Objective To analyze the correlation between sleep disorder and bone mineral density(BMD)and fracture risk in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods 150 T2DM patients over 50 years old who were hospitalized in the Endocrine Metabolism Department of Changsha First Hospital from September 2022 to April 2023 were selected.According to the Pittsburgh Sleep Quality Index(PSQI),they were divided into a non-sleep disorder group(66 cases)and a sleep disorder group(84 cases).The general data and biochemical indicators of the two groups were compared.The relationship between sleep disorder and BMD,fracture risk was analyzed.Results Compared with the non-sleep disorder group,HbA1c,FPG,female proportion,the proportion of hypnotics and risk scores of vertebral fracture in the sleep disorder group were higher,and BMI,BMD of femoral neck and hip were lower(P<0.05).Pearson correlation analysis showed a negative correlation between PSQI score and BMD of femoral neck and hip(P<0.05).Pearson or Spearman correlation analysis showed that the risk scores of vertebral fracture was positively correlated with age,duration of DM,use of hypnotics and sleep disorder(P<0.05 or P<0.01),and negatively correlated with BMD of femoral neck and hip(P<0.01).Binary logistic regression analysis showed that FPG,use of hypnotics and hip BMD were influencing factors of sleep disorders,while sleep disorders and PSQI scores were influencing factors of osteoporosis.Conclusions For middle-aged and elderly T2DM patients,improving sleep may help reduce the occurrence of osteoporosis and reduce the risk of fractures.

Objective:To study the expression of forkhead box P1 (FOXP1) in intrahepatic cholangiocarcinoma (ICC), and its clinicopathological and prognostic significance.Methods:The clinical data of ICC patients treated with radical resection at Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 1, 2013 to December 12, 2019 were retrospectively analysed. Of 48 ICC patients, there were 24 males and 24 females, with age of (59.1±10.1) years old (range 42 to 83 years old). Their clinicopathological data, including age, gender, tumor size, degree of differentiation, and staging were recorded. Immunohistochemical method was used to detect the expression of FOXP1 protein in ICC cancer tissues and the corresponding adjacent normal tissues. Kaplan-Meier method was used to calculate survival rates and to construct survival curves of patients. Cox regression model was used to analyze factors affecting prognosis of patients.Results:Forty-eight ICC cancer tissues and 40 corresponding paracancerous tissues were collected. The positive rates of FOXP1 proteins in ICC were significantly lower than the adjacent normal tissues [54.2%(26/48) vs. 92.5%(37/40), χ 2=15.76, P<0.05]. The degrees of tumor differentiation, lymph node metastasis, organ invasion and TNM staging were related to expression of FOXP1 ( P<0.05). Forty-two patients were followed-up with a median follow-up time of 11.5 (7.75, 19.25) months. Cox multivariate analysis revealed that invasion to adjacent organs, lymph node metastasis, high TNM staging (stage Ⅲ) and negative expression of FOXP1 were independent risk factors affecting overall survival of ICC patients. The overall survival and recurrence-free survival of FOXP1-positive ICC patients were 17.5 months and 15.5 months, which were significantly higher than the 14.0 months and 11.1 months, respectively, in FOXP1-negative patients. Conclusion:Negative FOXP1 expression was closely correlated with aggressive biological behavior and poor prognosis of ICC. FOXP1 may be used as new diagnostic and therapeutic targets.

