Escitalopram is widely regarded as a well-tolerated selective serotonin reuptake inhibitor (SSRI) with a favorable safety profile. However, severe adverse events can occur even at therapeutic doses in susceptible individuals. Here, we report a rare case of simultaneous life-threatening Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) and cardiac toxicity induced by standard-dose escitalopram. A 51-year-old female (weight 50 kg) presented with severe fatigue and anorexia. Initial laboratory results revealed profound hyponatremia (116.1 mmol/L). Following sodium supplementation, serum sodium paradoxically decreased to 114.7 mmol/L (“desalination phenomenon”), while urinary sodium excretion was markedly elevated (220 mmol/24 h) alongside significant hypouricemia (76 μmol/L), confirming the diagnosis of SIADH. Concurrently, the patient manifested significant cardiac toxicity, including sinus bradycardia (41–55 bpm) and marked QTc prolongation (570 ms). Pharmacogenetic analysis identified the CYP2C19 *1/*2 genotype (Intermediate Metabolizer). Despite the therapeutic dosage (10 mg/day) and a non-toxic serum concentration (5 ng/mL measured 72 h post-discontinuation), the patient exhibited severe toxicity, likely driven by “phenoconversion” due to low muscle mass and physiological vulnerability, exacerbated by a pharmacodynamic synergism with low-dose quetiapine. Discontinuation of medications and strict fluid management resulted in complete resolution of both hyponatremia and arrhythmia. The causality was assessed as “probable” for both drugs using the Naranjo Algorithm, and the drug-drug interaction was rated as “probable” using the Drug Interaction Probability Scale (DIPS). This case highlights that genotype-phenotype mismatch, combined with pharmacodynamic synergism (escitalopram-quetiapine interaction), can precipitate severe neuro-cardiac toxicity even at therapeutic levels. It underscores that severe neuro-cardiac toxicity can occur even at therapeutic levels due to individual vulnerability. Therefore, routine monitoring of electrolytes and electrocardiograms (ECG) remains indispensable for patient safety, as pharmacogenetic screening and therapeutic drug monitoring may not predict such idiosyncratic reactions in resource-constrained settings.

This study investigates the material basis and mechanism of Chaige Qingsan Decoction (CGQSD) in early influenza A virus-induced respiratory infections using plasma proteomics and enzyme-linked immunosorbent assay (ELISA) validation. Ultra-performance liquid chromatography coupled with Orbitrap high-resolution mass spectrometry (UPLC-Orbitrap HRMS) characterized the chemical profile of CGQSD. In the discovery cohort, 54 plasma samples from 22 influenza A patients (paired pre- and post-treatment) and 5 healthy controls underwent label-free quantitative proteomics. Patients received CGQSD monotherapy (n = 15), oseltamivir alone (n = 4), or combined drug therapy (n = 3). Key candidate proteins were validated via ELISA in an independent cohort (76 samples from 32 patients and 6 controls). A total of 1444 proteins were quantified after removing those with > 75% missing values, with high technical reproducibility (quality control [QC] r > 0.98). Compared with healthy controls, 263 differentially expressed proteins (DEPs) were identified. CGQSD modulated 178 DEPs enriched in complement/coagulation and interferon pathways. ELISA confirmed the significant regulation of C4BPB (P = 0.0003) and IFI6 (P = 0.016), consistent with proteomics.CGQSD mediates anti-influenza activity through a dual immunomodulatory mechanism centered on "Complement-Interferon Homeostasis," targeting C4BPB (a complement regulator) and IFI6 (an interferon-stimulated gene). CGQSD monotherapy fine-tunes complement activation via precise C4BPB downregulation; combination therapy buffers this effect and normalizes the interferon pathway by universally decreasing IFI6. Notably, combination therapy triggers extracellular matrix remodeling (e.g., COL1A upregulation), indicating enhanced tissue repair beyond antiviral effects. These findings provide a molecular foundation for CGQSD and advocate for its further development as a host-directed immunomodulatory therapy.

