Objective:To evaluate the efficacy of early bronchoalveolar lavage using electronic bronchoscopy in pediatric drowning cases.Methods:A retrospective analysis of clinical data from 81 pediatric drowning cases treated in the intensive care unit of Hunan Children's Hospital from January 2017 to September 2023 was conducted.Among these,43 cases underwent bronchoalveolar lavage with electronic bronchoscopy within 24 hours of drowning,constituting the treatment group,while 38 cases either did not receive treatment within 24 hours or underwent the procedure after 24 hours,forming the control group.We compared the two groups regarding pre-admission observations,admission observations,and disease progression or prognosis indicators to assess the clinical efficacy of early bronchoalveolar lavage with electronic bronchoscopy in pediatric drowning cases.Results:Compared to the control group,children in the treatment group exhibited a significant reduction in invasive ventilation time [(73.33±13.33) h vs.(94.82±15.77) h] and a significant decrease in pediatric intensive care unit stay [105.00 (94.00,121.00) h vs.123.5 (109.75,149.00) h],with both differences being statistically significant( P<0.05).No significant differences in white blood cell count and neutrophil percentage were observed between the treatment group and control group at admission and on the first day( P>0.05).However,by the third day,there was a significant improvement in white blood cell count in both groups,with statistical significance( P<0.05).There was a significant decrease in C-reactive protein and procalcitonin levels between the treatment group and control group on the 1st and 3rd days,with the differences being significant( P<0.05).Six hours after electronic bronchoalveolar lavage,the P/F ratio in the treatment group was lower than that in the control group (177.09±41.27 vs. 233.50±48.23),but it increased more significantly at 24 hours (286.00±34.32 vs.256.34±44.22),with a significant difference between two groups.The positive rate of lavage fluid culture in the treatment group was significantly higher than that in the control group,and the difference was statistically significant( P<0.05).There was no significant difference in the number of organ function damage between two groups( P>0.05).However,regarding prognosis,the treatment group showed significantly better outcomes than the control group( P<0.05). Conclusion:For pediatric patients with wilderness drowning,early electronic bronchoscopy with alveolar lavage may shorten the duration of invasive mechanical ventilation and pediatric intensive care unit stay,improving prognosis,and is worth promoting.

Objective:To investigate the efficacy and safety of doxycycline in children with macrolide-resistant mycoplasma pneumoniae pneumonia（MRMPP）.Methods:A retrospective analysis was conducted on the data from 92 children with severe MRMPP admitted to the Intensive Care Unit of Hunan Children's Hospital from January 2020 to November 2023.Depending on antibiotic treatment strategies for mycoplasma pneumoniae，patients were divided into three groups：Doxycycline group（those treated with doxycycline，12 cases）；Azithromycin group（those treated with azithromycin，53 cases）；and Switch group（those switched from azithromycin to doxycycline，27 cases）.Clinical outcomes and adverse reactions were compared among the three groups.Results:Significant statistical differences were found among the three groups in terms of age（ F=49.365， P<0.001）and weight（ H=40.595， P<0.001），with the Doxycycline group presenting the highest average age and median weight，followed by the Switch group，and then the Azithromycin group.After antibiotic treatment，children in the Doxycycline group，when compared to the Switch group and the Azithromycin group，showed a shorter fever resolution time[3.0（2.0，3.8）days vs.5.0（4.0，5.0）days vs.6.0（5.0，7.0）days， H=25.243， P<0.001]，a higher defervescence rate at 48 hours and 72 hours (41.7% vs.0 vs.0 at 48 hours，and 75.0% vs.0% vs.5.7% at 72 hours，both P<0.001]，a shorter mechanical ventilation duration[83.0（70.0，93.0）hours vs.135.0（129.0，172.0）hours vs.152.0（139.0，164.5）hours， H=9.980， P=0.007]，a shorter ICU stay[7.0（6.0，8.0）days vs.10.0（8.0，13.0）days vs.11.0（9.0，13.0）days， H=21.887， P<0.001]，and a lower proportion of Methylprednisolone usage [8.3% vs.57.1% vs.54.7%， P=0.008].There was no significant statistical difference in extrapulmonary complications and co-pathogens（both P>0.05）.Gastrointestinal reactions occurred in all children treated with doxycycline and azithromycin，with rates of 10.3%（4/39）and 13.8%（11/80）,respectively，showing no statistical significance（ P=0.771）.Among the 67（72.8%）cases with available follow-up data，the incidence of bronchiolitis obliterans was 8.3%（1/12）in the Doxycycline group，13.6%（3/22）in the Switch group，and 15.2%（5/33）in the Azithromycin group，with no statistical significance（ P>0.05）.Among the 34 cases using doxycycline with follow-up data available，none had tooth discoloration or enamel hypoplasia related to the medication. Conclusion:Doxycycline in the treatment of severe MRMPP in children could rapidly improve clinical symptoms，shorten the course of the disease，reduce the likelihood of methylprednisolone use，and is relatively safe for short-term use.

