Objective Liver is a common site of metastasis of gastric cancer and hitherto there has been no uniform treatment for liver metastasis of gastric cancer. This study was to investigate the clinical characteristics and prognostic factors of liver metastasis of gastric cancer in order to provide some evidence for the improvement of the diagnosis and treatment of the disease. Methods We ret-rospectively analyzed the clinical characteristics and survival data of 143 patients with liver metastasis of gastric cancer treated in our hospital between March 2007 and September 2012. We investigated the independent risk factors affecting the prognosis of the disease u-sing the Cox Regression Model. Results Seventy-five ( 52. 4%) of the 143 patients survived for 12 months, 41 ( 28. 7%) for 24 months, and 18 (12.6%) for 36 months, with a median survival time of 14 months. Univariate analysis revealed statistically significant differences in the survival time among the patients with different histological grades of primary gastric cancer, time of liver metastasis, types of metastatic liver cancer, extra-liver metastasis, and treatment methods ( P<0.05) . Multivariate Cox regression analysis showed the histological grade of gastric cancer to be low-or non-differentiation ( HR=2.67, 95% CI:1.51-4.72) and the type of liver meta-static cancer to be H2 ( HR=1.89, 95% CI:1.08-3.29) or H3 ( HR=2.13, 95% CI:1.32-3.44) , which were independent risk fac-tors affecting the prognosis of liver metastasis of gastric cancer, while palliative chemotherapy ( HR=0.55, 95% CI:0.32-0.95) was an independent protective factor of its prognosis. Conclusion Patients with liver metastasis from gastric cancer usually have a poor prognosis, especially those with histologically low-grade gastric cancer or type-H2 or -H3 liver metastatic cancer. The prognosis of thepatients undergoing palliative chemotherapy may have a better prognosis than those receiving best supportive care. A comprehensive therapy should be recommended to patients with liver metastasis from gastric cancer.

Objective: To understand the prevalence and influencing factors of Children s Dental Fear (CDF) among 12-15 year-old children in Shenzhen city, so as to provide a framework to alleviate CDF and promote oral health. Methods: Multi-stage stratified random sampling was used to select 5 509 children, aged 12-15 years, to participate in this study, which was carried out from October to November, 2018. The Children s Fear Survey Scheduling-Dental Subscale (CFSS-DS) and oral health examinations were conducted in Shenzhen. Results: The prevalence of dental fear in children aged 12, 13, 14, and 15 years in Shenzhen was 30.3%, 30.5%, 33.6%, and 26.9%, respectively(χ 2=11.97, P=0.01). The CFSS-DS scores were(29.86±13.23)(29.72±13.59)(31.23±14.47)(29.79±13.24), respectively(F=3.60, P=0.01). The CFSS-DS scores of male and female participants were (27.92±13.69) and (32.62±13.12)(t=-12.97, P<0.01), respectively, and the CDF prevalence rates were 23.8% and 38.8%, respectively(χ 2=159.29, P<0.01). Multivariate Logistic regression analysis showed that gender, brushing frequency, visiting experience, oral knowledge level, oral health attitude, oral health and general health status were correlated with CDF (P<0.05). Conclusion Attention should be paid to the prevalence of dental phobia among children aged 12-15 years in Shenzhen, and comprehensive intervention measures should be taken to improve children s oral health.

