ObjectiveTo construct and validate a clinical prediction model for inflammatory remission outcomes in rheumatoid arthritis （RA） patients with liver and kidney deficiency syndrome treated with Bushen Zhiwang Decoction （补肾治尪汤， BZD） based on metabolomics. MethodsA prospective cohort study was conducted， enrol-ling 60 RA patients with liver and kidney deficiency syndrome. All patients were treated with BZD and conventional-dose oral conventional synthetic disease-modifying antirheumatic drugs （csDMARDs） for 12 months. Clinical data were collected， and the change in disease activity score in 28 joints （DAS28） after treatment compared with baseline （△DAS28） was used as the primary outcome and grouping criterion. Peripheral blood samples were collected before treatment to analyze plasma metabolites. Differential analysis and least absolute shrinkage and selection operator （LASSO） regression were used to preliminarily screen differential metabolites， followed by machine learning algorithms to further identify a core metabolite combination. Based on the expression levels of the core metabolite combination， a novel metabolite index， namely the metabolomics-based inflammatory remission score （Met-IRS）， was calculated using standar-dized metabolite values， and its clinical applicability was evaluated. A clinical prediction model was constructed by integrating clinical characteristics and Met-IRS， and the model performance was assessed. ResultsAmong the 60 patients， those with △DAS28 ≥ 0.27 were assigned to the high inflammatory remission group， while those with △DAS28 ＜ 0.27 were assigned to the low inflammatory remission group， with 30 cases in each group. Compared to the low inflammatory remission group， the high inflammatory remission group showed a higher frequency of methotrexate use and a lower positive rate of rheumatoid factor （RF） （P＜0.05）. Seven core metabolites were identified as the optimal combination， including mangiferic acid， fatty acid-hydroxy fatty acid ester 40∶6， fatty acid-hydroxy fatty acid ester 18∶0， fatty acid-hydroxy fatty acid ester 36∶1， glucosylceramide， lysophosphatidylcholine 22∶5， and pregnanetriol ketone. The calculated Met-IRS comprehensively reflected the characteristics of differential metabolites and demonstrated clinical applicability. Met-IRS was significantly higher in the high inflammatory remission group than in the low inflammatory remission group， and was positively correlated with high inflammatory remission outcomes （P＜0.05）. Based on the variables Met-IRS， methotrexate use， leflunomide use， and RF positivity， a clinical prediction model for inflammatory remission in RA treatment （Cj-RTRM） was constructed. Model performance evaluation demonstrated that the model had good clinical predictive ability， with an area under the receiver operating characteristic curve （AUC） of 0.880， sensitivity 0.967， specificity 0.700 and Youden's index 0.667. ConclusionThe clinical prediction model Cj-RTRM constructed based on the metabolomics-based inflammatory remission score Met-IRS can effectively predict clinical inflammatory remission outcomes in RA patients treated with BZD and accurately identify the advantageous population for this treatment. This model provides guiding evidence for dynamic inflammation monitoring， targeted management， and identification of populations with advantages in traditional Chinese medicine.

