1.Clinical observation of ultra early enteral nutrition support in critically ill children undergoing extracorporeal membrane oxygenation
Yan LI ; Yucai ZHANG ; Minjie JU ; Conghui FU ; Ji LIU ; Xiaoya YANG ; Yun CUI ; Tingting XU
Chinese Journal of Pediatrics 2025;63(3):249-253
Objective:To investigate the feasibility and clinical effects of ultra early enteral nutrition (≤24 h) in critically ill children supported by extracorporeal membrane oxygenation (ECMO).Methods:A retrospective cohort study was conducted. Clinical data of 43 critically ill children who received ECMO support in the pediatric intensive care unit (PICU) of Shanghai Children′s Hospital from January 2016 to December 2023 were collected, including general information, nutritional support modalities, and enteral nutrition tolerance. Based on the timing of enteral nutrition initiation, patients were divided into the within 24 h enteral nutrition group and the after 24 h enteral nutrition group. Nutritive indicators, nutritional intake, duration of ECMO support, duration of mechanical ventilation duration, and mortality rates were compared between the 2 groups using the two independent sample t test, Mann-Whitney U test, χ2 test and Fisher′s exact test. Results:Among the 43 children, 25 were male and 18 were female, with an age of 47 (18, 97) months. There were no statistically significant differences between the within 24 h enteral nutrition group (21 cases) and the after 24 h enteral nutrition group (22 cases) in terms of age, body mass index Z score, total protein, albumin, hemoglobin levels before ECMO support, duration of ECMO support, duration of mechanical ventilation, length of PICU stay, number of enteral nutrition intolerance events, number of enteral nutrition interruption, or mortality rate (all P>0.05). The protein intake adequacy rate during ECMO support was higher in the within 24 h enteral nutrition group than in the after 24 h enteral nutrition group (0 (0, 21%) vs. 0 (0, 0), U=175.00, P<0.05). Conclusions:Ultra early enteral nutrition is safe for children supported by ECMO. Initiating enteral nutrition within 24 h can increase the proportion of days with adequate protein intake in ECMO children without increasing the occurance of enteral nutrition intolerance or interruptions.
2.Clinical observation of ultra early enteral nutrition support in critically ill children undergoing extracorporeal membrane oxygenation
Yan LI ; Yucai ZHANG ; Minjie JU ; Conghui FU ; Ji LIU ; Xiaoya YANG ; Yun CUI ; Tingting XU
Chinese Journal of Pediatrics 2025;63(3):249-253
Objective:To investigate the feasibility and clinical effects of ultra early enteral nutrition (≤24 h) in critically ill children supported by extracorporeal membrane oxygenation (ECMO).Methods:A retrospective cohort study was conducted. Clinical data of 43 critically ill children who received ECMO support in the pediatric intensive care unit (PICU) of Shanghai Children′s Hospital from January 2016 to December 2023 were collected, including general information, nutritional support modalities, and enteral nutrition tolerance. Based on the timing of enteral nutrition initiation, patients were divided into the within 24 h enteral nutrition group and the after 24 h enteral nutrition group. Nutritive indicators, nutritional intake, duration of ECMO support, duration of mechanical ventilation duration, and mortality rates were compared between the 2 groups using the two independent sample t test, Mann-Whitney U test, χ2 test and Fisher′s exact test. Results:Among the 43 children, 25 were male and 18 were female, with an age of 47 (18, 97) months. There were no statistically significant differences between the within 24 h enteral nutrition group (21 cases) and the after 24 h enteral nutrition group (22 cases) in terms of age, body mass index Z score, total protein, albumin, hemoglobin levels before ECMO support, duration of ECMO support, duration of mechanical ventilation, length of PICU stay, number of enteral nutrition intolerance events, number of enteral nutrition interruption, or mortality rate (all P>0.05). The protein intake adequacy rate during ECMO support was higher in the within 24 h enteral nutrition group than in the after 24 h enteral nutrition group (0 (0, 21%) vs. 0 (0, 0), U=175.00, P<0.05). Conclusions:Ultra early enteral nutrition is safe for children supported by ECMO. Initiating enteral nutrition within 24 h can increase the proportion of days with adequate protein intake in ECMO children without increasing the occurance of enteral nutrition intolerance or interruptions.
