Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.
Humans ; Consensus ; Dental Caries/etiology* ; Dental Enamel/pathology* ; Tooth Demineralization/etiology* ; Tooth Remineralization

The prevalence of Class III malocclusion varies among different countries and regions. The populations from Southeast Asian countries (Chinese and Malaysian) showed the highest prevalence rate of 15.8%, which can seriously affect oral function, facial appearance, and mental health. As anterior crossbite tends to worsen with growth, early orthodontic treatment can harness growth potential to normalize maxillofacial development or reduce skeletal malformation severity, thereby reducing the difficulty and shortening the treatment cycle of later-stage treatment. This is beneficial for the physical and mental growth of children. Therefore, early orthodontic treatment for Class III malocclusion is particularly important. Determining the optimal timing for early orthodontic treatment requires a comprehensive assessment of clinical manifestations, dental age, and skeletal age, and can lead to better results with less effort. Currently, standardized treatment guidelines for early orthodontic treatment of Class III malocclusion are lacking. This review provides a comprehensive summary of the etiology, clinical manifestations, classification, and early orthodontic techniques for Class III malocclusion, along with systematic discussions on selecting early treatment plans. The purpose of this expert consensus is to standardize clinical practices and improve the treatment outcomes of Class III malocclusion through early orthodontic treatment.
Humans ; Malocclusion, Angle Class III/classification* ; Orthodontics, Corrective/methods* ; Consensus ; Child

Objective:To evaluate the efficacy and safety of sodium hyaluronate gel in preventing adhesion after prophylactic enterostomy.Methods:One hundred and twenty four patients from 6 hospitals were enrolled in this prospective multi-center randomized controlled trial. Patients were randomized into the study group ( n=59) or the control group ( n=65).All patients underwent prophylactic enterostomy. Patients of study group received odium hyaluronate gel for adhesion-prevention,while those in control group did not receive any adhesion-prevention treatment. The incidence of moderate to severe adhesion around the incision in the stoma area were evalutated during stoma reduction surgery. Results:The incidence of moderate to severe adhesion around the incision in the stoma area was 6.3% in the study group, the difference was statistically significant ( P<0.05) compared to that of the control group (32.6%). Conclusion:Sodium hyaluronate gel can safely and effectively reduce the incidence of moderate and severe adhesions after abdominal surgery.

Objective: To improve the understanding of thyrotropin-secreting adenoma in multiple endocrine neoplasia type 1(MEN1) through analyzing the clinical diagnosis and treatment process, as well as outcomes in one case of this disorder. Methods: The clinical manifestations, biochemical and hormone levels, imaging presentations, medical and surgical treatments, and post-operational pathologic findings in the process of diagnosis and treatment of a patient with thyrotropin-secreting adenoma in MEN1 were analyzed. The next generation sequencing followed by Sanger method was used for analyzing MEN1 and related genes. The results were evaluated with online PolyPhen2 and PROVEAN for variation hazard. Results: One 19-year old male patient was diagnosed with hyperthyroidism due to thyrotoxicosis and high level of thyroid hormones(THs) with measurable TSH(2.78 mIU/L) and negative thyrotropin receptor antibody(TRAb). Meanwhile, primary hyperparathyroidism was suggested by hypercalcemia, hypophosphatemia, and elevated intact parathyroid hormone(PTH) level, all the parameters were returned to normal after surgical resection of the mass which was below the left thyroid lobe indicated by ultrasound and ^99mTc scan. Thyrotoxicosis remained in spite of one year treatment with antithyroid drug, thyrotropinoma was then suspected, and subsequent MRI scan found a macroadenoma at right pituitary. TSH and THs returned to normal 1 month after transsphenoidal removal of the adenoma. As expected, immunohistochemical staining revealed TSH positive. In addition, a pancreatic mass was found by both CT and MRI scan, which was considered as a silent neuroendocrine tumor. Gene analysis revealed a missense mutation of MEN1 as c. 415C>T and p. His139Tyr(H139Y), which was predicted highly hazard. Only five cases of thyrotropinoma in MEN1 were previously reported. Conclusion Thyrotropinoma should be cautiously identified from hyperthyroidism to avoid misdiagnosis and mistreatment, and it should keep in mind that thyrotropinoma may be associated with MEN1 though it would be very rare.

