Objective:To analyze the iodine nutritional status of children aged 8 - 10 in Tongren City, Guizhou Province, and provide a basis for scientific iodine supplementation for children.Methods:From 2020 to 2022, a systematic sampling method was adopted in 10 districts and counties of Tongren City. Each year, each district and county was divided into 5 districts based on east, west, south, north, and center. One township (street) was selected from each district, and 40 non boarding students aged 8 to 10 were selected from each township (street) to measure the iodine content of household salt and urine samples. The content of salt iodine in children of different yesas as well as the distribution of urine iodine in children of different districts and counties and different genders were analyzed and compared. Additionally, B-ultrasound was used to measure the thyroid volume of some children and the situation of thyroid enlargement was analyzed.Results:From 2020 to 2022, a total of 6 000 salt samples were collected and monitored from children's households, and 5 989 samples of iodized salt were detected, the coverage rate of iodized salt was 99.8%; and 5 750 samples of qualified iodized salt were found, the qualified rate of iodized salt was 96.0%, the consumption rate of qualified iodized salt was 95.8%; and the median salt iodine was 27.3 mg/kg, the difference in the median salt iodine among children between different years was statistically significant ( H = 10.04, P < 0.001). A total of 6 000 urine samples from children were tested, the median urinary iodine was 225.2 μg/L, the median urinary iodine among children in different districts and counties were statistically significantly different ( H = 85.73, P < 0.001); 3 077 male and 2 923 female urine samples were tested, and the median urinary iodine between different genders was statistically significant different ( Z = - 67.10, P < 0.001). The median urinary iodine of male samples were higher than those of female samples(227.8 vs 222.9 μg/L). The thyroid gland of 2 000 children was examined, and the rate of goiter was 1.0% (21/2 000). Conclusions:From 2020 to 2022, the consumption rate of qualified iodized salt, urinary iodine content and goiter rate of children in Tongren City have all met the national standard for eliminating iodine deficiency disorders. The overall iodine nutrition level exceeds the appropriate amount (urinary iodine of 200 - 299 μg/L).

Objective:To investigate the iodine nutrition status of pregnant women in Tongren City, and to provide a basis for scientific iodine supplementation of key population.Methods:From 2020 to 2022, a cross-sectional survey was conducted, and one township (street) was selected from each of the five districts of east, west, south, north, and central in 10 counties (districts) of Tongren City each year. Twenty pregnant women were selected from each township (street) for the determination of iodine level in household salt samples and one random urine sample. The levels of salt iodine and urinary iodine in pregnant women from different years and regions, as well as the distribution of urinary iodine during different pregnancy periods, were compared and analyzed.Results:A total of 3 000 household edible salt samples were collected from pregnant women, with a median salt iodine level of 27.3 mg/kg. The coverage rate of iodized salt was 99.7% (2 991/3 000), the qualified rate of iodized salt was 96.1% (2 875/2 991), and the consumption rate of qualified iodized salt was 95.8% (2 875/3 000). There was a statistically significant difference in the iodine level of household salt consumed by pregnant women in different years ( H = 6.85, P < 0.001). A total of 3 000 urine samples from pregnant women were tested, and the median urinary iodine was 177.4 μg/L. By years, the median urinary iodine levels in different years were 197.8, 169.2, and 168.3 μg/L, with statistically significant differences ( H = 35.46, P < 0.001). By region, there were statistically significant differences in the median urinary iodine levels of pregnant women in different counties (districts, H = 104.00, P < 0.001); among them, Yuping County had the lowest median urinary iodine level, at 149.8 μg/L. By pregnancy periods, there were no statistically significant difference in the median urinary iodine levels of pregnant women in different pregnancy periods ( H = 177.44, P = 0.290). Conclusions:The overall iodine nutrition level of pregnant women in Tongren City is appropriate, and the iodine nutrition of pregnant women in individual areas is insufficient. We should continue to strengthen the monitoring of iodine nutrition level, pay attention to the iodine nutrition status of pregnant women in key areas, and guide pregnant women to supplement iodine scientifically.

