Protrusive facial deformities, characterized by the forward displacement of the teeth and/or jaws beyond the normal range, affect a considerable portion of the population. The manifestations and morphological mechanisms of protrusive facial deformities are complex and diverse, requiring orthodontists to possess a high level of theoretical knowledge and practical experience in the relevant orthodontic field. To further optimize the correction of protrusive facial deformities, this consensus proposes that the morphological mechanisms and diagnosis of protrusive facial deformities should be analyzed and judged from multiple dimensions and factors to accurately formulate treatment plans. It emphasizes the use of orthodontic strategies, including jaw growth modification, tooth extraction or non-extraction for anterior teeth retraction, and maxillofacial vertical control. These strategies aim to reduce anterior teeth and lip protrusion, increase chin prominence, harmonize nasolabial and chin-lip relationships, and improve the facial profile of patients with protrusive facial deformities. For severe skeletal protrusive facial deformities, orthodontic-orthognathic combined treatment may be suggested. This consensus summarizes the theoretical knowledge and clinical experience of numerous renowned oral experts nationwide, offering reference strategies for the correction of protrusive facial deformities.
Humans ; Orthodontics, Corrective/methods* ; Consensus ; Malocclusion/therapy* ; Patient Care Planning ; Cephalometry

Despite therapy with potent antiviral agents, chronic hepatitis B (CHB) patients remain at high risk of hepatocellular carcinoma (HCC). While metabolites have been rediscovered as active drivers of biological processes including carcinogenesis, the specific metabolites modulating HCC risk in CHB patients are largely unknown. Here, we demonstrate that baseline plasma from CHB patients who later developed HCC during follow-up exhibits growth-promoting properties in a case-control design nested within a large-scale, prospective cohort. Metabolomics analysis reveals a reduction in long-chain acylcarnitines (LCACs) in the baseline plasma of patients with HCC development. LCACs preferentially inhibit the proliferation of HCC cells in vitro at a physiological concentration and prevent the occurrence of HCC in vivo without hepatorenal toxicity. Uptake and metabolism of circulating LCACs increase the intracellular level of acetyl coenzyme A, which upregulates histone H3 Lys14 acetylation at the promoter region of KLF6 gene and thereby activates KLF6/p21 pathway. Indeed, blocking LCAC metabolism attenuates the difference in KLF6/p21 expression induced by baseline plasma of HCC/non-HCC patients. The deficiency of circulating LCACs represents a driver of HCC in CHB patients with viral control. These insights provide a promising direction for developing therapeutic strategies to reduce HCC risk further in the antiviral era.

Objective:To explore the predictive value of hepatitis B surface antibody (HBsAb) quantitative level for achieving hepatitis B surface antigen (HBsAg) seroclearance and serological conversion in patients with chronic hepatitis B (CHB) treated with nucleos(t)ide analogs (NAs) or interferon (IFN).Methods:A two-center prospective cohort study was conducted, including CHB patients from Nanfang Hospital Southern Medical University and Eastern Theater General Hospital treated with NAs and IFN. All patients were followed up once every three to six months. Basic clinical information and test results were collected at each follow-up. The presence or absence of HBsAg seroclearance and serological conversion rate was evaluated. HBsAg serological conversion was defined as HBsAg quantification continuously below the detection limit (<0.05 IU/mL) at two detection time points at least six months apart. HBsAg serological conversion was defined as HBsAb positivity (≥10 IU/L) at the same time as the first HBsAg seroclearance. The Kruskal-Wallis test was used to compare the quantitative data of multiple groups, and the Wilcoxon rank-sum test was used to compare the data between groups. The chi-square test was used for the count data, and the Fisher exact test was used when the chi-square test was not met. Univariate and multivariate Cox analysis was used to determine the predictors of the study endpoints, and stepwise regression was used for variable screening.Results:A total of 2 266 CHB cases were included, of which 86.5% (1 959/2 266) were NA antiviral-received population. The median treatment duration before baseline was 10.5 (2.5, 37.6) months, and the baseline HBsAg quantification was 3.1 (2.6, 3.5) log 10 IU/mL. A total of 68 cases (3.0%) had HBsAg seroclearance, and 44 cases (1.9%) achieved serological conversion after 85.0 (62.7, 97.3) months of prospective follow-up. The level and positivity rate of HBsAb showed a progressive increase 36 months before and significantly after HBsAg seroclearance. Cox regression analysis results showed that baseline HBsAb level was an independent predictor of HBsAg serological conversion ( HR=2.26, P=0.002) in the overall population, especially in the subgroup with HBsAg between 100 and 1 000 IU/mL, suggesting HBsAb level had important predictive value. In addition, the serological conversion development rate was significantly higher in the GOLDEN model favourable patients than in the unfavourable patients (11.5% vs. 0, P<0.001). Conclusion:The baseline HBsAb quantitative level can predict HBsAg seroclearance and serological conversion for patients with CHB receiving antiviral treatment, which is of significant value in long-term treatment monitoring.

