The lumbosacral transitional vertebra (LSTV) is a common lumbar vertebral variation characterized by unilateral or bilateral enlarged transverse processes. When the enlargement of the transverse processes alters the local biomechanics of LSTV, it may give rise to a series of clinical symptoms known as Bertolotti syndrome. The main manifestations include pain in the lumbosacral region, buttocks, outer side of the lower limbs, numbness, and symptoms related to the sciatic nerve. LSTV is often classified using the Castellvi classification. The presence of lumbosacralization and sacralization of vertebrae in LSTV makes it challenging to accurately locate and number LSTV. So various anatomical landmarks and spinal parameters have been proposed to assist in the localization and numbering of LSTV, but they all have a certain error rate. Even after the lumbar vertebrae is clearly numbered, there is often controversy over the baseline selection for preoperative spinal parameters. Currently, the horizontal level of S 1 is considered the optimal measurement baseline, but this conclusion needs further confirmation in a clinical context. The main basis for LSTV diagnosis is imaging signs, while the diagnosis of Bertolotti syndrome requires local injection of local anesthetics or corticosteroids into the pseudo-joint and the exclusion of other degenerative diseases of the lumbar spine. The treatment of Bertolotti syndrome includes conservative and surgical approaches. Common surgical procedures include fusion and decompression, both of which can achieve good short-term outcomes. However, due to the limited number of patients studied or a lack of direct comparisons, it is challenging to determine the superiority of these two methods in terms of medium to long-term effectiveness. This article provides a comprehensive review of the symptoms and causes of Bertolotti syndrome, preoperative localization and numbering of LSTV, baseline selection for preoperative spinal parameter measurements, and treatment methods.

Objective:To explore the correlation between the expression level of the serum CircRNA_ 0005853 and cognitive impairment in elderly patients with acute cerebral infarction (ACI).Methods:A total of 120 elderly patients with ACI admitted to Haikou Third People′s Hospital from January 2019 to March 2022 were retrospectively selected. According to the Montreal Cognitive Assessment (MoCA) score of the patients 4 weeks after treatment, they were divided into a cognitive impairment free group (MoCA score≥26, 55 cases) and a cognitive impairment group (MoCA score<26, 65 cases). The cognitive impairment group was redivided into mild group (MoCA score 21-25, 16 cases), moderate group (MoCA score 15-20, 38 cases), and severe group (MoCA score<15, 11 cases) based on the severity of cognitive impairment. The serum CircRNA_0005853 expression level of each group was compared. multivariate logistic regression analysis was applied to identify the risk factors for cognitive impairment after ACI. A receiver operating characteristic (ROC) curve was drown to analyze the value of CircRNA_0005835 expression level in predicting cognitive impairment. Using Pearson correlation analysis, the correlation between the expression level serum CircRNA_0005835 and MoCA score in patients with cognitive impairment was analyzed.Results:There were statistically significant differences in age, infarct size, and triglycerides between the cognitive impairment group and the non cognitive impairment group (all P<0.05). The MoCA score of the cognitive impairment group was lower than that of the non cognitive impairment group [(19.62±2.73)points vs (28.10±1.05)points, P<0.001]. The expression level of Serum CircRNA_0005835 in the cognitive impairment group was higher than that of the non cognitive impairment group (2.48±1.02 vs 1.25±0.46, P<0.001), and in the severe group, the expression level of the serum CircRNA_0005835 (2.90±1.26) was higher than that of the moderate group (1.87±0.84) and the mild group (0.92±0.35) ( P<0.001). Multivariate logistic regression analysis shew that age ( OR=1.662, 95% CI: 1.140-2.873), infarct size>3.0 cm 2 ( OR=1.853, 95% CI: 1.317-4.112), and CircRNA_0005835 ( OR=2.217, 95% CI: 1.635-5.540) were risk factors for cognitive impairment after ACI. The area under the curve (AUC) of CircRNA_0005835 expression level predicting cognitive impairment was 0.837(95% CI: 0.779-0.894), with a sensitivity of 80.2% and a specificity of 83.7%. The AUC of CircRNA_0005835 expression level predicting cognitive impairment was 0.837(95% CI: 0.779-0.894), with a sensitivity of 80.2% and a specificity of 83.7%. The correlation analysis shew that the expression level of serum CircRNA_0005835 in elderly ACI patients was negatively correlated with MoCA score ( r=-0.773, P<0.001). Conclusions:The increased expression level of serum CircRNA_0005853 is related to the occurrence and development of cognitive dysfunction after elderly ACI, and has certain value in predicting cognitive dysfunction.

