Pulp health and calcific healing of a complicated crown–root fracture with additional root fracture in a maxillary incisor: A case report

BACKGROUND Complicated crown–root fracture (CRF) involves severe injury to the crown, root,and pulp, and may be accompanied by multiple root fractures. The loss of a toothhas lifelong consequences for children and teenagers, but the maintenance of pulphealth and the calcific healing of multiple root fractures are rarely reported in theliterature.CASE SUMMARY This case reports healing of a permanent tooth with complicated crown–root andadditional root fractures, in which pulp health was maintained. A 10-year-old girlfell and fractured the root of her maxillary left central incisor at the cervical level.After the coronal fragment was repositioned, the tooth was splinted until thetooth was no longer mobile, 2 years later. Eight years after treatment, the toothhas remained asymptomatic with vital pulp and localized gingival overgrowth.Cone-beam computed tomography revealed not only calcified healing of the CRFbut also spontaneous healing in an additional undiagnosed root fracture. Thefracture line on the enamel could not be healed by hard tissue and formed agroove in the cervical crown. It was speculated that the groove was related to thelocalized gingival overgrowth.CONCLUSION This case provides a clinical perspective of the treatment of a tooth with acomplicated CRF and an additional root fracture.

Correlation between anxiety, depression, and social stress in young patients with thoracolumbar spine fractures

BACKGROUND Traumatic injuries,such as falling,car accidents,and crushing mostly cause spinal fractures in young and middle-aged people,and>50%of them are thoracolumbar fractures.This kind of fracture is easily combined with serious injuries to peripheral nerves and soft tissues,which causes paralysis of the lower limbs if there is no timely rehabilitation treatment.Young patients with thoracolumbar fractures find it difficult to recover after the operation,and they are prone to depression,low self-esteem,and other negative emotions.AIM To investigate the association between anxiety,depression,and social stress in young patients with thoracolumbar spine fractures and the effect on rehabilitation outcomes.METHODS This study retrospectively analyzed 100 patients admitted to the orthopedic department of Honghui Hospital,Xi’an Jiaotong University who underwent thoracolumbar spine fracture surgery from January 2022 to June 2023.The general data of the patients were assessed with the Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),life events scale,and social support rating scale(SSRS)to identify the correlation between anxiety,depression scores,and social stress and social support.The Japanese Orthopedic Association(JOA)was utilized to evaluate the rehabilitation outcomes of the patients and to analyze the effects of anxiety and depression scores on rehabilitation.RESULTS According to the scores of HAMD and HAMA in all patients,the prevalence of depression in patients was 39%(39/100),and the prevalence of anxiety was 49%(49/100).Patients were categorized into non-depression(n=61)and depression(n=39),non-anxiety(n=51),and anxiety(n=49)groups.Statistically significant differences in gender,occupation,Pittsburgh Sleep Quality Index(PSQI)score,and monthly family income were observed between the non-depression and depression groups(P<0.05).A significant difference in occupation and PSQI score was found between the non-anxiety and anxiety groups.Both depression(r=0.207,P=0.038)and anxiety scores(r=0.473,P<0.001)were significantly and positively correlated with negative life events.The difference in negative life event scores as well as SSRS total and item scores was statist-ically significant between patients in the non-depression and depression groups(P<0.05).The difference between the non-anxiety and anxiety groups was statistically significant(P<0.05)in the negative life event scores as well as the total SSRS scores.Additionally,JOA scores were significantly lower in both anxious and depressed patients.CONCLUSION Young patients with thoracolumbar fractures are prone to anxiety and depression.Patients’anxiety and depression are closely associated with social pressure,which reduces the life pressure of young patients with thoracolumbar fractures,enhances social support,and improves the psychology of anxiety and depression.,which affects patients’recovery.

