OBJECTIVE To assess the scientific rigor， clarity and feasibility of the recommendations of the Guidelines for Evidence-based Use of Biological Agents for the Clinical Treatment of Osteoporosis （hereinafter referred to as the Guideline） through external review， in order to further revise and improve the Guideline recommendations. METHODS This study employed a cross-sectional survey research design， a convenience sampling method was adopted to select frontline medical workers in the field of osteoporosis （including clinical doctors， clinical pharmacists， and nurses） as well as patients or their family members. External review was conducted through a combination of closed-ended and open-ended electronic questionnaires to get feedback from them on the appreciation，clarity and feasibility of the 32 preliminary recommendations in the Guideline. RESULTS A total of 90 external review subjects from 15 hospitals were collected， including 45 clinical doctors， 15 clinical pharmacists， 15 nurses and 15 patients or their family members. The overall appreciation degree of recommendations was 99.38%， the overall clarity degree of recommendations was 98.92%， and the overall feasibility degree of recommendations was 99.65%. At the same time， 111 subjective suggestions were collected， which provided an important reference for the further improvement of the Guideline recommendations. Based on the above feedback， the Guideline steering committee and core expert group revised the wording of 12 draft recommendations without deletion， and finally determined 32 recommendations. CONCLUSIONS The external review provides an important basis for the final formation of the Guideline， further improves the scientific rigor， clarity and feasibility of the recommendations， and ensures the standardization， practicality and implementability of the Guideline.

BACKGROUND:There is an increasing demand for orthodontic treatment,and periodontally accelerated osteogenic orthodontics(PAOO)technique can make it possible to move orthodontic teeth that are limited by thin alveolar bone. OBJECTIVE:To investigate the biomechanics of orthodontic tooth movement before and after periodontally accelerated osteogenic orthodontics(PAOO)surgery to increase alveolar bone volume using the three-dimensional finite element method. METHODS:A patient undergoing PAOO surgery before orthodontic treatment to increase bone volume on the labial side of the mandibular anterior region was selected.The patient was under invisible orthodontics.Two three-dimensional finite element models were constructed based on the patient's preoperative and 6-month postoperative cone beam CT data.Both models simulated the movement of tooth 33:experiment Ⅰ:distal-central movement of 0.25 mm;experiment Ⅱ:lingual movement of 0.25 mm;and experiment Ⅲ:intrusion movement of 0.10 mm.The stress distribution and initial displacement trend of tooth 33,periodontal ligament and surrounding alveolar bone under the action of the invisible aligner were analyzed before and after the PAOO procedure. RESULTS AND CONCLUSION:Dental stress analysis:In the same orthodontic tooth movement,the maximum Von-Mises stress and overall stress values of tooth 33 were all higher before surgery than after surgery;there were similar distribution areas of maximum equivalent stress and overall distribution trends of Von-Mises stress before and after surgery.Periodontal ligament stress analysis:In the same orthodontic tooth movement,the maximum Von-Mises stress and overall stress values of the periodontal ligament were higher before surgery than after surgery,and there were similar distribution areas of the maximum equivalent stress and overall distribution trends of Von-Mises stress before and after surgery.Alveolar bone stress analysis:In the same orthodontic tooth movement,the maximum Von-Mises stress values of the alveolar bone around tooth 33 were higher before surgery than after surgery,while the equivalent stress distribution showed a gradual decrease from the top of the alveolar ridge to the root.Initial displacement analysis:In the same orthodontic tooth movement,the initial displacements in the main displacement direction for all six observation points of tooth 33 were smaller before surgery than after surgery,and showed a tendency to gradually decrease from the tooth tip to the apex.Therefore,there were differences in the biomechanical characteristics of orthodontic tooth movement before and after the PAOO surgery.With the clear aligner,the postoperative equivalent stress values on the dentition,periodontal ligament,and surrounding alveolar bone were lower than before the surgery,and the initial displacements of the orthodontic teeth after the surgery are larger than before.These findings suggest that PAOO can release the restriction of thin alveolar bone on the movement of orthodontic tooth by increasing alveolar bone thickness,effectively improving the force on the roots,periodontal ligament,and alveolar bone,avoiding the stress concentration on orthodontic tooth in the thin alveolar bone area that can cause complications when moving,and improving the efficiency of tooth movement.

