Objective: To evaluate the clinical efficacy and stability of a centric relation (CR)-guided approach combined with micro-implant anchorage and long traction hooks for root-controlled retraction of the maxillary anterior teeth in a patient with skeletal maxillary protrusion and dual bite, and to provide a reference for clinical practice. Methods: A case of a 29-year-old female patient with skeletal maxillary protrusion and an asymptomatic discrepancy between the maximum intercuspation position (MIP) and CR (dual bite) was reported. First, the CR was identified and obtained by cone beam computed tomography examination and clinical techniques, then was stabilized by glass ionomer bite registration and myofunctional training. Maintaining the CR, the maxillary micro-implants combined with long traction hooks were used to correct skeletal maxillary protrusion by facilitating maxillary anterior teeth retraction, and finally a new intercuspal occlusion was established to maintain long-term stability. A literature review was conducted to contextualize the treatment rationale and key steps. Results: Post-treatment, a coordinated and stable functional occlusion was established in CR without temporomandibular joint symptoms, and the condylar location was coordinated with the glenoid fossa. Controlled root retraction of the maxillary anterior segment and facial profile improvement were achieved. At 3-year follow-up, both occlusion in the CR and condylar positions remained stable. The literature review indicated that, in patients with CR-MIP discrepancy, prioritizing the identification and stabilization of CR is critical, and micro-implant anchorage with long traction hooks effectively facilitates maxillary anterior teeth retraction and profile improvement. Conclusion For skeletal maxillary protrusion with dual bite, a CR-first strategy combined with micro-implant anchorage and long-hook mechanics for root-controlled anterior retraction can concurrently improve stomatognathic function and facial aesthetics, demonstrating favorable mid- to long-term stability.

Objective To analyze the epidemiological characteristics and spatial-temporal clustering trend of scarlet fever in Nantong from 2009 to 2023, and to provide a scientific basis for scarlet fever prevention and control. Methods The incidence data of scarlet fever in Nantong from 2009 to 2023 were analyzed. Descriptive analysis, seasonal index method and Joinpoint 5.2.0 software were used to analyze epidemiological characteristics. Spatial-temporal clustering was assessed with SaTScan 10.2.5 software. Results The average annual incidence of scarlet fever in Nantong from 2009 to 2023 was 6.54/100 000. The overall morbidity rate of scarlet fever in Nantong had an increasing trend from 2009 to 2019 with an average annual percentage change of 14.55% (t=3.36，P<0.05). The cases mainly occurred during late spring to early summer and late autumn to early winter. Students, preschool children and scattered children were the main scarlet fever population. The average annual incidence of males was significantly higher than that of females (χ²=7.00, P<0.05). Rugao City, Chongchuan District and Tongzhou District were identified as high-incidence areas, accounting for 76.51% of all reported cases. Spatial-temporal scan analysis indicated that Rugao City and Chongchuan District were primary cluster areas, spanning from 2015 to 2021 (RR=3.77, LLR=1 308.07, P<0.05). Conclusion The number of reported cases of scarlet fever in Nantong City from 2009 to 2023 shows epidemic and spatial clustering, mainly concentrated in the central urban area and adjacent counties (cities). It is necessary to strengthen health education and disease surveillance in high-incidence areas, as well as in key institutions and key populations before epidemic peaks.

Objective To preliminarily explore the potential efficacy of Xuesaitong Soft Capsule(XST)against post-stroke depression(PSD),and to investigate the material basis of XST's anti-PSD effect based on the metabolomics results to analyze its related pharmacokinetic(PK)characteristics and further analyze the pharmacodynamic(PD)equation of representative ingredients.Methods The initial evaluation of drug effica-cy was conducted by detecting the depressive-like behavior and neurotransmitter levels in rats.The Pearson correlation analysis was employed to analyze the correlation between the main metabolites regulated by XST and the saponin components entering the bloodstream.At various time points after drug administration,the blood concentration of ginsenoside Re and the concentration of norepinephrine(NE)in the serum of PSD rats were measured,and the compartment model was fitted accordingly.Furthermore,the liquid chromatography-mass spectrometry was utilized to determine the content of ginsenoside Re in the liver,spleen,kidney,prefron-tal cortex,hippocampus and striatum of PSD rats.Results Ginsenoside Re showed the optimal correlation by the Pearson correlation analysis.Based on its pharmacokinetic parameters,the pharmacodynamic equation with NE was E=160.462 × Ce/(38.663+Ce).The contents of ginsenoside Re in the liver,spleen,kidney,prefron-tal cortex,hippocampus and striatum of rats were(17.23+11.90),(19.05+5.67),(1.95+0.79),(70.13+6.75),(57.03+3.11),and(72.45+5.45)ng/g,respectively.Conclusion XST could improve the depressive-like behaviors in PSD rats by regulating the expression levels of neurotransmitter NE and 5-HT.Ginsenoside Re may be the pharmacodynamical material foundation for XST's preventative treatment of PSD.

