Background: Sjögren's syndrome (SS) is a chronic autoimmune disease with lymphocytic exocrine gland infiltration causing dry mouth and eyes. The disease can develop alone (primary SS, PSS) or with other autoimmune diseases (secondary SS, SSS). PSS has been suggested to increase the acute pancreatitis risk. However, whether all patients with SS share this higher risk remains uncertain. This nationwide population-based cohort study aimed to detect associations between SS and acute pancreatitis. Methods: We identified 11,922 individuals with SS cohort and 47,688 individuals without SS (non-SS cohort) between 2000 and 2010 from the Taiwan National Health Insurance database. We matched the individuals between the SS and non-SS cohorts according to age, gender, and index year at a 1:4 ratio. We used a Cox multivariable proportional-hazards model to determine the effects of SS on the acute pancreatitis risk. Results: The SS cohort had a higher acute pancreatitis risk than the non-SS cohort after covariate adjustments (adjusted hazard ratio [HR], 3.374; 95% confidence interval [CI], 2.869–3.969). Patients with PSS exhibited a 2.872-fold risk (95% CI, 2.611–3.901) and patients with SSS a 4.121-fold risk (95% CI, 3.752–5.124) for acute pancreatitis. Our subgroup analyses revealed that patients with SS and systemic lupus erythematosus (adjusted HR, 3.85; 95% CI, 3.259–4.999), rheumatoid arthritis (adjusted HR, 4.298; 95% CI, 3.862–5.286), systemic sclerosis (adjusted HR, 2.765; 95% CI, 2.26–3.68), or polymyositis (adjusted HR, 2.641; 95% CI,1.847–3.101) and dermatomyositis (adjusted HR, 3.77; 95% CI, 2.894–4.502) had higher acute pancreatitis risk. Conclusions: Patients with SS presented increased acute pancreatitis risks than patients without SS, and patients with SSS had higher acute pancreatitis risks than patients with PSS. Physicians should be aware of this increased risk in patients with SS.

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Background: The spastic hemiparetic gait pattern is characterized by temporal and spatial asymmetries, which are resistant features to correction. More information about the effect of new therapeutic modalities on the hemiparetic gait pattern should be investigated and obtained. Aim: The purpose of this study was to investigate the effect of rhythmic auditory-cued gait training on spatiotemporal asymmetries of gait in hemiparetic children. Methods: A randomized controlled study was conducted on 30 spastic hemiparetic children (15 boys and 15 girls) in the age range of 6–10 years. They were randomly allocated in two equal groups. The investigator performed two-dimensional gait analysis for every child before and after the treatment program to assess the gait symmetry. Gait Symmetry Index (SI) was applied to investigate the spatiotemporal gait symmetry. The study group received rhythmic auditory-cued gait training in addition to traditional physical therapy program training, whereas the control group received the traditional physical therapy program training, three times/week for 4 months. Results: There was a statistically significant decrease in SI of step length, stride length, stance time, and swing time posttreatment in the study and control groups compared with that pretreatment (P > 0.01). Furthermore, comparison between the study and control groups posttreatment revealed a significant decrease in SI of step length, stride length, stance time, and swing time of the study group compared with that of the control group (P > 0.01) which indicate improvement of symmetry. Conclusions: Gait training using rhythmic auditory feedback is superior to conventional physical therapy training for improving the gait symmetry of children with spastic hemiparesis.

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Background: Asthma is the most common chronic disease in childhood. The increased prevalence of asthma has led to extensive research on its mechanism. Vitamin D is one of the factors believed to be effective in asthma. The present study was conducted to investigate the relationship between the frequency and severity of asthma attacks and Vitamin D levels in children. Methods: The study population consisted of children with asthma aged 5–12 years. Three-milliliter blood samples were taken from the patients and their serum Vitamin D levels were measured using electrochemiluminescence. Data were analyzed using descriptive statistics, including frequency distribution tables and mean and standard deviation. Results: Thirty children were enrolled in the study. None of the children had any history of Vitamin D supplementation. There were no differences between the children with mild and moderate asthma in terms of the demographic variables. There were no significant relationships between the severity of asthma and blood and biochemistry factors. Serum Vitamin D levels were 59.8 ng/ml in the patients with mild asthma and 42.8 ng/ml in those with moderate asthma (P < 0.05). Vitamin D levels had a negative correlation with the severity of asthma. Conclusions: The findings showed that lower levels of Vitamin D increase the severity of asthma. Vitamin D levels should, therefore, be consistently monitored in patients with asthma.

