Objective To evaluate the clinical efficacy of four different methods of laparoscopic hysterectomy: laparoscopic supracervical hysterectomy(LSH),classic intrafascial supracervical hysterectomy(CISH),laparoscopic-assisted vaginal hysterectomy(LAVH),and total laparoscopic hysterectomy(TLH). Methods A retrospective analysis was carried out on 740 cases of laparoscopic hysterectomy in this hospital from January 1999 to December 2004 in respect of operating time,intraoperative blood loss,weight of removed uterus,postoperative recovery,time to normal sexual life,sexual satisfaction,and incidence of complications. Results The operations were accomplished under laparoscope in all the 740 cases.The operating time of LSH,CISH,TLH,and LAVH were 95.3?32.4 min,84.5?31.7 min,105.3?34.5 min,and 169.4?37.4 min,respectively.The time to normal sexual life of LSH,CISH,TLH,and LAVH were 30?5 d,50?9 d,35?7 d,and 54?11 d,respectively.The incidences of complications of LSH,CISH,TLH,and LAVH were 1.7%(2/120),1.3%(4/310),2.8%(7/250),and 1.7%(1/60),respectively. Conclusions Laparoscopic hysterectomy is safe and reliable.Of four methods of laparoscopic hysterectomy,each has its advantages and disadvantages,and method selection should be based on patient's own conditions.

Objective: To investigate the awareness of human papillomavirus (HPV) vaccine knowledge among women in Hainan Province and the willingness to receive HPV vaccination among women and their daughters, so as to provide insights into HPV vaccine promotion and cervical cancer control. Methods: Women aged 20 to 64 years who participated in the cervical cancer screening program in Hainan Province from July 2021 to February 2022 were enrolled, and participants' demographics, awareness of knowledge about HPV vaccine, and willingness to receive HPV vaccination among themselves and their daughters using a questionnaire survey. The factors affecting willingness to receive HPV vaccination were identified using a multivariable logistic regression model. Results: A total of 4 300 questionnaires were allocated and 4 023 valid questionnaires were recovered, with an effective recovery rate of 93.56%. The respondents had a mean age of (35.52±6.48) years, and their daughters had a mean age of (8.93±4.83) years. There were 826 participants knowing HPV vaccine-related knowledge, with an awareness rate of 20.35%. The proportions of willingness to receive HPV vaccination were 75.07% among respondents and 71.36% among their daughters. Multivariable logistic regression analysis identified age (20 to <30 years, OR=1.474, 95%CI: 1.167-1.862; 30 to <40 years, OR=1.455, 95%CI: 1.199-1.765), urban-registered residence (OR=1.251, 95%CI: 1.016-1.541), monthly household income (3 000 to <5 000 Yuan, OR=1.568, 95%CI: 1.314-1.873; 5 000 Yuan and more, OR=1.231, 95%CI: 1.014-1.496), affordable fees for a single dose of HPV vaccination (100 to <500 Yuan, OR=1.358, 95%CI: 1.159-1.590; 500 Yuan and higher, OR=1.609, 95%CI: 1.188-2.180), and awareness of HPV vaccine-related knowledge (OR=4.473, 95%CI: 3.416-5.855) as factors affecting respondents' willingness to receive HPV vaccination, and participation in New Rural Cooperative Medical Insurance (OR=1.652, 95%CI: 1.087-2.511), affordable fees for a single dose of HPV vaccination (100 to <500 Yuan, OR=1.905, 95%CI: 1.633-2.221; 500 Yuan and higher, OR=1.683, 95%CI: 1.275-2.223), awareness of HPV vaccine-related knowledge (OR=3.625, 95%CI: 2.847-4.615), daughter's active request for HPV vaccination (OR=1.695, 95%CI: 1.293-2.222), and frequency of sexual health education for daughters (frequently, OR=2.142, 95%CI: 1.789-2.564; occasionally, OR=1.707, 95%CI: 1.416-2.059) as factors affecting the willingness to receive HPV vaccination among respondents' daughters. Conclusions The awareness of HPV vaccine-related knowledge is low among women aged 20 to 64 years in Hainan Province, and the women's and their daughters' willingness to receive HPV vaccination is associated with age, household registration, economic level, price of HPV vaccine and awareness of HPV vaccine-related knowledge.

