BACKGROUND:Arthroscopic anchor repair has become the main treatment method for rotator cuff tears at present.Among them,the insertion status of the anchor is a key factor in the success or failure of the operation.However,currently,the impact of the insertion depth of the anchor on the stress of the bone tunnel and the anchor under different bone density conditions remains unclear.OBJECTIVE:To explore the stress distribution of the bone tunnel and the anchor when the insertion depth of the anchor varies under different bone density conditions by using three-dimensional finite element analysis technology.METHODS:The CT image data of the humerus of volunteers were collected,and the models of the humerus and the anchor were constructed by using Mimics,3-Matic,and Solidworks software.In 3-Matic,holes with distances of 0,2,4,6,and 8 mm from the surface of the humerus were respectively created at the same position of the humerus and assembled with the anchor.In Mimics,values were assigned based on the CT gray value to obtain a model with normal bone mass(T value ≥-1.0).The parameters were changed to construct models with reduced bone mass(-2.5＜T value＜-1.0)and osteoporosis(T value＜-2.5).In each model,a 70 N pulling force was applied to the anchor along the direction tangent to the inner edge of the bone tunnel.The stress distribution and magnitude of the bone tunnel and the anchor when inserted at different depths under different bone density conditions were observed.RESULTS AND CONCLUSION:(1)When the insertion depth was the same,as the bone density decreased,the maximum equivalent stress of the anchor increased,while the maximum equivalent stress of the bone tunnel decreased.(2)When the bone density was the same,as the insertion depth of the anchor increased,the maximum equivalent stress of the anchor decreased.When the insertion depth was 4 mm,the stress of the bone tunnel was the smallest and the distribution was relatively uniform.The stress of the anchor was mainly distributed around the lower anchor hole and the proximal thread,and the stress of the bone tunnel was mainly at the part in contact with the proximal thread.The increase in the insertion depth would change the uniformity and pattern of the stress distribution,while the bone density had a relatively small impact on the stress distribution pattern.(3)It is concluded that the bone density of the humerus is crucial for the anchor repair of rotator cuff tears.It is recommended that clinicians measure the bone density of the greater tuberosity of the humerus before the operation.Excessive insertion depth of the anchor does not significantly increase its stability.Clinicians can conduct personalized preoperative assessments by using the finite element analysis method in combination with the actual situation of patients to achieve the best surgical results.

BACKGROUND:Arthroscopic anchor repair has become the main treatment method for rotator cuff tears at present.Among them,the insertion status of the anchor is a key factor in the success or failure of the operation.However,currently,the impact of the insertion depth of the anchor on the stress of the bone tunnel and the anchor under different bone density conditions remains unclear.OBJECTIVE:To explore the stress distribution of the bone tunnel and the anchor when the insertion depth of the anchor varies under different bone density conditions by using three-dimensional finite element analysis technology.METHODS:The CT image data of the humerus of volunteers were collected,and the models of the humerus and the anchor were constructed by using Mimics,3-Matic,and Solidworks software.In 3-Matic,holes with distances of 0,2,4,6,and 8 mm from the surface of the humerus were respectively created at the same position of the humerus and assembled with the anchor.In Mimics,values were assigned based on the CT gray value to obtain a model with normal bone mass(T value ≥-1.0).The parameters were changed to construct models with reduced bone mass(-2.5＜T value＜-1.0)and osteoporosis(T value＜-2.5).In each model,a 70 N pulling force was applied to the anchor along the direction tangent to the inner edge of the bone tunnel.The stress distribution and magnitude of the bone tunnel and the anchor when inserted at different depths under different bone density conditions were observed.RESULTS AND CONCLUSION:(1)When the insertion depth was the same,as the bone density decreased,the maximum equivalent stress of the anchor increased,while the maximum equivalent stress of the bone tunnel decreased.(2)When the bone density was the same,as the insertion depth of the anchor increased,the maximum equivalent stress of the anchor decreased.When the insertion depth was 4 mm,the stress of the bone tunnel was the smallest and the distribution was relatively uniform.The stress of the anchor was mainly distributed around the lower anchor hole and the proximal thread,and the stress of the bone tunnel was mainly at the part in contact with the proximal thread.The increase in the insertion depth would change the uniformity and pattern of the stress distribution,while the bone density had a relatively small impact on the stress distribution pattern.(3)It is concluded that the bone density of the humerus is crucial for the anchor repair of rotator cuff tears.It is recommended that clinicians measure the bone density of the greater tuberosity of the humerus before the operation.Excessive insertion depth of the anchor does not significantly increase its stability.Clinicians can conduct personalized preoperative assessments by using the finite element analysis method in combination with the actual situation of patients to achieve the best surgical results.

