Transtornos Mentais Comuns em quilombolas rurais do Norte de Minas Gerais, Brasil / Common Mental Disorders in rural "quilombolas" in the North of Minas Gerais, Brazil

Resumo O objetivo deste artigo é avaliar a prevalência e fatores associados aos Transtornos Mentais Comuns (TMC) em quilombolas residentes em comunidades rurais localizadas no norte de Minas Gerais, Brasil. Trata-se de estudo transversal realizado em 2019 a partir de entrevistas estruturadas e aplicação do Self Reporting Questionnaire (SRQ-20). Foi conduzida regressão logística binária. A prevalência de TMC foi de 38,7%. Houve maior chance de TMC entre quilombolas do sexo feminino (OR: 2,69; IC95% 2,00-3,62), com 1 a 8 anos de estudo (OR: 1,70; IC95% 1,15-2,51), renda familiar entre 1 a 1,5 salário mínimo (OR: 2,51; IC95% 1,60-3,94); que sofreram discriminação em serviços de saúde (OR: 2,44; IC95% 1,44-4,13); com autorrelato de doença pulmonar (OR: 2,10; IC95% 1,25-3,54), doença cardíaca (OR: 1,58; IC95% 1,01-2,50) e insuficiência renal crônica (OR: 1,97; IC95% 1,08-3,94), e com autopercepção de saúde negativa (OR: 3,07; IC95% 2,31-4,07). A alta prevalência de TMC observada neste estudo demonstra a necessidade de políticas de atenção à saúde mental voltadas para as populações vulnerabilizadas, como as comunidades quilombolas, a fim de mitigar o sofrimento mental e favorecer uma atenção profissional contextualizada com as singularidades das condições de vida e saúde desse grupo populacional.

Abstract The scope of this article is to assess the prevalence and factors associated with Common Mental Disorders (CMD) in "quilombolas" (Afro-Brazilian residents of quilombo settlements) in rural communities located in the North of Minas Gerais, Brazil. It is a cross-sectional study of 2019 based on structured interviews and application of a Self-Reporting Questionnaire (SRQ-20). Binary logistic regression was conducted. The prevalence of CMD was 38.7%. There was a higher preponderance of CMD among female quilombolas (OR: 2.69; 95%CI 2.00-3.62), with 1 to 8 years of schooling (OR: 1.70; 95%CI 1.15-2,51), family income of 1 to 1,5 minimum wages (OR: 2.51; 95%CI 1.60-3.94); who suffered discrimination in health services (OR: 2.44; 95%CI 1.44-4.13); with self-reported lung disease (OR: 2.10; 95%CI 1.25-3.54), heart disease (OR: 1.58; 95%CI 1.01-2.50) chronic renal failure (OR: 1.97; 95%CI 1.08-3.94), and negative self-perception of health (OR: 3.07; 95%CI 2.31-4.07). The high prevalence of CMD revealed in this study demonstrates the need for mental health care policies aimed at vulnerable populations, such as quilombola communities, in order to mitigate mental suffering and promote professional contextualized care for the idiosyncrasies of health and living conditions of this population group.

Calculation of Likelihood Ratios for Incest Cases Using IBD Patterns / 法医学杂志

OBJECTIVES@#To calculate the likelihood ratios of incest cases using identity by descent (IBD) patterns.@*METHODS@#The unique IBD pattern was formed by denoting the alleles from the members in a pedigree with a same digital. The probability of each IBD pattern was obtained by multiplying the prior probability by the frequency of non-IBD alleles. The pedigree likelihoods of incest cases under different hypotheses were obtained by summing all IBD pattern probabilities, and the likelihood ratio(LR) was calculated by comparing the likelihoods of different pedigrees.@*RESULTS@#The IBD patterns and the formulae of calculating LR for father-daughter incest and brother-sister incest were obtained.@*CONCLUSIONS@#The calculations of LR for incest cases were illustrated based on IBD patterns.

