Objective:To design a set of simulation system for surgical operation based on virtual reality(VR)technique and intelligent scoring functions,so as to assess its clinical application effect.Methods:The Digital Imaging and Communications in Medicine(DICOM)images of typical patients were collected.Materialise Interactive Medical Image Control System(MIMICS)software was adopted to reconstruct the three-dimensional(3D)model of diseased organs.Surgical instrument models were constructed by using 3D Max software.Unity 3D software was adopted to construct simulation system for surgical operation with VR+intelligent scoring.A total of 40 surgical resident physicians,who were employed with 3 years since 2019 in The Second Affiliated Hospital of Kunming Medical University,were selected.They were divided into observation group and control group,with 20 cases in each group.The observation group used simulation system for surgical operation to conduct intelligent scoring for cholecystectomy under laparoscope,and the control group used conventional scoring for surgical operation.The scores of surgical operation and test between the two groups were compared.Results:The mean value of surgical operation time of the observation group was(1.72±0.41)h,and the average incidence of complication was(0.03±0.02)%,both of them of the observation group were significantly lower than those of the control group[(2.25±0.42)h and(0.05±0.03)%].The differences of them between two groups were statistically significant(t=9.00,4.08,P<0.05).The test scores of surgical operation of the observation group was also significantly higher than that of the control group(t=5.26,P<0.001).Conclusion:The developed simulation system for surgical operation with VR+intelligent scoring can significantly enhance users'surgical operation skills and improve learning outcomes,which has favorable prospects in future applications.

Objective:To investigate the establishment, structural, and bonding interface characteristics of an artificial caries-affected dentin model with demineralization and discoloration as a basis of research on caries-affected dentin bonding repair.Methods:One hundred intact molars without caries were collected (acquired from Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University from March to May 2023) and prepared as 5 mm thick dentin specimens. Then, they were screened and divided into 3 parts. One part of dentin specimens was subjected to bacterial biofilms to prepare artificial carious dentin (ACD). They were further ground by 600-grit SiC paper for 0, 12, 24, 36, and 48 s, respectively to obtain 5 groups with different layers of ACD: ACD-0, 12, 24, 36, and 48 s. Sound dentin was used as the control group. To determine the preparation parameter for artificial caries-affected dentin (ACAD), the first part of specimens was used for bacterial visualization observation ( n=3) and demineralization analysis experiments (micro-CT, Raman spectroscopy, and surface micro-hardness analyses, n=3). Another part of dentin specimens was allocated to 3 groups: control group (sound dentin), artificial caries-infected dentin group (ACD-0 s) and ACAD group (prepared according to the parameter determined by the experiments above). They were used for color tests ( n=10), Raman spectroscopy analysis ( n=6) and scanning electron microscope (SEM) observation ( n=1), thus comparing color, chemical composition and structure, and micro-morphology of 3 groups. The rest of dentin specimens were divided into 2 groups: sound dentin and ACAD ( n=6), which were bonded to composite resin with Single Bond Universal in a self-etch mode. Then, the bonding interface was measured using an electron probe micro-analyzer (EPMA). Results:The depth of bacterial invasion for ACD-0 s was (142.4±25.8) μm. And obvious bacteria were observed in the dentin tubules for the ACD-12 s group. For micro-CT, the demineralization depth was (283.9±25.6) μm for ACD-0 s and (139.2±27.9) μm for ACD-36 s. The grey values in some regions of the dentin surface for ACD-48 s resembled those of sound dentin. For Raman spectroscopy, the peak ratio of phosphate to amide Ⅰ was significantly lower for ACD-24 s [4.2 (3.2,6.7)] than ACD-36 s [6.7 (6.0,7.7)] ( P<0.05). Additionally, there was no significant difference in surface micro-hardness between ACD-24 s [8.3 (7.0,10.2) HV] and ACD-36 s [10.2 (9.1,11.4) HV] ( P>0.05). The preparation parameter of ACAD was determined to be grinding for 36 s based on the experimental results above. The brightness (L * value) and the yellow-blue chromaticity (b * value) of ACAD (76.69±2.54, 33.15±1.89) were significantly lower than those of the control group (85.23±1.68, 35.87±1.55) ( P<0.05). The red-green chromaticity (a * value) of ACAD (5.38±1.20) was significantly higher than that of the control group (0.71±0.86) ( P<0.05). Moreover, the collagen structure parameter in Raman spectroscopy (the peak ratio of amide Ⅲ to CH 2) of ACAD (1.089 7±0.038 5) was significantly higher than that of the control group (0.985 2±0.020 1) ( P<0.05). As shown in EPMA, the hybrid layer of ACAD [(4.72±1.03) μm] was significantly thicker than that of sound dentin [(3.02±0.66) μm] ( F=21.09, P<0.001) in a self-etch mode. Conclusions:ACAD is established through bacterial biofilm challenges followed by grinding for 36 s. It is partly demineralized and discolored with collagen structure changes, making it suitable for research on caries-affected dentin bonding.

