Abstract Mental health education of adolescents has received lots attention,while complex systems in sport are of great significance for promoting mental health of primary and middle school students. By comprehensively analyzing relevant findings, the paper discusses the effects of complex systems in sport on mental health problems of primary and middle school students,especially depression,anxiety,sleep,cognition,and social ability,and explores possible strategies associated with complex systems in sport to promote mental health of primary and middle school students,aiming provide data for effective sports health education among school teachers.

Objective:To find out the occurrence of anxiety and depressive symptoms, and the major risk factors, and the participation rate, as well as the experience of medical personnel who are involved in the intervention.Methods:Since January 2018, a pilot intervention had been carried out on pregnant women registered in the antenatal clinic. The Generalized Anxiety Disorder Scale and the Patient Health Questionnaires were used as screening tools for anxiety and depression symptoms, and risk factors were screened too. Interventions were carried out on the psychological moderate and high risk women by obstetric medical staff and mental health personnel. A qualitative interview was conducted on the intervention providers.Results:A total of 9 488 pregnant women were included, and the positive rate of moderate anxiety symptoms was 3.0%, the positive rate of severe anxiety symptoms was 1.4%; the positive rate of moderate depression symptoms was 18.1%, and the positive rate of severe depressive symptoms was 5.2%; the comorbidity rate of anxiety and depression symptoms was 3.4%. The first three risk factors for pregnant women with anxiety symptoms were: once had premenstrual stress symptom, excessive fear of fetal growth, previous abnormal maternal history; the first three risk factors for pregnant women with depressive symptoms: once had premenstrual stress symptom, previous abnormal maternal history, this pregnancy was cherished; the first three risk factors for pregnant women with moderate and above anxiety combined with depression were: once had premenstrual stress symptom, excessive fear of fetal growth, and fear the delivery process is not successful. Among the psychological moderate risk pregnant women, 19.1% participated in the midwife joint counselor clinic, and 1.7% participated in the obstetrician joint psychological specialist nurse clinic, 2.2% of the pregnant women with high risk participated in the psychological multidisciplinary consultation, and 1.7% referred to the psychiatric department. From the interviews, providers believed that it was necessary to further strengthen the ability of psychological intervention capacity, and the psychological screening tools needed to be improved, and the problems sought by pregnant women involved in physical, psychological and social aspects, and the influence of pregnant women's treatment compliance included multiple factors.Conclusions:The psychological health care service during pregnancy was feasible, but the screening scales needed further examination. The mental health care ability of obstetric medical staff needed to be strengthened, and the compliance of pregnant women with mental health services needed to be improved.

Objective To investigate the immunization coverage of oral live attenuated rotavirus vaccines and its influencing factors among children under 5 years old in Jinshan District of Shanghai in order to provide references for optimizing vaccination management in this area. Methods A cross-sectional study was conducted in 6 community vaccination clinics randomly selected from 12 vaccination clinics in Jinshan District. In each selected clinic,145 children under 5 years old were continuously recruited. Information on immunization status,demographics of children,family socioeconomic status and parents′knowledge of vacci-nation were collected through questionnaire interview. Logistic regression was used to analyze factors influen-cing immunization status by using SPSS22.0. Results Among the 863 participating children, the immuni-zation coverage rate of oral live attenuated rotavirus vaccines was 61.07%. Multivariate analysis revealed that children having an urban registration status (OR=2.21),better family income (OR=1.47) and par-ents with high recognition of rotavirus diarrhea (OR=8.56) and stronger intention to following "doctor′s suggestions" (OR=1.96) were more likely to accept oral live attenuated rotavirus vaccines, while those from families with a medical professional were less likely to be vaccinated (OR=0.57). Conclusion The immunization coverage rate of oral live attenuated rotavirus vaccines among children in Jinshan District were influenced by various factors such as children′s household registration status, household income, parents′knowledge regarding vaccination and doctors′suggestions. Health education on immunization should be strengthened and tailor-made to improve the coverage of oral rotavirus vaccination.

