The epidemic characteristics of Kaschin-Beck disease (KBD) in different eco-environments

Epidemiological survey of 573 families, clinical examination of 2593 persons, and X-ray examination of 1136 persons (in 16 typical endemic villages) were conducted, based on the classification of endemiology for KBD disease areas, i.e, mountain type, loess plateau type, plateau type, and flatlands type. It was revealed that the KBD disease areas exhibited the regular pattern of corming-into-being, development and passing-away and the characteristics of growth and decline. Further, it was found clinically that the disease areas may be divided into 4 types, i.e., recent onset, developing, stable, and historical. This division is simple and easy, practical, scientific, and reliable and can be applied by medical personnel at different levels.

Effect of applying selenium fertilizer to improve soil and increase selenium level in food for prevention and treatment of Kaschin-Beck disease

For prevention and treatment of Kaschin-Beck disease by applying Se fertilizer to soil to increase Se up to normal level for the wheat grains is introduced in this paper. After use this measure the intake of Se by the residents in the exemplary area increased from 10.4μg to 33.6 μg per day in average. After supplementing Se to human body one year, there is no new patient found among 300 healthy children in the exemplary area but 4 patients found among 264 healthy children in the control area. It is shown that by applying Se fertilizer to KBD area is a effective way for preventing and cure this disease.

Study on correlation between humic acid and selenium in Kaschin-Beck disease areas

The relationship between humic acid and selenium content was studied in this research. The results of calculation showed that there is more humic acid and less selenium in Kaschin-Beck disease areas in China. Fulvic acid in soil could increase selenium level in plants. The chemical bonding between humic acid and selenium was observed with an I.R. spectroscope. It was remarkable for the changes of absorption peak and frequency in 1100-1000 cm-1, 900-700 cm-1.

Perturbations in Amino Acid Metabolism in Children with Kaschin-Beck Disease: A Study of Urinary Target Metabolomics

Kaschin-Beck disease (KBD) is an endemic and chronic osteoarthropathy characterized by pathological aspects including chondrocyte degeneration, necrosis, progressive loss of articular cartilage, and secondary degenerative osteoarthrosis of epiphyseal cartilage, epiphyseal plate cartilage, and articular cartilage, during puberty[1]. The main clinical symptoms are limb joint pain, thickening, deformation, limited movement, muscle atrophy, and in case of more severely affected patients, short fingers (toes), short limbs, and even short stature[1].

The roles of organic degradation products andselenium in the pathogenesis ofKaschin-Beck disease

An investigation on the organic degradation products and selenium in the pathogenesis of Kaschin-Beck disease was carried out. The results demonstrated that the organic degradation products existed in food and drinking water were the pathogens of the KBD; their leading pathological process of cells would be 'membrane injury' due to peroxide. As GSH-Px is a selenium contained enzyme, therefore insufficient selenium would be one of the most important conditions to cause KBD.

Redox potential E_H [Se(VI)/Se(IV)] of aqueous extractof soils from Yongshou Kaschin-Beck diseaseregion and the influence by humic acid

The relation between EH [Se(VI)/Se(IV)] and pH of soil aqueous extract in Kaschin-Beck disease region and the effects of natural redox agents, namely humic substances, MnO2 and Fe2+, on the redox property of the system were studied. The results indicated that both humic acid and Fe2+ could enhance the reducibility of Se(VI) and MnO2, a limited oxidizability for Se(IV). Fe2+ showed a weak reducibility only at low pH value. The reducibilities of three sulfur-containing compounds for Se(VI) were in following order:thioglycollic acid > L-cysteine > sulfide

Role of interaction between selenium and organic matters on causes of Kaschin-Beck disease

Influences of organic matters of soil and water on speciation and biological utilization of selenium are discussed. Humic acid is found to be the main pool of selenium in soil and affects the bio-availability of the element in soil-plant system. Fulvic acid from drinking water inhibits the absorption of selenium taken from diet. The relationship between high content of organic matters of water and selenium deficiency on the causes of KBD could be reflected in the limited synthesis of glutathione peroxidase, which is generally stimulated by fulvic acid from drinking water.

