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 explore the prognostic factors associated with clear cell adenocarcinoma (CCAC) of the uterine cervix based on data in the Surveillance, Epidemiology and End Results (SEER) database.Methods:Clinical data were collected from 431 patients with confirmed CCAC in the SEER database from 1976 to 2017. Survival analysis was performed using the Kaplan-Meier method with log-rank test for comparison between subgroups. Cox proportional hazards model was used to analyze the influencing factors of overall survival (OS).Results:The median age [ M ( Q1, Q3)] of 431 patients was 54 years old (40 years old, 71 years old); there were 333 cases (77.3%) of whit. The median OS time of 431 patients was 93 months (95% CI: 47-148 months), and the 1-, 2-, and 5-year OS rates were 80.1%, 65.8% and 54.2%, respectively. The median OS time was not reached in patients with American Joint Committee on Cancer (AJCC) stage Ⅰ, 83 months (95% CI: 21-144 months) for stage Ⅱ, 32 months (95% CI: 16-47 months) for stage Ⅲ, and 9 months (95% CI: 5-13 months) for stage Ⅳ ( P < 0.001). Median OS time was not reached in patients with SEER stage of localized lesions, 46 months (95% CI: 8-83 months) for regional lesions stage, and 9 months (95% CI: 5-12 months) for distant metastases stage ( P < 0.001). Of the patients with clear AJCC staging and some with unspecified AJCC staging, 118 received surgical treatment alone and 119 received postoperative radiotherapy, the median OS time of the two groups was 443 months (95% CI: 162-723 months) and 102 months (95% CI: 75-129 months), and the difference in OS between the two groups was statistically significant ( P < 0.001). Among the patients with AJCC stage Ⅰ, the 5-year OS rates in surgery-only group and postoperative radiotherapy group were 82.5% and 78.5%, the stage Ⅱ were 80.0% and 52.3%, and the stage Ⅲ were 27.8% and 63.3%, respectively; the differences in OS between different stages were not statistically significant (all P>0.05). Among the patients with SEER localized lesions stage, the 5-year OS rates in surgery-only group and postoperative radiotherapy group were 88.9% and 73.1%, and the difference was statistically significant ( P = 0.012); the regional lesions stage were 45.5% and 60.0%, and the difference was not statistically significant ( P = 0.568). The results of multivariate Cox regression analysis showed that AJCC staging (stage Ⅰ vs. stage Ⅳ, HR = 0.281, 95% CI: 0.178-0.543, P < 0.001; stage Ⅱ vs. stage Ⅳ, HR = 0.347, 95% CI: 0.113-0.439, P < 0.001; stage Ⅲ vs. stage Ⅳ, HR = 0.399, 95% CI: 0.030-0.145, P < 0.001), SEER staging (localized lesions stage vs. distant metastases stage, HR = 0.104, 95% CI: 0.059-0.182, P < 0.001; regional lesions stage vs. distant metastases stage, HR = 0.301, 95% CI: 0.195-0.463, P < 0.001) and whether or not receive surgery (yes vs. no, HR = 0.359, 95% CI: 0.241-0.535, P < 0.001) were independent influencing factors of OS in CCAC patients. Conclusions:AJCC staging, SEER staging and surgery are independent influence factors for OS in patients with CCAC, and postoperative radiotherapy may not provide more survival benefit.

