Objective: To understand the level and trend of health literacy among residents in Zhoushan City, Zhejiang Province from 2015 to 2023, so as to provide the reference for developing promotion strategies and interventions of health literacy. Methods: Permanent residents aged 15 to 69 years in Zhoushan City were selected as the survey subjects using a multi-stage stratified random sampling combined with population-size proportional sampling method. The residents' health literacy was investigated using the Questionnaire on the Health Literacy among Chinese Residents, and standardized by Zhoushan City population data captured from the national population census in China. The absolute increase and growth rate of health literacy level from 2015 to 2023 were calculated to investigate the changing trends in health literacy levels. Results: A total of 19 296 residents were monitored from 2015 to 2023, including 8 006 men (41.49%) and 11 290 women (58.51%), and had a mean age of (50.06±12.67) years. The health literacy levels among residents in Zhoushan City from 2015 to 2023 were 13.10%, 18.33%, 20.35%, 23.71%, 27.58%, 30.75%, 34.36%, 37.03% and 39.47%, respectively, showing an upward trend (P<0.05), with an average annual growth rate of 2.93%. The 9-year absolute increase rates of 26.37%, and the growth rate reached 201.30%. The health literacy levels of basic knowledge and concept, healthy lifestyle and behaviors and basic skills all appeared increasing trends (all P<0.05), and the 9-year absolute increase and growth rate of the basic skills were the smallest (7.64% and 34.60%). The health literacy levels of six categories of health issues all showed upward trends (all P<0.05). The health literacy levels of residents in different regions and genders showed upward trends (both P<0.05). Except for the age of 65 to 69 years, the health literacy levels among all the other age groups showed upward trends (all P<0.05). There was no significant changing trend in the health literacy level among illiterate/semi-literate residents (P>0.05), the health literacy level among residents with primary school education showed a downward trend (P<0.05), while the health literacy levels of residents with other educational levels all showed upward trends (all P<0.05). There was no significant changing trend in the health literacy level among farmers (P>0.05), while the health literacy levels among residents with other occupations showed upward trends (all P<0.05). Conclusions The health literacy level among residents in Zhoushan City steadily increased from 2015 to 2023. Health education and promotion efforts have been targeted at key populations of the elderly aged over 65 years, residents with a primary school education or below and farmers.

Objective: To investigate epidemiological characteristics of cancers in Zhoushan City in 2018, so as to provide the evidence for the formulation of cancer control strategies. Methods: The cancer data in Zhoushan City in 2018 were captured from Zhejiang Provincial Information Management System for Chronic Disease Surveillance. The gender- and age-specific incidence of cancers was descriptively analyzed. The cancer incidence was standardized to the data of the Sixth National Population Census in China in 2010 ( Chinese standard population ) and Segi's world standard population. Results: The crude incidence rate, age-standardized incidence rate by Chinese standard population ( ASR China ), and age-standardized incidence rate by world standard population ( ASR world ) of cancers were 468.65/105, 300.12/105 and 232.79/105 in Zhoushan City in 2018, and the cumulative cancer incidence rate was 26.91% among residents at ages of 0 to 74 years, while the truncated-age cancer incidence rate was 431.90/105 among residents at ages of 35 to 64 years. The crude incidence rate, ASR China, and ASR world of cancers were 473.00/105, 285.67/105 and 229.03/105 in men, and 464.43/105, 317.66/105 and 241.30/105 in women in Zhoushan City in 2018, respectively. In addition, the mean age of new cases with cancers in 2018 was ( 61.34±13.19 ) years in Zhoushan City in 2018, and the highest crude cancer incidence was seen in residents at ages of 70 to 74 years ( 1 327.50/105 ). The crude cancer incidence rate was higher in new female cases at ages of 25 to 54 years than in new male cases, and the crude cancer incidence rate was higher in new male cases at ages of 60 to 84 years than in new female cases ( P<0.05 ). The 10 most common cancers included lung cancer, female breast cancer, thyroid cancer, gastric cancer, colorectal cancer, liver cancer, cervical cancer, prostatic cancer, pancreatic cancer and bladder cancer, which accounted for 80.20% of all cancers in Zhoushan City in 2018. Conclusions High cancer incidence was found in Zhoushan City in 2018, and elderly populations are at high risk of developing cancers. The management of lung cancer, female breast cancer, thyroid cancer, gastric cancer and colorectal cancer should be given a high priority.

