Objective:To explore the effectiveness of limb motor rehabilitation program based on patient health engagement (PHE) model in patients with hemorrhagic stroke, and to provide reference for the limb motor rehabilitation management of hemorrhagic stroke patients.Methods:Through literature review and Delphi expert correspondence, a limb motor rehabilitation program for hemorrhagic stroke patients based on the PHE model was constructed. A non-contemporaneous controlled study was conducted, 45 hemorrhagic stroke patients hospitalized in the Department of Neurosurgery of Shanxi Bethune Hospital from March to August 2022 were selected by convenience sampling method as the control group, and routine exercise rehabilitation measure was given, 45 hemorrhagic stroke patients from September 2022 to February 2023 were selected as the intervention group, a limb motor rehabilitation program based on PHE model was implemented on the basis of control group. The functional exercise compliance, limb motor function, daily activity ability, emotional and social dysfunction of patients in the two groups were observed before intervention, 1 and 3 months after intervention respectively.Results:A total of 85 patients with hemorrhagic stroke were included. There were 42 patients in the intervention group, 25 males and 17 females, aged (52.07 ± 9.91) years old, and 43 patients in the control group, 21 males and 22 females, aged (53.93 ± 10.52) years old. There were no significant differences in the functional exercise compliance, limb motor function, daily activity ability, emotional and social dysfunction of patients before intervention between the two groups. At 3 months after intervention, the functional exercise compliance score in the intervention group was (40.83 ± 7.92) points, higher than that in the control group (37.14 ± 6.44) points, and the difference was statistically significant ( t = 2.36, P<0.05). At 1 and 3 months after intervention, the scores of limb motor function and daily activity ability in the intervention group were (27.12 ± 6.74), (33.67 ± 6.54) points and (61.31 ± 6.72), (74.40 ± 8.71) points, which were higher than (24.91 ± 6.03), (27.02 ± 6.59) points and (52.33 ± 9.78), (60.12 ± 10.03) points of the control group, the differences were statistically significant ( t values were 2.06-7.01, all P<0.05), the scores of emotional and social dysfunction were (75.52 ± 22.09) and (58.33 ± 18.88) points, which were lower than (86.02 ± 23.04), (78.51 ± 21.67) points of the control group, and the differences were statistically significant ( t = - 2.14, - 4.57, both P<0.05). Conclusions:The limb motor rehabilitation program based on the PHE model could improve the exercise compliance of patients with hemorrhagic stroke, improve the limb motor function and daily activity ability of patients, alleviate negative emotions, and reduce the level of social dysfunction.

Objective: To investigate the health-related quality of life and its influencing factors among urban adults in Hangzhou City, so as to provide the evidence for formulation and assessment of health policy. Methods: A total of 1 800 permanent residents at ages of 18 to 64 years were sampled from Gongshu and Xihu districts, Hangzhou City using a stratified cluster random sampling method from May to August 2022. The health-related quality of life was measured with the EuroQol five-dimensional questionnaire (EQ-5D-5L), and factors affecting health-related quality of life were identified with a Tobit regression model. Results: A total of 1 624 valid questionnaires were recovered, with a response rate of 90.22%, and the respondents included 693 men (42.67%) and 931 women (57.33%). The proportions of difficulty in mobility, self-care, usual activities, pain/discomfort, and anxiety/depression were 1.23%, 0.43%, 0.74%, 11.15% and 8.56%, and the median (interquartile range) of health state utility value and EuroQol Visual Analogue Scale (EQ-VAS) score were 1 (0) and 90 (15) points, respectively. Female (β=-0.050), age of 45 to 64 years (β=-0.067) and development of chronic disease (one chronic disease: β=-0.036; two and more chronic diseases: β=-0.090) were factor affecting of health state utility values, and age of 35 to 44 years (β=-1.945) and 45 to 64 years (β=-3.459), unemployment (β=-1.913), development of chronic disease (one chronic disease: β=-3.444; two and more chronic diseases: β=-8.529), high-level physical activity (β=2.355) and overweight/obesity (β=-1.456) were factors affecting the EQ-VAS score. Conclusions The overall health related quality of life is relatively good among urban adults in Hangzhou City. Gender, age, employment, physical activity, presence of chronic diseases and overweight/obesity may be associated with health-related quality of life among urban adults in Hangzhou City.