ObjectiveTo analyze the epidemiological characteristics of a local dengue fever cluster outbreak in Qingpu District of Shanghai in 2024, and to provide a reference for subsequent dengue fever prevention and control. MethodsSeven confirmed local dengue fever cases reported through the National Notifiable Infectious Diseases Surveillance System in Qingpu District of Shanghai in 2024 were selected as the research subjects. Descriptive epidemiological methods were used to conduct investigation and analysis from the aspects of onset, medical treatment and reporting, clinical symptoms, travel and contact history within 15 days before onset, and activity trajectories. ResultsA total of 7 cases were identified in this outbreak. None of the cases had a travel history to dengue-endemic areas within 15 days prior to onset, while all had shared exposure environments and mosquito bite histories, indicating a local clustered transmission pattern. The main clinical manifestations included fever (100.00%) and myalgia (42.86%). All 7 cases were positive for dengue virus serotype 2 (DENV-2) by nucleic acid testing. Genetic sequencing showed that the virus strains belonged to the Cosmopolitan genotype and were most closely related to the epidemic DENV strains circulating in southern China in recent years. ConclusionThis outbreak might be a local secondary infection caused by the short-term stay of dengue fever-infected individuals, and the possible source of importation was dengue fever endemic areas in southern China.

ObjectiveTo investigate the effect of Sanet Vision Integrator (SVI)-based visuomotor integration training on the severity of neglect symptoms, upper limb motor function and activities of daily living (ADL) in patients with post-stroke unilateral spatial neglect (USN). MethodsFrom July, 2023 to September, 2025, 41 patients with post-stroke USN in Beijing Bo'ai Hospital were enrolled and randomly assigned to control group (n = 20) and experimental group (n = 21). Both groups received conventional rehabilitation and visual scanning training, while the experimental group received supplementary SVI-based visuomotor integration training, including saccadic, rotation and hand-eye coordination training, for eight weeks. They were assessed with Chinese Behavioral Inattention Test-Hong Kong version (CBIT-HK), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after treatment. ResultsAfter treatment, all the scores significantly improved in both groups (|t| > 4.004, P < 0.001), and the total scores of CBIT-HK and the core visual search sub-items (star cancellation, line crossing and letter cancellation), FMA-UE and MBI were better in the experimental group than in the control group (t > 2.096, P < 0.05). ConclusionSVI-based visuomotor training can effectively alleviate the USN symptoms, broaden the span of visual attention, facilitate the functional recovery of the affected upper extremity, and improve ADL in patients after stroke.

