Objective:To compare the efficacy of robot system-assisted versus freehand screw revision for ankylosing spondylitis (AS) with lower cervical fractures.Methods:A multicenter retrospective cohort study was conducted to analyze the clinical data of 57 patients with AS combined with lower cervical fractures admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University School of Medicine, Henan Provincial People's Hospital, Zhengzhou Orthopedic Hospital, and Qilu Hospital of Shandong University, including 46 males and 11 females, aged 38-77 years [(65.4±9.5)years]. Injury segments involved C 3 in 7 patients, C 4 in 13, C 5 in 25, C 6 in 10, and C 7 in 2. All the patients underwent revision surgery, among whom, 22 patients were treated with robot system-assisted cervical pedicle screw placement (robot nailing group, with 190 screws), and 35 with freehand cervical pedicle screw placement (freehand nailing group, with 300 screws). The operative duration, intraoperative bleeding volume, frequency of intraoperative fluoroscopy, incision length, and length of hospital stay of the two groups were compared; the time of single nscrew insertion, the number of single nail revisions, the distance between screws and the anterior cortex, the accuracy of screw placement of grade 0 and grade 0+1 were recorded in the two groups. The visual analogue scale (VAS), Japanese Orthopedic Society (JOA) score, neck dysfunction index (NDI), American Spine Injury Association (ASIA) classification before operation, at 3 days, 3 months after operation and at the last follow-up were compared between the two groups. The complication rate was also noted. Results:All the patients were followed up for 12-16 months [(14.3±2.1)months]. The operative duration, intraoperative bleeding volume, and frequency of intraoperative fluoroscopy were (186.4±12.9)minutes, (486.1±68.6)ml, and (3.4±1.3)times in the robot nailing group, which were shorter or less than (206.7±14.4)minutes, (660.3±45.2)ml, and (13.5±3.6)times in the freehand nailing group ( P<0.01). The incision length was (9.4±2.4)cm in the robot nailing group, longer than (5.6±1.2)cm in the freehand nailing group ( P<0.01), and the length of hospital stay was (3.7±0.4)days, shorter than (4.4±1.4)days in the freehand nailing group ( P<0.01). The length of single nail insertion, the number of single nail revision, and the distance between the screws and the front cortex were (6.5±0.4)minutes, (1.1±0.1)times, and (3.5±1.3)mm in the robot nailing group, which were shorter or less than (11.6±0.2)minutes, (1.5±0.2)times, and (12.4±4.7)mm in the freehand nailing group ( P<0.01). The accuracy of the screw placement in the robot nailing group was 90.0% (171/190) and 95.8% (182/190) with level 0 and 0+1 screws, better than 80.0% (240/300) and 89.0% (267/300) in the freehand nailing group ( P<0.05). There was no significant difference in VAS, JOA score, NDI, or ASIA grading between the two groups before operation ( P>0.05). The VAS, JOA, and NDI scores at 3 days after operation were (3.1±0.6)points, (12.1±1.2)points, and (15.6±2.9)points, respectively in the robot nailing group, which were better than (5.0±1.4)points, (11.3±1.1)points and (22.5±3.7)points, respectively in the freehand nailing group ( P<0.05). No statistically significant difference was observed in the ASIA grade between the two groups at 3 days after operation ( P>0.05). There were no significant differences in VAS, JOA, NDI scores, or ASIA grading between the two groups at 3 months after operation and at the last follow-up ( P>0.05). Compared with those before operation, the VAS, JOA, NDI scores, and ASIA grading were significantly improved at 3 days, 3 months after operation and at the last follow-up in the two groups, which were further improved with the passage of time. Two patients in the robot nailing group had pneumonia, with a complication rate of 9% (2/22), while 2 patients in the freehand nailing group had dural sac rupture and cerebrospinal fluid leakage and 3 had lung infection after operation, with a complication rate of 14% (5/35) ( P<0.05). Conclusion:Compared with freehand nailing, the robot system-assisted nailing revision for AS with lower cervical fracture has more advantages in terms of the operative duration, length of hospital stay, intraoperative bleeding volume, frequency of intraoperative fluoroscopy nailing speed and accuracy, screw holding force, early pain relief, function restoration, and complication rate, despite longer surgical incision.

