Objective To explore the CT diagnosis and differential diagnosis of perivascular epithelioid cell neoplasms (PEComa), improve the accuracy of PEComa diagnosis, and reduce misdiagnosis. Methods CT findings of 8 cases of PEComa confirmed by pathology in Jining First People’s Hospital from January 2020 to April 2024 were retrospectively analyzed for the location, shape, size, boundary, plain scan density, and enhancement characteristics of the lesions. Results All 8 tumors were solitary, with 5 located in the kidney, 1 in the liver, 1 in the extraperitoneal space, and 1 in the retroperitoneal space. The tumors were round in 3 cases, oval in 1 case, and irregular in 4 cases. Seven cases were benign with clear boundaries and 1 case was malignant with unclear boundaries. On plain CT, 2 cases showed slightly low density, 3 cases showed slightly high density, and 3 cases showed low density. One tumor had uniform density, and 7 tumors had nonuniform density with internal necrosis and cystic changes. Contrast-enhanced CT revealed diverse enhancement patterns. Four cases showed a “fast in and fast out” enhancement pattern, with significant arterial-phase enhancement and reduced portal venous-phase enhancement. Three cases showed a “fast-in and slow-out” enhancement pattern, with significant enhancement in the arterial phase, persistent enhancement in the portal venous phase, and slightly reduced density in the delayed phase. One case showed mild enhancement in the arterial phase and significant enhancement in the portal venous phase. In 3 cases, multiple tortuous and thickened blood vessels were observed around the tumors, while 3 cases showed tortuous vascular shadows within the tumors. Conclusion PEComa demonstrates characteristic CT features, predominantly with “fast in and fast out” or “fast in and slow out” enhancement patterns. When thickened and tortuous blood vessels are observed within or around the tumor, PEComa should be considered in combination with clinical findings.

BACKGROUND:Various proteins,signaling pathways,and inflammatory mediators are involved in the pathophysiological process of osteoarthritis.The development of small molecule drugs targeting these proteins,signaling pathways,and inflammatory mediators can effectively delay the progression of osteoarthritis and ameliorate its clinical manifestations. OBJECTIVE:To review the research progress of small molecule drugs in the treatment of osteoarthritis based on the pathogenesis of osteoarthritis. METHODS:PubMed,CNKI,and WanFang databases were searched with English search terms"osteoarthritis,arthritis,osteoarthrosis,degenerative,arthritides,deformans,small molecule drugs,small molecule inhibitors,small molecule agents"and Chinese search terms"osteoarthritis,small molecule drugs,small molecule inhibitors."A total of 68 articles were included for review according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION:(1)Currently,studies concerning the pathogenesis of osteoarthritis remain unclear.The occurrence and development of osteoarthritis are strongly associated with proteins,cytokines,and signal transduction pathways,so its therapeutic mechanism is relatively complex.Currently,targeting proteins,cytokines,and signal transduction pathways related to osteoarthritis with small molecule drugs has become a major research focus.(2)Small molecule drugs frequently possess visible intracellular or extracellular targets and efficacy,containing enhancing cartilage repair,resisting joint degradation,attenuating inflammation,and relieving pain.Other anti-osteoarthritis small molecule drugs have shown promise in promoting stem cell chondrogenic differentiation and cartilage matrix reconstruction.(3)At present,small molecule drugs targeting the pathophysiological process of osteoarthritis to delay the progression of osteoarthritis are still in the experimental stage,but most of these small molecule drugs have shown the expected results in the experimental process,and there are no relevant studies to illustrate the efficacy of small molecule drugs in the treatment of osteoarthritis.(4)Small molecule drugs for the treatment of osteoarthritis have reached the expected experimental results in the basic experimental stage.Numerous studies have exhibited that small molecule drugs can target the suppression of specific proteins,cytokines,and signal transduction pathways that cause osteoarthritis,so as to treat osteoarthritis.Nevertheless,its safety and effectiveness still need to be identified by further basic and clinical studies.This process needs to be investigated and studied by more scholars.(5)At present,many scholars in and outside China have made contributions to the treatment of osteoarthritis.Compared with traditional treatment methods,small molecule drugs reveal better efficacy and safety in the basic experimental stage,and it is expected to become an emerging method for the treatment of osteoarthritis in the future to rid patients of pain.

