[Choice of immediate breast reconstructive methods after modified radical mastectomy].

OBJECTIVE: To investigate the choice of immediate breast reconstructive methods and asso-ciated outcomes after modified radical mastectomy. METHODS: Retrospective analysis of patients undergoing immediate breast reconstruction after modified radical mastectomy in Peking University Third Hospital from January 2009 to May 2019. The reconstructive methods were summarized, and the clinical outcomes and the safety of immediate breast reconstruction were evaluated. RESULTS: One hundred and twenty-three patients were enrolled in this study. Different reconstructive methods were applied according to the clinical stage, the amount of skin removal, the size of contralateral breasts, the physical condition and the preference of the patients. Seventy-nine cases were performed with tissue expander/implant two-stage reconstruction, twenty-three cases received direct breast implant insertion, seven cases were applied for latissimus dorsi (LD) myocutaneous flap transfer combined with implant insertion, five cases were provided transverse rectus abdominis myocutaneous (TRAM) flap transfer, six cases underwent tissue expander/implant combined with endoscopic LD muscle flap transfer, and three cases chose tissue expander/deep inferior epigastric artery perforator (DIEP) flap transfer. The average follow-up time was (12.3±9.0) months (3.5-41.0 months). One patient with direct implant insertion had partial blood supply distur-bance of the mastectomy flap. One case had necrosis of distal end of TRAM zone Ⅳ. One patient with expander/DIEP reconstruction had partial fat liquefaction. And two cases had expander leakage at the end of the expansion period. The tumor local recurrence occurred in one patient, and the implant was finally removed. The outcomes were evaluated by Harris method, and 90.2% patients were good or above in shape evaluation. Among the patients with implant based reconstruction, there was no obvious capsular contracture, and most of the implants had good or fair mobility. CONCLUSION: It is safe and feasible of immediate breast reconstruction after modified radical mastectomy for appropriate cases. The reconstructive methods can be individualized according to the individual's different conditions. The appropriate reconstructive methods could achieve satisfactory results.

[Techniques enhancement for tissue expander/implant two-stage breast reconstruction].

OBJECTIVE: To investigate the outcomes of breast reconstruction with employing improved techniques throughout the tissue expander/implant two-stage breast reconstructed process, which involved the tissue expander placement, the saline filling intraoperatively and postoperatively, the implant selection, and the permanent implant replacement. METHODS: In this study, 68 patients who had been provided immediate or delayed tissue expander/implant two-stage breast reconstruction with autologous fat injection post-mastectomy in Peking University Third Hospital from April 2014 to September 2018 were involved, and the relevant information was analyzed retrospectively. The enhancements of the techniques, involving the incision selection, the expander placement, the principle of expansion, the management of capsule, the prosthesis selection, and the assisted reconstruction method were summarized, and the reconstruction outcomes were evaluated objectively through three-dimensional surface imaging. RESULTS: Among the 68 patients in this study, immediate reconstruction was conducted in 25 patients and 43 patients underwent delayed reconstruction. The median time of tissue expansion was 7.0 (3.0, 20.0) months, and the average volume of expansion was (372.8±87.2) mL. The median size of breast implant was 215 (100, 395) mL. The median number of injections for fat grafting was 1 (1, 3), and the average volume of fat grafting was (119.3±34.1) mL. The median follow-up time was 7.0 (4.0, 24.0) months. During the process of breast reconstruction, the tissue expander leakage was observed in two patients, and one of them underwent expander replacement due to the secondary infection. In the immediate reconstruction cases, the volume symmetry of bilateral breasts after reconstruction got even better than that before mastectomy (t=4.465, P<0.01). And in the delayed reconstruction cases, the volume between bilateral breasts also achieved good symmetry after reconstruction (t=0.867, P>0.1). CONCLUSION: Good results of tissue expander/implant two-stage breast reconstruction could be achieved through the techniques enhancement, which involved the preferred transverse incision, the downward placement of expander, the rapid expansion of chest soft tissue, the release of capsule tension, the application of sizer in prosthesis selection, and the assisted autologous fat grafting.

[Trends of prevalence of excellent health status and physical fitness among Chinese Han students aged 13 to 18 years from 1985 to 2014].

