Predictive value of proximal and distal ureteral diameter ratio for impacted stones in the middle and upper ureter / 中华泌尿外科杂志

Objective:To evaluate the predictive value of proximal ureteral diameter (D1)to distal ureteral diameter (D2)ratio (DDR) for impacted stones in the middle and upper ureter.Methods:The clinical data of 173 patients with middle and upper ureteral calculi admitted to the Third Hospital of Shanxi Medical University from January 2014 to November 2021 were retrospectively analyzed. There were 75 males and 98 females, with the median age of 56.0 (51.0, 62.0) years old and median body mass index of 26.1 (24.8, 27.2) kg/m 2. The imaging data of the patients were analyzed. The impacted stones were defined as the inability of the contrast agent to pass through the site of obstruction when intravenous urography or CT urography was performed, resulting in the inability of the ureter to visualize normally in parts below the site of obstruction. D1 was defined as the proximal ureteral diameter at the lower pole of the kidney on horizontal CT images. D2 was defined as the ureteral diameter 3 cm from the calculi. The stone diameter, stone CT value, D1, D2, and DDR were compared between impacted stone group and non-impacted stone group. Univariate logistic regression analysis was used to analyze the different indicators. Random number table was used to divide the training set and validation set according to the ratio of 7∶3. Through least absolute shrinkage and selection operator(LASSO) regression analysis, the independent influencing factors were obtained and the nomogram model was established (Model 1). Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to verify the predictive efficacy of the model, and the other three effective models (Model 2-4) were constructed by stepwise multivariate logistic regression. The deLong test was used to compare whether there was a significant difference in the AUC between Model 1 and the other three models, and the net benefit of patients was analyzed by clinical decision curve analysis(DCA). Results:In this study, 64 cases (37.0%) were impacted ureteral calculi and 109 cases (63.0%) were non-impacted ureteral calculi, and there were significant differences in diameter[7.8(6.2, 8.8)mm vs. 6.3(5.2, 8.1)mm] , CT value[878.5(763.8, 940.5)HU vs.764.0 (613.0, 854.0) HU], D1[11.1(8.9, 14.9) mm vs. 9.1(7.1, 10.8) mm], D2[4.1(3.1, 4.9) mm vs. 5.0(4.1, 5.9) mm] and DDR[3.1(2.3, 3.9) vs. 1.8(1.4, 2.4)] between the two groups( P < 0.05). The results of univariate logistic regression analysis showed that stone diameter ( OR = 1.333, P < 0.001), CT value ( OR = 1.002, P=0.002), D1 ( OR = 1.146, P<0.001), D2 ( OR = 0.652, P < 0.001) and DDR ( OR = 2.995, P<0.001) were the influencing factors of impacted stones. The training set and validation set included 122 cases and 51 cases, respectively, without significant differences in their image characteristics and outcomes ( P > 0.05). The results of LASSO regression analysis showed that λ corresponding to the simplest result in the optimal range was 0.0908, and three variables were included at this time, and the influencing factors of impacted stones were stone diameter (coefficient 0.0700, OR = 1.073), CT value (coefficient 0.0003, OR = 1.001) and DDR (coefficient 0.5960, OR = 1.815). Moreover, Model 1 was established. According to the model fitting results, ROC curves were plotted, and the AUC of Model 1 was 0.862, and the AUCs of Model 2-4 were 0.859, 0.762, and 0.793, respectively. After deLong test, there was no significant difference between Model 1 and Model 2 ( Z = 0.248, P = 0.804). The AUC of Model 1 was superior to that of Model 3 ( Z = 2.888, P = 0.004) and Model 4 ( Z = 2.321, P = 0.020). The DCA suggested that Model 1 could improve the net benefit rate by up to approximately 21% of patients. Conclusions:DDR is the influencing factor of impacted ureteral calculi, and the model constructed by DDR, stone CT value and stone diameter can effectively predict the probability of impacted ureteral calculi in the middle and upper ureter.

Land-use patterns determine the distribution of soil microplastics in typical agricultural areas on the eastern Qinghai-Tibetan Plateau.

Land-use patterns may affect the distribution characteristics of soil microplastics (MPs), but the effects in the agricultural areas of the Qinghai-Tibetan Plateau are still unknown. This study investigated the abundance of MPs in facility, farmland, grassland, and orchard soils in the Qaidam basin and Hehuang valley of Qinghai Province and analyzed its shape, size, color, and polymer composition distribution characteristics from 105 sites. The average abundance of MPs in facility, farmland, and grassland soils in the Hehuang valley were 2795.7, 1860.5, and 910.9 items kg-1, which were 1.33, 4.84, and 1.50 times higher than those in the Qaidam basin, respectively. Orchard soils had 1322.2 items kg-1 MPs. Soil MPs abundance in grassland and farmland was positively correlated with precipitation and 0 cm ground temperature; and negatively correlated with average wind speed (p < 0.05). Both the particle size of < 1 mm and pellet-shape MPs abundance showed a positive correlation with SOC (p < 0.05). Land-use patterns had the most significant affecting force (51.35%) on soil MPs abundance (p < 0.0001). Hence, land-use patterns, regional climate, and soil properties influence the distribution characteristics of soil MPs; besides, the land-use patterns were dominant.

Health risk factor and effectiveness of intervention for hospital employees / 中华全科医师杂志

Objective To evaluate the effectiveness of intervention for health risk factor in hospital employees. Methods This study was carried out among 339 employees of a hospital in Jinan, Shandong Province. Based on the results of Health Risk Appraisal for 14 health risk factors, we designed a 6-months intervention program for the most widely distributed and intervenable health risk factors; and then evaluated the changes of health risk factors after 6 months. Results After 6-month intervention the prevalence of 3 health risk factors decreased (P ＜ 0.05 ): physical inactivity decreased from 57.8% to 38.6%,hyperlipidemia from 9.4% to 5.3%, and unhealthy dietary from 28.9% to 14.8%. Compared with the baseline data, the average number of health risk factors were reduced from 3.10 to 2. 71 ( P ＜ 0. 01 ).Conclusion The intervention can reduce health risk factors effectively.

The effects of gait training with a gait orthosis on the neurogenic bladder after spinal cord injury / 中华物理医学与康复杂志

Objective To explore the effects of gait training with an alternative gait orthosis (AGO) on the neurogenic bladders of patients with spinal cord injury (SCI). Method Twelve patients with complete SCI at the thoracic and lumbar level were trained for 8 weeks on motor and bladder function. After that, specific gait training with an AGO was given for another 8 weeks. American Spinal Injury Association ( ASIA ) sensation and motor function assessments were done before and after the gait training with the AGO, and bladder capacity, residual urine and urine flow rates were also assessed. Results Compared with pre-treatment there was no significant difference in average ASIA senzsation and motor scores after training, but the maximum rate of urine flow, average urine volume and single urination had significantly increased and residual urine volume had significantly decreased. Conclusions Therapeutic gait training with an AGO can improve bladder function after SCI.