Abstract:Spinal deformity is a complex three-dimensional malformation. The related imaging measurements are vital to its diagnosis and classification, treatment selection, efficacy evaluation and progress monitoring. With the development of science and technology and the deepening of research on spinal deformity, conventional deformity measurement methods and radiographic imaging techniques have been continually improved. The feasibility and effectiveness of the application of EOS imaging system and three-dimensional ultrasound imaging technology in spinal deformity have been confirmed by many studies, and the application of new measurement tools, techniques and artificial intelligence is also emerging. These technologies jointly promote the development of the spinal deformity measurement, making it more simple, safe, efficient and accurate, and convenient for clinical application. In this paper, based on the review of the current research progress in the imaging parameter measurement of spinal deformity, the advantages and limitations are analyzed in order to provide references for clinical application and research.

Abstract:The assessment of flexibility of scoliosis is a conventional preoperative examination for adolescent idiopathic scoliosis, and it is important in selecting fusion level, deciding surgical approach, and predicting postoperative correction. With the innovation of orthopaedic concepts and the continuous development of internal fixation orthopaedic instruments, the commonly used methods for assessing scoliosis flexibility, including supine side-bending, fulcrum-bending and traction, however, have showed some disadvantages such as poor predictability, inconsistent evaluative criteria and radiation exposure. Therefore, it is important to choose a suitable method to evaluate the flexibility of scoliosis according to the clinical characteristics. This paper reviews the influencing factors and different evaluation methods for the flexibility of adolescent idiopathic scoliosis.

Abstract:Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis, affecting patients physically and psychologically. Physically, AIS may impair patient cardiopulmonary function and can be complicated with a variety of diseases in severe cases. It may also affect the chest development of female patients, and even their fertility. Psychologically, AIS-caused physical deformities can induce psychological problems such as adolescent autism and depression. In recent years, the evaluation of the quality of life of patients with AIS has drawn increasing attention clinically. The scale to evaluate the quality of life of patients is an important part of the treatment and prognosis of AIS. This paper mainly introduces several health-related quality of life assessment scales commonly used in AIS patients, briefly summarizes their evaluation contents, reliability, validity and development, and discusses their clinical application.

Abstract:Lumbar interbody fusion is the primary treatment of degenerative lumbar diseases; however, the outcome of the operation is seriously affected by the postoperative adjacent segment pathology (ASP), and some patients even need revision surgery. Many factors affect the occurrence of ASP, including age, preoperative adjacent segment degeneration, sagittal imbalance, length of fusion segment and surgical methods. Meanwhile, great progresses, such as minimally invasive and non-fusion surgery, have been made in treating ASP. This paper reviews the pathogeny, risk factors and treatment of ASP.

Abstract:Objective To apply spine morphology measuring instrument based on three-dimensional projection position of the spinous process on the body surface in different types of scoliosis. Methods Thirty-two adolescent idiopathic scoliosis (AIS) patients were enrolled in this study. The spine morphology measuring instrument based on space posture sensor was used to measure the spinous process angle (SPA) of the projection position on the patient back surface. Then linear regression model was used to establish the quantitative relationship between SPA and Cobb angle measured by full-spine X-ray film. Based on the Lenke classification, subgroup analysis was conducted to further explore the quantitative relationship between SPA and Cobb angle in different types of scoliosis. Results The 32 AIS patients included 11 males and 21 females, with an average age of (13.94±0.84) years; 20 cases were Lenke typeⅠ and 12 cases were Lenke typeⅤ; eight cases had main curvature of T₅-T₁₁, four cases of T₅-T₁₂, one case of T₆-T₁₁, seven cases of T₆-T₁₂, four cases of T₁₁-L₃, and eight cases of T₁₂-L₄. Linear regression analysis found that the Cobb angle had a linear relationship with the SPA in AIS patients:Cobb angle=1.128×SPA+3.724. Further subgroup analysis showed that for Lenke typeⅠ AIS patients, the quantitative relationship was:Cobb angle=1.128×SPA+3.303. Conclusion The spine morphology measuring instrument based on three-dimensional projection position of the spinous process on the body surface can be initially applied to measure the spine morphology of the thoracic scoliosis. The spatial projection position of the spinous process on the body surface is an effective anatomical reference marker for spinal morphometry.