BACKGROUND:Small intestinal submucosal acellular matrix has been proven by clinical and basic studies to be useful for urethral repair and reconstruction.However,when applied alone,it has problems such as slow growth of host cells,difficulty in survival due to insufficient stent vascularization,and obstruction of reconstructed urethral stricture,and is only suitable for short urethral stricture.OBJECTIVE:To investigate the feasibility of constructing tissue engineered urethra with acellular matrix combined with exosomes in small intestinal submucosa.METHODS:Exosomes were isolated from rabbit bone marrow mesenchymal stem cells.The porcine small intestinal submucosal acellular matrix was prepared,and exosomes were loaded on the porcine small intestinal submucosal acellular matrix.The extracellular stroma-exosome(PKH26 dye labeled)complex of small intestinal submucosa was co-cultured with umbilical vein endothelial cells for 12 hours to observe the uptake of exosomes.The umbilical vein endothelial cells with good growth status were selected and cultured in three groups:the blank group was cultured routinely.The control group was added with small intestinal submucosal acellular matrix,and the experimental group was added with small intestinal submucosal acellular stromat-exosome complex.The angiogenesis was evaluated by scratch test,tube formation test,and angiogenic factor secretion test.Thirty New Zealand white rabbits were selected to establish a long(3 cm)urethral defect model,and the intervention was divided into three groups by random number table method(n=10).The single material group was implanted with small intestinal submucosal acellular matrix.The control group was implanted with small intestinal submucosal acellular matrix-bone marrow mesenchymal stem cell complex.The experimental group was implanted with small intestinal submucosal acellular matrix-exosome complex.Urethrography,urodynamic examination,and pathological observation of reconstructed urethral sections were performed 12 weeks after implantation.RESULTS AND CONCLUSION:(1)Exosomes in the acellular matrix of small intestinal submucosa could be taken up by umbilical vein endothelial cells under the fluorescence microscope.(2)Compared with the blank group and the control group,the experimental group could promote the migration of umbilical vein endothelial cells,angiogenesis ability,and the secretion of angiogenic factors vascular endothelial growth factor,hepatocyte growth factor,and interleukin 8(P<0.05).(3)Urethrography results showed that all 10 rabbits in the single material group had urethral stenosis;2 out of 10 rabbits in the control group had urethral stenosis,and none of the 10 rabbits in the experimental group had urethral stenosis.The results of urodynamic examination showed that the maximum urethral pressure at 12 weeks after implantation was higher in the single material group than before surgery(P<0.05),and the maximum urethral pressure at 12 weeks after implantation was lower in the control group and the experimental group than in the blank group(P<0.05).Hematoxylin-eosin,Masson and immunohistochemical staining showed that in the single material group,there were obvious regenerated epidermis,a small amount of subcutaneous smooth muscle and blood vessels,mainly fibrous tissue hyperplasia,accompanied by obvious inflammatory cell infiltration.In the control group,there were more complete regenerated epithelium and a small amount of collagen,a large number of subcutaneous blood vessels and smooth muscle,accompanied by inflammatory cell infiltration.The experimental group showed complete regenerated epidermis,a large number of subcutaneous blood vessels and smooth muscle,and no obvious inflammatory cell infiltration.The positive expressions of AE1/AE3,alpha smooth muscle actin,and CD31 in the experimental group were higher than those in the single material group and the control group(P<0.05).(4)The results show that the small intestinal submucosal acellular matrix-exosome tissue engineered urethra can repair the urethral defect by promoting angiogenesis.

Objective This study aims to explore the efficacy and complication rates of the transcranial approach(TCA)and extended endoscopic endonasal approach(EEEA)for the treatment of craniopharyngiomas based on the QST classification,providing a scientific reference for clinical decision-making on surgical approach.Methods A total of 151 patients who underwent craniopharyngioma surgery at our center from January 2018 to December 2023 were enrolled.The patients were categorized into Q-CP(suprasellar type),S-CP(infundibular type),and T-CP(tuberal type)according to the QST classification.Systematic collection and analysis were performed on the outcomes of TCA and EEEA treatments,respectively.The differences in effectiveness between the two approaches were evaluated based on the QST classification.Results The improvement rate of visual symptoms was overall higher in the EEEA group than in the TCA group(59.1%vs.36.5%,P=0.006),and the visual deterioration rate was lower(3.0%vs.14.1%,P=0.006).However,the incidence of cerebrospinal fluid leakage was higher in the EEEA group(15.2%vs.3.5%,χ2=4.986,P=0.026).The incidence of postoperative seizures(8.2%vs.0,P=0.019),brain contusions(10.6%vs.0,P=0.005),and subdural hematoma(9.4%vs.0%,P=0.01)was higher in the TCA group.For patients with Q-CP type,the EEEA group had a higher rate of total tumor resection(92.9%vs.65.2%,P=0.025)and a lower recurrence rate(3.6%vs.21.7%,P=0.047),with shorter hospital stays and lower postoperative costs.The TCA group had higher intraoperative blood loss in this type(300 mL vs.200 mL,Z=-2.261,P=0.024).For S-CP type patients,the EEEA group showed a higher rate of total tumor resection(91.3%vs.74.2%)and a lower recurrence rate(0 vs.12.9%,P=0.031),with lower postoperative hospital costs.In T-CP type,due to the deeper location,EEEA showed limitations in protecting hypothalamic function and the TCA group had a better postoperative hypothalamic function score(P=0.035).Conclusion Based on QST classification,EEEA has advantages in Q-CP and S-CP types and is recommended as the preferred surgical procedure;In the T-CP type,TCA surgery is more helpful in protecting hypothalamic function.

