OBJECTIVE: To investigate the short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery (UNSES) via crossing midline approach (CMA) in the treatment of free lumbar disc herniation (FLDH). METHODS: Between March 2024 and June 2024, 16 patients with FLDH were admitted and treated with UNSES via CMA. There were 9 males and 7 females with an average age of 55.1 years (range, 47-62 years). The disease duration was 8-30 months (mean, 15.6 months). The pathological segments was L _{3, 4} in 4 cases, L _{4, 5} in 5 cases, and L ₅, S ₁ in 7 cases. The preoperative pain visual analogue scale (VAS) score was 6.9±0.9 and the Oswestry disability index (ODI) was 57.22%±4.16%. The operation time, intraoperative bleeding volume, postoperative hospital stay, and incidence of complications were recorded. The spinal pain and functional status were evaluated by VAS score and ODI, and effectiveness was evaluated according to the modified MacNab criteria. CT and MRI were used to evaluate the effect of nerve decompression. RESULTS: All 16 patients underwent operation successfully without any complications. The operation time was 63-81 minutes (mean, 71.0 minutes). The intraoperative bleeding volume was 47.3-59.0 mL (mean, 55.0 mL). The length of hospital stay after operation was 3-4 days (mean, 3.5 days). All patients were followed up 1-3 months, with 15 cases followed up for 2 months and 14 cases for 3 months. The VAS score and ODI gradually decreased over time after operation, and there were significant differences between different time points ( P<0.05). At 3 months after operation, the effectiveness was rated as excellent in 12 cases and good in 2 cases according to the modified MacNab criteria, with an excellent and good rate of 100%. CT and MRI during follow-up showed a significant increase in the diameter and cross-sectional area of the spinal canal, indicating effective decompression of the canal. CONCLUSION When using UNSES to treat FLDH, choosing CMA for nerve decompression has the advantages of wide decompression range, large operating space, and freedom of operation. It can maximize the preservation of the articular process, avoid fracture and breakage of the isthmus, clearly display the exiting and traversing nerve root, and achieve good short-term effectiveness.
Humans ; Male ; Intervertebral Disc Displacement/diagnostic imaging* ; Middle Aged ; Female ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Treatment Outcome ; Operative Time ; Pain Measurement ; Length of Stay

PURPOSE: To analyze risk factors for severe trauma and establish a nomogram for early risk prediction, to improve the early identification of severe trauma. METHODS: This study was conducted on the patients treated in 81 trauma treatment institutions in Gansu province from 2020 to 2022. Patients were grouped by year, with 5364 patients from 2020 to 2021 as the training set and 1094 newly admitted patients in 2020 as the external validation set. Based on the injury severity score (ISS), patients in the training set were classified into 2 subgroups of the severe trauma group (n = 478, ISS scores ≥25) and the non-severe trauma group (n = 4886, ISS scores <25). Univariate and binary logistic regression analyses were employed to identify independent risk factors for severe trauma. Subsequently, a predictive model was developed using the R software environment. Furthermore, the model was subjected to internal and external validation via the Hosmer-Lemeshow test and receiver operating characteristic curve analysis. RESULTS: In total, 6458 trauma patients were included in this study. Initially, this study identified several independent risk factors for severe trauma, including multiple traumatic injuries (polytrauma), external hemorrhage, elevated shock index, elevated respiratory rate, decreased peripheral oxygen saturation, and decreased Glasgow coma scale score (all p < 0.05). For internal validation, the area under the receiver operating characteristic curve was 0.914, with the sensitivity and specificity of 88.4% and 87.6%, respectively; while for external validation, the area under the receiver operating characteristic curve was 0.936, with the sensitivity and specificity of 84.6% and 93.7%, respectively. In addition, a good model fitting was observed through the Hosmer-Lemeshow test and calibration curve analysis (p > 0.05). CONCLUSION This study establishes a nomogram for early risk prediction of severe trauma, which is suitable for primary healthcare institutions in underdeveloped western China. It facilitates early triage and quantitative assessment of trauma severity by clinicians prior to clinical interventions.
Humans ; Nomograms ; Male ; Female ; Wounds and Injuries/diagnosis* ; Risk Factors ; Middle Aged ; Adult ; Injury Severity Score ; Risk Assessment ; ROC Curve ; Aged ; Logistic Models ; China ; Glasgow Coma Scale

