【Objective】 To understand factors associated with children′s attendance at nursery care institutions (NCIs) and the basic characteristics of the NCIs children were enrolled in, so as to provide scientific evidence for policymakers. 【Methods】 During November 2020 and January 2021, parents who visited the Department of Child Health Care in six selected maternal and children′s hospitals, as well as nearby NCIs in Zhejiang were invited to finish an online questionnaire. Information such as children′s sociodemographic characteristics, parents′ knowledge, attitude and practice regarding nursery and feeding, etc. were collected. A total of 1 756 questionnaires were collected. 【Results】 Compared to children who were not in NCIs, children enrolled in NCIs were older (94.4% of children ≥24 months vs. 30.1%, χ²=835.27), more likely to be from the local area (87.2% vs. 81.4%,χ²=12.25), more likely to have parents with a college degree (mother: 83.6% vs. 74.2%, χ²=35.29; father: 79.9% vs. 70.0%, χ²=27.01), had a higher prevalence of family annual income >200 000 CNY (49.5% vs. 28.2%, χ²=110.49), and were less likely to have their grandparents available to take care of them (16.7% vs. 26.8%, χ²=31.4) The difference all have great significant.(P<0.05). In a multivariate Logistic regression model, the older the child, the more likely they were to attend an NCI (for children aged 6 - 23 months, OR=6.70; for children aged 24 - 35 months, OR=134.03; and for children aged 36 - 42 months, OR=699.33; P<0.05). Family annual income was positively associated with children′s attendance at NCIs (for those earning 100 000 - 200 000 CNY/year, OR=1.63; for those earning 200 000 - 500 000 CNY/year, OR=2.96; and for those earning >500 000 CNY/year, OR=4.62, P<0.05). Conversely, the higher the level of grandparent involvement in daily care, the lower the attendance at NCIs (for children cared for by both parents and grandparents, OR=0.57; for those primarily cared for by grandparents, OR=0.26, P<0.05). For children who used to stay at NCIs, 82.8% stayed at institutions that only recruited children aged 0 - 3 years, 97.4% spent their whole day in NCIs, and 71.4% spent less than 3 000 CNY per month for NCI services. Additionally, over 95% of parents were satisfied with the food and care services in NCIs, as well as their children′s physical development in NCIs. However, 32.1% of NCIs were reported by parents as having no room for breastfeeding. 【Conclusions】 Children′s age, grandparent involvement in routine care, and family annual income are the main factors associated with children′s attendance at NCIs. There is a greater need for more affordable and community-based NCIs, particularly for children under 2 years old. Additionally, more attention should be paid to the quality surveillance, assessment and management of NCIs.

Objective To construct an integrated pharmaceutical care model for chronic respiratory system disease patients,and to provide policy recommendations.Methods A field survey,a semi-structured interview,and a questionnaire survey were comprehensively used to investigate the effect of the reform and the status quo of pharmaceutical care for chronic respiratory diseases after the medicine consistency reform in the medical alliance of Chongqing.Subsequently,the rainbow model was used to assess the challenges in the macro,meso,micro,and supporting element's dimensions,and the integrated pharmaceutical care model was established as a consequence.Results The primary issues involved in the medical alliance were as followed:insufficient joint reformation for public health services,medical insurance,and medical production and circulation(JRPMM);deficient supporting policies;a dearth of information support;an inadequately list of medications;insufficient collaboration among chronic disease specialties;and unstandardized pharmaceutical care.Consequently,the following recommendations were:in the macro dimension,to strengthen the JRPMM to enhance the service capacity of primary hospitals and to develop suitable human resource coordination mechanisms.In the meso dimension,to intensify the reform of pharmaceutical care in the medical alliance and enhance specialty collaboration horizontally.In the micro dimension,to establish a pharmaceutical management committee in the medical alliance,to formulate pharmaceutical technical specifications for the hierarchical medical system,and to combine"talent and technology"training innovatively.In the supporting elements dimension,to bolster information support in the area and to develop suitable incentives and assessment institutions.Conclusion This paper reported an integrated pharmaceutical care model for chronic respiratory diseases,which could serve as a reference for standardizing the hierarchical medical system for chronic diseases.

