OBJECTIVE To construct a risk prediction model for nonattainment plasma concentration of zonisamide in children with epilepsy， and to provide evidence for individualized dosing.METHODS Children with epilepsy who received standardized zonisamide treatment orally in Kunming Children’s Hospital were retrospectively selected as research subjects. Those treated from May 2022 to May 2024 were included in the modeling cohort， and those treated from June 2024 to January 2025 were included in the external validation cohort. According to plasma concentration， children were divided into therapeutic group and nonattainment group. Independent influencing factors for nonattainment plasma concentration of zonisamide were screened by collinearity diagnosis， univariate analysis， Lasso regression and random forest， based on which a nomogram risk prediction model was constructed and validated. Finally， the Shapley additive explanations （SHAP） method was used to interpret the features of the nomogram risk prediction model.RESULTS A total of 945 children with epilepsy were included in this study. There was no statistically significant difference in baseline data between the modeling cohort （531 cases） and the external validation cohort （414 cases） （ P ＞0.05）， indicating comparability. Through multi-stage feature screening， seven influencing factors were finally included to construct the prediction model， namely gender， age， dosage， aspartate transferase， total bilirubin， uric acid and vitamin D. The corrected area under the curve of the model was 0.799 in the modeling cohort and 0.762 in the external validation cohort， showing good calibration and clinical applicability. SHAP analysis showed that gender， dosage， total bilirubin， age and aspartate transferase were the top five important variables affecting model prediction.CONCLUSIONS The nomogram risk prediction model for nonattainment plasma concentration of zonisamide constructed in this study has stable predictive performance. Clinically， the risk of nonattainment plasma concentration can be quickly assessed by combining the child’s gender， age， dosage， liver and kidney function， and vitamin D， and the dosing regimen can be adjusted in time.

[Objective] To explore the safety and efficacy of submucosal injection of glycerol and fructose saline in bladder tumor endoscopic submucosal dissection (BT-ESD) with a 450 nm blue laser semiconductor treatment machine in the treatment of non-muscular invasive bladder cancer (NMIBC). [Methods] Clinical data of 20 patients with bladder tumor treated with submucosal injection of glycerol and fructose saline BT-ESD via a 450 nm blue laser semiconductor treatment machine at our hospital during Nov.2023 and Apr.2024 were retrospectively analyzed.The patients included 13 males and 7 females, aged (64.95±6.89) years, tumor diameter (1.02±0.24) cm, and preoperative hemoglobin (Hb) (130.55±4.36) g/L.The operation time, Hb the next day after operation, positive rate of tumor basal biopsy, postoperative bladder irrigation time, catheter indwelling time, postoperative hospital stay, complications and recurrence rate were recorded. [Results] All operations were successful, and 28 lesions were removed.The postoperative pathological results confirmed that all cases were NMIBC, and the basal mucosa biopsies were negative.The operation time was (9.40±3.14) min, postoperative Hb (130.15±4.59) g/L, bladder irrigation time (17.70±1.34) h, catheter indwelling time 1 day, and postoperative hospital stay 1 day.There were no complications such as obturator nerve reflex, bladder perforation.There were no need for blood transfusion, no conversion to open surgery, and no secondary bleeding after operation.No tumor recurrence was found during 6-month postoperative follow up. [Conclusion] Submucosal injection of glycerol and fructose saline BT-ESD with a 450 nm blue laser semiconductor treatment machine is a safe and effective method for the treatment of NMIBC.It has advantages of whole enucleation of bladder tumor, clear basal layer, small amount of bleeding, short operation time and few complications.It can be used as a day surgery and is worthy of clinical promotion.

