With the continuous advancements in immunotherapy and targeted therapy, the treatment management and surgical resection assessment of locally advanced lung cancer have undergone significant changes. In October 2024, the Society of Thoracic Surgeons (STS) released the "STS expert consensus on the multidisciplinary management and resectability of locally advanced non-small cell lung cancer", which provides the latest insights on the evaluation of resectability and multidisciplinary management of locally advanced lung cancer, neoadjuvant (including perioperative) therapy, and adjuvant therapy. This article aims to interpret this consensus, with the goal of introducing the latest perspectives of the STS consensus to thoracic surgeons and providing a reference for the rational implementation of surgical resection, multidisciplinary management, and standardized comprehensive treatment models for non-small cell lung cancer in China.

In 1929, George Soulié de Morant and Paul Ferreyrolles co-authored their first acupuncture-moxibustion paper titled "L' Acuponcture en Chine vingt siècles avant J.-C. et la réflexothérapie moderne", greatly advancing the development of acupuncture-moxibustion in Europe. Their paper systematically explains the holistic view and the concept of yin-yang balance in traditional Chinese medicine, describes the techniques of acupuncture and moxibustion, innovatively classifies acupuncture-moxibustion as "reflexotherapy", organizes the effects of certain acupuncture points illustrated on human acupoint atlas; and for the first time, it summarizes the correspondence between acupuncture points and Weihe trigger points. In the historical background of the neo-Hippocratic movement, they used the existing theories at that time to explain acupuncture, and adopted the analogical medicine to explore the mechanisms of acupuncture-moxibustion, which gradually initiated the modern era of acupuncture-moxibustion in France. Such research method is conducive to reducing the unfamiliarity of acupuncture-moxibustion among westerners, deepening their understanding of its theories and therapeutic effect, and also integrating it with other medical research. It breaks through the limitations of traditional theories and obtains the self-improvement and progress.
Humans ; Moxibustion/history* ; Acupuncture Therapy/history* ; China ; History, Ancient ; History, 20th Century ; Acupuncture/history* ; Reflexotherapy/history* ; Acupuncture Points ; History, 19th Century ; Medicine, Chinese Traditional/history*

Objective:To compare the diagnostic efficacy of 18F-prostate specific membrane antigen (PSMA)-1007 PET/CT, 18F-FDG PET/CT and multi-parameter MRI (mpMRI) in prostate cancer (PCa). Methods:Retrospective analysis was conducted on data from 22 patients ((72.6±6.2) years) with pathologically confirmed PCa in the Affiliated Taizhou People′s Hospital of Nanjing Medical University between April 2021 and September 2022. All patients underwent 18F-PSMA-1007 PET/CT, 18F-FDG PET/CT, and mpMRI examination within 30 d, and the imaging parameters were collected, including PSMA-SUV max, FDG-SUV max, minimum apparent diffusion coefficient (ADC min), mean apparent diffusion coefficient (ADC mean), PSMA-SUV max/ADC min, PSMA-SUV max/ADC mean, FDG-SUV max/ADC min, FDG-SUV max/ADC mean. Patients were divided into groups based on the International Society of Urological Pathology (ISUP) grading (≤3 vs >3) and serum total prostate specific antigen (TPSA; ≤20 μg/L vs >20 μg/L), and differences of imaging parameters between groups were compared (Mann-Whitney U test or independent-sample t test). ROC curves were generated to evaluate the diagnostic ability of each parameter for different levels of PCa. χ2 test and ROC curve analysis were used to compare the detection rate and diagnostic efficiency of three imaging methods for primary focus, lymph node metastasis, and bone metastasis in PCa. Results:Differences were found between ISUP≤3 ( n=6) and >3 ( n=16) groups in PSMA-SUV max/ADC min, PSMA-SUV max/ADC mean, PSMA-SUV max, and ADC min ( z values: from -2.65 to -2.36, t=3.60, P values: 0.002-0.018). But there was no significant difference found between TPSA≤20 μg/L ( n=5) and >20 μg/L ( n=17) groups in all indices ( z values: from -1.76 to -1.45, t values: -1.19 and 1.28, all P>0.05). The optimal cut-off value for PSMA-SUV max/ADC min in differentiating high-grade and low-grade PCa was determined to be 22.628×10 3. In the patient-based analysis, no statistical difference was found in the detection rate of PCa primary tumors among 18F-PSMA-1007 PET/CT, 18F-FDG PET/CT, and mpMRI ( χ2=1.91, P=0.767). However, the detection rates of lymph node and bone metastasis among three imaging methods were significantly different (72.73%(16/22), 59.09%(13/22), 36.36%(8/22) and 81.82%(18/22), 63.64%(14/22), 45.45%(10/22); χ2 values: 6.03, 6.29; P values: 0.049, 0.043). 18F-PSMA-1007 PET/CT resulted in a 36.36%(8/22) increase in N stage and the 40.91%(9/22) increase in M stage compared to mpMRI. Conclusions:PSMA-SUV max/ADC min is a valuable parameter for differentiating high-grade and low-grade PCa. 18F-PSMA-1007 PET/CT demonstrates superior detection rate of PCa lymph node and bone metastasis compared to 18F-FDG PET/CT and mpMRI, and exhibits higher diagnostic efficiency, so it can be recommended for NM staging in patients with PCa.

