Objective:To investigate the level of health literacy and its influencing factors among residents aged 15-69 years with different chronic disease in Zhejiang Province.Methods:In this cross-sectional study, a stratified multistage whole cluster random sampling method was used to select 19 200 permanent residents aged 15-69 years from 30 monitoring sites in Zhejiang Province from June to November 2022, and a household questionnaire survey was carried out with the National Health Literacy Monitoring Questionnaire for the Population. The content of the survey included socio-demographic characteristics, health-related factors and health literacy level. A total of 19 200 questionnaires were distributed and 19 051 were collected, of which 18 857 (98.98%) were valid. The χ2 test was used to compare the health literacy levels of residents with different chronic diseases, and logistic regression was used to analyze the influencing factors of the health literacy levels. Results:The health literacy level of residents aged 15-69 in Zhejiang Province in 2022 was 38.36%. Among them, the health literacy level of patients with multiple chronic diseases was much lower than those with single chronic disease and those without chronic disease (14.70% vs 25.37%, 42.21%) ( χ2=483.05, P<0.001). It was positively associated between having multiple chronic diseases and insufficient health literacy ( OR=1.26, 95% CI: 1.01-1.58); compared with those without chronic disease ( OR=1.00), patients with multiple chronic diseases were significantly more likely to have inadequate health literacy in basic knowledge and concepts ( OR=1.29, 95% CI: 1.03-1.63), health behaviors ( OR=1.24, 95% CI: 1.01-1.53), basic skills ( OR=1.37, 95% CI: 1.11-1.69), and health information literacy ( OR=1.27, 95% CI: 1.08-1.50). Conclusions:The number of chronic diseases is a key factor that affects the residents′ health literacy level, and people with multiple chronic diseases are often associated with a higher risk of inadequate health literacy.

Objective:To investigate the exposure to tobacco advertisement/promotion and smoking scenes from television/movie/video among middle school students in Zhejiang Province in 2021, and the influence on the knowledge and behavior about smoking of the students.Methods:Total 7 692 students were selected from 60 middle schools with the proportional probability sampling (PPS) method in Zhejiang Province. The investigation was performed with self-administered questionnaire survey which consisted of tobacco use, exposure to tobacco advertisement/promotion, et. The collected data was weighted and analyzed using the complex survey module of SPSS 21.0 software.Results:The prevalence of exposure to tobacco advertisement/promotion and smoking scenes from television/movie/video among the middle school students were 24.8% and 63.8% respectively. In recent 30 d, among those who had been exposed to the tobacco retail point, the proportion of those exposed to tobacco advertisement/promotion was 46.1%, and among those who surfed the internet, the proportion of those exposed to tobacco advertisement/video was 23.4%. Among the whole students, the proportion of those exposed to free tobacco product was 2.4%. The junior middle school students, regular high school students, and vocational school students who had been exposed to tobacco advertisement/promotion were more likely to feel smoking more comfortable in social occasions (5.6%, 6.7%, 8.8%), to feel smoking attractive for the young (9.1%, 8.4%, 8.8%), and also had higher rate of attempted smoking (12.5%, 16.9%, 20.5%) than non-exposed ones (junior middle school students: 2.3%, 5.5%, 4.8%; regular high school students: 2.9%, 2.9%, 9.8%; vocational school students: 4.0%, 4.0%, 15.3%) (all P<0.05). Among the students who had seen television/movie/video within 30 days, the junior middle school students, regular high school students, and vocational school students who had been exposed to smoking-related scenes had higher rate of attempted smoking (8.1%, 14.7%, 20.0%) than non-exposed ones (5.4%, 8.0%, 10.6%) (all P<0.05). Conclusion:The prevalence of exposure to tobacco advertisement/promotion and smoking scenes from television/movie/video are relatively high among the middle school students in Zhejiang province, which make exposed students more likely to report positive attitude to tobacco use, and more likely to smoke, to attempt to smoke.

Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

Objective:To evaluate the effects of hemoclips on preventing delayed bleeding for early gastric cancer (EGC) after endoscopic submucosal dissection (ESD).Methods:Clinical data of 459 patients who underwent ESD for EGC in Beijing Friendship Hospital from June 2013 to August 2020 were collected retrospectively. Patients were divided into group A (hemoclip group, n=162) and group B (non-hemoclip group, n=297) according to whether preventive hemostatic clip treatment was performed after resection. Delayed bleeding within 2 weeks after ESD was observed. Univariate analysis and subgroup analysis were conducted for the delayed bleeding incidence and clinicopathological features. Results:Delayed bleeding incidences of group A and group B were 3.1% (5/162) and 8.1% (24/297) with significant difference between the two groups ( χ2=4.418, P=0.036). Subgroup analysis showed that there were significant differences in the delayed bleeding incidence between the two groups when the diameter of the tumor >20 mm [3.5% (2/57) VS 15.3% (13/85), χ2=5.016, P=0.025], the tumor located in the lower part of the stomach [1.0% (1/97) VS 10.4% (20/192), χ2=8.425, P=0.004], and the depth of tumor invasion was M/SM1 [3.2% (5/157) VS 8.1% (23/285), χ2=4.072, P=0.044]. There were no significant differences in the delayed bleeding incidence between group A and group B when the diameter of the tumor ≤20 mm, the tumor located in the upper/medial part of the stomach and the depth of tumor invasion was SM2 ( P>0.05). Conclusion:Hemoclips can prevent delayed bleeding after ESD for EGC, which is mainly observed in a tumor of diameter >20 mm, located in the lower part of the stomach and M/SM1 tumor invasion. It has little effect on the prevention when the tumor diameter ≤20 mm and located in the upper/medial part of the stomach.

Objective:To evaluate the application of three-dimensional (3D) imaging device to colonoscopy.Methods:A total of 60 patients who underwent painless colonoscopy in Beijing Friendship Hospital, Capital Medical University from November to December, 2019 were enrolled and divided into 2 groups according to random code. Each patient underwent colonoscopy twice, while 2D colonoscopy was used for cecal intubation. Thirty patients were assigned to the experimental group (primary withdrawal used 3D colonoscopy, and secondary withdrawal used 2D colonoscopy), and 30 others to the control group (primary withdrawal used 2D colonoscopy, and secondary withdrawal used 3D colonoscopy). The detection of polyps, the withdrawal time, operating experience, image quality and complication were evaluated in the two groups.Results:The polyp detection rate at the first colonoscopy in the experimental group was 77.3% (17/22), which was higher than 43.5% (10/23) in the control group ( χ2=5.351, P=0.021). Ten operators in the experimental group had dizziness, while the operators in the control group had no dizziness ( P=0.001). There were no significant differences between the two groups in the polyp diameter [0.50 (0.70) cm VS 0.30 (0.20) cm, U=57.000, P=0.170], withdrawal time (4.6±1.5 min VS 5.2±1.9 min, t=-1.189, P=0.239) or image quality (27 cases with 3 points in the identification of lesion nature, and 28 cases with 3 points in the identification of duct both in the two groups, P=1.000) at the first colonoscopy. No complication occurred in either group. Conclusion:Application of 3D imaging device is feasible for colonoscopic polyp detection, and it can be used in clinical practice.

