Objective:To investigate the operation of water improvement projects in villages affected by drinking-water-borne endemic arsenic poisoning in Shaanxi Province, the arsenic level in both internal and external environments, the trend of disease development and patient management, and evaluate the effectiveness of prevention and control measures.Methods:From March to December 2023, in accordance with the requirements of the "Notice of the Office of Shaanxi Provincial Health Commission on Issuing the Monitoring Plan for Key Endemic Diseases such as Kashin-Beck Disease" and the "Monitoring Plan for Endemic Fluorosis and Arsenism in Shaanxi Province", all villages affected by drinking-water-borne arsenic disease were monitored. Water arsenic testing was carried out in accordance with the "Standard Test Methods for Drinking Water Inorganic Nonmetallic Indicators" (GB/T 5750.5-2006), and the evaluation of whether water arsenic exceeded the standard was conducted based on the "Sanitary Standards for Drinking Water" (GB 5749-2022). According to the "Diagnosis of Endemic Arsenism" (WS/T 211-2015), the arsenic poisoning status of all population in the disease affected areas was investigated. In 5 villages of 3 monitoring counties, 358 people were randomly selected to determine the urinary arsenic level, and the determination was made according to the "Safety Guideline Value of Urinary Arsenic for Human Population" (WS/T 665-2019). According to the "Notice of the National Health Commission on Issuing the Evaluation Measures for Control and Elimination of Key Endemic Diseases (2019 Edition)", elimination evaluation was conducted.Results:A total of 2 cities, 3 counties, 9 towns, and 13 endemic villages were monitored, with a water improvement rate of 100% (13/13), and all were operating normally. The arsenic level in residents' drinking water was < 0.01 mg/L. A total of 12 688 people were examined, and 338 cases of arsenic poisoning were detected, all of whom were historical cases. There were no new cases of arsenic poisoning or skin cancer patients. The geometric mean of urinary arsenic was 0.026 0 mg/L, which was lower than the safety guideline value of 0.032 mg/L for urinary arsenic in the population. All 338 existing arsenic poisoning patients had received family doctor contract services and implemented follow-up management. The drinking-water-borne endemic arsenic poisoning areas counties in Shaanxi Province have reached the elimination standard.Conclusions:The water improvement project in drinking-water-borne endemic arsenic poisoning areas in Shaanxi Province is operating normally. The arsenic content in both the internal and external environments of the population meets the standard. The condition is stable and no new cases have been detected. Follow up management has been implemented for all current cases. All affected counties have reached the elimination standard.

Objective:Through microscopic and ultrastructural observations,to explore the origin of the cartilage of the anteroposterior pseudocyst.Staging for the auricular pseudocyst according to the different pathological changes and exploring its clinical significance.Methods:48 cases(51 ears)of the auricular pseudocyst were collected as the observation objects(46 males, 2 females, 15-76 years old) and 45 patients(45 ears)chronic suppurative otitis media hospitalized patients who underwent tympanic membrane repair as a normal control group(43 males, 2 females, 12-74 years old).The outer wall of the cyst was surgically resected and the residual auricular cartilage was retained in the control group for HE staining or transmission electron microscopy specimens, and the specimens were observed and analyzed under light microscope and transmission electron microscopy.Results:According to the data of this study, auricular pseudocyst was relatively common in people aged 21-60 years. The disease course of 4 ears was ≤ 10 days,the course of 16 ears was > 10 days yet ≤ 30 days, the course of 20 ears was > 1 month but ≤ 2 months,the course of 6 ears was > 2 months yet ≤ 1 year, the course of 3 ears was > one year but ≤ two years,and the course of 2 ears was > 2 years. The observation of microstructure and ultrastructure of the different course of outer walls of the auricle pseudocyst was shown:due to various causes of cartilage fluid that separated perichondrium and cartilage tissue, when the perichondrium was stimulated, the bone progenitor cells from the quiescence phase came to the activities period. With the extension of the course, the periosteum was thickening gradually, cartilage the bone progenitor cells idifferentiated into chondroblasts, which idifferentiated into chondrocytes last, from native to mature, from thin to thick. It was stable a period of time when the cartilage mature. The outer wall of the cyst was new cartilage, which reflected additional growth. The nucleus of the chondrocytes evolved into nucleolysis, and necrosis, when the lesions was stimulated.The control group had a thin layer of cartilage and periosteum, containing a small amount of osteoprogenitor cells; the cartilage layer was thick, the cartilage cells were small near the periosteum, and the deep cartilage cells were large, all of which were mature chondrocytes.Conclusions:The outer cartilage of auricle pseudocyst is newborn cartilage. The pathological staging is divided into early stage(cartilage formation), middle stage(cartilage maturity) and late stage(cartilage necrosis).This stage can provide a reference for exploring the pathogenesis of pseudocysts of the auricle and formulating surgical treatment principles.

