Objective Through the dynamical monitoring of the water improvement projects operation,we intend to understand the prevalent trends of endemic fluorosis of children aged 8 to 12 in Hubei,to evaluate the effect of control measures and to provide the basis for making preventive measures.Methods In Hubei,ten surveillance counties were selected,and three epidemic villages were selected as fixed monitoring villages in each county from 2010 to 2014.In those villages,the operation situation of water improvement projects and the fluoride content in drinking water were detected,and the dental fluorosis of children aged 8 to 12 was diagnosed.Results From 2010 to 2014,the normal operation rate of water improvement projects was 75.61％-100.00％,the average of water fluorine content did not change,the differences were not statistically significant (F =2.00,P ＞ 0.05).The numbers of water improvement projects with water fluorine content in excessive amount was increased in the past five years which was only one project in 2010-2012 and was increased to two projects in 2013 and 2014.In 2010-2014,the dental fluorosis prevalence rate of whole children was 9.45％ (525/5 557),the dental fluorosis prevalence rate of exceeding-standard villages of water fluoride content was 42.40％ (92/217),the dental fluorosis prevalence rate of qualified villages was 8.11％ (433/5 340).The children's dental fluorosis prevalence rate of exceeding-standard villages of water fluoride content was higher than that in qualified villages;the differences were statistically significant (x2 =282.60,P ＜ 0.05).Conclusions The operation rate of water-improving projects is mostly higher than 90％,and so is the qualification rate of fluoride content in drinking water.The operation condition and water quality of the water-improving projects in Hubei need to be improved.The prevalence of children dental fluorosis of affected villages has dropped significantly after low fluoride water is provided continuously.

Objective To investigate and analyze the examination and acceptance results for coalburning-borne endemic fluorosis control and elimination in Hubei Province.Methods A county-level selfinspection and a provincial-level spot-check were conducted to investigate the status of improved-stove usage,the situation of correctly drying corn and chili,and the dental fluorosis prevalence among children aged 8 to 12 in 501 historic coal-burning-borne endemic fluorosis villages of 6 counties (cities) in Hubei Province from 2012 to 2014.The endemic areas were selected according to the Control Standards of Endemic Fluorosis in Endemic Areas (GB 17017-2010) and Eliminating Standards of Coal-burning Type Endemic Fluorosis.Results The results of county-level inspection showed that the qualified rates of improved stoves,the correct-usage rates of qualified stoves,and the correctly drying rates of corn and chili were all higher than 98％ in targeted villages,and the prevalence rate of dental fluorosis of children was 7.73％ (2 319/30 003).The results of provincial-level recheck were more than 99％ and 8.25％ (353/4 277),respectively.The results of county-level inspection were of good consistency with those of provincial-level recheck (88.89％,48/54).Five counties (cities) but one had met the standard of fluorosis control or elimination.Conclusion Coal-burning-borne endemic fluorosis scope in Hubei Province is narrowed greatly and the prevalence rates are decreased significantly.

Objective To know the changing characteristics of residents' iodine nutritional status after eating salt with different iodine concentrations in Hubei Province,according to the assessment standard of iodine nutrition recommended by WHO/UNICEF/ICCIDD provide a scientific standard for appropriate iodine concentration in edible salt.Methods According to inhabitants' salt and urine surveillance of Hubei in 2010,Xinzhou District,Tianmen City and Changyang County were selected for trial.Salt with two kinds of iodine content was used in 3 trial areas in 4 months for the study of community intervention.Before the intervention,3 months and 4 months after the intervention,urine samples of observed participants(40 from 8-10 old children,40 from pregnant women or lactating women and 40 from adults aged older than 18) were collected and tested.The urinary medians of different groups of people and at different times were calculated and compared.Results Three months and 4 months after the intervention,in those towns using iodized salt of (15 ± 3) mg/kg,the urinary medians of children,declined from 294.2 μg/L to 185.6,195.7 μg/L,respectively.The urinary medians of pregnant women or lactating women dropped from 269.0 μg/L to 141.7,176.1 μg/L.For adults aged 18 and older,the urinary medians changed from 304.9 μg/L to 199.7,202.2 μg/L.In those trial towns of using (25 ± 3)mg/kg iodized salt,the urinary medians of children,pregnant women or lactating women and adults older than 18 all went down from 301.1 μg/L to 229.7,253.8 μg/L,from 261.4.0 μg/L to 196.6 and 206.5 μg/L and from 379.7 μg/L to 244.3,237.4 μg/L,respectively.Conclusions According to the assessment standard of iodine nutrition recommended by WHO/UNICEF/ICCIDD and the decreasing of urinary iodine median and per capita daily salt intake,salt with 25 mg/kg iodine is suitable as the average level of salt iodine concentration after the adjustment in Hubei Province.

