Objective To identify the effect of health risk behaviors on accidental injury of adoles-cents.Then analyze the strength and approach of the health risk behaviors. Methods Cluster sampling on various stages and strata methods was adopted. The adolescents from grade one to three in junior school students and grade one to three in senior high school students completed the questionaire. A total of 4408 students were surveyed and 4309 samples were valid. Path analysis was used to understand how factors could influence injury incidence. Results The incidence of adolescent injury was 15.53%. Statistical differences were found between genders (male 17.77%,female 13.36%,χ2=15.91, P<0.01),education levels (junior high school 17.36%,senior high school 13.99%,χ2=11.45, P<0.01) and cities ( Beijing 12.97%,Zhongs-han 17.95%,χ2=20.33, P<0.01) . Those who got injured were found with more health risk behaviors. Health risk behavior was the direct influencing factor to injury,as well as a possible risk factor to multiple injuries. Conclusion Health risk behaviors can strongly affect adolescent injury,and can be an indicator. Reducing health risk behaviors is important in adolescent injury prevention.

ObjectiveTo compare the efficacy and safety of oxaliplatin combined with tegafur and calcium folinate with FOLFOX4 regimens on patients with advanced gastric cancer.Methods120 patients with advanced gastric cancer were randomly divided into two groups. concluding 60 cases in observation group (modified group)treated with oxaliplatin combined with tegafur and leucovorin and 60 cases in control group (FOLFOX4 group)treated with oxaliplatin combined with calcium folinate and fluorouracil.Clinical efficacy was evaluated after 2 (3-6) cycles. ResultsThe clinical efficacy rates of observation group and control group were 63.3 ％ (38/60) and 41.7 ％ (25/60), respectively (x2 =5.647, P =0.028). The median progression-free survival and median overall survival of patients in observation group were 7.7 months and 11.6 months,respectively,and those in control group were 7.3 months and 10.1 months,respectively.The median progression-free survival(P =0.032)and median overall survival(P =0.005)were statistically significant differences.The increased ratio of Karnofsky score of patients in observation group was higher than that in control group(P =0.015).The incidence of myelosuppression in observation group was lower than that in control group (P =0.044). There was no significant difference between the two groups on other adverse reaction rates. ConclusionThe efficacy and safety of oxaliplatin plus tegafur and leucovorin in the treatment of advanced gastric cancer is superior to FOLFOX4 regimen, and worthy of clinical application.

Objective: To explore the related factors and working way of adolescent injury,and to provide a basis for the effective prevention and intervention of adolescent injury. Methods: The framework of the questionnaire in this study was developed based on the Social Ecology Model. A cross-sectional survey was conducted on a valid sample of 4 309 students from 8 junior high schools and 8 senior high schools in Beijing and Zhongshan city respectively, using stratified random cluster sampling method. Students from grade 7 to grade 12 were invited to participate and investigated with injury prevalence. Results: The incidence of adolescent injury by person and by person-time was 15.53% and 22.49% respectively, and there were differences by sex, age and regions(χ2=15.92，11.45，20.33，P<0.05). The occurrence of adolescent injury was affected by adolescent psychological behavior and social environment through different underlying pathways. The intrapersonal factors and perception of environmental safety showed direct effects on the adolescents’ injuries (effect size was 0.29 and 0.05 respectively, P<0.05). Conclusion Adolescent injury is associated with diverse factors and pathways in a synergistic and complex manner, suggesting that a three-dimensional and diverse strategy should be taken to intervene the injures.

Objective: To explore the prevalence and characteristics of traditional bullying and cyberbullying behavior among primary and middle school students and to provide evidence for the comprehensive intervention. Methods: An anonymous self-administrated questionnaire survey was conducted among 12 417 students (grade 5 to 12) selected with multi-stage cluster random sampling in 16 districts in Beijing between Sept. and Oct. 2017. Descriptive statistics and chi square test were used for statistical analysis. Results: In the past 6 months, 2.6% of students were reported to be involved in traditional bullying,10.6% were reported of being bullied. 1.0% of students were reported to be involved in cyberbullying, and 2.8% reported of being bullied. Boys reported significantly higher rates of traditional bullying and cyberbullying behavior. The reporting rate of traditional bullying and cyberbullying gradually increased with grade. The reporting rate of traditional bullying was highest in junior high school, while cyberbullying was common in both junior and senior high school. Students with low academic performance were more likely to involve in bully as perpetrators in both types(P<0.05). The higher maternal education background was, the higher their children involved in bullying perpetrators(P=0.03). The proportion of students who reported bullied at school was higher than cyberbullying(χ2=15.25, P<0.01). Cyberbullying were more likely to take place outside school compared with traditional bullying(χ2=3.98, 9.76, P<0.05). Compared with traditional bullying, cyberbullying has a higher proportion of various types of bullying or being bullied. Conclusion Bullying is still prevalent among primary and middle school students in Beijing, and cyberbullying is becoming more widespread. Schools, family and the community-based comprehensive prevention strategies should be developed for a safe campus and network environment to prevent traditional and cyberbullying.

