Pediatric pneumonia is a prevalent infectious disease within respiratory system disorders and constitutes one of the leading causes of mortality among children under five years old. Macrolide antibiotics are frequently used as therapeutic agents for community-acquired pneumonia in pediatric patients， particularly in cases of mycoplasma pneumonia. Both domestic and international guidelines for the diagnosis and treatment of pneumonia have underscored the clinical significance of macrolide antibiotics in pediatric pneumonia management. Nevertheless， variations exist among different guidelines regarding the emphasis and recommendations on drug selection. In light of the severe issue of macrolide resistance in China， this article aims to interpret the content concerning the rational use of macrolide antibiotics in pediatric pneumonia as outlined in recently published guidelines， thereby providing a valuable reference for promoting appropriate drug utilization in pediatric pneumonia care within China.

Spinal muscular atrophy （SMA） is a hereditary neurodegenerative disease characterized mainly by symmetrical and progressive muscle weakness and atrophy in the proximal limbs. Pediatric SMA patients often experience respriatory problems. Disease-modifying therapies are beneficial for improving respiratory problems in children with SMA. This article reviews the effects of disease-modifying therapies on respiratory outcome in children with different types of SMA.

Luspatercept has been approved for the treatment of anemia associated with myelodysplastic syndromes （MDS）， but its efficacy is not consistent across all cases of MDS-related anemia. The real-world effectiveness of luspatercept in treating low- to intermediate-risk MDS， as well as its application in high-risk MDS， remains to be fully explored. This article reviews the clinical applications of luspatercept in both low-to intermediate-risk and high-risk MDS， with a particular focus on its efficacy and safety in patients with SF3B1 and TP53 gene mutations. Additionally， it discusses the feasibility of precision and combination therapies guided by genetic testing.

Atractylodes is a commonly used herb in traditional Chinese medicine （TCM）， with various processing methods， primarily including bran frying and rice swill water processing. Rice swill water processing， as one of the distinctive methods for preparing Atractylodes， plays a significant role in clinical practice and has been documented in numerous ancient medical texts and local processing standards. Notably， the 2023 edition of the Beijing Municipal Standard for Processing Chinese Medicinal Slices newly includes Atractylodes processed with rice swill water. However， the 2020 edition of the Chinese Pharmacopoeia only lists raw Atractylodes and bran-fried Atractylodes， and recent literature on rice swill water-processed Atractylodes is scarce. Moreover， current provinicical processing standards differ in their methods and criteria for this preparation. Through a comprehensive review of ancient and modern literature， provincial and municipal processing standards， and contemporary research， this paper further elaborates on the historical evolution， processing techniques， mechanisms， and pharmacological differences of rice swill water-processed Atractylodes， aiming to provide a theoretical foundation and future research direction for its development.

Lazertinib is an oral tyrosine kinase inhibitor （TKI） developed by Janssen Biotech， Inc. for combination therapy with amivantamab in adult patients with locally advanced or metastatic non-small cell lung cancer （NSCLC） harboring epidermal growth factor receptor （EGFR） exon 19 deletions or exon 21 L858R substitution mutations. On August 19， 2024， the Food and Drug Administration （FDA） approved this combination regimen. This review comprehensively summarizes the drug's basic information， mechanism of action， pharmacokinetic profiles， clinical efficacy， safety， and other research and development dynamics， aiming to provide scientific evidence and reference for rational clinical use of the drug.

Deuruxolitinib is an orally available Janus kinase （JAK） inhibitor developed by Sun Pharmaceuticals of India for the treatment of adult patients with severe alopecia areata. On July 25， 2024， the U.S. FDA approved deuruxolitinib for marketing. This review provides an overview of the basic information， mechanism of action， pharmacokinetics， clinical efficacy， safety evaluation， usage and dosage， and drug interactions of deuroxolitinib， aiming to provide reference for rational drug use in clinical practice.

