Objective To assess causal associations between specific gut microbiota and different types of cancer by using the two-sample Mendelian randomization(MR)analysis method.Methods On the basis of summary statistics of gut microbiota from a genome-wide association study(GWAS)conducted in German population(n=8956),single nucleotide polymorphisms(SNPs)that were significantly associated with 430 gut microbiota features were extracted as instrumental variables(Ⅳs).Summary statistics from the GWAS of 17 types of cancer were used as outcomes.Two-sample MR analysis was used to explore the causal relationship between gut microbiota and pan-cancer,where the analysis results were dominated by inverse variance weighting.Meanwhile,sensitivity analyse of heterogeneity and horizontal pleiotropy test were done to keep the stability of results.Results The genetic susceptibility of 17 gut microbiota features was causally associated with the occurrence and development of 11 different types of cancer,respectively.Conclusion By exploring the causal relationship between different gut microbiota features and pan-cancer,this study has found a potential causal relationship between specific gut microbiota features and cancer,and these gut microbiota may become new biomarkers to provide new ideas for cancer prevention,early screening,and treatment.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective:To investigate the efficacy and safety of argon plasma coagulation (APC) in the treatment of patients with hemorrhagic chronic radiation proctitis (HCRP).Methods:The clinical data of 36 HCRP patients who received APC treatment in Shanxi Province Cancer Hospital between January 2017 and June 2021 were retrospectively analyzed. The severity of HCRP was assessed by using the Zinicola endoscopic score and the Vienna proctoscopy score. The elimination of rectal bleeding or occasional bloody stools that did not require further treatment within 6 months of the last APC treatment was considered to be the therapy success.Results:The median follow-up time was 1.63 years (0.85-2.68 years). There were 20 (55.6%) patients with severe HCRP according to the Zinicola endoscopic score. After APC treatment, 32 patients with HCRP obtained adequate rectal hemostasis, whereas 4 patients with severe HCRP still experienced rectal bleeding symptoms after APC treatment for several times. All patients received APC treatment for (2.7±1.0) times in total. The endoscopic scores of HCRP patients before and after APC treatment were (3.6±0.8) scores, (1.4± 1.1) scores, respectively; Vienna proctoscopy scores were (3.8±0.8) scores, (1.2±1.1) scores, respectively; and the differences were statistically significant ( t values were 22.37, 18.96; all P < 0.001). The hemoglobin levels of HCRP patients before and after APC treatment were (85±15) g/L, (100±17) g/L, respectively, and the difference was statistically significant ( t = 17.86, P < 0.001). Serious side effects including strictures, perforations, or fistulas and other severe complications related to APC therapy were not found. Conclusions:APC may be an effective and safe treatment option for patients with HCRP.

Objective:To investigate the feasibility of reducing radiation dose in coronary CT angiography for patients with arrhythmia with absolute phase and narrow window in prospective electrocardiogram-gating.Methods:200 patients with arrhythmia underwent coronary CT angiography procedure with prospective electrocardiogram-gating adaptive sequence in dual source CT were randomly divided into 2 groups according to the scan mode. Group A was scanned with absolute phase and narrow window(250-450 ms) and group B uesd relative phase and wide window (30%-75%). The other parameters and injection protocol of contrast media were the same in 2 groups. Both image quality and radiation dose of the 2 groups were analyzed.Results:No significant difference of image quality was found between the 2 groups. CTDI vol, DLP, E of group A were all lower than those in group B [CTDI vol : (16.71±8.35) vs.(29.35±17.90)mGy , DLP: (231.04±114.86) vs.(398.27±238.40)mGy·cm , E: (3.23±1.60) vs.(5.57±3.33)mSv, t=-6.40, -6.32、-6.32, P<0.05] . The patients with repeat scan cycles in group A and group B were 81 vs. 22 for 0 cycle , 17 vs. 62 for 1 cycle, 2 vs. 10 for 2 cycles, 0 vs. 6 for 3 cycles( χ2=70.76, P<0.05). Conclusions:The prospective electrocardiogram-gating adaptive CCTA sequence with absolute phase and narrow window can reduce radiation dose while the image quality meets the requirementsfor patients with arrhythmia.

