Objective:To investigate the clinical significance of intraoperative prepositioning of dual mediastinal drains in elderly patients developing anastomotic leakage(AL)after a total endoscopic Ivor-Lewis procedure.Methods:This retrospective case-control study analyzed the clinical data of 500 elderly patients who underwent total endoscopic Ivor-Lewis surgery for esophageal or cardia cancer from January 2020 to December 2022.In the control group, one mediastinal drainage tube was placed intraoperatively, while in the study group, two mediastinal drainage tubes were placed.Both groups had a chest tube placed conventionally.The study compared the incidence of anastomotic leak(AL)at 1 month postoperatively, inflammatory indexes in patients with AL, grading of AL, rate of nasal fistula placement, incision infection, anastomotic stenosis, and incidence of hoarseness.Additionally, it compared ICU occupancy, ventilator use, and ICU length of stay between the two groups.Results:The analysis included clinical data from 455 elderly patients.Among the patients who developed AL, the study group had significantly lower peak body temperature[(39.58±1.03)℃ vs.(38.05±0.56)℃, t=4.298, P<0.05], white blood cell count[(18.63±3.35)×10 9/L vs.(14.28±2.78)×10 9/L, t=3.450, P<0.05], and C-reactive protein(CRP)levels[(154.66±41.64)mg/L vs.(122.19±31.29)mg/L, t=2.131, P<0.05]. The study group also had a significantly lower grading of AL and rate of nasal fistula placement(82.4% vs.30.0%, P<0.05). In terms of ICU indicators, the study group had a significantly lower ICU admission rate(64.7% vs.10.0%, P<0.05), shorter period of ventilator use[(6.47±8.15)days vs.(0.90±2.23)days, t=2.62, P<0.05], and shorter ICU stay[(11.70±8.89)days vs.(4.70±6.27)days, t=2.184, P<0.05]. Conclusions:Double mediastinal drainage tubes, have been found to significantly alleviate inflammation, decrease the rate of nasal fistula placement and ICU admission, and shorten the length of ICU stay in elderly patients.Therefore, they are considered safe and deserving of clinical promotion.

ObjectiveTo identify and analyze the possible influencing factors of obesity among public primary school students in Minhang District， Shanghai. MethodsBasic data， collected through questionnaire stars， was imported with merged physical examination data into Excel to form a database. Data were collected by questionnaire and analyzed by SPSS 22.00. Independent sample t-test was used for the data with normal distribution. Nonparametric test was used for the data with non-normal distribution. χ² test was used for the quantitative data. Logistic regression was used for univariate and multivariate analysis. ResultsAccording to the national physical health standards for students （revised in 2014） ， the prevalence rate of obesity among primary school students in Minhang district was 29.63% . The prevalence of overweight and obesity was 32.1% in boys and 26.9% in girls. The trend of overweight and obesity in different grades was similar among different genders .A single factor analysis showed that， being the only child （χ²=9.300， P<0.01） ， father obesity（χ²=106.417， P<0.001） or mother obesity（χ²=118.534， P<0.001） ， mother's overweight during pregnancy （χ²=159.731， P<0.001） ， caregiver's role as grandparents （χ²=38.736， P<0.001） ， low education level （χ²=111.309， P<0.001） had effects on overweight and obesity of children while the differences had statistical significance. Pupil's bad eating habit （χ²=18.905，P<0.001） and preference （χ²=22.901， P<0.001） ， insufficient sleep time （χ²=61.685， P<0.001） ， long-time using of electronic products （χ²=37.182， P<0.001） and low-time of exercise （χ²=15.328， P<0.001） also affected the obesity of primary school students. Among the five factors of family， diet， psychology， static state and dynamic state， the influencing factors of obesity in primary school students from grade one to grade four were being the only child， obese father and/or mother， overweight mother during pregnancy， caregivers without higher education. In terms of diet， it was mainly based on eating habits before bedtime， as well as partial and picky eating habits. In terms of psychology， the main psychological source was the pressure of learning in school. There was a clear relationship between the pace of learning and not keeping up. Static analysis revealed a correlation with lack of sleep. After assigning values based on eye hygiene recommendations for the use of electronic products， it was found that there was no direct correlation between obesity in primary school students and the duration of electronic product use. Dynamic analysis showed that not taking part in school physical exercise was related to obesity. ConclusionThe obesity of primary school students is influenced by family， diet， psychology， static and dynamic factors. The intervention of obesity in primary school needs the joint efforts of school， society， family， self-cognition and so on.

