Objective To explore the clinical features of sentinel polyps (rectal polyps with proximal colon carcinoma) and its correlation with proximal colon carcinoma.Methods From January 2011 to June 2015,the clinical features of 331 hospitalized patients with rectal polyps were retrospectively analyzed.According to whether the patient with colon carcinoma,the clinical data of rectal polyps patients were divided into pure polyps group (n =294) and sentinel polyps group (n =37).The characteristics under endoscopy,clinical pathological features,treatment and prognosis of two groups were observed.Results The positive rate of tumor marker of sentinel polyps group was higher (67.6 ％,25/37) than that of pure polyps group (6.8 ％,20/294;x2 =32.174,P ＜ 0.01).When compared to pure polyps group,most polyps of sentinel polyps group were in maximum diameter over 1 cm [62.2％ (23/37) vs 46.9 ％ (138/294)],multi-polyps [n ＞5,43.2％ (16/37)vs11.6％ (34/294)] and adenomatous polyp [83.8 ％ (31/37) vs 35.7 ％ (105/294)] (x2 =10.863,15.686,and 22.653,P ＜0.01).Majority of the proximal colon carcinoma with rectal polyps was papillary adenoearcinoma and tubular adenocarcinoma which was account for 75.7 ％ (28/37);Duke A,29.7％ (11/37),Duke B,29.7％ (11/37),Duke C,24.3％ (9/37) and Duke D,16.2％ (6/37).96.6 ％ (282/294) of patients with pure polyps underwent endoscopic treatment and all of them were cured and discharged.40.5％ (15/37) of patients of sentinel polyps group accepted the radical operation and 24.3％ (9/37) received endoscopic submucosal dissection.Conclusions If multiple,maximum diameter over 1 cm and adenomatous rectal polyps were detected under colon endoscope,the possibility of carcinogenesis of the polyps or the proximal colon should be aware.The patient should be followed up in short-term and complete the whole colon examination.

Objective To find out the distribution of drinking-tea-borne fluorosis in the six ethnics in Qinghai Province, and to provide basic data for prevention and control of the disease. Methods In 2010, according to the requirement of “The National Surveillance Program of Drinking-Tea-borne Fluorosis”, six ethnics accounted for 99.59% of total population in Qinghai Province were investigated in 28 counties having brick-tea drinking habit. Three townships and a town in each county, two administrative villages(residents’ committee) in each township and town were chosen and 50 adults in each administrative village and residents ’ committee were selected to check skeletal fluorosis, dental fluorosis, urine fluoride and daily drinking amount of tea water. Five to six samples of drinking tea water were determined. Dental fluorosis was examined by Deans method; the fluoride content of brick-tea and urine were determined by fluoride ion selective electrode; the skeletal fluorosis was diagnosed based on “Endemic Osteofluorosis Clinical Indexing Diagnosis Standard”( WS 192-2008 ) . Results A total of 10 335 adults were surveyed, the number of Tibetan, Han, Hui, Mongolian, Tu and Salar ethnics were 4 972, 3 063, 1 196, 634, 235 and 235, respectively. The daily drinking amounts of tea water in Mongolian, Tibetan, Hui, Tu, Han and Salar ethnics were 2.53, 2.19, 1.74, 1.63, 1.22 and 1.07 L, respectively. Daily fluoride intakes in Tibetan, Mongolian, Tu, Hui, Han and Salar ethnics were 3.99, 2.78,2.27, 2.16, 1.78 and 1.28 mg, respectively. The medians of urinary fluoride concentration of the Tibetan, Tu, Hui, Han, Mongolian and Salar ethnics were 1.46, 1.19, 1.12, 0.98, 0.93 and 0.81 mg/L, respectively. The prevalence rates of dental fluorosis of the Hui, Han, Tibetan, Tu, Mongolian and Salar ethnics were 34.53%(413/1 196), 27.07%(829/3 063), 21.60%(1 074/4 972), 20.00%(47/235), 17.98%(114/634) and 6.38%(15/235), respectively. The incidence rates of clinical skeletal fluorosis of the Tibetan, Mongolian, Han, Hui, Tu and Salar ethnics were 13.42%(667/4 972), 11.04%(70/634), 9.31%(285/3 063), 7.61%(91/1 196), 5.53%(13/235) and 4.26%(10/235), respectively. Conclusions The distribution and prevalent status of drinking-tea-borne fluorosis in the six ethnics of Qinghai Province are different. Tibetan and Mongolian ethnics are the key population concerning the prevention and control of the disease.

