[Exploring the causality between intestinal flora and hyperplastic scars of human based on two-sample Mendelian randomization analysis].

Objective: To investigate the causality between intestinal flora and hypertrophic scars (HS) of human. Methods: This study was a study based on two-sample Mendelian randomization (TSMR) analysis. The data on intestinal flora (n=18 473) and HS (n=208 248) of human were obtained from the genome-wide association study database. Genetically variable genes at five levels (phylum, class, order, family, and genus) of known intestinal flora, i.e., single nucleotide polymorphisms (SNPs), were extracted as instrumental variables for linkage disequilibrium (LD) analysis. Human genotype-phenotype association analysis was performed using PhenoScanner V2 database to exclude SNPs unrelated to HS in intestinal flora and analyze whether the selected SNPs were weak instrumental variables. The causal relationship between intestinal flora SNPs and HS was analyzed through four methods of TSMR analysis, namely inverse variance weighted (IVW), MR-Egger regression, weighted median, and weighted mode. Scatter plots of significant results from the four aforementioned analysis methods were plotted to analyze the correlation between intestinal flora SNPs and HS. Both IVW test and MR-Egger regression test were used to assess the heterogeneity of intestinal flora SNPs, MR-Egger regression test and MR-PRESSO outlier test were used to assess the horizontal multiplicity of intestinal flora SNPs, and leave-one-out sensitivity analysis was used to determine whether HS was caused by a single SNP in the intestinal flora. Reverse TSMR analyses were performed for HS SNPs and genus Intestinimonas or genus Ruminococcus2, respectively, to detect whether there was reverse causality between them. Results: A total of 196 known intestinal flora, belonging to 9 phyla, 16 classes, 20 orders, 32 families, and 119 genera, were obtained, and multiple SNPs were obtained from each flora as instrumental variables. LD analysis showed that the SNPs of the intestinal flora were consistent with the hypothesis that genetic variation was strongly associated with exposure factors, except for rs1000888, rs12566247, and rs994794. Human genotype-phenotype association analysis showed that none of the selected SNPs after LD analysis was excluded and there were no weak instrumental variables. IVW, MR-Egger regression, weighted median, and weighted mode of TSMR analysis showed that both genus Intestinimonas and genus Ruminococcus2 were causally associated with HS. Among them, forest plots of IVW and MR-Egger regression analyses also showed that 16 SNPs (the same SNPs number of this genus below) of genus Intestinimonas and 15 SNPs (the same SNPs number of this genus below) of genus Ruminococcus2 were protective factors for HS. Further, IVW analysis showed that genus Intestinimonas SNPs (with odds ratio of 0.62, 95% confidence interval of 0.41-0.93, P<0.05) and genus Ruminococcus2 SNPs (with odds ratio of 0.62, 95% confidence interval of 0.40-0.97, P<0.05) were negatively correlated with the risk of HS. Scatter plots showed that SNPs of genus Intestinimonas and genus Ruminococcus2 were protective factors of HS. Both IVW test and MR-Egger regression test showed that SNPs of genus Intestinimonas (with Q values of 5.73 and 5.76, respectively, P>0.05) and genus Ruminococcus2 (with Q values of 13.67 and 15.61, respectively, P>0.05) were not heterogeneous. MR-Egger regression test showed that the SNPs of genus Intestinimonas and genus Ruminococcus2 had no horizontal multiplicity (with intercepts of 0.01 and 0.06, respectively, P>0.05); MR-PRESSO outlier test showed that the SNPs of genus Intestinimonas and genus Ruminococcus2 had no horizontal multiplicity (P>0.05). Leave-one-out sensitivity analysis showed that no single intestinal flora SNP drove the occurrence of HS. Reverse TSMR analysis showed no reverse causality between HS SNPs and genus Intestinimonas or genus Ruminococcus2 (with odds ratios of 1.01 and 0.99, respectively, 95% confidence intervals of 0.97-1.06 and 0.96-1.04, respectively, P>0.05). Conclusions: There is a causal relationship between intestinal flora and HS of human, in which genus Intestinimonas and genus Ruminococcus2 have a certain effect on inhibiting HS.

