Objective:To conduct survival analysis of patients with Kashin-Beck disease (KBD) and explore influencing factors of mortality in KBD patients.Methods:A retrospective analysis was conducted on data on management services and deaths of KBD patients from January 1, 2023 to August 31, 2024 in Shaanxi Province, which were collected from the "Shaanxi Provincial Endemic Disease Information Platform", and death of KBD patients was considered as the outcome event. The direct method was used to calculate standardized mortality rates. The survival rate, and cumulative survival rate of KBD patients were calculated using the life table method. Kaplan-Meier method and Log-rank test were used to plot and compare survival curves, respectively, with residential area as the time-dependent covariate, and stratified by gender for multivariate analysis using time-dependent Cox proportional hazards regression model.Results:A total of 54 957 KBD patients were included, with females accounting for 51.66% (28 390/54 957), the age [ M( Q1, Q3)] was 66 (59, 72) years. Patients with gradeⅠ,Ⅱ, and Ⅲ KBD accounted for 63.90% (35 120/54 957), 31.16% (17 125/54 957), and 4.93% (2 712/54 957), respectively. During the observation period, 2 989 deaths (5.44%) occurred, with an age standardized mortality rate of 1.94%. The cumulative survival rates at 6th, 12th, and 18th months were 97.63%, 96.11%, and 94.64%, respectively. The standardized mortality rate of gradeⅠKBD patients was lower than that of gradeⅡandⅢ KBD patients in all, female, and male KBD patients, and their cumulative survival rate was higher than that of gradeⅡand Ⅲ KBD patients ( P < 0.001). Age, education level, residential area, severity of illness, poverty, and relocation were influencing factors for mortality in KBD patients ( P < 0.05). Conclusions:The standardized mortality rate of gradeⅠKBD patients in Shaanxi Province is lower than that of gradeⅡand Ⅲ KBD patients, and their cumulative survival rate is higher than that of grade Ⅱand Ⅲ KBD patients. The influencing factors for mortality in KBD patients include age, education level, residential area, severity of illness, poverty, and relocation.

Objective:To understand the changes in the prevelance smoking in people aged ≥15 years in Baoji, and provide evidence for the improvement of tobacco control strategies.Methods:Data were from the sampling survey of chronic diseases and their risk factors conducted in Baoji at an interval of five years from 2013 to 2023. The survey used multi-stage cluster random sampling method to select local people aged ≥15 years, and the information about their tobacco use were collected by face-to-face interview. Descriptive epidemiological methods were used to analyze the prevalence of smoking, and χ2 test was used to analyze the change trend. Results:The smoking rate in people aged ≥15 years in Baoji decreased from 2013 to 2023, and the standardized smoking rate decreased by 13.6% in 2023 compared with 2013. The standardized smoking cessation rate increased by 13.4% in 2018 compared with 2013, and the standardized smoking cessation rate decreased by 7.3% in 2023 compared with 2018. The standardized passive smoking rate decreased by 15.1% in 2018 compared with 2013, and the standardized passive smoking rate increased by 8.8% in 2023 compared with 2018. The average daily smoking amount increased by 3.7 cigarettes in 2018 compared with 2013, and the average daily smoking amount decreased by 3.9 cigarettes in 2023 compared with 2018.Conclusion:Progress has been made in tobacco control in Baoji, but problems still exist in tobacco control, to which close attention needs to be paid.

Objective:To establish and assess the quality control and improvement system for metabolic and bariatric surgery in Beijing.Methods:Based on relevant documents from the National Health Commission and the Beijing Municipal Health Commission,and referencing the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) by the American Society for Metabolic and Bariatric Surgery,a quality control system was developed under the Beijing Quality Control and Improvement Center of Metabolic and Bariatric Surgery. The system incorporated on-site evaluations,data registration,and specialized training. From May to December 2023,on-site assessments were conducted at 21 hospitals in Beijing performing bariatric surgery,evaluating personnel qualifications,infrastructure,clinical workflows,and postoperative follow-up. A quality control database was created to collect real-time surgical data,and training was provided for data entry and professional skills. Assessment results were classified as excellent,qualified,or needing improvement,with rectification suggestions offered and follow-up visits conducted to track progress.Results:All 21 hospitals achieved a 100% compliance rate for surgical indications, 16 (76.2%) met standardized surgical operation criteria,and 14 (66.7%) had standardized postoperative management. However,only 5 (23.8%) achieved a 12-month postoperative follow-up rate of ≥60%,and 4 (19.1%) had established specialized databases. Key challenges included insufficient specialized staffing (19.1%), lack of multidisciplinary collaboration (47.6%), inadequate equipment (57.1%), and low follow-up rates (57.1%). The database collected data from over 2 000 patients across 111 fields. After rectification, specialized database coverage rose to 61.9% (13 hospitals). Multi-level training programs developed backbone physicians and specialized nurses,significantly addressing the shortage of specialized personnel.Conclusion:The quality control system established in this study,through the integration of on-site evaluation,data registration,and specialized training,effectively enhances the standardization of surgical practices and data management capabilities.

