Attention deficit hyperactivity disorder （ADHD） is often accompanied by tic disorder. The core pathogenesis is considered to be ministerial fire scorching yin and internal stirring of deficient wind， which leads to disharmony between the body and spirit， resulting in clinical manifestations. The treatment principles emphasize nourishing yin fluids， calming ministerial fire， and extinguishing endogenous wind （内风）. The method of nourishing yin fluids is applied throughout the entire treatment process， commonly using ingredients such as Shudihuang （Rehmanniae Radix Praeparata）， Shanzhuyu （Corni Fructus）， Gouqizi （Lycii Fructus）， Wuweizi （Schisandrae Chinensis Fructus）， and Tusizi （Cuscutae Semen）. These are combined with approaches to harmonize the zang-fu organs， primarily including extinguishing liver wind， clearing heart fire， nourishing kidney water， and strengthening spleen earth， thereby stabilizing ministerial fire and extinguishing endogenous wind. Additionally， emotional regulation and smoothing emotional constraint are essential to improve clinical symptoms in children with ADHD comorbid with tic disorder.

The core pathogenesis of attention deficit hyperactivity disorder （ADHD） lies in deficiency， stasis and stagnation. Deficiency arises from kidney essence depletion and spleen dysfunction in transportation and transformation， leading to inadequate nourishment of the marrow sea. Stasis caused by qi deficiency leads to obstruction in channels and collaterals， resulting in obstructed marrow transport. Stagnation is associated with the excess of the five minds transforming into fire， which scorches the brain orifices and leads to loss of control over marrow utilisation. Based on this， a "supplementation-unblocking-regulation" therapeutic approach is proposed. For deficiency， the focus is on supplementing kidney and fortifying spleen， and replenishing the marrow sea. For stasis， the priority is to unblock and open the orifices， and clear the marrow channels. For stagnation， the core is to clear fire and contain the mind， regulate and restore vital activity. In clinical practice， it is necessary to identify the primary and secondary pathogenic mechanisms and apply dynamic， combined treatment， integrating Chinese herbal medicine， acupuncture， and guiding exercises throughout the process， aiming to provide a reference for the diagnosis and treatment of ADHD with traditional Chinese medical.

The Expert Consensus on Clinical Application of Qinbaohong Zhike Oral Liquid in Treatment of Acute Bronchitis and Acute Attack of Chronic Bronchitis （GS/CACM 337-2023） was released by the China Association of Chinese Medicine on December 13^th， 2023. This expert consensus was developed by experts in methodology， pharmacy， and Chinese medicine in strict accordance with the development requirements of the China Association of Chinese Medicine （CACM） and based on the latest medical evidence and the clinical medication experience of well-known experts in the fields of respiratory medicine （pulmonary diseases） and pediatrics. This expert consensus defines the application of Qinbaohong Zhike oral liquid in the treatment of cough and excessive sputum caused by phlegm-heat obstructing lung， acute bronchitis， and acute attack of chronic bronchitis from the aspects of applicable populations， efficacy evaluation， usage， dosage， drug combination， and safety. It is expected to guide the rational drug use in medical and health institutions， give full play to the unique value of Qinbaohong Zhike oral liquid， and vigorously promote the inheritance and innovation of Chinese patent medicines.

Objective: To systematically evaluate the influencing factors for autism spectrum disorder (ASD) in Chinese children, so as to provide the evidence for risk prediction and intervention of ASD. Methods: The publications pertaining to the influencing factors for ASD in Chinese children were retrieved from CNKI, Wanfang Data, VIP, PubMed and Embase database from inception to August 2024. A meta-analysis was performed using R package version 4.4.1. Sensitivity analysis was performed using the "leave-one-out" evaluation procedure. Publication bias was assessed using Egger regression test. Results: A total of 38 high-quality articles out of 9 015 articles were finally included, covering 149 607 individuals, with 5 974 cases of ASD. The meta-analysis showed that demographic factors including family history of related diseases (OR=14.958), maternal age of ≥35 years (OR=2.287) and parental history of hazardous occupations (OR=3.511); pregnancy-related factors including history of abortion (OR=5.832), no folate supplementation before and during pregnancy (OR=4.566), tobacco exposure before and during pregnancy (OR=2.596), history of other adverse exposures before and during pregnancy (OR=3.533), history of infectious diseases during pregnancy (OR=3.753), history of non-infectious diseases during pregnancy (OR=2.563), psychological problems during pregnancy (OR=3.864), history of medication during pregnancy (OR=6.651), adverse environmental exposures during pregnancy (OR=3.754), severe pregnancy reactions (OR=5.082), abnormal perinatal period (OR=2.987), cesarean delivery (OR=1.659), other perinatal adverse factors (OR=3.856), history of neonatal asphyxia (OR=2.792) and neonatal jaundice (OR=3.687); parenting factors including non-exclusive breastfeeding (OR=2.510), early/excessive screen exposure (OR=3.589) and feeding problems (OR=3.113); and individual factors including being male (OR=3.333) and history of convulsions/epilepsy (OR=7.035) were influencing factors for ASD in Chinese children. Conclusions The prevalence of ASD in Chinese children is primarily associated with 23 influencing factors, including family history of related diseases, history of abortion, no folate supplementation before and during pregnancy, medication during pregnancy, early/excessive screen exposure and history of convulsions/epilepsy.

