Objective:To investigate the impact of aging on the correlation between the intestinal microorganism Akkermansia and obesity, and to analyze the features of the correlation in the elderly population. Methods:This was a cross-sectional study.A total of 6896 cases were collected from the Guangdong intestinal microbiome in 2018, aged 18-94 years old, including 3806 females, 1641 cases with abdominal obesity(23.7%)and 707 cases with systemic obesity(10.3%). The 16S rRNA sequencing data were from individuals of Cantonese descent.The abundance of Akkermansia was calculated after data cleaning, clustering and annotation.The type of abdominal obesity or systemic obesity was diagnosed based on the standards of the Working Group on Obesity in China(2002). According to the five quintiles of the abundance of Akkermansia, subjects were divided into Q1~Q5(Q1-Q4: n=1379, Q5: n=1380). Logistic regression was used to study the relationship between Akkermansia and obesity after adjusting for common confoundors such as gender.Subjects were subgrouped into two types of age groups: the <65 group(n=5467)and the ≥65 group(n=1519); the <70 group(n=6136)and the ≥70 group(n=850). Age windows were used to analyze changes in characteristics of this relationship with increasing age. Results:There were significant differences in age and gender among different Akkermansia groups( t/ χ2=3.51, -5.03, P<0.01). Logistic regression analysis showed that after adjusting for two main confounding factors, age and gender, the risk of systemic obesity and abdominal obesity gradually decreased from Q2 to Q5 group, compared with Q1 group( P<0.001). The correlation between Akkermansia and obesity decreased with age.The protective effect of Akkermansia on obesity was weaker in the ≥65 and ≥70 groups, respectively, than in the <65 and <70 groups. Conclusions:Akkermansia is a protective factor for obesity, but the protective effect is affected by aging and weakened in the elderly.

Objective:To investigate the clinical application of the free medial plantar artery perforator flap for soft tissue defect reconstruction of the weight-bearing surface of the heel.Methods:The clinical data of patients with soft tissue defects in the weight-bearing surface of the heel were analyzed retrospectively, which were reconstructed with the free medial plantar artery perforator flaps in the Second Hospital of Tangshan from April 2011 to November 2017. The medial plantar artery was anastomosed with the posterior tibial artery. The venae comitantes were anastomosed with the great saphenous vein. The cutaneous branch of the medial plantar nerve was also anastomosed with the saphenous nerve. The donor sites were covered with full-thickness skin grafting. The survival condition, sensory function, countour, stability, and donor site scars were observed during follow-up.Results:A total of 11 patients with soft tissue defects in the weight-bearing surface of the heel were enrolled. There were six males and five females aged 24-41 years (mean, 31.3 years). All flaps survived uneventfully. Patients were followed up 11-56 months (mean 18.5 months). The appearance and function recovery of the flaps were satisfactory with 6-13 mm two-point discrimination(2-PD). No ulcer occurred. All patients returned to a normal walk.Conclusions:It is a feasible way for one-staged reconstruction of the combined loss of Achilles tendon and soft tissue in the heel by using free anterolateral femoral artery perforator flap with fascia lata, which has the advantages of good functional recovery, less trauma, short curing course, the satisfactory contour, and protective sensation achievable.

Objective:To investigate the clinical application of the free medial plantar artery perforator flap for soft tissue defect reconstruction of the weight-bearing surface of the heel.Methods:The clinical data of patients with soft tissue defects in the weight-bearing surface of the heel were analyzed retrospectively, which were reconstructed with the free medial plantar artery perforator flaps in the Second Hospital of Tangshan from April 2011 to November 2017. The medial plantar artery was anastomosed with the posterior tibial artery. The venae comitantes were anastomosed with the great saphenous vein. The cutaneous branch of the medial plantar nerve was also anastomosed with the saphenous nerve. The donor sites were covered with full-thickness skin grafting. The survival condition, sensory function, countour, stability, and donor site scars were observed during follow-up.Results:A total of 11 patients with soft tissue defects in the weight-bearing surface of the heel were enrolled. There were six males and five females aged 24-41 years (mean, 31.3 years). All flaps survived uneventfully. Patients were followed up 11-56 months (mean 18.5 months). The appearance and function recovery of the flaps were satisfactory with 6-13 mm two-point discrimination(2-PD). No ulcer occurred. All patients returned to a normal walk.Conclusions:It is a feasible way for one-staged reconstruction of the combined loss of Achilles tendon and soft tissue in the heel by using free anterolateral femoral artery perforator flap with fascia lata, which has the advantages of good functional recovery, less trauma, short curing course, the satisfactory contour, and protective sensation achievable.