Speeding up the training of quality personnel in clinical medicine is an important historic mission of clinicians. Practice has proven that the training, growth and maturity of quality clinical personnel are inseparable from clinical practice. Thus, firstly, clinical workers must, in accordance with the goals of training, rigorously enforce process management, including implementation of the training regulations, strict assessments, and cultivation of abilities in doing scientific research and writing up research papers. Secondly, the overall quality of postgraduates must be enhanced. Thirdly, files of postgraduates must be set up. Fourthly, experience in training academic degree postgraduates in clinical medicine should be constantly summed up, including ways of strengthening organization and control and clarifying goals and requirements

Objective To measure the vitamin B1 levels in plasma,erythrocytes and urine of the patients with type 2 diabetes,and to analyze the correlation of vitamin B1 level with the progression of diabetic nephropathy,and to clarify the metabolism of nutrtion mechanism of type 2 diabetic nephropathy.Methods Total 90 patients with type 2 diabetes and 30 healthy volunteers were recruited.According to the levels of microalbuminuria,the patients with type 2 diabetes were divided into non diabetic nephropathy (NDN)group,early diabetic nephropathy (EDN)group and clinical diabetic nephropathy (CDN)group (n=30);the healthy people was used as normal control (NC) group.The vitamin B1 levels in the plasma,erythrocytes and urine were examined with high performance liquid chromatography (HPLC). The correlation of microalbuminuria with the plasma viamin B1 level was analyzed. Results The level of vitamin B1 in plasma of the patients in NC group was (7.1±3.3)μg·L-1,while it was (4.0±2.3)μg·L-1 in NDN group,(3.1±1.0)μg·L-1 in EDN group and (2.3±0.6)μg·L-1 in CDN group. Compared with NC group,the vitamin B1 levels in the plasma in NDN,EDN and CDN groups dropped 43.7%, 56.3%,and 67.6%,respectively (P<0.05). The excretion of vitamin B1 in urine were (2.9 ± 0.8),(9.0 ± 4.7),(11.7±3.9),and (15.6±5.0)μg·L-1 in NC group,NDN group,EDN group and CDN group, respectively.Compared with NC group,the vitamin B1 levels in the urine in NDN,EDN and CDN groups were increased by 2,3 and 4 times,respectively (P<0.05).A negative correlation was found between the level of microalbuminuria and the level of vitamin B1 in plasma (r=-0.62,P=0.013).Conclusion Vitamin B1 deficiency can be observed in the early stage of diabetic nephropathy,and the level of vitamin B1 is closely correlated with the progression of diabetic nephropathy.

The pearly gallstone was discharged after Treatment with Magnetic Field (TMF). The pearly gallstones are measured with FT-IR spectrometer. The results demonstrate that mostly composition of this gall-stones is cholesterol and intermixture with some protean and inorganic calcium salt. Nature pearls is mostly composed with calcium carbonate. Their compositions are different. The pearly gall-stones show sandwich of cholesterol crystal in structure.

Objectives:To analyze the effect of vertebral or intraspinal abnormalities on the efficacy of pos-terior corrective surgery for scoliosis patients with arthrogryposis multiplex congenita(AMC).Methods:A retro-spective study was conducted on 30 scoliosis patients with AMC who underwent posterior corrective surgery in the Department of Spine Surgery of Drum Tower Hospital between August 2001 and November 2021.There were 18 males and 12 females with a mean age of 15.9±5.8(6-32)years.The patients were divided into ab-normal group(15 cases)and control group(15 cases)according to with or without vertebral or intraspinal ab-normalities.The types of vertebral or intraspinal abnormalities in the abnormal group were recorded,and the number of fusion segments,operative time and intraoperative blood loss were compared between groups.The complications during follow-up were also collected.The flexibility of major curve was assessed on Bending radiographs,and the main curve Cobb angle,the distance between C7 plumb line and center sacral vertical line(C7PL-CSVL),the sagittal vertical axis(SVA),the thoracic kyphosis(TK),and the lumbar lordosis(LL)were measured on the standing whole spine anteroposterior and lateral X-ray images at pre-operation,postoperative two weeks and two years,and the correction rate of major curve was calculated at 2 weeks after surgery and the final follow-up.Results:There were 10 cases of simple poor segmentation(66.6％),2 cases of poor seg-mentation combined with tethered cord(13.3％),and 1 case of poor segmentation combined with arachnoid cyst,simple hemivertebra,and simple wedge-shaped vertebra(6.7％)each in the abnormal group.There were no significant differences between abnormal group and control group in the number of fusion segments,opera-tive time and intraoperative blood loss(P＞0.05).No complication was observed during operation in the abnor-mal group,and 3 complications were observed during follow-up,including 2 cases with screw misplacements and 1 case with thoracic effusion and the right brachial plexus paralysis;5 cases of complications in the control group were observed,including 1 case with malignant hyperthermia and cardiac arrest during the surgery,3 cases with screw misplacements and 1 with thoracic effusion and screw placement failure.The in-cidence of complications was not statistically different between the two groups(P=0.628).The flexibility of ma-jor curve before operation was not statistically different between the two groups(P＞0.05);The major curve Cobb angle,C7PL-CSVL,SVA,TK and LL at pre-operation,post-operative two weeks and 2 months were not statistically different between groups(P＞0.05);The correction rate of major curve at 2 weeks and 2 months after surgery were not significantly different as well(P＞0.05).Conclusions:Vertebral or intraspinal abnormali-ties have no obvious effects on the efficacy of posterior corrective surgery for the treatment of scoliosis pa-tients with AMC,and there is no significant increase in the incidence of intraoperative and postoperative com-plications.

