Childhood simple obesity has become a significant public health issue in China. Modern medicine primarily relies on lifestyle interventions and often suffers from poor long-term compliance， while pharmacological options are limited and associated with potential adverse effects. Traditional Chinese Medicine （TCM） has a long history in the prevention and management of this condition， demonstrating eight distinct advantages， including systematic theoretical foundation， diversified therapeutic approaches， definite therapeutic efficacy， high safety profile， good patient compliance， comprehensive intervention strategies， emphasis on prevention， and stepwise treatment protocols. Additionally， TCM is characterized by six distinctive features： the use of natural medicinal substances， non-invasive external therapies， integration of medicinal dietetics， simple exercise regimens， precise syndrome differentiation， and diverse dosage forms. By combining internal and external treatments， TCM facilitates individualized regimen adjustment and holistic regulation， demonstrating remarkable effects in improving obesity-related metabolic indicators， regulating constitutional imbalance， and promoting healthy behaviors. However， challenges remain， such as inconsistent operational standards， insufficient high-quality clinical evidence， and a gap between basic research and clinical application. Future efforts should focus on accelerating the standardization of TCM diagnosis and treatment， conducting multicenter randomized controlled trials， and fostering interdisciplinary integration， so as to enhance the scientific validity and international recognition of TCM in the prevention and treatment of childhood obesity.

OBJECTIVE To establish the high-performance liquid chromatography （HPLC） fingerprint of Sagina japonica ， and to establish a quantitative analysis of multi-components by single-marker （QAMS） method for simultaneous determination of six componen ts in S. japonica ， aiming to provide references for the quality control of this medicinal herb. METHODS HPLC method was used to establish the fingerprints of 12 batches （No. S1-S12） of S . japonica according to Similarity Evaluation System of Chromatographic Fingerprint of Traditional Chinese Medicine . The similarity evaluation and identification of common peaks were conducted， followed by cluster analysis （CA） and principal component analysis （PCA） for 12 batches of samples. Using vicenin-2 as internal reference， the contents of p-hydroxy cinnamic acid， apigenin-6-C-arabinoside-8-C-glucoside， isoorientin， vitexin and 20-hydroxyecdysone were determined by QAMS method. The results were then compared with those obtained by the external standard method. RESULTS The similarities of HPLC fingerprints for 12 batches of S . japonica ranged from 0.828-0.998. A total of 17 common peaks were calibrated， and 6 common peaks were identified. Specifically， peak 5 was identified as vicenin-2， peak 7 as p-hydroxycinnamic acid， peak 10 as apigenin-6-C-arabinoside-8-C-glucoside， peak 11 as isoorientin， peak 13 as vitexin， and peak 15 as 20-hydroxyecdysone. The results of CA showed that S1-S5， S7 and S9-S11 were clustered into one category， S6 was clustered into one category， and S8 and S12 were clustered into one category. The results of PCA revealed that the accumulative contribution rate of the four main components was 89.430%. The content ranges measured by QAMS method for p-hydroxy cinnamic acid， apigenin-6-C-arabinoside-8-C-glucoside， isoorientin， vitexin and 20-hydroxyecdysone were 0.017 4-0.269 4， 0.568 8-4.240 3， 0.503 2-5.040 3， 0.024 0-0.132 0 and 2.551 3-4.881 1 mg/g， respectively. There was no significant difference in the contents of components measured between QAMS method and the external standard method （ P ＞0.05）. CONCLUSIONS The established HPLC fingerprint and QAMS method can be used for quality evaluation and quality control of S . japonica.

Objective To explore the value of MR modulated flip angle technique in refocused imaging with extended echo train(MATRIX)contrast enhanced(CE)T1-weighted fluid attenuated inversion recovery(T1 FLAIR)for detecting skull metastases.Methods Forty-four patients with malignant tumors who underwent head MR scanning for screening skull metastasis were prospectively enrolled,and skull metastasis were then confirmed by pathology or imaging examinations,including MRI,CT,radionuclide bone imaging(BS),PET/CT and follow-up.Head MATRIX CE-T1 FLAIR(group A),3D gradient recalled echo_fast spin echo with magnetization preparation(GRE_fsp)CE-T1 FLAIR(group B)and fast spin echo(FSE)CE-T1 FLAIR(group C)images of all 44 cases were acquired.The subjective scores(including images quality and diagnostic confidence)and objective evaluation results of images were compared among groups.Taken BS or PET/CT results as standards,the efficacy of 3 kinds of images for detecting skull metastases was calculated.Results The subjective scores of images quality and diagnostic confidence,as well as signal-to-noise ratio(SNR)in group A and C were all higher than those in group B(all P＜0.001),and signal intensity(SI)metastases in group A was higher than those in group B and C(both P＜0.05).No significant difference of subjective score and SNR was found between groups A and C,nor of SImetastases between groups B and C(all P＞0.05).Totally 102 skull metastases were diagnosed with PET/CT or BS,while 129,151 and 115 lesions were detected in group A,B and C,respectively,with accuracy rate of 79.07%(102/129),67.55%(102/151)and 88.70%(102/115),respectively.Conclusion MATRIX CE-T1 FLAIR sequence could be used to detect skull metastases.