Objective:To study the distribution of species type, biotype and genotype of human Brucella isolated and identified in Nanjing. Methods:A total of 89 strains of human Brucella were collected from microbiology laboratories of three sentinel hospitals in Nanjing from 2017 to 2022. The species type was identified using biological methods and Brucella nucleic acid detection (BCSP31-PCR and AMOS-PCR). Further biotyping of Brucella melitensis isolates was conducted by serological results of A and M factors. Meanwhile, genotype analysis was performed using multiple-locus variable number tandem repeat analysis (MLVA), multilocus sequence typing (MLST) and single nucleotide polymorphism (SNP). Results:From 2017 to 2022, 89 strains of Brucella isolated and identified in Nanjing were all Brucella melitensis. Among them, Brucella melitensis biotype 3 accounted for 82.02% (73/89), and biotype 1 accounted for 17.98% (16/89). MLVA typing showed that 89 strains of Brucella melitensis belong to the "Eastern Mediterranean" cluster and could be divided into 50 MLVA genotypes; among which panel 1 had 3 genotypes, namely Type 42 (84.27%, 75/89), Type 63 (8.99%, 8/89) and Type 43 (6.74%, 6/89). The results of MLST-9 and MLST-21 were both ST8, and the core genome multilocus sequence typing (cgMLST) classified 89 strains into 11 genotypes. SNP analysis revealed a total of 4 013 SNP loci, with SNPs ranging from 0 to 409 across different strains, involving 59 SNP genotypes. Conclusions:The human Brucella strains isolated and identified in Nanjing are all Brucella melitensis, mainly biotype 3. The MLVA cluster is the "Eastern Mediterranean" cluster. The traditional MLST-9 and MLST-21 typing results are all ST8 type, while cgMLST divides all the strains into 11 genotypes with higher resolution.

Objective To comparatively observe the value of TIPS combined with catheter-directed thrombolysis and percutaneous transhepatic portal vein catheterization thrombolysis for acute non-cirrhotic non-neoplastic portal vein thrombosis(PVT).Methods Twenty-five patients with acute non-cirrhotic non-neoplastic PVT were retrospectively enrolled and clustered into TIPS group(n=17,underwent TIPS combined with catheter-directed thrombolysis)and liver puncture group(n=8,underwent percutaneous transhepatic portal vein catheterization thrombolysis)according to the access of thrombolysis.The technical success rate,duration of catheter-directed thrombolysis,complications within 7 days,as well as portal vein patency 3 months after treatment,Child-Pugh grading of liver function and occurrence of hepatic encephalopathy(HE)were recorded and compared between groups.Results The technical success rates were both 100%in 2 groups.There was no significant difference of the duration of catheter-directed thrombolysis between groups(P＞0.05).The thrombolytic effect in TIPS group was better than that in liver puncture group(P＜0.05).No significant difference of the occurrence of bleeding within 7 days was found between groups(P＞0.05).After 3 months'follow-up,the degree of portal vein patency in TIPS group was higher than that in liver puncture group(P＜0.05).No significant difference of Child-Pugh grading of liver function nor occurrence of HE was found between groups(both P＞0.05).Conclusion Both TIPS combined with catheter-directed thrombolysis and percutaneous transhepatic portal vein catheterization thrombolysis were effective for treating acute non-cirrhotic non-neoplastic PVT,and the thrombolytic effect of the former was better than the latter.

