Objective    To investigate the clinical safety and feasibility of thoracic sympathectomy in the treatment of palmar hyperhidrosis based on ambulatory surgery. Methods    A retrospective analysis of 74 patients who underwent thoracoscopic sympathectomy in the Department of Thoracic Surgery of the First People's Hospital of Yunnan Province from January 2017 to April 2021 was performed, including 35 males and 39 females aged 12-38 (21.32±4.13) years. Patients were divided into two groups according to different treatments. There were 34 patients in a control group (adopting traditional surgery), and 40 patients in an observation group (adopting ambulatory surgery). The clinical effects of the two groups were compared. Results    No massive bleeding, conversion to thoracotomy, postoperative pneumo-thorax or severe pneumonia occured in all patients. Univariate analysis of intraoperative indexes showed that the two groups had no statistical difference in total hospitalization cost, operation time, anesthesia time or postoperative waiting time (P>0.05). The amount of intraoperative blood loss in the observation group was less than that in the control group (P<0.05). The time of postoperative out of bed and recovery of walking capacity and the incidence of electrolyte disturbance in the observation group were shorter or lower than those in the control group (P<0.05). There was no statistical difference in white blood count, neutrophils count or postoperative 24 h pulse oxygen saturation fluctuation peak between the two groups (P>0.05). Conclusion    Based on the optimized diagnosis and treatment model, thoraco-scopic sympathectomy with laryngeal mask airway which is performed during ambulatory surgery, is feasible and worth popularizing in thoracic surgery.

Objective:To assess the changes of selenium nutrition of school-age children in Kashin-Beck disease (KBD) areas of Linzhou County, Lhasa City and Xietongmen County, Shigatse City in Tibet Autonomous Region (referred to as Tibet), and provide a scientific basis for evaluating the effectiveness of prevention and control measures.Methods:According to the historical condition of KBD, a total of 344 children's hair samples were collected to determine the content of selenium in Kazi (KBD area) and Jiangxia townships (non-KBD area) of Linzhou County in 2013 and 2021, Renqinze (KBD area) and Tongmen townships (non-KBD area) of Xietongmen County in 2015 and 2021.Results:Compared to 2013/2015, in 2021, the hair selenium level of children in the four townships increased ( P < 0.001). The selenium nutritional level of more than 90% of the children reached medium or above (hair selenium > 0.25 μg/g) in 2021. The hair selenium levels of girls in the two KBD areas (Kazi and Renqinze townships) were lower than those of boys ( Z = - 2.83, - 2.83, P < 0.05). Conclusions:The selenium nutrition level of school-age children in KBD areas in Linzhou and Xietongmen counties has increased rapidly in recent years. However, the selenium nutrition level of girls is significantly lower than that of boys. It is necessary to strengthen prevention, controlling and monitoring, and to further improve the dietary structure of school-age children through the joint efforts of families and schools, to increase the proportion of exogenous high selenium food intake.

Objective:To analyze the spatiotemporal characteristics and spatial aggregation of the incidence of hemorrhagic fever with renal syndrome (HFRS) in China from 2004 to 2020, and to provide a scientific basis for prevention and control of HFRS.Methods:The epidemic information of HFRS in China from 2004 to 2020 was collected from the Public Health Science Data Center, the China Health Statistics Yearbook, and the National Statutory Infectious Disease Epidemic Profile Report. The Joinpoint model was used to analyze the annual average incidence rate change trend, ArcGIS 10.5 software was used for spatial visualization analysis, and global spatial autocorrelation, local spatial autocorrelation and spatiotemporal scan analysis were applied to detect hot spots and aggregation areas.Results:From 2004 to 2020, a total of 208 441 cases of HFRS were reported in China, with an average annual incidence rate of 0.91/100 000. Joinpoint model analysis showed that the average annual incidence rate of HFRS in China showed a decreasing trend from 2004 to 2020. In the provinces with high incidence, the disease was mostly distributed with multimodal distribution in spring, autumn and winter, especially in autumn and winter. The results of global spatial autocorrelation analysis showed that the global Moran's I of HFRS incidence rate in China from 2004 to 2019 were all positive. Except 2012 and 2020, the random distribution pattern was not excluded, other years showed spatial clustering ( Z > 1.65, P < 0.05). The results of phased local spatial autocorrelation analysis indicated that Heilongjiang, Jilin and Liaoning provinces were high-high aggregation regions. A total of five aggregation regions were detected in the month-by-month spatiotemporal scan analysis, and the differences of each aggregation region were statistically significant ( P < 0.001). Conclusions:From 2004 to 2020, the overall incidence of HFRS in China shows a downward trend, and the incidence rate has obvious spatial aggregation. High-risk areas still exist, and it is necessary to focus on and take targeted prevention and control measures.

