Objective:To observe any effect of supplementing treatment according to the Early Start Denver model (ESDM) with repeated transcranial magnetic stimulation (rTMS) in the treatment of children with autism spectrum disorder (ASD).Methods:Sixty-seven children on the autism spectrum aged 2 or 3 years were randomly divided into a control group of 33 and an observation group of 34. Both groups were treated as specified by the ESDM for 24 weeks, but the observation group additionally received rTMS. At 12 and 24 weeks, both groups were evaluated using the Autism Behavior Checklist, the Childhood Autism Rating Scale (CARS), the revised version of the Repetitive Behavior Scale (RBS-R), Gesell Development Schedules, and the Autism Treatment Evaluation Checklist (ATEC).Results:The CARS, Gesell, RBS-R and ATEC results of both groups had improved significantly after 12 weeks, with further improvements observed another 12 weeks later, when the average Autism Behavior Checklist scores had also improved significantly. At that point the results of the observation group were significantly better than those of the control group, on average.Conclusions:Combining ESDM and rTMS can significantly relieve the main symptoms of autism and improve the comprehensive development of children on the autism spectrum 2 or 3 years old. Therefore, such combination is worthy of application in clinical practice.

Objective To evaluate the clinical efficacy of Jiannao Kaiqiao Acupuncture combined with sensory integration training(SIT)in children with autism spectrum disorder(ASD)based on the brain-gut interaction theory.Methods A total of 135 children diagnosed with ASD at the Shenzhen Longgang Maternal and Child Health Hospital from March 2021 to March 2024 were enrolled.The patients were randomly divided into an observation group and a control group,with 68 patients in each group.The control group was given SIT treatment,while the observation group was treated with Jiannao Kaiqiao Acupuncture plus SIT,both groups were treated for 3 months.The changes in Childhood Autism Rating Scale(CARS)scores,Autism Behavior Checklist(ABC)scores,developmental quotient(DQ),serum neurofilament light chain(NFL),S100 calcium-binding protein β(S100β),and gut microbiota(Lactobacillus,Enterococcus,Bifidobacterium,Escherichia coli)were observed.Results(1)Both groups showed significant improvements in CARS,ABC,and DQ scores(P＜0.05),the observation group showed superior improvements compared to the control group,the difference being statistically significant(P＜0.05).(2)Serum NFL and S100β levels improved in both groups(P＜0.05),the observation group showed superior improvements compared to the control group,the difference being statistically significant(P＜0.05).(3)Gut microbiota composition(Lactobacillus,Enterococcus,Bifidobacterium,Escherichia coli)significantly normalized in both groups(P＜0.05),the observation group showed superior improvements compared to the control group,the difference being statistically significant(P＜0.05).(4)The total efficacy rate was 94.06％(66/68)in the observation group versus 85.07％(57/67)in the control group,the observation group showed superior improvements compared to the control group,the difference being statistically significant(P＜0.05).Conclusion Jiannao Kaiqiao Acupuncture combined with SIT effectively enhances cognitive function,alleviates clinical symptoms,modulates serum NFL/S100β levels,and restores gut microbiota balance in children with ASD.

