Metagenomic Next Generation Sequencing applied in diagnosis of osteoarticular nontuberculous mycobacterial infection / 中华创伤骨科杂志

Objective:To investigate the value of metagenomic Next-Generation Sequencing (mNGS) in etiological diagnosis of osteoarticular nontuberculous mycobacterial (NTM) infection.Methods:From January 2014 to October 2019, 119 patients were definitely diagnosed as osteoarticular infection at Department of Bone Tumor & Joint Surgery, The First Affiliated Hospital to Fujian Medical University. All of them underwent conventional culture followed by mNGS to screen out those with NTM infection by the etiological testing. Optimized culture was conducted for NTM infections. Demographic data, and results of conventional culture, mNGS and optimized culture were recorded for patients with NTM infection.Results:mNGS showed that 12 of the 119 patients with osteoarticular infection (12/119, 10.1%) had NTM infection. They were 6 males and 6 females aged from 31 to 82 years(average, 51.1 years). There were 5 cases of slowly-growing mycobacterial type and 7 cases of rapidly-growing mycobacterial type. The positive rate of primary culture was only 16.7% (2/12) by the conventional culture, but increased to 66.7% (8/12) by the optimized culture. The positive rate of optimized culture was 100% (7/7) for the rapidly-growing mycobacterial type and 20% (1/5) for the slowly-growing mycobacterial type.Conclusion:As the positive rate of conventional culture is low for patients with osteoarticular NTM infection, mNGS is superior due to its advantage in accurate etiological diagnosis, especially for that of rapidly-growing mycobacterial type.

Clinical outcomes of articulating spacers in treatment of chronic knee periprosthetic joint infection / 中华创伤骨科杂志

Objective:To explore the clinical outcomes of articulating spacers in the treatment of chronic knee periprosthetic joint infection (PJI).Methods:A retrospective study was conducted of the 38 patients who had undergone stage-two revision for chronic knee PJI from January 2014 to January 2020 at Department of Articular Surgery, The First Affiliated Hospital to Fujian Medical University. They were 8 men and 30 women, aged from 37 to 84 years (average, 66.2 years). The PJI was unilateral in all, affecting 19 left sides and 19 right sides. According to the kind of spacers used in the stage-one revision, they were divided into 3 groups: metal-polyethylene one (10 cases), metal-cement one (15 cases) and cement one (13 cases). In the stage-two revision following infection control, the spacers were removed for sonication and microbial culture. Infection control, range of motion (ROM), Knee Society Score (KSS), and complications were followed up.Results:The 38 patients were followed up for an average of 30.8 months (from 13 to 75 months). All patients underwent spacer implantation at stage-one revision and infection was controlled in 37 of them (97.4%, 37/38). After stage-one revision, metal-polyethylene, metal-cement and cement groups achieved 95.0°±11.3°, 92.9°±8.3° and 75.5°±11.9° in ROM, 79.4±6.1, 77.3±4.0 and 73.0±7.2 in clinical KSS and 67.5±11.8, 69.0±10.4 and 60.8±11.0 in functional KSS, showing significant improvements in the above indexes between preoperation and postoperation ( P<0.05). The ROMs for the metal-polyethylene and metal-cement groups were significantly better than for the cement group ( P<0.05). A total of 32 patients completed stage-two revision, with 7 in the metal-polyethylene group, 12 in the metal-cement group and 13 in the cement group. Respectively, ROMs after stage-two revision were 104.6°±9.8°, 98.5°±8.7° and 86.1°±8.9°, clinical KSSs 85.3±4.6, 82.7±4.3 and 78.0±4.8 and functional KSSs 78.6±6.9, 77.3±8.2 and 69.5±8.3 for the metal-polyethylene, metal-cement and cement groups, showing significant improvements after stage-one revision ( P<0.05). The postoperative sonication fluid culture showed negative results in all. Conclusions:Articulating spacers can effectively control knee PJI and improve the knee function during revision interval and after revision. Metal spacers may lead to a better range of motion than traditional cement ones.

Unique characteristics of "the second brain" - The enteric nervous system / 生理学报

Enteric nervous system (ENS) is composed of intestinal submucosal and myenteric plexuses. ENS may independently regulate intestinal digestive and absorptive function, and it is also known as "the second brain" or gut brain. ENS has significant specificity relative to central nervous system (CNS) in properties and functional activities of neurons and neural circuits. ENS is connected with CNS through the feedback pathway (brain-gut-axis) of sympathetic and parasympathetic nerves and peripheral primary sensory afferent nerves to form the bidirectional brain-gut-axis, which may affect emotion, appetite and behavioral states of individuals. Gastrointestinal functional disorder (GIFD) induced by ENS dysfunction may not only cause abnormal gastrointestinal function but also has been implicated in cognitive and mood disorders, such as irritable bowel syndrome (IBS). GIFD would influence deeply the quality of life in patients. Nevertheless, in the worldwide, ENS has so far received much less attention as compared with CNS. The depth of research and scale of investment in ENS studies have been much lower than those in CNS studies. The situation in China is even more evident. From ENS research history, an outstanding problem is to ignore largely the unique properties of ENS and apply mechanically the hypotheses formed in CNS studies to ENS researches. In this review, the structure and function of ENS are briefly introduced, and the importance of extraordinary characteristics of ENS is illustrated by the problems encountered in our studies.

