Objective:To analyze the influencing factors of thyroid volume in children aged 8 - 10 in Yunnan Province, and provide scientific basis for improving iodine deficiency disorders monitoring.Methods:From March to July 2020, in 129 counties (cities, districts) under the jurisdiction of Yunnan Province, each county (city, district) was divided into 5 sampling areas based on east, west, south, north, and middle. One township was selected from each area, and 40 non-boarding children aged 8 - 10 from one primary school were selected from each township (age balanced, half male and half female) as survey subjects. One random urine sample and household edible salt samples were collected for urine iodine and salt iodine testing, and physical examination and thyroid volume measurement were conducted for children. The influencing factors of thyroid volume were analyzed using Pearson correlation.Results:A total of 24 934 urine samples were collected from children, with a median urine iodine of 233.2 μg/L. A total of 24 933 household edible salt samples were collected from children, the median salt iodine was 24.17 mg/kg, and the qualified rate of iodized salt was 96.63% (24 003/24 839); A total of 24 937 children were examined of their thyroid gland, with a median thyroid volume of 2.62 ml and a goiter rate of 1.12% (280/24 937). Among them, there were 12 410 boys and 12 527 girls, with thyroid volumes of 2.61 and 2.64 ml, respectively. The thyroid volume of boys was positively correlated with age, height, weight, body mass index, body surface area, and salt iodine ( r = 0.15, 0.21, 0.26, 0.18, 0.25, 0.03, P < 0.001). The thyroid volume of girls was positively correlated with age, height, weight, body mass index, and body surface area ( r = 0.17, 0.26, 0.28, 0.17, 0.27, P < 0.001). Conclusion:Children aged 8 - 10 in Yunnan Province are at an iodine excess level; the age, weight, height, body mass index, and body surface area are influencing factors of thyroid volume.

Objective:To investigate the surgical method of preoperative computed tomography angiography(CTA) combined with color Doppler ultrasonography(CDU) vascular localization assisted by downstream vascularized medial femoral condylar bone flap and its clinical effect in the treatment of refractory scaphoid fracture nonunion.Methods:Retrospective analysis of case data from January 2018 to June 2022 in the Department of Orthopedics at Xingtai General Hospital of North China Medical and Health Group, using a free medial femoral condylar bone flap with descending knee artery as the blood supply to repair old fractures of the scaphoid bone with bone damage. Prior to surgery, CTA combined with CDU technology was used to locate the descending knee artery, and the medial femoral condylar bone flap was designed based on the localization result and bone defects. Follow-up was conducted using outpatient and telephone method. The degree of wrist pain was evaluated using the visual analogue scale (VAS), wrist function was evaluated using the improved Mayo scoring method, the degree of scaphoid arch back deformity was evaluated based on the angle of the scaphoid bone, and stability between the carpal bones was evaluated based on the angle of the scaphoid moon. The normal distribution metric data was represented as Mean±SD, and paired sample t-tests were used to compare the preoperative CDU measurement and the actual intraoperative measurement of the vessel diameter at the origin of the descending knee artery, as well as the distance to the inferior edge of the medial femoral condyle. The VAS score for pain before and after surgery, the Mayo score for wrist function, wrist grip strength, range of motion, scaphoid angle, and scaphoid angle are also compared. Results:A total of 12 patients were enrolled, including 9 males and 3 females; age ranged from 23 to 56 years old, with an average of 36 years old. There were 7 cases of right side fractures, 5 cases of left side fractures, 8 cases of scaphoid waist fractures, and 4 cases of proximal pole fractures. There was no difference between the preoperative CDU location and the actual vessel diameter at the origin of the descending geniculate artery [(1.7±0.5) mm vs. (1.8±0.7) mm] and the distance to the inferior border of the medial femoral condyle [(11.9±2.1) cm vs. (12.1±1.9) cm]( P>0.05). All patients were followed up after the operation, the specific time ranged from 6 months to 2 years, with an average of 13 months. The X-ray films showed that the scaphoid bone healed in all patients after operation, and the average healing time was 15 weeks. After 6 months of follow-up, the VAS scores (3.7±0.9 vs. 0.5±0.1), Mayo scores (46.1±3.8 vs. 86.2±6.1), scapholunar angle [(65.3±4.1)° vs. (47.9±3.5)°], scaphoid angle [(37.1±3.9)° vs. (22.8±2.3)°], wrist flexion and extension range of motion [(79.0±11.7)° vs. (118.5±15.8)°], grip strength [(6.7±4.6) kg vs. (26.1±5.3) kg]were compared before and after surgery, the differences were statistically significant (all P<0.05). Conclusion:The free medial femoral condyle bone flap with a vascular pedicle is one of the ideal method to repair the old navicular fracture with osteonecrosis. The preoperative vascular positioning technique effectively guides the design and cutting of the bone flap and ensures fast and accurate operation during the operation.

