Background Occupational stress is an important public health problem in the military. At present, there are few studies about occupational stress of officers and soldiers of the armed forces in China, especially the effects of plateau related environmental factors on occupational stress. Objective To understand current status and identify influencing factors of occupational stress among officers and soldiers stationed in plateaus, and provide a scientific basis for managing occupational stress. Methods In April 2023, stratified cluster sampling was used to recruit troops by deployed altitudes ranging from 500 to 3000 m into two strata of low altitude (＜2500 m) and high altitude (≥2500 m) based on the medical definition of plateau. Two regimental units were randomly selected from each stratum respectively, and one battalion unit was randomly selected from each regimental unit with all the officers and soldiers. Four selected battalion units were surveyed with a total of 2284 officers and soldiers. We designed a general questionnaire to collect their basic information, and distributed effort-reward imbalance questionnaires to evaluate occupational stress. We used logistic regression to identify potential influencing factors of occupational stress. Results Positive occupational stress was reported in 508 plateau-stationed officers and soldiers, with a prevalence rate of 22.2%. The total effort-reward imbalance score and the dimensional scores of effort, reward, and overcommitment in M (P₂₅, P₇₅) were 0.9 (0.7, 1.0), 16.0 (13.0, 19.0), 36.0 (33.0, 39.0), and 18.0 (15.0, 19.0), respectively. There were significant differences in the positive rate of occupational stress by gender, age, military service length, marital status, only child or not, physical fitness condition, reporting underlying diseases or not, exercise frequency before conscription, psychological changes after entering the plateaus, and having altitude sickness or not (P <0.05). The results of logistic regression showed that being female (OR=1.532, 95%CI: 1.061, 2.213), only child (OR=1.281, 95%CI: 1.038, 1.581), and with underlying diseases (OR=1.950, 95%CI: 1.340, 2.839) were associated with a higher risk of occupational stress. While setting 0 to <3 years of military service as the control group, the risk of occupational stress was higher in subgroups of 3 to 9 years (OR=1.380, 95%CI: 1.113, 1.710) and ≥9 years (OR=2.141, 95%CI: 1.461, 3.137). The participants reporting nervousness or fear (OR=1.728, 95%CI: 1.133, 2.635) and agitation or euphoria (OR=1.380, 95%CI: 1.113, 1.710) had a higher risk of reporting occupational stress than those with no psychological changes after entering the plateaus. Meanwhile, those who had regular exercise (OR=0.670, 95%CI: 0.492, 0.913) before enlistment, good physical fitness condition (OR=0.572, 95%CI: 0.426, 0.767) and excellent physical fitness condition (OR=0.502, 95%CI: 0.366, 0.688) had a lower risk of occupational stress. Conclusion Officers and soldiers in plateaus generally report a high rate of occupational stress. Female, military service length ≥3 years, being only child, with underlying diseases, nervousness/ fear or agitation/ euphoria after entering plateaus are risk factors for elevated occupational stress in this group; while good or excellent physical fitness condition and frequent exercise before enlistment are protective factors for occupational stress. Therefore, it is necessary to pay attention to the occupational stress problems in officers and soldiers stationed in plateaus and provide targeted intervention measures.

Objective:To study the clinical effects of modified surgical method with H-uvulopalatopharyngoplasty(H-UPPP)and traditional surgical method in the treatment of obstructive sleep apnea hypopnea syndrome(OSAHS)in children.Methods:The clini-cal data of 364 pediatric patients with OSAHS were retrospectively analyzed.The patients were divided into 2 groups and treated by low-temperature plasma knife radio frequency ablation for bilateral tonsil removal combined with H-UPPP(group A,n=204)and low-temperature plasma knife radio frequency ablation only(group B,n=160)respectively.The operative time,intraoperative bleed-ing,postoperative secondary bleeding,VAS of pain following operation,postoperative traumatic white film shedding time,OAH1,LSaO2,ESS scores and complications of the 2 groups were compared.Results:In group A the operative time,intraoperative bleed-ing,VAS,OAHI and ESS scores were lower than those in group B(P＜0.05),wile postoperative traumatic white film detachment time and LSaO2 were higher(P＜0.05).No statistically significant difference in terms of the number of cases of postoperative seconda-ry bleeding and complications was observed between the 2 groups(P＞0.05).Conclusion:The combination of low-temperature plas-ma radio frequency ablation and H-UPPP for the treatment of OSAHS may provide clear intraoperative view,and may improve the treatment effects.

