ObjectiveThis paper aims to observe the syndrome improvement and negative antigen conversion rate of Qingxuan Daozhi formula in the treatment of influenza in children （heat accumulation in the lung and stomach syndrome）. MethodsThrough a multi-center randomized controlled methodology design，confirmed influenza cases were collected from October 2022 to April 2023 in the pediatrics department of eight hospitals，such as Dongfang Hospital of Beijing University of Chinese Medicine. A total of 180 children with influenza and heat accumulation in the lung and stomach syndrome conforming to the standard were recruited through the clinic. The sick children meeting the inclusion criteria were randomly divided into groups by a block-randomized method. The children in the experimental group were treated with Qingxuan Daozhi formula for five days，and those in the control group were treated with Oseltamivir Phosphate Granules for five days. The primary efficacy indicator was the negative conversion rate of influenza antigen detection. Secondary efficacy indicators were the Canadian acute respiratory illness and flu scale （CARIFS） and the incidence of complications，severe cases， and critical cases. Follow-up observation was conducted on the day of enrollment，48 hours after medication，72 hours after medication， and （6+1） d after medication. ResultsOne hundred and eighty participants were randomly assigned to the experimental group （90 cases） or the control group （90 cases）. All participants were followed up during the study. Comparison of influenza antigen detection results in the primary efficacy indicators showed that the average time of negative influenza antigen conversion in the experimental group was （5.29±1.25） d，and that in the control group was （5.40±1.68） d，without a statistically significant difference. After five days of intervention，52 cases in the experimental group and 51 cases in the control group converted to negative，without a statistically significant difference. CARIFS score results in the secondary efficacy indicators showed that during 72 hours after intervention，there were statistically significant differences between the experimental group and the control group in three dimensions， including headache，muscle soreness， and the need for extra care （P<0.05）. On the （6+1） days after the intervention，the differences in both the experimental group and the control group were statistically significant in 10 dimensions， including sore throat，bad sleep，uncomfortable feeling，poor spirit and fatigue，crying more than usual，the need for extra care，symptom，function，influence on parents，and total score （P<0.05）. The comparison results within the group in the dimensional scores of symptom， function， and influence on parents，as well as the CARIFS total score showed that with the delay of follow-up time，scores of both groups decreased significantly，with a statistically significant difference （P<0.01）. Inter-group comparison results showed that the mean score of the experimental group was higher than that of the control group at the time of enrollment. With the progress of intervention，the score of the experimental group was significantly decreased compared with that of the control group. At the end of follow-up，the mean score of the experimental group was lower than that of the control group，with no statistically significant difference. In terms of the incidence of complications，severe cases， and critical cases， there were no complications，severe cases， and critical cases in the two groups，without a statistically significant difference. ConclusionThe symptom improvement effect and negative antigen conversion rate of Qingxuan Daozhi formula in the treatment of influenza in children （heat accumulation in the lung and stomach syndrome） are not inferior to Oseltamivir Phosphate granules， and children's acceptance is better. It can be more widely used in clinical treatment of influenza in children （heat accumulation in the lung and stomach syndrome）.

Objective To investigate the three-dimensional changes in hard and soft tissues before and after treatment with digitally fabricated maxillary skeletal expanders in patients with maxillary transverse deficiency.Methods Twenty late adolescents or adults with maxillary transverse deficiency treated at the Orthodontic Department of Affiliated Stomatological Hospital of Nanjing Medical Uni-versity using digitally fabricated maxillary skeletal expanders were included.Cone-beam computed tomography(CBCT)scans were ob-tained before and after treatment.Three-dimensional measurements were analyzed using Dolphin 3D 11.95 software,and statistical anal-ysis was performed with SPSS software.Paired t-tests were used to compare pre-treatment and post-treatment changes in hard and soft tissues.Results Significant increases were observed in anterior midpalatal suture width,posterior midpalatal suture width,maxillary apical base width,and maxillary alveolar width(P＜0.001).No significant changes were found in alveolar ridge inclination,alveolar ridge height,LSNA(P＞0.05).Significant increases occurred in apical distance,cementoenamel junction distance,and inter-fossa distance(P＜0.001),while first molar inclinationand ∠U1-SN remained stable(P＞0.05).Significant improvements were noted in upper airway volume,nasal floor base width,and nasal cavity width(P＜0.001).Conclusion For late adolescents or adults with max-illary transverse deficiency,digitally fabricated maxillary skeletal expanders can achieve near-parallel expansion of the midpalatal suture,effectively improving maxillary transverse dimensions and airway volume while minimizing dental side effects.

