Do Only Calcium and Vitamin D Matter? Micronutrients in the Diet of Inflammatory Bowel Diseases Patients and the Risk of Osteoporosis

Osteoporosis is one of the most common extraintestinal complications among patients suffering from inflammatory bowel diseases. The role of vitamin D and calcium in the prevention of a decreased bone mineral density is well known, although other nutrients, including micronutrients, are also of extreme importance. Despite the fact that zinc, copper, selenium, iron, cadmium, silicon and fluorine have not been frequently discussed with regard to the prevention of osteoporosis, it is possible that a deficiency or excess of the abovementioned elements may affect bone mineralization. Additionally, the risk of malnutrition, which is common in patients with ulcerative colitis or Crohn's disease, as well as the composition of gut microbiota, may be associated with micronutrients status.

Condition of mineralized tooth tissue in a population of 15-year-old adolescents living in a region of Ukraine with slightly exceeded fluorine concentration in the water

INTRODUCTION

Fluorine is a common element in nature; however, the difference between a beneficial dose and a toxic dose for the organisms is small. The main source of fluoride for humans is water in addition to food.

OBJECTIVE

The aim of this study was to estimate the degree of severity of pathological changes, namely, caries or fluorosis, in the mineralized tooth tissue of 15-year-old adolescents with respect to their hygienic and nutritional habits, and the content of fluorine in drinking water, soil and plant products.

MATERIAL AND METHODS

100 adolescents aged 15 from schools in Sosniłka, L'viv region, were examined. The condition of mineralized tooth tissue was evaluated by the caries severity, expressed by the mean number D3MFT, caries frequency and value of the SIC index. Fluorine in plant material and soil were determined according to the PN-G-04543:1982 standard, and water according to the PN-EN ISO 10304 - 1: 2009+ AC: 2012 standard.

RESULTS

Severity of caries disease expressed by the D3MFT number in the examined group of 15-year-olds was 3.39; in the group of girls - 3.08, and in the group of boys - 3.76. In the examined group, the average number of teeth with fluorosis was 7.59. Value of the SIC index among the examined population of students (n-31) was 6.26: 5.89 (n-18) for girls and 7.31 (n-13) for boys. Fluorine concentration in the water was 0.78 - 1.25(mg·dm-3). In the soil, it also did not vary across the sampled areas and amounted, on average, to 176 mg·dm-3. The biggest fluorine content noted in the dry mass of beetroots was 3.50 (mg F· kg), and the lowest - 3.34 (mg F· kg).

CONCLUSIONS

Close to optimal fluorine content lowers caries severity and frequency of fluorosis. Optimal fluorine content in drinking water and food does not require additional diet supplementation.

Occurrence of perfluorinated compounds in agricultural environment, vegetables, and fruits in regions influenced by a fluorine-chemical industrial park in China

The occurrence of perfluorinated compounds (PFCs) in vegetables and fruits, as well as agricultural environment, was investigated in the downstream regions of Changshu fluorine-chemical industrial park (CFCIP) in China. Twenty-one PFCs were analyzed in irrigation water, agricultural soil, typical vegetables, and fruits, with the maximum total PFC concentrations of 369.9 ng/L, 64.7 ng/g dw, 11.5 ng/g ww, and 10.5 ng/g ww, respectively. Short-chained perfluoroalkyl carboxylic acids (PFCAs) such as perfluorooctanoic acid (PFOA), perfluorobutanoic acid (PFBA), and perfluorohexanoic acid were the dominant PFCs in terms of their concentrations and detection frequency. PFCs in irrigation water and agricultural soils showed a decreasing trend with increasing distance from CFCIP, while this pattern was not observed in agricultural products. The predominant compounds varied in different vegetables and fruits. Simultaneous bioaccumulation of PFBA and PFOA was found in melons and solanaceous species and pears. Leafy vegetables and grapes exhibited high bioaccumulation of PFOA and PFBA, respectively. Health risk assessment by calculating estimated daily intake showed that no direct risk was caused by the consumption of vegetables and fruits for the residents in the investigated regions. However, the tolerable weekly intake of PFOA exceeded the established thresholds for the adult residents. A comprehensive health assessment of the dietary exposure of PFCs, including all exposure pathways, in fluorine-chemical industrial park-impacted regions is needed.

