Narrow therapeutic index drugs （NTIDs） are drugs where small alterations in the dose or blood concentration may lead to serious therapeutic failures and/or adverse drug reactions that are life-threatening or persistently or significantly cause disability/incapacity. The rational clinical use of NTIDs helps prevent or avoid ineffective drug therapy， ensuring medication safety and reducing drug-related risks. To enhance the understanding of NTIDs among clinicians， pharmacists， and other healthcare professionals， and to standardize the rational use of these drugs， this consensus aims to improve the safety of NTID clinical applications. This consensus was developed by the Hospital Pharmacy Professional Committee of Chinese Pharmaceutical Association and the Clinical Pharmacy Branch of Chinese Medical Association. It provided guidance on therapeutic drug monitoring （TDM）， pharmacogenetic testing， drug interactions， adverse drug reaction management， overdose management， medication use in special populations， and principles for drug substitution.
OBJECTIVE This study aims to investigate the mechanism of Huaier in regulating the proliferation and apoptosis of chronic myeloid leukemia （CML） cell line K562. METHODS K562 cells were induced with Huaier at different concentrations alone or in combination with imatinib. Cell proliferation was determined by CCK-8 assay. The combination index （CI） was calculated using CompuSyn software to study the interaction between Huaier and imatinib. Flow cytometry was used to measure cell apoptosis， cell cycle distribution， and intracellular reactive oxygen species （ROS） levels. Oxidative stress-related markers were also measured with reagent kits， such as catalase （CAT）， glutathione peroxidase （GSH-PX）， and total superoxide dismutase （T-SOD）. Western blot analysis was performed to detect the expressions of proteins related to the PI3K/AKT/NF-κB signaling pathway. RESULTS Huaier significantly inhibited K562 cell proliferation. Drug interaction analysis revealed synergistic effects （CI < 1） at Huaier concentrations of 1， 2， 4， 8 and 16 mg·mL–1 combined with 1 μmol·L–1 imatinib over 48 hours， yielding CI values of 0.92， 0.70， 0.59， 0.67 and 0.78， respectively. Huaier significantly inhibited the proliferation of K562 cells， induced G0/G1 cell cycle arrest， and promoted cell apoptosis. It significantly reduced intracellular oxidative stress-related antioxidant enzyme indicators， and increased ROS levels. Mechanistically， Huaier significantly inhibited the protein expressions of p-PI3K/PI3K， p-Akt/Akt， and NF-κB p-P65/P65. Moreover， a synergistic effect was observed when Huaier was combined with imatinib. CONCLUSION Huaier can promote apoptosis of K562 cells by inhibiting the ROS/PI3K/AKT/NF-κB signaling pathway.
OBJECTIVE To explore the clinical efficacy and safety of Shenshao Tablets in improving exercise tolerance in chronic heart failure （CHF） patients with traditional Chinese medicine （TCM） of Qi deficiency and blood stasis syndrome. METHODS A total of 112 CHF patients with TCM syndrome of Qi deficiency and blood stasis were included， and they were randomly divided into the treatment group and control group by the random number table method， with 56 cases in each group. Patients in the control group were treated with standardized drug therapy for CHF， and those in the treatment group were treated with Shenshao Tablets plus standardized drug therapy for CHF. All patients were required to have continuous interventions for 8 weeks. The main efficacy indicators ［metabolic equivalents （METs）， and 6-minute walking distance （6MWD）］ and secondary efficacy indicators ［TCM symptom scores， New York Heart Association （NYHA） cardiac function classification， amino-terminal pro-B-type natriuretic peptide （NT-proBNP）， and Kansas city cardiomyopathy questionnaire （KCCQ） scores］ were compared between the two groups before and after treatment. The occurrence of adverse events was observed for safety analysis. RESULTS All of the 112 CHF patients completed this study， and data from 56 patients in each group were included in the analysis. Intra-group comparisons showed that the METs， 6MWD， and KCCQ scores after treatment significantly increased （P<0.05）， and the TCM symptom scores， NT-proBNP levels， and NYHA cardiac function grading significantly decreased in comparison to pre-treatment values in both groups （P<0.05）， and the improvement in the treatment group was more obvious than the control group （P<0.05）. The total effective rates of TCM syndromes （91.07% vs 75.00%） and cardiac function （85.71% vs 73.21%） in the treatment group were significantly higher than the control group （P<0.05）. A total of 12 cases of adverse events occurred during the treatment period， all of which were admitted to the hospital due to the aggravation of wheezing evidence caused by upper respiratory tract infections. Adverse events were reported by 7 （12.5%） patients in the treatment group and 5 （8.93%） patients in the control group， and the incidence of adverse events was comparable in both groups （P>0.05）. CONCLUSION Shenshao Tablets demonstrated significant efficacy and good safety in improving exercise tolerance of CHF patients with TCM syndrome of Qi deficiency and blood stasis.
