Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents.

China is home to the second largest population of children and adolescents in the world. Yet demographic shifts mean that the government must manage the challenge of fewer children with the needs of an ageing population, while considering the delicate tension between economic growth and environmental sustainability. We mapped the health problems and risks of contemporary school-aged children and adolescents in China against current national health policies. We involved multidisciplinary experts, including young people, with the aim of identifying actionable strategies and specific recommendations to promote child and adolescent health and wellbeing. Notwithstanding major improvements in their health over the past few decades, contemporary Chinese children and adolescents face distinct social challenges, including high academic pressures and youth unemployment, and new health concerns including obesity, mental health issues, and sexually transmitted infections. Inequality by gender, geography, and ethnicity remains a feature of health risks and outcomes. We identified a mismatch between current health determinants, risks and outcomes, and government policies. To promote the health of children and adolescents in China, we recommend a set of strategies that target government-led initiatives across the health, education, and community sectors, which aim to build supportive and responsive families, safe communities, and engaging and respectful learning environments. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

The Method of Portal Making in Lumbar Unilateral Biportal Endoscopic Surgery with Different Operative Approaches According to the Constant Anatomical Landmarks of the Lumbar Spine: A Review of the Literature.

STUDY DESIGN: Review. OBJECTIVE: Unilateral Biportal Endoscopy (UBE) is a minimally invasive surgery that is gaining recognition and being employed in clinical practice. Nevertheless, the precise method for determining UBE portals' location varies depending on the originator's preferences or the anatomical structure's proximity to the portal positions. Consequently, the relationship among UBE portals' locations is messy. This study aims to elaborate on the specific portal localization and explore the positional association and commonality among different UBE approaches' portals. METHODS: The following keywords are used to search in the PubMed, Ovid, Web of Science, ScienceDirect, SpringerLink, Scopus, CNKI, and Wanfang database: "Biportal endoscopic spinal surgery", "Two portal endoscopic spinal surgery", "Percutaneous biportal endoscopic decompression", "Unilateral biportal endoscopy", "Irrigation endoscopic discectomy", "UBE" and "BESS". RESULTS: After screening, 29 pieces of literature are included. The study summarizes different UBE approach portal localizations, categorized by fusion or non-fusion surgery and pathological classification. The study presents an inaugural method for categorizing the lumber into four surgical intervals based on bone landmarks and assigns different UBE approaches to the appropriate intervals based on their characteristics, making the selection of UBE surgical approaches' portal locations more flexible. Additionally, the study provides an overview of the indications, complications, and distinct benefits associated with each interval, further refining the novel UBE portal interval localization method. CONCLUSION: The study clarifies the interrelationship and commonality between the portals of different UBE approaches and proposes a new UBE portal interval localization method to enhance surgeons' understanding and proficiency in UBE procedures.

Hybrid pedicle screw and modified cortical bone trajectory technique in transforaminal lumbar interbody fusion at L4-L5 segment: finite element analysis.

BACKGROUND: Investigate the biomechanical properties of the hybrid fixation technique with bilateral pedicle screw (BPS) and bilateral modified cortical bone trajectory screw (BMCS) in L4-L5 transforaminal lumbar interbody fusion (TLIF). METHODS:  Three finite element (FE) models of the L1-S1 lumbar spine were established according to the three human cadaveric lumbar specimens. BPS-BMCS (BPS at L4 and BMCS at L5), BMCS-BPS (BMCS at L4 and BPS at L5), BPS-BPS (BPS at L4 and L5), and BMCS-BMCS (BMCS at L4 and L5) were implanted into the L4-L5 segment of each FE model. The range of motion (ROM) of the L4-L5 segment, von Mises stress of the fixation, intervertebral cage, and rod were compared under a 400-N compressive load with 7.5 Nm moments in flexion, extension, bending, and rotation. RESULTS:  BPS-BMCS technique has the lowest ROM in extension and rotation, and BMCS-BMCS technique has the lowest ROM in flexion and lateral bending. The BMCS-BMCS technique showed maximal cage stress in flexion and lateral bending, and the BPS-BPS technique in extension and rotation. Compared to the BPS-BPS and BMCS-BMCS technique, BPS-BMCS technique presented a lower risk of screw breakage and BMCS-BPS technique presented a lower risk of rod breakage. CONCLUSION:  The results of this study support that the use of the BPS-BMCS and BMCS-BPS techniques in TLIF surgery for offering the superior stability and a lower risk of cage subsidence and instrument-related complication.

