BACKGROUND:Epidemiologic investigations and some experiments have shown that there is a close relationship between peripheral blood cells and osteoporosis,but the causal relationship between the two at the genetic level is still unclear. OBJECTIVE:To explore the causal relationship between peripheral blood cells and osteoporosis using Mendelian randomization methods. METHODS:Genome-wide association study data sets on peripheral blood cells,overall bone density at different ages,and calcaneal bone density were obtained from databases such as Blood Cell Consortium and MRC Integrative Epidemiology Unit. Blood cells were used as exposure data,with bone density at different ages and calcaneal bone density serving as outcome data. Mendelian randomization analyses were performed using methods such as inverse variance weighting,MR-Egger,weighted median method,and simple median. The results were assessed for heterogeneity,pleiotropy,and sensitivity using Cochran's Q,MR-Egger regression,and Leave-one-out method. The causal relationship between exposure and outcomes was evaluated using β values. RESULTS AND CONCLUSION:Due to the heterogeneity revealed by Cochran's Q test in the Mendelian randomization results,the results of the study were based on the inverse variance weighting method. The inverse variance weighting results showed that when age-specific bone density was used as an outcome,there was a negative causal relationship between white blood cell count and whole-body bone mineral density at the age of 45-60 years[β=-0.07,95％ confidence interval (CI):-0.13,-0.01,P=0.02],a positive causal relationship between monocyte count and whole-body bone mineral density at the age of 45-60 years (β=0.05,95％ CI:0.00,0.10,P=0.037),a negative causal relationship between white blood cell and basophil counts and whole-body bone mineral density over 60 years old (β=-0.04,95％ CI:-0.07,-0.01,P=0.005;β=-0.04,95％ CI:-0.07,-0.00,P=0.038),a positive causal relationship between hemoglobin concentration and hematocrit and whole-body bone mineral density over 60 years old (β=0.04,95％ CI:0.01,0.08,P=0.012;β=0.04,95％ CI:0.00,0.07,P=0.039),and a negative causal relationship between white cell count and whole-body bone mineral density at an undistinguished age (β=-0.10,95％ CI:-0.16,-0.03,P=0.002). When heel bone mineral density was used as an outcome,there was a negative causal relationship between white cell count and heel bone mineral density (β=-0.04,95％ CI:-0.07,-0.01,P=0.016),and a positive causal relationship between hemoglobin concentration and hematocrit and heel bone mineral density (β=0.05,95％ CI:0.01,0.08,P=0.007;β=0.05,95％ CI:0.01,0.08,P=0.004). To ensure the robustness of the results,meta-analyses of Mendelian randomization results of peripheral blood cells and whole-body bone mineral density as well as heel bone mineral density in different age groups were conducted. The results suggested that for every standard deviation decrease in log-transformed white blood cell count,there was a 5％ reduction in the risk of decreased bone mineral density (OR=0.95,95％ CI:0.94,0.97,P<0.001);whereas for every standard deviation increase in hemoglobin concentration and hematocrit,there was a 4％ reduction in the risk of decreased bone density (OR=1.04,95％ CI:1.03,1.06,P<0.001). In conclusion,increased white blood cell count in peripheral blood is a risk factor for bone mineral density;whereas increased hematocrit and hemoglobin concentration are protective factors for bone mineral density.