OBJECTIVE: To report on the clinical pictures of 7 patients from a pedigree affected with X-linked adrenal hypoplasia congenita (XL-AHC) and hypogonadotropic hypogonadism (HH) and the underlying mutations. METHODS: Seven patients were identified from a four-generation pedigree affected with XL-AHC and HH. Their clinical features, endocrinological changes, treatment and drug response were recorded. The patients were subjected to next-generation sequencing, and the result was verified by Sanger sequencing. PolyPhen-2 was used for predicting the influence of the mutation on protein production. RESULTS: Three deceased patients had manifested adrenal insufficiency (AI) within one year after birth. Two died at 6 and one died at 12. The four survivors presented with salient clinical and endocrinological features of AHC and HH, adrenal and testicular atrophy, and renin-angiotensin compensation. Two adult patients had testicular micro-stone detected by ultrasound.One of them also had remarkable seminiferous tubule degeneration by biopsy. The patients were followed up for 0.5 to 10 years. All required hyper-physiological dose of hydrocortisone to stabilize their clinical condition. In three patients, gonadotropic or androgen replacement induced cardinal masculine development but with unsatisfactory testis growth and sperm production.Genetic analysis revealed a novel missense c.827A>C (p.Q276P) mutation in a hotspot region within a highly conserved domain. PolyPhen-2 predicted the mutation to be highly hazardous. CONCLUSION The novel p.Q276P mutation of the DAX1 gene probably underlies the XL-AHC and HH in this pedigree with variable clinical presentations in the patients.
Adrenal Insufficiency ; DAX-1 Orphan Nuclear Receptor ; genetics ; Humans ; Hypoadrenocorticism, Familial ; genetics ; Male ; Mutation ; Mutation, Missense ; Pedigree ; Repressor Proteins

Objective To investigate the application value of Braun anastomosis in pancreaticoduodenectomy.Methods The retrospective cohort study was conducted.The clinicopathological data of 389patients who underwent pancreaticoduodenectomy in the Fudan University Shanghai Cancer Center from March 2012 to July 2014 were collected.Of 389 patients,235 receiving Braun anastomosis and 154 receiving non-Braun anastomosis were respectively allocated into Braun anastomosis group and non-Braun anastomosis group.All the patients underwent pancreaticoduodenectomy with digestive tract reconstruction using Child method.Patients in the Braun anastomosis group received 5-10 cm Braun anastomosis between input and output end of jejunum,and patients in the non-Braun anastomosis group didn't receive jejunum-jejunum Braun anastomosis after gastrojejunostomy.Observation indicators included:(1) intraoperative situations;(2) postoperative recovery;(3) follow-up.Patients were followed up using outpatient examination and telephone interview up to May 2015.Follow-up included monthly routine blood retest,hepatorenal function retest and urine and stool routine retest,and enhanced CT scan in the epigastric region for every three months to detect recovery of digestive tract function.Measurement data with normal distribution were represented as x±s.Comparison between groups was analyzed using t test,and count data were analyzed using chi-square test.Results (1) Intraoperative situations:389 patients underwent successful pancreaticoduodenectomy.Standard pancreaticoduodenectomy and pyloric-preserving pancreaticoduodenectomy were respectively applied to 205 and 30 patients in the Braun anastomosis group and 137 and 17 patients in the non-Braun anastomosis group,with no statistically significant difference (x2=0.259,P＞0.05).Anastomosis and reconstruction of pancreatic stump:anastomosis of main pancreatic duct and jejunal mucosa,embedded anastomosis of papillary main pancreatic duct and pancreas-stomach anastomosis were detected in 138,89,8 patients in the Braun anastomosis group and 85,60,9 patients in the non-Braun anastomosis group,respectively,with no statistically significant difference (x2 =1.535,P＞ 0.05).Total operation time,pancreasjejunum anastomosis time and volume of intraoperative blood loss were (398.9 ± 61.9) minutes,(20.6 ±3.5) minutes,(401 ± 59) mL in the Braun anastomosis group and (401.3± 59.2) minutes,(20.7± 2.1) minutes,(407± 159)mL in the non-Braun anastomosis group,respectively,with no statistically significant difference (t =-0.380,-0.562,-0.319,P＞0.05).(2) Postoperative recovery:time to initial anal exsufflation,time for fluid diet intake and time of drainage tube removal were (103 ± 28) hours,(77± 25) hours,(12 ± 5) days in the Braun anastomosis group and (102 ± 31) hours,(79 ± 30) hours,(13 ± 6) days in the non-Braun anastomosis group,respectively,with no statistically significant difference (t =0.330,-0.712,-1.783,P＞0.05).Delayed gastric emptying,gastrointestinal hemorrhage,obstruction of afferent loop and pancreatic fistula were detected in 25,3,0,30 patients in the Braun anastomosis group and 27,4,2,23 patients in the non-Braun anastomosis group,respectively,with no statistically significant difference (x2=3.818,0.918,3.068,0.695,P＞0.05).Seventeen patients were combined with delayed gastric emptying and pancreatic fistula,including 8 in the Braun anastomosis group and 9 in the non-Braun anastomosis group,with no statistically significant difference between the 2 groups (x2=1.363,P＞0.05).Patients with postoperative complications were improved by symptomatic and supporting treatment.Duration of hospital stay and treatment expenses were (14±7) days,(73 205±4 538)yuan in the Braun anastomosis group and (22± 11) days,(83 219±5 738) yuan in the non-Braun anastomosis group,with statistically significant differences between the 2 groups (t=-8.767,-19.139,P＜0.05).(3) Follow-up:389 patients were followed up for 6 months,without death.Six and 9 patients in the Braun anastomosis group and non-Braun anastomosis group had regurgitation cholangitis.There was no readmission due to gastrointestinal hemorrhage and digestive tract obstruction,and no signs of hyperglycaemia and intractable diarrhea occurred.Conclusion Braun anastomosis can reduce duration of postoperative hospital stay and treatment expenses.

