Objective To study the effect of spectrum irradiation combined with operative laparoscopy on inflammatory reaction and immune function in children with appendicitis.Methods 120 children with appendicitis from January 2022 to January 2023 were selected as the study subjects,randomly divided them into two groups using a random number table method:the control group(n = 60)and the study group(n = 60).The control group underwent laparoscopic minimally invasive appendectomy,and the study group underwent spectrum irradiation combined with laparoscopic minimally invasive appendectomy.The two groups compared perioperative recovery,procalcitonin(PCT),C-reactive protein(CRP)level,cellular immune function(CD4+,CD8+,and CD4+/CD8+),humoral immune function[immunoglobulin M(IgM),immunoglobulin G(IgG),C3,and C4],pain visual analogue scale(VAS),Alvarado score,and treatment effect and postoperative complication rate.Results Compared with the control group,the study group showed a significant reduction in the time to first anal exhaust and hospital stay after surgery,the differences were statistically significant(P<0.05).Compared with preoperative levels,the levels of PCT and CRP in both groups of patients increased at 12 and 24 h postoperatively,with the highest levels occurring at 12 h postoperatively;The PCT and CRP levels in the study group were lower than those in the control group at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).Compared with preoperative data,the CD4+,CD8+,and CD4+/CD8+ levels decreased in both groups at 12 and 24 h postoperatively,with the lowest levels observed at 12 h postoperatively;The CD4+,CD8+,and CD4+/CD8+ levels in the study group were higher than those in the control group at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).Compared with preoperative levels,the levels of IgM,IgG,C3,and C4 in both groups of patients decreased after surgery,with the lowest levels occurring 12 h after surgery;The levels of IgM,IgG,C3,and C4 in the study group were higher than those in the control group at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).Compared with preoperative conditions,the VAS and Alvarado scores in both groups of patients decreased at 12 and 24 h after surgery.The VAS and Alvarado scores of the study group were lower than those of the control group at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).Compared with the control group,the study group had a higher overall effective rate and a lower total incidence of complications,the differences were statistically significant(P<0.05).Conclusion Spectrum irradiation combined with operative laparoscopy can reduce postoperative inflammatory reaction,and improve immune function in children with appendicitis,shorten inflammatory reaction and immunosuppression time,reduce pain,and have a low incidence of postoperative complications,with ideal effect.

Objective:To compare the clinical efficacy between arthroscopically assisted reduction versus open reduction in the treatment of paediatric humeral lateral condylar fractures with Kirschner wire fixation.Methods:A retrospective study was conducted to analyze the data of 28 children with humeral lateral condylar fracture who had undergone surgery at Department of Pediatric Orthopedics, Beijing Jishuitan Hospital from August 2023 to September 2023. There were 24 males and 4 females with an age of (6.5±1.6) years, 24 cases of type Ⅱ and 4 cases of type Ⅲ fractures according to the Jacob classification, and 1 case of type Ⅰ and 27 cases of type Ⅱ fractures according to the Milch classification. The time from injury to surgery averaged (71.6±21.3) hours. The children were divided into 2 groups according to their reduction methods: an arthroscopic group of 16 cases treated by arthroscopically assisted reduction and K-wire fixation and an open reduction group of 12 cases treated by open reduction and K-wire fixation. The operation time, incision length, Kirschner wire removal time, Mayo elbow performance score (MEPS) and the incidence of lateral bony spur on the X ray at the last follow-up were compared between the 2 groups; the flexion-extension and carrying angle of the elbow were compared between the healthy side and the affected side within each group at the last follow-up.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The 28 pediatric patients were followed up for (4.9±0.4) months after surgery. The incision length [(1.3±0.4) cm] and Kirschner wire removal time [(42.8±3.5) d] in the arthroscopic group were significantly shorter than those in the open reduction group [(4.8±0.5) cm and (95.5±16.4) d] ( P<0.05). There was no significant difference in the operation time between the 2 groups [(70.6±15.5) min versus (61.7±14.5) min] ( P>0.05). There was no significant difference in the flexion-extension or in the carrying angle between the healthy and affected sides within each group at the last follow-up ( P>0.05). There was no significant difference either in the MEPS score or in the incidence of lateral bony spur between the 2 groups at the last follow-up ( P>0.05). Follow-up revealed pin infection in 1 patient in the arthroscopic group, and exposure of Kirschner wire tail in 1 patient in the open reduction group. Conclusions:In the treatment of humeral lateral condylar fractures, arthroscopically assisted reduction and Kirschner wire fixation can allow for debridement of the fracture ends in a minimally invasive way, visual fracture evaluation and reduction. Compared with open reduction, arthroscopically assisted reduction can reduce operative trauma without significantly increasing operation time.

