Objective To compare the incidence of pancreatic fistula after hand and stapler suture in preventing pancreatic fistula after distal pancreatectomy.Methods The literatures published before December 2011 were retrieved from SinoMed and electronic database.Prospective controlled trials and retrospective reports were screened out for Meta analysis.The diagnostic criteria of pancreatic fistula were based on the criteria formulated by the International Study group of Pancreatic Fistula.The heterogeneity of the studies was analyzed using the Ⅰ2 test.The data were integrated using the fixed or random effect model.The results of the Meta analysis were presented with odds ratio (OR) and 95％ confidence interval (95％ CI).Results According to the selection criteria,lO literatures were selected which included 1 prospective randomized controlled study,3 prospective nonrandomized controlled studies and 6 retrospective studies.There were 1 441 cases in the hand suture group and 612 cases in the stapler suture group.There was no significant difference in the incidences of the pancreatic fistula between the hand suture group and the stapler suture group (OR =1.10,95％ CI:0.86-1.40,P ＞0.05).Six studies compared the incidences of severe pancreatic fistula (grade B or C) between the hand suture group and the stapler suture group.There were 1 182 cases in the hand suture group and 383 cases in the stapler suture group.There was no significant difference in the incidence of severe pancreatic fistula between the hand suture group and the stapler suture group (OR=1.33,95％CI:0.94-1.88,P＞0.05).Conclusion The efficacies of hand suture and stapler suture in preventing pancreatic fistula after distal pancreatectomy are comparable.Stapler suture provides an another option in distal pancreatectomy.

BACKGROUND: Appropriate direction and angle of traction for the vertebral artery type cervical spondylosis(CSA)make significant effect.Selective angiography is recognized as"gold standard"to diagnose the vascular disease.Although magnetic resonance angiography as a non-invasive examination,there exist shortcomings such as a longer time checking,vulnerable to man-made factors,a certain aggressive feature.OBJECTIVE: Through the use of color Doppler flow imaging(CDFI)and transcranial Doppler sonography(TCD)adding the test of turning neck,to analyze the change of blood current parameter before and after the tractions from different directions and angles.METHODS: 240 cases suffering CSA were selected and divided into groups according to anatomy angle of lesion parts(upper cervical segments,lower cervical segments,mixed type)and traction mode,angel(anteversion sitting position 1°-10°,11°-20°,21°-30° groups,posterior extension sitting position 1°-10°,11°-20°,21°-30° groups,neutral position sitting position group).Local massage served as control group.The indexes of vertebral artery of neck part including inner diameter(D)of narrowest location,peak systolic velocity and average velocity of blood were measured by CDFI adding the test of turning neck.The indexes of left vertebral artery,right vertebral artery and basiiar artery including peak velocity(Vp)of period of contraction and mean velocity(Vm)of blood were measured by TCD adding the test of turning neck.RESULTS AND CONCLUSION: ①We determined vertebral artery type of cervical spondylosis on the base of anatomic site. On the basis of diseased region,we divided cervical syndrome into 3 types.They were superior part(C1-C3),inferior part (C4-C6) and commixture.it offers clinical guidance for traction therapy from spondylous morphous and mechanics.② We determined the gbest angle of traction.The therapeutic efficacy in posterior extension sitting position occupying 11-20～was better in upper hind neck;the therapeutic efficacy in anteversion sitting position occupying 11-20° was better in inferior neck; the therapeutic efficacy in anteversion sitting position occupying 1-10° was better in neutral position sitting position.③ We knew that CDFI and TCD are the convenient,non-invasive,safe and reduplicative methods to guide traction therapy in vertebral artery type of cervical spondylosis.

Objective: To investigate the general situation of sleep duration, sleep quality and related risk factors among primary students in Shanghai and to provide evidence for the prevention and control of students sleep health. Methods: By using stratified cluster random sampling method, 3 410 students from 16 primary schools in four urban areas and four suburb areas of Shanghai were selected to conduct sleep health questionnaire survey and physical examination Chi square test was used for group comparison while binary Logistic regression was used to assess possible factors related with sleep quality. Results: The detection rate of sleep insufficiency (<10 h) among students was 93.0%. The detection rate of poor sleep quality was 66.8% with 67.1% in girls and 66.6% in boys. The top three sleep problems were daytime sleepiness(80.9%), irregular sleep duration (74.1%) and sleep anxiety(59.5%). Multivariate Logistic regression analysis showed that everyday moderate-intensity physical activity (OR=1.51, 95%CI=1.04-2.21) and daily walking activity (more than 10 minutes)(OR=1.27, 95%CI=1.08-1.50) were risk factors of poor sleep quality(P<0.05). Conclusion In Shanghai, the prevalence of sleep insufficiency and poor sleep quality among primary students are high. Sleep health was associated with moderate physical activity and walking activity. Increasing the duration of moderate physical activity and daily walking activity is the very important measures in prevention and control of the sleep problems.

