Previous studies have uncovered a negative correlation between problematic smartphone use (PSU) and both depression and anxiety, yet the investigation of PSU with depression and anxiety on a symptomatic level among medical students remains limited. This study aims to analyze the network structure of PSU and its relation to symptoms of depression and anxiety, as well as examine the role of mindfulness among these factors. A sample of 456 medical students was assessed using the Smartphone Addiction Scale - Short Version (SAS-SV), the nine-item Patient Health Questionnaire (PHQ-9), the seven-item Generalized Anxiety Disorder Scale (GAD-7), and the Mindful Attention Awareness Scale (MAAS). Network analysis was employed to build the network structure and to identify central and bridge symptoms with centrality indices. The analysis revealed that preoccupation with smartphone and withdrawal symptoms serve as central symptoms in the development of PSU among medical students. Excessive use and fatigue emerged as bridge symptoms linking PSU to depression, while excessive use and restlessness were identified as bridge symptoms connecting PSU with anxiety. Mindfulness exhibited a negative association with numerous symptoms across PSU, depression, and anxiety. The findings indicate that targeting preoccupation with smartphone and withdrawal symptoms might prevent the development of PSU among medical students. Targeting excessive use may be essential in preventing the progression of PSU to depression and anxiety. Given the backgrounds of medical students, online mindfulness interventions could be a viable approach to mitigate PSU and improve mental health among them.

To evaluate the safety and clinical utility of capsule endoscopy in preschool-aged children. A multicenter retrospective study design was used, including data from eight specialized pediatric hospitals in China. Children aged < 6 years who were hospitalized and underwent capsule endoscopy between January 2020 and August 2025 were included. This study included 155 patients (mean age 56.9 ± 14.2 months). The most common indication was chronic abdominal pain (50.97

Pediatric inflammatory bowel disease (pIBD) often begins early in life, progresses rapidly, and is associated with impaired growth and delayed development. These challenges demand treatment strategies that address both intestinal inflammation and the broader developmental needs of children. This review summarizes current advances in small-molecule therapies for pIBD based on published clinical trials, real-world studies, and mechanistic investigations retrieved from PubMed and clinical trial registries. Special emphasis is placed on Janus kinase (JAK) inhibitors and sphingosine-1-phosphate (S1P) modulators, which represent the main translational research focus in pediatric IBD. JAK inhibitors such as tofacitinib and upadacitinib have demonstrated promising efficacy in pediatric patients with refractory disease, although their use remains off-label worldwide. Long-term safety concerns persist, including infection risk, developmental effects, and potential risks of malignancy or major adverse cardiovascular events. S1P modulators such as ozanimod are under clinical evaluation in children, but robust long-term data are still lacking. Emerging technologies such as single-cell and spatial profiling have begun to reveal age-dependent remodeling of gut immune architecture, emphasizing the importance of developmentally informed therapeutic approaches. Small-molecule therapies offer a promising and mechanistically precise direction for the management of pIBD. Future progress will depend on age-specific clinical trials, physiologically based pharmacokinetic modeling, and biomarker discovery through integrated multiomics. Collaborative multicenter research is essential to optimize the safety and efficacy of these agents in children.

Depression and social anxiety are highly comorbid in young adults, posing significant harm. This study aimed to identify central and bridge symptoms of depression and social anxiety in medical students, providing insights for intervention strategies. This cross-sectional study recruited 456 medical students. Depression symptoms were measured using the nine-item Patient Health Questionnaire (PHQ-9), while social anxiety was assessed using the Interaction Anxiousness Scale (IAS). Network analysis was utilised to examine symptom-level associations between depression and social anxiety. The study identified 'anxious at parties' and 'nervous with authority figures' as the most central symptoms, while 'nervous in informal gatherings' and 'fatigue' were the most bridge symptoms in the network of depression and social anxiety symptoms among medical students. These symptoms were crucial in the development of depression and social anxiety, indicating the target for interventions. The network analysis perspective suggests that the development of social anxiety in medical students is closely related to career development, while its comorbidity with depression is associated with social and emotional support. Distinct intervention strategies could target central and bridge symptoms to address social anxiety and its comorbidity with depression among medical students.