Objective:To analyze the clinical characteristics and all-cause mortality influencing factors of patients with Keshan disease.Methods:Clinical data of patients with Keshan disease from Keshan disease areas in Sichuan Province and Yunnan Province were collected and retrospectively analyzed for clinical characteristics and survival status during regular follow-up. According to the survival status of patients, the survey subjects were divided into a survival group and a death group. All-cause mortality (referring to the death caused by various reasons throughout the follow-up period) was used as the study endpoint. Kaplan-Meier (K-M) survival curve analysis and log-rank χ 2 test were performed, univariate and multivariate Cox regression analysis were used for all-cause mortality factor analysis. Results:A total of 176 patients with Keshan disease were collected, including 92 cases in Sichuan Province and 84 cases in Yunnan Province. Among all the patients, there were 105 males, accounting for 59.66%, and 71 females, accounting for 40.34%. The age was (53.89 ± 13.19) years old. Thirty-five cases died from all causes, with a mortality rate of 19.89%. There were significant differences in age ( t = 2.09, P = 0.038), New York Heart Association (NYHA) cardiac function grading (χ 2 = 14.62, P < 0.001) and ventricular premature contraction (χ 2 = 6.82, P = 0.009) between the survival group and the death group. K-M survival curve analysis showed that patients with Keshan disease complicated by premature ventricular contraction and high NYHA cardiac function grading (Ⅲ and Ⅳ) had higher all-cause mortality (log-rank χ 2 = 8.72, 22.49, P < 0.05). Univariate Cox regression analysis showed that NYHA cardiac function grading and ventricular premature contraction ( HR = 3.09, 2.71, P < 0.05) were predictive influencing factors for all-cause mortality in patients with Keshan disease. Multivariate Cox regression analysis showed that NYHA cardiac function grading ( HR = 6.57, P = 0.002) and ventricular premature contraction ( HR = 2.98, P = 0.050) were independent factors for all-cause mortality in patients with Keshan disease. Conclusions:Among 176 patients with Keshan disease, the number of patients with poor cardiac function (NYHA cardiac function grading Ⅲ and Ⅳ) and arrhythmia is high. NYHA cardiac function grading and ventricular premature contractions are independent influencing factors for all-cause mortality in patients with Keshan disease.

Objective:To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues.Methods:From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed.Results:This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage ( HR=1.47, 95% CI: 1.06-2.04), primary tumor site ( HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ( HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy ( HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site ( HR=0.68, 95% CI: 0.48-0.95), ECOG score ( HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy ( HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death ( P＜0.05). Conclusion:Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.

Objective:To investigate the surgical method of preoperative computed tomography angiography(CTA) combined with color Doppler ultrasonography(CDU) vascular localization assisted by downstream vascularized medial femoral condylar bone flap and its clinical effect in the treatment of refractory scaphoid fracture nonunion.Methods:Retrospective analysis of case data from January 2018 to June 2022 in the Department of Orthopedics at Xingtai General Hospital of North China Medical and Health Group, using a free medial femoral condylar bone flap with descending knee artery as the blood supply to repair old fractures of the scaphoid bone with bone damage. Prior to surgery, CTA combined with CDU technology was used to locate the descending knee artery, and the medial femoral condylar bone flap was designed based on the localization result and bone defects. Follow-up was conducted using outpatient and telephone method. The degree of wrist pain was evaluated using the visual analogue scale (VAS), wrist function was evaluated using the improved Mayo scoring method, the degree of scaphoid arch back deformity was evaluated based on the angle of the scaphoid bone, and stability between the carpal bones was evaluated based on the angle of the scaphoid moon. The normal distribution metric data was represented as Mean±SD, and paired sample t-tests were used to compare the preoperative CDU measurement and the actual intraoperative measurement of the vessel diameter at the origin of the descending knee artery, as well as the distance to the inferior edge of the medial femoral condyle. The VAS score for pain before and after surgery, the Mayo score for wrist function, wrist grip strength, range of motion, scaphoid angle, and scaphoid angle are also compared. Results:A total of 12 patients were enrolled, including 9 males and 3 females; age ranged from 23 to 56 years old, with an average of 36 years old. There were 7 cases of right side fractures, 5 cases of left side fractures, 8 cases of scaphoid waist fractures, and 4 cases of proximal pole fractures. There was no difference between the preoperative CDU location and the actual vessel diameter at the origin of the descending geniculate artery [(1.7±0.5) mm vs. (1.8±0.7) mm] and the distance to the inferior border of the medial femoral condyle [(11.9±2.1) cm vs. (12.1±1.9) cm]( P>0.05). All patients were followed up after the operation, the specific time ranged from 6 months to 2 years, with an average of 13 months. The X-ray films showed that the scaphoid bone healed in all patients after operation, and the average healing time was 15 weeks. After 6 months of follow-up, the VAS scores (3.7±0.9 vs. 0.5±0.1), Mayo scores (46.1±3.8 vs. 86.2±6.1), scapholunar angle [(65.3±4.1)° vs. (47.9±3.5)°], scaphoid angle [(37.1±3.9)° vs. (22.8±2.3)°], wrist flexion and extension range of motion [(79.0±11.7)° vs. (118.5±15.8)°], grip strength [(6.7±4.6) kg vs. (26.1±5.3) kg]were compared before and after surgery, the differences were statistically significant (all P<0.05). Conclusion:The free medial femoral condyle bone flap with a vascular pedicle is one of the ideal method to repair the old navicular fracture with osteonecrosis. The preoperative vascular positioning technique effectively guides the design and cutting of the bone flap and ensures fast and accurate operation during the operation.

