OBJECTIVE To investigate the inhibitory effect and mechanism of Modified qifang weitong granules on gastric cancer based on in vitro and in vivo experiments. METHODS Human gastric cancer HGC-27 cells were divided into the following groups: control group （treated with fetal bovine serum）， 10% drug-containing serum group， 15% drug-containing serum group， 20% drug-containing serum group， and 5-fluorouracil （5-Fu） group （positive control， 3.90 μg/mL）. After culturing the cells in each group with the corresponding serum/drug solution， their proliferation， migratory and invasive abilities， as well as the cell cycle， were assessed. Additionally， the expression levels of epithelial-mesenchymal transition （EMT）-related proteins [E-cadherin， N-cadherin， and vimentin] in the cells were measured. Logarithmic-phase HGC-27 cells were harvested and subcutaneously injected into the right axillary region of nude mice to establish a subcutaneous xenograft tumor model in nude mice. The successfully modeled tumor-bearing nude mice were randomly divided into model group， low-， medium- and high-dose groups of Modified qifang weitong granules （17.65， 35.29 and 70.58 g/kg， respectively）， and 5-Fu group （25 mg/kg）， with 5 mice in each group. After 14 days of treatment with the corresponding drugs in each group， the histopathological morphology of the tumor tissues in the nude mice was observed. Immunohistochemistry and Western blot assay were employed to detect the expression levels of EMT- related proteins in the tumor tissues of the nude mice. RESULTS In the cell experiment， compared with the control group， the cell proliferation rate， migration rate， number of invasive cells， as well as the expression levels of N-cadherin and vimentin proteins， and the percentage of cells in the G2/M phase were all significantly decreased/reduced in the 15% drug-containing serum group， 20% drug-containing serum group （P＜0.05）. Conversely， the percentage of cells in the G0/G1 phase and the expression level of E- cadherin protein were significantly increased （P＜0.05）. In animal experiment， compared with the model group， the high-dose group of Modified qifang weitong granules exhibited significantly reduced tumor mass and expression levels of N-cadherin and vimentin proteins in the tumor tissues of nude mice （P＜0.05）， while the expression level of E-cadherinprotein in the tumor tissues was significantly increased （P＜0.05）. Additionally， the tumor cells varied in size and showed extensive necrosis. CONCLUSIONS Modified qifang weitong granules effectively inhibit gastric cancer in both in vitro and in vivo models， and the mechanism of action is related to the suppression of EMT.

Objective: To understand and assess the current situation of primary and secondary school students health services in community health service organizations in Shenzhen, so as to provide a basis for upgrading the capacity of health services. Methods: A total of 684 community health service organizations and 587 part time health vice principals in the Shenzhen City were selected for the study in June 2022, and the special questionnaire surveys regarding primary and secondary school students health service capacity and the community health service organizations and part time health vice principals performance ability were administered in Shenzhen. SPSS 26.0 software was used for a descriptive analysis. Results: The staffing rate of general practitioners or clinical physicians in Shenzhen s community health service organizations was 99.9%, 67.1% of community health service organizations established counterpart collaborative relationships with schools, 50.8% of community health service organizations provided diagnostic and treatment services for students, 24.8% of community health service organizations provided health check up services for students, 85.2% of community health service organizations provided health guidance to schools, and 94.3% of community health service organizations had a part time vice principal of health with a score of (7.63±1.59) in the self assessment of their ability to carry out their duties, and space constraints and shortage of nursing were the main problems in promoting student medical check ups in the community health service organizations. Conclusions The community health service organizations in Shenzhen suffer from inadequate medical service resources and inadequate training for professional staff, resulting in low service capacity for providing physical examinations and health management for primary and secondary school students. There is a need to further promote the integrated development of education and health, and continuously enhance service capabilities, to promote the orderly development of student health work.