Isotretinoin is a highly effective and commonly used drug in the clinical treatment of severe acne, but its significant reproductive toxicity limits its clinical application. Current literature studies have shown that isotretinoin exerts widespread effects on the reproductive system through multiple pathways, including interference with the retinoic acid signaling pathway, induction of oxidative stress, and apoptosis. Therefore, in-depth dissection of its reproductive toxicity mechanisms, optimization of clinical risk management strategies, and development of safer alternative drugs are of great clinical and practical significance. Future research may focus on deepening mechanisms under the framework of precision medicine, individualized prevention and control strategies, and drug innovation to balance drug efficacy and safety.This article systematically reviews the toxic effects of isotretinoin on the reproductive system, including teratogenicity, its impact on female and male reproductive function , and explores in depth its molecular mechanisms, and clinical risk management strategies.

Objective To observe the value of intratumoral and peritumoral ROI-based CT radiomics combined with clinical and imaging features for preoperatively predicting renal capsule invasion of clear cell renal cell carcinoma(ccRCC).Methods Totally 105 ccRCC patients were retrospectively collected and divided into invasion group(n=70)and non-invasion group(n=35)according to post operation pathology,also divided into training set(n=84,including 56 cases of invasion group and 28 of non-invasion group)and test set(n=21,including 14 cases of invasion group and 7 of non-invasion group)at a ratio of 8∶2.A clinical-imaging model was constructed based on clinical and CT features being significantly different between groups.Radiomics features related to renal capsule invasion were extracted and selected from intratumoral and of 1-6 mm peritumoral ROI on unenhanced phase(UP),corticomedullary phase(CMP)and nephrographic phase(NP)CT images,respectively.The optimal algorithm was selected among 6 machine learning algorisms based on CMP intratumoral ROI.With the optimal and selected features,single intratumoral or peritumoral models,combined intratumoral and peritumoral models within the same phase and combined pairwise models within the same range across different phases images were established.The best performing radiomics model was chosen and integrated with clinical and imaging features to form a combined model.Receiver operating characteristic(ROC)curves were drawn,the area under the curve(AUC)was calculated to evaluate the efficacy of model for predicting renal capsule invasion of ccRCC,which were compared using DeLong's test.Results Hypertension,presence of clinical symptoms and high enhancement degree on CMP images were all independent predicting factors for renal capsule invasion of ccRCC,which were used to establish clinical-imaging model.Support vector machine(SVM)was the optimal algorithm.CMP peritumoral 3 mm model,CMP intratumoral model,NP peritumoral 4 mm model,NP intratumoral+peritumoral 4 mm model and CMP peritumoral 3 mm+NP peritumoral 3 mm model showed higher performance than the others,with AUC being not significantly different(all P＞0.05).CMP peritumoral 3 mm model was the optimal radiomics model,with the highest AUC(0.898)in test set.The combined model demonstrated superior AUC(0.979)in training set compared to both clinical-imaging model and the optimal radiomics model alone(both P＜0.05),while in test set(AUC 0.918)showed comparable performance with the latter two(both P＞0.05).Conclusion CT-based peritumoral radiomics models were equally effective for preoperatively predicting renal capsule invasion of ccRCC.Combining with clinical and imaging features might further enhance diagnostic performance.

Isotretinoin is a highly effective and commonly used drug in the clinical treatment of severe acne, but its significant reproductive toxicity limits its clinical application. Current literature studies have shown that isotretinoin exerts widespread effects on the reproductive system through multiple pathways, including interference with the retinoic acid signaling pathway, induction of oxidative stress, and apoptosis. Therefore, in-depth dissection of its reproductive toxicity mechanisms, optimization of clinical risk management strategies, and development of safer alternative drugs are of great clinical and practical significance. Future research may focus on deepening mechanisms under the framework of precision medicine, individualized prevention and control strategies, and drug innovation to balance drug efficacy and safety.This article systematically reviews the toxic effects of isotretinoin on the reproductive system, including teratogenicity, its impact on female and male reproductive function , and explores in depth its molecular mechanisms, and clinical risk management strategies.

Objective To investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.