Objective To observe the symptom and characteristics of liver injury induced by different dosage of long-term administration of rifampicin(RIF) in mice.Methods Twenty-four healthy female ICR mice were randomly divided into 4 groups(6 mice in each group):control group,low dosage group,medium dosage group and high dosage group.The four groups were treated with 0,100,200,400 mg·kg-1·d-1 RIF respectively for 2 weeks.Mice blood and liver tissue samples were collected at 6 hours after the last administration for serological test and liver histological observation.Results No mice died before execution.The TBA,DBIL and TBIL of high dosage group all increased compared with the control group, but the ALT,AST and ALP showed no obvious change.The TBA and DBIL of medium dosage group increased compared with the control group, while the TBIL,ALT,AST and ALP showed no obvious change.In the low dosage group,there was no obvious change in terms of TBA,DBIL,TBIL,ALT,AST,and ALP compared with the control group.Obvious pathological change occured in the liver of mice in all the experimental groups.HE staining showed edema and feather steatosis in liver cells, accompanied by a large number of inflammatory cells infiltration and a few sporadic cholestasis.With the increasing of RIF dosage,the liver pathological change became more obviously.In the experimental group,electron microscope showed that there were a lot of fat droplets in the liver cells wrapped slurry,and part of the capillary bile duct were slightly expanded with different electron density and irregular shape of bile sample material inside.The pathologic changes get more obvious with the increase of the concentration of rifampicin as well.Conclusion RIF could induce liver injury after 2 weeks' treatment at different dosages,mainly pathological changes included liver cell steatosis,inflammatory cell infiltration,and cholestasis.Rifampicin induced liver injury in a concentration-dependent manner.However,the mechanism of rifampicin-induced liver injury in mice needs further study.

Objective To investigate the effect of butylphthalide on the memory,movement and ERP (event-related potentials) in patients with cerebral infarction cognitive impairment.Methods A total of 134 patients with cerebral infarction cognitive impairment were randomly divided into treatment group (67 patients) and control group (67 patients).All patients were given conventional cerebral infarction treatment as well as cognitive improvement intervention.Oral administration of butylphthalide was added onto the patients in the treatment group.Curative effects were observed after 30 days′ continued treatment.The cognitive function scores,memory scores,movement scores,ERP test and adverse reaction were compared between the two groups before and after treatment.Results After 30 days′ treatment,two groups of the montreal cognitive assessment scale (MoCA) scores were 27.2±4.9 and 25.1±4.1 respectively;the total scores of memory were 5.5±0.5 and 4.9±0.5 respectively;the scores of motor assessment scale (Fugl-meyer) were 85.6±6.2 and 74.2±6.1 respectively and P3 amplitudes were (9.5±0.9)μV and (8.1±0.9)μV respectively.All the indexes mentioned above in treatment group were significantly increased compared with those of before treatment(P<0.05).The results of N1,N2,P2 and P3 in the latency detection were significantly decreased compared with those of before treatment(P<0.05).And the results of P2 and P3 in the latency detection of the treatment group were shorter than those of the control group(P<0.05).After treatment,no adverse reaction was observed in both groups.Conclusion Based on conventional cerebral infraction treatment,oral administration of butyraldehyde effectively improve the therapeutic effect.

Objective To study the function and effect of Oleanolic acid to cholestasis on regulating bile acids transporters. Methods A total of 45 rats were divided into 9 groups,5 rats in each group. The Sham group,Bile duct ligation group and Oleanolic acid group were treated with saline or Oleanolic acid for 3 days,7 days and 14 days. Then the liver and tested bile acids transporters in mRNA and protein lev-els were collected. Results The expression of bile acids transporter OSTβ with Oleanolic acid was increased after 3 days. The expression of OSTβ and BESP in Oleanolic acid group after 7 days were increased than those in Sham group. Fourteen days later,the increasing tendency of OSTα,OSTβ and BSEP were sensiable. Conclusion Oleanolic acid can stimulates the expression of bile acids transporters OSTalpha-beta and BSEP in bile duct-ligation rats.

Immunoglobulins ( Ig ) , also called antibodies, are important components in humoral -mediated immunity. Ig can bind with their receptors, called immunoglobulin receptors ( IgR ) , trigger biologic activities respectively. Different sub-types of Igs show different function. And IgRs have been treated as therapeutic targets in inflammation and immunity related dis-eases for many years. This article reviewed the recent progresses in the study of IgR function and its therapeutic role in inflamma-tion and immunity related diseases.