Objective:To investigate the Helicobacter pylori ( H. pylori) infection of Tibetan families and individuals in the Western Sichuan Plateau region and explore the related factors which affected H. pylori infection. Methods:This was a single-center cross-sectional study. Questionnaires were collected from 50 Tibetan families including 155 individuals in Western Sichuan Plateau region during March to May 2023. The 13C-urea breath test was performed to confirm the current infection status of participants. Binary logistic regression were used to analyze the related factors associated with H. pylori infection. Results:Among the 50 Tibetan households, the individual-based H. pylori infection rate was 47.10%(73/155), with two out of nine children and 48.63%(71/146) adults infected. The age group of 18 to 40 years had the highest infection rate (55.00%, 11/20). The prevalence of infection based on family was 80.00%(40/50), of which 16.00%(8/50) had all family members infected. Of the 59 couples surveyed, 23.73%(14/59) were both infected, and 45.76%(27/59) had one person infected. Of the six families which had children and adolescents, two households had their children infected. Logistic regression analysis showed that size of the family was a factor related to H. pylori infection (odds ratio=3.038, 95% confidence interval 1.043 to 10.491, P=0.042). Conclusions:The family-based H. pylori infection rate is relatively high in Tibetan residents in the Western Sichuan Plateau, and larger family size is related with higher risk of H. pylori infection within the family.

ObjectiveTo understand the health information needs of chronic disease inpatients and the current utilization of community health resources， and to analyze the influencing factors， so as to provide basis for personalized and high-quality health education for chronic disease inpatients and to guide them to make full use of community health resources. MethodsFrom November 2020 to February 2021， we conducted a face-to-face multi-center clinical epidemiological survey with paper questionnaire in three general hospitals of Shanghai. The study included 404 inpatients with diabetes， hypertension， coronary heart disease， chronic respiratory diseases， cancer and other chronic diseases. Results94.01% of the 404 respondents had different needs for disease or health related information， and there was no significant difference between patients of different ages， genders and educational backgrounds in their needs for health knowledge. Among these patients， only 39.11% of them participated in the establishment of a card for chronic disease management in the community or signed for a family doctor. The participation rate of male patients was lower than that of female patients （P<0.05）. ConclusionPatients with chronic diseases have a high demand for health related information， and we need to provide health information in multiple ways. We should increase investment in community health resources， improve service quality， and guide residents with chronic diseases to make full use of community health resources.

Objective:To analyze the changes in the epidemiological characteristics of scarlet fever cases in Shanghai City before and after the outbreak of coronavirus disease 2019 (COVID-19), and to provide a reference for scientific prevention and control of scarlet fever.Methods:The information of scarlet fever reported cases in Shanghai City from January 2016 to June 2021 in the information system of Chinese Disease Prevention and Control was collected, and the differences in time trend, regional distribution, age and gender distribution of cases before and after the outbreak of COVID-19 in Shanghai City were analyzed by descriptive epidemiologic method.Results:The incidence rate of scarlet fever reported in 2016-2019 was (0.22-4.02)/100 000 in each month, with a median of 1.13/100 000. During January 2020 (the outbreak began in Shanghai City) and June 2021, the incidence rate of scarlet fever was (0.01-1.64)/100 000, with a median of 0.14/100 000, which was 12.39% of that before the outbreak of COVID-19. During February and June 2020, the monthly reported incidence rate of scarlet fever was (0.18-0.58)/100 000, showing an upward trend compared with the same period in 2020 ((0.01-0.05)/100 000). From 2016 to 2019, the annual reported incidence rate of each district was (0.55-65.48)/100 000, with a median of 9.57/100 000; while in 2020, the annual reported incidence rate of each district was (0.29-9.85)/100 000, with a median of 2.18/100 000, which was 22.78% of that before the outbreak of COVID-19. The incidence of scarlet fever dropped significantly. The incidence rate in Minhang District was still the highest. The cases were mainly four to eight years old, and there was no substantial difference of the proportions before and after COVID-19 pandemic, with the incidence rate of six years old group the highest. The proportion of male was more than female in reported case, while the male ratio in reported cases was not significantly different before and after COVID-19 pandemic.Conclusions:The incidence rate of scarlet fever in Shanghai City has dropped sharply after COVID-19 pandemic. The main epidemiological characteristics of the regional and population distribution of cases remain unchanged.

