Objective To explore effective ways for community health service institutions to change patients' health service seeking patterns. Methods Yuetan Community Health Service Center of Fuxing Hospital affiliated to Capital Medical University and 9 community health service stations under its subordination in the 1996～2002 period were selected as a representative of the community health service institutions to be studied and intervened while the headquarters of Fuxing Hospital in the same period was selected as a representative of the third-tier hospitals to be studied. A comparison was made between the two in outpatient volume change. Questionnaires were distributed randomly to residents of the Yuetan area where Fuxing Hospital is located in order to study their health service seeking behaviors each year from 1996 to 2002. Results As a result of hard work in the 6 years, Yuetan Community Health Service Center saw a steady increase in outpatient volume whereas the headquarters of Fuxing Hospital witnessed a steady decrease in outpatient volume. Survey via questionnaires sent randomly to permanent residents of the Yuetan area indicated a change in residents' health service seeking patterns. Conclusion It is effective and viable for community health service institutions to change patients' health service seeking patterns through providing social-psychological-biological community medical services, enhancing health education and setting up a two-way referral system with third-tier hospitals.

OBJECTIVE To estimate the distribution of pathogens of nosocomial infection in intensive care units,the sites where infections often taken place and the related antibiotic-resistance of bacteria.METHODS Various samples of bacteria from intensive care units have been examined by applying half-automatic analyzer ATB Expression,with bacteria inspecting cards and drug-sensitivity cards,all from Bio-Merieux,France.RESULTS Totally 153 strains of nosocomial pathogens have been found,where Acinebacter baumannii,fungi and Pseudomonas aeruginosa ranked top three,with rates of 32.0%,16.3%,and 15.0%,respectively.About 45.8% of pathogens were found in samples from the lower respiratory tract.Approximately 4.3% of A.baumannii showed drug-resistance to imipenem.However,more than 50.0% of A.baumannii presented its strong drug-resistance to rest of eight regular antibiotics.CONCLUSIONS A.baumannii is a dominating pathogen to cause nosocomial infection in intensive care units,and has shown strong multi-drug-resistance,which should incur high clinical attention.It comes to be crucial to highlight sanitization and sterilization operation,applying proper antibiotics in order to reduce appearance of bacteria with drug-resistance.

BACKGROUND:High expression of stem cell transcription factors, Sox2 and Oct4, has been confirmed to be closely related to the occurrence of lung cancer.OBJECTIVE:To explore the expression of Sox2 and Oct4 in lung cancer tissues and its correlation with microvascular generation and clinical-pathologic features.METHODS:The expression levels of Sox2 and Oct4 and microvessel density (MVD) in lung cancer tissues (60 cases) and normal tissues (60 cases) were examined by immunohislochemistry. Then, the correlation of the expression of Sox2 and Oct4 and MVD value with clinical-pathologic features in lung cancer was analyzed.RESULTS AND CONCLUSION:The positive expression of Sox2 and Oct4 was 46.67% (28/60) and 71.67% (43/60) in lung cancer tissues, respectively, while Sox2 and Oct4 were negatively expressed in normal tissues, and there was a significant difference between lung cancer and normal tissues (P < 0.001). The MVD value was 16.22±2.18 in lung cancer tissues, which was significantly higher than that in normal tissues (4.36±2.07) (P < 0.001). Expression of Sox2,Oct4 and MVD value were correlated with TNM stage, differentiation degree, ymph node metastasis, vessel invasion,and liver metastasis (all P < 0.05), but not with the patient's age and gender (both P > 0.05). The MVD value with Sox2 and Oct4 positive expression was significantly higher than that with Sox2 and Oct4 negative expression (P < 0.001).Spearmen analysis results showed that there was no correlation between Sox2 and Oct4 in lung cancer tissues (r=2.752,P > 0.05). To conclude, the high expression of Sox2 and Oct4 has a high correlation with the initiation and progression of lung cancer, and has positive correlation with the MVD, both of which are significantly concerned with the microvascular generation, invasion and hematogenous metastasis of lung cancer.

Objective To apply 3C3R model in problem design of PBL for pediatrics teaching.Methods The 3C3R model comprises two classes of components:core components and processing components.Core components of the model are 3C,which are content,context and connection while processing components are 3R,which are researching,reasoning and reflecting.3C3R model was used in the problem design for the PBL case of ‘ Why the mouth of Baobao became purple when he was crying?' Totally 76 eight-year program medical students and 7 tutors were enrolled as teaching object.The anonymous questionnaires from the students were collected for assessment of PBL teaching.Results The percentage of students with scores ≥4 for content in PLB problem design was 90.8％,for context was 80.3％,for connection was 64.5％,for researching was 81.6％,for reasoning was 69.7％ and for reflecting was 40.8％.The percentage of tutors with scores ≥4 for content in PLB problem design was 100％,for context was 71.4％,for connection was 28.6％,for researching was 71.4％,for reasoning was100％,for reflecting was57.1％.Both students and tutors held a positive attitude towards the component of content,context,researching and reasoning in problem design model.But the components of connection and reflection needed to be improved.Conclusion The 3C3R model is helpful for problem design of PBL in pediatric teaching.

