ObjectiveTo study the chemical constituents of Painong powder and the constituents absorbed into blood after oral administration to rats by ultra performance liquid chromatography-quadrupole-electrostatic field orbitrap high-resolution mass spectrometry （UPLC-Q-Orbitrap-MS）. MethodsUPLC-Q-Orbitrap-MS was employed for mass spectrometry data acquisition. The chemical constituents of Painong Powder and the constituents absorbed into blood were characterized and identified via Xcalibur 4.2 and Compound Discoverer v3.3.1 （CD） based on retention time， accurate molecular weights， secondary fragmentation ions， and comparison with reference standards and literature reports. ResultsA total of 176 chemical compounds， including 56 flavonoids， 42 triterpenoid saponins， 23 monoterpenes， 7 coumarins， 5 tannins， and other 43 compounds were identified from Painong powder. 49 components were identified in the rat plasma after oral administration of Painong powder， including 33 prototype constituents and 16 metabolites. The major metabolic pathways included hydrolysis in phase Ⅰ metabolic reactions， as well as methylation， sulfation， and glucuronidation in phase Ⅱ metabolic reaction. ConclusionThe method comprehensively identified the chemical constituents of Painong powder both in vitro and in vivo， and may provide a reference for the study of quality control and clinical applications.

Background: Postoperative hypokalemia is a common electrolyte disturbance associated with adverse outcomes, particularly in older adults. This study aimed to identify risk factors and develop predictive models for hypokalemia within 24 hours after carotid endarterectomy (CEA) for severe carotid artery stenosis, a condition that primarily affects older patient populations. Methods: A retrospective cohort of 1,076 CEA patients (October 2021 to May 2023) was analyzed. Risk factors were identified using univariate and multivariate logistic regression. A predictive nomogram was developed and internally validated via bootstrapping. Machine learning models (Random Forest and XGBoost) were developed and interpreted using SHAP (SHapley Additive exPlanations) analysis. Subgroup analyses were performed in patients aged ≥70 years and by comparing postoperative potassium levels >4.0 mmol/L versus 3.5–4.0 mmol/L. Results: The cohort had a median age of 65 years. Multivariate analysis identified preoperative potassium (odds ratio [OR]=0.60, 95% confidence interval [CI] 0.50–0.72), hemoglobin (OR=0.74, 95% CI 0.63–0.88), BMI (OR=0.74, 95% CI 0.63–0.88), and postoperative visual analogue scale score (OR=1.28, 95% CI 1.09–1.51) as independent predictors. Frailty showed borderline significance (OR=1.56, 95% CI 1.00–2.44, p=0.05). The nomogram achieved an area under the curve (AUC) of 0.710, demonstrating good discrimination and calibration. Machine learning models similarly performed well (AUC 0.707–0.709). Conclusion We developed a validated tool to predict postoperative hypokalemia after CEA. The model highlights that in addition to biochemical and surgical factors, geriatric syndromes like frailty and nutritional status are pivotal risk determinants. This facilitates early, individualized management, including tailored potassium supplementation, nutritional support, and pain control, especially for vulnerable older adults, to mitigate complications and promote recovery.

