BACKGROUND:Osteoporotic fracture is the most serious complication of osteoporosis.Previous studies have demonstrated that gut microbiota has a regulatory effect on skeletal tissue and that gut microbiota has an important relationship with osteoporotic fracture,but the causal relationship between the two is unclear. OBJECTIVE:To explore the causal relationship between gut microbiota and osteoporotic fractures using Mendelian randomization method. METHODS:The genome-wide association study(GWAS)datasets of gut microbiota and osteoporotic fracture were obtained from the IEU Open GWAS database and the Finnish database R9,respectively.Using gut microbiota as the exposure factor and osteoporotic fracture as the outcome variable,Mendelian randomization analyses with random-effects inverse variance weighted,MR-Egger regression,weighted median,simple model,and weighted model methods were performed to assess whether there is a causal relationship between gut microbiota and osteoporotic fracture.Sensitivity analyses were performed to test the reliability and robustness of the results.Reverse Mendelian randomization analyses were performed to further validate the causal relationship identified in the forward Mendelian randomization analyses. RESULTS AND CONCLUSION:The results of this Mendelian randomization analysis indicated a causal relationship between gut microbiota and osteoporotic fracture.Elevated abundance of Actinomycetales[odds ratio(OR)=1.562,95%confidence interval(CI):1.027-2.375,P=0.037),Actinomycetaceae(OR=1.561,95%CI:1.027-2.374,P=0.037),Actinomyces(OR=1.544,95%CI:1.130-2.110,P=0.006),Butyricicoccus(OR=1.781,95%CI:1.194-2.657,P=0.005),Coprococcus 2(OR=1.550,95%CI:1.068-2.251,P=0.021),Family ⅩⅢ UCG-001(OR=1.473,95%CI:1.001-2.168,P=0.049),Methanobrevibacter(OR=1.274,95%CI:1.001-1.621,P=0.049),and Roseburia(OR=1.429,95%CI:1.015-2.013,P=0.041)would increase the risk of osteoporotic fractures in patients.Elevated abundance of Bacteroidia(OR=0.660,95%CI:0.455-0.959,P=0.029),Bacteroidales(OR=0.660,95%CI:0.455-0.959,P=0.029),Christensenellacea(OR=0.725,95%CI:0.529-0.995,P=0.047),Ruminococcaceae(OR=0.643,95%CI:0.443-0.933,P=0.020),Enterorhabdus(OR=0.558,95%CI:0.395-0.788,P=0.001),Eubacterium rectale group(OR=0.631,95%CI:0.435-0.916,P=0.016),Lachnospiraceae UCG008(OR=0.738,95%CI:0.546-0.998,P=0.048),and Ruminiclostridium 9(OR=0.492,95%CI:0.324-0.746,P=0.001)would reduce the risk of osteoporotic fractures in patients.We identified 16 gut microbiota associated with osteoporotic fracture by the Mendelian randomization method.That is,using gut microbiota as the exposure factor and osteoporotic fracture as the outcome variable,eight gut microbiota showed positive causal associations with osteoporotic fracture and another eight gut microbiota showed negative causal associations with osteoporotic fracture.The results of this study not only identify new biomarkers for the early prediction of osteoporotic fracture and potential therapeutic targets in clinical practice,but also provide an experimental basis and theoretical basis for the study of improving the occurrence and prognosis of osteoporotic fracture through gut microbiota in bone tissue engineering.

Small cell carcinoma of the prostate is a rare and highly malignant tumor of the urinary system. It is less common for prostate small cell carcinoma coexisting with bladder carcinoma. One such case was reported in this paper. The patient underwent ultrasound-guided transrectal prostate biopsy, and transurethral bladder endoscopy + bladder tumor electric resection. Postoperative pathology and immunohistochemistry showed prostate small cell carcinoma accompanied by high-grade invasive urothelial carcinoma of the bladder and small cell carcinoma. The patient underwent local bladder perfusion chemotherapy, relying on etoposide plus lobaplatin systemic chemotherapy and toripalimab immunotherapy. Prostate MRI, cystoscopy, and prostate-specific antigen (PSA) were performed 12 months after operation. The size of the lesions in the prostate and seminal vesicles had decreased, and there was a significant reduction in PSA levels. Additionally, no masses were detected in the bladder.

