Multiparametric MRI-based radiomics nomogram for predicting malignant transformation of sinonasal inverted papilloma.

AIM: To investigate the feasibility of a radiomics nomogram model for predicting malignant transformation in sinonasal inverted papilloma (IP) based on radiomic signature and clinical risk factors. MATERIALS AND METHODS: This single institutional retrospective review included a total of 143 patients with IP and 75 patients with IP with malignant transformation to squamous cell carcinoma (IP-SCC). All patients underwent surgical pathology and had preoperative magnetic resonance imaging (MRI) and computed tomography (CT) sinus studies between June 2014 and February 2022. Radiomics features were extracted from contrast-enhanced T1-weighted images (CE-T1WI), T2-weighted images (T2WI), and apparent diffusion coefficient (ADC) maps. The least absolute shrinkage and selection operator (LASSO) were performed to select the features extracted from the sequences mentioned above. Independent clinical risk factors were identified by multivariate logistic regression analysis. Radiomics nomogram was constructed by incorporating independent clinical risk factors and radiomics signature. Based on discrimination and calibration, the diagnostic performance of the nomogram was evaluated. RESULTS: Twelve radiomics features were selected to develop the radiomics model with an area under the curve (AUC) of 0.987 and 0.989, respectively. Epistaxis (p=0.011), T2 equal signal (p=0.003), extranasal invasion (p<0.001), and loss of convoluted cerebriform pattern (p=0.002) were identified as independent clinical predictors. The radiomics nomogram model showed excellent calibration and discrimination (AUC: 0.993, 95% confidence interval [CI]: 0.985-1.00 and 0.990, 95% CI: 0.974-1.00) in the training and validation sets, respectively. CONCLUSION: The nomogram that the combined radiomics signature and clinical risk factors showed a satisfactory ability to predict IP-SCC.

T2-FLAIR mismatch sign and machine learning-based multiparametric MRI radiomics in predicting IDH mutant 1p/19q non-co-deleted diffuse lower-grade gliomas.

AIM: To investigate the application of the T2-weighted (T2)-fluid-attenuated inversion recovery (FLAIR) mismatch sign and machine learning-based multiparametric magnetic resonance imaging (MRI) radiomics in predicting 1p/19q non-co-deletion of lower-grade gliomas (LGGs). MATERIALS AND METHODS: One hundred and forty-six patients, who had pathologically confirmed isocitrate dehydrogenase (IDH) mutant LGGs were assigned randomly to the training cohort (n=102) and the testing cohort (n=44) at a ratio of 7:3. The T2-FLAIR mismatch sign and conventional MRI features were evaluated. Radiomics features extracted from T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), FLAIR, apparent diffusion coefficient (ADC), and contrast-enhanced T1WI images (CE-T1WI). The models that displayed the best performance of each sequence were selected, and their predicted values as well as the T2-FLAIR mismatch sign data were collected to establish a final stacking model. Receiver operating characteristic curve (ROC) analyses and area under the curve (AUC) values were applied to evaluate and compare the performance of the models. RESULTS: The T2-FLAIR mismatch sign was more common in the IDH mutant 1p/19q non-co-deleted group (p<0.05) and the area under the curve (AUC) value was 0.692 with sensitivity 0.397, specificity 0.987, and accuracy 0.712, respectively. The stacking model showed a favourable performance with an AUC of 0.925 and accuracy of 0.882 in the training cohort and an AUC of 0.886 and accuracy of 0.864 in the testing cohort. CONCLUSION: The stacking model based on multiparametric MRI can serve as a supplementary tool for pathological diagnosis, offering valuable guidance for clinical practice.

Factors associated with nocturnal and diurnal glycemic variability in patients with type 2 diabetes: a cross-sectional study.

