KANGGANRAN YAOXUE

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  • Research Progress in Biological Characteristics, Pharmacokinetics and Analytical Methods of Caspofungin*1
    MEI Meng-yu, FU Xiang-xiang, REN Shou-zhong, WANG Min
    2025, 22(9): 859-864. https://doi.org/10.13493/j.issn.1672-7878.2025.09-001
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    Invasive fungal infections constitute a major clinical challenge, associated with extremely high mortality in critically ill and immunocompromised patients. As a representative agent of the echinocandin class of antifungals, caspofungin has emerged as a key option in clinical practice owing to its distinctive mechanism of action and favorable safety profile. Nevertheless, the drug demonstrates complex nonlinear pharmacokinetic behaviors in patients, with pronounced interindividual variability under specific pathophysiological conditions, which presents obstacles to precise clinical medication. This article reviews the research advances in the biological characteristics, pharmacokinetics and analytical methods of caspofungin. It elaborates on its physicochemical properties, mechanism of action and antifungal spectrum, summarizes the pharmacokinetic profiles and modeling studies across diverse patient populations, and outlines the therapeutic drug monitoring methods based on liquid chromatography-tandem mass spectrometry. This review aims to provide comprehensive literature evidence and theoretical support for further comprehending the clinical pharmacological properties of caspofungin and optimizing individualized dosing regimens.
  • Research on Optimization of Extraction Process for Shengbai Decoction by Orthogonal Experimental Design*1
    GUAN Cheng-zhen, WAN Mei-ling, JIA Xian-hong, LIU Lei1, GUO Lin, KAN Si-yu
    2025, 22(9): 865-869. https://doi.org/10.13493/j.issn.1672-7878.2025.09-002
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    Objective: To optimize the water extraction parameters of Shengbai Decoction, a clinical empirical prescription, and establish its key quality control methods, so as to ensure the stability and reproducibility of the preparation and provide experimental support for its standardized production and application. Methods: An HPLC-MS/MS method was developed for the determination of astragaloside IV. Thin-layer chromatography (TLC) was applied for the qualitative identification of Astragali Radix and Sanguisorbae Radix in the prescription. Orthogonal experimental design was adopted with decoction times, decoction duration and water-to-material ratio as the factors, and the total extract content and astragaloside IV content as the comprehensive evaluation indices to screen the optimal extraction process. Results: The established HPLC-MS/MS method for astragaloside IV showed a good linear relationship in the range of 31.3-1 000 ng/mL (r = 0.999). The precision, repeatability, stability and sample recovery tests all met the requirements, indicating that the method was accurate and reliable. The optimal extraction process obtained by orthogonal experiment was as follows: 235 g of herbs according to the formula, adding 8 times the amount of water, decocting twice for 1 h each time. Under these conditions, the extraction rate of astragaloside IV was high, and the process was stable, feasible and reproducible. Conclusion: The optimized extraction process is stable and feasible, which not only ensures the effective dissolution of key components but also improves the preparation efficiency, providing a scientific basis for the standardized preparation and quality control of Shengbai Decoction.
  • Establishment of HPLC Fingerprint and Attribution Analysis of Common Peaks of Sanhuang Capsules*1
    JIN Shun-qi, KANG Yue-qi, HUANG Fei, ZHANG Lu-rong
    2025, 22(9): 870-875. https://doi.org/10.13493/j.issn.1672-7878.2025.09-003
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    Objective: To establish the high-performance liquid chromatography (HPLC) fingerprint of Sanhuang Capsules, a hospital's drug product, and carry out the attribution analysis of its common peaks, so as to provide a reference for the improvement of its specifications. Methods: An Agilent Extend-C18 column (250 mm×4.6 mm, 5 μm) was used with methanol-phosphoric acid solution (pH 2.5) as the mobile phase for gradient elution. The flow rate was 1 mL/min, column temperature was 30 ℃, detection wavelength was 280 nm, and injection volume was 10 μL. The fingerprint was established by analyzing 10 batches of Sanhuang Capsules samples. The identification and attribution analysis of common peaks were performed by comparison with reference standards, as well as chromatograms of single herb and negative herb samples. Results: The HPLC fingerprint of Sanhuang Capsules was established, with 40 common peaks calibrated and the similarities not smaller than 0.998. Eleven components were successfully identified, namely berberine hydrochloride, baicalin, quercetin, wogonoside, baicalein, wogonin, aloe-emodin, rhein, emodin, chrysophanol and physcion. After attribution analysis, 11 peaks were confirmed to be derived from Rhei Radix et Rhizoma, 14 peaks from Scutellariae Radix, and 3 peaks from Phellodendri Chinensis Cortex. Peaks 21 and 22 were common to Rhei Radix et Rhizoma and Scutellariae Radix, while peak 11 was common to Scutellariae Radix and Phellodendri Chinensis Cortex. Conclusion: The established HPLC fingerprint method is stable and reliable, which can comprehensively characterize the overall chemical characteristics of Sanhuang Capsules. It provides a scientific basis for the subsequent establishment of multi-index component determination method and further improvement of its quality control standard
