BACKGROUND:Multiple observational studies have suggested a potential association between telomere length and musculoskeletal diseases.However,the underlying mechanisms remain unclear. OBJECTIVE:To investigate the genetic causal relationship between telomere length and musculoskeletal diseases using two-sample Mendelian randomization analysis. METHODS:Genome-wide association study summary data of telomere length were obtained from the UK Biobank.Genome-wide association study summary data of 10 common musculoskeletal diseases(osteonecrosis,osteomyelitis,osteoporosis,rheumatoid arthritis,low back pain,spinal stenosis,gout,scapulohumeral periarthritis,ankylosing spondylitis and deep venous thrombosis of lower limbs)were obtained from the FinnGen consortium.Inverse variance weighting,Mendelian randomization-Egger and weighted median methods were used to evaluate the causal relationship between telomere length and 10 musculoskeletal diseases.Inverse variance weighting was the primary Mendelian randomization analysis method,and sensitivity analysis was performed to explore the robustness of the results. RESULTS AND CONCLUSION:(1)Inverse variance-weighted results indicated a negative causal relationship between genetically predicted telomere length and rheumatoid arthritis(odds ratio=0.78,95%confidence interval:0.64-0.95,P=0.015)and osteonecrosis(odds ratio=0.56,95%confidence interval:0.36-0.90,P=0.016).No causal relationship was found between telomere length and the other eight musculoskeletal diseases(all P>0.05).(2)Sensitivity analysis affirmed the robustness of these causal relationships,and Mendelian randomization-Egger intercept analysis found no evidence of potential horizontal pleiotropy(all P>0.05).(3)This Mendelian randomized study supports that telomere length has protective effects against rheumatoid arthritis and osteonecrosis.However,more basic and clinical research will be needed to support our findings in the future.

In recent years, China has been facing the dual challenges of declining fertility rates and births, with male reproductive health issues, especially the decline in semen quality, identified as a pivotal contributor to this phenomenon. Meanwhile, accumulating evidence indicates that air pollutants, an increasingly severe environmental problem, can damage semen quality not only directly through their biological toxicity but also indirectly by disrupting the composition of microbial communities in the gut and semen, thereby dysregulating immune function, endocrine homeostasis, and oxidative stress responses. The gut microbiota and semen microbiota, as important components of the human microecosystem, play crucial roles in maintaining reproductive health. This article comprehensively reviewed the research progress on the potential effects of air pollutants (particulate matter and gaseous pollutants), gut microbiota, and semen microbiota on semen quality. Specifically, it elucidated the mechanisms of interaction between these factors and explored how they affect male fertility.

Pneumothorax during pediatric laparoscopic surgery is a potentially fatal complication that may not be promptly recognized. It can occur due to congenital anatomical abnormalities, pre-existing pulmonary disease, or operative factors during laparoscopy. Clinical presentation may range from asymptomatic to acute respiratory distress, pleuritic chest pain, and even life-threatening circulatory collapse. Here, we report a case of sudden intraoperative pneumothorax accompanied by extensive subcutaneous emphysema of the neck and chest wall during laparoscopic high ligation of the hernial sac in a child. The child presented with a reducible left lower abdominal mass and mild pain 3 days prior but did not seek medical attention. Symptoms worsened 1 day prior to admission, with difficulty reducing the mass. On April 8, 2021, the patient was admitted to the Department of Anesthesiology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine of Central South University, with a diagnosis of "left inguinal hernia." On the second day of hospitalization, laparoscopic high ligation of the left inguinal hernia sac was performed under general anesthesia. During the procedure, the patient developed a sudden increase in airway pressure, marked hemodynamic fluctuations, crepitus in the neck and right anterior chest regions, and significantly diminished breath sounds in the right lung. Emergent bedside chest X-ray confirmed a right-sided pneumothorax. Immediate intervention including thoracic needle decompression, closed thoracic drainage, the lung re-expansion was performed. The patient was discharged on the 7th postoperative day with full recovery. This case highlights the need for clinicians to remain vigilant for iatrogenic pneumothorax during pediatric laparoscopic surgery. Close intraoperative monitoring of vital signs is crucial for early detection, recognition, and timely management of pneumothorax to ensure patient safety during minimally invasive procedures.
Humans ; Laparoscopy/methods* ; Pneumothorax/etiology* ; Ligation/methods* ; Hernia, Inguinal/surgery* ; Male ; Intraoperative Complications/etiology* ; Child ; Herniorrhaphy/methods* ; Female ; Subcutaneous Emphysema/etiology*

