Objective: To explore the relationship between snack consumption and depressive symptoms in first year junior high school students with different left behind experiences in Yunnan Province, so as to provide a basis for improving depressive symptoms among first year junior high school students with different left behind experiences. Methods: From October to December 2022,a cluster random sampling method was used to select 8 500 first year junior high school students from 11 ethnic minority areas (Fugong County, Longling County, Longyang District, Luchun County, Mojiang County, Nanjian County, Qiaojia County, Shuangjiang County, Tengchong City, Yuanmou County, Zhenyuan County) in Yunnan Province for a questionnaire survey. The Chinese version of Depression Anxiety Stress Scale-21 was applied to assess depressive symptoms in first year junior high school students, and snack consumption was collected by employing food frequency questionnaire. The generalized linear model was used to analyze the association between first year junior high school students snack consumption and depressive symptoms, and the analysis was stratified according to left behind experience. Results: The detection rates of depressive symptoms among firstyear junior high school students with and without left behind experience were 36.25% and 26.91%, respectively. After controlling for confounding variables, the generalized linear model analysis showed that sweet snacks ( β=0.16, 95%CI =0.07-0.25), fast food ( β=0.14, 95%CI =0.04-0.23) and carbonated drinks ( β=0.09, 95%CI =0.01-0.17) of first year junior high school students with left behind experience (all P <0.05). Compared with those without such behavior, the risk of depressive symptoms was higher in consumption of fast food ( β=0.13, 95%CI =0.07-0.18) and carbonated drinks ( β=0.10, 95%CI =0.06-0.15)among first year junior high school students without left behind experience (both P <0.05). Conclusion Snack consumption among first year junior high school students in Yunnan may increase the risk of developing depressive symptoms, while first year junior high school students with left behind experience may have a greater risk of developing depressive symptoms.

Background The moderation role of environmental factors in the spread of hand-foot-and-mouth disease (HFMD) has attracted much attention, but the existing conclusions are inconsistent. For example, some scholars believe that high temperature, high humidity, and high concentrations of fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) increase the risk of HFMD, but other scholars have reached the opposite conclusion, or believe that there is no significant relationship. Objective Based on distributed lag nonlinear model (DLNM), to investigate the relationship between the incidence of HFMD and meteorological and air pollutant variables in Lianyungang City, and to provide scientific basis for early warning. Methods Daily data of meteorological factors and air pollutants in Lianyungang City from 2021 to 2024 were retrieved. Meteorological factors included average daily temperature, average wind speed, average air pressure, and relative humidity. Air pollutant indicators included PM_2.5, inhalable particulate matter (PM₁₀), carbon monoxide (CO), sulfur dioxide (SO₂), NO₂, and ozone (O₃). Spearman correlation analysis was used to analyze their correlations with HFMD, and the R package (version 4.3.1) dlnm was used to construct a DLNM model. Results During the study period, a total of 10503 cases were reported, with a male to female ratio of 1.47∶1 and the highest proportion of scattered children (49.97%). The Spearman correlation analysis results showed that daily average temperature (r=0.40), relative humidity (r=0.17) and O₃ (r=0.14) were positively correlated with the incidence of HFMD (all Ps<0.01), while average air pressure (r=−0.34), PM_2.5 (r=−0.24), PM₁₀ (r=−0.24), CO (r=−0.22), and NO₂ (r=−0.06) were negatively correlated with it (all Ps<0.05). There was no statistical relationship of SO₂ and average wind speed with the incidence of HFMD (both Ps>0.05). The cumulative risk effect was greatest when the daily average temperature was 28.50 ℃ (CRR=4.63, 95%CI: 2.68, 8.01). The average wind speed below 0.50 m·s⁻¹ and in the range of 2.50-3.50 m·s⁻¹ showed an acute risk effect, and low pressure (below 1016.00 hPa) could immediately increase the risk of the disease. The cumulative risk effect was greatest when the relative humidity was 100% (CRR=3.16, 95%CI: 1.77, 5.65). The greatest cumulative protective effects of PM_2.5 and PM₁₀ were present at concentrations of 158.00 μg·m⁻³ (CRR=0.12, 95%CI: 0.01, 0.99) and 561.50 μg·m⁻³ (CRR=0.01, 95%CI: 0.01, 0.99) respectively. The protective effect of CO was the strongest at the highest concentration (67.00 μg·m⁻³) (RR=0.67, 95%CI: 0.34, 0.64). The cumulative protective effects of SO₂ and NO₂ were both most significant at the concentration of 0.50 μg·m⁻³. Low concentrations of O₃ (below 48.00 μg·m⁻³) showed a risk effect, and the single-day protective effect was significant when the concentration was 141.00 μg·m⁻³. Conclusion There is a nonlinear and hysteretic relationship between environmental factors and the incidence of HFMD. A rational and efficient early warning and prevention and control system can be constructed accordingly.