Objective:To compare the efficacy of robot system-assisted versus freehand screw revision for ankylosing spondylitis (AS) with lower cervical fractures.Methods:A multicenter retrospective cohort study was conducted to analyze the clinical data of 57 patients with AS combined with lower cervical fractures admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University School of Medicine, Henan Provincial People's Hospital, Zhengzhou Orthopedic Hospital, and Qilu Hospital of Shandong University, including 46 males and 11 females, aged 38-77 years [(65.4±9.5)years]. Injury segments involved C 3 in 7 patients, C 4 in 13, C 5 in 25, C 6 in 10, and C 7 in 2. All the patients underwent revision surgery, among whom, 22 patients were treated with robot system-assisted cervical pedicle screw placement (robot nailing group, with 190 screws), and 35 with freehand cervical pedicle screw placement (freehand nailing group, with 300 screws). The operative duration, intraoperative bleeding volume, frequency of intraoperative fluoroscopy, incision length, and length of hospital stay of the two groups were compared; the time of single nscrew insertion, the number of single nail revisions, the distance between screws and the anterior cortex, the accuracy of screw placement of grade 0 and grade 0+1 were recorded in the two groups. The visual analogue scale (VAS), Japanese Orthopedic Society (JOA) score, neck dysfunction index (NDI), American Spine Injury Association (ASIA) classification before operation, at 3 days, 3 months after operation and at the last follow-up were compared between the two groups. The complication rate was also noted. Results:All the patients were followed up for 12-16 months [(14.3±2.1)months]. The operative duration, intraoperative bleeding volume, and frequency of intraoperative fluoroscopy were (186.4±12.9)minutes, (486.1±68.6)ml, and (3.4±1.3)times in the robot nailing group, which were shorter or less than (206.7±14.4)minutes, (660.3±45.2)ml, and (13.5±3.6)times in the freehand nailing group ( P<0.01). The incision length was (9.4±2.4)cm in the robot nailing group, longer than (5.6±1.2)cm in the freehand nailing group ( P<0.01), and the length of hospital stay was (3.7±0.4)days, shorter than (4.4±1.4)days in the freehand nailing group ( P<0.01). The length of single nail insertion, the number of single nail revision, and the distance between the screws and the front cortex were (6.5±0.4)minutes, (1.1±0.1)times, and (3.5±1.3)mm in the robot nailing group, which were shorter or less than (11.6±0.2)minutes, (1.5±0.2)times, and (12.4±4.7)mm in the freehand nailing group ( P<0.01). The accuracy of the screw placement in the robot nailing group was 90.0% (171/190) and 95.8% (182/190) with level 0 and 0+1 screws, better than 80.0% (240/300) and 89.0% (267/300) in the freehand nailing group ( P<0.05). There was no significant difference in VAS, JOA score, NDI, or ASIA grading between the two groups before operation ( P>0.05). The VAS, JOA, and NDI scores at 3 days after operation were (3.1±0.6)points, (12.1±1.2)points, and (15.6±2.9)points, respectively in the robot nailing group, which were better than (5.0±1.4)points, (11.3±1.1)points and (22.5±3.7)points, respectively in the freehand nailing group ( P<0.05). No statistically significant difference was observed in the ASIA grade between the two groups at 3 days after operation ( P>0.05). There were no significant differences in VAS, JOA, NDI scores, or ASIA grading between the two groups at 3 months after operation and at the last follow-up ( P>0.05). Compared with those before operation, the VAS, JOA, NDI scores, and ASIA grading were significantly improved at 3 days, 3 months after operation and at the last follow-up in the two groups, which were further improved with the passage of time. Two patients in the robot nailing group had pneumonia, with a complication rate of 9% (2/22), while 2 patients in the freehand nailing group had dural sac rupture and cerebrospinal fluid leakage and 3 had lung infection after operation, with a complication rate of 14% (5/35) ( P<0.05). Conclusion:Compared with freehand nailing, the robot system-assisted nailing revision for AS with lower cervical fracture has more advantages in terms of the operative duration, length of hospital stay, intraoperative bleeding volume, frequency of intraoperative fluoroscopy nailing speed and accuracy, screw holding force, early pain relief, function restoration, and complication rate, despite longer surgical incision.

