Objective:To analyze the iodine nutrition status of children aged 8 to 10 years in Zhejiang Province from 2016 to 2021.Methods:A multi-stage stratified sampling method was used to select non-residential children aged 8 to 10 years from 90 counties in Zhejiang Province. A total of 114 103 children were included in the study from 2016 to 2021. Direct titration method and arsenic-cerium catalytic spectrophotometry were used to detect salt iodine content and urinary iodine level, respectively, to evaluate the iodine nutritional status of children. Ultrasound was used to detect thyroid volume and analyze the current prevalence of goiter in school-age children.Results:The age of 114 103 children was (9.04 ± 0.81) years old, with 50.0% of (57 083) boys. The median of iodine content M ( Q1, Q3) in children's household salt was 23.00 (19.80, 25.20) mg/kg, including 17 242 non-iodized salt, 6 173 unqualified iodized salt, and 90 688 qualified iodized salt. The coverage rate of iodized salt was 84.89%, and the coverage rate of qualified iodized salt was 79.48%. The proportion of non-iodized salt increased from 11.85% in 2016 to 16.04% in 2021 ( χ 2trend=111.427, P<0.001). The median of urinary iodine concentration M ( Q1, Q3) in children was 182.50 (121.00, 261.00) μg/L, among which the proportions of iodine deficiency, iodine suitability, iodine over suitability, and iodine excess were 17.25% (19 686 cases), 39.21% (44 745 cases), 26.85% (30 638 cases), and 16.68% (19 034 cases), respectively. The median of urinary iodine concentration in children in inland areas [ M ( Q1, Q3): 190.90 (128.80, 269.00) μg/L] was significantly higher than that in children in coastal areas [ M ( Q1, Q3): 173.00 (113.00, 250.30) μg/L] ( P<0.001). From 2016 to 2021, a total of 39 134 ultrasound examinations were conducted, and 1 229 cases of thyroid enlargement were detected. The goiter rate was 3.14% (95% CI: 2.97%-3.32%). The incidence of goiter in children in coastal areas [3.45% (95% CI: 3.19%-3.72%), 641/18 604] was higher than that in children in inland areas [2.86% (95% CI: 2.64%-3.10%), 588/20 530] ( P=0.001). Conclusion:From 2016 to 2021, the iodine nutrition level of children aged 8-10 years in Zhejiang Province is generally suitable, and the rate of goiter in children meets the limit of iodine deficiency disease elimination standards.

Objective To explore the effect of training mode based on action learning on improving the practicing ability of hospital pharmacists.Methods Thirty pharmacists who received training from September 2022 to December 2023 at Panzhihua Central Hospital were randomly divided into an education reform group(16 cases)and a routine group(14 cases).The education reform group adopted a routine teaching method based on action learning,while the routine group adopted a routine teaching method.The differences between the two groups of pharmacists in theoretical knowledge,practical operation,pharmaceutical services,emergency response,and comprehensive quality were compared.Results The pharmacists in the education reform group were better than the routine group in prescription review,clinical medication analysis,pharmaceutical services,emergency response,andcomprehensive quality.The difference was statistically significant(P＜0.05).Conclusion The teaching model based on action learning can effectively enhance the higher order thinking ability of pharmacists and help them better apply medical knowledge and skills to serve patients and physicians.

AIM: To explore the mechanism of action of alkaloid components of compound kushen Injection (CKI) in the treatment of lung cancer based on serum metabolomics, network pharmacology, and molecular docking techniques. METHODS: A lung cancer model was established in C57 mice by inoculation of Lewis mouse lung cancer tumor strain. Thirty male mice were randomly divided into normal group, model group and CKI group. The drug was administered by tail vein injection once daily for 17 consecutive days. Mouse serum was examined by ultrahigh performance liquid chromatography tandem mass spectrometry (LC-MS) metabolomics, and several multivariate statistical analyses including principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA), combined with databases such as the human metabolic database (HMDB) and related literature to identify and identify differential metabolites, the relevant metabolic pathways were searched for by the metaboanalyst online tool. Using network pharmacology, construct the“component-target-disease”network of CKI in the treatment of lung cancer. Molecular docking method was used to verify the interaction between potential active ingredients and core targets. Serum metabolomics was jointly analyzed with network pharmacology to construct a“metabolite-germinal-enzyme-gene” network. RESULTS: Through metabolomics technology, 16 differential metabolites associated with lung cancer were screened from serum, and CKI addback these differential metabolite levels compared with the model group. Metabolic pathways mainly involve retinol metabolism, tryptophan metabolism, glycerophospholipid metabolism and other metabolic pathways. Network pharmacology analysis indicated that CKI treatment of lung cancer mainly targets STAT3, MAPK3, and MAPK1, which are closely related to proteoglycans, cellular senescence, and HIF − 1 signaling pathways in cancer. CONCLUSION: This article explains the mechanism of CKI in treating lung cancer from the perspective of metabonomics and network pharmacology, and provides basis for further study of CKI.

