Assessing a cut-off point for the diagnosis of abnormal uterine bleeding using the Menstrual Bleeding Questionnaire (MBQ): a validation and cultural translation study with Brazilian women

ABSTRACT BACKGROUND: Abnormal uterine bleeding (AUB) is a common condition, and the Menstrual Bleeding Questionnaire (MBQ) is used for its assessment. OBJECTIVES: To translate, assess the cut-off point for diagnosis, and explore psychometric properties of the MBQ for use in Brazilian Portuguese. DESIGN AND SETTING: Prospective cohort study including 200 women (100 with and 100 without AUB) at a tertiary referral center. METHODS: MBQ translation involved a pilot-testing phase, instrument adjustment, data collection, and back-translation. Cut-off point was obtained using receiver operating curve analysis. Menstrual patterns, impact on quality of life due to AUB, internal consistency, test-retest, responsiveness, and discriminant validity were assessed. For construct validity, the Pictorial Blood Assessment Chart (PBAC) and World Health Organization Quality of Life - abbreviated version (WHOQOL-BREF) were applied. RESULTS: Women with AUB were older, had higher body mass indices, and had a worse quality of life during menstruation. Regarding the MBQ's psychometric variables, Cronbach's alpha coefficient was > 0.70 in all analyses, high intraclass correlation coefficient was found in both groups; no ceiling and floor effects were observed, and construct validity was demonstrated (correlation between MBQ score, PBAC score, and clinical menstrual cycle data). No difference between MBQ and PBAC scores were perceived after the test-retest. Significant differences were found between MBQ and PBAC scores before and after treatment. An MBQ score ≥ 24 was associated with a high probability of AUB; accuracy of 98%. CONCLUSION: The MBQ is a reliable questionnaire for Brazilian women. The cut-off ≥ 24 shows high accuracy to discriminate AUB.

Risk Assessment of the Onset of Sleep-related Painful Erection / 中山大学学报(医学科学版)

ObjectiveSleep-related painful erections （SRPE） is a rare sleep disorder characterized by repeated awakening due to painful interruptions of penile erections during nighttime sleep， and its etiology is currently unclear. The purpose of this study is to explore the impact of potential risk factors on the incidence of SRPE. MethodsInformation was collected through questionnaires administered to patients who presented at the urology department and suffered from SRPE or did not suffer from SRPE. A total of 290 participants completed the study， including 145 controls and 145 cases. Logistic regression analysis was used to assess the impact of age， occupation， sleep initiation time per night， frequency of sexual intercourse per week， psychological status， erectile dysfunction， chronic prostatitis， prostate enlargement， lumbar spine disease， central nervous system disease， hypertension， diabetes and family history on the onset of SRPE. ResultsSingle-factor logistic regression analysis found that a history of chronic prostatitis， intellectual labor occupation， central nervous system disease， late sleep onset， frequency of sexual activity， and anxiety status might be related to the onset of SRPE. After incorporating these factors into a multivariate regression analysis model， it was found that having sexual activity ≥2 times/week （OR 95%CI = 0.326（0.179，0.592） and late sleep onset （after 24：00） （OR 95%CI = 0.494（0.265，0.918）might be protective factors for SRPE， while a history of chronic prostatitis（OR 95%CI = 3.779（2.082，6.859） might be a risk factor for SRPE. However， there was no significant statistical difference in the impact of central nervous system diseases and occupation on multivariate analysis. ConclusionChronic prostatitis and anxiety status may be independent risk factors for SRPE； having sexual activity ≥2 times/week and delaying sleep time appropriately may be independent protective factors.

Germenectomía de los terceros molares con cefalometría predictiva de brote / Germenectomy of third molars with predictive cephalometry of abnormal eruption

Introducción: Las complicaciones, asociadas al brote anormal de los terceros molares, es posible evitarlas con la germenectomía de estos dientes. Objetivo: Caracterizar la evolución de la germenectomía de terceros molares en pacientes con diagnóstico cefalométrico de brote anormal. Métodos: Se realizó un estudio observacional, descriptivo y transversal en el Servicio de Cirugía Maxilofacial del Hospital Provincial "Saturnino Lora Torres", desde febrero de 2019 hasta marzo de 2021. Se estudiaron 32 pacientes de 13 a 15 años de edad, interviniéndose quirúrgicamente 78 terceros molares. Las variables fueron edad, sexo, color de la piel, localización y posición del tercer molar; así como las complicaciones trans y posoperatorias y la evolución. Resultados: Entre los 32 pacientes incluidos en el estudio predominó el sexo femenino (62,5 por ciento) y la edad de 14 años (40,6 por ciento). Las complicaciones ocurridas durante la germenectomía fueron más frecuentes en la arcada inferior. Aunque no fueron detectadas diferencias estadísticamente significativas según localización (valor de p>0,05); con 30 transoperatorias para un 38,4 por ciento y 75 posoperatorias para un 96,2 por ciento. Conclusiones: Se evidencia una evolución marcadamente favorable posterior a la germenectomía de terceros molares en la población de pacientes con diagnóstico cefalométrico de brote anormal. En ellos el sangrado transoperatorio y el dolor posoperatorio constituyen las complicaciones a considerar en este tipo de procedimiento quirúrgico(AU)

