Objective: To investigate the prevalence and associated factors of depressive symptoms among middle and high school students in Zhejiang Province, so as to provide scientific basis for the implementation of depressive intervention. Methods: Based on the health status and associated factors of middle and high school students in the project "Monitoring of Common Diseases and Health Influencing Factors of Students" during 2018 to 2021, a total of 73 309 students including middle school, ordinary high school and vocational high school surveyed in 11 cities of Zhejiang Province were selected by multi stage stratified cluster random sampling method. From 2018 to 2021, there were 6 008, 21 917, 23 712 and 21 672 students, respectively. The Chi square test and Logistic regression model were used to analyze the influencing factors of depressive symptoms in middle and high school students. Results: From 2018 to 2021, depressive symptoms detection rate of middle school students was 14.8%, with higher rate in girls (17.1%) than in boys (12.7%), higher rate in high school (17.1% in ordinary high school, 17.6% in vocational high school) than middle school (12.5%)( χ 2=278.77, 327.22, P <0.05). Univariate analysis showed that there were statistically significant differences in depressive symptoms detection rate among middle school students with different years (2018: 16.7%，2019: 17.9% , 2020: 13.1%, 2021: 13.0%), residence (yes: 16.3%, no:13.5%), body mass index classification (not overweight or obesity: 14.8%, overweight: 14.2%, Obesity: 15.7%), weekly exercise days (0-2 d: 17.1%, 3-5 d: 12.5%, 6-7 d: 13.1%) and bullying (yes: 35.5%, no: 10.7%) ( χ 2=293.40, 118.35, 7.83, 287.24, 4 978.84, P <0.05). Multivariate Logistic regression analysis showed that female students, ordinary high schools, vocational high schools, obesity, school bullying were positively correlated with depression ( OR =1.65, 1.70, 1.60, 1.12, 5.21), exercise 3 to 5 days per week, exercise 6 to 7 days per week were negatively correlated with depression ( OR=0.77, 0.81, P <0.01). Conclusions Depressive symptoms among middle and high school students in Zhejiang Province are prominent. Strengthening mental health education for students and providing attention and support from families, schools, and society are essential steps to reduce the occurrence of depressive symptoms among these students.

Objective: To describe the prevalence characteristics and trend of malnutrition among primary and secondary school students in Zhejiang Province from 2008 to 2021, so as to provide scientific references for targeted interventions on malnutrition among children and adolescents. Methods: Based on the National Student Common Diseases and Health Influencing Factors Surveillance Project, 81 228 primary and middle school students aged 9-17 from Zhejiang Province were recruited for a questionnaire in 2008, 2014 and 2021, with stratified cluster random sampling method. Malnutrition was determined by Screening for Malnutrition in School aged Children and Adolescents. The Kruskal-Wallis test was used for non normally distributed data, and the Chi square test was used for categorical data. A trend Chi square test analyzed detection rates across different years. Results: The prevalence rates of malnutrition, stunting, mild wasting, and moderate to severe wasting among primary and secondary school students in 2008, 2014 and 2021 were 12.0%, 6.6%, 6.0%; 1.2%, 0.5%, 0.3%; 6.0%, 3.9%, 3.6%; and 4.7%, 2.2%, 2.2%, with an overall declining trend ( χ 2 trend =532.73, 181.43, 161.24, 240.38, P <0.05). The prevalence rates of malnutrition and mild wasting in each year were higher in boys (13.7%, 7.6%; 7.5%, 5.0%; 7.1%, 4.5%) than in girls (10.3%, 4.4%; 5.5%, 2.7%; 4.8%, 2.5%) ( χ 2=54.45, 88.67; 47.04, 81.07; 85.28, 98.81; P <0.01). The difference in malnutrition prevalence between urban and rural areas gradually narrowed (12.5%, 11.6%; 6.9%, 6.3%; 6.0%, 6.0%), with no statistically significant difference in 2021 ( χ 2= 0.01 , P >0.05). Malnutrition among primary and secondary school students was primarily characterized by mild wasting (56.0%) in Zhejiang Province. Compared to 2008, the prevalence of malnutrition in 2014 and 2021 showed a steady upward trend with increasing age in Zhejiang Province( χ 2 trends =44.52, 11.78, P <0.01). Conclusions The prevalence of malnutrition among primary and secondary school students aged 9 to 17 years in Zhejiang Province decreases by year from 2008 to 2021. However, the prevalence increase steadily with age, and boys have a higher prevalence of malnutrition. Policies should be developed age , gender , and growth appropriate dietary patterns to reduce malnutrition among primary and secondary school students.

