Methods: Fifty patients who underwent UBE-TLIF and 50 patients who underwent W-TLIF, each with >2 years of follow-up, were retrospectively analyzed. Outcomes included operative parameters, time to postoperative mobilization, paravertebral muscle atrophy and fat infiltration rates, clinical scores (Visual Analog Scale [VAS], Oswestry Disability Index [ODI], Japanese Orthopaedic Association [JOA]), modified Macnab criteria, fusion rates, and complications. Results: Compared with W-TLIF, the UBE-TLIF group had significantly less intraoperative blood loss, shorter operative times, and lower postoperative drainage volumes (p <0.05). The UBE-TLIF group showed faster postoperative recovery and shorter hospital stays. At 6 months, 1 year, and 2 years, W-TLIF patients had higher multifidus and erector spinae atrophy, and greater paravertebral muscle fat infiltration (p <0.05). The UBE-TLIF group also had lower VAS and ODI scores at 1 year and 2 years (p <0.05) and fewer surgical complications (6% vs. 10%). Fusion rates (94% vs. 92%) and modified Macnab outcomes (88% vs. 86%) were comparable (p >0.05). Conclusions UBE-TLIF is associated with reduced intraoperative trauma, quicker recovery, and fewer complications. In the long-term, it better preserves paravertebral muscle integrity and provides superior pain and functional outcomes.

Objective:To explore the expression level of m6A methyltransferase ZC3H13 gene in primary acute myeloid leukemia(AML)and its relationship with clinical features and prognosis.Methods:A total of 131 newly diagnosed AML patients and 12 controls were enrolled from July 1,2018 to December 1,2021 in the Hematology Department of the Second Hospital of Shanxi Medical University.RT-qPCR technology was used to detect the expression level of ZC3H13 mRNA in bone marrow(BM)samples.A retrospective analysis was conducted to examine the correlation between ZC3H13 expression level and clinical indicators,gene mutations,and prognosis.Results:The expression level of ZC3H13 mRNA in primary AML patients was significantly higher than that in the control group(P＜0.001).The white blood cell count,proportion of BM blast cells,and relapse rate in the high ZC3H13 expression group were higher than those in the the low ZC3H13 expression group(all P＜0.05),while the Th/Ts ratio was lower(P＜0.01).Univariate survival analysis showed that patients with high expression of ZC3H13 had shorter median overall survival(OS)and disease-free survival(DFS)than those with low expression of ZC3H13(both P＜0.05).The results of multivariate Cox regression analysis showed that high-risk stratification(OS:HR=1.612,95％CI:1.151-2.257,P=0.005;DFS:HR=1.551,95％CI:1.031-2.335,P=0.035)and high ZC3H13 expression(OS:HR=1.756,95％CI:1.028-2.999,P=0.039;DFS:HR=1.935,95％CI:1.018-3.678,P=0.044)were both independent risk factors for OS and DFS in AML patients.Conclusion:The expression of ZC3H13 in AML patients may be related to tumor burden and immune function.Patients with high expression of ZC3H13 have poor prognosis,and high expression of ZC3H13 is an independent risk factor for the prognosis of AML patients.