Objective    To investigate the feasibility and safety of non-intubation anesthesia in thoracic surgery. Methods    From September 2017 to December 2019, 296 patients were operated at department of thoracic surgery in our hospital. There were 167 males and 129 females with an average age of 50.69±12.95 years, ranging from 16 to 76 years. The patients were divided into two groups according to whether they were intubated: 150 patients were in a non-intubation group, including 83 males and 67 females with an average age of 49.91±13.59 years, ranging from 16 to 76 years, and 146 patients were in an intubation group including 84 males and 62 females with an average age of 51.49±12.26 years, ranging from 16 to 74 years. Intraoperative data, postoperative recovery, inflammatory response of the two groups were compared. Results    There was no statistical difference between the two groups in operation time, blood loss, the lowest oxygen saturation or other indicators (P>0.05). But the highest partial pressure of carbon dioxide of the non-intubation group was higher than that of the intubation group (P=0.012). The non-intubation group was superior to the intubation group in postoperative recovery and inflammatory response (P<0.05). Conclusion    The non-intubation anesthesia is safe and maneuverable in thoracic surgery, and it has some advantages in accelerating postoperative rehabilitation.

Objective:To investigate the levels of urinary arsenic metabolites in arsenic-exposed people with different degrees of skin lesions.Methods:A cluster sampling method was used to select people with different degrees of skin lesions in the drinking water arsenic poisoning area of Bayannaoer City, Inner Mongolia Autonomous Region. According to the "Standard of Diagnosis for Endemic Arsenism" (WS/T 211-2001), the research subjects were divided into four clinical grading: normal, suspicious, mild, moderate and above on the basis of the degrees of skin lesions. Urine samples from any 1 middle section were collected, and the levels of urinary arsenic metabolites of different forms in different clinically graded people were detected by inductively coupled plasma mass spectrometry (ICP-MS).Results:A total of 522 people were included, including 309 males and 213 females; the age was (39.11 ± 12.38) years old, ranging from 11 to 65 years old. There were 337, 80, 31, 74 people in normal, suspicious, mild, moderate and above clinical grading, the levels of inorganic arsenic (iAs, medians: 15.46, 37.16, 104.46, 163.06 μg/L), monomethylarsonic acid (MMA, medians: 15.95, 33.27, 82.80, 123.84 μg/L), dimethylarsenic acid (DMA, medians: 78.16, 147.86, 301.28, 371.30 μg/L), total arsenic (tAs, medians: 113.90, 220.94, 501.25, 684.46 μg/L), iAs percentage (iAs%, medians: 15.66%, 15.53%, 21.67%, 21.65%), MMA percentage (MMA%, medians: 13.51%, 15.40%, 17.14%, 16.43%), DMA percentage (DMA%, medians: 70.37%, 67.98%, 63.25%, 61.23%), monomethylation rate (PMI, medians: 0.84, 0.84, 0.78, 0.78), dimethylation rate (SMI, medians: 0.84, 0.81, 0.79, 0.79), and ratio of MMA to DMA (MMA/DMA, medians: 0.20, 0.23, 0.27, 0.27) were compared in different clinically graded people, the differences were statistically significant ( H = 97.98, 96.44, 85.50, 95.08, 38.58, 29.94, 51.98, 38.58, 43.20, 43.20, P < 0.01). Compared with normal people, iAs, MMA, DMA, tAs, MMA%, and MMA/DMA levels significantly increased, and SMI level significantly decreased in suspicious, mild, moderate and above people ( P < 0.017); compared with normal people, iAs% level significantly increased, and DMA% and PMI levels significantly decreased in mild, moderate and above people ( P < 0.017). Conclusion:The levels of urinary arsenic metabolites in arsenic-exposed people with different degrees of skin lesions are different, showing a dose-response relationship.

