Objective:To understand the characteristics and trends of acute myocardial infarction (AMI) in Shandong Province and to provide evidence for formulating prevention and control strategies.Methods:Data were derived from the AMI incidence reports of Shandong Province's Chronic Disease Surveillance Information Management System in 2012-2021. The crude and standardized incidence rates were used as indicators to describe the incidence level of AMI. Joinpoint regression analysis was used to analyze the trends in the incidence and age of onset over the years. The contribution of population aging to the increase in AMI incidence was assessed using the rate difference decomposition method. The incidence of AMI in each district (county) in Shandong Province was visualized using ArcGIS 10.8 software, and global and local spatial autocorrelation analysis was performed using DeoDa 1.12 software.Results:From 2012 to 2021, 198 233 cases of AMI were reported from 19 provincial monitoring sites in Shandong Province, of which 53.13% were males and 97.12% were ≥45 years old. The reported crude incidence increased from 90.12 per 100 000 in 2012 to 176.54 per 100 000 in 2021, with an average annual increase of 7.01% ( Z=7.35 , P<0.001). There was no significant upward trend in standardized incidence ( Z=1.64 , P=0.140), but the standardized incidence of male residents showed an increasing trend ( Z=2.76 , P=0.028). Before 2014, the reported crude incidence of males was similar to that of females, but after 2014, the reported crude incidence of males was continuously higher than that of females. However, males' standardized incidence was higher than females in all years. Both crude and standardized incidence rates were higher in rural residents than in urban areas. The median onset of AMI increased from 71.6 years old in 2012 to 73.5 years old in 2021. The median age of onset in males was lower than that in females in all years, and in most years, the median age of onset in urban residents was lower than that in rural residents. The incidence of AMI in males showed a trend in younger age groups. According to the seasonal decomposition, the incidence peak of AMI was in January, and the trough was in September. The contribution of aging population to the increase in crude incidence of AMI increased from 8.63% in 2013 to 52.58% in 2021. The global spatial autocorrelation analysis showed that the incidence of AMI presented an obvious spatial clustering distribution. Local spatial autocorrelation analysis found that the high-incidence areas (counties) were mainly concentrated in Liaocheng City and Dezhou City in the northwest region of Shandong Province and Heze City in the southwest. Conclusions:The incidence of AMI among residents in Shandong Province was rising, with spatial clustering and seasonal clustering characteristics. People aged 45 years and older, male residents, and rural residents were at high risk of developing AMI. There was a certain trend of younger age at onset among men. Targeted prevention and control measures should be taken for high-incidence seasons, high-risk groups, and high-incidence clustering areas in northwestern Shandong Province.

Objective To investigate the value of coronary computed tomography angiography(CCTA)for the non-invasive discrimination of chronic total occlusion(CTO)and subtotal occlu-sion(SO).Methods A total of 134 elderly patients undergoing CCTA and invasive coronary angio-graphy in our hospital from January 2019 to December 2021 were enrolled,and assigned into CTO group(62 cases)and SO(72 cases)according to the results of the examinations.Occlusion length,shape of proximal stump(blunt/conical),and collateral vessels were measured as anatomical find-ings.Transluminal attenuation gradient was obtained by a post-processing software.Univariate and multivariate logistic regression analyses were performed to explore factors related to CTO.Re-stricted cubic splines with three knots at the 10th,50th,and 90th percentiles were used to flexibly model the association of the factors with CTO,and ROC curve was plotted to evaluate the per-formance.Results Diabetes(OR=0.423,95％CI:0.186-0.963),occlusion length(OR=1.088,95％CI:1.031-1.148)and blunt-shaped stump(OR=2.453,95％CI:1.042-5.773)were inde-pendent predictors for discriminating CTO and SO(P＜0.05,P＜0.01).ROC curve analysis showed that the AUC value of occlusion length in the discrimination was 0.718(95％CI:0.634-0.792,P=0.001).Conclusion CCTA can be used to discriminate CTO and SO in elderly patients.

