China Initiative for Multi-Domain Intervention (CHINA-IN-MUDI) to Prevent Cognitive Decline: Study Design and Progress.

BACKGROUND: Alzheimer's disease (AD), the most common type of irreversible dementia, is predicted to affect 152 million people by 2050. Evidence from large-scale preventive randomized controlled trials (RCTs) on modifiable risk variables in Europe has shown that multi-domain lifestyle treatments for older persons at high risk of dementia may be practical and effective. Given the substantial differences between the Chinese and European populations in terms of demographics and living conditions, direct adoption of the European program in China remains unfeasible. Although a RCT has been conducted in China previously, its participants were mainly from rural areas in northern China and, thus, are not representative of the entire nation.There is an urgent need to establish cohorts that represent different economic, cultural, and geographical situations in order to explore implementation strategies and evaluate the effects of early multi-domain interventions more comprehensively and accurately. MEDTODS: We developed an integrated intervention procedure implemented in urban neighborhood settings, namely China Initiative for Multi-Domain Intervention (CHINA-IN-MUDI). CHINA-IN-MUDI is a 2-year multicenter open-label cluster-randomised controlled trial centered around a Chinese-style multi-domain intervention to prevent cognitive decline. Participants aged 60-80 years were recruited from a nationally representative study, i.e. China Healthy Aging and Dementia Study cohort. An external harmonization process was carried out to preserve the original FINGER design. Subsequently, we standardized a series of Chinese-style intervention programs to align with cultural and socioeconomic status. Additionally, we expanded the secondary outcome list to include genomic and proteomic analyses. To enhance adherence and facilitate implementation, we leveraged an e-health application. RESULTS: Screening commenced in July 2022. Currently, 1,965 participants have been randomized into lifestyle intervention (n = 772) and control groups (n = 1,193). Both the intervention and control groups exhibited similar baseline characteristics. Several lifestyle and vascular risk factors were present, indicating a potential window of opportunity for intervention. The intervention will be completed by 2025. CONCLUSIONS: This project will contribute to the evaluation of the effectiveness and safety of intervention strategies in controlling AD risk and reducing clinical events, providing a basis for public health decision-making in China.

[LncRNA SNHG11 promotes malignant progression of colorectal cancer cells through the PI3K/Akt/mTOR signaling pathway].

Objective: To investigate the effects of lncRNA SNHG11 on proliferation, migration, invasion and apoptosis of colorectal cancer cancer cells and possible mechanisms. Methods: qRT-PCR was performed to detect the expression level of lncRNA SNHG11 in colorectal cancer tissues and its related cell lines. The correlation between SNHG11 expression and clinical prognosis of patients was assessed by bioinformatics techniques. Cultured CRC cell lines were transfected with shCtrl (shCtrl group), shSNHG11#1 (shSNHG11#1 group), shSNHG11#2 (shSNHG11#2 group), Control cDNA (Control cDNA group), and SNHG11 cDNA (SNHG11 cDNA), respectively. Thiazolyl blue (MTT), clone formation assay, Transwell assay, cell scratch assay, and flow cytometry were used to detect the proliferation, migration, invasion, and apoptosis of CRC cells in each group. Western protein blotting was used to detect the expression of relevant proteins in each group, and the effect of lncRNA SNHG11 knockdown on the growth of tumour cells in vivo was analysed by nude mice tumouring assay. Phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signalling pathway inhibitor LY294002 was used for rescue experiments. Results: The expression of lncRNA SNHG11 was significantly higher in colorectal cancer cells and tissues than in normal tissues (P<0.05). Survival analysis showed that the expression level of SNHG11 was not statistically associated with CRC survival (P>0.05). shSNHG11#2 group compared with shCtrl group. MTT OD490/570 values decreased, the number of CRC cell clones decreased, the number of Transwell cells decreased, the area of cell scratch decreased, and the apoptosis rate increased (P<0.05). The mesenchymal markers matrix metalloproteinase (MMP9), N-cadherin and vimentin were significantly reduced, and the expression of the epithelial marker E-cadherin was upregulated. The expression of anti-apoptotic proteins Bcl-2 and Bcl-xl was decreased, and the expression of pro-apoptotic protein Bax was increased (P<0.05).In vivo experiments showed that lncRNA SNHG11 knockdown inhibited the growth of colorectal cancer cells, and the expression of Ki67 was reduced in tumours (P<0.05). LncRNA SNHG11 knockdown inhibited the expression of p-PI3K, p-Akt and p-mTOR.The PI3K/Akt/mTOR signaling pathway inhibitor LY294002 was able to restore the malignant cytological progression of colorectal cancer cells induced by the overexpression of lncRNA SNHG11. Conclusions: LncRNA SNHG11 is highly expressed in colorectal cancer. lncRNA SNHG11 can promote the malignant progression of colorectal cancer cells by regulating the PI3K/Akt/mTOR signaling pathway, and this finding provides a new theoretical basis for targeted therapy of colorectal cancer.

