Objective To explore the association between different levels of fluoride exposure and dyslipidemia in elderly people, and to analyze the influencing factors and their interactions. Methods A total of 1 143 elderly people over 60 years old were randomly selected from historical high water fluorosis areas and control areas in Tianjin. Logistic regression model and classification tree model were used to analyze the influencing factors of dyslipidemia, and to analyze the interaction between high fluoride exposure and relevant influencing factors on dyslipidemia. Results The prevalence of elevated low density lipoprotein cholesterol (LDL-C) was 5.69% (65/1 143). There was a significant difference in the prevalence of high LDL-C in different fluoride-exposed areas (2 = 0.092，P = 0.762). Multivariate logistic analysis showed that high fluoride exposure (OR=2.306，95%CI：1.185-4.491) and abdominal obesity (OR=2.274，95%CI：1.299-3.978) were risk factors for high LDL-C, while type B personality (OR=0.529，95%CI：0.308-0.908) was a protective factor for high LDL-C. The results of classification tree model showed that abdominal obesity contributed the most to the prevalence of high LDL-C in the elderly, followed by high fluoride exposure and hyperglycemia. There was a significant multiplicative interaction between high fluoride exposure and abdominal obesity on dyslipidemia (OR=5.191,95%CI：1.609-16.745，P=0.006). Conclusion High fluoride exposure may increase the risk of high LDL-C, and there is a multiplicative interaction between high fluoride exposure and abdominal obesity on dyslipidemia.

Objective To investigate the status and the influencing factors of thyroid volume of children aged 8-10 years in Tianjin. Methods Among the 1-2 primary schools were randomly selected from 12 districts in Tianjin. A total of 1 090 children were selected by class cluster sampling method (half male and half female, with a balanced age distribution). A questionnaire survey was conducted. Children’s height, weight and thyroid volume were measured, and their salt iodine content and urinary iodine content were detected. Results I n this study, the median urinary iodine in children was 161.35 µg/L, the mean thyroid volume was 2.56 mL, and the goiter rate was 3.58%. Univariate analysis showed that age, BSA, salt iodine content, urinary iodine content, eating habits, food taste, eating lunch at school, father's work, anxiety and depression, pressure, and different regional grouping were the influencing factors of thyroid volume (P<0.05). Multivariate linear regression showed that BSA, age, food taste, and urinary iodine content had significant independent effects on thyroid volume (P<0.05). Conclusion In Tianjin, the iodine nutrition level of children aged 8-10 years is at an appropriate level. When evaluating the thyroid volume of children, in addition to age factors, other factors such as physical development level and iodine intake should also be considered.

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infec-tion.Sepsis-associated encephalopathy(SAE)is one of the common complications of sepsis patients,which can be seen in 70％of sepsis patients,mainly manifested by sepsis-related cognitive dysfunction,and its pathogen-esis is complex,mainly including mitochondrial dysfunction,oxidative stress,neuroinflammation,autophagy,etc.Pyroptosis is a special type of programmed cell death that is involved in the regulation of inflammation and immune responses.Neuronal pyroptosis plays an important role in the pathogenesis of SAE.This paper re-views the pathologic mechanism,physiological mechanism,related signaling pathways and potential molecular regulatory mechanisms of neurons pyroptosis in SAE in order to provide the new ideas for the prevention and treatment of SAE.

