Metformin has been demonstrated to attenuate hyperglycaemia by modulating the gut microbiota. However, the mechanisms through which the microbiome mediates metformin monotherapy failure (MMF) are unclear. Herein, in a prospective clinical cohort study of newly diagnosed type 2 diabetes mellitus (T2DM) patients treated with metformin monotherapy, metagenomic sequencing of faecal samples revealed that Phocaeicola vulgatus abundance was approximately 12 times higher in nonresponders than in responders. P. vulgatus rapidly hydrolysed taurine-conjugated bile acids, leading to ceramide accumulation and reversing the improvements in glucose intolerance conferred by metformin in high-fat diet-fed mice. Interestingly, C22:0 ceramide bound to mitochondrial fission factor to induce mitochondrial fragmentation and impair hepatic oxidative phosphorylation in P. vulgatus-colonized hyperglycaemic mice, which could be exacerbated by metformin. This work suggests that metformin may be unsuitable for P. vulgatus-rich T2DM patients and that clinicians should be aware of metformin toxicity to mitochondria. Suppressing P. vulgatus growth with cefaclor or improving mitochondrial function using adenosylcobalamin may represent simple, safe, effective therapeutic strategies for addressing MMF.

Objective: To construct a Family with sequence similarity 50 member A(FAM50A) gene knockout mouse insulinoma pancreatic β-cell line Beta-TC-6 using CRISPR/Cas9 gene editing technology and to prepare polyclonal antibodies specifically recognizing FAM50A. Methods: Two guide RNAs(sgRNAs) targeting the FAM50A gene were designed,and a recombinant plasmid expressing blue fluorescent protein(BFP) was constructed for gene knockout.The successfully constructed plasmid was transfected into Beta-TC-6 cells,and BFP-positive single cells were isolated for clonal expansion.The expanded monoclonal cell lines were genotyped by Sanger sequencing,and FAM50A protein expression was assessed by Western blot.Purified human recombinant FAM50A protein was used to immunize New Zealand rabbits for the preparation of a polyclonal antibody.The specificity of the prepared antibody was then validated using the successfully established FAM50A knockout cell line. Results: A monoclonal cell line with a successful knockout of the FAM50A gene was identified.Sanger sequencing confirmed base deletions at the target site.Western blot analysis showed a complete absence of FAM50A protein expression in this cell line.The prepared polyclonal antibody successfully recognized endogenous murine FAM50A protein in wild-type Beta-TC-6 cells and in hTERT-RPE1 cells overexpressing human FAM50A-GFP fusion protein,while no signal was detected in the FAM50A knockout cells. Conclusion This study successfully established a FAM50A gene knockout Beta-TC-6 cell model and generated a FAM50A polyclonal antibody,providing powerful tools for future research.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective:To evaluate the impact of orthopedic robotic assistance and conventional freehand methods on surgical strategies, the safety of pedicle screw placement, and clinical efficacy in patients with upper cervical spine diseases.Methods:From January 2017 to March 2023, a total of 63 cases with upper cervical spine disease, were divided into two groups based on the screw placement technique: the robot-assisted pedicle screw placement (RA) group (41 cases) and the conventional freehand pedicle screw placement (CF) group (22 cases), were retrospectively included. These patients in the RA and CF groups underwent two types of posterior cervical surgery, including occipitocervical fusion (9 cases and 8 cases) and fixation and fusion of atlantoaxial and distal vertebrae (32 cases and 14 cases). The outcome parameters, including the disease course, surgical time, intraoperative blood loss, fluoroscopy frequency, radiation dose, hospital stay, treatment costs, complications, the rate of the pedicle screw placement, accuracy of upper cervical pedicle screw placement, and the risk factors that possibly affected the accuracy were recorded and analyzed. Postoperative follow-up was conducted for at least 6 months, and the efficacy of patients was assessed using imaging parameters, ASIS classification, VAS, and JOA scores.Results:Both groups had no screw-related complications and no spinal cord or vertebral artery injuries. In the RA group, the pedicle screw placement rates for the patients with occipitocervical fusion, and fixation and fusion of atlantoaxial and distal vertebrae were 100% (48/48) and 89.6% (138/154), respectively, far exceeding the placement rate in the CF group 42.9% (18/42) and 78.3% (54/69) (χ 2=37.403, P<0.001; χ 2=5.128, P=0.024). The fluoroscopic exposure dose and operation time of the two types of surgical patients in the RA group were both higher than those in the CF group ( P<0.05). Compared with the CF group, the accuracy of C 1 screws in the RA group increased from 42% (11/26) to 80% (51/64), with statistical significance (χ 2=13.342, P=0.004); while the accuracy of C 2 screws improved from 77% (33/43) to 88% (63/72) with no statistical difference (χ 2=2.863, P=0.413). Non-parametric correlation analysis found a significant correlation between the accuracy of C 1 and C 2 pedicle screw placement and the order of guide wire insertion in the RA group ( r=0.580, P<0.001; r=0.369, P=0.001). Postoperatively, both groups showed significant differences in cervicomedullary angle (CMA), Chamberlain angle (CL), McGregor angle, Boogard angle, Bull angle, clivus-canal angle (CCA), occipitocervical (C 0-C 2) angle, posterior occipitocervical angle (POCA), C 2-C 7 angle, and anterior atlantodental interval (ADI) ( P<0.05). The ASIA classification improved to varying degrees for both groups postoperatively, but there were no statistically significant differences between preoperative, postoperative, and last follow-up evaluations. VAS and JOA scores significantly improved for both groups postoperatively and at the last follow-up ( P<0.05). Conclusion:Both orthopedic robotic-assisted and conventional freehand pedicle screw placement techniques achieved satisfactory therapeutic effects in the treatment of upper cervical spine diseases. The orthopedic robot can effectively ensure the accuracy of upper cervical pedicle screw placement, the increase placement rate of pedicle screws in the upper cervical spine, and reduce fluoroscopy exposure. However, it is necessary to avoid the vertebral displacement caused by the priority insertion of the guide needle, which may affect the accuracy of subsequent planning.

