Objective To observe the epidemic trends of Keshan disease (KD) from 1967 to 2012 in Chuxiong City,in order to provide a scientific basis for prevention and control of the disease.Methods The data below was collected and analyzed with epidemiological method.KD cases reported through registration and the death case reported were collected in Chuxiong City from 1960 to 2012,also the reported monitoring results of KD and the adult KD screening results of dilated cardiac patients and mountain patients in 2012 were collected,then epidemic trends of KD was analysed comprehensively.Results There were 1 569 cases of KD registered from 1967 to 2012.There were 566 death cases of KD.The total prevalence rate of KD was 7.7％ (226/2 953) by monitoring children KD at the diseased areas of KD and the potential KD patients accounted for 97.3％ (220/226) from 1990 to 1994.The total prevalence rate of KD was 0.6％ (44/7 174) by surveillance at KD diseased areas from 2005-2012 and the potential KD patients accounted for 70.5％ (31/44),there were 7 children cases of KD under 15 years who accounted for 15.9％ from 2005 to 2012.Totally 313 551 children were given sodium selenium for supplying selenium from 1976 to 2008.Totally 151 cases of KD were found by screening from the patients with dilated cardiac patients since 1988 and they were all chronic KD patients.There were 112 cases of KD in 2012 and there were 6 children cases of KD under 15 years,which accounted for 5.4％.Chuxiong City Keshan disease epidemic presented from subacute Keshan disease to Keshan disease,to latent Keshan disease a slow transition;age from children (＜6 years) to children (＜15 years) to adult-oriented features.Conclusions The incidence and prevalence rate of KD has reached the basic control standards,but children KD is coexisting with adults KD.The pathogenic factors have not been eliminated,disease monitoring and health promotion should be carried out.

Objective To examined the relationship between the Fast Plasma Glucose(FPG) and the Postprandial Plasma Glucose(PPG) by analyzing 3 588 OGTT and IRT,and assessed the role of PPG in the diagnosis of type 2 diabetes.Methods Data of OGTT and IRT in 3 588 patients from 2000-Jan to 2007-June were collected and the distribution of the patients evaluated with cut-points of fasting plasma glucose by 5.6 mmol/L,6.1 mmol/L & 7.0 mmol/L and postprandial plasma glucose by 7.8 mmol/L and 11.1mmol/L were analyzed.T-test and corrected t-test of two independent samples have been done with SPSS 11.5.Results By WHO standard,3 097 T2DM were diagnosed.Of 2654 T2DM patients diagnosed by FPG≥7.0 mmol/L,54 patients showed 2 h PG0.05).202 cases were NGT(but hyperinsulinemia and/or delayed insulin secretion were found in 113 of them,55.94%).Other 289 cases were IFG and/or IGT.In the 291 cases diagnozed with 1 h PG≥11.1 mmol/L and 2 h PG

OBJECTIVETo summarize the techniques and evaluate the therapeutic effect of posterior fixation and fusion in the treatment of Os odontoideum complicated by atlantoaxial dislocation.

METHODSFrom March, 2007 to October, 2010, 10 patients with Os odontoideum (including 6 male and 4 female patients aged from 20 to 65 years, mean 39.8 years) were treated in our hospital. Before and after the operation, the patients underwent X ray, CT and MRI examinations to measure and evaluate the degree of dislocation and neural compression. After preoperative traction for 1-2 weeks, all the 10 patients showed deductible atlantoaxial dislocation. Through a posterior approach, Atlantoaxial pedicle screws fixation were performed in 9 cases, and C2/3 pedicle-Occiput screw fixation was performed in 1 case. All the patients wore cervical collars as external support for 3 months after the operation.

RESULTSThe mean operative time was 3 h in these patients with a mean intraoperative blood loss of 420 ml. The symptoms were relieved after the surgery in all the patients, who showed no neck pain or neurological defects. The patients were followed up for 6 to 52 months (mean 22 months), and bony fusion was observed in all the 10 cases within 6 to 8 months without such complications as internal fixation failure or redislocation of the atlas.

CONCLUSIONPatients with Os odontoideum complicated by atlantoaxial dislocation should undergo surgical stabilization to avoid severe neurological injury. Pedicle screw instrument in the atlas allows restoration of the spinal stability, short-segment fusion, and maximal preservation of the mobility of the neck.

