Iodine is an essential micronutrient for the synthesis of thyroid hormones and for growth and development in the human body. Recent studies have revealed that iodine can exert biological functions beyond the thyroid. By modulating oxidative stress and gut microbiota abundance, it influences systemic metabolic homeostasis. Imbalance in iodine nutrition during pregnancy is closely associated with the onset and progression of gestational metabolic diseases. Based on studies pertaining to the relationship between iodine nutrition during pregnancy and gestational metabolic diseases from 1980 to 2025, this review summarized the relationship of iodine nutrition during pregnancy with gestational metabolic diseases, including gestational diabetes mellitus, gestational hypertension and preeclampsia, gestational overweight or obesity, and gestational dyslipidemia, and described the underlying biological mechanisms, so as to provide the evidence for formulating prevention and control strategies for gestational metabolic diseases.

Duodenum-preserving pancreatic head resection， also known as Beger surgery， has a high incidence rate of bile duct injury after surgery， while the treatment modality for bile duct injury depends on the severity of the injury， and endoscopic therapy is often challenging in case of severe bile duct injury. Recently a patient with biliary fistula after Beger surgery was admitted to Affiliated Hangzhou First People’s Hospital， Westlake University， and successful diagnosis and treatment were achieved through oral choledochoscopy-assisted percutaneous-endoscopic rendezvous technique.

Objective:To analyze the iodine nutrition status of children and adolescents and influencing factors in Zhejiang Province, providing scientific basis for optimizing iodine deficiency disorders (IDD) prevention and control strategies.Methods:In June 2022, a multistage stratified sampling method was used to divide 16 counties (cities, districts, abbreviated as counties) in Zhejiang Province into three categories based on their geographical locations (average distance from the coastline): coastal areas (including Dinghai District, Jiaojiang District, Sanmen County, Cixi City and Lucheng District), sub-coastal areas (including Wuxing District, Haining City, Linping District, Fuyang District and Fenghua District), and inland areas(including Suichang County, Changshan County, Shengzhou City, Jindong District, Dongyang City and Yongjia County). One county was selected from each category, and one township (street) was selected from each county. Two administrative villages (neighborhood committees) were selected from each township (street). Ten households including all children and adolescents aged 6-17 in each household were selected from each administrative village (neighborhood committee). Demographic information and personal dietary characteristics were collected via questionnaires, while household salt and a random urine sample were tested for iodine level. Trend analysis was conducted using a χ 2trend test, and a multivariate logistic stepwise regression model was used to analyze the influencing factors of urinary iodine levels. Results:A total of 755 children and adolescents aged 6-17 were selected, including 387 males (51.26%) and 368 females (48.74%), with an age of (11.24 ± 3.32) years. There were 269 children and adolescents in coastal areas (35.63%) and 409 children and adolescents in urban areas (54.17%). A total of 755 household salt samples were collected, with a median salt iodine concentration of 21.80 mg/kg. These included 263 non-iodized salt samples, 38 unqualified iodized salt samples, and 454 qualified iodized salt samples. The coverage rate of iodized salt was 65.17% (492/755), and the consumption rate of qualified iodized salt was 60.13% (454/755). The distribution of salt iodine quality among children and adolescents in different geographical locations showed statistically significant differences (χ 2 = 111.95, P < 0.001), with the proportion of non-iodized salt gradually decreasing from coastal areas to inland areas (χ 2trend = 90.17, P < 0.001). A total of 755 urine samples were collected, with a median urinary iodine concentration of 186.60 μg/L. The proportions of urinary iodine < 100, 100-199, 200-299, and ≥300 μg/L were 16.95% (128/755), 37.62% (284/755), 24.37% (184/755), and 21.06% (159/755), respectively. The χ 2trend test revealed a nonlinear positive correlation between salt iodine level and urinary iodine level (χ 2regression = 21.98, P < 0.001; χ 2partial = 6.96, P < 0.001). The frequency distribution of urinary iodine in children and adolescents from different geographical locations and between urban and rural areas showed statistically significant differences (χ 2 = 29.63, 16.56, P < 0.001). Among them, the proportion of children and adolescents with urinary iodine < 100 μg/L gradually decreasing from coastal areas to inland areas (χ 2trend = 6.15, P = 0.013). The results of multivariate logistic regression analysis revealed that sub-coastal regions, inland regions, and urban-rural regions ( OR = 1.57, 1.53, 1.64, 95% CI: 1.11-2.24, 1.03-2.27, 1.17-2.32, P < 0.05) were significantly associated with urinary iodine levels in children and adolescents aged 6-17. Conclusions:In 2022, the iodine nutrition of children and adolescents in Zhejiang Province is generally suitable, but there is a risk of iodine deficiency among coastal children and adolescents. Geographic location and urban/rural areas are influencing factors on iodine nutrition status of children and adolescents in Zhejiang Province.

