BackgroundExecutive function deficits constitute a core problem in attention-deficit/hyperactivity disorder （ADHD）. Previous assessments of executive function in children with ADHD have predominantly relied on performance-based neuropsychological tests conducted in laboratory settings， though their predictive validity for real-world functional outcomes remains limited. In contrast， ecological executive function emphasizes the evaluation of complex task management in naturalistic contexts， demonstrating a stronger predictive power for functional adaptation in daily living among children with ADHD， such as multitasking performance， social interactions and so on. However， current empirical evidence regarding ecological executive function in this population remains insufficient. ObjectiveTo investigate the executive function characteristics of children with ADHD from an ecological perspective， thereby providing references for developing targeted interventions. MethodsA case control study was conducted， including 277 ADHD children who met the Diagnostic and Statistical Manual of Mental Disorders， fourth edition （DSM-IV） criteria and were selected at the Child Health Care and Mental Health Center of Shenzhen Children's Hospital from June 2017 to December 2020， as well as 98 healthy controls were recruited from primary and secondary schools in Shenzhen. All participants were assessed using Wechsler Intelligence Scale for Children， fourth edition （WISC-IV） and Behavior Rating Inventory of Executive Function （BRIEF）. Differences in WISC-IV and BRIEF scores were compared between ADHD group and control groups， followed by the comparison of BRIEF scores by gender and ADHD subtypes. ResultsAmong the 277 children with ADHD， 136 cases （49.10%） had predominantly inattentive type （ADHD-I）， 6 cases （2.17%） had predominantly hyperactive-impulsive type （ADHD-HI）， and 135 cases （48.73%） had combined type （ADHD-C）. ADHD group demonstrated significantly lower scores on both the WISC-IV total IQ and four index scores （verbal comprehension， perceptual reasoning， working memory and processing speed） than control group （t=3.698~9.335， P<0.01）. After controlling for WISC-IV total IQ as a covariate， the scores of each factor in the dimensions of behavioral regulation index （inhibition， shifting， emotional control） and metacognition index （task initiation， working memory， planning， monitoring and organization） were all higher in ADHD group than in control group， and the differences were statistically significant （F=46.563~290.475， P<0.01）. In terms of gender， no statistically significant difference was found in BRIEF composite scores （behavioral regulation index or metacognition index） of children with ADHD （t=0.105~1.190， P>0.05）. In terms of ADHD subtypes， children with ADHD-C reported significantly higher scores than those with ADHD-I on the scores of inhibition， emotional control， organization and monitoring in BRIEF （t=2.481~7.343， P<0.05 or 0.01）. ConclusionChildren with ADHD have multidimensional deficits in ecological executive function， which vary across different subtypes. ［Funded by Shenzhen Excellent Science and Technology Innovation Talent Training Project （number， RCYX20221008092849069）； the Sanming Project of Medicine in Shenzhen］

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Objective:To investigate the causes and management strategies of anesthetic complications during percutaneous spinal endoscopic surgery under local anesthesia.Methods:A total of 16 800 patients (8 625 males and 8 175 females) who underwent percutaneous spinal endoscopic surgery under local anesthesia (including intravenous basic anesthesia) in Tianjin Hospital, Shandong Public Health Clinical Center and Hebei General Hospital from February 2012 to February 2023 were retrospectively analyzed. The average age was 45.3±21.6 years (range, 12-84 years). There were 220 cases of posterior cervical keyhole endoscopic surgery, 50 cases of thoracic transforaminal endoscopic surgery, 70 cases of thoracic posterior interlaminar endoscopic surgery, 11 670 cases of lumbar transforaminal endoscopic surgery, and 4 790 cases of lumbar posterior interlaminar endoscopic surgery. The occurrence time, clinical manifestations, management of intraoperative anesthesia complications were recorded, as well as surgical segments, puncture sites, complication symptoms, signs, outcome and prognosis.Results:All patients received percutaneous water-mediated uniaxial spinal endoscopic surgery under local anesthesia. There were 9 patients experienced anesthesia complications, including 6 cases of epidural diffusion of anesthetics and 3 cases of anesthetics mistakenly entering the subarachnoid space. There were 4 males and 5 females, aged 48.4±18.2 years (range, 28-84 years). There were 1 case of T 12L 1 disc herniation, 1 case of C 5-6 disc herniation, 3 cases of L 4-5 disc herniation and 4 cases of L 5S 1 disc herniation. Surgical segments and procedures: 1 case of C 5-6 posterior Keyhole endoscopic surgery, 1 case of T 12L 1 transforaminal endoscopic surgery, 2 cases of L 4-5 transforaminal endoscopic surgery, 1 case of L 4-5 interlaminar endoscopic surgery, and 4 cases of L 5S 1 interlaminar endoscopic surgery. Anesthesia complications all appeared 5-10 min after injection of local anesthetics, with symptoms of decreased oxygen saturation, decreased blood pressure, altered consciousness, and sensory and motor dysfunction of limbs. 