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Dandy-Walker syndrome (DWS) is a group of brain malformations which occasionally accompanied by psychotic symptoms. The co-occurrence of DWS and epilepsy in children is quite rare.We reported a 14-year-old male who presented with a 8-month history of inconsistent upper limb tremor and accidental seizure. The MRI showed the typical alterations of DWS: cystic dilatation of the fourth ventricle, vermian hypoplasia, enlarged posterior fossa. He received the ventriculoperitoneal shunting (VPS) placement for hydrocephalus and had a symptom-free period for 8 days. Then he experienced a recurrence of involuntary upper limb tremor and behavior disturbance after decreasing the pressure of cerebrospinal fluid (CSF) from 150 to 130 mm Hg. After being treated with Olanzapine 10 mg/d, Clonazepam 3 mg/qn and Valproate acid (VPA) 500 mg/bid for nearly a month, his mental status and psychotic symptoms fluctuated. A search of Pub Med showed little report of hydrocephalus and DWS comorbidity with seizure and psychosis. Here we presented the whole process of a rare disease from the very beginning with all his symptoms, examinations and treatments.VPS placement surgery at an earlier stage may be an effective way to avoid inevitable brain damage so as to improve the clinical outcomes for patients with DWS. Continued treatment with regard to DWS condition may include shunt placement, but it mainly focus on developmental concerns, with occupational and physical therapy along with ongoing supportive psychotherapy to improve the coping skills and quality of life.

Hepatocellular carcinoma (HCC) is a common malignancy with high mortality and poor prognosis due to a lack of predictive markers. However, research on small nuclear RNAs (snoRNAs) in HCC were very little. This study aimed to identify a potential diagnostic and prognostic snoRNA signature for HCC.HCC datasets from the cancer genome atlas (TCGA) and international cancer genome consortium (ICGC) cohorts were used. Differentially expressed snoRNA (DEs) were identified using the limma package. Based on the DEs, diagnostic and prognostic models were established by the least absolute shrinkage and selection operator (LASSO) regression and COX analysis, and Kaplan-Meier (K-M) survival analysis and receiver operating characteristic (ROC) curve analysis were conducted to evaluate the efficiency of signatures. Gene set enrichment analysis (GSEA) and gene set variation analysis (GSVA) were used to analyze the risk score and further explore the potential correlation between the risk groups and tumor immune status in TCGA. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to determine the functions of key snoRNAs.We constructed a 6-snoRNAs signature which could classify patients into high- or low-risk groups and found that patients in the high-risk group had a worse prognosis than those in the low-risk group and were significantly involved in p53 processes. Tumor immune status analysis revealed that CTLA4 and PDCD1 (PD1) were highly expressed in the high-risk group, which responded to PD1 inhibitor therapy. Additionally, a 25-snoRNAs diagnostic signature was constructed with an area under the curve (AUC) of 0.933 for distinguishing HCCs from normal controls. Finally, 3 key snoRNAs (SNORA11, SNORD124, and SNORD46) were identified with both diagnostic and prognostic efficacy, some of which were closely related to the spliceosome and Notch signaling pathways.Our study identified 6 snoRNAs that may serve as novel prognostic models and 3 key snoRNAs with both diagnostic and prognostic efficacy for HCC.

Maturity-onset diabetes of the young (MODY) is a group of autosomal dominant monogenic diabetes mellitus with a wide range of clinical manifestations that require distinct treatment strategies. MODY9 (OMIM # 612225) is a rare type of MODY, caused by a mutation in the Paired box gene 4 (PAX4).A 19-months boy was admitted to the department of endocrinology at Beijing Children's Hospital due to excessive water drinking, polyuria for over half a month, and wheezing for 3 days.The whole-exon sequencing analysis demonstrated that the child carried the heterozygous missense mutation of c.487T in the 7th exon region of PAX4 gene and diagnosed MODY9.The patient was treated with fluid therapy, ketosis correction, insulin, and anti-infection treatment.After 17 days in the hospital, the blood glucose levels remained stable and the patient was discharged.In Chinese children, the heterozygous mutation of c.487CT in the PAX4 gene can lead to the occurrence of MODY9.Gene sequencing analysis is of great significance in the diagnosis and classification of MODY.

