Objective To compare the midterm outcomes of the Bentall procedure versus isolated aortic valve replacement(AVR)in patients with bicuspid aortic valve(BAV)complicated with severe stenosis and ascending aortic dilation in order to assess the therapeutic value of these surgical approaches for this complex cardiac condition.Methods A retrospective cohort study was conducted on 96 eligible patients who underwent surgical treatment in our institute between January 2018 and December 2022.According to surgical approaches,they were divided into an AVR group(65 cases)and a Bentall group(31 cases).Demographic features,comorbidities,preoperative status,and echocardiographic parameters were collected in all patients.Propensity score matching(PSM)was applied in a 1:1 ratio to balance baseline characteristics.Perioperative indicators and follow-up data were compared and analyzed between matched cohorts after control of cofounding factors.Results After PSM,25 matched pairs were screened out and analyzed with comparable baseline data(all P>0.05).The Bentall group demonstrated significantly more superior intraoperative effective orifice area(EOA,2.69±0.47 vs 2.35±0.47 cm2,P=0.013)and EOA index(EOAI,1.69±0.30 vs 1.47±0.29 cm2/m2,P=0.010),and obviously longer cardiopulmonary bypass time[190.00(147.00,257.00)vs 101.00(88.50,124.50)min,P<0.01]and aortic cross-clamp time[141.00(120.00,166.00)vs 66.00(55.00,81.50)min,P<0.01]when compared with the AVR group.During a median follow-up of 28 months,the AVR group had notably larger aortic sinus diameter[32.00(30.00,34.00)vs 26.80(26.00,28.00)mm,P<0.01]and ascending aortic diameter[38.00(34.50,42.00)mm vs 26.00(26.00,28.00)mm,P<0.01],with ongoing dilation in the ascending aorta,while the Bentall group maintained stable dimensions.The Bentall group also showed statistically lower peak aortic valve pressure gradients[21.00(15.50,27.00)vs 25.00(19.50,31.00)mmHg,P=0.049].Conclusion Both Bentall procedure and AVR are effective in treatment of BAV complicated with severe stenosis and ascending aortic dilation.But,Bentall procedure offers advantages in hemodynamic optimization and aortic stability.

Objective:To investigate the impact of central screw size on the stability of the glenoid baseplate in reverse shoulder arthroplasty using a finite element analysis.Methods:Four sizes of central screws (length × diameter) were designed: 25.0 mm×5.5 mm (G1), 30.0 mm×5.5 mm (G2), 25.0 mm×6.5 mm (G3), and 30.0 mm×6.5 mm (G4), along with a glenosphere, a baseplate, and peripheral screws. The central screw of group G1 was selected for a biomechanical test along with a set of customized prosthesis. The results were used to validate a finite element model. The validated finite element model was employed to analyze the central screws of 4 different sizes under a vertically downward 490 N load in simulation. After the model calculation was completed, the total displacement of each model, the maximum Von Mises stress on the bone surface at the baseplate-bone contact interface, the maximum Von Mises stress on the bone tissue around the screw-bone interface, the maximum value of the maximum principal strain (tensile strain), the maximum value of the minimum principal strain (compressive strain), the total volume of bone damage, and the volume of bone damage around the central screw were analyzed.Results:Insignificant differences were found in the total displacement and total volume of bone damage across the 4 models. On the bone surface at the baseplate-bone contact interface, the maximum Von Mises stress in G3 and G4 (11.26 MPa and 9.88 MPa, respectively) was slightly higher than that in G1 and G2 (9.11 MPa and 8.90 MPa, respectively). On the bone tissue around the screw-bone interface, G4 exhibited significantly higher maximum stress (15.82 MPa) and significantly higher maximum value of the maximum principal strain (10.09×10 -2) than G1 (8.51 MPa, 3.88×10 -2), G2 (9.45 MPa, 4.29×10 -2), and G3 (9.92 MPa, 3.92×10 -2), while the maximum value of the minimum principal strain in G3 (12.12×10 -2)was significantly higher than that in G1 (8.23×10 -2), G2 (8.10×10 -2), and G4 (8.34×10 -2). The volume of bone damage around the central screw in G3 (11.4 mm 3) was significantly smaller than that in G1 (24.9 mm 3), G2 (28.5 mm 3), and G4 (20.3 mm 3). Conclusions:In reverse shoulder arthroplasty, to a certain extent, increasing the length of a central screw amplifies bone damage volume around the screw. Conversely, increasing only the diameter of a central screw reduces bone damage volume around the screw, consequently lowering the loosening risk of a central screw.

