OBJECTIVE To investigate the efficacy and safety of omadacycline in the treatment of macrolide-unresponsive Mycoplasma pneumoniae pneumonia （MUMPP） in children. METHODS A retrospective study was conducted on children aged 1-18 years old with MUMPP who were hospitalized in the Department of Pediatrics， the First Affiliated Hospital of Xinjiang Medical University from January 2022 to June 2025. According to the selection of secondary antibiotics after 72 h of initial treatment with macrolides， they were divided into the omadacycline group and the doxycycline group. Based on conventional treatment， children in the omadacycline group were given intravenous infusion of 2.4 mg/kg （once daily） of omadacycline tosylate， while children in the doxycycline group were given oral doxycycline hydrochloride tablets at 2 mg/kg （twice daily）. The efficacy and safety were compared between the two groups of pediatric patients. Univariate analysis and multivariate Logistic regression analysis were performed on clinical efficacy， and subgroup analysis along with multiple sensitivity analyses were conducted to verify the robustness of the conclusions. RESULTS A total of 284 children with MUMPP were included in this study， with 142 in the omadacycline group and 142 in the doxycycline group. In terms of efficacy， although the hospitalization time of children in the omadacycline group was longer than that in the doxycycline group （ P ＜0.05）， the lung lesion absorption rate and clinical efficacy were significantly higher or better than those in the doxycycline group （ P ＜0.05）. The results of multivariate Logistic regression analysis showed that medication （OR＝5.300， 95%CI： 2.526-11.123）， length of hospital stay （OR＝1.348， 95%CI： 1.167-1.556）， and medication duration （OR＝1.422， 95%CI： 1.169-1.729） were influencing factors of clinical efficacy （ P ＜0.05）. The subgroup analysis results showed that the clinical efficacy of omadacycline was significantly better than that of doxycycline in all subgroups （ P ＜0.05）. The results of multiple sensitivity analysis showed that the regression coefficients B of the four models （gradually adjust variables） before and after inverse probability of treatment weighting were significantly greater than 1 （ P ＜0.05）. In terms of safety， there was no statistically significant difference in the inci dence of adverse drug reactions between the two groups of patients （ χ 2 ＝0.447， P ＝0.504）. CONCLUSIONS In the case of hospitalization and prolonged medication， the efficacy of omadacycline in treating childhood MUMPP is superior to that of doxycycline， and its safety is good.

Chronic obstructive pulmonary disease (COPD) is the most common chronic respiratory disease around the world, and pharmacotherapy is the foremost treatment method currently. In recent decades, with the rapid development of bronchoscopic interventional therapy, endoscopic physical ablation technology presents a therapeutic effect in treating COPD, with few treatment-related side effects, showing excellent application prospects in treating COPD. Since ablation techniques in this field are emerging technologies with low patient acceptance, they are not widely used in the clinical treatment of COPD. This article reviews the development process of physical ablation techniques. Moreover, their current application status and the prospects in the field of COPD treatment are also summarized and analyzed. We hope to promote the application of physical ablation in the clinical treatment of COPD and provide practical references and a theoretical basis for the clinical treatment of COPD.

