Multi-omics analysis reveals the roles of purple acid phosphatases in organic phosphorus utilization by the tropical legume Stylosanthes guianensis.

Stylo (Stylosanthes guianensis) is a tropical legume known for its exceptional tolerance to low phosphate (Pi), a trait believed to be linked to its high acid phosphatase (APase) activity. Previous studies have observed genotypic variations in APase activity in stylo; however, the gene encoding the crucial APase responsible for this variation remains unidentified. In this study, transcriptomic and proteomic analyses were employed to identify eight Pi starvation-inducible (PSI) APases belonging to the purple APase (PAP) family in the roots of stylo and seven in the leaves. Among these PSI-PAPs, SgPAP7 exhibited a significantly positive correlation in its expression levels with the activities of both internal APase and root-associated APase across 20 stylo genotypes under low-Pi conditions. Furthermore, the recombinant SgPAP7 displayed high catalytic activity toward adenosine 5'-diphosphate (ADP) and phosphoenolpyruvate (PEP) in vitro. Overexpression (OE) of SgPAP7 in Arabidopsis facilitated exogenous organic phosphorus utilization. Moreover, SgPAP7 OE lines showed lower shoot ADP and PEP levels than the wild type, implying that SgPAP7 is involved in the catabolism and recycling of endogenous ADP and PEP, which could be beneficial for plant growth in low-Pi soils. In conclusion, SgPAP7 is a key gene with a major role in stylo adaptation to low-Pi conditions by facilitating the utilization of both exogenous and endogenous organic phosphorus sources. It may also function as a PEP phosphatase involved in a glycolytic bypass pathway that minimizes the need for adenylates and Pi. Thus, SgPAP7 could be a promising target for improving tolerance of crops to low-Pi availability.

Magnetic-field-assisted optical fiber quantum temperature sensor with enhanced sensitivity.

In recent years, utilizing nitrogen-vacancy color centers in diamond for temperature sensing has drawn great attention. However, increasing the sensitivity has encountered challenges due to the intrinsic temperature-dependent energy level shift, i.e., temperature responsivity, being limited to -74 kHz/K. In this Letter, we take advantage of the magnetic field to regulate the energy level to enhance temperature sensitivity. The sensor is formed by adhering a micron-sized diamond on the end face of an optical fiber, and a small magnet is mounted at a certain distance with the diamond exploiting a cured polydimethylsiloxane block as the bridge. The temperature change leads to the variation of the distance between the diamond and the magnet, thus affecting the magnetic strength felt by the diamond. This finally contributes an additional temperature-induced energy level shift, giving rise to an enhanced sensitivity. Experimental results demonstrated the proposed scheme and achieved a 4.2-fold improvement in the temperature responsivity and a 2.1-fold enhancement in sensitivity. Moreover, the diamond and the fiber-optic integrated structure improve the portability of the sensor.

Pre- vs Post-Operative Levator Ani Subtended Volume in Patients Undergoing Hysterectomy: A Comparative Imaging Study.

INTRODUCTION AND HYPOTHESIS: The effects of hysterectomy on pelvic floor function remain uncertain, with the levator ani muscle (LAM) playing a critical role in pelvic support. The levator ani subtended volume (LASV) is an objective measure of the LAM's anatomical volume, derived from magnetic resonance imaging (MRI). This study was aimed at assessing the consistency between MRI and computed tomography (CT) in quantifying LASV, and to investigate the effect of hysterectomy on the LAM. METHODS: This retrospective study analyzed a cohort of 55 hysterectomy patients, utilizing pre-operative pelvic MRI and post-operative CT scans to measure the LASV. To evaluate the consistency between MRI and CT, the study employed the intraclass correlation coefficient and Bland-Altman agreement analysis in a subset of 32 patients with both pre-operative scans. A paired-samplet test was used to analyze LASV changes pre- and post-hysterectomy, and linear regression analysis was performed to account for potential risk factors that may influence post-operative LASV. RESULTS: High consistency between MRI and CT in measuring LASV was found, with an ICC of 0.911. We observed a significant increase in LASV following hysterectomy, with mean volume pre- and post-operatively of 16.66 cm3 and 18.87 cm3 respectively. Age and body mass index were significant predictors of post-hysterectomy LASV, whereas parity and the type of hysterectomy had no significant impact. CONCLUSIONS: Hysterectomy significantly affects the LAM, resulting in an increase in post-operative LASV. Moreover, this study verifies that MRI and CT can be used interchangeably for LASV measurements in clinical practice.

