Objective To evaluate the prevalence of atherosclerosis in Chinese premenopausal women with systemic lupus erythematosus (SLE) and study possible associations between non-traditional risk factors with premature atherosclerosis. Methods One hundred and eleven premenopausal women with SLE and 40 healthy controls without clinical cardiovascular disease were evaluated. B-mode ultrasonography was used to measure carotid plaque and intima-media wall thickness( IMT). The relationship between the patients' clinical characteristics and carotid plaque was examined. At the same time, B-mode ultrasound was used to measure flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) in the brachial artery. Using this method, the difference in endothelial function between SLE patients and controls was assessed. T-test,χ2 test and logistic regression were used for statistical analysis. Results Carotid plaque was more frequently observed in patients with SLE (16 of 111 patients) than in control subjects (0 of 40 subjects) (P=0.007). The mean IMT (m-IMT) (0.62 mm vs 0.45 mm, P<0.01) and maximum IMT(M-IMT) (0.7 mm vs 0.6 mm, P<0.01) was significantly higher in patients than in controls. As compared with patients without plaque, patients with plaque were significantly older, had longer disease duration, higher body mass index (BMI), higher blood pressure, shorter prothrombin time, elevated C-reactive protein level, higher SLICC score, higher cumulative prednisone dose, less hydroxychloroquine accumulated dosage, higher m-IMT and M-IMT, lower FMD and NMD. In logistic regression analysis, older age (P=0.012, OR=1.137), higher BMI (P=0.051, OR=1.205) and higher SLICC score (P=0.000, OR=2.888) were independently related to the presence of plaque. Conclusion SLE patients have higher prevalence of carotid atherosclerosis plaque than healthy controls and the age at onset is younger than controls. In addition to traditional risk factors for cardiovascular disease, SLE itself and disease related factors play important roles in premature atherosclerosis in SLE. SLE patients have significant endothelial dysfunction. Thus, endothelial dysfunction can be regarded as one manifestation of premature atherosclerosis in SLE.

Objective The evaluate the accuracy of loss of resistance technique for location of fascia iliaca compartment using ultrasound technique.Methods One hundred and seventy-five patients undergoing hip surgery were enrolled in the study.A line was drawn on the skin from the pubic tubercle to the anterior superior iliac spine and divided in three equal parts.The site of puncture was marked 2 cm distal to the point at which the lateral met the middle third of the line.The needle was inserted until a loss of resistance was felt twice (fascia lata and fascia iliaca),at which point 0.5 ％ ropivacaine 30 ml was infused.Correct puncture was identified by visualized spread of local anesthetic solution under the guidance of ultrasound technique.The effective sensory block was recorded within 20 min after administration.Results The accuracy of loss of resistance method for locating the fascia iliac compartment was 56.6 ％ using ultrasound technique.There were 80 patients in whom fault site of puncture occurred:25 cases in the superficial layer of the fascia iliac and 51 cases in the iliopsoas muscle.The rate of effective block was 98.0 ％ for correct location and 82.9 ％ for fault location.Conclusion Loss of resistance technique cannot accurately locate the fascia iliac compartment.

Objective:To systematically evaluate the effectiveness and safety of intra-articular in-jection of mesenchymal stem cells (MSCs) and hyaluronic acid (HA) in the treatment of knee osteoarthritis.Methods:The relevant literatures published in both English and Chinese were systematically searched in PubMed, Embase, Wanfang database, China Knowledge Network (CNKI), SinoMed database and other data-bases from inception to May 2020. Two researchers independently extracted data and evaluated the included literature. Risk assessment of literature bias was carried out. RevMan 5.3 software was used for Meta analysis, and the combined sensitivity were calculated.Results:Finally, 13 references were included, including a total of 726 patients with knee osteoarthritis. Meta-analysis results showed that compared with the HA group, the Western Ontario and McMaster University Osteopathic Index Total Score (WOMAC) [ MD=-10.92, 95% CI (-16.87, -4.96), P<0.01], the visual analogue scale (VAS) score [ MD=-1.70, 95% CI(-2.44, -0.95), P<0.01], and the knee joint Lequesne index score of MSCs group all decreased significantly [ MD=-13.78, 95% CI (-15.03,-12.52), P<0.01]. Furthermore, there was no significant difference in the incidence of adverse events (AEs) between the two groups [ RR=1.11, 95% CI(0.90, 1.37), P=0.33]. However, American Knee Association Score (AKS score) [ MD=-10.15, 95% CI(-22.33, 2.03), P=0.10] and whole-organ magnetic resonance imaging score (WORMS) [ MD=-3.93, 95% CI(-11.60, 3.75), P=0.32] were not statistically significant ( P>0.05). Conclusion:Compared with intra-articular injection of HA, intra-articular injection of MSCs can significantly improve the symptoms and dysfunction, and has favorable clinical tolerability and safety, suggesting that MSCs is expected to bea new treatment for knee osteoarthritis.

