Objective To analyze the causal relationship between gut microbiota and childhood asthma based on Mendelian randomization (MR). Methods The human gut microbiota dataset was downloaded from the MiBioGen database, and 196 known bacterial groups (9 phyla, 16 classes, 20 orders, 32 families, and 119 genera) were retained as exposure factors. Single nucleotide polymorphisms (SNPs) that were strongly correlated with exposure factors and independent of each other were selected as effective instrumental variables. A childhood asthma dataset with 3 025 patients and 135 449 controls was downloaded from the genome-wide association studies database as the outcome variable. Two-sample MR analysis was performed using inverse variance weighted, weighted median, MR-Egger, weighted model and simple model methods, respectively. The causal association between gut microbiota and childhood asthma was evaluated by odds ratio (OR). Sensitivity analysis was performed by leave-one-out method. Horizontal pleiotropy was tested by MR-Egger intercept test and MR-PRESSO global test, and Cochran’s Q test was used for heterogeneity. Results A total of 15 out of 196 gut microbiota groups were found to have a causal association (P<0.05) with the risk of childhood asthma, with a total of 181 SNPs included in the analysis. Inverse variance weighted analysis showed that Mollicutes [OR=1.42, 95% confidence interval (CI) (1.10, 1.83), P=0.007], Escherichia-Shigella [OR=1.39, 95%CI (1.02, 1.90), P=0.036], Oxalobacter [OR=1.30, 95%CI (1.10, 1.54), P=0.002], Ruminococcaceae UCG-009 [OR=1.34, 95%CI (1.09, 1.64), P=0.006] and Tenericutes [OR=1.42, 95%CI (1.10, 1.83), P=0.007] were significantly positively correlated with childhood asthma. Actinobacteria [OR=0.76, 95%CI (0.58, 0.99), P=0.042], Bifidobacteriaceae [OR=0.76, 95%CI (0.58, 0.98), P=0.035], Eubacterium nodatum group [OR=0.81, 95%CI (0.70, 0.94), P=0.007], Bifidobacterales [OR=0.76, 95%CI (0.58, 0.98), P=0.035] and Actinobacteria [OR=0.74, 95%CI (0.56, 0.99), P=0.040] were negatively correlated with childhood asthma. In addition, the results of leave-one-out sensitivity analysis were stable, MR-Egger intercept test and MR-PRESSO global test showed no horizontal pleiotropy, and Cochran’s Q test showed no heterogeneity. Conclusions There is a causal relationship between gut microbiota and childhood asthma. Mollicutes, Escherichia-Shigella, Oxalobacter, Ruminococcaceae UCG-009 and Tenericutes may increase the risk of childhood asthma. Actinobacteria, Bifidobacteriaceae, Eubacterium nodatum group, Bifidobacterales and Actinobacteria can reduce the risk of childhood asthma.
ObjectiveTo evaluate the effectiveness of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in pubic branch fractures.MethodsThe clinical data of 42 patients with pubic branch fractures treated by hollow screw fixation between March 2008 and March 2019 were analyzed retrospectively. According to the operation method, they were divided into the traditional operation group (20 cases in group A, fixed with traditional retrograde pubic screws) and the modified operation group (22 cases in group B, fixed with percutaneous retrograde pubic screws assisted by hollow pedicle opener). There was no significant difference (P>0.05) between the two groups in terms of gender, age, cause of injury, fracture classification, comorbidity, and time from injury to operation. The operation time, blood loss, incision length, screw length, and complications were recorded and compared between the two groups. The fracture reduction was evaluated according to Matta standard on the next day after operation, and the function was evaluated by Majeed score at 12 months after operation.ResultsThe operation was successfully completed in both groups. The operation time, blood loss, and incision length of group B were significantly less than those of group A (P<0.05); there was no significant difference in screw length between the two groups (t=0.793, P=0.437). All patients were followed up 8-24 months, with an average of 16.8 months. There was no complication in the two groups, such as injury of blood vessels and nerves, fracture of internal fixation, screw entering into joint cavity, and nonunion of fracture. There was no significant difference in the fracture healing time between the two groups (t=−1.068, P=0.299). There were 2 cases of incision infection, 1 case of incision fat liquefaction, 2 cases of lower extremity deep vein thrombosis in group A, the incidence of complications was 25.0%; there was only 1 case of lower extremity deep vein thrombosis in group B, the incidence of complication was 4.5%, which was lower than that in group A, but the difference was not significant (χ2=2.104, P=0.147). In group A, 1 case was found to be dislocated, but in group B, there was no dislocated fracture. There was no significant difference between the two groups in the evaluation of Matta imaging on the next day after operation and the evaluation of Majeed function at 12 months after operation (P>0.05).ConclusionPercutaneous retrograde pubic screw implantation assisted by hollow pedicle opener is effect for the pubic branch fractures with the advantage of smaller incision, shorter operation time, and less bleeding compared with traditional methods.
