OBJECTIVE To form an expert consensus on the clinical application of parenteral direct thrombin inhibitors （DTIs） in patients during the perioperative period. METHODS Led by Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital （the Affiliated Hospital of UESTC）， a multidisciplinary working group was established. Through literature review and the Delphi method， clinical questions related to the rational perioperative use of parenteral DTIs were identified. A structured design was adopted using the “Population-Intervention-Comparison-Outcome” framework； systematic searches were conducted in CNKI， Medline， Embase and other databases. Relevant evidence from randomized controlled trials and cohort studies was included and synthesized. Evidence quality was assessed using the Grades of Recommendations Assessment，Development and Evaluation （GRADE） approach， and recommendations were formulated through multiple rounds of Delphi surveys and expert consensus meetings. RESULTS &CONCLUSIONS Seven recommendations （each with an expert consensus rate exceeding 90%） on the use of parenteral DTIs in perioperative patients were developed. These recommendations specify drug selection， dosing ranges， key monitoring points， and safety management strategies for parenteral DTIs in various scenarios， including the perioperative period of ventricular assist device implantation， the perioperative period of cardiac surgery， perioperative patients with lower-extremity atherosclerotic disease， the perioperative period of percutaneous coronary intervention in patients with acute coronary syndrome， the perioperative period of carotid artery stenting in patients with carotid stenosis， the perioperative period of patients with right heart thrombosis， and patients who develop related thrombosis and dysfunction after a central venous catheter insertion. In addition， warning and management pathways for perioperative bleeding and thrombotic events were proposed. This expert consensus， which is formulated based on the best available evidence， provides evidence-based guidance for standardized and individualized use of parenteral DTIs in perioperative period.

Objective To evaluate the value of postoperative radiotherapy (PORT) in patients with stage ⅢA-N2 non-small cell lung cancer who received complete resection and chemotherapy. Methods Patients with stage ⅢA-N2 non-small cell lung cancer who received complete resection and chemotherapy were chosen from the SEER Research Plus Database [17 Registries, November 2012 Submission (2000-2019)]. The patients were divided into a PORT group and a non-PORT group according to whether the PORT was used. To balance baseline characteristics between non-PORT and PORT groups, R software was used to conduct a propensity score matching (PSM) with a ratio of 1 : 1 and a matching tolerance of 0.01. Both the Cox regression analysis and Kaplan-Meier survival analysis were conducted to evaluate the value of PORT in terms of overall survival (OS) and disease-specific survival (DSS). Results In total, 2468 patients with stage ⅢA-N2 non-small cell lung cancer were enrolled, including 1078 males and 1390 females with a median age of 65 (58-71) years. There were 1336 patients in the PORT group, and 1132 patients in the non-PORT group. Cox regression analysis showed that PORT was not significantly associated with OS (multivariate analysis: HR=1.051, 95%CI 0.949-1.164, P=0.338) and DSS (multivariate analysis: HR=1.094, 95%CI 0.976-1.225, P=0.123). No statistical difference was found in the OS or DSS between non-PORT group and PORT group after PSM analysis (P＞0.05). Conclusion PORT does not have a survival benefit for patients with stage ⅢA-N2 non-small cell lung cancer who received complete resection and chemotherapy.

