Objective To explore the effect of metformin combined with insulin detemir on intestinal flora in patients with gestational diabetes mellitus (GDM). Methods A total of 176 patients with GDM admitted to Luzhou People's Hospital from May 2022 to July 2023 were selected and randomly divided into a single drug group and a combined group, with 88 cases in each group. The single drug group was treated with insulin detemir, and the combined group was given metformin combined with insulin detemir. The glucose metabolism levels and intestinal flora distribution were compared between the two groups before treatment and during delivery. The maternal-infant outcomes were statistically analyzed and compared between the two groups. Results During delivery, the levels of fasting plasma glucose (FPG), glycosylated hemoglobin (HbAlc), and largest amplitude of glycemic excursions (LAGE), and the contents of Enterobacterium, Enterococcus and Escherichia coli in both groups were reduced compared with those before treatment, and the above indicators in the combined group were lower than those in the single drug group (all P<0.05). The contents of Bifidobacterium and Lactobacillus were increased in both groups, and the indicators were higher in the combined group than those in the single drug group (all P<0.05). There was no significant difference in adverse maternal-infant outcomes between the two groups (P>0.05). Conclusion Metformin combined with insulin detemir can effectively reduce blood glucose levels and improve intestinal flora distribution in patients with GDM, without increasing adverse maternal-infant outcomes.

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.

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 understand the current status and characteristics of clinical trials for oral diseases in China, for the purpose of providing a reference for the research and development of oral diseases in China.Methods:Retrieving the information on clinical trials related to oral diseases registered on the "Platforms for drug clinical trial registration and information" of the National Medical Products Administration from the date of the database establishment to December 31, 2024. The number of clinical trials, type of drugs, trial phases, indication, trial scope, design types were statistically analyzed.Results:As of December 31, 2024, a total of 578 drug clinical trials for oral disease were registered, accounting for 2.1% (578/27 905) of the clinical trials disclosed on the platform during the same period. Bioequivalence clinical trials accounted for the highest proportion [73.9% (427/578)], followed by Phase Ⅰ [9.0% (52/578)], Phase Ⅱ [8.0% (46/578)], and Phase Ⅲ [4.5% (26/578)]. The 578 clinical trials involved 149 types of trial drugs, mainly chemical drugs, among which 127 were developed by domestic pharmaceutical enterprises and 27 by international pharmaceutical enterprises (the five investigational drugs have undergone clinical trials by both domestic and international pharmaceutical companies). The project leader units of the 578 drug clinical trials were distributed in 27 provinces, autonomous regions, municipalities, and Hong Kong Special Administrative Region. Excluding 427 bioequivalence clinical trials, the project leader units of 151 new drug clinical trials showed a significant aggregation phenomenon, and only three specialized oral hospitals have served as project leader units for drug clinical trials.Conclusions:The number of drug clinical trials for oral disease in China has generally shown an increasing trend, but there are still problems such as small number of clinical trials, low proportion of investment in new drug development and international multicenter trials, concentrated indications of clinical trials and insufficient clinical trial experience in specialized oral medical institutions. Enhancing the enthusiasm and innovation capabilities of domestic pharmaceutical enterprises in the research and development of oral diseases drugs, exploring the advantages of traditional Chinese medicine/natural medicine resources for oral diseases, and establishing a clinical research system in specialized oral medical institutions are of great significance for the development of oral drugs.

Objective:To understand the current status and characteristics of clinical trials for oral diseases in China, for the purpose of providing a reference for the research and development of oral diseases in China.Methods:Retrieving the information on clinical trials related to oral diseases registered on the "Platforms for drug clinical trial registration and information" of the National Medical Products Administration from the date of the database establishment to December 31, 2024. The number of clinical trials, type of drugs, trial phases, indication, trial scope, design types were statistically analyzed.Results:As of December 31, 2024, a total of 578 drug clinical trials for oral disease were registered, accounting for 2.1% (578/27 905) of the clinical trials disclosed on the platform during the same period. Bioequivalence clinical trials accounted for the highest proportion [73.9% (427/578)], followed by Phase Ⅰ [9.0% (52/578)], Phase Ⅱ [8.0% (46/578)], and Phase Ⅲ [4.5% (26/578)]. The 578 clinical trials involved 149 types of trial drugs, mainly chemical drugs, among which 127 were developed by domestic pharmaceutical enterprises and 27 by international pharmaceutical enterprises (the five investigational drugs have undergone clinical trials by both domestic and international pharmaceutical companies). The project leader units of the 578 drug clinical trials were distributed in 27 provinces, autonomous regions, municipalities, and Hong Kong Special Administrative Region. Excluding 427 bioequivalence clinical trials, the project leader units of 151 new drug clinical trials showed a significant aggregation phenomenon, and only three specialized oral hospitals have served as project leader units for drug clinical trials.Conclusions:The number of drug clinical trials for oral disease in China has generally shown an increasing trend, but there are still problems such as small number of clinical trials, low proportion of investment in new drug development and international multicenter trials, concentrated indications of clinical trials and insufficient clinical trial experience in specialized oral medical institutions. Enhancing the enthusiasm and innovation capabilities of domestic pharmaceutical enterprises in the research and development of oral diseases drugs, exploring the advantages of traditional Chinese medicine/natural medicine resources for oral diseases, and establishing a clinical research system in specialized oral medical institutions are of great significance for the development of oral drugs.