Methods and Research Hotspots of Forensic Kinship Testing / 法医学杂志

Kinship testing is widely needed in forensic science practice. This paper reviews the definitions of common concepts, and summarizes the basic principles, advantages and disadvantages, and application scope of kinship analysis methods, including identity by state (IBS) method, likelihood ratio (LR) method, method of moment (MoM), and identity by descent (IBD) segment method. This paper also discusses the research hotspots of challenging kinship testing, complex kinship testing, forensic genetic genealogy analysis, and non-human biological samples.

Preliminary identification of pathogenic variants in an Afro-Colombian Raizal family with risk factors for glaucoma / Identificación preliminar de variantes patógenas en una familia raizal afrocolombiana con factores de riesgo para glaucoma

Abstract Objective: To identify pathogenic variants in an Afro-Colombian Raizal family with risk factors for glaucoma. Methods: In the present study, whole exome sequencing was performed on seven members of a Raizal family from the archipelago of San Andrés, Providencia, and Santa Catalina, in the Caribbean region of Colombia. Four of them had been diagnosed with glaucoma. In addition, two healthy volunteers from the island were included. Results: Of the 198 single nucleotide variants associated with glaucoma, previously reported by the DisGeNET database, four were identified in members of the Raizal family: rs11938093, rs7336216, rs3817672, and rs983034. Furthermore, single nucleotide variant rs983034 was identified in the Wnt ligand secretion mediator gene in all members of the family but not in healthy volunteers. Notably, WLS dysfunctions have been linked to pathology in the trabecular meshwork of the eye. Trabecular meshwork is an important regulator of the outflow of aqueous humor that maintains intraocular pressure (intraocular pressure) at normal levels. Damage to trabecular meshwork is associated with ocular hypertension, which leads to glaucoma progression. In relation to the other single nucleotide variants that were identified, their presence was confirmed in some members of the Raizal family. However, it is still unclear the pathophysiological cause that associates these single nucleotide variants with glaucoma. Conclusions: It was possible to identify four non-synonymous single nucleotide variants that predict significant damage to the structure and function of genes associated with glaucoma pathology in an Afro-Colombian.

Resumen Objetivo: Identificar las variantes patogénicas en una familia raizal afrocolombiana con factores de riesgo para el glaucoma. Métodos: En el presente estudio, se realizó una secuenciación de exoma completo en siete miembros de una familia Raizal del archipiélago de San Andrés, Providencia y Santa Catalina del Caribe colombiano. La mitad de ellos habían sido diagnosticados con glaucoma. Además, se incluyeron dos voluntarios sanos de la isla. Resultados: De las 198 variantes de un solo nucleótido (SNV) asociadas con el glaucoma, previamente informadas por la base de datos DisGeNET, se identificaron cuatro en los miembros de la familia Raizal: rs11938093, rs7336216, rs3817672 y rs983034. Ademas, en todos los miembros de la familia, pero no en voluntarios sanos, se identificó SNV rs983034 en el gen mediador de secreción de ligando Wnt (WLS). Notablemente, las disfunciones WLS se han relacionado con patologías en la red trabecular (TM) del ojo. TM es un regulador importante del flujo de salida del humor acuoso que mantiene la presión intraocular (presión intraocular) en niveles normales. El daño a la TM se asocia con hipertensión ocular que conduce a la progresión del glaucoma. En relación con los demás SNV identificados, se constató su presencia en algunos miembros de la familia Raizal. Sin embargo, aún no está clara la causa fisiopatológica que asocia estas SNV con el glaucoma. Conclusiones: Fue posible identificar cuatro SNVs no sinónimos con predicción de daño significativo en la estructura y función de genes asociados a patología de glaucoma en un afrocolombiano.

Risco nutricional e cardiovascular em idosos quilombolas / Nutritional and cardiovascular disease risk in older persons living in Quilombola communities

