AIM: To prepare a novel functionalized upconversion nanomaterial UCNPs-PEG-Tf through an improved method and observe its specific imaging phenomenon to choroidal melanoma cells(OCM-1).METHODS: NaYF4:Yb/Er(Up-conversion nanoparticles, UCNPs)was Prepared and plasma was treated to carboxylate the surface; then amino polyethylene glycol and transferrin(Tf)were respectively loaded to prepare UCNPs-PEG-Tf. Characterized them accordingly, its biocompatibility was tested accordingly, and the specific fluorescence phenomenon of OCM-1 was detected by fluorescence spectrophotometer and inverted fluorescence microscopy.RESULTS: Characterization confirmed successful synthesis of UCNPs, UCNPs-PEG, and further loading of Tf to form UCNPs-PEG-Tf. UCNPs-PEG-Tf showed excellent biocompatibility and emitted significant green fluorescence. Under the same conditions, fluorescence intensity measurement and observations from the inverted fluorescence microscope both demonstrated its significant specificity in imaging to OCM-1 cells.CONCLUSION: The synthesized novel functionalized UCNPs-PEG-Tf nanocomposite showed good biocompatibility and achieve specific imaging to OCM-1 cells.

Objective: To explore the association between negative life events and smartphone addiction among middle school students, so as to provide theoretical support and practical guidance for prevention and intervention of smartphone addiction among middle school students. Methods: Using cluster sampling, 8 890 students were selected to survey from 27 junior high schools and 3 senior high schools in a district of Shenzhen in 2022 (baseline) and 2023 (followup). Data were collected through selfresigned questionnaires on basic information, the Smartphone Addiction Scale-Short Version, and the Adolescent Selfrating Life Events Checklist. Mixedeffects models were employed to analyze the association. Results: Compared to 2022, the punishment scores of middle school students in 2023 [1.00 (0.00, 6.00) and 1.00 (0.00, 6.00)] decreased (Z=4.27), while the scores of interpersonal stress, learning stress and adaptation [4.00(0.00, 8.00), 4.00(0.00, 8.00); 4.00(1.00, 8.00), 5.00(2.00, 9.00); 2.00 (0.00, 6.00), 3.00 (0.00, 7.00)] increased (Z=-3.04, -8.36, -6.80) (P<0.01). Mixedeffects models revealed a positive doseresponse relationship between negative life events and smartphone addiction (OR=1.08-1.17, P<0.01). Stepwise regression showed independent positive effects of interpersonal stress (OR=1.05), academic stress (OR=1.03), and adaptation stress (OR=1.11) on smartphone addiction (P<0.01). Subgroup analysis of nonaddicted students in 2022 confirmed persistent associations for academic stress (OR=1.03) and adaptation (OR=1.07) (P<0.01). Conclusion Negative life events exhibit a positive doseresponse relationship with smartphone addiction, particularly interpersonal stress, academic stress, and adaptationrelated events.

Objective: To explore the longitudinal association between only-child status and smartphone addiction among middle school students, so as to provide a basis for establishing family intervention measures for smartphone addiction in middle school students. Methods: In October 2022 and October 2023, a preliminary survey and follow-up were conducted among 8 759 middle and high school students from 30 schools in a district of Shenzhen. A self-designed questionnaire was used to determine whether the students were the only-child, and the Chinese Version of the Smartphone Addiction Scale-Short Version (C-SAS-SV) was utilized to assess the students smartphone addiction status. A multilevel mixed-effects model and subgroup analysis were applied to examine the association between only-child status and smartphone addiction among middle school students. Results: During 2022 to 2023, the prevalence of smartphone addiction in the cohort of middle school students increased from 24.1% to 25.2%. Compared with only-child, non-only child were more likely to be addicted to smartphones (adjusted model: OR =1.2, 95% CI =1.1-1.4) and also scored higher on smartphone addiction (adjusted model: β =0.9, 95% CI =0.2-1.5)( P <0.05). Subgroup analysis further revealed that compared to baseline, non-only child demonstrated an increased prevalence of smartphone addiction (adjusted model: OR = 1.2 , 95% CI =1.0-1.5) and higher addiction scores (adjusted model: β =0.8, 95% CI =0.2-1.5) after one year( P <0.05). Conclusions Non-only child face higher risk of smartphone addiction. Under the current population policy, it is crucial to address smartphone addiction among middle school students who is not only child.

