Ulcerative colitis is a chronic relapsing inflammatory bowel disease. Modern research indicates that immune dysregulation resulting from disruptions in circadian rhythm is closely associated with its pathogenesis. Both Western chronomedicine and traditional Chinese medicine（TCM）" treatment based on temporal factors" emphasize the temporal relationship between natural rhythms and human physiology and pathology. The " midnight-noon and ebb-flow " theory represents the concrete application and deepening of TCM " treatment based on temporal factors" within the realm of chronomedicine. This article correlates the onset time of ulcerative colitis with specific periods in the " midnight-noon and ebb-flow"theory：the Mao period（05：00-07：00），when the yangming large intestine meridian of hand is dominant； the Si period（09：00-11：00），when the taiyin spleen meridian of foot is dominant； and the You period（17：00-19：00），when the shaoyin kidney meridian of foot is dominant. According to this perspective，if the disease manifests during the Mao period，the pathogenesis is attributed to dampnessheat accumulation and disorder of qi and blood. Treatment should focus on clearing heat，resolving dampness，and harmonizing qi and blood，using modified formulas such as Shaoyao Decoction or Baitouweng Decoction. If it occurs during the Si period，the pathogenesis involves spleen deficiency with dampness obstruction and disharmony of qi and blood. Treatment should focus on strengthening the spleen，eliminating dampness，and restoring qi and blood，using modified formulas such as Huangya Decoction or Shenling Baizhu Powder. If it presents during the You period，the pathogenesis is characterized by fire failing to warm earth，and consumption resulting in qi and blood leakage. Treatment should focus on warming the kidney and spleen，and securing qi and blood，using modified formulas such as Sishen Pill or Tianhun Decoction. In addition to oral administration of Chinese herbal medicine，comprehensive therapies including acupuncture，herbal enemas，and acupoint application can provide novel insights for the clinical diagnosis and treatment of ulcerative colitis.

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 clinical characteristics,diagnosis,treatment,and prognosis of descending necrotizing mediastinitis(DNM)to provide a reference for the early diagnosis and timely treatment of DNM.Methods Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023.The infection,pathogenic microorganisms,main symptoms,comorbidities and treatment methods of DNM were analyzed.Results The data of a total of 781 DNM patients,with an average age of(52.97±5.64)years,were retrieved,including 554 males and 227 females.Odontogenic source,tonsillitis,pharyngeal abscess,sialoadenitis,upper respiratory tract infection,foreign body injury,or iatrogenic traumatic procedures are common causes.Among these,odontogenic infection is the most common source.Streptococcus sp.(n=217)and Staphylococcus sp.(n=82)were most isolated,followed by Klebsiella pneumoniae and Pseudomonas aeruginosa(equally n=59).A total of 69.4％(542/781)of DNM patients recruited in this study were discovered to have various comorbidities,and more than one-third of these patients(n=185)had diabetes.Of the broad antibiotics,carbapenem was most frequently used as treatment,and vancomycin was the most frequently coadministered.The mediastinal drainage approach varies widely,and the optimal regimen is still unknown.Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage,22 patients were treated with percutaneous catheter drainage,30 underwent the transcervical approach,and 40 underwent thoracotomy.A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus.The overall mortality rate of all 781 DNM pa-tients included was 11.2％.Conclusion The most effective diagnosis and treatment of DNM is a high degree of clini-cal vigilance followed by prompt and adequate drainage with intensive care,including hemodynamic monitoring,nutri-tional support,computer tomographic scanning repeated as necessary,and combined use of systemic antibiotics.

Objective:To investigate the association between congenital hypothyroidism (CH) and the adverse outcomes during hospitalization in very low birth weight infants (VLBWI).Methods:This prospective, multicenter observational cohort study was conducted based on the data from the Sino-northern Neonatal Network (SNN). Data of 5 818 VLBWI with birth weight <1 500 g and gestational age between 24-<37 weeks that were admitted to the 37 neonatal intensive care units from January 1 st, 2019 to December 31 st, 2022 were collected and analyzed. Thyroid function was first screened at 7 to 10 days after birth, followed by weekly tests within the first 4 weeks, and retested at 36 weeks of corrected gestational age or before discharge. The VLBWI were assigned to the CH group or non-CH group. Chi-square test, Fisher exact probability method, Wilcoxon rank sum test, univariate and multivariate Logistic regression were used to analyze the relationship between CH and poor prognosis during hospitalization in VLBWI. Results:A total of 5 818 eligible VLBWI were enrolled, with 2 982 (51.3%) males and the gestational age of 30 (29, 31) weeks. The incidence of CH was 5.5% (319 VLBWI). Among the CH group, only 121 VLBWI (37.9%) were diagnosed at the first screening. Univariate Logistic regression analysis showed that CH was associated with increased incidence of extrauterine growth retardation (EUGR) ( OR=1.31(1.04-1.64), P<0.05) and retinopathy of prematurity (ROP) of stage Ⅲ and above ( OR=1.74(1.11-2.75), P<0.05). However, multivariate Logistic regression analysis showed no significant correlation between CH and EUGR, moderate to severe bronchopulmonary dysplasia, grade Ⅲ to Ⅳ intraventricular hemorrhage, neonatal necrotizing enterocolitis in stage Ⅱ or above, and ROP in stage Ⅲ or above ( OR=1.04 (0.81-1.33), 0.79 (0.54-1.15), 1.15 (0.58-2.26), 1.43 (0.81-2.53), 1.12 (0.70-1.80), all P>0.05). Conclusion:There is no significant correlation between CH and in-hospital adverse outcomes, possibly due to timely diagnosis and active replacement therapy.

