1.Bibliometric analysis of research trends and hotspots in gamma-aminobutyric acid and liver-related diseases
Zhihao BAI ; Jiaxin LI ; Zhen YANG ; Ning ZHOU
Chinese Journal of General Surgery 2025;34(6):1246-1261
Background and Aims:Gamma-aminobutyric acid(GABA),the principal inhibitory neurotransmitter in the central nervous system,has been increasingly recognized in recent years as being closely associated with various liver-related diseases,such as hepatic encephalopathy,liver cirrhosis,and hepatocellular carcinoma.Abnormal GABA expression is strongly linked to pathological processes including cognitive impairment and neuroinflammation.Although numerous studies have investigated the mechanistic roles of GABA in neurological complications of liver disease,a systematic overview of the field's research trends,collaborative networks,and emerging hotspots remains lacking.This study employs bibliometric methods to comprehensively map the evolution and frontier topics in GABA and liver-related disease research from 2005 to 2024,aiming to inform future research planning and resource allocation in this area.Methods:English-language publications from 2005 to 2024 related to GABA and liver-related diseases were retrieved from the Web of Science Core Collection.Eligible articles were analyzed using VOSviewer,CiteSpace,and the R package"bibliometrix"to visualize and evaluate contributions by countries/regions,institutions,authors,and journals.Additional analyses included keyword clustering,co-citation analysis,and thematic evolution of research topics.Results:A total of 237 articles were included,contributed by 1 340 authors across 456 institutions in 47 countries,and published in 168 journals.The United States and China are leading contributors in this field.Although countries such as the United Kingdom and Italy had fewer publications,they demonstrated higher average citation counts,indicating strong research quality.Notably,Spain's Centro Investigación Principe Felipe and the research team led by Felipo Vicente exhibited high academic influence.Neurochemistry International and Hepatology were identified as core journals,with Hepatology having the highest impact factor(12.9).Keyword clustering revealed major research focuses including the regulatory role of GABA in the neural mechanisms of hepatic encephalopathy,the impact of liver-related metabolic disorders on neurotransmitter balance,the development and evaluation of GABA receptor-targeted therapeutics,and the function of the GABAergic system in the pathogenesis of hepatocellular carcinoma.As research deepens,the frequency of emerging keywords has diversified,with recent emphasis on terms such as"quality of life,""gene expression,"and"fatty liver disease,"reflecting a shift from fundamental mechanisms to clinical translation and interdisciplinary integration.Conclusion:The relationship between GABA and liver diseases has become a focal point of interdisciplinary research.Investigations have expanded from pathological mechanisms to therapeutic applications,with growing interest in GABA's roles in hepatic encephalopathy,metabolic dysregulation,and tumor progression.Future studies should explore the specific functions of GABA receptor subtypes,promote the development of precision-targeted therapies,and investigate novel mechanisms such as the gut microbiota-GABA metabolism-brain-liver axis to broaden the clinical and translational potential of GABA in neurological,metabolic,and oncological contexts.
2.Multi-omics analysis of the relationship between oxidative stress-related gene and prostate cancer
Jiaxin NING ; Haoran WANG ; Shuhang LUO ; Jibo JING ; Jianye WANG ; Huimin HOU ; Ming LIU
Journal of Peking University(Health Sciences) 2025;57(4):633-643
Objective:To investigate the relationship between oxidative stress-related genes and pros-tate cancer(PCa)from a multi-omics perspective using summary-data-based Mendelian randomization(SMR),colocalization analysis,and cellular experiments.Methods:Summary-level data on DNA methylation,gene expression,and circulating proteins were obtained and filtered.The PRACTICAL con-sortium was used as the discovery cohort,with the deCODE database serving as the validation cohort.SMR analysis and heterogeneity in dependent instruments(HEIDI)tests were conducted to assess the association and heterogeneity between oxidative stress-related genes and PCa.Colocalization analysis was performed to determine whether oxidative stress-related genes and PCa shared common causal variants.Final-ly,CCK-8 assays,wound healing assays,and Transwell invasion assays and Western blotting,were con-ducted to examine the effects of oxidative stress-related genes on the biological behavior of the PCa cell line C4-2.Results:Multi-omics analysis identified SCP2 as significantly associated with increased PCa risk across gene methylation,gene expression,and circulating protein levels.GSTP1 showed significant associations at the methylation and protein levels,while LPO was associated at the protein level.At the methylation level,SCP2 sites cg00581603(OR=1.11,95%CI:1.05-1.17)and cg13078931(OR=1.12,95%CI:1.05-1.18)were identified as pathogenic.Among the four methylation sites in GSTP1,only cg05244766(OR=0.89,95%CI:0.84-0.95)was considered protective.At the gene expression level,SCP2(OR=1.05,95%CI:1.02-1.07)was also found to be a pathogenic factor.At the circu-lating protein level,SCP2(OR=2.10,95%CI:1.34-3.29)showed a consistent pathogenic trend.In addition,GSTP1(OR=1.16,95%CI:1.07-1.25)and LPO(OR=1.12,95%CI:1.05-1.19)were significantly associated with increased PCa risk.Further functional assays demonstrated that knock-down of SCP2 significantly reduced the oncogenic phenotype of prostate cancer cells.Conclusion:Through integrated multi-omics analysis and experimental validation,this study confirmed a significant as-sociation between SCP2 and increased PCa risk.These findings enhance our understanding of PCa patho-genesis and provide new potential targets and therapeutic directions for PCa treatment.