Objective To investigate the three-dimensional changes in hard and soft tissues before and after treatment with digitally fabricated maxillary skeletal expanders in patients with maxillary transverse deficiency.Methods Twenty late adolescents or adults with maxillary transverse deficiency treated at the Orthodontic Department of Affiliated Stomatological Hospital of Nanjing Medical Uni-versity using digitally fabricated maxillary skeletal expanders were included.Cone-beam computed tomography(CBCT)scans were ob-tained before and after treatment.Three-dimensional measurements were analyzed using Dolphin 3D 11.95 software,and statistical anal-ysis was performed with SPSS software.Paired t-tests were used to compare pre-treatment and post-treatment changes in hard and soft tissues.Results Significant increases were observed in anterior midpalatal suture width,posterior midpalatal suture width,maxillary apical base width,and maxillary alveolar width(P＜0.001).No significant changes were found in alveolar ridge inclination,alveolar ridge height,LSNA(P＞0.05).Significant increases occurred in apical distance,cementoenamel junction distance,and inter-fossa distance(P＜0.001),while first molar inclinationand ∠U1-SN remained stable(P＞0.05).Significant improvements were noted in upper airway volume,nasal floor base width,and nasal cavity width(P＜0.001).Conclusion For late adolescents or adults with max-illary transverse deficiency,digitally fabricated maxillary skeletal expanders can achieve near-parallel expansion of the midpalatal suture,effectively improving maxillary transverse dimensions and airway volume while minimizing dental side effects.

Objective To establish a combined model of spectral CT multi-parameters and clinical features to distinguish between gastric poorly cohesive carcinoma and tubular adenocarcinoma.Methods A total of 87 patients with gastric cancer confirmed by postoperative pathology were retrospectively selected,including 26 patients with poorly cohesive carcinoma and 61 patients with tubular adenocarcinoma.Predictors were identified by univariate and multivariate logistic regression analyses,and a combined model was established.The area under the curve(AUC)of receiver operating characteristic(ROC)curve was used to evaluate the differential diagnostic efficiency of the parameters and the model.The AUC was compared by DeLong method.Results The gender[odds ratio(OR)5.124,P=0.004],normalized iodine density in the arterial phase(nIoDAP)(OR 5.789,P=0.017),arterial enhancement fraction(AEF)(OR 7.007,P=0.002)and ΔIoD(OR 0.025,P=0.021)were identified as independent predictors for poorly cohesive carcinoma by logistic regression analysis.The AUC of combined model established by four variables in distinguishing poorly cohesive carcinoma and tubular adenocarcinoma was 0.837[95％confidence interval(CI)0.716-0.907],which was significantly higher than that of single tumor spectral CT parameters(P＜0.01).Conclusion The combined model based on patients'gender and tumor spectral CT parameters(nIoDAP,AEF and ΔIoD)can effectively distinguish gastric poorly cohesive carcinoma and tubular adenocarcinoma,providing a basis for gastric cancer patients'individualized treatment strategy.

