A new approach for percutaneous ilio-sacral screw fixation: CT-based pre-operative planning with conventional fluoroscopy to reduce malposition rate and operating time.

PURPOSE: Percutaneous ilio-sacral screw (ISS) insertion using conventional C-arm fluoroscopy has been a widely employed technique for pelvic posterior ring fixation, particularly in developing regions. However, this approach presents technical challenges, leading to a high malposition rate. We introduced a new method for ISS insertion without additional equipment or software and suggested whether it could reduce the malposition rate and operating time. METHODS: This is a retrospective cohort study. The study included all patients who underwent percutaneous ISS fixation between January 2020 and December 2022. Patients treated with open reduction or other types of implants were excluded. The patients were divided into 2 groups based on the screw insertion method: Group A utilized the traditional dual-plane adjustment method, while Group B received the newly introduced method. In all cases, conventional C-arm fluoroscopy was the sole guidance during the surgical procedure. Malposition rate, radiation exposure, and operating time were compared between groups. Post-operative CT scans were used to assess screw accuracy using the Smith grading method. The Student's t-test or the Mann-Whitney U test was chosen for comparing the quantitative variables based on the normality test results. The Chi-squared test was utilized for comparing qualitative variables. RESULTS: A total of 72 patients with pelvic posterior ring disruption treated with percutaneous ISS under conventional fluoroscopy guidance were included in this study. Among them, 32 patients were in Group A and 40 patients were in Group B. In Group B, the average operation duration per screw was 33 min with 29 fluoroscopy applications, which was significantly lower than that in Group A (44 min, p < 0.001, 38 times, p < 0.001, respectively). Furthermore, the post-operative CT scan revealed that only 10.7% (6/56) of screws in Group B were inappropriately positioned according to the Smith criteria. CONCLUSION: The novel method introduced in this study demonstrated a reduction in both malposition rates and operating time compared to the traditional dual-plane adjustment method. Precise pre-operative CT planning in conjunction with conventional fluoroscopy could establish this method as a widely applicable technique for percutaneous ISS fixation.

Relationship between sleep quality and duration and the incidence rate of arthritis: A prospective cohort study.

Little is known about the relationship between sleep duration and quality and the risk of arthritis in the older adult population of China. The participants were a prospective cohort of adults aged 65 years and over who had not had arthritis at baseline and had participated in follow-up surveys from 2011 to 2018 in the Chinese Longitudinal Health and Longevity Survey (CLHLS). A Cox proportional-hazards regression model was established. The dose-response relationship between sleep duration and the incidence of arthritis was analyzed. The results of a Cox proportional-risk regression model revealed that sleep duration and quality were associated with the risk of arthritis in the participants. Specifically, compared with participants with good sleep quality, those with poor sleep quality had a 38% higher risk of developing arthritis (hazard ratio [HR] = 1.38, 95% confidence interval [CI] = 1.09-1.74), and compared with participants with a sleep duration of 5 to 10 hours, those with a sleep duration shorter than 5 hours had a higher risk of developing arthritis (HR = 1.56, 95% CI = 1.27-1.91). Moreover, the results of a restricted cubic spline Cox proportional-hazards regression model showed that there was an approximately non-linear dose-response relationship between sleep duration and the incidence rate of arthritis (P nonlinear < .0001). Participants with poor sleep quality and a sleep duration shorter than 5 hours had a higher risk of developing arthritis than those with better sleep quality and a longer sleep duration.

Relationship between mixed exposure to phenyl hydroxides, polycyclic aromatic hydrocarbons, and phthalates and the risk of arthritis.

BACKGROUND: To determine the relationship between mixed exposure to three types of endocrine-disrupting chemicals (EDCs), namely phenyl hydroxides, polycyclic aromatic hydrocarbons (PAHs), and phthalates (PAEs), and risk of arthritis. METHODS: Participants were selected from National Health and Nutrition Examination Survey (NHANES). The relationships between the urinary concentrations of phenyl hydroxides, PAHs, and PAEs and the risk of arthritis were analyzed by generalized linear regression model. The mixed exposure to these EDCs and the risk of arthritis was analyzed by weighted quantile sums (WQSs) and Bayesian kernel machine regression (BKMR) model. RESULTS: Our analysis showed that participants with urinary benzophenone-3 and methylparaben concentrations in the highest quartile (Q4) had an increased risk of arthritis compared with those in Q1. For each one-unit increase in the natural logarithm-converted urinary concentrations of 1-hydroxynapthalene and 2-hydroxynapthalene, the risk of arthritis increased by 5% and 8%, respectively. Chemical mixing index coefficients were significantly associated with risk of arthritis in both WQS positive- and negative-constraint models. In the BKMR model, there was a significant positive correlation between mixed exposure and the risk of arthritis. CONCLUSION: Mixed exposure to phenyl hydroxides, PAHs, and PAEs increased the risk of arthritis, with exposure to PAHs being the key factor.

