Background The prevalence of osteoporosis and osteopenia is higher among underground coal miners than surface workers. The special underground work environment and unhealthy habits such as smoking, drinking, and a high-salt diet may lead to changes in bone metabolism, increasing the risk of fragility fractures and placing a heavy economic burden on individuals and society. Objective To identify potential factors influencing fragility fractures among coal miners in different working environments and to provide a basis for targeted preventive measures to reduce the occurrence of fragility fractures. Methods Male participants who attended at least one of the physical examinations in Kailuan Group between June 2006 and December 2020 were included in the study. The participants were divided into two groups based on their working environment: surface or underground. A case-control study was conducted, where patients with new fragility fractures served as the case group and participants without fragility fractures served as the control group. The two groups were matched with a case:control ratio of 1:4 by age (±1 year) and the same year of physical examination. The matching process was repeated twice, once for the surface working population and once for the underground working population. The analysis of risk factors was conducted using conditional logistic regression models. Results Among a total of 113138 employees in Kailuan Group, 82631 surface workers and 30507 underground workers were included, respectively. The number of individuals who suffered fragility fractures was 1375, accounting for 1.22% of the total population. The incidence of fragility fractures in underground workers was significantly higher than that in surface workers (1.63%>1.07%, P<0.001). The results of conditional logistic regression model showed that current smoking (OR=1.26, 95%CI: 1.05, 1.51), manual labor (OR=1.37, 95%CI: 1.06, 1.78), diabetes (OR=1.26, 95%CI: 1.04, 1.54), sinus tachycardia (OR=1.81, 95%CI: 1.23, 2.66), history of stroke (OR=1.51, 95%CI: 1.09, 2.09), education at college and above (OR=0.65, 95%CI: 0.45, 0.95), high income level (OR=0.69, 95%CI: 0.54, 0.90), elevated hemoglobin (OR=0.91, 95%CI: 0.85, 0.98), and elevated total cholesterol (OR=0.90, 95%CI: 0.82, 0.99) were associated with fragility fractures in the surface working population of coal mines; current smoking (OR=1.48, 95%CI: 1.17, 1.87), current drinking (OR=1.26, 95%CI: 1.01, 1.56), manual labor (OR=2.64, 95%CI: 1.41, 4.94), history of dust exposure (OR=1.28, 95%CI: 1.03, 1.58), and obesity (OR=0.72, 95%CI: 0.52, 0.96) were associated with fragility fractures in the underground working population of coal mines. Conclusion In preventing fragility fractures, special attention should be paid to the bone health of underground workers engaged in manual labor or having a history of dust exposure. It is important to correct their unhealthy behaviors in a timely manner, such as smoking and drinking, and to appropriately increase body weight to prevent fragility fractures. For surface workers, particular attention should be given to the high-risk group for fragility fractures, such as low family income per capita, manual labor, and having a history of stroke or diabetes; in addition, close monitoring of their resting heart rate, hemoglobin levels, and total cholesterol levels may help prevent fragility fractures.

Objective:To explore the diagnostic value of ultrasound in posterior fossa anomalies (PFA) at 11-13 + 6 gestational weeks by measuring brainstem (BS), brainstem-to-occipital bone (BSOB) diameter and BS/BSOB ratio. Methods:A total of 209 normal fetuses (control group) were randomly selected from Beijing Obstetrics and Gynecology Hospital, Capital Medical University, between March 2018 and November 2021. Reference ranges for BS, BSOB diameter and BS/BSOB ratio were obtained on the mid-sagittal view of the fetal profile and the relationship of three parameters and crown-rump length (CRL) was investigated. The intra- and inter-observer reliabilities were determined by intraclass correlation coefficient (ICC) in 30 normal fetuses. Fourteen fetuses diagnosed with PFA in the same period including 10 cases of cystic posterior fossa malformations (cPFM) and 4 cases of open spine bifida (OSB) were retrospectively selected to compare BS, BSOB diameter and the BS/BSOB ratio with control group.Results:BS and BSOB diameters were successfully obtained in all control fetuses (100%), and the intra- and inter-observer reliabilities for BS and BSOB diameters were good (ICC=0.877, 0.846 and 0.939, 0.895). In the control group, BS and BSOB diameter linearly correlated with CRL ( r=0.867, 0.794; all P<0.001), while the BS/BSOB ratio was 0.75 (0.71, 0.79). There were significant differences of BSOB diameter and BS/BSOB ratio between control group and PFA group (all P<0.05). Except for one isolated vermian hypoplasia (VH), the BSOB diameters in 9 (90%) cases of cPFM were above the 95th percentile of the calculated normal range and were below the 5th percentile in 4(100%) cases of OSB.Except for one isolated VH, the BS/BSOB ratio in 9 (90%) cases of cPFM was below the 5th percentile of the calculated normal range. The BS/BSOB ratio in 4 (100%) cases of OSB was above the 95th percentile of the calculated normal range. Conclusions:The measurements of BS and BSOB diameter are feasible with good repeatability. Abnormal BSOB diameter and BS/BSOB ratio are suggestive for PFA. The posterior fossa of isolated VH can be normal in the first trimester.

