Objective To investigate the correlation between serum C-reactive protein (CRP) level and carotid atherosclerotic plaque calcification in patients with ischemic stroke or transient ischemic attack (TIA).Methods The patients with non-cardiogenic ischemic stroke or TIA in anterior circulation performed head and neck vascular CTA at 1-6 months from the time of onset were enrolled prospectively.The demographic and clinical data were collected and serum CRP levels were detected.Univariate and multivariate logistic regression analyses were used to determine the correlation between the serum CRP level and the carotid atherosclerotic plaque calcification.Results A total of 165 patients were enrolled.Their age was 62.4± 10.6years,male patients accotnted for 66.7％;113 patients (68.5％)had carotid atherosclerotic plaque calcification (calcification group),52 (31.5％) did not have carotid atherosclerotic plaque calcification (non-calcification group).The age of the calcification group (median,interquartlle;66 [58-73] years vs.58 [51-66] years;Z=-3.738,P＜0.001) and CRP levels (1.9 [0.5-3.8] mg/L vs.0.0 [0.0-2.2] mg/L;Z =-4.126,P ＜ 0.001) were significantly higher than those of the non-calcification group.There were no significant differences in other baseline clinical data between the two groups.Multivariate logistic regression analysis showed that age (odds ratio 1.063,95％ confidence interval 1.024-1.104;P =0.001) and CRP levels (odds ratio 1.209,95％ confidence interval 1.030-1.419;P=0.020) were still significantly correlated with the plaque calcification after adjusting for other confounding factors.Conclucions Carotid plaque calcification was correlated with older age and increased serum CRP level in patients with ischemic stroke or TIA.

Objective Carotid artery stenosis is closely related not only with the cognitive function impairment, but also can cause patients to physical fatigue and a series of consequences.The aim of this study was to investigate the correlation between carotid artery stenting for carotid artery stenosis in patients with cognitive function improvement effect and fatigue and cognitive function in this paper. Methods One hundred cases of clinical data of patients with carotid artery stenosis of carotid artery stentingwere analyze pro-spectively.The cognitive scales of mini mental state examination (mini mental scale state examination, MMSE), Montreal cognitive as-sessment(Montreal cognitive, assessment, MoCA), activities of daily living scale (activities of dailyliving, ADL), fast vocabulary test ( verbal fluency) , Webster's count test, digit span test( working memory) , Digit Symbol Substitution Test ( speed) and the the fatigue scales of fatigue assessment scale-14 ( Fatigue Scale-14, FS-14) , fatigue severity scale ( FatigueSeverity Scale, FSS-9) were observed before and 3, 6 months after surgery.The correlation between fatigue and cognitive impairment was also analyzed Results Operation was successful in all patients, and no serious complications occurred after surgery.Patients'clinical symptoms were significantly im-proved compared with those on admission.MMSE, MoCA, ADL, verbal fluency test, Wechsler arithmetic, digit span and digit symbol substitution test results showed that, the scores were significantly improved compared with those on admission( P<0.05) , and with the time prolonging, cognitive function improved more obviously( P<0.001) .Compared with before operation,FS-14 score [ ( 7.11±1.37) vs (4.38±0.97)] and FSS-9 scores were significantly decreased6 months after operation, [(52.45±6.77) vs (43.29±7.21)](P<0.05). The correlation coefficient of FS-14 and MMSE, FFS 9 and MMSE were -0.357, -0.311 6 months after surgery, and the correlation coefficientof FSS-14 and MoCA, FSS-9 and MoCA were -0.547,-0.351, which showed a significant negative correlation (P<0.05). Conclusion Carotid artery stenting therapy can improve cognitive function and fatigue in patients with carotid artery stenosis, and the effect was more significant with the time prolonging, and there was a certain correlation between fatigue and cognitive impairment.

Endovascular therapy has become a research focus for the treatment of acute ischemic stroke,mainly including intra-arterial thrombolysis,combined intravenous and intra-arterial thrombolysis,mechanical recanalization,angioplasty and stenting,etc.This article reviews the evidence of evidence-based medicine of endovascular therapy in patients with acute ischemic stroke.