Objective:To conduct survival analysis of patients with Kashin-Beck disease (KBD) and explore influencing factors of mortality in KBD patients.Methods:A retrospective analysis was conducted on data on management services and deaths of KBD patients from January 1, 2023 to August 31, 2024 in Shaanxi Province, which were collected from the "Shaanxi Provincial Endemic Disease Information Platform", and death of KBD patients was considered as the outcome event. The direct method was used to calculate standardized mortality rates. The survival rate, and cumulative survival rate of KBD patients were calculated using the life table method. Kaplan-Meier method and Log-rank test were used to plot and compare survival curves, respectively, with residential area as the time-dependent covariate, and stratified by gender for multivariate analysis using time-dependent Cox proportional hazards regression model.Results:A total of 54 957 KBD patients were included, with females accounting for 51.66% (28 390/54 957), the age [ M( Q1, Q3)] was 66 (59, 72) years. Patients with gradeⅠ,Ⅱ, and Ⅲ KBD accounted for 63.90% (35 120/54 957), 31.16% (17 125/54 957), and 4.93% (2 712/54 957), respectively. During the observation period, 2 989 deaths (5.44%) occurred, with an age standardized mortality rate of 1.94%. The cumulative survival rates at 6th, 12th, and 18th months were 97.63%, 96.11%, and 94.64%, respectively. The standardized mortality rate of gradeⅠKBD patients was lower than that of gradeⅡandⅢ KBD patients in all, female, and male KBD patients, and their cumulative survival rate was higher than that of gradeⅡand Ⅲ KBD patients ( P < 0.001). Age, education level, residential area, severity of illness, poverty, and relocation were influencing factors for mortality in KBD patients ( P < 0.05). Conclusions:The standardized mortality rate of gradeⅠKBD patients in Shaanxi Province is lower than that of gradeⅡand Ⅲ KBD patients, and their cumulative survival rate is higher than that of grade Ⅱand Ⅲ KBD patients. The influencing factors for mortality in KBD patients include age, education level, residential area, severity of illness, poverty, and relocation.

Objective:To understand the changes in the prevelance smoking in people aged ≥15 years in Baoji, and provide evidence for the improvement of tobacco control strategies.Methods:Data were from the sampling survey of chronic diseases and their risk factors conducted in Baoji at an interval of five years from 2013 to 2023. The survey used multi-stage cluster random sampling method to select local people aged ≥15 years, and the information about their tobacco use were collected by face-to-face interview. Descriptive epidemiological methods were used to analyze the prevalence of smoking, and χ2 test was used to analyze the change trend. Results:The smoking rate in people aged ≥15 years in Baoji decreased from 2013 to 2023, and the standardized smoking rate decreased by 13.6% in 2023 compared with 2013. The standardized smoking cessation rate increased by 13.4% in 2018 compared with 2013, and the standardized smoking cessation rate decreased by 7.3% in 2023 compared with 2018. The standardized passive smoking rate decreased by 15.1% in 2018 compared with 2013, and the standardized passive smoking rate increased by 8.8% in 2023 compared with 2018. The average daily smoking amount increased by 3.7 cigarettes in 2018 compared with 2013, and the average daily smoking amount decreased by 3.9 cigarettes in 2023 compared with 2018.Conclusion:Progress has been made in tobacco control in Baoji, but problems still exist in tobacco control, to which close attention needs to be paid.