OBJECTIVE：To study the anti-inflammatory effects of Yuyang capsule on bacterial dermatitis model rats and its effect on TLR/NF-κ B pathway. METHODS：Minimum inhibition concentration （MIC）and minimal bactericidal concentration （MBC）of Yuyang capsule against Staphylococcus aureus were determined by microdilution test. Totally 50 SD rats were randomly divided into model group ，positive control group （amoxicillin and clavulanate potassium ，120 mg/kg as amoxicillin ），Yuyang capsules high-dose ，medium-dose and low-dose groups （according to MIC ），with 10 rats in each group. The model of bacterial dermatitis was established by using the burned skin of rats infected with S. aureus . 24 h after modeling ，administration groups were intragastrically given the corresponding drug ，and model group was intragastrically given the same amount of normal saline ，once a day，for consecutive 7 days. The skin healing rate was calculated on the 1st，3rd，5th and 7th day of administration ，and the scab formation，decrustation and healing were recorded. The contents of IL- 1β，IL-6，IL-10，TNF-α，hydroxyproline（HYP），collagen Ⅰ（Col Ⅰ）and Col Ⅲ in skin tissue were detected by ELISA. Morphology changes of skin tissues were observed by HE staining. The ultrastructure was observed by transmission electron microscope. Protein expression of TLR 2，TLR4 and p-NF-κB p65 were detected by Western blotting assay. RESULTS ：MIC and MBC of Yuyang capsule were 25 mg/mL and 50 mg/mL，respectively. Dose of Yuyang capsules high-dose ，medium-dose and low-dose groups were set at 600，300，150 mg/kg. Compared with model group，scab appeared on the injured skin 3 days after administration in Yuyang capsule high-dose and medium-dose groups ，and decrustation appeared on the injured skin of part mice 5-7 days after administration ；the skin healing rate of the positive control group，Yuyang capsule high-dose and medium-dose groups were all significantly increased at each time point. The contents of IL- 1 β，IL-6，IL-10 and TNF-α，pathological score ，protein expression of TLR 2，TLR4 and p-NF-κB p65 were decreased significantly （P＜0.05 or P＜0.01）；the pathological changes such as inflammatory cell infiltration in skin tissue were improved. The contents of HYP，Col Ⅰ and Col Ⅲ were increased significantly in positive control group and Yuyang capsule high-dose group （P＜0.05 or P＜0.01）. There was no statistical significance in most above indexes in positive control group ，Yuyang capsule high-dose and medium-dose groups （P＞0.05）. CONCLUSIONS ：Yuyang capsule can promote skin healing of bacterial dermatitis model rats and shows certain anti-inflammatory effects ；the mechanism may be related to inhibiting TLR/NF-κB signaling pathway and reducing inflammatory response.