Objective:To determine whether the transepidermal water loss rate (TEWL) is correlated with the stratum corneum (SC) hydration level.Methods:Healthy children aged ≤ 17 years were enrolled from Medical Center for Public Health of Puning, 2 kindergartens and 2 primary schools, from October 2021 to June 2022. TEWL and SC hydration levels were measured on the left forearm and right anterior shank using a device for measuring skin physiological funcitons. Pearson correlation analysis was used to determine the correlations between TEWL and SC hydration levels in children of different ages and genders.Results:A total of 1 396 healthy children were enrolled, aged from 1 month to 17 years. Among them, 783 were male children and 613 were female children. In children aged 1 to < 12 months, no correlation was observed between TEWL and SC hydration levels on the forearms of male children, while TEWL was positively correlated with SC hydration levels on the anterior shanks of male children, as well as on the forearm and anterior shanks of female children ( r = 0.283, 0.404, 0.420, respectively, all P < 0.05) . In children aged 1 to 2 years, positive correlations were observed between the above two indicators on the anterior shanks of male children and forearms of female children ( r = 0.370, 0.419, respectively, both P < 0.01) , while there were no correlations between the two indicators on the anterior shanks of female children or forearms of male children. Positive correlations were observed between TEWL and SC hydration levels on both the forearms and anterior shanks of female children and the forearms of male children aged 3 to 5 years and 6 to 11 years ( r values ranging from 0.172 to 0.293, all P < 0.05) , but not on the anterior shanks of male children aged from 6 to 11 years. The group aged 12 to 17 years exhibited significantly positive correlations between TEWL and SC hydration levels on both the anterior shanks and forearms of male and female children ( r values ranging from 0.269 to 0.485, all P < 0.001) . Conclusion:SC hydration levels are positively correlated with TEWL on the anterior shanks and forearms of healthy children, and the degree of correlation tends to increase with age.

Background::Gestational weight gain (GWG) is associated with the risk of gestational diabetes mellitus (GDM). However, the effect of weight gain in different trimesters on the risk of GDM is unclear. This study aimed to evaluate the effect of GWG on GDM during different trimesters.Methods::A birth cohort study was conducted from 2017 to 2020 in Shenzhen, China. In total, 51,205 participants were included comprising two models (early pregnancy model and middle pregnancy model). Gestational weight (kg) was measured at each prenatal clinical visit using a standardized weight scale. Logistic regression analysis was used to assess the risk of GDM. Interaction analysis and mediation effect analysis were performed in the middle pregnancy model.Results::In the early pregnancy model, the risk of GDM was 0.858 times lower (95% confidence interval [CI]: 0.786, 0.937) with insufficient GWG (iGWG) and 1.201 times higher (95% CI: 1.097, 1.316) with excessive GWG after adjustment. In the middle pregnancy model, the risk of GDM associated with iGWG increased 1.595 times (95% CI: 1.418, 1.794) after adjustment; for excessive GWG, no significant difference was found ( P = 0.223). Interaction analysis showed no interaction between GWG in early pregnancy (GWG-E) and GWG in middle pregnancy (GWG-M) ( F = 1.268; P = 0.280). The mediation effect analysis indicated that GWG-M plays a partial mediating role, with an effect proportion of 14.9%. Conclusions::eGWG-E and iGWG-M are associated with an increased risk of GDM. Strict control of weight gain in early pregnancy is needed, and sufficient nutrition should be provided in middle pregnancy.

Thrombocytopenia is one of the common complications of cirrhotic patients, which can induce an increasing bleeding risk and closely correlate with bleeding following invasive procedures. Consequently, how to respond to thrombocytopenia is crucial for improving the prognosis of patients with cirrhosis. This article reviews the main mechanisms of cirrhosis concurrent with thrombocytopenia, as well as the corresponding clinical management strategies.

Objective To investigate the value of radiomics nomogram model based on enhanced CT for predicting postoperative pancreatic fistula(POPF)in patients undergoing pancreaticoduodenectomy(PD).Methods The clinical and abdominal imaging data of 82 patients who underwent PD were analyzed retrospectively.They were divided into training set and validation set at a ratio of 3∶2.In the venous phase of CT,the maximum slice of the pancreatic duct was selected to delineate the region of interest(ROI),and the features were extracted and screened to construct the radiomics model.The independent risk factors associated with POPF were screened by univariate and multivariable logistic regression analyses to construct the clinical model.A nomogram model was created by combining Radiomics score(Radscore)and clinical risk factors.The diagnostic performance of the model was verified by the vali-dation set.Results The nomogram model demonstrated significant predictive power,with an area under the curve(AUC)of 0.862 and 0.806 in the training set and validation set,respectively.Conclusion The nomogram model exhibits excellent predictive performance and outperforms the clinical model and radiomics model in predicting POPF,which can provide important guidance for clinical deci-sion-making.