Adult ; Aged ; Atlanto-Axial Joint ; injuries ; Bone Transplantation ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Joint Dislocations ; complications ; surgery ; Joint Loose Bodies ; complications ; surgery ; Male ; Middle Aged ; Odontoid Process ; pathology ; Spinal Fusion ; methods ; Treatment Outcome ; Young Adult

Objective    To investigate the clinical effect of in situ fenestration combined with chimney technique in the treatment of aortic dissection involving left common carotid artery. Methods    From January 2012 to June 2019, 53 patients with aortic dissection involving left common carotid artery were selected. There were 21 patients in the test group, including 14 males and 7 females, with an average age of 57.2±11.2 years; there were 32 patients in the control group, including 20 males and 12 females, with an average age of 56.7±12.1 years. In the test group, the left subclavian branch was reconstructed by in situ fenestration and the left common carotid artery was reconstructed by chimney technique. In the control group, the left common carotid artery was reconstructed by hybrid operation. The clinical data of the patients were compared. Results    The operation time of the test group was significantly longer than that of the control group (151.8±35.2 min vs. 101.3±29.6 min, P=0.00). The patients in the two groups were followed up for 6-20 months. There was no significant difference in the incidence of pulmonary infection, stroke, steal blood syndrome, false lumen thrombosis or internal leakage between the two groups (P>0.05). The diameters of the distal and proximal ends of the true cavity in the test group increased significantly compared with those in the control group (P<0.05). Conclusion    In situ fenestration combined with chimney technique is an effective method for the treatment of aortic dissection involving left common carotid artery, which is worthy of further clinical promotion.

Objective To study the effect of diffusion-weighted magnetic resonance imaging (DW-MRI) in the differential diagnosis of hydronephrosis and pyonephrosis.Methods From March 2015 to October 2017,50 patients with renal stone and highly suspected infectious hydronephrosis underwent renal DW-MRI,and clinical materials were collected and analyzed retrospectively.Seventeen male and 33 female patients were enrolled with a mean age of (49.40 ±-10.51) years.The median maximum diameter of renal stone was 30.30 (17.38,56.01) mm and hydronephrosis was 46.39 (34.33,56.55) mm.No pyonephrosis was diagnosed by preoperative ultrasound or CT,while 29 cases of hydronephrosis and 21 cases of pyonephrosis were reported by preoperative DW-MRI.Final diagnoses of hydronephrosis and pyonephrosis were made according to whether the pelvic urine drainage was purulent or not during the surgery.DW-MRI reports and characteristics of DW images were analyzed retrospectively.Apparent diffusion coefficient (ADC) was calculated and ADC map constructed,which was compared between the two groups.Receiver operating characteristic curve (ROC) was drawn to analyze the area under curve (AUC) and the optimal cutoff of ADC value,with sensitivity and specificity.Results Thirty-three patients of hydronephrosis and 17 pyonephrosis were confirmed intraoperatively.The overall accuracy of diagnosis using DW-MRI was 84.00％ (42/50),with sensitivity of 88.24％ (15/17) and specificity of 81.82％ (27/33).Among 30 patients who underwent CT scan in our hospital,mean CT value of 18 hydronephrosis was (7.03 ± 3.26)HU and that of 12 pyonephrosis was (8.67 ± 3.52) HU,with no statistical significance (P ＞ 0.05).On DW image,when b ≥ 500 s/mm2,hydronephrosis signal intensity was lowered apparently,whereas pyonephrosis signal intensity was intensified.On ADC map,hydronephrosis appeared as hyperintensity,whereas pyonephrosis appeared as hypointensity.The mean ADC value of pyonephrosis group was lower than hydronephrosis group [(1.53 ±0.58) × 10-3 mm2/s vs.(2.86 ±0.56) × 10-3 mm2/s,p ＜0.01].ROC analysis revealed that AUC =0.92 (95％ CI 0.80-0.98),and the cut-off value of ADC for pyonephrosis diagnosis was 1.39 × 10-3 mm2/s,of which the sensitivity and specificity was 94.12％ and 84.85％ respectively.Conclusions Signal of pyonephrosis was enhanced on DW image,while decreased on ADC image.The ADC value of pyonephrosis was much lower than that of hydronephrosis,with which the differential diagnosis between pyonephrosis and hydronephrosis could be made efficiently.