Digital technologies have become an integral part of complete denture restoration. With advancement in computer-aided design and computer-aided manufacturing (CAD/CAM), tools such as intraoral scanning, facial scanning, 3D printing, and numerical control machining are reshaping the workflow of complete denture restoration. Unlike conventional methods that rely heavily on clinical experience and manual techniques, digital technologies offer greater precision, predictability, and efficacy. They also streamline the process by reducing the number of patient visits and improving overall comfort. Despite these improvements, the clinical application of digital complete denture restoration still faces challenges that require further standardization. The major issues include appropriate case selection, establishing consistent digital workflows, and evaluating long-term outcomes. To address these challenges and provide clinical guidance for practitioners, this expert consensus outlines the principles, advantages, and limitations of digital complete denture technology. The aim of this review was to offer practical recommendations on indications, clinical procedures and precautions, evaluation metrics, and outcome assessment to support digital restoration of complete denture in clinical practice.
Humans ; Denture, Complete ; Computer-Aided Design ; Denture Design/methods* ; Consensus ; Printing, Three-Dimensional

Image 1.

The current low quality of fixed restoration margins is highly correlated with the high incidence of margin-related complications. It is also related to the unclear spatiotemporal geometric position relationship among the consensus definitions of the gingival margin (G), preparation margin (P), and restoration margin (R). This paper discusses the existing problem of the existing term "gingival margin" as a surface anatomical landmark; proposes the term "free gingival margin line" that conforms to geometry and measurement and has importance as a surface anatomical landmark; and clarifies the participants that exist in the marginal area. These participants include the P, R, and G; cementation (adhesive) layer; and gingival sulcus. Moreover, this paper discusses the various iatrogenic damages induced by entering the gingival sulcus via the P, R, and cementing (adhesive) layer. Through the discussion of the design deficiencies of the subgingival and biologically oriented preparation technique, the physiological and clinical importance of the concept of gingival sulcus/gingival sulcus fluid + supercrestal tissue attachment (biological width) = first periodontal protective barrier was analyzed. The value of preserving the physiological role of the gingival sulcus is emphasized. Furthermore, the newly defined RPG distance represents the distance between the successive P or R line and free G line and can be measured in the clinical procedure of tooth preparation. The optimal solution is 0-200 µm, that is, RPG200: the P and R are located on the free G line and the distance between these margins is less than 200 µm. This distance not only has the aesthetic effect of invisibility to the naked eye, it also has a minimal effect on the G and gingival sulcus and is convenient for doctors and patients to clean. Furthermore, in accordance with the positional relationship between the three margins and cementation (adhesive) layer, a new classification of marginal positions is proposed. This classification overcomes the problems of incomplete inclusion objects and uncontrolled risk factors in the previous classification. It also has the advantages of strong practicability, good efficiency of main control geometric quantity, and clear risk control points. The new design scheme and classification of the margi-nal position of RPG200 proposed in this paper provide a new understanding for margin design and complication prevention in the future.
Humans ; Gingiva/anatomy & histology* ; Cementation ; Dental Restoration, Permanent/methods*

Occlusal rehabilitation is an effective means of treating tooth wear, edentulous jaws and other oral diseases. Among them, full-mouth fixed occlusal reconstruction can effectively restore aesthetics and function, but the complexity of the clinical process, the high sensitivity of the technique, and the high incidence of various complications have always drawn much attention. With the application and development of digital technology in occlusal rehabilitation, the treatment outcome has been improved compared with traditional treatment. However, there are many kinds of digital technology with different efficacy, how to build an efficiently standardized digital clinical technical solution is a current difficulty. Therefore, combined with the long-term work of the department of prosthodontics in our hospital, in this paper, the minimum (occlusal perception of thickness) and maximum (centric relation) geometric quantities which should be paid attention to during reconstruction are put forward. We systematically organized the clinical procedure of digital full-mouth fixed occlusal rehabilitation used in our department for a long time. In conclusion, a 5-stage 19-step or n-step solution (5-19N for short) characterized by "from large to small" restorative space splitting logic is proposed. It has a certain reference value for the future use of digital technology to deal with complex occlusal rehabilitation cases.
Humans ; Dental Occlusion ; Computer-Aided Design ; Mouth, Edentulous/rehabilitation*