OBJECTIVE: To analyze the trends of prevalence of excellent health status and physical fitness among Chinese Han students aged 13 to 18 years from 1985 to 2014. METHODS: In the study, 738 523 students aged 13 to 18 years were extracted from the 1985 to 2014 Chinese National Survey on Students' Constitution and Health. Height, weight, vital capacity and indicators of physical fitness were measured for each student. According to National Standards for Students' Physical Health (2014 Revision), students meeting an overall score ≥ 90.0 were considered to be of excellent health status and physical fitness. We used the Chi-square test to compare the differences in prevalence of excellent health status and physical fitness among different subgroups and draw maps of regional distribution of prevalence by using ArcGIS. RESULTS: From 1985 to 2014, the average height, weight, and BMI for Chinese Han students aged 13 to 18 years increased consistently, while the average vital capacity and indicators of physical fitness fluctuated largely. The overall prevalence of excellent health status and physical fitness increased from 2.7% in 1985 to 4.4% in 1995, dropped consistently to 1.1% in 2005, rebounded 0.6 percentage points in 2010, and increased to 2.2% in 2014. In each survey year, the prevalence for the boys was always higher than for the girls (P<0.001), the prevalence for middle school students aged 13 to 15 years was always higher than for high school students aged 16-18 years (P<0.001), and the prevalence for students in eastern region was higher than in western and central regions (P<0.001). In 1985 and 1995, the prevalence in certain provinces in eastern and central regions was <1%. In 2005, almost half provinces (14/30) had a prevalence <1%. In 2014, provinces in eastern coastal areas had relatively high prevalence of excellent health status and physical fitness in students aged 13 to 18 years, while provinces in central and western regions had relatively low prevalence. CONCLUSION: A fluctuating trend of the prevalence of excellent health status and physical fitness has been observed among Chinese Han students aged 13 to 18 years during the past three decades. There is great difference between the current prevalence of excellent health status and physical fitness and the goal of Outline of the Healthy China 2030 Plan, thus, the effective interventions and strategies for promoting students' physical activity and physical fitness are urgently needed in China.

[The status of spermarche, menarche and corresponding relationships with nutritional status among students of 13 ethnic minorities in Southwest China in 2014].

Objective: To describe the current situation of spermarche/menarche of 13 ethnic minority groups in China in 2014, and analyze the association between spermarche/menarche and nutritional status among ethnic minority groups. Methods: The sample of 13 ethnic minorities (Bai, Hani, Dai, Lisu, Wa, Naxi, Miao, Shui, Buyi, Dong, Zhuang, Yao and Qiang) from Yunnan, Guizhou, Sichuan province and Guangxi Zhuang autonomous region were selected from Chinese National Survey on Students' Constitution and Healthy of 2014. A total of 25 964 students with completed records of height, weight, spermarche and menarche were selected, including 11 276 boys aged 11-18 years old and 14 688 girls aged 9-18 years old. Probit analysis was used to calculate the median age at spermarche or menarche. All subjects were classification into four nutritional status groups (normal, malnutrition, overweight and obesity) according to the Screening standard for malnutrition of school-age children and adolescents (WS/T 456-2014) and the Screening for overweight and obesity among school-age children and adolescent (WS/T 586-2018) of China. Binary logistic regression was used to analyze the association between spermarche, menarche and nutritional status. Results: The median age at spermarche (95%CI) of 13 ethnic minorities were ranged from 13.4 (13.1, 13.7) years old to 15.3 (15.1, 15.5) years old. In the 11 -year age group, all ethnic girls experienced menarche. The median age at menarche (95%CI) of 13 ethnic minorities were ranged from 12.1 (11.4, 12.7) years old to13.6 (13.4, 13.7) years old. Logistics regression analysis showed that students with malnutrition experienced spermarche or menarche later than normal weight students, the OR (95%CI) for boys about 0.49 (0.42, 0.56) and girls about 0.15 (0.12, 0.19), while overweight and obese students entered puberty at earlier age, the OR (95%CI) for boys about 1.37(1.10, 1.72) and girls about 3.21(2.51, 4.12). Conclusion: Boys from 13 ethnic minorities began to have spermatorrhea at the age of 13, and girls from 13 ethnic minorities began menstruating at the age of 9 in 2014. Nutrition status was closely related to spermarche and menarche.

