An expert consensus on pharmacological treatment with cardiac myosin inhibitors was developed in accordance with the methodological requirements of the WHO Handbook for Guideline Development （2014） and was registered on Practice guideline REgistration for transPAREncy. A multidisciplinary working group conducted evidence retrieval and appraisal by systematically searching PubMed， Embase， and the Cochrane Library. Evidence was graded using the Oxford Centre for Evidence-Based Medicine （OCEBM） levels of evidence. Using the GRADE decision framework， two rounds of Delphi surveys were conducted to prioritize clinical questions and formulate recommendations. Targeting clinicians， pharmacists， nurses， and other healthcare professionals， this consensus addresses key decision points in CMIs therapy. The recommendations cover 14 clinical questions and 17 corresponding recommendations. The recommendations cover indication selection， dose titration and echocardiographic monitoring， criteria for treatment interruption and re-initiation， management of drug-drug interaction risks， identification and management of adverse drug reaction， and use in special populations， providing actionable guidance for comprehensive， process-based management. This consensus provides evidence-informed practical guidance for the standardized， individualized， and full-process management of CMIs （mavacamten and aficamten） in patients with hypertrophic cardiomyopathy.

Severe pulmonary tuberculosis is characterized by critical condition and complex complications， and the standardized implementation of drug therapy is a key factor to improve patient prognosis. This paper systematically interprets the core points of drug therapy in the expert consensus on the diagnosis and treatment of severe pulmonary tuberculosis， including the treatment principles of “early， combined， regular， appropriate dosage， full course + individualization”， hierarchical drug selection strategies， timing of treatment initiation， as well as drug combination strategies， drug interaction avoidance and dosage adjustment points for special populations such as concurrent fungal infection， human immunodeficiency virus （HIV） infection， and liver/kidney dysfunction. It also elaborates on the clinical application value of dynamic optimization of administration routes and therapeutic drug monitoring （TDM）. The core practical guidelines extracted from this interpretation can reduce the threshold of clinical translation of the consensus and help improve the homogenization level of diagnosis and treatment of severe pulmonary tuberculosis.

In May 2024， the International Society on Thrombosis and Haemostasis （ISTH） released the guidance anticoagulation for stroke prevention in atrial fibrillation and treatment of venous thromboembolism and portal vein thrombosis in cirrhosis， which for the first time issue specific recommendations for anticoagulation treatment in adults with cirrhosis complicated by atrial fibrillation （AF）， venous thromboembolism （VTE）， and portal vein thrombosis （PVT）. The guidance establishe a stratified decision-making system centered on the Child-Pugh Classification： For patients with Child-Pugh A or B cirrhosis and AF， we recommend anticoagulation with standard-dose direct oral anticoagulants （DOACs）. For patients with Child-Pugh C cirrhosis， there is inadequate evidence with respect to the benefit and risk of anticoagulation for stroke prevention in AF； For patients with cirrhosis and acute deep vein thrombosis or pulmonary embolism， we recommend anticoagulation with DOACs or low-molecular-weight heparin （LMWHs） in Child-Pugh A or B cirrhosis and LMWHs alone in Child-Pugh C cirrhosis； We recommend anticoagulation for patients with cirrhosis and symptomatic PVT. We suggest anticoagulation for those with asymptomatic， progressing PVT and recommend continuing extended anticoagulation for liver transplant candidates with PVT. Despite the lack of high-quality evidence， the guideline provides an operational framework for anticoagulation treatment in patients with cirrhosis and has significant reference value for clinical practice in China.

Driven by the dual impetus of the surging demand for anticoagulation therapy and the increasing refinement of pharmaceutical care， pharmacists are confronted with significant challenges in improving both the efficiency and quality of management. From the perspective of pharmacy practice， this paper systematically elucidates the progress and effectiveness of artificial intelligence （AI） technology in areas such as bleeding and thromboembolism risk assessment， intelligent review of anticoagulation orders， anticoagulation therapy decision support， and standardized and personalized medication guidance and education. It explores the role of AI in promoting the transformation of anticoagulation management models toward greater scale， standardization， and individualization. Furthermore， the paper discusses the challenges during implementation， so as to provide a reference for the practice of intelligent pharmaceutical care in anticoagulation therapy.

