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.

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 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 ameliorative effects of the liver X receptor(LXR)agonist T0901317 on reti-nal structure and function damage caused by high glucose in mice.Methods A total of 30 12-week-old male C57BL/6J mice were randomly divided into the control,STZ-DMSO,and STZ-T0901317 groups,with 10 mice in each group.After a 12-hour fast,the mice were intraperitoneally injected with streptozotocin(STZ)at a dosage of 50 mg·kg-1 for 5 days.The mice in the control group were intraperitoneally injected with an equal volume of citrate buffer.The random blood glucose level was measured 72 hours after injection,and mice with the random blood glucose level exceeding 16.7 mmol·L-1 and polyuria were considered successful model candidates.These model mice were included in the STZ-DMSO and STZ-T0901317 groups,respectively,and the mice in the two groups were intravitreally injected with 1 μL of DMSO and 1 μL of T0901317(30 μmol·L-1),respectively.The thickness of the retinal nerve fiber layer(RNFL)was measured at 100 μm,200 μm,300 μm,400 μm,and 500 μm from the optic disc 6 weeks after STZ modeling.The cell density of the ganglion cell layer(GCL)(cells·mm-1)was quantified using ImageJ.Electroretinogram(ERG)analyses were employed to record the amplitude and latency of dark-adapted 0.01 ERG b-wave,dark-adapted 3.0 ERG a-and b-waves,dark-adapted 3.0 oscilla-tory potentials(OPs),and light-adapted 3.0 ERG a-and b-waves.The quantitative reverse transcription polymerase chain reaction(qRT-PCR)was used to detect the expression changes of inflammatory factors NLRP3,Caspase1,interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)in the retinal tissue of mice from each group.Results The optical coherence tomography(OCT)findings indicated that the RNFL thickness measured at 100 μm,200 μm,300μm,400 μm,and 500 μm from the optic disc in the STZ-DMSO group was significantly lower than that observed in the con-trol group,and the differences were statistically significant(all P＜0.05).In the STZ-T0901317 group,the RNFL thickness at all measurement points was greater than that in the STZ-DMSO group,and the differences were statistically significant(all P＜0.05).However,there were no statistically significant differences in the RNFL thickness at all measurement points between the STZ-T0901317 group and the control group(all P＞0.05).The hematoxylin and eosin(HE)staining results re-vealed that the GCL cell count in the control,STZ-DMSO,and STZ-T0901317 groups was(90.53±9.13)cells·mm-1,(82.06±0.98)cells·mm-1,and(94.94±10.61)cells·mm-1,respectively,with no significant differences among these groups(P＞0.05).The ERG results demonstrated that the amplitude of dark-adapted 0.01 ERG b-wave,dark-adapted 3.0 ERG a-and b-waves,the second wave of dark-adapted 3.0 oscillatory potentials(OPs2),and light-adapted ERG a-and b-waves was lower in the STZ-DMSO and STZ-T0901317 groups compared with the control group,and the differences were statistically significant(all P＜0.05).However,in the STZ-T0901317 group,the amplitude of dark-adapted 3.0 ERG a-and b-waves and OPs2 was higher than that in the STZ-DMSO group,and the differences were statistically significant(all P＜0.05).qRT-PCR analyses revealed that in the STZ-DMSO group,the relative mRNA expression level of NLRP3,Caspase-1,IL-1β,and IL-6 was elevated compared with the control group,and the differences were statistically significant(all P＜0.05).The relative mRNA expression level of NLRP3 and IL-6 in the STZ-T0901317 group was higher compared with the control group,and the differences were statistically significant(both P＜0.05).The relative mRNA expression level of NLRP3,Caspase-1,and IL-1β in the STZ-T0901317 group decreased compared with the STZ-DMSO group,and the differences were statistically significant(all P＜0.05).Conclusion The LXR agonist T0901317 may ameliorate early RNFL thickness alterations and im-prove visual function in DR mice by down-regulating the expression of NLRP3,Caspase-1,and IL-1β in mouse retinal tissues.

