Objective:To investigate the impact of four registration methods on the accuracy of virtual occlusal records (VOR) in intraoral scanning for implant restorations with multiple missing teeth.Methods:A mandibular model simulating clinical conditions with multiple missing teeth (right first molar, left second premolar, left first molar, left second molar) and a maxillary compete dentition model were mounted on a semi-adjustable articulator. Subsequently, twelve 0.5 mm stainless steel spheres were adhered to reference positions (16, 46, 13, 43, 23, 33, 25, 35, 26, 36, 27, 37) as fiducial markers. Following this, a laboratory scanner generated reference datasets by digitizing the models in maximum intercuspation (MIP). Meanwhile, ten maxillary and mandibular scans were acquired using an intraoral scanner, with all nonarticulated scans duplicated four times to ensure data consistency. Forty VOR intraoral scans were performed in MIP using four registration protocols: left-side, right-side, anterior, and bilateral registration ( n=10 per group), randomized via a computer-generated pseudo-random sequence. For measurement, linear distances (D16-46, D13-43, D23-33, D25-35, D26-36, D27-37, D16-46 represented the single-tooth defect position, whereas D25-35, D26-36, D27-37 reflected positions in free-end edentulism areas) between opposing markers were measured in a reverse engineering software, with deviations (ΔD) from the reference scan calculated to assess accuracy. Specifically, negative ΔD values indicated vertical dimension underestimation. Given that non-normally distributed data were analyzed using medians [interquartile ranges (IQR)], trueness (median ΔD) and precision (IQR) were evaluated. The interaction effect between the registration method and the position of the measurement items was evaluated by using the generalized linear model. The accuracy was compared overall by the Kruskal-Wallis test with the two-sided significance level of α=0.05. For pairwise comparisons, post-hoc tests were conducted by Dunn′s t-test with the Bonferroni correction for the significance level. Results:The accuracy of VOR was affected by registration method ( P<0.05), with a significant position×registration method interaction observed ( P<0.05). In particular, in all four groups, only the bilateral registration group showed trueness of less than 0.1 mm for both free-end edentulism and the single tooth defect, with ΔD16-46, ΔD25-35, ΔD26-36, and ΔD27-37 being 0.059 (0.015), -0.082 (0.052), -0.065 (0.032), -0.070 (0.050) mm, respectively. Moreover, trueness in free-end edentulism showed negative values across all groups, with the largest negative deviations observed in the right-side registration group, with ΔD25-35, ΔD26-36 and ΔD27-37 being -0.410 (0.174), -0.442 (0.225), -0.439 (0.262) mm, respectively. Conclusions:In fully digital workflows of implant restorations for mandibular free-end edentulism with multiple missing teeth, registration method critically influences VOR accuracy. While four registration methods exhibited underestimation of occlusal vertical dimension, bilateral registration achieved the highest accuracy.

Objective:To investigate the impact of four registration methods on the accuracy of virtual occlusal records (VOR) in intraoral scanning for implant restorations with multiple missing teeth.Methods:A mandibular model simulating clinical conditions with multiple missing teeth (right first molar, left second premolar, left first molar, left second molar) and a maxillary compete dentition model were mounted on a semi-adjustable articulator. Subsequently, twelve 0.5 mm stainless steel spheres were adhered to reference positions (16, 46, 13, 43, 23, 33, 25, 35, 26, 36, 27, 37) as fiducial markers. Following this, a laboratory scanner generated reference datasets by digitizing the models in maximum intercuspation (MIP). Meanwhile, ten maxillary and mandibular scans were acquired using an intraoral scanner, with all nonarticulated scans duplicated four times to ensure data consistency. Forty VOR intraoral scans were performed in MIP using four registration protocols: left-side, right-side, anterior, and bilateral registration ( n=10 per group), randomized via a computer-generated pseudo-random sequence. For measurement, linear distances (D16-46, D13-43, D23-33, D25-35, D26-36, D27-37, D16-46 represented the single-tooth defect position, whereas D25-35, D26-36, D27-37 reflected positions in free-end edentulism areas) between opposing markers were measured in a reverse engineering software, with deviations (ΔD) from the reference scan calculated to assess accuracy. Specifically, negative ΔD values indicated vertical dimension underestimation. Given that non-normally distributed data were analyzed using medians [interquartile ranges (IQR)], trueness (median ΔD) and precision (IQR) were evaluated. The interaction effect between the registration method and the position of the measurement items was evaluated by using the generalized linear model. The accuracy was compared overall by the Kruskal-Wallis test with the two-sided significance level of α=0.05. For pairwise comparisons, post-hoc tests were conducted by Dunn′s t-test with the Bonferroni correction for the significance level. Results:The accuracy of VOR was affected by registration method ( P<0.05), with a significant position×registration method interaction observed ( P<0.05). In particular, in all four groups, only the bilateral registration group showed trueness of less than 0.1 mm for both free-end edentulism and the single tooth defect, with ΔD16-46, ΔD25-35, ΔD26-36, and ΔD27-37 being 0.059 (0.015), -0.082 (0.052), -0.065 (0.032), -0.070 (0.050) mm, respectively. Moreover, trueness in free-end edentulism showed negative values across all groups, with the largest negative deviations observed in the right-side registration group, with ΔD25-35, ΔD26-36 and ΔD27-37 being -0.410 (0.174), -0.442 (0.225), -0.439 (0.262) mm, respectively. Conclusions:In fully digital workflows of implant restorations for mandibular free-end edentulism with multiple missing teeth, registration method critically influences VOR accuracy. While four registration methods exhibited underestimation of occlusal vertical dimension, bilateral registration achieved the highest accuracy.