Objective:To evaluate the distribution characteristics of choroidal vascularity index (CVI) in macula among normal children using swept-source optical coherence tomography (SS-OCT), and to investigate the influencing factors.Methods:A cross-sectional study was conducted.Sixty-three children aged 6 to 12 years were enrolled in The First Affiliated Hospital of Zhengzhou University from May 2021 to November 2021.Spherical equivalent refraction, axial length (AL) and other ocular biological parameters were measured.Macula-centered CVI and choroidal thickness (ChT) were measured by SS-OCT angiography.According to the ETDRS partition, the obtained image was divided into macular central fovea (0-1 mm diameter), inner ring (1-3 mm diameter) and outer ring (3-6 mm diameter) zones.Data from the right eye were selected for statistical analysis.CVI in the three rings and four zones (superior, temporal, inferior and nasal zones) of the inner and outer rings were compared.Univariate and multiple linear regression analyses were used to analyze the correlation between CVI and sex, AL, anterior chamber depth (ACD), ChT and pupil diameter.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of The First Affiliated Hospital of Zhengzhou University (No.2021-KY-0399-003). Written informed consent was obtained from each guardian.Results:The average CVI in the macular central fovea, inner ring and outer ring were 0.35±0.12, 0.32±0.10 and 0.27±0.08, respectively, with a significant difference ( F=10.96, P<0.001), and significant differences in CVI were found in pairwise comparisons of the three ring zones (all at P<0.05). Significant differences in CVI were found among superior, temporal, inferior and nasal zones in inner and outer rings ( Fring=11.60, P=0.001; Fzone=12.02, P<0.05). The CVI was smaller in superior and nasal zones in inner ring than in temporal zone, greater in superior, temporal and inferior zones in outer ring than in nasal zone, smaller in superior zone of outer ring than that of the inner ring, and the differences were statistically significant (all at P<0.001). The single factor linear regression analysis showed that ChT in the fovea, inner ring and outer ring were the influencing factors of CVI in the three ring zones (all at β=0.001, P<0.001). Pupil diameter ( β=0.034, P=0.038; β=0.040, P=0.003; β=0.024, P=0.011) and ACD ( β=0.097, P=0.034; β=0.097, P=0.013; β=0.061, P=0.032) were the influencing factors of CVI in fovea, inner ring and outer ring.After multiple linear regression analysis, the regression equations were established as follows: CVI in the macular fovea=0.001×ChT in the macular fovea + 0.001×ChT in the inner ring+ 0.001×ChT in the outer ring-0.301 ( R2=0.514, F=6.875, P<0.001); CVI in the inner ring=0.001×ChT in the macular fovea+ 0.001×ChT in the inner ring+ 0.001×ChT in the outer ring+ 0.088×AL-0.307 ( R2=0.603, F=9.870, P<0.001); CVI in the outer ring=0.001×ChT in the macular fovea+ 0.001×ChT in the inner ring+ 0.001×ChT in the outer ring-0.135 ( R2=0.601, F=9.781, P<0.001). Conclusions:In children aged 6-12 years old, the CVI is higher in the macular central fovea than in inner and outer rings, and the CVI in nasal zone is the smallest in both inner and outer rings.The thicker the ChT, the higher the CVI in all zones in the macular area; the deeper the anterior chamber, the higher the CVI in the inner ring.

