Abstract To clarify the service targets, service contents, and safeguard mechanisms of the basic public service program for student vision health management, the study grounded in the current status of child and adolescent myopia prevention and control in China and integrated with the practical experience and innovative practices of Wuhan National Demonstration Area for Student Vision Health Management, takes education as the main thread and schools as the base, consolidating resources from multiple stakeholders including education administrative departments, schools, families, and professional technical service institutions. Centering on four core components—vision health education, monitoring and record keeping, risk prevention and control, and dynamic management, the study constructs a multi tiered basic public service system for vision health management of primary and secondary school students. It further proposes the use of an intelligent management platform and a "three tier color coded early warning" mechanism (red, yellow, blue) to prevent and control student myopia at the source, providing schools with replicable and operable implementation pathways to enhance the level of student vision health management.

Objective:To analyze the clinical features and genetic sequencing results of a patient with Kallmann syndrome(KS) carrying digenic mutations who initially presented with osteoporosis, and to enhance awareness of this disease phenotype.Methods:Clinical data were collected, and peripheral blood DNA was extracted for whole-exome sequencing. Relevant literature was reviewed to summarize phenotypes associated with digenic/oligogenic variants involving CHD7.Results:The patient exhibited back pain, delayed development of secondary sexual characteristics, and hyposmia. Laboratory tests revealed reduced sex hormones and gonadotropin levels, while pituitary imaging was unremarkable. Bone mineral density imaging confirmed osteoporosis, and thoracolumbar X-rays showed multiple vertebral compression fractures. Genetic analysis identified a heterozygous splice-site mutation in CHD7(c.2698-1G>T) and a heterozygous missense mutation in WDR11(c.439G>A: p.D147N). According to ACMG criteria, the CHD7 mutation was classified as pathogenic, while the WDR11 variant was defined as a variant of uncertain significance(VUS). Literature review indicated that 40% of KS patients with digenic/oligogenic variants involving CHD7 presented with hearing or ocular abnormalities.Conclusion:This study reports a novel CHD7 mutation and a previously undescribed digenic combination of CHD7 and WDR11 variants in a KS patient. CHD7 variants may be implicated in auditory or ocular involvement in KS cases with digenic/oligogenic inheritances. KS patients may also manifest skeletal abnormalities in addition to hypogonadotropic hypogonadism. Tailored management of sex hormones and osteoporosis therapies across life stages is essential for optimizing bone health in KS.

Anorectal malignant melanoma is a rare and highly aggressive malignant tumor,often misdiagnosed as benign conditions such as rectal polyps or thrombosed hemorrhoids.In this case,the patient underwent 3D laparoscopic abdominoperineal resection for rectal cancer at our hospital on April 16,2024,with pathological examination confirming malignant melanoma.As of August 9,2024,contrast-enhanced computed tomography of the chest and abdomen and magnetic resonance imaging of the whole abdomen suggested multiple systemic metastases.This underscores that patients with malignant melanoma are often at an advanced stage at the time of clinical presentation.Current treatment primarily involves surgery combined with various adjuvant therapies;however,the prognosis remains poor.The cornerstone of management lies in early recognition and timely intervention.

[Objective]Based on the holistic view of"correspondence between nature and humans"in Huangdi Neijing,which is central to traditional Chinese time medicine theory,to explore a new diagnostic and therapeutic approach to insomnia from the perspective of"time".[Methods]By grounding in ancient and modern literature,this study elucidates the connotations of traditional Chinese time medicine and systematically reviews the temporal rhythms and derived theories related to insomnia in Huangdi Neijing,summarizing the approach to treating insomnia through time medicine.[Results]The disruption of the wake-sleep rhythm is a primary pathological mechanism of insomnia.The circadian rhythm,the four seasons rhythm,the exceeding the age rhythm and the meridians rhythm discussed in Huangdi Neijing are closely related to insomnia.They could be encapsulated into four major theories:the waxing and waning of Yin and Yang,the viscera and bowels managing time,the five movements and six climates,and the midnight-midday ebb flow theory.This study advocates a four-level strategy for insomnia,closely aligned with time medicine theory and the pathogenesis of insomnia,namely"regulating Yin and Yang""adapting to the four seasons""responding to annual Qi"and"reinforcement and elimination of Nazhi".[Conclusion]The time medicine concept in Huangdi Neijing has objectively effects in the prevention and treatment of insomnia,providing a new breakthrough and integration point for clinical diagnosis and treatment of insomnia.In clinical diagnosis and treatment of insomnia,the consideration of time rhythms should be fully integrated to achieve optimal therapeutic outcomes.