Objective:To explore the epidemiological characteristics and spatiotemporal clustering of foodborne infection of Vibrio ( V.) parahaemolyticus in Ningbo, Zhejiang Province, from 2014 to 2022, and provide reference and evidence for the prevention and control of related diseases. Methods:The incidence data on of foodborne infection of V. parahaemolyticus in Ningbo from 2014 to 2022 were collected from Ningbo Foodborne Disease Surveillance System, and the case counts and the positive rates in different districts (counties, cities) were calculated. Spatial autocorrelation analysis and spatiotemporal scanning analysis were conducted to analyze the spatiotemporal clustering of the diseases. Results:A total of 1 822 cases of foodborne infection of V. parahaemolyticus were reported in Ningbo from 2014 to 2022, with an overall positive rate of 3.78%. Spatial autocorrelation analysis showed that the positive rate of foodborne infection of V. parahaemolyticus in Ningbo was unevenly distributed from 2014 to 2022, Ninghai was a high-high clustering area, while Zhenhai was a high-low clustering area, and Jiangbei was a low-low clustering area. The annual incidence was high during July-September. Spatiotemporal scanning analysis found one class Ⅰ spatiotemporal clustering area and three class Ⅱ spatiotemporal clustering areas, with the class Ⅰ spatiotemporal clustering area being observed in Jiangbei and Zhenhai from 2019 to 2022. Conclusions:Spatiotemporal clustering of foodborne infection of V. parahaemolyticus existed in Ningbo from 2014 to 2022, with an annual high incidence period from July to September. The key areas for the prevention and control of foodborne infection of V. parahaemolyticus are coastal districts (counties, cities) in Ningbo.

OBJECTIVE To evaluate the impact of sublingual immunotherapy(SLIT)on the balance of Treg/Th17 cells and related cytokines in preschool children aged 3-6 years with allergic rhinitis(AR).METHODS Seventy preschool children aged 3-6 years with AR were divided into the SLIT group and the medication group,and their clinical data were retrospectively analyzed.The medication group received symptomatic treatment alone,while the SLIT group received a combined treatment of SLIT and symptomatic medication,with a 3-year follow-up period.The Treg/Th17 cell balance,serum levels of TGF-β,IL-10,IL-17,IL-21,as well as the total nasal symptom score(TNSS),total medication score(TMS),and visual analog scale(VAS)scores were compared before and after treatment between the two groups.RESULTS After 3 years of treatment,both groups showed significant improvements(P<0.05)in the percentages of CD4+CD25+Foxp3+Treg and CD4+IL-17+Th17 cells among CD4+T cells,percentages of Treg and Th17 cells,serum levels of TGF-β,IL-10,IL-17,IL-21,TNSS,TMS,and VAS scores.Moreover,the SLIT group exhibited significantly better outcomes compared to the medication group(P<0.05).CONCLUSION SLIT can modulate the balance of Treg/Th17 cells and improve serum levels of TGF-β,IL-10,IL-17,and IL-21.

Objective: To analyze the situation and associated factors of school lunch leftovers of primary and middle school students in Ningbo, so as to provide a basis for formulating policies to improve the quality of nutritious meals and reduce the leftover meal rates. Methods: During March to May of 2022, 20 primary and middle schools were selected from 10 districts in Ningbo, and 4 443 students were selected from grade 4 to 6 of primary school and grade 1 to 3 of middle school. A questionnaire was conducted among them for the students general situation and remaining meal situation. Results: The total leftover rate was 62.4%, 7.9% of the students left rice every day, and 18.3% of the students left vegetables every day. The frequency of primary school students leftover food was lower than that of junior high school students ( χ 2=-2.18, P <0.05). Most of the students (68.3%) had only a little leftover food, half of the students (49.4%) had less than half leftovers, and the proportion of primary school students with large leftover food and leftovers was smaller than that of junior high school students ( χ 2=-2.05, -2.36, P <0.05). The main reason for students leftover food was "too much to eat" (accounting for 30.6%), and there was a statistical difference between primary school students and junior high school students in the composition of leftover food and leftovers ( χ 2=16.94, 14.28, P <0.05). The leftover rate of vegetables was the highest (54.5%) and the leftover rate of milk was the lowest (2.5%). Multivariate Logistic regression model showed that nutrition and food related courses during recent year, being aware the Chinese residents dietary guidelines, statisfaction with canteen food (general, more satisfied, very satisfied), reckoning school canteen food better than home food (almost, better than home) were less possibility to have leftover meals ( OR=0.79, 0.73, 0.57, 0.41, 0.26, 0.69, 0.82, P <0.05). Students chosed the meal after the teacher served the meal, the teacher divided meals and students who ate more frequently (4-6 times/week, 1 time/d, 2 times/d, ≥3 times/d) were more likely to have leftover meals ( OR=1.64, 2.23, 1.27, 1.21, 1.52, 1.44 , P < 0.05). Conclusion More than half of the students have leftovers. It should optimize the configuration of nutrition lunch, strengthen the education of nutrition knowledge and reduce the leftovers rate.