[Analysis on the urban-rural disparity of childhood stunting and its association with economic growth among Chinese Han students aged 7-18 years old].

Objective: To analyze the urban-rural disparity of childhood stunting and its association with subnational economic growth among Chinese Han students aged 7-18 years. Methods: We used the data from 2014 Chinese National Survey on Students' Constitution and Health. 213 940 Chinese Han students aged 7-18 years with complete height records were included in this study. Stunting was defined according to the Screening Criteria of Malnutrition for School-age Children and Adolescents(2014 version, in Chinese). We divided students into two groups (economically developed and underdeveloped areas) according to the provincial GDP per capita. Spearman correlation coefficient was used to explore the association between the difference of urban-rural stunting prevalence and the provincial GDP per capita. Logistic regression models were established to assess the risk of stunting in rural children compared with urban children. Results: Among 213 940 students, 107 033 (50.0%) were from urban areas. The average height of 7-18 years old and 18 years old [(152.9±15.7) and (166.1±8.7) cm] of urban students were both higher than those of rural students [(150.7±16.0) and (165.1±8.6) cm] (P<0.001). The stunting prevalence of Chinese urban students (0.4%) was statistically significant lower than that of rural students (1.1%) (P<0.001), which was consistent in all age groups (P<0.05). The urban-rural disparity was found in 60% (18/30) of Chinese provinces. The difference of urban-rural stunting prevalence was negatively associated with provincial GDP per capita (r=-0.62, P<0.001). In economically underdeveloped areas, the risk of stunting for rural students aged 7-9 years was 4.69 (95%CI: 2.93-7.52) times that for urban children, while for students aged 10-18 years, the odds ratio was 2.44 (95%CI: 2.02-2.96). In economically developed areas, the risk of stunting for rural students aged 7-9 years was 5.43 (95%CI: 3.67-8.03) times that for urban children, while for students aged 10-18 years, the odds ratio was 2.15 (95%CI: 1.85-2.49). Conclusions: The urban-rural disparity of childhood stunting existed in most places in China. The difference of growth retardation between urban and rural areas was related to regional economic development.

[Situation analysis of physical fitness among Chinese Han students in 2014].

OBJECTIVE: To analyze the situation of physical fitness among Chinese Han students in 2014, so as to develop the guideline of physical activity regarding to the targeted students and to provide bases for the improvements of students' physical fitness. METHODS: Subjects were from 2014 Chinese National Surveys on Students' Constitution and Health (CNSSCH). In this survey, 212 401 Han students aged 7-18 years participated and the measurement of physical fitness completed. The qualified rates of indicators regarding to physical fitness were evaluated based on "National Students Constitutional Health Standards" (2014 revised edition). Logistic regression was used to assess the association between the indicators of pull ups (boys) and endurance run (boys and girls) and influencing factors. RESULTS: In 2014, among the boys, the qualified rates of pull ups and endurance run were 18.7% and 76.6% respectively, while the qualified rate of endurance run was 80.6% among the girls. These two indicators were the weak items of physical fitness among the Chinese Han students. There was regional difference in the qualified rates of physical fitness, and the students in Zhejiang and Jiangsu provinces had higher qualified rates. Logistic regression showed that the urban students (OR=0.67), the students with malnutrition (OR=0.76), overweight (OR=0.32) or obesity (OR=0.12) were less likely to be qualified to pull ups; the students who had physical activity more than 1 h per day (OR=1.31) was more likely to be qualified to pull ups. The influencing factors of endurance run showed the similar pattern, in addition, the students with enough physical education (PE) were more likely to be qualified to endurance run, while the students with "Squeeze" or "no" PE class were less likely to be qualified to endurance run. CONCLUSION: The pull ups and endurance run have become the weak items of the physical fitness among primary and secondary school students in our national and provincial levels. Based on ensuring physical exercise time and PE curriculum and class hours, as well as improving students' nutrition, we should also strengthen the rational design of physical exercise and ensure the balanced development of various items so as to improve the overall development of students' physical fitness.

[Histologic classification and prognosis factors in phyllodes tumors of breast].