Objective To compare the clinical effect of three-dimensional printing template technology with X-ray fluoroscopy in assisting surgery for sacroiliac screw placement. Methods A retrospective case-control study was conducted on 28 cases of sacroiliac complex injury from January 2015 to December 2016. The patients were divided into template group (13 cases) and fluoroscopy group (15 cases) according to whether the preoperative three-dimensional printing template was adopted. In template group, there were nine males and four females, with an average age of 46.7 years (range, 18-68 years). According to Tile typing, there were eight cases of type B (two type B1, three type B2, and three type B3) and five cases of type C (three type CI and two type C2). In fluoroscopy group, there were 11 males and four females, with an average age of 47.1 years (range, 18-65 years). According to Tile typing, there were 10 cases of type B (three type B1, four type B2, and three type B3) and five cases of type C (three type C 1 and two type C2). The screw numbers, time for single screw placement, and fluoroscopy frequency were recorded. The Matta criteria was used to evaluate fracture reduction quality, and Majeed score was used to evaluate pelvic fracture function at the last follow-up. Results All patients were followed up for 6-20 months [(10.4±0.6) months]. Fifteen screws were implanted in template group, and 17 in fluoroscopy group. The time for single screw placement was 25-38 minutes [(28 ±5.3) minutes] in template group and 45-70 minutes [(60.3 ±5.8) minutes] in fluoroscopy group (P ＜0.01). The fluoroscopy frequency was 2-5 times [(2.8 ±0.5) times] in template group and 11-23 times [(15.4 ±3.5) times] in fluoroscopy group. According to the Matta criteria, there were eight excellent cases, four good, one fair, with an excellent and good rate of 92％ in template group; there were seven excellent cases, six good, two fair, with an excellent and good rate of 87％ in fluoroscopy group (P＞0.05). According to Majeed score at the last follow up, there were eight excellent cases, three good, two fair, with an excellent and good rate of 85％ in template group; there were six excellent cases, six good, three fair, with an excellent and good rate of 80％ in fluoroscopy group (P＞0.05). Conclusions Compared with traditional surgery, three-dimensional printing template technology assisted surgery for sacroiliac screws placement presents advantages of less operation time and reduced fluoroscopy frequency. This technology improves the safety profile and should be further promoted in clinical applications.

Objective To analyze the related factors of femoral head necrosis after internal fixation operation of femoral neck fracture.Methods Clinical data of 524 patients with femoral neck fracture who underwent internal fixation surgery between January 2012 and January 2015 were retrospectively analyzed.Taking the femoral head necrosis as an observable indicator,the clinical data of postoperative femoral head necrosis and those other patients who were treated at the same period were compared.Whether the clinical factors (gender,age,surgical reduction type,fracture type,quality of reduction,post-injury operation time,loading time after operation,and whether to withdraw internal fixation) were in correlation with postoperative femoral head necrosis was analyzed by univariate analysis.Then the statistically significant indicators were integrated into logistic regression analysis to determine the related factors of femoral head necrosis.Results According to inclusion and exclusion criteria,the study group consisted of 212 cases,including 94 males and 118 females;the follow-up time was 2-5 years,and the average follow-up time was 3.6±1.6 years.There were 46 cases with femoral head necrosis and 166 cases without femoral head necrosis after operation.The rate of femoral head necrosis was 21.7％ (46/212).The femoral head necrosis group included 46 cases with 21 males and 25 females;20 cases below 60 years old and 26 cases above 60 years old;17 cases using open reduction and 29 cases using closed reduction;6 cases belong to type Ⅰ/Ⅱ and 40 cases belong to type Ⅲ/Ⅳ according to Garden classification;16 cases got satisfactory reduction while 30 cases with unsatisfactory reduction;30 cases below 48 h and 16 cases above 48 h on post-injury operation time;17 cases below 3 months and 29 cases above 3 months on post-operation loading time;22 cases with internal fixation removal and 24 cases without internal fixation removal.The femoral head without necrosis group included 166 cases with 73 males and 93 females;84 cases below 60 years old and 82 cases above 60 years old;69 cases using open reduction and 98 cases using closed reduction;120 cases belong to type Ⅰ/Ⅱ and 46 cases belong to type Ⅲ/Ⅳ according to Garden classification;160 cases got satisfactory reduction while 6 cases with unsatisfactory reduction;119 cases below 48 h and 47 cases above 48 h on post-injury operation time;70 cases below 3 months and 96 cases above 3 months on post-operation loading time;74 cases with internal fixation removal and 92 cases without internal fixation removal.Univariate x2 analysis suggested that fracture type and quality of reduction were associated with postoperative femoral head necrosis.Other clinical factors (gender,age,surgical reduction type,post-injury operation time,loading time after operation and whether to remove internal fixation or not) were not associated with postoperative femoral head necrosis.The multivariate Logistic regression analysis showed fracture type and quality of reduction were significantly related to postoperative femoral head necrosis.Conclusion Femoral head necrosis after internal fixation operation of femoral neck fracture is affected by many factors.The fracture type and quality of reduction are important factors affecting femoral head necrosis after internal fixation operation of femoral neck fracture.

