Clinical application of subjective global assessment in Chinese patients with gastrointestinal cancer

AIM： To investigate the role of subjective global assessment （SGA） in nutritional assessment and outcome prediction of Chinese patients with gastrointestinal cancer. METHODS： A total of 751 patients diagnosed with gastrointestinal cancer between August 2004 and August 2006 were enrolled in this study. Within 72 h after admission, SGA, anthropometric parameters, and laboratory tests were used to assess the nutritional status of each patient. The outcome variables including hospital stay, complications, and in-hospital medical expenditure were also obtained.RESULTS： Based on the results of SGA, 389 （51.8%）, 332 （44.2%）, and 30 （4.0%） patients were classified into well nourished group （SGA-A）, mildly to moderately malnourished group （SGA-B）, and severely malnourished group （SGA-C）, respectively. The prevalence of malnutrition classified by SGA, triceps skinfold thickness （TSF）, mid-upper arm muscle circumference （MAMC）, albumin （ALB）, prealbumin （PA）, and body mass index （BMI） was 48.2%, 39.4%, 37.7%, 31.3%, 21.7%, and 9.6%, respectively. In addition, ANOVA tests revealed significant differences in body mass index （BMI）, TSF, PA, and ALB of patients in different SGA groups. The more severely malnourished the patient was, the lower the levels of BMI, TSF, PA, and ALB were （P 〈 0.05）. x^2 tests showed a significant difference in SGA classification between patients receiving different types of treatment （surgery vs chemotherapy/radiotherapy）. As the nutritional status classified by SGA deteriorated, the patients stayed longer in hospital and their medical expenditures increased significantly. Furthermore, multiple regression analysis showed that SGA and serum ALB could help predict the medical expenditures and hospital stay of patients undergoing surgery. The occurrence of complications increased in parallel with the increasing grade of SGA, and was the highest in the SGA-C group （23.3%） and the lowest in the SGA-A group （16.8%）. CONCLUSION： SGA is a reliable assessment too and helps to predict the hospital stay and medica expenditures of Chinese surgical gastrointestina cancer patients.

Relationship between Contraceptive Knowledge,Cognition and Behaviors among Vocational High School Students

Objective To study the relationship between contraceptive knowledge, cognition and behaviors among vocational high school students. Methods A cross-sectional survey was anonymously self-administrated by way of computer to all the 1st graders＇ among three vocational high schools in a district of Shanghai. Four cognition indicators, including perceived benefits, perceived barriers, perceived risks and self eJficacy were applied according to Health Belief Model. Results The percentage of respondents who reported ever sexual practices and contraceptives use at first sex was 7.01% and 56.64% respectively. Condom （58. 70%） and oral contraceptive pills （27.78%） were used by the majority. Main reasons for non-use were ＂shy to buy it＂ （26.53%） and ＂partner don＇t want to use any＂ （18.37%）. Proportion of respondents who ever had sex regarded withdrawal and rhythm as effective were 68.35% and 68.42% respectively. Proportion of respondents having sex knew ＂If a person was infected with STDs, he/she might not have noticeable symptoms＂ were 22.86%. Proportion of respondents who reported non-use of contraceptives at first sex considered that ＂infrequent intercourse could not cause a girl pregnant even she had experienced her menstruation＂ were 40.63%. Proportion of respondents who had ever used condom got full score of knowledge on ＂how to correctly use condom＂ were 23,26%. Perceived risks were poorest among four cognition indicators. High level of contraceptive knowledge was connected with high rate of contraceptives use at first sex, whereas high level contraceptive cognition was connected with high rate of contraceptive use both at first and recent sex. Conclusions It is important to provide youth-friendly services as well as message on contraceptives among vocational school students.

The Denver Tube Combined with Antiviral Drugs In the Treatment of HBV-related Cirrhosis with Refractory Ascites: A Report of Three Cases

Treatment of nucleos(t)ide antiviral drugs for decompensated HBV-related cirrhosis can significantly improve the prognosis. But those patients with refractory ascites possibly deteriorate due to the complications of ascites before any benefit from anti-viral drugs could be observed. Therefore, it is important to find a way to help the patients with HBV-related cirrhosis and refractory ascites to receive the full benefits from antiviral therapy. Peritoneovenous shunt(PVS) using Denver tube enables ascites to continuously bypass into systemic circulation, thereby reducing ascites and albumin input and improving quality of life. We report herein 3 cases of decompensated HBV-related cirrhosis with refractory ascites, PVS using Denver tube was combined with lamivudine for antiviral treatment before and after. Then, ascites was alleviated significantly or disapeared and viral responsed well. All patients achieved a satisfactory long-term survival from 6.7 to 14.7 years. It was suggested that the Denver shunt could be used as an adjuvant method to antiviral drugs for decompensated HBV-related cirrhosis with refractory ascites to help the patients reap the full benefits and maximize efficacy of antiviral treatment.

