Objective To summarize the clinical features of different racial patients with celiac disease (CD) and analyze the disease prevalence,diagnosis and treatment in Chinese population.Methods All the patients were diagnosed as CD and enrolled in Beijing United Family Hospital between January 2005 and July 2015.Clinical data including nationality,age,symptoms,endoscopic and pathological findings,outcome were collected and compared in patients from different countries.Results A total of 87 patients were enrolled including 63 Caucasians,18 Asian patients and 6 Middle East patients.The peak age of disease onset was 40-60 years old.Patients with typical symptoms such as chronic diarrhea and weight loss only accounted for 20.7％ (18/87) and 9.2％ (8/87) respectively.Some patients presented with nonspecific symptoms such as abdominal pain and bloating [32.2％ (28/87)],even constipation [5.7％ (5/87)].13.8％ (12/87) patients were previously diagnosed as irritable bowel syndrome.The incidence of abdominal pain,bloating,diarrhea and constipation between Asians and Caucasians had no statistical significance (P ＞ 0.05);but the proportions of weight loss,growth retardation,iron deficiency anemia and dermatitis herpetiformis in Asian group were significantly higher than that in Caucasian group (P ＜ 0.05).IgA type of anti-gliadin antibody (AGA),endomysium antibody (EMA) and tissue transglutaminase antibody (tTGA) were dominant autoimmune antibodies in patients with CD,which accounted for 58.6％ (51/87),44.8％ (39/87) and 36.8％ (32/87) respectively.The endoscopy showed that the lesion of CD was mainly located in small intestine,with reducing severity from the proximal to the distal small intestine.The lesions of duodenal bulb and descending duodenum appeared more significant in Asian group.Accordingly pathological intestinal atrophy and the degree of intraepithelial lymphocytosis were more severe in Asian patients.All 87 cases took the gluten-free diet (GFD).Eighty-one cases received serological follow up and 8 with endoscopic intestinal biopsy.The celiac disease antibodies in 47 patients turned negative from 6-9 months after GFD treatment,while 34 patients turned negative from 12-18 months after GFD.All patients reported disease remission to some extent.After 1 year GFD treatment,the pathology of endoscopic intestinal biopsy in 8 patients showed significant improvement of villous atrophy and lymphocyte infiltration.Conclusions CD patients with typical clinical manifestations are not the majority.Serological celiac disease antibodies (AGA,EMA and tTGA) have a high diagnostic value.GFD treatment is effective on majority of celiac patients.Clinical manifestations,endoscopy,intestinal pathology,and response to GFD in Chinese patients are not the same as Caucasians.Clinicians need to pay attention to the differential diagnosis.

Objective To compare the clinical effects of combined anterolateral and posterolateral approach,lateral incision via double intermuscular spatia approach,and posterolateral transfibular approach in the treatment of fractures of anterolateral and posterolateral columns of tibial plateau.Methods A retrospective analysis was done of the 18 patients with fracture of anterolateral and posterolateral columns of tibial plateau who had been treated at our hospital from January 2012 to January 2015.They were 10 men and 8 women,aged from 28 to 58 years (mean,35.5 years).They were divided into 3 equal groups.Group A was treated with combined anterolateral and posterolateral approach,group B with lateral incision via double intermuscular spatia approach and group C with posterolateral transfibular approach.Operation time,surgical blood loss and complications were recorded.At the final follow-ups,Rasmussen score was used to evaluate the fracture reduction and Hospital for Special Surgery (HSS) knee score to assess functions of the involved knees.Results The 18 patients were followed up for 10 to 18 months (average,13.3 months).No such early complications as incision infection or deep vein thrombosis occurred.The operation time (89.5 min and 79.3 min,respectively) and surgical blood loss (151.7 mL and 207.8 mL,respectively) for groups A and B were obviously less than those for group C (102.5 min;260.2 mL);the incision length for group A (10.5 cm) was shorter than that for group B (17.4 cm) and for group C (16.3 cm);group C had more cases of excellent reduction (6) than groups A and B (4 for both).There were no obvious differenc es between groups A,B and C in the Rasmussen score (16.8,17.0 and 16.3) or HSS score (86.3,86.0 and 85.7).One case of delayed incision healing due to partial necrosis occurred in group B.At the final follow-ups in group C,the varus stress test showed 2 cases of laxation of degree Ⅱ and 2 cases of laxation of degree Ⅰ.Conclusions In the treatment of fractures of anterolateral and posterolateral columns of tibial plateau,all the 3 approaches can lead to good exposure,fine reduction,rigid fixation and satisfactory outcomes.Although the combined anterolateral and posterolateral approach and lateral incision via double intermuscular spatia approach can lead to similar exposure ranges and fixation effects,the latter is easier in operation while the former exposes the anterior and posterior spatia more fully,allowing the anterior and posterior plates to be better positioned.The posterolateral transfibular approach can lead to the largest exposure range and more precise reduction,but it has risks of damage to the lateral ligamentous structure,greater invasion,postoperative lateral instability and injury to the common peroneal nerve.

