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Objective:To learn about the current situation of prevention and control of coal-burning-borne endemic fluorosis (coal burning fluorosis for short) in Yunnan Province, and comprehensively evaluate the implementation effect of prevention and control measures.Methods:From August to November 2020, according to the requirements of the Monitoring Program of Yunnan Province for Coal-burning-borne Endemic Fluorosis (2019 edition), monitoring was carried out in all natural villages in the disease areas of 13 counties (cities and districts, hereinafter referred to as counties) of the province, and 30 households were selected from each natural village to monitor the use of stoves and the formation of related healthy living behaviors. At the same time, children aged 8 - 12 years in the natural villages in the disease areas were examined for the prevalence of dental fluorosis. The evaluation for control and elimination of disease areas was carried out in accordance with the Evaluation Approach for Control and Elimination of Priority Endemic Diseases (2019 edition).Results:A total of 392 244 households were investigated, and the rates of qualified improved stoves, the correct utilization of qualified improved stoves and correct drying of corn and pepper were 99.42% (389 982/392 244), 99.70% (388 796/389 982) and 99.07% (388 579/392 244), respectively. A total of 227 057 children aged 8 - 12 years were examined, 9 413 children of dental fluorosis were detected, the detection rate of dental fluorosis was 4.15%, the dental fluorosis index was 0.10, and the prevalence intensity was negative. Taking the county as a unit, except Fuyuan and Zhenxiong, which reached the control standard of the disease area, the remaining 11 counties reached the elimination standard.Conclusion:The prevention and control measures on coal burning fluorosis are implemented well in Yunnan Province and healthy lifestyle has gradually taken shape, with the overall condition of the disease reduced.
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Objective To understand the current situation on coal-burning-borne endemic fluorosis control and prevention in Yunnan Province,timely discover problems in prevention and control of the disease,and achieve the "13th Five-Year Plan" objectives as scheduled.Methods Simple random sampling method was adopted to conduct investigations in Weixin County,Daguan County of Zhaotong City,and Fuyuan County of Qujing City in the key diseased areas of Yunnan Province in 2017.Three townships from each endemic fluorosis area were randomly selected,and 2 villages of each township were randomly selected.The use of improved stoves (types of stoves,integrity rate and correct use),knowledge and behavior changes of endemic fluorosis prevention among local grade five pupils and housewives or household heads and the condition of endemic fluorosis (dental fluorosis and urinary fluoride situation in children) were investigated in above mentioned villages.Results A total of 532 households were investigated.The consumption rate of self-produced corn and pepper were 53.4％ (284/532) and 44.7％ (238/532),respectively.Totally 81.0％ (431/532) of households burned coal,the average annual coal burning time per household was 6.3 months.Totally 44.5％ (237/532) of the households used the improved iron stove,89.5％ (476/532) used the electric cooker to cook rice,84.2％ (448/532) used the induction cooker to cook,and 36.7％ (195/532)used the portable open stove.The integrity rate of improved stoves and the correct usage rate were 86.9％ (206/237) and 84.0％ (199/237),respectively,among the 237 households using improved stoves.The awareness rate of the prevention and control of coal-burning-borne fluorosis in grade five pupils and housewives or household heads were 85.8％ (921/1 074) and 17.7％ (283/1 596),respectively.The correct drying rates of edible corn and peppers were 66.5％ (189/284) and 52.9％ (126/238),respectively.A total of 3 333 children aged 8-12 years old were examined and the dental fluorosis positive rate was 11.28％ (376/3 333).Totally 377 samples of immediate urine samples were detected,the geometric mean of urinary fluoride content of children was 0.37 (0.06-2.14) mg/L.Conclusions The situation of coal-burning-borne endemic fluorosis in Yunnan Province is effectively controlled,but the correct use rate of improved stoves,the correct drying rate of edible com and peppers are low,and do not meet the requirements of the "13th Five-Year Plan".
