Objective:To cultivate English talents with expertise. Methods:Based on the poll of 803 medical students in Grade 2013 with different professional questionnaires and the interview of 30 students who have graduated in the past 5 years and are working now, together with the successful experience from others and our own training objectives, English curriculum model has been built whose purpose is to satisfy professional needs in the future. Results: In addition to the regular courses of 2 years of intensive reading and self-studying audio-visual online learning, we also offer 12 optional courses including practical oral medical English and IELTS English Training Course. The students’enthusiasm for learning English is aroused,and 24.7%of all the students at school take an active part in English selective courses. Conclusion:The multi-mode English curriculum setting based on ESP is the key and inevitable trend in English teaching.

Objective To find out the cognition understanding of iodine deficiency disorders(IDD) of target population in Xi’an City, and evaluate the effectiveness of a health education project on prevention and control of IDD. Methods By using the random number table, three towns in each project county were selected. Obeying the requirements of the education program for IDD control, the health education activities were implemented during 2007 - 2011. Before and after intervention, questionnaire was used to investigate the intervention effect. The primary school grade 5 students and women of childbearing age were included in the survey of IDD knowledge. Hierarchical random sampling method was used to select pupils and childbearing women. Results After health education, the rate of knowledge on IDD increased from 66.97%(13 321/19 890) to 93.49%(18 610/19 905,χ2 = 4 413.07, P < 0.05) among pupils, and 62.27%(6 193/9 945) to 93.96%(9 361/ 9 963, χ2= 2 924.18, P<0.05) among childbearing women. And the awareness had reached the national standard. But the survey results showed that: the rate of IDD related knowledge in rural areas was lower than that in town areas. The awareness rates of IDD in precaution, main hazards, identification of iodized salt were 46.50%(239/514), 55.25%(284/514) and 50.97%(262/514) among pupils in rural areas and 61.44%(376/612), 65.69%(402/612) and 70.59%(432/612) among pupils in town areas, and the awareness rates of pupils in rural areas were lower than those of pupils in town areas. Thirty-six point ninety-three per cent(226/612) of the pupils in towns and 35.60%(183/514) of the pupils in rural areas told this information to their parents. The awareness rates of IDD in precaution, main hazards, IDD prevention day were 49.25%(197/400), 50.75%(203/400) and 36.50%(146/400) among women in rural areas and 75.44%(298/395), 80.25%(317/395) and 57.97%(229/395) among women in town areas, and the rates of women in rural areas were lower than those of women in town areas. The rate of consciously purchasing of qualified iodized salt was 51.75%(207/400) and the consumption rate of iodized salt was 36.75%(147/400) among women in rural areas, which were 73.42%(290/395) and 43.80%(173/395) among women in town areas, and the rates in rural areas were lower than those in town areas. Conclusions Before health education of IDD, the rate of IDD related knowledge in Xi’an City is poor, rural areas are lower than town areas. Health education project is effective in promoting the understanding and grasp of IDD knowledge.

