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 analyze the clinical characteristics, prognosis and gene mutation in patients with dilated cardiomyopathy (DCM) in Keshan disease area of Sichuan Province, and to explore the risk factors for all-cause death in DCM patients.Methods:In June 2016, 55 DCM patients diagnosed at the local disease prevention and control center through clinical manifestations, electrocardiogram examination, and echocardiography were selected as the survey subjects in Mianning County, Liangshan Yi Autonomous Prefecture, and Renhe District, Panzhihua City, Keshan disease areas of Sichuan Province. Baseline clinical data were analyzed and long-term follow-up was conducted. The follow-up period ended June 15, 2021, with the endpoint of all-cause death. Univariate Cox regression was used to analyze the influencing factors of all-cause death in patients, and Kaplan-Meier (K-M) survival curve was used to analyze the survival time of patients. At the same time, peripheral venous blood was collected from 27 DCM patients. After separating white blood cells, DNA was extracted, and whole exome sequencing was performed to screen potential pathogenic genes.Results:Among the 55 DCM patients, 40 were males and 15 were females. The age was (54.09 ± 12.38) years old. The heart function classification of New York Heart Association (NYHA) was mainly grade Ⅱ and Ⅲ, accounting for 94.55% (52/55). The follow-up time for 55 DCM patients was (7.02 ± 2.96) years, and 17 patients experienced all-cause death, accounting for 30.91% (17/55), including 15 males and 2 females. Compared with the survival group, the death group had a lower incidence of syncope (χ 2 = 6.57, P = 0.010), but higher rates of bilateral lower limb edema (χ 2 = 6.43, P = 0.017), pulmonary congestion (χ 2 = 7.61, P = 0.006), intraventricular conduction block (χ 2 = 6.41, P = 0.011), and angiotensin-converting enzyme inhibitor (ACEI) use (χ 2 = 6.57, P = 0.010), as well as increased left ventricular diameter ( t = 2.36, P = 0.022). Univariate Cox regression analysis showed that bilateral lower limb edema [hazard ratio ( HR) = 4.61, P = 0.042] and intraventricular conduction block ( HR = 3.20, P = 0.019) were risk factors for all-cause death of DCM patients. The results of K-M survival curve analysis showed that patients with bilateral lower limb edema and intraventricular conduction block had higher all-cause death rates (log-rank χ 2 = 5.02, 6.24, P = 0.025, 0.012). Whole exome sequencing results showed that 4 patients were detected to carry pathogenic or suspected pathogenic gene mutations, with a positive rate of 14.81% (4/27), involving three genes: β-myosin heavy chain 7 (MYH7), calreticulin 3 (CALR3), and gelsolin (GSN). Conclusions:The all-cause death rate of DCM patients in the Keshan disease area of Sichuan Province is relatively high. Dead patients are prone to bilateral lower limb edema, pulmonary congestion, and intraventricular conduction block, as well as increased left ventricular diameter. Bilateral lower limb edema and intraventricular conduction block are independent predictive risk factors for all-cause death in DCM patients. MYH7, CALR3 and GSN are involved in the pathogenesis of DCM.

Objective:To study the iodine nutrition status of key populations in Sichuan Province, so as to provide a basis for scientific supplementation of iodine and adjustment of prevention and control measures.Methods:From 2018 to 2022, the stratified cluster sampling method was used in 21 counties (district) in Sichuan Province. Each county (district) was divided into 5 areas based on east, west, south, north, and center. One township (street) was selected as a monitoring site from each area. Forty children aged 8 - 10 years old and 20 pregnant women, women of childbearing age, lactating women, and their infants and young children (0 - 2 years old) were randomly selected from each monitoring site. Household edible salt and urine samples were collected for salt and urine iodine testing. B-ultrasound method was used for thyroid examination in children.Results:A total of 52 019 samples of edible salt were collected, including 50 084 qualified iodized salt samples. The qualified iodized salt consumption rate was 96.3%, and the median salt iodine was 27.1 mg/kg. A total of 21 021 urine samples from children were tested, with a median urine iodine level of 199.5 μg/L. A total of 10 293 urine samples were taken from pregnant women, and the median urine iodine level was 172.6 μg/L. A total of 10 502 urine samples were taken from women of childbearing age, with a median urine iodine level of 174.4 μg/L. A total of 10 444 urine samples were taken from lactating women, and the median urine iodine level was 164.9 μg/L. There were 10 442 urine samples from infants and young children, and the median urine iodine level was 191.9 μg/L. A total of 21 028 children underwent thyroid examination, with a goiter rate of 1.8% (370/21 028).Conclusion:From 2018 to 2022, the iodine nutrition of key populations in Sichuan Province is at an appropriate level, and the elimination of iodine deficiency disorders continues to be maintained.