Objective:To analyze the influencing factors of dental fluorosis of children in the drinking-water-borne endemic fluorosis (referred to as drinking-water-borne fluorosis) areas with qualified drinking water.Methods:In 2020 and 2021, the cluster sampling method was used to select the children aged 8 to 12 years old from the drinking-water-borne fluorisis areas with qualified drinking water in Tianjin City for water and urine fluoride detection, dental fluorosis examination and questionnaire survey, and logistic regression and classification tree model were used to analyze the influencing factors of dental fluorosis in children.Results:A total of 3 795 cases children aged 8 to 12 years old were investigated, and 1 001 cases of dental fluorosis were detected, and the detection rate of dental fluorosis was 26.38% (1 001/3 795). The results of logistic analysis showed that age [odds ratio ( OR) = 1.193, 95% confidence interval ( CI): 1.115 - 1.277], high urinary fluoride (1.84 - 19.40 mg/L, OR = 1.510, 95% CI: 1.169 - 1.952) and the number of permanent residents at home ≥6 ( OR = 1.377, 95% CI: 1.090 - 1.739) were risk factors of dental fluorosis in children; and the mother's with higher education level (college degree or above, OR = 0.664, 95% CI: 0.441 - 0.999), the years of water improvement ≥5 years (5 - < 10 years, OR = 0.193, 95% CI: 0.157 - 0.238; ≥10 years, OR = 0.254, 95% CI: 0.193 - 0.333) were protective factors of dental fluorosis in children. The results of classification tree model analysis showed that the years of water improvement contributed the most to the prevalence of dental fluorosis among children in the drinking-water-borne fluorisis areas with qualified drinking water, followed by age, number of permanent residents at home and urinary fluoride. The area under the receiver operating characteristic curve (AUC) of logistic regression model and classification tree model were 0.730 (95% CI: 0.711 - 0.748) and 0.721 (95% CI: 0.702 - 0.739), respectively, with good fitting effect. Conclusion:The detection rate of children's dental fluorosis in the drinking-water-borne fluorosis areas with qualified drinking water is mainly related to the years of water improvement, age, the number of permanent residents at home and urinary fluoride.

Objective:To understand the current status of overweight and obesity, the iodine nutrition level and goiter among children in Tianjin, and explore their relationships, so as to effectively adjust the prevention and control measures.Methods:From January 2019 to December 2020, one primary school was selected from all towns or streets in 16 districts of Tianjin, and non-boarding children aged 8 to 10 (age and gender balanced) were selected from each primary school. The number of children sampled in towns or streets in each district was as even as possible. Every year, 200 children from each district were investigated for height, weight, iodine of household edible salt, urinary iodine and thyroid volume. Body mass index (BMI) was calculated and its relationship with iodine nutrition level and goiter of children was analyzed.Results:A total of 6 552 children were investigated, and the median urinary iodine was 178.95 μg/L, the goiter rate was 2.15% (141/6 552). There was no significant difference in iodine content of household edible salt among children in different BMI groups ( P = 0.835), but the difference in thyroid volume was statistically significant ( P < 0.001). By constructing a restrictive cubic spline model, the risk of goiter in children of different age groups increased with increase of BMI ( P < 0.001 or P = 0.002). Conclusions:The BMI of children is closely related to thyroid volume. The influence of height and weight should be considered in diagnosis of goiter of children.

Objective:To analyze the clinical characteristics and outcomes of critically ill pregnant and parturient women in intensive care unit (ICU), and to provide clinical experience for the subspecialty construction of critical obstetrics.Methods:The clinical data of critically ill pregnant and parturient women admitted to the department of critical care medicine, the Second Affiliated Hospital of Kunming Medical University from January 2011 to December 2019 were collected. The main reasons for maternal transfer to ICU, the causes of maternal death, and organ support measures, etc. were summarized.Results:A total of 39 567 critically ill pregnant and parturient women were admitted to the department of obstetrics in our hospital, and 360 were transferred to ICU, with an average ICU transfer rate of 0.91%. Since 2016, the number of obstetric admissions, the number of ICU transfers and the ICU transfer rate had increased significantly. The average age of severe maternals admitted to ICU was (30.9±5.7) years old. The average acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score was 7 (4, 10). The average length of ICU stay was 1 (1, 2) day. The average ventilator duration was 9.0 (3.0, 17.5) hours. The main delivery mode of pregnant women in ICU was cesarean section (84.72%). Forty-eight patients (13.33%) underwent hysterectomy, of which 42 (87.5%) due to postpartum hemorrhage. The top 3 causes of ICU admission were severe postpartum hemorrhage [36.94% (133/360)], hypertensive disorders of pregnancy [21.67% (78/360)], pregnancy with cardiac disease [15.00% (54/360)]. The leading cause of postpartum hemorrhage in women transferred to ICU was placental abnormality [63.98% (103/161)], followed by uterine atony [28.57% (46/161)]. The average blood loss was (4 019±2 327) mL within 24 hours after delivery, and the number of women who underwent hysterectomy due to postpartum hemorrhage decreased year by year. During the study period, there were 2 maternal deaths, which were indirect obstetric deaths, 3 cases were discharged against-advice (expected death), including 1 indirect death and 2 direct obstetric death; the mortality in ICU was 1.39% (5/360).Conclusions:The most common reasons for pregnant and parturient women to be admitted to ICU were severe postpartum hemorrhage and hypertensive disorders of pregnancy. The leading cause of postpartum hemorrhage was placental problem. Indirect obstetric deaths exceeded direct obstetric deaths, mainly due to pregnancy complicated with cardiac disease and severe pneumonia. ICU has become an important battlefield for rescuing critically ill maternal and an important guarantee for reducing the maternal mortality.