Objective To research the jugular foramen,internal auditory pore (IAP)and the turning point between its components by imageological methods and to provide theoretical basis for retrosigmoid approach in the operation of acoustic neurinoma.Methods The skulls of 100 volunteers were scanned to get the final result with thin-section computed tomographic image. High-resolution spiral CT multiplane reformation was used to reform images that were parallel to the Frankfort horizontal plane to measure the distance between the turning point of retrosigmoid (A),the edge of jugular foramen(B)and the lower edge of the internal auditory canal(C)(denoted AC,AB,BC) and the shortest distance from the jugular foramen to AC.The angles between AC,AB and sagittal axis(α,β) were measured.Results The distance of AC was (44.94 ± 3.84)mm,the distance of AB was (43.68 ± 4.56)mm.The distance of BC was (6.15 ±2.04)mm,and the shortest distance between jugular foramen and AC was (5.21±0.23)mm.The angleαwas measured as (39.50±4.74)°,and the angleβwas measured as (46.35± 5.51)°.Conclusion The research measure the distance and angle between entry points and landmarks of retrosigmoid approach and the safe distance.

Objective:To measure the safe range from the foramen rotundum to the siphon of internal carotid artery using three-dimensional reconstruction technique, and to provide guidance for operation through pterygopalatine fossa.Methods:The skulls of 121 volunteers were scanned to get the final results with thin-section computed tomographic images.The position of the siphon of internal carotid artery (point A)and foramen rotundum (pointB)were ascertained.Three-dimensional reconstruction technique was used to build a coordinate system paralleled to the frankfort horizontal plane and the nasal septum plane.The coordinate system took point A as the coordinate origin.Point C and point D were the projections of point A in two planes parallel with frankfort horizontal plane and nasal septum plane which included point B.The distances of AC,AB,and BC were measured. The angles of the line went through A and B to the three planes were also measured.Results:The distance of AC was measured as 13.22 (3.79)mm (range,8.33 - 105.67 mm;95%CI:8.55 - 21.39 mm).The angle to the sagittal plane was measured as 33.54 (9.23)° (range,5.38- 66.58°;95%CI:30.88 - 34.20°). The angle to the coronal plane was measured as 53.17 (10.48)°(range,5.60-75.02°;95%CI:51.29-55.06°).The angle to the horizontal plane was measured as 9.43 (12.91 ) mm (range,- 28.44 - 82.22;95% CI:7.11 - 11.76 ). Conclusion:The safety distance from foramen rotundum to the siphon of internal carotid artery in the operation through pterygopalatine fossa (PPF) under nasoendoscope is obtained by thin-section computed tomographic images.

Hepatocellular carcinoma (HCC) has high incidence and mortality rates and poor prognosis and greatly threatens human health .Early identification and diagnosis is an important method for reducing the incidence and mortality rates of HCC .The sensitivities and specificities of commonly used serum tumor markers cannot meet the need in clinical practice .Metabolomics focuses on the changes in metabolites produced by organisms, such as lipids, bile acid, and amino acids, which are located at the downstream of systems biology and can directly reflect the biochemical status of tissues .With the help of the techniques including chromatography , mass spectrometry, and magnetic resonance,metabolomics can identify the differences in metabolites in serum , urine, and tissue samples, evaluate their diagnostic values, and help to find potential markers for HCC.In the early screening of tumors, metabolomics has the advantages of easily available specimens ,simple operation, and processing a large number of specimens simultaneously .This article reviews the recent research advances in metabolic markers for HCC with the application of metabolomics.

