Clinical observation of 5 cases of diabetes insipidus complicated with skeletal fluorosis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the mechanism of diabetes insipidus complicated with skeletal fluorosis and the surgical treatment of spinal canal stenosis caused by skeletal fluorosis.</p><p><b>METHODS</b>From January 2000 to November 2011, 5 patients with diabetes insipidus complicated with skeletal fluorosis were treated with drug and cervical or thoracic posterior decompression including 2 males and 3 females with age of 35, 45, 47, 49, 55 years old respectively. The symptoms was mainly limb motor sensory disturbance accompanied by polyuria and polyuria. Imaging showed that cervical and thoracic multi-segmental continuous spinal stenosis. It was diagnosed with diabetes insipidus according to the symptoms and laboratory tests. According to the symptoms, the vertebral with problems were located and treated by posterior laminectomy decompression or the expansive open-door laminectomy. The recovery of neurological symptoms were recorded and the operation result were evaluate by JOA score improvement rate.</p><p><b>RESULTS</b>The wound healed well in 5 cases, and 1 case of cervical axial pain was improved after symptomatic treatment. Five patients were followed up for 2 to 6 years with an average of 4 years. Numbness of limb and weakness symptoms of follow-up patients were significantly improved, muscle strength and acupuncture hypothyroidism were significantly improved compared with preoperative, the JOA score was significantly improved. At the final follow-up, the improvement rate got excellent results in 2 cases, good in 2 and fair in 1.</p><p><b>CONCLUSIONS</b>Long-term high intake of fluoride can cause skeletal fluorosis in patients with diabetes insipidus. The posterior decompression is effective for the majority of spinal canal stenosis caused by skeletal fluorosis.</p>

Histomorphometrical analysis of vertebral lamina with osteofluorosis and its correlation with signal intensity in MRI / 中华骨科杂志

Objective To analyze histomorphometrical characteristics of bone and bone marrow tissue in the vertebral lamina of patients with osteofluorosis, and to explore the influencing factors on signal intensity in MRI. Methods Spinal MRI of 109 patients (57 men, 52 women;age range 32-80 years;mean age 52 years) with osteofluorosis from December 2001 to May 2012 was analyzed retrospectively, including 48 patients in cervical segment, 31 in thoracic segment and 30 in lumbar segment. 36 pa?tients (16 men, 20 women;mean age 51 years;age range 34-68 years) had undergone laminectomy and the vertebral lamina speci?mens were collected. The cervical MRI of 48 patients with matching gender and age (26 men, 22 women;mean age 51 years, age range 34-71 years) was selected as control group, who were from areas where fluorosis is not endemic. All patients were divided in?to vertebra low, medium and high signal groups according to T1WI of MRI. The vertebra signal to noise ratio measure and stan?dardization of signal intensity were performed. Osteosclerosis, osteoporosis and normal bone were differentiated under spinal X?ray plain film. Combined with histomorphometric analysis of vertebra lamina in 36 patients, correlation between MRI signal intensity, histomorphometric parameters of the vertebra lamina and influencing factors on signal intensity were studied. Results 77 pa?tients (70.6%, 77/109) had osteosclerosis indicated by appearance of spine under X?ray, 29 (26.6%, 29/109) osteoporosis and 3 (2.8%, 3/109) normal bone. T1WI of MRI showed 25 cases had low signal vertebra, 52 medium signal and 32 high signal. The ver? tebra SNR in patients with osteofluorosis was lower on T1WI, T2WI and short time inversion recovery (STIR) sequences, compared with control group. Those with a low versus high signal on T1WI had 6.04 times the odds of osteosclerosis (OR=6.04, 95%CI 2.44-14.91, P<0.001). Histomorphometry of vertebral lamina in 36 patients with osteofluorosis was performed, revealing that not only the trabecular bone volume had changed, but also did the adipocyte volume and hemopoietic cell volume in the bone marrow tis?sues. Compared with normal reference values, trabecular bone volume was significantly increased (47.7%± 13.3% vs. 14.7%± 4.3%) (P<0.001);adipocyte volume was significantly decreased (12.3%±9.1%vs. 50.5%±8.7%);hematopoietic cell volume was decreased (40.0%±7.0%vs. 42.5%±8.5%) (P=0.038). There were inverse associations between trabecular bone volume and adipo?cyte volume (r=-0.869, P<0.001), and between trabecular bone volume and T1WI (r=-0.851, P<0.001) found by Pearson correla?tion test. In contrast, there were positive associations between T1WI and adipocyte volume (r=0.927, P<0.001). Conclusion The vertebra T1WI signal intensity is decreased in patients with osteofluorosis, resulting from increase of trabecular bone volume and re?duction of adipocyte volume. The vertebra STIR signal intensity is decreased, mainly caused by increase of trabecular bone volume.

The situation of brick tea type fluorosis in Inner Mongolia in 2009 and 2012 / 中华地方病学杂志

