BackgroundAttention deficit hyperactivity disorder （ADHD） is a neurodevelopmental disorder characterized by age-inappropriate inattention， excessive activities incongruous with setting， and emotional impulsivity. Subthreshold ADHD （sADHD） is clinically defined as the presence of ADHD symptoms that do not meet the full diagnostic criteria for ADHD. Children with sADHD exhibit deficits in executive function， demonstrate more conduct， learning， and anxiety-related problems compared to typically developing children， and show even poorer working memory performance than children diagnosed with ADHD. Currently， there is limited epidemiological research on sADHD in China， with few studies simultaneously investigating the prevalence of both ADHD and sADHD in children. ObjectiveTo investigate the prevalence of ADHD and sADHD among children aged 6–13 years in Chongqing， analyzing their distribution characteristics within this population， with the aim of providing references for developing preventive measures against both ADHD and sADHD. MethodsFrom October to November 2023， a total of 3 398 students in grades 1–6 from six primary schools in Jiangbei District， Chongqing were selected using a stratified cluster random sampling method. The occurrence of ADHD and sADHD was evaluated by using the short version （18-item version） of the Swanson， Nolan， and Pelham IV rating scales （SNAP-IV） and the Chinese vision of Schedule for Affective Disorder and Schizophrenia for School-aged Children-Present and Lifetime Version （K-SADS-PL）. ResultsThe ADHD detection rate among children in Chongqing was 1.90% （95% CI： 0.014–0.024）. Boys showed a significantly higher ADHD detection rate than girls （χ²=7.733， P=0.005）. No statistically significant differences were found in ADHD detection rates across different grades or age groups （χ²=7.347， 12.362， P>0.05）. The sADHD detection rate was 6.32% （95% CI： 0.054–0.072）. Similarly， boys exhibited significantly higher sADHD detection rates than girls （χ²=21.005， P<0.01）. Significant differences emerged across different grades （χ²=20.559， P=0.001）， while no statistically significant difference was observed in age groups （χ²=12.070， P=0.060）. ConclusionThe ADHD detection rates were comparable across all grade levels and age groups from 6–13 years old. Second-grade children demonstrated notably higher sADHD rates compared to other grades， while boys demonstrated higher prevalence rates than girls for both ADHD and sADHD. ［Funded by Science and Health Joint Medical Research Project in Jiangbei District， Chongqing City in the Second Half of 2023 （number， 2023JBKWLH022）］

Objective To observe the clinical efficacy of Dulongneedling in the treatment of vertigo in cervical spondylosis of vertebral artery(CSA).Methods A total of 46 cases of patients with definitive diagnosis of vertigo in CSA admitted to the outpatient clinic of the Acupuncture,Muxibustion and Rehabilitation Department of Guangdong Second Traditional Chinese Medicine Hospital from June to October 2024 were selected for the study.The patients were randomly divided into observation group and control group according to the random number table method,with 23 cases in each group.The observation group was treated with Dulongten-needling in shoulder and neck,and the control group was given conventional acupuncture treatment,the course of treatment for the two groups covered two weeks.After two weeks of treatment,the clinical efficacy of the two groups was evaluated,and the changes in the scores of Evaluation Scale For Cervical Vertigo(ESCV)before and after treatment were observed in the patients of the two groups.Three dimensional pseudo-continuous arterial spin labeling(3D-pCASL)technique was applied to determin the changes in cerebral blood flow(CBF)values in the region of region of interest(ROI),and the changes in CBF values in the patients of the two groups were compared.Results(1)The total effective rate of the observation group was 91.30%(21/23),and that of the control group was 78.26%(18/23),and the efficacy of the observation group was superior to that of the control group,the difference being statistically significant(P<0.05).(2)After treatment,the ESCV scores of patients in the two groups were significantly improved(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,the difference being statistically significant(P<0.05).(3)After treatment,the CBF change values of each ROI in the two groups showed elevated(positive),and the CBF change values of the right middle cerebral artery(R-MCA)in the control group showed decreased(negative).After treatment,the CBF change values of the observation group in the blood supply areas of the right posterior inferior cerebellar artery(R-PICA),right anterior inferior cerebellar artery(R-AICA),right anterior cerebral artery(R-ACA),branches from vertebral arteries(VA)and basilar arteries(BA),bilateral superior cerebellar arteries(SCA),and bilateral posterior cerebral arteries(PCA)were significantly elevated,and the observation group was significantly superior in improving the above ROIs in the CBF change value to that of the control group,the difference being statistically significant(P<0.05).Conclusion Dulongneedling in the treatment of vertigo in CSA can significantly improve the CBF of patients,reduce the clinical symptoms such as vertigo,neck and shoulder pain,headache.