Abstract:Objective To introduce a new method to evaluate the flexibility of adolescent idiopathic scoliosis (AIS)-in vivo biomechanical response characteristic curve. Methods A total of 18 patients with Lenke type Ⅰ AIS from Nov. 2017 to Jun. 2018 in our hospital were retrospectively selected; the patients included 16 females and two males, aged from 10 to 17 years old. The initial coronal Cobb angle of the main thoracic curve was 40.00° to 63.00°, averaging at (44.50±6.35)°. The coronal Cobb angle of the main thoracic curve was evaluated by the extracorporeal scoliosis Cobb angle measuring instrument under natural gravity, and then the longitudinal traction force was gradually increased from 0 N to 160 N, with the coronal Cobb angle of the main thoracic curve evaluated every 20 N. Pearson correlation and linear regression analysis were used to analyze the coronal Cobb angle and longitudinal traction for each patient. The regression coefficient (dynamic flexibility index, K) was calculated and the in vivo biomechanical response characteristic curve was drawn. Results The coronal Cobb angle of the main thoracic curve decreased with the increase of longitudinal traction in 18 patients with Lenke type Ⅰ AIS. Pearson correlation regression analysis showed that the coronal Cobb angle of the main thoracic curve in each patient was negatively correlated with the longitudinal traction force (all P<0.05). The K values of the 18 Lenke type Ⅰ AIS patients were -0.239 to -0.098, and K value had no significant correlation with age, height, body weight, body mass index or Risser sign (all P>0.05), but had a negative correlation with the coronal Cobb angle of the initial main thoracic curve (r=-0.704, P=0.001). Conclusion In vivo biomechanical response characteristic curve is an effective method to evaluate the flexibility of scoliosis for Lenke type Ⅰ AIS, and it can dynamically and comprehensively evaluate the overall flexibility.

Abstract:Objective To investigate the correlation between thoracic kyphosis (TK) and vertebral rotation in patients with Chiari malformation and scoliosis. Methods Thirty patients with Chiari malformation and scoliosis and 34 patients with adolescent idiopathic scoliosis (AIS) who underwent EOS imaging from Jul. 2017 to Jul. 2019 in Nanjing Drum Tower Hospital of Nanjing University Medical School were retrospectively selected. According to the Cobb angle and apical vertebral segment of the coronal main thoracic curve, patients with TK ≤ 20° in the AIS group and TK ≥ 30° in the Chiari group were enrolled. The EOS imaging of the patients was selected and three-dimensional reconstruction was performed. The Cobb angle, apical vertebral segment, vertebral rotation angle and TK of the coronal main thoracic curve were measured by the threedimensional reconstruction image, and the mean vertebral rotation (MTR) of the main thoracic curve was calculated. Pearson correlation analysis was used to study the correlation between TK and MTR in the main curvature region in the two groups. Results A total of 24 patients (12 pairs) were enrolled, including four males and eight females in the AIS group, and five males and seven females in the Chiari group. There was no differences in the gender composition between the two groups (χ²=0.00, P>0.05). The mean age of the two groups were 12-18 (15.25±2.00) years and 11-18 (14.42±2.43) years (P>0.05). The mean Cobb angle of the coronal main thoracic curve of the two groups were (58.13±11.45)° and (55.35±12.35)° (P> 0.05). The mean TK and MTR (absolute value) of the AIS group and the Chiari group were (13.89±6.35)° vs (37.11±9.40)° (t=-6.38, P<0.01) and (24.62±2.78)° vs (21.53±1.66)° (t=3.94, P=0.002), both with significant differences. Pearson correlation analysis showed that TK was associated with MTR in the both groups (r=-0.667 and -0.645, P=0.018 and 0.024). Conclusion Under the same coronal plane, the larger TK in patients with Chiari malformation and scoliosis may be caused by vertebral rotation, which suggests that spine surgeons should pay attention to sagittal rotation as well as coronal correction in Chiari malformation patients with scoliosis.