3.Progress in studies on factors affecting antiviral therapy for chronic hepatitis C
Conghui XU ; Wanting LYU ; Jiahuan GUO ; Zhaozhen LIU ; Can PANG ; Hongyan LU
Chinese Journal of Experimental and Clinical Virology 2024;38(6):717-721
Antiviral therapy is an effective means of curing chronic hepatitis C (CHC) and a key focus of preventing the spread of hepatitis C. By analyzing domestic and foreign literature, this paper provides an overview of the estimation of the antiviral treatment rate for CHC, the current situation of antiviral treatment for CHC both domestically and internationally, and the factors that affect acceptance of antiviral treatment. At present, the antiviral treatment rate for CHC cases is relatively low both domestically and internationally. The treatment status of CHC cases is related to factors such as the general situation of the case, knowing their HCV status or self-perceived condition, concurrent presence of other diseases or conditions, knowledge of hepatitis C prevention and treatment, and social interaction and behavioral guidance. In response to the relevant difficulties, in-depth research or more support is needed to improve the antiviral treatment rate of CHC cases and achieve the goal of eliminating hepatitis C by 2030. Efforts should be made to strengthen policy support, improve the diagnosis of hepatitis C, prevent and control multiple diseases together, conduct targeted publicity and education, and enhance social support.
4.Iodine level in drinking water of residents in Guangzhou City in 2022
Conghui XU ; Haiyan CHEN ; Ke LI ; Hongwei ZHOU ; Hao ZHANG ; Jianmin XU ; Lirui FAN
Chinese Journal of Endemiology 2024;43(12):959-963
Objective:To investigate the iodine level in drinking water of residents in Guangzhou City.Methods:From March to October 2022, a survey of iodine level in residents' drinking water was conducted in 2 702 administrative villages (communities) in 11 municipal districts of Guangzhou City. Water samples were collected according to different water supply methods (centralized, decentralized, and mixed), and the water iodine level was determined using inductively coupled plasma mass spectrometry. The distribution of iodine level in drinking water of residents in administrative villages (communities) was analyzed.Results:In 2 702 administrative villages (communities) in Guangzhou City, centralized water supply was the main way of water supply, accounting for 95.34% (2 576/2 702); decentralized water supply accounted for 3.66% (99/2 702); mixed water supply accounted for 1.00% (27/2 702). The overall water iodine of each administrative village (community) was 8.93 (5.93, 13.19) μg/L, ranging from 0.00 to 67.79 μg/L. Among them, 99.81% (2 697/2 702) of the administrative villages (communities) had a median water iodine level of less than 40 μg/L, indicating iodine deficiency areas; 0.19% (5/2 702) of the administrative villages (communities) had a median water iodine of 40 - 100 μg/L, indicating suitable iodine areas; no high iodine area with a median water iodine level greater than 100 μg/L was found.Conclusions:The iodine level in the drinking water of residents in Guangzhou City is generally at a low level, and the external environment is generally deficient in iodine. No area with high iodine level has been found.
5.Expression and clinical significance of FAT1 gene in pancreatic adenocarcinoma
Xinyuan LIU ; Ying YANG ; Chaodan YANG ; Zhengxiao MA ; Conghui WU ; Chen XU ; Rui ZHU ; Pan LIU ; Lisha YING ; Wenjuan YIN ; Dan SU
Chinese Journal of Oncology 2024;46(11):1029-1037
