Based on the theory of "yang governs and yin follows"， it is believed that pediatric obesity is primarily involves the key pathogenesis of constraint and stagnation due to yang deficiency， and the excessive accumulation of yin turbid. The root cause lies in the spleen-stomach yang deficiency and impaired digestion and transformation， while the branch manifestation is characterized by constraint and stagnation in sanjiao （三焦） and excessive accumulation of yin turbid. This emphasizes the imbalance between the governing function of yang qi and the transformation mechanism of yin essence in the overall pathological process. Accordingly， the treatment approach of reinforcing yang and unblocking stagnation， inhibiting yin and resolving turbid has been proposed. And a comprehensive treatment plan is suggested， including abdominal tuina combined with spinal manipulation， timed acupuncture according to the the eightfold method of the sacred tortoise， syndrome differentiation-based acupuncture， and mild moxibustion. This approach aims to provide an integrated approach for the prevention and treatment of pediatric obesity.

ObjectiveTo develop and validate a diagnostic prediction model for differentiating pulmonary tuberculosis from community-acquired pneumonia based on routine blood parameters. MethodsA total of 642 patients with pulmonary tuberculosis and 503 patients with community-acquired pneumonia were retrospectively enrolled from the Seventh Hospital of Tangshan. They were randomly divided into a training set and an internal validation set at a 7∶3 ratio. Additionally， 218 patients from the 981st Hospital were independently included as an external validation set. The Boruta algorithm and recursive feature elimination were employed to select predictors from 82 blood parameters， sex， and age. A multivariate Logistic regression model was established and evaluated using receiver operating characteristic （ROC） curves， calibration curves， and decision curve analysis. ResultsThe final model incorporated eight predictors， namely uric acid， urea nitrogen， alkaline phosphatase， monoamine oxidase， alanine aminotransferase， glutathione， neutrophil percentage， and age. The model achieved areas under the curve （AUCs） of 0.800 （95%CI： 0.769-0.830）， 0.787 （95%CI： 0.738-0.836）， and 0.736 （95%CI： 0.667-0.835） in the training， internal validation， and external validation sets， respectively. The model demonstrated good calibration， and decision curve analysis showed clinical net benefit within the threshold probability range of 10%-80%. ConclusionThe developed model exhibits good discriminative ability and clinical utility， serving as an effective early screening tool for primary healthcare institutions.

Objective To investigate the risk factors for mortality and bleeding complications in extracorporeal membrane oxygenation(ECMO)treated patients and to evaluate the impact of thrombocytopenia severity on the prognosis of ECMO therapy.Methods A total of 153 patients who received ECMO treatment at Peking University Third Hospital between January 2013 and September 2024 were en-rolled in this study.The patients were divided into death group(n=97)and recovery group(n=56)based on their final outcomes.Additionally,the patients were categorized into bleeding group(n=104)and non-bleeding group(n=49)based on the occurrence of bleeding complications during ECMO.Clinical baseline characteristics and extreme laboratory values during ECMO were compared be-tween groups.Logistic regression was used to analyze the risk factors for mortality and bleeding.The patients were further divided,based on the initial platelet(PLT)values on the day of catheter placement and the lowest platelet count during ECMO,into normal group(PLT≥ 100× 109/L),moderate reduction group[PLT=(50～99)× 109/L],and severe reduction group(PLT＜50× 109/L).Kaplan-Meier analysis was used to compare survival rates among these groups.The patients in the moderate and severe reduction groups were further divided into a platelet transfusion group and a non-transfusion group,and the outcomes and complication rates were com-pared.Results The recovery group had a higher proportion of myocarditis,higher minimum values of PLT,Hb,and Fib,and higher initial PLT values,while the maximum values of lactic dehydrogenase(LDH),total bilirubin(T-Bil),prothrombin time(PT),and procalcitonin(PCT)were lower(all P＜0.05)with significant differences.Logistic regression showed that age and maximum PCT were independent risk factors for mortality(OR=1.025 and 1.015 respectively,all P＜0.05).The bleeding group had longer ECMO dura-tions,more plasma transfusions,lower minimum Hb values,and higher maximum values of WBC,neutrophils(Neu),and APTT(all P＜0.05)with statistical differences.The minimum PLT value,maximum WBC value,and maximum APTT value were independent risk factors for bleeding complications(OR=0.986,1.062,and 1.004 respectively,all P＜0.05).Kaplan-Meier analysis showed that the patients in the severe reduction group had lower survival rates,regardless of whether the grouping was based on initial or minimum platelet counts(all P＜0.05).Platelet transfusion improved the mortality in the severe reduction group(P＜0.05)but had no effect on the moderate reduction group.Conclusion Age and peak value of PCT are the risk factors for mortality in ECMO patients,while mini-mum PLT count,peak value of WBC and APTT are the risk factors for bleeding complications.Early intervention for infection and in-flammation during ECMO may improve the outcome of patients.Severe thrombocytopenia during ECMO therapy increased the risk of mortality,and targeted platelet transfusion may improve the survival of these patients.

