Genetic Causal Association Between the Gut Microbiome and Intracranial Aneurysm and Subarachnoid Hemorrhage: A Two-Sample Mendelian Randomization Study.

INTRODUCTION: The causal association between the gut microbiome and the risk of intracranial aneurysm (IA), subarachnoid hemorrhage (SAH), and unruptured aneurysm (uIA) is unclear. METHODS: The single nucleotide polymorphisms concerning gut microbiome were retrieved from the gene-wide association study (GWAS) of the MiBioGen consortium. The summary-level datasets of IA and SAH were obtained from the GWAS meta-analysis of the International Stroke Genetics Consortium (ISGC). Inverse variance weighting (IVW) was utilized as the primary method, complemented with sensitivity analyses for pleiotropy and increasing robustness. RESULTS: Five, seven, and six bacterial traits were found to have a causal effect on IA, SAH, and uIA, respectively (IVW, all P < 0.05). Family.Porphyromonadaceae and genus.Bilophila were common protective bacterial features for both SAH and uIA. The heterogeneity and pleiotropy analyses confirmed the robustness of IVW results. CONCLUSION: Our study demonstrates that gut microbiomes may exert therapeutic effects on IA, uIA, and SAH, providing clinical implications for the development of novel biomarkers and therapeutic targets.

Skin antiseptics in venous puncture site disinfection for preventing blood culture contamination: A Bayesian network meta-analysis of randomized controlled trials.

OBJECTIVE: To compare the efficacy of several antiseptics in decreasing the blood culture contamination rate. DESIGN: Network meta-analysis. DATA SOURCE: Electronic searches of PubMed and Embase were conducted up to November 2015. Only randomized controlled trials or quasi-randomized controlled trials were eligible. We applied no language restriction. A comprehensive review of articles in the reference lists was also accomplished for possible relevant studies. REVIEW METHODS: Relevant studies evaluating efficacy of different antiseptics in venous puncture site for decreasing the blood culture contamination rate were included. The data were extracted from the included randomized controlled trials by two authors independently. The risk of bias was evaluated using Detsky scale by two authors independently. We used WinBUGS1.43 software and statistic model described by Chaimani to perform this network meta-analysis. Then graphs of statistical results of WinBUGS1.43 software were generated using 'networkplot', 'ifplot', 'netfunnel' and 'sucra' procedure by STATA13.0. Odds ratio and 95% confidence intervals were assessed for dichotomous data. A probability of p less than 0.05 was considered to be statistically significant. Compared with ordinary meta-analyses, this network meta-analysis offered hierarchies for the efficacy of different antiseptics in decreasing the blood culture contamination rate. RESULTS: Seven randomized controlled trials involving 34,408 blood samples were eligible for the meta-analysis. No significant difference was found in blood culture contamination rate among different antiseptics. No significant difference was found between non-alcoholic antiseptics and alcoholic antiseptics, alcoholic chlorhexidine and povidone iodine, chlorhexidine and iodine compounds, povidone iodine and iodine tincture in this aspect, respectively. CONCLUSIONS: Different antiseptics may not affect the blood culture contamination rate. Different intervals between the skin disinfection and the venous puncture, the different settings (emergency room, medical wards, and intensive care units) and the performance of the phlebotomy may affect the blood culture contamination rate.

Treatment with a neutralising anti-rat interleukin-17 antibody after multiple-trauma reduces lung inflammation.

BACKGROUND: It has been well recognised that a deficit of numbers and function of CD4(+)CD25(+)Foxp3(+) cells (Treg) is attributed to the development of autoimmune diseases and inflammatory diseases; additionally, IL-17-producing cells (Th17) have a pro-inflammatory role. The balance between Th17 and Treg may be essential for maintaining immune homeostasis and has long been thought as one of the important factors in the development/prevention of autoimmune diseases and inflammatory diseases. In our previous research, we explored that cytokines (IL-17) and the balance of Treg/Th17 had a significant relevance with tissue (lung) inflammation and injury in acute-phase after multiple-trauma. OBJECTIVE: To more verify whether an imbalance of Treg/Th17 is characteristic of rats suffering from multiple trauma. METHODS AND SUBJECTIVE: Using IL-17 monoclonal antibody (IL-17mAb)-treated multiple-trauma rat, we tested the pathogenic role of IL-17 in the development of multiple-trauma. Rat models were treated respectively with IL-17mAb or rat IgG 2A isotype control or phosphate-buffered solution after model was established. Normal rats only received anaesthesia and cannulation were taken as sham. Rats in each group were killed respectively at the end of 1h, 4h, 8h after injection. Collected serum and lung samples for assessment dynamically of MPO, IL-17, IL-6, and TGF-ß-mRNA, and cytokine (IL-17, IL-6, TGF-ß) and lung tissue for pulmonary histological analysis. RESULTS: Neutralisation of IL-17 with anti-IL-17 can decrease serum IL-17 level and the IL-17-mRNA transcript level in lung, and ameliorate tissue inflammatory, defer disease course. CONCLUSION: Our data suggest that IL-17 is crucially involved in the pathogenesis of multiple-trauma in rat, IL-17 inhibition might ameliorate the lung inflammation in acute-phase after multiple-trauma.

