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）］

AIM: To assess the association between the Dem, axial length/corneal radius ratio(AL/CR ratio), and the refractive status of children aged 3 to 14, compare the efficiency of Dem with AL/CR ratio in predicting myopia, and to explore a more effective method for quantitatively predicting the refractive state of children.METHODS: This cross-sectional study involved 519 children aged 3 to 14, including 519 eyes(data from the right eyes were used). All participants were out-patients at the ophthalmic clinic of Xi'an No.1 Hospital from March 2021 to December 2022. The axial length(AL), keratometry(K), Dem, and spherical equivalent refraction(SER)were recorded before ciliary paralysis, and myopia was defined when the SER ≤-0.50 D.RESULTS: There was a positive correlation between SER and Dem(r=0.88, P<0.01), and a negative correlation between SER and the AL/CR ratio(r=-0.87, P<0.01)in children aged 3-14. The optimal cutoff points for the Dem and AL/CR ratio were 20.40 D, and 3.02, respectively. Myopia could be diagnosed when the Dem ≤20.40 D or the AL/CR ratio ≥3.02. SER decreased by 0.57 D for every 1 D decrease in Dem and by 1.00 D for every 0.06 increase in the AL/CR ratio. The area under the ROC curve(AUC)for Dem(0.958)was significantly greater than that for the AL/CR ratio(0.940).CONCLUSION: There is a positive correlation between SER and Dem, and a negative correlation between SER and the AL/CR ratio in children aged 3-14. Dem is more efficient than the AL/CR ratio in myopia assessment. The eye biometrics directly provide Dem values, which is more convenient for calculating the dose-effect relationship with SER, thus making it more efficient for predicting SER in children.

Objective:To detect the changes in the levels of miR-21-5p and miR-125a-5p modified with 3′-terminal 2′-O-methylation (3′t-2′Ome) in serum extracellular vesicles (EV) of non-small cell lung cancer (NSCLC) patients, and evaluate their value as auxiliary screening molecular markers for NSCLC patients.Method:A retrospective analysis was conducted on the data of 69 NSCLC patients diagnosed at the Eastern Theater Command General Hospital from May 1st to October 31st,2023, as well as 65 age and gender matched healthy controls during the same period. Two real-time fluorescence quantitative PCR (RT-qPCR) techniques, namely stem-loop method and poly (A) tailed method, were used to detect the levels of 3′t-2′Ome-miR-21-5p and 3′t-2′-Ome miR-125a-5p in serum EV of NSCLC patients and controls.Analyze the correlation between the levels of two types of 3′t-2 ′Ome miRNAs and the differences in clinical stage, pathological classification, and other tumor indicators in patients. Receiver operating characteristic (receiveroperating curve, ROC) curves were used to analyze the efficacy of 3′t-2 ′Ome miR-21-5p and 3′t-2′ Ome miR-125a-5p in serum EV, as well as their combination, in diagnosing NSCLC.Result:Compared with the control group, the levels of 3′t-2′Ome-miR-21-5p in serum EV of NSCLC patients increased [(0.30±0.05) vs (0.35±0.09), t=3.32, P=0.001], while the levels of 3′t-2′Ome-miR-125a-5p decreased [(0.33±0.06 vs 0.25±0.06, t=7.45, P<0.001]. The differences were statistically significant. The expression levels of 2′Ome-miR-21-5p in EV were also significantly elevated in the NSCLC patients at 0-Ⅱ stage, adenocarcinoma patients, and squamous cell carcinoma patients, respectively. Notably, the levels of EV 3′t-2′Ome-miR-21-5p was also statistically significant between the adenocarcinoma patients and squamous cell carcinoma patients [(0.34±0.85) vs (0.40±0.12), P<0.05]. ROC curve analysis showed that the levels of 3′t-2 ′Ome miR-21-5p and 3′t-2′ Ome miR-125a-5p in serum EV, as well as their combined AUC for discriminating NSCLC patients, were 0.647(95% CI 0.550-0.743), 0.825(95% CI 0.756-0.894) and 0.860(95% CI 0.797-0.923), respectively. The sensitivity was 92.3%, 80.0%, 89.2%, and the specificity was 46.4%, 73.9%, and 78.3%, respectively. Conclusion:There are changes in the levels of 2 ′Ome miR-21-5p and 2′ Ome miR-125a-5p in the serum EV of NSCLC patients, and the combined detaction has the potential as an auxiliary screening molecular marker of NSCLC patients.