Objective To analyze of related factors in affecting condylar buttress plate (CBP) surgical treatment of distal femoral fractures.Methods One hundred patients with distal femoral fractures were grouped according to eight related factors (gender,age,fracture type,fracture classification,surgical time,reset quality,whether bone graft and plaster braking),respectively.Operative efficacy was scored by the Neer knee functional score table,and score ≥ 72 was excellent,while ＜ 72 was good.Eight related factors were carried out single factor analysis with x2 test to compare the operative efficacy of each group,then the related factors with single factor analysis result of P＜0.05 were put in Logistic multifactor regression analysis,in order to clarify the independent risk factors for CBP treatment of distal femoral fractures.Results There was no significant difference (P＞0.05) in the operative efficacy between male and female group,open fracture and closed fracture group.The difference between youth,middle-aged and elderly group,type A and type C fracture group was statistically significant (P＜0.05).The operative efficacy of patients got surgery within 7 d was obviously better than those who got surgery 7 d later (P＜0.05).The operative efficacy of patients who had no intraoperative bone graft was better than those who had bone graft (P＜0.05).The operative efficacy of satisfactory reset group and none plaster braking group was better than that of unsatisfied reset group and plaster braking group (P＜0.05),respectively.Conclusions Age,fracture type and reset quality are CBP therapy independent risk factors for the efficacy of operation for patients with distal femoral fractures,which will provide some reference for improving the operative efficacy of CBP operation in treatment of distal femoral fractures.

Objective: To investigate the health information needs and use habits of primary and secondary school students in Shanghai, and to provide a reference for appropriate health education. Methods: An online survey was conducted from May to June 2022 for 979 primary and secondary school students in eight schools in Shanghai, using a self administered questionnaire, through stratified random sample method. Results: Health information with the higher demand among primary and secondary school students in Shanghai were myopia prevention [5(4,5)], oral health [5(3,5)], physical fitness [5(3,5)], healthy posture enhancement [5(3,5)], accidental injury protection[5(3,5)], prevention of Internet addiction[5(3,5)]. The most frequently used channels of health information were WeChat[4(3,5)], family, friends, classmates[4(3,5)], websites or online forums[4(3,5)], school teachers[4(3,5)], video websites or APPs[4(3,5)],doctors and experts[4(3,5)] and school activities or clubs[4(3,5)]. The most interesting forms of health information dissemination were videos, cartoons, short videos[5(4,5)]. High trust recipients of help for health problems were parents[5(4,5)], doctors and other professionals[5(4,5)],grandparents[4(3,5)], school teachers[4(3,5)], as well as peers and friends[4(3,5)]. Conclusion Shanghai primary and secondary school students had a high demand for health information. Most often obtained health information through social media and interpersonal communication. The most interested forms of health communication included videos, pictures,etc. The form and content of health education should be carefully designed according to the needs and characteristics of the audience. A three dimensional matrix of media, organizations, and interpersonal health communication should be created to strengthen the effectiveness of health education.

Objective To assess the reliability and validity of the Chinese version of the neuropsychiatric inventory (CNPI). Methods The CNPI was administered to 219 caregivers of patients with Alzheimer's disease (AD). Each caregiver was retested 4 weeks after initial testing. Results The Cronbach a coefficient of the total symptom scale was 0.69. The Cronbach α coefficient of the total caregiver distress subscale was 0.72. The Cronbach α coefficient of the entire inventory was 0. 82. The test-retest coefficients ranged from 0.66 to 0.98 (P < 0.01). Principal axis factoring analysis of the symptom subscale yielded a five-factor solution which contributed to 67.0% of the cumulative variance. Factor 1, which included aberrant motor behavior, hallucinations, delusion and irritability had the most significant contribution to the cumulative variance. Principal axis factoring analysis of the caregiver distress subscale also yielded a five-factor solution which contributed to 70.2% of the cumulative variance. Factor 1, which included depression, delusion, sleep/night behavior, aberrant motor behavior, and irritability had the most significant contribution to the cumulative variance. Conclusion This Chinese version of NPI is a reliable and valid tool for measuring neuropsychiatric disturbances in patients with AD.

