Objective:To investigate the clinical efficacy of robot-assisted screw fixation for unstable pelvic ring multifocal fractures.Methods:A retrospective analysis was performed on 76 patients with unstable pelvic fractures treated with orthopaedic robot-assisted screw fixation in the Trauma Center of the Affiliated Central Hospital of Shandong First Medical University from January 2015 to June 2022, including 43 males and 33 females, aged 52.53±13.68 years (range, 16-87 years). There were 43 cases of falling injuries from high places, 22 cases of traffic accidents, 11 cases of crushing injuries and heavy objects. Fifty-five patients were employed before the injury, while 21 were not. Fractures were classified according to the Tile classification, with 72 cases classified as type B and 4 cases as type C. Robot-assisted fixation techniques included internal fixator (INFIX), anterior ring screws, sacroiliac screws, and LC-II screws. Intraoperative blood loss, fluoroscopy frequency, surgical time, and the success rate of initial guidewire placement were recorded. Fracture reduction quality was evaluated using the Matta criteria, and postoperative pelvic function recovery was assessed using the Majeed criteria.Results:A total of 150 surgical procedures were performed on 76 patients, including 34 cases of INFIX fixation, 48 cases of anterior ring screws, 61 cases of sacroiliac joint screws, and 7 cases of LC-II screws. The mean intraoperative fluoroscopy frequency was 46.63±17.50 times (range, 15-93 times). Intraoperative fluoroscopy frequency varied among different fixation techniques, with INFIX group at 16.44±4.32 times, LC-II group at 21.59±5.80 times, anterior ring screws group at 29.44±11.65 times, and sacroiliac screws group at 23.10±11.87 times. The intraoperative blood loss was 20 (10, 47.5) ml (range, 5-300 ml), and the surgical time was 105 (86, 150) min (range, 30-290 min). The mean surgical time varied among different fixation techniques. All patients were followed up for an average of 6.46±2.26 months (range, 3-16 months). Clinical healing was achieved in all patients within 6 months, with an average time of 3.14±0.50 months. At the last follow-up, fracture reduction quality assessed by the Matta score was excellent in 21 cases and good in 43 cases, with an excellent/good rate of 84% (64/76). The Majeed score was 81.82±9.14 points (range, 50-92 points). For patients who were employed before the injury, the Majeed score was 86.55±4.85 points (range, 60-92 points), with 49 cases rated as excellent, 5 cases as good, and 1 case as fair. For patients who were not employed before the injury, the Majeed score was 69.43±5.34 points (range, 50-73 points), with 18 cases rated as excellent, 2 cases as good, and 1 case as fair. The overall excellent and good rate was 97% (74/76). Among patients who underwent INFIX internal fixation, 8 cases experienced lateral femoral cutaneous nerve injury postoperatively, all of which recovered sensation after 3 months; 1 case using LC-II screws experienced screw loosening postoperatively and was advised to reduce activity, then the screw was removed after fracture healing at 6 months postoperatively; 1 case using anterior ring channel screws experienced surgical site infection postoperatively, which was controlled after debridement.Conclusion:In the treatment of unstable pelvic ring multiple fractures, robot-assisted screw fixation has less blood loss, less fluoroscopy times, high success rate of planning guide needle, satisfactory reduction quality and postoperative function.

Digestival functional surgery refers to surgical treatment for patients with functional diseases of the digestive tract. With the continuous development of minimally invasive surgery, most of surgical procedures for digestive functional diseases have been conducted by minimal invasive approach. Based on decades of clinical practice, the authors focus on minimally invasive surgeries for a group of digestive functional diseases such as achalasia of cardia, gastroesophageal reflux disease, volvulus of stomach, gastroptosis, dolichocolon, refractory constipation, rectocele and rectal prolapse, and make ageneral summary on current status and prospects of its clinical application combined with literatures.

Objective:To investigate the therapeutic efficacy of Ilizarov bone shortening-lengthening technique for tibial defects of bone and soft tissue without vascular injury.Methods:A retrospective analysis was made of the 28 patients who had been treated by Ilizarov bone shortening-lengthening technique at Department of Orthopaedics, Wuxi No.9 People's Hospital from January 2007 to October 2017 for tibial de-fects of bone and soft tissue without vascular injury.They were 20 males and 8 females, aged from 18 to 69 years (average, 36.4 years).By the Gustillo classification, 5 cases belonged to type Ⅱ, 6 to type ⅢA and 17 to type ⅢB.Infection was complicated in 17 cases.After debridement or epluchage, the area of skin defects ranged from 4 cm × 3 cm to 16 cm × 5 cm and the length of bone defects from 4.5 to 11.0 cm (average, 6.9 cm).The wound healing, bone healing, functionary recovery of lower extremity and complications were observed postoperatively.Bone healing and functional recovery of lower extremity were evaluated according to the grading of Association for the Study and Application of the Method of Ilizarov (ASAMI).The complications associated with Ilizarov technique were assessed according to the Paley criteria.Results:The follow-up for all the patients lasted from 12 to 45 months (average, 20.5 months).The healing time for wounds ranged from 13 to 35 days (average, 21.9 days), the healing time for lengthened bone from 6 to 12 months (average, 8.9 months), and the healing time for bone defects at the dock sites from 6 to 11 months (8.3 months).According to the ASAMI grading, the bone healing was excellent in 21 cases and good in 7, giving an excellent to good rate of 100%(28/28) while the functionary recovery of lower extremity was excellent in 10 cases, good in 15, fair in 2 and poor in one, giving an excellent to good rate of 89.3%(25/28).The incidence was 14.3%(4/28) for major complications after Ilizarov surgery, 57.1%(16/28) for minor complications, 60.7%(17/28) for overall complications, and 1.7 times for each case.Conclusion:In the treatment of tibial defects of bone and soft tissue without vascular injury, Ilizarov bone shortening-lengthening technique can deal with the difficulties in repair of soft tissue defects, characterized by simplified wound closure, fast and improved bone healing at the dock sites, reduced complications and satisfactory functionary recovery of lower extremity.