Due to the lack of precise microstructure and functions of the two-dimensional culture model, the in vitro culture models of lung organoids and lung-on-chips, as two main research tools to mimic lung development, homeostasis, injury, and regeneration, allow further exploration of pulmonary fibrosis, lung cancer, and other diseases. Lung organoid refers to isolated lung epithelial stem cells growing in a three-dimensional environment in vitro to form mini-clusters of cells that self-renew, self-reorganize, and differentiate into functional cell types. Based on the microfluidic chip technology, lung-on-chips use porous flexible membrane made of poly to provide tissue-layered structures for cells and simulate microenvironment and mechanical forces. We reviewed the classification, research and development history, establishment methods, practical applications, advantages and disadvantages of two main in vitro culture models derived from lung adult stem cells, hoping to provide a reference for organ transplantation and regeneration and drug screening.
Adult ; Adult Stem Cells ; Humans ; Lung ; Lung Neoplasms ; Organoids ; Stem Cells ; Tumor Microenvironment

Objective:To explore the effect of physical development on thyroid volume of children aged 8 - 10 years in Sichuan Province, and explore the thyroid volume correction method suitable for school-age children, so as to accurately prevent and control iodine deficiency disorders.Methods:From June to July 2020, Shuangliu District of Chengdu City, Pengshan District of Meishan City, Miyi County of Panzhihua City and Qingchuan County of Guangyuan City were selected as the survey counties (districts). One township (town and street) was selected from each county (district) according to the five directions of East, West, South, North and Middle, one primary school was selected from each township (town and street), and 40 children aged 8 - 10 years (gender and age balanced) were selected as the survey subjects from each primary school, height and weight were measured, the body mass index (BMI) and body surface area (BSA) were calculated. Thyroid volume was measured by B-ultrasound, and the different thyroid volume indexes [height volume index 1 (HVI1), height volume index 2 (HVI2), body mass volume index (BMIV), weight and height volume index (WHVI), body surface volume index (BSAV)] were calculated, respectively. Urine samples of all children were collected, the iodine concentration in urine was measured, and the correlation between different measurement indexes and children's growth and development indexes was analyzed.Results:A total of 805 children aged 8 - 10 years were investigated, including 403 boys and 402 girls. There were 312, 288 and 205 children in the 8-, 9- and 10-year-old groups, respectively. A total of 805 urine samples were collected, and the median urinary iodine was 251.4 μg/L. There was no statistically significant difference in thyroid volume between boys and girls ( Z = - 0.44, P = 0.661), but was statistically significant difference between ages ( H = 64.95, P < 0.001). In all age groups, thyroid volume was positively correlated with height and weight (8-year-old group: r = 0.29, 0.42, P < 0.001; 9-year-old group: r = 0.29, 0.41, P < 0.001; 10-year-old group: r = 0.34, 0.47, P < 0.001). In all age groups, after HVI1 correction, thyroid volume was positively correlated with height and weight (8-year-old group: r = 0.13, 0.32, P < 0.05; 9-year-old group: r = 0.12, 0.30, P < 0.05; 10-year-old group: r = 0.18, 0.37, P < 0.05). In all age groups, there was a positive correlation between thyroid volume and weight after HVI2 correction (8-year-old group: r = 0.20, P < 0.001; 9-year-old group: r = 0.17, P = 0.004; 10-year-old group: r = 0.26, P < 0.001). In the 8- and 10-year-old groups, there was a positive correlation between thyroid volume and height after BMIV correction ( r = 0.20, P < 0.001; r = 0.21, P = 0.003). In all age groups, there was a negative correlation between thyroid volume and height and weight after WHVI correction (8-year-old group: r = - 0.35, - 0.37, P < 0.001; 9-year-old group: r = - 0.38, - 0.39, P < 0.001; 10-year-old group: r = - 0.31, - 0.38, P < 0.001). In the 8-year-old group, there was a positive correlation between thyroid volume and weight after BSAV correction ( r = 0.11, P = 0.045). Conclusions:Thyroid volume is closely related to height and weight. It may be inappropriate to judge goiter in children only based on age. After the preliminary comparison of five correction methods, it is found that BSAV is better.