Objective To explore the efficacy of proximal femur locking plate(PFLP) for the treatment of unstable femoral intertrochanteric fractures in elderly patients.Methods Data of 120 cases of patients with unstable femoral intertrochanteric fractures who were treated by PFLP were retrospectively analyzed.There were 56 males and 64 were females,aging from 62 to 78 year-old (average,69.4 year-old).85 cases were left hip,and 35 cases right hip.According to AO fracture classification,there were 12 cases of A2.2,23 A2.3,34 A3.1,29 A3.2,and 22 A3.3.According to Evans intertrochanteric fractures classification:there were 93 cases of type Ⅲ,19 type Ⅳ,and 8 type Ⅴ.Operation time,length of hospital stay,fracture healing time,postoperative complications and hip joint Harris scores were recorded.Results All patients were followed up for 8-14 months (average,12.4 months).Their operating time were 51-80 min (average,63.1 min);X-ray exposure were 8-15 times (average,11.6 times);intraoperative blood loss were 70-120 ml (average,92.7 ml);postoperative drainage volume were 50-100 ml (average,61.7 ml),and length of hospital stay were 7-14 d (average,10.2 days).The healing time ranged from 12 to 32 weeks (20.4 weeks average).14 cases had delayed union,and healing time was 8-10 months.In addition,4 cases had deep vein thrombosis (after thrombolysis therapy the vein was recanalized);2 had internal fixation broken,who were then treated with PFNA Ⅱ,and bone healed after 6 months;5 had hip varus,who were then treated via hip replacement,and no hip prosthesis fracture were found.No other complications occurred in the remaining patients.At the latest follow-up,according to Harris hip score:there were 38 cases with excellent results,71 good,9 fair,and 2 poor,and the rate of excellent and good was 90.8％ (109/120).Conclusion PFLP for the treatment of unstable femoral intertrochanteric fractures has advantages of less invasion,less complication,reliable fixation and high fracture healing rate,thus it is suitable for unstable intertrochanteric fractures in elderly patients.

Objective To investigate the advantage and application prospect of 3D printing technology in assisting surgery for complex tibial plateau fractures.Methods The complete clinical data of 41 patients (48 knees) were retrospectively analyzed.And these patients were divided into two groups as 3D printing assisted operation group and traditional operation group,according to whether 3D printing technology was applied.Study was carried out to compare the clinical efficacy of surgery assisted by 3D printing technology and traditional surgery in the treatment of complex tibial plateau fractures.The 3D printing assisted operation group included 18 patients (22 knees,12 males and 6 females),aging from 16 to 68 (mean age 45.5±7.2),and there were 12 cases of Schatzker Ⅴ and 10 Ⅵ.The traditional operation group included 23 patients (26 knees,15 males and 8 females),aging from 19 to 69 (mean age,46.2±6.8),and there were 14 cases of Schatzker Ⅴ and 12 Ⅵ.The operation time,intraoperative blood loss,the Rasmussen score and hospital for special surgery knee score (HSS) at 6 weeks post-operation were analyzed and the difference between the two groups was tested.Results All those patients were followed up for 7 to 20 months (mean 15 months).For 3D printing assisted operation group,the mean operation time was 81.4±6.3 min for Schatzker Ⅴ and 90.6± 15.4 min for Schatzker Ⅵ;the mean intraoperative blood loss was 200.4±72.3 ml for Schatzker Ⅴ and 280.6±101.6 ml for Schatzker Ⅵ;the result of 6-week Rasmussen score was 14 excellent,6 good and 2 fair (excellent and good rate 90.9％);the result of 6-week HSS score was 15 excellent,5 good and 2 fair (excellent and good rate 90.9％).Then for traditional operation group,the mean operation time was 100.4± 15.3 min for Schatzker Ⅴ and 111.5±20.2 min for Schatzker Ⅵ;the mean intraoperative blood loss was 450.4±173.3 ml for Schatzker Ⅴ and 500.5±247.2 ml for Schatzker Ⅵ;the result of 6-week Rasmussen score was 14 excellent,8 good,2 fair and 2 bad (excellent and good rate 84.6％);the result of 6-week HSS score was 13 excellent,8 good,2 fair and 3 bad (excellent and good rate 80.8％).The difference in operation time,intraoperative blood loss had statistical significance between the two groups;but the difference in 6-month post-operation Rasmussen score and HSS score had no statistical significance.Conclusion Compared with traditional surgery,3D printing technology assisted surgery for complex tibial plateau fracture possesses advantage such as shortened operation time,reduced intraoperative blood loss;but there's no evidence for improved knee function at 6 weeks post-operation.

