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Emiliania huxleyi is the most prominent modern coccolithophore, a group of marine unicellular eukaryotes that play a critical role in ocean biogeochemistry. Coccolithoviruses are large double stranded DNA viruses, which is responsible for the demise of large oceanic blooms formed by E. huxleyi. E. huxleyi virus (EhVs) acquired a series of enzyme-coding genes predicted to be involved in the sphingolipid biosynthesis by horizontal gene transfer between virus-host. Currently, there is limited experimental validation identifying the functions of these genes in EhV. Genetic transformation of eukaryotic cells is a powerful tool to get an insight into gene functions of the studied organisms. Serine palmitoyltransferase (SPT) catalyzes the first committed step in de novo sphingolipid biosynthetic pathway. Here, a novel vector system for the transformation of E. huxleyi was designed. It contained fragments of promoter and terminator sequences of E. huxleyi endogenic fucoxanthin chlorophyll a/c-binding protein gene 'fcp' and harbored EhV-99B1 spt gene. The resultant recombinant transformation vectors pEhux-I-spt and pEhux-II were co-transferred into E. huxleyi BOF92 by electroporation. Transformants were obtained upon glufosinate-ammonium selection, and confirmed by Southern hybridization, genome PCR, qRT-PCR and Western blot screening of spt gene, which indicated that spt gene was integrated into the nuclear genome and was expressed at the mRNA and protein levels. The expression of the viral spt gene led to differences in lipid compositions analyzed using thin-layer chromatography (TLC). The results present the genetic transformation system for E. huxleyi, providing additional genetic resource with potential for exploring basic biological questions such as the virus-host interactions.

This prospective study was to describe the incidence and characteristics of physical activity-related injuries (PARI) among college students in southern China. Online questionnaires and telephone interviews were combined to investigate the physical activity (PA) participation and PARI occurrences every two weeks. Totally, 84 college students (men: 49; women: 35) with a mean age of 19.4 years completed the entire 1-year follow-up. Overall, 14250.3 PA exposure hours were collected and 36 PARI episodes were reported by 26 students, with an injury incidence density of 2.53 injuries per 1000 PA exposure hours and an injury risk of 0.43 injuries/student/year. July to September accounted for a highest proportion of injuries and half of the injuries happened in the evening. The majority of injuries occurred outdoors, happened in non-contact activities, were acute and involved the lower limbs, with sprains and strains being the primary injury types. Of all injuries, 80.6% resulted in PA withdrawal immediately and 58.3% led to absence from the next planned PA. No significant difference was found between men and women. This study reveals the problem of PARI among college students, which provides the direction for the prevention of PARI in this population.

This cross-sectional study aimed to describe the characteristics of physical activity-related injury (PARI) and to explore its associated factors among university students in Chaoshan district. Selected from the baseline survey in March and April, 434 students graded 1–3 from two universities were interviewed face-to-face in April and May 2017. Socio-demographics, physical activity (PA) participation, risk-taking behaviors, and PARI occurrences in the past 12 months were collected. Group Lasso logistic regression was applied to identify the risk factors of PARI. Totally, 317 PARI episodes were reported by 184 subjects with an overall injury risk of 0.73 injuries/student/year (males: 1.00, females: 0.63) and an injury incidence density of 0.81 injuries per 1000 PA exposure hours (males: 1.13, females: 0.69). Most injuries involved the lower extremities and were sprains and strains. Males, sports team members, and those with high-risk rebellious and anti-social behaviors were more likely to sustain PARI compared to their counterparts. Those who participated in vigorous-intensity PA with longer duration (particularly ≥ 150 min/week) were at a higher risk for PARI. This study indicates that PARI is a health concern among university students and great efforts should be taken to prevent them from PARI when promoting a physically active lifestyle.

The objective of this study was to determine the effectiveness of an intervention program based on Health-Related Behavior Theory (HRBT) in reducing physical activity-related injuries (PARIs) occurrence and individual risk-taking behaviors, as well as improving PA-related behaviors. A total of 1044 students from six junior middle schools in Shantou city were included and divided randomly into an intervention group (n = 550) and a control group (n = 494), respectively. The intervention group followed a prescribed PARIs intervention program based on HRBT, and the control group performed a common health education program, consisting of seven sessions and lasting seven months from May to November 2018. After the intervention, both groups showed a significantly lower prevalence of PARIs (intervention group: from 25.45% to 10.91%, control group: from 29.76% to 11.74%, both p < 0.05), but no significant between-group differences could be observed in the post-intervention PARIs prevalence (p > 0.05). Compared with the control group, students in the intervention group had a higher improvement in PA-related behaviors and a lower score of risk-taking behaviors (both p < 0.05). Thus, it could be concluded that the HRBT intervention program had a positive effect on PA-related and risk-taking behaviors in junior middle school students, though its effectiveness in reducing the occurrence of PARIs was not significant.