Objective: To study the relationship between morphological characteristics, grading, diagnosis and prognosis in phyllodes tumors (PT) of the breast. Methods: A retrospective study was carried out on 83 PTs diagnosed between 1999 and 2003 that were classified semi-quantitatively according to the WHO recommendation. Follow-up data was available for some cases, and Cox regression analysis was used to evaluate factors affecting metastasis and recurrence. Results: All cases were classified into the benign (57.8%), borderline (28.9%) and malignant (13.3%). The overall recurrence rate for the 72 cases with follow-up data was 20.8% (15/72), and was 17.5% (7/40) in benign, 22.7% (5/22) in borderline and 3/10 in malignant PT, respectively, with no significant difference (P>0.05). The median interval between the initial diagnosis and the first recurrence was 24 months. Lung or bone metastases occurred in 1/22 borderline and 3/10 malignant PT patients 5 years post-surgery. The mitotic count and the degree of stromal cell atypia were significantly correlated with recurrence (P=0.001 and P=0.006). Multivariate analysis showed that severe stromal cell atypia was an independent predictor of recurrence-free survival in PT [HR=6.40 (95% CI=1.378 to 29.732), P=0.018]. Conclusions: Each parameter in the histological grading of PT may have different prognostic value, and markedly increased mitotic count and were predictive of relapse.

[Comparison of status of physical activity time at school and influencing factors in students in China, 2010 and 2014].

Objective: To compare the probability of physical activity (PA) time ≥1 hour at school and influencing factors in students in China between 2010 and 2014. Methods: We used the data of 2010 and 2014 Chinese National Survey on Students' Constitution and Health (CNSSCH). The surveys covered the Han students aged 9-22 years and Tibetan students aged 9-18 years (Tibet). The participants were primary school students (9-12 years old), junior high school students (13-15 years old), senior high school students (16-18 years old) and college students (19-22 years old). The probability of PA time ≥1 hour at school was compared using χ(2) tests between 2010 and 2014 survey years. Log-binomial Regression was used to estimate the relative risk (RR) for the probability of PA time ≥1 hour at school in different age groups. Results: The overall probability of PA time ≥1 hour at school in students aged 9-22 years was 20.5% in 2010, and 23.8% in 2014. The difference between 2010 and 2014 was significant (P<0.001). On the whole, the probability of PA time ≥1 hour at school increased in the eastern, central and western areas in 2014 compared with 2010 (P<0.05), and the increase range was highest in eastern area, followed by western area and central area (P<0.05). The probability of PA time of 1 hour at school in all age groups increased in 2014 compared with 2010 (P<0.05). The increase in the probability of PA time ≥1 hour at school was larger in primary school students than that in high school students and college students (P<0.05). The probability of PA time ≥1 hour at school increased in all age groups in three areas, except in junior and senior high school students in the central area where the probability of PA time ≥1 hour at school decreased. The probability of PA time ≥1 hour at school in primary and junior/senior high school students in the eastern area had the greatest increase, but in college students it had the smallest increase in the three areas. From 2010 to 2014, the changes in the probability of PA time ≥1 hour at school in students in different provinces were quite different, especially in primary school students. The probability of PA time ≥1 hour at school in four age groups increased in only three provinces. With the probability of PA time ≥1 hour at school in primary school students as the reference, the RR in junior high students had no significant change between 2010 and 2014. The RR in senior high school increased from 0.34 (0.33-0.35) in 2010 to 0.36 (0.36-0.37) in 2014, and the RR in college students increased from 0.33 (0.32-0.34) in 2010 to 0.43 (0.42-0.44) in 2014. Conclusions: The probability of PA time ≥1 hour at school in all age groups increased in 2014 compared with 2010, but there were great differences among provinces. The findings of our study suggests that although the national policy played a certain role, the provinces should take specific measures to improve the probability of PA time ≥1 hour at school in students according to their own conditions. In addition, more attention should be paid to PA of older students.

[Secular trends and geographic disparities of all-cause mortality among Chinese adolescents aged 10-24 years, between 1953 and 2010].