Based on the theory of the liver's"using bitter herbs to nourish or purge"from Huangdi Neijing,this paper systematically elucidates the theoretical foundation for treating functional constipation from liver.Focusing on the physiological characteristic of"liver desires to disperse"and the pathological manifestation of"liver bitterness and urgency,"combined with the"liver communicates with the large intestine"theory,this paper establishes a diagnostic and therapeutic framework for managing functional constipation by regulating liver function.The pathological evolution of functional constipation manifests in three distinct stages:in the early stage,liver qi stagnation leads to large intestine qi obstruction,where damaged by an excess of seven emotions resulting in symptoms such as difficult defecation,abdominal bloating,and hypochondriac pain;in the middle stage,liver depression transforms into fire,scorching bodily fluids to generate dryness,thereby creating a pathological interplay of stagnation,fire,and dryness,which is marked by anal heat,dry mouth,and yellow urine;in the late stage,yin deficiency in liver and kidney causes large intestine malnutrition,resulting in a complex pathological state where yin deficiency,collateral blockage,dryness accumulation,and blood stasis intertwine,clinically manifesting as pellet-like stools(resembling sheep feces)and soreness and weakness of the waist and knees.In treatment,the formula design follows the principle of"sweetness to relieve,acridity to tonify,and sourness to purge,"with treatment principles varying across stages.In the early stage,the focus is on dispersing liver and regulating qi,and unblocking the zang-fu viscera;in the middle stage,the priority shifts to clearing heat-fire,nourishing large intestine,and promoting fluid production;whereas,in the late stage,the emphasis lies on nourishing yin,unblocking collaterals,and promoting blood circulation.This staged treatment of functional constipation overcomes the limitations of solely focusing on nourishing large intestine and facilitating feces excretion,thereby advancing the treatment of different stages based on syndrome differentiation and personalized treatment.It provides theoretical support for improving patients' intestinal function and enhancing overall health outcomes.

Objective:To evaluate the efficacy of early bronchoalveolar lavage using electronic bronchoscopy in pediatric drowning cases.Methods:A retrospective analysis of clinical data from 81 pediatric drowning cases treated in the intensive care unit of Hunan Children's Hospital from January 2017 to September 2023 was conducted.Among these,43 cases underwent bronchoalveolar lavage with electronic bronchoscopy within 24 hours of drowning,constituting the treatment group,while 38 cases either did not receive treatment within 24 hours or underwent the procedure after 24 hours,forming the control group.We compared the two groups regarding pre-admission observations,admission observations,and disease progression or prognosis indicators to assess the clinical efficacy of early bronchoalveolar lavage with electronic bronchoscopy in pediatric drowning cases.Results:Compared to the control group,children in the treatment group exhibited a significant reduction in invasive ventilation time [(73.33±13.33) h vs.(94.82±15.77) h] and a significant decrease in pediatric intensive care unit stay [105.00 (94.00,121.00) h vs.123.5 (109.75,149.00) h],with both differences being statistically significant( P<0.05).No significant differences in white blood cell count and neutrophil percentage were observed between the treatment group and control group at admission and on the first day( P>0.05).However,by the third day,there was a significant improvement in white blood cell count in both groups,with statistical significance( P<0.05).There was a significant decrease in C-reactive protein and procalcitonin levels between the treatment group and control group on the 1st and 3rd days,with the differences being significant( P<0.05).Six hours after electronic bronchoalveolar lavage,the P/F ratio in the treatment group was lower than that in the control group (177.09±41.27 vs. 233.50±48.23),but it increased more significantly at 24 hours (286.00±34.32 vs.256.34±44.22),with a significant difference between two groups.The positive rate of lavage fluid culture in the treatment group was significantly higher than that in the control group,and the difference was statistically significant( P<0.05).There was no significant difference in the number of organ function damage between two groups( P>0.05).However,regarding prognosis,the treatment group showed significantly better outcomes than the control group( P<0.05). Conclusion:For pediatric patients with wilderness drowning,early electronic bronchoscopy with alveolar lavage may shorten the duration of invasive mechanical ventilation and pediatric intensive care unit stay,improving prognosis,and is worth promoting.

