Objective:To analyze the learning curve of TiRobot-assisted lumbar pedicle screw fixation (LPSF) by cumulative sum (CUSUM) test method.Methods:The clinical data of 50 patients who underwent TiRobot-assisted LPSF from January 2020 to December 2022 in Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. CUSUM analysis and learning curve fitting were performed with robot usage time as the main indicator with the time for each step refined (robot registration time, path planning time and guide wire placement time), to select the best learning curve fitting model with the R2 value closest to 1. Using the turning point of the learning curve as the boundary, the learning curve was divided into two stages as learning stage and maturity stage, and then the observation indexes were compared between the two stages. Results:All 50 patients successfully completed the surgery without perioperative complications, with a total of 244 pedicle screws implanted. The total robot usage time and robot registration time showed a gradually decreasing trend with the increase of case number, and the learning curves were successfully fitted and reached their peaks at the seventeenth and thirteenth cases respectively. The entire learning process was divided into learning stage (17 cases) and maturity stage (33 cases) based on the turning point of the learning curve of total robot usage time. The path planning time and guide wire placement time did not show significant changes with the increase in the case number. The total robot usage time, robot registration time and the intraoperative blood loss in the learning stage were significantly higher than those in the maturity stage: (35.35 ± 1.58) min vs. (30.61 ± 0.43) min, (20.83 ± 1.56) min vs. (14.94 ± 0.29) min and 400 (150, 500) ml vs. 200 (110, 300) ml, the guide wire placement time of per screw was significantly lower than that in the maturity stage: 2.00 (1.83, 2.34) min/screw vs. 2.33 (2.13, 2.69) min/screw, and there were statistical differences ( P<0.05 or <0.01). There were no statistical difference in the path planning time, path planning time of per screw, guide wire placement time and the accuracy of screw placement between two stages ( P>0.05). Conclusions:TiRobot-assisted LPSF is a new technology with safety and effectiveness, and it has a relatively short learning curve. To achieve technological maturity, at least 17 surgeries are required with accumulated experience, and the robot registration is the main step of the learning process. After reaching maturity stage, the robot usage time is significantly shortened and intraoperative trauma is significantly reduced while the relatively high screw placement accuracy is ensured.

Objective:To analyze the learning curve of TiRobot-assisted lumbar pedicle screw fixation (LPSF) by cumulative sum (CUSUM) test method.Methods:The clinical data of 50 patients who underwent TiRobot-assisted LPSF from January 2020 to December 2022 in Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. CUSUM analysis and learning curve fitting were performed with robot usage time as the main indicator with the time for each step refined (robot registration time, path planning time and guide wire placement time), to select the best learning curve fitting model with the R2 value closest to 1. Using the turning point of the learning curve as the boundary, the learning curve was divided into two stages as learning stage and maturity stage, and then the observation indexes were compared between the two stages. Results:All 50 patients successfully completed the surgery without perioperative complications, with a total of 244 pedicle screws implanted. The total robot usage time and robot registration time showed a gradually decreasing trend with the increase of case number, and the learning curves were successfully fitted and reached their peaks at the seventeenth and thirteenth cases respectively. The entire learning process was divided into learning stage (17 cases) and maturity stage (33 cases) based on the turning point of the learning curve of total robot usage time. The path planning time and guide wire placement time did not show significant changes with the increase in the case number. The total robot usage time, robot registration time and the intraoperative blood loss in the learning stage were significantly higher than those in the maturity stage: (35.35 ± 1.58) min vs. (30.61 ± 0.43) min, (20.83 ± 1.56) min vs. (14.94 ± 0.29) min and 400 (150, 500) ml vs. 200 (110, 300) ml, the guide wire placement time of per screw was significantly lower than that in the maturity stage: 2.00 (1.83, 2.34) min/screw vs. 2.33 (2.13, 2.69) min/screw, and there were statistical differences ( P<0.05 or <0.01). There were no statistical difference in the path planning time, path planning time of per screw, guide wire placement time and the accuracy of screw placement between two stages ( P>0.05). Conclusions:TiRobot-assisted LPSF is a new technology with safety and effectiveness, and it has a relatively short learning curve. To achieve technological maturity, at least 17 surgeries are required with accumulated experience, and the robot registration is the main step of the learning process. After reaching maturity stage, the robot usage time is significantly shortened and intraoperative trauma is significantly reduced while the relatively high screw placement accuracy is ensured.

