暖风机在青少年特发性脊柱侧凸手术中的应用

目的探讨暖风机在青少年特发性脊柱侧凸手术中的应用价值。方法选取上海长征医院2015-2016年收治的147例青少年特发性脊柱侧凸手术患者,术前根据患者住院号奇偶性将患者分为观察组和对照组,观察组术中拟使用暖风机进行保暖,对照组术中无特殊保暖措施。比较两组患者术前、术中60 min、术中120 min及术后的体温,在患者送入苏醒室后30 min、60 min两次对患者进行寒战程度分级,并在60 min时进行复苏质量评分。分别比较两组患者术中保暖、术后寒战及复苏质量的差异。结果观察组术中60 min、术中120 min和术后的体温分别为(36.7±0.3)℃、(36.5±0.2)℃及(36.3±0.3)℃,明显高于对照组(36.5±0.5)℃(P0.05)、(36.4±0.2)℃(P0.05)及(36.2±0.3)℃(P0.05)。观察组患者术后30 min和60 min时寒战分级明显低于对照组(P0.05),且术后60 min复苏评分也显著高于对照组(P0.05)。结论暖风机能够减少青少年特发性脊柱侧凸患者术中热量丢失、减少低体温的发生,并可有效降低患者术后寒战及改善患者复苏质量。     

Understanding Concussion Reporting Using a Model Based on the Theory of Planned Behavior

PurposeAthlete's report of concussion symptoms to coaching or medical personnel is an important component of concussion risk reduction. This study applies a model based on the Theory of Planned Behavior (TPB) to the prediction of concussive symptom underreporting among late adolescent and young adult male ice hockey players.MethodsParticipants were members of an American Tier III Junior A ice hockey league (ages 18–21 years; male; n = 256). Twelve of 14 league teams and 97% of players within these teams agreed to participate. Written survey items assessed symptom reporting behavior, intention, perceived norms, self-efficacy, perceived outcomes of reporting, and concussion knowledge. Structural equation modeling was used to assess the significance of relationships hypothesized by the TPB-based model and the overall model fit. Data were collected in January 2013.ResultsResults supported the fit of the TPB-based model in explaining reporting behavior; all model pathways were significant in the hypothesized direction. Of the perceived reporting outcomes assessed, those related to athletic performance were identified as most strongly associated with reporting intention.ConclusionsResults of this study suggest the importance of considering factors such as perceived outcomes of reporting, perceived norms, and self-efficacy, in addition to knowledge, when analyzing concussion underreporting among adolescent athletes. As concussion education for athletes becomes increasingly mandated, testing and applying psychosocial theories such as TPB may help increase program efficacy.     

When you see it,let it be: Urgency,mindfulness and adolescent substance use

The emotion-based domains of impulsivity, positive and negative urgency, are facets that have garnered attention due to their associations with substance use, and mindfulness based strategies have shown promise in reducing substance use in adults. The aim of the current study was to examine relations among urgency, mindfulness, and substance use in adolescence. Cross-sectional data were collected from students (N = 1,051) at a large, private high school in the Pacific Northwest. Both positive and negative urgency were uniquely associated with greater likelihood of lifetime and current alcohol use; only positive urgency predicted lifetime marijuana use. Mindfulness was associated with a lower likelihood of lifetime alcohol or marijuana use. Interactions between urgency and mindfulness were not supported. Our findings highlight the need to explore relations among baseline mindfulness, skills based mindfulness, and personality in adolescent alcohol and other drug use.     

Adolescent intermittent ethanol exposure diminishes anhedonia during ethanol withdrawal in adulthood

Adolescent alcohol use may interfere with neurodevelopment, increasing the likelihood of adult alcohol use disorders (AUDs). We investigated whether adolescent intermittent ethanol (AIE) exposure alters the adult reward response to ethanol. Adolescent rats were administered ethanol once (moderate exposure; Cohort 1) or three times per day (severe exposure; Cohort 2) in a 2 days on/2 days off pattern. In adulthood, subjects responded for electrical stimulation directed at the posterior lateral hypothalamus in a discrete-trial intracranial self-stimulation (ICSS) procedure that provides current-intensity thresholds as a measure of brain reward function. The effects of ethanol administration and withdrawal were assessed. Control rats showed dose-dependent threshold elevations after acute ethanol, indicating reward deficits. A majority of moderately AIE-exposed rats (Cohort 1) showed threshold lowering after ethanol, suggesting ethanol-induced reward enhancement in this sub-set of rats. Rats exposed to severe AIE (Cohort 2) showed no threshold elevation or lowering, suggesting a blunted affective ethanol response. Daily ethanol induced threshold elevations 24 h after administration in control rats but not in either group of AIE-exposed rats, suggesting decreased sensitivity to the negative affective state of ethanol withdrawal. Withdrawal from a 4-day ethanol binge produced robust and enduring threshold elevations in all rats, although threshold elevations were diminished in rats exposed to severe AIE. These results indicate that AIE exposure diminished reward deficits associated with ethanol intoxication and withdrawal and may have increased ethanol-induced reward enhancement in a sub-set of rats. In humans, enhanced ethanol reward accompanied by reduced withdrawal severity may contribute to the development of AUDs.     