Objective To retrieve,evaluate and summarize the related evidences on non-pharmacological management of sarcopenia in community-dwelling older adults to provide an evidence-based basis for formula-ting a scientific and effective health management program for sarcopenia in older adults.Methods According to the"6S"evidence resource pyramid model,the UpToDate,JBI Center for Evidence-based Health Care,Co-chrane Library,DynaMed,Guidelines International Network,Registered Nurses'Association of Ontario,Med-Sci,Yimaitong,PubMed,CINAHL,Web of Science,CNKI,Wanfang,and CBM for evidence related to the non-pharmacological management of sarcopenia in older adults.The retrival time was from January 1,2018 to No-vember 1,2023.Results A total of 20 literatures were included,including 1 clinical decision,2 guidelines,7 expert consensuses and 10 systematic evaluations or meta analysis.Forty-two pieces of evidence were summa-rized in 4 aspects including screening and assessment,dietary and nutritional management,exercise guidance and health education,in which there were 25 recommendations for the level A and 17 recommendations for Level B.Conclusion Medical staff should select the best evidence by combining with the actual situation,medical conditions and individual factors of the patients,and guide elderly patients with sarcopenia to improve their lifestyle and quality of life safely and effectively.

【Objective:】 To explore the effect of metacognition on self-directed learning ability of undergraduate nursing students, and the role of interpersonal communication ability and sense of self-worth between them. 【Methods:】 A total of 905 undergraduate nursing students from six colleges and universities in Shaanxi were selected as the survey subjects by convenient sampling method during August to November 2022. Metacognitive Assessment Inventory, Self-Directed Learning Ability Measurement Scale for Nursing Students, Adolescent Sense of Total Self-Worth Scale, and Supportive Communication Scale were used to conduct a questionnaire survey on undergraduate nursing students. SPSS 25.0 software was used for statistical analysis of the data. 【Results:】 Finally, 854 valid questionnaires (94.36%) were collected, and the results showed that: a) Metacognition of undergraduate nursing students significantly positively predicted self-directed learning ability (β=0.172, P<0.001). b) Interpersonal communication ability played a partial mediating role between metacognition and self-directed learning ability [β=0.019, 95%CI: 0.004~0.034)] . c) The predictive effect of metacognition on self-directed learning ability was regulated by the level of self-worth (R²=0.314, P<0.001). 【Conclusion:】 This paper indicated that the metacognition of undergraduate nursing students indirectly affects their self-learning ability through interpersonal communication ability, and their sense of self-worth plays a moderating role. It is recommended to improve the metacognitive level of undergraduate nursing students, strengthen their interpersonal communication skills, and focus on the cultivation of self-worth, so as to improve their self-directed learning ability.

Objective To examine the expression pattern of miR-135a-5p and miR-135b-5p in seminal plasma as well as the clinical value of their variation in the male patients with infertility.Methods The clinical samples of 5 kinds,including serum,morning urine,pleural effusion,cerebrospinal fluid and seminal plasma,were collected from 30 patients respectively in the Department of Clini-cal Laboratory,Jiangsu Province Hospital of Chinese Medicine from January 2019 to December 2021.In addition,the frozen seminal plasma samples from the patients with non-obstructive azoospermia,asthenozoospermia of 54 cases for each illness statuses,and 54 healthy controls with fertile ability from 2010 to 2019 in Jiangsu Province Hospital of Chinese Medicine and Jinling Hospital were also selected.Fluorescent quantitative RT-qPCR analyses were applied to measure the expression levels of miR-135a-5p and miR-135b-5p in seminal plasma.Receiver operating characteristic curve(ROC)was used to construct the area under the curve(AUCROC)to evalu-ate the ability for discriminating infertility males from healthy controls.Correlation analyses were performed to explore the correlations between the levels of miR-135a-5p and miR-135b-5p in seminal plasma and other semen parameters.Results The concentrations of miR-135a-5p and miR-135b-5p in the samples from five different kinds of body fluid showed significantly difference(H=64.88,P＜0.01 and H=64.7,P＜0.01,respectively).The highest levels were found in serum and seminal plasma,and the lowest levels were in u-rine.The concentrations of miR-135a-5p and miR-135b-5p in seminal plasma were also showed marked difference among the azoosper-mia group,asthenozoospermia group and healthy fertile control group(H=32.14,P＜0.01 and H=21.37,P＜0.01,respectively).Compared to the fertile control group,the levels of miR-135a-5p and miR-135b-5p in seminal plasma were significantly downregulated in azoospermia patients(U=687,P＜0.01 and U=843,P＜0.01,respectively).The contents of the two miRNAs showed no statistical-ly difference between asthenozoospermia patients and healthy fertile controls,but showed markedly difference between the two patients groups(U=635,P＜0.01 and U=779,P＜0.01,respectively).Receiver operating characteristic curve(ROC)analyses results re-vealed that levels of miR-135a-5p and miR-135b-5p in seminal plasma could successfully discriminate the azoospermia patients from fertile controls and asthenozoospermia patients with the AUCROC of 0.764(95％CI:0.675 to 0.854),0.711(95％CI:0.612 to 0.810)and 0.782(95％CI:0.695 to 0.869),and 0.733(95％CI:0.637 to 0.829),respectively.Correlation analyses demonstrated that the concentrations of miR-135a-5p and miR-135b-5p in seminal plasma were significantly associated with sperm concentration,total sperm motility,and percentages of progressive sperm and non-progressive sperm(all with the P-value＜0.01).Conclusion miR-135a-5p and miR-135b-5p are the highly expressed miRNA in seminal plasma,and significantly decreased in azoospermia patients.Both of them may play pivot roles in male infertility.