Objective To investigate the effect of acupuncture at Hegu(LI4)on neural activity in the visual cortex of healthy volunteers using functional near-infrared spectroscopy(fNIRS).Methods Each healthy volunteer underwent three sets of trials in a resting state:the LI4 group received acupuncture stimulation at the right Hegu(LI4)acupoint;the negative control was the sham acupoint group(SHAM group);and the positive control was the visual stimulation group(VISUAL group).fNIRS was used to simultaneously monitor changes in oxygenated hemoglobin(Oxy-Hb)levels in the vis-ual cortex during various stages of acupuncture or visual tasks,thereby reflecting the activation level of the visual cortex.The entire acupuncture procedure was performed with the subjects' eyes closed.fNIRS recorded the raw optical density values of hemodynamics in the region of interest(ROI)of the visual cortex during each task phase.The relative coefficientβ value for oxygenated hemoglobin was obtained via Matlab analysis,and the coefficient difference Δβ value between the task period and the baseline period was calculated,representing the degree of change in oxygenated hemoglobin content in-duced by the stimulus,which reflected the change in activation level of the visual cortex after acupuncture or visual stimu-lation.A larger Δβ value indicates a higher degree of visual cortex activation.Generalized estimating equations(GEE)were applied to analyze the differences in visual cortex activation levels among the LI4,SHAM,and VISUAL groups.Results In channels 15 and 17 of the striate area and channels 10 and 13 of the extrastriate area,the Δβ values of sub-jects in the LI4 group during the needle manipulation and withdrawal phases were significantly higher than those in the SHAM group(all P＜0.01).When comparing the Δβ values of the LI4 group during the needle manipulation and withdrawal phases with those of the VISUAL group,under the current sample size,the differences were not statistically significant(all P＞0.05).The Δβ values in both the striate and extrastriate areas of the LI4 group peaked during the needle manipulation phase.Conclusion Acupuncture at Hegu(LI4)can effectively activate the visual cortex in healthy volunteers,with the most significant increase in activation observed during the needle manipulation phase.

Kaempferol(KAE),as a natural flavonoid compound,possesses multiple biological activities including po-tent anti-inflammatory,antioxidant,and immunomodulatory effects,as well as anti-cancer properties.It has demonstrated good therapeutic effects in the intervention and treatment of various ocular diseases such as fungal keratitis,corneal trans-plantation rejection,age-related macular degeneration,and diabetic retinopathy.Furthermore,the development of novel ocular drug delivery systems-such as KAE-loaded bovine serum albumin porous membranes,KAE eye drops based on poly-vinylpyrrolidone nanocomplexes,gelatin nanoparticles encapsulating KAE,and platelet-derived extracellular vesicles loaded with KAE-has improved the bioavailability of KAE,laying a foundation for expanding its applications.However,there is a lack of systematic and comprehensive reviews on the application of KAE in ophthalmic diseases.Therefore,this article summarizes the research progress,efficacy mechanisms,and novel delivery methods of KAE in ophthalmic diseases,ai-ming to provide new diagnostic and therapeutic strategies for the treatment of related ocular conditions.