Objective:To observe the therapeutic effects of electroacupuncture(EA)stimulation on chronic pain and associated negative emotions,and to investigate the activity changes of glutamatergic neurons in the primary motor cortex(M1)following EA stimulation.Methods:Male C57BL/6J mice were randomly divided into four groups:sham surgery(Sham),pure electroacupuncture stimulation(EA),nerve injury(SNI)and electroacupuncture treatment of nerve injury(SNI+EA).Thirty days after the SNI model establishment,EA stimulation was administered bilaterally to the Zusanli(ST36)acupoints in mice.von Frey filaments and Hargreaves heat sensitivity testing were used to detect mechanical and thermal hyperalgesia.The elevated plus maze test was conducted to assess the impact on anxiety-like behaviors in mice.Dual immunofluorescence staining was employed to observe changes in c-Fos expression in M1 gluta-matergic neurons.Results:As compared to Sham group,SNI-treated mice exhibited significant mechanical and thermal hyperalgesia in bilateral hindpaws at 30 days post-modeling(P＜0.01)and displayed obvious anxiety-like behaviors(P＜0.01).The SNI+EA group showed significant relief in pain and anxiety-like behaviors(P＜0.01).c-Fos expression in M1 glutamatergic neurons was significantly decreased in SNI mice.Conversely,after electroacupuncture(EA)treatment,compared to the SNI group,M1 glutamatergic neurons in the SNI+EA group showed significantly in-creased c-Fos expression(P＜0.01).Conclusion:Electroacupuncture significantly alleviated chronic pain and associ-ated anxiety-like behaviors induced by SNI,which might involve the activation of glutamatergic neurons in the M1 in this process.

Objective This study aims to explore the efficacy and complication rates of the transcranial approach(TCA)and extended endoscopic endonasal approach(EEEA)for the treatment of craniopharyngiomas based on the QST classification,providing a scientific reference for clinical decision-making on surgical approach.Methods A total of 151 patients who underwent craniopharyngioma surgery at our center from January 2018 to December 2023 were enrolled.The patients were categorized into Q-CP(suprasellar type),S-CP(infundibular type),and T-CP(tuberal type)according to the QST classification.Systematic collection and analysis were performed on the outcomes of TCA and EEEA treatments,respectively.The differences in effectiveness between the two approaches were evaluated based on the QST classification.Results The improvement rate of visual symptoms was overall higher in the EEEA group than in the TCA group(59.1%vs.36.5%,P=0.006),and the visual deterioration rate was lower(3.0%vs.14.1%,P=0.006).However,the incidence of cerebrospinal fluid leakage was higher in the EEEA group(15.2%vs.3.5%,χ2=4.986,P=0.026).The incidence of postoperative seizures(8.2%vs.0,P=0.019),brain contusions(10.6%vs.0,P=0.005),and subdural hematoma(9.4%vs.0%,P=0.01)was higher in the TCA group.For patients with Q-CP type,the EEEA group had a higher rate of total tumor resection(92.9%vs.65.2%,P=0.025)and a lower recurrence rate(3.6%vs.21.7%,P=0.047),with shorter hospital stays and lower postoperative costs.The TCA group had higher intraoperative blood loss in this type(300 mL vs.200 mL,Z=-2.261,P=0.024).For S-CP type patients,the EEEA group showed a higher rate of total tumor resection(91.3%vs.74.2%)and a lower recurrence rate(0 vs.12.9%,P=0.031),with lower postoperative hospital costs.In T-CP type,due to the deeper location,EEEA showed limitations in protecting hypothalamic function and the TCA group had a better postoperative hypothalamic function score(P=0.035).Conclusion Based on QST classification,EEEA has advantages in Q-CP and S-CP types and is recommended as the preferred surgical procedure;In the T-CP type,TCA surgery is more helpful in protecting hypothalamic function.

