1.Epidemiological characteristics of mumps in Guangxi in 2012-2024
Jiagui CHEN ; Qiuyun DENG ; Rencong YANG ; Jing LIU ; Sha LI ; Ying HUANG ; Jianan WEI ; Jinfa DU
Journal of Public Health and Preventive Medicine 2025;36(6):21-24
Objective To analyze the epidemiological characteristics of mumps in Guangxi from 2012 to 2024, and to provide a scientific basis for formulating prevention and control strategies. Methods Descriptive epidemiological methods were used to analyze the incidence data of mumps in Guangxi from 2012 to 2024. Results A total of 159 873 mumps cases were reported from 2012 to 2024 in Guangxi, with an average annual reported incidence of 25.41/100 000, and no death. Mumps occurred every month, with the peak incidence mainly concentrated in April to July and October to January of the next year. There were 96,118 male cases (29.43 /100 000), and 63 755 female cases (21.07 /100 000). The male to female ratio was 1.40:1, and the difference between male and female was significant (χ2=4 321.276,P<0.05). The annual incidence of mumps showed a certain periodic change, with the incidence peak and trough alternating every 4 - 5 years. The majority of patients were under 15 years old, accounting for 85.32% of the total number of cases. The patients mainly included students, preschool children and scattered children. The highest average incidence was in Nanning City with 40 231 cases (42.08/100 000), and the lowest was in Qinzhou City with 3 466 cases (8.16/100 000). From 2012 to 2024, a total of 210 mumps outbreaks with 4 483 cases were reported in Guangxi. Conclusion The incidence of mumps in Guangxi from 2012 to 2024 shows a periodic change and obvious seasonality. People under 15 years old are the key group at risk of mumps. The prevention and control of the epidemic of mumps in schools and kindergartens should be strengthened. It is suggested to carry out long-term monitoring of mumps as well as immune effect research, and continue to maintain a high vaccination rate of 2 doses of mumps-containing vaccines.
2.Comparison of effects of endoscopic mucosal dissection and endoscopic mucosal resection on gastrointestinal function in patients with early gastric cancer
Jinhua HE ; Jianan WEI ; Liting WANG
Tianjin Medical Journal 2025;53(4):407-411
Objective To compare the effects of endoscopic mucosal dissection(ESD)and endoscopic mucosal resection(EMR)on gastrointestinal function in patients with early gastric cancer.Methods According to different treatment methods,86 patients with early gastric cancer were divided into the ESD group and the EMR group,with 43 cases in each group.The operation duration,postoperative exhaust time and hospital stay of the two groups were observed and compared.Inflammatory factors including interleukin(IL-6)and IL-8 before surgery and 1 month after surgery were compared between the two groups of patients.Gastrointestinal hormone indexes including motilin(MTL),gastrin(GAS),apoptosis-related factors including anti-apoptotic factor(Livin)and epidermal growth factor(EGF),European Organization for Research and Treatment of Cancer(EORTC)Quality of Life Scale(QLQ-C30)score before surgery,3 months after surgery and 6 months after surgery were compared between the two groups of patients.An adverse reaction was also compared between the two groups of patients.Results The operation time,postoperative exhaust time and hospital stay were shorter in the ESD group than those of the EMR group(P<0.05),and the intraoperative blood loss was significantly less than that of the EMR group(P<0.05).Compared with the pre-operation,serological indexes such as IL-6,IL-8,MTL,GAS and Livin were decreased after surgery in the two groups(P<0.05).One month after surgery,IL-6,IL-8 and Livin were decreased,and MTL and GAS were increased in the ESD group compared with those of the EMR group(P<0.05).QLQ-C30 scores were higher at 3 months and 6 months after operation than those before operation in both groups,and the QLQ-C30 scores of the two groups were significantly higher at 6 months after operation(P<0.05).The scale scores of the ESD group were significantly higher than those of the EMR group at 3 months and 6 months after operation(P<0.05).The overall incidence rates of adverse reactions were(4.65%)in the ESD group and(20.93%)in the EMR group(P<0.05).Conclusion Compared with EMR,ESD can more effectively improve the gastrointestinal function,improve the quality of life and reduce the levels of inflammation and apoptosis-related factors in patients with early gastric cancer.
