approval of rare disease drugs in China has been accelerated, and the negotiation of access to the national medical insurance drug catalogue has been fully launched. Through comparative analysis of the national conversation catalogue over the years, it can be seen that from 2017 to 2022, the number of rare disease drugs included in medical insurance through national negotiations has increased from zero to 29 year by year, the time from listing to inclusion in medical insurance has been significantly shortened, and the accessibility has been significantly improved. The list of rare diseases drugs covered 16 rare disease, including 26 (89.6%) imported enterprise products and 3 (10.4%) domestic enterprise products. It reveals that although the number of rare disease drugs listed and medical insurance coverage in China have increased, the coverage of rare diseases is still small, and the research and innovation ability of domestic pharmaceutical enterprises is relatively weak. It is suggested that medical insurance, medical treatment and medicine should continue to play a synergistic role to provide sustainable impetus for the guarantee of rare disease drug use in China.

Bronchial asthma is one of the common chronic respiratory diseases in clinic. Western medicine mainly treats with glucocorticoids and bronchodilation drugs, but there are many adverse reactions, resulting in poor patient compliance and high recurrence rate. Traditional Chinese medicine(TCM) has certain advantages in the prevention and treatment of bronchial asthma, which can reduce the hormone dependence of patients, reduce the occurrence of adverse reactions, and reduce the number of recurrence. This article reviews the etiology and treatment, syndrome differentiation and clinical research progress of TCM in the prevention and treatment of bronchial asthma, in order to provide new ideas for the prevention and treatment of bronchial asthma.

In recent years, the number of rare dise ase drugs included in the national medical insurance negotiation list has been increased, and the landing of rare disease drugs in National Negotiation Drugs is the key to evaluate the effect of the policy. Based on the online drug procurement data of medical institutions in Hubei province from January 2018 to December 2022, this article conducted a study on rare disease drugs that had been negotiated four times between 2017 and 2021. Defined daily doses(DDDs), defined daily dose cost and procurement amount were selected to compare before and after the policy, and catastrophic health expenditure indicators were used to evaluate the affordability of rare disease drugs. The analysis revealed that among the 21 negotiated rare disease drugs, 5 drugs were not procured by medical institutions in Hubei province from 2017 - 2021. Compared with 2018, the DDDs and procurement amount decreased in 2019, but the DDDs and amount of negotiated rare disease drugs increased year by year from 2020 to 2022. Before reimbursement by medical insurance, there were 14 and 15 drugs with annual treatment costs exceeding catastrophic health expenditures for urban and rural residents, respectively. After reimbursement by employee medical insurance, there were 7 and 10 drugs with annual treatment costs exceeding catastrophic health expenditures for urban and rural residents, respectively. There were 10 and 13 drugs after reimbursement by residents' medical insurance, respectively. Therefore, it is suggested that the government should take lead improving the multi-party co-payment for rare disease drugs and achieve classified management for the extremely poor population, so as to consolidate the guarantee of people's livelihood.

Objective To evaluate the cost-effectiveness analysis of nintedanib esylate in the treatment of idiopathic pulmonary fibrosis(IPF). Methods From the perspective of Chinese healthcare system, a Markov model was constructed to evaluate the cost-effectiveness of nintedanib esylate compared with pirfenidone in the treatment of IPF patients. The model cycle was one month using a lifetime horizon. The discount rate of both cost and effectiveness was 5%. One-way sensitivity analysis, probabilistic sensitivity analysis and scenario analysis were used to verify the robustness of the base case results. Results The results of the base case showed that compared with generic pirfenidone, nintedanib esylate had lower costs and higher quality-adjusted life years output in the treatment of IPF patients, which had absolute advantages and was a more economical program. The conclusion was verified in one-way sensitivity analysis, probabilistic sensitivity analysis and scenario analysis. Conclusion Nintedanib esylate is a cost-effective alternative compared with generic pirfenidone in Chinese patients with IPF.

High-value orphan drugs for rare diseases can fill the clinical therapeutic gaps and significantly improve symptoms and patients' quality of life compared with standard treatment regimens. However, due to uncertainties in the number of patients, real-world efficacy and safety performance of drug, and fund budget impact and other factors, the decision-making risk of the medical insurance department is extremely uncertain. The high price also leads to the increasing difficulty of medical insurance access. Due to the particularity of rare diseases, there are certain limitations in drug list adjustments using the same selection and evaluation principle of conventional drugs and following the track of "strict access, loose extension" for high-value orphan drugs. According to the international experience, the medical insurance access of rare disease drugs needs a differentiated evaluation system. This article explored the dilemma of medical insurance access for high-value orphan drugs and analyzes the causes. Drawing on international experiences and combining with domestic medical insurance access practice, we put forward some ideas to improve the medical insurance access for high-value orphan drugs in China, in order to provide references for relevant department to make adjustments on the medical security for rare diseases and innovate the selection and evaluation mechanism, and further improve the accessibility of high-value orphan drugs for patients with rare diseases.

