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  • Research Progress in Regulatory Mechanism of Deubiquitinating Enzyme in Hepatitis B Virus Infection*1
    WANG Yu, CHEN Yuan-mei, ZHU Li, ZHU Chuan-wu
    2026, 23(4): 329-333. https://doi.org/10.13493/j.issn.1672-7878.2026.04-001
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    During hepatitis B virus (HBV) infection, protein ubiquitination plays a pivotal role in host immune regulation and viral replication. By reversing protein ubiquitination, deubiquitinating enzyme (DUB) modulate the localization, metabolism and degradation of viral proteins, and further regulate HBV replication and clearance. This article systematically summarizes the functional mechanism of DUB in regulating HBV infection via protein ubiquitination, elucidates the intricate regulatory network between viral immune evasion and host immune defense, provides new ideas for the research and development of antiviral agents, and facilitates the clinical cure of chronic hepatitis B.
  • Clinical Diagnosis, Treatment and Pharmaceutical Care of a Patient with Hepatitis B Cirrhosis Complicated by Brucella Bloodstream Infection
    WU Yan, GAO Ting, MA Li, XIONG Shi-juan
    2026, 23(4): 334-338. https://doi.org/10.13493/j.issn.1672-7878.2026.04-002
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    Objective: To analyze the anti-infective treatment regimen for a patient with Brucella bloodstream infection complicated by liver cirrhosis, explore the selection and adjustment of anti-infective regimens in patients with moderate to severe hepatic insufficiency, and provide a reference for individualized treatment of similar cases. Methods and Results: A 54-year-old male patient with a history of cattle and sheep rearing was admitted due to "recurrent fever accompanied by cough and low back pain", with a prior diagnosis of decompensated cirrhosis. Brucella infection was confirmed by blood culture after admission. The initial anti-infective regimen was doxycycline combined with rifampicin. After 4 days of treatment, the patient's bilirubin levels increased progressively (with total bilirubin rising to 34.6 μmol/L and direct bilirubin to 22.4 μmol/L). Rifampicin-associated hepatotoxicity was suspected, thus, rifampicin was discontinued, the regimen was switched to doxycycline monotherapy, and ursodeoxycholic acid was added. Bilirubin levels decreased significantly after drug withdrawal. The patient was discharged with prescribed medications after his condition stabilized. One week after discharge, the patient developed low-grade fever and low back pain again, and received anti-infective therapy with levofloxacin plus doxycycline at a local hospital, with symptoms gradually relieved. Conclusion: For the anti-infective treatment of Brucella infection complicated with hepatic insufficiency, a balance between therapeutic efficacy and drug safety should be achieved. The combination of rifampicin and doxycycline is a commonly used regimen, but it may aggravate liver injury, while monotherapy is associated with a higher risk of recurrence. In clinical practice, combination regimens with lower hepatotoxicity should be prioritized based on the patient's liver function, and liver function monitoring as well as pharmaceutical care should be strengthened throughout the treatment course.
  • Anti-infective Therapy and Pharmaceutical Care of a Patient with Carbapenem-resistant Gram-negative Bacterial Infection after Craniocerebral Injury Surgery
    ZHENG Li-xia
    2026, 23(4): 339-344. https://doi.org/10.13493/j.issn.1672-7878.2026.04-003
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    Objective: To analyze the anti-infective therapy and pharmaceutical care of a patient with carbapenem-resistant Gram-negative bacterial infection after craniocerebral injury surgery, and provide a reference for rational clinical drug use. Methods and Results: The patient underwent intracranial hematoma evacuation and decompressive craniectomy for multiple cerebral contusions and lacerations, and developed persistent high fever after surgery. After admission to the ICU, sputum culture, blood culture and drug susceptibility tests all indicated multidrug-resistant Acinetobacter baumannii, which was sensitive to tigecycline and polymyxin E. Clinical pharmacists participated in the treatment. The initial regimen was tigecycline intravenous infusion combined with intravenous infusion and aerosol inhalation of colistimethate sodium. Later, cerebrospinal fluid culture and drug susceptibility test confirmed multidrug-resistant Acinetobacter baumannii. For the intracranial infection, intrathecal injection of polymyxin E and tigecycline was administered, and the infection was partially controlled. Subsequently, due to renal injury (creatinine clearance rate decreased to 31.71 mL/min), abnormal liver function (total bilirubin 47.0 μmol/L) and coagulation dysfunction, the doses of polymyxin E and tigecycline were adjusted or the drugs were discontinued respectively. Afterwards, cerebrospinal fluid culture turned positive for Enterobacter cloacae. Drug susceptibility tests showed that the strain was resistant to ceftazidime-avibactam sodium but sensitive to aztreonam. Clinical pharmacists recommended ceftazidime-avibactam sodium combined with aztreonam, and the infection was brought under control. During treatment, the dosage regimen was adjusted in a timely manner through therapeutic drug monitoring and dynamic monitoring of hepatorenal function and coagulation function. Eventually, the patient's intracranial infection improved, and the patient was transferred to the department of neurosurgery for hydrocephalus shunt surgery. Conclusion: The treatment is difficult for intracranial infection caused by carbapenem-resistant Gram-negative bacteria after craniocerebral injury surgery. Individualized combination anti-infective regimens should be formulated based on drug susceptibility results, blood-brain barrier permeability and adverse drug reaction monitoring. The full participation of clinical pharmacists helps optimize medication, reduce toxicity and improve patient prognosis.
