OBJECTIVE To investigate the effect of Buyang Huanwu Decoction （BYHWD） on the TNF/RIPK1 signaling pathway， and to clarify the mechanism by which BYHWD inhibited ventricular pathological remodeling after myocardial infarction. METHODS A total of 70 Wistar rats were randomly divided into the control group， model group， low-dose BYHWD group， medium-dose BYHWD group， high-dose BYHWD group， Western medicine group and tumor necrosis factor alpha （TNF-α） inhibitor group， with 10 animals in each group. Rats in the low-dose BYHWD group， medium-dose BYHWD group， and high-dose BYHWD group were administered with 3.22， 6.44， and12.87 g·kg–1·d–1 BYHWD， respectively， and those in the Western medicine group were administered 0.36 mg·kg–1·d–1 perindopril tert-butylamine tablet. Rats in the TNF-α inhibitor group were subcutaneously injected with 5 mg·kg–1·w–1 TNF-α inhibitor etanercept. Rats in both control and model groups were given oral gavage of normal saline. Interventions were continuously performed for 4 weeks. The left ventricular ejection fraction （LVEF）， left ventricular fractional shortening （FS）， left ventricular end diastolic diameter （LVEDD）， and left ventricular end systolic diameter （LVESD） were detected on Doppler ultrasound. The hematoxylin and eosin （H&E） staining and Masson staining were used to identify the pathological morphology and fibrosis degree of myocardial tissue. Apoptosis in myocardial cells was detected using terminal deoxy-transferase-mediated deoxyuridine triphosphate （dUTP） nick-end labeling （TUNEL） staining. The reverse transcription-quantitative polymerase chain reaction （RT-qPCR） was performed to detect the mRNA levels of TNF-α， receptor-interacting protein kinase 1（RIPK1）， RIPK3， and mixed lineage kinase-like（MLKL） in the myocardial tissue. Western blot was conducted to detect the protein levels of TNF-α， RIPK1， P-RIPK1， RIPK3， and MLKL in the myocardial tissue. RESULTS Compared with the control group， rats in the model group had destroyed cardiac structure， thinned chamber wall， disordered cardiomyocyte arrangement， local fibrotic reconstruction， significantly lower LVEF and FS， and significantly higher LVEDD， LVESD， mRNA and protein levels of TNF-α， P-RIPK1， RIPK3， and MLKL （P<0.05）. Compared with the model group， rats in the low-dose BYHWD group， medium-dose BYHWD group， high-dose BYHWD group， Western medicine group and TNF-α inhibitor group had alleviated cardiac structure damage and cardiac fibrosis， significantly higher LVEF and FS， and significantly lower LVEDD， LVESD， mRNA and protein levels of TNF-α， P-RIPK1， RIPK3， and MLKL （P<0.05）. The best efficacy was seen in the high-dose BYHWD group. CONCLUSION BYHWD inhibits pathological ventricular remodeling after myocardial infarction by regulating necroptosis via the TNF/RIPK1 signaling pathway.
