Objective To explore the causal association between serum 25-hydroxyvitamin D[25(OH)D]and tic disorder(TD)based on two sample Mendelian randomization(TSMR)analysis.Methods Single nucleotide polymorphisms(SNP)associated with exposure and outcome were selected from the Genome-Wide Association Studies datasets of the publicly gene databases.Serum 25(OH)D was taken as the exposure factor and TD as the outcome factor.The inverse variance weighted(IVW)method was used as the main analysis method for data analysis and visualization.Results Forward Mendelian randomization(MR)analysis included 75 25(OH)D SNPs.IVW results showed no statistically significant difference in the effect of serum 25(OH)D levels on TD.In the reverse MR analysis involving 5 TD SNPs,the IVW results indicated no statistically significant impact of TD on serum 25(OH)D levels.All auxiliary method results demonstrated no causal association between TD and serum 25(OH)D levels(P＞0.05).Conclusion Through the analysis of TSMR,the results showed that there was no direct causal relationship between serum 25(OH)D level and TD,and 25(OH)D may affect TD through indirect action.

Objective To explore the causal association between serum 25-hydroxyvitamin D[25(OH)D]and tic disorder(TD)based on two sample Mendelian randomization(TSMR)analysis.Methods Single nucleotide polymorphisms(SNP)associated with exposure and outcome were selected from the Genome-Wide Association Studies datasets of the publicly gene databases.Serum 25(OH)D was taken as the exposure factor and TD as the outcome factor.The inverse variance weighted(IVW)method was used as the main analysis method for data analysis and visualization.Results Forward Mendelian randomization(MR)analysis included 75 25(OH)D SNPs.IVW results showed no statistically significant difference in the effect of serum 25(OH)D levels on TD.In the reverse MR analysis involving 5 TD SNPs,the IVW results indicated no statistically significant impact of TD on serum 25(OH)D levels.All auxiliary method results demonstrated no causal association between TD and serum 25(OH)D levels(P＞0.05).Conclusion Through the analysis of TSMR,the results showed that there was no direct causal relationship between serum 25(OH)D level and TD,and 25(OH)D may affect TD through indirect action.

Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

Objective:To study the correlation between the acute-phase characteristics of motor evoked potential (MEP) and severities of spinal cord injury in patients with acute cervical hyperextension injury and central cord syndrome (CCS).Methods:Retrospectively analyzed were the data of 45 patients with acute cervical hyperextension injury and CCS (observation group) who had been admitted to Department of Orthopedics, Tongji Hospital Affiliated to Tongji University from December 2018 to July 2021 and 20 healthy controls. Examination of transcranial magnetic stimulation-induced MEP was performed in patients with CCS and healthy controls using a magpro x100 magnetic stimulator, and recording was conducted in bilateral abductor pollicis brevis (APB). The characteristics of MEP waveform latency, amplitude and motor threshold were described and compared between the healthy control and observation groups; the correlations were analyzed between the MEP latency and the severity of spinal cord injury [American Spinal Injury Association (ASIA) total score and motor function of Upper Extremity Motor Subscores (UEMS)] in the observation group. According to different MEP-induced states, the patients in the observation group were divided into a resting group ( n=19), a facilitation group ( n=18), and a no-waveform group ( n=8). The severity of spinal cord injury (ASIA total score) and the functional independence of the spinal cord (SCIM-Ⅲ score) were compared among the 3 groups to analyze the correlation between the MEP-induced state and the severity of spinal cord injury (ASIA total score). Results:The observation group had a significantly longer MEP latency [(30.16±6.32) ms], a significantly smaller amplitude [(0.54±0.30) mV] and a significantly higher motor threshold [(65%±11%)] than the healthy control group (all P<0.05). The MEP latency in the observation group was significantly correlated with ASIA total score ( r=-0.730, P<0.001) and UEMS ( r=-0.740, P<0.001). The ASIA total score and SCIM-Ⅲ score were significantly different among the 3 groups ( P<0.05), and the MEP-induced state was significantly correlated with the severity of spinal cord injury (ASIA total score) ( r=0.668, P<0.001). Conclusions:In patients with acute cervical hyperextension injury and CCS, the MEP latency is prolonged, the amplitude lowered, and the motor threshold enhanced. The MEP latency is strongly correlated with the severity of spinal cord injury and upper limb motor function. The MEP-induced state is also closely related to the severity of spinal cord injury.