Objective To investigate the associations between physical health status,refraction and ocular biometrics in school-age children,and further clarify the relation of eyes'refractive status to physical growth and development,so as to provide scientific evidences for myopia prevention and con-trol.Methods A total of 1718 children(977 boys and 741 girls)aged 8-12 years were enrolled in this study.They were collected uncorrected visual acuity,refraction and ocular biometrics,including spherical equivalent,cylindrical equivalent,axial length(AL),corneal refraction(K1,K2)and anteri-or chamber depth(ACD),as well as the AL/CR ratio and spherical equivalent refraction(SER).Moreover,their height,weight and physical fitness level were measured,including speed,strength,flexibility,agility and aerobic endurance.Then all data were analyzed using the Pearson correlation,One-way ANOVA and multiple linear regression model.Results The overall prevalence of myopia was 43.83%,which was higher in girls than in boys(46.96%vs.41.45%).Moreover,the height and weight of school-age children were negatively correlated with SER(P<0.01),but positively correlated with AL,ACD and AL/CR(P<0.01).After controlling the age and gender variables in the multiple linear regression model,it was found that for 10-cm increase in height,SER decreased by 0.013 D(P<0.01),AL extended by 0.022 mm(P<0.01),and ACD increased by 0.002 mm(P<0.05).In addi-tion,for 10-kg increase in the body weight,the AL would be 0.009 mm longer(P<0.05)and ACD 0.002 mm deeper(P<0.05).Moreover,the speed,strength and agility were negatively correlated with SER(P<0.01,P<0.05),but positively correlated with AL,ACD and AL/CR(P<0.01,P<0.05).The maximal oxygen uptake level was positively correlated with SER(P<0.01),and negatively correlated with AL,ACD and AL/CR(P<0.01,P<0.05).After controlling the age and gender variables in the multiple linear regression model,it was found that the children with worse speed quality had shorter AL(-0.043 D,P<0.05).Meanwhile,the better agility was accompanied by the lower SER(-0.003 D,P<0.01),longer AL(+0.002 mm,P<0.05),lighter ACD(+4.812e-4 mm,P<0.05),and higher AL/CR(+2.446e-4,P<0.05).Conclusion With variables of age and gender controlled,the height,weight,and the speed and agility quality are highly associated with eyes'refractive status among chil-dren aged 8-12 years old.It is suggested that the human body may have a coordination mechanism to regulate the development of the body stature,physical fitness and ocular biometrics in the early child-hood,which should be considered in their myopia prevention and control.