Objective To explore the risk factors for infusion-related reactions （IRRs） during the initial administration of rituximab in patients with primary glomerular diseases and to investigate the dose-response relationship between these risk factors and the occurrence of IRRs.Methods A retrospective analysis was conducted on patients with primary glomerular diseases who received their initial infusion of rituximab at the Department of Nephrology in a tertiary grade A general hospital in Beijing from May 2018 to June 2024. Demographic data， disease-related information， medication history， and laboratory test results were collected and compared between the IRRs group and non-IRRs group. Logistic regression analysis was employed to identify independent risk factors associated with rituximab-induced IRRs in patients with primary glomerular diseases. Additionally， restricted cubic splines were utilized to examine the dose-response relationship between continuous independent risk factors and the risk of rituximab-induced IRRs， and corresponding dose-response relationship figures were subsequently generated. Results A total of 350 patients was included， the incidence rate of rituximab-induced IRRs was 39.43%. Multivariate logistic regression analysis revealed that younger age（OR=0.962，95%CI：0.946~0.978，P<0.001）， elevated CD19 levels before rituximab administration（OR=1.001，95%CI：1.000~1.002，P=0.034）， and absence of glucocorticoid therapy before rituximab administration（OR=3.496，95%CI：2.122~5.761，P<0.001） were independent risk factors for rituximab-induced IRRs in this patient population during their first infusion of rituximab. After adjusting for confounders， age showed a linearly decreasing dose-response relationship with IRR risk （P_overall<0.001， P_non-linear=0.151）， while no significant dose-response relationship was observed for pre-administration CD19 levels （P_overall=0.057， P_non-linear=0.255）. Conclusion The incidence of IRRs following the initial rituximab infusion in patients with primary glomerular diseases is high. Clinically， enhanced pre-administration assessments and preventive measures are recommended for high-risk populations， particularly those with younger age， elevated CD19 levels， and no prior glucocorticoid therapy.

Objective To assess the effectiveness， safety， and cost-effectiveness of acyclovir in the treatment of infectious mononucleosis based on real-world data， with the aim of providing reference for clinical treatment and rational drug use. Methods A retrospective study was conducted on pediatric patients with infectious mononucleosis admitted to a tertiary hospital between January 2021 and June 2024. Patients who received acyclovir treatment comprised the observation group， while those who did not receive acyclovir comprised the control group. The propensity score matching method was employed to minimize data bias， allowing for a comparison of differences in clinical efficacy， safety， and economy between the two groups. Results After analysis of all observation indexes， 187 patients who did not meet the test criteria were excluded， and 189 patients were finally included in each of the observation group and control group. The analysis showed that there was no significant difference between the two groups in the time when allolymphocytes decreased to 10% ［observation group：（6.80±1.94） d vs control group：（7.31±1.78） d］， when tonsil exudation subsided ［observation group：4.25 d vs control group： 4.95 d］， the duration of fever ［observation group：（6.50±2.87） d vs control group：（7.13±3.69） d］， the number of patients with hepatomegaly， splenomegaly， lymphadenopathy that did not subside after the occurrence of the disease （15， 30， 90， 180 d）， and other expenses during hospitalization （P>0.05）. In the observation group and control group， the discharge time was 9.60 d and 7.15 d， respectively. For the safety evaluation， the incidences of adverse reactions in the two groups were 6.34% and 0.53%， and the total hospitalization costs were 5899.92 yuan and 1862.59 yuan， respectively. The total other costs were 4225.13 yuan and 3510.60 yuan， respectively. The difference between the two groups was statistically significant （P<0.05）. Conclusion For hospitalized patients with infectious mononucleosis caused by EB virus infection， acyclovir treatment has no advantages in terms of curative effect， but increases the length of hospital stay， the incidence of adverse drug reactions， and the total cost.

