OBJECTIVE To evaluate the comprehensive value of novel oral anticoagulant drugs （NOACs） after major orthopedic surgery. METHODS The evaluation evidence was collected through literature research； evidence and value：impact on decision-making （EVIDEM） framework was introduced to integrate the evaluation process； the multi-criteria decision analysis （MCDA） method was used to construct a multi-dimensional evaluation system； the weights assigned to each evaluation criterion were determined by the combination of Delphi method and analytic hierarchy process， and the rivaroxaban， dabigatran and apixaban were comprehensively evaluated. RESULTS The clinical comprehensive evaluation system of NOACs after major orthopedic surgery was successfully established， and the final clinical comprehensive evaluation weights of NOACs （rivaroxaban， dabigatran， apixaban） after major orthopedic surgery were calculated， with scores of 0.399 7 for rivaroxaban， 0.244 4 for apixaban， and 0.355 9 for dabigatran， indicating that rivaroxaban demonstrated the highest overall clinical value. Among them， rivaroxaban had the highest weight score in the evaluation of pharmaceutical characteristics， cost-effectiveness and other attributes in a single dimension. In terms of efficacy and safety evaluation， apixaban had the highest weighting score. CONCLUSIONS Among NOACs， rivaroxaban is more suitable for routine anticoagulation management after major orthopedic surgery， especially in terms of pharmacological properties， cost-effectiveness and other attributes.

Objective: To investigate the incidence and influencing factors of falls among the elderly in Ningbo City, Zhejiang Province, so as to provide the basis for developing effective prevention strategies. Methods: The residents aged 60 years and above in Haishu District and Yuyao City of Ningbo City were selected by the multi-stage cluster random sampling method from June to October 2022. Demographic information, fall incidence in the past year, history of disease and self-rated health were collected through questionnaire surveys. Incidence of falls was descriptively analyzed, and factors affecting falls were identified using a multivariable logistic regression model stratified by gender and age. Results: A total of 1 275 elderly people were surveyed, including 635 men and 640 women. The median age was 72.00 (interquartile range, 13.00) years. In the past year, 158 residents fell, accounting for 12.39%. Additionally, 14 individuals experienced two or more falls, accounting for 8.86%. The incidence of falls was 14.69% in women, which was higher than the 10.08% in men (P<0.05). The incidence of falls was 14.86% in the elderly over 70 years, which was higher than the 9.39% in those aged 60 to 70 years (P<0.05). Multivariable logistic regression showed that the educational level (primary school and above, OR=0.501, 95%CI: 0.301-0.836), heart disease (present, OR=1.996, 95%CI: 1.076-3.703), and self-rated health status (good, OR=0.529, 95%CI: 0.319-0.875) were factors affecting falls in women; educational level (primary school and above, OR=0.514, 95%CI: 0.285-0.928) and self-rated health status (good, OR=0.456, 95%CI: 0.253-0.824) were factors affecting falls in residents aged 60 to 70 years. Conclusion Fall risk among the elderly is associated with gender, age, heart disease, educational level and self-rated health status, and the influencing factors for falls vary in different genders and ages.

Objective: To investigate the incidence trend of diabetes among children and adolescents in Ningbo City, Zhejiang Province from 2011 to 2021, so as to provide the basis for the prevention and control of diabetes among children and adolescents. Methods: Data on diabetes incidence among children and adolescents aged 0 to 18 years in Ningbo City were collected through the Diabetes Monitoring Platform of the Ningbo Chronic Disease Collaborative Management System from 2011 to 2021. Crude incidence rates were calculated and standardized using data from the Sixth National Population Census in 2010. The trend of incidence rates were analyzed by average annual percent change (AAPC). Results: A total of 701 cases of diabetes among children and adolescents were reported in Ningbo City from 2011 to 2021. The crude and standardized incidence rates were 6.86/105 and 7.27/105, respectively, showing upward trends (AAPC=5.886%, 7.147%, both P<0.05). The crude and standardized incidence rates of type 1 diabetes mellitus were 3.36/105 and 3.35/105, respectively, with no significant trend observed (AAPC=1.229%, 1.449%, both P>0.05). The crude incidence rate was higher in children and adolescents aged 10 to <15 years (4.56/105) than in other age groups (all P<0.05). The standardized incidence rate was higher in females than in males (3.49/105 vs. 3.04/105, P<0.05). The standardized incidence rate was higher in urban areas than in rural areas (3.60/105 vs. 3.15/105, P<0.05). The crude and standardized incidence rates of type 2 diabetes mellitus were 3.43/105 and 3.87/105, respectively, showing upward trends (AAPC=4.904%, 7.579%, both P<0.05). The crude incidence rate was higher in children and adolescents aged 15 to 18 years (10.53/105) than in other groups (all P<0.05). The crude incidence rates in children and adolescents who aged 10 to <15 years and 15 to 18 years showed upward trends (AAPC=15.030%, 6.637%, both P<0.05). The standardized incidence rate was higher in males than in females (4.01/105 vs. 3.57/105, P<0.05). The standardized incidence rate was higher in urban areas than in rural areas (4.57/105 vs. 3.34/105, P<0.05). Conclusions From 2011 to 2021, the incidence of type 2 diabetes mellitus showed an upward trend, with cases mainly concentrated in children and adolescents aged 15 to 18 years, males, and those living in urban areas. The incidence of type 1 diabetes mellitus remained stable, with cases mainly concentrated in children and adolescents aged 10 to <15 years, females, and those living in urban areas.

