In recent years， with the increasing severity of multi-drug resistant and extensively drug-resistant Gram-negative bacterial infections， polymyxin B has become a crucial option for clinical salvage therapy and plays a key role in the first-line treatment of severe infections. However， its significant nephrotoxicity severely limits its clinical application. This article systematically reviews the factors related to the nephrotoxicity of polymyxin B， including the chemical composition of the drug， epidemiological characteristics and incidence of nephrotoxicity， clinical manifestations of renal injury， molecular mechanisms of nephrotoxicity， biomarkers for monitoring nephrotoxicity and recent advances in prevention and management strategies. By integrating current evidence-based medical findings， this review aims to provide a theoretical basis and practical guidance for the formulation of individualized drug administration regimens and the exploration of new detoxification methods in clinical practice， ultimately aiming to achieve an optimal balance between efficacy and safety.

Objective To compare and analyze the differences between the 2023 and 2025 editions of the WHO Model List of Essential Medicines (EML), and to explore the trends of changes and their implications for global medicine policy. Methods The 2023 and 2025 WHO EMLs were retrieved. Drug names, formulations, and specifications were matched and compared. A descriptive analysis was conducted to identify additions, deletions, and clarifications in the updated list. Results The 2025 WHO EML included 523 medicines, representing a net increase of 21 compared with 502 medicines in the 2023 edition. Specifically, 29 medicines were newly added and 8 were removed, while some existing medicines were further specified in terms of source and specification. The newly added medicines covered multiple therapeutic areas, including neurological disorders, anti-infection, cystic fibrosis, cardiovascular diseases, diabetes, oncology, and vaccines. Notably, five of the newly added medicines were fixed-idose combinations. The deleted medicines were mainly excluded due to safety concerns, insufficient efficacy, or clinical substitutability. Conclusion The 2025 WHO EML reflects WHO′s ongoing response to the global disease burden and evolving clinical needs, with increased attention to rare diseases, innovative medicines, and novel vaccines. The inclusion of more fixed-dose combinations highlights their importance in improving treatment adherence and chronic disease management.

Objective To investigate the clinical efficacy of calcium polycarbophil in cancer-related constipation by target trial emulation， and to provide a reference for its application in the real-world. Methods The electronic medical record data of five hospitals including the Affiliated Jintan Hospital of Jiangsu University （the First People's Hospital of Jintan District， Changzhou） were collected from January 2020 to December 2024 for simulating effectiveness RCT. After inverse probability weighting， patients who met the inclusion criteria were grouped， the control group were treated with wheat cellulose， while the observation group was treated with calcium polycarbophil. The primary outcome was the objective response rate after two weeks of treatment； The secondary outcomes were 30-day recurrence risk of constipation and incidence of adverse reactions. Results A total of 2224 patients were collected， and after inverse probability-weighted matching， 1726 cases were included， including 1002 cases in the control group and 724 cases in the observation group. The objective response rate of the observation group was 53.4% （387/724）， significantly higher than that of the control group （43.4%， 435/1002）， and the difference was statistically significant （P<0.05）， especially in patients with digestive system tumors （OR=1.90， 95%CI： 1.44~2.22， P=0.017， P_interaction=0.015）， opioid-related constipation （OR=1.43， 95%CI： 1.25~1.67， P<0.001， P_interaction=0.015）， and chemotherapy-related constipation （OR=1.41， 95%CI： 1.37~1.66， P<0.001， P_interaction=0.018）， the effect of the observation group were all better than those of the control group. In addition， there was no statistically significant difference in 30-day recurrence risk of constipation and the total incidence of adverse reactions between the two groups （P>0.05）， and no serious adverse events occurred. Conclusion Compared with wheat cellulose， calcium polycarbophil has better clinical efficacy in patients with cancer-related constipation without serious adverse reactions， especially in patients with digestive system tumors， which can provide a reference for clinical drug decision-making.

