Objective To investigate urinary iodine and dietary iodine intake in adults, and to ana-lyze the relationship of urinary iodine and daily dietary iodine intakes with thyroid nodules.Methods To-tally 30 participants with nutritional background were enrolled prospectively from January to March 2015 in Shanghai.The 3-day survey of 24-hour's diet record was made using weighting method to evaluate the daily nutrient intakes.On the second and third days of dietary records, urine samples in fasting status and 2 hours after meals were collected from all the participants (n=240).The levels of urine iodine were meas-ured, and dietary iodine intake calculated.3-month food frequency questionnaire was completed and thy-roid ultrasonography performed.Results The median urinary iodine ( MUI) of fasting and 2 h postprandi-al urine samples was 137.56 μg/L ( 91.4-211.5 μg/L) .The portions of participants with iodine insuf-ficiency, iodine adequate, and iodine above requirements or excess were 20.2%, 56.7%, and 23.3%, respectively.Inter-individual MUI varied from 36.31 μg/L to 359.20 μg/L.No significant difference was found between the fasting urinary iodine and 2 h postprandial urinary iodine ( P=0.389 ) .The average di-etary iodine intake was (197.2 ±74.2) μg/d, and the proportions from iodine salt and drinking water were 70.2% and 5.4%, respectively.There was a significant positive correlation between dietary iodine intake and urinary iodine value of the same day (r=0.426, P=0.019).Participants with thyroid nod-ules had higher urinary iodine than participants without thyroid nodules [ ( 194.0 ±101.5 ) μg/L vs. (135.7 ±72.9) μg/L, P<0.001].Conclusions Inter-individual iodine nutritional status are signifi-cantly different under natural living status.Increased urinary iodine may be related with thyroid nodules. Repeat random urine iodine test combined dietary assessment may reduce the error in evaluating individual iodine nutritional status.

Objective To investiga~ the effect of remote ischemic preconditioning (RIPC) combined with dexmedetomidine on the lung injury during one-lung ventilation (OLV) in the patients undergoing thoracic surgery.Methods Thirty ASA physical status Ⅰ or Ⅱ patients,aged 45-70 yr,weighing 51-69 kg,scheduled for elective radical operation for esophageal cancer,were randomly divided into 2 groups (n =15 each) using a random number table:control group (group C) and RIPC combined with dexmedetomidine group (group ORD).In ORD group,at 10 min after endotracheal intubation,RIPC was induced by 3 cycles of 5 min lower extremity ischemia followed by 5 min reperfusion,and at the same time a loading dose of dexmedetomidine 1.0 μg/kg was infused intravenously over 15 min and then dexmedetomidine was infused at a rate of 0.5 μg· kg-1 · h-1 until the end of operation.At 0,30 min,1 h and 2 h of OLV (T1-4),blood samples were obtained from the radial artery for blood gas analysis and determination of plasma concentrations of tumor necrosis factor-α (TNF-α),interleukin-1β (IL-1β) and IL-10.Oxygenation index and respiratory index were calculated.Exhaled breath condensate was collected at T1,T3 and T4,and the pH value was measured.Results Compared with group C,oxygenation index was significantly increased,and respiratory index was decreased at T2-4,the plasma concentrations of TNF-α and IL-1β were decreased,and the pH value of exhaled breath condensate was increased at T3-4,and the plasma concentration of IL-10 was increased at T4 in group ORD.Conclusion RIPC combined with dexmedetomidine can inhibit inflammatory responses and reduce airway acidification,thus attenuating the lung injury during OLV in the patients undergoing thoracic surgery.

Objective To investigate the distribution and changes of microorganisms on the skin of submariners under a chronically closed environment , and provide reference for targeted medical support .Methods One hundred and twenty-two samples were collected using swab.After culture and isolation, the microbes were identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry ( MALDI-TOF-MS) .Results A total of 52 types of 229 bacteria and 2 types of fungi were isolated . Major opportunistic pathogens included Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter cloacae, while major dwelling bacteria included Micrococcus luteus, Oslo Mora bacteria, Acinetobacter, Staphylococcus epidermidis, and Serratia marcescens.Compared with the early period of the task, major opportunistic pathogens and dwelling bacteria were significantly increased in the middle and late period of the task .Conclusion The skin microbes of the submariners are investigated , targeted drugs need to be prepared for daily medical support and war trauma .