Abstract:Objective To investigate the clinical features, diagnosis, gene detection, treatment and prognosis of Steel syndrome caused by the mutation of collagen type ⅩⅩⅦ α1 chain (COL27A1). Methods A case of Han adolescent Steel syndrome complicated with scoliosis in the Department of Orthopaedics, Changhai Hospital, Naval Medical University (Second Military Medical University) was reported. Altogether 13 related articles (54 cases of Steel syndrome) from Jan. 1993 to Oct. 2020 were retrieved by using "Steel syndrome" AND "COL27A1" as subject word in the PubMed database. Among them, 17 cases of Steel syndrome caused by COL27A1 mutation and confirmed by whole exome sequencing were included. The clinical features of the 18 patients with Steel syndrome caused by COL27A1 mutation were analyzed. Results In this case, in addition to common clinical manifestations such as developmental delay, carpal coalition, scoliosis, long oval-shaped face, prominent forehead, anteverted nares and other common clinical manifestations, the patient also had webbed neck and low hairline at the back of neck. Whole exome sequencing indicated that COL27A1 gene had two compound heterozygous mutations:p.Pro705Ser and p.Asn1723Ser, which originated from father and mother, respectively. The diagnosis of Steel syndrome with congenital scoliosis was confirmed by the results of all examinations and the whole exome sequencing. After the preoperative examination, the patient was treated with posterior threedimensional orthopaedic bone graft fusion and internal fixation (surgical segments T₃-L₁). The anteroposterior and lateral X-rays of the full spine of the patient were performed in the outpatient department at 3 months, 1 year and 2 years after the operation. The results showed satisfactory segmental fusion without complications such as fracture of screws and rods, junctional kyphosis and distal adding-on phenomenon. Among the 18 patients, there were nine males and nine females, with a diagnosis age of 0.17-14 years. Three were COL27A1 complex heterozygous mutations, including p.Pro705Ser and p.Asn1723Ser (one case), c.93del and c.3075del (one case), and p.Cys174Serfs*34 and p.Arg707* (one case); 15 were homozygous missense mutations, including p.Gly697Arg (11 cases), p.Gly802Glu (one case), p.Gly904Arg (one case), c.4261-1G>A (one case), and c.3556-2A>G (one case). The main clinical features (unknown in one patient) included scoliosis (17 cases), short stature (12 cases), long oval-shaped face (nine cases), prominent forehead (nine cases), developmental delay (five cases), hearing loss (five cases), etc. The imaging features of the 18 patients included hip dislocation (16 cases), radial head dislocation (11 cases), carpal coalition (nine cases), etc. Conclusion Steel syndrome caused by COL27A1 mutation is a rare autosomal recessive genetic disease. Its family history, clinical features and imaging examinations provide a preferential diagnosis, but the final diagnosis should be based on the result of gene sequencing. The treatment of this disease should be further researched to improve the prognosis.

Abstract:Objective To observe the expressions of farnesol X receptor (FXR)/nuclear factor receptor 1H4 (NR1H4) mRNA and protein in pancreatic ductal adenocarcinoma tissues, and to analyze their correlations with clinicopathological features and prognosis. Methods A total of 176 pancreatic ductal adenocarcinoma specimens were collected from Changhai Hospital of Naval Medical University (Second Military Medical University) from 2013 to 2016. The clinicopathological data of the patients were collected. All the specimens were made into tissue microarray. The expression of NR1H4 mRNA was detected by RNAscope in situ hybridization and NR1H4 probe, and FXR/NR1H4 protein was detected by polymer two-step immunohistochemistry. Chi-square test was used to analyze the relationship between the expression levels of FXR/NR1H4 mRNA and protein and clinicopathological features. Kaplan-Meier survival analysis and Cox regression model were used to study the relationship between the expression levels of FXR/NR1H4 mRNA and protein and patient prognosis. Results The positive rate of NR1H4 mRNA detected by RNAscope in situ hybridization was 68.75% (121/176), and that of FXR/NR1H4 protein detected by immunohistochemistry was 77.27% (136/176). FXR/NR1H4 mRNA and protein expression levels were correlated with clinical stage (χ²=5.391, P=0.020; χ²=4.108, P=0.042) and differentiation (χ²=6.560, P=0.010; χ²=4.969, P=0.026); and the protein expression was also related to tumor size (χ²=4.957, P=0.026). No correlations were found between FXR/NR1H4 expression and the patient gender, age, nerve invasion, tumor location or lymph node metastasis (all P>0.05). Kaplan-Meier survival analysis showed that the progression-free survival and overall survival of patients with high expression levels of FXR/NR1H4 mRNA and protein were shorter than those with low expression levels (P<0.05). Cox regression analysis showed that high expression of FXR/NR1H4 protein was an independent risk factor of progressionfree survival (RR=1.701, 95% CI 1.235-2.432, P<0.05) and overall survival of patients (RR=2.356, 95% CI 1.983-2.832, P<0.05). Conclusion RNAscope in situ hybridization and immunohistochemistry can confirm each other to ensure the reliability of the detection results. The expression of FXR/NR1H4 is related to the clinical stage and differentiation of pancreatic ductal adenocarcinoma, and its high expression is an independent risk factor of prognosis.