The traditional herbal Antipyretic Gel Plaster (TAGP) is a transdermal formulation effective against respiratory virus-induced fevers. This study employed a systematic computational workflow to elucidate its mechanism against COVID-19 and Influenza. Network pharmacology identified a multi-target regulatory network centered on inflammatory hubs, including IL-6, TNF-alpha, and AKT1. Molecular docking validated that Quercetin exhibited reliable binding affinity to TNF-alpha (-7.32 kcal/mol). Crucially, the volatile permeation enhancers Borneol and Cinnamaldehyde also exhibited moderate and pharmacologically relevant binding affinities to AKT1 and TNF-alpha. These findings suggest a synergistic mechanism where volatile oils act as both penetration enhancers and direct anti-inflammatory agents. This study provides a theoretical basis for the pharmaceutical development of TAGP.

OBJECTIVE:To develop a core outcome set (COS) for clinical trials on post COVID-19 condition (PCC), that is, what, when, and how to measure PCC. METHOD:A comprehensive collection of outcomes (including their measurement methods and phases) was launched via literature review and clinician and patient surveys. Two rounds of Delphi surveys were conducted under the predefined criteria for rating, followed by a consensus meeting to finalize the COS for PCC (COS-PCC). RESULTS:Fifty-two outcomes within 7 categories and 206 measurement methods were identified. Sixty participants from five stakeholder groups completed the first round of the Delphi survey and 41 the second. Consensus was reached among 36 representatives on four domains of respiratory, physical, neuropsychological, and health conditions, including nine core outcomes and their respective measurement methods of priority: dyspnea (modified Medical Research Council scale), cough (Leicester Cough Questionnaire), exercise capacity (6-min walk test), fatigue (Fatigue Severity Scale), pain (Numerical Rating Scale), sleeping disturbance (Pittsburgh Sleep Quality Index), anxiety (Generalized Anxiety Disorder Scale-7), depression (Patient Health Questionnaire-9), and health status (36-item Short Form Health Survey); 16 optional measurement methods achieved consensus for supplement. Measuring phases of each core outcome were prioritized by importance through short and long terms of PCC. CONCLUSIONS:The COS-PCC highlights the key PCC concerns and provides an essential outcome set for PCC assessment in clinical trials and evidence synthesis. With improving the understanding of PCC and accumulating research evidence, the COS-PCC needs to be continuously updated and improved in practice.

BACKGROUND:Multidrug-resistant Gram-negative (MDR-GN) pneumonia presents an urgent global health challenge, characterized by limited therapeutic options and high mortality rates. Traditional Chinese medicine (TCM) offers a rich source of multi-component interventions with potential multi-target effects, demanding rigorous evaluation as an alternative or adjunctive strategy. METHODS:This multicenter, randomized, double-blind, head-to-head, placebo-controlled clinical trial was conducted by 4 hospitals in China (June 2022 - March 2025), evaluated Xinjia Dayuan San (XJDS), a standardized TCM formulation, against standard broad-spectrum antibiotics (imipenem/cilastatin [I/C] or cefoperazone/sulbactam [C/S]) in 224 adult patients with confirmed MDR-GN pneumonia. Patients were randomized (1:1) within antibiotic strata to receive either XJDS granules (3 g BID) plus intravenous antibiotic placebo (normal saline) or XJDS placebo plus active antibiotic for 7 days. Primary endpoints were 28-day all-cause mortality and 7-day reduction in sputum bacterial load score (Day 0 minus Day 7, 0-3 scale). Key secondary endpoints included changes in Clinical Pulmonary Infection Score (CPIS) and inflammatory markers. Safety was assessed throughout. FINDINGS:In this trial of 224 critically ill patients, XJDS did not meet the primary endpoint of non-inferiority for 28-day all-cause mortality compared to standard antibiotics. However, XJDS demonstrated superiority in key secondary endpoints reflecting disease control. Specifically, XJDS resulted in a significantly greater reduction in the 7-day sputum bacterial load score versus both comparators (median reduction 1.0 vs 0.0, p < 0.001). This microbiological improvement was paralleled by a more rapid clinical stabilization; XJDS significantly accelerated the reduction in both the Clinical Pulmonary Infection Score (CPIS) and the APACHE-II score by Day 7 (p ≤ 0.001 for all comparisons). These clinical benefits were associated with a significant attenuation of key pro-inflammatory cytokines, including TNF-α and IL-1β. The safety profile was comparable between groups. INTERPRETATION:While not demonstrating definitive non-inferiority for 28-day mortality in this severe cohort, XJDS significantly improved microbiological clearance and clinical scores (CPIS, APACHE-II) in patients with MDR-GN pneumonia. Its benefits in immune modulation and microbial control, coupled with a comparable safety profile and rigorous standardization, suggest XJDS warrants further investigation as a promising adjunctive therapy as an alternative or adjunctive therapeutic option in managing critical drug-resistant infections. Further research into its precise mechanisms and clinical applications is warranted.

