OBJECTIVE:Percutaneous sacroiliac screw internal fixation has become the main surgical procedure for the treatment of posterior pelvic ring fractures;however,the unassisted closure operation requires high operator experience and repeated fluoroscopy increases the radiation hazard for patients and medical personnel.This article compares the clinical efficacy of robot-assisted versus unassisted percutaneous sacroiliac screw placement for posterior pelvic ring fractures by meta-analysis. METHODS:Computer searches of CNKI,WanFang,VIP,CBM,PubMed,Embase,Cochrane Library and ClinicalTrials.gov were conducted from the time of database inception to December 2022.The literature on the clinical efficacy of robot-assisted versus freehand percutaneous sacroiliac screw placement in the treatment of posterior pelvic ring fractures was collected in and outside China.The data were independently screened and extracted by two investigators according to the inclusion and exclusion criteria,respectively.The quality of randomized controlled trials was evaluated using Cochrane risk assessment criteria.The quality of included cohort studies was assessed using the Newcastle-Ottawa Scale.Meta-analysis was performed using RevMan 5.4 software for inclusion metrics.Outcome metrics included operative time,intraoperative bleeding,fluoroscopy time,fluoroscopy frequency,number of holes drilled,Majeed postoperative function score,the excellent and good rates of Matta fracture reduction,the excellent and good rates of Gras screw position,fracture healing time and complications. RESULTS:(1)A total of 13 publications were included,2 were randomized controlled trials both referring to randomized methods,11 non-randomized controlled studies were evaluated for quality of literature according to the Newcastle-Ottawa Scale,1 scored 8,9 scored 7;and 1 scored 6;the quality of literature was good.A total of 748 patients were included,including 430 in the robot-assisted group and 318 in the freehand group.(2)The results of the meta-analysis showed that the operative time(MD=-28.30,95%CI:-40.20 to-16.40),intraoperative bleeding(MD=-6.36,95%CI:-10.06 to-2.66),intraoperative fluoroscopy time(MD=-12.13,95%CI:-19.54 to-4.72),intraoperative fluoroscopy frequency(MD=-17.39,95%CI:-29.00 to-5.78),number of intraoperative needle drillings(SMD=-9.50,95%CI:-14.27 to-4.73)and the excellent and good rates of Gras screw position(OR=8.65,95%Cl:3.26-22.92)in the robot-assisted group were significantly better than those in the freehand group(P<0.05).(3)In the robot-assisted group,the overall postoperative complication rate was significantly reduced(OR=0.10,95%Cl:0.02-0.48,P<0.05).(4)No significant difference was detected in fracture healing time(MD=-0.08,95%CI:-0.21,0.06),the excellent and good rates of Matta fracture repositioning rate(OR=2.06,95%Cl:0.97-4.39),and Majeed functional score(MD=0.91,95%CI:-0.31-2.13)between both groups(P>0.05). CONCLUSION:Compared with freehand sacroiliac joint nailing,robotic assistance shortens the operative time,reduces intraoperative bleeding,decreases radiation damage to patients and medical staff,improves the excellent and good rate of screw position,and reduces the overall incidence of postoperative complications in patients,but there was no significant improvement in fracture reduction quality,fracture healing time,and postoperative function.In the future,more large-sample,multicenter,and high-quality randomized controlled trials are still needed to verify.

Objective:To investigate the changes of thickness and area of the ligamentum flavum after lateral lumbar interbody fusion (LLIF) for lumbar degenerative diseases.Methods:From 2019 to 2021, a total of 54 patients with lumbar degenerative diseases who underwent LLIF combined with percutaneous pedicle screw internal fixation were retrospectively analyzed. There were 9 males and 45 females, aged 59.46±6.91 years (range, 45-76 years), followed up for 14.69±6.87 months (range, 12-33 months). The disc height (DH), midsagittal canal diameter (CD), dural sac axial cross-sectional area (DCSA), ligamentum flavum area (LFA) and ligamentum flavum thickness (LFT) before and after surgery and at the last follow-up were evaluated and compared. Pearson correlation analysis was used to assess the relationship between the amount of change in the DCSA and LFA in the immediate postoperative period and at the last follow-up, as well as the correlation between the two and the amount of change in the DH. The data of patients at the last follow-up of 12 months after operation were extracted. Pearson correlation was used to evaluate the changes in DCSA and LFA at the last follow-up and the visual analogue scale (VAS) of low back pain and leg pain and Oswestry disability index (ODI) at 1 year after surgery.Results:All patients were followed up for 14.69±6.87 months (range, 12-33 months). The differences in DH ( F=354.93, P<0.001), sagittal CD ( F=44.78, P<0.001) and DCSA ( F=130.97, P<0.001) before, immediately after surgery and at the last follow-up were statistically significant. The DH, sagittal CD, and DCSA immediate after surgery and last follow-up were higher than those before surgery ( P<0.05). The differences in LFA ( F=51.59, P<0.001) and bilateral LFT ( F=53.49, P<0.001; F=50.53, P<0.001) before and after surgery and at the last follow-up were statistically significant, and both LFA and bilateral LFT at immediate after surgery and last follow-up were smaller than those before surgery ( P<0.05). Pearson correlation analysis showed that the change of DH immediately after surgery was moderately correlated with the change of DCSA ( r=0.57, P<0.001), and was strongly correlated with the change of LFA ( r=0.65, P<0.001). The change of DH at the last follow-up was moderately correlated with the change of DCSA ( r=0.43, P<0.001), and was weakly correlated with the change of LFA ( r=0.25, P=0.042). The differences in VAS-leg ( F=199.51, P<0.001), VAS-low back ( F=233.90, P<0.001), and ODI ( F=199.17, P<0.001) were statistically significant in patients before operation, 3 months after operation and 12 months after operation. There was no correlation between the changes of DCSA and LFA at the last follow-up and the changes of VAS and ODI at 1 year after operation ( P>0.05). Conclusion:LFA and LFT decrease and DCSA increase in patients with lumbar degenerative diseases after LLIF. LFA and LFT gradually decrease with time, and VAS and ODI are significantly improved compared with those before surgery. The DH loss caused by a certain degree of cage subsidence after surgery does not affect the clinical efficacy. There is no correlation between the improvement of DCSA and LFA and the improvement of clinical symptoms.

