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.

Objective To explore the application of artificial intelligence (AI) in the standardized training of thoracic surgery residents, specifically in enhancing clinical skills and anatomical understanding through AI-assisted lung nodule identification and lung segment anatomy teaching. Methods Thoracic surgery residents undergoing standardized training at Peking Union Medical College Hospital from September 2023 to September 2024 were selected. They were randomly assigned to a trial group and a control group using a random number table. The trial group used AI-assisted three-dimensional reconstruction technology for lung nodule identification, while the control group used conventional chest CT images. After basic teaching and self-practice, the ability to identify lung nodules on the same patient CT images was evaluated, and feedback was collected through questionnaires. Results A total of 72 residents participated in the study, including 30 (41.7%) males and 42 (58.3%) females, with an average age of (24.0±3.0) years. The trial group showed significantly better overall diagnostic accuracy for lung nodules (91.9% vs. 73.3%) and lung segment identification (100.0% vs. 83.70%) compared to the control group, and the reading time was significantly shorter [ (118.5±10.5) s vs. (332.1±20.2) s, P<0.01]. Questionnaire results indicated that 94.4% of the residents had a positive attitude toward AI technology, and 91.7% believed that it improved diagnostic accuracy. Conclusion AI-assisted teaching significantly improves thoracic surgery residents’ ability to read images and clinical thinking, providing a new direction for the reform of standardized training.

ObjectiveTo observe the efficacy of Sangmei Pingfeng granules combined with western medicine in the treatment of patients with allergic asthma in the chronic persistent stage， diagnosed with lung-spleen Qi deficiency syndrome in traditional Chinese medicine （TCM）. MethodsA retrospective analysis was conducted on 420 patients with allergic asthma in the chronic persistent stage and TCM-diagnosed lung-spleen Qi deficiency syndrome， treated at the Third Affiliated Hospital of Beijing University of Chinese Medicine from January 2017 to September 2024. Patients were divided into an exposed group （320 cases） and a non-exposed group （100 cases） based on whether they used Sangmei Pingfeng granules. The non-exposed group received conventional western medicine treatment， while the exposed group took Sangmei Pingfeng Granules in addition to conventional western medicine. The following indicators were observed： recurrence rate per 100 patients per year， pulmonary function tests， fractional exhaled nitric oxide （FeNO） and fractional nasal nitric oxide （FnNO） tests， serum total IgE （TIgE） detection， TCM syndrome score， and changes in asthma control test （ACT） scores between the two groups. ResultsThe annual recurrence rate per 100 people was 8.4 times/100 person-years in the exposed group， lower than the 13 times/100 person-years in the unexposed group. After treatment， the exposed group showed increases in forced vital capacity percentage predicted （FVC%pred）， forced expiratory volume in one second percentage predicted （FEV₁%pred）， the ratio of forced expiratory volume in one second to forced vital capacity （FEV₁/FVC）， and peak expiratory flow percentage predicted （PEF%pred） （P0.05）. Lung function indicators in the non-exposed group showed no statistically significant differences after treatment. Residual volume as a percentage of total lung capacity （RV%TLC） showed no statistically significant difference after treatment in either group. Compared with the non-exposed group， the exposed group had increased FVC%pred， FEV₁%pred， FEV₁/FVC， and PEF%pred， without statistically significant differences. After treatment， fractional exhaled nitric oxide （FeNO）， fractional nasal nitric oxide （FnNO）， and total immunoglobulin E （TIgE） decreased in the exposed group. FeNO decreased in the non-exposed group （P0.05）. FnNO decreased， and TIgE increased in the non-exposed group， without statistically significant differences. After treatment， compared with the non-exposed group， the treatment group had decreased FeNO （P0.05）. After treatment， traditional Chinese medicine （TCM） syndrome scores decreased， and asthma control test （ACT） scores increased in both groups （P0.01）. After treatment， compared with the non-exposed group， the exposed group had decreased TCM syndrome scores and increased ACT scores （P0.01）. ConclusionCombining Sangmei Pingfeng granules with Western medicine significantly reduces recurrence rates， enhances clinical efficacy， improves lung function， lowers serum TIgE and FeNO levels， and reduces reliance on Western medications in patients with allergic asthma. This integrated approach is worthy of clinical promotion and application.

