Objective To assess the safety, effectiveness and predictive factors of endoscopic balloon dilatation for the treatment of esophageal stricture and esophageal achalasia in children. Methods 28 patients with esophageal stricture and esophageal achalasia treated by endoscopic balloon dilatation from January 2012 to November 2014 were included. All the patients were divided into two groups, 22 in group A (esophageal stricture) and 6 in group B (esophageal achalasia). All procedures were performed under tracheal intubation and intravenous anesthesia using the 3rd grade controlled radial expansion (CRE) balloon with gastroscope. Outcomes, including success, complications and recurrence data were recorded, and predictors for outcomes were analyzed. Results A total of EBD 57 sessions (1 to 5 per patient, 2.00 ± 1.15) were performed on 28 patients in this study. 22 patients were diagnosed with esophageal stricture (78.57%) and 6 with esophageal achalasia (21.43%). The median age was 25 months (range 0 ~ 150), and female/ male ratio was 12/16. EBD was successful in all the 28 cases. The total success rate was 100.00%. Complications occurred in 6 patients during the dilatation, and no complication in 22 patients. Completely remission of symptoms was seen in 82.14% cases (n = 23), relief in 14.28% (n = 4), non-response in 3.57% (n = 1), and recurrence in 3.57% (n = 1). The stricture diameter before EBD was (6.28 ± 1.77) mm (range 3.0 ~ 10.0 mm), and it was (10.85 ± 2.51) (range 6 ~ 15 mm) after the last EBD. The difference was significant (P < 0.01). There was no significant difference in success, effectiveness, complications and recurrence among the two groups (P > 0.05). The effectiveness of EBD was significantly associated with the diameter and number of strictures (P < 0.05), more complications were seen in the patients with multiple and/or smaller strictures (P < 0.05). In group A, the longer interval between surgery and the first EBD was related to more dilatation in the patients with anastomotic esophageal strictures (P < 0.05). The age and the interval between symptom onset and the first EBD were not the predicting factors for treatment in group B (P > 0.05). Conclusions The results of this study indicated that EBD under general anesthesia was an effective primary treatment in children with esophageal stricture and esophageal achalasia. The diameter and number of stricture were the most important predictive factors for successful clinical outcomes, while the interval between surgery and the first EBD was the most risk factor for EBD sessions in the patients with anastomotic esophageal strictures.

OBJECTIVETo explore the effects of angiotensin-(1-7) on the learning and memory abilities and the expressions of glial fibrillary acidic protein (GFAP) and glial cell line-derived neurotrophic factor (GDNF) in the hippocampus of diabetic rats.

METHODSForty male SD rats were randomly assigned into 4 groups, namely the control group, diabetic group, Ang(1-7)-treated diabetic group (DM1 group), and Ang-(1-7)- and Mas receptor antagonist A779-treated diabetic group (DM2 group). Diabetic rat models were established by a single intraperitoneal injection of streptozotocin (60 mg/kg). The cognitive function of the rats was assessed with Morris water maze (MWM) test. The expressions of GDNF in the hippocampus were examined by RT-PCR and Western blot. Nissl staining was performed to evaluate the morphological changes in rat hippocampus. The expressions of glial fibrillary acidic protein (GFAP, a key indicator of astrocytic reactivity) and caspase-3 were measured by immunohistochemistry.

RESULTSCompared with the control group, the diabetic rats exhibited significantly impaired learning and memory abilities (P<0.05) with lowered expression of GDNF and increased caspase-3 expression in the hippocampus (P<0.05) and significant hippocampal neuronal and astrocyte injuries (P<0.05). Treatment with Ang(1-7) obviously improved the learning and memory abilities of the diabetic rats (P<0.05), increased GDNF and GFAP expressions (P<0.05), lowered caspase-3 expression (P<0.05), and increased the number of surviving neurons in the hippocampus (P<0.05). Such effects of Ang(1-7) effect was blocked by treatment with A779 of the diabetic rats.

CONCLUSIONAng(1-7) can alleviate cognitive dysfunction in diabetic rats possibly by up-regulating the expressions of GFAP and GDNF and promoting neuron survival in the hippocampus.