Objective·To explore the value of combined diaphragm and intercostal muscle ultrasound assessment compared with conventional diaphragm ultrasound in predicting the weaning outcome in mechanically ventilated patients with sepsis.Methods·Mechanically ventilated patients with sepsis,consecutively admitted to the Department of Critical Care Medicine of Affiliated Hospital of Nantong University from October 2022 to December 2023,were selected.During the peri-weaning period,after the patient's sepsis condition improved and the patient passed the spontaneous breathing trial(SBT),ultrasound evaluation of respiratory muscles was performed by ultrasound qualified personnel with ultrasound qualification and experience in bedside ultrasound examination.Diaphragm excursion(DE),thickening fraction of diaphragm(TFD),and thickening fraction of intercostal muscle(TFic)were measured,respectively.The patients were divided into a successful weaning group(n=114)and a failed weaning group(n=24)according to the weaning results.Receiver operating characteristic(ROC)curves were used to analyze the value of diaphragm ultrasound and intercostal muscle ultrasound,alone and in combination,in predicting ventilator weaning outcome.Results·TFic and TFic/TFD were significantly higher in the failed weaning group during SBT than in the successful weaning group(all P<0.05).The areas under the ROC curve(AUROC)of DE,TFD,and TFic to predict weaning failure in mechanically ventilated patients with sepsis during the period of SBT were 0.689(0.591?0.776),0.657(0.557?0.747),and 0.769(0.676?0.846),respectively,whereas the combined indexes TFic/TFD and TFic&TFD_mix had AUROCs of 0.867(0.786?0.925)and 0.860(0.778?0.920),respectively.TFic/TFD with a cutoff value of>0.95 had a sensitivity of 86.7%and a specificity of 75.3%in predicting weaning failure,and TFic&TFD_mix with a cutoff value of>0.13 had a sensitivity of 86.6%and a specificity of 80.9%in predicting weaning failure.Moreover,the intercostal muscle ultrasonography method had an intra-observer intraclass correlation coefficient(ICC)of 0.890 and an extra-observer ICC of 0.876 for measurement reliability,which were both rated as good(P<0.001).Conclusion·Combined diaphragm and intercostal muscle ultrasonography provides a more comprehensive picture of the patient's overall respiratory muscles,and has a higher guiding value in predicting the weaning outcomes in mechanically ventilated patients with sepsis than diaphragm ultrasound alone.

Objective To explore the biomechanical safety of applying traditional Chinese orthopedic manipulation therapy after anterior cervical discectomy and fusion(ACDF)surgery,so as to provide a theoretical basis for clinical treatment in biomechanics.Methods Based on CT data,a three-dimensional finite element model of the normal C0-T1 cervical spine was established,and an ACDF postoperative finite element model of the C5-6 segment was constructed on this basis.Cervical spine rotation manipulation was simulated at the C4 and C7 segments of both models,and the von Mises stresses of the vertebral body,bilateral facet joints,intervertebral discs,and internal fixation system under manipulation loading of the C4 and C7 segments in both models were compared and analyzed.Results When the C4 segment was manipulated,the stress on the C5,C6,and C7 vertebral bodies in the ACDF postoperative model decreased by 12.3％,11.5％,and 26.4％,compared to the normal model.The stress on the left facet joints of the C4-5,C5-6,and C6-7 segments decreased by 12.3％,58.8％,and 15.4％,and the stress on the right facet joints decreased by 16.6％,92.1％,and 17.2％.The stress on the C4-5 and C6-7 segments decreased by 13.2％and 4.0％,while the maximum stress of the fusion cage,titanium plate,and screws in the C5-6 segment were 9.349,111.9,and 300.8 MPa.When the C7 segment was manipulated,the stress on the C4,C5,and C6 vertebral bodies in the ACDF postoperative model increased significantly compared to the normal model,especially the C5 vertebral body,with an increase of nearly 18 times.Except for the stress on the left facet joint of the C4-5 segment increased by 57.7％,the stress on the bilateral facet joints of other segments generally decreased,but the stress on the C4-5 and C6-7 segments increased by 43.2％and 21.7％and the stresses on the fusion cage,titanium plate,and screws in the C5-6 segment were 2.926,205.4,and 256.2 MPa.Conclusions The safety of performing manipulation on the upper vertebral body of the fusion segment after ACDF surgery is relatively high,but performing manipulation on the lower vertebral body of the fusion segment may lead to stress concentration and increase the risk of injury.When postoperative conservative treatment is implemented,the manipulation safety and indications should be considered to avoid operations in high-risk areas,and more precise and safe manipulation intervention treatment should be implemented based on the specific postoperative biomechanical state of the patient.

