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  • Research Progress in the Treatment of Septic Shock with Levosimendan
    YU Xing-feng
    2024, 21(6): 555-558. https://doi.org/10.13493/j.issn.1672-7878.2024.06-001
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    Septic shock occurs when pathogenic microorganisms and their toxins invading the blood circulation activate the host's cellular and humoral immune systems, producing various cytokines and inflammatory mediators to cause systemic inflammatory response syndrome, and further act on various organs and systems, causing histiocytic destruction, metabolic disorders, dysfunction, and even multiple organ dysfunction, ultimately leading to a critical syndrome with shock as a prominent manifestation. Levosimendan, as a calcium ion sensitizer, can not only improve myocardial contractility without increasing cellular oxygen consumption, but also dilate coronary arteries and systemic blood vessels, thereby improving hemodynamics. In this article, the epidemiological characteristics and pathogenesis of septic shock, the pharmacological effects and mechanisms of levosimendan, and the application and potential risks of levosimendan in septic shock are mainly reviewed, to provide a reference for the clinical use of levosimendan.
  • Research on Anti-inflammatory Effects of the Fresh Oldenlandia Diffusa Water Extract and Alcohol Extract*1
    YUAN Qin, LI Man, ZHANG Lu-rong
    2024, 21(6): 559-563. https://doi.org/10.13493/j.issn.1672-7878.2024.06-002
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    Objective: To compare the differences in the anti-inflammatory effects in vivo and in vitro of fresh Hedyotis diffusa water extract and alcohol extract, so as to lay a theoretical foundation for further clinical studies. Methods: Fresh Hedyotis diffusa was subjected to refluxing extraction with water or 75% ethanol, and the extract was concentrated and freeze-dried to obtain the extract powder. The extract powder was prepared into the corresponding herbal medicine solution, then the anti-inflammatory effects on mouse macrophages (RAW264.7) and mice in an inflammatory model were observed, and the differences between the water extract and alcohol extract were compared. Results: Both the water extract and the alcohol extract of fresh Hedyotis diffusa inhibited the viability of lipopolysaccharide-induced RAW264.7, and the water extract was generally superior to the alcohol extract in terms of the inhibition rate of inflammatory factors such as interleukin-6, interleukin-1β, and tumor necrosis factor-α. In addition, both the water extract and the alcohol extract of fresh Hedyotis diffusa reduced ear swelling and writhing times in inflammatory model mice. The overall effect of the water extract was superior to the alcohol extract. Conclusion: The anti-inflammatory effects of the water extract and the alcohol extract of Hedyotis diffusa are different, and the former was superior to the latter, which may be correlated with the difference in their components.
  • Analysis of Pharmaceutical Care for Anti-infective Therapy in One Patient with Right-sided Infective Endocarditis Complicated by Infection at Other Sites*1
    LU Yan-quan, LIU Sha
    2024, 21(6): 564-569. https://doi.org/10.13493/j.issn.1672-7878.2024.06-003
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    Objective: To analyze the pharmaceutical care for anti-infective therapy in one patient with right-sided infective endocarditis (IE) complicated by infection at other sites, and provide a reference for the anti-infective therapy of similar patients in clinical practice. Methods and Results: The patient was admitted to the Hospital due to intermittent fever for nearly a month, and was preliminarily diagnosed with pulmonary infection clinically due to occasional coughing and expectoration. Empiric treatment with piperacillin-tazobactam sodium was administered. Upon completion of the admission examination, it was clinically considered, based on the results of the cardiac color ultrasonography, that a right-sided IE was present. Accordingly, the clinical pharmacist recommended the addition of vancomycin for the methicillin-resistant Staphylococcus aureus (MRSA); but in consideration of gradual alleviation of the fever, the recommendation was not adopted. However, the patient developed a fever a week later, and Staphylococcus aureus was detected in the blood culture. Considering the renal function of the patient, linezolid and levofloxacin were administered clinically. Two days later, in consideration of the improved renal function, vancomycin was administered instead. Shortly after, the patient's fever symptoms improved significantly. In addition, given that candida parapsilosis was repeatedly detected in the urine fungal culture recently, fluconazole was added for treatment, and the urine fungal culture result turned negative after 10 days. Conclusion: For patients suffering from complicated infections, clinical pharmacists should fully consider the conditions of the patients to assist physicians in making more accurate judgments, so as to formulate more individualized anti-infective treatment regimens and implement pharmaceutical care, thereby ensuring the medication safety and effectiveness for patients.