Objective:To learn about the operation of arsenic reduction and water improvement projects and the present situation of arsenic level in drinking water in drinking water type endemic arsenic poisoning areas in Jinzhong City, Shanxi Province.Methods:From May to August 2023, in accordance with the requirements of the "Investigation Plan for Arsenic Content in Drinking Water of Residents in Arsenic Exposed Areas of Shanxi Province", 29 high arsenic villages in the drinking water type endemic arsenic poisoning historical areas of Pingyao County, Jiexiu City and Qi County in Jinzhong City, Shanxi Province were selected as monitoring villages to investigate the operation of water improvement projects. The drinking water samples of village residents were collected and water arsenic level was measured by hydride atomic fluorescence spectrophotometry. At the same time, monitoring of the operation of water improvement projects and water arsenic level for residents within adjacent local areas were carried out in townships where 29 high arsenic villages located.Results:In 2023, a total of 29 high arsenic villages in 3 counties (cities) of Jinzhong City, Shanxi Province were monitored, all of which had undergone water improvement and all water improvement projects were operating normally. The range of water arsenic level was 0.000 - 0.047 mg/L, with 27 high arsenic villages had water arsenic level < 0.01 mg/L. A total of 81 natural villages within the adjacent local areas of high arsenic villages in Jinzhong City were monitored, all of which had undergone water improvement and the water improvement projects were operating normally. The range of water arsenic level was 0.000 - 0.043 mg/L, and there were 4, 7, and 2 natural villages in Pingyao County, Jiexiu City and Qi County with water arsenic level ranging from 0.01 to 0.05 mg/L.Conclusions:All high arsenic villages in Jinzhong City, Shanxi Province have completed water improvement, and the water improvement projects are operating normally. The water arsenic level in most high arsenic villages meets the national drinking water standard (< 0.01 mg/L).

Objective:To analyze the review results of salt iodine monitoring in the county-level laboratories of iodine deficiency disorders in Jinzhong City, and to learn about the quality of the monitoring in the county-level laboratories, so as to provide scientific basis for formulating iodine deficiency disorders prevention and control strategies.Methods:From 2021 to 2023, Jinzhong Center for Disease Control and Prevention used the systematic random sampling method to select 5% (15 samples each) of all edible salt samples (short for salt samples) tested by 11 county-level iodine deficiency disorders laboratories under its jurisdiction for retesting each year. The salt iodine was determined by the redox titration method in accordance with the "General Test Method in Salt Industry-Determination of Iodine" (GB/T 13025.7-2012). Comparisons between groups for count data were analyzed using the χ 2 test, and the comparisons between groups for measurement data were analyzed using a random group design t-test. Results:From 2021 to 2023, the municipal laboratories reviewed and tested 165 salt samples (495 in total over 3 years). The proportion of households using adquately iodized salt tested by county-level laboratories was 92.53% (458/495), with annual rates of 89.70% (148/165), 93.33% (154/165), and 94.55% (156/165), respectively. The proportion of households using adquately iodized salt detected by municipal laboratories was 94.95% (470/495), with annual rates of 90.91% (150/165), 96.36% (159/165), and 97.58% (161/165), respectively. There was no significant difference in the proportion of households using adquately iodized salt detected by the two-level laboratories from 2021 to 2023 (χ 2 = 2.48, P = 0.116). The proportion of salt samples with relative error > 20% in the salt iodine detection results of county-level laboratories reviewed at the municipal laboratory from 2021 to 2023 were 20.00% (33/165), 16.97% (28/165), and 8.48% (14/165), respectively. The differences between different years were statistically significant (χ 2 = 8.49, P = 0.004). Compared with 2023, in 2021 and 2022, the differences were statistically significant ( P < 0.05). The proportion of salt samples with relative error > 30% were 7.88% (13/165), 6.06% (10/165), and 3.64% (6/165), respectively. There was no significant difference among different years (χ 2 = 2.69, P = 0.101). The comparison of laboratory test results between the two-level laboratories showed statistically significant differences ( t = 6.05, P < 0.001). Among the group data reviewed, there were a total of 16 groups with statistical significance, including 4 groups in 2021, 7 groups in 2022, and 5 groups in 2023. Conclusions:The review results indicate that the quality of salt iodine monitoring in county-level laboratories in Jinzhong City continues to improve, and the testing data are authentic and reliable. In the future, training for county-level laboratory inspectors should be increased to enhance their operational skills and minimize testing result errors.

Objective:To evaluate the efficacy and safety of interstitial brachytherapy for locally recurrent and metastatic advanced gynecologic tumors.Methods:The data of patients with local recurrence and metastasis of advanced gynecological tumors who underwent brachytherapy in Shanxi Province Cancer Hospital from June 2020 to July 2021 were retrospectively analyzed. Objective remission rate (ORR) was compared among patients grouped according to the size, location of the lesion, and progression-free survival (PFS) before recurrence. Kaplan-Meier method was used to analyze the PFS after recurrence and group comparison was performed by using log-rank (Mantal-Cox) test. Multivariate Cox proportional hazard model was used to analyze the influencing factors of PFS after recurrence. The acute and advanced radiation injuries were also summarized.Results:A total of 20 patients were enrolled and the whole ORR was 80% (16/20). Subgroup analysis showed that 13 patients with focal length < 4 cm had objective remission, and 3 patients with focal length ≥ 4 cm had objective remission; the difference in ORR between the two groups was statistically significant ( P = 0.007). And 3 cases out of 6 cases with PFS time less than 6 months before recurrence and 13 cases out of 14 cases with PFS time equal to or more than 6 months before recurrence all had objective remission, and the difference was statistically significant ( P = 0.061). The median follow-up time was 6 months (1-13 months). By the end of follow-up, 9 patients (45%) had disease progression. Univariate survival analysis showed that patients with focal length < 4 cm (≥ 4 cm vs. < 4 cm: HR = 4.192, 95% CI 0.992-17.710, P = 0.029), PFS time before recurrence ≥ 6 months (≥ 6 months vs. < 6 months: HR = 0.163, 95% CI 0.038-0.696, P = 0.004), and radiation dose ≥ 15 Gy (≥ 15 Gy vs. < 15 Gy: HR = 0.207, 95% CI 0.049-0.881, P = 0.016) had better PFS after recurrence, but multivariate Cox regression analysis showed that the above factors were not independent factors of PFS after recurrence (all P > 0.05). None of 20 patients had radiation injury of rectum and bladder above grade 3. Conclusion:The therapeutic effect of interstitial brachytherapy for local recurrence and metastasis of advanced gynecological tumors is clear and safe.