Vaccination is an effective public health measure to prevent and control vaccine-preventable diseases for individual and society. However, China currently confronts significant challenges, including a dearth of skilled professionals in the field of vaccination and disparities in the capacity for immunization services. This review introduced the experiences of four prime international vaccinology education models, including London School of Hygiene & Tropical Medicine, Johns Hopkins University, Leading International Vaccinology Education, and the Bill & Melinda Gates Foundation, in the aspect of personnel development, academic research and communication platforms establishment. It is supposed to give some insights and feasible suggestions on the establishment and advancement of vaccinology as a sub-discipline within high-level public health school in China, with the aim of development of a robust vaccinology education framework in China, which is essential for nurturing the next generation of public health leaders and practitioners for our country.

Vaccination is an effective public health measure to prevent and control vaccine-preventable diseases for individual and society. However, China currently confronts significant challenges, including a dearth of skilled professionals in the field of vaccination and disparities in the capacity for immunization services. This review introduced the experiences of four prime international vaccinology education models, including London School of Hygiene & Tropical Medicine, Johns Hopkins University, Leading International Vaccinology Education, and the Bill & Melinda Gates Foundation, in the aspect of personnel development, academic research and communication platforms establishment. It is supposed to give some insights and feasible suggestions on the establishment and advancement of vaccinology as a sub-discipline within high-level public health school in China, with the aim of development of a robust vaccinology education framework in China, which is essential for nurturing the next generation of public health leaders and practitioners for our country.

Humans ; Cross-Sectional Studies ; SARS-CoV-2 ; COVID-19 Vaccines/therapeutic use* ; Pandemics ; COVID-19/prevention & control* ; China/epidemiology* ; Attitude ; Vaccination

OBJECTIVE To investigate the effect of gene CD47 on immune microenvironment of lung squamous cell carcinoma and predict its immune response. METHODS The differences in the expression of CD47 between lung squamous cell carcinoma tissues and normal tissues were compared through The Cancer Genome Atlas(TCGA) databases. CD47 involved immune-related pathways were analyzed by Gene Set Enrichment Analysis(GSEA). Tumor Immune Estimation Resource(TIMER) databases and TISIDB databases(http://cis.hku.hk/TISIDB/TISIDB) were employed to analyze the relationship between CD47 gene expression in lung squamous cell carcinoma and immune cells infiltration in the tumor microenvironment. And further explored the associations between CD47 and other immune-related molecules such as PD-1, PD-L1, CTLA-4, IDO-1. Using the pRRophetic and TIDE algorithms, this study predicted the correlation between the expression of CD47 gene and chemotherapy drug sensitivity as well as the response to immunotherapy. RESULTS Compared with normal tissues, CD47 was lower expressed in lung squamous cell carcinoma tissues. It was found that CD47 could activate immune-related pathways such as the inflammatory response, interferon alpha response, interferon gamma response and JAK-STAT pathway. In lung squamous cell carcinoma tissues, the expression level of CD47 was significantly positively correlated with the infiltration level of B-cells, CD8T-cells, CD4T-cells, macrophage, neutrophils and dendritic cells according to the two databases. At the same time, CD47 showed a positive correlation with other immune checkpoints such as PD-1, PD-L1, CTLA-4, IDO1. The result of chemotherapy sensitivity indicated that in lung squamous cell carcinoma tissues, IC50 values of high expression CD47 group were lower than that for chemotherapy drugs such as sunitinib, dasatinib, doxorubicin and gemcitabine. However, the response rate to immunotherapy was lower in the low expression group for the immunotherapy. CONCLUSION CD47 is low expressed in lung squamous tissue, it can activate immune related pathways, and has a high response rate to immunotherapy. It can be used as a novel molecular marker for lung squamous cell carcinoma.