OBJECTIVE To investigate the expression of miR-200b in a mouse model of α-naphthylisothiocyanate （ANIT）-induced intrahepatic cholestasis （IHC） and the interventional effect of Cichorium glandulosum Boiss. et Huet. extract （CGE）. METHODS A total of 36 C57BL/6 mice were randomly divided into six groups， with six mice in each group. CGE at varying concentrations （1.4， 2.8， 5.6 g·kg–1） and ursodeoxycholic acid （85 mg·kg–1） were administered by gavage for seven consecutive days. The IHC model was constructed by oral gavage of ANIT （100 mg·kg–1） on day 5， and mice in the normal control group were given an equal amount of olive oil. The mice were weighed 48 hours after administration of ANIT， after which they were executed. Serum and liver samples were collected， and the liver weight ratio was calculated. The therapeutic efficacy of CGE on IHC was evaluated by serum liver function-related biochemical indices， including alanine aminotransferase （ALT）， alkaline phosphatase （AKP）， aspartate aminotransferase （AST）， and cholestatic indices， namely total bile acids （TBA） and total bilirubin （TBIL）. Hematoxylin-eosin （H&E） assay was performed in liver tissues. In in vitro experiments， HepG2 cells were transfected with miR-200b mimics or inhibitor to overexpress or inhibit the expression level of miR-200b， respectively. The cell counting kit-8 （CCK-8） assay was performed to detect the viability of HepG2 cells. The reverse transcription-quantitative polymerase chain reaction （RT-qPCR） and Western blot were performed to detect expression levels of miR-200b， Caspase-3 and Bcl-2 in moues liver and HepG2 cells. RESULTS CGE significantly reduced serum levels of liver injury biomarkers in ANIT-induced mice （P<0.05）， alleviated weight loss， liver index increase and pathological damage. Compared with the model group， CGE significantly upregulated the mRNA level of Bcl-2 （P<0.05）， downregulated those of miR-200b and Caspase-3 （P<0.05）. After transfection of miR-200b mimics， HepG2 cells showed significantly decreased cell viability， downregulated Bcl-2 and upregulated Casepase-3 （P<0.01）. Transfection of miR-200b inhibitor showed the opposite results. CONCLUSION CGE inhibits apoptosis by regulating the miR-200b/Bcl-2 axis， thus playing a therapeutic role in the mouse model of ANIT-induced IHC.
OBJECTIVE To develop a simple， accurate， and sensitive high performance liquid chromatography tandem-mass spectrometry （HPLC-MS/MS） method for the quantification of plasma ganciclovir （GCV） in pediatric renal transplant recipients. METHODS A 100 μL aliquot plasma was processed using protein precipitation with acetonitrile. GCV-d5 was used as the internal standard. The supernatant was taken for HPLC-MS/MS analysis. Chromatographic separation was performed on the Hypersil Gold C18 column （Thermo Scientific） with a mobile phase consisting of 0.1% formic acid in water （A） and methanol （B）， at a flow rate of 0.4 mL·min–1. The column temperature was maintained at 35 ℃， and the injection volume was 5 μL. Mass spectrometric detection was carried out in positive electrospray ionization mode using multiple reaction monitoring （MRM）. The transitions monitored were m/z 256.01→152.00 for GCV and m/z 261.27→ 152.00 for the internal standard. Methodological verification of the established method was conducted， and it was used to determine the plasma GCV steady-state trough concentration in children with kidney transplants. RESULTS The HPLC-MS/MS method showed excellent linearity over the concentration range of 0.04–20.00 μg·mL–¹ （r²=0.999 1）， with the calibration curve described by the equation Y=1.018X+8.759×10–4. Intra- and inter-day precision （RSD） were both <15%， and the accuracy ranged from 98.94% to 104.11%. The method met all validation criteria for selectivity， matrix effect， extraction recovery， and stability. The validated method was successfully applied to measure steady-state trough concentrations of plasma GCV in 17 pediatric renal transplant patients， with concentrations ranging 0.05–2.72 μg·mL–¹. CONCLUSION HPLC-MS/MS method is a simple， rapid， accurate， sensitive， specific， reliable， and well-suited method for the therapeutic drug monitoring of plasma GCV in pediatric renal transplant recipients.
