Objective To retrospectively analyze the clinical risk factors and prognosis of perioperative myocardial injury(MINS)in non-cardiac surgery patients admitted to the intensive care unit(ICU).Methods A total of 478 postoperative patients admitted to the Department of Intensive Medicine,Minhang Hospital,Fudan University from Jan 2020 to Dec 2023 were selected.They were divided into MINS group(n=302)and normal group(n=176)based on whether myocardial injury occurred within 7 days after surgery.The differences in clinical characteristics between the two groups were compared,and risk factors for perioperative myocardial injury were identified.Risk factors for mortality in the MINS group were analyzed with 30-day mortality as the clinical endpoint.Results The prevalence of acute physiology and chronic health evaluation Ⅱ(Apache Ⅱ)score,coronary artery disease,and chronic kidney disease were all higher in the MINS group than those in the normal group,with statistically significant differences(P<0.05).The proportion of emergency surgeries,co-infection,and perioperative hypotension were significantly different between the MINS group and the normal group(P<0.05).Multivariate logistic regression analysis revealed that chronic kidney disease,emergency surgery,co-infection,and intraoperative and postoperative hypotension were risk factors for MINS occurrence.Prognostic analysis indicated that perioperative hypotension was a risk factor for 30-day mortality in MINS patients.Conclusion MINS is closely associated with patients'underlying conditions,timing of surgery,and perioperative hypotension status,and especially perioperative hypotension affects the final outcomes.

Objective To retrospectively analyze the clinical risk factors and prognosis of perioperative myocardial injury(MINS)in non-cardiac surgery patients admitted to the intensive care unit(ICU).Methods A total of 478 postoperative patients admitted to the Department of Intensive Medicine,Minhang Hospital,Fudan University from Jan 2020 to Dec 2023 were selected.They were divided into MINS group(n=302)and normal group(n=176)based on whether myocardial injury occurred within 7 days after surgery.The differences in clinical characteristics between the two groups were compared,and risk factors for perioperative myocardial injury were identified.Risk factors for mortality in the MINS group were analyzed with 30-day mortality as the clinical endpoint.Results The prevalence of acute physiology and chronic health evaluation Ⅱ(Apache Ⅱ)score,coronary artery disease,and chronic kidney disease were all higher in the MINS group than those in the normal group,with statistically significant differences(P<0.05).The proportion of emergency surgeries,co-infection,and perioperative hypotension were significantly different between the MINS group and the normal group(P<0.05).Multivariate logistic regression analysis revealed that chronic kidney disease,emergency surgery,co-infection,and intraoperative and postoperative hypotension were risk factors for MINS occurrence.Prognostic analysis indicated that perioperative hypotension was a risk factor for 30-day mortality in MINS patients.Conclusion MINS is closely associated with patients'underlying conditions,timing of surgery,and perioperative hypotension status,and especially perioperative hypotension affects the final outcomes.

Objectives:To develop a new type of multifunctional rectangle transoral exposure retractor(MRTER)and explore its clinical application value.Methods:From 2020 to 2025,we performed 310 cases of transoropharyngeal atlantoaxial surgery,of which 162 cases used Codman retractors[Codman group,72 males and 90 females,aged 9-67 years old,47 cases were with simple atlantoaxial dislocation(AAD),115 cases were with basilar invagination],and 148 cases used the MRTER retractor system(MRTER group,63 males and 85 females,aged 6-72 years old,39 cases were with AAD,109 cases were with basilar invagination).The main clinical symptoms of the patients included cervical pain and restricted mobility in 49 cases,torticollis in 54 cases,weak and numbness of the limbs in 259 cases,finger inflexibility in 43 cases,walking instability in 178 cases,and bladder dysfunction in 5 cases.After admission,a transoral atlantoaxial reduction and plate internal fixation(TARP)was performed.Among the patients,86 with AAD did not undergo a soft palate split,and 224 patients with basilar invagination underwent a soft palate split to expand the exposure and then un-derwent transoral release and reduction+TARP procedures.Intraoperative oral opening distance(D value)and o-ral floor field of view area(S value)were measured to evaluate the exposure ability of the retractor system.The global reduction rate of atlantoaxial dislocation was measured on the cervical sagittal CT film,and the JOA score improvement rate at the final follow-up was calculated to evaluate the effect of the operation.Re-sults:The surgical procedure of 310 patients was smooth,the operation time was 138±25min in Codman group and 118±31min in MRTER group(P＜0.05);The surgical blood loss was 105±45mL in Codman group and 113±28mL in MRTER group(P＞0.05).The intraoperative measured D value was 4.0±2.1cm in Codman group and 4.2±1.9cm in MRTER group(P＞0.05);the S value was 6.3±2.8cm2 in Codman group and 7.1±3.1cm2 in MRTER group(P＜0.05).After operation,the symptoms of headache and neck pain were significantly relieved;the symptoms of limb numbness,weakness and walking instability were improved to varying degrees.The overall reduction rate of AAD was 81.3％in Codman group,and 82.5％in MRTER group(P＞0.05);JOA improvement rate was 71％in Codman group,and 73％in MRTER group(P＞0.05).Conclusions:The new MRTER exposure system provides an effective auxiliary tool for the implementation of atlantoaxial transoropha-ryngeal surgery.

