Growth and development status and related factors of children in drinking-water-borne endemic fluorosis area after water improvement in Xi'an / 中华地方病学杂志

Objective:To investigate the current situation and related factors of children's growth and development in drinking-water-borne endemic fluorosis areas after water improvement, and provide a basis for improving the control strategies.Methods:The stratified random sampling method was used to select children aged 7 to 13 in villages with different years of water improvement in Xi'an from November 2019 to June 2020. The height and weight of children were measured, and body mass index (BMI) was calculated. The height development level of children was graded according to the "Standard for Height Level Classification among Children and Adolescents Aged 7 - 18 Years" (WS/T 612-2018), and the physical development (BMI) level of children was determined according to the "Comprehensive Evaluation of Development Level for Children and Adolescents" (GB/T 31178-2014). At the same time, according to the standard of "Diagnosis of Dental Fluorosis" (WS/T 208-2011), the diagnosis of dental fluorosis in children was performed. The serum fluoride level was determined by ion selective electrode method, and the levels of other chemical elements (calcium, iron, magnesium, copper, zinc, iodine, selenium, lead, arsenic, cadmium, chromium, mercury, nickel) in blood were determined by inductively coupled plasma mass spectrometry.Results:A total of 469 children were included in the investigation. After water improvement, 67.38% (316/469) of the children in the disease area were at the moderate level of height development, 7.89% (37/469) were at the medium to upper and upper levels, and 24.73% (116/469) were at the medium to lower and lower levels. The BMI of the children in the emaciation group was 8.53% (40/469), while it was 10.87% (51/469) in the overweight group and 8.74% (41/469) in the obesity group. There was statistically significant difference in the distribution of height development level of children in areas with different water improvement years ( P = 0.005), but no statistically significant difference in BMI distribution ( P = 0.154). There was no significant difference in height development level and BMI distribution of children with or without dental fluorosis ( P > 0.05). There were significant differences in serum levels of iron and zinc among children with different height development levels ( P < 0.05). There were significant differences in serum levels of magnesium, copper, iodine and chromium among children with different BMI ( P < 0.05). Conclusion:The growth and development of children in drinking-water-borne endemic fluorosis area after water improvement are not correlated with the prevalence of dental fluorosis, but may be related to the levels of chemical elements such as iron, magnesium, copper, and iodine in the body.

Polysaccharides from Chinese herbal medicine: a review on the hepatoprotective and molecular mechanism / 中国天然药物

Polysaccharides, predominantly extracted from traditional Chinese medicinal herbs such as Lycium barbarum, Angelica sinensis, Astragalus membranaceus, Dendrobium officinale, Ganoderma lucidum, and Poria cocos, represent principal bioactive constituents extensively utilized in Chinese medicine. These compounds have demonstrated significant anti-inflammatory capabilities, especially anti-liver injury activities, while exhibiting minimal adverse effects. This review summarized recent studies to elucidate the hepatoprotective efficacy and underlying molecular mechanisms of these herbal polysaccharides. It underscored the role of these polysaccharides in regulating hepatic function, enhancing immunological responses, and improving antioxidant capacities, thus contributing to the attenuation of hepatocyte apoptosis and liver protection. Analyses of molecular pathways in these studies revealed the intricate and indispensable functions of traditional Chinese herbal polysaccharides in liver injury management. Therefore, this review provides a thorough examination of the hepatoprotective attributes and molecular mechanisms of these medicinal polysaccharides, thereby offering valuable insights for the advancement of polysaccharide-based therapeutic research and their potential clinical applications in liver disease treatment.

Wernekink Commissure Syndrome With Hallucinations and Involuntary Groping:Report of One Case / 中国医学科学院学报

Wernekink commissure syndrome is a rare midbrain syndrome with bilateral cerebellar dysfunction,eye movement disorder,and palatal myoclonus.Few cases of this syndrome have been reported in China,let alone those combined with hallucinations and involuntary groping.This paper reports the diagnosis and treatment of a case of Wernekink commissure syndrome with hallucinations and involuntary groping,aiming to enrich the knowledge about this disease for clinicians.

Application of PDCA circle model in improving the completion rate of after-department examination in pediatric professional base / 中华医学教育探索杂志

Objective:To explore the effectiveness of PDCA (plan, do, check, action) cycle management method in improving the completion rate of after-department examination in pediatric professional base.Methods:Through the residency management system platform, the completion rate of after-department examination from February 2019 to March 2019 differed greatly. Referring to the PDCA cycle management methods, according to the analysis of fishbone diagram, relevant reasons were obtained and a series of rectification measures were implemented including the formulation of relevant programs from the four aspects such as department, resident, rules and regulations and tools. The rectification courses were taken for 5 months. SPSS 17.0 was used for Chi-square test.Results:April to August 2019 was the main rectification execution stage, during which the monthly completion rate of after-department examination increased, but fluctuated (66.70%-89.70%).Compared with the rectification courses before (in February), the completion rate of after-department examination was significantly increased after rectification (in October) [(96.00%) vs. (42.11%)], with statistical significance ( P < 0.01). Conclusion:PDCA cycle management method can effectively improve the completion rate of after-department examination in pediatric professional base, which should be further widely promoted.