Objective: To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus. Methods: From January 2013 to May 2017, 159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating. They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years). They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not. The stiffness group had extension-flexion and/or pronation-supination <100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥100° and no secondary elbow arthrolysis. Age, gender, fracture side, mechanism of injury, AO fracture classification, open/close fracture, additional fracture, preoperative nerve injury, time from injury to surgery, surgical approach, configuration of plating, medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis. Results: The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months). The latest follow-up showed fracture union in all the patients. The stiffness group had 38 patients and the non-stiffness group 121. Multivariate regression analysis showed that high energy trauma (OR=3.141, 95%CI 1.396~7.070, P=0.006) and time from injury to surgery >one week (OR=2.596, 95%CI 1.123~6.000, P=0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus. Conclusion The patients with high energy trauma and time from injury to surgery >one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus.

Objective: To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate. Methods: From January 2013 to December 2017, 54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma, Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration). According to their age, the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5±3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1±5.8 years. The 2 groups were compared in terms of perioperative data, ranges of motion (flextion, extension and rotation), numeric rating scale for pain (NRS), Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) at the last follow-up, complications and secondary surgery. Results: The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy, combined injury and gender between them (P>0.05). The young group had significantly more cases of high-energy injury and combined injuries than the elderly group(P<0.05). All patients were followed up for 33.6±15.0 months (from 12 to 63 months). The total blood loss in the elderly group (643.9±298.7 mL) was significantly less than that in the young group (953.9±554.6 mL) (P<0.05). At the last follow-up, there were no significant differences between the 2 groups in ranges of motion, NRS or MEPS (P>0.05), but the elderly group had significantly higher Quick-DASH scores (13.9±14.4 points) than the young group (5.7±8.9 points) (P<0.05). There was no significant difference in postoperative elbow stiffness or postoperative ulnar nerve symptoms betwee the 2 groups (P>0.05), but the rate of secondary surgery in the young group (37.9%, 11/29) was significantly higher than that in the elderly group (4.0%, 1/25) (P<0.05). Conclusions In the treatment of humeral intercondylar fractures, ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients.

Total elbow arthroplasty (TEA) is an effective surgical method for treatment of end-stage elbow arthritis. However, compared with hip and knee arthroplasties, the implant survival rate of TEA remains low, with a high postoperative complications rate and a high revision rate. The main reasons for revision include aseptic loosening, periprosthetic infection, periprosthetic fracture, component failure, and postoperative instability, of which the most common cause is aseptic loosening. Unlike the initial TEA, revision surgery usually needs to deal with complicated conditions such as infection, scars, bone defects, prosthetic stem extraction and cement removal, making the operation more difficult. There are few clinical studies related to TEA revision in China. Therefore, the authors review the reasons for postoperative revision, the management of key intraoperative issues, and the outcomes of treatment to provide the basis for future clinical application and academic research of TEA revision surgery in China.

Objective To investigate the diagnostic value of superb microvascular imaging ( SM I ) , advanced dynamic flow ( ADF ) and color Doppler flow imaging ( CDFI) in breast microcarcinoma ,and to compare the correlation coefficients between these three indicators and postoperative pathological tumor microvascular density ( M VD ) . Methods A total of 85 patients ( 87 lesions ) with BI‐RADS 4 and the maximum diameter≤1 cm were selected ,of which ,46 lesions were benign ( benign group) and 41 lesions were malignant( malignant group) . All the patients and the corresponding lesions were examined by SM I , ADF and CDFI . Blood flow grading was performed on the images using Adler grade of blood flow ,and the difference of blood flow among the 3 methods was compared . T he expression level of M VD in pathological tumor tissues was detected and analyzed for its correlation with Adler classification by three detection techniques . Results T he areas under the ROC curve( AUR) of CDFI ,ADF and SM I were 0 .694 ,0 .705 and 0 .776 respectively based on the gold standard with pathological diagnosis . T he sensitivity ,specificity , positive predictive value ,negative predictive value ,and accuracy of CDFI were 78 .0% ,54 .3% ,60 .4% , 73 .5% ,and 65 .5% , respectively ; those of ADF were 75 .6% , 60 .9% , 63 .3% , 73 .7% and 67 .8% , respectively ; and those of SM I were 78 .0% ,69 .6% ,69 .6% ,78 .0% and 73 .6% ,respectively . T he Adler grades of CDFI , ADF and SM I were positively correlated with M VD ( P ＜ 0 .05 ) , w hich the highest correlation coefficient between SM I and M VD ( r ＝0 .430 , P ＜0 .001 ) . Conclusions SM I is superior to ADF and CDFI in detecting the abundance of breast microcarcinoma , and has the highest correlation coefficient among those 3 detection techniques with tumor pathological M VD ,which indicates that SM I may be used for differential diagnosis of breast microcarcinoma and indirectly evaluate the prognosis of patients .

