Objective:To analyze the intention to receive influenza vaccination and its associated factors among urban and rural residents aged≥50 in Zhejiang Province, China, in 2024.Methods:This cross-sectional study was conducted between March and May 2024 through a multi-stage intercept survey in 35 counties (cities, districts) selected from a total of 90 in Zhejiang Province, involving 175 communities/villages. The survey targeted residents visiting local hospitals and community health service centers/community health clinics. The questionnaire included basic demographic information, knowledge related to influenza prevention and treatment, chronic disease status, history of influenza vaccination, and intention to vaccinate. Urban and rural residents were classified based on their registered residence, according to the "Rules for Compilation of Statistical Regional Code and Urban-Rural Division Code" issued by the National Bureau of Statistics. Chi-square tests, ANOVA, and multivariate logistic regression models were used to analyze the factors influencing the intention to receive the influenza vaccine.Results:A total of 10 500 participants were surveyed, comprising 4 885 rural residents (46.52%) and 5 615 urban residents (53.48%). Of these, 3 430 rural residents (70.21%) and 3 718 urban residents (66.22%) expressed intention to receive the influenza vaccine. Multivariate logistic regression analysis revealed that for rural residents aged≥50, younger age groups (50-59 years: OR=1.747, 95% CI: 1.290-2.366; 60-69 years: OR=1.838, 95% CI: 1.401-2.411), history of influenza vaccination ( OR=6.721, 95% CI: 5.152-8.767), doctor′s recommendation for vaccination ( OR=3.788, 95% CI: 3.078-4.662), and higher scores on knowledge related to influenza prevention and treatment ( OR=1.090, 95% CI: 1.054-1.128) were significant promoting factors for vaccination intent. For urban residents aged≥50, belonging to the 60-69 age group ( OR=1.264, 95% CI: 1.023-1.563), history of influenza vaccination ( OR=5.392, 95% CI: 4.309-6.748), doctor′s recommendation for vaccination ( OR=5.307, 95% CI: 4.420-6.371), and higher scores on knowledge related to influenza prevention and treatment ( OR=1.051, 95% CI: 1.021-1.082) were significant promoting factors for vaccination intent. Conclusions:The intention to receive the influenza vaccination is notably high among residents aged≥50 in both urban and rural areas of Zhejiang Province, yet there remains potential for improvement. Age, history of influenza vaccination, doctor recommendation, and knowledge related to influenza prevention and treatment are significant factors influencing the intention to receive the influenza vaccination.

Objective:To analyze the attributable burden of active smoking on the deaths of cancer in inhabitants aged 30 years and above in Zhejiang Province.Methods:Comparative risk assessment approach in the Global Burden of Disease Study was used with the data from Zhejiang Adult Tobacco Surveillance System and Death Monitoring Surveillance System in 2020, and population attributable fraction (PAF), years of life lost (YLL), work of potential years of life lost (WPYLL) attributed to smoking on the deaths of cancer in inhabitants aged 30 years and above in Zhejiang Province were calculated with a linear regression model.Results:In 2020, there were 81 536 cancer deaths aged 30 years and above in the surveillance areas of Zhejiang Province, of which 24 518 were attributed to active smoking (PAF: 30.07%, attributable mortality rate: 55.04/100 000). The YLL was 553 078 person-years, with a standardized YLL rate of 12.40‰, and the WPYLL was 56 606 person-years. Among various cancer types, laryngeal cancer had the highest smoking-attributable PAF (44.75%), while lung cancer accounted for the most significant number of attributable deaths and life loss, with an age-standardized YLL rate of 4.65‰.Conclusions:Active smoking is a significant risk factor for cancer mortality in Zhejiang Province, with lung cancer posing the most significant disease burden. It is urgent to advance tobacco control legislation, strengthen targeted interventions, and promote early cancer screening to reduce the disease burden associated with smoking-related cancers effectively.