Objective To understand the trend of drinking-tea type fluorosis in the diseased areas in Inner Mongolia Autonomous Region,and to evaluate the effect of prevention and control measures.Methods In 2009 and 2012,6 monitored counties were selected in Inner Mongolia Autonomous Region; 5 diseased villages were selected in each monitored county,and 10 families were selected in each monitored village; fluorine content of brick tea was tested,and dental fluorosis conditions of all 8 to 12-year-old students and skeletal fluorosis conditions of all 36 to 45-year-old adults were examined.In 2012,in each monitored village,1 water sample of the drinking water source was collected respectively from five positions(east,south,west,north and the central of the village),and fluoride content of drinking water wastested.Results In 2009,the mean of brick tea fluorine content was 541.48 mg/kg in the monitored villages,and the fluoride content ≤ 300 mg/kg accounted for 17.62％.(49/278).In 2012,the mean of brick tea fluorine content was 536.06 mg/kg,and the fluoride content ≤300 mg/kg accounted for 11.00％(33/300).Total exceeding standard rate of the water fluoride content was 40.00％(12/30).In 2009,the detection rate of the children's dental fluorosis was 52.39％ (274/523),very mild,mild,moderate and severe cases accounted for 9.56％(50/523),19.86％(104/523),21.03％(110/523) and 1.91％(10/523),respectively.In 2012,the detection rate of the children's dental fluorosis was 35.71％(200/560),very mild,mild,moderate and severe cases accounted for 14.11％ (79/560),11.43％ (64/560),9.64％ (54/560),and 0.54％ (3/560),respectively.Compared with 2009,the proportion of moderate and severe cases reduced in 2012(W =40 696.0,P ＜ 0.01).In 2009,the detection rate of adult skeletal fluorosis was 23.52％ (167/710),mild,moderate and severe cases accounted for 17.32％(123/710),4.51％(32/710) and 1.69％(12/710),respectively.In 2012,the detection rate of adult skeletal fluorosis was 20.12％ (103/512),mild,moderate and severe cases accounted for 17.38％ (89/512),2.54％ (13/512) and 0.20％ (1/512),respectively.Compared with 2009,the proportion of moderate and severe cases reduced in 2012(W =12 797.5,P ＜ 0.01).Conclusion The drinking-tea type fluorosis in Inner Mongolia Autonomous Region has been controlled to some degree,but still serious in some areas;prevention and control measures need to be further strengthened.

An survey of endemic fluorosis in Jining City, Shandong Province / 中华地方病学杂志

Objective To investigate the epidemic status of endemic fluorosis in Shandong Province,Jining City,and to provide a basis for prevention and control of the disease.Methods Based on Shandong Provincial Project Technical Solutions for Endemic Fluorosis,Rencheng,Jinxiang,Yutai,Jiaxiang and Liangshan Counties in Jining were selected as monitoring sites.According to the illness situation of mild,moderate or serious districts,one village was selected as a major survey site from each county(district).There were a total of 15 such villages selected.Survey content included drinking water fluorine level; dental fluorosis of children,adults' clinical skeletal fluorosis and urinary fluorine levels; water and urinary fluoride content were determined by the method of fluoride ion selective electrode; dental fluorosis of children was diagnosed by Deans method and clinical diagnosis was based on the Diagnostic Criteria of Endemic Skeletal Fluorosis (WS 192-2008).Results Sixty-one water samples from 15 villages of five counties (districts) were tested.Fluoride levels of 9 out of the 61 samples were exceeded the national standard (＞ 1.0 mg/L),and the rate was 14.75％; 1 sample ＞ 2.0 mg/L,and the maximum water fluoride was 2.25 mg/L.Seven hundred and seventeen people's real time urinary fluoride was detected in the 15 villages,including 420 children and 297 adults,and the geometric mean were 1.53 and 1.69 mg/L,respectively.Clinical examination of 755 children aged 8 to 12 showed that the detection rate of dental fluorosis was 26.89％ (203/755); defect rate was 9.12％(29/755) and dental fluorosis index weres 0.65.The detection rate of clinical skeletal fluorosis of 11 565 adults was 4.76％(550/11 565),including 303 moderate or serious cases.Conclusions The situation of excessive water fluorine in outside environment in Jining City has been controlled at a certain degree; groups urinary fluoride level is closed to the normal upper limit; the prevalence of dental fluorosis or skeletal fluorosis has been suppressed at a certain degree,therefore,the results of control should be further consolidated and expanded,in order to completely eliminate the fluoride hazard.

Evaluation of imaging quality of X-ray films of endemic fluorosis in Shandong Province / 中华地方病学杂志

Objective To evaluate the photo quality of X-ray films of endemic fluorosis in Shandong Province,and to provide a basis for correct implementation of X-ray examination.Methods Three villages were selected as survey sites in each of the 20 endemic fluorosis counties (cities,districts) of Shandong Province;anteroposterior X-ray films of the villagers forearm(including elbow) and leg(including knee) were taken; 20 films were taken in each village,each film comprising two recording sites.X-ray examination carried out in the 42 patients' villages of 14 counties(cities,districts) were undertaken by the Institute for Endemic Disease Control,Shandong Province,a total of 840 X-ray films shoot,which was edited group A,and the remaining six counties (cities,districts) were undertaken by the local Hospital,shooting X-ray films 360 copies,compiled for group B.The quality of X-ray film examination was determined in accordance with technical requirements and diagnostic indicators.The difference of photo quality between group A and group B was compared at three levels:sub-surface defects photos,structural defects and comprehensive quality.Results In evaluation of surface defects in the photo,the total detection rate of the defects indicators in group A of forearm was 7.98％(67/840),while the rate of leg was 9.77％(82/840).And the rates of group B were 35.27％(127/360) and 39.16％(141/360),respectively,and the differences were statistically significant between the two groups(x2forearm=138.6,P ＜ 0.01 ; x2leg =144.0,P ＜ 0.01).In assessment of structural defects,the total forearm defection rate of group A was 7.14％(60/840),and the leg was 8.33％ (70/840).And the rates of group B were 27.22％ (98/360) and 31.38％ (113/360),respectively.The differences were statistically significant(x2forearm =88.867,P ＜ 0.01; x2leg =103.6,P ＜ 0.01).In the photo quality comprehensive assessment,the excellent rate of forearm in group A was 72.73％(611/840),and the leg was 71.67％ (602/840),while the poor quality rates in the same parts were 9.89％ (83/840) and 11.43％ (96/840),respectively.And the excellent rates of Group B were 44.14％(159/360) and 42.22％(152/360),poor quality rates were 34.74％(125/360) and 38.06％(137/360).The differences were statistically significant(Z value were-20.161 and-16.229,respectively,P ＜ 0.01).Conclusions X-ray films taken in the counties (cities,districts) have more defects,and image is poor.The reason for that is that the skill levels of local hospital X-ray technician are low,and photos quality is not strictly followed requirements.Supervision team of professional technicians should be established to provide professional supports.It is more important to take mobile X-ray examination by the provincial institutes,and to provide a reliable technical support.

