【Objective】 To clarify the concept of health literacy among children and adolescents with accidental injuries through literature review and analysis. 【Methods】 A systematic search was conducted across multiple databases, including China National Knowledge Infrastructure, Wanfang database, VIP database, China Biomedical literature database, PubMed, CINAHL, and PscyINFO database. The literature was analyzed using Rodgers′ evolutionary concept analysis method. 【Results】 A total of 56 articles were included. The health literacy of children and adolescents with accidental injuries comprised three conceptual attributes:cognition, emotion and behavior. The influencing factors included children′s demographic factors, family and school related factors and social related factors. The result can be beneficial to reduce the occurrence of injury events, save family economic expenditure and alleviate the burden on social medical resources. However, there is currently a lack of specific measurement tools for assessing health literacy in this population, as the existing evaluation items are drawn from general health literacy scales. 【Conclusions】 The concept of health literacy among children and adolescents with accidental injuries is multifaceted and evolving. Future research should focus on exploring the characteristics of health literacy among children and adolescents of different ages and regions from their own perspectives. Additionally, efforts should be made to refine the concept and develop specialized measurement tools to facilitate further studies in this area.

Objective:To investigate the serum thyroglobulin (Tg) levels of women in early pregnancy in Dali City, Yunnan Province, and provide a scientific basis for evaluation of individual iodine nutrition of early pregnant women in this area.Methods:Dali City, Yunnan Province was divided into 5 sampling areas according to east, west, south, north and middle. One township (town) was selected from each area, and at least 20 women in early pregnancy were selected from each township (town) as survey subjects. General condition and medical history of all subjects were collected, and random urine samples and fasting venous blood samples were collected for determination of urinary iodine and thyroid function indexes, and a portable ultrasound machine was used for thyroid ultrasonography. After excluding the patients with a history of thyroid disease and abnormal thyroid function, the level of Tg in the included early pregnant women was analyzed.Results:A total of 120 women in early pregnancy were investigated, aged from 19 to 40 years. Among them, 61 cases came from urban areas and 59 were from rural areas. The median urinary iodine was 156.54 μg/L, which was at the appropriate level of iodine nutrition. A total of 102 women with normal thyroid function in early pregnancy were included, and the Tg level was 11.56 (6.67, 15.27) ng/ml. Among them, 58 cases were in urban areas and 44 cases were in rural areas. There was no significant difference in serum Tg levels between rural and urban women in early pregnancy ( U = 1 362.50, P = 0.559). Conclusion:The serum Tg level of women in early pregnancy in Dali City can provide a reference for evaluation of individual iodine nutrition of relevant populations in this area.

