Objective To access the effectiveness of withdrawing iodized salt on correcting the iodine excess in the population living in high iodine areas.Methods Before withdrawing iodized salt,2 twons were selected from each of 5 cities with water-borne iodine excess areas in Hebei province.All the selected towns were divided into 7 groups according to their iodine content in drinking water.Two villages wereselected from each group where urine samples of children aged 8 to 10 years old were collected to investigate the change of urinary iodine content of these children before and after withdrawing iodized salt.The urinary iodine content was determined using the method for determination of ammonium persulfate digestion arsenic cerium catalytic spectrophotometry (WS/T 107-2006).Correlation between children's urinary iodine and drinking water iodine was analyzed.Results Before and after withdrawing iodized salt,744 and 771 urine samples were collected from the examined children aged 8-10 years respectively.The overall median urinary iodine content (MUIC) of the examined children after withdrawing iodized salt (350.1 μg/L) decreased significantly than that of before withdrawing iodized salt (460.8 μg/L,U =3 127.8,P ＜ 0.05).After withdrawing iodized salt,the MUIC of the children decreased significantly in 8 of 12 villages (P ＜ 0.05).Before and after withdrawing iodized salt,the percentage of urine samples with iodine content above 300 μg/L was 76.7％ (571/744),58.5％ (451/771) respectively,with significant statistical difference (x2 =57.7,P ＜ 0.05).After withdrawing iodized salt,Children's MUIC also decreased significantly across gender and age (boys:558.5,351.6 μg/L,U =960,P ＜ 0.05; girls:522.9,355.5 μg/L,U =698,P ＜ 0.05; 8 years old:536.0,295.5 μg/L,U =529.5,P ＜ 0.01; 9 years old:386.2,323.2 μg/L,U =753.5,P ＜ 0.01; 10 years old:525.5,368.8 μg/L,U =521.5,P ＜ 0.05).The children's MUIC correlated positively with the median water iodine contert (MWIC) in the villages where they lived (r =0.951,P ＜ 0.01).Analyzed by linear regression,approximately 89％ of the variability in MUIC was associated with variability in MWIC.Conclusions Withdrawing iodized salt could only correct the iodine excess caused by consuming iodized salt in the population living in the areas with MWIC below 100 μg/L.In the areas with water iodine above 100 μg/L,intervention should be focused on seeking water with proper iodine content.

Objective:To investigate the cognition of terminal stage patients'dignity therapy,attitude towards its concept and scheme,willingness of its promotion in college students and to gain some recommendations for improvement.Methods:Combined quantitative and qualitative methods,an anonymous questionnaire survey was conducted in a convenience sample of 220 college students,of which 20 students were selected for in-depth interviews.Results:Only 17.73％ of students had a correct understanding of dignity therapy,94.98％ of them accepted its concept,92.96％ of them held a positive attitude,74.38％ of them were willing to promote dignity therapy,in which female students were dominated (P =0.041).Interview results showed that the contents of dignity therapy were to some extent stiff and not fit for Chinese patients,which might impede its promotion.Conclusion:College students lack the cognition of dignity therapy.But they hold a positive attitude and are willing to promote dignity therapy when they get to know its concept and contents.As seen,dignity therapy has a good future but there are still some obstructions in the promotion,and need to be localized.

Paroxysmal sympathetic hyperactivity (PSH) is mainly secondary to a variety of acquired brain injuries, with the highest incidence of traumatic brain injury. Multiple symptoms such as paroxysmal tachycardia, shortness of breath, hypertension, hyperthermia and dystonia can occur simultaneously and repeatedly. The pathophysiological mechanism of PSH is complex. At present, drug treatment is mainly used to control symptoms; however, the combined use of multiple drugs will bring different degrees of toxic and side effects to multiple organs such as liver, kidney and lung while inhibiting sympathetic excitement. This paper mainly reviews the recent advance in non-drug treatment of PSH after craniocerebral injury from 4 aspects: nutritional support, hyperbaric oxygen therapy, avoidance of adverse stimulation and family support to standardize the PSH comprehensive management, and reduce episodes in order to improve prognosis and provide reference for clinical treatment.

Objective To understand the prevalence of goiter and nodule as well as the iodine nutritional status of 8 to 10 years old children after changing water source with lower iodine so as to evaluate its intervention effectiveness.Methods From 2014 to 2017,Machang Village and Liangzhang Village of Haixing County in Haixing County were selected as monitoring sites in the water-sourced high iodine area in Hebei Province.Using the cross-sectional survey method,100 children aged 8 to 10 years old were randomly selected in each village,half male and half female.Dynamic monitoring of drinking water iodine content,children's prevalence of goiter and nodule as well as urinary iodine content were conducted before and 1-3 years after changing water resource.Iodine detection was performed using an arsenic cerium-catalyzed spectrophotometric method suitable for iodine-deficient and high-iodine areas (recommended method for national iodine deficiency disease reference experiment);urinary iodine was detected by arsenic cerium catalytic spectrophotometry (WS/T 107-2006).The thyroid test was performed using the B-ultrasound method and the criterion was based on the "Diagnostic Criteria for Endemic Goiter" (WS 276-2007).Results The median iodine content of water in the two villages before the reformation was 861.0 μg/L,and it was 71.6,29.1 and 30.4 μg/L in 1-3 years after water was changed.The overall difference before and after water change was statistically significant (x2 =8.48,P ＜ 0.05).The median urine iodine of children in the two villages before the change of water was 705.0 μg/L,and the median urine iodine of children was 306.0,143.0 and 140.0 μg/L after 1-3 years.The differences were statistically significant (Z =6.56,10.82,11.19,P ＜ 0.05).The goiter rate was 10.3％ (21/203) before changing water,and the goiter rate was 6.3％ (13/205),6.4％ (13/203) and 3.8％ (8/208) in 1-3 years after water exchange,and the difference between before and 3 years after water exchange was statistically significant (x2 =6.61,P ＜ 0.05).Children's nodule prevalence before and 3 years after changing water was 11.3％ (23/203) and 1.4％ (3/208),the difference was statistically significant (x2 =13.42,P ＜ 0.05).Conclusion Three years after changing water resource,children's goiter prevalence is back to normal in general,and nodule prevalence is decreased significantly,which indicates sound intervention effectiveness.

