Objective:To analyze the clinical efficacy and learning curve for robot-assisted cortical bone trajectory (CBT) screw fixation performed by surgeons with different seniority in the treatment of lumbar degenerative disease.Methods:The clinical data of 91 lumbar degenerative disease patients underwent robot-assisted CBT screw fixation from August 2020 to December 2022 in Beijing Shijitan Hospital, Capital Medical University were retrospectively analyzed. Among them, 48 patients underwent surgery performed by the same senior surgeon (senior group), with a total of 234 CBT screws were placed; while 43 patients underwent surgery performed by the same junior surgeon (junior group), with a total of 206 CBT screws were placed. The surgical related indexes, functional improvement score, lower back pain and lower limb radiation pain scores, acceptable nail insertion rate, non invasion rate of facet joints and incidence of postoperative complications were compared between two groups. The functional improvement score was evaluated using the Japanese Orthopaedic Association (JOA) score, the pain score was evaluated using visual analog score (VAS). The cumulative sum (CUSUM) method was used to depict the learning curve with "single screw placement time" as the observation index.Results:There were no statistical difference in incision length, operation time, intraoperative blood loss and postoperative hospital stay between two groups ( P>0.05). The least squares means of JOA scores 1, 3 and 6 months after surgery in both groups increased significantly compared to baseline, while the least squares means of lower back pain VAS and lower limb radiation pain VAS decreased significantly compared to baseline; there were no statistical differences between two groups ( P>0.05). There were no statistical difference in acceptable nail insertion rate, non invasion rate of facet joints and incidence of postoperative complications between two group ( P>0.05). The CUSUM learning curves were fitting well and the inflection point for senior surgeon corresponded to 18 cases, while it was reached after performing surgery on 21 cases for junior surgeon. Conclusions:Robot-assisted CBT screw fixation performed by surgeons with different seniority could achieve similar clinical outcomes for treating lumbar degenerative disease. The senior surgeons are able to complete the initial learning stage faster than the junior surgeons, but there is not much difference in the number of surgeries performed the learning curve.

Objective To investigate the influencing factors of grade 3-4 multiple myeloma bone disease(MBD)in newly diagnosed multiple myeloma(NDMM)patients,and establish a risk prediction model based on a nomogram.Methods A total of 261 patients with NDMM who were treated in Ningbo Medical Center Lihuili Hospital from January 2015 to December 2021 were retrospectively selected.The patients were divided into group A(MBD grade 0-2,110 cases)and group B(MBD grade 3-4,151 cases)according to MBD grade at the time of initial diagnosis.Logistic regression analysis was used to screen the risk factors for grade 3-4 MBD in NDMM patients,and the risk prediction model was constructed.The receiver operating characteristic(ROC)curve was used for comprehensive evaluation.Results Multivariate regression analysis showed that age,serum phosphorus,C-reactive protein(CRP),globulin(GLB)and bone marrow plasma cell percentage(BMPCp)were independent risk factors for grade 3-4 MBD in NDMM patients(P<0.05).Based on this,risk prediction model was constructed as follows:logit(P)=-15.092+0.107(age)+1.150(serum phosphorus)+0.057(CRP)+0.040(GLB)+0.212(BMPCp).There was no significant difference between the predicted probability and the actual incidence by the Hosmer-Lemeshow goodness of fit test(P=0.770).The accuracy of the model in predicting grade 3-4 MBD in NDMM patients was 90.40%,and the area under the curve was 0.957(95%CI:0.932-0.981),indicating a reliable prediction ability.Conclusion Age,serum phosphorus,CRP,GLB and BMPCp were all independent risk factors for grade 3-4 MBD in NDMM patients,and the constructed risk prediction model has a relatively good predictive effect on the occurrence of grade 3-4 MBD in NDMM patients.

Objective To investigate the influencing factors of grade 3-4 multiple myeloma bone disease(MBD)in newly diagnosed multiple myeloma(NDMM)patients,and establish a risk prediction model based on a nomogram.Methods A total of 261 patients with NDMM who were treated in Ningbo Medical Center Lihuili Hospital from January 2015 to December 2021 were retrospectively selected.The patients were divided into group A(MBD grade 0-2,110 cases)and group B(MBD grade 3-4,151 cases)according to MBD grade at the time of initial diagnosis.Logistic regression analysis was used to screen the risk factors for grade 3-4 MBD in NDMM patients,and the risk prediction model was constructed.The receiver operating characteristic(ROC)curve was used for comprehensive evaluation.Results Multivariate regression analysis showed that age,serum phosphorus,C-reactive protein(CRP),globulin(GLB)and bone marrow plasma cell percentage(BMPCp)were independent risk factors for grade 3-4 MBD in NDMM patients(P<0.05).Based on this,risk prediction model was constructed as follows:logit(P)=-15.092+0.107(age)+1.150(serum phosphorus)+0.057(CRP)+0.040(GLB)+0.212(BMPCp).There was no significant difference between the predicted probability and the actual incidence by the Hosmer-Lemeshow goodness of fit test(P=0.770).The accuracy of the model in predicting grade 3-4 MBD in NDMM patients was 90.40%,and the area under the curve was 0.957(95%CI:0.932-0.981),indicating a reliable prediction ability.Conclusion Age,serum phosphorus,CRP,GLB and BMPCp were all independent risk factors for grade 3-4 MBD in NDMM patients,and the constructed risk prediction model has a relatively good predictive effect on the occurrence of grade 3-4 MBD in NDMM patients.

