OBJECTIVE: To investigate the effectiveness of endoscopic-assisted median nerve decompression with one-stage extensor indicis proprius (EIP) tendon transfer for reconstruction of thumb abduction in patients with severe carpal tunnel syndrome (CTS). METHODS: The clinical data of 12 patients with severe CTS who met the selection criteria between December 2019 and December 2024 were retrospectively analyzed. There were 2 males and 10 females with an average age of 55.4 years ranging from 35 to 67 years. The symptom duration of CTS was 12-120 months (mean, 48.7 months) and the thenar muscle atrophy duration was 6-48 months (mean, 13.4 months). The median nerve was released with the help of endoscope, and the EIP tendon was transferred to reconstruct the abduction function of the thumb. The operation time and complications were recorded. Two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, and pinch force of the thumb were measured and compared before operation and at last follow-up, and the effectiveness was evaluated by Kapandji score and Disabilities of the Arm, Shoulder and Hand (DASH) score. The satisfaction of the operation was evaluated at last follow-up. RESULTS: All surgeries were successfully completed with a mean operation time of 54 minutes (range, 45-68 minutes). All patients were followed up 6-50 months, with an average of 15.3 months. There was no complications such as wound infection, scar pain of wrist, or tendon rupture of transposition, and there were 3 cases of mild limitation of finger extension in the donor site of index finger. At last follow-up, two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, Kapandji score, and DASH score were significantly better than those before operation ( P<0.05), but there was no significant difference in thumb pinch force between pre- and post-operation ( P>0.05). The evaluation of surgical satisfaction showed that 7 cases were very satisfied and 5 cases were satisfied. CONCLUSION The combination of endoscopic-assisted median nerve decompression and one-stage EIP tendon transfer effectively improves hand function and quality of life in patients with severe CTS by restoring thumb abduction and alleviating neurological symptoms.
Humans ; Tendon Transfer/methods* ; Male ; Middle Aged ; Carpal Tunnel Syndrome/physiopathology* ; Female ; Decompression, Surgical/methods* ; Aged ; Adult ; Thumb/physiopathology* ; Endoscopy/methods* ; Retrospective Studies ; Median Nerve/surgery* ; Treatment Outcome ; Plastic Surgery Procedures/methods*

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

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective:To investigate the feasibility of segmented total marrow and lymphoid irradiation(TMLI)using Helical TomoTherapy(HT)in adults,and to analyze the impact of positional errors in the treatment on the actually received dose.Methods:Imaging data from four adult patients with acute myeloid leukemia were treated at the First Medical Center of the Chinese PLA General Hospital between November 2022 and December 2024 were retrospectively selected.The prescribed dose was 12 Gy in 3 fractions,and the heights range of patient was from 162 to 178 cm.The planning target volume(PTV)included the entire bone marrow and lymphatic drainage regions.The mid-femur was used as the dividing landmark,and the segmented location of head-in first(upper segmentation)and foot-in first(lower segmentation)were adopted to design plan for each segmentation.The upper segmentation used helical tomotherapy,and the lower segmentation used tomo direct therapy.The dosimetric parameters of planning target volume,and organ at risk(OAR)included eye lens,testicles and lungs were analyzed.The located computed tomography(CT)images of patients were used to simulate the changes of dosimetric parameters of each planning target region and OAR when the positions of patients moved 3,5,10 and 15 mm to outside of rack aperture.The changes of dose distribution of connection region of upper and lower segmentation were further analyzed.Results:The segmented irradiation technique can better achieve the cover(95%)of whole target region of TMLI under the condition of protecting normal organs.Under the condition with different position errors,the cover rate of the most of target region significant decreased.The largest dose of right lens increased 9.272%than primary under the 5 mm position error,and that of left and right lens increased respectively 40.199%and 67.898%under the 10 mm position error,and the max dose and mean dose of testicles increased respectively 5.847%and 5.240%under the 3mm position error.The mean dose of whole lung increased all under the error at different grades,which increased 3.021%under the 10mm position error.The non-uniformity of dose distribution of connection region increased after the position error was introduced,and the largest variation range reached to 4 Gy.Conclusion:The technique of segmented radiotherapy of Helical Tomotherapy has feasibility for TMLI of adult.But the error of the position of patients can reduce the cover of target region,and decrease the control rate for target region,and can lead to the occurrences of excessive doses on eye lens,testicles,lung and other OAR at the same time,which can increase the probability of occurring OAR injury.It should be high pay attention in treatment and implementation.

