ObjectiveTo investigate the level of hepatitis B surface antibody (anti-HBs) among preschool children (aged 3‒6 years) and primary and secondary school students in Tonglu County, Zhejiang Province, to evaluate the effectiveness of hepatitis B vaccination, and to provide a basis for hepatitis B prevention and control in the region. MethodsAs part of the 2023 Tonglu County Urban and Rural Residents Health Examination Program, blood samples were collected during health check-ups. Fingertip blood samples were obtained from preschool children, while venous blood samples were collected from primary and secondary school children. The anti-HBs levels in blood (positive + / negative -) were qualitatively tested using hepatitis B surface antibody test kits (latex method). The differences in anti-HBs positivity rates among different age groups were analyzed. ResultsBetween April 1, 2023 and June 30, 2023, a total of 52 919 individuals were surveyed, including 11 973 preschool children and 40 946 primary and secondary school students. The overall anti-HBs positivity rate was 39.74%, with the highest positivity rate observed among preschool children (60.20%). Age was negatively correlated with the anti-HBs positivity rate (P<0.001). No significant gender differences in anti-HBs positivity rates were observed. The anti-HBs positive rate in rural areas was higher than that in urban areas, with statistically significant differences across school grade groups (primary grades 1‒3, grades 4‒6, middle school, and high school) (P<0.001). ConclusionThe anti-HBs positivity rate among preschool and school-age children in Tonglu County decreases with age and remains relatively low. It is recommended to strengthen the monitoring of hepatitis B antibody levels and promote health education among preschool and school-age children. Children who have not completed the full hepatitis B vaccination should receive timely catch-up vaccination.

Objective:To investigate the mid-and long-term clinical efficacy of modified Colonna arthroplasty in the treatment of unilateral dislocation type developmental dysplasia of hip (DDH) in adolescents.Methods:A total of 28 adolescent DDH patients with unilateral dislocation who underwent modified Colonna capsular arthroplasty from January 2016 to January 2018 in the 920th Hospital of Joint Logistics Support Force of People's Liberation Army were retrospectively analyzed. There were 4 males and 24 females, aged 16.5±5.0 years (range, 10-25 years). The mean body mass index was 21.2±1.1 kg/m 2 (range, 18.7-24.1 kg/m 2). According to DDH classification, 10 cases were Tonnis type III and 18 cases were Tonnis type IV. The postoperative lateral center-edge angle, acetabular coverage, femoral anteversion angle and leg length discrepancy were measured. The operation time, intraoperative blood loss, visual analogue scale (VAS) of hip pain, Harris hip score (HHS) and congenital dislocation of the hip score were recorded. Results:All patients successfully completed the operation and were followed up for 72.1±5.2 months (range, 60-84 months). The operation time was 81.6±4.3 min (range, 70-90 min), the intraoperative blood loss was 177.5±12.6 ml (range, 160-200 ml), and the hospital stay was 6.8±0.7 days (range, 6-9 days). The VAS score of the hip joint was 1.8±0.6 before operation and 2.3±0.6 at the last follow-up, and the difference was not statistically significant ( t=2.845, P=0.224). The preoperative HHS score was 57.1±5.9, and it increased to 87.3±4.0 at the last follow-up, and the difference was statistically significant ( t=-22.141, P=0.001). At the last follow-up, the femoral anteversion angle was 17.0°±1.5°, which was lower than that before operation 41.6°±2.4°, with a statistically significant difference ( t=-44.868, P=0.008). The leg length discrepancy was 10.2±2.3 mm, which was lower than that before operation (26.4±6.1 mm), with a statistically significant difference ( t=-12.892, P<0.001). The lateral center-edge angle was 28° (26°, 30°), and the acetabular coverage rate was 78% (76%, 79%). The curative effect evaluation standard score of congenital dislocation of the hip was 24 (16.7, 25.7) points, including 7 excellent cases, 14 good cases, 4 fair cases, and 3 poor cases. The excellent and good rate was 75% (21/28). Conclusion:The modified Colonna arthroplasty for the treatment of unilateral dislocation DDH in adolescents has good mid-and long-term hip function recovery and radiographic improvement.