Objective:To explore the effectiveness of LEARNS model combined with video health education in patients undergoing painless gastrointestinal endoscopy.Methods:From February 2021 to November 2022, convenience sampling was used to select 128 patients who underwent painless gastrointestinal endoscopy at the Endoscopy Center of Affiliated Hospital of Shaoxing University as research subjects. A total of 64 patients admitted from February to December 2021 served as control group, while 64 patients admitted from January to November 2022 served as observation group. Control group patients received routine health education, while observation group was treated with LEARNS model combined with video health education on the basis of control group. The degree of cooperation, psychological state, and satisfaction with health education were compared between two groups of patients.Results:The proportion of patients in observation group who actively cooperated was higher than that in control group, and there was a statistically significant difference in the degree of cooperation between the two groups ( P<0.05). Thirty minutes before and after the endoscopy, the scores of both subscales of the State-Trait Anxiety Inventory (STAI) in observation group were lower than those in the control group, and the difference was statistically significant ( P<0.05). The satisfaction scores of observation group patients with health education in all dimensions were higher than those of control group, and the differences were statistically significant ( P<0.05) . Conclusions:LEARNS model combined with video health education can effectively improve the cooperation of patients undergoing painless gastrointestinal endoscopy, alleviate their pre-examination anxiety, and enhance their satisfaction with health education, which is worthy of clinical practice.

The high-quality development of Traditional Chinese Medicine(TCM)is a significant issue faced by the development of TCM in the new era.Artificial Intelligence(AI),as one of the representatives of new productive forces,is expected to provide strong momentum for the inheritance,innovation,and development of TCM.By focusing on three major directions—intelligent TCM early warning and diagnosis,intelligent TCM treatment and rehabilitation,and intelligent TCM research and teaching—the paper reviews the existing problems and challenges in AI-empowered TCM and proposes solutions.In terms of intelligent TCM early warning and diagno-sis,there are issues with the normalization and standardization of TCM theory itself,insufficient open and high-quality large-scale TCM annotation data resources,and lack of TCM theory and thinking guidance in the design of intelligent methods.In terms of intelli-gent TCM treatment and rehabilitation,there are issues such as the feedback and adjustment mechanism are not yet sound,the depth of multidisciplinary collaborative innovation is insufficient,and technical safety and laws and regulations are not perfect.In terms of intel-ligent TCM research and teaching,there are issues such as insufficient mining and interpretation of TCM implicit knowledge,and insuf-ficient learning and simulation of TCM expert thinking.Based on the above issues,corresponding solutions are proposed to explore ide-as for the research in the interdisciplinary field of"artificial intelligence+TCM"and to provide reference for the high-quality develop-ment of TCM inheritance and innovation.

The high-quality development of Traditional Chinese Medicine(TCM)is a significant issue faced by the development of TCM in the new era.Artificial Intelligence(AI),as one of the representatives of new productive forces,is expected to provide strong momentum for the inheritance,innovation,and development of TCM.By focusing on three major directions—intelligent TCM early warning and diagnosis,intelligent TCM treatment and rehabilitation,and intelligent TCM research and teaching—the paper reviews the existing problems and challenges in AI-empowered TCM and proposes solutions.In terms of intelligent TCM early warning and diagno-sis,there are issues with the normalization and standardization of TCM theory itself,insufficient open and high-quality large-scale TCM annotation data resources,and lack of TCM theory and thinking guidance in the design of intelligent methods.In terms of intelli-gent TCM treatment and rehabilitation,there are issues such as the feedback and adjustment mechanism are not yet sound,the depth of multidisciplinary collaborative innovation is insufficient,and technical safety and laws and regulations are not perfect.In terms of intel-ligent TCM research and teaching,there are issues such as insufficient mining and interpretation of TCM implicit knowledge,and insuf-ficient learning and simulation of TCM expert thinking.Based on the above issues,corresponding solutions are proposed to explore ide-as for the research in the interdisciplinary field of"artificial intelligence+TCM"and to provide reference for the high-quality develop-ment of TCM inheritance and innovation.