ObjectiveTo explore the potential mechanism of Xianglian Huazhuo prescription （XLHZ） in treating chronic atrophic gastritis （CAG） by regulating cell cycle and inhibiting proliferation， using bioinformatics technology and animal experiments. MethodsDifferential expressed genes （DEGs） related to CAG were screened using GEO database and GEO2R tool. Weighted gene co-expression network analysis （WGCNA） was employed to search for hub genes of CAG. These hub genes were intersected with cell cycle proliferation based on GeneCards database. Eenrichment analysis of the intersecting genes was performed to obtain signaling pathways and biological processes related to CAG. Protein protein interaction （PPI） analysis of genes was conducted using the Protein Interaction Platform （STRING） database to search the super hub gene （hub 2.0）， and animal experiments were conducted for further validation. Fourteen of 70 male Wistar rats were randomly selected as the normal group， and the remaining 56 rats were prepared by the combined modeling method of "starvation disorder+N-methyl-N-nitro-N-nitrosoguanidine （MNNG） + sodium salicylate". The successfully modeled rats were randomly divided into the model group， XLHZ-H， XLHZ-M， and XLHZ-L groups （36， 18， 9 g·kg^-1， respectively）， and Morodan group （1.4 g·kg^-1）. Each group was given corresponding intervention for 60 days. Hematoxylin-eosin （HE） staining was used to observe the histopathological changes of gastric mucosa in rats. The ultrastructure of gastric mucosal tissue cells was observed by transmission electron microscopy. The relative expression levels of TGF-β₁， Smad2 and Smad3 proteins， S/G₂/M phase marker geminin and proliferation marker MCM2 were detected by Western blot in gastric mucosal tissue， and Spearman correlation analysis was performed. ResultsA total of 15 hub 2.0 genes were identified， including TGF-β₁， suggesting the involvement of the TGF-β₁ signaling pathway in the CAG pathogenesis. Compared with the normal group， the expressions of TGF-β₁， Smad2， geminin and MCM2 proteins in the gastric mucosa tissue of the model group were increased （P<0.05）， and the expression of Smad3 protein was decreased （P<0.05）. Compared with the model group， the expressions of TGF-β₁ and geminin in the gastric mucosa were decreased in the drug groups （P<0.05）. The XLHZ-M group， XLHZ-H group and Morodan group had significantly decreased protein expression of Smad2 and MCM2 （P<0.05）. The protein expression of Smad3 was significantly increased in XLHZ-M， XLHZ-H， and Morodan groups （P<0.05）. Spearman correlation analysis showed that Smad3 was negatively correlated with other indicators， and positively correlated with other indicators （P<0.01）. ConclusionXLHZ may inhibit TGF-β₁/Smads signaling pathway， regulate cell cycle， and inhibit proliferation in the treatment of CAG.

ObjectiveTo explore the potential mechanism of Xianglian Huazhuo prescription （XLHZ） in treating chronic atrophic gastritis （CAG） by regulating cell cycle and inhibiting proliferation， using bioinformatics technology and animal experiments. MethodsDifferential expressed genes （DEGs） related to CAG were screened using GEO database and GEO2R tool. Weighted gene co-expression network analysis （WGCNA） was employed to search for hub genes of CAG. These hub genes were intersected with cell cycle proliferation based on GeneCards database. Eenrichment analysis of the intersecting genes was performed to obtain signaling pathways and biological processes related to CAG. Protein protein interaction （PPI） analysis of genes was conducted using the Protein Interaction Platform （STRING） database to search the super hub gene （hub 2.0）， and animal experiments were conducted for further validation. Fourteen of 70 male Wistar rats were randomly selected as the normal group， and the remaining 56 rats were prepared by the combined modeling method of "starvation disorder+N-methyl-N-nitro-N-nitrosoguanidine （MNNG） + sodium salicylate". The successfully modeled rats were randomly divided into the model group， XLHZ-H， XLHZ-M， and XLHZ-L groups （36， 18， 9 g·kg^-1， respectively）， and Morodan group （1.4 g·kg^-1）. Each group was given corresponding intervention for 60 days. Hematoxylin-eosin （HE） staining was used to observe the histopathological changes of gastric mucosa in rats. The ultrastructure of gastric mucosal tissue cells was observed by transmission electron microscopy. The relative expression levels of TGF-β₁， Smad2 and Smad3 proteins， S/G₂/M phase marker geminin and proliferation marker MCM2 were detected by Western blot in gastric mucosal tissue， and Spearman correlation analysis was performed. ResultsA total of 15 hub 2.0 genes were identified， including TGF-β₁， suggesting the involvement of the TGF-β₁ signaling pathway in the CAG pathogenesis. Compared with the normal group， the expressions of TGF-β₁， Smad2， geminin and MCM2 proteins in the gastric mucosa tissue of the model group were increased （P<0.05）， and the expression of Smad3 protein was decreased （P<0.05）. Compared with the model group， the expressions of TGF-β₁ and geminin in the gastric mucosa were decreased in the drug groups （P<0.05）. The XLHZ-M group， XLHZ-H group and Morodan group had significantly decreased protein expression of Smad2 and MCM2 （P<0.05）. The protein expression of Smad3 was significantly increased in XLHZ-M， XLHZ-H， and Morodan groups （P<0.05）. Spearman correlation analysis showed that Smad3 was negatively correlated with other indicators， and positively correlated with other indicators （P<0.01）. ConclusionXLHZ may inhibit TGF-β₁/Smads signaling pathway， regulate cell cycle， and inhibit proliferation in the treatment of CAG.