The imbalance between regulatory and IL-17-secreting CD4⁺T cells in multiple-trauma rat.

BACKGROUND: It has been well recognised that a deficit of numbers and function of CD4(+)CD25(+)Foxp3(+)cells (Treg) is attributed to the development of auto-immune diseases, inflammatory diseases, tumour and rejection of transplanted tissue; however, there are controversial data regarding the suppressive effect of Treg cells on the T-cell response in auto-immune diseases. Additionally, interleukin-17 (IL-17)-producing cells (Th17) have a pro-inflammatory role. The balance between Th17 and Treg may be essential for maintaining immune homeostasis and has long been thought as one of the important factors in the development/prevention of auto-immune diseases, inflammatory diseases, tumour and rejection of transplanted tissue, but their role in multiple trauma remains unclear. OBJECTIVE: This study aims to investigate whether an imbalance of Treg and Th17 effector cells is characteristic of rats suffering from multiple trauma. METHODS AND SUBJECTIVE: Sixty Sprague-Dawley (SD) rats were randomly divided into three groups. The control group (n=20, group I) no received procedures (normal). The sham group (n=20, group II) only received anaesthesia, cannulation and observation. The bilateral femoral shaft fractures with haemorrhagic shock groups (n=20, group III). Rats in groups II and III were killed at the end of 4h after models were established. Peripheral blood samples were collected for assessment of Treg cells, Th17 cells and cytokines (IL-17, IL-6, IL-2, transforming growth factor beta (TGF-ß)) and intestine tissue was collected for intestine histological analysis. RESULTS: We observed decreased Treg/Th17 ratios in CD4(+)T cells in rats with multiple trauma and a strong inverse correlation with disease activity (intestinal histological scores). CONCLUSION: We suggest a role for immune imbalance in the pathogenesis and development of multiple trauma. The alteration of the index of Treg/Th17 cells likely indicates the therapeutic response and progress in the clinic.

Long term efficacy of minimal incision osteotomy for hallux abducto valgus.

OBJECTIVE: To observe and evaluate the long-term results of minimal incision osteotomy for hallux abducto valgus. METHODS: From February 1995 to May 1999, 372 cases (705 feet) with hallux abducto valgus were treated with minimal incision osteotomy. Seventy-nine patients (150 feet) were followed up for more than five years (mean 7.5; range, 5.3-13.2 years) after surgery. The preoperative and postoperative hallux abducto valgus angles (HVA), intermetatarsal angles (IMA), tibial sesamoid position (TSP), American Orthopaedic Foot And Ankle Society (AOFAS) score, range of movement of the first metatarsophalangeal joint and lateral metatarsalgia were observed, measured and evaluated. RESULTS: Based on clinic curative effect evaluation criterion, 56 feet (37.3%) were excellent, 88 feet (58.7%) good, 6 feet (4.0%) fair. The postoperative mean AOFAS score was 84.20 ± 4.32 points. The mean HVA decreased from 33.28° to 12.31° and the mean IMA1-2 from 11.75° to 6.80°. The TSP was corrected from an average preoperative grade of 4.29 to a grade of 3.07 by final follow-up. There was no nonunion or delayed union, no avascular necrosis, no infection, and no hallux varus. Numbness in the big toe was found in 4 feet (2.7%). The range of motion of the first metatarsophalangeal joint decreased from 70.20° to 69.53°. Of 97 feet (64.7%) with pre-operative 2-5 metatarsalgia, this had disappeared in 35 feet, improved in 54 feet and was aggravated in 8 feet postoperatively. CONCLUSION: Minimal incision osteotomy is a simple and reliable technique for treating hallux abducto valgus with minimal complications.