Ultrasonography for confirmation of emergency department endotracheal tube placement: a meta-analysis.

OBJECTIVE: This meta-analysis aimed to summarize the evidence on the use of ultrasonography for confirming endotracheal tube placement in emergency departments. MATERIALS AND METHODS: We conducted electronic searches on PubMed, Embase, Web of Science, and Cochrane databases. All databases were searched from their inception until February 2023. We selected studies published in English that used ultrasonography to confirm endotracheal tube placement. Case reports, case series, retrospective studies, cadaveric studies, pediatric studies, animal studies, and conference abstracts were excluded. Two reviewers independently extracted and verified data. Forest plots, hierarchical summary receiver operating characteristic (HSROC) curves, and bivariate random-effects models were used to summarize the test performance characteristics. The Stata statistical software package and Meta-DiSc version 1.4 software were used for statistical analysis. RESULTS: A total of 1,772 intubations were analyzed. For the detection of endotracheal tube placement, the estimated pooled sensitivity and specificity were 0.98 (95% CI: 0.97-0.99) and 0.92 (95% CI 0.85-0.95), respectively. The pooled positive and negative likelihood ratios were 11.70 (95% CI: 6.49-21.07) and 0.02 (95% CI: 0.01-0.03), respectively. The diagnostic odds ratio of ultrasonography was 221.13, and the area under the HSROC curve revealed an appropriate accuracy of 0.99. CONCLUSIONS: Current evidence supports the use of ultrasonography as a worthwhile alternative for endotracheal tube identification for intubations performed in emergency departments. This method can be used in conjunction with capnography as a preliminary test before final confirmation with capnography.

The progress and controversies regarding steroid use in acute spinal cord injury.

Acute spinal cord injury (SCI) is a devastating disease that causes immense physical and mental harm to the patient and the family, and society and requires a multidisciplinary approach to treatment. The study of acute SCI has a long history but is still emerging. As the mechanism and pathophysiology of acute SCI are continuously being studied and explored, the treatment of SCI has developed significantly. Steroids are thought to provide neuroprotection in patients with acute SCI by improving perfusion, reducing edema, modulating inflammatory cells, and inhibiting lipid peroxidation, leading to their widespread application in clinical medicine. The use of steroids for SCI is controversial because of limited clinical evidence. With the accumulation of evidence on the effectiveness of steroid treatment in improving neurological function and the evidence of severe side effects, a gradual change in the treatment of SCI with steroids has become inevitable. Most scholars have focused on the routine use of steroids because of the indefinite improvement in neurological function and the occurrence of severe adverse events. Therefore, this review aims to provide an overview of the mechanism, progress, and related controversies to comprehensively understand the value and future direction of steroid application in acute SCI.

Transtracheal ultrasound for confirmation of endotracheal tube placement in the intensive care unit: a systematic review and meta-analysis.

OBJECTIVE: The major objective of this review was to compare the diagnostic accuracy of ultrasound in confirming tracheal intubation to the standard methods of confirmation in the intensive care unit (ICU). MATERIALS AND METHODS: This systematic review and meta-analysis of observational studies was conducted from inception to July 2022. We included studies that compared the diagnostic accuracy of ultrasound-detected tracheal intubation to that of the gold standard diagnostic technique performed in adult patients who underwent tracheal intubation as part of any procedure. We searched the following electronic databases for published studies: PubMed, EMBASE, Cochrane Central, and Web of Science. Risk of bias was assessed using a standard procedure based on the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. The results were analyzed using the RevMan or Meta-Disc software to determine the adequacy and conclusiveness of the available evidence. RESULTS: Five studies that included 344 patients met the inclusion criteria. Pooled sensitivity was 0.96 (95% confidence interval (CI) (0.92-0.98) and 1.00 (95% CI: 0.97-1.00), respectively. Furthermore, the diagnostic odds ratio of ultrasonography was 311.25 (95% CI: 63.77-1,519.22), which was confirmed by a summary receiver operating characteristic curve with an area under the curve of 0.98. CONCLUSIONS: Ultrasonography has high sensitivity and specificity, is a valuable adjunct for confirming tracheal intubation in the ICU and should be performed when capnography is unavailable or unreliable.