PURPOSE: There is little information on factors that influence the glycemic variability (GV) during the nocturnal and diurnal periods. We aimed to examine the relationship between clinical factors and GV during these two periods. METHODS: This cross-sectional study included 134 patients with type 2 diabetes. 24-h changes in blood glucose were recorded by a continuous glucose monitoring system. Nocturnal and diurnal GV were assessed by standard deviation of blood glucose (SDBG), coefficient of variation (CV), and mean amplitude of glycemic excursions (MAGE), respectively. Robust regression analyses were performed to identify the factors associated with GV. Restricted cubic splines were used to determine dose-response relationship. RESULTS: During the nocturnal period, age and glycemic level at 12:00 A.M. were positively associated with GV, whereas alanine aminotransferase was negatively associated with GV. During the diurnal period, homeostatic model assessment 2-insulin sensitivity (HOMA2-S) was positively associated with GV, whereas insulin secretion-sensitivity index-2 (ISSI2) was negatively associated with GV. Additionally, we found a J-shape association between the glycemic level at 12:00 A.M. and MAGE, with 9.0 mmol/L blood glucose level as a cutoff point. Similar nonlinear associations were found between ISSI2 and SDBG, and between ISSI2 and MAGE, with ISSI2 value of 175 as a cutoff point. CONCLUSION: Factors associated with GV were different between nocturnal and diurnal periods. The cutoff points we found in this study may provide the therapeutic targets for beta-cell function and pre-sleep glycemic level in clinical practice.

Association between non-alcoholic fatty liver disease and metabolic abnormalities in children with different weight statuses.

OBJECTIVES: Both obesity and non-alcoholic fatty liver disease (NAFLD) increase the risk of metabolic abnormalities. However, the metabolic status of children suffering from NAFLD and exhibiting various subtypes of obesity is currently unclear. We aimed to explore the association between NAFLD and metabolic abnormalities in children with different weight statuses. METHODS: We included 6086 participants aged 6-18 years from the China Child and Adolescent NAFLD Study (CCANS), all of whom had undergone ultrasonography or magnetic resonance imaging-proton density fat fraction (MRI-PDFF) to identify NAFLD and metabolic abnormalities, including hyperglycemia, high triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C), high low-density lipoprotein cholesterol, high total cholesterol, and hyperuricemia. RESULTS: Among the participants, there were 2408 children with obesity and NAFLD, 174 with NAFLD, 2396 with obesity, and 1108 without obesity and NAFLD. The odds ratios (ORs) of suffering from individual metabolic abnormalities were significantly greater in children with obesity and NAFLD than in children without obesity and NAFLD, with ORs ranging from 6.23 (95% CI: 4.56, 8.53) to 1.77 (95% CI: 1.06, 2.94). The ORs of metabolic abnormalities, except for low HDL-C, were greater in children with NAFLD alone than in children without obesity or NAFLD, with ORs ranging from 4.36 (95% CI: 2.77, 6.84) to 2.08 (95% CI: 1.14, 3.78). Notably, obesity and NAFLD had a multiplicative effect on overall metabolic abnormalities, high TG levels, and low HDL-C levels. CONCLUSIONS: Children with obesity and NAFLD could be at a significantly increased risk of metabolic abnormalities. Even for children without obesity, NAFLD appears to be associated with an increased risk of experiencing a worsened metabolic status.

[Advances in basic research on choline and central nervous system development and related disorders].

Choline is an essential nutrient that plays an integral role in all stages of the life cycle, with increasing interest in the relationship between choline and neurodevelopment. Choline is a major component in the synthesis of phospholipids, phosphatidylcholine and sphingolipids, and is an essential nutrient for methyl metabolism, acetylcholine synthesis and cell signaling. Choline plays an important role in neurogenesis and neural migration during fetal development, potentially influencing the development and prognosis of neurological disorders, but its mechanism of action is not yet clear. This article reviews the source and metabolism of choline, the effects and mechanism of choline on neurodevelopment and central nervous system related disorders.

Incidence and risk factors of female urinary incontinence: a 4-year longitudinal study among 24 985 adult women in China.

