BACKGROUND:Osteoporotic fracture is the most serious complication of osteoporosis.Previous studies have demonstrated that gut microbiota has a regulatory effect on skeletal tissue and that gut microbiota has an important relationship with osteoporotic fracture,but the causal relationship between the two is unclear. OBJECTIVE:To explore the causal relationship between gut microbiota and osteoporotic fractures using Mendelian randomization method. METHODS:The genome-wide association study(GWAS)datasets of gut microbiota and osteoporotic fracture were obtained from the IEU Open GWAS database and the Finnish database R9,respectively.Using gut microbiota as the exposure factor and osteoporotic fracture as the outcome variable,Mendelian randomization analyses with random-effects inverse variance weighted,MR-Egger regression,weighted median,simple model,and weighted model methods were performed to assess whether there is a causal relationship between gut microbiota and osteoporotic fracture.Sensitivity analyses were performed to test the reliability and robustness of the results.Reverse Mendelian randomization analyses were performed to further validate the causal relationship identified in the forward Mendelian randomization analyses. RESULTS AND CONCLUSION:The results of this Mendelian randomization analysis indicated a causal relationship between gut microbiota and osteoporotic fracture.Elevated abundance of Actinomycetales[odds ratio(OR)=1.562,95%confidence interval(CI):1.027-2.375,P=0.037),Actinomycetaceae(OR=1.561,95%CI:1.027-2.374,P=0.037),Actinomyces(OR=1.544,95%CI:1.130-2.110,P=0.006),Butyricicoccus(OR=1.781,95%CI:1.194-2.657,P=0.005),Coprococcus 2(OR=1.550,95%CI:1.068-2.251,P=0.021),Family ⅩⅢ UCG-001(OR=1.473,95%CI:1.001-2.168,P=0.049),Methanobrevibacter(OR=1.274,95%CI:1.001-1.621,P=0.049),and Roseburia(OR=1.429,95%CI:1.015-2.013,P=0.041)would increase the risk of osteoporotic fractures in patients.Elevated abundance of Bacteroidia(OR=0.660,95%CI:0.455-0.959,P=0.029),Bacteroidales(OR=0.660,95%CI:0.455-0.959,P=0.029),Christensenellacea(OR=0.725,95%CI:0.529-0.995,P=0.047),Ruminococcaceae(OR=0.643,95%CI:0.443-0.933,P=0.020),Enterorhabdus(OR=0.558,95%CI:0.395-0.788,P=0.001),Eubacterium rectale group(OR=0.631,95%CI:0.435-0.916,P=0.016),Lachnospiraceae UCG008(OR=0.738,95%CI:0.546-0.998,P=0.048),and Ruminiclostridium 9(OR=0.492,95%CI:0.324-0.746,P=0.001)would reduce the risk of osteoporotic fractures in patients.We identified 16 gut microbiota associated with osteoporotic fracture by the Mendelian randomization method.That is,using gut microbiota as the exposure factor and osteoporotic fracture as the outcome variable,eight gut microbiota showed positive causal associations with osteoporotic fracture and another eight gut microbiota showed negative causal associations with osteoporotic fracture.The results of this study not only identify new biomarkers for the early prediction of osteoporotic fracture and potential therapeutic targets in clinical practice,but also provide an experimental basis and theoretical basis for the study of improving the occurrence and prognosis of osteoporotic fracture through gut microbiota in bone tissue engineering.

