Patients with inflammatory bowel disease (IBD) require long-term pharmacotherapy. Due to the wide variety of clinically available drugs, medication safety has become increasingly concerning. As an indispensable component of pharmaceutical formulations, drug excipients may induce various adverse reactions, including rash, allergic responses, and gastrointestinal discomfort, and may even lead to severe organic injury. However, they are often overlooked in clinical practice. Therefore, identifying and managing excipient-related adverse reactions is crucial for ensuring medication safety. To address this issue, this article systematically reviews common excipients in IBD therapeutics, the underlying mechanisms of excipient-induced adverse reactions, and corresponding management strategies, aiming to enhance clinicians' awareness of excipient-related issues, improve their ability to recognize and manage such reactions, and ultimately ensure patient safety.

Objective To investigate the potential therapeutic effects of trifolin on hypertension-induced renal injury,as well as the key targets and pathways involved.Methods The mRNA transcriptional profiles of peripheral blood clinical samples from hypertensive patients were analyzed using Gene Expression Omnibus(GEO),a high-throughput gene expression database.The network pharmacology method was employed to screen key targets of trifolin in treating hypertension-induced renal injury.Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses were conducted.NRK-52E cells,a rat renal proximal tubular cell line,were used to construct an angiotensin Ⅱ(Ang Ⅱ)-stimulated cell model.Flow cytometry was performed to assess cell apoptosis rates and Western blotting was performed to determine the expression levels of apoptosis-related proteins,including Bax,Bcl-2,cleaved caspase-3,and caspase-3,and the phosphorylation and total protein levels of the key MAPK pathway proteins,including ERK,p38 MAPK,and JNK.Results Analysis of the dataset GSE75360 revealed that,compared with healthy controls,3 331 genes were upregulated and 3 197 genes were downregulated in peripheral blood mononuclear cells of hypertensive patients.According to network pharmacology analysis,472 potential targets of trifolin were identified,including CASP3 and MAPK1.Protein-protein interaction network analysis showed that these targets were closely associated with apoptosis regulatory signaling pathways.GO and KEGG pathway enrichment analyses indicated that trifolin was significantly enriched in pathways associated with negative regulation of apoptosis,apoptotic signaling pathways,and the MAPK signaling pathway.The in vitro experiments confirmed that,compared with the Ang Ⅱ group,trifolin intervention inhibited apoptosis in Ang Ⅱ-stimulated NRK-52E cells,suppressed the expression of Bax and cleaved caspase-3,promoted Bcl-2 expression,and inhibited the phosphorylation of p38 MAPK,ERK,and JNK(P<0.05).Conclusion Trifolin may exert its protective effect against hypertension-induced renal injury by inhibiting Ang Ⅱ-induced NRK-52E cell apoptosis and regulating the MAPK signaling pathway,representing an important mechanism underlying its therapeutic action.

Objective To evaluate the application of problem-based learning(PBL)and case-based learning(CBL)combined with ideological-political elements in surgical clinical ethics.Methods Eighty graduate students of grade 2022 majoring in surgery from Peking Union Medical College were selected as the subjects for the clinical ethics course offered in the first semester of the 2022-2023 academic year.They underwent the innovative pedago-gies of PBL and CBL combined with ideological-political elements.The satisfaction investigation and questionnaire surveys were performed to evaluate the effects.Results A total of 78 valid questionnaires were received.The results showed that 96.2%of students believed that this course supported them to understand the fundamental prin-ciples and knowledge of surgical clinical ethics and 94.9%of students expressed their willingness to expand their knowledge,indicating high satisfaction with the course.There were 91%of students acknowledged this model in terms of improving active learning and 93.6%stated that the course helped in developing good professional ethics.Most students responded positively to this model because of its contribution to enhance core clinical competencies.Conclusions The PBL and CBL combined with ideological-political elements have a better effect on surgical clini-cal ethics with high satisfaction of the students.

