Methods: Retrospective study of 120 patients (223 fusion levels) who underwent ACDF between 2016 and 2021. Spacer types included structural allografts, PEEK, titanium, and ceramic cages. Radiographic measurements of subsidence were obtained from immediate (≤8 weeks) and long-term (≥6 months) postoperative lateral cervical radiographs. Multivariable linear regression was used to assess the association between spacer type and subsidence, adjusting for patient demographics, surgical levels, smoking history, and osteopenia. Results: The mean age of patients was 53.6±10.9 years and 41.7% were male; 47.5% had a smoking history and 20.8% had osteopenia. There were 38 one-level (31.7%), 61 two-level (50.8%), and 21 three-level fusions (17.5%). Spacer distribution included 62 structural allografts (51.7%), 27 PEEK (22.5%), 20 titanium (16.7%), and 11 ceramic (9.2%) cages. On multivariable analysis, PEEK cages were associated with significantly less anterior subsidence (β=−0.972, p <0.001) and posterior subsidence (β=−0.666, p=0.001) compared to allografts, and greater preservation of segmental lordosis (β=1.393, p=0.024). No significant differences in subsidence were found between titanium, ceramic, and allograft spacers. Conclusions PEEK cages showed reduced subsidence and better preservation of cervical lordosis compared to structural allografts, while titanium and ceramic cages did not differ significantly from structural allografts. These results suggest that PEEK cages may help minimize subsidence-related complications and improve outcomes.

Purpose: This study retrospectively investigated the long-term clinical and radiographic outcomes of a bone-level type, 2-piece, internal connection dental implant system characterized by coronal microthreads. Methods: A total of 872 implants placed in 284 patients were selected from 1,845 implants placed in 691 patients by experienced periodontists at Yonsei University Dental Hospital.These selected implants had been followed up for over 10 years and were included in the present study. A statistical evaluation of implant survival and treatment success, based on changes in marginal bone levels, was conducted using electronic records and consecutively taken radiographs. Results: Over a follow-up period of 12.3±2.0 years, 830 of the 872 implants remained intact, yielding a cumulative survival rate of 95.2% at the implant level and 88.4% at the patient level.The cumulative treatment success rates, characterized by marginal bone loss of less than 2 mm, stood at 87.0% for implants and 76.1% for patients. Among the 830 surviving implants, 113 fixtures were classified as ailing, with an average marginal bone loss of 4.09±1.44 mm.Cox regression analysis revealed that implants 8 mm in length or shorter were significantly more likely to fail or experience pathologic marginal bone resorption, with hazard ratios of 3.71 and 2.00, respectively (P<0.05). Conclusions The survival and treatment success of the investigated microthreaded, bone-level, 2-piece, internal connection implants were acceptable over a follow-up period exceeding 10 years. However, shorter dental implants exhibited a higher propensity for failure and excessive marginal bone loss.

Humeral head avascular necrosis (AVN) can cause significant shoulder morbidity and represents the second most common site of nontraumatic osteonecrosis after the femoral head. The pathophysiology centers on disrupted blood supply, ultimately leading to bone death and structural compromise. It is associated with various etiologies, including trauma, iatrogenic factors, hematologic conditions, lifestyle factors, certain environmental exposures, and systemic diseases. Diagnosis relies on a combination of clinical assessment and radiographic evaluation, with magnetic resonance imaging serving as the most sensitive modality for early detection. The Cruess classification system guides treatment decisions. Although conservative measures are used in early stages, they carry a risk of progression, as they do not alter the disease course—unlike surgical techniques such as core decompression. Arthroplasty is reserved for later stages with evidence of collapse, with research suggesting that the use of pyrocarbon in hemiarthroplasty may help reduce glenoid erosion. This review provides a comprehensive overview of humeral head osteonecrosis, emphasizing its etiology, clinical evaluation, imaging findings, and treatment strategies. It highlights the growing support for early operative intervention over conservative management, emerging treatment modalities such as biologic augmentation and allografting, and promising new materials like pyrocarbon in hemiarthroplasty to mitigate glenoid erosion.

Midshaft clavicular fractures account for approximately 80% of all clavicle fractures in pediatric and adolescent populations and represent up to 15% of all fractures in adolescents. These injuries commonly result from falls, sports-related trauma, or motor vehicle accidents, with adolescent males experiencing fractures at rates up to three times higher than females. This review examines the diagnosis, classification, and management of these fractures, highlighting the nuances between pediatric and adult treatment approaches. Historically, nonoperative management has been favored, leveraging the adolescent clavicle’s remodeling capacity. Recent trends reflect increasing operative interventions, driven by adult studies demonstrating faster recovery and improved functional outcomes in displaced fractures. While nonoperative treatment, using slings or figure-of-8 braces, remains effective for most cases, operative fixation, including open reduction and internal fixation or elastic stable intramedullary nailing, is indicated for open fractures, neurovascular injury, or significant displacement. Studies demonstrate high union rates with both methods, but operative treatment offers quicker return to activity, albeit with higher risks of hardware- related complications. The Function after Adolescent Clavicle Trauma and Surgery study notably supports nonoperative management, showing similar long-term functional outcomes compared to operative treatment. Future research should focus on refining patient-reported outcome measures specific to adolescents and identifying subsets of patients who may benefit from surgery. Shared decision-making remains crucial for optimal patient-centered care.