3.GDF-15 promotes collateral circulation and improves cardiac function in rats with acute myocardial infarction by activating the NO/cGMP/PKG signaling pathway
Xiaosen SHANG ; Yichun YANG ; Jianan HOU ; Linhua FAN ; Xiaoping CHEN ; Bingyan WEI ; Zhaoyang CHEN
Chinese Journal of Comparative Medicine 2025;35(5):60-70
Objective To observe the effects of growth differentiation factor-15(GDF-15)on collateral circulation and cardiac function in rats with acute myocardial infarction(AMI)in relation to the nitric oxide(NO)/cyclic guanosine monophosphate(cGMP)/protein kinase G(PKG)signaling pathway.Methods An AMI rat model was constructed by ligating the left anterior descending coronary artery.After modeling,the rats were divided randomly into Sham,Model,and GDF-15 groups(n=12 rats per group).Rats in the GDF-15 group were injected intraperitoneally with recombinant GDF-15 protein,and the other two groups were injected with the same amount of normal saline twice a week for 8 consecutive weeks.Cardiac function was detected by echocardiography.Pathological damage to rat myocardial tissue was detected by hematoxylin and eosin staining and the collateral circulation was observed by CD31 immunohistochemical staining.Vascular endothelial growth factor(VEGF)mRNA expression was detected by quantitative polymerase chain reaction.Transcriptomic sequencing of heart tissues in the model and GDF-15 groups was performed and differentially expressed genes(DEGs)were screened.Pathway enrichment analysis of the DEGS was carried out according to the Kyoto Encyclopedia of Genes and Genomes(KEGG).Nitric oxide(NO),reactive oxygen species(ROS),and cGMP were detected using kits,and VEGF,endothelial nitric oxide synthase(eNOS)monomer,p-eNOSser1177monomer,eNOS dimer,and PKG protein were detected by Western blot.Results Left ventricular end-systolic diameter(LVEDs)and left ventricular end-diastolic diameter(LVEDd)were increased(P<0.001),and left ventricular ejection fraction(LVEF)and the short-axis shortening rate(FS)were decreased in the Model group compared with the Sham group(P<0.001).Myocardial cell necrosis was more severe,vascular density in the infarcted area was decreased(P<0.05),but VEGF mRNA and protein levels were no change(P>0.05),and levels of NO,eNOS dimer,cGMP,and PKG protein were decreased(P<0.05),and expression levels of ROS,eNOS monomer,and p-eNOSser1177 monomer were increased(P<0.05).LVEDs and LVEDd decreased(P<0.05),LVEF and FS increased(P<0.01),myocardial cell necrosis was relieved,vascular density in the infarcted area increased significantly(P<0.0001),and VEGF mRNA levels increased(P<0.0001),compared with the Model group.Transcriptomic sequencing identified 324 DEGs,including 230 up-regulated and 94 down-regulated genes.According to KEGG enrichment analysis,the cGMP-PKG signaling pathway showed the most significant difference in the T20 pathway.VEGF,NO,eNOS dimer,cGMP,and PKG protein levels were all increased(P<0.05),while ROS,eNOS monomer,and p-eNOSser1177 monomer were decreased in the GDF-15 group(P<0.05).Conclusions GDF-15 can promote collateral circulation in ischemic myocardium and improve cardiac function by inhibiting eNOS decoupling and activating the NO/cGMP/PKG pathway.
4.PARylation promotes acute kidney injury via RACK1 dimerization-mediated HIF-1α degradation.
