Objective:To investigate the distribution of physical and chemical water improvement areas of drinking water-borne endemic fluorosis in Inner Mongolia Autonomous Region, as well as the use of household water purifiers.Methods:From April to October 2021, a survey was conducted in a drinking water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region where physical and chemical water improvement was carried out. The survey included the basic situation of the affected villages (number of permanent households, number of permanent residents, historical water fluoride content) and the use of residential water purifiers. Household peripheral water samples were collected to test the water fluoride content. Water purifier installation rate, normal usage rate, qualified water fluoride rate in normal usage, and the proportion of households covered by filter replacement departments were calculated.Results:In Inner Mongolia Autonomous Region, the physical and chemical water improvement areas of drinking water-borne endemic fluorosis were distributed in 2 735 villages in 11 leagues (cities) throughout the region, with 192 950 permanent households and 540 216 permanent residents. The average historical water fluoride content in all leagues (cities) was 2.18 mg/L, and the current average water fluoride content was 0.40 mg/L. A total of 134 763 water purifiers were installed, with an installation rate of 69.84% (134 763/192 950). A total of 10 773 households were surveyed, with 10 396 households using water purifiers normally and a normal usage rate of 96.50% (10 396/10 773). Among them, 10 158 households had qualified water fluoride of normal usage, with a qualified water fluoride rate of 97.71% (10 158/10 396). Of the 10 396 households using water purifiers normally, 3 974 households (38.23%) had filter cartridges used within one year, and 3 961 households had qualified water fluoride, with a qualified rate of water fluoride of 99.67% (3 961/3 974). Six thousand four hundred and twenty-two households (61.77%) had filter cartridges used for more than one year, with 6 197 households had qualified water fluoride and a qualified rate of water fluoride of 96.50% (6 197/6 422). There was a statistically significant difference in the qualified rate of water fluoride between purifiers with different filter cartridge usage times (χ 2 = 110.73, P < 0.001). Among the 10 773 surveyed households, the filter cartridges replacement department covered 10 470 households, accounting for 97.19% (10 470/10 773). Conclusions:In Inner Mongolia Autonomous Region, the physical and chemical water improvement areas of drinking water-borne endemic fluorosis are widely distributed, and the normal usage rate of household water purifiers is relatively high. The qualified rate of water fluoride in household water purifiers with filter cartridges used for more than one year is low.

Objective:To investigate the arsenic metabolism pattern and possible influencing factors in the population in drinking-water-borne endemic arsenic poisoning (drinking-water-borne arsenic poisoning for short) areas.Methods:In December 2004, a cluster sampling method was used to select arsenic poisoning population (arsenic poisoning group) and healthy population (control group) in drinking-water-borne arsenic poisoning area of Bayannur City, Inner Mongolia Autonomous Region as the survey subjects. A questionnaire survey was conducted. Arsenic content in drinking water at home of survey subjects, the levels of urinary arsenic and its metabolites, including [trivalent arsenic (As Ⅲ), inorganic arsenic (iAs), monomethylarsenic acid (pentavalent, MMA V), dimethylarsenic acid (pentavalent, DMA V), total arsenic (tAs), percentage of inorganic arsenic (iAs%), percentage of monomethylarsenic acid (MMA%), percentage of dimethylarsenic acid (DMA%), primary methylation index (PMI), secondary methylation index (SMI)] were tested using high performance liquid chromatography-inductively coupled plasma mass spectrometry; nail arsenic and nail selenium levels were tested using atomic fluorescence spectrometer. The influencing factors of arsenic metabolism pattern were analyzed by multiple