Objective To investigate the situation of drinking water fluorosis in Tianjin, to study the benchmark dose of urinary fluoride, and to provide a reference for the formulation of the standard for urinary fluoride. Methods Three fluorosis endemic areas were selected in Tianjin, and three villages in each area were selected in this study. The water fluoride was detected, and the prevalence of dental fluorosis and the urinary fluoride of children aged 8-12 years old were investigated. Results The prevalence of dental fluorosis and urinary fluoride content in children in the villages with water fluoride exceeding the standard were significantly higher than those in the villages with water fluoride qualified, and the difference was statistically significant (χ²=88.821, P＜0.001; Z=6.089, P＜0.001). The analysis of the prevalence of dental fluorosis in children showed that the younger the age, the lower the prevalence and severity of dental fluorosis (χ²_trend=14.584, P<0.001; χ²_trend= 20.525, P<0.001). There were no significant differences in the prevalence and severity of dental fluorosis among children of different genders (χ²=0.736, P=0.391; χ²=3.649, P=0.456). There were significant differences in urinary fluoride between children with different ages and genders (H=14.768, P=0.011; Z=-2.526, P=0.012). According to the level of urinary fluoride, the children were divided into 5 groups. With the increase of urinary fluoride concentration, the prevalence of dental fluorosis gradually increased and the difference was statistically significant (χ²_trend=16.348, P<0.001), showing a dose-effect relationship. Based on the prevalence of dental fluorosis in children, BMDS was used to calculate the BMD and BMDL, which were 2.20 mg/L and 1.54 mg/L, respectively. Conclusion The water reform and fluoride reduction in Tianjin has achieved certain results. There is a dose-effect relationship between urinary fluoride and prevalence of dental fluorosis in children, and the reference dose value is slightly higher than the current standard, suggesting that the current standard can be updated timely.

Objective To understand the iodine nutrition status of pregnant women in Tianjin from 2015 to 2019, and to provide a theoretical basis for pregnant women's scientific iodine supplement in the future. Methods A total of 6 939 pregnant women were randomly selected from 16 districts in Tianjin. The urine samples and home salt of the pregnant women were collected to test iodine content. Results The iodine content was determined in a total of 6 939 household salt samples of the pregnant women. The coverage rate of iodized salt was 81.78%, the consumption rate of qualified iodized salt was 66.85%, and the median salt iodine content was 25.96 mg/kg. A total of 6,938 urine samples were determined for iodine content. The median urinary iodine of the pregnant women (154.26 µg/L) reached an appropriate level of iodine nutrition, but there was an imbalance in the regional distribution (suburbs < urban areas, pregnant women in the third trimester of suburbs < pregnant women in the third trimester of urban areas, and non-elderly pregnant women in the suburbs < non-elderly pregnant women in the suburban areas). Spearman correlation analysis found that urinary iodine was positively correlated with salt iodine and the coverage rate of iodized salt (all P<0.05). The urinary iodine level in pregnant women who consumed uniodized salt was lower than the level in those who consumed qualified iodized salt (P<0.05). Conclusion The coverage rate of iodized salt and the consumption rate of qualified iodized salt in Tianjin had not yet reached the national standard for eliminating iodine deficiency disorders. Although the median urine iodine level of pregnant women generally reached an appropriate level, the level of pregnant women's urinary iodine in the suburbs was significantly lower than that in urban areas. The urinary iodine level of pregnant women in the first trimester, suburban areas (pregnant women in the first and third trimester) and pregnant women who consumed uniodized salt were still in the iodine deficiency level. Therefore, it is necessary to continue to strengthen the monitoring of pregnant women's iodine nutrition, strengthen the promotion of scientific consumption of qualified iodized salt in key populations, and provide a basis for formulating a scientific iodine supplementation policy for pregnant women.