Objective To investigate the risk factors for pediatric acute perforation appendicitis,and to construct a nomogram predictive model and conduct the verification.Methods A total of 426 children patients with appendectomy in this hospital from June 30,2020 to June 30,2022 were selected as the study subjects 340 children with acute appendicitis admitted to the hospital from 30 June 2020 to 28 February 2022 were the training set and 86 children patients with appendicitis hospitalized in this hospital from March 1,2022 to June 30,2022 conducted the external validation(verification set).The univariate and multivariate logistic regression models were employed to analyze the independent risk factors of pediatric acute perforation appendicitis.The nomograms predictive model was constructed.The receiver operating characteristic(ROC)curve and calibra-tion curve were used to evaluate the predictive efficiency of the model.The decision curve analysis(DCA)was used to evaluate the application value of the model.Results Of the 426 children,198 were perforated and 228 were not perforated.The univariate and multivariate logistic regression analyses revealed that elevated C-reac-tive protein(CRP),presence of stercorolith in appendiceal cavity,time of onset to visiting hospital ≥2 d and body temperature ≥37.3 ℃ were the independent risk factors for pediatric acute perforation appendicitis(P＜0.05).The Hosmer-Lemeshow test demonstrated that the nomogram predictive model had good fitting(P=0.869),and the area under the curve(AUC)for the training and validation sets were 0.808 and 0.860 respectively,showing the good predictive ability of the model.The calibration curve closely approach the ideal diagonal.The model showed good discrimination,consistency and accuracy.The DC A revealed that the curve was far away from oblique and horizontal lines,and the model had good clinical practicability.Conclusion The constructed nomogram model of pediatric acute perforation appendicitis has good predictive ability and may help clinic to identify as early as possible.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

BackgroundSleep disorder can adversely affect human physical and mental health， with important implications for socioeconomic development. And higher vocational college students are subject to various pressures and stimuli exerted by academic studies， job seeking and family socioeconomic status， which may contribute to the onset insomnia symptom or sleep disorder. ObjectiveTo discuss the sleep status and influencing factors among higher vocational college students， and to provide references for improving their sleep status. MethodsIn January and February， 2022， a stratified random sampling method was utilized to enroll 3 300 students from five higher vocational colleges in Wenjiang district of Chengdu city. All the participants were assessed using Insomnia Severity Index （ISI）， Patient Health Questionnaire Depression Scale-9 item （PHQ-9） and Generalized Anxiety Disorder Scale-7 （GAD-7）. Pearson correlation analysis was conducted to test the correlation of ISI with PHQ-9 and GAD-7 scores， and the Logistic regression analysis was performed to identify the influencing factors of insomnia symptom in higher vocational college students. ResultInsomnia symptom was detected in 81.90% （2 497 / 3 300） of higher vocational college students. The detection rate of insomnia symptom among vocational college students yielded statistical difference in terms of gender， family socioeconomic status， being an only child or having siblings， degree of psychological pressure exerted by academic studies or job seeking， amount of hours spent on Internet per day， frequency of physical exercise， and the presence or absence of anxiety symptom and depression symptom （χ²=21.032， 22.172， 8.983， 75.939， 36.781， 32.350， 54.512， 86.561， P<0.01 or 0.05）. Among higher vocational college students， ISI score was positively correlated with GAD-7 and PHQ-9 scores （r=0.620， 0.714， P<0.01）， and GAD-7 score was positively correlated with PHQ-9 score （r=0.824， P<0.01）. Gender， family socioeconomic status， degree of psychological pressure exerted by academic studies or job seeking， amount of hours spent on Internet per day， frequency of physical exercise， and the presence or absence of anxiety symptom and depression symptom were effective factors in predicting the insomnia symptom in higher vocational college students （P<0.01 or 0.05）. ConclusionFemale gender， average and below average family socioeconomic status， moderate-to-severe degree of psychological pressure exerted by academic studies or job seeking， spending 2~5 h， 5~7 h or >7 h on Internet per day， inadequate physical exercise and presence of depressive symptom are the risk factors for insomnia symptom in higher vocational college students.［Funded by Sichuan Provincial Primary Health Development Research Center in 2022， North Sichuan Medical College （number， SWFZ22-C-89）］