This article explores the compatibility of traditional Chinese medicine for external treatment of ulcers from the perspec-tive of"the principle of internal and external treatment"in Rhymed Discourse on External Remedies.First,it discusses the clinical un-derstanding of chronic skin ulcers,and then it explains the connotation of"the principle of internal and external treatment",which has the characteristics of theoretical homology,syndrome differentiation and treatment,and focusing on the property and taste of the medi-cine first.Finally,based on"the principle of internal and external treatment",it discusses the compatibility ideas of Chinese medicine for external treatment of ulcers,and specifically analyzes the compatibility ideas of property and taste and monarch,minister,assistant and envoy,so as to provide some reference for the external treatment and compatibility of Chinese medicine for chronic skin ulcers,and also hopes to provide some directions for the research and development of external traditional Chinese patent medicines and simple prep-arations.

Complete mesocolic excision in radical colorectal cancer surgery enhances both surgical quality and the accuracy of pathological staging. In the context of sigmoid colon cancer, the optimal extent of lymphadenectomy and the appropriate level of vascular ligation remain controversial. High ligation of the inferior mesenteric artery may facilitate more thorough lymph node dissection and allow for tension-free anastomosis. However, it requires a comprehensive assessment of postoperative complication risks and the preservation of organ function. Para-aortic lymph node dissection has shown potential survival benefits in patients with oligometastatic disease, yet its application should be individualized. Moreover, intraoperative navigation technologies, such as indocyanine green fluorescence imaging, can assist in accurately delineating the dissection field and support the feasibility of personalized surgical strategies. This review synthesizes current evidence and leading domestic and international clinical guidelines to systematically examine the latest developments in lymphadenectomy strategies for sigmoid colon cancer, focusing on mesenteric anatomy, D3 dissection, complete mesocolic excision, vascular ligation levels, para-aortic lymph node dissection, and fluorescence-guided imaging techniques.

Objective:To investigate the establishment, structural, and bonding interface characteristics of an artificial caries-affected dentin model with demineralization and discoloration as a basis of research on caries-affected dentin bonding repair.Methods:One hundred intact molars without caries were collected (acquired from Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University from March to May 2023) and prepared as 5 mm thick dentin specimens. Then, they were screened and divided into 3 parts. One part of dentin specimens was subjected to bacterial biofilms to prepare artificial carious dentin (ACD). They were further ground by 600-grit SiC paper for 0, 12, 24, 36, and 48 s, respectively to obtain 5 groups with different layers of ACD: ACD-0, 12, 24, 36, and 48 s. Sound dentin was used as the control group. To determine the preparation parameter for artificial caries-affected dentin (ACAD), the first part of specimens was used for bacterial visualization observation ( n=3) and demineralization analysis experiments (micro-CT, Raman spectroscopy, and surface micro-hardness analyses, n=3). Another part of dentin specimens was allocated to 3 groups: control group (sound dentin), artificial caries-infected dentin group (ACD-0 s) and ACAD group (prepared according to the parameter determined by the experiments above). They were used for color tests ( n=10), Raman spectroscopy analysis ( n=6) and scanning electron microscope (SEM) observation ( n=1), thus comparing color, chemical composition and structure, and micro-morphology of 3 groups. The rest of dentin specimens were divided into 2 groups: sound dentin and ACAD ( n=6), which were bonded to composite resin with Single Bond Universal in a self-etch mode. Then, the bonding interface was measured using an electron probe micro-analyzer (EPMA). Results:The depth of bacterial invasion for ACD-0 s was (142.4±25.8) μm. And obvious bacteria were observed in the dentin tubules for the ACD-12 s group. For micro-CT, the demineralization depth was (283.9±25.6) μm for ACD-0 s and (139.2±27.9) μm for ACD-36 s. The grey values in some regions of the dentin surface for ACD-48 s resembled those of sound dentin. For Raman spectroscopy, the peak ratio of phosphate to amide Ⅰ was significantly lower for ACD-24 s [4.2 (3.2,6.7)] than ACD-36 s [6.7 (6.0,7.7)] ( P<0.05). Additionally, there was no significant difference in surface micro-hardness between ACD-24 s [8.3 (7.0,10.2) HV] and ACD-36 s [10.2 (9.1,11.4) HV] ( P>0.05). The preparation parameter of ACAD was determined to be grinding for 36 s based on the experimental results above. The brightness (L * value) and the yellow-blue chromaticity (b * value) of ACAD (76.69±2.54, 33.15±1.89) were significantly lower than those of the control group (85.23±1.68, 35.87±1.55) ( P<0.05). The red-green chromaticity (a * value) of ACAD (5.38±1.20) was significantly higher than that of the control group (0.71±0.86) ( P<0.05). Moreover, the collagen structure parameter in Raman spectroscopy (the peak ratio of amide Ⅲ to CH 2) of ACAD (1.089 7±0.038 5) was significantly higher than that of the control group (0.985 2±0.020 1) ( P<0.05). As shown in EPMA, the hybrid layer of ACAD [(4.72±1.03) μm] was significantly thicker than that of sound dentin [(3.02±0.66) μm] ( F=21.09, P<0.001) in a self-etch mode. Conclusions:ACAD is established through bacterial biofilm challenges followed by grinding for 36 s. It is partly demineralized and discolored with collagen structure changes, making it suitable for research on caries-affected dentin bonding.