Bladder paraganglioma is a rare neuroendocrine tumor, accounting for only 0.05% of all bladder tumors. This article reports the diagnosis and treatment of a 16-year-old male patient with acute hemorrhage secondary to a giant bladder paraganglioma(approximately 10 cm in maximum diameter). Preoperative imaging evaluation suggested locally advanced disease, and the patient subsequently received three cycles of neoadjuvant chemotherapy with temozolomide. He patient's blood tests revealed hemorrhagic shock. During the waiting period of surgery, hemostasis was successfully achieved through emergency transarterial embolization. Subsequently, the patient underwent emergency radical cystectomy combined with orthotopic ileal neobladder reconstruction under general anesthesia and recovered well after surgery. Postoperative pathological examination confirmed the diagnosis of bladder paraganglioma, with positive immunohistochemical staining for succinate dehydrogenase subunit B and a Ki-67 proliferation index of 3%. At the 6-week follow-up, the patient's blood pressure and endocrine parameters had returned to normal, with a satisfactory quality of life. This case demonstrates that a multidisciplinary team approach can effectively integrate expertise from various specialties to formulate comprehensive and systematic treatment plans, which is crucial for ensuring successful management of such complex cases.

Objective:To investigate the efficacy and safety of bendamustine combined with anti-CD20 monoclonal antibody in the first-line treatment of older patients with indolent B-cell non-Hodgkin lymphoma (B-iNHL) .Methods:The clinical data of 159 patients with B-iNHL enrolled in 16 hospitals from Jiangsu Cooperative Lymphoma Group from December 1, 2019, to April 20, 2024, were analyzed for regimen efficacy and safety. Bendamustine plus rituximab (BR) and bendamustine plus obinutuzumab (BG) were administered to 139 (87.4% ) and 20 (12.6% ) patients, respectively.Results:Among the 159 patients, 101 (63.5% ) were male and 58 (36.5% ) were female, with a median age of 69 years (range: 60–84). Efficacy could be assessed in 138 (86.8% ) patients. The efficacy assessment demonstrated that the overall response rate was 92.0% with complete and partial remissions in 75 (54.3% ) and 52 (37.7% ) cases, respectively. With a median follow-up of 24 months (range: 4–64), the progression-free survival rate was (87.5 ± 3.0) % and the overall survival rate was (83.2 ± 3.3) %. Of the 27 patients who died, 6 (22.2% ) died due to disease progression. The mean applied dose of bendamustine per cycle was 73.0 (50.8–89.7) mg/m 2 per day, administered on days 1 and 2. Adverse events of grade 3 or higher were reported in 53 (33.3% ) patients, with infection (30 cases,18.9% ) and neutropenia (24 cases, 15.1% ) demonstrating the highest incidence. Conclusion:Bendamustine combined with anti-CD20 monoclonal antibody demonstrated good efficacy and is well-tolerated in the first-line treatment of elderly patients with B-iNHL.

The chemical constituents of the petroleum ether extract derived from the 90% ethanol extract of Elephantopus scaber were investigated. By silica gel column chromatography, C_(18), MCI column chromatography and semi-preparative high performance liquid chromatography, ten compounds were isolated. Their structures were identified as 3β-hydroxy-6β,7β-epoxytaraxeran-14-ene(1), 3β-hydroxyolean-12-en-28-oic acid(2), D-friedoolean-14-ene-3β,7α-diol(3), 3β-hydroxy-11α-methoxyolean-12-ene(4), 3β-hydroxyolean-11,13(18)-diene(5), 11α-hydroxy-β-amyrin(6), betulinic acid(7), 3β-hydroxy-30-norlupan-20-one(8), 6-acetonylchelerythrine(9), and 4',5'-dehydrodiodictyonema A(10) by analysis of the 1D NMR, 2D NMR, MS, and IR spectral data. Among them, compound 1 was a new triterpene and other compounds except compounds 2 and 7 were isolated from this plant for the first time.
Triterpenes/isolation & purification* ; Drugs, Chinese Herbal/isolation & purification* ; Molecular Structure ; Asteraceae/chemistry* ; Chromatography, High Pressure Liquid ; Magnetic Resonance Spectroscopy