Objective:To study the difference of facilitative glucose transporter 8 (GLUT8) expression in sperms among asthenozoospermia (AS) patients, teratozoospermia (TM) patients and normal reproductive men, thus to investigate the correlation between the expression of GLUT8 and sperm motility.Methods:The sperm motility parameters of each group were detected by computer-assisted semen analysis system (CASA). A case-control study method was used to collect semen from patients with AS, TM and normal reproductive men who underwent routine semen examination in the Andrology Laboratory, Department of Reproductive Medicine, the Affiliated Taizhou People's Hospital of Nanjing Medical University from December 2019 to December 2020. The semen of AS patients (41 samples), normal viable spermatozoa (NV) patients (41 samples), TM patients (40 samples) and normal morphology spermatozoa (NM) patients (40 samples) were collected and selected into AS group, NV group, TM group and NM group according to the criteria of enrollment. Western blotting was used to assess the expression of GLUT8 protein in NV group, AS group, NM group and TM group, with 7 cases in each group. The differences of sperm parameters and GLUT8 protein between NV group and AS group, NM group and TM group were compared.Results:Sperm parameters of NV group and AS group were significantly different in progressive rate (62.64%±37.14%, 14.41%±11.89%, P<0.001), motility rate (55.62%±12.31%, 24.40%±12.75%, P<0.001), curvilinear velocity [(87.22±12.35) μm/s, (71.75±18.35) μm/s, P<0.001], the straight line velocity [(40.22±6.71) μm/s, (33.31±10.11) μm/s, P<0.001], average path velocity [(47.66±6.49) μm/s, (39.42±10.25) μm/s, P<0.001], and amplitude of lateral head displacement [(2.88±0.49) μm, (2.35±0.66) μm, P<0.001], and there were no significant differences in sperm parameters between NM group and TM group (all P>0.05). The relative expression of GLUT8 protein in AS group (0.26±0.17) was significantly lower than that in NV group (2.00±0.38, P=0.002), but there was no significant difference in GLUT8 protein expression in NM group and TM group ( P>0.05). Conclusion:GLUT8 protein expression in sperm decreased in AS, but there was no significant correlation between GLUT8 protein expression and sperm morphology.

Objective:To study the difference of facilitative glucose transporter 8 (GLUT8) expression in sperms among asthenozoospermia (AS) patients, teratozoospermia (TM) patients and normal reproductive men, thus to investigate the correlation between the expression of GLUT8 and sperm motility.Methods:The sperm motility parameters of each group were detected by computer-assisted semen analysis system (CASA). A case-control study method was used to collect semen from patients with AS, TM and normal reproductive men who underwent routine semen examination in the Andrology Laboratory, Department of Reproductive Medicine, the Affiliated Taizhou People's Hospital of Nanjing Medical University from December 2019 to December 2020. The semen of AS patients (41 samples), normal viable spermatozoa (NV) patients (41 samples), TM patients (40 samples) and normal morphology spermatozoa (NM) patients (40 samples) were collected and selected into AS group, NV group, TM group and NM group according to the criteria of enrollment. Western blotting was used to assess the expression of GLUT8 protein in NV group, AS group, NM group and TM group, with 7 cases in each group. The differences of sperm parameters and GLUT8 protein between NV group and AS group, NM group and TM group were compared.Results:Sperm parameters of NV group and AS group were significantly different in progressive rate (62.64%±37.14%, 14.41%±11.89%, P<0.001), motility rate (55.62%±12.31%, 24.40%±12.75%, P<0.001), curvilinear velocity [(87.22±12.35) μm/s, (71.75±18.35) μm/s, P<0.001], the straight line velocity [(40.22±6.71) μm/s, (33.31±10.11) μm/s, P<0.001], average path velocity [(47.66±6.49) μm/s, (39.42±10.25) μm/s, P<0.001], and amplitude of lateral head displacement [(2.88±0.49) μm, (2.35±0.66) μm, P<0.001], and there were no significant differences in sperm parameters between NM group and TM group (all P>0.05). The relative expression of GLUT8 protein in AS group (0.26±0.17) was significantly lower than that in NV group (2.00±0.38, P=0.002), but there was no significant difference in GLUT8 protein expression in NM group and TM group ( P>0.05). Conclusion:GLUT8 protein expression in sperm decreased in AS, but there was no significant correlation between GLUT8 protein expression and sperm morphology.