Objective:To evaluate the short-term efficacy of endoscopic-laparoscopic regional gastric resection combined with sentinel lymph node basin dissection in patients with early-stage gastric cancer.Methods:This is a retrospective case series study. Data of 17 consecutive early gastric cancer patients from a prospective cohort at Beijing Friendship Hospital,Capital Medical University were analyzed between August 2023 and August 2024. Sixteen cases were from the department of general surgery and 1 from the department of gastroenterology. The cohort included 9 males and 8 females,with a mean age of 61.4 years (range: 46 to 79 years). Clinical data,including demographics,pathological features,surgical procedures,and follow-up outcomes,were collected through medical records and databases. All patients were followed for over 3 months,with follow-up ending on December 5,2024.Results:A total of 17 patients were involved. Among them, 5 patients underwent endoscopic submucosal dissection (ESD) combined with laparoscopic sentinel lymph node dissection (LSBD),and another 3 patients who underwent complete ESD resection received LSBD due to pathological stage meeting the expanded indications. 6 patients who underwent non-curative ESD resection received laparoscopic gastric regional resection (LRG) combined with LSBD,and another 3 patients directly received LRG combined with LSBD. The average number of sentinel lymph nodes dissected before surgery ( M(IQR)) was 8.9 (4.5) (range: 4 to 21),and the detection rate and accuracy rate were both 100%. Postoperative pathology confirmed that there was no metastasis in the sentinel lymph nodes of 5 patients who underwent ESD combined with LSBD and 3 patients who underwent LSBD after complete ESD resection. The vertical and horizontal margins of ESD were all negative. One patient was an absolute indication for ESD. For the 6 patients who underwent non-curative ESD resection combined with LRG and LSBD,the horizontal margins were all negative. Two patients showed 1 metastasis in each of the 21 and 9 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed during the operation. Postoperatively,73 and 39 lymph nodes were retrieved respectively. The former had 1 additional metastasis,while the latter had no metastasis. Among the 3 patients who underwent direct LRG combined with LSBD,the horizontal margins were negative. One patient was confirmed as an absolute indication for ESD by postoperative pathology,and one patient had 1 metastasis in 8 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed. Postoperatively,there was no metastasis in 54 lymph nodes. All patients had no complications such as infection,bleeding,perforation,or death after surgery. Among the 14 patients who did not receive additional radical surgery,they were able to pass gas and defecate within 3 days after surgery,with an average hospital stay of 6 days. The nutritional indicators and gastric radionuclide emptying imaging half-emptying time were similar to those before surgery at 3 months after surgery. Conclusions:Laparoscopic and endoscopic cooperative regional gastrectomy with sentinel lymph node basin dissection has the advantages of minimal invasiveness,preservation of gastric function,and precise treatment. It maybe suitable for patients with early-stage gastric cancer at high risk of lymph node metastasis and has good short-term efficacy.

Objective:To analyze the attributable burden of active smoking on the deaths of cancer in inhabitants aged 30 years and above in Zhejiang Province.Methods:Comparative risk assessment approach in the Global Burden of Disease Study was used with the data from Zhejiang Adult Tobacco Surveillance System and Death Monitoring Surveillance System in 2020, and population attributable fraction (PAF), years of life lost (YLL), work of potential years of life lost (WPYLL) attributed to smoking on the deaths of cancer in inhabitants aged 30 years and above in Zhejiang Province were calculated with a linear regression model.Results:In 2020, there were 81 536 cancer deaths aged 30 years and above in the surveillance areas of Zhejiang Province, of which 24 518 were attributed to active smoking (PAF: 30.07%, attributable mortality rate: 55.04/100 000). The YLL was 553 078 person-years, with a standardized YLL rate of 12.40‰, and the WPYLL was 56 606 person-years. Among various cancer types, laryngeal cancer had the highest smoking-attributable PAF (44.75%), while lung cancer accounted for the most significant number of attributable deaths and life loss, with an age-standardized YLL rate of 4.65‰.Conclusions:Active smoking is a significant risk factor for cancer mortality in Zhejiang Province, with lung cancer posing the most significant disease burden. It is urgent to advance tobacco control legislation, strengthen targeted interventions, and promote early cancer screening to reduce the disease burden associated with smoking-related cancers effectively.

Objective:To analyze the intention to receive influenza vaccination and its associated factors among urban and rural residents aged≥50 in Zhejiang Province, China, in 2024.Methods:This cross-sectional study was conducted between March and May 2024 through a multi-stage intercept survey in 35 counties (cities, districts) selected from a total of 90 in Zhejiang Province, involving 175 communities/villages. The survey targeted residents visiting local hospitals and community health service centers/community health clinics. The questionnaire included basic demographic information, knowledge related to influenza prevention and treatment, chronic disease status, history of influenza vaccination, and intention to vaccinate. Urban and rural residents were classified based on their registered residence, according to the "Rules for Compilation of Statistical Regional Code and Urban-Rural Division Code" issued by the National Bureau of Statistics. Chi-square tests, ANOVA, and multivariate logistic regression models were used to analyze the factors influencing the intention to receive the influenza vaccine.Results:A total of 10 500 participants were surveyed, comprising 4 885 rural residents (46.52%) and 5 615 urban residents (53.48%). Of these, 3 430 rural residents (70.21%) and 3 718 urban residents (66.22%) expressed intention to receive the influenza vaccine. Multivariate logistic regression analysis revealed that for rural residents aged≥50, younger age groups (50-59 years: OR=1.747, 95% CI: 1.290-2.366; 60-69 years: OR=1.838, 95% CI: 1.401-2.411), history of influenza vaccination ( OR=6.721, 95% CI: 5.152-8.767), doctor′s recommendation for vaccination ( OR=3.788, 95% CI: 3.078-4.662), and higher scores on knowledge related to influenza prevention and treatment ( OR=1.090, 95% CI: 1.054-1.128) were significant promoting factors for vaccination intent. For urban residents aged≥50, belonging to the 60-69 age group ( OR=1.264, 95% CI: 1.023-1.563), history of influenza vaccination ( OR=5.392, 95% CI: 4.309-6.748), doctor′s recommendation for vaccination ( OR=5.307, 95% CI: 4.420-6.371), and higher scores on knowledge related to influenza prevention and treatment ( OR=1.051, 95% CI: 1.021-1.082) were significant promoting factors for vaccination intent. Conclusions:The intention to receive the influenza vaccination is notably high among residents aged≥50 in both urban and rural areas of Zhejiang Province, yet there remains potential for improvement. Age, history of influenza vaccination, doctor recommendation, and knowledge related to influenza prevention and treatment are significant factors influencing the intention to receive the influenza vaccination.