OBJECTIVE: To estimate the incidence of urinary incontinence (UI), including its subtypes stress UI (SUI), urgency UI (UUI) and mixed UI (MUI), and to examine risk factors for de novo SUI and UUI in Chinese women. DESIGN: Nationwide longitudinal study. SETTING: Six geographic regions of China. PARTICIPANTS: Women aged ≥20 years old were included using a multistage, stratified, cluster sampling method. METHODS: This study was conducted between May 2014 and March 2016, with follow up in 2018. Data on demographics, medical history, lifestyle and physiological and anthropometric information were collected. MAIN OUTCOME MEASUREMENTS: Incidence, rate ratio (RR). RESULTS: Analyses included 24 985 women (mean age 41.9 years).The follow-up response rate was 55.5%, median follow-up time was 3.7 years. The standardised incidences of UI, SUI, UUI and MUI were 21.2, 13.1, 3.0 and 5.1 per 1000 person-years, respectively. Risk factors for de novo SUI included delivery pattern (vaginal spontaneous delivery RR 2.12, 95% CI 1.62-2.78 and instrumental delivery RR 3.30, 95% CI 1.99-5.45), high body mass index (BMI) (overweight RR 1.52, 95% CI 1.33-1.74 and obesity RR 1.67, 95% CI 1.32-2.11), cigarette smoking (RR 1.54, 95% CI 1.12-2.12), chronic cough (RR 1.44, 95% CI 1.17-1.76), diabetes (RR 1.33, 95% CI 1.10-1.60) and older age (50-59 years RR 1.49, 95% CI 1.16-1.90 and 60-69 years RR 1.61, 95% CI 1.22-2.13).The risk factors significantly associated with de novo UUI were age (RR increased from 1.21, 95% CI 0.74-1.99, at 30-39 years to 6.3, 95% CI 3.85-10.30, at >70 years) and diabetes (RR 1.48, 95% CI 1.05-2.09). CONCLUSIONS: The incidence of female UI is 21.2 per 1000 person-years in China. Delivery (vaginal spontaneous delivery, instrumental delivery), high BMI, cigarette smoking, chronic cough, diabetes and older age were risk factors. TWEETABLE ABSTRACT: The incidence of female urinary incontinence was 21.2 per 1000 person-years in China. Delivery, BMI, diabetes and old age are risk factors.

[Analysis of changes in self-efficacy and its influencing factors in type 2 diabetic patients after community-based self-management group intervention].

Objective: To analyze the changes in self-efficacy and its influencing factors in type 2 diabetic patients after community-based self-management group intervention. Methods: From August to November 2014, a 3-month community-based self-management intervention study of type 2 diabetes patients was implemented in Fangshan District, Beijing. 510 patients were recruited through posters, household inquiries and telephone notification and then were randomly divided into intervention group (260 patients) and control group (250 patients). Finally, 500 patients completed the study, including 259 in the intervention group and 241 in the control group. Self-efficacy score was measured through face-to-face interview at different time points, including pre-intervention, post-intervention, 2 years after the intervention and 5 years after the intervention, respectively. A two-level random coefficient model was fitted to analyze the long-term trend of self-efficacy and its relationship with group intervention. Results: Individual-level educational attainment, disease duration as well as their treatment plans had a positive correlation with self-efficacy of type 2 diabetic patients while gender and age did not affect their self-efficacy. Patients with junior middle school education, senior high school education and university and above education had 4.66 (P<0.05), 6.40 (P<0.05) and 11.02 (P<0.05) points higher than those with primary education, respectively. The self-efficacy of diabetic patients increased by 0.23 (P<0.05) for each additional course year. The effect of treatment plan on self-efficacy was mainly reflected in the self-efficacy of taking medication or insulin injection as prescribed and blood glucose monitoring. After controlling for the confounding factors, i.e., gender, age, disease duration, educational attainment, and treatment plan, self-efficacy scores at the post-intervention increased in both groups compared to those at the pre-intervention. The intervention group had 7.95 points higher than the control group (P<0.05). After the intervention, the self-efficacy scores of both groups decreased year by year while the intervention group declined faster, with 5.41 points (P<0.05) at 2 years after the intervention and 8.94 points (P<0.05) at 5 years after the intervention. Conclusion: Community-based self-management group intervention could improve the self-efficacy of type 2 diabetic patients while the self-efficacy decreases year by year in the absence of follow-up intervention.

A nationwide population-based survey on the prevalence and risk factors of symptomatic pelvic organ prolapse in adult women in China - a pelvic organ prolapse quantification system-based study.