Objective : To study the epidemiological characteristics of coronavirus disease 2019 （COVID-19） in Zhoushan, so as to provide reference for improving the prevention and control capability of COVID-19. Methods : All the confirmed cases of COVID-19 in Zhoushan, diagnosed according to China’s “COVID-19 diagnosis and treatment plan （fifth version） ” and reported from January 19 to February 17, 2020, were extracted from the infectious disease surveillance system. Data of general information, clinical characteristics, laboratory Results, transmission and detection routes were collected and analyzed. Results : By February 17, Ten confirmed cases of COVID-19 in Zhoushan had been reported, including 7 males and 3 females. They were all adults, with an average age of （50.90±15.00） years. Five cases were discharged. The incubation period ranged from 2 to 12 days, with a median of 5 days. The first symptoms were fever （8 cases）, cough （7 cases） and muscle pain （2 cases）. Chest computed tomographic （CT） scans showed ground glass opacities in the lungs of all the cases. Six cases had Wuhan related exposure. SARS-CoV-2 was tested positive in the sputum specimens or throat swabs of all the cases and the faeces of 4 cases. The last suspicious exposure of 5 cases occurred before, and that of another 5 cases occurred after the onset of clinical symptoms in the confirmed maternal cases. Three cases were found in active consultation after clinical symptoms, and another 7 cases were found in the monitoring of close contacts. Conclusions The 10 confirmed cases of COVID-19 reported in Zhoushan are all adults, and most have Wuhan related exposure. SARS-CoV-2 can be detected in the fecal samples, but the existence of fecal-oral transmission needs more research. SARS-CoV-2 has strong infectivity, and may also have infectivity before the onset of symptoms （at the end of incubation period）. Isolation and early detection of close contacts are conducive for early case-finding.

Objective: To learn the characteristics of drowning deaths and potential years of life lost（PYLL）among residents in Zhoushan，and to provide basis for formulating drowning prevention and control measures. Methods: The death surveillance data in Zhoushan from 2009 to 2018 were collected from Zhejiang Chronic Disease Surveillance Information Management System. Demographic features，causes of drowning，life and labor lost due to drowning were analyzed through indicators such as mortality，standardized mortality，early death index，PYLL and working potential years of life lost（WPYLL）. Results: The crude and standardized drowning mortality of Zhoushan residents were 7.97/100 000 and 4.68/100 000. The drowning mortality showed a decreasing trend from 2009 to 2018（P<0.05）. The mortality of drowning in males was 8.03/100 000，which was higher than 1.33/100 000 in females（P<0.05）. Totally 322 deaths from drowning were fishery workers，accounting for 41.44%. The main cause of drowning death in residents aged 0-14 years，15-29 years and 65 years or above was accidental fall，accounting for 36.11%（13 cases），23.91%（11 cases）and 14.40%（47 cases），respectively. The main cause of drowning death in residents aged 30-44 years and 45-64 years was ship accident，accounting for 33.33%（58 cases）and 36.01%（130 cases），respectively. PYLL and WPYLL caused by drowning death were 22 511 and 11 911 person-years，of which residents aged 30 to 64 years were accounted for 73.33% and 70.55%. The early death index was 28.97. Conclusion Drowning mortality in Zhoushan showed an downward trend from 2009 to 2018. Men and fishery workers are at higher risk of death from drowning. Drowning can lead to serious life loss，especially for population aged 30-64 years.

Objective To explore the expression of nutrition information based on consumer cognitive psychology,and improve the applicability of pre-packaged food nutrition labels.Method Taking the "nutrition label" of a biscuit as an example:First,the energy (kilojoules) of the biscuit is converted into "food exchange serving";Then,the energy supply ratio of three major calorigenic nutrients of various foods in the biscuit is calculated according to the "China Food Composition Table",and the energy supply ratio of three major calorigenic nutrient in different food combinations is also calculated.Finally,we determined whether energy supply ratio of the three major calorigenic nutrients of the biscuit is similar to a mix of certain energy ratios of certain types of food.Thus,the new nutritional information expression of'nutrition labels' was determined.The applicability and operability of balanced food practice was compared between the existing and improved nutrition information expression by the'desktop deduction'method.Results The biscuit contains 1 823 k] of energy per 100 g,which is about 5 "food exchange servings".The average energy supply ratio of protein,fat,and carbohydrate of all kinds of food are as follows:The cereals were 15％,5％ and 80％ respectively;the meats were 55％,39％ and 10％ respectively;the vegetables were 27％,9％ and 58％ respectively;and the fruits were 5％,3％ and 91％,respectively.If different types of food are mixed according to their energy ratio,then the energy supply ratio of the three energy producing nutrients is different.The energy ratio of the three energy producing nutrients of the prepackaged food will always be similar to that of the mixture of some kinds of food.The biscuit is similar to 1:4 energy mixed with oil foods and cereals,which translates to about 10 g of oils and 100 g of grains,based on the'food exchange serving'.Hence,if you eat 100 g of these cookies,subtract about 10 g of fat and 100 g of cereal from your three meals per day.Conclusion The nutritional ingredient list of'prepackaged food nutrition label'should increase the expression of 'food exchange'and food category and energy proportion,so as to facilitate the practice of balanced diet by consumers.