Objective To explore the efficacy of precise surface positioning method in percutaneous screw fixation for Jones fracture.Methods Data of 46 patients with Jones fractures admitted to our hospital from September 2021 to December 2023 were retrospectively analyzed.According to the different treatment methods,the patients were divided into screw groups(24 patients fixed by percutaneous screws)and tension band groups(22 patients fixed by incision and reset tension band).The general conditions,follow-up time,surgical time,hospitalization time,fracture reduction quality,postoperative complete weight-bearing time,fracture healing time,and complications in the two groups were recorded and compared.The American Association of Foot and Ankle Surgery(AOFAS)system was used to assess the recovery of foot function.Results There was no statistically significant difference in the general data before the operation between the two groups of patients(P＞0.05).The follow-up time of the two groups was 6 to 24 months.Compared with the tension band group,the screw group had shorter operation time[(32.96±5.35)min vs.(47.27±9.42)min],shorter hospitalization time[(5.75±1.18)d vs.(7.68±2.05)d],earlier postoperative complete weight-bearing time[(6.47±0.73)w vs.(7.29±1.66)w],faster fracture healing time[(3.31±0.68)months vs.(4.29±1.29)months],higher AOFAS score[(89.13±2.62)vs.(79.59±4.49)](all P＜0.05).The tension band group of fracture reduction quality was better than the screw group(P＜0.05).The quality of fracture reduction during the operation in the tension band group was better than that in the screw group(P＜0.05).In terms of complications:no complications occurred in the screw group,one patient in the tension band group developed infection,and one patient had a loose Kirchner needle.Conclusion Precise surface positioning method in percutaneous screw fixation for Jones fracture is a safe and effective method with precise positioning,simple operation,small trauma,and rapid rehabilitation,which is worthy of clinical promotion,but the indications need to be strictly controlled according to the type of fracture.

Objective To explore the efficacy of precise surface positioning method in percutaneous screw fixation for Jones fracture.Methods Data of 46 patients with Jones fractures admitted to our hospital from September 2021 to December 2023 were retrospectively analyzed.According to the different treatment methods,the patients were divided into screw groups(24 patients fixed by percutaneous screws)and tension band groups(22 patients fixed by incision and reset tension band).The general conditions,follow-up time,surgical time,hospitalization time,fracture reduction quality,postoperative complete weight-bearing time,fracture healing time,and complications in the two groups were recorded and compared.The American Association of Foot and Ankle Surgery(AOFAS)system was used to assess the recovery of foot function.Results There was no statistically significant difference in the general data before the operation between the two groups of patients(P＞0.05).The follow-up time of the two groups was 6 to 24 months.Compared with the tension band group,the screw group had shorter operation time[(32.96±5.35)min vs.(47.27±9.42)min],shorter hospitalization time[(5.75±1.18)d vs.(7.68±2.05)d],earlier postoperative complete weight-bearing time[(6.47±0.73)w vs.(7.29±1.66)w],faster fracture healing time[(3.31±0.68)months vs.(4.29±1.29)months],higher AOFAS score[(89.13±2.62)vs.(79.59±4.49)](all P＜0.05).The tension band group of fracture reduction quality was better than the screw group(P＜0.05).The quality of fracture reduction during the operation in the tension band group was better than that in the screw group(P＜0.05).In terms of complications:no complications occurred in the screw group,one patient in the tension band group developed infection,and one patient had a loose Kirchner needle.Conclusion Precise surface positioning method in percutaneous screw fixation for Jones fracture is a safe and effective method with precise positioning,simple operation,small trauma,and rapid rehabilitation,which is worthy of clinical promotion,but the indications need to be strictly controlled according to the type of fracture.

ObjectiveTo investigate the effect and underlying mechanism of the Wulao Qisun prescription on pathological new bone formation in ankylosing spondylitis （AS）. MethodsSynovial fibroblasts were isolated from the hip joints of AS patients and observed under a microscope to assess cell morphology. The cells were identified using immunofluorescence staining. The isolated AS fibroblasts were divided into blank group， low drug-containing serum group， medium drug-containing serum group， high drug-containing serum group， and positive drug group. After drug intervention， cell proliferation was measured using the cell counting kit-8 （CCK-8） assay to observe fibroblast growth and determine the optimal intervention time. Alkaline phosphatase （ALP） activity was measured using the alkaline phosphatase assay. Protein expression of osteocalcin （OCN）， osteopontin （OPN）， and runt-related transcription factor 2 （Runx2） was detected by Western blot. The mRNA expression levels of Wnt5a， β-catenin， and Dickkopf-1 （DKK-1） were measured by real-time quantitative polymerase chain reaction （Real-time PCR）. ResultsCompared with the blank group， each drug-containing serum group of Wulao Qisun prescription and the positive drug group inhibited the proliferation of AS fibroblasts and reduced ALP expression （P<0.01）. Compared with the blank group， the low drug-containing serum group of Wulao Qisun prescription downregulated β-catenin mRNA expression （P<0.05）. The medium and high drug-containing serum groups and the positive drug group significantly downregulated Wnt5a and β-catenin mRNA expression （P<0.05， P<0.01）， with the positive drug group showing the most pronounced effect （P<0.01）. The high drug-containing serum group and the positive drug group significantly upregulated DKK-1 mRNA expression （P<0.01）. Compared with the blank group， the low drug-containing serum group of Wulao Qisun prescription inhibited the expression of OPN and Runx2 proteins （P<0.05， P<0.01）， while the medium and high drug-containing serum groups and the positive drug group inhibited the expression of OCN， OPN， and Runx2 proteins （P<0.05， P<0.01）. ConclusionThe Wulao Qisun prescription can inhibit the proliferation and osteogenic differentiation of AS fibroblasts， thereby delaying the formation of pathological new bone in AS. The possible mechanism involves the regulation of Wnt/β-catenin-related gene expression， further inhibiting the transcription of downstream target genes.