The catechol-O-methyltransferase (COMT) is a candidate gene to provide promising evidence of psychiatric disorders, but there is a knowledge gap between the genetic factor and multiple physical activity-related injuries (PARIs). The aim of this study was to explore the contribution of COMT to the risk of PARIs among university students in the Chinese Han population. We can further search for the intrinsic risk factors for the occurrence of multiple physical activity injuries and provide a scientific basis for early screening and precise intervention for the high-risk group of college students with multiple PARIs. A 1:1 matched case-control study of 61 PARIs cases and 61 healthy controls were carried out. DNA samples of the participants were isolated from saliva and genotyped on eight SNPs of the COMT gene (rs9265, rs4680, rs6269, rs4818, rs4633, rs165655, rs165656, and rs165722) using the MALDI-TOF MS method. We found that rs6269 and rs4818 were significantly associated with PARIs, and rs6269-GG and rs4818-GG contributed to the reduced risk of PARIs. Further haplotype analysis showed a four-marker C-G-C-G haplotype (rs165722-rs6269-rs4633-rs4818) acted with a protective role in the development of PARIs (p = 0.037, OR: 0.474, 95% CI: 0.269 to 0.834). However, the interactions between club membership and rs6269 or rs4818 would significantly increase the risk of PARIs (both p &lt, 0.001, OR: 5.121 and 4.977, respectively). This is the first study to find the contribution of COMT to PARIs occurrence, suggesting that the COMT polymorphisms and the gene–environment interactions may alter the risk of PARIs.

Background: The aim of this article is to elucidate the current situation of renal interventional therapy and discuss the indications for this treatment. Methods: A retrospective study was performed evaluating the electronic medical records of all patients with renal trauma admitted to two major comprehensive hospitals in Shantou city from January 2006 to December 2015. Results: There were 264 and 304 renal traumatic patients admitted to hospital A and B, respectively. low-grade renal trauma(LGRT) was the reason for presentation in the majority of patients (522, 91.9%). A total of 534 (94.0%) patients were treated conservatively. RAE was performed in 9 patients from 2012 to 2015 at hospital A, including in 6 patients (6/9, 66.7%) with LGRT, and 3 patients (3/9, 33.3%) with high-grade renal trauma (HGRT). No patient underwent interventional therapy (RAE) at hospital B during the same period. No significant differences in the operative rate of hospital A were observed between the two time periods (2006-2011 and 2012-2015). The operative rate for LGRT between the two hospitals from 2006 to 2011 and 2012 to 2015 was not significantly different. Hospital A showed a significant decrease in the rate of conservative treatment for patients with LGRT. In the univariate analyses, the American Association for the Surgery of Trauma (AAST) renal grade was significantly associated with undergoing RAE. Additionally, in the multivariate analysis, only the AAST renal grade (odds ratio [OR], 13.56; 95% confidence interval [CI], 2.91-63.06) was significantly associated with undergoing RAE. Conclusions: LGRT was present in the majority of patients, and most cases of renal trauma could be treated with conservative treatment. RAE was well utilized for the treatment of renal trauma. However, some patients with LGRT were treated with unnecessary interventional therapy.

