Emerging evidence suggests that dysbiosis of the gut microbiota is associated with the pathogenesis of Parkinson's disease (PD), a prevalent neurodegenerative disorder. The microbiota-gut-brain axis plays a crucial role in the development and progression of PD, and numerous studies have demonstrated the potential therapeutic benefits of modulations in the intestinal microbiota. This review provides insights into the characterization of the gut microbiota in patients with PD and highlights associations with clinical symptoms and underlying mechanisms. The discussion underscores the increased influence of the gut microbiota in the pathogenesis of PD. While the relationship is not fully elucidated, existing research demonstrates a strong correlation between changes in the composition of gut microbiota and disease development, and further investigation is warranted to explain the specific underlying mechanisms.
Humans ; Parkinson Disease/microbiology* ; Gastrointestinal Microbiome/physiology* ; Dysbiosis/microbiology*

Objective:Differences between randomized controlled trial (RCT) results and real world study (RWS) results may not represent a true efficacy-effectiveness gap because efficacy-effectiveness gap estimates may be biased when RWS and RCT differ significantly in study design or when there is bias in RWS result estimation. Secondly, when there is an efficacy- effectiveness gap, it should not treat every patient the same way but assess the real-world factors influencing the intervention's effectiveness and identify the subgroup likely to achieve the desired effect.Methods:Six databases (PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP) were searched up to 31 st December 2022 with detailed search strategies. A scoping review method was used to integrate and qualitatively describe the included literature inductively. Results:Ten articles were included to discuss how to use the RCT research protocol as a template to develop the corresponding RWS research protocol. Moreover, based on correctly estimating the efficacy-effectiveness gap, evaluate the intervention effect in the patient subgroup to confirm the subgroup that can achieve the expected benefit-risk ratio to bridge the efficacy-effectiveness gap.Conclusion:Using real-world data to simulate key features of randomized controlled clinical trial study design can improve the authenticity and effectiveness of study results and bridge the efficacy-effectiveness gap.

Objective:Randomized controlled trials (RCT) usually have strict implementation criteria. The included subjects' characteristics of the conditions for the intervention implementation are quite different from the actual clinical environment, resulting in discrepancies between the risk-benefit of interventions in actual clinical use and the risk-benefit shown in RCT. Therefore, some methods are needed to enhance the extrapolation of RCT results to evaluate the real effects of drugs in real people and clinical practice settings.Methods:Six databases (PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP) were searched up to 31 st December 2022 with detailed search strategies. A scoping review method was used to integrate and qualitatively describe the included literature inductively. Results:A total of 12 articles were included. Three methods in the included literature focused on: ①improving the design of traditional RCT to increase population representation; ②combining RCT Data with real-world data (RWD) for analysis;③calibrating RCT results according to real-world patient characteristics.Conclusions:Improving the design of RCT to enhance the population representation can improve the extrapolation of the results of RCT. Combining RCT data with RWD can give full play to the advantages of data from different sources; the results of the RCT were calibrated against real-world population characteristics so that the effects of interventions in real-world patient populations can be predicted.

In recent years, the number of patients with vaginal relaxation has increased year by year, and the minimally invasive vaginal contraction has been carried out more and more widely in clinical practice, but the treatment normalization and safety have not been thoroughly studied. We summarized six cases of characteristics and treatment measures for patients with various complications after minimally invasive vaginal contraction surgery from September 2021 to December 2023 at Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital. The patients' age ranged from 26 to 44 years. Two cases accepted vaginal contraction with embedded vaginal thread, and four accepted vaginal contraction with acellular allogenic dermis. One patient showed vaginal hyper-tightness, one patient showed subcutaneous suture nodules, two patients showed explosion of acellular allogenic dermis, and three patients showed vaginal infection symptoms such as yellow leucorrhea and peculiar smell. All patients had sexual pain and discomfort. One patient underwent vaginal orifice dilation, one patient underwent suture extraction and secondary vaginal contraction, one patient underwent acellular allogenic dermis extraction and immediate vaginal contraction, two patients underwent acellular allogenic dermis extraction and secondary vaginal contraction, and one patient underwent secondary vaginal contraction. The symptoms of all six patients were relieved after treatment. Despite the short operation time and fast postoperative recovery of minimally invasive vaginal contraction, there are still complications after surgery, causing physical and mental damage to patients. Plastic surgeons, therefore, should be cautious in the treatment process to avoid collateral damage, so that patients get the best treatment effect.