Objectives:To explore the value of improving the sensitivity of Epstein-Barr virus(EBV) DNA detection for the diagnosis and efficacy assessment of nasopharyngeal carcinoma.Methods:This was an observational study. The precision of the EBV DNA detection system used in this study was verified at the level of 100 copies/ml in accordance with the requirements of verification experiments, and the accuracy of the detection system was evaluated by comparing with digital PCR method. Totally 52 plasma samples were collected from patients who were newly diagnosed with undifferentiated non-keratinizing carcinoma of the nasopharynx at Nanfang Hospital of Southern Medical University from December 2021 to May 2022 in addition to156 plasma samples from nasopharyngeal carcinoma patients treated at the Radiotherapy Department of the hospital, and a retrospective analysis was also performed on 5 488 plasma samples that had been submitted for quantitative EBV DNA detection over the same period at the hospital. The effetcs of raising the EBV DNA detection threshold from 500 copies/ml to 100 copies/ml on the detection rate of nasopharyngeal carcinoma and the therapeutic efficacy assessment were compared.Results:The bias between the logarithmic values of the detected quantities and the target quantities was below±0.4 ( CV=6.94%) for the testings of 30 repetitions of the sample at the level of 100 copies/ml. The circulating EBV DNA of 156 patients with nasopharyngeal carcinoma was measured by the detection system and by digital PCR, and the results of the two methods showed good consistency ( r=0.95, P<0.001). By raising the EBV DNA detection threshold from 500 copies/ml to 100 copies/ml, the detection rate of nasopharyngeal carcinoma in untreated patients increased from 67.31% (35/52) to 82.69% (43/52). For nasopharyngeal carcinoma patients under treatment, the peripheral blood EBV DNA detection rates were 12.82% (20/156) and 23.72% (37/156) with detection thresholds of 500 copies/ml and 100 copies/ml, respectively. Conclusion:This research improved the EBV detection rate by increasing the sensitivity of EBV DNA assays, which is of great significance for the auxiliary diagnosis and therapeutic efficacy assessment in nasopharyngeal carcinoma patients.

Objective:To study the experience and efficacy of treating the isolated left vertebral artery (ILVA) during total aortic arch replacement combined with stent-trunk surgery in patients with Stanford type A aortic dissection (TAAD) combined with ILVA.Methods:The clinical data of 21 patients with TAAD combined with ILVA from July 2017 to March 2022 in the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed. All patients were treated with ILVA-left common carotid artery transplantation and total arch replacement combined with stent-trunk surgery under moderate hypothermia cardiopulmonary bypass and selective cerebral perfusion (SCP). Among them, aortic root repair surgery was in 15 cases, Bentall surgery in 6 cases, coronary artery bypass grafting performed simultaneously in 2 cases. The surgical details, postoperative complications and length of stay were recorded. The patients were followed up 1 and 12 months after surgery for CTA examination to observe the patency of transplanted ILVA. The follow-up was performed until October 1, 2022, and survival, aorta-related death and ILVA patency rate were recorded.Results:Three hundred and thirty-five TAAD patients were admitted during the same period, including 21 (6.27%) with ILVA. ILVA was reconstructed successfully in all patients. No complications related to ILVA were observed. Three cases died during the perioperative period: 1 case had preoperative myocardial infarction due to coronary artery involvement and the CPB could not be removed after operation; 1 case died of postoperative liver and renal failure due to severe organ hypoperfusion; 1 case suffered from postoperative acute renal failure and died of low cardiac output. The patients did not experience damage to the vagus nerve or recurrent laryngeal nerve, lymphatic leakage, chylothorax, ILVA thrombosis, paraplegia or cerebral vascular complications. The other 18 patients recovered and discharged from hospital. The median duration of follow-up was 30 (6 to 62) months. During the follow-up, aortic-related death did not observe, ILVA was unobstructed, and there were no manifestations of anastomotic stenosis or arterial stenosis.Conclusions:ILVA is a supra-aortic trunk variant, it is not so rare. ILVA may pose additional difficulties during total arch replacement surgery. The clinical effect of prior reconstruction of ILVA by ILVA-LCCA transposition is satisfactory, and it may be a simple and efficient method to complete reconstruction and optimize arch surgery before cardiopulmonary bypass.