Objective:To investigate the clinical efficacy of perihilar surgical techniques for diffuse hepatolithiasis.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 122 patients with diffuse hepatolithiasis who were admitted to Hunan Provincial People's Hospital from January 2010 to December 2015 were collected. There were 39 males and 83 females, aged from 21 to 82 years, with a median age of 51 years. After perihilar hepatectomy, the first, second and third divisions of hepatic ducts were opened longitudinally. Strictures in the bile ducts were relieved by stricturoplasty and internal bile duct anastomosis, and stones were removed by multiple methods under direct vision. After resection of severe atrophic liver segment along the plane of hepatic atrophy or bile duct stricture, T-tube or hepaticojejunos-tomy was used for internal drainage. Observation indicators: (1) surgical situations; (2) stricture relief and stone removal. (3) Follow-up. Follow-up was conducted by Wechat, telephone interview or outpatient examination. Patients were followed up once every 3 months in the postoperative 1 year through liver function and abdominal B-ultrasound examination. Subsequently, liver function and abdominal B-ultrasound were reexamined once a year. Magnetic resonance cholangiopancreato-graphy and computed tomography were performed when cholangitis or stone recurrence was suspected to analyze stone recurrence and patient survival. The follow-up was up to July 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical situations: for the 122 patients, the operation time, hepatic portal occlusion time, volume of intraoperative blood loss, duration of postoperative hospital stay were (253±71)minutes, 15 minutes(range, 14?38 minutes), 200 mL(range, 100?1 100 mL), (12±5)days. Postoperative complications occurred to 40 of 122 patients. There were 9 cases of incision infection, 8 cases of bile leakage (5 cases of bile leakage at hepatic section, 3 cases of choledochojejunostomy leakage), 8 cases of septicemia, 7 cases of pleural effusion, 5 cases of abdominal abscess, 3 cases of liver failure, 1 case of biliary bleeding. Some patients had multiple complications. Among the 122 patients, 2 cases died after operation, including 1 case of postoperative liver failure and 1 case of disseminated intravascular coagulation caused by biliary-intestinal anastomotic leakage complicated with sepsis. Patients with bile leakage and abdominal abscess were improved after puncture and drainage under the guidance of B-ultrasound. Patients with cholangiojejunal anastomotic bleeding were embolized through the right hepatic artery. The other complications were improved after conservative treatment. (2) Stricture relief and stone removal: 85 of 88 patients with biliary stricture were relieved, with the stricture relief rate of 96.59%(85/88). Among the 122 patients, 103 cases had stones completely removed and 19 cases had residual stones. The immediate stone clearance rate was 84.43%(103/122). Of the 19 patients with residual stones, choledochoscopy was refused in 3 cases and choledochoscope lithotripsy was performed in 16 cases, of which 7 cases were removed and 9 cases were still residual stones. Of the 122 patients, 110 cases were finally removed stones, 12 cases were eventually residual stones, and the final stone clearance rate was 90.16%(110/122). (3) Follow-up: among the 122 patients, 120 cases including 110 cases with find stone removal and 10 cases with residual stones were followed up for (78±14)months. The 1-, 3, 5-year stone recurrence rates of 120 patients were 0.83%(1/120), 6.67%(8/120), 9.17%(11/120), respectively. The 1-, 3-, 5-year stone recurrence rates of 110 patients with final stone removal were 0, 5.45%(6/110), 5.45%(6/110), respectively. The number of cases with stone recurrence at postoperative 1-, 3- and 5-year of 10 patients with residual stones were 1, 2, 5 cases, respectively. Of 120 patients with follow-up, 1 case died of end-stage liver disease, and the other patients had good survival.Conclusion:Perihilar surgical techniques for diffuse hepatolithiasis is safe and effective.