ObjectiveTo investigate the mechanism by which Xiebai San regulates respiratory tract and intestinal mucosal immunity in rats with allergic asthma. MethodsForty male SD rats were randomly divided into four groups based on body weight: control group, model group, positive control group, and Xiebai San group. The model group, positive control group, and Xiebai San group were sensitized with ovalbumin to establish a rat model of allergic asthma. From day 21 (the aerosol challenge phase), each group received daily gavage interventions simultaneously: the positive control group was administered dexamethasone (0.068 mg/kg), the Xiebai San group received Xiebai San solution (2 g/mL, 11.3 mL/kg), while the control and model groups were given an equal volume of normal saline, once daily for 14 consecutive days. After euthanasia, lung and intestinal tissues were collected. Hematoxylin and eosin staining was used to observe histopathological changes. Transmission electron microscopy was employed to examine tissue ultrastructure. Immunohistochemistry was applied to detect the positive reaction areas of phosphatidyl-inositol 3-kinase (PI3K) and protein kinase B (Akt) proteins. Total protein and total RNA were extracted from lung and intestinal tissues, then the protein and mRNA expression levels of PI3K and Akt genes were detected by Western blotting and real-time quantitative PCR, respectively. ResultsHistopathological results showed alveolar emphysema accompanied by inflammatory cell infiltration, and intestinal mucosal injury with inflammatory cell infiltration in the model group as compared with the control group; the cellular structure of lung tissues was disrupted in the model group, with reduced organelles, while the ultrastructural lesions in the intestine were relatively mild. Compared with the model group, Xiebai San group exhibited milder pathological changes in lung tissues, with occasional alveolar wall damage and a small amount of inflammatory cell infiltration; the intestinal mucosal structure was improved, glands were arranged regularly, and pathological changes such as tissue loosening and inflammatory infiltration were alleviated; the cellular structure of lung tissues was relatively intact with reduced severity of lesions, and no ultrastructural pathological changes were observed in intestinal tissues. Immunohistochemistry and Western blotting results showed that compared with the control group, the specific positive reaction areas of PI3K and Akt in lung and intestinal tissues were significantly increased in the model group (all P<0.001); meanwhile, the protein expression levels of PI3K and Akt were significantly upregulated (all P<0.05). Compared with the model group, the positive area of Akt protein in lung tissue was significantly reduced in the Xiebai San group (P<0.001), and the positive area of PI3K in intestinal tissue was also significantly decreased (P<0.000 1). Additionally, the protein expression levels of PI3K and Akt in lung and intestinal tissues were significantly downregulated (all P<0.01). Real-time quantitative PCR results showed that compared with the control group, the mRNA expression levels of PI3K and Akt genes in lung and intestinal tissues were significantly elevated in the model group (all P<0.05). Compared with the model group, the mRNA expression levels of PI3K and Akt genes in lung and intestinal tissues were significantly reduced in the Xiebai San group (all P<0.05). ConclusionXiebai San exerts protective effects on rats with allergic asthma by inhibiting the expression of key nucleic acids and proteins in the PI3K-Akt signaling pathway in lung and intestinal tissues, improving the morphological structure of lung tissue, and maintaining intestinal mucosal integrity, and regulating intestinal mucosal immune function.

