Spanning two decades since the 1st generation spinal robotics inception, the robot-assisted spine surgery (RSS) technology has evolved through generations, culminating in the 4th generation characterized by real-time visual navigation and wire-free screw placement. The fundamental principles of RSS technology include surgical planning, tracking, image registration, and robotic arm control technologies. Currently, RSS technology is maturely employed in thoracolumbar procedures and is progressively being applied in cervical surgeries, spinal tumor resections, and percutaneous operations, offering advantages in reducing tissue trauma and exposure to radiation, thereby improving patient outcomes. Emerging research also focuses on the cost-effectiveness of clinical applications and robot-specific complications. With the integration of artificial intelligence into surgical planning, RSS technology is poised to further incorporate emerging technologies and expand its application across a broader clinical spectrum.
ObjectiveTo systematically review the efficacy of closed and open tracheal suction system on the prevention of ventilator-associated pneumonia.MethodsThe Cochrane Library, CNKI, WanFang Data, Airiti Library, PubMed, CINAHL and Proquest databases were electronically searched to collect randomized controlled trials (RCTs) on closed and open tracheal suction system on the prevention of ventilator-associated pneumonia. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 11 RCTs involving 1 187 patients were included. The results of meta-analysis showed that compared with open tracheal suction system, closed tracheal suction system was associated with a reduced incidence of ventilator-associated pneumonia (RR=0.55, 95%CI 0.44 to 0.67, P<0.000 01), late-onset ventilator-associated pneumonia (RR=0.47, 95%CI 0.28 to 0.80, P=0.005), length of stay in intensive care unit (MD=−0.85, 95%CI −1.66 to −0.04, P=0.04) and rate of microbial colonization (RR=0.69, 95%CI 0.56 to 0.86, P=0.000 9). However, there were no significant differences between two groups in time to ventilator-associated pneumonia development (MD=0.96, 95%CI −0.21 to 2.12, P=0.11), length of mechanical ventilation (MD=−2.24, 95%CI −4.54 to 0.06, P=0.06), and rate of mortality (RR=0.88, 95%CI 0.73 to 1.05, P=0.15).ConclusionsCurrent evidence shows that compared with open tracheal suction system, closed tracheal suction system can reduce the incidence of ventilator-associated pneumonia and late-onset ventilator-associated pneumonia, shorten the hospital stay in intensive care unit, and reduce rate of microbial colonization. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To explore the effectiveness and safety of topical phenytoin for wound healing. Methods We searched MEDLINE (1966 to Oct. 2002), EMBASE (1984 to 2002), The Cochrane Library (Issue 4, 2002), Biological Abstracts (1993 to 1996), Cancerlit (1997 to Sept. 2002), Life Science Collection (1982 to Mar. 1995), International Pharmaceutical Abstracts (1970 to 2002), and CBMdisc (1978 to Jan. 2003). Controlled trials on topical phenytoin for wound healing were identified. The methodological quality of included studies was assessed, and a descriptive analysis was performed. Results Nine studies (507 cases) including 1 randomized controlled trials (RCT) and 8 non-randomized controlled trials were included. These studies were of poor methodological quality. Because there were a variety of etiology of ulcers, differnet interventions in control groups, and different outcome measures, for which meta-analysis was difficult to perform, a descriptive analysis of the results was presented. Most studies showed that topical phenytoin had better effects on improving healthy granulation appearance, increasing complete recovery rate, reducing time for complete recovery, and positive cases of bacterial culture than those of control groups. Mild side effects were observed in only one study.Conclusions The reviewers think that the inclusion studies less rigorous than randomized controlled trials could result in misleading findings.Some well designed randomized controlled trials of topical phenytoin for wound healing are warranted.