There is a lack of research exploring the possible patterns of social problem perception across major public concerned issues and their mental health impacts. We aimed to identify the latent patterns of social problem perception and examine the dynamic associations between the patterns and depressive symptoms. Two waves of data (2018 and 2020) from the China Family Panel Studies were used in this study, including 15 414 Chinese adults. Latent profile and latent transition analysis were employed to identify social problem perception patterns and their changes over time. Multivariable linear regression analysis was used to examine concerned relationships. Three latent profiles were identified for social problem perceptions in both 2018 and 2020 waves (high, middle and low). The low profile presented a tendency for stability rather than change, meanwhile the middle and high profiles had a high probability of remaining stable after two years. Higher and upward transition of social problem perception pattern were associated with short-term and long-term depressive symptoms. These findings suggest that social problem perception patterns dynamically impact mental health. Tailored strategies should be introduced to mitigate people's perception severity of socially concerned problems.

Background: Self-management behaviors can prevent the negative consequences among patients with coronary heart disease (CHD). The reality of patients followed the self-management behaviors rate are unoptimistic. Objective: This study aimed to examine whether self-efficacy serves as a mediating role between family functioning and self-management behaviors among coronary heart disease patients. Methods: A cross-sectional approach was applied, and 140 patients with CHD were included using a cluster sampling strategy. Family functioning was assessed utilizing the Family APGAR Index, self-efficacy was evaluated using the Self-efficacy for Chronic Disease 6-item Scale, and self-management behaviors was examined utilizing the Coronary Artery Disease Self-Management Scale. Data were collected from July to October 2022 and analyzed using descriptive statistics and regression analyses to evaluate the mediating influence. Results: The degree of self-management behaviors among patients with CHD was at a low level (Mean = 82.23, SD = 11.863). Self-efficacy had a direct and positive impact on self-management behaviors (β = 0.39, p <0.001). Moreover, self-efficacy had a partially intermediary function in the relationship between family functioning and self-management behaviors (indirect effect = 0.14, 95% CI [0.04, 0.27]; direct effect = 0.39, p <0.001). Conclusion: Self-efficacy demonstrated an association with self-management behaviors and served as a mediation function in the relationship between self-management behaviors and family functioning. Therefore, the significance of family functioning and self-efficacy should be highlighted in nursing practice when developing methods to encourage patients with CHD to improve their self-management behaviors.

The optimal initial management strategy for cervical cancer with lymph node metastases (LNM) remains a topic of ongoing debate. This study aimed to explore the correlation between surgery followed by postoperative radiotherapy (PORT) and definitive radiotherapy (RT), as well as their impact on the prognosis of patients with LNM. Patients with positive lymph nodes (PLNs) in 2009 FIGO stage I–III cervical cancer were selected from SEER database. Kaplan–Meier and log-rank analysis were utilized to assess survival outcomes. Cox and Interaction analyses were employed to compare the survival benefits. 2936 patients were included in this study. Multivariate analysis revealed the choice of primary treatment significantly impacted both cancer-specific survival (CSS) and overall survival (OS), serving as an independent prognostic factor for patients with LNM. After adjusting for imbalanced variables, surgery plus PORT exhibited significant improvements in CSS and OS in the stage I–II and PLNs ≤ 5 subgroups. However, no statistically significant difference was observed between the two treatment modalities in stage III and PLNs > 5 subgroups. Through interaction analysis, it was observed that stage I–II and PLNs ≤ 5 subgroups exhibited a significant survival benefit from surgery plus PORT. Surgery plus PORT could lead to improved outcomes for cervical cancer in patients with stage I–II or PLNs ≤ 5. However, this approach did not apply to patients with stage III or PLNs > 5. Therefore, a comprehensive assessment of LNM and local tumor spread should guide rationalized treatment modalities when managing patients presenting LNM.