Objective:To investigate the association of body weight and body mass index (BMI) with bone mineral density (BMD) and osteoporotic risk in elderly men with type 2 diabetes mellitus (T2DM).Methods:210 elderly male patients with T2DM admitted to the Department of Endocrinology of the First Hospital of Changsha from June 2017 to May 2018 were selected as the research objects. The height, weight and bone mass index (BMI) were measured. BMDs of the left hip [including femoral neck (FN), greater trochanter (G.T.), intertrochanter (InTro), and total hip (TH)] and lumbar spine (LS) were measured in 210 elderly male patients with T2DM by dual-energy X-ray absorption method. Patients were divided into three groups according to BMI: the overweight group (24.0 kg/m 2≤BMI<28.0 kg/m 2), the obesity (BMI≥28.0 kg/m 2) group, and the normal group (18.5 kg/m 2≤BMI<24.0 kg/m 2). The influence of body weight and BMI on BMD and osteoporotic risk in these elderly men with T2DM was analyzed. Results:The BMDs in various sites of the hip of the overweight group and obesity group were higher compared with those in the normal weight group ( P<0.05). There was a positive correlation between weight and BMI with BMDs in various sites of the hip femoral neck (including FN, G. T., InTro, and TH) ( r=0.239-0.427, P<0.05). All patients were divided into different tertiles (T1-T3) stratified by weight and BMI respectively. The BMDs in various sites of the hip increased with tertiles stratified by weight ( P<0.05). The TH-BMD also increased with tertiles stratified by BMI ( P<0.05). The odd ratios ( OR) were calculated using T3 as the control group and T1 as the case group, using T2 as the control group and T1 as the case group, respectively. The osteoporotic risks of T1/T3, T1/T2 at FN stratified by weight were significantly increased by 4.50 times ( OR=4.50, 95% CI: 1.41-14.35) and 9.27 times ( OR=9.27, 95% CI: 2.03-42.30); The osteoporotic risks of T1/T3, T1/T2 at TH were significantly increased by 3.25 times ( OR=3.25, 95% CI: 1.10-9.59) and 8.50 times ( OR=8.50, 95% CI: 1.85-38.99). The osteoporotic risks of T1/T3, T1/T2 at FN stratified by BMI respectively were significantly increased by 4.13 times ( OR=4.13, 95% CI: 1.28-13.25) and 5.58 times ( OR=5.58, 95% CI: 1.53-20.42); while the osteoporotic risks of T1/T3, T1/T2 at TH stratified by BMI were not significantly increased ( P>0.05). There was no statistically significant difference in BMDs and the osteoporotic risks of the LS among T1, T2, and T3, regardless of stratified by weight or BMI ( P>0.05). Conclusions:For elderly males with T2DM, weight and BMI are important factors affecting BMDs in the hip, and also affecting the osteoporotic risks of the hip, especially that of FN. Osteoporotic risks of the FN decrease with the increase of weight and BMI within a certain range.

OBJECTIVE: To investigate the changes in diversity, relative abundance and distribution of intestinal flora in patients with chronic rhinosinusitis and nasal polyps (CRSwNP) using high-throughput sequencing technology identify the intestinal flora significantly related to pathogenesis and progression of CRSwNP. METHODS: Ten patients with CRSwNP hospitalized in the Department of Otolaryngology-Head and Neck Surgery of Guangdong Provincial People's Hospital were selected as the case group with 10 healthy volunteers recruited in the same period as the control group. Fecal genomic DNA extraction kit was used to extract the DNA in the fecal samples, and the DNA fragment length was measured and quantified. The V3 and V4 highly variable regions of the 16S rDNA gene of prokaryotes were amplified followed by library construction, Illumina MiSeq sequencing, sequence alignment and species identification analysis. The relative abundance, diversity and distribution characteristics of the intestinal flora were analyzed, and the relevant metabolic pathways were predicted. RESULTS: Compared with the control group, the patients with CRSwNP had significant changes in the overall structure of the intestinal flora, highlighted by increased abundance of Saccharopolyspora and decreased contents of , , and . Among the metabolic pathways predicted to be associated with CRSwNP, 9 showed significant changes in patients with CRSwNP as compared with the control group ( < 0.05). CONCLUSIONS Patients with CRSwNP have significant changes in the structural characteristics of intestinal flora related with multiple metabolic pathways, and these changes may play an important role in the development of chronic rhinosinusitis.

Objective To improve the recognition and knowledge of autosomal dominant polycystic kidney disease (ADPKD) related male infertility through investigation for MRI characteristics of this disease. Methods Fourteen patients confirmed with ADPKD related obstructive azoospermia were retrospectively analyzed. All patients referred to clinic with male infertility, and obstructive azoospermia were additionally confirmed by laboratory tests and clinical examination. Subsequent abdominopelvic MR examinations were performed to comfirm obstructive factors and obstructive location. All patients were performed an abdominopelvic MR examination including non-enhanced and enhanced MR. MR imaging characteristics were analyzed and summarized by two experienced radiologists. Results MRI results for all cases were classified into 4 groups:10 cases with bilateral polycystic kidneys and bilateral seminal vesicle cysts, 2 cases with bilateral polycystic kidneys, polycystic liver and bilateral seminal vesicle cysts, 1 case with bilateral polycystic kidneys, polycystic liver and absence of bilateral seminal vesicles, 1 case with bilateral cystic kidneys, bilateral seminal vesicle cysts as well as Müllerian duct cyst. A wide range of coronal T2WI scan was necessary to observe cystic lesions in both liver and bilateral kidneys as well as abnormal changes in pelvis. The obstructive sites in all cases were located in level from ejaculatory duct to seminal vesicle. Bilateral seminal vesicle cysts presented as significantly dilated glandular ducts of seminal vesicles, in which flocculence or nodular sediment can be found. Conclusion Male infertility caused by ADPKD-related deferential duct obstrution is characterized by bilateral polycystic kidney disease and Seminal vesicle ejaculatory duct obstruction in MRI, which can be combined with other abnormalities.