Objective To report the incidence and mortality rates of oral and oropharyngeal cancer in Chinese population. Methods Data were taken from a population-based cancer registry collected by the National Central Cancer Registry of China (NCCRC) in 2015. The data collected from 501 local cancer registries in China were assessed using NCCRC screening methods and criteria. Incidence and mortality rates of oral and oropharyngeal cancer were stratified by age group, gender, and area. Age-standardized incidence and mortality rates were adjusted using the Chinese standard population in 2000 and Segi's world population. Results In 2015, it was estimated that there were 51,765 oral and oropharyngeal cancer incident cases and 23,830 deaths in China. The crude incidence rate of oral and oropharyngeal cancer was 3.77/100,000, and the age-standardized incidence rate by Chinese standard population and by Segi's world standard population were 2.55/100,000 and 2.49/100,000, respectively. The crude mortality rate and the age-standardized mortality rates by Chinese standard population and by Segi's world standard population were 1.73/100,000, 1.09/100,000 and 1.08/100,000, respectively. Both incidence and mortality rates of oral and oropharyngeal cancer were higher in males and in urban areas. Residents in eastern areas had the highest incidence and mortality rates, followed by those from middle areas and western areas. The rates of oral and oropharyngeal cancer increased greatly with age, especially after the age of 40 years. Conclusions This study reports the latest incidence and mortality rates of oral and oropharyngeal cancer in China. Prevention intervention including early detection, treatment, and regular follow-ups is encouraged to be set up to reduce incidence and mortality rates of oral and oropharyngeal cancer in the future.

Emiliania huxleyi (Coccolithophore) plays a prominent role in the global carbon cycle and in climate processes. The annual collapse of massive E. huxleyi blooms in the marine environment has been shown to be frequently linked to viral control. These host-virus interactions shape the evolution and dynamics of oceanic microscale ecosystems, yet we still understand little of the molecular mechanism of these virus-mediated processes. Here, we present a detailed characterization of the lipidome of E. huxleyi BOF92 strain, both of uninfected cells and those infected with its specific lytic virus EhV-99B1. Non-targeted lipidomics analysis was performed in order to evaluate the dynamic alterations underlying virus-induced metabolic remodeling. The host lipidome (both lipid content and composition) significantly changed in response to the viral infection. The most statistically significant differential lipids were screened as potential biomarkers for assessing E. huxleyi population sensitivity to EhV infection. Our results reveal that the remodeling of lipid metabolism that underlies the pathogenesis of this infection primarily involved sphingolipid, glycerolipid and fatty acid metabolic pathways. Our study provides insights into how viruses shape their hosts metabolism to support their unique life cycle and a lipid-based chemical arms race during host-virus dynamic interactions in a marine environment.

Knowledge gaps of the physical activity-related injury (PARI) problem among general undergraduates exist. We conducted a study in four universities, where 1421 students graded 1-3 were interviewed face-to-face during April and May after their completion of the baseline survey in March and April 2017, aiming to describe the incidence and characteristics of PARI. PARI experience and physical activity (PA) participation in the past 12 months were collected. Injury incidence density (IID) and risk, and injury characteristics were evaluated for the overall sample and by gender. Pearson chi-square or Fisher's exact tests and independent-sample t tests were used to test between-group differences. We found that 486 PARIs were reported totally by 289 participants, with an overall IID of 0.57 per 1000 hours of exposure (males: 1.07, females: 0.45) and an injury risk of 0.34 injuries/student/y (males: 0.52; females: 0.28). Higher IIDs were found in roller skating, football, and basketball. The majority of injuries occurred outdoors and involved the lower extremities, with sprain and strain being the primary injury types. Moreover, most injuries were new, acute, and happened in non-contact situations. Of all injuries, 52.1% required medical attention and 64.6% resulted in inactivity of one or more days. Some significant differences were observed between males and females. Our study indicates that PARI is a public health concern among Chinese university students, which can provide direction for targeted prophylactic interventions to underpin the sex-specific injury mechanism to reduce PARI.

ObjectivesData on the problem of physical activity-related injury (PARI) in university students and the risk factors for PARI among different genders are rare. We conducted a multicentre population-based study to investigate the occurrence of PARI and to explore the gender-specific risk factors for PARI among Chinese university students.DesignCross-sectional study.ParticipantsA total of 5341 students in grades 1–3 at eight universities in four Chinese cities were selected to complete the online questionnaires during March and April 2017. The questionnaires assessed sociodemographic characteristics, physical activity PA) involvement, sleep duration, sedentary behaviour and PARI experiences in the past 12 months.Main outcome measuresPARI during the past 12 months.ResultsAmong the 5341 participants, 1293 suffered from at least one PARI in the past 12 months, with an overall incidence rate of 24.2% (males: 26.2%, females: 23.2%) and an injury risk of 0.38 injuries/student/year (males: 0.48, females: 0.32). Over half of the injured (57.3%) experienced a withdrawal time of PA and nearly two-fifths (39.6%) required medical attention. Irrespective of gender, Shantou and Xi’an students, sports team members and those who engaged in sports and leisure-time vigorous-intensity PA (VPA) at a higher frequency were more likely to suffer from PARI. Male students who participated in sports and leisure-time VPA for long durations had a greater likelihood of sustaining PARI, while having a chronic condition and being involved in sports and leisure-time moderate-intensity PA at a higher frequency and longer duration were potential contributors to PARI among females.ConclusionsThe occurrence of PARI and its risk factors differed by gender, which provides a direction towards developing targeted and effective gender-specific preventative programmes to protect Chinese university students from PARI.