Objective:To clarify the characteristics of dynamic change of pelvic incidence (PI) in patients with adult spinal deformity in a longitudinal study, to explore the relationship of PI change and other sagittal parameters, and to investigate the role of PI change in the progression of global sagittal imbalance.Methods:The patients with adult spinal deformity (ASD) who were followed up at our clinic from December 2014 to December 2022 were retrospectively reviewed. All patients were older than 50 years and had a minimum of 2-year follow-up. Full-spine frontal and lateral X-ray films were taken at pre-operation, post-operation, and last follow-up. Radiographic parameters were measured, including Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), regional kyphosis (RK), sagittal vertical axis (SVA), T1 pelvic angle (TPA), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). Intraclass correlation coefficient (ICC) was used to evaluate intra- and inter-observers' reliability, of which ICC>0.75 indicated excellent; 0.5< ICC≤0.75 indicated good; ICC≤0.5 indicated poor. Independent t-test, paired t-test and Pearson coefficient correlation were performed for statistical analysis. Results:A total of 30 patients were included in this study with a mean age of 61.93±6.20 years (range 54-72 years). The mean follow-up duration was 37.47±8.57 months (range 25-46 months). ICC test showed an excellent intra- and inter-observer reliability of PI in ASD patients from baseline to last follow-up (inter-observer ICC: 0.917 at baseline and 0.923 at last follow-up; intra-observer ICC: 0.913 at baseline and 0.915 at last follow-up). From first-visit to the last follow-up, PI significantly increased from 44.47°±5.96° to 52.07°±7.42° ( t=13.375, P<0001), PT (22.33°±5.77° vs. 28.07°±8.16°, t=4.268, P=0.001), SVA (40.03±13.34 mm vs. 64.37±27.06 mm, t=5.303, P<0.001), TPA (16.20°±5.02° vs. 27.13°±6.45°, t=13.742, P<0.001) and PI-LL (15.07°±13.92° vs. 29.67°±13.54°, t=10.802, P<0.001) were significantly increased while LL was significantly decreased (29.40°±15.53° vs. 22.40°±16.47°, t=4.814, P<0.001) at last follow-up. Pearson correlation analysis showed that the change of PT ( r=0.659, P=0.008), the change of TPA ( r=0.629, P=0.012), pre-operation PI ( r=0.560, P=0.030), and the last follow-up PI ( r=0.746, P=0.001) were significantly correlated with last follow-up PI. Conclusion:This study suggested that PI could significantly increase during follow-up in ASD patients. The dynamic change of PI may be correlated with the deterioration of sagittal imbalance.

Objective:To investigate the correlation between pelvic compensatory capacity and proximal junctional kyphosis (PJK) in patients with adult spinal deformity undergoing spino-pelvic fixation utilizing second sacral alar iliac (S 2AI). Methods:A cohort of 55 patients diagnosed with adult spinal deformity and treated with spino-pelvic fixation utilizing S 2AI between January 2016 and January 2019 was included. The pelvic tilt to pelvic incidence ratio (PT to PI ratio, PTr) was used to categorize patients into high PTr group (PT/PI>0.4) and low PTr group (PT/PI<0.4). Subsequently, patients were further classified into PJK group and non-PJK group based on the occurrence of PJK during the last follow-up. Radiographic parameters such as Cobb angle, coronal balance distance (CBD), global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), proximal junctional angle (PJA), T 1 pelvic angle (T 1PA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and PI-LL were measured preoperatively, postoperatively, and at final follow-up. The chi-square test was employed to compare the incidence of PJK between the high PTr and low PTr groups at the last follow-up. Additionally, multivariable logistic regression analysis was conducted to identify independent risk factors for PJK. Results:The incidence of PJK was significantly higher in the high PTr group compared to the low PTr group [high PTr group (38%) vs. low PTr group (8%), P<0.05]. Multivariable logistic regression analysis identified pre-operative PTr [ OR=3.274, 95% CI(1.100, 36.973), P=0.035], post-operative PTr [ OR=5.700, 95% CI(1.271, 65.272), P=0.029], and PJA at the last follow-up [ OR=1.274, 95% CI(0.998, 1.624), P=0.009] as independent risk factors for PJK. Conclusion:Patients with higher PTr exhibited poor pelvic compensatory ability, struggled to maintain optimal sagittal balance post-operation, and were at increased risk of developing PJK during follow-up.