Objective:To analyze the consistency and repeatability for quantitative evaluation of normal fetal posterior fossa anatomy using transabdominal three-dimensional ultrasound, and assess the clinical value.Methods:The midsagittal planes of fetal brain from 127 normal singleton fetuses with 22-34 weeks of gestation were obtained using transabdominal three-dimensional ultrasound between May, 2020 and May, 2021. The quantitative three-dimensional indicators were measured by two observers, then were measured twice by one of the two observers. The double blind was performed in course of measuring procedures. The intraobserver and interobserver agreements were evaluated. The relationships between three-dimensional indicators and gestational age were analyzed.Results:The quantitative three-dimensional indicators expressing the size of vermis, including area, perimeter, suprainferior diameter and anteroposterior diameter, had positive correlations with advanced gestational age ( r=0.934, 0.936, 0.920, 0.879; all P<0.001). The intra- and interobserver reproducibilities of measurements were very good with all intraclass correlation coefficients >0.80 (all P<0.001). Brainstem-vermis (BV) angle and Brainstem-tentorium (BT) angle had negative and positive correlations with advanced gestational age respectively ( r=-0.317, 0.366; both P<0.001). The intra-and interobserver reproducibilities of measurements were moderate or poor. Conclusions:The quantitative three-dimensional indicators describing the size of vermis are worthy of clinical application for evaluation of fetal posterior fossa owing to the excellent reproducibility and simple and feasible method of measurement. BV angle and BT angle are not applicable for junior physicians due to the poor reproducibility of measurement.

We report two cases of Joubert syndrome initially tentatively diagnosed by prenatal ultrasound in the first or second trimester which were thereafter confirmed by whole exome sequencing (WES). Case 1 was one of the twins who presented with increased intracranial transparency (IT) and thinner brainstem at 12 +1 gestational weeks. Ultrasound at 18 +2 weeks found multiple intracranial malformations, "molar tooth sign (MTS)" at the midbrain-hindbrain junction level in the cerebral cross section, and bilateral ventriculomegaly. Enlarged and echogenic kidneys and oligohydramnios were also detected. In case 2, ultrasound image at 17 +5 weeks of gestation indicated multiple intra-and extra cranial and extracranial malformations, MTS in the midbrain-hindbrain junction plane, bilateral ventriculomegaly, unclear cavum septum pellucidum. Extracranial anomalies were bilateral multicystic enlarged kidneys, invisible bladder, and oligohydramnios. Both fetuses underwent amniocentesis, which showed normal karyotype and no copy number variation was detected. However, variation of the TMEM67 gene (c.312+5G>A at introns 2 and c.1175C>G at exon12) was detected in both fetuses by WES, supporting the diagnosis of Joubert syndrome. Selective reduction and termination of pregnancy were performed on case 1 and case 2 at 18 +5 and 19 weeks of gestation, respectively.

Proton pump inhibitor (PPI) is the first-line drug for treatment of abnormal secretion of gastric acid and acid related diseases,and is effective in the treatment of peptic ulcer,Helicobacter pylori (Hp) infection,upper gastrointestinal bleeding and gastroesophageal reflux disease (GERD).Recent studies have shown that PPI could be used in other clinical fields,such as tumor,pulmonary fibrosis,atrial fibrillation,tuberculosis infection and premature delivery,which provides new insights for the treatment of these diseases.This article reviewed the new fields of clinical application of PPL.

Objective To use warm needling moxibustion plus Julisanjie Bolus for the treatment of hysteromyoma and explore a new way to treat hysteromyoma. Method A treatment group of 40 hysteromyoma patients received warm needling moxibustion plus Julisanjie Bolus; a conventional treatment group of 40 hysteromyoma patients, Julisanjie Bolus; a control group of 40 hysteromyoma patients, mifepristone. The therapeutic effects were compared between the treatment group and the conventional treatment or control group. Result The cure rate and the total efficacy rate were 12.5% and 97.5%, respectively, in the treatment group, 5.0% and 75.0%, respectively, in the conventional treatment group and 5.0% and 72.5%, respectively, in the control group. Conclusion The therapeutic effect was significantly better in the treatment group than in the conventional treatment and control groups (P<0.05). There were no obvious adverse reactions during the clinical trial of warm needling moxibustion plus Julisanjie Bolus for the treatment of hysteromyoma.