Aims To search for a set of reference genes for reliable gene expression analysis in the globally important marine coccolithophore Emiliania huxleyi-virus model system. Methods and results Fifteen housekeeping genes (CDKA, CYP15, EFG3, POLAI, RPL30, RPL13, SAMS, COX1, GPB1-2, HSP90, TUA, TUB, UBA1, CAM3 and GAPDH) were evaluated for their stability as potential reference genes for qRT-PCR using ΔCt, geNorm, NormFinder, Bestkeeper and RefFinder software. CDKA, TUA and TUB genes were tested as loading controls for Western blot in the same sample panel. Additionally, target genes associated with cell apoptosis, that is metacaspase genes, were applied to validate the selection of reference genes. The analysis results demonstrated that putative housekeeping genes exhibited significant variations in both mRNA and protein content during virus infection. After a comprehensive analysis with all the algorithms, CDKA and GAPDH were recommended as the most stable reference genes for E huxleyi virus (EhV) infection treatments. For Western blot, significant variation was seen for TUA and TUB, whereas CDKA was stably expressed, consistent with the results of qRT-PCR. Conclusions CDKA and GAPDH are the best choice for gene and protein expression analysis than the other candidate reference genes under EhV infection conditions. Significance and impact of the study The stable internal control genes identified in this work will help to improve the accuracy and reliability of gene expression analysis and gain insight into complex E. huxleyi-EhV interaction regulatory networks.

Child restraint system (CRS) is effective to protect child passenger safety in a motor vehicle crash. However, research on CRS is limited and the use rate of CRS is not high in China. We carried out a cross-sectional study to examine the use of CRS and its associated factors in Shenzhen. Via the method of cluster random sampling, parents who had at least one child aged 0 to 6 and owned a car from nine community health service centers and eight kindergartens were invited to complete the self-administered questionnaire during April and May 2014, including their knowledge of, attitude toward, and use behavior of CRS and socio-demographics. Multivariable logistic regression was used to explore the factors associated with CRS use. A total of 3768 parents participated in the survey, with a mean age of 33.94. Parents’ knowledge and attitude regarding CRS were fair, with the mean score of 3.07 and 3.33 out of 6, respectively, and only 22.8% of them used CRS for their child passengers. Children aged below 3 years, drivers owing expensive cars and wearing seatbelts, and parents with higher knowledge and attitude scores had greater likelihoods to use CRS. Moreover, trip frequency and distance were also significantly associated with CRS use. The findings indicate that the use rate of CRS is low in Shenzhen and parents have fair levels of knowledge and attitude regarding CRS use. Comprehensive public education programs and legislative interventions are urgently required to increase the use of CRS and ensure child passenger safety in Shenzhen

Lytic viral infection and programmed cell death (PCD) are thought to represent two distinct death mechanisms in phytoplankton, unicellular photoautotrophs that drift with ocean currents. PCD (apoptosis) is mainly brought about by the activation of caspases, a protease family with unique substrate selectivity. Here, we demonstrated that virus infection induced apoptosis of marine coccolithophorid Emiliania huxleyi BOF92 involving activation of metacaspase. E. huxleyi cells exhibited cell death process akin to that of apoptosis when exposed to virus infection. We observed typical hallmarks of apoptosis including cell shrinkage, associated nuclear morphological changes and DNA fragmentation. Immunoblotting revealed that antibody against human active-caspase-3 shared epitopes with a protein of ≈ 23 kDa; whose pattern of expression correlated with the onset of cell death. Moreover, analysis on two-dimensional gel electrophoresis revealed that two spots of active caspase-3 co-migrated with the different isoelectric points. Phosphatase treatment of cytosolic extracts containing active caspases-3 showed a mobility shift, suggesting that phosphorylated form of this enzyme might be present in the extracts. Computational prediction of phosphorylation sites based on the amino acid sequence of E. huxleyi metacaspase showed multiple phosphorylated sites for serine, threonine and tyrosine residues. This is the first report showing that phosphorylation modification of metacaspase in E. huxleyi might be required for certain biochemical and morphological changes during virus induced apoptosis.