6 patients with epidural diffusion of anesthetics recovered completely after symptomatic treatment in 5 cases, and 1 case was left with foot drop. Three patients with anesthetics mistakenly entering the subarachnoid space were immediately converted to the supine position, of which one recovered by mask oxygenation; 1 patient improved after emergency tracheal intubation, rehydration, and application of vasoconstrictive medications; and 1 patient developed multiple complications such as multiorgan failure, rhabdomyolysis, and sepsis after tracheal intubation, and recovered at 3 months after surgery with symptomatic treatment. Conclusions:Epidural diffusion and entering into subarachnoid space of anesthetics are serious complications of local anesthesia in percutaneous spinal endoscopic surgery. In addition to sensory and motor dysfunction of the limbs, the functions of the respiratory and circulatory systems can also be affected. It is necessary to be alert to the occurrence of anesthesia-related complications during operation and early identification and treatment.

Objective:To evaluate the sound localization ability of patients with different degrees of unilateral conductive hearing loss (UCHL) in quiet and noisy environments, and to explore the changes and characteristics of sound localization.Methods:This was a cross-sectional study. 41 patients with UCHL were hospitalized in Shandong Provincial ENT Hospital from January to April 2024, including 22 males and 19 females, aged 18-55 years old, with an average age of 36.9 years. According to the pure-tone average (PTA) of 500, 1000 and 2000 Hz in the suffered ear, subjects were divided into slight-mild UCHL group (20 numbers) and moderate-moderately severe UCHL group (21 numbers). 21 patients with normal hearing (NH) were enrolled as controls. All subjects were assessed through pure-tone audiometry, horizontal sound localization test (including azimuth identification test in quiet and noisy environments), Chinese edition short form of Spatial Hearing Questionnaire (C-SHQ12) and twelve-item version of Speech, Spatial, and Qualities of Hearing Scale (SSQ12). SPSS, version 26.0, was used for statistical analysis.Results:There were significant differences in the root-mean-square errors (RMSE) of the sound localization azimuth identification test in quiet and noisy environments among the NH group, slight-mild UCHL group, and moderate-moderately severe UCHL group (Quiet: F=29.109, P<0.001; Noisy: F=24.351, P<0.001). This presented statistically marked difference in the RMSEs between the two listening environments in the slight-mild UCHL group ( t=-4.911, P<0.001). There was a statistical difference in the RMSEs between the normal and affected sides of the subjects in the slight-mild UCHL group in the quiet environment ( t=-2.055, P<0.05), but not in the noisy environment. For moderate-moderately severe UCHL subjects, there were no differences in the RMSEs between the quiet and noisy environments ( P>0.05). What’s more，no significant differences were found between normal side and affected side in both environments ( P>0.05). The RMSEs of UCHL patients in quiet and noisy environments were positively correlated with PTA of air-conduction in the suffered ears (Quiet: r=0.681, P<0.001; Noisy: r=0.346, P<0.05). RMSEs in quiet and noisy environments were negatively correlated with the average localization scores in C-SHQ12 (Quiet: r=-0.576, P<0.001, Noisy: r=-0.613, P<0.001) and in SSQ12 (Quiet: r=-0.634, P<0.001, Noisy: r=-0.663, P<0.001). Conclusions:The sound localization ability of UCHL subjects decreased compared with those with normal hearing, and the RMSE gradually increased with the worse of air conduction hearing threshold. The localization ability of UCHL subjects was further reduced in the noisy environment compared with that in the quiet environment. The slight-mild UCHL subjects had better localization performance in the normal ears while worse in the suffered ears, however, when they were in noisy environment or their hearing loss deteriorated, the localization advantage of the normal ears was no longer obvious, and both sides of the subjects presented poor localization performance.