ObjectiveTo investigate the mechanism by which Xianglian Huazhuo prescription alleviates chronic atrophic gastritis （CAG） through modulating the nuclear factor erythroid 2-related factor 2 （Nrf2）/quinone oxidoreductase 1 （NQO1）/heme oxygenase-1 （HO-1） pathway of oxidative stress （OS） based on animal experiments. MethodsFifty rats were modeled for CAG by gavage of 2% sodium salicylate （10 mL·kg^-1）， free access to 180 mg·L^-1 N-methyl-N′-nitro-N-nitrosoguanidine （MNNG）， and periodic diet intervention （72 h cycle： 24 h fasting + 48 h free access to food）. The modeled rats were grouped by a random number method as follows： low-， medium-， and high-dose （9， 18，36 g·kg^-1， respectively） Xianglian Huazhuo prescription， Moradan， and model， with 10 rats in each group. The general state of all rats was observed. Hematoxylin-eosin （HE） staining was employed to observe the pathological changes of the gastric mucosal tissue. The ultrastructure of cells was observed under transmission electron microscopy. Biochemical methods were adopted to determine the levels of malondialdehyde （MDA） and total superoxide dismutase （T-SOD） in the rat serum. The mRNA and protein levels of Kelch-like ECH-associated protein 1 （Keap1）， Nrf2， NQO1， and HO-1 in the gastric mucosal tissue of rats from each group were measured by Real-time polymerase chain reaction （Real-time PCR） and Western blot， respectively. Reactive oxygen species （ROS） staining was employed to detect the fluorescence intensity of ROS in the gastric mucosal tissue of rats in each group. ResultsCompared with the normal group， the modeled rats were sluggish， had yellowing and sparse hair， short and dark tail， loose stool， and reduced food intake， and showed the gastric mucosa characterized by atrophy， thinning， congestive edema， declined gland density and disarrangement， and apparent inflammatory cell infiltration， irregular nucleus morphology， nuclear condensation， mitochondria with decreased number， declined density， and abnormal morphology， vacuolization， declined serum T-SOD level （P<0.05）， elevated serum MDA level （P<0.05）， downregulated mRNA and protein levels of Nrf2， NQO1， and HO-1 （P<0.05）， upregulated mRNA and protein levels of Keap1 （P<0.05）， and enhanced mean fluorescence intensity of ROS （P<0.05）. Compared with the model group， each treatment group exhibited improved general state， alleviated histopathological changes in gastric mucosa， improved ultrastructural characteristics of cells， elevated T-SOD level and declined MDA level in the serum （P<0.05）， upregulated mRNA and protein levels of Nrf2， NQO1， and HO-1， downregulated mRNA and protein levels of Keap1 （P<0.05）， and attenuated mean fluorescence intensity of ROS （P<0.05）. ConclusionXianglian Huazhuo prescription can improve the general status， ameliorate pathological changes of gastric mucosa， and repair the cell ultrastructure to varying degrees， demonstrating a definite therapeutic effect on CAG. It may restrain OS and safeguard the natural physiological function of gastric mucosa in CAG rats by regulating the Nrf2/NQO1/HO-1 signaling pathway.