Objective:To investigate the clinical outcomes and complication of posterior surgery for Scheuermann kyphosis fusing to different distal fusion levels.Methods:From January 2012 to December 2017, a consecutive cohort of 34 patients who were treated with posterior spinal instrumented correction and satisfied the inclusion criteria were retrospectively reviewed, including 29 males and 5 females, aged 17.1±4.3 years (range, 12-30 years). All of the patients had a minimum follow-up of 2 years. According to the distal fusion level, patients were divided into 2 groups. Group sagittal stable vertebra (SSV) (22 cases) included patients whose lowest instrumented vertebra (LIV) was SSV; Group SSV-1 (12 cases) included patients who had a LIV one level above the SSV. Radiographic parameters including global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured in the standing radiographs before and after operation and at the latest follow up. Intraoperative and postoperative complications were recorded. The Scoliosis Research Society-22 questionnaire (SRS-22) were conducted at pre-operation and the final follow up to evaluate the clinical outcomes. The sagittal radiographic parameters and the incidence of distal junctional kyphosis (DJK) were compared between the two groups.Results:There were no significant differences in terms of age, sex, radiographic measurements and scores of SRS-22 between two groups preoperatively ( P>0.05). The correction rates of GK in the SSV group and the SSV-1 group were 42.8%±7.6% and 43.2%±8.4% ( t=0.151, P=0.881) respectively. While the correction rates loss were 1.2%±5.2% and 3.9%±7.2% ( t=0.767, P=0.449) at the latest follow up. No significant difference was observed in terms of other radiographic parameters ( P>0.05). During the postoperative follow up period, 3 patients (16.7%) in SSV group and 2 patients (13.6%) in SSV-1 group developed DJK. The incidence of DJK did not show any significant difference between two groups ( χ2=0.057, P=0.812). At the final follow-up, the function scores of SRS-22 in SSV-1 group (4.1±0.6) was significantly higher than SSV group (3.7±0.5) ( t=2.300, P=0.028) and there was no significant difference in the rest of the domain ( P>0.05). Conclusion:Compared with stopping at SSV, fusion to SSV-1 could achieve comparable curve correction with the preservation of more lumbar motility. Moreover, it would not increase the risk of DJK. As a result, we recommend selecting SSV-1 as the ideal LIV for SK patients.

Objective:To establish age- and gender-based normative values of sagittal spinal-pelvic alignment in Chinese adult population, and to investigate influence of age, gender and ethnicity on sagittal spinal-pelvic alignment in Chinese normal adults.Methods:A total of 786 asymptomatic Chinese adult volunteers aged between 20 and 89 years were prospectively recruited from different spine centers. The inclusion criteria were: 1) age between 20 to 89 years old; and 2) Oswestry disability index (ODI) scored lower than 20. The exclusion criteria were: 1) previous history of spinal, pelvic or lower limb pathologies that could affect the spine; 2) presence of recent and/or regular back pain; 3) previous surgeries on spine, pelvic and/or lower limb; and 4) pregnancy. Demographic characteristics of these subjects including age, gender, body weight and height were recorded. During the enrollment of volunteers, 16 groups were defined based on the age (20 s, 30 s, 40 s, 50 s, 60 s, 70 s and 80 s) and gender. Whole body biplanar standing EOS X-ray radiographs were acquired to evaluate the sagittal alignment. Spinal-pelvic parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (T 5-T 12, TK), lumbar lordosis (L 1-S 1, LL), lower lumbar lordosis (L 4-S 1, LLL), global tilt (GT), T1 pelvic angle (TPA) and sagittal vertical axis (SVA) were measured. Values of PI-LL and lordosis distribution index (LLL/LL, LDI) were calculated. Radiographic measurements of 100 subjects were randomly selected to determine the intra- and inter-observer reliabilities using inter- and intra-class correlation coefficients (ICC). The spinal-pelvic parameters were compared among volunteers between different age and gender groups. The comparison was also made among various ethnic population. Results:The mean value was 23.7±7.1 kg/m 2 for BMI and 6.9%±2.5% (range, 0-18%) for ODI score. Each sagittal spinal-pelvic parameter was presented with mean value and standard deviationbased on age and gender. The ICCs of radiographic measurements ranged from 0.89 to 0.95, suggesting good to excellent intra- and inter-observer reliabilities. Significant differences were observed between males and females in multiple sagittal parameters (all P values <0.05). Compared to the male subjects, significantly higher values of PI (41.4° for male vs. 45.0° for female, P<0.001), PT (10.7° for male vs. 13.9° for female, P<0.001), PI-LL (-0.5° for male vs. 1.8° for female, P<0.001), and GT (10.9° for male vs. 13.5° for female, P<0.001) were documented in female subjects. Males had significantly higher values of LLL (28.6° for male vs. 26.6° for female, P<0.001) and LDI (0.68 for male vs. 0.63 for female, P<0.001). PI-LL, SVA, GT and TPA increased with aging from Group 40 s to Group 80 s, while LL, LLL and LDI decreased gradually, and TK decreased slowly with aging. Comparison of sagittal spinal-pelvic parameters between different ethnic subjects showed that Chinese adult population presented lower PI, SS, TK and LL as compared with American population; lower PI, SS and LL as compared with Japanese population. But the variation trend with aging tended to be consistent among different ethnic populations. Conclusion:Age- and gender-based normative values of sagittal spinal-pelvic alignment were established in asymptomatic Chinese adult population. Sagittal spinal-pelvic alignment varies with age and gender, and presented different compensation mechanism among different ethnic populations. Therefore, to achieve balanced sagittal alignment, age, gender and ethnicity should be take intoconsideration when planning spine correction surgery.

