Objective To study Keshan disease and its developmental trend in Zhangjiakou City in 2010 and to provide a scientific basis for further prevention of the disease.Methods From the eight diseased counties of Zhangjiakou City,five diseased countries were selected; in each diseased county a diseased village was selected as the clinical investigating point.Physical examination and Electrocardiography (ECG) tracings were carried out to suspicious patients with Keshan disease.Suspected heart enlargement,and ECG abnormalities were taken anteroposterior chest X-ray to measure the cardiothoracic ratio.Results A total of 2519 people were examined,16 cases were diagnosed as chronic Keshan disease,79 as latent Keshan disease,and the detection rate was 0.64％ (16/2519) and 3.14％(79/2519),respectively.Total of 2519 ECG tracings were taken,and electrocardiogram abnormalities were 268 cases,with a abnormal rate 10.64％,and most of them were complete right bundle branch block[accounted for 17.16％ (46/268)].Totally 94 cases of anteroposterior chest X-ray films were taken and 42 cases were cardiac enlargement,with a detection rate 44.68％.The numbers of mild,moderate and severe cases were 20,12 and 10,respectively,and the constituent ratio was 47.62％ (20/42),28.57％ (12/42),23.81％ (10/42),respectively.Conclusions The incidence of Keshan disease in Zhangjiakou City is relatively low,and the condition is stable.But monitoring and comprehensive prevention and control measure still should be strengthened.

Objective To find out the relation between element (non-iodized salt and iodized salt that below standard) and epidemic strength of iodine deficiency disorders and level of iodine, in order to find out the factors affecting the result of using iodized salt in controlling of this disorders. Methods Retrospective analyses was used in the study. Six counties were selected randomly from Zhangjiakou every year from 2000 to 2008, and these counties were randomly divided into non-iodized salt group (the ratio of non-iodized salt > 5%), iodized salt below standard group (the ratio of qualified iodized salt < 95%) and control group (the ratio of using qualified iodized salt > 95%). The indexes from different groups were compared as well as the ratio of large thyroid syndrome in children aged 8-10 years and the level of iodine in urine. Results The number of iodized salt monitored were 12 468 units from 2000 to 2008. We examined 5655 children's thyroid and collected 4404 urine samples. The median was 30.1 mg/kg for the average of iodized salt and 7.30% (232/3180) for ratio of non-iodized salt in noniodized salt group, while 30.9 mg/kg and 93.10%(3776/4056) in iodized salt below standard group, and 32.0 mg/kg and 99.27%(5194/5232) in control group. Compared the median of the three groups[5.31%(78/1468) ,4.84% (92/1902) ,2.06% (47/2285)], we observed significant difference (χ2 = 72.07, P < 0.05), especially the ratio of large thyroid in non-iodized salt group which was apparently higher than that of the control group (χ2 = 8.70, P < 0.017). However there was no significant difference between iodized salt below standard group and non-iodized salt group(χ2 = 6.83, P > 0.017) and control group(χ2 = 5.65, P > 0.017). The median of urinary iodine was 188.20 μg/L in non-iodized salt group, 219.62 μg/L in iodized salt below standard group and 262.39 μg/L in control group, indicated that the index in control group was higher than that of others. Conclusion Both of non-iodized salt and iodized salt below standard have effect on prevalence of child iodine deficiency disorders, especially the non-iodized salt.

Objective To analyze the monitoring results of urinary iodine of students aged 8 - 10 in Zhangjiakou city,problems in monitoring results,and to provide basic information for working out control strategies of iodine deficiency disorders.Methods A township(town,street) in each country of each city(district) in Zhangjiakou was selected according to 5 positions of the east,the west,the south,the north and center,and 1 village elementary school was sampled in each chosen township,twenty students(half male and female) aged 8 - 10 were selected to collect their urine samples in each school.Urinary iodine concentration was determined by arseniccerium method.Results The median of urinary iodine of the 1700 children aged 8 - 10 was 291.5 μg/L,with ＜ 50 μg/L accounted for 0.8％(13/1700),50 ～ 99 μg/L about 4.9％(83/1700),100 - 199 μg/L about 20.5％ (349/1700),200 - 299 μg/L about 29.7％(504/1700),and ≥300 μg/L about 44.9％(764/1700).Conclusions Urinary iodine has reached the elimination standard of iodine deficiency disorders in Zhangjiakou city.But the situation of more than adequate amount of urinary iodine and iodine excess is relatively serious and it is necessary to lower iodine concentration.