Identifying sensors-based parameters associated with fall risk in community-dwelling older adults: an investigation and interpretation of discriminatory parameters.

BACKGROUND: Falls pose a severe threat to the health of older adults worldwide. Determining gait and kinematic parameters that are related to an increased risk of falls is essential for developing effective intervention and fall prevention strategies. This study aimed to investigate the discriminatory parameter, which lay an important basis for developing effective clinical screening tools for identifying high-fall-risk older adults. METHODS: Forty-one individuals aged 65 years and above living in the community participated in this study. The older adults were classified as high-fall-risk and low-fall-risk individuals based on their BBS scores. The participants wore an inertial measurement unit (IMU) while conducting the Timed Up and Go (TUG) test. Simultaneously, a depth camera acquired images of the participants' movements during the experiment. After segmenting the data according to subtasks, 142 parameters were extracted from the sensor-based data. A t-test or Mann-Whitney U test was performed on the parameters for distinguishing older adults at high risk of falling. The logistic regression was used to further quantify the role of different parameters in identifying high-fall-risk individuals. Furthermore, we conducted an ablation experiment to explore the complementary information offered by the two sensors. RESULTS: Fifteen participants were defined as high-fall-risk individuals, while twenty-six were defined as low-fall-risk individuals. 17 parameters were tested for significance with p-values less than 0.05. Some of these parameters, such as the usage of walking assistance, maximum angular velocity around the yaw axis during turn-to-sit, and step length, exhibit the greatest discriminatory abilities in identifying high-fall-risk individuals. Additionally, combining features from both devices for fall risk assessment resulted in a higher AUC of 0.882 compared to using each device separately. CONCLUSIONS: Utilizing different types of sensors can offer more comprehensive information. Interpreting parameters to physiology provides deeper insights into the identification of high-fall-risk individuals. High-fall-risk individuals typically exhibited a cautious gait, such as larger step width and shorter step length during walking. Besides, we identified some abnormal gait patterns of high-fall-risk individuals compared to low-fall-risk individuals, such as less knee flexion and a tendency to tilt the pelvis forward during turning.

Genome-Wide Mining of the Tandem Duplicated Type III Polyketide Synthases and Their Expression, Structure Analysis of Senna tora.

Senna tora is one of the homologous crops used as a medicinal food containing an abundance of anthraquinones. Type III polyketide synthases (PKSs) are key enzymes that catalyze polyketide formation; in particular, the chalcone synthase-like (CHS-L) genes are involved in anthraquinone production. Tandem duplication is a fundamental mechanism for gene family expansion. However, the analysis of the tandem duplicated genes (TDGs) and the identification and characterization of PKSs have not been reported for S. tora. Herein, we identified 3087 TDGs in the S. tora genome; the synonymous substitution rates (Ks) analysis indicated that the TDGs had recently undergone duplication. The Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis showed that the type III PKSs were the most enriched TDGs involved in the biosynthesis of the secondary metabolite pathways, as evidenced by 14 tandem duplicated CHS-L genes. Subsequently, we identified 30 type III PKSs with complete sequences in the S. tora genome. Based on the phylogenetic analysis, the type III PKSs were classified into three groups. The protein conserved motifs and key active residues showed similar patterns in the same group. The transcriptome analysis showed that the chalcone synthase (CHS) genes were more highly expressed in the leaves than in the seeds in S. tora. The transcriptome and qRT-PCR analysis showed that the CHS-L genes had a higher expression in the seeds than in other tissues, particularly seven tandem duplicated CHS-L2/3/5/6/9/10/13 genes. The key active-site residues and three-dimensional models of the CHS-L2/3/5/6/9/10/13 proteins showed slight variation. These results indicated that the rich anthraquinones in S. tora seeds might be ascribed to the PKSs' expansion from tandem duplication, and the seven key CHS-L2/3/5/6/9/10/13 genes provide candidate genes for further research. Our study provides an important basis for further research on the regulation of anthraquinones' biosynthesis in S. tora.