Aim To establish the cells co-expressing 5-HT2C re-ceptor(5-HT2C R)and enhanced green fluorescent protein(EG-FP)-tagged nuclear factor of activated T cells 2(NFAT2)in U2OS cells.Methods The 5-HT2CR stably expressed U2OS-EGFP-NFAT2-5-HT2CR cells were screened by hygromycin B af-ter 5-HT2C plasmid was transfected into U2OS-EGFP-NFAT2 cells.The mRNA and protein expression of 5-HT2CR in the se-lected U2OS-EGFP-NFAT2-5-HT2CR cells were detected by RT-qPCR and Western blot.The activation of U2OS-EGFP-NFAT2-5-HT2CR cells was verified by nuclear translocation level assay.The effects of 5-HT,LSD,DOM,DOI,psilocybin(PSI),lisuride(LIS)on the U2OS-EGFP-NFAT2-5-HT2CR cells were detected by the high throughout screening assay.Results Among these cells,No 56 had the highest nuclear translocation function.5-HT2CR mRNA and protein were stably expressed in U2OS-EG-FP-NFAT2-5-HT2CR transfected cell line for 1-15 generations by RT-qPCR and Western blot.Vabicaserin increased the EGFP-NFAT2 nuclear translocation in U2OS-EGFP-NFAT2-5-HT2C R during 1-15 generations.The 5-HT2CR antagonist SB242084 significantly decreased EGFP-NFAT2 nuclear translocation in-duced by Vabicaserin in U2OS-EGFP-NFAT2-5-HT2CR cells.5-HT,LIS,PSI slightly increased the EGFP-NFAT2 nuclear trans-location in U2OS-EGFP-NFAT2-5-HT2C R cells,whereas LSD,DOI,DOM had no effect.Conclusions U2OS-EGFP-NFAT2-5-HT2CR cells co-expressing 5-HT2CR and EGFP-NFAT2 are es-tablished,which can be used for high throughout screening of chemicals and the study on the mechanism of the5-HT2CR.

Aim To explore the effect of neurite out-growth inhibitor A/neurite outgrowth inhibitor receptor(Nogo-A/NgR)pathway on psychedelic-reduced pre-pulse inhibition in mice.Methods Mice were injec-ted intraperitoneally with psilocybin,DOI to establish an animal model of prepulse inhibition(PPI)reduc-tion.The effects of psilocybin and DOI on PPI in mice after lateral ventricular injection of Nogo-A inhibitor NEP1-40 30 min in advance were evaluated.Finally,Rtn4r knockout mice were constructed to further verify the conclusion.Results The injection of NEP1-40(1 g·L-1,5 μL/mice,i.c.v)30 min in advance had no effect on PPI of mice.Under the conditions of 70 dB and 75 dB prepulse stimulation,NEP1-40 significantly up-regulated the PPI reduction induced by psilocybin.At the same time,NEP1-40 significantly up-regulated the DOI induced PPI reduction in mice at 70 dB and 80 dB prepulse stimulation.Compared with the two solvent groups,the PPI of Rtn4r-/-mice was not differ-ent from that of wild-type mice.Compared with the mice in Rtn4r-/-solvent group,the PPI of mice in Rtn4r-/-administration group showed a decreasing trend,but had no significant difference.Under the con-dition of 70 dB prepulse stimulation,there was a signif-icant difference between the Rtn4r-/-administration group and wild-type mice.Conclusion Nogo-A/NgR pathway is involved in the destruction of sensorimotor gating in mice by the psychedelic psilocybin or DOI.

