Nivolumab combined with ipilimumab (NIVO-IPI) and nivolumab combined with relatlimab (NIVO-RELA) are approved treatments for advanced melanoma. However, the data on the differential adverse event (AE) risks associated with these two regimens are lacking. We performed a disproportionality analysis using the FDA Adverse Event Reporting System (FAERS) database for NIVO-IPI and NIVO-RELA from the fourth quarter (Q4) of 2015 to Q4 of 2024. We calculated the reporting odds ratios (ROR) and information component (IC) with 95% confidence intervals (CIs). A total of 7,482 records for NIVO-IPI and 185 records for NIVO-RELA were extracted from FAERS. NIVO-IPI showed significantly higher risks for gastrointestinal (ROR = 1.39), endocrine (ROR = 3.10), hepatobiliary (ROR = 2.32), metabolism and nutrition (ROR = 1.44), and respiratory, thoracic, and mediastinal disorders (ROR = 1.18), particularly in preferred terms (PTs) such as colitis, hypophysitis, pneumonia, and hepatitis. NIVO-RELA was associated with increased risks for cardiac (ROR = 2.84) and vascular disorders (ROR = 2.04), notably in PTs like myocarditis, troponin elevation, and myasthenia gravis. 80% of AEs occurred within three months for both regimens. The median time-to-onset was 42 days for NIVO-IPI compared to 57 days for NIVO-RELA, with no statistically significant difference (p = 0.66). NIVO-IPI is linked with a broader range of immune-related toxicities, whereas NIVO-RELA presents higher cardiac-specific risks. These findings emphasize the need for tailored AE monitoring based on treatment selection.

Background: Protocatechualdehyde (PCA), a phenolic compound derived from Salvia miltiorrhiza, exhibits anti-proliferative and antioxidant properties. However, its molecular mechanisms in reducing oxidative stress in diabetic cataract (DC) remain unclear. This study systematically investigated the role of PCA in modulating glyoxalase-1 (GLO1)-dependent suppression of advanced glycation end product (AGE)-receptor for AGE (RAGE) axis activation and oxidative stress in DC models.Methods: A galactose-induced DC rat model and high glucose-stimulated human lens epithelial cells (HLECs) were employed. Lens opacity was assessed using slit-lamp microscopy. GLO1, AGE, and RAGE expressions were analyzed through immunohistochemistry (IHC), immunofluorescence (IF), ELISA, and Western blotting. Molecular docking was performed to validate PCA–GLO1 interactions.Results: PCA administration (25 mg/kg) significantly alleviated lens opacity and epithelial cell disorganization in DC rats (p < 0.01). In vitro, PCA (10 μM) restored HLEC viability under hyperglycemic conditions (p < 0.05). Mechanistically, PCA upregulated GLO1 expression while suppressing AGE accumulation and RAGE activation in both models. Molecular docking revealed strong binding affinities between PCA and GLO1 (-CDOCKER energy: 26.41 kcal/mol).Conclusion: PCA ameliorates DC progression by enhancing the GLO1-mediated detoxification of AGE precursors, thereby inhibiting AGE/RAGE-driven oxidative stress. These findings provide a foundation for PCA as a therapeutic candidate for DC.

Previous studies have reported that brimonidine, a widely used therapeutic agent, may be associated with vision-related adverse effects that can lead to serious clinical consequences. In this study, we conducted a comprehensive pharmacovigilance analysis of brimonidine-induced vision disorders using real-world data, combined with network toxicology and molecular docking to investigate underlying mechanisms. Pharmacovigilance analysis revealed that among adverse events (AEs) linked to brimonidine, ophthalmic AEs were the most common, among which vision disorders ranking third (3/10). We analyzed the mechanisms of four high-frequency vision disorders: blurred vision, visual impairment, reduced visual acuity, and blindness. By intersecting the pathogenic genes of these AEs with brimonidine’s predicted targets, 29 common genes were identified. Enrichment analysis highlighted key pathways associated with brimonidine-induced vision disorders, such as the ErbB signaling pathway, C-type lectin receptor signaling pathway, and HIF-1 signaling pathway. Subsequently, a protein-protein interaction network was constructed, which highlighted PIK3CA, SRC, and PTPN11 as the top hub proteins. Molecular docking confirmed stable interactions between brimonidine and these core targets. In conclusion, pharmacovigilance supports the vision safety assessment of brimonidine, while network toxicology provides mechanistic insights into its vision toxicity. These findings contribute to advancing clinical monitoring, risk management and mechanisms exploration of brimonidine-related vision disorders.