Objective:To evaluate effects of propofol on cognitive dysfunction and underlying mechanisms after splenectomy in aged mice.Methods:Fifty SPF grade male aged mice were divided into five groups: control group, sham operation group, surgery group, sham operation + propofol group, and surgery + propofol group, with 10 mice in each group. The Morris water maze test was used to assess the learning and memory abilities of mice in each group. The hematoxylin-eosin (HE) staining and TUNEL staining were used to observe the apoptosis of brain neurons.ELISA was performed to measure the expression of inflammatory factors in brain tissues. Transmission electron microscopy was used to observe the structure of hippocampal post-synaptic density. Immunofluorescence was employed to determine the expression of ionized calcium-binding adapter molecule 1 (IBA-1) and postsynaptic density protein-95 (PSD-95) in the hippocampus. Immunohistochemistry was used to measure the expression of microtubule-associated protein tau (tau) in the cortex. The expression of B-cell lymphoma-2 (Bcl-2), recombinant Bcl-2-associated X protein (Bax), and cysteine protease-3 (Caspase-3) was determined using both immunohistochemistry and Western blot. Data were statistically analyzed using SPSS 21.0.For comparisons among multiple groups, the results of Morris water maze experiment were compared by repeated measures ANOVA, while other data comparison was conducted by one-way ANOVA, and pairwise comparisons were conducted using the LSD- t test. Results:The results of the Morris water maze test showed that the interaction effect of time and group on the escape latency of the five groups of mice was significant ( F=95.17, P<0.01). During the spatial navigation test of day 4-6, the escape latency of the surgery group was significantly higher than that of the sham operation group ( P<0.05), while the escape latency of the surgery + propofol group was significantly lower than that of the surgery group and higher than that of sham operation+ propofol group(both P<0.05). In the spatial exploration test, the number of platform crossings, the percentage of the distance traveled in the target quadrant out of the total exploration distance, and the duration spent in the target quadrant were all significantly different among the five groups of mice ( F=27.88, 50.21, 32.04, all P<0.01). These values were all lower in the surgery group compared to the sham operation group (all P<0.05), and higher in the surgery + propofol group compared to the surgery group((2.60±0.66) vs (0.80±0.40); (40.56±1.51)% vs (13.82±3.11)%; (19.25±1.31)s vs (6.12±2.00)s) (all P<0.05).ELISA results showed that the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6) in the brain tissues of the five groups of mice were significantly different ( F=1 017.11, 583.55, 185.35, all P<0.01). The levels of TNF-α, IL-1β and IL-6 in the brain tissues of the surgery + propofol group were all lower than those in the surgery group and higher than that of sham operation+ propofol group (all P<0.05).Transmission electron microscopy results showed that the length, width, and number of synapses in the hippocampal postsynaptic density of the five groups of mice were significantly different ( F=137.06, 55.36, 19.93, all P<0.01), and these values were all higher in the surgery + propofol group compared to the surgery group (all P<0.05).Immunofluorescence results showed that the relative fluorescence intensity of PSD95 and IBA-1 in the hippocampus of the five groups of mice were significantly different ( F=14.33, 38.23, both P<0.01). The relative fluorescence intensity of PSD95 in the hippocampus of the surgery + propofol group was higher than that of the surgery group and lower than that of sham operation+ propofol group (both P<0.05), while the relative fluorescence intensity of IBA-1 in the hippocampus of the surgery + propofol group was lower than that of the surgery group and higher than that of sham operation+ propofol group (both P<0.05).TUNEL results showed that the proportion of positive apoptotic cells in the dentate gyrus (DG) region of the brain tissue of the five groups of mice was significantly different ( F=101.94, P<0.01), and this proportion was lower in the surgery + propofol group compared to the surgery group((72.15±3.71)% vs (82.24±4.40)%) and was higher than that of sham operation+ propofol group((50.64±2.36)%)(both P<0.05).Immunohistochemical and Western blot results showed that the relative expression levels of phosphorylated tau protein, Bcl-2, Bax, and Caspase-3 in the brain tissues of the five groups of mice were significantly different ( F=56.54, 50.48, 23.00, 91.10, all P<0.01). The relative expression levels of phosphorylated tau protein, Bax, and Caspase-3 in the brain tissues of the surgery + propofol group were all lower than those in the surgery group (all P<0.05), while the relative expression level of Bcl-2 was higher in the surgery + propofol group compared to the surgery group ( P<0.05). Conclusion:Propofol pretreatment can significantly alleviate postoperative learning and memory impairments in aged mice, mitigate structural damage to the hippocampal postsynaptic density, and improve postoperative cognitive dysfunction by inhibiting the neuronal apoptosis signaling pathway.