Introduction: Complications associated with the abnormal eruption of third molars can be avoided with germenectomy of these teeth. Objective: To characterize the evolution of third molar germenectomy in patients with a cephalometric diagnosis of abnormal bud. Methods: An observational, descriptive and cross-sectional study was carried out in the Maxillofacial Surgery Service at Saturnino Lora Torres Provincial Hospital, from February 2019 to March 2021. Thirty two patients aged 13 to 15 years were studied, with 78 third molars undergoing surgery. The variables were age, sex, skin color, location and position of the third molar; as well as trans and postoperative complications and evolution. Results: Among the 32 patients included in the study, the female sex (62.5 percent) and the age of 14 years (40.6 percent) predominated. Complications that occurred during germenectomy were more frequent in the lower arch. Although no statistically significant differences were perceived according to location (p value > 0.05); with 30 intraoperative for 38.4 percent and 75 postoperative for 96.2 percent. Conclusions: There is evidence of a markedly favorable evolution after germenectomy of third molars in the population of patients with cephalometric diagnosis of abnormal bud. In them, transoperative bleeding and postoperative pain are the complications to consider in this type of surgical procedure(AU)

Hemoglobina Denver, una causa de desaturación en oximetría de pulso. Reporte de caso en un paciente pediátrico / Hemoglobin Denver, a cause of desaturated pulse oximetry. A pediatric case report

Las hemoglobinopatías son trastornos genéticos que afectan a la molécula de hemoglobina (Hb). Las mutaciones en las cadenas a o b que alteran el tetrámero de Hb pueden modificar la capacidad de la molécula para unirse al oxígeno. Las hemoglobinopatías con baja afinidad al oxígeno pueden presentarse con cianosis y una lectura alterada de la oximetría de pulso, lo que lleva a pruebas innecesarias y, a veces, invasivas para descartar afecciones cardiovasculares y respiratorias. En el siguiente reporte de caso, presentamos a una paciente pediátrica, asintomática, que se presentó a la consulta por detección de desaturación en oximetría de pulso. Las pruebas de laboratorio iniciales mostraron una anemia normocítica, normocrómica. Las muestras de gas venoso demostraron una p50 elevada. Después de extensas herramientas de diagnóstico, se diagnosticó una variante de Hb con baja afinidad al oxígeno, Hb Denver.

Hemoglobinopathies are genetic disorders that affect the hemoglobin (Hb) molecule. Mutations in the alpha or beta chains altering the Hb tetramer may modify the molecule's oxygen-binding capacity. Hemoglobinopathies with low oxygen affinity may occur with cyanosis and an altered pulse oximetry reading, leading to unnecessary and sometimes invasive tests to rule out cardiovascular and respiratory conditions. In the case report described here, we present an asymptomatic pediatric patient who consulted for desaturated pulse oximetry. Her initial laboratory tests showed normocytic, normochromic anemia. Venous blood gas samples showed an elevated p50. After using extensive diagnostic tools, a variant of Hb with low oxygen affinity was diagnosed: Hb Denver.

Immunophenotypic characterization of normal and abnormal plasma cells in bone marrow of newly diagnosed multiple myeloma patients

Background: Identification of plasma cells into abnormal (APC) and normal (NPC) compartments is of utmost importance in flow cytometric (FC) analysis of multiple myeloma (MM) and related plasma cell dyscrasias for diagnosis, prognosis, and follow-up. No single phenotypic marker is sufficient to distinguish NPC from APC. Materials and Methods: 43 newly diagnosed cases of MM and 13 controls were included in the study. Bone marrow (BM) samples from the 2nd pass were processed on the same day with antibodies against CD38, CD138, CD19, CD81, CD45, CD117, CD200, CD56, cytoKappa, and cytoLambda in a 4-color experiment with CD38 and CD138 as gating antibodies. Results: Mean APC% in cases was 96.5%. The expected Immunophenotype (IP) of APC which is CD19-/56+/45-/81-/117+/200+ was found in only 13/43 MM cases. In 30/43 cases, APC revealed deviation from expected IP either for single or a combination of markers. Sensitivity for APC detection was highest for CD19 (95.2%) followed by CD56 (90.4%) and CD81 (83.7%). Specificity was highest for CD19 (100%), CD56 (100%), and CD81 (100%) followed by CD117 (92.3%). Combination of markers with maximum sensitivity to detect APC (97.6%) was CD81- or CD19- and CD200+ or CD56+ (two markers); and for NPC (92.3%) was CD81+ and CD19+ and CD56- (three markers). Conclusion: Plasma cell IP can be highly variable with multiple minor subpopulations in both cases and normal controls. CD 19 and CD56 are highly informative markers for a 4-color experiment. Assessment of multiple markers in an 8–10 color experiment is more informative but the lack of advanced flow cytometers should not limit the use of FC in a 4-color approach. Our results emphasize that even basic equipment with limited fluorochrome can provide meaningful information if used appropriately.