Objective:To evaluate the current situation of prevention and control of iodine deficiency disorders (IDD), and to describe the iodine nutrition level of pregnant women in key population in Zhejiang Province.Methods:In 2021, a cross-sectional survey on iodine nutrition status of the population was conducted in all 90 counties (cities, districts) in Zhejiang Province. Each county (city, district) was divided into five districts: east, west, south, north, and central. One township (street) was selected from each district, and 20 pregnant women were selected from each township (street) to collect edible salt samples and one random urine sample for salt and urinary iodine testing. The above indicators were stratified and analyzed according to urban, rural, coastal, inland, early pregnancy, mid pregnancy, and late pregnancy.Results:A total of 9 679 pregnant women's salt samples were tested, with a salt iodine content of (20.2 ± 9.2) mg/kg, an iodized salt coverage rate of 84.2% (8 153/9 679), and a qualified iodized salt consumption rate of 80.4% (7 785/9 679). Among them, the qualified iodized salt consumption rate of pregnant women in coastal areas was 69.4% (3 175/4 575), significantly lower than that in inland areas [90.3% (4 610/5 104)]; and the proportion of non iodized salt consumption in coastal areas [25.8% (1 181/4 575)] was significantly higher than inland areas [6.8% (345/5 104)]. A total of 9 679 pregnant women's urine samples were tested, with a median urinary iodine of 133.0 μg/L ( < 150 μg/L). In urban areas, the median urinary iodine (129.8 μg/L) was lower than that in rural areas (135.0 μg/L). Likewise, the median urinary iodine was 126.0 μg/L, lower than inland areas (140.3 μg/L). And as pregnancy progressed, the iodine nutrition level of pregnant women gradually decreased (the median urinary iodine: 137.0 μg/L in early pregnancy, 134.1 μg/L in mid pregnancy, and 129.4 μg/L in late pregnancy).Conclusion:In 2021, pregnant women in Zhejiang Province are in a state of iodine deficiency, and there is a greater risk in urban areas compared to rural areas and coastal areas compared to inland areas.

Objective: To investigate the status of iodine nutrition and prevalence of goiter among children at ages of 8 to 10 years in Zhejiang Province in 2021, so as to provide insights into the management of iodine deficiency in children. Methods : A total of 90 counties (districts) were sampled as field survey sites from 11 cities of Zhejiang Province using a multi-stage stratified random sampling method in 2021, and non-residential children at ages of 8 to 10 years in these sites were sampled as study subjects. Subjects' household edible salt samples and random urine samples were collected. The iodine content in salt and urinary iodine level were determined using the direct titration method and arsenic-cerium catalytic spectrophotometry for evaluation of iodine nutrition among children. In addition, the lateral lobe of the thyroid gland was measured using ultrasound, and the prevalence of goiter was estimated. Results: A total of 19 363 children were recruited, including 9 710 male children and 9 653 female children, with a male to female ratio of 1.01︰1, and there were 10 704 urban children (55.28%) and 8 659 rural children (44.72%), 9 149 children living in coastal areas (47.25%) and 10 214 children in inland regions (52.75%). The mean iodine content was (19.79±9.25) mg/kg in salt, and the coverage of qualified iodized salt (15 252) was 78.77%. The coverage of qualified iodized salt was significantly lower in urban children than in rural children (76.70% vs. 81.21%; χ2=68.301, P<0.001), and was lower in children living in coastal regions than in inland regions (68.05% vs. 88.27%; χ2=1 270.769, P<0.001). The median urinary iodine concentration was 195.1 μg/L, and the household iodine content in salt correlated positively with urinary iodine concentration in children (rs=0.383, P<0.001). There were 2 885 children with iodine deficiency (14.90%), 7 137 children with adequate iodine (36.86%), 5 414 children with excessive iodine intake (27.96%), and 3 927 children with iodine overdose (20.28%), and the distribution of iodine nutrition in children varied significantly in regions (χ2=283.277, P<0.001) and gender (χ2=126.349, P<0.001). The prevalence of goiter was 2.45% among 7 195 children receiving ultrasound examinations, and a higher prevalence rate of goiter was detected in urban children than in rural children (2.76% vs. 2.00%; χ2=3.962, P=0.047). Conclusions The overall urinary iodine nutrition was adequate among children at ages of 8 to 10 years in Zhejiang Province in 2021, and the prevalence of goiter in children fell within the threshold defined in the criteria of elimination of iodine deficiency. However, the supervision of the iodized salt quality remains to be improved and iodine deficiency control remains to be reinforced.