An Innovative Deep Learning Approach to Spinal Fracture Detection in CT Images.

AIM: Spinal fractures, particularly vertebral compression fractures, pose a significant challenge in medical imaging due to their small-scale nature and blurred boundaries in Computed Tomography (CT) scans. However, advanced deep learning models, such as the integration of the You Only Look Once (YOLO) V7 model with Efficient Layer Aggregation Networks (ELAN) and Max-Pooling Convolution (MPConv) architectures, can substantially reduce the loss of small-scale information during computational processing, thus improving detection accuracy. The purpose of this study is to develop an innovative deep learning approach for detecting spinal fractures, particularly vertebral compression fractures, in CT images. METHODS: We proposed a novel method to precisely identify spinal injury using the YOLO V7 model as a classifier. This model was enhanced by integrating ELAN and MPConv architectures, which were influenced by the Receptive Field Learning and Aggregation (RFLA) small object recognition framework. Standard normalization techniques were utilized to preprocess the CT images. The YOLO V7 model, integrated with ELAN and MPConv architectures, was trained using a dataset containing annotated spinal fractures. Additionally, to mitigate boundary ambiguities in compressive fractures, a Theoretical Receptive Field (TRF) based on Gaussian distribution and an Effective Receptive Field (ERF) were used to capture multi-scale features better. Furthermore, the Wasserstein distance was employed to optimize the model's learning process. A total of 240 CT images from patients diagnosed with spinal fractures were included in this study, sourced from Ningbo No.2 Hospital, ensuring a robust dataset for training the deep learning model. RESULTS: Our method demonstrated superior performance over conventional object detection networks like YOLO V7 and YOLO V3. Specifically, with a dataset of 200 pathological images and 40 normal spinal images, our method achieved a 3% increase in accuracy compared to YOLO V7. CONCLUSIONS: The proposed method offers an innovative and more effective approach for identifying vertebral compression fractures in CT scans. These promising findings suggest the method's potential for practical clinical applications, highlighting the significance of deep learning in enhancing patient care and treatment in medical imaging. Future research should incorporate cross-validation and independent validation and test sets to assess the model's robustness and generalizability. Additionally, exploring other deep learning models and methods could further enhance detection accuracy and reliability, contributing to the development of more effective diagnostic tools in medical imaging.

Enhancing the Diagnostic Accuracy of Sacroiliitis: A Machine Learning Approach Applied to Computed Tomography Imaging.

Aims/Background Sacroiliitis is a challenging condition to diagnose accurately due to the subtle nature of its presentation in imaging studies. This study aims to improve the diagnostic accuracy of sacroiliitis by applying advanced machine learning techniques to computed tomography (CT) images. Methods We employed five convolutional neural network (CNN) models-Visual Geometry Group 16-layer Network (VGG16), ResNet101, DenseNet, Inception-v4, and ResNeXt-50-to analyze a dataset of 830 CT images, including both sacroiliitis and non-sacroiliitis cases. Each model's performance was evaluated using metrics such as accuracy, precision, recall, F1 score, Receiver Operating Characteristic (ROC), and Area Under the Curve (AUC). The interpretability of the models' decisions was enhanced using Gradient-weighted Class Activation Mapping (Grad-CAM) visualization. Results The ResNeXt-50 and Inception-v4 models demonstrated superior performance, achieving the highest accuracy and F1 scores among the tested models. Grad-CAM visualizations offered insights into the decision-making processes, highlighting the models' focus on relevant anatomical features critical for accurate diagnosis. Conclusion The use of CNN models, particularly ResNeXt-50 and Inception-v4, significantly improves the diagnosis of sacroiliitis from CT images. These models not only provide high diagnostic accuracy but also offer transparency in their decision-making processes, aiding clinicians in understanding and trusting Artificial Intelligence (AI)-driven diagnostics.