Geochemical valuation and intake of F, As, and Se in coal wastes contaminated areas and their potential impacts on local inhabitants, Shaanxi China

This study probe the human health risk of fluoride (F), arsenic (As), and selenium (Se) and their daily intake available quantity to human through different sources in different regions of Shaanxi, China. For this purpose, a number of samples, including coal and coal wastes, rocks, soil, and vegetables were collected from south Qinling Mountain stone-like coal (Geo type-I), Binxian-Jurassic (Geo type-II), Hancheng Permo-Carboniferous (Geo type-III), and countryside (Huanglong County) of Shaanxi province. All these samples were analyzed through atomic fluorescence spectroscopy and combustion hydrolysis methods. Results showed that Geo type-I was enriched with As, Se, and F, Geo type-II, III, and the countryside were slightly enriched with As and F and deficient in Se. The average daily intake (ADI) of Se in Geo type-I was 0.005-0.0045, Geo type-II 0.0005-0.0004, Geo type-III 0.0006-0.0005, and countryside 0.0002-0.001 in mg kg^-1 day^-1 adult-children, respectively, which was lower than the optimum level (0.06-0.075 mg kg^-1day^-1). ADI of As at Geo type-I was 0.0085-0.0075, Geo type-II 0.004-0.0037, Geo type-III 0.0008, and countryside 0.00022-0.00019 in mg kg^-1 day^-1 adult-children, respectively, which was above the acceptable range (10^-6-10^-4). ADI of F at Geo type-I was 0.0047-0.0041, Geo type-II 0.0098-0.0087, Geo type-III 0.002-0.0017 and countryside 0.0015-0.0013 in mg kg^-1 day^-1 adult-children, respectively. The toxicity level of Se and F at all the regions was lower than the NOAEL and LOAEL, while As was higher at Geo type-II and I. The extreme deficient of Se than the optimum range along with high F could deregulate the normal body growth especially causes bones and joint problems. However, the study found a rare patient with bone and joint disease (maybe Kashin-Beck disease) in the countryside. To find the exact cause of Kashin-Beck disease, the study needs further medical investigation in Se-deficient regions and their association with selenium deficiency and enriched fluoride.

The Influence of Fluorine on the Disturbances of Homeostasis in the Central Nervous System

Fluorides occur naturally in the environment, the daily exposure of human organism to fluorine mainly depends on the intake of this element with drinking water and it is connected with the geographical region. In some countries, we can observe the endemic fluorosis-the damage of hard and soft tissues caused by the excessive intake of fluorine. Recent studies showed that fluorine is toxic to the central nervous system (CNS). There are several known mechanisms which lead to structural brain damage caused by the excessive intake of fluorine. This element is able to cross the blood-brain barrier, and it accumulates in neurons affecting cytological changes, cell activity and ion transport (e.g. chlorine transport). Additionally, fluorine changes the concentration of non-enzymatic advanced glycation end products (AGEs), the metabolism of neurotransmitters (influencing mainly glutamatergic neurotransmission) and the energy metabolism of neurons by the impaired glucose transporter-GLUT1. It can also change activity and lead to dysfunction of important proteins which are part of the respiratory chain. Fluorine also affects oxidative stress, glial activation and inflammation in the CNS which leads to neurodegeneration. All of those changes lead to abnormal cell differentiation and the activation of apoptosis through the changes in the expression of neural cell adhesion molecules (NCAM), glial fibrillary acidic protein (GFAP), brain-derived neurotrophic factor (BDNF) and MAP kinases. Excessive exposure to this element can cause harmful effects such as permanent damage of all brain structures, impaired learning ability, memory dysfunction and behavioural problems. This paper provides an overview of the fluoride neurotoxicity in juveniles and adults.

