Influenza virus pneumonia （IVP） is an acute inflammatory disease of the lung with high incidence rate and infectivity caused by invading of the virus into the lower respiratory tract. At present, the treatment of IVP is mainly based on anti-influenza virus infection strategies, including the use of influenza vaccines and anti-influenza virus drugs. Due to the strong variability of viral antigens, it is difficult to obtain long-lasting immunity through vaccination. Commonly used chemical//biological antiviral drugs usually target a single specific viral protein. The mutation and evolution of the virus can reduce its efficacy or render it ineffective, which may lead to drug resistance, limiting the clinical application of these treatment options. Traditional Chinese Medicines （TCMs） have a long history in the prevention and treatment of IVP and are widely used in clinical practice due to their unique advantages and clear therapeutic effects. The research progress on the pathogenesis of IVP, effective prevention and treatment of TCMs for IVP, and the mechanism of action of its active ingredients were reviewed, which could provide new ideas for the treatment of IVP and reference for the development of new multi-target and low toxicity drugs.

OBJECTIVE: To evaluate the operability and effectiveness of a self-developed patellar bone canal locator (hereinafter referred to as "locator") in the reconstruction of the medial patellofemoral ligament (MPFL). METHODS: A total of 38 patients with recurrent patellar dislocation who met the selection criteria admitted between January 2022 and December 2022 were randomly divided into study group (the patellar canal was established with a locator during MPFL reconstruction) and control group (no locator was used in MPFL reconstruction), with 19 cases in each group. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, body mass index, disease duration, patella Wiberg classification, constituent ratio of cartilage injury, Caton index, tibia tubercle-trochlear groove, and preoperative Lysholm score, Kujal score, Tegner score, visual analogue scale (VAS) score, and so on. The Lysholm score, Kujal score, Tegner score, and VAS score were used to evaluate knee joint function before operation and at 3 days,1 month, 3 months, and 6 months after operation. The ideal prepatellar cortical thickness and canal length were measured before operation, and the actual prepatellar cortical thickness and canal length after operation were also measured, and D1 (the distance between the ideal entrance and the actual entrance), D2 (the ideal canal length minus the actual canal length), D3 (the ideal prepatellar cortical thickness minus the actual prepatellar cortical thickness) were calculated. RESULTS: Patients in both groups were followed up 6-8 months (mean, 6.7 months). The incision length and intraoperative blood loss in the study group were smaller than those in the control group, but the operation time was longer than that in the control group, the differences were significant ( P<0.05). There was no complication such as incision infection, effusion, and delayed healing in both groups, and no further dislocation occurred during follow-up. One patient in the study group had persistent pain in the anserine area after operation, and the symptoms were relieved after physiotherapy. The VAS score of the two groups increased significantly at 3 days after operation, and gradually decreased with the extension of time; the change trends of Lysholm score, Kujal score, and Tegner score were opposite to VAS score. Except that the Lysholm score and Kujal score of the study group were higher than those of the control group at 3 days after operation, and the VAS score of the study group was lower than that of the control group at 3 days and 1 month after operation, the differences were significant ( P<0.05), there was no significant difference in the scores between the two groups at other time points ( P>0.05). Patellar bone canal evaluation showed that there was no significant difference in preoperative simulated ideal canal length, prepatellar cortical thickness, and postoperative actual canal length between the two groups ( P>0.05). The postoperative actual prepatellar cortical thickness of the study group was significantly smaller than that of the control group ( P<0.05). D1 and D3 in the study group were significantly higher than those in control group ( P<0.05), but there was no significant difference in D2 between the two groups ( P>0.05). CONCLUSION The locator can improve the accuracy of MPFL reconstruction surgery, reduce the possibility of intraoperative damage to the articular surface of patella and postoperative patellar fractures.
Humans ; Patella/surgery* ; Patellar Dislocation/surgery* ; Patellofemoral Joint/surgery* ; Knee Joint/surgery* ; Joint Dislocations ; Ligaments, Articular/surgery*