Electrocardiogram abnormalities detected during a routine medical examination of healthy members of the armed forces: An observational study

Background and objective: Only few studies addressed ECG findings in healthy members of the Indian armed forces or the general population of India. The study was conducted to assess the prevalence of abnormal electrocardiogram (ECG) detected during a routine medical examination of healthy members of the Indian armed forces. Method: The ECG of all the healthy members performed during a routine medical examination was initially reported by physicians at various armed forces service hospitals in the Eastern Command (EC) and later perused by the cardiologist at Command Hospital Eastern Command (CHEC). Individuals with abnormal ECG underwent relevant cardiac evaluation at CHEC to determine the underlying pathology. Results: A total of 1,045 members of the Indian armed forces were included in the study and were categorised as follows: 244 in Group-1 (aged < 25years), 478 in Group-2 (aged between 25 to 40 years) and 323 in Group-3 (aged > 40years). Abnormal ECG was found in 108 (10.3%) individuals. Left axis deviation was the most common abnormality detected in 18 (1.2%) individuals, followed by incomplete RBBB and T wave inversion which were each found in 15 subjects (1.43% of all individuals and 13.9% of the subjects with abnormal ECG). The prevalence of ECG abnormalities detected in our study was similar to that reported in previous studies. Only five (0.47%) of the 108 individuals with abnormal ECG were found to have underlying cardiovascular disease. Conclusion: Morphological ECG abnormalities were common in the subjects but did not vary significantly from the general population, and only a minority had underlying pathology. While most of the abnormalities may only represent normal variations and their occurrence in healthy individuals during routine health check-ups should not be alarming. Evaluation of structural heart disease should be done for ECG abnormalities with prognostic significance that has been well-characterised.

Histopathological changes in the uterus in women with abnormal uterine bleeding – A 2-year hospital-based retrospective study in a tertiary care center in Assam, India

Background: Abnormal uterine bleeding (AUB) or menstrual bleeding of abnormal amount, duration, or schedule is a common gynecological condition occurring in up to 50% of women of all age groups. Chronic, heavy, prolonged, or irregular uterine bleeding can lead to anemia, and raise a concern about severe underlying malignancy. Therefore, histopathological examination of the endometrium is critical in evaluating the cause of AUB. Aims and Objectives: The aims of this study were to study the various histomorphological patterns in endometrial biopsies in cases of AUB. Materials and Methods: This is a retrospective study done on 212 endometrial tissues in women presenting with AUB. The study is aimed at analyzing the histopathological changes occurring in the endometrium by identifying the cause of bleeding and recording the incidence of various histopathological findings in different age groups. Results: Proliferative endometrium, the most common histopathological finding, accounted for 51.9% of cases, followed by secretory endometrium (24.5%). Eight cases of disordered proliferative endometrium were found in the present study. Eight cases, accounting for 3.8% of endometrial hyperplasia, were associated with AUB, out of which two cases were found to be complex hyperplasia with atypia. Endometrial carcinoma was seen in two cases associated with AUB. Pregnancy-related changes were found in 7 (3.3%) cases, retained product of conception was the leading cause of bleeding (3 cases). Conclusion: Histopathological evaluation of endometrium in women presenting with AUB is of paramount importance not only to diagnose various benign conditions but also to detect some highly malignant lesions and precancerous conditions so that early interventions can be started.

Hyperprolactinemia among the patients of menstrual disorders in a tertiary care hospital

Background: Menstrual disorders are a common clinical problem due to multiple causes. Hyperprolactinemia, is disorders of hypothalamic-pituitary axis in young women, is usually associated with amenorrhea, oligomenorrhea, anovulation, and ovulatory cycles with short or inadequate luteal phase, and galactorrhoea. Menstrual disorder affects physical and mental health of every woman. Aims and Objectives: The aim of the study was to know hyperprolactinemia among the patients of menstrual disorders in a tertiary care hospital. Materials and Methods: Women with menstrual irregularities attending Gynae outpatient department and admitted initially checked clinically and their serum prolactin level were measured. Women in reproductive age group (15–45 years) with complain of abnormal uterine bleeding were included in the study. Menopausal women, women with organic diseases in uterus and cervix, and pregnant women were excluded from the study. Results: Prolactin level is statistically significant with age (P = 0.011). The patients from age group of 20 to 35 years had high proportion (14.4%) of hyperprolactinemia followed by age group <20 years. (12.9%) and >35 years (12.9%). The women presenting with menstrual disorders enlisted in the study were evaluated on the basis of their sociodemographic parameters. About (15.5%) were below 20 years. About (27%) were above 35 years and majority of the women (57.5%) enrolled in the study were from age group of 2035 years of age. Serum prolactin level was observed in 15.4% in patients with frequent menses, 9.1% in patients with metrorrhagia and 7.7% in patients with heavy menstrual bleeding. That result was statistically significant with P = 0.039. Conclusion: Serum prolactin level should be evaluated in every patient of menstrual disorders.

