Animals ; Humans ; Liver ; growth & development ; Liver Diseases ; Receptors, Notch ; metabolism ; Signal Transduction

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.

OBJECTIVETo study the risk factors for capillary leak syndrome (CLS) in neonates.

METHODSThe clinical data of 52 neonates with CLS (case group) were retrospectively reviewed. Fifty hospitalized neonates without CLS were used as the control group. The possible factors for the development of CLS were identified by univariate analysis. The independent risk factors for CLS were determined by multivariate logistic regression analysis.

RESULTSThe univariate analysis showed that the incidences of hyperglycemia, respiratory distress syndrome (RDS), sepsis and cold injury syndrome in the case group were significantly higher than those in the control group (P<0.05). The logistic regression analysis showed that sepsis (OR=5.004, P=0.001), RDS (OR=3.880, P=0.013) and cold injury syndrome (OR=3.207, P=0.023) were the independent risk factors for the development of CLS.

CONCLUSIONSRDS, sepsis and cold injury syndrome are independent risk factors for CLS in neonates. Hyperglycemia may be associated with the development of CLS.

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.

ObjectiveTo find out the condition of endemic fluorosis in Liangshan and Boxing counties of Shandong province,and to provide the basis for future prevention and treatment of the disease.MethodsIn 2007 -2009,100 water facilities per year were selected in each county and the water fluoride was tested in Liangshan and Boxing counties of Shandong province.Ten households were selected and their water fluoride content was measured.Dental fluorosis prevalence and dental fluorosis index of school children aged 8 - 12 were checked in all monitored places(3 villages in each county).Meanwhile,urinary fluoride was detected in children carried dental fluorosis test.ResultsIn 2007 - 2009,the median of urinary fluoride in Liangshan county was 2.35,3.73 and 1.29 mg/L,respectively; dental fluorosis detection rate was 72.73％ (88/121),78.08％ (57/73),and 70.64％ (77/109),and the dental fluorosis index was 1.43,1.76 and 1.34.While in Boxing county,the median of urinary fluoride was 4.50,6.71 and 5.64 mg/L; dental fluorosis detection rate was 95.93％ (118/123),99.06％ (105/106),94.41％(152/161) and dental fluorosis index was 2.23,2.54 and 2.09,respectively.ConclusionsThe effect of prevention and control of endemic fluorosis in Liangshan county was better than that of Boxing county of Shandong province.Altering water source is an important measure to control endemic fluorosis.More defluoridation project should be carried out in endemic fluorosis areas.

Objective To investigate the current status of endemic fluorosis in Shandong province, and to provide the scientific evidence for making strategies for prevention and control of the disease. Methods According to "The National Technical Scheme for Endemic Disease Control in 2008", thirty-four counties were divided into mild, moderate and severe endemic fluorosis areas and a village was randomly selected from each category of the area to carry out the monitoring of endemic fluorosis. The content of fluoride in drinking water and urine was determined by F-ion selective electrode, dental fluorosis of children aged 8 to 12 was diagnosed by Dean method and skeletal fluorosis diagnosed by clinic and X-rays. Results The monitoring was done in 70 water-improving villages in 34 counties, among which 54 villages had water fluoride content ≤ 1.00 mg/L and accounted for 77.14%(54/70), 16 villages had water fluoride content ＞ 1.00 mg/L and accounted for 22.86%(16/70), the highest water fluoride content was 4.46 mg/L. The monitoring was also carried out in 32 non-water-improving villages in 34 counties, among which 9 villages had water fluoride content ≤ 1.00 mg/L and accounted for 28.12%(9/32), 23 villages had water fluoride content ＞ 1.00 mg/L and accounted for 71.88% (23/32), the highest water fluoride content was 4.09 mg/L. The total rate of dental fluorosis of children aged 8 to 12 was 45.81%(1988/4340), the index of dental fluorosis was 0.97 and the rate of dental damage was 6.91%(300/4340). The urinary fluoride values above 1.40 mg/L were found in 55.33%(1417/2657) of children aged 8 to 12, with the highest urinary fluoride concentrations was 18.53 mg/L. The rate of skeletal fluorosis by clinic and X-rays in adults older than 16 years were 4.25% (2462/57 968) and 28.40%(23/81 ), respectively. The urinary fluoride values above 1.60 mg/L were found in 55.86% (1130/2023) of adults older than 16 years, with the highest urinary fluoride concentrations was 25.44 mg/L. Conclusions Endemic fluorosis in Shandong province has not yet been effectively controlled,control situation is still grim. Prevention efforts need to be further strengthened.

