Objective:To explore the pathogenic characteristics of incision wound infections after breast cancer surgery and related influencing factors.Methods:Clinical files of 200 middle-aged and elderly patients who underwent breast-conserving surgery for breast cancer in the Affiliated Three Gorges Hospital from May 2016 to April 2021 were retrospectively analyzed.The results of pathogenic bacteria and drug sensitivity tests were examined, and the influencing factors of postoperative incision infections after breast cancer surgery were analyzed.Results:Among 200 middle-aged and elderly patients aged 55-75 years who underwent breast-conserving surgery for breast cancer, 13 patients(4.64%)developed postoperative incision infections, with 40 strains of pathogenic bacteria isolated, including 14 strains of gram-positive bacteria, 25 strains of gram-negative bacteria and 1 fungal strain.Univariate and multivariate logistic regression analysis showed that age( OR=3.40), duration of surgery( OR=2.50), albumin level( OR=2.83), underlying diseases( OR=4.23), preventive use of antibiotics( OR=3.14)and length of hospital stay( OR=2.33)were independent risk factors for postoperative incision infections in breast cancer patients(all P<0.05). Conclusions:Common pathogens of incision infections after breast-conserving surgery are Gram-negative bacteria.There are many factors affecting postoperative incision infections.Clinical measures need to be taken to reduce or prevent postoperative incision infections.

Objective: To understand the prevention and control of coal-burning-borne endemic fluorosis in Hubei Province, and to evaluate the effects of prevention and control measures on coal-burning-borne endemic fluorosis. Methods: According to the requirements of national "Coal-burning-borne Endemic Fluorosis Monitoring Program", 9 fixed monitoring villages and 15 non-fixed villages in Jianshi, Badong and Zhuxi were selected as the monitoring sites every year from 2012 to 2017, 10 households were selected in each village to carry out the dynamic monitoring of the usage of stove and health behavior related to the corn and pepper for human consumption. At the same time, the monitoring survey of children's dental fluorosis and urinary fluoride were carried out. Results: From 2012 to 2017, the residents of the monitoring villages mainly used the improved stoves, the usage rates of the improved stove were all > 96%. There were statistically significant differences in the qualified rate and correct usage rate of the improved stove between each year (fixed monitoring villages: χ²= 48.71, 63.72, P < 0.05; non-fixed monitoring villages: χ²= 74.02, 84.80, P < 0.05). The correct usage rates of the improved stove were all 100.00% from 2015 to 2017. There were statistically significant differences in the correct rate of drying, keeping and washing eating corn and pepper between each year (fixed monitoring villages: χ²= 10.18, 10.41, 4.99, 15.71, 4.67, 6.80, P < 0.05; non-fixed monitoring villages: χ²= 6.22, 6.23, 18.86, 49.90, 23.88, 6.42, P < 0.05). From 2015 to 2017, all the rest rates were 100.00% except for the washing rate of pepper before eating. It showed a significant decline of dental fluorosis detection rate in 8 to 12 years old children annually (χ²=251.89, P < 0.05), from 33.57% (330/983) of 2012 to 10.26% (111/1 082) of 2017. The geometric means of urinary fluoride of children were 0.62, 0.60, 0.54, 0.53, 0.54 and 0.47 mg/L, respectively. There was statistically significant difference between each year (H=56.91, P < 0.05). Conclusions The prevention and control measures on coal-burning-borne endemic fluorosis of the 3 monitoring counties are implemented well in Hubei Province. Health behavior and life style are gradually formed, and the general condition gets better obviously.

Objective To analyze the status of iodine nutrition after implementing new standard of iodized salt in Hubei Province,and to evaluate the effectiveness of prevention and control measures.Methods In 2016,in 103 counties (cities,districts) of Hubei Province,the townships (streets) under the jurisdiction of each county (city,district) were divided into five regions:east,south,west,north,and middle.One township (street) was selected from each region,and one primary school was selected from each township (street).From each primary school 40 children aged 8-10 (half males half females) were selected to collect salt samples from their households.Twenty pregnant women from townships (streets) near the selected schools were chosen to collect edible salt samples from their households.According to the method of population proportionate sampling (PPS),35 counties (cities,districts) were chosen from 103 counties (cities,districts).Thyroid volume of children aged 8-10 was examined,and urinary iodine of children and pregnant women were tested.Iodine nutrition criteria:the median urinary iodine of children ＜ 100 μg/L is iodine deficiency,100-＜ 200 μg/L is iodine appropriate,200-＜ 300 μg/L is iodine overdose,≥300 μg/L is iodine excess;pregnant women urinary iodine median ＜ 150 μg/L is iodine deficiency,150-＜ 250 μg/L is iodine appropriate,250-＜ 500 μg/L is iodine overdose,and ≥ 500 μg/L is iodine excess.Results Totally 30 967 edible salt samples from children's and pregnant women's households were examined,and the median of salt iodine was 23.85 mg/kg.The coverage rate of iodized salt was 99.46％ (30 799/30 967),the consumption rate of qualified iodized salt was 94.00％ (29 108/30 967).Totally 6 789 children aged 8-10 were examined thyroid volume and detected urinary iodine,the goiter rate was 0.85％ (58/6 789) and the median urinary iodine was 263.54 μg/L.Totally 3 348 urine samples of pregnant women were examined,and the median urinary iodine was 166.71 μg/L.Conclusions The salt iodine content of residents and the goiter rate of children in Hubei Province meet the national standard for eliminating iodine deficiency disorders.The iodine nutrition level of children and pregnant women is iodine appropriate or iodine overdose.The iodine nutrition level monitoring of key populations should be continuously strengthened.

