Objective To retrospectively investigate diagnostic and therapeutic value of intradiscal steroid injection in patients with discogenic low back pain combined with radial fissure of annulus fibrosis.Methods Totally 120 patients who had undergone CT guided intervertebral discography and steroid injections,including 72 males and 48 females,aged from 25 to 60 years (average,48 years),were recruited to this study.According to Dallas discography description system,7 cases were rated as grade 0,36 grade 1,48grade 2,and 29 grade 3.The Visual Analogue Scale (VAS) and Roland Morris Disability Questionnaire (RMDQ) were used to evaluate clinical effect at 2 weeks,2 months,6 months,12 months and 24 months postoperatively.Results Most of patients who underwent steroid injection in single highly suspect diseased disc claimed significant symptom improvement.There were statistically significant differences between pre- and post-operative VAS and RMDQ.The clinical effect in grade 3 group was better than those in grade 1 and grade 2 groups,and the differences were significant.Patients with severe disc disruption (grade 3) had a lower recurrence rate of low back pain compared with other patients.Conclusion Intradiseal steroid injection not only can significantly relieve discogenic low back pain,but also can benefit diagnosis of discogenic low back pain,especially in patients who fail to reproduce concordant pain on discography.For patients with severe rupture of the annulus fibrosus,the relief of discogenic low back pain is more significant.

The epidural venous plexus is considered as a cause of low back and leg pain but has been neglected for a long time. As an auxiliary drainage system of the vena cava, the epidural venous plexus plays an important role in the circulation of body fluids, and its tortuous expansion may lead to clinical symptoms similar to a herniated disc or spinal stenosis, by compressing nerve roots or dura. Due to the lack of specificity of imaging findings, it is difficult to distinguish accurately from disc herniation or spinal stenosis. The epidural venous plexus is tortuous and thin-walled, which is easy to be broken during the operation that resulted in obscuring the surgical field and leading to other complications such as postoperative hematoma. Despite researches of epidural venous plexus have been carried out for years, details are still left unknow. We hereby reviewed the latest research progress of the epidural venous plexus including anatomical structure, morphological characteristics, clinical significance and imaging examination.

Objective: To understand the epidemiological characteristic of the prevalence of aasthma in children in China, and to provide clues for the prevention and treatment of asthma in China. Methods: A systematical literature retrieval on children asthma prevalence from CNKI, WanFang Data, VIP and PubMed databases was performed. Random effects model was used to calculate the combined prevalence of asthma and its 95% confidence interval (CI) with Stata 16.0 software, the subgroup analysis was conducted according to sex, age and region. Results: A total of 26 studies were included, including 213 729 children, 112 169 boys and 101 560 girls. Meta-analysis showed that the combined prevalence of asthma in children aged 14 and under in China was 3.3%(95%CI=2.7%-4.0%). The subgroup analysis showed that the prevalence of asthma in boys was higher than that in girls(Q=11.42, P=0.01). The prevalence of asthma in preschool children aged 4-6 was higher than that in infants aged 0-3 and school children aged 7-14(Q=8.03, P=0.02). And there was no significant discrepancy of the asthma prevalence among children between the north and south(Q=0.72, P>0.05). Conclusion The prevalence of childhood asthma in China presented an increasing trend. Our findings underscore more efforts to control and prevent asthma among children.