In recent years, the number of patients with vaginal relaxation has increased year by year, and the minimally invasive vaginal contraction has been carried out more and more widely in clinical practice, but the treatment normalization and safety have not been thoroughly studied. We summarized six cases of characteristics and treatment measures for patients with various complications after minimally invasive vaginal contraction surgery from September 2021 to December 2023 at Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital. The patients' age ranged from 26 to 44 years. Two cases accepted vaginal contraction with embedded vaginal thread, and four accepted vaginal contraction with acellular allogenic dermis. One patient showed vaginal hyper-tightness, one patient showed subcutaneous suture nodules, two patients showed explosion of acellular allogenic dermis, and three patients showed vaginal infection symptoms such as yellow leucorrhea and peculiar smell. All patients had sexual pain and discomfort. One patient underwent vaginal orifice dilation, one patient underwent suture extraction and secondary vaginal contraction, one patient underwent acellular allogenic dermis extraction and immediate vaginal contraction, two patients underwent acellular allogenic dermis extraction and secondary vaginal contraction, and one patient underwent secondary vaginal contraction. The symptoms of all six patients were relieved after treatment. Despite the short operation time and fast postoperative recovery of minimally invasive vaginal contraction, there are still complications after surgery, causing physical and mental damage to patients. Plastic surgeons, therefore, should be cautious in the treatment process to avoid collateral damage, so that patients get the best treatment effect.

Objective:To investigate the application effect of case-based collaborative learning (CBCL) based on data-information-knowledge-wisdom (DKIW) model in the training of the informatization teaching ability of clinical teachers.Methods:From March to August in 2022, 71 clinical teachers from four grade A tertiary hospitals in Tianjin, China, were selected as subjects and were randomly divided into control group with 35 patients and experimental group with 36 patients using a random number table. The teachers in the control group received blended teaching online and offline, and those in the experimental group received CBCL teaching based on DIKW model. The two groups were compared in terms of theoretical assessment score, informatization teaching demonstration score, and informatization teaching ability score before and after intervention. SPSS 27.0 was used for the t-test and the Mann-Whitney U rank sum test. Results:Compared with the control group after intervention, the experimental group had significantly higher scores of theoretical assessment (83.50±3.11) and informatization teaching demonstration (84.19±1.89) ( P<0.05). After intervention, the control group had significant increases in the total score of informatization teaching ability (74.34±4.08) and the scores of each dimension (15.40±1.19, 19.29±1.62, 28.54±1.67, and 11.11±1.79), and the experimental group also had significant increases in the total score of informatization teaching ability (83.64±5.25) and the scores of each dimension (16.53±1.21, 20.94±1.98, 33.03±2.10, and 13.14±1.48); the experimental group had significantly higher scores than the control group ( P<0.05). Conclusions:The CBCL teaching model based on DIKW model can help to improve the comprehensive informatization teaching ability of clinical teachers.