Abstract:Objective To develop an artificial intelligence (AI) model for analyzing pathological sections of lung tissue and providing real-time auxiliary diagnosis based on the deep learning algorithm. Methods Pathological sections of lung lesion tissues from 952 patients obtained by surgery or ultrasound/computed tomography guided biopsy in the Department of Thoracic Surgery and Respiration, Tongji Hospital and the Department of Ultrasound, Shanghai Pulmonary Hospital, Tongji University from Jul. 2019 to Feb. 2020 were retrospectively collected, including 254 (26.68%) cases of squamous cell carcinoma, 278 (29.20%) cases of adenocarcinoma, 47 (4.94%) cases of other malignant tumors, and 373 (39.18%) cases of benign lesions. According to the pathological subtypes, the slices were divided into training set (476 cases), validation set (286 cases) and test set (190 cases) using stratified random sampling (5:3:2). In each slice of the training set, 10 single field images (×400) were randomly captured for the training of YOLO (you only look once) v3 and Google Inception v3 networks, and then the module for segmenting benign and malignant regions and the module for classifying pathological subtypes were developed. Finally, the AI model with two parallel modules was constructed. In the validation set, single field images were captured in the same way to compare the diagnostic ability between the model and the pathologists. In the test set, two pathologists read the whole slices under the microscope for diagnosis, and one of them would get additional auxiliary diagnostic information from the AI model to compare their diagnostic ability. Results There were 2 860 single field images in the validation set, including 1 700 (59.44%) of malignant lesions and 1 160 (40.56%) of benign lesions. The sensitivity of benign and malignant differentiation of the model was better than that of pathologists (100%[1 700/1 700] vs 99.65%[1 694/1 700], χ²=4.167, P=0.031) and the accuracy of pathological subtype classification was similar to that of pathologists (95.52%[2 732/2 860] vs 94.30%[2 697/2 860], P>0.05). However, the overlap rate of segmented area with the gold standard ([92.72±12.75]% vs[95.42±6.99]%, t=7.628, P=0.001), specificity (97.67%[1 133/1 160] vs 99.31%[1 152/1 160], χ²=12.000, P=0.001) and accuracy (99.06%[2 833/2 860] vs 99.51%[2 846/2 860], χ²=4.364, P=0.037) of benign and malignant differentiation of the model were lower than those of pathologists. The test set consisted of 190 pathological sections, including 117 malignant lesions and 73 benign lesions. There were no significant differences between the pathologists who assisted by AI model and who did not in the accuracy rates of benign and malignant differentiation (100%[190/190] vs 99.47%[189/190], P>0.05) or classification of pathological subtypes (96.84%[184/190] vs 93.68%[178/190], P>0.05). However, it took significantly less time for the pathologist to diagnose with the AI model[(12.53±10.93] s vs[79.95±40.02] s, t=28.939, P<0.01). Conclusion The AI model based on deep learning algorithm can help pathologists quickly analyze lung tissue pathological sections stained by H-E staining, which can effectively improve the sensitivity and work efficiency without reducing the accuracy.