Objective To investigate the characteristics of prothrombin time （PT） changes in patients with atrial fibrillation （AF） receiving rivaroxaban across different renal function stages， and to analyze the impact of dosage and renal function on PT as well as the incidence of bleeding events. Methods A single-center retrospective study was conducted. Patients were divided into four groups based on creatinine clearance （CrCl）. PT values of patients were collected. Analysis of variance and chi-square tests were used to compare differences in bleeding incidence among renal function groups. Results A total of 4162 AF patients treated with rivaroxaban between September 2021 and September 2023 were included. At the rivaroxaban dose of 15 mg， PT was significantly higher in patients with moderately or severely decreased renal function compared to those patients with normal or mildly decreased renal function. Across all dosage groups， patients with severely decreased renal function exhibited significantly higher PT values and bleeding incidence than other groups. Conclusion For patients with moderately or severely decreased renal function who are treated with rivaroxaban at doses ≥15 mg， enhanced PT monitoring is warranted. In particular， the 20 mg dosage of rivaroxaban should be avoided in patients with severely decreased renal function.

Objective To evaluate the current status of anticoagulation pharmacists' clinical practice in China and provide evidence for optimizing pharmaceutical services and formulating relevant policies. Methods A cross-sectional survey was conducted in April 2025 through electronic questionnaires to investigate anticoagulation pharmacists from 153 hospitals in 21 provinces and municipalities under the Central Government nationwide. Results A total of 184 valid questionnaires were collected （effective response rate： 73.6%）. Anticoagulation pharmacists were predominantly concentrated in tertiary Grade A hospitals （n=154， 83.7%）， primarily serving cardiovascular medicine departments （n=138， 75.0%）. The team was 36-45 years old （n=103， 56.0%）， held intermediate professional titles （n=108， 58.7%）， and 170 pharmacists （92.4%） had received standardized training. Regarding service provision， 135 pharmacists （73.4%） carried out medication education and followed-up survey， 131 （71.2%） participated in medication regimen development and evaluation， 118 （64.1%） managed adverse drug reactions， while only 40 （21.7%） were involved in pharmacogenetic testing interpretation. Pharmaceutical clinics were available in 92（60.1%） hospitals， and anticoagulation clinics in 36 （23.4%） hospitals worked. No charging mechanism was established in institutions where 106 pharmacists （57.6%） worked， and only 4 pharmacists （2.1%） had collaborative prescribing authority. Physician support rate was 82.1% and nurse support rate was 72.3%. Major challenges included insufficient human resources （73.9%）， lack of professional tools （58.2%）， and absence of charging mechanisms （49.5%）. Conclusion Anticoagulation pharmaceutical services in China have preliminarily established a specialized workforce and service system， but challenges persist including low popularity of outpatient services coverage， absence of charging mechanisms， and lack of collaborative prescribing authority.