PPARγ2 functions as a tumor suppressor in a translational mouse model of human prostate cancer / 亚洲男科学杂志(英文版)

Peroxisome proliferator-activated receptors γ (PPARγ) is a master regulator that controls energy metabolism and cell fate. PPARγ2, a PPARγ isoform, is highly expressed in the normal prostate but expressed at lower levels in prostate cancer tissues. In the present study, PC3 and LNCaP cells were used to examine the benefits of restoring PPARγ2 activity. PPARγ2 was overexpressed in PC3 and LNCaP cells, and cell proliferation and migration were detected. Hematoxylin and eosin (H&E) staining was used to detect pathological changes. The genes regulated by PPARγ2 overexpression were detected by microarray analysis. The restoration of PPARγ2 in PC3 and LNCaP cells inhibited cell proliferation and migration. PC3-PPARγ2 tissue recombinants showed necrosis in cancerous regions and leukocyte infiltration in the surrounding stroma by H&E staining. We found higher mixed lineage kinase domain-like (MLKL) and lower microtubule-associated protein 1 light chain 3 (LC3) expression in cancer tissues compared to controls by immunohistochemistry (IHC) staining. Microarray analysis showed that PPARγ2 gain of function in PC3 cells resulted in the reprogramming of lipid- and energy metabolism-associated signaling pathways. These data indicate that PPARγ2 exerts a crucial tumor-suppressive effect by triggering necrosis and an inflammatory reaction in human prostate cancer.

Development of A Patient-reported Outcomes Scale for Post-stroke Aphasia Based on Traditional Chinese Medicine Holism / 中国康复理论与实践

Objective:To develop a patient-reported outcomes (PRO) scale for post-stroke aphasia based on the Traditional Chinese Medicine (TCM) holism. Methods:Referring to the TCM holism, the theoretical model was established following the standard process for the development of the PRO scale. An item pool was established and optimized with case review, patient interview, expert questionnaire survey and consensus conference. The PRO scale was established finally. Results:A pool of post-stroke aphasia items based on the holistic view of TCM was constructed in the physical, psychological and social model. The Expert Comment Form for the PRO Scale for Aphasia after Stroke was formed after sorting out the item pool. After expert surveys and meeting discussion, 40 items were finally selected to form the first version of Patient-reported Outcomes Scale for Post-stroke Aphasia-TCM. Conclusion:The first version of Patient-reported Outcomes Scale for Post-stroke Aphasia-TCM has been developed based on the TCM holism and the concept of PRO, which can be evaluated clinically.

Effect of different water-improving methods on dental fluorosis of children in 50 drinking-water-borne fluorosis areas in Xi'an City / 中华地方病学杂志

Objective:To evaluate the effect of different water-improving methods on dental fluorosis of children aged 8 to 12 in drinking-water-borne fluorosis areas in Xi'an City, and provide basis for making fine prevention and control measures.Methods:In 2018, 50 drinking-water-borne fluorosis villages in Xi'an City with water improvement time from 2011 to 2013 were selected as survey sites. The condition and the way of water improvement were surveyed, water fluoride content was determined and the prevalence of dental fluorosis in children aged 8 to 12 was examined, and the rates of dental fluorosis were compared before and after the water improvement in the 50 villages.Results:The water-improving projects were in normal operation in 50 villages. The medians of water fluoride content were 0.31, 0.88 and 1.14 mg/L in villages with municipal water supply, low fluorine well and defluoridation treatment water supply (the villages of different water-improvement methods were 12, 24 and 14, respectively), the differences were statistically significant ( H = 75.54, P < 0.01). The qualification rates of water fluoride in villages with different water-improvement methods were 100.00% (12/12), 79.17% (19/24) and 57.14% (8/14), and the difference was statistically significant (χ 2 = 6.95, P < 0.05). The detection rate of dental fluorosis was 43.17% (218/505) in the 11 villages with excessive water fluoride content, and the detection rate was 20.77% (331/1 594) in the 39 villages with qualified water fluoride content, the difference was statistically significant (χ 2 = 99.66, P < 0.01). After water improvement, the total detection rate of dental fluorosis (26.16%, 549/2 099) in the 50 villages was lower than that before water improvement (41.66%, 959/2 302), the difference was statistically significant (χ 2 = 117.17, P < 0.01). The detection rates of dental fluorosis were reduced after the water improvement in villages with municipal water supply and low fluorine well, the differences were statistically significant (χ 2 = 74.37, 69.36, P < 0.01). The detection rate was declined after water improvement in villages with defluoridation treatment water supply, but the difference was not significant (χ 2 = 0.78, P > 0.05). There was a statistically significant difference in the detection rate of dental fluorosis among children in villages with different water-improvement methods (χ 2 = 72.79, P < 0.01). The detection rate of dental fluorosis in villages with defluoridation treatment water supply [39.53% (200/506)] was higher than that in villages with municipal water supply [17.97% (133/740)] and low fluorine well [25.32% (216/853)], the differences were statistically significant ( P < 0.017); the detection rate of dental fluorosis in villages with municipal water supply was lower than that in villages with low fluorine well ( P < 0.017). Conclusions:The dental fluorosis of children's has been effectively controlled in the villages after water improvement in Xi'an City. The fluoride content in the water and the detection rate of dental fluorosis in children in some endemic areas are still high. It is necessary to further improve the water quality or consolidate the improvement effect as soon as possible.