Objective To investigate the present situation of water-improving defluoridation project and the distribution of water fluoride in fluorosis areas in Shandong province. Methods In 2005 - 2007, according to "The National and Shandong province Technical Scheme for Endemic Disease Control", the water-improving form,water type and the running status of defluoridation project in 17 cities of Shandong province were investigated, and the water-fluoride of the running projects were determined by F- ion selective electrode. Results A total of 5816projects were built that involved 8776 villages, 110 counties, 17 cities distributed in Shandong province. In which,the drilling of water-improving projects accounting for 94.55% (5499/5816), under-ground water type 97.73%(5684/5816);operating normally accounting for 75.91% (4415/5816), 7246 villages were supplied with the water, beneficiary population 6 946 459 people, non-normal projects accounting for 24.09%(1401/5816), including 1530 diseased villages. There were still 4415 projects running well. The projects with water fluoride lower than 1.0mg/L were 2893, accounting for 65.53% (2893/4415). The water fluoride higher than 1.0 mg/L accounted for 34.47%(1522/4415), ＞ 2.0 mg/L of 548, ＞ 4.0 mg/L of 97, and the maximum value of water fluoride was 9.71mg/L. Conclusions Nearly 1/4 of the water-improving projects in Shandong province are abnormal. The water fluoride of the project of more than 1/3 are exceeding the standard( ＞ 1.0 mg/L) in 4415 projects, and water-fluoride of 97 projects are higher than 4.0 mg/L. More measures should be taken to strengthen the supervision of the projects and monitoring of water fluoride.

Objective To investigate the present status of Kaschin-Beck disease(KBD) in Qingzhou at present, and provide a scientific basis for decision-making in controlling the disease. Methods According to The National Technical Scheme for Endemic Disease Control in 2007, children aged 7 to 12 were chosen to receive clinical and X-ray examination in 3 villages of 2 towns in Qingzhou. Local adults aged 16 years and older were clinically diagnosed in 10 villages of 4 towns and divided into different groups according to the clinical degrees and their ages. The Diagnostic Criteria of Kashin Beck Disease(GB 16003-1995) was carded out by clinical and X-ray diagnosis. Results Two hundred and sixty school children aged 7 to 12 were clinically diagnosed, and the patients of I degree upwards of KBD were not detected. One hundred and ninety-eight school children aged 7 to 12 were examined by X-ray, and the detectable rate was 0(0/198). In 7099 adults aged 16 years old upwards clinically tested, 502 patients of degree I and higher of KBD were detected and the detectable rate was 7.07%(502/7099). The patients distributed mainly in the population aged 36 years old and older, accounting for 99.00% (497/502). Conclusions Although KBD in children have been controlled in Qingzhou, it is still serious in adults. So the monitoring of KBD should be carried on and prevention and control for KBD in adults should be strengthened.