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 establish the ultra-high performance liquid chromatography(UPLC)fingerprint of Jingtian granule,and to evaluate its quality by chemical pattern recognition.METHODS Luna? Omega Polar C18 column(150 mmX2.1 mm,1.6 μm)was used as the chromatographic column,and acetonitrile-0.2％phosphoric acid solution was used as the mobile phase for gradient elution.The flow rate was 0.2 mL/min,the column temperature was 30 ℃,and the detection wavelength was 265 nm.With peak 16 as the reference peak,the UPLC fingerprint of Jingtian granule was established by the Similarity Evaluation System of Chromatographic Fingerprint of Traditional Chinese Medicine(2012 edition).The common peaks were identified,the similarity evaluation was carried out,and the ownership of each common peak was confirmed.Hierarchical cluster analysis(HCA)and principal component analysis(PCA)in chemical pattern recognition methods were used to classify 13 batches of samples(S1-S13),and orthogonal partial least squares-discriminant analysis(OPLS-DA)was used to identify the key components of the differences between different batches of samples.RESULTS RSDs of precision,repeatability and stability of the UPLC method were not more than 4.4％.A total of 25 common peaks were identified in the fingerprints of 13 batches of Jingtian granules.By comparing with the reference substance fingerprint,10 common peaks were identified,namely peak 3(5-hydroxymethyl-2-furaldehyde),peak 5(salidroside),peak 8(chlorogenic acid),peak 15(cinnamic acid),peak 19(aloe-emodin),peak 20(ammonium glycyrrhizinate),peak 21(rhein),peak 23(emodin),peak 24(glycyrrhetinic acid),peak 25(chrysophanol).The similarities of fingerprints of 13 batches of samples were 0.955-0.996.The results of HCA showed that 13 batches of samples could be divided into three categories,among which samples S1,S5,S7,S11-S13 were clustered in one category,S4 and S6 were clustered in one category,S2,S3 and S8-S10 were clustered in one category.PCA results showed that the cumulative variance contribution rate of principal components 1-7 was 92.666％.OPLS-DA further identified 13 differential components,which were mainly derived from Polygonati Rhizoma with wine steaming,Rhodiolae Crenulatae Radix Et Rhizoma,prepared Rhei Radix Et Rhizoma and Glycyrrhizae Radix Et Rhizome Praeparata Cum Melle.CONCLUSIONS The established UPLC fingerprint of Jingtian granule is simple,stable and reproducible.Combined with the chemical pattern recognition method,it can effectively reveal the overall quality difference between different batches of Jingtian granule.The quality of Polygonati Rhizoma with wine steaming,Rhodiolae Crenulatae Radix Et Rhizoma,prepared Rhei Radix Et Rhizoma,Dioscoreae Nipponicae Rhizoma,Polyporus,Cinnamomi Ramulus,Glycyrrhizae Radix Et Rhizome Praeparata Cum Melle is the key to the overall quality of Jingtian granule.

Computational fluid dynamics (CFD) is an emerging technology applied in the field of cardiovascular medicine, which can obtain hemodynamic data by simulating the blood flow in the patient′s heart for cardiac function assessment and disease diagnosis. Left ventricular function plays a key role in the occurrence and development of cardiomyopathies and coronary disease. CFD can reconstruct the left ventricular anatomic structures of patients to clarify pathophysiologic mechanisms and analyze hemodynamic parameters to evaluate left ventricular function, verify surgical efficacy, and guide surgical strategy, which has a positive effect on achieving early diagnosis and reducing mortality from cardiomyopathies and coronary disease. At present, there are still technical limitations in the large-scale clinical application of CFD, and various solutions are being developed and tested, and further improvement and refinement are needed.