OBJECTIVE: Salt-processed Psoraleae Fructus (SPF) is widely used as a phytoestrogen-like agent in the treatment of osteoporosis. However, due to improper clinical use or misuse, resulting in liver damage. In this study, network pharmacology was employed to analyze the mechanism of cholestatic liver damage. An adeno-associated virus overexpressing SULT1E1 (rAAV8-SULT1E1) was constructed and the hepatotoxicity of SPF, psoralen, and isopsoralen was determined. METHODS: By utilizing three databases inclding TCMSP, TCMID, and BATMAN- TCM, the targets of the three databases were summarized, and a total of 45 psoralen compounds were included. Network pharmacology analysis was then performed. The adenoviral vectors were injected into the tail vein of C57BL6 mice to elucidate the role of SULT1E1 in SPF-induced cholestasis-mediated hepatotoxicity in vivo. SPF (10 g/kg), psoralen, and isopsoralen (50 mg/kg each) were intragastrically administered to mice for 30 d. B-ultrasound and samples were collected and examined for follow-up experiments. RESULTS: A total of 854 targets were predicted for 45 active components, with 151 cholestasis-mediated hepatotoxicity-related disease targets obtained for SPF. A total of 126 pathways were enriched based on KEGG pathway analysis, with the "estrogen signaling pathway" identified as one of the top 20 pathways. In terms of pathological hepatic changes, treated mice had visually swollen hepatocytes, dilated bile ducts, and elevated serum biochemical markers, which were more prominent in mice treated with isopsoralen than in those treated with other compounds. Notably, the overexpression of SULT1E1 could reverse liver damage in each treatment group. B-ultrasound was used to observe the size of the gallbladder in vivo. The size of the gallbladder was found to significantly increase on day 30 after treatment in the SPF-, psoralen-, and isopsoralen-treated groups, especially the SPF group. Compared with the expression levels in the negative control group (rAAV8-empty + con), the expression levels of FXR, Mrp2, Bsep, SULT1E1, SULT2A1, Ntcp, and Nrf2 decreased, whereas those of CYP7a1 and IL-6 increased in the SPF-, psoralen-, and isopsoralen-treated groups. CONCLUSION The overexpression of SULT1E1 could alleviate the decreased or increased expression of indicators, indicating that SULT1E1 is an important target gene for SPF-induced liver damage. The severity of liver damage was significantly lower in the rAAV8-SULT1E1 groups than in the rAAV8-empty groups.