3.Association between mental health and muscle strength among Chinese adolescents aged 13-18
Chinese Journal of School Health 2025;46(9):1232-1236
Objective:
To explore the association between mental health and muscle strength among Chinese adolescents aged 13- 18, providing a theoretical foundation and intervention strategies for mental health promotion.
Methods:
Data were obtained from the 2019 Chinese National Survey on Students Constitution and Health, including 98 631 Chinese adolescents aged 13- 18. Psychological distress was assessed by using the Kessler Psychological Distress Scale (K10), and mental well being was measured with the Warwick-Edinburgh Mental Well being Scale (WEMWBS). Based on the gender and age specific Z scores of various test items [grip strength, standing long jump, pull ups (for males), and sit ups (for females)], muscle strength index (MSI) was constructed to evaluate the comprehensive level of muscle strength in adolescents. According to the Dual factor Model (DFM) of mental health, participants were categorized into four groups:troubled, symptomatic but content, vulnerable, and complete mental health. Gender differences were analyzed by using Chi-square tests, trends were tested with Cochran-Armitage tests, and multinomial Logistic regression models were applied to assess associations between muscle strength and mental health among adolescents.
Results:
In 2019, 37.4% of Chinese adolescents aged 13-18 were reported of high mental distress, and 59.9% were reported of low mental well being. Boys had significantly lower rates of high mental distress (35.3%) and low mental well being (55.6%) compared to girls (39.4%, 64.3%), and the differences were of statistical significance ( χ 2=176.13, 780.42, both P <0.05). In 2019, the rate of complete mental health among adolescents showed a downward trend with increasing age ( χ 2 trend = 258.47) and a gradual upward trend with increasing muscle strength levels ( χ 2 trend =123.14),and both boys and girls exhibited similar trends ( χ 2 trend =103.83, 168.46; 57.00 , 67.34) (all P <0.05). The results of the unordered multiclass Logistic regression model showed that after controlling for confounding factors such as age and gender, when the completely pathological group as a reference, for every 1 unit increase in MSI in adolescents, the likelihood of being in a completely mental health state increased by 29% ( OR = 1.29); for every unit increase in the Z-score for pull ups, the likelihood of being in a completely mental health state increased by 6% ( OR =1.06) among boys; for every 1 unit increase in sit up Z score, the likelihood of being in a completely mental health state increased by 19% ( OR =1.19) among girls (all P <0.05).
Conclusions
The mental health status of Chinese adolescents is not good enough. Muscle strength is positively associated with mental health.
