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 observe the effects of acupuncture at Houxi(SI3)and Huantiao(GB30)on the expression levels of nuclear factor kappa B(NF-κB),inducible nitric oxide synthase(iNOS),and nitric oxide(NO)of NF-κB inflammatory signaling pathway in L5 spinal nerve root of lumbar disc herniation(LDH)model rats and explore the mechanism of acupuncture in LDH treatment.Methods:Forty specific-pathogen-free healthy male Sprague-Dawley rats were randomly divided into a sham operation group,a model group,acupuncture group 1,and acupuncture group 2,with 10 rats in each group.The non-compression nucleus protrusion model was made by puncturing L4-L5 spinous process space and injecting autologous nucleus suspension.Acupuncture at bilateral Shenshu(BL23),Dachangshu(BL25),and Weizhong(BL40)was carried out in acupuncture group 1,and acupuncture at bilateral Houxi(SI3)and Huantiao(GB30)in acupuncture group 2.All rats were treated with balanced reinforcing and reducing needling manipulations,and the needles were retained for 30 min/time with one episode of needling manipulation every 10 min,once a day,14 times in total.The threshold value of paw withdrawal pain was measured by a thermal stimulation pain instrument;the serum NF-κB,iNOS,and NO levels were measured by enzyme-linked immunosorbent assay.The pathomorphological changes of spinal nerve roots were observed by hematoxylin-eosin(HE)staining;quantitative reverse transcription polymerase chain reaction was used to detect iNOS mRNA expression in spinal nerve roots;the NF-κB and iNOS protein expression in spinal nerve roots was detected by the immunofluorescence method.Results:Compared with the sham operation group,the threshold of paw withdrawal pain in the model group was decreased,and the expression levels of serum NF-κB,iNOS,and NO were increased;HE staining showed many degenerated and dissolved Schwann cells in spinal nerve roots with vacuolar changes;meanwhile,the expression levels of NF-κB and iNOS proteins,and the iNOS mRNA in spinal nerve roots were increased.Compared with the model group,the paw withdrawal pain thresholds in acupuncture group 1 and acupuncture group 2 were increased,and the increase in acupuncture group 2 was greater(P<0.05);the expression levels of serum NF-κB,iNOS,and NO in acupuncture group 1 and acupuncture group 2 were decreased,especially in acupuncture group 2(P<0.01);the vacuolar changes of spinal nerve roots,and the degeneration and lysis of Schwann cells in acupuncture group 1 and acupuncture group 2 were decreased,which were more obvious in acupuncture group 2;the NF-κB and iNOS protein expression and the iNOS mRNA expression levels in spinal nerve roots of acupuncture group 1 and acupuncture group 2 were decreased,especially in acupuncture group 2(P<0.01).Conclusion:Acupuncture at Houxi(SI3)and Huantiao(GB30)can improve the morphology of spinal nerve roots,inhibit the NF-κB and iNOS protein expression levels in spinal nerve roots and the serum NO level,and relieve the pain caused by inflammation of spinal nerve roots,which may be one of the mechanisms of acupuncture in LDH treatment.

Objective:To summarize the levels of individual dose to radiation workers in Shandong province from 2016 to 2020, and to analyze the trends in their change in order to provide scientific basis for radiation workers′ health management.Methods:The experimental detection and quality control were carried out in compliance with the national standards Specifications for individual monitoring of occupational external exposure (GBZ 128-2019) and the Testing criteria of personnel dosimetry performance for external exposure (GBZ 207-2016). The result of the personal dose monitoring of occupational external exposure of all radiation workers monitored by the Centers for Disease Control and Prevention in 16 cities of Shandong province were retrospectively analyzed by using SPSS 23.0 software.Results:The total number of monitored workers were 25 523 with an average annual individual effective dose of 0.28 mSv. There were statistically significant differences among radiation workers in different years ( H= 2 815.91, P<0. 001). The average annual individual effective dose showed an upward trend followed by a downward trend. The average annual effective dose of 0.55 mSv for nuclear medicine radiation workers in medical applications was the highest, with statistically significant differences among different occupational radiation workers ( H=310.37, P<0.001). The average annual effective dose of 0.37 mSv for radioactivity logging workers in industrial applications was the highest, with statistically significant differences among different occupational radiation workers ( H=448.07, P<0. 001). The average annual effective dose to radiation workers in medical applications was higher than in industrial applications ( Z = -14.93, P<0.001). Conclusions:The average annual effective dose to nuclear medicine radiation workers in medical applications and logging radiation workers in industrial applications are relatively high. There would be a push to furthe improve workplace protection measures and strengthen the management and supervision of radiological workers.