Objective To explore the protective effect and possible mechanism of modified Shenqi Dihuang Decoction on podocytes in db/db mice based on ROS/NLRP3/GSDMD signaling pathway.Methods Fifty 8-week-old male db/db mice(SPF grade)were randomly divided into the model group,losartan group and TCM low-,medium-and high-dosage groups,with 10 mice in each group.Ten heterozygous db/m mice served as the blank group.Interventions were administered respectively for 12 weeks.The body mass,random blood glucose,serum creatinine,blood urea nitrogen and 24 h urinary protein content were detected,HE,PAS,PASM,Masson and Sirius red staining was used to observe the morphology of renal tissue,transmission electron microscopy was used to observe the ultrastructure of renal tissue,fluorescent probes were used to observe the release of ROS in renal tissue,immunofluorescence staining was used to detect the expression of Nephrin,NLRP3,Cleaved Caspase-1 and GSDMD-N in renal tissue,and Western blot was used to detect the expression of NLRP3,Cleaved Caspase-1,GSDMD-N,IL-1β,IL-18,Nephrin,Podocin,PODXL,WT-1 and Desmin proteins.Results Compared with the blank group,the body mass and random blood glucose of the model group mice significantly increased(P<0.05),and the contents of serum creatinine,blood urea nitrogen and 24 h urinary protein were significantly increased(P<0.05);glomerular hypertrophy,dilation of renal glomeruli and tubules,thickening of basement membrane,matrix proliferation in mesangial area,abnormal deposition of collagen fibers in renal interstitium,accompanied by damage to renal tubular epithelial structure and focal glomerulosclerosis,significant increase in type Ⅰ collagen deposition,extensive fusion of podocyte processes,and scattered electron dense material in the basement membrane or subepithelial layer;the ROS content in renal tissue significantly increased(P<0.05),and the protein expression of NLRP3,Cleaved Caspase-1,GSDMD-N,IL-1β,IL-18 and Desmin significantly increased(P<0.05),the protein expression of Nephrin,Podocin,PODXL and WT1 significantly decreased(P<0.05).Compared with the model group,the body mass and random blood glucose of mice in each dosage of TCM group were relatively stable,the contents of serum creatinine,blood urea nitrogen and 24 h urinary protein decreased;the pathological damage to renal tissue was reduced,the ultrastructure of podocytes was improved,and the density of podocytes increased;the ROS content decreased,and the protein expression of NLRP3,Cleaved Caspase-1,GSDMD-N,IL-1β,IL-18 and Desmin decreased,while the protein expression of Nephrin,Podocin,WT1 and PODXL increased.With the dosage of modified Shenqi Dihuang Decoction increased,the improvement effect gradually strengthened,and the differences in TCM high-dose group was statistically significant(P<0.05).Conclusion Modified Shenqi Dihuang Decoction can protects podocytes in db/db mice,potentially by modulating the ROS/NLRP3/GSDMD signaling pathway.

Objective This review aims to investigate the application of eye tracking(ET)in patients with speech impairment in the ICU.The review summarizes the current status and prospects of ET technology applications.Methods Following the scoping reviews framework,a systematic search was conducted across Web of Science,PubMed,Cochrane Library,Embase,CINAHL,CNKI,Wanfang Data,Chinese Medical Database,and Chinese biomedical database.The search covered publications from the inception of each database to October 29th,2024.The included studies were comprehensively analyzed.Results A total of 12 pieces of the literature were included,including 4 prospective cohort studies,4 experimental studies,3 prospective observational studies,and 1 randomized controlled trial.The application population of ET in the ICU mainly includes patients on mechanical ventilation,those at high risk of delirium,patients with spinal cord injury,etc.The types of integrated ET system equipment are mainly head-mounted and fixed;the types of ET involve gaze,blinking,etc.;the functions include standardized scale assessment,free interaction,and eye-movement model recognition.The main outcome indicators of the research are feasibility,physical symptoms and social-psychological status.Conclusion ET is applicable to a specific group of ICU patients with aphasia,and has shown good feasibility and effectiveness in the expression of patients'basic needs,self-assessment of symptoms and improvement of psychosocial status.

Objective To assess the dietary quality of preschool children and explore the relationship between feeding practices and dietary quality.Methods Relying on the Shanghai Maternal-Child Pairs Cohort,3 177 preschool children were selected as the subjects for this study,and questionnaire were surveyed on their dietary intake and feeding practice.The diet balance index was used to evaluate dietary quality among preschool children.High bound score(HBS),the low bound score(LBS),and the dietary quality distance(DQD)were calculated to respectively reflect overall dietary overconsumption,insufficiency,and imbalance.Logistic regression was utilized to analyze the association between feeding practice and dietary quality in preschool children.Results The HBS,LBS,and DQD of the subjects were 2(0,8),22.19±10.80,and 26.78±9.57,respectively.Only 7.68%of the children had a balanced dietary intake,with 74.73%and 33.99%of overall dietary intake being inadequate and excessive,respectively.Parental perceived weight were negatively associated with the risk of moderate to high over intake among children(aOR=0.79,95%CI:0.63-0.98).The higher the perceived responsibility(aOR=1.19,95%CI:1.03-1.37)score,the lower the monitoring score(aOR=0.83,95%CI:0.74-0.93),and the higher the likelihood that the child had a moderate to high under intake.The scores of pressure to eat were also positively correlated with the risks of under intake and moderate to high overall unbalance in preschool children(aOR=1.15-1.39,95%CI:1.02-1.63).Conclusion Preschool children commonly experience dietary imbalance,with inadequate and excessive intake coexisting.Parental perceived weight and monitoring were positively associated with preschoolers'dietary quality,whereas perceived responsibility and pressure to eat were negatively associated with it.