Objective:To explore the influence of anxiety on the quality of life and its associated factors in patients with polycystic ovary syndrome (PCOS).Methods:PCOS patients were enrolled in this cross sectional study in Reproductive Endocrinology, Obstetrics and Gynecology Hospital of Fudan University from May 2019 to January 2022. Anxiety and quality of life were scored for patients diagnosed with PCOS. All patients were divided into PCOS with or without anxiety group. The associated factors of PCOS complicated with anxiety were screened from clinical features, endocrine, ovarian reserve function and metabolic status by logistic analysis and receiver operating characteristic (ROC).Results:Totally 125 PCOS patients were enrolled, of whom 44 were complicated with anxiety. The scores for the quality of life in patients with PCOS and anxiety related to obesity (12.7±1.4 vs. 18.8±0.9, P<0.001), abnormal menstruation (17.9±0.9 vs. 23.2±0.6, P<0.001) and PCOS itself (28.3±1.6 vs. 35.0±0.9, P<0.001) were all lower than those in PCOS patients without anxiety. The body mass index (BMI) [(25.74±0.97) kg/m 2vs. (23.46±0.45) kg/m 2, P=0.038] and area of insulin under the curve (IAUC) [(2 844.28±303.61) pmol/L vs. (1 834.28±147.89) pmol/L, P=0.001] of PCOS patients with anxiety were all higher, while sex hormone binding globulin (SHBG) levels [(33.29±6.21) nmol/L vs. (41.94±4.11) nmol/L, P=0.045] were lower than those without anxiety, and the differences were all statistically significant. Logistic regression analysis screened out the most relevant factor with anxiety in PCOS as IAUC ( OR=1.001, 95% Cl=1.000-1.001, P=0.021) and BMI ( OR=1.113, 95% CI=1.016-1.219, P=0.003). ROC analysis showed that IAUC was an associated factor for PCOS complicated with anxiety, and the area under the ROC curve were 0.701 ( P=0.020). Conclusion:The prevalence of anxiety in PCOS patients is higher than that in the general population. The quality of life is lower in PCOS patients with anxiety than those without. Anxiety may be closely related to weight gain and hyperinsulinemia/insulin resistance in PCOS patients.

Objective:To explore the influence of anxiety on the quality of life and its associated factors in patients with polycystic ovary syndrome (PCOS).Methods:PCOS patients were enrolled in this cross sectional study in Reproductive Endocrinology, Obstetrics and Gynecology Hospital of Fudan University from May 2019 to January 2022. Anxiety and quality of life were scored for patients diagnosed with PCOS. All patients were divided into PCOS with or without anxiety group. The associated factors of PCOS complicated with anxiety were screened from clinical features, endocrine, ovarian reserve function and metabolic status by logistic analysis and receiver operating characteristic (ROC).Results:Totally 125 PCOS patients were enrolled, of whom 44 were complicated with anxiety. The scores for the quality of life in patients with PCOS and anxiety related to obesity (12.7±1.4 vs. 18.8±0.9, P<0.001), abnormal menstruation (17.9±0.9 vs. 23.2±0.6, P<0.001) and PCOS itself (28.3±1.6 vs. 35.0±0.9, P<0.001) were all lower than those in PCOS patients without anxiety. The body mass index (BMI) [(25.74±0.97) kg/m 2vs. (23.46±0.45) kg/m 2, P=0.038] and area of insulin under the curve (IAUC) [(2 844.28±303.61) pmol/L vs. (1 834.28±147.89) pmol/L, P=0.001] of PCOS patients with anxiety were all higher, while sex hormone binding globulin (SHBG) levels [(33.29±6.21) nmol/L vs. (41.94±4.11) nmol/L, P=0.045] were lower than those without anxiety, and the differences were all statistically significant. Logistic regression analysis screened out the most relevant factor with anxiety in PCOS as IAUC ( OR=1.001, 95% Cl=1.000-1.001, P=0.021) and BMI ( OR=1.113, 95% CI=1.016-1.219, P=0.003). ROC analysis showed that IAUC was an associated factor for PCOS complicated with anxiety, and the area under the ROC curve were 0.701 ( P=0.020). Conclusion:The prevalence of anxiety in PCOS patients is higher than that in the general population. The quality of life is lower in PCOS patients with anxiety than those without. Anxiety may be closely related to weight gain and hyperinsulinemia/insulin resistance in PCOS patients.