Objective This study aims to assess the effect of Problem-Based Learning(PBL)and Case-Based Learning(CBL)based on the Plan-Do-Check-Act(PDCA)cycle on the quality control training for clinical residents in medical record writing on the first page.Methods A total of 293 clinical residents who participated in first page of medical record writing train-ing in 2021 in a hospital were selected as control group,and 243 clinical residents who participated in first page of medical record writing training in 2022 were selected as observation group.The control group were trained only with the PBL+CBL teaching method,while the observation group with the PDCA cycle in combination with PBL+CBL teaching methods.Upon completion of the training,the two groups were compared in terms of scores on basic theoretical examinations.Results The observation group showed a significantly higher average theoretical score compared to the control group(84.41±12.27 vs.74.32±14.39,P＜0.05).Conclusion PBL and CBL teaching methods based on PDCA cycle can enhance the effect of quality control training for clinical residents in medical record writing on the first page,ultimately improving the quality of medical record writing on the first page and ensuring that objectivity,accuracy,and authenticity of information on the first page.

Objective To evaluate the short-term efficacy and safety of etanercept treatment in Chinese patients with active ankylosing spondylitis ( AS ). Methods This was a 12-week multicenter,double-blind, placebo-controlled, randomized phase Ⅲ clinical study. The first part was a 6-week placebocontrolled period followed by a 6-week open-label period. The primary efficacy endpoint was the percentage of subjects achieving a 20% improvement in assessment in ankylosing spondylitis (ASAS) ( ASAS 20). The secondary efficacy endpoints were the percentage of patients achieving a 40% improvement in ASAS (ASAS 40), achieving a 50% improvement in ASAS( ASAS 50), achieving a 70% improvement in ASAS (ASAS 70), and ASAS 5/6 responses at all visits, and the improvement in subject global assessment,physician global assessment, nocturnal and total back pain, bath AS functional index ( BASFI ), bath AS disease activity index (BASDAI), spinal mobility, joint assessment and quality of life assessment. All subjects in the study were evaluated for safety. Results The primary endpoint, ASAS 20 at week 6, was achieved by 86. 5% (64/74) patients in the etanercept group compared to 29. 5% (23/78) patients in the placebo group(P ＜0. 001 ). As early as week 2, the percentages of patients achieving the ASAS 20 between the two groups were significantly different. Furthermore, the majority of secondary efficacy end points were also significantly improved. Most of adverse events (AE) were mild in nature, the commonest adverse events were elevated liver function levels, injection site reactions and nasopharyngitis. No death or serious AE were observed. Conclusion Etanercept can improve symptoms fastly,significantly and safely in Chinese patients with active AS.

Objective To design and synthesize novel triazole antifungal derivatives with 1 ,3 ,4-oxadiazole side chain for the study of antifungal activities. Methods Fourteen title compounds were synthesized via acylation ,aminolysis reaction ,cy-clization ,nucleophilic substitution ,etc. All the compounds were characterized by 1 H NMR ,MS spectra. The in vitro antifun-gal activities were evaluated against six human pathogenic fungi through the micro-broth dilution method. Results The title compounds exhibited strong antifungal activities against all the tested fungi ,especially against Candida albicans. Compounds 10d ,10i , 10l , and 10n were found to be the most effective , with a minimum inhibitory concentration (MIC80 ) of 0.003 9 μg/ml .They are 16-fold more potent than ICZ ( MIC80 0.062 5 μg/ml) and 64-fold more potent than FCZ (MIC80 0.25 μg/ml) .Conclusion The 1 ,3 ,4-oxadiazole side chain could affect the antifungal activities. That could be due to the prop-er incorporation between the 1 ,3 ,4-oxadiazole substituted phenyl ring with the target enzyme.