The elastic stress and viscous shear stress experienced by the vessel wall under pulse blood pressure and blood flow and the mechanical properties of the substrate constitute the in vivo mechanical niches of vascular cells, and these mechanical stimuli are involved in regulating the biological responses of vascular cells and inducing the remodeling and pathological changes of vascular tissues. Although many experimental studies on vascular mechanobiology have been reported, the quantitative correlation between the mechanical stimuli of in vitro experiments and the physiological and pathological conditions of blood vessels remains to be elucidated. This paper summarized the quantitative evaluation method of in vivo mechanical niches of vascular cells from the viewpoint of biomechanics, and then focused on effects of the physiological locations and aging on mechanical behaviors of the vessel wall. This paper also explored the physiological and pathological characteristics of the cellular mechanical niches and their implications for current vascular mechanobiological studies.

Objective:Objectives The aim of the study is to evaluate the mechanical performance, safety and efficacy of the novel robotic-assistant flexible ureteroscopy system (Ra-fURS) under in vitro and in vivo environments.Methods:Combing with commercial flexible ureteroscopes, the novel Ra-fURS was used for the in vitro test and animal model operation in October 2020. The study included three sections. ①Basic mechanical performance assessment: including endoscope motion control (dual deflection, axial rotation and forward/backward distance), reaction time and fiber regulation. ②Simulated surgery in ex-vivo 3D-printing renal collecting system model: including completion rate and time of calyxes exploration, directional movement and laser fragmentation [gypsum models (0.5×0.5×0.5 cm) were used to stimulate kidney stones]. ③Intrarenal surgeries in animal models (two 5-month female Yorkshire white pigs). In total, 32 surgeries was performed (8 surgeons × 2 pigs × 2 kidneys/pig). In vivo assessments were carried out including: ①consuming time for Ra-fURS installation and offloading; ②completion rate and time of calyxes exploration; ③comfort score (ranging from 0-10) as compared to the manual f-URS, which was corresponding to each Ra-fURS surgery. In simulated surgery and animal surgery sections, 8 surgeons were enrolled in the study (group A 4 without flexible ureteroscopy experience; group B: 4 highly experienced), and results were compared between two groups.Results:Under the Ra-fURS control, the flexible ureteroscope movement in three degrees of freedom (forward / backward: + 11 to -11 cm, axial rotation + 225°to -225°; active duel-flection: + 270°to -270°, as well as the laser fiber regulation + 2.5 to -2.5 cm). In simulated surgery tests, both groups achieved 100% completion rate of calyxes exploration, and there were no statistical differences in the time of the calyxes exploration between group A and group B (116.0±8.0)s vs.(110.3±15.4)s( P>0.05). Time-consumption for laser fragmentation of group B was shorter than that of group A (525.8±58.5)s vs. (780.5±141.2)s( P<0.01). In animal surgery, the installation time of Ra-fURS gradually shortened within the first 7 cases was(234.0±43.0)s, and became comparable in the later 8-32 cases was(149.3±8.0)s. The average uninstall time was (43.9 ±5.9)s and was relatively stable. There were 51 renal calyxes in two pigs. It was higher for the completion rate of calyxes exploration in group B than in group A [(95.5±9.1)% vs. (59.1±9.1)%, P<0.05], and the exploration time was also statistically variant between the two groups group A and group B[(274.8±34.6)s vs.(127.3±18.2)s, P<0.05]. For all the operators, the comfort scores were favorable to the Ra-fURS as compared to the manual f-URS (8.9±0.3 vs. 5.9±1.1, P<0.05). Conclusions:This preliminary study demonstrated that the novel Ra-fURS was capable of controlling flexible ureteroscope to perform retrograde intrarenal surgery and fragmenting stones with laser. Besides, other features, including easy installation, stable performance and comfortable manipulating environment, made it easy to use in clinical application.

Objective To investigate the in vivo stress distribution of the atherosclerotic plaque at carotid bifurcation, so as to provide references for the mechanical mechanisms of plaque rupture at carotid bifurcation and the design for further medical treatment. Methods The three-dimensional geometric model of carotid bifurcation and plaque were established according to average geometric parameters of human carotid bifurcation. Residual stress of the carotid bifurcation and plague was reestablished with “thermal-structure” coupling method, and in vivo stresses of vessels with the plaque at carotid bifurcation under blood pressure and blood flow were calculated. Results Both the maximum principal stress and elastic shear stress concentrated on the shoulder of the plaque. Elastic shear stress increased with the increase of stenosis ratio and blood pressure. Wall shear stress in the upstream of the plaque was considerably higher than that of the downstream. The distribution of oscillatory shear index(OSI) was quite the opposite. The changing patterns of the elastic shear stress and flow shear stress were quite different with the change of stenosis ratios. Conclusions Tension grew gradually from the centrality to shoulder surface of the plaque. The centrality of the plaque might bear compression when the stenosis was very severe. The periodic variation of the structural stress might cause structural fatigue of the plaque, thus increasing the rupture risk. Distinction of the component and vulnerability of the plaque between upstream and downstream might be caused by differences in hemodynamic parameters of the plaque between upstream and downstream.