Background: and Purpose Posterior cerebral artery occlusion (PCAo) can cause long-term disability, yet randomized controlled trials to guide optimal reperfusion strategy are lacking. We compared the outcomes of PCAo patients treated with endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) to patients treated with IVT alone. Methods: From the multicenter retrospective Posterior cerebraL ArTery Occlusion (PLATO) registry, we included patients with isolated PCAo treated with reperfusion therapy within 24 hours of onset between January 2015 and August 2022. The primary outcome was the distribution of the modified Rankin Scale (mRS) at 3 months. Other outcomes comprised 3-month excellent (mRS 0–1) and independent outcome (mRS 0–2), early neurological improvement (ENI), mortality, and symptomatic intracranial hemorrhage (sICH). The treatments were compared using inverse probability weighted regression adjustment. Results: Among 724 patients, 400 received EVT+/-IVT and 324 IVT alone (median age 74 years, 57.7% men). The median National Institutes of Health Stroke Scale score on admission was 7, and the occluded segment was P1 (43.9%), P2 (48.3%), P3–P4 (6.1%), bilateral (1.0%), or fetal posterior cerebral artery (0.7%). Compared to IVT alone, EVT+/-IVT was not associated with improved functional outcome (adjusted common odds ratio [OR] 1.07, 95% confidence interval [CI] 0.79–1.43). EVT increased the odds for ENI (adjusted OR [aOR] 1.49, 95% CI 1.05–2.12), sICH (aOR 2.87, 95% CI 1.23–6.72), and mortality (aOR 1.77, 95% CI 1.07–2.95). Conclusion Despite higher odds for early improvement, EVT+/-IVT did not affect functional outcome compared to IVT alone after PCAo. This may be driven by the increased risk of sICH and mortality after EVT.

Arthroscopic shoulder procedures are one of the most common procedures used to restore function through minimally invasive techniques. With the demand for shoulder arthroscopic procedures comes the need for safe, effective, and efficient surgery that maximizes patient outcomes while minimizing complications. Many variables contribute to visualization in shoulder arthroscopy including vascular anatomy, blood pressure control, arthroscopic pump systems, turbulence control, epinephrine, and tranexamic acid. Furthermore, patient positioning can have a dramatic effect on visualization with both the beach chair position and lateral decubitus positioning having various strengths and weaknesses depending on the intended procedure being performed. The purpose of this review is to examine the benefits and complications reported in the literature for improving visualization in shoulder arthroscopy.

As the most pervasive epigenetic marker present on mRNAs and long non-coding RNAs (lncRNAs), N⁶-methyladenosine (m⁶A) RNA methylation has been shown to participate in essential biological processes. Recent studies have revealed the distinct patterns of m⁶A methylome across human tissues, and a major challenge remains in elucidating the tissue-specific presence and circuitry of m⁶A methylation. We present here a comprehensive online platform, m6A-TSHub, for unveiling the context-specific m⁶A methylation and genetic mutations that potentially regulate m⁶A epigenetic mark. m6A-TSHub consists of four core components, including (1) m6A-TSDB, a comprehensive database of 184,554 functionally annotated m⁶A sites derived from 23 human tissues and 499,369 m⁶A sites from 25 tumor conditions, respectively; (2) m6A-TSFinder, a web server for high-accuracy prediction of m⁶A methylation sites within a specific tissue from RNA sequences, which was constructed using multi-instance deep neural networks with gated attention; (3) m6A-TSVar, a web server for assessing the impact of genetic variants on tissue-specific m⁶A RNA modifications; and (4) m6A-CAVar, a database of 587,983 The Cancer Genome Atlas (TCGA) cancer mutations (derived from 27 cancer types) that were predicted to affect m⁶A modifications in the primary tissue of cancers. The database should make a useful resource for studying the m⁶A methylome and the genetic factors of epitranscriptome disturbance in a specific tissue (or cancer type). m6A-TSHub is accessible at www.xjtlu.edu.cn/biologicalsciences/m6ats.
Humans ; Methylation ; RNA, Messenger/metabolism* ; Neoplasms/genetics* ; Mutation