Objective: To investigate whether a deep learning-based model using unenhanced computed tomography (CT) at baseline could predict the malignancy of pulmonary nodules. Methods: A deep learning model was trained and applied for the discrimination of pulmonary nodule in Dr. Wise Lung Analyzer. This study retrospectively recruited 130 consecutive participants with pulmonary nodules detected on CT who undergoing biopsy or surgery from May 2009 to June 2017 in Jinling hospital. A total of 136 pulmonary nodules were included in this study, including 86 malignant nodules and 50 benign ones. All patients underwent CT scans 2 times at least, the first scan was defined as baseline and the last scan before the pathological results was defined as final scan. The ROC curve of deep learning model was plotted and the AUCs were calculated. Delong test was used to examine the difference of AUCs baseline and final scan. The nodules were further divided into subsolid nodule group (pure ground-glass nodule and part solid nodule) (n=87) and solid nodule group (n=49). The difference of AUCs at baseline and final scans was evaluated intra two groups. Results: The AUCs of the deep learning model at final and baseline scans were 0.876 and 0.819, respectively. There was no significant difference between them (P=0.075). The result indicated that the model could predict the consequences of pulmonary nodules well at baseline. In small nodules (longest diameter ≤10mm), the AUC at final scan (0.847) was better than it at baseline scan (0.734), but there was no significant difference between them (P=0.058). In solid nodule group, The AUC at final scan (0.932) was better than it at baseline scan (0.835), but there was no significant difference between them (P=0.066). In subsolid nodule group, the deep learning model exhibited consistent performance at final scan (AUC, 0.759) with the baseline scan (AUC, 0.728, P=0.580). Conclusions The deep learning model could predict the malignancy of pulmonary nodules including small ones at baseline, and the model exhibited consistent performance between baseline and final scans in subsolid nodules.

Objective: To evaluate the efficacy and safety of sofosbuvir (Nanjing Zhengda Tianqing Pharmaceutical Co., Ltd.) combined with ribavirin in patients with genotype 2 chronic hepatitis C virus infection. Methods: Treatment-naïve or treatment experienced genotype 2 chronic hepatitis C patients from sixteen research centers of China were screened. All subjects received once-daily dose of sofosbuvir (400 mg) combined with ribavirin (body weight < 75 kg, 1 000 mg/day, 400 mg in the morning and 600 mg in the evening; body weight > 75 kg, 1 200 mg/d, 600 mg in the morning and 600 mg in the evening) for 12 weeks. Patients were followed-up for a period of 12 weeks after discontinuation of treatment. Continuous variables were expressed as mean ± standard deviation. The proportion of subjects with virologic response at different follow-up time points and 95% confidence intervals were estimated by maximum likelihood ratio and Clopper-Pearson interval. Results: 132 cases with genotype 2 chronic hepatitis C virus infection from sixteen research centers of China were included, 12 cases of whom were associated with cirrhosis, and the remaining 120 cases were not associated with cirrhosis. One hundred and thirty-one cases completed the study, and one patient lost to follow-up at week 4 after the end of treatment. The sustained virological response rate was 96.2% (95% confidence interval: 92.37% - 99.16%) after 12 weeks of drug withdrawal. Virological relapse occurred in four cases. Of the 132 subjects enrolled in the study, 119 (90.2%) reported 617 adverse events during treatment, of which 359 (76.5%) were TEAE related to sofosbuvir and/or ribavirin. There were nine TEAEs of grade 3 and above, and six cases (4.5%) of them had six severe adverse events. Only one serious adverse event was associated with sofosbuvir and ribavirin (unstable angina pectoris). There were no adverse events leading to drug discontinuation or death. Conclusion Sofosbuvir combined with ribavirin has a high SVR rate in the treatment of genotype 2 chronic hepatitis C virus infection, and most of the adverse events occurred were mild with acceptable safety profile.