ObjectiveTo analyze the lipid characteristics and related risk factors of children with Wilson disease （WD）. MethodsThe clinical data of 315 children with WD and 248 healthy children who underwent physical examination were retrospectively collected. The differences in lipid levels between the two groups were compared. The WD group was divided into the normal lipid group （85 cases） and the dyslipidemia group （230 cases） according to lipid levels. General data and biochemical indicators were compared between the two groups， and multivariate Logistic regression analysis was used to analyze the independent risk factors for dyslipidemia in children with WD. ResultsThe incidence of dyslipidemia in children with WD was 73.0% （230/315）， comprising 77 cases （33.5%） of hypertriglyceridemia， 11 cases （4.8%） of hypercholesterolemia， 104 cases （45.2%） of combined hyperlipidemia， 9 cases （3.9%） of hyperlipoprotein（a）emia， and 29 cases （12.6%） of hypoalphalipoproteinemia. There were statistically significant differences in age distribution among different types of dyslipidemia （P<0.05）， whereas no significant differences were observed in gender distribution （P>0.05）. Compared with the normal lipid group， the dyslipidemia group showed significantly higher levels of homocysteine， superoxide dismutase （SOD）， platelet count （PLT）， fibrinogen， alanine aminotransferase， aspartate aminotransferase， γ-glutamyl transferase， uric acid， cystatin C （Cys-C）， type IV collagen （C-IV）， and laminin （all P<0.05）. Multivariate Logistic regression analysis showed that C-IV （OR=5.037， 95% CI： 2.562-9.900）， PLT （OR=2.297， 95% CI： 1.580-3.339）， Cys-C （OR=2.008， 95% CI： 1.395-2.890）， and SOD （OR=1.996， 95% CI： 1.342-2.970） were all independent risk factors for dyslipidemia in children with WD. ConclusionChildren with WD have a high incidence of dyslipidemia， which is dominated by combined hyperlipidemia and hypertriglyceridemia. C-IV， PLT， Cys-C， and SOD are independent risk factors for dyslipidemia in children with WD.

With the rapid advancement of medical technology and the increasing complexity of clinical environments, competence in clinical ethical decision-making has become an indispensable core competency for exemplary physicians. However, traditional medical ethics education has long been confronted with the persistent challenges of theory-practice dissociation and the disconnect between pedagogical settings and clinical realities. Thus, how to construct a "Clinical Ethics" curriculum that aligns with the objectives of training high-caliber medical professionals has emerged as a critical and challenging issue in current medical education reform. To effectively address this challenge, the Office of Education at Peking University Third Hospital, since 2021, has assembled a multidisciplinary "Clinical Ethics" teaching and management team comprising faculty from Peking University School of Humanities and key clinical specialists from the hospital. In 2022, the "Clinical Ethics" elective course was formally launched for fourth-year students in the eight-year MD program who had completed coursework in "Medical Ethics" and organ-system-based curricula, with the aim of exploring and operationalizing a pre-clinical ethics education model tailored for senior medical students. The course employs a modular instructional design encompassing "theoretical review-case-based deliberation-clinical workshop", which effectively facilitates the deep integration of medical humanities with clinical practice.Following four years of iterative refinement through the "plan-act-observe-reflect" cycle, the course has demonstrated positive outcomes in enhancing students' ethical awareness and decision-making capabilities, and has preliminarily established a sustainable collaborative mechanism among the multidisciplinary faculty team. This article systematically delineates the course development background, pedagogical model and methodological innovations, and the multidisciplinary collaborative framework, alongside reflections and summaries based on implementation outcomes, with the intent of providing references for the future development of "Clinical Ethics" curricula.

Digital medical insurance governance， as an important component of digital transformation， improves the efficiency of medical insurance services while facing complex ethical challenges. Taking stakeholder theory as the analytical framework， this paper explored the generative mechanisms， manifestations， and countermeasures of ethical issues in digital medical insurance governance. This study uncovered that accelerated technological iteration and lagging ethical and legal norms， as well as interest conflicts among multiple participants in governance， constituted the major causes of ethical issues. These issues specifically manifested as data privacy leakage， unfair algorithmic decision-making， widening digital divide， ambiguous accountability， and other aspects. To address these issues， this paper put forward systematic countermeasures， such as establishing a dynamic ethical and legal regulatory system， balancing the demands of stakeholders， strengthening technological ethical governance， narrowing the digital divide， and enhancing accountability mechanisms. Through the implementation of multi-dimensional governance strategies， it aimed to balance technological innovation and ethical constraints， advance the inclusiveness， fairness， and sustainable development of digital medical insurance， and provide theoretical reference and practical references for improving China’s digital medical insurance governance system.