X-rays changes of forearm and shank of residents from areas with different fluoride contents in drinking water in Jilin province / 中国地方病学杂志

Objective To understand common X-ray signs of bone and joint of forearm and shank,in order to provide a basis for diagnosis of skeletal fluorosis.Methods A total of 15 villages which were built for more than 50 years in Nongan and Qianan counties of Jilin province were selected and surveyed by quantitative epidemiological methods.These villages had no industrial and coal-burning-borne fluorine pollution; no other high fluoride sources; had not yet changed to low-fluoride drinking water,and had complete and stable historic data of fluoride content in drinking water.Drinking water fluoride content was determined.Inhabitants lived in the local for more than 10 years,between the age of 16-60 were chosen from the villages based on the 11 levels of fluoride content of drinking water from 0.5-7.0 mg/L and these people were divided into 5 age groups:16-,21-,31-,41-,51 to 60.In each age group,10-15 individuals were taken by stratified random sampling to do the forearm and shank joint X-ray examination.Drinking water fluoride content between 0.5-1.0 mg/L acted as the low fluoride group(control group),1.5-7.0 mg/L as the high fluoride group and various X-ray findings and the detection rate were observed.Results Three X-ray signs of skeletal fluorosis,joint degenerative change and osteoporosis were observed.Thereinto,joint degenerative change was the most common.In the high fluoride group(31.55％,153/485),the detection rate of joint degenerative change was higher than that of the low fluoride group (21.58％,41/190) and the difference was statistically significant (x2 =6.62,P ＜ 0.05).Seventy two of 675 peoples used by X-ray were detected with skeletal fluorosis,which occurred mainly in the higher intake of high fluoride group (x2 =25.65,P ＜ 0.01).When water fluoride was up to 6.0-7.0 mg/L,the detection rate of endemic skeletal fluorosis was increased to 44.92％(53/118).Regardless of higher or lower of water fluoride and mild or more serious of the state of fluorosis,changes of X-ray signs of bone surroundings happened first; on average with a detection rate of 95.83％ (69/72),the joint change followed by 79.17％ (57/72) and bone substance change the least at 56.94％(41/72),and the difference was statistically significant (x2=9.64,P ＜ 0.01).Regardless of water fluoride high and low,joint of elbow knee and wrist underwent degenerative change.Degenerative change of elbow joint happened first with a detection rate of 17.78％ (120/675),knee joint followed by 15.41％ (104/675),and wrist joint was the least at 7.85％ (53/675).The difference was statistically significant (x2 =30.74,P ＜ 0.01).Elbow degeneration detection rate(21.03％,102/485) in high fluoride group was significantly higher than that of the low fluoride group(9.47％,18/190; x2=12.47,P ＜ 0.01).X-ray examination showed 35 kinds of signs; most signs could be seen in the high fluoride and the low fluoride groups.But the changes of bone around were seen more often in higher fluoride content group than in lower fluoride content group.Conclusions X-ray signs of endemic skeletal fluorosis are complex and diverse.Only after comprehensive analysis,the diagnostic results are accurate and reliable.

Analysis of surveillance results of drinking-water-borne endemic fluorosis in Jiangsu Province in 2009 / 中国地方病学杂志

Objective To investigate the development trend of drinking-water-borne endemic fluorosis in Jiangsu Province,and to provide the basis for further prevention and treatment of the disease.Methods In 2009,eight major counties were chosen,and in each county all diseased villages were classified into light,moderate and severe disease types according to water fluorine content based on historical data,and one village was chosen from each type.In monitoring villages with improved water,one source water and three tap water samples were collected,respectively.Five water samples were collected in water unimproved monitoring villages according to water well locations of the east,the west,the south,the north and the center.The fluorine content in water was determined according to the Standard Testing Methods for Drinking Water (GB/T 5750-2006).Children aged 8 to 12 were examined for dental fluorosis by Dean method.Residents over the age of 16 were examined for clinical osteofluorosis,and two monitoring counties were chosen,then one village was respectively chosen in each county,and clinically diagnosed patients with skeletal fluorosis were examined again by X-ray.Both clinical and X-ray diagnosis were on the basis of Diagnostic Criteria of Endemic Skeletal Fluorosis (WS 192-2008).Urine samples of 30 children aged 8 to 12 and of 20 adults over the age of 16 were randomly collected and urinary fluoride was determined by F-ion selective electrode method(WS/T 89-1996).Results Of all the 24 villages of 8 counties,20 villages were water improved,and water-improvedprojects ran normally in 18 villages,while scrapped in the rest 2 villages.One hundred and two samples were tested,and the mean of water fluoride in water-improved villages was 1.10 mg/L,while in water unimproved villages and villages with water improved projects scrapped was 1.90 mg/L.The prevalence of dental fluorosis was 42.51％(854/2009).The prevalence of clinical skeletal fluorosis was 23.23％ (2024/8713) and the X-ray detection rate was 32.00％ (24/75).Six hundred and sixty-four urine samples of children were determined,and geometric mean of urinary fluorine was 1.59 mg/L,while 370 adult urine samples were determined,and geometric mean of urinary fluorine was 2.20 mg/L.Conclusions Endemic fluorosis in Jiangsu Province has not been fully controlled and there are signs of recovery.We must pay attention to water improvement measures to reduce fluoride and the management and maintenance of water improvement projects,and further strengthen the prevention and control of endemic fluorosis.