Alterações mínimas em enzimas hepáticas à admissão hospitalar correlacionam-se à gravidade da COVID-19 em uma grande coorte no Brasil / Minimal liver enzymes abnormalities at admission are related to severe covid-19 clinical course in a large brazilian cohort

ABSTRACT Background: COVID-19 is a multisystemic disease, primarily affecting the respiratory system. Liver involvement is frequent, but the impact on the clinical course and outcomes are controversial. Objective: The aim was to assess liver function at the admission and evaluate its effects on severity and mortality in hospitalized patients with COVID-19. Methods: This is a retrospective study of hospitalized patients in a tertiary hospital in Brazil, with a PCR-confirmed SARS-CoV-2 infection between April and October 2020. 1080 out of 1229 patients had liver enzymes on admission and were divided in two cohorts, based on the presence or absence of abnormal liver enzymes (ALE). Demographic, clinical, laboratory, imaging, clinical severity, and mortality were evaluated. Patients were followed until discharge, death or transfer to another institution. Results: Median age was 60 years and 51.5% were male. The more frequent comorbidities were hypertension (51.2%), and diabetes (31.6%). Chronic liver disease and cirrhosis were present in 8.6% and 2.3%, respectively. ALE (aminotransferases higher than 40 IU/L) were present in 56.9% of patients [mild (1-2 times): 63.9%; moderate (2-5 times): 29.8%; severe (>5 times): 6.3%]. Male gender [RR 1.49, P=0.007], increased total bilirubin [RR 1.18, P<0.001] and chronic liver disease [RR 1.47, P=0.015] were predictors of abnormal aminotransferases on admission. Patients with ALE had a higher risk of disease severity [RR 1.19; P=0.004]. There was no association among ALE and mortality. Conclusion: ALE is common in COVID-19 hospitalized patients and were independently correlated with severe COVID-19. Even mild ALE at admission may be a severity prognostic marker.

RESUMO Contexto: COVID-19 é uma doença sistêmica que afeta primariamente o sistema respiratório. O comprometimento hepático é frequente, mas seu impacto no curso clínico da doença ainda é controverso. Objetivo: Avaliar na admissão hospitalar a função hepática de pacientes com COVID-19 e correlacioná-la à gravidade e mortalidade da doença. Métodos: Estudo retrospectivo de pacientes admitidos a um hospital terciário no Brasil, com infecção confirmada por SARS-CoV-2 entre abril e outubro de 2020. A coorte foi dividida em pacientes com enzimas normais ou alterada, e avaliados dados demográficos, clínicos, laboratoriais e de imagem, bem como a gravidade clínica e a mortalidade. Os pacientes foram seguidos até a alta ou óbito. Resultados: 1080 de 1229 pacientes tiveram enzimas hepáticas na admissão. A mediana de idade foi de 60 anos e 51,5% eram homens. As comorbidades mais comuns foram hipertensão (51,2%) e diabetes mellitus (31,6%). Doença hepática crônica ou cirrose estiveram presentes em 8,6% e 2,3%, respectivamente. Enzimas normais ou alterada (aminotransferases >40 IU/L) esteve presente em 56,9% [leve (1-2 vezes o normal): 63,9%; moderada (2-5 vezes): 29,8%; acentuada (>5 vezes): 6,3%]. Homens [RR 1,49; P=0,007], bilirubina total elevada [RR 1,18; P<0,001] e doença hepática crônica [RR 1,47, P=0,015] foram preditores de enzimas normais ou alterada na admissão. Pacientes com enzimas normais ou alterada tiveram maior risco de COVID-19 grave [RR 1,19; P=0,004]. Não houve associação entre enzimas normais ou alterada e mortalidade. Conclusão: Enzimas normais ou alterada é comum em pacientes hospitalizados com COVID-19. Mesmo alterações mínimas correlacionam-se de forma independente com a gravidade da doença e podem ser úteis como marcador prognóstico.

Leiomioma uterino gigante en adolescente mexicana de 14 años, un caso raro de sangrado uterino anormal. Reporte de caso / Giant uterine leiomyoma in a 14-year-old Mexican adolescent, a rare case of abnormal uterine bleeding. Case Report

Resumen ANTECEDENTES: Los leiomiomas son neoplasias benignas comunes durante la edad reproductiva. Su aparición en adolescentes es excepcional y un reto diagnóstico en menores de 18 años de edad. El caso aquí reportado se integra a los 26 casos asentados en la bibliografía y se trata del tumor más grande en la paciente más joven hasta ahora comunicado. CASO CLÍNICO: Paciente de 14 años, con inicio de sangrado uterino anormal, aumento del perímetro abdominal y tres semanas con hipermenorrea. El reporte inicial de la química sanguínea informó: anemia severa y el ultrasonido pélvico: un gran tumor anexial sólido. Luego de mejorar las condiciones hemodinámicas de la paciente por medio de transfusiones de concentrados eritrocitarios se practicó una laparotomía exploradora y se extirpó un leiomioma gigante, dependiente del útero. El informe histopatológico fue de: leiomioma de 16 cm de diámetro, con degeneración roja. La paciente cursó sin complicaciones posquirúrgicas y hasta la actualidad no ha experimentado datos de recurrencia ni sangrado uterino anormal. CONCLUSIÓN: La fisiopatología de la miomatosis uterina sigue aún sin comprenderse del todo. El tratamiento quirúrgico a una edad temprana debe tomar en consideración el deseo de embarazo y llevar a cabo un seguimiento estrecho para valorar: la fertilidad, recurrencia, atipia celular y trastornos menstruales.