Objective:To explore the clinical and genetic characteristics of two children with Neurodevelopmental disorders (NDDs) due to variants of TANC2 gene. Methods:Clinical data of two children who were admitted to the Third Affiliated Hospital of Zhengzhou University respectively in April 2020 and April 2021 were retrospectively analyzed. Peripheral blood samples of the children and their parents were collected and subjected to whole exome sequencing. Candidate variants were verified by Sanger sequencing. By using " TANC2 gene", "Neurodevelopmental disorders", "Nervous system development disorders", " TANC2" as the key words, similar cases were searched from the CNKI, Wanfang database platform and PubMed database, with the search time set as from the establishment of the database to December 2023. This study was approved by Medical Ethics Committee of the Third Affiliated Hospital of Zhengzhou University (Ethics No. 2020-57). Results:Case 1 was a 1-year-and-3-month-old girl who had developed convulsions at 1 year old and had three episodes of seizures. Her epilepsy had resolved with the treatment of oxcarbazepine, which was stopped at the age of 2-year-and-7-month. Her language, movement and intelligence development were all normal. Case 2 was a 1-year-and-10-month-old boy, who had developed convulsions at 1 year old. His seizure type was myoclonus, and the frequency was dozens of times a day. His epilepsy had resolved with the treatment of sodium valproate. His language, movement and intelligence development was delayed for about half a year. Genetic analysis showed that both children had harbored novel variants of the TANC2 gene (NM_025185.4), including c. 3398G>A (p.Gly1133Glu) and c.2829+ 1G>A, respectively. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the former was rated as likely pathogenic (PS2+ PM2_Supporting+ PP3) and the latter was rated as pathogenic (PVS1+ PS2+ PM2_Supporting). Two previous reports were retrieved, which had involved 17 cases and 16 variants. Common features had included autism spectrum disorder (70.6%, 12/17), intellectual disability (94.1%, 16/17), language and motor retardation (88.2%, 15/17; 58.8%, 10/17), facial dysmorphism, epilepsy, ataxia, and thoracic and spinal deformities. Conclusion:Variants of the TANC2 gene probably underlay the epilepsy and development delay in these children with NDDs.

Although significant progress has been made in the development of novel targeted drugs for the treatment of acute myeloid leukemia(AML)in recent years,chemotherapy still remains the mainstay of treatment and the overall survival is poor in most patients.Here,we demonstrated the antileukemia activity of a novel small molecular compound NL101,which is formed through the modification on bendamustine with a suberanilohydroxamic acid(SAHA)radical.NL101 suppresses the proliferation of myeloid malignancy cells and primary AML cells.It induces DNA damage and caspase 3-mediated apoptosis.A genome-wide clustered regularly interspaced short palindromic repeats(CRISPR)library screen revealed that phosphatase and tensin homologous(PTEN)gene is critical for the regulation of cell survival upon NL101 treatment.The knockout or inhibition of PTEN significantly reduced NL101-induced apoptosis in AML and myelodysplastic syndrome(MDS)cells,accompanied by the activation of protein kinase B(AKT)signaling pathway.The inhibition of mammalian target of rapamycin(mTOR)by rapamycin enhanced the sensitivity of AML cells to NL101-induced cell death.These findings uncover PTEN protein expression as a major determinant of chemosensitivity to NL101 and provide a novel strategy to treat AML with the combination of NL101 and rapamycin.

