Cyclin-dependent kinase 4/6 （CDK4/6） inhibitors combined with conventional endocrine therapy can significantly improve progression-free survival （PFS） and overall survival （OS） in hormone receptor （HR）-positive， human epidermal growth factor receptor 2 （HER-2）-negative breast cancer patients. This combination therapy has a wide range of applications. Most CDK4/6 inhibitors are metabolized by cytochrome P450 enzymes and transported by some drug transporters， and may be susceptible to drug-drug interaction （DDI） mediated by drug-metabolizing enzymes and drug transporters with other drugs. To ensure the efficacy and safety of CDK4/6 inhibitors in clinical use， our writing group drafted the Chinese Expert Consensus on the Management of Drug-Drug Interaction with CDK4/6 inhibitors in Breast Cancer （2024 Edition） based on the definition of clinical practice guidelines of the Institute of Medicine （IOM） and the requirements of the World Health Organization （WHO） Handbook for Guideline Development and the Guidelines for the Formulation/Revision of Clinical Guidelines in China （2022 Edition）. We will follow the consensus development process to develop and publish the consensus document. This plan focuses on the consensus development methodology and process， such as the target population of the consensus， the composition of the consensus development working group， the formulation and collection of clinical questions， the screening and summarization of evidence， and the generation of recommendations， so as to make it more standardized and transparent.

OBJECTIVE To investigate the role of Wumen Nephritis Oral Liquid Ⅰ on protecting adriamycin-induced injury of podocytes and the underlying mechanism. METHODS Rat renal podocytes were divided into blank group， adriamycin-induced model group， low-dose， medium-dose and high-dose Wumen Nephritis Oral Liquid Ⅰ groups （0.1， 0.5， and 1.0 mg·mL^–1， respectively）， and transfection groups. Renal podocyte injury was induced by administering 0.40 μg·mL^–1 adriamycin. Cells were also transfected with miR-30b-3p mimic or inhibitor. The cell viability was detected by CCK-8 assay. Proteins in the Wnt/β-catenin signaling pathway and apoptotic markers were detected by Western blot， quantitative real-time polymerase chain reaction （qPCR） and immunofluorescence staining. The regulatory effect of Wumen Nephritis Oral Liquid I on the miRNA-30b-3p-mediated Wnt/β-catenin pathway and the expressions of apoptosis-related proteins was explored. RESULTS Wumen Nephritis Oral Liquid Ⅰ significantly alleviated adriamycin-induced podocyte injury and inhibited the activation of the Wnt/β-catenin signaling pathway， manifested by increased podocyte viability and upregulation of key molecules in the Wnt/β-catenin pathway. The protective effect of Wumen Nephritis Oral Liquid Ⅰ on podocytes was interfered by the inhibition of the GSK-3β pathway via the treatment of the inhibitor LY2090314， which was associated with the downregulation of Wnt1. Wumen Nephritis Oral Liquid Ⅰ significantly upregulated miR-30b-3p in podocytes. Transfection of miR-30b-3p mimics or inhibitors significantly activated or inhibited the expression of miR-30b-3p， respectively， further upregulating or downregulating Wnt1 after intervention with Wumen Nephritis Oral Liquid Ⅰ. CONCLUSION Wumen Nephritis Oral Liquid Ⅰ ameliorates adriamycin-induced podocyte dysfunction through upregulating miR-30b-3p and suppressing the Wnt/β-catenin signaling.

