Eravacycline is a new class of fully synthetic fluortetracycline antibiotics with broad-spectrum antibacterial activity. The existing clinical trials have shown that eravacycline has good efficacy and safety in the treatment of various complex infections, especially in the application of multi-drug resistant bacteria. In this paper, the chemical structure, mechanism of action, antibacterial spectrum, pharmacokinetics/pharmacodynamics, clinical application, and drug resistance of eravacycline were reviewed in order to provide basis and reference for clinical drug use.

AIM To evaluate the anesthetic effect of esketamine combined with remimazolam in elderly patients undergoing gastroenteroscopy, as well as the influence on oxygen desaturation saturation and hemodynamics. METHODS A total of 160 elderly patients scheduled to undergo gastroenteroscopy in our hospital from September 2021 to October 2023 were included, and randomly equally divided into remimazolam group (R group) or esketamine combined remimazolam group (E+R group). Both two groups received intravenous injection of sufentanil 0.1 μg·kg^-1 and remimazolam 0.2 mg·kg^-1 for anesthesia induction. The E+R group additionally was given intravenous esketamine 0.25 mg·kg^-1. The primary outcomes during the examination include occurrence of desaturation and hypotension. Secondary outcomes include hemodynamic parameters during the examination, rescue sedation, time to loss of consciousness, time to recovery of consciousness, and PACU stay time. The MAP and HR are recorded at different time points: before anesthesia induction (T₀), immediately after anesthesia induction (T₁), immediately after the placement of gastroscopy (T₂), immediately after the placement of colonoscopy (T₃), and immediately after the surgery (T₄). The PACU outcome include nausea/vomiting, dizziness/headache, delayed awakening, emergence agitation, and patient satisfaction scores. RESULTS There were 78 and 80 patients included eventually in the E+R group and the R group, respectively. The rates of deoxygenation saturation, hypotension and remedial sedation ≥2 times in the E+R group were significantly lower than those in the R group (P<0.05). The loss time of consciousness, recovery time of consciousness and PACU residence time in the E+R group were significantly shorter than those in the R group (P<0.05). MAP and HR of T₁-T₃ time points in the E+R group were significantly higher than those in the R group (P<0.05). The MAP and HR of T₂ and T₃ were significantly higher than those of T₁ in the R group (P<0.05), but there was no significant difference between MAP and HR of T₂ or T₃ and those of T₁ in the E+R group (P>0.05). There were no significant differences in PACU nausea and vomiting, dizziness/headache, delayed recovery, emergence agitation and satisfaction scores between the two groups (P>0.05). CONCLUSION Compared with remimazolam, esketamine combined with remimazolam can shorten the recovery time, reduce the incidence of desaturation and hypotension in elderly patients undergoing gastroenteroscopy, and contribute to maintain hemodynamic stability without increasing adverse reactions during recovery.

AIM To explore the risk factors of drug-induced liver injury (DILI) of compound sulfamethoxazole (sulfamethoxazole-trimethoprim, SMZ-TMP) in acquired immunodeficiency syndrome (AIDS) patients and provide reference for clinical pharmacovigilance and rational drug use. METHODS The data of AIDS patients treated with SMZ-TMP in our hospital from December 2020 to December 2022 were collected retrospectively. The general information of patients with DILI after taking SMZ-TMP was compared with that of patients without DILI, and binary logistic regression equation was constructed to screen out the risk factors of DILI in AIDS patients induced by SMZ-TMP. RESULTS Totally 271 AIDS patients were involved, and 29 patients had DILI, all of whom were male. Among them, 27 patients were of hepatocellular injury pattern and 2 patients were of cholestatic injury pattern. All DILI patients were cured or improved after symptomatic treatment. Relevant factor analysis showed that, allergy history (OR=15.334，95%CI: 3.147 to 74.710), no receiving antiviral treatment or tenofovir+lamivudine+lopinavir/ritonavir (TDF+3TC+LPV/r) regimen (OR=56.123, 95% CI: 10.797 to 291.719), daily dose of SMZ-TMP ≥ 12 tablets (OR=52.809, 95% CI: 9.894 to 281.868), alanine transaminase (ALT) ≥ 23 U·L^-1 (OR=18.514, 95% CI: 3.993 to 85.843), CD4⁺ T cell ≤110·µL^-1 (OR=40.586，95%CI：6.625 to 248.634), and CD8⁺ T cell ≤ 920·µL^-1 (OR=135.978，95%CI：11.190 to 1 652.303) can increase the risk of SMZ-TMP related DILI in AIDS patients (P<0.05). CONCLUSION The incidence of SMZ-TMP related DILI is relatively high in AIDS patients. Allergy history, selection of antiviral treatment regimens, dose of SMZ-TMP, ALT level, and CD4⁺ and CD8⁺ T lymphocyte counts are the independent risk factors for SMZ-TMP related DILI in AIDS patients. Monitoring of high-risk population should be strengthened and early intervention measures should be taken.