Mutation screening and function prediction of melanocortin-4 receptor gene in obese children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To screen the coding region of melanocortin-4 receptor gene (MC4R) for mutations in children, analyze the association of the identified variants with obesity-related phenotypes, and predict the potential functions of the identified variants.</p><p><b>METHODS</b>A case-control study was conducted in 160 severely obese children and 100 normal-weight controls, all aged 7-18 years. Their anthropometric data were collected and blood tests were performed. The coding region of MC4R gene was screened by polymerase chain reaction (PCR), single strand conformation polymorphism and sequencing, and the potential functions of the identified variants were predicted by related online databases.</p><p><b>RESULTS</b>Three heterozygous missense mutations were identified in obese children (Val95Ile, Val166Ile and Val179Ala), and one heterozygous missense mutation was found in controls (Met218Thr). Val103Ile variant was found to be carried by seven subjects in the obese group and six in the control group (P>0.05). Val179Ala was a newly identified heterozygous mutation. No significant differences in BMI, weight, waist circumstance, hip circumstance, serum lipid parameters, fasting glucose, and body fat percentage were found between Val95Ile, Val166Ile or Val179Ala mutation carriers and non-carriers in obese children. The function prediction of the variants showed that all the five identified variants influenced the protein function.</p><p><b>CONCLUSIONS</b>Five variants were identified in the coding region of MC4R gene, among which Val179Ala was newly identified. All the five variants might influence the protein function as evidenced by online prediction.</p>

Dietary Glutamate: Interactions With the Enteric Nervous System

BACKGROUND/AIMS: Digestion of dietary protein elevates intraluminal concentrations of glutamate in the small intestine, some of which gain access to the enteric nervous system (ENS). Glutamate, in the central nervous system (CNS), is an excitatory neurotransmitter. A dogma that glutamatergic neurophysiology in the ENS recapitulates CNS glutamatergic function persists. We reassessed the premise that glutamatergic signaling in the ENS recapitulates its neurotransmitter role in the CNS. METHODS: Pharmacological analysis of actions of receptor agonists and antagonists in concert with immunohistochemical localization of glutamate transporters and receptors was used. Analysis focused on intracellularly-recorded electrical and synaptic behavior of ENS neurons, on stimulation of mucosal secretion by secretomotor neurons in the submucosal plexus and on muscle contractile behavior mediated by musculomotor neurons in the myenteric plexus. RESULTS: Immunoreactivity for glutamate was expressed in ENS neurons. ENS neurons expressed immunoreactivity for the EAAC-1 glutamate transporter. Neither L-glutamate nor glutamatergic receptor agonists had excitatory actions on ENS neurons. Metabotropic glutamatergic receptor agonists did not directly stimulate neurogenic mucosal chloride secretion. Neither L-glutamate nor the metabotropic glutamatergic receptor agonist, aminocyclopentane-1,3-dicarboxylic acid (ACPD), changed the mean amplitude of spontaneously occurring contractions in circular or longitudinal strips of intestinal wall from either guinea pig or human small intestinal preparations. CONCLUSIONS: Early discoveries, for excitatory glutamatergic neurotransmission in the CNS, inspired enthusiasm that investigation in the ENS would yield discoveries recapitulating the CNS glutamatergic story. We found this not to be the case.

Discussion on needling sensation, arrival of qi and needling response (Deqi) / 中国针灸

The current appointed teaching material of Science of Acupuncture and Moxibustion holds that there is no difference among the needling sensation, arrival of qi and needling response. However, the author has a different understanding. Therefore, Neijing (Internal Classic), its annotation, exposition and understandings of ancient and modern famous experts are cited to analyze their meanings. And the result indicates that the needling sensation is subjective feelings and perceived responses of doctors and patients. Arrival of qi is the healing process of the organ through activating the anti-pathogenic qi to expel the pathogens. The needling response is the final aim of acupuncture therapy. Thus, the meaning of needling sensation, arrival of qi, and needling response are different. And an accurate understanding can better guide acupuncture treatment.