Pediatric patients suffer from chronic pancreatitis (CP), especially those with diabetes mellitus (DM). This study aimed to identify the incidence of and risk factors for DM in pediatric CP. CP patients admitted to our center from January 2000 to December 2013 were assigned to the pediatric (

Rationale: Sclerosing pneumocytoma accompanied with other type of tumor in one patient is very rare. Here, we report a case of a sclerosing pneumocytoma mixed with a typical carcinoid tumor in a same neoplasm. Patient concerns: A 55-year-old woman incidentally detected a space-occupying lesion of right lung in routine health examination. The patient was asymptomatic and there were no positive findings in routine laboratory examination, physical examination, and pulmonary function test. Computed tomography revealed a solitary round mass in the middle lobe of the right lung. Diagnosis: The lesion was diagnosed as a sclerosing pneumocytoma accompanied with a typical carcinoid tumor of the right lung. Intervention: The patient underwent thoracoscopic lobectomy in our hospital. Outcomes: The postoperative course was uneventful. Lessons: This case is rare and noteworthy for a lesion containing two different types of neoplasms, which may cause diagnostic difficulties.

Rationale Urinary bladder urothelial carcinoma is the most common malignant tumor in the urinary system, and noninvasive papillary urothelial carcinoma (NIPUC) comprises most bladder malignancies. NIPUC grading is important for therapeutic and clinical protocol selection. Here, we report a case of NIPUC with pathological features in between low (LG-NIPUC) and high (HG-NIPUC) grades NIPUC. Patient concerns A 72-year-old male, presenting with a 20-year history of hypertension and 5 months of hematuria. Diagnoses Computed tomography examination revealed a tumor in the urinary bladder neck. Microscopic investigation revealed that most tumor tissue samples had a branching papillary architecture, with well-developed fibrous-vascular cores. Tumor cells were slightly crowded, with somewhat altered cell polarity and cell adhesion. Immunohistochemistry showed positive Ki67 staining, mostly in the basal layer, while p53 staining was rarely positive. These samples were diagnosed as LG-NIPUC. However, a few tumor tissue samples presented mildly fused papillary architectures without cell polarity or adhesion. Most nuclei stained intensely and were pleomorphic. All epithelial tissue layers were ki67 positive, and the p53 positive rate was higher than that in the LG samples. Therefore, these were classified as HG-NIPUC. Interventions The tumor was completely resected during lithotomy postural surgery. Outcomes The patient is alive with a good recovery during 3 months after the surgery. Lessons We diagnosed this patient as having LG-NIPUC with local HG-NIPUC components. HG- and LG-HIPUC have different outcomes. This case is a new challenge for the pathological grading of NIPUC. An intermediate HIPUC grade might need to be added to the original NIPUC grading system.

Background: The aim of this systematic review with meta-analysis is to determine the efficacy and security of acupuncture in treatment of ocular myasthenia gravis and find out whether or not the quick short-term efficacy of acupuncture exists. Methods: The following electronic databases will be searched by 2 independent reviewers: PubMed, Cochrane Library, EMBASE, Springer, China National Knowledge Infrastructure, Wanfang, and Chinese Biomedical Literature Database. All randomized controlled trials on acupuncture for ocular myasthenia gravis published in electronic databases from inception to March 1, 2020, with language restricted in Chinese and English will be included in the study. Methodologic quality is assessed by 2 blinded reviewers independently screen and score the articles using the PEDro scale and the Cochrane Collaboration risk of bias tool. A meta-analysis was performed when there is sufficient clinical homogeneity in at least 2 studies. The Grading of Recommendations Assessment, Development and Evaluation approach is used to rate the body of evidence in each meta-analysis. When the quantitive evaluation is not available, a qualitative description of the results of single study is provided. Results: An evidence of variety of acupuncture treatment methods for treating ocular myasthenia gravis will be illustrated using subjective reports and objective measures of performance. The primary outcomes consisted of effective rate, MGFA PIS, QMG, and MG-composite. Secondary outcomes involve clinical absolute and relative score, titers of AchR antibodies, and the side effects. The treatment frequency and courses will be measured. Conclusion: This protocol will present the evidence of whether acupuncture is an effective and safe intervention for ocular myasthenia gravis. Trial registration number: CRD42019141325