Objective: To retrospectively assess whether a lower hematocrit level (between 18% and 20%) had any impact on the safety of patients undergoing therapeutic plasma exchange (TPE), and to further determine the threshold for red blood cell supplementation prior to TPE. Methods: Clinical data from 181 adult patients who underwent TPE treatment at the Department of Blood Transfusion of our hospital from March 2023 to July 2024 were collected. The patients were divided into a study group of 44 patients (Hct ≥18% and <20%) and a control group of 137 patients (Hct≥20%). In two groups, blood volume-related safety indicators including respiration rate, heart rate, systolic blood pressure, and blood oxygen saturation levels before and after TPE were compared using t-test. Between-group differences in the grading of adverse reactions such as allergies and hypotension were analyzed using chi-square test. Results: A total of 659 TPE treatments were performed on 181 patients, with 169 TPE treatments on 44 patients in the study group (Hct≥18% and <20%) and 490 TPE treatments on 137 patients in the control group (Hct≥20%). There were no statistically significant differences in age, gender, BMI category, and the presence of cardiac insufficiency between the two groups. In the study group, there were no statistically significant differences in safety indicators such as respiration rate, heart rate, systolic blood pressure, and blood oxygen saturation level before and after TPE. In the control group, there were no statistically significant differences in heart rate and systolic blood pressure before and after TPE, but there were statistically significant differences in respiration rate and blood oxygen saturation level (P<0.05). There were no statistically significant differences in the grading of adverse reactions such as allergic reactions and hypotension between the two groups. Conclusion: For adult patients with stable conditions, maintaining a lower hematocrit level (Hct ≥18% and <20%) during TPE is relatively safe. It is feasible to lower the TPE red blood cell supplementation threshold to 18%≤Hct<20%，which may save blood resources while potentially benefit patients by avoiding unnecessary red blood cell transfusion.

Objective: To evaluate the efficacy and safety of the single-use hemoperfusion device (UA230) in treating refractory gout (RG) via plasma perfusion. Methods: Thirty-four RG patients aged 18-65 years were recruited and randomly divided into a control group (febuxostat therapy, n=17) and an experimental group (plasma perfusion combined with febuxostat therapy, n=17). Differences in serum uric acid (SUA) levels and urate-lowering rates between the two groups were analyzed using t-tests. Between-group differences in incidence of adverse reactions were analyzed using chi-square tests. Results: At 7 and 14 days post-treatment, SUA levels in the experimental group were significantly lower than those in the control group, with a higher urate-lowering rate (all P<0.05). However, no statistically significant differences in SUA levels or urate-lowering rate were observed at 28 days post-treatment (all P>0.05). The incidence of adverse reactions showed no significant difference between the two groups (χ =0.15, P>0.05). Conclusion: The single-use hemoperfusion device (UA230), combined with plasma perfusion technology, is a safe and effective treatment for RG. It may serve as a novel therapeutic approach for RG patients in clinical practice.

When artificial intelligence is integrated into medical decision-making,the ambiguous definition of technological autonomy and the multi-party game of responsibility allocation lead to legal disputes over rights and responsibilities as well as ethical challenges.Focusing on clinical diagnosis,treatment strategy generation,and prognosis assessment,this paper reveals the data bias and decision traceability deficiencies caused by the"black box"of algorithms,and then proposes solutions from 3 dimensions:defining responsible parties,standardizing technical defect assessments,and promoting interdisciplinary collaboration.From a legal perspective,based on the"high-risk system"classification under the European Union Artificial Intelligence Act and no-fault liability principle under the product liability relative laws,a 3-tier responsibility framework of developer-operator-medical institution is constructed:for auxiliary systems,operating physicians bear ultimate responsibility;for decision-making systems,developers are required to provide verifiable algorithms and take joint liability.Ethically,dynamic review mechanisms(such as mandatory disclosure of decision tree logic and data balance metrics)are suggested to balance technological efficiency with patients' right to informed consent.

