Objective To define the peroneal nerve’ s safety zone and study its clinical value in treatment of MIPPO for proximal tibia fracture. Methods The peroneal nerve’ s safety zone was defined according to dead body anatomy. Patients with proximal tibia fracture were divided into traditional therapy group ( control group) and peroneal nerve’ s safety zone therapy ( observation group) . The curative effects and complications were compared. Results The peroneal nerve’s safety zone of R1 was (45. 30 ± 1. 55) mm,R2 was (45. 61 ± 1. 40) mm,R3 was(45. 42 ± 1. 62) mm,angle A was(33 ± 2. 1)°,angle B was(97 ± 2. 3)°. The operating time,bleeding volume,hospitalization time and fracture time in observation group were significantly lower than those in the control group,but there was no siginificant difference in post-ther-apy infection,delayed healing and other complications. Conclusion The curative effects according to peroneal nerve’ s safety zone are better than traditional MIPPO in proximal tibia fracture.

Objective To study the clinical value of rapid prototyping oriented template for total hip replacement in patients with adult developmental dysplasia of the hip .Methods Totally 51 cases with adult developmental dysplasia of the hip who were admitted into our hos -pital from January 2014 to March 2015 were randomly divided into the observation group and the control group .The observation group were treated by total hip arthroplasty assisted with rapid prototyping oriented template , while the control group were treated with traditional surgical method for total hip replacement.The curative effect, operation time, amount of bleeding, hospitalization time and satisfaction rate were compared between the two groups .Results The operation time , intraoperative blood loss and length of hospital stay of the observation group were significantly lower than those in the control group , and the differences were statistically significant (P<0.01).The Harris hip function score and satisfaction rate of the observation group were significantly higher than those in the control group with statistically significant differ -ences (P<0.05).Conclusion Total hip arthroplasty assisted with rapid prototyping oriented template could shorten the operation time , re-duce the intraoperative blood loss , cut down the hospitalization time , quicken the hip joint function recovery , and improve the satisfaction rate of patients .

Objective To investigate the effects of dexmedetomidine continuous intravenous infusion on the hemodynamic response of ephedrine and the recovery process of patients undergoing neck surgery under general anesthesia.Methods Select elective fitting line surgery under general anesthesia of 100 patients with cervical disease from January 2015 to December 2015 in the First People's Hospital of Yongkang,randomly divided into low dose group and high dose group, 50 cases in each group, before induction of anesthesia, patients received continuous intravenous pumping of dexmedetomidine 0.4μg/kg in low dose group or 0.8μg/kg in high dose group,after ten mins 0.4μg/kg prior to anesthesia induction,until the end of operation withdrawal;5 min after laryngeal mask insertion, ephedrine 0.1 mg/kg were intravenous administered in two groups.Observe the following indicators:the after entering the operation room ( T0 ) , anesthesia before induction ( T1 ) , after induction ( T2 ) , administration of ephedrine ( T3 ) , the maximum value time(TBP,THR) of heart rate and blood pressure in 10 minutes.Increased of HR,SBP,DBP,recovery related indicators.Results HR, SBP and DBP levels compared no significant difference of T0 with two groups,T1, T2 and T3,HR,SBP, DBP were lower than T0 with two groups(P<0.05),high dose group were lower than low dose group of HR, SBP, DBP(P <0.05);TBP and THR no significant difference of two groups,high dose group were higher than low dose group of Increased of HR,SBP,DBP(P<0.05);high dose group were lower than low dose group of after extubation cough score and sedation agitation score(P<0.05).Spontaneous breathing recovery time and extubation time, called the open time, orientation recovery time,the difference between the two groups was not statistically significant.Conclusion 0.8μg/kg dexmedetomidine continuous intravenous injection of ephedrine in patients with neck pressor effect stronger than the 0.4μg/kg,0.8μg/kg compared with 0.4μg/kg can reduce the recovery period of cough and restlessness,different doses had no effect on recovery.

