Background Enhancing the sense of honor and belonging among medical staff is a key component of establishing a modern hospital management system. Compared to medical staff at general hospitals, medical staff at oncology hospitals are more prone to job burnout, yet few studies in China have focused on job burnout among employees in oncology hospitals. Objective To propose a hypothetical model in which job well-being moderates the relationship between stressors and occupational burnout, to explore how stressors influence burnout and potential moderating role of job well-being, and to provide better understanding of job burnout and motivate employees based on the double-edge sword effect of stressors. Methods A cross-sectional survey was conducted in May 2022 at a tertiary oncology specialty hospital in Chongqing, China. A total of 1 898 medical staff were recruited. Data were collectedthrough four scales including a general information questionnaire, Maslach Burnout Inventory-Human Service Survey, Work Stressor Scale, and Occupational Well-being Scale for Medical Staff. Independent sample t-tests and one-way ANOVA were used for univariate comparisons of job burnout. Pearson correlation analysis was employed to examine the relationships between job burnout, stressors, and job well-being. Hierarchical linear regression was conducted to identify factors influencing job burnout and to examine potential moderating role of job well-being in the relationship between stressors and job burnout. Results A total of 2 123 questionnaires were distributed, with 1 898 valid responses, yielding an effective response rate of 89.4%. The prevalence of job burnout was 60.1%. The correlation coefficient was 0.717 (P<0.001) between stressors and burnout, −0.784 (P<0.05) between job well-being and burnout, and −0.744 (P<0.001) between stressors and job well-being. The quadratic stressors showed a statistically significant effect on burnout (β=0.404, P<0.01). Job well-being positively moderated the relationship between the linear stressors and burnout (β=1.289, P<0.001) and negatively moderated the relationship between the quadratic stressors and job burnout (β=−0.571, P<0.01), explaining 7.1% of the variance. Conclusion Job burnout prevalence is relatively high among employees in oncology hospitals. There is a curvilinear relationship between stressors and job burnout, with job well-being moderating this relationship. From a practical perspective, it is recommended to establish a tiered stress alert system to monitor employees’ stress levels and prevent prolonged exposure to high-pressure conditions. Additionally, improving employees’ job well-being through institutional incentives and developmental support can enhance its moderating role in mitigating the adverse effects of stressors on job burnout. Meanwhile, fostering coordinated responses between organizations and individuals is crucial for strengthening mental health management systems, thereby supporting a healthy, stable, and sustainable development of the healthcare workforce.

Objective: To examine the association between parent-child relationships and bullying behaviors among junior high school students, and to explore the moderating effect of community cohesion, so as to provide evidences for bullying intervention strategies. Methods: From November to December 2017, a cluster sampling method was used to survey 1 589 students in grades 6- 8 from three junior high schools in Jing an District,Shanghai. Anonymous electronic questionnaires collected data on parent-child relationships, community cohesion, and bullying behaviors. Multivariate Logistic regression analyzed the associations and moderation effects. Results: The prevalence of bullying behaviors among junior high school students was 7.80%. Spearman correlation analysis revealed negative associations between both parent-child relationships ( r =-0.13) and community cohesion ( r =-0.10) with bullying behaviors, while parent-child relationships positively correlated with community cohesion ( r =0.29) (all P <0.01). Junior high school students with positive parent-child relationships and higher perceived community cohesion showed lower risks of bullying behaviors ( OR=0.51, 95%CI =0.36-0.72; OR=0.58, 95%CI =0.45-0.76), with a significant interaction effect between the two factors (all P <0.05). Conclusions Positive parent-child relationships and community cohesion are negatively associated with bullying behaviors in middle school students. Supportive family relationships help reduce bullying, while stronger community cohesion enhances the protective effect of positive parent-child relationships against bullying.