Xiangyu LI ; Xiaoyu SHEN ; Xinfei MAO ; Yuqing WANG ; Yuhang DONG ; Shuai SUN ; Mengmeng ZHANG ; Jie WEI ; Jianan WANG ; Chao LI ; Minglu JI ; Xiaowei HU ; Xinyu CHEN ; Juan JIN ; Jiagen WEN ; Yujie LIU ; Mingfei WU ; Jutao YU ; Xiaoming MENG
Acta Pharmaceutica Sinica B 2025;15(9):4673-4691
Poly(ADP-ribosyl)ation (PARylation) is a specific form of post-translational modification (PTM) predominantly triggered by the activation of poly-ADP-ribose polymerase 1 (PARP1). However, the role and mechanism of PARylation in the advancement of acute kidney injury (AKI) remain undetermined. Here, we demonstrated the significant upregulation of PARP1 and its associated PARylation in murine models of AKI, consistent with renal biopsy findings in patients with AKI. This elevation in PARP1 expression might be attributed to trimethylation of histone H3 lysine 4 (H3K4me3). Furthermore, a reduction in PARylation levels mitigated renal dysfunction in the AKI mouse models. Mechanistically, liquid chromatography-mass spectrometry indicated that PARylation mainly occurred in receptor for activated C kinase 1 (RACK1), thereby facilitating its subsequent phosphorylation. Moreover, the phosphorylation of RACK1 enhanced its dimerization and accelerated the ubiquitination-mediated hypoxia inducible factor-1α (HIF-1α) degradation, thereby exacerbating kidney injury. Additionally, we identified a PARP1 proteolysis-targeting chimera (PROTAC), A19, as a PARP1 degrader that demonstrated superior protective effects against renal injury compared with PJ34, a previously identified PARP1 inhibitor. Collectively, both genetic and drug-based inhibition of PARylation mitigated kidney injury, indicating that the PARylated RACK1/HIF-1α axis could be a promising therapeutic target for AKI treatment.
5.Mechanism of Th17 cell differentiation in acute viral myocarditis induced by Coxsackievirus B3
Jianan WANG ; Huilan LIU ; Jiantao ZHENG ; Wei WANG ; Tingpei ZHUANG ; Jiexiang HUANG ; Jiadong FU
Chinese Journal of Immunology 2025;41(9):2179-2184
Objective:To explore the potential mechanism underlying IL-6 production through the TLR7 signaling pathway,which regulates Th17 cell differentiation in the context of Coxsackievirus B3(CVB3)-induced acute viral myocarditis(AVMC).Meth-ods:A total of 110 patients diagnosed with AVMC were admitted to Quanzhou First Hospital,Fujian between January 2020 and Janu-ary 2023,alongside 93 healthy volunteers.CD4+T cells were isolated from the subjects'blood,and the levels of CVB3 and the number of Th17 cells were assessed.Subsequently,CD4+T cells were infected with CVB3,and the levels of Th17 cells,IL-17,IL-21,and TNF-α were measured.After knockdown of TLR7 or treatment with TLR7 inhibitors,the differentiation of CVB3-infected CD4+T cells into Th17 cells was observed.Results:In comparison to healthy controls,AVMC patients exhibited elevated plasma levels of hsCRP,IL-17,IL-21,and TNF-α(P<0.05).The levels of CVB3 mRNA in CD4+T cells were also notably higher in AVMC patients compared to healthy controls(P<0.05).The mean viral titer in AVMC patients measured 230 PFU/ml,while no detectable virus was found in healthy volunteers(P<0.05).In CD4+T cells,the count of Th17 cells was significantly increased in AVMC patients compared to healthy volunteers(P<0.05).Moreover,the number of Th17 cells in peripheral blood CD4+T cells of AVMC patients showed a positive correlation with CVB3 virus titer(P<0.05).Following CVB3 infection,the number of Th17 cells increased compared with the control group(P<0.05),accompanied by elevated levels of IL-17,IL-21,and TNF-α in the supernatant(P<0.05).Knockdown of TLR7 and CVB3 infection in CD4+T cells significantly reduced the levels of Th17 cells(P<0.05),while the expression level of phosphorylated-activated TLR7 increased significantly after CVB3 infection of CD4+T cells compared to the control group(P<0.05).Treatment with the TLR7 inhibitor M5049 and CVB3 infection led to a significant decrease in Th17 cell levels(P<0.05).The secretion of IL-6 in CD4+T cells increased after CVB3 infection(P<0.05),and this increase was mitigated by TLR7 knockdown and CVB3 infection(P<0.05)as well as TLR7 inhibitor M5049 treatment and CVB3 infection(P<0.05).Conclusion:CVB3 activates TLR7 via phosphoryla-tion,prompting CD4+T cells to release IL-6 and undergo differentiation into Th17 cells.Consequently,TLR7 emerges as a promising therapeutic target for AVMC.