Objective:To investigate the effect of metformin on the microRNA (miRNA) expression and screen potential target with network pharmacology analysis in patients with type 2 diabetes.Methods:Fifteen patients with new diagnosed type 2 diabetes admitted to our hospital were selected, who received metformin during hospitalization and after discharge. The expression of serum matrix metalloproteinase (MMP)-9, transforming growth factor (TGF)-β1, and myocardial fibrosis related miRNAs were compared before and 6 month after metformin treatment. In addition, gene ontology (GO) and KEGG pathway enrichment analysis were applied to analyze differential expression miRNAs showing statistical significance. Meanwhile, the network figure was established to reflect the target gene messenger RNA (mRNA) corresponding to differentially expressed miRNA.Results:Compared with pre-medication, the serum level of MMP-9 was significantly decreased after treatment ( P<0.05). Besides, the expression of homo sapiens microRNA (hsa-miR)29a-3p, hsa-miR133a-5p, hsa-miR21-5p, hsa-miR30c-5p, and hsa-miR1-3p in patients with type 2 diabetes were dramatically down-regulated by metformin ( P<0.05 or P<0.01). Results of GO analysis and KEGG pathway enrichment analysis showed that differentially expressed miRNAs were mainly concentrated in endoplasmic reticulum lumen, synapse, basement membrane and other cell components. The molecular functions such as Rho GTPase binding and participation in extracellular matrix structural constituent were exerted through biological processes such as collagen catabolic process, regulation of short-term neuronal synaptic plasticity, and axon extension, which were mainly enriched in advanced glycation end products-receptor for advanced glycation end products (AGE-RAGE) signaling pathway in diabetic complications, tumor necrosis factor (TNF) signaling pathway, and Wnt signaling pathway, etc. The outcome of miRNA-mRNA network analysis demonstrated that there were 230 target genes mRNAs corresponding to differentially expressed miRNA. Conclusion:Metformin could play its role in the treatment of type 2 diabetes by down regulating the expression of miRNA, participating in the transduction of related cellular signaling pathways, regulating chromatin, nucleic acid binding, and enzyme activities.

Objective:To investigate the incidence and risk factors of acute kidney injury in patients admitted to the resuscitation room of the Emergency Department.Methods:Patients were enrolled from the resuscitation room of our hospital from September to December 2018 by a retrospective cohort study. Patients were divided into AKI group and non-AKI group according to whether AKI occurred within seven days after admission. Demographic characteristics, APACHEⅡ score, whether to use nephrotoxic drugs,24-hour fluid volume, and patients survival time were collected. Multivariate regression analysis was used to explore the risk factors for AKI. Cox regression was used to study the effect of the occurrence of AKI on survival and to analyze the influence of AKI severity on the death risk of patients in the resuscitation room.Results:Among 238 critical patients who were finally included, 108 patients developed AKI(45.4%), 83 patients were in AKI stage 1 (34.9%), and 25 patients were in AKI stage 2-3 ( 10.5%).APACHEⅡ score>13( OR=1.11, 95% CI (1.08-1.16), P <0.01), vasoactive drugs ( OR=2.20, c95% CI (1.08-4.49), P=0.03), diabetes mellitus ( OR=2.33, 95% CI (1.23-4.42), P=0.01), and fluid load> 3 L( OR=3.10, 95% CI (1.17-8.25). P=0.02) were independent risk factors for AKI. After adjustment for APACHEⅡ score and age by multivariate COX regression, AKI remained an independent risk factor for death in emergency patients, and the severity of AKI significantly increased the risk of death in these patients(AKI 1: HR=1.45, 95% CI (1.08-2.03), P =0.04; AKI 2~3: HR=3.15, 95% CI (1.49-4.81), P=0.03). Conclusions:AKI occurred commonly in the resuscitation room of the emergency department. APACHE Ⅱ score>13, vasoactive drugs, diabetes, and fluid load>3 L were independent risk factors for AKI. The risk of death increased with the aggravation of AKI severity.

Objective? To summarize the nursing practice and coordination skills of endoscopic upper gastrointestinal foreign body. Methods? 120 patients with upper gastrointestinal foreign bodies admitted to the affiliated hospital of shaoxing university of arts and sciences from May 2017 to April 2018 were selected. Endoscopic removal of upper gastrointestinal foreign bodies was performed, and preoperative, intraoperative and postoperative nursing coordination was given to summarize nursing coordination skills and application effects. Results? The success rate of foreign body removal in 120 patients was 96.67%. Conclusions? The endoscopic upper gastrointestinal foreign body undergoing comprehensive nursing evaluation and coordination operation can improve the success rate of foreign body removal, it is worthy of clinical promotion.