Objective: To investigate the situation and influencing factors of school bullying experienced by primary and middle school students, so as to provide the basis for formulating school bullying intervention measures and promoting students' physical and mental health development. Methods: All the counties (cities, districts) in Zhejiang Province were stratified to urban and suburban areas, primary, junior high and senior high school students were selected using a stratified cluster sampling method. Basic information, lifestyle and school bullying were collected through questionnaire surveys. Factors affecting school bullying experienced by primary and middle school students were analyzed using a multivariable logistic regression model. Results: Totally 137 846 valid questionnaires were recovered, with an effective recovery rate of 97.17%. There were 72 526 males (52.61%) and 65 320 females (47.39%). There were 47 561 primary school students (34.50%), 47 701 junior high school students (34.61%) and 42 584 senior high school students (30.89%). A total of 3 987 students suffered from school bullying, accounting for 2.89%. The proportions of being maliciously teased, being intentionally excluded from group activities/isolated, being teased about physical defects or appearance, being hit/kicked/pushed/shoved/locked in a room, being threatened, and being extorted for money were 2.04%, 1.18%, 1.11%, 0.86%, 0.84% and 0.83%, respectively. Multivariable logistic regression analysis showed that the students who were males (OR=1.122, 95%CI: 1.048-1.202), lived in suburban areas (OR=1.322, 95%CI: 1.233-1.418), lived in areas with medium (OR=1.086, 95%CI: 1.006-1.173) or underdeveloped (OR=1.298, 95%CI: 1.191-1.415) economic level, had higher academic levels (junior high school, OR=1.380, 95%CI: 1.270-1.499; senior high school, OR=1.210, 95%CI: 1.083-1.351), lived on campus (OR=1.489, 95%CI: 1.372-1.616), engaged in fights (OR=6.029, 95%CI: 5.585-6.509), attempted to smoke (OR=1.320, 95%CI: 1.128-1.545), drank (OR=1.735, 95%CI: 1.575-1.912), were scolded and beaten by parents (OR=1.972, 95%CI: 1.822-2.135) and were obese (OR=1.240, 95%CI: 1.132-1.360) were more likely to experience school bullying. Conclusion The harm of school bullying to the physical and mental health of primary and middle school students should be taken seriously, and active policy measures should be adopted to strengthen intervention.

Objective To retrieve and evaluate the evidence related to surgical instrument management,and to integrate the evidence to provide an evidence-based basis for clinical surgical instrument management practice.Methods Evidence on surgical instrument management,including guidelines,expert consensuses,and clinical decision-making,was systematically searched from domestic and international databases and related websites.The search timeframe was from database construction to 4 November 2024.Literature was screened and evaluated,and the evidence was integrated by 2 researchers.Results A total of 16 papers were included,including 2 systematic evaluations,1 class experimental study,2 clinical decisions,4 expert consensuses,5 guidelines,and 2 evidence summaries,resulting in a total of 33 pieces of evidence in 5 areas,including requirements for surgical instrument management,general principles of surgical instrument handling,logistics and supply chain management of surgical instruments,surgical instrument pre-treatment and cleaning,disinfection,and sterilisation processes,and personnel training.Conclusion This study summarises the best available evidence on the management of surgical instruments in hospitals and provides an evidence-based basis for healthcare professionals to manage surgical instruments,thereby improving the quality and efficiency of surgical instrument disposal.

Objective:To analyze the multimorbidity trends and influencing factors of internet addiction and depressive symptoms among middle school students in Zhejiang Province.Methods:From 2018 to 2023, a multistage stratified random cluster sampling method was used to select middle school students aged 12 to 18 in Zhejiang Province. Internet addiction and depression status were measured by the Internet Addiction Scale and the Center for Epidemiologic Studies Depression Scale. When both symptoms were present, it was defined as multimorbidity.The multivariate logistic regression model was used to analyze the influencing factors of multimorbidity among middle school students, and a trend Chi-square test was used to analyze the changing trends of internet addiction, depression and multimorbidity prevalence. Results:A total of 193 505 students were included in the study. From 2018 to 2023, the prevalence of multimorbidity of internet addiction and depressive symptoms among middle school students ranged from 2.7% to 3.5%. The prevalence of internet addiction ranged from 4.7% to 6.0%, while the prevalence of depressive symptoms ranged from 18.7% to 25.1%. Multivariate logistic regression showed that boarding students ( OR=1.34 , 95% CI: 1.26-1.42), low-frequency ( OR=1.59, 95% CI: 1.46-1.73), and high-frequency sugary drink consumption ( OR=3.91, 95% CI: 3.55-4.31) increased the risk of multimorbidity among middle school students. In contrast, higher frequencies of moderate-to-high-intensity exercise (medium: OR=0.54, 95% CI: 0.50-0.58; high: OR=0.49, 95% CI: 0.44-0.55) and sufficient sleep ( OR=0.52, 95% CI: 0.49-0.56) were protective factors. From 2018 to 2023, there was no significant change in the trend of multimorbidity prevalence among middle school students ( χ2trend=3.82, P=0.051). The prevalence of internet addiction showed an upward trend ( χ2trend=20.54, P<0.001), while depressive symptoms showed a downward trend ( χ2trend=181.41, P<0.001). Conclusion:The prevalence of internet addiction and depression symptoms among middle school students in Zhejiang Province remains stable from 2018 to 2023. The prevalence of internet addiction shows an upward trend, while the prevalence of depression symptoms shows a downward trend. The risk of multimorbidity is related to students′ boarding, consumption of sugary drinks, lack of exercise, and insufficient sleep.