Relationship between dental fluorosis and serum chemical element levels of children in drinking-water-borne fluorosis areas / 中华地方病学杂志

Objective:To explore the relationship between dental fluorosis and serum chemical elements in children after water modification.Methods:Using the method of stratified sampling, according to the monitoring data of the Xi'an Center for Disease Control and Prevention in the past 20 years, the drinking-water-borne fluorosis areas in Xi'an City were changed according to the water-improvement period of 1-, 5-, 10- and ≥15 years, and 2 villages in each layer were selected as the survey sites. Each survey site selected school-age children aged 7 to 13 years old as the survey subjects to detect the prevalence of dental fluorosis; and blood samples were collected to detect 14 chemical elements contents in the serum [calcium (Ca), iron (Fe), magnesium (Mg), copper (Cu), zinc (Zn), iodine (I), selenium (Se), lead (Pb), arsenic (As), cadmium (Cd), chromium (Cr), fluorine (F), mercury (Hg), nickel (Ni)]. The differences of chemical element contents in children with different water improvement years and different dental fluorosis conditions were analyzed.Results:The prevalence of dental fluorosis of children were 51.40% (55/107), 16.92% (11/65), 16.67% (17/102) and 5.08% (6/118) in the villages with different water improvement period, the difference was statistically significant (χ 2 = 74.444, P < 0.05). Serum levels of Ca, Fe, Mg, Cu, Zn, I, Se, Pb, As, Cr, F and Ni in children of different water improvement period were compared, the difference were statistically significant ( P < 0.05). Levels of Fe, Zn and Ni in dental fluorosis patients were lower than those in normal children ( P < 0.05), and the serum fluoride level was higher than that of normal children ( P < 0.05). There were no significant differences in the contents of other chemical elements levels between children with dental fluorosis and normal children ( P > 0.05). Conclusions:The detection rate of dental fluorosis in children in ward villages whose water has been improved for more than 15 years is the lowest, and the detection rate of children with dental fluorosis can be reduced by improving water to reduce fluoride. Children in the drinking-water-borne fluorosis areas are deficient in some trace element.

Surveillance on the prevention and control status of drinking-water-borne endemic fluorosis areas and dental fluorosis of children in Xi'an City, 2018 / 中华地方病学杂志

Objective:To assess the implementation of control measures and dental fluorosis of children in drinking-water-borne endemic fluorosis areas in Xi'an City, and to evaluate the implementation effects of the prevention and control measures.Methods:All drinking-water-borne endemic fluorosis villages in Xi'an were selected as the investigation sites. The progress and running condition of all water-improved projects were investigated, fluoride concentration in all the water-improved projects and tap water were tested. "Standard Test Method for Drinking Water" (GB/T 5750.5-2006) was used to test the water fluoride. A cross-sectional analytical study was conducted on school children aged 8 - 12 years old, the dental fluorosis was determined according to "Diagnosis of Dental Fluorosis" (WS/T 208-2011).Results:There were 273 drinking-water-borne endemic fluorosis villages, the rate of water improved villages was 91.58% (250/273), and all of the water-improved projects were operating normally (100.00%, 196/196). The rate of water-improved projects with qualified water fluoride was 88.27% (173/196), 237 villages had fluoride safe drinking water and the qualified rate was 86.81% (237/273). The median of water fluoride in the 250 villages with water-improved projects was 0.78 mg/L, the median was 0.83 mg/L in the 23 villages without water-improved projects, and the difference was not significant ( Z = 1.475, P > 0.05) . The overall prevalence of dental fluorosis among children aged 8 - 12 years old was 19.86% (1 960/9 871), and the dental fluorosis index was 0.39. The prevalence of dental fluorosis in the villages with qualified water fluoride was 16.13% (1 377/8 539), and the rate was 43.77% (583/1 332) in the villages with unqualified water fluoride, and the difference was significant (χ 2 = 553.283, P < 0.01). The prevalence of dental fluorosis in children with water fluoride content of 0.00 - 1.20, 1.21 - 1.50, and ≥1.51 mg/L was 16.13% (1 377/8 539), 41.20% (281/682), 46.46% (302/650), and the difference was significant (χ 2 = 559.011, P < 0.01), the severity of the disease was positively correlated with water fluorine concentration ( r = 0.273, P < 0.01). The epidemic situation in 202 villages was effectively controlled and 71 villages did not reach the control standard. Conclusions:The progress of water-improved projects and the rate of qualified water fluoride are not optimistic in Xi'an, the dental fluorosis of children is still higher than the government standard in the high fluoride drinking-water areas. The measures for water improving defluorination and disease surveillance should be strengthened.

Prevalence of thyroid diseases and status of iodine nutrition in the population of different water iodine areas in Xi'an City / 中华地方病学杂志