Objective To investigate the spatiotemporal distribution characteristics and potential influencing factors of newly diagnosed echinococcosis cases in Qinghai Province from 2016 to 2022, so as to provide insights into the formulation of the echinococcosis control strategy in Qinghai Province. Methods The number of individuals screened for echinococcosis, number of newly diagnosed echinococcosis cases, number of registered dogs and number of stray dogs were captured from the annual reports of echinococcosis control program in Qinghai Province from 2016 to 2022, and the detection of newly diagnosed echinococcosis cases was calculated. The number of populations, precipitation, temperature, wind speed, sunshine hours, average altitude, number of year-end cattle stock, number of year-end sheep stock, gross domestic product (GDP) per capita, and number of village health centers in each county (district) of Qinghai Province were captured from the Qinghai Provincial Statistical Yearbook, and county-level electronic maps in Qinghai Province were downloaded from the National Platform for Common Geospatial Information Services. The software ArcGIS 10.8 was used to map the distribution of newly diagnosed echinococcosis cases in Qinghai Province, and the spatial autocorrelation analysis of newly diagnosed echinococcosis cases was performed. In addition, the spacetime scan analyses of number of individuals screened for echinococcosis, number of newly diagnosed echinococcosis cases and geographical coordinates in Qinghai Province were performed with the software SaTScan 10.1.2, and the spatial stratified heterogeneity of the detection of newly diagnosed echinococcosis cases was investigated with the software GeoDetector. Results A total of 6 569 426 residents were screened for echinococcosis in Qinghai Province from 2016 to 2022, and 5 924 newly diagnosed echinococcosis cases were found. The detection of newly diagnosed echinococcosis cases appeared a tendency towards a decline over years from 2016 to 2022 (χ² = 11.107, P < 0.01), with the highest detection in Guoluo Tibetan Autonomous Prefecture in 2017 (82.12/10⁵). There were spatial clusters in the detection of newly diagnosed echinococcosis cases in Qinghai Province from 2016 to 2018 (Moran’s I = 0.34 to 0.65, all Z values > 1.96, all P values < 0.05), and the distribution of newly diagnosed echinococcosis cases appeared random distribution from 2019 to 2022 (Moran’s I = −0.09 to 0.04, all Z values < 1.96, all P values > 0.05). Local spatial autocorrelation analysis showed high-high clusters and low-low clusters in the detection of new diagnosed echinococcosis cases in Qinghai Province from 2016 to 2022, and space-time scan analysis showed that the first most likely cluster areas of newly diagnosed echinococcosis cases in Qinghai Province from 2016 to 2022 were mainly distributed in Yushu Tibetan Autonomous Prefecture and Guoluo Tibetan Autonomous Prefecture. GeoDetector-based analysis of the driving factors for the spatial stratified heterogeneity of detection of newly diagnosed echinococcosis cases in Qinghai Province showed that average altitude, number of village health centers, number of cattle and sheep stock, GDP per capita, annual average sunshine hours, and annual average temperature had a strong explanatory power for the spatial distribution of newly diagnosed echinococcosis cases, with q values of 0.630, 0.610, 0.600, 0.590, 0.588, 0.537 and 0.526, respectively. Conclusions The detection of newly diagnosed echinococcosis cases appeared a tendency towards a decline in Qinghai Province over years from 2016 to 2022, showing spatial clustering. Targeted control measures are required in cluster areas of newly diagnosed echinococcosis cases for further control of the disease.