Objective To determine the trend of emergency department (ED)mortality of a tertiary general hospital from 2004 to 2014 in order to find the factors that may impact on ED mortality.Methods Mortality in ED was estimated according to the ratio of ED visiting patients to ED deaths.And the data of all ED deaths in 2004,2009 and 2014 were collected.Variance analysis and chi-square test were used for data analysis.Results During the past decade,ED visiting patients was increased significantly by 38.0% in 2014,compared with those in 2004,and the mortality was also increased accordingly from 0.7% in 2004, to 0.9% in 2009,to 1.2% in 2014 (P <0.01).Finally,a total of 1,091 deaths occurred in these three years were included for further evaluation.There were no significant changes in average age and gender distribution,and the average age was 61.9 and the male /female ratio was 1.36∶1 during past decade.The number of adults under 40 years old (18 -39)increased from 7.5% in 2004,to 10.6% in 2009,to 14.4% in 2014 (P <0.05).Both the facilities were upgraded and the number of staffs in ED increased markedly.The cardiovascular illness,cerebrovascular diseases,and sudden death were the leading causes of ED death during past decade.The incidences of trauma and tumor remained unchanged.Average time consumed from onset of illness to arrival to ED didn’t vary significantly during past decade.The study showed no changes in use of ambulance,but remarkable increases in number of non-compliant patients or their family from 18.3% in 2004,to 25.6% in 2009,to 38.3% in 2014 (P <0.01).The percentage of patients in the night time was higher,but there were no significant changes in number of emergency patients in the night time and during holidays in the past decade,but the mean ED stay time increased obviously from 22.4 h in 2004 to 53.3 h in 2014 (P <0.05 ).Conclusions During the past decade,although ED facilities and number of staffs have been improved apparently,ED mortality rate still keeps on escalating. The increase in ED mortality rate may be related to the severely ill patients presenting to ED,the obvious decrease in compliance of patients and the prolonged ED stay time.

Objective:To analyze and summarize the clinical features, diagnosis and treatment of primary malignant melanoma of the lung (PMML).Methods:To report a confirmed case. And searched the keywords " malignant melanoma, primary, lung" from the databases of CNKI, Weipu, Wanfang and PubMed, then reviewed the relevant literature.Results:A 65-year-old male admitted to the First Affiliated Hospital of Zhengzhou University with the complaint of frequent coughs with bloody sputum for 2 months. Computed tomography (CT) showed a large space-occupying lesion in the upper lobe of the right lung and to be a hyper metabolic tumor by positron emission tomography-CT. The pathological biopsy of the mass confirmed a malignant tumor cell, immunohistochemical results showed S-100(+ ), SOX-10(+ ), HMB45(+ ), MelanA(-), AE1/AE3(-), CK5/6(-), Ki-67(40%). The patient died after 3 months of diagnosis because of refusing any further therapy. There were 36 papers searched from mentioned databases reported 41 Chinese patients with PMML. And we analyzed the clinical data of 42 cases (include the present case) and discussed the diagnosis and treatment while referring to the existing literatures.Conclusions:PMML is extremely rare, and difficult to differentiate from lung cancer, A diagnosis of PMML is based on the combination of clinical, imaging characteristics and pathological outcomes. The choice of treatment is an aggressive surgical approach, combined with radiation therapy and chemotherapy. Because of high degree of malignancy, powerful capacity for invasiveness and recurrence, the overall prognosis is poor.

IgA nephropathy (IgAN) is one of the common primary glomerulonephritis, which is also an important risk factor for end-stage renal disease. Kidney transplantation is the optimal treatment for end-stage renal disease induced by IgAN, whereas there is still a risk of recurrence of IgAN after kidney transplantation. At present, research progress upon IgAN recurrence after kidney transplantation is relatively lacking. The pathogenesis of IgAN recurrence remains elusive, and its pathological manifestations are not specific. The diagnosis of IgAN recurrence still depends on renal biopsy. Besides, no effective prevention and treatment are available for recurrent IgAN. In this article, research progress on IgAN recurrence after kidney transplantation was illustrated from the perspectives of pathogenesis, diagnosis, risk factors and treatment, aiming to provide reference for clinical prevention and treatment of IgAN recurrence after kidney transplantation and improve clinical prognosis of kidney transplant recipients.