Objective:To estimate the economic burden of 14 chronic diseases among middle-aged and elderly people in China.Methods:This cross-sectional study was based on longitudinal data from five waves (2011 to 2020) of the China Health and Retirement Longitudinal Study (CHARLS). Participants aged 45 and over who had been diagnosed with exactly one target chronic disease were included in the study. The 14 chronic diseases included: hypertension, dyslipidemia, diabetes or elevated blood glucose, malignant tumors, chronic pulmonary diseases, liver diseases, heart diseases, stroke, kidney diseases, digestive system diseases, emotional and mental diseases, memory-related diseases, arthritis or rheumatic diseases, and asthma. The economic burden of disease was measured in terms of both direct and indirect economic burden, with the results adjusted using a healthcare-specific Consumer Price Index (CPI). The direct economic burden included direct medical and non-medical burden. The human capital method was employed to calculate the indirect economic burden. A generalized linear mixed model (GLMM) was conducted to compare the differences in the economic burden between urban and rural areas, with provinces and prefecture-level cities set as random effects and residence (urban or rural areas) as fixed effects to control for the effects of geographic hierarchical structure. Gender, age and educational attainment were also included as covariates to control for confounding factors. The model′s robustness was assessed by comparing the significance of urban-rural differences before and after adding the covariates.Results:The median annual economic burden of the 14 chronic diseases among the middle-aged and elderly population in China ranged from 7 565 to 17 174 CNY, of which the direct economic burden ranged from 6 909 to 16 565 CNY, and the indirect burden ranged from 284 to 1 276 CNY. The direct economic burden was primarily driven by direct medical burden (83.67% to 95.01% of direct economic burden). Out-of-pocket expenses for outpatient medical burden ranged from 50% to 100%, while those for inpatient ranged from 36.30% to 61.29%. GLMM analysis revealed no statistically significant difference in the overall economic burden between urban and rural areas across diseases. However, the burden of inpatient medical burden for arthritis or rheumatism was higher in urban areas than in rural areas (5 338 vs. 3 898 CNY; LR=6.04, P=0.014). Similarly, the burden of self-treatment for hypertension was also higher in urban areas than in rural areas (324 vs. 238 CNY; LR=8.30, P=0.004). The outpatient non-medical burden for diabetes or elevated blood glucose (59 vs. 149 CNY; LR=5.99, P=0.014), stroke (0 vs. 307 CNY; LR=4.55, P=0.033), and digestive system diseases (45 vs. 107 CNY; LR=9.58, P=0.002) was lower in urban areas than rural. Conclusions:Chronic diseases cause heavy economic burden on middle-aged and elderly people in both urban and rural areas of China, with direct economic burden accounting for the majority of expenditure. The outpatient medical burden accounts for a higher proportion of out-of-pocket expenses than the inpatient.

Objective:To investigate the efficacy and safety of doxycycline in children with macrolide-resistant mycoplasma pneumoniae pneumonia（MRMPP）.Methods:A retrospective analysis was conducted on the data from 92 children with severe MRMPP admitted to the Intensive Care Unit of Hunan Children's Hospital from January 2020 to November 2023.Depending on antibiotic treatment strategies for mycoplasma pneumoniae，patients were divided into three groups：Doxycycline group（those treated with doxycycline，12 cases）；Azithromycin group（those treated with azithromycin，53 cases）；and Switch group（those switched from azithromycin to doxycycline，27 cases）.Clinical outcomes and adverse reactions were compared among the three groups.Results:Significant statistical differences were found among the three groups in terms of age（ F=49.365， P<0.001）and weight（ H=40.595， P<0.001），with the Doxycycline group presenting the highest average age and median weight，followed by the Switch group，and then the Azithromycin group.After antibiotic treatment，children in the Doxycycline group，when compared to the Switch group and the Azithromycin group，showed a shorter fever resolution time[3.0（2.0，3.8）days vs.5.0（4.0，5.0）days vs.6.0（5.0，7.0）days， H=25.243， P<0.001]，a higher defervescence rate at 48 hours and 72 hours (41.7% vs.0 vs.0 at 48 hours，and 75.0% vs.0% vs.5.7% at 72 hours，both P<0.001]，a shorter mechanical ventilation duration[83.0（70.0，93.0）hours vs.135.0（129.0，172.0）hours vs.152.0（139.0，164.5）hours， H=9.980， P=0.007]，a shorter ICU stay[7.0（6.0，8.0）days vs.10.0（8.0，13.0）days vs.11.0（9.0，13.0）days， H=21.887， P<0.001]，and a lower proportion of Methylprednisolone usage [8.3% vs.57.1% vs.54.7%， P=0.008].There was no significant statistical difference in extrapulmonary complications and co-pathogens（both P>0.05）.Gastrointestinal reactions occurred in all children treated with doxycycline and azithromycin，with rates of 10.3%（4/39）and 13.8%（11/80）,respectively，showing no statistical significance（ P=0.771）.Among the 67（72.8%）cases with available follow-up data，the incidence of bronchiolitis obliterans was 8.3%（1/12）in the Doxycycline group，13.6%（3/22）in the Switch group，and 15.2%（5/33）in the Azithromycin group，with no statistical significance（ P>0.05）.Among the 34 cases using doxycycline with follow-up data available，none had tooth discoloration or enamel hypoplasia related to the medication. Conclusion:Doxycycline in the treatment of severe MRMPP in children could rapidly improve clinical symptoms，shorten the course of the disease，reduce the likelihood of methylprednisolone use，and is relatively safe for short-term use.