  • Anti-infective Diagnosis and Treatment Analysis of a Patient with Pulmonary Mixed Infection Caused by Gram-Negative Bacteria
    GONG Yan-qing, ZHONG Hai-li, WANG Jiang-hong
    2025, 22(9): 876-880. https://doi.org/10.13493/j.issn.1672-7878.2025.09-004
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    Objective: To analyze the anti-infective diagnosis and treatment process of a patient with pulmonary mixed infection caused by Gram-negative bacteria including Elizabethkingia anophelis and Klebsiella pneumoniae, and provide a reference for the diagnosis and treatment of complex or rare infectious diseases in clinical practice. Methods and Results: The patient was treated for respiratory symptoms at another hospital, where pulmonary infection was confirmed and Klebsiella pneumoniae (carbapenem-resistant) was detected. Antimicrobial agents including imipenem-cilastatin sodium, linezolid, tigecycline and amikacin were administered sequentially. After several days of treatment, the patient was transferred to the intensive care unit (ICU) due to disease deterioration. After initial diagnosis, the patient was treated with polymyxin B combined with meropenem. However, no improvement was observed in clinical symptoms or inflammatory indicators. Subsequent microbial culture identified Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae (the latter two were carbapenem-resistant by susceptibility test). Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) revealed that Elizabethkingia anophelis had the highest sequence number and relative abundance, indicating its pathogenic role. Minocycline was therefore added to the regimen. After more than 10 days of treatment, the patient's clinical symptoms and infection-related indicators improved significantly. Conclusion: In the management of refractory infections, advanced techniques should be fully utilized to identify potential pathogens not covered by antibacterial drugs. Clinical pharmacists should also actively assist clinicians in formulating targeted therapeutic regimens to achieve favorable clinical outcomes.
  • Pharmaceutical Care for a Patient with Brainstem Hemorrhage Complicated by Pulmonary Infection
    LI Zhi-yue, LI Shan
    2025, 22(9): 881-885. https://doi.org/10.13493/j.issn.1672-7878.2025.09-005
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    Objective: To analyze the pharmaceutical care process for a patient with brainstem hemorrhage complicated by pulmonary infection caused by Pseudomonas aeruginosa, and provide a reference for optimizing therapeutic regimens for such patients. Methods and Results: The patient was admitted to the hospital due to brainstem hemorrhage and pulmonary infection accompanied by fever. On admission, the patient was presented with high fever (39.4 ℃) and elevated levels of interleukin-6 (IL-6), procalcitonin (PCT) and other inflammatory indicators, and was initially given cefoxitin empirically. One day later, the patient still had persistent high fever with progressively worsening inflammatory markers; the anti-infective regimen was then adjusted to meropenem (1 g, q8h, intravenous infusion) plus linezolid (0.6 g, q24h, intravenous infusion), with no obvious improvement. Five days later, carbapenem-resistant Pseudomonas aeruginosa (CRPA) was identified in bronchoalveolar lavage fluid of the patient. Following multidisciplinary consultation (MDT), the regimen was switched to colistin E (0.1 g, q24h, intravenous injection) + colistin E (0.1 g, q24h, intravenous infusion) + colistin E (0.05 g, q24h, aerosol inhalation) + meropenem (1 g, q8h, intravenous infusion). With this regimen and continuous pharmaceutical care, the patient's inflammatory markers declined steadily. The infection was basically controlled, and colistin E and meropenem were tapered and discontinued. Approximately one month later, the patient's condition continued to improve with no further indications for intensive care, and the patient was transferred to the rehabilitation department for further rehabilitation. Conclusion: Widespread use of carbapenems has led to rising detection and resistance rates of CRPA. Given its complex resistance mechanisms, limited effective therapeutic agents and high mortality, combination therapy should be initiated as early as possible once the pathogen is confirmed. For colistin E administration, renal function must be rigorously assessed to determine dosage and frequency, with dynamic monitoring of efficacy and nephrotoxicity to ensure medication safety.