Objective To investigate the expression characteristics of S100 calcium binding protein P(Sl00P)and thymic stromal lymphopoietin(TSLP)in patients with breast cancer and their relationship with prognosis.Methods GEPIA database and bc-GenExMiner v4.3 were used to analyze the expression levels of S100P and TSLP in breast cancer tissues,and Kaplan-Meier Plotter was used to analyze effects of S100P and TSLP on patient prognosis.The protein interaction network analysis of S100P and TSLP were carried out by using STRING database.The co-expressed genes of S100P and TSLP were analyzed using Linked Omics database,and the role of S100P and TSLP co-expressed genes in related biological processes and signaling pathways were evaluated by gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis.The correlation between S100P and TSLP and breast cancer immunoinfiltration was analyzed by TIMER.Results The expression of S100P in breast cancer patients was significantly higher than that in normal population,and the expression of TSLP was significantly lower than that in normal population(P＜0.05).The overall survival,disease-free survival and distant metastasis-free survival of patients with high S100P expression were significantly shorter than those of patients with low S100P expression(P＜0.05).The distant metastasis-free survival of patients with high expression of TSLP was significantly longer than that of patients with low expression of TSLP(P＜0.05).The results of protein interaction showed that S100P had a strong interaction with interleukin-11,and TSLP had a strong interaction with interleukin family proteins.The co-expressed genes of S100P and TSLP were mainly responsible for biological functions such as DNA replication and immune function.TSLP was correlated with breast cancer immune cell infiltration.Conclusion S100P and TSLP can be used as biomarkers to predict the prognosis of breast cancer,and they can also help to evaluate the tumor immunoinfiltration in breast cancer patients,and TSLP could provide theoretical basis for predicting the prognosis and tumor immunotherapy in breast cancer patients.

Objective To explore the relationship of the preoperative serum alanine aminotransferase(ALT)/aspartate aminotransferase(AST)ratio and imaging features to the prognosis of patients with hepatocellular carcinoma(HCC)after receiving transarterial chemoembolization(TACE),and to develop a nomogram model used for predicting the patient's overall survival(OS).Methods A total of 211 patients,who were diagnosed as HCC and were treated with TACE as the initial therapy at the Guangci Branch of the First Affiliated Hospital of Soochow University of China between July 2016 and July 2020,were enrolled in this study.The patients were randomly divided into the modeling group(n=139)and validation group(n=72).The receiver operating characteristic(ROC)curve was used to determine the optimal cutoff value of AST/ALT ratio.The univariate and multivariate Cox regression analyses were conducted in the modeling group to screen out the independent predictors affecting HCC patient's OS and to establish a prognostic model.Harrell consistency index(C-index)was used to evaluate the predictive ability of the nomogram model for OS in HCC patients,and the calibration curves were plotted to assess the predictive accuracy of the nomogram model.Results No statistically significant difference in the baseline feature distribution existed between the modeling group and validation group(P＞0.05).The median OS of the modeling group and validation group was 28.5 months(95％CI:22.1-34.9)and 25.1 months(95％CI:19.2-29.0)respectively,the difference was not statistically significant(x2=1.395,P=0.322).The optimal cutoff value of AST/ALT ratio for predicting OS was 1.10,and the area under curve(AUC)value was 0.674(95％CI:0.604-0.753).The Cox regression analysis indicated that the tumor number(HR=2.080,95％CI=1.245-3.475,P=0.005),tumor capsule(HR=1.771,95％CI=1.128-2.780,P=0.013),irregular marginal enhancement(HR=1.884,95％CI=1.190-2.984,P=0.007),and AST/ALT ratio(HR=2.450,95％CI=1.506-3.987,P＜0.01)were the independent prognostic factors for HCC patients receiving TACE treatment.Based on the above variables,a nomogram model for predicting OS was established,and the C-index values in the modeling group and validation group were 0.733(95％CI:0.650-0.826)and 0.770(95％CI:0.688-0.862)respectively.The calibration curves showed that no significant deviations existed between the predictive curves of the prognostic model and the ideal reference curves for one-,2-and 3-year OS.Conclusion The nomogram model,which is established based on the tumor number,imaging features and preoperative AST/ALT ratio,has an excellent value in predicting the prognosis of HCC patients treated with TACE.