Teriparatide as a non-surgical salvage therapy for prolonged humerus fracture nonunion:A case report and literature review

BACKGROUND Fracture nonunion represents a challenging complication during fracture repair,often necessitating surgical intervention.Teriparatide,a recombinant human parathyroid hormone,has demonstrated promise in enhancing fracture healing,although its efficacy in treating established nonunion remains under investigation.CASE SUMMARY We report a case of a 27-year-old male who presented with a right humerus fracture following a traffic accident.Despite undergoing open reduction and internal fixation,the fracture resulted in a delayed union and subsequent nonunion.After 4 years of conservative management,teriparatide treatment was initiated due to persistent nonunion.Teriparatide injections were administered daily for 6 months,resulting in complete fracture healing and resolution of pain.CONCLUSION Our case demonstrates the successful use of teriparatide in treating a prolonged nonunion of a humerus fracture.Teriparatide may provide a valuable therapeutic option for established bone nonunion,even in cases that have not responded to conservative treatments.

Effect of extended nursing based on self-efficacy theory on the anxiety of patients with intertrochanteric fracture

BACKGROUND Extended care based on self-efficacy theory to elderly patients with intertrochanteric fractures will provide data reference to optimize the care plan of these patients,reduce patients’concurrent mental diseases,and improve prognosis.AIM To analyze the value of extended nursing based on the self-efficacy theory in older patients with intertrochanteric fractures.METHODS Older patients with intertrochanteric fractures(n=88)admitted to our hospital between January 2021 and December 2024 were randomly divided into two groups-the control group(n=44,routine nursing)and the observation group(n=44,extended nursing)-via balloting and treated for 12 weeks.The mental state,pain severity,limb function,and self-nursing ability of all patients before and after nursing were analyzed.RESULTS After nursing,the Hamilton Anxiety Scale and General Self-Efficacy Scale scores of patients in the two groups improved.Notably,Hamilton Anxiety Scale and General Self-Efficacy Scale scores in the observation group were lower and higher,respectively,than those in the control group(P<0.05).The pain severity in the observation group(2.64±0.22)was lower than that in the control group(2.85±0.41)(P<0.05).The recovery rate of limb function was higher in the observation group than in the control group(P<0.05).In addition,the self-nursing ability scores of the patients in both groups increased,with a significantly higher score in the observation group(P<0.05).CONCLUSION Extended nursing based on the self-efficacy theory can significantly improve mental state,relieve pain,and promote the recovery of limb function and self-nursing ability in older patients with intertrochanteric fractures.

An adjustable bio-sealing method for rock fracture leakage mitigation

This study proposed a repeated adjustable mixture injection strategy(RAM)based microbial induced carbonate precipitation(MICP)for efficient mitigation of rock fracture leakage.Granite fractures with small apertures were investigated,and bio-sealing experiments were conducted using five different cementation solution(CS)concentrations(0.25−2 M).The results showed that the RAM-based bio-sealing method can seal and bond the small aperture rock fractures with high efficiency and uniform precipitation by adjusting the CS concentration.The RAM-based bio-sealing mechanism is attributed to the following four stages:(1)fixation of bacterial flocs onto the fracture surfaces,(2)precipitation of CaCO3 onto the fracture surfaces,(3)growth of pre-precipitated CaCO3 and adhesion of new-suspended CaCO3,and(4)bridging and clogging processes.The optimal CS concentration of 1 M resulted in a fracture filling rate up to 85%,a transmissivity reduction of 4 orders of magnitude,and a shear strength ranging from 512 kPa to 688 kPa.The bio-sealing effect was found to be influenced by the CS concentration on bacterial attachment,calcium carbonate yield and calcium carbonate bulk density.The CS concentration of 1 M promoted bacterial attachment,and increased calcium carbonate yield as well as calcium carbonate bulk density,while concentrations above 1 M had the opposite effect.The bulk density of calcium carbonate played a crucial role in the sealing and bonding performance of bio-sealed fractures,particularly at comparable filling ratios and bridging areas.The bulk density was regulated by the size of calcium carbonate crystals and was determined by Ca2+concentration in the CS.This study provides valuable insights into the RAM-based bio-sealing method,highlighting its potential for efficient rock fracture leakage mitigation through precise control of CS concentration and understanding the underlying mechanisms.

