Objective:To study the clinical efficacy of digital design combined with three-dimensional (3D) printing model minimally invasive extraction of complex impacted mandibular third molars.Methods:Eight patients who visited the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from April 2023 to March 2024 were included, including 3 males and 5 females, aged from 27 to 57 years old. The impacted mandibular third molars of all patients were closely related to the mandibular canal, and part of the dental tissue entered the mandibular canal. Preoperative digital design was used to simulate the intraoperative tooth segmentation and bone removal operation of the power system and the segmented tooth dislocation path, and analyze the tooth extraction resistance. The mandibular teeth, mandibular canal and mandibular model were three-dimensionally printed using light-curing resin inkjet. During the operation, an endoscope was used combined with the 3D printed model to minimally invasively extract the impacted mandibular third molar. Quantitative sensory testing of the patient′s lower lip skin on the operated side was performed before surgery, 2 days after surgery, and 7 days after surgery. Clinical data such as operation time were collected. A paired sample t test was performed on the 2 and 7 days postoperative data and the preoperative data to compare the data differences.Results:All 8 patients successfully completed preoperative design, model printing and minimally invasive surgery. The number of teeth segmented in the preoperative design was (4.4±1.3), and the number of teeth segmented in the actual operation was (4.0±1.1). The operation time was (33.3±13.0) min. None of the patients had postoperative numbness of the lower lip or other postoperative complication. It was observed endoscopically that the inferior alveolar neurovascular bundle was exposed in the extraction socket during the operation. The patient′s pressure pain threshold 2 days after surgery (0.601±1.170) was significantly lower than before surgery (1.251±1.109) ( t=2.83, P=0.025). Conclusions:For complicated impacted mandibular third molars, digital design combined with 3D printing model can be used to perform minimally invasive extraction with the assistance of an endoscope.

Objective:To investigate the feasibility of a three-dimensional no new U-Net (3D nnU-Net) deep learning (DL) network for the automatic segmentation of colorectal cancer (CRC) based on abdominal CT images.Methods:This was a cross-sectional study. From January 2018 to May 2023, a total of 2180 primary CRC patients, confirmed by pathology at the Guangdong Provincial Hospital of Traditional Chinese Medicine (center 1, n=777), Nanfang Hospital, Southern Medical University (center 2, n=732), and Sun Yat-sen Memorial Hospital (center 3, n=671), were enrolled in this retrospective study. The baseline abdominal CT examination of each patient was conducted using CT equipment from 7 different models across 4 vendors, at the 3 centers, encompassing both the arterial phase (AP) and venous phase (VP). Two radiologists manually delineated the volume of interest to circumscribe the entire tumors in dual-enhanced phase CT images. The CT data of CRC patients from center 1 and center 3 were merged and divided into a training set ( n=1 159) and a validation set ( n=289) using a weighted random method with a ratio of 4∶1. The patients from center 2 were used as an independent external test set ( n=732). The 3D nnU-Net segmentation model was trained and tested. Using manually annotated label data as the benchmark, segmentation performance of the model was evaluated based on different phases and tumor locations. The segmentation coverage rate (SCR), Dice similarity coefficient (DSC), recall (REC), precision (PRE), F1-score, and 95% Hausdorff distance (HD 95) were calculated. The mean manual segmentation time and the mean automatic time were compared using independent samples t-test. Results:In the independent external test set, the performance of the 3D nnU-Net model based on the AP CT images was superior to that based on the VP CT images. On the AP images, the SCR, DSC, REC, PRE, F1-score, and HD 95 were 0.865, 0.714, 0.716, 0.736, 0.714, and 27.228, respectively; on the VP images, they were 0.834, 0.679, 0.710, 0.675, 0.679, and 29.358, respectively. The model achieved the best performance on right-sided colon cancer, with SCR, DSC, REC, PRE, F1-score, and HD95 on the AP CT images at 0.901, 0.775, 0.780, 0.787, 0.775, and 21.793, respectively. Next were left-sided colon cancer and rectal cancer, while the segmentation performance for transverse colon cancer was the worst (SCR, DSC, REC, PRE, F1-score, and HD 95 were 0.731, 0.631, 0.641, 0.630, 0.631 and 38.721, respectively). The automatic segmentation time on a single phase was (1.0±0.3) min, while the manual segmentation time was (17.5±6.0) min ( t=128.24, P<0.001). Conclusions:After training and validating on a dataset from multiple centers with various CT scanner vendors, the 3D nnU-Net DL model demonstrates the capability to automatically segment CRC based on abdominal CT images, while also showcasing commendable robustness and generalization ability.