X-ray diagnostic site selectivity studies of skeletal fluorosis / 中国地方病学杂志

Objective To study the X-ray signs of forearm and leg in skeletal fluorosis and its diagnostic value,aim at finding the easy examination parts.Methods One thousand four hundred and forty subjects were examined using developed shield,darkroom and other portable dedicated device combined with a small X-ray machine.A total of 384 cases were diagnosed skeletal fluorosis.All patients were divided into different groups and the time,degree and range of X-ray to the forearm and calf elbow,knee,and long bone were compared.Results The X-ray change in the forearm elbow was earlier than that of the leg knee,and trabecular bone change was the earliest indicator,197 cases and 157 cases,respectively,and the difference was statistically significant (x2 =28.006,P ＜ 0.01).Membrane ossification of forearm backbone was earlier than that of the leg,and most of them were degree Ⅰ photos,213 cases and 126 cases respectively.The difference was statistically significant (x2 =17.626,P ＜ 0.01).The direction of the interosseous membrane ossification was from the forearm radius to the ulna,then to the fibula and tibia,and was accompanied by changes in the aggravation of forearm.A variety of indicators were observed,especially the membrane ossification in bone and joint trabecular bone and the long bone was the most active,and the forearm was more sensitive,obviously than that of the calf.Conclusion In the X-ray screening or detection of endemic fluorosis,the forearm radiography is a simple,economical,and effective diagnostic method.

Epidemiological investigation and analysis of water-related endemic fluorosis in the south area of Shandong province in 2009 / 中国地方病学杂志

Objective To investigate the prevailing status of endemic fluorosis in the south area of Shandong province and to provide a scientific basis for formulating control measures against the disease.Methods According to the present distribution of fluorosis areas in the south area of Shandong province and the Shandong Province Technical Scheme for Endemic Disease Control,13 counties(districts) in the south area of Shandong province were selected as the survey counties in 2009.Based on the state of endemic fluorosis,the disease was classified into light,moderate and severe types in the 13 monitoring counties (districts),and one diseased village was selected from each type as the survey spots.The drinking water fluoride level,the prevalence of dental fluorosis of children aged 8-12,adult clinical skeletal fluorosis and urinary fluoride level of the children and adults were surveyed in the 39 villages selected.The content of fluoride in drinking water and urine was dctermined by F-ion selective electrode while dental fluorosis of the children aged 8-12 was diagnosed by Dean method and adults skeletal fluorosis by the national standard for Diagnosis of Endemic Skeletal Fluorosis (WS 192-2008).Results A total of 172 water samples were tested in the 39 villages(26 villages with improved water and 13 villages with unimproved water) of the 13 counties(districts),the fluoride content of the 74 water samples(51 from 13 villages with unimproved water and 23 from 6 villages with improved water) exceeded the national standard(＞ 1.0 mg/L),and the rate of exceeded the standard was 43.02％(74/172) with 24 of ＞ 2.0-4.0 mg/L and 3 of ＞ 4.0 mg/L,and the maximum value of the water fluoride was 7.76 mg/L.A total of 1118 copies of children urine samples were tested,geometric mean of urinary fluoride was 1.82 mg/L; 764 copies of adults' urine samples were tested,geometric mean of urinary fluoride was 1.98 mg/L.A total of 1908 children aged 8-12 were examined of dental fluorosis,the detection rate was 45.18％ (862/1908),tooth defection rate was 9.12％ (174/1908),and dental fluorosis index was 1.07.A total of 25 295 adults were checked of clinical skeletal fluorosis,the detection rate was 5.96％(1509/25 296) with 670 moderate or scrious cases.Conclusions In the south area of Shandong province,excessive water fluoride is still serious,mainly in the diseased villages with unimproved water(including water improvement villages discarded water improvement thereafter).Urine fluoride remains at a relatively high level,and the dental and skeletal fluorosis are still comparatively serious.High tluoride hazard still exists to a certain degree.Therefore,the scientific control measures need to be strengthened to control the prevalent of endemic fluorosis.

Epidemiological investigation of endemic fluorosis of Shandong province in 2010 / 中国地方病学杂志

Objective To investigate the current status of endemic fluorosis in Shandong province,and to provide a scientific basis for the development of preventive strategies.Methods In accordance with the requirements of the national Technical Implementation Plan for Endcmic Disease Control Project in 2009 and Drinking-Water-Borne Endemic Fluorosis Monitoring Program (trial),ten counties were selected to carry out the epidemiological investigation,to understand the progress and the effect of the water improvement projects; three villages were selected in each county,to determine fluoride content of drinking water,to check dental fluorosis of children aged 8 to 12 and skeletal fluorosis of adults over the age of 25.Water fluoride content was determined by fluoride ion selective electrode method,children dental fluorosis was diagnosed with Dean method and adults skeletal fluorosis by the National Standard for Diagnosis of Endemic Skeletal Fluorosis (WS 192-2008).Results There were a total of 687 improved-water defluoridation projects of the 10 counties,the improved-water rate was 83.34％ (3247/3896).The investigation was taken place in 84 improved-water projects of the 10 counties,the projects running normally accounted for 98.81％ (83/84); 41 projects had water fluoride concentration ≤1.20 mg/L,and the pass rate was 48.81％(41/84),with the maximum water fluoride as 5.76 mg/L.In the 26 villages with improved-water projects of the 10 counties,villages with a mean water fluoride ≤ 1.20 mg/L were 15,which accounted for 57.69％ (15/26),＞ 1.20 mg/L were 11,which accounted for 42.31％ (11/26),with the maximum water fluoride as 5.58 mg/L.In the 4 yet to improve water quality villages of the 10 counties,1 village had mean water fluoride ≤ 1.20 mg/L,3 villages had mean water fluoride ＞ 1.20 mg/L,with the maximum water fluoride as 2.92 mg/L.A total of 1331 children aged 8 to 12 were checked in the 26 improved water villages,the detection rate of dental fluorosis was 59.73％ (795/1331),the index of dental fluorosis was 1.17 and the defect rate was 10.14％ (123/1331).A total of 138 children aged 8 to 12 were checked in the 4 yet to improve water quality villages,the detection rate of dental fluorosis was 51.45％(71/138),the index of dental fluorosis was 0.95 and the defect rate was 0.72％ (1/138).In water quality improved villages and yet to improve water quality villages,X-ray detection rates of skeletal fluorosis were 8.80％ (113/1284) and 3.05％ (6/197),respectively,in adults over the age of 25.Conclusions The water fluoride content of improved-water defluoridation projects exceeds the national standard seriously and fluorosis has not been effectively controlled in Shandong province.