Hyperparathyroidism is a secondary or primary endocrine disorder.In recent years,the incidence of hyperparathyroidism in China is increasing.Clinical manifestations tend to be multi-systemic injuries,which poses challenges for patients and clinicians.At the same time,with the advancement of medical science and technology,new detection means and innovative therapies are emerging.In this paper,recent progress of diagnosis and treatments is reviewed to provide basis for clinical work.

Objective:To monitor iodine nutrition of women during late pregnancy and examine the correlation between maternal urine iodine concentration and newborn physical development.Methods:Prospective cohort study was conducted in 151 pregnant women at 28-34 weeks' gestation who accepted nutrition follow-up between December 2014 and August 2015. Participants were surveyed twice at enrollment and hospitalization for delivery respectively by iodine related food frequency method and 24 h diet diary and dietary nutrition software was used to calculate diet iodine consumption amount. Spot urine samples were taken three times totally every two weeks and data of antenatal care was recorded and the participants were divided into groups during this period. The physical development indexes and neonatal thyroid stimulating hormone (TSH) levels were obtained.Results:Maternal median urinary iodine concentration was 100.0 μg/L. Using urinary iodine levels 150 μg/L and 249 μg/L as cut-off points, participants were divided into three subgroups as iodine-insufficient, iodine-adequate and iodine-over, with incidences of 76.8% ( n=116), 19.2% ( n=29), and 4.0% ( n=6), respectively. Subgroup analysis showed no significant differences between the iodine-insufficient group ( n=116) and the iodine-sufficient group ( n=35) in neonatal weight [(3 295±370) vs (3 395±450)g, P=0.183], neonatal length [50.0(48.0, 50.0) vs 50.0(49.0, 51.0)cm, P=0.171], neonatal head circumference [34.5 (34.0, 35.0) vs 34.5(34.0, 35.0)cm, P=0.691], or neonatal thyroid stimulating hormone levels [(4.0±1.9) vs (4.2±2.5)mIU/L, P=0.438]. Conclusions:According to World Health Organization criteria, iodine deficiency rate in women during late pregnancy reaches 76.8%. In this study there is no significant difference in newborn physical development indexes among various pregnancy iodine nutrition statuses.

Objective: To investigate the diagnostic value of superb microvascular imaging(SMI), advanced dynamic flow(ADF) and color Doppler flow imaging(CDFI) in breast microcarcinoma, and to compare the correlation coefficients between these three indicators and postoperative pathological tumor microvascular density(MVD). Methods: A total of 85 patients(87 lesions) with BI-RADS 4 and the maximum diameter≤1 cm were selected, of which, 46 lesions were benign(benign group) and 41 lesions were malignant(malignant group). All the patients and the corresponding lesions were examined by SMI, ADF and CDFI. Blood flow grading was performed on the images using Adler grade of blood flow, and the difference of blood flow among the 3 methods was compared. The expression level of MVD in pathological tumor tissues was detected and analyzed for its correlation with Adler classification by three detection techniques. Results: The areas under the ROC curve(AUR) of CDFI, ADF and SMI were 0.694, 0.705 and 0.776 respectively based on the gold standard with pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CDFI were 78.0%, 54.3%, 60.4%, 73.5%, and 65.5%, respectively; those of ADF were 75.6%, 60.9%, 63.3%, 73.7% and 67.8%, respectively; and those of SMI were 78.0%, 69.6%, 69.6%, 78.0% and 73.6%, respectively. The Adler grades of CDFI, ADF and SMI were positively correlated with MVD(P<0.05), which the highest correlation coefficient between SMI and MVD (r=0.430, P<0.001). Conclusions SMI is superior to ADF and CDFI in detecting the abundance of breast microcarcinoma, and has the highest correlation coefficient among those 3 detection techniques with tumor pathological MVD, which indicates that SMI may be used for differential diagnosis of breast microcarcinoma and indirectly evaluate the prognosis of patients.