Objective: To explore the potential causal association between adolescent compulsive behaviour and smartphone addiction based on longitudinal data, so as to provide reference for the establishment of adolescent smartphone addiction interventions. Methods: A preliminary survey and follow-up were conducted on 8 907 middle and high school students in a district of Shenzhen in 2022 and 2023, respectively. Compulsive behaviours were measured by using the Mental Health Inventory for Middle School Students-60 Items (MMHI-60), smartphone addiction was assessed by using the Smartphone Addiction Scale-Short Version ( SAS- SV), and the associations between compulsive behaviours and smartphone addiction were analysed by using multilevel mixed-effects models and subgroup analyses. Results: Smartphone addiction detection rates among middle school students were significantly associated with genders, father s education level, mother s education level, study load subgroups, and whether or not they were single-parent families, and there were statistical differences ( χ 2=17.21-175.34, P <0.05). Students with compulsive behaviours were 2.98 times more likely to develop smartphone addiction than those without compulsive behaviours ( OR=2.98, 95%CI=2.77-3.22, P <0.05). Subgroup analysis of middle school students without smartphone addiction in the first year found that compulsive behaviours significantly predicted smartphone addiction ( OR= 1.76 , 95%CI=1.54-2.01, P <0.05). Conclusion There is a potential causal association between obsessive-compulsive behaviours and smartphone addiction in middle school students, and obsessive-compulsive behaviours in middle school students could significantly predicted the occurrence of smartphone addiction.

Objective: To investigate the changing trends for associations of anxiety and depressive symptoms with smartphone addiction among middle school students, so as to provide a scientific basis for preventing smartphone addiction in middle school students. Methods: From 2022 to 2023, a method of combining convenient sampling with cluster sampling was used to select 8 923 middle school students from 27 junior high schools and 3 senior high schools in a district of Shenzhen City between September 2022 (baseline, T1) and September 2023 (follow up, T2). The Smartphone Addiction Scale-Short Version (SAS-SV), Patients Health Questionnaire-9 Item (PHQ-9), and Generalized Anxiety Disorder 7-item Scale (GAD-7) were administered to assess smartphone addiction, anxiety and depressive symptoms. Mixed effects models were used to analyze the association of anxiety and depressive symptoms with smartphone addiction among middle school students. Results: From September 2022 to September 2023, the reported prevalence of smartphone addiction increased from 24.22% to 25.25% ( χ 2=45.71); and smartphone addiction scores [ 24.00 (16.00, 32.00),25.00(16.00, 33.00)], anxiety symptom scores [2.00(0.00, 7.00),3.00(0.00, 7.00)] and depressive symptom scores[3.00(0.00, 8.00),5.00(0.00, 9.00)] all significantly increased ( Z =-17.43, -42.38, -41.57) (all P <0.05). There were statistically significant difference in the distribution of anxiety and depression symptom levels among middle school students in 2022 and 2023 ( χ 2=85.15, 106.85, both P <0.05). After adjusting for covariates such as age, gender and family background, mixed effects models revealed dose response associations of anxiety and depressive symptoms with smartphone addiction among middle school students:mild anxiety symptom( OR =3.22), moderate to severe anxiety symptom ( OR =5.36), mild depressive symptom ( OR =3.32) and moderate to severe depressive symptom ( OR =6.13) were significantly associated with higher risks of smartphone addiction (all P <0.05). Interaction effect analysis found that co existing anxiety and depressive symptoms synergistically increased addiction risk by 5.60 times ( OR =5.60) compared to the asymptomatic group, with 32% of the combined risk attributable to their interaction ( S=1.64, AP =0.32)(both P < 0.05 ). Conclusions Anxiety and depressive symptoms are significantly associated with smartphone addiction, exhibiting a synergistic effect. Attention should be paid to emotional issues and smartphone addiction among middle school students.

