The pedicle screw internal fixation system plays a crucial role in spinal surgery, with the advantage of enhancing spinal stability. However, potential complications such as internal fixation loosening and screw pullout still exist clinically. Currently, pullout of strength is commonly used to evaluate the short-term biomechanical properties of internal fixation, fatigue test is performed to evaluate the long-term biomechanical properties of internal fixation, and torque is used to evaluate the interaction between screws and spinal bone. Factors that influence the biomechanical properties of pedicle screws include spine-related factors (bone density) and screw-related factors (screw size, screw design, and screw augmentation materials). In bones with high bone density, pullout of strength is significantly increased, and fixation strength can also be improved by increasing screw diameter and length, improving screw design, and using screw augmentation materials. Biomechanical research on pedicle screw internal fixation provides key information for achieving individualized and functional optimal channel selection. Designing screw channels with optimal fixation strength is expected to reduce the risk of screw loosening and the occurrence of surgical complications, and improve surgical effects.

Objective:To investigate the correlation between CHA 2DS 2-VASC score and the recurrence risk of paroxysmal atrial fibrillation after radiofrequency ablation. Methods:It was a retrospective cohort study. A total of 150 patients who underwent radiofrequency ablation for paroxysmal atrial fibrillation in Xingtai People′s Hospital from January 2017 to January 2021 were consecutively included in the study. According to the preoperative CHA 2DS 2-VASC score, patients were divided into high score group (≥3 points, n=90) and low score group (<3 points, n=60). Baseline clinical data was collected. All patients underwent circumferential pulmonary vein isolation, and those with atrial flutter before ablation also underwent tricuspid isthmus isolation. Holter and electrocardiogram examinations were performed at 3, 6 months and 1 year after ablation to evaluate whether there was recurrence of atrial fibrillation. Univariate and multivariate Cox regression was used to analyze the risk factors for recurrence of atrial fibrillation after radiofrequency ablation. Results:Among 150 patients 90 were males and 60 were females with a mean age of (64.0±3.6) years. There were no significant differences in age, sex, and proportion of hypertension, diabetes, chronic heart failure and stroke or transient ischemic attack (TIA), medication of antiarrhythmic and anticoagulant drugs between the two groups (all P>0.05). The longest duration of atrial fibrillation in the high score group was significantly longer than that in the low score group (26.0±6.1) hours vs. (10.0±2.1) hours, P<0.05). There were no patients with cardiac tamponade, atrial esophageal fistula and severe vascular puncture complications in the two groups. During the follow-up period, the recurrence rate in the high score group was significantly higher than that in the low score group (16.7% (15/90) vs. 8.3% (5/60), P<0.05). Multivariate Cox regression analysis showed that CHA 2DS 2-VASC score≥3 was an independent risk factor for atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation after radiofrequency ablation ( HR=3.84, 95% CI: 1.87-7.89, P=0.02). Conclusion:CHA 2DS 2-VASC score≥3 is an independent risk factor for atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation after radiofrequency ablation.

Objective:To investigate the risk factors of atrial fibrillation (AF) in patients with typical atrial flutter after radiofrequency ablation.Methods:This study was a case-control study. The clinical data of 120 patients with typical atrial flutter who underwent radiofrequency ablation in Xingtai People′s Hospital from January 2017 to January 2021 were retrospectively analyzed. Patients were followed up every 3-6 months for a period of 2 years, and AF occurred in 30 patients (25.0%). The risk factors of AF were analyzed with univariate and multivariate logistic regressions.Results:The mean age of patients was (62.0±6.5) years and 64(53.3%) were males. No patients in the two groups had complications such as cardiac tamponade, pulmonary embolism and cerebral infarction after radiofrequency ablation. Compared with non-AF patients, patients in AF group had older age and higher CHA 2DS 2-VASC score ( P<0.001). Multivariate regression analysis showed that age ( HR=1.09, 95% CI:1.01-1.17) and CHA 2DS 2-VASC score ( HR=3.84, 95% CI:1.87-7.89) were independent risk factors for the occurrence of atrial fibrillation after radiofrequency ablation in patients with atrial flutter. Conclusion:After radiofrequency ablation of typical atrial flutter, nearly 25% of patients will relapse into AF, old age and higher CHA 2DS 2-VASC score increase the risk of AF recurrent.