表皮生长因子受体(EGFR)突变型非小细胞肺癌（NSCLC）容易出现脑转移，EGFR酪氨酸激酶抑制剂(TKI)(EGFRTKI)则为此类患者的治疗带来极大获益。但第一、二代靶向药物脑穿透力弱和最终获得性耐药，导致颅内疾病进展，是脑转移治 疗的主要挑战。近年来，随着第三代EGFR-TKI、免疫检查点抑制剂（ICB）的深入研发，EGFR突变型NSCLC脑转移的治疗发生 了极大变化。本文将回顾脑转移的靶向治疗及免疫治疗方面取得的进展，并对目前存在的问题及未来发展方向进行探讨。

Objective:To report a case of lung adenocarcinoma of stage Ⅳ with epidermal growth factor receptor (EGFR) mutation treated by Erlotinib HCL Tablets and chemotherapy combined with bevacizumab after drug resistance,and to review the related literatures.Methods:A female patient without smoking history was diagnosed with lung adenocarcinoma (stage cT3N2M1 Ⅳ) with metastatic lesions in liver and bones by chest CT,lung puncture biopsy,and whole-body PET-CT.EGFR gene test reported mutation (19 del).Through treatment of overall survival,pemetrexed disodium for injection plus carboplatin injection,gemcitabine hydrochloride for injection plus cisplatin injection,paclitaxel for injection (albumin bound) single and with bevacizumab;the overall survival (OS) was assessed as 32 months.And the period of Erlotinib HCL Tablets showed 10 months of progressive-free survival (PFS).However,due to the metastatic lesions that suppressed biliary system in liver,hyperbilirubinemia emerged (total bilirubin 304 μmol · L-1,direct bilirubin 193 μmol · L-1).Bevacizumab was adopted and the syndrome relieved (total bilirubin 70 μmol · L-1,direct bilirubin 35 μmol · L-1),yielding three months of PFS.But the bilirubin level upgraded with total bilirubin of 908 μmol · L-1.The patient died because of hyperbilirubinemia.Results:10-month PFS occupied 1/3 of OS was acquired in the patients with EGFR-mutated lung adenocarcinoma (stage Ⅳ) after treated with Erlotinib HCL Tablets.Chemotherapy combined with bevacizumab acquired 3 months of PFS after hyperbilirubinemia emerged with drug resistance and multi-lines of chemotherapy.Conclusion:EGFR-TKIs are effective in treatment of lung adenocarcinoma with EGFR mutation;bevacizumab can inhibit the formation of vessels by targeting on VEGF under the circumstance of multiple drug resistance.Therefore,chemotherapy combined with bevacizumab can be used as the fifth-line of therapy in dealing with the hyperbilirubinemia induced by lung adenocarcinoma with liver metastasis.

Objective: To analyze the characteristics of influenza virus detection in an influenza outbreak in schools, so as to provide a strategic basis for the treatment of influenza outbreaks in schools. Methods: A total of 1 702 samples were collected from 52 school influenza outbreaks reported in Linyi City in 2021-2022. The samples were divided into 3 types according to different symptoms during the management of the epidemic [group A:influenzalike illness (ILI) group; group B:mild illness group; group C:close contacts group]. Rt-PCR was used to detect influenza virus nucleic acid in the collected samples. The detection rate of influenza virus in the outbreaks was analyzed by χ2 test. Results: In total, 1 071 samples (62.93%) tested positive for influenza virus nucleic acid. Among them, 610 out of 726 samples (84.02%) were detected in group A, while 331 out of 634 samples (52.21%) were detected in group B. In group C, 130 out of 342 samples (38.01%) tested positive. The differences were statistically significant (χ2=260.71, P<0.01). In group A, males had a detection rate of 80.83% for influenza virus nucleic acid, compared to 91.36% for females. For group B, the rates were 53.31% for males and 50.87% for females. In group C, males had a rate of 30.72%, while females had a rate of 43.92%. Statistical significance for gender differences was observed only in groups A and C (χ2=12.67, 6.25, P<0.05). According to the days of onset, the detection rates of influenza virus nucleic acid among patients with onset 0-6 days were 56.30%, 74.49%, 89.35%, 86.23%, 69.67%, 62.75%, 34.33%, respectively, and the difference was statistically significant (χ2=128.27, P<0.01). Conclusions Mild cases and close contacts are likely key factors contributing to the prolonged emergence of new cases within classrooms during school influenza outbreaks. The progression of influenza symptoms is related to the risk of transmission.