Objective:To observe the therapeutic effects of electroacupuncture(EA)stimulation on chronic pain and associated negative emotions,and to investigate the activity changes of glutamatergic neurons in the primary motor cortex(M1)following EA stimulation.Methods:Male C57BL/6J mice were randomly divided into four groups:sham surgery(Sham),pure electroacupuncture stimulation(EA),nerve injury(SNI)and electroacupuncture treatment of nerve injury(SNI+EA).Thirty days after the SNI model establishment,EA stimulation was administered bilaterally to the Zusanli(ST36)acupoints in mice.von Frey filaments and Hargreaves heat sensitivity testing were used to detect mechanical and thermal hyperalgesia.The elevated plus maze test was conducted to assess the impact on anxiety-like behaviors in mice.Dual immunofluorescence staining was employed to observe changes in c-Fos expression in M1 gluta-matergic neurons.Results:As compared to Sham group,SNI-treated mice exhibited significant mechanical and thermal hyperalgesia in bilateral hindpaws at 30 days post-modeling(P＜0.01)and displayed obvious anxiety-like behaviors(P＜0.01).The SNI+EA group showed significant relief in pain and anxiety-like behaviors(P＜0.01).c-Fos expression in M1 glutamatergic neurons was significantly decreased in SNI mice.Conversely,after electroacupuncture(EA)treatment,compared to the SNI group,M1 glutamatergic neurons in the SNI+EA group showed significantly in-creased c-Fos expression(P＜0.01).Conclusion:Electroacupuncture significantly alleviated chronic pain and associ-ated anxiety-like behaviors induced by SNI,which might involve the activation of glutamatergic neurons in the M1 in this process.

BACKGROUND:Small intestinal submucosal acellular matrix has been proven by clinical and basic studies to be useful for urethral repair and reconstruction.However,when applied alone,it has problems such as slow growth of host cells,difficulty in survival due to insufficient stent vascularization,and obstruction of reconstructed urethral stricture,and is only suitable for short urethral stricture.OBJECTIVE:To investigate the feasibility of constructing tissue engineered urethra with acellular matrix combined with exosomes in small intestinal submucosa.METHODS:Exosomes were isolated from rabbit bone marrow mesenchymal stem cells.The porcine small intestinal submucosal acellular matrix was prepared,and exosomes were loaded on the porcine small intestinal submucosal acellular matrix.The extracellular stroma-exosome(PKH26 dye labeled)complex of small intestinal submucosa was co-cultured with umbilical vein endothelial cells for 12 hours to observe the uptake of exosomes.The umbilical vein endothelial cells with good growth status were selected and cultured in three groups:the blank group was cultured routinely.The control group was added with small intestinal submucosal acellular matrix,and the experimental group was added with small intestinal submucosal acellular stromat-exosome complex.The angiogenesis was evaluated by scratch test,tube formation test,and angiogenic factor secretion test.Thirty New Zealand white rabbits were selected to establish a long(3 cm)urethral defect model,and the intervention was divided into three groups by random number table method(n=10).The single material group was implanted with small intestinal submucosal acellular matrix.The control group was implanted with small intestinal submucosal acellular matrix-bone marrow mesenchymal stem cell complex.The experimental group was implanted with small intestinal submucosal acellular matrix-exosome complex.Urethrography,urodynamic examination,and pathological observation of reconstructed urethral sections were performed 12 weeks after implantation.RESULTS AND CONCLUSION:(1)Exosomes in the acellular matrix of small intestinal submucosa could be taken up by umbilical vein endothelial cells under the fluorescence microscope.(2)Compared with the blank group and the control group,the experimental group could promote the migration of umbilical vein endothelial cells,angiogenesis ability,and the secretion of angiogenic factors vascular endothelial growth factor,hepatocyte growth factor,and interleukin 8(P<0.05).(3)Urethrography results showed that all 10 rabbits in the single material group had urethral stenosis;2 out of 10 rabbits in the control group had urethral stenosis,and none of the 10 rabbits in the experimental group had urethral stenosis.The results of urodynamic examination showed that the maximum urethral pressure at 12 weeks after implantation was higher in the single material group than before surgery(P<0.05),and the maximum urethral pressure at 12 weeks after implantation was lower in the control group and the experimental group than in the blank group(P<0.05).Hematoxylin-eosin,Masson and immunohistochemical staining showed that in the single material group,there were obvious regenerated epidermis,a small amount of subcutaneous smooth muscle and blood vessels,mainly fibrous tissue hyperplasia,accompanied by obvious inflammatory cell infiltration.In the control group,there were more complete regenerated epithelium and a small amount of collagen,a large number of subcutaneous blood vessels and smooth muscle,accompanied by inflammatory cell infiltration.The experimental group showed complete regenerated epidermis,a large number of subcutaneous blood vessels and smooth muscle,and no obvious inflammatory cell infiltration.The positive expressions of AE1/AE3,alpha smooth muscle actin,and CD31 in the experimental group were higher than those in the single material group and the control group(P<0.05).(4)The results show that the small intestinal submucosal acellular matrix-exosome tissue engineered urethra can repair the urethral defect by promoting angiogenesis.