Angiotensin I ; pharmacology ; Animals ; Astrocytes ; Caspase 3 ; metabolism ; Cognition ; Cognition Disorders ; Diabetes Mellitus, Experimental ; physiopathology ; Glial Cell Line-Derived Neurotrophic Factor ; metabolism ; Glial Fibrillary Acidic Protein ; metabolism ; Hippocampus ; cytology ; metabolism ; Male ; Memory ; Neurons ; Peptide Fragments ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Streptozocin

Objective: The growing body of literature showed a link between uric acid and pulmonary hypertension (PH), but the impact of hyperuremia on outcome of patients with PH has not been well defined. Therefore, the present study was performed to analyze the impact of uric acid on outcome of PH patients. Methods: One hundred seventy-three PH patients (112 females, mean age 38 years old), who were hospitalized in our department between January 2010 and December 2015, were included in our study, the PH diagnosis was made based on right heart catheterization examination result (mean pulmonary artery pressure≥25 mmHg(1 mmHg=0.133 kPa)). PH patients were divided into mild to moderate PH group (Rp/Rs≤0.6, n=97) and severe PH group (Rp/Rs>0.6, n=76). Fifty-one patients (33 females, mean age 45 years old) without PH based on right heart catheterization were included as control subjects. All participants were followed up for a median of 24 months(6-71 months). Clinical endpoints were defined as cardiogenic death or heart-and-lung transplantation. Results: Uric acid was positively correlated with pulmonary vascular resistance(r=0.398, P<0.01), systemic vascular resistance(r=0.244, P<0.01) and mean right atrial pressure (r=0.26, P<0.01), and was negatively correlated with cardiac index(r=-0.278, P<0.01)and mixed venous oxygen saturation (r=-0.322, P<0.01)in PH patients. Serum uric acid level was significantly higher in patients with severe PH than in patients with mild-to-moderate PH and the control subjects (both P<0.05). According to the receiver operating characteristic curve (ROC), 425.5 μmol/L was found to be the best cut-off value of serum uric acid level to predict the outcome of PH patients (sensitivity 50%, specificity 72%). During follow-up, patients with higher level of uric acid (>425.5 μmol/L) were linked with poorer clinical outcome compared to patients with uric acid <425.5 μmol/L(P=0.027). Conclusion Our findings suggests that uric acid is associated with the severity of PH and higher uric acid level serves as an important predictor for poor clinical outcome of PH patients.

Objective: To evaluate the effects of physical activity interventions based on social ecology model, and to explore promising approach for increasing physical activity of students in large cities. Methods: A quasi-experimental design with parallel control was implemented. Students from grade 4 in 20 primary schools in 3 districts of Shanghai were recruited. Based on social ecology model, physical activity interventions were carried out in three levels: personal, social-and physical environment. The interventions lasted for 6 months. Questionnaires, physical examinations and physical fitness tests were carried out. Rank sum test, chi-square test and logistic stepwise regression was used to analyze the intervention effects. Results: In the intervention group, the proportion of students who favored physical activity increased from 47.9% to 50.7%. Time spent in moderate to vigorous intensity physical activity (MVPA) increased from 64 min/d to 70 min/d, mainly during the weekend. The interventions showed significant effects, especially for girls. In the intervention group, the proportion of students spent 1 h/d in MVPA increased from 53.7% to 57.7%(χ2=4.95, P<0.05). Multivariate analysis showed that after intervention, the proportion of students spent more than 1 h/d in MVPA in the intervention group was higher than that in the control group (OR=1.22, 95%CI=1.02-1.48, P=0.03). Conclusion Physical activity interventions based on social ecology model can increase uptake of physical activity among school students.

