Objective:To master the changes of Kashin-Beck disease (KBD) in Shaanxi Province, and provide scientific basis for formulating the prevention and control strategy of KBD and adjusting the prevention and treatment priorities of KBD.Methods:In 2008, 15 administrative villages in 12 townships (towns), 6 ward counties (districts) of 4 cities of Shaanxi Province were selected as survey points; from 2009 to 2011, according to the sampling requirements of the national Kashin-Beck disease surveillance plan, 7 ward counties were selected each year, and 4 townships from each county and 1 village from each township were selected as survey points; from 2012 to 2015, 31 ward counties were selected each year, with 5 townships from each county and 3 villages from each township as survey points; from 2016 to 2018, 43, 12 and 12 ward counties were selected each year, and 5 townships from each county and 3 villages from each township were selected as survey points; in 2019, all ward villages of 62 ward counties were selected as survey points. Children aged 7 to 12 years old (7 to 16 years old in 2009 - 2011 for clinical examination) were selected for X-ray and clinical examination of KBD. The clinical positive detection rate of KBD, the positive detection rate of X-ray and the positive detection rate of metaphysis were calculated, and the disease condition in KBD areas was determined.Results:From 2009 to 2011, a total of 7 628 children aged 7 to 16 years old were clinically examined, and a total of 323 356 children aged 7 to 12 years old were examined in 2008 and 2012 - 2019. No clinically positive cases of KBD were detected. From 2008 to 2018, a total of 114 199 children aged 7 to 12 years old were examined for KBD. A total of 48 cases were positive on X-ray, with a detection rate of 0.04% (48/114 199), of which 47 cases were positive on metaphysis, the detection rate was 0.04% (47/114 199). The positive X-ray detection rate in each year was lower than 3.0%, and the positive X-ray detection rate and the positive metaphysis detection rate of KBD in children in the whole province had been kept below 0.10% since 2011, which was in a low fluctuation. From 2012 to 2016, and 2018, 2019, all of the ward villages monitored in the KBD areas had reached the standard of elimination of KBD. In 2017, 99.49% (194/195) of KBD areas reached the standard of elimination of KBD.Conclusion:From 2008 to 2019, the incidence of KBD in Shaanxi Province continues to decline, the incidence of KBD in ward villages has reached the elimination level and it is in the state of continuous elimination.

Objective To master the basic conditions of Kaschin-Beck disease areas and patients in Shaanxi Province,and provide a theoretical basis for prevention and control of Kaschin-Beck disease.Methods In 2018,the basic situation of the villages in Kaschin-Beck disease areas of Shaanxi Province and the implementation of prevention and control measures were investigated.The data of general population information,condition and treatment were collected from all the disease affected villages.Results The Kaschin-Beck disease areas of Shaanxi Province involves 4 194 disease affected villages in 62 counties.Among them,3 886 villages had completed the whole village water reform,215 villages changed some of the water,and 93 villages had not changed water;there were 3 835 disease affected villages met the hygienic standard of drinking water,accounting for 91.44％.A total of 60 157 patients with Kaschin-Beck disease were diagnosed.The male-female ratio was 1.0:0.9 (31 531:28 626).The age of the patients was mainly between 40 and 65 years old.There were no new cases of children.Among them,38 448 were degree Ⅰ patients,18 589 were degree Ⅱ patients and 3 120 were degree Ⅲ patients.The occupational distribution of patients was mainly peasant,with 59 703 cases,accounting for 99.25％.The distribution of education was mainly primary school,with 31 108 cases,accounting for 51.71％.There were 876 patients who had completed surgery and 23 284 patients who had been treated with long-term medication.Conclusions In recent years,there is no new case of Kaschin-Beck disease in children in Shaanxi Province.However,the condition of Kaschin-Beck disease in adults is serious,and great efforts should be made in rescue.