Objective:To analyze the thyroid health status of residents in different water iodine areas in Xi'an City and understand the iodine nutritional level of the population.Methods:Using the stratified cluster sampling method, the towns in Xi'an City were divided into 3 levels of < 10, 10-100, and > 100 μg/L according to the median of water iodine of 2017. One street (township) was selected from each level, two communities (natural villages) were selected from each street (township), and 100 households were selected from each community (natural village) to carry out the survey. One drinking water sample was collected from each household for determination of water iodine content. Residents over 18 years old were selected as the subjects of the survey, and their urine iodine content test and thyroid B-ultrasound examination were carried out.Results:A total of 343, 227, 226 water samples were collected in 3 regions with water iodine content, and the median water iodine was 4.14, 38.95, 124.15 μg/L, respectively. A total of 1 308 people were investigated. The detection rate of abnormal thyroid morphology was 9.86% (129/1 308), the detection rate of abnormal echo was 10.86% (142/1 308), and the detection rate of thyroid space-occupancy was 33.94% (444/1 308). The detection rate of nodules was 26.22% (343/1 308). The detection rates of thyroid abnormal echo, space-occupying, and nodules in women were higher than those in men[11.75% (120/1 021) vs 7.67%(22/287), 35.85% (366/1 021) vs 27.18% (78/287), 27.82% (284/1 021) vs 20.56% (59/287), χ 2=3.868, 7.509, 6.101, P < 0.05]. The differences of detection rates of thyroid abnormal echo, space-occupying, and nodules were statistically significant in different age groups (χ 2=11.223, 68.032, 64.543, P < 0.05); the detection rate of thyroid abnormal echo was different in different water iodine areas (χ 2=6.297, P < 0.05). The detection rate of multiple thyroid nodules in women was higher than that in men [11.75% (120/1 021) vs 7.32% (21/287), χ 2=4.584, P < 0.05]; the detection rates of single nodules, multiple nodules, nodule diameter ≤1 cm and nodule diameter > 1 cm were different in different age groups (χ 2=26.010, 31.807, 22.859, 10.392, P < 0.05); the detection rate of thyroid nodule diameter > 1 cm in water iodine < 10 μg/L area was higher than that in water iodine 10-100 and > 100 μg/L areas ( P < 0.05). A total of 755 urine samples were collected, and the median urine iodine was 217.00 μg/L, there were satistically signficant differences in urine iodine levels among residents in different water iodine areas( H=93.806, P < 0.05). Conclusions:The detection rate of thyroid diseases in Xi'an City is relatively high, and the adult iodine nutrition is at a super-suitable level. The detection rate of thyroid nodules increases with age, women are higher than men, so follow-up and early diagnosis and treatment should be strengthened.

Research and development of osteogenic differentiation of bone marrow mesenchymal stem cells / 中国骨伤

Supercritical large area or large segmental bone defects are still a clinical problem. Researchers are committed to the development of artificial bone materials, but in order to solve the problem of poor bone formation of artificial bone materials, people are paying more and more attention to application of bone marrow mesenchymal stem cells in bone tissue engineering. In this review, bone marrow mesenchymal stem cells, osteogenic differentiation, osteoblasts cells, clinical application were used as keywords to search CNKI database, Wanfang database, Weipu database and PUBMED database by computer. The isolation and culture of bone marrow mesenchymal stem cells, bone marrow mesenchymal stem cell identification method, osteogenic induction method, osteogenic differentiation identification and clinical applicationt were comprehensively summarized in order to provide a theoretical basis for its use as a seed cell in the treatment of bone tissue diseases. Scholars have preliminarily studied the treatment of bone and cartilage defects, osteoarthritis, femoral head necrosis and other diseases with bone marrow mesenchymal stem cells combined with transplantation, and obtained good clinical efficacy.However, bone marrow mesenchymal stem cells have certain advantages and disadvantages, and further clinical studies and long-term efficacy verification are needed.

Value of molecular genetics combined with bone marrow imaging detection in the prognosis judgement of acute myeloid leukemia with normal karyotype / 白血病·淋巴瘤

Objective To investigate the value of NPM1 and FLT3 gene mutation combined with bone marrow imaging detection in the prognosis judgement of initial treatment cytogenetically normal acute myeloid leukemia (CN-AML). Methods The clinical data of 100 patients (non-M3 type) with primary and initial treatment CN-AML from January 2010 to January 2014 in the Peace Hospital Affiliated of Changzhi Medical College were retrospectively analyzed. All patients were enrolled in the bone marrow imaging examination on the end day of induction treatment or the first day after the end of induction treatment (T time point). Univariate and multivariate prognostic analyses were performed on AML patients according to FLT3 and NPM1 gene status, bone marrow juvenile cell ratio at T time point. Results A total of 100 patients included 36 cases with FLT3 gene mutation and 44 cases with NPM1 gene mutation. The complete remission (CR) rate of CN-AML patients was 13.9% (5/36) and 71.9% (46/64), respectively (P< 0.01), 2-year recurrence-free survival (RFS) rate was 5.6% and 59.8%, respectively (P< 0.01), 2-year overall survival (OS) rate was 15.6% and 66.2%, respectively in FLT3+group and FLT3-group (P<0.01). The median RFS and median OS time in FLT3+ group was 6.9 months and 9.4 months, respectively, and the median RFS and median OS time in FLT3-group had not yet reached. There were no significant differences of all the indexes between the two groups (all P< 0.01). And there were no significant differences in CR rate, 2-year RFS rate and 2-year OS rate between NPM1+group and NPM1-group (all P＞0.05). The CR rate, 2-year RFS rate and 2-year OS rate in NPM1+ FLT3-group were better than those in NPM1- FLT3-, NPM1-FLT3+and NPM1+FLT3+groups; NPM1-FLT3+and NPM1+FLT3+groups had the worst prognosis, and there were no statistical differences in the CR rate, RFS and OS time between the two groups (all P＞ 0.05). The prognosis of the patients in bone marrow juvenile cell ratio < 0.05 group at T time point was better than that in ratio ≥0.05 group (all P< 0.05). CN-AML patients were classified into the good prognosis group (NPM1-FLT3-), the medium prognosis group (NPM1+FLT3-), and the poor prognosis group (NPM1-FLT3+and NPM1+FLT3+) according to the FLT3 and NPM1 genes. The good prognosis group+the ratio of bone marrow juvenile cells at T time point<0.05 group, the good prognosis group+the ratio of bone marrow juvenile cells at T time point≥0.05 group, the medium prognosis group + the ratio of bone marrow juvenile cells at T time point < 0.05 group had no statistical differences in CR rate, 2-year RFS rate and 2-year OS rate (all P ＞0.05). The medium prognosis group + the ratio of bone marrow juvenile cells at T time point ≥0.05 group, the poor prognosis group+the ratio of bone marrow juvenile cells at T time point<0.05 group had the equivalent prognosis, and the average prognosis was moderate; the poor prognosis group + the ratio of bone marrow juvenile cells at T time point ≥ 0.05 group had the worst prognosis. According to Cox multivariate regression analysis, FLT3 gene mutation and the ratio of bone marrow juvenile cells at T time point were independent influencing factors for RFS and OS in CN-AML patients (all P< 0.05). NPM1 was an independent prognosis factor affecting RFS and OS of FLT3-patients (all P < 0.05). Conclusions After induction chemotherapy, the responsiveness and sensitivity of AML patients to chemotherapy regimen can be assessed early and objectively according to molecular genetics and the ratio of bone marrow juvenile cells at T time point, which has a certain value in the prognosis judgement.