Fluoride concentrations in a range of ready-to-drink beverages consumed in Heilongjiang Province, north-east China

Consumption of ready-to-drink beverages, as a potential source of fluoride (F), has increased considerably in China over the last decade. To help inform the public and policy makers, this study aimed to measure F concentration of ready-to-drink beverages on sale in Heilongjiang province, north east China. Three batches of 106 drink products manufactured by 26 companies were purchased from the main national supermarkets in Harbin, Heilongjiang province, China. The F concentration of all samples was determined, in triplicate, using a fluoride ion-selective electrode in conjunction with a meter and a direct method of analysis. The products were categorised into 10 groups according to product type. F concentrations of the samples ranged from 0.012-1.625 mg/l with a mean of 0.189 mg/l and a median of 0.076 mg/l. More than half of the products (55%) had an F concentration of ≤0.1 mg/l, while <5% had a F concentration of >0.7 mg/l. The 'tea with milk' group contained the highest mean F concentration (1.350 mg/l), whereas the lowest mean F concentration (0.027 mg/l) was found for the 'fruit juice' group. For some products, such as tea, fruit juice and carbonated beverages, there were substantial variations in F concentration between batches, manufacturers and production sites. In conclusion, ready-to-drink products (apart from tea), sold in Heilongjiang province, China, when consumed in moderation are unlikely to constitute a substantial risk factor for the development of dental or skeletal fluorosis.

[Application study on regional infusion chemotherapy by celiac trunk during operation in advanced gastric cancer patients]

OBJECTIVE

To explore the feasibility, safety and efficacy of intraoperative regional infusion chemotherapy by celiac trunk in advanced gastric cancer patients.

METHODS

One hundred and twenty-six patients with advanced gastric cancer(stageII(-III() were screened from database of Gastrointestinal Surgery Department of Taizhou People's Hospital between January 2008 and December 2010 who underwent R0 resection and D2 lymphadenectomy, received postoperative chemotherapy(XELOX or FOLFOX), and had complete follow-up data. They were divided into infusion chemotherapy group (65 cases) and control group (61 cases) according to regional infusion chemotherapy or not (fluorine 1 000 mg and cisplatin 60 mg). The side effects of chemotherapy, parameters related to the operation, long-term survival and relapse rate were compared between the two groups.

RESULTS

The baseline data between the two groups were comparable(all P>0.05). Postoperative III( and IIII( adverse reaction of chemotherapy was not significantly different between the two groups (P>0.05). The time of postoperative intestinal function recovery [(67.9±14.8) hours vs. (68.9±15.0) hours, t=-0.380, P=0.705), volume of postoperative 1-week drainage [(66.1±17.1) ml vs.(61.9±18.2) ml, t=1.478, P=0.142], recent morbidity of complications[55.4%(36/65) vs. 49.2%(30/61), χ²=0.256, P=0.613], and the long-term morbidity of complications [16.9% (11/65) vs. 14.8% (9/61), χ²=0.111, P=0.739] were all not significantly different between the two groups. The 3-year survival rate and 3-year relapse-free survival rate in infusion chemotherapy group were significantly higher than those in control group(58.4% vs. 37.7%, χ²=5.382, P=0.020; 58.4% vs. 34.4%, χ²=6.636, P=0.010).

CONCLUSION

Regional infusion chemotherapy by celiac trunk during operation for advanced gastric cancer patients is safe and feasible, and can reduce the risk of local recurrence and improve survival rate.

Coal-burning endemic fluorosis is associated with reduced activity in antioxidative enzymes and Cu/Zn-SOD gene expression

To study the effect of fluorine on the oxidative stress in coal-burning fluorosis, we investigated the environmental characteristics of coal-burning endemic fluorosis combined with fluorine content surveillance in air, water, food, briquette, and clay binder samples from Bijie region, Guizhou Province, southwest of China. The activities of antioxidant enzymes including copper/zinc superoxide dismutase (Cu/Zn-SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and level of lipid peroxidation such as malondialdehyde (MDA) were measured in serum samples obtained from subjects residing in the Bijie region. Expression of the Cu/Zn-SOD gene was assessed by quantitative reverse transcriptase PCR (qRT-PCR). Our results showed that people suffering from endemic fluorosis (the high and low exposure groups) had much higher MDA level. Their antioxidant enzyme activities and Cu/Zn-SOD gene expression levels were lower when compared to healthy people (the control group). Fluorosis can decrease the activities of antioxidant enzymes, which was associated with exposure level of fluorine. Down-regulation of Cu/Zn-SOD expression may play an important role in the aggravation of oxidative stress in endemic fluorosis.