Objective:To summarize and share the experience of one-stage feminization surgery in children with congenital adrenal hyperplasia (CAH).Methods:The clinical data of CAH female children in the Department of Pediatric Urology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from January 2018 to December 2020 were retrospectively analyzed. According to the Prader classification standard, the external genital virilism of children was graded. The cases of Prader grades Ⅱ to Ⅳ were underwent clitoroplasty and labiaplasty, while the cases of Prader Ⅱ and Ⅳ grades were required further vaginoplasty.Partial urogenital sinus mobilization(PUM) or total urogenital sinus mobilization(TUM )was performed according to the length of the urethrovaginal junction to the vulvar opening during the procedure. The postoperative follow-up was included the recovery of the external genitalia wound, the child’s ability to control urination, and the family members’ satisfaction with the child’s external genitalia appearance. Six months after the operation, the satisfaction with the appearance of the external genitalia was evaluated in the outpatient clinic, including four aspects: clitoris, labia majora, labia minora, and vaginal appearance.Results:A total of 18 female children were enrolled, ranging in age from 2 to 9 years old, with an average age of 4.5 years. There were 5 cases of Prader grade Ⅱ, 9 cases of grade Ⅲ, and 4 cases of grade Ⅳ. Ten cases (9 cases of Prader grade Ⅲ and 1 case of grade Ⅳ) underwent PUM, and 3 cases of Prader grade Ⅳ underwent TUM. All patients were followed up for 6-12 months after the operation, and all the wounds of the external genitalia of the children were healed in one stage. The satisfaction of family members to the appearance of external genitalia of children: 15 cases were satisfied, 3 cases were not satisfied; 3 patients were found to have overactive bladder two weeks after the operation, and no special treatment was given, the symptoms disappeared three months after the procedure, and the other children had no abnormal urination control ability. Six months after the process, the external genitalia was evaluated in the physician’s clinic: 17 cases were satisfied, and one was dissatisfied.Conclusions:The surgical method can be selected for better results according to the degree of external genitalia virilism and the common channel length in CAH female children.

Objective:To summarize and share the experience of one-stage feminization surgery in children with congenital adrenal hyperplasia (CAH).Methods:The clinical data of CAH female children in the Department of Pediatric Urology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from January 2018 to December 2020 were retrospectively analyzed. According to the Prader classification standard, the external genital virilism of children was graded. The cases of Prader grades Ⅱ to Ⅳ were underwent clitoroplasty and labiaplasty, while the cases of Prader Ⅱ and Ⅳ grades were required further vaginoplasty.Partial urogenital sinus mobilization(PUM) or total urogenital sinus mobilization(TUM )was performed according to the length of the urethrovaginal junction to the vulvar opening during the procedure. The postoperative follow-up was included the recovery of the external genitalia wound, the child’s ability to control urination, and the family members’ satisfaction with the child’s external genitalia appearance. Six months after the operation, the satisfaction with the appearance of the external genitalia was evaluated in the outpatient clinic, including four aspects: clitoris, labia majora, labia minora, and vaginal appearance.Results:A total of 18 female children were enrolled, ranging in age from 2 to 9 years old, with an average age of 4.5 years. There were 5 cases of Prader grade Ⅱ, 9 cases of grade Ⅲ, and 4 cases of grade Ⅳ. Ten cases (9 cases of Prader grade Ⅲ and 1 case of grade Ⅳ) underwent PUM, and 3 cases of Prader grade Ⅳ underwent TUM. All patients were followed up for 6-12 months after the operation, and all the wounds of the external genitalia of the children were healed in one stage. The satisfaction of family members to the appearance of external genitalia of children: 15 cases were satisfied, 3 cases were not satisfied; 3 patients were found to have overactive bladder two weeks after the operation, and no special treatment was given, the symptoms disappeared three months after the procedure, and the other children had no abnormal urination control ability. Six months after the process, the external genitalia was evaluated in the physician’s clinic: 17 cases were satisfied, and one was dissatisfied.Conclusions:The surgical method can be selected for better results according to the degree of external genitalia virilism and the common channel length in CAH female children.