Abstract: Objective　To analyze the risk factors for HIV/AIDS mortality after receiving antiviral treatment in Tongchuan City, and to provide a scientific basis for implementing precision treatment in Tongchuan City. Methods　A retrospective cohort study was conducted to collect general demographic characteristics and survival-related information of HIV/AIDS individuals who received antiviral treatment in Tongchuan City from 2005 to 2023. Mortality table analysis was used to assess the cumulative survival rate, Cox regression model was used to analyze survival influencing factors, and a nomogram was constructed to predict the prognosis of antiviral treatment. Results A total of 410 HIV/AIDS patients underwent antiviral treatment, with the shortest observation period being 0 months and the longest 222 months, and the median survival time was 71 months (QR: 64-106); among the 362 cases followed up, there were 39 AIDS-related deaths. The cumulative survival rates after 1, 5, and 10 years of antiretroviral therapy were 96.2%, 91.3%, and 83.0%, respectively. Multivariate Cox analysis showed that patients with a higher level of education (college degree or above) (HR=0.349, 95%CI: 0.159-0.769) and without clinical symptoms (HR=0.357, 95%CI: 0.178-0.715) had a lower risk of death after antiretroviral treatment, whereas patients with a CD4 cell count <200 cells/μL group (HR=9.383, 95% CI: 2.879-30.578) had a higher risk of death. Based on the above three influencing factors, a nomogram model was constructed. Internal validation showed that the model's discriminative ability with a C-index of 0.859 (95% CI: 0.762-0.956), and the calibration curve indicated good consistency, demonstrating the model's good predictive ability. Conclusions　Tongchuan City should expand health education on AIDS prevention and control, strengthen HIV monitoring, carry out education on compliance with antiviral treatment among HIV/AIDS individuals, conduct timely CD4 cell count detection, and use the constructed nomogram model to assist in precise diagnosis and treatment in clinical practice.

Objective To explore the MRI findings of diffuse midline gliomas with H3K27M mutation, and help us understand this new entity and improve the accuracy of diagnosis. Methods The clinical and imaging data of 17 diffuse midline gliomas with H3K27M mutation confirmed by pathology were retrospectively collected from July 2016 to April 2018 in Guangdong Sanjiu Brain Hospital. All patients were performed with pre?contrast and post?contrast MRI examination. All images were analyzed according to the location, shape, boundary, solid or cystic, signal feature, enhancement feature, and degree of edema. Results (1) Location:Six cases located in thalamus,4 cases located in brainstem,1 located in hypothalamus, 6 cases had multiple lesions in the midline and/or involving one or more brain. (2) Morphology and boundary:Seven cases had regular shape and clear boundary, 10 cases had irregular shapes and unclear boundaries. (3) Necrosis, cystic degeneration, hemorrhage: Twelve cases had necrosis or cystic degeneration in varying degree, 4 cases had hemorrhage. (4) Signal and enhancement features: The solid component showed slightly?low or low signal on T1WI, and slightly?high or high signal on T2WI; the cystic component showed obvious low signal on T1WI and obvious high signal on T2WI. T1WI enhancement:Eight cases showed uneven light?moderate enhancements, and all cases were adults; Six cases showed significant enhancements with large or small rings; Three cases showed uneven obvious enhancement. (5) Peritumoral edema: Fourteen cases had mild peritumoral edema,1 case had moderate peritumoral edema,2 cases had obvious peritumoral edema. Conclusion The MRI findings of diffuse midline gliomas with H3K27M mutation had certain characteristics,which can help to improve the level of diagnosis and differential diagnosis.