This paper reported the clinical manifestations, pathological features, immunophenotype and follow-up of two patients with superficial CD34-positive fibroblastic tumor (SCPFT), who were admitted to Shandong Provincial Hospital in 2022 and 2023, and discussed the relevant literatures. The two patients, aged 43 and 20 years old, were both male. Their tumors were located in the perineum and the back of left shoulder, respectively. Both presented as single slow-growing subcutaneous masses with a course typically measured in years, accompanied by mild tenderness but without pain or pruritus. Microscopically, spindled to epithelioid cells and pleomorphous nuclear cells arranged in cellular fascicles and solid sheets were the main findings. Immunophenotypically, positive expression of CD34 was found in both cases. Extended resection ensured negative marginal and basal margins for both cases. No recurrence was observed after 22 and 12 months of follow-up, respectively. Clinical features, pathology, and differential diagnosis were discussed and summarized through a review of relevant literature. SCPFT is a novel type of fibroblastic tumor categorized as a low-grade malignant soft tissue tumor with unique pathological and biological characteristics that is relatively rare clinically. Routine resection may lead to recurrence; therefore, long-term follow-up is necessary. The combination of morphological characteristics and immunohistochemistry is helpful to diagnosis. It is important to differentiate this disease from other tumors to avoid misdiagnosis or mistreatment.

BACKGROUND:Gambogic acid is highly cytotoxic to breast cancer and can effectively kill triple negative breast cancer stem cells,but the underlying mechanism is still unclear.OBJECTIVE:To investigate the lethal effect of gambogic acid on triple negative breast cancer stem cells as well as the possible mechanisms.METHODS:PharmMapper database was used to predict the target protein of gambogic acid.String website was used to construct the protein interaction network of various drug targets.Active ingredient-target network was constructed by Cytoscape software.KEGG signal pathway enrichment analysis was performed on potential targets by R language software.The effect of different concentrations of gambogic acid on the activity of human breast cancer cell line MDA-MB-231 was detected by CCK-8 assay.The appropriate concentration was screened.MDA-MB-231 stem cells were enriched by cell ball culture method and treated with gambogic acid at different concentrations(0,0.5,1.0,and 2.0 μmol/L)for 24 hours.TUNEL fluorescence staining and flow cytometry were used to detect apoptosis of stem cells.qPCR and western blot assay were used to detect protein C receptor expression.The expression levels of p-PI3K,p-AKT,Caspase-3,and cleaved Caspase-3 were detected by western blot assay.Stem cells were cultured in four groups:Blank control group(stem cells were not treated),siRNA-NC group,siRNA-protein C receptor group,and siRNA-protein C receptor+PI3K agonist group.After culture for 36 hours,the expression levels of p-PI3K,p-AKT,Caspase-3,and cleaved Caspase-3 were detected by western blot assay.RESULTS AND CONCLUSION:(1)Network pharmacology exhibited that the protein C receptor,a marker of triple negative breast cancer stem cells,was one of the targets of gambogic acid.KEGG enrichment analysis involved apoptosis,epithelial growth factor receptor,RAS,and PI3K-AKT signaling pathways.(2)CCK-8 assay results showed that gambogic acid could inhibit the viability of MDA-MB-231 cells,and the median inhibitory concentration IC50 value was(1.18±0.34)μmol/L,so the concentrations of 0.5,1.0,and 2.0 μmol/L were selected for subsequent experiments.(3)TUNEL fluorescence staining and flow cytometry showed that gambogic acid induced apoptosis of triple negative breast cancer stem cells in a dose-dependent manner(P<0.05).qPCR and western blot assay confirmed that gambogic acid down-regulated mRNA and protein expression of protein C receptor,down-regulated Caspase-3,p-PI3K,and p-Akt protein expression,and up-regulated cleaved Caspase-3 protein expression(P<0.05).siRNA-protein C receptor transfection experiments further confirmed that knockdown of protein C receptor expression in triple negative breast cancer stem cells increased cleaved Caspase-3 protein expression(P<0.05),and down-regulated phosphorylation of PI3K/AKT signaling pathway(P<0.05).Application of PI3K agonist 740 Y-P decreased cleaved Caspase-3 protein expression(P<0.05),increased phosphorylation levels of p-PI3K and p-AKT(P<0.05),and improved apoptosis to a certain extent.(4)The results show that gambogic acid may play a role in killing and inducing apoptosis of triple negative breast cancer stem cells by down-regulating protein C receptor,and the further molecular mechanism may be related to the inhibition of PI3K/AKT signaling pathway.