This study constructed a core outcome set(COS)for traditional Chinese medicine(TCM)treatment of early-stage external cold and internal heat syndrome in respiratory viral infections,aiming to provide a reference for selecting outcomes in related clinical studies.A literature review was conducted to collect outcomes related to the early-stage external cold and internal heat syndrome in respiratory viral infections under TCM treatment from randomized controlled trials,systematic reviews,guidelines,and registered clinical trial protocols.Supplementary searches were performed in high-impact journals for systematic reviews on conventional medicine treatments for respiratory viral infections,as well as on the official websites of the Center for Drug Evaluation of the National Medical Products Administration and the US Food and Drug Administration,to develop the initial outcome pool.Two rounds of the Delphi surveys using a 9-point Likert scale were conducted to evaluate the importance of outcomes.The final outcomes were determined through a face-to-face expert consensus meeting.A total of 31 clinical studies,five systematic reviews,two guidelines,five registered clinical trial protocols,and eight new drug evaluation guidelines were included.After standardizing and sorting the outcomes,a pool of 34 outcomes was established.After two rounds of Delphi surveys,17 outcomes were initially included.After the expert consensus meeting,10 core outcome indicators were finally determined,including rate of progression to severe cases,time to major symptom improvement,time to resolution of all symptoms,dosage of antipyretic and analgesic medications,incidence of adverse events,time to viral clearance,mortality rate,quality of life,length of hospital stay,and time to normalization of body temperature.

Background:Chinese herbal acupoint application (HAA) is recommended by certain guidelines for treating mild-to-moderate COVID-19; however, evidence supporting its effectiveness remains limited. This study aimed to evaluate the effectiveness and safety of HAA in adult patients with fever and mild-to-moderate COVID-19. Methods:This multicenter, randomized, double-blind, placebo-controlled trial was conducted at six hospitals in China. Overall, 364 participants were randomly assigned in a 1:1 ratio to receive either the herbal or placebo acupoint application. All participants received applications at the Dazhui (GV14) and Feishu (BL13) acupoints three times daily for 2 h per application over 5 days and Fuzheng Jiebiao Decoction orally three times daily, three bags per dose. The primary outcome was complete fever relief time. Secondary outcomes included the onset time of fever reduction, changes in symptom scores, routine blood tests, and acetaminophen usage rates and dosages. Results:Regarding the primary outcome, HAA significantly reduced complete fever relief time compared to placebo (31.75 vs. 52.00 h; p < 0.0001). Regarding secondary outcomes, the herbal group also demonstrated a shorter onset time of fever reduction than the placebo group (24.35 vs. 34.42 h; p < 0.0001). HAA significantly reduced total symptom scores, particularly fever, headache, and cough symptoms. Moreover, 52 patients (29.05%) in the herbal group used acetaminophen, with a median dosage of 0.3 g (0.3, 0.6), which was significantly lower than that in the placebo group, with 94 patients using 0.6 g (0.3, 0.9; p < 0.05). No significant differences were observed in routine blood test results between the groups (p > 0.05), and no serious adverse events (SAEs) were reported in either group. Conclusion:Chinese herbal acupoint application effectively and safely shortened the complete fever relief time and onset time of fever reduction; alleviated clinical symptoms, particularly fever, headache, and cough; and reduced the need for antipyretic analgesics in adult patients with fever and mild-to-moderate COVID-19. Clinical trial registration:https://www.chictr.org.cn/showproj.html?proj=188270, identifier: ChiCTR2200067178.

