Table Of ContentZhi-Zhong Guan Editor
Coal-burning
Type of Endemic
Fluorosis
Pathophysiology and Clinical Treatments
Coal-burning Type of Endemic Fluorosis
Zhi-Zhong Guan
Editor
Coal-burning Type
of Endemic Fluorosis
Pathophysiology and Clinical Treatments
Editor
Zhi-ZhongGuan
DepartmentofPathology,Affiliated
HospitalandKeyLaboratoryofEndemic
andEthnicDiseasesoftheMinistryof
Education
GuizhouMedicalUniversity
Guiyang,Guizhou,People’sRepublicofChina
ISBN978-981-16-1497-2 ISBN978-981-16-1498-9 (eBook)
https://doi.org/10.1007/978-981-16-1498-9
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Preface
Endemic fluorosis is a geochemical disease. In addition to the typically clinic
manifestations of skeletal and dental fluorosis, it also causes systemic damages. In
the natural environment, excessive fluoride intake in the human body through
drinking water, air, food, tea, and other sources results in systematacially chronic
toxic lesions. In international community, endemic fluorosis affects more than
20 countries, including China, India, Bangladesh, Sri Lanka, Vietnam, Thailand,
Iran, Argentina, the United States, Canada, Mexico, Morocco, Algeria, Tunisia,
Egypt,SouthAfrica,andsoon.Amongthesecountries,China andIndia areworst
afflicted by endemic fluorosis with the most widespread range. In China, most
provinces and regions have areas with endemic fluorosis, in which three types are
found, i.e., drinking water, coal-burning, and brick tea drinking type of endemic
fluorosis. There were as many as 1308 counties with such areas in China with a
populationof116millionaffectedbythediseasebasedonpastsurveys.
The concept regarding excessive fluoride intake from food instead of water
contamination as previously thought was first proposed in the 1970s by a team,
leadingbythewell-knownprofessorZan-DaoWei,fromGuizhouMedicalUniver-
sity.Later,itwasconfirmedbythescientistsintheCenterforDiseaseControland
Prevention in Guizhou and Guiyang Institute of Geochemistry at the Chinese
AcademyofSciences.Thefactisthatlocalresidentsinthesefluorosisareasburned
thecoalcontaininghighamountoffluorideindoorsandusedstoveswithoutexhaust
systems to cook, bake (grains, peppers, and vegetables), and keep warm in the
winter. Such results lead to chronic poisoning caused by excessive fluoride intake,
which is termed as coal-burning type of endemic fluorosis. At present, there are
13provinces(Guizhou,Yunnan,Sichuan,Chongqing,Hubei,andHunanwithworst
conditionofsuchendemicfluorosis)withapopulationof34millionatriskofcoal-
burningtypeofendemicfluorosis.
For a long time, Chinese scientists and preventative workers have done a lot of
basic and on-site prevention and control research on coal-burning type of endemic
fluorosisandachievedremarkableresults.
v
vi Preface
Thisbookcoverstheseaspectsconcerningorigin,relevantepidemiology,pathol-
ogy,molecularmechanism,biologicalmarkersofearlydiagnosis,clinicaltreatment
andprevention,andevaluationofcomprehensivecontrolonthecoal-burningtypeof
endemicfluorosis.
Ihavebeenworkingonfluorosisresearchsincethe1970s.Thestudyofendemic
fluorosis could be daunting with hardships and difficulties, but when we discover
effective research to address the sufferings of the population living in the disease
areas,thejoyisunparalleled.Ibelievethatthisbookcouldbeagoodreferenceand
helpful for researchers, graduate students, and undergraduates in this field to raise
theirawarenessofthisdiseaseandtakeeffectivelypreventivemeasuresforthegoal
tocompletelyeliminatethedisease.
Guiyang,Guizhou,People’sRepublicofChina Zhi-ZhongGuan
Acknowledgments
Iwouldliketoexpressmyheartfeltgratitudetomycolleaguesandfriendswhohave
contributedinmanywaystowardthecompletionofthebook.
Firstandforemost,Iwishtoexpressmyutmostappreciationtothekeycontrib-
uting authors in China for their commitment to this book. They are Zi-Gui Zhang
(at Zhejiang Normal University), Hui Xu (at Jilin University), Jian-Cao Bian
(at Shandong Institute of Prevention and Control for Endemic Disease), Fa Sun
(Health Commission of Guizhou Province), Fu-Chen Li (at Liupanshui Center for
Disease Control and Prevention), and Di-Dong Lou (at Guizhou University of
Traditional Chinese Medicine); my colleagues in Guizhou Medical University:
Chang-Xue Wu, Yi Zhao, Xiao-Lan Qi, Wen-Feng Yu, Ri-Guang Liu, Yong
Wang, Xu-Guang Chen, Qing-Hong Duan, Jian Liao, Ling Mao, Kai-ling Zhang,
Yan-Jie Liu, Na Wei, Jie Deng, and Yang-Ting Dong; also the coauthors (young
scientists andPhDstudents):Feng-Yang Guo, Zhong-YuanZhang,ManZhang,Ji
Bian,ZhiHuang,Yue-HaiXiao,Long-YanRan,JieXiang,Xiao-XiaoZeng,Xiao
Xiao, Jian Zou, and Yan-Long Yu. These authors have years of experience in the
research and prevention of endemic fluorosis and achieved valuable results in the
field. The research teams of several authors are also first-tier ones in the field of
endemic fluorosis research. The authors have profound understanding concerning
theprogressofchaptersinrelevant international scientificsocieties,theprevention
andcontrolofthedisease,andtheneedsofthereader,whichserveasguaranteefor
thequalityofthebook.