Objective:To evaluate the short-term efficacy of endoscopic-laparoscopic regional gastric resection combined with sentinel lymph node basin dissection in patients with early-stage gastric cancer.Methods:This is a retrospective case series study. Data of 17 consecutive early gastric cancer patients from a prospective cohort at Beijing Friendship Hospital,Capital Medical University were analyzed between August 2023 and August 2024. Sixteen cases were from the department of general surgery and 1 from the department of gastroenterology. The cohort included 9 males and 8 females,with a mean age of 61.4 years (range: 46 to 79 years). Clinical data,including demographics,pathological features,surgical procedures,and follow-up outcomes,were collected through medical records and databases. All patients were followed for over 3 months,with follow-up ending on December 5,2024.Results:A total of 17 patients were involved. Among them, 5 patients underwent endoscopic submucosal dissection (ESD) combined with laparoscopic sentinel lymph node dissection (LSBD),and another 3 patients who underwent complete ESD resection received LSBD due to pathological stage meeting the expanded indications. 6 patients who underwent non-curative ESD resection received laparoscopic gastric regional resection (LRG) combined with LSBD,and another 3 patients directly received LRG combined with LSBD. The average number of sentinel lymph nodes dissected before surgery ( M(IQR)) was 8.9 (4.5) (range: 4 to 21),and the detection rate and accuracy rate were both 100%. Postoperative pathology confirmed that there was no metastasis in the sentinel lymph nodes of 5 patients who underwent ESD combined with LSBD and 3 patients who underwent LSBD after complete ESD resection. The vertical and horizontal margins of ESD were all negative. One patient was an absolute indication for ESD. For the 6 patients who underwent non-curative ESD resection combined with LRG and LSBD,the horizontal margins were all negative. Two patients showed 1 metastasis in each of the 21 and 9 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed during the operation. Postoperatively,73 and 39 lymph nodes were retrieved respectively. The former had 1 additional metastasis,while the latter had no metastasis. Among the 3 patients who underwent direct LRG combined with LSBD,the horizontal margins were negative. One patient was confirmed as an absolute indication for ESD by postoperative pathology,and one patient had 1 metastasis in 8 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed. Postoperatively,there was no metastasis in 54 lymph nodes. All patients had no complications such as infection,bleeding,perforation,or death after surgery. Among the 14 patients who did not receive additional radical surgery,they were able to pass gas and defecate within 3 days after surgery,with an average hospital stay of 6 days. The nutritional indicators and gastric radionuclide emptying imaging half-emptying time were similar to those before surgery at 3 months after surgery. Conclusions:Laparoscopic and endoscopic cooperative regional gastrectomy with sentinel lymph node basin dissection has the advantages of minimal invasiveness,preservation of gastric function,and precise treatment. It maybe suitable for patients with early-stage gastric cancer at high risk of lymph node metastasis and has good short-term efficacy.