Objective To explore the correlation between the ratio of free triiodothyronine/free thyroxine(FT3/FT4)and the early-phase insulin secretion index(ΔI30/ΔG30)in type 2 diabetes mellitus(T2DM)patients with normal thyroid function.Methods 200 patients with T2DM with normal thyroid function in Hebei General Hospital from September 2019 to June 2021 were selected and divided into the Q1 group with FT3/FT4≤0.26(n=67),the Q2 group with 0.27≤FT3/FT4≤0.29(n=67),and the Q3 group with FT3/FT4≥0.30(n=66)according to the tertiles of the FT3/FT4.The general data,biochemical indicators and islet functions of the three groups were compared,and the relationship between the FT3/FT4 ratio and the ΔI30/ΔG30 as well as the islet β cell function was analyzed.Results The fasting insulin(FIns),2 h postprandial insulin(2 hIns),homeostatic model assessment of islet β cell(HOMA-β)and area under the curve of insulin(AUCI)in Q3 group were higher than those in Q1 and Q2 groups(P<0.05),2 h postprandial blood glucose(2 hPG)in Q3 group was lower than those in Q1 and Q2 groups(P<0.05).Systolic blood pressure in Q2 group was higher than those in Q1 group(P<0.05).Compared with Q1 group,diastolic blood pressure,body mass index(BMI),alanine aminotransferase(ALT),fasting C-peptide(FC-P),area under curve of C-P(AUCC),2 h postprandial C-peptide(2 hC-P)and ΔI30/ΔG30 in Q3 group were significantly higher(P<0.05),and HbA1c was significantly lower(P<0.05).Spearman correlation analysis showed that Δ I30/Δ G30,HOMA-β,AUCI,AUCC and HOMA-IR were positively correlated with BMI,ALT,FC-P,2 hC-P,FIns,2 hIns and FT3/FT4(P<0.05),it was negatively correlated with HbA1c and 2 hPG(P<0.05).Linear regression analysis showed that ΔI30/ΔG30,HOMA-β,AUCI and AUCC were the influencing factors of FT3/FT4 after adjusting for confounding factors.Conclusions ΔI30/ΔG30,HOMA-β,AUCI and AUCC are the influencing factors of FT3/FT4 in T2DM patients with normal thyroid function,suggesting that FT3/FT4 is higher in patients with better islet β cell secretion function.