Objective To evaluate the changes in the expression of c-fos protein in the spinal cord in a rat model of oxycodone dependence or withdrawal response.Methods Thirty SPF adult male Sprague-Dawley rats,aged 6-8 weeks,weighing 180-220 g,were divided into 3 groups (n=10 each) using a random number table method:normal saline group (group NS),oxycodone dependence group (group OD),and oxycodone withdrawal group (group OW).In OD and OW groups,oxycodone was injected subcutaneously in back,5 days in total,with the dose of 2,3,4,5 and 6 mg/kg in turn,3 times a day (8:00/15:00/22:00).The equal volume of normal saline was given instead in group NS.The mechanical paw withdrawal threshold was measured at 3 days before administration and 30 min after the last administration every day.The oxycodone withdrawal was induced by intraperitoneal injection of naloxone 4 mg/kg at 8 h after the last administration of oxycodone on 5th day in group OW.The withdrawal response scores and range of weight changes were recorded within 15 min after giving naloxone or normal saline in NS and OW groups.Spinal cord tissues were collected at 1 h after the last administration on 5th day in group OD and at 1 h after giving normal saline or naloxone on 5th day in NS and OW groups for determination of the expression of c-fos protein by Western blot.Results Compared with group NS,the mechanical paw withdrawal threshold was significantly increased on 1 and 2 days after administration,and the expression of c-fos protein in the spinal cord was up-regulated in OD and OW groups,and withdrawal response scores were significantly increased,and the range of weight change was increased in group OW (P＜0.05).The expression of c-fos protein was significantly down-regulated in group OW as compared with group OD (P＜0.05).Conclusion Oxycodone dependence or withdrawal response may be related to the expression of c-fos protein in the spinal cord of rats,and the expression is up-regulated during oxycodone dependence,while down-regulated during oxycodone withdrawal.

Objective To evaluate the minimally invasive treatment of calcaneal fractures of Sanders Ⅱ &Ⅲ by closed reduction or a sacral sinus arc-shaped minimally invasive incision under subtalar arthroscopy assisted by a self-designed cervical retractor and a self-designed reducer to expose and assist the reduction followed by internal fixation with hollow nails and Kirschner wires.Methods From June 2016 to February 2018,53 patients (60 feet) were treated at Department of Hand and Foot Surgery,Central Hospital of Linyi for closed intra-articular calcaneal fractures.Of them,24 (28 feet) received the minimally invasive treatment and 29 (32 feet) open surgery via the conventional lateral L-shaped incision.The 2 groups were compared in terms of B(o)hler angle,Gissane angle,and the width,length and height of the calcaneus before operation,one week after operation and at the final follow-up,as well as in terms of preoperative preparation time,operation time,surgical bleeding volume,incision complications,subtalar joint stiffness,and anklehindfoot score of the American Foot and Ankle Surgery Association (AOFAS).Results The 2 groups were comparable because there were no significant differences between them in the preoperative general data (P ＞ 0.05).All the patients were followed up for 10 to 22 months (average,16 months).The B(o)hler angles,Gissane angles,and the widths,lengths and heights of the calcaneus after operation and at the final follow-up were significantly better than the preoperative values in the minimally invasive group (all P ＜ 0.05).The preoperative preparation time (2.5 d ± 1.2 d) and operation time (62.6 min ± 6.3 min) in the minimally invasive group were significantly shorter than those (7.6 d ± 3.5 d and 85.9 min ± 9.7 min) in the conventional group (P ＜ 0.05),the surgical bleeding volume in the former (30.5 mL ± 3.8 mL) was significantly smaller than that in the latter (80.9 mL ± 8.3 mL) (P ＜ 0.05),and the rates of incision complications (0) and subtalar joint stiffness (10.7％) in the former were significantly lower than in the latter (9.4％ and 43.7％) (P ＜ 0.05).However,there was no significant difference between the 2 groups in the AOFAS anlle-hindfoot score (92.8 ± 5.9 versus 89.5 ± 7.5) (P ＞ 0.05).Conclusion The minimally invasive treatment of calcaneal fractures of Sanders Ⅱ & Ⅲ by closed reduction or a sacral sinus arc-shaped minimally invasive incision under subtalar arthroscopy assisted by a self-designed cervical retractor and a self-designed reducer to expose and assist the reduction followed by internal fixation with hollow nails and Kirschner wires can lead to satisfactory clinical results,because this method shortens significantly the time for hospitalization and leads to less invasion,fewer complications,accurate reposition and reliable fixation.

Objective To understand the prevalence of deliberate self-harm in middle school students in Beijing,and explore the relationship between self-harm and suicidal behaviors.Methods An anonymous self-administered questionnaire survey was conducted among 5 807 students selected through cluster random sampling from grade 9 to grade 12 in 16 middle schools in Beijing.Results Among the surveyed middle school students,35.6％ reported that they once had self-harm behaviors,7.0％ reported often had self-harm behaviors in the past 30 days before the survey.More girls reported self-harm behaviors than boys did.And the prevalence of self-harm behaviors was highest in girls in grade 8 and in boys in grade 9.The students in key senior high schools,or living with single or remarried parents were the risk population to have self-harm behaviors.Higher suicide behavior reporting rate was correlated with higher self-harm behavior reporting rate.Compared with students who reported no self-harm behaviors during the past month,the suicide behavior reporting rate in students reporting self-harm behaviors increased by 5.7-12.3 times.Conclusion Deliberate self-harm behaviors were associated with suicide behaviors among middle school students in Beijing.Early psychological intervention and life education should be carried out among middle school students in order to find risk population and save their life.