  • Pharmaceutical Care for Anti-infective Therapy in One Patient with Neurobrucellosis Complicated by Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy
    LIN Hui-guo, WANG Chang-sheng
    2024, 21(6): 569-573. https://doi.org/10.13493/j.issn.1672-7878.2024.06-004
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    Objective: To analyze the pharmaceutical care process of anti-infective therapy in one patient with neurobrucellosis complicated by autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A), and provide a reference for the treatment of patients with such complex and rare diseases. Methods and Results: The patient visited the hospital due to "dizziness and weakness of both lower limbs for 4 days". Upon admission, the patient was preliminarily diagnosed with tuberculous meningitis based on the symptoms, laboratory tests and imaging results. The GFAP antibody test showed that the patient also had GFAP-A. After 10 days of anti-tuberculosis therapy, the patient's symptoms and related laboratory indicators were improved, and the patient was permitted to be discharged. However, the patient experienced headaches and fever again on the second day after discharge. Upon further inquiry, it was discovered that the patient had been engaged in lamb processing for a prolonged period of time. A serum and cerebrospinal fluid test for brucella antibodies was then performed, and the results were both positive. The patient was then diagnosed with brucella meningitis. Following consultation with the clinical pharmacist, the patient was prescribed doxycycline, rifampicin, and ceftriaxone for treatment. After 11 days, the patient's symptoms were improved and he was discharged from the hospital. The clinical pharmacist recommended that the discharge treatment regimen was adjusted to doxycycline + rifampicin + compound sulfamethoxazole. More than four months later, the patient's brain images showed significant improvement over the previous results. The results of the cerebrospinal fluid brucella antibody test were negative, and the headache and limb weakness had also alleviated, however, the results of the serum brucella antibody test were still positive. Conclusion: Neurobrucellosis was a relatively complex and serious disease. The treatment should be performed with sufficient dosage and duration. The involvement of clinical pharmacists can assist physicians in formulating more optimized anti-infective treatment regimens, and can also monitor the safety of medication in the process of pharmaceutical care to safeguard the safety and effectiveness of medication treatment for patients.
  • Diagnosis and Treatment Analysis of One Case of Neutropenic Fever Caused by Linezolid Substitution for Vancomycin*1
    GAO Lin, FAN Lei, PANG Ji-min, LIU Hong-zhi, MAO Yang
    2024, 21(6): 574-577. https://doi.org/10.13493/j.issn.1672-7878.2024.06-005
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    Objective: To analyze the diagnosis and treatment process of one case of neutropenia with fever caused by substitution of linezolid for vancomycin, and provide a reference for the safe use of linezolid and vancomycin in clinical practice. Methods and Results: The patient was admitted to the hospital due to "right knee pain and limited mobility caused by trauma for 9 days". Arthroscopic examination of the knee joint showed purulent arthritis, and vancomycin was administered empirically. Subsequent culture of the joint drainage fluid did reveal methicillin-resistant Staphylococcus aureus. After ten days of vancomycin treatment, the results of blood and joint drainage fluid cultures were negative, however, the patient still had intermittent fever, and the neutrophil count was progressively decreasing to 1.29×109/L. After consultation with the infectious disease experts, it was believed that the neutropenia and fever were possibly caused by vancomycin, and it was suggested to use linezolid. Within one week after administration of linezolid, the neutrophil count continued to decrease, even falling below 0.1×109/L. Therefore, linezolid was immediately discontinued and recombinant human granulocyte colony-stimulating factor was administered. Three days later, the neutrophil count recovered significantly, and 13 days later, the neutrophil count returned to normal level without further decline. Conclusion: Neutropenia caused by non-chemotherapy drugs is a serious adverse drug reaction. Vancomycin and linezolid can both cause neutropenia. Clinically, the adverse drug reactions should be monitored and neutropenia without other obvious inducements should be concerned, so as to ensure the safe medication for patients.
  • Epidemiological Analysis of Lacosamide-related Adverse Drug Reactions Based on OpenFDA*1
    ZHOU Tian-tian, ZHANG Ying, WANG Lu
    2024, 21(6): 577-581. https://doi.org/10.13493/j.issn.1672-7878.2024.06-006
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    Objective: To explore the clinical characteristics of adverse drug reactions (ADRs) related to lacosamide based on OpenFDA, a public database of U.S. Food and Drug Administration, and provide a reference for the clinically safe medication of lacosamide. Methods: All information on lacosamide-related ADRs from January 1, 2004 to February 1, 2023 was searched in the OpenFDA database using "lacosamide" as the key word to analyze its epidemiological characteristics. Results: A total of 10 510 patients with lacosamide-related ADRs were searched from the OpenFDA database, of which, the number of reported patients increased significantly since 2018. Among all lacosamide-related ADRs, most of ADRs were of "serious" (9 170 patients, 87.25%), and only a small number of patients (1 340 patients, 12.75%) were of "ordinary". The lacosamide-related ADRs were mainly manifested as various neurological symptoms, followed by systemic or administration site discomforts or abnormalities and psychiatric symptoms. Among 10 510 patients with lacosamide-related ADRs, the outcomes of 1 011 patients were death and 76 patients had sequelae. Conclusion: Most of the lacosamide-related ADRs are serious, and even cause deaths. Therefore, it is necessary to strengthen the clinical medication monitoring when lacosamide is used for treatment, to avoid or reduce the occurrence of serious adverse outcomes.