ObjectiveTo analyze the correlation between the clinical symptoms， signs， syndrome characteristics and laboratory indicators of cough variant asthma （CVA） and deepen the understanding of the treatment of this disease based on the theory of "Fu Feng". MethodsAn observational study was conducted. A total of 207 CVA patients who visited the respiratory department of the Third Affiliated Hospital of Beijing University of Chinese Medicine from September 2022 to November 2023 were included. The information from the four diagnostic methods and the laboratory test results of patients were collected. Factor analysis was conducted on the information obtained through the four diagnostic methods in TCM， and the nature and location of CVA were extracted. Sample cluster analysis （Q clustering） and the K-means method were used for data clustering analysis to determine the syndrome types of CVA and analyze the syndrome characteristics and differences in laboratory indicators among different syndrome types. ResultsThe main symptom of CVA patients was cough， accompanied by symptoms such as itchy throat， foreign body sensation in the throat， dry throat， shortness of breath， dry mouth， chest tightness， hoarseness， bitter mouth， poor appetite， and skin itching. Factor analysis showed that the disease was located in the lung， involving the liver， spleen， and kidney. The pathological factors involved Yin deficiency， Yang deficiency， wind factor， dampness factor， Yin factor， and Qi stagnation. Cluster analysis revealed four syndrome types： Fengfu Yinshang syndrome， Shixie Neiyun syndrome， Tanyin Zufei syndrome， and Ganhuo Fanfei syndrome. Fengfu Yinshang syndrome accounted for the highest proportion， followed by Tanyin Zufei syndrome. There were no significant differences in eosinophil count and percentage， fractional nasal nitric oxide （FnNO） level， and pulmonary function indexes among the four syndromes. The levels of serum total IgE and fractional exhaled nitric oxide （FeNO） in patients with Fengfu Yinshang syndrome were significantly higher than those in patients with Shixie Neiyun syndrome and Tanyin Zufeisyndrome. ConclusionCough is the main symptom of CVA， accompanied by pharyngeal itching， foreign body sensation in the throat， dry throat， shortness of breath， dry mouth， and allergic manifestations. The disease involves the lung， liver， spleen， and kidneys. The essence of the pathogenesis lies in a latent dormant pathogen and a disorder of the pivot mechanism. The four common syndrome types are Fengfu Yinshang syndrome， Shixie Neiyun syndrome， Tanyin Zufei syndrome， and Ganhuo Fanfei syndrome. The TCM syndrome types are correlated with laboratory indexes. The serum total IgE and FeNO of patients with Fengfu Yinshang syndrome are worse.

Based on the theory of "three regions and sanjiao" in traditional Chinese medicine (TCM), the acupuncture-moxibustion differentiation and treatment system is explored and constructed for spasm syndrome, so as to provide a clearer guiding framework for TCM treatment of spasm syndrome. This disorder is caused essentially by the invasion of pathogenic wind, and located in brain marrow. The key regions of illness cover five zang organs and five tissues, and the core pathogenesis is associated with wind disturbance in brain marrow. In differentiation, spasm syndrome refers to overall transmission (from the upper to the lower) and local transmission (from exterior to interior). This disorder can be classified into sanjiao spasm (heart-lung spasm of the upper jiao, liver-spleen spasm of the middle jiao, and liver-kidney spasm of the lower jiao) and three-region spasm (skin-vessel spasm of the upper region, tendon-muscle spasm of the middle region, and tendon-bone spasm of the lower region). Based on "three regions and sanjiao" theory of acupuncture and moxibustion, 7 "expelling-wind" points can be selected in terms of the etiology of this disease. Baihui (GV20)-toward-Taiyang (EX-HN5) needling is applied to regulate the brain marrow, focusing on the core location of illness; and regarding the key location of illness, the combination of back-shu and front-mu points and that of jing-well and xing-spring points are adopted to regulate five zang organs. The five needling techniques (half needling, leopard-spot needling, joint needling, Hegu needling and shu needling) are used to regulate five tissues.
Humans ; Acupuncture Therapy ; Spasm/diagnosis* ; Moxibustion ; Acupuncture Points ; Medicine, Chinese Traditional ; Diagnosis, Differential