Objective:To understand the prevalence of hypertension among residents in Keshan disease areas of Sichuan Province, in order to provide scientific basis for prevention and control of hypertension among residents in Keshan disease areas in Sichuan Province in the future.Methods:From 2017 to 2018, Keshan disease case search was carried out in 28 Keshan disease counties (cities, districts, referred to as counties) in Sichuan Province. According to the results of case search, survey sites were selected. Questionnaire survey and blood pressure measurement on permanent residents of the survey sites were conducted according to the unified Keshan disease monitoring plan by professionals. The diagnostic criteria of hypertension refer to the "Chinese Guidelines for Prevention and Treatment of Hypertension" (2019).Results:Totally 24 709 people aged 16 and over were investigated in 28 counties, and 6 022 patients with hypertension were detected, with a detection rate of 24.4% (6 022/24 709); the prevalence of hypertension was 25.5% (2 597/10 199) in male and 23.6% (3 425/14 510) in female; isolated systolic hypertension accounted for 46.5% (2 798/6 022); the constituent ratio of hypertension was 61.9% (3 725/6 022) in grade one, 27.6% (1 665/6 022) in grade two and 10.5% (632/6 022) in grade three.Conclusions:Although the detection rate of hypertension in Keshan disease areas in Sichuan Province is lower than that in the whole country (26.3%), it is still a long-term public health problem. The monitoring of related diseases and health education should be carried out continuously in Keshan disease areas.

Objective:To understand the levels of selenium and T-2 toxin in the historical critical disease area of Kashin-Beck disease in Aba State of Sichuan Province.Methods:From July 2018 to February 2019, in five cities (counties) of historical critical Kashin-Beck disease areas, namely, Ma'erkang, Rangtang, Aba, Ruo'ergai and Hongyuan, one township was selected, respectively, and then one village in the historical critical disease area and one village in non-disease area were selected from the selected townships. Hair samples from 30 children aged 6 to 12 years old were collected to test selenium content in each village. Staple food samples of 10 households were collected to test the selenium and T-2 toxin contents in each village. Ten soil samples were collected from each village to test the selenium content.Results:The medians selenium of children's hair in the diseased and non-diseased villages ( n= 180, 120) were 0.260 0 and 0.330 0 mg/kg, respectively, and the diseased village was lower than non-diseased village ( Z = - 6.319, P < 0.01). In Ma'erkang and Hongyuan, the medians selenium in the diseased villages were lower than those in non-diseased villages ( Z = - 3.327, - 4.939, P < 0.01), and there were no statistically significant differences between the diseased villages and non-diseased villages in Rangtang and Ruo'ergai ( P > 0.05). The medians selenium of staple food in the diseased and non-diseased villages ( n = 110, 70) were 0.005 8 and 0.018 0 mg/kg, respectively, and the diseased village was lower than non-diseased village ( Z = - 2.263, P < 0.05). In Ruo'ergai, the median selenium in the diseased village was lower than that in non-diseased village ( Z = - 2.306, P < 0.05), and there were no statistically significant differences between the diseased villages and non-diseased villages in Ma'erkang, Rangtang and Hongyuan ( P > 0.05). The T-2 toxin contents in staple food were all less than detection limit (1 μg/kg) in the diseased and non-diseased villages ( n = 103, 65). The soil selenium contents in the diseased and non-diseased villages ( n = 60, 40) were (0.045 3 ± 0.021 5) and (0.065 8 ± 0.045 4) mg/kg, respectively, and the diseased village was lower than non-diseased village ( t = 2.672, P < 0.05). The soil selenium content in the diseased village was lower than that in non-diseased village in Hongyuan ( t = 14.838, P < 0.01). There were no statistically significant differences in the soil selenium content between the diseased villages and non-diseased villages in Ma'erkang, Rangtang and Ruo'ergai ( P > 0.05). Conclusions:The overall selenium level of children's hair is at a medium level (0.25 - < 0.50 mg/kg) in the historical critical disease area of Aba State of Sichuan Province, the selenium levels of staple food and soil are at a deficiency level (< 0.025, < 0.125 mg/kg), and the diseased villages are lower than non-diseased villages. No T-2 toxin is detected in staple food.

