BACKGROUND:The individualized precise puncture approach is a new approach proposed for vertebral body augmentation in recent years,and has achieved good clinical results,but there is still a lack of relevant biomechanical research.OBJECTIVE:To investigate the biomechanical effects of individualized precise puncture vertebral augmentation on the vertebral endplate and intervertebral disc of osteoporotic vertebral compression fracture using finite element analysis method.METHODS:A total of six preoperative and postoperative models of wedge type,biconcave type,and collapse type were established using the preoperative and postoperative CT imaging data of three osteoporotic vertebral compression fracture patients who had completed individualized precise puncture vertebral augmentation.500 N moment and 10 N/m rotation moment were loaded in the vertical direction of the vertebral body to simulate the normal physiological activities of the vertebral body,including forward flexion,back extension,left bending,right bending,left rotation,and right rotation,to observe the stress changes of endplates,adjacent endplates,and intervertebral discs of different types of fractured vertebral bodies after individualized precise puncture vertebral augmentation.RESULTS AND CONCLUSION:(1)Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established.(2)After individualized precise puncture vertebral augmentation,the maximum von Mises stress values of wedge-shaped,biconcave,and collapsed fractured vertebral endplates and adjacent vertebral endplates were reduced to a certain extent.The postoperative maximum von Mises stress value increased in the T10 inferior endplate of the superior vertebral body with wedge deformity and the L1 superior endplate of the inferior vertebral body with collapsed deformity.(3)After individualized precise puncture vertebral augmentation,the overall maximum von Mises stress value of adjacent intervertebral discs in the three finite element models decreased.(4)The results show that individualized precise puncture vertebral augmentation can reduce the maximum von Mises stress value of the endplate of wedge-shaped deformity,biconcave deformity and collapsed vertebral body to a certain extent,and diminish the risk of postoperative vertebral body re-fracture.In addition,individualized precise puncture vertebral augmentation decreases the maximum von Mises stress value of the intervertebral disc,which can theoretically alleviate intervertebral disc degeneration to a certain extent.

BACKGROUND:Pedicle internal bone cement augmentation combined with vertebroplasty has been used to treat diseases such as Kummell's disease and osteolytic metastases of the pedicle.However,the impact of this surgical method on adjacent vertebrae and intervertebral discs remains unclear.OBJECTIVE:A three-dimensional finite element model was used to explore the impact of percutaneous vertebroplasty combined with pedicles augmentation in the treatment of severe osteoporotic vertebral fractures on the biomechanics of adjacent segmental vertebral bodies and intervertebral discs.METHODS:A female patient who had undergone percutaneous vertebroplasty combined with pedicles augmentation for a severe osteoporotic vertebral fracture(L1)was selected.Preoperative and postoperative CT files were extracted.The study range was T12 to L2,including the injured vertebra,adjacent vertebrae,and intervertebral discs.Software like Mimics,SolidWorks,and Geomagic was used to establish finite element models of the spinal functional unit before and after surgery.A 500 N force and a 10 N·m rotational torque were applied in the vertical direction of the T12 upper endplate to simulate movements such as flexion,extension,lateral bending,and rotation,analyzing the stress changes in the vertebral endplates and intervertebral discs of adjacent segments before and after surgery.RESULTS AND CONCLUSION:(1)Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established.(2)We calculated and analyzed that under simulated load,the stress distribution of the inferior endplate of T12 was more uniform and the maximum stress value was reduced after surgery,with no significant difference compared with before surgery(P＞0.05).The stress distribution of the superior endplate of L2 after surgery was more uniform and the maximum stress was not significantly different from that before surgery(P＞0.05).Similarly,the stress distribution of T12/L1 and L1/L2 intervertebral discs after surgery was also more uniform and the maximum stress value was significantly reduced(P＜0.05).(3)Therefore,percutaneous vertebroplasty combined with pedicles augmentation can effectively improve the stress distribution of adjacent vertebral endplates and intervertebral discs after surgery and reduce stress,ultimately reducing the risk of postoperative re-fractures and significantly delaying intervertebral disc degeneration.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Acute ischemic stroke (AIS) is a cerebrovascular disease characterized by high morbidity, disability, and mortality, posing a significant threat to human health. Endovascular treatment has now been established as a key method for AIS management, in which stent retrievers that can mechanically remove blood clots play a key role in this technique. In recent years, stent retrievers have evolved in complexity and functionality to improve the ability of clot removing and surgical safety. However, the present instruments still have limitations on treatment efficiency, vascular adaptability, and operational precision, posing an urgent need for innovation in the design of stent retrievers. This paper systematically reviewed the structural features and working principles of AIS stent retrievers from the perspective of efficacy evaluation metrics, historical development, recent advancements in stent retrieval technology, and future prospects.
Humans ; Ischemic Stroke/surgery* ; Stents ; Endovascular Procedures/methods* ; Thrombectomy/methods* ; Device Removal/methods*