Objective:To explore the efficacy and safety of hyaluronic acid filler VYC-20L for full-face lifting in aesthetic seeking patients.Methods:Between November 2020 and November 2021, a total of 216 aesthetic seeking patients were enrolled in Shanghai Chingho Outpatient Department, World Path Clinic International, Qihe Medical Beauty Hospital and Qinhuangdao Qiaozhi Beauty Hospital, including 37 males and 179 females, aged 25-67 (41.42±10.93) years. According to the needs and requirements, the novel injection technique of " ROYGBbP-rainbow lifting method" was used to inject hyaluronic acid filler VYC-20L. The global aesthetic improvement scale (GAIS) and the treatment satisfaction questionnaires were scored and evaluated before the injection, and at follow-up visits 1, 6, and 12 months after the injection. Any adverse reaction or adverse events presenting or reported by the patients post-injection were recorded.Results:At 1 month, 6 months and 12 months after the injection, about 203 (94.0%), 208 (96.3%) and 205 (94.9%) of the aesthetic seeking patients rated their full-face appearance as " excellently improved" or " much improved" on the GAIS, respectively. And 12 months after the injection, the overall facial satisfaction scores and appearance recognition scores of all aesthetic seeking patients were all significantly higher than those before injection ( P<0.01). 197 (91.2%), 198 (91.7%) and 198 (91.7%) of the aesthetic seeking patients were " very satisfied" or " relatively satisfied" with the treatment at 1 month, 6 months and 12 months, respectively. Treatment site responses most frequently reported were tenderness, bruising, topical swelling and skin redness. Most of the symptoms were moderate or mild feeling, lasting for no more than two weeks. Conclusions:The application of hyaluronic acid filler VYC-20L is safe and effective for full-face lifting in aesthetic seeking patients, which can significantly improve facial sagging and rejuvenate the face. The effect of improvements can last for 12 months.

Objective:To investigate the safety and effectiveness of robot-assisted total knee arthroplasty (TKA).Methods:From August 2021 to March 2022, the data of 69 patients who received robot-assisted TKA for inflammatory disease of knee in 6 hospitals were collected, including 24 males and 45 females, aged 52±6 years (range, 46-72 years), including 53 cases of knee osteoarthritis,10 cases of rheumatoid arthritis, and 6 cases of traumatic arthritis. Imaging data examination of patients was completed according to the multicenter specification. Preoperatively, the patient's CT data were extracted before surgery and a personalized prosthesis positioning plan was designed by the robotic system to determine the prosthesis size, lower limb force lines, and femoral and tibial osteotomy volumes; intraoperatively, the osteotomy template was robotically controlled to complete the osteotomy according to the prosthesis positioning plan, and the intraoperative osteotomy volumes were measured to verify the accuracy of the robot-assisted TKA osteotomy with the preoperative planning. Postoperatively, the lateral angle of the distal femur, the medial angle of the proximal tibia and the hip-knee-ankle angle were measured in the coronal plane according to radiographs; the postoperative outcome was evaluated 3 months after operation, using the American Knee Society score (KSS), including the KSS knee score and functional score.Results:The operative time was 97.3±2.3 min (range, 80-110 min) and the amount of bleeding was 320.0±6.2 ml (range, 300-350 ml) in 69 patients. Three months after operation, the mean range of motion of knee joint was increased from 82.2°±1.1° before surgery to 119.7°±0.8° after surgery ( t=27.65, P<0.001), and the line of force of lower limb was improved from 160.9°±0.5° before surgery to 178.0°±0.2° after surgery ( t=32.03, P<0.001). KSS-knee score increased from 54.8±0.7 points before operation to 85.0±0.5 points after operation, and KSS-functional score increased from 56.5±0.7 points before operation to 85.9±0.4 points after operation, the difference was statistically significant ( t=35.45, 36.58, P<0.001). The proportion of patients with intraoperative femoral and tibial osteotomies within 2 mm osteotomy error compared with preoperative planning was 97% for the lateral tibial plateau, 100% for the medial tibial plateau, 100% for the lateral distal femur, 99% for the medial distal femur, 93% for the lateral posterior femoral condyle, and 100% for the medial posterior femoral condyle; The proportion of patients with postoperative anteroposterior X-ray measurement angle error within 3° was: 100.0% for the distal lateral femoral angle, 100.0% for the proximal medial tibial angle, and 100% for the hip-knee-ankle angle. No complications occurred in all patients except for one case in which fat liquefaction occurred in the postoperative wound. Conclusion:Robot-assisted TKA is a safe and effective surgical method for the treatment of inflammatory disease of knee with accurate prosthesis installation and good postoperative recovery of lower limb alignment.