OBJECTIVE To explore the current status,etiological characteristics and risk factors for nosocomial in-fections in the patients who are treated with extracorporeal membrane oxygenation(ECMO)so as to provide bases for treatment and prevention of nosocomial infections in the ICU patients treated with ECMO.METHODS The clinical data were retrospectively collected from the patients who were treated with ECMO in the ICU of Xinyang Central Hospital from Jan.2021 to Dec.2023.The patients were divided into the infection group and the non-infec-tion group according the status of nosocomial infection during the ECMO treatment period.The constituent ratios of pathogens isolated from the patients with infections were recorded,and multivariate logistic regression analysis was performed for independent risk factors for the ECMO-related nosocomial infections.RESULTS Of 86 patients who were finally enrolled in the study,33(38.37％)had nosocomial infections.Totally 54 strains of pathogens were isolated from the patients with the infections,43(79.63％)of which were gram-negative bacteria,7(12.97％)were gram-positive bacteria,and 4(7.41％)were fungi.There were 36(66.67％)strains of multi-drug-resistant organisms(MDROs)among the 54 strains of pathogens,and 27(81.82％)patients were detected with MDROs.Among the ECMO patients with postoperative nosocomial infections,21(63.64％)cases had pul-monary infections,8(24.24％)cases had bloodstream infection,and 4(12.12％)had urinary system infections.Multivariate logistic analysis showed that the high blood glucose level at the beginning of treatment with ECMO,long duration of ECMO treatment and long time of central venous catheter indwelling were the independent risk factors for the nosocomial infections in the patients treated with ECMO(P＜0.05).CONCLUSION The isolation rate of gram-negative bacteria is relatively high among the pathogens isolated from the ECMO patients with post-operative nosocomial infections,and the drug resistance rates are high.The high blood glucose level,long duration of ECMO supporting treatment and long time of central venous catheter indwelling are the independent risk factors for the nosocomial infections in the patients treated with ECMO.

Aim To explore the impact and mechanism of proprotein convertase subtilisin kexin 9(PCSK9)on the progression of abdominal aortic aneurysm(AAA).Methods 6～8 week old ApoE-/-mice were selected to estab-lish the AAA model.Angiotensin Ⅱ(Ang Ⅱ)was continuously infused through subcutaneous implantation of a micro-os-motic pump.The mice were fed with high-fat diet and killed after 28 days.The expression of PCSK9 in abdominal aor-tic smooth muscle cells was detected by immunohistochemistry and immunofluorescence in normal abdominal aortic blood vessels and AAA samples in human and mice.Primary cultured murine vascular smooth muscle cells(mVSMC)of C57BL/6 mice were treated with different concentrations of AngⅡ for 24 h,and the expression of PCSK9 mRNA and pro-tein was detected.PCSK9 overexpression and knockdown cell models were established,and mitochondrial reactive oxygen species(mtROS),mitochondrial membrane potential(MMP),mitochondrial permeability transition pore(MPTP)open-ing,and Z-DNA binding protein 1(ZBP1)protein expression were detected.Bioinformatics was used to analyze the dif-ferential expression of multiple single-cell sequencing datasets to obtain the key differentially expressed genes,and to study their expression and role in AAA.Results Immunohistochemistry and immunofluorescence results showed that PCSK9 expression in human and mouse AAA increased(P＜0.01),and co-localized with smooth muscle.Ang Ⅱ promoted PCSK9 expression in mVSMC in a concentration-dependent manner,the 2.0 μmol/L Ang Ⅱ group showed a 2.9-fold and 1.1-fold increase in the expression of PCSK9 mRNA and protein,respectively(P＜0.01),with the most significant effect observed.After successfully constructing PCSK9 overexpression and PCSK9 interference mVSMC models,PCSK9 overex-pression led to an increase in intracellular mtROS,a decrease in MMP,an increase in MPTP opening,and a decrease in cellular activity(P＜0.01);PCSK9 knockdown could reduce Ang Ⅱ induced increase in mtROS,decrease in MMP and MPTP opening;compared with the siNC+Ang Ⅱ group,the siPCSK9+Ang Ⅱ group showed a decrease in mtROS and an in-crease in the fluorescence brightness of MMP and MPTP(P＜0.05).Bioinformatics analysis revealed that ZBP1 was a core differentially expressed gene in AAA.Immunohistochemistry and immunofluorescence results showed that ZBP1 ex-pression in human and mouse AAA tissues increased,and co-localized with smooth muscle.Western blot results showed that PCSK9 overexpression or treatment with 2.0 μmol/L Ang Ⅱ could increase ZBP1 protein expression(P＜0.01),while PCSK9 knockdown could alleviate the increased ZBP1 expression caused by AngⅡ(P＜0.05).Conclusion PCSK9 may induce mitochondrial damage in smooth muscle cells,activate downstream molecule ZBP1 to cause cell damage,and promote the development of AAA.