Objective:To investigate the preferences for professional risks insurance among healthcare professionals in Chinese tertiary hospitals,providing a reference for understanding core demands and formulating personalized insurance plans.Methods:A questionnaire survey was conducted among 187 healthcare professionals from 9 tertiary hospitals in Shandong Province using acombination of stratified and convenience sampling.Mixed Logit models and the joint utility method were employed for analysis of the overall sample and clinical/non-clinical subgroups.Results:The mixed Logit model revealed that the type of compensation,insurance platform,and insurance duration significantly influenced the insurance attribute preferences of healthcare professionals(P<0.05),with the type of compensation having the greatest impact(β=0.220).The joint utility analysis indicated that insurance duration was of the highest relative importance(39%),while the premium amount was of the least importance(4%).In subgroup analysis,for clinical professionals,the type of compensation and insurance duration significantly influenced insurance attribute preferences,with the type of compensation having the greatest impact(β=0.277),followed by insurance duration.For non-clinical professionals,the premium amount and insurance platform were significant factors,with the premium amount being the most influential.Conclusion:Efficiency is a common core consideration for healthcare professionals when choosing insurance preferences,while economic factors are not central to the considerations of clinical professionals.The influence and role of medical associations in mitigating occupational risks need to be enhanced.It is suggested that future insurance products should fully consider the differences in the scope of practice,target certain attributes for enhancement,and strengthen the influence of medical associations in ensuring professional risks.

Objective To design an 8-channel gene analyzer to take the place of the widely used gene analyzer with problems in inconvenient consumable replacement and short storage time of electrophoresis polymer.Methods The 8-channel gene analyzer had its mechanical components composed of an automatic sample loading table,a polymer injection module,a high-voltage temperature control module,an optical module and an integrated U box,its electrical control system made up of a host computer(an embedded computer)and three slave computers(a sampling control board,a polymer injection control board and a high-voltage temperature control board).The automatic sample loading table involved in four motors and transmission systems for x,y,z directions and optical alignment,the transmission systems adopted mainly belt drive mode and the optical alignment motor had its threads with an anti-backlash structure;the polymer injuection module was manipulated by the polymer injection control board,and the polymer block was made of highly transparent acrylic material;the high-voltage temperature control module realized the regulation of electrophoresis voltage and the detection of electrophoresis current by the low-ripple precision high-voltage power supply,and controlled the temperature of the heating furnace by the proportional-integral-differential(PID)algorithm;the optical module consisted of an excitation module and a light-receiving module,which had the base of the reflector made of low expansion coefficient alloy material;the integrated U box had the electrophoresis polymer,capillary array,polymer block and anode buffer in a plastic housing;the host computer had the data acquisition software programmed with C# and C++,and the slave computers were controlled by STM32 SCM.Results The 8-channel gene analyzer had no significant differences with the widely used ABI3500 gene analyzer in resolution,precision accuracy and clinical results.Conclusion The 8-channel gene analyzer gains advantages in consumable replacement and storage time of electrophoresis polymer,and can meet the requirements for gene sequencing.[Chinese Medical Equipment Journal,2025,46(2):24-30]

Objectives:To develop a new type of multifunctional rectangle transoral exposure retractor(MRTER)and explore its clinical application value.Methods:From 2020 to 2025,we performed 310 cases of transoropharyngeal atlantoaxial surgery,of which 162 cases used Codman retractors[Codman group,72 males and 90 females,aged 9-67 years old,47 cases were with simple atlantoaxial dislocation(AAD),115 cases were with basilar invagination],and 148 cases used the MRTER retractor system(MRTER group,63 males and 85 females,aged 6-72 years old,39 cases were with AAD,109 cases were with basilar invagination).The main clinical symptoms of the patients included cervical pain and restricted mobility in 49 cases,torticollis in 54 cases,weak and numbness of the limbs in 259 cases,finger inflexibility in 43 cases,walking instability in 178 cases,and bladder dysfunction in 5 cases.After admission,a transoral atlantoaxial reduction and plate internal fixation(TARP)was performed.Among the patients,86 with AAD did not undergo a soft palate split,and 224 patients with basilar invagination underwent a soft palate split to expand the exposure and then un-derwent transoral release and reduction+TARP procedures.Intraoperative oral opening distance(D value)and o-ral floor field of view area(S value)were measured to evaluate the exposure ability of the retractor system.The global reduction rate of atlantoaxial dislocation was measured on the cervical sagittal CT film,and the JOA score improvement rate at the final follow-up was calculated to evaluate the effect of the operation.Re-sults:The surgical procedure of 310 patients was smooth,the operation time was 138±25min in Codman group and 118±31min in MRTER group(P＜0.05);The surgical blood loss was 105±45mL in Codman group and 113±28mL in MRTER group(P＞0.05).The intraoperative measured D value was 4.0±2.1cm in Codman group and 4.2±1.9cm in MRTER group(P＞0.05);the S value was 6.3±2.8cm2 in Codman group and 7.1±3.1cm2 in MRTER group(P＜0.05).After operation,the symptoms of headache and neck pain were significantly relieved;the symptoms of limb numbness,weakness and walking instability were improved to varying degrees.The overall reduction rate of AAD was 81.3％in Codman group,and 82.5％in MRTER group(P＞0.05);JOA improvement rate was 71％in Codman group,and 73％in MRTER group(P＞0.05).Conclusions:The new MRTER exposure system provides an effective auxiliary tool for the implementation of atlantoaxial transoropha-ryngeal surgery.