Objective To evaluate the effectiveness of tumor cell Vimentin combined with endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB)in diagnosing solid pancreatic tumors.Methods Clinical data from 110 patients who underwent EUS-FNB from October 2021 to December 2023 were retrospectively analyzed.Solid pancreatic tumors including but not limited to pancreatic cancer and pancreatic neuroendocrine tumors.The sensitivity,specificity,and accuracy of EUS-FNB were assessed by comparing its results with the final pathological diagnoses.Result Clear histopathological diagnoses were obtained in 106 cases,accounting for 96.37%.Among them,87 cases were definitively diagnosed as adenocarcinoma or pancreatic ductal adenocarcinoma.Immunohistochemical staining showed that Vimentin was expressed in the tumor cells.There was no statistically significant difference in positive rates among biopsies from different anatomical sites(P>0.05),but significant differences were observed in lesions of different diameters(P<0.05).Immunohistochemical staining suggested that Vimentin expression levels might be associated with the nature of the lesions.The overall diagnostic accuracy,sensitivity,and specificity of Vimentin combined with EUS-FNB for pancreatic masses were 86.09%,84.57%,and 100.00%,respectively.Specifically,for solid masses,the diagnostic accuracy,sensitivity,and specificity were 87.67%,86.55%,and 100.00%,respectively.For pancreatic cystic tumors,the diagnostic accuracy,sensitivity,and specificity were 65.42%,69.79%,and 100.00%,respectively.Conclusion The combination of tumor cell Vimentin and EUS-FNB demonstrates high diagnostic accuracy for solid pancreatic tumors,making it a valuable tool for clinical application.

OBJECTIVE: To investigate the short-term effectiveness of transverse antecubital incision in the treatment of failed closed reduction of Gartland type Ⅲ supracondylar humeral fractures (SHFs) in children. METHODS: Between July 2020 and April 2022, 20 children with Gartland type Ⅲ SHFs who failed in closed reduction were treated with internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision. There were 9 boys and 11 girls with an average age of 3.1 years (range, 1.1-6.0 years). The causes of injuries were fall in 12 cases and fall from height in 8 cases. The time from admission to operation ranged from 7 to 18 hours, with an average of 12.4 hours. The healing of the incision and the occurrence of complications such as nerve injury and cubitus varus were observed after operation; the elbow flexion and extension range of motion after removing the gypsum, after removing the Kirschner wire, and at last follow-up were recorded and compared, as well as the elbow flexion and extension and forearm rotation range of motion at last follow-up between healthy and affected sides; the Baumann angle was measured on the X-ray film, and the fracture healing was observed. At last follow-up, the effectiveness was evaluated according to the Flynn elbow function evaluation criteria. RESULTS: All incisions healed by first intention, and there was no skin necrosis, scar contracture, ulnar nerve injury, and cubitus varus. Postoperative pain occurred in the radial-dorsal thumb in 2 cases. The gypsum was removed and elbow flexion and extension exercises were started at 2-4 weeks (mean, 2.7 weeks) after operation, and the Kirschner wire was removed at 4-5 weeks (mean, 4.3 weeks). All the 20 patients were followed up 6-16 months, with an average of 12.4 months. The fracture healing time was 4-5 weeks, with an average of 4.5 weeks, and there was no complication such as delayed healing and myositis ossificans. The flexion and extension range of motion of the elbow joint gradually improved after operation, and there were significant differences between the time after removing the gypsum, after removing the Kirschner wire, and at last follow-up ( P<0.017). There was no significant difference in the flexion and extension of the elbow joint and the forearm rotation range of motion between the healthy and affected sides at last follow-up ( P>0.05). There was no significant difference in Baumann angle between the time of immediate after operation, after removing the Kirschner wire, and at last follow-up ( P>0.05). According to Flynn elbow function evaluation standard, 16 cases were excellent and 4 cases were good, the excellent and good rate was 100%. CONCLUSION The treatment of Gartland type Ⅲ SHFs in children with failed closed reduction by internal and external condylar crossing Kirschner wire fixation through transverse antecubital incision has the advantages of complete soft tissue hinge behind the fracture for easy reduction and wire fixation, small incision, less complications, fast fracture healing, early functional recovery, reliable reduction and fixation, and can obtain satisfactory results.
Male ; Female ; Humans ; Child ; Child, Preschool ; Calcium Sulfate ; Humerus ; Humeral Fractures/surgery* ; Plastic Surgery Procedures ; Fracture Fixation, Internal/methods* ; Bone Wires ; Fracture Healing ; Treatment Outcome ; Range of Motion, Articular