Objective To evaluate the effect of auto adjusted triggering mechanism on the triggering balance of sensitivity and anti-interference in non invasive ventilator field. Methods Taking the breathing simulator as the experimental platform, for the same ventilator, the experiments of "automatic adjustment mode" and "manual adjustment mode" were carried out in a self-control manner, comparing the sensitivity and anti-interference indexes of the experimental group and the control group in the triggering stage. The results were statistically analyzed. Results In case of large air leakage, for ventilator of "A40", the group of "automatic adjustment mode" presented auto-triggered cycle and the group of "manual adjustment mode" (the inspiratory trigger sensitivity was adjusted to 5 to 9 L/min) could provide breathing assistance ventilation. While for ventilator of "VENT", both the group of "automatic adjustment mode" and the group of "manual adjustment mode" (the inspiratory trigger sensitivity was adjusted to 1 to 8 arbitrary unit) appear auto-triggered cycle. In case of medium air leakage, for ventilator of "A40", the trigger delay time, trigger pressure and trigger work of the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 3 to 5 L/min) were significantly less than those of the "automatic adjustment mode" group, and the trigger delay time, trigger work of the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 8 to 9 L/min) were significantly higher than those of the "automatic adjustment mode" group; While for ventilator of "VENT", compared with the inspiratory trigger sensitivity of the "automatic adjustment mode" group and the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 4 arbitrary unit), the trigger delay time, trigger pressure and trigger work were not statistically significant. In case of small air leakage, for ventilator of "A40", the trigger delay time and trigger work of the "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 2 to 6 L/min) were significantly less than those in the "automatic adjustment mode" group, and the trigger pressure of "manual adjustment mode" group (the inspiratory trigger sensitivity was adjusted to 2 to 5 L/min and 7 L/min) was significantly lower than that of "automatic adjustment mode" group. While for ventilator of "VENT", the trigger delay time, trigger pressure and trigger work of the "manual adjustment" group (the inspiratory trigger sensitivity was adjusted to 1 to 2 arbitrary unit) were less than those of the experimental group, and they were statistically significant. Conclusions In case of large air leakage, ventilator of "VENT" can not provide breathing assistance ventilation no matter which inspiratory trigger mode. While ventilator of "A40" should be used the "manual adjustment mode", and adjust the inspiratory trigger sensitivity to the less sensitive arbitrary unit to increase its performance of anti-interference. In case of medium air leakage, for both ventilator of "A40" and ventilator of "VENT", it is better to use "automatic adjustment" mode for breathing assistance ventilation. In case of small air leakage, for both ventilator of "A40" and ventilator of "VENT", it is better to use "manual adjustment" mode for breathing assistance ventilation and we should adjust the inspiratory trigger sensitivity to the higher sensitive arbitrary without auto-triggered cycle.
Objective To summarize the current research advances of colorectal signet-ring cell carcinoma (SRCC). Methods In this paper, the related literatures of colorectal SRCC in recent years were collected and reviewed. Results Colorectal SRCC was a pathological subtype of colorectal adenocarcinoma, with extremely low incidence but high malignancy and poor prognosis. At present, its molecular mechanism was still not very clear and the clinicopathological manifestations were not specific. Surgical treatment was the major treatmen. Conclusions Although we already have a certain degree of understanding about colorectal SRCC, due to the limitations in the results of some related researches because of the small sample size or the single-center study, we still need more researches to improve the cognition of colorectal SRCC.