Objective: To investigate the changes of dentin surface and the effects of different surface treatments on the rebonding effect following non-destructive restoration removal by an Er:YAG laser and to provide reference for oral clinical operation Methods: This study was approved by the ethics review committee of the unit. Using computer-aided design and computer-aided manufacturing (CAD/CAM) technology, 102 zirconia specimens (4 mm × 4 mm × 1.5 mm) were fabricated. In total, 110 impacted third molar teeth were extracted, and 102 dentine blocks (4 mm × 4 mm × 2 mm) were prepared. The zirconia specimen and dentin blocks were bonded with resin cement before removal with an Er: YAG laser. Three disassembled dentin blocks were randomly selected, and the components of dentin surface elements were analyzed by energy dispersive X-ray spectroscopy (EDX). The removed dentin blocks were randomly divided into three groups (n = 33) based on the different surface treatments: control group (no treatment), sandblasting group (50 μm, Al2O3 sandblasting), and laser irradiation group (Er: YAG laser irradiation, parameters were set to 10 Hz, 60 mJ, 0.6 W). Three dentin blocks were randomly selected in each group for scanning electron microscopy (SEM) observation, and the residual resin on dentin surface of remaining 30 dentin blocks in each group were observed under an optical microscope at 20 times magnification. Scores were obtained using the adhesive remnant index (ARI) method. Three groups of dentin blocks (n = 30) that underwent different surface treatments were rebonded with resin cement according to standard procedures and then divided into two subgroups for aging (n = 15). One subgroup was subjected to a 37 ℃ water bath for 24 h, and the other subgroup was subjected to 5 000 thermal cycles after a 37 ℃ water bath for 24 h, and the micro-shear bonding strength of each group was measured. The microshear bonding strength of each group was measured, and fracture modes were analyzed. The differences of dentine surface ARI between the three groups, as well as the inter-group differences in fracture mode, and bonding strength, and the intra-group differences before and after aging were compared between the three groups. Results: When zirconia was removed by Er: YAG laser, there was no obvious damage on the dentin surface, but C and Si elements in dentin increased significantly. After different surface treatments, the ARI scores of the sandblasting and laser irradiation groups were lower than those of the control group (P<0.05), while ARI was not significantly different between the sandblasting and laser irradiation groups (P>0.05). The dentin surface morphology was also different. There was a large amount of residual resin on the dentin surface of the control group. In the sandblasting group, the residual resin was lower, the dentin surface was rough, and the dentin tubules were visible. A large amount of residual resin was observed on the dentin surface of the laser irradiation group. After 24 h of water bath at 37 ℃, the bonding strengths of the control group, sandblasting group, and laser irradiation group were (6.13 ± 2.40) MPa, (9.39 ± 2.00) MPa, and (5.85 ± 1.44) MPa, respectively, and the bonding strength of the sandblasting group was significantly higher than that of the other two groups (P<0.05). After being subjected to 24 h of water bath at 37 ℃ and 5 000 thermal cycles, the bonding strengths of the control group, sandblasting group, and laser irradiation group were (5.39 ± 0.83) MPa, (8.45 ± 1.20) MPa and (4.84 ± 1.43) MPa, respectively. The bonding strength of the sandblasting group was significantly higher than that of the other two groups (P<0.05). There was no significant difference between the control group, sandblasting group, and laser irradiation group before and after 5 000 thermal cycles following 24 h of water bath at 37 ℃ (P>0.05). In the control group, sandblasting group, and laser irradiation group, cohesive fracture was not observed. The fracture mode was mainly adhesive fracture. Before and after 5 000 thermal cycles, the frequency of mixed fracture in the sandblasting group was significantly higher than that in the other two groups (P<0.05). Conclusion Er: YAG laser removal of zirconia does not damage dentin, but a large amount of resin remains on the dentin surface after removal. The sandblasting process can effectively remove these residual resins, thereby improving the dentine rebonding effect.