Objective:The objective of this study was to investigate the preventive and therapeutic effects of Shenzhu Jiedu Granule on COVID-19 using network pharmacology and animal experiments. Methods:Obtain the chemical components of Shenshu Jiedu Granule from the online pharmacology database and analysis platform (ETCM) of the Chinese traditional medicine system, obtain the potential target of the compound through the UniProt database, and obtain the related target of COVID-19 from GeneCards and OMIM databases; Construct a component target network diagram using Cytascape 3.7.0 software, import the protein interaction (PPI) of intersection targets into Cytascape software through STRING database, and use the Metascape platform to conduct gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomics (KEGG) enrichment analysis on intersection targets.To explore its anti-inflammatory and analgesic effects through animal ear swelling, hot plate and torsion experiments. Results:Analysis revealed 72 key target proteins associated with the effects of Shenzhu Jiedu Granule demonstrated that mainly interleukin-6 (IL-6), interleukin-1 β (IL 1 β), B cells κ Light peptide gene enhancer nuclear factor inhibitor 1 (NFKB1), B cells κ Light peptide gene enhancer nuclear factor inhibitor 1B (NFKB1A), interferon β IFNB1, tumor necrosis factor TNF, recombinant human mitogen activated protein kinase 12 (MAPK12), serine/threonine kinase 1 (AKT1), B cells κ Light peptide gene enhancer inhibitor kinase β (IKBKB), etc.The analysis found that it is mainly related to multiple biological processes such as intercellular immune regulation, inflammatory cytokines, and ion channels in the microenvironment; KEGG analysis showed that COVID-19 pathway, influenza virus pathway and multiple immune inflammatory response pathways were mainly involved. Obtained 91 effective ingredients of Shenshu Jiedu Granule, 10 anti-inflammatory, bactericidal, and antiviral compounds, and 4 immune enhancing compounds. Shenzhu Jiedu Granule demonstrated an inhibitory effect on xylene-induced ear swelling in mice and significantly enhanced the anti-inflammatory and analgesic effects by reducing body twists and prolonging the time mice licked their feet. Conclusions:It is suggested that Shenzhu Jiedu Granule has anti COVID-19, influenza virus, antibacterial and anti-inflammatory effects, and can significantly enhance the anti-inflammatory and analgesic effects of mice, which highlight the significance of the study in the context of current global health concerns.

新型冠状病毒感染为疫毒所伤.因病毒株不同,流行季节与气候以及地域与生活习惯,尤其是患者体质不同,会呈现出不同临床特点,或为寒湿,或为湿热,常见湿邪致病.应当基于中医外感病理论,重视审证求因,根据临床表现推求病机,辨证治疗不能拘于伤寒六经或温病体系.新冠疫情传变具有鲜明的阶段性的特征,可分为早期、进展期、极期(高峰期)、恢复期,应重视早发现、早治疗、中西医辨病辨证分期论治,以求在阻断病程、降低重症发生率、降低病死率等方面发挥积极作用.临床首当明辨顺逆,强调辨识体质与内伤基础病人群的特殊性,重视辨证处理发热等关键症状,同时重视喘促等反映缺氧和呼吸衰竭病理变化的症状.

Purpose: Antibiotic-resistant bacterial pneumonia poses a significant therapeutic challenge. In China, Chinese herbal compound (CHC) is commonly used to treat bacterial pneumonia. We aimed to evaluate the efficacy and safety of CHC and identify core herb combinations for the treatment of multidrug-resistant or extensively drug-resistant bacterial pneumonia.Methods: Stata 16 and TSA 0.9.5.10 beta software were used for meta-analysis and trial sequential analysis (TSA), respectively. Exploring the sources of heterogeneity through meta-regression and subgroup analysis.Results: Thirty-eight studies involving 2890 patients were included in the analyses. Meta-analysis indicated that CHC combined with antibiotics improved the response rate (RR = 1.24; 95% CI: 1.19–1.28; p < 0.0001) and microbiological eradication (RR = 1.41; 95% CI: 1.27–1.57; p < 0.0001), lowered the white blood cell count (MD = −2.09; 95% CI: −2.65 to −1.53; p < 0.0001), procalcitonin levels (MD = −0.49; 95% CI: −0.59 to −0.40; p < 0.0001), C-reactive protein levels (MD = −11.80; 95% CI: −15.22 to −8.39; p < 0.0001), Clinical Pulmonary Infection Scores (CPIS) (MD = −1.97; 95% CI: −2.68 to −1.26; p < 0.0001), and Acute Physiology and Chronic Health Evaluation (APACHE)-II score (MD = −4.08; 95% CI: −5.16 to −3.00; p < 0.0001), shortened the length of hospitalization (MD = −4.79; 95% CI: −6.18 to −3.40; p < 0.0001), and reduced the number of adverse events. TSA indicated that the response rate and microbiological eradication results were robust. Moreover, Scutellaria baicalensis Georgi, Fritillaria thunbergii Miq, Lonicera japonica Thunb, and Glycyrrhiza uralensis Fisch were identified as core CHC prescription herbs.Conclusion: Compared with antibiotic treatment, CHC + antibiotic treatment was superior in improving response rate, microbiological eradication, inflammatory response, CPIS, and APACHE-II score and shortening the length of hospitalization. Association rule analysis identified four core herbs as promising candidates for treating antibiotic-resistant bacterial pneumonia. However, large-scale clinical studies are still required.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42023410587.