Multi-label classification of pelvic organ prolapse using stress magnetic resonance imaging with deep learning.

INTRODUCTION AND HYPOTHESIS: We aimed to develop a deep learning-based multi-label classification model to simultaneously diagnose three types of pelvic organ prolapse using stress magnetic resonance imaging (MRI). METHODS: Our dataset consisted of 213 midsagittal labeled MR images at maximum Valsalva. For each MR image, the two endpoints of the sacrococcygeal inferior-pubic point line were auto-localized. Based on this line, a region of interest was automatically selected as input to a modified deep learning model, ResNet-50, for diagnosis. An unlabeled MRI dataset, a public dataset, and a synthetic dataset were used along with the labeled image dataset to train the model through a novel training strategy. We conducted a fivefold cross-validation and evaluated the classification results using precision, recall, F1 score, and area under the curve (AUC). RESULTS: The average precision, recall, F1 score, and AUC of our proposed multi-label classification model for the three types of prolapse were 0.84, 0.72, 0.77, and 0.91 respectively, which were improved from 0.64, 0.53, 0.57, and 0.83 from the original ResNet-50. Classification took 0.18 s to diagnose one patient. CONCLUSIONS: The proposed deep learning-based model were demonstrated feasible and fast in simultaneously diagnosing three types of prolapse based on pelvic floor stress MRI, which could facilitate computer-aided prolapse diagnosis and treatment planning.

A Systematic Review of Wearable Sensor-Based Technologies for Fall Risk Assessment in Older Adults.

Falls have been recognized as the major cause of accidental death and injury in people aged 65 and above. The timely prediction of fall risks can help identify older adults prone to falls and implement preventive interventions. Recent advancements in wearable sensor-based technologies and big data analysis have spurred the development of accurate, affordable, and easy-to-use approaches to fall risk assessment. The objective of this study was to systematically assess the current state of wearable sensor-based technologies for fall risk assessment among community-dwelling older adults. Twenty-five of 614 identified research articles were included in this review. A comprehensive comparison was conducted to evaluate these approaches from several perspectives. In general, these approaches provide an accurate and effective surrogate for fall risk assessment. The accuracy of fall risk prediction can be influenced by various factors such as sensor location, sensor type, features utilized, and data processing and modeling techniques. Features constructed from the raw signals are essential for predictive model development. However, more investigations are needed to identify distinct, clinically interpretable features and develop a general framework for fall risk assessment based on the integration of sensor technologies and data modeling.

Sex differences in changes in BMI and blood pressure in Chinese school-aged children during the COVID-19 quarantine.

There may be sex differences in BMI and blood pressure levels in school-age children, especially in the face of lifestyle changes. This study aimed to explore sex differences in changes in BMI and blood pressure in Chinese school-aged children during the COVID-19 quarantine. The cohort study of 445 school-aged children examined the change of BMI and blood pressure during the five-month quarantine. Multivariable Cox regression models were created to identify potential predictors of overweight, obesity, and elevated blood pressure (EBP). During the COVID-19 quarantine, the proportion of boys with overweight and obesity increased (P = 0.036), and the proportion of both boys and girls with Pre-EBP and EBP increased (P = 0.004 in boys; P < 0.001 in girls). The multivariate Cox regression analysis demonstrated that the setting, eating chili, parents' perception of their child's size and family doting were associated with overweight, obesity, and EBP. The study showed that BMI was more likely to increase in boys, and blood pressure increased in both boys and girls during the COVID-19 quarantine.

Feasibility of a deep learning-based method for automated localization of pelvic floor landmarks using stress MR images.