Objective:To understand the current status of anemia, iron deficiency, and iron-deficiency anemia among preschool children in China.Methods:A cross-sectional study was conducted with a multi-stage stratified sampling method to select 150 streets or townships from 10 Chinese provinces, autonomous regions, or municipalities (East: Jiangsu, Zhejiang, Shandong, and Hainan; Central: Henan; West: Chongqing, Shaanxi, Guizhou, and Xinjiang; Northeast: Liaoning). From May 2022 to April 2023, a total of 21 470 children, including community-based children aged 0.5 to<3.0 years receiving child health care and kindergarten-based children aged 3.0 to<7.0 years, were surveyed. They were divided into 3 age groups: infants (0.5 to<1.0 year), toddlers (1.0 to<3.0 years), and preschoolers (3.0 to<7.0 years). Basic information such as sex and date of birth of the children was collected, and peripheral blood samples were obtained for routine blood tests and serum ferritin measurement. The prevalence rates of anemia, iron deficiency, and iron-deficiency anemia were analyzed, and the prevalence rate differences were compared among different ages, sex, urban and rural areas, and regions using the chi-square test.Results:A total of 21 460 valid responses were collected, including 10 780 boys (50.2%). The number of infants, toddlers, and preschoolers were 2 645 (12.3%), 6 244 (29.1%), and 12 571 (58.6%), respectively. The hemoglobin level was (126.7±14.8) g/L, and the serum ferritin level was 32.3 (18.5, 50.1) μg/L. The overall rates of anemia, iron deficiency, and iron-deficiency anemia were 10.4% (2 230/21 460), 28.3% (6 070/21 460), and 3.9% (845/21 460), respectively. The prevalence rate of anemia was higher for boys than for girls (10.9% (1 173/10 780) vs. 9.9% (1 057/10 680), χ2=5.58, P=0.018), with statistically significant differences in the rates for infants, toddlers and preschoolers (18.0% (475/2 645), 10.6% (662/6 244), and 8.7% (1 093/12 571), respectively, χ2=201.81, P<0.01), and the rate was significantly higher for children in rural than that in urban area (11.8% (1 516/12 883) vs. 8.3% (714/8 577), χ2=65.54, P<0.01), with statistically significant differences in the rates by region ( χ2=126.60, P<0.01), with the highest rate of 15.8% (343/2 173) for children in Central region, and the lowest rate of 5.3% (108/2 053) in Northeastern region. The prevalence rates of iron deficiency were 33.8% (895/2 645), 32.2% (2 011/6 244), and 25.2% (3 164/12 571) in infants, toddlers, and preschoolers, respectively, and 30.0% (3 229/10 780) in boys vs. 26.6% (2 841/10 680) in girls, 21.7% (1 913/8 821), 40.0% (870/2 173), 27.1% (2 283/8 413), 48.9% (1 004/2 053) in Eastern, Central, Western, and Northeastern regions, respectively, and each between-group showed a significant statistical difference ( χ2=147.71, 29.73, 773.02, all P<0.01). The prevalence rate of iron-deficiency anemia showed a significant statistical difference between urban and rural areas, 2.9% (251/8 577) vs. 4.6% (594/12 883) ( χ2=38.62, P<0.01), while the difference in iron deficiency prevalence was not significant ( χ2=0.51, P=0.476). Conclusions:There has been a notable improvement in iron deficiency and iron-deficiency anemia among preschool children in China, but the situation remains concerning. Particular attention should be paid to the prevention and control of iron deficiency and iron-deficiency anemia, especially among infants and children in the Central, Western, and Northeastern regions of China.

Objective To observe the impact of ultrasonic image quality on the consistency of artificial intelligence(Al)assisted diagnosis system and manual measurements of biological indicators of developmental dysplasia of hip(DDH).Methods Hip ultrasonic data of 75 DDH and 345 non-DDH children were retrospectively analyzed,and the quality of ultrasonic images were subjectively scored.An evaluation model of ultrasonic image quality was constructed based on 140 ultrasonic images acquired from 140 cases(group A,containing 25 DDH and 115 non-DDH)using entropy weighting method,the weight of anatomic structures and impact factors related to DDH were obtained.The comprehensive image quality scores of other ultrasonic images acquired from 280 cases(group B,including 50 DDH and 230 non-DDH)were calculated,and the images in group B were classified into grade A,B and C in descending order.The consistency of AI and manual measurements of DDH biological indicators in group B was assessed.Results The weight of each anatomic structure and impact factors of DDH obtained with the model were as follows:The lower edge of iliac branch＞ilium＞glenoid labrum＞bony margin＞femoral head＞motion artifacts.In group B,grade A was observed in 67(9 DDH and 58 non-DDH),grade B was found in 160(26 DDH and 134 non-DDH),while grade C was noticed in 53(15 DDH and 38 non DDH)images.Except for β,femoral head coverage(FHC)and femoral head length diameter,the consistencies between AI and manual measurements of other indicators of DDH were grade A＞B＞C.In group B,AI and manual measurements were more consistent in DDH than in non-DDH cases.Conclusion Ultrasonic image quality affected the consistency between AI and manual measurements of biological indicators of DDH.When image quality was not good enough,further attention should be paid to measurement of FHC and sizes of femoral head.

