Objective:To understand the pathogenic situation of hand, foot and mouth disease (HFMD) in Linyi City, and to analyze the gene characteristics of Coxsackievirus A10 complete VP1 region.Methods:The samples of HFMD cases from Linyi City in 2023 were tested for typing and strain isolation, and the VP1 gene of CV-A10 isolate was amplified and sequenced. The obtained sequences were compared with those in the NCBI database, and the phylogenetic tree was constructed for gene characteristics and molecular epidemiological analysis.Results:In 2023, a total of 861 samples of HFMD were collected, and 594 (68.99%) were positive for nucleic acid tests. The male to female ratio of positive cases was 1.56∶1. Children under 5 years old accounted for 81.65%, and the highest incidence season was from June to August (83.84%). CV-A6 was the main pathogen (84.51%), followed by CV-A10 (9.93%). The nucleotide and amino acid homology of VP1 gene sequence among 13 isolates were 93.29%-100.00% and 97.65%-100.00%, respectively. The nucleotide and amino acid homology with AF081300-Kowalik/USA/1950 was lower (75.95%-76.62%, 91.72%-92.41%). The amino acid and nucleotide homology with C2c was the highest (94.28%-96.76%, 98.28%-100.00%), and the genetic distance was the closest (0.04-0.06). Amino acid site variation analysis showed that compared with the prototype strain AF081300-Kowalik/USA/1950, the isolates had more site variation, while only some isolates had I80V, E141K, P147S, T219I, E240K and V261I mutations compared with the representative strain C2c. The genetic evolution tree showed that the isolates were all in the same clade as the C2c representative strains, and they all belonged to the C2c genotype, and the isolates were further divided into two smaller clades.Conclusions:In 2023, CV-A6 was the main pathogen of HFMD in Linyi City, followed by CV-A10. All CV-A10 isolates were C2c genotypes and can be divided into two evolutionary clades. Continuous monitoring and genetic characterization of CV-A10 should be strengthened.

As a new clinical concept, comfortable treatment is gaining increasingly acceptance. Pain is the fifth vital sign in humans and the primary concern for patients. It is also a clinical issue that must be faced in alveolar surgery. This article summarizes pain cognition, the impact of postoperative pain and clinical pain grading, discusses the significance of postoperative pain management, categorizes commonly used analgesic medications in clinical practice. It also introduces the concepts and techniques of comfortable treatment and comfortable therapy. The author suggests that in order to achieve comfortable treatment in alveolar surgery, the first step is to relieve postoperative pain. Postoperative pain management should not only be treated as temporary analgesia but also be managed around the perioperative period as the key stage. Using preemptive analgesia before the onset of pain, combined with non-pharmacological methods, provides basic support and guarantee for patients to achieve the goal of comfortable treatment. The purpose of this article is to emphasize comprehensive control of postoperative pain in alveolar surgery, guiding and promoting the popularization and promotion of corresponding technologies with the concept of comfortable treatment. This aims to reduce the adverse impact of surgery on both physical and mental well-being, facilitating physiological recovery and enhancing patient compliance. To ensure that patients undergo diagnosis, treatment, and rehabilitation processes with ease, comfort, and satisfaction.

Objective:To establish a two-stage surgical procedure of impacted mandibular third molars (IMTM) extractions assisted by coronectomy and microimplant anchorage traction and to investigate the influencing factors of root movement and the effects of different traction angles on the clinical outcomes.Methods:Fifty-three IMTM in contact with inferior alveolar nerve (IAN) that underwent tooth extraction in the Department of Oral and Maxillofacial Surgery Peking University School of Stomatology from January 2022 to June 2023 were included, with coronectomy and microimplant anchorage implantation in the first stage of the surgery, root traction was achieved with orthodontic elastic and microimplant anchorages by about 5.886 N of force, when the IMTM root was detached from IAN, a second surgery was performed to extract the residual root. The basic information of patients and M3M, data on the microimplant anchorage implantation and traction, imaging measurements, and complications were recorded and analyzed.Results:The movement distance of the residual roots was (1.80±0.92) mm, and the duration of traction was (32.9±7.9) d. Multiple linear regression analysis showed that the residual root movement distance was significantly correlated with age, gender, number of roots, traction angle, and depth of the distal bone defect of the second molar ( P<0.05). The smaller the traction angle, the more significant the movement of the residual roots ( P=0.044). In one case, the patient experienced abnormal sensation in the lower lip 16 days after one IMTM (1.9%, 1/53) traction. Conclusions:The two-stage surgical method of combined coronectomy with rapid traction technique to extract the IMTM allows for rapid movement of the residual root and reduces the risk of IAN injury. The efficiency of root movement can be accelerated by appropriately reducing the traction angle during surgery. The traction effect can be predicted based on indicators such as age, gender, number of roots and depth of distal bone defects of second molar.