Finite element study on the microdamage progression within bone / 医用生物力学

Objective To study the effects of mineral-collagen interfacial behavior on the microdamage progression within bone tissue. Methods Based on the finite element model, cohesive elements were introduced and the traction-separation law was used to simulate the role of ionic interactions, hydrogen bonds and van der waals forces. The effects of aforementioned interactions on the microdamage progression within bone were studied by the random field theory and probabilistic failure analysis. Results Strong interfaces (ionic interactions in both opening and sliding modes) between the mineral and collagen phases might encourage the formation of linear cracks in bone, whereas weak interfaces (van der Waals in opening mode and viscous shear in sliding mode) might facilitate the formation of diffuse damages. In addition, there existed a transitional interfacial bonding strength (hydrogen/van der Waals bonds) that governed the transition of microdamage accumulation from linear microcrack to diffuse damage.Conclusions The results from this study will help to understand the effects of mineral collagen interfacial behavior on microdamage accumulation in bone and further investigate the underlying mechanism of bone fracture due to osteoporosis or ageing.

Clinical efficacy comparison between laparoscopy and open radical resection for 191 advanced colorectal cancer patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility, the radicalness and efficacy of laparoscopy for advanced colorectal cancer.</p><p><b>METHODS</b>From June 2006 to December 2007, laparoscopic surgery and open radical resection were performed in 191 cases of colorectal cancer. The curative effect and clinical data were collected and analyzed.</p><p><b>RESULTS</b>The patients were randomized to two groups, 98 patients underwent laparoscopic surgery and 93 open operation. Five cases(5.1%) were converted to open surgery in laparoscopic surgery group. The average intraoperative blood loss of open surgery group was(279.5+/-189.4) ml, while that of laparoscopic surgery group was(87.2+/-27.1) ml, the difference between the two groups was statistically significant(P=0.011). Within postoperative 48 hours, the intestinal function and early mobile physical activity were restored in 37.8% (37/98) and 30.6% (30/98) patients of laparoscopic surgery group, while in 6.5%(6/93, P=0.000) and 3.2% (3/93, P=0.000) patients of open surgery group, the differences between two groups were statistically significant. The average hospital stay of laparoscopic surgery group was (8.9+/-5.9) d, whereas open surgery group(12.1+/-7.6) d, the difference was statistically significant(P=0.036). No significant differences were found between the two groups in gender, age, tumor location, resection range of surgery, TNM staging, post-operative complication and lymph node harvest(P>0.05).</p><p><b>CONCLUSIONS</b>Laparoscopic surgery is feasible for the patients with advanced colorectal cancer. The radicalness of laparoscopic surgery is similar to that of open surgery, and laparoscopic surgery can provide less intraoperative blood loss, better intestinal function restoration, early mobile physical activity and shorter hospital stay.</p>

Study on the theory of "Shaoyang Meridians being in charge of the bone" / 中国针灸

To explore the theory of "Shaoyang Meridians being in charge of the bone" in Huangdi's Internal Classic, which has been buried for long time. With citation of Huangdi's Internal Classic and exposition of famous experts, speculate on the contents and meanings systematically. Results indicate that the theory of "Shaoyang Meridians being in charge of the bone" possibly first in the world recognizes osteoporosis being a general bony disease, and articulates that the Foot-Shaoyang Meradians can modulate bony strength under physiological and pathological conditions, and treat osteoporosis which mainly manifests as ostealgia and easy fracture.

Comparison of anatomical dynamic hip lock plate and Gamma nail for the treatment of unstable intertrochanteric femoral fractures / 中国矫形外科杂志

[Objective] To compare anatomical dynamic hip lock plate with Gamma nail internal fixation in terms of the early intermediate clinical effect of the unstable intertrochanteric femoral fractures. [Methods]From January 2003 to August 2008, 69 patients with unstable intertrochanteric femoral fractures were fixed with plate (n=34)and Gamma nail(n=35).They were randomized into two treatment groups.A retrospective comparison was made between the two differet fixation devices in terms of operation time,blood loss,intraoperative and postoperative complications,frequency of exposure to X-ray,healing time of fracture and functional recovery of hip-joint.[Results]Comparing with Gamma nail,cases with anatomical dynamic hip lock plate experienced fewer X-ray during operation and had fewer postoperative complications,and the differences had statistical significance(P

Forebrain NMDA receptors contribute to neuronal spike responses in adult mice / 生理学报

Glutamate is the major fast excitatory transmitter in the central nervous system. While normal synaptic transmission is mediated by alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) and kainate receptors, N-methyl-D-aspartate (NMDA) receptors are thought to selectively contribute to plasticity. Genetically enhancing NMDA receptor functions enhances animal behavior in normal physiological learning and enhances their sensitivity in the case of tissue injury. One major mechanism for NMDA receptors is synaptic long-term potentiation (LTP). Here we present evidence that NMDA receptors not only contribute to normal synaptic responses induced by stimulation of local layer V or white matters, but also contribute to generation of action potentials induced by a depolarizing step applied to the soma. Calcium-calmodulin sensitive adenylyl cyclase 1 and cAMP signal pathways likely mediate these effects. Considering the importance of cingulate neurons in nociception and pain, our results provide a new mechanism for NMDA receptor contributing to neuronal synaptic transmission, spiking properties in forebrains, and possible forebrain-related behavioral nociceptive responses and pain.

