The Department of Thoracic Surgery of Shanghai Chest Hospital has performed esophageal function testing for over 30 years, being the only department of its kind in China with this capability. The pressure testing and 24-hour pH/impedance monitoring of the esophagus is of great help to assist in the diagnosis and treatment of benign and malignant esophageal diseases related to it. Thanks to the esophageal function test, in addition to the routine various endoscopic anti-reflux procedures, our hospital has taken the lead in China in recent years to carry out a series of clinical and research work for benign esophageal diseases, such as the development of magnetic ring, double nedoscopic combination and new anti-reflux endoscopic techniques. In recent years, we have carried out high-resolution esophageal manometry and 24-hour pH/impedance monitoring for patients with interstitial pneumonia and pulmonary fibrosis suspected to be caused by gastroesophageal acid reflux. We can better assess the correlation between gastroesophageal reflux and pulmonary fibrosis, and to provide the different clinical treatments and even surgical interventions. The Bravo capsule is used more often in the United States, and it has obvious advantages over traditional approach for acid measurement. We strongly call for the collaboration between industry and academic institutions in this field, and the development of our own related products with independent intellectual property rights.

Objective To investigate the predictive value of urinary exosomal microRNA(miR)-29 c in the clinical outcome of organ-and non-organ-confined bladder urothelial carcinoma(BUC).Methods From January 2017 to March 2022,152 patients with BUC were recruited from the Department of Urology in our hospital as a validation set.In addition,126 non-cancer controls were selected from the physical examination center of our hospital.The expression level of urinary exosomal miR-29c was detected by real-time quantitative PCR.Results In the validation set,urinary exosomal miR-29c level in BUC patients was significantly lower than that in non-cancer control group(P＜0.05),while urinary exosomal miR-17-5p level and miR-590-5p level were not significantly different(P＞0.05).The area under ROC curve of urinary exosomal miR-29c for the diagnosis of BUC was 0.969(95％CI:0.953～0.986),and the corresponding sensitivity and specificity were 92.1％and 90.2％,respectively.In subtype analysis,urinary exosomal miR-29c levels were further reduced in patients with non-organ-confined BUC compared with patients with organ-confined BUC(P=0.009).Overall survival(OS),disease-free survival(DFS)and disease-specific survival(DSS)were longer in the urinary exosomal miR-29c high expression group(P＜0.05).Conclusion Low levels of urinary exosomal miR-29c are an adverse prognostic factor for survival in patients with BUC,and are promising as a predictor of adverse clinical outcomes of organ-and non-organ-confined BUC.

Objective:To investigate the status of self-management and family support among elderly diabetic patients in community.Methods:Eight elderly patients with type 2 diabetes were interviewed in Xietu Community Health Service Center in Shanghai by semi-structured interviews from March 1st to March 15th, 2022. The interview outline focused on the impact of the disease on the patients' daily life, the status of disease self-management, and the support provided by their family. The contents of interviews were analyzed and extracted by Colaizz 7-step analysis method.Results:Of the 8 interviewees, there were 2 males and 6 females, aged (75.25±3.01)years old, with a disease course of (17.50±8.50)years. The interviews showed that there were three themes in the area of family support: difficulties in disease management (in terms of diet, exercise, medication, disease surveillance, health knowledge and quitting unhealthy habits), helpfulness of family support in management of above behaviors, differences between family support and support from others (including eating habits, information sharing, emotional support, patient trust, and continuity of support).Conclusions:The elderly diabetic patients in the community have some awareness of health management, but there is still much room for improvement. The supervision and support from family members can help patients improve their self-management and quality of life.

Objective: To understand the status and related knowledge requirements of health emergency literacy among college students in Shaanxi Province, so as to provide the basis for improving college students health emergency literacy. Methods: A total of 2 723 students from 18 colleges and universities in Shaanxi Province were selected by multi stage random sampling and simple random sampling methods in November 2023, and the survey of health literacy in emergency and knowledge requirements of health emergency literacy was conducted. Statistical analysis was carried out by using χ 2 test, Wilcoxon rank sum test, Kruskal-Wallis H test and Logistic regression analysis. Results: About 28.98% of the surveyed college students had a high level of health emergency literacy, which varied by students whether being only one child, whether having left behind experience, with different personality types, whether being student cadres, and with different frequencies of community or social activities ( χ 2=9.15, 7.90, 32.73, 16.29 , 120.25, P <0.05). The equivalence scores of the four dimensions of health emergency literacy from high to low were poisoning and nuclear and radiation (0.84), medical rescue (0.83), infectious disease (0.82), and basic knowledge and behavior ( 0.77 ). Logistic regression analysis found that college students with left-behind experience were negatively correlated with health emergency literacy and its four dimensions ( OR =0.74, 0.72, 0.80, 0.80, 0.83), while personality type (rational type), community or social activity frequency were positively correlated with the cognitive levels of health emergency literacy and its four dimensions among college students ( OR =1.57, 1.50, 1.33, 1.27, 1.38)( P <0.05). There was a higher level of basic knowledge and behavioral cognition among only child college students ( OR =3.73), and female students had a higher level of health emergency literacy, as well as awareness of infectious disease outbreaks and medical rescue ( OR =1.21, 1.28, 1.21)( P <0.05). The radar map showed that the level of health emergency literacy was positive development radar map. About 67.68 % of the students had a high willingness to acquire health emergency literacy knowledge, and the demand for basic health emergency knowledge and behavioral knowledge was the highest (52.37%). Conclusions College students have insufficient health emergency literacy, but they have the highest demand for health emergency. Publicity and education should be strengthened for students with left behind experience, irrational type, and low frequency of community or social activities.