This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.

Objective:To analyze the revision strategies for failed atlantoaxial dislocation (AAD) surgery.Methods:A retrospective analysis was conducted on 145 patients who underwent revision surgery for AAD at the General Hospital of Southern Theatre Command of PLA between September 2009 and December 2023. The cohort included 74 males and 71 females, with a mean age of 43±16 years (range, 6-72 years). The initial surgical approaches were: anterior 31 cases, posterior 114 cases. Based on imaging assessments of immediate postoperative reduction and fusion status prior to revision, the cases of failure were classified into reduction-nonfusion type (22 cases), nonreduction-fusion type (31 cases), and nonreduction-nonfusion type (92 cases). Among the nonreduction-nonfusion cases, 39 had initial surgery with internal fixation for reduction, while 53 had initial surgery with simple decompression (posterior arch resection, foramen magnum decompression) without reduction. In the nonreduction-fusion cases, 8 cases had spot fusion and 23 had extensive fusion. Japanese Orthopaedic Association (JOA) scores were compared before and after revision, and complication rates were observed.Results:All patients successfully underwent surgery. The revision approaches included: anterior (anterior fixation and fusion 52 cases, anterior implant removal combined anterior fixation and fusion 4 cases, transoral odontoidectomies 16 cases, anterior implant removal combined transoral odontoidectomy 2 cases), posterior (posterior fixation and fusion 2 cases, posterior implant removal combined posterior fixation and fusion 22 cases), and combined anterior-posterior (posterior implant removal combined anterior fixation and fusion 18 cases, anterior implant removal combined posterior fixation and fusion 25 cases, posterior implant removal combined transoral odontoidectomy 5 cases). Operative time was 254.20±107.63 min (range, 90-660 min), and blood loss was 218.83±172.17 ml (range, 20-800 ml). Except for 3 patients who died due to postoperative complications, all patients were followed up for a duration of 12±11 months (range, 3-60 months). Six patients who failed to achieve bony fusion after the initial revision surgery underwent a second revision due to poor reduction (1 case), infection (1 case), suboptimal implant position (3 cases), and graft nonunion (1 case). All three patients with bony fusion after the initial revision surgery underwent a second revision due to poor reduction. Following the second revision surgery, none of the 9 patients exhibited graft nonunion or spinal cord compression. The 136 successful initial revision cases had a final follow-up JOA score of 14.75±2.00, significantly higher than the preoperative score of 11.93±2.92 ( t=-18.869, P<0.001). Conclusions:Revision surgery for AAD should take into account the immediate postoperative reduction status and fusion status prior to revision. An appropriate revision strategy should be selected to achieve satisfactory reduction and bony fusion.

Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.
Humans ; Consensus ; Dental Caries/etiology* ; Dental Enamel/pathology* ; Tooth Demineralization/etiology* ; Tooth Remineralization

Objective:To investigate the preferences for professional risks insurance among healthcare professionals in Chinese tertiary hospitals,providing a reference for understanding core demands and formulating personalized insurance plans.Methods:A questionnaire survey was conducted among 187 healthcare professionals from 9 tertiary hospitals in Shandong Province using acombination of stratified and convenience sampling.Mixed Logit models and the joint utility method were employed for analysis of the overall sample and clinical/non-clinical subgroups.Results:The mixed Logit model revealed that the type of compensation,insurance platform,and insurance duration significantly influenced the insurance attribute preferences of healthcare professionals(P<0.05),with the type of compensation having the greatest impact(β=0.220).The joint utility analysis indicated that insurance duration was of the highest relative importance(39%),while the premium amount was of the least importance(4%).In subgroup analysis,for clinical professionals,the type of compensation and insurance duration significantly influenced insurance attribute preferences,with the type of compensation having the greatest impact(β=0.277),followed by insurance duration.For non-clinical professionals,the premium amount and insurance platform were significant factors,with the premium amount being the most influential.Conclusion:Efficiency is a common core consideration for healthcare professionals when choosing insurance preferences,while economic factors are not central to the considerations of clinical professionals.The influence and role of medical associations in mitigating occupational risks need to be enhanced.It is suggested that future insurance products should fully consider the differences in the scope of practice,target certain attributes for enhancement,and strengthen the influence of medical associations in ensuring professional risks.