Mesorectal metastasis of middle and lower rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To detect mesorectal metastasis of middle and lower rectal cancer and to evaluate its relationship with clinicopathologic characteristics.</p><p><b>METHODS</b>Cancer specimens resected from 56 patients with middle and lower rectal cancer who received total mesorectal excision were examined by routine pathologic observation. The relationship between mesorectal metastasis and clinicopathologic characteristics of middle and lower rectal cancer was also investigated.</p><p><b>RESULTS</b>Mesorectal metastasis was detected in 36 (64.3%) of 56 cancer specimens. In 18 cancer specimens with tumor diameter > or = 5 cm, 15 (83.3%) were detected mesorectal metastasis, while in 38 cancer specimens with tumor diameter < 5 cm only 21 (55.3%) were detected mesorectal metastasis (P = 0.041). Mesorectal metastasis was more frequent in T(3) cancer specimens (81.5%) and T(2) cancer specimens (56.6%), compared with T(1) cancer specimens (1/6) (P = 0.007). 85.7% poorly differentiated cancer specimens were detected mesorectal metastasis, while moderate and well-differentiated cancer specimens were only 63.2% and 1/5 respectively (P = 0.028). Mesorectal metastasis was more frequent in stage III cancer specimens (100%), compared with stage II and I cancer specimens (27.3% and 1/5 respectively, P = 0.000). No significant correlations were found between mesorectal metastasis and other variables such as age, gender and Ming classification (P > 0.05).</p><p><b>CONCLUSION</b>Mesorectal metastasis of middle and lower rectal cancer has significant correlation with tumor diameter, tumor invasion, tumor differentiation and TNM stage. Total mesorectal excision or > or = 5 cm mesorectal distal to the rectal tumor should be followed in the management of middle and lower rectal cancer.</p>

Matrix metalloproteinase-2 expression and its correlation with mesorectal metastasis in middle and lower rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To examine the expression of matrix metalloproteinase-2 (MMP-2) and to evaluate its correlation with mesorectal metastasis in middle and lower rectal cancer.</p><p><b>METHODS</b>The resected primary tumors from 56 patients with middle and lower rectal cancer who received total mesorectal excision were studied from Dec. 2001 to Jul. 2003.</p><p><b>RESULTS</b>The MMP-2 expression was positive in 42 (75%) cases. The positive rate of MMP-2 expression was 88.9% in T3 tumors and 69.6 % in T2 tumors respectively, while only 33.3% in T1 tumors (P=0.013). MMP-2 was positive in 91.2% (31/34) infiltrative rectal carcinomas while 40.0% (6/15) expansive rectal carcinomas (P=0.001). Mesorectal metastasis was detected in 36 (64.3%) of 56 cases. The expression of MMP-2 was positive in 31 (86.1%) of the 36 patients with mesorectal metastasis, while in 11(55%) of the 20 patients without mesorectal metastasis (P=0.01).</p><p><b>CONCLUSIONS</b>The expression of MMP-2 in middle and lower rectal cancer is significantly associated with depth of tumor invasion and Ming classifications. The high expression of MMP-2 may play an important role in the development of mesorectal metastasis in middle and lower rectal cancer.</p>

NMDA receptors contribute to synaptic transmission in anterior cingulate cortex of adult mice / 生理学报

Glutamatergic synapses are common excitatory chemical connections in mammalian central nervous system. At these synapses, most of baseline synaptic transmission is mediated by glutamate AMPA receptors. NMDA receptors that are sensitive to voltage-dependent magnesium blockade selectively contribute to activity-dependent synaptic plasticity. However, inhibition of NMDA receptors by systemic or local administration of NMDA receptor antagonists produced significant effects on different physiological functions that are not believed to depend on NMDA receptor related synaptic plasticity. Here we show that NMDA receptors contribute to synaptic responses in the anterior cingulate cortex (ACC), a region important for cognitive and other brain functions. The contribution of NMDA receptors became more prominent when synapses are stimulated at higher frequencies. Furthermore, at temperatures more close to physiological brain temperatures, more NMDA receptor mediated responses were recorded as compared to the room temperature. These data suggest a new function for NMDA receptors in the ACC as important postsynaptic receptors involved in synaptic transmission, in particular when cells are firing at high frequencies.