Objective To enhance CT radiation dose management in radiology department via applying Six Sigma management method.Methods The radiation quality control processes in the radiology department were optimized according to the Six Sigma quality management DMAIC pattern.The volume CT dose index(CTDIvol),dose length product(DLP),radiation quality control problems of adult and pediatric CT scans from January 2022 to February 2022 were collected as baseline data,and data collected from August 2022 to September 2022 were taken as the control group for analysis via Six Sigma management method.All data of the dose values and problem rates were compared and analyzed between before and after Six Sigma management methods.Results The DLP in the adult group was decreased by 65.5％in computed tomography urography(CTU),decreased by 25.5％in neck enhancement,decreased by 9.8％in head,decreased by 24％in facial cranial,and decreased by 27.7％in chest enhancement,with a statistical difference(P＜0.05).While DLP in the adult group was decreased by 9.7％in abdominal enhancement,with no significant difference(P＞0.05).The DLP in the pediatric(＜1 year)group was increased by 35％in head scans,with no significant difference(P＞0.05).While the DLP was decreased by 30.2％in 1 to 5 years group,decreased by 21.8％in 6 to 10 years group,decreased by 27.6％in 11 to 15 years group,with statistical difference(P＜0.05).The DLP of facial cranial was decreased by 43.3％in 6 to 10 years group,decreased by 29.1％in 11 to 15 years group,with statistical difference(P＜0.05).The DLP of chest was decreased by 13％in＜1 year group(P＞0.05),increased by 2.2％in 1 to 5 years group(P＞0.05),decreased by 42.6％in 6 to 10 years group,decreased by 54.2％in 11 to 15 years group(P＜0.05).The incidence of radiological quality control problems of after Six Sigma management was significantly lower than that of before Six Sigma management(P＜0.05).Conclusion Six Sigma management method can identify problems in the clinical practice and enhance the ability of radiation quality control through optimization.

Objective:To investigate the intention to stay on among primary health care workers (PHWs) during the COVID-19 epidemics and its influencing factors.Methods:An online questionnaire survey was conducted among PHWs from 62 primary health institutions in 31 provinces, autonomous regions and municipalities across China selected by multi-stage whole cluster random sampling method between May and October 2022. According to the job position, the PHWs were divided into 5 categories: general practitioners (GPs), nurses, public health doctors, managers and support staff. Intention to stay was measured using the Chinese version of the Intention to Stay Questionnaire. Multiple linear regression model was used to analyze the influencing factors of the intention to stay in PHWs of different occupational categories, including personal factors, work factors, factors related to the COVID-19 and psychological reactions.Results:A total of 3 769 PHWs from 44 community health service centers, 18 township hospitals of 27 provinces/autonomous regions and 4 municipalities participated in this survey. The mean age of participants was (37.4±9.2) years, including 2 971(78.8%) women. The mean score of intention to stay of participants was 21.7±4.1. Compared with GPs, managers had lower intention to stay ( P=0.004). Age, female, in marriage, monthly income, years of primary care service, self-evaluation of unit support function, MSQ-SF score, and PA score were positively correlated with the score of intention to stay (all P<0.05), while PHQ-9 score, EE score, and DP score were negatively correlated with the score of intention to stay (all P<0.05). The MSQ-SF scores of all occupational categories were positively correlated with the scores of intention to stay (all P<0.01). In addition, among GPs, monthly income, years of service in primary care, self-evaluation of unit support function, and PA scores were positively correlated with the score of intention to stay (all P<0.05), while PHQ-9 scores and EE scores were negatively correlated with the score of intention to stay (all P<0.05). Among nurses, age, female gender, monthly income, self-evaluation of unit support function, and PA score were positively correlated with the score of intention to stay (all P<0.05), while EE scores and retention will score were negatively associated with ( P<0.001). Among public health doctors, in marriage was positively correlated with the score of intention to stay ( P=0.018). Among managers, DP score was negatively correlated with the score of intention to stay ( P=0.001). Among support staff, female gender, monthly income, years of primary care service, self-evaluation of unit support function, and PA scores were positively correlated with the score of intention to stay (all P<0.05), while EE score and DP score were negatively correlated with intention to stay (all P<0.05). Conclusions:The intention to stay of PHWs in China during the COVID-19 was at an intermediate level, which was affected by many factors. Among them, job satisfaction was positively correlated with the intention to stay of all occupational categories, and the influencing factors of different occupational categories have some variations.