Sclerostin, a protein secreted from osteocytes, negatively regulates the WNT signaling pathway by binding to the LRP5/6 co-receptors and further inhibits bone formation and promotes bone resorption. Sclerostin contributes to musculoskeletal system-related diseases, making it a promising therapeutic target for the treatment of WNT-related bone diseases. Additionally, emerging evidence indicates that sclerostin contributes to the development of cancers, obesity, and diabetes, suggesting that it may be a promising therapeutic target for these diseases. Notably, cardiovascular diseases are related to the protective role of sclerostin. In this review, we summarize three distinct types of inhibitors targeting sclerostin, monoclonal antibodies, aptamers, and small-molecule inhibitors, from which monoclonal antibodies have been developed. As the first-in-class sclerostin inhibitor approved by the U.S. FDA, the monoclonal antibody romosozumab has demonstrated excellent effectiveness in the treatment of postmenopausal osteoporosis; however, it conferred high cardiovascular risk in clinical trials. Furthermore, romosozumab could only be administered by injection, which may cause compliance issues for patients who prefer oral therapy. Considering these above safety and compliance concerns, we therefore present relevant discussion and offer perspectives on the development of next-generation sclerostin inhibitors by following several ways, such as concomitant medication, artificial intelligence-based strategy, druggable modification, and bispecific inhibitors strategy.

Objective:To investigate the clinical characteristics and etiology of pulmonary embolism in children, and to discuss the efficacy and safety of anticoagulation therapy.Methods:The data of 30 children with pulmonary embolism, who were treated with anticoagulation therapy in the Department of Pediatrics, Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2021, were analyzed retrospectively.The etiology, clinical characteristics, complications, outcomes and prognosis after anticoagulation treatment were analyzed.Results:There were 17 males and 13 females, with an average age of (8.95±2.58) years (age range: 4-13 years). The follow-up duration was 3-59 months.(1) The symptoms included cough in 30 cases (100.0%), fever in 29 cases (96.7%), shortness of breath in 27 cases (90.0%), chest pain in 15 cases (50.0%), hemoptysis in 9 cases (30.0%), bloody secretions under bronchoscopy but no hemoptysis in 4 cases (13.3%), and respiratory failure in 2 cases (6.7%). (2) The protopathy was Mycoplasma pneumoniae infection in 23 cases (76.7%), whose symptoms accorded with refractory Mycoplasma pneumoniae pneumonia.About 16 cases (53.3%) were positive for Mycoplasma pneumoniae drug resistance mutation 2063A>G or 2064A>G.Two cases (6.7%) had nephrotic syndrome.One case (3.3%) had purpura nephritis (nephrotic syndrome type). One case (3.3%) was lupus nephritis (nephrotic syndrome type). One case (3.3%) was hereditary protein S deficiency.One case (3.3%) had osteomyelitis and Staphylococcus aureus sepsis.One case (3.3%) had congenital heart disease.(3) Complications included limb thrombosis in 7 cases (23.3%), atrial thrombosis in 2 cases (6.7%), thoracic and abdominal deep venous thrombosis in 2 case (6.7%), cerebral infarction in 2 cases (6.7%), and splenic infarction in 1 case (3.3%). (4) Imaging examination showed that 30 children had lung consolidation/atelectasis (100.0%), and 24 cases had pleural effusion (80.0%). (5) Coagulation function examination suggested D-dimer increased to ≥ 5 mg/L in 21 cases (70.0%). (6) One case (3.3%) was given thrombolytic therapy with urokinase at the acute stage.Nine cases (30.0%) were treated with heparin/low molecular weight heparin.Twenty-one cases (70.0%) first received anticoagulation therapy with heparin/low molecular weight heparin and later took oral anticoagulant.Four cases (13.3%) were treated with Warfarin and 17 cases (56.7%) with Rivaroxaban.The anticoagulant treatment lasted 1-9 months.No recurrence of embolism or sequelae of chronic thromboembolic pulmonary hypertension was observed. Conclusions:Infection, especially Mycoplasma pneumoniae infection, is the main cause of pulmonary embolism in children.The symptoms of pulmonary embolism in children are atypical, so it is difficult to distinguish this disease from primary underlying diseases.Bronchoscopy can help find occult pulmonary hemorrhage.Unexplained shortness of breath in children of any age suggests the possibility of pulmonary embolism.Combination of clinical symptoms and necessary examination contribute to early diagnosis of pulmonary embolism.Then selection of appropriate anticoagulant drugs and timely anticoagulant therapy can improve the prognosis of children.

