Objective:To investigate the hard and soft tissue changing trend and contributing factors of skeletal class Ⅱ hyperdivergent patients before and after orthodontic camouflage treatment by analyzing the cephalogram and the three dimensional(3D)facial scan data.Methods:Eighteen skeletal class Ⅱhyperdivergent adult female patients who finished camouflage orthodontic treatment were selected.Skele-tal and dental measurements were carried out with the cephalometric analysis before and after the treat-ment.3D facial data before and after orthodontic treatment were acquired and the anatomical landmarks were set after the repositioning and superimposition process.Hard tissue measurement included 17 mea-surement indicators(sella-nasion-subspinale angle,sella-nasion-supramental angle,subspinale-nasion-supramental angle,facial angle,angle of convexity,Frankfort horizontal plane-mandibular plane angle(FH-MP),Y axis angle,sella-nasion plane-mandibular plane angle(MP-SN),pogonion-nasion-supra-mental distance,upper incisor-nasion-subspinale distance,upper incisor to sella-nasion,lower incisor-nasion-supramental distance,lower incisor-nasion-supramental angle,upper incisor to lower incisor,up-per incisor to sella-nasion,lower incisor-mandibular plane angle,and Z angle),and the changes before and after treatment were measured for 11 of them.Twenty soft tissue landmarks(left/right cheekbone,left/right chelion,left/right crista philtra,soft tissue gnathion,left/right gonion,glabella,labrale infe-rius,labrale superius,soft tissue menton,left/right mid-mandibular border,soft tissue pogonion,stomi-on superius,sublabial,subnasale,and supralabial)and 9 soft tissue indicators(lower lip height,facial convexity,lower vermilion height,mandibular contour,nasolabial angle,philtral length,philtral width,upper lip height,and upper vermilion height)were measured and recorded for treatment changes.Linear-regression analysis and correlation analysis were carried out for analyzing the relationship between hard and soft tissue changes before and after the treatment.Results:Significant differences were noticed for 18 out of the 20 cephalometric measurements and facial measurements before and after the treatment(P＜0.05),which mainly represented the sagittal retraction of lip area after the treatment.Significant vertical displacements were revealed for soft tissue menton after treatment[(1.88±2.61)mm,P＜0.05].Significant sagittal displacements were revealed for left/right cheilion[(-2.95±1.9)mm,(-2.90±1.92)mm],labrale inferius[(-4.94±1.95)mm],labrale superius[(-3.25±1.44)mm],sublabial[(-3.10±3.5)mm],and subnasale[(-1.23±1.06)mm]after treatment(P＜0.05).An average of 4.10°±2.57° increasement was noticed for Z angle after treatment.High correla-tion(r＞0.7)was noticed for the displacement of menton after treatment with FH-MP,with the rate of-0.183:1,and MP-SN,with the rate of-0.157:1.Moderate correlations(0.7≥r＞0.4)were no-ticed for the other measurements with correlations(P＜0.05).Conclusion:A certain extent of facial improvements could be achieved with orthodontic camouflage treatment for skeletal class Ⅱ hyperdiver-gent patients,which were mostly represented by the improvement of sagittal relationship of nose,lips,and chin.Certain correlations were noticed for the hard and soft tissue changes.

Objective:To study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.

{L-End}Objective To investigate the current status of academic procrastination, psychological resilience, and emotional intelligence among undergraduate nursing students in Hebei Province. {L-End}Methods A total of 2 121 undergraduate nursing students from seven medical universities in Hebei Province were selected as the research subjects using a convenient sampling method. The Academic Procrastination Scale, Psychological Resilience Scale, and Emotional Intelligence Scale were used to investigate their academic procrastination, psychological resilience, and emotional intelligence. {L-End}Results The median score for academic procrastination among undergraduate nursing students was 62.5 points. The scores for psychological resilience and emotional intelligence were (79.9±10.1) and (100.7±11.6) points, respectively. The results of the multiple logistic regression analysis showed that students from urban areas experienced more severe academic procrastination than those from rural areas (P<0.05). Students with indifferent family relationships experienced more severe academic procrastination than those with close family relationships (P<0.05). Higher grade levels, lower scores in psychological resilience, and lower scores in emotional intelligence were associated with more severe academic procrastination among these nursing students (all P<0.05). {L-End}Conclusion The overall degree of academic procrastination among undergraduate nursing students in Hebei Province is at a moderate level. The level of psychological resilience and emotional intelligence can negatively affect the degree of academic procrastination among these undergraduate nursing students.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