ObjectivesTo summarize the clinical and pathological features of patients with congenital liver fibrosis （CHF）， and to investigate the differences in clinical and pathological features between patients in different age groups. MethodsA retrospective analysis was performed for the clinicopathological data of 26 patients with pathologically confirmed CHF in China-Japan Friendship Hospital from August 2005 to June 2023， and the patients were stratified by age to investigate the clinical and pathological features of patients in different age groups. ResultsAmong the 26 patients， there were 12 male patients and 14 female patients， with an age of onset of 4 — 61 years. There were 19 patients with portal hypertension type （73.08%）， 2 patients with cholangitis type （7.69%）， 4 patients with mixed type （15.38%）， and 1 patient with occult type （3.85%）. Of all 26 patients， 4 had unknown clinical symptoms， and among the 22 patients with clear clinical symptoms， 10 （45.45%） attended the hospital due to upper gastrointestinal bleeding caused by portal hypertension. Pathological manifestations included roughly normal liver parenchyma separated by fibrous septa in the portal area， with the presence of abnormal reactive bile duct hyperplasia. Denser fibrous septa and a lack of portal veins with the corresponding caliber were observed in 4 pediatric patients with disease onset before the age of 10 years， with a significant reduction or even disappearance of compensatory thin-walled blood vessels. ConclusionPortal hypertension-type CHF is the most common type in clinical practice. Patients with an early age of onset have certain histopathological features of the liver， with the presence of serious complications associated with portal hypertension. Therefore， liver biopsy should be performed for patients suspected of CHF in clinical practice， and genetic testing should be performed when necessary. Early identification and diagnosis are of great importance for improving the prognosis of patients.

Objective To investigate the relationship between serum high mobility group protein B1(HMGB1),Golgi protein 73(GP73),interleukin-37(IL-37)and HBV-DNA load in patients with hepatitis B virus-associated chronic plus acute liver failure(HBV-ACLF)and the value of predicting prognosis.Methods A total of 112 HBV-ACLF patients from the 980th Hospital of PLA Joint Logistic Support Force from July 2018 to July 2023 were retrospectively analyzed,and were divided into death group(n=42)and sur-vival group(n=70)according to the clinical outcomes of HBV-CALF patients within 90 days after admis-sion.The clinical data and serum levels of HMGB1,GP73 and IL-37 of the two groups were compared,the prognotic factors of the HBV-CALF patient were analyzed,and the relationship between serum HMGB1,GP73 and IL-37 and HBV-DNA load was analyzed.The prognostic value of serum HMGB1,GP73 and IL-37 in HBV-CALF patients were evaluated.Results There were significant differences in disease stage,peritonitis,hepatic encephalopathy,pulmonary infection,HBV-DNA load and MELD score between the death group and the survival group(P＜0.05).Serum levels of HMGB1,GP73 and IL-37 in death group were higher than those in survival group(P＜0.05).Disease stage,peritonitis,hepatic encephalopathy,pulmonary infection,HBV-DNA load,MELD score and serum HMGB1,GP73 and IL-37 levels were all independent prognoses of HBV-ACLF patients(P＜0.05).The levels of serum HMGB1,GP73 and IL-37 in HBV-ACLF patients were negatively correlated with HBV-DNA load(P＜0.05).The area under the curve(AUC)values of serum HMGB1,GP73 and IL-37 in predicting the prognosis of HBV-ACLF patients were 0.781,0.790 and 0.782,re-spectively.The AUC value of the combined prediction was the largest(0.944),and the sensitivity and speci-ficity were 86.33％and 91.43％,respectively.Conclusion Serum HMGB1,GP73 and IL-37 levels are closely related to HBV-DNA load and prognosis of HBV-CALF patients,and the combined detection of these three indexes is helpful to improve prognosis prediction efficiency.