[Study the involvement of Langerin in mediating epicutaneous sensitization of atopic dermatitis-like mouse model].

Objective: To explore the role of Langerin in mediating epicutaneous sensitization of atopic dermatitis (AD) in mouse model. Methods: Mice were topically treated with calcipotriol (MC903) plus ovalbumin (OVA) on the ears to establish AD mouse models, and mice were divided into wild-type control group, wild-type AD group, Langerin knockout control group, and Langerin knockout AD group. Changes of lesion were daily observed. Infiltration of inflammatory cells, mRNA expression of Tslp, Il4, Il13, Il17a, and Il22, levels of serum total IgE, OVA-specific IgE (sIgE), OVA sIgG1 and OVA sIgG2a, proportion of regulatory T (Treg) cells in cervical draining lymph nodes were evaluated at the end of model preparation. Results: Skin tumidness and thickness, dermal inflammatory cells infiltration, the mRNA expression levels of Tslp, Il4, Il13, Il17a and Il22 in wild-type AD groups were higher than those in wild-type control groups, with (1.80±0.66, 1.64±0.25, 1.71±0.54, 2.41±0.23, 2.49±0.32) and (0.53±0.45, 0.85±0.29, 0.73±0.50, 0.72±0.25, 0.56±0.29), respectively (all P<0.05). In addition, the levels of serum total IgE, OVA sIgE and OVA sIgG1 in wild-type AD groups were higher than those in wild-type control groups, with [(1 216.00±572.70) ng/ml, (597.00±538.30) ng/ml, 1.59±0.09] and [(24.22±35.04) ng/ml, (20.01±41.71) ng/ml, 1.16±0.03], respectively (all P<0.05). In Langerin knockout mice, compared to wild-type mice, skin erythema, skin tumidness, epidermal thickening, inflammatory cell infiltration were more obvious; the mRNA expression levels of Tslp, Il4, Il13, Il17a and Il22 were upregulated with (8.19±6.44, 2.53±0.69, 2.82±0.73, 3.94±1.32, 3.80±1.43) (all P<0.05); the levels of serum total IgE, OVA sIgE and OVA sIgG1 were significantly increased with (2 508.00±657.10) ng/ml, (1 808.00±470.70) ng/ml, (1.73±0.09) (all P<0.05); the number of CD4+CD25+CD127-Treg cells were decreased significantly with (13.25±0.96)% and (15.31±1.47)%, respectively (P<0.05). Conclusion: Langerin is involved in mediating epicutaneous sensitization of the AD mouse model and plays a negative immunoregulatory role.

[An historical study of Hua Tuo Temples in Henan province].

Hua Tuo was a medical figure renowned for his legendary magic medical skills in the late Eastern Han Dynasty. He has been honored in history by temples or shrines built in memory of him. Based on the local records and historical books in Henan Province, Hua Tuo temples and shrines in this area were examined. A total of twelve temples or shrines were built in nine counties or cities in Henan province. They were mainly distributed in the counties of Shangqiu, Zhoukou and Xinyang along the Huai River, and were close to the hometown of Hua Tuo. Most of them were built in the Ming and Qing Dynasties. They were named as Huatuo Temple, Medical Ancestor Huatuo Temple, Medical Ancestor Hua Gong Temple, Hua Zu Temple and Divine Doctor Huatuo Ancestral Temple.