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Objectives To study the prevailing status of coal-burning type endemic fluorosis in Fuyuan County of Yunnan Province, and to provide a scientific basis for fluorosis control and prevention. Methods In 2013, five towns were selected from the villages and towns which the defluoridation stove project was implemented and by the end of 2007 defluoridation stove rate was higher than 95%(including 95%), and two natural villages were selected in each township to carry out the investigation. Dental fluorosis was examined of all children aged 8 to 12 of survey points. At least 20 people were selected in each village. At the same time, 20 copies of instant urine samples were collected from these children of half male and half female, and urinary fluoride was determined. Then five natural villages were sampled from all survey points, and permanent residents were divided into25-,35-,45-,55-and≥65groups according to age. Six people were selected from each group with male and female in half who were conducted examination of adult skeletal fluorosis by X-ray. Dental fluorosis diagnosis was based on theDental Fluorosis Diagnosis(WS/T 208-2011). Urinary fluoride determination was done in accordance withUrine-Determination of Fluoride-Ion Specific Electrode Method(WS/T 30-1996). Skeletal fluorosis diagnosis was carried out according to Diagnostic Criteria for Endemic Skeletal Fluorosis (WS 192-2008). Results A total of 556 children aged 8 to 12 were monitored, the detection rate of dental fluorosis was 41.55%(231/556), the dental fluorosis index was 0.78. The very mild, mild, moderate and severe proportions of children's dental fluorosis were 20.50%(114/556), 17.09%(95/556), 3.60%(20/556) and 0.36%(2/556), respectively, given priority to very mild. The prevalence of dental fluorosis in children was increased with increasing age (χ2=74.27, P<0.05). One hundred and ninety-three copies of child urine samples were tested, the geometric mean of urinary fluoride was 0.62 mg/L, and the urinary fluoride contents were between 0.10-2.93 mg/L. A total of 116 adults were examined, and the detection rate of skeletal fluorosis was 9.48%(11/116). Detected cases of skeletal fluorosis was given priority to mild (9 cases, accounted for 81.81%), more men cases [16.36% (9/55)] than those of women [3.28% (2/61), χ2 = 5.77, P< 0.05]. Conclusion The hazard of coal-burning type fluorosis has been reduced in Fuyuan County , the affect of defluoridation stove project is obvious.
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Objective To investigate the current situation of coal-burning-borne endemic arsenism in the disease affected areas,the usage of anti-arsenism stove and the formation of related behavior;,to evaluate the control effect,so as to provide a basis for development of control strategies.Methods Surveillances were carried out according to the provisions and requirements of The Surveillance Project for Shaanxi Institute Coal-Burning-Borne Endemic Arsenicosis (Trial.).Four villages in two counties of Ankang city and Hanzhong city in Shaanxi Province were monitored in 2010-2014.Using simple random sampling method,10 families in each village were randomly selected to survey the situation of the stove used and related behavior changes.Five households in each village were randomly selected; arsenic level in coal was determined; high arsenic exposed population was investigated according to Endemic Arsenism Diagnostic Criteria (WS/T 211-2001).Urine samples of 30 patients with arsenism were randomly selected to determine the arsenic content.Results The proper utilization rate and the qualified households of improved stoves and iron stoves were all low; the correct drying rate and the correct storage rate of peppers and corns were higher than 95％.The washing rate of corns and peppers before eating were all 100％.A total of 100 copies of coal samples were tested and the arsenism content was between 12.295-455.827 mg/kg,and the geometric mean value of the arsenism content was (91.819 ± 80.989)mg/kg.Seventeen thousand eight hundred and fifty-five individuals were investigated and 1 232 cases of arsenism were diagnosed in the 4 villages; the prevalence rate was 6.90％ (1 232/17 855); urinary arsenism content was between not detected-0.287 mg/L; and the geometric mean value of the arsenic content was 0.033 mg/L.Conclusions The coal-burning-borne endemic arsenism in Shaanxi is in a prevalent state; many anti-arsenism stoves are out of order; and the proper utilization rate is low.To strengthen the disease surveillance,health education and management of anti-arsenism stoves are key measures in control of coal-burning borne endemic arsenism in the future.