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Objective: To explore the value of modified Chinese Version of Test for Respiratory and Asthma Control in Kids(TRACK) in the management of asthmatic children aged 0-5 years old by comparing with Global Ini-tiative for Asthma(GINA) guideline. Methods: A total of 157 children aged 0-5 years old were enrolled at the Pedia-tric Asthma Outpatient Department of the Affiliated Hospital of Qingdao University from March to August 2018.All children were treated with individualized anti-asthma treatment for 3 months.After treatment, asthma experts assessed the level of asthma symptom control based on the GINA guideline, while caregivers of all children completed TRACK questionnaire.The optimal threshold of the TRACK questionnaire for asthma control was determined by analyzing receiver operating characteristic curve(ROC curve), and consistency of the 2 evaluation methods was compared. Results: All enrolled children were divided into 3 groups based on GINA guideline: 59 children for the well controlled group, 52 children for the partly controlled group and 46 children for the uncontrolled group.There was a significant difference statistically in TRACK scores among the well controlled group [90(85, 95) scores], the partly controlled group [80(70, 85) scores] and the uncontrolled group [60(55, 65) scores] after treatment (H=101.740, P<0.001). Area under the ROC curve was 0.909 for diagnosing asthma control by the modified Chinese version of TRACK, with 80 scores for optimal threshold, 87.3% for sensitivity and 73.5% for specificity.The Kappa value of the consistency test between the TRACK questionnaire and the GINA guideline was 0.553, and consistency rate of these 2 evaluation methods was 77.1%. Conclusions The modified Chinese version of TRACK can be used as an effective assessment tool to monitor and manage asthmatic children aged 0-5 years.

Objective To investigate the biomechanical stability of 5 kinds of internal fixation for acetabular T-shaped fractures using finite element analysis.Methods After a three-dimensional model of normal pelvis was reconstructed using Mimics software,the model of acetabular T-shaped fracture was divided by Solidworks software.Models of acetabular T-shaped fracture fixated by 5 methods were reconstructed:(A) a reconstruction plate for anterior column + lag screws for posterior column,(B) lag screws for anterior column + a reconstruction plate for posterior column,(C) a reconstruction plate for anterior column + a medial ilioischial plate for posterior column (combination plating),(D) retrograde lag screws for 2 columns,and (E) a reconstruction plate for anterior column + and a posterior ilioischial plate for posterior column.Valuation was conducted with software Ansys to simulate 600 N loading on the terminal plate of S1 vertebral body at standing and sitting positions.The biomechanical stabilities were compared between the 5 models of internal fixation.Results At standing and sitting positions,the displacements of anterior column in modelA (0.522±0.121 mmand0.762±0.181 mm),modelC (0.512±0.207mmand0.730±0.181mm) and model E (0.513 ± 0.184 mm and 0.733 ± 0.166 mm) were significantly smaller than those in model B (0.622±0.224 mmand 1.328±0.537 mm) and in modelD (0.655±0.174mm and 1.591± 0.270 mm) (P ＜ 0.05).However,there were no statistically significant differences in anterior column displacements between models A,C and E or between models B and D (P ＞ 0.05).At standing and sitting positions,the displacements of posterior column in model B (0.631 ± 0.151 mm and 0.572 ± 0.693 mm),in model C (0.621 ± 0.195 mm and 0.538 ± 0.075 mm) and in model E (0.625 ± 0.192 mm and 0.544 ± 0.063 mm) were significantly smaller than those in model A (0.742 ±0.140 mm and 0.715 ±0.072 mm)and in modelD (0.754±0.247 mm and 0.717 ± 0.071 mm) (P ＜0.05).However,there were no statistically significant differences in posterior column displacements between models B,C and E or between models A and D (P ＞ 0.05).Conclusions In the treatment of acetabular T-shaped fractures,reconstruction plating has better stability than screwing.Reconstructive plating shows the best stability for anterior and posterior columns,followed by combination plating which is the best choice for reducing surgical injury.