Objective:To establish and assess the quality control and improvement system for metabolic and bariatric surgery in Beijing.Methods:Based on relevant documents from the National Health Commission and the Beijing Municipal Health Commission,and referencing the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) by the American Society for Metabolic and Bariatric Surgery,a quality control system was developed under the Beijing Quality Control and Improvement Center of Metabolic and Bariatric Surgery. The system incorporated on-site evaluations,data registration,and specialized training. From May to December 2023,on-site assessments were conducted at 21 hospitals in Beijing performing bariatric surgery,evaluating personnel qualifications,infrastructure,clinical workflows,and postoperative follow-up. A quality control database was created to collect real-time surgical data,and training was provided for data entry and professional skills. Assessment results were classified as excellent,qualified,or needing improvement,with rectification suggestions offered and follow-up visits conducted to track progress.Results:All 21 hospitals achieved a 100% compliance rate for surgical indications, 16 (76.2%) met standardized surgical operation criteria,and 14 (66.7%) had standardized postoperative management. However,only 5 (23.8%) achieved a 12-month postoperative follow-up rate of ≥60%,and 4 (19.1%) had established specialized databases. Key challenges included insufficient specialized staffing (19.1%), lack of multidisciplinary collaboration (47.6%), inadequate equipment (57.1%), and low follow-up rates (57.1%). The database collected data from over 2 000 patients across 111 fields. After rectification, specialized database coverage rose to 61.9% (13 hospitals). Multi-level training programs developed backbone physicians and specialized nurses,significantly addressing the shortage of specialized personnel.Conclusion:The quality control system established in this study,through the integration of on-site evaluation,data registration,and specialized training,effectively enhances the standardization of surgical practices and data management capabilities.

Objective:To report the long-term outcomes of Chinese rectal cancer patients after adopting a Watch and Wait (W&W) strategy following neoadjuvant therapy (NAT).Methods:This multicenter, cross-sectional study was based on real-world data. The study cohort comprised rectal cancer patients who had achieved complete or near complete clinical responses (cCRs, near-cCRs) after NAT and were thereafter managed by a W&W approach, as well as a few patients who had achieved good responses after NAT and had then undergone local excision for confirmation of pathological complete response. All participants had been followed up for ≥2 years. Patients with distant metastases at baseline or who opted for observation while living with the tumor were excluded. Data of eligible patients were retrospectively collected from the Chinese Wait-and-Watch Data Collaboration Group database. These included baseline characteristics, type of NAT, pre-treatment imaging results, evaluation of post-NAT efficacy, salvage measures, and treatment outcomes. We herein report the long-term outcomes of Chinese rectal cancer patients after NAT and W&W and the differences between the cCR and near-cCR groups.Results:Clinical data of 318 rectal cancer patients who had undergone W&W for over 2 years and been followed up were collected from eight medical centers (Peking University Cancer Hospital, Fudan University Shanghai Cancer Center, Sun Yat-sen University Cancer Center, Shanghai Changhai Hospital, Peking Union Medical College Hospital, Liaoning Cancer Hospital, the First Hospital of Jilin University, and Yunnan Cancer Hospital.) The participants comprised 221 men (69.4%) and 107 women (30.6%) of median age 60 (26-86) years. The median distance between tumor and anal verge was 3.4 (0-10.4) cm. Of these patients, 291 and 27 had achieved cCR or near-cCR, respectively, after NAT. The median duration of follow-up was 48.4 (10.2-110.3) months. The 5-year cumulative overall survival rate was 92.4% (95%CI: 86.8%-95.7%), 5-year cumulative disease-specific survival (CSS) rate 96.6% (95%CI: 92.2%-98.5%), 5-year cumulative organ-preserving disease-free survival rate 86.6% (95%CI: 81.0%-90.7%), and 5-year organ preservation rate 85.3% (95%CI: 80.3%-89.1%). The overall 5-year local recurrence and distant metastasis rates were 18.5% (95%CI: 14.9%-20.8%) and 8.2% (95%CI: 5.4%-12.5%), respectively. Most local recurrences (82.1%, 46/56) occurred within 2 years, and 91.0% (51/56) occurred within 3 years, the median time to recurrence being 11.7 (2.5-66.6) months. Most (91.1%, 51/56) local recurrences occurred within the intestinal lumen. Distant metastases developed in 23 patients; 60.9% (14/23) occurred within 2 years and 73.9% (17/23) within 3 years, the median time to distant metastasis being 21.9 (2.6-90.3) months. Common sites included lung (15/23, 65.2%), liver (6/23, 26.1%), and bone (7/23, 30.4%) The metastases involved single organs in 17 patients and multiple organs in six. There were no significant differences in overall, cumulative disease-specific, or organ-preserving disease-free survival or rate of metastases between the two groups (all P>0.05). The 5-year local recurrence rate was higher in the near-cCR than in the cCR group (41.6% vs. 16.4%, P<0.01), with a lower organ preservation rate (69.2% vs. 88.0%, P<0.001). The success rates of salvage after local recurrence and distant metastasis were 82.1% (46/56) and 13.0% (3/23), respectively. Conclusion:Rectal cancer patients who achieve cCR or near-cCR after NAT and undergo W&W have favorable oncological outcomes and a high rate of organ preservation. Local recurrence and distant metastasis during W&W follow certain patterns, with a relatively high salvage rate for local recurrence. Our findings highlight the importance of close follow-up and timely intervention during the W&W process.