Objective To explore the clinical characteristics and risk factors of hypocalcemia caused by denosumab， and provide reference for the rational use of denosumab in clinical practice. Methods Basic data， biochemical indicators， combination therapy， and blood calcium levels before and after using denosumab were collected from hospitalized patients at Nanjing Drum Tower Hospital， the Affiliated Hospital of Nanjing University Medicine School， from January 2022 to January 2024. The patients were divided into a hypocalcemia group and a non-hypocalcemia group based on their blood calcium levels after medication. Univariate analysis and logistic binary regression analysis were performed between the two groups. Results A total of 350 patients were included， with incidence rates of 64.3% and 5.1% for all grades and severe hypocalcemia， respectively. The median latency period of hypocalcemia was 15 days， and 97.3% of hypocalcemia patients had no or no recorded symptoms. Regression analysis showed that high serum alkaline phosphatase （OR=1.004， 95%CI： 1.001~1.007， P=0.006） and low serum albumin （OR=0.837， 95%CI： 0.770~0.910， P<0.001） were independent risk factors for hypocalcemia associated with denosumab， while intravenous bisphosphonates used within 6 months prior to administration （OR=0.422， 95%CI： 0.221~0.808， P=0.009） were protective factors. Conclusion Close monitoring of blood calcium levels is necessary after the use of denosumab， especially in patients with high serum alkaline phosphatase or low serum albumin levels before medication.

Objective To evaluate the efficacy and safety of telitacicept in combination with conventional therapy for the treatment of myasthenia gravis （MG）. Methods A single-center， retrospective cohort study based on propensity score matching （PSM） was conducted. Patients diagnosed with MG at Henan Provincial People's Hospital between February 2023 and February 2024 were enrolled. Those receiving telitacicept （160 mg/week） plus conventional immunotherapy for ≥12 weeks were designated as the telitacicept group. Using 1∶1 PSM， a control group receiving conventional immunotherapy alone was established. Comparative analyses were performed on changes in glucocorticoid dosage， peripheral blood CD19⁺ B-cell levels， myasthenia gravis activities of daily living （MG-ADL） score， and quantitative myasthenia gravis （QMG） score before and after treatment. Results After propensity score matching， 14 patients were included in each group， all receiving glucocorticoids. The telitacicept group demonstrated a significantly lower glucocorticoid dosage at 12 weeks compared to the control group （P<0.05）. Peripheral blood CD19⁺ B-cell levels in the telitacicept group showed a transient increase at 4 weeks， followed by an overall downward trend. The MG-ADL and QMG scores of the telitacicept group at 4 weeks and 12 weeks of treatment were lower than those of the control group， and a higher proportion achieved minimal manifestation status （MMS） by 24 weeks （P<0.05）. No serious adverse events leading to treatment discontinuation or death occurred in either group. Conclusion Telitacicept effectively alleviates clinical symptoms in patients with MG， facilitates glucocorticoid reduction， and enables earlier attainment of MMS. It represents a novel therapeutic alternative that integrates efficacy with a favorable safety profile.

Objective To investigate the characteristics and mechanisms of carbapenem-induced drug fever （DF）， and to provide a reference for timely clinical judgment of DF. Methods A systematic literature search was conducted in CNKI， Wanfang， VIP， Embase， PubMed， and Web of Science databases to retrieve case reports on carbapenem-induced DF from database inception to June 27， 2025. Data extraction and analysis were performed on meeting inclusion criteria. Results A total of 10 literatures involving 10 patients were identified. DF predominantly occurred within 2 weeks after drug initiation （9 cases）. Most patients presented with high-grade fever （>39.0， 5 cases）. 8 cases clearly demonstrated that the body temperature returned to normal within 3 days after discontinuation of the medication. There were 5 cases of combination drugs， but the influences of combination drugs were excluded. Clinical manifestations primarily included rash with pruritus and the changes of laboratory abnormalities. Conclusion There are few reports on carbapenem-induced DF， and it is difficult to diagnose. Clinical practice should enhance understanding of DF and ensure the safety of patients' medication.