Objective To explore MSCT appearances of lung lacerating injury.Methods The MSCT findings of lung lacerating injury in 31 patients were analyzed retrospective.Results The lung lacerating injury of the 31 cases with 67 lesions in total was found,18 of whom were located on the back side of lung near the pleura,11 of whom had solitary lesion and 20 of whom had multiple ones. The MSCT findings included lung cavity in 9 eases,liquid airbag cavity in 1 7 and lung hematoma in 5 .The pulmonary contusion with different degrees was found in all 3 1 cases.Dynamic observation showed the cavities and hematoma could be transformed into each other.Conclusion MSCT is the best method for diagnosis and observation of lung lacerating injury and helpful for the guide of clinical treatment.

Objective To evaluate the trimester specific reference ranges and dynamic changes of thyroid functional indicators during gestation of healthy pregnant women.Methods According to the selection criteria,139 cases were selected as the normal pregnant population to establish a self-sequential longitudinal reference range.We collected samples eight times in every case throughout the gestation(including the 8th,12th,16th,20th,28th,36th week of prenatal,the 3rd and the 6th month postpartum) and detected the indicators of thyroid funciton.Meanwhile,301 healthy non-pregnant women of childbearing age were selected as the control group.Results The median of TSH was lowest in the first trimester,and then was increased in the second and third trimesters.The reference ranges of TSH were 0.20-4.01 mIU/L,0.43-3.97 mIU/L,and 0.57-3.96 mIU/L in the above trimesters.The free thyroxine (FT4) level from the 12th week of gestation to the 6th month of postpartum was gradually decreased and was lower than the non-pregnant level.The total thyroxine (TT4) was significantly increased at the 12th week of gestation and thereafter it was stable and returned to normal after childbirth.The free triiodothyronine(FT3) was gradually declined from the 12th week to the 28th week and returned to normal postpartum.Total triiodothyronine(TT3) was significantly increased at the 12th week and thereafter was stable,and returned to normal after childbirth.There was a significant negative correlation between TSH and FT4 in the first trimester(P＜0.01).There was no correlation between TSH and TT4 during the whole gestation.There were positive correlations between FT4 and TT4,FT3 and TT3 since the 12th week of gestation (P ＜ 0.01).Conclusions The gestational specific reference range of TSH based on the selfsequential longitudinal study was narrow,however,the upper limit was still higher than that recommended in foreign guidelines.

ObjectiveTo investigate the value of prospective ECG-gated dual-source CT (DSCT)in the diagnosis of coarctation of aorta ( CoA ).MethodsSixteen patients clinically suspected of CoA underwent prospective ECG-gated DSCT angiography and color Doppler flow imaging (CDFI). The diagnostic accuracy of DSCT and CDFI were compared according to the results of operation or DSA.The nonparametric chi-square test was used for the statistics.ResultsSixteen patients were diagnosed as CoA by DSCT,4 were complicated with artial septal defect (ASD),9 with ventricular septal defect (VSD),1 with transposition of the great arteries,3 with dysplasia of aortic arch,7 with patent ductus arteriosus (PDA),1 with abnormal origin of the coronary artery, 1 with bronchus artery dilation. Fifteen patients were diagnosed as CoA by CDFI,1 was diagnosed as interruption of aortic arch. Four were complicated with ASD,9 with VSD,2 with bicuspid aortic valve (BAV),1 with transposition of the great arteries,2 with dysplasia of aortic arch,7 with PDA,1 with bronchus artery dilation.Abnormal origin of the coronary artery was not found.The diagnostic accuracy of DSCT and CDFI were 97.2％ ( 140/144)and 97.9％ (141/144)respectively,there was no significant difference (x2 =0.00,P ＞ 0.05 ).The sensitivity of DSCT and CDFI were both 93.2％ ( 41/44 ),the specificity were 99.0％ (99/100) and 100.0％ (100/100).The mean effective radiation dose was 0.42 mSv. Conclusion Prospective ECG-gated DSCT is a good imaging technique for the diagnosis of aortic coarctation in children.

