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Introduction The most serious erratic migration of paragonimiasis is a cerebral paragonimiasis. Infection in the temporal and occipital lobes of the brain has been previously reported in cerebral paragonimiasis. Here, we report a case of chronic brainstem paragonimiasis. Case presentation A 29-year-old Chinese woman presented to our hospital complaining of a sudden onset, three days previously, of double vision and dizziness. A computed tomography scan and diffusionweighted images looked like an ischemic stroke. However, conglomerates of multiple ringlike enhancements on contrast magnetic resonance imaging, and the characteristic appearance of the 'tunnel sign', were found on further examination. Our patient was treated with praziquantel to prevent the spread of the paragonimiasis. She was followed up three months later and showed good recovery. Conclusions Conglomerates of multiple ring-like enhancements on contrast magnetic resonance imaging and the characteristic appearance of the 'tunnel sign' were important for the diagnosis of chronic brainstem paragonimiasis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of serum osteocalcin with carotid atherosclerosis in patients with type 2 diabetes., Methods: We performed a cross-sectional community-based study in metropolitan area. Serum total osteocalcin was measured by radioimmunoassay in 382 men and 435 postmenopausal women. The carotid artery intima-media thickness (IMT) and carotid plaques (PLQ) were measured by B-mode ultrasound., Results: The crude mean of serum osteocalcin concentrations were 4.52±2.43 ng/ml for men and 5.75±2.92 ng/ml for postmenopausal women (P <0.001), respectively. Osteocalcin levels were associated inversely with age, fasting serum insulin, HOMA-IR, ALT, triglycerides, total cholesterol, LDL- cholesterol, CRP (all P<0.001) and positively with adiponectin and HOMA-B (all P<0.05). After multiple adjustment, the odds ratios (ORs) were substantially higher risk for carotid plaques (OR 1.77 for 1 SD decrease in osteocalcin, 95% CI 1.23-2.76, p=0.005). These associations remained significant after further adjustment for potential confounder., Conclusions: Serum osteocalcin levels is an independent risk factor for carotid atherosclerosis in patients with type 2 diabetes.