Abstract BACKGROUND: Leiomyomas are common benign neoplasms during reproductive age. Its appearance in adolescents is exceptional and a diagnostic challenge in children under 18 years of age. The case reported here is one of the 26 cases reported in the bibliography and it is the largest tumor reported in the youngest patient to date. CLINICAL CASE: A 14-year-old patient with onset of abnormal uterine bleeding, increased abdominal circumference and three weeks with hypermenorrhea. Initial blood chemistry report: severe anemia and pelvic ultrasound: a large solid adnexal tumor. After improving the patient's hemodynamic conditions through transfusions of erythrocyte concentrates, an exploratory laparotomy was performed and a giant leiomyoma, dependent on the uterus, was removed. The histopathological report was: leiomyoma of 16 cm in diameter, with red degeneration. The patient had no postoperative complications and to date she has not experienced recurrence or abnormal uterine bleeding. CONCLUSION: The pathophysiology of uterine fibroids remains poorly understood. Surgical treatment at an early age should take into account the desire for pregnancy and carry out a close follow-up to assess: fertility, recurrence, cellular atypia and menstrual disorders.

Chromosomal abnormalities detected by karyotyping among patients with secondary amenorrhea: a retrospective study

ABSTRACT BACKGROUND: Chromosomal abnormalities (CAs) have been described in patients with secondary amenorrhea (SA). However, studies on this association are scarce. OBJECTIVES: To evaluate the frequency and types of CAs detected by karyotyping in patients with SA. DESIGN AND SETTING: This retrospective study was performed in a reference clinical genetic service in South Brazil. METHODS: Data were obtained from the medical records of patients with SA who were evaluated between 1975 and 2022. Fisher's bicaudate exact test and Student's t-test were used, and P < 0.05 was considered significant. RESULTS: Among 43 patients with SA, 14 (32.6%) had CAs, namely del (Xq) (n = 3), 45,X (n = 2), 46,X,r(X)/45,X (n = 2), 46,XX/45,X (n = 1), 46,X,i(q10)/45,X (n = 1), 47,XXX (n = 1), 46,XX/47,XXX (n = 1), 46,XX/47,XX,+mar (n = 1), 45,XX,trob(13;14)(q10;q10)/46,XXX,trob(13;14)(q10;q10) (n = 1), and 46,XX,t(2;21)(q23;q11.2) (n = 1). Additional findings were observed mostly among patients with CA compared with those without CA (P = 0.0021). No difference in the mean age was observed between the patients with SA with or without CAs (P = 0.268025). CONCLUSIONS: CAs are common among patients with SA, especially those with short stature and additional findings. They are predominantly structural, involve the X chromosome in a mosaic, and are compatible with the Turner syndrome. Patients with SA, even if isolated, may have CAs, particularly del (Xq) and triple X.

Screening and diagnostic system construction for optic neuritis and non-arteritic anterior ischemic optic neuropathy based on color fundus images using deep learning / 中华眼底病杂志

Objective:To construct and evaluate a screening and diagnostic system based on color fundus images and artificial intelligence (AI)-assisted screening for optic neuritis (ON) and non-arteritic anterior ischemic optic neuropathy (NAION).Methods:A diagnostic test study. From 2016 to 2020, 178 cases 267 eyes of NAION patients (NAION group) and 204 cases 346 eyes of ON patients (ON group) were examined and diagnosed in Zhongshan Ophthalmic Center of Sun Yat-sen University; 513 healthy individuals of 1 160 eyes (the normal control group) with normal fundus by visual acuity, intraocular pressure and optical coherence tomography examination were collected from 2018 to 2020. All 2 909 color fundus images were as the data set of the screening and diagnosis system, including 730, 805, and 1 374 images for the NAION group, ON group, and normal control group, respectively. The correctly labeled color fundus images were used as input data, and the EfficientNet-B0 algorithm was selected for model training and validation. Finally, three systems for screening abnormal optic discs, ON, and NAION were constructed. The subject operating characteristic (ROC) curve, area under the ROC (AUC), accuracy, sensitivity, specificity, and heat map were used as indicators of diagnostic efficacy.Results:In the test data set, the AUC for diagnosing the presence of an abnormal optic disc, the presence of ON, and the presence of NAION were 0.967 [95% confidence interval ( CI) 0.947-0.980], 0.964 (95% CI 0.938-0.979), and 0.979 (95% CI 0.958-0.989), respectively. The activation area of the systems were mainly located in the optic disc area in the decision-making process. Conclusion:Abnormal optic disc, ON and NAION, and screening diagnostic systems based on color fundus images have shown accurate and efficient diagnostic performance.