Objective:To evaluate the changes of mTOR signaling molecules in granulosa cells from polycystic ovary syndrome (PCOS) patients, and whether the change of mTOR siganaling is related to serum hormones.Methods:The phosphorylation levels of mTOR signaling molecules in primary granulosa cells were compared between PCOS group and control group. The correlation between phosphorylation levels of mTOR signaling and serum hormones was also analyzed. Then effects of exogenous testosterone and insulin on mTOR signaling were investigated in vitro. Results:Granulosa cells from PCOS patients (0.66±0.29) had higher phosphorylation levels of mTOR compared with control group (0.34±0.32, P=0.02). The level of p-s6k1 in PCOS group (0.95±0.42) was higher than that in control group (0.62±0.29), but the difference was not statistically significant ( P>0.05). The serum testosterone was associated with p-mTOR and p-S6k1 ( P=0.01, P=0.01). Serum follicle-stimulating hormone (FSH) ( P=0.67, P=0.75) and luteinizing hormone (LH) ( P=0.75, P=0.37) levels were irrelevant with p-mTOR and p-S6k1. Conclusion:Granulosa cells from PCOS patients had higher activated mTOR signaling. Testosterone and insulin could elevate the phosphorylation levels of mTOR signaling of granulosa cells in vitro, which maybe contributed to the dysfunction of granulosa cells and follicular development stagnation of PCOS.

Objective:To evaluate the changes of mTOR signaling molecules in granulosa cells from polycystic ovary syndrome (PCOS) patients, and whether the change of mTOR siganaling is related to serum hormones.Methods:The phosphorylation levels of mTOR signaling molecules in primary granulosa cells were compared between PCOS group and control group. The correlation between phosphorylation levels of mTOR signaling and serum hormones was also analyzed. Then effects of exogenous testosterone and insulin on mTOR signaling were investigated in vitro. Results:Granulosa cells from PCOS patients (0.66±0.29) had higher phosphorylation levels of mTOR compared with control group (0.34±0.32, P=0.02). The level of p-s6k1 in PCOS group (0.95±0.42) was higher than that in control group (0.62±0.29), but the difference was not statistically significant ( P>0.05). The serum testosterone was associated with p-mTOR and p-S6k1 ( P=0.01, P=0.01). Serum follicle-stimulating hormone (FSH) ( P=0.67, P=0.75) and luteinizing hormone (LH) ( P=0.75, P=0.37) levels were irrelevant with p-mTOR and p-S6k1. Conclusion:Granulosa cells from PCOS patients had higher activated mTOR signaling. Testosterone and insulin could elevate the phosphorylation levels of mTOR signaling of granulosa cells in vitro, which maybe contributed to the dysfunction of granulosa cells and follicular development stagnation of PCOS.

OBJECTIVETo establish three-dimension finite element model of mandible with two kinds of Replace implant, and to study stress of implant and abutment.

METHODSThe data of components of the dental implant was measured, cross section of the mandible was scanned by spiral CT and image reconstruction technique was conducted. Three-dimension finite element analysis software UG and MSC. Marc/Mentat were used to built the conjunction model and bone model of two implant systems. Axial loading (200N) and 30 degrees oblique loading (100N) were applied on the models respectively, the stress distribution patterns of the implant and abutment of two implant systems were analyzed.

RESULTSThe peak stress district was concentrated on the structure of the implant cervix, which was more obviously displayed on the Replace Select implant. The peak stress of oblique loading was higher than that of axial loading. The peak stress on the implant cervix of Replace Select implant was higher than that of Replace External Hex implant in all loadings.

CONCLUSIONTo Replace Select especially, oblique force should be avoided on clinical practice in case of the implant fracture.

Objective To investigate the effect of cyclooxygenase-2(COX-2) inhibitor celecoxib on bladder cancer xenografts in nude mice and apoptosis of tumor cells in the xenografts. Methods Models of bladder cancer xenograft in nude mice was used to observe the effect of celecoxib on the animals and the xenografts.TUNEL was used to assess apoptotic index of tumor cells in the xenografts. Results Celecoxib could effectively inhibit the growth of xenografts(P0.05). Conclusions Celecoxib maybe inhibit the growth of bladder cancer via inducing apoptosis of tumor cells and perhaps will become a choice of chemoprevention and adjuvant therapy of bladder cancer.