Objective To understand the characteristics of molecular epidemiology of enterovirus 71(EV71) in children with hand, foot and mouth disease (HFMD) in Shanghai area during the first half year of 2009. Methods Seventy-three throat swabs and 38 stool samples were collected from 95 hospitalized children with clinical diagnosis of HFMD in Children's Hospital of Fudan University during April to May 2009. TaqMan real-time reverse transcription-polymerase chain reaction (RT-PCR) and nest RT-PCR were used to detect EV71 VP1, followed by gene sequencing analysis. Results Six of the 73 throat swabs were EV71 positive with the detection rate of 8.2%. In the 38 stool samples, 24 were EV71 positive with the detection rate of 63.2%. Twenty-eight nested RT-PCR positive samples were sequenced and the genetic analysis showed that 27 were C4 subtype,which were absolute dominant strain and the other one was C2 subtype. The isolated strain from a fatal case was C4 subtype and there was no obvious mutation found in VP1 region. Conclusions EV71 is an important pathogen in HFMD children in Shanghai area during April to May 2009. C4 subtype strains are absolutely dominant, and accompanied by epidemic strains of subtype C2.

Objective To evaluate the diagnostic value of MRI for meniscal bucket-hanle tears. Methods 21patients with bucket-handle tears and 11 patients without bucket-handle tears were put under MRI examinations with the dedicated MRI system(Artoscan 0.2T ESAOTE) and confirmed by arthroscopy.Each was accessed for the presence of (1) the double-anterior sign,(2)the double posterior cruciate ligament sign,(3)the fragment within the intercondylar notch sign and (4)the absent bow tie sign.Results Of 33 cases, the double-anterior sign were seen in 10 cases, the double posterior cruciate ligament sign were seen in 5 cases,the fragment within the intercondylar notch sign were seen in 20 cases and the absent bow tie sign were seen in 25 cases. Conclusion MRI plays an important role in the diagnosis of meniscal bucket-handle tears.The sensitivity and specificity of medial meniscal bucket-handle tears are higher than that of lateral meniscus. The fragment within the intercondylar notch sign is the most valuable sign in diagnosing meniscal bucket-handle tears.

Objective To investigate the initial effect of LARS artificial ligaments arthroscopically in reconstruction of ipsilateral anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL).Methods A total of 21 patients (13 males and 8 females,at average age of 31.5 years) received ACL and PCL restoration using LARS artificial ligaments since June 2006.Preoperative MRI exactly confirmed them as ACL and PCL ruptures.Lysholm score on knee joint was (47.6 ±6.7) points.Surgery had reconstruction of PCL prior to ACL under arthroscope.Results All patients were followed up for average 42 months (range,36-49 months),which showed no infection,ligament rupture,ligament loosening,or other postoperative complications.At postoperative 3 years,Lysholm score was (90.8 ± 3.7) points and International Knee Documentation Committee (IKDC) score was normal in 14 patients,near normal in six,and abnormal in one,with excellent-good rate of 95％.Conclusions LARS artificial ligaments can attain anatomical reconstruction and stability of the knee joint in treatment of ACL and PCL ruptures.Meanwhile,arthroscopic surgery shows superiorities of micro-wound,rapid recovery and satisfactory curative effect.

Objective To discuss the operation skills and clinical effects of C-arm fluoroscopy in arthroscopic reconstruction of anterior cruciate ligament(ACL)with the Ligament Advancement Reinforcement System(LARS)artificial ligaments.Methods The study involved 36 patients with acute ACL rupture treated with the LARS artificial ligaments from June 2006.There were 25 males and 11 females,at age range of 22-51 years(average 28.3 years),involving 19 left knees and 17 right knees.The results of preoperative MRI of all patients suggested discontinuation of ACL,with average score of Lysholm on knee joint for 50.The operation was completed under arthroscope.While the locations of the femoral tunnel portal and the tibial tunnel exit were mainly determined by the C-arm fluoroscopy.The diameter of the LARS artificial ligament was 7.5 mm while that of the interference screw 8 mm.Results All 36 patients were followed up for a mean duration of 18 months(9-20 months).The average Lysholm Score was 52 preoperatively and 92 at the 12th week after operation.The clinical results were graded as excellent in 23 patients,good in nine and fair in four according to the Lysholm's classification,with excellence rate of 89%.Conclusions Arthroscopic reconstruction of anterior cruciate ligament with LARS artifical ligament under C-arm fluoroscopy takes advantages of convenient operation,accurate location and satisfactory clinical effect.