Objective To explore the application of regional cerebral oxygen saturation(rSO2)-bispectral index(BIS)monitoring anesthesia in children undergoing surgery for supracondylar fractures of the humerus.Methods A total of 60 children with supracondylar fractures of the humerus undergoing surgery in Department of Orthopedi,Jiangxi Provincial Children's Hospital were chosen and randomly number table method segmented into control group and observation group from January 2020 to December 2022,30 cases in each group.After anesthesia,children in observation group were carried out with rSO2-BIS monitoring,while children in control group were given routine anesthesia management.Results The dosage of propofol and long chain fat emulsion/remifentanil injection in observation group were significantly lower than those in control group(P＜0.05),while there was no difference in heart rate,blood oxygen saturation and mean arterial pressure at various time points during awakening(P＞0.05);The recovery rate of postoperative analgesics of observation group was lower than that of control group,and the extubation time of observation group was shorter than that of control group(P＜0.05);The incidence of postoperative adverse reactions and behaviors in observation group were lower than those in control group(P＜0.001).The dosage of propofol and long chain fat emulsion/remifentanil injection,as the independent risk factors inducing the occurrence of postoperative adverse reactions and adverse behaviors were proved by multivariate analysis.rSO2-BIS monitoring is a key factor in reducing postoperative adverse behaviors and reactions in pediatric patients(P＜0.05).Conclusion The use of rSO2-BIS monitoring during surgery for supracondylar fractures of the humerus in children can reduce the incidence rate of postoperative adverse behaviors and adverse reactions,thereby improving postoperative efficacy.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To explore the effect of partial splenectomy with minimally invasive surgical technique in treating splenic benign lesions.Methods:The clinical data of 19 patients, who underwent partial splenectomy with laparoscopic and robotic surgery for benign lesions of spleen, in Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital from January 2021 to January 2023 were retrospectively analyzed. There were 11 males and 8 females, with the age of (29.2±10.1) years old. Clinical data, such as gender, age, operating procedure, intraoperative blood loss, operation time, postoperative hospital stay and postoperative complications, were collected.Results:Nineteen patients successfully underwent partial splenectomy with minimally invasive surgery, including laparoscopic partial splenectomy (13 cases) and robotic partial splenectomy (6 cases). Irregular partial splenectomy was performed in 10 patients, and regular partial splenectomy in 9 patients. There was no conversion to open surgery. Operation time, intraoperative blood loss, postoperative hospital stay and time of postoperative drainage tube indwelling were 178(130, 200) min, 200(50, 300) ml, 6 (4, 7) d and 3(2, 5) d. Postoperative complications developed in 4 cases (21.1%, 4/19), including left pleural effusion (3 cases) and spleen remnant infarction (1 case).Conclusion:Partial splenectomy by minimally invasive surgery in treating splenic benign lesions is safe and feasible.

Intraspinal air is a rare complication of intraspinal anesthesia.Reported cases of intraspinal or intracranial air are mostly associated with the air insufflation resistance test,while those associated with the normal saline resistance test are rare.This article presents a case of intracranial air following intraspinal anesthesia performed using the normal saline resistance method.The patient was a 38-year-old female who underwent elective intraspinal anesthesia for 1 week without obvious cause of perianal swelling and pain.The procedure included incision and drainage of perianal abscess,excision of anal fistula with internal thread insertion,mixed hemorrhoid exfoliation and internal ligation,and electrocautery of anal papilloma.On the second postoperative day,she experienced headaches,dizziness,severe neck and back pain,along with numbness in the arms and inability to touch or move them.Resting in a supine position did not alleviate the symptoms.Head CT revealed scattered multiple air collections in the cranial cavity,with a total volume of approximately 3 mL.After a multidisciplinary consultation,symptomatic supportive treatment including bed rest,fluid supplementation,oxygen therapy,and anti-inflammatory and analgesic treatment was administered,leading to improvement and discharge.Follow-up at 6 months showed no discomfort.Currently,intracranial air is mostly associated with the air insufflation resistance test,while cases following the normal saline resistance method are rare,with unclear pathophysiological mechanisms,diagnosis,treatment,and prevention,necessitating further research.

【Objective】 To investigate the condition of confidential unit exclusion(CUE) in Guangzhou, so as to ensure blood safety. 【Methods】 The number of CUE donors, demographic characteristics of CUE donors, reasons for CUE, and response time of CUE after blood donation in Guangzhou from 2009 to 2022 were statistically analyzed. 【Results】 From 2009 to 2022, the response ratios of CUE was 0.006 2% (260/4 170 984) and the ratios had statistically significant difference between different years(P<0.05). For the response ratios of CUE, no statistically significant difference was noticed in gender and occupation (P>0.05), but statistically significant differences were found in age, number of blood donations, education background, and marital status (P<0.05). Blood donors aged 18~30 (0.007 3%, P<0.05) and first-time blood donors (0.010 8%, P<0.05) were the main groups of CUE. High risk sexual behavior (28.46%, 74/260) was the primary reason for CUE. The CUE response peak was within 72 hours after blood donation, and the response ratios within 24-72 hours after blood donation was the highest (68.46%, 178/260). 【Conclusion】 CUE is a crucial measure to ensure blood safety. Detailed pre-donation health consultations are suggested for blood donors aged 18-30 and first-time blood donors so as to better excluding high-risk blood donors. Strengthening the publicity of CUE response and process, registering and classifying the reasons for CUE are also important.