The paper analyzed the challenges for community-based rehabilitation of schizophrenic patients in China' s rural areas,from such six aspects as culture, prevention and control system for mental health, fairness of health resources allocation, shortage of specialists, confidence in treatment,and delay in rehabilitation. These studies aim at providing the government with decision making evidence for enacting rural mental health policies and taking effective intervention measures.

Objective To study the prognosis in the patients with distant metastasis after nasopharyngeal carcinoma radical radiotherapy and to analyze its influencing factors .Methods One hundred and fifty patients with distant metastasis after nasopha-ryngeal carcinoma radical radiotherapy were followed up .Their clinical data were collected to conduct the prognosis analysis and in-fluencing factors analysis .Results The median survival time in the follow up cases was 13 .50 months ,the one-year survival rate was 49 .8% ,two-year survival rate was 31 .0% and three-year survival rate was 19 .3% .The Cox model single factors analysis re-sults showed that the N stage in initial diagnosis ,whether conducting chemotherapy in initial diagnosis ,time interval from radiother-apy finish to distant metastasis occurrence ,metastasis site ,chemotherapy after distant metastasis ,chemotherapy cycles and palliative radiotherapy were the prognosis related influencing factors (P<0 .05) ,in which the N stage ,metastatic site ,chemotherapy after dis-tant metastasis ,time interval from radiotherapy finish to distant metastasis occurrence and palliative radiotherapy were the inde-pendent influencing factors of prognosis(P<0 .05) .Conclusion The independent factors of prognosis in the patients with distant metastasis after nasopharyngeal carcinoma radical radiotherapy are the N stage at initial diagnosis ,metastatic site ,whether having chemotherapy after distant metastasis ,time interval from radiotherapy finish to distant metastasis occurrence and whether conduc-ting the palliative radiotherapy .

Objective:In this study, the feasibility of this method was evaluated in children with large distance femoral lengthening cases, and the acute correction and staging surgeries were compared at healing speed. At the same time the key points of surgical techniques would be summarized, so as to clarify the application value of this technology in children patients.Methods:Since July 7 of 2014 to January 16 of 2018, a total of 10 cases of Lengthening Over Retrograde Nail (LORN) surgery have been formulated and carried out, including 9 males and 1 females.The average age of the operation was 13.10±2.18 y. In all cases, the osteotomy point was located in the metaphysis of the distal femur, and the records from the first meeting to the end of follow-up included gender, date of birth, reason of discrepancy and treatment history, age at surgery, lengthing distance, the length of duration with frame, healing time, ROM of the knee joint, complications, et al. To compare the healing time of acute correction and staging surgery. Statistical analysis was made by SPSS 22.0 software, and then reasonable treatment strategies were proposed.Results:The average lengthing distance of 7.07±1.01 cm. The median time of the duration with frame was 8.5 (4,16) months, and the median follow-up time was 39 (34, 54) months. All cases obtained good clinical and imaging healing (1.70±1.10 month/cm vs. 1.16±0.54 month/cm), and all regained to normal walking function (136.67°±20.82° vs. 125.71°±26.37°), without the occurrence of fracture after therapy. There were no statistically significant differences in the speed of healing, range of joint motion or complication rate between acute correction and staging treatment. Conclusion:It is feasible for femoral lengthening surgery assisted by retrograde intramedullary nail in the treatment of femoral shortening deformityin children. The correction of mild angular deformity and lengthening surgery can be performed simultaneously. The osteotomy site was proposed at distal metaphysealof the femur for better quality of osteogenesis and shorter duration for fixator. It is safe to osteotomy and lengthening in the area of enchondroma.