Ocular trauma is a leading cause of permanent visual impairment and loss of working a-bility.Among them,orbital foreign body injuries are often accompanied by multiple injuries to the eye-ball and surrounding tissues,adversely affecting the quality of life.This paper reported a 33-year-old male patient with right orbital foreign body resulting in eyeball contusion,extraocular muscle injury,and restricted ocular movement.After surgical removal of the foreign body combined with integrated traditional Chinese and western medicine treatment,the patient's visual acuity improved from 0.4 to 0.8,and ocular motility function significantly improved.This suggests that comprehensive treatment contributes to promoting functional recovery and enhancing clinical efficacy.

Objective:To analyze the iodine nutrition status and its related factors among adults aged 18 years and above in Zhejiang Province in 2022.Methods:A multistage stratified sampling method was used to select 4 320 adults aged 18 years and above from 16 on-site survey sites in Zhejiang Province for the study. A questionnaire was used to investigate the general demographic information and personal dietary characteristics of the study participants. Household edible salt and urine samples were collected to detect salt iodine content and urinary iodine level by using direct titration and cerium arsenate-catalyzed spectrophotometry, respectively, to evaluate the iodine nutritional status according to the standard. The multiple-ordered logistic regression model was used to analyze the factors influencing the urinary iodine concentration.Results:The age of the 4 320 study participants was (51.19±15.33) years, with males accounting for 44.44% (1 920). About 40.16% of adults (1 735) were from coastal areas and 56.37% (2 435) from urban areas. The salt iodine content, M ( Q1, Q3), of the 4 320 household edible salt samples was 21.10 (0.00, 24.16) mg/kg, including 1 662 non-iodized salt samples, 182 unqualified iodized salt samples and 2 476 qualified iodized salt samples. The rate of iodized salt coverage was 61.53%, and the rate of qualified iodized salt consumption was 57.31%. There was a statistically significant difference in the proportion of qualified iodized salt in adult households among different regions ( P<0.001), with the proportion of non-iodized salt gradually decreasing from coastal to inland areas ( χ 2trend=618.458, P<0.001). The urinary iodine concentration M ( Q1, Q3) was 137.60 (86.85, 210.60) μg/L in 4 320 adult urine samples, with the urinary iodine levels of<100, 100-199, 200-299, and≥300 μg/L accounting for 31.64% (1 367), 40.56% (1 752), 17.66% (763), and 10.14% (438), respectively. There was a nonlinear positive correlation between household salt iodine content and urinary iodine level in adults aged 18 years and above by using the χ 2 test for trend ( χ 2regression=231.10, P<0.001 and χ 2skew=28.81, P<0.001). Urinary iodine concentrations were higher in men than in women ( P=0.029) and higher in adults in rural areas than in urban areas ( P<0.001). There were statistically significant differences in the distribution of iodine nutritional status among adults of different ages, regions, and urban and rural areas (all P<0.001). The proportion of those with urinary iodine levels<100 μg/L gradually increased with age ( χ 2trend=37.493, P<0.001), and gradually decreased from coastal areas to inland areas ( χ 2trend=71.381, P<0.001). The results of the multiple-ordered logistic regression model analysis showed that compared with adults aged 18 to 44 years and male adults, those aged 45 to 59 years and female adults had lower urinary iodine levels, with OR (95% CI) of 0.75 (0.68-0.83) and 0.85 (0.76-0.95), respectively. Compared with adults in coastal and urban adults, those in sub-coastal, inland and rural adults had higher levels of urinary iodine, with OR (95% CI) of 1.89 (1.63-2.19), 2.02 (1.72-2.37) and 1.46 (1.28-1.66), respectively. Conclusion:The overall iodine nutrition level of adults aged 18 years and above in Zhejiang Province in 2022 is generally appropriate. However, there is a potential risk of iodine deficiency among adults in coastal areas.