Objective: To explore the effect of cardiorespiratory fitness (CRF) on cardiometabolic health and physical activity among obese adolescents, in order to provide a scientific basis for health promotion of obese adolescents. Methods: From July to August 2021 and 2022, 140 obese adolescents aged 10-17 were recruited in a residential weight loss camp. Sedentary behavior (SB), low intensity physical activity (LPA), total physical activity (TPA) and moderate to vigorous physical activity (MVPA) were measured by ActiGraph GT3X+ triaxial motion accelerometer, and CRF levels were measured by 20 meter shuttle run test. Cardiometabolic risk Z score (CMR- Z ) was constructed by measuring the cardiometabolic health indicators of obese adolescents, including waist circumference (WC), sagittal abdominal diameter (SAD), systolic blood pressure (SBP), diastolic blood pressure (DBP), average blood pressure (ABP), fasting insulin (FINs), fasting plasma glucose (FPG), total cholesterol (TC), and high density lipoprotein cholesterol (HDL-C). The mediating effect analysis was conducted by using the SPSS Process plug in compiled. Results: Cardiovascular health indicators WC, SAD, SBP, DBP, ABP, FINs, FPG, TC, HDL-C and CMR-Z were (93.21± 11.51 )cm, (21.77±2.71)cm, (111.24±11.86)mmHg, (66.08±9.03)mmHg and (88.66±8.97)mmHg, (8.98±6.42)μU/mL, ( 4.42 ±0.62)mmol/L, (4.43±0.97)mmol/L, (1.29±0.28)mmol/L, -0.43(-1.83,1.78)min, respectively. In the daily activity behavior indicators, the duration of SB, LPA, MVPA and TPA were (345.16±78.47, 267.35±62.65, 64.77±39.52, 677.30±57.63)min, respectively. SB, LPA and MVPA accounted for 50.96%, 39.47% and 9.56%, respectively. The indicator VO 2max of CRF was (37.95±4.96)mL/(kg min). Mediation analysis showed that CRF played a fully mediating role between LPA and waist to height ratio (WHtR), accounting for 44.2%. It exhibited a suppressing effect between LPA and ABP accounting for 31.5%, with a suppressing effect between MVPA and SAD accounting for 43.2% and a suppressing effect between MVPA and CMR- Z accounting for 96.0%. Conclusions CRF may be an important factor in the relationship between physical activity and cardiometabolic health of obese adolescents. Improving CRF level may be conducive to promoting cardiometabolic health of obese adolescents.

Talents are the main force for the development of traditional Chinese medicine（TCM）， and the construction of TCM talents and the reformation of talent evaluation system are essential to promote the inheritance and innovation of TCM. At present， we are still exploring and developing in the fields of the formulation， implementation and evaluation indicators of TCM talent evaluation system. However， there are shortcomings and difficulties. For instance， insufficient stratification in the evaluation， excessive emphasis on the quantity of achievements， neglecting the quality of the achievements and the actual contribution， imperfect assessment indicators， and the weak characteristics of TCM. Therefore， national ministries and commissions have jointly issued a document requesting to break the four only and set a new standard， in order to promote the construction of a scientific and technological talent evaluation system oriented by innovation value， ability and contribution. For the evaluation of TCM clinical talents， China Association for Science and Technology commissioned China Association of Chinese Medicine to build the China Clinical Cases Library of TCM（CCCL-TCM）， which aims at collecting the most authoritative and representative TCM clinical cases and exploring the advantages of applying clinical cases as masterpiece of achievement in TCM clinical talents evaluation. CCCL-TCM can promote the construction of a talent evaluation system that is more in line with the development characteristics of TCM industry， and to carry out relevant pilot in TCM colleges and institutions across the country in order to promote the reformation of TCM talent evaluation system.