Using fracture mechanics method to analyze the failure mechanism and equilibrium equation of interfacial loess-mudstone landslides

Loess-mudstone landslides are common in the Loess Plateau.Investigations into the mechanical theory of loess-mudstone landslides have become a challenging undertaking due to the distinctive interfacial properties of loess-mudstone and the unique water sensitivity characteristics of mudstone.Hence,it is imperative to develop innovative mechanical models and mathematical equations specifically tailored to loess-mudstone landslides.In this study,we analyze the fracture mechanism of the loess-mudstone sliding zone using plastic fracture mechanics and develop a unique fracture yield model.To calculate the energy release rate during the expansion of the loess-mudstone interface tip region,the shear fracture energy G is applied,which reflects both the yield failure criterion and the fracture failure criterion.To better understand the instability mechanism of loess-mudstone landslides,equilibrium equations based on G are established for tractive,compressive,and tensile loess-mudstone landslides.Based on the equilibrium equation,the critical length Lc of the sliding zone can be used for the safety evaluation of loess-mudstone landslides.In this way,this study proposes a new method for determining the failure mechanism and equilibrium equation of loessmudstone landslides,which resolves their starting mechanism,mechanical equilibrium equations,and safety evaluation indicators,thus justifying the scientific significance and practical value of this research.

High cycle fatigue performance at 650℃and corresponding fracture behaviors of GH4169 joint produced by linear friction welding

GH4169 joints manufactured by Linear Friction Welding(LFW)are subjected to tensile test and stair-case method to evaluate the High Cycle Fatigue(HCF)performance at 650℃.The yield and ultimate tensile strengths are 582 MPa and 820 MPa,respectively.The HCF strength of joint reaches 400 MPa,which is slightly lower than that of Base Metal(BM),indicating reliable quality of this type of joint.The microstructure observation results show that all cracks initiate at the inside of specimens and transfer into deeper region with decrease of external stress,and the crack initiation site is related with microhardness of matrix.The Electron Backscattered Diffraction(EBSD)results of the observed regions with different distances to fracture show that plastic deformation plays a key role in HCF,and the Schmid factor of most grains near fracture exceeds 0.4.In addition,the generation of twins plays a vital role in strain concentration release and coordinating plastic deformation among grains.

An extended discontinuous deformation analysis for simulation of grouting reinforcement in a water-rich fractured rock tunnel

Grouting has been the most effective approach to mitigate water inrush disasters in underground engineering due to its ability to plug groundwater and enhance rock strength.Nevertheless,there is a lack of potent numerical tools for assessing the grouting effectiveness in water-rich fractured strata.In this study,the hydro-mechanical coupled discontinuous deformation analysis(HM-DDA)is inaugurally extended to simulate the grouting process in a water-rich discrete fracture network(DFN),including the slurry migration,fracture dilation,water plugging in a seepage field,and joint reinforcement after coagulation.To validate the capabilities of the developed method,several numerical examples are conducted incorporating the Newtonian fluid and Bingham slurry.The simulation results closely align with the analytical solutions.Additionally,a set of compression tests is conducted on the fresh and grouted rock specimens to verify the reinforcement method and calibrate the rational properties of reinforced joints.An engineering-scale model based on a real water inrush case of the Yonglian tunnel in a water-rich fractured zone has been established.The model demonstrates the effectiveness of grouting reinforcement in mitigating water inrush disaster.The results indicate that increased grouting pressure greatly affects the regulation of water outflow from the tunnel face and the prevention of rock detachment face after excavation.