4.Exploration on the mechanism of Amomi Fructus in ameliorating ethanol-induced gastric ulcer in mice based on metabolomics and network pharmacology
Wanyu CAO ; Jiaxin LI ; Guang LI ; Xuan DING ; Jianglong CHEN ; Lixia ZHANG ; Ning ZHANG
International Journal of Traditional Chinese Medicine 2025;47(4):501-509
Objective:To explore the mechanism of Amomi Fructus in ameliorating ethanol-induced gastric ulcer (GU) in mice using metabolomics, network pharmacology and molecular docking techniques.Methods:The mice were divided into the blank group, model group, aqueous extract of Amomi Fructus group, volatile oil of Amomi Fructus group, combined aqueous extract and volatile oil of Amomi Fructus group and omeprazole group according to the random number table method, with 10 mice in each group. The blank and model groups were gavaged with sodium carboxymethyl cellulose, the Amomi Fructusaqueous extract group was gavaged with 0.152 5 g/kg of Amomi Fructus aqueous extract, the Amomi Fructus volatile oil group was gavaged with 26 μl/kg of Amomi Fructus volatile oil, the Amomi Fructus aqueous extract and volatile oil combined group was gavaged with 0.152 5 g/kg+26 μl/kg of Amomi Fructus aqueous extract and volatile oil synergistic solution, and the omeprazole group was gavaged with 5.2 mg/kg of omeprazole, 1 time/day, which was administered continuously for 7 d. The gastric ulcer model was established by using ethanol 2 h after the last administration, and the pathological changes of gastric histology were observed by using HE staining; the main differential metabolites were detected by UPLC-Q-TOF-MS/MS non-targeted metabolomics technique, and the metabolic pathway enrichment analysis was carried out; the potential targets and key pathways of the anti-GU action of Amomi Fructus were predicted by network pharmacology; the "metabolite-response-enzyme-gene" network was established by combining the serum metabolomics and network pharmacology; and the key targets were verified by molecular docking technology.Results:HE staining showed that the gastric mucosa of mice in the model group was severely damaged, with cellular tissue damage and inflammatory cell infiltration, whereas the drug administration group showed some protective effects; the results of non-targeted metabolomics showed that 2 metabolites were up-regulated and 17 metabolites were down-regulated in sera of mice in the co-administration group of aqueous extract and volatile oil of Amomi Fructus compared with the control group, and the 19 metabolites were strongly correlated and well clustered, involving nicotinic acid and nicotinamide metabolism, citric acid cycle, glyoxylate and dicarboxylic acid metabolism, phenylalanine metabolism, alanine, aspartate and glutamate metabolism and other metabolic pathways; the results of network pharmacology showed that Amomi Fructus improved GU by affecting target proteins, such as STAT3, AKT1, SRC, and TLR4, which were closely linked to the signaling pathways of cancer pathway, human cytomegalovirus infection, and lipids and atherosclerosis; the joint analysis of network pharmacology and the combined analysis of network pharmacology and metabolomics identified the glycerophospholipid metabolic pathway as the main metabolic pathway in which Amomi Fructus may exert gastroprotective effects; the molecular docking results showed that the main active component of quercetin had a better binding ability to the key targets.Conclusion:Amomi Fructus exerts a protective effect on ethanol induced GU model by regulating the glycerophospholipid metabolism pathway, providing theoretical basis for further research on Amomi Fructus.
5.Multi-omics analysis of the relationship between oxidative stress-related gene and prostate cancer
Jiaxin NING ; Haoran WANG ; Shuhang LUO ; Jibo JING ; Jianye WANG ; Huimin HOU ; Ming LIU
Journal of Peking University(Health Sciences) 2025;57(4):633-643
Objective:To investigate the relationship between oxidative stress-related genes and pros-tate cancer(PCa)from a multi-omics perspective using summary-data-based Mendelian randomization(SMR),colocalization analysis,and cellular experiments.Methods:Summary-level data on DNA methylation,gene expression,and circulating proteins were obtained and filtered.The PRACTICAL con-sortium was used as the discovery cohort,with the deCODE database serving as the validation cohort.SMR analysis and heterogeneity in dependent instruments(HEIDI)tests were conducted to assess the association and heterogeneity between oxidative stress-related genes and PCa.Colocalization analysis was performed to determine whether oxidative stress-related genes and PCa shared common causal variants.Final-ly,CCK-8 assays,wound healing assays,and Transwell invasion assays and Western blotting,were con-ducted to examine the effects of oxidative stress-related genes on the biological behavior of the PCa cell line C4-2.Results:Multi-omics analysis identified SCP2 as significantly associated with increased PCa risk across gene methylation,gene expression,and circulating protein levels.GSTP1 showed significant associations at the methylation and protein levels,while LPO was associated at the protein level.At the methylation level,SCP2 sites cg00581603(OR=1.11,95%CI:1.05-1.17)and cg13078931(OR=1.12,95%CI:1.05-1.18)were identified as pathogenic.Among the four methylation sites in GSTP1,only cg05244766(OR=0.89,95%CI:0.84-0.95)was considered protective.At the gene expression level,SCP2(OR=1.05,95%CI:1.02-1.07)was also found to be a pathogenic factor.At the circu-lating protein level,SCP2(OR=2.10,95%CI:1.34-3.29)showed a consistent pathogenic trend.In addition,GSTP1(OR=1.16,95%CI:1.07-1.25)and LPO(OR=1.12,95%CI:1.05-1.19)were significantly associated with increased PCa risk.Further functional assays demonstrated that knock-down of SCP2 significantly reduced the oncogenic phenotype of prostate cancer cells.Conclusion:Through integrated multi-omics analysis and experimental validation,this study confirmed a significant as-sociation between SCP2 and increased PCa risk.These findings enhance our understanding of PCa patho-genesis and provide new potential targets and therapeutic directions for PCa treatment.