Objective To set up the reference ranges of thyroid hormones for pregnant and lactating woman in Zhejiang.Methods A total of 338 pregnancy,322 lactating women and 139 non-pregnant women (as a control) were selected from 1 079 women in 13 survey sites of Zhejiang as survey subjects,through the questionnaire survey and thyroid B-ultrasound tests from June 2010 to September 2010.The level of urinary iodine was measured by spectrophotometer,and the thyroid hormone [free triiodothyronine (FT3),free (unbound) thyroxin (FT4),triiodothyronine (T3),tetraiodothyronine (T4),thyroid stimulating hormone (TSH)] was measured by automated chemiluminescence immunoassay.Analysis of thyroid hormone 95％ in pregnant women and lactating women.Results The median urinary iodine of all women investigated were in optimal urine levels (150-249 μg/L),which indicated they were in iodine sufficient status.The FT3 index of lactating women was higher than that of pregnant women and non pregnant women (Zlactating-pregnant =3.98,Zlactating-pregnant =2.46,all P ＜ 0.05);the FT4 index level of lactating women was higher than that of pregnant women and non pregnant women (Zlactating-pregnant =2.68,Zlactating-non-pregnant =2.25,all P ＜ 0.05);the T3 index level of lactating women was higher than that of pregnant women and non pregnant women (Zlactating-pregnant =3.51,Zlactating-non pregnant =2.41,all P ＜ 0.05);levels of T4 in lactating women was the highest (Zlactating-pregnant =2.30,Zlactating-pregnant =4.90,Zlactating-non pregnant =1.57,all P ＜ 0.05);TSH index of lactating women and non pregnant women were higher than that of pregnant women (Zlactating-pregnant =2.81,Zlactating-non pregnant =1.68,all P ＜ 0.05).And in pregnant,the 95％ medical reference interval of FT3 was 3.37-6.53 pmol/L,FT4 was 10.68-20.85 pmol/L,T3 was 1.40-2.79 nmol/L,T4 was 72.72-166.41 nmol/L,and TSH was 0.15-4.44 mU/L;in lactating woman,FT3 was 3.39-6.44 pmol/L,FT4 was 10.81-20.33 pmol/L,T3 was 1.44-2.77 nmol/L,T4 was 71.94-164.61 nmol/L,and TSH was 0.25-4.47 mU/L.Conclusion The thyroid hormone levels of pregnant and lactating women are different from those of non-pregnant women,therefore establishing reference data of thyroid hormones for pregnant and lactating women may be a very important step for clinical practice.

Objective To find out the status of iodine nutrition and the goiter of population in Zhejiang Province after adjustment of salt iodine concentration.Methods From April to June 2013,the probability proportionate to size sampling method was applied in 31 countries in Zhejiang Province to select 1 650 school-age children aged 8-10 to examine thyroid by B ultrasound,to collect urine and salt samples,and to test the iodine level using the colorimetric titration method and the spectrophotometer method.Six hundred and twenty pregnant women were selected to collect urine samples and urinary iodine was tested by the spectrophotometer method.Results The coverage rate of iodized salt and the consumption rate of qualified iodized salt in Zhejiang Province after adjustment of salt iodine concentration were 93.20％ (1 521/1 632) and 89.71％ (1 464/1 632),respectively;and the medians urinary iodine in children and pregnant women were 178.40 μg/L and 127.23 μg/L,respectively;and the goiter and median thyroid volume were 5.27％ (87/1 650) and 3.45 ml,respectively;the P97 thyroid volume of children in Zhejiang Province in the 8,9 and 10 years old groups (4.76,5.29,6.36 ml) were higher than those (4.5,5.0,6.0 ml) in the thyroid volume reference (WS 276-2007);and the correlations between thyroid volume,goiter and urinary iodine were not found.Conclusions After adjustment of salt iodine concentration,the status of iodine nutrition in Zhejiang Province in general is down to optimum level,which indicates that it is appropriate for this adjustment,but the level of iodine nutrition in pregnant women is less than appropriate,which should be pay attention to.

Comprehensive therapy is widely received for esophageal carcinoma in our country and worldwide. The treatment approaches consist of sugery,radiotherapy and chemotherapy,and chemoradiation therapy is very important. Many randomized controlled studies and meta-analysis reveal that preoperative neoad-juvant chemoradiotherapy and radical concurrent chemoradiation are the preferred modalities for local advanced esophageal carcinoma.