Excessive stress has a significant impact on an indi-vidual's physical and mental health and quality of life.Al-though psychotherapy is commonly used for post-traumatic stress disorder(PTSD),pharmacotherapy plays an important role in the treatment of severe PTSD.At present,there are limited types of approved medications for PTSD,and their efficacy and safety have certain limitations,such as low remission rates,high relapse rates,and increased behavioral risks.Studies have shown that hallucinogens such as psilocybin and ketamine can enhance neuroplasticity,modulate brain network connections,and regulate the immune system by interacting with different re-ceptors,so as to effectively alleviate PTSD symptoms such as anxiety,depression and fear,showing great potential in PTSD treatment.However,these hallucinogens are not yet widely used in clinical practice.This review summarizes the effects and neu-robiological mechanisms of hallucinogens in the treatment of stress-related symptoms,aiming to provide references for the clinical treatment of PTSD.

Pruritus is one of the serious side effects in patients receiving opioid analgesia in clinic.A lot of studies have eluci-dated the analgesic mechanisms of opioids,but the mechanism of opioid-induced pruritus is still unclear,and the relationship between pruritus and analgesia is ambiguous.In the recent stud-ies,after activation of μ,κ and δ opioid receptors,opioids transmit itch information by interacting with the gastrin-releasing peptide receptor(GRPR)directly or indirectly.Neuropeptides such as neuromedin B(NMB),neuropeptide Y(NPY),B-type natriuretic peptide(BNP)and other receptors transient receptor potential vanilloids 1 receptor(TRPV1R),N-methyl-D-aspar-tate receptor(NMDAR)and 5-hydroxytryptamine(5-HT)re-ceptor also play important roles in morphine-induced itching.In addition,the prevention and treatment of opioid-induced pruritus are still one of the difficulties and hot spots of perioperative mor-phine analgesia.Therefore,it is important to clarify the specific occurrence mechanism of pruritus to find new research ideas for the prevention and treatment of opioid-induced pruritus.

Objective To analyze the habitat suitability status of Rhododendron anthopogonoides Maxim.in Gansu and Qinghai Provinces;To predict its potential suitable areas in different climate scenarios;To provide references for the protection and rational utilization of Rhododendron anthopogonoides Maxim.Methods The MaxEnt model,combined with ArcGIS 10.3,was used to simulate and analyze the potential habitat suitability and spatial distribution of Rhododendron anthopogonoides Maxim.under current and future climate conditions,using species distribution data and environmental factors.Additionally,the habitat suitability was classified,and key environmental factors influencing the distribution of Rhododendron anthopogonoides Maxim.under current climate conditions were identified through a comprehensive evaluation of factor contribution rates and validation using the Jackknife method.Results The predicting results showed that under the current climate,the total area of potential suitable habitat for Rhododendron anthopogonoides Maxim.was 21.27×104 km2,primarily distributed in Lanzhou,Linxia Hui Autonomous Prefecture and Gannan Tibetan Autonomous Prefecture in Gansu Province,and in Xining,Haidong,Huangnan Tibetan Autonomous Prefecture and Hainan Tibetan Autonomous Prefecture in Qinghai Province.Under different future climate scenarios,the potential suitable habitat area was projected to increase by 4.51%to 21.91%,and migrating to high altitude areas.Elevation,precipitation in the driest month,annual precipitation and the average temperature in the driest quarter were identified as the main environmental factors influencing the distribution of Rhododendron anthopogonoides Maxim.Conclusion Under different climate scenarios in the future,the habitat area of Rhododendron anthopogonoides Maxim.in Gansu and Qinghai Provinces is showing an increasing trend,which can provide reference for the protection and rational utilization of Rhododendron anthopogonoides Maxim.resources under climate change.