Study on the action and mechanism of humic acids in Kaschin-Beck disease

Humic acids, especially FA in fractions, contain more oxygen functional groups. In this experiment, on the basis of confirming the action of humic acids on KBD, what was studied is the biological effects of one of main oxygen functional groups, hydroxy group (-OH). The results indicate that inducing pathologic process of KBD, obviously decrease the GSH-Px activity and induce peroxidation membrane injury of tissue. The SOD activity increase in the tissues caused by oxygen functional groups showed that enhancing of free radical reaction should not be neglected.

A retrospective survey on the effect of Kaschin-Beck disease prophylaxis by a change of water sources

In order to provide further references for studing on the causes of Kaschin-Beck discase (KBD) and measuring for its prevention and treatment from a macroscopic view, we analyzed the natural growth and declineof KBD and the effects of selenium and humic acid on its occurrence from an epidemiologic angle. In this article through a retrospective survey on the spots of disease areas by comparison between a change in water sources and that without. It was proved that a change in water sources was an effective measure for the prevention of KBD occurrence, and the pathogenic factor of KBD was one (or several kinds) of organic compounds or active radicals related to water.

Humic acid and free radical in environment of Kaschin-Beck disease areas

The humic acid contents in drinking water and soil in Kaschin-Beck disease areas were found more than that of non-disease areas in this research. Changes of free radical concentration in drinking water were agreed with that of humic acid contents in drinking water of Kaschin-Beck disease areas. A positive correlation of free radical concentration and humic acid content in drinking water has been shown (r=0.913) . The structure of I. R. spectra of humic acid under ultraviolet light has been changed. Thus it indicated that free radical was resulted from benzoqiunonyl groups of humic acid in environment.

Research on organic matters in the drinking water of Kaschin-Beck disease area

Organic matters in drinking water of Kaschin-Beck disease areas were extracted. Then analyses and characterization were performed by means of multiply chemical and physical methods. The results did not show the obvious difference in the frame structure of humic substances and the structure of rmcromolecular compounds in the drinking water of disease and non-disease areas, but the difference in the contents of some micromolecular compounds and radicals. The investigation also includes the preliminary research on the photoreaction of drinking water from disease and non-disease areas and the accumulation of natural organic matter in the bone of tested animals.

In vitro effects of sodium hyaluronate on the proliferation and the apoptosis in chondrocytes from patients with Kashin-Beck disease and osteoarthritis

Objective：To identify the in vitro effects of sodium hyaluronate（HA） on the proliferation and the apoptosis of chondrocytes from patients with Kashin-Beck disease（KBD） and osteoarthritis（OA）. Methods：Samples of articular cartilages from KBD and OA patients, as well as healthy volunteers（6 subjects in each of the 3 groups） were dissected, digested with collagenase and the cells cultured in monolayers. Chondrocytes from each sample were assigned to an untreated group and two HA-treated groups： H0（no HA）, H100（HA, 0.1 g/L） and H500（HA, 0.5 g/L）. The first passage chondrocytes were used to observe proliferation using the MTT assay, and apoptosis by flow cytometry through Annexin V/PI staining. Results：HA promoted proliferation of chondrocytes in all the three groups, and.in KBD and OA groups, for cells cultured for 4 and 6 days, H500 significantly promoted the cell proliferation. The apoptotic rates of both KBD and OA group chondrocytes were in the order H500 〈 HA100 〈 H0. Conclusion：Sodium hyaluronate administration has a dosedependent in vitro effect to promote proliferation and inhibit apoptosis of chondrocytes from patients with KBD and OA.