Objective:This study aims to explore the predictive value of T2-weighted imaging (T2WI), apparent diffusion coefficient (ADC), and early-delayed phases enhanced magnetic resonance imaging (DCE-MRI) radiomics prediction model in determining human epidermal growth factor receptor 2 status in breast cancer.Methods:A retrospective study was conducted, involving 187 patients with confirmed breast cancer by postsurgical pathology at Zhenjiang First People's Hospital during January 2021 and May 2023. Immunohistochemistry or fluorescence in situ hybridization was used to determine the HER-2 status of these patients, with 48 cases classified as HER-2 positive and 139 cases as HER-2 negative. The training set was used to construct the prediction models and the validation set was used to verify the prediction models. Layers of T2WI, ADC, and early-delayed phase DCE-MRI images were used to delineate the volumeof interest and 960 radiomic features were extracted from each case using Pyradiomic. After screening and dimensionality reduction by intraclass correlation coefficient, Pearson correlation analysis, least absolute shrinkage, and selection operator, the radiomics labels were established. Logistic regression analysis was used to construct the T2WI radiomics model, ADC radiomics model, DCE-2 radiomics model, DCE-6 radiomics model, and the joint sequence radiomics model to predict the HER-2 expression status of breast cancer, respectively. Based on the clinical, pathological, and MRI image characteristics of patients, univariate and multivariate logistic regression analysis wasused to construct a clinicopathological MRI feature model. The radscore of every patient and the clinicopathological MRI features which were statistically significant after screening were used to construct a nomogram model. The receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of each model and the decision curve analysis wasused to evaluate the clinical usefulness.Results:The T2WI, ADC, DCE-2, DCE-6, and joint sequence radiomics models, the clinicopathological MRI feature model, and the nomogram model were successfully constructed to predict the expression status of HER-2 in breast cancer. ROC analysis showed that in the training set and validation set, the areas under the curve (AUC) of the T2WI radiomics model were 0.797 and 0.760, of the ADC radiomics model were 0.776 and 0.634, of the DCE-2 radiomics model were 0.804 and 0.759, of the DCE-6 radiomics model were 0.869 and 0.798, of the combined sequence radiomics model were 0.908 and 0.847, of the clinicopathological MRI feature model were 0.703 and 0.693, and of the nomogram model were 0.938 and 0.859, respectively. In the training set, the combined sequence radiomics model outperformed the clinicopathological features model ( P＜0.001). In the training and validation sets, the nomogram outperformed the clinicopathological features model ( P＜0.05). In addition, the diagnostic performance of the nomogram was better than that of the four single-modality radiomics models in the training cohort ( P＜0.05) and was better than that of DCE-2 and ADC models in the validation cohort ( P＜0.05). Decision curve analysis indicated that the value of individualized prediction models was higher than clinical and pathological prediction models in clinical practice. The calibration curve showed that the multimodal radiomics model had a high consistency with the actual results in predicting HER-2 expression. Conclusions:T2WI, ADC and early-delayed phase DCE-MRI imaging histology models for HER-2 expression status in breast cancer are expected to provide a non-invasive virtual pathological basis for decision-making on preoperative neoadjuvant regimens in breast cancer.

Objective:To compare the effect of delaying progression of myopia in children between defocus incorporated multiple segments (DIMS) spectacle lens and orthokeratology.Methods:A nonrandomized controlled clinical study was conducted.A total of 390 children (390 eyes) with myopia who were treated in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2020 were included, with the spherical equivalent (SER) of -0.75 to -6.00 D. According to the willingness of patients and patients' guardians, the subjects were divided into DIMS group, orthokeratology group and single-vision spectacle lens group, with 130 cases (130 eyes) in each group, wearing DIMS spectacle lenses, standard or astigmatic design orthokeratology and conventional single-vision full-correction aspheric spectacle lenses, respectively.The SER of the eyes was measured using an automatic computerized refractometer in combination with subjective refraction before and one year after lens wear, and the axial length (AL) of the eyes was measured using IOLMaster.A total of 327 patients in the three groups met the inclusion and exclusion criteria, including 107 in the DIMS group, 112 in the orthokeratology group, and 104 in the single-vision spectacle lens group.All the right eyes were included in this study.The changes in SER and AL before and after wearing lenses for 1 year were compared among the three groups.The relationship between AL and SER changes and baseline data in the DIMS group was evaluated by Pearson linear correlation analysis.The study followed the Declaration of Helsinki, and the study protocol was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University (No.2023-KY-0174-002). The subjects and their guardians were fully aware of the purpose and methodology of the study, and voluntarily signed an informed consent form.Results:There were statistically significant overall differences in SER and AL at different time points among the three groups (SER: Fgroup=7.065, P=0.009; Ftime=183.730, P<0.001.AL: Fgroup=6.151, P=0.014; Ftime=175.290, P<0.001). One year later, the differences in SER and AL changes among the three groups were statistically significant ( F=7.065, P=0.009; F=6.151, P=0.014). The SER and AL of each group after 1 year was greater than the baseline, with the SER and AL and their changes significantly smaller in orthokeratology group and DIMS group than in single-vision spectacle lens group and greater in DIMS group than in orthokeratology group, showing statistically significant differences (all at P<0.05). Compared with single-vision spectacle lenses, wearing orthokeratology for 1 year can inhibit SER and AL progression by 58.3% and 59.0%, and wearing DIMS frame glasses for 1 year can inhibit SER and AL progression by 46.9% and 43.6%.The percentage of eyes with no change in SER was 5.77%(6/104), 24.11%(27/112) and 17.76%(19/107) in the single-vision spectacle lens group, orthokeratology group and DIMS group, respectively, and the percentage of AL was 0.00%(0/104), 8.93%(10/112) and 7.48%(8/107), respectively, showing statistically significant differences among the three groups ( χ2=9.316, 8.676; both at P<0.001). The AL change in the DIMS group was weakly negatively correlated with age ( r=-0.252, P=0.006). Conclusions:Wearing DIMS spectacle lenses is not as effective as orthokeratology in delaying myopia in children, but it is significantly better than wearing conventional single-vision spectacle lenses.