[Objective] To analyze the infection status of hepatitis E virus (HEV) among blood donors in Zhengzhou, so as to provide data support for formulating local blood screening strategies. [Methods] Random samples from blood donors from January to December 2022 were tested for HEV RNA using PCR technology. Reactive samples were sequenced for gene analysis, and the donors were followed up. [Results] Among 21 311 samples, 3(0.14‰) were reactive for HEV RNA, all of whom were male. Genetic sequencing results revealed that one strong positive sample was genotype 4, while sequencing failed for the other two due to low viral load. A follow-up of 25 strong positive donors showed that ALT significantly increased on day 7 after donation, anti-HEV IgM and anti-HEV IgG turned positive. On day 21, ALT returned to normal, and on day 35, HEV RNA turned negative. Notably, anti-HEV IgM and anti-HEV IgG persisted until day 482. [Conclusion] There is HEV infection among blood donors in Zhengzhou, and it is necessary to expand the screening scope to comprehensively explore the prevalence and genotype distribution of HEV among blood donors.

It is believed that patients with cirrhotic ascites exhibit a pathological mechanism characterized by the decline of healthy qi and the accumulation of pathogenic factors. Clinically， treatment should be based on the theory of tonification and purging， with a staged approach distinguishing between the active phase and the remission phase. The balance between tonification and purging should be adjusted according to the progression of pathogenic and healthy actors. In the acute phase， purging should take precedence over tonification， using purging as a means of tonification to facilitate the flow of water and qi through the triple energizer. The severity of water retention， dampness， blood stasis， and heat should be carefully assessed to ensure thorough elimination of pathogenic factors while avoiding harm to healthy qi. Medication adjustments should be made once the pathogenic factors are significantly weakened. In the remission phase， an integrated approach combining both tonification and purging should be adopted， incorporating purging within tonification to clear residual pathogens and prevent recurrence. Concurrently， proactive treatment of the underlying disease is essential to achieve complete recovery and prevent the recurrence of ascites.

OBJECTIVE To compare the efficacy and safety of chemotherapy combined with tislelizumab or sintilimab in patients with advanced non-small cell lung cancer （NSCLC）， and to analyze the influential factors of prognostic. METHODS A retrospective study was conducted on 163 patients with advanced NSCLC who received chemotherapy combined with tislelizumab or sintilimab at the First People’s Hospital of Yunnan Province from September 1， 2021 to November 30， 2024. Among them， there were 90 patients in the tislelizumab group and 73 patients in the sintilimab group. The objective response rate （ORR）， disease control rate （DCR）， progression free survival （PFS）， and overall survival （OS） of two groups were observed， and the occurrence of adverse drug reactions in patients was evaluated. Kaplan-Meier method was used to plot PFS and OS survival curves， Log-rank test was applied for univariate analysis， and Cox regression model was used to evaluate the independent prognostic factors of PFS and OS. RESULTS The median PFS of patients in the tislelizumab group and the sintilimab group were 14.14 months （95%CI of 10.95-17.33） and 10.95 months （95%CI of 8.75-13.15）， respectively. The median OS was 25.89 months （95%CI of 22.67-29.11） and 24.25 months （95%CI of 19.34-29.16）， with ORR of 45.56% and 49.32%， DCR of 94.44% and 90.41%， and the incidence of adverse drug reactions of 84.44% and 79.45%， respectively， the differences were not statistically significant （P＞0.05）. Age ≥60 years （HR＝1.542， 95%CI of 1.044-2.278， P＝0.029） and systemic immune inflammatory nutritional index （SIINI）＞ 116.58 （HR＝1.541， 95%CI of 1.058-2.245， P＝0.024） were risk factors for PFS in NSCLC patients receiving immune checkpoint inhibitor therapy； the use of antibiotics may affect the overall survival of patients （P＝0.001）. CONCLUSIONS The efficacy and safety of chemotherapy combined with tislelizumab or sintilimab for advanced NSCLC are comparable； age≥60 years and SIINI ＞116.58 are risk factors for PFS in NSCLC patients， and the use of antibiotics may affect the patients’ OS.

