Objective: To explore the causal link of cumulative ecological risk and future orientation with health risk behaviors among higher vocational college students, so as to provide reference for reducing and preventing health risk behaviors among higher vocational college students. Methods: A longitudinal follow up study was conducted on 612 students using convenience sampling from 2 vocational colleges in Hunan Province. The Cumulative Ecological Risk Scale, Future Orientation Scale, and Health Risk Behavior Scale were used during three follow up visits (T1: September 2022, T2: June 2023, T3: March 2024), and a cross lagged panel model was constructed to examine the longitudinal causal relationship of cumulative ecological risk, future orientation and health risk behaviors. Analysis of longitudinal intermediary effect between variables by Bootstrap. Results: The cumulative ecological risk scores of T1, T2 and T3 among higher vocational college students were (2.94±1.44,2.99±1.63,3.02±1.54), future orientation scores (40.49±4.71,41.51±5.72,41.06±4.35) and health risk behavior scores (3.73±2.01,3.49±2.00,3.23±2.00). The results of repeated measures ANOVA showed that the future orientation score of T2 was higher than that of T1, and the main effect of measurement time was statistically significant ( F=5.09，P＜0.01,η 2=0.02). The health risk behavior score of T1 was higher than that of T2, and the health risk behavior score of T2 was higher than that of T3, and the main effect of measurement time was statistically significant ( F=10.12，P＜0.01,η 2=0.03).The cross lagged model showed good adaptability, with χ 2/df =7.20 ( P <0.01), relative fitting indicators GFI=0.98, CFI=0.99, TLI=0.96, IFI=0.99, NFI =0.99, and absolute fitting indicator RMSEA =0.06. Among them, the T1, T2 cumulative ecological risk showed negatively predictive effects on T2, T3 future orientation ( β =-0.24, -0.47 ), and T1, T2 cumulative ecological risk positively predicted T2, T3 health risk behavior ( β =0.20, 0.24), while T1, T2 future orientation negatively predicted T2, T3 health risk behavior ( β =-0.25, -0.18) ( P ＜0.01). Bootstrap test analysis found that T2 future orientation had a longitudinal mediating effect ( β=0.04, P ＜0.01) on the T1 cumulative ecological risk and T3 health risk behavior. Conclusions The accumulation of ecological risk among higher vocational college students can positively predict health risk behaviors, while future orientation can negatively predict healthrisk behaviors. Moreover, future orientation plays a longitudinal mediating role between accumulated ecological risks and health risk behaviors.

Objective: To explore the association of latent profiles of mobile phone dependence and self control with physical exercise among junior high school students, so as to provide references for the prevention of mobile phone dependence and the improvement of self control among junior high school students. Methods: From April to May 2024, a stratified random cluster sampling method was used to select a total of 2 311 students from grade 7 to grade 9 in three public junior high schools in Xiangxi Autonomous Prefecture, Hunan Province. Latent profile analysis was conducted to identify the latent profiles of mobile phone dependence and self control among junior high school students. Pearson correlation analysis was used to examine the correlation between mobile phone dependence and self control, and Chi square test was used to analyze the distribution differences of latent profiles of adolescents across different demographic characteristics. Multiple Logistic regression analysis was applied to explore the association between mobile phone dependence, self control, and physical exercise. Results: Four latent profiles of mobile phone dependence and self control were identified: low dependence-moderate self control group ( n =885, 38.3%), moderate dependence-low self control group ( n =910, 39.4%), high dependence-no self control group ( n =232, 10.0%), and no dependence-high self control group ( n =284, 12.3%). Significant differences were observed in the distribution of latent profiles across gender, grade and only child status ( χ 2=10.85, 35.72, 13.85， P <0.05). Logistic regression analysis showed that, after controlling for demographic variables, compared with the low dependence-moderate self control group, physical exercise was negatively associated with the moderate dependence-low self control group ( OR =0.79) and the high dependence-no self control group ( OR =0.81), while positively associated with the no dependence-high self control group ( OR =1.58) ( P <0.01). Conclusions The influence of physical exercise on junior high school students different potential profile types of mobile phone dependence and self control is different. Schools and families should adopt targeted physical exercise interventions based on the characteristics of different profiles to promote the physical and mental health of junior high school students.