Objective:To investigate the current status of pertussis laboratory diagnosis and confirmed pertussis cases reporting in Shaanxi Province, and evaluate the quality of case reports.Methods:The information of confirmed pertussis cases reported in Shaanxi Province from January to July 2022 was collected through the China Disease Control and Prevention Information System. The laboratory diagnostic methods and pertussis vaccine immunization history of confirmed cases were investigated, and the descriptive epidemiological method was used for statistical description.Results:Of the 164 confirmed cases of pertussis reported from January to July 2022, two were not tested in the laboratory and 162 were tested in the laboratory. The proportions of different detection methods were 1.85% (3/162) of isolation and culture, 31.48% (51/162) of serum antibody IgG, 14.20% (23/162) of serum antibody IgM, 49.38% (80/162) of serum antibody PCR and 3.09% (5/162) of serum antibody IgM+ PCR. Among the 79 serological positive cases, 12 cases (15.19%)had no history of pertussis immunization, and 15 cases (18.99%), 11 cases (13.92%) and 41 cases (51.90%) had the time interval from vaccination to detection of <1 year, 1-3 years and >3 years, respectively. Based on the analysis of laboratory testing methods and vaccination history, 38 cases were misdiagnosed/misreported among 164 cases, with a misdiagnosis or misreported rate of 23.17%. There were 17, 12 and 9 cases of misdiagnosis/misreport in 0-2 years old group, 3-6 years old group and≥7 years old group, and the misdiagnosis or misreported rates were 27.42%(17/62), 26.67%(12/45) and 15.79%(9/57), respectively.Conclusions:The selection of pertussis laboratory testing methods in some medical institutions in Shaanxi Province is incorrect, which leads to a certain proportion of misdiagnosis or misreport, and it is necessary to further strengthen the training and standardization.

Effective referral management of health and clinical services in maternal and child health hospitals plays an important role in enhancing patients′ medical experience, improving the efficiency and quality of maternal and child health services. A tertiary grade A maternal and child health hospital has carried out a practice of health and clinical service referral management based on information technology construction. A referral information module embedded in the hospital information system has been designed and constructed, and started to be applied in outpatient clinics in July 2021. At the same time, corresponding system and process construction, as well as quality control management and continuous improvement, have been carried out. The outpatient referral rate from July to December 2021 was 2.8% (11 466/412 808), from January to June 2022 it was 5.6% (22 705/402 586), from July to December 2022 it was 5.5% (22 233/402 959), and from January to June 2023 it was 6.7% (23 373/347 898). The referral rate has continued to improve and can provide reference for the referral management of other maternal and child health institutions.