Objective:To summarize and share the experience of one-stage feminization surgery in children with congenital adrenal hyperplasia (CAH).Methods:The clinical data of CAH female children in the Department of Pediatric Urology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from January 2018 to December 2020 were retrospectively analyzed. According to the Prader classification standard, the external genital virilism of children was graded. The cases of Prader grades Ⅱ to Ⅳ were underwent clitoroplasty and labiaplasty, while the cases of Prader Ⅱ and Ⅳ grades were required further vaginoplasty.Partial urogenital sinus mobilization(PUM) or total urogenital sinus mobilization(TUM )was performed according to the length of the urethrovaginal junction to the vulvar opening during the procedure. The postoperative follow-up was included the recovery of the external genitalia wound, the child’s ability to control urination, and the family members’ satisfaction with the child’s external genitalia appearance. Six months after the operation, the satisfaction with the appearance of the external genitalia was evaluated in the outpatient clinic, including four aspects: clitoris, labia majora, labia minora, and vaginal appearance.Results:A total of 18 female children were enrolled, ranging in age from 2 to 9 years old, with an average age of 4.5 years. There were 5 cases of Prader grade Ⅱ, 9 cases of grade Ⅲ, and 4 cases of grade Ⅳ. Ten cases (9 cases of Prader grade Ⅲ and 1 case of grade Ⅳ) underwent PUM, and 3 cases of Prader grade Ⅳ underwent TUM. All patients were followed up for 6-12 months after the operation, and all the wounds of the external genitalia of the children were healed in one stage. The satisfaction of family members to the appearance of external genitalia of children: 15 cases were satisfied, 3 cases were not satisfied; 3 patients were found to have overactive bladder two weeks after the operation, and no special treatment was given, the symptoms disappeared three months after the procedure, and the other children had no abnormal urination control ability. Six months after the process, the external genitalia was evaluated in the physician’s clinic: 17 cases were satisfied, and one was dissatisfied.Conclusions:The surgical method can be selected for better results according to the degree of external genitalia virilism and the common channel length in CAH female children.

Objective:To summarize and share the experience of one-stage feminization surgery in children with congenital adrenal hyperplasia (CAH).Methods:The clinical data of CAH female children in the Department of Pediatric Urology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from January 2018 to December 2020 were retrospectively analyzed. According to the Prader classification standard, the external genital virilism of children was graded. The cases of Prader grades Ⅱ to Ⅳ were underwent clitoroplasty and labiaplasty, while the cases of Prader Ⅱ and Ⅳ grades were required further vaginoplasty.Partial urogenital sinus mobilization(PUM) or total urogenital sinus mobilization(TUM )was performed according to the length of the urethrovaginal junction to the vulvar opening during the procedure. The postoperative follow-up was included the recovery of the external genitalia wound, the child’s ability to control urination, and the family members’ satisfaction with the child’s external genitalia appearance. Six months after the operation, the satisfaction with the appearance of the external genitalia was evaluated in the outpatient clinic, including four aspects: clitoris, labia majora, labia minora, and vaginal appearance.Results:A total of 18 female children were enrolled, ranging in age from 2 to 9 years old, with an average age of 4.5 years. There were 5 cases of Prader grade Ⅱ, 9 cases of grade Ⅲ, and 4 cases of grade Ⅳ. Ten cases (9 cases of Prader grade Ⅲ and 1 case of grade Ⅳ) underwent PUM, and 3 cases of Prader grade Ⅳ underwent TUM. All patients were followed up for 6-12 months after the operation, and all the wounds of the external genitalia of the children were healed in one stage. The satisfaction of family members to the appearance of external genitalia of children: 15 cases were satisfied, 3 cases were not satisfied; 3 patients were found to have overactive bladder two weeks after the operation, and no special treatment was given, the symptoms disappeared three months after the procedure, and the other children had no abnormal urination control ability. Six months after the process, the external genitalia was evaluated in the physician’s clinic: 17 cases were satisfied, and one was dissatisfied.Conclusions:The surgical method can be selected for better results according to the degree of external genitalia virilism and the common channel length in CAH female children.