Deformation mechanism and NPR anchor cable truss coupling support in tunnel through fault fracture zone

To address the issue of extensive deformation in the Tabaiyi Tunnel caused by the fault zone,nuclear magnetic resonance(NMR)technology was employed to analyze the physical and mechanical properties of waterabsorbing mudstone.This analysis aimed to understand the mechanism behind the significant deformations.Drawing from the principle of excavation stress compensation,a support scheme featuring NPR anchorcables and an asymmetric truss support system was devised.To validate the scheme,numerical analysis using a combination of the Discrete Element Method(DEM)-Finite Element Method(FEM)was conducted.Additionally,similar material model tests and engineering measurements were carried out.Field experiments were also performed to evaluate the NPR anchor-cable and truss support system,focusing on anchor cable forces,pressures between the truss and surrounding rock,pressures between the initial support and secondary lining,as well as the magnitude of settlement and convergence deformation in the surrounding rock.The results indicate that the waterinduced expansion of clay minerals,resulting from damage caused by fissure water,accelerated the softening of the mudstone's internal structure,leading to significant deformations in the Tabaiyi Tunnel under high tectonic stress.The original support design fell short as the length of the anchor rods was smaller than the expansion depth of the plastic zone.As a result,the initial support structure bore the entire load from the surrounding rock,and a non-coupled deformation contact was observed between the double-arch truss and the surrounding rock.The adoption of NPR asymmetric anchor-cable support effectively restrained the expansion and asymmetric distribution characteristics of the plastic zone.Considering the mechanical degradation caused by water absorption in mudstone,the rigid constraint provided by the truss proved crucial for controlling the stability of the surrounding rock.These research findings hold significant implications for managing large deformations in soft rock tunnels situated within fractured zones under high tectonic stress conditions.

Mesoscopic fracture damage evolution and fractal damage constitutive model of heat-treated red sandstone under direct tensile impact loadings

Understanding the mesoscopic tensile fracture damage of rock is the basis of evaluating the deterioration process of mechanical properties of heat-damaged rock. For this, tensile tests of rocks under high-temperature treatment were conducted with a ϕ75 mm split Hopkinson tension bar (SHTB) to investigate the mesoscopic fracture and damage properties of rock. An improved scanning electron microscopy (SEM) experimental method was used to analyze the tensile fracture surfaces of rock samples. Qualitative and quantitative analyses were performed to assess evolution of mesoscopic damage of heat-damaged rock under tensile loading. A constitutive model describing the mesoscopic fractal damage under thermo-mechanical coupling was established. The results showed that the high temperatures significantly reduced the tensile strength and fracture surface roughness of the red sandstone. The three-dimensional (3D) reconstruction of the fracture surface of the samples that experienced tensile failure at 900 °C showed a flat surface. The standard deviation of elevation and slope angle of specimen fracture surface first increased and then decreased with increasing temperature. The threshold for brittle fracture of the heat-damaged red sandstone specimens was 600 °C. Beyond this threshold temperature, local ductile fracture occurred, resulting in plastic deformation of the fracture surface during tensile fracturing. With increase of temperature, the internal meso-structure of samples was strengthened slightly at first and then deteriorated gradually, which was consistent with the change of macroscopic mechanical properties of red sandstone. The mesoscopic characteristics, such as the number, mean side length, maximum area, porosity, and fractal dimension of crack, exhibited an initial decline, followed by a gradual increase. The development of microcracks in samples had significant influence on mesoscopic fractal dimension. The mesoscopic fractal characteristics were used to establish a mesoscopic fractal damage constitutive model for red sandstone, and the agreement between the theoretical and experimental results validated the proposed model.

FRACTURE序列在中轴型脊柱关节炎骶髂关节结构性病变中的诊断价值

目的:评估限制回波间隔的快速梯度回波类CT成像(FRACTURE)序列在检测中轴型脊柱关节炎(SpA)骶髂关节结构病变中的诊断价值。方法:回顾性分析83例确诊中轴型SpA患者在2021年12月-2022年8月进行骶髂关节MRI和CT检查的影像资料。评估图像包括FRACTURE、T_(1)WI序列和CT平扫图像。对骶髂关节的影像图像进行结构性病变评分:关节间隙变化(0~5分)、骨质侵蚀(0~3分)和骨质硬化(0~2分)。根据修改后的纽约标准评分系统对骶髂关节炎进行综合评分。结果:总共有166个骶髂关节图像(83名受试者)可供分析。以CT图像作为参考标准,FRACTURE序列在关节间隙改变、骨质侵蚀、骨质硬化和骶髂关节炎综合评分与CT结果表现出较高的一致性,AUC分别为0.908、0.943、0.918和0.944。与T_(1)WI相比,FRACTURE在关节间隙变化(91.8%vs.70.5%)、骨质侵蚀(93.3%vs.56.4%)、骨质硬化(94%vs.77.6%)和骶髂关节炎综合评分(98.9%vs.75.3%)方面具有更高的诊断准确性。结论:FRACTURE成像可以评估中轴型SpA患者骶髂关节的结构性病变,并显示出良好的诊断性能。