Objective To analyze the current status of patient consultation content in the internet hospital， and to study the feasibility of using artificial intelligence to replace manual services. Methods The patient consultation records of our hospital's internet hospital from May 2022 to March 2024 were retrieved. The demographics of patients， the distribution of consultation question types， and the distribution of Chinese and Western medicine types involved in the consultation content were analyzed. Baidu's Wenxin Yanyan （large model version 3.5） and Baidu AI drug instructions were used to answer questions related to drug use in the consultation records， and their equivalence compared to manual answers was evaluated. Results A total of 978 consultation records were obtained. The gender distribution of patients was balanced， with the majority being middle-aged and young adults， followed by the elderly. In terms of question types， 92.95% of the consultation questions were related to pharmacy， of which 65.24% involved drug use， and the dosage and administration of drugs were the most concerned issues for consultants. Regarding drug categories， 86.83% of the consultation involved Western medicine， among which nervous system drugs were the most concerned by consultants， accounting for 46.55%. In the answers provided by Wenxin Yanyan to the consultation questions， 82.75% were equivalent to manual answers， and 83.86% of the answers provided by AI drug instructions were equivalent. The equivalence of both was still not as good as manual answers， with significant statistical differences. Conclusion Although artificial intelligence （AI） currently demonstrates overall quality inferior to human professionals in answering pharmacy-related questions， it has shown considerable potential. The AI-pharmacist collaborative service model may represent a promising developmental direction worthy of exploration in this field.

Objective To analyze the effects of atosiban and nifedipine on pregnancy outcomes and maternal and infant blood glucose levels in pregnant women with gestational diabetes mellitus （GDM）. Methods Pregnant women with GDM from January 2022 to April 2024 were divided into atosiban group and nifedipine group. The blood glucose levels of pregnant women and neonates during hospitalization were collected， the pregnancy outcomes， the incidence of hyperglycemia at delivery and neonatal hypoglycemia were compared between the two groups， and the influencing factors of maternal hyperglycemia and neonatal hypoglycemia were analyzed. Results A total of 80 patients were included， with 40 in each group. Fasting blood glucose ［（5.74±1.42） mmol/L in atosiban group vs （4.97±0.60） mmol/L in nifedipine group， P=0.002］ and 2 h postprandial blood glucose ［（8.08±1.80） mmol/L vs （6.47±1.23） mmol/L， P<0.001］ in the two groups at delivery were lower than those before treatment， and the decrease in nifedipine group was greater. The cesarean section rate， glucocorticoid use rate， incidence of hyperglycemia at delivery and incidence of neonatal hypoglycemia （P=0.010） in nifedipine group were significantly lower than those in atosiban group，respectively 40.0% vs 75.0%， 32.5% vs 77.5%， 57.5% vs 80.0%， 7.5% vs 30.0%. Multiple linear regression showed that atosiban treatment increased the abdominal blood glucose by 0.128 mmol/L during delivery （β=3.128， P=0.001）， and the blood glucose increased by 0.151 mmol/L for every 1 kg/m² increase in pre-pregnancy BMI （P<0.001）. Logistic regression showed that atosiban significantly increased maternal fasting hyperglycemia （OR=2.568， 95%CI：1.345-4.903）， postprandial hyperglycemia （OR=9.152， 95%CI：1.444-17.993） and neonatal hypoglycemia risk （OR=2.077， 95%CI：1.313-3.286）. Conclusion Compared with nifedipine， atosiban has an increased risk of maternal hyperglycemia and neonatal hypoglycemia when used for fetus protection in preterm GDM women.

Objective To investigate the incidence， temporal characteristics， and independent risk factors of linezolid-associated thrombocytopenia （LIT） in long-term pulmonary tuberculosis treatment， and provide clinical decision support. Methods A retrospective cohort study analyzed 120 pulmonary tuberculosis patients treated with linezolid at Beijing Chest Hospital from 2019-2023. Thrombocytopenia was defined as platelet count <100×10⁹/L or ≥30% decline from baseline. Survival analysis and logistic regression were used to assess temporal patterns and risk factors. Results LIT incidence was 34.2% （41/120）. Median onset was （28.5±12.7） days. Cumulative incidence rose over time： 17.5% at 1 month， 37.5% at 2 months， 67.5% at 3 months. Independent risk factors included baseline platelet count <150×10⁹/L （OR=3.86， 95%CI：1.42~10.44）， age ≥60 years （OR=1.82， 95%CI：1.05~3.16）， and eGFR <60 mL/（min·1.73 m²） （OR=3.16， 95%CI：1.61~6.20）. Conclusion LIT risk increases with treatment duration in drug-resistant tuberculosis. Patients with low baseline platelet count， advanced age， or renal insufficiency are at high risk. Enhanced monitoring and optimized dosing are crucial for high-risk patients to balance efficacy and safety.