中国10～17岁中小学生耐力素质影响因素分析

目的 探讨中国10～ 17岁中小学生耐力素质的影响因素.方法 利用2010年中国学生体质与健康调研数据,选取资料完整的10 ～ 17岁中小学生为研究对象,共68 458名,将耐力跑测试时间≤同年龄、同性别第25位百分数(P25)时间值确定为耐力素质好,耐力跑测试时间≥同年龄、同性别P75时间值确定为耐力素质差.比较不同耐力素质者,耐力跑时间的差异,同时,采用x2检验、logistic回归及多水平模型分析城乡、BMI、饮食、运动、锻炼意愿等因素对耐力素质的影响.结果 68 458名研究对象中,耐力素质好者有34 239名(50.0％),耐力素质差者有34 219名(50.0％).耐力素质好者的比例,乡村学生为53.8％(18 285/33 996),高于城市学生的46.3％(15 954/34 462)(x2=384.16,P＜0.01)；肥胖学生为12.2％(448/3660),低于BMI正常[55.2％(28 183/51 028)]、超重[29.3％ (2012/6874)]和消瘦的学生[52.1％ (3596/6896)],差异有统计学意义(x2=3840.08,P＜0.01).；每天吃早餐的学生为52.5％(25 534/48 679),高于从来不吃或每周吃1～2次早餐的学生[41.3％(3209/7768)](x2=438.31,P＜0.01)；每天喝牛奶的学生为51.7％(11 580/22 379),高于从来不喝或有时喝牛奶的学生[49.2％(22 659/46 079)](x2=39.84,P＜0.01)；体育课充足的学生为55.3％(18 961/34 314),高于体育课不足的学生[44.7％(15 278/34 144)] (x2 =756.41,P＜0.01)；每天体育锻炼lh及以上的学生占58.6％ (9484/16 195),高于锻炼lh以下学生[47.4％ (24 755/52 263)](x2=619.82,P＜0.0l)；愿意参加长跑锻炼学生占60.1％(19 287/32 118),高于意愿为“一般”[45.4％(10 569/23 272)]和“不愿意”[33.5％(4383/13068)]学生(x2 =2909.61,P＜0.01).多水平分析显示,耐力素质差的风险,乡村学生低于城市学生(OR=0.80,95％CI:0.77～0.82)；消瘦(OR=1.11,95％CI:1.05～1.17)、超重(OR =2.69,95％CI:2.55～2.85)及肥胖(OR =7.71,95％ CI:6.97 ～8.52)学生高于BMI正常的学生；从不吃早餐或每周吃1～2次早餐(OR=1.20,95％CI:1.13 ～ 1.26)、每周吃3～5次早餐的学生(OR=1.13,95％ CI:1.08～1.18)高于每天吃早餐的学生；每天喝l袋牛奶的学生(OR=1.09,95％CI:1.02～1.17)高于每天喝2袋牛奶的学生；体育课不足的学生(OR=1.20,95％CI:1.16～ 1.24)高于体育课充足的学生；每天体育锻炼不足lh的学生(OR=1.34,95％CI:1.29 ～ 1.40)高于每天锻炼lh及以上的学生；长跑锻炼意愿为“一般”(OR=1.67,95％CI:1.61～ 1.73)和“不愿意”的学生(OR =2.72,95％ CI:2.60 ～2.85)高于“愿意”的学生.结论 城乡居住差异、BMI、吃早餐、喝牛奶、体育课、运动时间及锻炼意愿与中小学生耐力素质相关.     

A harmless evil: Giant fungating benign breast mass in an adolescent mimicking malignancy - Case report

IntroductionJuvenile giant fibroadenoma is a rare type of fibroadenoma characterized by rapid growth of a breast tumor in an adolescent. Benign in nature, they rarely present as fungating and ulcerating tumors. Benign tumors masquerading as malignancies are surgical conundrums. No co nsensus exists yet on the management of these cases. We aim to discuss the dilemma in managing a bleeding, fungating giant fibroadenoma in an adolescent female and highlight risks of alternative therapies.Presentation of caseA 19-year-old lady presented with a bleeding, fungating breast mass worsened with topical herbal concoction. Examination revealed a 10 × 15 cm fungating breast mass that obliterated her nipple- areolar complex (NAC). Computed Tomography (CT) scan reported a huge heterogeneously enhancing mass 10.6 × 14.5 × 15.1 cm with loss of normal fat plane with the overlying skin but a clear fat plane with the pectoralis muscle posteriorly.DiscussionGiant breast masses that fungate and ulcerate usually indicate a sinister pathology. Traditional remedies have been reported to exacerbate growth. In cases where most of the breast parenchyma and NAC has been destroyed, it is no longer possible to proceed with breast conserving techniques. Breast reconstruction is crucial in adolescents and should be tailored to the patient’s existing breast size as well as body habitus.ConclusionIn juvenile giant fibroadenomas where breast parenchyma and NAC has been destroyed, breast reconstruction is the goal. The lack of consensus in both diagnosis and management further compounds the difficulty in dealing with this sensitive population. Awareness needs to be raised regarding negative effects related to traditional medicine.