Objective: To analyze the epidemiological and pathogenic characteristics of foodborne diseases among students in Ningbo from 2014 to 2021, so as to provide a scientific basis for the prevention and control of foodborne diseases in schools. Methods: Information on foodborne disease cases among students attending all surveillance hospitals in Ningbo from 2014 to 2021 was collected from the Foodborne Disease Surveillance System of Zhejiang Province, and epidemiological characteristics and pathogenic analysis were analyzed. Results: A total of 3 602 cases of foodborne diseases in the student population were reported in Ningbo, of which 54.58% were males and 45.42% were females. Students aged 18 years and above accounted for the highest incidence group, and the incidence time mainly showed two peaks in May to June and September to October. Meat and meat products accounted for the largest proportion of suspicious foods (21.11%), and the positive pathogen detection rates were 11.20% for Norovirus, 3.30% for Vibrio parahaemolyticus, 1.77% for Salmonella, 1.30% for diarrheogenic Escherichia coli and 0.18% for Shigella. Conclusion The main suspect foods for foodborne diseases among students in Ningbo are primarily meat and meat products, and the main etiological agent is norovirus, which requires strengthening food safety health education and food safety management.

Objective: To investigate the lunch supply in primary and middle school dining rooms in Ningbo City, so as to provide the scientific evidence for guiding rational dietary supply and improving student health. Methods: A primary school and a junior high school were randomly sampled from each of 10 counties (districts) in Ningbo City. Food receipt and balance, dinner supply and number of students with meals were collected from school dining rooms with questionnaires formulated by Zhejiang Provincial Center for Disease Control and Prevention, and all foods in school dining rooms provided by enterprises were sorted and recorded. Daily mean lunch food, energy and nutrient supply was calculated per student, and evaluated with the Student Electronic Nutritionist platform, the 2013 revision of Chinese Dietary Reference Intakes and the national criteria of Nutrition Guidelines of Student Meals (WS/T 554-2017). Results: Six urban primary schools, six urban junior high schools, four rural primary schools and four rural junior high schools were enrolled, and there were two schools with meals provided by enterprises and eighteen schools with meals provided by their dining rooms. Appropriate supply of cereals and potatoes, excessive supply of livestock and poultry meat, vegetable oil and salt, and low supply of fruits, eggs, milk and soybean and nuts were found in primary and junior high school, and notably, milk and fruits were not provided by any rural junior high schools. Excessive energy supply was found in primary schools (excessive energy supply in rural primary schools and appropriate in urban primary schools), and appropriate energy supply was seen in junior high schools. High energy ratios of protein and fat, low energy ratio of carbohydrate, low supply of diatery fiber, vitamin A and calcium, appropriate supply of vitamin B1, B2 and C, and sufficient supply of iron and zinc were found in primary and junior high school. Conclusion Unreasonable dietary structure, excessive energy supply and nutrient imbalance are found in lunch supply by primary and junior high schools in Ningbo City.

