Breast milk is the optimal natural food for newborns. However， some newborns cannot receive maternal breast milk due to reasons such as mother-infant separation or insufficient lactation. The establishment of human milk banks （HMB） can effectively address these issues， thereby increasing the breastfeeding rate among hospitalized newborns and improving their quality of survival. However， HMB in China is still in the development and improvement stage. Its implementation involves a series of ethical issues， such as informed consent， privacy protection， economic incentives， quality and safety， and fair resource distribution， which hinder HMB’s widespread promotion. Therefore， discussing the ethical dilemmas faced by the widespread establishment of HMB in China’s hospitals and analyzing coping strategies are crucial for improving the breastfeeding rate of newborns. This paper deeply analyzed and sorted out the ethical issues and challenges currently faced by HMB in China， and proposed corresponding strategies， including “ensuring informed consent and voluntary participation of both donors and recipients，” “protecting the privacy of donors and recipients，” “establishing an ethics-based moral incentive and social support system，” “strictly controlling quality and safety issues”， and “developing fair and rational policies，” aiming to provide a reference solution for addressing ethical concerns in the establishment and operation of HMB.

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 compare the effectiveness and safety between robot-assisted percutaneous kyphoplasty (PKP) and traditional fluoroscopy-assisted PKP in the treatment of dual-segment recurrent osteoporotic vertebral compression fracture (OVCF) including in situ vertebral fracture.Methods:The clinical data of 33 patients with dual-segment recurrent OVCF including in situ vertebral fracture from January 2016 to January 2023 in Beijing Shijitan Hospital Affiliated to Capital Medical University were retrospectively analyzed. All the patients were treated with PKP. Among them, 14 patients were treated with robot-assisted surgery (robot-assisted group), and 19 patients were treated with fluoroscopy-assisted surgery (fluoroscopy-assisted group). The total surgical time, preparation time and number of fluoroscopy were recorded. The in situ and other fracture vertebral operation time, number of punctures, amount of bone cement injection, bone cement filling effect, bone cement leakage, pedicle wall breakthrough and other special intraoperative situations were separately recorded. The visual analogue score (VAS) before surgery and 1 d, 3 months after surgery was recorded.Results:The preparation time in robot-assisted group was significantly longer than that in fluoroscopy-assisted group: (30.8 ± 6.9) min vs. (19.1 ± 4.5) min, the number of fluoroscopy was significantly lower than that in fluoroscopy-assisted group: (17.1 ± 4.1) times vs. (41.0 ± 6.3) times, and there were statistical differences ( P<0.01 and <0.05); there were no statistical differences in total surgical time and VAS at any time point between the two groups ( P>0.05). For the in situ fracture segment, the operation time and number of punctures in robot-assisted group were significantly lower than those in fluoroscopy-assisted group: (15.4 ± 2.8) min vs. (22.0 ± 5.5) min and (1.1 ± 0.4) times vs. (2.4 ± 1.2) times, the amount of bone cement injection was significantly higher than those in fluoroscopy-assisted group: (2.36 ± 0.75) ml vs. (1.79 ± 0.69) ml, the filling effect of bone cement was significantly better than that in fluoroscopy-assisted group, and there were statistical differences ( P<0.01 and <0.05); there were no statistical difference in bone cement leakage and pedicle wall breakthrough between the two groups ( P>0.05). For the other fracture segment, the operation time in robot-assisted group was significantly shorter than that in fluoroscopy-assisted group: (13.8 ± 3.8) min vs. (19.2 ± 6.4) min, and there was statistical difference ( P<0.01); there were no statistical difference in number of punctures, amount of bone cement injection, filling effect of bone cement, bone cement leakage and pedicle wall breakthrough between the two groups ( P>0.05). Conclusions:Robot-assisted PKP in the treatment of dual-segment OVCF including in situ vertebral fracture, could reduce operation time, minimize punctures and fluoroscopy numbers, and provide superior bone cement filling results.