Abstract： Objective　To establish a screening-diagnosis-evaluation system of neonatal congenital heart disease (CHD) suitable for Hainan Province based on the application of percutaneous blood oxygen saturation measurement and cardiac auscultation screening, and to provide a basis for further promotion of the evaluation effect. Methods　Screening agencies (all midwifery institutions) used the "double index method" to screen newborns for congenital heart disease. Those who were screened positive for any index were transferred to diagnostic institutions (the people's hospitals of all cities and counties and some tertiary hospitals) for echocardiography examination within 1 week. Those with abnormal results were transferred to the treatment institution (two tertiary hospitals) for reconfirmation and evaluation. All data were managed online. Results　In this study, 96 913 newborns born in midwifery institutions in 19 cities and counties were screened, with a response rate of 99.44%. The ratio of male infants (50 836) to female infants (46 077) was 1.10∶1. A total of 2 284 positive patients were screened by dual index method, and ultrasound diagnosis was performed, with the rate of cardiac ultrasonography of 98.07% (2 240/2 284) and a high response rate. A total of 238 cases of congenital heart disease were diagnosed (incidence rate of 0.25%), with the top three main types were ventricular septal defect, atrial septal defect, and patent ductus arteriosus. The sensitivity (88.24%) and Youden index (0.86) of dual-indicator screening for CHD detection were significantly higher than the other separate indicators. Through Kappa consistency test analysis, the consistency of dual-indicator screening with simple heart murmur screening results was excellent, with a Kappa coefficient value of 0.835 (>0.75); the consistency of dual-indicator screening and simple POX screening results was good, with a Kappa coefficient value of 0.429 (between 0.40-0.75), and the differences were statistically significant (P<0.001). By the end of the study, 136 children had undergone open-chest/occlusion surgery, with good postoperative recovery, and the rest were followed up. Conclusions　The neonatal CHD screening-diagnosis-assessment technology system established in this study, with close connections between various blocks, high screening response rate and echocardiography examination rate, is beneficial for the early diagnosis and treatment of CHD children, and has certain application value in institutions at all levels in Hainan Province, and is worth further promotion.

Objective To explore the digital tomosynthesis(DTS)technology application value in children with atlanto-axial joint subluxation inspection.Methods 30 children with torticollis after injury,head and neck activities obstacles or local pain were selected.The consent of patient and family was obtained.At the same time the atlanto-axial joint open mouth,cervical lateral radiographies and DTS scanning were performed,two imaging quality and the diagnosis were compared.Results In all 30 cases,excellent imaging rate was 90% (27/30)on DTS and 53% (1 6/30)on DR respectively.On DTS atlanto-axial sublution were found in 22 cases but on DR atlanto-axial sublution were diagnosed in only 12 cases,suspicious subluxation in 4 cases,and misdiagnosis in 6 cases.Conclusion For diagnosis of atlanto-axial joint subluxation in children,DTS can obtain high quality images,clearly display anatomic structures and pathological morphology of atlanto-axial joint.

Objective: To investigate the screen exposure status and influencing factors among 6-12 year-old children in Hainan Province, so as to provide insights into screen exposure intervention for children. Methods: Children aged 6-12 years from 18 counties (cities) in Hainan Province were selected using multi-stage stratified cluster sampling method from December 2020 to July 2021. Demographic information, parents' educational level, family type and screen time was collected using questionnaire surveys. The screen exposure rate of children was analyzed, and factors affecting screen exposure were identified using a multivariable logistic regression model. Results: A total of 27 501 children were surveyed, including 13 901 boys (50.55%) and 13 600 girls (49.45%). The mean age was (9.22±1.86) years. Among them, 3 925 children had screen exposure, with a screen exposure rate of 14.27%. Multivariable logistic regression analysis showed that gender (female, OR=0.859, 95%CI: 0.796-0.926), age (OR=1.078, 95%CI: 1.049-1.108), ethnicity (ethnic minorities, OR=1.147, 95%CI: 1.041-1.254), place of residence (rural area, OR=0.869, 95%CI: 0.801-0.944), father's educational level (high school or technical secondary school, OR=0.879, 95%CI: 0.788-0.981; college degree or above, OR=0.686, 95%CI: 0.589-0.818), mother's educational level (college degree or above, OR=0.706, 95%CI: 0.588-0.846), family type (others, OR=1.250, 95%CI: 1.105-1.414), and annual family income (>100 000 Yuan, OR=0.741, 95%CI: 0.619-0.885) were the influencing factors for screen exposure among children aged 6-12 years. Conclusion The screen exposure among children aged 6-12 years in Hainan Province was affected by gender, age, ethnicity, place of residence, parental education level, family type and annual family income.