Causal association of genetically determined plasma metabolites with osteoarthritis: a two-sample Mendelian randomization study.

Background: We aimed to elucidate the causal relationship between plasma metabolites and the vulnerability to Osteoarthritis (OA), encompassing both hip OA and knee OA. Methods: We conducted a two-way two-sample Mendelian randomization (MR) analysis to investigate the association of 1,400 plasma metabolites with OA. The Inverse Variance Weighted (IVW) model served as the primary two-sample MR Analysis method, with supplementary analysis using the Weighted Median (WM) and MR Egger methods. To ensure the robustness of our findings, sensitivity analyses were performed, incorporating Cochran's Q test, MR-Egger intercept test, MR-PRESSO, and Leave-One-Out analyses. To validate the identified metabolites, we utilized the Steiger test and linkage disequilibrium score regression. Results: A total of 94 plasma metabolites were associated with osteoarthritis, with 60 associated with hip OA and 106 associated with knee OA. IVW analysis revealed that tryptophan levels showed the strongest positive association with hip OA (OR [95% CI]: 1.119 [1.024, 1.223]), while X-24757 levels exhibited the highest positive association with knee osteoarthritis (OR [95% CI]: 1.095 [1.032, 1.162]). Ethylparaben sulfate levels were found to have the greatest positive association with hip OA (OR [95% CI]: 1.118 [1.015, 1.231]). Notably, the plasma metabolite X-2475 showed a strong robust random effect across all three types of osteoarthritis. Metabolic pathway analysis revealed that the pathogenesis of osteoarthritis in the hip was mediated by acetylarginine, specifically in four important metabolic pathways: ethanol degradation (p = 0.044), amino sugar metabolism (p = 0.090), fatty acid biosynthesis (p = 0.095), and aspartate metabolism (p = 0.097816). Conclusion: There is a significant association between tryptophan levels and the risk of hip OA, as well as X-24757 levels and the risk of knee osteoarthritis. Additionally, X-24757 levels are also linked to the risk of hip OA. Moreover, this study has identified four crucial metabolic pathways in hip osteoarthritis, which are all regulated by acetylarginine. These findings provide valuable insights into potential biomarkers for OA and highlight potential pathways for its prevention and clinical intervention.

[A new fluoroscopic view to evaluate the medial and lateral articular reduction quality in patella fractures during internal fixation].

Objective: To introduce a new fluoroscopic method for assessing the quality of medial and lateral joint surface reduction during internal fixation of patellar fractures and to summarize the clinical outcomes of patients treated using this method. Methods: A retrospective analysis was conducted on the clinical data of 52 patients with patellar fractures treated between January 2018 and January 2022 who met the inclusion criteria. There were 27 male and 25 female patients, aged 21-75 years, with an average age of 62 years. The types of patellar fractures included 9 transverse fractures, 37 comminuted fractures, and 6 longitudinal fractures. According to the AO/Orthopaedic Trauma Association (AO-OTA)-2018 fracture classification, there were 21 cases of type 34A, 6 cases of type 34B, and 25 cases of type 34C. The time from injury to operation ranged from 1 to 5 days, with an average of 2.3 days. Treatments included internal fixation with hollow screws or hollow screw tension bands, with or without anchor repair. During operation, the medial and lateral joint surfaces of the patella were observed using the tangential fluoroscopic method to assess the smoothness of reduction of the median ridge, lateral joint surface, medial joint surface, and lateral joint edge. Patients were followed up regularly, and X-ray films were taken to observe fracture healing. Knee joint range of motion, Böstman score, and Lysholm score were used to evaluate functional recovery. Results: The tangential fluoroscopic method for the medial and lateral joint surfaces of the patella during operation showed satisfactory reduction of the joint surfaces and good positioning of the implants. All patients were followed up 12-16 months, with an average of 13.4 months. During the follow-up, fracture displacement occurred in 1 case and titanium cable breakage in 1 case. All patella fractures healed successfully, with a healing time of 8-16 weeks (mean, 11.4 weeks). At last follow-up, knee joint range of motion ranged from 120° to 140°, with an average of 136°. The Böstman score ranged from 20 to 30, with an average of 28, yielding excellent results in 45 cases and good results in 7 cases. The Lysholm score ranged from 88 to 100, with an average of 93, yielding excellent results in 40 cases and good results in 12 cases. Conclusion: The intraoperative application of the tangential fluoroscopic method for the medial and lateral joint surfaces of the patella can quickly determine the fluoroscopic plane of the patella, accurately assess the quality of fracture reduction and the position of internal fixator, thereby improving effectiveness.