OBJECTIVE To explore the current status,etiological characteristics and risk factors for nosocomial in-fections in the patients who are treated with extracorporeal membrane oxygenation(ECMO)so as to provide bases for treatment and prevention of nosocomial infections in the ICU patients treated with ECMO.METHODS The clinical data were retrospectively collected from the patients who were treated with ECMO in the ICU of Xinyang Central Hospital from Jan.2021 to Dec.2023.The patients were divided into the infection group and the non-infec-tion group according the status of nosocomial infection during the ECMO treatment period.The constituent ratios of pathogens isolated from the patients with infections were recorded,and multivariate logistic regression analysis was performed for independent risk factors for the ECMO-related nosocomial infections.RESULTS Of 86 patients who were finally enrolled in the study,33(38.37％)had nosocomial infections.Totally 54 strains of pathogens were isolated from the patients with the infections,43(79.63％)of which were gram-negative bacteria,7(12.97％)were gram-positive bacteria,and 4(7.41％)were fungi.There were 36(66.67％)strains of multi-drug-resistant organisms(MDROs)among the 54 strains of pathogens,and 27(81.82％)patients were detected with MDROs.Among the ECMO patients with postoperative nosocomial infections,21(63.64％)cases had pul-monary infections,8(24.24％)cases had bloodstream infection,and 4(12.12％)had urinary system infections.Multivariate logistic analysis showed that the high blood glucose level at the beginning of treatment with ECMO,long duration of ECMO treatment and long time of central venous catheter indwelling were the independent risk factors for the nosocomial infections in the patients treated with ECMO(P＜0.05).CONCLUSION The isolation rate of gram-negative bacteria is relatively high among the pathogens isolated from the ECMO patients with post-operative nosocomial infections,and the drug resistance rates are high.The high blood glucose level,long duration of ECMO supporting treatment and long time of central venous catheter indwelling are the independent risk factors for the nosocomial infections in the patients treated with ECMO.

Aim To explore the impact and mechanism of proprotein convertase subtilisin kexin 9(PCSK9)on the progression of abdominal aortic aneurysm(AAA).Methods 6～8 week old ApoE-/-mice were selected to estab-lish the AAA model.Angiotensin Ⅱ(Ang Ⅱ)was continuously infused through subcutaneous implantation of a micro-os-motic pump.The mice were fed with high-fat diet and killed after 28 days.The expression of PCSK9 in abdominal aor-tic smooth muscle cells was detected by immunohistochemistry and immunofluorescence in normal abdominal aortic blood vessels and AAA samples in human and mice.Primary cultured murine vascular smooth muscle cells(mVSMC)of C57BL/6 mice were treated with different concentrations of AngⅡ for 24 h,and the expression of PCSK9 mRNA and pro-tein was detected.PCSK9 overexpression and knockdown cell models were established,and mitochondrial reactive oxygen species(mtROS),mitochondrial membrane potential(MMP),mitochondrial permeability transition pore(MPTP)open-ing,and Z-DNA binding protein 1(ZBP1)protein expression were detected.Bioinformatics was used to analyze the dif-ferential expression of multiple single-cell sequencing datasets to obtain the key differentially expressed genes,and to study their expression and role in AAA.Results Immunohistochemistry and immunofluorescence results showed that PCSK9 expression in human and mouse AAA increased(P＜0.01),and co-localized with smooth muscle.Ang Ⅱ promoted PCSK9 expression in mVSMC in a concentration-dependent manner,the 2.0 μmol/L Ang Ⅱ group showed a 2.9-fold and 1.1-fold increase in the expression of PCSK9 mRNA and protein,respectively(P＜0.01),with the most significant effect observed.After successfully constructing PCSK9 overexpression and PCSK9 interference mVSMC models,PCSK9 overex-pression led to an increase in intracellular mtROS,a decrease in MMP,an increase in MPTP opening,and a decrease in cellular activity(P＜0.01);PCSK9 knockdown could reduce Ang Ⅱ induced increase in mtROS,decrease in MMP and MPTP opening;compared with the siNC+Ang Ⅱ group,the siPCSK9+Ang Ⅱ group showed a decrease in mtROS and an in-crease in the fluorescence brightness of MMP and MPTP(P＜0.05).Bioinformatics analysis revealed that ZBP1 was a core differentially expressed gene in AAA.Immunohistochemistry and immunofluorescence results showed that ZBP1 ex-pression in human and mouse AAA tissues increased,and co-localized with smooth muscle.Western blot results showed that PCSK9 overexpression or treatment with 2.0 μmol/L Ang Ⅱ could increase ZBP1 protein expression(P＜0.01),while PCSK9 knockdown could alleviate the increased ZBP1 expression caused by AngⅡ(P＜0.05).Conclusion PCSK9 may induce mitochondrial damage in smooth muscle cells,activate downstream molecule ZBP1 to cause cell damage,and promote the development of AAA.