Objective:To evaluate the clinical outcomes and complications of second sacral alar-iliac (S 2AI) technique utilized in adult patients with neuromuscular scoliosis, and to evaluate the impact on patients' quality of life. Methods:All of 11 patients (6 males and 5 females) applying S 2AI technique from January 2014 to December 2016 were retrospectively reviewed. The average age of the patients was 39.6±12.7 years. Among them, 8 cases were poliomyelitis, 2 cases were spinal muscular atrophy and 1 case was muscular dystrophy. All of 11 patients underwent posterior spinal fusion and utilized S 2AI screws for pelvic fixation. All patients were taken anteroposterior and lateral radiographs of the entire spine. Cobb's angle, spinal pelvic obliquity (SPO), regional kyphosis (RK), sagittal vertical axis (SVA) were recorded at pre-operation, post-operation and last follow-up. The Scoliosis Research Society (SRS)-22 questionnaires and Oswestry disability index (ODI) were utilized to evaluate the patient-reported outcomes. All complications were also recorded. Repeated measurement analysis of variance, t-test or non-parametric test was used to analyzed the data, respectively. Results:The average follow-up period was 62.4±10.8 months. The pre-operative Cobb angle was 98.0°±24.0°, and the post-operative Cobb angle was 60.7°±20.8°, of which difference was significant ( Z=3.015, P=0.003). The correction rate of Cobb angles was 57.2%±17.7%. 1-year after operation, the Cobb angle was 62.8°±23.6°, no loss of correction was found ( Z=0.294, P=0.797). And at last follow-up, the Cobb angle was 61.6°±21.7°, the correction maintained well ( Z=0.603, P=0.594). The pre-operative, post-operative, 1-year post-operative and last follow-up spinal pelvic obliquity were 37.0°±11.8°, 21.5°±11.6°, 23.2°±10.1° and 21.1°±8.6°. The significant improvement was obtained ( Z=2.934, P=0.003) and no loss of correction was found ( Z=0.690, P=0.519; Z=0.000, P=1.000). The pre-operative, post-operative, 1-year post-operative and last follow-up regional kyphosis were 46.8°±23.6°, 18.6°±10.6°, 18.9°±11.4° and 19.5°±9.8°. The significant improvement was obtained postoperatively ( Z=4.364, P<0.001) and remained stable at the last follow-up ( Z=0.074, P=0.945; Z=0.271, P=0.838). When compared the pre- and post-operative sagittal vertical axis, no significant difference was detected. In these patients, one patient had rod breakage and underwent revision, one patient suffered deep infection, and recovered by debridement surgery, one patient suffered from severe pain in the lower back and relieved with conservative treatment. Conclusion:The S 2AI technique utilized in patients with neuromuscular scoliosis could obtain satisfying clinical outcomes and provides safe, durable fixation with low rates of complications.