Objective To evaluate the clinical effectiveness of single-incision intervertebral foraminotomy in treating double-segment lumbar spinal stenosis accompanied by lumbar disc herniation.Methods A retrospective analysis was conducted on 40 cases of double-segment lumbar spinal stenosis and lumbar disc herniation treated in our orthopedic(spinal surgery)department from March 2016 to May 2018.Among these cases,11 patients(Group A)were treated with percutaneous discectomy,13 patients(Group B)underwent percutaneous endoscopic discec-tomy,and 16 patients(Group C)received double-incision percutaneous surgery.General clinical data for all patients were recorded.Visual Analog Scale(VAS)scores,Japanese Orthopaedic Association(JOA)scores,and clinical outcomes were assessed at five different time points:preoperatively,immediately postoperatively,one week postoperatively,one month postoperatively,and at the final follow-up.Statistical analysis was performed on the collected data.Results The operation time,the number of fluoroscopies performed on the hands,the length of the skin incision,and patient satisfaction were all statistically significant(P<0.05).An interaction effect was observed between the operation time and the surgical procedure on both the VAS and JOA scores.Both the operation time and the surgical method had significant main effects on the VAS and JOA scores(P<0.05).Significant differences in VAS and JOA scores were found among the three groups immediately post-surgery,one week post-surgery,one month post-operation,and at the end of the study(P<0.05).Immediately after surgery,there were statistically significant differences in VAS and JOA scores among the three groups(P<0.05).One week post-surgery,there were also statistically significant differences in VAS scores among the three groups(P<0.05).Conclusions The single-incision intervertebral foramen technique is an effective approach for simultaneously addressing double-seg-ment lumbar spinal stenosis and lumbar disc herniation through decompression.This method boasts a shorter opera-tive duration,reduced intraoperative radiation exposure,and minimal tissue damage.Patient satisfaction is high,making it a valuable addition to clinical practice.

Objective To evaluate the clinical effectiveness of single-incision intervertebral foraminotomy in treating double-segment lumbar spinal stenosis accompanied by lumbar disc herniation.Methods A retrospective analysis was conducted on 40 cases of double-segment lumbar spinal stenosis and lumbar disc herniation treated in our orthopedic(spinal surgery)department from March 2016 to May 2018.Among these cases,11 patients(Group A)were treated with percutaneous discectomy,13 patients(Group B)underwent percutaneous endoscopic discec-tomy,and 16 patients(Group C)received double-incision percutaneous surgery.General clinical data for all patients were recorded.Visual Analog Scale(VAS)scores,Japanese Orthopaedic Association(JOA)scores,and clinical outcomes were assessed at five different time points:preoperatively,immediately postoperatively,one week postoperatively,one month postoperatively,and at the final follow-up.Statistical analysis was performed on the collected data.Results The operation time,the number of fluoroscopies performed on the hands,the length of the skin incision,and patient satisfaction were all statistically significant(P<0.05).An interaction effect was observed between the operation time and the surgical procedure on both the VAS and JOA scores.Both the operation time and the surgical method had significant main effects on the VAS and JOA scores(P<0.05).Significant differences in VAS and JOA scores were found among the three groups immediately post-surgery,one week post-surgery,one month post-operation,and at the end of the study(P<0.05).Immediately after surgery,there were statistically significant differences in VAS and JOA scores among the three groups(P<0.05).One week post-surgery,there were also statistically significant differences in VAS scores among the three groups(P<0.05).Conclusions The single-incision intervertebral foramen technique is an effective approach for simultaneously addressing double-seg-ment lumbar spinal stenosis and lumbar disc herniation through decompression.This method boasts a shorter opera-tive duration,reduced intraoperative radiation exposure,and minimal tissue damage.Patient satisfaction is high,making it a valuable addition to clinical practice.