自2023 年春季以来,流行性感冒发病在我国各地呈上升趋势,本病属于中医"疫病""时行感冒"范畴,中医药在减轻、消除流感症状、缩短病程方面疗效显著,为有效防治当前春季流感,提高中医药治疗流感的诊疗水平,世界中医药学会联合会急症专业委员会和呼吸病专业委员会、中华中医药学会肺系病分会、中华医学会急诊分会中西医结合急救学组、中国医师协会急诊医师分会中西医结合急救医学专业委员会、上海中医药学会急诊分会、上海中医药大学急危重研究所等学术组织与机构组织全国中医一线防治专家在就流感发病特点、证候规律及治疗原则等开展调研与讨论,进而形成本《2023 年春季成人流行性感冒中医药防治专家共识》,以期对当前春季流行性感冒中医药防治起到临床指导作用.

新型冠状病毒感染恢复期的临床表现复杂多样,需要分辨不同的临床特点,针对性治疗.中医认为其基本病机是正虚邪恋,把握主病、主症的病机特点非常关键.中医药治疗新型冠状病毒感染恢复期具有显著疗效,中药、针灸、推拿、气功等多种治疗方法综合运用,能够更好地发挥优势.

新型冠状病毒-奥密克戎毒株传播性强,短期内可致大量人群发病,约92％的感染者以上呼吸道症状为主,但仍有8％的患者出现了肺炎,早期识别、早期救治肺炎中的重型和危重型患者,是降低病死率的关键.本文就新型冠状病毒肺炎重型、危重型患者的中医诊疗方案进行了专家共识推荐.共识推荐涵盖了新型冠状病毒肺炎的病因、核心病机和基本诊疗原则;并凝练出了临床重型、危重型救治中最常见的3个难点问题,同时也是中医优势突出的3个方面——发热、腹胀、厥脱,就其中医诊治方案进行了共识推荐.

肿瘤免疫治疗可有效抑制免疫逃逸、延长生存期,但其所引起的免疫相关不良反应已成为新的临床挑战.免疫检查点抑制剂相关糖尿病为典型的不良反应,具有病程隐匿、病情危重等临床特点,与中医"伏毒"相似.据此,本文基于"伏毒"理论,探析免疫检查点抑制剂相关糖尿病的发病机制,认为肿瘤患者正气亏虚、脏腑失调,"伏毒"藏匿积累,外加药毒侵袭,损伤气阴、阻滞气机、耗伤肾精,以致脾肾亏虚而发生糖尿病,并提出补行兼施、清热解毒、益气养阴、健脾益肾等治法,以期为中医治疗免疫检查点抑制剂相关糖尿病及其他免疫相关不良反应提供理论基础.

Objective To explore the intervention effect of New DaYuan Powder（NDYP）combined with common antibiotics on the floating status of multi-drug resistant Escherichia coli isolated from patients.Methods The first 5 strains of Escherichia coli which produced extended-spectrum beta-lactamases（ESBLs）and had the best ability of forming membrane were selected as the research objects, the effect of NDYP combined with common antibiotics on the status of bacterial plankton was determined by（MTT）and Chess-Board methods.Results The results showed that the combination of NDYP and common antibiotics had synergistic or additive effects on the first 5 strains with the strongest membrane-forming ability.Conclusion This in vitro study shows that the combination of NDYP and common antibiotics has an inhibitory effect on floating multi-drug resistant Escherichia coli, and NDYP can enhance the sensitivity and synergize with antibiotics.