Objective:To investigate cancer mortality in Zhejiang cancer registration areas from 2010 to 2014. Methods:Cancer regis-tration data were collected from 14 cancer registries of Zhejiang province. The number of cases, crude rates, proportions, age stan-dardized rates, cumulative rates, cut rates, age-specific rates, top 10 mortality ranks, and annual percentage change (APC) of cancer mortality were calculated. Results:A total of 108,514 cancer deaths in Zhejiang cancer registration areas from 2010 to 2014, including 70,578 males and 37,936 females, were recorded. The crude mortality rate was 186.06/105. The standardized mortality rates in Chi-nese (ASMRC) and world populations were 103.02/105 and 101.73/105, respectively. The cumulative mortality rate (0-74 years old) was 11.46%. The ratio of ASMRC in male and female was 1.95, and that in urban and rural areas was 0.93. Age-specific cancer mortality in-creased significantly after 40 years old and peaked at the 85+age group. The crude cancer mortality increased from 2010 (182.85/105) to 2014 (191.00/105) by 4.46%. After age standardization, the mortality rate standardized by Chinese population was reduced from 107.85/105 to 100.60/105. The APC of ASMRC was-1.96%(P=0.017). The top three mortality cancers were lung cancer, liver cancer and gastric cancer. The top 10 cancers accounted for 89.51%of all cancer deaths. The mortality rates in different age groups were inconsis-tent. Leukemia was the main cancer type among 0~14-year-old population. Liver cancer was the most common cancer type in 15~44-year-old population. Lung cancer was the main cancer in population above 45 years old. The ASMRCs of liver cancer, gastric cancer and esophageal cancer decreased, whereas those of pancreatic cancer, prostate cancer and ovarian cancer increased. Conclusion:Can-cer mortality in Zhejiang cancer registration areas increased, which revealed that the number of cancer deaths will continue to in-crease. However, the ASMRC decreased, which indicated that cancer prevention in Zhejiang province had achieved certain effects. Fur-ther measurements, such as health education, cancer screening, and early detection and treatment, should be improved to reduce the danger of cancer.

Objective: To investigate the current awareness of core knowledge about cancer prevention and its influencing factors among residents in Zhejiang Province, in order to provide a reference for formulating provincial health education strategies of cancer prevention. Methods : From November 2019 to October 2020, the permanent residents aged 18-74 years in Zhejiang Province were selected using multi-stage stratified sampling method. A questionnaire was designed according to Core Information and Knowledge on Cancer Prevention to collect general information, health status, and awareness of core knowledge about cancer prevention. The multivariate logistic regression model was used to analyze the influencing factors. Results: Among 6 974 valid respondents, 3 139 ( 45.01% ) were males and 3 835 ( 54.99% ) were females. The overall awareness rate of core knowledge about cancer prevention was 74.66%; the awareness rates of basic knowledge, risk factors and primary prevention, screening and early diagnosis as well as treatment and rehabilitation were 79.08%, 80.83%, 76.08% and 82.99%, respectively. The multivariate logistic regression analysis showed that the residents who were in rural areas ( OR=0.659, 95%CI: 0.585-0.743 ), ≥45 years old ( OR: 0.794-0.801, 95%CI: 0.655-0.981 ) and with obesity (OR=0.531, 95%CI: 0.436-0.647) had lower awareness rates, while the residents who were with an educational level of junior high school/technical school/senior high school or above ( OR: 1.390-4.361, 95%CI: 1.208-5.600 ), married (OR=1.414, 95%CI: 1.142-1.752), administrative/technical personnel ( OR=2.602, 95%CI: 2.005-3.377 ), service staff/private business owners ( OR=1.368, 95%CI: 1.111-1.684), retired ( OR=1.345, 95%CI: 1.105-1.639 ) and others ( OR=1.542, 95%CI: 1.295-1.838 ), and with experience of cancer screening or examination ( OR=1.267, 95%CI: 1.123-1.428 ) had higher awareness rates. Conclusions The awareness rate of core knowledge about cancer prevention in Zhejiang Province is 74.66%. Health education for the residents aged ≥45 years, living in rural areas, having low educational levels, and having obesity should be

BACKGROUND: Traditional open surgery will do great damage to the patients with thoracolumbar fractures, and easily induces local degeneration. In contrast, the novel method is minimally invasive, which contributes to the functional recovery of the spine.OBJECTIVE: To discuss the essential procedures and precautions in the treatment of thoracolumbar fractures with percutaneous pedicle screw fixation.METHODS: Twenty-seven cases of single-level thoracolumbar fractures without spinal neurological deficits treated with percutaneous pedicle screw fixation were selected. The operation time and intraoperative blood loss were observed. The Visual Analogue Scale scores during axial turning at baseline and 3 days postoperatively, and the Visual Analogue Scale scores of the operation region at 1 and 3 days postoperatively were detected, respectively.RESULTS AND CONCLUSION: (1) Twenty-seven patients with 108 vertebrae underwent percutaneous pedicle screw fixation under the guidance of the needle, the puncture was smooth, 98 vertebrae was punctured successfully once, and 10 vertebrae were punctured successfully twice. (2) The Visual Analogue Scale scores during axial turning at 3 days postoperatively were significantly lower than those at baseline, and the scores of the operation region at 3 days postoperatively were significantly lower than those at 1 day postoperatively (P < 0.001). (3) The mean operation time was (109±18) minutes, and the mean intraoperative blood loss was (60±16) mL. (4) There were no nerve root injury and other complications. (5) Our results indicate that percutaneou pedicle screw fixation is a minimally invasive and safe method to treat the patients suffering single-level thoracolumbar fractures without spinal neurological deficits.