Resumo O objetivo deste artigo é avaliar o risco nutricional e cardiovascular segundo medidas antropométricas em idosos quilombolas do estado do Maranhão. Trata-se de estudo transversal realizado em 11 comunidades remanescentes de quilombolas do município de Bequimão, Maranhão, Brasil. Realizou-se censo da população idosa que representou 205 pessoas. Foram estimados os riscos nutricional e cardiovascular por meio dos indicadores antropométricos segundo sexo e idade. Realizou-se Testes de Qui-quadrado de Pearson ou Exacto de Fisher e análises de variância. Diferenças foram consideradas estatisticamente significantes quando p<0,05. Idosos quilombolas vivem em precárias condições de moradia e de infraestrutura sanitária, com elevado risco nutricional e cardiovascular, mas com diferenças entre sexo e idade. O excesso de peso foi mais prevalente em mulheres e idosos mais jovens, enquanto os homens e idosos com 80 ou mais anos apresentaram-se mais desnutridos e com maior perda de massa corporal. O risco cardiovascular foi maior entre as mulheres e em todas as faixas etárias. Idosos quilombolas vivem em vulnerabilidade socioeconômica e apresentaram alta prevalência de baixo peso, perda de massa muscular e alto risco cardiovascular, sendo maior risco entre mulheres e idosos do grupo de maior idade.

Abstract This article aims to assess nutritional and cardiovascular disease (CVD) risk based on anthropometric measures among older persons living in Quilombola communities in the state of Maranhão, Brazil. We conducted a cross-sectional study with 205 older persons living in 11 Quilombola communities in Bequimão, Maranhão. Nutritional and CVD risk were estimated according to sex and age group based on anthropometric indicators using Pearson's chi-square or Fisher's exact tests and analysis of variance, adopting a significance level of p<0.05. The study participants suffer precarious housing, basic sanitation and social conditions. Prevalence of nutritional and CDV risk was high across the sample, showing differences between sexes and age groups. Prevalence of excess weight was higher in women and the youngest age group, while prevalence of malnourishment and loss of muscle mass was higher in men and individuals aged 80 years and over. Prevalence of CVD risk was high across all age groups and higher in women than men. The older persons living in the Quilombola communities investigated by this study are socially vulnerable and showed high prevalence of low weight, loss of muscle mass and CDV risk. The prevalence of CVD risk was higher among women and the oldest age group.

Repair of the middle and posterior compartments of the pelvic floor via perineal and vaginal routes without the use of mesh - technique description and case series / Correção dos compartimentos médio e posterior do assoalho pélvico por vias perineal e vaginal sem uso de tela - descrição de técnica e série de casos

ABSTRACT Introduction: Currently, problems such as constipation due to outlet obstruction, rectal/vaginal prolapse and fecal and urinary incontinence have become increasingly more frequent because of the population aging process, with great impact on the quality of life. Objective: To describe a technique for surgical repair of middle/posterior pelvic floor compartments and extra-mucosal rectal wall treatment by transperineal and vaginal approach, using native tissues and present the results in twenty patients submitted to this surgical technique. Method: Patients with symptoms secondary to middle/posterior pelvic floor descent and anatomical changes confirmed by proctological exam and pelvic MRI defecography. Results were evaluated through the Agachan constipation score, using pre- and post-operative questionnaires. Results: Immediate repair of rectocele and musculature, with prompt improvement of constipation, sustained by 42 months. There were no severe complications in the postoperative period. Conclusion: This is an effective technique, with adequate anatomic repair, improvement of constipation scores and with low risk.

RESUMO Introdução: Problemas como constipação intestinal por obstrução de saída, prolapsos retal/vaginal e incontinências fecal e urinária são cada vez mais frequentes pelo envelhecimento populacional, com grande impacto na qualidade de vida. Objetivo: Descrever técnica para correção do compartimento médio/posterior do assoalho pélvico e tratamento extramucoso da parede retal, por vias perineal e vaginal, utilizando tecidos nativos. Apresentar os resultados da cirurgia em 20 pacientes submetidas à técnica. Método: Pacientes com sintomas secundários ao descenso de assoalho pélvico médio/posterior, submetidas à propedêutica - exame proctológico e defecografia por RNM de pelve que confirmaram as alterações anatômicas. A avaliação dos resultados foi feita com questionários no pré e pós-operatório, com a utilização do escore de Agachan para constipação intestinal. Resultado: Correção imediata da retocele e da musculatura, com melhora imediata da constipação intestinal, sustentada ao longo de 42 meses. Sem complicações graves no pós-operatório. Conclusão: Técnica eficaz, com correção anatômica adequada, associada a melhora significativa dos escores de constipação e de baixo risco.