Objective:To evaluate the effect of different water-improving methods on dental fluorosis of children aged 8 to 12 in drinking-water-borne fluorosis areas in Xi'an City, and provide basis for making fine prevention and control measures.Methods:In 2018, 50 drinking-water-borne fluorosis villages in Xi'an City with water improvement time from 2011 to 2013 were selected as survey sites. The condition and the way of water improvement were surveyed, water fluoride content was determined and the prevalence of dental fluorosis in children aged 8 to 12 was examined, and the rates of dental fluorosis were compared before and after the water improvement in the 50 villages.Results:The water-improving projects were in normal operation in 50 villages. The medians of water fluoride content were 0.31, 0.88 and 1.14 mg/L in villages with municipal water supply, low fluorine well and defluoridation treatment water supply (the villages of different water-improvement methods were 12, 24 and 14, respectively), the differences were statistically significant ( H = 75.54, P < 0.01). The qualification rates of water fluoride in villages with different water-improvement methods were 100.00% (12/12), 79.17% (19/24) and 57.14% (8/14), and the difference was statistically significant (χ 2 = 6.95, P < 0.05). The detection rate of dental fluorosis was 43.17% (218/505) in the 11 villages with excessive water fluoride content, and the detection rate was 20.77% (331/1 594) in the 39 villages with qualified water fluoride content, the difference was statistically significant (χ 2 = 99.66, P < 0.01). After water improvement, the total detection rate of dental fluorosis (26.16%, 549/2 099) in the 50 villages was lower than that before water improvement (41.66%, 959/2 302), the difference was statistically significant (χ 2 = 117.17, P < 0.01). The detection rates of dental fluorosis were reduced after the water improvement in villages with municipal water supply and low fluorine well, the differences were statistically significant (χ 2 = 74.37, 69.36, P < 0.01). The detection rate was declined after water improvement in villages with defluoridation treatment water supply, but the difference was not significant (χ 2 = 0.78, P > 0.05). There was a statistically significant difference in the detection rate of dental fluorosis among children in villages with different water-improvement methods (χ 2 = 72.79, P < 0.01). The detection rate of dental fluorosis in villages with defluoridation treatment water supply [39.53% (200/506)] was higher than that in villages with municipal water supply [17.97% (133/740)] and low fluorine well [25.32% (216/853)], the differences were statistically significant ( P < 0.017); the detection rate of dental fluorosis in villages with municipal water supply was lower than that in villages with low fluorine well ( P < 0.017). Conclusions:The dental fluorosis of children's has been effectively controlled in the villages after water improvement in Xi'an City. The fluoride content in the water and the detection rate of dental fluorosis in children in some endemic areas are still high. It is necessary to further improve the water quality or consolidate the improvement effect as soon as possible.

Objective:To explore the relationship between dental fluorosis and serum chemical elements in children after water modification.Methods:Using the method of stratified sampling, according to the monitoring data of the Xi'an Center for Disease Control and Prevention in the past 20 years, the drinking-water-borne fluorosis areas in Xi'an City were changed according to the water-improvement period of 1-, 5-, 10- and ≥15 years, and 2 villages in each layer were selected as the survey sites. Each survey site selected school-age children aged 7 to 13 years old as the survey subjects to detect the prevalence of dental fluorosis; and blood samples were collected to detect 14 chemical elements contents in the serum [calcium (Ca), iron (Fe), magnesium (Mg), copper (Cu), zinc (Zn), iodine (I), selenium (Se), lead (Pb), arsenic (As), cadmium (Cd), chromium (Cr), fluorine (F), mercury (Hg), nickel (Ni)]. The differences of chemical element contents in children with different water improvement years and different dental fluorosis conditions were analyzed.Results:The prevalence of dental fluorosis of children were 51.40% (55/107), 16.92% (11/65), 16.67% (17/102) and 5.08% (6/118) in the villages with different water improvement period, the difference was statistically significant (χ 2 = 74.444, P < 0.05). Serum levels of Ca, Fe, Mg, Cu, Zn, I, Se, Pb, As, Cr, F and Ni in children of different water improvement period were compared, the difference were statistically significant ( P < 0.05). Levels of Fe, Zn and Ni in dental fluorosis patients were lower than those in normal children ( P < 0.05), and the serum fluoride level was higher than that of normal children ( P < 0.05). There were no significant differences in the contents of other chemical elements levels between children with dental fluorosis and normal children ( P > 0.05). Conclusions:The detection rate of dental fluorosis in children in ward villages whose water has been improved for more than 15 years is the lowest, and the detection rate of children with dental fluorosis can be reduced by improving water to reduce fluoride. Children in the drinking-water-borne fluorosis areas are deficient in some trace element.

Objective To investigate the pathogenic distribution characteristics and drug resistance of opportunistic Candida in patients with pulmonary tuberculosis on the Qinghai-Tibet Plateau.Methods 3 012 hospitalized cases of pulmonary tuberculosis at Qinghai Province Fourth People's Hospital from March 1,2020 to December 31,2020 were analyzed,sputum samples were collected,Candida identification was carried by VITEK-32-YBC automatic bacterial analysis system,and the detected Candida was tested for drug sensitivity.Results Among the 3 012 cases of pulmonary tuberculosis in this investigation,283 cases of pulmonary tuberculosis patients with Candida infection,accounting for 9.40%.Among them,Candida albicans was the main type of Candida,accounting for 79.86%of the total.Conclusion The prevalence rate of pulmonary tuberculosis complicated with Candida infection was high in Qinghai-Tibet Plateau.Therefore,the selection of antimicrobial drugs should be based on a comprehensive analysis of the patient's condition,in order to select the best and most effective drugs for treatment.

