Objective: To understand the relationship between stress and Internet addiction among middle school students in Shanghai, so as to provide a scientific basis for promoting students mental health and preventing Internet addiction. Methods: From May to June 2021, a stratified random cluster sampling method was used to select 6 123 middle and high school students in Shanghai for health risk behavior monitoring. Daily Stressors Evaluation Scale for Urban Secondary School Students was used to evaluate students' stress, and the Internet Addiction Test compiled by Young was used to evaluate students Internet addiction. The correlation between student stress and Internet addiction was analyzed by Kruskal-Wallis H test , Chi square test and multiple Logistic regression. Results: Total stress score of middle school students in Shanghai was 24 (12, 39), academic stress score was 8 (5, 13), physical and psychological stress score was 6 (2, 10), interpersonal stress score was 5 (1, 9), and family stress score was 4 (1, 8). The detection rate of Internet addiction was 4.7%. Multivariate Logistic regression analysis showed that the risk of Internet addiction among middle school students with high levels of stress was 8.05 times(95% CI =4.59-14.12) that of students with low levels of stress( P <0.05). The risk of Internet addiction among middle school students with high levels of academic stress, physical and psychological stress, interpersonal stress and family stress was 5.98(95% CI =3.69-9.70), 6.92(95% CI =4.03-11.88), 4.85(95% CI =3.11-7.55), and 4.18(95% CI =2.73-6.40) times that of students with low levels of stress, respectively( P <0.05). Conclusion The academic stress, physical and psychological stress, interpersonal stress, and family stress among middle school students can all lead to an increased risk of Internet addiction.

Objective: To explore the association between dietary behaviors and sleep duration among middle school students in Shanghai, so as to provide reference for interventions targeting insufficient sleep. Methods: From May to June 2021, a stratified cluster random sampling method was employed to select a sample of 10-17yearold middle school students for monitoring their healthrisk behaviors. A total of 5 538 valid questionnaires were collected. The survey included items such as daily sleep duration, weekly consumption of sugary beverages, freshly squeezed fruit juice, fresh fruits, fresh vegetables, fried foods, milk and yogurt, breakfast habits, and frequency of eating outside. Statistical analysis was conducted using Chisquare test, Wilcoxon ranksum test, and multivariable Logistic regression model. Results: About 73.7% of middle school students reported insufficient sleep in Shanghai. There was a positive correlation between the average daily consumption of fresh fruits and breakfast consumption with sleep duration. In other words, a higher frequency of consuming fresh fruits (OR=1.29) and eating breakfast (OR=1.07) were associated with a higher likelihood of sufficient sleep. Conversely, there was a negative correlation between the frequency of consuming desserts (OR=0.78) and fried foods (OR=0.88) and sleep duration (P<0.05). Conclusions Increasing the consumption of fresh fruits and maintaining regular breakfast habits while reducing the intake of fried foods can contribute to achieving sufficient sleep among middle school students. When implementing interventions to improve sleep among middle school students, promoting healthy and balanced diets can be considered as one of the intervention strategies.

Objective: To investigate child injury prevention practice and associated factors among parents of primary school students. Methods: Parents of 2 577 students were selected from three primary schools in three administrative regions of Shanghai by multi stage sampling method between May and June in 2021. Questionnaire survey was administered to parents based on the Index System for Assessing Parent s Ability on Child Injury Prevention, which was developed previously by the present research group. Results were converted into standardized scores for descriptive analysis, and the original scores were analyzed by multiple linear regression model. Results: The standardized scores of parents on environment safety, product safety, behaviors and skills and psychological safety were (0.91±0.08)(0.93±0.08)(0.97±0.04)(0.95±0.05), respectively. The standardized score of general ability was (0.95±0.04). The standardized scores on knowledge, attitude and practice of injury prevention were (0.99±0.03)( 0.97± 0.05)(0.89±0.10), respectively. Mothers performances were generally better than fathers . Parents with higher education performed better than those with lower education. Parents with "being a parent" in mind performed better on child injury prevention. Conclusion There is a gap between practice with the knowledge as well as attitude towards child injury prevention among parents of primary school students. Parenting role, educational background and parental awareness of the importance of parental role are primary factors that affect child injury prevention practice.

Objective: To construct and determine the weight of Index System for Assessing Parent s Ability on Child Injury Prevention, and to provide the basis for childhood injury intervention in family. Methods: Twenty four experts majored in related fields were invited to participate in Delphi consultation. The final index system was constructed according to the consulting results and the weight of primary and secondary indicators were calculated. Results: The final index system consisted of 5 subscales corresponding to 5 age groups: 0,1-2,3-5,6-11 and 12-17 years old. Each scale included 4 primary indicators and 11 secondary indicators. The weight of primary indicators obtained by analytic hierarchy process is 0.28 for "environment", 0.16 for "product", 0.31 for "behaviors and skills", and 0.25 for "psychology". The highest weight of secondary indicators for "environment", "product" and "behaviors and skills" was "water area", while the top secondary indicators for "psychology" included "parental style""emotional control" "family atmosphere", with all indicators weighted higher than 0.2. Conclusion The Index System for Assessing Parent s Ability on Child Injury Prevention by Delphi consultation is comprehensive in content, and with the focus on parental behaviors and skills on injury prevention.