Objective:To investigate the safety and clinical efficacy of primary anterior lesion removal and bone graft fusion combined with secondary posterior fixation in the treatment of cervical suppurative spondylitis.Methods:Retrospective analysis was performed on the data of twenty cervical suppurative spondylitis patients treated with primary anterior lesion removal and bone graft fusion combinedwith secondary posterior fixation in our hospital from May 2016 to December 2020, including 14 males and 6 females. Aging from 40 to 87 years, with an average of 60.2±12.6 years. The laboratory tests of preoperative blood culture, such as white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and hypersensitive C-reactive protein (CRP) were performed.The selection and duration of antibiotic usewere guided according to bacterial culture and laboratory test results. visual analogue scale (VAS) score, Japanese Orthopeadic Association (JOA) score and Frankle classification of neurological function were evaluated before surgery, 3 months after surgery, and 12 months after surgery, so were the Cobb angle and segmental angle of cervical lordosis. Single factor repeated measure ANOVA was used for statistical analysis of data.Results:Surgeries were performed successfully for all the 20 patients. 9 cases of Staphylococcus aureus, 4 cases of Streptococcus and 2 case of Escherichia coli were detected by pathogen examination. The remaining 5 cases were negative in bacterial culture. All 20 patients were followed up for 18.3±6.7 months. WBC, ESR and CRP at 3 and 12 months after surgery were significantly lower than those before surgery ( F value: 17.90, 30.65, 18.64, P<0.001). The VAS at 3 months after surgery 1.35±0.49 and 12 months after surgery 1.15±0.48 were significantly lower than that before surgery 4.95±1.10 ( F=176.12, P<0.001). The JOA score at 3 months after surgery 15.40±1.93 and 12 months after surgery 16.06±1.36 were significantly better than that before surgery 11.45±2.78 ( F=65.33, P<0.001). The Cobb Angle of C 2-C 7 cervical lordosis after surgery 14.45°±4.36° and 12 months after surgery (13.70°±3.15°) were significantly larger than that before surgery (8.25°±4.36°) ( F=72.54, P<0.001). Cobb angle of the lesion segment after surgery (3.60°±1.90°) and 12 months after surgery (2.90°±1.44°) were significantly better than that before surgery (-3.55°±5.74°) (negative value indicated kyphosis) ( F=42.49, P<0.001). Bone fusion was observed in all graft areas at 12 months of follow-up. Conclusion:The treatment of cervical suppurative spondylitis with primary anterior lesion removal and bone graft fusion combined with secondary posterior fixation can effectively obtain intraspinal decompression, improve pain and nerve function, as well as restore cervical stability and correct kyphosis, with satisfactory clinical efficacy.

【Objective】 To investigate the effects of one-stage additional posterior pedicle screws （PPS） internal fixation on early Cage subsidence after oblique lateral interbody fusion （OLIF）. 【Methods】 We made a retrospective analysis of 118 patients with lumbar degenerative diseases treated with OLIF at the Department of Orthopedics， Sir Run Run Shaw Hospital， School of Medicine， Zhejiang University， from January 2016 to December 2019. We divided the patients into OLIF stand-alone group （58 ones） and OLIF with PPS fixation group （60 ones） according to the surgical procedure. All the patients had preoperative frontal and lateral radiographs of the lumbar spine， and CT and MR scans were performed. The clinical outcomes and reoperation rates of the two groups were compared at immediate postoperative follow-up and at 1， 3， 6 and 12 months. X-ray and CT examinations were performed to assess Cage subsidence in both groups at each postoperative follow-up. 【Results】 There was no statistical difference between the two groups in baseline data and surgical segmentation. Of the 118 patients with 141 discs who underwent OLIF surgery， 58 patients with 68 discs received OLIF stand-alone surgery and 60 ones with 73 discs received OLIF with PPS fixation. There were no significant differences in intraoperative bleeding， complications， or postoperative clinical outcomes between the two groups （P>0.05）， and the Cage subsidence rate was 22.4% in OLIF stand-alone group and 5% in OLIF with PPS fixation group， with significant difference between the two groups （P<0.01）. 【Conclusion】 Both OLIF stand-alone and OLIF additional PPS fixation can achieve good early clinical outcomes， and first-stage additional PPS fixation can significantly reduce the occurrence of Cage subsidence in the early postoperative period after OLIF.