Objective To investigate the associations between physical health status,refraction and ocular biometrics in school-age children,and further clarify the relation of eyes'refractive status to physical growth and development,so as to provide scientific evidences for myopia prevention and con-trol.Methods A total of 1718 children(977 boys and 741 girls)aged 8-12 years were enrolled in this study.They were collected uncorrected visual acuity,refraction and ocular biometrics,including spherical equivalent,cylindrical equivalent,axial length(AL),corneal refraction(K1,K2)and anteri-or chamber depth(ACD),as well as the AL/CR ratio and spherical equivalent refraction(SER).Moreover,their height,weight and physical fitness level were measured,including speed,strength,flexibility,agility and aerobic endurance.Then all data were analyzed using the Pearson correlation,One-way ANOVA and multiple linear regression model.Results The overall prevalence of myopia was 43.83%,which was higher in girls than in boys(46.96%vs.41.45%).Moreover,the height and weight of school-age children were negatively correlated with SER(P<0.01),but positively correlated with AL,ACD and AL/CR(P<0.01).After controlling the age and gender variables in the multiple linear regression model,it was found that for 10-cm increase in height,SER decreased by 0.013 D(P<0.01),AL extended by 0.022 mm(P<0.01),and ACD increased by 0.002 mm(P<0.05).In addi-tion,for 10-kg increase in the body weight,the AL would be 0.009 mm longer(P<0.05)and ACD 0.002 mm deeper(P<0.05).Moreover,the speed,strength and agility were negatively correlated with SER(P<0.01,P<0.05),but positively correlated with AL,ACD and AL/CR(P<0.01,P<0.05).The maximal oxygen uptake level was positively correlated with SER(P<0.01),and negatively correlated with AL,ACD and AL/CR(P<0.01,P<0.05).After controlling the age and gender variables in the multiple linear regression model,it was found that the children with worse speed quality had shorter AL(-0.043 D,P<0.05).Meanwhile,the better agility was accompanied by the lower SER(-0.003 D,P<0.01),longer AL(+0.002 mm,P<0.05),lighter ACD(+4.812e-4 mm,P<0.05),and higher AL/CR(+2.446e-4,P<0.05).Conclusion With variables of age and gender controlled,the height,weight,and the speed and agility quality are highly associated with eyes'refractive status among chil-dren aged 8-12 years old.It is suggested that the human body may have a coordination mechanism to regulate the development of the body stature,physical fitness and ocular biometrics in the early child-hood,which should be considered in their myopia prevention and control.