Objective: To investigate the prevalence of anemia among students aged 6-15 years old participated in the Nutrition Improvement Program for Rural Compulsory Education Program in 2012-2021 in Hunan Province, and to explore associated factors. Methods: A cluster random sampling method was used. The survey was conducted among compulsory education students who came from counties in Hunan Province where nutrition improvement plan and key surveillance were carried out. Height and weight were measured, hemoglobin, dietary habits and health knowledge were collected. Results: Since the implementation of nutrition improvement plan in 2012, the anemia rate decreased from 12.8% to 9.3%, the average hemoglobin content decreased from 133.9 g/L to 130.0 g/L. The proportion of students eating meat every day increased from 20.4% to 47.3%. Students eating three or more servings of table tennis ball size of meal increased from 21.4% to 47.3%. The proportion of students eating more than three kinds of vegetables per day was 39.1% in 2016 and 32.6% in 2019, and less than 30% in other years. The proportion of students eating three or more servings of table tennis ball size of vegetables increased from 19.5% to 39.6%, and the proportion of students eating snack less than once a day increased from 13.1% to 76.9%. The proportion of students drinking beverages less than once a day increased from 36.5% to 90.7%. Girls, older than 12 years, not eating meat every day, and who eat less than 1 serving of table tennis ball size of meat, eat less than 3 servings of table tennis ball size of vegetables and fruit at one time, and who eat less than 3 kinds of vegetables every day, and those who grow slowly had higher risk of anemia. Potential factors of anemia in students varied by survey year. Conclusion The implementation of the compulsory education has improved the nutritional status of compulsory education students in rural areas of Hunan Province, but anemia still occurs. Potential factors associated with childhood anemia are changing. Child health literacy education should adapt to the changing social and economic enviornment, as well as lifestyles. Targeted and appropriate nutritional education and intervention are greatly needed.

Objective:To investigate the clinical effect of "ladder reduction method" in the treatment of iliac fracture combined anterior dislocation of sacroiliac joint.Methods:The retrospective analysis was performed on 10 cases of iliac fracture combined anterior sacroiliac joint dislocation admitted to the Affiliated Hospital of Yunnan University from February 2010 to January 2022, among which 5 cases were males and 5 cases were females, aged ranging from 22 to 52 years, with an average age of 38.8 years. All patients were injured in car accidents including 5 cases of C1.2, 3 cases of C2, and 2 cases of C3 fractures according to Tile classification. All patients were treated with the "ladder reduction method" with plate and screw fixation. In the first step, 1-2 Schanz pins were inserted into the iliac crest to control the ilium, and the Schanz pins were appropriately pulled laterally; in the second step, the periosteal stripper was used to pry the reduction between the sacrum and ilium; in the third step, for the patients who still could not be reduced, a 2.5 mm diameter Kirschner wire was placed on the sacrum close to the iliac crest, and a periosteal stripper was inserted between the sacrum and iliac crest, with its tip against the Kirkner wire, and the iliac crest as the fulcrum for pry pulling to separate the two. In the fourth step, the pry was maintained, and then another 2.5 mm diameter Kirschner wire was placed on the sacrum close to the internal margin of the iliac bone. The periosteal stripper was continued to pry between the sacrum and the iliac bone, and the operation was repeated. At the same time, the anterior dislocation of the sacroiliac joint was reduced with traction of the lower limb. Postoperatively, the quality of reduction was evaluated by the Matta score, and the degree of functional recovery after pelvic fracture was evaluated by the Majeed score.Results:Four patients completed the reduction through the first and second steps, and 6 cases of refractory sacroiliac joint anterior dislocation were successfully reduced through the first to fourth steps. The fracture reduction time of 6 patients with refractory anterior sacroiliac joint dislocation was 39.67±3.09 min (range, 35-44 min), with intraoperative blood loss of 300.00±141.42 ml (range, 150-600 ml); in the other 4 cases, the fracture reduction time was 36.75±4.38 min (range, 30-42 min), and the intraoperative blood loss was 225.00±44.30 ml (range, 200-300 ml). All 10 patients were followed up for 12.9±3.7 months (range, 9-20 months). The anterior and posterior pelvic ring fractures were healed in all patients, and the fracture healing time was 12.77±1.62 weeks (range, 10.71-15.28 weeks). At the last follow-up, Matta evaluation was excellent in 5 cases, good in 1 case, and excellent in the other 4 cases. The Majeed scores of 6 cases were 86.50±6.08 points (range, 74-92 points), of which 5 cases were excellent and 1 case was good. The other 4 cases were 81.5±9.39 scores (range, 71-94), of which 2 were excellent and 2 were good.Conclusion:The "ladder reduction method" is a safe, effective and easy-to-operate method for the treatment of iliac fracture combined anterior dislocation of the sacroiliac joint, especially for refractory anterior dislocation of the sacroiliac joint, which can still obtain satisfactory curative effects.