Objective:To investigate the relationship between transcription factors (TFs) and the prognosis of colon cancer, and to construct a prognosis model through TCGA and GEO dual databases, so as to quantify the risk of patients and guide clinical treatment decisions.Methods:The transcriptome and clinical data of colon cancer in TCGA and GEO databases were used in this study. The transcriptome data were annotated and the gene expression was calculated. The difference analysis of TFs in TCGA and GEO (log2FC > 1, P-value (Fdr) < 0.05) was performed. The difference TFs of double data intersection were used for correlation prognosis analysis ( P<0.01). The risk coefficient and risk value of prognosis-related TFs were calculated by COX multivariate analysis, and the prognosis model of TFs was constructed by COX model with "survival" and "glmnet" package. The survival curve ( P<0.001) and ROC curve (AUC>0.75) of the sequence set and verification set were drawn, and the distribution of risk value was visualized. After grouping according to risk value, GSEA enrichment analysis was calculated, gene set grid was constructed, target genes were predicted, and finally, pathway enrichment analysis of GO and KEGG was carried out. Results:387 TFs with different expressions in TCGA and GEO databases were used to draw heat map, volcanic map and TFs-related forest map, and the prognosis model of colon cancer was constructed according to COX multivariate analysis=0.310×HSF4+0.137×IRX3-0.127×ATOH1+0.290×OVOL3+0.137×HOXC6+0.155×SIX2+0.092×ZNF556-0.444×CXXC5+0.429×TIGD1+0.413×TCF7L1. Through enrichment analysis, our results showed that these prognostic factors may directly or indirectly act on cancer pathways, such as basic cell carcinoma and cancer signaling pathway, local tissue-cell adhesion, and extracellular matrix.Conclusions:The constructed TFs prognosis model of colon cancer can quantify the prognostic risk of colon cancer, and its high-risk group is an independent risk factor of colon cancer prognosis. This model is a new way to evaluate the prognosis of colon cancer.

ObjectiveIn the previous stage，our research group isolated Pseudomonas ZL8 from Polyporus umbellatus， which has a broad-spectrum inhibitory effect on plant pathogenic fungi such as Fusarium oxysporum of Salvia miltiorrhiza and promotes plant growth. On this basis， this study optimized the fermentation medium and conditions of Pseudomonas ZL8，to improve the number of bacteria in the fermentation broth per unit volume， and provide a basis for the development and application of this strain. MethodThe growth curve of strain ZL8 in LB culture medium was determined and its growth law in liquid medium was clarified. With the number of live bacteria in the fermentation broth of strain ZL8， the dry weight of the bacteria and the A₆₀₀ value of the broth as detection indicators， single factor investigation was carried out on different nitrogen sources，carbon sources and inorganic salts to determine the optimal medium components. Additionally， orthogonal test was conducted to optimize the component ratio to screen the optimal fermentation medium. Similarly， single factor investigation and orthogonal test were also carried out in four aspects： inoculation amount，culture temperature，time and rotating speed to obtain the optimal culture conditions. ResultThe optimal medium for liquid fermentation of strain ZL8 was peptone 15 g·L^-1， glucose 7.5 g·L^-1， and potassium chloride 10 g·L^-1. After 48 h of fermentation，the number of viable bacteria in the fermentation liquid could reach 8.93×10⁹ cfu·mL^-1，3.93 times that of LB liquid medium （P<0.01）. The optimal fermentation conditions were as follows： inoculation amount 3%， temperature 28 ℃， time 72 h，and rotating speed 220 r·min^-1， and the number of viable bacteria in the fermentation broth could reach 6.37×10¹⁰ cfu·mL^-1. ConclusionCompared with LB culture medium and the initial fermentation conditions，the optimized culture medium and conditions could effectively increase the bacterial volume of strain ZL8 per unit volume and prolong the stable growth of the strain， with low medium cost， which provided a theoretical basis for the efficient fermentation and application of Pseudomonas ZL8.