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 investigate the correlations between cosmetic and radiographic parameters in patients with congenital scoliosis (CS) with vertebral segmentation failureand the clinical implication of cosmetic parameters.Methods:A total of 27 CS patients were retrospectively reviewed. Anteroposterior and lateral radiographs of the entire spine was taken. Simultaneously, photos were taken from the back in natural standing position and standing forward bending position. Seven cosmetic parameters were measured on the photographs: shoulder area index 1 (SAI1), shoulder area index 2 (SAI2), lumbar area index (LAI), shoulder angle (α 1), axilla angle (α 2), right and left waist angle difference (RLWAD) and hump index. Also, seven radiographic parameterswere measured on the radiographs: radiographic shoulder height difference (RSHD), T 1 tilt, first rib angle (FRA), clavicle angle (CA), clavicle-rib cage intersection (CRCI), clavicle chest cage angle difference (CCAD) and Cobb's angle. The correlation between cosmetic parameters and radiographic parameters was analyzed by Pearson correlation coefficient. Results:Of the 27 patients, 4 were males and 23 were females, with a mean of age 14.0±2.6 years (range 11-18 years). The apical vertebra ranged from T 5 to T 11. LAI was significantly correlatedwith CCAD, but correlation coefficient was only -0.44. The range of correlation coefficientsbetween SAI1 and all radiographic parameters was -0.17 to 0.53, and the range of correlation coefficients between SAI2 and all radiographic parameters was -0.16 to 0.53. However, all correlation coefficients were less than 0.56. Conclusion:Radiographic parameters cannot reflect cosmetic appearances of CS patients with vertebral segmentation failures accurately. More attention should be paid to cosmetic parameters in the evaluation of patients' appearances.

Objective:To investigate the imaging features and surgical strategies of late-onset spinal deformity after myelomeningocele (MMC) repair.Methods:A total of 23 patients with late-onset spinal deformity after MMC repair from January 2006 to December 2019 were retrospectively analyzed, including 16 males and 7 females, aged 15.4±5.9 years (range, 6-28 years). All patients underwent MMC resection and repair in infancy (0-4 years). The complications of MMC, imaging characteristics of spinal deformity (Cobb angle of scoliosis, coronal balance, regional kyphosis), surgical methods, clinical outcomes and incidence of complications were analyzed. The Scoliosis Research Society-22 (SRS-22) score and Oswestry disability index (ODI) were used to evaluate the quality of life.Results:All patients were followed up for 2.4±0.8 years (range, 1-4 years). Among 23 patients, MMC occurred in the upper thoracic segment in 3 cases, thoracic segment in 1 case, thoracolumbar segment in 13 cases, and lumbosacral segment in 6 cases. 16 patients had scoliosis or kyphosis with the apex of the spine in the same segment as the MMC lesion. Among 13 patients with MMC located in thoracolumbar segment, 12 patients had scoliosis and 9 patients had kyphosis. Among 6 patients with MMC located in lumbosacral segment, 3 patients had pelvic tilt. Vertebral deformities included widening of pedicle space in 21 cases, enlargement of spinal canal in 19 cases, absence of spinous process in 17 cases, malsegmentation in 17 cases, and hemivertebra deformity in 9 cases. Intramedullary lesions included split cord in 6 cases and tethered cord in 9 cases. The overall implant density was 57.2%±17% (range, 16.6%-100%). At the last follow-up, the Cobb angle of scoliosis was 40.9°±19.1°, which was significantly smaller than 71.5°±28.2° before operation ( P<0.001). The local kyphosis angle was 26.7°±12.9°, which was significantly lower than that before operation (40.4°±21.5°), the difference was statistically significant ( P<0.001).The coronal balance was 16.1±13.6 mm, which was smaller than that before operation 28.5± 23.7 mm, the difference was statistically significant ( P<0.001). The total score of SRS-22 was 18.7±0.7, which was higher than that before operation 17.7±0.9, and the difference was statistically significant ( t=-9.74, P<0.001); ODI was 25.5%±6.2% after operation, which was significantly lower than that before operation (44.8%±10.1%), the difference was statistically significant ( t=13.66, P<0.001). Dural rupture occurred in 4 patients, including postoperative cerebrospinal fluid leakage in 2 cases; postoperative pleural effusion in 1 patient; and screw malposition in 2 patients. Three patients had broken rods and one had deep infection at final follow-up. Conclusion:About 70% of MMC patients who underwent resection and repair in early childhood developed late-onset spinal deformity in adulthood with the lesion at the parietal vertebrae. Posterior correction can obtain satisfactory clinical results. If the posterior element of the apical vertebral body is hypoplastic, the implant density can be increased by anterior vertebral screw, lamina hook fixation, and S 2 sacroiliac screw.