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 understand the contents of edible salt iodine and urinary iodine of children and pregnant women in Yunnan Province, and to evaluate the iodine nutrition status, so as to provide a basis for scientific prevention and treatment of iodine deficiency disorders (IDD).Methods:From November to December 2020, one county (city) was selected from each prefecture (city), two townships (towns and streets) were selected from each county (city) and two villages (neighborhood committees) were selected from each township (town and street) from each of the 16 prefectures (cities) in Yunnan Province as the investigation sites. A total of 20 non-boarding children (male and female balanced) aged 8 - 10 years old were selected from each primary school in each village (neighborhood committee) to collect salt and urine samples. A total of 80 children were investigated in each county (city). A total of 20 pregnant women were selected from each township (town and street) to collect salt and urine samples. A total of 40 pregnant women were investigated in each county (city). All salt samples and urine samples were tested for iodine contents.Results:A total of 2 009 salt samples and 2 041 urine samples (1 375 for children, 666 for pregnant women) were collected from children aged 8 - 10 years old and pregnant women in 16 counties (cities) of Yunnan Province. Among them, the median salt iodine was 26.0 mg/kg, the coverage rate of iodized salt was 100.0% (2 009/2 009), the qualified rate of iodized salt was 98.7% (1 982/2 009), and the consumption rate of qualified iodized salt was 98.7% (1 982/2 009). The difference of salt iodine content in key populations in different counties (cities) was statistically significant ( H = 258.98, P < 0.01). The median urinary iodine of children aged 8 - 10 years old was 188.5 μg/L. There was statistically significant difference in urinary iodine content among children of different ages ( H = 29.45, P < 0.01), but there was no statistically significant difference in urinary iodine content among children of different genders ( H = 1.43, P > 0.05). In addition, the median urinary iodine of pregnant women was 141.9 μg/L, 52.1% (347/666) was < 150 μg/L. There was statistically significant difference in urinary iodine content of pregnant women in different counties (cities, H = 88.32, P < 0.01). Conclusions:The qualified rate of iodized salt, the coverage rate of iodized salt and the consumption rate of qualified iodized salt in key populations of Yunnan Province are more than 90%, and the iodized salt supply is good. Iodine nutrition of children aged 8 - 10 years old is at an appropriate level (100 - 199 μg/L); iodine nutrition of pregnant women is in an state of iodine deficiency ( < 150 μg/L). It is suggested to strengthen IDD monitoring and health education among key populations, improve residents' awareness of disease prevention, and make scientific iodine supplementation.

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.

Themedical's () infantgenre in western Hunan Province is one of the most famous infantgenres in China. Based on physiological and pathological characteristics of infants, generation-inhibition theory of five-elements andmedical's promotion-inhibition theory of five-meridians, theprotocol of "" was flexibly adjusted; according to different constitution types, including lung-deficiency type, spleen-deficiency type, kidney-deficiency type,-deficiency type,-deficiency type,-deficiency type, phlegm-wet type, phlegm-heat type, different protocols were adopted to prevent or reduce the asthma recurrence and reach the aim of regulating constitution and disease prevention.

Objective· To investigate the clinical features of macrophage activation syndrome (MAS) associated with adult-onset Still's disease (AOSD),and provide the basis for clinical diagnosis and treatment of the disease.Methods· The clinical data of 42 patients with AOSD,including 14 patients with AOSD-induced MAS (the MAS group) and 28 AOSD patients paired by age and sex (the non-MAS group),diagnosed in Department of Rheumatology,Renji Hospital,Shanghai Jiao Tong University School of Medicine from October 2013 to June 2016 were collected and then retrospectively analyzed.Results· There was no significant difference in age,sex and duration of AOSD between two groups.The mortality rate of patients in MAS group was significantly higher than that of patients in non-MAS group,as well as the rates of rash,splenomegaly and hemophagocytosis.The levels of ALT and serum ferritin in MAS group were higher than those in non-MAS group,while the level of FDP is lower.Glucocorticoids were used in all 42 patients,and the dosage of glucocorticoids was significantly higher in MAS group than non-MAS group.Only 1 patient with AOSD-induced MAS received MTX,the percentage of patients receiving MTX was significantly lower in MAS group than non-MAS group.Five patients with AOSD-induced MAS received IVIG,the percentage of patients receiving IVIG was significantly higher in MAS group than non-MAS group.Two patients with AOSD-induced MAS received VP-16.Conclusion · The mortality rate of patients in MAS group was significantly higher than that of patients in non-MAS group,as well as the rates of rash,splenomegaly and hemophagocytosis.The levels of ALT and serum ferritin in patients with AOSD-induced MAS were higher than patients without MAS,while the level of FDP was lower.Early diagnosis and active treatment is the key point to improve clinical outcome.