Objective: To investigate the clinicopathological features, diagnosis and differential diagnosis of monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL). Methods: A total of 12 specimens were collected, which were surgically resected and verified as MEITL by postoperative pathology, immumohistochemical staining and gene rearrangement at the First Affiliated Hospital of Nanjing Medical University from 2012 to 2018, and all of these had complete clinical and pathological data. The MEITL cases were reviewed to compare the clinicopathological characteristics, including morphologic and immunophenotypic features and followed up by telephone and clinic visit. Results: All the cases were diagnosed with MEITL. There were 8 males and 4 females. Male to female ratio was 2∶1, at a median age of 54 years. The sites of involvement included jejunum (4 cases), ileum (5 cases), duodenum (1 case), ileocecal junction (1 case) and rectum (1 case). The neoplastic cells were monotonous of small to intermediate cells in size with round to slightly irregular nuclei in 11 cases. The immunophenotyping showed that CD3 (12/12), CD8 (11/12), CD43 (11/12), CD56 (11/12), TIA-1 (12/12) were positive; CD5 (12/12), Gran B (9/12), and perforin (7/12) were negative. Two cases aberrantly expressed the B-cell marker CD20. A high proliferation index was demonstrated by Ki-67 immunostaining. In situ hybridization for EBER was all negative(12/12). The whole exome sequencing(WES) mutational landscape of MEITL was remarkably homogeneous, showing significantly enriched clusters among histone modifier genes, JAK-STAT and MAPK-signal pathways. Histonelysine N-methytransferase SETD2 gene was mutated in 2/4 tumors. All the patients analyzed harbored at least one mutation in the JAK-STAT signal pathway, including STAT5B (2/4), JAK3 (3/4) and STAT5A (2/4). Furthermore, frequent alterations (TP53) were observed in the MAPK pathway in 3/4 of MEITL cases. The CNV analysis derived from WES data identified multiple regions of frequent gains and losses. In particular, gains in 1q, 7q and 9q, and recurrent losses involving 7p and 8p were observed. Conclusions MEITL is a rare and aggressive type of extranodal T-cell lymphoma. The differential diagnosis of MEITL includes EATL, extranodal NT/T-cell lymphoma and other types of PTCL. Diagnosis should be correlated to clinical symptoms while the final diagnosis is mainly based on the pathological features, immunophenotypes and genetic testing.