AIM To investigate the efficacy of combined use of sodium oligomannate on psychological and behavioral symptoms in patients with mild to moderate Alzheimer’s disease (AD). METHODS Mild to moderate AD patients with behavioral and psychological symptoms of dementia (BPSD) who visited the outpatient department and inpatient department of our hospital from January 2021 to June 2022 were randomly divided into two groups. The control group was orally administered with donepezil at an initial dose of 5 mg·d^-1, which increased to 10 mg·d^-1 after 4 weeks. On the basis of taking donepezil, the study group combined the use of sodium oligomannate, 450 mg each time, twice a day. The two groups were all treated for 8 weeks. The mini-mental state examination (MMSE) and neuropsychiatric inventory (NPI) were assessed and compared between the two groups at baseline and after 4 and 8 weeks of treatment. The general linear model was used to analyze the effect of combined use of sodium oligomannate on the improvement of NPI scores after the 8-week treatment. RESULTS Finally, 60 patients completed the clinical study, with 30 in each group. The total score of NPI in two groups was significantly decreased compared with baseline after 4 weeks and 8 weeks of treatment (P<0.05), and the decrease was more significant in the study group with significant difference between groups (P<0.05). Compared with the baseline, the scores of apathy, depression, anxiety, and irritability in the study group were significantly decreased at the end of 4 weeks (P<0.05), and agitation and delusion scores were also significantly decreased at the end of 8 weeks (P<0.05). Compared with the control group, the study group showed a more significant decrease in depression, anxiety, agitation, irritability, and appetite scores compared to baseline after 4 weeks of treatment (P<0.05), and a more significant decrease in emotional apathy score after 8 weeks of treatment (P<0.05). The MMSE scores of the two groups were significantly higher than those of the baseline at the end of 4 and 8 weeks (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). CONCLUSION Combined use of sodium oligomannate can not only improve the cognitive function of AD patients, but also improve their BPSD, especially emotional problems such as anxiety, depression, agitation, and irritability, without obvious adverse reactions.