Objective :To evaluate therapeutic effect of allisartan isoproxil tablet on carotid atherosclerosis (CAS) le‐sion in patients with mild to moderate essential hypertension (EH).Methods :A total of 120 patients with mild to moderate EH complicated CAS treated in our hospital were enrolled .They were randomly divided into valsartan group (n＝60 ,received valsartan 80mg／d) and allisartan isoproxil group (n＝60 ,received allisartan isoproxil tablet 240mg／d) ,both groups received measure by carotid vascular ultrasound before treatment ,24 weeks and 48 weeks af‐ter treatment and its result were compared between two groups .Results :Compared with before treatment ,there were significant reductions in IMT ,size ,thickness and number of carotid atherosclerotic plaques on 24 weeks and 48 weeks after treatment in two groups ,and above indexes of 48 weeks were significantly lower than those of 24 weeks , P＜0.05 or ＜0.01. The decreased value of IMT in allisartan isoproxil group was significantly higher than that of valsartan group ,and there were no significant difference between two groups in time point of size ,thickness and number of carotid atherosclerotic plaques , P＞0.05 all.Conclusion :Therapeutic effect of two drugs on size ,thick‐ness and number of carotid atherosclerotic plaques are similar ;but therapeutic effect of allisartan isoproxil tablet on IMT is significantly better than that of valsartan .

Objective To observe the effectiveness of injecting mouse nerve growth factor ( mNGF) on the recovery of hand motor function among patients with cubital tunnel syndrome. Methods A total of 138 patients with moderate to severe cubital tunnel syndrome were randomly divided into groups designated as A, B and C, each of 46. Twenty micrograms of mNGF was injected daily 1 mm from the ulnar nerve at the cubital tunnel for the patients of group A and the injection site was moved 1 mm distally everyday along the nerve , but injected intramuscularly for those in group B. Those in group C received 500 μg of mecobalamin injected intramuscularly 3 times a week. The whole intervention consisted of two 4-week phases, with an interval of 2 months. Before and after the intervention, the function of internal hand muscles, hand function recovery rates and any electrophysiological changes in the ulnar nerve were measured and compared between the two groups. Results All of the patients showed significant improve-ment in hand muscle function and neuroelectrophysiology. The incidence of had muscle atrophy, Tinel′s sign, posi-tiveness in the paper clamping test and claw hand all significantly improved compared with before the treatment in all three groups. The average Disability of Arm Shoulder and Hand score in group A after the treatment was significantly higher than the group B and group C averages. The average ulnar nerve conduction velocity, incubation period and amplitude of group A after the treatment were all significantly better than before the treatment and better than the other groups′averages. After the treatment, the average hand function recovery in group A reached 91％, significantly high-er than in groups B ( 76％) and C ( 59％) . Conclusion Injecting mNGF next to the ulnar nerve is superior to in-jecting it intramuscularly in promoting the recovery of the ulnar nerve and hand function for patients with moderate to severe cubital tunnel syndrome.