Objective:To analyze the clinical characteristics, treatment strategies, and prognostic outcomes of patients infected with Listeria monocytogenes, thereby providing evidence-based insights for the prevention and control of this disease.Methods:A retrospective analysis was performed on the clinical data, diagnostic tests, treatment protocols, and prognostic outcomes of patients definitively diagnosed with Listeria monocytogenes infection at Sichuan Provincial People's Hospital over the past decade. Additionally, a comprehensive literature review was conducted, encompassing studies published between 2014 and 2024, sourced from CNKI, Wanfang Data, and PubMed. This review focused on summarizing the clinical features, treatment regimens, and prognostic outcomes of patients with Listeria monocytogenes infection.Results:The study cohort comprised 17 patients, with a mean age of (61.29 ± 16.24) years. The confirmed cases included 7 cases of bloodstream infections, 3 cases of central nervous system infections, and 7 cases of combined infections. Sepsis developed in 9 patients. The average time from symptom onset to the initiation of empirical antibiotic therapy was 72 hours, while the mean time to definitive diagnosis was 102 hours. Antimicrobial regimens predominantly featured penicillins, meropenem, and vancomycin. The average hospitalization duration was 16 days, with 9 patients experiencing adverse outcomes. A total of 78 relevant literature pieces were retrieved, encompassing data from 85 patients. The average age of these patients was (57.96 ± 16.48) years. Primary diagnostic methods relied on blood/cerebrospinal fluid cultures and Next-Generation Sequencing (NGS). Treatment regimens primarily involved antibiotics such as penicillins, aminoglycosides, carbapenems, and glycopeptides. Despite these interventions, the proportion of patients with poor prognosis remained significantly high at 30.6% (26/85). Logistic regression analysis identified sepsis and delayed antibiotic administration as independent predictors of poor prognosis.Conclusions:Listeriosis, caused by an opportunistic pathogen, necessitates early antibiotic administration and timely identification of at-risk populations to mitigate the risk of poor prognostic outcomes in patients.

Objective A survival outcome prediction model for postoperative pancreatic cancer patients was constructed by applying large-scale data based on the new version of American Joint Committee on Cancer(AJCC)staging using different machine learning algorithms.Methods Based on the Surveillance,Epidemiology,and End Results(SEER)database,synthetic minority over-sampling technique(SMOTE)and synthetic minority over-sampling technique and edited nearest neighbors(SMOTE-ENN)algorithms were used to process unbalanced data,random forest,support vector machine,decision tree,and extreme gradient boosting(XGBoost)algorithms were used to build and compare prognostic models,and Shapley additive explanation(SHAP)was introduced to interpret the models.Results The SMOTE-ENN combined with XGBoost model had the best performance(accuracy rate was 86.2％,precision rate was 95.2％,recall rate was 71.2％,F1 value was 0.762,area under the curve was 0.884,Brier score was 0.108).The calibration curve and decision curve respectively showed that this model had good calibration effect and high clinical application value.In addition,SHAP analysis showed that the most important impact on prognostic outcomes was N stage.Conclusion The XGBoost model has the best performance and can be used as a new high-performance postoperative prognosis prediction model under AJCC staging that conforms to the current clinical staging system,providing theoretical support for predicting postoperative patient survival outcomes and formulating personalized treatment plans.

Objective:To evaluate the effect of acupuncture on postoperative delirium (POD) in diabetic patients undergoing surgery under general anesthesia.Methods:In this randomized controlled trial, 92 diabetic patients of either sex, aged 30-80 yr, with a body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective surgery under general anesthesia, were divided into 2 groups ( n=46 each) using a table of random numbers: control group (group C) and acupuncture group (group A). Group A received acupuncture at the Baihui (GV20), Shenting (GV24) and Sishencong (EX-HN1) acupoints before anesthesia. The needles were retained for 30 min, with manual stimulation applied every 10 min for 10 s each time. After 4 stimulations, routine anesthesia was carried out. Group C received routine anesthesia only. Regional cerebral oxygen saturation was recorded on admission to the operating room (T 0), after anesthesia induction (T 1), at the start of surgery (T 2), at the end of surgery (T 3), and immediately after tracheal extubation (T 4). The POD developed within 3 days after surgery was assessed. The occurrence of needle-related adverse effects such as fainting, subcutaneous bleeding, and local paresthesia was recorded. Results:Compared with group C, the incidence of POD was significantly reduced, and the regional cerebral oxygen saturation was increased at T 1, 4 in group A ( P<0.05). Conclusions:Acupuncture can decrease the development of POD in diabetic patients undergoing surgery under general anesthesia, which is related to an increase in regional cerebral oxygen saturation.