Objective: To assess the changes of students’ hand washing behaviors after implementing comprehensive interventions, and to provide the reference for hand-washing promotion among students. Methods: The implementation of comprehensive intervention projects had been carried out in three aspects: hardware transformation, system establishment, health management and health education. A randomized controlled trial method was used to select each one primary and secondary school in 2016 from 17 districts in Shanghai, and 17 intervention schools and 17 control schools were taken as object. Non-participant observation was used for students’ hand washing behaviors for 4 times during May, 2016 to May, 2017. Descriptive analysis and chi square test were used to analyze the data. Results: Compared with the control group, the hand washing rate of the intervention group was lower than that of the control group at baseline. The intervention group has got a higher rate than that of the control group in the evaluation of 1, the assessment 2 and the assessment 3 after intervention. The difference was statistically significant(χ2=7.70, 24.23, 38.88, 21.71, P<0.05). Compared with the control group, the hand washing rate of the intervention group after class was lower than that of the control group. After the intervention, the rate of the intervention group was higher than that of the control group in the evaluation 1, the assessment 2 and the assessment 3 after the intervention. The difference was statistically significant (χ2=8.52, 33.79, 54.64, 13.99, P<0.05). Compared with the control group, there was no difference between the baseline intervention group and the control group before meals. The intervention group after intervention was higher than the control group in the evaluation of 1, evaluation 2 and evaluation 3. The difference was statistically significant (χ2=45.01, 42.19, 27.82, P<0.05). Conclusion After comprehensive intervention, the effect was significant under different temperature conditions, and the effect of intervention lasted for one year.

Objective: To understand the influencing factors and family burden of bicycle injury among middle school students in Shanghai for bicycle injury prevention. Methods: Based on 1∶2 matched case-control design, students who were injured when cycling were selected from Shanghai student injury case reporting system during Sept. 2017 to Dec. 2018 as the case group. The same-sex control was selected from the same grade in the same school with the case. A total of 61 cases and 122 control were selected. Self-reported questionnaires were conducted by parents of children. Univariate and multivariate logistic regression were used to analyze the influencing factors of bicycle injury. Results: Poor eyesight (OR=2.27, 95%CI=1.02-5.07), lots of intersections near the residence (OR=2.00, 95%CI=1.00-3.98), and lots of cyclists near the residence (OR=2.15, 95%CI=1.06-4.36) were positively correlated with bicycle injuries among middle school students. About 34.43% and 8.20% of parents reckon bicycle injuries had a moderate impact on family economic, daily activities and recreational activities. Among the students with bicycle injury, 70.49% of the students were absent from school because of illness, and 36.07% of their parents missed work because of illness. The average absence time for school and working were 10.79 days and 3.03 days respectively. The total economic loss caused by the lack of work was 84 950 yuan, with an average of 1 393 yuan. Conclusion Bicycle injury of middle school students in Shanghai causes certain family burden. Poor eyesight, lots of intersections near the residence, lots of cyclists near the residence are positively correlated with bicycle injuries among middle school students.

Objective: To analyze the trends of smoking and drinking behaviors among adolescents in Shanghai from 2004 to 2019, and to provide theoretical evidence for effective tobacco and alcohol interventions among adolescents. Methods: Data regarding smoking and drinking behaviors from adolescent health risk behavior surveillance program in Shanghai from 2004 to 2019 were collected, and the prevalence of ever smoking, current smoking, ever drinking and current drinking were comparatively analyzed. Results: The prevalence of ever smoking, current smoking, ever drinking and current drinking among boys were significantly higher than those among girls in 2004 to 2019( χ 2=58.20-347.44, P <0.01). Except the prevalence of ever drinking in 2012, the prevalence of ever smoking, current smoking, ever drinking and current drinking in vocational school students were the highest in each survey( χ 2=111.19-1 196.61, P <0.01). From 2004 to 2019, the standardized rates of smoking and drinking of boys and girls showed a downward trend ( APC =-6.20--1.80, P <0.05). The standardized ever smoking rate and the standardized ever drinking rate of both boys and girls declined significantly from 2004 to 2019（ APC=-5.00, -1.80, P ＜0.05）. The overall standardized rate of ever smoking decreased from 21.02% in 2004 to 12.23% in 2019, and that of ever drinking decreased from 60.52% in 2004 to 47.17 % in 2019）. However, the overall standardized rates of current smoking and current drinking did not reach statistically significance（ P >0.05）. Conclusion From 2014 to 2019,the prevalence of ever smoking and ever drinking among adolescents in Shanghai over the observed period showed a declining trend by years, but there was no significant change in current smoking and current drinking among adolescents. Specific interventions targeting on smoking and drinking behaviors among adolescents need to be strengthened.