OBJECTIVE To preliminarily explore the pharmacological mechanism of Wufa Shengfa Tincture through bioinformatics technology， 3D skin model experiments， and in vitro hair follicle experiments. METHODS The effective components， core targets and related pathways of Wufa Shengfa Tincture in the treatment of alopecia were predicted by bioinformatics. The safe concentration range of Wufa Shengfa Tincture was determined using human dermal papilla cells， and the skin irritation of Wufa Shengfa Tincture was detected based on 3D skin model in vitro. The hair shaft growth of isolated hair follicles after Wufa Shengfa Tincture administration was observed and the hair follicle cycle was scored. Then the relative expression levels of core target mRNAs were detected by quantitative polymerase chain reaction （qPCR）. Five small molecule compounds were screened from the predicted active components， and the hair follicles were incubated with those in vitro to observe the growth of hair shafts and the cycle of hair follicles. RESULTS Kyoto Encyclopedia of Genes and Genomes （KEGG） enrichment analysis showed that a large number of genes were significantly enriched in the advanced glycation end product （AGE）-receptor of AGE （RAGE） signaling pathway involved in blood lipids and atherosclerosis， and diabetes complications. Through experiments in 3D skin models and in vitro hair follicle， Wufa Shengfa Tincture had minimal skin irritation and significantly promoted hair stem growth. The qPCR experiment results showed that high-dose Wufa Shengfa Tincture significantly increased the mRNA expression levels of vascular endothelial growth factor A （VEGFA）， interleukin-6 （IL6）， epidermal growth factor （EGF）， epidermal growth factor receptor （EGFR）， and epiregulin （EREG）， indicating that Wufa Shengfa Tincture may facilitate hair growth by activating multiple growth factors and promoting angiogenesis. Among the screened small molecule compounds， three components， namely tanshinone I， tanshinone IIA， and cryptotanshinone， increased the number of hair follicles in the anagen stage. CONCLUSION According to the regulatory network， components such as quercetin， kaempferol， and tanshinone in Wufa Shengfa Tincture may play important roles. The key targets of Wufa Shengfa Tincture responsible for the treatment of hair loss include VEGFA， STAT3， AKT1， IL6， EGF， and EGFR， which are mainly related to cell proliferation and apoptosis， cell cycle， cell inflammation， and promotion of angiogenesis.
OBJECTIVE To develop a gel based on self-assembled nanoparticles isolated from Huangqin Decoction （HQD-N） and to evaluate its anti-dermatophyte effect. METHODS HQD-N was prepared by high-speed centrifugation combined with dialysis， and then further loaded into gel （HQD-N-gel）. The formulation was optimized by Box-Behnken response surface method. The concentrations of propylene glycol， HQD-N and Carbopol 940 were used as the investigation factors， and the particle size， polydispersity index （PDI）， Zeta potential， in vitro release of baicalin for 12 h， skin penetration and skin retention of baicalin for 12 h were considered as the investigation indexes. The characteristics and antifungal effect of the optimal HQD-N-gel were evaluated. RESULTS The particle size， PDI， Zeta potential， in vitro release of baicalin for 12 h， skin penetration of baicalin for 12 h and skin retention of the optimized formulation （12.0 mg·g–1 Carbopol 940， 86.0 mg·g–1 HQD-N and 60.0 mg·g–1 propylene glycol） were 355.67±19.04 nm， 0.31±0.01， –（34.73±1.32） mV， 41.09%±2.42%， 74.25±12.94 μg·cm–2 and 4.54±1.78 mg·g–1， respectively. The actual measured values were close to the predicted values of the model， and the model had good predictability. The optimized HQD-N-gel had the characteristics of good appearance， moderate pH， uniform shape and size， etc. HQD-N-gel could effectively inhibit the growth of dermatophytes. CONCLUSION HQD-N-gel has good anti-dermatophyte effect.