A study on the prevalence of dental fluorosis of children after change of water in the endemic fluorosis areas in Xi'an City and influencing factors / 中华地方病学杂志

Objective To assess the effects of defluoridation on prevalence of children's dental fluorosis in Xi'an City and study related influencing factors.Methods In 2017,the survey results of 2013 were collected from the previous investigation of drinking water type fluorosis in Xi'an Center for Disease Control and Prevention,and villages from drinking water type fluorosis areas were divided into five groups:0.0-,0.2-,0.5-,1.0-,and ≥ 1.5 mg/L,according to the fluoride concentrations of water.Four villages were randomly selected from each group,a total of 20 villages were selected as the investigation sites.A cross-sectional analytical study was conducted in the 20 villages,the fluoride in drinking water,the dental fluorosis of children aged 8-12 years and fluoride content in urine were detected,and the survey results were compared with those of 2013.Children were divided into five groups according to urinary fluoride contents as:0.0-(control),0.4-,0.8-,1.2-,and ≥ 1.6 mg/L,and the logistic regression model was used to evaluate the risk of dental fluorosis.Results There were no significant differences in water fluoride content between 2013 and 2017 (P ＞ 0.05).The rates of dental fluorosis among the study population in 2013 and 2017 were 25.35％ (200/789) and 20.58％ (164/797),and the difference was significant (x2 =5.11,P＜0.05).The prevalence rate and severity of dental fluorosis in 2013 [3.52％ (9/256),13.28％ (17/128),31.62％ (43/136),37.82％(45/119),57.33％(86/150)] and 2017[4.02％(10/249),11.82％(13/110),18.05％(24/133),29.13％(37/127),44.94％ (80/178)] were significantly increased with increase of water fluoride concentration (x2 =168.02,117.83,P ＜ 0.01).The prevalence rate of dental fluorosis was higher than 30％ in the three groups with water fluoride content 0.5-,1.0-and ≥ 1.5 mg/L in 2013,and the prevalence rates were decreased in these groups in 2017.The prevalence rate of dental fluorosis was lower than 30％ in the groups with water-fluorine content of 0.5-,1.0-＜1.5 mg/L,while the rate of dental fluorosis in the group with water-fluorine content of higher than 1.5 mg/L was still over 40％.The geometric mean of urinary fluoride of children in 2013 and 2017 were 1.02,0.67 rg/L,and the difference was significant (t =10.24,P ＜ 0.01).There were significant differences in children urinary fluoride between water fluoride groups in 2013 and 2017 (F =85.36,151.14,P ＜ 0.01).The risk of dental fluorosis increased with increase of urinary fluoride content,the odds ratio (OR) values were 5.26,7.83 and 13.28 in the three groups with the urinary fluoride 0.8-,1.2-,≥1.6 mg/L in 2013;the OR values in 2017 were 5.18,7.65 and 13.36,the differences were statistically significant (P ＜ 0.05).Conclusions The situation of water fluoride and dental fluorosis are not optimistic after defluoridation of drinking water.It is necessary to reinforce the measures of water defluoridation,and carry out classified management in endemic fluorosis areas.

Value of molecular genetics combined with bone marrow imaging detection in the prognosis judgement of acute myeloid leukemia with normal karyotype / 白血病·淋巴瘤