Objective To evaluate the warfarin anticoagulation knowledge level， awareness of treatment-related issues， and satisfaction of pharmacists among post-cardiac surgery patients and their guardians after receiving medication education from clinical pharmacists. Methods Patients who underwent cardiac surgery and received warfarin anticoagulant therapy in Fuwai Hospital， Chinese Academy of Medical Sciences， along with their guardians， were selected as research subjects from June 2024 to December 2024. At discharge， they received face-to-face medication education and guidance on filling out anticoagulation records from clinical pharmacists， completed a warfarin knowledge questionnaire and a satisfaction survey， and the questionnaire results were statistically analyzed. Results A total of 121 inpatients receiving warfarin anticoagulant therapy were included， 136 questionnaires were collected， and 133 valid questionnaires were finally obtained after excluding duplicate submissions. After receiving medication education from clinical pharmacists， 47.37% of participants had fully mastered warfarin anticoagulation knowledge and treatment-related issues， 43.61% had basically mastered such knowledge， while 9.02% still had insufficient knowledge. Differences of age， relationship with the patient， and place of residence had no significant effect on warfarin anticoagulation awareness （P>0.05）. There was a statistically significant difference in the awareness of warfarin anticoagulation-related knowledge among participants with different educational levels （P<0.05）， and a significant positive correlation was observed （Spearman's rₛ=0.25， P=0.004）， meaning that the higher the educational level， the better the participant's awareness of warfarin anticoagulation knowledge. All participants expressed satisfaction with the medication education provided by clinical pharmacists. Conclusions Warfarin medication education provided by clinical pharmacists to patients or their guardians is an indispensable part of pharmaceutical care. Educational level can significantly affect the warfarin anticoagulation awareness of patients or their guardians. Attention should be paid to the group with low health literacy to provide personalized support； meanwhile， re-education should be conducted targeting knowledge gaps， so as to ensure the safety and effectiveness of warfarin anticoagulation therapy.

An ultra-elderly patient with low body weight was admitted for pulmonary infection. Prolonged immobilization led to the development of bilateral muscular calf vein thrombosis and right posterior tibial vein thrombosis， accompanied by elevated D-dimer levels. Considering the patient's advanced age， body weight below 45 kg， history of gastrointestinal bleeding， and the necessity of drug administration via nasojejunal tube， the pharmacist conducted a comprehensive evaluation of available oral anticoagulants—based on pharmacological properties and formulation suitability for enteral administration. It was recommended to utilize 15 mg once-daily edoxaban regimen， following signed informed consent for off-label use. Alongside anticoagulation therapy， passive lower limb mobilization was implemented. Follow-up venous Doppler ultrasonography confirmed complete resolution of the deep vein thrombosis.

In China， only a minority of dialysis patients achieve recommended serum phosphate targets， underscoring the urgent need for stratified and individualized management. In early chronic kidney disease （CKD）， declining glomerular filtration rate precipitates phosphate retention and dysregulation of the FGF-23/PTH/Klotho axis， driving multi-organ calcification. Conventional interventions exhibit limited efficacy and tolerability such as dietary phosphate restriction， intensified dialysis， and phosphate binders. The advent of tenapanor and other novel agents， together with artificial intelligence （AI） has markedly improved phosphate control and safety， shifting the therapeutic goal from “biochemical normalization” to “patient-centered outcomes.” The 2023 KDIGO Controversies Conference advanced a new paradigm that integrates “CKD-osteoporosis” and “CKD-cardiovascular disease” syndromes. Future strategies will emphasize intensified dialysis， combination pharmacotherapy， and AI-guided individualized decision-making.

Hemophilia B is an X-linked recessive genetic disorder characterized by a deficiency of factor Ⅸ （FⅨ） in the blood， with the primary clinical manifestation being a bleeding tendency. Patients often suffer from recurrent spontaneous bleeding， which seriously affects their quality of life and may even shorten their lifespan. The BBM-H901 injection， an innovative drug independently developed in China， has been approved for market in China in April 2025. Clinical studies have shown that a single infusion of BBM-H901 injection enables the long-term and stable expression of biologically active factor Ⅸ （FⅨ） in the body， thereby providing a sustained therapeutic effect for hemophilia B and demonstrating a good safety. This article introduces the mechanism of action， pharmacodynamics， AAV vector pharmacokinetics， clinical efficacy， and safety of BBM-H901 injection， aiming to provide a new option for the clinical treatment of hemophilia B.