Background This systematic review aims to evaluate the effectiveness of electroacupuncture in treatment of lumbar disc herniation (LDH). Methods Electronic databases of all electroacupuncture for LDH will be searched at PubMed, Cochrane Library, Springer, EMBASE, China National Knowledge Infrastructure (CNKI), Wan-Fang, and Chinese Biological Medical disc, (CBM) from inception to February 29, 2020, with language restricted in Chinese and English. The primary outcome is Japanese Orthopedic Association Scores, a quantification scale for a comprehensive assessment according to patients' subjects feeling and objective function. Secondary outcomes included visual analogue scale (VAS), Oswestry dysfunction index (ODI), Pittsburgh sleep quality index (PSQI), Self-rating anxiety scale (SAS), self-depression rating scale (SDS), follow-up relapse rate. The systematic review and searches for randomized controlled trials of this therapy for LDH. The Cochrane RevMan V5.3 bias assessment tool is implemented to assess bias risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). Mean difference (MD), standard mean deviation (SMD) and binary data will be used to represent continuous results. Results This study will provide a comprehensive review and evaluation of the available evidence for the treatment of LDH with this therapy. Conclusion This study will provide new evidence to evaluate the effectiveness and side effects of electroacupuncture for LDH. Due to the data is not personalized, no formal ethical approval is required.

Background: This study aimed to describe clearly the normal imaging features of the meniscal roots on the magnetic resonance imaging (MRI) with a 3-dimensional (3D) proton density-weighted (PDW) sequence at 3T. Methods: A total of 60 knees of 31 young asymptomatic volunteers were examined using a 3D MRI. The insertion patterns, constitution patterns, and MR signals of the meniscal roots were recorded. Results: The anterior root of the medial meniscus (ARMM), the anterior root of the lateral meniscus (ARLM), and the posterior root of the medial meniscus (PRMM) had 1 insertion site, whereas the posterior root of the lateral meniscus (PRLM) can be divided into major and minor insertion sites. The ARLM and the PRMM usually consisted of multiple fiber bundles (≥3), whereas the ARMM and the PRLM often consisted of a single fiber bundle. The ARMM and the PRLM usually appeared as hypointense, whereas the ARLM and the PRMM typically exhibited mixed signals. Conclusions: The meniscal roots can be complex and diverse, and certain characteristics of them were observed on 3D MRI. Understanding the normal imaging features of the meniscal roots is extremely beneficial for further diagnosis of root tears.

Objective The aim of this systematic review with meta-analysis is to determine the effect of miniscalpel-needle/needle-knife in treatment of chronic pain symptoms. Methods The following electronic databases will be searched by 2 independent reviewers: PubMed, Cochrane Library, EMBASE, Springer, China National Knowledge Infrastructure (CNKI), Wanfang, and Chinese Biomedical Literature Database (CBM). All randomized controlled trials on miniscalpel-needle/need-knife for chronic pain published in electronic databases from inception to August 1, 2019 with language restricted in Chinses and English will be included in the study.Methodologic quality is assessed by 2 blinded reviewers independently screen and score the articles using the Physiotherapy Evidence Database (PEDro) scale and the Cochrane Collaboration risk of bias tool. A meta-analysis was performed when there is sufficient clinical homogeneity in at least 2 studies. The Grading of Recommendations Assessment, Development and Evaluation approach is used to rate the body of evidence in each meta-analysis. When the quantitive evaluation is not available, a qualitative description of the results of single study is provided. Results A high-quality synthesis of current evidence of miniscapel-needle/needle-knife treating chronic pain will be illustrated using subjective reports and objective measures of performance. The primary outcomes consisted of pain intensity improvement rate clinically meaningful improvements in pain and disability are also noted. Secondary outcomes involve the short form of McGill Pain Questionnaire score (SF-MPQ) and the side effects. Conclusion This protocol will present the evidence of whether miniscalpel-needle/needle-knife is an effective intervention for chronic pain. Prospero registration number CRD42019129076.