Objective: To analyze the heterogeneity of mobile phone dependence development trajectory in middle school students and its association with loneliness and selfcontrol ability, so as to provide reference for the prevention of mobile phone dependence in middle school students. Methods: A total of 941 grade 1 students from 4 public middle schools in Xiangxi Autonomous Prefecture, Hunan Province were selected for the followup survey by random cluster sampling from October 2023 to April 2024 and October 2024. Mobile Phone Addiction Index (MPAI), University of California, Los Angeles Loneliness Scale-20 (UCLA-20) and Selfcontrol Scales (SCS) were used for questionnaire survey. The heterogeneity of the developmental trajectory of middle school students mobile phone dependence was analyzed by the latent growth curve model (LGMM), and the influencing factors of the developmental trajectory of middle school students mobile phone dependence were explored by multiple Logistic regression analysis. Results: The development trajectory of middle school students mobile phone dependence could be divided into four categories: C1 "low risk slow decline group (n=438,44.6%)", C2 "medium risk slow rise group (n=272,29.7%)", C3 "high risk rapid decline group (n=73,8.6%)" and C4 "high risk rapid rise group (n=158,17.1%)". There were significant differences in the distribution of mobile phone dependence development track heterogeneity subgroups among sex, only child, lodging, and leftbehind students (χ2=117.79, 44.88, 37.09, 130.50, P <0.01). The results of the multinomial Logistic regression model analysis showed that, with C1 group as the reference, C2, C3, and C4 were positively correlated with students loneliness [OR(95%CI)=1.04 (1.02-1.06), 1.11(1.08-1.14), 1.12(1.09-1.14)]; C2 and C4 groups were negatively correlated with students selfcontrol [OR(95%CI)=0.97(0.96-0.99), 0.95(0.93-0.97)] (P<0.01). Conclusions The development trajectory of mobile phone dependence among middle school students is heterogeneous. Reducing the loneliness of individuals and cultivating good selfcontrol ability are helpful to alleviate mobile phone dependence behavior among middle school students.

Objective: To explore the influence of social support and school connectedness on the developmental trajectory of self efficacy in adolescents and analyze its subgroup effects, so as to provide a basis for enhancing adolescents self-efficacy. Methods: Using a cluster random sampling method, 930 first year middle school students from four schools in Xiangxi Autonomous Prefecture, Hunan Province, were selected for three longitudinal surveys in October 2023 (T1), April 2024 (T2), and October 2024 (T3). The General Self-efficacy Scale (GSES), Social Support Scale (SSS), and School Connectedness Scale (SCS) were administered. Latent growth mixture modeling (LGMM) was used to identify different developmental trajectories of self-efficacy in early adolescence. Multivariate Logistic regression was employed to examine the associations of self-efficacy trajectories with social support and school connectedness in adolescents. Results: The developmental trajectory of self-efficacy in adolescents was classified into three categories:category 1 was low efficacy-rapid growth group (53 students, 6.6%), category 2 was moderate efficacy-stable growth group (793 students, 84.1%), and category 3 was high efficacy-rapid decline group (84 students, 9.3%). Using the low efficacy- rapid growth group as the reference, students with higher social support were more likely to belong to the moderate efficacy- stable growth group ( OR=1.06, 95%CI =1.03-1.08) and the high efficacy-rapid decline group ( OR=1.06, 95%CI = 1.03 -1.09), students with higher school connectedness were more likely to belong to the high efficacy-rapid decline group ( OR= 1.10 , 95%CI =1.03-1.18) (all P <0.05). Subgroup analysis revealed significant effects for boarding status (low efficacy-rapid growth group at T1, t =2.10; high efficacy-rapid decline group in social support, t =-2.15) and only child status (moderate efficacy-stable growth group at T2, t =2.05) (all P <0.05). Conclusions The developmental trajectory of self-efficacy in adolescents exhibits group heterogeneity, with boarding status and only child status showing subgroup effects. Enhancing social support and school connectedness can help improve self-efficacy in adolescents.