Non-descent vaginal hysterectomy in previous cesarean section: a retrospective study

Background: Non-descent vaginal hysterectomy (NDVH) is removal of uterus through vagina in non-prolapsed uterus. As there is an increase in caesarean section, hysterectomy in women with previous caesarean section is also increasing. The objective of this study is to assess the feasibility and safety of non-descent vaginal hysterectomy in patients with previous caesarean section.Methods: This is a retrospective study conducted in the department of obstetrics and gynecology, Government Medical College, Thrissur from January 2017 to December 2018. Non-descent vaginal hysterectomy in 24women with previous caesarean section was studied. Details regarding age, parity, number of caesarean sections, indication of surgery, intraoperative and postoperative complications were evaluated.Results: All 24 women underwent non-descent vaginal hysterectomy successfully. 10 women (41.7%) were between 46-49 years. Commonest indication of hysterectomy was fibroid uterus (41.7%) and most common complaint was heavy menstrual bleeding (79%). There was bladder injury in one woman with history of previous 2 caesarean section. 3 women developed UTI in postoperative period.Conclusions: Vaginal hysterectomy is associated with lower complications and more rapid recovery. A successful NDVH in previous caesarean section depends on the expertise and experience of the surgeon. NDVH in previous caesarean is safe in expert hands.

A comparative study of non-descent vaginal hysterectomy and total laparoscopic hysterectomy

Background: Hysterectomy is the second most common operation performed by the gynecologists, next only to caesarean section. Objective of the study was to compare fall in blood haemoglobin level, duration of operation, intra- and post-op complications between non-descent vaginal hysterectomy and total laparoscopic hysterectomy and establish the better method for hysterectomy in non-descent uterus.Methods: A retrospective comparative study of 90 hysterectomies was done from a period of May 2018 - April 2019 at GMERS Medical College and Hospital Sola, with 45 cases in group of non-descent vaginal hysterectomy (NDVH) and 45 in group of total laparoscopic hysterectomy (TLH). Demographic characteristics, co-morbid conditions, indications for surgery, operative time, intra- operative blood loss, post-operative analgesia requirements, post-operative hospital stay and post-operative complications were compared between both groups. Those patients having malignancy as diagnosed by Pap smear or by D and C were excluded from the studyResults: The most common age in both groups was 41-50 years. Adenomyotic uterus was the most common indication for surgery in both groups. The mean operative time in NDVH group was 45 min while it was 80 min in TLH group. p<0.001 suggested significant difference when operative time were compared between both groups. Both groups were similar in post-operative analgesia requirement and post-operative hospital stay. Post-operative complications were similar in both groups.Conclusions: In which way to approach the uterus shall depend upon skill of the surgeon, size and pathological nature of uterus, technology available in the hospital and preference of patient as well as surgeon.

Changes in dynamic stability, motor coordination and joint mechanics of the lower extremity during stair descent and performing phone task / 中国组织工程研究

BACKGROUND: The coupling and coordination control of the multi-link rigid body of human body is the key to stable walking. It is reported that the use of cell phones greatly increases the chance of falling down stairs when walking; however, it lacks the analysis of the dynamic stability, motion coordination and joint mechanics of the lower limbs when walking down stairs with cell phone intervention. OBJECTIVE: To investigate the effects of cell phone on coupling control strategy of the multi-link rigid body in lower extremity during stair descent. METHODS: Twenty healthy university students were recruited and conducted the stair descent under no-interference (single task) and cell phone (phone task) randomly. Using the method of synchronous acquisition of 3D kinematics and dynamics, the kinetic and kinematic data were synchronously collected to acquire the parameters of stair descent under both conditions. RESULTS AND CONCLUSION: (1) The intervention of phone task significantly reduced the dynamic stability in anterior-posterior/media-lateral direction, the first knee extension moment peak, the first dorsiflexion moment peak, the second hip flexion moment peak in sagittal plane during stance phase, and significantly increased the mean and standard deviation of hip-knee/knee-ankle relative phase angles during swing phase. (2) It is concluded that when the gait of human body changes from time to time, the coupling control ability of multi-link rigid bodies decreased and the risk of falling increased. (3) The intervention of phone task reduces the supporting moment of lower limbs in the supporting phase, reduces the stability of adjacent joint coordination control in the swinging phase, reduces the dynamic stability in front, back and inside directions, and increases the risk of falling.