Objective:To investigate the willingness of patients with Kashin-Beck disease (KBD) to accept drug treatment and its influencing factors in Shaanxi Province, in order to provide a reference for promoting the standardized management of KBD patients.Methods:The general information of KBD patients in Shaanxi Provincial Endemic Disease Prevention and Control Information System from January 2018 to December 2020 was collected, including gender, age (< 50, 50 - 79, ≥80 years old), ethnicity (Han nationality, others), education level (primary school and below, junior high school, senior high school and above), occupation (farmer, others), region (northern Shaanxi, central Shaanxi, southern Shaanxi), disease severity (gradeⅠ,Ⅱ,Ⅲ), etc. A face-to-face questionnaire survey was conducted to investigate the willingness of KBD patients to accept drug treatment, mainly including the willingness of patients to accept drug treatment, management services (whether the poor population, participation in medical insurance, disability assessment) and the implementation of comprehensive prevention and control measures (type of drinking water, types and sources of staple food, relocation from other places and returning farmland to forests). Multivariate logistic regression analysis was used to analyze the influencing factors of KBD patients' willingness to accept drug treatment.Results:A total of 58 501 KBD patients were included, including 51.60% (30 185/58 501) males and 48.40% (28 316/58 501) females; the median age was 64 years old; the ethnicity was mainly Han nationality, accounting for 99.87% (58 427/58 501); the education level of primary school and below accounted for 81.76% (47 831/58 501); the occupation was mainly farmers, accounting for 99.24% (58 059/58 501); mainly distributed in central Shaanxi [81.40% (47 619/58 501)]; patients with gradeⅠaccounted for 63.68% (37 254/58 501). Totally 89.02% (52 078/58 501) of KBD patients were willing to accept drug treatment. By multivariate logistic regression analysis, gender, age, education level, disease severity, region, medical insurance, disability assessment, type of drinking water, type of staple food, relocation from other places and returning farmland to forests were the influencing factors of KBD patients' willingness to accept drug treatment ( P < 0.05). Conclusions:KBD patients in Shaanxi Province have a high willingness to accept drug treatment. In the future, the standardized management of KBD patients should take into account the factors such as age, education level, disease severity and region, and implement precise drug treatment.

Objective:To grasp the current situation of Keshan disease in Shaanxi Province, and to provide scientific basis for evaluation of local Keshan disease control and elimination.Methods:From May to November 2020, Keshan disease surveillance was carried out in all the diseased townships (towns) of 29 diseased counties (districts, cities) in Shaanxi Province. The diseased village was used as the unit to collect the demographic data of the diseased areas, and the village doctor's clues were used to investigate suspected myocardial cases, and recent outpatient or inpatient clinical examination data of Keshan disease cases were collected; suspected cases were organized for clinical physical examination, electrocardiography (ECG), chest X-ray and echocardiography examination. According to "Notice of the National Health Commission on Printing and Distributing the Evaluation Measures for the Control and Elimination of Key Endemic Diseases (2019 Edition)", the diseased compliance status was assessed.Results:There were 174 diseased townships (towns) and 2 653 diseased villages in the whole province, with a permanent population of 2 819 342 people. A total of 87 suspected cases and 29 confirmed cases of Keshan disease were found, including 27 cases of chronic Keshan disease and 2 cases of latent Keshan disease. The acute and subacute Keshan disease and new cases with disease duration less than 1 year were not detected. The ST-T changes, premature ventricular contractions, complete right bundle branch block, left ventricular hypertrophy, and atrial fibrillation were the most common ECG changes in 29 cases of Keshan disease, and the single ECG change accounted for 6.90% (2/29), two changes accounted for 44.83% (13/29), and three or more changes accounted for 48.28% (14/29). There were 1 case with normal cardiothoracic ratio in chest X-ray examination, 10, 13, and 4 cases with mild, moderate and severe enlargement, respectively; 13 cases with enlarged left atrium in echocardiography, 15 cases with enlarged left ventricle, and 6 cases with enlarged heart.Conclusions:All the diseased areas in Shaanxi Province have reached the national standard for elimination of Keshan disease. Keshan disease monitoring should be continued, self-management of patients with chronic Keshan disease and follow-up observation of patients with latent Keshan disease should be strengthened, and treatment programs for patients with Keshan disease should be actively carried out to improve the quality of life of the patients.