Relationship between whole blood chemical dements and coal-burning borne endemic fluorosis / 中国地方病学杂志

ObjectiveTo investigate the differences of whole blood chemical elements and urinary fluorine between patients with endemic fluomsis and patients without endemic fluorosis,and to find out the elements associated with endemic fluorosis and further lay a theoretical basis for clarify the pathogenesis of the disease.MethodsUsing case-control study,100 children aged 8 - 12 with dental fluorosis in Wushan and Fengjie counties of Chongqing from December 2010 to February 2011,and 30 adults with skeletal fluorosis were enrolled as case group; 100 children aged 8 - 12 without dental fluorosis and 30 adults without skeletal fluorosis were enrolled as internal control group; and 50 children without dental fluorosis and 30 healthy adults were selected as external control group in non-epidemic areas in Yubei district.Whole blood copper,zinc,calcium,magnesium,iron and urinary fluorine of all subjects were determined,and differences of these indexes were compared between groups.ResultsThe levels of copper,zinc,calcium,magnesium,iron and urinary fluorine of children in the case group were (30.08 ± 2.83),(74.04 ± 9.75)μmol/L,(1.65 ± 0.29),(1.37 ± 0.17),(6.79 ± 1.27)mmol/L,and (0.73 ±0.37)mg/L,respectively; the levels of these elements of children in internal control group were (28.65 ± 3.96),(72.83 ± 11.35)μmol/L,(1.62 ± 0.27),(1.36 ± 0.18),(6.73 ± 1.22)mmol/L,and (0.48 ± 0.21)mg/L,respectively; in external control group were (32.03 ± 2.99),(77.78 ± 10.85)μmol/L,(1.41 ± 0.11),(1.43 ± 0.13),(7.66 ±0.55)mmol/L,and (0.49 ± 0.26)mg/L,respectively(all P＜ 0.05),the comparison between any two groups indicated the levels of copper,zinc,magnesium,iron of the case group were lower than that of external control group,urinary fluorine was higher than that of internal and external control groups(all P ＜ 0.05).The levels of copper,zinc,calcium,magnesium,iron and urinary fluorine of adult case were (26.93 ± 4.37),(95.89 ± 12.45)μmol/L,(1.50 ± 1.76),(1.56 ± 1.96),(8.15 ± 1.00)mmol/L,and (2.17 ± 0.99)mg/L; internal control group were (26.26 ±4.96),(94.86 ± 12.18)μmol/L,(1.57 ± 0.12),(1.46 ± 0.16),(7.64 ± 1.00)mmol/L,and (1.44 ± 1.22)mg/L;external control group were (26.20 ± 2.96),(96.52 ± 11.11)μmol/L,(1.48 ± 0.14),(1.45 ± 0.16),(7.81 ±0.91 )mmol/L,and (0.55 ± 0.21 )mg/L,respectively.The levels of magnesium,iron and urinary fluorine of case group were higher than that of internal control group,magnesium and urinary fluorine were higher than that of external control group(all P ＜ 0.05).ConclusionsIn vivo anti-fluorine elements are deficient in the areas with endemic fluorosis.Other chemical elements,the environment and genetic factors may be related to the pathogenesisof the disease,which needs a further comprehensive analysis.

Surveillance analysis of drinking water-born endemic fluorosis in 2009 in Xuchang city, Henan province / 中国地方病学杂志

ObjectiveTo investigate the status of an illness of endemic fluorosis in Xuchang city,and to evaluate the effect of implementation of control measures.MethodsIn 2009,Changge city and Xuchang county were chosen as survey counties(city).We investigated the surveillance counties (city) about the running state of water-inproving projects,and fluoride content of drinking water in the villages,and ten villages were chosen as survey villages,dental fluorosis and fluoride content of children aged 8 to 12,clinical skeletal fluorosis and urinary fluoride content of 16-year-old adult were investigated.ResultsIn all the villages with projects of defluoridation for drinking water of the two monitoring counties,that the projects was being used accounted for 61.39％(97/158),and the projects discarded accounted for 38.61％(61/158).In the 9 non-water-improving villages,the average water fluoride ranged 1.32 - 2.25 mg/L; in the 1 water-improving village,the mean water fluoride was 0.44 mg/L.The total rate of dental fluorosis of children aged 8 to 12 was 38.65％ (80/207),and the geometric mean of urinary fluoride was 1.65 mg/L.The rate of adult skeletal fluorosis by clinical detection was 0.30％ (9/2982),and the geometric mean of urinary fluoride was 2.09 mg/L.ConclusionsXuchang city is a mild to moderate fluorosis epidemic areas of endemic fluorosis,and condition of the disease has not yet been effectively controlled,and there is need to further intensify the prevention and control efforts.