Occupational chronic n-hexane poisoning incidents have been effectively curtailed in traditional printing and footwear industries, but its hazards are emerging in new industries. In recent years, two cluster incidents involving eight patients with occupational chronic n-hexane poisoning had occurred in Longgang District, Shenzhen City. Unlike the cleaning processes of electronic components in the electronics industry, these two incidents occurred during cleaning operations of non-electronic products. The rapid on-site detection tubes indicated the presence of n-hexane in the organic solvents used at the work site, and subsequent analysis of volatile components of the organic solvents further confirmed the involvement of n-hexane. Although the n-hexane exposure concentration of short term in the workplace air samples were below its occupational exposure limit, all eight cases were diagnosed as occupational chronic n-hexane poisoning, based on occupational exposure history, clinical manifestations, field investigations, and laboratory test results. These two poisoning incidents highlight that in air-conditioned or enclosed workshops with substandard occupational disease prevention facilities, the use of n-hexane containing organic solvents may result in occupational chronic n-hexane poisoning, even when the air monitoring results do not exceed the occupational exposure limits.

Objective:To investigate the eosinophil-to-platelet ratio (EPR) in predicting the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:Based on the prognosis within 3 months after discharge, 158 patients with AECOPD admitted to Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from February 2020 to February 2024 were divided into a good prognosis group and a poor prognosis group. General data, eosinophil count, platelet count, eosinophil-to-platelet ratio (EPR), procalcitonin (PCT) level, and neutrophil-to-lymphocyte ratio (NLR), were retrospectively collected from both groups. The factors influencing prognosis within 3 months after discharge were analyzed using a multivariate logistic regression model. The predictive value of these factors for poor prognosis was assessed through receiver operating characteristic curve analysis.Results:Among the 158 patients with AECOPD, 23 had a poor prognosis, 127 had a good prognosis, and 8 were lost to follow-up or died unexpectedly. The eosinophil count and EPR in the peripheral blood of patients with a poor prognosis were significantly lower than those in patients with a good prognosis ( t = 3.22, 4.11, both P < 0.05). The eosinophil count [ OR = 5.709, 95% CI: (2.653, 12.285)] and EPR [ OR = 19.747, 95% CI: (8.352, 46.686)] were independent risk factors for a poor prognosis in patients with AECOPD at 3 months after discharge (both P < 0.05). The results of the receiver operating characteristic curve analysis indicated that the area under the curve for eosinophil count and EPR in predicting a poor prognosis in patients with AECOPD at 3 months after discharge was 0.706 [95% CI: (0.596, 0.815)] and 0.730 [95% CI: (0.630, 0.829)], respectively. The cut-off values were 109.20 counts/μL for eosinophil count and 1.06 for EPR, with corresponding sensitivities and specificities of 43.48% and 88.19%, and 82.61% and 59.06%, respectively. Conclusions:EOS and EPR have good predictive value for the adverse prognosis of patients with AECOPD within 3 months after discharge, and EPR has better efficacy.

