Objective To investigate the urinary arsenic levels of exposed population in various forms of and total arsenic (TAs) content as well as their relationship with arsenic poisoning in southern Shaanxi arsenic poisoning area.Methods According to the historical data of the investigation on arsenic poisoning,11 disease villages were chosen as survey sites in Ziyang and Pingli counties,Ankang city;three neighbor villages were chosen as control sites in Baihe.Baihe was a non-endemic arsenic poisoning area county,which had the same natural environment and living habits.In the survey sites,people over the age of 40 were selected for epidemiological investigation in both heating and non-heating seasons,and 40 urine samples were collected at each severity levels of the disease and in different seasons.Meantime,20 urine samples of the same age group were collected in the control sites in each season.Hydride generation-atomic fluorescence spectrometry (HG-AFS) was used to determine TAs,liquid chromatography-hydride generation-atomic fluorescence spectrometry (LC-HG-AFS) was used to determine the amount of inorganic trivalent arsenic (As3+),dimethylarsine (DMA),monomethylarsine (MMA) and inorganic pentavalent arsenic (AS5+),and the various forms and TAs were compared between different survey sites,severity levels,ages,sexes,and seasons.Results The medians of TAs,As3+,DMA,primary methylation index (PMI),and secondary methylation index (SMI) in diseased area (35.3,2.2,24.5 μg/L;0.84,0.90) were significantly higher than those of the control group (16.0,0.6,10.3 μg/L;0.78,0.81;Z =-9.069,-7.314,-8.913,-2.183,-3.853,P ＜ 0.01 or ＜ 0.05),and the medians of TAs,As3+,DMA,and SMI (31.6,2.0,23.1 μg/L;0.91) of the normal population in the diseased area were significantly higher than those of the control group (16.0,0.6,10.3 μg/L;0.81;Z =-7.164,-6.136,-7.023,-2.916,all P ＜ 0.01).Illness had positive correlations with TAs,DMA,and ages (r =0.370,0.367,0.594,all P ＜ 0.01).Men arsenic poisoning detection rate,TAs,As3+,and DMA (59.9％,37.4,2.5,25.2 μg/L) were significantly higher than those of women (22.4％,30.0,1.6,20.9 μg/L;x2 =54.878,P ＜ 0.01;Z =-3.332,-4.449,-2.681,all P ＜ 0.01).The medians of As3+,MMA,As5+,PMI,and SMI in the heating season (1.5,2.1,1.4 μg/L;0.87,0.92) were significantly different from those in the non-heating season (2.6,3.3,3.0 μg/L;0.82,0.88;Z =-6.870,-5.512,-8.542,-2.262,-4.544,P ＜ 0.01 or ＜ 0.05).Conclusions The TAs,As3+,and DMA of urine samples are related to local arsenic background,so they have some reference value for determination of diseased areas.Men are more susceptible to arsenic poisoning than women.

Objective To investigate the operating situation of water-improvement projects,fluoride content in drinking water and the tendency of drinking-water-born fluorosis in Shaanxi Province.Methods In the areas of drinking-water-born endemic fluorosis,15 villages in 5 counties were randomly selected as monitoring sites,by random number table method.Ten water-improvement projects in each county were randomly selected to investigate the operating situation and 1 water sample from the tap water of each water-improvement project was collected to determine the fluoride level in 2009-2011.For water-improvement villages,the operating situation of the water-improvement projects was monitored and 1 water sample from the tap water of each water-improvement project was collected to determine the fluoride level,and for water-unimprovement villages,1 water sample from each direction of the east,west,south,north and middle of the villages was collected,respectively,to determine fluoride level in 2009-2013.Dental fluorosis of 8-12 years old children and X-ray skeletal fluorosis of adults 25 years old were examined in each village.Water fluoride was tested according to the Standard Testing Methods for Drinking Water (GB/T 5750.5-2006).Diagnosis of dental fluorosis was based on the Dean's Standard (2009 to 2011 edition) and WS/T 208-2011 (2012 to 2013 edition) and that of the adults X-ray skeletal fluorosis was based on WS 192-2008.Results The number of investigated water-improvement projects was 146 in survey counties and 68 in survey villages.The normal operation rates were 97.95％ (143/146) and 98.53％ (67/68),respectively.The qualified rates of water fluoride were 53.42％ (73/146) and 61.67％ (42/68),respectively.The populations covered by the qualified water-improvement projects were 18.93％ and 8.70％ of the total water-improvement projects.And,78.95％ (15/19) of the water-unimproved villages had a water fluoride level of over 1.2 mg/L in the drinking water.In the water-improved villages,children dental fluorosis rate reached an average of 41.62％ (1 061/2 549) and decreased year by year from 2009 to 2013 (except 2012) (x2 =46.818,P ＜ 0.01),but in the water-unimproved villages,the rate was 64.73％(1 167/1 803) on average and did not go down year by year,and the difference was statistically significant (x2 =225.557,P ＜ 0.01).Adults X-ray skeletal fluorosis rate was 22.55％(124/550) in the water-improved villages and 30.00％ (60/200) in the water-unimproved villages in 2009,and the difference was statistically significant (x2 =4.402,P ＜ 0.05).In 2013,adults X-ray skeletal fluorosis rate was 34.17％(219/641) in the water-improved villages and 24.67％(37/150) in the water-unimproved villages,and the difference was statistically significant (x2 =5.010,P ＜ 0.05).Conclusions The measures of water improvement against fluoride have showed definitely control effects,but excess fluoride in drinking water is still a health problem,and the prevalence of fluorosis is not controlled completely.The control work remains to be further strengthened and deepened.