Objective:To analyze the expression of FAT1 gene in pancreatic adenocarcinoma and its relationship with clinicopathological features, prognosis, and immunotherapy for pancreatic adenocarcinoma.Methods:(1) Bioinformatics analysis: based on FAT1 mRNA expression and clinical data of 179 cases of pancreatic adenocarcinoma in the TCGA database, and FAT1 mRNA expression data of 328 cases of normal pancreatic tissues in the GTEx database. We analyzed the differences in FAT1 mRNA expression in pancreatic adenocarcinoma and normal pancreatic tissues and the relationship between FAT1 mRNA expression and the degree of differentiation, clinical stage, prognosis, immune cell infiltration, and immune checkpoint-associated genes in pancreatic adenocarcinoma. FAT1-related differentially expressed genes were analyzed by applying Limma 3.40.2 software package, and GO and KEGG enrichment analysis was performed on the differentially expressed genes. Immunohistochemical (IHC) of FAT1 in pancreatic adenocarcinoma and normal pancreatic tissues was analyzed by HPA database. (2) Validation of own tissue samples: tissue samples and clinical and prognostic data of 192 patients with pancreatic ductal adenocarcinoma admitted to Zhejiang Cancer Hospital from March 8, 2010 to September 30, 2020 were collected. IHC was performed on the tissue samples to verify the protein expression of FAT1 in pancreatic adenocarcinoma and its relationship with immune-related proteins, the degree of differentiation of pancreatic adenocarcinoma, clinical staging, and prognosis.Results:(1) Bioinformatics analysis: the FAT1 mRNA expression of 179 pancreatic adenocarcinoma tissues from the TCGA database was 5.55±1.04, which was higher than that of 328 normal pancreatic tissues with FAT1 mRNA from the GTEx database (2.95±0.53, P<0.001). FAT1-specific IHC images showed that FAT1 expression was generally high in pancreatic adenocarcinoma tissues, and FAT1 expression shifted from the cell membrane to the cytoplasm. The FAT1 mRNA expression in the highly differentiated group (31 cases), the moderately differentiated group (96 cases), and the lowly differentiated group (52 cases) were 4.99±1.46, 5.51±0.80, and 5.68±1.08, the expression of pancreatic adenocarcinoma tissues were all higher than that of normal pancreatic tissues (all P<0.001), and the FAT1 mRNA expression of the moderately differentiated group and the poorly differentiated group were all higher than that of the highly differentiated group (all P<0.001). The median progression-free survival time (PFS) and median overall survival time (OS) of the 90 patients in the FAT1 mRNA low-expression group were 16.5 and 24 months, respectively, which were longer than those of the 89 patients in the FAT1 mRNA high-expression group (median PFS and OS were 13 and 18 months, respectively; P-values were 0.011 and 0.005, respectively). Multifactorial Cox regression analysis showed that FAT1 mRNA expression level was an independent influencing factor for OS in pancreatic adenocarcinoma patients ( HR=1.47, 95% CI: 1.09-1.99). Correlation analysis showed that FAT1 mRNA expression in pancreatic adenocarcinoma was positively correlated with B-cell infiltration, CD8+ T-cell infiltration, neutrophil infiltration, macrophage infiltration, and myeloid dendritic cell infiltration ( ρ=0.27, P<0.001; ρ=0.28, P<0.001; ρ=0.32, P<0.001; ρ=0.21, P=0.004; ρ=0.32, P<0.001), and also positively correlated with mRNA expression of CD274, HAVCR2, and PDCD1LG2 ( r=0.327, P<0.001; r=0.231, P=0.002; r=0.258, P<0.001). GO and KEGG enrichment analyses showed that FAT1 mRNA expression levels were associated with activation of the Wnt signaling pathway ( P=0.029), the PI3K/Akt pathway ( P<0.001), and other tumor microenvironment-related pathways. (2) Validation of own tissue samples: among 192 pancreatic adenocarcinoma tissues, FAT1 was highly expressed in 58 cases (30.21%), and the proportion of FAT1-expressing positive tumor cells was positively correlated with the combined positive score of PD-L1 and the number of CD3+ T-cells infiltration ( r=0.154, P=0.032; r=0.287, P<0.001), and the protein expression of FAT1 had no correlation with the differentiation degree of pancreatic adenocarcinoma ( ρ=0.082, P=0.254). The median OS of 58 patients in the FAT1 high-expression group and 134 patients in the FAT1 low-expression group were 18.89 and 25.84 months, respectively, and the difference was not statistically significant (χ2=1.93, P=0.165). Conclusion:FAT1 gene is highly expressed in pancreatic adenocarcinoma tissues, may play an oncogenic role in pancreatic adenocarcinoma, may be an adverse influence on overall survival and progression-free survival of patients; FAT1 gene may be involved in multiple immune-related pathways and promote tumor immune escape.