Anorectal malignant melanoma is a rare and highly aggressive malignant tumor,often misdiagnosed as benign conditions such as rectal polyps or thrombosed hemorrhoids.In this case,the patient underwent 3D laparoscopic abdominoperineal resection for rectal cancer at our hospital on April 16,2024,with pathological examination confirming malignant melanoma.As of August 9,2024,contrast-enhanced computed tomography of the chest and abdomen and magnetic resonance imaging of the whole abdomen suggested multiple systemic metastases.This underscores that patients with malignant melanoma are often at an advanced stage at the time of clinical presentation.Current treatment primarily involves surgery combined with various adjuvant therapies;however,the prognosis remains poor.The cornerstone of management lies in early recognition and timely intervention.

Objective:To evaluate the efficacy and safety of nebulized inhalation of recombinant human interferon (IFN) α1b injection in the treatment of respiratory syncytial virus (RSV) associated lower respiratory tract infections (pneumonia and bronchiolitis) in children.Methods:A randomized, double-blind, parallel, placebo-controlled add-on design was used.Children with pneumonia or bronchiolitis aged 2 months to 5 years who tested positive for RSV antigen within 72 hours of onset from 30 clinical trial sites including Beijing Children′s Hospital, Capital Medical University between February 2021 and December 2022 were included in this study and randomly divided into 2 groups at a ratio of 1∶1 based on a stratified-block method.Both groups received basic treatments such as cough control, asthma relieving, expectorant treatment, fever reduction, oxygen therapy, etc.The experimental group received additional nebulized inhalation of IFN α1b injection at a dose of 2.0 μg/(kg·time), twice a day.The control group received nebulized inhalation of placebo twice a day.Clinical efficacy was evaluated based on indicators such as the duration of clinical symptoms and signs, and the Kaplan-Meier method was used to calculate the median and 95% CI of the duration of clinical symptoms and signs.The Log-rank test was used to compared data between groups.Safety was assessed through the incidence of adverse reactions and laboratory tests, and the Chi-square test was used to analyze the difference between groups. Results:There were 123 children in the experimental group and 122 children in the control group.The median durations of all the 5 clinical symptoms and signs [including shortness of breath, wheezing, dyspnea (visible retractions), decreased transcutaneous oxygen saturation, and abnormal mental state] in the experimental group after treatment were slightly shortened than those in the control group [2.7 d(95% CI: 1.9-3.0 d)] vs.[2.9 d(95% CI: 2.6-3.6 d), P=0.027].The improvement in dyspnea (retractions) was especially pronounced in the experimental group, with a relief rate of 50.0% (0, 100%) on the first day of administration[compared with 0 (0, 50.0%) in the control group ( Z=2.002, P=0.025)].The median duration of dyspnea in the experimental group was nearly 1 day shorter than that in the control group [1.0 d(95% CI: 0.7-1.7 d) vs.1.8 d(95% CI: 1.0-2.5 d), P=0.046].There were no significant difference in hospital stay [6.0(5.0, 8.0) d vs.6.5(5.0, 8.0) d, Z=0.675, P=0.500], oxygen therapy duration [32.0(14.0, 96.3) h vs.39.0 (24.0, 83.2) h, Z=0.094, P=0.925], the recovery rate from clinical symptoms during treatment [(105/106, 99.1%) vs.(96/101, 95.0%)], and recurrence rate [(0/106, 0) vs.(2/101, 2.0%)] between the 2 groups (all P>0.05).However, the above-mentioned four indicators in the experimental group showed a trend of clinical benefits.The quantitative virus detection results showed that the RSV viral load in both groups decreased after treatment compared to before treatment.After 2 days of treatment, the decline rate of RSV viral load from the baseline was 0.90 lg copies/(mL·d) in the experimental group and 0.25 lg copies/(mL·d)in the control group, with a statistically significant difference ( P<0.05).Furthermore, there was no statistically significant difference in the incidence of adverse reactions between the 2 groups ( P>0.05).Importantly, no drug-related serious adverse reactions occurred in both groups. Conclusions:The nebulized inhalation therapy of IFN α1b demonstrates efficacy and safety in treating pediatric RSV associated lower respiratory tract infections.It particularly offers outstanding clinical therapeutic value for severe children.