Silent mutations within the RAS  gene have garnered increasing attention for their potential roles in tumorigenesis and therapeutic strategies. Kirsten-RAS ( KRAS ) mutations, predominantly oncogenic, are pivotal drivers in various cancers. While extensive research has elucidated the molecular mechanisms and biological consequences of active KRAS  mutations, the functional significance of silent mutations remains relatively understudied. This review synthesizes current knowledge on KRAS  silent mutations, highlighting their impact on cancer development. Silent mutations, which do not alter protein sequences but can affect RNA stability and translational efficiency, pose intriguing questions regarding their contribution to tumor biology. Understanding these mutations is crucial for comprehensively unraveling KRAS -driven oncogenesis and exploring novel therapeutic avenues. Moreover, investigations into the clinical implications of silent mutations in KRAS -mutant tumors suggest potential diagnostic and therapeutic strategies. Despite being in early stages, research on KRAS  silent mutations holds promise for uncovering novel insights that could inform personalized cancer treatments. In conclusion, this review underscores the evolving landscape of KRAS  silent mutations, advocating for further exploration to bridge fundamental biology with clinical applications in oncology.
Humans ; Mutation/genetics* ; Neoplasms/genetics* ; Proto-Oncogene Proteins p21(ras)/genetics* ; Animals

OBJECTIVE To explore the time windows for postoperative pneumonia in patients undergoing different surgeries,providing evidence-based references for optimizing infection monitoring and prevention and control strategies.METHODS Sociodemographic characteristics,clinical information and surgical details of 263 patients with postoperative pneumonia from four different types of medical institutions between Jan.2019 and Dec.2024 were retrospectively collected.The time windows for postoperative pneumonia in patients undergoing different surgeries were analyzed.RESULTS There were no statistically significant differences in the time windows for post-operative pneumonia among groups in terms of sociodemographic factors and underlying diseases.However,sta-tistically significant differences were observed in the time windows for postoperative pneumonia based on surgery type,incision type,surgical approach and surgery duration(P＜0.05).The average time for the onset of postop-erative pneumonia in 263 patients was 2.00(1.00,7.00)days.The postoperative time windows varied for sur-geries involving different systems.The peak incidence occurred on day 0(16 cases)and day 1(17 cases)af-ter neurological surgery,while the peak incidence for digestive system and orthopedic surgeries was on day 1.The time span for the onset of pneumonia after skin surgeries was wider(0-53 days postoperatively)without a clear peak.In addition,33.33％of cardiovascular system surgery cases developed pneumonia 10 days postoperatively.There were also significant time differences in the diagnostic elements of postoperative pneumonia,with fever and abnormal white blood cell counts appearing earlier(median appearance time length:4.00 days)than lung imaging changes(median appearance time length:7.00 days).CONCLUSIONS This study demonstrates significant time differences in the on-set of postoperative pneumonia and confirms the significant spatiotemporal heterogeneity in the diagnostic elements of postoperative pneumonia.These findings provide a quantitative basis for developing dynamic,surgery-type-spe-cific monitoring protocols and prevention and control measures for postoperative pneumonia.

BACKGROUND:Pedicle internal bone cement augmentation combined with vertebroplasty has been used to treat diseases such as Kummell's disease and osteolytic metastases of the pedicle.However,the impact of this surgical method on adjacent vertebrae and intervertebral discs remains unclear.OBJECTIVE:A three-dimensional finite element model was used to explore the impact of percutaneous vertebroplasty combined with pedicles augmentation in the treatment of severe osteoporotic vertebral fractures on the biomechanics of adjacent segmental vertebral bodies and intervertebral discs.METHODS:A female patient who had undergone percutaneous vertebroplasty combined with pedicles augmentation for a severe osteoporotic vertebral fracture(L1)was selected.Preoperative and postoperative CT files were extracted.The study range was T12 to L2,including the injured vertebra,adjacent vertebrae,and intervertebral discs.Software like Mimics,SolidWorks,and Geomagic was used to establish finite element models of the spinal functional unit before and after surgery.A 500 N force and a 10 N·m rotational torque were applied in the vertical direction of the T12 upper endplate to simulate movements such as flexion,extension,lateral bending,and rotation,analyzing the stress changes in the vertebral endplates and intervertebral discs of adjacent segments before and after surgery.RESULTS AND CONCLUSION:(1)Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established.(2)We calculated and analyzed that under simulated load,the stress distribution of the inferior endplate of T12 was more uniform and the maximum stress value was reduced after surgery,with no significant difference compared with before surgery(P＞0.05).The stress distribution of the superior endplate of L2 after surgery was more uniform and the maximum stress was not significantly different from that before surgery(P＞0.05).Similarly,the stress distribution of T12/L1 and L1/L2 intervertebral discs after surgery was also more uniform and the maximum stress value was significantly reduced(P＜0.05).(3)Therefore,percutaneous vertebroplasty combined with pedicles augmentation can effectively improve the stress distribution of adjacent vertebral endplates and intervertebral discs after surgery and reduce stress,ultimately reducing the risk of postoperative re-fractures and significantly delaying intervertebral disc degeneration.