OBJECTIVE To establish the high-performance liquid chromatography （HPLC） fingerprints， contents of index components， and index components transfer rate from decoction pieces to mixture of Sanao Yulong Mixture， thus providing references for the improvement of dosage form and quality control. METHODS The HPLC fingerprints of 15 batches of Sanao Yulong Mixture were established by the Similarity Evaluation System of Traditional Chinese Medicine Chromatographic Fingerprint （2012 version）， and the common peaks were identified. Contents of the designated components were detected by HPLC. Hesperidin and naringin in tangerine peel， glycyrrhizin and ammonium glycyrrhizinate in licorice root， hyperoside in dried houttuynia cordata and amygdalin in fried bitter almonds were used as index components to investigate the transfer rate of the six components in decoction pieces and mixtures. RESULTS A total of 36 common peaks with similarity coefficients ≥0.996 were found among the 15 batches of Sanao Yulong Mixture. Eight components were identified， including amygdalin （peak 11）， liquiritin （peak 24）， hyperoside （peak 25）， ferulic acid （peak 26）， naringin rutin （peak 27）， hesperidin （peak 28）， quercetin （peak 35）， and ammonium glycyrrhizinate （peak 36）. The average contents per mL for these eight components were respectively determined as follows： amygdalin –302.71 μg·mL–1， liquiritin –57.06 μg·mL–1， hyperoside –5.93 μg·mL–1， ferulic acid –6.75 μg·mL–1， naringin rutin –120.89 μg·mL–1， hesperidin –517.06 μg·mL–1， quercetin-8.89 μg·mL–1， ammonium glycyrrhizinate–195.66 μg·mL–1. The mean transfer rates of hesperidin， naringin， glycyrrhizin， ammonium glycyrrhizinate， amygdalin and hyperoside from the decoction pieces to the mixture were 87.74%， 74.54%， 45.01%， 36.67%， 46.53% and 18.11% respectively. CONCLUSION The established HPLC fingerprinting along with content determination demonstrates good repeatability and strong specificity. Its index components are stably transferred between the decoction pieces and the mixture， providing a reference for the improvement of dosage forms and quality control.
OBJECTIVE To study the effects of genetic polymorphisms in liver transplant donors and recipients at 3 months of liver transplantation on sirolimus trough concentration. METHODS Forty patients after liver transplantation were retrospectively enrolled. The dosage of sirolimus， sirolimus trough concentration and laboratory testing results within 3 months after transplantation were recorded. CYP3A4 （rs2242480 and rs4646437）， CYP3A5 （rs776746）， ABCB1 （rs1045642， rs2032582， and rs1128503）， ABCC2 （rs2273697， rs3740066） polymorphisms in donors and recipients were genotyped using DNA microarrays. The impact of donor and recipient genetic polymorphisms on the sirolimus dose/weight-adjusted trough concentration ratio （C0/D） was analyzed. RESULTS The interindividual variability in sirolimus trough concentration was significantly influenced by CYP3A4 rs4646437 （C>T）， ABCB1 2677G>T/A （rs2032582）， and ABCC2 3972C>T （rs3740066） polymorphisms in donors （P<0.05）. The sirolimus C0/D ratio was significantly higher in donors carrying the CC genotype of CYP3A4 rs4646437 （C>T） compared with the TC genotype （P<0.05）. It was significantly higher in donors carrying the GG genotype of ABCB1 2677G>T/A （rs2032582） than the TT and GT genotypes （P<0.05）. The sirolimus C0/D ratio was significantly higher in donors carrying the CC genotype of ABCC2 3972C>T （rs3740066） than the TC and TT genotypes （P<0.05）. The genetic polymorphisms of recipients did not significantly affect sirolimus C0/D ratio （P>0.05）. CONCLUSION The trough concentrations of sirolimus in liver transplant patients during the early post-transplantation period are significantly associated with donor CYP3A4 rs4646437 （C>T）， ABCB1 2677G>T/A （rs2032582）， and ABCC2 3972C>T （rs3740066） polymorphisms. This finding indicates that sirolimus may also be transported by multi-drug resistance protein 2 （MRP2， encoded by the ABCC2 gene）， thereby providing a reference for personalized medication.