大陷胸丸作为峻下逐水法的代表方剂,因其药力峻猛,临床运用较少.此方在治疗顽固性水停证疗效显著,特别针对恶性胸腔积液,现介绍峻下逐水法治疗恶性胸腔积液医案1则如下. 1病例介绍 患者,男,74岁.2020年8月10日初诊,主诉:反复右侧胸腔积液1年,加重3个月.

眩晕是临床常见病、多发病,病机复杂多变,证候分型包括肝郁气滞、肝阳上亢、肝郁脾虚等,若患者经年不愈,则将严重影响正常工作生活.本案患者因顽固性眩晕多方求治未果前来就医,症见反复头晕数年,迁延不愈,伴有乏力,耳鸣,胸闷,喜出长气等;患者证属肝胃郁热、痰郁化火,该火不同于"阳盛则热"之实火,不可过用苦寒清热之药,譬如堆积之麦垛,久之其内腐热,若一味浇注冰水,则其内霉腐、积热更甚,若挑散晾晒,则其霉腐可去,且本案患者寒热错杂,虚实夹杂,体内郁热较甚,故施以行气活血,透散郁热之法,透散伏火,先清后补.四个疗程后,患者眩晕症状已完全消失,周身状态好转,治疗效果显著.

肺炎克雷伯菌是一种常见的条件致病菌,广泛存在于人类口腔和肠道.近年来,肺炎克雷伯菌肝脓肿侵袭综合征(klebsiella pneumoniae liver abscess,KPLA)的发病率逐年升高.KPLA中医属"发热""热病""温病""风温肺热病"范畴,病因病机与伏邪致病一致,邪气深伏体内,不易尽除,病程缠绵反复,可在正气进一步受损,或复感外邪时诱发.笔者根据多年临证经验,总结出以清透伏邪为本、扶正透脓为标的KPLA治疗法则.本案患者素有消渴病,耗气伤阴,体质虚弱,加之正气不足,引动伏邪,发而为病,伏邪毒郁闭于内日久,火毒凝结,进而化脓成痈,因而呈现高热、喘逆、舌淡苔白等本虚标实之象,治疗时既使用益气养阴、升清降浊、解毒散结等清透伏邪之法,又佐以托里排脓、溃脓消痈等扶正透脓之法,取得了满意的疗效.

新冠肺炎奥密克戎变异株自首次发现及传播以来,在世界100多个国家流行,严重危害人类的生命健康.中医药防治新冠肺炎疗效确凿、优势显著.为了更加有效指导奥密克戎变异株感染临床防治,世界中医药学会联合会急症专业委员会、中国上海中医药大学急危重症研究所、陕西中医药大学疫病研究院组织国内《新型冠状病毒肺炎诊疗方案(试行第九版)》修订专家和临床防控一线救治专家,在《新型冠状病毒诊疗方案(试行第九版)》基础上,结合新型冠状病毒奥密克戎变异株感染防治临床经验,就新型冠状病毒奥密克戎变异株感染中医药防治相关问题展开调研与讨论,形成本专家建议,以期对当下新冠肺炎奥密克戎变异株感染临床治疗与预防起到指导作用.

新型冠状病毒奥密克戎( Omicron )变异株自2021年11月首次发现并传播以来,增速迅猛,已席卷全球,全球已有100 多个国家和地区发现奥密克戎变异株感染病例.新型冠状病毒肺炎(简称新冠肺炎)疫情发生以来,中医药在防治方面发挥了重要作用.为了有效指导临床防治,世界中医药学会联合会急症专业委员会、中国上海中医药大学急危重症研究所、美国中医药针灸学会组织国内外中医药防控新冠肺炎领域临床一线专家及相关学术机构与组织,在参照中华人民共和国国家卫生健康委员会、国家中医药管理局《新型冠状病毒肺炎诊疗方案(试行第九版)》基础上,结合新型冠状病毒奥密克戎变异株感染防治临床经验,就新型冠状病毒奥密克戎变异株感染中医药防治相关问题展开调研与讨论,并最终形成本共识.6