OBJECTIVE To explore the time windows for postoperative pneumonia in patients undergoing different surgeries,providing evidence-based references for optimizing infection monitoring and prevention and control strategies.METHODS Sociodemographic characteristics,clinical information and surgical details of 263 patients with postoperative pneumonia from four different types of medical institutions between Jan.2019 and Dec.2024 were retrospectively collected.The time windows for postoperative pneumonia in patients undergoing different surgeries were analyzed.RESULTS There were no statistically significant differences in the time windows for post-operative pneumonia among groups in terms of sociodemographic factors and underlying diseases.However,sta-tistically significant differences were observed in the time windows for postoperative pneumonia based on surgery type,incision type,surgical approach and surgery duration(P＜0.05).The average time for the onset of postop-erative pneumonia in 263 patients was 2.00(1.00,7.00)days.The postoperative time windows varied for sur-geries involving different systems.The peak incidence occurred on day 0(16 cases)and day 1(17 cases)af-ter neurological surgery,while the peak incidence for digestive system and orthopedic surgeries was on day 1.The time span for the onset of pneumonia after skin surgeries was wider(0-53 days postoperatively)without a clear peak.In addition,33.33％of cardiovascular system surgery cases developed pneumonia 10 days postoperatively.There were also significant time differences in the diagnostic elements of postoperative pneumonia,with fever and abnormal white blood cell counts appearing earlier(median appearance time length:4.00 days)than lung imaging changes(median appearance time length:7.00 days).CONCLUSIONS This study demonstrates significant time differences in the on-set of postoperative pneumonia and confirms the significant spatiotemporal heterogeneity in the diagnostic elements of postoperative pneumonia.These findings provide a quantitative basis for developing dynamic,surgery-type-spe-cific monitoring protocols and prevention and control measures for postoperative pneumonia.

BACKGROUND:The individualized precise puncture approach is a new approach proposed for vertebral body augmentation in recent years,and has achieved good clinical results,but there is still a lack of relevant biomechanical research.OBJECTIVE:To investigate the biomechanical effects of individualized precise puncture vertebral augmentation on the vertebral endplate and intervertebral disc of osteoporotic vertebral compression fracture using finite element analysis method.METHODS:A total of six preoperative and postoperative models of wedge type,biconcave type,and collapse type were established using the preoperative and postoperative CT imaging data of three osteoporotic vertebral compression fracture patients who had completed individualized precise puncture vertebral augmentation.500 N moment and 10 N/m rotation moment were loaded in the vertical direction of the vertebral body to simulate the normal physiological activities of the vertebral body,including forward flexion,back extension,left bending,right bending,left rotation,and right rotation,to observe the stress changes of endplates,adjacent endplates,and intervertebral discs of different types of fractured vertebral bodies after individualized precise puncture vertebral augmentation.RESULTS AND CONCLUSION:(1)Three-dimensional finite element models of preoperative and postoperative spinal functional units were successfully established.(2)After individualized precise puncture vertebral augmentation,the maximum von Mises stress values of wedge-shaped,biconcave,and collapsed fractured vertebral endplates and adjacent vertebral endplates were reduced to a certain extent.The postoperative maximum von Mises stress value increased in the T10 inferior endplate of the superior vertebral body with wedge deformity and the L1 superior endplate of the inferior vertebral body with collapsed deformity.(3)After individualized precise puncture vertebral augmentation,the overall maximum von Mises stress value of adjacent intervertebral discs in the three finite element models decreased.(4)The results show that individualized precise puncture vertebral augmentation can reduce the maximum von Mises stress value of the endplate of wedge-shaped deformity,biconcave deformity and collapsed vertebral body to a certain extent,and diminish the risk of postoperative vertebral body re-fracture.In addition,individualized precise puncture vertebral augmentation decreases the maximum von Mises stress value of the intervertebral disc,which can theoretically alleviate intervertebral disc degeneration to a certain extent.

The rapid development of digital intelligence technologies is providing a powerful boost to the high-quality development of the healthcare system.Considering the current state of our healthcare services and guided by General Secretary Xi Jinping's insights on new quality productive forces and the directives from Third Plenary Session of Communist Party of China's 20th Central Committee,the high-quality development of the healthcare service system should focus on digital intelligence technologies such as cloud computing,big data,privacy computing,blockchain,Internet of Things(IoT),mobile computing,and AI.The key measures should include the optimization of production factors,services,and governance.Emphasis should be placed on enhancing the efficient and intensive development of the development model,ensuring the high-quality and continuous integration of the supply model,and transitioning to scientific and modern management methods.Herein,we analyzed the"factor optimization—service optimization—governance optimization"development mechanism driven by digital intelligence and proposed corresponding implementation pathways,intending to provide references for establishing a high-quality and efficient healthcare service system with Chinese characteristics.