Lack of evolutionary convergence in multiple primary lung cancer suggests insufficient specificity of personalized therapy

Multiple primary lung cancer(MPLC)is an increasingly prevalent subtype of lung cancer.According to recent genomic studies,the different lesions of a single MPLC patient exhibit functional similarities that may reflect evolutionary convergence.We perform whole-exome sequencing for a unique cohort of MPLC patients with multiple samples from each lesion found.Using our own and other relevant public data,evolutionary tree reconstruction reveals that cancer driver gene mutations occurred at the early trunk,indicating evolutionary contingency rather than adaptive convergence.Additionally,tumors from the same MPLC patient are as genetically diverse as those from different patients,while within-tumor genetic heterogeneity is significantly lower.Furthermore,the aberrant molecular functions enriched in mutated genes for a sample show a strong overlap with other samples from the same tumor,but not with samples from other tumors or other patients.Overall,there is no evidence of adaptive convergence during the evolution of MPLC.Most importantly,the similar between-tumor diversity and between-patient diversity suggest that personalized therapies may not adequately account for the genetic diversity among different tumors in an MPLC patient.To fully exploit the strategic value of precision medicine,targeted therapies should be designed and delivered on a per-lesion basis.

Comparison of mini-percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy for treatment of impacted proximal ureteral stones greater than 15 mm

Background:The optimal treatment for large impacted proximal ureteral stones remains controversial.The aim of this study was to evaluate the efficacy,safety,and potential complications of mini-percutaneous nephrolithotomy(MPCNL)and retroperitoneal laparoscopic ureterolithotomy(RPLU)in the treatment of impacted proximal ureteral stones with size greater than 15 mm.Methods:A total of 268 patients with impacted proximal ureteral stones greater than 15 mm who received MPCNL or RPLU procedures were enrolled consecutively between January 2014 and January 2019.Data on surgical outcomes and complications were collected and analyzed.Results:Demographic and ureteral stone characteristics found between these two groups were not significantly different.The surgical success rate(139/142,97.9%vs.121/126,96.0%,P=0.595)and stone-free rate after 1 month(139/142,97.9%vs.119/126,94.4%,P=0.245)of RPLU group were marginally higher than that of the MPCNL group,but there was no significant difference.There was no significant difference in the drop of hemoglobin between the two groups(0.8±0.6 vs.0.4±0.2 g/dL,P=0.621).The mean operative time(68.2±12.5 vs.87.2±16.8 min,P=0.041),post-operative analgesics usage(2/121,1.7%vs.13/139,9.4%,P=0.017),length of hospital stay after surgery(2.2±0.6 vs.4.8±0.9 days,P<0.001),double J stent time(3.2±0.5 vs.3.9±0.8 days,P=0.027),time of catheterization(1.1±0.3 vs.3.5±0.5 days,P<0.001),and time of drainage tube(2.3±0.3 vs.4.6±0.6 days,P<0.001)of MPCNL group were significantly shorter than that of the RPLU group.The complication rate was similar between the two groups(20/121,16.5%vs.31/139,22.3%,P=0.242).Conclusions:MPCNL and RPLU have similar surgical success and stone clearance in treating impacted proximal ureteral stones greater than 15 mm,while patients undergoing MPCNL had a lower post-operative pain rate and a faster recovery.

Association of Sexual Intercourse with Psychological Suppression and Copying Modes for Vocational School Students

Objective To evaluate the association of sex behavior with sexual related psychological suppression and coping modes among students in three vocational schools in Shanghai. Methods A cross-sectional survey was conducted among 1 368 grade one students from three vocational schools in a district of Shanghai, with Computer Assisted Self- Interview （CASI）. The field work began in the April 2003 for a baseline survey, and completed in the December, 2003. Data on students＇ sexual intercourse, sexual related psychological suppression and psychological coping modes, and communication with parents were collected and analyzed. Binary logistic regression was used to adjust the potential confounding factors. Results After controlling for demographic factors, adolescents with middle or high scores of active psychological coping strategies on sexual related events were less likely to have sexual intercourse （ORadj=0.48, 95%CI=0.30-0. 77 and ORadj=0.49, 95%CI=0.30-0.83, respectively）, while association between psychological suppression on sex related events and sexual intercourse was not statistically significant （ORadj= 0.93, 95%CI=0.63-1.37）; sexual related psychological suppression and active coping modes were positively associated with adolescents＇ communicating with parents for 2-7 h/week about school things, but negatively associated with parents＇ open attitudes towards heterosexual contacts and talking sex related things with others. Conclusion Vocational school students with active psychological coping strategies on sexual related events were less likely to engage in sexual intercourse, so interventions focus on reducing unprotected sexual behaviors should target on psychological coping modes skills training.