Background As the pace of economic development slows, college students are facing an increasingly challenging employment landscape. For instance, the expansion of higher education has led to a swell in the number of job seekers, which has in turn intensified competition. Given the limited job opportunities, it’s understandable that many college students are developing a pessimistic employment mindset. Therefore, it’s crucial to explore how objective factors influence their work aspirations. But few studies have explored the role of mediating factors between the two, such as family and resource factors. Thus, this study examines the effects of family support and work resources between the relationship between economic constraints and work volition. Methods The study examined 1249 Chinese undergraduate students as participants ((714 men and 535 women; Mage = 19.32, SD = 1.50), using the questionnaire with the Wenjuanxing online survey tool. The questionnaire were collected between August, 2022 and December, 2022. SPSS 21.0 and AMOS 24.0 were used to conducted a comprehensive analysis of the collected data, and investigate the relationships among latent variables and assess the goodness of fit of the observed indicators on their associated latent constructs. Additionally, we evaluated all the hypothesized direct and indirect effects. Results The results showed the direct and indirect relationships among economic constraints, family support, work resources and work volition. Economic constraints can directly predict work volition. Moreover, economic constraints have a significant negative impact on work volition via two mediators: family support and work resources. On the one hand, economic constraints negatively affect work volition through family support and work resource separately. On the other hand, economic constraints negatively predict family support and work resource, thus negatively impact work volition. Contribution The current study has established the independent mediating and chain-mediated effects of family support and work resources on the relationship between economic constraints and work volition. This deeper understanding of internal mechanisms provides valuable insights that can inform strategies for enhancing individual’s work volition, particularly from the perspectives of economic constraints, family support, and work volition.

Previous studies had identified the significant issue of burnout and sleep quality in medical students. However, no studies have explored the interactions between learning burnout and sleep quality on a symptom level. This study used network analysis to explore the interaction and construct the network structure of learning burnout and sleep quality among medical students in China. We recruited 553 medical students to participate in our study. Learning Burnout of Undergraduates and Scale (LBUS) and the Pittsburgh Sleep Quality Index (PSQI) were used to measure learning burnout and sleep quality. Expected influence and bridge expected influence were used to identify the central and bridge symptoms. Results showed 'B9' (Tired of learning) and 'B17' (I want to learn but feel bored with it) had the highest expected influence. 'B12' (I often fall asleep while studying) and 'P_DD' (Daytime dysfunction) had the highest bridge expected influence. Our findings revealed the characteristics of learning burnout and sleep quality in online learning and provided information to further understand the difference in the influence of mental health between online and offline learning.

BACKGROUND:In China, Shidu parents, who have experienced the pain of losing their only child, are more likely to suffer from mental health issues such as depression, anxiety, and suicidal ideation compared to other bereaved groups. Currently, the relationships between symptoms of depression, anxiety, and suicidal ideation among Shidu parents remain unclear, necessitating further research to elucidate these connections. Our study aims to estimate the network of depression and anxiety symptoms and identify the bridge symptoms between depression, anxiety and suicidal ideation based on network analysis. METHODS:This study was conducted in five urban districts and one rural district in Shenyang City, Liaoning Province, China. Data collection was conducted from March 2017 to February 2020. Network analysis was implemented by using the R packages qgraph and bootnet. RESULTS:'Felt depressed' and 'felt sad' were central symptoms of depression, while 'feeling fainting and passing out' and 'afraid for no reason' were central symptoms of anxiety. Two pairs of bridge symptoms and one overlapping symptom were found in the transdiagnostic network. In addition, one depressive symptom and one anxiety symptom were identified to be significantly associated with suicidal ideation. CONCLUSIONS:The current study is the first to conduct a network analysis of depression, anxiety, and suicidal ideation among Chinese Shidu parents. The association among disease symptoms were found, and the most central symptoms were identified. Results of the present study can provide some new intervention and treatment ideas for corresponding diseases, which lays a theoretical foundation for the future longitudinal research.

