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.

Objective:To study the implementation progress of the prevention and control measures for drinking water-borne endemic fluorosis and the changing trend of fluorosis conditions in Inner Mongolia Autonomous Region, comprehensively evaluate the effectiveness of prevention and control measures, and provide a basis for the next step of prevention and control of the disease.Methods:In 2015 and 2023, a cross-sectional survey method was used to investigate the water improvement situation, the operation of water improvement projects, the detection of fluoride level in water, and the prevalence of dental fluorosis in children aged 8 to 12 in all affected villages of 11 leagues (cities) in the entire autonomous region. The prevention and control effect of drinking water-borne endemic fluorosis in the entire autonomous region was evaluated.Results:The water improvement rates of all affected villages in the entire autonomous region in 2015 and 2023 were 84.12% (8 218/9 769) and 95.38% (8 944/9 377), respectively. The qualified rates of water fluoride in the villages with water improvement in the entire autonomous region were 66.21% (5 441/8 218) and 91.00% (8 139/8 944), respectively. The water improvement rate and water fluoride qualification rate of water improvement villages in 2023 were both higher than those in 2015, and the differences were statistically significant (χ 2 = 652.96, 1 593.81, P < 0.001). The detection rates of dental fluorosis in children aged 8 to 12 years in the entire autonomous region in 2015 and 2023 were 9.26% (7 548/81 484) and 4.46% (3 441/77 155), respectively. The detection rate of dental fluorosis in children in 2023 was lower than that in 2015, and the difference was statistically significant (χ 2 = 1 418.20, P < 0.001). In 2015 and 2023, the total compliance rate of all affected villages in the entire autonomous region reaching the control standards were 57.94% (5 660/ 9 769) and 92.37% (8 662/9 377), respectively. The total compliance rate of all affected villages in 2023 was higher than that in 2015, and the difference was statistically significant (χ 2 = 3 010.38, P < 0.001). Conclusions:Compared with 2015, the prevention and control measures of drinking water-borne endemic fluorosis in Inner Mongolia Autonomous Region have been effectively implemented in 2023, with a significant decrease in the detection rate of dental fluorosis in children. However, there are still a few affected villages that have not achieved the control standards, and prevention and control work still need to be further strengthened.

Objective:To investigate the characteristics of the population of skeletal fluorosis patients in drinking-tea-borne endemic fluorosis (referred to as drinking-tea-borne fluorosis) areas in Inner Mongolia Autonomous Region (referred to as Inner Mongolia) and the influencing factors of treatment willingness, and to provide a basis for improving the prevention and control measures of drinking-tea-borne fluorosis and the treatment plan of skeletal fluorosis.Methods:From August to October 2022, a face-to-face questionnaire survey was conducted in key areas of drinking-tea-borne fluorosis in Inner Mongolia (administrative villages with an average daily intake of tea fluoride > 3.5 mg and skeletal fluorosis patients identified by the general survey of drinking-tea-borne fluorosis in Inner Mongolia in 2019), and to investigate the demographic, severity, and treatment status of patients with skeletal fluorosis, analyze the demographic characteristics of patients with skeletal fluorosis and the influencing factors of treatment willingness.Results:A total of 734 patients with skeletal fluorosis were investigated, including 543 mild cases, 125 moderate cases and 66 severe cases. The gender ratio of patients with skeletal fluorosis was 0.71 ∶ 1.00 (305/429), the age was concentrated in > 50 - 70 years old (70.57%, 518/734), the proportion of Mongolians was 94.28% (692/734), the proportion of herders was 97.68% (717/734), the educational level was mainly primary school (54.63%, 401/734), and the proportion of poor households and immigrants who had moved to their current residence was 7.08% (52/734) and 8.04% (59/734), respectively. The distribution of the severity of skeletal fluorosis in patients of different ages, genders, and educational levels was compared, and the differences were statistically significant ( P < 0.05). Fifty-three point two seven percent (391/734) of the patients had a willingness to undergo non-pharmacological treatment, of which 69.82% (273/391) had already started non-pharmacological treatment, with a treatment effectiveness rate of 73.99% (202/273). Sixty-five point two six percent (479/734) of the patients had a willingness to receive medication treatment, of which 7.31% (35/479) had already started medication treatment, with a treatment effectiveness rate of 54.29% (19/35). Zero point two seven percent (2/734) of the patients expressed a willingness to undergo surgical treatment, while no patients underwent surgical treatment. Multivariate logistic regression analysis showed that the age, ethnicity, occupation, educational level, poverty status, immigrants status, and the severity of skeletal fluorosis were all influencing factors of non-pharmacological treatment willingness ( P < 0.05). Occupation, educational level, poverty status, immigrants status, and the severity of skeletal fluorosis were all influencing factors of medication treatment willingness ( P < 0.05). Conclusions:Patients with skeletal fluorosis caused by tea drinking in Inner Mongolia are mainly from Mongolian ethnic groups, herders, middle-aged and elderly people, and those with a lower educational levels. The willingness of patients to receive treatment is influenced by various factors, and corresponding intervention measures can be formulated and taken based on these influencing factors to effectively improve the disease prevention awareness and treatment willingness of patients and the public.