linear regression. Results:A total of 536 survey subjects were included, including 155 individuals in the arsenic poisoning group and 381 in the control group. The water arsenic level ranged from 0.0 to 825.7 μg/L. Compared with the control group, there was no significant difference in the distribution of gender, education level and dental fluorosis in the arsenic poisoning group ( P > 0.05), but there were significant differences in the distribution of age, marital status, smoking, drinking and water arsenic ( P < 0.05). Compared with the control group, the levels of urinary As Ⅲ, iAs, MMA V, DMA V, tAs, MMA%, MMA/DMA and nail arsenic in the arsenic poisoning group were higher ( P < 0.05), while the levels of urinary DMA%, SMI and nail selenium were lower ( P < 0.05); but there was no statistically significant difference in the levels of urinary iAs% and PMI ( P > 0.05). Gender, education level, depth of wells, water arsenic, total number of wells and nail arsenic were the influencing factors of urinary As Ⅲ (β = - 19.82, - 23.83, 0.61, 0.21, 7.26, 2.98, P < 0.05). Age, depth of wells, water arsenic and nail arsenic were the influencing factors of urinary tAs (β = 3.18, 3.25, 1.31, 15.59, P < 0.05). Gender, education level, depth of wells, water arsenic, total number of wells and nail arsenic were the influencing factors of urinary iAs (β = - 20.47, - 25.90, 0.64, 0.25, 7.87, 3.11, P < 0.05). Age, gender, education level, water arsenic and nail arsenic were the influencing factors of urinary MMA V (β = 0.52, - 17.07, - 21.84, 0.22, 2.77, P < 0.05). Age, depth of wells, water arsenic and nail arsenic were the influencing factors of urinary DMA V (β = 2.35, 2.47, 0.85, 9.22, P < 0.05). Conclusions:Compared with healthy individuals, there are differences in arsenic metabolism pattern among individuals with drinking-water-borne arsenic poisoning. Age, gender, education level, depth of wells, water arsenic, total number of wells and nail arsenic may be influencing factors of different arsenic metabolism patterns.

Objective:To analyze the main causes of death of residents in arsenic poisoning areas of Inner Mongolia Autonomous Region, providing a scientific basis for preventing and controlling the long-term effects of arsenic poisoning and ensuring the health of residents.Methods:The data on the causes of death among residents in arsenic poisoning areas of Inner Mongolia Autonomous Region from 2016 to 2021 were collected from the population death information registration management system and the population information system of various league and city statistical bureaus in Inner Mongolia Autonomous Region. Residents were divided into exposed and non exposed groups based on whether they drank high arsenic water. SPSS 25.0 software was used to statistically analyze the crude mortality rate (CDR), standardized mortality rate (SMR), disease-specific mortality rate, proportion of causes of death, and order of causes of death.Results:Over the past 6 years, there was a total of 9 583 deaths, with an average annual CDR of 633.12/100 000 and an average annual SMR of 446.65/100 000. The CDR of each year showed a decreasing trend over time (χ 2 = 1 058.86, P < 0.001). Male CDR was higher than female CDR (χ 2 = 325.04, P < 0.001). Heart diseases and malignant tumors were the main causes of death for residents in arsenic poisoning areas, with proportions of 25.00% (2 396/9 583) and 18.86% (1 807/9 583), respectively. The top three leading causes of malignant tumor death were lung cancer, liver cancer and gastric cancer. Among residents who died from various diseases and malignant tumors, the SMR of the exposed group was higher than that of the non exposed group (χ 2 = 147.08, 26.26, P < 0.001). Conclusions:The main causes of death of residents in arsenic poisoning areas in Inner Mongolia Autonomous Region are heart diseases and malignant tumors, with lung cancer, liver cancer, and gastric cancer being the top three leading causes of death for malignant tumors. Although the arsenic poisoning areas in the entire region have basically achieved water improvement, the long-term effects of chronic arsenic exposure still exist.