Objective To assess the dietary quality of preschool children and explore the relationship between feeding practices and dietary quality.Methods Relying on the Shanghai Maternal-Child Pairs Cohort,3 177 preschool children were selected as the subjects for this study,and questionnaire were surveyed on their dietary intake and feeding practice.The diet balance index was used to evaluate dietary quality among preschool children.High bound score(HBS),the low bound score(LBS),and the dietary quality distance(DQD)were calculated to respectively reflect overall dietary overconsumption,insufficiency,and imbalance.Logistic regression was utilized to analyze the association between feeding practice and dietary quality in preschool children.Results The HBS,LBS,and DQD of the subjects were 2(0,8),22.19±10.80,and 26.78±9.57,respectively.Only 7.68%of the children had a balanced dietary intake,with 74.73%and 33.99%of overall dietary intake being inadequate and excessive,respectively.Parental perceived weight were negatively associated with the risk of moderate to high over intake among children(aOR=0.79,95%CI:0.63-0.98).The higher the perceived responsibility(aOR=1.19,95%CI:1.03-1.37)score,the lower the monitoring score(aOR=0.83,95%CI:0.74-0.93),and the higher the likelihood that the child had a moderate to high under intake.The scores of pressure to eat were also positively correlated with the risks of under intake and moderate to high overall unbalance in preschool children(aOR=1.15-1.39,95%CI:1.02-1.63).Conclusion Preschool children commonly experience dietary imbalance,with inadequate and excessive intake coexisting.Parental perceived weight and monitoring were positively associated with preschoolers'dietary quality,whereas perceived responsibility and pressure to eat were negatively associated with it.

BACKGROUND:Cervical instability is a common orthopedic disease in young and middle-aged people,and is the early manifestation of cervical spondylosis,which has a great impact on the quality of life of patients.Therefore,early diagnosis of cervical instability to implement early intervention has positive clinical and social significance.OBJECTIVE:The clinical prediction model of cervical instability in young and middle-aged people was constructed based on machine learning to realize early screening of cervical instability in young and middle-aged people before X-ray examination.METHODS:From September 2022 to October 2023,155 young and middle-aged adults with cervical instability and 88 with non-cervical instability recruited through recruitment advertisements and spinal department outpatient of Wangjing Hospital,China Academy of Chinese Medical Sciences were selected as research subjects.The research subjects'general information,living and working habits,discomfort symptoms,visual analog scale score,Neck Disability Index,and 36-ltem Short Form Health Survey were collected on site based on questionnaires.The above information was used as predictive factors.After screening,six machine learning algorithms of Support Vector Machine,LightGBM,RandomForest,Logistic,AdaBoost,and XGBClassifier were used to train the model by ten-fold cross-validation method,and the clinical prediction model of cervical instability was constructed.Area under the curve was used as the main evaluation index.Univariate analysis was performed on the predictors,and SHAP method was used to rank the importance of the predictors.Correlation heat maps were used to show the degree of linear correlation between the predictors and the cervical instability.RESULTS AND CONCLUSION:(1)Among the six machine learning models,RandomForest model was chosen as the final prediction model,including nine predictors,such as age,body mass index,neck circumference/neck length,visual analog scale score,Neck Disability Index,bodily pain,general health,vitality,and mental health,area under the curve=0.725 4,and the calibration degree was good.It could be used as a reference tool for early screening of cervical instability in young and middle-aged people.(2)There were significant differences in age,visual analog scale score,Neck Disability Index,bodily pain,general health,and vitality between the two groups(P＜0.05).(3)The order of importance of predictors was age,Neck Disability Index,visual analog scale score,general health,body mass index,vitality,bodily pain,neck circumference/neck length,mental health,among which age,visual analog scale score,Neck Disability Index were positively correlated with cervical instability,while general health,body mass index,vitality,bodily pain,neck circumference/neck length,and mental health were negatively correlated with cervical instability.