ObjectiveTo investigate the mechanism by which Xianglian Huazhuo prescription alleviates chronic atrophic gastritis （CAG） through modulating the nuclear factor erythroid 2-related factor 2 （Nrf2）/quinone oxidoreductase 1 （NQO1）/heme oxygenase-1 （HO-1） pathway of oxidative stress （OS） based on animal experiments. MethodsFifty rats were modeled for CAG by gavage of 2% sodium salicylate （10 mL·kg^-1）， free access to 180 mg·L^-1 N-methyl-N′-nitro-N-nitrosoguanidine （MNNG）， and periodic diet intervention （72 h cycle： 24 h fasting + 48 h free access to food）. The modeled rats were grouped by a random number method as follows： low-， medium-， and high-dose （9， 18，36 g·kg^-1， respectively） Xianglian Huazhuo prescription， Moradan， and model， with 10 rats in each group. The general state of all rats was observed. Hematoxylin-eosin （HE） staining was employed to observe the pathological changes of the gastric mucosal tissue. The ultrastructure of cells was observed under transmission electron microscopy. Biochemical methods were adopted to determine the levels of malondialdehyde （MDA） and total superoxide dismutase （T-SOD） in the rat serum. The mRNA and protein levels of Kelch-like ECH-associated protein 1 （Keap1）， Nrf2， NQO1， and HO-1 in the gastric mucosal tissue of rats from each group were measured by Real-time polymerase chain reaction （Real-time PCR） and Western blot， respectively. Reactive oxygen species （ROS） staining was employed to detect the fluorescence intensity of ROS in the gastric mucosal tissue of rats in each group. ResultsCompared with the normal group， the modeled rats were sluggish， had yellowing and sparse hair， short and dark tail， loose stool， and reduced food intake， and showed the gastric mucosa characterized by atrophy， thinning， congestive edema， declined gland density and disarrangement， and apparent inflammatory cell infiltration， irregular nucleus morphology， nuclear condensation， mitochondria with decreased number， declined density， and abnormal morphology， vacuolization， declined serum T-SOD level （P<0.05）， elevated serum MDA level （P<0.05）， downregulated mRNA and protein levels of Nrf2， NQO1， and HO-1 （P<0.05）， upregulated mRNA and protein levels of Keap1 （P<0.05）， and enhanced mean fluorescence intensity of ROS （P<0.05）. Compared with the model group， each treatment group exhibited improved general state， alleviated histopathological changes in gastric mucosa， improved ultrastructural characteristics of cells， elevated T-SOD level and declined MDA level in the serum （P<0.05）， upregulated mRNA and protein levels of Nrf2， NQO1， and HO-1， downregulated mRNA and protein levels of Keap1 （P<0.05）， and attenuated mean fluorescence intensity of ROS （P<0.05）. ConclusionXianglian Huazhuo prescription can improve the general status， ameliorate pathological changes of gastric mucosa， and repair the cell ultrastructure to varying degrees， demonstrating a definite therapeutic effect on CAG. It may restrain OS and safeguard the natural physiological function of gastric mucosa in CAG rats by regulating the Nrf2/NQO1/HO-1 signaling pathway.

Objective To evaluate the predictive value of pathological tumor cell proportion size(PTS)and invasive lesion classification for recurrence of stage Ⅰ lung adenocarcinoma(LUAD).Methods A total of 160 patients who underwent stage Ⅰ LUAD resection in the hospital from February 2019 to February 2022 were retrospectively enrolled.According to PTS,the patients were divided into a high proliferation group(n=76)and a low proliferation group(n=84).According to the invasive lesion classification,the patients were divided into adenocarcinoma in situ(AIS)group(n=58),minimally invasive adenocarcinoma(MIA)group(n=52)and invasive adenocarcinoma(IAC)group(n=50).Cox proportional hazards regression was used to analyze the influencing factors of recurrence of stage Ⅰ LUAD.Kaplan-Meier was used to analyze the disease-free sur-vival(DFS)of each group,and the statistical power of variable factors was analyzed by receiver operating characteristic(ROC)curve.Results There were significant differences in mean tumor diameter,nodule type,margin condition,spread through air spaces(STAS),TNM stage,maximum tumor diameter,degree of differ-entiation,lymph node metastasis and proliferation cell nuclear antigen(Ki-67)proliferation index among pa-tients with different PTS(P＜0.05).STAS was a risk factor for DFS in patients with different PTS(P＜0.05),and the difference in DFS among patients with different PTS was statistically significant(P＜0.05).DFS in the low proliferation group was higher than DFS in the high proliferation group.PTS combined with STAS had a better efficacy in predicting stage Ⅰ LUAD recurrence[area under the curve(AUC)was 0.748].There were significant differences in mean tumor diameter,nodule type,margin condition,STAS,TNM stage,maximum tumor diameter,degree of differentiation,lymph node metastasis and Ki-67 proliferation index a-mong patients with different invasive lesions(P＜0.05).Margin condition and STAS were risk factors for DFS in patients with different invasive lesion types(P＜0.05).There was a significant difference in DFS be-tween patients with different invasive lesion types(P＜0.05),DFS in AIS group＞DFS in MIA group＞DFS in IAC group.The type of invasive lesions and margin condition combined with STAS had a good predictive value for stage Ⅰ LUAD recurrence(AUC was 0.784).Conclusion Different PTS combined with STAS can predict the recurrence of stage Ⅰ LUAD.Different invasive lesions combined with margin condition and STAS also have important predictive value for the recurrence of stage Ⅰ LUAD.