Objective:To analyze the clinicopathological features of de novo early colorectal cancer and to evaluate the efficacy of endoscopic treatment.Methods:Patients with de novo early colorectal cancer who underwent endoscopic resection in Beijing Friendship Hospital, Capital Medical University from June 2020 to May 2022 were enrolled. The baseline data, endoscopic manifestations, treatment methods, postoperative pathological results and prognosis of the patients were collected retrospectively.Results:A total of 33 patients with de novo early colorectal cancer were enrolled with the age of 62.67 ± 8.62 years, and the male to female ratio was 7.25∶1. The long diameter of lesions was 0.96 ± 0.36 cm. The lesion morphology was mainly superficial phenotype (type 0-Ⅱ), accounting for 72.7% (24/33). Endoscopic submucosal dissection (ESD) was performed in 29 cases and endoscopic mucosal resection (EMR) was performed in 4 cases. Postoperative pathology showed that 11 cases (33.3%) were well differentiated tubular adenocarcinoma, of which the superficial submucosal layer was invaded in 2 cases. Twenty cases (60.6%) were moderately differentiated tubular adenocarcinoma, of which the superficial submucosa layer was invaded in 5 cases and the deep submucosa layer in 15 cases. Two cases (6.1%) were moderately-poorly differentiated tubular adenocarcinoma, where the deep submucosa layer was invaded in both. There was significant correlation between the depth of invasion and the degree of differentiation ( P<0.001), and moderately and moderately-poorly differentiated lesions were more likely to invade the deep submucosa layer. The en bloc resection rate was 100.0% (33/33), the complete resection rate was 97.0% (32/33), and the curative resection rate was 42.4% (14/33). Among the 19 patients who did not achieve curative resection, 13 patients received supplementary surgical treatment. No tumor residue or lymph node metastasis was found in the postoperative pathology. All patients were followed up for 3-25 months, and no signs of local recurrence or metastasis were found. Conclusion:Most de novo early colorectal cancers are superficial phenotype under endoscopy. The pathology is mainly moderately differentiated tubular adenocarcinoma. Endoscopic resection of de novo early colorectal cancer shows encouraging short-term efficacy.

Gastroesophageal reflux disease （GERD） is a frequently and commonly occurring disease in clinic. In recent decades， with the development in pathophysiology and drug researches， modern medicine has achieved remarkable progress and results in diagnosis and treatment. However， the treatments for non-erosive reflux disease， refractory gastroesophageal reflux disease， proton pump inhibitor resistance， overlap of disease symptoms， and extraesophageal symptoms are limited and ineffective. Traditional Chinese medicine （TCM） was widely used in clinical practice， which has been proved effective in relieving symptoms and improving the quality of life. Sponsored by China Association of Chinese Medicine （CACM） and undertaken by the Spleen and Stomach Disease Branch of CACM， "the 12^th Youth Salon of Clinical Predominance Disease Series （GERD）" invited 18 authoritative digestive experts of TCM and western medicine to discuss "the difficulties of clinical diagnosis and treatment of GERD and TCM advantages". The focus issues such as modern medical diagnosis and treatment achievements and contributions， improvement and maintenance of symptoms， response to overlapping disease symptoms， reduction and withdrawal of acid suppressors， and treatment of extra-esophageal symptoms were discussed in depth. TCM and western medicine exchanged and complemented each other's strengths， combing the difficulties of modern medical diagnosis and treatment， which clarified the positioning and advantages of TCM and provided guidance for clinical and scientific research.

Objective:To describe the prevalence of tobacco use among college students in Zhejiang Province and analyze the influencing factors of second-hand smoke exposure on campus.Methods:In 2021, college students were selected from 9 colleges through stratified multi-stage cluster sampling from Zhejiang Province and surveyed using questionnaire. A total of 6 530 questionnaires were distributed and 6 035 were returned, with 6 030 valid questionnaires (96.48%). A descriptive analysis of the demography characteristics, cigarettes and electronic cigarettes (e-cigarettes) use, and second-hand smoke exposure of the subjects was carried out, and chi-square test was used for statistical analysis and multivariate logistic regression analysis was used to analyze influencing factors of second-hand smoke exposure on campus.Results:The current smoking rate and current use rate of e-cigarettes among college students were 3.70% and 1.56%, respectively, and the dual use rate of cigarettes and e-cigarettes was 1.16%. The exposure rate of second-hand smoke among college students on campus was 25.06%, while the exposure rate of second-hand smoke in off campus places was 32.35%. The awareness rates of smoking related diseases among college students were as follows: lung cancer (92.02%), heart disease (73.15%), stroke (72.87%), and impotence (64.08%). The awareness rate of second-hand smoke related diseases were as follows: lung cancer in adults (91.11%), heart disease in adults (78.91%), and lung disease in children (89.35%). The multivariate logistic regression analysis showed that seven factors (including gender, school type, major, grade, smoking ban regulations, smoking scenes, and knowledge about the health hazards of second-hand smoke) had a statistically significant impact on college students′ exposure to second-hand smoke at school [ OR=2.63, 0.67, 0.69, (0.39, 0.60, 0.68), 0.51, 1.74, 0.72] (all P<0.01). Conclusions:The use of cigarettes and e-cigarettes among college students in Zhejiang Province is not optimistic, especially the use rate of e-cigarettes is higher than adult. The status of second-hand smoke exposure among college students remains serious, with male students, non-medical students, students of special programs, and senior college students having more severe second-hand smoke exposure on campus, and students with high awareness of second-hand smoke exposure, less exposure to smoking scenes from media, from college with comprehensive smoke-free regulations are less exposed to second-hand smoke on campus.

