OBJECTIVE To explore the intervention mechanism of Bushen anzhi decoction （BSAZD） in rats with insomnia induced by kidney failing to store spirit. METHODS A total of 36 SD rats were randomly divided into normal group （normal saline）， model group （normal saline）， eszopiclone group （positive control group， 0.27 mg/kg）， and low-， medium- and high-dose BSAZD groups （5.85， 11.70， 23.40 g/kg）， with 6 rats in each group. Except for the normal group， rats in the remaining groups were subjected to combined administration of D-galactose and DL-4-chlorophenylalanine to establish the rat model of insomnia due to kidney failing to store spirit. After successful modeling， corresponding liquid medicine or normal saline was intragastrically administered once daily for 14 consecutive days. After the last administration， behavioral indicators and hippocampal histopathological morphology of rats were detected. Untargeted metabolomics was adopted to screen serum differential metabolites and enrich relevant signaling pathways. RESULTS Compared with the model group， the high-dose BSAZD group exhibited significantly increased open arm entries ， open arm time and sleep time （ P ＜0.05）， accompanied by markedly decreased closed arm entries， closed arm time and sleep latency （ P ＜0.05）. Hippocampal neurons in the high-dose BSAZD group were arranged regularly， and the size， morphology and location of cell nuclei were nearly normal. Untargeted metabolomics analysis identified oxidized glutathione， glutamate and other differential metabolites in serum of rats in the high-dose BSAZD group； these differential metabolites were mainly enriched in GABAergic synapse， glutamatergic synapse， cAMP signaling pathway and 2-oxocarboxylic acid metabolism pathway. CONCLUSIONS BSAZD can improve sleep quality， relieve anxiety-like behaviors in rats with insomnia due to kidney failing to store spirit. Its therapeutic mechanism may be associated with regulating GABAergic and glutamatergic synaptic pathways to restore neurotransmitter balance and further alleviate oxidative stress injury， modulating the cAMP signaling pathway to facilitate neural repair， and intervening the 2-oxocarboxylic acid metabolism pathway to optimize energy supply.

OBJECTIVE To explore the intervention mechanism of Bushen anzhi decoction （BSAZD） in rats with insomnia induced by kidney failing to store spirit. METHODS A total of 36 SD rats were randomly divided into normal group （normal saline）， model group （normal saline）， eszopiclone group （positive control group， 0.27 mg/kg）， and low-， medium- and high-dose BSAZD groups （5.85， 11.70， 23.40 g/kg）， with 6 rats in each group. Except for the normal group， rats in the remaining groups were subjected to combined administration of D-galactose and DL-4-chlorophenylalanine to establish the rat model of insomnia due to kidney failing to store spirit. After successful modeling， corresponding liquid medicine or normal saline was intragastrically administered once daily for 14 consecutive days. After the last administration， behavioral indicators and hippocampal histopathological morphology of rats were detected. Untargeted metabolomics was adopted to screen serum differential metabolites and enrich relevant signaling pathways. RESULTS Compared with the model group， the high-dose BSAZD group exhibited significantly increased open arm entries ， open arm time and sleep time （ P ＜0.05）， accompanied by markedly decreased closed arm entries， closed arm time and sleep latency （ P ＜0.05）. Hippocampal neurons in the high-dose BSAZD group were arranged regularly， and the size， morphology and location of cell nuclei were nearly normal. Untargeted metabolomics analysis identified oxidized glutathione， glutamate and other differential metabolites in serum of rats in the high-dose BSAZD group； these differential metabolites were mainly enriched in GABAergic synapse， glutamatergic synapse， cAMP signaling pathway and 2-oxocarboxylic acid metabolism pathway. CONCLUSIONS BSAZD can improve sleep quality， relieve anxiety-like behaviors in rats with insomnia due to kidney failing to store spirit. Its therapeutic mechanism may be associated with regulating GABAergic and glutamatergic synaptic pathways to restore neurotransmitter balance and further alleviate oxidative stress injury， modulating the cAMP signaling pathway to facilitate neural repair， and intervening the 2-oxocarboxylic acid metabolism pathway to optimize energy supply.