Objective:To explore the diagnostic value of the macrophage activation syndrome/systemic juvenile idiopathic arthritis（MS）score in macrophage activation syndrome（MAS）associated with systemic juvenile idiopathic arthritis（sJIA），and to provide a reference for clinical work.Methods:This study was a retrospective case-control analysis，conducted on the patients initially diagnosed as sJIA-associated with MAS and admitted into the Department of Rheumatology and Immunology of Children's Hospital Affiliated to Xi 'an Jiaotong University from July 1st，2016 to June 30th，2023. All of the patients met the diagnostic criteria for patients with MAS associated with sJIA according to the 2016 European Alliance of Associations for Rheumatology（EULAR）/American College of Rheumatology（ACR）/Pediatric Rheumatology International Trials Organization（PRINTO）standards. The basic information at baseline，clinical manifestations，and auxiliary examination results were collected. The MS score was applied to re-evaluate the children diagnosed as sJIA-associated with MAS. When the MS score ≥-2.1，the possibility of sJIA with MAS was high. Thirty cases of sJIA without MAS were randomly selected as the control group.Results:There were 28 cases in the MAS group，including 13 males（46.43%）and 15 females（53.57%），with an average age of（7.51±4.01）years. Compared with the control group，the MAS group were significantly more likely to have high fever（ χ2=8.539， P=0.003），hepatomegaly（ χ2=11.621， P<0.001），splenomegaly（ χ2=11.710， P<0.001）and neurological involvement（ χ2=27.619， P<0.001），with the differences being statistically significant. Meanwhile，there were statistically significant differences between the two groups in terms of white blood cell count（ Z=-4.001， P<0.001），neutrophil count（ Z=-3.659， P<0.001），platelet count（ Z=-4.687， P<0.001），albumin level（ Z=-4.018， P<0.001），alanine aminotransferase（ Z=-3.846， P<0.001），aspartate aminotransferase（ Z=-5.932， P<0.001），lactate dehydrogenase（ Z=-6.150， P<0.001），triglycerides（ Z=-5.874， P<0.001），fibrinogen（ Z=-5.808， P<0.001），ferritin（ Z=-5.280， P<0.001），erythrocyte sedimentation rate（ Z=-3.971， P<0.001），ferritin/erythrocyte sedimentation rate（ Z=-5.433， P<0.001），reduction of two-line cells in blood（ χ2=11.408， P<0.001）and the presence of hemophagocytosis in bone marrow smears（ χ2=28.260， P<0.001）. Moreover，there was a statistically significant difference in MS scores between the two groups（ Z=-6.148， P<0.001），with higher MS scores in the MAS group. Nevertheless，this study showed the median MS scores of both groups ≥-2.1. Conclusion:The MS score was significant to a certain degree as reference for the diagnosis of MAS，and this study showed that the MS score in the MAS group was significantly higher than the control group. However，the median MS scores in both groups were no less than -2.1. This might be related to the influence of factors during the assessment，which made it necessary to optimize the cutoff values of the MS score. Therefore，prospective studies should be carried out on the role of MS score in early identification of MAS.

Objective:To analyze the clinical features and genetic sequencing results of a patient with Kallmann syndrome(KS) carrying digenic mutations who initially presented with osteoporosis, and to enhance awareness of this disease phenotype.Methods:Clinical data were collected, and peripheral blood DNA was extracted for whole-exome sequencing. Relevant literature was reviewed to summarize phenotypes associated with digenic/oligogenic variants involving CHD7.Results:The patient exhibited back pain, delayed development of secondary sexual characteristics, and hyposmia. Laboratory tests revealed reduced sex hormones and gonadotropin levels, while pituitary imaging was unremarkable. Bone mineral density imaging confirmed osteoporosis, and thoracolumbar X-rays showed multiple vertebral compression fractures. Genetic analysis identified a heterozygous splice-site mutation in CHD7(c.2698-1G>T) and a heterozygous missense mutation in WDR11(c.439G>A: p.D147N). According to ACMG criteria, the CHD7 mutation was classified as pathogenic, while the WDR11 variant was defined as a variant of uncertain significance(VUS). Literature review indicated that 40% of KS patients with digenic/oligogenic variants involving CHD7 presented with hearing or ocular abnormalities.Conclusion:This study reports a novel CHD7 mutation and a previously undescribed digenic combination of CHD7 and WDR11 variants in a KS patient. CHD7 variants may be implicated in auditory or ocular involvement in KS cases with digenic/oligogenic inheritances. KS patients may also manifest skeletal abnormalities in addition to hypogonadotropic hypogonadism. Tailored management of sex hormones and osteoporosis therapies across life stages is essential for optimizing bone health in KS.

