Refractive error is a common ophthalmic disease in children. It refers to the mismatch between the axial length and the refractive power that results in visual blur, which is usually driven by the interaction of genetic and environmental factors. The impacts of pregnancy and puerperium-related factors on refractive error in children have gradually gained attention. According to the different stages of pregnancy, this review summarizes the impacts of four aspects on refractive error in children, including lifestyle during pregnancy, complications and comorbidities during pregnancy, adverse pregnancy outcomes and other factors, which aims to provide perinatal healthcare clues for the prevention and control of refractive error in children, achieve prevention beforehand and reduce the public health burden of refractive error in children.

Refractive error is a common ophthalmic disease in children. It refers to the mismatch between the axial length and the refractive power that results in visual blur, which is usually driven by the interaction of genetic and environmental factors. The impacts of pregnancy and puerperium-related factors on refractive error in children have gradually gained attention. According to the different stages of pregnancy, this review summarizes the impacts of four aspects on refractive error in children, including lifestyle during pregnancy, complications and comorbidities during pregnancy, adverse pregnancy outcomes and other factors, which aims to provide perinatal healthcare clues for the prevention and control of refractive error in children, achieve prevention beforehand and reduce the public health burden of refractive error in children.

ObjectiveTo analyze the relationship between somatic symptoms， five-state personality and emotional symptoms of bipolar disorder （BD）， and to provide a reference for the clinical diagnosis and treatment of BD. MethodsThe basic information of the BD patients was collected， and the self-administered somatic symptom questionnaire was used to investigate the somatic symptoms with a frequency of ＞20%， which were scored as the somatic symptom scores； the 24-item Hamilton Depression Scale （HAMD） was used to evaluate the patients' depressive symptoms， the Young Mania Rating Scale （YMRS） was used to evaluate the patients' manic symptoms， the Hamilton Anxiety Scale （HAMA） was used to evaluate the patients' anxiety symptoms， and Five-State Personality Test was used to evaluate the patients' five-state personality （including taiyang personality， shaoyang personality， yin-yang balance personality， shaoyin personality， and taiyin personality）. Network analysis and linear regression were used to analyse the correlation between the somatic symptom scores and the five-state personality scores， HAMD scores， YMRS scores， and HAMA scores. ResultsThere were 269 patients with BD included， and 19 somatic symptoms with a frequency of ＞20%， the top three being lack of strength （152 cases， 56.51%）， dry mouth （137 cases， 50.93%）， and preference for cold drinks （112 cases， 41.64%）， and the somatic symptom scores were ［7.0 （0，10.0）］ points； the YMRS scores were ［3.0 （0， 7.5）］ points； the HAMD scores were ［11.0 （5.0， 18.0）］ points； and HAMA score was ［6.0 （2.0， 10.0）］ points. Among the five-state personalities， taiyang personality ［10.0 （7.0， 13.0）］ score； shaoyang personality ［10.0 （7.5， 13.0）］ score； yin-yang balance personality ［5.0 （3.0， 7.0）］ score； shaoyin personality ［13.0 （10.0， 16.0）］ score； and taiyin personality ［14.0 （9.0， 18.0）］ score. Complex network analysis showed that BD somatic symptoms were positively correlated with taiyin personality score （r = 0.23）， HAMD score （r = 0.21）， and YMRS score （r = 0.13）； taiyin personality score was positively correlated with HAMD score （r = 0.17） and negatively correlated with YMRS score （r = -0.03）. Linear regression analyses showed that somatic symptom scores were positively correlated with HAMD score （β = 0.138， P = 0.003）， YMRS score （β = 0.128， P = 0.006）， and taiyin personality scores （β = 0.182， P＜0.001）. ConclusionDepression， mania， and taiyin personality are independent risk factors for somatic symptoms in patients with BD， and taiyin personality is strongly associated with somatic symptoms in patients with BD.