To investigate the current state of compassion fatigue among operating room nurses, analyze the factors influencing compassion fatigue (particularly psychological resilience), and provide a basis for developing a compassion fatigue intervention program for operating room nursing managers. This cross-sectional study was conducted in February 2022. A total of 258 operating room nurses were surveyed using the Professional Quality of Life (ProQOL) scale and the Resilience Scale for Adults (RSA). The ProQOL demonstrated internal consistency reliability, with Cronbach’s α values ranging from 0.75 to 0.88 across its three subscales. The Cronbach’s α coefficient for the RSA was 0.91. Scores on various dimensions of compassion fatigue among operating room nurses were as follows: the total score was 84.07 (standard deviation [SD] = 7.74), with a mean score of 28.02. 92 nurses (35.5

The long-term mental health consequences of COVID-19 in children and adolescents remain unclear. We investigated the impact of COVID-19 infection on mental health after China's zero-COVID policy relaxation, focusing on symptom-specific and social-family risk factors for mental health issues in children and adolescents. In a longitudinal study, 8348 youths (aged 10-18) were assessed twice (T1: September to October 2022 and T2: April to May 2023). Mental health changes (Δ=T1-T2) were compared between COVID-19-infected (COVID+, n = 4108) and non-infected (COVID-, n = 4240). After balancing social-family confounding factors at T1 with propensity score-based inverse probability weights, multivariable logistic regression was employed to assess associations between COVID-19 infection and the onset/worsening of mental health symptoms. Multivariable logistic regression was conducted to explore specific acute COVID-19 symptoms and social-family risk factors associated with the onset/worsening of mental health symptoms in COVID + group. Compared to COVID- group, COVID + group exhibited lower overall mental health improvement (Δ). COVID + group was associated with increased risks of depression worsening (OR 1.20, 95 % CI 1.04-1.39), anxiety worsening (OR 1.30, 95 % CI 1.15-1.47), stress worsening (OR 1.23, 95 % CI 1.03-1.46), insomnia worsening (OR 1.21, 95 % CI 1.05-1.39), and emotional symptoms worsening (OR 1.72, 95 % CI 1.27-2.33). Moderate-to-severe difficulty thinking, breathlessness, and gastrointestinal symptoms were specific COVID-19 symptoms associated with worsening of various mental health outcomes. Furthermore, academic difficulties, economic disadvantages, family conflicts, food addiction, and alcohol consumption were identified as social-family risk factors for worsening mental health symptoms in COVID + youths. COVID-19 infection leaves lasting mental health scars in youths, extending beyond the acute phase. Specific symptoms, particularly cognitive dysfunction and respiratory/gastrointestinal distress play a significant role in this vulnerability. Social-family factors further modulate these effects, highlighting the need for comprehensive interventions that address both biological and psychosocial aspects. This study provides valuable insights for tailoring mental health support to youths navigating the consequences of the COVID-19 pandemic.

OBJECTIVE:To explore the change trends in incidence and leading factors to peripartum hysterectomy (PH) at a regional tertiary medical center in northeast China.METHODS:This was a retrospective observational study of all PH cases conducted at Shengjing Hospital between January 1, 2012 and December 31, 2021. Information on maternal characteristics of pregnancy and delivery, indications of PH, inventions before hysterectomy, complications, and maternal and neonatal outcomes obtained from the Shengjing Hospital Information System were analyzed.RESULTS:Among a total of 157 553 deliveries, there were 127 cases of PH (overall PH incidence: 0.85/1000 deliveries); 120 patients (94.49%) underwent hysterectomy after cesarean section, and seven (5.51%) underwent vaginal delivery (P < 0.001). Abnormal placentation was the leading indication for PH (101, 79.53%), including placenta previa (PP) with placenta accreta spectrum (PAS) (93, 73.23%), PP alone (5, 3.94%), and PAS alone (3, 2.36%). Among the patients who underwent PH with abnormal placentation, 92.08% had at least one cesarean section (P < 0.001) and 20.19% had bladder injury (P = 0.044). All maternal deaths (n = 2) occurred in referral patients, and the maternal mortality rate was 1.57/100 hysterectomies.CONCLUSION:Abnormal placentation was the primary indication for PH. For such patients, adequate assessment of their condition and complete communication are strongly recommended. The identification of high-risk groups for postpartum hemorrhage, timely and effective rescue, and referral are equally important for avoiding PH.