Objective: To investigate the association of sugar sweetened beverage (SSB) consumption with insomnia and depressive symptoms among first grade middle school students from Yunnan Province, so as to provide evidence to guide interventions for the treatment of these symptoms in this population. Methods: From October to December 2022, 8 500 firstgrade middle school students from 11 counties in Yunnan Province were selected by cluster random sampling. Depressive symptoms, SSB consumption, and insomnia symptoms among students were evaluated by the Child Depression Scale (CDI), dietary frequency questionnaire, and Insomnia Severity Index (ISI). A Logistic regression model was employed to analyze the relationship between SSB consumption, insomnia, depressive symptoms, and their interaction effects among students. Results: The detection rate of depressive symptoms was 28.3%, and having insomnia symptoms ( OR=6.07, 95%CI =5.46-6.75), consuming carbonated beverages ( OR=1.20, 95%CI =1.08-1.34), tea ( OR=1.13, 95%CI =1.02-1.25), energy drinks ( OR=1.36, 95%CI =1.23-1.50), and other beverages ( OR=1.32, 95%CI =1.19-1.45) were positively correlated with depressive symptoms among first grade middle school students ( P < 0.05). Carbonated beverages (additive effect: OR=2.96, 95%CI =2.72-3.22, multiplicative effect: OR=4.75, 95%CI =4.25- 5.32 ), fruit drinks (additive effect: OR=2.61, 95%CI =2.40-2.82; multiplicative effect: OR=4.43, 95%CI =3.94-4.97), tea (additive effect: OR=2.70, 95%CI =2.47-2.89; multiplicative effect: OR=4.34, 95%CI =3.86-4.89), energy drinks (additive effect: OR=2.82, 95%CI =2.61-3.05; multiplicative effect: OR=4.48, 95%CI =3.92-5.12), sweetened milk (additive effect: OR= 2.73, 95%CI =2.06-2.96; multiplicative effect: OR=4.61, 95%CI =4.12-5.17) and other beverages (additive effect: OR= 2.73 , 95%CI =2.53-2.95; multiplicative effect: OR=4.56, 95%CI =4.00-5.20) had both additive and multiplicative effects with insomnia, and increased the risk of depressive symptoms in first grade middle school students ( P <0.01). Conclusions The interaction between the consumption of SSB and insomnia symptoms may increase the risk of depressive symptoms among first grade middle school students in Yunnan Province. It is necessary to advocate middle school students to reduce SSB intake, in order to decrease the occurrence of depressive symptoms among this population.

Objective: To investigate the effects of after school exercise service (referred to as the "after school ES") on physical health, so as to provide evidence for possible beneficial effect of after school ES. Methods: Students in the fourth grade of primary school were recruited from September 2021 to July 2022 in Changsha City and divided into the control group ( n =220) and the after school ES group ( n =220). The control group only participated in the regular physical education activities of the school. The after school ES group received after school ES for one academic year, 4 times a week, 40-50 minutes per time, for a total of 32 weeks. Body shape indicators such as height, weight and percentage of body fat, as well as physical fitness indicators such as 50 meter running, grip strength and progressive aerobic cardiovascular endurance run (PACER) were measured in September to October 2021 and June to July 2022, respectively. Independent sample t-test, Chi square test and two factors repeated measurement analysis of variance were used for statistical analysis of the data. Results: After one academic year, compared with the control group [(13.52±2.30)kg], muscle mass of primary school students in the after school ES group [(13.76±2.32)kg] significantly increased, while waist to hip ratio [(0.95±0.16)] and percentage of body fat [(20.17±7.43)%] significantly decreased compared to the control group [(1.01±0.21), (22.02±12.34)%]( F=330.70, 6.85, 4.33, P <0.05). The proportion of overweight and obesity in after school ES group decreased significantly from 19.5% to 12.3% ( χ 2=4.35, P <0.05). Compared with the control group, the scores of 50 meter running [(10.00±1.06, 10.21±0.83)s], 1 minute sit up [(33.25±8.24, 30.76±9.34)times], sitting and flexion [(14.53±7.50, 8.59±6.32)cm], 1 minute rope skipping [(125.01±30.50, 115.97±32.09)times], eyes closed and single legged standing [(30.00±34.72, 25.72±23.82)s], selective response time [(635.66±91.72, 652.79±120.42)ms] and VO 2max [(45.31± 1.02 , 43.67±0.85)mL/(kg〖 ·min)] in the after school ES group were significantly improved, with statistical significance ( F= 5.32 , 443.14, 97.23, 814.07, 36.49, 6.11, 396.91, P <0.05). Conclusions After school ES can improve body shape of primary school students, reduce the risk of overweight and obesity and enhance physical fitness. It is recommended that schools should appropriately increase after school ES to promote physical fitness of students.