Objective:To analyze the surveillance data of Kashin-Beck disease (KBD) in Shandong Province, master the changes of KBD, and provide scientific basis for formulating prevention and control strategies of KBD and adjustment of the prevention and control focus of KBD.Methods:According to the requirements of the "National KBD Monitoring Plan" and the "Shandong KBD Monitoring Plan", from 2016 to 2020, the disease monitoring was carried out in the villages of KBD areas in Shandong Province, including the number of clinical positive cases, the number of X-ray positive cases, and the number of metaphyseal positive cases. The detection rate was calculated, and the dynamic changes of the disease was analyzed macroscopically.Results:From 2016 to 2020, a total of 1 816 children aged 7 - 12 years were clinically examined in Shandong Province, and no child with KBD was found. A total of 1 224 children were examined by X-ray, among which 1 positive patient was found in 2016 and 2017, respectively, both of whom were metaphyseal changes, with a total detection rate of 0.16%. There were 367 adult patients with KBD in Shandong Province, including 304 patients with grade Ⅰ, 47 patients with grade Ⅱ and 16 patients with grade Ⅲ. All villages in the KBD areas in Shandong Province had reached the elimination standard, with the elimination rate of 100%.Conclusion:No clinical case of KBD is detected in children aged 7 - 12 years in Shandong Province from 2016 to 2020, which has reached the elimination standard and is in a continuous elimination state.

Objective:To evaluate the effect of health education of a three-year special action for prevention and control of drinking water-borne endemic fluorosis (referred to as drinking water-borne fluorosis) in Shandong Province, and to provide basis for formulating health education measures in the next step.Methods:Nineteen of the disease affected counties (cities and districts) were selected as project counties (cities and districts) in key areas for prevention and control of drinking water-borne fluorosis in Shandong Province in 2018, and 50 disease affected counties (cities and districts) were selected in 2019, and the project counties (cities and districts) were expanded to all of the 105 disease affected counties (cities and districts) in Shandong Province in 2020. Three disease affected townships (towns) were selected in each county (city and district), and health education activities on drinking water-borne fluorosis were carried out in Grade 4 to Grade 6 of the central primary schools and the three villages under its jurisdiction. Students and housewives were selected to conduct questionnaire surveys on prevention and control knowledge of drinking water-borne fluorosis before and after health education. The incidence of dental fluorosis among children aged 8 - 12 years was investigated annually in 6 villages (with children aged 8 - 12 years > 50) , where health education activity was implemented and the incidence of dental fluorosis among children was > 30%, water fluoride content was > 1.5 mg/L and water improvement time was < 5 years.Results:After health education, the awareness rates of drinking water-borne fluorosis in fifth grade pupils [92.46% (4 571/4 944) vs 65.80% (3 334/5 067) in 2018; 94.84% (12 897/13 599) vs 73.55% (9 993/13 587) in 2019; 95.59% (30 407/ 31 809) vs 77.52% (24 463/31 557) in 2020] and housewives [94.12% (2 400/2 550) vs 76.04% (1 939/2 550) in 2018; 94.99% (6 412/6 750) vs 72.00% (4 860/6 750) in 2019; 95.53% (16 183/16 941) vs 78.43% (12 971/16 539) in 2020] were significantly improved (χ 2 = 1 070.47, 2 315.27, 4 456.40, 328.25, 1 294.80, 2 174.63, P < 0.05). After health education in 2020, there were significant differences in the correct answer rates of epidemic causes, hazards and preventive measures of drinking water-borne fluorosis in the questionnaire of fifth grade pupils and housewives (χ 2 = 390.78, 164.94, P < 0.05). The awareness rates of drinking water-borne fluorosis in fifth grade pupils and housewives in the eastern region (Qingdao City, Yantai City and Weifang City) were significantly higher than those in the western region (Dezhou City, Liaocheng City and Heze City) before health education (χ 2 = 547.43, 210.12, P < 0.05), and after health education, the awareness rates increased to more than 90%. The detection rate of dental fluorosis in children decreased year by year (χ 2trend = 27.95, P < 0.05). Conclusions:Through implementation of a three-year special action for prevention and control of drinking water-borne fluorosis in Shandong Province, the awareness rate of fluorosis among target populations has been significantly improved. However, it is still necessary for government departments to further increase investment in health education and carry out health education activities in a deep-going way.