Objective: To explore the latent class characteristics and related factors of health risk behaviors among higher vocational college students (referred to as vocational students) in the Wuling Mountain Area, so as to provide references for promoting their healthy development and formulating effective intervention measures. Methods: From April to June 2024, a stratified random cluster sampling method was used to survey 1 737 students from three higher vocational colleges in the Wuling Mountain Area (Xiangxi in Hunan, Enshi in Hubei, and Tongren in Guizhou). The study employed the Health risk Behavior Questionnaire for College Students, the Parent-Child Relationship Scale, the Social Support Scale, and the School Connection Scale for data collection. Latent class analysis (LCA) was used to examine the heterogeneous distribution characteristics of health risk behaviors among vocational students, and multivariate Logistic regression was applied to analyze the related factors of latent classes. Results: The LCA results identified three latent classes based on 12 health risk behaviors: the comprehensive high risk group (151 students, 8.7% ), the psychological distress group (883 students, 50.8%), and the low risk group (703 students, 40.5%). The distribution of latent classes showed statistically significant differences in gender and only child status ( χ 2=121.25, 9.85, both P <0.05). The low risk group scored higher in parent-child relationship (29.26±6.19), social support (63.98±18.16), and school connection (35.97± 7.71 ) compared to the comprehensive high risk group (27.28±6.03, 57.67±15.60, 32.97±7.55) and the psychological distress group (27.52±5.19, 62.06±14.54, 33.80±6.14) ( F =20.37, 23.51, 9.89, all P <0.05). Multivariate Logistic regression revealed that boys( OR =3.29) were more likely to belong to the comprehensive high risk group, social support ( OR =0.03, 0.21) and school connection ( OR =0.92, 0.96) were less likely to belong to both the comprehensive high risk and psychological distress groups (all P < 0.05). Conclusions There are three potential categories of healthharmful behaviors among vocational college students in Wuling Mountain Area. Schools, families and society should enhance the levels of parent-child relationship, school connections and social support for vocational college students of different categories to promote their physical and mental health development.

Objective: To explore the dynamic relationship between depressive symptom and non-suicidal self-injury(NSSI) behavior among rural left behind junior high school students, as well as the mediating role of social support, so as to provide a reference for preventing the occurrence of behaviors that endanger the physical and mental health of rural adolescents. Methods: In October 2023, 828 rural left behind junior high school students from four counties and cities in Xiangxi Autonomous Prefecture, namely Luxi County, Huayuan County, Baojing County and Longshan County, were selected by cluster random sampling for a one year follow up investigation (T1:October 2023,T2:April 2024,T3:October 2024). Depressive symptom, NSSI behavior and social support of junior high school students were evaluated by using the Patient Health Questionnaire-9(PHQ-9),Adolescent Non suicidal Self injury Assessment Questionnaire (ANSAQ), and Social Support Scale for University Students(SSSUS). A cross lag panel model was constructed to analyze the dynamic relationship between depression symptom and NSSI behavior, as well as the longitudinal mediating role of social support. Results: The levels of depressive symptoms(T1-T3:150.00±5.88，14.29±7.52，13.97±6.70) and NSSI behavior (T1-T3:6.91±4.65，6.10±3.92，4.79±3.51) of rural left behind junior high school students both showed downward trends ( F =13.41, η 2=0.02; F =50.49, η 2=0.06), the level of social support (59.17±14.68，62.27±15.36，61.82±15.90) showed an upward trend ( F =20.94, η 2=0.03), and the depressive symptom and NSSI behavior of girls were higher than those of boys ( F =19.91, η 2=0.02; F =4.57, η 2=0.01)(all P <0.05). The positive predictive relationships between depressive symptom and NSSI behavior among rural left behind junior high school students [depressive symptom of T1 positively predicted NSSI behavior of T2 and T3 ( β =0.10, 0.16); depressive symptom of T2 positively predicted NSSI behavior of T3 ( β =0.14), all P <0.01]. Social support during the T2 period played a partial mediating role between depressive symptom in T1 and NSSI in T3, with a mediating effect of 0.02 (95% CI =0.01-0.17, P <0.05). Conclusions Depressive symptom positively predict the occurrence of NSSI behavior among rural left behind junior high school students. Social support is an important mediating factor in alleviating the influence of depressive symptoms on the occurrence of NSSI behavior. It should prevent and reduce the occurrence of depression symptoms and NSSI behavior by improving the social support level of rural left behind junior high school students.

