Objective: To investigate the correlation between social jetlag and psychological behavior in upper primary school students,so as to provide reference for sleep health promotion in primary school students. Methods: From April to June 2024, a survey was conducted among 4 341 fourth and fifth grade students from 9 public primary schools in a district in Beijing. Sleep patterns were assessed using a self designed questionnaire, while psychological behavior was evaluated using the Strengths and Difficulties Questionnaire (SDQ)(parent version). A generalized estimating equation (GEE) model was used to examine the association between different levels of social jetlag and psychological behavior problem scores in primary school students. Results: The proportions of students with social jetlag of <1.0, 1.0-<2.0, and ≥2.0 h were 57.6%, 30.6%, and 11.8%, respectively. The GEE model analysis found that after adjusting for covariates, compared with primary school students with social jetlag of <1.0 h, those with 1.0 -<2.0 and ≥2.0 h had higher scores for internalizing behavior problems [ β (95% CI ) =0.23(0.05-0.41)，0.28(0.02-0.54), P < 0.01]. Primary school students with ≥2.0 h of social jetlag had higher scores for externalizing behavior problems [ β (95% CI )=0.42 (0.13-0.71)， P <0.01]. Among boys and primary school students with an average nighttime sleep duration of ≥9 h, comparied with social jetlag of <1.0 h,those with sucial jetlag 1.0-<2.0 h had higher scores on internalizing and externalizing behavior problems[ β (95% CI )=0.32(0.07-0.56),0.51 (0.11-0.90), 0.26 (0.06-0.46)，0.58 (0.25-0.91), P <0.05]. Conclusions Greater social jetlag may be a risk factor for internalizing and externalizing behavior problems in upper primary school students. Reducing social jetlag may help decrease the occurrence of psychological behavior problems in primary school students.

Objective: To explore the association of screening myopia and sitting posture habits as well as screen viewing distance among primary school students, providing a scientific basis for myopia prevention and intervention among primary school students. Methods: From April to June 2024, a convenient sampling method was used to enroll 1 394 fourth grade students from four primary schools in a district of Beijing for vision examinations and questionnaire surveys. Logistic regression models were employed to analyze the relationship of screening myopia detection and sitting posture habits as well as viewing distance. Results: The screening myopia prevalence among primary school students was 63.8%. About 13.1% of students self reported poor sitting posture, and 47.1% selfreported a viewing distance of ≤20 cm. After adjusting for covariates including age, gender, school, sleep quality, parental myopia status, physical fitness level, daily high intensity physical activity, weekend outdoor activity time and types of after school services, Logistic regression analysis showed that students with poor sitting posture were more likely to have screening myopia than those with normal sitting posture ( OR =1.73,95% CI =1.03-2.92); students with a viewing distance of ≤20 cm were more likely to have screening myopia than those with a viewing distance of >20 cm( OR =1.32, 95% CI =1.02-1.71)( P <0.05). The association between sitting posture and screening myopia was more significant among boys( OR =2.00, 95% CI =1.03-3.88, P < 0.05 ). A multiplicative interaction was observed between sitting posture and viewing distance. Compared to primary school students with normal posture and a viewing distance of >20 cm, those with poor posture and a viewing distance of >20 cm were more likely to have screening myopia ( OR =1.82, 95% CI =1.12-2.96， P <0.05). Conclusions Both sitting posture habits and screen viewing distance are related to screening myopia in primary school students. Poor sitting posture poses a higher risk than screen distance, and the two factors exhibit an interactive effect on myopia risk.

Objective:To explore the effectiveness of short-term prehabilitation in elderly patients undergoing gastrointestinal tumor surgery.Methods:Elderly patients(139 cases) with gastrointestinal tumors who were admitted to Nanfang Hospital, Southern Medical University for surgery from December 2020 to January 2022 were included through the purposive sampling method, and were divided into the intervention group (69 cases) and the control group (70 cases) according to the patient's wishes using a quasi-experimental research design of non randomized grouped. Routine perioperative nursing was used in the control group, while the short-term prehabilitation was used in the intervention group in addition. The incidence of postoperative complications, the performance indicators, and postoperative functional recovery indicators were analyzed in the two groups.Results:The 6MWD in the intervention group of 1 day and 7 days after the surgery were (460.93 ± 76.36) m and (391.72 ± 72.93) m, which were significant higher than those in the control group, (423.69 ± 72.88) m and (351.13 ± 65.04) m ( t = 8.65, 12.01, both P<0.05). The first exhaust time, first postoperative ambulatory time, the first full fluid intake time and the duration of drainage tube indwelling in the intervention group were (51.28 ± 21.74) h, (33.93 ± 12.50) h, (69.39 ± 29.36) h and (4.30 ± 1.44) d, which were significant lower than those in the control group, (71.51 ± 23.68) h, (47.37 ± 14.58) h, (96.29 ± 38.36) h and (5.35 ± 2.09) d ( t values were -5.83 - -3.44, all P<0.05). Besides, the best critical value of preoperative 6MWD to predict postoperative rehabilitation effect was 477.5 m, with a sensitivity of 68% and specificity of 71%. Conclusions:Short-term prehabilitation improves the perioperative functional reserve and promotes overall functional recovery after surgery to a certain extent, and the postoperative functional recovery effect may be better when the patient′s preoperative 6MWD reaches 477.5 m.