Objective To evaluate the short-term efficacy,safety and impact on the quality of life of anlotinib in third-line and above treatment for advanced non-small cell lung cancer (NSCLC) patients.Methods All the patients received alotinib 12 mg/d.One cycle was defined as 2 weeks on-treatment followed by 1 week off-treatment until disease progression or treatment intolerance.Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 was used to assess tumor responses.Common Terminology Criteria for Adverse Events (CTCAE) 4.02 was used to assess the adverse events.The European Organization for Research on Treatment of Cancer (EORTC) QLQ-C30 and QLQ-LC13 were used to assess quality of life.Results Among 27 patients in study,no complete response (CR) was found,2 patients (7.4％) achieved partial response (PR),16 patients (59.3％) achieved stable disease (SD),9 patients (33.3％) achieved progressive disease (PD),objective response rate (ORR) was 7.4％,and disease control rate (DCR) was 66.7％.The scores of physical functioning (76.00 ± 10.55 vs.64.44 ± 11.59),emotional functioning (81.67 ± 8.71 vs.76.11 ±6.71) and global health status (48.87 ±7.97 vs.40.56 ± 12.49) of the QLQ-C30 scale after treatment were higher than those before treatment,with statistically significant differences (t =-4.516,P ＜0.001;t=-2.646,P=0.019;t=-3.872,P=0.002).Fatigue (50.37±8.95 vs.40.74±13.86),nausea and vomiting (26.54 ± 16.18 vs.14.20 ± 11.97),loss of appetite [M(QR):33.33 (33.33) vs.33(33.33)] were better than before (t =-2.476,P =0.027;t =-5.036,P ＜0.001;Z =-2.923,P =0.003);pain (28.88 ± 14.23 vs.33.33 ± 13.60) and dyspnea [33.33 (33.33) vs.33.33 (66.67)] scores were lower than before (t =3.674,P =0.003;Z =-3.266,P =0.001).The scores of cough (24.44 ±19.12 vs.45.24 ±20.34),shortness of breath [11.11(22.22) vs.33.33(22.22)] and chest pain [0.00(33.33)vs.33.33 (33.33)] in the QLQ-LC13 scale after treatment were lower than those before treatment,with statistically significant differences (t =4.000,P =0.001;Z =-4.125,P ＜0.001;Z =-1.890,P =0.034);the scores of sore mouth or tongue [0.00(33.33) vs.0.00(0.00)] and hands and feet tingling [33.33(33.33) vs.0.00(0.00)] were higher than before (Z=-2.000,P=0.046;Z=-2.264,P=0.024).Common adverse reactions included hypertension,fatigue,elevated thyroid stimulating hormone,proteinuria,hand-foot syndrome,oral mucositis,hemoptysis,etc,mainly grade 1-2,and they were all improved after the treatments.Conclusion Anlotinib as a third-line and further therapy is positive effected and well tolerated.It can alleviate the clinical symptoms and significantly improve the quality of life of NSCLC patients.