Vaginal hysterectomy a safe option in non-descent uterus as compared to abdominal hysterectomy

Background: The objective of present study was to compare the advantage of vaginal hysterectomy over abdominal hysterectomy in non-descent uterus.Methods: A non-randomized controlled trial was carried out in the Bundelkhand Medical College, Sagar and associated hospital from October 2015 to September 2017. A total of 150 cases were included in the study. Out on 150, 75 underwent vaginal hysterectomy for non-descent uterus and other 75 underwent abdominal hysterectomy for similar indications.Results: Among total 150 cases, 75 were underwent non-descent vaginal hysterectomy and similar number of cases underwent abdominal hysterectomy. Common age group was 35-54 years. Commonest indication was DUB (48.7%). Postoperatively, complications were more common in those who underwent abdominal hysterectomy such as ambulation (18 hours), incidence of nausea, vomiting, abdominal discomfort, bladder injury and wound infection were less in vaginal hysterectomy compared to abdominal hysterectomy. It was also observed that blood transfusion requirement, operative timing and hospital stay (3 days) were less in vaginal hysterectomy group.Conclusions: Vaginal hysterectomy for benign gynecological disorders is a safe, effective, least invasive and is associated with lesser complications as compare to abdominal hysterectomy. Today in the era where patient is more cosmetically concern, vaginal hysterectomy for non-descent uterine disorder needs to be considered as good and safe option.

Comparative study of non-descent vaginal hysterectomy with abdominal hysterectomy

Background: Hysterectomy is one of the most common operation performed in Obstetrics and Gynecology next to caesarean section. Due to its advantages vaginal hysterectomy are more and more performed now. Only drawback is lack of expertise. Present study focuses on comparison between outcomes in abdominal versus vaginal hysterectomy and to determine which route of hysterectomy is superior, safer and effective.Methods: The study is a prospective study conducted in the department of obstetrics and Gynecology. Civil hospital, Ahmedabad between the period of Jan 2016 to 2017. Of 100 patients. Fifty patients who underwent hysterectomy by vaginal route are taken as study group A, and the remaining 50 patients who underwent by the abdominal route are taken as study group B.Results: Majority of women undergoing hysterectomy were in age group of 30-50 years; postmenopausal age group women were less;13 NDVH and 5 in AH. Majority of the women were multipara in both age groups. Menorrhagia was found to be major indication with 42 in NDVH and 40 in AH. There is much significant difference in the postoperative pain in both groups with less in NDVH group. There is not much significant difference in blood loss in both the groups. Postoperative complications were more with AH.Conclusions: Thus, it can be concluded that NDVH is feasible, safe and provide more patient comfort without increasing the duration of surgery and other post-operative complications.

Effect of melatonin on the onset of puberty in male juvenile rats / 대한해부학회지

Melatonin or N-acetyl-5-methoxytryptamine, the fascinating molecule secreted by the pineal gland. Melatonin has a close interaction with hypothalamic-pituitary-gonadal axis. In non-seasonal breeders like rat its exact role in reproduction is controvertible. So it is worth to explore the possible role of melatonin on the onset of puberty in male albino rats. Two groups of male rats aged 5 and 10 days were used for the study. In each group, there were three subgroups, each receiving melatonin for 5 days, 10 days or till the day of descent of testes. Similar subgroups were used as controls. Without handling, animals were observed daily for the onset of puberty. On the day of descent of testes, body weight of the animal was noted, blood was collected, serum was separated and used for radio immunoassay. For histomorphometric analysis, all morphometric measurements were done using an occular micrometer. Volume fraction of seminiferous tubules, intertubular connective tissue of testes, cortex and medulla of thymus were estimated by point count method. In both the age groups melatonin advanced the age on descent of testes, increased the body weight, organ weight. It also increased the serum hormone levels. So, in conclusion this study indicates that exogenous melatonin advances the onset of puberty in male albino wistar rats and this effect is more pronounced in the younger animals.