Objective To systematically review the correlation between fluoride exposure through drinking water and dental fluorosis of school-age children,and to provide a theoretical basis for further development of prevention strategies against dental fluorosis.Methods Such databases as China National Knowledge Infrastructure (CNKI),WanFang Data,VIP Database and China Biology Medicine Disc (CBM) were searched through computer to find out the relationship between fluoride exposure through dringking water and occurrence of dental fluorosis.The retrieval time was from January 1,2000 to January 1,2018.Meta-analysis was performed using RevMan 5.3.Funnel plot and fail-safe method were used to evaluate publication bias,and these data were analyzed sensitivity with random and fixed effect models.Results Totally 20 literatures entered into this study,79 814 people in fluoride exposure group,and 181 876 people in control group.The meta-analysis showed that,20 literatures were inhomogeneous through the heterogeneity test,which was analyzed in the random effect model,the pooled odds ratio (OR) value and 95％ confidence interval (95％CI) was 4.25 (3.66-4.94),which suggested that the risk of dental fluorosis in the fluoride exposure group was 4.25 times higher than that in control group.Funnel plot was asymmetrical,the fail-safe number was 47 791.56,which was 2 389.6 (47 792/20) times higher than included literatures.Literatures publication bias was small,sensitivity analysis revealed that the results were basically reliable.Conclusion Excessive fluoride exposure through dringking water could be one of the main risk factors leading to dental fluorosis.

Objective To make clear the arsenic distribution in drinking water sources in Hubei Province, make provincial distribution map of high-arsenic water and provide scientific basis for formulating refined measures to prevent and control arsenic poisoning of drinking water type in Hubei Province. Methods In 103 counties of Hubei Province, residents were sampled according to different water supplies (centralized water supply, small centralized water supply in rural areas and decentralized water supply). One water sample was collected from source water and tap water in centralized water supply system and at least 3 samples were collected from decentralized water supply system in a village. Water iodine content was tested using atomic fluorescence spectrometry and a distribution map of high-arsenic water at county level was drawn using ArcGIS 10.2. Results Totally 38 292 water samples were collected. The water-arsenic-concentration median was less than 1.00 μg/L. The high-arsenic water detection rate in urban centralized water supply was 3.7%(80/2 176);which were all 0.1%(4/4 304,30/31 812) in small centralized water supply in rural areas and decentralized water supply. The high-arsenic water sources from centralized water supplies were distributed centrally in the south, the central and the east of Hubei Province and those from dispersed water supplies were distributed dispersedly in the south, the central and the east of Hubei Province.Conclusions There are still some dispersed water supplies with very high arsenic concentration in Hubei Province, which should be included to change the water area as soon as possible. Moreover, high arsenic water samples are found from centralized water supplies, which means the water treatment process should be upgraded or water resources should be changed.

Objective To make clear the fluorine content distribution in drinking water of residents in Hubei Province,draw a provincial distribution map of high-fluorine water and provide scientific basis for formulating refined prevention and control measures of drinking water type fluorosis in Hubei Province.Methods In 116 counties of Hubei Province,including development zones,scenic zones and farmlands,drinking water of residents was sampled according to different water supplies (centralized water supply,small centralized water supply in rual areas and decentralized water supply) from 2013 to 2015.For a centralized water supply,one sample was collected from the source water and the tap water each and at least 3 samples were collected for decentralized water supply in a village.Selective electrode method was used to detect the water fluorine content and ArcGIS 10.2 was used to draw distribution map of high-fluorine water at county level.Results A total of 38 284 water samples were collected,the median of fluorine content was 0.21 mg/L.The highest detective rate of all types of water supply with high fluorine content was pressure water well (64/100,64.0％) and high-fluorine water sample was not found in the reservoir.The high-fluorine water sources from centralized water supplies were distributed dispersedly in the north-west and the east of Hubei Province and those from decentralized water supplies were distributed dispersedly in the middle-north and the east of Hubei Province.Conclusions Fluorine concentration in drinking water is generally low.However,there are still some high-fluorine water supplies which should be reported to Hubei Provincial Water Resources Department as soon as possible.Moreover,there is a phenomenon of fluorine rebounce in the water reduction project,and managements of those projects should be strengthened.