Objective:To explore the pathogenic characteristics of incision wound infections after breast cancer surgery and related influencing factors.Methods:Clinical files of 200 middle-aged and elderly patients who underwent breast-conserving surgery for breast cancer in the Affiliated Three Gorges Hospital from May 2016 to April 2021 were retrospectively analyzed.The results of pathogenic bacteria and drug sensitivity tests were examined, and the influencing factors of postoperative incision infections after breast cancer surgery were analyzed.Results:Among 200 middle-aged and elderly patients aged 55-75 years who underwent breast-conserving surgery for breast cancer, 13 patients(4.64%)developed postoperative incision infections, with 40 strains of pathogenic bacteria isolated, including 14 strains of gram-positive bacteria, 25 strains of gram-negative bacteria and 1 fungal strain.Univariate and multivariate logistic regression analysis showed that age( OR=3.40), duration of surgery( OR=2.50), albumin level( OR=2.83), underlying diseases( OR=4.23), preventive use of antibiotics( OR=3.14)and length of hospital stay( OR=2.33)were independent risk factors for postoperative incision infections in breast cancer patients(all P<0.05). Conclusions:Common pathogens of incision infections after breast-conserving surgery are Gram-negative bacteria.There are many factors affecting postoperative incision infections.Clinical measures need to be taken to reduce or prevent postoperative incision infections.

Objective To analyze the status of iodine nutrition after implementing new standard of iodized salt in Hubei Province,and to evaluate the effectiveness of prevention and control measures.Methods In 2016,in 103 counties (cities,districts) of Hubei Province,the townships (streets) under the jurisdiction of each county (city,district) were divided into five regions:east,south,west,north,and middle.One township (street) was selected from each region,and one primary school was selected from each township (street).From each primary school 40 children aged 8-10 (half males half females) were selected to collect salt samples from their households.Twenty pregnant women from townships (streets) near the selected schools were chosen to collect edible salt samples from their households.According to the method of population proportionate sampling (PPS),35 counties (cities,districts) were chosen from 103 counties (cities,districts).Thyroid volume of children aged 8-10 was examined,and urinary iodine of children and pregnant women were tested.Iodine nutrition criteria:the median urinary iodine of children ＜ 100 μg/L is iodine deficiency,100-＜ 200 μg/L is iodine appropriate,200-＜ 300 μg/L is iodine overdose,≥300 μg/L is iodine excess;pregnant women urinary iodine median ＜ 150 μg/L is iodine deficiency,150-＜ 250 μg/L is iodine appropriate,250-＜ 500 μg/L is iodine overdose,and ≥ 500 μg/L is iodine excess.Results Totally 30 967 edible salt samples from children's and pregnant women's households were examined,and the median of salt iodine was 23.85 mg/kg.The coverage rate of iodized salt was 99.46％ (30 799/30 967),the consumption rate of qualified iodized salt was 94.00％ (29 108/30 967).Totally 6 789 children aged 8-10 were examined thyroid volume and detected urinary iodine,the goiter rate was 0.85％ (58/6 789) and the median urinary iodine was 263.54 μg/L.Totally 3 348 urine samples of pregnant women were examined,and the median urinary iodine was 166.71 μg/L.Conclusions The salt iodine content of residents and the goiter rate of children in Hubei Province meet the national standard for eliminating iodine deficiency disorders.The iodine nutrition level of children and pregnant women is iodine appropriate or iodine overdose.The iodine nutrition level monitoring of key populations should be continuously strengthened.

Objective To understand the variation of arsenic concentration in underground water at the endemic arsenic poison disease area of Jianghan Plain so as to better understand the spatial distribution of high arsenic groundwater,hydro-chemical evolution and source of arsenic in this region.Methods Thirty underground water samples were collected respectively around 3 km radius of the two houses where arsenic poisoning patients lived,in Xiantao and Honghu.Sediment cores of three drillings were collected as well.Both paired t-test or paired Wilcoxon Signed Ranking Test were used to compare the arsenic concentration of water.Results The arsenic concentration in 2011-2012 appeared lower than that in 2006-2007 at the Nanhong village of Xiantao (t=4.645 3,P＜0.000 1),but was higher(S=-150,P＜0.000 1) in the Yaohe village of Honghu.The pH value showed weak acidity with Eh as weak oxidated.Positive correlations were observed between arsenic concentration and C1,HCO3-,Fe,Mn.However,negative correlations were found between As and SO42-,NO3-.The range of arsenic content in the sediment was 1.500 mg/kg to 17.289 mg/kg.The maximum arsenic content existed in the soil layer,while the minimum arsenic content existed in the sand layer.Conclusion The concentration of arsenic varied widely with time and space at endemic arsenic poison disease area of Jianghan Plain.Characteristics of these water chemicals showed significant differences,when compared to the groundwater from Datong Basin,Shanxi Shanyin and Hetao Plain of Inner Mongolia,which presented a typical environment with high arsenic contents in the groundwater.The arsenic content in the sediment samples seemed related to the lithologic structure.