Abstract:Objective To predict the target of the main components of Qingyi Huaji recipe (QYHJ) through network pharmacology investigations, and to explore its mechanism in treating pancreatic cancer. Methods The Bioinformatics Analysis Tool for Molecular Mechanism of Traditional Chinese Medicine (BATMAN-TCM) database was used to identify the major effective components of QYHJ and their target genes. The xenograft model of pancreatic cancer was established in nude mice, and they were divided into QYHJ-treated group and control group. The tumor tissues of nude mice were sequenced to screen the differentially expressed genes. The target genes were screened by Venn analysis, and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed to identify the related pathways; then the regulatory mechanism network of QYHJ in treating pancreatic cancer was constructed. The protein-protein interaction network was obtained from the STRING database, and Gene Expression Profiling Interactive Analysis (GEPIA) was used to evaluate the relationship between the key genes and the prognosis of pancreatic cancer. Results A total of 149 potential active components and 963 predicted targets were obtained. Gene sequencing of pancreatic cancer tissues of nude mice (QYHJtreated group vs control group) showed 6 039 differentially expressed genes. Venn analysis showed 248 potential targets and KEGG pathway enrichment analyses found that the mechanism of QYHJ in treating pancreatic cancer might involve mitogenactivated protein kinase (MAPK), forkhead box O (FoxO), cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate-dependent protein kinase or protein kinase G (cGMP-PKG) and other signaling pathways. Compared with the control group, the QYHJ-treated group showed suppressed MAP2K1 (MEK1), MAPK3 (ERK), MAP2K3 (MKK3), and MAPK13 (p38) expressions. GEPIA results showed that the high expression levels of MAP2K1 (MEK1), MAPK3 (ERK), MAP2K3 (MKK3) and MAPK13 (p38) were related to the poor prognosis of pancreatic cancer patients. Conclusion The mechanism of QYHJ in treating pancreatic cancer may be related to MAPK signaling pathways. MAP2K1 (MEK1), MAPK3 (ERK), MAP2K3 (MKK3) and MAPK13 (p38) may be potential prognostic factors of QYHJ for treating pancreatic cancer.

Abstract:Gut microbiota is a complex and dynamic micro-ecosystem in human intestinal tract, and it has a balanced symbiotic relationship with the host under physiological conditions. However, in pathological conditions such as chronic liver diseases and hepatocellular carcinoma, the composition of gut microbiota and intestinal permeability will significantly change, leading to dysbiosis and bacterial translocation. Intestinal bacteria and their metabolites enter the liver to activate the inflammation associated signalling pathways, and flow into the systemic circulation to form endotoxemia, which jointly promote the progress of chronic liver diseases and hepatocellular carcinoma. Currently, therapeutic strategies aiming at gut microbiota for the treatment of chronic liver diseases and hepatocellular carcinoma include rational administration of antibiotics, probiotics or prebiotics, and fecal microbiota transplantation. This paper reviews the potential role and clinical significance of gut microbiota in chronic liver diseases and hepatocellular carcinoma.

Abstract:Pyroptosis is a kind of programmed cell death that can lead to the release of cellular contents and inflammatory factors involved in the development of many diseases, and it has become another research focus. This paper is to study the research progress in the relationship between pyroptosis and metabolic diseases, such as type 2 diabetes, obesity, non-alcoholic fatty liver disease and gout, so as to further broaden the understanding of the pathogenesis of these diseases and to provide new treatment strategies.

Abstract:Susac syndrome (SS) is a rare immune-mediated disorder characterized by occlusion of arterioles associated with the brain, inner ear and retina. The main clinical manifestations of SS are encephalopathy, branch retinal artery occlusion and sensorineural hearing loss. However, they always appear one after another, and always lead to missed diagnosis and misdiagnosis. Brain magnetic resonance imaging, fundus fluorescein angiography and audiometry are helpful for the early diagnosis of SS. Glucocorticoid, intravenous injection of immunoglobulins and immunosuppression are suggested for the comprehensive treatment of SS.

Abstract:Motion sickness refers to vestibular and autonomic nervous responses such as dizziness, nausea and vomiting caused by stimulation of real or virtual environment, and its pathogenesis remains to be fully elucidated. Due to the multiple symptoms and great individual variability, there is no single effective treatment for motion sickness, and acclimatization training is still one of the most effective strategies. The innovative development of traditional Chinese medicine and its combined application with Western medical equipment such as electrical nerve stimulation, have shown great potential for the prevention and treatment of motion sickness. This article reviews the pathogenesis, diagnosis and treatment of motion sickness, hoping to provide guidance for exploring new effective treatment programs of motion sickness.

Abstract:Objective To investigate the sleep status and its influencing factors of medical officers and soldiers on their first long-distance navigation. Methods With cluster sampling method, 91 medical officers and soldiers were investigated with self-made general information questionnaire and Pittsburgh sleep quality index (PSQI). Results A total of 91 valid questionnaires were collected, with an effective rate of 100%. During the long-distance navigation, the insomnia rate of medical officers and soldiers was 63.74% (58/91), which was significantly higher than that before the navigation (43.96%,40/91) (P<0.01). The PSQI score was 7.59±5.35 at the end of 4 months, and 39 cases (42.86%) had PSQI score>7. The most common symptom of insomnia was "difficulty in falling asleep" (89.66%, 52/58); and the most cases (70.69%, 41/58) were affected by timing adjustment, followed by environmental changes (56.90%, 33/58). Logistic regression analysis showed that bed position was the main influencing factor of insomnia (P<0.05). The medical officers and soldiers alleviated insomnia mainly by increasing exercise, only one of them alleviated insomnia through psychological counseling. Conclusion Long-distance navigation has a serious impact on the sleep status of medical officers and soldiers. Sleep problems in medical officers and soldiers on their first long-distance navigation tasks are serious. The incidence of insomnia is high due to the influence of timing adjustment and environmental changes, and there is a lack of reasonable prevention and treatment measures.