Objective To investigate the ameliorative effects of the liver X receptor(LXR)agonist T0901317 on reti-nal structure and function damage caused by high glucose in mice.Methods A total of 30 12-week-old male C57BL/6J mice were randomly divided into the control,STZ-DMSO,and STZ-T0901317 groups,with 10 mice in each group.After a 12-hour fast,the mice were intraperitoneally injected with streptozotocin(STZ)at a dosage of 50 mg·kg-1 for 5 days.The mice in the control group were intraperitoneally injected with an equal volume of citrate buffer.The random blood glucose level was measured 72 hours after injection,and mice with the random blood glucose level exceeding 16.7 mmol·L-1 and polyuria were considered successful model candidates.These model mice were included in the STZ-DMSO and STZ-T0901317 groups,respectively,and the mice in the two groups were intravitreally injected with 1 μL of DMSO and 1 μL of T0901317(30 μmol·L-1),respectively.The thickness of the retinal nerve fiber layer(RNFL)was measured at 100 μm,200 μm,300 μm,400 μm,and 500 μm from the optic disc 6 weeks after STZ modeling.The cell density of the ganglion cell layer(GCL)(cells·mm-1)was quantified using ImageJ.Electroretinogram(ERG)analyses were employed to record the amplitude and latency of dark-adapted 0.01 ERG b-wave,dark-adapted 3.0 ERG a-and b-waves,dark-adapted 3.0 oscilla-tory potentials(OPs),and light-adapted 3.0 ERG a-and b-waves.The quantitative reverse transcription polymerase chain reaction(qRT-PCR)was used to detect the expression changes of inflammatory factors NLRP3,Caspase1,interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)in the retinal tissue of mice from each group.Results The optical coherence tomography(OCT)findings indicated that the RNFL thickness measured at 100 μm,200 μm,300μm,400 μm,and 500 μm from the optic disc in the STZ-DMSO group was significantly lower than that observed in the con-trol group,and the differences were statistically significant(all P＜0.05).In the STZ-T0901317 group,the RNFL thickness at all measurement points was greater than that in the STZ-DMSO group,and the differences were statistically significant(all P＜0.05).However,there were no statistically significant differences in the RNFL thickness at all measurement points between the STZ-T0901317 group and the control group(all P＞0.05).The hematoxylin and eosin(HE)staining results re-vealed that the GCL cell count in the control,STZ-DMSO,and STZ-T0901317 groups was(90.53±9.13)cells·mm-1,(82.06±0.98)cells·mm-1,and(94.94±10.61)cells·mm-1,respectively,with no significant differences among these groups(P＞0.05).The ERG results demonstrated that the amplitude of dark-adapted 0.01 ERG b-wave,dark-adapted 3.0 ERG a-and b-waves,the second wave of dark-adapted 3.0 oscillatory potentials(OPs2),and light-adapted ERG a-and b-waves was lower in the STZ-DMSO and STZ-T0901317 groups compared with the control group,and the differences were statistically significant(all P＜0.05).However,in the STZ-T0901317 group,the amplitude of dark-adapted 3.0 ERG a-and b-waves and OPs2 was higher than that in the STZ-DMSO group,and the differences were statistically significant(all P＜0.05).qRT-PCR analyses revealed that in the STZ-DMSO group,the relative mRNA expression level of NLRP3,Caspase-1,IL-1β,and IL-6 was elevated compared with the control group,and the differences were statistically significant(all P＜0.05).The relative mRNA expression level of NLRP3 and IL-6 in the STZ-T0901317 group was higher compared with the control group,and the differences were statistically significant(both P＜0.05).The relative mRNA expression level of NLRP3,Caspase-1,and IL-1β in the STZ-T0901317 group decreased compared with the STZ-DMSO group,and the differences were statistically significant(all P＜0.05).Conclusion The LXR agonist T0901317 may ameliorate early RNFL thickness alterations and im-prove visual function in DR mice by down-regulating the expression of NLRP3,Caspase-1,and IL-1β in mouse retinal tissues.

Objective : To analyze the status and influencing factors of the intention of people aged 18 to 25 years to primary medical institutions and their satisfaction for health services in Zhejiang Province, so as to provide basis for the improvement of health services in primary medical institutions. Methods: During November and December in 2019,the 18-25 year-old people in Zhejiang Province were recruited to investigate the general information, intention to seek medical advice and satisfaction for health services in primary medical institutions through WeChat. Logistic regression was performed to analyze the influencing factors of the intention and the satisfaction. Importance matrix was used to analyze the key drivers of the satisfaction. Results: Among the 620 people surveyed, with a response rate of 93.37%, 142 (22.90%) chose primary medical institutions for advice. Actually 516 (83.23%) people went to primary medical institutions last year, and 384 ( 74.42% ) of them were satisfied with the health services. The results of multivariate logistic regression analysis showed that the people aged 18-25 years who were under the new rural cooperative medical care system ( OR=3.062, 95%CI: 1.745-5.373 ) and who had records in community health centers ( OR=0.547, 95%CI: 0.308-0.970 ) were more likely to go to primary medical institutions for medical advice; the ability of doctors ( OR=1.478, 95%CI:1.168-1.871 ) ,the drug notification by medical staff ( OR=1.308, 95%CI: 1.065-1.606 ) , routine examination items ( OR=1.523, 95%CI: 1.227-1.889 ) , the ways of payment ( OR=1.168, 95%CI: 1.017-1.340 ) , the comfort of environment ( OR=1.785, 95%CI: 1.437-2.219 ) and the bulletin boards of health knowledge ( OR=1.302, 95%CI: 1.086-1.561 ) were associated with the satisfaction. The results of importance matrix analysis showed that the ability of doctors and routine examination items were the priorities to improve, followed by the drug notification by medical staff; the comfort of environment had competitive advantages; the ways of payment and the bulletin boards of health knowledge needed to be further analyzed. Conclusions The 18-25-year-old people in Zhejiang Province were less intended to seek medical advice in primary medical institutions, which was associated with the type of medical insurance and records in community health centers. They were satisfied with the health services, the ability of doctors and routine examination items were the key drivers.