Objective:To analyze the oral phenotype and gene variation of children with hypophosphatasia (HPP), and explore the genotype-phenotype correlations.Methods:Eight children diagnosed with HPP from January 2008 to January 2023 in The Children′s Hospital, Zhejiang University School of Medicine were recruited in this study. The pathogenic genes of 5 of them were sequentially analyzed and all of their oral manifestations, laboratory tests and genetic variation types were retrospectively analyzed.Results:A total of 8 children were recruited in the study, 3 males and 5 females, aged from 20 to 104 months, whose main complaints were premature deciduous tooth loss. Among them, 3 children were diagnosed with odonto HPP, and the other 5 children were diagnosed with childhood HPP, including 2 children was odonto HPP at the first diagnosis and modified as childhood HPP at the age of 5. The age range of first deciduous tooth loss is 9 to 18 months, and the age range of diagnosis was 20 to 104 months. The patients of odonto HPP only showed premature loss of deciduous anterior tooth, while the patients with childhood HPP also showed premature loss of multiple deciduous molars. Panoramic radiographic film revealed enlarged pulp chambers and radicular canals in some primary and permanent teeth. The enamel hypoplasia, hypoplastic short roots, and alveolar resorption of deciduous molar were observed in some cases. The serum alkaline phosphatase (ALP) (30-107 U/L) levels of all the patients were lower than that in the normal children of same age and gender, and the ALP value of the 1-3 years old girls with childhood HPP (30-33 U/L) was lower than that of the three children with odonto HPP (61-107 U/L), but there was no significant difference in statistical analysis. There were 8 variation sites of ALP liver/bone/kidney (ALPL) gene detected in 5 children and their families, all of which were missense variation, including the new variants in the mutations of c.1334C>G (p.Ser445Cys) and c.1259G>T (p.Gly420Val) that were not reported in the literature. One case was autosomal dominant inheritance and other 4 cases were complex heterozygous variation with autosomal recessive inheritance.Conclusions:Pediatric stomatologists are often the first doctors to detect childhood and odonto HPP. Diagnosis of mild HPP is often delayed. The severity of HPP is related to serum ALP level and ALPL gene mutation sites.

Dyslipidemia is an important risk factor of atherosclerotic cardiovascular disease (ASCVD). Statins delay the occurrence and development of ASCVD, and reduce the risk of cardiovascular events and death. Due to safety concerns, there exist insufficient use of lipid-lowering agents and a high withdrawal rate of the agents in the elderly. To promote the prevention and treatment of ASCVD, this expert consensus is issued and focuses on the management of dyslipidemia of Chinese elderly basing on the clinical evidence of the use of lipid-lowering drugs by the elderly, and the lipid management guidelines and expert consensus recommendations at home and abroad.