Objective To understand the current status of the prevention and control of endemic fluorosis in the southwestern area of Shandong province. Methods In 2007, the progress of water-improving defluoridation, the operating state and water fluoride content of the water-improving project, which was determined by fluorosis selective ion electrode, and the inhabitant related indexes of endemic fluorosis were extensively surveyed in the three main fluorosis counties-Jiaxiang, Yuncbeng and Liangshan of the southwestern area of Shandong province. Results Among 1371 fluorosis villages in the 3 counties, 53.61%(735/1371) of which had undergone water-improving defluoridation, the rate in Jiaxiang, Yuncheng and Liangshan being 38.0% (220/579),65.51% (378/577) and 63.72% ( 137/215 ) respectively; the normally functioning rate of this project was 76.73% (564/735), projects out of order accounted for 23.27% (171/735). Among 263 well-functioning projects from the three counties, the rate with water fluoride higher than 1.0 mg/L was 35.36%(93/263), the maximum value being 4.17 mg/L. The urine fluoride content of 440 children aged 8 - 12 years and 484 adults over 30 years old were examined in 13 fluorosis villages of the three counties, the geometric mean was 2.98,3.06 mg/L respectively; the individual maximum was 12.83,14.49 mg/L respectively; the detectable rate of dental fluorosis among children aged 8 - 12 was 84.28% (649/770) ,17.66%(136/770) had defect and the index of dental fluorosis was 1.89; the rates of the clinical and X-ray skeletal fluorosis of the adults aged more than 30 were 44.40%(234/527) and 24.67%(130/527) respectively, and the abnormal electrocardiography rate was 32.43% (168/518) in the adult, mostly T-wave abnormality. Conclusions The progress of the water-improving defluoridation in the southwestern area of Shandong province was relatively slow, the water fluoride content of the water-improving projects seriously exceeded standard, and the condition of the fluorosis had not been effectively controlled.

Objective To understand the fulfillment of control measures of endemic fluorosis and find out the prevalent trend of this disease in Shandong Province from 1992 to 2006 in order to provide a scientific basis for the set up of control strategies. Methods According to "the National Survey Scheme of Endemic fluorosis", Huantai County in 1992-1996 and Liaagshan County in 1997-2006 were selected, where water-improving defluoridation and the contents of water fluoride were searched in two counties; dental fluorosis and urine fluoride in children aged 8-12 years old, clinical and X-ray skeletal fluorosis in adult over 16 years old were searched respectively in Lijia Village of Huantai County and Dongxu Village of Liangshan County. Results One hundred percent(304/304) high-fluoride villages of Huantai County in 1992 and 63.72% (137/215) villages of Liangshan County in 2006 had finished the project of water-improving defluoridation; the rate of high-fluorine water(>1.0 mg/L) in normal operation projects was 5.00%(5/100)-17.14%(18/105) in Huantai County from 1992 to 1996, and 18.97%(11/58)-45.61%(26/57) in Liangshan County from 1997 to 2006. The water fluoride of Lijia Village was<1.0 mg/L from 1992 to 1996, the water fluoride of Dongxu Village was<0.5 mg/L from 1997 to 2006. The detection rate of dental fluorosis of children aged 8-12 years at Lijia Village dropped from 30.86%(25/81) in 1992 to 10.13%(8/79) in 1996(χ2=12.41, P<0.05), and the Dongxu Village dropped from 68.95%(151/219) in 1997 to 0(0/38) in 2006(χ2=222.04, P<0.01). In the Lijia and Dongxu Villages, urine fluoride in children aged 8-12 years old was lower than 1.40 mg/L. In the adults over 16 years of the two villages, the positive rate of X-ray skeletal fluorosis of Lijia Village dropped from 30.0%(15/50) in 1992 to 13.95%(6/43) in 1996(χ2=3.41, P>0.05), and all the cases were in degree I, the rate of Dongxu Village dropped from 64.58%(31/48) in 1997 to 16.67% (4/24) in 2006(χ2=14.71, P<0.01), and no eases of degrees Ⅲ was detected. Conclusions The progress of water defluoridation was uneven in 2 counties, slow in Liangshan County; and the water fluoride in part of the project exceeded standard; the water fluorid of 2 surveyed villages was normal and the endemic fluorosis was under control. More financial input is requested to accelerate the process of water defluoridation and to reinforce the management of the projects and illness monitoring, thus to reduce the harm of fluorosis to the limit.