Objective:To evaluate the effect of family intervention on self-management and glycaemic control in patients with type 2 diabetes mellitus (T2DM).Methods:Clinical interventional trials on the family intervention for T2DM patients were searched in PubMed, Medline, Embase, Cochrance libraries, the CNKI, and the Wan Fang Database from January 2016 to June 2023. Literature was screened according to the inclusion and exclusion criteria. Self-management behavior, BMI and glycated haemoglobin of T2DM patients were used as outcome indicators. Meta-analysis and mapping were performed using Review Manager 5.3 software. A systematic review of the literature on indicators of self-management behavior measured using other instruments except Summary of Diabetes Self-Care Activities.Results:A total of 1 342 relevant papers were retrieved and 13 papers were included in the analysis, involving 1 454 patients, 740 in the intervention group and 714 in the control group. Meta-analysis showed that the inclusion of home-based intervention helped adult T2DM patients to improve self-management ( WMD=5.03, 95% CI:4.43-5.63, P<0.001) and reduce glycated hemoglobin compared with the hospital-patient dichotomous model ( WMD=-0.77, 95% CI:-1.32--0.21, P=0.007), but the effect on BMI was unclear ( WMD=-0.38, 95% CI:-1.04-0.28, P=0.25). The results of the systematic review supported that home-based intervention improving self-management behaviors of adult T2DM patients. Conclusion:Family intervention can improve self-management behaviors and reduce glycated haemoglobin levels in adults T2DM patients.

Objective:To analyze factors related to clinic attendance for contracted residents in a community health service center in Shanghai.Methods:It was a cross-sectional study. Through the 'Cloud Management of the Community' APP and the 'Service Fee of Contracted Residents' APP, the basic information, contracted time, hospital visits, number of visits, and medical insurance expenses of the contracted residents in Shanggang Community Health Service Center in 2021 were collected, the visiting rate to the contracted community health center and the contracted medical combination hospitals were analyzed.Results:In 2021, the contracting rate of all residents in the community was 49.96% (51 478/103 033). The contracting rate of the key population was 84.59% (43 545/51 478),among whom 66.28% (34 118/51 478) were over 60 years, 49.93% (25 702/51 478) had been contracted for more than 3 years, and 37.43% (19 270/51 478) had hypertension and/or diabetes. The number of contracted general practitioners was 4.89 times of contracted TCM doctors (1 345.17/274.81). Among all contracted residents 78.75% (40 540/51 478) had at least one visit annually, and 65.00% (33 463/51 478) had at least one visit to community health service center and the average number of visits was 17.63(5.00, 24.00)annually. The rate of visit to contracted the community health service center was (46.97±38.37) %, and 41.78% (16 937/40 540) had≥60% visit to contracted community center; the average visiting rate to the combination hospitals was (70.59±34.57) %, and 55.75% (22 602/40 540) had consultation rate≥80%. These residents were older in age, had longer contract time, higher proportion of hypertension and diabetes, and higher medical expenses, compared to those with less visits to contracted community health center and combination hospitals ( P<0.01). Meanwhile, 11 736 residents (35.07%) only visited to the contracted community health service center. Conclusion:The contracted residents are mainly the elderly and the sick ones in the community, but the use of contracted service is inadequate. Improving the visiting rate to community health center is a challenge for make a full use of the contracted health facilities.

Objective:To compare the breadth of condition coverage, accuracy of suggested conditions and appropriateness of urgency advice of the 8 symptom assessment mobile applications (APPs) available on the Chinese market.Methods:The APPs were assessed using 200 primary care vignettes and were measured against the vignettes′ standard. The primary outcome measures were proportion of conditions covered by an APP, proportion of vignettes with the correct primary diagnosis,and proportion of safe urgency advice.Results:For APPs assessed,condition-coverage was from 29.0%(58/200)to 99.5%(199/200), top-3 suggestion accuracy was from 8.5%(17/200) to 61.5%(123/200), the proportion of safe urgency advice was from 84.8%(167/197) to 99.5% (198/199).Conclusions:The APPs showed a wide range of coverage, safety performance and condition-suggestion accuracy. Symptom assessment APPs with good performance could be used by general practitioners as supporting tools. However, even symptom assessment APPs with excellent performance need to be further assessed in a real clinical environment.

The standardized residency training of general practice is a complex project, the functional departments of the training base should play an active role for its management. The functional department of education in Zhongshan Hospital constantly explores its position and role, connects relevant departments vertically and horizontally to provides management and service for general practice residency training. That means that it should not only to provide advice for leadership decision-making, but also coordinate with all functional departments of the training base. The department has participated in the teaching management and supervision, educational research and training quality control, and accomplished positive results in general practice residency training for last 35 years.