Objective To study the relationship between environment selenium distribution characteristic and Kaschin-Beck disease (KBD) in the Yarlung Zangbo River banks and to provide some measures for prevention and control of KBD in the north side of the river bank.Methods Considering the geography and KBD distribution,we made a survey in Xietongmen (KBD area),Lazi and Sajia (non-KBD area) counties in 2013 and 2015.Water,soil,herbage,grain food and children hair samples were collected.Selenium of the samples was measured by hydride generation-atomic fluorescence spectrometry.Results A total of 246 samples of natural soil,cultivated soil,drinking water,food and forage,and 103 samples of children hair were collected.The selenium in natural soil,cultivated soil,herbage,barley,tsampa,self-produced wheat in non-KBD area in the south side of Yarlung Zangbo River bank were significantly higher than those in KBD areas in the north side [mean (μg/kg):288.62 vs 134.90,228.26 vs 160.28,41.85 vs 5.10,13.99 vs 4.02,12.64 vs 8.07,27.44 vs 13.56,U =7,23,0,19,62,0,P ＜ 0.05].Hair selenium in school children in KBD area in the north side was higher than that previously reported,but still significantly lower than that in non-KBD areas in the south side of the river bank [mg/kg:0.221 vs 0.306,U =650,P ＜ 0.01],and about 65.45％ (36/55)of school children in KBD area were at a risk of selenium deficiency in the north of the Yarlung Zangbo River bank.Conclusions The selenium contem in the food chain of soilplants-animals (human being) is significantly lower in KBD area in the north side of Yarlung Zangbo River bank than that in non-KBD areas in the south side.It's still a key factor for the occurrence and prevalence of KBD that low selenium in environment in KBD areas in the north side.

Objective To explore the effect of transcutaneous electrical acupoint stimulation bracelet at Neiguan acupoint on the postoperative nausea and vomiting after thyroidectomy under general an-esthesia.Methods Seventy-two female patients underwent thyroidectomy,aged 18-50 years,ASA physical status Ⅰ or Ⅱ,were enrolled.The patients were assigned 1 ∶ 1 to two groups by permuted block randomization:the electrical stimulation group and the control group,36 patients in each group.Before an-esthesia induction,patients in both groups wore domestic transcutaneous electrical acupoint stimulation bracelets,and the electrodes were aimed at Neiguan acupoint.The electrical stimulation group started to stimulate Neiguan acupoint,and adjusted the proper intensity to make the patient feel tingling in the related area of the hand.When the bracelet was fixed firmly,turned it off.At the end of the operation,the bracelet was turned on with the stimulation intensity set before induction for 24 hours.Patients in the control group also wore the bracelet for 24 hours,but it was never turned on.The number of cases of postoperative nausea and vomiting(PONV)and the number of remedial cases of antiemetic drugs were recorded.Results Compared with the control group,the incidence of PONV and postoperative vomiting in the electrical stimula-tion group were significantly reduced within 24 hours after surgery(P＜0.05),and the differences were mainly in 1-6 hours after surgery(P＜0.05).There was no significant difference in the rate of remedial ca-ses of antiemetic drugs between the two groups at different time periods.Conclusion Transcutaneous electri-cal stimulation bracelet at Neiguan acupoint can effectively reduce the incidence of PONV within 24 hours after thyroidectomy.

Objective A pilot study found the masking level difference (MLD) normal value of Chinese aged from 10 to 40,served to clinical practice.Method Seventy-three normal persons with hearing threshold ＜ 20 dB and no disorder of otology were divided into three groups:classified 10-20 age as A group,21-30 age as B group,31-40 age as C group.MLD of age,gender and race were determined by the audiometer with dual channel by playing audio test disc.Same tests were compared with English language.Results The mean value of MLD in Chinese was (11.1 ± 3.4) dB and the 95 ％ normal reference values were between 4.4 to 17.8 dB.There was no difference in term of gender.The value of MLD increased with age.In the term of language,foreign showed high value of MLD than that of Chinese.Conclusions The measuring of MLD depends on age and language but not depends on gender.The normal threshold of MLD depends on age and language should be measured when normal values were applied to assess MLD in clinical practice.

From April to November 2019, 5 community health service centers in Shanghai Hongkou District were randomly selected for thematic group interviews to investigate the current status, problems and challenge for further development of chronic disease management. The community chronic disease management was mainly divided into growth period (typically hypertension and diabetes) and introduction period (cardiovascular and cerebrovascular diseases, respiratory diseases, dementia, osteoporosis). The management of hypertension and diabetes in the growing stage mainly faced difficulties such as refusal or non-cooperation of patients, loss of follow-up, incomplete quality control, not meeting quality control indicators, repeated management of comorbidities, insufficient information sharing, and discrepancy in assessment indicators of multiple parties. The management of cardiovascular and cerebrovascular diseases, respiratory diseases and other diseases in the introduction period mainly faced poor awareness rate of patients, loss of follow-up, difficulty in diagnosis, irregular medication, insufficient information sharing, lack of management plan, insufficient resource investment, and few variety of medicines in the community. The current management system should be refined to provide more effective and efficient chronic disease management in the community. Meanwhile, the awareness of residents, the information network and multi-center collaborative research also need to be strengthened.