OBJECTIVE: To determine the prevalence, risk factors and burden of symptomatic pelvic organ prolapse (POP) in adult Chinese women. DESIGN: A nationwide cross-sectional study. SETTING: Six geographic regions of mainland China. PARTICIPANTS: Women aged ≥20 years old were included using a multistage, stratified, cluster sampling method from February 2014 through March 2016. METHODS: We conducted a nationwide epidemiological survey. 'Symptomatic POP' was determined by a screening questionnaire and physical examination. MAIN OUTCOME MEASUREMENTS: Prevalence, odds ratio (OR). RESULTS: A total of 55 477 women (response rate, 92.5%; mean age, 45.1 years old) were included. The prevalence of symptomatic POP was 9.6% (95% CI 9.3-9.8%) and it increased with age in each stage (P < 0.05). Symptomatic POP-Q stage II, which mainly involved anterior compartment prolapse, was the most common (7.52%). Minor/moderate burden of symptomatic POP was the most common, with a prevalence of 9.7% (95% CI 9.5-10.0%). The odds for each type of symptomatic POP increased with age (>50 vs 20-29 years old in symptomatic POP-Q stage II or higher, OR increased from 1.34 [95% CI 1.32-1.45] to 7.34 [95% CI 4.34-12.41]) and multiple vaginal deliveries (multiparous [≥3] vs nulliparous in symptomatic POP-Q stage II or higher, OR increased from 1.91 [1.71-2.13] to 2.78 [2.13-3.64]). CONCLUSIONS: We found a lower prevalence of symptomatic POP than that found in other surveys. The main type of symptomatic POP was anterior compartment prolapse, indicating that it should be considered first. Older age and multiple vaginal deliveries increased the odds of each type of symptomatic POP. TWEETABLE ABSTRACT: The prevalence of female symptomatic pelvic organ prolapse (POP) was 9.6% in China. It is related to old age and multiple vaginal deliveries.

[Impact of combined nerve blocks on the outcome of hip replacement in elderly patients with acute cerebral infarction].

Objective: To investigate the impact of ultrasound-guided lumbar plexus, sciatic nerve and L1 paravertebral combined nerve blocks on the outcomes of elderly acute cerebral infarction patients with femoral neck fracture who underwent hip replacement. Methods: The clinical data of 114 elderly acute cerebral infarction patients with femoral neck fracture and underwent artificial hip replacement surgery from May 2013 to September 2018 in Renmin Hospital of Wuhan University were retrospectively analyzed. The patients were divided into two groups based on the different anesthetic methods they received: general anesthesia (G group, n=48), lumbar plexus, sciatic nerve and L1 paravertebral combined nerve blocks (N group, n=66). The operation time, anesthesia time, blood loss, urine volume, norepinephrine dose, length of intensive care unit (ICU) stay, hospital mortality and postoperative 6-month mortality were observed and compared between the two groups. The mini-mental state examination (MMSE) scores and the national institute of health stroke scale (NIHSS) scores were evaluated, respectively. Meanwhile, plasma D-Dimer and S100ß levels were measured 1 d before surgery, 3 d and 7 d after surgery. Results: There were no significant differences in the baseline characteristics, operation time, anesthesia time, blood loss and length of ICU stay between the two groups (all P>0.05). Compared with group G, the dosage of norepinephrine [(86±23) µg vs (184±28) µg], hospital mortality [7.6% (5/66) vs 25.0% (12/48)] and postoperative 6-month mortality [12.1% (8/66) vs 31.3% (15/48)] were significantly decreased in group N, while the urine volume [(265±58) ml vs (160±55) ml] was significantly increased (all P<0.01). The MMSE scores (9.9±3.0 vs 14.6±2.4) in group N were significantly higher than those in the group G 3 d after surgery, while the NIHSS scores (15.3±3.2 vs 9.9±3.5), plasma D-Dimer [(10.8±2.5) mg/L vs (7.3±2.2) mg/L] and S100ß levels [(326±35) ng/L vs (276±29) ng/L] were significantly lower than those in group G (all P<0.01). Conclusion: Combined nerve blocks can reduce the mortality of acute cerebral infarction patients undergoing hip replacement surgery, and improve the brain function and prognosis of the patients.