Occurrence of high altitude cerebral edema (hace) and high altitude pulmonary edema (HAPO) simultaneously at 12000 ft: a rare phenomen

High altitude cerebral edema (HACE) and High altitude pulmonary edema (HAPO) are the most dreaded complications related to high altitude. Authors managed a case of HACE and HAPO simultaneously set at unusually low height (1200 ft) in a patient. The altitude was not too much to develop these comorbidities as studied earlier. Relationship with altitude was immaterial in our case. However, rapid ascent without proper acclimatisation, young and tender age, male sex and smoking were associated contributing factors. He was managed with standard protocol and descent to lower altitude.

Plantar Pressure and Surface EMG Parameters During Stair Walking / 医用生物力学

Objective To explore the plantar pressure and surface electromyography (sEMG) parameters during human stair walking, so as to provide theoretical support for foot structure design of dynamic walker, selection of power element and distribution of installation location. Methods Ten healthy young males were recruited to perform stair walking trials, respectively. The motion capture system, plantar pressure system and surface myoelectricity acquisition system were used to collect plantar peak pressure, trajectory of COP(center of pressure) and sEMG parameters of lower limb muscles at the same time. Results Compared with level walking, the percentage of stance time in the whole gait cycle increased during stair walking. The peak pressure of forefoot area increased during stair ascent, while the peak pressure of toe area decreased during stair descent. During stair walking, rectus femoris, biceps femoris, medialis and lateralis gastrocnemius played a main role in maintaining the stability of human body. Conclusions The plantar pressure distribution should be fully considered for foot structure design of dynamic walker and the function of main muscles should be considered for selection of power element and distribution of installation location.

The known and unknown about the testicular descent and undescended testes / 中华实用儿科临床杂志

The mechanism of testicular descent in development of testis in embryonic period is very complex,and undescended testes(cryptorchidism) is a very common anomaly of the male genitalia.As it is close relatively with the later impaired fertility and cancer risk,involving reproduction,development,endocrinology and psychology,et al,the explorations of the mechanisms of testicular descent are continuing,and the studies on undescended testes such as the exact cause,pathogenesis,proper strategies for diagnosis and treatment are in progress.Along with some muddle becoming clear,the new puzzles often emerged.Perhaps this is getting closer to the truth.This paper is basically outlining the current research situation from the known and unknown aspects.

Surface Electromyography Changes of Vastus Medialis, Rectus Femoris and Vastus Lateralis during Stair Descent in Healthy Youth / 中国康复理论与实践

@#Objective To evaluate the activities of vastus medialis, rectus femoris and vastus lateralis during stair descent in healthy youth. Methods Thirty healthy college students were recruited from the Capital Medical University 2015 admissions in 2016. The electrode was put on the dominant side of the quadriceps. Surface electromyography was used to record muscle activity during stair descent. Results During stair descent, the maximum amplitude and mean amplitude were significantly lower in rectus femoris than in vastus medialis and vas-tus lateralis (P<0.001). No significant difference was found between vastus medialis and vastus lateralis (P>0.05). Conclusion The activa-tion of both vastus medialis and vastus lateralis during stair descent is significantly higher than that of rectus femoris. The coactivation of vastus medialis and vastus lateralis is equal in healthy youth.

To determine effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy

Introduction: Hysterectomy is a very common surgery and can be performed by abdominal, vaginal or laparoscopic method though the abdominal route is more popular. Vaginal hysterectomy has distinct health and economic benefits. We designed this study to compare the outcomes in TAH and non-descent vaginal hysterectomy and to determine which route of hysterectomy is superior, safe and effective. Aims of the study: To determine the safety and effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy and to compare both in terms of duration of surgery, blood loss, intra operative complications, postoperative complications and duration of hospital stay. Materials and methods: This was a prospective, study done on total of 100 patients were divided randomly into two groups. One group underwent total abdominal hysterectomy and the other underwent vaginal hysterectomy. Both groups were compared for patient demographics, indications for surgery, size of uterus, duration of surgery, blood loss, need for blood transfusions, complications and duration of hospital stay. Results: Fibroid was the most common indication in both the groups. Most of the patients had 6 – 8 weeks size uterus. Mean intra operative blood loss in TAH group was slightly more than NDVH group. The need for blood transfusion was similar. The mean duration of surgery was 100.2 minutes in TAH group and 83 minutes in NDVH group. Fever was the most common complication in both groups. Abdominal wound infection and secondary suturing was seen in TAH group. The mean postoperative stay was 8.1 days in TAH group and 5.8 days in NDVH group. P. Divya Daniel, D. Anupama. To determine effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy. IAIM, 2017; 4(10): 77-86. Page 78 Conclusion: NDVH is associated with less duration of surgery, less blood loss, less postoperative stay than TAH. There was no difference between the need for blood transfusion between the two groups. Therefore, vaginal hysterectomy is safe and feasible in most of the women requiring hysterectomy for benign conditions and should therefore be attempted.