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 observe the effect of a new cell delivery tool(MSC exo)on the proliferation of pancreatic cancer by transferring targeted genes.Methods Transmission Electron Microscope(TEM)and Nanoparticle Tracking Analysis(NTA)were used to identify human mesenchymal stem cell exosomes(MSC-exo)and transport miR-450a-5p into CFPAC-1,to explore the effect of miR-450a-5p targeting BZW2 on inhibiting the proliferation of pancreatic cancer cells.Results The expression of miR-450a-5p was low in pancreatic cancer tissue(P<0.05),and the expression of CD63 and TSG101 of MSC-exo-miR-450a-5p in CFPAC-1 cells was higher than that of MSC-exo by Western blot(P<0.05).CCK-8 and EdU results showed that MSC-exo-miR-450a-5p significantly inhibited the proliferation of CFPAC-1 cells(P<0.05).Cell scratch and Transwell experiments showed that MSC-exo-miR-450a-5p can inhibit the migration and invasion of CFPAC-1 cells(P<0.05).Through dual luciferase assay,it was confirmed that miR-450a-5p targets BZW2,and RT-qPCR and Western blotting showed a negative correlation(P<0.05)between miR-450a-5p and BZW2 expression.Overexpression of BZW2,CCK-8,EdU,cell scratch,and Transwell experiments confirmed that pc-BZW2 reversed the anti-cancer function of MSC-exo-miR-450a-5p on CFPAC-1.Western blot detected PCNA,Ki-67,MMP2,MMP9,and the results were consistent with the above experiments(P<0.05).Conclusion hMSC exo is a new delivery system,targeting BZW2 to transport miR-450a-5p to inhibit the biological malignancy of pancreatic cancer cells,which provides an important clue for the research of targeted treatment of pancreatic cancer.

Radical cystectomy combined with pelvic lymph node dissection is the standard procedure for the treatment of muscle invasive bladder cancer and complex non-muscle invasive bladder cancer.Our department has routinely carried out laparoscopic radical cystectomy(ELRC)through the extraperitoneal approach in 340 cases.This article summarizes the establishment of the peritoneal space,the expansion of the peritoneal space,the operation steps of bladder resection and lymph node dissection through the peritoneal channel,and how to shorten the operation time and reduce the difficulty of the operation.During the surgery,the bladder is removed periperitoneally without destroying the peritoneum to preserve the functions of peritoneum support,secretion,protection and lubrication,which has little impact on the abdominal organs,reduces the incidence of complications,and provides favorable conditions for subsequent treatment.

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 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.