Objective:To dynamically monitor the prevalence and trend of dental fluorosis in children in Shandong Province, and to evaluate the prevention and control measures for drinking water-borne endemic fluorosis (referred to as drinking water-borne fluorosis), and to provide scientific basis for the next step.Methods:Totally 40 counties (cities, districts) were selected as project counties (cities, districts) from drinking water-borne fluorosis areas in Shandong Province in 2018, and all counties (cities, districts) were selected in 2019 and 2020, to investigate the situation of water improvement, detect water fluoride content, and investigate the prevalence of dental fluorosis in children aged 8 - 12 years.Results:From 2018 to 2020, the detection rates of dental fluorosis in children aged 8 - 12 years were 10.30% (503/4 884), 8.94% (25 895/289 539) and 8.66% (24 061/277 689), respectively, with statistically significant differences (χ 2 = 27.10, P < 0.001), and the dental fluorosis indexes were 0.21, 0.18 and 0.17, respectively. The total detection rates of dental fluorosis in children of different age groups in the 3 years were 7.26% (6 590/90 775), 7.97% (9 303/116 680), 9.29% (12 167/130 915), 9.29% (12 238/131 670) and 9.95% (10 161/102 072), the differences were statistically significant (χ 2 = 615.71, P < 0.001). In the 3 years, the total detection rate of dental fluorosis was 8.93% (28 101/314 737) in boys and 8.69% (22 358/257 375) in girls, the difference was statistically significant (χ 2 = 10.27, P = 0.001). In 2018 and 2019, the detection rates of dental fluorosis of children aged 8 - 12 years in water fluoride qualified villages [5.74% (235/4 095) and 7.98% (20 200/253 082)] were significantly lower than those in villages with excessive water fluoride [33.97% (268/789) and 15.62% (5 695/36 457), χ 2 = 570.61, 2 283.76, P < 0.001]. Conclusions:The prevalence of dental fluorosis among children aged 8 - 12 years has been effectively controlled, and remarkable results have been achieved in prevention and treatment of drinking water-borne fluorosis in Shandong Province. However, the detection rate of dental fluorosis among children in a few endemic villages is high, so it is necessary to continue to strengthen the monitoring of fluoride content in drinking water and the condition of dental fluorosis among children.

Hospice care is the product of the development of social civilization. Our country has gradually promoted the development of hospice care from the government, society, education and other levels, but has invested less in systematic education. This article reviews the development status of hospice care education at home and abroad in order to provide a reference for the development of related education in our country.

Objective To examine the value of bronchoscopy in the diagnosis of sputum-negative pulmonary tuberculosis in a general hospital.Methods A retrospective study was conducted for the 459 patients treated in a general hospital from June 2010 to May 2015.All the patients had symptoms and radiographic changes suggestive of pulmonary tuberculosis but smearnegative.All patients were subjected to bronchoscopy,including brushing,bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB).The bronchoscopic specimens were submitted for direct smear and acid-fast stain,Mycobacterium tuberculosis culture or histopathological assay,respectively.Results The diagnosis was confirmed by bronchoscopy in 378 (82.4％) of the 459 patients.Of the 378 patients whose diagnosis was confirmed,pulmonary tuberculosis was identified in 238 patients (63.0％).Other diagnoses included bronchogenic carcinoma,non-specific inflammation,organizing pneumonia,pulmonary fungal infection,interstitial pneumonia,sarcoidosis,nontuberculous mycobacterial infection.Of the patients with confirmed diagnosis by bronchoscopy,the sensitivity for diagnosis was 57.95％ by direct smear and acid-fast stain of brushing or BALF,79.78％ by culture of BALF,and 56.93％ by histopathological assay of TBB specimens.The integrated method by combining smear and stain,culture and histopathological assay of TBB specimens could improve the sensitivity,specificity,positive predictive value,and negative predictive value to 91.01％,97.46％,97.98％ and 88.89％.Conclusions For the patients whose clinical manifestations and imaging changes are suggestive of pulmonary tuberculosis but smear-negative,bronchoscopy is a valuable method for the diagnosis,which should be adopted as a routine test in clinical practice.

Objective Monkey B virus(BV), also known as Cercopithecine herpesvirus 1,is an important zoonotic pathogen.According to the national standard, antibodies are detected using BV as an antigen.However, the preparation of BV antigen is very stricted due to biosafety issues.Therefore, in this study, we used alternative antigens to detect the BV antibody by serological assay and verified their specifity and sensitivity.Methods A total of 135 blood samples from rhesus monkeys were tested by two ELISA method (BV and HVP2) and enzyme immunosorbent assay (EIA)method.The positive and suspicious samples were verified by immuno-fluorescence assay (IFA), Western blot and immunoblotting technique using HSV-1 gC1 purified glycoprotein as an antigen.Results The positive rates of HVP2-ELISA, BV-ELISA and HSV-1-EIA were 32.6%, 37.8% and 34.8%, respectively.Consistant result of the three detection method accounted for 91.1% (123/135), and the positive result were confirmed by IFA And WB.There were 12 suspicious samples,in which 33.3% (4/12) were verified to be positive.Conclusions Compared with BV antigen, the sensitivity and specificity of the alternative antigen HSV-1 are moe close than HVP2.Positive and suspicious samples should be verified by several method to avoid missed detection.