Objective:To evaluate the current situation of prevention and control of iodine deficiency disorders (IDD), and to describe the iodine nutrition level of pregnant women in key population in Zhejiang Province.Methods:In 2021, a cross-sectional survey on iodine nutrition status of the population was conducted in all 90 counties (cities, districts) in Zhejiang Province. Each county (city, district) was divided into five districts: east, west, south, north, and central. One township (street) was selected from each district, and 20 pregnant women were selected from each township (street) to collect edible salt samples and one random urine sample for salt and urinary iodine testing. The above indicators were stratified and analyzed according to urban, rural, coastal, inland, early pregnancy, mid pregnancy, and late pregnancy.Results:A total of 9 679 pregnant women's salt samples were tested, with a salt iodine content of (20.2 ± 9.2) mg/kg, an iodized salt coverage rate of 84.2% (8 153/9 679), and a qualified iodized salt consumption rate of 80.4% (7 785/9 679). Among them, the qualified iodized salt consumption rate of pregnant women in coastal areas was 69.4% (3 175/4 575), significantly lower than that in inland areas [90.3% (4 610/5 104)]; and the proportion of non iodized salt consumption in coastal areas [25.8% (1 181/4 575)] was significantly higher than inland areas [6.8% (345/5 104)]. A total of 9 679 pregnant women's urine samples were tested, with a median urinary iodine of 133.0 μg/L ( < 150 μg/L). In urban areas, the median urinary iodine (129.8 μg/L) was lower than that in rural areas (135.0 μg/L). Likewise, the median urinary iodine was 126.0 μg/L, lower than inland areas (140.3 μg/L). And as pregnancy progressed, the iodine nutrition level of pregnant women gradually decreased (the median urinary iodine: 137.0 μg/L in early pregnancy, 134.1 μg/L in mid pregnancy, and 129.4 μg/L in late pregnancy).Conclusion:In 2021, pregnant women in Zhejiang Province are in a state of iodine deficiency, and there is a greater risk in urban areas compared to rural areas and coastal areas compared to inland areas.

Objective:We investigated the incidence of surgical site infection (SSI) following emergency abdominal surgery (EAS) in China and further explored its risk factors, providing a reference for preventing and controlling SSI after EAS.Methods:This was an observational study. Data of patients who had undergone EAS and been enrolled in the Chinese SSI Surveillance Program during 2018–2021were retrospectively analyzed. All included patients had been followed up for 30 days after surgery. The analyzed data consisted of relevant patient characteristics and perioperative clinical data, including preoperative hemoglobin, albumin, and blood glucose concentrations, American Society of Anesthesiologists (ASA) score, grade of surgical incision, intestinal preparation, skin preparation, location of surgical site, approach, and duration. The primary outcome was the incidence of SSI occurring within 30 days following EAS. SSI was defined as both superficial and deep incisional infections and organ/space infections, diagnoses being supported by results of microbiological culture of secretions and pus. Secondary outcomes included 30-day postoperative mortality rates, length of stay in the intensive care unit (ICU), duration of postoperative hospitalization, and associated costs. The patients were classified into two groups, SSI and non-SSI, based on whether an infection had been diagnosed. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with SSI following EAS.Results:The study cohort comprised 5491 patients who had undergone EAS, comprising 3169 male and 2322 female patients. SSIs were diagnosed in 168 (3.1%) patients after EAS (SSI group); thus, the non-SSI group consisted of 5323 patients. The SSIs comprised superficial incision infections in 69 (41.1%), deep incision infections in 51 (30.4%), and organ or space infections in 48 (28.6%). Cultures of secretions and pus were positive in 115 (68.5%) cases. The most frequently detected organism was Escherichia coli (47/115; 40.9%). There were no significant differences in sex or body mass index between the SSI and non-SSI groups (both P>0.05). However, the proportion of individuals aged 60 years or older was significantly greater in the SSI than in the non-SSI group (49.4% [83/168] vs. 27.5% [1464/5323), χ 2=38.604, P<0.001). Compared with the non-SSI group, the SSI group had greater proportions of patients with diabetes (11.9% [20/168] vs. 4.8% [258/5323], χ 