Objective To investigate the effect of isorhyncophylline on cognitive impairment in rats with acute cerebral infarction and its corresponding mechanism.Methods SD rats were separated into acute cerebral infarction group,sham operation group,low-dose isorhyncophylline group,high-dose isorhyncophylline group,nimodipine group,and high-dose isorhyncophylline+ADU-S100 group,with 24 rates for each group.Except the sham operation group,the rats in other groups were treated with filament model to construct the model of acute cerebral infarction.In the sham operation group,only the right external carotid artery,common carotid artery and internal carotid artery were exposed,and the filament was not inserted.After successful modeling,the medication was administered once a day for 2 weeks.After the modeling was successful,the rats in the low dose group and the high dose group were given 5 mg/kg and 20 mg/kg respectively,and the same amount of isotonic saline was injected intraperitoneally.Nimodipine group rats were given 30 mg/kg nimodipine by intragastric administration,and the same amount of isotonic saline was also injected intraperitoneally.The rats in high dose isorhyncophylline+ADU-S 100 group were given 20 mg/kg isorhyncophylline by intragastric administration and 20 mg/kg ADU-S 100 intraperitoneally.Rats in sham operation group and acute cerebral infarction group were injected with 10 ml/kg isotonic saline by intragastric administration and intraperitoneal injection.The medication was administered once a day for 2 weeks.The Zela-Longa neurological function score was evaluated in all the rats 24 h after the final medication,and then Morris water maze test was conducted and their escape latency and the number of stays in the original platform quadrant were recorded.The levels of interleukin 6(IL-6)and tumor necrosis factor(TNF)α in serum were detected by enzyme-linked immunosorbent assay(ELISA).The water content of brain tissue was detected in each group.The volume of cerebral infarction was measured by 2,3,5-triphenyltetrazolium chloride(TTC)staining.Evans blue was applied to detect blood-brain barrier permeability.Real-time quantitative polymerase chain reaction(qRT-PCR)was used to detect the expression of ZO-1 and occludin messenger RNA(mRNA)in brain tissue of each group.The expression of STING,phosphorylated tank-bound kinase 1(p-TBK1)and phosphorylated interferon regulatory factor 3(p-IRF3)in rat brain tissues was detected by western blot and compared between groups.Results Compared with sham operation group,the neurological function score([2.96±0.32]vs.0),brain tissue water content([86.9±3.2]％vs.[71.8±3.1]％),serum TNF-a([86.7±3.5]ng/L vs.[35.6±1.7]ng/L)and IL-6([167.8±6.1]ng/L vs.[50.2±2.2]ng/L)levels,cerebral infarction volume([28.6±1.3]mm3 vs.0 mm3),evans blue content([1.57±0.13]g/Lvs.[0.96±0.08]g/L),STING([1.83±0.16]vs.[0.86±0.08]),p-TBK1([0.89±0.07]vs.[0.41±0.03]),and p-IRF3([0.67±0.05]vs.[0.13±0.01])protein expression in brain tissue were increased,expression of ZO-1([0.45±0.04]vs.[1.00±0.00])and occludin mRNA([0.23±0.02]vs.[1.00±0.00])in brain tissue were decreased,the escape latency was prolonged([33.6±1.6]s vs.[12.3±0.5]s),and the number of stays in the original platform quadrant([5.9±0.2]times vs.[15.7±0.4]times)was decreased in the acute cerebral infarction group 24 h after last medication administration(all P＜0.05).(2)Compared with acute cerebral infarction group,the neurological function score([2.37±0.21],[1.14±0.17],[1.18±0.13]vs.[2.96±0.32]),brain tissue water content([81.8±3.0]％,[74.9±3.0]％,[74.3±2.9]％vs.[86.9±3.2]％),serum TNF-α([71.1±1.4]ng/L,[43.4±2.0]ng/L,[41.5±1.9]ng/L vs.[86.7±3.5]ng/L)and IL-6([129.8±5.4]ng/L,[81.2±3.8]ng/L,[80.0±3.6]ng/L vs.[167.8±6.1]ng/L)levels,cerebral infarction volume([21.7±1.0]mm3,[10.5±0.5]mm3,[10.7±0.5]mm3 vs.