Objective:To study the effects of water fluoride and tea fluoride on the occurrence of dental fluorosis in children, and to provide a basis for scientific prevention and control of the disease.Methods:From April to September 2020, Baolongshan Town with qualified water fluoride but no habit of drinking brick tea, Xingyao Town with qualified water fluoride and habit of drinking brick tea, Baokang Town with exceeded water fluoride but no habit of drinking brick tea, and Wuliyasitai Town with exceeded water fluoride and habit of drinking brick tea were selected as survey sites in Inner Mongolia Autonomous Region based on historical monitoring data. In all Gacha (villages) of 4 towns, a survey was carried out on residents' drinking water, brick tea drinking habits and children's dental fluorosis detection, and the water fluoride, tea fluoride exceeding standard rates, daily per capita intake of brick tea fluoride and the detection rate of children's dental fluorosis were calculated. At the same time, multivariate logistic regression was used to analyze the influencing factors affecting the occurrence of dental fluorosis in children.Results:In 2020, a total of 165 water samples were collected in 4 towns of Inner Mongolia Autonomous Region, and the total water fluoride exceeding standard rate was 38.18% (63/165). A total of 320 tea samples were collected, the tea fluoride exceeding standard rates in Xingyao Town and Wuliyasitai Town were 96.38% (213/221) and 89.90% (89/99), respectively; the daily per capita intake of brick tea fluoride was 5.67 and 7.35 mg, respectively. A total of 1 652 children were examined for dental fluorosis, and 639 cases were detected, the detection rate was 38.68%. The detection rates of dental fluorosis in boys and girls were 37.18% (322/866) and 40.33% (317/786), respectively, with no significant difference between sexes (χ 2 = 1.72, P = 0.104); the detection rates of dental fluorosis in children aged 8 - 12 years were 43.93% (105/239), 40.50% (147/363), 46.57% (163/350), 30.56% (88/288) and 33.01% (136/412), respectively, with statistical significant difference among ages (χ 2 = 26.07, P < 0.001); the detection rates of dental fluorosis in children in Baolongshan, Baokang, Xingyao and Wuliyasitai towns were 0.68% (2/293), 14.09% (31/220), 24.79% (89/359) and 66.28% (517/780), respectively, with statistical significant differences among regions (χ 2 = 213.05, P < 0.001). Multivariate logistic regression analysis showed that when the fluoride content in water was 1.2 - < 2.0, 2.0 - < 2.5, and ≥2.5 mg/L, the risk of dental fluorosis in children was 3.93, 6.60, and 9.02 times of water fluoride content < 1.2 mg/L; when the daily per capita intakes of brick tea fluoride was 3.6 - 7.0 and > 7.0 mg, the risk of dental fluorosis in children was 2.94 and 3.90 times of daily per capita intakes of brick tea fluoride ≤3.5 mg; the risk of dental fluorosis in children aged 10 years was 1.81 times of children aged 8 years; the risk of dental fluorosis in children in Xingyao, Baokang, and Wuliyasitai towns was 22.35, 40.93, and 151.58 times of Baolongshan Town, respectively. Conclusions:The prevalence of dental fluorosis in children still exists in Inner Mongolia Autonomous Region, and the detection rate of dental fluorosis is high. High water fluoride and high tea fluoride are the main risk factors for dental fluorosis in children.

Objective:To investigate the distribution of fluoride content in water and dental fluorosis in children and skeletal fluorosis in adults in drinking water-borne endemic fluorosis areas of Inner Mongolia Autonomous Region.Methods:From April to November 2021, all natural villages in the drinking water-borne endemic fluorosis areas of Inner Mongolia Autonomous Region were investigated on the status quo of water improvement and water fluoride monitoring. At the same time, all children aged 8 - 12 and adults aged 18 and older were examined for dental fluorosis and skeletal fluorosis, respectively, and the detection rates were calculated.Results:There were 9 465 villages in drinking water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region, among which 8 920 villages had completed the water improvement, with a water improvement rate of 94.24% (8 920/9 465); 8 664 villages had completed the water improvement with qualified water fluoride, and the qualified rate of water improvement was 97.13% (8 664/8 920). A total of 80 915 children aged 8 - 12 in the villages underwent dental fluorosis examination, and 4 868 children were diagnosed with dental fluorosis, with a detection rate of 6.02%. A total of 3 545 915 adults aged 18 and older in the villages were examined for skeletal fluorosis, and 3 567 adults were diagnosed with skeletal fluorosis, with a detection rate of 0.10%.Conclusion:The water improvement rate and qualified rate of water improvement in drinking water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region are high, while both of the detection rates of dental fluorosis in children and skeletal fluorosis in adults are relatively low.

【Objective】 To explore the safety and efficacy of a modified one-piece posterior laparoscopic total nephroureterectomy with cystic sleeve resection in the treatment of upper urinary tract uroepithelial carcinoma (UTUC). 【Methods】 A total of 24 patients treated during Jan. and Jun. 2022 were involved, including 16 males and 8 females, aged 62 to 90 (average 73) years. The UTUC was in the left side in 15 cases, and in the right side in 9 cases. There were 10 cases of renal pelvis tumor, 6 cases of upper ureteral tumor and 8 cases of lower ureteral tumor. 【Results】 All operations were successful without conversion to open surgery. The operation time ranged from 60 to 100 minutes, average (71.25±9.80) minutes. The intraoperative bleeding volume was 20 to 200 mL, average (30.03±8.13) mL. No significant intraoperative or postoperative complications occurred. The postoperative hospital stay was 4 to 7 days, average (5.83±1.44) days. Bladder perfusion chemotherapy was performed after surgery. 【Conclusion】 The modified one-piece posterior laparoscopic total nephroureterectomy plus cystic sleeve resection for UTUC is an effective and feasible procedure with satisfactory tumor control, which is worth further promotion in clinical practice.