Objective: To review the articles evaluating parental ability on child injury prevention and to provide suggestions for developing assessment index for parental ability on child injury prevention. Methods: Relevant studies were retrieved from the Chinese Biomedical Literature Database (CBM), Wanfang, CNKI, VIP, PubMed, Medline, Springer, and Web of Science, and were reviewed based on instruments, contents, as well as reliability and validity of instruments. Results: A total of 47 articles were included for analysis. The methods for assessment mainly include quantitative and qualitative investigation, mainly quantitative surveys through scales or questionnaires. Assessment contents mainly included parental knowledge, attitudes and practice on child injury prevention(44 papers), as well as home safety(3 papers).The evaluation object mainly concentrated on parents of preschool children. A small part of studies tested the reliability and validity of the instruments in quantitative investigations.The reliability test indexes included retest reliability and Kronbach coefficient, and the validity test indexes included content validity, structure validity and scale validity. Conclusion There is a lack of assessment tools for evaluating parents ability on child injury prevention in Chinese background. The development of corresponding assessment tools should consider the characteristics of children in different age groups, injury types, as well as its reliability and validity.

Objective: To explore the dose-response relationship between duration of emotional experience of primary school students and the intensity of anxiety disorders, and to understand the risk of anxiety disorders corresponding to different emotional state levels. Methods: A total of 7 152 primary students from grade 3 to 5 were investigated with questionnaire survey from 16 public primary schools, by using the Screen for Child Anxiety Related Emotional Disorder (SCARED) and Positive Affect and Negative Affect Scale. Results: The prevalence of anxiety disorders was 19.91%, among which the prevalence rates of anxiety disorders in boys and girls were 19.41% and 20.43%, respectively. After adjusting for gender, grade, household register, the only child, parental marital status, parental occupation, parental educational level, family financial level, serving as a class leader, receiving special training or counseling in sports and art, and being bullied, the risk of anxiety disorder in children with positive emotions lasting for 7-16 days, 17-24 days and >24 days was lower compared to those with positive emotions lasting for less than 6 days(P<0.05); the risk of anxiety disorder in children with negative emotions lasting for 0.27-0.93 day, 0.94-2 days and >2 days was higher compared to those with negative emotions lasting less than 0.26 day(P<0.05). Restricted cubic spline analysis showed that the duration of emotional state and anxiety disorder showed a significant non-linear dose-response relationship (non-linear test, P<0.01), that is, as the number of days of positive emotions increases, the risk of anxiety disorder continues to decrease, and as the number of days of negative emotions increases, the risk of anxiety disorder continues to increase. Conclusion There is a significant dose-response relationship between the duration of the emotional state of primary school students and the prevalence of anxiety disorders. Acquirement and maintain positive emotions m be an important entry point for mental health promotion among primary school students.

Objective:To provide epidemiological data and clinical evidence for cosmetic adverse reactions.Methods:A retrospective clinical analysis was carried out on a total 820 outpatients (23 males and 797 females) suspected to be with cosmetic adverse reactions from January 2014 - October 2017, and average age of these patients was 7~75 (32.66±8.09) years. Suspicious cosmetics patch tests were performed in some patients. Suspicious cosmetics patch tests were performed in 687 patients.Results:Among 820 patients with cosmetic adverse reactions, women accounted for 97.20% and men accounted for 2.80%. Age distribution was most common among young people aged 21-40 years, accounting for 71.34%. The highest level of education was higher education, accounting for 59.69%. Occupational distribution was most commonly concentrated in employees and unemployed persons, accounting for 28.54% and 18.66%, respectively. A history of cosmetics allergies accounted for 17.28%. Cosmetic contact dermatitis was the most common clinical type of cosmetic adverse reactions, accounting for 92.70%. A total of 1682 suspected pathogenic cosmetics were involved. The positive rate of the cosmetic original patch test was 42.39%. Among the cosmetics with a positive patch test, moisturizing, anti-wrinkle and whitening freckle cosmetics accounted for the highest proportion, 31.59%, 15.09%, and 12.68%, respectively.Conclusions:Cosmetic contact dermatitis is the most common type of cosmetic adverse reaction. Patch testing is helpful in identifying the contact allergens in cosmetic adverse reaction.