Chronic obstructive pulmonary disease is a heterogeneous lung condition with multiple complications and requires multidimensional evaluation. The international classification of functioning, disability and health(ICF) constructs a bio-psycho-social model, including physical functions, body structure, activities and participation and environmental factors. Based on the ICF framework, this paper mainly applied the literature research method to analyze the core set of obstructive pulmonary disease(OPD), which means “why this category can be included in the ICF-OPD core sets”, and analyzed the clinical application of this set.

Objective To review and analyze the effects of voriconazole in the treatment of invasive fungal infection(IFI) secondary to blood tumors in children. Methods Through the network resource sharing information platform, systematic analysis method was used to search the mainstream medical database in China, and the case reports on voriconazole treatment of IFI in children with blood tumors were collected. The overall efficacy, safety degree and related clinical information were statistically summarized. Results A total of 21 clinical data, including 558 cases, were collected and could be analyzed. The results were as follows. The total effective rate of voriconazole in the treatment of IFI in children with blood tumors was 81.36%. Voriconazole was suitable for both infants and older children. The efficacy of voriconazole was better than that of amphotericin, but there was no difference between voriconazole and echinocin. The efficacy of domestic and imported preparations of voriconazole was similar(80.88% vs 82.75%, P＝0.683). Voriconazole has high safety. The common adverse reactions of voriconazole were mild gastrointestinal reactions, liver injury and hypokalemia. Conclusion Voriconazole is the preferred antifungal drug for the treatment of IFI in children with hematologic tumors. It is necessary to constantly summarize and improve the quality of diagnosis and treatment of IFI based on strict implementation of relevant diagnosis and treatment guidelines, and pay attention to the development trend of potential drug resistance..

随着女性卵巢功能的衰退，全身其他重要器官功能也逐步下降，部分围绝经期女性出现躯体、精神症状或疾病，影响 女性生活质量。绝经激素治疗(menopause hormone therapy，MHT) 通过添加外源性性激素，改善并缓解卵巢功能下降甚至 衰竭所导致的相关症状。该文就孕激素、雌激素以及雌孕激素复方制剂等各类性激素在MHT 中的应用范围、常用方案及风 险获益进行探讨、总结，以期对围绝经期女性用药提供参考。

Objective To observe the efficacy and safety of Pudilan Xiaoyan oral liquid in the treatment of moderate acne vulgaris with dampness and heat. Methods A total of 210 cases of moderate acne vulgaris were collected according to the principles of multi-center, randomized, double-blind single simulation and placebo parallel control. Among them, 105 cases in the experimental group were treated with Pudilan anti-inflammatory oral liquid＋clindamycin gel, the control group(105 patients) were treated with Pudilan Xiaoyan oral liquid simulator＋clindamycin gel for 4 weeks. The clinical efficacy was evaluated after the treatment. Results The effective rate of the experimental group was 86.54%, and the recovery rate was 4.81%, while the effective rate of the control group was 35.92%, and the recovery rate was 0.00%, and the differencewas statistically significant(P＜0.05). The total number of skin lesions and the improvement of papules and pustules in experimental group were significantly better than those in the control group, with statistical significance(P＜0.05). The experimental group was better than the control group in improving the tongue coating and constipation, and the difference was statistically significant(P<0.05). In terms of safety, no adverse reactions were observed in the experimental group and the control group. Conclusion Pudilan Xiaoyan oral liquid in the treatment of moderate acne vulgaris of damp-heat type has obvious curative effect, quick effect and small adverse reaction.

Objective To establish an evaluation index system for the rational use of drugs in the treatment of multiple myeloma(MM). Methods A total of 30 experts were selected for two rounds of expert consultation by Delphi method. The opinions of experts were collected and the results were statistically analyzed. The basic information and questionnaire results of the questioned experts were analyzed, and the positive coefficient, average score, full score ratio, coefficient of variation and weight value were calculated. Results The evaluation indexes of rational use of MM drugs included 6 primary indexes and 36 secondary indexes. The effective recovery rate of the expert questionnaire was 100%, the authority coefficient was 0.86, and the coordination coefficient was 0.293, which had statistical significance(P＜0.001). Conclusion The experts are highly motivated, authoritative and coordinated, and the evaluation system of MM is objective and reasonable, which can provide quantifiable evaluation for MM drug selection.

Objective To explore the way of carrying out the risk communication method of "patient safety medication guides" in China. Methods We reviewed the guidelines and regulations on "patient safety medication guides" issued by the drug regulatory authorities in typical countries, the United States and Japan, and the differences in their production, format content and other aspects were analyzed. Result Although both the United States and Japan implement the "patient safety medication guides" work, there are different regulatory requirements in various aspects. In addition, Japan does not have specific requirements for the format of patients safe medication, nor does it elaborate on the specific distribution requirements. Conclusion China could appropriately learn from the advanced experience of the United States and Japan, carry out the work of "patient safety medication guides", issue relevant guidelines as soon as possible, and specify the specific production requirements of "patient safety medication guides" in detail.