INTRODUCTION AND HYPOTHESIS: Magnetic resonance imaging (MRI) plays an important role in assessing pelvic organ prolapse (POP), and automated pelvic floor landmark localization potentially accelerates MRI-based measurements of POP. Herein, we aimed to develop and evaluate a deep learning-based technique for automated localization of POP-related landmarks. METHODS: Ninety-six mid-sagittal stress MR images (at rest and at maximal Valsalva) were used for deep-learning model training and generalization testing. We randomly split our dataset into a training set of 73 images and a testing set of 23 images. One soft-tissue landmark (the cervical os [P1]) and three bony landmarks (the mid-pubic line [MPL] endpoints [P2&P3] and the sacrococcygeal inferior-pubic point [SCIPP] line endpoints [P3&P4]) were annotated by experts. We used an encoder-decoder structure to develop the deep learning model for automated localization of the four landmarks. Localization performance was assessed using the root square error (RSE), whereas the reference lines were assessed based on the length and orientation differences. RESULTS: We localized landmarks (P1 to P4) with mean RSEs of 1.9 mm, 1.3 mm, 0.9 mm, and 3.6 mm. The mean length errors of the MPL and SCIPP line were 0.1 and -2.1 mm, and the mean orientation errors of the MPL and SCIPP line were -0.7° and -0.3°. Our method predicted each image in 0.015 s. CONCLUSIONS: We demonstrated the feasibility of a deep learning-based approach for accurate and fast fully automated localization of bony and soft-tissue landmarks. This sped up the MR interpretation process for fast POP screening and treatment planning.

Metabolic alterations provide insights into Stylosanthes roots responding to phosphorus deficiency.

BACKGROUND: Phosphorus (P) deficiency is one of the major constraints limiting plant growth, especially in acid soils. Stylosanthes (stylo) is a pioneer tropical legume with excellent adaptability to low P stress, but its underlying mechanisms remain largely unknown. RESULTS: In this study, the physiological, molecular and metabolic changes in stylo responding to phosphate (Pi) starvation were investigated. Under low P condition, the growth of stylo root was enhanced, which was attributed to the up-regulation of expansin genes participating in root growth. Metabolic profiling analysis showed that a total of 256 metabolites with differential accumulations were identified in stylo roots response to P deficiency, which mainly included flavonoids, sugars, nucleotides, amino acids, phenylpropanoids and phenylamides. P deficiency led to significant reduction in the accumulation of phosphorylated metabolites (e.g., P-containing sugars, nucleotides and cholines), suggesting that internal P utilization was enhanced in stylo roots subjected to low P stress. However, flavonoid metabolites, such as kaempferol, daidzein and their glycoside derivatives, were increased in P-deficient stylo roots. Furthermore, the qRT-PCR analysis showed that a set of genes involved in flavonoids synthesis were found to be up-regulated by Pi starvation in stylo roots. In addition, the abundances of phenolic acids and phenylamides were significantly increased in stylo roots during P deficiency. The increased accumulation of the metabolites in stylo roots, such as flavonoids, phenolic acids and phenylamides, might facilitate P solubilization and cooperate with beneficial microorganisms in rhizosphere, and thus contributing to P acquisition and utilization in stylo. CONCLUSIONS: These results suggest that stylo plants cope with P deficiency by modulating root morphology, scavenging internal Pi from phosphorylated metabolites and increasing accumulation of flavonoids, phenolic acids and phenylamides. This study provides valuable insights into the complex responses and adaptive mechanisms of stylo roots to P deficiency.

Target-triggered configuration change of DNA tetrahedron for SERS assay of microRNA 122.

