Objective:To investigate the feasibility and value of nomogram based on base line clinical and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) characteristics for pretreatment predicting the depth of myometrial invasion and tumor grade of endometrioid endometrial carcinoma (EEC).Methods:Preoperative baseline clinical characteristics and DCE-MRI characteristics of 194 EEC patients were prospectively collected at Obstetrics and Gynecology Hospital, Fudan University from October 2020 to January 2022 and used as a training set. Univariate analysis was conducted to compare baseline clinical characteristics and DCE-MRI quantitative parameters [including tumor volume, and mean, median, and standard deviation of volume transfer constant (K trans), rate constant (K ep), extravascular extracellular volume fraction (V e), and initial area under the enhancement curve (iAUC)] between patients with deep myometrial invasion (DMI) and those with superficial myometrial invasion (SMI), as well as between high-grade and low-grade EEC. Multivariate logistics regression analysis was used to identify independent predictors for the construction of nomogram. An independent external testing set comprising 127 EEC patients was retrospectively collected from Zhongshan Hospital, Fudan University and Zhongshan Hospital, Fudan University (Xiamen Branch). The area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were used for evaluating the model′s predictive performance and clinical net benefit, respectively. Results:(1) The depth of myometrial invasion: univariate analysis showed that in the training set, the EEC patients with DMI differed significantly from those with SMI in clinical characteristics including higher proportion of postmenopausal state and overweight [body mass index (BMI)≥25 kg/m2], and abnormal levels of serum cancer antigen (CA) 125, CA 199, and human epididymis protein 4 (HE4), and in DCE-MRI quantitative parameters including tumor volume, and median, mean, and standard deviation of K trans, median of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, CA 199, tumor volume, and mean of iAUC were independent predictors of the depth of myometrial invasion, and constructed the nomogram (recorded as Nomogram_1), achieving an AUC of 0.861 (95% CI: 0.803-0.919) in the training set. In the independent external testing set, the AUC was 0.876 (95% CI: 0.815-0.938), with corresponding sensitivity of 82.0%, specificity of 80.7%, accuracy of 81.1%, positive predictive value (PPV) of 65.3%, and negative predictive value (NPV) of 91.0% for predicting DMI. (2) The EEC grade: univariate analysis showed that in the training set, high-grade EEC patients differed significantly from low-grade EEC in clinical characteristics including patient′s age, the proportion of postmenopausal state and overweight, and abnormal levels of serum CA 125, and in DCE-MRI quantitative parameters including tumor volume, median, mean, and standard deviation of K trans, median and mean of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, tumor volume, and median of V e emerged as independent predictors of EEC grade, and constructed the nomogram (recorded as Nomogram_2), achieving an AUC of 0.845 (95% CI: 0.786-0.893) in the training set. While in the external testing set, the AUC was 0.819 (95% CI: 0.744-0.894), with corresponding sensitivity of 72.4%, specificity of 72.4%, accuracy of 72.4%, PPV of 43.8%, and NPV of 89.9% for predicting high-grade EEC. (3) The DCA curves demonstrated that both Nomogram_1 and Nomogram_2 yielded obvious positive clinical net benefits across a wide range of threshold probabilities. Conclusion:The nomogram based on pretreatment clinical and DCE-MRI characteristics has the potential to noninvasive predict the depth of myometrial invasion and grade of EEC, providing valuable reference information for clinical management decision-making.