Objective: To investigate the spatio-temporal distribution characteristics of pulmonary tuberculosis in Ningbo City from 2015 to 2020, so as to provide insights into tuberculosis control. Methods: The data of pulmonary tuberculosis cases in Ningbo City from 2015 to 2020 were collected from Tuberculosis Management Information System of China Disease Control and Prevention Information System, and were linked with the geographic information database of Ningbo Planning Design and Research Institute. The software SaTScan version 10.3 was employed for monthly spatio-temporal scanning and cluster analysis of reported pulmonary tuberculosis cases, populations, longitude and latitude in 153 townships of Ningbo City from 2015 to 2020. Results: There were one class Ⅰ cluster and two class Ⅱ clusters of pulmonary tuberculosis cases in Ningbo City from 2015 to 2020, and the class Ⅰ cluster was centered in Song'ao Township and covered 37 townships, with aggregation time from January 1, 2015 to December 31, 2017, while class Ⅱ clusters were covered 38 tounships which were centered in Sanqishi Township of Yuyao County, and one township in Hangzhou Bay New Town. The aggregation time was from January to June in 2015 and 2016, from March to August between 2017 and 2019 and between May and October, 2020. The overall reported incidence of pulmonary tuberculosis appeared a tendency towards a decline in each township of Ningbo City from 2015 to 2020; however, the incidence of pulmonary tuberculosis was more than 80 per 100 thousand in Fuming Township of Yinzhou District and Juexi Township of Xiangshan County in 2020. Conclusions There were significant spatio-temporal clustering characteristics of pulmonary tuberculosis incidence at a township level in Ningbo City from 2015 to 2020, and the clusters were mainly concentrated in the central and eastern Ningbo City. The reported incidence of pulmonary tuberculosis is high in Fuming Township of Yinzhou District and Juexi Township of Xiangshan County, where targeted regional tuberculosis control strategies should be implemented.

Objective:To investigate the effect of peer support-based narrative therapy on postoperative self-image and stigma of patients with head and neck cancer, to provide reference for clinical nursing.Methods:A total of 78 head and neck cancer patients from August 2018 to August 2020 in Fudan University Shanghai Cancer Center were divided into experimental group and control group by random digits table method, each group were 39 cases. The control group was given conventional nursing, while the experimental group implemented support-based narrative therapy on the basis of routine nursing. The intervention time was 4 weeks. The self-image and stigma of the two groups before and after intervention were assessed by Body Image Scale (BIS) and Social Impact Scale (SIS), respectively.Results:Finally, 37 cases were included in the experimental group and 38 cases in the control group. There was no significant difference in BIS, SIS dimension scores and total scores between the two groups before intervention ( P>0.05). After intervention, the emotional demension scores, behavior dimension scores, cognitive dimension scores and total scores in BIS were 4.41 ± 1.04, 1.95 ± 0.51, 3.81 ± 0.63 and 10.16 ± 2.05 in the experimental group, significantly lower than in the control group 5.08 ± 1.08, 2.82 ± 0.60, 5.42 ± 0.76 and 13.32 ± 1.93, the differences were statistically significant ( t values were 2.76-6.86, all P<0.01); the social exclusion scores, internal shame scores, social isolation scores and total stigma scores in SIS were 17.57 ± 2.67, 9.08 ± 1.55, 12.14 ± 3.73 and 46.14 ± 4.95 in the experimental group, significantly lower than in the control group 19.18 ± 3.70, 10.68 ± 1.61, 14.18 ± 3.83 and 51.68 ± 6.09, the differences were statistically significant ( t values were 2.16-4.38, all P<0.05). Conclusions:Peer support-based narrative therapy can effectively alleviate the postoperative self-image problems and stigma of patients with head and neck cancer, which is worthy of clinical application.