BACKGROUND: Autogenous bone has been used in cervical vertebra graft bone fusion in earliest stage and at most. However, its source is limited, simultaneously, induced many complications such as infection, hemorrhage and postoperative pain in the donor bone region. Recently, above-mentioned complications were avoided or reduced with the usage of new graft bone fusion material. OBJECTIVE: To compare clinical efficacy using MC+~R combination of autogenous bone or calcium sulfate artificial bone in antador cervical fusion.METHODS: A total of 26 patients (34 levels) with cervical spondylotic myelopathy underwent anterior cervical discectomy and cervical intervertebral fusion from January to December 2008. Anterior cervical oblique cut was 3.0-4.0 cm. The endplate were preserved after the cervical intervertebral disc and the posterior longitudinal ligament were removed. Autogenous bone group was filled with autogenous bone. Calcium sulfate artificial bone group was filled with Wdght's Osteoset artificial bone. Anchoring clip was implanted between the cervical vertebrae. Every patient had a short neck incision was assessed with X-ray, JOA grade and Odom's evaluation scale.RESULTS AND CONCLUSION: The two groups of 26 patients (34 segments)were followed up. The JOA score of postoperation was no significant difference between the two groups. According to the Odom's evaluation scale, the excellent and good rate of calcium sulfate group was higher than autogenous bone group, but there was not statistical significance (P>0.05). The fusion rate of autogenous bone group was higher than calcium sulfate group at 3 and 6 months, but the fusion rate of two groups were 100% at 12 months. Although the calcium sulfate group at 6 months, lordosis angle lost more than 0.4°than the autogenous bone group,but no significant statistically between the two groups (P>0.05). MC+ combination of autogenous bone or Calcium sulfate had the same clinical efficacy in the treatment of cervical spondylotic myelopathy, but the calcium sulfate artificial bone could be effectively avoided the complications of donor site.

Objective To explore clinical characteristic of metal-on-metal hip joint prosthesis with large heads(ASRTMXL).Methods Total hip arthroplasty(THA)with ASRTMXL was performed in 14 patients including two with ankylosing spondylitis combined with hip amalgamation,three with avascular necrosis,two with secondary osteoarthritis and seven with femoral neck fractures.Based on shortterm follow-up results,we analyzed its design characteristic and clinical properties.Results All patients walked with crotches one week after operation and began weight bearing without support six weeks later.An improvement was seen on the average range of motion of the hip including anteflexion,retroextension,internal rotation,external rotation,adduction and abduction.The mean Harris score was increased from precperative 30 points(13-50 points)to postoperative 90 points(75-100 points),with statistical difference.Postoperative X-ray showed right positions of the prostheses,normal abduction angle and anteversion angle,without complications cccurred.Condusion Short-term follow-up results show that metal-on-metal hip joint prosthesis with large heads has advantages of lower wearing,large range of motion,few dislocation and small deformation of acetabular cup.

Objective To explore the treatment of children with EB virus infection accompanied by facial paralysis. Method The clinical data of a child with EB virus infection accompanied by facial paralysis was analyzed retrospectively, and the related literature were reviewed. Results A 2-year-old boy was admitted to hospital due to fever and mouth askew for 4 days. After admission, he was confirmed to have EB virus infection and viremia by serology and polymerase chain reaction, and then treated with acyclovir. The symptoms of facial paralysis and EB viremia disappeared completely 14 days after antiviral treatment. There was no recurrence in the short-term follow-up. Interestingly, the literature analysis shows that there is still limited evidence for the antiviral treatment by acyclovir in children with acute infection of EB virus associated with facial paralysis. Conclusion Antiviral treatment may be beneficial to EB viremia with facial paralysis.

Folic acid belongs to the group of water-soluble B vitamins and naturally exists in multiple forms in a wide variety of foods such as legumes, vegetables, liver, and milk (Iyer and Tomar, 2009; Lyon et al., 2020). It is involved in many biochemical reactions critical for cell division, such as purine and pyrimidine biosynthesis, DNA/RNA biosynthesis, and amino acid metabolism (Iyer and Tomar, 2009). Mammals cannot synthesize folic acid and thus they must acquire it from food. Although folic acid is ubiquitous in foods, folic acid deficiency still often occurs due to various causes such as unhealthy diet (Hildebrand et al., 2021; Iimura et al., 2022), disease-related malabsorption (Arcot and Shrestha, 2005), medication-related depletion (Arcot and Shrestha, 2005), or vitamin B12 deficiency (Fishman et al., 2000). Folic acid deficiency has been associated with several health problems, such as anemia (Carmel, 2005; Bailey and Caudill, 2012), cancer (Duthie, 1999), cardiovascular diseases (Wald et al., 2002), neural tube defects in newborns (van der Put et al., 2001), neuropsychiatric dysfunction (Shea et al., 2002), depression (Falade et al., 2021), inflammatory diseases (Suzuki and Kunisawa, 2015; Jones et al., 2019), and eye diseases (Sijilmassi, 2019). To prevent folic acid deficiency, its daily intake (400 μg/d) has been recommended for adults in the European Union, and its increased intake (600 μg/d) is advised for women before and during pregnancy (FAO/WHO, 2002; IOM, 2004). The New Zealand government mandated the fortification of non-organic wheat flour with folic acid in July 2021, and the UK government mandated the fortification of non-wholemeal wheat flour with folic acid in September 2021 (Haggarty, 2021).
Adult ; Animals ; Female ; Flour ; Folic Acid/metabolism* ; Folic Acid Deficiency/prevention & control* ; Food, Fortified ; Humans ; Infant, Newborn ; Mammals/metabolism* ; Pregnancy ; Triticum/metabolism*