Objective:To summarize the clinical features of Chlamydia pneumoniae pneumonia (CPP) in children. Methods:Case series study. Clinical data of 10 children with CPP hospitalized in Department No.2 of Respiratory Medicine of Beijing Children′s Hospital, Capital Medical University from January 2019 to August 2024 were retrospectively collected, including general information, clinical manifestations, chest imaging, laboratory examination and treatment. The clinical features and prognosis were summarized.Results:Among the 10 children with CPP, 7 were male and 3 were female. The age of onset was 11.2 (10.3, 13.1) years. The course were 17 (7, 23) days. Cough occurred in 9 cases with wet cough in 7 cases, while moderate and high fever occurred in 6 cases. Besides, chest pain occurred in 4 cases, rash and hemoptysis occurred in 1 case respectively. High density mass shadow was found in 7 cases chest CT imaging, accompanied by air bronchogram sign, surrounded by halo sign, 6 cases of which were distributed under the pleura, while patchy consolidation in the remaining 3 cases. Pulmonary embolism was present in 2 cases. Among the 10 children with CPP, bilateral lung involvement was found in 3 cases and unilateral lung involvement in 7 cases. The white blood cell count was 10.21 (7.45, 11.64)×10 9/L and the proportion of neutrophils was 0.69 (0.63, 0.71). C-reactive protein increased in 7 cases, with the level of 33 (16, 77) mg/L. D-dimer increased slightly in 3 cases (0.393, 0.396, 0.739 mg/L). Serum Chlamydia pneumoniae-IgM antibody test was positive in 6 cases. Chlamydia pneumoniae nucleic acid test by bronchoalveolar lavage fluid (BALF) next-generation sequencing was positive in 6 cases. Both serum IgM antibody and BALF nucleic acid tests were positive in 2 cases. Among the 10 children with CPP, azithromycin alone was used in 5 cases, while glucocorticoid was added in 1 case. Due to poor response to azithromycin in 4 cases, doxycycline was replaced in 3 cases and minocycline was replaced in 1 case, while glucocorticoid was added in 2 cases. Moxifloxacin combined with glucocorticoid therapy was adopted in 1 case with long course after the poor response to azithromycin and doxycycline. All patients were cured finally. Conclusions:CPP mostly occurs in elderly children. The main clinical manifestations include cough, fever and chest pain. The common chest imaging feature is subpleural high-density mass shadow with halo sign. Pulmonary embolism is present in a few cases. Nucleic acid detection and (or) serology is helpful for etiological diagnosis. Some cases need glucocorticoid therapy.

Objective:To explore the risk factors for bronchiolitis obliterans (BO) after Mycoplasma pneumoniae bronchiolitis in children. Methods:A retrospective cohort study was conducted on 122 children diagnosed with Mycoplasma pneumoniae bronchiolitis in Department No.2 of Respiratory Medicine of Beijing Children′s Hospital, Capital Medical University, from March 2017 to December 2024. Clinical data, including general information, clinical manifestations, imaging findings, laboratory tests, and outcomes, were analyzed. Patients were divided into BO and non-BO groups based on the presence of BO. Differences between groups were assessed using Mann-Whitney U test, χ2 test, or Fisher exact test. Logistic regression and receiver operating characteristic (ROC) curve analysis were employed to identify risk factors and evaluate predictive performance. Results:Among 122 children (73 males, 49 females), the age at onset was 5.0 (2.4, 7.1) years. The BO group included 21 patients, and the non-BO group 101. The BO group exhibited significantly longer durations of persistent high fever and higher peak levels of C-reactive protein, lactate dehydrogenase, and D-dimer compared to the non-BO group (9 (7, 11) vs. 4 (2, 6) d, 19 (7, 35) vs. 10 (7, 18) mg/L, 438 (337, 498) vs. 315 (274, 351) U/L, 0.36 (0.27, 0.91) vs. 0.21 (0.15, 0.29) mg/L, U=295.00, 743.50, 463.50, 470.50, all P<0.05). The BO group also had higher proportions of resting oxygen saturation <0.95 on room air (100.0% (21/21) vs. 43.6% (44/101)), inspiratory retractions (57.1% (12/21) vs. 18.8% (19/101), χ2=11.53), and adenovirus co-infection (38.1% (8/21) vs. 5.0% (5/101)) (all P<0.05). Multivariate Logistic regression identified prolonged high fever ( OR=1.83, 95% CI 1.31-2.58, P<0.001), inspiratory retractions ( OR=10.48, 95% CI 1.72-63.85, P=0.011), and adenovirus co-infection ( OR=42.47, 95% CI 4.04-446.87, P=0.002) as independent risk factors for BO. ROC curve analysis revealed that a fever duration cutoff of 7.5 days predicted BO with 0.71 sensitivity and 0.92 specificity. Conclusions:Prolonged high fever (≥7.5 days), inspiratory retractions, and adenovirus co-infection are significant predictors of BO after Mycoplasma pneumoniae bronchiolitis in children, which are helpful for early clinical identification.