Objective The objective of this study was to investigate the effects of maytansine on proliferation,migration,in-vasion,apoptosis and autophagy of human thyroid cancer C643 cells.Methods C643 cells were treated with different concentrations(0.049,0.195,0.781,3.125,12.5,50 and 200 μmol/L)of maytansine,the effect of maytansine on the proliferation of C643 cells was detected by the sulforhodamine B(SRB)method,and the concentration of subsequent experiments was determined.C643 cells in the logarithmic growth stage period were divided into the control group,low-dose group,mid-dose group and high-dose group.The effects of maytansine on migration and invasion abilities of C643 cells were detected by cell scratch and Transwell chamber assay;The levels of reactive oxygen species(ROS)were detected by 2′,7′-dichlorofluorescein diacetate(DCFH-DA)fluorescent probe experi-ment;The apoptosis rate of C643 cells was detected by flow cytometry;The expression of proteins related to apoptosis or autophagy was detected by Western blot.Results Maytansine at concentrations of 0.049,0.195,0.781,3.125,12.5,50 and 200 μmol/L could in-hibit the proliferation of C643 cells(P<0.05),and exhibited a significant concentration time dependence.The half maximal inhibitory concentrations(IC50)at 24,48 and 72 h were 54.255,5.193 and 0.647 μmol/L,respectively;The cell scratch and Transwell chamber results showed that maytansine at concentrations of 0.1,1 and 10 μmol/L could reduce the migration and invasion abilities of C643 cells(P<0.05 and P<0.01).The fluorescence probe results showed that maytansine at concentrations of 0.1,1 and 10μmol/L could increase the intracellular ROS levels of C643 cells(P<0.01).The flow cytometry results showed that maytansine at concentrations of 0.1,1 and 10 μmol/L could concentration dependently increase the apoptosis rate of C643 cells(P<0.01).The Western blot results showed that with the increase of maytansine concentrations,the expression of Bax protein related to apoptosis in C643 cells increased(P<0.05),the expression of Bcl-2 decreased(P<0.05),the expression of LC3Ⅱ/Ⅰ(P<0.05)and Beclin-1(P<0.01)increased,while the expression of p62 decreased(P<0.001).Conclusion Maytansine can inhibit the proliferation,migration and invasion of human thyroid cancer C643 cells,and induce the synergistic effect on apoptosis and autophagy by increasing intracellular ROS levels.

Objective To investigate the effect of acupuncture at Hegu(LI4)on neural activity in the visual cortex of healthy volunteers using functional near-infrared spectroscopy(fNIRS).Methods Each healthy volunteer underwent three sets of trials in a resting state:the LI4 group received acupuncture stimulation at the right Hegu(LI4)acupoint;the negative control was the sham acupoint group(SHAM group);and the positive control was the visual stimulation group(VISUAL group).fNIRS was used to simultaneously monitor changes in oxygenated hemoglobin(Oxy-Hb)levels in the vis-ual cortex during various stages of acupuncture or visual tasks,thereby reflecting the activation level of the visual cortex.The entire acupuncture procedure was performed with the subjects' eyes closed.fNIRS recorded the raw optical density values of hemodynamics in the region of interest(ROI)of the visual cortex during each task phase.The relative coefficientβ value for oxygenated hemoglobin was obtained via Matlab analysis,and the coefficient difference Δβ value between the task period and the baseline period was calculated,representing the degree of change in oxygenated hemoglobin content in-duced by the stimulus,which reflected the change in activation level of the visual cortex after acupuncture or visual stimu-lation.A larger Δβ value indicates a higher degree of visual cortex activation.Generalized estimating equations(GEE)were applied to analyze the differences in visual cortex activation levels among the LI4,SHAM,and VISUAL groups.Results In channels 15 and 17 of the striate area and channels 10 and 13 of the extrastriate area,the Δβ values of sub-jects in the LI4 group during the needle manipulation and withdrawal phases were significantly higher than those in the SHAM group(all P＜0.01).When comparing the Δβ values of the LI4 group during the needle manipulation and withdrawal phases with those of the VISUAL group,under the current sample size,the differences were not statistically significant(all P＞0.05).The Δβ values in both the striate and extrastriate areas of the LI4 group peaked during the needle manipulation phase.Conclusion Acupuncture at Hegu(LI4)can effectively activate the visual cortex in healthy volunteers,with the most significant increase in activation observed during the needle manipulation phase.