Increase in physical activity (PA) might elevate risks for physical-activity-related injuries (PARIs). This study aimed to investigate the incidence rate and risk factors for PARIs among secondary school students in Hong Kong. All eligible students from three secondary schools were invited to participate in the study from November to December 2014. Information on PARI occurrences in the past 12 months, PA participation, and sociodemographics was collected. Multivariate and hierarchical logistic regression models were performed to estimate the risk of potential factors for PARIs. In total, 1916 students in forms 1&ndash, 6 (aged 14.3 &plusmn, 1.7 years) completed valid questionnaires, with an overall yearly PARI incidence rate of 32.1% (boys: 34.3%, girls: 29.3%). There were sex differences in the risk factors identified, except that family size was associated with PARIs for all participants. Longer duration and higher intensity of PA increased the risk for PARI occurrences in both sexes. In conclusion, PARIs were prevalent among secondary school students in Hong Kong, and different sexes had different PARI incidence rates and were influenced by different risk factors. There is an urgent call for effective sex-specific interventions to prevent PARIs in this population.

ObjectivesThis study aimed to investigate the epidemiological characteristics and preliminarily explore possible risk factors of physical activity-related injury (PARI) occurrences among Chinese university students via a multicentre mixed survey.DesignCross-sectional study.ParticipantsA total of 4758 undergraduates graded 1–3 in nine universities in three Chinese cities were enrolled via cluster random sampling and completed the self-administered online questionnaires during March and April 2017.Main outcome measuresPARI in the past 12 months.ResultsOf the 4758 participants, 1081 sustained PARI in the past 12 months, with an overall PARI incidence rate of 22.7% (27.3% (367/1343) in males and 20.9%(714/3415) in females). Around one-quarter of the injured (26.4%) suffered from PARI over at least three episodes. More than half of the injured subjects experienced physical activity (PA) absenteeism and sought medical attention. All PA indicators were significantly and positively associated with PARI, with a frequency of sports and leisure-time vigorous-intensity PA (VPA) participation being the strongest (adjusted OR: 1.079, 95% CI: 1.018 to 1.144). Moreover, males (OR=1.199), Shantou students (OR=4.239), year 1 students (OR=1.287), university and other sports team members (OR=1.717–2.360) and those with insufficient sleep time (OR=1.262–1.333) were also at a higher risk of PARI.ConclusionsPARI is prevalent among university students in China. The frequency of sports and leisure-time VPA participation was most strongly associated with PARI among all PA indicators. These data can inform future programmes for injury intervention among university students. Safety issues should also be emphasised when promoting PA among the public to reduce PARI.

Background In China, university students might be more physically active as their release from heavy academic burdens for college admission and independence from parents, resulting in their frequent engagement in relatively risky activities without parents’ supervision. Correspondingly, an increment of physical activity-related injury (PARI) can be expected. Objective This study, funded by the National Natural Science Foundation of China (No. 31640038), was designed to investigate the epidemic and explore risk factors of PARI among Chinese university students via a multi-center survey. Methods By the method of cluster sampling, students graded 1–3 from eight universities in four Chinese cities (namely Shantou [Guangdong], Jinan [Shandong], Xi’an [Shanxi] and Nanchang [Jiangxi]) were selected and invited to complete the online questionnaire during March and April, 2017. The questionnaire was comprised of basic characteristics, physical activity (PA) involvement, sleep duration, and PARI episodes happened in the past 12 months. The multivariate logistic regression was used to estimate risk factors for PARI. Findings Of 5341 participants, 1293 suffered from PARI in the past 12 months, with an overall rate of 24.2% (males: 26.2%, females: 23.2%). More than one fifth of the injured (22.9%) sustained PARI at least three episodes. Over half of the injured (57.3%) experienced a withdrawal time of PA and nearly two fifth (39.6%) received medical treatment owing to PARI. Frequent PA participation, including vigorous-intensity and moderate-intensity, with longer duration would elevate risk for injury. Males, sports team members, and those with diagnosed chronic conditions were also at higher risks. Conclusion and policy implications PARI was prevalent among Chinese university students. Being physically active would increase risk for injury. The above data provide insights that focused and effective injury-intervention approaches should be implemented in university students. Safety issues should also be emphasized when promoting PA to the public to reduce PARI occurrence.