Objective:To report the long-term outcomes of Chinese rectal cancer patients after adopting a Watch and Wait (W&W) strategy following neoadjuvant therapy (NAT).Methods:This multicenter, cross-sectional study was based on real-world data. The study cohort comprised rectal cancer patients who had achieved complete or near complete clinical responses (cCRs, near-cCRs) after NAT and were thereafter managed by a W&W approach, as well as a few patients who had achieved good responses after NAT and had then undergone local excision for confirmation of pathological complete response. All participants had been followed up for ≥2 years. Patients with distant metastases at baseline or who opted for observation while living with the tumor were excluded. Data of eligible patients were retrospectively collected from the Chinese Wait-and-Watch Data Collaboration Group database. These included baseline characteristics, type of NAT, pre-treatment imaging results, evaluation of post-NAT efficacy, salvage measures, and treatment outcomes. We herein report the long-term outcomes of Chinese rectal cancer patients after NAT and W&W and the differences between the cCR and near-cCR groups.Results:Clinical data of 318 rectal cancer patients who had undergone W&W for over 2 years and been followed up were collected from eight medical centers (Peking University Cancer Hospital, Fudan University Shanghai Cancer Center, Sun Yat-sen University Cancer Center, Shanghai Changhai Hospital, Peking Union Medical College Hospital, Liaoning Cancer Hospital, the First Hospital of Jilin University, and Yunnan Cancer Hospital.) The participants comprised 221 men (69.4%) and 107 women (30.6%) of median age 60 (26-86) years. The median distance between tumor and anal verge was 3.4 (0-10.4) cm. Of these patients, 291 and 27 had achieved cCR or near-cCR, respectively, after NAT. The median duration of follow-up was 48.4 (10.2-110.3) months. The 5-year cumulative overall survival rate was 92.4% (95%CI: 86.8%-95.7%), 5-year cumulative disease-specific survival (CSS) rate 96.6% (95%CI: 92.2%-98.5%), 5-year cumulative organ-preserving disease-free survival rate 86.6% (95%CI: 81.0%-90.7%), and 5-year organ preservation rate 85.3% (95%CI: 80.3%-89.1%). The overall 5-year local recurrence and distant metastasis rates were 18.5% (95%CI: 14.9%-20.8%) and 8.2% (95%CI: 5.4%-12.5%), respectively. Most local recurrences (82.1%, 46/56) occurred within 2 years, and 91.0% (51/56) occurred within 3 years, the median time to recurrence being 11.7 (2.5-66.6) months. Most (91.1%, 51/56) local recurrences occurred within the intestinal lumen. Distant metastases developed in 23 patients; 60.9% (14/23) occurred within 2 years and 73.9% (17/23) within 3 years, the median time to distant metastasis being 21.9 (2.6-90.3) months. Common sites included lung (15/23, 65.2%), liver (6/23, 26.1%), and bone (7/23, 30.4%) The metastases involved single organs in 17 patients and multiple organs in six. There were no significant differences in overall, cumulative disease-specific, or organ-preserving disease-free survival or rate of metastases between the two groups (all P>0.05). The 5-year local recurrence rate was higher in the near-cCR than in the cCR group (41.6% vs. 16.4%, P<0.01), with a lower organ preservation rate (69.2% vs. 88.0%, P<0.001). The success rates of salvage after local recurrence and distant metastasis were 82.1% (46/56) and 13.0% (3/23), respectively. Conclusion:Rectal cancer patients who achieve cCR or near-cCR after NAT and undergo W&W have favorable oncological outcomes and a high rate of organ preservation. Local recurrence and distant metastasis during W&W follow certain patterns, with a relatively high salvage rate for local recurrence. Our findings highlight the importance of close follow-up and timely intervention during the W&W process.