Objective To investigate the effect of intravenous lidocaine combined with thoracic paravertebral nerve block （TPVB） on early postoperative recovery in patients undergoing thoracoscopic surgery. Methods Patients scheduled for elective thoracoscopic surgery from July to December 2023 were selected and randomly divided into two groups： the lidocaine combined with TPVB group （intervention） and the TPVB-only group （control）. The intervention group received intravenous lidocaine （1 mg/kg bolus over 10 minutes before anesthesia induction， followed by continuous infusion at 2 mg/kg/h until surgery completion）， while the control group received equivalent volumes of normal saline at identical infusion rates. After anesthesia induction， both groups underwent ultrasound-guided TPVB and received postoeprative patient-controlled intravenous analgesia （PCIA）. Primary outcome： 24-hour postoperative Quality of Recovery-15 （QoR-15） score； Secondary outcomes： Numerical Rating Scale （NRS） scores at rest and during movement （6，12，24，and 48 hours postoperatively）； Ramsay sedation scores； serum levels of TNF-α， IL-1β， and IL-6 at 24 and 48 hours postoperatively； mean arterial pressure （MAP） and heart rate （HR） at pre-induction （T0），1 minute post-induction （T1）， immediately after tracheal intubation （T2）， immediately after skin incision （T3），and immediately after tracheal extubation （T4）； Recovery time， extubation time， PACU stay duration； incidence of postoperative nausea and vomiting （PONV）； and postoperative adverse events. Results A total of 90 patients were included， with 45 cases in each group.Compared with the control group， the intervention group showed significantly higher QoR-15 scores at both 24 h （119.4±3.23 vs 112.5±5.15） and 48 h postoperatively （137.20±3.05 vs 129.00±3.74， P<0.05）. The intervention group also showed shorter recovery time （7.31±2.53 vs 9.81±2.43） min， extubation time （8.87±2.89 vs 10.95±4.06） min and PACU stay duration （30.89±4.80 vs 33.95±6.32 min， all P<0.05）. Additionally， the intervention group had lower movement NRS scores at 24 h （2.42±0.72 vs 2.79±0.60） and 48 h （2.20±0.73 vs 2.58±0.82， P<0.05）， reduced TNF-α levels at both time point（P<0.05）， and significantly decreased IL-1β and IL-6 levels（P<0.01）. The intervention group maintained lower MAP at T₂， T₃ and T₄（P<0.01） and lower HR at T₁， T₂， T₃， T₄（P<0.05）. The incidence of PONV within 48 h was significantly lower in the intervention group （6.7% vs 23.2%， P<0.05）. Conclusion Perioperative intravenous infusion of lidocaine combined with TPVB in patients undergoing thoracoscopic surgery provides more stable intraoperative hemodynamics， improves postoperative QoR-15 score， reduces the incidence of PONV， and enhances the quality of early postoperative recovery.

Objective To conduct a comprehensive clinical evaluation of tenecteplase for acute ischemic stroke from six dimensions： efficacy， safety， economy， suitability， innovation， and accessibility. Methods Systematic searches were performed in PubMed， Embase， the Cochrane Library， CNKI， Wanfang Data，SinoMed， and health technology assessment（HTA）datadases， as well as professional websites （e.g.， National Center for Drug Evaluation， yaozhi）， pharmacopoeias， and drug labels. Literature was screened， data were extracted. Quality assessments were conducted using the HTA Checklist， AMSTAR-2 scale， and CHEERS checklist to evaluate the methodological rigor of the included Health HTA reports， systematic reviews/meta-analyses， and economic evaluations. Results A total of 33 studies were included， involving 1 HTA reports， 28 systematic review/meta analyses， and 4 pharmacoeconomic evaluations， with overall high methodological quality. For patients with acute ischemic stroke， intravenous tenecteplase demonstrated non-inferiority to alteplase in occluded vessel recanalization rates， early neurological improvement， and functional recovery， without increasing intracranial hemorrhage or mortality. The 0.25 mg/kg dose of tenecteplase showed superior efficacy and safety at a lower cost. Domestically developed tenecteplase formulations offered more convenient administration， thereby better addressing clinical needs. Conclusion For acute ischemic stroke patients eligible for intravenous thrombolysis， tenecteplase is non-inferior to alteplase in efficacy without increasing adverse events. The dosage of 0.25 mg/kg is optimal， with advantages in innovation， suitability， and accessibility.