To examine the growth activity and osteogenic differentiation of bone mesenchymal stem cells (BMSCs) in rats with Type 2 diabetes mellitus (T2DM) as well as the expression level of Dickkopf-1 (DKK-1) in bone marrow, and to explore the relationship between the osteogenic activity of BMSCs and the expression of DKK-1.
 Methods: The BMSCs were isolated from T2DM rats and were cultured in vitro. The BMSCs were divided into a T2DM group and a control group. The proliferation of BMSCs was detected by cell counting kit-8 (CCK8). Apoptosis rate was detected by annexin V- fluorescein isothiocyanate (FITC)/propidium iodide (PI) double staining. In the osteogenic induction phase, the expression level of alkaline phosphatase (ALP) in BMSCs was detected by ALP staining and ALP activity assay kit. The osteogenic differentiation of BMSCs was analyzed by alizarin red staining and mineralized nodule quantification. In addition, the expression of Runx2 and DKK-1 in BMSCs was detected by qRT-PCR.
 Results: Compared with the control group, the proliferation of BMSCs was decreased and the apoptosis was increased in the T2DM group (both P<0.01). In the osteogenic induction process of BMSCs, the expression of ALP significantly decreased, the formation of calcium nodules reduced, and the expression of osteoblast transcription factor Runx2 was down-regulated in the T2DM group compared with those in the control group (all P<0.01). The levels of DKK-1 protein and mRNA were up-regulated in the T2DM group, which were higher than those in the control group (both P<0.01). The levels of DKK-1 protein and mRNA were related to the increase of Runx2 (both P<0.01).
 Conclusion: The growth activity of BMSCs and the potential of osteogenic differentiation are attenuated in the T2DM rats, which may be related to the increase of DKK-1 expression in BMSCs.
Animals ; Bone Marrow Cells ; Cell Differentiation ; Cells, Cultured ; Diabetes Mellitus, Experimental ; Diabetes Mellitus, Type 2 ; physiopathology ; Gene Expression Regulation ; Intercellular Signaling Peptides and Proteins ; genetics ; Mesenchymal Stem Cells ; Osteogenesis ; genetics ; Rats

Objective:To investigate the risk factors of breast cancer complicated with deep venous thrombosis (DVT) in lower limb and to explore the predictive significance of the thrombus risk assessment model for patients with breast cancer. Methods:A total of 703 patients with breast cancer in Tianjin Medical University Cancer Institute and Hospital who suffered from DVT after operation dur-ing January 2013 to June 2016 were retrospectively selected as the thrombosis group. A total of 706 cases for the control group were selected by systematic sampling. The risk factors of lower limb DVT after surgery were investigated. The predictive values of the Khora-na and Caprini thrombosis risk assessment models for these patients were also presented in this research. Results:Age, BMI≥30 kg/m2, diagnosis by excisional biopsy, neoadjuvant chemotherapy, operation time>2 h, lipoprotein a (Lpa)>475.5 mg/L, protein C (PC)<102.5%, blood coagulation factor-Ⅷ(F-Ⅷ)>129.8%, and D-Dimer (D-D)>289.99 ng/mL had statistical differences between in the two groups (P<0.05). Significant difference between the groups was found in the Caprini scores (P<0.001) but not in the Khorana thrombo-sis risk assessment model (P=0.207). Conclusion:Age, BMI≥30 kg/m2, diagnosis by excisional biopsy, neoadjuvant chemotherapy, op-eration time>2 h, Lpa>475.5 mg/L, PC<102.5%, F-Ⅷ>129.8%, and D-D>289.99 ng/mL are the independent risk factors of thrombo-sis. The Caprini thrombosis risk assessment model may require complicated evaluation. Hence, a new model that is suitable for pa-tients with breast cancer must be developed.

Severe fever with Thrombocytopenia Syndrome (SFTS) is an emerging hemorrhagic fever disease in the rural areas of east-central China,which is caused by SFTSV-a newly discovered bunyavirus.SFTSV is most likely transmitted by tick bites but can also be transmitted within human beings.The onset of SFTS is sudden and with rapid progress,with main clinical manifestations as fever,thrombocytopenia,leucopenia and gastrointestinal and hepatorenal dysfunctions.Some patients may die from multiple organ failure,and the case fatality rate is approximately 10％.In this paper,we use the method of literature review to summarize the recent research progress of SFTS which includes the epidemic distribution characteristics,medium of transmission,host animals,transmission routes and susceptibility in the general population.