ObjectiveTo investigate the effects of Erchentang （ECD） on the body weight of the mouse model of simple obesity induced by a high-fat diet （HFD） and decipher the underlying mechanisms. MethodsFirstly， single-cell transcriptomics （Sc-RNAseq） was employed to analyze the transcriptional changes in the ileum tissue of mice in the normal group and model group. Then， a mouse model of simple obesity was established with a high-fat diet. The successfully modeled mice were randomly allocated into the following four groups （n=8）： model， low-dose （7.5 g·kg^-1） ECD， medium-dose （15 g·kg^-1） ECD， and high-dose （30 g·kg^-1） ECD. Additionally， 8 mice of the same age were selected as the normal group. The body weight was measured at fixed time points during the 4-week gavage period. The overall efficacy of ECD in alleviating obesity was evaluated through glucose tolerance testing， behavioral analysis， hematoxylin-eosin （HE） staining， and biochemical testing. Protein docking was employed to predict the degree of binding between corresponding proteins. Molecular docking was employed to predict the binding degree between key components of ECD and target proteins. Real-time PCR was employed to determine the mRNA levels of tumor necrosis factor-α （TNF-α）， inducible nitric oxide synthase （iNOS）， interleukin-1β （IL-1β）， CD68， CD206， zonula occludens-1 （ZO-1）， and Claudin-5 in the ileum. Immunofluorescence staining was used to observe the expression and distribution of Claudin-5 and ZO-1. ResultsThe Sc-RNAseq results indicated that the differentially expressed genes of immune cells in the model group in comparison with the normal group were primarily enriched in biological functions related to lipid metabolism and inflammatory metabolism. Additionally， these genes were associated with the janus kinases（JAK）/signal transducers and activators of transcription （STAT） signaling pathway， an inflammation-related pathway. Compared with the normal group， the model group showed increases in body weight （P<0.01） and blood glucose level （P<0.01）， a decrease in limb strength （P<0.01）， an increase in liver weight （P<0.05）， and elevated serum alanine amino-transferase （ALT） and aspartate transferase （AST） levels （P<0.05， P<0.01）. Additionally， the model group exhibited increased hepatic fat vacuoles， notably enlarged adipocytes in the epididymal and inguinal white adipose tissue， and increased inflammation. Compared with the model group， ECD groups showed reduced body weights （P<0.01） and blood glucose levels （P<0.01）， increased limb strength （P<0.05， P<0.01）， decreased liver weights （P<0.05， P<0.01）， and declined serum ALT and AST levels （P<0.05， P<0.01）. Additionally， ECD reduced hepatic fat vacuoles and the adipocyte volume in the epididymal and inguinal white adipose tissue， and alleviated inflammation. Potential interactions existed between CD68 and ZO-1/Claudin-5， as well as between CD206 and ZO-1/Claudin-5. The key components of ECD， nobiletin， diosmetin， and naringenin， all demonstrated strong binding affinity with the target proteins ZO-1 and Claudin-5. Compared with the normal group， the model group exhibited up-regulated mRNA levels of the pro-inflammatory cytokines TNF-α， iNOS， IL-1β， and CD68 （P<0.05， P<0.01） and down-regulated mRNA levels of the anti-inflammatory cytokine CD206 （P<0.01） and the tight junction proteins Claudin-5 and ZO-1 （P<0.05， P<0.01）. In comparison with the model group， the ECD groups showed down-regulated mRNA levels of TNF-α， iNOS， IL-1β， and CD68 （P<0.05， P<0.01） and up-regulated mRNA levels of CD206， Claudin-5， and ZO-1 （P<0.05， P<0.01）. Compared with the normal group， the model group exhibited down-regulated expression of tight junction proteins Claudin-5 and ZO-1 （P<0.01）. Compared with the model group， ECD groups showed up-regulated expression of Claudin-5 and ZO-1 （P<0.05， P<0.01）. ConclusionECD can significantly ameliorate HFD-induced obesity and excessive body weight gain in mice by improving the inflammatory microenvironment in the ileum and further restoring the integrity of the impaired ileal barrier.