Objective:To study the current status of research in the field of iodine nutrition for pregnant women and to detect the hot spots and future trends in the field of iodine nutrition for pregnant women.Methods:Using "pregnant women" and "iodine" as search terms, we searched the literature related to iodine nutrition in pregnant women from January 2000 to December 2021 in China Knowledge Network (CNKI) database, Wanfang database and Chinese Medical Journal Full Text Database. CiteSpace 6.2.2.0 software was used to sort out the publication status, core authors and research hotspots of the papers.Results:A total of 879 valid papers were included, with an overall number of publications increasing trend from 2000 - 2021 and a decline after 2017. Among the 879 papers, 29 first authors were core authors (M≈3), and 109 papers were published, accounting for 12.40% of the total literature; several research groups with relatively stable collaborative relationships had been formed, with the larger collaborative team of Chen Zupei and Zhang Wanqi at Tianjin Medical University. Keyword co-occurrence analysis showed that pregnant women, urinary iodine, and iodine nutrition were high-frequency keywords; keywords with mediated centrality > 0.07 were pregnant women (0.48), pregnancy (0.40), urinary iodine (0.37), iodine deficiency disorders (0.25), iodine nutrition (0.20), thyroid (0.12), thyroxine (0.10), infants and children (0.09). The analysis of the emergent words showed that the evolution of iodine nutrition research themes in pregnant women was broadly based on studies of iodine nutrition monitoring results in key populations such as newborns and infants from 2000 - 2011, studies such as the range of thyroxine reference values during pregnancy from 2012 - 2016, and changes in iodine nutrition status of pregnant women and children after adjustment of iodized salt concentration from 2017 - 2021. The clustering results showed that a total of 355 keywords were aggregated to yield 10 clusters, and the average profile value of clusters (Silhouette) > 0.8, which was a reasonable clustering result; the study topics can be divided into three major categories, iodine nutrition and goiter monitoring results in key populations, thyroid hormones and pregnancy outcomes during pregnancy, and studies on thyroid-related diseases.Conclusions:Iodine plays an important role in the health of pregnant women and their offspring, and changes in the iodine nutrition status of pregnant women should be closely monitored. In response to the new trends of change that are currently present, multidisciplinary cooperation should be developed to respond to social concerns and jointly promote the maintenance of iodine nutrition in pregnant women at appropriate levels.

Objective:To explore the association between internet use and healthy lifestyles in urban adults.Methods:From May to August, 2022, a face-to-face questionnaire survey was conducted in residents aged 18-64 years selected in the urban area of Hangzhou by integrated cluster stratified random sampling and Kish grid method. The information about internet use included the internet use time in the past 7 days and 12 kinds of internet use contents. Using factor analysis and K-means clustering, three types of internet use were summarized, i.e. general type, video game type and working/learning type. Healthy lifestyles were defined as active physical activity, healthy diet habit, non-smoking, non-drinking, healthy weight, and healthy waist circumference. The correlations between internet use and healthy lifestyles were evaluated by using binary logistic regression and multinomial logistic regression analyses.Results:A total of 1 624 participants were included. After adjusting for potential confounding factors, the longer internet use time group (≥8.5 h/d) was less likely to have healthy weight ( OR=0.59, 95% CI:0.41-0.85) and 5-6 healthy lifestyles ( OR=0.55, 95% CI: 0.32-0.96) compared with those with shorter internet use time group (<2.5 h/d). For different types of internet use, it was found that compared with working/learning type group, the general type group was less likely to have healthy diet habits ( OR=0.63, 95% CI: 0.46-0.86), non-drinking ( OR=0.68, 95% CI: 0.47-0.99), healthy waist circumference ( OR=0.59, 95% CI: 0.42-0.84) and 5-6 healthy lifestyles ( OR=0.40, 95% CI: 0.23-0.69), the video game type group was less likely to have active physical activity ( OR=0.73, 95% CI: 0.55-0.97) and healthy diet habits ( OR=0.79, 95% CI: 0.62-0.99). Conclusion:Too long internet use (≥8.5 h/d), general type and video game type of internet use were associated with unhealthy lifestyles.