Objective To investigate the effect of anterior artificial vertebral body reconstruction and internal fixation after the failed posterior thoracolumbar fracture surgery.Methods A retrospective case series study was conducted to analyze the clinical data of 14 patients whose posterior thoracolumbar fracture surgery failed admitted to Sir Run Run Shaw Hospital School of Medicine affiliated to Zhejiang University from January 2014 to June 2017,There were eight males and six females,aged 29-69 years[(43.6±11 .9)years].The involved segments included T11 in one patient,T12 in two patients,L1 in five patients,L2 in four patients and L3 in two patients.According to AO classification,there were four patients with type A2,six with type A3,two with type B1 and two with type B2.The thoracolumbar injury severity scores(TLICS)ranged from 4 to 8 points[(5.3±1.1)points].There were six patients with nonunion,three with nonunion following screw loosening,three with nonunion following breakage,and two with neurological dysfunction.Revision plan:for patients with internal fixation loosening or rupture or long nail placement,the posterior internal fixation would be removed first,and then the stage I anterior revision would be performed after changing the position;for patients with complete internal fixation,only anterior revision would be performed.The operation time,intraoperative blood loss,intraoperative and postoperative complications,pain visual analogue score(VAS),Oswestry dysfunction index(ODI)score and kyphosis angle changes before and after operation were recorded.Results All patients were followed up for 12-54 months[(25.9±13.0)months].The anterior operation time ranged from 100 to 180 minutes[(137.9±23.6)minutes].The intraoperative blood loss ranged from 280 to 750 ml[(452.9±145.4)ml].There were no intraoperative or postoperative complications such as spinal nerve injury,cerebrospinal fluid leakage,vascular injury,abdominal organ injury,incision infection and hemorrhage.VAS decreased from preoperative(6.1±0.9)points to(1.9±0.7)points 3 months after operation and to(1.4±0.5)points at the last follow-up;ODI increased from preoperative(30.4±7.1)points to(7.9±6.4)points 3 months after operation and to(8.1±4.3)points at the last follow-up;kyphosis degree decreased from preoperative(-20.1±6.5)° to(5.6±6.4)° 3 months after operation and to(5.4±6.8)0 at the last follow-up.The VAS,ODI score and kyphosis degree were significantly improved at the last follow-up compared with those before operation(P＜ 0.01).Conclusions For patients with failed thoracolumbar fracture posterior surgery,anterior artificial vertebral body reconstruction and internal fixation can significantly relieve back pain,improve function and kyphosis deformity,with satisfactory clinical effect,which can be an ideal treatment option for the revision of thoracolumbar fracture.

Objective To investigate the application of combination of thoracolumbar injury classification severity score and load sharing classification (TLICS + LSC) in deciding the surgery for thoracolumbar fractures.Methods A retrospective case series study was conducted to analyze the clinical data of 42 patients with thoracolumbar fractures admitted to Sir RunRun Shaw Hospital affiliated to Medical College of Zhejiang University from January 2013 to November 2015.There were 28 males and 14 females,aged 19-58 years [(39.5 ± 11.5)years].The injured segments included T11 in 2 patients,T12 in 12,L1 in 4,L2 in 24.According to American Spinal Injury Association (ASIA) classification,there were two patients with grade A,five patients with grade B,six patients with grade C,and two patients with grade D.The rest of the patients had good neurological function.Surgical methods were selected according to the TLICS + LSC system.Seventeen patients were treated with posterior internal fixation (TLICS ＞ 4 points,LSC ＜ 7 points) (Group A),19 patients were treated with anterior reconstruction and internal fixation (TLICS ≤4 points,LSC ≥ 7 points) (Group B),and six patients were treated with anterior reconstruction and posterior internal fixation (TLICS ＞ 4 points,LSC ≥ 7 points) (Group C).ASIA grading criteria were used to assess the neurological function recovery of the patients.Vertebral height and sagittal Cobb angle changes were measured on full-length,lateral X-ray or CT sagittal reconstruction images.Artificial vertebral body and screw loosening were observed on lateral X-ray or CT sagittal reconstruction images.Visual analogue scale (VAS) and Oswestry dysfunction index (ODI) were used to evaluate pain relief and functional recovery.Results All patients were followed up for 18-24 months [(22.2 ± 2.0) months].base on ASIA grading criteria:one grade A (Group C) was restored to grade C,three grade B (Group B) were restored to grade D,two grade B (Group C) were restored to grade C,six grade C (four in Group A,two in Group B) and two grade D (Group A) were restored to grade E (P ＜ O.05).The correction of sagittal Cobb angle was restored from (26.1 ± 5.6) ° before surgery to (3.7 ± 1.5) ° immediately after surgery and was (4.8 ± 1.0) ° at last follow-up (P ＜ 0.05).There was no loosening of artificial vertebral body or screw in any patient.The VAS score dropped from (6.3 ± 0.9) points before surgery to (2.0 ± O.7) points at the last follow-up,and ODI score was also significantly decreased from (72.6 ± 9.2) points before surgery to (25.2 ± 5.2) points at the last follow-up (P ＜ 0.05).Conclusion The combination of TLICS and LSC can clearly guide the surgical decision-making of patients with thoracolumbar fracture.The operation plan can be made according to the results of the combined scoring.After the operation,the local kyphosis angle of the patients recovers significantly,the pain is relieved and the function is improved significantly.