OBJECTIVE: To investigate the short-term effectiveness of transverse antecubital incision in the treatment of failed closed reduction of Gartland type Ⅲ supracondylar humeral fractures (SHFs) in children. METHODS: Between July 2020 and April 2022, 20 children with Gartland type Ⅲ SHFs who failed in closed reduction were treated with internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision. There were 9 boys and 11 girls with an average age of 3.1 years (range, 1.1-6.0 years). The causes of injuries were fall in 12 cases and fall from height in 8 cases. The time from admission to operation ranged from 7 to 18 hours, with an average of 12.4 hours. The healing of the incision and the occurrence of complications such as nerve injury and cubitus varus were observed after operation; the elbow flexion and extension range of motion after removing the gypsum, after removing the Kirschner wire, and at last follow-up were recorded and compared, as well as the elbow flexion and extension and forearm rotation range of motion at last follow-up between healthy and affected sides; the Baumann angle was measured on the X-ray film, and the fracture healing was observed. At last follow-up, the effectiveness was evaluated according to the Flynn elbow function evaluation criteria. RESULTS: All incisions healed by first intention, and there was no skin necrosis, scar contracture, ulnar nerve injury, and cubitus varus. Postoperative pain occurred in the radial-dorsal thumb in 2 cases. The gypsum was removed and elbow flexion and extension exercises were started at 2-4 weeks (mean, 2.7 weeks) after operation, and the Kirschner wire was removed at 4-5 weeks (mean, 4.3 weeks). All the 20 patients were followed up 6-16 months, with an average of 12.4 months. The fracture healing time was 4-5 weeks, with an average of 4.5 weeks, and there was no complication such as delayed healing and myositis ossificans. The flexion and extension range of motion of the elbow joint gradually improved after operation, and there were significant differences between the time after removing the gypsum, after removing the Kirschner wire, and at last follow-up ( P<0.017). There was no significant difference in the flexion and extension of the elbow joint and the forearm rotation range of motion between the healthy and affected sides at last follow-up ( P>0.05). There was no significant difference in Baumann angle between the time of immediate after operation, after removing the Kirschner wire, and at last follow-up ( P>0.05). According to Flynn elbow function evaluation standard, 16 cases were excellent and 4 cases were good, the excellent and good rate was 100%. CONCLUSION The treatment of Gartland type Ⅲ SHFs in children with failed closed reduction by internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision has the advantages of complete soft tissue hinge behind the fracture for easy reduction and wire fixation, small incision, less complications, fast fracture healing, early functional recovery, reliable reduction and fixation, and can obtain satisfactory results.
Male ; Female ; Humans ; Child ; Child, Preschool ; Calcium Sulfate ; Humerus ; Humeral Fractures/surgery* ; Plastic Surgery Procedures ; Fracture Fixation, Internal/methods* ; Bone Wires ; Fracture Healing ; Treatment Outcome ; Range of Motion, Articular

Objective:To investigate the current status of diagnosis and treatment of Helicobacter pylori ( H. pylori) infection in primary hospitals in Jiangsu Province, and to evaluate the capability of comprehensive prevention and management of H. pylori infection in the primary hospitals. Methods:From 2020 to 2022, a questionnaire survey was conducted among 430 primary hospitals, which participated in the Incubation Center Project of Primary Gastroenterology Specialty Department in Jiangsu Province. The questionnaire survey includedthe establishmment of endoscopy and department of gastroenterology, items of H. pylori detection, H. pylori treatment, eradication plans and treatment course. The questionnaire was filled by the director of the primary hospital. Descriptive analysis was used for statistical analysis. Results:A total of 413 valid questionnaires were received. Among the 413 primary hospitals, 286 (69.2%) were equipped with endoscopy centers, and 202 (48.9%) had departments of gastroenterology. In terms of diagnostic methods for H. pylori, 35.8% (148/413) of the primary hospitals did not have urea breath test equipment, of which 84 hospitals did not carry out any H. pylori testing items, 8 hospitals only had rapid urease test, 45 hospitals only had serum H. pylori antibody test, 7 hospitals had both rapid urease test and serum H. pylori antibody test, and 4 hospitals had fecal H. pylori antigen test. In terms of therapeutic drugs, all the hospitals could provide proton pump inhibitors, and 82.8% (342/413) of the hospitals had bismuth agents. According to diagnosis and treatment guideline for H. pylori infection at the primary care, 7 combinations of two antibiotics were recommended. A total of 14 (3.4%) hospitals could provide all the combinations, 369 (89.3%)hospitals could provide 2 to 6 combinations, 20(4.8%)hospitals could provide only one combination, and 10 (2.4%) hospitals could not provide any combination. For the selection of the eradication scheme and treatment course, the bismuth-based quadruple scheme was chosen in 248 (60.0%) hospitals, 14-day course was selected in 363(87.9%) hospitals, and 14-day course of bismuth-based quadruple scheme was selected in 232 (56.2%) hospitals. Conclusion:Improving the H. pylori testing equipment in primary hospitals, preparing all types of therapeutic drugs, and improving doctors′ knowledge of diagnosis and treatment of H. pylori in are of great significance for improving the prevention and treatment efficacy of H. pylori infection at the primary hospitals.