The vasoactive substance resistance (VSR) in the end-stage liver disease (ESLD) refers as the reduction of patients' responsiveness to endogenous and exogenous vasoactive substances, cardiac and vascular excitability, peripheral circulatory dysfunction, but induction of related adverse events. VSR is closely related to pathogenesis and treatment-related ESLD complications. However, to date, there are so many unsolved issues, like 1). The cause and underlying mechanism of VSR in ESLD patients; 2). VSR and ESLD multiple organ damages; 3). The preventive and mitigated measurement of VSR; and 4). VSR vasoactive drug use in ESLD patients. This review discussed and summarized the up to date progress in this field of research and clinical VSR in patients with ESLD, i.e., VRS in ESLD patients, disputes of vasoconstrictor drug therapy in ESLD patients, and future research direction of the field.

Objective:Using the monoclonal antibody to Brucella Omp31, flow cytometry (FCM) method for detecting Brucella antigens is established, and to analyze its potential value in clinical diagnosis. Methods:The supernatants of sonicated proteins (SSPs) from Brucella abortus (2308, 104M and S19), Brucella melitensis (M5-90), and Brucella suis (S2) were identified by Western blotting and enzyme-linked immunosorbent assay (ELISA) with monoclonal antibody (mAb) 5H3 to Brucella Omp31, which were prepared by breaking Brucella species with ultra-sonication. The recombinant eukaryotic plasmid (pcDNA3.1-Omp31) was constructed and transfected in 293FT cells, and the expression of Omp31 was detected by Western blotting. THP-1 cells were infected by Brucella melitensis M5-90 strain to simulate mononuclear phagocytes carrying with Brucella spp. To identify the ability of mAb 5H3, FCM for detecting intracellular Brucella was established, mAb 5H3 was labeled with fluorescein isothiocyanate (FITC-5H3) or P-phycoerythrin (PE-5H3), and then the transfected 293FT cells and THP-1 cells invaded by M5-90 strain were individually identified by FCM with FITC-5H3, and sensitivity of FITC-5H3 in FCM was tested. The PBMCs collected from brucellosis patients or normal blood donors were tested by FCM with double mAbs including PE-5H3 and FITC-CD14 to evaluate this method's feasibility in clinical practice. Results:MAb 5H3 was able to identify Brucella melitensis (M5-90) and Brucella suis (S2), as well as Brucella abortus (2308, 104M and S19) with Omp31 gene deletion. The mAb 5H3 labeled with FITC or PE was used for identifying Brucella antigen in various cells by FCM. The results revealed that the proportion of 293FT positive cells expressing Omp31 was about 59.3%, and the proportion of THP-1 positive cells infected by vaccine strain M5-90 was about 6.2%. In addition, the sensitivity of FCM with FITC-5H3 for the 293FT cells transfected with pcDNA3.1-Omp31 was about 4%. The FCM based on double mAbs staining of PE-5H3 and FITC-CD14 was preliminarily established. For brucellosis patients, the proportion of cells (1.93%) stained with the double mAbs in PBMCs was higher than that of normal blood donors (< 0.30%, negative) in FCM. Conclusions:A FCM assay is preliminary established basing on mAb 5H3 against Omp31 for detecting intracellular Brucella. Moreover, we have found that mAb 5H3 could recognize Brucella abortus originally lacking Omp31, which reduces the defect of Omp31 applied in all Brucella species detection. The development of this FCM assay provides a new strategy and usable reagents for brucellosis pathogens diagnosis.

（正）结肠代食管术（esophageal replacement with colon，ERC）被称作食管外科“皇冠上的明珠”，也是食管重建的最后一种选择。ERC 手术操作复杂，吻合口瘘等并发症发生率较高，一直没有得到广泛开展[1]。传统 ERC 手术常选择经右侧胸腹联合切口，手术创伤较大、术后恢复慢、术后肋间神经损伤等并发症较多，但随着胸腔镜微创技术的日益发展，我们使用胸腔镜微创技术游离胸腔食管并清扫纵隔淋巴结，开腹横结肠代食管行消化道重建，该技术可减少手术创伤、减轻术后疼痛，加速康复。本视频在于展示胸腔镜辅助食管癌根治横结肠代食管术手术入路、操作技巧。