Advances in the application of ultrasound for fracture diagnosis and treatment.

Fractures are commonly encountered in clinical practice. Early diagnosis and individualized treatment are the basis for achieving high-quality fracture healing and functional recovery. Radiographic examinations play an important role in the diagnosis and treatment of fractures. In recent years, with the innovation in ultrasonic examination technology and equipment, its application in the diagnosis and treatment of fractures has greatly increased. Long bone, rib, radius and ulnar, metacarpal, cartilage, nasal bone, and occult are common fracture types. Ultrasound has long been used in fracture diagnosis and treatment. This narrative review summarizes and discusses the application of ultrasound in the diagnosis and treatment of fractures.

The diagnostic values of lung ultrasound for ARDS.

OBJECTIVE: Acute respiratory distress syndrome (ARDS) is a critical disease commonly found in many clinical cases, with a mortality rate of approximately 50%. Early diagnosis and intervention are important for improving ARDS prognosis. In this study, the applications of lung ultrasound in ARDS diagnosis and assessment are reviewed to clarify its key clinical values and application prospects. MATERIALS AND METHODS: According to the standard diagnosis of ARDS based on the Berlin definition, CXR or CT examination should be conducted. However, both the blurred images of the former, as well as the inconvenience and high risks of the latter, impose restrictions on their application in critically ill patients. RESULTS: Lung ultrasound was shown to improve safety, effectiveness, lacked radiation, can be performed bedside, and offers dynamic functionality. CONCLUSIONS: It may be a suitable approach to replace or complement traditional imaging examinations with lung ultrasound.

Diagnostic accuracy of ultrasonography for detecting gastric tube placement: an updated meta-analysis.

OBJECTIVE: This study aimed at reviewing the diagnostic accuracy of ultrasonography for detecting correct nasogastric tube placement compared with X-ray imaging as the reference standard. MATERIALS AND METHODS: This was a systematic review and meta-analysis of observational studies published between 1961 and 2022. We included studies that compared the diagnostic accuracy of ultrasound detection for nasogastric tube placement with that of X-ray imaging in adult patients who were undergoing nasogastric tube placement for any reason. We searched for published studies in the following electronic databases: Cochrane Library, PubMed, EMBASE, and Web of Science. The risk of bias was assessed using a standard procedure according to the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. The results were analyzed using RevMan or Meta-Disc software to determine the adequacy and conclusiveness of the available evidence. RESULTS: Fourteen studies met our inclusion criteria. Overall, 1,812 patients were included in these studies. The results included a pooled sensitivity of 0.96 (95% confidence interval [CI] 0.94-0.97), specificity of 0.91 (95% CI 0.85-0.96), positive likelihood ratio of 5.08 (95% CI 1.49-17.39), and negative likelihood ratio of 0.08 (95% CI 0.06-0.10). This was confirmed through a summary receiver operating characteristic curve, which showed that the area under the curve was 0.96. CONCLUSIONS: We found evidence about validity of ultrasound as an efficient method for verifying nasogastric tube placement, although there is insufficient evidence to suggest that it can be used as a diagnostic tool for incorrect gastric tube placement.

Application of point-of-care ultrasound in patients receiving enteral nutrition.

OBJECTIVE: Enteral nutrition (EN) is the first-choice nutritional support, as it is more in line with normal physiological processes. During EN, the major goals to achieve include accurate confirmation of the feeding tube position, monitoring the gastric residual volume, assessing gastrointestinal motility, and monitoring the nutritional status of patients. With rapid development in technology, point-of-care ultrasound (POCUS) has become a more convenient and effective technical tool for monitoring critically ill patients receiving EN. In this review, we have summarized and discussed the value of POCUS in the implementation, monitoring, and evaluation of EN therapy to provide a reference for nutritional support of critically ill patients in critical care settings. MATERIALS AND METHODS: This is a narrative review. A literature search for Scopus-indexed articles was performed randomly using PubMed and MEDLINE databases as the primary sources. No specific term was used for the search. RESULTS: POCUS can be used for positioning of nasogastric and nasointestinal tubes, evaluation of gastric residuals and gastrointestinal motility as well as monitoring of nutritional status. CONCLUSIONS: POCUS is a real-time, highly repeatable, radiation-free, and non-invasive visual inspection technique, with high application value in assessing the nutritional status of patients receiving EN and guiding the development of further nutritional treatment plans. It is an important diagnostic and monitoring tool that can be used by the clinicians in the ICU.