Objective To perform a clinical comprehensive evaluation of gonadotropin-releasing hormone analogs （GnRHa）， focusing on triptorelin and leuprorelin， for central precocious puberty （CPP） in children. Methods Systematic review of guidelines/consensus， relevant literature and multi-source data research were conducted to comprehensively evaluate the effectiveness， safety， economy， suitability， accessibility and innovation. Results The overall efficacy and safety of triptorelin and leuprorelin were similar. The cost minimization analysis showed that the total cost of the 6-month dosage form of triptorelin was the lowest. The specifications and dosage forms of triptorelin were more diverse. The accessibility of the two agents was comparable， and the 6-month forms of triptorelin had the lightest economic burden on families. Both had innovations in structure and device. Conclusion Triptorelin and leuprorelin are efficacious and safe therapeutic options with comparable effectiveness. Among them， the 6-month forms of triptorelin has more comprehensive advantages in compliance and economic outcomes.

Objective To evaluate the changes in lipid profiles after discontinuation of levothyroxine in patients with differentiated thyroid carcinoma （DTC） before radioactive iodine （¹³¹I） therapy， and to analyze the correlation with peak thyroid-stimulating hormone （TSH） level and free thyroxine （FT₄） level. Methods Postoperative DTC patients admitted to Shanxi Province Hospital of Traditional Chinese Medical from March 2022 to March 2025 were enrolled. All patients discontinued levothyroxine for ≥3 weeks in prepare for ¹³¹I therapy. Lipid profiles， including total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）， apolipoprotein B （ApoB） and apolipoprotein A1 （ApoA1） were measured before levothyroxine withdrawal （T₀） and before ¹³¹I therapy （T₁）. The association between changes in lipid parameters and peak TSH and FT₄ levels was analyzed. Results A total of 80 patients were enrolled. Compared with T₀， T₁ showed significant increases in TSH， TC， TG， LDL-C， and ApoB levels， while FT₄， HDL-C， and ApoA1 levels significantly decreased. ΔTC， ΔTG， ΔLDL-C， and ΔApoB correlated positively with TSH peaks and negatively with FT₄ levels； ΔHDL-C and ΔApoA1 correlated negatively with TSH peaks and positively with FT₄ levels. Stratified by median TSH， the ΔLDL-C and ΔApoB in the high TSH group （≥71.80 mU/L） were significantly higher than those in the low TSH group. Stratified by median FT₄， the ΔLDL-C in the low FT₄ group （<10.40 pmol/L） was significantly higher than that in the high FT₄ group. After adjusting for confounding factors， TSH peaks were independent positive predictors of ΔLDL-C， ΔApoB， and ΔTG， while FT₄ levels were independent negative predictors of these indicators. Conclusion Short-term hypothyroidism induced by levothyroxine withdrawal is associated with adverse lipid profile changes， and the extent of these changes correlates with TSH elevation and FT₄ decline.

Objective To investigate the short-term effects of a fixed-dose triple inhalation regimen （beclometasone/formoterol/glycopyrronium） versus a fixed-dose dual inhalation regimen （budesonide/formoterol） on pulmonary hyperinflation and exercise tolerance in patients with chronic obstructive pulmonary disease （COPD）. Methods A retrospective analysis was conducted on patients with stable COPD treated from May 2023 to April 2025. Patients were categorized based on their initial fixed-dose maintenance inhalation regimen after adjustment. After 1∶1 propensity score matching， patients were included in the observation group and in the control group. Changes in inspiratory capacity （IC）， lung volume parameters ［functional residual capacity （FRC）， residual volume/total lung capacity ratio （RV/TLC）］， and 6-minute walk distance （6MWD） were compared between the two groups after 12 weeks of treatment. Results A total of 127 patients were included， with 48 cases each in the observation group and the control group after matching. After treatment， the increase in IC from baseline was significantly greater in the observation group （0.18±0.02 L） compared to the control group （0.07±0.01 L） ［adjusted mean difference （aMD）=0.113 L， P<0.001］. The observation group also showed significantly greater reductions in RV/TLC （-3.13±1.21%） and FRC （-0.29±0.05 L） than in the control group （all P<0.05）. Furthermore， the increase in 6MWD was significantly higher in the observation group （38.52±13.13 m） than in the control group （18.26±5.05 m） （aMD=20.302 m， P=0.012）. Conclusion Compared with the fixed-dose budesonide/formoterol dual regimen， the fixed-dose beclometasone/formoterol/glycopyrronium triple regimen is associated with greater short-term improvement in inspiratory capacity， reduction of pulmonary hyperinflation， and enhancement of exercise tolerance in patients with COPD.