Based on the theory of the liver's"using bitter herbs to nourish or purge"from Huangdi Neijing,this paper systematically elucidates the theoretical foundation for treating functional constipation from liver.Focusing on the physiological characteristic of"liver desires to disperse"and the pathological manifestation of"liver bitterness and urgency,"combined with the"liver communicates with the large intestine"theory,this paper establishes a diagnostic and therapeutic framework for managing functional constipation by regulating liver function.The pathological evolution of functional constipation manifests in three distinct stages:in the early stage,liver qi stagnation leads to large intestine qi obstruction,where damaged by an excess of seven emotions resulting in symptoms such as difficult defecation,abdominal bloating,and hypochondriac pain;in the middle stage,liver depression transforms into fire,scorching bodily fluids to generate dryness,thereby creating a pathological interplay of stagnation,fire,and dryness,which is marked by anal heat,dry mouth,and yellow urine;in the late stage,yin deficiency in liver and kidney causes large intestine malnutrition,resulting in a complex pathological state where yin deficiency,collateral blockage,dryness accumulation,and blood stasis intertwine,clinically manifesting as pellet-like stools(resembling sheep feces)and soreness and weakness of the waist and knees.In treatment,the formula design follows the principle of"sweetness to relieve,acridity to tonify,and sourness to purge,"with treatment principles varying across stages.In the early stage,the focus is on dispersing liver and regulating qi,and unblocking the zang-fu viscera;in the middle stage,the priority shifts to clearing heat-fire,nourishing large intestine,and promoting fluid production;whereas,in the late stage,the emphasis lies on nourishing yin,unblocking collaterals,and promoting blood circulation.This staged treatment of functional constipation overcomes the limitations of solely focusing on nourishing large intestine and facilitating feces excretion,thereby advancing the treatment of different stages based on syndrome differentiation and personalized treatment.It provides theoretical support for improving patients' intestinal function and enhancing overall health outcomes.