Objective To investigate the efficacy of adductor canal block (ACB) under the guidance of ultrasound for postoperative analgesia in the pediatric patients undergoing knee operation.Methods Sixty pediatric patients,aged 3-12 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,weighing 12-35 kg,scheduled for elective unilateral knee operation,were selected and randomly divided into 2 equal groups using a random number table:ultrasound-guided ACB group (group ACB) and ultrasound-guided femoral nerve block (FNB) group (group FNB).After induction of general anesthesia,ACB or FNB was performed under the guidance of ultrasound,and 0.3％ ropivacaine 1 ml/kg was injected.Anesthesia was maintained with intravenous infusion of remifentanil combined with propofol,and bispectral index value was maintained at 40-60.Immediately after injection of local anesthetics (T0),and at 4,8,12 and 24 h after injection (T1-4),analgesic efficacy was assessed using the FLACC pain scale,and quadriceps strength was assessed by manual muscle testing.Satisfactory analgesia was defined as FLACC score ≤ 3,and obvious quadriceps weakness was defined as manual muscle testing grade 0-2.The complications associated with nerve block (such as local anesthetic toxicity,bleeding at the puncture site,hematoma),and occurrence of postoperative nausea and vomiting and delayed emergence were recorded.Results There was no significant difference between two groups in the rate of satisfactory analgesia at T1-T4 (P＞ 0.05).Compared with group FNB,the incidence of obvious quadriceps weakness was significantly lower at T1-T3 (P＜0.05),and no significant change was found at T4 in group ACB (P＞0.05).There was no significant difference in the incidence of nausea or retching between two groups (P＞0.05).Complications associated with nerve block,vomiting and delayed emergence were not observed in the two groups.Conclusion Ultrasound-guided ACB can be safely and effectively used for postoperative analgesia in the pediatric patients undergoing knee operation,and it has less influence on the quadriceps strength than FNB.

Objective To evaluate the value of ultrasound-measured quantification of anterior neck soft tissue in predicting the difficult laryngoscopy in the obese patients.Methods Ninety-six patients,with body mass index ≥ 28 kg/m2,aged 22-60 yr,of ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia with endotracheal intubation,were selected.Assessment methods of modified Mallampati grade (method M) and anterior neck soft tissue quantification measured by ultrasound (method U) were performed before anesthesia.The level of vocal cords was selected using ultrasound scanning for anterior neck.The positive result was greater than 20 mm in method U,and was grade Ⅲ or Ⅳ in method M.Direct laryngoscope was placed after induction of anesthesia.Difficult laryngoscopy was defined as Cormack-Lehane grade Ⅲ or Ⅳ,or in whom laryngoscope could not be placed.The sensitivity,specificity and accuracy of the two assessment methods for predicting the difficult laryngoscopy were calculated.Results Twenty-two patients were found to have difficult laryngoscopy,and the anterior neck soft tissue quantification was (23.0±3.0) mm,which was significantly thicker than that in the patients of non-difficult laryngoscopy ((1.9±2.2) mm).The sensitivity,specificity and accuracy of method U were 91％,92％ and 92％,respectively,and of method M were 77％,81％ and 80％,respectively,and there was significant difference between the two methods.There was no significant difference in the parameters of difficult laryngoscopy which were predicted using method U between the patients of different ages or gender.Conclusion It can accurately predict the difficult laryngoscopy in the obese patients when the ultrasound-measured quantification of anterior neck soft tissue is greater than 20 mm.