Objective To investigate the effects of dexmedetomidine combined with sevoflurane on elderly patients with postoperative recovery quality.Methods Selected 60 cases of abdominal rectal cancer resection for elderly patients,which were ASA I or II,were randomly divided into two groups by a random number table method, while each groupincluded 30 cases:the control group( group N) and the dexmedetomidine group( group D) .Before the induction of anesthesia,group D vein was injected with micro pump ( more than 10 min) of dexmedetomidine 1μg/kg ( which was formulated with physiological saline as 4μg/mL) ,and then was given to maintain the dexmedetomidine 0.5μg/h and N group was injected with micro pump of the same volume of normal saline.The two groups of anesthesia were same,by which the static inhalation of composite general anesthesia.Observation were recorded before induction of anesthesia(T0),given dexmedetomidine(TI),after intubation 1 min(T1),5 min(T2),drawing tube immediately (T3),extubation after 5min(T4),30min(T5)the time of HR,BP,SpO2,BIS;propofol and remifentanil dosage,opera-tive time,operation time,a nesthesia time,recovery time,drawing tube time,extubation after Ramsay Sedation score, pain score,patient satisfaction and adverse reactions were recorded.Results In T3 period,the changes of HR (82 ± 14)times/min,SBP (130 ±8)mmHg,DBP (85 ±13)mmHg in group N were more obvious than (70 ±12)timse/min, SBP (121 ±7)mmHg,DBP (79 ±9)mmHg in group D,the difference between the two groups had statistical signifi-cance(t=6.28,4.63,2.08,all P<0.05).In T5 period,the levels of blood glucose (5.3 ±1.1)mmol/L and cortisol (402 ±78) nmol/L and ( 0.260 ±0.044 ) ng/L in group D were significantly lower than ( 5.9 ±1.2 ) mmol/L, (550 ±92)nmol/L,IL-6 (0.300 ±0.066)ng/L in group N(t=2.02,6.72,2.76,all P<0.05).However,the composite of dexmedetomidine group D patients with respiratory recovery time(7.5 ±2.3)min,calling the eyes open time(7.8 ±2.5) min,pull out the time of endotracheal tube (14.2 ±3.3) min compared with groups N of patients with respiratory recovery time (7.8 ±2.5)min,calling the eyes (14.8 ±3.2)min,pull out the time of endotracheal tube (13.9 ±3.1)min,showed no statistical significance (t=0.88,0.44,0.36,all P>0.05).In group N,postoper-ative restlessness in 8 cases,nausea and vomiting in 10 cases,chills in 9 cases,which were significantly higher than 2 cases,2 cases,2 cases in group D(χ2 =4.32,6.67,5.45,all P<0.05).At the same time,the satisfaction score of patient in group D (3.0 ±0.3)point,which was significant higher than (2.7 ±0.5)points in group N (t=1.88,P<0.05).Conclusion Dexmedetomidine detomidine composite sevoflurane anesthesia can improve the postoperative re-covery quality of elderly patients with rectal cancer radical surgery.

Objective To evaluate the effect of dexmedetomidine and tramadol on perioperative insulin resistance in patients undergoing radical resection of rectal carcinoma.Methods Sixty ASA I or II patients undergo-ing radical resection of rectal carcinoma were randomly divided into 3 groups(n =20 each):dexmedetomidine group (group D),tramadol group(group T),control group(group C).Group D was given dexmedetomidine intravenously at 1μg/kg 15min before induction of anesthesia followed by a continuous infusion of 0.5μg·kg -1 ·h -1 until the abdo-men was closed,and group T was given tramadol intravenously at 1.5mg/kg 15min before induction of anesthesia fol-lowed by a continuous infusion of 0.5mg·kg -1 ·h -1 until the abdomen was closed,whereas group C received the same volume of normal saline.Venous blood samples were taken at 30min before anesthesia induction(T1 ),1 h after the beginning of the operation(T2 ),1h after operation(T3 ),24h after operation(T4 )for determination of blood con-centrations of glucose(BG),insulin(INS),interleukin -6 (IL -6),tumor necrosis factor -α(TNF -α).Insulin resistance(HOMA -IR)and insulin sensitivity index(QUICKI)were calculated.The numbers of patients with PONV were studied respectively.Results The serum IL -6,TNF -α,BG,INS concentrations and HOMA -IR were signifi-cantly lower while ISI was significantly higher in both group D[t =7.71,3.37,8.78,8.73,11.45,2.82(T2 ),3.04, 2.95,12.75,10.73,16.09,2.92(T3 ),11.26,2.45,11.40,5.10,14.5,2.51(T4 ),all P <0.05]and group T[t =3.02,2.59,2.93,7.76,6.32,2.03(T2 ),8.78,2.27,4.14,8.83,7.68,2.12(T3 ),6.10,2.05,3.71,2.35,7.12, 2.09(T4 ),all P <0.05]at T2 ,T3 and T4 than those in group C.The serum TNF -αconcentration and HOMA -IR were significantly lower while ISI was significantly higher in group D[t =6.68,4.58,2.05 (T2 ),9.01,6.66,2.23 (T3 ),7.54,5.5,2.02(T4 ),all P <0.05]at T2 ,T3 and T4 than those in group T.The numbers of patients with PONV were significantly higher in group T than those in group D and group C (χ2 =26.13,18.75,all P <0.05 ). Conclusion Both dexmedetomidine and tramadol can attenuate perioperative insulin resistance in patients undergo-ing Radical Resection of Rectal Carcinoma,and the decrease the consentrations of IL -6 and TNF -αmay be involved in the mechanism.The roles of prevention of perioperative insulin resistance in dexmedetomidine group are superior to tramadol group.The incidence of PONV is less in a dexmedetomidine group than that in a tramadol group.