Objective:To evaluate the perioperative application effect of enhanced recovery after surgery (ERAS) clinical pathway in percutaneous vertebro plasty (PVP).Methods:The clinical data of 274 patients who underwent PVP treatment for osteoporotic vertebral compression fracture (OVCF) in Beijing Friendship Hospital, Capital Medical University from May 2023 to August 2024 were retrospectively analyzed. The patients were divided into two groups according to the different numbers of surgical segments: the single-segment group ( n=211) and the multisegment group ( n=63). Patients in the single-segment group underwent single-segment surgery, while patients in the multisegment group underwent surgery on ≥2 segments. The core points of the ERAS clinical pathway adopted in this study include perioperative education, pain management, early mobilization, application of "outfast", and joint guidance from the departments of nutrition and rehabilitation. Comparison was made between the two groups of patients in terms of visual analog scale (VAS) scores for low back pain at preoperative, 2 h, 6 h, 24 h postoperatively, and on the day of discharge; Oswestry disability index (ODI) scores preoperatively and on the day of discharge; time to first ambulation postoperatively, total length of hospital stay, postoperative length of stay, perioperative complications, and perioperative application of Opioid consumption. Measurement data were expressed as mean±standard deviation ( ± s), and the independent sample t-test was used for comparison between groups; count data were expressed as cases and percentage, and the Chi-square test was used for comparison between groups. The VAS pain scores at each stage of the perioperative period were evaluated using repeated measures analysis of variance or generalized estimating equations. Results:Compared with that before the operation [(6.17±0.93) points, (6.29±0.83) points], the VAS scores of low back pain of patients in the single-segment group and the multisegment group at 2 hours after surgery [(3.09±0.82) points, (3.27±0.65) points], 6 hours after surgery [(2.60±0.79) points, (2.62±0.55) points], and 24 hours after surgery [(1.89±0.77) points, (1.97±0.72) points] and on the day of discharge [(1.72±0.71) points, (1.81±0.64) points] were significantly decreased, and the differences were statistically significant ( P<0.05). At the same stage, the VAS scores of low back pain in both groups were not statistically significant ( P>0.05). The ODI scores of patients in the single-segment group and the multisegment group on the day of discharge [(24.21±2.35) points, (24.63±3.31) points] were significantly lower than those before the operation [(64.50±4.81) points, (65.52±4.08) points], and the differences were statistically significant ( P<0.05). There were no statistically significant differences in perioperative complications and the proportion of Opioid drug application between the two groups of patients ( P>0.05). Conclusion:For patients with single-segment or multisegment OVCF, PVP surgical treatment under ERAS clinical pathway management can achieve immediate pain relief, early ambulation exercise, and satisfactory perioperative efficacy.

Objective To investigate the effect of remimazolam on anesthetic effect and postoperative cognitive function during painless bronchoscopy in elderly patients.Methods A total of 90 patients with painless bronchoscopy admitted to Wenzhou People's Hospital were selected.And randomly dividing into 45 patients in control group,45 patients in observation group.The control group was given propofol,and the observation group was given remimazolam.Mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO2)were monitored.Effective time after induction,recovery time after withdrawal and discharge time were compared.Patient's cognitive function was assessed using the mini-mental state examination(MMSE),auditory word learning test(AVLT),shape connection test(STT),and animal language fluency test(AFT).Enzyme linked immunosorbent assay(ELISA)was used to determine substance P(SP),C-reactive protein(CRP),noradrenaline(NE),tumor necrosis factor-α(TNF-α)in serum,interleukin(IL)-6 and prostaglandin E2(PGE2)concentrations.Results Compared with the control group,the MAP of the observation group patients at time points T2 and T3 showed statistically significant differences(P<0.05);HR was especially significant at T2,T3 and T6 periods(P<0.05).SpO2 at T2 and T3(P<0.05).The awakening time,discharge time of the observation were shorter than control(P<0.05).At 1 day after surgery,the MMSE score,STT score,AFT score were significantly higher(P<0.05);The serum levels of SP,PGE2 and NE and IL-6,TNF-α and CRP were decreased in the control(P<0.05).The incidence of adverse reactions was 17.78％in control group and 8.89％in observation group(χ2=7.654,P=0.031).Conclusion Remazolam is used in painless bronchoscopy in elderly patients,intraoperative hemodynamics is stable,having little impact on postoperative cognitive function,and inhibits the release of inflammatory factors and the secretion of pain mediators,which is worthy of clinical use.