BACKGROUND:The majority of studies on developmental dysplasia of the hip focus on hip malformations,but there are few reports on the effects of acetabular dysplasia on the spine. OBJECTIVE:To investigate the compensation of spinopelvic parameters in coronal and sagittal views in patients with developmental dysplasia of the hip,and to explore the correlation between acetabular development and spinopelvic parameters. METHODS:A total of 101 patients with developmental dysplasia of the hip admitted to the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2018 to June 2022 were selected as the trial group,and 114 healthy subjects were selected as the control group during the same period.The spinopelvic parameters of the subjects were measured through the full-length X-ray films of the coronal and sagittal spines:lumbar lordosis,anterior pelvic tilt,thoracolumbar kyphosis,Cobb angle,and the distance between the C7 plumb line and the center sacral vertical line,sacral slope,pelvic incidence,and thoracic kyphosis.The differences in spinopelvic parameters were compared between the two groups.In addition,the differences in spinopelvic parameters in patients with unilateral,bilateral and different Crowe classifications of developmental dysplasia of the hip were compared.Pearson correlation analysis was used to explore the correlation between Sharp angle and spinopelvic parameters. RESULTS AND CONCLUSION:(1)In the sagittal view,the lumbar lordosis in the trial group was significantly lower than that in the control group(P<0.05).The pelvic tilt and kyphosis angle of the thoracolumbar segment in the trial group were significantly greater than those in the control group(P<0.05).In the coronary position,the Cobb angle and the distance between the C7 plumb line and center sacral vertical line in the trial group were significantly greater than those in the control group(P<0.05).There was no significant difference in the remaining spinopelvic parameters between the two groups(P>0.05).(2)The lumbar lordosis of patients with bilateral developmental dysplasia of the hip was significantly lower than that of patients with unilateral developmental dysplasia of the hip(P<0.05).The pelvic tilt,thoracolumbar kyphosis,Cobb angle and the distance between the C7 plumb line and center sacral vertical line in bilateral developmental dysplasia of the hip patients were significantly greater than those in unilateral developmental dysplasia of the hip patients(P<0.05).(3)The lumbar lordosis decreased with the increase of Crowe classification severity(P<0.05).The pelvic tilt increased with the severity of the Crowe classification(P<0.05).(4)Pearson correlation analysis showed that Sharp angle was negatively correlated with lumbar lordosis(P<0.05),while Sharp angle was positively correlated with anterior pelvic tilt,Cobb angle,C7 plumb line and center sacral vertical line(P<0.05).(5)It is concluded that the pelvic tilt,thoracolumbar kyphosis,Cobb angle and the distance between the C7 plumb line and center sacral vertical line increase,while lumbar lordosis decreases in developmental dysplasia of the hip patients.The degree of acetabular dysplasia was significantly correlated with lumbar lordosis,pelvic tilt,Cobb angle,C7 plumb line and center sacral vertical line.

【Objective】 To investigate the electronic screen exposure of preschool children in Longhua District of Shenzhen, and to analyze the influencing factors. 【Methods】 A total of 25 266 children in kindergarten in Longhua District of Shenzhen were selected as study subjects. A self-designed questionnaire (completed by their guardians) was used to investigate the use of electronic products in the families of preschoolers in April 2019. 【Results】 A total of 23 407 valid questionnaires were collected in this survey, of which 12 593 (53.80%) were boys and 10 814 (46.20%) were girls; and 17 188(73.43%) children were 5 years old. Among the surveyed children, the rate of excessive exposure to electronic screens (>1h/d) was 37.72%, and 6.40% of preschool children used electronic products for more than 2 hours per day. There were statistically significant differences between the excessive exposure group and the non-excessive exposure group in gender, household registration, parents′ educational level, average monthly household income, whether exclusive electronic products,whether restriction of children′s use of electronic products, whether living with elders, only children or not, and the type of main caregiver (P<0.05). Multivariate binary Logistic regression analysis showed that girls, mothers with college education or above,not living with elders,primary caregivers being parents or nannies/others,and no exclusive electronic products were protective factors for children′s excessive exposure to electronic products(P<0.05).Non-household resident population,not-only child,and non-restriction of children′s use of electronic products were risk factors for children′s excessive exposure to electronic products(P<0.05). 【Conclusions】 The excessive use of electronic products in preschoolers is a common phenomenon in Longhua district, Shenzhen. Therefore, it is necessary to strengthen the intervention on the use time of electronic products in preschoolers, and pay more attention to the influence of family environmental factors.