Objective:To explore the clinical efficacy of internal fixation with a reduction plate assisted by our self-designed lower extremity fracture traction reduction device for tibial plateau fractures of Schatzker type Ⅵ.Methods:A retrospective study was conducted of the 32 patients with tibial plateau fracture of Schatzker type Ⅵ who had been treated at Orthopaedic Department, Mindong Hospital Affiliated to Fujian Medical University from April 2018 to July 2021. Depending on their treatments, they were divided into 2 groups. In the control group of 16 cases subjected to open reduction and internal fixation with manual traction, there were 9 males and 7 females with an age of 50.0±11.7 years; in the observation group of 16 cases subjected to internal fixation with a reduction plate assisted by our self-designed lower extremity fracture traction reduction device, there were 8 males and 8 females with an age of 54.6±11.1 years. The operation time, fracture reduction time, total incision length, intraoperative blood loss, Rasmussen knee function score and maximum active range of knee motion were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability between the groups ( P>0.05). The operation time [(158.6±26.0) min], fracture reduction time [(61.6±9.6) min], and total incision length [16.0 (13.3, 17.0) cm] in the observation group were significantly shorter than those in the control group [(199.9±60.9) min, (73.8±17.2) min, and 20.0 (17.0, 21.8) cm]; the intraoperative blood loss [175.0 (100.0, 200.0) mL] in the observation group was significantly less than that in the control group [200.0 (162.5, 387.5) mL]; the maximum active ranges of knee motion at one week and one month in the observation group were 94.9°±12.0° and 113.8°±14.1°, significantly larger than those in the control group (78.3°±14.6° and 96.8°±11.4°) (all P<0.05). Fractures achieved bony union at one year after operation in both groups. At 12 months after operation, there was no significant difference in the maximum active range of knee motion or the Rasmussen knee function score between the 2 groups ( P>0.05). Conclusion:In the treatment of Schatzker type Ⅵ tibial plateau fractures, compared with manual traction and open reduction, internal fixation with a reduction plate assisted by our self-designed lower extremity fracture traction reduction device can shorten operation time and total incision length, reduce intraoperative blood loss, and facilitate postoperative functional recovery of the knee for the patients.

ObjectiveTo investigate the clinical characteristics and risk factors of hyperamylasemia and acute pancreatitis after percutaneous transhepatic biliary stenting (PTBS). MethodsA retrospective analysis was performed for the clinical data of 249 patients with malignant biliary obstruction who were admitted to Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, and underwent PTBS from March 2016 to February 2020, and according to the presence or absence of postoperative hyperamylasemia or acute pancreatitis, the patients were divided into two groups to analyze incidence rate, severity, and related risk factors. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed for the factors with P＜0.1 in the univariate analysis to investigate independent risk factors for hyperamylasemia and acute pancreatitis after PTBS. ResultsAfter PTBS, 55 patients (221%) patients had abnormally elevated serum amylase, among whom 26 (10.4%) were diagnosed with hyperamylasemia and 29 (11.7%) were diagnosed with acute pancreatitis. All patients with acute pancreatitis had mild manifestations. The multivariate logistic regression analysis showed that age ≤60 years (odds ratio ［OR］=2.2, 95% confidence interval ［CI］: 1.07-4.52, P=0033), iodine-125 seed strand implantation (OR=2.8, 95%CI: 1.21-6.45, P=0.016), biliary stent placement across the papilla (OR=6.3, 95%CI: 2.85-1405, P＜0.001), and visualization of the pancreatic duct during surgery (OR=13.9, 95%CI: 5.64-3403, P＜0.001) were risk factors for hyperamylasemia and acute pancreatitis after PTBS. ConclusionHyperamylasemia and acute pancreatitis are relatively common complications after PTBS. Age ≤60 years, iodine-125 seed strand implantation, biliary stent placement across the papilla, and visualization of the pancreatic duct during surgery are independence risk factors for hyperamylasemia and acute pancreatitis after PTBS.