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The Ommaya device is commonly used during intraventricular therapy. However, the superiority of intraventricular or intralumbar therapies for intrathecal administration is disputable. Here, we report the case of a 63-year-old woman who received intraventricular chemotherapy for breast cancer with progression and leptomeningeal metastases. We describe external ventricular port device implantation to establish a modified intraventricular route to replace the traditional Ommaya device.

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Most patients with partial intestinal obstruction can be managed without surgical intervention. Here, we report the case of a patient who presented with partial intestinal obstruction. He had been diagnosed with high-grade urothelial cell carcinoma (UCC) 1.5 years previously, for which the surgery and adjuvant chemotherapy had been successfully performed. He showed a poor response to medical treatment for the partial intestinal obstruction, and surgery provided only a short-term benefit. Such cases of intractable small-bowel obstruction are infrequent and pose a challenge to clinicians. Although very rare, the possibility of UCC metastasis to the gastrointestinal tract should be considered in the differential diagnosis of refractory intestinal obstruction and history of UCC.

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Paraneoplastic leukemoid reaction (PLR) is exceedingly uncommon syndrome in oral cancer and has implicated a worse outcome. This report describes a case of buccal mucosa cancer encountered PLR syndrome during the course of tumor progression. We conduct a literature review to highlight the relationship between PLR and the outcome in oral cancer. PLR is associated with rapid tumor growth and worse outcome in head-and-neck cancer.

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Background: The real-time image-guided system can aid us in localization for complex neurological diseases. Aim: The study aimed to survey the advantages and novel techniques of hybrid surgery in pediatric neurosurgery. Methods: Study design involves a retrospective cohort study. At our hybrid operation room (OR), 10 children at the ages from 16 months to 17 years underwent brain or spine surgery. Eight of them received procedures assisted with real-time images of flat-panel detector (FD)-based computed tomography, DynaCT: three patients underwent cerebrospinal fluid diversions, three frameless stereotactic aspirations (brain abscess 2, intracerebral hemorrhage 1), one frameless stereotactic skull and sinus biopsy, and one spine and neck surgery. Two of them received intraoperative digital subtraction angiography and three-dimensional rotational angiography (3D-RA) for arteriovenous malformation surgery. Results: All of our patients tolerated the whole procedures well. Frameless stereotactic aspiration with navigation was performed for one patient with brain abscess first, but the abscess progressed with mass effect later. The child underwent frameless stereotactic aspirations at the hybrid OR and recovered well within 2 weeks. One patient having neck and high cervical spinal lipoblastoma with the presentation of stridor received surgeries twice before. The patient was quite well without airway compression after tumor resection as maximal as possible with safety at the hybrid OR. Conclusions: For the treatment of complex neurological diseases in children, hybrid surgeries can be considered to be feasible, good alternative, or salvage surgical procedures.

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A-12-year old girl presented with acute exacerbation of mild upper abdominal pain and nausea associated with weight loss. Subsequent work up revealed raised serum lipase and a bulky (7.8 cm x 4.9 cm x 2 cm) mass involving the head of the pancreas with areas of necrosis and cystic degeneration and peripheral rim enhancement, without any calcification. MPD was dilated (6mm). The cyst fluid had normal amylase, CA 19-9 level, CEA levels, and cytology revealed atypical epithelial cells. Patient underwent an uneventful pancreaticoduodenectomy. Subsequent histopathology revealed solid pseudopapillary tumor of the pancreas of low-grade malignancy.

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