Objective: To estimate the epidemic threshold and graded intensity thresholds of influenza in Zhejiang Province from 2012 to 2023 using the moving epidemic method (MEM), and evaluate the intensity of influenza epidemics, so as to provide the reference for influenza prevention and control in Zhejiang Province. Methods: The positive rates of influenza virus per week during the influenza epidemic seasons (from 40th week to 20th week of the following year) in Zhejiang Province from 2012 to 2022 were collected through the Chinese Influenza Surveillance Information System. A MEM model was established and optimized using cross-validation. The maximum accumulated rates percentage was used to divide the epidemic into pre-epidemic, epidemic, and post-epidemic periods, and to estimate the epidemic thresholds and graded intensity thresholds. The intensity of influenza epidemics in Zhejiang Province during the 2022-2023 epidemic season were assessed. Results: The positive rates of influenza virus in five epidemic seasons from 2012 to 2022 were included in the model. The MEM model performed best when the parameter δ was set to 1.5, with a sensitivity of 0.971, a specificity of 0.745, and a Youden's index of 0.716. According to the model analysis, the epidemic beginning and ending thresholds of influenza in Zhejiang Province during the 2022-2023 epidemic season were 19.32% and 10.92%, respectively, and the medium, high, and extremely high intensity thresholds were 48.65%, 63.49%, and 68.47%, respectively. During 2022-2023, the influenza epidemic was in the pre-epidemic period from the 40th week in 2022 to the 7th week in 2023; the epidemic period was from the 8th to the 18th week, the epidemic intensity was low in the 8th week and increased to a high level in the 9th week, and reached to a extremely high level from the 10th to the 13th week, then fell to the high and the medium level in the 14th week and 15th week, respectively, and fell to a low level from the 16th to the 18th week; the influenza epidemic entered the post-epidemic period since the 19th week. Conclusion MEM could be applied for evaluation of influenza epidemic intensity, providing the reference for early identification and taking graded preventive and control measures.

Objective:To observe the clinical effect of free posterior interosseous artery perforator flap carrying superficial vein for reconstructing severe perioral scar hyperplasia and contracture.Methods:The retrospective observational study method was used. From August 2019 to March 2023, 11 patients with severe perioral scar hyperplasia and contracture after severe facial burns who met the inclusion criteria were admitted to General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University). All patients were male and aged 23 to 56 years, with an average age of 31.3 years. After the perioral scar was removed and released, the wound area was 3.0 cm×2.0 cm to 10.5 cm×2.0 cm. The free posterior interosseous artery perforator flap carrying superficial vein was used to repair the wound, and the flap incision area was 3.5 cm×2.5 cm to 11.0 cm×2.5 cm. Among them, 6 patients required repair of wounds after resecting scar around ipsilateral upper and lower lips, and the lobular treatment of the flap was conducted. The wound in the flap donor area was directly sutured. After surgery, the survival of the flap and the occurrence of vascular crisis were observed. During follow-up after surgery, the appearance, texture, and color of the flap, the appearance of the flap donor area, and improvements of crooked mouth, drooling, limited mouth opening, and lip valgus in patients were observed.Results:All the flaps in patients completely survived after surgery, with no occurrence of vascular crisis. During follow-up of 6 to 36 months after surgery, the flap was not significantly bloated, was soft in texture, and had a similar color to that of the normal facial skin. Only linear scars were left in the flap donor area, and crooked mouth, drooling, limited mouth opening, and lip valgus in patients were significantly improved.Conclusions:The free posterior interosseous artery perforator flap carrying superficial vein can reconstruct severe perioral scar hyperplasia and contracture, with low incidence of postoperative flap vascular crisis, and the lobular treatment of flaps can repair wounds around unilateral upper and lower lips at the same time. After surgery, the appearance and function of the perioral area are significantly improved. The flap is a good choice for repairing small area of severe perioral scar hyperplasia and contracture.

Objective:To study the expression of forkhead box P1 (FOXP1) in intrahepatic cholangiocarcinoma (ICC), and its clinicopathological and prognostic significance.Methods:The clinical data of ICC patients treated with radical resection at Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 1, 2013 to December 12, 2019 were retrospectively analysed. Of 48 ICC patients, there were 24 males and 24 females, with age of (59.1±10.1) years old (range 42 to 83 years old). Their clinicopathological data, including age, gender, tumor size, degree of differentiation, and staging were recorded. Immunohistochemical method was used to detect the expression of FOXP1 protein in ICC cancer tissues and the corresponding adjacent normal tissues. Kaplan-Meier method was used to calculate survival rates and to construct survival curves of patients. Cox regression model was used to analyze factors affecting prognosis of patients.Results:Forty-eight ICC cancer tissues and 40 corresponding paracancerous tissues were collected. The positive rates of FOXP1 proteins in ICC were significantly lower than the adjacent normal tissues [54.2%(26/48) vs. 92.5%(37/40), χ 2=15.76, P<0.05]. The degrees of tumor differentiation, lymph node metastasis, organ invasion and TNM staging were related to expression of FOXP1 ( P<0.05). Forty-two patients were followed-up with a median follow-up time of 11.5 (7.75, 19.25) months. Cox multivariate analysis revealed that invasion to adjacent organs, lymph node metastasis, high TNM staging (stage Ⅲ) and negative expression of FOXP1 were independent risk factors affecting overall survival of ICC patients. The overall survival and recurrence-free survival of FOXP1-positive ICC patients were 17.5 months and 15.5 months, which were significantly higher than the 14.0 months and 11.1 months, respectively, in FOXP1-negative patients. Conclusion:Negative FOXP1 expression was closely correlated with aggressive biological behavior and poor prognosis of ICC. FOXP1 may be used as new diagnostic and therapeutic targets.