Objective    To evaluate the early and mid-term safety of transcatheter aortic valve replacement via transfemoral (TF), transapical (TAp) and transsubclavian (TSc) approaches by meta-analysis. Methods    We systematically searched the clinical comparative trials published from inception to June 2019 from PubMed, Web of Science, EMbase and The Cochrane Library, to evaluate the safety of transcatheter aortic valve replacement through TF, TAp or TSc approaches. The information of all-cause mortality at 30 days, 1 year, 2 years and the incidence of common complications at 30 days after operation (including pacemaker-dependent block, major vascular complications, severe bleeding events, acute renal injury and stroke) were exacted, and a meta-analysis was conducted by RevMan 5.3 software. Results    This study included 11 literatures, with a total of 7 833 patients, among whom 5 348 patients were treated by TF TAVR, 1 796 patients by TAp TAVR and 689 patients by TSc TAVR. The results of the meta-analysis were as follows: (1)  at 30 days after operation, the mortality of TF and TSc approaches were lower than that of the TAp approach (TF vs. TAp:OR=0.57, 95%CI 0.39-0.84, P=0.004; TSc vs. TAp: OR=4.12, 95%CI 1.93-8.79, P=0.000 3). There was no statistical difference between the TF and TSc approaches (TF vs. TSc: OR=0.98, 95%CI 0.38-2.51, P=0.97); at 1 year, there was no statistical difference in mortality among the three approaches (P>0.05); at 2 years, there was no statistical difference between TSc and TF or TAp approaches (TF vs. TSc: OR=1.21, 95%CI 0.95-1.54, P=0.13; TSc vs. TAp: OR=1.02, 95%CI 0.76-1.36, P=0.91). (2) The incidence of acute kidney injury after TF approach was lower than that of the TAp approach (OR=0.30, 95%CI 0.22-0.41, P<0.000 01). (3) There was no statistical difference in major vascular complications between TSc and TF or TAp approaches (TF vs. TSc: OR=0.75, 95%CI 0.38-1.49, P=0.41; TSc vs. TAp: OR=1.37, 95%CI 0.56-3.32, P=0.49). (4) There was no statistical difference in severe bleeding events between TF and TSc (OR=0.97, 95%CI 0.53-1.76, P=0.92). (5) There was no statistical difference in the incidence of postoperative stroke, pacemaker dependent block among the three approaches (P>0.05). Conclusion    TAp and TSc approaches are safe and effective. They are not only an alternative to TF approach, but also the first choice in some patients with poor condition of iliofemoral artery.

Objective:To rapidly evaluate the level of healthcare resource demand for laboratory testing and prevention and control of corona virus disease 2019 (COVID-19) in different epidemic situation, and prepare for the capacity planning, stockpile distribution, and funding raising for infectious disease epidemic response.Methods:An susceptible, exposed, infectious, removed infectious disease dynamics model with confirmed asymptomatic infection cases and symptomatic hospitalized patients was introduced to simulate different COVID-19 epidemic situation and predict the numbers of hospitalized or isolated patients, and based on the current COVID-19 prevention and control measures in China, the demands of resources for laboratory testing and prevention and control of COVID-19 were evaluated.Results:When community or local transmission or outbreaks occur and total population nucleic acid testing is implemented, the need for human resources is 3.3-89.1 times higher than the reserved, and the current resources of medical personal protective equipment and instruments can meet the need. The surge in asymptomatic infections can also increase the human resource demand for laboratory testing and pose challenge to the prevention and control of the disease. When vaccine protection coverage reach ≥50%, appropriate adjustment of the prevention and control measures can reduce the need for laboratory and human resources.Conclusions:There is a great need in our country to reserve the human resources for laboratory testing and disease prevention and control for the response of the possible epidemic of COVID-19. Challenges to human resources resulted from total population nucleic acid testing and its necessity need to be considered. Conducting non-pharmaceutical interventions and encouraging more people to be vaccinated can mitigate the shock on healthcare resource demand in COVID-19 prevention and control.