Current situation of health checkup and the management willingness of post-test abnormal values among residents of mega communities / 中华健康管理学杂志

Objective:To investigate the current status of health checkups and the management willingness of post-test abnormal values in residents of mega communities, and to explore the factors affecting the demand for health management of abnormal values after examination.Methods:A cross-sectional study. The residents of Huaguoyuan Community in Guiyang City were enrolled as the objects of this surveywith stratified systematic sampling method and questionnaire survey. The binary logistic regression was used to analyze the influencing factors of health management demand for abnormal values after examination.Results:There were 404 residents participating in this survey, and 182 cases were male (45.05%) and 222 cases were female (54.95%); the mean age was (39.64±15.03) years. There were 179 (44.31%) urban residents and 225 (55.69%) rural residents. There were 162 (40.10%) floating population and 242 (59.90%) non-floating population. Of the residents, 34.2% participated in the physical examination independently due to physical reasons. The age ( χ 2=16.227), household registration ( χ 2=16.117) and occupation ( χ 2=36.454) had statistically significant differences in residents′ participation in physical examination; the household registration ( χ 2=18.726, P<0.001) and occupation ( χ 2=18.094, P=0.034) had significant differences in the handling methods of abnormal values of physical examination. The age ( OR=7.00, P=0.032) and income ( OR=0.33, P=0.047) were the influencing factors of health management needs of abnormal values after health checkup. Conclusion:The awareness of active physical examination of residents in mega community is weak, and it is recommended to strengthen health education and health promotion; residents have a high willingness to the management of abnormal values after health checkup, it can be an important supplement to improve the service quality of physical examination related institutions.

Analysis of abnormal results of individual dose monitoring for radiation workers in medical institutions in Henan province from 2020 to 2022 / 中华放射医学与防护杂志

Objective:To analyze the abnormal dose monitoring result of radiation staff in medical institutions and provide a basis for standardizing the personal dose management of radiation staff in medical institutions.Methods:Through the occupational radiation disease monitoring subsystem of the National Radiation Health Information Platform, 516 individual dose monitoring abnormal result of 410 radiation workers in a single monitoring period, which in 168 medical institutions under the 18 cities in Henan province were collected from 2020 to 2022 as research objects. Based on gender, age, length of service, occupational category, medical institution level, whether the dosimeter wearing standard, the abnormal result of radiation workers were grouped to analyze the influencing factors of individual dose monitoring result.Results:The incidence of abnormal individual dose monitoring result in 2020-2022 was 6.83 × 10 -3, 5.22 × 10 -3 and 6.30 × 10 -3, respectively. Abnormal results were mainly distributed in male radiology workers (66.83%), diagnostic radiology (59.51%) and interventional radiology (34.63%), tertiary (54.39%) and secondary medical institutions (36.34%). In the case of wearing personal dosimeter in a standard or irregular way, there were statistically significant differences in the incidence of abnormal outcomes between different levels of medical institutions and different occupational categories( χ2=14.42, 6.56, 32.96, 177.15, P<0.05). The median annual individual dose of radiology workers with " abnormal exposure dose" due to increased workload was 3.95 mSv, and the annual individual dose of interventional radiology workers was higher than that of radiotherapeutic workers ( Z=5.07, P<0.05). Conclusions:The education and training of radiological protection should be strengthened, and the wearing of individual dosimeters should be standardized; focus on the occupational exposure of interventional radiology staff, and take effective measures to reduce their exposure dose.

Accuracy of bone age assessment system based on deep learning in children with abnormal growth and development / 中华放射学杂志

Objective:To explore the accuracy of artificial intelligence (AI) system based on deep learning in evaluating bone age of children with abnormal growth and development.Methods:The positive X-ray films of the left wrist of children with abnormal growth and development who were treated at the Affiliated Hospital of Guizhou Medical University from January 2020 to December 2021 were collected retrospectively. A total of 717 children were collected, including 266 males and 451 females, aged 2-18 (11±3) years. Based on Tanner Whitehouse 3 (TW 3)-RUS (radius, ulna, short bone) and TW3-Carpal (carpal bone) method, bone age was measured by 3 senior radiologists, and the mean value was taken as reference standard. The bone ages were independently evaluated by the AI system (Dr.Wise bone age prediction software) and two junior radiologists (physicians 1 and 2). The accuracy within 0.5 year, the accuracy within 1 year, the mean absolute error (MAE) and the root mean square error (RMSE) between the evaluation results and the reference standard were analyzed. Paired sample t-test was used to compare MAE between AI system and junior physicians. Intraclass correlation coefficient (ICC) was used to evaluate the consistency between AI system, junior physician and reference standard. The Bland-Altman diagram was drawn and the 95% consistency limit was calculated between AI system and reference standard. Results:For TW3-RUS bone age, compared with the reference standard, the accuracy within 0.5 year of AI system, physician 1 and physician 2 was 75.3% (540/717), 62.1% (445/717) and 66.2% (475/717), respectively. The accuracy within 1 year was 96.9% (695/717), 86.3% (619/717) and 89.1% (639/717), respectively. MAE was 0.360, 0.565 and 0.496 years, and RMSE was 0.469, 0.634 and 0.572 years, respectively. For TW3-Carpal bone age, compared with the reference standard, the accuracy within 0.5 year of AI system, physician 1 and physician 2 was 80.9% (580/717), 65.1% (467/717) and 71.7% (514/717), respectively. The accuracy within 1 year was 96.0% (688/717), 87.3% (626/717) and 90.4% (648/717), respectively. MAE was 0.330, 0.527 and 0.455 years, and RMSE was 0.458, 0.612, 0.538 years, respectively. Based on TW3-RUS and TW3-Carpal bone age, the MAE of AI system were lower than those of physician 1 and physician 2, and the differences were statistically significant ( P all<0.001). The evaluation results of AI, physician 1 and physician 2 were in good agreement with the reference standard (ICC all>0.950). The Bland-Altman analysis showed that the 95% agreement limits of AI system for assessing TW3-RUS and TW3-Carpal bone age were -0.75-1.02 years and-0.86-0.91 years, respectively. Conclusion:The accuracy of AI system in evaluating the bone age of children with abnormal growth and development is close to that of senior doctors, better than that of junior doctors, and in good agreement with senior doctors.

