Background::The potential impact of pre-existing coronary artery stenosis (CAS) on acute pulmonary embolism (PE) episodes remains underexplored. This study aimed to investigate the association between pre-existing CAS and the elevation of high-sensitivity cardiac troponin I (hs-cTnI) levels in patients with PE.Methods::In this multicenter, prospective case-control study, 88 cases and 163 controls matched for age, sex, and study center were enrolled. Cases were patients with PE with elevated hs-cTnI. Controls were patients with PE with normal hs-cTnI. Coronary artery assessment utilized coronary computed tomographic angiography or invasive coronary angiography. CAS was defined as ≥50% stenosis of the lumen diameter in any coronary vessel >2.0 mm in diameter. Conditional logistic regression was used to evaluate the association between CAS and hs-cTnI elevation.Results::The percentage of CAS was higher in the case group compared to the control group (44.3% [39/88] vs. 30.1% [49/163]; P = 0.024). In multivariable conditional logistic regression model 1, CAS (adjusted odds ratio [OR], 2.680; 95% confidence interval [CI], 1.243–5.779), heart rate >75 beats/min (OR, 2.306; 95% CI, 1.056–5.036) and N-terminal pro-B type natriuretic peptide (NT-proBNP) >420 pg/mL (OR, 12.169; 95% CI, 4.792–30.900) were independently associated with elevated hs-cTnI. In model 2, right CAS (OR, 3.615; 95% CI, 1.467–8.909) and NT-proBNP >420 pg/mL (OR, 13.890; 95% CI, 5.288–36.484) were independently associated with elevated hs-cTnI. Conclusions::CAS was independently associated with myocardial injury in patients with PE. Vigilance towards CAS is warranted in patients with PE with elevated cardiac troponin levels.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective:Verstaile free superficial circumflex iliac artery perforator flap(SCIAPF) were adopted for various reconstructive scenarios, and its clinical effect and value was evaluated.Methods:Retrospective analysis was performed on 42 patients with tissue defects admitted in the Department of Orthopeadic of the Second Affiliated Hospital of Wenzhou Medical University from January 2015 to May 2019. Nine patients had injury in the foot, 8 in ankle, 8 in calf, 7 in forearm, 9 in hand, and 1 in the mouth. All of the defects were repaired by SCIAPF, including 28 single soft tissue defect wounds, 8 multiple soft tissue defect, and 6 composite defects. The size of soft tissue defect were 1.2 cm×1.8 cm-14.0 cm×20.8 cm. The size of flaps were 1.5 cm×2.0 cm-15.3 cm×22.3 cm. The patients entered follow up by outpatient clinic visit and telephone reviews to observe the survival of the flaps, functional recovery and complications.Results:In this series, there were 28 flaps, including 18 pedicled with superficia branch of superficial circumflex iliac artery, 2 pedicled with deep branch of superficial circumflex iliac artery, and 8 pedicled with 2 branches. Six were chimeric flaps. Among them, 4 flaps were iliac bone flaps with superficial branch of superficial circumflex iliac artery flaps, and 2 were superficial iliac circumflex artery flap with sartorius muscle flap. Eight cases were resurfaced with lobulated SCIAPF. Arterial anastomoses: end-to-side in 35 arteries and end-to-end in 7 arteries. Venous anastomosis: end-to-end in 27 veins and end-to-side in 15 veins. Venous return through superficial iliac circumflex vein in 25 flaps, through venae comitantes in 12 flaps and through both in 5 flaps. All flap donor sites were sutured directly. All flaps survived uneventfully except for one that compromised with end-to-side anastomotic dehiscence and bleeding, and survived after re-anastomosis. All flaps and donor sites healed primarily. During the follow-up of 6-24(mean, 11.5) months, the pliable flaps were ruddy in colour and soft in texture, without obvious bloatness and pigmentation. The donor site healed well with linear scars in 35 cases and mild scar hyperplasia in 7 cases. The donor hip function were normal. Three patients suffered a numbness of the thigh caused by intraoperative injury lateral femoral cutaneous nerve and it disappeared completely after 3 months.Conclusion:New applications of lobulated or chimeric SCIAPF, based on the SCIA vasculature or its branches, can meet most of the clinical repair requirement.

Objective: To analyze the association between masculine and feminine traits, gender role in students and family factors, and to provide a scientific basis for promoting the healthy development of children and adolescents gender role. Methods: Cluster random sampling method was used to selected 823 students from 2 schools of Xiamen in May, 2018, participants were asked to report individual masculine and feminine traits through the Child s Sex Role Inventory, and then gender role was divided into four types (masculine, feminine, androgynous, undifferentiated). Non parametric tests, generalized linear model, and Logistic regression model were used to explore the association between masculine and feminine traits, gender role and family factors. Results: Compared with the boys from the nuclear family, the masculine traits were lower in boys of other families by 0.282( 95% CI = -0.452 --0.110), and the feminine traits were also lower by 0.192 (95% CI =-0.369--0.014). Compared with boys of middle socioeconomic status (SES), the masculine traits of boys from low SES decreased by 0.157 (95% CI =-0.286--0.029), and the feminine traits decreased by 0.140 (95% CI =-0.274--0.005). The proportion of androgynous in boys from other families was significantly lower than boys from the nuclear family ( OR =0.45, 95% CI =0.21-0.94), with the proportion of undifferentiated significantly higher than nuclear family 2.33 (95% CI =1.22-4.44). The proportion of androgynous in boys from low SES was significantly lower than boys from middle SES ( OR =0.59, 95% CI =0.35-0.99), with the proportion of undifferentiated significantly higher than middle SES 1.62 (95% CI =1.00-2.65). Among girls, the differences in masculine and feminine traits and gender role of different family factors were not statistically significant ( P >0.05). Conclusion The masculine and feminine traits and gender role in students are associated with family structures and socioeconomic status, especially in boys. Therefore, the family environment is an important factor affecting children s gender role, and the healthy development of children s gender role needs parents attention and correct guidance.