Objective: To compare the safety and immunogenicity of two different sequential schedules of inactivated poliomyelitis vaccine made from Sabin strain (sIPV) followed by typeⅠ+Ⅲ bivalent oral poliovirus vaccine (bOPV) in Drug Candy (DC) form or liquid dosage form). Methods: This randomized, blinded, single center, parallel-group controlled trial was done from September 2015 to June 2016 in Liuzhou, Guangxi province. Healthy infants aged ≥2 months were eligible for enrollment and divided into 1sIPV+2bOPV or 2sIPV+1bOPV sequential schedules. According to the bOPV dosage form each sequential schedules, the subjects again were divided into drug candy(DC) form or liquid dosage form group, being 1sIPV+bOPV (DC)/1sIPV+2bOPV(liquid)/2sIPV+1bOPV(DC)/2sIPV+1bOPV(liquid). According to 0, 28, 56 d immunization schedule, Each group were given 3 doses. We recorded adverse events during the clinical trial (399 participants who receive at least one dose). 28 days post-Dose 3, we receive a total of 350 blood samples (excluding the quitters or subjects against trial plan), using cell culture trace against polio virus neutralization test Ⅰ, Ⅱ, Ⅲ neutralizing antibody (GMT), calculating the antibody positive rate.PolioⅠ,Ⅱand Ⅲ antibody titers were assessed by virus-neutralizing antibody assay and the seroconversion (4-fold increase in titer) from pre-Dose 1 to 28 days post-Dose 3 was calculated (total 350 samples) . Results: During the vaccination, the incidence of AEs in 1sIPV+2bOPV(DC), 1sIPV+2bOPV (liquid), 2sIPV+1bOPV(DC), 2sIPV+1bOPV (liquid) group were 79%, 76%, 80% and 74% (χ²=1.23, P=0.747) , respectively. The severe AEs in groups were 6%, 5%, 6% and 4% (χ²=0.57, P=0.903) , respectively, and none was considered to be vaccination related. 28 days after 3^rd vaccination, the seroconversion rates in 1sIPV+2bOPV (DC), 1sIPV+2bOPV (liquid), 2sIPV+1bOPV (DC), 2sIPV+1bOPV (liquid) group, were 99%, 100%, 99% and 99% (χ²=0.94, P=0.815) , respectively, for type Ⅰ poliovirus; and 47%, 57%, 80%, 79% (χ²=31.56, P<0.001) , respectively, for type Ⅱ; and were 100%, 99%, 100%, 99% (χ²=2.02, P=0.568) , respectively, for type Ⅲ. In each group, the GMT of antibody against poliovirus typeⅠ were 4 539.68, 6 243.43, 6 819.53 and 7 916.29 (F=25.87, P<0.001) , respectively; Type Ⅱ were 12.98, 10.54, 63.75 and 84.21 (F=8.68, P=0.034) , respectively; Type Ⅲ were 1 172.55, 1 416.03, 2 648.89 and 3 250.75 (F=14.50, P=0.002) , respectively. Conclusion On the same sequential schedules, there was no significant difference between the dosage forms, all of them showed good safety and immunogenicity. In the same dosage forms with different sequential schedules, the seroconversion rate was higher in 2 dose sIPV group than the 1 dose sIPV group, especially at the neutralizing antibody GMT level against polio type Ⅱ and Ⅲ after vaccination.

Objective To evaluate the feasibility and clinical effects of percutaneous endoscopic technique in treating multi-segmental lumbar spinal stenosis in the elderly.Methods Thirty elderly patients with multi-segmental lumbar spinal stenosis and an indefinite positioning of duty segments were retrospectively analyzed.Based on treatment mode of the stenotic segment of lumbar spine,all patients were divided to two groups.The segments of lateral recess or foraminal stenosis were treated with percutaneous endoscopic decompression via the transforaminal approach,while the segments of central stenosis were treated with percutaneous endoscopic decompression via the interlaminar approach.Results Twenty-seven (90％) patients were treated in double segments and three patients (10％) were treated in three segments.There were significant improvements in Visual Analogue Scale,Japanese Orthopaedic Association and Oswestry disability index scores at 3 day and 1 year after therapy as compared with pre-therapy (both P ＜ 0.05).Conclusions Percutaneous endoscopic technique is safe and effective in the treatment of elderly multi-segmental lumbar spinal stenosis.