Objective: To examine the association between the visceral adiposity index (VAI) and nonalcoholic fatty liver disease (NAFLD) in the pediatric population in order to improve risk stratification and prevention systems for chronic liver disease. Methods: A total of 510 overweight/obese children aged 6-8 years old were enrolled from the child cohort which was designed to study puberty, obesity, and cardiovascular risk (PROC), and complete data from liver ultrasounds and the VAI were obtained. Used Spearman s rank correlation coefficient, Chi-square tests, and Logistic regression analyses to explore the association between the VAI and NAFLD. Results: The detection rates of NAFLD for boys and girls were 25.9% and 11.1%, respectively. VAI for normal group and the NAFLD group were 0.43(0.31, 0.61) and 0.61(0.44, 0.87) in boys, and 0.74(0.56, 1.07) and 1.08(0.67, 1.51) in girls, respectively. Spearman s correlation coefficient analysis showed that triglycerides(TG), VAI, and the third quintile VAI group were positively correlated with NAFLD in both boys and girls(r=0.19,0.26,0.29;0.16,0.16,1.18,P<0.05), and high-density lipoprotein-cholesterol (HDL-C) was negatively correlated with NAFLD in boys (r=-0.21, P<0.05). With advancing tertiles of VAI, the increasing trend in the NAFLD detection rate was statistically significant in boys and girls(Chi-square for trend were 21.77,7.66, P<0.01). The results of univariate and multivariable Logistic regression showed that, by taking the first tertile of VAI as a reference, the risk of NAFLD among boys was higher in the second tertile (cOR=2.59, 95%CI=1.15-5.86; aOR=2.33, 95%CI=1.01-5.36) and in the third tertile(cOR=5.73, 95%CI=2.62-12.53; aOR=4.87, 95%CI=2.15-11.03), where as the risk among girls was higher in the third tertile(cOR=4.43, 95%CI=1.40-14.00). Conclusion VAI is positively correlated with pediatric NAFLD. Higher tertiles of VAI were associated with an increased risk of NAFLD in overweight and obese children, which indicates that VAI can be used as an early predictor of NAFLD.

Objective: To investigate the sleeping status of the first grade primary students aged 6-8 in Beijing, to investigate the association between maternal parenting stress and children s sleep, and to inform intervention of addressing sleep problems among children in Beijing. Methods: Online survey was conducted based on the child cohort study designed to study puberty, obesity, and cardiovascular risk (PROC). The Children s Sleep Habits Questionnaire (CSHQ) and Parenting Stress Index Short Form (PSI-SF) were completed by parents, and 1 136 school aged children and their mothers were included as study participants. Logistic regression models were used to determine the association between maternal parenting stress and children s sleep. Results: The prevalence of sleep problems among first grade primary students was 78.52%. Among the children who received PSI-SF, the score of children with sleeping problems(86.66±17.31) was higher than that of the children with no sleeping problems(78.59±17.75)( t =6.42, P <0.01). After adjusting sociodemographic characteristics, multivariable logistic regression results showed children of mothers with parenting stress were more likely to have sleep problems ( OR =2.52, 95% CI =1.55-4.11, P <0.01). Taking 3 dimensions in PSI-SF as independent variables, the analysis indicated that compared with the children having mothers free from parental stress and difficult children, the children with mothers with parental stress were more likely to suffer from the sleeping problems( OR = 1.66 ,1.76, P <0.05). Conclusion Sleep problems are prevalent among first grade primary students, and it underscores providing psychological support to alleviate maternal parenting stress to address children s sleep problems.