Objective:To investigate cognitive function changes and their influential factors in patients with ischemic stroke and leukoaraiosis.Methods:A total of 500 patients with ischemic stroke who received treatment in Yiwu Central Hospital from January 2018 to October 2019 were included in this study. They were divided into simple ischemic stroke group ( n = 200) and ischemic stroke complicated by leukoaraiosis group (combination group, n = 300). The infarct location and the degree of leukoaraiosis in the combination group were analyzed. An additional 150 volunteers who concurrently underwent the Cognitive Function Test in the same hospital were selected as controls. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Patients in the combination group were divided into cognitive impairment group (MoCA score ≥ 26 points) and non-cognitive impairment group (MoCA score < 26 points) according to MoCA score. The risk factors of cognitive impairment in patients with ischemic stroke and leukoaraiosis were analyzed. Results:The scores of the MMSE, MoCA, Clock Drawing Test (CDT), Verbal Fluency Test (VFT), and Digit Span Test (DST) in the control group were (28.93 ± 2.70) points, (28.35 ± 2.74) points, (4.69 ± 1.14) points, (4.94 ± 0.42) points, and (14.33 ± 1.66) points respectively. They were (26.92 ± 2.18) points, (25.02 ± 3.52) points, (3.61 ± 1.60) points, (4.77 ± 0.46) points, and (11.73 ± 1.16) points, respectively in the simple ischemic stroke group and (24.91 ± 2.79) points, (20.70 ± 3.06) points, (2.87 ± 1.23) points, (4.07 ± 0.85) points, and (10.82 ± 0.93) points respectively in the combination group. There were significant differences in the scores of the MMSE, MoCA, CDT, VFT, and DST among the three groups ( F = 124.50, 318.50, 93.43, 112.60, 428.60, all P < 0.001). Significant differences in the scores of the MMSE, MoCA, CDT, VFT, and DST were observed between patients with different degrees of leukoaraiosis ( F = 69.09, 102.40, 20.98, 60.90, 57.00, all P < 0.001). Spearman correlation analysis results showed that the scores of the MMSE, MoCA, CDT, VFT, and DST were negatively correlated with the degree of leukoaraiosis ( r = -0.61, -0.69, -0.43, -0.56, -0.44, all P < 0.05). Logistic regression analysis results showed that age, history of smoking and drinking, history of diabetes, history of stroke, and infarct location were the independent risk factors for cognitive impairment in patients with ischemic stroke and leukoaraiosis. Education level was a protective factor against ischemic stroke and leukoaraiosis. Conclusion:The degree of cognitive impairment in patients with ischemic stroke and leukoaraiosis is related to the degree of leukoaraiosis. Age, history of smoking and drinking, history of diabetes, history of stroke, infarction location, and education level are the influential factors of cognitive impairment.

The brain-gut axis is an important pathway for the interaction between the central nervous system and the gastrointestinal tract. Ischemic stroke can promote the imbalance and displacement of intestinal flora, and the intestinal flora and its metabolites in turn can affect the occurrence, development and outcome of ischemic stroke. This article reviews the related literature on ischemic stroke and intestinal flora, in order to review the relationship between the two and related mechanisms, and to prospect the stroke treatment of targeting intestinal flora.

Objective:To investigate the correlation between the door-to-needle time (DNT) delay and the short-term functional outcome after intravenous thrombolysis in patients with minor ischemic stroke and the influencing factors of DNT delay.Methods:From October 2016 to May 2018, patients with minor ischemic stroke received intravenous thrombolysis with alteplase from the Stroke Database of Nanjing First Hospital were enrolled retrospectively. DNT delay was defined as DNT > median. The modified Rankin Scale was used to evaluate the short-term functional outcome at 3 months after stroke. 0-1 was defined as good outcome, and ≥2 was defined as poor outcome. Univariate analysis was used to evaluate the correlation between DNT delay and short-term functional outcome. Multivariate logistic regression analysis was used to evaluate the possible influencing factors of DNT delay. Results:A total of 102 patients with minor ischemic stroke were enrolled. The median DNT was 40 min, 36 patients (35.3%) had DNT delay, and 27 patients (26.5%) had poor short-term outcome. Univariate analysis showed that there was no significant difference in the proportion of patients with DNT delay between the poor outcome group and the good outcome group (44.4% vs. 32.0%; χ2=1.346, P=0.252). Multivariate logistic regression analysis showed that there was a significant independent negative correlation between hypertension and DNT delay (odds ratio 0.359, 95% confidence interval 0.137-0.939; P=0.037). Conclusion:For patients with minor ischemic stroke receiving intravenous thrombolysis, DNT delay is not associated with the outcome. The absence of hypertension may be one of the factors affecting the DNT delay.

Objective To investigate the predictive value of serum lipoprotein (a) (Lp [a]) levels for short-term functional outcomes in elderly patients with acute ischemic stroke and type 2 diabetes mellitus.Methods Elderly patients with acute ischemic stroke and type 2 diabetes mellitus admitted to Nanjing First Hospital from June 2016 to December 2016 were enrolled retrospectively.The modified Rankin scale was used to assess the outcomes at 90 d after onset;0-2 was defined as good outcome and ＞2 were defined as poor outcome.Multivariate logistic regression analysis was used to determine independent risk factors for poor outcomes,and the receiver operator characteristic (ROC) curve analysis was used to evaluate the predictive value of serum Lp(a) levels for poor outcomes.Results A total of 231 patients were enrolled,with an average age of 69.7 years and males accounting for 65.4％.The median serum Lp(a) was 166 mg/L (interquartile range 78-331 mg/L).At 90 d after onset,140 patients (60.6％) had good outcomes and 91 (39.4％) had poor outcomes.After adjustment for other confounding variables,multivariate logistic regression analysis showed that elevated serum Lp(a) (referenced to the lowest quartile,the 3rd quartile:odds ratio[OR]2.899,95％ confidence interval[CI] 1.154-7.285,P =0.024;the 4th quartile:OR 3.334,95％ CI 1.329-8.361,P =0.010),the baseline National Institute of Health Stroke Scale score (OR 1.224,95％ CI 1.143-1.310;P＜ 0.001),and complicated with coronary heart disease (OR 2.504,95％ CI 1.196-5.243;P =0.015) were the independent risk factors for poor outcomes.ROC curve analysis showed that the area under the curve of serum Lp(a) level in predicting the poor outcome was 0.775 (95％ CI 0.696-0.854;P=0.04).The optimal cut-off value was 119 mg/L,the sensitivity was 71.15％,the specificity was 75.90％,the positive predictive value was 38.52％,and the negative predictive value was 61.48％.Conclusion Serum Lp(a) level has certain predictive value for the short-term poor outcomes in elderly patients with acute ischemic stroke and type 2 diabetes mellitus.

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 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.