Objective: To explore the associations of family structure with adolescent mental health and health associated behaviors, to support interventions to decrease the occurrence of psychological problems and adverse health associated behaviors among adolescents in families without two parents. Methods: The multi stage stratified random cluster sampling method was used to select 18 700 adolescents of the 13 districts and cities from Jiangsu Province for a questionnaire survey on mental health and health associated behaviors, to compare differences in mental health and health associated behaviors among adolescents with different family structures. Results: Among the adolescents, 82.1% had two parent families, 8.6% had single mother families, 4.0% had single father families, and 5.3 % had families with both parents absent. After controlling for age, urban/rural areas, gender, academic period and region, Logistic multivariate regression analysis showed that compared with adolescents from two parent families, the incidence of depression, social anxiety and bullying on campus of adolescents with single mother families increased significantly( OR=1.31, 1.15, 1.36，P ＜0.05). Compared with adolescents in two parent families, adolescents in families without two parents had significantly more types of health risk behaviors, and those in single mother families had significantly less frequent intake of a healthful diet( OR =0.81), significantly more smoking( OR =1.20), drinking behaviors( OR =1.22), and significantly less moderate intensity physical activity ( OR =0.84) and shorter duration of sleep( OR =0.87)( P <0.05). Conclusion Psychological and health associated problems were significantly higher among adolescents in families without two parents than in those with two parent families. Psychological problems and adverse health associated behaviors were particularly prominent among adolescents in single mother families.

Objective: To investigate the incidence of juvenile myopia and associated factors in Nantong, to analyze the relationship between food intake and juvenile myopia, so as to provide a reference for preventing and controlling myopia of adolescents. Methods: Stratified cluster random sampling was used to select 13 schools in Nantong. A total of 3 437 students were selected for health monitoring and questionnaire survey, and the students sociodemographic characteristics and diet related information were collected. Results: The prevalence of myopia was 73.4%( n =2 522). The myopia rate of urban teenagers(74.1%) was higher than that in suburbs(72.4%), and the myopia rate of urban girls (78.2%)was higher than that of suburban girls(73.6%). Multivariate Logistic regression analysis showed that there was a significant positive correlation between the frequency of high energy food intake and myopia among urban adolescents ( OR =1.50, P <0.01). After adjusting for covariates, e.g. age, parental myopia, participation in extracurricular classes, outdoor inter class activities, the frequency of high energy food intake was significantly positively associated with myopia ( OR =1.29, P =0.03). Frequency of high energy food intake was significantly positively correlated with myopia of suburban adolescents ( OR =1.35, P =0.02). The association disappeared after adjusting for above ment ioned covariates ( P = 0.60 ). Conclusion There are differences in the main risk factors affecting the incidence of myopia between urban and suburban adolescents in Nantong. Parents, schools and the society should pay attention to adolescent myopia and high energy diet mode, pay attention to guide their reasonable eating habits, and prevent and control adolescent myopia from multiple angles.

Objective:To evaluate the 3-year survival outcomes and late injury between the self-designed patent single-channel applicator, which was modified from the traditional tandem applicator and wrapped with a oval-shield alloy around the source channel and standard Fletcher-type applicator in the high-dose-rate brachytherapy for cervical cancer.Methods:Patients initially diagnosed with cervical cancer in the Affiliated Hospital of Southwest Medical University from December 2011 to April 2017 were enrolled and randomly assigned into the external beam radiotherapy (EBRT)+ single-channel intracavitary applicator group (the patent single-channel group) and EBRT+ the Fletcher applicator group. The whole pelvis irradiation was delivered with 6-MV photons via a four-field box variant or anterior and posterior parallel fields. Five to six fractions of intracavitary brachytherapy were performed at a dose of 7 Gy at point A once a week after 30 Gy (Equivalent Dose in 2 Gy at point A: 80-90 Gy). Chemotherapy was given with intravenous injection of cisplatin at a dose of 40 mg/m 2 once weekly during EBRT. Clinical efficacy and safety were evaluated after corresponding treatment. Results:In total, 150 eligible cases were assigned into the Fletcher applicator group and 149 cases into the patent single-channel group. Up to December 2020, all patients had been followed up for 3 years, and the median duration of follow-up was 61 months. In the Fletcher group, the 3-year overall survival, progression-free survival and locoregional failure-free survival was 76.3%, 78.1% and 75.4%, and 83.8%, 80.3% and 85.5% in the single-channel group, respectively. In the Fletcher group, the cumulative rate of grade 3-4 late rectal complications was 3.3% and 6.7% in the single-channel group ( P=0.122). The cumulative rate of grade 3-4 bladder complications was 1.3% in the Fletcher group and 0.7% in the single-channel group ( P=1.000). Conclusion:The self-designed patent single-channel intracavitary applicator yields equivalent long-term clinical efficacy and safety to the standard Fletcher-type three-channel applicator in the HDR brachytherapy for uterine cervical cancer.

