Background: Insomnia often responds to the orexin receptor antagonist suvorexant. This study aimed to evaluate the efficacy and adverse events of suvorexant for Chinese patients with primary insomnia over 6 months. Methods: A total of 120 patients with primary insomnia were assigned randomly to two groups that received placebo or suvorexant (40 mg) for 6 months. The primary outcomes were the total sleep time (sTST), time to sleep onset (sTSO), and sleep quality (sQUAL). The secondary outcomes were the Insomnia Severity Index (ISI) score and adverse events. Results: A total of 111 patients completed the study and all of them were included in the final analysis. Suvorexant showed greater efficacy than the placebo in enhancing sTST, sTSO, sQUAL and ISI score at months 1 and 6. Serious adverse events were documented in 2 patients (3.3%) in the suvorexant group and 1 patients (1.7%) in the placebo group. The most common adverse event was somnolence, which occurred in 7 patients (11.7%) in the suvorexant group and 2 patients (3.3%) in the placebo group. No death related to suvorexant treatment was recorded. Conclusions: Suvorexant was efficacious and well-tolerated in a group of Chinese patients with primary insomnia over 6 months.
Sleep Initiation and Maintenance Disorders

Osteonecrosis of the femoral head （ONFH） is a painful and debilitating disease caused by impaired blood supply to the femoral head and cellular and tissue degeneration， leading to gradual destruction of the bone structure and progressive collapse of the femoral head. The main pathological mechanism of ONFH is the disruption of the balance between bone absorption and the reconstruction of new bone， resulting from microcirculation damage and decreased cellular tissue ability. This imbalance leads to biomechanical changes and accelerates the pathological progression of ONFH. In the early stages， clinical manifestations may not be obvious， mainly presenting as pain or discomfort in the hip or groin area， which can be relieved after rest. In the later stage of the disease， pain intensifies， and limb shortening， lower limb weakness， difficulty walking， or limping may occur. Currently， western medicine commonly uses osteogenic agents， anticoagulants， and artificial joint replacement for treatment， but there are also many issues such as prosthesis loosening and infection. Research has shown that traditional Chinese medicine （TCM） treatment of ONFH takes a holistic approach and employs multi-functional， multi-target， and multi-system Chinese medicine therapies， ensuring the safety and effectiveness of the treatment. The osteoprotegerin （OPG）/receptor activator of nuclear factor-κB （RANK）/RANK ligand （RANKL） signaling pathway plays a crucial role in maintaining the dynamic balance of bone remodeling. TCM treatments utilize this pathway to promote apoptosis of osteoclasts， reduce bone resorption， and accelerate bone formation， thereby playing an important role in the prevention and treatment of ONFH. This paper reviewed the role of OPG/RANK/RANKL signaling pathway and related cytokine expression in ONFH by reviewing relevant literature in China and abroad and research status of Chinese medicinal monomers， Chinese medicinal formulations， and combinations with physical therapy in increasing osteoblast secretion， promoting OPG expression， enhancing cytokine expression levels， and inhibiting osteoclast activity for the prevention and treatment of ONFH. This paper is expected to provide new ideas and directions for TCM in the prevention and treatment of ONFH.