Colorectal cancer has high incidence and mortality. Early diagnosis could increase patient survival, but early diagnosis has been poor in China for the past decades. The purpose of this study is to assess the polyp detection rate (PDR) and adenoma detection rate (ADR) by colonoscopy in a Chinese population, and to determine the risk factors for adenoma. This prospective study at Sichuan Provincial People's Hospital evaluated patients who underwent colonoscopy in September 2017 to February 2018. Basic information, exact insertion and withdrawal times, PDR, and ADR were assessed. Risk factors for colorectal adenoma in the adenoma-positive and adenoma-negative groups (based on pathology) were assessed by multivariable logistic regression analysis. A total of 1058 procedures with 767 polyps were analyzed. The overall PDR and ADR were 36.96% (391/1058) and 24.67% (261/1058), respectively. Occurrence of adenoma was associated with age, gender, body mass index (BMI), family history of colon cancer, personal history of adenoma, diabetes mellitus, and tobacco use. There was a significant association between withdrawal time and ADR (P

Circulating tumor cells (CTCs) are suspected of predicting the prognosis of malignant tumor, but there are few relevant reports specific to esophageal squamous cell carcinoma (ESCC). This study investigated the clinical significance of CTCs in patients with ESCC. Sixty patients with ESCC were enrolled, from whom CTCs had been tested by our team previously. Peripheral blood samples were obtained from these patients before treatment; and CTCs were assayed by isolation by size of epithelial tumor cells (ISET). Associations between the presence of CTCs and patients’ clinicopathological parameters and clinical outcomes were analyzed. CTCs were detected in 20 patients (33.3%), who experienced significantly shorter progression-free survival (PFS) than did the CTC-negative patients. Overall, PFS was negatively associated with the number of CTCs. Multivariate analyses showed that a CTC count >2 was a strong independent prognostic indicator of tumor recurrence (hazard ratio [HR] 5.63; 95% confidence interval [CI] 1.77–17.89; P = .003). In the subgroup of 50 patients who underwent R0 resection and postoperative adjuvant radiotherapy or chemotherapy, CTC was a strong, independent, and prognostic indicator of tumor recurrence (HR 10.70; 95% CI, 1.40–81.91; P = .022). The number of CTCs correlated with the T stage (r = 0.26, P = .043) but not with the N or M stage. For subgroups in stages II or I-IIIB or T3 or T3 + T4, the PFS of patients with CTCs > 1 or > 2 was significantly shorter than that of the patients with CTCs ≤ 1 or CTCs ≤ 2. In the stage III or T3 + T4 groups, the PFS of patients with CTCs > 0 was significantly shorter than that of patients with CTC = 0. This is the first study to report that the CTC detected by ISET is an independent and prognostic indicator of patients’ outcome in ESCC. Consideration of CTCs may improve the accuracy of preoperative staging in ESCC.

Rationale Deep vein thrombosis (DVT) is the formation of a blood clot formed in the deep veins of the lower limbs. Known genetic factors of DVT include deficiencies of antithrombin (AT), protein C, protein S, factor V Leiden mutation, and prothrombin G20210A mutation. Here, a 5-generation Chinese family with inherited DVT was recruited for genetic analysis. Patient concerns The patient came to see a doctor because of leg swelling. A color Doppler ultrasound examination showed extensive thrombosis within the deep veins of her left leg. Computed tomography angiography showed a pulmonary embolism in her right lower pulmonary artery. Diagnoses Type II AT deficiency lead to inherited DVT. Interventions Whole-exome sequencing and cosegregation analysis were carried for the DVT family. Outcomes An unreported heterozygous missense variation, c.281T>C, was identified within the SERPINC1 gene. This missense variation of SERPINC1 leads to type II AT deficiency. Lessons This result further enriched the variation spectrum of the SERPINC1 gene.