Objective:To evaluate the teaching effects of a comprehensive LPC model (combining lecture-based learning, problem-based learning, and case-based learning) in the observership of basic surgery for pediatric medical students of the five-year program.Methods:We divided 69 students of grades 2019 and 2020 majoring in pediatrics of the five-year program of Capital Medical University who were in the observership of basic surgery at Beijing Friendship Hospital into experimental group ( n=33, adopting the LPC teaching mode) and control group ( n=36, using the LBL teaching mode). Teaching and assessment were completed in stages. The two groups were compared in terms of clinical skill practice score, clinical thinking score, observership enthusiasm, and satisfaction with observership teaching. SPSS 25.0 was used for the t test, chi-square test, or rank sum test. Results:The LPC group showed significantly higher scores in clinical skill practice [(99.91±0.29) vs. (84.72±10.21), P<0.05] and clinical thinking [(91.06±5.93) vs. (84.31±7.98), P<0.05] and significantly better enthusiasm for observership ( P<0.05) compared with the LBL group. The LPC group was superior to the LBL group with respect to the proportion of students with proficiency in surgical skills (100.0% vs. 63.9%, P<0.05), the proportion of students with good literacy in aseptic surgical principles (100.0% vs. 69.4%, P<0.05), the proportion of improvement in clinical competency (97.0% vs. 66.7%, P<0.05), the proportion of improvement in communication ability (93.9% vs. 72.2%, P<0.05), the proportion of increase in interest in literature search and review (90.9% vs. 63.9%, P<0.05), the proportion of increase in interest in scientific research (93.9% vs. 69.4%, P<0.05), the proportion of satisfaction with learning atmosphere (100.0% vs. 72.2%, P<0.05), and the proportion of satisfaction with teaching methods (100.0% vs. 63.9%, P<0.05). Conclusions:The LPC teaching model shows better effects than LBL in basic surgery observership teaching for pediatric medical students of the five-year program, which is worth promotion.

【Objective】 To compare the efficacy and safety of thulium laser enucleation of the prostate (ThULEP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH). 【Methods】 Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were searched in PubMed, Embase, Cochrane Library, CNKI and Wanfang Database from Jan.1,2010 to May 30,2022. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. All divergences were resolved by a third researcher. RevMan 5.4 software was used for Meta analysis. 【Results】 A total of 7 studies were included, involving 1 726 patients, 750 in the ThULEP group and 976 in the HoLEP group. Meta analysis showed that, compared with HoLEP group, the ThULEP group had shorter catheter indwelling time [MD=-0.10, 95%CI (-0.17--0.03), P=0.004] , shorter hospital stay [MD=-0.43, 95%CI (-0.60--0.25), P<0.000 01] , lower IPSS score 12 months after surgery [MD=-1.13, 95%CI (-1.95- -0.30), P=0.007] , lower QoL score 12 months after surgery [MD=-1.00, 95%CI (-1.19- -0.81), P<0.001] ,lower transfusion rate [OR=0.11, 95%CI (0.03-0.36), P=0.000 3] and lower incidence of urinary incontinence [OR=0.24, 95%CI (0.09-0.66), P=0.006] . 【Conclusion】 ThULEP may have similar efficacy and safety as HoLEP in the treatment of BPH, and has more advantages in some aspects.

Objective To investigate the effects of different doses of dexmedetomidine (Dex) combined with ropivacaine continuous transverse abdominal plane (TAP) block on analgesia and immune function in patients with laparoscopic colon cancer surgery. Methods Fifty colon cancer patients who had underwent laparoscopic radical resection from January 2017 to May 2018 in Wenzhou People′s Hospital were selected. The patients were divided into group A and group B according to random digits table method with 25 cases each. Group A was treated with 0.75 μg/kg Dex before operation; group B was treated with 1.00 μg/kg Dex before operation, then 2.00 μg/kg Dex continuous analgesia 48 h after operation. Both groups were given 0.375% ropivacaine 40 ml before operation for TAP block, and 0.2% ropivacaine 5 ml/h continuous analgesia 48 h after operation. The visual analogue score (VAS), interferon γ (IFN-γ), interleukin 10 (IL-10), T lymphocyte subsets (CD4+and CD8+) 12, 24 and 48 h after operation and adverse reactions were observed. Results The VAS 12, 24 and 48 h after operation in group B was significantly lower than that in group A: (2.2 ± 0.6) scores vs. (3.1 ± 0.9) scores, (1.6 ± 0.4) scores vs. (2.3 ± 0.8) scores and (1.1 ± 0.3) scores vs. (1.9 ± 0.6) scores, and there was statistical difference (P＜0.05). The IFN-γ and CD4+12, 24 and 48 h after operation in group B were significantly higher than those in group A, IFN-γ: (281.6 ± 42.1) ng/L vs. (213.5 ± 37.4) ng/L, (335.7 ± 42.5) ng/L vs. (244.2 ± 36.3) ng/L and (362.4 ± 42.8) ng/L vs. (258.6 ± 36.8) ng/L; CD4 +: 0.186 ± 0.047 vs. 0.163 ± 0.045, 0.265 ± 0.058 vs. 0.215 ± 0.052 and 0.314 ± 0.062 vs. 0.226 ± 0.053. The IL-10 and CD8+were significantly lower than those in group A, IL-10: (263.5 ± 28.7) ng/L vs. (314.2 ± 35.6) ng/L, (225.4 ± 26.9) ng/L vs. (279.5 ± 29.8) ng/L and (206.3 ± 26.1) ng/L vs. (272.1 ± 29.2) ng/L; CD8 +:0.268 ± 0.062 vs. 0.295 ± 0.064, 0.217 ± 0.048 vs. 0.266 ± 0.061 and 0.164 ± 0.036 vs. 0.243 ± 0.055. There were statistical differences (P＜0.05). There was no statistical difference in the incidence of adverse reactions between 2 groups (P＞0.05). Conclusions Different doses of Dex combined with ropivacaine continuous TAP block has good analgesic effect on colon cancer patients who had underwent laparoscopic radical resection. However, high first dose load and continuous combination is better and has less effect on immune function.