  • Pharmaceutical Care for a Patient with Acute Liver Injury Induced by Combination of Nemonoxacin and Omadacycline
    LIN Ting-ting, HU Pei, LIU Jia, GOU Xiao-yan, JIANG Jin-lin, CAI Jin, WANG Ping
    2025, 22(9): 891-894. https://doi.org/10.13493/j.issn.1672-7878.2025.09-007
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    Objective: To analyze the onset process, management measures and possible mechanism of acute liver injury induced by the combination of nemonoxacin and omadacycline, and provide a reference for the safe and rational clinical use of antibacterial drugs. Methods and Results: The patient was admitted on August 7, 2023, with recurrent fever for 7 days, cough and expectoration with hemoptysis for 4 days, and aggravated dyspnea for 1 day. Severe pneumonia was preliminarily diagnosed according to the examinations. On August 8, nemonoxacin was administered empirically for anti-infective therapy. On August 9, high-throughput sequencing of bronchoalveolar lavage fluid indicated Chlamydia psittaci, and omadacycline was added for combined anti-infective therapy. On August 10, biochemical results showed significantly abnormal alanine transaminase and aspartate transaminase, suggesting acute liver injury. Clinical pharmacists recommended hepatoprotective treatment, after which the patient's liver function gradually improved. The Naranjo scale assessed the correlation between acute liver injury and the combined use of nemonoxacin and omadacycline as "probable". Conclusion: The combination of nemonoxacin and omadacycline may induce acute liver injury. Therefore, risk assessment should be carried out when clinically combining drugs with hepatotoxicity, and unnecessary drug combinations should be avoided to reduce the occurrence of adverse drug reactions.
  • Study on the Mechanism of Hanchuan Zupa Granules in the Treatment of Bronchial Asthma Based on Network Pharmacology and Differential Gene Analysis of GEO
    GAO Rui, YUAN Feng-juan, ZHANG Li-juan, LIU Chun
    2025, 22(9): 907-914. https://doi.org/10.13493/j.issn.1672-7878.2025.09-010
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    Objective: To explore the potential mechanism of action of Hanchuan Zupa Granules in the treatment of bronchial asthma based on network pharmacology, mining of asthma-related microarray data from the Gene Expression Omnibus (GEO) database and molecular docking verification, and provide evidences for the clinical application and mechanistic interpretation of this compound Chinese medicine. Methods: The active components and corresponding targets of Hanchuan Zupa Granules were screened via the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) and the HERB database. Asthma-related targets were retrieved from the GEO, OMIM and GeneCards databases with "bronchial asthma" and "asthma" as keywords, followed by correction and deduplication via the Uniprot database. The intersection targets of drugs and diseases were extracted to construct a "drug-component-target" regulatory network and protein-protein interaction (PPI) network. GO functional enrichment and KEGG pathway enrichment analyses of the intersection targets were performed using the DAVID database. Core components and key targets were screened according to network topological parameters, and the top-ranked component and the top 3 targets were selected for molecular docking and visualization analysis. Results: A total of 123 active components and 303 potential targets of Hanchuan Zupa Granules were identified. The top 3 key active components for bronchial asthma treatment were quercetin, luteolin and kaempferol. PPI network analysis showed that the top 10 targets sorted by Degree value included serine/threonine-protein kinase 1 (AKT1), tumor necrosis factor (TNF), interleukin-6 (IL-6), tumor protein p53, interleukin-1β, caspase-3, hypoxia-inducible factor-1α, estrogen receptor 1, signal transducer and activator of transcription 3, and B-cell lymphoma-2. These targets were mainly enriched in inflammation-related signaling pathways including phosphatidylinositol 3-kinase/AKT (PI3K/AKT), TNF and interleukin-17 pathways. Molecular docking results revealed that the binding affinity of the core component quercetin with key targets was less than -6 kcal/mol, indicating strong binding stability. Conclusion: Hanchuan Zupa Granules may alleviate the symptoms of bronchial asthma by acting on targets such as AKT1, TNF and IL-6 through effective components including quercetin, thereby regulating inflammatory responses and airway remodeling.