AIM To analyze the effects of different doses of ciprofol on general anesthesia induction in elderly patients, and the influence on hemodynamics during general anesthesia induction. METHODS One hundred and twenty elderly patients undergoing elective surgery were randomly included in ciprofol 0.2 mg·kg^-1 group (C_0.2 group), ciprofol 0.3 mg·kg^-1 group (C_0.3 group) and ciprofol 0.4 mg·kg^-1 group (C_0.4 group), with 40 cases in each group. The corresponding dose of ciprofol was injected intravenously according to the group, and the injection time was 30 s. And all patients induced by rocuronium 0.6 mg·kg^-1 and sufentanil 0.5 μg·kg^-1 were injected intravenously, followed by ciprofol 0.8-2.4 mg·kg^-1·h^-1, remifentanil 8-15 μg·kg^-1·h^-1 was injected intravenously and 1% sevoflurane was inhaled for anesthesia maintenance. The bispectral index (BIS) was maintained 40~60 during the operation. The mean arterial pressure (MAP), heart rate (HR) and BIS of the patients were monitored, the success rate of anesthesia induction, the number of cases of remedial sedation and the time of loss of consciousness were recorded, and the occurrence of adverse reactions were observed. RESULTS The MAP, HR and BIS of the three groups immediately after anesthesia induction (T₁), 10 s after tracheal intubation (T₂) and 3 min after tracheal intubation (T₃) were significantly lower than those of the same group at the time of entering the operating room (P<0.05), and the MAP and HR of T₁-T₃ in the C_0.4 group were significantly lower than those in the C_0.2 group and C_0.3 groups (P<0.05). There were no significant differences in MAP and HR of T₁-T₃ between the C_0.3 group and C_0.2 group (P>0.05). There were no significant differences in the success rate of anesthesia induction among the three groups (P>0.05). The rate of remedial sedation in the C_0.2 group was significantly higher than that in the C_0.3 group and C_0.4 group (P<0.05), and the time of consciousness loss was significantly longer than that in the C_0.3 group and C_0.4 group (P<0.05). There was no significant difference in rate of remedial sedation and consciousness loss time between the C_0.3 group and C_0.4 group (P>0.05). The incidence of hypotension and bradycardia in the C_0.4 group was significantly higher than that in the C_0.2 group and C_0.3 group (P<0.05), but there was no significant difference in the incidence of hypotension and bradycardia between the C_0.3 group and C_0.2 group (P>0.05). CONCLUSION Ciprofol 0.3 mg·kg^-1 has good safety and efficacy for general anesthesia induction in elderly patients.

AIM To investigate the effects of salidroside ( Sal) on the proliferation, migration and collagen synthesis of human keloid fibroblasts ( HKF) by regulating Notch1/Hes1 pathway. METHODS HKF in logarithmic growth period was divided into control group ( NC group), Sal-L, Sal-M, Sal-H ( 10, 20, 40 μmol·L^-1) group, Jagged1 group (Notch activator,5 mg·L^-1), Sal ( 40 μmol·L^-1) + Jagged1 (5 mg·L^-1) group. MTT assay was used to detect cell proliferation. Cell cycle and apoptosis were detected by flow cytometry. Cell migration was detected by scratch test, and Western blot was used to detect the expression of collagen-Ⅰ, collagen-Ⅲ, proliferating cell nuclear antigen ( PCNA), matrix metalloproteinase-2 (MMP-2), Notch1 and Hes1 proteins. RESULTS Compared with the NC group, the A value, the proportion of cells in S phase and G2/M phase decreased, scratch healing rate decreased, the protein expression of collagen-Ⅰ, collagen-Ⅲ, PCNA, MMP-2, Notch1 and Hes1 decreased in the Sal-L, Sal-M and Sal-H group, the proportion of cells in G0/G1 phase and the rate of apoptosis increased, in a dose-dependent manner ( P<0.05), while the Jagged1 group showed the opposite change of the above indexes. Compared with the Sal-H group, the A value, the proportion of cells in S phase and G2/M phase, scratch healing rate, the protein expression of collagen-Ⅰ, collagen-Ⅲ, PCNA, MMP-2, Notch1 and Hes1 increased, the proportion of cells in G0/G1 phase and the rate of apoptosis decreased in the Sal group ( P<0.05). CONCLUSION Sal may inhibit the proliferation, migration and collagen synthesis of HKF by inhibiting Notch1/Hes1 pathway.