Objective To evaluate the predictive value and to verify the clinical effect of JPKD-vancomycin for the trough concentration of vancomycin in patients with augmented renal clearance (ARC), and to provide a reference for clinical individualized drug therapy. Methods A retrospective analysis was conducted. The clinical data of 48 adult patients with ARC using vancomycin and monitoring steady-state trough concentration of vancomycin admitted to Suzhou Hospital Affiliated to Nanjing Medical University from July 2013 to July 2017 were collected. A combination of classical Vancomycin Calculator software and JPKD-vancomycin software was used. Based on the individual conditions of patients [gender, age, height, weight, serum creatinine (SCr), disease status], Vancomycin Calculator software was used to obtain the recommended regimen and its steady-state trough concentration, and then JPKD-vancomycin software was used to predict the steady-state trough concentration of initial regimen. If the regimen was adjusted during the treatment, JPKD-vancomycin software was used to predict the steady-state trough concentration of the adjusted regimen. The measured values of steady-state trough concentration were recorded. The weight deviation between predicted concentration and measured concentration (WRES) was calculated. WRES < 30% was considered as good prediction, and the predictive value of JPKD-vancomycin software was evaluated for vancomycin trough concentration. Results Forty-eight patients with ARC were enrolled, of whom 24 patients had adjusted the dosing regimen during the treatment. The initial concentration of blood samples was 48, after adjusting the dosage regimen, 24 blood samples were collected. The initial and adjusted daily dose of vancomycin was (2 000±500) mg/d and (2 500±600) mg/d, respectively, and the initial trough concentrations and adjusted trough concentrations was (8.4±7.3) mg/L and (9.1±4.3) mg/L, respectively. Only 14.6% and 25.0% of initial and adjusted trough concentrations reached the target range (10-20 mg/L) without significant difference (P > 0.05). The WRES value of adjusted trough concentrations predicted by JPKD-vancomycin software was significantly lower than that of initial regimen [10.6% (3.0%, 16.4%) vs. 14.3% (10.5%, 38.2%), P < 0.05], and the percentage of WRES < 30% also tended to increase [95.8% (23/24) vs. 70.8% (34/48), P < 0.05]. The well predictive rate of JPKD-vancomycin software for vancomycin trough concentration was 79.2% (57/72), but there were 15 patients with WRES > 30%. Conclusions JPKD-vancomycin software has good predictive value for the vancomycin trough concentration of ARC patients, especially for the trough concentration after adjusting the treatment regimen. JPKD-vancomycin can provide a reference for the design of clinical individualized application of vancomycin.

OBJECTIVE To stu dy the effects of different processing me thods on the contents of the pharmacodynamic index components in Citrus aurantium and their antioxidant activity. METHODS According to the general principles of 2020 edition of Chinese Pharmacopoeia （volume Ⅳ） and the relevant processing methods in 2015 edition of Processing Specifications of Traditional Chinese Medicine in Zhejiang Province ，the samples of C. aurantium were prepared by steaming with water ，boiling with water ，stir-frying with vinegar ，stir-frying with wine ，stir-frying with bran ，processing with bran and processing with honey. The contents of moisture and ash in different products of C. aurantium were detected. The contents of naringin and neohesperidin in different products of C. aurantium were determined by high performance liquid chromatography. The antioxidant activity of different products was investigated by DPPH and ABTS + radical scavenging experiments and the total reducing power test. RESULTS The contents of moisture ，ash，naringin and neohesperidin were in line with the relevant requirements in 2015 edition of Processing Specifications of Traditional Chinese Medicine in Zhejiang Province . The content of naringin in descending order was as follow ： unprocessed sample ＞sample processed with honey ＞sample processed with bran ＞sample boiled with water ＞sample stir-fried with vinegar＞sample stir-fried with wine ＞sample stir-fried with bran ＞sample steamed with water. The content of neohesperidin in descending order was as follow ：unprocessed sample ＞sample boiled with water ＞sample processed with bran ＞sample processed with honey ＞sample stir-fried with vinegar ＞sample steamed with water ＞sample stir-fried with wine ＞sample stir-fried with bran. The samples after boiling with water ，processing with bran ，and stir-fried with bran had better DPPH radicals scavenging ability （IC50 were 7.49，8.37 and 10.22 mg/mL，respectively）. The samples after boiling with water ，steaming with water ，and processed with bran had better ABTS + radicals scavenging ability （IC50 were 1.76，2.03 and 2.72 mg/mL，respectively）. In addition ， compared with sample stir-fried with wine and processed with 发。E-mail：wanglu1286@163.com honey，unprocessed sample and other processed products of C.aurantium had bet ter total reducing ability. CONCLUSIONS After processing ，the contents of the main pharmacodynamic index components in C. aurantium have been reduced ，but they were also in line with the relevant requirements in 2015 edition of Processing Specifications of Traditional Chinese Medicine in Zhejiang Province . The antioxidant ability of some processed products has been enhanced.