Objective To investigate the dental fluorosis and intelligence level of children in drinking water-type of endemic fluorosis areas in Xi'an,and to provide a scientific basis for development of prevention and control strategies.Methods In 2016,six drinking water-type of endemic fluorosis villages and one non-diseased village were selected as investigation sites in Xi'an.According to the detection rate and prevalence of dental fluorosis in children,six diseased villages were divided into three groups,the disease light-affected areas were Huidong and Xingnan,the moderate-affected areas were Liulin and Xiazhu,and the serious-affected areas were Hetou and Xiaoyang;and the Deng village was the non-diseased.A cross-sectional survey was conducted to collect 3 tap water samples in each village to test the fluorine content in water.For all children aged 8 to 12 years in diseased villages and 100 children aged 8 to 12 years in non-diseased villages,dental fluorosis examination and intelligence test were carried out.Results Mean value of water fluoride in non-diseased village and endemic fluorosis areas were (0.25 ± 0.01),(0.78 ± 0.43) mg/L,and the water fluoride content in two diseased villages was over 1.20 mg/L.The detection rate of dental fluorosis in children aged 8 to 12 (30.32％,67/221) in diseased areas was significantly higher than that in non-diseased area (2.00％,2/100;x2 =31.32,P ＜ 0.01).Children's IQ scores in the four groups were 108.68 ± 10.83,102.54 ± 12.54,101.70 ± 14.85,93.45 ± 10.84,and the IQ scores were decreased with the severity of dental fluorosis,the difference in IQ scores was significant between the endemic fluorosis areas and non-endemic fluorosis area (P ＜ 0.05);the percentage of children with IQ≤89 in endemic fluorosis areas was significantly higher than that in non-endemic fluorosis area (x2 =22.02,P ＜ 0.01).The IQ scores of children with dental fluorosis was 94.96 ± 13.75,and the IQ was 105.26 ± 10.19 in children with normal condition,the difference was significant (t =5.61,P ＜ 0.01),the mean value of IQ was decreased with the severity of dental fluorosis (F =7.42,P ＜ 0.05),the percentage of children with IQ≤89 in patient was higher than that in normal children,the difference was significant (x2 =45.70,P ＜ 0.01).Conclusion Low level of water fluoride still has negative influence on children's dental health and intelligence,water improving and surveillance should be strengthened to ensure the health of children.

Objective To find out the iodine nutrition and thyroid function of adults in rural and urban areas of Xi'an City, and to analyze the relationship between iodine intake and thyroid function. Methods Two streets ( townships ) were selected in urban and rural areas of Xi'an City according to multi-stage stratified cluster sampling, one community (administrative village) was selected in each street (township), and 100 residents were selected from each community (administrative village). Drinking water, household salt, urine and blood samples of people over the age of 16 were collected to test water iodine, salt iodine, urinary iodine and thyroid function. Results A total of 354 drinking water samples were examined, and the median of water iodine was 4.50 μg/L in Xi'an, and iodine concentrations of ≥10 μg/L in urban group was higher than that of rural group [ 48 . 21％ ( 94/195 ) vs 20.13％ (32/159), χ2= 30.123, P < 0.05]. The highest value of urban water iodine was 244.10 μg/L. A total of 354 edible salt samples were examined, and the median of salt iodine was 19.62 mg/kg in urban and rural areas of Xi'an. The edible rate of qualified iodized salt in urban group was higher than rural group [78.97％(154/195) vs 69.18％(110/159),χ2=12.523,P<0.05]. The median of urinary iodine of urban and rural groups were 236.00 and 196.00μg/L, respectively, and urban group was higher than rural group (Z = - 3.121, P < 0.05). The frequency distribution of urinary iodine in urban group was different from rural group (χ2=24.440,P<0.05). The mean value of thyroxine (T4) in urban group was lower than that of rural group,and there was statistical difference [nmol/L:(89.43 ± 19.70) vs (93.57 ± 16.89), t = - 2.098,P < 0.05]. The positive rates of anti-thyroglobulin antibody (TgAb) of urban and rural groups were 21.54％(42/195) and 13.21％(21/159), the positive rate of TgAb was higher in urban than in rural (χ2=4.155, P < 0.05). The positive rates of thyroid peroxidases antibody (TPOAb) were 13.33％ (26/195) and 6.92％(11/159), respectively. There were no statistically significant differences of thyroid dysfunction in urban and rural groups [14.87％(29/195) vs 12.58％(20/159), P > 0.05]. Subclinical hypothyroidism in all thyroid dysfunction was the main thyroid disorder, which was 7.18％(14/195) and 6.92％ (11/159) in urban and rural groups. Conclusions Xi'an urban healthy adult iodine intake is at an ultra-appropriate level. In rural areas, the intake of iodine in healthy adults is at an appropriate level. The areas of high water iodine are found in Xi'an for the first time. Increased iodine intake may promote the occurrence of subclinical hypothyroidism.