Obesity, as a chronic recurrent disease, has become a major public health challenge in China. To implement the requirements of the Healthy China Initiative (2019—2030), under domestic guidelines or consensus statements on overweight and obesity, and in alignment with the latest scientific advances globally, the Quality control protocol for adult overweight and obesity screening in health management (examination) institutions (2025 edition) was developed. This protocol was drafted by the Health Management Center of Shanghai Changzheng Hospital and formulated through multiple rounds of deliberation by experts in China’s health examination quality control field. The protocol establishes unified standards for screening facilities, personnel qualifications, and measurement or testing procedures. It defines specific screening items, outlines a standardized screening pathway, and sets requirements for the final medical review, ensuring the scientific validity, effectiveness, and safety of the screening process. The implementation of this protocol will enhance the consistency of weight management practices for adults across health examination institutions and strengthen the quality control of overweight and obesity screening programs.

Objective To develop the Children's Screen Interaction Quality Questionnaire(CSIQ)suit-able for measuring Chinese children aged 0 to 4 years,and to test its reliability and validity.Methods The purposive sampling method was used,and the guardians of 30 normal children aged 0 to 4 years undergoing physical examinations in the Department of Child Health Care of Guiyang Maternal and Child Health Care Hospital from February to April 2023 were selected as the interview objects.25 initial items were constructed through literature review,semi-structured interviews,and the Delphi expert consultation method.With the convenience sampling method,2 242 guardians of children aged 0 to 4 years old in the small and middle classes of 9 kindergartens in Guiyang City,Zunyi City,and Renhuai City were surveyed for item analysis,exploratory factor analysis,confirmatory factor analysis,and reliability and validity analysis.Results Exploratory factor a-nalysis extracted three factors,namely screen content interaction,reality interaction,and media interaction,with a total of 12 items.The cumulative variance explained rate of the 3-factor model was 69.829％.Confirma-tory factor analysis supported the three-factor model of CSIQ:x2/df=4.424,root mean square error of ap-proximation(RMSEA)=0.066,normed fit index(NFI)=0.955,comparative fit index(CFI)=0.965,incre-mental fit index(IFI)=0.965,Tucker-Lewis index(TLI)=0.955,goodness-of-fit index(GFI)=0.955,and the CSIQ had good convergent validity and discriminant validity.Conclusion The CSIQ has good reliability and validity.

Remimazolam is a novel ultra-short-acting benzodiazepine characterized by rapid metabolism via hydrolysis by non-specific esterases.This mechanism enables fast onset and quick recovery,significantly shortening the duration of anesthesia and effectively reducing the risk of drug accumulation in the body.It ex-hibits high binding specificity for the γ-aminobutyric acid(GABA)receptor,leading directly to central nerv-ous system inhibition and producing a pronounced sedative effect.This profile offers a more precise and con-trollable approach to anesthesia in clinical practice.The safety and efficacy of remimazolam have been demon-strated across various clinical settings,including procedural sedation,induction and maintenance of general an-esthesia,and sedation in the intensive care unit(ICU).Its adverse effects are relatively infrequent and highly predictable,as substantiated by numerous clinical trials;however,the optimization of its dosing regimens re-quires further in-depth investigation.This review summarized the pharmacological properties of remimazolam and provides a detailed discussion on the impact of various factors on its pharmacodynamics.These factors in-clude basic patient characteristics(such as gender,age,obesity,hepatic and renal function,and circadian rhythms)and external influences(such as altitude and drug interactions).