The experience of famous and veteran physicians in traditional Chinese medicine （TCM） is a supplement to the cognition of industry groups and a high-quality learning resource. Digital inheritance of the experience of famous and veteran TCM physicians refers to the use of digital technology to record， organize， protect， spread， share and innovate the knowledge， skills and experiences of famous and veteran TCM physicians， which helps to overcome the inefficiency of traditional experience inheritance and realize the inheritance and development of TCM culture. Digital inheritance has certain advantages in accessibility， loss resistance， accuracy， innovation ability and effectiveness， which can assist the digital preservation， analysis and excavation of the experience of famous and veteran TCM physicians， and is an important supplement to the traditional way of learning from teachers. Digital inheritance is usually divided into the following steps： building a database of TCM knowledge， building a database of experienced medical records of famous and veteran TCM physicians， discovering laws by data mining， and assisting clinical decision-making with machine learning. The digital inheritance of famous and veteran TCM physicians is not only the use of experience information， but also the process of innovation and productization based on experience， which may become a new service model of TCM diagnosis and treatment.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Objective:To understand the status of life quality related to cough in lung cancer patients after video-assisted thoracoscopic surgery (VATS) and to explore its influencing factors based on enhanced recovery after surgery(ERAS).Methods:By using the convenience sample way, a total of 140 patients in lung cancer who were admitted to the VATS from Chinese Academy of Medical Science, Cancer Hospital were selected as study objects from June to August 2020. Mandarin Chinese version of the Leicester cough questionnaire(LCQ-MC) was used to measure the status of life quality related to cough in lung cancer patients after surgery.The influencing factors were analyzed by single factor analysis and multivariate linear regression analysis.Results:The score of LCQ-MC of patients after VATS (15.83±1.93) was significantly lower than before (19.03±1.64) ( t value was 17.149, P<0.01) . In terms of physiology,psychology and society, the score of LCQ-MC after VATS (4.88±0.84, 5.25±0.71, 5.70±0.73) was also apparently lower than before (6.23±0.77, 6.20±0.84, 6.60±0.72) ( t values were 14.816, 11.338,11.276, P<0.01).The single factor analysis indicated that life quality related to cough had some connections with age( F value was 3.274), cough condition before surgery ( t value was -2.174), operation methods ( F value was 2.837), the time of chest tube retained ( F value was 3.690) and drinking ( t value was -3.033) after VATS( P<0.05). The multiple-factor result showed that age, cough condition before surgery and the time of chest tube retained were the independent factors affecting the life quality related to cough in lung cancer patients after VATS( P<0.05). Conclusion:The lung cancer patients after VATS cough obviously, and their life quality is lower. At the same time, it has some effect on physiology, psychology and society to a certain extent. Medical staff should pay more attention to the elderly and who cough obviously and develop individual interventions before the surgery.After that, in order to remove the chest tube as early as possible, the guidance of pulmonary rehabilitation and mental nursing should be suggested to patients to improve their life quality.

Objective To investigate whether pyrrolidine dithiocarbamate (PDTC) can attenuate the acute radiation-induced heart damage (RIHD) by inhibiting the activation of NF-κB and its downstream signaling pathways in rat models. Methods Twenty-one male adult Sprague-Dawley (SD) rats were randomly divided into the blank control, irradiation and PDTC plus irradiation groups (n=7 for each group). In the irradiation and PDTC+ irradiation groups,the rats received 6 MV X-ray at a single fraction of 20.0 Gy. In the PDTC+ irradiation group, intraperitonal injection of PDTC was administered at a dose of 120 mg/kg body weight,30 minutes prior to radiation, once daily for 1-14 days. On the 14thday,pathological changes of myocardial tissue were observed. Masson's trichrome staining was performed to calculate the collagen volume fraction (CVF) of myocardial cells. The expression levels of NF-κB family members including p50, p65,HIF-1α,connective tissue growth factor (CTGF) and collagen type 1(COL-1) proteins and mRNA were quantitatively measured by Western blot and quantitative real-time PCR (qPCR). Statistical analysis was conducted by using t-test. Results HE staining demonstrated that compared with the irradiation group, the severity of myocardial edema was alleviated,the infiltration of inflammatory cells was mitigated and the quantity of fibroblasts was reduced in the PDTC+irradiation group. Masson's trichrome staining revealed that PDCT intervention could decrease the deposition of collagen fiber in the interstitial tissues. Semi-quantitative analysis demonstrated that the CVF value in the PDTC+irradiation group was (9.99± 0.32)%, significantly lower compared with (22.05±0.21)% in the irradiation group (P<0.05). Western blot and qRT-PCR demonstrated that the expression levels of p50,p65,and HIF-1αproteins and mRNA in the PDTC+ irradiation group were significantly down-regulated compared with those in the irradiation group (all P<0.05). Compared with the irradiation group,the expression levels of CTGF protein and mRNA tended to decline (all P>0.05),and the expression levels of COL-1 protein and mRNA were equally inclined to decrease (P<0.05 and P>0.05). Conclusion PDTC can alleviate the acute RIHD by suppressing the activation of NF-κB and its downstream HIF-1α transcription.