OBJECTIVE To explore the protective effect of Gualou Guizhi Granules （GLGZG） on rats with cerebral ischemia-reperfusion injury and BV-2 cells by mediating the mitogen-activated protein kinase （MAPK）/NOD-like receptor protein 3 （NLRP3） signaling pathway. METHODS A cerebral ischemia-reperfusion injury model in Sprague-Dawley （SD） rats was created by middle cerebral artery occlusion （MCAO）. Rats were randomly divided into sham operation group， model group， GLGZG group and nimodipine group. Each group received corresponding drugs or saline at 2 h after the molding， once a day for 7 consecutive days. Neurofunction and limb muscle tone were evaluated by the modified Neurological Severity Scale （mNSS） and the Ashworth rating. Protein expressions of NLRP3， apoptosis-associated speck-like protein containing a caspase recruitment domain （ASC）， p-p38MAPK， phosphorylated-extracellular signal-regulated kinase （p-ERK） in the ischemic brain were measured by Western Blot. The mRNA levels of Caspase-1， interleukin （IL）-6， IL-18， and IL-1β were detected by real-time polymerase chain reaction （RT-PCR）. At the same time， BV-2 cells were randomly divided into blank control， lipopolysaccharides （LPS）， GLGZG， MCC950 inhibitor and GLGZG + MCC950 inhibitor groups， and the cell viability of each group was measured by MTT assay. The amounts of IL-6， IL-1β， and tumor necrosis factor-alpha （TNF-α） in BV-2 microglia cells were detected by enzyme-linked immunosorbent assay （ELISA）. Western Blot was performed to detect protein level of NLRP3 in BV-2 cells. RESULTS Compared with the model group， GLGZG significantly reduced the mNSS score and Ashworth rating in rats， improved nerve function and the degree of hemiplegia muscle spasm， downregulated mRNA levels of IL-1β， IL-18， NLRP3 and Caspase-1， and protein levels of p-ERK， p-p38， ASC and NLRP3 in the ischemic cerebral cortex. Compared with the LPS group， GLGZG significantly increased the viability of BV-2 cells， decreased contents of IL-1β， IL-6， and TNF-α levels， and downregulated protein level of NLRP3 in BV-2 cells （all P <0.01）， which was more pronounced when combined with MCC950. CONCLUSION GLGZG improves the cerebral ischemia-induced cerebral nerve injury and inflammatory response by downregulating the MAPK/NLRP3 signaling pathway.

OBJECTIVE To explore the effect of oxymetrine （OMT） on alleviating cholestatic hepatic fibrosis by downregulating V-Mafavian musculoaponeurotic fibrosarcoma oncogene homolog G （MAFG）. METHODS In vivo， six-week-old male C57BL/6J mice were randomly divided into 5 groups. The model group and the test groups were supplemented with 0.1% of the 3，5-diethoxycarbonyl-1，4-dihydro-2，4，6-collidine （DDC） diet. The positive control group was administrated with 5 mg·kg^-1 obeticholic acid （OCA）， and the low-dose and high-dose OMT groups were supplied with 25 mg·kg^–1 OMT and 50 mg·kg^–1 OMT， respectively. Mice were administrated once a day for 27 days and sacrificed by cervical vertebra removal. Serum aspartate transaminase （AST）， alanine transaminase （ALT）， total bile acid （TBA） and total bilirubin （TBIL） were detected. Pathological changes and collagen deposition in liver tissue were observed by hematoxylin and eosin （H&E） and Masson staining. Protein expressions of fibrosis-related proteins alpha-smooth muscle actin （α-SMA）， fibronectin （FN）， and MAFG were observed by immunohistochemistry， and the protein levels of α-SMA， collagen type Ⅰ， collagen type Ⅲ， FN， and MAFG were detected by Western blot.An in vitro fibrosis model was created by induction of transforming growth factor β1 （TGF-β1） in human liver stellate cells LX-2. Cells were divided into the control group， model group （10 ng·mL^–1 TGF-β1）， and low-dose and high-dose OMT groups （2 μmol·L^–1 and 10 μmol·L^–1， respectively）. Western blot was used to detect the protein expressions of α-SMA， collagen type Ⅰ， collagen type Ⅲ， FN， and MAFG. The stable overexpression and knockdown of MAFG were constructed by lentiviral transfection， and the expressions of hepatic fibrosis-related proteins were detected. RESULTS OMT significantly attenuated DDC-induced cholestatic liver fibrosis （P<0.05） and reduced serum AST， ALT， TBA， and TBIL in cholestatic mice （P<0.05）. OMT significantly down-regulated the protein levels of fibrosis-related proteins α-SMA， collagen type Ⅰ， collagen type Ⅲ， FN， and MAFG in the liver of mice （P<0.05）. Besides，OMT significantly inhibited fibrosis-related indicators and expression level of MAFG in TGF-β1-induced LX-2 cells （P<0.05）. Overexpression or knockdown of MAFG in LX-2 cells showed similar changing trends in the protein levels of fibrosis-associated proteins to that of MAFG. CONCLUSION OMT significantly alleviates the DDC-included cholestatic liver fibrosis via downregulating MAFG. MAFG is a potential target for the treatment of cholestatic liver fibrosis.