2=16.878, P<0.001), hypertension (25.6% [43/168] vs. 12.2% [649/5323], χ 2=26.562, P<0.001); hemoglobin <110 g/L (27.4% [46/168] vs. 13.1% [697/5323], χ 2=28.411, P<0.001), and albuminemia <30 g/L (24.4% [41/168] vs. 5.9% [316/5323], χ 2=91.352, P<0.001), and a reduced rate of preoperative skin preparation (66.7% [112/168] vs. 75.9% [4039/5323], χ 2=7.491, P=0.006). Furthermore, fewer patients in the SSI group had preoperative ASA scores of between one and two (56.0% [94/168] vs. 88.7% [4724/5323], χ 2=162.869, P<0.001) in the non-SSI group. The incidences of contaminated and infected incisions were greater in the SSI group (63.1% [106/168] vs. 38.6% [2056/5323], χ 2=40.854, P<0.001). There was a significant difference in surgical site distribution between the SSI and non-SSI groups (small intestine 29.8% [50/168] vs. 10.6% [565/5323], colorectal 26.2% [44/168] vs. 5.6% [298/5 323], and appendix 24.4% [41/168] vs. 65.1% [3465/5323]) χ 2=167.897, P<0.001), respectively. There was a significantly lower proportion of laparoscope or robotic surgery in the non-SSI group (24.4 % [41/168] vs. 74.2% [3949/5323], χ 2=203.199, P<0.001); the percentage of operations of duration less than 2 hours was significantly lower in the SSI than non-SSI group (35.7% [60/168] vs. 77.4% [4119/5323], χ 2=155.487, P<0.001). As to clinical outcomes, there was a higher 30-day postoperative mortality rate (3.0%[5/168] vs. 0.2%[10/5323], χ 2=36.807, P<0.001) and higher postoperative ICU occupancy rate (41.7% [70/168] vs. 19.7% [1046/5323], χ 2=48.748, P<0.001) in the SSI group. The median length of stay in the ICU (0[2] vs. 0[0] days, U=328597.000, P<0.001), median total length of stay after surgery (16[13] vs. 6[5] days, U=128146.000, P<0.001), and median hospitalization cost (ten thousand yuan, 4.7[4.4] vs. 1.7[1.8], U=175965.000, P<0.001) were all significantly greater in the SSI group. Multivariate logistic regression analysis revealed that the absence of skin preparation before surgery (OR=2.435,95%CI: 1.690–3.508, P<0.001), preoperative albuminemia <30 g/L (OR=1.680, 95%CI: 1.081–2.610, P=0.021), contaminated or infected incisions (OR=3.031, 95%CI: 2.151–4.271, P<0.001), and laparotomy (OR=3.436, 95% CI: 2.123–5.564, P<0.001) were independent risk factors of SSI. Operative duration less than 2 hours (OR=0.465, 95%CI: 0.312–0.695, P<0.001) and ASA score of 1–2 (OR=0.416, 95% CI: 0.289–0.601, P<0.001) were identified as independent protective factors for SSI. Conclusions:It is important to consider the nutritional status in the perioperative period of patients undergoing EAS. Preoperative skin preparation should be conducted and, whenever possible, laparoscope or robot-assisted surgery. Duration of surgery should be as short as possible while maintaining surgery quality and improving patient care.

Background::Visual inputs are critical for locomotor navigation and sensorimotor integration in the elderly; however, the mechanism needs to be explored intensively. The present study assessed the gait pattern after cataract surgery to investigate the effects of visual restoration on locomotion.Methods::The prospective study recruited 32 patients (70.1 ± 5.2 years) with bilateral age-related cataracts in the Department of Ophthalmology at Peking University Third Hospital from October 2016 to December 2019. The temporal-spatial gait parameters and kinematic parameters were measured by the Footscan system and inertial measurement units. Paired t-test was employed to compare data normally distributed and Wilcoxon rank-sum test for non-normally distributed. Results::After visual restoration, the walking speed increased by 9.3% (1.19 ± 0.40 m/s vs. 1.09 ± 0.34 m/s, P=0.008) and exhibited an efficient gait pattern with significant decrease in gait cycle (1.02 ± 0.08 s vs. 1.04 ± 0.07 s, P=0.012), stance time (0.66 ± 0.06 s vs. 0.68 ± 0.06 s, P=0.045), and single support time (0.36 ± 0.03 s vs. 0.37 ± 0.02 s, P=0.011). High amplitude of joint motion was detected in the sagittal plane in the left hip (37.6° ± 5.3° vs. 35.5° ± 6.2°, P=0.014), left thigh (38.0° ± 5.2° vs. 36.4° ± 5.8°, P=0.026), left shank (71.9° ± 5.7° vs. 70.1° ± 5.6°, P=0.031), and right knee (59.1° ± 4.8° vs. 56.4° ± 4.8°, P=0.001). The motor symmetry of thigh improved from 8.35 ± 5.30% to 6.30 ± 4.73% ( P=0.042). Conclusions::The accelerated gait in response to visual restoration is characterized by decreased stance time and increased range of joint motion. Training programs for improving muscle strength of lower extremities might be helpful to facilitate the adaptation to these changes in gait.