Objective To explore the current status of depression and anxiety in China's children and its relationship with medication behavior， and to determine whether medication behavior is correlated with children's depression and anxiety symptoms. Methods A cross-sectional study was conducted， including 4918 children who visited the children's hospitals in 18 provinces and cities from the eastern， central， and western regions of China from October 2023 to May 2024 as survey subjects. Through questionnaire surveys， children were divided into the depression and anxiety group and the non-depression and anxiety group. Univariate and multivariate linear regression analyses were used to examine the factors influencing children's depression and anxiety. Results A total of 4918 questionnaires were distributed and 4431 valid responses were finally collected， resulting in a valid response rate of 90.1%. Among them， the depression and anxiety group included 2083 cases （47.0%）， and the non-depression and anxiety group included 2348 cases （53.0%）. Univariate analysis showed that gender， age， BMI， place of household registration， whether being an only child， parents' educational level， family structure， and time spent with parents were associated with children's depression and anxiety （P<0.05）. Comparisons of scores in seven subscales （drug instructions， adverse drug reactions， drug storage， administration methods， medication adherence， unsafe medication use， and difficulty in taking medication） between the two groups showed statistically significant differences （P<0.05）. Multivariate logistic regression results indicated that drug storage， medication adherence， unsafe medication use， and difficulty in taking medication were protective factors for depression and anxiety （P<0.05）. Conclusion The symptoms of depression and anxiety in children are significantly related to medication behavior and closely related to age. Future research and practice should integrate mental health management and medication behavior education to develop comprehensive treatment plans to improve children's physical and mental health.

Objective To investigate the causal relationship between cholesterol-lowering drug use and the risk of Parkinson′s disease （PD） using a two-sample Mendelian randomization （MR） approach. Methods This study utilized publicly available GWAS data to select SNPs that were significantly associated with exposure to cholesterol-lowering drugs and were mutually independent， which were then used as instrumental variables for subsequent MR analysis. The inverse variance weighted （IVW） method was employed as the primary analysis， with heterogeneity tests， pleiotropy assessments， leave-one-out analyses， and reverse MR analyses performed to assess the robustness of the results. Subgroup analyses were conducted for statins， non-statin drugs， and LDL-C levels to explore potential heterogeneity in effects through different intervention pathways. Results A total of 39 SNPs that were strongly associated with cholesterol-lowering drugs and independent were selected as instrumental variables. IVW analysis demonstrated a significant association between genetically predicted cholesterol-lowering drug use and reduced PD risk （OR=0.816， 95%CI： 0.704~0.945， P=6.700×10^-³）. Sensitivity analyses indicated no significant heterogeneity （Cochran′s Q_p =0.426） or horizontal pleiotropy （P>0.05）. Leave-one-out analysis confirmed the stability of the results， and reverse MR analysis excluded the possibility of reverse causation. Subgroup analyses suggested that simvastatin might reduce PD risk， though results were unstable； no significant causal association was found between ezetimibe and PD （P>0.05）， nor between LDL-C cholesterol levels and PD （P>0.05）. Conclusion The findings support a potential protective causal effect of cholesterol-lowering drugs on PD risk， providing evidence for their role as neuroprotective agents. However， further research is needed to clarify the effects of specific drugs.

Objective To systematically evaluate the association between ocular adverse events （OAEs） and bisphosphonates based on the FDA adverse event reporting system （FAERS） database， providing reference for clinical safe drug use. Methods We collected reports of OAEs associated with bisphosphonates （alendronate， risedronate， etidronate， ibandronate， zoledronate， pamidronate） in the FAERS database from the first quarter of 2004 to the second quarter of 2025. Disproportionality and Bayesian analyses were performed to investigate and evaluate the association between bisphosphonates and OAEs， and the prognosis of adverse events was compared. Results A total of 125 632 adverse event reports were associated with bisphosphonates， among which 7171 cases related to OAEs. There were more females than males （80.49% vs 12.79%）， and patients and physicians were the primary reporters （69.22%）. Parophthalmia demonstrated the strongest signal intensity across all OAEs associated with bisphosphonates （ROR025=56.32）. Among the six bisphosphonates， risedronate， etidronate， zoledronate， and pamidronate met the positive signal criteria using both reporting odds ratio and Bayesian confidence propagation neural network. There were significant differences in the distribution of OAEs signal profiles among different bisphosphonates， and significant differences were observed in mortality and hospitalization rates related to OAEs （P<0.001）. Conclusion Bisphosphonates increase the risk of some ocular disease， and clinical practitioners should be alert to this adverse effect in its application and can adjust the treatment of bisphosphonates according to the patient′s specific attributes and risk factors.

