BACKGROUND:After the treatment of femoral shaft fracture with the intramedullary nail,the third fracture open reduction indications are controversial.Some scholars believe that limited open reduction can achieve anatomical reduction,conducive to fracture healing;but some scholars believe that no open reduction of the third fracture still has a high fracture healing rate. OBJECTIVE:To investigate the effect of the circumference and displacement of the third fragment on fracture healing after intramedullary nailing of femoral shaft fractures with the third fragment. METHODS:A retrospective cohort study was conducted to analyze the clinical data of 142 patients suffered a femoral shaft fracture with a third fragment admitted to the Affiliated Lianyungang Hospital of Xuzhou Medical University from February 2016 to December 2021.The fracture were classified into three types according to the circumference of the third fracture with reference to the diaphyseal circumference at the fracture site:type 1 in 71 cases,type 2 in 52 cases,and type 3 in 19 cases.Referring to the diaphyseal diameter,the fractures were classified into three degrees according to the degree of the third fragment displacement:degree I in 95 cases,degree II in 31 cases,and degree III in 16 cases.All patients were treated with femoral interlocking intramedullary nails,and no intervention was performed for the displaced third fragment during the operation.Postoperative follow-up was performed to compare the fracture healing rate,healing time,and the modified Radiographic Union Scale for Tibia at month 9 after surgery in each group.The effect of third fracture fragment circumference and degree of displacement on fracture healing was assessed. RESULTS AND CONCLUSION:(1)All 142 patients were followed up for at least 12 months,with a mean of(14.7±4.1)months,and the overall healing rate was 73.4%.(2)When the third fragment was displaced by degree I,the healing rate,healing time,and modified Radiographic Union Scale for Tibia score at month 9 were not statistically significant among the three sub-groups of circumference classification.(3)When the third fragments were displaced by degree II or III,the healing rate and healing time were not statistically significant among the three subgroups of circumference classification;the modified Radiographic Union Scale for Tibia score at month 9 in the type 1 group was higher than that in the type 2 and 3 groups(P = 0.017).(4)Logistic regression analysis showed that a greater third fragment displacement and circumference were associated with lower fracture healing rates(P<0.05).(5)These findings indicate that in the treatment of femoral shaft fractures with third fragment by intramedullary nails,when the fracture fragment is displaced to degree I,the circumference size has little effect on fracture healing,and no intervention is required during surgery.When the third fragment is displaced to degree II or III and the circumference of which is type 1,a higher modified Radiographic Union Scale for Tibia score can still be obtained with no intervention of the third fragment.However,when the circumference is of type 2 or type 3,it significantly affects the fracture healing.Consequently,intraoperative intervention to reduce the distance of displacement of the fragment is required to lower the incidence of nonunion.The displacement of the third fracture fragments has a greater impact on fracture healing than their circumference.

The vagus nerve, as an important "guardian" of the body, is involved in the steady-state regulation of cardiovascular, respiratory, gastrointestinal digestion and endocrine systems. Recent studies have shown that the vagus nerve plays an important regulatory role in inflammatory response via the inflammatory reflex, which is closely related to the fact that the afferent and efferent fibers of the vagus nerve can sense and regulate inflammation, respectively. The pathophysiological mechanism of sepsis is based on the dysregulation of immune response, and it is often initiated by the excessive inflammatory response of the innate immune system. In recent years, in order to expand intervention strategies for the immune dysregulation of sepsis, researchers have made many efforts on regulating the inflammatory response of the vagus nerve in sepsis. This article focuses on the mechanism of vagus nerve-mediated inflammatory reflex and the regulatory role of vagus nerve in inflammatory response of sepsis, in order to reveal new therapeutic strategies for the treatment of sepsis.