Objectives:To observe the efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)under microscope via fixed channel in the treatment of patients with double segment lumbar spondylolisthesis,and analyze its impact on lumbar stability and complications.Methods:108 patients with bilateral lumbar spondylolisthesis admitted and treated in our hospital from January 2022 to January 2024 were selected as the study subjects in this prospective study.Using a random number table,the patients were divided into two groups:conventional group(n=53,29 males and 24 females,53.23±4.30 years old)and microscope group(n=55,28 males and 27 females,53.45±4.28 years old).The patients in the conventional group underwent MIS-TLIF via fixed channel through conventional approach,and patients in the microscope group received MIS-TLIF via fixed channel under microscope.There was no significant difference between the two groups in baseline data(P＞0.05).The drainage volume and bleeding volume,fluoroscopy frequency,operative time and the occurrence of complications of the two groups of patients were recorded and compared.The clinical efficacy was evaluated using the modified MacNab scoring standard 6 months after operation.X-ray examinations were performed before operation,3 months and 6 months after operation,and the height of intervertebral space and spondylolisthesis angle were measured and compared to evaluate the stability of the lumbar spine;During the same period,Japanese Orthopaedic Association(JOA)score and Oswestry disability index(ODI)were used to evaluate and compare the lumbar dysfunction of the two groups of patients.The levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),and creatine kinase(CK)in the two groups of patients were detected and compared by enzyme-linked immunosorbent assay(ELISA)before operation,3d,and 6d after operation to evaluate inflammatory factors.Results:Compared with the conventional group,the total excellent and good rate of the microscope group was higher(78.18％vs 60.38％,P＜0.05),and the drainage and bleeding volume were less(98.03±9.77mL vs 120.73±13.52mL and 113.42±11.03mL vs 142.69±15.72mL,P＜0.05),fluoroscopy frequency was fewer(6.71±0.58 vs 8.36±0.72,P＜0.05),operative time was shorter(123.59±13.58min vs 157.42±16.89min,P＜0.05),and complication rate were lower(3.64％vs 16.98％,P＜0.05).Before operation,the intervertebral space height,slip angle,JOA score,and ODI were comparable between the two groups(P＞0.05).At 3 and 6 months after operation,the intervertebral space height and JOA score increased,and the microscope group was higher(Postoperative 3 months:8.03±0.80mm vs 6.12±0.72mm,15.28±1.24 points vs 11.14±1.02 points;Postoperative 6 months,11.02±1.27mm vs 9.23±0.95mm,21.72±2.14 points vs 18.03±1.60 points,P＜0.05),while the slip angle and ODI score decreased,and the microscope group was lower(Postoperative 3 months:2.41°±0.28° vs 3.01°±0.32°,32.14±2.96 points vs 36.01±3.14 points;Postoperative 6 months:1.60°±0.16° vs 2.03°±0.25°,24.77±2.15 points vs 28.01±2.60 points,P＜0.05).Before operation and on 6d after operation,the levels of CRP,TNF-α,and CK were comparable between the two groups(P＞0.05);3d after operation,the levels of CRP,TNF-cc and CK in the microscope group were lower(6.01±0.75mg/L vs 8.23±0.93mg/L,23.01±2.01 pg/mL vs 29.36±2.57pg/mL,170.43±19.01U/L vs 205.72±30.89U/L,P＜0.05).Conclusions:Microscopically-assisted MIS-TLIF demonstrates excellent short-term efficacy in treating two-segment lumbar spondylolisthesis,which can significantly reduce complication risks.It effectively enhances postoperative lumbar stability,promotes functional recovery,and suppresses early inflammatory responses,making it a clinically valuable treatment option.

Objectives:To observe the efficacy of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)under microscope via fixed channel in the treatment of patients with double segment lumbar spondylolisthesis,and analyze its impact on lumbar stability and complications.Methods:108 patients with bilateral lumbar spondylolisthesis admitted and treated in our hospital from January 2022 to January 2024 were selected as the study subjects in this prospective study.Using a random number table,the patients were divided into two groups:conventional group(n=53,29 males and 24 females,53.23±4.30 years old)and microscope group(n=55,28 males and 27 females,53.45±4.28 years old).The patients in the conventional group underwent MIS-TLIF via fixed channel through conventional approach,and patients in the microscope group received MIS-TLIF via fixed channel under microscope.There was no significant difference between the two groups in baseline data(P＞0.05).The drainage volume and bleeding volume,fluoroscopy frequency,operative time and the occurrence of complications of the two groups of patients were recorded and compared.The clinical efficacy was evaluated using the modified MacNab scoring standard 6 months after operation.X-ray examinations were performed before operation,3 months and 6 months after operation,and the height of intervertebral space and spondylolisthesis angle were measured and compared to evaluate the stability of the lumbar spine;During the same period,Japanese Orthopaedic Association(JOA)score and Oswestry disability index(ODI)were used to evaluate and compare the lumbar dysfunction of the two groups of patients.The levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),and creatine kinase(CK)in the two groups of patients were detected and compared by enzyme-linked immunosorbent assay(ELISA)before operation,3d,and 6d after operation to evaluate inflammatory factors.Results:Compared with the conventional group,the total excellent and good rate of the microscope group was higher(78.18％vs 60.38％,P＜0.05),and the drainage and bleeding volume were less(98.03±9.77mL vs 120.73±13.52mL and 113.42±11.03mL vs 142.69±15.72mL,P＜0.05),fluoroscopy frequency was fewer(6.71±0.58 vs 8.36±0.72,P＜0.05),operative time was shorter(123.59±13.58min vs 157.42±16.89min,P＜0.05),and complication rate were lower(3.64％vs 16.98％,P＜0.05).Before operation,the intervertebral space height,slip angle,JOA score,and ODI were comparable between the two groups(P＞0.05).At 3 and 6 months after operation,the intervertebral space height and JOA score increased,and the microscope group was higher(Postoperative 3 months:8.03±0.80mm vs 6.12±0.72mm,15.28±1.24 points vs 11.14±1.02 points;Postoperative 6 months,11.02±1.27mm vs 9.23±0.95mm,21.72±2.14 points vs 18.03±1.60 points,P＜0.05),while the slip angle and ODI score decreased,and the microscope group was lower(Postoperative 3 months:2.41°±0.28° vs 3.01°±0.32°,32.14±2.96 points vs 36.01±3.14 points;Postoperative 6 months:1.60°±0.16° vs 2.03°±0.25°,24.77±2.15 points vs 28.01±2.60 points,P＜0.05).Before operation and on 6d after operation,the levels of CRP,TNF-α,and CK were comparable between the two groups(P＞0.05);3d after operation,the levels of CRP,TNF-cc and CK in the microscope group were lower(6.01±0.75mg/L vs 8.23±0.93mg/L,23.01±2.01 pg/mL vs 29.36±2.57pg/mL,170.43±19.01U/L vs 205.72±30.89U/L,P＜0.05).Conclusions:Microscopically-assisted MIS-TLIF demonstrates excellent short-term efficacy in treating two-segment lumbar spondylolisthesis,which can significantly reduce complication risks.It effectively enhances postoperative lumbar stability,promotes functional recovery,and suppresses early inflammatory responses,making it a clinically valuable treatment option.