ObjectiveTo investigate the developmental characteristics of gross motor skills and executive functions, and the correlation between them in school-age children with attention deficit hyperactivity disorder (ADHD). MethodsFrom November, 2020 to May, 2021, 90 children with ADHD were recruited from Peking University Sixth Hospital and Beijing Haidian Wanquan Primary School, and other 90 children with normal development from this primary school were recruited matched their age and gender. Gross motor skills were assessed with the Test of Gross Motor Development in Children, Third Edition (TGMD-3), and inhibitory control, working memory, and cognitive flexibility were assessed with Stroop Color Words Test (SCWT), Rey-Osterrich Complex Figure Test (ROCFT) and Trail Making Test (TMT), respectively. ResultsThe TGMD-3 score was significantly lower in children with ADHD than in normal children (t = -6.275, P < 0.001), while the test results of SCWT, ROCFT and TMT were worse (|t| ≥ 1.986, P ≤ 0.05). The TGMD-3 score of children with ADHD was negatively correlated with the word sense reaction time (r = -0.261), the number of word sense errors (r = -0.404) and the number of color errors (r = -0.326) (P < 0.05), positively correlated with the delayed structural memory scores (r = 0.228) (P < 0.05), and negatively correlated with the TMT-A reaction time (r = -0.255), the number of TMT-A errors (r = -0.329), TMT-B reaction time (r = -0.214) and the number of TMT-B errors (r = -0.474) (P < 0.05). Stratified linear regression analyses showed that the TGMD-3 score of children with ADHD was significant only in predicting test results for inhibitory control and cognitive flexibility (P < 0.05), with explanations of 8.7% and 22.5%, respectively. ConclusionDevelopments of both gross motor skills and executive function delay in children with ADHD, and there is a relation between them, especially the level of gross motor skills relating to the developments of inhibitory control and cognitive flexibility.

Objective: To explore the longitudinal correlation between smartphone multitasking and depressive symptoms, so as to provide an evidence based basis for promoting the mental health of college students. Methods: A total of 967 college students were recruited from one university in Taiyuan, Chongqing, and Shenzhen cities, China, by using multi stage randomized cluster sampling from October to December 2021 at baseline, and a follow up survey was conducted in May 2022. Smartphone multitasking behaviors were assessed by means of the Assessment of Smartphone Multitasking for Adolescents (ASMA), and depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) among college students. Chi square tests were performed to compare the differences in depressive symptoms between different groups of demographic characteristics, and binary Logistic regression models were employed to analyze the associations between smartphone multitasking and depressive symptoms among college students. Results: The rates of depressive symptoms among college students at baseline and follow up were 35.2% and 42.3%, respectively. Compared to the low level smartphone multitasking index group at baseline, the moderate and high level groups were more likely to experience depressive symptoms at baseline (moderate level group: OR=1.74, 95%CI =1.22-2.50, high level group: OR=2.77, 95%CI =1.94-3.95) and followup (moderate level group: OR=1.41, 95%CI =1.01-1.95, high level group: OR=1.64, 95%CI =1.17-2.29) ( P <0.05). In addition, compared to the persistently low smartphone multitasking index, increased risk of depressive symptoms was associated with maintaining a moderate to high ( OR=2.94, 95%CI =1.83-4.71), and a higher ( OR=2.07, 95%CI =1.31-3.27) or lower smartphone multitasking index ( OR=2.02, 95%CI =1.27-3.19) ( P <0.05). Moreover, higher smartphone multitasking index scores were positively associated with the risk of new-onset depressive symptoms at follow up ( OR=1.87, 95%CI=1.07-3.27, P <0.05). Conclusions Smartphone multitasking behaviors are find to be associated with an increased risk of depressive symptoms in college students. There is a need to reduce smartphone multitasking in order to decrease depressive symptoms and promote students mental health.