AIM To analytical hierarchy process (AHP) and technique for order preference by similarity to an ideal solution (TOPSIS) were used to evaluate the rationality of the use of sacubitril valsartan in the treatment of chronic heart failure, to provide a reference for clinical pharmacists to intervene and promote the rational use of clinical drugs. METHODS Based on the drug instruction of sacubitril valsartan, treatment guidelines, expert consensus and relevant literature, the evaluation criteria for the rational use of sacubitril valsartan in the treatment of chronic heart failure was established, and the AHP method was used to assign weights to the indicators and the TOPSIS method was used to evaluate the rational use of sacubitril valsartan in the treatment of chronic heart failure in our hospital records from January 2022 to June 2022. RESULTS The top 5 indicators with higher weight of the established evaluation criteria were 0.277 8 for indications, 0.199 6 for prohibited combination, 0.176 3 for combination therapy, 0.114 0 for dose administration and 0.081 5 for drug conversion. Ninety medical records were included, of which 22 cases (24%) were evaluated as reasonable medication use, 50 cases (56%) as basic reasonable medication use and 18 cases (20%) as unreasonable medication use. CONCLUSION The AHP-weighted TOPSIS method can be used to evaluate the rationality of sacubitril valsartan in the treatment of chronic heart failure, which can identify problems in clinical application, provide a basis for pharmacological intervention by clinical pharmacists and promote rational drug use in clinical departments.

Chronic kidney disease is a global public health problem, which can progress to end-stage kidney disease. Podocyte injury is a common pathological type of various glomerular diseases, and the incidence of proteinuria can increase with the decrease of podocyte number. The treatment of podocyte injury is still limited by complex etiology, significant side effects of immunotherapy, and late initiation of targeted non-immunosuppressive therapy. In recent years, the research on the mechanism of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in chronic kidney disease had become increasingly extensive and in-depth, but there were still few reports on targeting podocytes. In this paper, the mechanism of SGLT2i against podocyte injury is reviewed, which provides a more sufficient theoretical foundation for the application of SGLT2i in the treatment of podocyte injury-related diseases.

AIM To investigate the clinical features of tacrolimus-related epilepsy, and provide reference for clinical rational antiepileptic drug use. METHODS Related domestic and foreign databases (both up to June 2023) were searched, and case-report literature on tacrolimus-related epilepsy were collected. Clinical information was extracted and analyzed by descriptive statistical method, including patient’s basic characteristics, tacrolimus application (such as indications, dose, route of administration, and blood concentration), and the occurrence time, clinical manifestation, imaging characteristics, intervention measures, and outcomes of epilepsy. RESULTS A total of 11 patients were enrolled in the study, including 6 males and 5 females, aged from 2 years 11 months to 63 years, with a median age of 44 years. In terms of indications, there were 2 cases of hematopoietic stem cell transplantation, 3 cases of kidney transplantation, 4 cases of liver transplantation,1 case of nephrotic syndrome, and 1 case of primary membranous nephropathy. Nine patients underwent tacrolimus plasma concentrations testing, and 3 of them exceed the upper limit of the treatment window when seizure occurred. Epilepsy mainly appeared in d1 to d44 of tacrolimus use. MRI examination in 4 patients showed abnormal signal shadows near the sickle, mild demyelinating of white matter, and patchy abnormal signals around the lateral ventricles. CONCLUSION Tacrolimus-related epilepsy are primarily caused by increased blood concentrations of tacrolimus. It is essential to strengthen the monitoring in clinical application of tacrolimus and provide active symptomatic treatment.

To explore the daily regulatory strategies of regulatory authorities after the implement of filing system of drug clinical trial institutions. From the perspective of administrative law, this article analyzes the differences between the qualification recognition and filing management of drug clinical trial institutions, as well as the characteristics of filing management, and explore the adjustments and response measures for regulatory authorities of drug clinical trial institutions under the current filing system through practice. The filing system simplifies the time limit for drug clinical trial institutions to obtain qualifications, refines the admission standards for drug clinical trial institutions, highlights the qualification requirements and main responsibilities of institutions and researchers, and puts forward higher requirements for post-supervision. The update of regulatory requirements and the increase in regulatory quantity require regulatory authorities to strictly inspect standards, transform law enforcement concepts, innovate regulatory methods, strengthen risk control, and continuously improve regulatory levels, thereby to help China build high-quality drug clinical trial institutions.