OBJECTIVE To investigate the effect of emodin on the composition of gut microbiota in chronic renal failure （CRF） rats by regulating the toll-like receptor 4/myeloid differentiation primary response 88/nuclear factor kappa B （TLR4/MyD88/NF-kappaB） signaling pathway. METHODS A CRF rat model was established by intragastric administration of adenine. The successfully modeled rats were divided into the model group， low-dose emodin group， high-dose emodin group， high-dose emodin+LPS （TLR4 activator） group， and control group. The contents of urea nitrogen （BUN）， creatinine （Scr）， arginine vasopressin （AVP） and creatinine clearance in serum were detected. Serum tumor necrosis factor-alpha （TNF-α）， interleukin （IL）-6， and IL-1β were measured by enzyme-linked immunosorbent assay （ELISA）. The pathological changes in the kidneys of rats was observed by hematoxylin and eosin （H&E） staining. Changes in gut microbiota in rats were detected by differential culture medium. The mRNA expressions of TLR4， MyD88， and NF-κB in renal tissues were detected by reverse transcription-quantitative polymerase chain reaction （RT-qPCR）. The protein expressions of Bax， Bcl-2， TLR4， MyD88， and p-NF-κB/NF-κB in rat kidney tissue were examined by Western blot. RESULTS The renal tissue structure of rats in the control group was normal. Compared with the control group， rats in the model group had glomerular atrophy and sclerosis， disordered arrangement of renal tissue cells， obviously widened renal interstitium， accompanied by a large number of inflammatory cell infiltration， and epithelial cell degeneration and necrosis. Serum BUN， Scr， AVP levels， TNF-α， IL-6 and IL-1β levels， abundances of Enterococcus and Enterobacteriaceae， mRNA levels of TLR4， MyD88 and NF-κB in kidney tissue， and protein levels of Bax， TLR4， MyD88， and p-NF-κB/NF-κB significantly increased， while the creatinine clearance， abundances of Bifidobacterium and Lactobacillus， and protein expression of Bcl-2 significantly decreased （P<0.05）. Compared with the model group， the renal tissue structure and morphology of rats in the low-dose and high-dose Emodin groups were obviously improved. Serum BUN， Scr， AVP levels， TNF-α， IL-6 and IL-1β levels， abundances of Enterococcus and Enterobacteriaceae， mRNA levels of TLR4， MyD88 and NF-κB in kidney tissue， and protein levels of Bax， TLR4， MyD88， and p-NF-κB/NF-κB significantly decreased， while the creatinine clearance， abundances of Bifidobacterium and Lactobacillus， and protein expression of Bcl-2 significantly increased （P<0.05） LPS can reduce the ameliorative effect of emodin on CRF rats （P<0.05）. CONCLUSION Emodin can promote the growth of intestinal beneficial bacteria， inhibit harmful bacteria， reduce inflammation and alleviate kidney injury in CRF rats， possibly by inhibiting the TLR4/MyD88/NF-κB signaling pathway.