Objective:To explore the reliability and validity of the Chinese version of Hammersmith Neonatal Neurological Examination (C-HNNE).Methods:A prospective cohort study.One hundred and fourteen neonates born in Longgang District Maternity & Child Healthcare Hospital of Shenzhen City between October 2022 and August 2023, who were hospitalized in the Neonatology or Obstetrics Department after birth and met the inclusion criteria, were enrolled as study subjects.They were divided into an early preterm group(34 cases), a mid-late preterm group(50 cases), and a full-term group(30 cases) based on gestational age.The first C-HNNE assessment was completed within 24 hours after birth, and 20 cases from each group were selected for inter-rater reliability assessment; 48 hours after the first C-HNNE assessment, 20 cases from each group were selected to undergo the C-HNNE assessment again for test-retest reliability assessment.At corrected 4 months of age, short-term neurodevelopmental outcomes were determined by pediatric rehabilitation physicians using clinical examination combined with general movements (GMs) assessment.Inter-rater reliability and test-retest reliability were assessed by calculating intra-class correlation coefficient (ICC). The optimal cutoff scores of the C-HNNE for each group were determined by plotting receiver operating characteristic(ROC) curves.Predictive validity was determined by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).Results:The highest sensitivity for predicting neonatal corrected neuromotor developmental outcome at 4 months of age was achieved when the optimal C-HNNE scores were taken as 22.25, 25.25, and 29.25 in the early preterm, mid-late preterm, and term groups, respectively.The ICCs for the inter-rater reliability of the total C-HNNE score and subscale scores in all 3 groups were above 0.7, indicating good reliability.The ICCs for test-retest reliability of some individual items were<0.6, indicating moderate reliability.In terms of validity, the correlation coefficients between the total C-HNNE scores and the GMs scores of the three groups were 0.550, 0.483, 0.473 (all P<0.01), and the sensitivity of the C-HNNE for predicting neurodevelopmental developmental outcomes in neonates corrected to 4 months of age was 82.9%, specificity was 70.4%, PPV was 58.0%, and NPV was 89.3%. Conclusions:C-HNNE demonstrates good reliability and validity and can be used as a routine bedside examination program for early neonatal life.

Objective:To explore the reliability and validity of the Chinese version of Hammersmith Neonatal Neurological Examination (C-HNNE).Methods:A prospective cohort study.One hundred and fourteen neonates born in Longgang District Maternity & Child Healthcare Hospital of Shenzhen City between October 2022 and August 2023, who were hospitalized in the Neonatology or Obstetrics Department after birth and met the inclusion criteria, were enrolled as study subjects.They were divided into an early preterm group(34 cases), a mid-late preterm group(50 cases), and a full-term group(30 cases) based on gestational age.The first C-HNNE assessment was completed within 24 hours after birth, and 20 cases from each group were selected for inter-rater reliability assessment; 48 hours after the first C-HNNE assessment, 20 cases from each group were selected to undergo the C-HNNE assessment again for test-retest reliability assessment.At corrected 4 months of age, short-term neurodevelopmental outcomes were determined by pediatric rehabilitation physicians using clinical examination combined with general movements (GMs) assessment.Inter-rater reliability and test-retest reliability were assessed by calculating intra-class correlation coefficient (ICC). The optimal cutoff scores of the C-HNNE for each group were determined by plotting receiver operating characteristic(ROC) curves.Predictive validity was determined by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).Results:The highest sensitivity for predicting neonatal corrected neuromotor developmental outcome at 4 months of age was achieved when the optimal C-HNNE scores were taken as 22.25, 25.25, and 29.25 in the early preterm, mid-late preterm, and term groups, respectively.The ICCs for the inter-rater reliability of the total C-HNNE score and subscale scores in all 3 groups were above 0.7, indicating good reliability.The ICCs for test-retest reliability of some individual items were<0.6, indicating moderate reliability.In terms of validity, the correlation coefficients between the total C-HNNE scores and the GMs scores of the three groups were 0.550, 0.483, 0.473 (all P<0.01), and the sensitivity of the C-HNNE for predicting neurodevelopmental developmental outcomes in neonates corrected to 4 months of age was 82.9%, specificity was 70.4%, PPV was 58.0%, and NPV was 89.3%. Conclusions:C-HNNE demonstrates good reliability and validity and can be used as a routine bedside examination program for early neonatal life.

Objective:To observe any effect of supplementing treatment according to the Early Start Denver model (ESDM) with repeated transcranial magnetic stimulation (rTMS) in the treatment of children with autism spectrum disorder (ASD).Methods:Sixty-seven children on the autism spectrum aged 2 or 3 years were randomly divided into a control group of 33 and an observation group of 34. Both groups were treated as specified by the ESDM for 24 weeks, but the observation group additionally received rTMS. At 12 and 24 weeks, both groups were evaluated using the Autism Behavior Checklist, the Childhood Autism Rating Scale (CARS), the revised version of the Repetitive Behavior Scale (RBS-R), Gesell Development Schedules, and the Autism Treatment Evaluation Checklist (ATEC).Results:The CARS, Gesell, RBS-R and ATEC results of both groups had improved significantly after 12 weeks, with further improvements observed another 12 weeks later, when the average Autism Behavior Checklist scores had also improved significantly. At that point the results of the observation group were significantly better than those of the control group, on average.Conclusions:Combining ESDM and rTMS can significantly relieve the main symptoms of autism and improve the comprehensive development of children on the autism spectrum 2 or 3 years old. Therefore, such combination is worthy of application in clinical practice.