Objective To investigate the relationship between the CD 8 +T cells results of clinical automatic analysis platform and the CD8lowT and CD8highT cell subsets.Methods A total of 1316 cases of lymphocyte and flow cytometry data were collected from the First Affiliated Hospital of China Medical University from December 2015 to September 2016 by cross-sectional study. There were 287 cases of malignant tumor , 389 cases of autoimmune disease , 320 healthy people and 320 cases of HIV infection , then to get automatic analysis platform returns result of CD 8+T cell.FlowJo software was used to analyze the CD8low T and CD8high T lymphocyte subsets in the patients , and the results were compared with the results of CD8 +T cells returned by the clinical automatic analysis platform .Results The results of clinical returns CD8 +T cells were consistent with the results of CD 8high T cells in patients with different diseases , and were not exactly the same as the results of CD8lowT cells, and the difference was as follows:the results of CD8low T cells in HIV-infected patients were significantly lower than those of healthy people (56.2 ±42.0, 68.8 ± 45.9, cells/μl P<0.001), which were different from the clinical results of CD 8 +T cells.The results of clinical report of CD8 +T cells were statistically correlated with CD8high T cells and CD8low T cells, and the correlation between CD8 +T cells and CD8highT were higher than that of CD8lowT cells.There was a positive correlation between CD8low T cell count and CD4 +T cell count ( r=0.204, P<0.001) .CD8low T was significantly higher in patients on antiviral treatment than that in untreated group (58.3 ±43.9, 42.9 ± 26.5, cells/μl, P<0.001).After treatment for more than 2 years, the CD8lowT cells in patients with CD4<500 cells/μl were significantly lower than those in patients with CD 4>500 cells/μl (50.1 ±47.0, 66.3 ±46.6, cells/μl, P<0.001).Conclusions The clinical report of CD8 +T cells was consistent with the results of CD8highT cells, and there was a great difference between the results of CD 8lowT cells and the results of CD8 +T cells.CD8low T cells were significantly reduced in HIV infected patients , and CD8low T cells could be effectively reconstructed by antiviral therapy .

Objective To analyze the clinical efficacy,toxicity and survival prognosis of patients diagnosed with Siewert type Ⅱ and Ⅲ locally advanced adenocarcinoma of esophagogastric junction (AEG) undergoing preoperative involved-field irradiation with concurrent chemotherapy. Methods A total of 45 cases were recruited in this prospective clinical trial. Prior to surgery, patients received 2 cycles of chemotherapy with XELOX and concurrent radiotherapy ( a total of 45 Gy in 25 fractions,5 times weekly). After 6-8 weeks,they underwent surgical resection. After the surgery,patients received 6 cycles of adjuvant chemotherapy. The completion of preoperative neoadjuvant chemoradiotherapy, postoperative pathological status,TNM down-staging effect and adverse reactions were observed. Kaplan-Meier method was applied to estimate survival analysis. Results All 45 patients completed preoperative neoadjuvant chemoradiotherapy. Among them, 39 patients completed 2 cycles of chemotherapy, and 6 patients completed 1 cycle of chemotherapy. The median time of surgical interval was 6 weeks. The R0resection rate was 96%.The pathological complete response (pCR) rate was 22%. The TNM down-staging rate was 69%.The incidence of acute radiation-induced esophagitis or gastritis was 44% and the incidence of radiation-induced pneumonitis was 7%. The incidence of grade 1-3 leukocytopenia,thrombocytopenia and neutropenia was 78%,47% and 44%,respectively. In terms of gastrointestinal reactions,the incidence of nausea,vomiting and loss of appetite was 62%,24% and 71%,respectively. No hematologic or nonhematologic adverse effects was observed at grade 4 or 5.The median follow-up time was 30 months. 11 patients died of cancer,1 patient was treatment-related death in the perioperative period and 1 patient died of pneumonia. The 1-,2-and 3-year progression-free survival (PFS) rates were 90%,70% and 67%,respectively. The 1-,2-and 3-year overall survival rates were 95%,80% and 75%,respectively. The 1-,2-and 3-year local control rates were 95%,84% and 84%, respectively. The 1-, 2-and 3-year distant metastasis rates were 7%, 25% and 25%, respectively. Conclusions Preoperative involved-field irradiation with concurrent chemotherapy yields relatively high clinical efficacy and is well tolerated by patients with Siewert typeⅡandⅢlocally advanced AEG.Patients are recommended to receive 4 cycles of adjuvant chemotherapy following neoadjuvant chemoradiotherapy and surgery.