Background: Management of intractable constipation is still challenging in children. Fecal impaction has been considered a common cause while retrograde colonic enema(RCE) is an effective method for this condition. Fecal microbiota transplantation(FMT) has also demonstrated great potential in many gastrointestinal diseases. However, the efficacy of RCE with FMT in childhood constipation remains unclear.Methods: A randomized, double-blind, controlled trial with 110 children who met the inclusion criteria was conducted. The subjects were randomly assigned to the FMT with RCE group or the placebo with RCE group. The duration of FMT treatment was 4 weeks, with a 12-week follow-up. The main observations were complete spontaneous bowel movements and bowel function satisfaction, and the adverse effects were assessed based on symptoms.Findings: At the end of follow-up, the effectiveness rates in the FMT with RCE and placebo with RCE groups were 43.64% and 21.82%, respectively (χ2 =11.24, P < 0.05). Compared with the end of treatment, there were eight recurrences (25.00%) in the FMT with RCE group and three recurrences (20.00%) in the placebo with RCE group( P >0.05). Among the primary outcome indicators, 27 patients (49.09%) in the FMT with RCE group and 15 patients (27.27%) in the placebo with RCE group were satisfied with defecation (χ2 =5.55, P <0.05). In total, 22 patients (40.00%) in the FMT with RCE group and 10 patients(18.18%) in the placebo with RCE group had complete spontaneous bowel movements for ≥ 3 weeks (χ2 =6.35, P <0.05). No adverse effects were found in all recruited cases.Interpretation: FMT enhances the efficacy of RCE and the use of RCE based FMT is a safe and effective method in the treatment of intractable constipation in children.Trial Registration Details: The study protocol was registered prospectively (https://clinicaltrials.gov/; registration number: NCT 05035784).Funding Information: This study was supported by the National Natural Science Foundation of China (No. 81570465, 30700917) and the General Funding Project from Department of Education of Liaoning Province (No. JC2019014).Declaration of Interests: We declare no competing interests.Ethics Approval Statement: The Ethics Committee of China Medical University (2018PS427K) approved the protocol, and written informed consent was obtained from all parents.

Parents who have lost their only child and cannot or do not wish to adopt or have another child are labeled Shidu parents. Network analysis is used to examine symptom-level interactions in mental disorders. This study aimed to investigate the comorbidity network structure of prolonged grief disorder (PGD) and anxiety symptoms among Shidu parents and compare network differences between child loss from natural and unnatural causes. Key findings revealed that faintness, feeling afraid, panic, and meaninglessness are central symptoms, while meaninglessness, inability to trust others, and nightmares are bridge symptoms. The strongest connection in the PGD-anxiety network is between avoidance and shock, and the edge between meaninglessness and weakness strongly links the two communities. Shidu parents who experience unnatural loss have a stronger edge between inability to trust others and bitterness/anger. Highlighting these symptoms may help interventions address the comorbidities associated with PGD and anxiety among Shidu parents.