Objective@#To investigate the value of NPM1 and FLT3 gene mutation combined with bone marrow imaging detection in the prognosis judgement of initial treatment cytogenetically normal acute myeloid leukemia (CN-AML).@*Methods@#The clinical data of 100 patients (non-M3 type) with primary and initial treatment CN-AML from January 2010 to January 2014 in the Peace Hospital Affiliated of Changzhi Medical College were retrospectively analyzed. All patients were enrolled in the bone marrow imaging examination on the end day of induction treatment or the first day after the end of induction treatment (T time point). Univariate and multivariate prognostic analyses were performed on AML patients according to FLT3 and NPM1 gene status,bone marrow juvenile cell ratio at T time point.@*Results@#A total of 100 patients included 36 cases with FLT3 gene mutation and 44 cases with NPM1 gene mutation. The complete remission (CR) rate of CN-AML patients was 13.9% (5/36) and 71.9% (46/64), respectively (P < 0.01), 2-year recurrence-free survival (RFS) rate was 5.6% and 59.8%, respectively (P < 0.01), 2-year overall survival (OS) rate was 15.6% and 66.2%, respectively in FLT3+ group and FLT3- group (P < 0.01). The median RFS and median OS time in FLT3+ group was 6.9 months and 9.4 months, respectively, and the median RFS and median OS time in FLT3- group had not yet reached. There were no significant differences of all the indexes between the two groups (all P < 0.01). And there were no significant differences in CR rate, 2-year RFS rate and 2-year OS rate between NPM1+ group and NPM1- group (all P > 0.05). The CR rate, 2-year RFS rate and 2-year OS rate in NPM1+ FLT3- group were better than those in NPM1- FLT3-, NPM1- FLT3+ and NPM1+ FLT3+ groups; NPM1- FLT3+ and NPM1+ FLT3+ groups had the worst prognosis, and there were no statistical differences in the CR rate, RFS and OS time between the two groups (all P > 0.05). The prognosis of the patients in bone marrow juvenile cell ratio < 0.05 group at T time point was better than that in ratio ≥0.05 group (all P < 0.05). CN-AML patients were classified into the good prognosis group (NPM1- FLT3-), the medium prognosis group (NPM1+ FLT3-), and the poor prognosis group (NPM1- FLT3+ and NPM1+ FLT3+) according to the FLT3 and NPM1 genes. The good prognosis group+ the ratio of bone marrow juvenile cells at T time point < 0.05 group, the good prognosis group+ the ratio of bone marrow juvenile cells at T time point ≥0.05 group, the medium prognosis group+ the ratio of bone marrow juvenile cells at T time point < 0.05 group had no statistical differences in CR rate, 2-year RFS rate and 2-year OS rate (all P > 0.05). The medium prognosis group+ the ratio of bone marrow juvenile cells at T time point ≥0.05 group, the poor prognosis group+ the ratio of bone marrow juvenile cells at T time point < 0.05 group had the equivalent prognosis, and the average prognosis was moderate; the poor prognosis group+ the ratio of bone marrow juvenile cells at T time point ≥ 0.05 group had the worst prognosis. According to Cox multivariate regression analysis, FLT3 gene mutation and the ratio of bone marrow juvenile cells at T time point were independent influencing factors for RFS and OS in CN-AML patients (all P < 0.05). NPM1 was an independent prognosis factor affecting RFS and OS of FLT3- patients (all P < 0.05).@*Conclusions@#After induction chemotherapy, the responsiveness and sensitivity of AML patients to chemotherapy regimen can be assessed early and objectively according to molecular genetics and the ratio of bone marrow juvenile cells at T time point, which has a certain value in the prognosis judgement.

Development and application of continuous and noninvasive glucose monitoring technology / 中华检验医学杂志

Blood glucose monitoring is an important part and means in the process of diabetes treatment and management. There is a high correlation between glucose concentration in interstitial fluid and glucose concentration in blood. Real-time monitoring of glucose concentration in interstitial fluid has important clinical significance. Continuous glucose monitoring (CGM) is an emerging glucose monitoring technology, which indirectly reflects the blood glucose level of the body through the glucose level in the interstitial fluid, providing continuous and comprehensive information and rules of blood glucose variation over a period of time. There are three main categories of CGM: minimally invasive implantation, non-invasive microtransparency and non-invasive technology. Noninvasive blood glucose monitoring technology is the future development direction, but accuracy and delay of blood glucose will be the biggest challenge to be overcome in clinical application.

Status of iodine nutrition and thyroid function of healthy adults in urban and rural areas of Xi'an City / 中华地方病学杂志

Objective To find out the iodine nutrition and thyroid function of adults in rural and urban areas of Xi'an City, and to analyze the relationship between iodine intake and thyroid function. Methods Two streets ( townships ) were selected in urban and rural areas of Xi'an City according to multi-stage stratified cluster sampling, one community (administrative village) was selected in each street (township), and 100 residents were selected from each community (administrative village). Drinking water, household salt, urine and blood samples of people over the age of 16 were collected to test water iodine, salt iodine, urinary iodine and thyroid function. Results A total of 354 drinking water samples were examined, and the median of water iodine was 4.50 μg/L in Xi'an, and iodine concentrations of ≥10 μg/L in urban group was higher than that of rural group [ 48 . 21％ ( 94/195 ) vs 20.13％ (32/159), χ2= 30.123, P < 0.05]. The highest value of urban water iodine was 244.10 μg/L. A total of 354 edible salt samples were examined, and the median of salt iodine was 19.62 mg/kg in urban and rural areas of Xi'an. The edible rate of qualified iodized salt in urban group was higher than rural group [78.97％(154/195) vs 69.18％(110/159),χ2=12.523,P<0.05]. The median of urinary iodine of urban and rural groups were 236.00 and 196.00μg/L, respectively, and urban group was higher than rural group (Z = - 3.121, P < 0.05). The frequency distribution of urinary iodine in urban group was different from rural group (χ2=24.440,P<0.05). The mean value of thyroxine (T4) in urban group was lower than that of rural group,and there was statistical difference [nmol/L:(89.43 ± 19.70) vs (93.57 ± 16.89), t = - 2.098,P < 0.05]. The positive rates of anti-thyroglobulin antibody (TgAb) of urban and rural groups were 21.54％(42/195) and 13.21％(21/159), the positive rate of TgAb was higher in urban than in rural (χ2=4.155, P < 0.05). The positive rates of thyroid peroxidases antibody (TPOAb) were 13.33％ (26/195) and 6.92％(11/159), respectively. There were no statistically significant differences of thyroid dysfunction in urban and rural groups [14.87％(29/195) vs 12.58％(20/159), P > 0.05]. Subclinical hypothyroidism in all thyroid dysfunction was the main thyroid disorder, which was 7.18％(14/195) and 6.92％ (11/159) in urban and rural groups. Conclusions Xi'an urban healthy adult iodine intake is at an ultra-appropriate level. In rural areas, the intake of iodine in healthy adults is at an appropriate level. The areas of high water iodine are found in Xi'an for the first time. Increased iodine intake may promote the occurrence of subclinical hypothyroidism.