Objective To observe the complication incidences after percutaneous lung biopsy and sealed the tract with different sealants.Methods A total of 129 patients with solitary pulmonary nodule who underwent CT-guided percutaneous lung biopsy were retrospectively included and divided into group A(n=37),B(n=47)and C(n=45).The biopsy tract was sealed with sealant A(1 g gelatin sponge particles mixed with 10 ml 50％glucose solution)in group A,with sealant B(1 g gelatin sponge particles mixed with 10 ml normal saline)in group B,while with sealant C(1 g gelatin sponge particles mixed with the coagulant enzyme from Bothrops atrox venom and 10 ml normal saline)in group C.The incidence rate of complications such as pneumothorax and hemoptysis were comparatively observed among groups.Binary logistic regression was performed to screen the independent influencing factors associated with complications of percutaneous lung biopsy.Results No significant difference of gender,age,proportion of smoking history nor emphysema,diameter of pulmonary nodules,depth of puncture into lung parenchyma nor times of puncture was found among groups(all P＞0.05).Complications occurred in 43 cases(43/129,33.33％),i.e.27 cases in group B(27/47,57.45％),11 cases in group A(11/37,29.73％)and 5 cases in group C(5/45,11.11％),and the complication rates decreased order of group B,A and C(all P＜0.05).Compared with sealant A,sealant B was associated with increased risk(OR[95％CI]=3.190[1.183,8.598],P=0.022),whereas sealant C was associated with reduced risk(OR[95％CI]=0.266[0.079,0.889],P=0.031)of complications.Conclusion After percutaneous lung biopsy,the complication incidences decreased sequentially when the needle tract was sealed with saline B,A and C.

Objective:To identify independent risk factors for early recurrence following curative resection of resectable pancreatic cancer and establish a nomogram prediction model.Methods:Clinical data from 405 patients with resectable pancreatic cancer treated at Renji Hospital, Shanghai Jiao Tong University School of Medicine from February 2010 to December 2020 were retrospectively reviewed. Patients were stratified into a training cohort (265 patients form February 2010 to December 2018) and a validation cohort (140 patients from January 2019 to December 2020) based on surgery dates. Optimal cutoff values for clinical variables were determined using X-tile software. Independent risk factors were identified through univariate and multivariate Cox proportional hazards regression analyses. Kaplan-Meier curves for recurrence-free survival (RFS) were generated across subgroups, and a nomogram was developed to predict early recurrence (within 1 year post-surgery). Time-dependent receiver operating characteristic (tROC) curves was drawn and area under the curve (AUC) metrics were utilized to evaluate predictive accuracy, while model reliability was assessed by calibration curves. Individualized risk scores derived from the nomogram were stratified into high- and low-risk groups using X-tile-derived cutoff values. Survival differences between groups were analyzed via log-rank tests. The clinical application value was judged by decision curve analysis (DCA) compared to TNM staging. Results:In the training cohort, 139 patients (52.45%) experienced early recurrence, with a median RFS of 11.1 months [interquartile range ( IQR): 6.0-26.0]. The validation cohort reported 70 early recurrences (50.00%) and a median RFS of 11.8 months ( IQR: 4.9-21.4). Univariate analysis revealed significant associations between early recurrence and tumor diameter, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), systemic immune-inflammation index (SⅡ), and prognostic nutritional index (PNI). Multivariate analysis identified tumor diameter ≥3.75 cm ( HR=1.718, 95% CI 1.223-2.412, P=0.002), CA19-9≥218 U/ml ( HR=1.567, 95% CI 1.107-2.220, P=0.011), CA125≥20.98 U/ml ( HR=2.501, 95% CI 1.768-3.539, P<0.001), SⅡ≥388.28 ( HR=1.708, 95% CI 1.096-2.662, P=0.018), and PNI<53.18 ( HR=0.596, 95% CI 0.404-0.879, P=0.009) as independent risk factors for early recurrence. The nomogram achieved AUC values of 0.771 and 0.708 in the training and validation cohorts, respectively. Calibration curves demonstrated strong agreement between predicted and observed survival probabilities. Kaplan-Meier analysis revealed significantly lower 1-year RFS rates in high-risk versus low-risk groups for both cohorts (training: HR=3.65, 95% CI 2.45-5.44, P<0.001; validation: HR=2.37, 95% CI 1.39-4.06, P=0.001). DCA indicated superior net benefit of the nomogram over TNM staging across threshold probabilities of 0.2-0.9. Conclusions:The proposed nomogram effectively integrates clinical and serological biomarkers to preoperatively assess early recurrence risk in resectable pancreatic cancer patients, offering enhanced precision for clinical decision-making.