Objective:To analyze the clinical efficacy of inter-spinal distraction fusion and fixation and Posterior lumbar interbody fusion in the treatment of lumbar disc herniation with stenosis, and to evaluate the health economics of the two surgical methods.Methods:Retrospectivly analyzed the clinical data of 400 patients with lumbar disc herniation with stenosis, who were enrolled in Beijing Friendship Hospital, Capital Medical University from Jan. 2015 to Jan. 2019, including 190 male cases and 210 female cases, aged from 50 to 87 years old, with the average age of 67.97. All patients were divided into two groups according to different surgical methods. Among them, 200 patients used interspinous process fusion and distraction fixation (ISDFF group), the other 200 cases used posterior lumbar decompression and pedicle internal fixation (PLIF group). All patients completed the follow-up time of more than 1 year after operation. The basic information of patients′ age, gender, total number of days in hospital, intraoperative bleeding, operation time, surgical incision length and other basic information were observed. The Oswestry dysfunction index (ODI), the Japanese Orthopaedic Association Score (JOA) and the visual analog scale (VAS) were used to evaluate the relief of symptoms before and after the two groups of patients. Total medical expenses, anesthesia expenses, surgical expenses and other expenses were analysed. The software of SPSS 20.0 were conducted to analyze data.Results:The patients in the ISDFF group were (70.84±8.93) years old, and the PLIF group was (65.10±10.23) years old ( t=5.98, P=0.008). The operation time in the ISDFF group was (59.21±16.22) min, and the operation time in the PLIF group was (81.31±17.24) min( t=13.20, P<0.001). The bleeding volume of the ISDFF group was (33.24±11.31) mL, and the bleeding volume of the PLIF group was (67.30±17.61) mL ( t=23.02, P<0.001). The length of the surgical incision in the ISDFF group was (8.27±2.53) cm, and the length of the surgical incision in the PLIF group was (11.15±1.91) cm ( t=11.848, P<0.001). The total hospitalization time in the ISDFF group was (15.15±0.54) days, and the total hospitalization time in the PLIF group was (19.86±0.97) days( t=4.26, P<0.001). There was no significant difference in preoperative ODI, JOA and VAS between the two groups ( P>0.05). Symptoms of postoperative patients were significantly improved compared with preoperative. There were statistical differences in ODI, JOA and VAS between the two groups before and after operation ( P<0.05). However, ODI, JOA and VAS were no statistical difference between the two groups after operation. Complications occurred in 5 cases of the two groups of patients, including two cases of superficial infection in the PLIF group, two cases of dural tear in the PLIF group, one case of spinous process fracture in the ISDFF group. The total hospitalization fee for ISDFF was (57 450±8 670) (yuan), and the total hospitalization fee for PLIF was (75 770±1 640) (yuan), with statistical differences ( t=9.92, P<0.001). The cost of ISDFF operation was 1864±38.19 (yuan), and the cost of PLIF operation was 2352±41.39 (yuan) ( t=8.65, P<0.001). ISDFF antibacterial drug usage fee was 635.5±64.69 (yuan), PLIF antibacterial drug usage fee was 1449±307.1 (yuan) ( t=2.59, P<0.001). The one-time medical material cost during the ISDFF operation was (38 990±300) (yuan), and the one-time medical material cost during the PLIF operation was (52 110±150) (yuan) ( t=5.88, P<0.001). The excellent and good rate of ISDFF group was 92%, and that of PLIF group was 86%. In this study, the total cost of hospitalization was used as an indicator to measure the cost, and further cost-effectiveness evaluation was made. For every good patient, the cost of the ISDFF group was 62 450 yuan, and the cost of the PLIF group was 88, 100 yuan. Conclusions:ISDFF is beneficial to reduce the cost of medical insurance in China, which is in line with the direction of national reform to reduce medical expenditure. It is a surgical method worthy of wide promotion and has a good application prospect.

Objective:To analyze the effect of inter-spinal distraction fusion and fixation (ISDFF) combined with limited decompression on the treatment of lumbar spinal stenosis in elderly patients.Methods:A total of 32 elderly patients with lumbar spinal stenosis, aged from 80 to 87 years old (mean age: 82.0±2.0 years) including 10 males and 22 females, in the Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University from January 2016 to January 2020 were enrolled in this retrospective study. Clinical evaluation and imaging measurement were performed before operation, after operation, 6 months and 24 months after operation. SPSS software was used for statistical analysis. Measured data of normal distribution were expressed as means±standard deviation. One way analysis of variance was used for comparison between groups. Paired t-test was used to compare between preoperative and postoperative as well as between preoperative and 24 months′ follow-up. Results:All of the 32 patients had one or more common accompanying diseases, such as hypertension, diabetes, coronary heart disease, and so on. All patients were successfully completed the operation with a total of 32 segments. VAS score was decreased from (6.22±0.91) before operation to (1.94±0.76) at 24 months( t=16.52, P<0.001). ODI score was also demonstrated the similar trend, from (54.17±10.65) preoperatively to (19.91±4.20) at 24 months follow-up( t=15.89, P<0.001). JOA score was significantly increased from (11.69±3.36) before surgery to (23.44±1.66) at the last follow-up ( t=-19.90, P<0.001). In the change of imaging, the intervertebral angle was decreased from preoperation (9.12±4.65) to (6.77±2.70) at 24 months( t=3.53, P=0.001). The posterior disk height was increased from (0.68±0.19) cm to (0.76±0.19) cm at the last follow-up( t=-2.45, P=0.020). Conclusions:As a new type of minimally invasive internal fixator, the ISDFF combined with limited decompression can relieve the pain of elderly patients with lumbar spinal stenosis and improve the quality of life. It is suitable for the treatment of elderly patients with lumbar spinal stenosis.