Objective:To investigate the prevalence of skeletal fluorosis and the management and treatment of patients in endemic fluorosis areas of Shaanxi Province.Methods:From March to November 2023, in accordance with the requirements of the "2023 Monitoring Plan for Endemic Fluorosis in Shaanxi Province", the implementation of prevention and control measures of endemic fluorosis in Shaanxi Province was investigated. The data of patients with skeletal fluorosis from January to December 2023 were downloaded from Shaanxi Province Endemic Disease Control Information Management Platform, and the epidemiological characteristics were analyzed. At the same time, the management and treatment of patients with skeletal fluorosis in endemic fluorosis areas of Shaanxi Province were carried out in accordance with the requirements of the "Shaanxi Province Endemic Disease Patient Management Service Specification".Results:In 2023, there were 10 drinking water-borne endemic fluorosis cities in Shaanxi Province, involving 3 715 endemic villages, including 3 650 water improvement villages with a water-improving rate of 98.25%. There were 2 coal-burning-borne endemic fluorosis cities in Shaanxi Province, involving 641 746 households in 1 414 endemic villages. Among them, 641 617 households had changed their furnaces and stoves, with a furnace and stove change rate of 99.98%. There were 37 462 patients with skeletal fluorosis in the province, with 35 792 from drinking water-borne endemic fluorosis areas and 1 670 from coal-burning-borne endemic fluorosis areas. The condition was mainly mild and moderate (94.12%, 35 258/37 462), with females accounting for 55.13% (20 654/37 462). The education level was mainly primary school and illiteracy (83.64%, 31 333/37 462), and the occupation was mainly farmers (99.29%, 37 196/37 462). A total of 37 116 patients with skeletal fluorosis were followed up and managed, with a management rate of 99.08% (37 116/37 462). A total of 35 756 patients were managed in a standardized manner, and the standardized management rate was 96.34% (35 756/37 116). A total of 30 649 patients with skeletal fluorosis were actually treated, with a treatment rate of 84.27% (30 649/36 370) and a total effective rate of 98.08% (30 062/30 649).Conclusion:In 2023, the prevalence of skeletal fluorosis in endemic fluorosis areas of Shaanxi Province is mainly mild and moderate, with a wide coverage of community management and a high level of treatment efficiency.

Objective:To investigate the prevalence of skeletal fluorosis and the management and treatment of patients in endemic fluorosis areas of Shaanxi Province.Methods:From March to November 2023, in accordance with the requirements of the "2023 Monitoring Plan for Endemic Fluorosis in Shaanxi Province", the implementation of prevention and control measures of endemic fluorosis in Shaanxi Province was investigated. The data of patients with skeletal fluorosis from January to December 2023 were downloaded from Shaanxi Province Endemic Disease Control Information Management Platform, and the epidemiological characteristics were analyzed. At the same time, the management and treatment of patients with skeletal fluorosis in endemic fluorosis areas of Shaanxi Province were carried out in accordance with the requirements of the "Shaanxi Province Endemic Disease Patient Management Service Specification".Results:In 2023, there were 10 drinking water-borne endemic fluorosis cities in Shaanxi Province, involving 3 715 endemic villages, including 3 650 water improvement villages with a water-improving rate of 98.25%. There were 2 coal-burning-borne endemic fluorosis cities in Shaanxi Province, involving 641 746 households in 1 414 endemic villages. Among them, 641 617 households had changed their furnaces and stoves, with a furnace and stove change rate of 99.98%. There were 37 462 patients with skeletal fluorosis in the province, with 35 792 from drinking water-borne endemic fluorosis areas and 1 670 from coal-burning-borne endemic fluorosis areas. The condition was mainly mild and moderate (94.12%, 35 258/37 462), with females accounting for 55.13% (20 654/37 462). The education level was mainly primary school and illiteracy (83.64%, 31 333/37 462), and the occupation was mainly farmers (99.29%, 37 196/37 462). A total of 37 116 patients with skeletal fluorosis were followed up and managed, with a management rate of 99.08% (37 116/37 462). A total of 35 756 patients were managed in a standardized manner, and the standardized management rate was 96.34% (35 756/37 116). A total of 30 649 patients with skeletal fluorosis were actually treated, with a treatment rate of 84.27% (30 649/36 370) and a total effective rate of 98.08% (30 062/30 649).Conclusion:In 2023, the prevalence of skeletal fluorosis in endemic fluorosis areas of Shaanxi Province is mainly mild and moderate, with a wide coverage of community management and a high level of treatment efficiency.