Objective:To assess the present situation of selenium nutrition in adults and school-age children in Kaschin-Beck disease area of Binxian, Shaanxi Province, and provide the basis for taking targeted measures.Methods:Binxian was divided into five grades according to the condition of Kaschin-Beck disease, and 11 representative villages were selected as the survey villages in 2018. Each survey village was located in five directions: east, west, south, north, and middle. Two household villagers were selected from each location, and adult hair samples were collected for hair selenium content determination. And school-age children hair samples were collected at the township central primary schools and 1 village primary school corresponding to the five ward levels, and the selenium content was determined.Results:A total of 85 adult hair samples were collected, the average selenium content was 237.1 μg/kg, generally at the marginal selenium deficiency level (200 - < 250 μg/kg), and there was no significant difference among different grades of disease areas (χ 2 = 5.616, P > 0.05) . A total of 162 children hair samples were collected, the average selenium content was 301.3 μg/kg, generally at the middle selenium nutrition level (250 - < 500 μg/kg), and there was significant difference among different grades of disease areas (χ 2 = 13.627, P < 0.05) . Conclusion:Although Binxian has got rid of the risk of Kaschin-Beck disease as a whole, the selenium nutrition levels of some adults and children are still low, so it is still necessary to strengthen the prevention and control measures, especially for school-age children living in a relatively serious historical disease villages.

Objective To explore the spatial description of Keshan disease(KD)and to provide a basis for reasonable allocation of health resources and for making precision prevention and control strategies. Methods In 2013 and 2014, the KD's condition, prevention and control measures and their effects were investigated in the diseased affected counties in the provinces through combination of case search and key survey. Results A total of 16(100.0%,16/16)diseased provinces,315(96.0%,315/328)diseased counties were surveyed,and 1 562 people with KD were detected in 281 000 residents, the detection rate was 55.6/10 000. Chronic and latent KD detection rates were 8.9/10 000(250)and 46.7/10 000(1 312),respectively.There were 261(82.9%)diseased counties that had reached the control standards of KD,and 54(17.1%)did not meet the control standards,which mainly distributed in the provinces of Henan, Inner Mongolia, Gansu and Shanxi. Conclusions The detection rate of KD has been at a low level, but in Henan, Inner Mongolia, Gansu, and Shanxi, there are prevalent KD areas that have not yet reached the control level.This part of the areas should be treated as key prevention and control areas of KD.

Objective To explore the spatial distribution clustering and influencing factors of chronic Keshan disease in China,and to provide evidence for prevention and control of Keshan disease.Methods Using non-probability sampling methods,combined with case search and key surveys,data on national detection rate of chronic Keshan disease,on disease influencing factors in 2013-2014 were collected;a spatial database was established,and ArcGIS 9.0 software was used to perform global Moran'sI,local Moran's I,local Getis-Ord Gi and inverse distance weighted interpolation analysis for the detection rate of national chronic Keshan disease.Spatial regression was used to analyze the influencing factors of chronic Keshan disease.Results Global autocorrelation analysis showed that Moran's I =0.03,Z =2.72,P ＜ 0.01,indicating that there was aggregation in the detection rate of Keshan disease.The results of local Moran's Ii showed that there were local high-detection rate clusters in the wards of Keshan disease,and the high-high aggregation areas were mainly concentrated in the wards of Gansu,Inner Mongolia,and Shanxi;the high-low aggregation areas were mainly located in the wards of Heilongjiang,Jilin,Shandong;the low-high aggregation area were mainly located in the wards of Heilongjiang.Getis-Ord Gi autocorrelation results showed that Keshan disease hotspots were mainly located in the wards of Inner Mongolia,Heilongjiang,Gansu,Shandong,Shanxi and Yunnan;the results of reverse distance weighted interpolation showed that the detection rates of the counties in Gansu and Inner Mongolia were higher than that in Heilongjiang,Jilin,Liaoning,Shanxi,Shandong,Shaanxi and Yunnan,the detection rate of wards in other provinces was at a lower level.Spatial regression analysis showed that the spatial distribution of chronic Keshan disease was negatively related to rural per capita net income and annual average temperature in the ward (Z =-2.808,-2.747,P ＜ 0.05).Conclusions Global chronic Keshan disease exists spatial aggregation,the local gathering area is mainly located in the wards of Gansu,Inner Mongolia.The spatial distribution of chronic Keshan disease may be affected by the level of rural per capita net income and annual average temperature in the ward.