OBJECTIVE: To explore the characteristics and rules of the locations of acupoints selected in weight loss after syndrome differentiation of acupuncture and moxibustion, and provide quantitative evidence for the location specificity of acupoint selection in weight loss. METHODS: Clinical research articles on acupoint selection based on syndrome differentiation of acupuncture and moxibustion in weight loss were retrieved in China National Knowledge Infrastructure (CNKI), from the inception to September 20th, 2024, and the data about acupoints and differentiated syndromes were extracted. Based on graph theory, the acupoint-syndrome network was established and its topological parameters such as node degree, value of betweenness centrality, description length and number of community were calculated. RESULTS: ①The description length of the limbs was 4 255.592, and that of the trunk was 3 274.312. The information contained in the acupoint-syndrome network for the acupoints on the limbs was greater than that for those on the trunk. ②The value of betweenness centrality and node degree showed a nonlinear relationship, with R²of 0.812 1 for the trunk and 0.321 8 for the limbs. The values of betweenness centrality for the acupoints on the trunk were uniformly distributed, and the difference among these values was much smaller than that for the acupoints on the limbs. It suggested that the distance from each trunk acupoint to network center was similar, and the importance among these acupoints to network was similar, while the importance among acupoints located on the limbs was different significantly. ③The frequency proportion of acupoints on the trunk showed uniform distribution among different syndromes, while that of some acupoints located on the limbs such as Taichong (LR3), Neiting (ST44) and Taixi (KI3) presented a correlation with the syndromes. CONCLUSION In weight loss with acupuncture and moxibustion, the correlation between the limb acupoints and syndromes is more diverse and specific than that between the trunk acupoints and syndromes. The differences in acupoint selection for simple obesity treated with acupuncture and moxibustion are mostly reflected in the acupoints on the four limbs rather than those on the trunk. It provides an approach to acupoint selection for "local weight loss" and "general regulation" in treatment with acupuncture and moxibustion.
Humans ; Acupuncture Points ; Moxibustion ; Weight Loss ; Acupuncture Therapy ; Obesity/physiopathology*

Chemotherapy is currently the mainstay of systemic management for triple-negative breast cancer (TNBC), but chemoresistance significantly impacts patient outcomes. Our research indicates that Doxorubicin (Dox)-resistant TNBC cells exhibit increased glycolysis and ATP generation compared to their parental cells, with this metabolic shift contributing to chemoresistance. We discovered that ALKBH3, an m¹A demethylase enzyme, is crucial in regulating the enhanced glycolysis in Dox-resistant TNBC cells. Knocking down ALKBH3 reduced ATP generation, glucose consumption, and lactate production, implicating its involvement in mediating glycolysis. Further investigation revealed that aldolase A (ALDOA), a key enzyme in glycolysis, is a downstream target of ALKBH3. ALKBH3 regulates ALDOA mRNA stability through m¹A demethylation at the 3'-untranslated region (3'UTR). This methylation negatively affects ALDOA mRNA stability by recruiting the YTHDF2/PAN2-PAN3 complex, leading to mRNA degradation. The ALKBH3/ALDOA axis promotes Dox resistance both in vitro and in vivo. Clinical analysis demonstrated that ALKBH3 and ALDOA are upregulated in breast cancer tissues, and higher expression of these proteins is associated with reduced overall survival in TNBC patients. Our study highlights the role of the ALKBH3/ALDOA axis in contributing to Dox resistance in TNBC cells through regulation of ALDOA mRNA stability and glycolysis.