[Surgical treatment methods and classification of proximal clavicle fracture].

OBJECTIVE: To summarize the surgical treatment of different proximal clavicle fractures, and discuss the classification of proximal clavicle fractures. METHODS: Total of 24 patients with displaced proximal clavicle fractures were treated from January 2017 to December 2020 including 16 males and 8 females, aged 28 to 66 years old. Among them, 20 cases were fresh fractures and 4 cases were old fractures. According to the Edinburgh classification, 14 cases were type 1B1 fractures and 10 cases were type 1B2 fractures. The different internal fixation methods were selected for internal fixation treatment according to different fracture types.The operation time, blood loss, preoperative and postoperative displacement difference, fracture healing time and Rockwood scoring system were recorded. RESULTS: All patients were followed up for 12 to 24 months. There were no patients with infection or loss of reduction after the operation. Three patients had internal fixation failure after operation, and the internal fixation device was removed. Results The operation time was 30 to 65 min, and the blood loss was 15 to 40 ml. No important nerves, blood vessels, or organs were damaged. The imaging healing time was 3 to 6 months. According to the Rockwood functional score, the total score was (13.50±1.86), pain (2.57±0.50), range of motion (2.78±0.41), muscle strength (2.93±0.28), restricted daily activity (2.85±0.35), subjective results (2.63±0.61);the results were excellent in 20 cases, good in 3 cases, fair in 1 case. CONCLUSION: Proximal clavicular fracture is a type of fracture with low incidence. According to different fracture types, different internal fixation methods and treatment methods can be selected, and satisfactory surgical results can be achieved.

Butyrate mitigates metabolic dysfunctions via the ERα-AMPK pathway in muscle in OVX mice with diet-induced obesity.

The higher prevalence of metabolic syndrome (MetS) in women after menopause is associated with a decrease in circulating 17ß-oestradiol. To explore novel treatments for MetS in women with oestrogen deficiency, we studied the effect of exogenous butyrate on diet-induced obesity and metabolic dysfunctions using ovariectomized (OVX) mice as a menopause model. Oral administration of sodium butyrate (NaB) reduced the body fat content and blood lipids, increased whole-body energy expenditure, and improved insulin sensitivity. Additionally, NaB induced oestrogen receptor alpha (ERα) expression, activated the phosphorylation of AMPK and PGC1α, and improved mitochondrial aerobic respiration in cultured skeletal muscle cells. In conclusion, oral NaB improves metabolic parameters in OVX mice with diet-induced obesity. Oral supplementation with NaB might provide a novel therapeutic approach to treating MetS in women with menopause. Video Abstract.

The correlation of triglyceride/high-density lipoprotein cholesterol ratio with muscle mass in type 2 diabetes patients.

OBJECTIVE: Triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio is correlated with metabolic diseases. The prevalence of sarcopenia is significantly higher in type 2 diabetes mellitus (T2DM) patients compared with healthy controls. The purpose of our study is to evaluate the correlation of TG/HDL-C ratio with muscle mass in T2DM patients. METHOD: Our study consists of 1048 T2DM inpatients recruited from the department of endocrinology. Skeletal muscle index (SMI) was detected with a dual energy X-ray absorptiometry method. Low muscle mass was diagnosed using the criteria of SMI less than 7.0 kg/m2 (in male subjects) or 5.4 kg/m2 (in female subjects). RESULT: The prevalence of low muscle mass was 20.9% and 14.5% in male and female groups respectively. SMI was correlated with TG/HDL ratio after adjustment for age, duration of diabetes, diastolic blood pressure (DBP), and HbA1c in male subgroup. In female subgroup, SMI was associated with TG/HDL ratio after adjustment for age and DBP. CONCLUSION: Higher TG/HDL-C ratio is correlated with muscle mass in T2DM patients.

[Finite element analysis of PMMA bone cement reinforced screw plate fixation for osteoporotic proximal humeral fracture].