BACKGROUND:It has been reported that the application of biotic amniotic membrane and corneal bandage lens in pterygium surgery can significantly reduce the pain reaction after pterygium excision and promote the healing of corneal wounds. OBJECTIVE:To compare the efficacy of biotic amniotic membrane and corneal bandage lens on the repair of corneal wounds and neuropathic pain after pterygium surgery. METHODS:A total of 121 cases(142 eyes)of primary pterygium patients admitted to Nanyang Second People's Hospital from August 2020 to May 2022 were retrospectively selected.They all underwent pterygium excision combined with autogenous free conjunctival flap transplantation.Among them,63 cases(68 eyes)of pterygium postoperative wound repair with biotic amniotic membrane were classified as the amniotic membrane group,and 58 cases(74 eyes)of pterygium wound repair with corneal bandage lens were classified as the bandage lens group.Postoperative follow-up was conducted,and the corneal wound repair of the patients within 2 weeks after surgery was recorded.Neuropathic pain was quantified by Wong-Baker face on the day after surgery,1 day,and 2 weeks after surgery.The corneal topographic map indicating asymmetry index,best corrected visual acuity,corneal refractive index,and surface rule index were recorded before surgery,1 and 3 months after surgery. RESULTS AND CONCLUSION:(1)2 weeks after treatment,the wound repair rate in the bandage lens group was significantly higher than that in the amniotic membrane group(P<0.05).The wound healing time was shorter in the bandage lens group than that in the amniotic membrane group(P<0.01).(2)The degree of neuropathic pain in the bandage lens group was lower than that in the amniotic membrane group on the day and 1 day after surgery(P<0.001),and there was no significant difference between the two groups in neuropathic pain at 2 weeks after surgery(P>0.05).(3)The corneal topographic map indicating asymmetry index,best corrected visual acuity,corneal refractive index,and surface rule index were significantly improved in both groups 1 and 3 months after surgery(P<0.05).The corneal topographic map indicating asymmetry index,corneal refractive index,and surface rule index of the bandage lens group were lower than those of the amniotic membrane group 1 and 3 months after surgery(P<0.05).(4)Recurrence occurred in 1 eye(1.47%)in the amniotic membrane group and 3 eyes(4.05%)in the bandage lens group within 3 months after operation,and there was no significant difference between the groups(P>0.05).(5)These findings suggest that the corneal bandage lens is more effective than the biotic amniotic membrane in the repair of corneal wounds after pterygium surgery.

Objective:To assess the prevalence of dentinal hypersensitivity (DH) and related factors in urban adults in China.Methods:The study was designed as an observational, cross-sectional epidemiological study carried out in adults aged 18-69 years old in seven cities (Beijing, Shanghai, Wuhan, Chengdu, Xi′an, Guangzhou, and Harbin) of China. The study was conducted from March 2021 to May 2023. Patients were required to complete a questionnaire regarding the subjects′ socio-economic factors, dietary behavior, oral health behavior and personal antecedent factors. DH was clinically diagnosed by judging whether the tooth cold air stimulation provoked DH or not, and recorded by investigator pain rating Schiff score. Compare the findings of six cities (Harbin excluded) with a similar study conducted in 2008.Results:In total, 11 622 subjects from seven cities in China participated the study. Fifty two point two percent (6 072/11 622) of subjects reported DH in questionnaire, 36.7% (4 266/11 622) of subjects reported experiencing DH in response to cold air stimulation for at least one study tooth. Risk factors including age, sex, city, toothbrush method and acid reflux showed marked associations with DH ( P<0.05). The prevalence of DH of urban residents in six cities (Harbin excluded) was 33.7% (3 335/9 882), higher than that in 2008 [29.7%(2 354/7 939)]. Conclusions:Overall, DH was common among urban adults in China and the prevalence increased in recent years. Better understanding of DH and its associated factors should be considered in its prevention and management by dental professionals.

Objective:To investigate the prevalence of dental caries of 4-year-old children in Miyun District of Beijing by international caries detection and assessment system(ICDAS),to detect the caries activity Cariostat value and to analyze the correlation between the Cariostat value and dental caries.Methods:Totally 815 children aged 4 years in 7 kindergartens in Miyun District of Beijing were recrui-ted.The clinical examination of all children was conducted by one examiner using ICDAS.The oral de-birs and plaques were collected by one doctor who recorded the Cariostat scores.The results of clinical examination were compared between genders.At the same time,the prevalence of dental caries,the mean d3-6ft/d3_6fs and d1-6ft/d1-6fs among high Cariostat scores group(2.0-3.0),medium Cariostat scores group(1.5)and low Cariostat scores group(0-1.0)were compared.The distributions of incipi-ent caries in different Cariostat scores groups were compared among children with incipient caries only.Results:All the children had incipient caries,and 78.3％of the children had cavitated caries with ICDAS score of 3 or above.The mean d1-2t scores were 9.76±3.65,the mean d3-6ft scores was 4.64±4.43 and the mean d1-6ft scores were 14.41±3.42.The incipient caries with ICDAS score of 1-2 were widely distributed,accounting for 67.7％of the total numbers of caries.There was no significant diffe-rence in caries prevalence and caries experience between genders(P＞0.05).The proportion of children with high Cariostat scores in boys(43.6％)was higher than that in girls(33％)and the difference was statistically significant(P＜0.05).With the increase of Cariostat scores,the prevalence of cavitated caries,the mean d3-6ft/d3-6fs and d1-6ft/d,_6fs scores in children was on the increase and the difference among the three groups was statistically significant(P＜0.05).For children with incipient caries only,the distribution of incipient caries in different Cariostat scores groups was no significant difference(P＞0.05).Conclusion:ICDAS can detect early enamel demineralization of deciduous teeth in children.The prevalence of dental caries among 815 4-year-old children in Miyun District of Beijing is more serious,and incipient caries is widely distributed in children.Cariostat value reflects the status of cavi-tated caries and has no correlation with the distribution of incipient caries.Therefore,the combined ap-plication of ICDAS and Cariostat caries activity detection method is helpful for the detection of incipient caries and screening of caries high-risk children,which has great significance for the comprehensive ma-nagement of caries in children and the formulation of early preventive measures.