Objective To evaluate TriVex based transilluminated powered phlebectomy (TIPP)three-stage management for lower limb venous ulcers.Methods This retrospective study included 86 patients with 103 diseased limbs treated in our hospital from October 2005 to July 2013.All received TriVex TIPP three-stage management.Results After therapy there was no acute cellulitis,skin necrosis nor lower limb deep venous thrombosis.There were 2 cases of subcutaneous ecchymosis,1 case of subcutaneous hematoma,1 case of skin abnormal sensation and 1 case of subcutaneous induration.Ulcers healed within one month postoperation in all cases,while skin abnomalities were alleviated with no ulcer recurrence during the follow-up ranging from 4 to 48 months.Conclusions TriVex TIPP centered threestage management is a good option for lower limb venous ulcer,with shortened healing time,low recurrence rate.

Objective To investigate the change of serum CD62p of coronary heart disease (CHD) patients after different doses of clopidogrel administration.Methods One hundred and ninety-one patients with CHD were selected as our subjects.Of which,95 cases were with SAP and 66 cases were with non ST segment elevation acute coronary syndrome (NST-ACS).SAP patients were randomly given clopidogrel at dose of 75 mg/d or 150 mg/d and served as A and B groups.NST-ACS patients were randomly given 300 mg clopidogrel,then randomly divided into C and D groups with sequentially taking clopidogrel at dose of 75 mg/d or 150 mg/d respectively.Thirty healthy peoples were served as E group without drug intervention.Concentrations of serum CD62p were detected by Elisa before taking clopidogrel,24 h and the fifty day of after taking clopidogrel.Results (1) Before taking clopidogrel,the serum concentrations of CD62p in CHD patients were higher (A group:(7.62 ± 2.99) ng/L,B group:(8.48 ± 3.13) ng/L,C group:(9.50 ± 3.32) ng/L,D group:(10.22 ± 5.14) ng/L than that of healthy control group ((5.49 ± 1.99) ng/L,P ＜ 0.05).The Serum CD62p levels in SAP patients were lower than that of NST-ACS patients (P ＜ 0.05).(2)The serum concentrations of CD62p in A and B groups at before taking clopidogrel were (7.62 ±2.99) ng/L and (8.48 ±3.13) ng/L respectively,higher than that four days after taking clopidogrel ((6.79 ± 2.51) ng/L,(6.37 ± 1.80) ng/L;t =2.390,4.520;P ＜0.05 or P ＜0.01).There was no statistical significant difference between A and B groups(P ＞0.05).(3) In C and D groups,the serum CD62p at before taking clopidogrel were (9.50 ±3.32) ng/L and (10.22 ±5.14) ng/L,higher than that after taking clopidogrel for four days ((8.21 ± 2.62) ng/L,(8.17 ± 2.37) ng/L; t =2.084,2.157 ; P ＜ 0.05).No significant difference was seen between C and D groups (P ＞ 0.05).Conclusion The serum CD62p in patients with CHD was higher than that in the healthy control.Clopidogrel administration can decrease serum CD62p in CHD patients.

OBJECTIVE: To introduce advances of cerebrovascular stent at home and abroad, analyze causes for complications following stenting and explore the biocompatibility of cerebrovascular stent and host.METHODS: A computer-based online search of Medline database (1989/2009) and CNKI (1989/2009) was performed to select related articles. According to inclusion and exclusion criteria, the collected articles were selected and evaluated. The treatment advances, complications, and stent biocompatibility were described and summarized to explore the current status, complication and biocompatibility of various cerebrovascular stents.RESULTS: The content of articles was summarized. Intracranial stent is commonly used in clinic. The diameter of vessels confines diameter of stent, so different diseases have different requirements for diameter of stents. The complications following stenting include retroperitoneal hematoma, carotid sinus, hypertransfusion syndrome, cerebral angio spasm and thrombosis. In various stents, polymer, eluting and drug stents have better biocompatibility compared with metal stent, and can effectively prevent restenosis.CONCLUSION: Cerebrovascutar stenting is one of the treatments for cerebrovascular diseases. During the treatment, sufficient operative preparation, appropriate stent and indication are important to avoid complications. Of various stents, polymer and drug stents have good biocompatibility, and the biocompatibility of other stents requires improvement.