The thioredoxin system is composed of thioredoxin (Trx), thioredoxin reductase (TR) and reduced nicotinamide adenine dinucleotide phosphate. Trx is an important antioxidant molecule that can resist cell death caused by various stresses and plays a prominent role in redox reactions. TR is a protein containing selenium (selenocysteine), mainly in three forms, i.e. TR1, TR2 and TR3. TR1 mainly distributed in the cytoplasm, TR2 mainly distributed in the mitochondria, and TR3 mainly distributed in the testes. TR can regulate cell growth and apoptosis. After the cell becomes cancerous, the expression of TR increases to promote cell growth and metastasis. Trx system is closely related to neurodegenerative diseases, parasitic infections, acquired immunodeficiency syndrome, rheumatoid arthritis, hypertension, myocarditis and so on. The Trx system can remove the reactive oxygen species (ROS) in the body, keep the inside and outside of the cell in a balanced state, and it interacts with the thioredoxin interacting protein (TXNIP), which plays an important role in the regulation of glucose metabolism and tumor treatment. The Trx system is an important target for drug treatment of many diseases. In this paper, the research progress of the thioredoxin system was reviewed.

Objective:To investigate and analyze the prevalence of thyroid disease during pregnancy in Dali, Yunnan Province, and to provide scientific basis for prevention and treatment of benign thyroid disease during pregnancy in the region.Methods:From July to December 2014, Dali in Yunnan Province was divided into 5 sampling areas according to east, west, south, north and middle. One township (town) was selected from each area, and at least 20 women in early, middle and late pregnancy, respectively, were selected from each township (town). To conduct this investigation, medical history data was collected, thyroid ultrasound examination and serological indexes of thyroid function test were performed based on the normal reference value of specific thyroid function serological indexes during pregnancy in this region.Results:A total of 370 cases of pregnant women were investigated, including 120 cases in early pregnancy (61 cases in urban areas and 59 cases in rural areas), aged 19 - 40 years; 126 cases in middle pregnancy (60 cases in urban areas and 66 cases in rural areas), aged 19 - 45 years; and 124 cases in late pregnancy (57 cases in urban areas and 67 cases in rural areas), aged 19 - 44 years. The detection rate of thyroid disease in pregnant women was 27.57% (102/370). The detection rate of thyroid dysfunction was 7.57% (28/370), the positive detection rate of thyroid antibody was 11.62% (43/370), and the detection rate of thyroid nodule was 13.51% (50/370). The detection rates of thyroid diseases in early, middle and late pregnancy were 33.33% (40/120), 23.02% (29/126), 26.61% (33/124), respectively, and the difference was not statistically significant(χ 2 = 3.362, P > 0.05). Conclusions:In Daliy, Yunnan Province, there is a high detection rate of thyroid diseases during pregnancy, especially in early pregnancy. Therefore, it is necessary to carry out further large-scale investigation and study to provide a more reliable scientific basis for prevention and treatment of thyroid disease during pregnancy in this region.

Objective:To evaluate the clinical effect of interspinous process fusion (BacFuse) in the treatment of lumbar disc herniation (LDH) with rheumatoid arthritis (RA).Methods:A retrospective analysis of the clinical data of 50 patients with RA and LDH from May 2013 to June 2018 in department of orthopedics, Beijing Friendship Hospital, Capital Medical University was conducted. Among them, there were 9 males and 41 females, aged (66.60±4.23) years, with an age ranging from 54 to 84 years. According to different surgical methods, the patients were divided into posterior lumbar interbody fusion (PLIF) group ( n=26) and BacFuse group ( n=24). Operative time, intraoperative blood loss and operative complications of the two groups were observed. Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA) scores were used to evaluate the clinical effect at preoperative, 3 days of postoperative and the last follow-up. The measurement data were expressed as mean±standard deviation( Mean± SD), comparison between groups used t test and the count data were expressed as percentage(%), the chi-square test was used for comparison between the two groups. The clinical effect of the two groups were compared by repeated analysis of variance. Results:In the PLIF group, the operation time and bleeding volume were (174.62±55.59) min, (309.62±30.26) mL, respectively. In the BacFuse group, the operation time and bleeding volume were (71.25±12.96) min, (57.92±9.32) mL, respectively. The differences between the two groups were statistically significant ( P<0.05). The operative complications in the PLIF group (8 cases) was significantly higher than that in the BacFuse group (2 cases) , the difference between the two groups was statistically significant ( χ2 = 3.926, P=0.048). There were significant differences between every two scores among the preoperative, 3 days of postoperative and last follow-up in ODI of the PLIF group( F=760.231, P<0.001). The preoperative, 3 days of postoperative and last follow-up ODI scores of the BacFuse group were significant differences between every two scores ( F= 952.525, P<0.001). There were no significant differences in ODI scores between the two groups [( t=-1.13, P=0.263), ( t=0.706, P=0.483), ( t=0.389, P=0.699)]. There were significant differences between every two scores among the preoperative, 3 days of postoperative and last follow-up in JOA of the PLIF group( F=406.012, P<0.001). The preoperative, 3 days of postoperative and last follow-up in JOA scores of the BacFuse group were significant difference between every two scores ( F=457.760, P<0.001). There were no significant differences in JOA scores between the two groups [( t=0.825, P=0.414), ( t=1.909, P=0.062), ( t=1.086, P=0.283). Conclusions:Compared with PLIF, BacFuse has a similar clinical effect in the treatment of LDH with RA, but BacFuse is less invasive and has fewer postoperative complications. BacFuse is an effective minimally surgical method for the treatment of LDH with RA.