Renal clear cell carcinoma metastasis to the gallbladder is rare. This paper reported a case of gallbladder metastasis of renal clear cell carcinoma detected after two years of left radical nephrectomy. The patient underwent laparoscopic cholecystectomy and followed by postoperative targeted therapy of sunitinib. No new metastasis was found after 5 months of follow-up.

Objective:To investigate the risk factors for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer, and application value of a nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 228 patients with stage Ⅱ-Ⅲ colon cancer who underwent radical resection in the First Affiliated Hospital of Xi′an Jiaotong University from January 2013 to June 2016 were collected. There were 118 males and 110 females, aged from 25 to 87 years, with a median age of 62 years. All patients underwent open or laparoscopic-assisted radical resection of colon cancer. Observation indicators: (1) postoperative tumor recurrence; (2) risk factors analysis for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer; (3) development and evaluation of a nomogram prediction model for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer. Follow-up using outpatient examination and telephone interview was performed to detect postoperative 3-year tumor recurrence up to June 2019. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers, and comparison between groups was analyzed using the Pearson chi-square test or Fisher exact probability. Multivariate analysis was performed using Logistic stepwise regression analysis. The independent risk factors were included into R 3.6.1 software to construct a nomogram prediction model. The receiver operating characteristic curve (ROC) was drawed, and the area under curve (AUC) was used to evaluate discrimination of the nomogram prediction model. The calibration chart with R software was used to evaluate consistency of the nomogram prediction model. Results:(1)Postoperative tumor recurrence: 53 of 228 patients had postoperative tumor recurrence including 19 cases with locoregional recurrence and 34 cases with distant metastasis. Of the 34 patients with distant metastasis, there were 14 cases with liver metastasis, 7 cases with lung metastasis, 4 cases with brain metastasis, and 9 cases with multiple metastasis or isolated metastasis in other sites. The time to recurrence was 12 months (range, 6-19 months). (2) Risk factors analysis for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer:results of univariate analysis showed that bowel obstruction, preoperative carcinoembryonic antigen (CEA) level, ascites, vascular invasion were related factors for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer ( χ2=4.463, 13.622, 10.914, 5.911, P<0.05). Pathological N stage was also a related factor for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer ( P<0.05). Results of multivariate analysis showed that preoperative CEA level >5 μg/L, ascites, vascular invasion and pathological N stage as stage N1 or N2 were independent risk factors for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer ( odds ratio=3.129, 3.071, 7.634, 3.439, 15.467, 95% confidence interval as 1.328-7.373, 1.047-9.007, 1.103-52.824, 1.422-8.319, 3.498-68.397, P<0.05). (3) Development and evaluation of a nomogram prediction model for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer: based on preoperative CEA level, ascites, vascular invasion and pathological N stage of multivariate analysis, a nomogram prediction model for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer was developed using R 3.6.1 software. The nomogram score was 41.7 for preoperative CEA level >5 μg/L, 41.0 for ascites, 74.2 for vascular invasion, 45.1 and 100.0 for pathological N stage as stage N1 and N2, respectively. The total of different scores for risk factors corresponded to the probability of postoperative recurrence. The ROC of nomogram for recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer was drawed,with the AUC of 0.805(95% confidence interval as 0.737-0.873, P<0.05). The calibration chart showed a good consistency between the probability of recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer predicted by nomogram and the actual probability of postoperative recurrence. Conclusions:Preoperative CEA level >5 μg/L, ascites, vascular invasion and pathological N stage as stage N1 or N2 are independent risk factors for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer. The nomogram prediction model contributes to prediction of the recurrent risks after radical resection of stage Ⅱ-Ⅲ colon cancer.