Objective:To investigate the efficacy of different treatment modes for locoregional recurrence after nephrectomy in patients with renal cell carcinoma.Methods:A total of 106 patients with locoregional recurrence after nephrectomy without distant metastasis (77 males and 29 females) admitted to Sun Yat-sen University Cancer Center from October 2001 to July 2020 were retrospectively analyzed. The median age was 51 (40, 60) years old. Radical nephrectomy was performed in 90 patients with primary tumor and partial nephrectomy was performed in 16 patients. Pathological diagnosis showed that 54 cases were clear cell carcinoma and 52 cases were non-clear cell carcinoma. 53 cases were in stage T 1-2 and 53 cases in stage T 3-4. The median diameter of recurrent lesions was 3.2 (2.0, 6.3) cm, and the median number was 2 (1, 4). The recurrence sites were divided into renal fossa recurrence (33 cases), renal fossa±retroperitoneal lymph node recurrence (38 cases), and intra-abdominal spread (35 cases). The median duration from primary surgery to local recurrence was 14.8 (7.3, 35.8) months. Two treatment groups were identified as systemic therapy alone (Group A) and local therapy with or without systemic therapy (Group B). The Kaplan-Meier method was used to compare the progression free survival (PFS) and overall survival (OS) between Group A and Group B. The Cox model was used to perform univariate and multivariate analysis. Results:Of all the 106 patients, 33 patients were in Group A and 73 patients were in Group B. In Group A, 29 patients (87.9%) received targeted therapy, and 4 patients (12.1%) received targeted therapy combined with immunotherapy. In Group B, 34 patients (46.6%) received surgery or ablation and 39 patients (53.4%) received SBRT, of which 62 patients (84.9%) received concurrent systemic therapy. Among them, 58 patients (93.5%) received targeted therapy, and 4 patients (6.5%) received targeted therapy combined with immunotherapy. The median follow-up period was 29.0 (15.4, 45.9) months, 64 patients progressed on tumor including 28 patients died. The median PFS and OS were 15.6 (7.1, 35.2) months and 66.9 (37.8, not reached) months. The median PFS of Group A and Group B were 7.6(5.0, 17.2)months and 22.2(9.6, 63.9)months respectively ( P=0.001), median OS of Group A and Group B were 45.7 (23.4, 62.8)months and 71.0(50.6, not reached)months respectively, and the 2-year OS were 70.6% and 85.5% in Group A and Group B respectively ( P=0.023). The univariate analysis showed local therapy with or without systemic therapy was significantly reduced 56% risk of tumor progression ( HR=0.44, P=0.003) and reduced 60% risk of death ( HR=0.40, P=0.028). The multivariate analysis showed that the OS was associated with ECOG score( HR=10.20, 95% CI 4.13-25.30, P<0.001)and local therapy( HR=0.23, 95% CI 0.09-0.58, P=0.002). Conclusion:Compared with systemic therapy alone, local therapy with or without systemic therapy can effectively improve the PFS and OS of patients with locoregional recurrence after nephrectomy.

Objective: To explore the relationship between family intergenerational contact, depressive symptoms and self-rated health status in the elderly, so as to provide insights into promoting health of the elderly and actively coping with population aging. Methods: Demographic information, intergenerational contact frequency, self-rated health status and depressive symptoms in the elderly at ages of 65 years and older were collected through the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Structural equation model was established to analyze the effects of intergenerational contact on self-rated health and the mediating role of depressive symptoms between family intergenerational contact and self-rated health in the elderly. Results: Totally 15 497 elderly participants were enrolled, with 6 727 males (43.41%) and 8 770 females (56.59%), and there 12 583 individuals lived with family members (81.19%). The median age was 85.00 (interquartile range, 16.00) years. The scores of self-rated health and depressive symptoms were (3.39±0.87) and (2.22±0.56), respectively. The results of structural equation model analysis showed that after adjusting for age, gender and residence, frequent intergenerational contact had a direct positive effect on self-rated health (effect size=0.038, P<0.001), and could improve the depressive symptoms (effect size=0.089, P<0.001) in the elderly. In addition, depressive symptoms had a negative effect on self-rated health in the elderly (effect size=-0.422, P<0.001). Conclusions Frequent intergenerational contact can improve the self-rated health status in the elderly, and indirectly improve the self-rated health level by alleviating depressive symptoms.