Cluster analysis of 2007 survey data of current status of the national brick-tea-born fluorosis / 中国地方病学杂志

ObjectiveCluster analysis method was applied to analyze the data of brick-tea-born fluorosis,to clarify the provincial and municipal classification hierarchy in nation-wide epidemic areas and to guide the prophylaxis and treatment of the disease.MethodsPrevalence survey database of the 2007 national brick-tea-born fluorosis was analyzed.Detection rate of second degree and above clinical skeletal fluorosis as clustered index,clustering analysis of all survey data was carried out,clustering figure was drawn,and analysis of variance and multiple comparison was done.ResultsThe provincial level of the nation-wide epidemic areas of the brick-teaborn fluorosis could be classified into three categories:the first category including Tibet and Sichuan province,the second category including Qinghai province,and the third including Inner Mongolia,Gansu,Xinjiang and Ningxia provinces; The city-level they were also could be classified into three categories:the first category including Aba,Shigatse region and Lhasa,the second including Wulanchabu,Hulun Buir,Baotou,Qinghai state,Guoluo state,Haixi state,Xining city,Haidong state,Ganzi state,Longnan city,Jiuquan city,Urumqi city and the state of Bortala,and the other cities were the third category cities.The differences of clinical skeletal fluorosis detection rate between the first,second,and third provincial and municipal categories(35.18％,16.21％,5.22％,41.16％,19.64％,4.19％) were statistically significant (all P ＜ 0.05).ConclusionsBrick-tea-born fluorosis can be classified by using cluster analysis at the provincial and municipal levels.Cluster analysis results can provide a scientific basis for effective implementation of the prophylaxis and treatment of brick-tea-born fluorosis.

Analysis of monitoring data of drinking-water borne endemic fluorosis in Xinzhou of Shanxi province in 2010 / 中国地方病学杂志

ObjectiveTo master the epidemic situation of drinking-water borne endemic fluorosis in Xinzhou,evaluate the effects of water improvement project to reduce fluoride,and to provide a timely scientific basis for monitoring the disease and for establishment of preventive countermeasures.MethodsAccording to the water fluoride concentration and type of the disease,after stratification 25 endemic villages were selected as survey points.Five water samples were collected in water unimproved monitoring villages according to water well locations of east,west,south,north and center.In monitoring villages with improved water,3 tap water and 1 source water samples were collected,respectively.The fluorine content in water samples was determined according to the “Standard Testing Methods for Drinking Water”(GB/T 5750-2006).All children aged 8 to 12 of the survey villages were examined for dental fluorosis by Dean method.Clinical osteofluorosis of all the resident over the age of 16 was examined,8 villages of these counties were selected,10 men and.women were randomly selected in each village,respectively,and they were examined again by X-ray using “Diagnostic Criteria of Endemic Skeletal Fluorosis” (WS/T 192-2007).Children aged 8 to 12 in 13 villages of chosen villages were selected for urine collection,6 unne samples were collected in each age group and a total of 30 samples were collected,and urinary fluoride was determined by F-ion selective electrode method(WS/T 89-2006).ResultsA total of 56 water samples were tested in water-unimproved villages,the average water fluorine was 2.7 mg/L And 52 water samples were tested in waterimproved villages,the average water fluorine was 1.6 mg/L,water fluoride content ＞ 1.5 mg/L accounted for 46.15％ (6/13) in the water-improved village.Incidences of dental fluorosis of children in the water-unimproved villages and water-improved villages were 74.75％ (622/832) and 23.67％ (241/1018),respectively.The difference was statistically significant(x2 =140,P ＜ 0.01).The prevalence rate of skeletal fluorosis was 30.02％(2803/9335) in water-unimproved villages,and 9.44％ (1230/13 022) in water-improved villages.The difference was statistically significant(x2 =1557.75,P ＜ 0.01 ).The mean of urine fluorine in a total sample was 3.31 mg/L,the urinary fluoride concentration of children in water-improved villages was significantly different from that of water-unimproved villages(t =2.27,P ＜ 0.05).ConclusionsBy reducing fluorine and improving drinking water,disease in drinkingwater borne endemic fluorosis areas in Xinzhou has been controlled to a certain degree.However,the disease is still very serious in some endemic areas.Fluoride in drinking water re-increases in some water-improved villages,the disease is also in a rise.So,the work of monitoring and prevention should be strengthened.

Analysis of monitoring results of drinking-tea borne endemic fluorosis in Lhasa of Tibet / 中国地方病学杂志

ObjectiveTo understand the harm of drinking-tea borne endemic flnorosis on human body and to provide a scientific basis for the formulation of effective control measures.MethodsSeven counties in Lhasa of Tibet were selected as monitoring counties in 2008.Four townships in each county were selected(including 2 villages in Chengguan county),and 2 administrative villages in each township were selected as monitoring villages.By using Dean method,dental fluorosis of every child aged 8 - 12 in the monitoring villages was examined.At the same time,urine samples were randomly collected in each age group in the above-mentioned villages.The content of fluoride in urine was determined by F-ion selective electrode (WS/T 30-1996) and evaluated according to “The Normal Concentration of Uriary Fluride of Population” (WS/T 256-2005).Over 18 years old in the monitoring counties were divided into five age group as - 25,- 35,- 45,- 55 and 56 -,at least 10 ment were randomly selected in each age group to be examined clinical skeletal fluorosis,and the diagnosis was based on the endemic skeletal fluorosis standard(WS 192-2007 ).At the same time,adult dental fluorosis diagnosis and urinary fluoride examination were done.Drinking water samples in each survey point were collected and water fluoride was determination by ion selective electrode method.Results①Dental fluorosis:a total of 723 children aged 8 to 12 were examined,91 cases of dental fluorosis were detected,and detection rate was 12.58％,dental fluorosis index was 0.34; ②adult dental fluorosis:a total of 2626 adults were examined,998 cases of dental fluorosis were detected,and detection rate was 38.00％,dental fluorosis index was 0.71; ③Adult clinical skeletal fluorosis:a total of 2626 adults were examined,15 degree Ⅱ clinical skeletal fluorosis patients were detected,and the detection rate was 0.57％ ; ④Child urine fluoride:a total of 700 child urine samples were collected.The geometric mean was 1.97 mg/L,ranged 0.01 to 17.56 rng/L; ⑤Adult urine fluoride:a total of 2626 adults were examined,geometric mean 2.16 mg/L,ranged 0.01 to 56.87 mg/L; ⑥Water fluoride:52 water samples were tested in survey sites,and fluoride content of 15 water samples exceeded the standard; ⑦Tea fluorine content:2000 tea samples were tested; median tea fluoride was 2.38 mg/L,ranged from 0.03 to 56.87 mg/L.ConclusionsFluorosis is serious in Lhasa,which is directly related to drinking brick tea,it is recommended that to drink brick tea with lowfluoride,and discard bad living habits.