Abstract: Objective To explore the trend of maternal mortality in Hainan Province during the period of 2003-2022, both in the province and in urban and rural areas, and to forecast the maternal mortality rate for the period 2023-2025. Methods The 2003-2022 data collected from Hainan Province's three-tier network for maternal mortality surveillance was examined using the Chi-square test for trend (CMH) to analyze the province-wide and urban-rural maternal mortality trends. The time series model forecasting using exponential smoothing was used to predict the maternal mortality rate in Hainan Province from 2023 to 2025. Results　From 2003 to 2022, a total of 201 011 616 live births and 463 maternal deaths were reported in Hainan Province, with a maternal mortality rate of 23.03 per 100 000. Over 20 years, the maternal mortality rate in Hainan Province showed a downward trend, with an annual rate of decline of -4.13%. The rate decreased significantly during this period.. From 2003 to 2022, the maternal mortality rate in rural areas of Hainan Province was 25.74/100 000 (373/1 448 943), and it was significantly higher than that in urban areas, 16.04/100 000 (90/561 173). In the first 10 years, the gap between urban and rural areas progressively reduced, but it widened significantly in the last decade, especially after 2017. The maternal mortality rate was significantly lower in urban than rural areas, and the differences had statistical significance. The annual rates of decline in maternal mortality in Hainan Province and in urban and rural areas from 2003 to 2022 were -5.0% and -3.71%, respectively, showing a negative growth with the decrease rate in rural areas lower than urban areas. The maternal mortality rate in Hainan Province showed a fluctuating downward trend, different from the stable trend of national decrease. The mortality rates for direct obstetric causes of death (233 cases) and indirect obstetric causes of death (230 cases) were 11.59/100 000 and 11.44/100 000, respectively. The results of the maternal mortality review showed a predominance of avoidable deaths (315 cases, 68.03%). Brown's cubic exponential smoothing predicted the maternal mortality rate in Hainan Province for 2023-2025 as 9.45/100 000, 8.17/100 000, and 6.89/100 000. Conclusions　The maternal mortality rate in Hainan Province is largely influenced by maternal deaths in rural areas, and maternal health care in rural areas should be emphasized. Measures such as intervening to address the main factors influencing avoidable maternal deaths, strengthening high-risk maternal management, improving the level of critical maternal care, and providing subsidies for critical maternal care can sustainably reduce the maternal mortality rate in Hainan.

Objective:To observe the effect of ankle stretching on ankle biomechanics, balance, walking ability and ability in the activities of daily living among stroke survivors.Methods:Eighteen hemiplegic stroke survivors were randomly divided into an experimental group ( n=9) and a control group ( n=9). In addition to routine medication and rehabilitation training, the experimental group received 20 minutes of ankle joint stretching daily while the control group underwent an additional twenty minutes of routine rehabilitation training. Before and after the treatment, both groups′ ankle joint stiffness (K), muscle strength, active range of motion (AROM) and passive range of motion (PROM) were evaluated. They were also assessed using the modified Ashworth scale (MAS), the Fugl-Meyer lower extremity assessment (FMA-LE), the Berg balance scale (BBS), the 6-minute walking test (6MWT) and the modified Barthel Index (MBI). Results:After two weeks of treatment significant improvement was observed in the AROM and muscle strength of both groups in dorsiflexion and plantarflexion. The average BBS and FMA-LE scores of both groups had also improved significantly. Significant improvement in the average PROM of plantarflexion and the K of dorsiflexion, as well as in average MBI score was observed only in the treatment group. After two weeks the treatment group′s average muscle strength in plantarflexion and dorsiflexion was significantly better than the control group′s.Conclusions:Stretching can reduce ankle stiffness, improve the range of motion, muscle strength, and ability of in the activities of daily living after a stroke.