Objective to analyze the Budget Execution Rate of administrative departments in sample hospitals,and to realize the cost control of Budget performance integration with Balanced Score Card(BSC)Financial Dimension Quantitative Assessment.Methods The budget and execution data of 23 administrative departments were collected from January to June in the sample 2023.The budget execution rate was calculated and cleaned,and the data were segmented by histogram.Using the financial dimension 25 to divide by the total number of items in each department's budget to obtain the scoreof each item in each department,and using the interpolation method to calculate the cost scores of each department,then into the performance appraisal.Results(1)Each item score should be multiplied by item coefficient,and then sum up;(2)The total score of self-executing Project+the total score of centralized executing project.(3)Cost score:1 the scores of 8 departments of non-homing items were 5.54～15.76,2 the scores of 15 departments of homing items were 7.68～17.06.Conclusion It adopts the concept of BSC and Hospital Resource Planning as the cost control of administrative departments to make up for the lack of qualitative and quantitative BSC;can focus on monitoring the dispersion of large data;histogram score results of segmentation objective and easy to operate,makes the interpolation calculation more credible.In a word,it provides quantitative ideas and methods in the aspects of different responsibilities and difficult performance evaluation.

Objective to analyze the Budget Execution Rate of administrative departments in sample hospitals,and to realize the cost control of Budget performance integration with Balanced Score Card(BSC)Financial Dimension Quantitative Assessment.Methods The budget and execution data of 23 administrative departments were collected from January to June in the sample 2023.The budget execution rate was calculated and cleaned,and the data were segmented by histogram.Using the financial dimension 25 to divide by the total number of items in each department's budget to obtain the scoreof each item in each department,and using the interpolation method to calculate the cost scores of each department,then into the performance appraisal.Results(1)Each item score should be multiplied by item coefficient,and then sum up;(2)The total score of self-executing Project+the total score of centralized executing project.(3)Cost score:1 the scores of 8 departments of non-homing items were 5.54～15.76,2 the scores of 15 departments of homing items were 7.68～17.06.Conclusion It adopts the concept of BSC and Hospital Resource Planning as the cost control of administrative departments to make up for the lack of qualitative and quantitative BSC;can focus on monitoring the dispersion of large data;histogram score results of segmentation objective and easy to operate,makes the interpolation calculation more credible.In a word,it provides quantitative ideas and methods in the aspects of different responsibilities and difficult performance evaluation.

