Current Medical Science最新文献

Objective: Vitamin deficiencies, particularly in vitamins A, B12, and D, are prevalent across populations and contribute significantly to a range of health issues. While these deficiencies are well documented, the underlying etiology remains complex. Recent studies suggest a close link between the gut microbiota and the synthesis, absorption, and metabolism of these vitamins. However, the specific causal relationships between the gut microbiota composition and vitamin deficiencies remain poorly understood. Identifying key bacterial species and understanding their role in vitamin metabolism could provide critical insights for targeted interventions.

Methods: We conducted a two-sample Mendelian randomization (MR) study to assess the causal relationship between the gut microbiota and vitamin deficiencies (A, B12, D). The genome-wide association study data for vitamin deficiencies were sourced from the FinnGen biobank, and the gut microbiota data were from the MiBioGen consortium. MR analyses included inverse variance-weighted (IVW), MR‒Egger, weighted median, and weighted mode approaches. Sensitivity analyses and reverse causality assessments were performed to ensure robustness and validate the findings.

Results: After FDR adjustment, vitamin B12 deficiency was associated with the class Verrucomicrobiae, order Verrucomicrobiales, family Verrucomicrobiaceae, and genus Akkermansia. Vitamin A deficiency was associated with the phylum Firmicutes and the genera Fusicatenibacter and Ruminiclostridium 6. Additional associations for vitamin B12 deficiency included the Enterobacteriaceae and Rhodospirillaceae and the genera Coprococcus 2, Lactococcus, and Ruminococcaceae UCG002. Vitamin D deficiency was associated with the genera Allisonella, Eubacterium, and Tyzzerella 3. Lachnospiraceae and Lactococcus were common risk factors for both B12 and D deficiency. Sensitivity analyses confirmed the robustness of the findings against heterogeneity and horizontal pleiotropy, and reverse MR tests indicated no evidence of reverse causality.

Conclusions: Our findings reveal a possible causal relationship between specific gut microbiota characteristics and vitamin A, B12 and D deficiencies, providing a theoretical basis for addressing these nutritional deficiencies through the modulation of the gut microbiota in the future and laying the groundwork for related interventions.

Objective: To compare the clinical outcomes of retrograde pubic ramus intramedullary nail (RPRIN) and percutaneous cannulated screw (PCS) in the treatment of anterior pelvic ring fractures (APRFs).

Methods: This retrospective cohort study included 45 patients with APRFs treated between February 2019 and October 2022 in our trauma center. Patients were divided into two groups based on the surgical method: 20 received RPRIN fixation, and 25 received PCS fixation. Key variables including operation time, fluoroscopic time, blood loss, and postoperative complications were analyzed. Fracture reduction quality was assessed using the Matta score system, and pelvic functional recovery was evaluated using the Majeed score system at the final follow-up. Quantitative variables were compared using the independent sample t test, while categorical variables were analyzed using Chi-square and Fisher's exact tests.

Results: The RPRIN group had significantly shorter operation time (36.3 ± 5.6 min vs. 49.5 ± 6.9 min, P < 0.01), fluoroscopic time (32.0 ± 2.8 s vs. 48.4 ± 3.6 s, P < 0.01), and less blood loss (20.4 ± 7.6 mL vs. 34.0 ± 5.7 mL, P < 0.01) than the PCS group. Fracture reduction quality (Matta outcome) and pelvic functional recovery (Majeed outcome) were comparable between the two groups (P > 0.05). No significant complications were reported in either group.

Conclusions: Both RPRIN and PCS are effective for treating APRFs. However, RPRIN offers distinct advantages by reducing operation time, fluoroscopic time, and blood loss, making it a more efficient and less invasive option. Further multicenter studies and biomechanical analyses are warranted to confirm these findings.

Depression is a multifaceted disorder with a largely unresolved etiology influenced by a complex interplay of pathogenic factors. Despite decades of research, it remains a major condition that significantly diminishes patients' quality of life. Advances in optogenetics have introduced a powerful tool for exploring the neural mechanisms underlying depression. By selectively expressing optogenes in specific cell types in mice, researchers can study the roles of these cells through targeted light stimulation, offering new insights into central nervous system disorders. The use of viral vectors to express opsins in distinct neuronal subtypes enables precise activation or inhibition of these neurons via light. When combined with behavioral, morphological, and electrophysiological analyses, optogenetics provides an invaluable approach to investigating the neural mechanisms of psychiatric conditions. This review synthesizes current research on the application of optogenetics to understand the mechanisms of depression. This study aims to enhance our knowledge of optogenetic strategies for regulating depression and advancing antidepressant research.

Objective and background: Early and accurate diagnosis of spinal infections, including spinal tuberculosis, is pivotal for effective treatment but remains challenging. This study aims to assess the diagnostic yield of metagenomic next-generation sequencing (mNGS) compared with that of conventional microbiological tests (CMTs) in identifying pathogens associated with spinal pathologies, with a special focus on infections leading to surgical interventions.

Methods: We enrolled 85 patients who underwent spinal surgery, comprising 63 patients with clinically diagnosed spinal infections, including patients with spinal tuberculosis, and 22 patients with noninfectious spinal conditions. The procedures involved irrigation and debridement for persistent wound drainage, with subsequent DNA extraction from plasma and joint fluid for mNGS and CMT analysis.

Results: Significantly increased C-reactive protein (CRP) levels were observed in patients with infections. The mNGS approach showed greater diagnostic sensitivity (92.06%) for detecting pathogens, including Mycobacterium tuberculosis, than did CMTs (36.51%). Despite its low specificity, mNGS had considerable negative predictive value (70.59%), underscoring its utility in ruling out infections.

