Humans ; Gastrointestinal Microbiome ; Constipation/therapy* ; Probiotics/therapeutic use* ; Patients

Objective To investigate the effect of final vowel types on the voice onset time(VOT)of differ-ent stops in children with hearing impairment,and to provide a basis for the acquisition and correction of stop sounds.Methods A total of 22 hearing-impaired children aged 3～6 and 22 children with normal hearing were ran-domly selected-18 consonant-vowel(CV)syllables composed of 6 stops and 3 single finals were recorded,using first tone.Using Praat 6.1.29 software to analyze and extract the stops VOT.Two-way ANOVA was used for each stop,the dependent variable was VOT,and the independent variables were hearing status and final type.Results Children in the hearing-impaired group had articulation errors in/t/,/g/,and/k/.Hearing status had significant effect on the main effect of plosives/g/,/p/,/t/,/k/(P＜0.05),and the VOT of slurs/g/,/p/,/t/,/k/in the normal hearing group significantly greater than the hearing-impaired group(P＜0.05).The main effect of finals on the VOT of the stops/b/,/p/and/t/was significant(P＜0.05).Hearing status and final type had an interac-tive effect on the stop/t/,and the simple main effect showed that the difference in VOT of/ti/between the hear-ing-impaired group and the normal hearing group was greater than that of/ta/and/tu/.Conclusion The stops/g/,/p//t/,/k/VOT of hearing-impaired children are smaller than those of with normal hearing.The difference in VOT of/ti/sound between the hearing impaired group and the normal hearing group is greater than that of/ta/sound and/tu/sound.In the teaching of the initial/t/sound for hearing-impaired children,we can start with/ta/and/tu/with less difference,and the/ti/sound is consolidated later.Pay attention to breathing and oral exercise training,to lay a good foundation for clear pronunciation.

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 simulate the neuroendoscopy assisted contralateral cervical 7 (C 7) nerve transfer via prespinal route and measure its relevant anatomical landmarks to explore the clinical feasibility and efficacy of this surgical approach for central upper limb spastic paralysis. Methods:(1) Six fresh cadaver specimens of the head and neck were obtained. Linear incisions of approximately 5 cm were made above the midpoint of the bilateral clavicles to simulate neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route. With the superior margin of midpoint of the clavicle as central point, distance to the distal bifurcation of the C 7 nerve, distances to the superior or inferior trunks of the proximal brachial plexus nerves, and distances to the exit of the intervertebral foramina of the C 6, C 7, and C 8 nerves were measured. (2) One patient with upper limb spastic paralysis after intracerebral hemorrhage accepted neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route; the clinical data and efficacy of the patient were retrospectively analyzed. Results:(1) The C 7 nerve, the upper trunk of brachial plexus formed by the C 5 and C 6 nerves and the lower trunk of brachial plexus formed by the C 8 and T 1 nerves could be exposed after neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route. The distance between the superior margin of midpoint of the clavicle and the distal bifurcation of the C 7 nerve is (2.20±0.11) cm, and its distance to the superior trunk of the proximal brachial plexus is (2.62±0.10) cm, and its distance to the inforior trunk of the proximal brachial plexus nerve is (2.72±0.11) cm. The distance between the superior margin of midpoint of the clavicle and the proximal C 7 nerve (at the exit of the intervertebral foramen) is (7.22±0.15) cm, its distance to the proximal C 6 nerve (at the exit of the intervertebral foramen) is (7.84±0.12) cm, and its distance to the proximal C 8 nerve (at the exit of the intervertebral foramen) is (6.96±0.12) cm. (2) The patient with central upper limb spastic paralysis accepted neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route successfully, with surgical time lasting for 2 h and bleeding amount of 20 mL. After surgery, the incision healed well, and the patient experienced pain and numbness in the healthy side of the upper limb with subsided symptoms one month after surgery. The spasticity symptoms of the affected upper limb obviously improved after surgery with decreased muscle tone. Follow-up after discharge was performed for 14 months, and the muscle strength of the affected upper limb recovered to level 1 +. Conclusion:Neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route can expose the proximal and distal C 7 nerves, with minimal invasion; this clinical study has preliminarily confirmed the safety and effectiveness of this transfer via prespinal route in central upper limb spastic paralysis.