Objective:To observe the clinical efficacy of Yin-Yang balancing acupuncture plus Tuina(Chinese therapeutic massage)for post-stroke depression(PSD). Methods:A total of 72 PSD patients were randomized into an acupuncture-Tuina group and a Western medicine group using the random number table method,with 36 cases in each group.The Western medicine group was treated with fluoxetine hydrochloride capsules.The acupuncture-Tuina group was treated with Yin-Yang balancing acupuncture plus Tuina therapy.Both groups were treated for 4 weeks.After treatment,the clinical efficacy was compared,and the changes in Hamilton depression scale(HAMD)score,National Institute of Health stroke scale(NIHSS)score,serum neurotransmitter levels,and electroencephalogram(EEG)were observed. Results:The total effective rate of the Western medicine group and the acupuncture-Tuina group was 83.3%and 94.4%,respectively.There was a significant difference in the total effective rate between the two groups(P<0.05).After treatment,the serum levels of 5-hydroxytryptamine(5-HT),norepinephrine(NE),and dopamine(DA)were higher than those in the same group before treatment,and the intra-group differences were all statistically significant(P<0.05).The serum levels of 5-HT,NE,and DA in the acupuncture-Tuina group were higher than those in the Western medicine group,and the differences between the groups were statistically significant(P<0.05).After treatment,the scores of HAMD and NIHSS in both groups decreased,and the intra-group differences were statistically significant(P<0.05).The scores in the acupuncture-Tuina group were lower than those in the Western medicine group,and the differences between the two groups were all statistically significant(P<0.05).After treatment,the EEG diffuse wave[(delta+theta)/(alpha+beta)]ratio(DTABR)and delta/beta ratio(DBR)in both groups decreased,and the intra-group differences were statistically significant(P<0.05).The ratios in the acupuncture-Tuina group were lower than those in the Western medicine group,and the differences between the two groups were statistically significant(P<0.05). Conclusion:Yin-Yang balancing acupuncture plus Tuina therapy has a better efficacy than oral fluoxetine hydrochloride capsules in the treatment of PSD,which can increase the levels of serum 5-HT,DA,and NE,and regulate brain waves.

Objective:To analyze the effectiveness and safety of the second course radiotherapy for unresectable colorectal cancer liver metastases.Methods:We retrospectively collected the data of 28 patients with unresectable colorectal cancer liver metastases who received the second course radiotherapy at Peking University Cancer Hospital and Institute from 2017 to 2023, to analyze the feasibility of re-irradiation.Results:For the 28 patients, the median follow-up time after re-irradiation was 20.2 months. The median time interval between the first- and second-course radiotherapy was 11.1 months. The median biologically effective doses of the first- and second-course radiotherapy were 100 Gy and 96 Gy, respectively. Stereotactic body radiotherapy was administered to 25 patients (89.3%) during the first course and 24 patients (85.7%) during the second course of radiotherapy. The mean equivalent dose in 2 Gy fractions to the normal liver was 10.1 Gy in the first-course radiotherapy and 7.9 Gy in the second-course radiotherapy. The complete response rate, partial response rate, and objective response rate after re-irradiation were 54.5%, 18.2%, and 72.7%, respectively. After re-irradiation, the 2-year cumulative local failure rate was 17.0% when calculated based on patients and 15.1% when calculated based on lesions, the 1-year progression-free survival rate was 27.4%, and the 3-year overall survival rate was 46.7%. The second-course radiotherapy was well tolerated, with most patients (75.0%) experiencing grade 1-2 acute adverse reactions and only one case (3.6%) experiencing grade 3 acute adverse events.Conclusions:Second course radiotherapy is an effective and safe treatment approach for selected patients with unresectable colorectal cancer liver metastases.

Objective:To analysis the relationship between symptomatic knee osteoarthritis and frailty in older Chinese adults.Methods:In this retrospective study, follow-up data between 2011 and 2015 from the China Health and Retirement Longitudinal Study(CHARLS)were analyzed.Participates over 60 years old were divided into a frailty group, a pre-frailty group, and a normal group, according to the frailty phenotype.Cross-sectional analysis was conducted to examine the relationship between frailty and symptomatic knee osteoarthritis, and the role of symptomatic knee osteoarthritis in the progression of frailty in normal elderly people was further analyzed using a retrospective cohort.Results:In 2011, 5.9% of the elderly were frail and 15.1% of the elderly suffered knee pain.Univariate and multivariate regression analysis indicated that knee pain was a risk factor for frailty( OR: 1.91, 95% CI: 1.37-2.61, P<0.01).After a 4 year-follow-up, 41.7% of the normal elderly participants progressed to the frail or pre-frail state.Multivariate regression analysis suggested that knee pain was a risk factor for normal elderly people to enter the frail or pre-frail state( OR: 1.57, 95% CI: 1.00-2.45, P<0.05). Conclusions:Knee pain is one of the important risk factors for the development of frailty in the elderly.Normal elderly people with knee pain are at an increased risk of frailty or pre-frailty in later years.

Environmental arsenic exposure is a worldwide public health problem. Long-term exposure to inorganic arsenic is closely related to diseases such as cardiovascular disease, diabetes and malignant tumors. Different dietary structure and intake of certain specific nutrients may have important effects on the pathogenic effect of arsenic. This article summarizes the effects of dietary nutrients on arsenic toxicity, providing reference for the follow-up arsenic toxicity research and reducing the risk of arsenic-related diseases through nutritional intervention.

