Robot-assisted fracture reduction usually involves fixing the proximal end of the fracture and driving the distal end of the fracture to the proximal end in a planned reduction path. In order to improve the accuracy and safety of reduction surgery, it is necessary to know the changing rule of muscle force and reduction force during reduction. Fracture reduction force was analyzed based on the muscle force of femoral. In this paper, a femoral skeletal muscle model named as PA-MTM was presented based on the four elements of skeletal muscle model. With this, pinnate angle of the skeletal muscle was considered, which had an effect on muscle force properties. Here, the muscle force of skeletal muscles in different muscle models was compared and analyzed. The muscle force and the change of the reduction force under different reduction paths were compared and simulated. The results showed that the greater the pinnate angle was, the greater the influence of muscle strength was. The biceps femoris short head played a major role in the femoral fracture reduction; the force in the z direction contributed the majority to the resulting force with maximums of 472.18 N and 497.28 N for z and resultant, respectively, and the rationality of the new musculoskeletal model was verified.
Objective To investigate the potential causal relationship between specific oral microbiota and peptic ulcer disease (PUD) using a Mendelian randomization (MR) approach. Methods The genome-wide association study (GWAS) data from East Asian populations was utilized to perform a two-sample MR analysis to determine the causal relationship between oral microbiota and PUD. The MR analysis was primarily conducted using the inverse-variance weighted (IVW) method, supplemented by MR-Egger and weighted median methods. Heterogeneity and pleiotropy were assessed, and the leave-one-out method was employed to evaluate the stability of the MR results. Results There was a complex association between specific bacterial genera of the oral microbiota and PUD. Prevotella was found to potentially promote duodenal ulcers while exerting a protective effect against gastric ulcers. Campylobacter and Streptococcus demonstrated differing effects on gastric and duodenal ulcers. Furthermore, Fusobacterium and Haemophilus_A were positively associated with peptic ulcers, suggesting an increased risk of gastroduodenal ulcer development. Conclusion This study explores the causal relationship between oral microbiota and PUD, providing new insights into the prevention and treatment of PUD mediated by oral microbiota.
Objective To investigate the effectiveness of tibial transverse transport (TTT) in treating Wagner grade 3-4 type 2 diabetic foot ulcers and analyze dynamic changes in immunoglobulin levels. Methods The clinical data of 68 patients with Wagner grade 3-4 type 2 diabetic foot ulcers treated with TTT between May 2022 and September 2023 were retrospectively analyzed. The cohort included 49 males and 19 females, aged 44-91 years (mean, 67.3 years), with 40 Wagner grade 3 and 28 grade 4 ulcers. The duration of type 2 diabetes ranged from 5 to 23 years, with an average of 10 years. The number of wound healing cases, healing time, amputation cases, death cases, and complications were observed and recorded. Serum samples were collected at 6 key time points [1 day before TTT and 3 days, 7 days (the first day of upward transverse transfer), 14 days (the first day of downward transverse transfer), 21 days (the first day after the end of transfer), 36 days (the first day after the removal of the transfer device)], and the serum immunoglobulin levels were detected by flow cytometry included immunoglobulin G (IgG), IgA, IgM, IgE, complement C3 (C3), C4, immunoglobulin light chain κ (KAP), immunoglobulin light chain λ (LAM). Results All the 68 patients were followed up for 6 months. Postoperative pin tract infection occurred in 3 cases and incision infection in 2 cases. Amputation occurred in 5 patients (7.4%) at 59-103 days after operation, and 8 patients (11.8%) died at 49-77 days after operation; the wounds of the remaining 55 patients (80.9%) healed in 48-135 days, with an average of 80 days. There was no recurrence of ulcer, peri-osteotomy fracture, or local skin necrosis during follow-up. The serum immunoglobulin levels of 55 patients with wound healing showed that the levels of IgG and IgM decreased significantly on the 3rd and 7th day after operation compared with those before operation (P<0.05), and gradually returned to the levels before operation after 14 days, and reached the peak on the 36th day. IgA levels continued to decrease with time, and there were significant differences at all time points when compared with those before operation (P<0.05). The level of IgE significantly decreased at 21 days after operation compared with that before operation (P<0.05), while it was higher at other time points than that before operation, but the difference was not significant (P>0.05). The level of C3 showed a clear treatment-related increase, which was significantly higher on the 7th, 14th, and 21st days after operation than that before operation (P<0.05), and the peak appeared on the 14th day. The change trend of C4 level was basically synchronous with that of C3, but the amplitude was smaller, and the difference was significant at 7 and 14 days after operation compared with that before operation (P<0.05). There was no significant difference in KAP/LAM between different time points before and after operation (P>0.05). Conclusion TTT can accelerate wound healing, effectively treat diabetic foot ulcer, and reduce amputation rate, and has definite effectiveness. The potential mechanisms of TTT in the treatment of diabetic foot ulcers include the dynamic regulation of IgG, IgA, IgM, and IgE levels to balance the process of inflammation and repair, and the periodic increase of C3 and C4 levels may promote tissue cleaning, angiogenesis, and anti-infection defense.
ObjectiveTo understand the trend and problems of asthma treatment in different levels of hospitals in Chongqing, and to provide objective basis for more refined and standardized asthma management. MethodsThe outpatient and inpatient asthma diagnosis and treatment data of four hospitals of different grades in Chongqing from 2017 to 2021 were extracted by medical big data capture platform, and the trend of outpatient and prescription changes was analyzed retrospectively according to natural year. ResultsThere were 19514 outpatients asthma visits in the four hospitals, of whom 11816 (60.6%) were female. There were 1875 hospitalizations, of which 1117 (59.6%) were female. ① Changes of asthma visit mode: From 2017 to 2019, the number of outpatient asthma visits and the proportion of asthma in the total outpatient volume increased, decreased significantly in 2021, and basically recovered to the level of 2019 in 2022. Asthma hospitalizations in tertiary hospitals showed a decreasing trend, while those in secondary hospitals increased significantly. The proportion of asthma patients who chose outpatient treatment in the four hospitals increased year by year, among which the increase was more significant in non-tertiary teaching hospitals, and the proportion of asthma acute attack in outpatient and inpatient treatment increased. ② Changes of medication pattern: The rate of inhaled corticosteroids/long-acting β2-agonists (ICS/LABA) prescription in outpatient department increased year by year, the highest was 48.6%, but the rate of short-acting β2-agonists (SABA) prescription also increased year by year, especially in secondary hospitals, the rate of SABA prescription in secondary hospitals reached 39.7%. The proportion of hospitalized asthma patients treated with inhaled corticosteroids (85.1%) was higher than that of intravenous corticosteroids (50.9%), and the proportion of intravenous theophylline prescription was as high as 91.7%, while the proportion of nebulized SABA prescription was 71.4%. ConclusionsThe trend of asthma diagnosis and treatment is that the number of outpatients and the use of ICS/LABA is gradually increasing, while the number of inpatients is decreasing. However, there is still a large gap in the proportion of asthma maintenance medication used in different levels of hospitals, so it is necessary to continuously promote standardized diagnosis and treatment management of asthma in hospitals at all levels, especially primary hospitals.