Background University students might be relatively physically active and tend to experience physical activity-related injury (PARI) under the current global campaign to promote physical activity (PA). However, scarce is known about the problem of PARI and its associated factors amongst university students thought it has been firmly appreciated for children and adolescents. Objective This study, supported by the National Natural Science Foundation of China (No. 31640038), aimed to explore the characteristics of PARI and its risk factors among university students in two Chinese cities (namely Shantou, Guangdong and Jinan, Shandong). Methods A cross-sectional study was conducted in four universities, where 1421 students Year 1–3 were selected randomly and invited to complete the questionnaires during April and May via the one-on-one investigation after their completion of the baseline survey in March and April, 2017. Information of socio-demographics, PA involvement, risk-taking behaviors, and PARI experience in the past 12 months and its related characteristics were collected. The group Lasso and multivariate logistic regression were performed to identify risk factors for PARI. Findings Totally, 486 PARIs were reported by 289 students, with an overall incidence rate of 0.82 injuries/1000 exposure hours of PA participation. Most injuries involved the lower extremities, were newly occurring and medically treated injuries, occurred in outdoor PA (skating, football and basketball particularly) and non-contact situations, with sprain and strain being the major injury types. Over half of the injured (52.1%) experienced an inactivity period of 2 days or above. Significant differences were seen between males and females. PARI was associated with city, gender, study year, club membership, higher vigorous-intensity PA (VPA) volume, and antisocial behaviors. Conclusion and policy implications The above data reinforce the necessary of implementing conditioning and practical programs to underpin the injury mechanism to prevent university students from PARI and maximize the benefits of PA.

Physical activity (PA) promotion is beneficial to gain and maintain optimal health, but might increase risks for physical activity-related injury (PARI). This cross-sectional study aimed to investigate the incidence rate and identify risk factors of PARI among Chinese middle school students. Selected via the method of cluster random sampling, students graded 7&ndash, 8 (junior) and 10&ndash, 11 (senior) from five middle schools (aged from 10 to 18 years old) in Shantou were invited to participate in the survey. Information on socio-demography, PA involvement, sleep duration, individual safety awareness and exercise behavior, and PARI experiences in the past 12 month was collected. Multivariate logistic regression model was performed to estimate the risk factors of PARI. A total of 3082 participants completed the valid questionnaires, with an overall incidence rate of 25.1%. Boys, junior school students, sports team members, and those with lower safety awareness, living with single parent, and without any chronic conditions were at higher risks for PARI. Moreover, exercising on wet floor or with illness frequently would also be more likely to experience injury, especially those with at least 120 min per day. In conclusion, PARI was prevalent among middle school students in southern China. The above data provide insights that were focused and effective actions should be taken to prevent school-aged adolescents from PARI and maximize the benefits of PA.

This cross-sectional study was carried out to explore the potential risk factors of physical activity-related injuries (PARI) among middle-school students of different genders. Selected by the random cluster sampling method, students aged from 12 to 16 years old in grades 7&ndash, 8 from six middle schools in Shantou, southern China, were recruited for this investigation in November 2017. Information about socio-demographics, physical activity (PA) exposure time, individual exercise behaviors, risk-taking behaviors, and PARI experiences in the past 12 months was collected. A multivariate logistic regression model was used to explore the risk factors of PARI. A total of 1270 students completed valid questionnaires, with an overall injury incidence of 33.6% (boys: 42.0%, girls: 25.0%), an injury risk of 0.68 injuries/student/year, and an injury rate of 1.43 injuries per 1000 PA exposure hours. For boys, living in a school dormitory, participating in sports teams, exercising on a wet floor, rebellious behavior, and having longer PA exposure time were the risk factors of PARI. For girls, those who were sports team members, whose parents were divorced or separated, and those with longer PA exposure time were more vulnerable to suffer from PARI. In conclusion, PARI was a health problem among middle school students in southern China. Boys and girls differed in PARI occurrence and were affected by different risk factors, which provides a basis for targeted gender-specific intervention programs to reduce the occurrence of PARI among middle-school students.