Objective:To evaluate the long-term effect of structured patient education and exercise therapy for knee osteoarthritis (KOA).Methods:Prospective cohort study, 162 patients with KOA were consecutively recruited from May 2016 to December 2019 to receive structured patient education and exercise therapy and were followed up 3 years after the recruitment. All the patients received two 1-hour educational courses and exercise therapy twice per week for six weeks under the supervision of physicians or physical therapists. Knee injury and osteoarthritis score (KOOS), visual analog score of pain (VAS), intermittent and constant OA pain (ICOAP), self-efficacy for arthritis were queried at 3-month and 36-month follow-up visit. We fitted linear mixed-effects models to examine the difference in scores between baseline and 3-month and 36-month visits.Results:109(67.3%) patients finished both 3-month and 36-month follow-up visits. The KOOS pain score increased from 70.8±1.7 at baseline to 79.7±1.8 at 36 months ( P<0.05). The KOOS symptom score increased from 66.8±2.0 at baseline to 74.9±2.1 at 36 months ( P<0.05). The KOOS daily function score increased from 81.7±1.4 at baseline to 87.0±1.5 at 36 months ( P<0.05). KOOS motor function score increased from 47.4±2.8 at baseline to 55.0±2.9 at 36 months ( P<0.05). The quality of life score of KOOS increased from 46.6±2.1 at baseline to 63.5±2.2 at 36 months ( P<0.05). Compared with the baseline data, there were statistically significant improvements in all subscales of KOOS in 36 months after exercise therapy intervention ( F=14.548, 8.102, 11.394, 5.687 and25.942, P<0.05). VAS pain score of left knee, VAS pain score of right knee, ICOAP score, self-efficacy pain score and other symptoms were also significantly improved ( F=17.643, 26.791, 8.290, 4.052 and 3.654, P<0.05). Conclusion:Structured patient education and exercise therapy are effective in improving knee pain and function as well as self-efficacy until as long as 36 months.

Objective:Through histological analysis, immunofluorescence staining, electrophysiological detection and Sensory and motor function evaluation to investigate the effects of 3D printed hydrogel scaffold combined with bone marrow mesenchymal stem cells (BMSCs) in promoting functional recovery of spinal cord injury.Methods:10% GelMA hydrogel and 10 6 U stem cell suspension were prepared into bioink of appropriate concentration to construct the biomimetic spinal cord scaffold through 3D printing platform. The scaffold was placed in the medium and cultured in an environment of 37 ℃ CO 2 incubator. The microstructure of the scaffolds and the distribution of BMSC in the scaffolds was observed by scanning electron microscope. CAM/PI staining and confocal microscopy were used to observe the survival of stem cells in the scaffolds and determine the biocompatibility of the scaffolds. The scaffolds were implanted into the subcutaneous tissues of the back of rats, and the subcutaneous tissues were determined by HE staining to detect the immunogenicity of the scaffolds. After the rat model of hemicytoma defect was made, stents were transplanted for treatment, and confocal microscopy was used to evaluate the regeneration of neurons and axons in local area of spinal cord injury. At the same time, BBB score was used to evaluate motor function, mechanical pain score was used to evaluate sensory function, and surface electrode detection method was used to evaluate electrophysiological recovery weekly. Results:The long spindle shaped BSMC were uniformly distributed in the scaffold with a loose reticular structure. The scaffolds had good biocompatibility, and the cell survival rate of the prepared scaffolds reached 96% after 24 hours of printing. After 28 days of subcutaneous transplantation, the immune rejection was mild and immunogenicity was low. It was shown that the regenerated spinal cord tissue in the treatment group was significantly increased compared with the control group, which was widely distributed with cells after 28 days by HE staining. It was confirmed that part of the regenerated spinal cord tissue was neurons by immunohistochemical staining.Compared with the injured group, the regeneration of neurons and axons in the treatment group were significantly increased by immunofluorescence staining and confocal microscopy. In the treatment group, the BBB score recovered to 10 points, while the control group only recovered to about 1 point in the first week, which was statistically significant. And it recovered to 17 in the fourth week, while the control group only recovered to about 4 point in the four week, which was statistically significant. The Angle of inclined plate support of the treatment group was restored to 40 degrees, while it was only restored to 22 degrees in the control group. The pain threshold of the treatment group decreased to 18.5 points, which was not statistically different from that of the control group. The latent recovery effect of electrophysiology in the treatment group was the same as that in the sham operation group and better than that in the control group.Conclusion:3D printing hydrogel scaffold with loose network structure is suitable for cell proliferation. It has well biological survival, low cytotoxicity and low immunogenicity, which promoted neurons and axons to recovery and extend so as to effectively promote the recovery of motor function, sensory function and neural signal transmission rate after spinal cord injury.