Objective To explore the correlation between acute gastrointestinal side effects caused by radiotherapy in pancreatic cancer and degree of gastroduodenal radioactive injury under gastoendoscopy.Methods From February 2010 to May 2015,112 patients with pancreatic cancer and received radiotherapy were enrolled.The correlation between gastroscopic findings and degree of gastrointestinal side effects (grade zero to five) was analyzed.The effects of different radiotherapy on the formation of radiation ulcers were also investigated.Chi-square test and Spearman correlation analysis were performed for statistically analysis.Results The incidence of radioactive gastroduodenitis was 57.1 ％ (64/112).The incidence of radiation-induced ulcer was 42.0 ％ (47/112).Among the 112 patients with pancreatic cancer and received radiotherapy,patients with over grade two nausea,vomiting,dyspepsia and constipation received symptomatic treatment.Thirty-one patients (27.7 ％) of them received appetitestimulating treatment,53 patients (47.3％) were given anti-nausea treatment,39 patients (34.8％)received therapy of promoting digestion,and 24 patients (21.4 ％) received therapy of relieving constipation.The incidence of radiation-induced ulcer in patients with grade one acute gastrointestinal side effects was 25.8 ％ (8/31),lower than that of patients with over grade two acute gastrointestinal side effects (48.1％,39/81),and the difference was statistically significant (x2 =4.595,P=0.032).The grade of acute gastrointestinal side effects was positively correlated with that of radiation-induced injury under gastroendoscopy (r=0.295,P =0.002).The incidences of radiation-induced ulcer of gamma knife radiotherapy and helical tomotherapy were 50.0 ％ (15/30) and 39.2 ％ (31/79),respectively,and the difference was not statistically significant (x2 =1.032,P =0.301).Conclusions The occurrence of radiation ulcers should be alerted if over grade two acute gastrointestinal side effects presented in patients with pancreatic cancer and received radiotherapy.The radiotherapy caused gastrointestinal side effects can not be evaluated just according to clinical symptoms.Endoscopic findings and pathological diagnosis are the gold standard.

ObjectiveTo investigate the efficacy and toxic and adverse effects of high-dose hypofractionated radiotherapy in elderly patients with stage Ⅳ pancreatic cancer. MethodsThe clinical data of the patients with pancreatic cancer and distant metastasis who were admitted to our hospital from September 2011 to May 2015 were collected, and all the patients underwent high-dose hypofractionated helical tomotherapy. The data on efficacy and toxic and adverse effects were obtained through follow-up, and the evaluation of adverse effects was performed according to National Cancer Institute-Common Terminology Criteria for Adverse Events version 4.02. The Kaplan-Meier method was used for survival analysis. ResultsA total of 33 patients older than 65 years received the high-dose hypofractionated radiotherapy. Of all the patients, 30 received follow-up visits, and the follow-up rate was 91.0%. The median survival time was 9 months, the 1-year overall survival rate was 24.0%, and the rate of pain relief was 80.0% (20/25). The treatment outcome of pancreatic lesions could be evaluated in 17 patients, among whom 4 (23.5%) achieved partial remission, 12 (70.6%) achieved stable disease, and 1 (5.9%) experienced progression. As for toxic and adverse effects, the incidence rate of grade 3 hematologic toxicity was 6.7% (2/30), and no patients experienced grade ＞2 upper gastrointestinal reactions. ConclusionIn elderly patients with stage IV pancreatic cancer, high-dose hypofractionated radiotherapy has tolerable toxic and adverse effects and can relieve cancer pain and prolong survival time.

OBJECTIVE To investigate the mechanism and treatment of diabetes among elderly patients from the view of traditional Chinese medicine(TCM).METHODS On the basis of clinical experience and the achievement of the modern medicine,we expounded the mechanism of diabetes among elderly patients and treat from eight parts.RESULTS Using eight different TCM methods to treat diabetes elderly patients,we found their good curative effect with less adverse reaction,good prognosis,and very suit for old man.CONCLUSIONS TCM has large potentiality and advantage among diabetes elderly patients complicated with respiratory tract infection.

Because of the effects of misbalance of Qi/Blood and Yin/Yang and abuse of medicine,food and emotion,phlegm and static blood syndrome is easy to be made in the course of pathological changes of migraine.Phlegm and static blood syndrome is the important factor in the occurrence and development of migraine. In the whole period of migraine it is showing not only stabbing pain immovable for a long time,but also showing languor and scarce of appetite;The method of dissipating blood stasis and phlegm should be used effectively.