[Assessment of exposure to fluorine and health effects in the production of aluminum]

To check the current levels of exposure to fluorine and possible implications for health, 429 workers of a plant for aluminum production were involved in this study. The protocol included a medical examination with standardized questionnaire and dosage of urinary fluorine at the beginning and end of the shift. Workers with an urinary value greater than 5 mg F/L (66% of the limit SCOEL) were examined also by X-ray of the pelvis (AP); they were classified for the presence of fluorosis by a semiquantitative scale. Workers directly exposed showed a statistically significant difference compared to non/indirectly exposed ones (mean at the end of shift 3.11 vs 0.59/0.29 mg F/L respectively). No worker showed actual clinical signs or symptoms uniquely related to fluorosis. According to the adopted criteria it was found "possible fluorosis" or "initial fluorosis" in 4.81% of the workers (all with duration of exposure more than 20 years), no case of confirmed fluorosis.

[X-ray analysis on 114 patients with moderate endemic skeletal fluorosis by treatment of Guo's Chinese herbal]

OBJECTIVE

To observe the X-ray features of bone damage in patients with moderate endemic skeletal fluorosis and the changes of X-ray after treatment with herbal therapy.

METHODS

From 2007.12 to 2009.8,114 patients with moderate endemic skeletal fluorosis were randomly divided into treatment group and control group by central randomization system. There were 60 patients in treatment group including 26 males and 34 females,aged from 39 to 60 years with an average of (51.68 +/- 4.98) years; There were 54 patients in control group included 30 males and 24 females, aged from 39 to 60 years with an average of (52.15 +/- 4.86) years. Both treatment and control groups were treated with basic treatment including calcium supplementation and preparation stage with herb decoction. Patients were orally given 600 mg Caltrate everyday for calcium suptrointestinal function and promoting the digestion and absorption of herb decoction for 3 days. Patients in treatment group were rally given Guo's Maqian decoction(200 ml,twice daily) for 8 weeks. Eight weeks later,Guo 's Maqian decoction was replaced y Guokangning capsule (0.44 g per cansule,2 capsules,three times daily) for 4 weeks. The treatment course lasted 12 weeks. The time for followed-up after treatment was 24 weeks. When the treatment finished, 7 experts on orthopaedics and radiology evaluated and statistically analyzed the X-ray features pre and post treatment,using expert evaluation scale (including the appearance and changes of osteosclerosis,osteoporosis softening,joint changes close to the bone and mixed changes) designed referring endemic skeletal fluorosis X-ray findings and sub-degree standard(WS192-2008).

RESULTS

All X-ray features of endemic skeletal fluorosis appeared in the X-ray of the 114 patients with moderate endemic skeletal fluorosis. Osteosclerosis: 4 cases in forearm, 7 in calf,4 in pelvis,4 in lumbar vertebrae ;Osteoporosis and bone softening: 23 cases in forearm patients, 23 in calf, 5 in pelvis, 8 in lumbar vertebrae; Mixed changes: 6 cases in forearm, 9 in calf, 10 in pelvis, 1 in lumbar vertebrae patients; oint changes: 107 cases in forearm, 47 in calf, 28 in pelvis, 19 in lumbar vertebrae. There were X-ray no changes before and after the treatment in all of parts in control group. In treatment group, there were only 2 patients showed extraperiostealin and joint changes after the treatment, in which one showed better ossification of interosseous membrane of leg and another one showed disappearance of the lateral hyperplasia of the left pelvic acetabulum. There were no changes between before and after treatment in X-ray of all parts in the rest patiens of the treatment group. There was no significant difference between before and after treatment in both groups (P > 0.05).

CONCLUSION

There is no obvious improvement in radiology of patients with skeletal fluorosis treated by Guo's therapy.

Decreased percentages of the peripheral blood T-cell subsets and the serum IL-2 contents in chickens fed on diets excess in fluorine

Three hundred 1-day-old Avian broilers were divided into four groups and fed on control diet (F 23 ppm) and high-fluorine diets (400 ppm, high-fluorine group I; 800 ppm, high-fluorine group II; 1,200 ppm, high-fluorine group III) for 42 days (n=75/group). The percentages of CD4+ and CD8+ T cells were decreased in three high-fluorine groups when compared with those of control group. Meanwhile, the CD4+/CD8+ ratio were lower in high-fluorine group II at 28 days of age and in high-fluorine group III at 42 days of age than in control group. Also, the serum interleukin-2 (IL-2) contents were decreased in three high-fluorine groups when compared with those of control group. Histopathologically, the thymus became hypocellular in three high-fluorine groups. It was concluded that dietary fluorine excess (400~1,200 ppm) reduced the percentages of T-lymphocyte subsets and the serum IL-2 contents, and cellular immune function could be affected in chickens.