BACKGROUND:The specific molecular mechanism of the transformation from normal healthy people to acute cervical spondylotic radiculopathy has not been clear,which needs to be further studied. OBJECTIVE:To investigate the differential expression of serum proteomics between normal healthy people and patients with acute cervical spondylotic radiculopathy,and to find and identify potential specific serum markers between them. METHODS:The serum samples of eight patients with acute cervical spondylotic radiculopathy and eight normal healthy people were collected,and the proteomic screening and analysis were performed by tandem mass tag combined with liquid chromatography-tandem mass spectrometry technology,in order to explore and identify serum proteins differentially expressed in patients with acute cervical spondylotic radiculopathy. RESULTS AND CONCLUSION:A total of 183 significantly differential proteins were screened by tandem mass tag technology,and 11 significantly differential proteins were identified(P＜0.05).Compared with normal healthy people,three differential proteins were significantly up-regulated,including human leukocyte antigen-A,secretoglobin family 1a member 1,and protein 4-hydroxyphenylpyruvate dioxygenase,and seven differential proteins were significantly down-regulated,such as immunoglobulin heavy constant gamma 3,skin factor,and myosin light chain 3,in patients with acute cervical spondylotic radiculopathy.Gene ontology enrichment analysis showed that these differential proteins participated in antigen binding,immunoglobulin receptor binding and other molecular functions.Protein-protein interaction analysis showed that among the common differential proteins between normal healthy people and patients with acute cervical spondylotic radiculopathy,HLA-A,HPD,PSMA3,DMKN,SCGB1A1,and MYL3 were located at the nodes of the functional network,and were closely related to the systems of body immunity,cellular inflammatory response,energy metabolism,and mechanical pressure.The significantly differential proteins HLA-A,HPD and MYL3 were verified by western blot,and the results were consistent with those of proteomics.To conclude,tandem mass tag combined with liquid chromatography-tandem mass spectrometry technology can be used to find the differentially expressed proteins in serum between normal healthy people and patients with acute cervical spondylotic radiculopathy.It is preliminarily believed that HLA-A,HPD and MYL3 may be specific serum markers of acute cervical spondylotic radiculopathy,providing a new direction for further research on its pathogenesis.

BACKGROUND:Anterior subtotal corpectomy,decompression and fusion is a conventional method to treat cervical degenerative diseases.A titanium cage is an important implant to maintain the stability of the cervical spine after subtotal corpectomy.In recent years,many patients have complications such as titanium cage sinking,which are highly controversial. OBJECTIVE:To investigate the internal biomechanical relationship between the tilt angle of the titanium cage and postoperative titanium cage subsidence after anterior subtotal cervical corpectomy,decompression and fusion. METHODS:A three-dimensional finite element model of the C4-C6 segment was established by CT images of a normal human cervical spine,in which the anterior subtotal resection,decompression and fusion of the C5 vertebral body were simulated,and titanium cages with different tilt angles(-6° to-1° negative angle,that is,the front edge of titanium cage is shorter than the rear edge of titanium cage;1° to 6° positive angle,that is,the front edge of titanium cage is longer than the rear edge of titanium cage)were placed.After setting the boundary conditions,preloads of 50,100 and 150 N were applied respectively on the C4 vertebral body.The stress value of each contact point between the titanium cage and C4 lower-end plate and C6 lower-end plate(seven stress contact points on the contact surface of titanium mesh)was recorded and statistical analysis was conducted. RESULTS AND CONCLUSION:(1)The tilt angles of the titanium cage of the positive angle group and negative angle group under 50,100 and 150 N stress respectively were found by Mann Whitn test,with P<0.05,which was statistically significant.The dispersion coefficients of the positive angle group were smaller than those of the negative angle group under 50,100 and 150 N stress conditions.(2)Under 50,100 and 150 N stress conditions,the Wilcoxon sign rank test in the positive angle group of titanium cage tilt angle found that when the angle was set to 1° to 5°,the difference was not statistically significant(P>0.05).However,when the tilt angle of the titanium cage was set to 6°,the difference was statistically significant(P<0.05).(3)Under 50,100 and 150 N stress conditions,the Wilcoxon sign rank test in the negative angle group of titanium cage tilt angle found that when the tilt angle was set to-1° to-6°,the difference was not statistically significant(P>0.05).(4)It is concluded that in the sagittal position,the titanium cage with a positive tilt angle is more stable than with a negative tilt angle,which is more suitable for clinical use.The tilt angle of the titanium cage is relatively stable in the range of 1° to 5°.When the tilt angle is 6°,the stability starts to decline,which is easy to cause complications of titanium cage sinking after surgery.It is more suitable to select the titanium cage with a tilt angle of 1° to 5° according to the clinical situation during surgery to improve the efficacy.