Objective To explore prenatal MRI findings of fetal midline dural sinus malformation(DSM).Methods Eleven fetuses of midline DSM were collected.Abnormalities in the fetal occipital or cerebellar area were found from 21 to 27 weeks of gestation.Then MR scanning in the following week was performed.Of all 11 fetuses,9 were pathologically proved to be midline DSM,and the other 2 were followed up and proved after birth.The imaging findings and pathological features were analyzed.Results MRI of 11 fetuses showed cystic dilation of the occipital cranium of torcular herophili area,with the size of 10 mm× 15 mm to 35 mm× 55 mm,and the adjacent sinuses were also dilated.On axial or coronal images,the lesions were cuneiform,while on sagittal images,the lesions were spindle-or crescent-shaped.The lesions displayed isointensity or slightly hyperintensity on T1WI,while slightly hypointensity,isointensity or slightly hyperintensity on T2WI.In 9 of the 11 fetuses,class round or bar thrombosis on the side wall of the cystic mass were observed,which were hyperintensity on T1WI and isointensity and hypointensity,isointensity or hyperintensity on T2WI.Hemosiderin deposition was observed around the thrombi in 6 fetuses.Lesion diameters in 2 fetuses were more than 30 mm,and the adjacent brain tissue was significantly dislocated.Nine fetuses of postmortem pathology after induced labor showed deformed and dilated venous sinuses,in which eccentric thrombi were seen in 7 fetuses with side branches around them.Normal brain development was observed in 2 live birth newborns.Conclusion Prenatal MRI can accurately diagnose fetal midline dural sinus malformation,and estimate the development of fetal brain,which may be helpful to prognosis prediction.

Objective To observe imaging features of uterus duplication combined with mesonephric duct dysplasia related abnormalities.Methods Imaging data of 17 female with uterus duplication and renal dysplasia were retrospectively analyzed.Seven patients underwent CT and 10 patients underwent MR scanning.Results The basic abnormalities in 17 patients were uterus duplication combined with unilateral renal-ureter dysplasia with/without other associated malformation which were further classified as follows:①7 patients presented as basic abnormalities without other associated malformations,include 5 (CT diagnosed 1,MR diagnosed 4) with uterus duplex and unilateral renal-ureter agenesis,2 (CT 1,MR 1) with uterus bifidus and unilateral renal-ureter dysplasia;②2 patients (CT 1,MR 1) presented as basic abnormalities accompanied with ectopic ureter orifice,uterus duplex and unilateral renal dysplasia with ectopic ureter orifice opening in vagina;③5 patients (CT 3,MR 2) of Herlyn-Werner-Wunderlich syndrome presented as uterus duplication,oblique vagina septum as well as unilateral renal-ureter dysplasia,which shown as uterus duplex,oblique vaginal septum with hematocolpos,also unilateral renal-ureter agenesis;④2 patients presented as basic abnormalities accompanied with mesonephric residual cyst,CT showed one with uterus duplex and unilateral renal-ureter agenesis with ipsilateral mesonephric residual cyst,MRI showed as the other one with Herlyn-Werner-Wunderlich syndrome combined with mesonephric residual cyst opening in vagina;⑤MRI showed 1 patient with basic abnormalities and a nephrogenic adenoma,which demonstrated as uterus duplex combined with left renal-ureter agenesis,and a tumor on the left wall of bladder accompanied with endometriosis.Conclusion Further classification into 5 types from simple to complex based on uterus duplication combined with unilateral renal-ureter dysplasia with/without other associated malformations is helpful to the diagnosis and treatment of these abnormalities.