Objective To evaluate the repeatability and stability of double antibody sandwich ELISA kit for micro-quantitative soluble complement receptor 1(sCR1) in human serum and to understand its practical application effect .Methods 50 patients with middle and advanced liver cirrhosis and 50 individuals undergoing physical examination served as the liver disease group and normal control group respectively .The mouse anti-human CD35 monoclone antibody ,rabbit anti-human sCR1 polyclonal antibody and goat anti-rabbit IgG labeled by horseradish peroxidase served as the envelope antibody ,sandwich antibody and detection antiboby .The purified recombinant human sCR1 protein served as the standard substance .The human serum micro-quantitative double antibody sandwich CR1 ELISA kit was established .Then the repeatability and stability tests were performed .Then the sCR1 protein level of two group of serum was detected by this kit .Results The linear range of double antibody sandwich ELISA for detecting human se-rum micro-quantitative sCR1 protein was 15 .60 -250 .00 ng/mL ;the regression equation of sCR1 protein concentration to absor-bance value was Y=112 .10X2 +18 .21X+1 .694(r2 =0 .998);in the repeatability test ,the intra-batch relative standard deviation (RSD) in high and low concentrations of standard substance detection value was 6 .20% and 7 .40% respectively ,the inter-batch RSD was 6 .70% and 7 .90% respectively ;in the stability test ,RSD was not more than 0 .01;the serum sCR1 expression level in the liver disease group was significantly higher than that in the normal control group (P<0 .01) .Conclusion The human serum double antibody sandwich ELISA kit for detecting human sCR1 has wide linear range ,good repeatability ,is easy to be stored and suitable for clini-cal and scientific research detection work .

Objective To find out the distribution and status of drinking-water-borne fluorosis in Qinghai,and to provide basic data for prevention and control of the disease.Methods According to the "Action Plan of Endemic Fluorosis and Arsenic Poisoning in Qinghai (2016-2020)",10 counties were selected to carry out the epidemiological study in 2016.The operation of the improvment project was investigated.The fluoride content of water was determined with fluoride ion-selective electrode,and dental fluorosis of 8-12 years old children was diagnosed by the Deans method.Results A total of 97 villages have been investigated,and all water was improved.The range of water fluoride was 0.20-2.13 mg/L.Normal operation rate of water-improving project was 83.33％ (50/60).The pass rate of water fluorine content was 96.67％ (58/60).The prevalence rate of dental fluorosis of the children was 18.70％ (774/4 140),and it was significantly lower than national standards (30％).Conclusions Water has been improved in all of the fluorosis villages.Most of the water-improving engineering projects to control drinking-water fluorosis has played a positive role,and drinking-water-borne fluorosis is under control.