Objective:To explore the clinical value of a trinity strategy for the treatment of multiple orthopedic trauma.Methods:A retrospective case series study was conducted to analyze the clinical data of 1 267 patients with multiple orthopedic trauma admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the First Affiliated Hospital of Navy Medical University from June 2013 to May 2023, including 862 males and 405 females, aged 18-93 years [(55.2±19.8)years]. Associated injuries included hemorrhagic shock in 632 patients, traumatic wet lung in 274, cranial injuries in 135, abdominal and pelvic bleeding in 116, pneumothorax in 89, urinary injury in 13, and vesical rupture in 8. All the patients were treated with the trinity strategy and the treatment process was divided into the phases of first aid, remodeling, and rehabilitation. The first aid phase focused on stabilizing symptoms and saving lives; the remodeling phase centered on restoring the anatomical structure and alignment; the rehabilitation phase aimed for functional recovery through the integration of both Western and traditional Chinese medicine. The all-cause mortality within 30 days after surgery and fracture healing time were calculated; the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, Hospital for Special Surgery (HSS) knee score and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at the last follow-up and the overall excellent and good rate of all joint function scores were measured. The short form health survey (SF-36) scores were collected preoperatively and at 6 months postoperatively, including 8 aspects such as physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health. The incidence of postoperative complications was recorded.Results:All the patients were followed up for 6-18 months [(10.2±4.2)months]. The mortality rate during the acute phase (within 30 days after surgery) was 2.37% with 12 deaths due to hemorrhagic shock, 10 due to traumatic brain injury, 6 due to multiple organ dysfunction syndrome (MODS), and 2 due to pulmonary infection. The average fracture healing time averaged 3.8-18 months [(11.5±4.2)months], with 89.49% of the patients having bone union within 12 months after surgery, 8.93% having bone union within 18 months after surgery, and 1.58% undergoing reoperation. For the patients with internal fixation failure and nonunion, the average healing time was extended to (10.2±2.2)months and (13.7±3.3)months respectively. At the last follow-up, the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, HSS knee score, and AOFAS ankle-hindfoot score were 83.93%, 90.24%, 94.12%, 85.57%, 88.46%, and 92.31% respectively, with an overall excellent and good rate of 89.11%. At 6 months after surgery, the SF-36 scores of all the patients in the eight dimensions,including the physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health were (74.4±8.6)points, (44.7±14.4)points, (77.4±10.9)points, (68.4±18.2)points, (72.5±16.0)points, (76.8±8.7)points, (49.9±17.6)points, and (72.8±17.9)points, significantly improved compared with those before operation [(63.4±12.7)points, (30.9±17.4)points, (56.4±18.0)points, (55.4±24.7)points, (53.5±21.0)points, (55.8±24.3)points, (36.9±24.0)points, (58.8±21.6)points] ( P<0.01). Complications of different degrees occurred in 214 patients (16.89%), including lung infections in 118 patients (9.31%), lower extremity deep vein thrombosis in 50(3.95%), pressure injuries in 26(2.05%), internal fixation failure in 12(0.95%), and nonunion in 8(0.63%). Conclusions:The trinity strategy provides whole-process management, personalized treatment, and overall rehabilitation for multiple orthopedic trauma. It can decrease mortality, shorten fracture healing time, improve joint function and quality of life, and reduce the incidence of complications.

With the gradual maturity of sequencing technology, many microbiome studies have published, driving the emergence and advance of related analysis tools. R language is the widely used platform for microbiome data analysis for powerful functions. However, tens of thousands of R packages and numerous similar analysis tools have brought major challenges for many researchers to explore microbiome data. How to choose suitable, efficient, convenient, and easy-to-learn tools from the numerous R packages has become a problem for many microbiome researchers. We have organized 324 common R packages for microbiome analysis and classified them according to application categories (diversity, difference, biomarker, correlation and network, functional prediction, and others), which could help researchers quickly find relevant R packages for microbiome analysis. Furthermore, we systematically sorted the integrated R packages (phyloseq, microbiome, MicrobiomeAnalystR, Animalcules, microeco, and amplicon) for microbiome analysis, and summarized the advantages and limitations, which will help researchers choose the appropriate tools. Finally, we thoroughly reviewed the R packages for microbiome analysis, summarized most of the common analysis content in the microbiome, and formed the most suitable pipeline for microbiome analysis. This paper is accompanied by hundreds of examples with 10,000 lines codes in GitHub, which can help beginners to learn, also help analysts compare and test different tools. This paper systematically sorts the application of R in microbiome, providing an important theoretical basis and practical reference for the development of better microbiome tools in the future. All the code is available at GitHub github.com/taowenmicro/EasyMicrobiomeR.
Software ; Microbiota ; Sequence Analysis, DNA ; Language