Objective To explore the relationship between the gut microbiome (GM) and psoriasis using a two-sample two-way Mendelian randomization (MR) approach. Methods The forward analysis uses the gut microbiota as the exposure factor, and its genetic data are derived from the genome-wide association study dataset published by the MiBioGen consortium. Psoriasis was used as the outcome variable, and its genetic data were obtained from the UK Biobank. The reverse MR analysis, on the other hand, took psoriasis as the exposure and the specific gut microbiota taxonomic units identified in the forward analysis as the outcome variable. MR analysis was conducted using maximum likelihood, MR Egger regression, weighted median, inverse variance weighting (IVW), and weighted models to study the causal relationship between the gut microbiota and psoriasis. Then, sensitivity analyses including horizontal pleiotropy test, Cochran’s Q test, and leave-one-out analysis were used to evaluate the reliability of the results. Results A total of 51 single nucleotide polymorphisms from 5 fungi were included in the forward study. The forward IVW analysis results showed that, the class Mollicutes [odds ratio (OR)=1.003, 95% confidence interval (CI) (1.001, 1.006), P=0.004], genus Lachnospiraceae FCS020 group [OR=1.003, 95%CI (1.000, 1.006), P=0.041], and phylum Tenericutes [OR=1.003, 95%CI (1.001, 1.006), P=0.004] were causally associated with an increased risk of psoriasis. The family Victivallaceae [OR=0.998, 95%CI (0.997, 1.000), P=0.005] and order Pasteurellales [OR=0.998, 95%CI (0.996, 1.000), P=0.047] were also linked to a decreased risk of psoriasis. The results of the sensitivity analysis were robust. There was no evidence of a reverse causal relationship from psoriasis to the identified bacterial taxa found in the results of reverse MR analysis results. Conclusions The abundance of three species, class Mollicutes, genus Lachnospiraceae and phylum Tenericutes, may increase the risk of psoriasis. The abundance of two species, family Victivallaceae and order Pasteurellales may reduce the risk of psoriasis. These results provide new directions for the prevention and treatment of psoriasis in the future, but further research is needed to explore how the aforementioned microbiome affects the progression of psoriasis.
Objective To design and construct the eukaryotic expressed vector of suicide genes, which contained 5 copies of hypoxia-responsive element (5HRE), promoter of alpha-fetoprotein gene (AFPp） and nitroreductase from Escherichia coli. Methods The constructing processes were as follows: ①The design of primer: Suicide genes of NTR in the Escherichia coli, which contained 6his-tag gene (6his-tag), were cloned by overlapping PCR. ②The construction of 5HRE: The single strand of synthetized HRE oligonucleotide was annealed, and 5HRE was constructed by multiple recombinant clone. ③The recombination of NTR gene, 5HRE, AFPp and pIRES2-EGFP: pIRES2-EGFP, which had removed the instant early promoter of cytomegalovirus, was recombined with NTR gene, 5HRE, AFPp. In this way, the eukaryotic expressed vector of pIRES2-EGFP-5HRE-AFPp-NTR, which carried NTR gene, 5HRE, AFPp was finally constructed. Results NTR gene, which contained the fusion of 684-base pair and 6his-tag gene, was cloned successfully, and its sequence was coincident with the result published by Genbank. A 221-base pair of 5HRE was also constructed, which was in accordance with the expected sequences. The integrity of the eukaryotic expressed vector was verified by restriction enzyme digestion and DNA sequence analysis, respectively. Conclusion The eukaryotic expressed vector of pIRES2-EGFP-5HRE-AFPp-NTR is successfully constructed, which may be used for its further investigation in vitro.