Objective To investigate the prenatal imaging features of fetal congenital esophageal atresia and to further evaluate the value of MRI and ultrasound scan in the same condition.Methods This study recruited 12 singleton gravidas whose fetuses were initially suspected with congenital esophageal atresia by prenatal ultrasound scan and then confirmed by surgery and/or upper gastrointestinal angiography after birth at Guangzhou Women and Children's Medical Center from May 2011 to May 2017.Imaging features of prenatal MRI and ultrasonography of the 12 fetuses were retrospectively analyzed.Differences in imaging findings of these two methods were analyzed by Chi-square test.Results All 12 women received prenatal ultrasound examination and eight of them underwent MRI scan when fetal congenital esophageal atresia was suggested by ultrasound.Both ultrasound and MRI were capable of identifing polyhydramnios and absent or small stomach bubble (12/12 and 8/8,respectively).However,MRI was superior to ultrasound in detecting "pouch sign "/"oral filling sign" or poor filling of small intestine (7/8 vs 3/12 and 8/8 vs 0/12,x2 were 7.500 and 20.000,both P＜0.01).While,no statistical difference was shown in detecting curved tracheal between MRI and ultrasound (2/8 vs 0/12,x2=3.333,P=0.067).For Gross Ⅰ or Gross Ⅲ congenital esophageal atresia fetuses,no statistically significant difference was found in their imaging features (all P＞0.05).The total detection rates after 32 weeks of gestation of Gross Ⅰ and Gross Ⅲ cases were both 3/6.Conclusions Prenatal MRI is a vital supplement to ultrasound due to its high display rate of characterized features of congenital esophageal atresia.Thus,the combined use of ultrasound and MRI is of great importance for prenatal diagnosis of this fetal abnormality.

Objective To analyze the operation of water improvement projects in drinking water-borne fluorosis areas of Qinghai Province and the trend of dental fluorosis in children aged 8 to 12 years, and to evaluate the effects of prevention and control measures comprehensively, so as to provide basis for improving prevention and control strategies. Methods In 2009 - 2017, according to the "Qinghai Drinking Water Endemic Fluorosis Surveillance Program", four project counties of Huangyuan, Minhe, Hualong and Guide were selected in Qinghai Province. Three villages in each project county were selected according to their mild, moderate and severe conditions, and monitored the operation of water improvement projects, water fluoride content and dental fluorosis among children aged 8 to 12-year-old in each diseased village. Results In 2009-2017, the normal operation rate of water improvement projects increased from 2/8 to 7/8; the batch operation rate of the projects decreased from 5/8 to 1/8; the number of abandoned projects decreased from 1 to 0; the number of people covered by qualified water fluoride increased from 9962 to 80760 people; there was no significant difference in water fluoride content between different years (F = 0.758, P > 0.05). The total detection rate of children's dental fluorosis was 33.01％(1812/5489) from 2009 to 2017, the index of dental fluorosis was 0.65, and the epidemic intensity was slightly prevalent;the detection rate of children's dental fluorosis was 30.02％(951/3168) in villages with normal operation of water improvement projects and qualified water fluoride content, the index of dental fluorosis was 0.58, and the epidemic intensity was marginal;the detection rate of children's dental fluorosis was 32.72％(583/1782) in villages with abnormal operation of water improvement projects or excessive fluoride, the index of dental fluorosis was 0.66, and the epidemic intensity was slight; the detection rate of children's dental fluorosis in villages without changing the water was 51.58％ (278/539), and the index of dental fluorosis was 1.04, belonging to the moderate epidemic intensity; the detection rate of children's dental fluorosis in villages without changing the water was significantly higher than that in villages with normal operation of water improvement projects and qualified water fluoride content (χ2 = 102.30, P < 0.01). Conclusions The water improvement project in drinking water-borne fluorosis areas is running well and the operation rate is increasing year by year. The detection rate of dental fluorosis in children aged 8-12 years old in villages with normal operation of water improvement projects and qualified water fluoride content was significantly lower than that in villages without changing the water. The monitoring of fluorosis and the maintenance of water-renovation projects should be strengthened, and the problem of drinking water for residents in villages without changing the water should be resolved as soon as possible.