Background Long-term excessive consuming sugar-sweetened beverages have a negative impact on health. In order to decrease the consumption of sugar-sweetened beverages and create a healthy food environment, the Health Commission of Shenzhen Municipality pioneered to enforce health warning labels presented in commercial locations vending sugar-sweetened beverages based on relevant provisions of the Health Regulations of Shenzhen Special Economic Zone，but its effect has not yet been evaluated. Objective To evaluate the impact of presenting health warning labels in commercial locations vending sugar-sweetened beverages in Shenzhen. Methods A multi-stage stratified sampling method was used to randomly select one street in each of the 10 districts (excluding the Shenzhen Shantou Special Cooperation Zone) of Shenzhen followed by a convenience sampling to select sampling sites to conduct an undercover investigation on the presentation of health warning labels for sugar-sweetened beverages in six different types of venues (n=232) such as shopping malls, ordinary supermarkets/convenience stores, self-service vending machines, catering service places, medical institutions, and venues serving minors' education and activities. At the same time, 238 site managers, 1002 adult consumers, and 7396 child and adolescent consumers were interviewed. Results Among 213 commercial locations vending sugar-sweetened beverages, the rate of health warning label installation was 26.3%, with the highest installation rate in shopping malls (55.0%). Among site managers, 47.8% were aware that commercial locations were required to install health warning labels, and 50.0% were aware of the standards for setting up health warning labels. The higher the awareness of relevant regulations, the higher the rate of installation of health warning labels. More than half of site managers (55.3%) believed that after installing health warning labels, the sales of sugar-sweetened beverages and sugar-sweetened beverages in large-volume packages had decreased compared to the same period in previous years. Most of the interviewed consumers indicated that if they saw the health warning labels for sugar-sweetened beverages, they would buy less, give up purchasing, or choose low-sugar or sugar-free beverages, and also discourage their family members or friends from drinking such beverages. Compared with participants without awareness of the health warning labels, both adult and child and adolescent consumers with awareness of the health warning labels believed that the installation is beneficial to their good eating habits and reported a higher proportion of discouraging family members or friends from drinking such beverages, with a lower frequency of consuming sugar-sweetened beverages. Conclusion Health warning labels for sugar-sweetened beverages have a significant effect on promoting behavior changes, and both site managers and citizens have a high level of support for them. However, in view of the low voluntary compliance rate of commercial locations and the installation rate of health warning labels, the publicity and enforcement of the Health Regulations of Shenzhen Special Economic Zone should be enhanced.

Objective: To understand health literacy and its associated factors among middle school students in Shenzhen, to provide scientific basis for further formulating targeted intervention measures. Methods: From October to December, 2019, 7 423 middle school students in 10 districts of Shenzhen were selected by multistage stratified random cluster sampling. Multivariate linear regression was used to analyze factors affecting health literacy and scores in each dimensions. Results: The total score for health literacy was(107.39±22.31), including physical activity(16.81±5.28), interpersonal relationship(20.69±4.10), stress management(21.64±5.53), spiritual growth(14.93±3.96), health awareness (15.61±4.96) and nutrition(17.71±4.65). According to the multivariate linear regression analysis, girls, general and vocational high schools, educational level of parents and boarding in school were significantly associated with health literacy of middle school students( B=-3.04, -7.72, -9.99, 1.56, 2.78, -3.85, P < 0.05 ). Conclusion Middle school students in Shenzhen have a high level of health literacy, which is related to school type and parental educational background. It is suggested that measures should be taken to improve the health literacy of middle school students.

Objective? To explore the power of modified early warning score (MEWS) in predicting Class I-Ⅲ patients to be transferred into the intensive care unit (ICU) and to provide an objective assessment tool for medical workers to properly triage patients. Methods? Totally 463 patients admitted into the Department of Emergency of a Class Ⅲ Grade A hospital from May 17 to September 27, 2017 by convenient sampling. MEWS was obtained by collecting the patients' data at admission. The outcome indicator was whether the patients were transferred into ICU. The patients were divided into the MEWS≥ 4 group and the MEWS＜4 group based on MEWS. The rate of transfer into ICU was compared between the patients. The area under the receiver operating characteristic curves (AUC-ROC), sensitivity, specificity and the best cutoff point of MEWS and MEWS combined with stratification in predicting whether the patients would be transferred into ICU were calculated. Results? The rate of transfer into ICU in the MEWS≥4 group and the MEWS＜4 group was 43.4% and 13.5%, respectively (χ2=52.3028, P＜0.001). The AUC-ROC of MEWS in predicting whether the patients would be transferred into ICU was 0.759, whose best cutoff point, sensitivity and specificity was 3.5, 68.91% and 68.90%. The AUC-ROC of MEWS combined with stratification in predicting whether the patients would be transferred into ICU was 0.861. Conclusions? The predictive power of MEWS in predicting whether class I-Ⅲ patients would be transferred into ICU is medium, but its predictive power is enhanced when stratification is combined with MEWS. The scoring tool is simple and practical, which provides a reference for properly triaging patients.[Key words]? Emergency service, hospital;? Condition assessment;? Stratification and triage;Modified early warning score;? Prediction