Abstract:Objective To analyze the specific causes of rejection of the students for navy teenager aviation school due to ophthalmic problems in entrance physical examination, so as to provide evidence for exploring the ophthalmic standard and scientific testing methods to improve the quality of enrollment physical examination. Methods A total of 3 583 male junior high school graduates, aged 14-16 years, received physical examination for 14 navy teenager aviation schools in 2019. The participating medical staff and 14 schools were randomly divided into three groups for the physical examination. The causes of rejection due to ophthalmic problems were classified and sorted, and the rejection rates and rejection causes were compared between the three physical examination groups and 14 schools. Results Altogether 3 583 students received ophthalmic physical examination, and 1 657 were rejected, with a rejection rate of 46.25%. The rejection rates in the ophthalmology department in the three groups were 39.18% (552/1 409), 45.26% (482/1 065) and 56.18% (623/1 109), respectively, showing significant differences between the three groups (χ²=72.74, P<0.05). The top three causes of rejection were far vision deficiency (34.25%, 1 227/3 583), latent deviation excess (2.32%, 83/3 583), and refractive excess (2.04%, 73/3 583). Among the potential students of the 14 schools, the difference in rejection rate by far vision deficiency was greater (14.00%-59.50%). Other items with great differences among different schools included latent deviation excess (0.41%-6.33%), refractive excess (0-8.00%), eye pressure excess (0-4.50%), and corneal topographic map abnormality (0-5.98%). Conclusion The rejection rate in ophthalmology department is high during entrance physical examination of students for navy teenager aviation school, and there are differences between different groups and different schools. To accurately understand the standards and optimize the physical examination process are keys to improve the quality of physical examination of students for navy teenager aviation schools.

Abstract:The coronavirus disease 2019 is a highly infectious disease, and the spread of the virus affects the normal diagnosis and treatment of medical facilities. It has brought great difficulties to some patients with oral diseases, and has aggravated their psychological and mental burden, especially those children who are susceptible to external influences and parents who are in lack of related knowledge. This paper comprehensively analyzes the psychological changes of children and their parents in stomatology department during the epidemic period, so as to provide effective psychological counseling and nursing intervention to improve the cooperation between doctors and patients and the quality of diagnosis and treatment.

Abstract:Objective To summarize the neurologic manifestations, diagnosis, treatment and prognosis of atypical primary aldosteronism (PA) with paroxysmal dizziness which is not associated with elevated blood pressure. Methods and Results The clinical data of five patients diagnosed as atypical PA with paroxysmal dizziness but without elevation of blood pressure were retrospectively analyzed. Among the five patients, one was male and four were females, aged 50-95 years, with onset of paroxysmal dizziness. The disease duration was 20 d to 1 year, with the frequency ranged from 0.5 times per month to 1-2 times a day, lasting for a few seconds to 30 min every time, with concomitant symptoms including headache, vertigo, nausea, tinnitus, fatigue, hyperidrosis, palpitation, etc. The complexion may turn red or the head and face may feel febrile consciously, especially during the posture changes or the activity, and there was no obvious discomfort during interictal period. Two patients had a history of hypertension, and three patients had blood pressure fluctuations after 24 h ambulatory blood pressure monitoring. The serum potassium of the five patients was in the normal range on admission, and it was decreased in two patients with dizziness onset. Adrenal contrast-enhanced computed tomography showed left adrenal hyperplasia in one case and no significant abnormalities in the other four cases. The aldosterone renin ratio (ARR) increased, and PA was diagnosed by combining the result of adrenal computed tomography. All the five patients were treated with spironolactone, and their dizziness was significantly improved after regular clinical follow-up. Conclusion Atypical PA with paroxysmal dizziness but without elevated blood pressure is rare, and further study is needed to better understand the disease. To avoid misdiagnosis and missed diagnosis, the history of hypertension should be inquired, and the aldosterone should be valued. Hypokalemia could not be used as a good indicator for PA screening due to low sensitivity and specificity.