Antimicrobials are frequently prescribed in Intensive Care Units (ICUs), where drug-drug interactions (DDIs) with other medications may exacerbate clinical outcomes. Limited evidence exists on the prevalence and clinical impact of these interactions. To estimate the prevalence of potential DDIs (pDDIs) between antimicrobials and other drugs in ICU patients using two electronic DDIs databases, identify the actual DDIs and the most frequently implicated antimicrobials, and determine the risk factors associated with actual DDIs. We conducted a retrospective study on patients admitted to intensive care units from January to December 2023. Micromedex and Lexi-Interact were used to identify pDDIs and their severities. Furthermore, we used the Drug Interaction Probability Scale (DIPS) criteria to identify actual DDIs. Among 2,154 patients, 2,163 pDDIs (108 unique pairs) were identified in 461 patients, and 2.87% (62 pDDIs in 46 patients) were classified as actual DDIs. The antimicrobials most likely to cause pDDIs included quinolones, triazole antifungals, and linezolid. Antimicrobial-drug pairs with a higher incidence of severe pDDIs included linezolid-dopamine/metoclopramide (hypertension), voriconazole-budesonide for inhalation (increased serum concentration of budesonide), and levofloxacin-amiodarone (QT prolongation). The antimicrobial-drug pairs with a higher occurrence of actual DDIs included linezolid-dopamine/dobutamine (hypertension), fluconazole-amiodarone/ritonavir (QT prolongation), and cefoperazone/vancomycin-furosemide (nephrotoxicity). Moderate agreement existed between the two databases for pDDIs detection (Cohen’s kappa = 0.546), but severity ratings diverged. Multivariable analysis identified the number of drugs per patient (OR = 1.178, p < 0.001), the number of antimicrobials per patient (OR = 1.146, p < 0.038), and the length of stay in the ICU (OR = 1.093, p < 0.038) as significant risk factors. High pDDI rates involving antimicrobials were observed in ICU patients, though actual DDIs were infrequent. Notable severe risk pairs warrant vigilant monitoring, especially with a higher occurrence of actual DDIs. Discrepancies in DDI databases emphasize the need for multi-tool validation to optimize medication safety.

The risk factors for gastrointestinal complications during glucocorticoid therapy in internal medicine inpatients are rarely reported. This study aimed to investigate the risk factors for gastrointestinal complications in internal medicine patients using glucocorticoids. Internal medicine inpatients receiving glucocorticoid therapy from February 2023 to September 2023 were included. Gastrointestinal complications were identified by careful review of the electronic medical records of these patients. The risk factors for gastrointestinal complications during glucocorticoid therapy were analyzed by univariable and multivariable logistic regression. Receiver operating characteristic (ROC) curve with Youden’s index was used to determine the best cutoff point of the identified continuous variables. Of the 960 inpatients included, 88 had gastrointestinal complications, with the most common complications including 27 (30.7%) with abdominal discomfort, 26 (29.5%) with acid regurgitation and heartburn, and 14 (15.9%) with asymptomatic positive fecal occult blood. Multiple logistic regression analysis showed that age ≥ 65 years [OR = 2.014, 95% CI (1.096, 3.703), p = 0.024], history of gastroesophageal reflux disease (GERD) [OR = 1.810, 95% CI (1.009, 3.250), p = 0.047], history of peptic ulcer (PU) [OR = 5.636, 95% CI (1.505, 21.102), p = 0.010], maximum dose of glucocorticoids [OR = 1.003, 95% CI (1.001, 1.004), p = 0.001], and nonsteroidal anti-inflammatory drugs (NSAIDs) [OR = 2.788, 95% CI (1.023, 7.597), p = 0.045] were associated with more gastrointestinal complications during glucocorticoid therapy in internal medicine inpatients. ROC curve analysis revealed that when the maximum dose of glucocorticoids was greater than 160 mg, gastrointestinal complications were more likely to occur. The study shows that age ≥ 65 years, history of GERD, history of PU, maximum dose of glucocorticoids, and NSAIDs are associated with more gastrointestinal complications during glucocorticoid therapy in internal medicine inpatients. Multidisciplinary teams, including physicians, pharmacists, and nurses, should consider increased monitoring to inpatients with high-risk factors.