Objective To study the treatment of sponteneous rupture of hepatocellular carcinoma(SRHCC).Methods The clinical data of 64 patients with SRHCC treated by non-operation or operation were analysed retrospectively.Results The mean survival time of 14 patients treated by conservative therapy was 7 days(12 hours～12 days), the mean surival time of 31 patients treated by packing and 6 patients treated by ligation of hepatic artery was 11 days(4 hours-3 months)and 2.5 months(8 days-6 months);and the 1-month survival rate was 3.2% and 66.7% respectively.1 patient underwent transhepatic artery embolism surviving 9 days.The 1-year survival rate of 12 patients treated by hepatectomy was 66.7%;the mean survival time was 36 months(4 days-25 years and 3 months).Of the 12 patients,11 survived for over one and a half months whose liver function was Child-Pugh grade A before operation; 1 died of liver function failure 4 days after operation,whose liver function was Child-Pugh grade B before operation.Conclusions Emergent hepatectomy should be reserved for patients with an easily resectable lesion whose liver function is in Child-Pugh grade A.Early two-stage or delayed hepatectomy would be suitable for those patients who are unsuitable for emergent operation.Conservative therapy and other therapies may be used for patients with terminal stage of SRHCC.

Objective To study the prevalence of health risk behaviors among the junior high school students.Methods An anonymous questionnaire survey was conducted among a stratified sampling of 1 200 students from six junior high schools to study the health risk behaviors occurred during the last year.Results The leading risk behaviors were lacking sports exercises(47.92%),violating traffic regulation(31.58%),fleeing the home(4.08%),suicide(1.83%),addicted to drugs(0.75%).Conclusion Multiple health risk behaviors exist among junior high school students.We should develop effective measures to prevent these dangerous behaviors and improve students' health.

Objective: To investigate the associations between smoking and literacy on health among 4-6 grade primary school students. Methods: A questionnaire survey was conducted to research on health literacy and smoking among 4-6 grade pupils in Shandong province, through a multi-stage stratified cluster random sampling method. Sociodemographic characteristics, health literacy level and smoking rate were collected from respondents. Binary logistic regression analysis was used to evaluate the association of smoking and health literacy. Results: A total of 9 240 questionnaires were distributed, with the rate of valid response as 99.7%. The current smoking rate of the students was 2.6%, on higher in boys (3.1%) than in girls (2.0%). 60.8% of 4-6 grade students were found to have adequate health literacy level. Levels of literacy health in both boy and girl school students appeared 56.7% and 64.9%, respectively. Results indicated that health literacy in smokers (14.4%) was lower than that in non-smokers (62.0%). Results from the binary logistic regression analysis showed that the independent influencing factors would include grade, father’s education level, economic situation of the family, self-assessment on the school record and literacy on health (P<0.01). After controlling the other independent variables, the smoking rate was 8.62 (1/0.116) times in students with low literacy level on health, than those with high literacy level. Conclusions Literacy on health was significantly associated with smoking in the 4-6 grade pupils of Shandong province.

Objective To investigate the clinical significance of neutrophil-to-lymphocyte ratio (NLR)in assessing response to cardiac resynchronization therapy(CRT)in elderly patients.Methods Clinical data of 105 elderly patients with chronic heart failure(CHF)who had received CRT at our hospital from January 2006 to January 2017 were retrospectively analyzed,and patients were divided into a no-response group(n=42)and a response group(n=63)according to CRT outcomes after 6 months.General clinical data were compared between the two groups.Factors influencing response to CRT were analyzed by logistic regression model analysis.The receiver-operating characteristic(ROC)curve was used to assess the predictive value of NLR in response to CRT.Results Compared with the response group,the no-response group had increased baseline levels of initial QRS width,serum creatinine(Scr) and uric acid(UA)(P ＜0.05).There was no significant difference in left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter (LVESD),the New York Heart Association (NYHA) functional classification,neutrophil count,lymphocyte count and NLR between the two groups before CRT(P＞0.05).After 6 months of CRT,the LVEDD,NYHA functional class,neutrophil count and NLR were higher,and LVEF and lymphocyte count were lower in the no-response group than in the response group(P ＜0.05).The difference in NLR between 6 months after CRT and before CRT(△NLR)was higher in the no-response group than in the response group(P ＜0.05).Multi-factor Cox regression analysis showed that NLR (OR =1.895,95％CI:1.538～5.284,P =0.031)and △NLR(OR =2.579,95％CI:2.110～8.329,P =0.005) were independent risk factors for CRT (HR =1.590,95 ％ CI:1.215 ～ 2.146,P =0.013).ROC curve analysis showed that ROCAUC of △NLR in the no-response group was 0.891,95％CI:0.832～0.937,which was higher than that at 6 months after CRT(0.813,95 ％ CI:0.765～0.864)(Z=2.712,P＜0.05).Conclusions The increase in NLR after CRT may be an early sign for noresponse to CRT,and dynamic monitoring of NLR should be promoted to assess the prognosis of patients undergoing CRT.