OBJECTIVE: With the help of finite element analysis, to explore the effect of proximal humeral bone cement enhanced screw plate fixation on the stability of internal fixation of osteoporotic proximal humeral fracture. METHODS: The digital model of unstable proximal humeral fracture with metaphyseal bone defect was made, and the finite element models of proximal humeral fracture bone cement enhanced screw plate fixation and common screw plate fixation were established respectively. The stress of cancellous bone around the screw, the overall stiffness, the maximum stress of the plate and the maximum stress of the screw were analyzed. RESULTS: The maximum stresses of cancellous bone around 6 screws at the head of proximal humeral with bone cement enhanced screw plate fixation were 1.07 MPa for No.1 nail, 0.43 MPa for No.2 nail, 1.16 MPa for No.3 nail, 0.34 MPa for No.4 nail, 1.99 MPa for No.5 nail and 1.57 MPa for No.6 nail. These with common screw plate fixation were:2.68 MPa for No.1 nail, 0.67 MPa for No.2 nail, 4.37 MPa for No.3 nail, 0.75 MPa for No.4 nail, 3.30 MPa for No.5 nail and 2.47 MPa for No.6 nail. Overall stiffness of the two models is 448 N/mm for bone cement structure and 434 N/mm for common structure. The maximum stress of plate appears in the joint hole:701MPa for bone cement structure and 42 0MPa for common structure. The maximum stress of screws appeared at the tail end of No.4 nail:284 MPa for bone cement structure and 240.8 MPa for common structure. CONCLUSION: Through finite element analysis, it is proved that the proximal humerus bone cement enhanced screw plate fixation of osteoporotic proximal humeral fracture can effectively reduce the stress of cancellous bone around the screw and enhance the initial stability after fracture operation, thus preventing from penetrating out and humeral head collapsing.

Indole-3-acetic acid improves the hepatic mitochondrial respiration defects by PGC1a up-regulation.

Recent evidences have linked indole-3-acetic acid (I3A), a gut microbiota-derived metabolite from dietary tryptophan, with the protection against non-alcoholic fatty liver disease (NAFLD). However, the values of I3A on mitochondrial homeostasis in NAFLD have yet to be analyzed. In this study, we verified that I3A alleviated dietary-induced metabolic impairments, particularly glucose dysmetabolism and liver steatosis. Importantly, we expanded the understanding of I3A further to enhance mitochondrial oxidative phosphorylation in the liver by RNA-seq. Consistently, I3A restored the deficiency of mitochondrial respiration complex (MRC) capacity in palmitic acid (PA)-induced HepG2 without initiating oxidative stress in vitro. These changes were dependent on peroxisome proliferator-activated receptor γ coactivator 1 (PGC1)-a, a key regulator of mitochondrial biogenesis. Silencing of PGC1a by siRNA and pharmacologic inhibitor SR-18292, blocked the restoration of I3A on mitochondrial oxidative phosphorylation. In addition, pre-treatment of I3A guarded against the deficiency of MRC capacity. In conclusion, our findings uncovered that I3A increased hepatic PGC1a expression, contributing to mitochondrial respiration improvement in NAFLD.

[CT imaging measurement of sacral related anatomical parameters].

OBJECTIVE: To investigate the CT measurement of sacral anatomical parameters and understand the safe nail placement channel of DenisⅠ area with a new sacral butterfly plate. METHODS: The CT data of 101 normal adult sacrum from January 2020 to June 2020 were retrospectively analyzed, including 49 females and 52 males, aged(49.11±15.02) years old. Firstly, the three-dimensional model of sacrum was reconstruct, the three-dimensional model according to the plane was re segment to be measured, and data measurement and statistical analysis were carried out. RESULTS: The vertical distance from the lower edge of superior sacral articular process to the lower edge of S2 posterior sacral foramen was (42.55±4.73) mm;The horizontal distance from the lateral sacral crest of S1, S2 and S3 hole plane to the sacroiliac joint surface was (19.09±3.07) mm, (15.34±2.69) mm and (8.29±2.48) mm respectively;The plane of S1 hole moves forward from the lateral sacral ridge, the inner and outer angles are (7.49±7.49)° and (24.07±4.89)° respectively;The inside and outside angles of S2 hole plane are (-3.10±8.95)° and (24.95±5.74)° respectively. There were significant differences between different genders except S1 horizontal distance and S1 medial angle, and there was no correlation between age and all data. CONCLUSION: The new sacral butterfly plate has enough safe nail placement range in DenisⅠ area;There are differences in sacral morphology among adults. The differences are mainly related to gender but not age.