Objective:To compare the clinical effects of pedicle screw internal fixation under different approaches for the treatment of asymptomatic thoracolumbar fractures.Methods:Retrospective analysis was conducted to collect data from 83 patients with asymptomatic thoracolumbar fractures treated with pedicle screw internal fixation at Handan Central Hospital from January 2023 to December 2023. Based on different surgical approaches, 40 patients who underwent regular percutaneous approach surgery were included in the conventional approach group, and 43 patients who underwent modified Wiltse approach surgery were included in the modified approach group. The perioperative indexes and postoperative complications of the two groups were statistically analyzed. The visual analogue score (VAS) was compared before operation, 1 month after operation and 3 months after operation. The anterior vertebral height, Cobb angle and fracture healing factors were compared before operation and 3 months after operation.Results:The surgical time, incision length and intraoperative fluoroscopy frequency of the modified approach group were all lower than those of the conventional approach group: (65.75 ± 7.16) min vs. (74.28 ± 6.85) min, (6.75 ± 0.42) cm vs. (9.58 ± 0.50) cm and (9.22 ± 1.24) times vs. (21.03 ± 2.45) times, with statistically significant differences ( P<0.05). The total incidence of postoperative complications in the modified approach group was 9.30% (4/43), while the total incidence of postoperative complications in the conventional approach group was 15.00% (6/40), with no statistically significant difference ( P>0.05). The VAS of the modified approach group was lower than that of the conventional approach group at 1 and 3 months after surgery: (3.05 ± 0.82) points vs. (3.86 ± 0.85) points and (1.62 ± 0.32) points vs. (2.24 ± 0.54) points, with statistically significant differences ( P<0.05). Three months after surgery, the height of the anterior vertebral edge, serum type Ⅰ procollagen N-terminal propeptide and platelet-derived growth factor in the modified approach group were significantly higher than those in the conventional approach group: (72.96 ± 9.27)% vs. (67.58 ± 9.02)%, (174.36 ± 16.75) μg/L vs. (146.24 ± 15.86) μg/L, (250.28 ± 14.62) U/L vs. (241.20 ± 12.75) U/L, the Cobb angle was lower than that of the conventional approach group: (10.15 ± 1.32)° vs. (12.20 ± 1.86)°, with statistically significant differences ( P<0.05). Conclusions:The modified Wiltse approach and percutaneous approach pedicle screw internal fixation are safe and effective in treating asymptomatic thoracolumbar fractures; but compared to the latter, the former has a shorter surgical time, fewer intraoperative fluoroscopy sessions, and less postoperative pain. It has better effects in improving the height of the anterior edge of the injured vertebra, Cobb angle recovery, and fracture healing factors.

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.