Objective To investigate the expression levels and significance of hypoxia inducible factor-1 α (HIF-1 α),vascular endothelial growth factor (VEGF) and matrix metalloproteinase-2 (MMP-2) in pathological scar.Methods 73 patients with pathological scar from March 2015 to February 2017 in our hospital were selected,including 42 cases in hypertrophic scar group and 31 cases in keloid group.20 cases of non pathological scar patients and 20 cases of normal plastic surgery were selected as control group.mRNA and protein expression levels of HIF-1,VEGF and MMP-2 in skin tissue of each group were detected by real-time fluorescence quantitative and Western blot,and the clinical significance was analyzed.Results Compared with non pathological scar tissue and normal skin tissue,the mRNA and protein expression levels of HIF-1α,VEGF and MMP-2 in pathological scar tissue were significantly increased,and the differences were statistically significant (P ＜ 0.05).The mRNA and protein expression levels of HIF-1α in keloid group were significantly higher than those in hypertrophic scar group (P ＜ 0.05);there was no significant difference in the expressions of mRNA and protein of VEGF between keloid group and hypertrophic scar group (P ＞ 0.05);the mRNA and protein expression levels of MMP-2 in keloid group were significantly lower than those in hypertrophic scar group (P ＜ 0.05).Pearson correlation analysis showed that there was a significant positive correlation between HIF-1α and VEGF,MMP-2 in pathological scar tissues (r =0.623,0.507,P ＜ 0.05).Conclusions The expressions of HIF-1α,VEGF and MMP-2 in pathological scar tissue is obviously increased,which is closely related to the formation of pathological scar.

Objective To study the relationship between hair selenium content and arsenism among population from endemic arsenism area caused by coal combustion in the southern of Shaanxi Province.Methods Four high-arsenic-exposed villages in southern Shaanxi Province were selected as the study area,and the nonarsenic-exposed villages nearby were selected as the control area,90 hair samples of residents exposed to high arsenic in the study area and 14 hair samples of residents in the control area were collected.Inductively Coupled Plasma Mass Spectrometry (ICP-MS) was used to determine the contents of arsenic and selenium in hair samples.Selenium/hair arsenic (Se/As) value was calculated,and the relationship between selenium content in hair samples and arsenicosis was analyzed.Results The geometric mean of selenium concentration in hair from the study area was 8.72 mg/kg,which was significandy higher than that from the control area (0.54 mg/kg,t =9.811,P ＜ 0.05).However,selenosis case was not found in the study area.Selenium content in hair was not obviously correlated with arsenism (r =0.075,P ＞ 0.05),while the Se/As value was negatively associated with the grade of arsenism (P ＞ 0.05).The geometric mean of selenium content in hair of female from the study area was 12.79 mg/kg,which was higher than that in hair of male (6.5 mg/kg,t =1.738,P ＜ 0.01).Meanwhile,the Se/As value in hair of female from the study area (1.15) was significantly higher than that in hair of male (0.65,t =3.218,P ＜ 0.05).Conclusions The environment of the study area is polluted by arsenic and selenium derived from stone-coal burning.Antagonism between arsenic and selenium might reduce the toxicity of selenium.Therefore,selenosis is not found in the study area.In addition,antagonism between arsenic and selenium might also induce lower prevalence of arsenism for female in the studly area.