Since the first Immune Checkpoint Inhibitor was developed, tumor immunotherapy has entered a new era, and the response rate and survival rate of many cancers have also been improved. Despite the success of immune checkpoint inhibitors, resistance limits the number of patients who can achieve a lasting response, and immune-related adverse events complicate treatment. The mechanism of immune-related adverse events (irAEs) is unclear. We summarize and discuss the mechanisms of action of immune checkpoint inhibitors, the different types of immune-related adverse events and their possible mechanisms, and describe possible strategies and targets for prevention and therapeutic interventions to mitigate them.

Ethnopharmacological Relevance: The dried rhizome of Ligusticum chuanxiong S.H.Qiu, Y.Q.Zeng, K.Y.Pan, Y.C.Tang and J.M.Xu (Apiaceae; including the horticultural variety Ligusticum chuanxiong Hort.) [synonym: Conioselinum anthriscoides (H.Boissieu) Pimenov and Kljuykov (The taxonomic classification has been adopted by the World Checklist of Vascular Plants)] is a traditional Chinese botanical drug renowned for its anti-inflammatory and antioxidant properties. It has been widely used to treatment various diseases, particularly cardio-cerebral vascular diseases (CCVDs).Aim of the review: This review aims to summarize recent advances in Ligusticum chuanxiong (CX) research, including its chemical composition and pharmacological effects, and modern clinical applications.Materials and methods: A systematic literature search was conducted using keywords such as “Chuanxiong,” “traditional Chinese medicine,” “chemical components,” “metabolites,” “CCVDs,” and “pharmacological effects” to identify relevant literature published between 2014 and 2025. Databases including PubMed, Web of Science, Google Scholar, and CNKI were utilized. Chemical structures in SMILES format were retrieved from the PubChem, and two-dimensional chemical structures were generated using ChemDraw Ultra 8.0. Classical prescriptions of chuanxiong were obtained from authoritative traditional Chinese medicine databases.Results: Over 100 metabolites have been isolated and identified from CX, classified into nine major classes. Key bioactive compounds include senkyunolide A, ligustilide, tetramethylpyrazine (TMP), and ligusticum CX polysaccharides (LCP). CX demonstrates significant pharmacological effects in treating CCVDs, such as atherosclerosis (AS), myocardial and cerebral ischemia-reperfusion injury, and hypertension. Its therapeutic mechanisms include antiplatelet activity, endothelial cell protection, anti-inflammatory, antioxidant, and anti-apoptotic properties. CX can be administered alone or in combination with other traditional Chinese medicines (TCMs) or chemical drugs, showing efficacy in cardiovascular, nervous system, digestive system disorders, as well as analgesia and anticancer activities.Conclusion: CX holds substantial clinical value for treating multi-system diseases, with extensive evidence supporting its use in CCVDs. Further research and clinical exploration of CX are warranted to fully harness its therapeutic potential.

Background: venous thromboembolism (VTE) is one of the most common complications after major orthopaedic surgery. Recent studies have suggested that aspirin may also be effective in preventing VTE, but it is still controversial whether it can be routinely used.Objectives: To compare the efficacy and safety of aspirin against oral anticoagulants in the prevention of VTE following total hip arthroplasty (THA), total knee arthroplasty (TKA) or hip fracture surgery (HFS).Methods: Relevant publications have been obtained using electronic search databases such as PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials. gov. from inception to 20 July 2023. Only RCTs evaluating the efficacy and safety of aspirin compared with oral anticoagulants undergoing major orthopaedic surgery were included in the meta-analysis. The primary outcome reported was any VTE event (including deep vein thrombosis (DVT) and pulmonary embolism (PE)). Secondary outcomes included mortality, major bleeding (including gastrointestinal bleed, cerebrovascular hemorrhage, or any bleeding requiring a return to the theater), minor bleeding (ecchymosis, epistaxis, hematuria), and wound complications. The risk of bias for all included studies was assessed according to the Cochrane Collaboration’s tool.Results: After screening 974 studies, 12 randomized clinical trials (RCTs) were included, involving 5,088 participants, including 2,540 participants in aspirin, 2,205 participants in rivaroxaban, and 323 participants in warfarin. Aspirin was found to be less effective than oral anticoagulants in thromboprophylaxis after major orthopedic surgery (RR = 1.206, 95% CI 1.053–1.383). After subgroup analysis according to the type of oral anticoagulant, the results showed that aspirin was similar to rivaroxaban and inferior to warfarin. Considering that the studies in the warfarin group were all conducted before 2000, our results need to be further confirmed. In addition, the aspirin group had a higher risk of VTE than the control group in other subgroups, including a follow-up time of ≤3 months, type of procedure as TKA, high-dose aspirin (≥650 mg qd), and no combined use of mechanical prophylaxis. In terms of safety events, aspirin did not show significant differences in major bleeding (RR = 0.952, 95% CI 0.499–1.815), all-cause mortality (RR = 1.208, 95% CI 0.459–3.177), and wound-related events (RR = 0.618, 95% CI 0.333–1.145) compared with oral anticoagulants, and aspirin was associated with a reduction in the risk of minor bleeding (RR = 0.685, 95% CI 0.552–0.850) events and total bleeding (RR = 0.726, 95% CI 0.590–0.892).Conclusion: Aspirin reduces bleeding risk after major orthopedic surgery compared with oral anticoagulants, but may sacrifice VTE prevention to some extent. Updated evidence is needed to analyze the thromboprophylaxis effects of aspirin in patients undergoing major orthopedic surgery.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=463481, identifier CRD42023463481.