Objective: To construct the public health performance evaluation index system for the county medical community, so as to provide reference for the assessment of the public health work in the county medical community. Methods: According to the 2019 Public Health Tasks of Zhejiang Province and the current status of the county medical community's public health work, a framework was developed. Twenty experts from universities, CDCs, and county medical community were invited to construct the index system after two rounds of Delphi expert consultation, and the index weight was determined by the analytic hierarchy process. Results : The experts aged ( 46.10±6.41 ) years and worked for ( 23.85±7.37 ) years, all of whom had a bachelor degree or above, and 18 had associate senior titles or above. The response rates of two rounds of consultation was both 100.00%; the authority coefficient was 0.811; the values of Kendall's W all had statistical significance ( P<0.05 ) , which in the second round were higher than those in the first round. The public health performance evaluation index system for county medical community finally included 10 first-level indexes, among which priority diseases surveillance and management weighed most ( 0.165 7 ) ; 32 second-level indexes, among which food-borne diseases surveillance, infectious diseases/public health emergencies reporting and infectious diseases/public health emergencies response weighed the top three ( 0.071 5, 0.064 7, 0.063 8 ); 120 third-level indexes, among which the timely reporting rate of food safety incidents, the reporting rate of infectious diseases and the information response rate of infectious diseases/public health emergencies weighed the top three ( 0.039 4, 0.022 1, 0.021 7 ). Conclusion The public health performance evaluation index system of the county medical community has been established, which can provide reference for the health administrative departments.

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

Objective: To investigate and analyze the awareness, utilization, and satisfaction of patients with chronic diseases (hypertension and type 2 diabetes mellitus), as well as the influencing factors related to health management services for chronic diseases in basic public health service projects in Zhejiang Province, in order to promote the development of effective health management services for chronic diseases. Methods: Between September and November 2017, 960 local patients with chronic diseases aged 35 years or older were randomly selected in eight counties (cities/districts) in Zhejiang province using the random number table, based on the chronic disease information from the information management system. A total of 394 (41.04%) male and 566 (58.96%) female patients, with an average age of (68.02±10.02) years, participated in this study. Face-to-face questionnaires were used to collect patients’ awareness, utilization, and satisfaction with health management services for chronic diseases. The awareness of health management services for chronic diseases and their utilization status were described and analyzed by statistical rate indicators. Possible factors affecting the awareness and utilization status were analyzed by χ² test and logistic regression. Satisfaction scores of patients with chronic diseases were analyzed by means and standard deviation. T-test was used to compare the satisfaction level with service items (service convenience, service environment, waiting time, medical skill level, and service attitude) between urban and rural patients with chronic diseases. Finally, multivariate logistic regression analysis was conducted to determine overall satisfaction. Results: The overall awareness of health management services for chronic diseases in chronic disease patients was 96.15%. Multivariate Logistic regression analysis showed that patients who lived in developed regions, rural areas, and patients who did not live alone had more awareness of health management services (OR= 0.347, 3.563, and 0.281, all P <0.05). The overall utilization rate of health management services for chronic diseases in chronic disease patients was 94.58%. Multivariate Logistic regression analysis revealed that patients who lived in developed regions and rural areas showed better utilization of health management services (OR= 0.297 and 4.145, all P<0.05). The average satisfaction score of patients for all items of health management services was above nine. The satisfaction scores of chronic disease patients in rural areas regarding service convenience, service environment, waiting time, and service attitude were better than those of chronic disease patients in urban areas (t=-2.157, -3.614, -3.164, -2.879, all P<0.05). The overall satisfaction score regarding health management services for chronic diseases was 92.95%. Multivariate Logistic regression analysis showed that patients who purchased health insurance for urban and rural residents reported higher overall satisfaction with health management services for chronic diseases compared to those patients who purchase other medical insurance (OR=2.943, P<0.05). Conclusion The current level of awareness, utilization, and satisfaction with health management services for chronic diseases among chronic disease patients in Zhejiang province should be further improved. Moreover, attention should be paid to the balanced development of urban and rural areas to further increase the equality level of basic public health services.