Objective:To explore the clinical efficacy of curcumin-mediated photodynamic therapy (PDT) for the treatment of cervical intraepithelial neoplasia (CIN) combined with human papillomavirus (HPV) infection.Methods:A prospective randomized controlled study was conducted. Eighty patients with CIN combined with HPV infection in Dingzhou People's Hospital from January 2022 to January 2023 were selected and divided into the observation group and the control group using the randomized numerical table method, with 40 cases in each group. The observation group was treated with curcumin-mediated PDT, and the control group was treated with recombinant human interferon α-2b suppository for topical application. The efficacy, HPV-DNA conversion rate, high-risk human papillomavirus (HR-HPV) load, recovery status, inflammatory cytokine level, expression of Ki-67, expression of Survivin, and occurrence of adverse reactions were compared between the two groups.Results:Eighty patients aged (35±4) years old. The age, disease duration, age of first sexual experience, CIN grading, HPV typing and other general data of the two groups were compared, and the differences were not statistically significant (all P > 0.05). The total effective rate of the observation group was higher than that of the control group [95.0% (38/40) vs. 75.0% (30/40)], and the difference was statistically significant ( χ2 = 6.28, P = 0.012). The HPV-DNA conversion rates in the observation group were higher than those in the control group at 1, 3 and 6 months after treatment [1 month: 65.0% (26/40) vs. 42.5% (17/40); 3 months: 87.5% (35/40) vs. 67.5% (27/40); 6 months: 95.0% (38/40) vs. 80.0% (32/40)], and the differences were statistically significant ( χ2 values were 4.07, 4.59 and 4.11, respectively, all P < 0.05). HR-HPV loads in the observation group were lower than those in the control group at 1, 3 and 6 months after treatment (1 month: 42.4±5.8 vs. 56.7±6.7; 3 months: 31.0±4.5 vs. 40.3±3.7; 6 months: 14.5±2.4 vs. 28.8±2.4), and the differences were statistically significant ( t values were 10.24, 10.17 and 26.77, respectively, all P < 0.001). The healing time of cervical wound in the observation group was shorter than that in the control group [(30±3) d vs. (39±5) d, t = 9.37, P < 0.001]. The levels of interleukin 4, interleukin 6, interleukin 10 and relative expressions of Ki-67 and Survivin in the observation group were lower than those in the control group at 6 months after treatment (all P < 0.001). The difference in the incidence of adverse reactions between the observation and control groups was not statistically significant [12.50% (5/40) vs. 7.50% (3/40), χ2 = 0.56, P = 0.456]. Conclusions:Curcumin-mediated PDT for the treatment of patients with CIN combined with HPV infection has a high total effective rate; it can reduce the HR-HPV load and inflammatory cytokine levels, and improve the HPV-DNA conversion rate.

Objective:To investigate the causes and management strategies of anesthetic complications during percutaneous spinal endoscopic surgery under local anesthesia.Methods:A total of 16 800 patients (8 625 males and 8 175 females) who underwent percutaneous spinal endoscopic surgery under local anesthesia (including intravenous basic anesthesia) in Tianjin Hospital, Shandong Public Health Clinical Center and Hebei General Hospital from February 2012 to February 2023 were retrospectively analyzed. The average age was 45.3±21.6 years (range, 12-84 years). There were 220 cases of posterior cervical keyhole endoscopic surgery, 50 cases of thoracic transforaminal endoscopic surgery, 70 cases of thoracic posterior interlaminar endoscopic surgery, 11 670 cases of lumbar transforaminal endoscopic surgery, and 4 790 cases of lumbar posterior interlaminar endoscopic surgery. The occurrence time, clinical manifestations, management of intraoperative anesthesia complications were recorded, as well as surgical segments, puncture sites, complication symptoms, signs, outcome and prognosis.Results:All patients received percutaneous water-mediated uniaxial spinal endoscopic surgery under local anesthesia. There were 9 patients experienced anesthesia complications, including 6 cases of epidural diffusion of anesthetics and 3 cases of anesthetics mistakenly entering the subarachnoid space. There were 4 males and 5 females, aged 48.4±18.2 years (range, 28-84 years). There were 1 case of T 12L 1 disc herniation, 1 case of C 5-6 disc herniation, 3 cases of L 4-5 disc herniation and 4 cases of L 5S 1 disc herniation. Surgical segments and procedures: 1 case of C 5-6 posterior Keyhole endoscopic surgery, 1 case of T 12L 1 transforaminal endoscopic surgery, 2 cases of L 4-5 transforaminal endoscopic surgery, 1 case of L 4-5 interlaminar endoscopic surgery, and 4 cases of L 5S 1 interlaminar endoscopic surgery. Anesthesia complications all appeared 5-10 min after injection of local anesthetics, with symptoms of decreased oxygen saturation, decreased blood pressure, altered consciousness, and sensory and motor dysfunction of limbs. 