Objective:To observe the efficacy of intravitreal injection of aflibercept (IVA) in the treatment of exudative age-related macular degeneration (wAMD) combined with RPE detachment (PED).Methods:A retrospective case study. From June 2018 to June 2019, 32 eyes (overall group) of 27 wAMD patients with PED were included in the study. All eyes were treated with IVA. The initial loading dose was 2.0 mg, which was injected once a month for 2 consecutive months and and then use a PRN regimen after evaluation. According to the maximum height of PED (PEDH) 2 months after treatment, the overall group was divided into the response group and the partial response group, with 20 (62.50%) and 12 (37.50%) eyes respectively. The response group: PEDH decreased by ≥25% compared with before treatment. The partial response: PEDH decreased by <25%. The macular fovea was scanned with the 3D-OCT 2000 instrument from Topcon (Japan). PEDH, PED area (PEDA), PED volume (PEDV), and macular foveal retinal thickness (CMT) were measured. There was no significant difference in BCVA, CMT, PEDH, PEDA, and PEDV of the eyes in the response group and the partial response group ( t=-0.791, -0.488, -0.900, -1.130, -0.400; P=0.435, 0.630, 0.380, 0.270, 0.690). The changes of BCVA, PEDH, PEDA, PEDV, CMT in each group were observed before treatment and 1, 2, 4, and 6 months after treatment. The comparison of BCVA and PED-related indicators and CMT before and after treatment were performed by repeated measures analysis of variance. Results:Compared with before treatment, the BCVA, CMT, PEDH, PEDA and PEDV of the eyes in the overall group, the response group, and the partial response group were obviously improved after treatment. Among them, there were statistically significant differences in all indicators of the overall group and the response group ( FBCVA=5.871, 3.798; P=0.001, 0.019. FCMT=24.526, 14.109; P=0.000, 0.001. FPEDH=12.569, 12.091; P=0.000, 0.000. FPEDA=7.534, 6.286; P=0.000, 0.000. FPEDV=5.139, 4.104; P=0.004, 0.014); there was no statistically significant difference in PED-related indicators in the partial response group ( FPEDH=3.210, P=0.054; FPEDA=1.913, P=0.183; FPEDV=3.500, P=0.051), the difference between BCVA and CMT was statistically significant ( FBCVA=3.033, P=0.027; FCMT=11.140, P=0.001). Two months after treatment, the eye number of PEDH reduction rate <25%, 25%-<50%, 50%-<75%, and ≥75% were 12 (37.50%), 8 (25.00%), 9 (28.13%), and 3 (9.38%) in the overall group, respectively. And PED in one eye (3.13%) was completely eliminated. Six months after treatment, the proportion was 13 (40.23%), 5 (15.63%), 7 (21.88%) and 7 (21.88%), respectively, among which 4 eyes (12.50%) with PED were completely resolved. Conclusions:Aflibercept treatment of wAMD combined with PED can restore its anatomical indicators and improve visual function of patients in a short time; the efficacy of PED in the PRN stage is related to the efficacy of the loading dose stage.