Current status on independent school health department in the centers for disease control and prevention across China / 中国学校卫生

Objective@#To understand the current status of main professional work in independent school health departments of Chinese centers for disease control and prevention, so as to provide reference and suggestions for the further development of school health work in China.@*Methods@#Electronic questionnaire was used to collect the basic work of school health, the monitoring work, the intervention action of common diseases and the development of health intervention among students in independent school health departments of centers for disease control and prevention in China.@*Results@#Among the 357 institutions that have set up independent school health departments, the implementation rates of school mental health work, safety emergency and risk avoidance health intervention were low, which were 11.8% and 11.5%, respectively. Relying on the project "national monitoring and intervention of common diseases and health influencing factors of students", the overall implementation of health monitoring in schools nationwide was successful, but the overall implementation rate of students nutritional status monitoring and "healthy parents action" were low, accounting for 44.5% and 24.4%, respectively. At the same time, there were still as many as 27.2% institutions that had not carried out the intervention action for common diseases of students which advocated in the monitoring program. The failure rate of county level institutions was higher than that of provincial level and prefecture level institutions, and the failure rate of the central and western institutions was much higher than that of the eastern institutions; the difference was statistically significant( χ 2=30.1, 41.6, P <0.05).@*Conclusion@#We should increase support including policy preference, fund guarantee, technical guidance and so on for the school health work of disease control institutions at the grass roots level and in economically underdeveloped areas, so as to ensure the healthy growth of children and adolescents in all respects.

Comparison of CT values in traditional trajectory, traditional cortical bone trajectory, and modified cortical bone trajectory.

BACKGROUND: To compare the CT values and length of the screw tracks of traditional trajectory (TT), cortical bone trajectory (CBT), and modified cortical bone trajectory (MCBT) screws and investigate the effects on the biomechanics of lumbar fixation. METHODS: CT scan data of 60 L4 and L5 lumbar spine were retrieved and divided into 4 groups (10 male and 10 female cases in the 20-30 years old group and 20 male and 20 female cases in the 30-40 years old group). 3-dimentional (3D) model were established using Mimics 19.0 for each group and the placement of three techniques was simulated on the L4 and L5, and the part of the bone occupied by the screw track was set as the region of interest (ROI). The mean CT value and the actual length of the screw track were measured by Mimics 19.0. RESULTS: The CT values of ROI for the three techniques were significantly different between the same gander in each age group (P < 0.05). The difference of screw track lengths for CBT and MCBT in the male and female is significant (P < 0.05). CONCLUSIONS: According to the CT values of the three screw tracks: MCBT > CBT > TT, the MCBT screw track has greater bone-screw surface strength and longer screw tracks than CBT, which is easier to reach the anterior column of the vertebral body contributing to superior biomechanical properties.

Biomechanical investigation of the hybrid modified cortical bone screw-pedicle screw fixation technique: Finite-element analysis.

Background: Hybrid fixation techniques including the both modified cortical bone trajectory (MCBT) and traditional trajectory (TT) at the L4 and L5 lumbar segment are firstly proposed by our team. Therefore, the purpose of this study is to evaluate and provide specific biomechanical data of the hybrid fixation techniques including the MCBT and TT. Methods: Four human cadaveric specimens were from the anatomy laboratory of Xinjiang Medical University. Four finite-element (FE) models of the L4-L5 lumbar spine were generated. For each of them, four implanted models with the following fixations were established: TT-TT (TT screw at the cranial and caudal level), MCBT-MCBT (MCBT screw at the cranial and caudal level), hybrid MCBT-TT (MCBT screw at the cranial level and TT screw at the caudal level), and TT-MCBT (TT screw at the cranial level and MCBT screw at the caudal level). A 400-N compressive load with 7.5 N/m moments was applied to simulate flexion, extension, lateral bending, and rotation, respectively. The range of motion (ROM) of the L4-L5 segment and the posterior fixation, the von Mises stress of the intervertebral disc, and the posterior fixation were compared. Results: Compared to the TT-TT group, the MCBT-TT showed a significant lower ROM of the L4-L5 segment (p ≤ 0.009), lower ROM of the posterior fixation (p < 0.001), lower intervertebral disc stress (p < 0.001), and lower posterior fixation stress (p ≤ 0.041). TT-MCBT groups showed a significant lower ROM of the L4-L5 segment (p ≤ 0.012), lower ROM of the posterior fixation (p < 0.001), lower intervertebral disc stress (p < 0.001), and lower posterior fixation stress (p ≤ 0.038). Conclusions: The biomechanical properties of the hybrid MCBT-TT and TT-MCBT techniques at the L4-L5 segment are superior to that of stability MCBT-MCBT and TT-TT techniques, and feasibility needs further cadaveric study to verify.