Objective:To evaluate the efficacy of combined cricopharyngeal myotomy (CPM) and autologous fat injection laryngoplasty (AFIL) in the management of dysphagia secondary to glossopharyngeal and vagal nerve injury.Methods:This retrospective cohort study collected the clinical data of 18 patients with persistent dysphagia due to glossopharyngeal and vagus nerve injuries, who underwent concurrent cricopharyngeal myotomy (CPM) and autologous fat injection laryngoplasty (AFIL) at the Department of Otolaryngology, Peking Union Medical College Hospital, from January 2017 to December 2024. Pre-and postoperative assessments included electronic flexible laryngoscope, the Chinese version of Swallow Quality-of-Life Questionnaire (CSWAL-QOL), videofluoroscopic swallowing study (VFSS), body weight changes, and nasogastric tube (NGT) removal status with routine follow-up. The comparison of swallowing function before and after surgery was conducted using paired samples t-test and χ2 test. Results:The study cohort comprised 10 male and 8 female patients, with ages ranging from 33 to 70 years (mean±SD: 53.8±10.5). All surgical procedures were completed successfully without complications. During the 6-to 24-month follow-up period, 10 of the 13 patients who were initially nasogastric tube-dependent achieved successful decannulation. Compared with preoperative values, postoperative measurements demonstrated statistically significant improvements across all parameters: mean body weight increased from (56.95±9.14) kg to (59.22±8.72) kg ( t=3.689 , P<0.01), CSWAL-QOL scores improved from 91.89±17.81 to 130.83±25.42 ( t=6.921 , P<0.01), while, both VFSS scales showed marked reductions (VFSS-SWAL: 6.78±1.40 to 3.39±1.61, t=-8.001, P<0.01; PAS: 6.56±1.15 to 2.94±1.26, t=-10.114, P<0.01). Conclusions:Combined CPM and AFIL represents an effective surgical approach for dysphagia following glossopharyngeal and vagal nerve injury, thereby demonstrating significant improvements in both swallowing function and quality of life.

Objective:To analyze the characteristics of CD4 + T cell subsets and cytokines in patients with mixed connective tissue disease (MCTD) and the correlation of MCTD disease activity, laboratory data, and clinical symptoms with cytokines. Methods:A total of 48 MCTD patients (including 24 newly diagnosed patients and 24 treated patients) were enrolled from the Department of Rheumatology and Immunology, the Second Hospital of Shanxi Medical University from 2018 to 2021. Meanwhile, 49 healthy subjects who underwent physical examination were recruited (healthy control group). The absolute counts of CD4 + T cell subsets in peripheral blood samples were analyzed by flow cytometry. The levels of serum cytokines were detected by flow bead array. Analysis of variance and Mann-Whitney U test were used to compare the differences between groups. Pearson or Spearman correlation analysis was used for correlation analysis. Logistic regression analysis was used to analyze related factors. The receiver operating characteristic curve was used to detect the best cut-off value and effectiveness. Results:The absolute counts of Th1 ( P<0.01), Th2 ( P<0.01) and Treg cells ( P<0.01) in the newly diagnosed MCTD patients and the treated MCTD patients were lower than those in the healthy subjects. The levels of cytokines (IL-2, IL-4, IL-6, IL-10, IL-17, IFN-γ, and TNF-α) in the two MCTD groups were higher than those in the healthy control group ( P<0.01). Further analysis revealed that the cardiac enzymes in MCTD patients included creatine kinase, creatine kinase-MB, aspartate aminotransferase, α-hydroxybutyrate dehydrogenase, and lactate dehydrogenase were positively correlated with cytokines ( P<0.05). In addition, it was found that IL-2 was positively correlated with erythrocyte sedimentation rate ( r=0.477, P<0.001), but it was negatively correlated with complement C3 ( r=-0.546, P=0.002) and complement C4 ( r=-0.422, P=0.02). IL-10 was correlated with the myositis symptoms in MCTD patients and the area under the receiver operator characteristic curve was 0.745 (95% CI: 0.576-0.915, P<0.05). Conclusions:This study provides insights into the unique immunological characteristics of CD4 + T lymphocyte subsets and cytokines in patients with MCTD, and also reveals a close correlation between cytokines and cardiac enzymes in MCTD patients. IL-2 has been shown to be associated with disease activity in MCTD patients. The level of IL-10 may be related to the occurrence of myositis symptoms in MCTD.