Objective:To investigate the operation of water improvement projects in villages affected by drinking-water-borne endemic arsenic poisoning in Shaanxi Province, the arsenic level in both internal and external environments, the trend of disease development and patient management, and evaluate the effectiveness of prevention and control measures.Methods:From March to December 2023, in accordance with the requirements of the "Notice of the Office of Shaanxi Provincial Health Commission on Issuing the Monitoring Plan for Key Endemic Diseases such as Kashin-Beck Disease" and the "Monitoring Plan for Endemic Fluorosis and Arsenism in Shaanxi Province", all villages affected by drinking-water-borne arsenic disease were monitored. Water arsenic testing was carried out in accordance with the "Standard Test Methods for Drinking Water Inorganic Nonmetallic Indicators" (GB/T 5750.5-2006), and the evaluation of whether water arsenic exceeded the standard was conducted based on the "Sanitary Standards for Drinking Water" (GB 5749-2022). According to the "Diagnosis of Endemic Arsenism" (WS/T 211-2015), the arsenic poisoning status of all population in the disease affected areas was investigated. In 5 villages of 3 monitoring counties, 358 people were randomly selected to determine the urinary arsenic level, and the determination was made according to the "Safety Guideline Value of Urinary Arsenic for Human Population" (WS/T 665-2019). According to the "Notice of the National Health Commission on Issuing the Evaluation Measures for Control and Elimination of Key Endemic Diseases (2019 Edition)", elimination evaluation was conducted.Results:A total of 2 cities, 3 counties, 9 towns, and 13 endemic villages were monitored, with a water improvement rate of 100% (13/13), and all were operating normally. The arsenic level in residents' drinking water was < 0.01 mg/L. A total of 12 688 people were examined, and 338 cases of arsenic poisoning were detected, all of whom were historical cases. There were no new cases of arsenic poisoning or skin cancer patients. The geometric mean of urinary arsenic was 0.026 0 mg/L, which was lower than the safety guideline value of 0.032 mg/L for urinary arsenic in the population. All 338 existing arsenic poisoning patients had received family doctor contract services and implemented follow-up management. The drinking-water-borne endemic arsenic poisoning areas counties in Shaanxi Province have reached the elimination standard.Conclusions:The water improvement project in drinking-water-borne endemic arsenic poisoning areas in Shaanxi Province is operating normally. The arsenic content in both the internal and external environments of the population meets the standard. The condition is stable and no new cases have been detected. Follow up management has been implemented for all current cases. All affected counties have reached the elimination standard.

Objective:Through microscopic and ultrastructural observations,to explore the origin of the cartilage of the anteroposterior pseudocyst.Staging for the auricular pseudocyst according to the different pathological changes and exploring its clinical significance.Methods:48 cases(51 ears)of the auricular pseudocyst were collected as the observation objects(46 males, 2 females, 15-76 years old) and 45 patients(45 ears)chronic suppurative otitis media hospitalized patients who underwent tympanic membrane repair as a normal control group(43 males, 2 females, 12-74 years old).The outer wall of the cyst was surgically resected and the residual auricular cartilage was retained in the control group for HE staining or transmission electron microscopy specimens, and the specimens were observed and analyzed under light microscope and transmission electron microscopy.Results:According to the data of this study, auricular pseudocyst was relatively common in people aged 21-60 years. The disease course of 4 ears was ≤ 10 days,the course of 16 ears was > 10 days yet ≤ 30 days, the course of 20 ears was > 1 month but ≤ 2 months,the course of 6 ears was > 2 months yet ≤ 1 year, the course of 3 ears was > one year but ≤ two years,and the course of 2 ears was > 2 years. The observation of microstructure and ultrastructure of the different course of outer walls of the auricle pseudocyst was shown:due to various causes of cartilage fluid that separated perichondrium and cartilage tissue, when the perichondrium was stimulated, the bone progenitor cells from the quiescence phase came to the activities period. With the extension of the course, the periosteum was thickening gradually, cartilage the bone progenitor cells idifferentiated into chondroblasts, which idifferentiated into chondrocytes last, from native to mature, from thin to thick. It was stable a period of time when the cartilage mature. The outer wall of the cyst was new cartilage, which reflected additional growth. The nucleus of the chondrocytes evolved into nucleolysis, and necrosis, when the lesions was stimulated.The control group had a thin layer of cartilage and periosteum, containing a small amount of osteoprogenitor cells; the cartilage layer was thick, the cartilage cells were small near the periosteum, and the deep cartilage cells were large, all of which were mature chondrocytes.Conclusions:The outer cartilage of auricle pseudocyst is newborn cartilage. The pathological staging is divided into early stage(cartilage formation), middle stage(cartilage maturity) and late stage(cartilage necrosis).This stage can provide a reference for exploring the pathogenesis of pseudocysts of the auricle and formulating surgical treatment principles.