Objective:To explore the predictive factors for ureteral stone impaction preoperatively and to construct a nomogram prediction model for impacted ureteral stones.Methods:A retrospective analysis was conducted on the clinical data of 209 patients with ureteral stones treated at The Second Affiliated Hospital of Zhengzhou University from July 2023 to June 2024. There were 164 males（78.5%）and 45 females（21.5%）. The age was 49（47，57）years，and the body mass index（BMI）was 25.10（23.55，27.24）kg/m2. Of the patients，85（40.7%）had comorbid hypertension and 85（40.7%）had comorbid diabetes. Stones were located on the left side in 124 patients（59.3%）and on the right side in 85 patients（40.7%）. Hydronephrosis was present in 169 patients（80.9%），and urine culture was positive in 29 patients（13.9%）. Patients were divided into impacted and non-impacted groups based on the presence or absence of ureteral stone impaction. Univariate and multivariate logistic regression analyses were performed to determine independent predictive factors for impacted ureteral stones. A nomogram model was constructed based on these results. The performance of the predictive model was evaluated using receiver operating characteristic（ROC）curves，calibration plots，and decision curve analysis（DCA）.Results:Among the 209 patients in this study，85（40.7%）experienced ureteral stone impaction. The impacted group had a significantly higher neutrophil-to-lymphocyte ratio（NLR）than the non-impacted group（3.91 ± 2.05 vs. 3.25 ± 2.10， P = 0.024），a higher rate of hydronephrosis［81.2%（69/85）vs. 80.6%（100/124）， P = 0.002］，larger stone surface area［（64.96 ± 39.96）mm2 vs.（51.86 ± 39.80）mm2， P = 0.021］，greater ureteral wall thickness（UWT）［（3.96 ± 1.37）mm vs.（3.06 ± 1.33）mm， P < 0.001］，and a higher ratio of the upper ureter diameter（D1）to the lower ureter diameter（D2）（DDR）（2.87 ± 1.58 vs. 2.00 ± 0.99， P < 0.001）. Univariate analysis showed that NLR，hydronephrosis，stone length，stone surface area，UWT，D1，D2，and DDR were statistically significant（ P < 0.05）. After multivariate logistic regression analysis，the following items were identified as independent predictors of impacted ureteral stones：NLR（ OR = 1.205，95% CI 1.026 - 1.415， P = 0.023），hydronephrosis（ OR = 1.840，95% CI 1.236 - 2.740， P = 0.003），stone length（ OR = 1.587，95% CI 1.142 - 2.206， P = 0.006），ureteral wall thickness（UWT）（ OR = 1.643，95% CI 1.263 - 2.136， P < 0.001），and DDR（ OR = 2.907，95% CI 1.040 - 8.130， P = 0.042）.Based on these independent predictive factors，a nomogram prediction model for impacted ureteral stones was constructed. The area under the ROC curve was 0.797（95% CI 0.737 - 0.858），and the calibration curve showed good consistency. The decision curve suggested that the model had good clinical net benefit. Conclusions:NLR，hydronephrosis，stone length，UWT，and DDR are all independent predictors for impacted ureteral stones. The nomogram model constructed based on these factors has good predictive performance.