OBJECTIVE To explore the effects of the Qushi Huayu Formula on the BVRA-GSK3β-PPARα signaling pathway in in vitro and in vivo models of metabolic dysfunction-associated fatty liver disease （MAFLD）. METHODS An in vitro MAFLD model was established using the liver cell line L02. Cells were treated with blank control， MAFLD modeling， MAFLD modeling plus Qushi Huayu Formula， and MAFLD modeling plus Essentiale for 48 hours. The content of triglycerides （TG） in cells was detected， and reverse transcription-polymerase chain reaction （RT-PCR） was used to detect the mRNA expressions of BVRA， GSK3β and PPARα. Sprague-Dawley （SD） rats were randomly divided into the control group， model group， Qushi Huayu Formula group， and Essentiale group （positive control）， with 8 rats in each group. Rats in the control group received a standard diet， while those in the remaining groups were fed with a high-fat diet for creating an in vivo model of MAFLD. From the fifth week of modeling， medication was administered for 4 consecutive weeks. Serum samples were collected from each group to assess the concentrations of various biochemical markers， including total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）， aspartate aminotransferase （AST）， and alanine aminotransferase （ALT）. Hematoxylin and eosin （H&E） staining was employed to examine pathological alterations and the extent of liver inflammation in liver tissue. Additionally， Oil Red O staining was utilized to assess lipid accumulation in the liver， while Western Blot analysis was conducted to evaluate the protein expression levels of BVRA， GSK3β， and PPARα. RESULTS In vitro experiments showed that compared with the model group， L02 cells induced with Qushi Huayu Formula had a significantly reduced TG content （P<0.05）， and upregulated mRNA levels of BVRA， GSK3β， and PPARα （P<0.01）. In vivo experiments revealed that compared with the model group， rats in the Qushi Huayu Formula group had reduced spherical lipid droplets and inflammatory cell infiltration in liver tissue， significantly improving lipid accumulation. Serum HDL-C significantly decreased （P<0.01）， while TG， LDL-C， AST， and ALT all significantly increased （P<0.01）. Protein expressions of BVRA， GSK3β， and PPARα were significantly elevated （P<0.01）. CONCLUSION Qushi Huayu Formula improves hepatic lipid metabolism and reduces lipid deposition through the BVRA-GSK3β-PPARα signaling pathway， thereby effectively ameliorating MAFLD.
OBJECTIVE To analyze the predictive quality markers of Cinnamomi Oleum （CO） against coronary heart disease. METHODS Soxhlet extraction method was used to extract the oil of CO.The fingerprints of 10 batches of CO were constructed by gas chromatography-mass spectrometry （GC-MS）， and then subjected to cluster analysis and principal component analysis （PCA）. The coronary heart disease model in Sprague-Dawley （SD） rats was established， and the effects of 10 batches of CO on triglyceride （TG）， total cholesterol （TC）， cardiac troponin I （cTn-I）， creatine kinase （CK）， lactate dehydrogenase （LDH）， and aspartate transaminase （AST） levels were detected. Gray correlation analysis and partial least squares regression analysis were also used to screen the quality markers （Q-markers） of CO against coronary heart disease， which were compared with 3-hydroxy-3-methylglutaryl-coenzyme A reductase （HMGCR）， Niemann-Pick C1Like1 （NPC1L1） and the preprotein convertase subtilisin/kexin type 9 （PCSK9） for molecular docking. RESULTS A total of 81 chemical constituents were identified by GC-MS， mainly including monoterpenes， sesquiterpenes， aliphatic and alkane constituents. Fingerprints selected nine common peaks with similarities ranging from 0.96 to 0.99. The 10 batches of CO were classified into three categories through cluster analysis and PCA， and all of them could reduce TG and TC contents， and AST， CK and LDH activities in the serum of rats with coronary heart disease. Gray correlation analysis and partial least squares regression analysis showed that 3，8-p-Menthadiene， p-cymene had strong correlation with all six indexes （TG， TC， cTn-I， CK， LDH， and AST）. Molecular docking showed that 3，8-p-Menthadiene， and p-cymene had strong binding activities with HMGCR， NPC1L1， PCSK9. CONCLUSION This study established the fingerprints of CO and analyzed its anti-coronary heart disease effects by spectrum-effect relationship. Furthermore， the 3，8-p-Menthadiene， p-cymene are the Q-markers for the anti-coronary heart disease effects of CO， showing strong binding activity to key proteins of the cholesterol synthesis and transport pathway in the development of coronary heart disease.