Objective To explore the financial compensation strategy on the basis of understanding the current situation of compensation for public health services at public hospitals in Zhejiang province.Methods From July to October,2017,an interview survey was conducted at 23 public hospitals in 7 cities in Zhejiang province to understand the current situation of financial compensation for public health services at public hospitals.At the same time,the data of income and expenditure in 2016 of every hospital were collected and analyzed by the methods of descriptive statistics.Results The average proportion of financial subsidies at the 23 public hospitals in 2016 was 6.29％,of which public health special subsidy accounted for 0.44％ of total hospital revenues.Only 9 of the 23 hospitals had surplus in 2016,accounting for 39.13％.Conclusions The public health services compensation mechanism of public hospitals in Zhejiang province calls for further reforms.The government departments should comprehensively formulate financial compensation policies at the provincial level according to the public health assignments and call into play a variety of compensation methods,to establish a long-term assessment mechanism and ensure that public hospitals can proactively carry out public health services.

Objective To investigate the therapeutic efficacy of minimally invasive modified transforaminal lumbar interbody fusion (TLIF) combined with unilateral nail holding system in patients with extreme lateral lumbar disc herniation.Methods Thirty-eight patients with extreme lateral lumbar disc herniation were divided into minimally invasive modified TLIF combined with unilateral nail holding system group (observation group) and conventional open TLIF group (control group) with 19 cases each according to random digital table method.The therapeutic efficacy was compared between 2 groups.Results Surgery was completed successfully in 2 groups,and there was no perioperative complications.The amount of bleeding and hospital stay length in observation group were significantly less than those in control group:(152 ± 82) ml vs.(258 ± 104) ml and (6.5 ± 2.3) d vs.(12.7 ± 3.6) d,and the rate of fusion and score of Japan Orthopaedic Association 6 months after surgery in observation group were significantly higher than those in control group:18/19 vs.10/19 and (14.5 ± 2.1) scores vs.(12.6 ± 1.9) scores.There were statistical differences (P ＜ 0.01).There was no statistical difference in complications between 2 groups (P ＞ 0.05).Conclusion Minimally invasive modified TLIF combined with unilateral nail holding system in patients with extreme lateral lumbar disc herniation has less blood loss and shorter hospital stay,and it is effective and safe.

BACKGROUND:Exendin can regulate blood glucose, blood lipid and blood pressure, exert anti-inflammation and anti-oxidative stress effects, improve myocardial infarction and heart failure, and protect heart vessels. However, the effect on the apoptosis of cardiac muscle cels after ischemia/reperfusion injury remains unclear. OBJECTIVE:To observe the effects of Exendin-4 pretreatment on the cardiomyocyte apoptosis and the expression of Bcl-2 and Bax in rats with myocardial ischemia/reperfusion injury. METHODS:The myocardial ischemia/reperfusion injury model was established in rats and then received Exendin-4 pretreatment. Ischemia/reperfusion group and sham operation group were set. RESULTS AND CONCLUSION:Immunohistochemical staining, TUNEL and reverse transcriptase-polymerase chain reaction results showed that Bcl-2 protein and mRNA expression levels in the Exendin-4 group were significantly increased (P < 0.05), while Bax protein and mRNA expression levels were significantly decreased compared with ischemia/reperfusion group (P < 0.05). In addition, apoptosis index was more significantly decreased in the Exendin-4 group than in the ischemia/reperfusion group (P < 0.05). Exendin-4 can protect rat heart muscle against ischemia/reperfusion injury and effectively inhibit the apoptosis of cardiomyocytes, and the underlying mechanism is mediated by up-regulating Bcl-2 expression and down-regulating Bax expression.

Objective To investigate the risk factors for deep vein thrombosis (DVT) after bone trauma.Methods The study involved 118 patients with traumatic fractures (traumatic fracture group),21 DVT patients diagnosed by color Doppler (DVT group) and 56 healthy patients (control group).Anti-cardiolipin antibody (ACA) was determined by ELISA method.D-dimer and fibrinogen (Fib) were detected by coagulation analyzer and C-reactive protein (CRP) by rate nephelometry.Results Levels of D-dimer,Fib and CRP in traumatic fracture group were significantly increased,but were lower than those in DVT group.ACA positive rate in DVT group presented significant increase and three patients with positive ACA in traumatic fracture group all suffered from DVT.The positive rates of Fib,D-dimer and CRP in lower limb fracture group,multiple fracture group and pelvic fracture group were higher than those in upper limb fracture group (P ＜ 0.05).Levels of Fib and D-dimer showed gradual rise with growth of age,but their levels in DVT group had different degree of reduction after thrombolytic therapy.Conclusions Positive ACA and enhancement of D-dimer,Fib and CRP are risk factors for DVT after bone trauma.Levels of Fib and D-dimer in patients with bone trauma are related with age and therefore risk of posttraumatic DVT increases with age.