Conclusions: The mNGS offers superior sensitivity over CMTs in the diagnosis of a variety of spinal infections, notably spinal tuberculosis. This study highlights the potential of mNGS in enhancing the diagnosis of complex spinal infections, thereby informing targeted treatment strategies.

Objective: This study aimed to analyze the adverse effects (AEs) of sacituzumab govitecan (SG) through multiple sources of data to provide a reference for clinical safety management.

Methods: Clinical trials of SG with available safety data were retrieved and included in the pooled analysis. The adverse drug reaction (ADR) signals of SG were collected from the FDA Adverse Event Reporting System (FAERS) database. Drug interactions with SG in the DDInter database were summarized.

Results: A total of 6 clinical trials involving 1737 patients were included in the pooled analysis, and the most common AEs of ≥ grade 3 were neutropenia (46%), leukopenia (13%), and anemia (8%). In the pharmacovigilance study, 1024 AE reports were extracted, and the most common toxicities of SG were hematologic and gastrointestinal. AEs not included in the drug instructions also presented high signals, such as meningitis, colitis and lymphedema. A total of 40 drugs identified could induce drug-drug interactions when they were concomitantly administered with SG.

Conclusions: This study provides the most comprehensive profile of SG toxicity on the basis of data from clinical trials and the FRAES and DDInter databases. Attention should be given not only to common ADRs but also to ADRs not reported in drug instructions, and potential drugs that can induce drug-drug interactions.

Objective: To develop a multimodal imaging atlas of a rat brain-computer interface (BCI) that incorporates brain, arterial, bone tissue and a BCI device using mixed reality (MR) for three-dimensional (3D) visualization.

Methods: An invasive BCI was implanted in the left visual cortex of 4-week-old Sprague-Dawley rats. Multimodal imaging techniques, including micro-CT and 9.0 T MRI, were used to acquire images of the rat cranial bone structure, vascular distribution, brain tissue functional zones, and BCI device before and after implantation. Using 3D-slicer software, the images were fused through spatial transformations, followed by image segmentation and 3D model reconstruction. The HoloLens platform was employed for MR visualization.

Results: This study constructed a multimodal imaging atlas for rats that included the skull, brain tissue, arterial tissue, and BCI device coupled with MR technology to create an interactive 3D anatomical model.

Conclusions: This multimodal 3D atlas provides an objective and stable reference for exploring complex relationships between brain tissue structure and function, enhancing the understanding of the operational principles of BCIs. This is the first multimodal 3D imaging atlas related to a BCI created using Sprague-Dawley rats.

Objective: The lack of clarity regarding the application performance of a hybrid operating room (HOR) and the uncertainty of surgical scheduling often lead to its inefficient application. This study aimed to review the clinical application of our neurosurgical HOR and propose a scale to score cases clearly.

Methods: We reviewed the operating procedures and duration of stay in 1865 HOR cases. The actual procedures of each case were summarized into 5 application types, and numerical assignment was used to distinguish the dependence of each type on our HOR: surgical procedures combined with interventional procedures (4 points, the highest dependence), surgical procedures combined with imaging procedures (3 points), interventional procedures (2 points), imaging procedures (1 point), and surgical procedures (0 points, the lowest dependence).

Results: A novel scale that could score 1865 cases into those 5 grades was developed. The percentages by grade were as follows: 4 points, 4.24%; 3 points, 4.88%; 2 points, 20.75%; 1 point, 69.38%; and 0 points, 0.75%. The cumulative usage time was 4241.9 h, the duration of which was as follows: 4 points, 16.17%; 3 points, 15.50%; 2 points, 31.32%; 1 point, 35.62%; and 0 points, 1.39%.

Conclusions: The HOR serves as a multifunctional room to treat neurosurgical diseases. The scale helps to quickly prioritize cases that rely more on HOR, providing guidelines for surgical scheduling. Although our HOR is unsuitable for emergency cases, it clearly shows the application performance of our HOR to provide a reference for promoting its efficient application.

Objective: To evaluate the efficacy and safety of third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in combination with radiotherapy (RT) for patients with advanced non-small cell lung cancer (NSCLC) harboring typical EGFR mutations.

Methods: Patients who received treatment with third-generation EGFR-TKIs alone or in combination with RT were retrospectively enrolled at a single center. The primary endpoint was progression-free survival (PFS). Differences in PFS between the two groups were assessed via the Kaplan-Meier method. Additionally, a subgroup analysis was conducted to further explore the effect of thoracic RT combined with EGFR-TKIs.

Results: This study included a total of 260 patients, among whom 81 patients received third-generation EGFR-TKIs and 179 patients received third-generation EGFR-TKIs plus RT. There was a significant difference in median PFS (mPFS) (13.0 versus 18.1 months, P = 0.0003) between the two groups. Moreover, third-generation EGFR-TKIs plus thoracic RT significantly improved the mPFS (13.0 versus 23.7 months, P < 0.0001). We observed that third-generation EGFR-TKIs plus RT increased the incidence of pneumonia, but all the cases were grade 1 or 2.

Conclusion: The addition of RT can delay the occurrence of acquired resistance to third-generation EGFR-TKIs, thereby significantly prolonging PFS in advanced NSCLC patients. RT for primary lung lesions exhibited a significant synergistic effect with EGFR-TKI treatment, and the adverse events of the combination therapy were acceptable.