Abstract:Objective To explore the effect of pelvic floor muscle training (PFMT) mode on the recovery of postoperative urinary continence after robot-assisted laparoscopic radical prostatectomy. Methods The clinical and followup data of 186 patients receiving robot-assisted laparoscopic radical prostatectomy by a single surgeon were retrospectively collected from Jun. 2013 to Jun. 2018. The patients were divided into three groups:rapid recovery group (≤ 1 pad, recovery time ≤ 3 months), slow recovery group (≤ 1 pad, recovery time >3 months) and urinary incontinence group (>1 pad). The clinical data of the three groups and the difference of PFMT mode were compared between the rapid and slow recovery groups. The influencing factors of rapid recovery of postoperative urinary incontinence were analyzed by multivariate binary logistic regression model. Results Sixty patients were lost during follow-up, hence 126 patients were finally followed-up and included in this study. Sixty-six patients in the rapid recovery group, 26 in the slow recovery group and 34 in the urinary incontinence group were diagnosed at the age of (62.7±6.8), (67.0±7.5) and (70.3±7.0) years, respectively (P<0.01). Meanwhile, the proportions of nerve sparing in the three groups were significantly different among the three groups (57.6%[38/66], 26.9%[7/26]and 17.6%[6/34], P=0.011). Among the 92 patients with urinary incontinence rehabilitation, eight patients recovered immediately after removing the catheter, and the remaining 84 patients underwent PFMT after operation, including 58 cases in the rapid recovery group and 26 cases in the slow recovery group. The proportions of patients who insisted on daily PFMT and chose to do PFMT in the daytime in the rapid recovery group were significantly higher than those in the slow recovery group (70.7%[41/58]vs 38.5%[10/26]and 69.0%[40/58]vs 23.1%[6/26], both P<0.05). Multivariate binary logistic regression analysis showed that age of diagnosis (OR=1.09, P=0.044), non-nerve sparing (OR=2.73, P=0.034), failure to continue PFMT after operation (OR=6.30, P=0.034) and absence of PFMT in the daytime (OR=6.76, P=0.006) were the risk factors for rapid recovery of urinary incontinence after operation. Conclusion PFMT is important to urinary continence after robot-assisted laparoscopic radical prostatectomy, especially for rapid recovery. Patients' age, nerve sparing or not, keeping PFMT and PFMT time are associated with the rapid recovery of early postoperative urinary incontinence.

Abstract:Objective To explore the feasibility of two-dimensional phase contrast magnetic resonance imaging (2D PC-MRI) for quantitatively monitoring the pulmonary arterial hemodynamics in normal population, and evaluate the influence of different levels of smoking status on pulmonary hemodynamics in normal population. Methods A total of 49 normal male smoking volunteers who underwent pulmonary artery 2D PC-MRI examinations in our hospital from May 2019 to Jan. 2020 were included in the study, and smoking parameters (smoking intensity, smoking time, and smoking burden) were recorded. The hemodynamic parameters of the main pulmonary artery were measured by 2D PC-MRI, including positive peak velocity (PPV), negative peak velocity (PNV), average blood flow (AF), average positive blood flow (APF) and average negative blood flow (ANF). Intraclass correlation coefficient (ICC) was used to analyze the intra- and inter-group consistency of hemodynamic parameters. The correlation between smoking parameters and hemodynamic parameters was analyzed. The differences of hemodynamic parameters between non-heavy smoking group (smoking time <20 years, n=24) and heavy smoking group (smoking time ≥ 20 years, n=25) were also analyzed. Results The intra- and inter-group ICC values of PPV, PNV, AF, APF and ANF were 0.890-0.987, indicating good consistency. Smoking time was negatively correlated with PPV, AF and APF, respectively (r=-0.321, -0.350, -0.311; P=0.024, 0.014, 0.029). PPV, AF and APF of the heavy smoking group were significantly lower than those of the non-heavy smoking group (all P<0.05). Conclusion The 2D PC-MRI technology can be used to monitor the influence of different smoking degrees on the main pulmonary hemodynamics in normal population. With the prolongation of smoking time, the main pulmonary artery positive flow parameters (PPV, AF and APF) decrease, especially in heavy smokers.