Objective To investigate the expression of serum micro ribonucleic acid(miR)-423-5p and fer-ritin in elderly osteoporosis(OP)and their relationship with hip fragility fracture.Methods A total of 79 eld-erly OP patients admitted to the hospital from March 2020 to March 2024 were selected as the observation group,and 62 healthy elderly patients with complete physical examination records and reports were selected as the control group during the same period.Patients in the observation group were divided into fracture group(42 cases)and non-fracture group(37 cases)according to the occurrence of hip fragility fracture.Serum miR-423-5p and ferritin levels were compared between the observation group and the control group and between the fracture group and the non-fracture group.The difference of bone mineral density(BMD)at different sites between the fracture group and the non-fracture group was compared.The correlation between serum miR-423-5p and ferritin and BMD at different sites was analyzed by Pearson,and the predictive value of serum miR-423-5p and ferritin in elderly hip fragility fractures was analyzed by receiver operating characteristic(ROC)curve.Results Serum miR-423-5p and ferritin in observation group were higher than those in control group,the differences were statistically significant(P＜0.05).The levels of serum miR-423-5p and ferritin in frac-ture group were higher than those in non-fracture group,and the differences were statistically significant(P＜0.05).Greater trochanteric BMD and total hip BMD in the non-fracture group were higher than those in the fracture group,and the differences were statistically significant(P＜0.05).According to Pearson correlation analysis,serum miR-423-5p and ferritin levels in elderly OP patients were negatively correlated with BMD de-tected in lumbar spine,femoral neck,greater trochanter,intertrochanter and total hip(P＜0.05).ROC curve analysis results showed that the sensitivity,specificity and the area under the curve(AUC)of serum miR-423-5p combined with ferritin were 0.786,0.892 and 0.818(95％CI:0.715-0.912),which were higher than the AUC predicted by the two alone and had higher predictive value(P＜0.05).Conclusion The combination of serum miR-423-5p and ferritin levels can predict the risk of hip fragility fracture in elderly OP patients.

Objective:To analyze the effect of continuous positive airway pressure (CPAP) on maternal and neonatal outcomes in pregnant women with obstructive sleep apnea syndrome (OSAS), especially on the incidence of hypertensive disorder in pregnancy (HDP) in women with moderate to severe OSAS.Methods:A total of 180 pregnant women with OSAS who were diagnosed through sleep monitoring during pregnancy due to high-risk factors of OSAS and registered in Peking University People′s Hospital from January 2021 to May 2024 were selected as the study subjects. Clinical data were collected from medical records for retrospective analysis. According to whether they received standardized treatment with CPAP, they were divided into the CPAP treatment group (42 cases) and the control group (138 cases). The CPAP treatment group consisted of 9 pregnant women with moderate to severe OSAS, while the control group consisted of 34 pregnant women with moderate to severe OSAS. The maternal and neonatal outcomes, the incidence of HDP, placental weight after delivery and placental weight/neonatal birth weight ratio were compared between the two groups.Results:(1) The average gestational age of pregnant women in the CPAP treatment group was higher than that in the control group [(38.7±1.0) vs (38.0±1.4) weeks], the proportion of infants small for gestational age (SGA) in the CPAP treatment group was lower [0 (0/42) vs 12.3% (17/138)], and the birth weight of infants in the CPAP treatment group was bigger [(3 396±475) vs (3 082±710) g); the differences between the two groups were statistically significant (all P<0.05). There were no significant differences between the CPAP treatment group and the control group in terms of delivery mode, rates of postpartum hemorrhage and preterm birth, umbilical artery blood gas analysis pH<7.1, lactate≥6.0 mmol/L, base excess<-12.0 mmol/L and the incidence of gestational diabetes mellitus and HDP (all P>0.05). (2) The placental weight of the CPAP treatment group was significantly lower than that of the control group [(554.0±70.6) vs (615.7±119.1) g], the placental weight/newborn birth weight ratio of the CPAP treatment group was significantly lower than that of the control group (median: 0.17 vs 0.19), and the differences were statistically significant (all P<0.05). (3) The incidence of HDP in pregnant women with moderate to severe OSAS in the CPAP treatment group was lower than that in the control group [1/9 vs 61.8% (21/34)], and the difference was statistically significant ( P<0.05). Conclusions:CPAP treatment could prolong the gestational age in pregnant women with OSAS, reduce the incidence of SGA, increase the birth weight of infants, and reduce the incidence of HDP in pregnant women with moderate to severe OSAS, and is worth promoting in clinical practice. The improvement of neonatal outcomes by CPAP treatment is closely related to the placenta, which is worthy of further exploration.