Due to advances in treatment methods, the survival rate and quality of life of cancer patients have been improved. Radiation-induced vascular injury (RIVI) is a common adverse reaction following radiotherapy, mainly manifested as capillary injury and atherosclerosis in the irradiated area. Radiotherapy induces RIVI in the cerebral vessels, carotid arteries, coronary arteries, and large arteries through mechanisms such as endothelial cell injury and senescence, oxidative stress and inflammatory responses, angiogenesis, and vascular remodeling. In this review research progress in the pathological features, pathophysiological mechanisms, clinical manifestations, prevention and treatment strategies of RIVI was summarized, aiming to provide insights for future research on RIVI.

Radiation-induced rectal injury (RRI) refers to inflammatory intestinal complications of patients with pelvic cavity, abdominal cavity and retroperitoneal tumor during or after radiotherapy, presenting symptoms such as diarrhea, abdominal pain, anal distension, bloody stool, etc. In severe cases, rectovaginal fistula, intestinal obstruction, canceration can occur, adversely affecting the quality of life of patients. The clinical factors of RRI involve total radiotherapy dose, tumor volume, radiotherapy mode and patient-related risk factors. The diagnosis mainly depends on imaging examinations (such as CT, MRI and ultrasound), endoscopy and laboratory examination. The mechanism of RRI is related to intestinal epithelial cell destruction, stem cell injury, microvascular changes and microbial flora imbalance. At present, there is no gold standard for RRI treatment, and the main measures include surgical treatment, internal medicine treatment, hyperbaric oxygen therapy and fecal microbiota transplantation, etc. In this article, the latest progress in the pathogenesis, diagnosis and treatment of RRI was reviewed.

Radiation-induced esophageal injury (RIEI) is a frequent complication following radiotherapy for thoracic and head-neck malignancies, which may lead to severe sequelae including esophageal stricture and perforation, adversely affecting patients' quality of life and therapeutic outcomes. With advancements in radiotherapy techniques — particularly the adoption of unconventional fractionation regimens, concurrent chemoradiotherapy, and combined molecular targeted / immunotherapy — the incidence of RIEI has been increasing. In this review, recent advances in understanding the pathogenesis, clinical manifestations, risk factors, and management strategies for RIEI were comprehensively summarized. Current therapeutic approaches have evolved beyond conventional anti-inflammatory and nutritional support to include novel interventions such as targeted therapy, free radical scavengers, and microbiota modulation, etc. Future research should prioritize the development of optimized, individualized prevention and treatment protocols to mitigate RIEI risk and improve patient prognosis.

The global incidence of head and neck cancer (HNC) is rising, with over 60% of patients presenting at a locally advanced stage. Radiotherapy remains a cornerstone of HNC treatment, and advancements in modern techniques and concurrent chemotherapy have improved local control and survival rates of HNC patients. However, these benefits also bring challenges in the management of toxicities. Due to the proximity of salivary glands and tumors, especially the highly radiosensitive parotid and submandibular glands, this condition is among the most common adverse effects of radiotherapy. Radiation damages acinar cells and ducts, causing glandular atrophy, fibrosis, and reduced saliva secretion, thereby leading to xerostomia and related complications. The risk and severity of injury are associated with the radiation dose and volume affecting the glands. Prevention and management strategies emphasize precise radiotherapy planning, target optimization, and supportive care. Emerging multimodal imaging techniques offer potential for non-invasive prediction and early diagnosis and treatment of radiation-induced salivary gland injury. Future research in regenerative medicine, tissue engineering, and molecular biology aims to elucidate molecular mechanisms, such as signaling pathways and genomics, facilitating personalized strategies to mitigate radiotherapy-induced toxicities and enhance the quality of life of patients.

Osteoradionecrosis of the jaws (ORNJ) is among the most severe oral complications following radiotherapy for head and neck tumors. It is essentially a form of pathological necrosis of the jawbone induced by radiation therapy. ORNJ is defined as bone damage, primarily characterized by inflammation and necrosis, occurring in the jawbone within the irradiated area and accompanied by soft tissue injury, persisting for more than 3 months without spontaneous healing. Diagnosis requires exclusion of other potential etiologies, including primary tumor recurrence, medication-related osteonecrosis, and radiation-induced neoplasms of the jawbone, etc. In this review, recent advances in the epidemiology, risk factors, diagnosis, classification and staging, dosimetric parameters, pathogenesis, treatment, and prevention of radiation-induced osteonecrosis of the jaws were summarized.