  • Diagnosis and Treatment Analysis of a Patient with Severe Adverse Drug Reactions Induced by Cefotaxime-Sulbactam Sodium
    PENG Yan-qiong
    2026, 23(4): 345-347. https://doi.org/10.13493/j.issn.1672-7878.2026.04-004
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    Objective: To analyze the occurrence and management process of severe adverse drug reactions (ADRs) induced by cefotaxime-sulbactam sodium, and provide a reference for the clinical medication safety of this agent. Methods and Results: A patient was admitted due to "36+4 weeks of gestation, lower abdominal distending pain with vaginal fluid leakage for 1 hour" and underwent cesarean section. Postoperatively, the patient presented with fever and elevated infection markers, which suggested bacterial infection. Cefotaxime-sulbactam sodium (1.5 g, q8h) was initiated for anti-infective therapy. Due to recurrent fever, the dose was adjusted to 2.25 g per dose 8 hours later. On the next day, the patient suddenly developed frisson, tachypnea, chest tightness and palpitations, with unmeasurable blood pressure, followed by hypertensive crisis and hyperthermia up to 40℃. The symptoms were relieved after symptomatic treatment. On the afternoon of the same day, the patient redeveloped chest tightness and palpitations during the administration of cefotaxime-sulbactam sodium. The symptoms were suspected to be ADRs induced by the drug. After immediate discontinuation and switching to an alternative anti-infective regimen, no further discomfort occurred. Conclusion: The severe ADRs in this patient following cefotaxime-sulbactam sodium administration involved the respiratory and cardiovascular systems. Clinical monitoring of ADRs should be strengthened during the use of this drug, and vigilance against severe ADRs is required for special populations (such as peripartum women) and after dose adjustment, so as to ensure medication safety of patients.
  • Diagnosis and Treatment Analysis of a Patient with Tislelizumab-Induced Diabetic Ketoacidosis
    FEI Tian-yu, LU Bing, LIU Dong, LIU Yu, XU Tao, YANG Hui
    2026, 23(4): 348-352. https://doi.org/10.13493/j.issn.1672-7878.2026.04-005
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    Objective: To analyze the pharmaceutical care process of tislelizumab-induced diabetic ketoacidosis (DKA) in a patient with advanced lung adenocarcinoma, and provide a reference for the safe and rational clinical use of immune checkpoint inhibitors (ICIs). Methods and Results: A 61-year-old male patient was admitted due to "over 2 years after surgery for left lung adenocarcinoma and half a day of impaired limb movement". The patient had no prior history of diabetes mellitus and had received 7 cycles of tislelizumab immunotherapy. The admission diagnoses were left lung adenocarcinoma stage IVA (T2N2M1) and chronic intractable pain. On the day of admission, his blood glucose level exceeded 38.86 mmol/L, and urinary ketone bodies tested positive (++). Continuous intravenous insulin infusion at 2 IU/h and fluid replacement were immediately initiated for glycemic control. The patient was subsequently transferred to the ICU due to critical condition, and received symptomatic and supportive treatments including continuous insulin pump therapy, airway management, anti-infective therapy, and acid suppression for gastric mucosal protection. After 3 days of treatment, the patient’s vital signs stabilized, and he was transferred back to the geriatrics department for further treatment, with dynamic blood glucose monitoring and insulin dose adjustment based on glucose levels. After 15 days of treatment, urinary ketone bodies and urinary glucose turned negative, and blood glucose was stably controlled. The patient was discharged with prescribed medications: insulin aspart (8 IU subcutaneously before breakfast, 6 IU subcutaneously before lunch and dinner) and insulin glargine (14 IU subcutaneously at bedtime). He was instructed to continue blood glucose monitoring and insulin dose adjustment after discharge. Conclusion: Vigilance against immune-related adverse reactions is required during ICI therapy. In clinical practice, blood glucose monitoring and management should be strengthened, and DKA should be identified and managed promptly to ensure medication safety of patients.