Objective To establish and verify the fluctuation of reference intervals for biochestry parameters in routine physical exami-nation. Methods The results of biochemistry parameters,i.e., total protein (TP), albumin (Alb), total bilirubin (T-Bil), alanine aminotransferase (ALT), glucose (Glu), urea (Urea), creatinine (Cr), uric acid (UA), triacylglycerol (TG) and total cholesterol ( TC) from 2 089 healthy subjects in routine physical examination during consecutive 2014, 2015 and 2016 were randomly collected, in which all the results were within the reference range. The ratio (λ1) of the results of 2015 to those of 2014, and ratio (λ2) of the re-sults of 2016 to those of 2015 were calculated. λ1was analyzed statistically to establish the fluctuation of reference interval (CIλ). CIλ was verified by λ2.The personalized reference interval (CIp) was established by multiplying each result of 2015 and the upper and low-er limits of CIλ. The CIpwas verified by the results of 2016. The ratios of CIpto the upper and lower limits of conventional reference in-terval were calculated. Results The values of CIλwere as follows: TP: 0.91 to 1.08, Alb: 0.91 to 1.08, T-Bil: 0.58 to 1.74, ALT:0.49 to 1.99, Glu: 0.84 to 1.20, Urea: 0.67 to 1.50, Cr: 0.82 to 1.22, UA: 0.77 to 1.32, TG: 0.51 to 1.98 and TC: 0.80 to 1.26. Compared with conventional reference interval, the ratio of the upper and lower limits of CIp was lessened. Conclusion The personal-ized reference interval (CIp) which may increase the sensitivity of conventional reference intervals was established and verified.

Objective To explore the risk factors for perioperative myocardial infarction(PMI) in aged patients undergoing nonneurologic and noncardiac surgery.Methods A total of 9285 inpatients aged 65 or above receiving nonneurologic and noncardiac surgery at Peking University People's Hospital from November 2012 to May 2016 were retrospectively recruited to our study.Patients who had suffered PMI were assigned to a myocardial infarction group(MI group)and others were allocated to a nonmyocardial infarction group(non-MI group).Clinical manifestations,comorbidities,preoperative laboratory test results,polypharmacy,characteristics of operation and anesthesia,and prognosis were analyzed and compared between the two groups.A multivariate logistic regression model was built to evaluate risk factors for PMI in aged patients undergoing nonneurologic and noncardiac surgery.Results PMI occurred in 12 patients(0.13％).Previous stroke or transient ischemic attack(TIA) history (OR =159.254,P ＜ 0.001),cardiovascular heart disease (CHD) history (OR=33.645,P ＜0.001),and chronic kidney disease(CKD) (OR =19.393,P =0.003) were independent risk factors for PMI in aged patients undergoing nonneurologic and noncardiac surgery.PMI was associated with longer hospitalization[29 (15 59) days vs.9 (6-15) days,P ＜ 0.001] and higher mortality(58.3 ％).Conclusions Previous stroke or TIA history,CHD history,and CKD are independent risk factors for PMI in aged patients undergoing nonneurologic and noncardiac surgery.The incidence of PMI in patients with these risk factors is not high,but the mortality will be high and hospitalization will be prolonged once PMI occurs.Patients with these characteristics need more careful perioperative care.

Objective To establish and verify the personalized reference interval of blood cells.Methods The results of blood cells from 2 089 health subjects in 2014,2015 and 2016 were collected.The ratio of the later results to the previous results was defined as the fluctuation (λ).The ratio (λ1) of the results of 2015 to the results of 2014 was calculated and λ1 was analyzed statistically to establish the fluctuation reference interval (CIλ).The ratio (λ2) of the results of 2016 to the results of 2015 was calculated.λ2 was used to verify λ2.The personalized reference interval (CIp) was established by multiplying each result of 2015 and CIλ.CIp was verified by results of 2016.The ratio of the upper and lower limits of CIp was calculated.The ratio of the upper and lower limits of the reference interval (WS/T 405) was calculated.Results The values of CIλ were as follows:WBC (0.66 to 1.53),L(0.67 to 1.51),M (0.50 to 2.00),N(0.56 to 1.78),E(0.4 to 2.51),PLT(0.76 to 1.32),RBC(0.92 to 1.12),Hb(0.92 to 1.11),Hct(0.91 to 1.12),MCV(0.95 to 1.07),MCH(0.95 to 1.05)and MCHC(0.94 to 1.06).The validation tests of CIλ and CIp showed that both CIλ and CIp were suitable for this laboratory.Compared with the reference interval of professional criteria,the ratio of the upper and lower limits of the CIp was smaller than that of traditional criteria.Conclusion CIp for this laboratory was established and verified.Compared with traditional criteria,CIp should be more personalized and highly sensitive.