Objective To make clear the arsenic distribution in drinking water sources in Hubei Province, make provincial distribution map of high-arsenic water and provide scientific basis for formulating refined measures to prevent and control arsenic poisoning of drinking water type in Hubei Province. Methods In 103 counties of Hubei Province, residents were sampled according to different water supplies (centralized water supply, small centralized water supply in rural areas and decentralized water supply). One water sample was collected from source water and tap water in centralized water supply system and at least 3 samples were collected from decentralized water supply system in a village. Water iodine content was tested using atomic fluorescence spectrometry and a distribution map of high-arsenic water at county level was drawn using ArcGIS 10.2. Results Totally 38 292 water samples were collected. The water-arsenic-concentration median was less than 1.00 μg/L. The high-arsenic water detection rate in urban centralized water supply was 3.7%(80/2 176);which were all 0.1%(4/4 304,30/31 812) in small centralized water supply in rural areas and decentralized water supply. The high-arsenic water sources from centralized water supplies were distributed centrally in the south, the central and the east of Hubei Province and those from dispersed water supplies were distributed dispersedly in the south, the central and the east of Hubei Province.Conclusions There are still some dispersed water supplies with very high arsenic concentration in Hubei Province, which should be included to change the water area as soon as possible. Moreover, high arsenic water samples are found from centralized water supplies, which means the water treatment process should be upgraded or water resources should be changed.

Objective To make clear the fluorine content distribution in drinking water of residents in Hubei Province,draw a provincial distribution map of high-fluorine water and provide scientific basis for formulating refined prevention and control measures of drinking water type fluorosis in Hubei Province.Methods In 116 counties of Hubei Province,including development zones,scenic zones and farmlands,drinking water of residents was sampled according to different water supplies (centralized water supply,small centralized water supply in rual areas and decentralized water supply) from 2013 to 2015.For a centralized water supply,one sample was collected from the source water and the tap water each and at least 3 samples were collected for decentralized water supply in a village.Selective electrode method was used to detect the water fluorine content and ArcGIS 10.2 was used to draw distribution map of high-fluorine water at county level.Results A total of 38 284 water samples were collected,the median of fluorine content was 0.21 mg/L.The highest detective rate of all types of water supply with high fluorine content was pressure water well (64/100,64.0％) and high-fluorine water sample was not found in the reservoir.The high-fluorine water sources from centralized water supplies were distributed dispersedly in the north-west and the east of Hubei Province and those from decentralized water supplies were distributed dispersedly in the middle-north and the east of Hubei Province.Conclusions Fluorine concentration in drinking water is generally low.However,there are still some high-fluorine water supplies which should be reported to Hubei Provincial Water Resources Department as soon as possible.Moreover,there is a phenomenon of fluorine rebounce in the water reduction project,and managements of those projects should be strengthened.

Objective To systematically review the correlation between fluoride exposure through drinking water and dental fluorosis of school-age children,and to provide a theoretical basis for further development of prevention strategies against dental fluorosis.Methods Such databases as China National Knowledge Infrastructure (CNKI),WanFang Data,VIP Database and China Biology Medicine Disc (CBM) were searched through computer to find out the relationship between fluoride exposure through dringking water and occurrence of dental fluorosis.The retrieval time was from January 1,2000 to January 1,2018.Meta-analysis was performed using RevMan 5.3.Funnel plot and fail-safe method were used to evaluate publication bias,and these data were analyzed sensitivity with random and fixed effect models.Results Totally 20 literatures entered into this study,79 814 people in fluoride exposure group,and 181 876 people in control group.The meta-analysis showed that,20 literatures were inhomogeneous through the heterogeneity test,which was analyzed in the random effect model,the pooled odds ratio (OR) value and 95％ confidence interval (95％CI) was 4.25 (3.66-4.94),which suggested that the risk of dental fluorosis in the fluoride exposure group was 4.25 times higher than that in control group.Funnel plot was asymmetrical,the fail-safe number was 47 791.56,which was 2 389.6 (47 792/20) times higher than included literatures.Literatures publication bias was small,sensitivity analysis revealed that the results were basically reliable.Conclusion Excessive fluoride exposure through dringking water could be one of the main risk factors leading to dental fluorosis.