A surface-enhanced Raman scattering (SERS) method is proposed for the assay of microRNA 122 based on configuration change of DNA tetrahedron. Firstly, a DNA tetrahedron was self-assembled with one vertex labeled with toluidine blue (TB). Then, it was immobilized on the porous Ni/SiO2@PEI@Au as a SERS platform, which was characterized by scanning electron microscopy (SEM) and X-ray diffraction (XRD). At this time, the DNA tetrahedron was contracted; so, the TB is close to AuNPs and the Raman signal is high. When target microRNA 122 existed, with the nicking enzyme amplification strategy, a great deal of DNA signal chains (S5) was obtained, which can extend the contracted DNA tetrahedron and change it into a three-dimensional DNA tetrahedron. In this case, the TB was far from AuNPs, resulting in a lower Raman signal. Due to the configuration change of DNA tetrahedron, the Raman signal at 1624 cm-1 (with the excitation wavelength of 633 nm) has a linear relationship with the logarithm concentration of microRNA 122. This SERS assay has high sensitivity for microRNA 122 with a determination range from 0.01 aM to 10 fM and a detection limit of 0.009 aM. The recoveries from spiked samples were in the range 95 to 109%. This SERS strategy is designed based on the target-triggered configuration change of DNA tetrahedron, which can give new insight for DNA structures in bioanalysis. Graphical abstract A sensitive surface-enhanced Raman scattering (SERS) biosensor was developed to detect microRNA 122 using the configuration change of DNA tetrahedron to indirectly control the position of TB and hot spot.

Physiological responses and proteomic changes reveal insights into Stylosanthes response to manganese toxicity.

BACKGROUND: Manganese (Mn), an essential element for plants, can be toxic when present in excess. Stylo (Stylosanthes) is a pioneer tropical legume with great potential for Mn tolerance, but its Mn tolerance mechanisms remain poorly understood. RESULTS: In this study, variations in Mn tolerance were observed among nine stylo genotypes. Stylo genotype 'RY5' exhibited the highest Mn tolerance compared to the other tested genotypes, whereas 'TF2001' was a Mn-sensitive genotype. The mechanisms underlying the response of stylo to Mn toxicity were further investigated using these two genotypes with contrasting Mn tolerance. Results showed that stylo genotype RY5 exhibited Mn tolerance superior to that of genotype TF2001, showing lower reductions in leaf chlorophyll concentration, chlorophyll fluorescence parameters, photosynthetic indexes and plant dry weight under Mn toxicity. A label-free quantitative proteomic analysis was conducted to investigate the protein profiles in the leaves and roots of RY5 in response to Mn toxicity. A total of 356 differentially expressed proteins (DEPs) were identified, including 206 proteins from leaves and 150 proteins from roots, which consisted of 71 upregulated, 62 downregulated, 127 strongly induced and 96 completely suppressed proteins. These DEPs were mainly involved in defense response, photosynthesis, carbon fixation, metabolism, cell wall modulation and signaling. The qRT-PCR analysis verified that 10 out of 12 corresponding gene transcription patterns correlated with their encoding proteins after Mn exposure. Finally, a schematic was constructed to reveal insights into the molecular processes in the leaves and roots of stylo in response to Mn toxicity. CONCLUSIONS: These findings suggest that stylo plants may cope with Mn toxicity by enhancing their defense response and phenylpropanoid pathways, adjusting photosynthesis and metabolic processes, and modulating protein synthesis and turnover. This study provides a platform for the future study of Mn tolerance mechanisms in stylo and may lead to a better understanding of the potential mechanisms underlying tropical legume adaptation to Mn toxicity.

Self-Aligned van der Waals Heterojunction Diodes and Transistors.

A general self-aligned fabrication scheme is reported here for a diverse class of electronic devices based on van der Waals materials and heterojunctions. In particular, self-alignment enables the fabrication of source-gated transistors in monolayer MoS2 with near-ideal current saturation characteristics and channel lengths down to 135 nm. Furthermore, self-alignment of van der Waals p-n heterojunction diodes achieves complete electrostatic control of both the p-type and n-type constituent semiconductors in a dual-gated geometry, resulting in gate-tunable mean and variance of antiambipolar Gaussian characteristics. Through finite-element device simulations, the operating principles of source-gated transistors and dual-gated antiambipolar devices are elucidated, thus providing design rules for additional devices that employ self-aligned geometries. For example, the versatility of this scheme is demonstrated via contact-doped MoS2 homojunction diodes and mixed-dimensional heterojunctions based on organic semiconductors. The scalability of this approach is also shown by fabricating self-aligned short-channel transistors with subdiffraction channel lengths in the range of 150-800 nm using photolithography on large-area MoS2 films grown by chemical vapor deposition. Overall, this self-aligned fabrication method represents an important step toward the scalable integration of van der Waals heterojunction devices into more sophisticated circuits and systems.