Objective: To compare the effectiveness of qualitative and quantitative fecal immunochemical tests (FIT) in identifying colorectal cancer, so as to provide insights into perfecting screening strategies for colorectal cancer. Methods: Participants in the Colorectal Cancer Screening Program for Key Populations in Zhejiang Province from May 2020 to December 2021 were recruited, and their demographic information, lifestyle and disease history were collected through a questionnaire survey. Qualitative or quantitative FIT along with a questionnaire-based risk assessment were employed as the initial screening tests. Individuals who were positive in any FIT or had high-risk assessment results were required to attend a subsequent colonoscopy examination. The positive rate, detection rate of colorectal cancer, positive predictive value and number of colonoscopies required were compared between qualitative and quantitative FITs, and stratified analyses by gender and age were conducted. Results: Totally 4 099 769 participants were included. The qualitative FIT group included 3 574 917 individuals, yielding a positive rate of 11.35%, a detection rate of 1.19%, a positive predictive value of 0.48% and 83.84 colonoscopies required to detect one cancer case. The quantitative FIT group involved 524 852 individuals, yielding a positive rate of 6.70%, a detection rate of 2.31%, a positive predictive value of 1.01% and 43.23 colonoscopies required to detect one cancer case. The quantitative FIT group showed significantly higher detection rate of colorectal cancer, higher positive predictive value and less number of colonoscopies required compared to the qualitative FIT group (all P<0.05). The same results were obtained after stratification by gender and age. Conclusion Compared to qualitative FIT, quantitative FIT improves the detection of colorectal cancer and reduces the workload of colonoscopy examinations, making it more suitable for colorectal cancer screening in large-scale populations.

Objective: To understand the incidence and mortality of colorectal cancer in tumor registration areas of Zhejiang Province,and to provide reference for prevention and control strategies for colorectal cancer. Methods: The colorectal cancer data was retrieved from fourteen tumor registries in Zhejiang Province were collected,the incidence rate and mortality rate were calculated and standardized according to the Chinese standard population in 2010 and Segi's world population in 2000. The incidence and mortality of colorectal cancer in different sex,age group and region were analyzed. Results: The crude incidence rate of colorectal cancer from 2010 to 2014 was 35.82/100 000（20 983 cases）. The standardized incidence rate by Chinese and world standard population were 20.80/100 000 and 23.01/100 000. The crude mortality rate of colorectal cancer was 15.25/100 000 （8 934 cases）. The standardized mortality rate by Chinese and world standard population were 8.01/100 000 and 9.39/100 000. The ratio of mortality to incidence was 0.43:1. From 2010 to 2014,the incidence and mortality rates of colorectal cancer were stable（P>0.05）. The incidence rates of colorectal cancer in urban and rural residents were 37.69/100 000 and 31.14/100 000,and the mortality rates were 15.73/100 000 and 14.05/100 000. The incidence rates of colorectal cancer in males and females were 41.53/100 000 and 30.11/100 000,and the mortality rates were 17.74/100 000 and 12.76/100 000. The incidence and mortality rates of colorectal cancer both increased with age. The incidence rate increased significantly in people after 40 years old,and peaked with 187.35/100 000 in people aged 80-84 years. The morbidity rate peaked with 171.27/100 000 in people aged 85 years or over. Conclusion The incidence and mortality of colorectal cancer in Zhejiang Province were stable,but the incidence was higher than the national average level. The incidence of colorectal cancer in people aged over 40 years increased significantly.