OBJECTIVE To investigate the immunoregulatory mechanism of Wuyi Yinqiao Fangyi Prescription on lipopolysaccharide （LPS）-induced acute lung injury in mice. METHODS ICR male mice were randomly divided into the control group， LPS model group， and low-dose （10 g crude drug/kg） and high-dose （20 g crude drug/kg） Wuyi Yinqiao Fangyi Decoction groups. The corresponding concentration of Water extract solution of low-dose （10 g crude drug/kg） and high-dose （20 g crude drug/kg） Wuyi Yinqiao Fangyi Decoction was performed in mice of the low-dose and high-dose Wuyi Yinqiao Fangyi Decoction groups， and the same volume of normal saline was given in the control group and LPS model group. After 4 weeks of intervention， except for the control group， mice in the other three groups were treated with intraperitoneal injection of LPS （5 mg·kg–1） to induce acute lung injury. After anesthesia and blood collection， the lung tissue was dissected and the pathological changes of lung tissue in each group were detected by hematoxylin and eosin （H&E） staining. The protein expressions of immunoglobulin A （IgA） and polyimmunoglobulin receptor （pIgR） in lung mucosa were detected by Western blotting. The levels of interleukin-4 （IL-4）， interleukin-6 （IL-6）， transforming growth factor-β （TGF-β）， interferon-γ （IFN-γ） and tumor necrosis factor-α （TNF-α） were detected by enzyme-linked immunosorbent assay （ELISA）. The distribution and intensities of angiotensin converting enzyme （ACE）， ACE2 and angiotensin II （Ang II） were detected by immunohistochemistry （IHC）. RESULTS Wuyi Yinqiao Fangyi Prescription significantly reduced LPS-induced acute lung injury in mice in a dose-dependent manner and effectively inhibited the down-regulation of IgA and pIgR protein expressions and the increases in related cytokines （IL-4， IL-6， TGF-β and IFN-γ， TNF-α） in lung mucosa of mice with acute lung injury. It significantly inhibited the immediate decreases in ACE and ACE2 protein distribution and intensities in lung mucosa of mice with acute lung injury and the increase in Ang II protein distribution and intensity. CONCLUSION Wuyi Yinqiao Fangyi Prescription may regulate the expression of IgA and pIgR related to mucosal immunity in lung tissue injury and their associated inflammatory factors， as well as inhibits the decreases in ACE and ACE2 proteins and overexpressed Ang II in lung mucosa， thereby reducing the degree of LPS-induced acute lung injury by regulating the immune function of lung mucosa.
OBJECTIVE To establish an on-line evaluation system of ultra-high-performance liquid chromatography coupled with biochemical detection （UHPLC-BCD） for rapidly screening the tyrosinase inhibitors in the different batches of tea， and to evaluate the differences in the activity of the main active components of the different tea extracts and the inhibitory types of main active components on tyrosinase. METHODS The UHPLC-BCD method was used to rapidly screen tyrosinase inhibitors in 14 batches of the tea samples from the different habitats and the preparation processes. Ultra-high-performance liquid chromatography linear ion trap/Orbitrap high resolution mass spectrometry （UHPLC-LTQ/Orbitrap MS）was applied to identify the tyrosinase inhibitors. The inhibitory activities of the tea extracts were compared based on the content-effect relationship. The enzyme kinetics was applied to assess the reaction types of the main active ingredients inhibiting tyrosinase. RESULTS UHPLC-BCD screened out that Epigallocatechin（EGC）and Epigallocatechin gallate（EGCG） in the tea samples showed stronger activities against tyrosinase， and their activities were significantly different. The titer range of EGC was 0.138–1.580 mg·mL–1， and that of EGCG was 2.143–5.900 mg·mL–1. The analyzed data of enzyme kinetics showed that the action types of EGC and EGCG against tyrosinase were the mixed inhibition types. CONCLUSION UHPLC-BCD method can be applied to a rapid screen of tyrosinase inhibitors in the matrixes and objective evaluation of the activity differences of the batches of the complex extracts. This method provides a new idea and way for the discovery of natural activity compounds and the quality control of the complex matrixes.