OBJECTIVE To evaluate the efficacy of metformin-based fixed-dose combination （FDC） in the treatment of type 2 diabetes mellitus （T2DM） by network Meta-analysis. METHODS Randomized controlled trials （RCTs） on metformin-based FDC in the treatment of T2DM published before April 2024 were searched in PubMed， Embase， Cochrane Library， Web of Science， China National Knowledge Infrastructure （CNKI）， Wanfang， VIP， and SinoMed databases. Literature screening， and data extraction were performed. Quality assessment of the included literatures was conducted according to the Cochrane Risk of Bias Assessment Tool. Risk of bias and network Meta-analysis were performed using Review Manager 5.4.1 and State 17.0 software. Results were sorted according to the surface under the cumulative ranking （SUCRA）. RESULTS A total of 45 RCTs were included， involving 9 704 patients and 8 FDCs. Network Meta-analysis showed that the use of metformin-based FDC in patients with T2DM improved blood glucose and lipids outcome indicators. Pioglitazone/metformin FDC was the most effective in reducing hemoglobin A1c （HbA1c）， fasting blood glucose （FBG）， and 2 hours postprandial blood glucose （PBG）. Sitagliptin/metformin FDC was most effective in reducing total cholesterol （TC） and triglyceride （TG）， and pioglitazone/metformin FDC was most effective in enhancing high-density lipoprotein cholesterol （HDL-C） and reducing low-density lipoprotein cholesterol （LDL-C）. CONCLUSION Eight metformin-based FDCs showed different degrees of improvement in glycemic and lipid indices in T2DM patients. However， due to the limitations of the studies and the lack of direct comparisons between different interventions， the results need to be further validated by high-quality studies.
OBJECTIVE To conduct an evaluation of tyrosine kinase inhibitors （TKIs） for the treatment of rare disease of gastrointestinal stromal tumors （GIST）， thus providing references for clinical drug selection and rational use of drugs. METHODS The evaluation of TKIs for the treatment of GIST was conducted from five dimensions： pharmaceutical characteristics， efficacy， safety， economy and other attributes， based on A Quick Guideline for Drug Evaluation and Selection in Chinese Medical Institutions（the Second Edition）. RESULTS The evaluation scores of the 5 TKIs in the treatment of GIST were above 60 points. Imatinib ranked first with a score of 70.7–80.4， making it a strong recommendation. Sunitinib ranked second with a score of 64.4–68.0， which was a weak recommendation. The evaluation scores of avapritinib， ripretinib， and regorafenib were 64.6， 65.1， and 64.9， respectively， indicating weak recommendation. CONCLUSION Imatinib， sunitinib， avapritinib， ripretinib and regorafenib are all recommended as targeted therapy drugs for GIST， with imatinib being strongly recommended， others being weakly recommended.
OBJECTIVE To establish a prompt system of intravenous drugs switching to oral drugs （intravenous to oral， IVOS） for inpatients and to analyze its effect after application. METHODS By comparing the intravenous infusion rate， the daily infusion volume per bed， the infusion volume of finished products for direct treatment， and proportion of infusion drug expenses of inpatients before and after the application of the system （March-December， 2023 vs. March-December， 2024）， the efficacy of the established prompt system of IVOS was verified. RESULTS During the study period， the system sent 4 698 reminders of IVOS to doctors， and the reminding was mainly applied to internal medicine departments. After the application of the prompt system， the intravenous infusion rate of inpatients significantly decreased from 83.60% to 83.02% （P=0.038）， and the daily infusion volume per bed significantly decreased from 3.68±0.12 bottles to 3.49±0.13 bottles （P=0.002）. The total number of infusion bottles significantly decreased by 6.1% （397 071 vs. 373 013 bottles， P=0.009）， and the dosage of finished infusion products for direct treatment significantly decreased by 17.3% （82 677 vs. 68 413 bottles， P<0.01）. The average drug cost significantly decreased from （5 471.39±474.12） yuan to （4 627.24±294.15） yuan（P<0.01）. CONCLUSION The establishment of the prompt system of IVOS can effectively reduce the intravenous infusion rate of inpatients and reduce the drug cost， which has clinical promotion value.