ObjectiveTo explore the elements， distribution and characteristics of traditional Chinese medicine （TCM） syndromes in depressive episodes of bipolar disorder （BD）. MethodsBasic information， along with the four examination information， the Hamilton Depression Scale and Young Mania Rating Scale scores， were collected from 293 outpatients with BD at Beijing Anding Hospital， Capital Medical University. The four examination information with an occurrence rate greater than 12% were retained. The R language “dist” function was used to calculate the distances between samples using the Euclidean distance method. The hierarchical clustering of the four examination information was performed using the “hclust” function and the squared Euclidean distance method. A team of five researchers was formed to determine the nature and location of the essential elements of TCM syndrome in BD based on the clustering results. The PC algorithm was used to construct a Bayesian network model of the essential elements. The working group combined the essential elements of TCM syndromes in the Bayesian network according to the reference model results， and then extracted common TCM syndromes. The score of each patient based on the essential elements was matched with the common TCM syndromes to determine the syndrome type of each patient. The working group then performs conformity and revision based on this， obtaining the final distribution of TCM syndromes for the patients. ResultsThere were 77 common TCM symptoms in BD with a frequency greater than 12%. The top 15 symptoms with higher frequencies were slippery pulse， mental fatigue and lack of strength， wiry pulse， excessive rumination， preference for solitude， vexation， agitation and irritability， dry mouth， palpitations， profuse dreaming， unwarranted worries， chest oppression， thin white coating， amnesia， frequent sighing， and poor appetite. TCM syndrome elements of BD can be grouped into 11 categories. The nature of disease-related essential elements included fire， qi deficiency， blood deficiency， qi counterflow， yin deficiency， dampness， heat， fire from constraint， and phlegm. The location of disease-related essential elements included heart， liver， spleen， stomach， kidney， bladder channel， and gallbladder. By constructing a Bayesian network model and considering the opinions from the experts， six common syndromes of BD were identified， among which the highest proportion was heart-stomach heat accumulation， accounting for 27.99% （82 cases）， followed by heart-spleen deficiency （55 cases， 18.77%）， non-interaction between the heart and the kidney （49 cases， 16.72%）， liver constraint and blood deficiency （42 cases， 14.33%）， heart qi deficiency （37 cases， 12.63%）， and damp-heat in the liver and gallbladder （28 cases， 9.56%）. ConclusionsThe nature of disease-related elements of BD are predominantly fire and heat， while the location of disease-related essential elements are primarily associated with the heart， liver， and spleen. The most common TCM syndromes are heart-stomach heat accumulation and heart-spleen deficiency.

Objective:To observe any effect of cooling on the amplitude of vibration-induced sensory nerve action potentials (SNAPs) in human digits.Methods:The middle fingers of 15 healthy adults were either cooled to about 22℃ using an ice pack or kept at about 32℃. A vibrator was applied to the joint connecting the middle finger and the palm vibrating with an amplitude of 2mm at a frequency of 60Hz. The amplitudes of middle finger SNAPs before, during and right after the vibration were recorded.Results:The SNAP amplitude at a given temperature was lower during vibration than before it, but it immediately returned to the pre-vibration level after the vibration ceased. The middle finger SNAP amplitudes at 22℃ were significantly higher than those at 32℃ throughout. The decrease in amplitude at 32℃ (61.7±15.1%) was significantly greater than that at 22℃ (24.1±7.0%).Conclusions:Cooling significantly reduces the effect of vibration on the amplitude of digital SNAPs. That suggests a way to protect the sensory nerves in hand-arm vibration syndrome.

ObjectiveTo explore the characteristics of fine motor skills of school-age children with attention deficit hyperactivity disorder (ADHD) in different sexes. MethodsFrom April, 2021 to April, 2023, 66 ADHD children from grades one to four in Beijing Haidian Wanquan Primary School were screened by psychiatrists, and other 69 ADHD children were recruited from hospitals and patient groups of WeChat, accounting to 135 ADHD children. Meanwhile, a total of 135 typically developed (TD) children matched with sex and age (< 0.5 year) were recruited from the same primary school as controls. They were assessed with Movement Assessment Battery for Children (MABC-2) four subtests of manual dexterit. ResultsAfter controlling age, the subtest scores and the total score of fine motor of MABC-2 were less in ADHD boys and girls than in the TD boys and girls (P < 0.05). The main effect of sex was significant on the subtest scores and the total score of fine motor for ADHD children (F > 5.133, P < 0.05), and they were less in the boy than in the girls (P < 0.05). ConclusionThe development of fine motor delays in school-aged ADHD children, especially for the boys.