OBJECTIVE To comprehensively evaluate the quality of Selaginella doederleinii from different origins using high-performance liquid chromatography （HPLC） fingerprinting and content determination combined with chemical pattern recognition method. METHODS Using a Thermo Scientific Betasil-C18 column （250 mm × 4.6 mm， 5 μm） with a detection wavelength of 330 nm and a mobile phase of acetonitrile 0.1% formic acid aqueous solution， a gradient elution HPLC technique was employed to construct the fingerprint spectra of 31 batches of S. doederleinii. At the same time， a quantitative analysis was conducted on the amentoflavone in 31 batches of S. doederleinii， and a comprehensive evaluation was conducted on 19 batches of S. doederleinii using chemical pattern recognition. RESULTS HPLC fingerprinting showed that 31 batches of test samples were divided into two categories， including 19 batches of S. doederleinii and 12 batches of S. moellendorffii. Heveaflavone and 7''-O-Methylsciadopitysin were unique components of S. doederleinii. Although there were three common peaks between the S. doederleinii and S. moellendorffii， distinct differences were found in their chemical compositions. The amentoflavone content of them was within 1.88–14.92 mg·g–1， and 20.42–25.23 mg·g–1， respectively. Chemical pattern recognition analysis divided 19 batches of S. doederleinii into two groups， and screened out 7 differential components that affect the quality of S. doederleinii through VIP value analysis. CONCLUSION The established method has good stability and high sensitivity. Through a combination with chemical pattern recognition， it can provide scientific basis for the identification and quality control of different origins of S. doederleinii， ensuring its medicinal value and the safety and effectiveness of clinical use.
OBJECTIVE To detect 9 exogenous impurities in Shexiang Jiegu Capsules， and to investigate the quality risk of this preparation. METHODS Contents of 9 components in Shexiang Jiegu Capsules were detected by ultra-performance liquid chromatography coupled with tandem mass spectrometry （UPLC-MS/MS）， including the adulterated substances of loureirin A and loureirin B， staining agent of 808 scarlet， Sudan Red Ⅰ， Sudan Red Ⅱ， Sudan Red Ⅲ， Sudan Red Ⅳ， similar chemical drugs of diclofenac sodium and paracetamol. The samples were ultrasonically extracted with methanol， separated by chromatographic column， eluted with acetonitrile-0.1% formic acid solution in gradient mode， and detected by electrospray ion source with positive mode and multiple reaction monitoring （MRM） mode. RESULTS Loureirin A， loureirin B， 808 scarlet， Sudan Red Ⅰ， Sudan Red Ⅱ， Sudan Red Ⅲ， Sudan Red Ⅳ， diclofenac sodium， and paracetamol had good linear relationships within their respective concentration ranges， with correlation coefficients ≥0.999 0. The average recoveries were 87.2%–113.6%. The method was used to screen 26 batches of samples， of which loureirin A and loureirin B were detected in 6 batches， and paracetamol was detected in 2 batches. CONCLUSION There are exogenous impurities in Shexiang Jiegu Capsules with a certain quality risk. It is necessary to consider improving the quality standard of the preparation， supplementing the test method of adulteration of draconis sanguis and illegal additives.
OBJECTIVE To evaluate the bioequivalence of the tested drug and reference tadalafil tablets in healthy adult male subjects. METHODS This was a single-center， open-label， random， single-dose， double-period， crossover dosing trial. Healthy male subjects were randomly divided into the fasting group and the fed group， and were given 20 mg of the tested drug（T） and reference drug （R） orally in two cycles， respectively. Plasma tadalafil concentration was determined by liquid chromatography tandem mass spectrometry （LC-MS/MS） with a quantitative range of 1.00–500.00 ng·mL–1. Non-compartmental pharmacokinetic calculations were conducted using Phoenix WinNonlin version 8.3， and other data processing was performed using SAS version 9.4. RESULTS Sixty-six healthy male subjects were enrolled in the trial， involving 36 in the fasting group and 30 in the fed group. The main pharmacokinetic parameters of the tested and reference drugs under fasting condition were as follows： Cmax：（271.01±65.17） ng·mL–1vs. （258.89±74.21） ng·mL–1； AUC0-t ：（8 579.83±2 472.21） h·ng·mL–1vs. （8 561.28±2 507.65） h·ng·mL–1； AUC0-∞ ：（9 464.97±2 948.89） h·ng·mL–1vs. （9 587.69±3 226.52） h·ng·mL–1. The 90% confidential interval （CI） of Cmax， AUC0-t and AUC0-∞ of tested drug was 100.93%–113.19%， 96.17%–109.16% and 95.30%–109.08%， respectively. The main pharmacokinetic parameters of the tested and reference drugs under the fed condition were as follows： Cmax：（380.45±103.64） ng·mL–1vs. （362.97±99.58） ng·mL–1； AUC0-t ：（9 683.25±3 368.31） h·ng·mL–1vs. （9 304.30±3 234.56） h·ng·mL–1： AUC0-∞：（10 540.82±4 422.77） h·ng·mL–1vs. （10 047.20±4 161.09） h·ng·mL–1. The 90% CI of Cmax， AUC0-t and AUC0-∞ of the tested drug was 98.28%–114.33%， 95.68%–110.95%， and 95.59%–112.20%， respectively. CONCLUSION The two formulations are bioequivalent in the rate and extent of absorption in healthy Chinese male adults.