Objectives:To investigate the feasibility of second sacral alar-iliac (S 2AI) screw placement and trajectories index in patients with neuromuscular scoliosis with severe pelvic obliquity; and to explore the accuracy of S 2AI screw placement by O-arm three-dimensional (3D) CT navigation (Medtronic, Minneapolis, MN, USA). Methods:All of 28 patients with neuromuscular scoliosis who underwent posterior long fusion with S 2AI between January 2017 and August 2020 were reviewed, with an average age of 22.2 years old (ranged from 10 to 51 years), and the pelvic obliquity angle was 27.54±9.90° (ranged from 16.2° to 53.6°). Based on 3D CT reconstruction of these specimens, virtual S 2AI screw channels were identified and measured. Entry point was determined by 1 mm inferior and 1 mm lateral to the S 1 dorsal foramen, and virtual S 2AI screw trajectories with maximum length and width were explored by rotating 3D pelvis. The parameters of the determined channels were measured including caudal angulation on the sagittal plane (sagittal angle, SA), lateral angulation on the transverse plane (transverse angle, TA) and the maximal length of the channel (maximal length, ML). The accuracy of screw placement was evaluated by postoperative pelvic CT scan. Results:All of the virtual S 2AI screw trajectories can be reconstructed. The screw trajectory parameters were shown as follows: SA was 30.20°±21.94° and 50.94°±16.02° on the high and low sides of pelvis, respectively, and the difference was statistically significant ( t=3.990 , P<0.001). SA was 30.14°±21.93° on the anterior side of the pelvis and 51.00°±15.96° on the posterior side, respectively, with statistical significance ( t=4.027, P<0.001). TA was 43.67°±12.86° on the high side of pelvic tilt and 31.95°±13.80° on the low side, with statistical significance ( t=2.834, P=0.009). TA was 42.56°±12.52° on the anterior side of the pelvis and 33.05°±14.94° on the posterior side, respectively, and the differences were statistically significant ( t=2.192, P=0.037). ML was 97.12±12.44 mm and 92.28±11.04 mm on the high and low side of pelvis, and there was no significant difference ( t=0.963 , P=0.060). ML was 97.72±12.41 mm on the anterior sides of the pelvis and 91.68±10.57 mm on the posterior side, and the difference was statistically significant ( t=2.556 , P=0.017). SA tended to be smaller on the high side of pelvic tilt ( r=0.474, P<0.01) and TA tended to be higher on the anterior side of pelvis ( r=-0.419, P<0.01) . Only 2 screws (3.6%) showed screw breaches after surgery, with no clinically notable neurovascular or visceral complications. Conclusion:In patients of neuromuscular scoliosis with severe pelvic obliquity, the virtual S 2AI screw trajectory can be found in 3D CT reconstruction of the pelvis. But the parameters are very discrete at SA and TA. In these patients, the O-arm 3D CT navigation can be used to make sure the direction and length of the S 2AI screw, greatly improving the accuracy of screw placement and effectively descending the ratio of poor screw.

Objective:To investigate the feasibility and effects of modified sequential correction technique combined 3-columns osteotomy for severe kyphoscoliosis.Methods:A retrospective analysis was performed on 18 patients (7 males and 11 females) with severe kyphosis who received modified sequential correction technique combined 3-columns osteotomy in our hospital from June 2019 to April 2020. Preoperative, postoperative and final follow-up clinical and imaging outcomes were evaluated.Results:In this cohort, the average fixed segment was 11.2±3.8. The average operative duration was 401.9±68.9 min and the average intraoperative blood loss was 2 418.8±736.9 ml. The Cobb angle was improved significantly from 65.0°±16.4° pre-operatively to 41.6°±14.1° post-operatively. At final follow-up, it was 41.4°±14.3°, which was not significantly different from that after operation. Global kyphosis (GK) was 65.5°±20.8° pre-operatively and 28.1°±13.8° post-operatively with correction rate of 57.8%±17.8%. However, GK was 29.3°±14 .2° at postoperative 1 year , which was not significantly different from that after operation. There was no significant difference in C 7PL-CSVL ( F=0.449 , P=0.642) or SVA ( F=3.519, P=0.058) among the three time points. There was no alter of SEP and MEP observed during operation. Four patients had temporary lower limb numbness after operation, while the symptoms disappeared at 6 months after operation. There was no instrumental failure during the follow-up. Conclusion:Patients with severe kyphoscoliosis can obtain satisfied local correction by undergoing modified sequential correction technique combined 3-columns osteotomy without significant loss of correction at 1 year after operation. It can effectively avoid instability and dislocation of the osteotomy site and massive bleeding during the operation. As a simplified surgical procedure, it can reduce the difficulty of rod loading without prolonged operation duration. Further, this technique can ensure lower incidence of neurological complications and rod failure.

