Objective To investigate HPV vaccine hesitancy and influencing factors among parents of primary and secondary schools in Guangyuan, and to provide scientific countermeasures for reducing the hesitancy rate of HPV vaccine in parents. Methods Using stratified multi-stage cluster random sampling, 1,018 parents of girls in primary and secondary schools in Guangyuan were selected for a questionnaire survey from March to July 2021. The data were analyzed by Chi-square test and multivariate logistic regression model. Results The hesitancy rate of HPV vaccine in parents was 42.95%. Multivariate logistic regression analysis showed that families with low economic income, parents who believed that HPV vaccination would have long-term side effects, and be unsafe and expensive, and parents who concerned with the effect of HPV vaccine on the prevention of cervical cancer and insufficient supply of first doses of vaccine, had positive effects on HPV vaccine hesitancy (OR = 2.02, 1.44, 3.13, 1.53, 3.76, and 2.43, respectively, P < 0.05). Conclusion HPV vaccine hesitancy rate is high among parents of primary and secondary schools in Guangyuan. It is necessary to fully promote school education and increase the publicity of HPV vaccine to improve parents' awareness of HPV vaccine. Government departments need to make an overall plan to reduce vaccine costs and ensure sufficient vaccine quantity, so as to reduce parents' hesitation to vaccinate their children with HPV vaccine.

The grading of evidence is an important factor in clinical decision-making. The current evidence grading system based on western medicine is limited in the clinical practice of traditional Chinese medicine （TCM）， therefore we propose the solutions to the development of grading system for TCM interventional evidence， following the international evidence grading standards， taking into considerations of the unique characteristics of TCM practice， based on the Grades of recommendation， assessment， development and evaluation （GARDE） evaluation system， and integrating with grading system regarding TCM classical literature and empirical evidence from modern famous doctors. The evidence from classical literature is suggested to be evaluated from three aspects including source of ancient medical records， comprehensive of treatment details， and the inheritance. The qualification of famous doctors， content integrity， and inheritance of experiences will be used to evaluate the evidence from famous doctors' experience. The multi-sourced evidence such as TCM classical literature， experience of modern famous doctors， and modern researches is mainly integrated in a qualitative way， and the overall level of evidence of TCM interventions will be graded consistently with the GRADE system based on modern research. The evidence from classical literature and modern famous doctors' experience will be assessed and considered as supplementary evidence， which will make the evaluation of clinical evidence more objectively and comprehensively， thereby guiding clinical practice further.

Yang-palm, through early systematic Zhan-zhuang training to raise qi, pats the affected area to extract pathological product outer surface using the distal of 2-5 fingers in palm dorsal. This therapy emphasizes infusing qi and extract silt. The treatment continues when pathological product scatters and disappears, so the short-term and long-term efficacy is significant, and especially suitable for the treatment of TCM arthralgia. This article introduced the clinical therapy in treating two rheumatism patients by Yang-palm, explained process and study method of Yang-palm therapy, and shared treatment experience and explored the basic principles of treatment, with a purpose to provide a new treatment for rheumatism.

Objective To explore the value of procalcitonin,C-reactive protein and neutrophil percentage in early diagnosis of bacterial bloodstream infection in patients with malignant tumor.Methods Retrospectively analyzed the clinical data of 413 cases with tumor fever who were performed PCT,CRP,blood test and blood culture in the same day in our hospital from January to December in 2015.According to blood culture results,they were divided into observation group(211 cases) and control group(202 cases).The observation group was divided into Gram-negative(G-) group and Gram-positive(G+) group.The diagnostic efficacy of PCT,CRP and NEUT％ on bacterial bloodstream infection was evaluated by receiver operating characteristic curve (ROC).Results The specificity of PCT in the observation group was the highest and the sensitivity of CRP was the highest.The levels of PCT,CRP and NEUT％ in the observation group were significantly higher than those in the control group(P＜0.05).PCT level in the G-group were apparently higher than that of G+ group(P＜0.05),while CRP and NEUT％ levels had no statistical significance between the two groups(P＞0.05).According to ROC curve,In the observation group,The AUC of PCT,CRP and NEUT％ were 0.848,0.796 and 0.718,respectively.In G-and G+ group,the AUC of PCT were 0.877 and 0.767,respectively.Conclusion PCT,CRP and NEUT％ were significantly increased in the malignant patient with bloodstream infection,PCT has showed better diagnostic efficiency compared to CRP or NEUT％ and better clinical value in distinguish between G-and G+ bacterial infection type.Combined detection of PCT,CRP,NEUT％ can help for early diagnosing malignant tumor with bacterial bloodstream infection.

Objective : To compare the clinical effects of polymer ceramic onlay and all ceramic crown in short crown molars Methods : 45 cases of polymer ceramic onlay and 45 cases of Zirconium dioxide all ceramic crowns which repaired the short crowm molars after root canal therapy were compared clinically from the aspects of beauty of restoration, fracture and dislodgement, marginal adaptation and the preservation of abutment teeth. Results : One polymer ceramic onlay had fall out form the teeth after half year, while the all ceramic crowns have been 8 cases after 6~12 months. There were significant differences in fracture and dislodgement between the two groups (χ2=4.44, P < 0.05). Conclusion Polymer ceramic onlay has good clinical effects in the restoration of short crown molars.