[Role of brain and muscle ARNT-like protein 1 in the rat periodontitis-induced liver injury model].

Objective: Brain and muscle ARNT-like protein 1 (BMAL1) is a core component of hepatocyte molecular clock and plays an important role in the regulation of other related rhythmic genes in the body through a transcriptional-translational feedback loop in molecular circadian oscillations. Therefore, the aim of this study was to investigate the role of BMAL1 in the rat periodontitis-induced liver injury. Methods: Twelve male Wistar rats were divided into the control group and the periodontitis group according to the random number table method. The rats in the control group were untreated. The periodontitis models were established by ligating the necks of the bilateral maxillary first molars in the periodontitis group rats. After 8 weeks, periodontal clinical indexes of rats in both groups were examined and executed. Micro-CT scans of the maxilla were performed and levels of the alveolar bone resorption were analyzed. Pathological changes in periodontal and liver tissue of rats in two groups were detected by HE and oil red O staining. Biochemical kits were used to detect glutamic-oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), total cholesterol (TC) and triglycerides (TG) in serum. The gene and protein expression levels of BMAL1, nuclear factor kappa-B (NF-κB) and tumor necrosis factor-α (TNF-α) in liver tissue were measured by real time fluorescent quantitative-PCR (qRT-PCR), immunohistochemistry (IHC) and Western blotting (WB) assays. Apoptosis was detected in liver tissues by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) kit staining. Results: The results of HE staining of maxillary first molars and micro-CT results of maxillary bones showed that alveolar bone resorption was significant in the periodontitis group of rats. The liver histopathology results showed infiltrated inflammatory cells in the liver tissue, disorganized liver cords and a large number of lipid droplets formed in the hepatocytes of the periodontitis group compared with the control group. The results of serum biochemical assay showed that the levels of GOT [(62.77±2.59) U/L], GPT [(47.54±1.04) U/L], TC [(3.19±0.23) mmol/L] and TG [(1.11±0.09) mmol/L] in the serum of rats with periodontitis were significantly higher than that in the control group respectively [GOT: (38.66±2.47) U/L, GPT: (31.48±1.57) U/L, TC: (1.60±0.05) mmol/L and TG: (0.61±0.09) mmol/L](P=0.003, P=0.001, P=0.002, P=0.038). qRT-PCR results showed that the mRNA expression level of BMAL1 was significantly decreased in liver tissue of the periodontitis group [(0.60±0.04)%] compared to the control group [(1.01±0.07)%] (t=4.80, P=0.009), while the mRNA expression levels of NF-κB and TNF-α [(1.62±0.12)%, (2.69±0.16)%] were significantly increased compared to the control group [(1.00±0.03)%, (1.03±0.16)%] (P=0.008, P=0.002); IHC results showed that the protein expression level of BMAL1 in liver tissue of the periodontitis group (averaged optical density, AOD) (11.58±2.15) was down-regulated compared to the control group (AOD) (22.66±1.67) (P=0.015), while NF-κB and TNF-α (AOD) (31.77±2.69, 24.31±2.32) were up-regulated compared to the control group (AOD) (19.40±1.82, 11.92±0.94) (P=0.019, P=0.008). WB results showed that the protein expression level of BMAL1 in liver tissue was down-regulated in the periodontitis group [(0.63±0.10)%] compared to the control group [(1.00±0.06)%] (t=3.19, P=0.033), while NF-κB and TNF-α [(1.61±0.12)%, (2.82±0.23)%] were up-regulated compared to the control group [(1.00±0.12)%, (1.00±0.11)%] (P=0.022, P=0.002). TUNEL staining showed increased apoptotic cells in the liver tissue of the periodontitis group of rats compared to the control group. Conclusions: Periodontitis may induce liver injury by down-regulating the BMAL1 expression levels in liver tissue, which in turn activates NF-κB signaling molecules, leading to the elevated levels of inflammation and apoptosis in rat liver.

[Wan's gynecology and obstetrics (Wan Shi Nv Ke) collected by the library of China Academy of Chinese Medical Sciences].