OBJECTIVE To explore potential risks of drug dispensing errors in pharmacy intravenous admixture services （PIVAS）， and to implement preventive measures， thus reducing error rates. METHODS The risk of dispensing procedures in PIVAS was identified and evaluated by applying the failure mode and effect analysis （FMEA） model. The risks of potential failure modes were quantitatively scored，and their risk priority number was calculated to screen failure modes that needed to be improved in priority. The corresponding improvement measures were developed by the SHEL （software ［S］， hardware ［H］， environment ［E］ and liveware ［L］） analysis. The effect of intervention before and after rectification was evaluated. RESULTS Based on the risk priority number （RPN）， 10 medium-to-high risk points were identified， such as failure to add dissolved drugs into the infusion according to the standard dosage， non-compliance with standardized operation procedures during preparation， and lack of thorough verification after compounding and dispensing. After interventions of preventive measures， the RPN scores of the 10 critical risk points decreased from 2 674 to 980， and the RPN reduction reached 63.35%. After implementations， the error rate was significantly reduced （P<0.05）. CONCLUSION The use of FMEA and SHEL analysis to the whole-process management of drug dispensing in the PIVAS can effectively prevent various risks， reduce the incidence of errors， and ensure medication safety.
OBJECTIVE To investigate the efficacy of nudge interventions in promoting the decision of initiating medications among elderly patients with chronic diseases， thus providing a scientific basis for optimizing medication behaviors in this population. METHODS A systematic review was conducted. Relevant literatures on the effectiveness of nudge interventions in promoting the decision of initiating medications among elderly patients with chronic diseases were searched in major Chinese and English databases， and analyzed. RESULTS A systematic search identified no relevant reports within Chinese databases， but 767 relevant articles in English databases， of which 14 studies met the inclusion criteria after further screening. The most frequently employed nudge strategies for the decision of initiating medications involved a combination of information visualization and reminders. These primarily functioned by optimizing physician prescribing decision-making processes and enhancing patient acceptance of medication therapy. Regarding intervention outcomes， 9 studies demonstrated that nudge interventions significantly improved medication initiation rates. However， 5 studies reported no statistically significant effect， potentially attributable to variations in sample characteristics or implementation contexts. CONCLUSION Nudge interventions demonstrate a significant potential in promoting the decision of initiating medications in elderly patients with chronic diseases. Optimization strategies， such as personalized design and long-term effectiveness evaluation， hold promise for further enhancing the scientific rigor and effectiveness of these interventions. This approach offers a novel practical pathway for the standardized management of chronic diseases.
Renal fibrosis （RF） is the basic pathology of chronic kidney disease （CKD）. The characteristic of RF is the excessive accumulation of extracellular matrix （ECM） that destroys renal tissue. Specific treatment of RF is currently scant. Available options can only alleviate the progress of RF， and limited by adverse events and high treatment costs. How to effectively prevent and treat RF is a key and difficult issue that needs to be solved urgently. The occurrence of RF is related to mesenchymal transformation of renal tubular epithelial cells， ischemia， hypoxia， and effector cell activation， which can be targeted by drug therapy. The signal transduction of RF involves multiple pathways， such as transforming growth factor-beta1 （TGF-β1）/Smad， Janus kinase 2 （JAK2）/signal transducer and activator of transcription 3 （STAT3）， phosphatase and tensin homolog （PTEN）-induced kinase 1 （PINK1）/Parkin， c-Jun N-terminal kinase （JNK）， and nuclear factor erythroid 2-related factor 2/antioxidant-response element （Nrf2/ARE）. This paper reviewed the new progress in the molecular mechanism of RF and its development， and summarized the drugs， targets and mechanisms for anti-RF and the treatment of CKD， thus providing a basis and strategy for clinical diagnosis and treatment， and new drug research and development acting on RF， and references for individualized medication.