Objective:To investigate the therapeutic efficacy of the combination therapy with CD47-based nanoparticles and anti-PD-L1 monoclonal antibody (αPD-L1) for preventing tumor recurrence and metastasis in vivo.Methods:BALB/c mice were used to construct 4T1 tumor-bearing mouse models. The mouse model was treated with the combination therapy to analyze the effects on local tumor recurrence, tumor growth volume, survival time and lung metastasis in the 4T1 mammary tumor-bearing mouse model.Results:The combination therapy could effectively inhibit local tumor recurrence and prolong the survival time of tumor-bearing mice ( P<0.001). Compared with the αPD-L1 group, the combination therapy can increase the expression of cytokines tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) in mouse serum (all P<0.05) and effector memory T cells in mouse spleen ( P<0.001). In addition, the results on the 4T1-Luc mammary tumor-bearing mouse lung metastasis model showed that the combination therapy could effectively inhibit tumor lung metastasis. Conclusions:The results strongly suggested that combination therapy with CD47-based nanoparticles and αPD-L1 can effectively elicit the memory immune response, and prevent tumor recurrence and lung metastasis.

Microsimulation model simulates individuals and estimates transition probabilities within the population using individual participant data. This approach could deal with the heterogeneous characteristics among the people or personal history of diseases and may be relevant in addressing cost-effectiveness problems of screening for complex conditions in epidemiology. This paper introduces the general principles, basic steps involved in implementation, analytic methods, and other related issues of the microsimulation model. Based on a practical research case of estimating the cost-effectiveness of microalbuminuria screening for chronic kidney disease in the United States, critical points in applications of the microsimulation model for cost-effectiveness analysis of screening were discussed in detail, including model development, model analysis, and the interpretation of the results. The microsimulation model considers the dynamic nature of complex diseases by estimating a broad range of individual characteristics and increasingly used to provide insights into complex problems that the Markov model does not efficiently address. For better supporting evidence-informed decision-making in public health, future studies should be aware of the accuracy of parameters in the decision-analytic model and the transparency of the models and results, as well as complying with the relevant reporting standards.

Objective:To study the clinical value of SpyGlass direct visualization system-guided radiofrequency ablation (RFA) combined with biliary stent implantation in the treatment of malignant biliary stricture.Methods:Clinical data of 29 patients with advanced malignant biliary stricture without surgical resectability who received palliative endoscopic treatment in Drum Tower Hospital of Nanjing University Medical School and Wuxi No.2 People’s Hospital were retrospectively analyzed, including 20 males and 9 females, aged (70.3±11.5) years. Patients were divided into two groups: the SpyGlass-guided biliary RFA combined with biliary stent implantation treatment group (combined group, n=14) and the simple biliary stent treatment group (simple stent group, n=15). The age, gender, body mass index (BMI), the total bilirubin, jaundice remission, postoperative complications, stent patency time and survival period were compared between the two groups. Results:Among 29 cases, 20 were cholangiocarcinoma (69.0%), 4 were hepatocellular carcinoma (13.8%), 3 were carcinoma of gallbladder (10.3%), and 2 were ampullary carcinoma (6.9%). There were no statistically significant difference in age, male proportion, primary tumor proportion, BMI and total bilirubin between the groups (all P>0.05). The postoperative total bilirubin of the combined group was 41.5(29.8, 52.5)μmol/L, and that of the stent group was 55.4(31.5, 107.1)μmol/L ( Z=1.18, P=0.247). There were 11 cases of jaundice remission in the combined group and 10 in the stent group ( χ2=0.51, P=0.474). The stent patency time in the combined group was 90 (77, 250) days, and that in the stent group was 100 (60, 190) days ( Z=0.28, P=0.793). There was no significant difference in cumulative survival rates and incidence of postoperative complications between the two groups ( P>0.05). Conclusion:SpyGlass-guided biliary RFA combined with biliary stent implantation neither improves the treatment efficacy nor prolongs stent patency time in patients with malignant biliary strictures.