Objective To investigate the iodine nutritional and thyroid stimulating hormone level of patients with thyroid nodules in different regions of Qinghai Province and analyze the characteristics of changes in different regions.Methods In 2014-2016,thyroid nodules in 9 regions of Qinghai Province (Tibetan areas:Xiewu,Nangqian,Jiegu,Guoluo;non-Tibetan areas:Xining,Huzhu,Menyuan,Minhe,and Ledu) were selected and serum thyroid stimulating hormone (TSH) and urine iodine were measured.Results A total of 553 thyroid nodules,the median urinary iodine (MUIC) was 160.8 μg/L and the median TSH was 2.97 mU/L.The iodine nutritional status was at an appropriate level.Among them,MUIC (206.8 μg/L) in thyroid nodules in the Menyuan area was slightly higher than the appropriate amount,there was a significant difference in MUIC among different region (x2 =47.747,P ＜ 0.05);of TSH in thyroid nudules in the 9 regions,the differences were statistically significant (x2 =34.832,P ＜ 0.05).Non-Tibetan areas were compared with Tibetan areas,there was a significant difference in MUIC (155.6,185.6 μg/L),TSH (2.68,3.45 mU/L,Z =-3.677,-5.410,P ＜ 0.05);Among them,the differences was statistically significant between MUIC (152.8,187.7 μg/L) of women with thyroid nodules (Z =-3.504,P ＜ 0.05);there was a statistically significant difference in TSH levels among men (2.58,3.46 mU/L) and women (2.80,3.44 mU/L) with thyroid nodules (Z =-3.613,-4.040,P ＜ 0.05);there were no significant differences in MUIC levels among thyroid nodules of each age groups (P ＞ 0.05);of the TSH level in 30-and 50-＜ 65 years groups (2.63,3.17;2.25,3.58 mU/L),the differences were statistically significant (Z =-2.892,-3.233,P ＜ 0.05),and other groups were no significant differences (P ＞ 0.05).Conclusion The iodine nutrition of patients with thyroid nodules in these regions of Qinghai Province is generally at an appropriate level,the MUIC and TSH levels in Tibetan areas were lower than those in non-Tibetan areas,and iodine nutrition status and TSH levels should be monitored for key populations.

Objective To explore the clinical efficacy and safety of off-clamping in robotic-assisted partial nephrectomy (RAPN) for the treatment of renal tumors.Methods From January 2015 to March 2017,the data of 48 patients who underwent off-clamping RAPN were reviewed retrospectively.There were 31 males and 17 females,and the mean age was 57 years (range:23-84 years).The mean tumor size was 3.1 cm (range:1.2-6.4 cm),with the upper,middle,and lower polar tumors account for 35.4％,27.1％,and 37.5％,respectively.The clinical tumor stage was T1N0M0 in all 48 cases,according to the AJCC tumor staging system for renal cancer.Results RAPNs were performed successfully in all 48 cases,without conversion to open surgery.In those patients,the application of off-clamping in robotic-assisted partial nephrectomy was performed in 44 cases.The renal artery and vein was exposed,dissected,isolated and then clamped in 4 cases due to bleeding.The mean surgical time was 85 min (range:75-185 min).The mean estimated blood loss was 134 ml (range:60-270 ml),and no blood transfusion was needed.The wound surface was closed using interrupted suture with Hem-o-lok clips securing each needle point.The mean time for renorrhaphy was 22 min (rang:11-31 min).No intraoperative severe complications such as vascular injury,trauma of abdominal organ occurred.There were 5 complications,including 2 cases of hematuria,2 cases of delayed healing of incision,and 1 case of pneumohypoderma.The pathological diagnosis included 40 cases of renal clear cell carcinoma,3 cases of papillary renal cell carcinoma,and 5 cases of angiomyolipomas.No tumor recurrence or distant metastasis was observed during the average follow-up of 17 months (range 3-27 months).Conclusions Off-clamping RAPN is safe and feasible approach to excise certain kidney tumors.It carries the benefits of less complication,quick recovery,and less ischemia reperfusion renal injury.Off-clamping RAPN would be suitable for those patients with solitary kidneys,renal insufficiency,and bilateral tumors.