Objective Based on the general belief that the tongue characteristics of blood stasis constitution is"purple tongue,tortuous sublingual vessels",this study systematically summarized blood stasis tongue characteristics using artificial intelligence image processing combined with expert evaluation.Methods A physical questionnaire survey was conducted on 1275 college students,and 100 cases were randomly selected from the blood stasis constitution group and the mild constitution group.After collecting the tongue images,Unet,OpenCV,YOLOv5 and YOLOv8 algorithms combined with expert evaluation method were used to extract and analyze the tongue features of the two groups.By comparing the differences of tongue image characteristics between the blood stasis constitution group and the mild constitution group,the tongue characteristics of blood stasis constitution were systematically summarized.Results Compared with the mild constitution group,the proportion of light dark tongue and light purple tongue in the blood stasis constitution group was significantly higher(P＜0.05).The I value,L value and a value of the tongue area 1 in the blood stasis constitution group were significantly larger(P＜0.01,P＜0.05).The S value and a value of area 2 and area 3 were significantly larger(P＜0.05),and the I value,L value,a value and b value of area 5 were significantly smaller(P＜0.01,P＜0.05).Compared with the mild constitution group,the proportion of tooth marks tongue in the blood stasis constitution group was significantly higher(P＜0.01),the proportion of cracked tongue in the blood stasis constitution group was significantly larger(P＜0.05),and the number of tooth marks,crack area,relative height of crack and relative width of crack in the blood stasis constitution group were significantly larger(P＜0.01,P＜0.05).Compared with the mild constitution group,the I value,L value,a value and b value of tongue coating area 1 in the blood stasis constitution group were significantly larger(P＜0.01,P＜0.05),the I value,L value,S value,a value and b value of tongue coating area 2 were significantly larger(P＜0.01,P＜0.05),the I value,S value,a value and b value of tongue coating area 3 were significantly larger(P＜0.01,P＜0.05),the b value of tongue coating area 4 was significantly larger(P＜0.05),the S value,a value and b value of tongue coating area 5 were significantly larger(P＜0.01,P＜0.05).The proportion of thick tongue coating and greasy tongue coating in the blood stasis group was significantly higher than that in the gentleness group(P＜0.05).Compared with the mild constitution group,the proportion of tortuous,thickened and nodular sublingual collaterals in the blood stasis constitution group was significantly larger(P＜0.01,P＜0.05).The a value,I value,S value,b value and relative width of sublingual collaterals in the blood stasis constitution group were significantly larger(P＜0.01,P＜0.05).Conclusion On the basis of the general belief that the characteristics of blood stasis constitution tongue are dark purple tongue and dark purple sublingual collaterals/varicose veins/thickening,blood stasis constitution people also have new tongue characteristics,such as redder tips and edges,more teeth marks and fissures,thicker and greasier coatings,and yellow fur.These findings offer new insights for"to identify the constitution of traditional Chinese medicine and prevent diseases by observing the tongue manifestation".