6.Iodine distribution in drinking water in Inner Mongolia Autonomous Region
Wei GUO ; Hongyu GUO ; Jianan QIAO ; Yuanyuan ZUO ; Haicheng JIA ; Xiaojun WANG
Chinese Journal of Endemiology 2025;44(9):732-736
Objective:To investigate the distribution of iodine in drinking water in Inner Mongolia Autonomous Region, and provide a basis for delineation of different types of water iodine areas and the adoption of targeted prevention and control measures, as well as scientific adjustment of intervention strategies.Methods:Using cross-sectional survey method, from June to December in 2017, a survey on the distribution of water iodine was conducted in the entire autonomous region on a township (street, Sumu, abbreviated as township) basis in accordance with the requirements of the "National Survey Plan for Iodine Content in Drinking Water". For townships with water iodine level greater than 10 μg/L found in the survey, the survey was conducted on an administrative village (community, Gacha, abbreviated as administrative village) basis. The water iodine of regions with water iodine level greater than 100 μg/L found in the survey were reviewed in 2018 - 2019. Arsenic-cerium catalytic spectrophotometry was used to test water iodine.Results:A total of 1 009 townships of 103 counties (cities, districts) were surveyed on a township by township basis, with a median water iodine of 6.7 μg/L. Among them, there were 707 townships with water iodine < 10 μg/L, accounting for 70.1%. There were 251 townships with water iodine of 10 - < 40 μg/L, accounting for 24.9%. There were 44 townships with water iodine of 40 - 100 μg/L, accounting for 4.4%. There were 7 townships with water iodine > 100 μg/L, accounting for 0.7%. A total of 3 326 administrative village of 298 townships were surveyed based on administrative villages, among which, 791 villages had water iodine < 10 μg/L, accounting for 23.8%. There were 2 031 villages with water iodine of 10 - < 40 μg/L, accounting for 61.1%. There were 468 villages with water iodine of 40 - 100 μg/L, accounting for 14.1%. There were 36 administrative villages with water iodine > 100 μg/L, accounting for 1.1%. After review, 96 administrative villages in 12 townships of 4 league cities had water iodine > 100 μg/L.Conclusions:Most areas in Inner Mongolia Autonomous Region are iodine deficiency areas, and there are localized areas with high iodine levels due to water sources. Different iodine supplementation or iodine reduction measures should be taken for areas with different water iodine levels.
7.Comparison of effects of endoscopic mucosal dissection and endoscopic mucosal resection on gastrointestinal function in patients with early gastric cancer
Jinhua HE ; Jianan WEI ; Liting WANG
Tianjin Medical Journal 2025;53(4):407-411
Objective To compare the effects of endoscopic mucosal dissection(ESD)and endoscopic mucosal resection(EMR)on gastrointestinal function in patients with early gastric cancer.Methods According to different treatment methods,86 patients with early gastric cancer were divided into the ESD group and the EMR group,with 43 cases in each group.The operation duration,postoperative exhaust time and hospital stay of the two groups were observed and compared.Inflammatory factors including interleukin(IL-6)and IL-8 before surgery and 1 month after surgery were compared between the two groups of patients.Gastrointestinal hormone indexes including motilin(MTL),gastrin(GAS),apoptosis-related factors including anti-apoptotic factor(Livin)and epidermal growth factor(EGF),European Organization for Research and Treatment of Cancer(EORTC)Quality of Life Scale(QLQ-C30)score before surgery,3 months after surgery and 6 months after surgery were compared between the two groups of patients.An adverse reaction was also compared between the two groups of patients.Results The operation time,postoperative exhaust time and hospital stay were shorter in the ESD group than those of the EMR group(P<0.05),and the intraoperative blood loss was significantly less than that of the EMR group(P<0.05).Compared with the pre-operation,serological indexes such as IL-6,IL-8,MTL,GAS and Livin were decreased after surgery in the two groups(P<0.05).One month after surgery,IL-6,IL-8 and Livin were decreased,and MTL and GAS were increased in the ESD group compared with those of the EMR group(P<0.05).QLQ-C30 scores were higher at 3 months and 6 months after operation than those before operation in both groups,and the QLQ-C30 scores of the two groups were significantly higher at 6 months after operation(P<0.05).The scale scores of the ESD group were significantly higher than those of the EMR group at 3 months and 6 months after operation(P<0.05).The overall incidence rates of adverse reactions were(4.65%)in the ESD group and(20.93%)in the EMR group(P<0.05).Conclusion Compared with EMR,ESD can more effectively improve the gastrointestinal function,improve the quality of life and reduce the levels of inflammation and apoptosis-related factors in patients with early gastric cancer.