An investigation of children's dental fluorosis and intelligence in drinking water-type of endemic fluorosis area in Xi'an / 中华地方病学杂志

Objective To investigate the dental fluorosis and intelligence level of children in drinking water-type of endemic fluorosis areas in Xi'an,and to provide a scientific basis for development of prevention and control strategies.Methods In 2016,six drinking water-type of endemic fluorosis villages and one non-diseased village were selected as investigation sites in Xi'an.According to the detection rate and prevalence of dental fluorosis in children,six diseased villages were divided into three groups,the disease light-affected areas were Huidong and Xingnan,the moderate-affected areas were Liulin and Xiazhu,and the serious-affected areas were Hetou and Xiaoyang;and the Deng village was the non-diseased.A cross-sectional survey was conducted to collect 3 tap water samples in each village to test the fluorine content in water.For all children aged 8 to 12 years in diseased villages and 100 children aged 8 to 12 years in non-diseased villages,dental fluorosis examination and intelligence test were carried out.Results Mean value of water fluoride in non-diseased village and endemic fluorosis areas were (0.25 ± 0.01),(0.78 ± 0.43) mg/L,and the water fluoride content in two diseased villages was over 1.20 mg/L.The detection rate of dental fluorosis in children aged 8 to 12 (30.32％,67/221) in diseased areas was significantly higher than that in non-diseased area (2.00％,2/100;x2 =31.32,P ＜ 0.01).Children's IQ scores in the four groups were 108.68 ± 10.83,102.54 ± 12.54,101.70 ± 14.85,93.45 ± 10.84,and the IQ scores were decreased with the severity of dental fluorosis,the difference in IQ scores was significant between the endemic fluorosis areas and non-endemic fluorosis area (P ＜ 0.05);the percentage of children with IQ≤89 in endemic fluorosis areas was significantly higher than that in non-endemic fluorosis area (x2 =22.02,P ＜ 0.01).The IQ scores of children with dental fluorosis was 94.96 ± 13.75,and the IQ was 105.26 ± 10.19 in children with normal condition,the difference was significant (t =5.61,P ＜ 0.01),the mean value of IQ was decreased with the severity of dental fluorosis (F =7.42,P ＜ 0.05),the percentage of children with IQ≤89 in patient was higher than that in normal children,the difference was significant (x2 =45.70,P ＜ 0.01).Conclusion Low level of water fluoride still has negative influence on children's dental health and intelligence,water improving and surveillance should be strengthened to ensure the health of children.

The value of blood oxygen level dependence and arterial spin labeling MRI in the early diagnosis of renal allograft dysfunction / 中华放射学杂志

Objective To investigate the value of blood oxygen level-dependent (BOLD) and arterial spin labeling (ASL) MRI in the early diagnosis of renal allograft dysfunction. Methods A total of 53 patients with allograft kidney transplantation from December 2014 to April 2017 in Tianjin First Center Hospital were prospectively collected. In all cases, the serum creatinine value was detected, and the estimated glomerular filtration rate (eGFR) was calculated. All patients were divided into three groups according to the eGFR. There were three groups;continuous renal transplant function group (group A, 19 cases), short term allograft dysfunction group (group B, 17 cases), and continuous renal function damage group (group C, 17 cases). Fifty-three patients were examined by BOLD and ASL MRI at 10 to 14 days after operation. Twenty one patients were reviewed by BOLD and ASL MRI at 10 to 13 weeks after operation (A, B and C group were 7, 6, 8 cases). The values of renal cortex R2* (R2*=1/T2*), renal medullary R2* and renal cortical renal blood flow (RBF) were measured in each group. One-way analysis of variance (ANOVA) was used to compare the differences of eGFR and BOLD, ASL index (renal cortex R2*, renal medulla R2*, renal cortex RBF value) after the first post renal transplant among the 3 groups. Correlations between BOLD and ASL index with eGFR index in the first post renal transplant were assessed by using Pearson correlation analysis. The efficacy of BOLD and ASL in the differential diagnosis of continuous renal transplant function group and short term allograft dysfunction group by the receiver operating characteristic (ROC). Paired samples t test was used to compare the differences of eGFR, BOLD and ASL indexes for the baseline and follow-up. Results The differences of eGFR, cortical R2*value, medullary R2*value and cortical RBF value were statistically significant between the 3 groups (P<0.05). The transplanted kidney medullary R2* value and cortical RBF value were positively correlated with eGFR (r values were 0.553, 0.687; P<0.01). There was no correlation between transplanted kidney renal cortex R2*value and eGFR value (P>0.05). The area under ROC was 0.776 for the renal medullary R2*in the diagnosis of continuous renal transplant function group and the short term allograft dysfunction group;with the threshold of 24.5, the sensitivity of diagnosis of renal allograft short term allograft dysfunction was 58.8%, specificity was 84.2%;the area under ROC for renal cortex RBF was 0.881, with the threshold of less than 277 ml·100 g-1·min-1, the sensitivity was 70.6%, specificity was 89.4%. During follow-up, eGFR, cortical R2*and medullary R2*in group A remained stable, while the renal cortex RBF value went slightly higher, and the differences were statistically significant ( P<0.05). The cortical R2* values in group B remained stable, eGFR, renal medulla R2* and renal cortex RBF decreased, and the differences were statistically significant (P<0.05). The values of eGFR and R2*in group C remained stable, while the renal medullary R2* value and cortex R2* value increased slightly, and the differences were statistically significant (P<0.05). Conclusions This study shows that BOLD and ASL MRI can longitudinally monitor the functional status of the transplanted kidney and detect the abnormality of renal allograft function early. CRBF value shows high diagnostic value.