Modern Traditional Chinese Medicine(TCM)physicians believed that"reproduction depends on the kidney"theory is the key in treating fetal leakage,fetal restlessness,slippery fetus and other diseases.However,before the Ming and Qing Dynasties,ancient physicians paid special attention to the theory of"Qi and blood in the spleen and stomach".The"the stem of fetal ties the spleen"came from the summary of Zhao Xianke's"Handan manuscripts"based on analogy of nature in Ming dynasty.However,at present,the relevant research reports on"spleen"and tocolysis are fragmented,and the theoretical traceability,clinical effects and experimental research are not systematically discussed.Based on the"fetal stem ties the spleen"theory,through integrated research,taking the differentiation of ancient and modern theories of traditional Chinese medicine gynecology as the"longitude",and the progress of modern biological research on"syndromes,prescriptions and components"as the"latitude".This study is an initial attempt to reveal the key inflection points deductively in the empty space(territorial schools)during(history and history of)tocolysis,and to systematically explore the"spleen main Qi","spleen main transportation","spleen main rising Qing"and"spleen main muscle",which are associated with the progress of the objectification and the bottleneck of research on the treatment of tocolysis.Furthermore,it is proposed that TCM prescription syndrome metabolism and spatiotemporal omics are the important trends to solve the disputes and difficulties in the study of tocolysis in the future,and provide a new reference idea for the inheritance,innovation,breakthrough and accurate research of modern TCM reproductive theory.

ObjectiveTo explore difference in the mechanism of Shoutaiwan， a representative kidney-tonifying and abortion-preventing formula， and Juyuanjian， a typical spleen-invigorating and abortion-preventing formula in reversing the pathology of decidua of spontaneous abortion （SA） patients and to expound the connotation of "uterine collaterals connecting kidney" and "fetal collaterals connecting spleen" theory. MethodThe targets of SA were retrieved from GeneCards， followed by gene ontology-biological process （GO-BP） annotation. Based on Cytoscape and previous research， the main processes and core targets were screened out. High-performance liquid chromatography-mass spectrometry （HPLC-MS） was used to identify the potential active components of Shoutaiwan and Juyuanjian and the regulatory networks were constructed. SA was induced in rats and the model rats were treated with Shoutaiwan and Juyuanjian at the same unit. Hematoxylin and eosin （HE） staining， transmission electron microscopy （TEM）， enzyme-linked immunosorbent assay （ELISA）， immunohistochemistry （IHC）， immunofluorescence （IF）， and other methods were employed to verify the mechanisms against miscarriage. ResultThe dysregulation of cell adhesion， inflammatory response， cell death， and angiogenesis was the core pathological process of SA. A total of 13 potential specific active components of Shoutaiwan and 14 active components of Juyuanjian were screened out. The regulatory networks showed that the potential active components of the two prescriptions modulated vascular endothelial growth factor （VEGF）， interleukin （IL）-2， estrogen receptor （ESR）-1， matrix metalloproteinase-9 （MMP-9）， and other targets to regulate the pathological process of SA. The two can significantly improve the pregnancy rate and the integrity rate and blood supply of decidua cells， control the apoptosis morphology and the expression of estrogen （E₂）， progesterone （P）， and its receptor， and down-regulate the expression of MMP-2， MMP-9， IL-2， and IL-6 in decidua tissue of SA rats. At the same time， they up-regulated the expression of anti-apoptotic protein B-cell lymphoma-2 （Bcl-2） and IL-4. Shoutaiwan significantly up-regulated the expression of VEGF， and Juyuanjian significantly down-regulated the expression of E-cadherin （E-Cad）. ConclusionBoth Shoutaiwan and Juyuanjian regulate the core pathological process of SA to prevent miscarriage. At the same unit， Shoutaiwan is overall superior to Juyuanjian. Shoutaiwan is better than Juyuanjian in regulating angiogenesis and Juyuanjian is superior to Shoutaiwan in regulating cell adhesion. This conclusion can partly explain the biological basis of "treating the same disease with different methods"， and provide objective data reference for the identification of quality marker （Q-marker） of anti-miscarriage Chinese medicine and further study of formula-syndrome metabolome.