Objective:To learn about the monitoring indicators and patient management in coal-burning-borne endemic arsenic poisoning areas in Shaanxi Province, and provide a basis for consolidating and improving the prevention and control achievements.Methods:From March to December 2023, in accordance with the requirements of the "Notice of the Office of Shaanxi Provincial Health Commission on Issuing of the Monitoring Plan for Key Endemic Diseases Such as Kashin-Beck Disease" and "The Monitoring Plan for Endemic Fluorosis and Arsenic Poisoning in Shaanxi Province", a basic situation investigation was conducted in the affected villages of all counties (districts) with coal-burning-borne endemic arsenic poisoning in Shaanxi Province, and on-site visits were conducted to check the management of high arsenic coal mines. Using the simple random sampling method, 30 families in each village were selected to investigate the use of stoves and the formation of health-related behaviors. A survey on arsenic poisoning was carried out among all populations in the affected villages. According to the requirements of the provincial monitoring program, 720 people were randomly selected from 12 affected villages in 3 monitoring counties to measure their urinary arsenic level. The determination was based on the "Guidelines for the Safety of Urinary Arsenic in Population" (WS/T 665-2019). The evaluation for elimination of disease areas was carried out in accordance with the "National Health Commission Issued the Evaluation Approach for Control and Elimination of Priority Endemic Diseases (2019 edition)".Results:A total of 2 cities, 8 counties (districts), 99 townships, and 1 414 affected villages were monitored. All 53 high arsenic coal mines had stopped mining. The rate of qualified improved stoves was 99.97%; the correct utilization rate of qualified improved stoves, and the correct drying rate of corn and chili peppers provided for human consumption in the affected villages were 100.00%. A total of 2 064 138 people were examined, and 2 682 cases of arsenic poisoning were detected, all of whom were historical patients. There were no new cases of arsenic poisoning or skin cancer. There were currently 2 682 arsenic poisoning patients who had received family doctor contract services and implemented follow-up management. The geometric mean of urinary arsenic was 0.016 7 mg/L, which was lower than the safety guideline value for human urinary arsenic (0.032 mg/L).Conclusions:The monitoring indicators in the coal-burning-borne endemic arsenic poisoning areas in Shaanxi Province have reached the elimination standards. In the future, we should continue to strengthen the management of high arsenic coal mines, implement comprehensive prevention and control measures mainly focused on furnace and stove renovation and health promotion, and do a good job in patient management to continuously consolidate and improve the prevention and control achievements.