Objective: To analyze the secular trends and geographic disparities of all-cause mortality among Chinese adolescents aged 10-24 years over the period of 1953-2010. Methods: Data were extracted from the Chinese National Census in 1953-2010. We calculated the all-cause mortality and annualized rates of the changes. Using the provincial gross domestic product (GDP) per capita as an indicator of regional socio-economic development level, we calculated the Wagstaff normal concentration indices for adolescent mortality. Results: Over the period of 1953-2010, the general patterns of Chinese adolescent mortality appeared higher in males than those in females, higher in the 20-24-year-old than those in the 15-19 year-old and in the 10-14 year-old groups, higher in adolescents from the western than those in the eastern regions. The mortality of adolescents decreased from 554.6/100 000 in 1953-1964 to 55.7/100 000 in 2010 in males and decreased from 488.4/100 000 to 26.7/100 000 in females, respectively. The percentage of decrease for females (94.5%) was higher than that for males (90.0%). In 1981-2010, the highest annualized rate of decline for males was seen in Beijing (4.4%), with the lowest seen in Qinghai (0.1%). For girls, Hubei showed the highest annualized rate of decline (6.4%) while Qinghai the lowest (0.8%). Provinces that with higher mortality tended to have lower annualized rate of decline. The concentration indices for boys were -0.07 (95%CI: -0.11- -0.03), -0.13 (95%CI: -0.18- -0.08), and -0.16 (95%CI: -0.22- -0.10) in 1990, 2000, and 2010, respectively, and were -0.07 (95%CI: -0.13- -0.02), -0.18 (95%CI: -0.24- -0.12), and -0.18 (95%CI: -0.26- -0.09) respectively in girls. The indices among 1990, 2000, and 2010 did not show statistically significantly differences, both for boys and girls (P>0.05). Conclusions: Over the half century, the mortality of Chinese adolescents showed dramatic decreasing trend. However, in terms of death rates, gender and geographic disparities were consistently seen in the adolescents.

[Comparative study on growth retardation prevalence in students aged 7-18 years from 26 minority ethnic groups in China].

Objective: To compare the prevalence of growth retardation in students aged 7-18 years from 26 minority ethnic groups in China and provides reference evidence to promote the growth and improve the health status of students in minority ethnic groups. Methods: The body height data of students aged 7-18 years in 26 minority ethnic groups in 2014 Chinese National Surveys on Students' Constitution and Health were used for the analysis and comparison. Growth retardation was defined according to the school-aged child and adolescent malnutrition screening standard (WS/T 456-2014). Results: In 2014, the average body heights of school boys and school girls aged 18 years in 26 ethnic minority groups were (168.3±6.8) cm and (156.2±5.9) cm respectively. The overall growth retardation prevalence rate of school boys and school girls in 26 ethnic groups were 5.4% and 5.1%, respectively. The growth retardation prevalence rate was highest in students of Shui ethnic group (24.5% for boys and 23.0% for girls), and lowest in students of Hui ethnic group (0.1% for boys and 0.3% for girls). The growth retardation prevalence rates in 9 ethnic minority groups were higher than the average level, in these 9 ethnic groups, the differences in prevalence rates of boys of Buyi ethnic group, girls of Lisu ethnic group and girls of Hani ethnic group had no significance among four age groups. Growth retardation in students of Sala ethnic group was mainly observed in age group 7-9 years, but in others ethnic group, for example, Wa ethnic, it was mainly observed in older age group. The students in minority ethnic groups in southwestern China had the highest growth retardation prevalence rate (8.1%), significantly higher than that in northern China (0.8%) (OR=10.6, 95%CI: 7.8-14.4). The overall growth retardation prevalence rate between 7 and 17 years old was negatively correlated with the body height of 18 years old (boys: r=-0.811, P<0.001; girls: r=-0.715, P<0.001). Conclusions: In 2014, the differences in body height among students aged 18 years in 26 minority ethnic groups in China were significant. In general, the first five minority ethnic groups with high detection rate of growth retardation in boys were Shui, Wa, Buyi, Yao and Yi, and the five minority ethnic groups with high detection rate of growth retardation in girls were Shui, Yao, Buyi, Wa and Miao. The detection rate of growth retardation was highest in students of minority ethnic groups in southwestern China. Nutritional interventions and healthy education should be carried out in minority ethnic groups and areas with high growth retardation prevalence rate to promote the growth of the students.