6.Expression of TRIP4 and DDIT4 in Glioma Tissue and Their Relationship with Clinical Pathological Parameters and Prognosis
Shanquan JING ; Liping LIANG ; Linlin LIU ; Hui LI ; Conghui LI ; Lifeng XU
Journal of Modern Laboratory Medicine 2024;39(2):18-22,128
Objective To study the expression of thyroid hormone receptor binding protein 4(TRIP4)and DNA damage inducing transcription factor 4(DDIT4)in glioma tissue and their relationship with clinical pathological characteristics and prognosis.Methods 94 glioma patients admitted to the First Hospital of Hebei Medical University from February 2018 to February 2019 were selected as the research subjects.The expression of TRIP4,DDIT4 proteins in tissues were detected by immunohistochemistry.The relationship between the expression of TRIP4,DDIT4 proteins in glioma tissues and clinical pathological characteristics were compared.The differences in survival prognosis of glioma patients with different levels of TRIP4,DDIT4 protein expression were analyzed by Kaplan-Meier survival curve.Univariate and multivariate COX regression analysis was conducted to analyze the factors affecting the survival prognosis of glioma patients.Results The positive rates of TRIP4(68.09%),DDIT4(65.96%)proteins in glioma tissues were higher than those in adjacent tissues(13.83%,10.64%),with statistically significant differences(χ2=57.212,60.866,all P<0.05).There was a significant positive correlation between TRIP4 and DDIT4 protein expression in glioma tissues(r=0.722,P<0.05).The positive rates of TRIP4(83.64%vs 46.15%,80.00%vs 51.28%)and DDIT4(80.00%vs 46.15%,76.36%vs 51.28%)proteins in glioma tissues with tumor diameter≥3cm,WHO grade Ⅲ were significantly higher than those in tissues with tumor diameter<3cm,WHO grade Ⅰ~Ⅱ(χ2=6.393~14.754,P<0.05).The 3-year overall survival rates of the TRIP4 positive and negative expression groups were 37.50%(24/64)and 66.67%(20/30),respectively.The 3-year cumulative survival of the TRIP4 positive expression group was significantly lower than that in the TRIP4 negative expression group(Log-rank χ2=5.949,P=0.015).The 3-year overall survival rate of DDIT4 positive and negative expression group was 37.10%(23/62)and 70.00%(21/30),respectively.The 3-year cumulative survival of the DDIT4 positive expression group was significantly lower than that in the DDIT4 negative expression group(Log-rank χ2=7.642,P=0.006).Tumor diameter≥3cm(HR=1.614,P=0.000),WHO grade Ⅲ(HR=1.790,P=0.000),positive TRIP4(HR=1.665,P=0.000)and positive DDIT4(HR=1.476,P=0.000)were independent risk factors affecting the survival prognosis of glioma patients.Conclusion The expression of TRIP4 and DDIT4 protein in glioma tissue was increased.Both of them were related to tumor diameter and WHO grade,and are potential tumor markers for survival prognosis of glioma.
7.Expression and clinical significance of FAT1 gene in pancreatic adenocarcinoma
Xinyuan LIU ; Ying YANG ; Chaodan YANG ; Zhengxiao MA ; Conghui WU ; Chen XU ; Rui ZHU ; Pan LIU ; Lisha YING ; Wenjuan YIN ; Dan SU
Chinese Journal of Oncology 2024;46(11):1029-1037
Objective:To analyze the expression of FAT1 gene in pancreatic adenocarcinoma and its relationship with clinicopathological features, prognosis, and immunotherapy for pancreatic adenocarcinoma.Methods:(1) Bioinformatics analysis: based on FAT1 mRNA expression and clinical data of 179 cases of pancreatic adenocarcinoma in the TCGA database, and FAT1 mRNA expression data of 328 cases of normal pancreatic tissues in the GTEx database. We analyzed the differences in FAT1 mRNA expression in pancreatic adenocarcinoma and normal pancreatic tissues and the relationship between FAT1 mRNA expression and the degree of differentiation, clinical stage, prognosis, immune cell infiltration, and immune checkpoint-associated genes in pancreatic adenocarcinoma. FAT1-related differentially expressed genes were analyzed by applying Limma 3.40.2 software package, and