Robotic Surgical Procedures ; Robotics ; Orthopedic Procedures ; Orthopedics ; Surgery, Computer-Assisted

Objective:To study the learning curve and inflection point of robot-assisted L 4 and L 5 pedicle screw insertion for lumbar spondylolisthesis. Methods:A retrospective study was conducted on the data of 43 patients with L 4 and L 5 pedicle screw insertion for lumbar spondylolisthesis from January 2016 to December 2020 using surgical robot, including 19 males and 24 females, aging 59 (48, 66) years old. According to Meyerding classification, there were 23 grade I slippage, 18 grade II slippage, and 2 grade III slippage. The screw deviation and screw accuracy grade were assessed. The operation time, intraoperative blood loss, the number of intraoperative fluoroscopies, postoperative complications, and postoperative hospital stay were recorded. Cumulative Sum (CUSUM) was used to analyze the learning curve, and the learning curve is divided into early and late learning stages according to morphology. T test and Wilcoxon rank-sum test were used for statistical analysis and comparison of indicators between early and late learning stages. Results:43 patients with lumbar spondylolisthesis successfully completed the operation, with 60 L 4 pedicle screws and 70 L 5 pedicle screws inserted. The accuracy of L 4 pedicle screw placement began to improve since the 23rd placement, and the accuracy of L 5 pedicle screw placement began to improve since the 20th placement. Using the 23rd pedicle screw (the 14th patient) to divide the learning curve as the early stage and the late stage. There was no statistically significant difference in the operation time (225.0±74.0 min vs. 207.0±81.2 min, t=0.65, P=0.521), intraoperative blood loss[200 (75, 500) ml vs. 100 (60, 200) ml, Z=1.30, P=0.195], the number of intraoperative fluoroscopies[10 (6, 10) vs. 10 (6, 10), Z=-0.37, P=0.712] and postoperative complications (8% vs. 0, P=0.302) between the early stage and late stage of learning curve. In the late stage of learning, the postoperative hospital stay was shorter[4.5 (3, 6) d vs. 6.0 (5, 9) d, Z=2.00, P=0.046]and the pedicle screw insertion accuracy was higher[L 4: 1.33 (1.06, 1.79) mm vs. 2.23 (1.12, 4.55) mm, Z=2.43, P=0.015; L 5: 1.47 (0.98, 1.87) mm vs. 3.21 (1.64, 4.87) mm, Z=3.90, P=0.001]. The accuracy of screw placement was similar between the early and late stages[L 4: 95%(21/22) vs. 97%(37/38), P=1.000; L 5: 91%(20/22) vs. 96%(46/48), P=0.585]. Conclusion:Robot-assisted L 4 and L 5 pedicle screw placement in the treatment of lumbar spondylolisthesis had a relatively obvious learning curve. Starting from the placement of the 23rd screws, the accuracy of screw placement gradually increased.

Perioperative patients have a high incidence of abnormal blood glucose, which seriously affects their postoperative rehabilitation. Reasonable monitoring and control of blood glucose is the key link of perioperative management. The continuous glucose monitoring system can reflect the changes of blood glucose in patients in real time, which is conducive to timely detection and correction of blood glucose abnormalities. This article reviews the significance, accuracy and effect of the continuous glucose monitoring system in perioperative patients, so as to provide a reference for medical and nursing staff to reasonably use the continuous glucose monitoring system to monitor and regulate blood glucose in perioperative patients.

Antibody-drug conjugates (ADCs) are gradually revolutionizing clinical cancer therapy. The antibody-drug conjugate linker molecule determines both the efficacy and the adverse effects, and so has a major influence on the fate of ADCs. An ideal linker should be stable in the circulatory system and release the cytotoxic payload specifically in the tumor. However, existing linkers often release payloads nonspecifically and inevitably lead to off-target toxicity. This defect is becoming an increasingly important factor that restricts the development of ADCs. The pursuit of ADCs with optimal therapeutic windows has resulted in remarkable progress in the discovery and development of novel linkers. The present review summarizes the advance of the chemical trigger, linker‒antibody attachment and linker‒payload attachment over the last 5 years, and describes the ADMET properties of ADCs. This work also helps clarify future developmental directions for the linkers.