Objective:To investigate the clinical characteristics and management status of children with Turner syndrome (TS) in China.Methods:As a cross-sectional study, 1 089 TS patients were included in the database of the National Collaborative Alliance for the Diagnosis and Treatment of Turner Syndrome from August 2019 to November 2023. Clinical characteristics (growth development, sexual development, organ anomalies, etc.), karyotypes, auxiliary examinations, and treatments were collected and analyzed.Results:Among the 1 089 TS cases, 809 were recorded karyotypes. The karyotype distribution was as follows: 45, X in 317 cases (39.2%), X chromosome structural variants (including partial deletions of p or q arm, ring chromosome, and marker chromosome) in 89 cases (11.0%), 45, X/46, XX mosaicism in 158 cases (19.5%), mosaicism with X chromosome structural variants in 209 cases (25.8%), and presence of Y chromosome material in 36 cases (4.4%). Among the 824 TS cases, the age of diagnosis was 9.7(6.4, 12.2) years, with a height standard deviation score (HtSDS) of -3.1±1.2. Five hundred and fifty three cases underwent growth hormone (GH) stimulation test, and 352 cases (63.7%) had GH peak values <10 μg/L and 75.9% (577/760) had low IGF1 levels, with IGF1 SDS ≤-2 accounting for 38.2% (290 cases). Among 471 cases aged ≥8 years, 132 cases (28.0%) showed spontaneous sexual development (mean bone age (11.0±1.7) years), 10 cases had spontaneous menarche (mean bone age (12.0±2.2) years), and 2 cases had regular menstrual cycles. Common physical features included cubitus valgus (311 cases (28.5%)), neck webbing (188 cases (17.2%)), low posterior hairline (185 cases (17.0%)), shield chest (153 cases (14.0%)), high arched palate (127 cases (11.6%)), short fourth metacarpal (43 cases (3.9%)), and spinal abnormalities (38 cases (3.5%)). Congenital cardiovascular and urogenital anomalies occurred in 91 cases (19.4%) and 66 cases (12.0%)respectively. Abdominal ultrasound in 33 cases (7.2%) indicated fatty liver, hepatomegaly, intrahepatic bile duct stones, and splenomegaly. Among 23 cases undergoing oral glucose tolerance test (OGTT) test, 2 were diagnosed with diabetes mellitus and 4 with impaired glucose tolerance. Following diagnosis, 669 cases (80.7%) received rhGH treatment at a chronological age of (9±4) years and bone age of (8.3±3.2) years. Additionally, 112 cases (19.4%) received sex hormone replacement therapy starting at the age of (14±4) years and bone age of (12.6±1.2) years.Conclusions:The karyotypes of 45, X and mosaicism were most common in Chinese children with TS. The clinical manifestations were mainly short stature and gonadal dysplasia. However, a few TS children could be in the normal range of height, and some cases among those aged of ≥8 years old had spontaneous sexual development. Some exhibited physical features, congenital cardiovascular and urogenital anomalies, and dysfunction of the hypothalamic-pituitary-IGF1 axis. Moreover, a few of them developed impaired glucose tolerance and diabetes mellitus. Following diagnosis, most of the patients received rhGH treatment, and a few of them received sex hormone replacement therapy.

Objective:To improve and optimize the modified surgical strategies for patents with Simon Ⅰ and Simon Ⅱ type of gynecomastia, based on their magnetic resonance imaging (MRI) features.Methods:Clinical data of 190 patients aged 12 to 56 years (mean age 26.7±8.6) with gynecomastia who underwent modified surgeries in the Department of Plastic Surgery of Peking Union Medical College Hospital from January 2017 to January 2023 were retrospectively analyzed. The study measured breast MRI images of 44 male patients to calculate the area ratio of the glands on the transverse plane via nipple. This provided insight into the physiological structure and the tissue distribution of gynecomastia for improving the modified surgical strategies. All 190 patients were treated with enhanced liposuction and " Pull-Through and Bottom-Up" techniques. The duration of operation, amount of liposuction and amount of glandular resection, postoperative complications were recorded, and postoperative satisfaction was investigated by questionnaire surveys.Results:MRI images of the 87-side male breast showed that the average area ratio of the glands on the transverse plane via nipple was (10.9±12.5) %. The most prevalent subtype of gynecomastia was branch pattern, accounting for 46.0%. The median surgical duration of 190 patients was 95 (65-210) minutes, the median liposuction volume was 300 (50-1 400) ml, and the median glandular removal was 19.9 (1.5-157.0) g. Eighty-eight patients (46.3%) went through followed up for more than 6 months post-posterative with an overall satisfaction score of 4.68±0.53. Postoperative complications occurred in 19 sides (5.1%), and the reoperation rate was 1.3%.Conclusions:The MRI imaging of gynecomastia shows that the component of patients′ breasts are mainly fat, with a small amount of glandular tissue and the dominant subtype is branch pattern. Enhanced liposuction combined with " Pull-Through and Bottom-Up" stab incision technique can be an effective treatment for Simon grades Ⅰ and Ⅱ gynecomastia. The method results in high patient satisfaction with fewer postoperative complications.