Objective:To investigate the impact of central screw size on the stability of the glenoid baseplate in reverse shoulder arthroplasty using a finite element analysis.Methods:Four sizes of central screws (length × diameter) were designed: 25.0 mm×5.5 mm (G1), 30.0 mm×5.5 mm (G2), 25.0 mm×6.5 mm (G3), and 30.0 mm×6.5 mm (G4), along with a glenosphere, a baseplate, and peripheral screws. The central screw of group G1 was selected for a biomechanical test along with a set of customized prosthesis. The results were used to validate a finite element model. The validated finite element model was employed to analyze the central screws of 4 different sizes under a vertically downward 490 N load in simulation. After the model calculation was completed, the total displacement of each model, the maximum Von Mises stress on the bone surface at the baseplate-bone contact interface, the maximum Von Mises stress on the bone tissue around the screw-bone interface, the maximum value of the maximum principal strain (tensile strain), the maximum value of the minimum principal strain (compressive strain), the total volume of bone damage, and the volume of bone damage around the central screw were analyzed.Results:Insignificant differences were found in the total displacement and total volume of bone damage across the 4 models. On the bone surface at the baseplate-bone contact interface, the maximum Von Mises stress in G3 and G4 (11.26 MPa and 9.88 MPa, respectively) was slightly higher than that in G1 and G2 (9.11 MPa and 8.90 MPa, respectively). On the bone tissue around the screw-bone interface, G4 exhibited significantly higher maximum stress (15.82 MPa) and significantly higher maximum value of the maximum principal strain (10.09×10 -2) than G1 (8.51 MPa, 3.88×10 -2), G2 (9.45 MPa, 4.29×10 -2), and G3 (9.92 MPa, 3.92×10 -2), while the maximum value of the minimum principal strain in G3 (12.12×10 -2)was significantly higher than that in G1 (8.23×10 -2), G2 (8.10×10 -2), and G4 (8.34×10 -2). The volume of bone damage around the central screw in G3 (11.4 mm 3) was significantly smaller than that in G1 (24.9 mm 3), G2 (28.5 mm 3), and G4 (20.3 mm 3). Conclusions:In reverse shoulder arthroplasty, to a certain extent, increasing the length of a central screw amplifies bone damage volume around the screw. Conversely, increasing only the diameter of a central screw reduces bone damage volume around the screw, consequently lowering the loosening risk of a central screw.

Due to advances in treatment methods, the survival rate and quality of life of cancer patients have been improved. Radiation-induced vascular injury (RIVI) is a common adverse reaction following radiotherapy, mainly manifested as capillary injury and atherosclerosis in the irradiated area. Radiotherapy induces RIVI in the cerebral vessels, carotid arteries, coronary arteries, and large arteries through mechanisms such as endothelial cell injury and senescence, oxidative stress and inflammatory responses, angiogenesis, and vascular remodeling. In this review research progress in the pathological features, pathophysiological mechanisms, clinical manifestations, prevention and treatment strategies of RIVI was summarized, aiming to provide insights for future research on RIVI.

Radiation-induced rectal injury (RRI) refers to inflammatory intestinal complications of patients with pelvic cavity, abdominal cavity and retroperitoneal tumor during or after radiotherapy, presenting symptoms such as diarrhea, abdominal pain, anal distension, bloody stool, etc. In severe cases, rectovaginal fistula, intestinal obstruction, canceration can occur, adversely affecting the quality of life of patients. The clinical factors of RRI involve total radiotherapy dose, tumor volume, radiotherapy mode and patient-related risk factors. The diagnosis mainly depends on imaging examinations (such as CT, MRI and ultrasound), endoscopy and laboratory examination. The mechanism of RRI is related to intestinal epithelial cell destruction, stem cell injury, microvascular changes and microbial flora imbalance. At present, there is no gold standard for RRI treatment, and the main measures include surgical treatment, internal medicine treatment, hyperbaric oxygen therapy and fecal microbiota transplantation, etc. In this article, the latest progress in the pathogenesis, diagnosis and treatment of RRI was reviewed.