The impacts of metabolic syndrome on the risk of severe urolithiasis.

Metabolic syndrome (MetS) is significantly correlated with urolithiasis. However, few studies have evaluated the severity of urolithiasis. This study aimed to investigate the relationship of MetS with severe urolithiasis disease (SUD). The data of 910 patients with urolithiasis in the Department of Urology, Second Hospital of Tianjin Medical University from June 2020 to May 2021 were retrospectively collected. The patients were divided into two groups according to the severity of urolithiasis, and the relationships of MetS and its components with SUD were evaluated. The results showed 605 SUD and 272 Mets patients. Multiple regression analysis showed that middle age, male gender, and MetS increased the risk of SUD, whereas serum magnesium decreased it (P < 0.05). Further analysis revealed that the odds ratio (OR) of SUD increased with MetS grade (0-4) (1.029-2.117). Grade 4 patients had a 2.1-fold higher risk of SUD than grade 0 patients (OR 2.117; 95% CI 1.053-4.256; P = 0.035); hypertension and dyslipidemia were most strongly associated with SUD among the four MetS features (P < 0.05). Additionally, calcium oxalate was the most predominant stone component (78.7%) in the SUD(+) group, which also had stones with higher uric acid and lower calcium oxalate dihydrate levels than those of the SUD(-) group (P < 0.05). Our study concluded that SUD is more common in middle-aged men, MetS is an independent risk factor for SUD. The more severe the MetS, the higher the risk of SUD, in which hypertension and dyslipidemia play major roles.

Preliminary results of iliosacral screws and plate combination in the management of tile B3 pelvic fractures: A retrospective case series.

OBJECTIVE: The aim of this study was to present preliminary results and experience with iliosacral screws and plate combination (horizontal triangular osteosynthesis, HTO) in the management of Tile B3 pelvic fractures. METHODS: In this retrospective study, 26 patients (18 male, 8 female; mean age = 46, age range = 31-58 years) who were treated with horizontal triangular osteosynthesis using the combination of bilateral percutaneous iliosacral screws and transiliac plates due to Tile B3 pelvic fractures in our institution were included. The accompanying symptoms, blood loss, operation time , fracture healing time, and postoperative complications were observed and recorded. Patients were followed up retrospectively with routine post-operation visits for clinical and radiographic examination. The reduction quality was evaluated according to Matta criterion. Clinical and nerve function outcomes were evaluated by Majeed and Gibbons criterion. RESULTS: The mean follow-up time was 15 months (range = 12-21 months). The mean blood loss and operation time were 24.6 ± 6.7mL and 30.5 ± 3.47 mins, respectively. Patients experienced early weight-bearing ability and no fracture reduction loss. Due to Matta criterion for fracture reduction, the results were excellent in 16 cases, good in 9 cases, and fair in 1 case. Due to Majeed functional scoring at the last follow-up, the results were excellent in 17 cases, good in 9 cases. Of 3 patients in whom neurologic impairment was detected preoperatively, 2 achieved complete recovery, and 1 achieved partial improvement postoperatively. CONCLUSION: As a new surgical concept in the management of Tile B3 pelvic fractures, HTO seems to provide the following advantages: horizontal triangular fixation, minimally invasive incisions, less blood loss, and permitting early weight-bearing ability. However, there still exist several problems regarding the technique and the option of implants. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Gut microbiota and butyrate contribute to nonalcoholic fatty liver disease in premenopause due to estrogen deficiency.

The incidence of nonalcoholic fatty liver disease (NAFLD) in postmenopausal women has increased significantly. Estrogen plays a very important role in NAFLD, but whether NAFLD in premenopausal women was caused by estrogen deficiency was unknown. Thus, it is of great clinical significance to explore the mechanism of NAFLD in premenopausal women. Gut microbiota and its metabolites short chain fatty acids (SCFA) have been shown to play important roles in the development of NAFLD. In this study, we investigated the impact of gut microbiota and SCFA in NAFLD patients and mice caused by estrogen deficiency. We showed that premenopause NAFLD patients had much lower estrogen levels. Estrogen deficient mice, due to ovariectomy (OVX), suffered more severe liver steatosis with an elevated body weight, abdominal fat weight, serum triglycerides and deterioration in hepatic steatosis. Altered gut microbiota composition and decreased butyrate content were found in NAFLD patients and in OVX mice. Furthermore, fecal microbiota transplantation (FMT) or supplementing with butyrate alleviated NAFLD in OVX mice. The production of antimicrobial peptides (AMP) Reg3É£, ß-defensins and the expression of intestinal epithelial tight junction, including ZO-1 and Occluding-5, were decreased in the OVX mice compared to control mice. Upregulation of PPAR-É£ and VLDLR, downregulation of PPAR-ɑ indicated that OVX mice suffered from abnormal lipid metabolism. These data indicate that changes in the gut microbiota and SCFA caused by estrogen reduction, together with a disorder in AMP production and lipid metabolism, promote NAFLD, thus provide SCFAs derived from microbiota as new therapeutic targets for the clinical prevention and treatment of NAFLD.