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 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 analyze the anatomical morphological characteristics of the trabecular bone of human mandibular condyle by observing the distribution of volume of interests (VOI).Methods:The micro-CT images of a right condyle specimen of a 61-year-old adult male was analyzed in this study. The cylindrical VOI with both diameter and height of 2 mm were arranged, according to a certain pattern, as many as possible at various levels within the trabecular bone of the condyle. Each VOI had no intersection area. The selected VOI were divided into 5 parts: medial part, middle part, lateral part, anterior part and posterior part, with 6 layers from top to bottom. And the distribution of the overall anatomical morphological characteristics of three-dimensional (3D) images of the trabecular bone of the condyle was analyzed by using seven morphological parameters of each VOI, i.e. bone mineral density (BMD), bone volume/total volume (BV/TV), bone surface area/bone volume (BS/BV), trabecular thickness (Tb.Th), trabecular bone number (Tb.N), trabecular spacing (Tb.Sp) and trabecular bone pattern factor (Tb.Pf).Results:In the present study, totally 34 VOI were selected from the condyle specimen.The morphological distribution of the VOI was uneven in the 3D structure of the trabecular bone of the human condyle. BMD, BV/TV, Tb.N and Tb.Th were much higher at the middle part, while showed the smallest at the medial part. The anterior part demonstrated much higher parameters than the posterior part at the first, second, fifth and sixth layers, respectively, however, the posterior part showed much higher parameters than the anterior part at the third and fourth layers, respectively. The BMD was much higher at the first [(332.66±97.11) mg/cm 3] and sixth [(255.79±45.68) mg/cm 3] layers, while the lowest at the second layer [(255.79±41.06) mg/cm 3]. The BV/TV and Tb.N were much higher at the first layer, with the lowest at the fifth layer. The Tb.Th at the first layer [(0.11±0.03) mm] was much higher than the others, which were similarly lower. The BS/BV, Tb.Sp and Tb.Pf were lower at the first layer and much higher at the medial and lateral parts, while were lower at the middle and anterior parts. The posterior part demonstrated much higher BS/BV, Tb.Sp and Tb.Pf than the anterior part at the first, fifth and sixth layers, respectively. However, the anterior part showed much higher scores than the posterior part at the third and fourth layers, respectively. The ANOVA results showed that the 7 morphological parameters of VOI were not statistically significant amongst the 6 layers ( P>0.05). However, the 6 out of the 7 parameters, i.e. BV/TV, BS/BV, Tb.Th, Tb.N, Tb.Sp and Tb.Pf, were statistically significant amongst the five parts ( P<0.05), while the only parameter of BMD was not statistically significant ( P>0.05). Conclusions:The anatomical distribution characteristics of the trabecular bone of condyle were analyzed by using 3D imaging measurement based on the VOI. The results showed uneven distributions and indicated that the method of dividing the trabecular bone of mandibular condyle into VOI sets, which accorded with its specific anatomical characteristics, was feasible for further reference.

Objective:To design a simple and reusable artificial airway cap to evaluate the application effect in establishing artificial airway of patients without mechanical ventilation.Methods:A total of 100 patients who were admitted to Yiwu Central Hospital from January 2018 to January 2019 to establish artificial airway without mechanical ventilation were selected as the research objects by convenient sampling. By the random number table method, they were divided into the control group and the observation group, with 50 cases in each group. The control group was given conventional airway management, that was intermittent intratracheal instillation while the observation group was given artificial airway caps for airway management. Airway comfort cases and complication cases, respiratory rate, blood oxygen saturation and respiratory tract infection were compared between the two groups.Results:After intervention, the number of patients with airway comfort in the observation group was larger than that in the control group and the number of cases of respiratory tract infection and foreign body inhalation was smaller than that in the control group, and the differences were statistically significant ( P<0.05) . The respiratory rate of the observation group was lower than that of the control group, and the blood oxygen saturation was higher than that of the control group, and the differences were statistically significant ( P<0.05) . The sputum dilution 1-4 level of the observation group was higher than that of the control group, and the frequency of sputum excretion was lower than that of the control group, and the differences between the two groups were statistically significant ( P<0.05) . Conclusions:The self-made simple and reusable artificial airway cap has better application safety and effectiveness in establishment of artificial airway in patients without mechanical ventilation. It is easy to operate, economical and practical and it can improve the comfort and nursing quality of airway management, which has good promotion value.