BACKGROUND:Various proteins,signaling pathways,and inflammatory mediators are involved in the pathophysiological process of osteoarthritis.The development of small molecule drugs targeting these proteins,signaling pathways,and inflammatory mediators can effectively delay the progression of osteoarthritis and ameliorate its clinical manifestations. OBJECTIVE:To review the research progress of small molecule drugs in the treatment of osteoarthritis based on the pathogenesis of osteoarthritis. METHODS:PubMed,CNKI,and WanFang databases were searched with English search terms"osteoarthritis,arthritis,osteoarthrosis,degenerative,arthritides,deformans,small molecule drugs,small molecule inhibitors,small molecule agents"and Chinese search terms"osteoarthritis,small molecule drugs,small molecule inhibitors."A total of 68 articles were included for review according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION:(1)Currently,studies concerning the pathogenesis of osteoarthritis remain unclear.The occurrence and development of osteoarthritis are strongly associated with proteins,cytokines,and signal transduction pathways,so its therapeutic mechanism is relatively complex.Currently,targeting proteins,cytokines,and signal transduction pathways related to osteoarthritis with small molecule drugs has become a major research focus.(2)Small molecule drugs frequently possess visible intracellular or extracellular targets and efficacy,containing enhancing cartilage repair,resisting joint degradation,attenuating inflammation,and relieving pain.Other anti-osteoarthritis small molecule drugs have shown promise in promoting stem cell chondrogenic differentiation and cartilage matrix reconstruction.(3)At present,small molecule drugs targeting the pathophysiological process of osteoarthritis to delay the progression of osteoarthritis are still in the experimental stage,but most of these small molecule drugs have shown the expected results in the experimental process,and there are no relevant studies to illustrate the efficacy of small molecule drugs in the treatment of osteoarthritis.(4)Small molecule drugs for the treatment of osteoarthritis have reached the expected experimental results in the basic experimental stage.Numerous studies have exhibited that small molecule drugs can target the suppression of specific proteins,cytokines,and signal transduction pathways that cause osteoarthritis,so as to treat osteoarthritis.Nevertheless,its safety and effectiveness still need to be identified by further basic and clinical studies.This process needs to be investigated and studied by more scholars.(5)At present,many scholars in and outside China have made contributions to the treatment of osteoarthritis.Compared with traditional treatment methods,small molecule drugs reveal better efficacy and safety in the basic experimental stage,and it is expected to become an emerging method for the treatment of osteoarthritis in the future to rid patients of pain.

Sepsis is a systemic inflammatory response syndrome caused by the invasion of pathogenic microorganisms such as bacteria. In addition to the manifestations of systemic inflammatory response syndrome and primary infection lesions， critical cases often have manifestations of organ hypoperfusion. The morbidity and mortality of sepsis have remained high in recent years， which seriously affect the quality of life of the patients. The pathogenesis of sepsis is complicated， in which uncontrollable inflammation is a key mechanism. The phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt） signaling pathway plays a key role in mediating inflammation in sepsis. The available therapies of sepsis mainly include resuscitation， anti-infection， vasoactive drugs， intensive insulin therapy， and organ support， which show limited effects of reducing the mortality. Therefore， finding new therapeutic drugs is a key problem to be solved in the clinical treatment of sepsis. In recent years， studies have shown that traditional Chinese medicine （TCM） can regulate the PI3K/Akt pathway via multiple pathways， multiple effects， and multiple targets to inhibit inflammation and curb the occurrence and development of sepsis， which has gradually become a hot spot in the prevention and treatment of sepsis. Moreover， studies have suggested that TCM has unique advantages in the treatment of sepsis. TCM can regulate the PI3K/Akt signaling pathway to inhibit inflammation， reduce oxidative stress， and control apoptosis in the prevention and treatment of sepsis. Despite the research progress， a systematic review remains to be performed regarding the TCM treatment of sepsis by regulating the PI3K/Akt signaling pathway. After reviewing relevant papers published in recent years， this study systematically summarizes the relationship between PI3K/Akt pathway and sepsis and the role of TCM in the treatment of sepsis， aiming to provide new ideas for the potential treatment of sepsis and the development of new drugs.