Objective : To learn the incidence trend of gestational diabetes mellitus (GDM) among women of childbearing age in Hangzhou from 2009 to 2018, providing evidence for GDM prevention and control. Methods: The information of GDM cases aged 15 to 49 years in Hangzhou from 2009 to 2018 was extracted from Zhejiang non-communicable diseases surveillance system. The crude and age-standardized (by national standard population in 2000) incidence rate of GDM were calculated, the annual change percentage (APC) and the average APC (AAPC) of GDM incidence rate were calculated to understand the trend of incidence in different age groups and areas. Results: A total of 45 519 cases of GDM were reported in Hangzhou from 2009 to 2018. The crude and age-standardized incidence rates were 248.04/100 000 and 158.52/100 000, respectively, both showed upward trends with 59.7% and 56.4% in AAPC (both P<0.05). The APCs of crude and age-standardized incidence rates of GDM were 139.76% and 134.60% from 2009 to 2012, 30.35% and 27.65% from 2012 to 2018, which all had increasing trends (all P<0.05). There were upward trends in GDM incidence in each age groups of 15-24, 25-29, 30-34, 35-39 and 40-49 years old (all P<0.05). The AAPC of GDM incidence in 40-49 year-old women was 65.3% and ranked the first among all the age groups. The age-standardized incidence rate of GDM increased more in rural areas (AAPC=66.0%) than in urban areas (AAPC=53.4%). Conclusion A rising trend in GDM incidence among women aged 15-49 years in Hangzhou has been found in recent ten years, especially in women aged 40-49 years and lived in rural areas.

Objective : To learn the association between dietary patterns and thyroid cancer in Hangzhou residents, and to provide evidence for thyroid cancer prevention. Methods: The newly diagnosed patients with thyroid cancer in Zhejiang Cancer Hospital were selected as the case group, while the healthy population matched (1∶1) by gender, age and residence were selected from community as the control group. A questionnaire survey was conducted to obtain demographic characteristics, disease history, dietary intake, lifestyle and other information. The dietary patterns were established by factor analysis. The multivariate conditional logistic regression model was conducted to explore the relationship between different dietary patterns and thyroid cancer. Results: A total of 258 pairs of cases and controls were recruited. Five dietary patterns were obtained, including vegetarian pattern, high-protein food pattern, salted vegetables and algae pattern, seafood and cereal pattern, as well as alcohol and tea pattern. The multivariate conditional logistic regression analysis suggested seafood and cereal pattern might reduce the risk of thyroid cancer (OR=0.286, 95%CI: 0.146-0.561). Conclusion More consumption of seafood and cereal may decrease the incidence of thyroid cancer.

Objective: To analyze the status and trend of death from leukemia from 2006 to 2015 in Hangzhou,and to provide scientific basis for leukemia prevention and control. Methods: The data of deaths in Hangzhou from 2006 to 2015 were collected from Zhejiang chronic diseases surveillance system. The crude mortality rates,standardized mortality rates and cumulative rates of the age group 0-74 of leukemia were calculated. The annual percentage change（APC）was used to examine the changing trend of leukemia mortality. Results: The crude mortality rate of leukemia in Hangzhou was 4.38/100 000 and the standardized mortality rate was 3.79/100 000 from 2006 to 2015. The standardized mortality rates from 2006 to 2015 showed a decreasing trend and the APC was -2.27%（P<0.05）. The crude mortality rate of leukemia was 5.15/100 000 in males,which was higher than 3.62/100 000 in females（P<0.05）. The crude and standardized mortality rates were 2.00/100 000 and 0.45/100 000 in residents aged below 15 years,3.03/100 000 and 1.85/100 000 in residents aged 15-64 years,15.63/100 000 and 1.05/100 000 in residents aged 65 years or above. The standardized mortality rates of residents aged below 15 years and 15-64 years showed decreasing trends,the APCs were -9.24% and -3.82%,respectively（P<0.05）. The standardized mortality rates of residents aged 65 years or above showed an increasing trend,the APC was 3.77%（P<0.05）. Conclusion The standardized mortality rates of leukemia has presented a declining trend in Hangzhou from 2006 to 2015,with higher mortality in men and people aged 65 years or above.