Objective To investigate the operating strategies and essentials of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with tubular channel (Spotlight) to treat single-level lumbar degenerative diseases. Methods From November 2013 to December 2015, 97 patients (47 males and 50 females) underwent single-level lumbar degenerative diseases fol-lowing MIS-TLIF with Spotlight were analyzed, whose age were from 35-82 years old with the average age of 57.6±12.3 years old. The preoperative diagnosis was lumbar spinal stenosis in 63 cases, lumbar spondylolisthesis in 25 cases, and lumbar instability in 9 cases. The affected level was L3,4 in 9 cases, L4,5 in 66 cases, and L5S1 in 22 cases. According to distinct clinical manifestations and radiological characteristics, different approaches of Spotlight channels were employed. Unilateral decompression via unilateral channel was performed in 52 cases, bilateral decompression via unilateral channel was performed in 22 cases, and bilateral decom-pression via bilateral channel was performed in 23 cases. Clinical outcomes included operation duration, surgical blood loss, post-operative drainage volume and complications was recorded. Average intervertebral height, lumbar and surgical Cobb angle were utilized to evaluate the reduction of intervertebral height and lumbar lordosis. The low back and leg pain were represented as Visu-al Analogue Scale (VAS) score. The preoperative and postoperative Oswestry Disability Index (ODI) score were recorded individu-ally to evaluate patients'functional recovery. Besides, the Bridwell criterion was introduced to define the extent of the lumbar fu-sion. The MacNab criterion was used for assessment of postoperative efficacy. Results The operation duration was 189.8 ± 41.3 min, the volume of surgical blood loss was 143.9 ± 102.0 ml and the volume of postoperative drainage 75.0 ± 59.0 ml in all cases. Among them, operation time was 165.0±24.2 min, surgical blood loss was 99.5±54.1 ml and postoperative drainage was 48.4±27.6 ml in the operation group of unilateral decompression via unilateral channel. The date in the group of Bilateral decompression via unilateral channel were 208.9 ± 46.0 min, 151.4 ± 96.3 ml, 88.0 ± 51.3 ml and in the group of bilateral decompression via bilateral channel were 225.4±32.0 min, 236.0±126.3 ml, 122.8±81.7 ml. All the patients were followed up for 16-42 months, the average follow-up time was 24.9 ± 7.0 months. Low back VAS reduced from 6.10 ± 0.84 preoperatively to 1.59 ± 0.49 at the final follow-up, leg VAS decreased from 6.56±0.85 preoperatively to 1.59±0.57 at the last follow-up, and ODI reduced from 59.36％±5.52％preop-eratively to 15.89％±2.90％at the final follow-up, compared with preoperative, the differences were significant. Average interverte-bral height improved from 9.92±2.25 mm preoperatively to 12.24±1.78 mm at latest follow-up time, which had statistically signifi-cant difference. Operative segment and lumbar Cobb angle were 13.81°±6.10° and 32.32°±11.97° preoperative, at the time of lat-est follow-up improved to 14.25° ± 5.57° and 35.83° ± 9.89° , Compared with preoperative, lumbar Cobb angle was significantly in-creased but operative segment Cobb had no significant difference. According to the criteria of Bridwell, intervertebral fusion at fi-nal follow-up of I and II grades were 90 cases in total (92.8％). The MacNab criteria was used to evaluate the clinical efficacy, which 69 were excellent, 23 were good, and 5 were acceptable, the excellent and good rate was 94.8％. Conclusion The tech-nique of MIS-TLIF with the tubular channel (Spotlight) is safe and efficient for the treatment of single segment lumbar degener-ative diseases. Different strategies can be selected by different preoperative clinical manifestations and radiological features.

Objective To explore the influence of homogeneity management on ICU nurses' clinical practice ability, job satisfaction and patient safety. Methods Shanghai Tenth People's Hospital implemented the homogeneity management from January 2016, through training, empowerment and optimization scheduling. A total of 30 ICU nurses were investigated for their clinical practice ability, job satisfaction and nursing adverse events. Data were collected from the results of Clinical Practice Ability Questionnaire and Job Satisfaction Questionnaire, and were used to analysis the differences before and after the homogeneity management. Results After the homogeneity management implementation the score of clinical practice ability of the ICU nurses raised to (84.77±3.80), which was (71.63±5.19) before,the difference was statistically significant (t=-11.181, P<0.01). The score of job satisfaction increased from (17.20±1.84) to (22.43±3.00), the difference was statistically significant (t=-8.454, P< 0.01). There were 2 cases of catheter slippage in 2016, and the incidence of nursing adverse events is 0.15% (2/1 300). Conclusions Homogeneity management can effectively improve the clinical practice ability and job satisfaction of nurses, reduce the incidence of nursing adverse events, and provide guarantee for the safety of patients.

Objective To assess the correlation of newly fracture and spinal sagittal parameters.Methods From March 2011 to December 2014,80 patients of osteoporosis vertebral compression fracture treated by PVP as observation group were studied.The whole-spine anteroposterior view and lateral view XRay Photographes of the patients were taken,the sagittal parameters such as Pelvic index (PI),sacral slope (SS),pelvic tilt (PT),thoracic kyphotic angle(TK),lumbar lordotic angle(LL),the C7/SFD ratio were recorded.The whole cases were divided into two groups according to the presence of new fracture or not after the last followup of one year,the index of two groups were compared,and the risk factors of newly vertebral compression fractures were analysed.Results There were no statistically significant difference in gender,age,body mass index,BMD,PI,TK,LL between the two trea ted groups (P＞0.05);there were statistically significant difference in SS,PT and the C7/SFD between the new vertebral fracture group and the control group (P＜0.05).The analytic results of Logistic regression model showed that the smaller SS,larger TK and C7/SFD were risk factors of newly vertebral compression fractures.Conclusion The newly occurred vertebral compression fractures,after the primary treatment of PVP,are associated with changed spinal sagittal parameters.