Objective:To investigate the clinicopathological features of missed synchronous multiple early gastric cancer (SMEGC).Methods:Clinical and pathological data of 10 missed SMEGC patients in Beijing Friendship Hospital collected from January 2015 to December 2019 were reviewed for the clinicopathological and endoscopic features.Results:Ten missed SMEGC patients were all over 60 years old, and 6 of them were males. Six patients had family history of tumor and 6 had comorbidity (hypertension, diabetes, dyslipidemia, cardiovascular or cerebrovascular diseases). In terms of endoscopic and pathological manifestations, missed lesions of 6 cases were not smaller than the initial lesions, and more than half of the missed lesions had the same vertical location in the stomach (6/10), infiltration depth (8/10), histological classification (9/10), atrophic (8/10) and intestinal metaplasia (8/10) as the initial lesions.Conclusion:Physicians should be aware of the possibility of missed lesions during the first endoscopic treatment and the follow-up, especially at the same vertical location of the initial lesions in elderly males with family history of tumor and comorbidity.

Objective: To investigate the changing trends in the prevalence of health literacy among rural residents in Zhejiang Province from 2016 to 2021, so as to provide the evidence for formulating the health promotion strategy in rural areas. Methods: Rural residents' health literacy surveillance data were retrieved in Zhejiang Province from 2016 to 2021. The prevalence of health literacy was evaluated among rural residents according to the criteria defined by Chinese Center for Health Education, and standardized by Zhejiang Provincial population data captured from the national population census in China. The 6-year cumulative increase from 2016 to 2021 was estimated to investigate the changing trends in the prevalence of health literacy. Results: Totally 55 568 rural residents were monitored in Zhejiang Province from 2016 to 2021, including 26 893 men (48.40%) and 28 675 women (51.60%) and 32 156 residents at ages of 45 to 65 years (57.87%). The prevalence of health literacy was 18.00%, 21.52%, 25.53%, 27.54%, 30.85%, and 34.32% among rural residents in Zhejiang Province from 2016 to 2021, appearing a tendency towards a rise (χ2trend=661.376, P<0.001), and a 16.32% 6-year cumulative increase was seen. The prevalence of basic knowledge and concept, healthy lifestyle and behaviors and basic skills all appeared a tendency towards a rise (P<0.05), with 6-year cumulative increase rates of 24.48%, 11.08% and 8.11%, respectively. Among six categories of health issues, the prevalence of chronic disease prevention, scientific health outlook and health information literacy showed a tendency towards a rise year by year (P<0.05), with 6-year cumulative increase rates of 29.73%, 21.07% and 15.98%, respectively, and the prevalence of basic medical care, safety and first aid, and infectious disease prevention literacy appeared a fluctuation (P<0.05), with 6-year cumulative increase rates of 12.85%, 6.36% and -0.47%, respectively. The prevalence of health literacy appeared an overall tendency towards a rise in rural residents with different genders, age groups, educational levels and occupations (P<0.05), with a minor 6-year cumulative increase in residents at ages of 55 years and older and farmers, while a tendency towards a decline was seen among illiterate rural residents, with a 6-year cumulative rise of -3.16%. Conclusions The prevalence of health literacy appeared a tendency towards a rise among rural residents in Zhejiang Province from 2016 to 2021; however, the rate of increase reduced year by year. Health education and promotion should be enhanced targeting the elderly, individuals with low educational levels and farmers.