Objective:We investigated the incidence of surgical site infection (SSI) following emergency abdominal surgery (EAS) in China and further explored its risk factors, providing a reference for preventing and controlling SSI after EAS.Methods:This was an observational study. Data of patients who had undergone EAS and been enrolled in the Chinese SSI Surveillance Program during 2018–2021were retrospectively analyzed. All included patients had been followed up for 30 days after surgery. The analyzed data consisted of relevant patient characteristics and perioperative clinical data, including preoperative hemoglobin, albumin, and blood glucose concentrations, American Society of Anesthesiologists (ASA) score, grade of surgical incision, intestinal preparation, skin preparation, location of surgical site, approach, and duration. The primary outcome was the incidence of SSI occurring within 30 days following EAS. SSI was defined as both superficial and deep incisional infections and organ/space infections, diagnoses being supported by results of microbiological culture of secretions and pus. Secondary outcomes included 30-day postoperative mortality rates, length of stay in the intensive care unit (ICU), duration of postoperative hospitalization, and associated costs. The patients were classified into two groups, SSI and non-SSI, based on whether an infection had been diagnosed. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with SSI following EAS.Results:The study cohort comprised 5491 patients who had undergone EAS, comprising 3169 male and 2322 female patients. SSIs were diagnosed in 168 (3.1%) patients after EAS (SSI group); thus, the non-SSI group consisted of 5323 patients. The SSIs comprised superficial incision infections in 69 (41.1%), deep incision infections in 51 (30.4%), and organ or space infections in 48 (28.6%). Cultures of secretions and pus were positive in 115 (68.5%) cases. The most frequently detected organism was Escherichia coli (47/115; 40.9%). There were no significant differences in sex or body mass index between the SSI and non-SSI groups (both P>0.05). However, the proportion of individuals aged 60 years or older was significantly greater in the SSI than in the non-SSI group (49.4% [83/168] vs. 27.5% [1464/5323), χ 2=38.604, P<0.001). Compared with the non-SSI group, the SSI group had greater proportions of patients with diabetes (11.9% [20/168] vs. 4.8% [258/5323], χ 2=16.878, P<0.001), hypertension (25.6% [43/168] vs. 12.2% [649/5323], χ 2=26.562, P<0.001); hemoglobin <110 g/L (27.4% [46/168] vs. 13.1% [697/5323], χ 2=28.411, P<0.001), and albuminemia <30 g/L (24.4% [41/168] vs. 5.9% [316/5323], χ 2=91.352, P<0.001), and a reduced rate of preoperative skin preparation (66.7% [112/168] vs. 75.9% [4039/5323], χ 2=7.491, P=0.006). Furthermore, fewer patients in the SSI group had preoperative ASA scores of between one and two (56.0% [94/168] vs. 88.7% [4724/5323], χ 2=162.869, P<0.001) in the non-SSI group. The incidences of contaminated and infected incisions were greater in the SSI group (63.1% [106/168] vs. 38.6% [2056/5323], χ 2=40.854, P<0.001). There was a significant difference in surgical site distribution between the SSI and non-SSI groups (small intestine 29.8% [50/168] vs. 10.6% [565/5323], colorectal 26.2% [44/168] vs. 5.6% [298/5 323], and appendix 24.4% [41/168] vs. 65.1% [3465/5323]) χ 2=167.897, P<0.001), respectively. There was a significantly lower proportion of laparoscope or robotic surgery in the non-SSI group (24.4 % [41/168] vs. 74.2% [3949/5323], χ 2=203.199, P<0.001); the percentage of operations of duration less than 2 hours was significantly lower in the SSI than non-SSI group (35.7% [60/168] vs. 77.4% [4119/5323], χ 2=155.487, P<0.001). As to clinical outcomes, there was a higher 30-day postoperative mortality rate (3.0%[5/168] vs. 0.2%[10/5323], χ 2=36.807, P<0.001) and higher postoperative ICU occupancy rate (41.7% [70/168] vs. 19.7% [1046/5323], χ 2=48.748, P<0.001) in the SSI group. The