Ultrasound-guided short-axis out-of-plane vs. long-axis in-plane technique for radial artery catheterization: an updated meta-analysis of randomized controlled trials.

OBJECTIVE: Short-axis out-of-plane (SA-OOP) and long-axis in-plane (LA-IP) are the two major approaches used in ultrasound (US)-guided radial arterial catheterization. Nevertheless, their efficacy and safety remain controversial. Therefore, this meta-analysis aimed at comparing the two approaches for radial arterial catheterization. MATERIALS AND METHODS: The PubMed, Embase, and Cochrane Library databases were searched for relevant articles published from database inception until December 2020. We selected randomized controlled trials comparing the short- and long-axis methods for US-guided radial artery catheterization. The results were analyzed using RevMan software to determine the adequacy and conclusiveness of the available evidence. RESULTS: Six studies (725 patients) ultimately met the inclusion criteria. No significant difference was observed between the SA-OOP and LA-IP approaches for US-guided radial artery catheterization (relative risk [RR], 0.99; 95% confidence interval [CI], 0.96-1.03; p =0.61; I2=0%). The first-attempt success rate was similar between the two groups (relative risk [RR], 1.02; 95% CI, 0.79-1.32; p =0.90; I2=87%). The incidence of hematoma formation was similar between the two groups (RR, 1.91; 95% CI, 0.66-5.56; p =0.24; I2=77%). CONCLUSIONS: The SA-OOP approach does not increase the total or first-attempt success rate of radial artery catheterization using the LA-IP approach. More highly powered well-designed trials are needed to evaluate additional outcomes.

Effects of treatment processes on AOC removal and changes of bacterial diversity in a water treatment plant.

The effectiveness of different treatment processes on assimilable organic carbon (AOC) removal and bacterial diversity variations was evaluated in a water treatment plant. The van der Kooij technique was applied for AOC analysis and responses of bacterial communities were characterized by the metagenomics assay. Results show that the AOC concentrations were about 93, 148, 43, 51, 37, and 38 µg acetate-C/L in effluents of raw water basin, preozonation, rapid sand filtration (RSF), ozonation, biofiltration [biological activated carbon (BAC) filtration], and chlorination (clear water), respectively. Increased AOC concentrations were observed after preozonation, ozonation, and chlorination units due to the production of biodegradable organic matters after the oxidation processes. Results indicate that the oxidation processes were the main causes of AOC formation, which resulted in significant increases in AOC concentrations (18-59% increment). The AOC removal efficiencies were 47, 28, and 60% in the RSF, biofiltration, and the whole system, respectively. RSF and biofiltration were responsible for the AOC treatment and both processes played key roles in AOC removal. Thus, both RSF and biofiltration processes would contribute to AOC treatment after oxidation. Sediments from the raw water basin and filter samples from RSF and BAC units were collected and analyzed for bacterial communities. Results from scanning electron microscope analysis indicate that bacterial colonization was observed in filter materials. This indicates that the surfaces of the filter materials were beneficial to bacterial growth and AOC removal via the adsorption and biodegradation mechanisms. Next generation sequencing analyses demonstrate that water treatment processes resulted in the changes of bacterial diversity and community profiles in filters of RSF and BAC. According to the findings of bacterial composition and interactions, the dominant bacterial phyla were Proteobacteria (41% in RSF and 56% in BAC) followed by Planctomycetes and Acidobacteria in RSF and BAC systems, which might affect the AOC biodegradation efficiency. Results would be useful in developing AOC treatment and management processes in water treatment plants.