AIM: Given the biofilm formation abili- ty of different ST-type Klebsiella pneumoniae, our study was aimed at exploring the inhibitory and clearance of azithromycin combined with levofloxacin on the biofilm of Klebsiella pneumoniae of different ST-types and providing a new strategy for the prevention of biofilm formation in the treatment of post-infectious Klebsiella pneumoniae. METHODS: 9 strains of Klebsiella pneumoniae from all susceptibility groups, 19 strains of Klebsiella pneumoniae producing extended-spectrum β - lactamases (ESBLs), and 37 strains of Carbapenem-resistant Klebsiella pneumoniae (CRKP) were randomly collected from the samples of patients hospitalized in the First Affiliated Hospital of Wannan Medical College from August 2019 to November 2021. The isolates were identified using VITEK MS IVD KB V3.2 and VITEK 2-Compact 60. Multilocus sequence typing (MLST) was performed to analyze the homology of each strain; crystal violet staining was used for semi -quantitative detection of biofilm to compare the differences in biofilm formation ability between different ST-type Klebsiella pneumoniae. Different ST-type strains were selected, and the partial inhibitory concentration index (FICI) was calculated by micro broth dilution method to judge the combination effect and select the optimal combination concentration; crystalline violet staining method was used to investigate the inhibition and clearance effect of azithromycin combined with levofloxacin on the biofilm of different ST-type Klebsiella pneumoniae; laser scanning confocal fluorescence microscopy was used to observe the structural changes of the biofilm of Klebsiella pneumoniae before and after the effect of the antibacterial drugs. RESULTS: MLST typing results showed that the sensitive group of Klebsiella pneumoniae strains had 8 sequences such as ST86, ST727, etc., the ESBLs group strains belonged to 14 sequence types such as ST15, ST37, ST11, etc., of which ST15 accounted for 26.32% (5 / 19). The CRKP group strains belonged to 9 sequence types such as ST11, ST15, ST656, etc., of which ST11 accounted for 48.65% (18/37), ST15 accounted for 27.03% (10/37); ST15 (ESBLs), ST11 (CRKP), ST15 (CRKP) type Klebsiella pneumoniae biofilms all reached maturity on the 5th day, the ST15 (ESBLs) group had a stronger ability to produce material to be membranous than the ST15 (CRKP) group. The ST11 (CRKP) group had a stronger ability to produce material to be membranous than the ST15 (CRKP) group (P<0.01); the results of azithromycin combined with levofloxacin drug sensitivity showed that it had an additive effect on different ST-type Klebsiella pneumoniae bacteria; in the inhibition of biofilm formation and clearance test, the 2×MIC azithromycin group and the combined concentration group had a stronger inhibition of biofilm formation of different ST-type Klebsiella pneumoniae bacteria, and the inhibitory ability of the combined group was better than that of the single-drug group, and the highest inhibition rate could reach 89.93%; the clearance effects were all combined drug group>azithromycin>levofloxacin, and the highest clearance rate was 44.79%. CONCLUSION: There are differences in biofilm formation ability between different ST-type Klebsiella pneumoniae, and azithromycin combined with levofloxacin has a better inhibitory effect on different ST-type Klebsiella pneumoniae biofilm, conbined application can be used in the treatment of biofilm infections early stage.