Objective:To investigate the eosinophil-to-platelet ratio (EPR) in predicting the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:Based on the prognosis within 3 months after discharge, 158 patients with AECOPD admitted to Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from February 2020 to February 2024 were divided into a good prognosis group and a poor prognosis group. General data, eosinophil count, platelet count, eosinophil-to-platelet ratio (EPR), procalcitonin (PCT) level, and neutrophil-to-lymphocyte ratio (NLR), were retrospectively collected from both groups. The factors influencing prognosis within 3 months after discharge were analyzed using a multivariate logistic regression model. The predictive value of these factors for poor prognosis was assessed through receiver operating characteristic curve analysis.Results:Among the 158 patients with AECOPD, 23 had a poor prognosis, 127 had a good prognosis, and 8 were lost to follow-up or died unexpectedly. The eosinophil count and EPR in the peripheral blood of patients with a poor prognosis were significantly lower than those in patients with a good prognosis ( t = 3.22, 4.11, both P < 0.05). The eosinophil count [ OR = 5.709, 95% CI: (2.653, 12.285)] and EPR [ OR = 19.747, 95% CI: (8.352, 46.686)] were independent risk factors for a poor prognosis in patients with AECOPD at 3 months after discharge (both P < 0.05). The results of the receiver operating characteristic curve analysis indicated that the area under the curve for eosinophil count and EPR in predicting a poor prognosis in patients with AECOPD at 3 months after discharge was 0.706 [95% CI: (0.596, 0.815)] and 0.730 [95% CI: (0.630, 0.829)], respectively. The cut-off values were 109.20 counts/μL for eosinophil count and 1.06 for EPR, with corresponding sensitivities and specificities of 43.48% and 88.19%, and 82.61% and 59.06%, respectively. Conclusions:EOS and EPR have good predictive value for the adverse prognosis of patients with AECOPD within 3 months after discharge, and EPR has better efficacy.

Objective:To explore the predictive value of hepatitis B surface antibody (HBsAb) quantitative level for achieving hepatitis B surface antigen (HBsAg) seroclearance and serological conversion in patients with chronic hepatitis B (CHB) treated with nucleos(t)ide analogs (NAs) or interferon (IFN).Methods:A two-center prospective cohort study was conducted, including CHB patients from Nanfang Hospital Southern Medical University and Eastern Theater General Hospital treated with NAs and IFN. All patients were followed up once every three to six months. Basic clinical information and test results were collected at each follow-up. The presence or absence of HBsAg seroclearance and serological conversion rate was evaluated. HBsAg serological conversion was defined as HBsAg quantification continuously below the detection limit (<0.05 IU/mL) at two detection time points at least six months apart. HBsAg serological conversion was defined as HBsAb positivity (≥10 IU/L) at the same time as the first HBsAg seroclearance. The Kruskal-Wallis test was used to compare the quantitative data of multiple groups, and the Wilcoxon rank-sum test was used to compare the data between groups. The chi-square test was used for the count data, and the Fisher exact test was used when the chi-square test was not met. Univariate and multivariate Cox analysis was used to determine the predictors of the study endpoints, and stepwise regression was used for variable screening.Results:A total of 2 266 CHB cases were included, of which 86.5% (1 959/2 266) were NA antiviral-received population. The median treatment duration before baseline was 10.5 (2.5, 37.6) months, and the baseline HBsAg quantification was 3.1 (2.6, 3.5) log 10 IU/mL. A total of 68 cases (3.0%) had HBsAg seroclearance, and 44 cases (1.9%) achieved serological conversion after 85.0 (62.7, 97.3) months of prospective follow-up. The level and positivity rate of HBsAb showed a progressive increase 36 months before and significantly after HBsAg seroclearance. Cox regression analysis results showed that baseline HBsAb level was an independent predictor of HBsAg serological conversion ( HR=2.26, P=0.002) in the overall population, especially in the subgroup with HBsAg between 100 and 1 000 IU/mL, suggesting HBsAb level had important predictive value. In addition, the serological conversion development rate was significantly higher in the GOLDEN model favourable patients than in the unfavourable patients (11.5% vs. 0, P<0.001). Conclusion:The baseline HBsAb quantitative level can predict HBsAg seroclearance and serological conversion for patients with CHB receiving antiviral treatment, which is of significant value in long-term treatment monitoring.

OBJECTIVE To predict the core ingredients, targets and signaling pathways of Sanhuang ointment in the treatment of haemorrhoids based on network pharmacology, and preliminarily discuss the mechanism of action preliminarily by means of molecular docking and experimental verification. METHODS Active ingredients, targets and haemorrhoid related targets of Sanhuang ointment were obtained through literature research and database screening. Association networks were constructed and core targets were screened by Cytoscape, and gene function analysis and pathway enrichment analysis were conducted. Autodock Vina was used for molecular docking verification, and the regulatory effects of Sanhuang ointment on core targets were verified by ELISA and immunohistochemistry. RESULTS The 77 active ingredients and 61 potential targets of Sanhuang ointment for treating haemorrhoids were collected. KEGG showed that Sanhuang ointment could regulate calcium signaling pathways, neuroactive ligand receptor interactions, cGMP-PKG pathway, etc. Affect 6 core targets of CGRP, NK-1R, TRPV1, VEGF, IL-6 and TNF-α. Molecular docking showed that Sanhuang ointment had a good affinity with target protein, and animal experiments verified that Sanhuang ointment could inhibit the expression of IL-6, CGRP, substance P, and promote the expression of VEGF. CONCLUSION Sanhuang ointment may act on CGRP, NK-1R and other targets, regulate Calcium signaling pathway and PI3K-Akt pathways, and exert analgesic and anti-inflammatory effects, promoting blood circulation and removing blood stasis to treat haemorrhoids.