Objective:To observe the effectiveness and safety of different doses of esketamine combined with propofol for intravenous administration in the child patients undergoing enhanced computed tomography(CT)examination,and to clarify the optimal clinical dose of esketamine in combination with propofol for sedation.Methods:This study is a randomized,controlled,double-blind(blinded to subjects and evaluators),and single-center clinical trial.A total of 120 preschool children undergoing enhanced CT examination were randomly divided into propofol group(P group),propofol+0.3 mg·kg-1 esketamine group(P+K3 group),and propofol+0.5 mg·kg-1 esketamine group(P+K5 group),and there were 40 cases in each group.All the children were given 2mg·kg-1 propofol,and additional propofol was administered in increments of 1 mng·kg-1 until the sedation criteria for entering the CT room were met[Modified Observer's Assessment of Alertness/Sedation(MOAA/S)score ≤3].The vital signs of the children were observed and recorded at four time points:before sedation(T0),when sedation was satisfactory(T1),during contrast agent injection(T2),and upon awakening(T3).The examination time,time to satisfactory sedation(from the start of sedation to MOAA/S score≤3),and awakening time(from the end of the examination to MOAA/S score＞4)of the children in various groups were recorded.The total dose of propofol and the proportion of cases requiring additional propofol were compared among various groups.Adverse reactions during induction,examination,and after awakening were also compared among various groups.Results:There were no significant differences in general conditions of the children in three groups(P＞0.05).Hemodynamic parameters:at T2,compared with P group,the SpO2 levels of the children in P+K3 group and P+K5 group were increased(P＜0.05);at T1,compared with P group,the SBP levels of the children in P+K3 group and P+K5 group were increased(P＜0.05).There were no significant differences in examination time of the children in three groups(P＞0.05).Compared with P group and P+K3 group,the time to satisfactory sedation of the children in P+K5 group was shorter(P＜0.05).Compared with P group,the awakening time of the children in P+K3 group and P+K5 group was shorter(P＜0.05).Compared with P group and P+K3 group,the total dose of propofol of the children in P+K5 group was decreased(P＜0.05),and the proportion of cases requiring additional propofol was lower(P＜0.05).Adverse reaction indicators:compared with P group,the incidence of respiratory depression of the children in P+K3 group and P+K5 group was lower(P＜0.05),and the incidence of nausea and vomiting was lower(P＜0.05).Compared with P group and P+K3 group,the incidence of movement during the examination of the children in P+K5 group was lower(P＜0.05),and the incidence of dizziness was higher(P＜0.05).There were no significant differences in the incidence of increased airway secretions of the children in three groups(P＞0.05).Conclusion:The use of 0.5 mg·kg-1 esketamine combined with 2 mg·kg-1 propofol for intravenous administration in the child patients for enhanced CT examination sedation can improve the efficiency of such examinations and offers high safety and effectiveness.