[Risk factors of urinary incontinence in Chinese women based on random forest].

Objective: To explore the risk factors of urinary incontinence (UI) in China by using random forest algorithm, and to evaluate the predictive effect of each risk factor on UI. Methods: A baseline survey with a multistage stratified cluster sampling design was conducted between February 2014 and January 2016, and followed up by telephone from June to December 2018. A total of 55 477 adult women from six provinces of China participated the survey. According to the ratio of 1:1, under sampling method was used to randomly select the same number of women as UI from the non UI women. The data were randomly divided into training set and verification set according to 7:3. The training set was used to establish the random forest model, which including the candidate variables with P<0.2 in univariate analysis, and the verification set was used to verify the predictive effects. Results: A total of 30 658 patients (55.26%, 30 658/55 477) completed the follow-up, the median follow-up time was 3.7 years. Among the 24 985 women without UI at baseline, 1 757 (7.03%, 1 757/24 985) had UI at followed up, including 1 117 (4.47%, 1 117/24 985) with stress UI, 243 (0.97%, 243/24 985) with urgency UI and 397 (1.59%, 397/24 985) with mixed UI. When fixed the number of features as 2 and the number of random trees as 300 in the random forest model, the out of bag error rate estimation was the lowest; with such parameter settings, the classification accuracy was 64.3%, the sensitivity was 64.2%, and the specificity was 64.4%. The top10 predictive UI factors that screening by the variable importance measure in random forest model were obtained as follows: age, parity, delivery pattern, body mass index (BMI), menopause, history of diabetes, education level, history of pelvic surgery, regions, and marital status. Conclusion: We identified the top10 predictive UI factors that screening by the variable importance in random forest model as follows: age, parity, delivery pattern, BMI, menopause, history of diabetes, education level, history of pelvic surgery, regions, and marital status.

[Determination of manganese in urine by direct dilution-inductively coupled plasma mass spectrometry].

Objective: To establish a direct dilution-inductively coupled plasma mass spectrometry method for the determination of manganese in urine. Methods: Using 1% nitric acid solution as diluent, the urine dilution factor and internal standard elements were determined by single factor rotation experiment. The linear range, correlation coefficient, precision, accuracy and detection limit of the direct dilution-inductively coupled plasma mass spectrometry for the determination of manganese in urine were evaluated. Results: The linear range of this method was 0.0-20 µg/L, the correlation coefficient was 0.999 9, the detection limit was 0.02 µg/L, the recoveries were 84.65%-103.40%, the relative standard deviations were 0.26%-8.17%. Conclusion: This method has the advantages of simple operation, high sensitivity and low detection limit. It can be used for the determination of urine manganese at the same time with other elements. It is suitable for the determination of urine manganese in workers and ordinary people.

The factors associated with natural disease progression from HIV to AIDS in the absence of ART, a propensity score matching analysis.

This study aimed at comparing the factors associated with the natural progression between typical progressors (TPs) and rapid progressors (RPs) in HIV-infected individuals. A retrospective study was conducted on 2095 eligible HIV-infected individuals from 1995 to 2016 in a high-risk area of Henan Province, China. Propensity score matching was used to balance covariates, and the conditional logistic regression analyses were performed to explore the factors of natural disease progression among HIV infectors. A total of 379 pairs of RPs and TPs were matched. The standardised difference values of all covariates were less than 10%. HIV-infected individuals transmitted through sexual transmission (odds ratio (OR) 0.56, 95% confidence interval (CI) 0.36-0.85) were more likely to progress to AIDS compared with those infected through contaminated blood. Older age at diagnosis of HIV-infected individuals (OR 0.72, 95% CI 0.58-0.89) exhibited a faster progression to AIDS. HIV-infected individuals identified through a unique survey (OR 7.01, 95% CI 2.99-16.44) were less likely to progress to AIDS compared with those identified through medical institutions. HIV-infected individuals who had higher baseline CD4+T cell counts (OR 3.37, 95% CI 2.59-4.38) had a slower progression to AIDS. These findings provide evidence for natural disease progression from HIV to AIDS between TPs and RPs.

[Clinical characteristics and esophageal function tests of refractory gastroesophageal reflux disease].