Objective:To assess the efficacy and safety of cinepazide maleate injection in the treatment of patients with acute ischemic stroke.Methods:A multicenter, randomized, double-blind, placebo-controlled phase Ⅳ clinical trial, led by Peking Union Medical College Hospital, was conducted in 65 Hospitals in China. The efficacy of cinepazide maleate injection in patients with acute anterior circulation cerebral infarction with onset time of ≤48 hours, 7≤National Institute of Health stroke scale (NIHSS) score ≤25 was assessed from August 2016 to February 2019, using the proportion of modified Rankin scale (mRS) score≤1 and Barthel index (BI) score≤95 on day 14 as efficacy endpoint. The patients were divided into treatment group who were treated with cinepazide maleate injection and control group who were treated with placebo.Results:A total 937 patients were involved in the final efficacy analysis (466 in treatment group and 471 in control group). The proportion of subjects with mRS score≤1 on day 14 after treatment were higher in the treatment group than that in the control group (102/466(21.89%) vs76/471(16.14%)). Logistic regression analysis showed that patients treated with cinepazide maleate were significantly more likely to have a favorable outcome (mRS score≤1) than patients treated with placebo on day 14 ( OR=0.677, 95% CI 0.484-0.948 , P=0.023), and patients treated with cinepazide maleate were more likely to reach independence in activities of daily living (Barthel Index ≥95) than those treated with placebo on day 14 (125/466(26.82%) vs 91/471(19.32%); OR=0.632, 95% CI0.459-0.869, P=0.005). The rate of adverse events was similar between the treatment and control groups. Conclusion:The 14-day treatment with cinepazide maleate injection could reduce the degree of disability whereas did not increase the risk of adverse events.

Objective:To investigate the blood pressure change in patients with acute ischemic stroke (AIS) and hypertension treated with cinepazide maleate injection.Methods:This was a subgroup analysis of post-marketing clinical confirmation study of cinepazide maleate injection for acute ischemic stroke: a randomized, double-blinded, multicenter, placebo-parallel controlled trial, which conducted in China from August 2016 to February 2019. Eligible patients fulfilled the inclusive criteria of acute anterior circulation ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 7-25. The primary endpoints were mean blood pressure of AIS patients treated with cinepazide maleate or control, which were assessed during the treatment period (14 days), and the proportion of the patients with normal blood pressure was analyzed after the treatment period. Furthermore, a subgroup analysis was performed to investigate a possible effect of the history of hypertension on outcomes.Results:This analysis included 809 patients with hypertension. There was no significant difference in patients blood pressure and the proportion of patients with normal blood pressure (60.5% vs. 59.0%, P>0.05) between cinepazide maleate group and control group. Conclusion:Administration of cinepazide maleate injection does not affect the management of clinical blood pressure in patients with AIS.

Objective:To confirm the efficacy and safety of cinepazide maleate injection in acute ischemic stroke patients with obvious motor function deficit.Methods:This study is a subgroup analysis of multi-center, randomized, double-blind, placebo-controlled phase Ⅳ clinical trial. A total 812 patients of acute ischemic stroke with obvious limb motor deficit [motor function of limbs score in National Institutes of Health Stroke Scale (NIHSS) ≥4] were enrolled in this subgroup analysis. Patients received either cinepazide maleate injection or placebo. The treatment period was 14 days and follow-up was 90 days. The efficacy endpoints included the proportions of patients with a modified Rankin Scale (mRS) score ≤2, mRS score ≤1 and Barthel Index <95 on day 90. Safety was evaluated by recording all adverse events, monitoring vital signs, laboratory parameters and electrocardiogram.Results:A total of 732 patients were involved in the final efficacy analysis (361 in cinepazide maleate group and 371 in control group). The baseline limb motor function score of NIHSS was 5.23±1.43 in the cinepazide maleate group whereas 5.20±1.36 in the control group. Logistic regression analysis showed that following treatment for 90 days, the proportion of patients with a mRS score ≤2 was significantly higher in the cinepazide maleate group than in the control group [56.0% (202/361) vs 44.2% (164/371), OR=0.60, 95% CI 0.44-0.82, P=0.002]. The proportion of patients with a mRS score ≤1 was higher in the cinepazide maleate group than in the control group [43.3% (139/361) vs 35.2% (118/371), OR=0.69, 95% CI 0.50-0.97, P=0.031]. The proportion of patients with a Barthel Index <95 on day 90 was significantly lower in the cinepazide maleate group than in the control group [45.2% (145/361) vs 55.2% (185/371), OR=0.64, 95% CI 0.46-0.88, P=0.007]. During the treatment and follow-up period, the incidence of the most common adverse events in the cinepazide maleate group was 50.4% (199/395). Constipation and abnormal liver function were more common, but there were no statistically significant differences between the two groups. Conclusion:Cinepazide maleate injection is superior to placebo in improving neurological function and activities of daily living, reducing disability, and promoting functional recovery and safe in patients with acute ischemic stroke with obvious limb motor deficit.