Objective: To investigate the pulmonary functions among the elderly in Hangzhou City, so as to provide insights into the management of respiratory diseases among the elderly. Methods: Permanent residents at ages of 60 to 75 years were sampled from Hangzhou City from November to December 2020. The pulmonary function was tested using a portable pulmonary function monitor, including large airway function parameters [forced expiratory volume (FVC), forced expiratory volume in a second (FEV1) and FEV1/FVC], and small airway function parameters [maximum expiratory flow rate at 75% vital capacity (MEF75%), the maximum expiratory flow rate at 25% of vital capacity (MEF25%) and the forced expiratory flow rate (FEF25%-75%) at 25% to 75% of vital capacity]. The pulmonary functions were compared among the elderly with different genders, ages and body mass index (BMI). Results : Totally 314 participants were recruited, including 126 men (40.13%), with a mean age of (68.49±4.47) years and mean BMI of (23.51±2.79) kg/m2. The mean FEV1, FVC, FEV1/FVC, MEF25%, MEF75% and FEF25%-75% were (1.97±0.53) L, (2.51±0.72) L, (79.79±11.47)%, (0.98±0.53) L/s, (3.84±1.65) L/s and (1.99±0.91) L/s among the participants, respectively. Higher FEV1 [(2.22±0.55) vs. (1.79±0.43) L, P<0.05], FVC [(2.92±0.75) vs. (2.24±0.55) L, P<0.05], MEF75% [(4.19±1.82) vs. (3.59±1.49) L/s, P<0.05] and FEF25%-75% [(2.14±1.07) vs. (1.90±0.77) L/s, P<0.05] were tested among men than among women, and lower FEV1 [(1.75±0.46) L], FVC [(2.27±0.64) L], MEF25% [(0.88±0.57) L/s], MEF75% [(3.39±1.45) L/s] and FEF25%-75% [(1.79±0.96) L/s] were tested among the elderly at ages of 70 to 74 years. The proportion of large and small airway dysfunctions was 40.45% among the participants. Conclusions The proportion of large and small airway dysfunctions was 40.45% among the elderly in Hangzhou City, and poor pulmonary functions were tested among the women and the advanced elderly.

Objective:To establish a nomogram based on features under endoscopic ultrasonography (EUS) for predicting the diagnosis of small gastric stromal tumors.Methods:The clinicopathological data of 189 patients with gastric submucosal tumors (diameter less than 2 cm) who underwent endoscopic resection at the Department of Gastroenterology, Tongji Hospital of Tongji University from June 2015 to August 2021 were retrospectively collected. All patients were divided into the modeling group ( n=126) and the validation group ( n=63) at 2∶1 by random function of software R. Independent influencing factors for the diagnosis of small gastric stromal tumors under EUS screened by univariable and multivariable logistic regression analysis were used to establish the diagnostic prediction nomogram. The receiver operator characteristic (ROC) curves were drawn to evaluate the discrimination of the model both in the modeling group and the validation group. Hosmer-Lemeshow test and calibration curve were used to evaluate the calibration of the model in both groups. Results:The age of patients >60 years ( OR=2.815, 95% CI:1.148-6.900, P=0.024), the lesions located in cardia/fundus ( OR=5.210, 95% CI:1.225-22.165, P=0.025), originated in muscularis propria ( OR=6.404, 95% CI:2.262-18.135, P<0.001) and of external growth ( OR=6.024, 95% CI:1.252-28.971, P=0.025) were independent influencing factors for the diagnosis of small gastric stromal tumors under EUS. The diagnostic prediction nomogram was established based on the four factors above. The areas under ROC curve of the modeling group and validation group were 0.834 (95% CI:0.765-0.903) and 0.780 (95% CI:0.667-0.893). Hosmer-Lemeshow test indicated that this model fit the data well ( χ2=10.23, P=0.176 in the modeling group; χ2=2.62, P=0.918 in the validation group). Calibration charts of the model drawn by Bootstrap method showed that the calibration curves fit well with the standard curves in both groups. Conclusion:The nomogram based on features under EUS for predicting the diagnosis of small gastric stromal tumors provides a visual reference for endoscopists to diagnose small gastric stromal tumors under EUS with good discrimination and calibration.

Partial thickness rotator cuff tears(PTRCTs) are a common cause of shoulder pain and dysfunction in adults, which are seen in middle-aged and older adults and young adults in over-the-shoulder sports(throwing sports are the most common). PTRCTs include partial tears on the articular side, partial tears on the bursal side, and intratendinous tears. Tears on the articular side are 2-3 times more likely than on the bursal side, but intratendinous tears are the most common type. The treatment of PTRCTs consists of both conservative and surgical treatments. Conservative treatment is suitable for most patients with PTRCTs, and recommended as the primary treatment for PTRCTs because of its good clinical efficacy and patients′ willingness to accept it. However, there is no genaral consensus on the best treatment and the results reported in the literature are controversial. In this paper, the anatomy, epidemiology, pathogenic factor, diagnosis and treatment progress of PTRCTs are summarized in light of relevant domestic and international studies in recent years to provide reference for clinical diagnosis and treatment.