Objective To compare the efficacy of sertraline combined with exposure and response prevention （ERP） or repetitive transcranial magnetic stimulation （rTMS） in treating obsessive-compulsive disorder （OCD）. Methods Patients with OCD from April 2023 to April 2025 were enrolled and randomly divided into ERP group and rTMS group using a random number table. Both groups received sertraline dose titration to a maintenance dose of 150-200 mg/day. The ERP group underwent structured individualized ERP therapy for 8 sessions over 4 weeks， while the rTMS group received low-frequency rTMS for 20 sessions over 4 weeks. Changes in scores on the Yale-Brown Obsessive Compulsive Scale （Y-BOCS）， Hamilton Depression Rating Scale （HAMD）， Hamilton Anxiety Rating Scale （HAMA）， Acceptance and Action Questionnaire-Ⅱ （AAQ-Ⅱ）， and Cognitive Fusion Questionnaire （CFQ） scores were compared after treatment， along with adverse events. Results A total of 120 patients were enrolled， with 60 patients in each group. 57 cases in the ERP group and 56 cases in the rTMS group completed the study. No statistically significant differences were observed in pre-treatment scores between the two groups. Aftertreatment， both groups showed reduced Y-BOCS total scores， obsessive-compulsive thoughts， and compulsive behaviors， with the rTMS group exhibiting lower scores than the ERP group （total score： 17.89±3.74 vs 20.88±3.89， P<0.001； obsessive-compulsive thoughts： 8.97±2.05 vs 10.46±2.18， P<0.001； compulsive behaviors： 8.92±2.12 vs 10.42±2.21， P<0.001）. After treatment， both groups showed decreased HAMD and HAMA scores， but there was no statistically significant differences between the two groups. Both groups showed reduced AAQ-Ⅱ and CFQ scores Aftertreatment， with more significant improvements in the ERP group （AAQ-Ⅱ： 28.09±3.18 vs 33.03±3.33， P<0.001； CFQ： 30.16±3.58 vs 34.84±4.24， P<0.001）. The incidence of adverse events did not differ significantly between the two groups. Conclusion Sertraline combined with rTMS is superior to sertraline combined with ERP in reducing the core severity of obsessive-compulsive symptoms in the short term， whereas sertraline combined with ERP is more advantageous in improving psychological flexibility. Both combined regimens effectively alleviated anxiety and depressive symptoms with good safety profiles.

We report a rare case of immune-related cholestasis in a breast cancer patient after treatment with Toripalimab. According to the Naranjo scale， imaging findings and the patient's follow-up treatment， it was determined to be cholestatic liver injury induced by Toripalimab. After treatment with Meprednisone and Ursodeoxycholic Acid， the patient's bilirubin was significantly improved. At the same time， the literature review on immune-related cholangitis is also provided.

This case report describes the diagnosis and management of active Crohn's disease in a 20-year-old male patient with psoriasis following long-term treatment with ixekizumab. Through multidisciplinary consultation， the diagnosis was confirmed， ixekizumab was discontinued， and the treatment was switched to ustekinumab， resulting in dual remission of both psoriasis and Crohn's disease. The potential mechanisms by which IL-17 inhibitors may trigger intestinal inflammation are discussed， along with biologic treatment strategies based on the concept of "treating different diseases with the same treatment" for patients with coexisting psoriasis and Crohn's disease. The case highlights the crucial role of pharmaceutical care in identifying adverse reaction risks and individualized therapy.