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 compare the effectiveness and safety between robot-assisted percutaneous kyphoplasty (PKP) and traditional fluoroscopy-assisted PKP in the treatment of dual-segment recurrent osteoporotic vertebral compression fracture (OVCF) including in situ vertebral fracture.Methods:The clinical data of 33 patients with dual-segment recurrent OVCF including in situ vertebral fracture from January 2016 to January 2023 in Beijing Shijitan Hospital Affiliated to Capital Medical University were retrospectively analyzed. All the patients were treated with PKP. Among them, 14 patients were treated with robot-assisted surgery (robot-assisted group), and 19 patients were treated with fluoroscopy-assisted surgery (fluoroscopy-assisted group). The total surgical time, preparation time and number of fluoroscopy were recorded. The in situ and other fracture vertebral operation time, number of punctures, amount of bone cement injection, bone cement filling effect, bone cement leakage, pedicle wall breakthrough and other special intraoperative situations were separately recorded. The visual analogue score (VAS) before surgery and 1 d, 3 months after surgery was recorded.Results:The preparation time in robot-assisted group was significantly longer than that in fluoroscopy-assisted group: (30.8 ± 6.9) min vs. (19.1 ± 4.5) min, the number of fluoroscopy was significantly lower than that in fluoroscopy-assisted group: (17.1 ± 4.1) times vs. (41.0 ± 6.3) times, and there were statistical differences ( P<0.01 and <0.05); there were no statistical differences in total surgical time and VAS at any time point between the two groups ( P>0.05). For the in situ fracture segment, the operation time and number of punctures in robot-assisted group were significantly lower than those in fluoroscopy-assisted group: (15.4 ± 2.8) min vs. (22.0 ± 5.5) min and (1.1 ± 0.4) times vs. (2.4 ± 1.2) times, the amount of bone cement injection was significantly higher than those in fluoroscopy-assisted group: (2.36 ± 0.75) ml vs. (1.79 ± 0.69) ml, the filling effect of bone cement was significantly better than that in fluoroscopy-assisted group, and there were statistical differences ( P<0.01 and <0.05); there were no statistical difference in bone cement leakage and pedicle wall breakthrough between the two groups ( P>0.05). For the other fracture segment, the operation time in robot-assisted group was significantly shorter than that in fluoroscopy-assisted group: (13.8 ± 3.8) min vs. (19.2 ± 6.4) min, and there was statistical difference ( P<0.01); there were no statistical difference in number of punctures, amount of bone cement injection, filling effect of bone cement, bone cement leakage and pedicle wall breakthrough between the two groups ( P>0.05). Conclusions:Robot-assisted PKP in the treatment of dual-segment OVCF including in situ vertebral fracture, could reduce operation time, minimize punctures and fluoroscopy numbers, and provide superior bone cement filling results.

Objective To investigate the effect of progressive early bed physical activity on blood flow in lower limb of patients on mechanical ventilation in intensive care unit (ICU). Methods Adult patients with mechanical ventilation ≥ 72 hours admitted to ICU of the Affiliated Hospital of Zunyi Medical University from February 22nd to November 30th, 2016 were enrolled. The patients were randomly divided into experimental group and control group by random number table method. Patients in the two groups were given the same basic treatment, including antibiotics, analgesia and sedation, mechanical ventilation, nutritional support, and routine ICU activities such as maintaining functional position of limbs and raising of bed head. On the basis of those, the experimental group was given early bed physical activity with gradual enhancement of grades Ⅰ-Ⅲ according to the nerve, circulation and respiration situations, such as passive/active exercise of the bicycle, straight leg lifting exercise, etc. The exercise intensity was evaluated with target heart rate, and the exercise was performed for 15-30 minutes at a time, twice a day. The control group was given intermittent pneumatic compression (IPC), 30 minutes in each time, twice a day. Mean blood flow and blood volume were measured before and immediately, 5, 10 and 15 minutes after intervention on the 3rd day. Heart rate and blood pressure were measured at 5 minutes before intervention, during 5 minutes, and 5, 10, 15, 30 minutes after intervention on the 3rd day. Results 214 adult patients were selected, after excluding the patients who died during the intervention or gave up treatment, 160 