Objective:To estimate the economic burden of 14 chronic diseases among middle-aged and elderly people in China.Methods:This cross-sectional study was based on longitudinal data from five waves (2011 to 2020) of the China Health and Retirement Longitudinal Study (CHARLS). Participants aged 45 and over who had been diagnosed with exactly one target chronic disease were included in the study. The 14 chronic diseases included: hypertension, dyslipidemia, diabetes or elevated blood glucose, malignant tumors, chronic pulmonary diseases, liver diseases, heart diseases, stroke, kidney diseases, digestive system diseases, emotional and mental diseases, memory-related diseases, arthritis or rheumatic diseases, and asthma. The economic burden of disease was measured in terms of both direct and indirect economic burden, with the results adjusted using a healthcare-specific Consumer Price Index (CPI). The direct economic burden included direct medical and non-medical burden. The human capital method was employed to calculate the indirect economic burden. A generalized linear mixed model (GLMM) was conducted to compare the differences in the economic burden between urban and rural areas, with provinces and prefecture-level cities set as random effects and residence (urban or rural areas) as fixed effects to control for the effects of geographic hierarchical structure. Gender, age and educational attainment were also included as covariates to control for confounding factors. The model′s robustness was assessed by comparing the significance of urban-rural differences before and after adding the covariates.Results:The median annual economic burden of the 14 chronic diseases among the middle-aged and elderly population in China ranged from 7 565 to 17 174 CNY, of which the direct economic burden ranged from 6 909 to 16 565 CNY, and the indirect burden ranged from 284 to 1 276 CNY. The direct economic burden was primarily driven by direct medical burden (83.67% to 95.01% of direct economic burden). Out-of-pocket expenses for outpatient medical burden ranged from 50% to 100%, while those for inpatient ranged from 36.30% to 61.29%. GLMM analysis revealed no statistically significant difference in the overall economic burden between urban and rural areas across diseases. However, the burden of inpatient medical burden for arthritis or rheumatism was higher in urban areas than in rural areas (5 338 vs. 3 898 CNY; LR=6.04, P=0.014). Similarly, the burden of self-treatment for hypertension was also higher in urban areas than in rural areas (324 vs. 238 CNY; LR=8.30, P=0.004). The outpatient non-medical burden for diabetes or elevated blood glucose (59 vs. 149 CNY; LR=5.99, P=0.014), stroke (0 vs. 307 CNY; LR=4.55, P=0.033), and digestive system diseases (45 vs. 107 CNY; LR=9.58, P=0.002) was lower in urban areas than rural. Conclusions:Chronic diseases cause heavy economic burden on middle-aged and elderly people in both urban and rural areas of China, with direct economic burden accounting for the majority of expenditure. The outpatient medical burden accounts for a higher proportion of out-of-pocket expenses than the inpatient.

Objective:To systematically integrate the psychological experience of sex life in perimenopausal and postmenopausal women, so as to provide evidence-based basis for clinical medical staff to provide sexual health guidance and targeted intervention plans.Methods:Qualitative studies on sexual experience of perimenopausal and postmenopausal women were searched by computer from China National Knowledge Infrastructure, Wanfang data, VIP, Chinese Medical Journal Network, China Biology Medicine disc, PubMed, Web of Science, Cochrane Library, Embase and other databases. The search period was from the establishment of the databases to May 25, 2023. The quality of the literature was evaluated using the quality evaluation criteria of the Australian Evidence-based Health Care Center, and the results were integrated by the pooled Meta-integration method.Results:A total of 13 literatures were included, and 32 complete results were extracted, which were summarized into nine new categories and synthesized into four integrated results. Integration result one showed significant differences in sexual cognition and needs between perimenopausal and postmenopausal women. Integration result two showed that perimenopausal and postmenopausal women experienced sexual physiological and psychological changes. Integration result three showed that multiple complex factors affected perimenopausal and postmenopausal women sex life. Integration results four was that perimenopausal and postmenopausal women took different ways to cope with sexual changes.Conclusions:Medical staff should pay attention to perimenopausal and postmenopausal women's sexual changes, explore its related influencing factors, help them establish a correct sexual concept and give sexual health support and help.

Objective:To analyze the prevalence and related factors of depression symptom among middle-aged and older adults belonging to Zhiguo ethnic minority groups,who experienced relative isolation prior to mod-emization and bypassed the transitional period associated with feudal monarchy in Yunnan Province.Methods:Using stratified cluster sampling,a total of 1 035 individuals from Zhiguo ethnic minority groups were investigated with the 9-item Patient Health Questionnaire(PHQ-9)to measure depression symptom scores(a total score≥5 was considered indicative of depression symptom).A self-administered questionnaire was utilized to investigate 24 cova-riates across five dimensions:sociodemographic,social-interpersonal network,mental health status,physical health status,and health behaviors.Results:Among the surveyed participants,231 individuals(22.32％)exhibited depres-sion symptoms.The logistic regression analysis showed that middle-aged and elderly people belonging to Zhiguo ethnic minority groups with occupations as laborers(OR=8.73),farmers(OR=7.34),and other professions(OR=7.13),those who reported feeling stressed or anxious in the last month(OR=5.43),those suffering from one(OR=2.81)or more chronic illnesses(OR=2.14),experiencing sleep problems(OR=3.74)/debilitating(OR=1.69)/mild-moderate pain(OR=2.23,4.37),and engaging in sedentary behavior(OR=2.27)were at higher risk for depressive symptoms.The risk of depressive symptoms was lower among middle-aged and elderly people be-longing to Zhiguo ethnic minority groups with higher social support scores(OR=0.96)and meaning in life scores(OR=0.96).Conclusion:The prevalence of depressive symptoms among middle-aged and elderly individuals of Zhiguo ethnic minorities is substantial,influenced by multiple factors.