ObjectiveTo evaluate the diagnostic value of endobronchial ultrasound technology in combination with LungPoint virtual navigation system for pulmonary peripheral nodules. MethodsRetrospective analysis of 317 patients with peripheral pulmonary nodules who underwent endobronchial ultrasound at the endoscopy center of Shanghai Pulmonary Hospital from January 2021 to March 2022 was used as the study population. They were divided into the endobronchial ultrasound group (EBUS-GS group) and the virtual navigation combined with endobronchial ultrasound group (VBN+EBUS-GS group) according to whether the path was planned with the LungPoint virtual navigation system preoperatively or not. The diagnostic rate, bronchoscopic arrival rate, arrival time, operation time and complications were compared between the EBUS-GS group and the VBN+EBUS-GS group, and the factors associated with the diagnostic rate of endobronchial ultrasound were analyzed. ResultsThere were 101 malignant nodules and 216 benign nodules. The mean size of lung nodules was (1.9±0.7) cm and (1.8±0.6) cm in the EBUS-GS and VBN+EUBS-GS groups, respectively (P>0.05); The time to reach the lesions was 7 (5 - 9) and 4 (3 - 5) min, and the total operation time was 18 (16 - 20) and 16 (14 - 18) min, respectively (P<0.05). The arrival rates of endobronchial ultrasound in the two groups was 82.6% and 98.1% (P<0.05), respectively. The overall diagnostic rate, malignant nodule diagnostic rate and benign nodule diagnostic rate of the two groups were 61.3% vs. 64.8%, 67.9% vs. 68.6% and 57.6% vs. 63.1% respectively (P>0.05). There was one pneumothorax in the EBUS-GS group after examination (0.6%, 1/155). No complications such as hemoptysis or infection occurred in all patients. ConclusionsLungPoint virtual navigation can significantly improve the arrival rate of lesions under endobronchial ultrasound, significantly reduce the arrival time of endobronchial ultrasound to the lesions and the total operation time, which is beneficial to improve the efficiency of clinical examination.
ObjectiveTo explore the optimal surgical timing of sequential laparoscopic cholecystectomy (LC) following percutaneous cholecystostomy (PC) in the patients with acute cholecystitis, so as to provide a clinical reference. MethodsThe patients who underwent PC and then sequential LC in the Fifth Affiliated Hospital of Xinjiang Medical University from March 2021 to July 2023 were selected based on the inclusion and exclusion criteria, who were categorized into 3 groups: the short interval group (3–4 weeks), the intermediate interval group (5–8 weeks), and the long interval group (>8 weeks) based on the time interval between the PC and LC. The gallbladder wall thickness before LC, operative time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, time and cases of drainage tube placement, admission to intensive care unit, conversion to open surgery, occurrence of complications, and total hospitalization costs were compared among the 3 groups. ResultsA total of 99 patients were enrolled, including 25 in the short interval group, 41 in the intermediate interval group, and 33 in the long interval group. The data of patients among the 3 groups including demographic characteristics, blood routine, C-reactive protein, interleukin-6, fibrinogen, international standardized ratio, liver function indicators, and comorbidities had no statistical differences (P>0.05). The gallbladder wall thickness before LC and the operative time, intraoperative blood loss, postoperative hospitalization time, total hospitalization time, time and cases of drainage tube placement, admission to intensive care unit, conversion to open surgery, occurrence of complications, and total hospitalization costs during and after LC had statistical differences among the 3 groups (P<0.05). These indicators of the intermediate interval group were better than those of the other two groups by the multiple comparisons (P<0.05), but which had no statistical differences except total hospitalization costs (P=0.019) between the short interval group and the long interval group (P>0.05). ConclusionAccording to the results of this study, the optimal surgical timing of sequential LC following PC is 5–8 weeks, however, which needs to be further validated by large sample size and multicenter data.