Objective To evaluate the difference of tracheobronchial stenosis and airway malformation between double aortic arches and pulmonary artery sling in children. Methods Clinical feature and imaging data of spiral CT were retrospectively analyzed in children with double aortic arches or pulmonary artery sling who was hospitalized from July 2010 to July 2015 . Results There were 16 children ( 11 males and 5 females) with double aortic arches whose median age at onset was 3 . 5 months old. There were 47 children ( 28 males and 19 females) with pulmonary artery sling whose median age at onset was 4-month-old. In these 16 cases of double aortic arches, 14 cases were coupled with tracheobronchial stenosis. Two cases had more than one segment involved and they were segments II or III. Twelve cases had only one segment involved. Different degrees of tracheobronchial stenosis occurred in 47 cases of pulmonary artery sling, among whom 27 cases had more than one segment involved and the common segment was II and III ( 19 cases). Two cases had four segments involved and 20 cases had only one segment involved. There was statistical signiifcance in the number of involved segments between children with double aortic arches and pulmonary artery sling (χ2=13 . 588 , P=0 . 001 ). In 16 cases of double aortic arches, one case was combined with tracheal bronchus, and 1 case was combined with pulmonary hypoplasia. In 47 cases of pulmonary artery sling, 8 cases were combined with bridging bronchus, 3 cases combined with tracheal bronchus, 3 cases combined with pulmonary hypoplasia, 5 cases combined with bronchial deifciency or tracheal diverticula, and 2 cases combined with bronchopulmonary foregut malformation. There was statistical signiifcance in the number of cases combined with airway malformation between children with double aortic arches or pulmonary artery sling (χ2=5 . 333 , P=0 . 021 ). Conclusions The tracheobronchial stenosis and pulmonary airway abnormalities are more prominent in children with pulmonary artery sling than those in children with double aortic arch.

Objective To observe the influence of coal-burning type of fluorosis on hypothalamic-pituitaryovary axis function and to explore possible mechanism in female rats.Methods Sixty SD rats were divided into two groups according to body weight with the method of random number table:control group and fluorosis group,30 rats in each group.Fluorosis group was feed with corn powder baked by high fluorine coal from Zhijin area.Changes of female rats' teeth during fluorine exposure were observed.After feeding for 180 days,24 h urine was collected in estrus and fluorine level was tested using fluoride ion-selective electrode; rats were executed and bone fluorine level was tested with high-temperature ashing-fluorine ion-selective electrode.Femoral artery blood was collected and serum was separated to test the contents of follicle stimulating hormone (FSH),luteinizing hormone (LH),testosterone (T),estradiol (E2) and progesterone (P) with electrochemiluminescence radioimmunoassay and gonadotropin-releasing hormone (GnRH),inhibin (INH) with enzyme-linked immunosorbent assay (ELISA),respectively.Organs,including hypothalamus,pituitary gland and ovary were weighted,and organ coefficients were calculated.Pathological morphology of hypothalamus,pituitary gland and ovary was observed after staining and ultrastructure of ovary was examined by electron microscopy.Results Coal-burning induced fluorine poisoning rat model was established successfully.There were no significant differences statistically in organ coefficients between fluorosis groups (0.032 ± 0.004,0.014 ± 0.008,0.037 ± 0.009) and controls (0.035 ± 0.005,0.012 ± 0.006,0.035 ± 0.004,t =0.46,0.87,0.64,all P ＞ 0.05).Rats serum GnRH,FSH,LH and T levels [(21.654 ± 4.765),(29.580 ± 5.221),(53.988 ± 6.506),(23.962 ± 2.255)μg/L] of fluorosis groups were all higher than those of controls [(10.384 ±2.250),(19.217 ± 4.743),(30.314 ± 4.443),(7.883 ± 1.973)μg/L,t =6.762,4.646,9.503,16.971,all P ＜ 0.05].But the level of P,INH [(12.635 ± 3.841),(18.926 ± 3.465)μg/L] were all lower than those of controls [(21.045 ±4.768),(48.076 ± 3.525)μg/L,t =4.344,18.649,all P ＜ 0.05].Serum E2 levels of control group and fluorosis group were (35.375 ± 10.662) and (27.500 ± 12.783)μg/L,respectively.The difference between groups was not statistically significant (t =1.821,P ＞ 0.05).No pathological changes were observed in the two groups of female hypothalamus,pituitary tissue by light microscopy and electron microscopy.Under light microscope,in the control group of normal ovarian tissue,more corpus luteum and different developmental stages of follicles were seen,granulosa cells were neatly arranged in a monolayer or multilayer.In fluorosis group,severe edema of ovarian interstitial cells and follicle degeneration increased.Cell structure and cell contours were blurred and unclear with occasional mature follicles.Under transmission electron microscope,in control group,normal ovarian granulosa cell ultrastructure was observed,nuclei were round,nuclear chromatin was uniform distributed,cytoplasm was rich in mitochondria and endoplasmic reticulum,and normal morphology.In fluorosis group,granulosa cells and interstitial cells showed apoptotic characters,such as nucleoli disappearing,mitochondrial swelling and chromatin aggregating at the nuclear membrane.Conclusions Fluorosis can induce ovarian tissue apoptosis,severely damage the micro environment.Reduction of P and INH affects ovarian,maturation and ovulation and leads to secretion of GnRH,FSH and LH.Fluorosis caused by coal-burning may induce the injury of ovary and cause abnormal secretion of hypothalamic-pituitary-ovary axis.Fluorosis has affected parts of female axis which may not be in the hypothalamus,pituitary,but causes ovarian tissue damage.