Objective to analyze the Budget Execution Rate of administrative departments in sample hospitals,and to realize the cost control of Budget performance integration with Balanced Score Card(BSC)Financial Dimension Quantitative Assessment.Methods The budget and execution data of 23 administrative departments were collected from January to June in the sample 2023.The budget execution rate was calculated and cleaned,and the data were segmented by histogram.Using the financial dimension 25 to divide by the total number of items in each department's budget to obtain the scoreof each item in each department,and using the interpolation method to calculate the cost scores of each department,then into the performance appraisal.Results(1)Each item score should be multiplied by item coefficient,and then sum up;(2)The total score of self-executing Project+the total score of centralized executing project.(3)Cost score:1 the scores of 8 departments of non-homing items were 5.54～15.76,2 the scores of 15 departments of homing items were 7.68～17.06.Conclusion It adopts the concept of BSC and Hospital Resource Planning as the cost control of administrative departments to make up for the lack of qualitative and quantitative BSC;can focus on monitoring the dispersion of large data;histogram score results of segmentation objective and easy to operate,makes the interpolation calculation more credible.In a word,it provides quantitative ideas and methods in the aspects of different responsibilities and difficult performance evaluation.

Objective to analyze the Budget Execution Rate of administrative departments in sample hospitals,and to realize the cost control of Budget performance integration with Balanced Score Card(BSC)Financial Dimension Quantitative Assessment.Methods The budget and execution data of 23 administrative departments were collected from January to June in the sample 2023.The budget execution rate was calculated and cleaned,and the data were segmented by histogram.Using the financial dimension 25 to divide by the total number of items in each department's budget to obtain the scoreof each item in each department,and using the interpolation method to calculate the cost scores of each department,then into the performance appraisal.Results(1)Each item score should be multiplied by item coefficient,and then sum up;(2)The total score of self-executing Project+the total score of centralized executing project.(3)Cost score:1 the scores of 8 departments of non-homing items were 5.54～15.76,2 the scores of 15 departments of homing items were 7.68～17.06.Conclusion It adopts the concept of BSC and Hospital Resource Planning as the cost control of administrative departments to make up for the lack of qualitative and quantitative BSC;can focus on monitoring the dispersion of large data;histogram score results of segmentation objective and easy to operate,makes the interpolation calculation more credible.In a word,it provides quantitative ideas and methods in the aspects of different responsibilities and difficult performance evaluation.

Objective to analyze the Budget Execution Rate of administrative departments in sample hospitals,and to realize the cost control of Budget performance integration with Balanced Score Card(BSC)Financial Dimension Quantitative Assessment.Methods The budget and execution data of 23 administrative departments were collected from January to June in the sample 2023.The budget execution rate was calculated and cleaned,and the data were segmented by histogram.Using the financial dimension 25 to divide by the total number of items in each department's budget to obtain the scoreof each item in each department,and using the interpolation method to calculate the cost scores of each department,then into the performance appraisal.Results(1)Each item score should be multiplied by item coefficient,and then sum up;(2)The total score of self-executing Project+the total score of centralized executing project.(3)Cost score:1 the scores of 8 departments of non-homing items were 5.54～15.76,2 the scores of 15 departments of homing items were 7.68～17.06.Conclusion It adopts the concept of BSC and Hospital Resource Planning as the cost control of administrative departments to make up for the lack of qualitative and quantitative BSC;can focus on monitoring the dispersion of large data;histogram score results of segmentation objective and easy to operate,makes the interpolation calculation more credible.In a word,it provides quantitative ideas and methods in the aspects of different responsibilities and difficult performance evaluation.

Objective to analyze the Budget Execution Rate of administrative departments in sample hospitals,and to realize the cost control of Budget performance integration with Balanced Score Card(BSC)Financial Dimension Quantitative Assessment.Methods The budget and execution data of 23 administrative departments were collected from January to June in the sample 2023.The budget execution rate was calculated and cleaned,and the data were segmented by histogram.Using the financial dimension 25 to divide by the total number of items in each department's budget to obtain the scoreof each item in each department,and using the interpolation method to calculate the cost scores of each department,then into the performance appraisal.Results(1)Each item score should be multiplied by item coefficient,and then sum up;(2)The total score of self-executing Project+the total score of centralized executing project.(3)Cost score:1 the scores of 8 departments of non-homing items were 5.54～15.76,2 the scores of 15 departments of homing items were 7.68～17.06.Conclusion It adopts the concept of BSC and Hospital Resource Planning as the cost control of administrative departments to make up for the lack of qualitative and quantitative BSC;can focus on monitoring the dispersion of large data;histogram score results of segmentation objective and easy to operate,makes the interpolation calculation more credible.In a word,it provides quantitative ideas and methods in the aspects of different responsibilities and difficult performance evaluation.