Objective: To investigate the relationship between body fat percentage (BF%) and high blood pressure among adolescents in Shanghai, and to provide basis for early prevention and intervention of cardcovascular diseases. Methods: By using stratified cluster sampling method, a total of 5 148 adolescent students in 16 schools from 16 districts of Shanghai were selected. Questionnaire survey and physical examination were performed. The bioelectrical impedance analysis (BIA) was used to measure body fat percentage. National Blood Pressure Reference for Chinese Han Children was used to define high blood pressure. And T test, chi-square test and Logistici regression were used to assess the relation between BF% with high blood pressure. Results: The prevalence of high blood pressure in 5 148 junior middle school students in Shanghai was 10.98%, with girls (13.13%) higher than boys (8.99%)(χ 2=22.48, P<0.01). The average total body fat percentage of male students was (20.90±10.73)%, which decreased with age (linear trend variance is 10.04, P<0.01). The average total body fat percentage of girls was (25.14±8.03)%, which increased with age (linear trend variance is 69.23, P<0.01). After adjusted for age, diet, exercise and other influencing factors, the prevalence of hypertension showed an increasing trend with the increase of body fat percentage for both boys and girls. The risk of high blood pressure in boys with BF%≥P 90 was 12.43 times higher than that in boys with BF%

Conclusion There was a positive correlation between body fat percentage and high blood pressure in adolescents. The prevalence of high blood pressure increased with the increase of body fat percentage, which was more obvious in boys.

Objective: To investigate the establishment of health care institutions and the staffing primary and secondary school health care in Shanghai, and to understand the capacity building needs of health care personnel. Methods: A survey was conducted on all primary and secondary schools in Shanghai from April to August in 2020. The content of the questionnaire covers the establishment of health care institutions, the staffing of school health care centers and the capacity building need of health care personnel. Chi square test was used to compare the difference of the health care institutions setting and staffing by schools and areas. Results: In 2020, there were 1 847 primary and secondary schools in Shanghai (including branches schools). About 51.4% of primary and secondary schools in Shanghai were equipped with school health care personnel in the ratio of the number of students at least 600∶1 , and the staffing compliance rate of urban schools (59.3%) was higher than that of suburban schools (47.3%)( χ 2=24.27, P <0.01). All school health care personnel believed that there are currently few opportunities for capacity buliding services from health facilities. Conclusion School health care institutions in Shanghai are well equipped, but the staffing shortage is substantial, with strong need for capacity building.

Objective: To establish a risk assessment index system for epidemic infectious diseases in primary and secondary schools, for early warning and prevention of school infectious diseases accurately and timely. Methods: Through literature review, the indicators pool was established by consulting relevant experts and referring to practical experience. Then two rounds of expert consultation using the Delphi method were conducted(13 experts of round 1, and 20 experts of round 2). The concentration of expert opinions (the average, the percentage of full marks) and the coordination of expert opinions (the coefficient of variation, the coordination coefficient W ) were calculated and analyzed. The coordination coefficient W was obtained by nonparametric Kendall s W test of multiple samples. According to the experts feedback, necessary addition, reduction and modification of the indicators were carried out to determine the evaluation index system, and the analytic hierarchy process (AHP) was used to calculate the weight of each indicator. Results: The expert authority coefficients of the two rounds of consultation were 0.89 and 0.88, respectively, and the form recovery rate was 100%. The range of the variation coefficient of each three level indicator was 0.07-0.31 and 0.06-0.19, and the coordination coefficient W was 0.25 and 0.47, respectively, indicating that the consistency and credibility of expert opinions were good. Finally, the risk assessment index system of infectious diseases in primary and secondary schools was established, which was composed of 5 first level indexes, 23 second level indexes and 86 third level indexes. The AHP was used to calculate the intra level weight of the index. The variation coefficient of five first level indicators of school health management and security system, school health personnel facilities, health monitoring and cognition level, severity and coping measures were 0.09, 0.06, 0.08, 0.12 and 0.06 , respectively, and the weight coefficients were 20.42%, 21.19%, 19.87%, 17.45% and 21.08%, respectively. Conclusion The risk assessment index system of school infectious diseases is applicable to primary and secondary schools. The initiative, coordination and authority of experts in this system are all high. It is of practical guiding significance for the early warning of infectious diseases in primary and secondary schools.

Objective: To investigate incidence of traffic injury and its associated factors among secondary school students in Shanghai, so as to provide scientific basis for intervention. Methods: Using the method of multi stage stratified random cluster sampling, an on-the-spot anonymous questionnaire survey was conducted among 19 629 adolescents from 16 districts in Shanghai from May to June 2021. The multivariate Logistic regression was used to analyze possible associated factors. Results: The rate of road traffic injuries among secondary school students in Shanghai was 0.74%, the highest reporting rate among secondary vocational school students (1.35%), followed by junior high school students (0.72%), and the lowest reporting rate of road traffic injuries among senior high school students (0.55%), with statistically significant differences ( χ 2=13.39, P <0.01). The results of multivariate Logistic regression analysis showed that the junior high school ( OR =0.56, 95% CI =0.35-0.89) or senior high school ( OR = 0.40 , 95% CI =0.24-0.68) and residential school ( OR =0.39, 95% CI =0.18-0.88) were protective factors of road traffic injuries( P <0.05). Male ( OR =1.65, 95% CI =1.14-2.37), unaware of seat belt ( OR =6.38, 95% CI =2.81-14.50), had a cycling chase/fight ( OR =2.33, 95% CI =1.39-3.90), music or phone calls on a bicycle ( OR =2.54, 95% CI =1.72-3.75) were positively correlated with road traffic injury( P <0.05). Conclusions The road traffic injury among secondary school students in Shanghai is related to many factors, and traffic hazards are common among students in all school sections. Targeted measures should be taken to strengthen traffic safety knowledge education and intervention in healthy behaviors among adolescents, in order to reduce the incidence of road traffic injury.