High-speed drill is the main osteotomy instrument in pedicle subtraction osteotomy (PSO) currently. Considering the long duration of surgery, the large amount of blood loss, and the high incidence of neurovascular injury, the osteotomy procedure is challenging. Use of trephine for the osteotomy displays high efficiency by shortening surgery time and reducing blood loss in anterior cervical corpectomy and fusion. However, the potential risk of neurological injury is high. We modified the trephine by adding locking instrument, when the serrated top of the trephine reaches the tip of the probe; the locking instrument on the probe restricts the trephine and improves security during the osteotomy procedure. The aim of this study was to compare the clinical and radiological improvement between the modified trephine and high-speed drill as main osteotomy instrument in PSO. From February 2009 to 2013, 50 patients with severe thoracolumbar kyphotic deformity caused by old compressive vertebrae were prospectively reviewed. All patients were randomly assigned to the experimental group (27 patients received PSO with modified trephine) and the control group (23 patients received PSO with high-speed drill). The clinical records were reviewed and compared for surgical time, operative blood loss, functional improvement (Oswestry Disability Index), and pain relief (visual analog scale). The radiological records were reviewed and compared for correction of kyphotic deformity postoperatively and correction loss at 2-year follow-up. All patients successfully finished the PSO procedure, and got satisfactory kyphotic deformity correction and overall function improvement. The surgery time was shorter in the experimental group than that in the control group (132.7 ± 12.6 vs 141.7 ± 16.7 min; P = 0.03). No significant difference was found in blood loss (882.9 ± 98.9 mL vs 902.2 ± 84.9 mL; P = 0.47) or correction of the kyphotic angle (33.4 ± 3.4° vs 32.1 ± 2.5°, P = 0.13) postoperatively between the 2 groups. At 24-month follow-up, no difference was discovered in loss of the correction (4.9 ± 1.6° vs 4.5 ± 1.6°; P = 0.42), change of Oswestry Disability Index (49.4 ± 6.2% vs 48.2 ± 4.2%; P = 0.44), or in back pain relief (6.2 ± 1.4 vs 6.4 ± 1.2 min; P = 0.51) between the 2 groups. No internal fixation related complication occurred and bony fusion was detected in lateral X-ray in all patients. In the control group, 2 patients had transient nerve root deficit, 14 patients at 3-month follow-up and 3 patients at 2-year follow-up experienced graft donor site morbidity, and pain killer medicine was always required. In conclusion, the modified trephine obviously shortens surgery time, and prevents graft donor site morbidity when compared to a high-speed drill. The learning curve for using the modified trephine in PSO procedure is short.

We aim to identify factors predicting patient dissatisfaction 2 years after discectomy for lumbar disc herniation (LDH) in a Chinese older cohort. Preoperative and 2-year follow-up data for 843 patients were analyzed. After 2 years of discectomy, the patients rated their satisfaction by Patient Satisfaction Index (PSI), with response of 1 or 2 defining satisfaction and a PSI response of 3 or 4 defining dissatisfaction. Associations between perioperative variables and satisfaction with the results of surgery were examined in univariate and multivariate analysis. Six hundred fifty-seven patients had a PSI of 1 or 2 and were enrolled as satisfied group, 186 patients had a PSI of 3 or 4 and were enrolled as dissatisfied group. At baseline, no significant differences were found between the 2 groups in age, occupation, Oswestry Disability Index (ODI), Visual Analog Scale (VAS)-leg, and VAS-back. Compared to satisfied group, dissatisfied group had a significantly higher BMI and a higher incidence of depression. Two years after discectomy, no significant differences were found between the 2 groups in decrease of ODI, decrease of VAS-back, decrease of VAS-leg, surgery complications. Compared to satisfied group, dissatisfied group experienced higher incidence of symptom recurrence and depression. Logistic regression analysis showed that obesity, pre- and postoperative depression, symptom recurrence were independently associated with patient dissatisfaction 2 years after discectomy. In conclusion, more than 70% patients expressed satisfaction with discectomy for LDH. Two factors could predict patient dissatisfaction and be assessed before surgery: obesity and preoperative depression. Symptom recurrence and postoperative depression are also associated with diminished patient satisfaction.