Objective:To explore the risk factors of acute kidney injury(AKI) in patients after radical nephrectomy.Methods:We retrospectively collected clinical information of 920 patients with renal cell carcinoma who underwent radical nephrectomy at Zhongshan Hospital, Fudan University from February 2013 to September 2017. There were 612 male and 308 female patients included in this study, with a median age of 60 (range from 20-75 years). 313 patients (34.0%) had hypertension, 132 patients (14.3%) had diabetes, and 111 patients (12.1%) had smoking history. 829 cases (90.1%) were in stage 1-2 for preoperative renal function staging, and 91 cases (9.9%) were in stage 3-5. Preoperative hemoglobin was lower than the lower limit of normal in 391 cases (42.5%), white blood cell count increased in 66 cases (7.2%), and platelet increased in 72 cases (7.8%). Albumin was lower than the lower limit of normal in 65 cases (7.1%), lactate dehydrogenase increased in 73 cases (7.9%). blood urea nitrogen increased in 48 cases (5.2%), uric acid increased in 123 cases (13.4%), and urinary protein was positive in 88 cases (9.7%). 496 cases (53.9%) underwent open surgery and 424 (46.1%) underwent laparoscopic surgery. The changes in serum creatinine were followed up within 48 hours after surgery. AKI was defined according to the KDIGO standard. Logistic regression was used to analyze the risk factors for postoperative stage 2-3 AKI in patients.Results:Stage 1-3 AKI occurred on 627, 42 and 10 patients during hospitalization, respectively. Univariate analysis showed that diabetes ( OR=2.34, P=0.01), positive urine protein ( OR=2.22, P=0.04), and elevated white blood cell count ( OR=2.54, P=0.02) were significantly associated with postoperative stage 2-3 AKI. Multivariate logistic regression analysis showed that diabetes ( OR=2.51, P=0.01) and elevated white blood cell count ( OR=2.69, P=0.02) were independent risk factors for postoperative stage 2-3 AKI. Conclusion:Renal cell carcinoma patients with diabetes or preoperative elevated white blood cell count are more likely to develop stage 2-3 AKI after radical nephrectomy.

Background and purpose:Perioperative anesthetic management is thought to be critical to the success of free flap breast reconstruction. The purpose of this study was to discuss intraoperative fluid, hemodynamic and temperature management in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction.Methods:From Jun. 2011 to Dec. 2015, 126 patients underwent DIEP lfap breast reconstruction. Postoperative complications were reviewed. Intraoperative fluid infusion rate was analyzed. Mean arterial blood pressure (MAP) and core temperature were measured before induction (T0), after lfap elevation but before lfap transfer (T1), 15 min after flap revascularization (T2), and at the end of surgery (T3).Results:Nine patients developed flap compromised: 7 were salvaged and 2 failed. The mean intraoperative lfuid infusion rate was (5.44±1.66) (mL?kg-1)/h. MAP at T0, T1, T2 and T3 were (87.45±8.90), (74.19±8.63), (74.60±8.71) and (79.62±7.88) mmHg, respectively. Core temperature at T0, T1, T2 and T3 were (36.69±0.14), (36.36±0.18), (36.27±0.14) and (36.21±0.15)℃, respectively. Conclusion:Standard practice focusing on intraoperative lfuid management, hemodynamic adjustment and temperature control in microsurgical reconstruction of the breast should be established to further improve free lfap outcome.

Antibodies, Monoclonal, Humanized ; therapeutic use ; Aptamers, Nucleotide ; therapeutic use ; Bevacizumab ; Humans ; Macular Edema ; drug therapy ; Ranibizumab ; Receptors, Vascular Endothelial Growth Factor ; therapeutic use ; Recombinant Fusion Proteins ; therapeutic use ; Retinal Vein Occlusion ; drug therapy ; Vascular Endothelial Growth Factor A ; antagonists & inhibitors ; Visual Acuity ; drug effects

OBJECTIVETo explore the current trends of breast reconstruction (BR) for breast cancer patients in China.