Objective To compare efficacy of etanercept versus conventional synthetic disease-modifying antirheumatic drugs （csDMARDs） in rheumatoid arthritis （RA） patients stratified by age. Methods RA patients treated from July 2022 to July 2024 in Hefei First People's Hospital were categorized into： etanercept youth group （≤60 years old）， csDMARDs youth group， etanercept elderly group （>60 years old） and csDMARDs elderly group. The therapeutic outcomes were compared between different patient groups at 6 and 12 weeks， including EULAR response criteria and changes from baseline in 28 joint disease activity scores based on C-reactive protein （DAS28-CRP）， 28 joint disease activity scores based on erythrocyte sedimentation rate （DAS28-ESR）， simple disease activity index （SDAI） and clinical disease activity index （CDAI） scores. Results After propensity score matching， a total of 160 patients were included， 40 cases in each group. At 6 and 12 weeks of treatment， the improvement rate of etanercept youth group ［6 weeks： 29 cases （72.5%）； 12 weeks： 34 cases （85.0%）］ was higher than that of csDMARDs youth group ［6 weeks： 20 cases （50.0%）； 12 weeks： 21 cases （52.5%）］， and the improvement rate of etanercept elderly group ［6 weeks： 28 cases （70.0%）； 12 weeks： 31 cases （77.5%）］ was higher than that of csDMARDs elderly group ［6 weeks： 18 cases （45.0%）； 12 weeks： 19 cases （47.5%）］. The ΔDAS28-ESR and ΔDAS28-CRP in etanercept young group were higher than those in etanercept elderly group and csDMARDs young group， and the csDMARDs old group was lower than that in csDMARDs young group and etanercept old group； The ΔSDAI and ΔCDAI of etanercept youth group were higher than those of etanercept elderly group and csDMARDs youth group， and that of etanercept elderly group was higher than that of csDMARDs elderly group. During the 12 week follow-up， a total of 11 patients had mild adverse events， and there was no significant difference in adverse events between the two groups. Conclusion Etanercept has good efficacy and safety for RA patients of different ages， and can significantly improve the disease activity of patients， especially for young patients.

Objective To evaluate the cleaning effect of combined use of simethicone emulsion， sodium bicarbonate and acetylcysteine on the upper gastrointestinal mucosa. Methods Patients who underwent gastroscopy in the Digestive Endoscopy Center of the First People's Hospital of Luoyang from November 2023 to January 2024 were randomly divided into four groups using a random number table， The groups received the following oral medicatins 10-30 minutes before gastroscopy， group 1： simethicone emulsion （80 mg） + sterilized water （40 mL）； group 2： simethicone emulsion （80 mg）+acetylcysteine （600 mg）+ sterilized water （40 mL）； group 3： simethicone emulsion （80 mg）+2.5% sodium bicarbonate （40 mL）； group 4， simethicone emulsion （80 mg）+2.5% sodium bicarbonate （40 mL）+acetylcysteine （600 mg）. The clarity of the gastroscopic visual field of the gastric fundus， gastric body， and gastric antrum was scored， and the occurrence of flocculation precipitation was compared among all groups. Results A total of 342 patients were included. Groups 1 （77 patients） and 2 （80 patients） showed visible flocculent precipitation in the gastric mucosa， with overall endoscopic clarity scores of （5.52±1.54） and （5.56±1.54）， respectively. Groups 3 （90 patients） and 4 （95 patients） showed significantly less flocculent precipitation， and their clarity scores were （7.53±1.34） and （7.82±1.15）， respectively. The clarity scores of groups 3 and 4 were statistically significantly higher than those of groups 1 and 2 （P<0.001）. Although group 4 had the highest clarity score， there was no statistically significant difference compared to group 3 （P=0.157）. Conclusion The combined use of simethicone and sodium bicarbonate before gastroscopy effectively reduces foam formation prevents flocculent precipitation and improves gastric mucosal cleanliness. However， the addition of acetylcysteine， a mucolytic agent， did not further enhance these effects.

