Objective:This study aimed to explore the status of radiological Kashin-Beck disease (KBD) among school-aged children in Chamdo City, Tibet, through a 3-year monitoring survey, providing epidemiological evidence for prevention and control strategies.Methods:The target areas for this study were Luolong, Bianba, and Basu counties in Chamdo City, Tibet Autonomous Region, identified as having the most severe historical cases of KBD. Children aged 7-12 years attending school were enrolled as study subjects. Anteroposterior X-ray films of the right-hand were taken, and radiological diagnoses were made based on the "Diagnosis of Kashin-Beck Disease" criteria (WS/T 207-2010). Two experienced researchers independently reviewed the X-rays, and intra- and inter-group consistency were assessed using weighted Kappa values and percentage agreement. Cross-sectional surveys were conducted in 2017 and 2020 to describe the X-ray detection rates of KBD, and logistic regression analysis was employed to construct a predictive model of risk factors for radiological KBD cases.Results:In 2017, a total of 5,711 children aged 7-12 years in Chamdo City, Tibet, participated in the baseline cross-sectional survey (average age 9.2 years, 48.0% female), with 28 cases of radiological KBD. The age- and gender-standardized prevalence rate was 0.527%. In 2020, 6,771 participants (average age 9.3 years, 49.5% female) underwent a second cross-sectional survey, with 9 cases of radiological KBD and a standardized prevalence rate of 0.134%. Logistic regression analysis indicated that older age [ OR=2.439, 95% CI(1.299, 4.580), P=0.006] and female gender [ OR=8.157, 95% CI(1.016, 65.528), P=0.048] were independent risk factors for radiological KBD cases. Conversely, higher residential altitude, under the premise of Tibet's high altitude, was a protective factor [ OR=0.995, 95% CI(0.990, 0.999), P=0.032). Conclusion:The radiographically positive detection rate of KBD among school-aged children in Chamdo City, Tibet Autonomous Region, is at an extremely low level and showing a declining trend, reaching the historical standard in 2020. Considering the absence of positive signs in affected children, it suggests that local KBD has been effectively eliminated.