Wan's gynecology and obstetrics (Wan Shi Nv Ke), collected by the library of China Academy of Chinese Medical Sciences, was examined with the field method. It was found some issues existed both in the recording and description of Wan's gynecology and obstetrics (Wan Shi Nv Ke) collected by the library of China Academy of Chinese Medical Sciences in the electronic catalogue of ancient books and in the General catalogue of ancient books of traditional Chinese Medicine (Zhong Guo Zhong Yi Gu Ji Zong Mu), in terms of the same version with different registration, wrong publication time, some contents missed in publication, and the version actually not collected.

Angular dependence of spin-flop transition in triangular lattice antiferromagnet Cu2(OH)3Br.

We report angular dependence of spin-flop transition in triangular lattice antiferromagnet Cu2(OH)3Br by angle-dependent magnetization and ESR measurements. The results show that the antiferromagnetic easy magnetization axis is the diagonal direction (θ= 45°) of theac*plane, i.e., the orientation of Cu1 spins based on the magnetic structure (2020Phys. Rev. Lett.125037204), whereas the spin-flop axis is thebaxis. A phenomenological model is proposed to describe the angle-dependent spin-flop transitions. Based on this model, Cu1 spins are sensitive to external magnetic field, while Cu2 spins are robust against to the field, showing partial decoupling. The model is expected to be used in other uniaxial antiferromagnets with a more general easy axis and complex spin-flop transitions.

Prognostic significance of lymph node ratio in patients with squamous cell carcinoma of the floor of the mouth.

The lymph node ratio (LNR) has been proposed as an independent prognostic factor for survival in patients with oral squamous cell carcinoma (OSCC). However, little attention has been paid to its role in the specific subsite of the floor of the mouth (FOM). The purpose of this study was to evaluate the prognostic significance of the LNR in patients with FOM SCC. A retrospective analysis of 92 patients with FOM SCC who were treated with primary curative resection and neck dissection was conducted. Overall survival (OS) and disease-free survival (DFS) were used to evaluate the prognostic significance of the LNR. Both of these parameters were significantly worse (P < 0.001) in patients with neck metastases. The mean LNR was 0.145 in patients with positive lymph nodes. A LNR <0.145 was predictive of longer DFS, while the receiver operating characteristic curve analysis demonstrated that a LNR ≥0.175 indicated a significantly lower OS. This study confirms that metastatic cervical lymph nodes correlate with an adverse prognosis in patients with FOM SCC, and specifically, a LNR ≥0.145 is predictive. Therefore, the LNR in patients with FOM SCC may be a predictor of survival in these patients.

[An interview with YU Ying-ao-a scholar in clinical literature].

Professor Ying-ao YU came from a family with medical background and studied under the guidance of Bo-wei QIN. He graduated from Shanghai Second Medical College. He also was a graduate of the first session of the Integrated Medicine in China. After that, he was assigned to the editorial office of the Academy of Chinese Medicine, engaging in the study of clinical literature of traditional Chinese medicine(TCM). With National Medical Master Zhi-zheng LU, he went to Baotou Steel Staff Hospital in Inner Mongolia to implement TCM training. He has devoted himself to research of TCM clinical literature and his clinical practice for more than 60 years. Based on this work, he developed his own clinical diagnosis and treatment model entitled Differentiation of Diseases, Differentiation of Symptoms and Signs-General Therapy-Treatment through Prescription-Treatment through Clinical Symptoms and Signs. This model makes an outstanding contribution to clinical TCM and clinical literature research. The author interviewed Professor YU systematically in terms of his experiences in TCM clinically and his cultural heritage in TCM clinical philology to share with readers.

[Application of endobronchial ultrasound in children: an analysis of 4 cases].