Increased fetuin-A has been reported in association with type 2 diabetes and other metabolic diseases. However, the large population data concerning fetuin-A and nonalcoholic fatty liver disease (NAFLD) were limited. In this study, we aimed to investigate the association of serum fetuin-A with fatty liver index (FLI), the indicator of NAFLD. A population-based cross-sectional analysis was performed in 5219 middle-aged and elderly participants who were recruited from 2 nearby urban communities in Shanghai, China. Serum fetuin-A concentrations were measured by enzyme-linked immunosorbent assay (ELISA). The fourth quartiles of FLI, alanine aminotransferance (ALT), aspartate aminotransferance (AST), and γ-glutamyl transpeptadase (GGT) were defined as elevated FLI, ALT, AST, and GGT, respectively. Fetuin-A was positively associated with log-transformed-FLI, -ALT, -AST, and -GGT after adjustment for the confounding factors (all P

Background:Due to increasing antimicrobial resistance, a bismuth-based quadruple regimen has been recommended as an alternative first-line therapy for Helicobacter pylori (H pylori) eradication. However, different results are varied greatly and the availability of bismuth was limited in some

Reducing the false negative rate of sentinel lymph node biopsy (SLNB) for breast cancer patients has always been a focus of clinical research. We aimed to map the sentinel lymph nodes (SLNs) in detail, and analyze the factors related to SLNs located at locations that are often ignored by surgeons, to reduce the rate of false negatives from SLNB. A retrospective analysis involving 545 breast cancer patients who underwent SLNB in west China hospital between August 2010 and February 2016 was performed. Blue dye, radioisotope, or combined methods were used for tracing SLNs. Using blue dye, radioisotope, and a combination of blue dye and radioisotope successfully traced SLNs in 479, 507, and 525 patients, the detection rate was 88.2%, 93.9%, and 97.4%, respectively. Among the 1559 detected SLNs, 139 (9.6%) were located at the latissimus dorsi lateral margin, and 108 (6.9%) were located at level 2. Subcutaneous injection of radioisotope (P = .004) and intradermal injection of blue dye (P = .002) were independent factors associated with SLNs distributed at level 2 and the latissimus dorsi lateral margin, respectively. It was noteworthy that 2 of 7 patients had skipping metastasis in level 2, so subcutaneous injection of the isotope is strongly recommended for tracing SLNs distributed in level 2 because of the possibility of skipping metastasis. Though intradermal injection of blue dye was superior methods for tracing SLNs located at the latissimus dorsi lateral margin, we surprisingly found those patients with metastasis to the latissimus dorsi lateral margin nodes also could have metastasis to level 1 (expect for the latissimus dorsi lateral margin) nodes, it seemed that maybe there is no need to excise SLNs at the latissimus dorsi lateral margin in SLNB, whether such nodes should be regarded as useful for SLNB still needs to be determined by further large, multicenter clinical studies.

A retrospective study aims to explore differences in spinopelvic sagittal alignment between thoracolumbar disc herniation (TLD) and lower lumbar disc herniation (LLD).A total of 185 patients included 26 with TLD and 129 with LLD and 30 asymptomatic volunteers in normal group (NG). Each individual took full spine X-ray to evaluate pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), TK+LL+PI, TK/LL, and sacrum-femoral-pubic symphysis (SFP). The Roussouly classification was used to categorize all subjects according to their sagittal alignment. Spinopelvic parameters and Roussouly classification results were compared between groups.PI (51.0°), SS (30.5°), and LL (42.0°) in the TLD were significantly higher than those in the LLD (47°, 27°, 33°, respectively). However, TK (30.0°), TK/LL (0.75), and TK+LL+PI (40.0°) in the TLD were significantly lower than these in the LLD (33.0°, 1.07, 47.2°, respectively) and the similar trend between TLD and NG (34.3°, 0.93, 48.5°, respectively). But LL (42.0°) in the TLD was significantly higher than in the NG (35°). Roussouly types among 3 groups were marked differences. The LLD had a higher rate (59.7%) of type II lordosis (flat back), and the TLD had a higher rate (61.5%) of type III lordosis than other groups.This study implied that patients with TLD have higher LL, lower TK, TK/LL, and TK+LL+PI than LLD patients. We inferred that high LL combined with low TK may be the prospective factors of TLD.