Production induced fracture closure of deep shale gas well under thermo-hydro-mechanical conditions

Deep shale gas reservoirs have geological characteristics of high temperature,high pressure,high stress,and inferior ability to pass through fluids.The multi-stage fractured horizontal well is the key to exploiting the deep shale gas reservoir.However,during the production process,the effectiveness of the hydraulic fracture network decreases with the closure of fractures,which accelerates the decline of shale gas production.In this paper,we addressed the problems of unclear fracture closure mechanisms and low accuracy of shale gas production prediction during deep shale gas production.Then we established the fluid—solid—heat coupled model coupling the deformation and fluid flow among the fracture surface,proppant and the shale matrix.When the fluid—solid—heat coupled model was applied to the fracture network,it was well solved by our numerical method named discontinuous discrete fracture method.Compared with the conventional discrete fracture method,the discontinuous discrete fracture method can describe the three-dimensional morphology of the fracture while considering the effect of the change of fracture surface permeation coefficient on the coupled fracture—matrix flow and describing the displacement discontinuity across the fracture.Numerical simulations revealed that the degree of fracture closure increases as the production time proceeds,and the degree of closure of the secondary fractures is higher than that of the primary fractures.Shale creep and proppant embedment both increase the degree of fracture closure.The reduction in fracture surface permeability due to proppant embedment reduces the rate of fluid transfer between matrix and fracture,which has often been overlooked in the past.However,it significantly impacts shale gas production,with calculations showing a 24.7%cumulative three-year yield reduction.This study is helpful to understand the mechanism of hydraulic fracture closure.Therefore,it provides the theoretical guidance for maintaining the long-term effectiveness of hydraulic fractures.

Study of hydro-mechanical behaviours of rough rock fracture with shear dilatancy and asperities using shear-flow model

The geometric properties of fracture surfaces significantly influence shear-seepage in rock fractures,introducing complexities to fracture modelling.The present study focuses on the hydro-mechanical behaviours of rough rock fractures during shear-seepage processes to reveal how dilatancy and fracture asperities affect these phenomena.To achieve this,an improved shear-flow model(SFM)is proposed with the incorporation of dilatancy effect and asperities.In particular,shear dilatancy is accounted for in both the elastic and plastic stages,in contrast to some existing models that only consider it in the elastic stage.Depending on the computation approaches for the peak dilatancy angle,three different versions of the SFM are derived based on Mohr-Coulomb,joint roughness coefficient-joint compressive strength(JRC-JCS),and Grasselli’s theories.Notably,this is a new attempt that utilizes Grasselli’s model in shearseepage analysis.An advanced parameter optimization method is introduced to accurately determine model parameters,addressing the issue of local optima inherent in some conventional methods.Then,model performance is evaluated against existing experimental results.The findings demonstrate that the SFM effectively reproduces the shear-seepage characteristics of rock fracture across a wide range of stress levels.Further sensitivity analysis reveals how dilatancy and asperity affect hydraulic properties.The relation between hydro-mechanical properties(dilatancy displacement and hydraulic conductivity)and asperity parameters is analysed.Several profound understandings of the shear-seepage process are obtained by exploring the phenomenon under various conditions.