Objectives:This study aimed to explore the association between perceived mental stress (MS), lymphocyte subset variations, and coronary lesion severity in patients with coronary artery disease (CAD).Methods:Patients with CAD were enrolled in this study from September 2023 to May 2024. Perceived Stress Scale-14 (PSS-14) was used to evaluate MS during the last 1 month. Lymphocyte subsets were analyzed, including the percentage and absolute counts of CD3 +, CD3 +CD4 +, CD3 +CD8 +, CD3 -CD19 +, CD3 -CD56 +16 +, and the Th/Ts ratio. Statistical analysis was conducted using SPSS 24.0. Results:This study recruited patients with 323 CAD, with an average age of 61 (56, 68) years, including 203 males and 120 females. According to the PSS-14, a score of 14-42 and 43-70 were categorized as normal and increased MS, respectively. Patients with CAD with increased MS had significantly higher Gensini scores than those with normal MS [37(19,64) vs. 28(12,50), Z=-2.19, P=0.029]. Male CAD patients with increased MS exhibited significantly higher Gensini scores [39(20, 58) vs. 26(12, 45), Z=-2.37, P=0.018], levels of CD3 +CD8 +%[28.3%(23.6%,36.6%) vs. 25.9%(21.0%,32.4%), Z=-2.05, P=0.041], and CD3 +CD8 +absolute value [485 (346, 675) vs. 396 (309, 510) cells/μl, Z=-2.55, P=0.011] than those with normal MS. In male patients with CAD, a positive correlation was observed between Gensini scores (correlation coefficient: 0.181, P=0.011), PSS-14 scores, and CD3 +CD8 +absolute value (correlation coefficient: 0.162, P=0.038). Conclusion:This study reveals a positive correlation between MS and coronary stenosis severity, with notable sex differences. In male patients with CAD, higher levels of MS are associated with more severe coronary stenosis. The potential underlying mechanism may involve the regulation of lymphocyte subsets .

Contralateral radiculopathy, a postoperative complication after transforaminal lumbar interbody fusion, refers to postoperative numbness, pain and other neurological symptoms of the lower limb on the side opposite to the symptomatic or the surgical decompression side. Its main causes include excessive restoration of lordosis, intervertebral space tilt caused by improper cage position, poor screw position, new protrusion of nucleus pulposus or bone graft, and hematoma. At present, attention to this complication is gradually increasing. This review summarizes its risk factors from the recent related reports of the condition and puts forward preventive measures in order to promote the preventive awareness of this complication.

The incidence of chronic venous disease(CVD)is significantly higher in the elderly population compared to non-elderly individuals,with more severe disease manifestations.Additionally,elderly CVD patients often have comorbid conditions such as cardiovascular diseases,making the evaluation process more complex and increasing treatment difficulty.Currently,there are no established recommendations in China for the diagnosis and treatment of CVD in individuals aged 60 and above.Against this backdrop,the Peripheral Vascular Disease Management Branch of the Chinese Geriatric Society has developed the Chinese Expert Consensus on the Diagnosis and Treatment of Chronic Venous Disease in the Elderly based on domestic and international guidelines,relevant evidence-based medical research,and the physiological and clinical characteristics of the elderly population in China.This consensus aims to provide an important reference for improving the diagnosis and treatment of CVD in elderly patients in China.

The incidence of chronic venous disease(CVD)is significantly higher in the elderly population compared to non-elderly individuals,with more severe disease manifestations.Additionally,elderly CVD patients often have comorbid conditions such as cardiovascular diseases,making the evaluation process more complex and increasing treatment difficulty.Currently,there are no established recommendations in China for the diagnosis and treatment of CVD in individuals aged 60 and above.Against this backdrop,the Peripheral Vascular Disease Management Branch of the Chinese Geriatric Society has developed the Chinese Expert Consensus on the Diagnosis and Treatment of Chronic Venous Disease in the Elderly based on domestic and international guidelines,relevant evidence-based medical research,and the physiological and clinical characteristics of the elderly population in China.This consensus aims to provide an important reference for improving the diagnosis and treatment of CVD in elderly patients in China.