Evaluation of the Sensitivity and Specificity of the New Clinical Diagnostic and Classification Criteria for Kashin-Beck Disease,an Endemic Osteoarthritis,in China

This study aimed to evaluate the sensitivity and specificity of the new clinical diagnostic and classification criteria for Kashin-Beck disease （KBD） using six clinical markers： flexion of the distal part of fingers, deformed fingers, enlarged finger joints, shortened fingers, squat down, and dwarfism. One-third of the total population in Linyou County was sampled by stratified random sampling.

Exploring Genome-wide DNA Methylation Profiles Altered in Kashin-Beck Disease Using Infinium Human Methylation 450 Bead Chips

To understand how differentially methylated genes（DMGs）might affect the pathogenesis of Kashin-Beck disease（KBD）.Genome-wide methylation profiling of whole blood from 12matched KBD and controls pairs was performed using a high-resolution Infinium 450 K methylation array.In total,97 CpG sites were differentially

Changing Grains for the Prevention and Treatment of Kashin-Beck Disease in Children: a Meta-analysis

To evaluate the efficacy of changing grains on the prevention and treatment of Kashin-Beck Disease （KBD） in children, community-based trials were acquired from seven electronic databases （up to July 2014）. As a result, the methodological quality of the six trials that have been included into our analysis was low. The pooled ORs favoring the prevention and treatment effects of changing grains were 0.15 （95% CI： 0.03-0.70） and 2.13 （95% CI： 1.44-3.16） respectively by meta-analysis. Subgroup analysis demonstrated the pooled OR favoring treatment effect of exchanging grains rather than drying grains both compared with endemic grains. The results showed that changing grains had obvious effects on the prevention and treatment of KBD in children. However, the evidences were limited by the potential biases and confounders. Large and well-designed trials are still needed.

陕西省大骨节病患者关节活动度及肌肉萎缩相关调查

目的描述陕西地区大骨节病(Kashin-Beck disease,KBD)患者膝、踝关节活动度(range of motion,ROM)和肌肉萎缩相关指标的分布特征,探究膝、踝ROM和肌肉萎缩指标的相关性,为KBD患者临床特征分析提供可参考依据。方法对来自陕西省KBD病区在册KBD患者进行抽样调查。采集KBD患者一般人口学资料,测量患者膝关节(屈曲、伸展),踝关节(背屈、跖屈)活动度以及患者上臂围、大腿围、小腿围和握力等肌肉萎缩相关指标。按照人群特征[性别、年龄、体质量指数(BMI)]和KBD分度分组,报告KBD患者ROM和肌肉萎缩指标的中位数和四分位数,分析不同组间各指标的差异。控制性别、年龄和BMI等变量后,采用偏相关分析探索各指标间的相关性。结果本研究共调查KBD患者480例,其中男性249(51.9%)例,女性231(48.1%)例,平均年龄(63.10±7.32)岁,平均BMI(23.49±8.90)kg/m^(2)。结果显示,KBD患者膝关节屈曲活动度[105.0(95.0,120.0)]°,膝关节伸展活动度[0.0(-15.0,0.0)]°,踝关节背屈活动度[5.0(0.0,15.0)]°,踝关节跖屈活动度[20.0(15.0,30.0)]°,左侧大腿围[43.0(40.0,47.0)]cm,右侧大腿围[43.0(39.0,47.0)]cm,左侧小腿围[29.0(27.0,32.0)]cm,右侧小腿围[29.5(27.0,32.0)]cm,左侧和右侧上臂围均为[27.0(25.0,30.0)]cm,左手握力[13.4(9.5,18.4)]kg,右手握力[13.9(9.8,18.2)]kg。随着年龄的增加,KBD患者两侧膝关节伸展活动度呈现降低趋势(H=31.499、31.847;P均<0.001)。BMI正常组两侧膝关节屈曲活动度高于超重或肥胖组,差异均有统计学意义(H=7.753、12.333;P=0.021、0.002)。不同KBD分度下,两侧膝关节屈曲、大腿围和小腿围均呈现降低趋势(H=14.345、17.256、8.000、8.462、8.558、9.633;P均<0.05)。相关性分析显示,KBD患者膝关节屈曲活动度与大腿围、小腿围和握力呈正相关关系(P均<0.05)。KBD患者膝关节伸展活动度与大腿围呈正相关关系(P均<0.01)。结论陕西省KBD患者ROM受损和肌肉萎缩较为严重,且ROM与肌肉萎缩存在相关关系。