Objective:To study the epidemic status of drinking tea type endemic fluorosis in Qinghai Province.Methods:In 2019, in counties (cities, districts, referred to as counties) that had the habit of drinking brick tea in 8 cities (prefectures) of Qinghai Province, epidemiological investigation of drinking tea type endemic fluorosis was carried out in villages. Ten households were randomly selected from each village, to investigate the demographic data of each household and the drinking situation of brick tea, residents' drinking water and brick tea samples were collected to determine the fluorine content, and calculate the daily per capita tea fluorine intake. At the same time, skeletal fluorosis was examined in all adults over 25 years old, and dental fluorosis was examined in all children aged 8 to 12 years old in survey sites. The content of fluorine in tea and water was detected by ion selective electrode method; the diagnosis of skeletal fluorosis was based on "Diagnostic Criteria for Endemic Skeletal Fluorosis" (WS 192-2008), the diagnosis of dental fluorosis was based on "Diagnosis of Dental Fluorosis" (WS/T 208-2011).Results:The mean (range) of fluorine of the 3 602 water samples was 0.31 (0.20 - 1.00) mg/L. The geometric mean (range) of fluorine of the 31 067 brick tea samples was 646 (40 - 2 295) mg/kg, the fluorine content of the brick tea ≤300 mg/kg accounted for 7.80% (2 422/31 067) of the total samples. The proportion of drinking Fu brick-tea was 89.97% (27 952/31 067); and the daily per capita tea fluorine intake was 1.93 mg, the daily per capita tea fluorine intake in Guoluo, Yushu and Hainan prefectures were higher than the health standard (3.50 mg). The detection rate of skeletal fluorosis in adults was 0.16% (2 357/1 484 907), Yushu Prefecture was the highest [29.23% (592/2 025)], followed by Guoluo Prefecture, which was 8.21% (771/9 393). The detection rate of dental fluorosis in children was 4.79% (8 076/168 623), Yushu Prefecture was the highest [32.61% (1 562/4 790)].Conclusion:Drinking tea type endemic fluorosis is prevalent in Qinghai Province, with obvious regional characteristics, covering a large population. The disease is relatively popular in Yushu Prefecture and Guoluo Prefecture.

Objective:To find out the variety, producing area, fluorine content of brick tea in Qinghai Province, and the drinking situation of brick tea among people, so as to provide basis for preventing and curing endemic fluorosis of drinking tea type.Methods:From April to November 2019, according to historical data, in 3 066 administrative villages in 39 counties (cities, districts, hereinafter referred to as counties) in Qinghai Province that had the habit of drinking brick tea, 10 families were randomly selected from each village to investigate the demographic data of each family and the drinking situation of brick tea, to collect brick tea samples to determine the fluorine content, and to calculate the daily average brick tea fluorine intake of the population > 16 years old.Results:A total of 31 067 brick tea samples were collected. The main brick tea consumed by the residents in the whole province was Fu brick tea, accounting for 89.97% (27 952/31 067), followed by Kang brick tea [5.12% (1 592/31 067)], Green brick tea [2.29% (710/31 067)], Black brick tea [1.85% (574/31 067)], and golden tip, mosaic, black wool and other brick tea [0.77% (239/31 067)]. There were 523 brands of brick tea in circulation in the province, among which there were 410 brands produced in Hunan Province, 26 brands in Sichuan Province, 11 brands in Hubei Province, and 76 brands in Henan Province and other provinces. The average content of fluorine in brick tea was 646.1 mg/kg, which ranged from 40.0 to 2 295.0 mg/kg. Brick tea with fluorine content ≤300 mg/kg accounted for 7.80% (2 422/31 067) of all samples. The annual average consumption of brick tea by population > 16 years old was 1.09 (0.35 - 7.40) kg, and the daily average brick tea fluorine intake was 1.93 (0.39 - 18.64) mg. There were 15 counties and 486 administrative villages in which the daily average brick tea fluorine intake exceeded the national standard (3.5 mg).Conclusion:The main brick tea in circulation in Qinghai Province is Fu brick tea, which has high fluorine content and is harmful to people, and prevention and control measures should be taken as soon as possible.