Objective To observe the electromyography characteristics of children's handwriting with attention deficit hyperactivity disorder(ADHD),and explore its electrophysiological mechanism,so as to provide an objective basis for developing non-pharmacological treatment for such children.Methods Between September 2021 and April 2022,29 ADHD children were recruited from an ordinary public primary school and the psychiatric clinic of a class-3 grade-A hospital in Beijing.Among them,25 were boys and 4 were girls,with an average age of 8.21±1.78 years.Meanwhile,23 male and 5 fe-male healthy counterparts were selected with the age gap no more than 6 months.The Delsys wireless surface EMG system was used to collect the electromyographic signals of the abductor pollicis breve,the first dorsal interosseous muscle,the flexor radial carpi motor and the extensor finger muscles dur-ing their writing tasks such as tracing trajectories,writing Arabic numerals 0-9,26 small and capital English letters,Chinese characters one to ten and"Yong".The percentage of the averaged electromyog-raphy(AEMG)of a muscle in the sum value of all measured muscles,and the coefficient of differ-ence were selected to evaluate the muscle contribution rate and the consistency of exertion,respective-ly.Moreover,the independent sample t-test was employed to compare the two different groups with the significance set at α=0.05.Results There was a significant difference in the muscle contribution of abductor pollicis breve and first dorsal interosseous muscles when writing Arabic numerals and that of abductor pollicis breve muscles when writing Chinese characters between ADHD children(27.29%,25.58%and 27.53%)and their healthy counterparts(42.87%,19.96%and 37.13%)(P<0.05).Most muscle differentiation coefficients of ADHD children were higher than 100%,with that of the domi-nant hand radial wrist flexor muscle reaching 270%in the trajectory tracing task.Conclusion Accord-ing to the characteristics of EMG signals,school-age ADHD children show an immature writing pat-tern,including poor stability of writing-related muscles,insufficient control of small finger muscle groups,poor control of hand coordination,and insufficient muscle inhibition of non-dominant hand.It is recommended to conduct the electromyoelectric assessment of handwriting movements in ADHD chil-dren,so as to carry out targeted intervention at an early stage.

Objective:To study the clinical and genetic features of neonatal Smith-Kingsmore syndrome (SKS).Methods:The clinical data of a newborn with SKS admitted to our hospital in November 2021 were reviewed. Using "Smith-Kingsmore", "rapamycin gene", "newborn", "premature infant", "the mammalian target of rapamycin", "MTOR", "mTOR", "Smith-Kingsmore syndrome", "megalencephaly", "macrocephaly" and "hemimegalencephaly" as keywords, databases including CNKI, Wanfang Database, VIP database, PubMed, Embase, Web of Science and the Cochrane Library were searched from the date of establishment to January 1, 2022. The clinical and genetic features of neonatal SKS from published literature were summarized.Results:The case admitted to our hospital was a male preterm infant. The presenting symptoms were groan and hypotonia. The facial abnormalities included macrocrania, ocular hypertelorism, depressed nasal bridge and low-set ears. Brain MRI showed lateral ventricle enlargement. Whole-genome sequencing (WGS) showed mTOR gene nonsense heterozygous mutation (NM_004958.4:c.7255G>A:p.Glu2419Lys). Neither father nor mother had any pathogenic gene mutations. The infant had seizure at 2-month and phenobarbital was effective reducing seizure. Gross motor delay was present at 3-month. Sixteen related articles were retrieved, including eight articles with 10 neonatal cases. Among them, 6 cases were male. The main clinical features were megalencephaly or hemimegalencephaly (9/10), facial developmental malformation (8/10), hypotonia (6/10), large-for-gestational age (LGA) infants (5/10), cerebral ventricle dilation (4/10) and abnormal corpus callosum (4/10). All the gene mutations were missense mutations, including c.5395G>A(p.Glu1799Lys) mutation in 5 cases, c.4448G>T(p.Cys1483Phe) mutation in 1 case, c.4448G>T(p.Cys1483Tyr) mutation in 1 case, c.7235A>T(p.Asp2412Val) mutation in 1 case, c.5663T>G(p.Phe1888Cys) mutation in 1 case, c.5390C>T(p.Thr1799IIe) mutation in 1 case.Conclusions:The clinical phenotypes of neonatal SKS are diverse, including megalencephaly, facial malformation, LGA and hypotonia. The brain MR findings included (hemi) megalencephaly, cerebral ventricle dilation and corpus callosum hypoplasia. Most of the gene mutations are missense mutations and c.5395G>A(p.Glu1799Lys) is the hotspot.