BACKGROUND:Osteoblasts are the main cell types responsible for bone formation and remodeling,and the normal performance of their function is precisely regulated by various signaling pathways.Among them,the bone morphogenetic protein and Wnt signaling pathways play a key role in osteogenesis. OBJECTIVE:To review the role of bone morphogenetic protein/Wnt signaling pathway in the regulation of osteoblast function and analyze its changes in different physiological and pathological conditions in order to further reveal the molecular mechanism of bone formation and remodeling. METHODS:The Chinese and English search terms"BMP signaling pathway,Wnt signaling pathway,and osteogenesis"were searched in CNKI,Wanfang,and PubMed databases for original researches published from the inception to June 2023.Totally 61 articles were finally selected for analysis and summary.Using the method of the literature review,the studies of the bone morphogenetic protein/Wnt signaling pathway in regulating osteogenesis were sorted out and analyzed. RESULTS AND CONCLUSION:(1)Bone morphogenetic protein and Wnt signaling pathways play important roles in the differentiation,proliferation,and maturation of osteoblasts.Bone morphogenetic protein signaling pathway mainly regulates the expression of osteogenesis-related genes through the activation of Smad protein.Smad protein enters the nucleus and regulates the expression of genes related to osteogenesis.Different Wnt signaling pathway from bone morphogenetic protein mainly depends on the activation of β-catenin to exert its biological effects.(2)The regulatory effect of bone morphogenetic protein/Wnt signaling pathway will be affected by many factors in different physiological and pathological states.Growth factors,hormones,and mechanical stress can affect the activity of bone morphogenetic protein/Wnt signaling pathway to some extent.(3)Bone morphogenetic protein/Wnt signaling pathway interacts with other signaling pathways in the regulation of osteogenesis,and they together constitute a complex regulatory network.(4)Chinese medicine and natural compounds can promote bone health by regulating signaling pathways,providing new possibilities for treating bone diseases.(5)Future studies can further explore the interaction of bone morphogenetic protein/Wnt signaling pathway and other signaling pathways and its changes in different physiological and pathological conditions,resolve the key nodes and regulation mechanism in the complex network,to provide more precise targets for the treatment of bone-related diseases,and also provide new ideas to reveal the molecular mechanism of bone formation and remodeling.

Objective:To explore the complement deposition levels on blood cell surfaces in patients with paroxysmal nocturnal hemoglobinuria (PNH) and evaluate their association with clinical manifestations.Methods:This study enrolled patients with PNH, who had not been treated with complement inhibitors and appeared at Peking Union Medical College Hospital from February 2021 to February 2023. The clinical information of participants was retrospectively recorded, and peripheral blood samples were collected. Gender- and age-matched normal controls (NC) were recruited accordingly. C5b-9, C3, C4b, and factor B (FB) deposition levels on peripheral red blood cells, white blood cells, and platelets were detected with flow cytometry. The correlation between complement deposition levels and clinical symptoms was analyzed.Results:This study involved 73 patients with PNH, including 42 (57.5%) males, with a median age of 36 (range: 14-76) years. 16 matched NC were collected. Among patients with PNH, 36 (49.3%) had classical PNH and 37 (50.7%) had aplastic anemia-PNH syndrome. Thromboembolic events (TEE) occurred in 18 (24.7%) patients. The median HGB, absolute reticulocyte count (Ret), and lactate dehydrogenase of PNH patients were 76 (37-116) g/L, 181.0 (45.9-495.8) ×10 9/L, and 1 875 (377 - 5 509) U/L, respectively. The median number of Flaer-negative white blood cells was 94.0% (13.0% - 99.9%) ; the median CD59 negative red blood cells was 46.7% (9.0% - 93.0%). The deposition of C5b-9, C3, C4b, and FB on red blood cells, white blood cells, and platelets in patients with PNH was significantly higher than that in NC (all P<0.05). C5b-9 deposition level was significantly higher than that of C3, C4b, and FB on all three blood cell lineages in PNH patients (all P<0.01). The deposition of all complement fragments on red blood cells was significantly lower than that on white blood cells and platelets (all P<0.01). C5b-9 deposition on red blood cells was positively correlated with Ret in PNH patients ( P=0.005). C3 ( P=0.001) and C4b ( P=0.017) deposition levels on white blood cells and C3 deposition on platelets ( P=0.002) in patients with TEE history were lower than those without. Conclusions:C5b-9, C3, C4b, and FB deposition levels on all three blood cells in patients with PNH were higher than NC. Increased C5b-9 on red blood cells may indicate active hemolysis. Reduced C3 and C4b levels on white blood cells and low C3 deposition on platelets may indicate TEE risk.