Objective: To investigate the feasibility, clinical efficacy and safety of endobronchial ultasound (EBUS) in children. Methods: The radiological features, EBUS images, pathological results and intraoperative and postoperative complications of 3 cases who underwent EBUS examination and 1 case who underwent EBUS guided transbronchial needle aspiration (EBUS-TBNA) were retrospectively analyzed. Results: Among the 4 cases, 2 were males and 2 were females, with the onset age of 7.4-9.2 years. The child who underwent successful EBUS-TBNA was presented with fever and diagnosed with mediastinal lymphadenopathy before the operation, and the postoperative pathology indicated histiocytic necrotic lymphadenitis (HNL). The other 3 children diagnosed with primary airway tumors, whose pre-operative CT imaging found no infiltration in extra-bronchial structures, had the masses resected through EBUS. According to postoperative pathological findings, two were diagnosed with mucoepidermoid carcinoma and one with bronchial leiomyoma. The lesions were located at the opening of the right main bronchus in 1 case and at the main airway in 2 cases. EBUS showed abnormal echogenicity of the tracheal wall in the 3 cases, including hyperechoic area in the water capsule and mucous layer, relatively hypoechoic area in the submucosal smooth muscle layer, hyperechoic area in the inner cartilage layer, hypoechoic in the cartilage layer and hyperechoic in the outer cartilage layer. In one case, structural disorder of the submucosal smooth muscle layer and partial disruption of the cartilage layer of the tracheal wall were found at the lesion site, while the other 2 cases had intact tracheal wall structure. There were no postoperative complications such as pneumothorax or hemoptysis in the 4 children. Conclusion: EBUS is a safe and feasible technique for evaluating mediastinal lymph node enlargement and the degree of airway wall infiltration in primary airway tumor.

Effect of adjunct thoracoplasty on Adolescent Idiopathic Scoliosis patients' 3D back contour.

The aims of this study were to evaluate the effect of a thoracoplasty procedure in addition to a posterior spinal fusion and instrumentation on an Adolescent Idiopathic Scoliosis (AIS) patient's 3D back contour as measured by surface topography. We performed a retrospective review to identify patients who were treated with posterior spinal fusion with spinal instrumentation and those who were treated with an additional thoracoplasty procedure. We analyzed changes in surface topography measurements between these two groups using t-test and ANCOVA statistical analyses. Although there were no statistically significant differences in 11 of 12 variables, thoracoplasty-posterior spinal fusion (n=10) group had a mean 6.6 unit reduction in trunk asymmetry while the posterior spinal fusion group (n=26) had a mean 22.8 unit reduction in trunk asymmetry (p-value<0.05). The posterior spinal fusion group and thoracoplasty-posterior spinal fusion group were not shown to have clinically significant differences in 3D back contour correction. An additional thoracoplasty procedure does not provide better correction in the transverse plane and in fact had a smaller degree of trunk asymmetry correction. This supports the current trends of decreasing use of thoracoplasty in AIS patients to address severe rib hump deformities given concerns for decreased post-operative lung function and alternative methods of vertebral body derotation, such as thoracic pedicle screws.

Eliminating 2D spinal assessments and embracing 3D and 4D: clinical application of surface topography.

The Adams Forward Bend Test recognizes the rotational aspect of the curve with the spine in flexion, and the AP X-ray measures the coronal plane deviation by using the Cobb Angle. However, modern techniques including CT-scan, biplanar radiograph, ultrasound, and surface topography allow the clinician to better evaluate and visualize the true 3-D nature of the spine. Surface Topography imaging uses the surface of the trunk to estimate the spine position using a mathematical algorithm that has been found to be accurate when compared to the radiologic Cobb Angle. The sagittal balance of the spine measured by surface topography is compared in three different situations, namely, "standing up straight," "standing relaxed," and "walking," which will help to best assess posture and risk of proximal junctional kyphosis before and after the treatment. Coronal imbalance (lateral deviation) and a range of maximal vertebral surface rotation (amplitude in either direction) are considered as the parameters with an excellent to good reproducibility. COP displacement or symmetry from the midline is used to measure the stability of the trunk. Therefore, those selected spine shape parameters and COP deviation would be considered as the best descriptors in the assessment of postural sway and outcome of PSSE in children with AIS.

Impact of corset bracing on 3D spine kinematics during ADL in children with Spondylolysis.