Objective: To explore the factors associated with the distance from the anal verge to rectal cancer (DAVtRC) ． Methods: 102 patients with rectal cancer provided the clinicopathological data．Two groups of patients were created : low rectal cancer group ( LRC) for those with DAVtRCs less than 7cm and mid / high rectal cancer group ( M / HRC) for those with DAVtRCs greater than 7 cm． The two groups' clinical and pathological differences were compared．Quantile regression was used to analyze the associations between DAVtRC and the clinicopathological factors. Results : LRC had a lower median DAVtRC (5. 00 cm ［IQR : 4. 00，6. 00 cm］) than that in M / HRC ［10. 00 cm(IQR : 10. 00，11. 00 cm) ］(P＜0. 01) ，but had higher mean monocytes［(0. 41 ± 0. 16) vs (0. 34 ± 0. 11) ，P＜0. 05］．In the model with continuous and categorical variables at 95% quantile，DAVtRC was negatively associated with age ( β = －0. 204 ，P ＜0. 01 ) ，TNM stage ( Ⅲ + Ⅳ vs Ⅰ : β = －6. 623 ，P < 0. 01) ，platelet (PLT，β = －0. 024，P＜0. 01) ，vessel invasion(β = －1. 544，P＜0. 01) ，but positively associat- ed with BMI(β = 0. 278，P＜0. 01) ，tumor diameters(β = 0. 548，P＜0. 01) ，male(β = 1. 421，P＜0. 01) ，low and middle differentiations(β = 4. 727，P＜0. 01) ，T stage(T2 vs T1 : β = 4. 422，P＜0. 01) ，N stage(N1 vs N0 : β = 6. 670，P＜0. 01) ，nerve invasion(β = 1. 825，P ＜0. 01) ，carcinoembryonic antigen( CEA，β = 0. 068，P < 0. 01) ，lymphocyte(L，β = 3. 068，P＜0. 01) ，platelet lymphocyte ratio(PLR , β = 0. 045，P＜0. 01) ，lymphocyte monocyte ratio(LMR , β = 1. 088，P ＜0. 01) ．Quantile regression curves showed that the coefficients of age，body mass index(BMI) ，tumor diameter，PLT，PLR and LMR were different in different quantiles of DAVtRC． Conclusion DAVtRC is significantly associated with multiple clinicopathological factors in rectal cancer，but in different quantiles，the coefficients are different.

Objective To investigate the effect of enteral nutritional support beginning at different time on aspiration events and immune function in the early post-traumatic (within 14 days) period in patients with severe traumatic brain injury.Methods From June, 2018, to February, 2021, 75 patients with acute traumatic brain injury admitted in the Department of Neurosurgery of the Second People's Hospital of Lianyungang were randomly divided into early feeding group (24 to 48 hours, n=35) and delayed feeding group (48 to 120 hours, n=40). The 14-day reflux rate, aspiration rate, incidence of aspiration pneumonia, immune indexes and complications were compared between two groups.Results There was no significant difference in the reflux rate, aspiration rate and the incidence of aspiration pneumonia between the two groups (P > 0.05). The levels of IgG, IgA, and complements C3 and C4 were significantly higher in the early feeding group than in the delayed feeding group (|t| > 1.720, P<0.001). The incidence of non-aspiratory lung infections was significantly lower in the early feeding group than in the delayed feeding group (χ2=4.728, P<0.05).Conclusion Initiating enteral nutrition within 24 to 48 hours after injury may preserve immune function and reduce the incidence of non-aspiratory lung infections in patients with severe traumatic brain injury.