Ultrasound-guided radial artery catheterization at different sites: a prospective and randomized study.

OBJECTIVE: Herein, we aimed to compare ultrasound (US)-guided radial artery catheterization at the wrist joint and mid-forearm level to evaluate the success rate of US-guided radial artery catheterization at the mid-forearm level. PATIENTS AND METHODS: This prospective randomized controlled study included 240 consecutive patients who were admitted to the intensive care unit of Taizhou Hospital of Integrated Traditional Chinese and Western Medicine and underwent radial artery catheterization between January 1, 2019, and October 1, 2021. All patients were randomly allocated to the mid-forearm and wrist groups, with 120 patients in each group. Patients in the mid-forearm and wrist groups underwent out-of-plane US-guided radial artery catheterization at wrist and mid-forearm levels, respectively. The overall success rate, first-attempt success rate, and related complications were recorded and compared between the two groups. RESULTS: The first-attempt success rate and overall success rate of radial artery catheterization were significantly higher in the mid-forearm group than in the wrist group (75.0% vs. 60.0%, p=0.013; 90.8% vs. 80.8, p =0.026, respectively). The incidence of hematoma was significantly lower in the mid-forearm group than in the wrist group (9.2% vs. 28.3%, p <0.001). CONCLUSIONS: US-guided radial artery catheterization at the mid-forearm level increased the first-attempt success rate and overall success rate, decreased the incidence of hematoma during puncture, and improved nurse satisfaction. This puncture site may afford a new choice to replace the traditional wrist site.

Slow light nanocoatings for ultrashort pulse compression.

Transparent materials do not absorb light but have profound influence on the phase evolution of transmitted radiation. One consequence is chromatic dispersion, i.e., light of different frequencies travels at different velocities, causing ultrashort laser pulses to elongate in time while propagating. Here we experimentally demonstrate ultrathin nanostructured coatings that resolve this challenge: we tailor the dispersion of silicon nanopillar arrays such that they temporally reshape pulses upon transmission using slow light effects and act as ultrashort laser pulse compressors. The coatings induce anomalous group delay dispersion in the visible to near-infrared spectral region around 800 nm wavelength over an 80 nm bandwidth. We characterize the arrays' performance in the spectral domain via white light interferometry and directly demonstrate the temporal compression of femtosecond laser pulses. Applying these coatings to conventional optics renders them ultrashort pulse compatible and suitable for a wide range of applications.

Colorectal anastomosis after laparoscopic extended left colectomy: techniques and outcome.

AIM: After extended left colectomy, traditional colorectal anastomosis is often not feasible because of insufficient length of the remaining colon to perform a tension-free anastomosis. Total colectomy with ileorectal anastomosis could be an alternative but this can lead to unsatisfactory quality of life. Trans-mesenteric colorectal anastomosis or inverted right colonic transposition (the so-called Deloyers procedure) are two possible solutions for creating a tension-free colorectal anastomosis after extended left colectomy. Few studies have reported their results of these two techniques and mostly via laparotomy. The aim of this study was to describe the trans-mesenteric colorectal anastomosis and the inverted right colonic transposition procedure via a laparoscopic approach and report the outcome in a series of 13 consecutive patients. METHOD: This was retrospective chart review of laparoscopic colorectal surgery with trans-mesenteric colorectal anastomosis or the inverted right colonic transposition procedure from January 2015 up to 2019. An accompanying video demonstrates these two techniques. RESULTS: Thirteen consecutive patients underwent either a laparoscopic trans-mesenteric colorectal anastomosis (n = 9) or an inverted right colonic transposition procedure (n = 4). One patient had intra-operative presacral bleeding that was stopped successfully without conversion. Two patients had a postoperative intra-abdominal abscess, but no anastomotic complications were recorded. The median number of bowel movements per day after 6 months was 2 (range 2-5). CONCLUSIONS: Trans-mesenteric colorectal anastomosis or the inverted right colonic transposition procedure is feasible laparoscopically. The now well-established classical advantages of the laparoscopic approach are associated with good functional outcome after these procedures.