Objective To evaluate factors associated with labor pain and delivery outcomes.Methods From Jul.to Dec.2009,111 normal singleton cephalic presentation pregnancies (including 5 elderly parturient) who delivered at the Department of Obstetrics and Gynecology,Second Affiliated Hospital,Zhejiang Chinese Medical University were enrolled in this study to evaluate the relationship between factors of labor pain and delivery outcomes.The labor pain of latent phase and active phase were scored by the visual analogue scale (VAS).Factors associated with pain included the age of parturient,the number of gravidity and parity,occupation,education profile,dwell location,etc.The questionnaire was designed by ourselves.Childbirth awareness,psychological preparation of delivery,emotional controllability,couple relationship,the relationship of parturient and mother-in-law,the relationship of parturient and parents,family economic status,use of sedative during the labor process and delivery outcomes were collected and analyzed.Results (1)Factors associated with pain:in the latent phase,the rate of moderate labour pain of 1/5 in women with more than 35 years old was statistically lower than 76.4％ ( 81/106 ) in suitable age group (P＜0.05 ).The women with a good understanding about delivery had a statistically lower rate of moderate pain of 64.7％( 44/68 ) than 88.4％ ( 38/43 ) of those having a poor understanding( P＜0.05 ).The women who had a better couple relationship had a significandy higher rate of moderate pain of 77.2％ (78/101) than 4/10 of those who had a general couple relationship ( P＜0.05 ).There was significant difference in rate of moderate pain between pluripara group ( 50.0％,11/22) and primipara group(79.8％,71/89;P＜0.01 ).In the active phase,women with tense,scared or a poor emotion control expressed significantly severe labour pain(59.0％,36/61 ) than 35.6％ ( 16/45 ) in well-prepared group.The rate of severe labour pain in good control of emotion group of 44.8％ (43/96) was a statistically lower than 9/10 in poor control group.There was a statistically lower severe labour pain in women given by sedatives ( 29.2％,7/24 ) than 54.9％ (45/82) in women without sedatives treatment (P ＜ 0.05).(2) Delivery outcomes:in latent phase,the rates of fetal distress and cesarean section were 36.6％ (30/82) and 39.0％ (32/82) in moderate pain group,which were significantly higher than 13.8％ (4/29) and 17.2％ (5/29) in mild pain group.In active phase,the rate of fetal distress,cesarean section and postpartum hemorrhage were 36.5％ ( 19/52),40.4％ (21/52) and 13.5％ (7/52) in severe pain group,which were significantly higher than [18.5％ (10/54) ;20.4％ (11/54) ;0] in moderate pain group (P＜0.05).Conclusions Women with poor understanding of delivery,tense,scared,poor emotion control,young age and uniparous have severe labour pain.Sedative use could alleviate pain in active phase.Women with mild labour pain have good delivery outcomes.

Objective To determine the feasibility and accuracy of velocity propagation within main pulmonary artery(VP)from color M-mode Doppler imaging using custom software on a personal computer for noninvasive estimation of PVR.Methods Color M-mode imaging of pulmonary flow was obtained and then transferred to computer,the velocity propagation of pulmonary flow was automatically obtained.Comparative studies among Doppler echocardiography,personal computer and cardiac catheterization for predicting PVR had been done in 20 children with congenital heart disease and 20 normal children.Results Velocity propagations of children with congenital heart disease were significant lower than those of normal children obtained by color Mmode echocardiography[(38.38±18.89)cm/s VS(80.34±15.65)cms,P＜0.01),and correlated well with invasive PVR measurements(r=-0.69,P＜0.01).The correlation and repeatability of VP obtained by the custom software were better than VP obtained by Doppler echocardiography(r=-0.78,P＜0.01).A VP cutoff value obtained by the custom software of 35.910 had a sensitivity of 92.9% and a specificity of 100% to within pulmonary artery obtained by color M-mode echocardiography using custom software on a personal computer.