Objective This study aims to evaluate the anesthetic efficacy of the combination of naltrexone hydrochloride with propofol and midazolam in painless gastroscopy. Methods A total of 148 patients who underwent painless gastrointestinal endoscopy in Hohhot first hospital from March to June 2023 were included in this study， and they were divided into the observation group and control group according to the random number table method. The observation group received the combination of nalbuphine hydrochloride， midazolam and propofol， while the control group received sufentanil， midazolam and propofol. Physiological indexes， including heart rate （HR）， pulse oxygen saturation （SpO₂）， respiratory rate （RR）， and mean arterial pressure （MAP）， were compared between the two groups before anesthesia induction （T₀）， when the eyelash reflex disappeared （T₁）， 5 minutes after anesthesia induction （T₂）， and at Awakening （T₃）. Additionally， the procedure duration， propofol dosage， the time needed to wake up， the time to leave the recovery room and the incidence of adverse events were recorded. Results A total of 148 patients were included in the study， with 74 in each group. At T₂ and T₃， the HR in both groups ［（72±5）， （72±5） （73±5）， （74±6） beats/min］ were significantly lower than their respective T₀ values ［（80±6）， （80±5） beats/min］. MAP at T₂ was also significantly lower in both groups ［（73±6）， （72±5）mmHg） compared to T₀ ［（87±4）， （87±5）mmHg）. In the control group， RR and SpO₂ at T₂ and T₃ ［（12.1±1.7）， （13.2±1.7）］ breaths/min， ［（96.5%±1.3%）， （96.9%±0.9%）］ were significantly lower than at T₀ ［（16.7±1.7）， （99.0%±0.2%）］. In the observation group， RR and SpO₂ levels at T₂ and T₃ ［（14.8±1.7）， （15.8±1.7）］ breaths/min， ［（98.0%±1.0%）， （98.6%±0.6%）］ were higher than those in the control group （P<0.05）. The observation group had a shorter awakening time than the control group［（2.1±0.5）min vs （3.8±0.6）min］， The incidence of adverse reactions in the observation group was lower than that in the control group， the differences were statistically significant（all P<0.05）. Conclusion The combination of nalbuphine hydrochloride with propofol and midazolam provides a stable anesthetic effect， rapid recovery， and fewer adverse reactions， making it a promising option for clinical use in painless gastroscopy.

This case report presents a patient with idiopathic pulmonary arterial hypertension （iPAH） who developed cholestatic liver injury following bosentan administration. Through the Roussel Uclaf Causality Assessment Method（RUCAM） evaluation， it is determined that acute drug-induced liver injury is caused by bosentan. After switching from bosentan to ambrisentan， the patient's bilirubin levels normalized. This case also provides an analysis of the potential mechanisms underlying bosentan-induced cholestatic liver injury.

This article reports a case of severe adverse reaction （severe rash accompanied by fever） in a patient with ankle sprain after combined use of Biqi Capsules and Tongzhi Surunjiang Capsules. The patient recovered completely after symptomatic treatment. Based on the Naranjo Assessment Scale evaluation， the adverse reactions were likely attributed to strychnine from strychnos nux-vomica in Biqi capsules and colchicine from Colchicum autumnale in Tongzhi Surunjiang capsules. This case highlights the importance of monitoring toxic components in Biqi Capsules and Tongzhi Surunjiang capsules during clinical application. Caution is advised when prescribing these medications， paying attention to individuals reactions to ensure clinical medication safety.