Objective To evaluate the effectiveness of screening-intervention management program for high risk population of stroke in community.Methods Participants aged≥60 years old in Tairi Community,Fengxian District,Shanghai from May 2019 to July 2022 were selected as screening and intervention objects.The first round of stroke high-risk group screening was conducted in 2019 and 2020 in two years respectively,and the second round of stroke high-risk group screening(re-screening)was conducted in 2021 and 2022 respectively for the 2019 and 2020 screening groups,and the groups who had received stroke high-risk screening in both rounds of screening(overlapping groups)were selected as the observation objects of this study.The cerebrovascular function score was used to screen the high-risk individuals of stroke,75-100 was classified as non-high-risk,＜75 were classified as high risk,among which 50-74,25-49,0-24 were light,medium and severe risk,in turn.Baseline and follow-up data were collected for all screening groups,including systolic blood pressure,diastolic blood pressure,overweight or obesity,fasting blood glucose,glycated hemoglobin,triglyceride,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,and blood uric acid.After the completion of screening,the test report interpretation and first diagnosis intervention were carried out on the screening site,and the screening results were recorded into the health examination file.The first intervention includes lifestyle intervention,risk factor intervention and therapeutic intervention for high-risk individuals.Lifestyle intervention and risk factor intervention were conducted through the distribution of popular science handbook for stroke prevention and individualized face-to-face guidance.Therapeutic intervention for high-risk individuals was guided by anti-platelet aggregation drug therapy,statin therapy,and further examination and treatment of cerebral vessels according to stroke risk assessment results and the incidence of related chronic diseases.Prior to the implementation of the project,the incidence of stroke in the community in 2018 was retrospectively investigated to compare annual changes in stroke screening-intervention.In the process of implementation of intervention management,stroke incidence monitoring of the whole community registered population was carried out,and the monitoring method was to conduct stroke incidence registration once a year,and cooperate with the disease control and community police station to obtain the community stroke incidence monitoring data and death registration information provided by the police station from 2018 to 2022.Results A total of 5 188 subjects who completed both the initial screening and the follow-up screening and met the inclusion and exclusion criteria were identified,of whom 2 269 were male and 2 923 were female.The age of participants ranged from 60 to 93 years at the time of the first round of screening,with a mean age of(68±6)years.The proportions of subjects in the age groups of 60-64,65-69,70-74,and≥75 years were 30.3％,34.7％,21.1％,and 14.0％,respectively.(1)After screening and intervention,the proportion of individuals with increased systolic blood pressure,diastolic blood pressure,fasting blood glucose,triglyceride,and low-density lipoprotein cholesterol all decreased(respectively 49.4％vs.57.3％,26.6％vs.28.7％,9.6％vs.10.9％,14.7％vs.17.0％,2.4％vs.3.3％;all P＜0.05),but the proportion of individuals with hyperuricemia increased(15.8％vs.13.1％,P＜0.01),with statistically significant differences.(2)Before the implementation of the screening-intervention program in 2018,the stroke incidence rate in the community was 332.1/100 000.The stroke incidence rates in the community during the period from 2019 to 2022 after the implementation of the screening-intervention program were 335.0/100 000,270.8/100 000,235.0/100 000,and 193.6/100 000,respectively.The incidence rates of ischemic stroke(x2trend=8.350,P=0.004)and stroke(x2trend=9.910,P=0.002)decreased during the period from 2019 to 2022,while the incidence rate of hemorrhagic stroke did not show a decreasing trend(x2trend=1.636,P=0.201).(3)The median baseline and follow-up cerebrovascular function scores for the 5 188 elderly individuals undergoing residual stroke risk screening were 82.50(52.50,98.75)and 88.5(59.00,100.00),respectively,with stroke risk rates of 39.8％and 35.6％before and after intervention,respectively.After intervention,the follow-up cerebrovascular function scores increased compared to the baseline,and the stroke risk rate decreased.The distribution of stroke risk levels before and after screening-intervention had statistically significant differences(P＜0.01).Conclusion Implementing a stroke high-risk population screening-intervention management program for the elderly in the community,combined with health examinations and family doctor team services,can significantly reduce the incidence,high-risk rate,and exposure level of risk factors for stroke in the community.

Objective:To evaluate the dosimetric characteristics, safety and effectiveness of magnetic resonance-guided fractionated stereotactic radiotherapy (FSRT) for brain tumors.Methods:Clinical data of 8 brain tumor patients treated with magnetic resonance-guided FSRT in the Radiotherapy Department of the First Medical Center of the PLA General Hospital from July 2023 to February 2024 were retrospectively analyzed. Online adaptive radiotherapy was adopted for all patients. Adapt-to-position (ATP) or adapt-to-shape (ATS) radiotherapy was chosen by radiologists. Each adaptation was initiated after the radiotherapy plan was re-examined. The radiotherapy fractionation plan was 21-30 Gy/3-5 F. Clinical characteristics, radiotherapy plans and plan parameters were analyzed by statistical description. Median ( Q1， Q3) was used to describe continuous data and percentage was used to describe categorical data. Results:In this study, 9 lesions were treated a total of 41 times, including 20 times (49%) of ATP plan and 21 times (51%) of ATS plan. The median target area coverage rate was 95.1% (95%, 99.8%), the median target area maximum dose rate was 1.15 (1.07, 1.31), the median conformity index (CI) was 0.75 (0.69, 0.86), the median homogeneity index (HI) was 1.09 (1.06, 1.21), and the median gradient index (GI) was 4.73 (3.36, 8.45), respectively. After ATS plan, the median reduction in gross target volume (GTV) was 8.22 cm3 (1.2, 10.1 cm3), and the median reduction in brain tissue V12 Gy was 30.46 cm3 (8.34, 31.13 cm3).The median follow-up was 3.2 months (1.4, 6.1 months). No radiation necrosis was found in any patient. There were 2 cases of acute brain edema during radiotherapy (both were mild). Except for 1 case who died due to systemic disease progression, the remaining patients had no local recurrence, and achieved good quality of life. Conclusions:The parameters of the treatment plan of magnetic resonance-guided FSRT are generally acceptable. The adaptive plan can effectively reduce the dose of normal brain tissues. It is safe and feasible to use the magnetic resonance-guided FSRT for brain tumors.