6.Bibliometric analysis of research trends and hotspots in gamma-aminobutyric acid and liver-related diseases
Zhihao BAI ; Jiaxin LI ; Zhen YANG ; Ning ZHOU
Chinese Journal of General Surgery 2025;34(6):1246-1261
Background and Aims:Gamma-aminobutyric acid(GABA),the principal inhibitory neurotransmitter in the central nervous system,has been increasingly recognized in recent years as being closely associated with various liver-related diseases,such as hepatic encephalopathy,liver cirrhosis,and hepatocellular carcinoma.Abnormal GABA expression is strongly linked to pathological processes including cognitive impairment and neuroinflammation.Although numerous studies have investigated the mechanistic roles of GABA in neurological complications of liver disease,a systematic overview of the field's research trends,collaborative networks,and emerging hotspots remains lacking.This study employs bibliometric methods to comprehensively map the evolution and frontier topics in GABA and liver-related disease research from 2005 to 2024,aiming to inform future research planning and resource allocation in this area.Methods:English-language publications from 2005 to 2024 related to GABA and liver-related diseases were retrieved from the Web of Science Core Collection.Eligible articles were analyzed using VOSviewer,CiteSpace,and the R package"bibliometrix"to visualize and evaluate contributions by countries/regions,institutions,authors,and journals.Additional analyses included keyword clustering,co-citation analysis,and thematic evolution of research topics.Results:A total of 237 articles were included,contributed by 1 340 authors across 456 institutions in 47 countries,and published in 168 journals.The United States and China are leading contributors in this field.Although countries such as the United Kingdom and Italy had fewer publications,they demonstrated higher average citation counts,indicating strong research quality.Notably,Spain's Centro Investigación Principe Felipe and the research team led by Felipo Vicente exhibited high academic influence.Neurochemistry International and Hepatology were identified as core journals,with Hepatology having the highest impact factor(12.9).Keyword clustering revealed major research focuses including the regulatory role of GABA in the neural mechanisms of hepatic encephalopathy,the impact of liver-related metabolic disorders on neurotransmitter balance,the development and evaluation of GABA receptor-targeted therapeutics,and the function of the GABAergic system in the pathogenesis of hepatocellular carcinoma.As research deepens,the frequency of emerging keywords has diversified,with recent emphasis on terms such as"quality of life,""gene expression,"and"fatty liver disease,"reflecting a shift from fundamental mechanisms to clinical translation and interdisciplinary integration.Conclusion:The relationship between GABA and liver diseases has become a focal point of interdisciplinary research.Investigations have expanded from pathological mechanisms to therapeutic applications,with growing interest in GABA's roles in hepatic encephalopathy,metabolic dysregulation,and tumor progression.Future studies should explore the specific functions of GABA receptor subtypes,promote the development of precision-targeted therapies,and investigate novel mechanisms such as the gut microbiota-GABA metabolism-brain-liver axis to broaden the clinical and translational potential of GABA in neurological,metabolic,and oncological contexts.