Objective To evaluate the application of prospective ECG-gated dual source CT (DSCT) in patients with acute chest pain, and compare it's image quality and radiation dose with those of retrospective ECG-gated spiral scan. Methods Thirty consecutive patients (Group A, average HR ≥85 bpm) with acute chest pain were scanned with prospective ECG-gated scan and another 30 consecutive patients (Group B, average HR ≥85 bpm)were analyzed by retrospective ECG-gated scan. Tube voltage and tube current were adapted by the BMI of patients. MPR, MIP, CPR and VR were used to display pulmonary arteries (PA), thoracic aorta and coronary arteries (CA). Image quality as well as radiation dose were assessed in 2 groups. Qualitative image quality was compared with chi-square test between the two groups,while quantitative image quality [the image noise ( IN ), signal-to-noise ratio ( SNR ) and contrast-to-noise ratio(CNR)] and radiation dose were evaluated with x2 test and Student's t test. Results The proportion of valid coronary segments for diagnosis were 379/385 ( 98. 44% ) and 390/396 ( 98.48% ) respectively in Group A and Group B with no significant difference(x2 =0. 002,P =0. 961 ). The IN [( 16. 23 ±5.75)vs ( 16. 31 ±3. 32) HU] ,SNR (26. 85 ±9. 94 vs 24. 78 ±9. 91 ) and CNR (20. 99 ±9. 31 vs 18. 65 ±8. 72)showed no significant differences between 2 groups ( t = 0. 069,0. 908 and 1. 224, P ＞ 0. 05, respectively).The ED was on average ( 8. 37 ± 2. 69 ) mSv in Group A, whereas on average ( 20. 05 ± 5.52 ) mSv in Group B. There was a statistical difference between 2 groups ( t = 9. 401, P = 0. 000). Conclusion Low dose prospective ECG-gated DSCT angiography can show similar image quality as retrospective ECG-gated spiral scan with radiation dose.

Objective To explore the optimal reconstruction windows in patients with heart rate (HR) over 91 (beats per minute) bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography.Methods Two hundred and thirty-two patients[body mass index (BMI):23-25 kg/m2, with stable HR, and average HR ≥91 bpm]with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography.They were divided into 3 groups (A-C) according to the average HR of scanning.Images were reconstructed from 29% to 80% of the R-R interval in 3% increments.Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges.Coronary arteries were segmented according to the guideline of the American Heart Association (AHA).The degree of interobserver agreement was determined by Kappa statistics.Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients.The ranges of optimal reconstruction windows of images were concentrated on 81%-61% and 51%-31%.In group A(91-95 bpm), there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94.51%,respectively; In group B(96-100 bpm), there were 986 segments in 68 patients, and the according proportions were 0.20%, 99.80%, respectively; In group C(≥ 101 bpm), there were 1174 segments in 81 patients, and the according proportions were 0.17%, 99.83%, respectively.The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%-31%.The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement (Kappa=0.883,P <0.05).Conclusion The optimal reconstruction windows of patients with stable HR(≥91 bpm) was concentrated in 41%, ranged from 51%-31%.When nothing except the window of data acquisition is considered, the prospective ECC,-gated DSCT coronary angingraphy can be used in patients with stable HR(≥91 bpm).

ObjectiveTo explore the value of low-dose gated dual-source CT(DSCT)in the diagnosis of interrupted aortic.arch.MethodsNine pediatric patients performed DSCT angiography and color Doppler flow imaging(CDFI)in the thoracic aorta and heart.All patients were operated.ResultsDSCT examination was finished in all patients with interrupted aortic arch.Nine patients were associated with ventricular septal defect(VSD),8 patients with patent ductus arteriosus(PDA),2 with bronchus artery dilation and 3 with abnormal origin of the coronary artery.Seven patients were diagnosed as interrupted aortic arch by CDFI,2 patients were diagnosed as truncus arteriosus and coarctation of the aorta respectively.All VSDs and PDAs were detected by CDFI.The diagnostic accuracy of DSCT and CDFI were 94.12%(32/34)and 82.35(28/34)respectively.Conclusion DSCT is a valuable imaging method for the diagnosis of pediatric interrupted aortic arch.