Objective: To analyze the correlation between the scores of masculinity and femininity and parental rearing pattern in lower grade primary school students in Xiamen, and to provide a policy suggestions and reference basis for establishing a correct concept of gender role among children and adolescents. Methods: A cluster random sampling method was used to select 823 students from two primary schools in Xiamen. Masculinity and femininity scores were assessed by Children s Sex Role Inventory(CSRI), while attitudes and behaviors of parental rearing pattern were obtained through EMBU. Regression analyses were used to analyze the correlation between masculinity and femininity scores and parental rearing pattern. Results: Masculinity scored 2.82 ( 2.41 ,3.24) and 2.82 (2.47,3.18), femininity scored 2.87 (2.40,3.20) and 3.13 (2.73,3.47) among boys and girls, with no significant gender difference ( P >0.05). Masculinity and femininity scores varied significantly by parental emotional warmth and understanding(father: Z/H =44.61, 37.24；mother: Z/H=41.68, 46.64, P <0.05). Among boys, increasing parental emotional warmth and understanding and paternal excessive interference were associated with higher masculinity and femininity scores. Increasing rejection and maternal deny were associated with lower masculinity scores. Among girls, increasing the understanding of emotional warmth of fathers was associated with masculinity and femininity scores, increasing excessive interference from mothers was associated with lower masculinity scores ( P <0.05). Conclusion There are gender differences in the relationship between parental rearing pattern and masculinity and femininity scores. In particular, increasing parents emotional warmth and understanding and reducing mothers punishment and harshness, rejection and denial, and other negative parenting styles could facilitate healthy development of masculinity and femininity among primary school students.

Objective: To investigate the association between the combined effect of height growth and overweight/obesity with elevated blood pressure in Chinese children. Methods: Based on a cohort study of puberty development in Xiamen, a cluster sampling method was used to select 1 313 children whose complete height, weight and blood pressure levels at baseline were obtained in 2017 and during a follow up in 2019. The incidence of elevated blood pressure was compared between four different subgroups, and multivariate Logistic regression was performed to analyze the combined effect in boys and girls. Results: Among 1 313 children, the prevalence of elevated blood pressure at baseline was 25.2%. After 2 years of follow up, the incidence of elevated blood pressure was 19.7% and 23.4% in boys, and 16.6% in girls. After adjusting for factors including age, sex, family history of hypertension, sleep time, intake of fruits, vegetables, sugar sweetened beverages, and meat products, multivariate Logistic regression analyses showed that children in the high height growth and overweight/obesity group were more likely to exhibit a higher incidence of elevated blood pressure (overall:RR=2.41，95%CI=1.44-4.04；boys：RR=2.69，95%CI=1.45-5.02). Among girls, the risk of elevated blood pressure in the low height growth and overweight/obesity group also increased significantly (RR=4.47, 95%CI=1.45-13.75). Conclusion A large magnitude of height growth and being overweight/obesity were associated with elevated blood pressure in children, especially boys. Therefore, interventions that are targeted toward obesity prevention in children before pubertal growth spurts in height may be beneficial to reduce childhood high blood pressure.

Objective: To explore the relationship between nutritional status and puberty onset in boys, and to provide a reference for promoting the development of physical and mental health of boys. Methods: A total of 2 724 boys aged 7 to 12 years from grade 2 to 6 were recruited from Xiamen city by cluster sampling method in 2017. The nutritional status was assessed by physical examination, pubertal developmental status was evaluated by rating scales of Tanner and Prader orchidometer, and puberty timing was determined by the P25 age of puberty onset. The association between nutritional status and puberty onset was estimated by logistic regression model. Results: Pubertal onset was found in 29.0% of the boys and the incidence of early pubertal timing was 2.9%. The prevalence of puberty onset in wasting, normal weight, overweight and obesity boys was 19.6%, 28.7%, 34.4% and 31.5%, respectively. The age of puberty onset was significantly earlier in obese boys (F=3.23, P<0.05). The results of Logistic regression analysis showed that with the increase of BMI, the possibility of puberty onset and risk of early pubertal timing increased. After adjusting for confounding factors, the odds of puberty onset in boys with wasting decreased by 64.0% (OR=0.36, 95%CI=0.22-0.60), the possibility of puberty onset and risk of early pubertal timing in boys with obesity increased by 78.3% (OR=1.78, 95%CI=1.14-2.79) and 192.9% (OR=2.93, 95%CI=1.46-5.86), respectively. These relationships were more pronounced in boys of households with lower economic level (P<0.05). Conclusion BMI was positively correlated with puberty onset in boys, the odds of puberty onset and risk of early pubertal timing were significantly increased in obese boys, especially in those with low household economic level.