Objective To study the iodine nutritional status in the key population in Tianjin before and after the implementation of the new standards of iodized salt content, and to provide a scientific basis for iodine supplementation. Methods According to the method of population proportion sampling, the family edible salt samples, the urinary iodine and goiter of children aged 8-10 years and the urinary iodine level of pregnant women were investigated before the adjustment of salt iodine content (2005, 2011) and after the adjustment (2014, 2017). The results were compared and analyzed. Results The median of salt iodine after the adjustment (26.05mg/kg) was significantly lower than that of before (30.20mg/kg, Z=12.867, P<0.001). After adjustment, the coverage of iodized salt, the qualified rate of iodized salt, and the qualified iodized salt consumption rate were 78.68%, 81.01%, and 63.74%, respectively, and there were statistically significant differences from before adjustment (92.44%, 96.78%, 89.47%, respectively) (χ²=221.916, 309.405, 540.148, respectively, P <0.001). The median urinary iodine in children aged 8 to 10 years decreased from 210.10μg/L to 172.08μg/L, and the difference was statistically significant before and after adjustment (Z=3.351, P<0.001). The thyroid goiter rate of children decreased from 2.21% to 2.05%, and the difference was not statistically significant between the groups (χ²=0.196, P=0.658). After stratified analysis based on salt iodine content, it was found that among children who took iodized salt and qualified iodized salt, the median urine iodine after adjustment was lower than that before adjustment, and the difference was statistically significant (Z=2.726, 2.742, all P<0.001), but the proportion of urine iodine at an appropriate level was higher than before adjustment. The median urine iodine of pregnant women increased from 145.20μg/L to 147.17μg/L, and there was no significant difference before and after adjustment (Z=1.121, P=0.162). The proportion of pregnant women with median urinary iodine from 150 to 250μg/L was significantly higher in post-adjustment (31.02%) than that of pre-adjustment (24.53%, χ²=4.769, P=0.029). Conclusion After adjusting the salt iodine content in Tianjin, children's iodine nutrition was optimized from a higher level to an appropriate level, and thyroid goiter rate of children remained at low level. The iodine nutrition of pregnant women was slightly lower than adequate level, but the proportion of pregnant women at the adequate level increased. The new standard of iodine salt was appropriate, but the proportion of children with urine iodine <100μg/L increased, which needs to be monitored. At the same time, the iodized salt coverage rate and the qualified iodized salt consumption rate did not reach the elimination standard of iodine deficiency diseases, and the supervision of the salt industry market should be strengthened.

Objective To comprehensively evaluate the health education effects of iodine deficiency disorders in different areas of Tianjin, and to provide a reference for improving the quality of iodine deficiency disorders health education. Methods The rank sum ratio method (RSR), TOPSIS and fuzzy combination were used to comprehensively evaluate the effect of health education intervention on iodine deficiency disorders in 16 areas of Tianjin. Results The evaluation results of RSR, TOPSIS and fuzzy combination method ranked N, D, and E areas in the last three places, while G, F, and P areas ranked first, second, and third. Combined with the RSR method, it was shown that in the evaluation of the effects of iodine deficiency health education interventions in 16 areas, the health education effect in G, F and P areas was classified as superior, the health education effect in D ,E and N areas was classified as inferior, and other areas were moderate. Conclusion The fuzzy combined RSR-TOPSIS method avoided the limitation of using either RSR or TOPSIS alone and made the conclusion more objective and accurate, and provided comprehensive quantitative results for the health education of iodine deficiency diseases in different areas of Tianjin. This fuzzy combination method objectively evaluated the intervention effect of health education in different areas, which provides a reference for improving the quality of health education for iodine deficiency disorders.