Objective To investigate the characteristics of X-ray signs of water-related and coal-burning borne endemic fluorosis in Shaanxi Province,so as to provide a theoretical basis for revising X-ray diagnostic criteria of skeletal fluorosis in the future.Methods The X-ray data of 2 525 cases of patients with endemic fluorosis from the central subsidies to local public health programs were collected from 2008 to 2011,and the X-ray signs,age,gender distribution,detection rate were analyzed statistically ; skeletal fluorosis was diagnosed on the basis of skeletal diagnostic criteria(WS 192-2008).Results The 2 525 cases observed were taken X-ray film on forearm and shank.In the X-ray signs of patients from fluorosis areas,the detection rates were higher,and these signs were mainly radial crest of increase,marginal sclerosis,surface thickening and forearm interosseous membrane ossification and forearm interosseous membrane calcification which showed bud break ground sign,which accounted for 29.91％(242/809),17.92％(145/809) and 17.69％ (143/809),respectively.Three X-ray signs occurred in the forearm,and the total detection rate based on the forearm signs was 88.12％ (721/809); 682 cases of skeletal fluorosis were detected and the detection rate was 27.01％ (682/2 525),including 401 mild cases accounting for 15.88％ (401/2 525); 236 moderate cases that accounted for 9.35％ (236/2 525); 45 severe cases accounted for 1.78％(45/2 525).With age,the prevalence increased gradually.After the age of 55 reached the peak,and the difference was significant statistically between different ages (x2 =228.58,P ＜ 0.05).The total prevalence was not significantly different between male group and female group (x2 =0.74,P ＞ 0.05).Conclusions With age,the prevalence of skeletal fluorosis is increased,and the skeletal fluorosis is not different between different sexes.The X-ray sign results have showed that the prevalence based on forearm signs is high and specific.We suggest to diagnose skeletal fluorosis by the X-ray signs of the forearm in the diagnostic standard revision,so as to reduce financial input,workload and radiation level to the patient.

Objective To observe the protein expressions of PI3Kp110, pAkt, pGSK3β of phosphatidylinositol 3-kinase (PI3K) and protein kinase B (Akt) signaling pathway in the whole blood of patients with Kashin-Beck disease and analyze the status of PI3K/Akt signaling pathway. Methods Patients with Kashin-Beck disease ( KBD group ) were from six counties ( Xunyi , Linyou , Yongshou , Qianyang , Changwu and Long County) of Shannxi Province in Kashin-Beck disease areas , and the healthy controls (control group) were matched by age and sex. Venous blood was collected from patients and healthy controls. Trizol method was applied to extract the whole blood protein; protein expression levels of PI3K/Akt signaling pathway in whole blood were detected by Western blotting; the gray values were observed and recorded by the sodium dodecyl sulfate polyacrylamide gel electrophoresis(SDS-PAGE) and GDS-8000 gel imaging analysis system. Differences between the two groups were assessed by Student’s t-test. Results Compared age and sex between KBD group and control group, differences were not statistically significant(t=0.701, P>0.05;χ2=0.400, P>0.05). The protein expression levels of PI3Kp110, pAkt and p-GSK3β in KBD group were higher than that in control group(156.1 ± 92.1 vs. 79.5 ± 21.5, 113.7 ± 15.2 vs. 43.3 ± 10.7 and 105.9 ± 17.5 vs. 37.3 ± 12.0, respectively) and the differences were statistically significant (t=2.563, 6.567, 7.916; all P < 0.05 or < 0.01). Conclusion The PI3Kp110, pAkt and p-GSK3β expressions of signaling pathway proteins in the whole blood of patiens with Kashin-Beck disease are up-regulated significantly and the status of PI3K/Akt signaling pathway is activated.

Objective To evaluate whether hypermethylation of calcitonin (CT) gene could serve as a transforming signal of myelodysplastic syndrome (MDS) to leukemia.Methods Bone marrow aspirates from 35 MDS patients, including 25 refractory anemia (RA), 10 refractory anemia with excess of blasts (RAEB) or refractory anemia with excess of blasts in transformation (RAEBt) and 7 cases of acute myeloid leukemia (AML) transformed from MDS, were studied on methylation rate in 5'end of CT gene by polymerase chain reaction (PCR) technique using methylation-sensitive endonuclease HpaⅡ with external references of undigested DNA and MspⅠ digested DNA and internal reference of 112 bp fragment containing codon 61 of N-ras oncogene. The results were expressed as calcitonin gene methylation rate (CTMR) calculated from the densitometer-analyzed integral calculus of PCR products of 566 bp CT(a1), 112 bp N-ras(b1) by using HpaⅡ-digested DNA and PCR products of 566 bp CT(a0), 112 bp N-ras(b0) by using undigested DNA according to the formula, CTMR = (a1/b1)/(a0/b0)×100%.Results The CTMRs in total 35 MDS, 25 RA, 10 RAEBt and 7 cases of AML transformed from MDS were 36.87%±25.10%, 28.12%±24.01%, 58.74%±16.49%, and 54.03%±7.06% respectively, significantly higher than that in control group (P<0.001, P<0.05, P<0.001 and P<0.001, respectively). Conclusion The results suggest that hypermethylation of CT gene occurs in early stage of leukemic transformation and CTMR might be a useful marker in predicting the transformation of MDS to AML.