INTRODUCTION: The management of childhood constipation is challenging. Pelvic floor dysfunction (PFD) is one of the most common causes of childhood constipation. Percutaneous tibial nerve stimulation (PTNS) with pelvic floor exercises (PFE) has achieved a satisfactory outcome in the elderly individuals and women with PFD. The efficacy of PTNS with PFE in childhood constipation has not been established. METHODS: A randomized, double-blind, controlled trial with 84 children who met the inclusion criteria was conducted. All participants were randomly assigned to PTNS with PFE or sham PTNS with PFE groups and received their individual intervention for 4 weeks with a 12-week follow-up evaluation. The spontaneous bowel movements (SBM) ≥3 per week were the main outcomes, and the risk ratio (RR) with 95% confidence interval (CI) were calculated. High-resolution anorectal manometry and surface electromyography were used for the assessment of pelvic floor function, and the adverse effects were assessed based on symptoms. RESULTS: At the end of the follow-up period, 26 patients (61.9%) in the PTNS with PFE group and 15 patients (35.7%) in the sham group had ≥3 SBM per week compared with baseline (net difference 26.2%, 95% CI 5.6%–46.8%; RR 2.750, 95% CI 1.384–5.466; P < 0.05). PFD remission occurred in 49 children, 33 (78.6%) in the PTNS with PFE group and 16 (38.1%) in the sham group (RR 2.063, 95% CI 1.360–3.128, P < 0.05). No adverse effects occurred. DISCUSSION: PTNS with PFE is a safe and effective method in the treatment of childhood constipation, particularly in children with PFD or dyssynergic defecation.

Background: Adolescent mood disorders (MD) have become an important public health problem worldwide. However, the psychopathological mechanisms underlying the occurrence of adolescent MD remain poorly elucidated. Therefore, in this study, we explored the mediating role of psychological resilience in the effects of rumination on depression in Chinese adolescents with MD.Methods: A total of 569 adolescent MD patients were included. Recruitment took place between October 2019 and June 2022. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. The 21-item Chinese version of the Ruminative Responses Scale (RRS) was used to assess rumination, and the 10-item Chinese version of the Connor-Davidson Resilience Scale (CD-RISC-10) was used to measure psychological resilience.Results: The prevalence of MD in adolescents with severe depressive symptoms (SDS) was 46.05%. The prevalence of SDS was much higher in females (50.75%) than in males (35.09%). The prevalence of SDS was much higher in adolescents with MD living with grandparents (56.25%) and living in single-parent families (61.36%) than in those living with parents (43.00%) and those having one parent who was away for a long time (40.00%). Adolescents with MD and also with SDS had higher levels of rumination and lower levels of psychological resilience than adolescents without SDS. Resilience partially mediated the relationship between rumination and depression.Conclusions: Lifestyle influences the severity of depressive symptoms in adolescents with MD. Rumination and psychological resilience were the risk and protective factors for SDS in adolescents with MD, respectively. Furthermore, resilience can reduce the impact of rumination on depressive symptoms, suggesting that clinical interventions to improve patients' resilience and reduce rumination may be a viable consideration for adolescents with MD.

The purpose of this study was to explore the relationship between loneliness and anxiety, and the mediating role of mobile phone addiction in this relationship, and whether this mediating role was moderated by gender among Chinese medical students. A cross-sectional study was conducted on March and April 2021 in Shenyang city of China. In total, 595 medical students were surveyed to complete an online questionnaire including demographic variables, mobile phone usage information, loneliness, mobile phone addiction, and anxiety, and 553 samples were effective for the final analyses. SPSS macro PROCESS was performed to test the mediating effect of mobile phone addiction and the moderating effect of gender. Our findings showed that loneliness was positively associated with anxiety, and mobile phone addiction was a partial mediator in this relationship. In addition, gender was found to moderate the indirect effect of loneliness on anxiety through mobile phone addiction. The effect of mobile phone addiction on anxiety was greater for boys than girls. This study illustrated that students with a higher level of loneliness would be more likely to develop anxiety directly and indirectly. Educational professionals should pay special attention to medical students who felt lonely or addicted to mobile phones, particularly boys.