[Evaluating fluorine effects in children of Irkutsk area]

The authors studied connection between exposure to fluorine compounds and fluorides excretion. Average fluorine content of urine and hair samples of children exceeds the reference values. Ambient air and soil pollution with fluorine was proved to be an important health risk factor for urban children in Irkutsk region.

[Changes in fluorosis clinical manifestations under treatment and during post-contact period]

The article covers results of health state monitoring in patients with fluorosis stages I and II, who remain or continue contact with fluor and its compounds. The author evaluated treatment efficiency for fluorosis patients and risk group members, demonstrated efficiency of therapy designed with consideration of biologic rhythms in various body systems, clinical manifestations and the disease pathogenesis.

Fluoride poisoning: a puzzle with hidden pieces

Key industry data regarding harm from chronically inhaled fluoride have been unavailable publicly for decades. Recent unveiling of unpublished reports reveals three examples of data mishandling that disguised the need for more stringent occupational standards for particulate and gaseous fluorides and fluorine. Injury reports from workers handling chemicals show that unjustifiable reductions of injury and disability numbers in the process of publication shifted concern from respiratory to mineralized tissue damage. Selective editing and data omissions allowed bias that fluoride reduces caries without detrimental effects. Finally, industry's failure to publish an important industry-funded laboratory study buried knowledge of low thresholds for fluoride-induced lung disease. Data from that study are presented to clarify the dose- and duration-dependent changes caused by chronic inhalation of calcium fluoride.

Health effects of occupational exposure to fluorine and its compounds in a small-scale enterprise

A 7-yr study was conducted to evaluate the respiratory effects of fluorine compounds on exposed workers in a small-scale enamel enterprise. Air monitoring was done and 75 pairs, exposed and non-exposed workers were examined. The applied tests were: an epidemiological questionnaire, the bronchitis record, clinical examinations and urinary fluorine. Linear regression analysis was done. The values of fluorine in the air of workplaces ranged from 0.1 to 3.7 mg/m3 air during the study. Twenty five point and seven percent of exposed workers presented chronic rhinitis, laryngotracheitis and bronchitis. The smoking habit was similar in both groups. The incidence of chronic bronchitis was significantly higher in exposed workers compared to the non-exposed ones. The values of urinary fluorine were higher in the exposed versus the control group. Linear regression analysis has shown positive correlations between the fluorine exposure and incidence of chronic bronchitis (r=0.75), as well as the incidence of chronic respiratory diseases (r=0.71). Fluorine exposure may be responsible for the high incidence of chronic irritative respiratory diseases, especially for chronic bronchitis in exposed workers. For diseases prevention it is advisable to reduce the levels of fluorine in the air of workplaces and to decrease the concentration of fluorine compounds in the composition of enamel.

The effect of fluorine and homeopathic medicines in rats fed cariogenic diet

Although some sectors of dentistry have benefited from technological advances, dental caries is still a major problem. Prevention and treatment of dental caries by fluorine is considered a major advance in public health. Nevertheless fluorosis, caused by ingestion of excessive amounts of fluorine during the period of teeth formation, is of great concern. In accordance with the homeopathic doctrine, minimum doses of fluorine and other substances could prevent and/or treat caries. In this experiment, we compared the preventive action of fluorine and evaluated the effect of homeopathic medicines on the teeth of rats fed a cariogenic diet. None of the groups included in this study developed caries. However, microscopy revealed the presence of precipitate and/or deposit in the groups treated with homeopathic medicines. This phenomenon might be due to deposit in the dental surface or precipitation of bacterial plaque or calcium salts. It was not possible to identify the composition of the deposit/precipitate due for technical reasons. In one of the groups treated with homeopathic medicines fur loss was observed in 40% of animals. These reactions might be caused due to the action of the homeopathic medicines.

[Some features of gastric disorders in occupational diseases]

Some features were revealed after study of 185 patients with various occupational diseases: chronic lead intoxication, bronchial asthma, and disorders caused by fluor. Considering polyetiology and nonspecificity of gastric diseases, the authors could not determine the changes revealed as caused only by occupational exposure.