Objective:To investigate the expression of miR-1243 and long non-coding RNA (lncRNA) HULC in papillary thyroid carcinoma (PTC) tissues, and their relationships with clinicopathological features and postoperative prognosis of patients.Methods:A total of 116 PTC patients treated in the Second Hospital of Nanjing from August 2021 to August 2023 were selected. The expression levels of miR-1243 and lncRNA HULC in PTC tissues and adjacent normal tissues were detected by real-time fluorescent quantitative polymerase chain reaction (PCR). The differences in the expression levels of miR-1243 and lncRNA HULC between PTC tissues and adjacent normal tissues, as well as among PTC tissues with different clinical features and different prognoses, were analyzed. Receiver operating characteristic (ROC) curve was used to analyze the value of miR-1243 in predicting postoperative recurrence of PTC patients.Results:The relative expression level of miR-1243 in PTC tissues was significantly lower than that in adjacent normal tissues ( P<0.05), while the relative expression level of lncRNA HULC was higher than that in adjacent normal tissues ( P<0.05). The relative expression level of lncRNA HULC in PTC tissues of patients with tumor diameter ≥2 cm, tumor node metastasis (TNM) stage Ⅲ-Ⅳ, and lymph node metastasis was higher than that in patients with tumor diameter <2 cm, TNM stage Ⅰ-Ⅱ, and no lymph node metastasis (all P<0.05). The relative expression level of miR-1243 in PTC tissues of patients with TNM stage Ⅲ-Ⅳ and lymph node metastasis was lower than that in patients with TNM stage Ⅰ-Ⅱ and no lymph node metastasis (all P<0.05). There was no significant correlation between the expression of miR-1243 and lncRNA HULC in PTC tissues ( r=0.129, P=0.167). All patients were followed up for 12 months, and 20 patients had postoperative recurrence. The proportion of TNM stage Ⅲ-Ⅳ in recurrent patients was 70.00%(14/20), which was higher than that in non-recurrent patients [29.17%(28/96), P<0.05], and the relative expression level of miR-1243 was lower than that in non-recurrent patients ( P<0.05). There was no significant difference in the relative expression level of lncRNA HULC between recurrent and non-recurrent patients ( P>0.05). The area under the ROC curve of miR-1243 relative expression level in predicting postoperative recurrence of PTC patients was 0.809(95% CI: 0.711-0.907, P<0.05), with a cut-off value of 1.17, sensitivity of 65.00% and specificity of 87.50%. Conclusions:The expression of miR-1243 is down-regulated and lncRNA HULC is up-regulated in PTC tissues, and both are related to clinicopathological features such as lymph node metastasis and TNM stage. Among them, the expression of miR-1243 is related to postoperative recurrence.

From the perspective of dynamic and static concept in traditional Chinese medicine， we explored the pathogenesis and treatment of attention deficit hyperactivity disorder （ADHD）. ADHD is categorized into "dynamic type" and "static type" based on symptom presentation. It is believed that the core disease mechanism of static type ADHD refers to insufficiency of essence and blood， as well as the loss of nourishment of brain marrow and heart blood； the dominant mechanism of dynamic type ADHD refers to excessive use of the mind and improper diet lead to the excessive movement of dragon-thunder fire （symbolizing hyperactivity）. The treatment should first differentiate between static type and dynamic type. The treatment for static type focuses on the spleen and kidney， and involves replenishing the acquired constitution to nourish the congenital， supporting the heart and spirit， and enriching the brain and marrow， so as to ensure sufficient qi and blood， abundant essence and strong spirit， thereby improving symptoms of attention deficits. The dynamic type should be treated by static method， and involves using calming medicinals to supplement， transform， and subdue to reach the aims of enriching yin and subduing yang， warming and supplementing the spleen and kidney， which helps restore the dragon-thunder fire to its balance. Based on the physiological characteristics of children， a dynamic-static differentiation and treatment system is established to provide a reference for the clinical treatment of ADHD.

ObjectiveTo develop the Evidence Grading Scale for Ancient classical prescriptions in Traditional Chinese medicine， assess its reliability and validity， and apply it in practice to provide multi-source evidence for clinical practice guidelines development. MethodsLiterature retrieval was conducted to extract and screen existing evaluation dimensions， then the initial items were summarized using thematic analysis. Experts in the clinical medicine， medical history and literature participated in the Delphi questionnaire survey to evaluate and refine the items. An expert consensus meeting was conducted to finalize the included items， refine the method for items evaluation and evidence grading. The evidence quality rating scale for ancient classical traditional Chinese medicine （TCM） prescriptions was then established and tested for reliability and validity. ResultsThrough literature review， extraction， screening and summarization， a total of 3 dimensions and 12 initial items were formed. Questionnaires were sent to 69 experts to evaluate the initial items， with a questionnaire response rate of 100% and an expert authority coefficient of 0.92. All 12 items were retained for they had importance scores above 4. The Evidence Grading Scale on Ancient classical prescriptions in Traditional Chinese medicine includes 3 dimensions with 12 items. The 3 dimensions includes ancient evidence， inheritance status， and modern application. Each dimension contains 4 items， and each item has a full score of 5 points. The evidence was rated as high-level， moderate-level， and low-level according to the final scores. The content validity index （CVI） of the 12 items was ＞0.9， the average CVI of the scale was 0.98， and the intraclass correlation coefficient （ICC） was 0.90. ConclusionThe Evidence Grading Scale on Ancient classical prescriptions in Traditional Chinese medicine has good reliability and validity， which is practical for use in the development of TCM clinical guidelines and can better support clinical decision-making.