Background Occupational stress has been shown to be an important factor affecting the mental health of workers. The role of affective commitment to the organization and overcommitment to work cannot be ignored. However, there is a lack of research on this topic in China. Objective To explore a potential mediating effect of affective commitment on how occupational stress affects the mental health of medical staff and a potential moderating effect of overcommitment on the mediating effect of affective commitment. Methods A total of 1372 health care workers in a tertiary Grade A hospital in Lanzhou City were selected as study subjects for a cross-sectional survey. The occupational stress, emotional commitment, and psychological distress of the subjects were evaluated by the Effort-Reward Imbalance Scale, Affective Commitment Scale, and Kessler 10 Scale. SPSS 26.0 was used for correlation analysis, mediation analysis, and moderated mediation analysis. Common method bias wasevaluated by Harman one-factor test. Results A total of 1372 questionnaires were distributed, of which 1277 valid questionnaires were returned, with a valid recovery rate of 93.08%. The mean occupational stress score was 1.14±0.23, the mean overcommitment score was 20.26±3.21, the mean affective commitment score was 20.25±3.34, and the mean psychological distress score was 26.26±7.90. The Spearman correlation analysis results showed that occupational stress among medical staff was positively correlated with overcommitment and psychological distress (r=0.153, 0.410, P＜0.01) and negatively correlated with affective commitment (r=−0.341, P＜0.01); overcommitment was negatively related to affective commitment and positively related to psychological distress (r=−0.107, 0.312, P＜0.01); affective commitment was negatively related to psychological distress (r=−0.464, P＜0.01). The positive effect of occupational stress on psychological distress of medical staff was significant (b=0.41, t=15.42, P<0.001); affective commitment presented a partial mediating effect on the relationship between occupational stress and psychological distress (effect value=0.13), accounting for 31.71% of the total effect; overcommitment moderated the process of occupational stress-affective commitment-psychological distress (P＜0.01). Conclusion Affective commitment of medical staff has a partial mediating effect on the relationship between occupational stress and psychological distress, and overcommitment plays a significant role in moderating the process of occupational stress-affective commitment-psychological distress.

Objective To evaluate the value of different surgical methods in the repair of huge chest wall defect after breast malignant tumor operation.Methods The clinical data of 22 patients with chest wall defect after chest operation were retrospectively analyzed.All patients received one-stage repair for the chest wall defect with different surgical methods.Of the patients,9 cases got repair with latissimus dorsi myocutaneous flap,4 cases received repairment with internal mammary perforator flap of contralateral breast,and the others received dermatoplasty.Results All the 22 cases were successfully repaired.Two cases of dermatoplasty got mild edema who was healed after acitive dressing change.No one got effusion,infection or necrosis.No recurrence or distant metastasis happened except one case of liver metastasis in the follow-up of 6 to 24 months.Conclusions Application of different surgical methods in repair for the chest wall defect can improve patients' life quality.It is easy,safe and effective.We should choose the most suitable surgical method according to individual situation.

Objective To investigate the survival status of people with disabilities in urban areas of Lanzhou, China and discuss the correlation of their quality of life to disability attitude and quality of care and support of disabled people. Methods From August to November, 2016, 606 persons with disability registered in Chengguan District of Lanzhou were selected by multistage stratified cluster sampling. They were investigated in home-based visit with World Health Organization Quality of Life-Disability Scale for physical disability, World Health Organization-Disability Attitude Scale and World Health Organization Quality of Care and Support Scale-Disability Scale. Results The quality of life scored in average of (40.76±14.79), and different with the demographic characteristics (P<0.05). Pearson's correlation analysis showed that the score in all fields of quality of life and the total score positively correlated with most dimensions of disability attitude score (r>0.080, P<0.05) and most dimensions score of quality of care and support (r>0.083, P<0.05).Conclusion It is important to strengthen the precise security system for people with disabilities, and strive to establish a full-cycle, all-round social support system for them.

Objective To study the safety and availability of extended resection,gland reconstruction and mammary gland lavage in treatment of mammary duct expansion.Methods 41 patients with duct expansion admitted from Mar.2012 to Jan.2015 were studied and they were randomly divided into two groups.15 patients in the control group received normal surgical treatment,and 26 patients in the observation group received extended resection,gland reconstruction and mammary gland lavage treatment.Results The operation time,intraoperatve blood loss,length of hospital stay and degree of satisfaction of the observation group were superior to those of the control group while the recurrence rate was lower than that of control group.The gland expanded resection reduced the recurrence rate,the shape of the breast was improved,and the continuous irrigation was the guarantee for the immediate formation of the gland.The three kinds of surgical procedures were organically combined and complement each other.Conclusion The surgical methord of extended resection,gland reconstruction and mammary gland lavage is worth of further exploring due to its advantages of easy to operate,good cosmetic effect and low recurrence rate.