OBJECTIVE To establish the chemical and physical fingerprints of Shugan Wei’an Granules， and to establish a method for evaluating the consistency of process and quality. METHODS The chemical fingerprints of 12 batches of Shugan Wei’an Granules were established by high-performance liquid chromatography （HPLC）. The correlation between each batch was calculated by similarity evaluation software， and the dimension of 12 batches of Granules was reduced by principal component analysis （PCA）. The load matrix of principal component was obtained by matrix transformation. The physical fingerprint was constructed by seven physical parameters， including the angle of repose， moisture content， bulk density， tap density， Hausner ratio， moisture absorption rate and relative homogeneity index. PCA and clustering analysis were used to analyze the classification of particles among different batches. RESULTS The similarity of chemical fingerprints of 12 batches of Shugan Wei’an Granules was greater than 0.95. The 12 batches （S1–S12） of Granules were clustered into two categories according to the contribution rate of components in PCA， with S1–S4 clustered into one category， and S5–S12 into another category. Five common peaks were identified， including chlorogenic acid， paeoniflorin， naringin， neohesperidin and baicalin. The similarity of physical fingerprint of 12 batches of Granules was greater than 0.98. Two components were extracted by PCA， and the main contribution rate of PC1 and PC2 was 55.8%， and 22.3%， respectively. The 12 batches of particles were clustered into 3 categories by cluster analysis. CONCLUSION The fingerprint of Shugan Wei’an Granules is constructed， which can be used in the consistency evaluation of process and quality， and provide new ideas for the improvement of quality standards of hospital preparations.

OBJECTIVE To investigate the mechanism of anti-viral pneumonia effect of the alcohol extract from the Gnaphalium affine D. Don in a zebrafish model and to predict the binding of its quality control components to its inflammatory targets by molecular docking. METHODS The ethanol extract of Gnaphalium affine D. Don was prepared. The nine main components， including the protocatechuic acid， chlorogenic acid， caffeic acid， 1，3-O-dicaffeoyl quinic acid， hypericin， iso-vermiculin， apigenin 7-O-β-D-glucopyranoside， quercetin， apigenin， were detected by high-performance liquid chromatography （HPLC）. A viral pneumonia zebrafish model was established by injecting polyinosinic acid through the swim bladder. Zebrafish were divided into the normal control group， model group， positive control group（indomethacin）， low-dose， medium-dose and high-dose groups （125， 250 and 500 μg·mL^-1） of alcohol extract from the Gnaphalium affine D. Don， with 30 zebrafish in each group. Based on the determined maximum tolerance concentration （MTC）， the number of neutrophils， fluorescence intensity of macrophages and pathological status of swim bladder in each group were analyzed under fluorescence microscope. The quantitative polymerase chain reaction （q-PCR） was used to detect the expressions of inflammatory factors interleukin-1beta （IL-1β） and tumor necrosis factor alpha （TNF-α） in zebrafish in each group. Finally， AutoDock version 1.5.7 was used for molecular docking and visualized by PyMOL software. RESULTS The HPLC data showed that the alcohol extract of Gnaphalium affine D. Don was stable and feasible. Injection of high-dose alcohol extract of Gnaphalium affine D. Don significantly reduced the number of neutrophils in the swim bladder， medium-dose and high-dose alcohol extract significantly reduced the fluorescence intensity of fish swim bladder macrophages. The pathological results of the swim bladder tissue showed that the inflammatory infiltration of zebrafish was significantly reduced in the medium-dose and high-dose groups， but the decrease in inflammatory infiltration was not significant in the low-dose group. q-PCR results showed that the alcohol extract of Gnaphalium affine D. Don significantly down-regulated IL-1β and TNF-α， especially the high-dose group significantly down-regulated IL-1β. Molecular docking results showed that chlorogenic acid， apigenin 7-O-β-D-glucopyranoside and quercetin had good binding ability to the key target IL-1β. 1，3-O-dicaffeoyl quinic acid， apigenin 7-O-β-D-glucopyranoside and apigenin had good binding ability to the key target TNF-α. CONCLUSION The anti-viral pneumonia effect of the alcohol extract of the Gnaphalium affine D. Don may be related to some of its components that can bind closely to the key inflammatory targets IL-1β and TNF-α， which competitively inhibit inflammatory response and reduce the number of neutrophils and macrophages in fish bladder by inhibiting inflammatory infiltration and down-regulating IL-1β and TNF-α.