Objective: To explore the relationship between one-child and low height level classification among children and adolescents, and the effects of fruits, vegetables and physical activities on this association, and to provide as cientific reference for probing into and improving the differences of their height level between one child and child with siblings. Methods: Using stratified cluster sampling method, 93 primary and secondary schools in 7 provinces and cities in China were selected for physical examination and questionnaire surveys. A total of 40 978 primary and middle school students aged 7-17 were selected. A multilevel Logistic regression model was used to analyze. Results: Univariate analysis found that being one-child was less likely to be classified as low height level(OR=0.63, 95%CI=0.58-0.67); the multilevel model also found that the probability that one-child being at low height level was still lower(OR=0.78, 95%CI=0.73-0.85), and daily vigorous-intensity physical activities ≥1 h (OR=0.92, 95%CI=0.85-0.99) and daily vegetables and fruits intake ≥5 servings (OR=0.83, 95%CI=0.75-0.92) could also reduce the probability of being at low height level. Hierarchical analysis found that when vegetables and fruits intake and physical activities time were sufficient, there was no longer a significant difference in the height level classification between one-child and child with siblings(P>0.05). Conclusion Being one-child could be a protective factor for the height level classification of children and adolescents. Adequate intake of vegetables and fruits and time of vigorous-intensity physical activities could fill the gap of height level classification between of being one-child and child with siblings. Effective behavioral intervention measures should be taken to protect the healthy growth of height among children and adolescences.

Objective: To understand the distribution of masculine and feminine traits and gender roles in primary school students who did not enter the Tanner Ⅱ stage in Xiamen and to provide a reference for promoting the development of mental and physical health of children. Methods: The present study was based on the blood pressure cohort of children in Xiamen. All 823 participants were from grade two, three, four of primary school. Participants were asked to obtain children’s masculine and feminine traits, gender role types (masculine, feminine, androgynous, undifferentiated) and heterogeneity through the Children’s Sex Role Inventory. In this study, non-parametric tests and chi-square tests were used to compare the differences of masculine and feminine traits, gender role types and heterogeneity rates between different groups. Results: The masculine traits of this study scored (2.80±0.52), and the feminine traits scored (2.95±0.55). The proportion of masculine, feminine, androgynous and undifferentiated was 12.8%, 11.9%, 39.1% and 36.2%, respectively. The proportion of undifferentiated among boys (41.8%) was higher than girls (31.5%), while the proportion of androgynous (34.6%) was lower than girls (43.0%), the differences were of statistical sigificance(χ2=9.22, 6.02, P<0.05). The rate of gender role heterogeneity was 7.0%, and there was no significant difference between different gender and age groups(P>0.05). Conclusion The gender roles of primary school students in Xiamen are mainly androgynous and undifferentiated, and the distribution of gender role is different in boys and girls. More specifically, the gender roles of boys were mainly undifferentiated, and girls were mainly androgynous. In general, the proportion of gender role heterosexuals is a little higher, which should be paid more attention and appropriate guidance by schools and parents.

Objective: To investigate the prevalence and related factors of dyslipidemia among children and adolescents aged 6-17 years in 7 provinces in China. Methods: Using the method of stratified cluster random sampling, 93 primary and secondary schools were selected from Guangdong, Hunan, Liaoning provinces, Shanghai, Chongqing, Tianjin municipalities and Ningxia Hui Autonomous Region in China, 2012. A total of 16 434 students aged 6-17 years old with completed physical and lipid profiles parameters were selected into this study from above 93 primary and secondary schools. Dyslipidemia was determined by the definition of Expert Advice on Prevention and Treatment of Dyslipidemia in Children and Adolescents in 2009. Logistic regression model was used to explore the factors related to dyslipidemia. Results: The prevalence of elevated total cholesterol, elevated triglyceride, elevated low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol, and dyslipidemia was 5.4% (887 cases), 15.7% (2 578 cases), 3.0% (492 cases), 13.5% (2 221 cases) and 28.5% (4 679 cases) among children and adolescents aged 6-17 years, respectively. Sugary drinks intake ≥once per week (OR=1.14; 95%CI: 1.05-1.24), sedentary time >10 hours per day (OR=1.14, 95%CI: 1.01-1.28), overweight (OR=1.50, 95%CI: 1.33-1.70), and obesity (OR=2.62, 95%CI: 2.31-2.96) were significantly associated with the prevalence of dyslipidemia. Conclusion The prevalence of dyslipidemia was high among children and adolescents aged 6-17 in 7 provinces in China, 2012. Sugary drinks intake ≥once per week, sedentary time >10 hours per day, overweight and obesity might be the risk factors of dyslipidemia among children and adolescents.