Objective: To investigate and compare the changes and associated factors of knowledge, attitude and practice of college students in Shanghai between the early 2020 and the end of 2021 stages of the COVID 19 epidemic and analyze the influencing factors, so as to provide reference for epidemic prevention and health education of college students. Methods: A retrospective cross sectional survey was conducted among 913 college students in 12 colleges and universities in Shanghai in 2021 from November to December with a self designed questionnaire by multi stage stratified cluster sampling, so as to investigate the changes of college students health literacy related to COVID 19 and the changes of knowledge, attitude and practice between the early 2020 and the end of 2021 stages of the COVID 19 epidemic. Results: In the early stage of the epidemic, the average score of understanding of epidemic prevention and control policies was(2.93±0.94), information judgment was(3.10±0.89), satisfaction degree was(4.11± 1.09 ), cooperation degree was(4.31±0.96), communication intention was (3.91±1.15). By the end of 2021, the understanding of prevention and control policies was (2.95±0.98); Information judgment was (3.77±0.94), satisfaction degree was (4.22±1.10), cooperation degree was (4.36±0.99), communication intention was (3.97±1.20), there were significant changes at different stages ( P <0.01). The results of binary Logistic regression showed that majors of social sciences (OR=0.62), majors of natural sciences ( OR =0.62), self rated good health ( OR =0.62) and self rated relatively good health ( OR =0.28) were negatively correlated with college students cognition and attitude changes to the COVID 19 epidemic ( P <0.05), while the choice of "relatively consistent"( OR =3.31) in "change in health behavior according to reasonable health information" was positively correlated with knowledge and attitude changes ( P <0.05). Shanghai college students health literacy about epidemic prevention was generally high. 79.4% of them had a "relatively high" score (>80), and 82.6% of the students rated themselves "very well" and "relatively well" knew epidemic prevention. Conclusion Relatively high level of health literacy on epidemic prevention is observed among college students in Shanghai. There had been significant changes in their knowledge, attitude, and practice of the epidemic since the early stage. It is necessary to carry out more accurate and effective health education and dissemination according to different characteristics, so as to build the prevention and control barrier of epidemic among college students.

BACKGROUNDMitochondrial DNA (mtDNA) is the only hereditary substance besides nucleus, which is composed of a code region and a non-code D-loop region. The aim of this study is to investigate the hypervariable region II (HVRII) mutation of mtDNA in peripheral blood leucocyte, pericancerous tissues and cancer tissues of lung squamous cell carcinoma patients, and to explore its significance.

METHODSWhite blood cells, pericancerous tissues and cancer tissues were obtained from 15 cases of lung squamous cell carcinoma patients and mtDNA were extracted by one step method. HVRII fragments were amplified by PCR. Mutations were determined by DNA sequencing and the mutations of HVRII were analysed.

RESULTSIn 15 lung squamous cell carcinoma patients, 14 patients showed mutation in HVRII(93.33%), 88 mutations were found totally. Eighty-seven mutations located in H-strand origin region, especially in the conserved sequence blocks and the mtTF1, 2 binding site (TFX and TFY).

CONCLUSIONSThe results suggest that the mutation frequency of HVRII in cancer tissues of lung squamous cell carcinoma patients is very high and it might play an important role in carcinogenesis of the lung.

Objective To explore the clinical significance of colonoscopy follow-up in Chinese Lynch syndrome mismatch repair (MMR) gene mutation carriers.Methods The results of colonoscopy follow-up was analyzed in 194 MMR gene mutation carriers of 50 Lynch syndrome families.The follow-up period was from April 2001 to November 2016.The detection rates of advanced adenomas and colorectal cancers,five-year survival rate and ten year survival rate were compared between 123 patients of regular follow-up group (colonoscopy interval less than two years) and 71 patients of irregular follow-up group (time colonoscopy interval more than two years).T test,chi-square test and Kaplan-Meier method were performed for statistically analysis.Results The incidence of colorectal cancer of irregular follow up group was significantly higher than that of regular follow-up group (57.7％,41/71 vs 22.8％,28/123);and the difference was statistically significant (x2 =24.00,P＜0.01).The average age at diagnosis for colorectal cancer in irregular follow up group was younger than that of regular follow up group ((45.3 ± 1.9) years vs (48.7±1.8) years);and the difference was statistically significant (t=4.10,P＜0.01).In regular follow-up group,28.6％ (8/28) advanced-stage colorectal cancer (TNM Ⅲ or Ⅳ) was found,while in irregular follow up group,73.2 ％ (30/41) advanced-stage colorectal cancer was found,and there was statistically significant difference in pathological stage between two groups (x2 =4.90,P =0.032).The five year and ten-year survival rates of regular follow-up group were 96.2 ％ and 85.1 ％,respectively,which were both higher than those of irregular follow-up group (46.3 ％ and 28.7 ％);and the differences were statistically significant (x2 =13.20 and 14.80,both P＜0.05).The incidence of advanced adenomas of irregular follow up group was significantly higher than that of regular follow-up group (49.3％,35/71 vs 18.7％,23/123);and the difference was statistically significant (x2 =20.10,P＜0.05).The detection rate of advanced adenomas of MMR gene mutation carriers was higher than those without MMR mutation gene (85.4％,35/41 vs 14.6％,6/41);and the difference was statistically significant (x2 =5.20,P＜ 0.05).Conclusion Regular colonoscopy surveillance may decrease the incidence and mortality of colorectal cancer in MMR mutation carriers of Lynch syndrome families,and increase five-year and tenyear survival rates.