[Objective]Based on the holistic view of"correspondence between nature and humans"in Huangdi Neijing,which is central to traditional Chinese time medicine theory,to explore a new diagnostic and therapeutic approach to insomnia from the perspective of"time".[Methods]By grounding in ancient and modern literature,this study elucidates the connotations of traditional Chinese time medicine and systematically reviews the temporal rhythms and derived theories related to insomnia in Huangdi Neijing,summarizing the approach to treating insomnia through time medicine.[Results]The disruption of the wake-sleep rhythm is a primary pathological mechanism of insomnia.The circadian rhythm,the four seasons rhythm,the exceeding the age rhythm and the meridians rhythm discussed in Huangdi Neijing are closely related to insomnia.They could be encapsulated into four major theories:the waxing and waning of Yin and Yang,the viscera and bowels managing time,the five movements and six climates,and the midnight-midday ebb flow theory.This study advocates a four-level strategy for insomnia,closely aligned with time medicine theory and the pathogenesis of insomnia,namely"regulating Yin and Yang""adapting to the four seasons""responding to annual Qi"and"reinforcement and elimination of Nazhi".[Conclusion]The time medicine concept in Huangdi Neijing has objectively effects in the prevention and treatment of insomnia,providing a new breakthrough and integration point for clinical diagnosis and treatment of insomnia.In clinical diagnosis and treatment of insomnia,the consideration of time rhythms should be fully integrated to achieve optimal therapeutic outcomes.

Objective:To evaluate the efficacy of a low-fluence Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser combined with light-emitting diode (LED) phototherapy in the treatment of melasma.Methods:A total of 46 female patients with melasma, with age ranging from 30 to 58 (41.4±5.8) years, were retrospectively collected from August 2022 to February 2024 at the Department of Plastic Surgery, the First Affiliated Hospital of Army Medical University. The patients were divided into two groups according to the treatment method. The experimental group received low-fluence Q-switched Nd:YAG laser treatment combined with LED phototherapy ( n=23), whereas the control group received low-fluence Q-switched Nd:YAG laser treatment alone ( n=23). The treatment interval for both groups was 4 weeks, and a total of four treatments were conducted. Treatment efficacy was evaluated at the 12-week follow-up after completion of the entire treatment course. Pre-treatment and post-treatment melasma area and severity index (MASI) scores were compared between the two groups. The pain visual analog scale (VAS) score was obtained immediately after each treatment. The occurrence of adverse reactions after treatment, including blisters, persistent erythema, hyperpigmentation, hypopigmentation, and scarring, was recorded in both groups. Results:The efficacy rates in the experimental and control groups were 87% (20/23) and 82.61% (19/23), respectively, with no statistically significant difference between them ( P=1.000). The pre-treatment MASI scores of the experimental and control groups were (24.60±8.69) and (21.48±9.01) scores, respectively, with no statistically significant difference between them ( P=0.239). The post-treatment MASI scores of the experimental group was (7.70±4.36) scores, which was significantly lower than that of the control group [(16.34±7.29) scores, P<0.001). In both groups, the post-treatment MASI scores were significantly lower than the pre-treatment MASI scores (all P<0.001). Both groups experienced mild pain during the treatment. The VAS scores for pain during laser treatment in the experimental and control groups were (1.78±0.90) and (1.61±0.89) scores, respectively, with no statistically significant differences between them ( P=0.514). In the experimental group, the VAS score for pain was zero during LED phototherapy, indicating no increase in pain. No adverse reactions such as blisters, persistent erythema, hyperpigmentation, hypopigmentation, or scarring were observed in either group. Conclusion:Low-fluence Q-switched Nd:YAG laser combined with LED phototherapy can effectively improve the efficacy of melasma treatment, without increasing pain or any other serious adverse effects during or after therapy.