Objective To investigate the effect of subanesthetic dose of esketamine on remifentanil-in-duced hyperalgesia after cesarean section under general anesthesia,and its effect on serum homocysteine(Hcy)level and postpartum depression.Methods A total of fifty patients undergoing cesarean section under general anesthesia were randomly divided into the esketamine group and the control group(25 cases in each group).The two groups were given esketamine 0.2 mg/kg and the same amount of normal saline by slow in-jection 10 min after fetal delivery.Then,the extubation time,visual analogue scale(VAS)score within two hours after operation,and consumption of morphine while in the post-anaesthesia care unit(PACU)were compared between the two groups.The Edinburgh Postnatal Depression Scale(EPDS)scores were compared at one day before surgery,one day,four days,and one month after surgery.Serum Hcy levels were measured at one day before surgery,one day and four days after surgery.Results There was no significant difference in extubation time between the two groups(P>0.05).Compared with the control group,it took a longer time for patients in the esketamine group to have a VAS score≥4 for the first time,but the time from morphine injection to a VAS score<4 was shortened(P<0.05).The amount of morphine used in the esketamine group was lower than that in the control group in PACU(P<0.05).Compared with the control group,the VAS scores of the esketamine group decreased at 15 min,30 min,45 min,one hour,and 90 min after surgery(P<0.05),while there was no statistical significance difference in VAS scores at two hours after surgery(P<0.05).EPDS scores in the esketamine group were lower than those in the control group at one day and four days after surgery(P>0.05),but there was no statistically significant between the two groups at one month after surgery(P>0.05).Serum Hcy level in the esketamine group was lower than that in the control group at one day and four days after surgery(P<0.05).Conclusion The subanesthetic dose of esketamine during caesarean section under general anesthesia can effectively relieve remifentanil-induced postoperative hy-peralgesia and prevent the occurrence of postpartum depression.