Objective: To analyze the association between latent class of health-risk behaviors and depressive symptoms among middle school students, so as to provide the evidence for the prevention and intervention of depressive symptoms among middle school students. Methods: Students in two junior high schools, two senior high schools and one vocational high school in Yinzhou District, Ningbo City, Zhejiang Province, were selected using a stratified multi-stage cluster sampling method. Demography and health-risk behaviors were collected using questionnaire surveys, depressive symptoms were investigated using the Center for Epidemiological Studies Depression-10 Scale, and latent class analysis was conducted for health-risk behaviors. The association between different latent classes and depressive symptoms was analyzed using a multivariable logistic regression model. Results: A total of 1 247 students were surveyed, including 641 boys (51.40%) and 606 girls (48.60%). There were 452 junior high school students (36.25%), 532 high school students (42.66%) and 263 vocational high school students (21.09%). Latent class analysis showed that health-risk behaviors in students were classified into three groups, namely healthy behavior group (52.93%), poor diet group (39.94%) and high-risk behavior group (7.14%), and the detection rates of depressive symptoms were 7.12%, 18.88% and 52.81%, respectively, with a statistically significant difference between groups (P<0.05). Multivariable logistic regression analysis showed that after adjusting for age, gender, native place, only child and living on campus, the poor diet group (OR=3.107, 95%CI: 2.086-4.627) and high-risk behavior group (OR=15.401, 95%CI: 9.031-26.262) had higher risks of depressive symptoms compared with the healthy behavior group. Conclusion Having high-risk behaviors and poor diet may increase the risk of developing depressive symptoms among middle school students.

Objective:To explore the epidemiological characteristics and spatiotemporal clustering of foodborne infection of Vibrio ( V.) parahaemolyticus in Ningbo, Zhejiang Province, from 2014 to 2022, and provide reference and evidence for the prevention and control of related diseases. Methods:The incidence data on of foodborne infection of V. parahaemolyticus in Ningbo from 2014 to 2022 were collected from Ningbo Foodborne Disease Surveillance System, and the case counts and the positive rates in different districts (counties, cities) were calculated. Spatial autocorrelation analysis and spatiotemporal scanning analysis were conducted to analyze the spatiotemporal clustering of the diseases. Results:A total of 1 822 cases of foodborne infection of V. parahaemolyticus were reported in Ningbo from 2014 to 2022, with an overall positive rate of 3.78%. Spatial autocorrelation analysis showed that the positive rate of foodborne infection of V. parahaemolyticus in Ningbo was unevenly distributed from 2014 to 2022, Ninghai was a high-high clustering area, while Zhenhai was a high-low clustering area, and Jiangbei was a low-low clustering area. The annual incidence was high during July-September. Spatiotemporal scanning analysis found one class Ⅰ spatiotemporal clustering area and three class Ⅱ spatiotemporal clustering areas, with the class Ⅰ spatiotemporal clustering area being observed in Jiangbei and Zhenhai from 2019 to 2022. Conclusions:Spatiotemporal clustering of foodborne infection of V. parahaemolyticus existed in Ningbo from 2014 to 2022, with an annual high incidence period from July to September. The key areas for the prevention and control of foodborne infection of V. parahaemolyticus are coastal districts (counties, cities) in Ningbo.

OBJECTIVE To study the protective mechanism of Bawei chenxiang powder containing serum on H9c2 cells injured by oxygen-glucose deprivation （OGD）. METHODS H9c2 cells were divided into blank group， model group and Bawei chenxiang powder low-dose， medium-dose and high-dose groups （the dose of drug containing serum 2.5， 8， 12 g/kg）. H9c2 cells were cultured in vitro to establish OGD model. After intervention with drug-containing serum， survival rate of cell was detected. The cell morphology was observed； the levels of lactate dehydrogenase （LDH）， creatine kinase （CK）， superoxide dismutase （SOD）， catalase （CAT）， respiratory chain complexⅠ （ComplexⅠ）， glutathione peroxidase （GSH-Px） and malondialdehyde （MDA） were detected. The contents of reactive oxygen species （ROS）， mitochondrial membrane potential and apoptosis were also detected. The expressions of oxidative stress-related proteins [Kelch ECH association protein 1 （Keap1）， nuclear factor erythroid 2- related factor 2 （Nrf2）， heme oxygenase 1 （HO-1）， NADH oxidoreductase coenzyme 10 （Ndufa10）， thioredoxin （Trx）] and apoptosis-related proteins [B-cell lymphoma 2 （Bcl-2）， Bcl-2 associated X protein （Bax）， Caspase-3 and cytochrome C （Cytc）] were detected. RESULTS Compared with blank group， the cell morphology of model group was damaged； the levels of LDH， CK and MDA were significantly increased （P＜0.01）， while the levels of CAT， ComplexⅠ， SOD and GSH-Px and mitochondrial membrane potential were significantly decreased （P＜0.01）. The content of intracellular ROS and apoptotic rate were significantly increased （P＜0.01）； the expressions of oxidative stress-related proteins （Keap1， Nrf2， HO-1， Ndufa10 and Trx） and pro- apoptosis proteins （Bax， Caspase-3 and Cytc） were significantly increased （P＜0.05）， while the expression of anti-apoptotic protein Bcl-2 was significantly decreased （P＜0.05）. After administration of Bawei chenxiang powder containing serum， the cell morphology improved， and most of the above indexes were significantly reversed （P＜0.05 or P＜0.01）.CONCLUSIONS Bawei chenxiang powder containing serum E-mail：345783110@qq.com has a good protective effect on H9c2 cells damaged by OGD，the mechanism of which is related to the reduction of oxidative damage and inhibition of cell apoptosis.