Objective: To understand the moderating effect of cohabitation with parents on the association between peer dating behavior and sexual behaviors among secondary vocational school students, so as to provide a scientific basis for preventing sexual behaviors among secondary vocational school students. Methods: From March to April 2021, an electronic questionnaire survey was conducted among 3 180 students from 6 vocational schools in Shanghai (urban, suburban, exurban) and Shaanxi (Shangluo, Ankang, Baoji) using cluster sampling. Spearman correlation analysis was used to investigate the relationship of cohabitation with parents, peer dating behavior and sexual behaviors among secondary vocational school students. Binary Logistic regression analysis was performed to investigate the role of cohabitation with parents on peer dating behavior and sexual behaviors among secondary vocational students. Results: There was a significant negative between cohabitation with parents and sexual ( r =-0.04); and there was a positive correlation between peer dating behavior and sexual behaviors ( r =0.24), as well as cohabitation with parents and peer dating behavior ( r =0.04)( P <0.05). Multivariable Logistic regression analysis showed an association between peer dating behavior and the occurrence of sexual behaviors ( OR=2.79-12.95, P <0.05). Cohabitation with parents played a moderating role in the association between peer dating behavior and sexual behaviors, and a signification interaction was found between cohabitation with parents and reporting that a small part or about half of their peers had dating behavior ( OR =0.48, P <0.05). Conclusions The more peers dating behavior are associated with a higher risk of sexual behaviors among secondary vocational school students, and cohabitation with parents can partly reduce this risk. School and family sexuality education for secondary vocational students should be strengthened to improve their interpersonal skills and decision-making, and ability to resist peer pressure, so as to reduce their risk of sexual behaviors.

OBJECTIVE To construct three-class （insufficient， normal， excessive） and two-class （insufficient， normal） models for predicting plasma concentration of valproic acid （VPA）， and compare the performance of these two models， with the aim of providing a reference for formulating clinical medication strategies. METHODS The clinical data of 480 patients who received VPA treatment and underwent blood concentration test at the Xi’an International Medical Center Hospital were collected from November 2022 to September 2024 （a total of 695 sets of data）. In this study， predictive models were constructed for target variables of three-class and two-class models. Feature ranking and selection were carried out using XGBoost scores. Twelve different machine learning algorithms were used for training and validation， and the performance of the models was evaluated using three indexes: accuracy， F1 score， and the area under the working characteristic curve of the subject （AUC）. RESULTS XGBoost feature importance scores revealed that in the three-class model， the importance ranking of kidney disease and electrolyte disorders was higher. However， in the two-class model， the importance ranking of these features significantly decreased， suggesting a close association with the excessive blood concentration of VPA. In the three-class model， Random Forest method performed best， with F1 score of 0.704 0 and AUC of 0.519 3 on the test set； while in the two-class model， CatBoost method performed optimally， with F1 score of 0.785 7 and AUC of 0.819 5 on the test set. CONCLUSIONS The constructed three-class model has the ability to predict excessive VPA blood concentration， but its prediction and model generalization abilities are poor； the constructed two-class model can only perform classification prediction for insufficient and normal blood concentration cases， but its model performance is stronger.

Icariin,which belongs to the class of flavonoids,is the main active ingredient of the traditional tonic Chinese herb Epimedii Folium.Modern studies have shown that icariin has a wide range of effects on the male reproductive system.It has various pharmacological activities such as regulating cell proliferation and apoptosis,antioxidants,promoting testosterone secretion,improving erectile function,inhibiting prostate cancer cell migration,invasion,and regulating cell cycle.It has research value and application prospects in the field of urology and assisted reproduction.Therefore,Icariin's pharmacological effects and molecular mechanisms on the male reproductive system are reviewed in this paper combined with literature visualization analysis.It is expected to provide a theoretical basis for the therapeutic value development and application of icariin in male reproductive health.