Objective To explore the related factors of lymph node metastasis in early gastric cancer and to analyze the clinical efficacy between laparoscopic D2 radical resection and endoscopic submucosal dissection(ESD).Methods A retrospective cohort study was conducted on 404 patients with early gastric cancer undergoing surgical treatment in our hospital from June 2018 to June 2022 were recruited in this study.According to their surgical treatment,they were divided into laparoscopy group(n=271)and ESD group(n=133).The lymph node metastases were compared in the patients with different clinical features,and the factors affecting lymph node metastasis were analyzed with multivariate logistic regression analysis.The lymph node metastasis rate of patients with absolute and expanded indications of ESD was calculated.Kaplan-Meier survival analysis was used to compare the long-term efficacy of ESD and laparoscopic D2 radical resection in these patients.Stratified regression analysis was applied to explore the relationship between surgical methods and long-term outcome in them.Results In the 404 patients with early gastric cancer,the rate of lymph node metastasis was 12.38％(50/404).Univariate analysis showed that 7 clinical features,such as ulcer,tumor pathological features and pathological differentiation,were related to lymph node metastasis.Multivariate logistic regression analysis revealed that low differentiation and tumor infiltration depth of submucous membrane(SM)were related factors affecting lymph node metastasis in early gastric cancer.The overall survival rate was 96.29％(389/404)in the 404 patients,96.31％in the laparoscopic group and 96.24％in the ESD group,and no statistical difference was seen between the 2 groups(P＞0.05).There was no obvious difference in 5-year survival rate between the patients who met the absolute indications for ESD and underwent laparoscopic D2 radical surgery and those receiving ESD treatment(96.00％vs 96.55％),and between those who were in accordance with the expanded indications for ESD and underwent laparoscopic D2 radical surgery and those receiving ESD treatment(94.74％vs 91.67％).After adjusting the clinical features such as lesion size,pathological differentiation and depth of tumor invasion by stratified regression analysis,the mode of operation for early gastric cancer was still correlated with the long-term efficacy(β=1.173,P=0.003).Conclusion The depth of tumor infiltration and differentiation are closely related to lymph node metastasis in early gastric cancer patients.The efficacy of laparoscopic D2 radical surgery on the patients with absolute and expanded indications for ESD is comparable to that of ESD treatment.

Objective To explore the value of probe-based confocal laser endomicroscopy(pCLE)in the differential diagnosis of fundic gland polyps.Methods A total of 63 patients who underwent conventional white light image(WLI)and suggested with gastric polyps in our gastroenterology endoscopy center during June and December 2023 were enrolled,and their clinical data,WLI,narrow band images(NBI),pCLE images and postoperative histopathological findings were collected.The characteristics of fundic gland polyps under pCLE were statistically verified,and the sensitivity,specificity,accuracy and consistency of different endoscopic diagnoses were calculated respectively.Results Under pCLE,fundic gland polyps were mainly manifested as elongated gastric pit opening,"hand-in-hand"gastric pit opening,well-arranged blood vessels around the pit opening,and no luciferin oozing.The sensitivity,specificity,accuracy of WLI were 72.73％,75.00％,73.13％and 0.343 for fundic gland polyps,and 81.82％,71.43％,71.64％and 0.354 for hyperplastic polyps,respectively.While,the above values of NBI were 87.27％,83.33％,86.57％and 0.673 for fundic gland polyps,and 81.82％,85.71％,85.07％and 0.554 for hyperplastic polyps;and those of pCLE were 92.73％,91.67％,92.53％and 0.769 for fundic gland polyps,and 90.91％,94.64％,94.03％and 0.797 for hyperplastic polyps pCLE had better sensitivity,specificity and accuracy than WLI and NBI,and had the results consistent with histopathological findings.Conclusion pCLE can be used in the differential diagnosis of fundic gland polyps.