Objective: To investigate the relationship between body fat percentage (BF%) and high blood pressure among adolescents in Shanghai, and to provide basis for early prevention and intervention of cardcovascular diseases. Methods: By using stratified cluster sampling method, a total of 5 148 adolescent students in 16 schools from 16 districts of Shanghai were selected. Questionnaire survey and physical examination were performed. The bioelectrical impedance analysis (BIA) was used to measure body fat percentage. National Blood Pressure Reference for Chinese Han Children was used to define high blood pressure. And T test, chi-square test and Logistici regression were used to assess the relation between BF% with high blood pressure. Results: The prevalence of high blood pressure in 5 148 junior middle school students in Shanghai was 10.98%, with girls (13.13%) higher than boys (8.99%)(χ 2=22.48, P<0.01). The average total body fat percentage of male students was (20.90±10.73)%, which decreased with age (linear trend variance is 10.04, P<0.01). The average total body fat percentage of girls was (25.14±8.03)%, which increased with age (linear trend variance is 69.23, P<0.01). After adjusted for age, diet, exercise and other influencing factors, the prevalence of hypertension showed an increasing trend with the increase of body fat percentage for both boys and girls. The risk of high blood pressure in boys with BF%≥P 90 was 12.43 times higher than that in boys with BF%

Conclusion There was a positive correlation between body fat percentage and high blood pressure in adolescents. The prevalence of high blood pressure increased with the increase of body fat percentage, which was more obvious in boys.

Objective: To analyze the trends of Internet addiction among adolescents in Shanghai, so as to provide theoretical evidence for the prevention and control of Internet addiction in adolescents. Methods: A multistage stratified cluster random sampling method was conducted, and 92 171 junior and senior high school students in Shanghai were selected for questionnaire survey in 2004-2019. Evaluation of Internet addiction, loneliness, academic pressure and depression among middle school students. Results: In 2004-2019, the rate of Internet addiction among middle school students in Shanghai was 4.3%, which without significant differences by year( t =1.8, P >0.05). The detection rate of Internet addiction in boys (5.3%) was higher than that in girls (3.4%) ( χ 2=186.8, P <0.01), and was highest in secondary vocational school (7.7%), followed by senior high school (4.6%) and junior middle school students (2.8%) ( χ 2=746.5, P <0.01). The prevalence of Internet addiction in girls, senior high school students, secondary vocational school students, students aged 16-20, students with loneliness or high academic pressure showed an increasing trend in 2004-2019, with the average annual increase rate ( APC ) of 6.62%, 5.45%, 2.13%, 3.36%, 4.09% and 3.60% respectively ( P <0.05). Conclusion Internet addiction among adolescents in Shanghai showed an increasing trend in some groups from 2004-2019, but without significant differences by year in the overall groups. Comprehensive prevention and control programs are needed for adolescent Internet addiction, especially for those with mental health problems.

Objective: To understand the status of teaching environmental health in primary and secondary schools and explore its association with myopia, so as to provide a basis for precision myopia prevention and control. Methods: From September to October 2020, a stratified cluster sampling method was used in 16 districts of Shanghai. After matching the teaching environment testing classrooms with the classrooms where the students were surveyed, totally 470 classrooms and 14 624 students were monitored. Trained professional technicians used laser range finder, luxmeter to measure parameters about teaching environmental health. Students were subject vision testing and questionnaires. Multilevel models was used to analyze the association between teaching environment and screening myopia. Results: The qualified rates of each indicators of teaching environmental health were as follows: window to floor area ratio (93.0%), classroom area per capita (82.1%), uniformity ratio of illuminance of blackboard ( 79.7% ), blackboard size (68.7%), daylight factor (67.0%), blackboard hanging height (66.9%), average illuminance on desk (66.4%), uniformity ratio of illuminance of desk (63.6%), reflectance of blackboard (46.8%), average illuminance on blackboard (41.4%), reflectance of wall (33.2%), desk and chair allocation compliance rate (19.8%). The results of two level Logistic model analysis showed that unqualified average illuminance on blackboard was positively associated with screening myopia ( OR =1.24, 95% CI = 1.05 -1.47, P <0.05). Conclusion Teaching environmental health of primary and secondary schools in Shanghai is not optimistic, teaching environment especially the desk and chair allocation compliance rate need to be improved. The average illumination on blackboard is positively correlated with screening myopia, suggesting that myopia prevention and control can focus on improving the illuminance on blackboard.