Objective:To analyze the surgical types of patients with Kashin-Beck disease (KBD) in Shaanxi Province, and to provide reference for optimizing KBD surgery.Methods:Retrospective analysis was used to investigate KBD patients who underwent surgical treatment, and the patient's information was from the Shaanxi Provincial Endemic Disease Prevention and Control Information System. Patients with incomplete surgical treatment information were excluded, and χ 2 test was used to analyze the impact of factors such as gender, education level, living area, disease severity, and social environment on the selection of different surgical types (free body enucleation or joint replacement) for KBD patients. Using propensity score method to perform a 1 ∶ 1 match on patients with different surgical types, and analyzing the influencing factors of KBD patients receiving different types of surgical treatment through multivariate logistic regression. Results:From 2018 to 2020, a total of 1 084 KBD patients in Shaanxi Province underwent surgical treatment, including 555 males (51.20%) and 529 females (48.80%), with a median age of 64 years old. There were 917 patients (84.59%) in the Guanzhong region (Tongchuan, Xi'an, Weinan, Xianyang, Baoji), 120 patients (11.07%) in the northern Shaanxi region (Yulin, Yan'an), and 47 patients (4.34%) in the southern Shaanxi region (Ankang, Hanzhong, Shangluo). The number of patients with KBD grade Ⅰ,Ⅱ, and Ⅲ was 401 (36.99%), 525 (48.43%), and 158 (14.58%), respectively. Five hundred and forty-eight patients (50.55%) underwent free body enucleation surgery, and 536 patients (49.45%) underwent joint replacement surgery. Univariate analysis showed that different genders, educational levels, living areas, disease severity, economic status, whether to relocate, type of drinking water, type of staple food, and source of staple food were the influencing factors for KBD patients to choose the type of surgery (χ 2 = 81.82, 22.38, 93.68, 22.38, 5.17, 15.68, 13.82, 39.37, 49.63, P < 0.05). Among 374 pairs of patients who underwent free body enucleation and joint replacement through propensity score matching, multivariate logistic regression analysis found that high school and above education level [odds ratio( OR) = 0.42, P = 0.008], Guanzhong region ( OR = 0.12, P < 0.001), relocation ( OR = 0.60, P = 0.004), and drinking well water ( OR = 2.15, P = 0.001) were the influencing factors for KBD patients to choose different surgical types for treatment. Conclusion:When performing surgical treatment for KBD patients in Shaanxi Province, clinicians can consider the severity of the disease, as well as factors such as the education level, living area, relocation status, and type of drinking water of KBD patients, to provide more suitable surgical types for KBD patients.

Objective:To screen differential metabolites and metabolic pathways in urine of adult patients with Kashin-Beck disease (KBD), so as to provide scientific basis for finding specific biomarkers and pathogenesis of KBD.Methods:In Yongshou County, the KBD area in Shaanxi Province, adult KBD patients were selected as the case group, and healthy people without clinical symptoms of KBD were selected as the control group in the same disease area. The subjects' fasting mid-morning urine was collected, and liquid chromatography-mass spectrometry (LC-MS) technology was used to detect small-molecule metabolites in the urine. Multivariate statistical analysis [partial least square discriminant analysis (PLS-DA)] and comparison with KEGG and human metabonomics database (HMDB) were used to identify and screen differential metabolites and metabolic pathways in KBD patients.Results:A total of 58 subjects were included, 39 cases in the case group, including 23 males and 16 females; the age was (61.2 ± 7.8) years old; the body mass index was (22.7 ± 6.5) kg/m 2. There were 19 cases in the control group, including 10 males and 9 females; the age was (50.0 ± 9.0) years old; the body mass index was (24.3 ± 5.5) kg/m 2. Three first-order differential metabolites (HT-2 toxin, T-2 tetraol and seleno-adenosine selenomethionine) were identified and screened, which were highly related to the pathogenesis of KBD, and all were down-regulated. There were 38 second-order differential metabolites, among them, 10 were up-regulated and 28 were down-regulated. Nine differential metabolic pathways were screened, mainly involving amino acid metabolism, lipid metabolism and energy metabolism. Conclusions:The urine metabolism profiles of adult KBD patients and healthy people are significantly different, mainly involving amino acid metabolism, lipid metabolism and energy metabolism. The first-order differential metabolites HT-2 toxin, T-2 tetraol and seleno-adenosine selenomethionine are highly correlated with the pathogenesis of KBD.