  • Analysis of Controversies and Consensus on Perioperative Prophylactic Use of Antibacterial Drugs in Inguinal Hernia Repair Patients
    LIU Shou-ling, WANG Zhen, SHEN Yang-chao, LIU Hui
    2026, 23(4): 358-365. https://doi.org/10.13493/j.issn.1672-7878.2026.04-007
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    Inguinal hernia repair is one of the most widely performed surgical procedures worldwide, with an annual volume of over 10 million cases. Although classified as a clean procedure (theoretical risk of surgical site infection (SSI) below 2%), the actual incidence rate of postoperative SSI can reach 4%-8% in clinical practice. Particularly in tension-free hernia repair with mesh implantation, SSI may not only lead to mesh exposure, migration or even surgical removal, but also increase the hernia recurrence rate by 3-5 folds, significantly prolonging hospital stay and raising medical costs. As a key intervention for SSI reduction, the clinical value, agent selection, administration timing and treatment course regarding prophylactic use of antibacterial drugs have long been debated. This article systematically reviews high-quality domestic and international studies (including randomized controlled trials, meta-analyses and guidelines) in the past 10 years, analyzes and summarizes the topic from four dimensions: the evidence base for key controversial issues, the formation logic of clinical consensus, existing problems in practical implementation, and future research directions. It aims to provide a reference for clinicians to develop individualized prophylactic regimens, and offer insights for promoting the rational use of antibacterial drugs and the prevention and control of bacterial resistance.
  • Clinical Comprehensive Evaluation of Injectable Nitroimidazoles
    ZHANG Wen-ying, Li Jia, ZHENG Yan-lin, ZHOU Qiao-ling, CHEN Jie
    2026, 23(4): 366-377. https://doi.org/10.13493/j.issn.1672-7878.2026.04-008
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    Objective: To comprehensively evaluate the clinical value of injectable nitroimidazoles, and provide a reference for drug selection and rational use of such drugs in medical institutions. Methods: Based on the quantitative evaluation and selection record form specified in the Rapid Guideline for Drug Evaluation and Selection in Chinese Medical Institutions (the Third Edition) (hereinafter referred to as the Selection Guideline), evaluation evidence was collected. A comprehensive evaluation was conducted on 7 preparations from five dimensions: effectiveness, safety, pharmaceutical properties, cost-effectiveness and other attributes. The preparations included metronidazole and sodium chloride injection (Baxter Healthcare (Shanghai) Co., Ltd.), metronidazole and sodium chloride injection (Huiyinbi Group Jiangxi Dongya Pharmaceutical Co., Ltd.), tinidazole and sodium chloride injection, ornidazole injection, levornidazole disodium phosphate for injection, morphinidazole and sodium chloride injection (Jiangsu Hansoh Pharmaceutical Group Co., Ltd.), and morphinidazole and sodium chloride injection (Shandong Qidu Pharmaceutical Co., Ltd.). Results: The quantitative scores of the above drugs in descending order were as follows: ornidazole injection (Shijiazhuang No.4 Pharmaceutical Co., Ltd., 79.8 points), metronidazole and sodium chloride injection (Huiyinbi Group Jiangxi Dongya Pharmaceutical Co., Ltd., 67.9 points), metronidazole and sodium chloride injection (Baxter Healthcare (Shanghai) Co., Ltd., 67.5 points), tinidazole and sodium chloride injection (Sichuan Meidakang Jiale Pharmaceutical Co., Ltd., 65.2 points), levornidazole disodium phosphate for injection (Yangtze River Pharmaceutical Group Jiangsu Zilong Pharmaceutical Co., Ltd., 54.5 points), morphinidazole and sodium chloride injection (Jiangsu Hansoh Pharmaceutical Group Co., Ltd., 49.4 points), and morphinidazole and sodium chloride injection (Shandong Qidu Pharmaceutical Co., Ltd., 48.6 points). Conclusion: With favorable performance in safety and cost-effectiveness, ornidazole injection, together with metronidazole and sodium chloride injection, are the priority choices for medical institutions in the selection of injectable nitroimidazoles. The comprehensive evaluation results based on the Selection Guideline can provide a reference for the selection and rational clinical use of such drugs in medical institutions.
  • Clinical Management and Medication Optimization of Amphotericin B-Induced Nephrotoxicity
    WANG Pei-hong, ZHANG Yin
    2026, 23(4): 378-383. https://doi.org/10.13493/j.issn.1672-7878.2026.04-009
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    Amphotericin B is an irreplaceable broad-spectrum antifungal drug for the treatment of invasive fungal diseases, yet nephrotoxicity remains its major dose-limiting adverse drug reaction, which severely restricts its clinical application. This article summarizes the pathogenesis of nephrotoxicity induced by amphotericin B deoxycholate and liposomal formulations, involving multiple pathways including direct renal tubular injury, renal vasoconstriction and oxidative stress. It focuses on the nephroprotective mechanism of liposomal formulations, achieved through pharmacokinetic advantages such as targeting the mononuclear phagocyte system and reducing free drug concentration in the kidney. Furthermore, clinical management strategies are summarized from multiple aspects, including risk assessment, hydration and volume expansion, infusion time optimization, dose and dosing interval adjustment, and combination with low-nephrotoxicity drugs. This article aims to provide a theoretical basis for the safe clinical use of amphotericin B and the optimization of individualized treatment regimens.