RESUMO
Background: A wide variety of materials are used for lumbar interbody fusion, but there is no unified consensus on the superiority of one material over another. The aim of this systematic review and network meta-analysis (NMA) is to compare and rank the various TLIF interbody materials based on fusion rates. Methods: We queried PubMed, EMBASE and Scopus from inception until August 2023, in which 2135 studies were identified. Inclusion criteria were applied based on the PRISMA guidelines. The fusion assessment employed the Bridwell's criteria with a length of follow-up of at least 12 months. The NMA was conducted to compare multiple approaches from multiple studies using the frequentist framework with STATA16. Results: In total, 13 TLIF studies involving 1919 patients with 1981 lumbar interbody levels fulfilled our eligibility criteria. Seven different cage materials were utilized: polyetheretherketone (PEEK, as the reference), allograft, autograft, PEEK with titanium coating (TiPEEK), titanium, carbon/carbon fiber reinforced polymer (CFRP) and 3D-printed titanium. The average patient age was 60.9 (SD = 7.5) years old. When compared to PEEK, the other six materials did not have a significantly different rate of lumbar fusion. However, the SUCRA number of the 3D-printed titanium, TiPEEK, Ti, allograft, autograft, CFRP, and PEEK were 0.8, 0.6, 0.5, 0.5, 0.4, 0.4, and 0.3 consecutively. Conclusions: Based on a network meta-analysis within the confines of our clinical study, 3D-printed titanium interbody cage may promote the highest success rate of fusion while PEEK may be the material with the least success rate of fusion in TLIF.
RESUMO
BACKGROUND: Psychological well-being is an important part that undergraduate students and universities cannot neglect as it helps students lead a better study life at the university. Various studies revealed that social support can affect students' psychological well-being. However, the causal relationship between social support and psychological well-being has received little attention in North China. Therefore, the aim of the current study was to analyze the causal relationship between social support and psychological well-being among undergraduate students in North China. MATERIALS AND METHODS: The survey approach was adopted and conducted with a total of 689 undergraduate students in North China. Data were collected using a reliable questionnaire. Data analysis was performed with descriptive statistics, Pearson's correlation, and structural equation modeling at P < 0.01 significance level using Statistical Package for Social Sciences (SPSS) and Linear Structural Relations (LISREL). RESULTS: The overall levels of social support and psychological well-being among undergraduate students in North China were high. All observed variables in this study were significantly correlated. The findings also confirmed that the causal relationship between social support and undergraduate students' psychological well-being in North China fitted to the empirical data well (χ2 [22, N = 689] = 27.69, χ2/degree of freedom [df] = 1.26, P = 0.19, goodness of fit index [GFI] = 0.99, adjusted goodness of fit index [AGFI] = 0.98, comparative fit index [CFI] = 1.00, standardized root mean square residual [SRMR] = 0.02, root mean square error of approximation [RMSEA] = 0.02). CONCLUSIONS: Undergraduate students' psychological well-being had been significantly affected by social support in North China. The findings from the current study will be useful for university administrators to develop strategies for the enhancement of undergraduate students' psychological well-being.