Vitamins are organic substances that are essential for the maintenance of life activities. Generally, vitamins need to be obtained from the diet or from some synthetic source as the body cannot synthesize vitamins, or the amounts of the synthesized vitamins are insufficient. At present, vitamins are widely used in medicine, food additives, feed additives, cosmetics and other fields, and the global demand for vitamins is constantly growing. Vitamins can be produced from chemical or microbial synthesis. Chemical synthesis usually requires harsh reaction conditions, produces serious wastes, and creates great potential safety hazard. In contrast, microbial synthesis of vitamins is greener, safer, and requires much less energy input. This review summarizes the advances in metabolic engineering for vitamins production in the past 30 years, with a focus on production of water-soluble vitamins (vitamins B1, B2, B3, B5, B6, B7, B9, B12 and vitamin C precursors) and lipid-soluble vitamins (vitamin A, precursors of vitamin D, vitamin E and vitamin K). Moreover, the bottlenecks for fermentative production of vitamins are discussed, and future perspectives for developing next generation vitamins producing strains using synthetic biotechnology are prospected.
Biotechnology ; Metabolic Engineering ; Vitamin A ; Vitamin K ; Vitamins/analysis*

Objective: To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage. Methods: Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate. Results: 32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34- ~ 21.15) mmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31- ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) mmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) mmol/L, respectively. Conclusion The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.

Objective:To investigate the risk factors, severity of symptoms, acute exacerbations, and pulmonary function in women with chronic obstructive pulmonary disease (COPD).Methods:A total of 4 204 COPD patients, including 533 female COPD patients and 3 671 male COPD patients, were investigated from January 2017 to December 2019 in Second Xiangya Hospital of Central South University, Hunan Prevention and Treatment Institute for Occupational Disease, affiliated Hospital of Guilin Medical College and Guilin Second People's hospital. The risk factors, severity of symptoms, risk of acute exacerbation and clinical characteristics of pulmonary function in patients with COPD were comprehensively analyzed.Results:There was no statistical difference in age between male and female COPD patients ( P>0.05). There were statistically significant differences in smoking history, occupational exposure history and biofuel exposure history ( P<0.001), among which smoking history and occupational exposure history were significantly higher in males than in females ( P<0.001), and exposure history of biofuels was significantly higher in females than in males ( P<0.001). The COPD assessment test (CAT) score of male and female patients was statistically different ( P<0.05), and the mean CAT score of female patients was higher than that of male patients. The modified medical research council dyspnea scale (mMRC) grading results of male and female patients were statistically different ( P<0.05), and the mMRC grading of female patients was higher than that of male patients. There was no statistical difference in the risk of acute exacerbation between male and female patients ( P>0.05). There were statistically significant differences between male and female patients in first second exertional volume as a percentage of predicted value (FEV 1%) and forced expiratory volume in one second/forced vital capacity (FEV 1/FVC) mean value ( P<0.001), and FEV 1% predicted value and FEV 1/FVC of female patients were better than that of male patients. Conclusions:The risk factors, symptom severity and pulmonary function of female patients with COPD are different from those of male patients, providing reference for the individualized treatment of female patients with COPD.