ObjectiveTo evaluate the efficacy and safety of Xiaoji Hufei Formula in protecting children with close contact exposure to influenza， and to provide reference and evidence-based support for better clinical prevention and treatment of influenza in children. MethodsA multicenter， prospective， non-randomized， parallel， controlled trial was conducted from October 2021 to May 2022 in five hospitals， including Dongfang Hospital of Beijing University of Chinese Medicine. Confirmed influenza cases and influenza-like illness （ILI） cases were collected， and eligible children with close contact exposure to these cases were recruited in the outpatient clinics. According to whether the enrolled close contacts were willing to take Xiaoji Hufei formula for influenza prevention， they were assigned to the observation group （108 cases） or the control group （108 cases）. Follow-up visits were conducted on days 7 and 14 after enrollment. The primary outcomes were the incidence of ILI and the rate of laboratory-confirmed influenza. Secondary outcomes included traditional Chinese medicine （TCM） symptom score scale for influenza， influenza-related emergency （outpatient） visit rate， influenza hospitalization rate， and time to onset after exposure to influenza cases. ResultsA total of 216 participants were enrolled， with 108 in the observation group and 108 in the control group. Primary outcomes： （1） Incidence of ILI： The incidence was 12.0% （13/108） in the observation group and 23.1% （25/108） in the control group， with the observation group showing a significantly lower incidence （χ²=4.6， P<0.05）. （2） Influenza confirmation rate： 3.7% （4/108） in the observation group and 4.6% （5/108） in the control group， with no statistically significant difference. Secondary outcomes： （1） TCM symptom score scale： after onset， nasal congestion and runny nose scores differed significantly between the two groups （P<0.05）， while other symptoms such as fever， sore throat， and cough showed no significant differences. （2） Influenza-related emergency （outpatient） visit rate： 84.6% （11 cases） in the observation group and 96.0% （24 cases） in the control group， with no significant difference. （3） Time to onset after exposure： The median onset time after exposure to index patients was 7 days in the observation group and 4 days in the control group， with a statistically significant difference （P<0.05）. ConclusionIn previously healthy children exposed to infectious influenza cases under unprotected conditions， Xiaoji Hufei formula prophylaxis significantly reduced the incidence of ILI. Xiaoji Hufei Formula can be recommended as a specific preventive prescription for influenza in children.

ObjectiveTo evaluate the efficacy and safety of Xiaoji Hufei Formula in protecting children with close contact exposure to influenza， and to provide reference and evidence-based support for better clinical prevention and treatment of influenza in children. MethodsA multicenter， prospective， non-randomized， parallel， controlled trial was conducted from October 2021 to May 2022 in five hospitals， including Dongfang Hospital of Beijing University of Chinese Medicine. Confirmed influenza cases and influenza-like illness （ILI） cases were collected， and eligible children with close contact exposure to these cases were recruited in the outpatient clinics. According to whether the enrolled close contacts were willing to take Xiaoji Hufei formula for influenza prevention， they were assigned to the observation group （108 cases） or the control group （108 cases）. Follow-up visits were conducted on days 7 and 14 after enrollment. The primary outcomes were the incidence of ILI and the rate of laboratory-confirmed influenza. Secondary outcomes included traditional Chinese medicine （TCM） symptom score scale for influenza， influenza-related emergency （outpatient） visit rate， influenza hospitalization rate， and time to onset after exposure to influenza cases. ResultsA total of 216 participants were enrolled， with 108 in the observation group and 108 in the control group. Primary outcomes： （1） Incidence of ILI： The incidence was 12.0% （13/108） in the observation group and 23.1% （25/108） in the control group， with the observation group showing a significantly lower incidence （χ²=4.6， P<0.05）. （2） Influenza confirmation rate： 3.7% （4/108） in the observation group and 4.6% （5/108） in the control group， with no statistically significant difference. Secondary outcomes： （1） TCM symptom score scale： after onset， nasal congestion and runny nose scores differed significantly between the two groups （P<0.05）， while other symptoms such as fever， sore throat， and cough showed no significant differences. （2） Influenza-related emergency （outpatient） visit rate： 84.6% （11 cases） in the observation group and 96.0% （24 cases） in the control group， with no significant difference. （3） Time to onset after exposure： The median onset time after exposure to index patients was 7 days in the observation group and 4 days in the control group， with a statistically significant difference （P<0.05）. ConclusionIn previously healthy children exposed to infectious influenza cases under unprotected conditions， Xiaoji Hufei formula prophylaxis significantly reduced the incidence of ILI. Xiaoji Hufei Formula can be recommended as a specific preventive prescription for influenza in children.