Objective: To examine the effect of lifestyle behaviors on myopia among primary and middle school students in Yinzhou District, Ningbo City using latent class analysis, so as to provide insights into prevention of myopia among primary and middle school students. Methods: A total of 1 547 students were sampled from primary and middle schools in Yinzhou District using a stratified cluster sampling method. Myopia-associated lifestyle behaviors were collected using questionnaires, and visual acuity was tested. Myopia-associated lifestyle behaviors were subjected to latent class analysis among primary and middle school students, and the association between lifestyle behaviors and risk of myopia was examined using a logistic regression model. Results: A total of 1 547 questionnaires were allocated, and 1 494 valid questionnaires were recovered, with an effective recovery rate of 96.57%. There were 247 primary school students (16.53%), 452 junior high school students (30.25%), 532 senior high school students (35.61%) and 263 vocational high school students (17.60%), and 773 men (51.74%) and 721 women (48.26%). Latent class analysis showed that students' lifestyle behaviors were classified into three groups, including the healthy behavior group (37.68%), reading and writing fatigue group (42.64%), and video fatigue and poor diet group (19.68%), with myopia prevalence of 79.22%, 88.38% and 86.73%, respectively. Moderate myopia was predominant in the reading and writing fatigue group and video fatigue and poor diet group, and low myopia was predominant in the healthy behavior group. A higher risk of myopia was found in the reading and writing fatigue group (OR=1.996, 95%CI: 1.454-2.739) and video fatigue and poor diet group (OR=1.715, 95%CI: 1.157-2.543) than in the healthy behavior group. Conclusions Long reading and writing duration, insufficient exercise and sleep, long video watching duration, and high intake frequency of sugary drinks and fried foods may increase the risk of myopia in primary and middle school students in Yinzhou District. Targeted myopia interventions are required tailored to different categories of lifestyle behaviors.

Objective: To analyze the epidemiological and pathogenic characteristics of foodborne diseases among students in Ningbo from 2014 to 2021, so as to provide a scientific basis for the prevention and control of foodborne diseases in schools. Methods: Information on foodborne disease cases among students attending all surveillance hospitals in Ningbo from 2014 to 2021 was collected from the Foodborne Disease Surveillance System of Zhejiang Province, and epidemiological characteristics and pathogenic analysis were analyzed. Results: A total of 3 602 cases of foodborne diseases in the student population were reported in Ningbo, of which 54.58% were males and 45.42% were females. Students aged 18 years and above accounted for the highest incidence group, and the incidence time mainly showed two peaks in May to June and September to October. Meat and meat products accounted for the largest proportion of suspicious foods (21.11%), and the positive pathogen detection rates were 11.20% for Norovirus, 3.30% for Vibrio parahaemolyticus, 1.77% for Salmonella, 1.30% for diarrheogenic Escherichia coli and 0.18% for Shigella. Conclusion The main suspect foods for foodborne diseases among students in Ningbo are primarily meat and meat products, and the main etiological agent is norovirus, which requires strengthening food safety health education and food safety management.

Objective:To examine the effect of physical activity (PA) on the incident risk of stroke among adults aged 40 years and above.Methods:The baseline data including PA and demographic characteristics were obtained from the Adult Chronic Disease Surveillance with population representativeness in Ningbo in 2015. The follow-up data of interested health outcomes from 2015 to 2019 were retrieved from a population-based Integrated Noncommunicable Disease Collaborative Management System in Ningbo. The two databases were matched to form a queue. PA was divided into three levels of low-intensity, moderate-intensity, and vigorous-intensity according to the metabolic equivalents (METs) spent per week. Cox regression model was used to calculate the hazard ratio ( HR) and 95% confidence interval. Results:A total of 3 353 subjects were included at baseline survey in 2015. Until Dec 31, 2019, there had been 31 stroke events had occurred since then, with accumulative incidence rate of 242/100 000, and an average follow-up time of (50.28±2.54) months. When adjusted for gender, age, education level, smoking status, alcohol consumption, BMI and hypertension, multivariate Cox regression analysis showed that greater PA was associated with a 37.9% reduction of incidence of stroke ( HR=0.621,95% CI:0.393-0.983). Compared with those who had low-intensity PA, those who were with vigorous-intensity. PA appeared associated with a 63.1% decrease in the incidence of stroke ( HR=0.369, 95% CI: 0.139-0.976). However, there was no statistical significance with moderate-intensity PA ( HR=0.712,95% CI:0.323-1.569), noticed. Conclusions:Greater PA is likely to reduce the incidence of stroke. Our findings indicated that people should be encouraged to increase the PA level and developing a healthy supportive environment in the community.