OBJECTIVE: To explore the applicability of Singapore Ministry of Manpower( MOM) risk model and MES model in risk assessment of occupational health hazard caused by chemical poisons in shoemaking enterprises. METHODS: A medium-sized shoemaking enterprise in Guangzhou City was selected as the research object to carry out on-the-spot investigation of occupational health,measure the level of chemical hazards in the air of the workplace. Occupational health risk assessment of chemical toxins in the workplace was conducted using the MOM model and the MES model,and the results of the two evaluations were compared. RESULTS: The occupational chemical hazards in workplace of the shoemaking enterprise mainly included the toluene,xylene,ethyl acetate,butyl acetate,n-hexane,and 1,2-dichloroethan( 1,2-DCE). The concentration-time weighted average( CTWA) of 1,2-DCE at the stitching post,methylbenzene at the brush coating post and ethyl acetate at the cleaning post exceeded occupational exposure limits. The MOM model assessment results showed that methylbenzene was of high risk and 1,2-DCE was of medium risk in brush coating post. n-Hexane and1,2-DCE were of medium risk in stitching post. Ethyl acetate and 1,2-DCE was of medium risk in cleaning post. The results of the MES model evaluation showed that the risk level of n-hexane and 1,2-DCE used in sticking,brush coating and cleaning posts was extremely high and the remaining chemicals were highly dangerous. CONCLUSION: Both MOM model and MES model can easily predict and assess the occupational health risk of various posts in shoemaking enterprises to some extent. The assessment result of MES model is more practical than that of MOM model.

Objective:Tumor-treating fields (TTFields) is a kind of non-invasive anti-mitotic tumor therapy, which has been approved for patients with newly diagnosed and recurrent glioblastoma. This study aims to explore the efficacy and safety of TTFields in high-grade gliomas in clinical practice settings.Methods:The clinical data of 15 patients with recurrent glioma and 9 patients with newly diagnosed high-grade glioma admitted to our center from April 2019 to January 2021 were retrospectively analyzed. All patients accepted TTFields≥1 month. Follow-up was performed for 5.3 months (ranged from 2.3 to 10.7 months); Response Assessment in Neuro-Oncology Working Group (RANO) criteria was used to evaluate the glioma responses. The progression-free survival (PFS) and overall survival (OS) were calculated according to Kaplan-Meier method. Common Terminology Criteria for Adverse Events v5.0 (CTCAE v5.0) and TTFields related skin adverse reaction (dAE) criteria were used to evaluate the adverse events. Quality of life questionnaire-core 30 (QLQ-C30) and QLQ-brain cancer module (QLQ-BN20) questionnaires were used to evaluate the health-related quality of life (HRQoL). Treatment compliance was evaluated by data on the use of NovoTTF-200A devices, and calculated as a percentage of daily TTFields usage.Results:The median duration of TTFields was 4.2 months (ranged from 1.0 to 10.7 months), with a median compliance rate of 91.5% (67.0%-97.0%). TTFields was used alone in 2 patients and used with combination of chemotherapy in 22 patients. From follow-up to April 2021, 14 patients had stable symptoms and 10 had disease progression (8 died). The median PFS and OS of recurrent patients were 5.9 months ( 95%CI: 3.3-8.6 months) and 8.5 months ( 95%CI: 3.2-13.8 months), respectively; and the median PFS and OS of newly diagnosed patients were both 10.7 months (without 95%CI). The common adverse events included grading 1 dAE (58.3%) and grading 2 dAE (12.5%), without grading 3 or 4 dAE, manifested as contact or allergic dermatitis, erosion, folliculitis and ulcers. And 87.5% patients had stable HRQoL. Conclusions:The preliminary results showed that the survival of recurrent high-grade glioma patients treated by TTFields is similar to that reported in foreign literature; and the newly diagnosed patients need further survival follow-up. The patients' treatment compliance and safety are good. The dAE incidence (grading 1-2) is higher than that reported in the literature, and the toxicity was acceptable.