Objective:To investigate the efficacy of arthroscopic superior capsular reconstruction using composite autologous patch graft combined with tenodesis of the long head of the biceps tendon in the treatment of irreparable massive rotator cuff tears (IMRCT).Methods:A retrospective case series study was performed on 11 IMRCT patients who were admitted to Affiliated Fuyang Hospital of Bengbu Medical University (Fuyang People′s Hospital) from May 2020 to June 2022, including 7 males and 4 females, aged 54-74 years [(62.6±7.3)years]. All the patients were treated with arthroscopic superior capsular reconstruction using composite patch graft combined with tenodesis of the long head of the biceps tendon. The Visual Analogue Scale (VAS), Acromiohumeral Distance (AHD), Constant-Murley score and University of California Los Angeles (UCLA) score and active range of motion of the shoulder joint before, at 6 months after surgery and at the last follow-up were compared. At the last follow-up, the integrity of reconstructed superior capsule and the long head of the biceps tendon was evaluated using MRI of the shoulder joint. Postoperative complications were observed.Results:All the patients were followed up for 13-39 months [16(13, 36)months]. The VAS score, AHD, Constant-Murley score, and UCLA score were 2(2, 3)points, (9.1±1.1)mm, (56.1±5.4)points, and (19.7±2.8)points respectively at 6 months after surgery, which were all significantly improved from those before surgery [6(5, 7)points, (5.1±1.2)mm, (37.9±2.2)points, and (11.8±1.2)points] ( P<0.05). The VAS score, AHD, Constant-Murley score, and UCLA score were 0(0, 1)points, (8.4±0.9)mm, (83.6±3.8)points, and (28.2±2.3)points respectively at the last follow-up, which were all significantly improved from those before surgery ( P<0.05). At the last follow-up, the VAS score or AHD were not significantly improved from those at 6 months after surgery ( P>0.05); Constant-Murley score and UCLA score were both significantly improved from those at 6 months after surgery ( P<0.05). At 6 months after surgery, shoulder active ranges of motion in forward flexion, abduction and external rotation were (134.6±13.5)°, (124.6±18.6)° and 45(40, 50)° respectively, which were all significantly improved compared with those before surgery [(63.2±36.1)°, (65.0±23.1)°, and [30(20, 40)°] ( P<0.05). At the last follow-up, shoulder active ranges of motion in forward flexion, abduction and external rotation were (144.1±12.6)°, (139.6±15.4)° and 60(45, 65)° respectively, which were all significantly improved compared with those before surgery ( P<0.05). There were no significant differences in active range of motion of the shoulder in forward flexion, abduction and external rotation between 6 months after surgery and the last follow-up ( P>0.05). At the last follow-up, MRI revealed integrity of the reconstructed superior joint capsule and the long head of the biceps tendon in 10 patients. One patient developed resorption of the greater tuberosity and 1 showed a partial tear of the supraspinatus tendon at 1 year after surgery. Conclusion:Arthroscopic superior capsular reconstruction using composite autologous patch graft combined with tenodesis of the long head of the biceps tendon can relieve shoulder pain, decrease upward displacement of the humerus head, improve the function and range of motion of the shoulder joint, and reduce complications in the treatment of IMRCT.

Objective:To investigate the relationship between the outcome of skin injury and urinary arsenic methylation metabolism levels in people exposed to arsenic through drinking water.Methods:Using cluster sampling method, permanent residents from drinking-water-borne endemic arsenic poisoning areas in Bayannur City, Inner Mongolia Autonomous Region were selected as survey subjects in 2004 (before water improvement). In 2017 (after water improvement), 74 survey subjects from 2004 were tracked and followed up. Urine samples were collected from survey subjects and high-performance liquid chromatography inductively coupled plasma mass spectrometry was used to detect the levels of arsenic methylation metabolites in urine. According to the "Diagnosis of Endemic Arsenic Poisoning" (WS/T 211-2015), the clinical grading (normal, suspicious, mild, moderate and severe) of skin injury of the survey subjects and the outcome of 2017 (improved, unchanged, aggravated) were assessed. A database was established and SPSS 25.0 software was used for statistical analysis.Results:The clinical grading ratios of skin injuries among survey subjects in 2004 and 2017 were compared, the differences were statistically significant (normal, suspicious, mild, moderate and severe: 38, 18, 4, 14 cases in 2004 and 27, 31, 3, 13 cases in 2017, χ 2 = 53.02, P < 0.001). Compared with 2004, in 2017, the levels of total arsenic (tAs), inorganic arsenic (iAs), monomethylarsenic (MMA), dimethylarsenic (DMA), percentage of inorganic arsenic (iAs%), and ratio of monomethylarsenic to dimethylarsenic (MMA/DMA) in the urine of survey subjects were low, and the differences were statistically significant ( Z = - 8.24, - 9.07, - 7.81, - 8.04, - 8.24, - 3.56, P < 0.001). The levels of dimethylarsenic percentage (DMA%), monomethylation rate (PMI) and dimethylation rate (SMI) were higher, and the differences were statistically significant ( Z = - 6.39, - 8.24, - 3.52, P < 0.001). In 2004, patients with different clinical grading of skin injuries had different outcomes in 2017 (χ 2 = 30.80, P < 0.001). There were statistically significant differences in tAs, iAs, MMA and DMA variation in urine among skin injury patients with different outcomes ( H = 10.62, 9.35, 8.80, 9.13, P < 0.05). Conclusions:Improving water can significantly reduce the levels of tAs, iAs, MMA, and DMA in the urine of arsenic exposed individuals. The outcome of skin injury in individuals exposed to arsenic through drinking water is related to the variation of urinary arsenic methylation metabolites tAs, iAs, MMA, and DMA.