Objective To investigate the clinical efficacy and safety of intravenous thrombolysis with tenecteplase in the treatment of CWS.Methods A prospective study was conducted on 136 CWS patients consecutively admitted in Department of Neurology of Zhengzhou People's Hospital from March 2019 to March 2024.They were randomly divided into a tenecteplase group(67 cases)and a control group(69 cases).NIHSS was used to evaluate the recovery of neurological function after treatment.mRS was employed to assess long-term prognosis.Results Significantly larger proportion of white matter lesions and higher baseline SBP level were observed in the tenecteplase group than the control group(P＜0.05).The tenecteplase group obtained obviously greater ratio of overall recovery than the control group,with notably lower NIHSS score,incidence of new CWS attacks and proportion of new acute cerebral infarction at 24 and 72 h and 7 d after treat-ment(P＜0.05,P＜0.01).Moreover,the proportion of mRS score of 0-2 was notably greater,while that of the score of 3-6 was lower in the tenecteplase group than the Control group(P＜0.05).Intravenous thrombolysis with tenecteplase was an influencing factors for 90-day mRS score of 0-2 and of 3-6 in the CWS patients(OR=0.264,95％CI:0.089-0.813;OR=4.144,95％CI:1.184-14.506,P＜0.05).Conclusion Intravenous thrombolysis with tenecteplase for CWS significantly improves the proportion of patients with good prognosis.

Objective To investigate the effects of different timing of initiation of rivaroxaban anti-coagulation therapy on the efficacy and bleeding risk of atrial fibrillation patients after stroke.Methods A total of 336 patients with atrial fibrillation and stroke admitted in our hospital be-tween January 2021 and December 2023 were consecutively enrolled,and randomly divided into an experimental group(165 cases)and a control group(171 cases).The experimental group received rivaroxaban treatment within 48 h of symptom onset,whereas the control group initiated oral ri-varoxaban treatment on the 3rd,6th,and 12th day post-stroke onset,respectively,depending on stroke severity(mild,moderate,and severe).Their baseline clinical data were collected,and all of them were followed up till 90 d after stroke.The incidences of recurrent ischemic stroke,symp-tomatic intracranial hemorrhage and extracranial hemorrhage,mortality,and proportion of pa-tients with mRS score≤ 2 and distribution of the score were observed and analyzed in the two groups.Results During a 90-day follow-up period,the patients with moderate stroke from the ex-perimental group of patients exhibited a significantly lower rate of recurrent ischemic stroke than those in the control group(5.4％vs 15.9％,P=0.037).However,for patients with mild and se-vere stroke,no obvious difference was observed in the primary endpoint of recurrent ischemic stroke between the experimental and control groups(3.0％vs 3.2％,12.5％vs 14.8％,P＞0.05).Though no statistical differences were observed,lower rates of symptomatic intracranial hemor-rhage(1.5％vs 3.2％,5.4％vs 9.8％),reduced incidence of extracranial hemorrhage(9.0％vs 14.5％,12.2％vs 15.9％),and lower mRS score[1(0,2)vs 1(1,2),3(1,4)vs 3(2,4)]were seen in the patients with mild and moderate stroke from the experimental group when compared with the control group(P＞0.05).Similarly,there were no statistically differences for the severe stroke patients between the experimental and control groups(P＞0.05)in the incidence of extracranial hemorrhage(20.8％vs 22.2％),rate of symptomatic intracranial hemorrhage(20.8％vs 7.4％),mortality(8.3％vs 3.7％),and mRS score[4(3,4)vs 3(3,4)].Two patients from the experimen-tal group died,with one case due to secondary pulmonary infection and the other due to brainstem hemorrhage.In the control group,only one death occurred due to brainstem hemorrhage.Conclu-sion For atrial fibrillation patients,anticoagulation with rivaroxaban within 48 h after stroke has no significant increase in the risk of bleeding,reduces the proportion of recurrent ischemic stroke in patients with moderate stroke,and may improve the prognosis of patients.