Urethral Closure Pressure at Stress: A Predictive Measure for the Diagnosis and Severity of Urinary Incontinence in Women / 대한배뇨장애요실금학회지

PURPOSE: Maintaining urinary continence at stress requires a competent urethral sphincter and good suburethral support. Sphincter competence is estimated by measuring the maximal urethral closure pressure at rest. We aimed to study the value of a new urodynamic measure, the urethral closure pressure at stress (s-UCP), in the diagnosis and severity of female stress urinary incontinence (SUI). METHODS: A total of 400 women without neurological disorders were included in this observational study. SUI was diagnosed using the International Continence Society definition, and severity was assessed using a validated French questionnaire, the Mesure du Handicap Urinaire. The perineal examination consisted of rating the strength of the levator ani muscle (0–5) and an assessment of bladder neck mobility using point Aa (cm). The urodynamic parameters were maximal urethral closure pressure at rest, s-UCP, Valsalva leak point pressure (cm H₂O), and pressure transmission ratio (%). RESULTS: Of the women, 358 (89.5%) were diagnosed with SUI. The risk of SUI significantly increased as s-UCP decreased (odds ratio [OR], 0.92; 95% confidence interval, 0.88–0.98). The discriminative value of the measure was good for the diagnosis of SUI (area under curve>0.80). s-UCP values less than or equal to 20 cm H2O had a sensitivity of 73.1% and a specificity of 93.0% for predicting SUI. The association between s-UCP and SUI severity was also significant. CONCLUSIONS: s-UCP is the most discriminative measure that has been identified for the diagnosis of SUI. It is strongly inversely correlated with the severity of SUI. It appears to be a specific SUI biomarker reflecting both urethral sphincter competence and urethral support.

Fast gradient descent based VMAT optimization algorithm / 中华放射医学与防护杂志

Objective To explore a new gradient descent based optimization algorithm in order to improve the efficiency and unrepeatability of current VMAT planning systems.Methods Firstly,fast monotonic descent method was used to generate intensity maps of a simple IMRT plan consisting of few static fields.Then,leaf sequencing algorithm was employed to determine the best segments (aperture shape and weight) of these fields.The segments of the existing beams were fixed,and the new beams were continuously added to the plan and optimized until the maximal number of beams arrived.The performance of this algorithm was evaluated with clinical cases.Results For the head-and-neck case,the computation time was about 5 min while the time for those commercial planning systems was 10-20 min.Due to the nature of gradient-based algorithm,the repeatability of optimization result was guaranteed.The conformity and homogeneity of VMAT plan was better than that of IMRT plan.For most of critical organs,the dose sparing of VMAT plan was better than that of IMRT plan.Conclusions Compared to existing VMAT optimization algorithms,the computation time of our algorithm is significantly reduced and the optimization result is repeatable.

The known and unknown about the testicular descent and undescended testes / 中华实用儿科临床杂志

The mechanism of testicular descent in development of testis in embryonic period is very complex,and undescended testes(cryptorchidism) is a very common anomaly of the male genitalia.As it is close relatively with the later impaired fertility and cancer risk,involving reproduction,development,endocrinology and psychology,et al,the explorations of the mechanisms of testicular descent are continuing,and the studies on undescended testes such as the exact cause,pathogenesis,proper strategies for diagnosis and treatment are in progress.Along with some muddle becoming clear,the new puzzles often emerged.Perhaps this is getting closer to the truth.This paper is basically outlining the current research situation from the known and unknown aspects.