Objective:The Chinese pediatric mesh-type reference phantoms were developed and applied in the dose assessment of X-ray radiography.Methods:The 5- and 10-year-old Chinese pediatric mesh-type reference phantoms were developed based on the CT data. Based on the phantoms, the Monte Carlo method was applied to simulate the X-ray radiography to calculate the organ dose conversion coefficient and the effective dose conversion coefficient in different radiography conditions.Results:The 5- and 10-year-old Chinese pediatric mesh-type reference phantoms were developed, and the physical parameters were consistent with the national standard. The differences of the organ mass between the established phantoms and reference data were within 2%. The database of the pediatric chest posteroanterior projection and abdominal anteroposterior projection, tube voltage 60-90 kVp, total filtration 2.5~4 mmAl were simulated, and the difference between the effective dose conversion factor and the literature result was within 3%.Conclusions:The established Chinese pediatric mesh-type reference phantoms can be applied in the studies of radiation protection and clinical medicine and their result can provide an important reference for the dose assessment of the pediatric X-ray radiography.

Objective:To estimate the deaths and life expectancy losses attributed to diet with high salt in Shandong province.Methods:Based on 24 h urinary sodium and blood pressure levels from the final evaluation survey of Shandong-Ministry of Health Action on Salt and Hypertension Project (SMASH) in 2016 and death cause data from Shandong Mortality Surveillance System, the population attributable fractions (PAF) and the deaths due to high-salt diet were calculated based on the framework of comparative risk assessment and the life expectancy loss was calculated by life table method.Results:A total of 32 987 deaths caused by high-salt diets were reported in 2016, accounting for 11.74% of related disease deaths and 4.95% of all deaths. The proportion of deaths due to high-salt diet in men (13.51%) was higher than that in women (9.17%). Cardiovascular diseases were the major causes of deaths due to high salt diet, accounting for 90.82% of all disease deaths caused by high-salt diets. The other causes were gastric cancer (8.10%) and chronic kidney disease (1.08%). The PAF in urban residents (13.87%) was higher than that in rural residents (10.87%). A loss of 0.58 years of the life expectancy were attributed to the high-salt diet. The different diseases caused by high-salt diet had different effects on life expectancy loss, ischemic heart disease ranked first, followed by cerebral hemorrhage and cerebral infarction.Conclusions:The proportion of deaths attributed to high-salt diets was high in Shandong. Cardiovascular diseases were the most important causes of deaths caused by high-salt diets. High-salt diet is still seriously affecting the health of residents in Shandong, indicating that salt reduction interventions need to be strengthened.

Objective:To investigate the relationship between serum matrix metalloproteinase-9(MMP-9) level and vascular cognitive impairment with no dementia (VCIND) in patients with cerebral small vessel diseases (CSVD).Methods:A total of 374 patients with CSVD treated in the First Affiliated Hospital of Xinxiang Medical University from January 2016 to January 2020 were collected and 150 healthy subjects in the same period were used as general data of the control group. All subjects were detected for serum MMP-9 level using enzyme linked immunosorbent assay and received cognitive function scoring using Montreal cognitive assessment (MoCA). The 374 patients with CSVD were divided into the Group A(186 cases with vascular cognitive impairment with no dementia) and the Group B(188 cases without cognitive impairment). The general data, serum MMP-9 level and cognitive function score were compared among the three groups and the correlation between MMP-9 level and cognitive function was analyzed.Results:The MMP-9 levels of Groups A and B ( (335.10±105.10)μg/L, (261.62±80.32)μg/L) were higher than those of the control group ( (168.23±48.85)μg/L), and the MMP-9 level of Group A was higher than that of Group B ( P<0.05). The MoCA scores of Groups A and B ( (18.45±5.24), (28.31±1.52) ) were lower than those of the control group (29.49±0.90), and the MoCA scores of Group A were lower than those of Group B ( P<0.05). The serum MMP-9 level, a risk factor for VCIND in patients with CSVD ( β=1.505, OR=1.323, 95% CI=1.149-1.527, P<0.05), was negatively correlated with total score of MoCA scale, visual-spatial and executive function, naming, language, abstract thinking, delayed recall, and directive force factor score ( r=-0.299, r=-0.155, r=-0.383, r=-0.358, r=-0.192, r=-0.259, r=-0.246 respectively, all P<0.05). Conclusion:The increased level of MMP-9 may be a risk factor of VCIND in CSVD patients, and it is closely related to cognitive impairment.