Biomechanical Investigation of the Posterior Pedicle Screw Fixation System at Level L4-L5 Lumbar Segment with Traditional and Cortical Trajectories: A Finite Element Study.

There is no detailed biomechanical research about the hybrid CBT-TT (CBT screws at cranial level and TT screws at caudal level) and TT-CBT (TT screws at cranial level and CBT screws at caudal level) techniques with finite element (FE) method. Therefore, the purpose of this study was to evaluate and provide specific biomechanical data of the hybrid lumbar posterior fixation system and compare with traditional pedicle screw and cortical screw trajectories without fusion, in FE method. Specimens were from the anatomy laboratory of Xinjiang Medical University. Four FE models of the L4-L5 lumbar spine segment were generated. For each of these, four implanted models with the following instruments were created: bilateral traditional trajectory screw fixation (TT-TT), bilateral cortical bone trajectory screw fixation (CBT-CBT), hybrid CBT-TT fixation, and hybrid TT-CBT fixation. A 400 N compressive load with 7.5 Nm moments was applied so as to simulate flexion, extension, left lateral bending, right lateral bending, left rotation, and right rotation, respectively. The range of motion (ROM) of the L4-L5 segment and the posterior fixation, the von Mises stress of the intervertebral disc, and the posterior fixation in four implanted models were compared. CBT-TT displayed a lower ROM of the fixation segment (3.82 ± 0.633°) compared to TT-TT (4.78 ± 0.306°) and CBT-CBT (4.23 ± 0.396°). In addition, CBT-TT showed a lower ROM of the posterior fixation (0.595 ± 0.108°) compared to TT-TT (0.795 ± 0.103°) and CBT-CBT (0.758 ± 0.052°). The intervertebral disc stress of CBT-TT (4.435 ± 0.604 MPa) was lower than TT-TT (7.592 ± 0.387 MPa) and CBT-CBT (6.605 ± 0.600 MPa). CBT-TT (20.228 ± 3.044 MPa) and TT-CBT (12.548 ± 2.914 MPa) displayed a lower peak von Mises stress of the posterior fixation compared to TT-TT (25.480 ± 3.737 MPa). The hybrid CBT-TT and TT-CBT techniques offered superior fixation strength compared to the CBT-CBT and TT-TT techniques.

Current status about school health department settings and staff building of the centers for disease control and prevention in China / 中国学校卫生

Objective@#To learn about the construction and staffing of the school health system in Chinese institutions for disease prevention and control, and to provide basic information for the school health system, team capacity building and work development.@*Methods@#Electronic questionnaire was used to collect the setting and staffing of school health departments (including school health centers and departments/rooms) at the provincial, prefecture and county (district) levels in the centers for disease control and prevention. Statistical analysis was made on the proportion of school health, the number of staff and the characteristics such as age, education, major and working years in the provincial, prefecture and county (district) levels.@*Results@#Among the 3 313 institutions, the proportion of independent school health departments was 10.8%, and those of the provincial, prefecture and county (district) levels were 74.2%, 15.0%, and 9.6%, respectively. Among the institutions with separated department, the average number of staff members was 4.4, while the number of staff was 2.5. The average age of school health workers was 40.4 years old, and the proportion of male and female employees was 45.2% and 54.8%. The proportion of personnel who have been engaged in school health work for less than 5 years on average was as high as 65.1%. The majors of the staff were mainly public health ( 40.4 %), 54.0% of the provincial staff had a master s degree or above, and 47.8% and 58.7% of the staff at the prefecture and county (district) levels were junior college or below respectively.The proportion of provincial level personnel with intermediate and senior titles was 69.6%, and the proportion of municipal and countylevel personnel at the junior level and below was 52.2% and 56.2% respectively.@*Conclusion@#The proportion of independent school health departments within centers of disease control and prevention across China was low. There is a serious shortage of school health personnel, and there are problems such as low levels of education and professional titles, especially in county (district) level institutions. It is urgent to strengthen the construction of the school health system of the centers for disease control and prevention in China.

