ObjectiveTo investigate the levels of serum antibodies against novel coronavirus （SARS-CoV-2） in healthcare workers after one month of natural infection， to explore the influencing factors and their correlations with the levels of antibodies， and to provide reference for strengthening the protection of healthcare workers and preventive intervention in Pudong New Area in Shanghai. MethodsVenous blood samples were collected from 1 102 medical staff in Pudong hospitals one month after infection. The serum levels of new coronavirus specific antibodies IgM， IgG and neutralizing antibodies were detected by chemiluminescent immunoassay. The information of gender， age， position， infection severity， vaccination， basic diseases and use of immunosuppressants were obtained by questionnaire to explore the influencing factors and their correlation with the antibody level. ResultsOne month after natural infection， 99.00% （1 091/1 102） of the subjects were found to be positive for IgG antibody against the new coronavirus， 17.79% （196/1 102） of the subjects were IgM antibody positive， and 99.00% （1 091/1 102） of the samples were positive for the neutralizing antibody. The level of antibody might be influenced by the severity of infection， the time of the last dose of vaccination， and the long-term use of immunosuppressants. The more severe the disease， the stronger the neutralizing antibody response. The antibody level in the people who received the final dose of vaccine within 6 months was higher than that of the people who received the vaccine 6 months ago， and the difference was statistically significant. The antibody levels were low in the subjects who received long-term immunosuppressants. ConclusionThe specific IgM， IgG and neutralizing antibody were found， one month after infection， in the medical workers in Pudong New Area， Shanghai， and the antibody titers were high， which had a good protective effect. The antibody level of the people who were vaccinated within 6 months was higher， it is recommended that people who receive the last vacination more than 6 months should be re-vaccinated with the booster vaccine， to improve the autoimmunity against the novel coronavirus.

Objective:To study the distribution of TCM constitutions in maintenance hemodialysis (MHD) patients.Methods:This is a multicenter cross-sectional study. The general clinical data, dialysis-related parameters and physical and chemical examination data of MHD patients from 6 dialysis centers in Sichuan were collected. At the same time, DS01-A tongue and facial pulse information collection system was used for TCM constitution discrimination.Results:A total of 232 MHD patients were enrolled , and 417 kinds of TCM constitutions were detected, including 59 patients (25.43%) with moderate constitution and 173 patients (74.57%) with biased constitution. Phlegm-dampness was the most common type of solid constitution 47 patients (20.26%). The most common deficiency constitution was qi deficiency 86 patients (37.07%). There were certain differences in the physical distribution of patients with different gender, age, dialysis age, BMI, and whether they had diabetes, hypertension or anemia.Conclusions:The TCM constitutions of MHD patients are mainly biased constitution. Gender, age, BMI, diabetes or hypertension have a certain impact on the distribution of TCM constitutions. At the same time, different constitutions may have an impact on the anemia of MHD patients. The intervention of TCM constitutions on MHD patients may be beneficial to the prognosis of MHD patients.

Objective:To investigate the medical narrative competence of pediatric staff, and analyze its influencing factors and correlation with psychological resilience, and to discuss strategies to improve narrative competence.Methods:From January 11 to February 25, 2022, by convenience sampling, we sampled pediatric personnel and those on refresher training at Children's Hospital, Zhejiang University School of Medicine for a questionnaire survey involving general information, the narrative competence scale, and the 14-item resilience scale. With the use of SPSS 26.0, the narrative competence of different populations was compared, and factors affecting narrative competence were determined through Pearson correlation analysis and multiple regression analysis.Results:A total of 361 valid questionnaires were included in this study, and there was significant differences in the narrative competence score between different ages, professional titles, working years, income levels, and whether they wrote parallel charts ( P<0.05). The total score of narrative competence of pediatric staffs was (147.13±18.76), and positively correlated with the total resilience score and the score of each dimension ( P≤0.001). The regression analysis showed that writing parallel charts and resilience could explain 53.10% of the variation in narrative competence ( P<0.001). Conclusions:Pediatric staff's narrative competence is at low or intermediate levels. Parallel chart writing and resilience training can improve narrative competence and promote a harmonious doctor-patient relationship.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Background The community is the main place for people's daily activities. A livable environment will improve the subjective well-being of residents. Objective To understand the current status of subjective well-being of residents in Pudong, Shanghai, and explore the impact of community environmental factors on residents' subjective well-being. Methods Using quota sampling, 6000 permanent residents from 12 sub-districts or towns in Pudong, Shanghai were selected to participate in an questionnaire survey. The questionnaire included three parts: participants' basic information, community environmental factors (neighborhood aesthetics, fitness environment, public service and security, natural environment), and subjective well-being. Using a multiple regression model, the influence of community environmental factors on the subjective well-being of residents was analyzed. Results A total of 5887 questionnaires were recovered, and the valid recovery rate was 98.1%. The subjective well-being score of the survey respondents was (7.03±1.61) points. There was no statistical difference in the subjective well-being score of study subjects of different gender and marital status groups; while those with different ages, education levels, occupations, and self-evaluated economic status showed statistical differences in their subjective well-being score (P<0.05). The multiple logistic regression analysis results showed that after controlling general demographic characteristics, with the low level as the control group (according predetermined cut-off values of 33.3% and 66.7%, the community environmental factors were divided into high-, medium-, and low-level groups), the OR values of subjective well-being of the high- and medium-level neighborhood aesthetics groups were 1.393 (95%CI: 1.173-1.654) and 1.235 (95%CI: 1.080-1.412); the OR values of the high- and medium-level fitness environment groups were 2.297 (95%CI: 1.929-2.734) and 1.349 (95%CI: 1.166-1.560); the OR values of the high- and medium-level public service and security groups were 1.101 (95%CI: 0.943-1.285) and 1.039 (95%CI: 0.905-1.193); the OR values of the high- and medium-level natural environment groups were 4.248 (95%CI: 3.321-5.434) and 1.652 (95%CI: 1.374-1.986), respectively. Conclusion Community environment factors could affect residents' subjective well-being, and good neighborhood aesthetics, fitness environment, natural environment have positive effects.