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Objective To observe the influence of coal-burning type of fluorosis on hypothalamic-pituitaryovary axis function and to explore possible mechanism in female rats.Methods Sixty SD rats were divided into two groups according to body weight with the method of random number table:control group and fluorosis group,30 rats in each group.Fluorosis group was feed with corn powder baked by high fluorine coal from Zhijin area.Changes of female rats' teeth during fluorine exposure were observed.After feeding for 180 days,24 h urine was collected in estrus and fluorine level was tested using fluoride ion-selective electrode; rats were executed and bone fluorine level was tested with high-temperature ashing-fluorine ion-selective electrode.Femoral artery blood was collected and serum was separated to test the contents of follicle stimulating hormone (FSH),luteinizing hormone (LH),testosterone (T),estradiol (E2) and progesterone (P) with electrochemiluminescence radioimmunoassay and gonadotropin-releasing hormone (GnRH),inhibin (INH) with enzyme-linked immunosorbent assay (ELISA),respectively.Organs,including hypothalamus,pituitary gland and ovary were weighted,and organ coefficients were calculated.Pathological morphology of hypothalamus,pituitary gland and ovary was observed after staining and ultrastructure of ovary was examined by electron microscopy.Results Coal-burning induced fluorine poisoning rat model was established successfully.There were no significant differences statistically in organ coefficients between fluorosis groups (0.032 ± 0.004,0.014 ± 0.008,0.037 ± 0.009) and controls (0.035 ± 0.005,0.012 ± 0.006,0.035 ± 0.004,t =0.46,0.87,0.64,all P ＞ 0.05).Rats serum GnRH,FSH,LH and T levels [(21.654 ± 4.765),(29.580 ± 5.221),(53.988 ± 6.506),(23.962 ± 2.255)μg/L] of fluorosis groups were all higher than those of controls [(10.384 ±2.250),(19.217 ± 4.743),(30.314 ± 4.443),(7.883 ± 1.973)μg/L,t =6.762,4.646,9.503,16.971,all P ＜ 0.05].But the level of P,INH [(12.635 ± 3.841),(18.926 ± 3.465)μg/L] were all lower than those of controls [(21.045 ±4.768),(48.076 ± 3.525)μg/L,t =4.344,18.649,all P ＜ 0.05].Serum E2 levels of control group and fluorosis group were (35.375 ± 10.662) and (27.500 ± 12.783)μg/L,respectively.The difference between groups was not statistically significant (t =1.821,P ＞ 0.05).No pathological changes were observed in the two groups of female hypothalamus,pituitary tissue by light microscopy and electron microscopy.Under light microscope,in the control group of normal ovarian tissue,more corpus luteum and different developmental stages of follicles were seen,granulosa cells were neatly arranged in a monolayer or multilayer.In fluorosis group,severe edema of ovarian interstitial cells and follicle degeneration increased.Cell structure and cell contours were blurred and unclear with occasional mature follicles.Under transmission electron microscope,in control group,normal ovarian granulosa cell ultrastructure was observed,nuclei were round,nuclear chromatin was uniform distributed,cytoplasm was rich in mitochondria and endoplasmic reticulum,and normal morphology.In fluorosis group,granulosa cells and interstitial cells showed apoptotic characters,such as nucleoli disappearing,mitochondrial swelling and chromatin aggregating at the nuclear membrane.Conclusions Fluorosis can induce ovarian tissue apoptosis,severely damage the micro environment.Reduction of P and INH affects ovarian,maturation and ovulation and leads to secretion of GnRH,FSH and LH.Fluorosis caused by coal-burning may induce the injury of ovary and cause abnormal secretion of hypothalamic-pituitary-ovary axis.Fluorosis has affected parts of female axis which may not be in the hypothalamus,pituitary,but causes ovarian tissue damage.