Current status about school health department settings and staff building of the centers for disease control and prevention in China / 中国学校卫生

Objective@#To learn about the construction and staffing of the school health system in Chinese institutions for disease prevention and control, and to provide basic information for the school health system, team capacity building and work development.@*Methods@#Electronic questionnaire was used to collect the setting and staffing of school health departments (including school health centers and departments/rooms) at the provincial, prefecture and county (district) levels in the centers for disease control and prevention. Statistical analysis was made on the proportion of school health, the number of staff and the characteristics such as age, education, major and working years in the provincial, prefecture and county (district) levels.@*Results@#Among the 3 313 institutions, the proportion of independent school health departments was 10.8%, and those of the provincial, prefecture and county (district) levels were 74.2%, 15.0%, and 9.6%, respectively. Among the institutions with separated department, the average number of staff members was 4.4, while the number of staff was 2.5. The average age of school health workers was 40.4 years old, and the proportion of male and female employees was 45.2% and 54.8%. The proportion of personnel who have been engaged in school health work for less than 5 years on average was as high as 65.1%. The majors of the staff were mainly public health ( 40.4 %), 54.0% of the provincial staff had a master s degree or above, and 47.8% and 58.7% of the staff at the prefecture and county (district) levels were junior college or below respectively.The proportion of provincial level personnel with intermediate and senior titles was 69.6%, and the proportion of municipal and countylevel personnel at the junior level and below was 52.2% and 56.2% respectively.@*Conclusion@#The proportion of independent school health departments within centers of disease control and prevention across China was low. There is a serious shortage of school health personnel, and there are problems such as low levels of education and professional titles, especially in county (district) level institutions. It is urgent to strengthen the construction of the school health system of the centers for disease control and prevention in China.

Improving Sanitary Latrines in Rural Areas Correlated to Decreasing the Related Disease Burden - China, 2006-2017.

What is already known on this topic? A Latrine Revolution was conducted to promote the coverage of sanitary latrines, and this coverage has shown to increase significantly from 2006 to 2017. Sanitary latrines are an important strategy for reducing disease burdens associated with poor sanitation infrastructure. What is added by this report? Mortality of diarrheal diseases attributable to unsafe sanitation decreased from 7,748.05 in 2006 to 2,405.46 in 2017 and was correlated with increased use of sanitary latrines. What are the implications for public health practice? The coverage of sanitary latrines in rural areas of China should be further improved through the adjustment of policies and plans and by combining health education and hygiene promotion.

Oseltamivir inhibits both viral entry and release but enhances apoptosis of cells infected with influenza A H1N1.

Oseltamivir (Tamiflu) has been shown to be effective as a treatment and chemoprophylaxis for influenza virus infections. However, the safety consideration of oseltamivir should not be overlooked because adverse events associated with the drug have frequently been reported after the use of Tamiflu for the treatment of influenza patients. Here, we investigated oseltamivir's influence on viral load, apoptosis, and cytokine response of influenza A H1N1-infected A549 or THP-1 cells. In addition, we analyzed the effect of the drug on the function of influenza-infected NK cells after oseltamivir treatment. The results of our study suggest that oseltamivir may inhibit both viral entry and release but may also enhance apoptosis of infected cells and interfere with NK cell function during influenza infection.

Ischemic postconditioning attenuates renal ischemic/reperfusion injury in mongrel dogs.