BACKGROUND:Sagittal imbalance induced by vertebral osteoporotic fractures has not been paid enough attention in previous studies.
OBJECTIVE:To assess the correlation of osteoporotic vertebral compression fracture and spinal sagittal imbalance.
METHODS:Sixty patients with old osteoporotic vertebral compression fracture, who were treated in the Department of Spine Surgery, the Affiliated Hospital of Chengde Medical Colege from February 2013 to August 2015, were enroled in this study as the observation group. Sixty healthy old people from physical examination center were enroled as the control group. The whole-spine anteroposterior and lateral X-ray films were taken in both groups. The number and the location of fractured vertebrae were recorded. Sagittal parameters of both groups including thoracic kyphotic angle, lumbar lordotic angle, T1-spinopelvic inclination angle and the C7plumb line/sacro-femoral distance (PL/SFD) ratio were measured and compared among groups. The observation group was dividedinto three subgroups according to the number of fractured vertebrae,i.e., single-vertebrae fracture subgroup, double-vertebrae fracture subgroup and above triple-vertebrae fracture subgroup. The C7PL/SFD ratio of the three subgroups was compared. The correlation between the number of fractured vertebrae and the C7PL/SFD ratio was analyzed.
RESULTS AND CONCLUSION:(1) The thoracic kyphotic angle of the observation group was bigger than that of the control group (P< 0.05). The lumbar lordotic angle of the observation group was smaler than that of the control group (P< 0.05). The absolute value of the T1-spinopelvic inclination angle of the observation group (-1.81±1.48)° was smaler than that of the control group (-3.35±1.22)° (P< 0.05). The C7PL/SFDratio of the observation group was significantly bigger than that of the control group (P< 0.05). (2) In the observation group, there were 4 cases of single-vertebrae fracture, 25 cases of double-vertebrae fracture and 31 cases of above triple-vertebrae fracture. Significant differences in the C7PL/SFD ratio were determined among subgroups (P< 0.05). The number of fractured vertebrae was positively correlated with the C7PL/SFD ratio; the correlation coefficient was 0.747. (3) Results indicated that osteoporotic vertebral compression fracture can change spinal local sagittal alignment. Multiple compression fractures of vertebrae can cause spinal sagittal imbalance. The gravity center of human body shifts forward. The number of fractured vertebrae was positively correlated with the range of shift forward.

BACKGROUND:Recent report addressing new vertebral fracture after vertebroplasty or bal oon kyphoplasty has increased gradual y. It remains controversial whether new vertebral fracture is induced by bone cement augmentation or osteoporosis.
OBJECTIVE:To observe new vertebral fracture after conservative treatment and bone cement augmentation for osteoporotic vertebral compression fractures, analyze the relationship between new vertebral fracture and spinal sagittal parameters, and explore the risk factors for new vertebral fracture.
METHODS:From June 2011 to December 2014, 160 patients with osteoporotic vertebral compression fractures in thoracic and lumbar vertebrae were selected from the Department of Spine Surgery, the Affiliated Hospital of Chengde Medical Col ege. According to therapeutic regimen, the patients were divided into two groups. The observation group (n=80) received vertebroplasty or kyphoplasty. The control group (n=80) underwent conservative treatment. At 1 day after surgery in the observation group and after walking in the control group, patients were subjected to anteroposterior and lateral X-ray in the entire length of the spine. Bone mineral density, number and location of new vertebral fractures and sagittal parameters during fol ow-up were recorded and compared between groups. After final fol ow-up, according to the appearance of new vertebral fracture, patients in both groups were assigned to two subgroups. The difference in above indicators was compared between the two subgroups. The relationship between new vertebral fracture and spinal sagittal parameters was analyzed.
RESULTS AND CONCLUSION:(1) There were no statistical y significant differences in gender, age, body mass index, bone mineral density, pelvic index, sacral slope, pelvic tilt, thoracic kyphotic angle, lumbar lordotic angle, C7/sacro-femoral distance ratio and occurrence rate of new fractures between the two treated groups (P>0.05). (2) There were no statistical y significant differences in gender, age, body mass index, pelvic index, and lumbar lordotic angle between new vertebral fracture group and non-fracture group. There were statistical y significant differences in bone mineral density, sacral slope, pelvic tilt, thoracic kyphotic angle and the C7/sacro-femoral distance between the new vertebral fracture group and the control group (P<0.05). (3) Results confirmed that new vertebral compression fractures after vertebroplasty, Kyphoplasty or conservative treatment for osteoporotic vertebral compression fractures were definitely associated with osteoporosis and spinal sagittal imbalance.

By introducing the stage management of ethics review for medical research protocols,this paper try to explain the submission requirement,the review procedures,the key points for focusing on,and analyze the issues found in ethical reviewing of research protocols,help to guide the procedures of ethical review,as well as improve the supervision of ethical review for research protocols.