Objective:To investigate the exposure to tobacco advertisement/promotion and smoking scenes from television/movie/video among middle school students in Zhejiang Province in 2021, and the influence on the knowledge and behavior about smoking of the students.Methods:Total 7 692 students were selected from 60 middle schools with the proportional probability sampling (PPS) method in Zhejiang Province. The investigation was performed with self-administered questionnaire survey which consisted of tobacco use, exposure to tobacco advertisement/promotion, et. The collected data was weighted and analyzed using the complex survey module of SPSS 21.0 software.Results:The prevalence of exposure to tobacco advertisement/promotion and smoking scenes from television/movie/video among the middle school students were 24.8% and 63.8% respectively. In recent 30 d, among those who had been exposed to the tobacco retail point, the proportion of those exposed to tobacco advertisement/promotion was 46.1%, and among those who surfed the internet, the proportion of those exposed to tobacco advertisement/video was 23.4%. Among the whole students, the proportion of those exposed to free tobacco product was 2.4%. The junior middle school students, regular high school students, and vocational school students who had been exposed to tobacco advertisement/promotion were more likely to feel smoking more comfortable in social occasions (5.6%, 6.7%, 8.8%), to feel smoking attractive for the young (9.1%, 8.4%, 8.8%), and also had higher rate of attempted smoking (12.5%, 16.9%, 20.5%) than non-exposed ones (junior middle school students: 2.3%, 5.5%, 4.8%; regular high school students: 2.9%, 2.9%, 9.8%; vocational school students: 4.0%, 4.0%, 15.3%) (all P<0.05). Among the students who had seen television/movie/video within 30 days, the junior middle school students, regular high school students, and vocational school students who had been exposed to smoking-related scenes had higher rate of attempted smoking (8.1%, 14.7%, 20.0%) than non-exposed ones (5.4%, 8.0%, 10.6%) (all P<0.05). Conclusion:The prevalence of exposure to tobacco advertisement/promotion and smoking scenes from television/movie/video are relatively high among the middle school students in Zhejiang province, which make exposed students more likely to report positive attitude to tobacco use, and more likely to smoke, to attempt to smoke.

Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

Objective:To investigate the level of health literacy and its influencing factors among residents aged 15-69 years with different chronic disease in Zhejiang Province.Methods:In this cross-sectional study, a stratified multistage whole cluster random sampling method was used to select 19 200 permanent residents aged 15-69 years from 30 monitoring sites in Zhejiang Province from June to November 2022, and a household questionnaire survey was carried out with the National Health Literacy Monitoring Questionnaire for the Population. The content of the survey included socio-demographic characteristics, health-related factors and health literacy level. A total of 19 200 questionnaires were distributed and 19 051 were collected, of which 18 857 (98.98%) were valid. The χ2 test was used to compare the health literacy levels of residents with different chronic diseases, and logistic regression was used to analyze the influencing factors of the health literacy levels. Results:The health literacy level of residents aged 15-69 in Zhejiang Province in 2022 was 38.36%. Among them, the health literacy level of patients with multiple chronic diseases was much lower than those with single chronic disease and those without chronic disease (14.70% vs 25.37%, 42.21%) ( χ2=483.05, P<0.001). It was positively associated between having multiple chronic diseases and insufficient health literacy ( OR=1.26, 95% CI: 1.01-1.58); compared with those without chronic disease ( OR=1.00), patients with multiple chronic diseases were significantly more likely to have inadequate health literacy in basic knowledge and concepts ( OR=1.29, 95% CI: 1.03-1.63), health behaviors ( OR=1.24, 95% CI: 1.01-1.53), basic skills ( OR=1.37, 95% CI: 1.11-1.69), and health information literacy ( OR=1.27, 95% CI: 1.08-1.50). Conclusions:The number of chronic diseases is a key factor that affects the residents′ health literacy level, and people with multiple chronic diseases are often associated with a higher risk of inadequate health literacy.

Objective:To evaluate the effects of hemoclips on preventing delayed bleeding for early gastric cancer (EGC) after endoscopic submucosal dissection (ESD).Methods:Clinical data of 459 patients who underwent ESD for EGC in Beijing Friendship Hospital from June 2013 to August 2020 were collected retrospectively. Patients were divided into group A (hemoclip group, n=162) and group B (non-hemoclip group, n=297) according to whether preventive hemostatic clip treatment was performed after resection. Delayed bleeding within 2 weeks after ESD was observed. Univariate analysis and subgroup analysis were conducted for the delayed bleeding incidence and clinicopathological features. Results:Delayed bleeding incidences of group A and group B were 3.1% (5/162) and 8.1% (24/297) with significant difference between the two groups ( χ2=4.418, P=0.036). Subgroup analysis showed that there were significant differences in the delayed bleeding incidence between the two groups when the diameter of the tumor >20 mm [3.5% (2/57) VS 15.3% (13/85), χ2=5.016, P=0.025], the tumor located in the lower part of the stomach [1.0% (1/97) VS 10.4% (20/192), χ2=8.425, P=0.004], and the depth of tumor invasion was M/SM1 [3.2% (5/157) VS 8.1% (23/285), χ2=4.072, P=0.044]. There were no significant differences in the delayed bleeding incidence between group A and group B when the diameter of the tumor ≤20 mm, the tumor located in the upper/medial part of the stomach and the depth of tumor invasion was SM2 ( P>0.05). Conclusion:Hemoclips can prevent delayed bleeding after ESD for EGC, which is mainly observed in a tumor of diameter >20 mm, located in the lower part of the stomach and M/SM1 tumor invasion. It has little effect on the prevention when the tumor diameter ≤20 mm and located in the upper/medial part of the stomach.