Rheumatoid arthritis(RA) is a chronic autoimmune disease characterized by multiple joint destruction, and in severe cases, there may be irreversible joint destruction and even systemic organ involvement. The therapeutic targets of RA have been constantly explored and updated. This article reviewed the new progress of biologics and targeted drugs for RA, to provide certain reference for clinical drug use.

In recent years, the research and development(R&D) of gene therapy has been increasingly highlighted, particularly in the field of rare diseases. As of August 4, 2023, a total of 10 rare disease gene therapy drugs have been approved for market in the world. There are 170 drugs in clinical and registration phases overseas, 46 drugs in clinical stages in China, and most of which are in early clinical phases. The indications covered by gene therapy drugs developed overseas are broader, while drugs developed locally in China have relatively concentrated indications. Biotech companies are the primary R&D enterprises of gene therapy for rare diseases, and many large MNC companies have entered this field through collaboration and acquisition. Currently, there are almost no large and medium-sized companies in China engaged in the R&D of gene therapy for rare diseases. With the development of innovative gene therapy-related technologies and support from relevant regulations, gene therapy will attract increasing attention from Chinese companies in the future. This article analyzed the gene therapy drugs that were currently approved and under development in the world for treating rare diseases to understand the R&D status of gene therapy for rare diseases drugs in China and abroad.

分析1 例泛耐药肺炎克雷伯菌脑脓肿患者的治疗过程，临床药师通过查阅相关文献，和临床医生共同探讨后，制定以 多黏菌素B 鞘内给药，联合美罗培南加用联磺甲氧苄啶的抗感染治疗，且临床药师对整个治疗过程进行药学监护。入院46 d 后， 患者一般情况良好，3 次脑脊液检查基本正常后转回地方医院继续治疗。该治疗可能是治疗泛耐药肺炎克雷伯菌脑脓肿一种 有效方法，可为临床治疗提供参考。

Diabetes mellitus(DM) has always been one of the major global public health issues. Insulin has been an irreplaceable drug for controlling blood sugar in DM patients for a long time. In order to obtain better hypoglycemic effect and improve patient compliance, insulin preparations are constantly updated and iterated. This article reviewed the research progress in weekly basal insulin, oral insulin administration route and insulin compound preparation, in order to provide reference for clinical practice.

头痛是神经科门诊常见主诉之一，其病因复杂、误诊率高，临床处理较为棘手。目前，我国头痛就诊率低，诊疗仍欠
规范。头痛专科医生培训及头痛专业队伍建设对规范头痛诊疗、提高头痛诊疗水平具有重要意义。解放军总医院国际头痛中
心是国内第一所获国际头痛学会授牌的国际头痛中心，在头痛诊疗、头痛专科医生培训及头痛专业队伍建设方面具有丰富经
验。现就我院头痛专科培训经验作总结及思考，以期为我国头痛专科医生培训及专科队伍建设提供参考，以进一步规范临床
头痛诊疗，提升临床诊疗质量。

Objective To investigate the effect of febuxostat combined with hemodialysis in the treatment of chronic kidney disease(CKD) and its effect on fibroblast growth factor(FGF)23 and bone metabolism. Methods A total of 105 patients with CKD who treated at the department of nephrology in our hospital from February 2020 to February 2021 were selected and divided into experimental group(n＝53, hemodialysis＋febuxostat) and control group(n＝52, hemodialysis) by random number table method. The clinical efficacy, serum FGF23, serum uric acid, serum calcium, blood phosphorus, parathyroid hormone(PTH), serum creatinine(Scr), blood urea nitrogen(BUN) and occurrence of adverse reactions were compared between the two groups. Results After treatment, there was a statistically significant difference in the total effective rate between the control group and the experimental group(51.92% vs 81.13%, P＜0.05), but no statistically significant difference in the incidence of adverse reactions(9.43% vs 19.23%, P＞0.05). The levels of serum FGF23, blood uric acid, blood phosphorus, PTH, Scr and BUN in both groups were decreased with time, and the experimental group were lower than those in the control group, the differences were statistically significant(P＜0.05). The serum calcium level of both groups increased with time, and the experimental group was higher than that in the control group, the difference was statistically significant(P＜0.05). Serum FGF23 and blood uric acid were positively correlated with blood phosphorus, PTH, Scr and BUN(P＜0.05), and negatively correlated with blood calcium(P＜0.05). Conclusion Febuxostat combined with hemodialysis has a significant effect in patients with CKD, which can effectively improve serum FGF23 and bone metabolism, with good safety.