Abstract: Objective　To evaluate the free thalassaemia screening programme for preconception and pregnancy in Hainan Province, and to provide a theoretical basis for optimizing the screening process for thalassaemia. Methods From November 2020 to July 2021, a survey was conducted on 10 396 adults with Hainan household registration who participated in the Epidemiological Survey of Thalassemia in Hainan Residents in 19 cities and counties of Hainan Province. All of them underwent routine blood tests, haemoglobin electrophoresis tests and genetic tests for thalassaemia. The optimal diagnostic cut-off values for mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and haemoglobin adult type 2 (HbA2) were determined using screening test indexes such as receiver operating characteristic curve and sensitivity. The diagnostic effectiveness of different primary screening programs for thalassemia gene carriers was evaluated. Results Using the existing MCV single-indicator thalassemia primary screening protocol in Hainan Province, where individuals with MCV<82 fL undergo thalassemia gene testing, resulted in a high missed diagnosis rate (34.06%) and low sensitivity (65.94%). The optimal cut-off values for MCV screening for alpha-and beta-thalassaemia were 84.45 fL and 79.05 fL, respectively; the optimal cut-off values for MCH screening for alpha-and beta-thalassaemia were 27.95 pg and 25.15 pg, respectively. The optimal cut-off value for HbA2 screening for alpha-thalassaemia was less than 2.55% and greater than 3.35% for beta-thalassaemia. The "combined HbA2 or MCH or MCV screening protocol" with the cut-off values recommended in this study had a better performance in primary screening for thalassemia, with the highest sensitivity (92.96%) and negative predictive value (92.67%) and the lowest underdiagnosis rate (7.04%), statistically significant differences compared with the existing protocol (P<0.05). Conclusions The current process of screening for thalassemia in Hainan Province may lead to missed diagnoses. The combined use of MCV, MCH and HbA2 for thalassemia screening, adopting locally suitable cutoff values for primary screening indicators, can improve the incidence of missed reporting of thalassemia and enhance diagnostic effectiveness.

Objective To study the value of MSCT in the diagnosis of neonatal type (Ⅲ) congenital esophageal atresia.Methods MSCT data of 25 cases with neonatal type (Ⅲ) congenital esophageal atresia confirmed by surgery and pathology were analyzed retrospectively.The full preparation before examination and the image post-processing function were checked,and MSCT data were compared with the findings of surgery.Results By full preparation and application of M PR,SSD technology after scanning,the esophageal proximal blind end,and the distance between the two esophageal blind ends were clearly displayed,furthermore,the opening position,morphology and diameter of the distal tracheoesophageal fistula were also showed,and bronchial tree morphology and inflammation in the lung can be visible.Conclusion MSCT full preparation and application of image post processing function are potential to the clinical diagnosis of congenital esophageal atresia and tracheoesophageal fistula.

To evaluate the value of two histological quantitative methods of hepatic fibrosis: semiquantative scoring system (SSS) and image analysis by computer. The prophylactic and therapeutic effect of Ganzhifu on hepatic fibrosis induced by CCl4 were studied on a total 73 of specimens from liver tissue of rats. All specimen were analyzed quantatively by two methods of SSS marks and image analysis respectively. Difference between groups was compared and hydroxyproline (Hyp) content of each liver tissue was examined. Correlation analysis was done between SSS marks, image analysis and Hyp content. Both prophylactic and therapeutic study showed the same information. Results of SSS marks, image analysis and Hyp content were coincidence. It suggest that both SSS marks and image analysis were interrelated well with Hyp content (P < 0.01). The result suggests that both SSS marks of hepatic fibrosis and image analysis by computer can be taken as reliable histological quantitative method of hepatic fibrosis.
Animals ; Carbon Tetrachloride ; Carbon Tetrachloride Poisoning ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hydroxyproline ; analysis ; Image Processing, Computer-Assisted ; Liver ; chemistry ; pathology ; Liver Cirrhosis, Experimental ; chemically induced ; drug therapy ; pathology ; Male ; Phytotherapy ; Rats ; Rats, Wistar