[28.6±1.3]mm3),evans blue content([1.39±0.12]g/L,[1.16±0.10]g/L,[1.18±0.19]g/L vs.[1.57±0.13]g/L),STING([1.50±0.14],[1.02±0.11],[1.01±0.09]vs.[1.83±0.16]),p-TBK1([0.75±0.05],[0.54±0.04],[0.52±0.05]vs.[0.89±0.07]),and p-IRF3([0.51±0.05],[0.25±0.02],[0.27±0.02]vs.[0.67±0.05])protein expression in brain tissue were decreased,expression of ZO-1([0.58±0.05],[0.87±0.07],[0.89±0.09]vs.[0.45±0.04])and occludin mRNA([0.36±0.03],[0.71±0.06],[0.69±0.05]vs.[0.23±0.02])in brain tissue were increased,the escape latency were shortened([28.6±1.0]s,[16.5±0.7]s,[16.4±0.7]s vs.[33.6±1.6]s),and the number of stays in the original platform quadrant([8.2±0.3]times,[12.8±0.5]times,[12.9±0.5]times vs.[5.9±0.2]times)were increased in the low-dose isorhyncophylline group,high-dose isorhyncophylline group,and nimodipine group(all P＜0.05).(3)Compared with high-dose isorhyncophylline group,the neurological function score([2.12±0.14]vs.[1.14±0.17]),brain tissue water content([78.7±3.2]％vs.[74.9±3.0]％),serum TNF-a([59.7±2.1]ng/L vs.[43.4±2.0]ng/L)and IL-6([118.9±4.6]ng/L vs.[81.2±3.8]ng/L)levels,cerebral infarction volume([16.6±0.4]mm3 vs.[10.5±0.5]mm3),evans blue content([1.36±0.10]g/L vs.[1.16±0.10]g/L),and STING([1.37±0.12]vs.[1.02±0.11]),p-TBK1([0.67±0.05]vs.[0.54±0.04]),and p-IRF3([0.39±0.03]vs.[0.25±0.02])protein expression in brain tissue were increased,expression of ZO-1([0.63±0.05]vs.[0.87±0.07])and occludin mRNA([0.46±0.05]vs.[0.71±0.06])in brain tissue were decreased,the escape latency was prolonged([23.4±1.0]svs.[16.5±0.7]s),and the number of stays in the original platform quadrant([9.6±0.3]times vs.[12.8±0.5]times)was decreased in the isorhyncophylline high-dose+ADU-S100 group(all P＜0.05).Conclusion Isorhyncophylline can inhibit inflammation,reduce blood-brain barrier damage,reduce cerebral edema,and improve cognitive impairment in rats with acute cerebral infarction,and the mechanism of which may be related to the inhibition of STING/TBK1/IRF3 pathway.

Objective To investigate the expression of circular RNA(Circ RNAS)Actinin α 4(ACTN4)and platelet thrombin protein 1(THBS1)in intrahepatic cholangiocarcinoma(ICC)and their relationship with clinicopathological characteristics and prognosis,and provide reference for clinical diagnosis and treatment.Method A retrospective analysis was conducted on 84 ICC patients diagnosed and treated in the Second Affiliated Hospital of Xian Jiaotong University from May 2017 to June 2020.The expressions of CircACTN4 mRNA,THBS1 mRNA and protein were detected by real-time fluorescent quantitative PCR and immunohistochemistry.Pearson correlation analysis was used to analyze the correlation between CircACTN4 mRNA and THBS1 mRNA in ICC cancer tissue.The prognostic differences of ICC patients with different CircACTN4 mRNA and THBS1 mRNA expressions were compared by the Kaplan-Meier method(log rank test).COX regression analysis was performed to identify prognostic factors in ICC patients.The prognostic value of CircACTN4 mRNA and THBS1 mRNA in evaluating the risk of death in ICC patients was assessed by receiver operating characteristic(ROC)curve analysis.Results The expression of CircACTN4 mRNA in ICC tissues(3.14±0.42)was higher than that in adjacent tissues(0.76±0.25),with significant difference(t=44.094,P＜0.001).The positive rates of THBS1 mRNA(2.82±0.36)and protein positive rate(92.86％)in ICC tissues were higher than those in adjacent tissues(0.81±0.24,7.14％),and the differences were statistically significant(t/x2=42.068,123.429,all P＜0.001).CircACTN4 mRNA was positively correlated with THBS1 mRNA in ICC cancer tissue(r=0.669,P＜0.001).The expressions of CircACTN4 mRNA,THBS1 mRNA in ICC cancer tissues with TNM stage Ⅲ,low differentiation,and lymph node metastasis were higher than those