Objective:To analyze the occurrence of malignant ventricular arrhythmias(VA)in elderly heart failure patients with reduced ejection fraction(HFrEF)and its influence on the prognosis.Methods:A total of 1 171 elderly patients with heart failure were included in this study.These patients were admitted to the First People's Hospital of Shangqiu from January 2017 to June 2020.They were divided into three groups: VA group(85 cases), HFrEF group(340 cases), and heart failure with normal left ventricular ejection fracture(LVEF)group(340 cases).The division was based on the propensity score matching(PSM)method with a 1∶4∶4 ratio.The main outcome measure was major adverse cardiovascular events(MACE)in the three groups, which were followed up for 2 years.Results:After PSM, the N-terminal pro-brain natriuretic peptide(NT-proBNP), left ventricular end diastolic diameter(LVEDD), and left ventricular end systolic diameter(LVESD)of the LVEF normal group were significantly lower than those of the HFrEF group and VA group, while LVEF was significantly higher( P<0.05 for all).During a median follow-up of 22(17-25)months, a total of 219 cases(28.6%)of MACE occurred, including 30 cardiac deaths, 133 readmissions with worsening heart failure, and 56 cases of acute coronary syndrome.Kaplan-Meier survival analysis revealed that the VA group had a significantly higher overall risk of MACE compared to the normal LVEF control group and LVEF reduced control group( χ2=6.213, P=0.012).Among the three groups, the VA group exhibited the highest risk of cardiogenic death and worsening heart failure readmission, surpassing the normal LVEF group and HFrEF group( χ2=4.143, 16.861, both P<0.05).The results of the multivariate Logistic regression analysis revealed that a history of VA( OR=1.317, 95% CI: 1.109-1.564, P=0.002), NT-proBNP( OR=2.138, 95% CI: 1.235-3.701, P=0.007), and LVEDD( OR=2.413, 95% CI: 1.134-5.135, P=0.022)were found to be associated with an increased risk of VA during hospitalization.Additionally, the multivariate Cox regression analysis indicated that age >68 years( HR=1.723, 95% CI: 1.134-2.618, P=0.011), new VA occurrence( HR=2.346, 95% CI: 1.268-4.341, P=0.007), diabetes( HR=2.008, 95% CI: 1.135-3.553, P=0.017), NT-proBNP>1 957.3 ng/L( HR=2.734, 95% CI: 1.368-5.464, P=0.004), LVEF<35.0%( HR=2.265, 95% CI: 1.206-4.254, P=0.011), implantable cardioverter defibrillators( HR=0.887, 95% CI: 0.789-0.997, P=0.045), and sodium glucose co transporter 2(SGLT2)inhibitors usage( HR=0.904, 95% CI: 0.833-0.981, P=0.016)were identified as factors related to MACE. Conclusions:Patients diagnosed with VA have a significantly increased risk of MACE during the follow-up period.Several factors, including age, new VA occurrence, diabetes, NT-proBNP levels, LVEF, implantable cardioverter defibrillators, and SGLT2 inhibitor usage, have been found to be associated with the risk of MACE during the follow-up.