Objective: To evaluate the dynamic prevalence of dental fluorosis of children and levels of fluoride in drinking water after improvement of water in Xi an City, to provide scientific basis for water fluoridation improvement. Methods: A total of 35 fluorosis endemic villages were selected as fixed monitor sites in 2014-2018, the ways of water improvement were surveyed, water fluorine content were detected and the prevalence of dental fluorosis in children aged 8 to 12 years were examined. Results: Rates of excess fluoride in drinking water from 2014 to 2018 were 22.86%, 14.29%,11.43%, 11.43% and 8.57%, the difference were significant(χ2=16.44, P<0.01).The dental fluorosis detection rates of children aged 8 to 12 years were 20.89%,18.22%,17.46%,18.13% and 16.76% in 2014-2018 which showed a obvious descending trend by year(χ2=10.02, P<0.01). The detection rate of dental fluorosis in children aged 8 and 9 years showed a decreasing trend by year(χ2=6.53, 4.54, P<0.05).The difference of total rate of dental fluorisis,rate of mild cases rate of moderate-to-severe cases were statistically between the villages without qualified water and the villages with normal fluorine water(χ2=179.22, 167.93,10.35, P<0.01). The rate of detection in the villages with the water fluorine exceed standard in 2014-2018 showed a declining trend year by year(χ2=28.50, P<0.01). The detection rate were significant different across water improvement methods(χ2=197.76, P<0.01). Detection rate of dental fluorosis decreased from 2014 to 2018 in the areas with municipal water supply showed a decreasing after year(χ2=12.16, P<0.01). Conclusion The improvement of municipal water supply shows significant effects on water fluorosis control, the detection rate of water fluoride and children s dental fluorosis in some villages with the other ways of water improvement are still higher than expected, the continuously monitor of fluoride content in water and dental fluorosis in children should be strengthened.