ObjectiveTo investigate the effectiveness of the extended Carlson approach in the treatment of lateral femoral condylar Hoffa fractures.MethodsThe clinical data of 17 patients with lateral femoral condyle Hoffa fractures between September 2012 and January 2019 were retrospectively analyzed. There were 10 males and 7 females, with a mean age of 43 years (range, 32-68 years). Fractures were caused by traffic accident in 9 cases, by falling from height in 6 cases, and by the other mechanism in 2 cases. According to the Letenneur’s classification, there were 8 cases of typeⅠ, 6 cases of type Ⅱ, and 3 cases of type Ⅲ. The mean time from injury to operation was 7 days (range, 3-32 days). All patients were treated with extended Carlson approach. Patients with Letenneur types Ⅰ and Ⅲ were fixed by a posterior antigliding plate combined with headless compression screws from anteroposterior direction, and patients with Letenneur typeⅡ were fixed by headless compression screws from anteroposterior direction. The anteroposterior and lateral X-ray films, CT and three-dimensional reconstruction of the knee joint were taken after operation to assess fracture healing and position of the internal fixators. The knee function was evaluated according to Letenneur’s functional assessment system.ResultsAll patients were followed up 13-28 months (mean, 15 months). All the incisions healed by first intention, and no complication such as fracture redisplacement, fracture nonunion, internal fixator fracture, and common peroneal nerve injury occurred. The mean time of fracture healing was 18 weeks (range, 16-32 weeks). At last follow-up, according to Letenneur’s functional assessment system, the knee function was excellent in 12 cases and good in 5 cases, with an excellent and good rate of 100%.ConclusionThe extended Carlson approach for the treatment of lateral femoral condylar Hoffa fractures has the advantages of clear exposure, easy reduction and fixation, high fracture healing rate, few complications, and good recovery of knee joint function.
Objective To evaluate the effectiveness of medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults. MethodsThe clinical data of 11 young adult patients with femoral neck fractures between February 2013 and February 2019 were analyzed retrospectively. There were 7 males and 4 females with a mean age of 45 years (range, 32-58 years). Fractures were caused by falling from height in 6 cases, by traffic accident in 4 cases, and by sports injury in 1 case. There were 7 cases in the left hip and 4 cases in the right hip. The mean Pauwels angle was 64° (range, 55°-75°). All patients were treated by medial buttress plate augmented hollow lag screws fixation and sartorius pedicled iliac flap. The X-ray film of pelvis, lateral X-ray film of hip joint, CT scan and three-dimensional reconstruction of hip joint were taken after operation to assess fracture healing and position of the internal fixators. The postoperative hip function was evaluated according to the Harris score. Results All the incisions healed by first intention, and no complication such as incision infection and lateral femoral cutaneous nerve injury happened. Re-examination on the second day after operation showed that reduction and fixation of fractures was good. All patients were followed up 18-36 months (mean, 29 months). All fractures achieved bony union. The time of bony union was 16-23 weeks, with an average of 18.2 weeks. One patient (9.1%) got osteonecrosis of the femoral head (ONFH) at 30 months after operation. At last follow-up, Harris score was used to evaluate hip joint function, 9 cases were excellent, 1 case was good, 1 case was fair, and the excellent and good rate was 90.9%. Conclusion Medial buttress plate augmented hollow lag screws fixation in combination with sartorius pedicled iliac flap for the treatment of femoral neck fractures in young adults has the advantage of strong biomechanical stability and can effectively improve the blood supply of femoral head and neck, which subsequently reduce the incidence of ONFH. However, the surgical indication should be fully considered.