Objective To explore the change trajectory of self-acceptance of patients with permanent urostomy,in order to provide basis for self-acceptance intervention practice of patients.Methods 168 patients with abdominal wall stoma with urinary diversion from June 2021 to June 2023 in Fudan University Cancer Hospital were selected as the survey subjects by convenience sampling.We used a general information questionnaire,SAQ,PTGI,SSRS,and COST-PROM.Baseline surveys were conducted a week after surgery(T0),and follow-up surveys were conducted at 1 month(T1),3 months(T2),and 6 months(T3)after discharge.The mixed model of latent variable growth was used to analyze the change trajectory of self-acceptance of patients with permanent urinary stoma,and the core predictors of each subtype were explored through the decision tree model.Results The number of patients who participated in the 4 surveys was 168,168,165 and 163,respectively,and the final questionnaire recovery rate was 97.02％(163/168).The self-acceptance scores of patients with permanent urostomy were(35.72±8.63)(36.81±9.23)(39.88±8.95)and(43.17±9.56)points,respectively.The 3 subgroups of self-acceptance changes were identified,including low self-acceptance slow rising group(49.08％),medium self-acceptance first falling then rising group(30.06％),and medium self-acceptance fast rising group(20.86％)(P＜0.001).The decision tree model showed that education level,age,post-traumatic growth,social support,and economic burden could all predict the change track subtype of self-acceptance of patients with permanent urostomy,and the importance of post-traumatic growth was 100％.Conclusion The self-acceptance of patients with permanent urostomy is generally on the rise,and there is a population heterogeneity development track.Posttraumatic growth is the core predictor.It is important to identify the slow increase group of low self-acceptance according to the predictive indicators,and construct an intervention program focusing on improving the post-traumatic growth of patients with permanent urinary stoma to improve their self-acceptance level.

Objective To investigate the mechanism of long non-coding RNA(LncRNA)FUT8-AS1 on diabetic ischemia-reperfusion injury by regulating growth differentiation factor 15(GDF15).Methods Male SD rats were randomly divided into Sham group,cerebral ischemia-reperfusion injury(MCAO/R)group,diabetic cerebral ischemia-reperfusion injury(DM-MCAO/R)group,DM-MCAO/R+sh NC group,and DM-MCAO/R+sh FUT8-AS1 group.TTC staining was used to assess the size of cerebral infarction.Tunel staining was selected to evaluate the apoptosis of neurons in brain tissue.Nissl staining was used to assess the number of neurons in brain tissue.The expression of LncRNA FUT8-AS1,GDF15 mRNA in Willis arterial loop and internal carotid artery tissues were detected by qRT-PCR.The expression of α-SMA,eNOS,p-eNOS,GDF15 protein in Willis arterial loop and internal carotid artery was detected by Western blot.The rat brain microvascular endothelial cells were divided into control(Con)group,OGD/R group,HG-OGD/R group,HG-OGD/R+sh NC group,HG-OGD/R+sh FUT8-AS1 group,HG-OGD/R+sh FUT8-AS1+oe NC group,and HG-OGD/R+sh FUT8-AS1+oe GDF15 group.MTT assay was used to detect cell viability.Lactate dehydrogenase(LDH)assay was used to detect cell damage.The expression ofα-smooth muscle actin(α-SMA),endothelial nitric oxide synthase(eNOS),p-eNOS protein was detected by Western blot.Results Compared with the Sham group,the percentage of cerebral infarction,the number of Tunel-positive cells,the FUT8-AS1 and mRNA expression of GDF15 and the expression of GDF-15 protein increased(P<0.05),and the expression of α-SMA,eNOS,p-eNOS proteins decreased in the MCAO/R group(P<0.05),and the number of neurons in the hippocampus decreased,the morphology was shrunk,and the color was dark in the MCAO/R group.Compared with the MCAO/R group,the percentage of cerebral infarction,the number of Tunel-positive cells,the FUT8-AS1 and mRNA expression of GDF15 and the expression of GDF-15 protein increased(P<0.05),and the expression of α-SMA,eNOS,p-eNOS proteins decreased in the DM-MCAO/R group(P<0.05),and the number of neurons in the hippocampus decreased in the DM-MCAO/R group.Compared with the DM-MCAO/R+sh NC group,the percentage of cerebral infarction,the number of Tunel-positive cells,the FUT8-AS1 and mRNA expression of GDF15 and the expression of GDF-15 protein decreased(P<0.05),and the expression of α-SMA,eNOS,p-eNOS proteins increased in the DM-MCAO/R+sh FUT8-AS1 group(P<0.05),and the number of neurons in the hippocampus increased in the DM-MCAO/R+sh FUT8-AS1 group.Compared with the Con group,the LDH release,FUT8-AS1 expression,GDF15 mRNA and protein expression increased(P<0.05),and the cell activity,α-SMA,eNOS,and p-eNOS protein expressions decreased in the OGD/R group(P<0.05).Compared with the OGD/R group,the LDH release,FUT8-AS1 expression,GDF15 mRNA and protein expression increased(P<0.05),and the cell activity,α-SMA,eNOS,and p-eNOS protein expressions decreased in the HG-OGD/R group(P<0.05).Compared with the HG-OGD/R+sh NC group,the LDH release,FUT8-AS1 expression,GDF15 mRNA and protein expression decreased(P<0.05),and the cell activity,α-SMA,eNOS,and p-eNOS protein expressions increased in the HG-OGD/R+sh FUT8-AS1 group(P<0.05).Compared with the HG-OGD/R+sh NC group,the LDH release,GDF15 mRNA and protein expression increased(P<0.05),and the cell activity decreased in the HG-OGD/R+oe GDF15 group(P<0.05).Compared with the HG-OGD/R+sh FUT8-AS1+oe NC group,the expression of α-SMA,eNOS,p-eNOS proteins decreased in the HG-OGD/R+sh FUT8-AS1+oe GDF15 group(P<0.05).Conclusions LncRNA FUT8-AS1 may exacerbate diabetic cerebral ischemia-reperfusion injury by regulating GDF15.