Objective:To summarise the main points of operation during thyroid surgery using bilateral axillo-breast approach (BABA) with a domestic robot and to analyse the learning curve.Methods:From May. 2023 to Oct. 2023, we retrospectively analysed the clinical data of 38 patients who underwent thyroid surgery with domestically manufactured robot via BABA attending the Department of Thyroid and Breast Surgery of the 960th Hospital of PLA Joint Logistics Support Force, proposed and constructed learning curves using cumulative and analytical methods to study the minimum number of learning cases required for the loading time of assistants and surgeon-in-charge with da Vinci surgical experience to transition from the initial learning stage to the proficiency stage. The age, BMI, surgical time (loading time, operating time), postoperative drainage time, and number of lymph nodes dissected were compared among patients at different stages of the learning curve.Results:A total of 38 thyroidectomy patients successfully underwent surgery, with an average surgical time of (176.61 ± 47.98) minutes. After 18 cases, the assistant's loading time shortened and stabilized at (42.20 ± 3.44) minutes. The operator reached peak proficiency at the 18th case (loading time, operating time), which was considered the dividing point between the learning phase and the proficiency phase. During the learning phase, the average surgical time was (209.72 ± 49.28) minutes, operation time: (165.44 ± 49.93) minutes, while in the proficiency phase, the average surgical time decreased to 146.80 ± 18.34 minutes, operation time: (104.60 ± 19.01) minutes. There were no statistically significant differences in baseline characteristics such as age, BMI, postoperative drainage time, or the number of central compartment lymph nodes dissected between the two phases ( P > 0.05) . Conclusion:Over the results of this study, it was shown that for robosurgeons with experience in da Vinci robotic surgery, the transition from the learning stage to the proficiency stage could be considered after crossing the learning curve for 18 cases, and that assistants could become proficient in loading techniques after 18 procedures.

Objective:To explore the expression level of m6A methyltransferase ZC3H13 gene in primary acute myeloid leukemia(AML)and its relationship with clinical features and prognosis.Methods:A total of 131 newly diagnosed AML patients and 12 controls were enrolled from July 1,2018 to December 1,2021 in the Hematology Department of the Second Hospital of Shanxi Medical University.RT-qPCR technology was used to detect the expression level of ZC3H13 mRNA in bone marrow(BM)samples.A retrospective analysis was conducted to examine the correlation between ZC3H13 expression level and clinical indicators,gene mutations,and prognosis.Results:The expression level of ZC3H13 mRNA in primary AML patients was significantly higher than that in the control group(P＜0.001).The white blood cell count,proportion of BM blast cells,and relapse rate in the high ZC3H13 expression group were higher than those in the the low ZC3H13 expression group(all P＜0.05),while the Th/Ts ratio was lower(P＜0.01).Univariate survival analysis showed that patients with high expression of ZC3H13 had shorter median overall survival(OS)and disease-free survival(DFS)than those with low expression of ZC3H13(both P＜0.05).The results of multivariate Cox regression analysis showed that high-risk stratification(OS:HR=1.612,95％CI:1.151-2.257,P=0.005;DFS:HR=1.551,95％CI:1.031-2.335,P=0.035)and high ZC3H13 expression(OS:HR=1.756,95％CI:1.028-2.999,P=0.039;DFS:HR=1.935,95％CI:1.018-3.678,P=0.044)were both independent risk factors for OS and DFS in AML patients.Conclusion:The expression of ZC3H13 in AML patients may be related to tumor burden and immune function.Patients with high expression of ZC3H13 have poor prognosis,and high expression of ZC3H13 is an independent risk factor for the prognosis of AML patients.

Objective To explore the disinfection effect of periodic hypochlorous acid infusion on water supply pipelines.Methods Water specimens from 6 water outlets of central sterile supply department were collected at baseline for microbial culture.After introducing a slightly acidic hypochlorous acid water generator,water speci-mens were collected every 10 days.Continuous disinfection with hypochlorous acid was carried out on the 1st-3rd day,and discontinued on the 4th-10th day.Water specimens of 6 water outlets were collected on the 1st,4th,7th,and 10th day of each cycle,in total 3 cycles.Microbial culture and metagenomic next-generation sequencing(mNGS)analysis were conducted simultaneously on all water specimens from the outlets of the endoscope cleaning tank.Results Before disinfection of the pipeline,a total of 18 bottles of water specimens were collected.Bacterial count of water specimens from 10 bottles(55.56％)was between 102 and 104 CFU/mL,mainly Sphingomonas ad-hesins and Bacillus cereus.After disinfection,only 2 out of 72 water specimens(2.78％)exceeded the bacterial lim-it.The mNGS results showed that three most dominant bacterial genera in the pre-disinfection water specimens were Sphingomonas,Methylobacterium,and Ralstonia,with stringent mapped reads number(SMRN)ranging from 10 000 to 100 000;while the most dominant bacterial genera in post-disinfection water specimens were Lacto-baci-llus,Ralstonia,Acinetobacter,and Bradyrhizobium.PCoA analysis showed that there was a statistically sig-nificant difference in β-diversity of water specimens before and after disinfection(P＜0.05).Conclusion Periodic hypochlorous acid infusion disinfection can effectively remove bacterial biofilms in water pipelines,but there is a risk of bacterial biofilm recovery during disinfection suspension.In the future,monitoring and management of medical water should be strengthened.