Attention deficit hyperactivity disorder is a common neurodevelopmental disorder characterized by persistent attention deficit, hyperactivity, and impulsive behaviors that are not consistent with developmental age.Academic and vocational difficulties, social exclusion, and delinquent behaviors are manifested in daily life.It is also commonly accompanied by psychiatric problems.At the same time, mental problems are common, and the overall quality of life is greatly affected, placing a heavy burden on society as well as the family.International attention deficit hyperactivity disorder experts have developed a common and comprehensive International Classification of Functioning, Disability and Health core set of classifications for assessing individual functioning in attention deficit hyperactivity disorder.

The special population with type 2 diabetes mellitus（T2DM）are different from the ordinary T 2DM patients in terms of drug treatment due to age ，gender，physiological and pathological status . Based on the latest evidence of evidence -based medical evidence ，this article systematically reviews the selection strategies of hypoglycemic drug in special population such as T2DM patients with complications ， elderly patients ， children patients ， pregnant/lactating women ， etc. To formulate an individualized hypoglycemic treatment plan for T 2DM special population ，it is necessary to reasonably select hypoglycemic drugs according to their different characteristics and the latest evidence -based medical evidence ，so as to precisely reduce blood sugar and prevent and delay the occurrence of diabetic complications . For example ，for T 2DM patients with atherosclerotic cardiovascular disease，heart failure ，kidney disease and liver disease ，sodium glucose co -transporter 2 inhibitors or glucagon-like peptide 1 receptor agonists should be used additionally on the basis of metformin ；for T 2DM patients with gastroparesis ，insulin is recommended ；for T2DM patients with hyperuricemia or gout ，hypoglycemic drugs with uric acid lowering effects should be preferred ，and insulin should be used with caution ；for T 2DM patients with osteoporosis ，hypoglycemic drugs that do not affect bone metabolism or have bone protection effects should be selected ；for the elderly patients with T 2DM，it is recommended to give priority to the drugs with low risk of hypoglycemia alone or in combination .

Objective To investigate the epidemiological characteristics of cerebral palsy(CP)in children aged 1-6 years in China,including the incidence,prevalence,type of CP,etiology,prevention and rehabilitation status. Methods The survey was carried out by standard questionnaires,multi-center collaboration,stratified-cluster ran-dom sampling method.The surveyed adopted the following principles:streets in the city and villages in the rural areas, and the number of the urban and rural children was the same,and the proportion of children in each age group was balanced.The investigation areas included provinces and autonomous regions,including Heilongjiang,Beijing,Henan, Shandong,Shanxi,Shaanxi,Anhui,Hunan,Guangxi,Guangdong,Chongqing and Qinghai,and 323 858 children were in-vestigated.Results The incidence of CP was 2.48‰(155/62 591 cases),and the prevalence was 2.46‰(797/323 858 cases)(1-6 years old).The prevalence varied in different regions,in which the highest prevalence was 5. 40‰(54/9 998 cases)in Qinghai province,and the lowest prevalence was 1.04‰(47/45 133 cases)in Shandong province.The prevalence of the males(2.64‰,461/174 391 cases)was higher than that of the females(2.25‰, 336/149 467 cases),and the difference was statistically significant(P<0.05).The types of CP were spastic type (58.85%,469/797 cases),mixed type(13.17%,105/797 cases),dyskinetic(9.79%,78/797 cases),hypotonic (8.28%,66/797 cases),ataxia(6.25%,52/797 cases)and rigid(3.39%,27/797 cases)respectively in 797 CP children.The first three risk factors for CP were long -term exposure to harmful physical factors during pregnancy, whether there were birth defects among the three generations of relatives of the children,such as children's peers, parents or grandparents,whether there were birth defects among the children's peers,parents or grandparents,and neonatal jaundice or persistent jaundice.Among 797 CP children,79.67% of the children with CP were timely detected and treated in the local hospitals,while the other 19.93% of them were not timely treated.The places which could give them timely detection and early diagnosis and treatment were general hospitals(42.97%),Maternity and Infant Hospitals (27.03%)and Children's Hospitals(20.31%). The main rehabilitation methods for 797 children with CP were 34.58% in the hospitals or rehabilitation centers,31.61% in the communities(including at home),33.80% mainly in the medical institution,and in the communities they could also receive partially rehabilitation services. Conclusions The prevalence of CP in China is coincident with international levels.The prevalence rate of CP in males is higher than that in females.The types of CP distribution are accorded with international distribution characteristics.There were still some children with CP who could not receive timely detection and treatment.Rehabilitation at the medical institutions is the chief way and proper rehabilitation guidance should be carried out in the communities.