Objective: To investigate the pH value of towels in public places in Hangzhou City, so as to provide the evidence for improving health supervision of towels in public places. Methods: One three- and higher-star hotel, one less than three-star hotel, one express hotel, one barber shop and one beauty shop were selected from 13 counties (districts) of Hangzhou City in 2021, and 3% to 5% of all cleaned and disinfected towels that planned to be used were randomly sampled. The type of public places and towels cleaning and disinfection were collected using the basic investigation form provided in the Public Place Health Risk Factors Surveillance Program (2021 version), and the pH value of towels was measured according to the national criteria Textiles-determination of pH of aqueous extract (GB/T 7573-2009). According to the national criteria of Hygienic indicators and limits for public places (GB 37488-2019), a pH value of 6.5 to 8.5 was defined qualified, and the rates of qualified pH values was estimated for towels sampled from different places and with different cleaning and disinfection types. Results: Totally 64 public places were investigated, and 807 towels were measured for pH values, with a median pH value of 7.3 (interquartile range, 0.7). A total of 655 towels had qualified pH values (81.16%). The rates of qualified pH values were 84.95%, 75.56%, 73.21%, 85.61% and 88.81% for towels sampled from the three- and higher-star hotel, less than three-star hotel, express hotel, barber shop and beauty shop, respectively (χ2=19.307, P=0.001). The rate of qualified pH values for self-cleaned and -disinfected towels was significantly higher than for towels with outsourcing cleaning and disinfection services (88.28% vs. 77.18%; χ2=14.973, P<0.001). The rate of qualified pH values was 83.82% for towels with outsourcing cleaning and disinfection services sampled from the three- and higher-star hotel, and was both 100.00% for self-cleaned and -disinfected towels sampled from the less than three-star hotel and beauty shop. Conclusion The cleaning quality of towels remains to be improved in public places in Hangzhou City, and health supervisions on towels are recommended to be improved in public places.

Objective:To learn about the knowledge and practice of iodine deficiency disorders (IDD) prevention and control among main caregivers of pregnant women in trimester and its related influencing factors, so as to provide a scientific basis for effectively improving the iodine nutrition level of pregnant women.Methods:In April 2020, using the stratified sampling method, 2 districts and counties were selected in the urban, suburban and rural areas of Hangzhou City, respectively, and 5 maternal and child health care institutions were selected as the survey sites in each district and county according to the five directions of East, West, South, North and Middle. A face-to-face questionnaire investigation was used to investigate the knowledge and practice of IDD prevention and control among main caregivers of pregnant women.Results:Totally 601 caregivers of pregnant women were investigated. Among them, 68.9% (414/601) knew that eating iodized salt was the best way to prevent IDD. However, 15.0% (90/601) thought that eating seafood was the best way to prevent IDD. And 41.9% (252/601) caregivers of pregnant women would actively purchase iodine-rich food for cooking, and 63.6% (382/601) would choose iodized salt. There were statistically significant differences in the knowledge and practice of IDD prevention and control among caregivers of pregnant women in urban, suburban and rural areas ( P < 0.05). And 50.3% (87/173) male caregivers would actively purchase iodine-rich food for cooking, which was higher than that of female caregivers [38.6% (165/428)], the difference was statistically significant (χ 2 = 6.97, P = 0.008). There was a statistically significant difference between the caregivers of pregnant women of different ages in actively purchasing iodine-rich food for cooking (χ 2 = 12.61, P = 0.013). And there were statistically significant differences between the caregivers of pregnant women with different educational levels in actively purchasing iodine-rich food for cooking and choosing iodized salt (χ 2 = 29.34, 39.42, P < 0.001). Conclusions:The awareness of knowledge about IDD prevention and control and the formation of prevention and control behavior among caregivers of pregnant women in Hangzhou City are poor. Active education of caregivers of pregnant women should be strengthened to promote maternal and infant health.