Objective Analyze the causes of coding issues in the inpatient medical record homepage of a hospital and propose targeted improvement measures,providing a reference basis for enhancing coding quality.Methods A total of 3 000 in-patient medical records from April 1,2021,to March 31,2022(pre-intervention group)and 2 900 records from April 1,2022,to March 31,2023(post-intervention group)were selected for analysis.Quality control statistics were performed on key indica-tors,including the overall coding accuracy rate,primary diagnosis coding,secondary diagnosis coding,primary surgical proce-dure coding,and other surgical procedure coding.Results After the implementation of intervention measures,the overall accu-racy rate of the first page coding of medical records increased from 80.77％to 86.72％(P＜0.001).While,the accuracy rate for primary diagnosis coding improved from 96.90％to 98.07％(P＜0.05).The secondary diagnosis coding accuracy showed significant enhancement from 87.48％to 92.26％(P＜0.001),and primary surgical procedure coding accuracy rose from 96.50％to 98.34％(P＜0.001).Although other surgical procedure coding demonstrated improvement,the difference was not statistically significant(P＞0.05).Conclusion Through a series of measures—including standardized training for coders,es-tablishing a robust quality control system,and adopting advanced information technology—both the professionalism of coders and coding efficiency were enhanced.These interventions effectively reduced coding defects and improved the quality of medical re-cord homepage coding.

Objective To analyze the quality of medical record home pages for discharged patients in a tertiary hospital in Guangzhou in 2023 based on the dual dimensions of Diagnosis-Related Groups(DRG)and Disease Intervention Program(DIP),and to provide a basis for improving the refinement of medical record home page quality management.Methods Dis-charge medical records from a tertiary general hospital in 2023 were selected.All medical records were grouped using DRG,while medical records under Guangzhou medical insurance and cross-province medical insurance implemented under DIP were simulated for DIP grouping.The writing defects in the discharge medical records were analyzed,as well as the DRG grouping,RW,and DIP standard scores of medical records with home page filling defects.Results Among 172 230 discharge medical records,171 786 were grouped into DRG,91 768 were grouped into DIP,and 91 604 were grouped into both DRG and DIP.A significant positive correlation was found between RW and DIP standard scores(r2=0.681,P＜0.001).Among the 91 604 medical records grouped into both DRG and DIP,1 942(2.12％)had writing defects,including 837(0.91％)with home page defects.DRG groups with more home page defect records included NC15,HK2,EJ13,EB15,HJ13,and RE19.Conclusion Quality defects in medical record home pages impact the accuracy of DRG and DIP grouping.Systematic measures such as strengthening medical record writing training and establishing scientific reward and punishment mechanisms should be implemented to provide data sup-port for the further advancement of DRG/DIP payment reform.