Objective To investigate the effect of SP600125 on the proliferation, cell cycle, apoptosis and invasion of human cervical cancer HeLa cells. Methods CCK-8 method was used to detect the proliferation of HeLa cells treated with different concentrations of SP600125 at different time points. The 20 μmol/L of SP600125 was determined for subsequent experiments. Cell proliferation ability was detected using plate clone formation assay; nuclear morphology was observed by DAPI staining; cell cycle and apoptosis were measured by flow cytometry; cell migration and invasion were detected by cell scratch and Transwell methods; the mRNA and protein levels of p53, Mad2L1 and CDC20 were measured by qRT-PCR and Western blot after SP600125 treatment at different time points. Results Compared with control group (0.1%DMSO), cells proliferative activity were reduced by 10, 20, 30, 40 and 50 μmol/L SP600125 treatment for 24h. Compared with control group, the rate of apoptosis was significantly increased in SP600125 treatment groups, and the cell proportion in G₂/M phase increased (P < 0.001), while the cell proportion in G₀/G₁ phases cells was reduced after SP600125 treatment for 24h and 48h (P < 0.001), and the clonal number, migration and invasion ability of HeLa cells also decreased significantly (P < 0.001). qRT-PCR and Western blot results showed a significant decrease in Mad2L1 mRNA and protein expression (P < 0.05) and a significant increase in p53 and CDC20 mRNA and protein expression (P < 0.01). Conclusion SP600125 can induce cell cycle arrest of cervical cancer HeLa cells in G₂/M phase by upregulating p53 and CDC20 and downregulating Mad2L1 expression, and promote cell apoptosis to inhibit cell proliferation, migration and invasion.

Objective: The study aimed to explore sex differences in the growth and physical development of Beijing school-aged children and adolescents. Methods: Data obtained from regular health examinations of 94 122 school-aged children and adolescents aged 6-18 years old were collected from primary and high schools in Shunyi District from 2009 to 2018, and a longitudinal dataset was compiled with complete anthropometric parameters including height, weight, and BMI levels after linkage of individuallevel information. The age-specific growth rate was calculated and a linear mixed-effects model was used to identify sex differences according to chronological or relative age to peak height velocity (PHA). Results: Height, weight, and BMI levels increased with age in both boys and girls. Girls were taller than boys in the 10-11 year-old age group, catch-up growth in height was observed in boys at age 12, whose height surpassed that of girls thereafter. Boys had a higher weight and BMI than girls in all age groups (P<0.01). Sex differences were found in the growth rates of height, weight, and BMI levels(t=-67.56，-47.46，3.22，P<0.01), which was demonstrated by the interaction effect of sex and age in the linear mixed-effects model. The PHA in boys was 12 years old, which was two years later than the PHA in girls. Boys reached peak weight velocity at 12 years old, lagging one year behind girls who reached their peak at 11 years old. The curves of the BMI growth rate with age showed double peaks in boys and the first peak appeared at 10 years, which was one year earlier than girls. The change in weight was highly synchronized in time with the increase in height, after adjusting for the growth rate of weight by PHA. Weight velocity increased with age before the onset of puberty until PHA, and then it declined; boys presented with obvious fat accumulation before the onset of puberty. Conclusion Sex differences in the growth and physical development of school-aged children and adolescents were persistent and apparent, and the change in weight was highly synchronized in time with the increase in height.

Objective: To explore sex differences between weight and systolic blood pressure (SBP) changes among school-age children and adolescents in Beijing, and to provide a basis for priority intervention to control the rapid growth of body weight and blood pressure. Methods: Anthropometric measurement data of 70 288 children and adolescents from primary and high schools in Shunyi District were collected from 2009 to 2018, and a longitudinal dataset with complete data related to weight and BP after individual data linkage was compiled. The age-specific weight and SBP growth rates were calculated, and a linear mixed-effects model was used to identify sex differences in chronological growth rates. Results: Weight and SBP increased with age in both boys and girls, and the mean weight and SBP were higher in boys than in girls across all age groups. The result of the linear mixed-effects model indicated apparent sex differences in weight and SBP growth rates, with an age and sex interaction term(β=-0.35, -0.40, P<0.01). The age at peak weight velocity (PWA) was 12 years old and the age at peak SBP velocity was 13 years old in boys, which occurred one and three years later than for girls, respectively. In addition, the peak weight and SBP velocity were higher in boys than in girls. The curves of the SBP growth rate adjusted for the PWA, showed that the peak SBP velocity occurred two years before PWA and the second peak SBP velocity occurred at the PWA, which indicated "double peaks" in both boys and girls. The SBP growth rate was always higher in boys than in girls, and the rates declined after PWA. Conclusion Sex differences in weight and SBP growth rates were persistent and obvious in school-age children and adolescents in Beijing and the change in SBP was highly time synchronized with the increase in weight.