Objective:To evaluate the safety and clinical efficacy of primary suturing of dog bite injuries on the head and face.Methods:A total of 42 cases with the dog bite injuries of Grade Ⅲ rabies exposure on the head and face(20 females and 22 males, aged from 1 to 81) were enrolled from October 2015 to October 2018 at the Department of Plastic Surgery, The Second People’s Hospital of Gansu Province. The primary suturing was performed after meticulous wound debridement and sufficient irrigation, the patients who were under 11 years old only received rabies vaccine for the rabies post-exposure prophylaxis, whereas the others were reinforced with tetanus antitoxin (1 500 IU) and human rabies immunoglobulin (20 IU/kg) around the wound, followed by Dermatix anti-scarring treatment for at least one year. Post-operative observation included wound healing and potential complications. All patients were followed up for facial deformities and bilateral symmetry, and the scars were assessed using the Vancouver Scar Scale (VSS).Results:Among the 42 cases, 38 cases (90.4%) were Class-A healed, 2 cases (4.8%) were Class-B healed (one of the two cases had a mandibular wound deep in the muscular layer. A deep abscess appeared in the neck 10 days after surgery, and was cured after puncture and drainage), and 2 cases (4.8%) were Class-C healed. Thirty-two patients had fever to different extent 2 to 5 days after surgery, and their body temperatures were below 38.5 ℃. The body temperature returned to normal after 1 to 2 days. During 6-24 months of follow-up, no tetanus and rabies occurred in all cases. During 1 to 2 years of follow-up, 1 of 42 cases had asymmetrical cheek 1 year post-operation. 1 case had scars on the upper eyelid 1 year after operation, and both eyes were asymmetric when eyes were open. Other 40 cases were recovered with bilateral symmetry without dysfunction of opening and closing the mouth and eyes. Facial contour recovery was cosmetically satisfactory with VSS score 1-3.Conclusions:Primary suturing of dog bite injuries on the head and face, according to the rabies prevention and treatment guideline, is a safe and effective treatment. It prevents rabies, and facial deformities and severe scar deformity in patients.

Objective:To evaluate the safety and clinical efficacy of primary suturing of dog bite injuries on the head and face.Methods:A total of 42 cases with the dog bite injuries of Grade Ⅲ rabies exposure on the head and face(20 females and 22 males, aged from 1 to 81) were enrolled from October 2015 to October 2018 at the Department of Plastic Surgery, The Second People’s Hospital of Gansu Province. The primary suturing was performed after meticulous wound debridement and sufficient irrigation, the patients who were under 11 years old only received rabies vaccine for the rabies post-exposure prophylaxis, whereas the others were reinforced with tetanus antitoxin (1 500 IU) and human rabies immunoglobulin (20 IU/kg) around the wound, followed by Dermatix anti-scarring treatment for at least one year. Post-operative observation included wound healing and potential complications. All patients were followed up for facial deformities and bilateral symmetry, and the scars were assessed using the Vancouver Scar Scale (VSS).Results:Among the 42 cases, 38 cases (90.4%) were Class-A healed, 2 cases (4.8%) were Class-B healed (one of the two cases had a mandibular wound deep in the muscular layer. A deep abscess appeared in the neck 10 days after surgery, and was cured after puncture and drainage), and 2 cases (4.8%) were Class-C healed. Thirty-two patients had fever to different extent 2 to 5 days after surgery, and their body temperatures were below 38.5 ℃. The body temperature returned to normal after 1 to 2 days. During 6-24 months of follow-up, no tetanus and rabies occurred in all cases. During 1 to 2 years of follow-up, 1 of 42 cases had asymmetrical cheek 1 year post-operation. 1 case had scars on the upper eyelid 1 year after operation, and both eyes were asymmetric when eyes were open. Other 40 cases were recovered with bilateral symmetry without dysfunction of opening and closing the mouth and eyes. Facial contour recovery was cosmetically satisfactory with VSS score 1-3.Conclusions:Primary suturing of dog bite injuries on the head and face, according to the rabies prevention and treatment guideline, is a safe and effective treatment. It prevents rabies, and facial deformities and severe scar deformity in patients.