Objective:To learn about the operation of fluoride reduction and water improvement projects, the current situation of water fluoride level and the changing trend of fluorosis in drinking water-borne endemic fluorosis areas in Shaanxi Province, and to evaluate the effect of prevention and control measures.Methods:From March 2014 to December 2021, 15 endemic villages in drinking water-borne endemic fluorosis areas of Dali, Dingbian, Jingbian, Jingyang and Liquan counties in Shaanxi Province were selected as monitoring villages to investigate the operation of water improvement projects. Water samples were collected, and the water fluoride level was detected according to the "Standard Examination Methods for Drinking Water - Nonmetal Parameters" (GB/T 5750.5-2006). "Diagnosis of Dental Fluorosis" (WS/T 208-2011) was done to detect dental fluorosis in all children aged 8 - 12 who were born and lived in the monitoring village. Using "Diagnostic Standard for Endemic Skeletal Fluorosis" (WS/T 192-2008) and "Determination of Fluoride in Urine - Ion Selective Electrode Method" (WS/T 89-2015), X-ray examination and urine fluoride level test were performed on adults over 25 years old who had lived in the monitoring village for more than 5 years, respectively.Results:From 2014 to 2021, a total of 122 water improvement projects were investigated, all of which were in normal operation. The qualified rate of water fluoride increased from 81.25% (13/16) in 2014 to 100.00% (11/11) in 2021. A total of 5 595 children aged 8 - 12 were examined, 1 790 children with dental fluorosis were detected, with a detection rate of 31.99%. The detection rate of dental fluorosis in children decreased from 52.05% (304/584) in 2014 to 9.68% (93/961) in 2021, showing an overall downward trend (χ 2trend = 533.76, P < 0.001). In 2014, 791 adults were examined, and 256 patients with skeletal fluorosis were detected, the detection rate was 32.36%. In 2019, 770 adults were examined, and 88 patients with skeletal fluorosis were detected, with a detection rate of 11.43%. The detection rate of skeletal fluorosis in adults in 2019 was lower than that in 2014, and the difference was statistically significant (χ 2 = 99.54, P < 0.001). In 2014, 754 adult urine samples were collected, and the geometric mean of urine fluoride was 2.571 mg/L. In 2019, 770 adult urine samples were collected, and the geometric mean of urine fluoride was 1.292 mg/L. The geometric mean of urine fluoride in adults in 2019 was lower than that in 2014, and the difference was statistically significant ( Z = - 12.74, P < 0.001). Conclusions:From 2014 to 2021, the water improvement projects in drinking water-borne endemic fluorosis areas in Shaanxi Province are running normally, and the qualified rate of water fluoride has increased. The incidence of dental fluorosis in children and skeletal fluorosis in adults has decreased. In the later stage, it is necessary to continuously strengthen the monitoring and management of water improvement projects to prevent the rebound of water fluoride from causing residents' illness.

Objective To investigate the correlation between the prevalence of dental fluorosis in children and the intake of dietary nutrients. Methods A total of 81 children aged 8-12 (34 males and 47 females) with fluorosis were randomly selected in the districts of Daxu, Fuping, and Fuyang in Shaanxi Province where the drinking water had been changed for more than 5 years. The diagnosis of dental fluorosis was carried out using Dean's method. According to the 1:1 case-control study method, 81 children aged 8-12 (34 males and 47 females) without dental fluorosis were selected as a control group. A ^“double meal method^“ was employed for dietary investigation for 3 consecutive days. The differences in dietary nutrient intake between the two groups of children were analyzed and compared. Results There was no significant difference between the two groups (P>0.05). Compared with the control group, the difference in the dietary intake of vitamin C, vitamin E, calcium, magnesium, iron, zinc, copper, phosphorus, and selenium in the fluorosis group was not statistically significant (P>0.05). The logistic regression analysis of the prevalence of dental fluorosis in children showed that the dietary nutrient magnesium was associated with the onset of dental fluorosis. Conclusion Within a certain range, dietary magnesium is a protective factor for children with dental fluorosis. It is suggested that school-age children in areas with excessive water fluoride should be supplemented with sufficient magnesium in their diets.

Objective:To investigate the relationship between different fluorine concentrations in drinking water and dental fluorosis and caries of children.Methods:In 2014-2019, 5 cities and 6 counties (districts) were selected, which were Dali and Heyang counties of Weinan City, Liquan County of Xianyang City, Fugu County of Yulin City, Chencang District of Baoji City, and Yanliang District of Xi'an City, villages of different water fluorine contents were selected, 3 tap water samples were collected from each village to detect the water fluoride content. The prevalence of dental fluorosis and caries in children aged 8 to 12 years old in villages was investigated, and children's urinary fluorine level was determined.Results:Totally 48 water samples and 868 urine samples were tested, and the water fluorine content was from 0.23 to 3.70 mg/L, and the urinary fluorine mean was 1.47 mg/L; 1 021 children aged 8-12 years old were examined, 372 were diagnosed with dental fluorosis, the detection rate was 36.43%; 198 with caries, the detection rate was 19.39%. The detection rate of caries in children decreased and then increased with the increase of water fluorine ( F=14.470, P < 0.05), and the detection rate of caries was the lowest when the water fluorine was 1.2-< 2.0 mg/L. The detection rate of dental fluorosis in children increased with the increase of water fluorine ( F=52.215, P < 0.05), when the water fluoride was 1.0-< 1.2 mg/L, the detection rate of children's dental fluorosis was 31.90% (37/116), which was basically within the national control line (30%). Conclusion:The content of water fluoride in 1.0-< 1.2 mg/L, can not only reduce the detection rate of caries, but also control the prevalence of dental fluorosis.