ObjectiveTo master iodized salt monitoring results in Zhangjiakou city Hebei province,search problems in these monitoring results,and provide a basis for the development of control measures to iodine deficiency disorders.MethodsBy 2010,in Zhangjiakou city,nine salt samples were collected to detect the iodine level in each processing,packing and wholesale enterprise according to their orientation of east,west,north,south and center positions.In each county(district) with nine townships(towns,street offices) and more,nine townships (towns,street offices) were selected according to their east,west,south,north and center positions,in each township (town,street office ) selected,four villages (neighborhoods) were selected,eight residents per household in each village (neighborhood) chosen were selected,and an edible salt was collected in each household to test iodine level; in a county(district) with nine or less townships(towns,street offices),five townships(towns,district offices) were selected according to their east,west,south,north and center positions,four villages (neighborhoods) were selected,and 15 residents per household in each village(neighborhood) were selected to test the iodine level in an edible salt samples;after population-weighted calculation,indicators of iodized salt monitoring were calculated.ResultsA batch quality pass rate of processing,packing and wholesale enterprise was 100％(192/192); the rate of weighted non-iodized salt in a household was 0.04％(2/4932),iodized salt coverage rate was 99.96％ (4930/4932),iodized salt passing rate was 99.55％ (4908/4930),and qualified iodized salt coverage rate was 99.51％ (4908/4932).ConclusionsMonitoring indicators of iodized salt in Zhangjiakou city have reached the standand to eliminate iodine deficiency disorders.However,there still have unqualified iodized salt and non-iodized salt,and the monitoring and iodized salt market management should be strengthened.

Objective To analyze comprehensively the monitoring data of iodized salt in Zhangjiakou city during 2001 to 2009, and to provide basic information for working out control strategies of the iodine deficiency disorders. Methods According to the iodized salt monitoring requirements in National Iodine Deficiency Disorders Monitoring Program of Ministry of Health, a batch of nine salt samples were taken from each processing (wholesale)company of each county or district of the seventeen counties(districts) of Zhangjiakou once a month. Two townships (towns, street offices) were selected by their location of east, south, west and north in each county(district), and a township in central area each year. Four villages(neighborhoods) were selected in each township(town, street office),and eight household salt samples were collected in each village(neighborhood), and quantitatively determined by direct titration of iodine. Results Iodized salt processing(wholesale) : during 2001 to 2009, a total of 1728 batches was monitored, 1689 batch qualified, batch qualification rate 97.74%;15552 salt samples were tested, 15 357 qualified, iodized salt qualification rate 98.75 %. Household salt levels : 5297 villages (neighborhoods) of 1305 townships(towns, street offices) were monitored, 44 316 salt samples were collected, 43 274 qualified, iodized salt qualification rate 98.04%(43 274/44 141 ), iodized salt coverage rate 99.61%(44 141/44 316), qualified iodized salt consumption rate 97.65%(43 274/44 316). Rate of non-iodized salt was 0.40%(260/44 316), and salt median iodine was 30.02 mg/kg. Conclusions The iodized salt quality indicators are within the state-controlled range in Zhangjiakou city for nine years which remaines at relatively stable levels with a smaller range of annual fluctuations.Detection of non-iodized salt over the years has become the main factors affecting the effectiveness of the prevention and control measures.We should increase monitoring,supervision,and universal health education,and prevent the spread of non-iodized salt.