7.Prevalence and influencing factors of work-related knee pain among workers in shoemaking industry
Jingwen ZHANG ; Yan YANG ; Si HUANG ; Jiaxin ZHENG ; Liangying MEI ; Jianchao CHEN ; Bo SHEN ; Huadong ZHANG ; Zhongxu WANG ; Zhi WANG ; Ning JIA
Journal of Environmental and Occupational Medicine 2024;41(6):648-654
Background Shoemaking industry workers are prone to work-related musculoskeletal disorders (WMSDs) due to long-term awkward postures during the work process. There is little research on the prevalence and influencing factors of WMSDs in the knee region of this industry, and it should be taken seriously. Objective To estimate the prevalence of work-related knee pain among shoemaking workers and analyze the related influencing factors. Methods A total of 6982 shoemaking workers were selected from 26 shoemaking factories in Guangdong, Hubei, Fujian, Chongqing, Shandong, Zhejiang, and Jingxi by convenience sampling. Prevalence of work-related knee pain in past year, demographic characteristics, occupational related factors, and work posture were collected by a cross-sectional survey using the electronic version of Musculoskeletal Disorder Questionnaire. Logistic regression analysis was used to analyze the influencing factors that may lead to work-related knee pain. Results This survey collected 6982 valid questionnaires with a recovery rate of 98.3%. The prevalence of work-related knee pain of shoemaking workers in the past 12 months was 13.0% (908/6982). According to the results of logistic regression analysis, compared with workers with less than 5 years of service, workers with 5-10 years of service (OR=1.21, 95%CI: 1.02, 1.45) and more than 10 years (1.53, 95%CI: 1.27, 1.83) showed a higher risk of knee WMSDs; sometimes, often and very frequent (reference : rarely or never) long-term standing (OR=1.33, 95%CI: 1.08, 1.64; OR=2.67, 95%CI: 2.10, 3.39; OR=2.75, 95%CI: 2.08, 3.63) and sometimes, often and very frequent (reference: rarely or never) long-term squatting or kneeling (OR=1.80, 95%CI: 1.47, 2.21; OR=2.43, 95%CI: 1.58, 3.75; OR=3.22, 95%CI: 1.66, 6.24) increased the risk of knee pain: long-term bending (OR=1.59, 95%CI: 1.34, 1.89) and often repeated movement of lower limbs and ankles (OR=1.48, 95%CI: 1.25, 1.75) were also risk factors for knee WMSDs among shoemaking industry workers (P<0.05). Adequate rest time (OR=0.58, 95%CI: 0.49, 0.68) and able to stretch or change leg posture (OR=0.75, 95%CI: 0.64, 0.88) reduced the risk of knee WMSDs (P<0.05). Conclusion In the shoemaking industry, length of service and awkward postures are risk factors for knee pain. The shoemaking enterprises should ensure that workers have sufficient rest time, reduce long-term standing, squatting, kneeling, and bending postures, as well as lower limbs repetition in order to reduce the occurrence of knee WMSDs of workers.
8.Effects of methimazole on urinary metabolomics in hyperthyroidism rats
Xu LU ; Ling LI ; Tao YE ; Youfeng PENG ; Jiaxin HE ; Ning ZHANG
China Pharmacy 2024;35(9):1064-1069
OBJECTIVE To study the effects of methimazole on the urinary metabolomics of hyperthyroidism rats, and to preliminarily investigate its possible mechanism. METHODS Thirty SD rats were randomly divided into control group, model group and methimazole group, with 10 rats in each group. Except for the control group, the rats in the other two groups were given Levothyroxine sodium tablets 160 mg/kg by intragastric administration for 15 days; at the same time, methimazole group was additionally given methimazole 3.6 mg/kg daily by intragastric administration every day. The basic condition of the rats was observed, and the body weight and anal temperature were measured. After the last medication, the serum levels of triiodothyronine (T3), tetraiodothyronine (T4), free triiodothyronine (FT3), free tetraiodothyronine (FT4), and thyroid stimulating hormone (TSH) were determined; 24-hour urine was collected on the 15th day after administration. UPLC-TOF-MS was used to analyze the urine metabolomics of rats. Principal component analysis and orthogonal partial least squares-discriminant analysis were used to screen out related differential metabolites, and potential metabolic pathways were analyzed by using HMDB and KEGG. RESULTS Compared with the control group, the rectal temperature, serum levels of T3, T4, FT3 and FT4, the expressions of differential metabolites sebacic acid, cholic acid 3-O-glucuronic acid and N6, N6, N6-trimethyl-L-lysine in urine were significantly up-regulated, while body weight, serum level of TSH, the expressions of deoxycytidine and 2-oxo-4-methylthiobutanoic acid in urine were significantly down-regulated (P<0.01). Compared with model group, above indexes of rats were reversed significantly in methimazole group (P<0.01 or P<0.05). Above five differential metabolites were mainly involved in four signaling pathways: pentose and glucuronate interaction, lysine degradation, cysteine and methionine metabolism, and pyrimidine metabolism. CONCLUSIONS Methimazole might improve hyperthyroidism by modulating the four pathways of pentose and glucuronate interaction, lysine degradation, cysteine and methionine metabolism, and pyrimidine metabolism.