Objective:To study the implementation progress of the prevention and control measures for drinking water-borne endemic fluorosis and the changing trend of fluorosis conditions in Inner Mongolia Autonomous Region, comprehensively evaluate the effectiveness of prevention and control measures, and provide a basis for the next step of prevention and control of the disease.Methods:In 2015 and 2023, a cross-sectional survey method was used to investigate the water improvement situation, the operation of water improvement projects, the detection of fluoride level in water, and the prevalence of dental fluorosis in children aged 8 to 12 in all affected villages of 11 leagues (cities) in the entire autonomous region. The prevention and control effect of drinking water-borne endemic fluorosis in the entire autonomous region was evaluated.Results:The water improvement rates of all affected villages in the entire autonomous region in 2015 and 2023 were 84.12% (8 218/9 769) and 95.38% (8 944/9 377), respectively. The qualified rates of water fluoride in the villages with water improvement in the entire autonomous region were 66.21% (5 441/8 218) and 91.00% (8 139/8 944), respectively. The water improvement rate and water fluoride qualification rate of water improvement villages in 2023 were both higher than those in 2015, and the differences were statistically significant (χ 2 = 652.96, 1 593.81, P < 0.001). The detection rates of dental fluorosis in children aged 8 to 12 years in the entire autonomous region in 2015 and 2023 were 9.26% (7 548/81 484) and 4.46% (3 441/77 155), respectively. The detection rate of dental fluorosis in children in 2023 was lower than that in 2015, and the difference was statistically significant (χ 2 = 1 418.20, P < 0.001). In 2015 and 2023, the total compliance rate of all affected villages in the entire autonomous region reaching the control standards were 57.94% (5 660/ 9 769) and 92.37% (8 662/9 377), respectively. The total compliance rate of all affected villages in 2023 was higher than that in 2015, and the difference was statistically significant (χ 2 = 3 010.38, P < 0.001). Conclusions:Compared with 2015, the prevention and control measures of drinking water-borne endemic fluorosis in Inner Mongolia Autonomous Region have been effectively implemented in 2023, with a significant decrease in the detection rate of dental fluorosis in children. However, there are still a few affected villages that have not achieved the control standards, and prevention and control work still need to be further strengthened.

Objective:To investigate the characteristics of the population of skeletal fluorosis patients in drinking-tea-borne endemic fluorosis (referred to as drinking-tea-borne fluorosis) areas in Inner Mongolia Autonomous Region (referred to as Inner Mongolia) and the influencing factors of treatment willingness, and to provide a basis for improving the prevention and control measures of drinking-tea-borne fluorosis and the treatment plan of skeletal fluorosis.Methods:From August to October 2022, a face-to-face questionnaire survey was conducted in key areas of drinking-tea-borne fluorosis in Inner Mongolia (administrative villages with an average daily intake of tea fluoride > 3.5 mg and skeletal fluorosis patients identified by the general survey of drinking-tea-borne fluorosis in Inner Mongolia in 2019), and to investigate the demographic, severity, and treatment status of patients with skeletal fluorosis, analyze the demographic characteristics of patients with skeletal fluorosis and the influencing factors of treatment willingness.Results:A total of 734 patients with skeletal fluorosis were investigated, including 543 mild cases, 125 moderate cases and 66 severe cases. The gender ratio of patients with skeletal fluorosis was 0.71 ∶ 1.00 (305/429), the age was concentrated in > 50 - 70 years old (70.57%, 518/734), the proportion of Mongolians was 94.28% (692/734), the proportion of herders was 97.68% (717/734), the educational level was mainly primary school (54.63%, 401/734), and the proportion of poor households and immigrants who had moved to their current residence was 7.08% (52/734) and 8.04% (59/734), respectively. The distribution of the severity of skeletal fluorosis in patients of different ages, genders, and educational levels was compared, and the differences were statistically significant ( P < 0.05). Fifty-three point two seven percent (391/734) of the patients had a willingness to undergo non-pharmacological treatment, of which 69.82% (273/391) had already started non-pharmacological treatment, with a treatment effectiveness rate of 73.99% (202/273). Sixty-five point two six percent (479/734) of the patients had a willingness to receive medication treatment, of which 7.31% (35/479) had already started medication treatment, with a treatment effectiveness rate of 54.29% (19/35). Zero point two seven percent (2/734) of the patients expressed a willingness to undergo surgical treatment, while no patients underwent surgical treatment. Multivariate logistic regression analysis showed that the age, ethnicity, occupation, educational level, poverty status, immigrants status, and the severity of skeletal fluorosis were all influencing factors of non-pharmacological treatment willingness ( P < 0.05). Occupation, educational level, poverty status, immigrants status, and the severity of skeletal fluorosis were all influencing factors of medication treatment willingness ( P < 0.05). Conclusions:Patients with skeletal fluorosis caused by tea drinking in Inner Mongolia are mainly from Mongolian ethnic groups, herders, middle-aged and elderly people, and those with a lower educational levels. The willingness of patients to receive treatment is influenced by various factors, and corresponding intervention measures can be formulated and taken based on these influencing factors to effectively improve the disease prevention awareness and treatment willingness of patients and the public.

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.

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 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.

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 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.