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Objective To explore the correlation between myeloperoxidase (MPO) genetic variation and coal-burning endemic fluorosis, and to understand the influence of integrated intervention including stove changes and health education on people’s health in the area. Methods In 2007, coal-burning endemic fluorosis disease areas were selected in Bijie City, Guizhou Province. No stove changes in Yachi Town, 150 patients with dental fluorosis were selected as fluorosis non-intervention group, and the intervention group was 150 patients in Changchun Town where the stoves were changed 2 years ago. The population in control group was selected in an area with non-endemic fluorosis in Changshun County. The mRNA expressions of MPO in leukoxytes were detected by real-time PCR. HepG2 cells were cultured in vitro and divided into four groups: pGL3-A group, pGL3-G group, pGL3-Control group and pGL3-Basic group. pGL3-A and pGL3-G were recombinant plasmid, while pGL3-Basic as a blank control and pGL3-Control as a positive one. The internal reference plasmid pRL-TK co-transfected the HepG2 cells with pGL3-G, pGL3-A, pGL3-Basic and pGL3-Control, respectively. The influence of sudden change of MPO gene promoter on the gene transfection activity was evaluated by a dual luciferasereporter gene system. Results The expression level of MPO mRNA in peripheral blood leukocytes in non-intervention group(0.054 ± 0 . 003 ) were higher than control and intervention groups (0.019 ± 0.004,0.019 ± 0.003, all P0.05). After the MPO-463G/A locus genetic variation occured, the luciferase reporter gene expression level of the recombinant plasmid pGL3-G(0.753 4 ± 0.086 6) was higher than that of the pGL3-A(0.490 0 ± 0.022 3, P < 0.05). Conclusions The study on MPO gene promoter-463G/A locus has prompted that MPO gene allele may be a protective factor to coal-burning fluorosis. The integrated interventions have a role in the prevention and treatment of endemic fluorosis.
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Objective To assess the association of zinc (Zn) with coal-burning endemic fluorosis (coal-burning fluorosis), so as to provide an evidence for the role of Zn in preventing coal-burning fluorosis. Methods Fifty children with dental fluorosis and 100 healthy controls were selected from Wushan County by stratified sampling, and the same number of children and controls were also selected from Fengjie County. Thirty adults were selected from skeletal fluorosis patients in Duping Township of Wushan County, and 60 healthy controls were selected in the same township. Fasting blood samples were collected from all the participants for Zn determination. Urine samples were collected to examine urine fluoride content. Wilcoxon rank sum test was used to analyze the differences in Zn and fluoride contents between cases and controls and between the two counties. The association between blood Zn and urine fluoride was examined by Pearson linear correlation/Spearman rank correlation. Results The average urine fluoride contents were significantly higher in the child fluorosis cases than in the controls from both counties (P<0.01); and the average blood Zn contents were significantly lower in the fluorosis cases than in the controls from both counties (P<0.01). Moreover, the child cases and controls from Wushan County had significantly lower average blood Zn contents compared with those from Fengjie County (P<0.05); the child fluorosis cases in Wushan County had a significantly lower urine fluoride content compared with those from Fengjie County (P<0.05). The average urine fluoride content of skeletal fluorosis adults from Wushan County was significantly higher than that of controls, and the average blood Zn content was significantly lower than that of controls (P<0.01). In addition, Pearson linear correlation/Spearman rank correlation showed a weak positive relationship between blood Zn and urine fluoride in both children and adults (P<0.05, P<0.01). Conclusion It is indicated that patients with fluorosis are generally Zn deficient, suggesting Zn deficiency might be a risk factor for fluorosis.
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Objective To establish a rat model of coal-burning-borne fluorosis,and to observe the expression changes of bone morphogenetic protein-2 (BMP-2) and bone morphogenetic protein-3 (BMP-3) in the serum of rat treated with different dose of fluoride and different treatment duration.Methods A total of 120 clean grade SD rats(body mass between 80 to 120 g) weaned for 4 weeks were randomly assigned into four groups,which were control,low-dose fluorid,medium-dose fluorid and high-dose fluorid groups,respectively,and 30 rats in each group (female 15,male 15).All of the rats were fed with coal drying corn from fluorosis area.Ten rats were killed by femoral artery bleeding 30 d,90 d and 180 d after exposed to fluoride,respectively.Serum BMP-2 and BMP-3 level was tested by enzyme-linked immunosorbent assay (ELISA).Results ①Results of BMP-2:after exposed to fluoride for 90 d and 180 d,the differences of serum BMP-2 level between groups were statistically significant(F=385.08,173.98,all P ＜ 0.01).In low-dose fluorid,medium-dose fluorid and high-dose fluorid groups,the expression of serum BMP-2 at 90 d[(18.80 ± 0.43),(22.22 ± 0.85),(25.14 ± 0.69)μg/L] and 180 d[(7.98 ± 0.68),(8.97 ± 0.78),(15.04 ± 0.89)μg/L] was higher than that of control group[(12.54 ± 1.29),(7.53 ± 0.97)μg/L,all P ＜ 0.05],and the level of BMP-2 increased with increasing dose of fluoride (all P ＜ 0.05).Within each group,the difference of serum BMP-2 was statistically significant(F =55.42,511.58,686.35,671.64,all P ＜ 0.01).The expression of BMP-2 in each group at 90 d [(12.54 ± 1.29),(18.80 ± 0.43),(22.22 ± 0.85),(25.14 ± 0.69)μg/L] was higher than that at 30 d[(11.75 ± 1.15),(11.42 ± 1.07),(11.38 ± 0.92),(11.15 ±1.03)μg/L,all P ＜ 0.05].The expression of BMP-2 in each group at 180 d[(7.53 ± 0.97),(7.98 ± 0.68),(8.97 ± 0.78),(15.04 ± 0.89) μg/L] was lower than that at 90 d.②Results of BMP-3:the difference between groups was not statistically significant at every experimental stage(F =0.7215,1.2951,0.0964,all P ＞ 0.05).Conclusions Longer excessive fluoride intake stimulates the expression of BMP-2 in rats,but with prolonged fluoride intake,the stimulation becomes weak.The effect of fluoride on BMP-3 is not as sensitive as that on BMP-2.