BACKGROUND:Epidemiologic investigations and some experiments have shown that there is a close relationship between peripheral blood cells and osteoporosis,but the causal relationship between the two at the genetic level is still unclear. OBJECTIVE:To explore the causal relationship between peripheral blood cells and osteoporosis using Mendelian randomization methods. METHODS:Genome-wide association study data sets on peripheral blood cells,overall bone density at different ages,and calcaneal bone density were obtained from databases such as Blood Cell Consortium and MRC Integrative Epidemiology Unit. Blood cells were used as exposure data,with bone density at different ages and calcaneal bone density serving as outcome data. Mendelian randomization analyses were performed using methods such as inverse variance weighting,MR-Egger,weighted median method,and simple median. The results were assessed for heterogeneity,pleiotropy,and sensitivity using Cochran's Q,MR-Egger regression,and Leave-one-out method. The causal relationship between exposure and outcomes was evaluated using β values. RESULTS AND CONCLUSION:Due to the heterogeneity revealed by Cochran's Q test in the Mendelian randomization results,the results of the study were based on the inverse variance weighting method. The inverse variance weighting results showed that when age-specific bone density was used as an outcome,there was a negative causal relationship between white blood cell count and whole-body bone mineral density at the age of 45-60 years[β=-0.07,95％ confidence interval (CI):-0.13,-0.01,P=0.02],a positive causal relationship between monocyte count and whole-body bone mineral density at the age of 45-60 years (β=0.05,95％ CI:0.00,0.10,P=0.037),a negative causal relationship between white blood cell and basophil counts and whole-body bone mineral density over 60 years old (β=-0.04,95％ CI:-0.07,-0.01,P=0.005;β=-0.04,95％ CI:-0.07,-0.00,P=0.038),a positive causal relationship between hemoglobin concentration and hematocrit and whole-body bone mineral density over 60 years old (β=0.04,95％ CI:0.01,0.08,P=0.012;β=0.04,95％ CI:0.00,0.07,P=0.039),and a negative causal relationship between white cell count and whole-body bone mineral density at an undistinguished age (β=-0.10,95％ CI:-0.16,-0.03,P=0.002). When heel bone mineral density was used as an outcome,there was a negative causal relationship between white cell count and heel bone mineral density (β=-0.04,95％ CI:-0.07,-0.01,P=0.016),and a positive causal relationship between hemoglobin concentration and hematocrit and heel bone mineral density (β=0.05,95％ CI:0.01,0.08,P=0.007;β=0.05,95％ CI:0.01,0.08,P=0.004). To ensure the robustness of the results,meta-analyses of Mendelian randomization results of peripheral blood cells and whole-body bone mineral density as well as heel bone mineral density in different age groups were conducted. The results suggested that for every standard deviation decrease in log-transformed white blood cell count,there was a 5％ reduction in the risk of decreased bone mineral density (OR=0.95,95％ CI:0.94,0.97,P<0.001);whereas for every standard deviation increase in hemoglobin concentration and hematocrit,there was a 4％ reduction in the risk of decreased bone density (OR=1.04,95％ CI:1.03,1.06,P<0.001). In conclusion,increased white blood cell count in peripheral blood is a risk factor for bone mineral density;whereas increased hematocrit and hemoglobin concentration are protective factors for bone mineral density.

Objective Clinical study on the treatment of bilateral lumbar spinal stenosis with percutane-ous fixation combined with unilateral open-ended spinal canal decompression. Methods 126 patients with bilater-al lumbar spinal stenosis admitted to our hospital were randomly divided into two groups.The observation group was treated by percutaneous nail combined with unilateral laminar fenestration,and the control group was treated by open reduction combined with bilateral hemi laminectomy and spinal canal decompression.The two groups of pa-tients with general surgical complications after treatment,index,lumbago and leg pain VAS score and ODI score were compared.Results The operation time of the observation group,the amount of bleeding,the time of hospital-ization and the cost of hospitalization were less than those of the control group.There were no complications such as incision infection after operation in the two groups.The two groups were statistically significant postoperative pain and leg pain VAS score and ODI score compared with preoperative difference.The two groups had statistical signifi-cance between low back and leg pain VAS score and ODI score after 6 and 12 months and last follow-up phase dif-ference.But the two groups after 3 months of lumbago and leg pain VAS score and ODI score had no significant dif-ference.Conclusions Percutaneous minimally invasive nail combined with unilateral laminar fenestration and de-compression for bilateral lumbar spinal stenosis has the advantages of less trauma,less bleeding,shorter hospitaliza-tion time and quicker recovery.It is worthy of clinical promotion.

ObjectiveTo investigate the effect of neoadjuvant chemotherapy in locally advanced cervical cancer on cell cycle,proliferation,and evaluate the feasibility of proportion of cell in different phase 　and proliferating cell nuclear antigen(PCNA) as sensitive indices to assess chemotherapeutical sensitivity and therapeutical effect.MethodsForty-nine cases of locally advanced cervical cancer were divided into response group and no-response group according to the clinical efficacy of neoadjuvant chemotherapy.Compared the proportion of cell in different phase and proliferation index of PCNA between two groups.The clinical therapeutic effect was evaluated after 4 weeks in the second neoadjuvant chemotherapy regimen.Results In 49 patients with locally advanced cervical cancer,clinical effective of 39 cases (response group),no effective of 10 cases(no-response group).The S-phase proportion of cell in the pre-neoadjuvant chemotherapy and post-neoadjuvant chemotherapy of response group[ (21.47 ± 5.21 )％ and(18.32 ±5.07)％] were higher than those of no-response group [ (9.63 ± 2.58)％ and ( 10.14 ± 2.32)％ ] (P ＜ 0.05 ).The proliferation index of PCNA of cervical cancer in the pre-neoadjuvant chemotherapy of response group [ ( 81.67 ± 7.14)％ ] was higher than that of no-response group [ (66.99 ± 2.29 )％ ] (P ＜ 0.05 ).Conclusion The S-phase proportion of cell and proliferation index of PCNA in the pre-neoadjuvant chemotherapy are important indexes to assess chemotherapeutical sensitivity and therapeutical effect.