Objective To clarify the active ingredients and the potential molecular mechanism of Guben Qushi Huayu Prescription in treating psoriasis recurrence.Methods An ultra performance liquid chromatography-quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF/MS)was applied to analyze the whole formula and the constituents absorbed into blood of Guben Qushi Huayu Prescription,and molecular docking technology was used to study the binding affinity of the constituents absorbed into blood with psoriasis-related immunomodulatory proteins such as CD69 and CD103 proteins.Results Mass spectrometry analysis identified 21 active ingredients such as paeoniflorin in Guben Qushi Huayu Prescription,including several known anti-inflammatory and immunomodulatory compounds.Analysis of the constituents absorbed into blood identified 11 ingredients,including paeoniflorin,that may affect the course of psoriasis through blood circulation.Molecular docking studies revealed that the constituents absorbed into blood,including astilbin,isoastilbin,chlorogenic acid,neochlorogenic acid,cryptochlorogenic acid,helicine,paeoniflorin,ononin,all had high binding affinities with CD69 and CD103 proteins.Conclusion This research reveals the main active ingredients of Guben Qushi Huayu Prescription and their potential mechanism for regulating the recurrence of psoriasis by mass spectrometry and molecular docking technology,contributing to providing scientific basis for further pharmacological research and clinical application.

Objective:To summarize the clinical features of Chlamydia pneumoniae pneumonia (CPP) in children. Methods:Case series study. Clinical data of 10 children with CPP hospitalized in Department No.2 of Respiratory Medicine of Beijing Children′s Hospital, Capital Medical University from January 2019 to August 2024 were retrospectively collected, including general information, clinical manifestations, chest imaging, laboratory examination and treatment. The clinical features and prognosis were summarized.Results:Among the 10 children with CPP, 7 were male and 3 were female. The age of onset was 11.2 (10.3, 13.1) years. The course were 17 (7, 23) days. Cough occurred in 9 cases with wet cough in 7 cases, while moderate and high fever occurred in 6 cases. Besides, chest pain occurred in 4 cases, rash and hemoptysis occurred in 1 case respectively. High density mass shadow was found in 7 cases chest CT imaging, accompanied by air bronchogram sign, surrounded by halo sign, 6 cases of which were distributed under the pleura, while patchy consolidation in the remaining 3 cases. Pulmonary embolism was present in 2 cases. Among the 10 children with CPP, bilateral lung involvement was found in 3 cases and unilateral lung involvement in 7 cases. The white blood cell count was 10.21 (7.45, 11.64)×10 9/L and the proportion of neutrophils was 0.69 (0.63, 0.71). C-reactive protein increased in 7 cases, with the level of 33 (16, 77) mg/L. D-dimer increased slightly in 3 cases (0.393, 0.396, 0.739 mg/L). Serum Chlamydia pneumoniae-IgM antibody test was positive in 6 cases. Chlamydia pneumoniae nucleic acid test by bronchoalveolar lavage fluid (BALF) next-generation sequencing was positive in 6 cases. Both serum IgM antibody and BALF nucleic acid tests were positive in 2 cases. Among the 10 children with CPP, azithromycin alone was used in 5 cases, while glucocorticoid was added in 1 case. Due to poor response to azithromycin in 4 cases, doxycycline was replaced in 3 cases and minocycline was replaced in 1 case, while glucocorticoid was added in 2 cases. Moxifloxacin combined with glucocorticoid therapy was adopted in 1 case with long course after the poor response to azithromycin and doxycycline. All patients were cured finally. Conclusions:CPP mostly occurs in elderly children. The main clinical manifestations include cough, fever and chest pain. The common chest imaging feature is subpleural high-density mass shadow with halo sign. Pulmonary embolism is present in a few cases. Nucleic acid detection and (or) serology is helpful for etiological diagnosis. Some cases need glucocorticoid therapy.