Objectives To determine the contents of heavy metals lead, cadmium, mercury, arsenic, and chromium in water and sediment samples from Luoyang River in Quanzhou City, Fujian Province, and to understand the temporal and spatial distribution of heavy metal pollutants. Methods In 2018, 231 water and sediment samples were collected from 43 sampling points in 6 representative areas in Luoyang River during normal, rainy and dry seasons. The presence of heavy metals in the samples was then determined. Results Pb, Cd, Hg, As and Cr⁶⁺ were not detected in the water samples. Pb, Cd, Hg, As and Cr were detected in the sediments were 10.33,0.33,0.029,5.18 and 23.3 mg/kg , but the contents were low. Conclusion The water and sediments of Luoyang River in 2018 had good quality, both of which met Class I standards according to the environmental quality standards for surface water and for marine sediment quality, respectively.

OBJECTIVETo compare the efficacy differences between ginger-separated moxibustion atpoints combined withformula andformula alone on patients with decreased ovarian reserve function.

METHODSFifty patients of decreased ovarian reserve function were randomly divided into an observation group and a control group, 25 cases in each one. The patients in the observation group were treated with ginger-separated moxibustion atpoints combined withformula; the moxibustion was given for 1.5 h, once every seven days, and no treatment was given during menstrual period. The patients in the control group were treated withformula. One-month treatment was taken as one treatment course, and totally three courses were given. The change of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E), anti-mullerian hormone (AMH), antral follicle count (AFC), peak systolic velocity (PSV), resistance index (RI) were observed before and after treatment in the two groups.

RESULTSAfter treatment, the FSH, FSH/LH and RI were significantly lowered, but the E, AFC, PSV were significantly increased in the two groups (all<0.05); the FSH, FSH/LH and Ein the observation group were lower and AFC was higher than those in the control group (all<0.05).

CONCLUSIONThe ginger-separated moxibustion atpoints combined withformula are superior toformula alone in improving ovarian reserve function.

Objective To analyze the influence of validating the parental origin to the interpretation of clinical pathogenicity of total 54 copy number variations(CNV)with different clinical significance in 46 patients undergo chromosomal microarray analysis(CMA).Methods A retrospective study.This study enrolled 46 patients conducted in Department of Pediatric Endocrinology and Genetics of Shanghai Xinhua Hospital during the period of August 2014 to December 2015,involving 54 different CNVs detected by CMA.The parental origin of CNVs was examined by CMA or quantitative real-time polymerase chain reaction.Results Totally 54 different CNVs were found in 46 patients by CMA.Seventeen out of the 54 CNVs were pathogenic variations.After validating the parental origin,14 CNVs were proved de novo mutation,while 3 CNVs have maternal origin including 1q21.1 deletion syndrome,Xq27.3q28 and Xq22.1q22.3 duplications which inherited from maternal X chromosome.CNVs of 1q21.1 deletion syndrome often inherited from parents,and no phenotype appears on mother which may be due to the deactivation mechanism of duplications on mother′s X chromosome.Therefore,these 17 pathogenic variations were still considered to be clinical pathogenic significance after validating the parental origin.Ten out of 54 CNVs were variants of uncertain significance-likely pathogenic.After parental original validation,3 CNVs were proved de novo mutation considering likely pathogenic significance,while 7 CNVs have parental origin still judged to be unknown clinical pathogenicity.Twenty-seven out of 54 CNVs were variants of uncertain significance.After validating the parental origin,only 1 CNV was proved de novo mutation considering likely pathogenic significance,while all the others had parental origin considered to be variations likely benign.Conclusion CNVs reported as likely pathogenic should be validated the parental origin in order to further study their clinical pathogenicity,while variants of uncertain significance can preliminary clear its nature by validating parental origin.