9.Effects of polystyrene microplastics on growth and development and hepatic lipid metabolism in mice
Xinxue GAO ; Jiaxin GAO ; Jianyu ZHU ; Xinqi SHI ; Bocheng TAO ; Ning LI ; Lijuan CHEN
Chinese Journal of Tissue Engineering Research 2024;28(29):4634-4638
BACKGROUND:Plastic as a durable,inexpensive,easy to manufacture organic synthetic polymer materials are widely used.At the same time,plastic resistance to high temperatures,acid and alkali resistance,corrosion-resistant properties make it difficult to degrade in nature,and ultimately forming a huge number of microplastic pollution threatening human health. OBJECTIVE:To investigate the effects of microplastic exposure on growth and development and hepatic lipid metabolism in mice. METHODS:Twenty C57BL/6J male mice were adaptively fed for one week,and then randomly divided into normal and microplastic groups(n=10 per group).Mice in the normal group were given a normal diet and water,for 4 weeks.Mice in the microplastic group were given a normal diet and free drinking of microplastic(polystyrene)water with a concentration of 1 000 μg/L,for 4 weeks.At 2 and 4 weeks of drinking,body mass and grip strength,blood lipids and liver and kidney function,ultrasonic morphology and pathological morphology of liver and lipid deposition were detected. RESULTS AND CONCLUSION:(1)With the extension of time,the body mass of mice in the two groups gradually increased,and the body mass of mice in the microplastic group was greater than that in the normal group after 2,4 weeks of drinking water(P<0.05).With the extension of time,the grip strength of mice in the normal group gradually increased,and the grip strength of mice in the microplastic group first decreased and then increased,and the grip strength of mice in the microplastic group was lower than that in the normal group after drinking water for 4 weeks(P<0.05).(2)Liver ultrasound examination showed that compared with the normal group,the ultrasonic echo signal of the liver in the microplastic group was enhanced after 2 and 4 weeks of drinking water.(3)Hematoxylin-eosin staining showed that the morphology of liver cells in the microplastic group did not change significantly after 2 and 4 weeks of drinking water,but inflammatory cell infiltration could be seen.Oil red O staining showed that obvious lipid deposition was observed in the liver of microplastic group after 2 and 4 weeks of drinking water.(4)Compared with the normal group,the levels of serum high density lipoprotein cholesterol,triacylglycerol,and aspartate aminotransferase in the microplastic group were decreased after 2 weeks of drinking water(P<0.05),and the serum triacylglycerol concentration was decreased after 4 weeks of drinking water(P<0.05).(5)These findings confirm that microplastics may cause weight gain,loss of physical strength,and abnormal hepatic lipid metabolism in mice.
10.Summary Analysis of National Surveillance on Kashin-Beck Disease from 1990 to 2023
Cui SILU ; Liu HUI ; Pei JUNRUI ; Li JIAXIN ; Jiao ZHE ; Deng QING ; Liu NING ; Cao YANHONG ; Yu JUN
Biomedical and Environmental Sciences 2024;37(9):1056-1066
Objective To analyze the epidemiological characteristics and epidemic situation of children with Kashin-Beck disease (KBD) in China,and provide the basis for formulating prevention and control measures. Methods Fixed-point monitoring,moving-point monitoring,and full coverage of monitoring were promoted successively from 1990 to 2023. Some children (7-12 years old) underwent clinical and right-hand X-ray examinations every year. According to the KBD diagnosis criteria,clinical and X-ray assessments were used to confirm the diagnosis. Results In 1990,the national KBD detectable rate was 21.01%. X-ray detection decreased to below 10% in 2003 and below 5% in 2007. Between 2010 and 2018,the prevalence of KBD in children was less than 0.4%,which fluctuated at a low level,and has decreased to 0% since 2019. Spatial epidemiological analysis indicated a spatial clustering of adult patients prevalence rate in the KBD areas. Conclusion The evaluation results of the elimination of KBD in China over the last 5 years showed that all villages in the monitored areas have reached the elimination standard. While the adult KBD patients still need for policy consideration and care.


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