Dynamics of arbuscular mycorrhizal fungal community structure and functioning along a nitrogen enrichment gradient in an alpine meadow ecosystem.

Nitrogen (N) availability is increasing dramatically in many ecosystems, but the influence of elevated N on the functioning of arbuscular mycorrhizal (AM) fungi in natural ecosystems is not well understood. We measured AM fungal community structure and mycorrhizal function simultaneously across an experimental N addition gradient in an alpine meadow that is limited by N but not by phosphorus (P). AM fungal communities at both whole-plant-community (mixed roots) and single-plant-species (Elymus nutans roots) scales were described using pyro-sequencing, and the mycorrhizal functioning was quantified using a mycorrhizal-suppression treatment in the field (whole-plant-community scale) and a glasshouse inoculation experiment (single-plant-species scale). Nitrogen enrichment progressively reduced AM fungal abundance, changed AM fungal community composition, and shifted mycorrhizal functioning towards parasitism at both whole-plant-community and E. nutans scales. N-induced shifts in AM fungal community composition were tightly linked to soil N availability and/or plant species richness, whereas the shifts in mycorrhizal function were associated with the communities of specific AM fungal lineages. The observed changes in both AM fungal community structure and functioning across an N enrichment gradient highlight that N enrichment of ecosystems that are not P-limited can induce parasitic mycorrhizal functioning and influence plant community structure and ecosystem sustainability.

9,9'-Bifluorenylidene-Core Perylene Diimide Acceptors for As-Cast Non-Fullerene Organic Solar Cells: The Isomeric Effect on Optoelectronic Properties.

Two different non-fullerene small-molecule acceptors, m-PIB and p-PIB, based on 9,9'-bifluorenylidene (BF) and perylene diimide (PDI) were designed and synthesized. Four ß-substituted PDIs were linked to BF in different positions. Based on DFT analysis, derivative p-PIB exhibited reduced intramolecular twisting between the PDI moieties, more delocalized wave function, and sufficiently wider π-electron delocalization than that of m-PIB. The absorption ability of p-PIB was enhanced due to increased intermolecular interactions. By blending p-PIB with poly{4,8-bis[5-(2ethylhexyl)thiophen-2-yl]benzo[1,2-b:4,5-b']dithiophene-co-3-fluorothieno[3,4-b]-thiophene-2-carboxylate} (PTB7-Th), organic solar cells (OSCs) based on p-PIB obtained a maximum power conversion efficiency of 5.95 % without any treatments. Due to the improved and balanced hole and electron mobilities, the short-circuit current and fill factor of OSCs based on PTB7-Th and p-PIB were significantly increased. The AFM and TEM results revealed that the PTB7-Th:p-PIB film had favorable nanoscale phase separation and formed a bicontinuous interpenetrating network.

Intraoperative cervix location and apical support stiffness in women with and without pelvic organ prolapse.