Long non-coding RNAs associated with oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is one of the most common and fatal diseases in the head and neck region worldwide. To better understand the carcinogenesis and to find efficient biomarkers and therapeutic targets are still in urgent need. The studies of expression profile and mechanisms of long non-coding RNAs (lncRNAs) develop fast in recent years. This molecule form is aberrantly expressing and influencing many cellular processes in different cancer types. But its expression pattern and association with oral squamous cell carcinoma are yet to be elucidated. Here we reviewed recently reported OSCC-related lncRNAs and their relationship with the clinical status of patients. Functional mechanisms were also discussed. With the emerging knowledge and techniques in this area, more efficient biomarkers and therapeutic targets are promising in the future.

[Relationship between expression level of sex-determining region Y box 9 and metastasis of oral squamous cell carcinoma].

Objective: To investigate the effects of sex-detemining region Y box9 (SOX9) expression levels on the proliferation, migration and metastasis in oral squamous cell carcinoma (OSCC). Methods: A total of 74 OSCC pathological specimens were collected from Shanghai OSCC Tissue and Biological Informations Bank, and clinicopathological information of these specimens were collected. Immunohistochemistry assay was used to examine the expression levels of SOX9 in OSCC and to analyze their relationship with clinicopathological features. Cell counting kit-8 assay and cloning formation was used to observe the relationship between the expression levels of SOX9 and the proliferation of OSCC. Transwell experiment and scratch test were used to detect the difference of the ability of OSCC in cell lines with different expression levels of SOX9. Results: The risk of lymph node metastasis in patients with high expression of SOX9 was significantly increased (P=0.010). In the Transwell experiment, the number of HN6 cells (671.0±57.4, P=0.000) migrated to the lower chamber more than that of CAL27 cells (172.0±13.9). In the scratch experiment, HN6 cells [0 h: (93.7±2.1) µm; 6 h: (56.7±2.5) µm; 12 h: (29.7±3.1) µm] migrated faster than CAL27 [0 h: (93.7±1.5) µm; 6 h: (78.0±2.0) µm; 12 h: (42.0±3.0) µm](P<0.05). The migration ability of the cell line (HN6) with high-expression of SOX9 was significantly higher than that in cell line (CAL27) with low-expression SOX9 (P<0.05). The expression levels of SOX9 in OSCC were no significant on cell proliferation (P>0.05). Conclusions: High expression of SOX9 can promote the migration and lymph node metastasis of OSCC. SOX9 is a candidate gene target for the diagnosis and intervention of lymph node metastasis in OSCC.

Impact of socioeconomic status on vision-related quality of life in primary open-angle glaucoma.

PurposeTo investigate the impact of socioeconomic status (SES) on vision-related quality of life (VRQOL) in patients with primary open-angle glaucoma (POAG).Patients and methodsThis prospective cross-sectional study included consecutive patients with POAG at a tertiary hospital between March 2012 and January 2013. All patients had visual acuity no worse than 20/60 in the better eye and reliable visual field tests. VRQOL was assessed by the validated Taiwan version 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25). Sociodemographic characteristics, medical history, and ocular parameters were recorded. SES was evaluated based on educational attainment and monthly income, both stratified into three levels. Analysis of variance and linear regression analysis were used to evaluate the relationship between SES, VRQOL, and clinical parameters.ResultsAmong the 186 patients recruited, intergroup differences were not observed among educational or monthly income levels for binocular vision or integrated visual field defects. Patients of lower educational and monthly income levels had lower self-reported general health ratings. After adjustment for visual function, treatment complexity, and general health in the multiple linear regression model, patients with a college degree or higher reported better NEI VFQ-25 scores for the composite score (P=0.041), mental health (P=0.035), and peripheral vision (P=0.05) than did those with education below junior high school. Monthly income levels did not affect the NEI VFQ-25 scores.ConclusionEducational attainment significantly affects VRQOL in patients with POAG. Additional counseling may be provided to patients with lower educational background to help them cope with the disease.