Objective:To investigate the clinical characteristics of choledocholithiasis com-bined with periampullary diverticulum and influencing factor for difficult cannulation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:The retrospective case-control study was conducted. The clinical data of 1 920 patients who underwent ERCP for choledocholithiasis in 15 medical centers, including the First Hospital of Lanzhou University, et al, from July 2015 to December 2017 were collected. There were 915 males and 1 005 females, aged (63±16)years. Of 1 920 patients, there were 228 cases with periampullary diverticulum and 1 692 cases without periampullary diverticulum. Observation indicators: (1) clinical characteristics of patients with choledocholithiasis; (2) intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis; (3) influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and com-parison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Logistic regression model was used for univariate and multivariate analyses. Results:(1) Clinical characteristics of patients with choledocholithiasis. Age, body mass index, cases with complications as chronic obstructive pulmonary disease, diameter of common bile duct, cases with diameter of common bile duct as <8 mm, 8?12 mm, >12 mm, diameter of stone, cases with number of stones as single and multiple were (69±12)years, (23.3±3.0)kg/m 2, 16, (14±4)mm, 11, 95, 122, (12±4)mm, 89, 139 in patients with choledocholithiasis combined with periampullary diverticulum, versus (62±16)years, (23.8±2.8)kg/m 2, 67, (12±4)mm, 159, 892, 641, (10±4)mm, 817, 875 in patients with choledocholithiasis not combined with periampullary diver-ticulum, showing significant differences in the above indicators between the two groups ( t=?7.55, 2.45, χ2=4.54, t=?4.92, Z=4.66, t=?7.31, χ2=6.90, P<0.05). (2) Intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis. The balloon expansion diameter, cases with intraoperative bleeding, cases with hemorrhage management of submucosal injection, hemostatic clip, spray hemostasis, electrocoagulation hemostasis and other treatment, cases with endoscopic plastic stent placement, cases with endoscopic nasal bile duct drainage, cases with mechanical lithotripsy, cases with stone complete clearing, cases with difficult cannulation, cases with delayed intubation, cases undergoing >5 times of cannulation attempts, cannulation time, X-ray exposure time, operation time were 10.0(range, 8.5?12.0)mm, 56, 6, 5, 43, 1, 1, 52, 177, 67, 201, 74, 38, 74, (7.4±3.1)minutes, (6±3)minutes, (46±19)minutes in patients with choledocholithiasis combined with periampullary diverticulum, versus 9.0(range, 8.0?11.0)mm, 243, 35, 14, 109, 73, 12, 230, 1 457, 167, 1 565, 395, 171, 395, (6.6±2.9)minutes, (6±5)minutes, (41±17)minutes in patients with choledocholithiasis not combined with periampullary diverticulum, showing significant differences in the above indicators between the two groups ( Z=6.31, χ2=15.90, 26.02, 13.61, 11.40, 71.51, 5.12, 9.04, 8.92, 9.04, t=?3.89, 2.67, ?3.61, P<0.05). (3) Influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Results of multivariate analysis showed total bilirubin >30 umol/L, number of stones >1, combined with periampullary diverticulum were indepen-dent risk factors for difficult cannulation in patients with periampullary diverticulum who underwent ERCP for choledocholithiasis ( odds ratio=1.31, 1.48, 1.44, 95% confidence interval as 1.06?1.61, 1.20?1.84, 1.06?1.95, P<0.05). Results of further analysis showed that, of 1 920 patients undergoing ERCP for choledocholithiasis, the incidence of postoperative pancreatitis was 17.271%(81/469) and 8.132%(118/1 451) in the 469 cases with difficult cannulation and 1 451 cases without difficult cannula-tion, respectively, showing a significant difference between them ( χ2=31.86, P<0.05). In the 1 692 patients with choledocholithiasis not combined with periampullary diverticulum, the incidence of postopera-tive pancreatitis was 17.722%(70/395) and 8.250%(107/1 297) in 395 cases with difficult cannula-tion and 1 297 cases without difficult cannulation, respectively, showing a significant difference between them ( χ2=29.00, P<0.05). In the 228 patients with choledocholithiasis combined with peri-ampullary diverticulum, the incidence of postoperative pancreatitis was 14.865%(11/74) and 7.143%(11/154) in 74 cases with difficult cannulation and 154 cases without difficult cannulation, respectively, showing no significant difference between them ( χ2=3.42, P>0.05). Conclusions:Compared with patients with choledocholithiasis not combined with periampullary divertioulum, periampullary divertioulum often occurs in choledocholithiasis patients of elderly and low body mass index. The proportion of chronic obstructive pulmonary disease is high in choledocholithiasis patients with periampullary diverticulum, and the diameter of stone is large, the number of stone is more in these patients. Combined with periampullary diverticulum will increase the difficult of cannulation and the ratio of patient with mechanical lithotripsy, and reduce the ratio of patient with stone complete clearing without increasing postoperative complications of choledocholithiasis patients undergoing ERCP. Total bilirubin >30 μmol/L, number of stones >1, combined with periampullary diverticulum are independent risk factors for difficult cannulation in patients of periampullary diverticulum who underwent ERCP for choledocholithiasis.

Objective To explore the outcome relationship between the baseline blood pressure level and the early antihypertensive therapy of acute ischemic stroke for 3 months. Methods A total of 828 patients who were admitted to hospital within 48 hours of onset and diagnosed with acute ischemic stroke with hypertension through imageological examination from August 2009 to May 2013 were collected. They were divided into 140～160 mmHg group (n=276),160～180 mmHg group (n=350),180～200 mmHg group (n=158),and 200～220 mmHg group (n=44) according to the level of systolic pressure at the time of enrollment,and given randomly or not given antihypertensive therapy. For the patients receiving the antihypertensive therapy,the blood pressure was reduced by 10%～20% within 24 hours,the systolic pressure and diastolic pressure were lower than 140 mmHg and 90 mmHg respectively at 7 days,and maintained at this level for 2 weeks. For the patients not receiving the antihypertensive therapy,antihypertensive drugs were discontinued or not given,and all patients were measured,with the blood pressure levels recorded. The mortality and good prognosis rate were compared at 3 months after discharge. Results Through 3 months of follow-up,the mortality of patients with antihypertensive therapy in the 140～160 mmHg group was significantly higher than that of those without antihypertensive therapy (13.7% vs 5.8%,P<0.05),the good prognosis rate was significantly lower than that of those without antihypertensive therapy (65.5% vs 77.4%,P<0.05),there was no statistically significant difference in mortality and all-cause mortality between 160～180 mmHg group,180～200 mmHg group,and 200～220 mmHg group (9.2% vs 13.4%,11.8% vs 12.3%,13.6% vs 9.1%,P>0.05),and the difference in good prognosis rate was not statistically significant (71.8% vs 62.6%,69.4% vs 60.3%,54.5% vs 59.1%,P>0.05). Conclusion Patients with acute ischemic stroke should not receive antihypertensive therapy when blood pressure is elevated mildly (SBP 140～160 mmHg);the impact of antihypertensive therapy on 3-month outcome is neutral in case of moderate to high blood pressure elevation (SBP 160～220 mmHg).