OBJECTIVE To construct and validate the hierarchical management model for multidrug patients with hypertension based on the Triangle theory， and to evaluate its effect in practice. METHODS Through literature review combined with data analysis of hypertension patients hospitalized in the Cardiovascular Department of Wuhan No.1 Hospital from October 2023 to March 2024， the hierarchical management method was performed by resident pharmacists and evaluated for the effect of pharmaceutical care. The evaluation indexes included blood pressure management quality， pharmaceutical-related quality indexes and pharmacists’ management time investment. RESULTS A systematic hierarchical management method was established， covering two levels： hierarchical management and whole-process management. A total of 112 patients were included. Compared with the whole-process management group， the graded management group performed better in blood pressure effect， compliance， medication knowledge score， and medical costs. In addition， the hierarchical management significantly reduced the management time of resident pharmacists， including the total management time， pharmaceutical ward round time， pharmaceutical ward round preparation time and pharmaceutical care time， doctor’s order review time， discharge medication education time and the average pharmaceutical management time of patients （P<0.05）. CONCLUSION The hierarchical management model established by resident pharmacists not only accurately identifies high-risk patients， and improves management quality， but also effectively reduces the work burden of pharmacists. The implementation of this model improves the management efficiency， and quantity and quality of pharmacists’ management of patients with chronic diseases， and provides a new and effective management strategy for the pharmaceutical care of patients with hypertension multi-medication.
OBJECTIVE To explore the clinical application of oxcarbazepine （OXC） in the management of epileptic seizures， focusing on the analysis of the recommendations and differences among various national guidelines and consensus. METHODS By searching databases such as PubMed， China National Knowledge Infrastructure （CNKI）， English-language databases， and Medlive Guideline Network， clinical practical guidelines related to OXC were collected and summarized to assess its applicability and recommendation for different types of seizures. RESULTS While there were slight variations in specific recommendations among different countries or regions， OXC was generally recommended for the use of focal seizures with or without secondary generalized seizures， generalized tonic-clonic seizures， and certain self-limited focal epilepsy syndrome in children. Additionally， OXC can also be considered for epilepsy patients with comorbidities， such as depression， bipolar disorder， and neuropathic pain. CONCLUSION In conclusion， based on the summary and analysis of existing guidelines and expert consensus， the indications and usage precautions of OXC are clarified， so as to provide important reference for clinical treatment decision-making.
OBJECTIVE To compare the safety and effectiveness of the generic drug of meropenem （trade name： Beineng） and the brand-name drug （trade name： Mepem） in combating infections in the real world. METHODS Diagnosis and treatment data of adult patients using Mepem and Beineng in Sichuan Provincial People’s Hospital， School of were retrospectively collected， and the effectiveness and safety of Beineng and Mepem in the real world were compared through propensity score matching （PSM）. RESULTS A total of 2 288 patients were eligible in the study， involving1，414 （61.8%）males and 874 （38.2%）females. After PSM， there were 600 cases each in the Beineng group and Mepem group ［729（60.8%） males and 471（39.2%） females］. Effectiveness analysis showed no significant differences in clinical efficacy， reduction of C-reactive protein （CRP）， procalcitonin （PCT）， white blood cell count （WBC）， neutrophil percentage （NEUT%）， and pulmonary imaging efficacy between the Beineng group and the Meiping group （P>0.05）. The bacterial clearance rate of the Mepem group was significantly higher than that of the Beineng group ［120（20.0%） vs. 83（13.8%）， P<0.01］， but this difference may be affected by multiple factors， and its clinical significance is still unclear. Safety analysis showed no significant difference in the incidence of adverse events between the two groups ［20（3.3%） vs. 25（4.2%）， P=0.447］. There were no significant differences in the incidences of abnormal creatinine （Cr）， alanine transaminase（ALT）， aspartate aminotransferase（AST）， total bilirubin （TBiL）， hemoglobin （Hb）， platelet count （PLT）， and eosinophil count between the two groups （P>0.05）. CONCLUSION In this study， Beineng and Mepem perform equally well in the efficacy and safety in real-world settings. The difference in bacterial clearance rate suggests that the brand-name drug may have certain advantages， and the relevant findings still need further research and verification.