In recent years， the competency-based education model has gradually emerged in the training of pharmacists in the United States， and a series of changes in pharmaceutical education have promoted the innovation of professional certification standards. The Accreditation Council for Pharmaceutical Education （ACPE） in the United States approved the latest version of the Pharmaceutical Professional Accreditation Standards in June 2024， which is known as the "2025 version of the standards". The new version of the standard has made innovations in the indicator system framework， certification concept， and certification focus. This article explored the motivations behind the revision of certification standards in the United States， analyzed the main changes in the latest standards for pharmaceutical professional certification in the United States， and provided recommendations for clinical pharmaceutical professional certification in China. Our findings are expected to provide references and inspiration for improving the quality assurance system of clinical pharmacy talent cultivation in China， thus promoting the professional certification of clinical pharmacy in China.
Anastatica hierochuntica （A. hierochuntica） belongs to the Brassicaceae family. It is a commonly used imported medicine in Uyghur， mainly grows in the arid areas of Middle East and Sahara Desert. Modern pharmacological studies have shown the anti-inflammatory， analgesic， antioxidant， liver-protecting， stomach-protecting， and hypoglycemic activities of A. hierochuntica. Flavonoids， volatile oils， and organic acids are the main chemical components. As a traditional Uyghur medicine， A. hierochuntica has been poorly studied in China. To better explore the material basis and mechanism of the clinical efficacy of A. hierochuntica， this paper summarized the literatures concerning on the chemical constituents and pharmacological effects of it based on the data from Web of Science， NSTL， PubMed， VIP， and Wanfang. This paper provided a scientific basis for the quality control， clinical application and research of A. hierochuntica.
This report described clinical experiences of a clinical pharmacist participated in the individualized treatment of a patient with hemophilia A during the perioperative period of a major orthopedic surgery with recombinant human coagulation FⅧ. Using the population PK tool myPKFiT® combined with Bayesian feedback， the pharmacist estimated the patient’s PK parameters and formulated an individualized perioperative dosing regimen of recombinant human coagulation FⅧ. Additionally， the pharmacist conducted an individualized assessment of venous thromboembolism risk in this hemophilia A patient during the perioperative period. Based on this evaluation， low-molecular-weight heparin was promptly discontinued， and the recombinant human coagulation FⅧ dose was adjusted， resulting in a favorable therapeutic outcome. The PK-guided， individualized treatment regimen of recombinant human coagulation FⅧ in hemophilia A patients during the perioperative period can significantly enhance drug therapy efficacy and safety while reducing the economic burden on patients.
Ademetionine 1，4-butanedisulfonate is a common drug in the digestive system，used for the treatment of intrahepatic cholestasis and that during pregnancy caused by pre-cirrhosis and cirrhosis， which has a good clinical effect. With its widespread use， adverse reactions have gradually attracted attention. This article reported a case of left heart failure after the use of ademetionine 1，4-butanedisulfonate injection， and reviewed the relevant literatures to explore potential correlation between ademetionine 1，4-butanedisulfonate and acute left heart failure. Currently， there are rare documented cases of acute left heart failure directly attributed to ademetionine 1，4-butanedisulfonate， but clinicians should remain vigilant for potential cardiovascular adverse effects during its use.
Bortezomib， as the first proteasome inhibitor introduced into clinical practice， has been extensively utilized in the treatment of multiple myeloma. Cutaneous and subcutaneous tissue-related diseases are common adverse events of bortezomib therapy. Most of them are mild and typically do not necessitate dose reduction or discontinuation of the medication. However， severe manifestations， such as toxic epidermal necrolysis （TEN） are extremely rare. This article reported a case of TEN that developed in a patient with multiple myeloma following bortezomib administration. Through a detailed analysis of the onset pattern， causality assessment， potential pathogenic mechanisms， and therapeutic interventions， this report aims to provide valuable insights for the safe and rational use of bortezomib in clinical settings.