Objective To study the incidence and prevalence in the children aged 1-2 years and 1-6 years with cerebral palsy(CP) in Qinghai province,and to identify the epidemiological characteristics and control status of the children with CP.Methods A stratified cluster random sampling method was used to conduct epidemiological survey of 10 000 children in Qinghai province.Children diagnosed as CP were asked to fill in the CP questionnaires,including children's development,and the status of prevention and treatment of CP.Compared with the children diagnosed as CP,4 healthy children at the same age were asked to fill in the questionnaires related to children's development.SPSS 15.0 statistical software was used for data analysis.Results Seven children with CP were diagnosed at the aged 1-2 years,and the total incidence rate was 3.3‰(7/2 148 cases).The incidence between the urban (0) and the rural areas (12‰) (7/582 cases) was significantly different(P =0.000 1),while there was no significant difference statistically between boys (5 cases) and girls (2 cases) (P ＞ 0.05).Fifty-four children with CP were diagnosed at the age of 1-6 years,and the total prevalence rate was 5.4‰(54/10 000 cases).The prevalence between the urban (2.3‰,17/7 348 cases) and the rural areas (13.9‰,37/2 652 cases) was statistically different (x2 =49.144,P ＜ 0.01),while there was no significant difference statistically between boys (31 cases) and girls (23 cases) (P ＞ 0.05).The proportions of various types of CP were as follows:29 cases(53.70％) of spastic type,9 cases(16.67％) of hypotonia,7 cases (12.96％) of mixed type,4 cases (7.41％) of ataxia,3 cases (5.56％) of rigidity and2 cases (3.70％) of dyskinetic,respectively.Among the spastic types,there were 16 cases (55.17％)of spastic quadriplegia,6 cases (20.69％) of spastic hemiplegia,4 cases (13.79 ％) of spastic diplegia,2 cases (6.89 ％) of spastic monoplegia and 1 case (3.45％) of spastic triplegia,respectively.The top three risk factors were premature (13 cases,24.1％),hypoxic-ischemic encephalopathy (9 cases,16.7％) and maternal threatened abortion (8 cases,14.8％).The first three complications were mental retardation,language dysfunction and epilepsy.Conclusions The incidence and prevalence of CP in children in Qinghai province are very high,which is higher in the rural areas than that in the urban areas.The most common CP is spastic type.The main risk factors for CP are preterm labor,hypoxic-ischemic encephalopathy and maternal threatened abortion.Intellectual disability,speech disability and epilepsy are the most common complications of CP.Maternal and perinatal infant health care and early intervention need to be further strengthened.

As the urgent need of both clinic and research,the identification of hypertonia subtypes is becoming more and more important. Hypertonia assessment tool is a standardized discriminative measure with good reliability and validity. Hypertonia assessment tool can identify paediatric hypertonia subtypes. For its easily learning,it can be easily generalized in clinician.