OBJECTIVE To optimize the extraction process of Qingre Runshi Formula （QRRSF） and to evaluate the clinical efficacy. METHODS The response surface methodology （RSM） was used to design and research the extraction process， and the amounts of indicator components （berberine， baicalin， geniposide）， dry extract yield and the in vitro pharmacodynamic indicators ［malondialdehyde （MDA）， interleukin-6 （IL-6）， tumor necrosis factor-alpha （TNF-α）］ were selected as testing index. Then， the data were processed using normalization method， weighted and evaluated comprehensively. The optimum extraction process was predicted and validated through calculation and analysis. The clinical efficacy was further compared before and after process optimization to confirm the rationality and effectiveness of optimization. RESULTS The optimum extraction process was as follows： adding 10-fold water， extracting for 3 times with 118 min each time. The optimized drug efficacy on wound evaluation （P<0.01）， pain evaluation （P<0.05）， and comfort evaluation （P<0.05） was significantly improved. CONCLUSION The optimized extraction process of QRRSF by RSM is stable and effective， and the clinical efficacy is significantly improved.

OBJECTIVE To explore the influencing factors of vancomycin-associated acute kidney injury and to construct a nomogram to predict its risk， thus providing scientific basis for an early identification of high-risk individuals and development of prevention strategies. METHODS Patients who received vancomycin treatment and underwent vancomycin blood concentration testing from January 2018 to December 2023 in the First Affiliated Hospital of Guangxi Medical University were included in the study. The least absolute shrinkage and selection operator （LASSO） regression was used to screen for influencing factors of vancomycin-associated acute kidney injury， and multivariate logistic regression analysis was performed to construct a nomogram to predict its risk. The receiver operating characteristic （ROC） curve and Hosmer-Lemeshow calibration curve were employed to evaluate the discrimination and calibration of the prediction model， respectively. RESULTS A total of 2 660 patients were included， with 2 128 in the training set and 532 in the validation set. A total of 451 （17.0%） patients developed acute kidney injury， including 360 （16.9%） in the training test and 91 （17.1%） in the validation test. Five factors， including the trough concentration of vancomycin， ICU admission， combined use of diuretics or carbapenems， and central nervous system infections， were determined as predictors for vancomycin-associated acute kidney injury by LASSO regression and logistic regression. The established nomogram showed a comparable discrimination in both the training set （AUC=0.810， 95% CI： 0.786， 0.834） and validation set （AUC=0.819， 95% CI： 0.773， 0.865 ）. The nomogram also demonstrated a good calibration by Hosmer-Lemeshow test in the training set （P=0.962） and validation set （P=0.594）. CONCLUSION The incidence of vancomycin-associated acute kidney injury is high. The nomogram established by LASSO regression and logistic regression demonstrated good discriminatory and calibration， which can be used to predict the risk of acute kidney injury after receiving vancomycin treatment.

OBJECTIVE To analyze the onset characteristics， associated drugs and risks of drug-induced movement disorders （DIMDs）. METHODS The reports of central nervous system-related adverse drug reactions （ADR） from January 1， 2009 to December 31， 2022， were extracted from the ADR database. The cases of DIMDs were screened， and the general conditions of the patients and distribution characteristics of the associated drugs were retrospectively analyzed. Four data mining technologies were used to obtain relevant drug risk signals， including the reporting odds ratio method， the proportional reporting ratio method， the Bayesian confidence propagation neural network method， and the standards proposed by the Medicines and Healthcare products Regulatory Agency （MHRA）. RESULTS A total of 2 025 cases of DIMDs were reported after screening， accounting for 0.72% of all ADR reports，and 6.63% of neurological disorders and psychiatric disorders reports. The male-to-female ratio was 1.12∶1， and most of them were seen in people over 65 years old. The top three associated drugs were central nervous system drugs， anti-infective drugs， and respiratory system drugs. The top three drugs leading to serious ADRs were moxifloxacin， imipenem-cilastatin sodium， and levofloxacin. A total of 31 drugs were risky by the four methods of data mining， with the top three of moxifloxacin， ipratropium bromide， and terbutaline. CONCLUSION The clinical application of central nervous system drugs， anti-infective drugs and respiratory drugs should be monitored to prevent ADRs like involuntary muscle contraction and tremor， It can provide a reference for the early clinical identification and intervention of DIMDs.