Objective:To explore the efficacy and prognosis of hepatectomy via Laennec membrane approach in patients with hepatocellular carcinoma (HCC).Methods:The data of 98 patients with HCC who underwent hepatectomy in the First Affiliated Hospital of Soochow University from January 2016 to December 2022 were retrospectively analyzed, including 76 males and 22 females, aged 61.0 (55.0, 66.0) years. Forty-eight patients treated with Laennec membrane approach hepatectomy were included in the study group and 50 patients treated with traditional approach hepatectomy were included in the control group. The age, gender, combined hypertension and diabetes, aspartate transaminase, alanine transaminase, albumin, total bilirubin, prealbumin, platelet, alpha-fetoprotein, carbohydrate antigen 19-9 and carbohydrate antigen 125 were compared between the two groups. The surgical bleeding, operation time and complications (abdominal bleeding, bile leakage, poor incision healing, etc.) were compared between the two groups. The prognosis of the two groups was compared.Results:There were no significant differences in gender, age, underlying diseases, preoperative biochemical and tumor serological indexes between the two groups (all P>0.05). The operation time of the study group was 180.0 (141.3, 227.3) min, which was lower than that of the control group 221.5 (187.5, 256.3) min ( Z=-0.41, P=0.002). The intraoperative blood loss in the study group was 295.0 (127.5, 350.0) ml, which was lower than that in the control group 300.0 (200.0, 500.0) ml, and the difference was statistically significant ( Z=-1.97, P=0.003). The levels of aspartate transaminase and alanine transaminase 1 week after surgery in the study group were 33.4 (24.0, 43.8) U/L and 64.5 (38.3, 119.1) U/L, respectively, which were lower than those in the control group 41.3 (29.7, 63.0) U/L and 102.8 (50.1, 140.7) U/L, the differences were statistically significant ( Z=-2.09, -2.38, P=0.035, 0.028). Postoperative complications occurred in 8 cases (16.7%) in the study group and 10 cases (20.0%) in the control group, with no significant difference between the two groups ( χ2=0.18, P=0.670). The median overall survival was 16 months in the study group and 18 months in the control group, respectively. There was no significant difference in cumulative survival between the two groups ( χ2=1.41, P=0.130). Conclusion:Laennec membrane approach hepatectomy can not only shorten the operation time and reduce the amount of blood loss, but also promote the recovery of liver function.

Objective:To explore the efficacy and prognosis of hepatectomy via Laennec membrane approach in patients with hepatocellular carcinoma (HCC).Methods:The data of 98 patients with HCC who underwent hepatectomy in the First Affiliated Hospital of Soochow University from January 2016 to December 2022 were retrospectively analyzed, including 76 males and 22 females, aged 61.0 (55.0, 66.0) years. Forty-eight patients treated with Laennec membrane approach hepatectomy were included in the study group and 50 patients treated with traditional approach hepatectomy were included in the control group. The age, gender, combined hypertension and diabetes, aspartate transaminase, alanine transaminase, albumin, total bilirubin, prealbumin, platelet, alpha-fetoprotein, carbohydrate antigen 19-9 and carbohydrate antigen 125 were compared between the two groups. The surgical bleeding, operation time and complications (abdominal bleeding, bile leakage, poor incision healing, etc.) were compared between the two groups. The prognosis of the two groups was compared.Results:There were no significant differences in gender, age, underlying diseases, preoperative biochemical and tumor serological indexes between the two groups (all P>0.05). The operation time of the study group was 180.0 (141.3, 227.3) min, which was lower than that of the control group 221.5 (187.5, 256.3) min ( Z=-0.41, P=0.002). The intraoperative blood loss in the study group was 295.0 (127.5, 350.0) ml, which was lower than that in the control group 300.0 (200.0, 500.0) ml, and the difference was statistically significant ( Z=-1.97, P=0.003). The levels of aspartate transaminase and alanine transaminase 1 week after surgery in the study group were 33.4 (24.0, 43.8) U/L and 64.5 (38.3, 119.1) U/L, respectively, which were lower than those in the control group 41.3 (29.7, 63.0) U/L and 102.8 (50.1, 140.7) U/L, the differences were statistically significant ( Z=-2.09, -2.38, P=0.035, 0.028). Postoperative complications occurred in 8 cases (16.7%) in the study group and 10 cases (20.0%) in the control group, with no significant difference between the two groups ( χ2=0.18, P=0.670). The median overall survival was 16 months in the study group and 18 months in the control group, respectively. There was no significant difference in cumulative survival between the two groups ( χ2=1.41, P=0.130). Conclusion:Laennec membrane approach hepatectomy can not only shorten the operation time and reduce the amount of blood loss, but also promote the recovery of liver function.