A large number of people would be exposed to irradiation in large-scale nuclear and radiation accidents or nuclear terrorist attacks. Therefore, it is urgent to establish rapid and high-throughput biodosimetry for in triage, providing a basis for emergency management. Imaging flow cytometry (IFC) possesses the high through put advantages of traditional flow cytometry and the sensitivity and specificity of microscope, and has a good application prospect in the research and development of rapid, automated, and high-throughput biological dose estimation technology. This article reviews the application progress of IFC in biodosimetry, and provides a reference for the development of biological dose estimation and detection equipment for large-scale nuclear and radiation accidents.

Objective:To compare the clinical results and costs of treatment between internal fixation and total hip replacement in patients aged 60 to 75 years with femoral neck fractures, in order to provide a reference basis for choosing the appropriate surgical procedure for patients in this age group.Methods:According to the inclusion and exclusion criteria, we selected 69 patients treated with internal fixation and 88 patients treated with total hip replacement for femoral neck fractures, and collected relevant data to analyze the differences in clinical characteristics and prognosis between the two groups.Results:The total hip replacement group was older than the internal fixation group[68(64, 72) vs.63(61, 68), Z=-4.536, P<0.001]. There were 20 men(29.0%)and 49 women(71.0%)in the internal fixation group, and 13 men(14.8%)and 75 women(85.2%)in the total hip replacement group.Both groups had more women than men( χ2=4.706, P=0.030). The ratio of the displaced type to the non-displaced type was higher in the total hip replacement group than in the internal fixation group(90.9% vs.46.4%, χ2=37.510, P<0.001). Postoperative serum albumin levels were lower than preoperative levels in both groups, with greater decreases in the total hip replacement group than in the internal fixation group[(9.06±3.45)g/L vs.(7.07±3.37)g/L, t=-3.393, P=0.001]. The total hip replacement group had a higher intraoperative bleeding volume and blood transfusion volume than the internal fixation group( P<0.05), and the days of hospitalization[12(9, 14)d]and hospitalization costs[￥89222.1(84826.8, 93040.0)]were higher than those in the internal fixation group[9(8, 10)d; ￥51158.9(47816.5, 54098.4), Z=-5.138, -10.737, P<0.001 for both]. Weight-bearing after total hip replacement occurred earlier than the internal fixation group[32.0(28.0, 36.5)d vs.92.0(89.3, 95.5)d, Z=-10.228, P<0.001]. There were no significant differences between the two types of surgery for non-displaced femoral neck fractures at 1 year after surgery in the Harris hip score and the quality of life score EQ-5D.For patients with displacement, the rates of excellent and good outcomes based on the Harris score for the total hip replacement group were significantly higher than those for the internal fixation group at 1 year after surgery(97.5% vs.81.3%, χ2=6.697, P=0.010); the postoperative quality of life score EQ-5D was also better than that of the internal fixation group[0.9(0.7, 1.0) vs.1.0(1.0, 1.0), Z=-4.785, P<0.001], and the incidence of postoperative pain and anxiety was lower than that in the internal fixation group(6.3% vs.28.1%, 1.3%, vs.50.0%, χ2=7.928, 38.032, all P<0.01). Conclusions:The mortality and short-term postoperative complications between internal fixation and total hip replacement have no significant differences.There is no significant difference in postoperative function between the two surgical methods for patients with non-displaced femoral neck fractures.For patients with displacement, total hip arthroplasty is superior to internal fixation.The cost of initial hospitalization for internal fixation is significantly lower than for total hip replacement.