Level of reduced glutathione and oxidized glutathione in a mouse bone cell line MC3T3-E1 cells exposed to fluoride / 中国地方病学杂志

Objective To observe the level of reduced glutathione(GSH) and oxidized glutathione(GSSG)in a mouse bone cell line MC3T3-E1 cells exposed to fluoride.Methods MTT method was used to detect cell viability of M C3T3-E1 cells exposed to varying concentrations and periods of fluoride [F-concentration:0(control),0.5,1.0,2.0,4.0,8.0,12.0,20.0 mg/L; F-periods:1,2,4 and 10 days].The Xevo TQ MS was employed to test the levels of GSH,GSSG and glutamine (Gln).Results The MC3T3-E1 cell viability was significantly higher in the 2 mg/L group(0.57 ± 0.05) 1 day after the exposure compared to the respective control(0.49 ± 0.03,P ＜0.01); conversely,cell viability was markedly lower in the 8 mg/L(0.49 ± 0.07) and 12 mg/L(0.47 ± 0.09)groups 4 days after the exposure in comparison to the control(0.63 ± 0.06,P ＜ 0.05 or P ＜ 0.01).The cell viability in the 8 mg/L group(1.52 ± 0.29) 10 days after the exposure was significantly higher than that in the control group (0.86 ± 0.23,P ＜ 0.01),however,the value in the 20.0 mg/L group (0.54 ± 0.07) was significantly lower(P ＜0.01).The level of cell GSH decreased significantly in the 20 mg/L groups 2 days[(13.92 ± 4.63)μmol/L]and 10 days [(0.53 ± 0.30)μmol/L]after exposure compared to the respective comtrols [(26.42 ± 3.67),(24.85 ± 5.68)μmol/L,all P ＜ 0.01].The level of cell GSSG markedly increased in the 2 mg/L group 2 days [(1.12 ± 0.62)μ mol/L]and the 8 mg/L group 4 days [(2.13 ± 0.62)μ mol/L]after exposure compared to the controls[(0.55 ± 0.22),(1.46 ± 0.46)μmol/L,all P ＜ 0.05].The similar change was observed in the 8 mg/L group[(2.97 ± 1.30)μmol/L] 10 days after exposure compared to the control [(1.35 ± 0.50)μmol/L,P ＜ 0.05].The level of Glndecreased significantly in the 2 mg/L group[ (62.80 ± 17.4l)μ mol/L] 4 days and in the 8 and 20 mg/L groups 10 days[ (122.26 ± 19.51), (19.38 ± 8.11)μmol/L] after exposure compared to the controls [ (83.28 ±14.32), ( 147.15± 16.95) μmol/L , all P ＜ 0.05 or P ＜ 0.01 ]. Conclusions Fluoride exposure can significantly promote the changes of GSH, GSSG and Gln levels in the osteoblast, thus affecting the intracellular redox equilibrium.

Immunoglobulin binding protein gene and protein expression in femur tissue of fluorosis rats / 中国地方病学杂志

Objective To observe the protein and gene expression of immunoglobulin binding protein (BiP) in the femur of fluoride-treated rats, and preliminarily study the possible role of endoplasmic reticulum stress in the pathogenesis of skeletal fluorosis. Methods Sixty Wistar rats were divided into 4 groups according to body weight, n =15. The control and low-calcium groups were fed with normal diet(0.79％ calcium) and low-calcium diet(0.063％ calcium), respectively, and both drank tap water(fluoride concentrations ＜ 1 mg/L). High-fluoride and coexpesure to low-calcium groups were fed with conventional feed (0.79％ calcium) and low-calcium diet (0.063％ calcium), respectively, and both drank tap water containing sodium fluoride (sodium fluoride concentration of 221 mg/L). During experimental period, rats were measured body weight once a week with a stand diet and water available ad libitum. The experiment lasted for 12 weeks. The immunohistochemical and reverse transcription polymerase chain reaction(RT-PCR) techniques were used to detect the protein and gene expression of BiP in the femur of fluoride-treated rats and control subjects. Results The bone mineral contents of high fluoride, lowcalcium and coexposure groups[(0.131 ± 0019), (0.097 ± 0.011 ), (0.083 ± 0.007)g/cm] were lower than those of the control group[(0.159 ± 0.029)g/cm, all P ＜ 0.05]; the bone mineral density of low calcium and coexpesure to fluoride group[(0.243 ± 0.018), (0.223 ± 0.022)g/cm2] was lower than that of the control group[(0.296 ± 0.046)g/cm2, all P ＜ 0.05]. The immunohistochemical staining showed that the anti-BiP antibody positive osteoblasts were significantly increased in the low calcium diet and coexposure to fluoride groups than that in the control, and coexposure to fluoride elevated the positive cells than that in only low calcium diet group. The mRNA expression of osteopontin(OPN) and osteocalcin(OCN) in coexposure to fluoride with low-calcium group(1.36 ± 0.20, 1.31 ±0.11 ) was higher than that of the control groups (0.82 ± 0.16, 0.85 ± 0.15, all P ＜ 0.05) ; moreover, OPN expression significantly increased in this group than that of the only high fluoride group (0.97 ± 0.29, P ＜ 0.05). The mRNA expression of BiP in the low calcium and coposure to fluoride group (1.38 ± 0.24,1.35 ± 0.12) was significantly higher than that of the control group ( 1.14 ± 0.06, all P ＜ 0.05 ). Conclusions Higher fluoride or coexposure to low calcium diet stimulates the gene and protein expression in rat femur BiP, indicating that varying degrees of endoplasmic reticulum stress is likely involved in the pathogenesis of rat skeletal fluorosis.