Objective To evaluate intraoperative tracing of sentinel lymph nodes ( SLNs) by fluorescence imaging combined with carbon nanoparticles .Methods 112 breast cancer patients eligible for sentinel lymph node biopsy were randomly assigned to the combination group (56 cases)receiving indocyanine green (ICG)and carbon nanoparticles as the lymphatic mapping tracers and ICG alone group (56 cases).Intraoperative frozen sec-tion was performed , followed by conventional histopathology .Results In the combination group , subcutaneous lymphatic vessels were successfully visualized in 53 patients and the detection rate was 94.6%(53/56).The flu-orescence SLNs were successfully detected in 54 patients and the detection rate was 96.4%(54/56)in ICG alone group.In the combination group , SLNs were successfully identified in 54 patients by fluorescence and 52 patients by black dyed, and the SLNs detection rate was 100%(56/56).While in the ICG alone group, the SLNs were found in 52 patients and the detection rate was 92.9%(52/56)(χ2 =2.3, P>0.050).The average number of detected SLNs was 3.7 ±1.5 ( 205/56 ) in combination group vs 2.5 ±1.4 ( 130/52 ) in ICG alone group ( t =-3.5, P=0.001).17 metastatic SLNs were found in 10 patients in the combination group vs 12 metastatic SLNs in 9 patients in ICG alone group .Conclusion Combination of ICG and carbon nanoparticles for mapping sentinel lymph nodes in breast cancer patients can increase the number of SLNs detected and the detection rate , reducing the rate of misdiagnosis and false negative rate .

OBJECTIVETo explore an ideal surgical method for nipple hypertrophy correction.

METHODSFrom July 2008 to June 2011, 44 nipple reductions were performed for 22 women (44 sides) by using the modified Z-shaped incision technique. The incision consists of two circles, one quadrangle and one triangle located on the top, body and base of the nipple. The nipple's height was decreased and the nipple diameter and base area were reduced. Bilateral nipples were designed symmetrically.

RESULTS22 cases(44 sides) were treated with primary healing. The mean diameter of the nipple was reduced to (9.8 +/- 1.6) mm from (17.6 +/- 3.4) mm, the average height from (18.8 +/- 3.6) mm to (8.2 +/- 1.4) mm, with the patient supine. All the patients were followed up for 14 months to 4 years with satisfactory results. No nipple necrosis, infection and numb happened. 20 patients completed the self-designed survey scale 1 year after operation, of which 4 cases achieved normal lactation, and the remaining patients didn't have childbirth and breastfeeding yet.

CONCLUSIONSThe modified Z-shaped incision technique could reduce the height, diameter, and most importantly, reduce the basal shape of all types of hypertrophic nipple to create a desired new cylindrical nipple without affection of nipple sensation and function.

Adolescent ; Adult ; Female ; Humans ; Hypertrophy ; Mammaplasty ; methods ; Nipples ; pathology ; surgery ; Treatment Outcome ; Young Adult

Objective To explore the relationship between the four different molecular subtypes of locally advanced breast cancer(LABC) and the clinical effect of neoadjuvant chemotherapy containing docetaxel and anthracyclines on breast cancer. Methods The record of 68 patients with LABC who were treated with the therapeutic scheme was reviewed. Breast cancer molecules were diagnosed by core needle biopsy through IHC and were divided into four subtypes. After 3 to 5 courses of treatment, the relationship of molecular subtype and clinical effects was analyzed. Results Univariate analysis showed that absence of estrogen receptor (ER) expression and size of tumor (≤5cm) were predictive factors for clinical complete response (cCR) (P<0.05).Over expression of HER-2 and molecular subtypes were predictive for pathologic complete response (pCR) (P<0.05). pCR rate of HER2+/ER- subtype in this therapeutic scheme was, higher than that of other subtypes and pCR rate of Luminal A subtype was the lowest. Multivariate analysis showed that molecular subtypes cant be the predictive factors for this therapeutic scheme (P>0.05) and only HER-2 (P<0.05) was the independent variable in predicting pCR for this therapeutic scheme. Conclusion Molecular subtypes can not independently predict pCR for neoadjuvant chemotherapy regimen containing docetaxel and anthracyclines.

Objective To detect the expression of Cytokeratin 19 (CK19) and human mammaglobin (hMAM) mRNA in the peripheral blood of breast cancer patients dynamically and to evaluate its clinical significance.Methods The expression of CK19 and hMAM mRNA was evaluated by real-time fluorescent quantitative reverse transcriptase pelymerase chain reaction in the peripheral blood of 40 breast cancer patients and 10 healthy volunteers.Results The expression of CK19 and hMAM in the peripheral blood of 40 breast cancer patients were higher than healthy donors.The positive expression rate of CK19 and hMAM was descending tendency during treatment.The different staging expression rate had no differences between before treatment and during treatment,but after treatment the expression rate had remarkably differences (CK19:P=0.044;hMAM:P=0.005).If the expression of CK19 and hMAM was continual positive,the rate of recurrence and metastasis would be higher (P＜0.001).Coneluslons Real-time fluorescent quantitative RT-PCR may detect the expression of CK19 and hMAM in the peripheral blood of breast cancer patients,and it is a sensitive and specific technique.The resuits suggest a possible use of this approach for evaluating prognosis,monitoring recurrence.