Objective To get to know the status of iodine deficiency disorders (IDD) and provide scientific basis for the 13th Five-year Plan of control and prevention of IDD in Hubei Province.Method In 2015,103 counties were selected to test or inspect iodine content of 300 salt samples from 300 residents,urinary iodine content and thyroid volume (palpation) of 200 children aged 8-10,and urinary iodine content of 100 pregnant women.Results Thirty thousand and nine hundred salt samples were collected.Coverage rate of iodized salt,qualified rate of iodine salt and qualified iodine salt edible rate were 99.61％ (30 780/30 900),94.46％ (29 074/30 780) and 94.09％ (29 074/30 900),respectively;the median iodine content of 20 600 urine samples of 8-10 old children was 252.0 μg/L and goiter rate was 0.39％ (80/20 600);the median iodine content of 10 257 urine samples of pregnant women was 180.0 μg/L.Conclusions As a whole,the measure of control and prevention of IDD by iodized salt is implemented well in Hubei Province.The overall iodine nutrition of residents is good.However there is space to lower the iodine concentration of iodized salt with coordinated measure of special edible salt for pregnant woman to satisfy different needs of special people.

Objective Through the dynamical monitoring of the water improvement projects operation,we intend to understand the prevalent trends of endemic fluorosis of children aged 8 to 12 in Hubei,to evaluate the effect of control measures and to provide the basis for making preventive measures.Methods In Hubei,ten surveillance counties were selected,and three epidemic villages were selected as fixed monitoring villages in each county from 2010 to 2014.In those villages,the operation situation of water improvement projects and the fluoride content in drinking water were detected,and the dental fluorosis of children aged 8 to 12 was diagnosed.Results From 2010 to 2014,the normal operation rate of water improvement projects was 75.61％-100.00％,the average of water fluorine content did not change,the differences were not statistically significant (F =2.00,P ＞ 0.05).The numbers of water improvement projects with water fluorine content in excessive amount was increased in the past five years which was only one project in 2010-2012 and was increased to two projects in 2013 and 2014.In 2010-2014,the dental fluorosis prevalence rate of whole children was 9.45％ (525/5 557),the dental fluorosis prevalence rate of exceeding-standard villages of water fluoride content was 42.40％ (92/217),the dental fluorosis prevalence rate of qualified villages was 8.11％ (433/5 340).The children's dental fluorosis prevalence rate of exceeding-standard villages of water fluoride content was higher than that in qualified villages;the differences were statistically significant (x2 =282.60,P ＜ 0.05).Conclusions The operation rate of water-improving projects is mostly higher than 90％,and so is the qualification rate of fluoride content in drinking water.The operation condition and water quality of the water-improving projects in Hubei need to be improved.The prevalence of children dental fluorosis of affected villages has dropped significantly after low fluoride water is provided continuously.

Objective To investigate and analyze the examination and acceptance results for coalburning-borne endemic fluorosis control and elimination in Hubei Province.Methods A county-level selfinspection and a provincial-level spot-check were conducted to investigate the status of improved-stove usage,the situation of correctly drying corn and chili,and the dental fluorosis prevalence among children aged 8 to 12 in 501 historic coal-burning-borne endemic fluorosis villages of 6 counties (cities) in Hubei Province from 2012 to 2014.The endemic areas were selected according to the Control Standards of Endemic Fluorosis in Endemic Areas (GB 17017-2010) and Eliminating Standards of Coal-burning Type Endemic Fluorosis.Results The results of county-level inspection showed that the qualified rates of improved stoves,the correct-usage rates of qualified stoves,and the correctly drying rates of corn and chili were all higher than 98％ in targeted villages,and the prevalence rate of dental fluorosis of children was 7.73％ (2 319/30 003).The results of provincial-level recheck were more than 99％ and 8.25％ (353/4 277),respectively.The results of county-level inspection were of good consistency with those of provincial-level recheck (88.89％,48/54).Five counties (cities) but one had met the standard of fluorosis control or elimination.Conclusion Coal-burning-borne endemic fluorosis scope in Hubei Province is narrowed greatly and the prevalence rates are decreased significantly.