Objective: To explore the value of combined detection of serum cystatin C (CysC), urinary β2-microglobulin (β2-MG), and liver type fatty acid binding protein (L-FABP) in early diagnosis of acute renal injury after cardiac surgery. Methods: 126 patients undergoing cardiac surgery in our hospital from April 2015 to August 2016 were selected as the subjects, according to the occurrence of acute renal injury after operation, 48 cases were divided into acute renal injury (AKI) group and 78 cases into non-acute renal injury (non AKI) group, the levels of serum CysC, urine β2-MG, and L-FABP were detected in the two groups. Receiver operating characteristic (ROC) curve was used to analyze the effects of serum CysC, urine β2-MG, L-FABP in the early diagnosis of acute renal injury after cardiac surgery. Results: The incidence of AKI after cardiac surgery was 38.10% (48/126); the serum CysC level in group AKI was significantly higher than that in non AKI group (P<0.05); the levels of urine β2-MG and L-FABP were significantly higher than those in non AKI group (P<0.05); the area under curve (AUC) of serum CysC for AKI diagnosis after cardiac surgery was 0.874 (P<0.05), with diagnostic sensitivity 85.7%, and specificity 76.5%; the AUC area of urinary β2-MG for AKI diagnosis after cardiac surgery was 0.754 (P<0.05), with diagnostic sensitivity 92.9%, and specificity 73.5%, respectively; the AUC area of urinary L-FABP for AKI diagnosis after cardiac surgery was 0.834 (P<0.05), with diagnostic sensitivity 92.9%, and specificity 74.1%. The AUC area of combined diagnosis of the three was 0.914 (P<0.05), with the diagnostic sensitivity 92.1%, and specificity 82.4%. Conclusions Serum Cys C, urine β 2-MG and L-FABP levels were significantly increased in patients with AKI. The diagnosis of the three alone has a certain reference value, which is lower than the combined diagnosis. The combined diagnosis of the three can provide an important reference for screening acute renal injury after heart surgery.

Objective To explore the efficiency of prophylactic peduncle ligature combined with high-frequency electrocoagulation in treatment of patients by peduncluated polyps of gastrointestinal tract. Methods A total of 41 patients with peduncluated polyps of gastrointestinal tract by treatment of high-frequency electrocoagulation resection were selected, and all patients were treated with prophylactic peduncle ligature by nylon rope or titanium clip before resection. The resection efficiency and complications were observed. Results All the patients underwent one-time removal of peduncluate polyps with a success rate of 100. 0％. One case had small amount of bleeding in the wound and was clipped with titanium clip. No complications such as perforation and delayed hemorrhage were observed in all patients. All the patients were followed up for 3 to 6 months, and wound healed well without recurrence. Conclusion For the large peduncluated polyps of gastrointestinal tract, prophylactic peduncle ligature before resection is a safe and effective method.

Objective To explore the efficiency of prophylactic peduncle ligature combined with high-frequency electrocoagulation in treatment of patients by peduncluated polyps of gastrointestinal tract. Methods A total of 41 patients with peduncluated polyps of gastrointestinal tract by treatment of high-frequency electrocoagulation resection were selected, and all patients were treated with prophylactic peduncle ligature by nylon rope or titanium clip before resection. The resection efficiency and complications were observed. Results All the patients underwent one-time removal of peduncluate polyps with a success rate of 100. 0％. One case had small amount of bleeding in the wound and was clipped with titanium clip. No complications such as perforation and delayed hemorrhage were observed in all patients. All the patients were followed up for 3 to 6 months, and wound healed well without recurrence. Conclusion For the large peduncluated polyps of gastrointestinal tract, prophylactic peduncle ligature before resection is a safe and effective method.