Objective To provide reference for rational drug use in clinical practice by investigating the effect of xueshuantong injection combined with alprostadil injection on neurological function in patients with acute ischemic stroke. Methods Patients diagnosed with acute ischemic stroke in Beijing Tongren Hospital， Capital Medical University from January 1 2018 to January 1 2023 were retrospectively selected. The patients were divided into an exposure group treated with xueshuantong combined with alprostadil and a non-exposure group treated with xueshuantong. The changes in the difference of National Institutes of Health Stroke Scale （NIHSS） scores （ΔNIHSS）， the number of patients with a reduction of NIHSS score by 4 points or more （ΔNIHSS ≤-4）， the changes in the difference of modified Rankin scale （mRS） scores （ΔmRS） before and after treatment， the number of patients with mRS score ≤1 in 14 days， and the incidence of bleeding and hypotension events were compared between the two groups. Results A total of 184 patients were included according to the inclusion and exclusion criteria， and they were divided into the exposure group （104 cases） and the non-exposure group （80 cases）. In the exposure group and the non-exposure group， the changes in ΔNIHSS were -1 （-2， 1） and -1.00 （-2， 0） respectively. The number of patients with ΔNIHSS ≤-4 was 15 cases and 13 cases respectively. The changes in ΔmRS were -1 （-1， 0） and 1.00 （-2， 0） respectively. The number of patients with mRS score ≤1 in 14 days was 30 cases in each group. The incidence of bleeding events was 10.6% and 15.0% respectively. There were no statistically significant differences in all the above indicators （P>0.05）. Conclusion There is no difference between xueshuantong injection combined with alprostadil injection and xueshuantong injection alone in improving neurological function in acute ischemic stroke.

Objective To investigate the effects of the Bushen Jiedu Tongluo Decoction combined with intradermal needle therapy on gastrointestinal reactions and sleep quality in patients with acute non-lymphocytic leukemia （ANLL） after chemotherapy. Methods A prospective cohort study design was employed， involving 100 chemotherapy-treated ANLL patients diagnosed and treated in the Hematology Department of Xiyuan Hospital， China Academy of Chinese Medical Sciences from January 2022 to January 2025. The patients were randomly divided into the control group and the observation group by computer random grouping system， with 50 cases in each group. The control group was given conventional treatment on the basis of chemotherapy， while the patients in the observation group were treated with bushen jiedu tongluo decoction combined with intradermal needle on the basis of the treatment in the control group. Pre-and post-treatment assessments included gastrointestinal symptom scores， traditional Chinese medicine （TCM） syndrome scores， gastrointestinal function ［motilin （MTL）， gastrin （GAS）］， sleep quality， quality of life， and immune function， as well as post-chemotherapy gastrointestinal reactions. Results After treatment， the observation group exhibited significantly lower scores in the gastrointestinal symptom rating scale and TCM syndrome scores， along with lower Pittsburgh sleep quality index scores compared to those of the control group， while showing higher European Organization for Research and Treatment of Cancer quality of life core questionnaire scores （all P<0.05）. Additionally， the observation group demonstrated higher MTL， CD3⁺， CD4⁺， and CD4⁺/CD8⁺ levels， while GAS， and CD8⁺ levels were lower than those in the control group （all P<0.05）. Post-chemotherapy， the total incidence of gastrointestinal adverse reactions was significantly lower in the observation group than that in the control group （P<0.05）. Conclusion The combination of bushen jiedu tongluo decoction and intradermal needle therapy effectively improves sleep quality and immune function in ANLL patients undergoing chemotherapy， reduces the incidence of post-chemotherapy gastrointestinal adverse reactions， and enhances overall quality of life.