Objective:To analyze the association between osteoporosis and the risk for Alzheimer's disease (AD).Methods:A total of 471 922 study subjects were selected from the UK Biobank database, including 12 818 osteoporosis cases and 459 104 controls. Cox proportional hazard regression model and competing risk model were used to evaluate the association between osteoporosis and AD after adjusting confounding factors. Furthermore, a Mendelian randomization (MR) study was conducted by using the data of two published genome-wide association studies, and 1 050 highly relevant single nucleotide polymorphisms were identified from the bone mineral density data as instrumental variables. The association between bone mineral density and the risk for AD was evaluated by using inverse variance weighted method, MR-Egger regression, and weighted median estimator method. Additionally, sensitivity analyses were performed.Results:After adjusting for confounders, no significant association between osteoporosis and an increased risk for AD was found in the cohort study (Cox proportional hazard regression model analysis: HR=1.10, 95% CI: 0.78-1.56, P=0.588). The MR analysis revealed no association between bone mineral density and the risk for AD (inverse-variance weighted: OR=1.03, 95% CI: 0.98-1.09, P=0.252), and the results remained robust in multiple sensitivity analyses. Conclusion:The study result does not support the association between osteoporosis and risk for AD.

Human Respiratory Stem Cells (RSCs) play a crucial role in the maintenance, repair and regeneration of the respiratory system. As a novel therapeutic method, stem cell therapy is a popular research direction in the medical field. And with the in-depth research on the mechanism of pneumonia caused by respiratory infections in recent years, the use of RSCs to explore pneumonia caused by respiratory infections and its therapeutic strategies has become a hot topic. In this paper, we firstly outlined the types of RSCs, summarized the mechanism of pneumonia caused by respiratory tract infections, discussed the advantages of RSCs application and the progress of culture differentiation, and elaborated the therapeutic exploration of RSCs in pneumonia caused by respiratory tract infections.

Objective:To identify the risk factors for postoperative sleep disturbance (PSD) in patients undergoing spine surgery.Methods:In this case-control study, patients who underwent spine surgery from December 2023 to June 2024 at Beijing Tiantan Hospital of Capital Medical University, were selected as the subjects of the study. The quality of postoperative sleep was assessed using the Athens Insomnia Scale (AIS). The baseline characteristics and various perioperative indicators of the patients were collected. The patients were divided into PSD group and non-PSD group according to whether they had PSD. The variables with statistically significant differences from the univariate analysis were included in a multivariate logistic regression to identify the risk factors for PSD.Results:The results of the multivariate logistic regression analysis showed that preoperative sleep disturbance (odds ratio [ OR]=2.23, 95% confidence interval [ CI] 1.06-4.72, P=0.036), course of disease > 12 months ( OR=2.20, 95% CI 1.14-4.24, P=0.019) and AIS score > 2 on the night before surgery ( OR=2.06, 95% CI 1.02-4.16, P=0.045) were the independent risk factors for PSD in patients undergoing spine surgery. Conclusions:Preoperative sleep disturbance, course of disease > 12 months and AIS score > 2 on the night before surgery are independent risk factors for PSD in patients undergoing spine surgery.