Objective: To analyze the developmental trajectories of middle school students loneliness and social support, as well as to explore the interaction between loneliness and social support, so as to provide the evidence based support for the mental health development of adolescents. Methods: A total of 989 first year students from four public middle schools in Xiangxi Tujia and Miao Autonomous Prefecture, Hunan Province were selected for three follow up surveys by a cluster random sampling method (T1:March 2023, T2:June 2023, T3:December 2023). The UCLA Loneliness Scale-20 (ULS-20) and Social Support Scale for University Students (SSSUS) were employed for questionnaire data collection. The growth mixture modeling was utilized to test the developmental trajectories of loneliness and social support among middle school students, while the cross lagged analysis was performed to investigate their mutual influence. Results: The scores for loneliness and social support in T1, T2 and T3 were (43.1±5.8, 42.5± 6.8 , 42.0±6.9; 55.9±12.0, 60.7±15.7, 60.4±16.7), respectively. Correlational analysis revealed a significant negative correlation between loneliness levels (T1, T2, T3) and social support (T1, T2, T3) ( r =-0.47 to -0.36, P <0.01). Growth mixture modeling indicated a linear declining trend of middle school students loneliness, and the developmental trajectory of social support showed a linear increasing trend, with significant individual differences in initial levels and rates of change ( P <0.05). Cross lagged analyses revealed that loneliness levels at T1 negatively predicted social support scores at T2 ( β =-0.16), and loneliness levels at T2 negatively predicted social support scores at T3 ( β =-0.12) ( P <0.05). Additionally, prior loneliness positively predicted its subsequent levels, with path coefficients of 0.58 and 0.47, respectively ( P <0.05). Social support scores at T1 negatively predicted loneliness levels at T2 ( β =-0.10), while scores at T2 negatively predicted loneliness levels at T3 ( β =-0.15) ( P <0.05). Prior loneliness also positively predicted its subsequent levels, with path coefficients of 0.43 and 0.44, respectively ( P <0.05). Conclusion The developmental trajectory of middle school students loneliness demonstrates a decreasing trend, while that of social support exhibits a linear increasing trend, indicating a longitudinal causal relationship between loneliness and social support.

Objective To explore quality evaluation system for standardized training of general residents based on the six core competencies of World Organization of Family Doctors(WONCA).Methods The literatures meeting the requirements were selected by literature screening method under the framework of WONCA's six core competencies.The qualitative data were collected in the form of open questionnaires,and the indicator system was determined after two rounds of consultation.The evaluation indexes for residents training quality were selected by Colaizzi 7-step analysis method based on phenomenology.The weights of all indexes were calculated by analytic hierarchy process(AHP)to formulate quality evaluation system.Results 33 indexes in the 10 dimensions(information about residents,understanding about training content,basic information about the training hospital,et al.)were determined to construct quality evaluation system for standardized training of general residents.The weights of all indexes were determined by AHP.In all the indexes,weights of trainees'income(0.082),superiors attention(0.081)and the total completion assessment(0.113)were the highest.Conclusion The research results show that in the evaluation of quality system for standardized training of general residents,it is necessary to pay close attentions to the indexes with the highest weights in the 10 dimensions(information about residents,understanding about training content,basic information about the training hospital,et al.),especially for trainees'income,superiors attention and the total completion assessment to improve the evaluation system.