Numerical modeling of fracture propagation of supercritical CO_(2)compound fracturing

The exploitation of shale gas is promising due to depletion of the conventional energy and intensification of the greenhouse effect.In this paper,we proposed a heat-fluid-solid coupling damage model of supercritical CO_(2)(SC-CO_(2))compound fracturing which is expected to be an efficient and environmentally friendly way to develop shale gas.The coupling model is solved by the finite element method,and the results are in good agreement with the analytical solutions and fracturing experiments.Based on this model,the fracture propagation characteristics at the two stages of compound fracturing are studied and the influence of pressurization rate,in situ stress,bedding angle,and other factors are considered.The results show that at the SC-CO_(2)fracturing stage,a lower pressurization rate is conducive to formation of the branches around main fractures,while a higher pressurization rate inhibits formation of the branches around main fractures and promotes formation of the main fractures.Both bedding and in situ stress play a dominant role in the fracture propagation.When the in situ stress ratio(δ_(x)/δ_(y))is 1,the presence of bedding can reduce the initiation pressure and failure pressure.Nevertheless,it will cause the fracture to propagate along the bedding direction,reducing the fracture complexity.In rocks without bedding,hydraulic fracturing has the lengthening and widening effects for SC-CO_(2)induced fracture.In shale,fractures induced at the hydraulic fracturing stage are more likely to be dominated by in situ stresses and have a shorter reorientation radius.Therefore,fracture branches propagating along the maximum principal stress direction may be generated around the main fractures induced by SC-CO_(2)at the hydraulic fracturing stage.When the branches converge with the main fractures,fracture zones are easily formed,and thus the fracture complexity and damage area can be significantly increased.The results are instructive for the design and application of SC-CO_(2)compound fracturing.

Characteristics of proppant transport and placement within rough hydraulic fractures

A three-dimensional reconstruction of rough fracture surfaces of hydraulically fractured rock outcrops is carried out by casting process,a large-scale experimental setup for visualizing rough fractures is built to perform proppant transport experiments.The typical characteristics of proppant transport and placement in rough fractures and its intrinsic mechanisms are investigated,and the influences of fracture inclination,fracture width and fracturing fluid viscosity on proppant transport and placement in rough fractures are analyzed.The results show that the rough fractures cause variations in the shape of the flow channel and the fluid flow pattern,resulting in the bridging buildup during proppant transport to form unfilled zone,the emergence of multiple complex flow patterns such as channeling,reverse flow and bypassing of sand-carrying fluid,and the influence on the stability of the sand dune.The proppant has a higher placement rate in inclined rough fractures,with a maximum increase of 22.16 percentage points in the experiments compared to vertical fractures,but exhibits poor stability of the sand dune.Reduced fracture width aggravates the bridging of proppant and induces higher pumping pressure.Increasing the viscosity of the fracturing fluid can weaken the proppant bridging phenomenon caused by the rough fractures.

Numerical analysis of hydraulic fracture propagation in deep shale reservoir with different injection strategies

Deep shale reservoirs are characterized by elevated breakdown pressures,diminished fracture complexity,and reduced modified volumes compared to medium and shallow reservoirs.Therefore,it is urgent to investigate particular injection strategies that can optimize breakdown pressure and fracturing efficiency to address the increasing demands for deep shale reservoir stimulation.In this study,the efficiency of various stimulation strategies,including multi-cluster simultaneous fracturing,modified alternating fracturing,alternating shut-in fracturing,and cyclic alternating fracturing,was evaluated.Subsequently,the sensitivity of factors such as the cycle index,shut-in time,cluster spacing,and horizontal permeability was investigated.Additionally,the flow distribution effect within the wellbore was discussed.The results indicate that relative to multi-cluster simultaneous fracturing,modified alternating fracturing exhibits reduced susceptibility to the stress shadow effect,which results in earlier breakdown,extended hydraulic fracture lengths,and more consistent propagation despite an increase in breakdown pressure.The alternating shut-in fracturing benefits the increase of fracture length,which is closely related to the shut-in time.Furthermore,cyclic alternating fracturing markedly lowers breakdown pressure and contributes to uniform fracture propagation,in which the cycle count plays an important role.Modified alternating fracturing demonstrates insensitivity to variations in cluster spacing,whereas horizontal permeability is a critical factor affecting fracture length.The wellbore effect restrains the accumulation of pressure and flow near the perforation,delaying the initiation of hydraulic fractures.The simulation results can provide valuable numerical insights for optimizing injection strategies for deep shale hydraulic fracturing.