BACKGROUND: It is unknown how initial cervix location and cervical support resistance to traction, which we term "apical support stiffness," compare in women with different patterns of pelvic organ support. Defining a normal range of apical support stiffness is important to better understand the pathophysiology of apical support loss. OBJECTIVE: The aims of our study were to determine whether: (1) women with normal apical support on clinic Pelvic Organ Prolapse Quantification, but with vaginal wall prolapse (cystocele and/or rectocele), have the same intraoperative cervix location and apical support stiffness as women with normal pelvic support; and (2) all women with apical prolapse have abnormal intraoperative cervix location and apical support stiffness. A third objective was to identify clinical and biomechanical factors independently associated with clinic Pelvic Organ Prolapse Quantification point C. STUDY DESIGN: We conducted an observational study of women with a full spectrum of pelvic organ support scheduled to undergo gynecologic surgery. All women underwent a preoperative clinic examination, including Pelvic Organ Prolapse Quantification. Cervix starting location and the resistance (stiffness) of its supports to being moved steadily in the direction of a traction force that increased from 0-18 N was measured intraoperatively using a computer-controlled servoactuator device. Women were divided into 3 groups for analysis according to their pelvic support as classified using the clinic Pelvic Organ Prolapse Quantification: (1) "normal/normal" was women with normal apical (C < -5 cm) and vaginal (Ba and Bp < 0 cm) support; (2) normal/prolapse had normal apical support (C < -5 cm) but prolapse of the anterior or posterior vaginal walls (Ba and/or Bp ≥ 0 cm); and (3) prolapse/prolapse had both apical and vaginal wall prolapse (C > -5 cm and Ba and/or Bp ≥ 0 cm). Demographics, intraoperative cervix locations, and apical support stiffness values were then compared. Normal range of cervix location during clinic examination and operative testing was defined by the total range of values observed in the normal/normal group. The proportion of women in each group with cervix locations within and outside the normal range was determined. Linear regression was performed to identify variables independently associated with clinic Pelvic Organ Prolapse Quantification point C. RESULTS: In all, 52 women were included: 14 in the normal/normal group, 11 in the normal/prolapse group, and 27 in the prolapse/prolapse group. At 1 N of traction force in the operating room, 50% of women in the normal/prolapse group had cervix locations outside the normal range while 10% had apical support stiffness outside the normal range. Of women in the prolapse/prolapse group, 81% had cervix locations outside the normal range and 8% had apical support stiffness outside the normal range. Similar results for cervix locations were observed at 18 N of traction force; however the proportion of women with apical support stiffness outside the normal range increased to 50% in the normal/prolapse group and 59% in the prolapse/prolapse group. The prolapse/prolapse group had statistically lower apical support stiffness compared to the normal/normal group with increased traction from 1-18 N (0.47 ± 0.18 N/mm vs 0.63 ± 0.20 N/mm, P = .006), but all other comparisons were nonsignificant. After controlling for age, parity, body mass index, and apical support stiffness, cervix location at 1 N traction force remained an independent predictor of clinic Pelvic Organ Prolapse Quantification point C, but only in the prolapse/prolapse group. CONCLUSION: Approximately 50% of women with cystocele and/or rectocele but normal apical support in the clinic had cervix locations outside the normal range under intraoperative traction, while 19% of women with uterine prolapse had normal apical support. Identifying women whose apical support falls outside a defined normal range may be a more accurate way to identify those who truly need a hysterectomy and/or an apical support procedure and to spare those who do not.

Difluorocarbene for Dehydroxytrifluoromethylthiolation of Alcohols.

Dehydroxytrifluoromethylthiolation of alcohols with a Ph3P+CF2CO2-/S8/F- system is described. Difluorocarbene generated from Ph3P+CF2CO2- would readily combine with elemental sulfur to furnish S═CF2. S═CF2 can be considered as a bifunctional intermediate, activating alcohol and providing scaffold for CF3S- formation, thus allowing for the convenient dehydroxytrifluoromethylthiolation of alcohols.

Quantitative analyses of variability in normal vaginal shape and dimension on MR images.

