Detail correction for Gross classification of esophageal atresia based on 434 cases in China

To the Editor:Esophageal atresia(EA)is the most common congenital abnormality of the esophagus.In 70%to 90%of those born with EA,a tracheoesophageal fistula(TEF)co-occurs.Since Vogt[1]recognized and classified the types of anomalies in 1929,many other classification systems have been proposed,including the Ladd,Gross,Swenson,and Kluth classification systems.[2]However,the Gross classification of anatomical patterns of EA/TEF proposed in 1953 is one of the most widely accepted and used classification systems[3]and has been cited in Pediatric Surgery.[4]While surgical and imaging techniques have evolved considerably over recent decades,434 consecutive cases of EA/TEF in China were reviewed.Through closely examining the imaging studies and the pathoanatomical configurations of these patients,we identified certain"defects"and details in the illustrations that need modification.

Association between new onset type 1 diabetes and real-world antibiotics and neonicotinoids’exposure-related gut microbiota perturbation

Background The real-world exposure levels of non-therapeutic antibiotics and neonicotinoids in type 1 diabetes(T1D)children and their associations as environmental triggers through gut microbiota shifts remained unknown.We thus investigated the antibiotics and neonicotinoids’exposure levels and their associations with gut microbiota in pediatric T1D.Methods Fifty-one newly onset T1D children along with 67 age-matched healthy controls were recruited.Urine concentrations of 28 antibiotics and 12 neonicotinoids were measured by mass spectrometry.Children were grouped according to the kinds of antibiotics’and neonicotinoids’exposures,respectively.The 16S rRNA of fecal gut microbiota was sequenced,and the correlation with urine antibiotics and neonicotinoids’concentrations was analyzed.Results The overall detection rates of antibiotics were 72.5%and 61.2%among T1D and healthy children,whereas the neonicotinoids detection rates were 70.6%and 52.2%(P=0.044).Children exposed to one kind of antibiotic or two or more kinds of neonicotinoids had higher risk of T1D,with the odd ratios of 2.579 and 3.911.Furthermore,co-exposure to antibiotics and neonicotinoids was associated with T1D,with the odd ratio of 4.924.Antibiotics or neonicotinoids exposure did not affect overall richness and diversity of gut microbiota.However,children who were exposed to neither antibiotics nor neonicotinoids had higher abundance of Lachnospiraceae than children who were exposed to antibiotics and neonicotinoids alone or together.Conclusion High antibiotics and neonicotinoids exposures were found in T1D children,and they were associated with changes in gut microbiota featured with lower abundance of butyrate-producing genera,which might increase the risk of T1D.