Objective:To observe the changes of serum C-terminal peptide of type Ⅰ collagen (CTX-1) and N-terminal lengthening peptide of type Ⅰ collagen (P1NP) in adult patients with skeletal fluorosis in the tea-drinking-borne endemic fluorosis area in Qinghai Province, and to find sensitive indicators for diagnosis of skeletal fluorosis.Methods:From April to August 2019, a case-control study was carried out in tea-drinking-borne endemic fluorosis area in Zhiduo County, Yushu Tibetan Autonomous Prefecture, and Gangcha County, Haibei Tibetan Autonomous Prefecture of Qinghai Province. According to the Diagnostic Standard for Endemic Skeletal Fluorosis (WS/T 192-2008), the clinical diagnosis and X-ray examination of skeletal fluorosis were carried out for permanent residents ≥25 years old and living for more than 10 years in the area, combined with face-to-face inquiry and investigation of past disease history, lifestyle and clinical manifestations. The patients with skeletal fluorosis and healthy people were selected as skeletal fluorosis group and control group, respectively. Randomized urine samples and fasting venous blood from the two groups were collected. The content of fluoride in urine was determined by ion selective electrode method, and the contents of CTX-1 and P1NP in serum were determined by enzyme-linked immunosorbent assay (ELISA).Results:A total of 127 people in the disease area were investigated, including 63 cases in skeletal fluorosis group and 64 cases in control group. There was no statistically significant difference in age and sex ratio between the two groups ( t = 0.42, χ 2 = 0.07, P > 0.05). The X-ray examination results showed that the patients with skeletal fluorosis were mainly mild, accounting for 71.43% (45/63); X-ray changes were mainly ossification of interosseous membrane and tendon. The urinary fluoride in control group and skeletal fluorosis group was 1.62 (1.12, 1.95) and 3.22 (2.38, 4.89) mg/L, respectively, with statistically significant difference between the two groups ( Z = 7.07, P < 0.001). The difference of serum CTX-1 and P1NP contents between the two groups was statistically significant ( Z = 2.00, 4.89, P < 0.05). Conclusions:The levels of serum CTX-1 and P1NP in patients with skeletal fluorosis are higher than those in healthy people. Serum CTX-1 and P1NP may be used as sensitive indicators for diagnosis of skeletal fluorosis.

Objective:To observe and evaluate the effect of health education on drinking brick-tea type fluorosis in Zhiduo County, Qinghai Province, so as to provide basis for further formulating health education strategies.Methods:From April 2019 to April 2020, according to the historical prevalence of drinking brick-tea type fluorosis in Zhiduo County, Qinghai Province, 3 townships (towns) were selected to carry out the health education activities on drinking brick-tea type fluorosis for students of grade 4 - 6, village doctors, adults and monks in each township (town). We carried out a one-year publicity on the prevention and treatment of drinking brick-tea type fluorosis, distributed health education materials and organized health education activities. Before and after the intervention, we conducted a questionnaire survey on health education among the target population (grade 4 - 6 students, village doctors, adults and monks), to evaluate the awareness rate and behavior formation rate of fluorosis prevention and control, and to evaluate the intervention effect.Results:A total of 86 students of grade 4 - 6, 40 village doctors, 42 adults and 20 monks were investigated, after the intervention, the awareness rates of prevention and treatment of drinking brick-tea type fluorosis in grade 4 - 6 students, village doctors, adults and monks were 87.98% (227/258), 96.67% (116/120), 81.75% (103/126), 83.33% (50/60), respectively, which were significantly higher than those before the intervention [38.38% (76/198), 83.33% (100/120), 15.45% (19/123), 28.89% (13/45), P < 0.05]. After the intervention, the behavior formation rates of prevention and treatment of the drinking brick-tea type fluorosis in grade 4 - 6 students, village doctors, adults and monks were 74.42% (128/172), 72.50% (58/80), 52.38% (44/84), 60.00% (24/40), respectively, which were significantly higher than those before the intervention [14.39% (19/132), 38.75% (31/80), 3.66% (3/82), 0(0/28), P < 0.05]. Conclusion:The comprehensive intervention measures based on health education can significantly improve the knowledge of local residents, and improve their bad drinking habits of drinking tea, which is of great significance to the prevention and treatment of drinking brick-tea type fluorosis.