Objective To explore the immunopathological mechanism for the imbalance between the positive signal mediated by inducible costimulator (ICOS) and the negative signal mediated by programmed death-1 (PD-1) in patients with myasthenia gravis (MG).Methods Eighty-two patients with MG,56 healthy controls (HC) and 20 non-MG (NMG) patients,collected in the First Affiliated Hospital of Suzhou University from February 2014 to December 2016,were chosen to participate in the study.The expression of ICOS and PD-1 on peripheral blood mononuclear cells was detected by immuno-fluorescence staining and flow cytometry.The levels of soluble programmed death-1 (sPD-1),soluble programmed death ligand 1 (sPD-L1),IL-4 and other cytokines were detected by enzyme-linked immunosorbent assay.Results (1) Flow cytometry analysis:The co-expression of PD-1,ICOS on CD4 + T cells from MG group (9.64％ (8.82％)) was higher than in HC (1.81％ (2.10％),Z =-7.389,P ＜0.05) and NMG group (2.86％ (1.49％),Z =-4.636,P ＜ 0.05).The expression of ICOS on CD4 + T cells,ICOS ligand (ICOSL) on CD14+ monocytes and CD19+ B cells were increased in MG group comparing with that of the control groups.The proportion of PD-1 + CD4 + T cells (MG group 16.82％ (10.66％),HC 9.34％ (9.18％),Z =-4.345,P＜0.05;NMG group 7.07％ (3.40％),Z=-4.594,P＜0.05) and PD-1 Ligand (PD-L1) + CD14+ monocytes was higher in MG patients.All of these were detected by flow cytometry.(2) ELISA analysis:Serum sPD-1 expression significantly increased in MG group compared with that in the control groups (MG group (1.87 ± 0.64) ng/ml,NMG group (1.49 ± 0.70) ng/ml,t =2.04,P ＜ 0.05;HC (1.05 ± 0.50)ng/ml,t =2.08,P ＜ 0.05),while for serum sPD-L1,there was no significant difference between MG and control groups.(3) Serum cytokines detection:The expression of IL-4 was increased in MG patients (MG group (61.88 ±5.15) pg/ml,HC (32.03 ±1.84) pg/ml,t=2.50,P＜0.05;NMG group (42.62± 3.31) pg/ml,t =2.34,P ＜0.05),and there was a negative correlation between the expression of sPD-1 and the concentration of IL-4.Conclusions The increased expression of PD-1 + ICOS + CD4 + T cells suggested the subset involved in the pathological progress of MG.sPD-1 might disturb the ligation of PD-1 on T cells and PD-L1 on antigen presenting cells,while the ligation of ICOS and ICOSL passed positive signal,leading to over activity of the subsets and the progression of disease.

Objective To investigate the effect of split-type ureteroscopic holmium laser in the treatment of patients with calculus more than 2 cm in the upper ureteral segment of kidney.Methods The clinical data of 110 patients with calculus in the upper ureteral segment of kidney was retrospectively analyzed.Two weeks before the operation,all the patients were left with double J tubes,and then the ureteroscopic holmium laser lithotripsy and removal of the stones were performed.Resuits All the patients finished operation successfully,and no ureteral perforation and exfoliation were observed.The average operation time was 51.21 min,and there were 91 cases with one time of operation,13 cases with two times of operations,4 cases with three times of operations and 2 cases with four times of operation.The stone clearance rate after 2 months was 91％.Conclusion Application of split-type ureteroscopic holmium laser is effective in the treatment of patients with calculus more than 2 cm in the upper ureteral segment of kidney.

Objective To study the safety and efficacy of transurethral plasma kinetic enucleation of prostate (PKEP) and transurethral plasma resection of prostate (PKRP) for the treatment of benign prostatic hyperplasia (BPH).Methods A total of 158 patients with BPH were divided into observation group (79 cases) treated with PKEP and control group (79 cases) treated with PKRP.The operation time,intraoperative blood loss,postoperative irrigation time,postoperative prostate symptom score (IPSS),quality of life (QOL) score,maximum flow rate (Qmax) and postoperative complications were compared.Results Compared with the control group,the observation group had shorter operation time,less bleeding,shorter irrigation time and shorter catheterization time (P ＜ 0.05).However,there was no significant difference in postoperative IPSS score,QOL score,Qmax and postoperative complications between the two groups (P ＞ 0.05).Conclusion PKEP can achieve the same efficacy as PKRP,with less intraoperative bleeding,shorter operative time and shorter catheter indwelling time.

Objective To investigate the effect of split-type ureteroscopic holmium laser in the treatment of patients with calculus more than 2 cm in the upper ureteral segment of kidney.Methods The clinical data of 110 patients with calculus in the upper ureteral segment of kidney was retrospectively analyzed.Two weeks before the operation,all the patients were left with double J tubes,and then the ureteroscopic holmium laser lithotripsy and removal of the stones were performed.Resuits All the patients finished operation successfully,and no ureteral perforation and exfoliation were observed.The average operation time was 51.21 min,and there were 91 cases with one time of operation,13 cases with two times of operations,4 cases with three times of operations and 2 cases with four times of operation.The stone clearance rate after 2 months was 91％.Conclusion Application of split-type ureteroscopic holmium laser is effective in the treatment of patients with calculus more than 2 cm in the upper ureteral segment of kidney.

Objective To study the safety and efficacy of transurethral plasma kinetic enucleation of prostate (PKEP) and transurethral plasma resection of prostate (PKRP) for the treatment of benign prostatic hyperplasia (BPH).Methods A total of 158 patients with BPH were divided into observation group (79 cases) treated with PKEP and control group (79 cases) treated with PKRP.The operation time,intraoperative blood loss,postoperative irrigation time,postoperative prostate symptom score (IPSS),quality of life (QOL) score,maximum flow rate (Qmax) and postoperative complications were compared.Results Compared with the control group,the observation group had shorter operation time,less bleeding,shorter irrigation time and shorter catheterization time (P ＜ 0.05).However,there was no significant difference in postoperative IPSS score,QOL score,Qmax and postoperative complications between the two groups (P ＞ 0.05).Conclusion PKEP can achieve the same efficacy as PKRP,with less intraoperative bleeding,shorter operative time and shorter catheter indwelling time.