Volcanogenic fluorine in rainwater around active degassing volcanoes: Mt. Etna and Stromboli Island, Italy

Many studies have assessed the strong influence of volcanic activity on the surrounding environment. This is particularly true for strong gas emitters such as Mt. Etna and Stromboli volcanoes. Among volcanic gases, fluorine compounds are potentially very harmful. Fluorine cycling through rainwater in the above volcanic areas was studied analysing more than 400 monthly bulk samples. Data indicate that only approximately 1% of fluorine emission through the plume is deposited on the two volcanic areas by meteoric precipitations. Although measured bulk rainwater fluorine fluxes are comparable to and sometimes higher than in heavily polluted areas, their influence on the surrounding vegetation is limited. Only annual crops, in fact, show some damage that could be an effect of fluorine deposition, indicating that long-living endemic plant species or varieties have developed some kind of resistance.

The effects of replacing dicalcium phosphate with Busumbu rock phosphate on performance and the mechanical properties of bone in growing chicks

Three hundred, day-old broiler chicks, with an average initial weight of 41.8 +/- 1.79 g, were used in a 15-day study (10 birds per battery cage) to characterize their performance and fluorine status when dicalcium phosphate (DCP) was replaced by Busumbu rock phosphate (BRP) as the source of phosphorus in the chicks' ration. The treatments comprised a standard ration with BRP replacing 0, 25%, 50%, 75% or 100% of DCP. Replacing DCP with BRP significantly reduced the final weight of the chicks (p < 0.01), feed intake (p < 0.01), weight gains (p < 0.01) and dry matter digestibility (p < 0.05) but increased (p < 0.05) the feed-to-gain ratio. True phosphorus absorption and the percentage of phosphorus in the tibia were not affected by increasing amounts of BRP in the diet. Increasing levels of BRP in the diet linearly reduced (p < 0.01) the percentage bone ash, calcium, Ca:P ratio, ultimate breaking force, bending moment, stress, and modulus of elasticity. Leg stiffness, lameness, reduced feed intake, and a decline in general health were recorded in 10-40% of the chicks on 75% and 100% BRP, respectively. These results suggest that excessive ingestion of fluorine from the BRP caused the reduction in the chicks' performance.

[Developmental abnormalities of mineralization in populations with varying exposure to fluorine compounds]

The aim of the study was to determine the influence of environmental factors on developmental defects of dental enamel. The examination was carried out in a group of 238 schoolchildren (group I) aged 14 to 15 years, living since birth in a region with elevated levels of chemical compounds (fluorine, ammonia, sulphur) in the atmosphere. The control group (group II) consisted of 240 schoolchildren of the same age, living in regions with normal atmospheric concentrations of these compounds. The Epidemiological Index of Developmental Defects of Dental Enamel (DDE Index), Dean fluorosis index, and DMF index were used in the clinical examination. Additionally, a questionnaire was given to parents of the examined children. It was found that the number of children and teeth with developmental defects of dental enamel was greater in group I. Significant differences between boys and girls were noticed. The most common developmental defect of dental enamel in both groups was white/creamy opacity. The next common defect was hypoplasia. The incidence of diffuse white/creamy mottling and lines was higher in the study group than in controls. This was the basic finding which differentiated the two populations studied. Both groups differed as to the Dean index. Nevertheless, a comparison of Dean and DDE indices led to inconsistent conclusions. The distribution of developmental defects of dental enamel was similar in both groups. The defects were most often found on the buccal surfaces of maxillary premolars and maxillary central incisors. Children with developmental defects of dental enamel had a significantly higher incidence of caries and elevated mean DMF, as compared to children without any abnormalities of mineralization. Similar correlations were not found in the control group. The questionnaire revealed a positive correlation between the education level of parents, standards of living, and of abnormalities mineralization in both groups of children.

[Positive and negative effects of fluorine in the human organism. The source of fluorine in the environment]

In Poland and in other countries around the world, a great number of epidemiological studies have provided evidence that fluorine contributes to decreasing the intensity of dental decay. Nevertheless, the negative effect of its overdose should not be ignored. At present, no data indicating the amount of fluorine uptake is available. A wide diversity of opinions on tolerable limits of fluorine, and its predicted dosage known as optimal, suggests a need to monitor constantly this element throughout the whole country, and not only in selected regions.