Objective:To investigate the clinical and imaging outcomes of Lenke 5 idiopathic scoliosis posterior selective fusion with "Last Touching Vertebra-1" as the lower instrumented vertebra (LIV).Methods:A total of 103 patients with Lenke 5 idiopathic scoliosis who underwent posterior selective fusion orthopedic surgery from April 2009 to March 2020 were analyzed retrospectively. The LIV was the last touching vertebra (LTV) in 45 cases (LTV group) and the LTV-1 in 58 cases (LTV-1 group). The follow-up duration was more than 2 years. SRS- 22 questionnaire was used to evaluate the clinical effects at 2 years after operation. The anterior and lateral radiographs of the whole spine were measured preoperatively, postoperatively and at 2 years after operation to obtain all the following imaging parameters, including scoliosis Cobb angle, apical vertebral translation (AVT), coronal balance, LIV tilt, LIV lower intervertebral disc angle, LIV translation, LIV lower vertebral translation, LTV/LIV rotation degree, lumbar lordosis angle, pelvic incidence angle, sagittal balance. The complications were summarized and were analyzed for investigating potential risk factors.Results:At 2 years after operation, the correction rates of main Cobb in LTV group and the LTV-1 group were 60.2%±11.1% and 55.3%±14.1%, respectively. The coronal balance was 3.5±9.8 mm and 4.9±10.6 mm respectively. The sagittal balance was -15.5±18.1 mm and -19.6±22.6 mm respectively. There was no significant difference between the two groups ( t=2.305, P=0.085; t=-0.695, P=0.489; t=0.992, P=0.324). The incidence of proximal junction kyphosis in the two groups was 2.2% (1/45) and 8.6% (5/58), respectively. The incidence of significant loss of main Cobb correction and distal adding-on was 13.3% (6/45) and 25.9% (15/58) respectively without significant difference (χ 2=1.891, P=0.169; χ 2=2.451, P=0.117). Compared with non-complication patients (39 cases), 19 patients with complications in LTV-1 group had a greater degree of coronal balance to the convex side (23.9±9.5 mm vs. 14.6±11.5 mm, t=3.06, P=0.003), a greater LIV tilt (29.2°±3.7° vs. 25.3°± 5.3°, t=2.85, P=0.006), and a greater degree of LTV rotation (1.0(1, 1) vs. 0.6(0, 1), Z=-2.97, P=0.003). Logistic regression analysis showed that large preoperative LIV tilt and large preoperative coronal balance were the risk factors of complications during follow-up. Conclusion:The selection of LTV and LTV-1 as LIV in patients with Lenke 5 adolescent idiopathic scoliosis could obtain satisfied coronal, sagittal balance and low incidence of mechanical related complications during follow-up. For patients with preoperative coronal balance >17.0 mm or LIV tilt >25.3°, the risk of mechanical related complications might be higher than that when "LTV-1" was selected as LIV.

Background/Aims: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disease characterized by recurrent abdominal pain and bowel dysfunction. However, the majority of previous neuroimaging studies focus on brain structure and connections but seldom on the inter-hemispheric connectivity or structural asymmetry. This study uses multi-modal imaging to investigate the abnormal changes across the 2 cerebral hemispheres in patients with IBS. Methods: Structural MRI, resting-state functional MRI, and diffusion tensor imaging were acquired from 34 patients with IBS and 33 healthy controls. The voxel-mirrored homotopic connectivity, fractional anisotropy, fiber length, fiber number, and asymmetry index were calculated and assessed for group differences. In addition, we assessed their relevance for the severity of IBS. Results: Compared with healthy controls, the inter-hemispheric functional connectivity of patients with IBS showed higher levels in bilateral superior occipital gyrus, middle occipital gyrus, precuneus, posterior cingulate gyrus, and angular gyrus, but lower in supplementary motor area. The statistical results showed no significant difference in inter-hemispheric anatomical connections and structural asymmetry, however negative correlations between inter-hemispheric connectivity and the severity of IBS were found in some regions with significant difference. Conclusions The functional connections between cerebral hemispheres were more susceptible to IBS than anatomical connections, and brain structure is relatively stable. Besides, the brain areas affected by IBS were concentrated in default mode network and sensorimotor network.

Background/Aims: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disease characterized by recurrent abdominal pain and bowel dysfunction. However, the majority of previous neuroimaging studies focus on brain structure and connections but seldom on the inter-hemispheric connectivity or structural asymmetry. This study uses multi-modal imaging to investigate the abnormal changes across the 2 cerebral hemispheres in patients with IBS. Methods: Structural MRI, resting-state functional MRI, and diffusion tensor imaging were acquired from 34 patients with IBS and 33 healthy controls. The voxel-mirrored homotopic connectivity, fractional anisotropy, fiber length, fiber number, and asymmetry index were calculated and assessed for group differences. In addition, we assessed their relevance for the severity of IBS. Results: Compared with healthy controls, the inter-hemispheric functional connectivity of patients with IBS showed higher levels in bilateral superior occipital gyrus, middle occipital gyrus, precuneus, posterior cingulate gyrus, and angular gyrus, but lower in supplementary motor area. The statistical results showed no significant difference in inter-hemispheric anatomical connections and structural asymmetry, however negative correlations between inter-hemispheric connectivity and the severity of IBS were found in some regions with significant difference. Conclusions The functional connections between cerebral hemispheres were more susceptible to IBS than anatomical connections, and brain structure is relatively stable. Besides, the brain areas affected by IBS were concentrated in default mode network and sensorimotor network.