Diversity of the T cell receptor ß chain complementarity-determining region 3 in peripheral blood of neonates with sepsis: an analysis based on immune repertoire sequencing. / å ç–«ç»„åº“æµ‹åºåˆ†æžæ–°ç”Ÿå„¿è„“æ¯’ç—‡æ‚£è€ å¤–å‘¨è¡€T细胞受体ß链CDR3çš„å¤šæ ·æ€§.

OBJECTIVES: To investigate the diversity of peripheral blood T cell receptor (TCR) ß chain complementarity-determining region 3 (CDR3) based on immune repertoire sequencing in neonates with sepsis and the possible pathogenesis of neonatal sepsis. METHODS: A total of 12 neonates with sepsis were enrolled as the case group, and 9 healthy full-term infants, matched for gestational age, birth weight, and age, were enrolled as the control group. Omega nucleic acid purification kit (SQ blood DNA Kit II) was used to extract DNA from peripheral blood samples, TCR ß chain CDR3 was amplified by multiplex PCR, and then high-throughput sequencing was performed for the products to analyze the diversity of TCR ß chain CDR3 and the difference in expression. RESULTS: The length and type of TCR ß chain CDR3 were similar between the case and control groups, and Gaussian distribution was observed in both groups. With D50 and Shannon-Wiener index as the evaluation indices for diversity, the case group had a significantly lower diversity of TCR ß chain CDR3 than the control group (P<0.05). The frequency of 48 genes in TCR ß chain V segment was compared, and the results showed that compared with the control group, the case group had significantly higher frequencies of TRBV10-3, TRBV2, and TRBV20-1 (P<0.05). The frequency of 13 genes in TCR ß chain J segment were compared, and the results showed that compared with the control group, the case group had significantly higher frequencies of TRBJ2-3, TRBJ2-5, and TRBJ2-7 (P<0.05). CONCLUSIONS: There is a significant change in the diversity of TCR ß chain CDR3 in the peripheral blood of neonates with sepsis, suggesting that it might be associated with the immune pathogenesis of neonatal sepsis.

[Preliminary development of guided template of middle and upper thoracic percutaneous vertebroplasty in thoracic pedicle approach due to three dimentional soft tissue print technique].

OBJECTIVE: To investigate the feasibility of a drill template for the placement of guided template of middle and upper thoracic percutaneous vertebroplasty in thoracic pedicle approach on digital design and 3D printing technology. METHODS: The preoperative CT images of 20 patients with thoracic fracture were collected retrospectively. With the 3D soft tissue printing technology, the data was reconstructed by 3D imaging reconstruction software to produce 1∶1 three dimensional soft tissue model. The pedicle screw channel and the digital template were designed by the 3-matic module of Mimics15.0 software. After guide template was printed by 3D printer and three dimensional template was fixed on the model, 2.0 mm Kirschner was placed and the accuracy of a drill template was observed by CT scans, bone cement was injected through the puncture tube and verified with images. The time of nail guide design, guide template production and cost were recorded. RESULTS: The effectiveness of three dimensional thoracic model and digital guided template of middle and upper thoracic percutaneous vertebroplasty of thoracic fractures in thoracic pedicle approach was confirmed. Kirschner was placed and the accuracy of screw placement was confirmed with CT scanning. Template and the corresponding anatomical landmark fitted well, bone cement had showed good filling. The average printing time of upper thoracic spine model with soft tissue, the mean time of nail guide design, guide template production and cost were (719.00±3.03) min, (12.30±1.01) min, (55.50±10.30) min and RMB 3 150 yuan on average respectively. CONCLUSION: By means of individual design and 3D soft tissue printingtechnology, accurate placement of guided template of middle and upper thoracic percutaneous vertebroplasty could be realized.