Objective To master current operating situation of water-defluoridation-project and the level of fluoride in drinking water of Zhangjiakou city and provide a scientific basis for prevention and control of the disease.Methods Itemized survey of current operating situation of water defluoridation projects built in 2010 and before,and the source of fund situation in Zhangjiakou city was carried out.One source water and 2 terminal water samples of the projects in use were collected,respectively.Water fluoride were determined by Sanitary Standard for Drinking Water Testing Method (GB/T 5750.5-2006).Results A total of 386 water improvement projects to reduce fluoride were investigated,310 in good operation,accounting for 80.31％; 6 in intermittent use,accounting for 1.55％; 70 out of use,accounting for 18.14％.Water fluoride was surveyed in 316 water improvement projects to reduce fluoride,175 of the projects provided water with normal fluoride,accounting for 55.38％; 141 of the projects provided water with fluoride exceeded the standard,accounting for 44.62％.The total investment of 386 water defluoridation projects was 21.8682 million yuan,the investment of the state,the collective and the individual were 10.0780 million yuan,6.2104 million yuan and 5.5798 million yuan,accounted for 46.09％,28.40％,25.51％,respectively.Conclusions The current situation of the projects is very worrying in Zhangjiakou city.Further instensify the water improvement project in diseased areas,insist on sustainable water defluoridation strategy.

Background/Aims: Chronic hepatitis C (CHC) patients who failed antiviral therapy are at increased risk for hepatocellular carcinoma (HCC). This study assessed the potential role of metformin and statins, medications for diabetes mellitus (DM) and hyperlipidemia (HLP), in reducing HCC risk among these patients. Methods: We included CHC patients from the T-COACH study who failed antiviral therapy. We tracked the onset of HCC 1.5 years post-therapy by linking to Taiwan’s cancer registry data from 2003 to 2019. We accounted for death and liver transplantation as competing risks and employed Gray’s cumulative incidence and Cox subdistribution hazards models to analyze HCC development. Results: Out of 2,779 patients, 480 (17.3%) developed HCC post-therapy. DM patients not using metformin had a 51% increased risk of HCC compared to non-DM patients, while HLP patients on statins had a 50% reduced risk compared to those without HLP. The 5-year HCC incidence was significantly higher for metformin non-users (16.5%) versus non-DM patients (11.3%; adjusted sub-distribution hazard ratio [aSHR]=1.51; P=0.007) and metformin users (3.1%; aSHR=1.59; P=0.022). Statin use in HLP patients correlated with a lower HCC risk (3.8%) compared to non-HLP patients (12.5%; aSHR=0.50; P<0.001). Notably, the increased HCC risk associated with non-use of metformin was primarily seen in non-cirrhotic patients, whereas statins decreased HCC risk in both cirrhotic and non-cirrhotic patients. Conclusions Metformin and statins may have a chemopreventive effect against HCC in CHC patients who failed antiviral therapy. These results support the need for personalized preventive strategies in managing HCC risk.

Objective To evaluate the application of adding ondansetron in morphine intravenous analgesia pump for prevention of postoperative nausea and vomiting(PONV)in women. Methods Data of surgical female inpatients who received general anesthesia and postoperative intravenous analgesia with morphine in our center from January 1st,2013 to December 31st,2014 were retrospectively analyzed. Based on whether ondansetron was added,patients were divided into the observation group(n=834) and the control group(n=856). Outcome variables including morphine consumption,visual analogue scale(VAS) score,nausea score,and total times of vomiting within 48 hours after surgery were collected and compared. Results Age(t=0.432,P=0.665),morphine consumption during the first post-operative day(t=0.599,P=0.548) and during the second post-operative day(t=0.236,P=0.813),maximum VAS score of postoperative pain during movement during the first post-operative day [3(2,4) vs. 3(2,5);Z=1.850,P=0.064] and at rest during the second post-operative day [0(0,1) vs. 0(0,1);Z=1.511,P=0.131] were not significantly different between two groups. While the maximum VAS score of postoperative pain at rest during the first post-operative day [0(0,2) vs.0(0,2);Z=2.435,P=0.015] and during movement during the second post-operative day [3(1,3)vs.3(2,4);Z=3.445,P=0.001] were significantly different between two groups. The maximum score of postoperative nausea(χ=9.810,P=0.020) and cumulative frequency of postoperative vomiting(Z=3.726,P=0.002)in the observation group were significantly lower than those in the control group during the first post-operative day;however,there was no significant difference during the second post-operative day(χ=5.017,P=0.170;Z=0.000,P=1.000). Logistic regression analysis showed that adding ondansetron in morphine intravenous analgesia pump was an independent influencing factor of reduced postoperative nausea. The probability of nausea during the first post-operative day was 0.781 time(P=0.015)of that in the control group and 0.736 time(P=0.030)during the second post-operative day. Conclusion Adding ondansetron in morphine intravenous analgesia pump may reduce PONV in women.