Objective To construct an optimal prediction model for lymph node metastasis(LNM)in early gastric cancer(EGC)using machine learning techniques and assess its predictive performance.Methods Clinical data of 433 EGC patients undergoing radical surgery in our hospital from January 2015 to December 2022 were collected.They were divided into a training set and a validation set in a 7:3 ratio.LASSO regression was used to screen variables and multivariate logistic regression analysis was employed to identify independent risk factors for LNM in the EGC patients.Ten machine learning models were constructed using categorical boosting(Catboost),light gradient boosting machine(LightGBM),extreme gradient boosting machine(XGboost),random forest(RF),gradient boosting machine(GBM),neural networks(NNET),support vector machine(SVM),K nearest(KNN),Naive Bayes(NB)and Logistic regression.The predictive power of the above models was evaluated and compared in terms of accuracy,precision,recall,F1 score value,sensitivity,specificity,positive predictive rate,negative predictive rate,Kappa value,area value under the receiver operating characteristic curve(AUC),calibration curve,decision curve,and precision-recall curve.Finally,SHAP(SHapley Additive exPlanations)was applied to explain the contribution of each variable in the best model for the prediction outcomes.Results Depth of tumor invasion,lymphovascular invasion and smoking history were independent risk factors for LNM in the EGC patients.Catboost model obtained the best predictive performance,and had 5 performance indicators outperforming the other models in the training set,that is,an AUC value of 0.904(95％CI 0.868～0.940),a F1-score of 0.633,a Brier score of 0.100,a negative predictive rate of 0.975,and a Kappa value of 0.520.Finally,calculating the SHAP values of Catboost revealed that the depth of tumor invasion and lymphovascular invasion were two key characteristic variables for predicting LNM.Conclusion The depth of tumor invasion of submucosal and lymphovascular invasion and smoking history are independent risk factors for LNM in early gastric cancer.ML can be used to predict LNM risk,the Catboost model has the best predictive performance and can provide guidance for clinical diagnosis and treatment decisions.

Objective:To identify early potential risk factors for sepsis-associated liver injury and to provide a reference for early clinical identification and intervention.Methods:The clinical data of septic patients admitted to the intensive care unit (ICU) in the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University from March 2020 to April 2023 were retrospectively analyzed. Patients with sepsis were categorized into the liver injury group and the non-liver injury group according to whether liver injury occurred or not, univariate and multivariate logistic regression analyses were used to explore the risk factors for SALI, receiver operating characteristic (ROC) curve analysis was used to assess its predictive effect for SALI, and performed subgroup analyses basing on the cut-off point.Results:Among 530 eligible patients, 403 patients were included. The incidence of liver injury was 39.45% in 159 cases with liver injury and 244 cases without liver injury. Multivariate logistic regression analysis showed that serum prealbumin, lactate and lactate dehydrogenase were independent risk factors for SALI. ROC curve analysis showed that all single indicators had some predictive value for SALI, the area under the curve was prealbumin (AUC: 0.752, 95% CI: 0.703-0.801), lactate (AUC: 0.679, 95% CI: 0.627-0.732), lactate dehydrogenase (AUC: 0.664, 95% CI: 0.611-0.718), respectively, The AUC for predicting SALI by lactate/prealbumin ratio (L/P) and lactate dehydrogenase/prealbumin ratio were 0.808 (95% CI: 0.766-0.850) and 0.795 (95% CI: 0.750-0.840), respectively, with the best efficacy of L/P in predicting SALI. Subgroup analyses showed that the incidence of liver injury was significantly higher in septic patients with L/P ≥0.23 than that in septic patients with L/P <0.23, at the same time, the acute physiology and chronic health evaluation II score, shock probability, and hospital mortality rate also increased accordingly, the differences were all statistically significant (all P < 0.001). Conclusions:L/P is early independent risk factor of SALI, for sepsis patients with L/P≥0.23 should be alerted to the development of liver injuryis.