GO and KEGG enrichment analysis was performed on the differentially expressed genes. Immunohistochemical (IHC) of FAT1 in pancreatic adenocarcinoma and normal pancreatic tissues was analyzed by HPA database. (2) Validation of own tissue samples: tissue samples and clinical and prognostic data of 192 patients with pancreatic ductal adenocarcinoma admitted to Zhejiang Cancer Hospital from March 8, 2010 to September 30, 2020 were collected. IHC was performed on the tissue samples to verify the protein expression of FAT1 in pancreatic adenocarcinoma and its relationship with immune-related proteins, the degree of differentiation of pancreatic adenocarcinoma, clinical staging, and prognosis.Results:(1) Bioinformatics analysis: the FAT1 mRNA expression of 179 pancreatic adenocarcinoma tissues from the TCGA database was 5.55±1.04, which was higher than that of 328 normal pancreatic tissues with FAT1 mRNA from the GTEx database (2.95±0.53, P<0.001). FAT1-specific IHC images showed that FAT1 expression was generally high in pancreatic adenocarcinoma tissues, and FAT1 expression shifted from the cell membrane to the cytoplasm. The FAT1 mRNA expression in the highly differentiated group (31 cases), the moderately differentiated group (96 cases), and the lowly differentiated group (52 cases) were 4.99±1.46, 5.51±0.80, and 5.68±1.08, the expression of pancreatic adenocarcinoma tissues were all higher than that of normal pancreatic tissues (all P<0.001), and the FAT1 mRNA expression of the moderately differentiated group and the poorly differentiated group were all higher than that of the highly differentiated group (all P<0.001). The median progression-free survival time (PFS) and median overall survival time (OS) of the 90 patients in the FAT1 mRNA low-expression group were 16.5 and 24 months, respectively, which were longer than those of the 89 patients in the FAT1 mRNA high-expression group (median PFS and OS were 13 and 18 months, respectively; P-values were 0.011 and 0.005, respectively). Multifactorial Cox regression analysis showed that FAT1 mRNA expression level was an independent influencing factor for OS in pancreatic adenocarcinoma patients ( HR=1.47, 95% CI: 1.09-1.99). Correlation analysis showed that FAT1 mRNA expression in pancreatic adenocarcinoma was positively correlated with B-cell infiltration, CD8+ T-cell infiltration, neutrophil infiltration, macrophage infiltration, and myeloid dendritic cell infiltration ( ρ=0.27, P<0.001; ρ=0.28, P<0.001; ρ=0.32, P<0.001; ρ=0.21, P=0.004; ρ=0.32, P<0.001), and also positively correlated with mRNA expression of CD274, HAVCR2, and PDCD1LG2 ( r=0.327, P<0.001; r=0.231, P=0.002; r=0.258, P<0.001). GO and KEGG enrichment analyses showed that FAT1 mRNA expression levels were associated with activation of the Wnt signaling pathway ( P=0.029), the PI3K/Akt pathway ( P<0.001), and other tumor microenvironment-related pathways. (2) Validation of own tissue samples: among 192 pancreatic adenocarcinoma tissues, FAT1 was highly expressed in 58 cases (30.21%), and the proportion of FAT1-expressing positive tumor cells was positively correlated with the combined positive score of PD-L1 and the number of CD3+ T-cells infiltration ( r=0.154, P=0.032; r=0.287, P<0.001), and the protein expression of FAT1 had no correlation with the differentiation degree of pancreatic adenocarcinoma ( ρ=0.082, P=0.254). The median OS of 58 patients in the FAT1 high-expression group and 134 patients in the FAT1 low-expression group were 18.89 and 25.84 months, respectively, and the difference was not statistically significant (χ2=1.93, P=0.165). Conclusion:FAT1 gene is highly expressed in pancreatic adenocarcinoma tissues, may play an oncogenic role in pancreatic adenocarcinoma, may be an adverse influence on overall survival and progression-free survival of patients; FAT1 gene may be involved in multiple immune-related pathways and promote tumor immune escape.