Objective: To investigate the levels of serum piR-015151 in patients with brucellosis and evaluate its clinical value in the auxiliary diagnosis of brucellosis. Methods: Serum samples and clinical data from 73 brucellosis patients diagnosed in the Affiliated Hospital of Inner Mongolia Medical University or Zhungeer Qi Center for Disease Control and Prevention and 65 age- and gender-matched healthy controls in the Eastern Theater General Hospital of PLA during 2016 and 2017 were collected. Serum piR-015151 levels were detected by quantitative real-time polymerase chain reaction (qRT-PCR). The diagnostic value of serum piR-01515 in brucellosis was evaluated by the receiver operating characteristic (ROC) curve. Results: Serum piR-015151 levels (median \[P25, P75\]) in brucellosis patients (0.216 \[0.069, 0.426\]) were significantly higher than that in healthy controls (0.036 \[0.021, 0.070\], U=834.5,P＜0.01). The area under the ROC curve (AUCROC), sensitivity and specificity of serum piR-015151 in the diagnosis of brucellosis were 0.824 (95% CI: 0.751-0.897), 75.3% and 76.9%, respectively. Conclusion Serum piR-015151 levels in brucellosis patients increase significantly, which may be a potential marker in the auxiliary diagnosis of brucellosis.

Objective: To investigate the levels of urinary exosomal miR-194-5p in children with idiopathic nephrotic syndrome (INS) and its clinical value as a non-invasive auxiliary diagnostic marker. Methods: Urine samples were collected from 101 INS children and 98 sex- and age-matched healthy children, and the levels of urinary exosomal miR-194-5p were determined by quantitative real-time polymerase chain reaction (qRT-PCR). The clinical value of urinary exosomal miR-194-5p in the diagnosis of children′s INS was evaluated by the ROC curve and correlation analysis. Results: The levels of urinary exosomal miR-194-5p in INS children (2.420 [0.650,9.515] fmol/L) were significantly higher than that in healthy controls (0.360 [0.220,0.653] fmol/L, U=1 552, P＜0.01). Compared with the INS children before treatment, the levels of urinary exosomal miR-194-5p in clinical remission period decreased significantly (0.320 [0.145,0.523] fmol/L vs 0.975 [0.375,4.358] fmol/L, W=708, P＜0.01). Moreover, the levels of miR-194-5p in INS children with heavy urine protein (8.430 [7.225,13.070] fmol/L) were significantly higher than that with light urine protein (2.130 [1.180,3.090] fmol/L, U=0, P＜0.01). The area under the ROC curve (AUC ROC ) of miR-194-5p was 0.843 (95%CI: 0.789-0.897) for the diagnosis of INS children. Spearman correlation analysis showed that the levels of urinary exosomal miR-194-5p in INS children were negatively correlated with serum albumin levels (r=-0.300), and were positively correlated with serum total cholesterol levels (r=0.278) and 24-hour urine protein content (r=0.296, all P＜0.01). Conclusion The levels of urinary exosomal miR-194-5p in INS children increase obviously, and are closely associated with 24-hour urine protein, serum albumin and total cholesterol levels, indicating that urinary exosomal miR-194-5p may be serve as a new non-invasive fluid biopsy molecular marker for the auxiliary diagnosis of INS in children.

Objective To determine the expression levels of serum miR-25 in the patients with non-small cell lung cancer (NSCLC),and evaluate its clinical significance in the screening of NSCLC.Methods Serum samples from 82 untreated NSCLC patients,including 4 with TNM satge Ⅰ,10 with TNM stage Ⅱ,11 with TNM stage Ⅲ,53 with TNM stage Ⅳ and 4 with unknown stage,and 82 healthy controls with matched age and gender were collected,and the levels of miR-25 in these samples were determined by quantitative reverse transcription PCR (qRT-PCR).The diagnostic value of miR-25 in NSCLC was evaluated by the receiver operating characteristic (ROC) curve.Results Serum miR-25 levels in NSCLC patients were significantly higher than that in healthy controls (0.017 ± 0.028 vs 0.004 ±0.004,t =4.098,P ＜0.01).The area under the ROC curve (AUGROC),sensitivity and specificity of miR-25 for the diagnosis of NSCLC were 0.818 (95％ CI:0.753-0.882),70.7％ and 80.7％,respectively.In addition,the AUCROC,sensitivity and specificity of serum miR-25 for the screening of stage Ⅰ/Ⅱ NSCLC were 0.852 (95％ CI:0.728-0.976),78.6％ and 87.8％,respectively.Logistic regression analysis showed that miR-25 was an independent risk factor of NSCLC (OR =10.84,95％ CI:5.07-23.19,P ＜ 0.01).Conclusion Serum miR-25 levels in NSCLC patients increase significantly,indicating that it may be a novel molecular biomarker for the screening of NSCLC.