  • Cost-effectiveness Analysis of Centrally Purchased and Original Cefoperazone-Sulbactam Sodium in the Treatment of Patients with Bacterial Infection*1
    LI Min, ZHANG Man-man
    2024, 21(6): 587-592. https://doi.org/10.13493/j.issn.1672-7878.2024.06-008
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    Objective: The effectiveness, safety and economy of centrally purchased and original cefoperazone-sulbactam sodium in the treatment of patients with bacterial infections were compared and evaluated based on the cost-effectiveness analysis method, to provide a reference for more rational allocation of medical resources clinically. Methods: Using 191 patients with bacterial infections who were treated with centrally purchased and original cefoperazone-sulbactam sodium in Suqian First Hospital from January to December 2022 as the research objects, the 1:1 nearest neighbor matching method was used to perform propensity score matching, and the effectiveness, safety and economy of centrally purchased and original cefoperazone-sulbactam sodium in the treatment of patients with bacterial infections were compared. Results: After propensity score matching, 110 effective cases were finally included, including 55 cases in each of the centrally purchase group and the original group. The clinical effective rates in the centrally purchase group and the original group were 69.09% and 70.91% respectively, the bacterial clearance rates were 58.18% and 60.00% respectively, and the incidences of adverse drug reactions were 5.45% and 3.64% respectively. There was no statistical significance for difference in the three indicators by comparison between the two groups (P>0.05). Pharmacoeconomic analysis showed that the per capita treatment costs of the centrally purchase group and the original group were RMB 67 804.11 and RMB 5 193.52 respectively, and the cost-effectiveness ratios (CER) were 981.39 and 1 060.56 respectively. The obtained incremental cost-effectiveness ratio (ICER) of the original cefoperazone-sulbactam sodium was 4 060.11. The sensitivity analysis showed that when the cost was reduced by 10%, the incremental cost required for each patient to benefit clinically was RMB 3 654.10 in the original group; when the effect was reduced by 10%, the incremental cost required for each patient to benefit clinically was RMB 4 505.74 in the original group. Conclusion: The effectiveness and safety of centrally purchased cefoperazone-sulbactam sodium and original cefoperazone-sulbactam sodium in the treatment of patients with bacterial infections were similar, but the centrally purchased cefoperazone-sulbactam sodium is significantly more economical.
  • Research on Mechanism of Action of Erigeron Breviscapus on Hypertension Based on Network Pharmacology and Molecular Docking*1
    WANG Sheng, GENG Li, QU Ming-chao
    2024, 21(6): 592-599. https://doi.org/10.13493/j.issn.1672-7878.2024.06-009
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    Objective: To explore the mechanism of action of erigeron breviscapus in treating hypertension using network pharmacology and molecular docking techniques. Methods: The active ingredients of erigeron breviscapus and its targets were searched on the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform, and the related protein targets of hypertension were searched in GeneCards, TTD and OMIM databases, and the gene names of the targets were available in the Uniprot and STRING databases. A Venn diagram was drawn to obtain the intersection targets. Then, the "erigeron breviscapus-ingredients-hypertension-targets" network diagram was constructed using the software Cytoscape 3.10.0 to obtain the main compound components, and then the main targets of erigeron breviscapus for the treatment of hypertension were obtained by constructing a protein-protein interactions (PPI) network; the DAVID database was used to perform GO functional enrichment analysis and KEGG pathway enrichment analysis on the intersection targets of drugs and diseases. Finally, molecular docking verification was performed on the main compounds and main targets, and the binding energy was calculated. Results: After screening, 207 targets of erigeron breviscapus, 1 585 hypertension-related targets and 113 intersection targets were obtained; among them, the top 5 components with the highest degree value were quercetin, kaempferol, luteolin, formononetin and baicalein, and the top 5 intersection targets with the highest degree value were transcription factor activator protein 1 (JUN), tumor suppressor gene p53 (TP53), heat shock protein HSP90-α (HSP90AA1), serine/threonine kinase 1 (AKT1), mitogen-activated protein kinase 1 (MAPK1). The GO functional enrichment analysis and KEGG pathway enrichment analysis showed that the reactive oxygen species signaling pathway, PI3K-Akt, tumor necrosis factor (TNF) signaling pathway, etc. were the main pathways of erigeron breviscapus in treating hypertension. The molecular docking results showed that the binding energy of the top 5 components and the top 5 intersection targets was less than -5 kJ/mol, indicating that the main components bound with the main targets well. Conclusion: The main active ingredients in erigeron breviscapus can bind with the therapeutic targets of hypertension well, so it is potentially developed into a drug for the treatment of hypertension.