Objective: To investigate the effects of ambient air pollution on the school age children s diseases, symptoms and school absence, and to provide a reference for preventing the harmful effect of air pollution on students. Methods: Health questionnaires surveys were conducted among 792 students of the fourth grade in a primary school in Hangzhou, and the incidence of diseases and symptoms were continuously monitored every day during the winter of 2014-2017. The generalized additive model based on Poisson regression was used to analyze the health effects caused by single pollution. The multivariate Logistic regression model was used to analyze the comprehensive effects of family, living environment and air pollution on student health. Results: Totally 415 students(52.4%) had a history of diseases and 265 students(33.5%) had a history of allergy. During the investigation, the average concentrations of PM 2.5 , PM 10 , SO 2 and NO 2 were (81.0±2.8) (122.2±3.9) (17.9±0.6) and (68.9±1.4)μg/m 3. Strongest associations were found for lag 3 day of exposure among PM 2.5 , PM 10 and NO 2 on illness and absence. Increases of 10 μg/m 3 in PM 2.5 , PM 10 and NO 2 were associated with 1.02(95% CI =1.01-1.02), 1.04(95% CI =1.03-1.06) and 1.03(95% CI =1.02- 1.04 ) increases in daily illness rates. SO 2 lag for 5 days had the most significant effect on students health. Father s education was the protective factor for illness ( OR =0.83) and symptoms( OR =0.84 ). The risk factors for symptoms included furniture replacement within one year( OR =1.78), pet feeding( OR =1.94), respiratory infections within one year( OR =1.82), allergies rhinitis( OR =2.24), family history with coronary heart disease/hypertension( OR =1.46), indoor activity time ( OR =1.02) and atmospheric PM 10 concentration( OR =1.09)( P <0.05). Conclusion The increase of air pollution concentration has an impact on the illness, symptoms and absence from school, and there is a lag effect. Father s education is a protective factor for the health of students. Indoor pollution and outdoor air pollution can lead to the occurrence of illness and symptoms.

Objective:To investigate the predominant serotypes and diversification of Echovirus (ECHOV) from viral encephalitis children in Quzhou area of Zhejiang province and the molecular characteristics of the ECHOV VP1 genes.Methods:Cerebrospinal fluid samples from 53 children with viral encephalitis were collected for viral isolation/culture. Fluorescent RT-PCR or PCR was used to detect human enteroviruses (HEV) including ECHOV, coxsackievirus(CoV) and new enterovirus (EV), and japanese encephalitis virus(JEV), mumps virus(MuV), west Nile virus(WNV) and chikungunya virus(CHLKV) or herpes simplex virus(HSV) and cytomegalovirus(CMV) in the cerebrospinal fluid samples. The complete VP1 gene sequence of HEV-B group in the HEV-positive cerebrospinal fluid samples was amplified by RT-PCR and sequenced, and then the typing of Echovirus isolates was performed. The VP1 genotypes of Echovirus isolates, gene recombination, inheritance and evolution characteristics were analyzed using multiple bioinformatic software.Results:Six viral strains were isolated by cell culture using rhabdomyosarcoma (RD) cells but not human epithelial-2 (Hep-2) cells. Eleven cerebrospinal fluid samples were positive for HEV by RT-PCR but the detection result of all the other viruses were negative. In the 11 HEV-positive samples, 6 samples were positive for ECHOV (4 for ECHO6, 1 for ECHO7 and 1 for ECHO30 serotype), which was coincident with the isolation result , but CoV and EV were undetectable. The 4 ECHO6 isolates belonged to ECHO6-C2 subgenotype but can be divided into two epidemic clones (ECHO6-41/46 and ECHO6-45/48). The ECHO7 and ECHO30 isolates belonged to ECHO7-C and ECHO30-C genotypes. The VP1 gene recombination between the ECHO6 and ECHO30 isolates were found during their evolutionary process.Conclusions:ECHOV is the major pathogen of viral encephalitis children in the area, and there is a possibility of local outbreak or epidemic. Because of the possibility of recombination of the VP1 gene of ECHO6 and ECHO30 virus, ECHO6 may become the dominant ECHOV serotype.

A total of 1 685 school-age children selected from Hangzhou received lung function testing to evaluate the short-term effects of air pollution on their lung function. The results showed that in every 10 μg/m³ increase of average concentration of PM_2.5 and PM₁₀ on the day of the test and the day before the test,peak expiratory flow (PEF) decreased 0.039 (95%CI: 0.012-0.067) L/s and 0.031 (95% CI:0.011-0.051) L/s,respectively. When the average concentration of SO₂ increased 10 μg/m³ on the day of test and the day prior to the test, PEF and 75% of the forced vital capacity that has not been exhaled (MEF₇₅) decreased 0.437 (95%CI: 0.217-0.658) L/s and 0.396 (95%CI: 0.180-0.613) L/s. After being adjusted for NO₂,with every 10 μg/m³ increase of average concentration of PM_2.5 and PM₁₀ on the day of the test and the day before the test,PEF and MEF₇₅ decreased 0.056 (95%CI: 0.028-0.085), 0.053(95%CI: 0.027-0.081) and 0.047 (95%CI: 0.026-0.068) L/s,0.044 (95%CI: 0.023-0.065) L/s on the day before the test, respectively. The results indicate that air pollution have short-term and lag effects on lung function of school-age children in Hangzhou.