Objective:To examine the correlation factors of acute appendicitis associated with appendiceal neoplasms.Methods:Consecutive 712 patients with acute appendicitis who treated at Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University from January 2002 to December 2016 were analyzed retrospectively. There were 314 females and 398 males, aging (42.5±16.2) years (range: 14 to 94 years). Among the 712 cases, 36 patients were diagnosed with acute appendicitis associated with appendiceal neoplasms, the other 676 patients had no appendiceal neoplasm. The patients ′ clinical baseline characteristics and clinical parameters were compared between the two groups. The correlation factors of acute appendicitis associated with appendiceal neoplasms were evaluated by using the univariate (χ 2 test or t test) and multivariate Logistic regression analysis. The area under curve of receiver operating characteristic curves was utilized to evaluate the discriminatory power of the predictive models. Results:According to the univariate analysis, gender, age, body mass index, the duration of chronic right low abdominal pains≥3 months, the frequency of recurrently acute right lower abdominal pain≥2, the frequency of acute right lower abdominal pain, past history of diabetes, hypertension or coronary heart disease, the level of neutrophils and leukocytes preoperatively, stercolith and periappendiceal effusion, and modified Alvarado score were positively correlated with appendiceal neoplasms (all P<0.05). Then four variables were incorporated into the model eventually by multivariate Logistic regression analysis, which were as follows: age (increased per decade) ( OR=2.23, 95% CI: 1.68 to 2.95, P<0.01), gender (female) ( OR=4.21, 95% CI: 1.74 to 10.19, P=0.001), the duration of chronic right low abdominal pains (more than 3 months) ( OR=2.53, 95% CI: 1.01 to 3.37, P=0.048), and modified Alvarado score (decreased per 1 score) ( OR=2.54, 95% CI: 1.87 to 3.34, P<0.01). The area of curve was 0.93 (95% CI: 0.88 to 0.97), which indicated that the model exhibits an excellent ability to discriminate between appendiceal neoplasms and acute appendicitis. Conclusions:The older age, female, the duration of chronic right low abdominal pains, and lower modified Alvarado score are independent correlation factors for acute appendicitis associated with appendiceal neoplasms. Clinicians should be alert for the above clinical characteristics and choose optimal treatment for acute appendicitis associated with appendiceal neoplasms.

Objective:We aimed to analyze the the genotyping of norovirus infectious diarrhea epidemic in Songjiang district, Shanghai, and explored the experience in handling the epidemic to provide a scientific basis for formulating prevention and treatment strategies.Methods:The epidemiological data and related samples of 69 outbreaks of infectious diarrhea caused by norovirus was collected from 2017 to 2019 in Songjiang district, Shanghai. Sequencing and type identification were performed by the method of gene sequencing for the junction region of Norovirus ORF1 and ORF2.Results:From 2017 to 2019, 69 outbreaks of norovirus infections diarrhea were reported in Songjiang district, Shanghai. A total of 1 767 samples were tested, including 619 case samples (positive rate 19.9%), 343 practitioner samples (positive rate 1.1%), 505 environmental samples (positive rate 0.5%) and 300 food samples (not detected). 141 sequences were obtained, and the genotype analysis showed that the genotype that mainly caused infectious diarrhea in 2017 and 2018 was GII.P16-GII.2 (50.98%, 26/51). In 2019, the genotypes that mainly caused infectious diarrhea were GII.P16-GII.2 (13.73%, 7/51) and GII.Pe-GII.4 (9.80%, 5/51).Conclusion:The main genotype of the 69 outbreaks of nororirus infectious diarrhea epidemic in Songjiang district, Shanghai from 2017 to 2019 was GII.P16-GII.2, which showed obvious peaks in spring, autumn and winter. There were more infections in kindergartens and schools. The surveillance of norovirus infection should be strengthened.