Three new points of view were reported in this study:1.Found out the distribution of KaschinBeck disease (KBD) in Tibet,the complexity of bone disease composition,and the types of osteopathy coexisted which need to be identified;2.The clinical symptoms of KBD in Tibet were significantly different from those in other areas of our country;3.The new clinical subtypes of KBD were found in Tibet,which had humeral shortness and short stature,but with normal hands and feet.This discovery made us understand KBD more profoundly and comprehensively,and promoted the research and prevention work of KBD.

Adolescent ; Foot Deformities ; genetics ; Humans ; Male

Objective To observe the individualized insertion choice in treatment of upper cervical injury with posterior atlantoaxial short-segmental pedicle screws or lateral mass screws and the relevant clinical outcome.Methods A total of 23 cases of upper cervical injuries received skull traction preoperatively.Individual surgery plan including internal fixation using pedicle screws or lateral mass screws as well as diameter,length,entry point,direction,and angle of screws was determined according to their atlantoaxial CT scan and three-dimensional reconstruction results.Results Six cases of Frankel grade C and eight of grade D were all recovered to grade E after operation.All cases presented rigid fixation and bony fusion in the follow-up of 6 to 36 months.Besides,screws were removed after bony fusion for three young cases and one case with left atlas pedicle screws emerged laterally out of cortex.Clinical outcome was all satisfactory.Conclusion Individualized posterior atlantoaxial fixation using pedicle screws or lateral mass screws is an effective way to treat upper cervical injury and gains advantages of stable threedimensional structures,short fixation segments,and few postoperative complications.

Objective To explore the risk factors of esophageal cancer and these factors' interaction Methods 472 new diagnosed cases of esophageal cancer in 2004—2005 and 472 controls were investigated by case-control study. Etiological fractions and interactions between family history of esophageal cancer and other risk factors of esophageal cancer were analyzed. Results The significant independent risk factors included taking hot-meal, preferring pickled-vegetables, preferring dry-rigidity-food, being irritable, drinking polluted-water perennially, family history of esophageal cancer and drinking alcohol a great deal. The etiologic fractions attributable to interaction were 0.855, 0.758, 0.683, 0.464, 0.459, 0.343 and 0.108 respectively. The synergy indexes of family history of esophageal cancer with taking hot-meal and with preferring dry-rigidity-food were both 0.86. Concludes The interactions between family history of esophageal cancer and ill life-behavior-style or drinking polluted-water perennially were particularly significant in the development of esophageal cancer in Dongping County.

OBJECTIVE:To investigate the complexation of clonazepam with hydroxypropyl-?-cyclodextrin(HP-?-CD)in aqueous solutions.METHODS:The complexation of clonazepam with(HP-?-CD),the inclusion molar ratio of host and guest molecules and thermodynamic parameters were detected using phase solubility method,equimolar series method,UV absorption spectroscopy etc.RESULTS:The solubility of clonazepam increased linearly with the increase of(HP-?-CD)level in aqueous solutions at different temperatures(25℃,35℃and45℃)and in buffers at different pH values(4.0,6.0and7.0),the phase solubility diagram was classified as type AL.CONCLUSIONS:Under the above research condition,the incl_ usion complexes of clonazepam with(HP-?-CD)can be formed spontaneously at a molar ratio of1∶1.

OBJECTIVE:To compare the substitution between the gray relation analysis( GRA) and the orthogonal design(OD) in data processing. METHODS:Take the four factors including the molar ration of drug and cyclodextrins,the agitating time and speed,and the temperature of complexation that influenced on loaded dosage of ursolic acid complex as example to analysis with 2 kinds of methods. RESULT:The result of analysis was similar by 2 kinds of methods,the molar ration of drug and the temperature of complexation were the major influence factors. CONCLUSION:When the data cannot fit to the analysis of range of OD,GRA can be used to it.

OBJECTIVE: To study the development strategy of clinical pharmacy under the condition of New Medical Reform in China. METHODS: The status quo and obstacle factors of clinical pharmacy were analyzed to probe into the chance for clinical pharmacy in China brought out by New Medical Reform. RESULTS: The reimbursement mechanism reform of state hospitals, National Essential Drug System, medical insurance system, charge for pharmaceutical care system and the construction of primary hospitals and public health service provide development opportunities of clinical pharmacy. CONCLUSION: The development strategy of clinical pharmacy should be associated with New Medical Reform and relevant policy, laws and regulations of clinical pharmacy should be improved. Great importance should be attached to exploring the training system of clinical pharmacists and approaches of clinical pharmacy.