[The physiobalneological treatment of the workers in industrial enterprises suffering from osteoarthrosis taking into account their biological rhythms]

Circadian rhythms of joint pains, body temperature, pulse and arterial pressure were studied in patients with osteoarthrosis. Group 1 consisted of industrial workers exposed occupationally to fluorine, group 2 consisted of workers who had no contact with toxic substances. Optimal time for physiobalneotreatment is recommended.

[Hygienic significance of geohydrochemical features of the Moscow region]

The biochemical features of the Moscow artesian pool and the influence of water on the population's health are shown. The paper present information on the sources of the water-supply system in the town of Zelenograd whose population uses river and artesian waters. The drinking water in Zelenograd and in the populated areas of the Moscow Region contains toxic elements, such lithium, born, strontium, fluorine, barium in the quantities greater than the adopted specifications. It is stated that the presents of the above agents in the waters of the Moscow artesian pool suggests regional geochemical anomaly. Mixing artesian and river waters in Zelenograd has a positive effect, by causing a reduction in the incidence of fluorosis.

Risk factors for fractures in the elderly

We report the results of a 5-year prospective cohort study of risk factors for fractures, including drinking fluoridated water, in a cohort of 3,216 men and women aged 65 years and older. We studied risk factors for hip fracture and fractures at other locations separately. We found a higher risk of hip fractures for subjects exposed to fluorine concentrations over 0.11 mg per liter but without a dose-effect relation (odds ratio (OR) = 3.25 for a concentration of 0.11-0.25 mg per liter; OR = 2.43 for > or = 0.25 mg per liter]. For higher thresholds (0.7 and 1 mg per liter), however, the OR was less than 1. We found no association between fluorine and non-hip fractures. Non-hip fractures were associated with polymedication rather than with specific drug use, whereas fracture was associated with polymedication and use of anxiolytic and antidepressive drugs. Subjects drinking spirits every day were more likely to have hip fractures. Tobacco consumption increased the risk for non-hip fractures.

The relationship of fluorosis and brick tea drinking in Chinese Tibetans

Brick tea-drinking fluorosis is an unusual environmental problem. As a result of an investigation of tea-drinking habits, total fluoride intakes, dental fluorosis, and skeletal fluorosis, this disease has been found in the Sichuan Province of China in Tibetans with a long history of drinking brick tea. The dental fluorosis investigation of 375 Tibetan children (213 males, 162 females) and 161 Han children (86 males, 75 females), 8-15 years of age, was carried out in Daofu County, Sichuan Province. According to the standard of the Chinese Health Ministry, a skeletal fluorosis survey of 658 Tibetans (264 males, 394 females) and 41 Hans (20 males, 11 females), all over 16 years old, was performed. The total fluoride intake and fluorosis were determined from a question--calculation method in all participants. The morbidities of dental fluorosis in Tibetan and Han children are 51.2% and 11.05%, respectively, and the indexes of dental fluorosis are 1.33 and 0.17 (chi 2 = 75.7, p < 0.01) respectively. The morbidity of skeletal fluorosis is 32.83% for Tibetan children and zero for the Han children. The fluoride intakes of Tibetan children and adults were 5.49 mg/person/day and 10.43 mg/person/day, respectively, in this area. Of total everyday fluoride intake, 94.2% by children and 94.4% by adults was from brick tea and zanba (r = 0.99).

[Caries prevalence in preschool children in industrial cities]

Caries incidence was analyzed in preschool children attending kindergartens living in two industrial towns differing by the level and specific features of air pollution and by fluorine levels in potable water. Caries incidence was found to be higher in a ferrous metallurgy center with very low (0.1 to 0.3 ml/l) fluorine levels in potable water. Passive smoking factor was found to contribute to development of caries in children, particularly so in girls. Motor car transport effects on caries development in children were not confirmed. Recommendations on reduction of caries development intensity are suggested.

[The effect of fluorine on the developing human brain]

Fifteen therapeutically aborted fetuses at the 5th-8th gestation month from the endemic fluorosis area were compared with those from the non-endemic area. Stereological study of the brains showed that the numerical density of volume of the neurons and the undifferentiated neuroblasts as well as the nucleus-cytoplasm ratio of the neurons were increased. The mean volume of the neurons was reduced. The numerical density of volume, the volume density and the surface density of the mitochondria were significantly reduced. The results showed that chronic fluorosis in the course of intrauterine fetal life may produce certain harmful effects on the developing brain of the fetus.