Objective To understand the current situation and influencing factors of health state utility value of the Tibetan elderly in Tibet Autonomous Region.Methods The multi-stage stratified cluster sampling method was used to recruit 1 690 elderly aged 60 and above from 7 cities of Tibet Autonomous Region as the research subjects.The general status of the elderly was investigated by questionnaire survey,and health utility value of the population was measured and computed by EuroQol Five Dimensions Questionnaire(EQ-5D-3L).The influencing factors were analyzed using Tobit regression model.Results The mean visual analogue scale(VAS)score of EQ-5D-3L and the mean health state utility value were 56.36±21.19 and 0.901±0.145,respectively.Those who were male,aged between 60 to 69 years,received middle school education and above,got married,were employed,had medical examination in the past year,and had no hypertension,rheumatoid arthritis or other chronic diseases had higher health state utility value and VAS score.Conclusion The mean health state utility value of Tibetan elderly aged 60 and above in Tibet Autonomous Region was higher than that of other regions in China,while the average score of self-assessment EQ-VAS was lower than that of other regions in China.The health state utility value was affected by gender,age,employment status,education level,living area,different medical examination status in the past year,and chronic disease status.In the future,the health care of the elderly who are aged 70 years and above,are female,have never been to school,live in rural areas,are unemployed,and have chronic diseases should be strengthened.Regular medical examination should be performed to identify health problems timely so as to improve the quality of life of the elderly.

Objective:To investigate the iodine nutrition status of residents and its changing trend in Baoji City, Shaanxi Province during the 10 years implementation of a new salt iodine standard, evaluate the prevention and treatment effects, and provide a basis for implementing iodine supplementation measures scientifically.Methods:From 2013 to 2015, each county (district) in Baoji City, Shaanxi Province was divided into 5 districts based on east, west, south, north, and central regions. One town (street, referred to as the town) was selected from each district, and four administrative villages were selected from each town. Fifteen residents from each administrative village were selected to collect edible salt samples from their homes and test the iodine content of the salt. At the same time, one primary school was selected from each selected town, and 42 children (age and gender were balanced) aged 8 - 10 were selected from each primary school for thyroid palpation examination. From 2016 to 2022, each county (district) was divided into 5 districts based on east, west, south, north, and central regions. One town was selected from each district, and one primary school was selected from each town. Forty-two non boarding students aged 8 - 10 were selected from each primary school to undergo thyroid palpation examination, and edible salt samples were collected from their home to detect salt iodine content. At the same time, 4 administrative villages were selected from each town, and 10 households were selected from each administrative village to collect edible salt samples and test the salt iodine content; 21 pregnant women were selected from each of the 5 towns in each county (district) to collect edible salt samples and test the salt iodine content. From 2013 to 2022, synchronous collection of urine samples from children and pregnant women (early, middle, and late pregnancy were balanced) was conducted to detect urine iodine content. Direct titration method was adopted for determination of salt iodine content, and arbitration method was adopted for Sichuan salt and other fortified edible salt (GB/T 13025.7-1999). Thyroid examination was performed according to the Diagnostic Criteria for Endemic Goiter (WS 276-2007). Urine iodine was detected by Arsenic Cerium Catalytic Spectrophotometric Method for Determination of Iodine in Urine (WS/T 107 - 2006).Results:From 2013 to 2022, a total of 37 609 household edible salt samples were collected. The coverage rate of iodized salt, the qualified rate of iodized salt and the consumption rate of qualified iodized salt for each year ranged from 98.00% to 100.00%, 94.16% to 99.55%, and 92.28% to 99.67%, respectively. The median range of salt iodine was 22.42 to 26.80 mg/kg. A total of 25 437 children aged 8 - 10 were examined, and the annual incidence of thyroid enlargement (goiter) ranged from 0.35% to 3.02%. A total of 33 270 urine samples were collected, including 21 698 from children and 11 572 from pregnant women. The median range of urine iodine for children in each year was 203.70 - 275.47 μg/L, median range of urine iodine in pregnant women was 167.65 - 218.57 μg/L. The median urine iodine in children showed a decreasing trend from 2013 to 2022 ( Z = 3.04, P = 0.002); the median urine iodine of pregnant women did not show a significant decrease ( Z = 1.61, P = 0.110). Conclusions:During the 10 years implementation of the new salt iodine standard in Shaanxi Province, all indicators of iodine deficiency disorders monitoring in Baoji City have met the standards and maintained the elimination status of iodine deficiency disorders. The urine iodine levels of children have shown a downward trend, while urine iodine levels of pregnant women do not show significant changes. It is recommended that Baoji City expand the scope of iodine nutrition monitoring for key populations, and effectively carry out iodine supplementation measures scientificlly guided by monitoring information, tailored to local conditions, and classified guidance.