Objective To investigate the clinical efficacy and safety of intravenous thrombolysis with tenecteplase in the treatment of CWS.Methods A prospective study was conducted on 136 CWS patients consecutively admitted in Department of Neurology of Zhengzhou People's Hospital from March 2019 to March 2024.They were randomly divided into a tenecteplase group(67 cases)and a control group(69 cases).NIHSS was used to evaluate the recovery of neurological function after treatment.mRS was employed to assess long-term prognosis.Results Significantly larger proportion of white matter lesions and higher baseline SBP level were observed in the tenecteplase group than the control group(P＜0.05).The tenecteplase group obtained obviously greater ratio of overall recovery than the control group,with notably lower NIHSS score,incidence of new CWS attacks and proportion of new acute cerebral infarction at 24 and 72 h and 7 d after treat-ment(P＜0.05,P＜0.01).Moreover,the proportion of mRS score of 0-2 was notably greater,while that of the score of 3-6 was lower in the tenecteplase group than the Control group(P＜0.05).Intravenous thrombolysis with tenecteplase was an influencing factors for 90-day mRS score of 0-2 and of 3-6 in the CWS patients(OR=0.264,95％CI:0.089-0.813;OR=4.144,95％CI:1.184-14.506,P＜0.05).Conclusion Intravenous thrombolysis with tenecteplase for CWS significantly improves the proportion of patients with good prognosis.

This article explores the compatibility of traditional Chinese medicine for external treatment of ulcers from the perspec-tive of"the principle of internal and external treatment"in Rhymed Discourse on External Remedies.First,it discusses the clinical un-derstanding of chronic skin ulcers,and then it explains the connotation of"the principle of internal and external treatment",which has the characteristics of theoretical homology,syndrome differentiation and treatment,and focusing on the property and taste of the medi-cine first.Finally,based on"the principle of internal and external treatment",it discusses the compatibility ideas of Chinese medicine for external treatment of ulcers,and specifically analyzes the compatibility ideas of property and taste and monarch,minister,assistant and envoy,so as to provide some reference for the external treatment and compatibility of Chinese medicine for chronic skin ulcers,and also hopes to provide some directions for the research and development of external traditional Chinese patent medicines and simple prep-arations.

Objective To investigate the effects of different timing of initiation of rivaroxaban anti-coagulation therapy on the efficacy and bleeding risk of atrial fibrillation patients after stroke.Methods A total of 336 patients with atrial fibrillation and stroke admitted in our hospital be-tween January 2021 and December 2023 were consecutively enrolled,and randomly divided into an experimental group(165 cases)and a control group(171 cases).The experimental group received rivaroxaban treatment within 48 h of symptom onset,whereas the control group initiated oral ri-varoxaban treatment on the 3rd,6th,and 12th day post-stroke onset,respectively,depending on stroke severity(mild,moderate,and severe).Their baseline clinical data were collected,and all of them were followed up till 90 d after stroke.The incidences of recurrent ischemic stroke,symp-tomatic intracranial hemorrhage and extracranial hemorrhage,mortality,and proportion of pa-tients with mRS score≤ 2 and distribution of the score were observed and analyzed in the two groups.Results During a 90-day follow-up period,the patients with moderate stroke from the ex-perimental group of patients exhibited a significantly lower rate of recurrent ischemic stroke than those in the control group(5.4％vs 15.9％,P=0.037).However,for patients with mild and se-vere stroke,no obvious difference was observed in the primary endpoint of recurrent ischemic stroke between the experimental and control groups(3.0％vs 3.2％,12.5％vs 14.8％,P＞0.05).Though no statistical differences were observed,lower rates of symptomatic intracranial hemor-rhage(1.5％vs 3.2％,5.4％vs 9.8％),reduced incidence of extracranial hemorrhage(9.0％vs 14.5％,12.2％vs 15.9％),and lower mRS score[1(0,2)vs 1(1,2),3(1,4)vs 3(2,4)]were seen in the patients with mild and moderate stroke from the experimental group when compared with the control group(P＞0.05).Similarly,there were no statistically differences for the severe stroke patients between the experimental and control groups(P＞0.05)in the incidence of extracranial hemorrhage(20.8％vs 22.2％),rate of symptomatic intracranial hemorrhage(20.8％vs 7.4％),mortality(8.3％vs 3.7％),and mRS score[4(3,4)vs 3(3,4)].Two patients from the experimen-tal group died,with one case due to secondary pulmonary infection and the other due to brainstem hemorrhage.In the control group,only one death occurred due to brainstem hemorrhage.Conclu-sion For atrial fibrillation patients,anticoagulation with rivaroxaban within 48 h after stroke has no significant increase in the risk of bleeding,reduces the proportion of recurrent ischemic stroke in patients with moderate stroke,and may improve the prognosis of patients.