Objective:To investigate the epidemic status of drinking-tea type endemic fluorosis (fluorosis for short) in Inner Mongolia Autonomous Region (Inner Mongolia for short), and to provide theoretical basis and basic data for formulation and evaluation of prevention and control measures.Methods:From May to October 2022, a cross-sectional survey was conducted in key areas (168 administrative villages in 6 leagues or cities) identified in the 2019 regional census with tea drinking habits, daily per capita intake of tea fluoride > 3.5 mg, and patients with skeletal fluorosis. The drinking condition of brick tea in 10 households of each administrative village was investigated, and the brick tea samples were collected to detect fluoride level. The prevalence of dental fluorosis in children aged 8 - 12 and skeletal fluorosis in adults aged 16 and older was investigated, and urine samples of patients with skeletal fluorosis were collected to detect urinary fluoride levels.Results:Totally 98.40% (1 657/1 684) of the households in the surveyed areas had a habit of drinking brick tea, with an annual per capita consumption of brick tea and a daily per capita intake of tea fluoride of 5.07 kg and 5.38 mg, respectively. The qualified rate of fluoride level in brick tea samples was 55.64% (922/1 657), the average fluoride level of all other brick tea varieties exceeded the national standard limit (300 mg/kg) except for black brick tea (291.08 mg/kg). Totally 2 747 children aged 8 to 12 were examined, with a detection rate of 13.91% (382/2 747) for dental fluorosis. The disease was mainly mild. There was no statistically significant difference in the detection rate of dental fluorosis among different age groups (χ 2 = 5.53, P = 0.238). Totally 71 708 adults aged 16 and older were examined, and the detection rate of skeletal fluorosis was 1.02% (734/71 708). Patients were mainly aged between 50 and 70 years old, and the condition in each age group was mainly mild. Totally 715 urine samples of skeletal fluorosis patients were collected and tested, and 55.24% (395/715) of the urine samples had fluoride levels higher than 1.6 mg/L. Conclusions:In Inner Mongolia, the proportion of high fluoride brick tea in endemic areas of drinking-tea type fluorosis is high. The detection rates of dental fluorosis in children and skeletal fluorosis in adults are relatively high. The prevention and control situation of drinking-tea type fluorosis is still serious.

Objective:To study the prevalence of skeletal fluorosis in drinking-water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region (Inner Mongolia), and to provide reference for further prevention and treatment of skeletal fluorosis at this stage.Methods:From March to October 2019, a survey of skeletal fluorosis was carried out in all diseased villages of the eight diseased leagues (cities) in Inner Mongolia, including Alxa, Bayannur, Baotou, Ordos, Hohhot, Hulunbeier, Ulanqab and Xilingol. Permanent residents aged 18 years and above in the diseased villeges were investigated. Face to face questionnaires were used to collect the basic data of age, sex, epidemiological history, etc. of all subjects, and clinical examination of skeletal fluorosis was carried out. Drinking water samples were collected from residents for fluoride content testing.Results:A total of 123 166 residents aged 18 years and above were investigated, 1 781 cases of skeletal fluorosis were detected, and the detection rate was 1.45%. The degree of skeletal fluorosis was mild, accounting for 72.26% (1 287/1 781); the others were moderate and severe, accounting for 20.38% (363/1 781) and 7.36% (131/1 781), respectively. There were statistically significant differences in the detection rates of skeletal fluorosis among people of different water fluoride content, age, gender and regions (χ 2 = 565.96, 671.32, 4.38, 17 283.80, P < 0.05). Among them, the detection rates of skeletal fluorosis in water fluoride content > 4.0 mg/L, ≥56 years old and female population were relatively high, which were 5.21% (49/941), 2.26% (1 428/63 188) and 1.52% (905/59 555), respectively. The detection rates of skeletal fluorosis in Xilingol League and Baotou City were significantly higher, 25.48% (745/2 924) and 24.32% (225/925), respectively. Conclusion:The situation of skeletal fluorosis in drinking-water-borne endemic fluorosis areas in Inner Mongolia has been effectively controlled, but there are still relatively many patients with skeletal fluorosis in some areas, and further targeted prevention and control work is needed.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Objective To identify the sets of lymphocytes that could systematically evaluate immune function of colorectal cancer patients, based on the expression of colorectal cancer T cells, natural killer (NK) cells, and NKT cell surface protein receptors. Methods Peripheral blood samples from 144 patients with colorectal cancer and 87 healthy controls were collected, and the differences in surface receptors of lymphocyte subsets in peripheral blood of patients and healthy controls were analyzed by means of flow cytometry and cell culture. Results Compared with healthy control group, the percentage of peripheral blood total lymphocytes, CD16^brightCD56^dimNK cells and NKT cells decreased in patients with colorectal cancer. The percentage of T cells, CD16^brightCD56^dimNK cells and NKT cell surface inhibitory receptors T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitor motif domains (TIGIT) increased; T cells, NK cells, NKT cell surface chemokine receptor C-C motif chemokine receptor 7 (CCR7) slightly decreased. Conclusion There are differences in the proportion of NK cell subsets and the expression profile of surface receptors in peripheral blood of patients with colorectal cancer.