Objective:To explore the risk factors for bronchiolitis obliterans (BO) after Mycoplasma pneumoniae bronchiolitis in children. Methods:A retrospective cohort study was conducted on 122 children diagnosed with Mycoplasma pneumoniae bronchiolitis in Department No.2 of Respiratory Medicine of Beijing Children′s Hospital, Capital Medical University, from March 2017 to December 2024. Clinical data, including general information, clinical manifestations, imaging findings, laboratory tests, and outcomes, were analyzed. Patients were divided into BO and non-BO groups based on the presence of BO. Differences between groups were assessed using Mann-Whitney U test, χ2 test, or Fisher exact test. Logistic regression and receiver operating characteristic (ROC) curve analysis were employed to identify risk factors and evaluate predictive performance. Results:Among 122 children (73 males, 49 females), the age at onset was 5.0 (2.4, 7.1) years. The BO group included 21 patients, and the non-BO group 101. The BO group exhibited significantly longer durations of persistent high fever and higher peak levels of C-reactive protein, lactate dehydrogenase, and D-dimer compared to the non-BO group (9 (7, 11) vs. 4 (2, 6) d, 19 (7, 35) vs. 10 (7, 18) mg/L, 438 (337, 498) vs. 315 (274, 351) U/L, 0.36 (0.27, 0.91) vs. 0.21 (0.15, 0.29) mg/L, U=295.00, 743.50, 463.50, 470.50, all P<0.05). The BO group also had higher proportions of resting oxygen saturation <0.95 on room air (100.0% (21/21) vs. 43.6% (44/101)), inspiratory retractions (57.1% (12/21) vs. 18.8% (19/101), χ2=11.53), and adenovirus co-infection (38.1% (8/21) vs. 5.0% (5/101)) (all P<0.05). Multivariate Logistic regression identified prolonged high fever ( OR=1.83, 95% CI 1.31-2.58, P<0.001), inspiratory retractions ( OR=10.48, 95% CI 1.72-63.85, P=0.011), and adenovirus co-infection ( OR=42.47, 95% CI 4.04-446.87, P=0.002) as independent risk factors for BO. ROC curve analysis revealed that a fever duration cutoff of 7.5 days predicted BO with 0.71 sensitivity and 0.92 specificity. Conclusions:Prolonged high fever (≥7.5 days), inspiratory retractions, and adenovirus co-infection are significant predictors of BO after Mycoplasma pneumoniae bronchiolitis in children, which are helpful for early clinical identification.