Objective:To investigate the iodine nutritional status of adults and pregnant women in Jianshui County and Zhenxiong County, Yunnan Province.Methods:From May to August 2021, one urban area and one rural area in Jianshui County and Zhenxiong County, Yunnan Province were selected as investigation sites. At least 100 adults (half male and half female) and 100 pregnant women were selected as survey subjects in each investigation site. Random urine samples were collected from all survey subjects once to detect urine iodine, creatinine and sodium contents. Venous blood samples of all pregnant women were collected to detect the serum iodine content, and the 95% medical reference range of serum iodine was established using the percentile method.Results:The medians urinary iodine, creatinine and sodium of adults in Jianshui County and Zhenxiong County were 184.7 μg/L ( n = 432), 12 355.0 μmol/L ( n = 431) and 156.5 mmol/L ( n = 420), respectively. The median urinary iodine of adults in Jianshui County was higher than that in Zhenxiong County (197.3 vs 170.2 μg/L), the difference was statistically significant ( Z = - 2.90, P = 0.003). The median serum iodine of pregnant women in Jianshui County and Zhenxiong County was 92.1 μg/L ( n = 412), with a 95% medical reference value ranged from 45.3 to 183.5 μg/L; the medians urinary iodine, creatinine and sodium of pregnant women were 138.6 μg/L ( n = 413), 12 173.0 μmol/L ( n = 408) and 152.2 mmol/L ( n = 409), respectively. The urinary iodine (154.1 vs 115.8 μg/L), urinary creatinine (13 216.0 vs 11 376.0 μmol/L) and urinary sodium (161.8 vs 141.8 mmol/L) of pregnant women in Jianshui County were higher than those in Zhenxiong County, with statistical differences ( Z = - 5.12, - 2.29, - 4.30, P < 0.05). Conclusion:Adults in Jianshui County and Zhenxiong County are at an appropriate level of iodine, but pregnant women in Zhenxiong County are at an iodine deficiency level.

Objective:To accurately grasp the current status of water iodine distribution in environmental of Yunnan Province, and provide a basis for scientific iodine supplementation.Methods:In 2017, according to the "National Drinking Water Iodine Content Survey Program", a survey of water iodine content was conducted in townships. In 2018, a search survey was carried out for administrative villages with water samples of iodine content > 40 μg/L in drinking water found in previous surveys. In centralized water supply villages, 2 samples of end water were collected. In decentralized or partially decentralized water supply villages, each village was divided into 5 parts: east, south, west, north and center. In villages with more than 50 water sources, 10% of the water sources were selected from each part; villages with less than 50 water sources, one water source was selected from each part; villages with less than 5 water sources, all the water sources were selected to determine the water iodine content. At the same time, the mode of water supply and demographic data were investigated.Results:At the township level water iodine survey, a total of 24 589 water samples were collected from 1 389 townships in 129 counties of 16 prefectures (cities). The median water iodine content of township was 1.3 μg/L, ranging 0.0 - 9.3 μg/L. The population covered by the survey accounted for 53.94% (25 013 804/46 371 207) of the total population of the province. According to the survey results of high iodine villages, 93 administrative villages in 68 townships of 37 counties in 12 prefectures (cities) were surveyed, covering 40 940 households and 208 880 people. A total of 761 samples of drinking water were tested, and the median water iodine content of administrative villages was 1.3 μg/L (ranging 0.0 - 196.8 μg/L). There were 2 administrative villages with iodine higher than 100 μg/L, which were Xiaobona Administrative Village (145.8 μg/L) in Liuchang Township, Xiangyun County, and Dasongshu Administrative Village (196.8 μg/L) in Yangchang Township, Xuanwei City.Conclusions:The iodine content of water in Yunnan Province is generally low, which belongs to the area of environmental iodine deficiency. For the high iodine villages, further investigation should be carried out to clarify the prevention and control measures.