Objective To explore the effects of Yiqi Jianpi decoction on inflammatory reaction, immune function and nutritional status in patients after surgery of laparoscopic rectal cancer. Methods Eighty-two patients with post-operative laparoscopic rectal cancer resection admitted to Pingxiang People's Hospital from June 2017 to March 2019 were enrolled, and according to whether traditional Chinese medicine (TCM) was used or not, they were divided into a western medicine treatment control group (control group) and a combined traditional Chinese and western medicine treatment group (combined group), 41 cases in each group. The control group was treated with symptomatic conventional western therapy, while the combined group was additionally treated with Yiqi Jianpi decoction based on the conventional western treatment as in the control group; the composition of the decoction: hedyotis herba, herba agrimoniae, radix astragali each 30 g; radix codonopsis, ganoderma lucidum each 20 g; rizoma atractylodes, poria cocos and prunella chinensis 15 g each; pinellia ternata 9 g, licorice root 6 g; all the above ingredients were together boiled with water and the fluid (decoction) was filtered, 150 mL once orally taken, twice a day, 21 days constituting one therapeutic course, and the clinical efficacy was evaluated after 1 course of therapy. The changes of TCM syndrome score, simple health situation scale (SF-36) score, inflammatory indexes, immune function and nutritional status of the two groups were observed before and after treatment. Results After treatment, the levels of TCM syndrome score, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and CD8+ in the two groups were significantly lower than those before treatment, while the levels of SF-36 score, CD4+, CD4+/CD8+, transferrin (TRF) and albumin (Alb) were significantly higher than those before treatment (all P < 0.05), and the degree of changes in the combined group were more significant than those in control group [TCM syndrome score: 3.79±2.22 vs. 6.86±2.02, SF-36 score:75.18±4.13 vs. 64.17±4.01, CRP (mg/L): 4.54±1.31 vs. 5.71±2.21, IL-6 (μg/L): 20.21±2.21 vs. 26.12±2.13, TNF-α (μg/L): 33.04±4.56 vs. 36.41±3.23, CD4+: 0.37±0.03 vs. 0.35±0.03, CD8+: 0.25±0.03 vs. 0.28±0.03, CD4+/CD8+: 1.51±0.39 vs. 1.19±0.37, TRF (g/L): 3.05±0.41 vs. 2.28±0.42, Alb (g/L): 43.88±2.28 vs. 39.86±2.03, all P < 0.05]. Conclusion Yiqi Jianpi decoction in the treatment of patients after surgery of laparoscopic rectal cancer can effectively promote the recovery of gastrointestinal function, reduce the inflammatory reaction, elevate the immune function and improve clinical prognosis.

Objective To study the effect of electroencephalograph (EEG) bionic electrical stimulation at Wangu (GB12), Tianzhu (BL10), Neiguan (PC6) on cerebral blood flow and metabolism in patients with persistent vegetative state (PVS). Methods 60 patients with PVS were divided into observation group (n=30) and control group (n=30) according to the random number table. The control group received routine treatment, including basic management, hyperbaric oxygen therapy, awaking medicine, sensory stimulation, and so on; while the observation group received EEG bionic electrical stimulation at bilateral Tianzhu, Wangu (cheif electrodes) and Neiguan (auxiliary electrodes) in addition. They were treated for 30 days. They were assessed with the PVS score, and observed with transcranial Doppler ultrasound (TCD) and magnetic resonance spectroscopy (MRS) one day before and one day after treatment. Results The incidence of improvement was 86.67% in the observation group, more than 60.00% in the control group (P<0.05). The difference of blood flow velocity before and after treatment (ΔVm) of anterior-middle cerebral artery was more in the observation group than in the control group respectively (P< 0.001), as well as those of posterior cerebral-vertebral-basilar artery (P<0.01). The N-acetyl aspartic acid/creatine (NAA/Cr) increased more in the observation group than in the control group respectively (P<0.01), and the choline/creatine (Cho/Cr) decreased more (P<0.01), after treatment. Conclusion EEG bionic electrical stimulation can improve the cerebral circulation and metabolism in patients with PVS, which may associate with the wake promoting.