Objective To assess the reliability and validity of the Pittsburgh sleep quality index (PSQI) .Methods The cross-sectional survey was conducted in the outpatient department of this hospital .544 insomnia and non-insomnia voluntary participants (18-65 years old) from July to October 2011 were assessed with PSQI and the insomnia severity index (ISI) ,which were randomly delivered to them .Results The test-retest reliability of PSQI was 0 .994 .The split-half reliability coefficient of PSQI was 0 .824 . The overall Cronbach′s alpha coefficient was 0 .845 .The confirmatory factor analysis showed that the fitting indicators for the χ2/df ,root mean square error of approximation(RMSEA) ,non-normed fit index(NNFI) ,comparative fit index(CFI) and goodness-of-fit index(GFI) were 4 .83 ,0 .09 ,0 .96 ,0 .98 and 0 .97 respectively .The correlation coefficient between the PSQI and ISI was 0 .842 . The correlations coefficients between PSQI with the questionnaire type ,interview date and interview department were -0 .046 , 0 .276 and -0 .331 .Grouping by individuals with or without insomnia ,the area under the receiver operator characteristic curve (ROC) for PSQI was 0 .944(95% CI:0 .925-0 .963) .Conclusion PSQI has good reliability and validity ,and could be used for the sleep quality comprehensive evaluation in the patients with insomnia .

Objective To build the indicators system for clinical pathway management as required by clinical pathway control.Methods An indicators system was proposed by means of evidence-based review,focus group discussions,and ratings of the indicators' importance by doctors and nurses.A multidisciplinary panel of 60 experts from across the country were selected.A 3-round Delphi survey was made on the proposed indicators.The weights of the indicators were established by analytical hierarchy process (AHP).The response rate,Cronbach's α,and the authority coefficient of experts were used as a measure of reliability.Results The response rates of the 3 rounds were 85％,70％,and 94％; the experts authority coefficient was 0.80.The ccoefficient of variation falls with the rising number of consultations.The Kendall's W ranged from 0.40 to 0.83.Following the 3 rounds,consensus was achieved among experts as such a system comprising three first-level,9 second-level,and 36 third-level indicators.Conclusion The expert consultation has achieved reliable results.The established indicators system can serve as a useful instrument for standardized development of clinical pathways management and constant improvement.

Objective To investigate the clinical value of velocity vector imaging (VVI) in the assessment of cardiac torsion in fetuses with gestational diabetes mellitus(GDM).Methods Digital dynamic four-chamber views of 98 fetuses with gestational diabetes mellitus and 135 normal fetuses were collected and analyzed using VVI.Left ventricular(LV) peak apical rotation of endocardium and epicardium at basal and apical level were measured,LV peak torsion was calculated.Results 140 of 233 cases were analyzed successfully.Direction of LV peak apical and basal rotation of endocardium and epicardium in fetus could be clockwise or counter clockwise,however apical and basal level was opposite.LV peak apical and basal rotation of endocardium and epicardium in fetus were stable throughout gestation ( P ＞ 0.05).LV peak rotation of endocardium was higher than that of epicardium in both apical and basal level.The peak rotation　in apical level of endocardium and epicardium was higher than that in basal level( P ＜0.05).LV peak　torsion of endocardium was significantly higher than that of epicardium( P ＜0.05).Compared with normal　group,LV peak rotation of endocardium and LV peak torsion in fetus with GDM were higher( P ＜0.05).　Conclusions VVI can measure the LV rotation and torsion parameters,and evaluate the cardiac function of　GDM fetus.

Objective To establish the normative data of the 2D and 3D ultrasound (US)measurements of the developing fetal thymus and comparing the 2DUS and 3DUS measurements of the fetal thymus. Methods The normal fetuses' thymus of 567 cases were assessed, and maximum transverse diameter(MTD),antero posterior diameter (APD), suprainferior diameter (SID), maximum transverse area (MTA) were measured by 2DUS,and thymic volume(TV) was measured by 3DUS. Results 2DUS,3DUS assessments of the fetal thymic MTD, APD, SID, MTA and TV were possible in 541 of 567 normal singletons. The fetal thymic 2D diameters/area and 3D volume grow with the gestational age(GA) in linear correlation. The 3D-US TV measurements and GA was significantly higher than that of any individual 2DUS measurements and GA ( P ＜0.05). Conclusions This study presents the normative data of the 2DUS and 3DUS measurements of the developing fetal thymus. 3DUS fetal thymus volume is more significantly correlated to GA than the other 2DUS measurements, which indicates 3DUS measurement of the fetal thymus is more accurate than that of 2DUS.

Objective To investigate the value of combination of B-flow imaging and spatio-temporal image correlation in prenatal diagnosis of congenital heart diseases. Methods Volume images of 50 normal fetuses and 14 fetuses with congenital heart diseases were recruited in the study. Surface mode was used to reconstruct the volume images. Results Sixty-three and twenty-six qualified volume images were obtained in 50 normal fetuses and 14 fetuses with congenital heart diseases respectively. All volume images were reconstructed successfully and showed the spacial relationship of cardiac blood vessel directly. Conclusions The combination of B-flow imaging and spatio-temporal image correlation was feasible and useful in prenatal diagnosis of congenital heart diseases.