The chemical constituents of the chloroform extract of the 90% methanol extract obtained from the dried branches and leaves of Croton lauioides were investigated. By using silica gel column chromatography, C_(18 )column chromatography, MCI column chromatography, and semi-preparative high-performance liquid chromatography(HPLC), six compounds were isolated. Their structures were identified as lauioidine(1), 2α-methoxy-8α-hydroxy-6-oxogermacra-1(10),7(11)-dien-8,12-olide(2), myrrhanolide B(3), gossweilone(4), 6β,7β-epox-4α-hydroxyguaian-10-ene(5), and 4(15)-eudesmane-1β,5α-diol(6) by analyzing the HR-ESI-MS, IR, ECD, 1D NMR and 2D NMR data, as well as their physicochemical properties. All compounds were isolated from C. lauioides for the first time, among which compound 1 is a new nor-clerodane diterpenoid.
Croton/chemistry* ; Diterpenes, Clerodane/isolation & purification* ; Molecular Structure ; Drugs, Chinese Herbal/isolation & purification* ; Magnetic Resonance Spectroscopy ; Chromatography, High Pressure Liquid

Moringa oleifera, widely utilized in Ayurvedic medicine, is recognized for its leaves, seeds, and velamen possessing traditional effects such as vātahara(wind alleviation), sirovirecaka(brain clearing), and hridya(mental nourishment). This study aims to identify the medicinal part of ■ in the Sārasvata ghee formulation as described in the Bower Manuscript, while investigating the ameliorative effects of different medicinal parts of M. oleifera on learning and memory deficits in mice and elucidating the underlying molecular mechanisms. A total of 144 male ICR mice were randomly assigned to the following groups: control, model(scopolamine hydrobromide, Sco, 2 mg·kg~(-1)), donepezil(donepezil hydrochloride, Don, 3 mg·kg~(-1)), M. oleifera leaf low-, medium-, and high-dose groups(0.5, 1, 2 g·kg~(-1)), M. oleifera seeds low-, medium-, and high-dose groups(0.25, 0.5, 1 g·kg~(-1)), and M. oleifera velamen low-, medium-, and high-dose groups(0.31, 0.62, 1.24 g·kg~(-1)). Learning and memory abilities were assessed using the passive avoidance test and Morris water maze. Nissl and HE staining were employed to examine histopathological changes in the hippocampus. Transcriptomics and targeted metabolomics were used to screen differential genes and metabolites, with MetaboAnalyst 6.0 and O2PLS methods applied to identify key disease-related targets and pathways. RESULTS:: demonstrated that M. oleifera leaf(1 g·kg~(-1)) significantly ameliorated Sco-induced learning and memory deficits, outperforming M. oleifera seeds(0.25 g·kg~(-1)) and M. oleifera velamen(1.24 g·kg~(-1)). This was evidenced by improved behavioral performance, reversal of neuronal damage, and reduced acetylcholinesterase(AChE) activity. Multi-omics analysis revealed that M. oleifera leaf upregulated Tuba1c gene expression through the synaptic vesicle cycle, enhancing glutamate(Glu), dopamine(DA), and acetylcholine(ACh) release via Tuba1c-Glu associations for neuroprotection. M. oleifera seeds targeted the dopaminergic synapse pathway, promoting memory consolidation through Drd2-ACh associations. M. oleifera velamen was associated with the cocaine addiction pathway, modulating dopamine metabolism via Adora2a-DOPAC, with limited relevance to learning and memory. In conclusion, M. oleifera leaf exhibits superior efficacy and mechanistic advantages over M. oleifera seeds and velamen, suggesting that the ■ in the Sārasvata ghee formulation is likely M. oleifera leaf, providing scientific evidence for its identification in ancient texts.
Animals ; Moringa oleifera/chemistry* ; Male ; Mice ; Seeds/chemistry* ; Plant Leaves/chemistry* ; Mice, Inbred ICR ; Memory Disorders/psychology* ; Transcriptome/drug effects* ; Memory/drug effects* ; Learning/drug effects* ; Metabolomics ; Humans ; Drugs, Chinese Herbal/administration & dosage* ; Maze Learning/drug effects*