Objective To observe the impact of coal-burning-borne fluorosis on the opening day of vagina,and estrogen cycle and endocrinology of female rat.Methods Ninety weaned two weeks and healthy female SD rats,weighing 60-80 g were selected,and divided into three groups by body weight using random number table:control group,moderate fluoride exposed group,and higher fluoride exposed group,thirty rates in each group.Rats in fluoride exposed groups were fed with baked corn collected from coal-burning-borne fluorosis areas containing different levels of fluorine(fluorine contents were 47.8 and 96.0 mg/kg,respectively) to establish coal-burning-borne fluorosis models.The corn fed to control group rats were collected from non-endemic areas (fluoride content was 5.2 mg/kg).After exposed to fluoride for 60,120 and 180 days,the rats were put to death during estrus in three batches (10 rats in every batche).The situation of female vaginal opening was observed and recorded every morning at 8:00 at the beginning of the experiment.Ten female rats in each group were randomly selected to observe vaginal exfoliated cells for 10 days continuously every morning,and HE staining was selected to discriminate estrogen cycle.Femoral artery blood was collected to observe the impact of estradiol(E2) in estrus.Results The vaginal opening day age of the longer fluoride exposed group [(49.0 ± 4.5)d] was longer than that of the control group[(45.4 ± 2.3)d] and the moderate fluoride exposed group[(46.7 ± 1.9)d,all P ＜ 0.05].Estrogen cycle of the longer fluoride exposed group[(5.8 ± 0.8)d] after fluoride exposure for 120 d was higher than that of the control group [(4.4 + 0.9)d] and the moderate fluoride exposed group [(4.9 ± 0.7)d,all P ＜ 0.05].Estrogen cycle increased with increasing dosage of fluoride after fluoride exposure for 180 d in three groups [control group:(4.3 ± 0.7)d,moderate fluoride exposed group:(5.4 ± 1.1)d,higher fluoride exposed group:(6.7 + 0.9)d,all P ＜ 0.05].Estrogen cycle in higher fluoride exposed group at 180 d[(6.7 ± 0.9)d] was higher than that of 60 d and 120 d[(5.2 ± 1.1),(5.8 ± 0.8)d,all P ＜ 0.05].At 60 d after exposed to fluoride,E2 levels of fluoride exposed groups were increased[control group:(30.125 ± 94.17)ng/L,moderate fluoride exposed group:(438.75 ± 71.80) ng/L],higher fluoride exposed group (456.25 ± 57.80)ng/L with increasing dosage of fluoride (all P ＜ 0.05).E2 level in rats exposed to fluoride for 180 d [(275.00 ± 127.83)ng/L] was lower than that of 60 d and 120 d [(456.25 ± 57.80),(392.50 ± 102.50)ng/L,all P ＜ 0.05] in higher fluoride exposed groups.Conclusions Coal-burning-borne fluorosis has a significant effect on vaginal opening day age,estrogen cycle and endocrinology of female rats.The higher the fluoride dose,and the longer the exposure time,the more severe the impact.