Analysis of surveillance results of drinking water type of endemic fluorosis in Qinghai province in 2009 / 中国地方病学杂志

ObjectiveTo investigate the development trend of drinking water type of endemic fluorosis in Qinghai province, and to provide the basis for the prevention and treatment of the disease. MethodsIn 2009, six monitoring counties were chosen by using simple random sampling methods, all diseased villages of the six monitoring counties were classified into light, moderate and severe disease types according to water fluorine content on the historical data, and 1 village was respectively chosen from each type. In monitoring villages with improved water, 3 tap water and one source water samples were collected, respectively. Five water samples were collected randomly in water unimproved monitoring villages according to water well locations of east, west, south, north and center. The fluorine content in water and urine was determined according to the Standard Testing Methods for Drinking Water (GB/T 5750-2006). Children aged 8 to 12 were examined for dental fluorosis by Dean method.Clinical osteofluorosis of all the resident over the age of 16 was examined, 2 village of these counties were randomly selected, and clinically diagnosed patients with skeletal fluorosis were examined again by X-ray using Diagnostic Criteria of Endemic Skeletal Fluorosis (WS 192-2008). Urine sample of 30 children aged 8 to 12 and of 20 adults over the age of 16 were randomly collected and urinary fluoride was determined by F-ion selective electrode method (WS/T 89-2006). ResultsImproving water projects had been implemented in 14 monitoring villages of the 18 villages in 6 counties, the rate of improved-water was 77.78％(14/18). Among the 14 projects, 5 improved-water projects ran normally, and 9 projects ran with intermittently water supply. Seventy-five water samples were tested, themean of water fluoride was 0.48 mg/L. The prevalence of dental fluorosis was 31.95％ (285/892), that of clinical skeletal fluorosis was 36.55％(1570/4295) and the X-ray detection rate of skeletal fluorosis was 25.64％ (20/78).Five hundred and seventy-one urine samples of children were determined, and geometric mean of urinary fluorine was 1.04 mg/L; 370 adult urine samples were determined, and geometric mean of urinary fluorine was 1.52 mg/L Conclusion Epidemic of drinking water type of endemic fluorosis is still serious in Qinghai province, and drinking water defluoride measures should be further strengthened and improved.

Analysis of survey results of endemic fluorosis in Shandong province in 2008 / 中国地方病学杂志

Objective To investigate the current status of endemic fluorosis in Shandong province, and to provide scientific evidence for the development of control strategies. Methods According to "The National Technical Scheme for Endemic Disease Control in 2007", 19 counties were chosen to carry out the epidemiological investigation in 2008. Water and urinary fluoride were determined by F-ion selective electrode, dental fluorosis of children aged 8 to 12 were diagnosed by Dean method and skeletal fluorosis of adults over the age of 16 were examined clinically and by X-rays. Results In 19 counties, 186 villages were surveyed, 44 villages were found with mean water fluoride ≤ 1.00 mg/L, accounting for 23.66%(44/186);the value ＞ 1.00 mg/L in 142 villages,accounting for 76.34% (142/186);maximum water fluoride 8.88 mg/L. Total detection rate of dental fluorosis of children aged 8 to 12 was 66.35% (4518/6809), dental fluorosis index was 1.55, and defect rate was 15.39%(1048/6809). Children with urinary fluoride ＞ 1.40 mg/L was 83.29%(2149/2580), and the maximum value was 31.92 mg/L. Detection rates of skeletal fluorosis clinically and by X ray among adults over 16 years were 6.37%(5577/87 607) and 20.23% (229/1132), respectively. Conclusions Endemic fluorosis in Shandong province is still serious, prevention efforts need to be further increased.

Drinking-water type endemic fluorosis in Northern Jiangsu province in 2008 : an analysis of survey results / 中国地方病学杂志

Objective To investigate the state of endemic fluorosis, running status of water improvement project to reduce fluoride in Jiangsu province, and to provide a scientific basis for prevention and control of endemic fluorosis. Methods In 2008, in the ten key counties of endemic fluorosis (zone), in Xuzhou,Lianyungang and Suqian, a stratified sampling method was employed to select 40 diseased villages according to their past water fluoride survey data. All children aged 8 to 12 were examined dental fluorosis, and all adults over 16 years were examined clinical skeletal fluorosis. Thirty per cent of the 40 diseased villages were selected, and 20 adults over the age of 16 in each selected village were examined by X-ray, respectively;50% of the 40 diseased villages were selected, and 30 any time urine samples of children aged 8 to 12 in each diseased village were tested urine fluoride. In each city, select a county, the status of water improvement project to reduce fluoride, water supply capacity and coverage in the county were investigated. Results A total of 3560 children aged 8 to 12 were examined, the detection rate of dental fluorosis was 38.51% (1371/3560), tooth defect rate was 5.34% (190/3560), and dental fluorosis index was 0.8. Seven hundred and eight urine samples were tested, the median urinary fluoride was 1.47 mg/L and the range was 0.08 ~ 10.08 mg/L. Clinical detection of skeletal fluorosis was 21.3% among adults over the age of 16, and X-ray detection rate of skeletal fluorosis was 39.2% (123/314).Investigated a total of 248 facilities of centralized water improvement projects, no funds to run or damaged 49, the water fluoride > 1.0 mg/L was 18. Conclusions Endemic fluorosis in Northern Jiangsu province has not been controlled completely, but has a rising trend, we should further strengthen the supervision of water fluoride reduction.