Objective:To investigate the feasibility and value of nomogram based on base line clinical and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) characteristics for pretreatment predicting the depth of myometrial invasion and tumor grade of endometrioid endometrial carcinoma (EEC).Methods:Preoperative baseline clinical characteristics and DCE-MRI characteristics of 194 EEC patients were prospectively collected at Obstetrics and Gynecology Hospital, Fudan University from October 2020 to January 2022 and used as a training set. Univariate analysis was conducted to compare baseline clinical characteristics and DCE-MRI quantitative parameters [including tumor volume, and mean, median, and standard deviation of volume transfer constant (K trans), rate constant (K ep), extravascular extracellular volume fraction (V e), and initial area under the enhancement curve (iAUC)] between patients with deep myometrial invasion (DMI) and those with superficial myometrial invasion (SMI), as well as between high-grade and low-grade EEC. Multivariate logistics regression analysis was used to identify independent predictors for the construction of nomogram. An independent external testing set comprising 127 EEC patients was retrospectively collected from Zhongshan Hospital, Fudan University and Zhongshan Hospital, Fudan University (Xiamen Branch). The area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were used for evaluating the model′s predictive performance and clinical net benefit, respectively. Results:(1) The depth of myometrial invasion: univariate analysis showed that in the training set, the EEC patients with DMI differed significantly from those with SMI in clinical characteristics including higher proportion of postmenopausal state and overweight [body mass index (BMI)≥25 kg/m2], and abnormal levels of serum cancer antigen (CA) 125, CA 199, and human epididymis protein 4 (HE4), and in DCE-MRI quantitative parameters including tumor volume, and median, mean, and standard deviation of K trans, median of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, CA 199, tumor volume, and mean of iAUC were independent predictors of the depth of myometrial invasion, and constructed the nomogram (recorded as Nomogram_1), achieving an AUC of 0.861 (95% CI: 0.803-0.919) in the training set. In the independent external testing set, the AUC was 0.876 (95% CI: 0.815-0.938), with corresponding sensitivity of 82.0%, specificity of 80.7%, accuracy of 81.1%, positive predictive value (PPV) of 65.3%, and negative predictive value (NPV) of 91.0% for predicting DMI. (2) The EEC grade: univariate analysis showed that in the training set, high-grade EEC patients differed significantly from low-grade EEC in clinical characteristics including patient′s age, the proportion of postmenopausal state and overweight, and abnormal levels of serum CA 125, and in DCE-MRI quantitative parameters including tumor volume, median, mean, and standard deviation of K trans, median and mean of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, tumor volume, and median of V e emerged as independent predictors of EEC grade, and constructed the nomogram (recorded as Nomogram_2), achieving an AUC of 0.845 (95% CI: 0.786-0.893) in the training set. While in the external testing set, the AUC was 0.819 (95% CI: 0.744-0.894), with corresponding sensitivity of 72.4%, specificity of 72.4%, accuracy of 72.4%, PPV of 43.8%, and NPV of 89.9% for predicting high-grade EEC. (3) The DCA curves demonstrated that both Nomogram_1 and Nomogram_2 yielded obvious positive clinical net benefits across a wide range of threshold probabilities. Conclusion:The nomogram based on pretreatment clinical and DCE-MRI characteristics has the potential to noninvasive predict the depth of myometrial invasion and grade of EEC, providing valuable reference information for clinical management decision-making.

Humans ; Tranexamic Acid/therapeutic use* ; Arthroplasty, Replacement, Knee ; Antifibrinolytic Agents/therapeutic use* ; Blood Loss, Surgical ; Postoperative Hemorrhage

Objective:To investigate the prevenlence of insomnia on workers and related influcecing factors in chip manufacturing industry.Methods:By using cluster sampling method, 2 251 workers in chip manufacturing industry were selected as study subjects. The simple Job Demand-Control model Questionnnaire (JDC) , Effort-Reword Imbalance (ERI) Questionnnaire and Insomnia Symptoms Scale were used to evaluate JDC occupational stress, ERI occupational stress and insomnia symptoms respectively.Results:22.6% (509/2251) workers were found high level of insomnia. The risk factors of insomnia symptoms were high score of effort and overcommitment ( P< 0.05) . The risk of insomnia symptoms in high effort was 1.689 times that of low score (95% CI: 1.334-2.138) . The risk of insomnia symptoms in high overcommitment was 1.835 times that of low score (95% CI: 1.461-2.305) . The protective factors for insomnia symptoms were women, monthly income of more than 3000 yuan, college dregree or above, high work control and high reward ( P<0.05) . Conclusion:The high scores of effort and overcommitment are the risk factors for insomnia symptoms of employees in manufacture electronic devices. Enterprises should take comprehensive measures to pay attention to the occurrence of insomnia symptoms among employees with high score of effort and overcommitment.