patients were included in the data analysis, with 81 in the experimental group and 79 in the control group. The mean blood flow velocity and blood volume were increased in both groups, and the mean blood flow velocity and blood flow volume in the experimental group were significantly increased and lasted longer than those in the control group [mean blood flow velocity (mm/s) of the experimental group were 11.92±1.06, 18.19±0.17, 17.24±0.14, 15.48±0.12, 12.68±0.16, and that of the control group were 12.01±1.41, 15.65±0.18, 12.91±0.14, 12.13±0.12, 11.59±0.16, respectively, the time effect was F = 1 043.101, P = 0.000, the intervention effect was F = 151.001, P = 0.000, and the interaction effect between intervention and time was F = 224.830, P = 0.001; the blood volume (mL/min) of the experimental group were 3.39±0.96, 5.59±0.11, 5.16±0.12, 4.19±0.10. 3.35±0.09, and that of the control group were 3.28±0.82, 4.04±0.11, 3.40±0.12, 3.02±0.10, 3.00±0.10, respectively, the time effect was F = 680.405, P = 0.000, the intervention effect was F = 125.359, P = 0.000, and the interaction effect between intervention and time was F = 79.631, P = 0.012]. The heart rate and blood pressure of the two groups of patients in the course of intervention were increased first, then decreased and then slowly recovered to the change trend before intervention, but the index of the experimental group fluctuated greatly [heart rate (bpm) of the experimental group were 97.64±1.50, 113.91±1.36, 105.96±1.34, 98.52±1.48, 97.84±1.46, 97.54±1.48, and that of the control group were 97.03±1.57, 105.39±1.38, 96.76±1.35, 96.54±1.50, 97.22±1.48, 96.53±1.49, respectively, the time effect was F = 235.030, P = 0.000, the intervention effect was F = 39.473, P = 0.000, and the interaction effect between intervention and time was F = 3.494, P = 0.063; the systolic blood pressure (mmHg, 1 mmHg = 0.133 kPa) of the experimental group were 118.57±1.06, 133.05±1.01, 120.44±1.10, 117.78±1.07, 117.65±1.01, 118.14±1.00, and that of the control group were 118.10±1.08, 126.68±1.02, 118.23±1.11, 117.48±1.08, 118.04±1.03, 118.90±1.10, respectively, the time effect was F = 336.604, P = 0.000, the intervention effect was F = 26.350, P = 0.000, and the interaction effect between intervention and time was F = 0.948, P = 0.332; the diastolic blood pressure (mmHg) of the experimental group were 68.07±0.72, 72.79±0.73, 70.68±0.74, 69.30±0.72, 68.73±0.74, 67.80±0.73, and that of the control group were 68.51±0.73, 72.03±0.74, 70.05±0.75, 69.10±0.73, 68.41±0.75, 67.85±0.74, respectively, the time effect was F = 286.390, P = 0.000, the intervention effect was F = 4.812, P = 0.000, and the interactive effect between intervention and time was F = 0.055, P = 0.815]. Conclusions The effects of progressive early bed physical activity on the mean blood flow velocity and blood volume of lower limbs in ICU patients with mechanical ventilation are better than those of IPC. Although the fluctuation of heart rate and blood pressure is large, it does not cause any harm to the patients.

AIM:To identify the serum proteins that might serve as biomarkers for predicting mucosal healing ( MH) in the patients with Crohn’ s disease ( CD) treated with infliximab ( IFX) .METHODS:We collected serum sam-ples before treatment (0 week, group A) and 14 weeks after treatment (group B) from 7 CD patients with IFX treatment who had achieved MH, as well as the serum samples from 7 CD patients who had not achieved MH (0 week, group C;14 weeks, group D) .Two-dimensional fluorescence difference gel electrophoresis was applied to analyze and compare the re-sults of serum profiles between groups A and B, C and D, A and C, B and D.Matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry and bioinformatics tools were utilized to preliminarily identify and figure out the dif-ferentially expressed proteins.RESULTS:(1) In total, there were 44 differentially expressed spots, 36, 3, 10 and 31 differentially expressed spots were detected while comparing A with B, C with D, A with C and B with D, respectively. (2) Among those spots, 17, 2, 2 and 15 proteins were identified, respectively.In total, there were 19 differentially ex-pressed proteins, including apolipoprotein E, apolipoprotein A-I, complement factor H, and so on.(3) Protein functional association networks were carried out based on STRING database.CONCLUSION: The serum protein profiles obviously change after IFX treatment in MH CD patients, and the serum protein profiles of MH patients are different from that of non-MH patients after IFX treatment.The 19 proteins we identified may serve as potential biomarkers for predicting MH in CD patients with IFX treatment.