Background:Postdural puncture headache (PDPH), mainly resulting from the loss of cerebral spinal fluid (CSF), is a well-known iatrogenic complication of spinal anesthesia and diagnostic lumbar puncture. Spinal needles have been modified to minimize complications. Modifiable risk factors of P

Rationale: Lumbar degenerative scoliosis (LDS) is a common spinal disease for senior citizens. However, LDS accompanied with thoracic lordosis and lumbar kyphosis (LK) is rare in clinic. No reports have reported LDS with thoracic lordosis and LK. Patient concerns: A 54-year-old woman just complained about sever back pain without any radiculopathy and neurodeficit of low limb for 2 years, Visual Analogue Scale (VAS) for back pain was 9 points and x-ray showed adult LDS with lordosis angle of 10° from 5th thoracic to 12th thoracic (T5-T12) and LK angle of 20°. Diagnoses: She was diagnosed with adult degeneration scoliosis (ADS). Interventions : The patient underwent posterior pedicle screw implantation from L1 to S1 levels. Outcomes : Two weeks after surgery, VAS for back pain was 2 points and x-ray showed thoracic lordosis angle of 6°, lumbar lordosis (LL) of 6° and sagittal vertical axis from C7 plumb line (SVA) of 77 mm. One year after surgery, VAS for back pain was 1 points and the x-ray showed thoracic lordosis angle of 6°, LL of 20°, and SVA of 36 mm, implying globe spine for this patient tends to balance. Lessons: Adult degenerative scoliosis accompanied with thoracic lordosis and LK is rare. Correcting sagittal imbalance is an effective treatment. The surgical outcome is satisfactory. Attention should be paid in sagittal balance for treatment of ADS. We still need further follow-up to observe change of sagittal parameters.

Thoracic cortical bone trajectory (CBT) screw fixation can maximize the thread contact with cortical bone, and it is 53.8% higher than that of the traditional pedicle screws. Moreover, it can also enable less tissue dissection and retraction for reduced muscle disruption. Eighty pediatric patients are divided into 4 age groups and their thoracic vertebrae are analyzed on computed tomography (CT) images. The maximal screw length, maximal screw diameter, screw diameter, and the cephalad angle are measured. The statistical analysis is performed using the Student's t-test and Pearson's correlation analysis. Maximal screw length increases from T9 to T12 and there are significant differences between girls and boys at T9, T10, T11, and T12 in majority of groups (P

Bile acid metabolism was reported to be involved in glucose metabolism homeostasis. However, the exact relationship between bile acid and glucose metabolism as well as insulin sensitivity is not clarified. Therefore, we sought to investigate the association between insulin sensitivity and hyperbileacidemia in type 2 diabetic and nondiabetic population. This community-based cross-sectional study included 9603 residents from Jiading, Shanghai, China, who were 40 years and older. Standardized questionnaire, anthropometric measurements and laboratory tests were conducted. Homeostasis model assessment of insulin resistance (HOMA-IR) ≥ 2.7 was defined as insulin resistance and fasting TBA ≥ 10 mmol/L was defined as hyperbileacidemia. Multivariate stepwise regression analysis revealed that HOMA-IR, age, and male sex were positively associated with hyperbileacidemia in both nondiabetic and diabetic participants. In multivariate logistic models, participants with insulin resistance had significantly higher risk of hyperbileacidemia compared to those who have no insulin resistance, in both nondiabetic and diabetic population (nondiabetic: OR = 1.76; 95% CI 1.42–2.19; P

Supplemental Digital Content is available in the text, This study aimed to evaluate the association between family history and prevalence of hypertension among Chinese community elderly, and also explore the gender difference. A population-based cross-sectional study was conducted in Miyun district of Beijing, in 2014. The family history information was obtained from each subject and was divided into 3 categories, no family history (FH0), 1 generation of first-degree relatives with hypertension (FH1), and 2 generations of first-degree relatives with hypertension (FH2). The prevalence of hypertension was 53.0%. Participants with positive family history had a significantly higher prevalence of hypertension (67.5%, 95% CI: 63.3–71.7) than those without (47.9%, 95% CI: 45.2–50.6), and even among participants without hypertension, the blood pressure levels were higher with positive FH. Multiple logistic regression analysis showed that a significantly linear-trend increase in hypertension according to family history of first degree relative numbers was observed in both genders (P for trend