Objective To analyze the predictive value of spermatic vein diameter in diagnosing occult oblique inguinal hernia in children.Methods A total of 93 children of oblique inguinal hernia were admitted to Hangzhou Linping District Maternal &Child Health Care Hospital from August 2021 to August 2023 as research objects,including 15 with 30 sides of bilateral dominant hernia and 78 with 78 sides of unilateral dominant hernia.Among them,21 with 21 sides of contralateral recessive hernia were found by laparoscopic exploration in unilateral dominant hernia.The 108 sides of dominant hernia were used as dominant hernia group and 21 sides of occult hernia group as recessive hernia group.According to different ages,the patients were divided into 1 to 3 years old group 60 cases,4 to 6 years old group 33 cases;Children with oblique inguinal hernia were divided into＜2 years group(68 cases)and ≥2 years group(25 cases).The color ultrasound diagnostic instrument uses a 7.5MHz linear transducer to measure the diameter of the spermatic vein in the inguinal region of the child using blood flow imaging with a signal displayed at 2mm/s.Receiver operating characteristic(ROC)curve analysis of the predictive value of spermatic vein diameter for the diagnosis of occult inguinal hernia in children.Results Compared with occult hernia group,diameter of spermatic cord was increased in dominant hernia group(P＜0.05).Compared with overt hernia group,diameter of spermatic cord in＜2 year group and ≥2 year group was smaller,and difference was statistically significant(P＜0.05).In prediction of disease diagnosis with different age and course of disease,sensitivity of 1 to 3 years old was lower than that of 4 to 6 years old,and specificity was higher.The sensitivity of ≥2 years group was lower than that of＜2 years group.The specificity was higher and difference was statistically significant(P＜0.05).Conclusion diameter of spermatic vein can be used to predict the diagnosis of occult oblique inguinal hernia in children with high sensitivity and specificity.

Objective This study aims to improve the evaluation index system for the operation of department levels in tertiary public hospitals,strengthen process management,and promote the comprehensive reform and high-quality development of public hospitals.Methods Through literature retrieval and theoretical analysis,a framework for the evaluation index system of department-level operation in tertiary general public hospitals was constructed,and evaluation indicators were initially proposed.Based on the Delphi method,a systematic sorting and adjustment of the evaluation indicators for department-level operation in public hospitals were carried out,and the evaluation index system was finally established.Results The response rates and effec-tive rates of the two rounds of questionnaires using the Delphi method were 90.00％and 83.33％,respectively.The authority co-efficient was 0.8,and the differences in coordination coefficients were statistically significant.The indicators passed the consis-tency test,and the final evaluation index system was composed of 5 first-level indicators,14 second-level indicators,and 43 third-level indicators.Conclusion The evaluation indicators for the operation of department levels in tertiary general public hos-pitals are conducive to guiding hospitals to improve their internal management level and providing support for the implementation of the high-quality development strategy of public hospitals.

Objective:To Exploring the protective effect of hearing protectors worn by noise workers in the petrochemical industry and the factors affecting the protective effect of hearing protectors.Methods:From June 2021 to July 2023, 929 petrochemical workers were selected as the research subjects through cluster sampling. The noise exposure of workers and the usage of two types of hearing protectors were surveyed through questionnaire surveys and on-site occupational hygiene surveys. The protective effect of hearing protectors were evaluated by testing the PAR of workers. If the noise exposure value of workers minus the PAR value was less than 85 dB (A) , it was considered passed. Otherwise, it was considered not passed. The passing rate of the protective effect test of hearing protectors was analyzed through chi square test and the influencing factors for the effectiveness of workers hearing protectors in test were explored through single factor analysis and logistic regression models.Results:Among the research subjects, 80.5% of workers (748/929) had noise exposure levels greater than 85 dB (A) . The passing rate (80.9%) of the earmuff is greater than that of the earplug (52.6%) , and the median of PAR of the earmuff is 22 (16, 25) , which is greater than that of the earplug 15 (3, 22) dB dB, with a statistically significant difference ( P<0.001) . Univariate analysis and logistic regression models showed that length of service, exposure level to noise, and wearing comfort were the influencing factors of earplug protection effect ( P<0.05) , while wearing comfort was the influencing factor of earmuff protection effect ( P<0.05) . Conclusion:This study indicates that the protective effect of hearing protectors on workers in the petrochemical enterprise is poor, and the protective effect of earmuffs is greater than that of earplugs. Working experience, noise exposure level, and wearing comfort are the influencing factors of earplug protection effect, while wearing comfort is the influencing factor of earplug protection effect.