Objective:In this study, lengthening over nail (LON) and plating after lengthening (PAL) were compared by the process of treatment and therapeutic effect in the children's femoral lengthening cases,to guide treatment choices; and in the PAL group there was another comparison between different timeline of plate fixation after lengthening to formulate reasonable technical route.Methods:Since January 7, 2014 to September 10, 2018, a total of 21 cases of LON and PAL surgery had been carried out, including 12 males and 9 females. The average age at their operation was 12.43±3.12 years. There were 10 patients in the LON group and 11 patients in the PAL group, in the PAL group 5 cases was synchronous fixation, which means removal of the external fixator and plate fixation would be performed in the same surgery, 6 cases was asynchronous fixation, which means plate fixation would be performed at least 2 weeks later after the removal offixator to reduce the risk of infection. The recorded data includesgender, date of birth, reason of discrepancy and treatment history, age at surgery, lengthening distance, the length of duration with frame, healing time, total duration time and total blood loss of seriesoperations, ROM of the knee joint, complications, etc.Statistical analysis was made by SPSS 22.0 software, and then reasonable treatment strategies were proposed.Results:In the LON group, the medianlengthening distance was 7.10 (6.63, 7.70) cm, the median total duration time was 300 (240, 330) min, the medianspeed of healing was 1.12 (0.78, 1.72) month/cm, complications were found in 3 cases, the median ROM of knee joint was 125.00° (117.50°, 150.00°); in the PAL group, the data respectively were 6.00 (5.00, 8.00) cm, 260 (230, 465) min, 1.00 (0.75,1.71) month/cm, 3 cases, 100.00° (90.00°, 150.00°), the difference between them was not statistically significant (all P>0.05). 2. In the PAL group, the difference of number of surgeries, total duration time, total blood loss, complication rate, healing speed and postoperative function between synchronous and asynchronous fixation was not statistically significant (all P>0.05). Conclusion:They are similarbetween LON and PAL techniques in the process of treatment and therapeutic effect. The surgeons could make choices according to the growth potential of the patients and their own custom operation methods. In the case of the current sample size, there is no statistical difference in the therapeutic effect between the synchronous and asynchronous plate fixation in the PAL method, but the sample size needs to be increased for further study.

Objective:To construct and validate prognostic nomograms predicting overall survival (OS) and cancer-specific survival (CSS) of patients with late-stage hepatocellular carcinoma (HCC).Methods:A retrospective cohort study was used in this report. Screened 2382 late-stage HCC patients obtained from Surveillance, Epidemiology, and End Results (SEER) database (2010—2015), were randomly classified into the training cohort and the internal validation cohort by using the function in R software according to the ratio of 1∶1. Chi-square test was applied to verify the comparability of data between two groups. The external validation cohort ( n=62) were collected from the Affiliated Zhangjiagang Hospital of Soochow University. Based on univariate and multivariate COX regression analyses in the training cohort, this study constructed nomograms for 6- and 12- month OS and CSS. Concordance index (C-index), calibration plots, the receiver operating characteristic (ROC) curves and Kaplan-Meier survival curves were applied to measure the performance of nomograms in the training cohort and to validate nomograms in two validation cohorts. The clinical utility was measured by decision curve analysis (DCA). Results:Two nomograms were constructed. The identified risk factors included sex, Edmondson-Steiner grade, T stage, N stage, M stage, tumor size, bone metastasis, Alpha-fetoprotein (AFP), surgery of primary site, radiation and chemotherapy. The C-index for OS in the training and two validation cohorts was 0.729(95% CI: 0.711-0.747), 0.721(95% CI: 0.705-0.737) and 0.860(95 CI: 0.831-0.889), respectively. The C-index for CSS in the training and two validation cohorts was 0.732(95% CI: 0.714-0.750), 0.725(95% CI: 0.707-0.743) and 0.862(95% CI: 0.829-0.895), respectively. Afterwards, for nomograms in the training and two validation cohorts, C-index and calibration plots expressed great predictive accuracy and concordance. ROC curves and Kaplan-Meier survival curves demonstrated good prognostic ability. Furthermore, nomograms performed superior to other models. DCA showed substantial clinical utility. Conclusion:This study has developed and validated nomograms predicting 6- and 12- month OS and CSS of patients with late-stage HCC, which may be useful to develop the individualized treatment.