Objective To observe the difference of caveolin-3(CAV3) gene polymorphism between normal people and diabetic patients in Chinese Han population. Methods Exon gene polymorphism in 50 normal people and 50 T2DM patients were detected by PCR-SSCP. Results The cumulative incidence rate of electrophoretic variation in T2DM patients was 48%, while cumulative incidence rate of normal people was 7%(P<0.001). It was proved that in the variant bands, there were base variant. Conclusions The variant base number of CAV3 gene in human T2DM samples are significantly more than the normal which can be preliminary detected by PCR-SSCP. It indicates that CAV3 gene polymorphism may be one of the genetic backgrounds for the occurence of Chinese T2DM.

Normal function of growth hormone-insulin-like growth factor Ⅰaxis is essential for linear growth after birth. A case of continuous growth with undetectable growth hormone level even under insulinhypoglycemia stimulation was reported. The growth hormone deficiency was due to pituitary stalk interruption combined with deficiency of multiple pituitary hormones. Taken together with reviewed literature, this so-called nongrowth hormone-dependent linear growth was preconditioned by other hormones, especially gonadotropin deficiency,and the unclosed epiphysis.

Objective To evaluate the mechanical homogeneity pattern of isolated carotid atherosclerotic plaque intima on longitudinal axis view using ultrasonic velocity vector imaging.Methods Fourty six patients with 48 isolated plaques were undergone the high frequency ultrasound scanning,the real-time two-dimensional longitudinal-axis gray scale view at the maximal thickness of the plaque was obtained in three complete cardiac cycles.A dedicated velocity vector imaging(ⅤⅤⅠ)workstation was used for the off-line dynamic two-dimensional gray-scale image analysis and mechanics parameter(i.e.,the peak strain and the absolute difference of the peak strain)assessment at the sites of the upper,middle and down stream separately.The length and direction distribution of the velocity vectors at the carotid atherosclerotic plaque intima were observed.Wilcoxon test was utilized for the comparison of the peak strain and the absolute difference of the peak strain between two sites.Results The chaos phenomenon of velocity vector distribution at the sites of plaque intima occurred significantly differed from those uniform velocity vectors at the reference sites.According to the two groups of the higher strain value side and the lower strain value side on the upper stream and the down stream of the plaque intima,the peak strain at the higher strain value side was significantly higher than the lower strain value side(P=0.000).There was a significantly difference between the absolute difference of peak strain from the higher strain value side to the middle stream point of the plaque intima and the absolute difference of peak strain from the lower strain value side to the higher strain value side of the plaque intima(P＜0.017).Conclusions The length and direction distribution of velocity vectors of the isolated carotid atherosclerotic plaque intima on longitudinal axis view are uneven,the mechanical heterogeneity pattern exists at the plaque intima and could be visualized and quantitatively evaluated using ultrasonic velocity vector imaging.

BACKGROUND: Ischemic stroke has a younger tendency; hence to explore the risk factors of stroke in the middle-aged and youth for primary rehabilitation has extremely important clinical significance.OBJECTIVE: To investigate the risk factor-of stroke in the middle-aged and youth.DESIGN: A case-control analysis based on diagnose.SETTING: Department of neurology in a university hospital.PARTICIPANTS: Totally 100 hospitalized patients including the middle-aged and youth ( ＜ 44 years old, n = 63 ) and the pre-elderly (45 - 49years old, n = 37) with mean age of(42. 91 ±6.8) were selected into stroke group from the Department of Neurology, Xiangya Second Hospital, Central South University between July 1997 and December 2000. Another 100 surgical patients without history of cerebrovascular diseases aged(42.70 ± 2.98) including the middle-aged and youth( n = 61 ) and the pre-elderly( n = 39) were collected randomly from the same corresponding period as control gruop.METHODS: A comparative study of 12 risk factors between two groups was studied and compared the middle-aged group and youth, the pre-elderly group with control group.MAIN OUTCOME MEASURES: Morbidity comparison of each risk factor in each group.RESULTS: Hypertension, hyperlipemia, abnormal electrocardiogram (ECG),family history of stroke, arteriosclerosis of the eyeground, diabetes, and rheumatic heart disease are risk factors of ischemic stroke in the middle-aged.CONCLUSION: It is extremely important significance to reduce blood pressure and blood-fat level in the prevention of ischemic stroke.