Objective:To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues.Methods:From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed.Results:This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage ( HR=1.47, 95% CI: 1.06-2.04), primary tumor site ( HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ( HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy ( HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site ( HR=0.68, 95% CI: 0.48-0.95), ECOG score ( HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy ( HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death ( P＜0.05). Conclusion:Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.

Objective:To translate the Pediatric Epilepsy-Specific Health-Related Quality of Life (PedsQL TM Epilepsy Module) into Chinese and test its reliability and validity in children aged 5 to 7 years old and their parents. Methods:Brislin translation model was used for forward translation, back translation, harmonization, and proofreading of the PedsQL TM Epilepsy Module. Chinese version of PedsQL TM Epilepsy Module beta version was developed through cognitive interviews, expert consultations, and pre-surveys for cross-cultural adaptation of the scale. From April to November 2023, convenience sampling was used to select 420 children with epilepsy and their parents admitted to the Children's Hospital of Soochow University as participants for a questionnaire survey to test its reliability and validity. Results:A total of 840 questionnaires were distributed (420 for children and 420 for parents), and 394 valid questionnaires were collected from children and 400 valid questionnaires were collected from parents, and the effective response rates of the questionnaires were 93.81% (394/420) and 95.24% (400/420), respectively. Chinese version of PedsQL TM Epilepsy Module (child report version) included five dimensions and 28 items. Chinese version of PedsQL TM Epilepsy Module (parent agent report version) consisted of five dimensions and 29 items. The content validity indices at the item level were 0.800 to 1.00, while the content validity indices at the scale level were 0.978 and 0.979, respectively. Exploratory factor analysis of two versions of the scale showed that five common factors were extracted, with cumulative variance contribution rates of 64.557% and 75.205%, respectively. Confirmatory factor analysis showed that the models of the two scales fitted well. The total Cronbach's α coefficients of the two scales were 0.906 and 0.914, respectively, with Cronbach's α coefficients for each dimension ranging from 0.869 to 0.991. The total test-retest reliability coefficients of the scale were 0.998 and 0.995, respectively, and the test-retest reliability coefficients of each dimension were 0.803 to 0.995. Conclusions:Chinese version of the PedsQL TM Epilepsy Module has good reliability and validity, and is suitable for evaluating the health-related quality of life of children with epilepsy aged 5 to 7 years old in China.

