The authors confirm that the PI for this paper is Rongsheng Zhao and that he had direct clinical responsibility for patients included in the study investigating the patients' willingness on individualized medication of high-dose methotrexate.

To achieve tumor-specific delivery of doxorubicin, TiO@FeO/PEI/delivery of doxorubicin conjugates were designed and synthesized. FeO could act as magnetically responsive carriers and enhance the visible light photodynamic activities of TiO Delivery of doxorubicin was conjugated via coordination bond. The drug release rate at pH 5.2 was much faster than that at pH 7.4, due to pH-sensitive coordination bond. Besides, TiO@FeO/PEI/delivery of doxorubicin showed high antitumor efficacy combining with phototherapy, good bio-safety, higher cellular uptake with an external magnetic field, and less toxicity in vitro and in vivo. These results suggested that TiO@FeO/PEI/delivery of doxorubicin may be promising for high tumor treatment efficacy with minimal side effects in future.

Methotrexate (MTX) is widely used in clinical settings for the treatment of various cancers and immunology diseases. Low-dose methotrexate (LDMTX, ≤50 mg/m 2) is always applied for non-oncologic conditions, such as rheumatic arthritis (RA), ectopic pregnancy (EP) and placenta accrete (PA). 1 Common toxicities of LDMTX, including nausea, oral mucositis, elevated ALT, punctate cutaneous eruption, CNS symptoms, alopecia and fever, which are always considered mild or moderate. 2 Severe LDMTX-induced adverse drug reactions (ADR) for PA treatment have not been previously reported. Placenta accreta is recognized by the abnormal attachment of the placenta villi to the uterine wall and is an important cause of maternal morbidity and mortality because of the high risk of delayed haemorrhage and sepsis. 3 During the past few decades, the incidence of PA has increased significantly as a consequence of the upsurge in Caesarean section deliveries, which have now reached a rate of approximately 1 per 1000 deliveries. 4 LDMTX remains one of the recommendations in the management of PA, 5-7 although there are still controversial data about its usage. Herein, we present the first known case of a PA patient who developed severe lethal adverse effects induced by LDMTX.

Background: Pharmacist-led clinical pathways/order sets (PLCOs) were first applied for designated diseases and surgical operations, such as cancer. They were not used in pharmacotherapy until recently. After screening a large number of publications, we found that PLCOs were rarely accessible.Objective: To evaluate the effects and the changes of relevant medical outcomes of PLCOs.Methods: Articles from PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang database, and China Biology Medicine disc (CBM) were systematically retrieved. Clinical research comparing cancer patients’ clinical effects with or without clinical pathway/order sets was performed. Two reviewers performed quality assessment, and the data were abstracted independently. A narrative synthesis of the extracted data was performed due to heterogeneity.Results: Nine studies were identified, including six uncontrolled before–after studies and three case-series studies. The scopes of PLCOs of included research can be divided into two types, one focusing on chemotherapy agents and the other on the managements of chemotherapy-induced complications. The PLCOs shortened hospital length of stay, decreased initial antibiotic time intervals in patients with febrile neutropenia, reduced medication error incidence, and increased physicians’ adherence rate to clinical pathway/order sets. Moreover, three articles included economic effects showing positive savings on medication costs through PLCOs.Conclusion: PLCOs can have beneficial effects on medication effectiveness, safety, and economic outcomes. Nevertheless, clinical pathway/order sets need to be further optimized and expanded to other clinical areas.