Objective:To explore the value of " internal anastomosis" of bile duct , ie intrahepatic duct stricture resection, cholangioplasty and bilioenteric anastomasis, in the treatment of hepatolithiasis with stricture of bile duct orifice.Methods:The clinical data of 74 patients undergoing this procedure from Dec 2017 to Dec 2019 at Hu′nan Provincial Peopole′s Hospital were retrospectively analysed.Results:All 74 patients received intraoperative choledochoscopy lithotomy, and 26 cases had a hepatectomy for atrophic fibrosis. There were 27 cases with orifice stricture of left-lateral bile duct or its major branchs; 22 cases with that of caudate lobe ducts. 3 cases with that of right anterior ducts; 8 cases with that of right posterior bileduct; and 14 cases with that of bilateral multiple bile ducts . The average operation time was (243±31) min (ranging from 180 to 360 min), the average intraoperative blood loss was (150±26) ml (ranging from 100 to 600 ml). The average postoperative hospital stay was (10.0±2.2) d. The occurrence rate of residual stone was 8.1%. 14 cases (18.9%) had postoperative complications , including 2 cases with bleeding, 1 case with bile leakage, 4 cases with wound infection, 13 cases with pleural effusion. All were cured by conservative therapy, and no complications of grading Ⅲa or above happened according to Clavien Dindo grading system. All 74 cases were followed up, the average follow-up time was (10.2±3.6) months (ranging from 6 to 18months) with good result.Conclusion:" internal anastomosis" is an effective method to remove the narrow openings of intrahepatic bile ducts , thus helps to preserve much possible liver parenchyma, while decreasing the rate of residual stone.

Objective: To summarize our clinical experience and management of an anomalous proximal bile duct joining the cystic duct in laparoscopic cholecystectomy (LC). Methods: A retrospective study was conducted on 8 patients who had an anomalous right anterior bile duct joining the cystic duct who were treated at the Hunan Provincial People's Hospital from March 2003 to January 2019. Results: All the 8 patients were diagnosed to have gallstones cholecystitis on preoperative CT, MRI and abdominal ultrasound. There were no suggestions of an anomalous bile duct. A total of 6 patients underwent reoperation after LC due to abdominal pain and biliary peritonitis. These 6 patients were treated with drainage and T-tube insertion. In the other 2 patients, the anomalous bile duct opening which joined the cystic duct were detected during LC. There was one patient converted to open laparotomy with preservation of the cystic duct and underwent common bile duct T-tube drainage. The other patients continued with laparoscopic surgery. The cystic duct was partially resected with removal of gallbladder, followed by common bile duct drainage. The average follow-up period was 3.4 years and the results were satisfactory. Conclusions Biliary duct anomaly is the main cause of iatrogenic proximal bile duct injury during laparoscopic cholecystectomy. It is not uncommon to have the anomaly of insertion of right anterior segmental bile duct to the cystic duct. To avoid iatrogenic biliary tract injury, careful preoperative study of X-ray films, accurate identification of the intraoperative gallbladder triangle anatomical structures. Strict adherence to carry out the three-word procedure of " discrimination, cut, identify" will help to reduce the incidence of biliary tract complications in laparoscopic cholecystectomy.