Spondylolysis is a stress fracture of the vertebral pars interarticularis that frequently affects adolescents involved in sports. Conservative bracing methods may assist the clinician in treating spondylolysis, though there is a need to further validate these techniques. The goal of this study was to evaluate differences in the 3D movements of the thoracic and lumbar spine before and after bracing. Five patients (mean age 14.4 ± 1.3 years) with spondylogenic back pain were evaluated for kinematic measurements using a Vicon motion capture system. Patients performed activities both with and without a lumbar corset brace including walking, kneeling, standing from a chair, standing from the floor, ascending and descending stairs, and lifting. Patients were evaluated for differences in thoracic and lumbar range of motion (ROM) in the braced and unbraced condition. While wearing the brace, patients demonstrated reduced extension ROM of the thoracic spine while walking (mean reduction = 0.4°), ascending stairs (3.0°), descending stairs (2.1°), lifting (14.8°), standing from a chair (4.1°), standing from the floor (16.7°), and kneeling (8.4°). Patients also exhibited reduced extension ROM of the total lumbar spine while ascending stairs (mean reduction = 1.8°), lifting (12.7°), standing from a chair (9.5°), standing from the floor (11.8°), and kneeling (4.7°). These results provide evidence that bracing reduces stress on the pars interarticularis and relieves symptoms in the athlete with spondylogenic back pain, thereby facilitating a return to sports.

Effect of PSSE on postural sway in AIS using center of pressure.

We haven't known whether the center of pressure (COP) could be considered as a better indicator in the evaluation of posture and balance change after the physiotherapeutic scoliosis specific exercise (PSSE) during level walking. The objective of this study was: 1) to determine changes in COP displacement in anterior-posterior (COP-AP) and medial-lateral (COP-ML) for AIS following the PSSE; 2) to find out COP oscillation(COP-OS) from the midline for the left and right foot; 3) to investigate max pressure at the forefoot, midfoot and hindfoot bilaterally. AIS patients with three reflective markers on their back walked on the pressure sensors embedded treadmill at 2 km/h and their trunks were also registered by DIERS Formetric 4D system. Each child received the PSSE for 12 weeks by the same physical therapist and had a dynamic pressure analysis before and after the PSSE. Six AIS children at a mean age of 13 years and with averaged major Cobb angle of 26° were enrolled. There was an increase in COP-AP (15%) and a decrease in the COP-ML (-25%) following the PSSE. COP-OS on the left foot shifted farther away from the midline (about 16%) as the right side moved closer (-1%), which becomes more symmetrical (Pre-PSSE: 0.86mm & Post-PSSE: 0.32mm). There were increased pressures on the left (35%) and right (26%) hallux after PSSE. Pressure metrics, especially including COP-ML, COP-AP, COP-OS, and peak pressures on the forefoot, may be opted as optimal predictors to posture improvements by the means of PSSE.

Comparison of two types of casting in early-onset scoliosis.

Early-onset scoliosis (EOS) can be a progressive and debilitating condition if left untreated. Different casting techniques have fallen in and out of favor over the years for conservative management. Two types of casting, elongation-derotation-flexion (EDF) and body casting (BC) are employed at our institution. Here we compare the radiographic outcomes between these two types of casting in a cohort of patients diagnosed with EOS. Sixteen children with EOS were treated by EDF serial casting while seventeen children with the same diagnosis were treated by BC. Radiographic measurements included Cobb angle, rib-vertebral-angle difference (RVAD) and vertebral rotation (VR) by Nash-Moe method in casting (IC) or out of casting (OOC), thoracic height (TH) and width (TW). All of the patients had x-ray measurements at pre-casting OOC, 1st IC and final post-casting OOC. Casts were changed every 2-4 months. Independent two sample t-test, Wilcoxon rank-sum test, and Chi-square test were performed. There were no significant differences at the initial treatment for age, classification of EOS, OOC, RVAD, VR, kyphosis, TH, and TW between EDF and BC casting. There were no significant differences of changes for OOC, RVAD, VR, kyphosis, TH and TW from pre-casting to the final post-casting status between two casting techniques (P>0.05). However, children with EDF tended to receive 3 to 4 more castings than those with BC (7.5 vs.4 casts) (P=0.007) and achieved better outcomes in success (25% vs.20%) and improvement (50% vs.10%) (P=0.03). EDF has better outcomes with EOS improvement when there is treatment of longer duration.

Follow-up of an Elongation Bending Derotation Brace in the treatment of infantile scoliosis.