Objective:To conduct a scoping review on the current status, assessment tools and influencing factors of malnutrition in elderly stroke patients, so as to provide new ideas for the development of individualized nutritional intervention programs.Methods:Studies related to malnutrition in elderly stroke patients were searched in China National Knowledge Infrastructure, VIP, WanFang Data, China Biology Medicine disc, PubMed, Web of Science, Embase and Clinical Trial Registration Center. The search period was from the establishment of the database to January 2024. Two researchers independently screened the literature, extracted information based on inclusion and exclusion criteria, and finally categorized and reported the findings.Results:A total of 33 papers were included. In elderly stroke patients, the prevalence of malnutrition varied between studies. There was a wide range of tools to assess the nutritional status of patients, but there was an overall lack of multidimensional and specific tools. Commonly used was the Short-form Mini-nutritional Assessment. Factors influencing malnutrition in patients included general demographic, disease-related and lifestyle factors, physiologic and biochemical indicators, functional correlates, nutrient literacy-related factors, psychological and supportive factors.Conclusions:Malnutrition in elderly stroke patients is influenced by a variety of factors and seriously affects patient prognosis. Standardized assessment tools should be adopted to detect timely and accurately, take targeted measures for each factor, and carry out personalized intervention programs to promote benign changes in the nutritional status of elderly stroke patients.

Objective:To analyze the clinical efficacy and learning curve for robot-assisted cortical bone trajectory (CBT) screw fixation performed by surgeons with different seniority in the treatment of lumbar degenerative disease.Methods:The clinical data of 91 lumbar degenerative disease patients underwent robot-assisted CBT screw fixation from August 2020 to December 2022 in Beijing Shijitan Hospital, Capital Medical University were retrospectively analyzed. Among them, 48 patients underwent surgery performed by the same senior surgeon (senior group), with a total of 234 CBT screws were placed; while 43 patients underwent surgery performed by the same junior surgeon (junior group), with a total of 206 CBT screws were placed. The surgical related indexes, functional improvement score, lower back pain and lower limb radiation pain scores, acceptable nail insertion rate, non invasion rate of facet joints and incidence of postoperative complications were compared between two groups. The functional improvement score was evaluated using the Japanese Orthopaedic Association (JOA) score, the pain score was evaluated using visual analog score (VAS). The cumulative sum (CUSUM) method was used to depict the learning curve with "single screw placement time" as the observation index.Results:There were no statistical difference in incision length, operation time, intraoperative blood loss and postoperative hospital stay between two groups ( P>0.05). The least squares means of JOA scores 1, 3 and 6 months after surgery in both groups increased significantly compared to baseline, while the least squares means of lower back pain VAS and lower limb radiation pain VAS decreased significantly compared to baseline; there were no statistical differences between two groups ( P>0.05). There were no statistical difference in acceptable nail insertion rate, non invasion rate of facet joints and incidence of postoperative complications between two group ( P>0.05). The CUSUM learning curves were fitting well and the inflection point for senior surgeon corresponded to 18 cases, while it was reached after performing surgery on 21 cases for junior surgeon. Conclusions:Robot-assisted CBT screw fixation performed by surgeons with different seniority could achieve similar clinical outcomes for treating lumbar degenerative disease. The senior surgeons are able to complete the initial learning stage faster than the junior surgeons, but there is not much difference in the number of surgeries performed the learning curve.

[This corrects the article DOI: 10.1016/j.apsb.2022.05.019.].

Salivary gland mucosa-associated lymphoid tissue lymphoma (SGML) is a subvariety of marginal zone B-cells that occurs outside of mucosal lymph nodes. The onset of SGML is closely related to immunity, chronic infections, and genetic factors, such as lymphoepithelial sialadenitis (LESA) and Sjogren’s syndrome (SS), as well as Helicobacter pylori, hepatitis C virus, Epstein-Barr virus, and human T-lymphocytic virus. The most common site of SGML is the parotid gland, followed by the submandibular gland, small salivary gland, and sublingual gland. SGML is more common in middle-aged and elderly women, and patients often have autoimmune diseases, such as Sjogren’s syndrome or rheumatoid arthritis. SGML can be diagnosed through clinical manifestations, imaging, and histopathology, but histopathological biopsy remains the main method for confirming SGML. Traditional treatment methods include anti-infective therapy and surgery combined with radiation or chemotherapy. In recent years, some new treatment methods, such as Bruton tyrosine kinase (BTK) inhibitors and programmed cell death protein-1 (PD-1) inhibitors, have been effective against recurrent or refractory SGML, but more clinical trial data are needed to support them. At present, the optimal treatment for SGML is not yet clear. Individualized treatment plans should be developed based on the location, staging, clinical characteristics, and overall health status of the patient. SGML progresses slowly and has a relatively good overall prognosis; however, the disease is recurrent, the treatment cycle is long, the recurrence rate is higher than that of other mucosa-associated lymphoid tissue lymphomas, and SGML may also cause other serious complications. Therefore, regular observation and follow-up are very important for its prognosis. This article reviews the etiology, diagnosis, treatment, and prognosis of SGML, with the aim of providing a reference for clinical diagnosis and treatment, and thus improve the survival rate of patients with SGML.