8.Mechanism of Th17 cell differentiation in acute viral myocarditis induced by Coxsackievirus B3
Jianan WANG ; Huilan LIU ; Jiantao ZHENG ; Wei WANG ; Tingpei ZHUANG ; Jiexiang HUANG ; Jiadong FU
Chinese Journal of Immunology 2025;41(9):2179-2184
Objective:To explore the potential mechanism underlying IL-6 production through the TLR7 signaling pathway,which regulates Th17 cell differentiation in the context of Coxsackievirus B3(CVB3)-induced acute viral myocarditis(AVMC).Meth-ods:A total of 110 patients diagnosed with AVMC were admitted to Quanzhou First Hospital,Fujian between January 2020 and Janu-ary 2023,alongside 93 healthy volunteers.CD4+T cells were isolated from the subjects'blood,and the levels of CVB3 and the number of Th17 cells were assessed.Subsequently,CD4+T cells were infected with CVB3,and the levels of Th17 cells,IL-17,IL-21,and TNF-α were measured.After knockdown of TLR7 or treatment with TLR7 inhibitors,the differentiation of CVB3-infected CD4+T cells into Th17 cells was observed.Results:In comparison to healthy controls,AVMC patients exhibited elevated plasma levels of hsCRP,IL-17,IL-21,and TNF-α(P<0.05).The levels of CVB3 mRNA in CD4+T cells were also notably higher in AVMC patients compared to healthy controls(P<0.05).The mean viral titer in AVMC patients measured 230 PFU/ml,while no detectable virus was found in healthy volunteers(P<0.05).In CD4+T cells,the count of Th17 cells was significantly increased in AVMC patients compared to healthy volunteers(P<0.05).Moreover,the number of Th17 cells in peripheral blood CD4+T cells of AVMC patients showed a positive correlation with CVB3 virus titer(P<0.05).Following CVB3 infection,the number of Th17 cells increased compared with the control group(P<0.05),accompanied by elevated levels of IL-17,IL-21,and TNF-α in the supernatant(P<0.05).Knockdown of TLR7 and CVB3 infection in CD4+T cells significantly reduced the levels of Th17 cells(P<0.05),while the expression level of phosphorylated-activated TLR7 increased significantly after CVB3 infection of CD4+T cells compared to the control group(P<0.05).Treatment with the TLR7 inhibitor M5049 and CVB3 infection led to a significant decrease in Th17 cell levels(P<0.05).The secretion of IL-6 in CD4+T cells increased after CVB3 infection(P<0.05),and this increase was mitigated by TLR7 knockdown and CVB3 infection(P<0.05)as well as TLR7 inhibitor M5049 treatment and CVB3 infection(P<0.05).Conclusion:CVB3 activates TLR7 via phosphoryla-tion,prompting CD4+T cells to release IL-6 and undergo differentiation into Th17 cells.Consequently,TLR7 emerges as a promising therapeutic target for AVMC.
9.GDF-15 promotes collateral circulation and improves cardiac function in rats with acute myocardial infarction by activating the NO/cGMP/PKG signaling pathway
Xiaosen SHANG ; Yichun YANG ; Jianan HOU ; Linhua FAN ; Xiaoping CHEN ; Bingyan WEI ; Zhaoyang CHEN
Chinese Journal of Comparative Medicine 2025;35(5):60-70
Objective To observe the effects of growth differentiation factor-15(GDF-15)on collateral circulation and cardiac function in rats with acute myocardial infarction(AMI)in relation to the nitric oxide(NO)/cyclic guanosine monophosphate(cGMP)/protein kinase G(PKG)signaling pathway.Methods An AMI rat model was constructed by ligating the left anterior descending coronary artery.After modeling,the rats were divided randomly into Sham,Model,and GDF-15 groups(n=12 rats per group).Rats in the GDF-15 group were injected intraperitoneally with recombinant GDF-15 protein,and the other two groups were injected with the same amount of normal saline twice a week for 8 consecutive weeks.Cardiac function was detected by echocardiography.Pathological damage to rat myocardial tissue was detected by hematoxylin and eosin staining and the collateral circulation was observed by CD31 immunohistochemical staining.Vascular endothelial growth factor(VEGF)mRNA expression was detected by quantitative polymerase chain reaction.Transcriptomic sequencing of heart tissues in the model and GDF-15 groups was performed and differentially expressed genes(DEGs)were screened.Pathway enrichment analysis of the DEGS was carried out according to the Kyoto Encyclopedia of Genes and Genomes(KEGG).Nitric