Objective:To investigate the effects of intensity modulated radiation therapy (imRT) and risk factors of radiation pneumonia caused by imRT in elderly patients with esophageal cancer.Methods:The clinical data of 80 elderly patients diagnosed with esophageal cancer and performed imRT in Traditional Chinese Medicine Hospital of Kunshan from February 2018 to February 2020 were analyzed, and the therapeutic effect and the incidence of adverse reactions were counted.Results:In the 80 patients, 13 patients occurred radiation pneumonia.The results of univariate analysis showed that the gender, smoking history, pathological stage and age had no correlation with radiation pneumonia ( P> 0.05), while tumor location, diabetes, concurrent chemotherapy, reradiotherapy and chronic obstructive pulmonary disease had correlation with the occurrence of radioactive pneumonia ( P<0.05). The levels of V30, V35, V40 between radioactive pneumonia patients and non-radioactive pneumonia patients had no significant differences ( P>0.05), but the levels of V5, V10, V15, V20 and mean lung dose(MLD) between radioactive pneumonia patients and non-radioactive pneumonia patients had significant differences ( P<0.05). The effect of imRT was no remission in 9 cases (11.25%), partial remission in 59 cases (73.75%) and complete remission in 12 cases (15.00%), and the clinical effective rate was 88.75%(71/80). By comparing the adverse reactions caused by imRT, it was found that the incidence of radiation esophagitis, leukopenia, and acute radiation pneumonia were 93.75%(75/80), 12.50%(10/80) and 22.50%(18/80), respectively, with grade 1 and grade 2 adverse reactions. Conclusions:Risk factors for radiation pneumonia in elderly patients with esophageal cancer after imRT include tumor location, diabetes, V5, V10, V15, V20, MLD, concurrent chemotherapy, reradiotherapy and chronic obstructive pulmonary disease.

Objective:To learn about the current situation of prevention and control of coal-burning-borne endemic fluorosis (coal burning fluorosis for short) in Yunnan Province, and comprehensively evaluate the implementation effect of prevention and control measures.Methods:From August to November 2020, according to the requirements of the Monitoring Program of Yunnan Province for Coal-burning-borne Endemic Fluorosis (2019 edition), monitoring was carried out in all natural villages in the disease areas of 13 counties (cities and districts, hereinafter referred to as counties) of the province, and 30 households were selected from each natural village to monitor the use of stoves and the formation of related healthy living behaviors. At the same time, children aged 8 - 12 years in the natural villages in the disease areas were examined for the prevalence of dental fluorosis. The evaluation for control and elimination of disease areas was carried out in accordance with the Evaluation Approach for Control and Elimination of Priority Endemic Diseases (2019 edition).Results:A total of 392 244 households were investigated, and the rates of qualified improved stoves, the correct utilization of qualified improved stoves and correct drying of corn and pepper were 99.42% (389 982/392 244), 99.70% (388 796/389 982) and 99.07% (388 579/392 244), respectively. A total of 227 057 children aged 8 - 12 years were examined, 9 413 children of dental fluorosis were detected, the detection rate of dental fluorosis was 4.15%, the dental fluorosis index was 0.10, and the prevalence intensity was negative. Taking the county as a unit, except Fuyuan and Zhenxiong, which reached the control standard of the disease area, the remaining 11 counties reached the elimination standard.Conclusion:The prevention and control measures on coal burning fluorosis are implemented well in Yunnan Province and healthy lifestyle has gradually taken shape, with the overall condition of the disease reduced.

Objective:To investigate clinical characteristics of pediatric psoriasis based on the information systems from two children′s hospitals.Methods:Clinical data on outpatients confirmly diagnosed with pediatric psoriasis were collected from information systems of Beijing Children′s Hospital affiliated to Capital Medical University and Children′s Hospital of Chongqing Medical University from January 1, 2015 to December 31, 2019, and a clinical and epidemiological investigation was conducted. Statistical analysis was carried out by using t test and chi-square test. Results:A total of 5 235 children with psoriasis were included, with the ratio of male to female being 1∶1.08. Their age at the clinic visit ( M [ Q1, Q3]) was 8.37 (6.48, 10.50) years, and the school-age children were the most common population; their age at onset was 7.57 (5.37, 9.82) years. Among the 5 235 children with psoriasis, there were 3 195 (60.82%) with psoriasis vulgaris, 281 (5.37%) with pustular psoriasis, 19 (0.36%) with erythrodermic psoriasis, and 1 (0.02%) with psoriatic arthritis. The trunk (87.76%, 1 097/1 250) was most frequently affected, followed by the limbs (87.68%, 1 096/1 250) , the scalp (62.56%, 782/1 250) , and the face and neck (35.76%, 477/1 250) . Among the 5 235 patients, 4 319 (82.50%) received topical treatments, 177 (3.38%) received systemic treatments, and 832 (15.89%) were treated with antibiotics. Among 3 497 children who received initial treatment regimens, the disease could be controlled in 3 423 (97.88%) without change in treatment regimens, while treatment regimens needed to be adjusted in 2.12%. Conclusions:In the two children′s hospitals, most children with psoriasis developed this condition and visited the clinic at school age, and the predominant clinical type was psoriasis vulgaris. Most skin lesions were extensive, and commonly occurred on the trunk and limbs. Scalp involvement was not uncommon. The condition could be controlled by topical treatments in most children with psoriasis, while a few patients needed systemic treatments.