8.RAD51B-AS1 promotes the malignant biological behavior of ovarian cancer through upregulation of RAD51B
WEI XINYI ; WANG CONGHUI ; TANG SANGSANG ; YANG QIAN ; SHEN ZHANGJIN ; ZHU JIAWEI ; CHENG XIAODONG ; WANG XINYU ; XIE XING ; XU JUNFEN ; LU WEIGUO
Journal of Zhejiang University. Science. B 2024;25(7):581-593,中插4-中插16
Long non-coding RNAs(lncRNAs)play an indispensable role in the occurrence and development of ovarian cancer(OC).However,the potential involvement of lncRNAs in the progression of OC is largely unknown.To investigate the detailed roles and mechanisms of RAD51 homolog B-antisense 1(RAD51B-AS1),a novel lncRNA in OC,reverse transcription-quantitative polymerase chain reaction(RT-qPCR)was performed to verify the expression of RAD51B-AS1.Cellular proliferation,metastasis,and apoptosis were detected using the cell counting kit-8(CCK-8),colony-formation,transwell,and flow cytometry assays.Mouse xenograft models were established for the detection of tumorigenesis.The results revealed that RAD51B-AS1 was significantly upregulated in a highly metastatic human OC cell line and OC tissues.RAD51B-AS1 significantly increased the proliferation and metastasis of OC cells and enhanced their resistance to anoikis.Biogenetics prediction analysis revealed that the only target gene of RAD51B-AS1 was RAD51B.Subsequent gene function experiments revealed that RAD51B exerts the same biological effects as RAD51B-AS1.Rescue experiments demonstrated that the malignant biological behaviors promoted by RAD51B-AS1 overexpression were partially or completely reversed by RAD51B silencing in vitro and in vivo.Thus,RAD51B-AS1 promotes the malignant biological behaviors of OC and activates the protein kinase B(Akt)/B cell lymphoma protein-2(Bcl-2)signaling pathway,and these effects may be associated with the positive regulation of RAD51B expression.RAD51B-AS1 is expected to serve as a novel molecular biomarker for the diagnosis and prediction of poor prognosis in OC,and as a potential therapeutic target for disease management.
9.Iodine level in drinking water of residents in Guangzhou City in 2022
Conghui XU ; Haiyan CHEN ; Ke LI ; Hongwei ZHOU ; Hao ZHANG ; Jianmin XU ; Lirui FAN
Chinese Journal of Endemiology 2024;43(12):959-963
Objective:To investigate the iodine level in drinking water of residents in Guangzhou City.Methods:From March to October 2022, a survey of iodine level in residents' drinking water was conducted in 2 702 administrative villages (communities) in 11 municipal districts of Guangzhou City. Water samples were collected according to different water supply methods (centralized, decentralized, and mixed), and the water iodine level was determined using inductively coupled plasma mass spectrometry. The distribution of iodine level in drinking water of residents in administrative villages (communities) was analyzed.Results:In 2 702 administrative villages (communities) in Guangzhou City, centralized water supply was the main way of water supply, accounting for 95.34% (2 576/2 702); decentralized water supply accounted for 3.66% (99/2 702); mixed water supply accounted for 1.00% (27/2 702). The overall water iodine of each administrative village (community) was 8.93 (5.93, 13.19) μg/L, ranging from 0.00 to 67.79 μg/L. Among them, 99.81% (2 697/2 702) of the administrative villages (communities) had a median water iodine level of less than 40 μg/L, indicating iodine deficiency areas; 0.19% (5/2 702) of the administrative villages (communities) had a median water iodine of 40 - 100 μg/L, indicating suitable iodine areas; no high iodine area with a median water iodine level greater than 100 μg/L was found.Conclusions:The iodine level in the drinking water of residents in Guangzhou City is generally at a low level, and the external environment is generally deficient in iodine. No area with high iodine level has been found.
10.Progress in studies on factors affecting antiviral therapy for chronic hepatitis C
Conghui XU ; Wanting LYU ; Jiahuan GUO ; Zhaozhen LIU ; Can PANG ; Hongyan LU
Chinese Journal of Experimental and Clinical Virology 2024;38(6):717-721
Antiviral therapy is an effective means of curing chronic hepatitis C (CHC) and a key focus of preventing the spread of hepatitis C. By analyzing domestic and foreign literature, this paper provides an overview of the estimation of the antiviral treatment rate for CHC, the current situation of antiviral treatment for CHC both domestically and internationally, and the factors that affect acceptance of antiviral treatment. At present, the antiviral treatment rate for CHC cases is relatively low both domestically and internationally. The treatment status of CHC cases is related to factors such as the general situation of the case, knowing their HCV status or self-perceived condition, concurrent presence of other diseases or conditions, knowledge of hepatitis C prevention and treatment, and social interaction and behavioral guidance. In response to the relevant difficulties, in-depth research or more support is needed to improve the antiviral treatment rate of CHC cases and achieve the goal of eliminating hepatitis C by 2030. Efforts should be made to strengthen policy support, improve the diagnosis of hepatitis C, prevent and control multiple diseases together, conduct targeted publicity and education, and enhance social support.

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