Objective To assess the gender-related differences of upper tract urothelial carcinoma and analyze the causes of the gender-related differences.Methods We retrospectively studied 942 patients underwent radical nephroureterectomy for upper tract urothelial carcinoma between January 2000 and December 2014 in our hospital.The mean age of the entire cohort was 64.5 years,with 424 males (45.0％)and518 females (55.0％).Compared with male patients,female patients tended to had a history of aristolochic acids exposure (5.2％ vs.11.1％,P =0.001),infrequent smoking (29.7％ vs.5.2％,P ＜0.001) and showed poorer renal function (P =0.023).We reviewed clinicopathologic data from these patients and used univariate analysis to determine the gender-related differences.The Kaplan-Meier method was adopted to investigate the gender differences of cancer specific survival,bladder recurrence-free survival and contralateral upper tract recurrence-free survival of patients.Results When compared with males,females were less likely to have high-stage disease (33.7％ vs.24.9％,P =0.003).The mean follow-up for the entire cohort was 70.2 months (4-193 months).The cancer specific survival rate (x2 =14.116,P ＜0.001)and the contralateral upper urinary tract recurrence rate(x2 =7.362,P =0.007)in females were both higher than those in males.The 5-year cancer specific survival rates were 72.0％ in the males and 83.5％ in females,respectively.In addition,the 5-year contralateral UTUC-free survival rates were 98.6％ in the males and 92.9％ in females.Conclusions Female patients in our cohort were more common and they were more likely to be exposed to aristolochic acids.Females were less likely to have high-stage disease but had significantly worse contralateral upper tract recurrence-free survival.

Objective:To evaluate the clinical effect of retroperitoneoscopic renal pedicle lymphatic disconnection via extra-adipose capsule in the management of chyluria and to discuss the management of its complications.Methods:From August 2013 to June 2008,five patients with chyluria were admitted. All the patients were female,aged from 26 to 73 years,and disease course from 1 to 10 years.All the five patients had complained of intermittently voiding milky urine with varying degrees of weight loss,and fa-tigue,of whom two presented with flank pain and one with anemia.Their urine chyle tests were con-firmed to be positive.Preoperative cystoscopy found that chyluria was from the left side in 3 cases,and from the right side in 2 cases.Their proteinuria ranged from +to ++++.All the cases had been treated with the modified procedure by which lymphatic ligation was performed to hilar vessels and proximalureter via extra-adiposecapsule without disconnection of perirenal fat tissues.The operation time,intraoperative blood loss,postoperative intestinal function recovery,catheter time,drainage tube removal time and com-plications during operation were collected.Results:All the five cases were performed successfully.The operation time ranged from 75 to 170 minutes,mean (126.0 ±39.6)minutes,with the intraoperative blood loss 20 to 60 mL,mean (38.0 ±16.4)mL,and the postoperative intestinal function recovery time 1 to 3 days,mean (1.9 ±0.4)days.The catheter time was 1 to 4 days,mean (2.1 ±0.3)days and the drainage tube removal time ranged from 3 to 15 days,mean (9.3 ±1.8)days.Postoperatively lym-phorrhagia was found in two cases.No renal vessels injury occurred during operation.Chyluria of all the patients disappeared on the operation day with negative chyluria test after surgery.Furthermore,urine test revealed that proteinuria was totally negative.No recurrence was detected in our patients in the 9 to 31 months’follow-up.Conclusion:This modified procedure does not have to disconnect perirenal fat tissues and nephropexy during operation.It was characterized with shorter operation time,definitive effect and fewer complications.