OBJECTIVE: To investigate the clinical and immunological characteristics, treatment and prognosis of common variable immune deficiency (CVID) in adult patients. METHODS: We retrospectively analyzed the clinical data of 13 adult patients hospitalized in our hospital for CVID diagnosed according to the criteria in International Consensus Document (2016), and analyzed their clinical manifestations, laboratory test results, imaging findings, pathological examinations and treatments. RESULTS: The mean age of onset was 24.46±16.82 years in these patients, who had a mean age of 32.54±14.86 years at diagnosis with a median diagnostic delay of 5 years (IQR: 2-15 years). The main manifestation of the patients was repeated infections, including repeated respiratory tract infection (10 cases; 76.9%) and repeated diarrhea (3 cases; 23.1%). Three (23.1%) of the patients had autoimmune disease and 10 (76.9%) had chronic pulmonary disease. IgG, IgA and IgM were decreased in all the patients. The proportion of CD4+T cells decreased in 10 patients (76.9%), CD8+T cells increased in 11 patients (84.6%), and CD4/ CD8 decreased in 10 patients (76.9%). Complement C3 decreased in 58.3% (7/12) and C4 decreased in 33.3% (4/12) of the patients. Twelve patients (92.3%) were treated with intravenous infusion of gamma globulin with symptomatic treatments. One patient died due to massive gastrointestinal hemorrhage, and the other patients showed improve ments after the treatments and were discharged. CONCLUSIONS The clinical manifestations of CVID are diverse, and recurrent respiratory tract infection is the most common manifestation. Decreased IgG often accompanied by lowered IgA and IgM levels is a common finding in laboratory tests. The treatment of CVID currently relies on gamma globulin with symptomatic treatments for the complications.
Adolescent ; Adult ; Autoimmune Diseases ; Child ; Common Variable Immunodeficiency ; Delayed Diagnosis ; Humans ; Immunoglobulins, Intravenous ; Middle Aged ; Retrospective Studies ; Young Adult

Objective To observe the protective mechanism of angiotensin-converting enzyme (ACE) 2 on lipopolysaccharide (LPS)-induced hepatocyte inflammation by inhibiting P38 mitogen activated protein kinase (MAPK)/activator protein (AP)-1 pathway.Methods Rat liver BRL cells after immortalized culture were randomly divided into five kinds of groups:control group,LPS (10 μg/ mL) group,LPS + recombinant(r) ACE2 (5,10,20 ng/mL rACE2 for 30 min before cells stimulated with LPS) groups,LPS+ACE2 inhibitor MLN-4760 (10-7,10-6,105 mmol/L MLN-4760 for 30 min before cells stimulated with LPS) groups,LPS + rACE2 (20 ng/mL rACE2 for 30 min before cells stimulated with LPS) + P38MAPK inhibitor SB203580 (10-5 mmol/L SB203580 for 30 min before cells stimulated with LPS) groups.The changes in protein levels of ACE2,P38MAPK,p-P38MAPK and AP-1 were detected by western blot after LPS exposure for 6,12 and 24 hours,and the mRNA expressions of P38MAPK,AP-1 and tumor necrosis factor-α were quantified by real-time RT-PCR.Results Compared with control group,the protein levels of ACE2,P38MAPK and AP-1 were up-regulated in LPS-induced hepatic cells in a time-dependent manner,peaking at 12 h after LPS stimulation (all P＜0.05).Compared with LPS group,the mRNA expressions ofAP-l,P38MAPK,p-P38MAPK and tumor necrosis factor-oα decreased significantly in rACE2 group (all P＜0.05).The dose of 20 ng/mL rACE2 had the best inhibitory effects on the mRNA expression of AP-1 (0.12±0.002 vs.0.04±0.005,P＜0.01),P38MAPK (0.17±0.02 vs.0.02±0.002,P＜0.01) and p-P38MAPK(0.29±0.01 vs.0.02±0.01,P＜0.01)compared with LPS group.The mRNA expressions of AP-1,P38MAPK and p-P38MAPK increased in MLN-4760 group in a concentration dependent manner (all P＜0.05).Furthermore,the inhibitory effects of rACE2 on AP-1 and tumor necrosis factor-α levels were cancelled by SB203580.Conclusion The rACE2 can alleviate the LPS-induced hepatocyte injury by down regulating the P38MAPK/AP-1 signaling pathway.

To identify the related substances in pioglitazone hydrochloride by hyphenated LC-MS techniques,an Ultimate XB-C18 (250 mm × 4.6 mm,5 μm) column was used for separation of the related substances with methanol and 0.1％ ammonium acetate buffer as the mobile phases in gradient elution.Electrospray positive ionization high resolution TOF/MS was used for the determination of the accurate mass and elemental composition of parent [M + H] + ions of the related substances,and triple quadrupole tandem mass spectrometry was employed for the product mass spectra determination.Eleven major related substances were detected and identified to be one synthesis intermediate,six by-products and four degradation products,by using LC-MS determination,spectra elucidation,and further synthetic process and stress degradation mechanisms analysis.The results are useful for pioglitazone hydrochloride manufacturing processes optimization and quality control.