INTRODUCTION AND HYPOTHESIS: We present a technique for quantifying inter-individual variability in normal vaginal shape, axis, and dimension, and report findings in healthy women. METHODS: Eighty women (age: 28∼70 years) with normal pelvic organ support underwent supine, multi-planar proton-density MRI. Vaginal width was assessed at five evenly-spaced locations, and vaginal axis, length, and surface area were quantified via ImageJ and MATLAB. RESULTS: The mid-sagittal plane angles, relative to the horizontal, of three vaginal axes were 90 ± 11, 72 ± 21, and 41 ± 22° (caudal to cranial, p < 0.001). The mean (± SD) vaginal widths were 17 ± 5, 24 ± 4, 30 ± 7, 41 ± 9, and 45 ± 12 mm at the five locations (caudal to cranial, p < 0.001). Mid-sagittal lengths for anterior and posterior vaginal walls were 63 ± 9 and 98 ± 18 mm respectively. The vaginal surface area was 72 ± 21 cm(2) (range: 34 ∼ 164 cm(2)). The coefficient of determination between any demographic variable and any vaginal dimension did not exceed 0.16. CONCLUSIONS: Large variations in normal vaginal shape, axis, and dimensions were not explained by body size or other demographic variables. This variation has implications for reconstructive surgery, intravaginal and surgical product design, and vaginal drug delivery.

Traction force needed to reproduce physiologically observed uterine movement: technique development, feasibility assessment, and preliminary findings.

INTRODUCTION AND HYPOTHESIS: This study aimed to describe a novel strategy to determine the traction forces needed to reproduce physiologic uterine displacement in women with and without prolapse. METHODS: Participants underwent dynamic stress magnetic resonance imaging (MRI) testing as part of a study examining apical uterine support. Physiologic uterine displacement was determined by analyzing uterine location in images taken at rest and at maximal Valsalva. Force-displacement curves were calculated based on intraoperative cervical traction testing. The intraoperative force required to achieve the uterine displacement measured during MRI was then estimated from these curves. Women were categorized into three groups based on pelvic organ support: group 1 (normal apical and vaginal support), group 2 (normal apical support but vaginal prolapse present), and group 3 (apical prolapse). RESULTS: Data from 19 women were analyzed: five in group 1, five in group 2, and nine in group 3. Groups were similar in terms of age, body mass index (BMI), and parity. Median operating room (OR) force required for uterine displacement measured during MRI was 0.8 N [interquartile range (IQR) 0.62-3.22], and apical ligament stiffness determined using MRI uterine displacement was 0.04 N/mm (IQR 0.02-0.08); differences between groups were nonsignificant. Uterine locations determined at rest and during maximal traction were lower in the OR compared with MRI in all groups. CONCLUSIONS: Using this investigative strategy, we determined that only 0.8 N of traction force in the OR was required to achieve maximal physiologic uterine displacement seen during dynamic (maximal Valsalva) MRI testing, regardless of the presence or absence of prolapse.

Using stress MRI to analyze the 3D changes in apical ligament geometry from rest to maximal Valsalva: a pilot study.

INTRODUCTION AND HYPOTHESIS: A method was developed using 3D stress magnetic resonance imaging (MRI) and was piloted to test hypotheses concerning changes in apical ligament lengths and lines of action from rest to maximal Valsalva. METHODS: Ten women with (cases) and ten without (controls) pelvic organ prolapse (POP) were selected from an ongoing case-control study. Supine, multiplanar stress MRI was performed at rest and at maximal Valsalva and was imported into 3D Slicer v. 3.4.1 and aligned. The 3D reconstructions of the uterus and vagina, cardinal ligament (CL), deep uterosacral ligament (USL(d)), and pelvic bones were created. Ligament length and orientation were then measured. RESULTS: Adequate ligament representations were possible in all 20 study participants. When cases were compared with controls, the curve length of the CL at rest was 71 ±16 mm vs. 59 ± 9 mm (p = 0.051), and the USL(d)was 38 ± 16 mm vs. 36 ± 11 mm (p = 0.797). Similarly, the increase in CL length from rest to strain was 30 ± 16 mm vs. 15 ± 9 mm (p = 0.033), and USL(d) was 15 ± 12 mm vs. 7 ± 4 mm (p = 0.094). Likewise, the change in USL(d) angle was significantly different from CL (p < 0.001). CONCLUSIONS: This technique allows quantification of 3D geometry at rest and at strain. In our pilot sample, at maximal Valsalva, CL elongation was greater in cases than controls, whereas USL(d) was not; CL also exhibited greater changes in ligament length, and USL(d) exhibited greater changes in ligament inclination angle.