Objective:To investigate the effect of preoperative pulmonary hypertension (PH) on right ventricular function in patients with heart transplantation(HTx) one year after surgery.Methods:A total of 120 patients who underwent HTx in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2017 to January 2020 were retrospectively recruited.According to the mean pulmonary arterial pressure (mPAP) obtained by preoperative right heart catheterization, the research subjects were divided into the pulmonary hypertension group (PH group, n=81) and without pulmonary hypertension group (NPH group, n=39). Conventional echocardiographic indices of right ventricular function such as right ventricular area change (RV-FAC), tricuspid annular plane systolic excursion (TAPSE), tricuspid lateral annular systolic velocity (S′), and two-dimensional speckle tracking imaging (2D-STI) strain parameters including right ventricular global longitudinal strain (RV-GLS), right ventricular free wall longitudinal strain (RV-FWLS) were obtained to assess the right ventricular function of grafted hearts. The echocardiographic parameters one year after the operation of the two groups were analyzed to compare the differences in right ventricular function and their correlation with preoperative mPAP. Results:The grafted heart RV-GLS and RV-FWLS were significantly decreased in the PH group (all P<0.01), while RV-FAC, TAPSE, and S′ were similar between the two groups (all P>0.05). RV-FWLS and RV-GLS correlated with preoperative hemodynamic parameter mPAP( rs=-0.46, -0.54; all P<0.05)while RV-FAC, TAPSE, and S′ were not significantly correlated with mPAP (all P>0.05). Conclusions:Preoperative PH correlates with right ventricular function in HTx patients 1 year after the operation. The absolute values of RV-FWLS and RV-GLS in HTx patients with preoperative PH decrease 1 year after the operation. 2D-STI is more sensitive than conventional echocardiography to monitor the changes in right ventricular function in HTx patients after the operation.

Posterior circulation ischemic stroke (PCIS) is caused by the infarction of the blood supply area of vertebrobasilar artery system, accounting for about 20% of all ischemic strokes. The clinical manifestations of PCIS are different and usually lack specificity. The commonly used pre-hospital stroke scale can not fully reflect signs and symptoms of PCIS, and even imaging examination is not easy to detect PCIS. As a result, it is difficult to correctly identify PCIS in the early stage in emergency settings, and the rates of misdiagnosis and missed diagnosis are significantly higher than those of the anterior circulation ischemic stroke. Early and correct identification of PCIS is of great significance to improve the prognosis of patients. By summarizing the relevant literature at home and abroad, this article discusses the diagnostic error factors of PCIS in emergency room from different angles, and summarizes the strategies and methods to improve the speed and accuracy of PCIS recognition and early management.

Objective : To explore the role and its clinical significance of P300 in biphasic differentiation and epithelial mesenchymal transition ( EMT) process in synovial sarcoma (SS) by detecting the expression of histone acetyltransferase P300 and EMT related molecules. Methods : 40 cases of SS paraffin embedded tissue samples were collected , and the SYT⁃SSX fusion gene subtype was detected by RT⁃PCR. Immunohistochemistry was used to detect the expression of P300 and EMT⁃related molecules. : Results Conclusion P300 may be involved in the biphasic differentiation and the EMT process of SS , suggesting that P300 plays a certain role in SS invasion and migration.

Objective: To investigate the changes of plasma protein expression profile in hyperhomocysteinemia rats and the protective effect of highly expressed angiopoietin 1 in plasma on endothelial cells. Methods: The hyperhomocysteinemia animal model was established. The difference in plasma protein content was analyzed by label-free protein spectroscopy. The effects of homocysteine and angiopoietin 1 on endothelial cell migration and proliferation were detected by wound healing and CCK-8 proliferation assay. Results: The results of protein profiling showed that 5 proteins were significantly up-regulated and 17 proteins were significantly down-regulated in the plasma of hyperhomocysteinemia rats, among which angiopoietin 1 was significantly up-regulated. In endothelial cells in the superior mesenteric artery of rats, treatment with 30 or 50 μmol/L homocysteine for 24 h significantly inhibited the migration and proliferation. Angiopoietin 1(600 ng/ml) significantly reduced the migration and proliferation of endothelial cells inhibited by 30 μmol/L homocysteine, but had no significant effect on the migration and proliferation of endothelial cells inhibited by 50 μmol/L homocysteine. Conclusion Hyperhomocysteinemia can significantly affect the protein expression profile in plasma. Angiopoietin 1 in plasma can compensate for the damage of vascular endothelial migration and proliferation function caused by homocysteine in a certain concentration range.