Inparticular,Iwanttoacknowledgemysupervisors,ProfessorsJia-LiuLiuand
Zan-Dao Wei, of Guizhou Medical University, who guided me to conduct the
research on endemic fluorosis when I was a young graduate student, and then
conductedusefuldiscussiononthecontentsofthisbookwhenIplannedtocompose
itmanyyearsago.Withouttheirguidanceandhelp,therewouldbenosuchbook.In
addition, I would like to express my sincere appreciation to Professor Nan-Shan
Zhong,the internationally renowned expert andacademician ofthe Chinese Acad-
emyofEngineering,whogavemeandmycolleagueslong-termsupportandsenthis
researchgrouptoparticipateintheclinicalresearchintheareasofcoal-burningtype
vii
viii Acknowledgments
ofendemicfluorosis.Itwassucheffortandassistancethatmadeusfaraheadinthe
fieldofcoal-burningtypeofendemicfluorosisresearch.Thevaluableresultsofthe
researchwerealsoincludedinthebook.
Importantly, this book is one of the implementations of these funds: National
Natural Science Foundation of China (U1812403, 81760571) and the Projects of
DepartmentofScienceandTechnologyofGuizhouProvinceandGuizhouMedical
University.Therefore,Iwouldliketoexpressmysincerethankstothesefoundations
fortheirfinancialsupportandassistanceinpublishingthisbook.
Zhi-ZhongGuan
Contents
PartI DiscoveryandEpidemiologyofEndemicFluorosis
1 DiscoveryandConceptofEndemicFluorosis. . . . . . . . . . . . . . . . . 3
Zhi-ZhongGuan
2 EpidemicStatusofCoal-burningTypeofEndemicFluorosis. . . . . 13
Zhi-ZhongGuan,Fu-ChengLi,YiZhao,andChang-XueWu
PartII PathologicalChangesofEndemic(Chronic)Fluorosis
3 SkeletalFluorosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
JieXiang,Xiao-XiaoZeng,andZhi-ZhongGuan
4 MedicalImagingManifestationofSkeletalFluorosis.. . . . .. . . . .. 63
Qing-HongDuan,Xu-GuangChen,andZhi-ZhongGuan
5 EpidemicCharacteristicandPathogenesisofDentalFluorosis. . . . 85
JianLiao
6 DamageinNervousSystem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
NaWeiandZhi-ZhongGuan
7 ModificationofDigestiveSystem. . . . . . . . . . . . . . . . . . . . . . . . . . . 125
JianZouandZhi-ZhongGuan
8 ModificationofUrinarySystem. . .. . . .. . . .. . . .. . . .. . . .. . . .. 137
XiaoXiaoandZhi-ZhongGuan
9 ModificationofCardiovascularSystem. . . . . . . . . . . . . . . . . . . . . . 151
Jian-ChaoBian,ManZhang,andJiBian
10 DamageofEndocrineSystem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Xiao-XiaoZeng,JieXiang,andZhi-ZhongGuan
ix
x Contents
11 DamagestoReproductiveSystembyCoal-burningType
ofEndemicFluorosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Yue-HaiXiaoandFaSun
PartIII MolecularPathogenesisofEndemic(Chronic)Fluorosis
12 EnhancedOxidativeStress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Long-YanRanandZhi-ZhongGuan
13 HighLevelofInflammation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Wen-FengYuandZhiHuang
14 EffectofFluorideonSignalTransductionPathways. . . . . . . . . . . . 225
Xiao-LanQi
15 ChangesofReceptors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Yang-TingDongandZhi-ZhongGuan
16 AlterationofEndoplasmicReticulumStress. . . . . . . . . . . . . . . . . . 269
HuiXu,Feng-YangGuo,andZhong-YuanZhang
17 MitochondrialChanges. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Di-DongLouandZhi-ZhongGuan
18 CalciumMetabolismDisorderinChronicFluorosis. . . . . . . . . . . . 297
Zi-GuiZhang
19 AlteringofCarbohydrateMetabolism. . . . . . . . . . . . . . . . . . . . . . . 307
Kai-LinZhangandZhi-ZhongGuan
20 ChangesinGeneExpression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
JieDengandZhi-ZhongGuan
PartIV ClinicalDiagnosisandTreatmentsofCoal-BurningType
ofEndemicFluorosis
21 BiologicalIndicatorsforEarlyDiagnosisofEndemicFluorosis. . . . 337
Yan-JieLiuandZhi-ZhongGuan
22 ComprehensivePreventionandControlofCoal-burningType
ofEndemicFluorosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Fu-ChengLiandChang-XueWu
23 SurgicalTreatmentofJointDamageinSkeletalFluorosis. . . . . . . 377
Ri-GuangLiu
24 ClinicalPreventionandTreatmentofCoal-burningType
ofEndemicFluorosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
LingMaoandYongWang