Objective: To analyze the clinical characteristics and pathogenesis of refractory gastroesophageal reflux disease(RGERD). Methods: The patients with acid regurgitation, heartburn and extraesophageal symptoms were enrolled in the study from November 2015 to September 2017 at Peking University Third Hospital. All the subjects filled the informed consent.Questionnaire, SCL-90, SAS and SDS scales were recorded. A 24 hour pH-impedance monitoring and esophageal high resonance manometry were carried out. According to the response to proton pump inhibitor(PPI), the patients were divided into RGERD and non-RGERD(NRGERD)groups. The clinical characteristics were compared between these two groups. Logistic regression was used to analyze the risk factors of RGERD. Results: One hundred and nineteen patients were finally enrolled in the study including 61 RGERD (51.3%) and 58 NRGERD patients (48.7%).The body mass index (BMI) and rates of, typical GER symptoms including acid regurgitation in RGERD patients were significantly lower than those in NRGERD patients (P<0.05).While the atypical GER symptoms such as poststernal discomfort or chest pain were more common in RGERD group (P<0.05).RGERD patients presented less acid reflux events and lower proximal segment reflux ratio than NRGERD patients. No obvious differences were found in the manometry metrics between these two groups. The scores of somatization, depression and hostility in RGERD patients by SCL-90 scales were significantly higher than those in NRGERD patients (P<0.05), and depression score was an independent risk factor for RGERD [OR=3.915 (95%CI 1.464-10.466), P =0.007]. Conclusions: RGERD patients present more atypical symptoms and pathological non-acid reflux.Depression is an independent risk factor for RGERD.

[Study of etiology and esophageal motility characteristics of esophagogastric junction outlet obstruction patients].

OBJECTIVE: To analyze the causes of the esophagogastric junction outlet obstruction (EGJOO) patients, to discuss the differences of the clinical manifestation and esophageal motility characteristics between the anatomic EGJOO (A-EGJOO) and functional EGJOO (F-EGJOO) subgroups, and to search the diagnostic values of the specific metrics for differentiating the subgroups of EGJOO patients. METHODS: For the current retrospective study, all the patients who underwent the esophageal high resonance manometry test were retrospectively analyzed from Jan 2012 to Oct 2018 in Peking University Third Hospital. The EGJOO patients were enrolled in the following research. The clinical characteristics, such as symptoms and causes of the patients were studied. Then the patients were divided into two subgroups as A-EGJOO subgroup and F-EGJOO subgroup. The clinical symptoms and the main manometry metrics were compared between these two subgroups. The significant different metrics between the two groups were selected to draw receiver operating characteristic (ROC) curves and the diagnostic values were analyzed in differentiating the A-EGJOO and F-EGJOO subgroups. RESULTS: The most common symptom of EGJOO was chest pain or chest discomfort (30.63%), then the dysphagia (29.73%), and acid regurgitation/heartburn (27.03%). Non-erosive reflux disease (36.04%) was the most popular cause for EGJOO, then the reflux esophagitis (17.12%). Besides the intra-EGJOO and extra-EGJOO lesions, the connective tissue disease (6.31%) and central nervous diseases (2.70%) were found to be the etiology of EGJOO. The causes of the rest 19 EGJOO were unknown. A-EGJOO patients presented significantly higher intra bolus pressure (IBP) than that of F-EGJOO [6.80 (5.20, 9.20) mmHg vs. 5.10 (3.10, 7.60) mmHg, P=0.016]. The area under curve of IBP was 0.637. When IBP≥5.15 mmHg, the sensitivity was 78.60% and specificity 50.70% to differentiate A- or F-EGJOO. CONCLUSION: Chest pain or chest discomfort was the most common symptom in EGJOO patients. Besides the intraluminal structural disorders, the extra-luminal causes were found in EGJOO patients. A-EGJOO presented higher IBP than that of F-EGJOO patients. The cutoff value of IBP to differentiate A-EGJOO from EGJOO was 5.15 mmHg with sensitivity 78.06% and specificity 50.70%. However for the low area under curve, the diagnostic value of IBP was limited.

Research Progress on the Determination of Electrical Conductivity in Forensic Science.