Clinical Significance of Detecting CD4T Cells in Peripheral Blood of Patients with Follicular lymphoma / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the changes of CD4T lymphocytes in peripheral blood of patients with follicular lymphoma and its clinical significance.</p><p><b>METHODS</b>Blood samples were collected for detection of whole blood cells, including absolute monocyte count (AMC), absolute lymphocyte count (ALC), hemoglobin (Hb), platelet count (Plt). Age, sex, pathological grade, number of involved lymph nodes, bone marrow involvement (BMI), Ann Arbor stage, B symptoms, serum lactate dehydrogenase (LDH) and serum β-2 microglobulin (β2-MG) were recorded, the prognostic stratification was performed by using FLIPI and FLIPI-2. The T lymphocyte subsets were analyzed by flow cytometry, including the absolute number of CD4T lymphocytes (ACD4C) and the absolute number of CD8T lymphocytes (ACD8C).</p><p><b>RESULTS</b>Patients were with higher Ann Arbor stage, Hb<120 g/L, LDH greater than the upper limit of normal, the number of lymph nodes were involved> 4, the bone marrow was involvement, β2-MG levels were high FLIPI score and FLIPI-2 score, AMC level was higher (P<0.05). There were no significant differences in ACD4C levels among different groups. Patients with AMC≥0.89×10/L showed a shorter progression-free survival (PFS) and a shorter overall survival time (OS) (P=0.010,0.002) as compared with patients with AMC<0.89×10/L. The patients with ACD4C>0.16×10/L had longer progression-free survival and overall survival time, as compared with patients with ACD4C ≤0.16×10/L (P=0.016,0.012). Low ACD4C and high AMC related with shorter PFS and OS (P=0.013, 0.020). Univariate Cox regression analysis showed that age (P=0.026), bone marrow involvement (P=0.017), elevated LDH (P=0.001), β2-MG (P=0.014), FLIPI and FLIP2 score (P= 0.004 and 0.000) related with a shorter PFS. Multivariable Cox regression analysis showed that Hb (P=0.015), elevated LDH (P=0.003), β2-MG (P=0.045), bone marrow involvement (P=0.016) and FLIPI-2 score(P=0.003) related with short OS. ACD4C ≤0.16×10/L was a factor influencing prognosis of FL patients (PFS and OS) (P<0.05).</p><p><b>CONCLUSIONS</b>Low ACD4C levels relatees with poor prognosis of patients with FL, and the ACD4C levels may be an important predictor for FL disease and prognosis.</p>

Investigation and analysis of malnutrition after adjuvant chemotherapy in patients with gastrointestinal tumor / 肠外与肠内营养

Objective:This study aims to investigate the incidence and potential cause of the undernutrition in gastrointestinal cancer patients received postoperatively adjuvant chemotherapy.Method:Between July and December 2016,a total of 181 gastrointestinal cancer patients who underwent postoperatively adjuvant chemotherapy in the Department of General Surgery of Nanjing General Hospital were enrolled in this study.Nutritional risks of the patients were screened by the patient-generated subjective global assessment (PG-SGA).Serum albumin concentrations,plasma hemoglobin levels and white blood cell numbers of the patients were determined during the chemotherapy.The patients'clinical data,including gender,age,tumor location,chemotherapy stage and adverse events post the chemotherapy,were recorded.Result:All patients completed the PG-SGA for nutritional risk screening.Among the patients,69 cases (38.1％) had a PG-SGA score of 0 ～ 3 points,showing absence of undernutrition.The remaining 112 cases (61.9％)had a PG-SGA score above 4 points,indicating moderate or severe undernutrition.71cases (39.2％) of them displayed moderate underuutrition (4-8 points),and 41 cases (22.7 ％) showing severe undernutrition (＞ 8 points).The PG-SGA scores in patients with gastric cancer were significantly higher than those in the rectal cancer patients (P ＜ 0.05) and in the colon cancer cases (P ＜ 0.01).In addition,the incidence of undernutrition in the male patients was much higher than in the female cases (P ＜ 0.05).The incidence of undernutrition in the patients aging ＞ 65 years was higher than in the cases below 65 years old (P ＜ 0.05).The levels of plasma hemoglobin and numbers of white blood cells were significantly lower in the patients with undernutrition (PG-SGA score ＞4 points),and adverse events such as nausea and vomiting were also more frequently presented in these cases.No significant difference in the incidence of the patients' undernutrition was observed between different stages of the chemotherapy.Conclusion:The patients with gastrointestinal cancer underwent postoperatively adjuvant chemotherapy had higher incidence ofundernutrition.Gender,age and tumor location were the risk factors for the development of undernutrition.Our findings provide evidence for the utilization of nutrition interventions in these patients.