Objective: To explore differences in the detection rate of elevated blood pressure (BP) in children aged 6-8 years old, and to verify the apparent existence of white-coat hypertension (BP) in children. Methods: Based on census data(PROC), and three subsequent BP readings were taken during follow-ups which were carried out from October 2018 to June 2019. A total of 1 785 children were included in the present study. Using updating blood pressure reference for Chinese children aged 3-17 years, compared the BP detection rate at baseline, at the first follow-up, and the average value of the last two BP readings. Fluctuations in the detection rate of elevated BP in children at different time-points were analyzed. Results: The detection rates of the three elevated BP measurements of 6-8-year-old children were 57.65%, 25.88% and 15.46%, respectively, and the detection rate was higher among boys than girls. The detection rate of baseline BP was higher than that of the first follow-up BP measurements and the average of the last two BP measurements(P<0.01). Given the agreement in the diagnosis of high SBP, high DBP, high BP at baseline, and the average of the last two follow-up BP measurements, elevated BP at baseline was the lowest among the three groups and SBP was higher than DBP. Conclusion Blood Pressure fluctuations might be caused by transient tension that was experienced during the baseline BP measurement and during the first of the three follow-ups. Therefore, the average value of last two BP measurements may better reflect the real BP level in children.

Objective: To examine the association between the visceral adiposity index (VAI) and nonalcoholic fatty liver disease (NAFLD) in the pediatric population in order to improve risk stratification and prevention systems for chronic liver disease. Methods: A total of 510 overweight/obese children aged 6-8 years old were enrolled from the child cohort which was designed to study puberty, obesity, and cardiovascular risk (PROC), and complete data from liver ultrasounds and the VAI were obtained. Used Spearman s rank correlation coefficient, Chi-square tests, and Logistic regression analyses to explore the association between the VAI and NAFLD. Results: The detection rates of NAFLD for boys and girls were 25.9% and 11.1%, respectively. VAI for normal group and the NAFLD group were 0.43(0.31, 0.61) and 0.61(0.44, 0.87) in boys, and 0.74(0.56, 1.07) and 1.08(0.67, 1.51) in girls, respectively. Spearman s correlation coefficient analysis showed that triglycerides(TG), VAI, and the third quintile VAI group were positively correlated with NAFLD in both boys and girls(r=0.19,0.26,0.29;0.16,0.16,1.18,P<0.05), and high-density lipoprotein-cholesterol (HDL-C) was negatively correlated with NAFLD in boys (r=-0.21, P<0.05). With advancing tertiles of VAI, the increasing trend in the NAFLD detection rate was statistically significant in boys and girls(Chi-square for trend were 21.77,7.66, P<0.01). The results of univariate and multivariable Logistic regression showed that, by taking the first tertile of VAI as a reference, the risk of NAFLD among boys was higher in the second tertile (cOR=2.59, 95%CI=1.15-5.86; aOR=2.33, 95%CI=1.01-5.36) and in the third tertile(cOR=5.73, 95%CI=2.62-12.53; aOR=4.87, 95%CI=2.15-11.03), where as the risk among girls was higher in the third tertile(cOR=4.43, 95%CI=1.40-14.00). Conclusion VAI is positively correlated with pediatric NAFLD. Higher tertiles of VAI were associated with an increased risk of NAFLD in overweight and obese children, which indicates that VAI can be used as an early predictor of NAFLD.