Established rat models with subclinical hypothyroidism (SCH) were divided into three groups:subclinical hypothyroid(SCH),SCH treated with levothyroxine (L-T4),and control group.The L-T4 group displayed lowered total cholesterol and endothelin levels compared with the SCH group[(1.29 ±0.05 vs 2.38 ±0.55) mmol/L,(98.54 ± 32.43 vs 160.62 ±37.25) nmol/L,both P＜0.05].Nitric oxide levels,left ventricular systolic pressure,and blood flow in abdominal aorta were significantly higher in the L-T4 group than those in the SCH group.The results of this study indicate that L-T4 treatment may improve endothclial dysfunction and hemodynamic changes in rats with SCH.

PurposeTo evaluate the safety and feasibility of transabdominal ultrasound guided multifetal pregnancy reduction performed in the second trimester.Materials and Methods Forty-three women receiving embryo implantation were divided into two groups according to whether they have received multifetal pregnancy reduction including 16 in the reduction group in the second trimester to reduce multiple fetuses to twins, and 27 with twin pregnancy and no reduction. The pregnancy outcome was compared.Results In the reduction group, 1 patient had miscarriage because of intrauterine infection; 1 patient lost one of the retained fetuses in two days after reduction and delivered the remaining fetus. In the other 14 cases, 8 delivered and 6 were still in pregnancy. This group had 17 newborns, all without neonatal death or birth defects. In the non-reduction group, there was 1 spontaneous abortion. In 2 patients, 1 of the twin embryos stopped development. 1 case had a spontaneous abortion, the other 24 cases delivered uneventfully. There were 50 newborns in this group with 3 birth defects and no neonatal death. There was no statistically significant difference in gestational age at delivery, birth weight, and the incidence of maternal and neonate complications (P>0.05).Conclusion Multifetal reduction improves pregnancy outcomes, similar to non-reduction twin pregnancy. It is safe and feasible to perform multifetal pregnancy reduction in the second trimester.

Two hundred and fifty patients with subclinical hypothyroidism ( SCH) and 120 euthyroid volunteers were recruited for the study, SCH patients were stratified into 2 groups according to TSH levels(group A:TSH<10 mIU/ L; group B: TSH>10 mIU/ L). All subjects were examined for clinical characteristics, thyroid profile, lipid profile, and biomarkers of early atherosclerosis. Patients in group B received L-thyroxine replacement treatment to achieve euthyroidism. After 6 months of stable euthyroidism all measurements were repeated. SCH patients had higher levels of total cholesterol(TC), low-density lipoprotein-cholesterol(LDL-C), asymmetric dimethyl arginine (ADMA), carotid artery intima media thickness(CIMT), thromboxane B2(TXB2), and C-reactive protein(CRP) but with lower nitric oxide(NO) level compared with euthyroid subjects. Levels of TC, LDL-C, CIMT, TXB2, and ADMA decreased, and NO level increased significantly after 6 months of euthyroidism. TSH was positively correlated with TC, LDL-C, CIMT, ADMA, and TXB2; and negatively correlated with NO. Based on multivariate regression analysis, TSH was an independent influential factor of CIMT and NO. We conclude that raised TSH is an important risk factor of atherosclerosis in SCH.

Objective To discuss the possible reasons of contrast agent reflux during transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy),and in order to provide scientific evidences for reducing the contrast agent reflux.Methods The sonographic features of contrast reflux were observed in the images of 167 infertile patients who underwent TVS RT-3D-HyCoSy, and the association of the incidence rate of the reflux with tubal patency,the types of infertility,endometrial thickness,menstrual clean days,abnormal uterine cavity,the history of intrauterine operations,pelvic operations and ectopic pregnancies were analyzed.Results The incidence rate of the reflux during TVS RT-3D-HyCoSy was 41 .3%.The incidence rates of reflux in unilateral patency and bilateral obstruction were 4.929 and 9.21 5 times of that of bilateral patency respectively.The incidence rate of reflux in the secondary infertility cases was significantly higher than that of primary ones(P <0.05).Logistic regression analysis demonstrated that the reflux is associated with the tubal patency,the endometrial thickness and the history of intrauterine operations,and none of the other factors.Conclusions TVS RT-3D-HyCoSy could differentiate the images of reflux better;the proper timing of the contrast examination and avoiding the damage of endometrium would reduce the incidence of the reflux.