Background: Thromboembolic disease is associated with a high rate of disability or death and gravely jeopardizes people’s health and places considerable financial pressure on society. The primary treatment for thromboembolic illness is anticoagulant medication. Fondaparinux, a parenteral anticoagulant medicine, is still used but is confusing due to its disparate domestic and international indications and lack of knowledge about its usage. Its off-label drug usage in therapeutic settings and irrational drug use are also common.Objective: The aim of this guideline is to enhance the judicious clinical application of fondaparinux by consolidating the findings of evidence-based research on the drug and offering superior clinical suggestions.Methods: Seventeen clinical questions were developed by 37 clinical pharmacy experts, and recommendations were formulated under the supervision of three methodologists. Through methodical literature searches and the use of recommendation, assessment, development and evaluation grading techniques, we gathered evidence.Results: This guideline culminated in 17 recommendations, including the use of fondaparinux for venous thromboembolism (VTE) prevention and treatment, perioperative surgical prophylaxis, specific diseases, special populations, bleeding and overdose management. For different types of VTE, we recommend first assessing thrombotic risk in hospitalized patients and then administering the drug according to the patient’s body mass. In surgical patients in the perioperative period, fondaparinux may be used for VTE prophylaxis, but postoperative use usually requires confirmation that adequate hemostasis has been achieved. Fondaparinux may be used for anticoagulation prophylaxis in patients hospitalized for oncological purposes, in patients with atrial fibrillation (AF) after resuscitation, in patients with cirrhosis combined with portal vein thrombosis (PVT), in patients with antiphospholipid syndrome (APS), and in patients with inflammatory bowel disease (IBD). Fondaparinux should be used with caution in special populations, such as pregnant female patients with a history of heparin-induced thrombocytopenia (HIT) or platelet counts less than 50 × 10⁹/L, pregnant patients with a prethrombotic state (PTS) combined with recurrent spontaneous abortion (RSA), and children. For bleeding caused by fondaparinux, dialysis may partially remove the drug.Conclusion: The purpose of this guideline is to provide all healthcare providers with high-quality recommendations for the clinical use of fondaparinux and to improve the rational use of the drug in clinical practice. Currently, there is a lack of a dedicated antidote for the management of fondaparinux. The clinical investigation of activated prothrombin complex concentrate (APCC) or recombinant activated factor VII (rFⅦa) as potential reversal agents is still pending. This critical gap necessitates heightened scrutiny and research emphasis, potentially constituting a novel avenue for future inquiries into fondaparinux sodium. A meticulous examination of adverse events and safety profiles associated with the utilization of fondaparinux sodium will contribute significantly to a more comprehensive understanding of its inherent risks and benefits within the clinical milieu.

Background: Statins are commonly prescribed in clinical practice and are associated with a high risk of drug-induced liver injury (DILI). This study aims to examine the real-world data on statin-induced liver injury to assess medication safety. Methods: All DILI cases reported with statins as primary suspected drugs were extracted based on the US Food and Drug Administration adverse event reporting system (FAERS) from 2004 to 2023. A disproportional analysis was conducted using reported odds ratios (ROR) and information component (IC) to assess the significant association between statins and DILI. Results: A total of 7779 statin-associated DILI cases were identified. DILI patients tended to be aged >65 years (45.43%), with more females than males (48.80% vs 43.75%), and 39.95% of DILI patients required hospitalization. Statin-induced DILI cases are most commonly reported with atorvastatin (53.48%), rosuvastatin (20.44%), and simvastatin (19.46%). The DILI signals (ROR; 95% CI) for statins were ranked as follows: fluvastatin (6.90; 5.89–8.10)> atorvastatin (3.09; 2.99–3.19)> simvastatin (2.96; 2.81–3.12)> lovastatin (2.77; 2.17–3.53)> rosuvastatin (2.27; 2.16–2.39)> pravastatin (2.07; 1.81–2.37). Age-stratified analysis showed that a stronger signal was detected in patients (aged ≥65 years) than patients (aged <65 years) for atorvastatin, simvastatin, pravastatin and fluvastatin. The onset time of DILI was significantly different among the different statins (p = 0.014), and simvastatin resulted in the highest mortality rate (12.15%). Conclusion: Based on FAERS database, six statins are significantly associated with liver injury, and fluvastatin, atorvastatin, and simvastatin had the greatest risk of DILI.