OBJECTIVE To determine the optimal conversion ratio （CR） between hydromorphone （H） and morphine （M） for pain management in cancer patients undergoing intrathecal drug delivery system （IDDS） for analgesia. METHODS A total of 62 cancer pain patients using IDDS for analgesia were included， and 74 instances of drug rotation were analyzed. The patients were divided into two groups： M-H group （M switched to H， n=50） and H-M group （H switched to M， n=24）. Based on the actual consumption of drugs to achieve the same analgesic intensity， correlation analysis and linear regression model analysis were conducted to estimate the potential optimal CR. Core indicators， such as the mean， median， maximum， minimum， highest density distribution， and 95% confidence interval （CI） of the actual clinical CR were calculated. Key indicators， such as the daily dose range of drugs before and after rotation， the 95% CI of daily doses， and changes in numeric rating scales （NRS）， were statistically analyzed to guide clinical practice. RESULTS The regression coefficient was 4.80 for the M-H group and 3.73 for the H-M group. The mean， median， maximum， minimum， strongest density distribution， and 95% CI of CR for the two groups were 4.93， 5.09， 5.89， 3.65， 5.22， and （3.62， 6.24） in the M-H group， and 3.64， 3.72， 4.69， 2.93， 3.77， and （2.73， 4.55） in the H-M group， respectively. The daily average dosage and 95% CI of M were 1.18–17.49 （0.89， 19.76） mg·d^–1 and 2.08–20.24 （–2.56， 24.37） mg·d^–1 in the M-H and H-M groups， and those of H were 0.22–4.05 （–0.14， 4.17） mg·d^–1 and 0.57–5.37 （–0.5， 6.35） mg·d^–1， respectively. CONCLUSION We recommend an initial optimal CR of 4.80 in cancer pain patients undergoing IDDS for analgesia when switching from M to H， and 3.73 when switching from H to M， but individual differences should be fully considered. The reference ranges are （3.62， 6.24） and （2.73， 4.55）， respectively.

OBJECTIVE To explore the internal logic and experience enlightenment of the medical and health system reform and the development and compensation of pharmacy administration and pharmaceutical services in China. METHODS The evolution process of development and compensation of pharmacy administration and pharmaceutical services in China were analyzed by systematically searching policy documents and combing information. RESULTS The pharmacy administration and pharmaceutical services in China could be divided into four stages： the initial stage of system establishment， the stage of practice promotion， the transition stage， and the expansion stage of management and services. Correspondingly， the development of compensation policies on pharmacy administration and pharmaceutical services consisted of four periods as the trial implementation of “pharmaceutical service fee”， medical service price adjustment， pharmaceutical service value exploration and pharmaceutical medical service price formation. CONCLUSION As the pharmaceutical management becomes more scientific and pharmaceutical services become more professional in China， the value of pharmaceutical services is gradually reflected， the connotation of the project is gradually clarified， and the compensation mechanism also needs to be further improved. Additionally， the establishment and improvement of pharmaceutical service quality evaluation index system will become a crucial task to ensure the high-quality development of pharmaceutical services.

OBJECTIVE To analyze the policy status of the dispensing and use of traditional Chinese medicine preparations in medical institutions， and put forward suggestions on the existing problems， so as to provide a reference for encouraging the research and development of new traditional Chinese medicine preparations and the revision of the policy on dispensing and use. METHODS By Using policy comparison， literature research and other methods to sort out and analyze the development process of the policy on the dispensing and the use of traditional Chinese medicine preparations in medical institutions in China， compare the current policies on the dispensing and use of traditional Chinese medicine in various provinces and some regions， and put forward reform measures and suggestions. RESULTS The policy of dispensing and using traditional Chinese medicine preparations in medical institutions has given great encouragement and support to the development of traditional Chinese medicine preparations； There are different problems in the variety， scope and procedure of adjustment in various provinces and some regions， which have caused obstacles to the adjustment behavior and inter-provincial adjustment. CONCLUSION It is recommended to build an information platform for the dispensing and use of traditional Chinese medicine preparations in medical institutions； Unify the approval process for the dispensing and use of traditional Chinese medicine preparations in medical institutions； Medical institutions themselves should also seize the opportunity to strengthen the transformation of new drugs， encourage all parties to actively communicate， and jointly make due contributions to the revitalization of traditional Chinese medicine.