Objective To develop and apply a teaching quality evaluation system for clinical pharmacy internships. Methods Evaluation indicators for internship teaching quality were established based on literature review and clinical pharmacy program syllabus. The analytic hierarchy process （AHP） was used to determine the weights of these indicators. A questionnaire survey was conducted， and the technique for order preference by similarity to ideal solution （TOPSIS） was applied to rank the teaching quality of eight hospitals. Results An evaluation system was constructed， comprising 9 first-level indicators and 29 second-level indicators， covering areas such as teaching conditions， teaching faculty， practical training and assessment. The indicators for clinical pharmacy practice， basic pharmaceutical skills， and construction of the teaching faculty team were assigned higher weights. The evaluation results ranked Hospitals 3， 8， and 2 as the top three in terms of teaching quality， while Hospitals 1， 4， and 5 ranked lower， indicating a need for improvement in areas such as practical skills， teaching faculty， and teaching arrangements. Conclusion The AHP-TOPSIS-based approach effectively enables the quantitative evaluation of teaching quality in clinical pharmacy internships and provides a reference for identifying weaknesses in teaching and promoting continuous quality improvement.

Objective To evaluate the safety， efficacy， and cost-effectiveness of ofatumumab in patients with relapsing multiple sclerosis （RMS） using a rapid health technology assessment （HTA） approach， and to provide evidence-based support for rational clinical drug use. Methods A rapid health technology assessment was conducted by systematically searching Chinese and English databases， with two researchers independently performing literature screening， data extraction， and quality assessment of included studies， followed by qualitative synthesis of the analysis results. Results A total of 2 HTA reports， 7 meta-analyses， and 4 economic studies were included. Regarding efficacy， ofatumumab significantly reduced the annualized relapse rate （RR： 0.30~0.50）， the risk of 3-month confirmed disability progression （3 m CDP） and 6 m CDP （HR： 0.46 and 0.52 for 3 m CDP； HR： 0.48 for 6 m CDP）， and decreased the number of MRI lesions by over 85%. In terms of safety， the incidence of adverse events with ofatumumab was intermediate compared to other disease-modifying therapies （P score： 0.574）， but the risk of serious adverse events was relatively higher （OR=1.52， RR=1.51）. From economic perspective， ofatumumab demonstrates lower costs over a 10-year treatment period compared to other first-line therapies. At a willingness-to-pay threshold of CA$50 000 per QALYs， the probability of being cost-effective was 64.3% for first-line therapy and 40.8% for second-line therapy. Conclusion Ofatumumab demonstrates significant clinical efficacy and an acceptable safety profile in the treatment of RMS. Based on its ability to delay disability progression and established cost-effectiveness advantages， it is recommended for prioritized early initiation as a first-line treatment option.

This article reports a case of a patient diagnosed with granulomatosis with polyangiitis （GPA） who presented with multi-system involvement. Despite two courses of pulse corticosteroid therapy， the patient's headache and hyperinflammatory state persisted. Tocilizumab was sequentially administered， leading to the control of both the symptoms and the hyperinflammatory state. Thereafter， rituximab was sequentially used for induction therapy， ultimately achieving sustained remission. This case suggests that in patients with GPA who respond poorly to conventional therapy， sequential administration of tocilizumab followed by rituximab may serve as an effective alternative therapy， leading to rapid symptom relief and improved prognosis.

This article reports two adult patients with atypical hemolytic uremic syndrome （aHUS）： a 68-year-old man with gastrointestinal bleeding and increased complement factor B activity， and a 29-year-old woman presenting with malignant hypertension. In both cases， other thrombotic microangiopathies were ruled out， and eculizumab therapy was started after diagnosis， resulting in control of microangiopathic hemolysis， normalization of platelet counts within 7 and 5 days， respectively， and improvement in renal function. Early use of eculizumab in adult aHUS is effective in controlling disease progression and facilitating renal function recovery.

This article reports a case of a child who underwent portoenterostomy for the treatment of biliary atresia and was treated with linezolid for cholangitis for more than one month. The child experienced a decrease in hemoglobin and was assessed to have severe anemia. After excluding other pathological and triggering factors， it is considered to be an adverse reaction induced by linezolid. After discussion between the clinical pharmacist and physician， the patient was advised to discontinue the medication. Upon re-examination， it was found that the patient's anemia had improved. This article retrospectively analyzes a case of severe anemia caused by postoperative cholangitis in portoenterostomy treated with linezolid， providing reference for the safe use of linezolid in clinical pediatric patients.