ObjectiveTo observe the clinical effects, advantages, and disadvantages of a new penile circumcision and suturing device in circumcision, by comparing it with traditional circumcision and circumcision with Shang Ring.MethodsThe clinical data of 397 outpatients who underwent surgery for redundant prepuce or phimosis between February 2016 and February 2018 in the Third Affiliated Hospital of Zunyi Medical University were retrospectively collected. The patients chose their surgical types in accordance with the principle of voluntary, with 134 cases undergoing traditional circumcision (the traditional circumcision group), 153 cases undergoing circumcision with Shang Ring (the Shang Ring group), and 110 cases undergoing circumcision with the new penile circumcision and suturing device (PCSD group). The safety, clinical efficacy, and complications among the three groups were compared.ResultsThere were significant differences in postoperative pain scores (F=86.901, P<0.001), edema scores (F=315.656, P<0.001), and appearance scores (F=230.952, P<0.001) among the three groups, and the pain, edema, and appearance scores were significantly better in the PCSD group than those in the traditional circumcision group (P<0.05) and the Shang Ring group (P<0.05). The differences among the three groups in the postoperative pain relief time (F=236.622, P<0.001), intraoperative bleeding volume (F=115.375, P<0.001), edema subsiding time (F=75.614, P<0.001), operation time (F=965.420, P<0.001), and incision healing time (F=42.584, P<0.001) were statistically significant, and the PCSD group was superior to the traditional circumcision group (P<0.05) and the Shang Ring group (P<0.05) in pain relief time, edema subsiding time, and incision healing time. The incidence of postoperative complications in the PCSD group was significantly lower than that in the traditional group and the Shang Ring group (χ2=21.622, P<0.001; χ2=22.778, P<0.001). However, there was no significant difference in intraoperative bleeding volume or operation time between the Shang Ring group and the PCSD group (P=1.000, 0.379), and no significant difference in the incidence of postoperative complications between the traditional circumcision group and the Shang Ring group (χ2=0.014, P=0.912). The proportion of cases undergoing the three surgical methods in each half year changed significantly (χ2=18.721, P<0.001).ConclusionThe use of the new type of penile circumcision and suturing device for circumcision is simple and convenient in clinical operation, with fewer complications, quick recovery, and high satisfaction, and it is worthy of application and promotion.
Objective To study the clinical features and prognosis of recurrent pneumonia associated with myotonic dystrophy. Methods A case of recurrent pneumonia related to myotonic dystrophy was retrospectively analyzed and the related literatures were reviewed. Results The patient was a 32-year-old man with recurrent fever, cough and expectoration for more than 10 years. He was diagnosed as " pneumonia” in the local hospital at every relapse, and improved after antibiotic therapy. Nine months ago, the symptoms of fever, cough and expectoration aggravated. The chest X-ray examination showed consolidation in right middle and lower lobe. After 2-month antibiotic treatment, the symptoms relieved. Then he was admitted to Beijing Anzhen Hospital for further diagnosis and treatment. Physical examination revealed " hatchet-faced” appearance with neck muscles atrophy and slightly flexion. Bilateral sternocleidomastoid muscle symmetrically rised. Few moist rales of bilateral lower lung were found. Lateral elbow and femoral quadriceps muscles symmetrically rised. The muscle strength of his four distal limbs became weakness, and the squat and standing movement was difficult. Chest CT showed pathy effusion and consolidation in right middle lobe and the lower left lobe. Electromyography showed myogenic damage in left extensor digitorum, left deltoid, right anterior tibial muscle, femoral quadriceps muscle, and left sternocleidomastoid, and spontaneous myotonic discharges in left extensor digitorum, right anterior tibial muscle and left sternocleidomastoid. Pathologic examination of left femoral quadriceps muscle showed inflammatory myopathy. The final diagnosis was myotonic dystrophy associated recurrent pneumonia. Two articles revolving 2 cases were retrieved in English literature. No case was reported in Chinese literature. Conclusion The possibility of myotonic dystrophy should be considered in the case of recurrent pneumonia complicated with muscle atrophy, weakness and myotonia.
目的 探讨新型玻璃化冷冻法对人卵巢组织超微结构的保存效果，尤其是对卵巢间质细胞的保存效果。 方法 收集2007年6月－2009年1月在我院行妇科手术的患者卵巢组织共8例，使用新型玻璃化冷冻法和慢速冷冻法保存，比较两种冷冻方法对于始基卵泡卵母细胞、颗粒细胞、卵泡周围间质细胞超微结构保存效果。 结果 对于始基卵泡卵母细胞和颗粒细胞，发现两种冷冻方法之间无显著差异（P＞0.05）；在间质细胞保存中，新型玻璃化冷冻法与慢速冷冻法相比较，正常间质细胞百分率增加（P＜0.05）。 结论 新型玻璃化冷冻法与慢速冷冻法相比能更好地保存卵泡周围间质细胞，在深低温保存人卵巢组织中具有较广阔的应用前景。