Shared genetic architecture highlights the bidirectional association between major depressive disorder and fracture risk

Background There is limited evidence suggesting that osteoporosis might exacerbate depressive symptoms,while more studies demonstrate that depression negatively affects bone density and increases fracture risk.Aims To explore the relationship between major depressive disorder(MDD)and fracture risk.Methods We conducted a nested case-control analysis(32670 patients with fracture and 397017 individuals without fracture)and a matched cohort analysis(16496 patients with MDD and 435492 individuals without MDD)in the same prospective UK Biobank data set.Further,we investigated the shared genetic architecture between MDD and fracture with linkage disequilibrium score regression and the MiXeR statistical tools.We used the conditional/conjunctional false discovery rate approach to identify the specific shared loci.We calculated the weighted genetic risk score for individuals in the UK Biobank and logistic regression was used to confirm the association observed in the prospective study.Results We found that MDD was associated with a 14%increase in fracture risk(hazard ratio(HR)1.14,95%CI 1.14 to 1.15,p<0.001)in the nested case-control analysis,while fracture was associated with a 72%increase in MDD risk(HR 1.72,95%CI 1.64 to 1.79,p<0.001)in the matched cohort analysis,suggesting a longitudinal and bidirectional relationship.Further,genetic summary data suggested a genetic overlap between MDD and fracture.Specifically,we identified four shared genomic loci,with the top signal(rs7554101)near SGIP1.The protein encoded by SGIP1 is involved in cannabinoid receptor type 1 signalling.We found that genetically predicted MDD was associated with a higher risk of fracture and vice versa.In addition,we found that the higher expression level of SGIP1 in the spinal cord and muscle was associated with an increased risk of fracture and MDD.Conclusions The genetic pleiotropy between MDD and fracture highlights the bidirectional association observed in the epidemiological analysis.The shared genetic components(such as SGIP1)between the diseases suggest that modulating the endocannabinoid system could be a potential therapeutic strategy for both MDD and bone loss.

Management and classification of the fracture of lateral process of talus:An overview and literature update

Fracture of the lateral process of the talus(FLPT)is uncommon in clinical practice and can be easily missed or misdiagnosed.In recent years,as researchers from all over the world have further deepened their research on FLPT,there has been a breakthrough in the classification,and the methods and principles of clinical management have changed accordingly;however,there is still no standardized guideline for the diagnosis and management of FLPT,and there have been few relevant literature review articles related to this kind of fracture in the past at least 5 years.In this article,we review the clinical classification,classification-based therapeutic recommendations,and prognosis of FLPT,with the aim of providing a reference for the clinical diagnosis and management of this infrequent fracture.

Effect of fracture fluid flowback on shale microfractures using CT scanning

The field data of shale fracturing demonstrate that the flowback performance of fracturing fluid is different from that of conventional reservoirs,where the flowback rate of shale fracturing fluid is lower than that of conventional reservoirs.At the early stage of flowback,there is no single-phase flow of the liquid phase in shale,but rather a gas-water two-phase flow,such that the single-phase flow model for tight oil and gas reservoirs is not applicable.In this study,pores and microfractures are extracted based on the experimental results of computed tomography(CT)scanning,and a spatial model of microfractures is established.Then,the influence of rough microfracture surfaces on the flow is corrected using the modified cubic law,which was modified by introducing the average deviation of the microfracture height as a roughness factor to consider the influence of microfracture surface roughness.The flow in the fracture network is simulated using the modified cubic law and the lattice Boltzmann method(LBM).The results obtained demonstrate that most of the fracturing fluid is retained in the shale microfractures,which explains the low fracturing fluid flowback rate in shale hydraulic fracturing.

Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures

BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.