Background The health and safety climate of workplace has an important impact on the physical and mental health of workers. There is no available scale for the evaluation of workplace health and safety climate in China at present. Objective This study aims to sinicize and evaluate the reliability and validity of the Health and Safety Climate Survey. Methods The English version of Health and Safety Climate Survey was translated to Chinese and back-translated to English, and followed by expert evaluation to develop a Chinese version. Quota sampling method was used to select 2600 employees from 16 enterprises and public institutions in Pudong New Area of Shanghai and to evaluate the reliability and validity of the Chinese version of the scale. Structural validity, convergent validity, and discriminant validity were included in validity evaluation. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to test structural validity. In EFA, an acceptable factor loading of items on their respective dimensions was > 0.60. In CFA, an acceptable root mean square error of approximation (RMSEA), a standard absolute fitness index, was < 0.05. Comparative fit index (CFI) and parsimony-adjusted non-normed fit index (PNFI), measures of incremental improvement and fit, > 0.90 indicated a good fit. Convergent validity was evaluated by average variance extracted (AVE), and an AVE > 0.50 indicated good convergent validity. Discriminant validity was determined as good by the square root of AVE greater than the correlation coefficient between latent variables. Cronbach’s α coefficient was used to evaluate the internal consistency of the scale; the internal consistency considered was very good with an α > 0.90. Cronbach’s α coefficient may cause underestimation of reliability in the case of error correlation. Therefore, composite reliability (CR) calculated based on structural equation model >0.70 indicated that the CR was good. Results The response rate was 95.69%. The Chinese version of Health and Safety Climate Survey included 22 items belonging to six dimensions which was extracted by the EFA, and the cumulative variance contribution rate was 74.79%. The corrected RMSEA was 0.045, the PNFI was 0.970, and the CFI was 0.975 in the CFA, indicating good fit. The dimensional AVE values were all greater than 0.50, indicating good CV. The square root of AVE was greater than the correlation coefficient between latent variables, indicating good DV. The Cronbach’s α was 0.90 for the total scale and were above 0.70 for all dimensions. The CR was 0.93 for the total scale and were above 0.70 for all dimensions, indicating that the overall reliability of the scale was good. Conclusion The Chinese version of Health and Safety Climate Survey has good reliability and validity, and can be further improved in field application.

Objective:To analyze the patients′ clinical and genetic characteristics with pseudohypoparathyroidism (PHP) and investigate the correlation between clinical phenotypes and genotypes.Methods:Twenty PHP patients were ascertained at Children′s Hospital Zhejiang University School of Medicine from January 2011 to July 2020. Clinical manifestation, laboratory examination and gene test results were retrospectively analyzed.Results:In these twenty patients, eighteen cases showed resistance to parathyroid hormone (PTH) and thirteen cases had Albright′s hereditary osteodystrophy (AHO) phenotype. Gene abnormalities were found in all the twenty PHP patients, which included seven patients with GNAS gene variations (six frameshifts and one missense) and thirteen patients with GNAS gene methylation defects. Moreover, twelve children with both PTH resistance and AHO phenotype were clinically diagnosed as PHP-Ⅰa, meanwhile, seven carried GNAS variations and five had methylation abnormalities with a correct diagnosis of PHP-Ⅰb.Conclusions:Patients with AHO phenotype and PTH resistance may have a high genetic diagnosis rate. Because PHP-Ⅰb clinical phenotype may be similar to PHP-Ⅰa, early genetic detection is required for the differential diagnosis. In addition, children without PTH resistance should also be followed up regularly, which may help the early diagnosis.