OBJECTIVE To create a dynamic monitoring system for the national centralized drug procurement （NCDP） to enable automated data processing and analysis， providing reliable technical support for the orderly execution of procurement tasks. METHODS A customized data analysis script was prepared using R language by extracting the usage data of centralized procurement drugs from the Hospital Information System （HIS） system of the Third People’s Hospital of Chengdu. This script enabled intelligent data cleaning and standardization， followed by automated statistical analysis of drug information across different centralized procurement batches， the completion status of procurement tasks， and the impact of centralized procurement on drug usage. Additionally， with the help of ggplot2 and rmarkdown packages， data visualization was achieved， and reproducible R markdown documents were created to notify each department about the unqualified drugs for task targets. RESULTS Automated data processing and analysis based on R language provides key metrics like the drug task amounts for each centralized procurement batch and the completion rates of departmental tasks. Data visualization intuitively displays the drug usage status， while the generated R markdown documents offer detailed progress evaluation and progress monitoring of task drugs for relevant departments. CONCLUSION A dynamic monitoring system created for centralized drug procurement using R programming language enables comprehensive， efficient， and accurate evaluation of centralized drug procurement task progress. This contributes to optimizing drug procurement and resource allocation， enhancing the rational use of medications， and improving the operational efficiency of healthcare institutions.
A large number of microorganisms exist in the human gastrointestinal tract. These gut microbial communities participate in critical pathophysiological processes， including the development and function maintenance of the nervous system， immune system maturation and homeostasis， and the regulation of endocrine-metabolic functions. They are crucial for maintaining normal physiological homeostasis and health，while also influencing the pathogenesis and progression of various diseases， including malignancies. Moreover， the gut microbiota participates in the absorption，metabolism and excretion of drugs in the intestine， which significantly affects the in vivo pharmacokinetic of many drugs. Consequently， gut microbiota is one of the important factors influencing the efficacy or safety of such drugs. The extensive use of antibacterial agents in clinical practice can disrupt the normal gut microbiota and may have an impact on the progress of various diseases and the effectiveness of drug treatment. Among them， the effect of antibacterial agents on the efficacy of antitumor drug treatment by interfering with the gut microbiota is of particular concern. This review synthesized recent studies on antibiotic-induced gut microbiota perturbations and their impact on the efficacy of tumor chemotherapy， immunotherapy， and targeted therapies， providing insights to optimize anti-cancer treatment strategies.
The 2023 《International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome》 stated that letrozole （LE） is the preferred first-line drug for infertility with polycystic ovary syndrome （PCOS）. It has the advantages of short half-life， good ovulation promotion and low impact on the endometrium. However， there are still controversies about the optimal period for ovulation induction， the optimal dose and the duration of medication. This article briefly reviewed the mechanism and the advantages of LE in the treatment of PCOS， the problems faced， the combination of drugs， and the application to endothelial preparation protocols for of LE in frozen embryo transfer. This study provided a scientific basis for the initiation time， dosage and duration of the use of LE to induce ovulation in PCOS patients with ovulation disorder infertility， thus achieving the best safe and effective ovulation induction effect. Meanwhile， we also provided a direction for clinical research reference in this field.
Corticosteroids are important therapeutic drugs for IgA nephropathy， although potentially inducing a series of adverse events. This article reported a patient with IgA nephropathy who experienced serious adverse events like poor control of blood pressure， elevated plasma glucose and uric acid levels， and gastric ulcer during treatment with methylprednisolone tablets. The pharmacists provided medication therapy management （MTM） services for the patient through pharmacy inquiry， medication evaluation， medication reconciliation， medication education， pharmacy follow-up， and therapeutic regimen optimized by physician-pharmacist collaboration. The patient had good treatment compliance， and methylprednisolone-associated adverse events were effectively controlled. Gastric ulcers cured， blood pressure， plasma glucose and uric acid levels returned normal. The renal function indicators， including 24-hour urine protein quantification， urine red blood cell count， and blood creatinine were significantly improved. The establishment of pharmacy clinic in our hospital effectively promoted rational drug use in clinical， enhanced pharmaceutical service capabilities， and the patient health management levels.