Objective:To investigate the iodine nutrition status of pregnant women in Zhejiang Province, explore the impact of salt industry system reform on iodine nutrition level of pregnant women, and provide scientific basis for prevention and treatment of iodine deficiency disorders.Methods:From 2016 to 2021, a multi-stage stratified sampling method was used to select 100 pregnant women from 90 counties (cities, districts) in Zhejiang Province each year as survey subjects. Salt samples were collected from pregnant women's families, and one random urine sample was taken for salt iodine and urinary iodine level testing, respectively.Results:A total of 56 581 samples of household edible salt were collected from pregnant women, with a median salt iodine level of 23.20 mg/kg. Among them, 7 961 were non iodized salt, 45 803 were qualified iodized salt, and 2 817 were unqualified iodized salt. The iodized salt coverage rate was 85.93% (48 620/56 581), and the qualified iodized salt consumption rate was 80.95% (45 803/56 581). The proportion of non iodized salt increased from 10.05% (897/8 928) in 2016 to 15.09% (1 461/9 679) in 2021 (χ 2trend = 95.16, P < 0.001). A total of 56 581 urine samples were collected from pregnant women, with a median urinary iodine level of 130.50 μg/L. Among them, the proportions of urinary iodine levels < 150, 150 - 249, 250 - 499, and ≥500 μg/L were 58.32% (32 996/56 581), 27.24% (15 410/56 581), 12.24% (6 926/56 581), and 2.21% (1 249/56 581), respectively. The median urinary iodine level of pregnant women in inland areas was significantly higher than that in coastal areas ( Z = 19.15, P < 0.001). Furthermore, urinary iodine levels exhibited a non-linear decline as age increased (χ 2regression = 12.65, P < 0.001; χ 2partial = 22.65, P < 0.001) and as pregnancy progressed (χ 2regression = 37.28, P < 0.001; χ 2partial = 18.89, P < 0.001). Conclusions:The overall iodine nutrition status of pregnant women in Zhejiang Province is in a state of iodine deficiency (< 150 μg/L), and there is a greater risk in coastal areas compared to inland areas. However, in the context of the reform of the salt industry system, it is still necessary to strengthen the quality supervision of iodized salt, provide scientific iodine supplementation education, promote specialized iodized salt for pregnant women, and strengthen interventions for prevention and control of iodine deficiency disorders.