AIM:To investigate the visual quality and stereopsis after the implantation of PanOptix trifocal intraocular lens(TFNT00).METHODS: A prospective clinical study was conducted. A total of 36 cataract patients(50 eyes)who underwent phacoemulsification combined with TFNT00 implantation in Jinan Mingshui Eye Hospital from November 2022 to April 2024 were selected. They were followed up until 3 mo after the operation. The uncorrected distance visual acuity(UCDVA), uncorrected intermediate visual acuity(UCIVA), uncorrected near visual acuity(UCNVA), objective scatter index(OSI), modulation transfer function cut off(MTF-cut-off), Strehl ratio(SR)and 100%, 20%, 9% contrast visual acuity(CVA)were observed. The binoptometer was used to collect the patients' far and near stereopsis acuities. The defocus curve was drawn after the operation; the Chinese version of the VF-14 Visual Function Index Scale was used to evaluate the visual quality and satisfaction after the operation.RESULTS: There were statistically significant differences in the UCDVA, UCIVA and UCNVA of the patients at different time after the operation(all P<0.05). The transition of the defocus curve was gentle between +0.5--3.0 D after the operation. The OSI value at 3 mo postoperatively after the operation was significantly lower than that before the operation(P<0.01), and the MTF-cut-off, SR, 100% CVA, 20% CVA and 9% CVA were significantly improved than those before operation(all P<0.01). The far and near stereopsis acuities of 34 patients were abnormal before the operation. The far stereopsis acuities of the patients who underwent bilateral eye surgeries were all normal after the operation, and the near stereopsis acuity of 12 patients was normal. Among the patients who underwent unilateral eye surgeries, the far stereopsis acuities of 13 patients were normal, and the near stereopsis acuities of 11 patients were normal. The far and near stereopsis acuities of the patients who underwent bilateral eye surgeries were significantly better than those patients who underwent unilateral eye surgeries.CONCLUSION: The PanOptix trifocal intraocular lens can provide patients with good full-range visual acuity. The stereopsis of the patients with bilateral implants is better than that of the patients with unilateral implants. The overall visual quality and satisfaction of the patients after the operation are relatively high.

Objective To retrieve and evaluate the evidence related to surgical instrument management,and to integrate the evidence to provide an evidence-based basis for clinical surgical instrument management practice.Methods Evidence on surgical instrument management,including guidelines,expert consensuses,and clinical decision-making,was systematically searched from domestic and international databases and related websites.The search timeframe was from database construction to 4 November 2024.Literature was screened and evaluated,and the evidence was integrated by 2 researchers.Results A total of 16 papers were included,including 2 systematic evaluations,1 class experimental study,2 clinical decisions,4 expert consensuses,5 guidelines,and 2 evidence summaries,resulting in a total of 33 pieces of evidence in 5 areas,including requirements for surgical instrument management,general principles of surgical instrument handling,logistics and supply chain management of surgical instruments,surgical instrument pre-treatment and cleaning,disinfection,and sterilisation processes,and personnel training.Conclusion This study summarises the best available evidence on the management of surgical instruments in hospitals and provides an evidence-based basis for healthcare professionals to manage surgical instruments,thereby improving the quality and efficiency of surgical instrument disposal.