Application value of ERCP in the diagnosis and treatment of pancreaticobiliary maljunction in children / 中华胰腺病杂志

Objective:To investigate the application value of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of pancreaticobiliary maljunction (PBM) in children.Methods:The clinical data of 77 PBM children who underwent ERCP in General Surgery Department of Children's Hospital affiliated to Nanjing Medical University between January 2018 and December 2021 were retrospectively evaluated. Clinical characteristics, classification and post-operative nursing interventions were summarized, and vital signs, changes of biochemical markers and the occurrence of postoperative complications were compared and recorded.Results:77 patients were classified according to Japanese Study Group on Pancreaticobiliary Maljunction (JSGPM), including 34 patients with type A, 18 patients with type B, 21 patients with type C, and 4 patients with type D. There were 68 patients with congenital bile duct dilation and 9 patients without congenital bile duct dialtion. 92 ERCP procedures were performed under general anesthesia, and 91 cases were successful with a success rate of 98.91%. Among these cases, including 7 cases of endoscopic sphincterotomy, 28 cases of endoscopic balloon dilation of the nipple, 22 cases of endoscopic probe dilation, 22 cases of endoscopic stone removal by balloon or basket, 35 cases of endoscopic retrograde biliary stent drainage, 4 cases of endoscopic pancreatic duct drainage, 18 cases of endoscopic nasobiliary drainage, 2 cases of endoscopic nasobiliary drainage, and 14 cases of biliary stent removal. In 77 children with PBM, body temperature, FLACC score, and laboratory-related biochemical indexes including direct bilirubin, serum amylase, ALT, AST and CGT decreased significantly after ERCP, and all the differences were statistically significant (all P value <0.001). The incidence of postoperative complications was 15.38%(14/91), including hyperamylasemia in 9 cases (9.89%) and abdominal pain in 5 cases (5.49%). Conclusions:ERCP is safe and effective in the treatment of abnormal confluence of pancreatic duct in children.

Prevalence and risk factors of lower urinary tract symptoms in rural children and adolescents / 现代泌尿外科杂志

【Objective】 To investigate the prevalence and risk factors of lower urinary tract symptoms (LUTS) in rural children and adolescents. 【Methods】 An epidemiological LUTS survey was carried out on 4 100 children and adolescents (aged 6-16 years) in five primary and secondary schools in rural Henan by means of stratified random cluster sampling using anonymous questionnaires. Daytime urinary incontinence (DUI), nocturnal enuresis (NE), and postnatal diaper use and toilet training were investigated. 【Results】 A total of 3 885 valid questionnaires were recovered (with a recovery rate of 94.76%). The total prevalence of the four symptoms of LUTS, including urgency, frequency, DUI and NE, were 16.42%, 10.91%, 7.41% and 7.95%, respectively. As much as 21.13% subjects had at least one symptom. The prevalence of the four symptoms decreased gradually with age, decreased sharply in those aged 6 to 12 years, and then decreased slowly. The prevalence of LUTS in children who stopped using diapers and stared urine training after 1 year of age was significantly higher than that of those within 1 year of age (χ2=21.605, 23.111, 24.189, 23.509, all P<0.05; χ2=102.17, 72.168, 53.656, 197.76, all P<0.05). There were significant differences in the prevalence of LUTS between those with and without toilet training (χ2=315.273, 198.438, 105.723, 272.502, all P<0.05). The prevalence of LUTS in males was significantly higher than that in females (P<0.05). Constipation, prepuce and phimosis in boys were significantly associated with the prevalence of LUTS (P<0.05). 【Conclusion】 Rural children and adolescents have a high prevalence of LUTS. Diaper use after 1 year of age, history of urinary tract infection (UTI), lack of toilet training, constipation, and abnormal prepuce are risk factors of LUTS. Urine training before 1 year of age is a protective factor of LUTS.