Objective:To evaluate effects of propofol on cognitive dysfunction and underlying mechanisms after splenectomy in aged mice.Methods:Fifty SPF grade male aged mice were divided into five groups: control group, sham operation group, surgery group, sham operation + propofol group, and surgery + propofol group, with 10 mice in each group. The Morris water maze test was used to assess the learning and memory abilities of mice in each group. The hematoxylin-eosin (HE) staining and TUNEL staining were used to observe the apoptosis of brain neurons.ELISA was performed to measure the expression of inflammatory factors in brain tissues. Transmission electron microscopy was used to observe the structure of hippocampal post-synaptic density. Immunofluorescence was employed to determine the expression of ionized calcium-binding adapter molecule 1 (IBA-1) and postsynaptic density protein-95 (PSD-95) in the hippocampus. Immunohistochemistry was used to measure the expression of microtubule-associated protein tau (tau) in the cortex. The expression of B-cell lymphoma-2 (Bcl-2), recombinant Bcl-2-associated X protein (Bax), and cysteine protease-3 (Caspase-3) was determined using both immunohistochemistry and Western blot. Data were statistically analyzed using SPSS 21.0.For comparisons among multiple groups, the results of Morris water maze experiment were compared by repeated measures ANOVA, while other data comparison was conducted by one-way ANOVA, and pairwise comparisons were conducted using the LSD- t test. Results:The results of the Morris water maze test showed that the interaction effect of time and group on the escape latency of the five groups of mice was significant ( F=95.17, P<0.01). During the spatial navigation test of day 4-6, the escape latency of the surgery group was significantly higher than that of the sham operation group ( P<0.05), while the escape latency of the surgery + propofol group was significantly lower than that of the surgery group and higher than that of sham operation+ propofol group(both P<0.05). In the spatial exploration test, the number of platform crossings, the percentage of the distance traveled in the target quadrant out of the total exploration distance, and the duration spent in the target quadrant were all significantly different among the five groups of mice ( F=27.88, 50.21, 32.04, all P<0.01). These values were all lower in the surgery group compared to the sham operation group (all P<0.05), and higher in the surgery + propofol group compared to the surgery group((2.60±0.66) vs (0.80±0.40); (40.56±1.51)% vs (13.82±3.11)%; (19.25±1.31)s vs (6.12±2.00)s) (all P<0.05).ELISA results showed that the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6) in the brain tissues of the five groups of mice were significantly different ( F=1 017.11, 583.55, 185.35, all P<0.01). The levels of TNF-α, IL-1β and IL-6 in the brain tissues of the surgery + propofol group were all lower than those in the surgery group and higher than that of sham operation+ propofol group (all P<0.05).Transmission electron microscopy results showed that the length, width, and number of synapses in the hippocampal postsynaptic density of the five groups of mice were significantly different ( F=137.06, 55.36, 19.93, all P<0.01), and these values were all higher in the surgery + propofol group compared to the surgery group (all P<0.05).Immunofluorescence results showed that the relative fluorescence intensity of PSD95 and IBA-1 in the hippocampus of the five groups of mice were significantly different ( F=14.33, 38.23, both P<0.01). The relative fluorescence intensity of PSD95 in the hippocampus of the surgery + propofol group was higher than that of the surgery group and lower than that of sham operation+ propofol group (both P<0.05), while the relative fluorescence intensity of IBA-1 in the hippocampus of the surgery + propofol group was lower than that of the surgery group and higher than that of sham operation+ propofol group (both P<0.05).TUNEL results showed that the proportion of positive apoptotic cells in the dentate gyrus (DG) region of the brain tissue of the five groups of mice was significantly different ( F=101.94, P<0.01), and this proportion was lower in the surgery + propofol group compared to the surgery group((72.15±3.71)% vs (82.24±4.40)%) and was higher than that of sham operation+ propofol group((50.64±2.36)%)(both P<0.05).Immunohistochemical and Western blot results showed that the relative expression levels of phosphorylated tau protein, Bcl-2, Bax, and Caspase-3 in the brain tissues of the five groups of mice were significantly different ( F=56.54, 50.48, 23.00, 91.10, all P<0.01). The relative expression levels of phosphorylated tau protein, Bax, and Caspase-3 in the brain tissues of the surgery + propofol group were all lower than those in the surgery group (all P<0.05), while the relative expression level of Bcl-2 was higher in the surgery + propofol group compared to the surgery group ( P<0.05). Conclusion:Propofol pretreatment can significantly alleviate postoperative learning and memory impairments in aged mice, mitigate structural damage to the hippocampal postsynaptic density, and improve postoperative cognitive dysfunction by inhibiting the neuronal apoptosis signaling pathway.