METHODSA questionnaire was designed for this study, and it included questions on surgeon demographics, number of mastectomy and BR, type and timing of BR, reconstructive choices in the setting of preoperative or postoperative radiotherapy or chemotherapy, etc. All data were collected until December 2012. Questionnaires were sent to 52 members of the Committee of Breast Cancer Society by e-mail or mail.

RESULTSBy July 2013, 41 questionnaires had been returned. Among all, 5 were excluded for not performing BR. These 36 hospitals covered 22 provinces and municipalities in China. A total of 538 surgeons working in the general surgery or oncological surgery department, but only 123 (22.9%) were qualified to perform BR. In 2012, except for 4 missing data, 24, 763 mastectomies were performed in 32 hospitals; among them, 1120 (4.5%) received BR. According to these 36 respondents, 32 (88.9%) performed prosthetic (1, 843 cases in all) while 4 (11.1%) performed prosthetic BR with acellular dermal matrix (17 cases in all) from the time of their first BR operation to the end of 2012. During the same period, 965 latissimus dorsi myocutaneous flaps with implant were performed in 23 (63.9%) hospitals while 738 latissimus dorsi myocutaneous flaps without implant were performed in 32 (88.9%) hospitals. At the same time, 366 pedicled transverse rectus abdominis myocutaneous flap BRs were performed in 28 (77.8%) hospitals, while 155 abdominal free flap BRs were carried out in 9 (25.0%) hospitals. The overall complication rate was 18.2%. Postoperative radiotherapy had some effect on influencing the esthetic outcomes of BR, so the autologous BR was recommended, but the timing remained controversial. Regarding chemotherapy, most respondents concluded that it had no effect or only a mild effect. The overall cosmetic outcomes of the reconstructed breasts satisfied the majority of physicians and patients.

CONCLUSIONSWith more attention paid to the quality of life after mastectomy, more and more BRs are needed, but the ratio is still low in China. To improve this situation, more efforts are needed, including the improvement of the intrahospital framework of multi-disciplinary service, the training for doctors and the educational program for patients, etc.

Breast Neoplasms ; epidemiology ; surgery ; China ; epidemiology ; Humans ; Mammaplasty ; Mastectomy ; trends ; Postoperative Complications ; Postoperative Period ; Quality of Life ; Reconstructive Surgical Procedures ; Surgical Flaps ; Surveys and Questionnaires

Animals ; Asian Continental Ancestry Group ; Chickens ; China ; epidemiology ; Cytokines ; metabolism ; Genetic Variation ; Genotype ; Humans ; Influenza A Virus, H7N9 Subtype ; classification ; genetics ; pathogenicity ; Influenza A Virus, H9N2 Subtype ; genetics ; Influenza in Birds ; transmission ; virology ; Influenza, Human ; ethnology ; transmission ; virology ; Mice, Inbred BALB C ; Molecular Sequence Data ; Orthomyxoviridae Infections ; metabolism ; mortality ; virology ; Phylogeny ; Seasons ; Survival Rate ; Virulence ; genetics

10.3969/j.issn.1000-3606.2013.06.019

Background and purpose:Along with the development of diagnosis and treatment technology, the disease free survival and overall survival of breast cancer have been extended. In order to improve the quality of life after mastectomy, more and more breast reconstructions were applied in breast cancer patients. We retrospectively reviewed 118 cases of free abdominal lfaps for breast reconstruction performed in Fudan University Shanghai Cancer Center. Clinical outcomes, reconstructive techniques and experiences are discussed. Methods:From November, 2006 to June, 2013, we used free abdominal lfaps to perform 118 cases of breast reconstruction on 117 female patients after mastectomy. We observed the surgery, complications and safety of this technic. Results:We performed 118 cases of lfaps based on deep inferior epigastric vessels. The average operation time was 7.72 h. The average time of ischemia was 78.74min. The average anastomosis time was 60.83min. The average number of perforators included in the lfap was 3. The internal thoracic vessels were preferred recipient vessels. Ten cases of vessel crisis occurred and 6 of them were venous thrombosis and 4 cases were venous kink. Seven of them were salvaged, and the other 3 failed, the success rate was 97.46%. Postoperative infection rate was 7.00%. Abdominal bulge occurred in 3.50%of patients. None of the patients developed abdominal hernia. The median interval between surgery and the ifrst cycle of adjuvant chemotherapy was 19 days. The median follow-up time was 12 months. One case of distant metastasis, but no local recurrence was observed. Conclusion: Although free abdominal flap breast reconstruction requires complicated microsurgical techniques, and the learning curve does exist, free abdominal lfap breast reconstruction has a high success rate with oncological safety and few complications.