Background: Epithelial ovarian cancer is the leading cause of death among gynecological malignancies. Platinum resistance remains a dilemma and bottleneck in treatment, and salvage chemotherapy has limited effectiveness. Recently, the role of secondary cytoreductive surgery (SCS) in patients with platinum-resistant recurrent ovarian cancer (ROC) has caused attention especially in patients with oligometastases. However, there is neither high-quality evidence-based evidence nor standardized criteria for selecting SCS for patients with platinum-resistant ROC until now. Methods This multicenter, randomized, controlled clinical trial is to evaluate the value of SCS and to clarify reliable criteria of utilizing SCS in women with ROC, which is led by Gynecologic Oncology Group, Women’s Hospital, Zhejiang University School of Medicine.Recruitment has started on January 1st, 2023, and is scheduled to end in December 2026.One hundred and forty participants with platinum-resistant ROC who meet the “RSCS criteria” will be randomized assigned at a ratio of 1:1 to either the experimental arm or the standard arm. Patients in the experimental arm will receive SCS followed by non-platinum single agent chemotherapy (paclitaxel, gemcitabine or liposomal adriamycin) for at least 4 cycles while patients in the standard arm will be provided with only non-platinum single agent chemotherapy. The primary outcome is progression-free survival. The secondary outcomes are overall survival, adverse events and health-related cancer-specific quality of life.

Background: Epithelial ovarian cancer is the leading cause of death among gynecological malignancies. Platinum resistance remains a dilemma and bottleneck in treatment, and salvage chemotherapy has limited effectiveness. Recently, the role of secondary cytoreductive surgery (SCS) in patients with platinum-resistant recurrent ovarian cancer (ROC) has caused attention especially in patients with oligometastases. However, there is neither high-quality evidence-based evidence nor standardized criteria for selecting SCS for patients with platinum-resistant ROC until now. Methods This multicenter, randomized, controlled clinical trial is to evaluate the value of SCS and to clarify reliable criteria of utilizing SCS in women with ROC, which is led by Gynecologic Oncology Group, Women’s Hospital, Zhejiang University School of Medicine.Recruitment has started on January 1st, 2023, and is scheduled to end in December 2026.One hundred and forty participants with platinum-resistant ROC who meet the “RSCS criteria” will be randomized assigned at a ratio of 1:1 to either the experimental arm or the standard arm. Patients in the experimental arm will receive SCS followed by non-platinum single agent chemotherapy (paclitaxel, gemcitabine or liposomal adriamycin) for at least 4 cycles while patients in the standard arm will be provided with only non-platinum single agent chemotherapy. The primary outcome is progression-free survival. The secondary outcomes are overall survival, adverse events and health-related cancer-specific quality of life.

BACKGROUND:Serum-specific biomarkers between normal healthy individuals and populations with developmental cervical canal stenosis(Qi deficiency and blood stasis syndrome)have not been fully defined. OBJECTIVE:To screen and identify the potential biomarkers of developmental cervical canal stenosis with Qi deficiency and blood stasis. METHODS:Serum samples were collected from nine patients with developmental cervical canal stenosis with Qi deficiency and blood stasis and eight healthy people.Differentially expressed proteins in serum were screened and identified using isotope relative labeling and absolute quantification combined with liquid chromatography tandem mass spectrometry.Western blot was used to verify some significant differentially expressed proteins. RESULTS AND CONCLUSION:A total of 61 differentially expressed proteins(P<0.05)were identified using tandem mass spectrometry techniques.Compared with the healthy normal population group,14 differentially expressed proteins such as complement component C1q receptor,apolipoprotein A4,and C-C motif chemokine ligand 18 were significantly upregulated,while 47 differentially expressed proteins such as myosin light chain 3,mitochondrial translation elongation factor,and nucleolar phosphoprotein 1 were significantly downregulated.The results of gene ontology enrichment analysis indicated that these differentially expressed proteins might participate in molecular functions such as regulation of chromosomal tissue,mitochondrial membrane tissue,and muscle system processes.Protein-protein interaction network analysis showed that 38 common differential proteins,including complement component C1q receptor,apolipoprotein A4,C-C motif chemokine ligand 18,myosin light chain 3,mitochondrial translation elongation factor,and nucleolar phosphoprotein 1,were located at functional network nodes between healthy normal individuals and those with developmental cervical canal stenosis(Qi deficiency and blood stasis syndrome),and were closely related to the local energy metabolism of the cervical spine,the production of cervical vertebral osteocytes,and the formation of osteoclasts.The main differentially expressed protein myosin light chain 3 was validated using western blot assay,and the validation results were consistent with the proteomic results.To conclude,the preliminary discovery of differentially expressed proteins in serum between healthy normal individuals and those with developmental cervical canal stenosis(Qi deficiency and blood stasis syndrome)through absolute quantitative technology combined with liquid chromatography tandem mass spectrometry technology suggests that myosin light chain 3 may be a specific serum marker for developmental cervical canal stenosis(Qi deficiency and blood stasis syndrome).