Objective:To investigate the epidemiological characteristics and late diagnosis of suspected occupational diseases in Guangzhou from 2006 to 2018.Methods:The cases of suspected occupational diseases reported in Guangzhou from January 1, 2006 to December 31, 2018 were collected and followed up to the end of 2018. The cases of suspected occupational diseases were analyzed statistically.Results:A total of 1502 suspected occupational cases were reported in Guangzhou from 2006 to 2018, including suspected occupational otorhinolaryngological and oral diseases (58.59%, 880/1502) , suspected occupational chronic poisoning (25.03%, 376/1502) and suspected occupational pneumoconiosis (11.72%, 176/1502) . The key reporting areas were Huangpu District (27.50%, 413/1502) and Panyu District (20.91%, 314/1502) . The key reporting industries were manufacturing industry (80.36%, 1207/1502) , among which railway, ship, aerospace and other transportation equipment manufacturing industry (13.26%, 160/1207) , automobile manufacturing industry (12.51%, 151/1207) and general equipment manufacturing industry (10.19%, 123/1207) were the main industries. The main type of reported economy was private economy (39.95%, 600/1502) . The scale of the key reporting enterprises was medium and small-sized enterprises (31.09%, 467/1502 and 34.62%, 520/1502) . As of December 31, 2018, 263 cases were diagnosed with occupational diseases, and the diagnosis rate was 17.51%.Conclusion:The number of suspected occupational diseases reported in Guangzhou from 2006 to 2018 is large, and the overall diagnosis rate of suspected occupational diseases is low. It is necessary to strengthen the supervision and management of key diseases, key regions, and key industries of suspected occupational diseases. It is suggested that the reporting system of suspected occupational diseases should be standardized as soon as possible.

Objective:To investigate the prevenlence of insomnia on workers and related influcecing factors in chip manufacturing industry.Methods:By using cluster sampling method, 2 251 workers in chip manufacturing industry were selected as study subjects. The simple Job Demand-Control model Questionnnaire (JDC) , Effort-Reword Imbalance (ERI) Questionnnaire and Insomnia Symptoms Scale were used to evaluate JDC occupational stress, ERI occupational stress and insomnia symptoms respectively.Results:22.6% (509/2251) workers were found high level of insomnia. The risk factors of insomnia symptoms were high score of effort and overcommitment ( P< 0.05) . The risk of insomnia symptoms in high effort was 1.689 times that of low score (95% CI: 1.334-2.138) . The risk of insomnia symptoms in high overcommitment was 1.835 times that of low score (95% CI: 1.461-2.305) . The protective factors for insomnia symptoms were women, monthly income of more than 3000 yuan, college dregree or above, high work control and high reward ( P<0.05) . Conclusion:The high scores of effort and overcommitment are the risk factors for insomnia symptoms of employees in manufacture electronic devices. Enterprises should take comprehensive measures to pay attention to the occurrence of insomnia symptoms among employees with high score of effort and overcommitment.

Objective:To investigate the epidemiological characteristics and late diagnosis of suspected occupational diseases in Guangzhou from 2006 to 2018.Methods:The cases of suspected occupational diseases reported in Guangzhou from January 1, 2006 to December 31, 2018 were collected and followed up to the end of 2018. The cases of suspected occupational diseases were analyzed statistically.Results:A total of 1502 suspected occupational cases were reported in Guangzhou from 2006 to 2018, including suspected occupational otorhinolaryngological and oral diseases (58.59%, 880/1502) , suspected occupational chronic poisoning (25.03%, 376/1502) and suspected occupational pneumoconiosis (11.72%, 176/1502) . The key reporting areas were Huangpu District (27.50%, 413/1502) and Panyu District (20.91%, 314/1502) . The key reporting industries were manufacturing industry (80.36%, 1207/1502) , among which railway, ship, aerospace and other transportation equipment manufacturing industry (13.26%, 160/1207) , automobile manufacturing industry (12.51%, 151/1207) and general equipment manufacturing industry (10.19%, 123/1207) were the main industries. The main type of reported economy was private economy (39.95%, 600/1502) . The scale of the key reporting enterprises was medium and small-sized enterprises (31.09%, 467/1502 and 34.62%, 520/1502) . As of December 31, 2018, 263 cases were diagnosed with occupational diseases, and the diagnosis rate was 17.51%.Conclusion:The number of suspected occupational diseases reported in Guangzhou from 2006 to 2018 is large, and the overall diagnosis rate of suspected occupational diseases is low. It is necessary to strengthen the supervision and management of key diseases, key regions, and key industries of suspected occupational diseases. It is suggested that the reporting system of suspected occupational diseases should be standardized as soon as possible.