Objective To discuss the efficacy and safety of covered Cheatham-Platinum stent (CCPS) implantation in treating coarctation of the aorta (CoA).Methods The clinical data of 11 patients with CoA who had received CCPS implantation were retrospectively analyzed.Results Successful implantation of single CCPS was accomplished in all 11 patients.After the implantation,the diameter of coarctation site was immediately dilated from preoperative (4.76+0.89) mm to postoperative (12.86+0.90) mm (t=24.86,P＜0.001),and the average systolic blood pressure difference across the coarctation was immediately reduced from preoperative (38.55+10.02) mmHg to postoperative (9.82+6.60) mmHg,the difference was statistically significant (t=10.8,P＜0.001).The patients were followed up for 3-79 months,with a mean of (31.91±27.58) months.The clinical symptoms were relieved in all patients and the activity tolerance was obviously improved.No complications such as endoleak,acute injury of aortic wall,re-coarctation or re-stenosis,vascular injury of puncture site,or death occurred in all patients.Conclusion For the treatment of CoA,implantation of CCPS has excellent short-term and mid-term effect,meanwhile,this technique can effectively avoid complications such as aortic wall iniurv.(J Intervent Radiol.2017.26:211-214)

Objective To observe the clinical efficacy of JIN’s three needle therapy plus rehabilitation in treating mental retardation (MR).Method Seventy-two MR patients were randomized into a treatment group of 37 cases and a control group of 35 cases. The control group was intervened by conventional rehabilitation training, while the treatment group was treated with JIN’s three needle therapy in addition to the rehabilitation training. The modified Chinese version of Gesell Developmental Schedules (GDS) was adopted to observe the improvements in gross and fine motor skills, language, social function and adaptability, and the clinical efficacies were compared between the two groups. Result In the treatment group, the adaptability, gross motor skills and fine motor skills scores were significantly changed after the intervention (P<0.05). In the control group, the gross and fine motor skills scores were significantly changed after the intervention (P<0.05). After the treatment, there were significant differences in comparing the gross and fine motor skills scores between the two groups (P<0.05). In the treatment group, the total effective rates were respectively 93.1% and 62.5% in the mild-moderate and severe-extremely severe patients, versus 76.9% and 44.4% in the control group. There was a significant difference in comparing the total effective rate in the mild-moderate patients between the two groups (P<0.05).Conclusion JIN’s three needle therapy plus rehabilitation is an effective approach, and it can significantly improve the gross and fine motor skills and adaptability in mild-moderate MR patients.

Objective To investigate the imaging characteristics of female Skene-gland (periurethral glands) disease. Methods A retrospective analysis of preoperative imaging findings was performed in 15 female patients with surgical-pathological proven Skene gland disease. MRI scans were performed in 8 cases, CT scans were performed in 5 cases, both CT and MRI were performed in 2 cases. Imaging characteristics were observed and summarized.Results There were 3 types of diseases,including:(1) Skene gland cyst (n=3), located in the distal and posterolateral urethra or close to the proximity of urethra, presenting as cystic lesions with teardrop shape on sagittal images, which appeared as hypo-attenuation on non-enhanced CT, and hypo-intensity on T1WI, hyper-intensity on T2WI, and without enhancement. One case complicated with infection presented as hyper-intensity on T1WI and gaseous intensity inside,with thickened cystic wall and enhancement.(2)Urethral diverticulum communicating with Skene gland (n=10), located in the middle or distal and posterolateral urethra, presented as a horseshoe shaped cystic lesion partially surrounding the urethral(n=3)or spoke wheel-like cystic lesion with multiple septum completely surrounding the urethra (n=7). They appeared as fluid attenuation on unenhanced CT, and hypo-intensity on T1WI, hyper-intensity on T2WI and without enhancement. Heterogenous signal or attenuation and enhanced septum or cystic wall were found in 6 cases complicated with infection. (3) Malignant tumor (n=2, one adenocarcinoma and one neuroendocrine carcinoma), presented as cystic-solid mass surrounding the urethral, showing heterogenous low attenuation on nonenhanced CT and iso-to hyper-intensity on T2WI and hypo-to iso-intensity on T1WI with significant enhancement.Conclusions Female Skene-gland disease has specific occurrence location and imaging characteristics.