Objective:To integrate the experience of terminal care of nurses in Neonatal Intensive Care Unit (NICU) and Pediatric Intensive Care Unit (PICU) .Methods:Qualitative and mixed studies related to the terminal care by neonatal and pediatric nurses were systematically searched on the Cochrane Library, the Australia Joanna Briggs Institute Evidence-based Health Care Center Database, PubMed, EBSCO, Web of Science, CINAHL, China National Knowledge Infrastructure, WanFang Data, VIP and the China Biomedical Medicine Database. The search time limit was from the establishment of the database to May 2022. The article quality was evaluated using the quality evaluation criteria for qualitative research of the Joanna Briggs Institute Evidence-Based Health Care Center (2016). Meta-synthesis was performed using the aggregation integration method.Results:A total of 9 articles were included. A total of 32 research results were extracted and summarized into 7 categories, forming 3 integrated results, including the ethical dilemmas and complex care experiences of nurses in NICU and PICU during the implementation of palliative care, the attitudes and coping strategies of neonatal and pediatric nurses in responding to death events, the realistic dilemmas and needs of nurses in NICU and PICU during terminal care.Conclusions:Terminal care in NICU and PICU requires multiple efforts. Hospital managers should pay attention to the emotional burden of nurses during terminal care, and enhance their positive coping ability, and focus on improving the terminal care environment and resources in NICU and PICU to provide high-quality terminal care services for children.

Objective:To evaluate four different diagnostic criteria for metabolic syndrome(MetS) in the Chinese Northern Population with alcohol use.Methods:Stratified random sampling was used to select male workers in Gaocheng District, Shijiazhuang in 2016. Alcohol Use Disorder Identification Test (AUDIT) was used to assess the risk of any alcohol use disorder. MetS-related physician and laboratory tests were performed. The MetS prevalence rate was calculated according to the diagnostic criteria of the Chinese Diabetes Society (CDS), the National Cholesterol Education Program (NCEP) Adult Treatment Panel-Ⅲ (ATP-Ⅲ), International Diabetes Federation (IDF), and the 2016 Chinese Adult Dyslipidemia Prevention and Control Guidelines, respectively. The CDS criteria were considered the reference standards for evaluating the significance of the other three MetS diagnostic criteria in disease screening.Results:A total of 1 267 men workers were investigated with a questionnaire, including 1 082 people with alcohol intake. The average age was (35.25±9.48) years. The MetS prevalence rates were 12.94%, 19.96%, 23.75%, and 23.94% according to CDS, NCEP ATP-Ⅲ, IDF, and Chinese Adult Dyslipidemia Prevention and Control Guidelines, respectively. In IDF, the highest prevalence rate of MetS was 18-25 and 35-45 age group; In the 45-68 age group, the highest and most consistent prevalence rate was found on MetS diagnostic criteria of IDF and Chinese Adult Dyslipidemia Prevention and Control Guidelines. MetS prevalence increased with drinking risk in all diagnostic criteria, and the MetS prevalence rate based on the IDF and Chinese Adult Dyslipidemia Prevention and Control Guidelines were higher than the other two. Referring to the CDS, the sensitivities of IDF,NCEP ATP-Ⅲ and Chinese Adult Dyslipidemia Prevention and Control Guidelines were 84.29%, 87.14%, and 92.14%; the specificities were 97.33%, 97.92%, and 98.66%, the positive predictive values were 45.91%, 56.48%, and 49.81%, respectively. Kappa consistency test found that IDF and Chinese Adult Dyslipidemia Prevention and Control Guidelines had the best consistency in total alcohol used population, lower-risk alcohol used population and lower-risk alcohol used population, with the compliance rate of 90.3%( Kappa=0.852),89.7%( Kappa=0.844) and 91.0%( Kappa=0.867). Conclusion:The MetS prevalence rate in the alcohol use population in northern China varies by four diagnostic criteria. The MetS prevalence rate is the lowest on CDS, and the Chinese Adult Dyslipidemia Prevention and Control Guidelines give the highest MetS prevalence rate with the best sensitivity and specificity for diagnosing the MetS.