median length of stay in the ICU (0[2] vs. 0[0] days, U=328597.000, P<0.001), median total length of stay after surgery (16[13] vs. 6[5] days, U=128146.000, P<0.001), and median hospitalization cost (ten thousand yuan, 4.7[4.4] vs. 1.7[1.8], U=175965.000, P<0.001) were all significantly greater in the SSI group. Multivariate logistic regression analysis revealed that the absence of skin preparation before surgery (OR=2.435,95%CI: 1.690–3.508, P<0.001), preoperative albuminemia <30 g/L (OR=1.680, 95%CI: 1.081–2.610, P=0.021), contaminated or infected incisions (OR=3.031, 95%CI: 2.151–4.271, P<0.001), and laparotomy (OR=3.436, 95% CI: 2.123–5.564, P<0.001) were independent risk factors of SSI. Operative duration less than 2 hours (OR=0.465, 95%CI: 0.312–0.695, P<0.001) and ASA score of 1–2 (OR=0.416, 95% CI: 0.289–0.601, P<0.001) were identified as independent protective factors for SSI. Conclusions:It is important to consider the nutritional status in the perioperative period of patients undergoing EAS. Preoperative skin preparation should be conducted and, whenever possible, laparoscope or robot-assisted surgery. Duration of surgery should be as short as possible while maintaining surgery quality and improving patient care.

Objective: To investigate the status of iodine nutrition and prevalence of goiter among children at ages of 8 to 10 years in Zhejiang Province in 2021, so as to provide insights into the management of iodine deficiency in children. Methods : A total of 90 counties (districts) were sampled as field survey sites from 11 cities of Zhejiang Province using a multi-stage stratified random sampling method in 2021, and non-residential children at ages of 8 to 10 years in these sites were sampled as study subjects. Subjects' household edible salt samples and random urine samples were collected. The iodine content in salt and urinary iodine level were determined using the direct titration method and arsenic-cerium catalytic spectrophotometry for evaluation of iodine nutrition among children. In addition, the lateral lobe of the thyroid gland was measured using ultrasound, and the prevalence of goiter was estimated. Results: A total of 19 363 children were recruited, including 9 710 male children and 9 653 female children, with a male to female ratio of 1.01︰1, and there were 10 704 urban children (55.28%) and 8 659 rural children (44.72%), 9 149 children living in coastal areas (47.25%) and 10 214 children in inland regions (52.75%). The mean iodine content was (19.79±9.25) mg/kg in salt, and the coverage of qualified iodized salt (15 252) was 78.77%. The coverage of qualified iodized salt was significantly lower in urban children than in rural children (76.70% vs. 81.21%; χ2=68.301, P<0.001), and was lower in children living in coastal regions than in inland regions (68.05% vs. 88.27%; χ2=1 270.769, P<0.001). The median urinary iodine concentration was 195.1 μg/L, and the household iodine content in salt correlated positively with urinary iodine concentration in children (rs=0.383, P<0.001). There were 2 885 children with iodine deficiency (14.90%), 7 137 children with adequate iodine (36.86%), 5 414 children with excessive iodine intake (27.96%), and 3 927 children with iodine overdose (20.28%), and the distribution of iodine nutrition in children varied significantly in regions (χ2=283.277, P<0.001) and gender (χ2=126.349, P<0.001). The prevalence of goiter was 2.45% among 7 195 children receiving ultrasound examinations, and a higher prevalence rate of goiter was detected in urban children than in rural children (2.76% vs. 2.00%; χ2=3.962, P=0.047). Conclusions The overall urinary iodine nutrition was adequate among children at ages of 8 to 10 years in Zhejiang Province in 2021, and the prevalence of goiter in children fell within the threshold defined in the criteria of elimination of iodine deficiency. However, the supervision of the iodized salt quality remains to be improved and iodine deficiency control remains to be reinforced.