Objective:To evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) on sedation in healthy volunteers.Methods:Forty-six healthy volunteers of both sexes, with the Sleep Self-Rating Scale score 10-30, aged 22-28 yr, with the body mass index 18.5-23.0 kg/m 2, were selected and divided into 2 groups ( n=23 each) using a random number table method: TEAS group (E group) and control group (C group). Bilateral Neiguan and Shenmen acupoints were stimulated for 30 min in group E, while the stimulator was only connected, and no current was given in group C. The bispectral index (BIS)value, heart rate, oxygen saturation and mean arterial pressure were recorded at 10 min in the supine position (T 0) during the quiet period, at 10 min intervals during stimulation (T 1, 2) and at 5 min intervals within 15 min after the end of electrical stimulation (T 3-5). Then the condition whether the patient had fallen asleep was observed, and the patients were followed up on the second day for sleep status and related complications. Results:Compared with the baseline at T 0, the BIS value was significantly decreased at T 2-5 in group E ( P<0.05). The BIS value was significantly lower at T 3, 4 in group E than in group C ( P<0.05). There was no significant difference in sleep status during stimulation and at the night of the trial between the two groups ( P>0.05). Heart rate, oxygen saturation and mean arterial pressure were in the normal range at each time point, and no trial-related complications occurred in the two groups ( P>0.05). Conclusion:TEAS can produce certain sedative effect on healthy volunteers.

Objective To investigate the prevalence of pertussis in infants and children with persistent cough in Beijing during 2011-2016.Methods The eligible infants and children from over ten hospitals who were suspected to have pertussis from 2011 to 2016 were enrolled for detection.Nasopharyngeal secretions and blood samples were collected.Multiplex-PCR was performed for Bordetella pertussis and real-time PCR was performed for nucleic acid of Bordetella pertussis.Results A total of 1 318 eligible cases were enrolled,including 820 males and 498 females.Pertussis was detected positive in 534 cases,including 81.3％ (434/534) of B.pertussis positive cases and 31.8％ (170/534) of IgG positive cases.There were 13.1 ％ (70/534) had double positive for bacteria and antibodies.From 2011 to 2016,the enrolled patients were increased from 103 cases per year to 460 cases per year,and the test positive patients were increased from 29 cases to 194 cases.Among the pertussis patients,466 (87.3 ％) cases were younger than one year old.From the first quarter to the fourth quarter of the year,There were 65 cases,151 cases,205 cases,and 113 cases,respectively.In further analysis of the 268 cases from Children's Hospital affiliated to Capital Institute of Pediatrics,90.7％ of the patients who had whooping cough were scattered children;185 cases (69.0％) of the patients had not begun programmed immunization,71 cases (26.5％) did not complete programmed immunization and 12 cases (4.5％)completed the programmed immunization.Of all the inpatients,21.6％ were critical ill,0.8％ (2 cases) dead,and the remaining patients were recovered and discharged.Conclusions The prevalence of pertussis is increasing,especially in summer.Infants are the most susceptible population.Bordetella pertussis is one of the most important pathogen that can induce persistent and chronic cough.

Objective To evaluate the efficacy of intermittent positive pressure ventilation (IPPV,1 ml/kg) of the operated lungs in preventing hypoxemia during one-lung ventilation (OLV) in elderly patients undergoing radical resection of esophageal cancer.Methods Sixty American Society of Anesthsiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 65-75 yr,with body mass index of 18.5-24.0 kg/m2,were divided into 2 groups (n =30 each) using a random number table method:convention group and IPPV group.In convention group,ventilator settings were adjusted with the tidal volume of 6-8 ml/kg,respiratory rate of 15 breaths/min,inspiratory/expiratory ratio of 1 ∶ 2,and fraction of inspired oxygen 70％ during OLV.In IPPV group,ventilator settings were adjusted with the tidal volume of 1 ml/kg,respiratory rate of 15 breaths/min,and fraction of inspired oxygen 70％ on the operated side during OLV,and the ventilator settings on the other side were consistent with those previously described in convention group.Before anesthesia induction (T0),at 10 min of two-lung ventilation (T1),at 15,30 and 45 min of OLV (T2,4) and at 10 min after the end of OLV (T5),blood samples were collected from the radial artery for blood gas analysis.The partial pressure of arterial oxygen (PaO2) and alveolar to arterial partial pressure of oxygen were recorded.Respiratory index (RI) and oxygenation index (OI) were calculated.The occurrence of PaO2 ＜ 60 mmHg,RI＞ 1.0 and OI＜ 200 mmHg was recorded during OLV.Results Compared with convention group,the RI was significantly decreased at T4,the PaO2 and OI were increased,and the incidence of PaO2＜60 mmHg,RI＞ 1.0 and OI ＜ 200 mmHg was decreased in IPPV group (P＜ 0.05).Conclusion IPPV (1 ml/kg) of the operated lungs can prevent the occurrence of hypoxemia during OLV in elderly patients undergoing radical resection of esophageal cancer.