6 patients with epidural diffusion of anesthetics recovered completely after symptomatic treatment in 5 cases, and 1 case was left with foot drop. Three patients with anesthetics mistakenly entering the subarachnoid space were immediately converted to the supine position, of which one recovered by mask oxygenation; 1 patient improved after emergency tracheal intubation, rehydration, and application of vasoconstrictive medications; and 1 patient developed multiple complications such as multiorgan failure, rhabdomyolysis, and sepsis after tracheal intubation, and recovered at 3 months after surgery with symptomatic treatment. Conclusions:Epidural diffusion and entering into subarachnoid space of anesthetics are serious complications of local anesthesia in percutaneous spinal endoscopic surgery. In addition to sensory and motor dysfunction of the limbs, the functions of the respiratory and circulatory systems can also be affected. It is necessary to be alert to the occurrence of anesthesia-related complications during operation and early identification and treatment.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Objective:To evaluate the sound localization ability of patients with different degrees of unilateral conductive hearing loss (UCHL) in quiet and noisy environments, and to explore the changes and characteristics of sound localization.Methods:This was a cross-sectional study. 41 patients with UCHL were hospitalized in Shandong Provincial ENT Hospital from January to April 2024, including 22 males and 19 females, aged 18-55 years old, with an average age of 36.9 years. According to the pure-tone average (PTA) of 500, 1000 and 2000 Hz in the suffered ear, subjects were divided into slight-mild UCHL group (20 numbers) and moderate-moderately severe UCHL group (21 numbers). 21 patients with normal hearing (NH) were enrolled as controls. All subjects were assessed through pure-tone audiometry, horizontal sound localization test (including azimuth identification test in quiet and noisy environments), Chinese edition short form of Spatial Hearing Questionnaire (C-SHQ12) and twelve-item version of Speech, Spatial, and Qualities of Hearing Scale (SSQ12). SPSS, version 26.0, was used for statistical analysis.Results:There were significant differences in the root-mean-square errors (RMSE) of the sound localization azimuth identification test in quiet and noisy environments among the NH group, slight-mild UCHL group, and moderate-moderately severe UCHL group (Quiet: F=29.109, P<0.001; Noisy: F=24.351, P<0.001). This presented statistically marked difference in the RMSEs between the two listening environments in the slight-mild UCHL group ( t=-4.911, P<0.001). There was a statistical difference in the RMSEs between the normal and affected sides of the subjects in the slight-mild UCHL group in the quiet environment ( t=-2.055, P<0.05), but not in the noisy environment. For moderate-moderately severe UCHL subjects, there were no differences in the RMSEs between the quiet and noisy environments ( P>0.05). What’s more，no significant differences were found between normal side and affected side in both environments ( P>0.05). The RMSEs of UCHL patients in quiet and noisy environments were positively correlated with PTA of air-conduction in the suffered ears (Quiet: r=0.681, P<0.001; Noisy: r=0.346, P<0.05). RMSEs in quiet and noisy environments were negatively correlated with the average localization scores in C-SHQ12 (Quiet: r=-0.576, P<0.001, Noisy: r=-0.613, P<0.001) and in SSQ12 (Quiet: r=-0.634, P<0.001, Noisy: r=-0.663, P<0.001). Conclusions:The sound localization ability of UCHL subjects decreased compared with those with normal hearing, and the RMSE gradually increased with the worse of air conduction hearing threshold. The localization ability of UCHL subjects was further reduced in the noisy environment compared with that in the quiet environment. The slight-mild UCHL subjects had better localization performance in the normal ears while worse in the suffered ears, however, when they were in noisy environment or their hearing loss deteriorated, the localization advantage of the normal ears was no longer obvious, and both sides of the subjects presented poor localization performance.