Objective: To investigate the development of public health human resource of the Centers for Disease Control and Prevention (CDCs) in Zhejiang Province from 2016 to 2020, so as to put forward the strategies for the talent team construction of CDCs. Methods: The general information of personnel of CDCs in Zhejiang Province from 2016 to 2020 was collected through China Information System for Disease Control and Prevention. A questionnaire survey and a qualitative interview were conducted to collect the data of staffing, talent training, salary and employee turnover, and to analyze the development of the talent team of CDCs. Results: By 2020, there were 105 CDCs, including 1 provincial, 11 prefectural and 93 county-level CDCs, and 5 277 staff on-the-job. From 2016 to 2020, the number of staff per 10 000 permanent residents in the province, prefecture and county levels were 0.062-0.070, 0.170-0.188 and 0.585-0.604, respectively, which did not meet the standard for the personnel establishment in Zhejiang CDCs; the proportion of the staff with bachelor degree or above increased from 90.05% to 94.25%; the proportion of the health professionals decreased from 82.91% to 80.01%; the proportion of the staff with senior professional titles increased from 35.20% to 45.25%. The results of the qualitative interview indicated a lack of health professionals and high-end talents, a gap between the approved staffing and post requirements, as well as demands for a stable team and higher pay. Conclusion From 2016 to 2020, the structure of educational background, major and professional title among the on-the-job staff of CDCs in Zhejiang Province has been improving; however, the total allocation of human resource is insufficient, and the stability and treatment of staff need to be further improved.

Objective:To study the effect of MYD88 L265P mutation on the expression of PD-L1 in tumor cells and tumor microenvironment in diffuse large B-cell lymphoma (DLBCL), and to provide theoretical basis for immunotherapy for patients.Methods:Multiplex ligation-dependent probe amplification (MLPA) was used to detect the frequency of MYD88 L265P mutation in 72 cases of DLBCL diagnosed by pathologists in Cancer Hospital of Chinese Academy of Medical Sciences from August 2008 to May 2010. Expression of PD-L1 in tumor cells and tumor microenvironment in all samples was evaluated using PD-L1 (22C3) and PD-L1 (SP142) with Ventana automatic immunohistochemical (IHC) platform. The relationship between MYD88 L265P mutation and the expression of PD-L1 in DLBCL tumor cells and tumor microenvironment was assessed.Results:Of the 72 cases of DLBCL, MYD88 L265P mutation was detected in 15 (20.8%) cases. Nine cases with JAK2 amplification were excluded, and the remaining 63 cases of DLBCL were divided into MYD88 L265P mutant group ( n=14) and MYD88 L265P wild-type group ( n=49). IHC results showed that among the 14 cases of MYD88 L265P mutant groups, PD-L1 (22C3) was positive in 7 cases (7/14) of tumor cells and PD-L1 (SP142) was positive in 4 cases (4/14) of tumor microenvironment. Among the 49 cases of MYD88 L265P wild-type group, 9 cases (18.4%) were positive for PD-L1 (22C3) in tumor cells, and 38 cases (77.6%) were positive for PD-L1(SP142) in tumor microenvironment. In addition, among the 16 cases with PD-L1(22C3) expression in tumor cells, only 2 of the 7 cases with MYD88 L265P mutation were positive for PD-L1 (SP142) in tumor microenvironment. All 9 cases with wild-type MYD88 L265P were positive for PD-L1 (SP142) in tumor microenvironment. Statistical analysis showed that the expression level of PD-L1 (22C3) in tumor cells in the MYD88 L265P mutant group was significantly higher than that in the MYD88 L265P wild-type group ( P=0.017). The expression level of PD-L1 (SP142) in tumor microenvironment in the MYD88 L265P mutant group was significantly lower than that in the MYD88 L265P wild-type group ( P=0.001). Conclusions:MYD88 L265P mutation may play an important role in the regulation of PD-L1 expression in DLBCL tumor cells and tumor microenvironment. Further studies will provide a theoretical basis for immunotherapy of DLBCL patients with MYD88 L265P mutation.