To observe the effect of penthorum chinense pursh(PCP)on diarrhea in weaned pig-lets,and to explore its mechanism through network pharmacology and in vivo animal experiments.Animal experiment 1 A total of 160 1-day-old piglets were randomly divided into control group,low-dose prevention group(0.25％),medium-dose prevention group(0.50％)and high-dose pre-vention group(1.00％).Starting from the 14 th day,0.25％,0.50％and 1.00％PCP were added to the basal diet of the three prevention groups and weaned.PCP was stopped on the 29th day,and the diarrhea rate of piglets was recorded for 35 d.In animal experiment 2,35 4-week-old male Kunming mice were randomly divided into 5 groups(control group,LPS group,low-dose group,medium-dose group and high-dose group)for 8 d.The low-dose group,the medium-dose group and the high-dose group were intragastrically administered with 200,400 and 800 mg/kg PCP for 7 consecutive days,respectively.The control group and the LPS group were intragastrically administered with the same amount of sterile saline.On the 8th day of the experiment,except that the Control group was intraperitoneally injected with sterile normal saline,the other groups were intraperitoneally injec-ted with the same amount of LPS(15 mg/kg)to establish an intestinal injury model.HE staining was used for ileal histopathological observation,and fluorescence quantitative PCR was used to de-tect the expression levels of inflammatory factors and tight junction protein mRNA.The TCMSP database was used to screen the active components and targets of PCP,and the GeneCards database was used to obtain the targets of diarrhea.The targets of PCP and diarrhea were imported into Li-anchuan biological cloud platform,and the Venn diagram was obtained after intersection.The pro-tein-protein interaction(PPI)network was constructed by combining Cytoscape 3.7.1 and STRING database,and GO and KEGG enrichment analysis was performed by KOBAS-i platform.The results showed that compared with the control group,the diarrhea rate of weaned piglets in the low-dose prevention group(0.25％),the medium-dose prevention group(0.50％),and the high-dose prevention group(1.00％)was significantly reduced at 28-62 d(P＜0.05).According to the prediction of network pharmacology,there were 32 corresponding targets of 145 potential com-ponents of PCP,6 332 targets of diarrhea,and 118 intersection targets.The protective mechanism of PCP in the treatment of diarrhea may be related to NF-κB and PI3k-Akt signaling pathways.Further experiments confirmed that compared with the LPS group,PCP can significantly improve the pathological state of ileum in mice,the mRNA expression level of intestinal tight junction pro-tein Occludin(P＜0.05)was reversed.At the same time,PCP also significantly down-regulated the mRNA level of NF-κB.The results showed that PCP may alleviate diarrhea in piglets through multiple targets and multiple pathways.The main mechanism may be related to the inhibition of Akt-NF-κB signaling pathway.This study is conducive to providing a theoretical basis for the clini-cal application of PCP.

Objective To explore the effect of acupuncture combined with manual reduction on pain and lumbar function in elderly patients with degenerative lumbar spondylolisthesis under the guidance of the Bone Strengthening and Tendon Softening Theory.Methods Ninety elderly patients with lumbar spondylolisthesis treated in our hospital from January 2021 to April 2023 were selected as study subjects.Based on a random number table method,the participants were divided into experimental group and control group,each consisting of 45 cases.The control group received acupuncture treatment,while the experimental group received manual reduction treatment on top of that.Both groups underwent continuous treatment for 4 weeks.We compared the two groups in Traditional Chinese Medicine(TCM)syndrome score,Visual Analog Scale(VAS)score,Japanese Orthopaedic Association(JOA)lumbar function score,Oswestry Disability Index(ODI),serum inflammatory factor level,and clinical efficacy between before and after treatment.Results Before treatment,there was no statistically significant difference in TCM syndrome scores or VAS scores between the two groups(P＞0.05).After treatment,both TCM syndrome scores and VAS scores significantly decreased in both groups,with the experimental group showing significantly lower scores than the control group(P＜0.05).Before treatment,there was no statistically significant difference in JOA scores and ODI scores between the two groups(P＞0.05).After treatment,JOA scores significantly increased in both groups,with the experimental group showing significantly higher scores than the control group(P＜0.05).ODI scores significantly decreased in both groups,with the experimental group showing significantly lower scores than the control group(P＜0.05).Before treatment,the two groups did not differ significantly in serum IL-6,TNF-α,or CRP levels(P＞0.05).After treatment,serum IL-6,TNF-α,and CRP levels significantly decreased in both groups,with the experimental group showing lower levels than the control group(P＜0.05).The total effective rate in the experimental group was 88.89％,significantly higher than 68.89％ in the control group(P＜0.05).Conclusion Acupuncture combined with manual reduction guided by the Bone Straightening and Tendon Softening theory can effectively alleviate pain,improve various TCM syndromes,enhance lumbar function level,and show significant clinical efficacy in patients.