Objective To investigate the impact of sarcopenia on effectiveness of lumbar decompression surgery in patients with lumbar spinal stenosis. Methods The clinical data of 50 patients with lumbar spinal stenosis who met the selection criteria between August 2017 and December 2020 were retrospectively analyzed. According to the diagnostic criteria of the European Working Group on Sarcopenia in Older People (EWGSOP), based on the calculation of the skeletal muscle index (SMI) at the L3 level, SMI<45.4 cm2/m2 (men) and SMI<34.4 cm2/m2 (women) were used as the diagnostic threshold, the patients were divided into sarcopenia group (25 cases) and non-sarcopenia group (25 cases). There was no significant difference in gender, age, disease duration, level of lumbar spinal stenosis, surgical fusion level, and comorbidity between the two groups (P>0.05); the body mass index in sarcopenia group was significantly lower than that in non-sarcopenia group (t=−3.198, P=0.002). Clinical data of the two groups were recorded and compared, including operation time, intraoperative blood loss, postoperative drainage volume, hospitalization stay, and complications. The visual analogue scale (VAS) scores of low back pain and sciatica and Oswestry disability index (ODI) scores were recorded preoperatively and at last follow-up. The effectiveness was evaluated according to modified MacNab standard. Results There was no significant difference between the two groups in terms of operation time, intraoperative blood loss, and postoperative drainage volume (P>0.05). However, the hospitalization stay in sarcopenia group was significantly longer than that in non-sarcopenia group (t=2.105, P=0.044). The patients were followed up 7-36 months (mean, 29.7 months). In sarcopenia group, 1 case of dural tear and cerebrospinal fluid leakage occurred during operation, as well as 1 case of internal fixator loosening during follow-up; 1 case of incision exudation and poor healing occurred in each of the two groups, and no adjacent segment degeneration and deep vein thrombosis of lower extremity occurred in the two groups during follow-up. There was no significant difference in the incidence of complications (12% vs. 4%) between the two groups (χ2=1.333, P=0.513). VAS scores in low back pain and sciatica as well as ODI scores in two groups significantly improved when compared with preoperative results at last follow-up (P<0.05). The differences of VAS scores in low back pain and ODI scores before and after operation in sarcopenia group were significantly lower than that in non-sarcopenia group (P<0.05). However, there was no significant difference of that in VAS scores of sciatica between the two groups (t=−1.494, P=0.144). According to the modified MacNab standard, the excellent and good rate of the sarcopenia group was 92%, and that of the non-sarcopenia group was 96%, showing no significant difference between the two groups (χ2=1.201, P=0.753). ConclusionPatients with sarcopenia and lumbar spinal stenosis may have longer postoperative recovery time, and the effectiveness is worse than that of non-sarcopenic patients. Therefore, for elderly patients with lumbar spine disease, it is suggested to improve preoperative assessment of sarcopenia, which can help to identify patients with sarcopenia at risk of poor surgical prognosis in advance, so as to provide rehabilitation guidance and nutritional intervention in the perioperative period.
The convective polymerase chain reaction (CCPCR) uses the principle of thermal convection to allow the reagent to flow in the test tube and achieve the purpose of amplification by the temperature difference between the upper and lower portions of the test tube. In order to detect the amplification effect in real time, we added a fluorophore to the reagent system to reflect the amplification in real time through the intensity of fluorescence. The experimental results show that the fluorescence curve conforms to the S-type trend of the amplification curve, but there is a certain jitter condition due to the instability of the thermal convection, which is not conducive to the calculation of the cycle threshold (CT value). In order to solve this problem, this paper uses the dynamic method, using the double S-type function model to fit the curve, so that the fluorescence curve is smooth and the initial concentration of the nucleic acid can be deduced better to achieve the quantitative purpose based on the curve. At the same time, the PSO+ algorithm is used to solve the double s-type function parameters, that is, particle swarm optimization (PSO) algorithm combined with Levenberg-Marquardt, Newton-CG and other algorithms for curve fitting. The proposed method effectively overcoms PSO randomness and the shortcoming of traditional algorithms such as Levenberg-Marquardt and Newton-CG which are easy to fall into the local optimal solution. The R2 of the data fitting result can reach 0.999 8. This study is of guiding significance for the future quantitative detection of real-time fluorescent heat convection amplification.