Objective:To investigate and summarize pediatric patients with severe Mycoplasma pneumoniae pneumonia (MPP) presenting with varied clinical and chest imaging features in order to guide the individualized treatment. Methods:This was a retrospective cohort study. Medical records of clinical, imaging and laboratory data of 505 patients with MPP who were admitted to the Department Ⅱ of Respirology Center, Beijing Children′s Hospital, Capital Medical University from January 2016 to October 2023 and met the enrollment criteria were included. They were divided into severe group and non-severe group according to whether lower airway obliterans was developed. The clinical and chest imaging features of the two groups were analyzed. Those severe cases with single lobe ≥2/3 consolidation (lobar consolidation) were further divided into subtype lung-necrosis and subtype non-lung-necrosis based on whether lung necrosis was developed. Comparison on the clinical manifestations, bronchoscopic findings, whole blood C-reactive protein (CRP) and other inflammatory indicators between the two subtypes was performed. Comparisons between two groups were achieved using independent-sample t-test, nonparametric test or chi-square test. Univariate receiver operating characteristic (ROC) curve analyses were performed on the indicators such as CRP of the two subtypes. Results:Of the 505 cases, 254 were male and 251 were female. The age of the onset was (8.2±2.9) years. There were 233 severe cases, among whom 206 were with lobar consolidation and 27 with diffuse bronchiolitis. The other 272 belonged to non-severe cases, with patchy, cloudy infiltrations or single lobe <2/3 uneven consolidation or localized bronchiolitis. Of the 206 cases (88.4%) severe cases with lobar consolidation, 88 harbored subtype lung-necrosis and 118 harbored subtype non-lung-necrosis. All 206 cases (100.0%) presented with persistent high fever, among whom 203 cases (98.5%) presented with inflammatory secretion obstruction and plastic bronchitis under bronchoscopy. Of those 88 cases with subtype lung-necrosis, there were 42 cases (47.7%) with dyspnea and 39 cases (44.3%) with moderate to massive amount of pleural effusion. There were 35 cases (39.8%) diagnosed with lung embolism during the disease course, of which other 34 cases (38.6%) were highly suspected. Extensive airway mucosal necrosis was observed in 46 cases (52.3%), and the level of their whole blood CRP was significantly higher than that of subtype non-lung-necrosis (131.5 (91.0, 180.0) vs. 25.5 (12.0, 43.1) mg/L, U=334.00, P<0.001). They were regarded as subtype "lung consolidation-atelectasis-necrosis". Of those 118 cases with subtype non-lung-necrosis, 27 cases (22.9%) presented with dyspnea and none were with moderate to massive amount of pleural effusion. Sixty-five cases (55.1%) presented with plastic bronchitis and localized airway mucosal necrosis was observed in 32 cases (27.1%). They were deemed as subtype "lung consolidation-atelectasis". ROC curve analyses revealed that whole blood CRP of 67.5 mg/L on the 6-10 th day of disease course exhibited a sensitivity of 0.96, a specificity of 0.89, and an area under the curve of 0.97 for distinguishing between these two subtypes among those with lobar consolidation. Conclusions:Pediatric patients with severe MPP present with lobar consolidation or diffuse bronchiolitis on chest imaging. Those with lobar consolidation harbor 2 subtypes as "lung consolidation-atelectasis-necrosis" and "lung consolidation-atelectasis". Whole blood CRP of 67.5 mg/L can be applied as an early discriminating indicator to discriminate between these two subtypes.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

The principles for surgical treatment of femoral neck fracture are anatomical reduction, rigid fixation and reduction of iatrogenic tissue damage to maintain sufficient blood supply and reduce the risk of complications such as avascular necrosis of the femoral head. In the evolution of internal fixation structures for femoral neck fracture, a variety of new products have been developed, such as the neck-shaft angle stabilization structure represented by dynamic hip screw, the multi-screw structure represented by three cannulated screws, and the plate-screw structure represented by multi-screw structure combined with a locked plate. These internal fixation structures have their own advantages and disadvantages in terms of stability and reduced risk of complications. However, none of them can perfectly meet the requirements of all the surgical principles. Femoral neck system (FNS) was firstly applied in clinic practice in 2017 to further improve the internal fixation of femoral neck fracture. In recent years, its mechanical properties and clinical effects have been widely reported in an attempt to further improve the implantation of this internal fixation device. This article reviews the researches on the mechanical properties and clinical efficacy of FNS and the suggestions put forward by orthopedic surgeons to improve the implantation methods of FNS.