Objective    To evaluate the early and mid-term safety of transcatheter aortic valve replacement via transfemoral (TF), transapical (TAp) and transsubclavian (TSc) approaches by meta-analysis. Methods    We systematically searched the clinical comparative trials published from inception to June 2019 from PubMed, Web of Science, EMbase and The Cochrane Library, to evaluate the safety of transcatheter aortic valve replacement through TF, TAp or TSc approaches. The information of all-cause mortality at 30 days, 1 year, 2 years and the incidence of common complications at 30 days after operation (including pacemaker-dependent block, major vascular complications, severe bleeding events, acute renal injury and stroke) were exacted, and a meta-analysis was conducted by RevMan 5.3 software. Results    This study included 11 literatures, with a total of 7 833 patients, among whom 5 348 patients were treated by TF TAVR, 1 796 patients by TAp TAVR and 689 patients by TSc TAVR. The results of the meta-analysis were as follows: (1)  at 30 days after operation, the mortality of TF and TSc approaches were lower than that of the TAp approach (TF vs. TAp:OR=0.57, 95%CI 0.39-0.84, P=0.004; TSc vs. TAp: OR=4.12, 95%CI 1.93-8.79, P=0.000 3). There was no statistical difference between the TF and TSc approaches (TF vs. TSc: OR=0.98, 95%CI 0.38-2.51, P=0.97); at 1 year, there was no statistical difference in mortality among the three approaches (P>0.05); at 2 years, there was no statistical difference between TSc and TF or TAp approaches (TF vs. TSc: OR=1.21, 95%CI 0.95-1.54, P=0.13; TSc vs. TAp: OR=1.02, 95%CI 0.76-1.36, P=0.91). (2) The incidence of acute kidney injury after TF approach was lower than that of the TAp approach (OR=0.30, 95%CI 0.22-0.41, P<0.000 01). (3) There was no statistical difference in major vascular complications between TSc and TF or TAp approaches (TF vs. TSc: OR=0.75, 95%CI 0.38-1.49, P=0.41; TSc vs. TAp: OR=1.37, 95%CI 0.56-3.32, P=0.49). (4) There was no statistical difference in severe bleeding events between TF and TSc (OR=0.97, 95%CI 0.53-1.76, P=0.92). (5) There was no statistical difference in the incidence of postoperative stroke, pacemaker dependent block among the three approaches (P>0.05). Conclusion    TAp and TSc approaches are safe and effective. They are not only an alternative to TF approach, but also the first choice in some patients with poor condition of iliofemoral artery.

ObjectiveTo investigate the clinical characteristics and risk factors of hyperamylasemia and acute pancreatitis after percutaneous transhepatic biliary stenting (PTBS). MethodsA retrospective analysis was performed for the clinical data of 249 patients with malignant biliary obstruction who were admitted to Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, and underwent PTBS from March 2016 to February 2020, and according to the presence or absence of postoperative hyperamylasemia or acute pancreatitis, the patients were divided into two groups to analyze incidence rate, severity, and related risk factors. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed for the factors with P＜0.1 in the univariate analysis to investigate independent risk factors for hyperamylasemia and acute pancreatitis after PTBS. ResultsAfter PTBS, 55 patients (221%) patients had abnormally elevated serum amylase, among whom 26 (10.4%) were diagnosed with hyperamylasemia and 29 (11.7%) were diagnosed with acute pancreatitis. All patients with acute pancreatitis had mild manifestations. The multivariate logistic regression analysis showed that age ≤60 years (odds ratio ［OR］=2.2, 95% confidence interval ［CI］: 1.07-4.52, P=0033), iodine-125 seed strand implantation (OR=2.8, 95%CI: 1.21-6.45, P=0.016), biliary stent placement across the papilla (OR=6.3, 95%CI: 2.85-1405, P＜0.001), and visualization of the pancreatic duct during surgery (OR=13.9, 95%CI: 5.64-3403, P＜0.001) were risk factors for hyperamylasemia and acute pancreatitis after PTBS. ConclusionHyperamylasemia and acute pancreatitis are relatively common complications after PTBS. Age ≤60 years, iodine-125 seed strand implantation, biliary stent placement across the papilla, and visualization of the pancreatic duct during surgery are independence risk factors for hyperamylasemia and acute pancreatitis after PTBS.