Objective: To evaluate the quality of clinical practice guidelines for kidney diseases in China and provide reference for selecting suitable high-quality guidelines for primary care and developing standardized guidelines. Methods: The China Guideline Clearinghouse, China Biology Medicine disc, VIP Database, Wanfang Database and CNKI, and other resources were searched from January 2013 to July 2018. In accordance with the criteria for inclusion and exclusion, the published guidelines for kidney diseases were screened. The Appraisal of Guidelines Research and Evaluation-China (AGREE-China) was used to systematically assess the current status of domestic guidelines for kidney diseases. Results: A total of 18 guidelines for kidney diseases were included, covering different types of kidney disease such as glomerulonephritis, nephrotic syndrome, end-stage renal disease and other diseases. The overall score ranged from 30 to 68, with an average score of 47.3. The average scores of these guidelines were 20.1, 12.8, 0.5, 9.9 and 3.9 in five review fields including scientificity/rigorism, effectiveness/safety, economy, availability/feasibility, and conflicts of interest, respectively. Of these 18 guidelines, 8(44.4%) guidelines were strongly recommended, and 10(55.6%) guidelines were weakly recommended. Conclusions There are still deficiencies in scientificity/rigorism and economy in current guidelines for kidney diseases in China. The AGREE-China can be used as an evaluation tool for guidelines for kidney diseases in accordance with China's situation, while its practicability and feasibility still need further verification and improvement.

Objective To investigate the diagnostic performance of ADC value for predicting proliferation and invasiveness of cervical squamous cell carcinoma (SCC).Methods Totally 96 patients with pathologically confirmed SCC underwent preoperative conventional MRI and DWI.Mini-ADC value,mean-ADC value and mini-ADC ratio (mini-ADC/meam ADC) were measured and compared for various patient groups divided based on Ki-67 labeling index and clinicopathological characteristics.Results The mini-ADC values were significantly lower in patients with high Ki-67 expression,tumor size ≥4 cm,high FIGO staging,low pathological grade,depth of cervical stromal infiltrating ≥ 1/2,parametrial involvement,lymphovascular invasion (LVI),lymph node metastasis and perineural invasion (PNI,all P＜ 0.05).Compared with mean-ADC value and mini-ADC ratio,mini-ADC value exhibited the most effective diagnostic performance in predicting clinicopathological characteristics with the highest areas under the ROC curve and efficacy.Mini-ADC value showed negative correlation with Ki-67 index (r=-0.48,P＜0.001) as well as other clinicopathological characteristics,including tumor size,FIGO staging,pathological grading,depth of cervical stromal infiltrating,parametrial involvement,LVI,lymph node metastasis and PNI (r=-0.36,-0.34,-0.27,-0.40,-0.33,-0.60,-0.61,-0.41,respectively,all P＜0.05).Conclusion Mini-ADC value can effectively reflect the proliferation and invasiveness of cervical SCC.

Objective To compare the outcomes of percutaneous pedicle instrumentation combined with vertebral augmentation or vertebra pedicle instrumentation for treatment of osteoporotic thoracolumbar fractures (OVCF) in elderly patients.Methods A retrospective case cohort study was conducted on 62 patients with OVCF manifesting non-neurological symptoms treated from January 2009 to January 2012.There were 22 males and 30 females,with a mean age of 61.3 years (range,55 to 70 years).Fracture level was T11 in 8 patients,T12in 20,L1 in 22 and L2 in 12.Treatments included percutaneous pedicle instrumentation combined with vertebral fracture fixation in 36 patients (Group A) and percutaneous pedicle instrumentation combined with vertebral augmentation in 26 patients (Group B).Operation time,intraoperative blood loss,anterior vertebral body height,sagittal Cobb angle and visual analogue score (VAS) were compared between the two groups.Results All patients were followed up for average 46.5 months (range,36 to 58 months).Operation time in Group A [(82.6 ±16.2) min] was shorter than that in Group B [(96.8 ± 20.6) min] (P ＜ 0.05).Blood loss in Group B [(40.5 ± 10.2) ml] was less than that in Group A [(52.2 ± 15.5) ml] (P ＜ 0.05).Before operation and 3 days and 1 year after operation,the anterior vertebral body height and sagittal Cobb angle in Group A showed no significant differences compared to Group B (all P ＞ 0.05).At the final follow-up,the ratio of anterior vertebral height and Cobb angle in Group B [(87.8 ± 2.5) ％,(7.8 ± 3.5) °] were better than these in Group A [(82.6 ±3.2)％,(9.1 ± 1.8)°] (P＜0.05).VAS showed no statistical significance between the two groups before and after operation (P ＞ 0.05).Bone cement leakage was seen in four patients in Group B.During the perioperative period,there were 3 patients with lung infection in Group A and 1 patient with lower limb deep vein thrombosis in Group B.No implant failure occurred in both groups.Conclusion Both procedures are effective in treating elderly patients with OVCF,but percutaneous pedicle instrumentation combined with vertebral augmentation is associated with better results in maintaining vertebral height and preventing kyphosis.