Purpose/Significance To review the knowledge discovery methods based on knowledge graph in the biomedical field,and to provide references for researchers.Methods/Process The paper summarizes the knowledge discovery methods based on knowledge graph by systematically searching and analyzing the relevant literatures,and compares the advantages and disadvantages of various knowl-edge discovery methods.It points out that the limitations and challenges of knowledge discovery methods based on knowledge graph in the biomedical field,and puts forward suggestions and prospects.Result/Conclusion In the future research,it is suggested to improve the in-terpretability of knowledge discovery results,build an effective result evaluation framework,and establish a standardized knowledge dis-covery process with multi-domain experts'collaboration,so as to improve the quality and efficiency of knowledge discovery research.

Objective:To explore the effect of collaborative teaching on anesthesia nursing.Methods:A total of 50 anesthesiology nursing undergraduates were randomly selected from the Batch 2018 of Harbin Medical University as experimental group and control group respectively. The two groups completed the teaching tasks in the same teaching hours. The control group was taught by traditional teaching method. The experimental group was jointly taught by the teaching team composed of anesthesia nursing teachers, humanistic medicine teachers and ideological and political teachers. After the completion of teaching, the two groups of students were surveyed by questionnaire to evaluate the teaching effect. SPSS 22.0 was used Fisher's exact probability test.Results:The questionnaire results showed that in the evaluation of collaborative teaching, the evaluation of expanded ideological, political and humanistic knowledge (96.00%, 48/50), strengthened the understanding of theoretical knowledge (88.00%, 44/50), improved doctor-patient communication ability (90.00%, 45/50), improved clinical strain ability (94.00%, 47/50), and improved professional identity (86.00%, 43/50) of the experimental group was significantly higher than that of the control group ( P<0.05). Conclusion:The collaborative teaching method in anesthesiology nursing course can not only strengthen students' mastery of clinical skills, but also cultivate lofty sense of mission and professional spirit, strengthen doctors' benevolent belief, improve medical students' comprehensive quality in an all-round way, and promote the development of new medical education.

Objective:To explore the effect of neutrophil-lymphocyte ratio (NLR) at the initial visit on the survival of children with newly diagnosed medulloblastoma (MB).Methods:This was a case-control study involving 61 children with newly diagnosed MB at the Department of Pediatrics, Beijing Shijitan Hospital, Capital Medical University from August 2018 to January 2020 .The blood cell counts, lymphocyte subsets and immunoglobulin in the periphe-ral blood were measured to calculate NLR at the initial visit.Based on the cut-off value determined by receiver opera-ting characteristic (ROC) curve, patients were divided into high NLR group (≥ 2.07, n=21) and low NLR group (<2.07, n=40). The progression-free survival (PFS) and overall survival (OS) between 2 groups were analyzed by the Kaplan-Meier method, followed by Log- rank test.The correlation between NLR at the initial visit with clinical characteristics, lymphocyte subsets and immunoglobulin of children with newly diagnosed MB was analyzed.Differences between groups were compared by the Chi- square test, Mann- Whitney U test and independent sample t test. Results:The survival analysis showed that the relapse rate (38.1% vs.10.0%, χ2=6.879, P=0.016) and mortality rate (19.0% vs.0, χ2=8.154, P=0.011) were significantly higher in high NLR group than those of low NLR group.PFS (12 months vs.19 months, χ2=9.775, P=0.002) and OS (19 months vs.20 months, χ2=8.432, P=0.004) were significantly shorter in high NLR group than those of low NLR group.No significant differences in clinical characteristics were detected between groups (all P>0.05). Compared with low NLR group, the percentage of T lymphocyte[(67.93±6.37)% vs.(73.38±8.08)%, t=2.886, df=48.865, P=0.006], T helper cells (Th)[(30.86±5.53)% vs.(34.29±7.44)%, t=2.037, df=51.981, P=0.047], and T suppressor cells (Ts)[(27.39±5.50)% vs.(30.84±6.58)%, t=2.164, df=47.581, P=0.035] were significantly lower in high NLR group.Spearman correlation analysis showed a negative correlation between NLR and T lymphocyte count ( r=-0.303, P=0.018), and Ts lymphocyte count ( r=-0.260, P=0.043). Conclusions:Children with newly diagnosed MB expressing a high level of NLR had a poor prognosis, which may be associated with T lymphocyte and Ts lymphocyte.