Objective To investigate the current state of quality management on intravenous therapy in secondary and tertiary hospitals in China.This study aims to provide a reference for the development of relevant policies,promoting the professionalization,standardization,and homogenization of intravenous therapy.Methods By a convenience sampling method,intravenous therapy nursing managers from secondary and tertiary hospitals in 31 provinces,autonomous regions,and municipalities were selected as survey participants in November 2023.A self-designed questionnaire was used for the survey.Results A total of 2 129 questionnaires were collected,of which 1,926 were valid,resulting in a response rate of 90.47％.Among the 1926 hospitals,1 733(89.98％)had established quality evaluation standards for intravenous therapy,and 1 734(90.03％)conducted regular quality inspections for intravenous therapy or peripherally inserted central catheter(PICC)insertion and maintenance.Additionally,1 604 hospitals(83.28％)had established protocols for handling and reporting intravenous therapy or PICC-related complications,and 1 574 hospitals(81.72％)regularly collected and analyzed data related to intravenous therapy or PICC insertion and maintenance.Moreover,371 hospitals(19.26％)had implemented intravenous therapy information management systems.Regarding various types of intravenous therapy documents,the highest rate of document types was informed consent forms,with a compliance rate of over 80.00％,followed by insertion records and catheter maintenance records,respectively.The lowest rate was complication management records,with a compliance rate of less than 50.00％.For catheter maintenance protocols,the highest compliance rate was for maintenance procedures,at over 85.00％,followed by insertion procedures.Except for PICCs,the compliance rate for establishing catheter removal and complication management procedures for other types of catheters was less than 65.00％.In terms of quality management of intravenous therapy,there are significant differences between secondary and tertiary hospitals.Conclusion The quality evaluation standards for intravenous therapy are relatively comprehensive,but the informatization of intravenous therapy quality management is still underdeveloped.Furthermore,there is a need to further standardize the documentation and procedures related to intravenous therapy,and there are differences in the level of intravenous therapy management among hospitals of different levels.

Objective: To understand sexual and reproductive health knowledge, access to sexuality education and associated factors among secondary vocational school students in Shanghai Municipality and Shaanxi Province, so as to provide a scientific basis for conducting sexuality educaiton in vocational schools. Methods: A crosssectional survey was conducted among 3 180 students in grades 1-3 selected by cluster sampling during April to June 2021 in six secondary vocational schools from three cities of Shanghai and Shaanxi (Shangluo, Ankang, Baoji). Participants were investigated through online questionnaire survey, inlcuding demographic characteristics, household information, sexual health at home and school, knowledge on sexual and reproductive health. Both t test and Chisquare test were used for group comparisons, and multivariate ordial Logistic regression was used to explore possible risk factors for sexual and reproductive health score in quartiles. Results: Respondents average score was (51.36±21.61), with the highest score on sexual harassment/sexual abuse (66.45±42.27) and the lowest score on reproduction and physiology (47.67±31.94) and contraception (43.85±26.81). Although significant differences were observed between two study sites, the primary source of knowledge in both sites was schools/teachers, followed by the Internet or friends; the main theme of school sexuality education was puberty development and health care (more than 80%); the most frequently reported topic between respondents and their parents in both sites was interpersonal relationships (more than 55%), and there were significant differences in the reporting rates of secondary vocational school students between the two regions(χ2=28.56，32.02，P<0.05). The results of multivariable Logistic regression analysis showed that residential area, gender, grade, registered residence, number of sexual related topics communicated with parents, number of subjects received from school sexuality education, and reported information sources from classmates/friends, books/magazines/newspapers, internet and communities were related to knowledge level of respondents (OR=1.62, 0.72, 1.20, 1.58, 2.09, 1.17, 1.18, 1.66, 1.62, 1.69, 1.22, P<0.05). Conclusions Vocational students of Shanghai and Shaanxi have poor sexual and reproductive health knowledge and limited access to school and family sexuality education. It is necessary to strengthen sexuality education for secondary vocational school students.