Background::Understanding the characteristics of newly diagnosed primary human deficiency virus-1 (HIV-1) infection in the context of the post-antiretroviral therapy era and HIV drug prophylaxis is essential for achieving the new target of 95-95-95-95 by 2025. This study reported the characteristics of newly diagnosed primary HIV-1 infection in Shenzhen.Methods::This is a real-world retrospective study. Eighty-seven newly diagnosed primary HIV-1-infected patients were recruited from January 2021 to March 2022 at the Third People’s Hospital of Shenzhen. Demographic, epidemiological, diagnostic, drug resistance, and medical data were described and analyzed.Results::Overall, 96.6% (84/87) of the newly identified primary HIV-1-infected patients were male, including 88.5% (77/87) men have sex with men (MSM), with a median age of 29.0 years (Q 1-Q 3: 24.0-34.0 years); of these, 85.1% (74/87) reported high-risk sexual behaviors with casual partners. The rate of condom usage was only 28.7% (25/87). The overall rate of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) was 8.0% (7/87, including 4 PrEP and 3 PEP cases) around the potential exposure, although 41.4% of the patients had prior awareness of such interventions. Moreover, only 19.5% (17/87) had previously used PrEP or PEP. Of those, 58.8% (10/17) of the patients obtained drugs from the internet, and only 35.3% (6/17) reported good compliance. A total of 54.0% (47/87) of subjects were diagnosed by the HIV nucleic acid test. Acute retroviral syndrome appeared in 54.0% (47/87) of patients. The prevalence of transmitted drug resistance (TDR) mutation was 33.9% (19/56), including 6 (10.7%) against nucleoside reverse transcriptase inhibitor (NRTI) plus non-nucleoside reverse transcriptase inhibitor (NNRTI), 8 (14.3%) against NNRTI, and 5 (8.9%) against protease inhibitor (PI) only. Conclusions::Owing to the low utilization rate and incorrect usage of PrEP and PEP, massive efforts are needed to promote HIV-preventive strategies in the MSM population. The extremely high prevalence of TDR mutation in this population implies the need for future pretreatment drug resistance surveillance.

Objective:To investigate the correlations of stable chronic obstructive pulmonary disease(COPD)with inositol 1, 4, 5-trisphosphate 3-kinase C(ITPKC)and phospholipase C-like 1 protein(PLCL1)single nucleotide polymorphisms(SNPs)in the Han elderly population in Ningxia.Methods:A case-control study was conducted.A total of 250 elderly patients with stable COPD were enrolled and divided into the COPD-related pulmonary hypertension(PH)group(n=103)and the COPD non-PH group(n=147). During the same period, 127 healthy elderly Han subjects were included as the control group.The ITPKC gene SNPs and the PLCL1 gene SNP were detected, and differences in alleles and genotype frequencies were compared between the groups.Results:The allele and genotype frequency distributions of rs2288450 and rs9789480 showed statistical differences between the COPD group and the control group(χ 2=6.09, 5.18, 30.14 and 32.89, P=0.048, 0.020, <0.001, <0.001). There was no difference in the allele and genotype frequency distributions of the ITPKC gene SNPs rs2290692 and rs17713068 between the control group and the COPD group(all P>0.05). The allele and genotype frequency distributions of rs9789480 showed differences between the COPD non-PH group and the COPD-PH group(χ 2=94.50 and 72.76, both P<0.001). There was no significant difference in the allele and genotype frequency distributions of rs2290692, rs17713068, rs2288450 between the COPD-PH group and the COPD non-PH group(all P>0.05). Conclusions:The ITPKC gene SNP rs2288450 CA and AA genotypes and A allele can reduce the incidence of COPD and may be a protective factor for COPD in the elderly.The PLCL1 gene SNP rs9789480 CA and AA genotypes and A allele can reduce the incidence of COPD and COPD-PH and may be a protective factor for COPD and COPD-PH in the elderly.

Objective To investigate the predictive value of pregnancy-associated plasmaprotein-A (PAPP-A) and GRACE risk score for death and nonfatal myocardial infarction (combined endpoint) in AMI patients.Methods All AMI patients hospitalized in our department during July 2011 to July 2015 were included consecutively in this prospective study.Plasma PAPP-A were measured at admission.GRACE risk score was acquired with the application of GRACE risk score calculator.Patients were followed up for at least 1 year for any nonfatal myocardial infarction or MACE.Kaplan Meier survival study was analysed according to PAPP-A and GRACE score risk stratification respectively.A cutoff value of 3.0 ng/ml of PAPP-A was chosen from pilot work in this cohort.Results A total of 220 patients were enrolled in the study.The death and nonfatal myocardial infarction during follow-up were significantly higher in patients with PAPP-A≥3.0 ng/ml compared to patients with PAPP-A<3.0 ng/ml (15.7% vs.6.0%, log-rank χ2=5.684, P=0.017).The area under ROC curve of PAPP-A was 0.796(95%CI 0.696-0.896, P<0.01) and the ROC curve of PAPP-A GRACE risk stratification was 0.715 (95%CI 0.567-0.863,P<0.01).Subgroup analysis showed that death and nonfatal myocardial infarction during follow-up was significantly higher in patients with PAPP-A≥3.0 ng/ml compared to patients with PAPP-A<3.0 ng/ml in intermediate and low risk group by GRACE risk stratifcation (log-rank χ2=14.63,P<0.001).Conclusions PAPP-A could predict mortality and nonfatal myocardial infarction in patients with AMI.PAPP-A combined with GRACE risk score can better predict outcome than GRACE risk score alone in intermediate and low risk patients by GRACE risk stratifcation.