Humans ; Lymphocyte Subsets ; Killer Cells, Natural ; Lymphocyte Count ; Receptors, Chemokine ; Colorectal Neoplasms

Objective:To investigate the epidemic scope and intensity of drinking water type endemic arsenic poisoning in Inner Mongolia Autonomous Region, as well as the prevalence and influencing factors, in order to provide scientific basis for precise formulation of prevention and control measures.Methods:A sampling survey was conducted on residents' drinking water in all villages and counties in Inner Mongolia Autonomous Region, water samples were selected according to different water supply methods (engineering water supply, physical and chemical water purification, and decentralized water supply), and the arsenic content was detected by atomic fluorescence method. The "Diagnosis of Endemic Arsenicosis" (WS/T 211-2015) was used for diagnosis of arsenic poisoning among all permanent residents who were exposing to or had been exposed to excessively high arsenic water, in order to search all the arsenic poisoning patients. Analyze the distribution of water arsenic in the historical disease areas and high arsenic villages and newly discovered high arsenic villages, and explore the prevalence and influencing factors of arsenic poisoning.Results:There were a total of 1 186 historical disease areas and high arsenic villages in Inner Mongolia Autonomous Region, mainly distributed in 28 banner counties of 8 league cities such as Bayannur, Hohhot and Baotou, with a regional distribution trend of more in the west and less in the east. At present, the water improvement rate in the historical disease areas and high arsenic villages was 98.23% (1 165/1 186), and the qualified rate of arsenic content in the water was 99.83% (1 184/1 186). The arsenic content in the water of historical disease areas and high arsenic villages ranged from 0.000 to 0.093 mg/L. Four newly discovered villages with arsenic exceeding standards had been found, and their arsenic content ranged from 0.074 to 0.142 mg/L. A total of 2 249 patients with arsenic poisoning were detected in the confirmed disease area/high arsenic villages, and the detection rate was 1.67% (2 249/134 645). The number of patients in Bayannur City was the largest with the most severe disease, accounting for 82.70% (1 860/2 249). Patients aged 60 and above accounted for 61.41% of the total cases (1 381/2 249), which was higher than other age groups (χ 2 = 840.52, P < 0.001). The detection rate of arsenic poisoning was higher in males than in females (χ 2 = 132.38, P < 0.001). There are statistically significant differences in the detection rate and severity distribution of arsenic poisoning patients among different water arsenic content groups(χ 2 = 1 557.85, 1 741.05, P < 0.001). Conclusions:After years of prevention and control work, the arsenic content in most historical disease areas and high arsenic villages in Inner Mongolia Autonomous Region is currently qualified, and some areas have water arsenic exceeding standards or newly discovered villages with arsenic exceeding standards. At the same time, there are still a large number of arsenic poisoning patients in Inner Mongolia Autonomous Region. In the future, the prevention and control of endemic arsenic poisoning in Inner Mongolia Autonomous Region cannot be relaxed, and it is necessary to strengthen water quality monitoring and improve water quality in newly discovered villages with arsenic exceeding standards to prevent the occurrence of new cases.