Objective To evaluate the reliability and validity of Chinese multi-dimensional health assessment questionnaire (MDHAQ-C) in patients with systemic lupus erythematosus (SLE) in China.Methods One hundred and twelve SLE patients were recruited in the evaluation.The reliability of the questionnaire was tested by intra-class coefficient (ICC) and Cronbach's alpha.Convergent validity and divergent validity were assessed by Spearman correlation coefficient of MDHAQ-C with health assessment questionnaire (HAQ),the 36-item short-form health survey (SF-36) and the hospital anxiety and depression scales(HAD).Discriminant validity was tested in groups of patients with varied disease activities and status of damage.Results The Cronbach's alpha was 0.886 in the function scale (FN) and 0.774 in the scale of psychological status (PS).The corrected item-total correlation ranged from 0.409-0.866.The ICC was 0.615-0.920(P＜0.05).MDHAQ-C correlated with the questionnaires satisfyingly in most scales (from P＜0.5 to P＜0.001).The scores of MDHAQ-C could discriminate different groups of patients (P＜0.05).Conclusion MDHAQ-C is a reliable,valid instrument for functional measurement and quality of life assessment in Chinese SLE patients.

Objective To evaluate the reliability of ultrasound for rapid identification of esophageal intubation in the patients with difficult airway.Methods Twenty-one patients requiring orotracheal intubation, aged 20-75 yr, with body mass index of 25-32 kg/m2, of ASA physical status Ⅰ or Ⅱ , Cormack-Lehane grade Ⅲ or Ⅳ under direct laryngoscope, undergoing elective general anesthesia, were selected.The carotid artery, trachea and esophagus were identified by ultrasonic scanning at suprasternal notch before induction of anesthesia.After induction of anesthesia, tracheal intubation was performed.During intubation, ultrasound was performed to detect esophageal intubation.After intubation, mechanical ventilation was performed.Auscultation of bilateral breath sounds was carried out to evaluate the tube position.The position of the tube was subsequendy determined through partial pressure of end-tidal CO2 monitoring.Results The sensitivity and specificity of ultrasound in identifying esophageal intubation were both 100％ in the patients with difficult airway.Conclusion Ultrasound can rapidly and effectively identify esophageal intubation in the patients with difficult airway.

Objective To establish ultra-high performance liquid chromatography-evaporative light scattering detector (UPLC-ELSD) method to determine the content of astragaloside in Guiqi Yiqi Yangxue Mixture and optimize the best water decoction process of the mixture.Methods The UPLC-ELSD conditions to determine the content of astragaloside in the mixture were as follow.The method was carried out on a Waters Acquity UPLC BEH C18 column (2.1 mm ×50 mm,1.7 μm) by using acetonitrile-water (35∶65) as mobile phase, and the flow rate was 0.3 mL/min and the column temperature 30℃.The parameter of ELSD:the drift tube temperature was set at 60℃, and the gas flow rate of N2 2.0 L/min.The content of paeoniflorin in the mixture was detected by previously established HPLC method.The orthogonal test was designed to optimize the water decoction process of the amount of water (A), decoction time (B) and decoction times (C), and the extract yield and the contents of astragaloside and paeoniflorin were evaluated as the comprehensive markers for the purpose.Results The UPLC-ELSD determination of astragaloside had a good linear relationship (r =0.9999), its mean recovery was 103.0%, and it had a good precision, specificity and repeatability.The orthogonal experimental results showed that decoction times (C) >the amount of water (A) >decoction time (B) were major factors affecting the decoction process in order and the ANOVA result showed that decoction times has significant effect on the decoction process (P<0.05).The optimal process of Guiqi Yiqi Yangxue Mixture was adding eight-fold water each time to decoct twice for 1.5 h totally.Conclusion This optimized water decoction process is feasible and stable, and suitable for industrialized production.