oxide(NO),reactive oxygen species(ROS),and cGMP were detected using kits,and VEGF,endothelial nitric oxide synthase(eNOS)monomer,p-eNOSser1177monomer,eNOS dimer,and PKG protein were detected by Western blot.Results Left ventricular end-systolic diameter(LVEDs)and left ventricular end-diastolic diameter(LVEDd)were increased(P<0.001),and left ventricular ejection fraction(LVEF)and the short-axis shortening rate(FS)were decreased in the Model group compared with the Sham group(P<0.001).Myocardial cell necrosis was more severe,vascular density in the infarcted area was decreased(P<0.05),but VEGF mRNA and protein levels were no change(P>0.05),and levels of NO,eNOS dimer,cGMP,and PKG protein were decreased(P<0.05),and expression levels of ROS,eNOS monomer,and p-eNOSser1177 monomer were increased(P<0.05).LVEDs and LVEDd decreased(P<0.05),LVEF and FS increased(P<0.01),myocardial cell necrosis was relieved,vascular density in the infarcted area increased significantly(P<0.0001),and VEGF mRNA levels increased(P<0.0001),compared with the Model group.Transcriptomic sequencing identified 324 DEGs,including 230 up-regulated and 94 down-regulated genes.According to KEGG enrichment analysis,the cGMP-PKG signaling pathway showed the most significant difference in the T20 pathway.VEGF,NO,eNOS dimer,cGMP,and PKG protein levels were all increased(P<0.05),while ROS,eNOS monomer,and p-eNOSser1177 monomer were decreased in the GDF-15 group(P<0.05).Conclusions GDF-15 can promote collateral circulation in ischemic myocardium and improve cardiac function by inhibiting eNOS decoupling and activating the NO/cGMP/PKG pathway.
10.Iodine distribution in drinking water in Inner Mongolia Autonomous Region
Wei GUO ; Hongyu GUO ; Jianan QIAO ; Yuanyuan ZUO ; Haicheng JIA ; Xiaojun WANG
Chinese Journal of Endemiology 2025;44(9):732-736
Objective:To investigate the distribution of iodine in drinking water in Inner Mongolia Autonomous Region, and provide a basis for delineation of different types of water iodine areas and the adoption of targeted prevention and control measures, as well as scientific adjustment of intervention strategies.Methods:Using cross-sectional survey method, from June to December in 2017, a survey on the distribution of water iodine was conducted in the entire autonomous region on a township (street, Sumu, abbreviated as township) basis in accordance with the requirements of the "National Survey Plan for Iodine Content in Drinking Water". For townships with water iodine level greater than 10 μg/L found in the survey, the survey was conducted on an administrative village (community, Gacha, abbreviated as administrative village) basis. The water iodine of regions with water iodine level greater than 100 μg/L found in the survey were reviewed in 2018 - 2019. Arsenic-cerium catalytic spectrophotometry was used to test water iodine.Results:A total of 1 009 townships of 103 counties (cities, districts) were surveyed on a township by township basis, with a median water iodine of 6.7 μg/L. Among them, there were 707 townships with water iodine < 10 μg/L, accounting for 70.1%. There were 251 townships with water iodine of 10 - < 40 μg/L, accounting for 24.9%. There were 44 townships with water iodine of 40 - 100 μg/L, accounting for 4.4%. There were 7 townships with water iodine > 100 μg/L, accounting for 0.7%. A total of 3 326 administrative village of 298 townships were surveyed based on administrative villages, among which, 791 villages had water iodine < 10 μg/L, accounting for 23.8%. There were 2 031 villages with water iodine of 10 - < 40 μg/L, accounting for 61.1%. There were 468 villages with water iodine of 40 - 100 μg/L, accounting for 14.1%. There were 36 administrative villages with water iodine > 100 μg/L, accounting for 1.1%. After review, 96 administrative villages in 12 townships of 4 league cities had water iodine > 100 μg/L.Conclusions:Most areas in Inner Mongolia Autonomous Region are iodine deficiency areas, and there are localized areas with high iodine levels due to water sources. Different iodine supplementation or iodine reduction measures should be taken for areas with different water iodine levels.


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