Objective:To investigate the incidence and treatment of gastric cancer in 16 medical centers in Tianjin from 2020 to 2021.Methods:The retrospective and descriptive study was conducted. The clinical data of 3 122 gastric cancer patients who underwent surgery in 16 medical centers, including Tianjin Medical University Cancer Institute & Hospital, et al, in Tianjin from 2020 to 2021 were collected. There were 2 112 males and 1 010 females, aged (64±11)years. Observation indicators: (1) general data of patients; (2) treatment situations; (3) postoperative complications. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were descri-bed as absolute numbers or percentages, and comparison between groups was conducted by the chi-square test. Results:(1) General data of patients. From 2020 to 2021, a total of 3 122 gastric cancer patients received surgeries in 16 medical centers in Tianjin, including 2 112 males and 1 010 females. There were 1 443 cases in 2020, including 976 males and 467 females, aged (63±11) years. There were 1 679 cases in 2021, including 1 136 males and 543 females, aged (65±11) years. Of the 3 122 pati-ents, cases in stage Ⅰ, Ⅱ, Ⅲ, Ⅳ were 696, 667, 1 466, 293, accounting for 22.293%(696/3 122), 21.365%(667/3 122), 46.957%(1 466/3 122), 9.385%(293/3 122), respectively. Cases with early gastric cancer, locally advanced gastric cancer, advanced gastric cancer account for 17.265%(539/3 122), 73.350%(2 290/3 122), 9.385%(293/3 122). There were 2 829 patients without distant metastasis and 293 patients with distant metastasis. For the 2 829 patients without distant metas-tasis, cases in stage T1, T2, T3, T4a, T4b accounted for 19.053%(539/2 829), 12.089%(342/2 829), 20.148%(570/2 829), 41.499%(1 174/2 829), 7.211%(204/2 829)respectively, cases in stage N0, N1, N2, N3 account for 37.328%(1 056/2 829), 16.331%(462/2 829), 15.836%(448/2 829), 30.505%(863/2 829). For the 293 advanced gastric cancer patients with distant metastasis, 190 cases had peri-toneal metastasis, 47 cases had lymph node metastasis, 27 cases had ovarian metastasis, 37 cases had liver metastasis, 14 cases had other metastasis (some patients had ≥2 distant metastases). (2) Treatment situations. ① For the 539 with early gastric cancer, cases undergoing endoscopic submu-cosal dissection, laparoscopic surgery, open surgery were 22, 150, 86 in 2020, versus 19, 212, 50 in 2021, showing a significant difference between them ( χ2=19.42, P<0.05). For the 498 patients with early gastric cancer who underwent laparoscopic or open surgery, cases undergoing open surgery including total gastrectomy, distal gastrectomy, proximal gastrectomy were 25, 81, 30, and cases undergoing laparoscopic surgery including total gastrectomy, distal gastrectomy, proximal gastrec-tomy were 18, 309, 35, respectively, showing a significant difference between them ( χ2=40.62, P<0.05). For the 2 290 patients with locally advanced gastric cancer, cases undergoing open surgery and laparoscopic surgery were 446 and 617 in 2020, versus 410 and 817 in 2021, showing a significant difference between them ( χ2=17.75, P<0.05). For the 2 290 patients with locally advanced gastric cancer, cases undergoing open surgery including total gastrectomy, distal gastrectomy, proxi-mal gastrectomy were 336, 377, 143, and cases undergoing laparoscopic surgery including total gastrectomy, distal gastrectomy, proximal gastrectomy were 377, 920, 137, respectively, showing a significant difference between them ( χ2=89.64, P<0.05). Of the 293 patients with advanced gastric cancer, 175 cases underwent surgeries due to hemorrhage, stenosis, perforation, 76 cases under-went surgery after chemotherapy, 42 cases underwent surgery directly. ② For 756 cases of 3 122 pati-ents undergoing total gastrectomy, 357 and 4 cases received open digestive tract reconstruction including Roux-en-Y and other anastomosis, versus 380 and 15 cases with laparoscopic digestive tract reconstruction including Roux-en-Y and other anastomosis, showing a significant difference between them ( χ2=5.57, P<0.05). For 1 687 cases undergoing distal gastrectomy, 84, 160, 158, 55 cases received open digestive tract reconstruction including Billroth Ⅰ anastomosis, Billroth Ⅱ + Braun anastomosis, Roux-en-Y anastomosis, uncut Roux-en-Y anastomosis, versus 154, 489, 417, 170 cases with laparoscopic digestive tract reconstruction including Billroth Ⅰ anastomosis, Billroth Ⅱ + Braun anastomosis, Roux-en-Y anastomosis, uncut Roux-en-Y anastomosis, showing a significant difference between them ( χ2=10.90, P<0.05) . Of the 539 patients with early gastric cancer, 65 cases had lymph node metastasis, in which 18 of 306 stage T1a cases had lymph node metastasis and 47 of 233 stage T1b cases had lymph node metastasis. The number of detected lymph nodes for the 2 290 patients with advanced gastric cancer was 31±15, including ≥16 for 2 059 cases and ≥30 for 1 276 cases. Of the 3 122 patients, cases with neoadjuvant therapy, complete response and incomplete response was 128, 13 and 115 in 2020, versus 250, 49 and 201 in 2021, showing a significant difference between them ( χ2=5.51, P<0.05). (3) Postoperative complications. Of the 3 122 patients, 746 cases had postoperative complications, with an incidence of 23.895%(746/3 122). There were 62 patients with grade 3 or more complications. Reoperation was conducted in 34 patients. There were 14 cases of postoperative death. The duration of postoperative hospital stay and hospital expense were (11±5)days and (98 114±46 598)yuan for the 3 122 patients, (26±14)days and (122 066±68 317)yuan for cases with complications, (40±21)days and (196 926±12 747)yuan for cases with grade 3 or more complications. Conclusion:Compared with 2020, cases undergoing laparoscopic surgery and distal gastrectomy for gastric cancer in Tianjin increases in 2021, and the digestive tract reconstruction also differs. The number of patients with neoadjuvant chemotherapy and complete response rate for advanced gastric cancer increases.