Objective: To explore the clinical symptoms of effective blood volume deficiency caused by ultrafiltration in hemodialysis patients with chronic renal failure, and to analyze the changes of blood pressure during the formation of symptoms. Methods: From October 2016 to February 2019, 146 patients with maintenance hemodialysis were selected from the Yangquan coalmine group General Hospital for 39 658 hemodialysis.There were 3527 cases of clinical symptoms of definable hypovolemia.The characteristics of clinical symptoms in the early stage of dialysis (>0-≤60 min), medium (>60-≤180 min) and late (>180-≤240 min) were analyzed.To define the hypotension, hypertension and maintenance blood pressure in dialysis, and to count the incidence of various blood pressure when clinical symptoms appear.The mean arterial pressure (mean arterial pressure, MAP) measured at the onset of the disease was compared with (MAP) at the onset of dialysis, and the evolution of (MAP) was classified.The dialysis interval weight gain≥5% or<5%, was counted for the onset of the condition caused by dialysis ultrafiltration.To analyze the clinical symptoms of hemodialysis caused by ultrafiltration speed and excess. Results: The incidence of clinical symptoms was 8.9% (3527/39658). The clinical symptoms caused by the insufficiency of effective blood volume are manifested in each period of dialysis, and have the characteristics of disease.Blood pressure index can not accurately reflect the correlation of clinical symptoms.There were 493 cases of effective blood volume deficiency during dialysis >0-≤60 min.Among them, 341 cases of hypotension, accounting for 69.1% (341/493), 79 cases of hypertension, accounting for 16.1% (79/493), 73 cases of maintaining blood pressure, accounting for 14.8% (73/493). The incidence of clinical symptoms was increased when dialysis was >60-≤180 min, which was related to continuous or excessive ultrafiltration.There were 1306 cases in total, including 1003 cases of hypotension, accounting for 76.8% (1003/1306); 179 cases of hypertension, accounting for 13.7% (179/1306); 124 times of maintaining blood pressure, accounting for 9.5% (124/1306). Dialysis>180-≤240 min is the high incidence period of clinical symptoms, which is related to continuous ultrafiltration and exceeding the setting of dry body mass.There are 1728 cases in total, including 1408 cases of hypotension, accounting for 81.5% (1408/1728); hypertension is reduced, but there are still cases of stubborn hypertension.When the clinical symptoms of hypovolemia occurred, 1989 cases were hypotension, which was easy to attract clinical attention; 763 cases were hypotension, which was stable before the clinical symptoms appeared, and then the blood pressure dropped suddenly; 446 cases were significantly higher than before the clinical symptoms appeared, which made it difficult to judge the clinical symptoms; 329 cases maintained the blood before the dialysis pressure.Excessive water retention in the whole process of dialysis has clinical symptoms, the total number of times increased significantly.The incidence of common water retention was less than that of dialysis>180-≤240 min.The osmotic pressure of plasma colloid and crystal affects the refilling of plasma, the change of ultrafiltration mode and the change of dialysis temperature on blood pressure and blood volume. Conclusion Because of the characteristics of the disease and the particularity of the treatment, the hemodialysis ultrafiltration process is prone to the related clinical symptoms caused by insufficient effective blood volume.However, the occurrence of clinical symptoms is not synchronous with the change of blood pressure.To improve the understanding of clinical symptoms of insufficient blood volume, to achieve early detection and early treatment is conducive to the safe treatment of follow-up hemodialysis and better completion of ultrafiltration target value.

In order to evaluate the intervention effect of the school-based salt reduction model, 28 primary schools were selected in Shandong Province in September 2014 and randomly divided into intervention group (1 361 students, 1 306 parents) and control group (1 364 students,1 340 parents). A series of "small hands and big hands" salt reduction intervention activities were conducted in intervention group for 8 months. After the intervention, the total awareness rate of salt reduction knowledge, the total holding rate of related beliefs and the total reporting rate of related behaviors were 70.65%, 80.30% and 67.03% among students, and 85.66%, 93.77% and 87.93% among parents, in the intervention group, which were higher than those in the control group (37.12%, 66.52% and 50.07% among students; 55.11%, 87.52% and 57.96% among parents) (all P values <0.05). The school-based salt reduction model is effective and feasible.