Objective To investigate the clinical efficacy of Jiedu Huayu Granules(mainly composed of the Chinese herbal medicines of Artemisiae Scopariae Herba,Rhei Radix et Rhizoma,Hedyotis Diffusae Herba,Paeoniae Radix Rubra,Curcumae Radix and Acori Tatarinowii Rhizoma)in the treatment of liver failure(LF)and to observe their effects on endoplasmic reticulum stress and inflammatory response.Methods From May 2022 to May 2024,a total of 102 patients with LF of toxin-heat-stasis stagnation syndrome were collected from Hepatology Department of Yulin Traditional Chinese Medicine Hospital,and were divided into the control group and the study group by using a table of random numbers,with 51 cases in each group.The two groups were given comprehensive western medicine treatment for inhibiting inflammatory response and protecting liver,regulating intestinal microecology,counteracting viral infection,decreasing transaminase level and treating jaundice.Additionally,the study group was treated with Jiedu Huayu Granules.The course of treatment for the two groups covered eight weeks.Before and after treatment,the two groups were observed in the changes of traditional Chinese medicine(TCM)syndrome scores,biochemical indicators,inflammatory factors and endoplasmic reticulum stress indicators.After treatment,the clinical efficacy and the incidence of adverse reactions of the two groups of patients were compared.Results(1)After eight weeks of treatment,the total effective rate of the study group was 86.27%(44/51)and that of the control group was 68.63%(35/51),and the intergroup comparison(tested by chi-square test)showed that the efficacy of the study group was significantly superior to that of the control group(P<0.05).(2)After treatment,the TCM syndrome scores in both groups were significantly decreased compared with those before treatment(P<0.01),and the decrease in the study group was significantly superior to that in the control group(P<0.05).(3)After treatment,the serum levels of biochemical indicators of total bilirubin(TBIL),total bile acid(TBA),alanine transaminase(ALT),and aspartate transaminase(AST)in the two groups were significantly decreased compared with those before treatment(P<0.05),and the decrease in the study group was significantly superior to that in the control group(P<0.05 or P<0.01).(4)After treatment,the serum levels of inflammatory factors of interleukin 6(IL-6),tumor necrosis factor α(TNF-α),transforming growth factor β(TGF-β),and C-reactive protein(CRP)in the two groups were significantly decreased compared with those before treatment(P<0.05),and the decrease in the study group was significantly superior to that in the control group(P<0.01).(5)After treatment,the levels of endoplasmic reticulum response indicators such as glucose-regulated protein 78(GRP78),CCAAT enhancer-binding protein homologous protein(CHOP),and cysteine aspartic acid specific protease 12(caspase-12)in the two groups were significantly decreased compared with those before treatment(P<0.05),and the decrease in the study group were significantly superior to those in the control group(P<0.01).(6)The incidence of adverse reactions in the study group was 15.69%(8/51)and that in the control group was 17.65%(9/51),and the comparison between the two groups showed that the difference was not statistically significant(P>0.05).Conclusion The combined use of Jiedu Huayu Granules with comprehensive western medicine treatment exerts certain efficacy in treating patients with LF of toxin-heat-stasis stagnation syndrome.The combined therapy is effective on relieving clinical symptoms and improving liver function,and is helpful for relieving endoplasmic reticulum stress and inflammatory response.