Clinical analysis of liver dysfunction induced by SHR-1210 alone or combined with apatinib and chemotherapy in patients with advanced esophageal squamous cell carcinoma / 中华肿瘤杂志

Objective: To investigate the clinical characteristics of abnormal liver function in patients with advanced esophageal squamous carcinoma treated with programmed death-1 (PD-1) antibody SHR-1210 alone or in combination with apatinib and chemotherapy. Methods: Clinical data of 73 patients with esophageal squamous carcinoma from 2 prospective clinical studies conducted at the Cancer Hospital Chinese Academy of Medical Sciences from May 11, 2016, to November 19, 2019, were analyzed, and logistic regression analysis was used for the analysis of influencing factors. Results: Of the 73 patients, 35 had abnormal liver function. 13 of the 43 patients treated with PD-1 antibody monotherapy (PD-1 monotherapy group) had abnormal liver function, and the median time to first abnormal liver function was 55 days. Of the 30 patients treated with PD-1 antibody in combination with apatinib and chemotherapy (PD-1 combination group), 22 had abnormal liver function, and the median time to first abnormal liver function was 41 days. Of the 35 patients with abnormal liver function, 2 had clinical symptoms, including malaise and loss of appetite, and 1 had jaundice. 28 of the 35 patients with abnormal liver function returned to normal and 7 improved to grade 1, and none of the patients had serious life-threatening or fatal liver function abnormalities. Combination therapy was a risk factor for patients to develop abnormal liver function (P=0.007). Conclusions: Most of the liver function abnormalities that occur during treatment with PD-1 antibody SHR-1210 alone or in combination with apatinib and chemotherapy are mild, and liver function can return to normal or improve with symptomatic treatment. For patients who receive PD-1 antibody in combination with targeted therapy and chemotherapy and have a history of long-term previous smoking, alcohol consumption and hepatitis B virus infection, liver function should be monitored and actively managed in a timely manner.

Epidemiological characteristics and antimicrobial resistance of 151 cases of melioidosis in Hainan Province / 中国热带医学

@#Abstract: Objective　To analyze the epidemiological characteristics of 151 cases of melioidosis and the drug resistance of Burkholderia pseudomallei (BP), in order to provide the basis for diagnosis, treatment and reasonable prevention of melioidosis. Methods　A total of 151 inpatients and outpatients from the Second Affiliated Hospital of Hainan Medical University from January 1, 2013 to August 31, 2022 were collected, and clinical specimens were submitted for examination to isolate and identify BP strains. The clinical data of 151cases of melioidosis and the drug resistance characteristics of pathogenic bacteria were retrospectively analyzed, and using SPSS26.0 software for statistical analysis. Results　Among 151 cases with BP infection, there were 138 males (91.4%) and 13 females (8.6%); the most patients were aged from 45-<60 years old, accounting for 74 cases (49.0%); melioidosis incidence was concentrated in October (19.2%), November (19.2%), August (9.9%) and July (8.6%), and; the number of confirmed cases showed an increasing trend and the time for confirmation was <10 d; Internal medicine system (31.1%), surgery system (26.5%) and intensive care department (20.5%) were the common departments for treating melioidosis; blood (49.0%), sputum (9.9%) and wound secretion (8.6%) were the main clinical specimens for detecting BP; pulmonary infection (68.2%), sepsis (35.1%) and local suppurative infection (23.8%) were the top clinical manifestations in patients with BP infection; the effective rate of treating melioidosis was 74.8%; abnormal liver function was a risk factor for the curative effect of melioidosis (χ2=5.010, P<0.05); the sensitivity rates of BP strains to sulfamethoxazole-trimethoprim (SXT), doxycycline (DOX), imipenem(IPM), ceftazidime (CAZ), amoxicillin/clavulanate (AMC) and tetracycline (TCY) were generally more than 90%, with sensitivities of 98.7%, 97.2%, 96.7%, 94.0%, 93.2% and 90.7%, respectively. Conclusions　It can be concluded that misdiagnosis or missed diagnosis of melioidosis is easy to occur, and the understanding of the epidemiological characteristics and risk factors in this area should be strengthened. The sensitivity of BP to commonly used antibiotics has shown a certain downward trend, clinical use should be standardized, and drug resistance monitoring should be strengthened to improve the efficacy of melioidosis treatment.

Research progress of tight junction protein Claudin of salivary glands / 口腔医学

@#Tight junction(TJ) is complex dynamic system involved in protein interactions in the paracellular secretory pathway, with both barrier and fence functions. Claudin family, the main section of tight junction strands, will be abnormal in expression pattern in the circumstances of radiation injuries, inflammation, Sj?gren's syndrome, diabetes and other pathological conditions in salivary glands. This change leads to abnormal structure and function of tight junctions, indirectly manifested as salivary gland dysfunction. In addition, the difference of Claudin expression in salivary gland tumors can also be used as an indicator of tumor type and prognosis. This review focuses on the progress of research on common Claudin in salivary glands, including the structure, function, expression patterns of related diseases and their applications. It is believed that the review may provide new ideas for clinical and basic research on Claudin protein-related diseases.