Objective To analyze the iodine nutritional status in the key populations before and after the adjustment of iodized salt in Yunnan Province,and to provide scientific basis for adjusting the strategy of prevention and treatment timely.Methods The probability proportional to size sampling method was employed in the investigation.In the pre-adjustment period (2011) and the post-adjustment period (2014),the changes in the residents' iodized salt,the urinary iodine and goiter prevalence of children aged 8-10,the urinary iodine of pregnant women and lactating women were analyzed.Results Before and after adjusting the salt iodine concentration,the coverage rate of iodized salt was 99.1％ (1 196/1 207) and 99.2％ (1 532/1 545),respectively,the mean of salt iodine after the adjustment (23.6 mg/kg) was significantly lower than that of before (30.1 mg/kg,F =17.287,P ＜ 0.01).There was significant difference in the iodine nutritional status of children from 271.4 to 180.9 μg/L (Z=-12.883,P ＜ 0.01).The difference of iodine nutritional status in pregnant women between pre-adjustment (217.3 μg/L) and postadjustment (143.7 μg/L) was also significant (Z =9.997,P ＜ 0.01).The thyroid goiter rate of children had inceased from 1.7％ (21/1 207) to 2.1％ (33/1 549),the difference was not statistically significant between the groups (x2=0.539,P ＞ 0.05).Conclusions After adjusting the salt iodine concentration in Yunnan Province,iodine nutrition of children has decreased from more than adequate level to adequate level,thyroid goiter rate of children has remained at the low level,and iodine nutrition of pregnant women is sightly lower than adequate level,but iodine deficiency of pregnant women is at a low risk because of the good iodized salt coverage.The new standard of iodized salt is appropriate,and it is more favorable to health in Yunnan Province.

Objective:To evaluate the efficacy of certolizumab pegol (CZP) in the treatment of Chinese women of childbearing age with inflammatory joint diseases and the effect of intrauterine exposure on infant vaccination and risk of infection.Methods:This study is a retrospective observation study, including female patients of childbearing age who were treated with CZP in the outpatient clinic from November 2019 to October 2020. The patients were followed up for 24 weeks, and the related data was collected. We adopted disease activity score-28 for rheumatoid arthritis with CRP (DAS28-CRP), clinical disease activity index (CDAI) and simplified disease activity index (SDAI) to evaluate disease activity. Bath ankylosing spon-dylitis disease activity index (BASDAI) and ankylosing spondylitis disease activity score (ASDAS-ESR) were used to assess the disease activity of patients with ankylosing spondylitis or spondyloarthritis (AS/SpA). Low disease activity (LDA), the dosage of glucocorticoid (GC) and the qualified rates of ACR20 and ASAS20 were calculated to validate the efficacy of CZP. The data of infants vaccination and infection was recorded to estimate the effect of intrauterine exposure on infants. Correlation analysis were performed using paired t test or Mann Whitney test. All statistical tests were bilateral, with a significance of P<0.05. Results:Twenty women entered the study and fifteen completed, including eight patients with RA, six patients with AS and 1 patient with SpA. The average age was (30±5) years and the median symptom duration was 5.0 (3.0, 6.5) years. When these RA patients were enrolled into the study, DAS28-CRP, CDAI and SDAI were (3.4±1.2), 15.5(9.5, 21.0) and (18±12) respectively; and after the use of CZP, the DAS28-CRP, CDAI and SDAI changed to (2.5±0.9)( t=2.48, P=0.042), 4.5(3.5, 10.8) ( U=12.50, P=0.040) and (9±6) (t=2.76, P=0.028). At the first follow-up, the ACR20 rate was 50%. and at the end of the study, the LDA rate was 75%(6/8), three(37.5%) women reduced the dosage of GC. Among the AS/SpA patients, BASDAI was 19.0(14.5, 26.0) and ASDAS-ESR was (2.4±1.0) at first, while after treatment, BASDAI turned into 9.0(1.0, 10.5) ( U=11.50, P=0.100) and ASDAS-ESR turned into (1.4±0.5) ( t=3.44, P=0.014). The ASAS20 rate at the first follow-up was 71.4%(5/7), and 85.7%(6/7) at the end of the study. Four patients experienced adverse events, resulting in drug withdrawal. Three women were pregnant when they were enrolled into the study, and three others became pregnant during the research. Six infants were vaccinated with live attenuated vaccines and inactivated vaccines according to the plan. No adverse event related to vaccination was reported, but one of the babies had perianal abscess and the other one had cold symptoms, while both improved after treatment. Conclusion:CZP can effectively control disease activity of women with inflammatory joint diseases during pregnancy, and intrauterine exposure is safe to infants during the study period.