Objective: To identify the association of carotid intima-media thickness (cIMT) and visceral fat area (VFA) to inform prevention of cardiovascular disease in later life. Methods: All the grade one students of six non-boarding primary schools in Shunyi District, Beijing were enrolled, based on population-based survey design, to establish the child cohort on sensitization, puberty, obesity and cardiovascular risk (PROC). Socio-demographic information survey and anthropometric measure, blood and urine test were carried out. Robust linear regression was used to determine the relationship between cIMT and other factors. Results: Among 1 711 participants, a significant difference were observed between normal, overweight and obesity children on cIMT [(0.35±0.02)(0.36±0.02)(0.37±0.03)mm] (F=41.4, P<0.01) and VFA [16.2(13.6-19.3), 22.7(18.6-27.3), 51.5(33.9-73.0)cm2] (χ2=854.5, P<0.01). After adjusting age and sex, univariate robust linear regression showed that cIMT was associated with height, SBP, DBP, HDL-C, VFA (P<0.05) and TG (P=0.055). Multivariable robust linear regression indicated that in total and boys only included models, cIMT was associated with VFA and SBP(β=0.000 2, 0.000 2, 0.000 2, 0.000 2, P<0.05); while in girls only included model cIMT was associated with VFA and TG (β=0.000 2, 0.006 2, P<0.05). Conclusion VFA is stable to predict the increase of cIMT in children. We can use VFA to simplify the classification management of children and inform targeted early prevention of cardiovascular disease in adulthood.

Acute abdomen, abdominal trauma, gastrointestinal bleeding and gastrointestinal tumors are the main conditions that are routinely treated in gastrointestinal surgery department with high incidence and critical condition. These conditions need emergency or selective operations. During the outbreak of the coronavirus disease 2019 (COVID-19), it's a great challenge for us to meet the patients' requirement under the situation. As the COVID-19 was brought under control in China, the Department of General Surgery in Nanfang Hospital resumed regular medical services gradually. Based on our clinical practice, the four major measures of strengthening pre-hospital screening, perioperative prevention and control, medical staff protection, and ward management were adopted. These main measures include the strict implementation of the appointment system and triage system before admission; the conduction of epidemiological and preliminary screening of viral nucleic acids; the chest CT examination during the perioperative period to re-screen COVID-19; the reduction of the risk of droplets and aerosol transmission; the minimally invasive surgery combined with enhanced recovery program in order to reduce patient's susceptibility and shorten the length of postoperative hospital stay; the reinforcement of specific infection control training for medical staff; the strict implementation of hierarchical protection; the establishment of gastrointestinal surgery prevention and control system; the rehearsal of emergency exercise; the installation of quarantine wards; the screening and management of family care-givers; the strict disinfection of environment and materials. Our preliminary practice shows that following the work guidelines issued by the Guangdong Province COVID-19 Prevention and Control Office and adopting precise management strategies in combination with the specific clinical features of gastrointestinal surgery, it is possible to safely resume regular care for the patients and comply to epidemic control at the same time.

Objective:The study is to explore the association between trunk fat index (TFI) and carotid intima-media thickness (cIMT) among children aged 6-8 years old in Shunyi District, Beijing.Methods:The participants were enrolled from the child cohort on sensitization, puberty, obesity and cardiovascular risk (PROC) conducted in Shunyi District, Beijing from October 2018 to June 2019. The PROC used a community-based census-like design, and all eligible first-grade children from six public non-boarding primary schools in urban area were approached. Finally, a total of 1 503 children with written informed consent from parents and had complete data of TFI and cIMT were included for the present study. Sequential baseline surveys including anthropometric measurements, laboratory testing and ultrasonography measurement were conducted to collect the data on height, weight, body composition, blood pressure, serum lipids and cIMT. Linear regression was used to determine the predictors of cIMT, receiver operating characteristic (ROC) curve analysis was used to determine the cut-off value of TFI to identify children with high cIMT, and analysis of covariance was used to evaluate the post-consistency classification of cIMT by TFI.Results:The age of 1 503 participants was (6.7±0.3) years, and 752 boys accounted for 50.0%. The average cIMT was (0.358±0.024) and (0.355±0.023) mm, and the M( P25, P75) of TFI was 0.70 (0.22, 1.78) and 0.74 (0.23, 1.52) kg/m 2 for boys and girls, respectively. The detection rates for boys and girls of high cIMT were 2.1% and 3.3%, respectively. Linear regression analysis showed that height, systolic blood pressure (SBP), diastolic blood pressure (DBP), TFI were positively correlated with cIMT in boys ( P values<0.05). And height, SBP, triglyceride (TG), TFI were positively correlated with cIMT, and high-density lipoprotein cholesterol (HDL-C) was negatively correlated with cIMT in girls ( P values<0.05). ROC curve analysis indicated that the best cut-off values for TFI to identify children with high cIMT were 1.78 and 1.14 kg/m 2, at P75 and P66 for boys and girls, respectively. After grouped with the cut-off value of TFI and adjusted for age, height, SBP, DBP, TG, HDL-C, multivariable covariance analysis showed a consistent cut-off of inter-group cIMT mean by TFI groups ( P values<0.005). Conclusion:TFI is associated with cIMT, which underscore its application potential in identifying early vascular structural damage.