INTRODUCTION: Inappropriate attendances (IAs) to emergency departments (ED) create an unnecessary strain on healthcare systems. With decreased ED attendance during the COVID-19 pandemic, this study postulates that there are less IAs compared to before the pandemic and identifies factors associated with IAs. METHODS: We performed a retrospective review of 29,267 patient presentations to a healthcare cluster in Singapore from 7 April 2020 to 1 June 2020, and 36,370 patients within a corresponding period in 2019. This time frame coincided with local COVID-19 lockdown measures. IAs were defined as patient presentations with no investigations required, with patients eventually discharged from the ED. IAs in the 2020 period during the pandemic were compared with 2019. Multivariable logistic regression was performed to identify factors associated with IAs. RESULTS: There was a decrease in daily IAs in 2020 compared to 2019 (9.91±3.06 versus 24.96±5.92, P<0.001). IAs were more likely with self-referrals (adjusted odds ratio [aOR] 1.58, 95% confidence interval [CI] 1.50-1.66) and walk-ins (aOR 4.96, 95% CI 4.59-5.36), and those diagnosed with non-specific headache (aOR 2.08, 95% CI 1.85-2.34), or non-specific low back pain (aOR 1.28, 95% CI 1.15-1.42). IAs were less likely in 2020 compared to 2019 (aOR 0.67, 95% CI 0.65-0.71) and older patients (aOR 0.79 each 10 years, 95% CI 0.78-0.80). CONCLUSION ED IAs decreased during COVID-19. The pandemic has provided a unique opportunity to examine factors associated with IAs.
COVID-19 ; Communicable Disease Control ; Emergency Service, Hospital ; Humans ; Pandemics ; Retrospective Studies ; SARS-CoV-2

PURPOSE: In intrahepatic cholangiocarcinoma (iCCA), genetic characteristics on ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG)-PET scans are not yet clarified. If specific genetic characteristics were found to be related to FDG uptake in iCCA, we can predict molecular features based on the FDG uptake patterns and to distinguish different types of treatments. In this purpose, we analyzed RNA sequencing in iCCA patients to evaluate gene expression signatures associated with FDG uptake patterns. METHODS: We performed RNA sequencing of 22 cases iCCA who underwent preoperative ¹⁸F-FDG-PET, and analyzed the clinical and molecular features according to the maximum standard uptake value (SUVmax). Genes and biological pathway which are associated with SUVmax were analyzed. RESULTS: Patients with SUVmax higher than 9.0 (n = 9) had poorer disease-free survival than those with lower SUVmax (n = 13, P = 0.035). Genes related to glycolysis and gluconeogenesis, phosphorylation and cell cycle were significantly correlated with SUVmax (r ≥ 0.5). RRM2, which is related to the toxicity of Gemcitabine was positively correlated with SUVmax, and SLC27A2 which is associated with Cisplastin response was negatively correlated with SUVmax. According to the pathway analysis, cell cycle, cell division, hypoxia, inflammatory, and metabolism-related pathways were enriched in high SUVmax patients. CONCLUSION: The genomic features of gene expression and pathways can be predicted by FDG uptake features in iCCA. Patients with high FDG uptake have enriched cell cycle, metabolism and hypoxic pathways, which may lead to a more rational targeted treatment approach.
Anoxia ; Cell Cycle ; Cell Division ; Cholangiocarcinoma ; Disease-Free Survival ; Fluorodeoxyglucose F18 ; Gene Expression ; Gluconeogenesis ; Glycolysis ; Humans ; Metabolism ; Phosphorylation ; Positron-Emission Tomography ; Sequence Analysis, RNA ; Transcriptome

Objective: Single-nucleotide polymorphisms (SNPs) in the ataxia telangiectasiaemutated gene ATM have been linked with pneumonitis after radiotherapy for lung cancer but have not been evaluated in terms of pulmonary function impairment. Here we investigated potential associations between SNPs in ATM and changes in diffusing capacity of the lung for carbon monoxide (DLCO) in patients with nonesmall-cell lung cancer (NSCLC) after radiotherapy. Methods: From November 1998 through June 2009, 448 consecutive patients with inoperable primary NSCLC underwent definitive (≥60 Gy) radiotherapy, with or without chemotherapy. After excluding patients with a history of thoracic surgery, ra-diation, or lung cancer; without DNA samples available for analysis; or without pulmonary function testing within the 12 months before and the 12 months after radiotherapy, 100 patients were identified who are the subjects of this study. We genotyped two SNPs of ATM previously found to be associated with radiation-induced pneumonitis (rs189037 and rs228590) and evaluated potential correlations between these SNPs and impairment (decreases) in DLCO by using logistic regression analysis. Results: Univariate and multivariate analyses showed that the AA genotype of ATM rs189037 was associated with decreased DLCO after definitive radiotherapy than the GG/AG genotypes [univariate coefficient, -0.122; 95％ confidence interval (CI),-0.236 to -0.008; P = 0.037; and multivariate coefficient, -0.102; 95％ CI, -0.198 to -0.005; P = 0.038]. No such correlations were found for rs228590 (univariate coefficient, -0.096; 95％ CI, -0.208 to 0.017; P = 0.096). Conclusions: The AA genotype of ATM rs189037 was associated with higher risk of lung injury than were the GG/AG genotypes in patients with NSCLC treated with radiotherapy. This finding should be validated prospectively with other patient populations.