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Objective To study the effects of coal burning related endemic fluorosis on body development and intelligence levels of fluorosic children in Zhijin county.Methods One hundred and seventy-six fluorosic children and 50 healthy(without fluorostic teeth) children aging 7-12 years who were sampled in cluster sampling were examined for urine fluorosis,physical examination and intelligence tests in Zhijin county,with coal burning pollution related fluorosis.Results Physical development of sick children and the children in control group were in low levels. The intelligence levels and the leves of urine fluorosis in study group were lower than those in control group and there was a significant difference(P
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Objective To explore the adverse effect of endemic fluorosis caused by fluoride from coal burning on the intelligence of children. Methods Four primary schools were selected respectively from slight, moderate, severe endemic fluorosis areas and the control area in Xinhua county of Hu'nan Province, and twenty children of grade 5 were randomly chosen in each school. The seriousness of dental fluorosis was examined by Dean's method and intelligence level was evaluated by CRT-RC. The morning urine was collected and the fluoride content in urine was measured by fluoride ion selection electrode method. Results The dental fluorosis was positively related to the fluoride content in urine (P0.05), but the difference was significant in the abilities of comparative inference, serial relationship and abstract inference (P
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Objective To study the interaction effect of indoor coal consumption and outdoor air pollution on children's lung function. Methods During 1995-1996, a cohort study on lung function measurements of children aged 6-12 was carried out in urban and suburban schools in 4 Chinese cities (twice a year in both warm and cold parts of the years). A so,called three,stage regression was used as statistic method. Results In the present paper it had been seen that the concentration of ambient air particles was negatively related to children's FEV1, FVC and FEV1/FVC, TSP and indoor coal consumption showed a significant interaction on children's lung function. There was only a weak interaction between indoor coal consumption and PM10 , but the results still showed a clue that indoor coal usage might aggravate the adverse impact of air particles on children's lung function. However, there were no significant interactive relations had been found for SO2 or NOx. Conclusion Indoor coal burning can aggravate the effects of outdoor particle pollution, especially TSP, on children's lung function.
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Objective To study the change of bone ?-carboxyglutamic acid containing protein(BGP) in serum of rats at the initial stage of skeletal fluorosis caused by fluoride in coal.Methods SD rats were randomly divided into 6 groups (the number of female and male in each group was the same respectively):the control group,the low-dose fluoride group,the middle-dose fluoride added nutrition group,the middle-dose fluoride group,the high-dose fluoride added nutrition group,the high-dose fluoride group.All rats in the experimental groups were fed on the corn collected from the prevalent areas and contained different contents of fluoride respectively for 90-100 days.Content of fluoride in the urine,bone,kidney,BGP in serum,bone mineral density (BMD)and calcium in the bone and urine were determined.Results The fluorosis of the rats became more serious as fluoride intake increased.On the condition of same fluoride intake,the fluorosis could be relieved if nutrients added.BGP in serum of rats in each experimental groups had a increase trend,at the earlier stage,BGP of the high-dose group was higher than that of the control group (P