Since 2013, an elongation bending derotation brace (EBDB) has been developed and applied to EOS in our institution. The goals of the study were: 1) to compare radiographic changes before the use of EBDB (Pre-B), in brace (IB), and after the use of EBDB (Post-B) in a minimal two year follow-up; 2) to determine the compliance with the EBDB. Thirteen children diagnosed with an infantile scoliosis (IS) were retrospectively recruited. Under general anesthesia in the OR, child was placed on a Spica casting table, and the spine was manipulated by stockinet straps. Then 3D child's torso was scanned, the EBDB was designed and manufactured for exact fitting to the torso in the corrected position using CAD/CAM technology.1 Mean age at start of EBDB was 2 years and 6 months. Average follow-up was 36 months. Compliance showed a mean 19 hours per day (14 to 23 hours). Pre-treatment Cobb angle was 40°, in brace 22°, and out of brace 28° (p<0.05). Axial vertebral rotation (AVR) by Nash-Moe method improved from 30% before treatment to 21% in brace and 19% at the end of visit (p<0.05). Kyphosis was significantly increased from 16° (Pre-B) to 32° (Post-B) (P<0.05). However, there was reduction of Rib-vertebral angle difference (RVAD) from 23° (Pre-B) to 11° (Post-B) (P>0.05). A cascade of EBDB effectively corrects and stabilizes the 3D spinal deformities in infantile. Thus the EBDB is considered as a successful modality in the treatment of IS children.

Boston vs. Providence brace in treatment of Adolescent Idiopathic Scoliosis.

Adolescent idiopathic scoliosis (AIS) is a complex condition characterized by a lateral curvature and axial rotational deformity of the spine. Though bracing is effective, a need remains to identify the effect brace type has on spine curvature. To examine differences in patient demographics between the Boston and Providence brace, determine the corrective change in Cobb angle and RVAD and investigate the effect of brace type on curvature over time. A retrospective chart review was conducted of 105 patients diagnosed with AIS from 2013-2016 at CHW. Five spinal parameters were measured: Cobb angle, Risser, RVAD, kyphosis and lordosis. Data was collected before bracing, in-brace and at 24 months. A final treatment outcome of either Cobb angle correction (reduction >5°), stabilization (change ±5°) or progression (deterioration >5°) was then evaluated. Providence brace provided significantly greater in-brace thoracolumbar Cobb angle and RVAD reduction in comparison to the Boston brace (Cobb angle -21.9° vs. -12.5°; RVAD: -1.8° vs. 1.62°). Similarly, Providence users had a significantly smaller increase in Cobb angle and RVAD over time (Cobb angle: thoracic 14.2° vs. 15.0°; thoracolumbar 23.6° vs. 26.0°; RVAD: 5.2° vs. 8.5°). Ultimately, no significant difference in final treatment outcome was established between brace groups. Although the Providence brace provides less of an increase in thoracic and thoracolumbar curvatures over time, both braces are an effective treatment and achieve comparable outcomes. Selection of braces may vary with primary curve angle, curve location, patient compliance and quality of life.

Development of orthosis following EDF serial casting for infantile scoliosis.

Elongation-de-rotation-flexion (EDF) casting is a popular treatment for early-onset-scoliosis (EOS). However, casting every 2 to 3 months using general anesthesia may affect cognitive function.[1,2] Aims of this study: 1) to develop a new orthosis for EOS treatment based on EDF technique (EDFO) and traction frame; 2) to evaluate emerging radiographic results from treatment. Mehta's EDF serial casting method and AMIL traction frame were used to manually correct the spine for 3D trunk scan. Afterward, a digital spinal model was created and helped design the EDFO with CAD/CAM technology. Radiographic measurements included Cobb angle, RVAD, and thoracic height and width. Six patients (2 girls; 4 boys) diagnosed with idiopathic EOS were enrolled in the study. EDFO was applied at mean 36.5 months of age, after final EDF casting. The average major Cobb angle stabilized after treatment. Average RVAD increased. The average normalized thoracic width at last EDFO out-of-brace was less than prior to EDFO. The new asymmetric EDFO offers an alternative to serial casting and TLSO. EDFO is considered a cost-effective, safer, more breathable, removable, and less invasive modality.