[Stress fractures during fluoride therapy. Physiopathological value of histomorphometry]

Bone histomorphometry was carried out in 11 women, aged 53 to 80 (mean = 69.6), treated with fluoride for vertebral osteoporosis for more than 6 months and having suffered one or more stress fractures (1 to 4 sites, mean = 1.7 sites) during that time. Classical contraindications were complied with in all cases but 2 patients did not have any combined calcium supplement. In 6 cases, histomorphometry showed no sign (notably hyperosteoidosis) of the effects of fluoride on bone. Bone trabecular volume was markedly below the fracture threshold in 4 patients. This group refractory to fluoride included the two patients who had received no calcium supplement. In 5 cases, histomorphometry showed hyperosteoidosis of normal or low thickness, with a normal mineralisation rate, reflecting the effects of fluoride on bone. However, bone trabecular volume remained below the fracture threshold in all cases. In all 11 cases, bone structure studied in polarised light was lamellar and there was no increase in cortical porosity. These results suggest that the imputability to fluoride of peripheral bone accidents must be viewed very relatively (the persistence of an insufficient bone trabecular volume being the feature usually found) or, at any event, that its possible iatrogenic effect is not linked to bone remoulding abnormalities.

[Pseudofluorosis: psychologic aspects of environmental pollution]

A middle-aged woman who had been living in close surroundings of a fluorine-emitting factory for many years, was examined because she claimed to be suffering from skeletal fluorosis. Radiological, histological and laboratory findings did not give evidence of fluorosis. Fluoride concentrations were normal in samples of blood, bone, pooled urine, nails and hair. Even this proof to the contrary did not shake her conviction of many years that she was suffering from fluorosis. Thus, psychological aspects have to be considered in the assessment of health implications of pollutants.

[Evaluation of the visual system in people having extended contact with fluorine]

Presented are the results of examination of 75 men, workers of the Chemical Works in Police, in whom in the scheme of complex clinical examinations detailed ophthalmological examinations have been carried out. The period of a professional contact with fluor amounted 6-15 years. The examined persons showed a variety of changes; the most important were opacities of the lens capsule, attenuation of the retinal arteries and a pathological record of the ERG.

[Action of the body fluorine of healthy persons and thyroidopathy patients on the function of hypophyseal-thyroid the system]

Altogether 123 persons were examined: 47 healthy persons, 43 patients with thyroid hyperfunction and 33 with thyroid hypofunction. It was established that prolonged consumption of drinking water with a raised fluorine content (122 +/- 5 mumol/l with the normal value of 52 +/- 5 mumol/l) by healthy persons caused tension of function of the pituitary-thyroid system that was expressed in TSH elevated production, a decrease in the T3 concentration and more intense absorption of radioactive iodine by the thyroid as compared to healthy persons who consumed drinking water with the normal fluorine concentration. The results led to a conclusion that excess of fluorine in drinking water was a risk factor of more rapid development of thyroid pathology. Indicators of the fluorine content in daily urine provide most of the information on changes of the fluorine amount in the body.

Fluorine and thyroid gland function: a review of the literature

The increasing use of fluoride for prevention of dental caries poses the problem as to whether this halogen has antagonistic properties towards iodine, whereby it could hamper the success of iodine prophylaxis of endemic goitre. Review of the literature shows that some authors have found an inhibition by fluoride of various steps of thyroid hormone biosynthesis in animal experiments. By and large, the inhibition was only slight and it was elicited only with fluoride doses greatly in excess of those recommended for caries prevention. The inhibition was not consistently present and other authors could not confirm it in comparable experiments. There is no convincing evidence that fluoride produces true goitres with epithelial hyperplasia in experimental animals. There are some reports based on casual observations that fluoride is goitrogenic in man. On the other hand, several good studies with adequate exposed and control populations failed to detect any goitrogenic effect of fluoride in man. It is noteworthy in particular that fluoride does not potentiate the consequences of iodine deficiency in populations with a borderline or low iodine intake. Published data failed to support the view that fluoride, in doses recommended for caries prevention, adversely affects the thyroid.