Objective:To understand the situation and epidemic characteristics of injury deaths among children aged 5 to 24 years in Jiangsu Province from 2012 to 2021 and the trend of annual changes.Methods:The main injury mortality data of children and adolescents was collected, and the crude and standardized mortality rates of road traffic accidents, drowning, suicide, and accidental falls among children and adolescents over a decade and the annual average percentage of change (AAPC) were calculated. The main injury mortality characteristics and trends of children and adolescents of different age groups and genders were analyzed.Results:The total number of injury deaths among 5 to 24 adolescents in Jiangsu Province was 16 052, with a standardized mortality rate of 9.58/100 000. There was no significant trend in the overall standardized mortality rate of injuries (AAPC=-3.450%, P=0.055). The standardized mortality rate of road traffic injuries among children and adolescents showed a decreasing trend over the past decade, with statistical significance (AAPC=-9.406%, P<0.001). The standardized suicide mortality rate showed an upward trend over the past decade, with statistical significance (AAPC=9.000%, P=0.001). The overall injury mortality rate showed an upward trend with age. Suicide rates in males and females were on the rise and both have statistical significance (AAPC=9.420% and AAPC=9.607%, both P<0.05). The standardized mortality rates of female traffic accidents, drowning, and male traffic accidents showed a decreasing trend and were statistically significant (AAPC for female traffic accidents=-7.364%, AAPC for female drowning=-5.352%, and AAPC for male traffic accidents=-10.242%, all P<0.05). The standardized mortality rate of urban and rural traffic accidents showed a decreasing trend and was statistically significant(AAPC=-7.899% and AAPC=-9.421%, both P<0.001). The standardized suicide mortality rate showed an upward trend and statistical significance (AAPC=11.009% and AAPC=7.528%, both P<0.05). Conclusions:The overall injury situation of children and adolescents in Jiangsu Province improved in the past decade from 2012 to 2021, but the suicide mortality rate was on the rise. It is necessary to focus on the mental health issues of this age group and to strengthen the prevention and control of suicide among children and adolescents, in Jiangsu.

Objective:To summarize the clinical phenotype and genetic characteristics of deficiency in ELF4 gene X-linked (DEX).Methods:A case series study was conducted to retrospectively analyze the clinical data and genetic testing results of 2 cases of DEX treated at Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and the First Hospital of Jilin University from January 2023 to April 2024. And literature up to April 2024 was searched from the PubMed database, as well as CNKI and Wanfang databases, using keywords such as "ELF4 deficiency" "deficiency in ELF4, X-linked""ELF4 gene". The main clinical manifestations and genotypes of DEX were summarized.Results:Both patients were male, with onset ages of 3 months and 3 years, respectively. Both patients presented with recurrent oral ulcers and abdominal pain. And the laboratory examination showed a significant increase in inflammatory markers. Intestinal examinations showed multiple intestinal ulcers, and both patients developed intestinal fistulas. Whole exome sequencing found ELF4 c.799C>T, p Arg267Trp and ELF4 c. 248-7G>A, both maternal variants. Based on clinical and genetic results, DEX were diagnosed. In terms of treatment, both patients underwent surgical treatment during the acute phase of the disease and received anti-tumor necrosis factor α therapy, but recurrent gastrointestinal symptoms were still observed in Patient 1, while the clinical effect in Patient 2 was still acceptable. However, the inflammatory markers in both patients were not normal even after treatment. Literature review found 18 patients including 2 patients in this study, reported in 5 English articles and no Chinese reports. Thirteen patients had disease onset age before 5. The main clinical manifestations were fever (12/17), oral ulcers (14/18), abdominal pain (8/18), diarrhea (6/18), perianal ulcers (5/17), ileum ulcers (6/16), colon ulcers (7/16), skin involvement (7/17) and recurrent infections (7/18); laboratory examinations found increased erythrocyte sedimentation rate (13/15) as well as C-reactive protein (9/9), and anemia (13/15); in terms of immunological function, there is a decrease in natural killer cells (9/15) as well as a decrease in class switching memory B cells (8/9). The main types of gene variantions were missense variantions (6/18), nonsense variantions (4/18) or frameshift variantions (3/18).Conclusions:DEX should be considered when an early-onset male patient manifested with recurrent fever, oral ulcers or mucosal ulcers, with elevated inflammatory markers, with or without recurrent infection. It is recommended to perform lymphocyte subsets analysis, gastrointestinal endoscopy and genetic testing to support the diagnosis.