Objective:To analyze the multimorbidity trends and influencing factors of internet addiction and depressive symptoms among middle school students in Zhejiang Province.Methods:From 2018 to 2023, a multistage stratified random cluster sampling method was used to select middle school students aged 12 to 18 in Zhejiang Province. Internet addiction and depression status were measured by the Internet Addiction Scale and the Center for Epidemiologic Studies Depression Scale. When both symptoms were present, it was defined as multimorbidity.The multivariate logistic regression model was used to analyze the influencing factors of multimorbidity among middle school students, and a trend Chi-square test was used to analyze the changing trends of internet addiction, depression and multimorbidity prevalence. Results:A total of 193 505 students were included in the study. From 2018 to 2023, the prevalence of multimorbidity of internet addiction and depressive symptoms among middle school students ranged from 2.7% to 3.5%. The prevalence of internet addiction ranged from 4.7% to 6.0%, while the prevalence of depressive symptoms ranged from 18.7% to 25.1%. Multivariate logistic regression showed that boarding students ( OR=1.34 , 95% CI: 1.26-1.42), low-frequency ( OR=1.59, 95% CI: 1.46-1.73), and high-frequency sugary drink consumption ( OR=3.91, 95% CI: 3.55-4.31) increased the risk of multimorbidity among middle school students. In contrast, higher frequencies of moderate-to-high-intensity exercise (medium: OR=0.54, 95% CI: 0.50-0.58; high: OR=0.49, 95% CI: 0.44-0.55) and sufficient sleep ( OR=0.52, 95% CI: 0.49-0.56) were protective factors. From 2018 to 2023, there was no significant change in the trend of multimorbidity prevalence among middle school students ( χ2trend=3.82, P=0.051). The prevalence of internet addiction showed an upward trend ( χ2trend=20.54, P<0.001), while depressive symptoms showed a downward trend ( χ2trend=181.41, P<0.001). Conclusion:The prevalence of internet addiction and depression symptoms among middle school students in Zhejiang Province remains stable from 2018 to 2023. The prevalence of internet addiction shows an upward trend, while the prevalence of depression symptoms shows a downward trend. The risk of multimorbidity is related to students′ boarding, consumption of sugary drinks, lack of exercise, and insufficient sleep.

Objective To explore the correlation between the ratio of free triiodothyronine/free thyroxine(FT3/FT4)and the early-phase insulin secretion index(ΔI30/ΔG30)in type 2 diabetes mellitus(T2DM)patients with normal thyroid function.Methods 200 patients with T2DM with normal thyroid function in Hebei General Hospital from September 2019 to June 2021 were selected and divided into the Q1 group with FT3/FT4≤0.26(n=67),the Q2 group with 0.27≤FT3/FT4≤0.29(n=67),and the Q3 group with FT3/FT4≥0.30(n=66)according to the tertiles of the FT3/FT4.The general data,biochemical indicators and islet functions of the three groups were compared,and the relationship between the FT3/FT4 ratio and the ΔI30/ΔG30 as well as the islet β cell function was analyzed.Results The fasting insulin(FIns),2 h postprandial insulin(2 hIns),homeostatic model assessment of islet β cell(HOMA-β)and area under the curve of insulin(AUCI)in Q3 group were higher than those in Q1 and Q2 groups(P<0.05),2 h postprandial blood glucose(2 hPG)in Q3 group was lower than those in Q1 and Q2 groups(P<0.05).Systolic blood pressure in Q2 group was higher than those in Q1 group(P<0.05).Compared with Q1 group,diastolic blood pressure,body mass index(BMI),alanine aminotransferase(ALT),fasting C-peptide(FC-P),area under curve of C-P(AUCC),2 h postprandial C-peptide(2 hC-P)and ΔI30/ΔG30 in Q3 group were significantly higher(P<0.05),and HbA1c was significantly lower(P<0.05).Spearman correlation analysis showed that Δ I30/Δ G30,HOMA-β,AUCI,AUCC and HOMA-IR were positively correlated with BMI,ALT,FC-P,2 hC-P,FIns,2 hIns and FT3/FT4(P<0.05),it was negatively correlated with HbA1c and 2 hPG(P<0.05).Linear regression analysis showed that ΔI30/ΔG30,HOMA-β,AUCI and AUCC were the influencing factors of FT3/FT4 after adjusting for confounding factors.Conclusions ΔI30/ΔG30,HOMA-β,AUCI and AUCC are the influencing factors of FT3/FT4 in T2DM patients with normal thyroid function,suggesting that FT3/FT4 is higher in patients with better islet β cell secretion function.