Objective To explore the clinical characteristics and treatment strategy of chronic low-er limb arterial ischemic. Methods The clinical data of 60 patients with chronic lower limb arterial ische-mic-treated from January 2017 to May 2017 were analyzed retrospectively (63 affected limbs). According to the patient's physical condition, clinical symptoms and pathological features, individualized surgical treat-ment was selected, including autogenous great saphenous vein or artificial blood vessel bypass grafting, ar-tery intima stripped, balloon dilatation, stenting, intracavity volume reduction, or hybrid procedures. The ankle brachial index of preoperative and postoperative 3 months was monitored, and patients were classified according to the Rutherford classification standard. Results Sixty cases were underwent surgery treatment, three patients were treated with bilateral lower limbs in the same period, successfully 58 cases and success rate reached 96. 67％. One case was subjected to amputation, and 1 case died (cardiovascular disease). Postoperative 3 month follow-up, the Rutherford grading of 59 affected limbs was improved markedly, aver-age ankle brachial index of postoperative was higher than preoperative ( P<0. 05 ) . Six cases of patients with ulcer were cured, the ulcer surface of 2 cases were significantly narrowed. Conclusions The inci-dence of chronic lower limb arterial ischemic is increasing year by year, the treatment ideas are constantly updated. It is safe and effective to select individualized treatment according to the patients' physical condi-tion, clinical symptoms and pathological feature. However it still needs to enlarge the sample and extend the time of follow-up to verify this point.

Objective To investigate the therapeutic effects of erythropoietin sustained-release gelatin hydrogel microspheres (EPO-GHM) on a murine model of hindlimb ischemia and related mechanisms.Methods Fifty two ten weeks old male C57BL/6J mice were assigned to 5 groups:shamoperated group (the right femoral artery suture was passed through the right femoral artery but not tied,n =8);saline group (right femoral artery ligation and intramuscular injection of saline at a dose of 4 ml/kg into the right hind limb,n =12);EPO group(right femoral artery ligation and intramuscular injection of EPO at a dose of 5 000 IU/kg into the right hind limb,n =12),empty GHM group (right femoral artery ligation and intramuscular injection of empty GHM at a dose of 4 ml/kg into the right hind limb,n =8);EPO-GHM group(right femoral artery ligation and intramuscular injection of EPO-GHM at a dose of 5 000 IU/kg into the right hind limb,n =12).The blood flow ratio of ischemic limb (right)/nonischemic limb (left) was measured using a laser Doppler perfusion imager.After 8 weeks,immunohistochemical analysis were used to evaluate the vessel density (vessel density of CD31 positive),arteriole density(vessel density of α-smooth muscle actin(α-SMA) positive) and muscle area(HHF35 positive area).The proliferating index of vessels was evaluated by double immunofluorescent labeling to evaluate effect of EPO-GHM on angiogenesis of ischemia limb.Western blot was used to evaluate the protein expression of EPO receptor,protein kinase B (AKT),p-AKT,endothelial nitric oxide synthase (eNOS),p-eNOS and matrix metalloproteinase 2(MMP-2).Results (1) Eight weeks later,the blood flow ratio of ischemic limb/nonischemic limb was significantly higher in the EPO-GHM group compared with other groups(0.810 ±0.080,0.563 ±0.051,0.570 ±0.056and 0.561 ± 0.052 respectively,all P ＜ 0.05).(2) CD31 antibody positive and α-SAM antibody positive densities were higher in the EPO-GHM group compared with other groups(P ＜ 0.01 or 0.05).(3)HHF35 positive area in saline group,EPO group,empty GHM group and EPO-GHM group were smaller than that of sham-operated group(all P ＜0.05).HHF35 positive area in saline group,EPO group,empty GHM group and EPO-GHM group were similar(all P ＞ 0.05).(4) The proliferating index of vessels was higher in the EPO-GHM group compared with other groups (P ＜ 0.01 or 0.05).(5) Compared with other groups,the protein levels of EPO receptor,AKT,p-AKT,p-eNOS and MMP-2 were significantly higher in EPO-GHM group(P ＜ 0.01 or 0.05) and level of eNOS was similar among five groups (P ＞ 0.05).Conclusion Results from present study suggest EPO-GHM could improve blood perfusion of ischemia limb in mice through increasing capillary and arteriolar densities and these beneficial effects are possibly mediated by EPOR up-regulation and AKT/p-eNOS/MMP-2 signaling pathway activation.