Objective To summarize our experience in robotic-assisted laparoscopic surgery for adrenal diseases Methods The clinical data of 243 patients with adrenal tumor treated by robotic-assisted laparoscopic surgery from March 2010 to February 2017 were retrospectively reviewed.There were 99 men and 144 women.The mean age was 51.6 years (range, 19-84).Tumors located at left adrenal in 140 cases, right in 97 cases,and both sides in 6 cases.The average diameter was 3.32 cm (range, 0.8-12 cm).However, there were 41 cases whose tumor diameter were greater than 5 cm.Results There were 2 cases of conversion during operation, 1 case converted to open surgery and the other to the traditional laparoscope surgery.The mean operative time was 35 min (range, 20-130 min).Estimated blood loss was 80 ml (range,20-1 200 ml).Blood transfusion was needed in 6 cases.The mean postoperative hospital stay was 5d (range, 3-20 d).The pathological diagnosis included 37 cases of pheochromocytoma, 149 cases of cortical adenoma, 3 cases of cortical carcinoma, 5 cases of metastatic tumor, 9 cases of adrenal myelolipoma, 3 cases of adrenal cyst, 2 cases of bronchogenic cyst, 25 cases of adrenal nodular hyperplasia,2 cases of angiomyolipomas, 1 case of mature teratoma, 1 case of diffuse large B-Cell lymphoma, 1 case of angioma, and 4 cases of neurofibromatosis.Conclusions Robotic-assisted laparoscopic adrenalectomy was safe and effective.Robotic-assisted laparoscopic surgery has the advantages over laparoscopic surgery in treatment of complicated adrenal tumor, such as large adrenal tumors, pheochromocytoma, bilateral adrenal diseases, overweight and obese patients with adrenal diseases.

OBJECTIVE:To observe clinical efficacy and safety of intraarticular injection of betamethasone and hyaluronate in the treatment of elderly knee osteoarthritis. METHODS:A total of 76 elderly patients with knee osteoarthritis were selected from our hospital during Jul. 2012 to Jul. 2015,and then divided into control group and observation group according to random number table,with 38 cases in each group. Control group was given intraarticular injection of Sodium hyaluronate injection 2 mL,once a week,for consecutive 3 weeks. Observation group was given Compound betamethasone injection 1 mL in the first week,and given sodium hyaluronate 2 mL,every week,in the following 2 weeks. Clinical efficacies and the occurrence of ADR as well as VAS score,WOMAC score,GQOLI-74 score and MMP levels before and after treatment were compared between 2 groups. RESULTS:Total response rate of observation group was 92.11％,which was significantly higher than 73.68％ of control group,with statistical significance (P<0.05). Before treatment,there was no statistical significance in VAS score,WOMAC score,GQOLI-74 score, MMP-1 level or MMP-3 level between 2 groups(P>0.05). After treatment,VAS,joint stiffness,joint pain and daily activity re-striction score as well as MMP-1,MMP-3 were decreased significantly in 2 groups,compared to before treatment;physical pain, physiological function,physiological limitations,vitality,social function,emotional function,mental health and GQOLI-74 total score were increased significantly,and the each index of observation group was significantly better than that of control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:The intraarticular in-jection of betamethasone and sodium hyaluronate in the treatment of elderly knee osteoarthritis can effectively reduce pain degree, improve knee function and quality of life,have good therapeutic efficacy and safety,the mechanism of which may be associated with the reduction of MMP level.