In this paper we are going to discuss the performance appraisal system based on RBRVS which has been used in residency program examination, as well as the new supervision and assessment mode of "self-sufficient training" that has been established. Formulas designed exclusively for residents are pro-posed based on RBRVS, respecting and embodying residents' value. Additional reward shall be offered to residents with the national and local financial aid, making sure that residents shall settle down in residency program and the quality of the program is ensured and improved.

Objective To explore the CT features and pathology of intrapulmonary lymph nodes (IPLNs), so as to improve the understanding and diagnosis of IPLNs. Methods A total of 38 patients (49 IPLNs) who were confirmed by the surgery and pathology were retrospectively analyzed, including 21 males and 17 females with a mean age of (56±8) years. All the patients underwent MSCT scan and 1.0 mm thin layer reconstruction before surgery. Double-blind method was used to analyze CT signs and the corresponding histopathological changes were compared. Results (1) Location: all IPLNs were located below the level of tracheal carina with 17 were on the left lung, and 32 were on the right lung. (2) Shape: 34 IPLNs were round, 15 were triangular or prism and so on. (3) Size: the maximum diameter of IPLNs ranged from 0.26 to 1.28 cm (0.66±0.23 cm), of which 45 cases were≤1.0 cm. (4) Quantity: 28 IPLNs were solitary and 10 were multiple. (5) Density: All 48 IPLNs were solid nodules with a median CT value of 43 HU (range from 19 to 106 HU), and there were no calcification, vacuoles and air bronchial signs were showed. (6) Margin and pleura: all the 48 IPLNs boundaries were clear and smooth, and 45 pieces were less than 1.0 cm from the pleura, of which 20 were close to the pleura or inter-lobar fissure. (7) Other: no"satellite focal", pleural depression syndrome, and vascular bundle sign were showed;22 peripheral fine lines of IPLNs were visible. (8) Pathology: IPLNs were dark brown or gray-black nodules with well-defined borders, coated, tough, hard, and carbon deposition could be seen in most cases. Conclusion IPLNs are benign nodules in the lung, which have certain CT features and typical pathological changes. Based on the CT performance and characteristics, it is helpful to make correct diagnosis of IPLNs before operation.

Objective: To analyze the mental health status and its impact factors among nurses, finding ways to improve the mental health of nurses. Methods: A total of 13 425 female healthcare workers aged from 18 to 65 were selected as study objects. The survey was conducted with unified design questionnaire. The survey included the basic situation of the individuals and SCL-90 questionnaire. Comparing the female doctors, the mental health status and its impact factors of nurses were analyzed. Results: The income, age, education and occupation, which include shift work, heavy work load and overtime work are different between nurses and doctors. The main mental health problems of nurses were obsessive-compulsive symptoms, depressive symptoms and somatization. The results of univariate analysis indicated that shift work, overtime work, and heavy work load affected the positive rate of each factor. The results of multivariate analysis showed that occupation, shift work, overtime work, and heavy work load have significant adverse effects on the positive rate of the total score in female healthcare workers (P<0.01) . The positive rate of each dimension of SCL-90 in nurses is significantly higher than that of doctors. Conclusion The mental health problems of nurses are significantly higher than doctors. The main reasons are low occupational level and adverse workstyles which include shift work, heavy workload and so on. Health administration and hospital management departments should pay much more attention to the mental health of nurses, improving their mental health through a variety of ways.