Objective:To explore the application effect of 3D technology-assisted teaching based on "four-in-one" flipped classroom in clinical teaching of neurosurgery, and provide a basis for optimizing the medical education mode.Methods:A total of 50 students from the Second Clinical College were selected between June 2020 and June 2024, including eight-year program medical students and postgraduate neurosurgery students. The control group ( n=25) received the conventional teaching mode. The experimental group ( n=25) was taught using the "four-in-one" flipped classroom combined with 3D technology, including characteristic textbooks with 3D model drawings, Internet platforms (video libraries and virtual simulation modules), mobile interactive terminals (real-time question and answer), and virtual simulation technology. Effectiveness was evaluated through theoretical assessment (e.g., neuroanatomy and clinical application ability, with a total score of 100 points), operational assessment (e.g., surgical design and aseptic concept, with a total score of 100 points), and a teaching quality questionnaire. Independent samples t-test was conducted using SPSS 22.0. Results:The total score of theoretical assessment was higher in the experimental group than that in the control group [(86.52±5.21) vs. (73.56±6.32), P<0.001], with the largest difference observed in case analysis questions [(26.03±3.65) vs. (22.22±3.50), P=0.001]. In the operational assessment, the experimental group performed better in "surgical process design" [(26.30±4.14) vs. (21.44±3.45), P<0.001] and "aseptic concept" [(8.18±0.98) vs. (6.64±0.79), P<0.001]. The teaching quality questionnaire showed that the experimental group scored higher in "clinical practice skill enhancement" [(23.13±1.39) vs. (21.45±1.86), P=0.001] and "self-directed learning motivation" [(21.84±1.60) vs. (19.75±1.45), P<0.001]. Conclusions:The combination of "four-in-one" flipped classroom and 3D technology can significantly improve the teaching effectiveness of neurosurgery, especially in the cultivation of clinical thinking and practical abilities. This approach is worth promoting.

Objective Analyze the causes of coding issues in the inpatient medical record homepage of a hospital and propose targeted improvement measures,providing a reference basis for enhancing coding quality.Methods A total of 3 000 in-patient medical records from April 1,2021,to March 31,2022(pre-intervention group)and 2 900 records from April 1,2022,to March 31,2023(post-intervention group)were selected for analysis.Quality control statistics were performed on key indica-tors,including the overall coding accuracy rate,primary diagnosis coding,secondary diagnosis coding,primary surgical proce-dure coding,and other surgical procedure coding.Results After the implementation of intervention measures,the overall accu-racy rate of the first page coding of medical records increased from 80.77％to 86.72％(P＜0.001).While,the accuracy rate for primary diagnosis coding improved from 96.90％to 98.07％(P＜0.05).The secondary diagnosis coding accuracy showed significant enhancement from 87.48％to 92.26％(P＜0.001),and primary surgical procedure coding accuracy rose from 96.50％to 98.34％(P＜0.001).Although other surgical procedure coding demonstrated improvement,the difference was not statistically significant(P＞0.05).Conclusion Through a series of measures—including standardized training for coders,es-tablishing a robust quality control system,and adopting advanced information technology—both the professionalism of coders and coding efficiency were enhanced.These interventions effectively reduced coding defects and improved the quality of medical re-cord homepage coding.

Objective To analyze the quality of medical record home pages for discharged patients in a tertiary hospital in Guangzhou in 2023 based on the dual dimensions of Diagnosis-Related Groups(DRG)and Disease Intervention Program(DIP),and to provide a basis for improving the refinement of medical record home page quality management.Methods Dis-charge medical records from a tertiary general hospital in 2023 were selected.All medical records were grouped using DRG,while medical records under Guangzhou medical insurance and cross-province medical insurance implemented under DIP were simulated for DIP grouping.The writing defects in the discharge medical records were analyzed,as well as the DRG grouping,RW,and DIP standard scores of medical records with home page filling defects.Results Among 172 230 discharge medical records,171 786 were grouped into DRG,91 768 were grouped into DIP,and 91 604 were grouped into both DRG and DIP.A significant positive correlation was found between RW and DIP standard scores(r2=0.681,P＜0.001).Among the 91 604 medical records grouped into both DRG and DIP,1 942(2.12％)had writing defects,including 837(0.91％)with home page defects.DRG groups with more home page defect records included NC15,HK2,EJ13,EB15,HJ13,and RE19.Conclusion Quality defects in medical record home pages impact the accuracy of DRG and DIP grouping.Systematic measures such as strengthening medical record writing training and establishing scientific reward and punishment mechanisms should be implemented to provide data sup-port for the further advancement of DRG/DIP payment reform.