OBJECTIVE Based on the Chinese Drug-Related Problem Classification System （v1.0）， the pharmaceutical care of chronic ophthalmic diseases was evaluated. METHODS Patients with chronic ophthalmic diseases like dry eye， glaucoma and diabetic retinopathy treated in Tianjin Eye Hospital from January to June 2023 were collected. The types， causes， intervention plans and acceptance results of drug-related problems （DRPs） were analyzed according to the Chinese Drug-Related Problems Classification System （v1.0）. The ophthalmic pharmaceutical care was provided for six months， and the results of ophthalmic pharmaceutical care were evaluated from eight dimensions， including ophthalmic-related clinical indicators， medication compliance， visual quality of life， disease and medication awareness. RESULTS A total of 306 patients were included， of which 247 patients had 523 DRPs， including 225 （43.02%） DRPs related to treatment effectiveness. A total of 543 associated reasons were identified， and 141 （19.37%） drugs were not correctly stored or used. Pharmacists provided 318 （38%） access schemes for patients/family members at most， and 392 （74.95%） interventional schemes were accepted and fully implemented. After six months of ophthalmic pharmaceutical care， the clinical indicators related to ophthalmology， medication compliance， visual quality of life， disease and medication awareness， and the number of medication related problems were all significantly improved （P<0.05）. CONCLUSION Based on the Chinese Drug-Related Problems Classification System （v1.0）， the DRPs of patients with chronic ophthalmic diseases can be clearly determined， thus providing clinical basis for the development of ophthalmic pharmaceutical care norms and standards， effectively reducing the incidence of ophthalmic DRPs， and ensuring the rational use of drugs by patients.

Pancreatic cancer （PC） is characterized by a poor prognosis and high mortality rate. It ranks the sixth among global cancer-related deaths. Advanced age， smoking， obesity， chronic pancreatitis （CP）， type 2 diabetes mellitus （T2DM） and family history are high-risk factors for PC. Epidemiological studies have discovered that certain medications might boost the risk of PC. This review summarized the latest researches on potential risk drugs of PC with epidemiological evidence， including insulin， insulin secretagogues， glucagon-like peptide-1 （GLP-1） analogs， dipeptidyl peptidase-4 inhibitors （DPP-4i）， thiazolidinediones （TZDs）， metformin， proton pump inhibitors （PPIs）， ranitidine， penicillins， sulfonamides and calcium channel blockers （CCBs）. Potential carcinogenic mechanisms were also discussed. We aim to provide references for clinical safe dosing and inspire ideas for follow-up researches.

Curcumin is a natural polyphenolic extracted from the rhizome of turmeric with diverse biological activities. This paper reviewed the experimental studies on curcumin in the treatment of different types of liver injury at home and abroad in recent years， and discussed its hepatoprotective effect and underlying mechanisms. Based on the experimental animal models of liver injury， the therapeutic effects of curcumin in chemical， drug， alcoholic， non-alcoholic and immune-induced liver injury models were summarized， and the mechanism in improving experimental liver injury was assessed. We aim to provide a reference for the further study of curcumin in the protection of liver injury.

Calcium channel blockers （CCBs） play an important role in the treatment of hypertension in China. With the development of antihypertensive drugs， the emergence of long-acting CCBs reduces the frequency of medication and conducive to control blood pressure more lasting and stable. There are two types of long-acting CCBs： CCB sustained/controlled release preparations and CCBs with molecular long half-life. The process of absorption and metabolism of antihypertensive drugs can be interfered by different factors， and further affect their efficacy， or even cause serious adverse events. This article mainly discussed how common clinical influencing factors affect the treatment of long-acting CCBs， aiming to provide references for the rational use of long-acting CCB and individualized medication.

Cyclosporine is a commonly used immunosuppressive agent in clinical practice known for its significant individual differences and the potential to induce adverse drug reactions. Therefore， therapeutic drug monitoring（TDM） is particularly important during the treatment. In this case report， a patient with antiphospholipid syndrome（APS） experienced an adverse reaction of tremor after cyclosporine administration， with a trough concentration C₀ of 212.1 ng·mL^–1. Through a close monitoring of the blood concentration of cyclosporine by clinical pharmacists and assessment of the adverse events， the patient was given an individualized treatment and suggested a temporary discontinuous use of cyclosporine. The treatment was adjusted to rituximab infusion， thus achieving a safer and more effective therapeutic outcome. The tremor symptoms gradually remitted and the condition stabilized through continuous pharmacological monitoring and careful treatment by the clinical team. This case highlighted the value of clinical pharmacists in assisting doctors to optimize treatment plans， and further emphasized the importance of individualized treatment and precise pharmaceutical monitoring in modern medical practice.

Autologous arteriovenous fistula （AVF） is the primary vascular pathway in maintenance hemodialysis （MHD） patients. Thrombosis can lead to the loss of AVF function， which is associated with hospitalization rate and all-cause mortality in MHD patients. So far， there are no reports of AVF occlusion caused by intravenous iron allergy. In this case， an allergic reaction and hypotension occurred after intravenous infusion of dextran iron， resulting in AVF thrombosis and occlusion. After intervention treatment， AVF function returned to normal. This article analyzed and discussed the case， suggesting that maintenance of AVF in MHD patients should be vigilant against intravenous iron allergy and hypotension symptoms.