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。

To study the role and molecular mechanism of epigallocatechin gallate (EGCG) in reversing drug-resistance to 5-fluorouracil (5-FU) in gastric cancer drug-resistant cell line SGC-7901/5-FU.

METHODSDrug-resistance gastric cancer cell line (SGC-7901/5-FU) was established by high doses of repeated impact joint drug concentration increment methods. The cell viability of the parent cell line and the drug-resistance cell line were determined by standard MTT assay. Cell survival rate of drug-resistance was calculated by the formula [(Aof the treatment group / Aof the control group) × 100%]. Cell half inhibitory concentration (IC) and resistance index (RI) were calculated by the Graphpad prime 6.0 software(RI=ICvalue of drug-resistance cells / ICvalue of parent cells). The apoptosis rate of SGC-7901/5-FU cells was quantified by flow cytometry after staining with annexin-V and PI. Western blot was used to detect the protein expression of drug-resistance-related proteins (ABCG2, P-gp, MDR-1 and GST-π) and apoptosis-related proteins (PARP, Survivin, Bax and bcl-2).

RESULTSICvalue was significantly increased in drug-resistant cells compared with parental cells [(64.7±3.9) mg/L and (4.1±0.3) mg/L, respectively, t=26.46, P=0.000], and the RI was 15.6. Proliferation activity in the drug-resistant cells was higher than that in parental cells at different 5-FU concentrations (all P<0.05). In drug-resistant cells, the ICvalue of 5-FU combined with EGCG group obviously decreased compared with 5-FU group [(7.3±0.1) mg/L and (63.1±1.4) mg/L respectively, t=40.84, P=0.000], and the RI was 0.12. Proliferation activity in drug-resistant cells was significantly decreased after EGCG treatment at different 5-FU concentrations (all P<0.05). Cell apoptosis rates in control group, 5-FU group, EGCG group and 5-FU combined with EGCG group were (3.0±1.0)%, (7.0±1.3)%, (6.0±1.2)% and (18.0±1.4)%, while apoptosis rate in 5-FU combined with EGCG group was significantly higher than those of other 3 groups(F=129.5, P=0.000). Western blot revealed that after EGCG treatment, the expression levels of drug-resistance-related proteins (ABCG2, P-gp, MDR-1 and GST-π) in the drug-resistant cell line SGC-7901/5-FU decreased significantly; the expression levels of apoptosis marker protein PARP and pro-apoptotic protein Bax increased significantly; and the expression levels of anti-apoptotic protein Survivin and Bcl-2 decreased significantly (all P<0.05).

CONCLUSIONEGCG can reduce the resistance of gastric cancer resistant cell line SGC-7901/5-FU, whose role may be via the inhibition of the expression of drug-resistance-related proteins, and the elevation of the protein expression ratio of PARP/Survivin and Bax/Bcl-2.

Anticarcinogenic Agents ; pharmacology ; Apoptosis ; Apoptosis Regulatory Proteins ; Catechin ; analogs & derivatives ; pharmacology ; Cell Line, Tumor ; Cell Proliferation ; Cell Survival ; Drug Resistance, Neoplasm ; Fluorouracil ; pharmacology ; Humans ; Stomach Neoplasms ; drug therapy ; pathology ; bcl-2-Associated X Protein

Objective To investigate the factors affecting the survival and prognosis of patients with stage Ⅲ～ Ⅳgastric cancers.Methods A total of 156 cases of Ⅲ ～ Ⅳ gastric cancer was studied retrospectively from September 1,2006 to December 31,2012.Kaplan-Meier analysis,Log-rank univariate analysis,Cox proportional hazards model analysis were used to analyze survival and prognostic factors.Results Twelve cases were lost,to the end of the follow-up,22 cases were alive.The median survival time was 29.3 months.1-year,3-year,and 5-year overall survival rates were 83.3％,37.8％,and 21.2％,respectively.Univariate analysis showed that tumor size,tumor node metastasis (TNM) staging,curative resection,hyperthermic intraperitoneal perfusion chemotherapy (HIPEC),and postoperative chemotherapy were correlated with prognosis (P ＜0.05 for all).Multivariate analysis showed that TNM staging,curative resection,HIPEC,and postoperative chemotherapy were independent prognostic factors (P ＜ 0.01 for all).Conclusions TNM staging,curative resection,hyperthermic intraperitoneal perfusion chemotherapy and postoperative chemotherapy are the independent factors affecting the prognosis of stage Ⅲ～ Ⅳ gastric cancer after resection.Hyperthermic intraperitoneal perfusion chemotherapy and postoperative chemotherapy can improve their survival.