Objective To assess the effects of defluoridation on prevalence of children's dental fluorosis in Xi'an City and study related influencing factors.Methods In 2017,the survey results of 2013 were collected from the previous investigation of drinking water type fluorosis in Xi'an Center for Disease Control and Prevention,and villages from drinking water type fluorosis areas were divided into five groups:0.0-,0.2-,0.5-,1.0-,and ≥ 1.5 mg/L,according to the fluoride concentrations of water.Four villages were randomly selected from each group,a total of 20 villages were selected as the investigation sites.A cross-sectional analytical study was conducted in the 20 villages,the fluoride in drinking water,the dental fluorosis of children aged 8-12 years and fluoride content in urine were detected,and the survey results were compared with those of 2013.Children were divided into five groups according to urinary fluoride contents as:0.0-(control),0.4-,0.8-,1.2-,and ≥ 1.6 mg/L,and the logistic regression model was used to evaluate the risk of dental fluorosis.Results There were no significant differences in water fluoride content between 2013 and 2017 (P ＞ 0.05).The rates of dental fluorosis among the study population in 2013 and 2017 were 25.35％ (200/789) and 20.58％ (164/797),and the difference was significant (x2 =5.11,P＜0.05).The prevalence rate and severity of dental fluorosis in 2013 [3.52％ (9/256),13.28％ (17/128),31.62％ (43/136),37.82％(45/119),57.33％(86/150)] and 2017[4.02％(10/249),11.82％(13/110),18.05％(24/133),29.13％(37/127),44.94％ (80/178)] were significantly increased with increase of water fluoride concentration (x2 =168.02,117.83,P ＜ 0.01).The prevalence rate of dental fluorosis was higher than 30％ in the three groups with water fluoride content 0.5-,1.0-and ≥ 1.5 mg/L in 2013,and the prevalence rates were decreased in these groups in 2017.The prevalence rate of dental fluorosis was lower than 30％ in the groups with water-fluorine content of 0.5-,1.0-＜1.5 mg/L,while the rate of dental fluorosis in the group with water-fluorine content of higher than 1.5 mg/L was still over 40％.The geometric mean of urinary fluoride of children in 2013 and 2017 were 1.02,0.67 rg/L,and the difference was significant (t =10.24,P ＜ 0.01).There were significant differences in children urinary fluoride between water fluoride groups in 2013 and 2017 (F =85.36,151.14,P ＜ 0.01).The risk of dental fluorosis increased with increase of urinary fluoride content,the odds ratio (OR) values were 5.26,7.83 and 13.28 in the three groups with the urinary fluoride 0.8-,1.2-,≥1.6 mg/L in 2013;the OR values in 2017 were 5.18,7.65 and 13.36,the differences were statistically significant (P ＜ 0.05).Conclusions The situation of water fluoride and dental fluorosis are not optimistic after defluoridation of drinking water.It is necessary to reinforce the measures of water defluoridation,and carry out classified management in endemic fluorosis areas.

Objective:To assess the implementation of control measures and dental fluorosis of children in drinking-water-borne endemic fluorosis areas in Xi'an City, and to evaluate the implementation effects of the prevention and control measures.Methods:All drinking-water-borne endemic fluorosis villages in Xi'an were selected as the investigation sites. The progress and running condition of all water-improved projects were investigated, fluoride concentration in all the water-improved projects and tap water were tested. "Standard Test Method for Drinking Water" (GB/T 5750.5-2006) was used to test the water fluoride. A cross-sectional analytical study was conducted on school children aged 8 - 12 years old, the dental fluorosis was determined according to "Diagnosis of Dental Fluorosis" (WS/T 208-2011).Results:There were 273 drinking-water-borne endemic fluorosis villages, the rate of water improved villages was 91.58% (250/273), and all of the water-improved projects were operating normally (100.00%, 196/196). The rate of water-improved projects with qualified water fluoride was 88.27% (173/196), 237 villages had fluoride safe drinking water and the qualified rate was 86.81% (237/273). The median of water fluoride in the 250 villages with water-improved projects was 0.78 mg/L, the median was 0.83 mg/L in the 23 villages without water-improved projects, and the difference was not significant ( Z = 1.475, P > 0.05) . The overall prevalence of dental fluorosis among children aged 8 - 12 years old was 19.86% (1 960/9 871), and the dental fluorosis index was 0.39. The prevalence of dental fluorosis in the villages with qualified water fluoride was 16.13% (1 377/8 539), and the rate was 43.77% (583/1 332) in the villages with unqualified water fluoride, and the difference was significant (χ 2 = 553.283, P < 0.01). The prevalence of dental fluorosis in children with water fluoride content of 0.00 - 1.20, 1.21 - 1.50, and ≥1.51 mg/L was 16.13% (1 377/8 539), 41.20% (281/682), 46.46% (302/650), and the difference was significant (χ 2 = 559.011, P < 0.01), the severity of the disease was positively correlated with water fluorine concentration ( r = 0.273, P < 0.01). The epidemic situation in 202 villages was effectively controlled and 71 villages did not reach the control standard. Conclusions:The progress of water-improved projects and the rate of qualified water fluoride are not optimistic in Xi'an, the dental fluorosis of children is still higher than the government standard in the high fluoride drinking-water areas. The measures for water improving defluorination and disease surveillance should be strengthened.