大骨节病病因病理学研究

目的寻找并认定大骨节病(Kashin-Beck disease,KBD)的病因。方法复查本所KBD剖检档案16例的骨切片。光镜观察KBD患儿末梢血涂片中白细胞的病变,电镜观察患儿白细胞的超微病变。观察KBD患儿血浆引发培养兔软骨细胞损伤的实验结果。结果KBD剖检例的软骨细胞、骨髓血细胞及KBD患儿的白细胞,这三类细胞病变的特征及其全过程完全一致,均显示特异的凝固性坏死,细胞核增大,核内出现由少到多、由小到大的嗜酸性(红色)包涵体,伴随以细胞核染色质的溶解减少;若病变持续恶化进展,则整个细胞核可转化成一个红染的大团块;其后出现该包涵体的后续性系列变化;细胞体缩小,细胞质红染。患儿血浆引发培养兔软骨细胞复制出等同于剖检例软骨细胞特异坏死病变的细胞模型,且在其细胞核内检可见病毒核衣壳。在患儿白细胞的核内亦可见相同的病毒核衣壳。在剖检例的骨髓内可见充血、水肿、纤维素渗出,造血主质和骨小梁的灶性坏死以及骨髓纤维化等。结论在KBD剖检例病变的软骨细胞和骨髓血细胞的核内及KBD病患儿末梢血白细胞的核内均显示相同的包涵体形成;包涵体形成是病毒杀细胞性感染最为熟知的病理形态学结果;特别是以KBD患儿血浆作用于培养软骨细胞所出现的阳性实验结果,均提示该三类细胞坏死的病因理应是两次检出的同一病毒,该病毒就应是KBD的病因。剖检例的骨髓内有急性骨髓炎伴发传染性迟发型超敏反应。KBD是该病毒引起的全身性传染病;软骨病变、骨髓病变和血液病变都仅是其全身病变的一部分。

西藏土壤-植物-动物(人)系统中硒含量与大骨节病的关系

通过对西藏大骨节病区与非病区中土壤、粮食和儿童发样匹配采样以及对样品中硒含量的分析,探讨了硒元素在土壤-植物-动物生态系统中的含量特征及其与大骨节病分布流行的关系。结果表明,西藏地区整体处于低硒水平,所有病区样品的硒含量显著低于非病区(P<0.05)。土壤低硒是导致西藏大骨节病区粮食、人体硒水平偏低及病情流行的一个主要原因。改善土壤硒环境,提高土壤硒含量是西藏地区大骨节病防治的主要措施之一;补硒能够显著提高人体发硒水平,并有效控制大骨节病,但是需要长期坚持。

西藏大骨节病区的地理环境特征

西藏90％以上的大骨节病县分布在高山温带环境中，病区最暖月平均气温在10—18℃之间，≥0℃日数在180—350天之间；病区集中分布在喜马拉雅山与冈底斯山和念青唐古拉山之间以及横断山北段山间地带的山区或高山谷地地区，病县山地、丘陵占78．4％，非病县山地、丘陵面积占66．7％；就海拔高度而言，病区主要分布在3600～4000m之间；病区涉及多种类型的耕作土壤，其中酸性棕壤和暗棕壤、灰褐土和石灰性褐土、褐土性土等淋溶、半淋溶土壤类型是大骨节病集中分布区；在高山土壤类型中病区趋于分布在典型亚高山草甸土和山地灌丛草原土地带，而亚高山草原土带相对较少。西藏大骨节病区地理环境特征既与内地大骨节病区有很强的相似性，又因其独特的地域分异格局而具特殊性。