ABSTRACT: Electrical conductivity （EC） is an important physical and chemical index in electrochemical analysis. In recent years, with the penetration and reference of transformation medicine and interdisciplinary theory and technology in the forensic field, new applications of EC in the field of forensic science have been developed. This paper reviews three aspects of the application of EC, the determination of biological tissue freshness, postmortem interval estimation and the application in forensic taphonomy, in order to provide reference for relevant scientific research and related practices.

Calhm2 governs astrocytic ATP releasing in the development of depression-like behaviors.

This corrects the article DOI: 10.1038/mp.2017.229.

An epidemiologic study of pelvic organ prolapse in postmenopausal women: a population-based sample in China.

OBJECTIVE: This study aimed to assess the prevalence and factors associated with symptomatic pelvic organ prolapse (POP) in a representative sample of postmenopausal Chinese women. METHODS: A total of 20,008 postmenopausal Chinese women were recruited to this cross-sectional study between February 2014 and March 2016. The prevalence of symptomatic POP, defined as any stage II or higher POP resulting in symptoms, was assessed using questionnaires and physical examinations. Multivariable logistic regression was used to assess factors associated with symptomatic POP. RESULTS: Among all women with natural menopause included in the study (mean age =61.98 ± 10.62 years), 2962 of 20,008 women (14.80%, 95% confidence interval [CI] 14.3-15.3%) had symptomatic POP. In the multivariate analysis, women were more likely to have symptomatic POP if aged 50-59 years (adjusted odds ratio [AOR] 1.322, 95% CI 1.123-1.560), 60-69 years (AOR 1.603, 95% CI 1.352-1.907), or above 70 years (AOR 1.824, 95% CI 1.158-2.197), compared with women aged 40-49 years. Having delivered two times (AOR 1.145, 95% CI 1.105-1.292) or three or more times (AOR 1.384, 95% CI 1.214-1.578) was significantly associated with symptomatic POP. Compared with normal weight women, overweight women (AOR 1.365, 95% CI 1.247-1.494) and obese women (AOR 1.548, 95% CI 1.344-1.780) were more likely to have POP. Living in an urban area, smoking, alcohol consumption, cough, constipation, mental labor, physical disease, and gynecological diseases were also associated with symptomatic POP. CONCLUSIONS: Symptomatic POP affects nearly 15% of postmenopausal women in China. The prevalence of symptomatic POP increases significantly with age, body mass index, and parity.

[Reduction of the atlantoaxial dislocation associated with basilar invagination through single-stage posterior approach: using Xuanwu occipital-cervical reduction surgical suite].

Objective: To examine the effect of posterior reduction in atlantoaxial dislocation (AAD) associated with basilar invagination(BI) using Xuanwu occipital-cervical fusion system in single stage. Methods: Thirty-seven AAD accompanied with BI cases treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy and the Second Hospital of Hebei Medical University were retrospective analyzed. There were 15 males and 22 females with age of (42.3±12.3)years (range: 18-69 yars). All the cases had congenital osseous abnormalities, such as assimilation of atlas and abnormal cervical fusion. Anterior tissue was released through posterior route followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including anterior atlantodental interval (ADI),the distance of odontoid tip above Chamberlain line,clivus-canal angle (CCA) and the length of syrinx were collected.The preoperative and postoperative JOA score and radiological measurements were compared by paired t-test. Results: The mean JOA score of the patients increased from 10.5 to 14.4 at the one-year follow-up(t=14.3,P=0.00).Complete reduction of AAD and BI was achieved in 34 patients.The mean clivus-canal angle improved from 118.0 degrees preoperative to 143.7 degrees postoperative(t=6.2,P=0.00). Shrinkage of the syrinx was observed 1 week after surgery in 24 patients, and 6 months in 31 patients. Twenty-eight patients achieved bone fusion 6 months after surgery. All the patients achieved bone fusion 12 months after surgery. One-side vertebral artery occlusion was diagnosed in 1 case postoperatively for transient dizziness, and relieved in 2 weeks. Two patients developed moderate neck pain after surgery, and relieved in 1 month. No implant failure, spacer subsidence or infection was observed. Conclusions: The treatment of AAD associated with BI using Xuanwu occipital-cervical fusion system from posterior approach in single stage is effective and safe. Cage implantation intraarticularly and fixation with cantilever technique achieve complete reduction in most cases.