Background/Aims: Real-world studies assessing the effectiveness and safety of sofosbuvir/velpatasvir (SOF/VEL) plus ribavirin (RBV) for Child-Pugh B/C hepatitis C virus (HCV)-related cirrhosis are limited. Methods: We included 107 patients with Child-Pugh B/C HCV-related cirrhosis receiving SOF/VEL plus RBV for 12 weeks in Taiwan. The sustained virologic response rates at off-treatment week 12 (SVR12) for the evaluable population (EP), modified EP, and per-protocol population (PP) were assessed. Thesafety profiles were reported. Results: The SVR12 rates in the EP, modified EP and PP were 89.7% (95% confidence interval [CI], 82.5–94.2%), 94.1% (95% CI, 87.8–97.3%), and 100% (95% CI, 96.2–100%). Number of patients who failed to achieve SVR12 were attributed to virologic failures. The SVR12 rates were comparable regardless of patient characteristics. One patient discontinued treatment because of adverse events (AEs). Twenty-four patients had serious AEs and six died, but none were related to SOF/VEL or RBV. Among the 96 patients achieving SVR12, 84.4% and 64.6% had improved Child-Pugh and model for endstage liver disease (MELD) scores. Multivariate analysis revealed that a baseline MELD score ≥15 was associated with an improved MELD score of ≥3 (odds ratio, 4.13; 95% CI, 1.16–14.71; P=0.02). Patients with chronic kidney disease (CKD) stage 1 had more significant estimated glomerular filtration rate declines than patients with CKD stage 2 (-0.42 mL/min/1.73 m2/month; P=0.01) or stage 3 (-0.56 mL/min/1.73 m2/month; P<0.001). Conclusions SOF/VEL plus RBV for 12 weeks is efficacious and well-tolerated for Child-Pugh B/C HCV-related cirrhosis.

Background/Aims: Real-world studies assessing the effectiveness and safety of sofosbuvir/velpatasvir (SOF/VEL) plus ribavirin (RBV) for Child-Pugh B/C hepatitis C virus (HCV)-related cirrhosis are limited. Methods: We included 107 patients with Child-Pugh B/C HCV-related cirrhosis receiving SOF/VEL plus RBV for 12 weeks in Taiwan. The sustained virologic response rates at off-treatment week 12 (SVR12) for the evaluable population (EP), modified EP, and per-protocol population (PP) were assessed. Thesafety profiles were reported. Results: The SVR12 rates in the EP, modified EP and PP were 89.7% (95% confidence interval [CI], 82.5–94.2%), 94.1% (95% CI, 87.8–97.3%), and 100% (95% CI, 96.2–100%). Number of patients who failed to achieve SVR12 were attributed to virologic failures. The SVR12 rates were comparable regardless of patient characteristics. One patient discontinued treatment because of adverse events (AEs). Twenty-four patients had serious AEs and six died, but none were related to SOF/VEL or RBV. Among the 96 patients achieving SVR12, 84.4% and 64.6% had improved Child-Pugh and model for endstage liver disease (MELD) scores. Multivariate analysis revealed that a baseline MELD score ≥15 was associated with an improved MELD score of ≥3 (odds ratio, 4.13; 95% CI, 1.16–14.71; P=0.02). Patients with chronic kidney disease (CKD) stage 1 had more significant estimated glomerular filtration rate declines than patients with CKD stage 2 (-0.42 mL/min/1.73 m2/month; P=0.01) or stage 3 (-0.56 mL/min/1.73 m2/month; P<0.001). Conclusions SOF/VEL plus RBV for 12 weeks is efficacious and well-tolerated for Child-Pugh B/C HCV-related cirrhosis.