Objective To evaluate the safety and efficacy of ciprofol in the anesthesia of elderly patients undergoing bronchoscopy.Methods A total of 96 elderly patients(≥65 years old)undergoing fiberoptic bronchos-copy under sedation and anesthesia were randomly assigned to either the ciprofol group(Group C,n=48)or the propofol group(Group P,n=48).In Group C,anesthesia was induced with an intravenous injection of sufentanil at 0.1 μg/kg and ciprofol at 0.3 mg/kg.In Group P,anesthesia was induced with an intravenous injection of sufent-anil at 0.1 μg/kg and propofol medium/long-chain fat emulsion at 1.5 mg/kg.Hemodynamic parameters,including heart rate(HR),mean arterial pressure(MAP),and peripheral oxygen saturation(SpO2),were recorded at five time points:before anesthesia induction(T1),immediately after the bronchoscope passed through the glottis(T2),immediately after it reached the carina(T3),immediately after the bronchoscope was withdrawn from the nostril post-procedure(T4),and upon full consciousness after leaving the recovery room(T5).Additionally,the success rate of sedation and anesthesia,cough severity scores,induction time(t1),bronchoscopy duration(t2),recovery time(t3),and orientation recovery time(t4)were documented for both groups.Intraoperative complications,such as hypotension,hypoxemia(SpO2<90%),injection pain during induction,airway interventions(e.g.,jaw support,mask ventilation),and the number of additional sedative doses administered,were also recorded.Results Compared with T1,MAP in both groups decreased at T2 and T3(P<0.05).Compared with group P,group C exhibited a higher MAP at T2 and T3(P<0.05).between the two groups in terms of sedation success rate,induction time,cough score,examination time,recovery time,and orientation recovery time(P>0.05).Compared with group P,group C demonstrated lower incidences of hypotension,hypoxemia,injection pain,and fewer airway intervention events(P<0.05).Conclusions Compared with propofol,ciprofol in combination with sufentanil demonstrates superior circulatory stability,a lower incidence of respiratory system-related adverse reactions,and reduced injection pain.Therefore,it can be safely and effectively utilized for painless bronchoscopic diagnosis and treatment in elderly patients.

Objective:To establish a similarity measurement model for patients with dentofacial deformity based on 3D craniofacial features and to validate the similarity results with quantifying subjec-tive expert scoring.Methods:In the study,52 cases of patients with skeletal Class Ⅲ malocclusions who underwent bimaxillary surgery and preoperative orthodontic treatment at Peking University School and Hospital of Stomatology from January 2020 to December 2022,including 26 males and 26 females,were selected and divided into 2 groups by sex.One patient in each group was randomly selected as a reference sample,and the others were set as test samples.Three senior surgeons rated the similarity scores between the test samples and the reference sample.Similarity scores ranged from 1 to 10,where 1 was completely different,and 10 was exactly the same.Scores larger than 7.5 was considered as clinical-ly similar.Preoperative cone beam computed tomography(CBCT)and 3D facial images of the patients were collected.The three-dimensional hard and soft tissue features,including distances,angles and 3D point cloud features were extracted.The similarity measurement model was then established to fit with the experts'similarity scoring by feature selection algorithm and linear regression model.To verify the relia-bility of the model,14 new patients were selected and input to similarity measurement model for finding similar cases.The similarity scoring of these similar cases were rated by experts,and used to evaluate the reliability of the model.Results:The similarity metric models indicated that the features of the middle and lower craniofacial features were the main features to influence the craniofacial similarity.The main features that were related to the expert's similarity scoring included distance of anterior nasal spine-menton(ANS-Me),distance of right upper canion point-Frankfurt horizontal plane(U3RH),distance of left superior point of the condyle-left gonion(CoL-GoL),distance of left gonion-menton(CoL-Me),dis-tance of pogonion-midsagittal plane(Pog-MSP),distance of right alar base-left alar base(AlR-AlL),angle of pronasale-soft tissue pogonion-labrale inferius(Pn-Pog'-Li),distance of trichion-right tragus(Tri-TraR),distance of left exocanthion-left alar base(ExL-AlL),lower 1/3 of skeletal face,middle and lower 2/3 of skeletal face and upper lip region of soft tissue.Fourteen new patients were chosen to evaluate the model.The similar cases selected by the model had an average experts'similarity scoring of 7.627±0.711,which was not significantly different with 7.5.Conclusion:The similarity measurement model established by this model could find the similar cases which highly matched experts'subjective simi-larity scoring.The study could be further used for similar cases retrieval in skeletal Ⅲ malocclusion patients.