Survival in Lung Cancer among Female Never-smokers in Rural Xuanwei and Fuyuan Counties in Eastern Yunnan Province, China / 中国肺癌杂志

BACKGROUND@#Lung cancer rates among women in rural Xuanwei and Fuyuan counties in eastern Yunnan province, China, are among the highest in the world, even though almost all women are non-smokers, and they tend to develop lung cancer at a younger age than other locations by roughly 5 yr-10 yr. This study investigated the survival of lung cancer patients among female never-smokers.@*METHODS@#The female never-smokers, who had lived for many years in Xuanwei and Fuyuan counties, with lung cancer newly-diagnosed between July 2006 to March 2010, were followed up through the end of 2016. Age-standardized relative survival for all cases was calculated using local life table. The Kaplan-Meier method and Log-rank test were used to analyze the relationship between the variables and the prognosis in univariate analysis. Cox regression analysis was employed in the multivariate analysis.@*RESULTS@#Among 1,250 total subjects, 1,075 died and the remaining 175 were censored during the follow-up, with a median follow-up period of 69 months (95%CI: 61.9-76.0). Overall, the mean age was (54.8 ±10.9) yr, with variable clinical stages: 3.5% of cases were stage I, 8.7% stage II, 20.7% stage III, 29.7% stage IV, and 37.4% stage unknown. The 645 patients(51.6%) with cyto-histological diagnosis contains 303 with Squamous cell carcinoma, and 231 with adenocarcinoma, 24 with small cell, 43 with other specified type and 39 with unknown histological type. Only 215 (17.2%) patients received surgery, 487 (39.0%) were treated without surgery, and 548 (43.8%) did not receive any specific anticancer therapy. The 5-year observed survival rate and age-standardized relative survival were 8.9% (95%CI: 7.0-10.6), and 10.1% (95%CI: 3.7-20.5) respectively, with a median survival of 13.2 months. The 5-year survival rates were 41.1% for stage I, 22.4% for stage II, 5.3% for stage III, 1.3% for stage IV, 11.2% for missing stage, 17.9% for adenocarcinoma, and 5.6% for squamous cell carcinoma respectively. Surgery significantly improved 5-year survival rate compared with non-surgery (34.8% vs 3.2%, P<0.001). The patients with non-treatment, aged 65 years and older, living in rural areas and farmer with low socioeconomic status had poorer survival, whereas the patients treated in provincial hospitals and chest X-ray screening had better survival. Cox multivariate analysis further showed that stage of tumor-node-metastasis (TNM), treatment status, hospital-level, and X-ray screening were factors correlated with survival.@*CONCLUSIONS@#Patients with lung cancer among female never-smokers in Xuanwei and Fuyuan experience poorer survival, because they are less likely to be diagnosed at early stage, as well as less likely to receive surgery and comprehensive treatment. Furthermore low socioeconomic status and poor health security are also responsible for the low survival.

The learning curve for laparoscopic splenectomy for massive splenomegaly: a single surgeon's experience / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoscopic splenectomy (LS) for massive splenomegaly is more technically challenging than for a normal-sized spleen. The purpose of this study was to determine the effect of operative experience on perioperative outcomes of LS for massive splenomegaly.</p><p><b>METHODS</b>Between January 2008 and December 2010, 36 consecutive patients who were diagnosed with massive splenomegaly underwent LS in our department. The perioperative outcomes were evaluated for evidence of a learning curve effect. Patients were divided into three groups (1, 2, and 3) of 12 consecutive patients, and outcomes of each group were compared.</p><p><b>RESULTS</b>The mean operative time decreased significantly from 252 minutes of Group 1 to 179 minutes of Group 3. The estimated blood loss and length of post-operative hospital stay showed a similar trend. No significant differences were found in the splenic length and weight, transfusion rate, or average amount of drainage. In this cohort, there were three cases with surgical complications and one conversion to open laparotomy.</p><p><b>CONCLUSIONS</b>The first 24 cases constitute the early stage of the learning curve for LS for massive splenomegaly. LS for massive splenomegaly is a technically challenging operation with a long learning curve, and strategies for developing training programs must address these challenges.</p>

Public health situation and needs assessment after Wenchuan earthquake in Anxian, Sichuan province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the public health situation and needs in Anxian after Wenchuan earthquake so as to make an effective strategy for disease control and prevention.</p><p><b>METHODS</b>69 concentrated settlements with 100 residents were investigated. Probability proportion to size was adopted for sampling of 2200 residents from 687 scattered households (about 440 000 scattered residents). The content of this survey included drinking water, food hygiene, environment sanitation, planning immunity and medical health service, disease surveillance and so on. SPSS 16.0 was used for data analysis, and statistical interpretation was used to describe the results.</p><p><b>RESULTS</b>90.9% (31/66) resettled residents in Anxian lived in tents, 7.6% (5/66) lived in the movable-plate house, 93.3% (621/666) scattered households lived in tents and 71.9% (446/621) of them lived in tents which were built by residents themselves; the rate of drinking water disinfection in resettlement sites and scattered households were 97.1% (66/68) and 94.6% (650/687); 12.8% scattered residents had mouldy or food; 50% of resettlement sites raised animals; 43.6% (17/39) medical station didn't have bacterin inoculation service; 66.7% (10/15) lacked sufficient disinfection equipment; register rate was 50.0% (33/66) and report rate of symptoms and infectious diseases was 56.1% (37/66).</p><p><b>CONCLUSION</b>There was still some risk of enteric and vector-borne diseases in Anxian, therefore, some tailored measures should be very important.</p>

Mental health assessment among scattered residents after Wenchuan earthquake in Anxian, Sichuan province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the mental health status of residents scattered living in Anxian after Wenchuan earthquake so as to provide scientific basis for further mental health intervention.</p><p><b>METHODS</b>A face to face interview was conducted among the scattered residents with designed questionnaire, which had three parts of the physical and emotional reaction, the relax methods and the social care and supports expected. Two-stage probability proportional to size (PPS) sample method was performed to sample 2184 from 0.44 million scattered residents in Anxian. On the basis of statistical description, mental health of different characteristics groups was compared.</p><p><b>RESULTS</b>Three main symptoms of posttraumatic stress disorders in 2184 residents (11.23+/-3.44) were higher than the 103 fire victims in Hunan in 2003 (10.06+/-3.26), three factor scores of SCL-90 (5.76+/-1.74) were higher than normal in 1998 repair mode (n=23 891) (4.72+/-1.44), and the statistical difference was observed (t=10.77, P<0.05; t=706.04, P<0.05). Comparing the mental health of different groups, some significant differences were found by age, gender and education background.</p><p><b>CONCLUSION</b>The earthquake disaster brought prevalent physical and emotional reaction. Elderly people, female, junior students need mental intervention immediately. Therefore, strengthen the mental education and assistance (especially in high risk groups) would be of more significance.</p>