in TNM stage Ⅰ～Ⅱ,high differentiation,and non-lymph node metastasis cancer tissues,and the differences were statistically significant(x2=7.949,9.164,12.207;23.270,18.625,19.828,all P＜0.001).The 3-year cumulative survival rates of the high expression group of CircACTN4 mRNA and THBS1 mRNA were lower than those of the low expression group of CircACTN4 mRNA(25.00％vs 56.82％)and THBS1 mRNA(19.51％vs 62.79％),and the differences were statistically significant(Log rank x2=13.601,24.310,all P＜0.001).CircACTN4 mRNA(OR=1.839,95％CI:1.228～2.753),THBS1 mRNA(OR=1.744,95％CI:1.245～2.443),lymph node metastasis(OR=1.925,95％CI:1.316～2.816),TNM staging(OR=1.613,95％CI:1.223～2.126),and tumor differentiation(OR=1.510,95％CI:1.205～1.892)were independent factors affecting the prognosis of ICC.The area under the curve of the combination detection of circACTN4 and THBS1 mRNA on the prognosis of death in patients with ICC was 0.868,which was greater than that of the single index(0.812 and 0.784),with significant differences(Z=3.348,3.847,all P＜0.001).Conclusion The expressions of CircACTN4 mRNA and THBS1 mRNA were increased in ICC,and they were associated with TNM stage,differentiation,and lymph node metastasis.These markers may serve as novel indicators to evaluate the poor prognosis of ICC patients.

Objective:To investigate serum vitamin A and vitamin D status in children aged 2-<7 years in 20 cities in China.Methods:A cross-sectional study was conducted. A total of 2 924 healthy children aged 2-<7 years were recruited from September 2018 to September 2019 from 20 cities in China, categorized by age groups of 2-<3 years, 3-<5 years, and 5-<7 years. The demographic and economic characteristics and health-related information of the enrolled children were investigated. Body weight and height were measured by professional staff members. The serum vitamin A and vitamin D levels were detected by high-performance liquid chromatography-tandem mass spectrometry. Chi-square test and Logistic regression were applied to analyze the association between vitamin A and vitamin D deficiency and insufficiency as well as their underlying impact factors.Results:The age of the 2 924 enrolled children was 4.33 (3.42, 5.17) years. There were 1 726 males (59.03%) and 1 198 females (40.97%). The prevalences of vitamin A and vitamin D deficiency in enrolled children were 2.19% (64/2 924) and 3.52% (103/2 924), respectively, and the insufficiency rates were 29.27% (856/2 924) and 22.20% (649/2 924), respectively. Children with both vitamin A and vitamin D deficiencies or insufficiencies were found in 10.50% (307/2 924) of cases. Both vitamin A ( χ2=7.91 and 8.06, both P=0.005) and vitamin D ( χ2=71.35 and 115.10, both P<0.001) insufficiency rates were higher in children aged 3-<5 and 5-<7 years than those in children aged 2-<3 years. Vitamin A and vitamin D supplementation in the last 3 months was a protective factor for vitamin A and D deficiency and insufficiency, respectively ( OR=0.68 and 0.22, 95% CI 0.49-0.95 and 0.13-0.40, both P<0.05). The rates of vitamin A and D insufficiency was higher in children with annual household incomes <60 000 RMB than in those with annual household incomes ≥60 000 RMB ( χ2=34.11 and 10.43, both P<0.01). Northwest and Southwest had the highest rates of vitamin A and vitamin D insufficiency in children aged 2-<7 yeas, respectively ( χ2=93.22 and 202.54, both P<0.001). Conclusions:Among 20 cities in China, children aged 2-<7 years experience high rates of vitamin A and vitamin D insufficiency, which are affected by age, family economic level, vitamin A and vitamin D supplementation, and regional economic level. The current results suggest that high level of attention should be paid to vitamin A and vitamin D nutritional status of preschool children.