Abstract:Objective To summarize the causes for conversion and reoperation of laparoscopic Ladd's procedure in children with intestinal malrotation, so as to explore the countermeasures. Methods The clinical data and surgical videos of 107 children with intestinal malrotation, who underwent laparoscopic Ladd's procedure from Jan. 2014 to Jan. 2017 in our hospital, were retrospectively analyzed. The intraoperative findings, postoperative complications and reoperation were analyzed. Results There were 88 males and 19 females, with the ratio of male to female being 4.6:1, and the median age was 28 d (1 d to 14 years), with 55 neonates (≤ 28 d) and 52 non-neonates (>28 d). Laparoscopic Ladd's procedure was successfully performed in 99 cases. All the eight cases converted to open surgery were neonates. Among them, four cases were difficult to judge the rotation direction, one case complicated with annular pancreas, one case with duodenal septum, one case with blurred visual field, and one case with mesenteric vascular injury. A total of 15 cases underwent reoperation. One 8-year old patient underwent laparoscopic exploration 2 weeks after laparoscopic Ladd's procedure due to intestinal obstruction, and duodenal ulcer perforation was confirmed during the operation; the remaining 14 cases were all neonates. During the reoperation of the 14 neonates, nine cases were confirmed as incomplete lysis of the initial end of duodenum jejunum, two cases were caused by intestinal adhesion, one case by duodenal diaphragm, one case by colonic stenosis, and one case by intestinal perforation due to intestinal obstruction closure of the incision. Conclusion Laparoscopic Ladd's procedure is safe and feasible in the treatment of intestinal malrotation, but there are still some difficulties in neonatal patients. It is helpful to improve the success rate of laparoscopic Ladd's procedure by improving the preoperative examination, strictly controlling the operation indications, adopting different surgical strategies and skilled laparoscopic techniques.

Abstract:Objective To observe the clinical efficacy of Huzhangye capsule (dispelling pathogenic wind and eliminating phlegm, and suppressing hyperactive liver and subsiding yang) combined with manual reduction on benign paroxysmal positional vertigo (BPPV). Methods A total of 70 patients with BPPV were prospectively enrolled and randomly divided into simple manual reduction group (n=35) and Huzhangye capsule combined with manual reduction group (n=35). The physical, emotional and functional status in residual symptoms were assessed by dizziness handicap inventory (DHI) before treatment, 2 weeks and 4 weeks after treatment. Results There were no significant differences in physical, emotional and functional scores, or total score in DHI between the two groups before treatment (all P>0.05). After 2 weeks and 4 weeks of treatment, the physical, emotional and functional scores, and total score in DHI in Huzhangye capsule combined with manual reduction group were significantly lower than those in the manual reduction group (all P<0.01). Conclusion Huzhangye capsule combined with manual reduction is more effective in improving the symptoms of BPPV than manual reduction alone.

Abstract:Objective To analyze the progress, research focus and future trends of Tuina therapy for knee osteoarthritis in the past 10 years by using CiteSpace knowledge mapping software. Methods The related literature on Tuina therapy for knee osteoarthritis from Jan. 1, 2010 to May 11, 2020 were retrieved from CNKI database. After Refworks format conversion, CiteSpace 5.6 R3 software was used to construct the knowledge map. The co-occurrence analysis of authors, institutions and keywords were conducted, and time-sharing hotspot views of the relevant literature on Tuina treatment for knee osteoarthritis were drawn. Results A total of 426 articles were identified, with the number of papers on a rise annually. There were 302 authors, and the main collaborators were GONG Li, FANG Min, YAN Jun-tao and SUN Wu-quan from Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine. The research institutions were relatively scattered, and the most published institutions was also Yueyang Hospital of Integrated Traditional Chinese and Western Medicine (19 articles); the cooperation among institutions in the same region or within the same system was much closer, while less cooperation was found between institutions in different regions. There were 92 key words, with 13 having frequency >10 and centrality ≥ 0.1. Four prominent words were detected, including "Tuina manipulation", "osteoarthritis", "review" and "curative effect", among which "osteoarthritis" (2011-2013) and "curative effect" (2018-2020) as heated research topics lasted 3 years. Conclusion The authors and the institutions should strengthen cooperation with each other and make efforts to increase the depth and innovation of the research, so as to promote the research on Tuina therapy for knee osteoarthritis.

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