Objective To investigate the predictive value of preoperative viable myocardium and postoperative left ventricular mechanical dyssynchrony (LVMD) for adverse cardiovascular events(ACE) after coronary artery bypass graft (CABG) in patients with coronary artery disease (CAD) using myocardial perfusion imaging (MPI).Methods From September 2012 to March 2016,49 patients (44 males,5 females,average age:(64±8) years) with CAD were prospectively recruited.All patients underwent 99Tcmmethoxyisobutylisonitrile (MIBI) SPECT gated MPI (GMPI) and 18F-fluorodeoxyglucose (FDG) PET myocardial metabolic imaging to assess myocardial viability preoperatively.GMPI was repeated 4-6 months after CABG to record postoperative LVMD.Phase analysis was used to measure bandwidth (BW) and standard deviation (SD).Regular follow-up was performed,and ACE were taken as the end point.Cox proportional hazard model,Kaplan-Meier method and log-rank test were used to analyze the data.Results The mean duration of follow-up was (3.82±0.80) years,and ACE were present after CABG in 17 CAD patients (34.7％,17/49).Cox multi-analysis revealed that the number of preoperative viable segments (hazard ratio (HR)=0.208,95％ CI:0.068-0.642) and postoperative BW (HR=1.245,95％ CI:1.099-1.411)were independent influencing factors of ACE in CAD patients after CABG (both P＜0.01).Kaplan-Meier survival analysis showed that the incidence of ACE in patients with ＜ 3 viable segments was significantly higher than those with ≥ 3 viable segments (57.1％ (12/21) vs 17.9％ (5/28);x2 =21.023,P＜0.01).The incidence of ACE was significantly higher in the postoperative BW≥98° group than that in the postoperative BW＜98° group (14/19 vs 10％ (3/30);x2 =38.395,P＜0.01).Conclusions Less preoperative viable segments and severe postoperative LVMD are independent risk factors of ACE after CABG in CAD patients.Postoperative LVMD in CAD patients undergoing CABG may have important clinical value in the riskrestratification and prognosis evaluation.

Objective: To explore the clinical effects and the influence factors of olfactory training in the treatment of olfactory dysfunction. Methods: A total of 86 patients with olfactory dysfunction (49 post-infectious and 37 post-traumatic) in Beijing Anzhen Hospital during Dec 2016 to May 2017 were recruited in this prospective study. The clinical data of patients were analyzed, including gender, age, body mass index (BMI), course of disease, smoking history, drinking history, diabetes history, hypertension history, hyperlipidemia history, and anxiety visual analogue score (VAS). All patients were treated with olfactory training for 16 weeks, and all of them underwent Sniffin′ Sticks olfactory test before and after treatment, which was evaluated by composite threshold-discrimination-identification score (TDI). SPSS 23.0 software, paired t test and univariate and multivariate Logistic regression analysis were used to analyze the data. Results: Eighty patients received treatment, including 46 post-infectious olfactory dysfunction and 34 post-traumatic olfactory dysfunction. After olfactory training, the total scores of TDI increased with statistically significant (18.3±8.6 vs 13.6±7.4, t=-6.158, P<0.05). The overall efficacy was 40% (32/80). The effective rate were 45.7% (21/46) in post-infectious olfactory dysfunction and 32.4% (11/34) in post-traumatic olfactory dysfunction respectively, with no statistically significant difference (χ²=1.441, P=0.230). Logistic regression analysis showed that the course of disease was an influence factor in the clinical curative effect (OR=0.881, 95%CI: 0.799-0.973, P=0.012). In patients with less than a year of olfactory dysfunction, the olfactory function improved obviously with the efficiency of 50.9% (29/57). Conclusion Sixteen weeks of olfactory training provides a significant therapeutic effect on the post-infectious and post-traumatic olfactory dysfunction, and the olfactory training can achieve better therapeutic effects at the early stage.