Elevated soluble E-cadherin during the epithelial-mesenchymal transition process and as a diagnostic marker in colorectal cancer.

Epithelial-mesenchymal transition (EMT) plays a crucial role in colorectal cancer (CRC) metastasis. Soluble E-cadherin (sE-cadherin) is a peptide degradation product of the E-cadherin, a key epithelial molecule of EMT. However, it is not known if elevated levels of sE-cadherin also occur during EMT. And the study of sE-cadherin in colorectal cancer is rare. The purpose of the study was to evaluate the relationship between sE-cadherin and EMT in CRC and to evaluate the diagnostic value of sE-cadherin as a serum marker for CRC. Transforming growth factor-ß1 (TGF-ß1) was used to induce EMT in HT29 and SW480 cells. The cells treated with TGF-ß1 showed morphological and biological behavior changes consistent with EMT. Western blot and ELISA showed the levels of sE-cadherin were increased during EMT in CRC cells. In addition, we intravenously injected luciferase-labeled SW480 cells into nude mice to construct CRC metastasis model. Following the elongation of time, the fluorescence intensity of the experimental group was gradually increased. Correspondingly, the serum concentration of sE-cadherin also increased during CRC metastasis in mice. Furthermore, compared to healthy subjects, significantly higher levels of serum sE-cadherin were also observed in CRC patients and correlated with clinicopathological features. For discriminating CRC from healthy controls, the area under the receiver operating characteristic (ROC) curve (AUC) of sE-cadherin was 0.853, while the optimal cut-off point was set at 5928.16 ng/ml, the diagnostic sensitivity was 73.9% and the specificity was 80%. Compared with current commercial biomarkers (CEA, CA19-9 and CA125), the diagnostic performance of sE-cadherin was highest. Combined sE-cadherin and CEA raised the sensitivity to 82.4%. Serum sE-cadherin level can be used as a potential diagnostic biomarker of CRC.

[Comparative study of percutaneous bridging plate and retrograde suprapubic intramedullary screw fixation for anterior pelvic ring fracture].

OBJECTIVE: To compare the effect of percutaneous bridging plate and retrograde suprapubic intramedullary screw in the treatment of anterior ring fracture of pelvis. METHODS: From January 2013 to June 2017, 40 patients with unstable pelvic fractures involving anterior ring were analyzed retrospectively. According to the fixation method, they were divided into two groups, there were 20 patients in percutaneous bridging plate group (plate group) including 9 males and 11 females; according to tile classification, fractures were classified as type B1 in 1 case, type B2 in 14, type B3 in 2, type C1 in 2 and type C2 in 1. There were 20 cases in retrograde suprapubic intramedullary screw group (screw group) including 10 males and 10 females; according to tile classification, there were 1 case of type B1, 12 cases of type B2, 3 cases of type B3, 3 cases of type C1 and 1 case of type C2. The incision length, operation time, times of fluoroscopy, intraoperative bleeding volume, postoperative Matta score, postoperative complications and the last follow-up Majeed function score of the two groups were compared and analyzed. RESULTS: Both groups were followed up for 8 to 15 (12.25±2.24) months in the plate group and 6 to 18 (12.4±2.6) months in the screw group, there was no significant difference between the two groups. The incision length of screw group was (3.85±0.75) cm shorter than that of steel plate group (7.05±1.39) cm; the operation time of screw group was (27.70±5.36) min longer than that of steel plate group (15.10±2.07) min; the fluoroscopy times of screw group was (6.00±1.83) more than that of steel plate group (3.75±1.33) . The bleeding volume was (22.50±10.82) ml in of screw group, (25.00±9.93) ml in steel plate group, there was no significant difference between the two groups (P>0.05) . There was no significant difference in Matta evaluation and Majeed functional score in the last follow-up. One case of superficial skin infection occurred in screw group, one case of superficial skin infection and one case of transient paralysis of lateral femoral cutaneous nerve occurred in steel plate group. CONCLUSION: Percutaneous bridging plate and retrograde suprapubic intramedullary screw fixation of pelvic anterior ring fracture have the same effect. The operation time of the percutaneous plate group was shorter, the times of intraoperative fluoroscopy was less, and the learning curve was shorter, but the variation of the lateral femoral cutaneous nerve should be noted during the operation.