OBJECTIVE: To investigate the effect of Postcond on renal ischemia-reperfusion (I/R) injury in a canine model. I/R injury is the most common cause of renal dysfunction. Ischemic postconditioning (Postcond) is a phenomenon by which intermittent interruptions of blood flow in the early phase of reperfusion can protect organs from I/R injury. MATERIAL AND METHODS: Forty adult male mongrel dogs were randomly divided into five groups of eight dogs each. Animals underwent 60 minutes of renal pedicle occlusion followed by reperfusion for 72 hours. Postcond was performed by 15-second, 30-second, or 1-minute I/R for six or three cycles. Blood and urine were collected at different reperfusion time points (24, 48, and 72 hours), and blood urea nitrogen (BUN), creatinine (Cr) levels, urine N-acetyl-ß-D-glucosaminidase (NAG), and Cr levels were assayed. Kidney samples were harvested after I/R, and renal superoxide dismutase (SOD), malondialdehyde (MDA), and myeloperoxidase (MPO) concentrations were measured, respectively. Apoptosis was evaluated by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling (TUNEL) assay in the tissue samples. RESULTS: Compared with the sham group, I/R resulted in renal dysfunction, decreased SOD levels, increased MDA and MPO levels, and increased apoptosis indexes. However, Postcond attenuated the aforementioned effects, the protection of which in the Postcond of 15-second reperfusion/ischemia for six cycles was the most notable. CONCLUSIONS: Postcond exerts protective effects on renal (I/R) injury. It may be a promising strategy against I/R injury in clinical practice. Its mechanisms may involve reduction of lipid peroxidation and cellular apoptosis.

[Distribution and role of denitrifying, nitrifying, nitrosation and ammonifying bacteria in east lake].

The most probable number (MPN) method was employed to determine the distribution and role of four nitrogen cycle bacteria, including ammonifying bacteria, denitrifying bacteria, nitrosobacteria and nitrobacteria, in East Lake, Wuhan. The results showed that the n(MPN) of nitrosobacteria in water was most in rainy season and least in dry season, while the number in common season between them. The n(MPN) of water nitrobacteria in rainy season was less than in the other two seasons. The n(MPN) of water ammonifying and denitrifying bacteria were most in common season, least in dry season. The n(MPN) of nitrosobacteria in sediment in rainy season was more than that in other seasons. The n(MPN) of sediment nitrobacteria was most in dry season while denitrifying bacteria was more in dry season than in other seasons. The n(MPN) of ammonifying bacteria had no difference among three seasons. Compared with water phase, the n(MPN) of nitrosobacteria in sediment phase was more in rainy and dry season (p < 0.01), while nitrobacteria's number was prevailing in water phase during common and rainy season while denitrifying bacteria's was prevailing only in common season(p < 0.01). The ammonifying bacteria had no difference in water and sediment. The results demonstrated that the difference in distribution of four nitrogen cycle bacteria in two phase and three season played a significant role in nitrogen removal, which promoted ammoniation, nitrification, nitrosification and denitrification in lake. The study also found that the lg[n(MPN)] of denitrifying and ammonifying bacteria in water and sediment had significant correlation with the catching gas volume(p < 0.001). Furthermore, different season had different gas volume (p < 0.01), which showed that ammoniation and denitrification could convert organic nitrogen and nitrate into gas nitrogen(NH3, N2O, N2) and also varied greatly with different season.

[Variations and transformations of nitrogen pollutants in source and tap water of D-lake].

Ammonia, nitrite and nitrate pollutions and variations in source water and tap water of D-Lake are investigated. The removal effects of nitrogen in routine proceeding of water production and the transformations of the different forms of nitrogen in natural condition with simulated test are studied at the same time. The results show that the nitrogen pollutions in source and tap water of D-waterworks are higher than T-waterworks', although both waterworks have same resource. Compared with D-waterworks, the nitrogen pollutions of source and tap water in Z-waterworks are lower than D-waterworks' and they have different variation and distribution. The forms of nitrogen could be partly transformed during the routine production, but the total percentage of nitrogen removal efficiency is not significant (just about 20%). The simulate test shows that NH4+(-)N could change into NO2-(-)N, while No2-(-)N into NO3-(-)N, which is partly transformed into nitrogen gas by microorganism and majority of which are remained in tap water by form of NO3-(-)N.