[Cardioversion efficacy of nifekalan in patients with sustained atrial fibrillation after radiofrequency ablation].

Objective: To evaluate the efficacy and safety of nifekalan (NIF) on cardioversion in atrial fibrillation (AF) patients post radiofrequency ablation, and investigate the relevant factors related to the cardioversion efficacy of NIF. Methods: We screened patients with sustained AF rhythm after radiofrequency ablation between November 2016 and July 2018. Participants were treated with intravenous NIF 0.4 mg/kg within 5-10 minutes after ablation. We observed the adverse reaction, and monitored the rhythm, heart rate, QT interval and QTc interval before the medication and at 5, 10, 20, 120 min after the medication. According to the drug outcome of NIF, patients were divided into conversion group and non-conversion group, related factors affecting conversion efficacy were evaluated using logistic regression analysis. Results: (1)A total of 116 patients were enrolled in the study (63 males and 53 females, mean age was (64±18) years). Among them, 72 patients were converted to sinus rhythm, and the overall successful rate was 62.1%. There were 84 patients with persistent AF, of which 50 cases (59.2%) were restored to sinus rhythm. There were 32 patients with paroxysmal AF, 22 cases (68.8%) of them were restored to sinus rhythm. The conversion time was 1.5 to 12 (6.8±3.4)min. (2) In 116 patients, the QT interval and QTc interval were significantly longer after medication than before the drug administration (P<0.01), and peaked at about 10th min, and restored to the level before drug administration at about 120th min. (3) There were 8 cases of bradycardia (6.9%), 3 cases of frequent and short ventricular tachycardia (2.6%). (4) The duration of atrial fibrillation was shorter and left atrial diameter was smaller in the cardioversion group than in the non-cardioversion group (both P<0.05). There were no significant differences in gender, disease history, atrial fibrillation type and structural heart disease between the two groups (P>0.05). (5) Multifactorial logistic regression analysis showed that the duration of atrial fibrillation (OR=0.980, 95%CI 0.966-0.994, P=0.004) and the left atrial diameter (OR=0.888, 95%CI 0.814-0.967, P=0.007) were the factors that influence the cardioversion efficacy of NIF on atrial fibrillation post ablation. Conclusions: The total effective rate of NIF was 62.1% in patients witrh sustained AF post radiofrequency ablation, was 68.8% in patients with paroxysmal AF. Besides, NIF has the advantage of short conversion time and few adverse reactions. Left atrium diameter and AF duration were relevant factors that influence the efficacy of NIF of cardioversion in patients with sustained AF after radiofrequency ablation.

Relationship between Electrical Conductivity and Chemical Content of Rat Skeletal Muscle Impregnating Solution and Postmortem Interval.

ABSTRACT: Objective To study the mechanism of change of the electrical conductivity （EC） of rat skeletal muscle impregnating solution that occurs with the change of postmortem interval （PMI）. Methods Healthy Sprague-Dawley rats were killed and kept at about 25 ℃. Skeletal muscles were extracted at different PMI--immediate （0 d）, 1 d, 2 d, 3 d, 4 d, 5 d, 6 d, and 7 d, then mixed with deionized water to make impregnating solution with a mass concentration of 0.1 g/mL. The solution's EC and nine common chemicals in it, such as potassium ion, calcium ion, and chloride ion, were determined. Results EC increased gradually with the extending of PMI （P=0.024） during the 7 days after the rats' death. The content of uric acid （P=0.032）, urea nitrogen （P=0.013） and phosphorus （P=0.022） also increased during the extension. However, the content of magnesium ions decreased with extending of PMI （P=0.047）. The correlation between potassium ion, sodium ion, chlorine ion, calcium ion, creatinine and PMI were weak （P>0.05）. Conclusion The molecular basis of skeletal muscle EC change in rats after their death is the changes of uric acid, urea nitrogen, inorganic phosphorus and other chemical components. Furthermore, combine use of various indicators can improve the accuracy of the EC method to infer PMI.