Objective:To explore the clinical efficacy of curcumin-mediated photodynamic therapy (PDT) for the treatment of cervical intraepithelial neoplasia (CIN) combined with human papillomavirus (HPV) infection.Methods:A prospective randomized controlled study was conducted. Eighty patients with CIN combined with HPV infection in Dingzhou People's Hospital from January 2022 to January 2023 were selected and divided into the observation group and the control group using the randomized numerical table method, with 40 cases in each group. The observation group was treated with curcumin-mediated PDT, and the control group was treated with recombinant human interferon α-2b suppository for topical application. The efficacy, HPV-DNA conversion rate, high-risk human papillomavirus (HR-HPV) load, recovery status, inflammatory cytokine level, expression of Ki-67, expression of Survivin, and occurrence of adverse reactions were compared between the two groups.Results:Eighty patients aged (35±4) years old. The age, disease duration, age of first sexual experience, CIN grading, HPV typing and other general data of the two groups were compared, and the differences were not statistically significant (all P > 0.05). The total effective rate of the observation group was higher than that of the control group [95.0% (38/40) vs. 75.0% (30/40)], and the difference was statistically significant ( χ2 = 6.28, P = 0.012). The HPV-DNA conversion rates in the observation group were higher than those in the control group at 1, 3 and 6 months after treatment [1 month: 65.0% (26/40) vs. 42.5% (17/40); 3 months: 87.5% (35/40) vs. 67.5% (27/40); 6 months: 95.0% (38/40) vs. 80.0% (32/40)], and the differences were statistically significant ( χ2 values were 4.07, 4.59 and 4.11, respectively, all P < 0.05). HR-HPV loads in the observation group were lower than those in the control group at 1, 3 and 6 months after treatment (1 month: 42.4±5.8 vs. 56.7±6.7; 3 months: 31.0±4.5 vs. 40.3±3.7; 6 months: 14.5±2.4 vs. 28.8±2.4), and the differences were statistically significant ( t values were 10.24, 10.17 and 26.77, respectively, all P < 0.001). The healing time of cervical wound in the observation group was shorter than that in the control group [(30±3) d vs. (39±5) d, t = 9.37, P < 0.001]. The levels of interleukin 4, interleukin 6, interleukin 10 and relative expressions of Ki-67 and Survivin in the observation group were lower than those in the control group at 6 months after treatment (all P < 0.001). The difference in the incidence of adverse reactions between the observation and control groups was not statistically significant [12.50% (5/40) vs. 7.50% (3/40), χ2 = 0.56, P = 0.456]. Conclusions:Curcumin-mediated PDT for the treatment of patients with CIN combined with HPV infection has a high total effective rate; it can reduce the HR-HPV load and inflammatory cytokine levels, and improve the HPV-DNA conversion rate.

Objective:To investigate the development of receptive and expressive vocabulary in Mandarin-speaking children with cochlear implants (CI) during the first year after CI activation.Methods:A total of 827 children (411 boys and 416 girls) who were implanted CI before 2.5 years of age from October 2019 to December 2022 in the Department of Auditory Implantation, Shandong Provincial ENT Hospital were included in this study. The Infant Checklist of the Mandarin Early Vocabulary Inventory (EVI) was used to assess the quantity and content of receptive and expressive vocabulary at the time of CI activation and at the 1st, 3rd, 6th, 9th, 12th months post-activation. SPSS 22.0 was used to describe the receptive and expressive vocabulary of CI children at the first year after activation.Results:During the first year after CI activation, CI children′s receptive and expressive vocabulary consistently increased with the CI usage. The average number of receptive vocabulary and expressive vocabulary respectively increased from 0 to 178, and from 0 to 97. At the first year of post-activation, the number of receptive and expressive vocabulary of CI children were superior to that of hearing-age matched typical-hearing children, but fell behind of that of chronological age matched typical-hearing children. In terms of lexical categories, receptive and expressive vocabulary was acquired in the following order: nouns, verbs, adjectives, and pronouns. Among the top 50 words that CI children could express, nouns were the most common, then followed by verbs, adjectives, and pronouns. Father′s education level can significantly and positively predictethe receptive vocabulary of CI children at the first year post-activation. At the first year after CI activation, the 10th, 25th, 50th, 75th, and 90th percentiles were 113, 149, 178, 202, 223 for the receptive vocabulary, and 9, 37, 97, 148, 188 for expressive vocabulary.Conclusion:For Mandarin speaking children with CI, the receptive and expression vocabulary continuely increased within the first year after CI activation. The ability to grasp receptive vocabulary precedes the ability to express expressive vocabulary. Compared to hearing-age matched typical-hearing children, CI children showed faster rate of the vocabulary growth, and earlier and more frequently verb expression. However, it still larged behind that of chronological age matched hearing normal children. CI children respectively understood and expressed nouns and verbs the first. In children with CI, the first concepts understood and expressed were nouns and verbs. Among the first 50 words expressed, nouns were the most numerous, and the age at which verbs were acquired was earlier than that for hearing-age matched typical-hearing children.