The multimorbidity of rheumatoid arthritis （RA） and periodontitis （PD） has drawn increasing attention， as both conditions are characterized by chronic inflammation， immune dysregulation， and progressive bone destruction. Modern research confirms that PD is a significant risk factor for RA development， and their coexistence mutually exacerbates disease progression. However， traditional Chinese medicine （TCM） currently lacks a systematic theoretical explanation for this complex multimorbid relationship. This study， based on the TCM theory of abnormal collateral， thoroughly examines the intrinsic connection between RA and PD multimorbidity， proposing "abnormal collateral as the pivot， with accumulated toxins eroding bone" as the core TCM pathogenesis. The research elucidates PD as the "origin of abnormal collateral"， where its pathogens act as toxic factors that invade the joints through collaterals， triggering RA via mechanisms such as molecular mimicry. The dynamic pathological progression of RA-PD multimorbidity can be described as follows： the displacement of Ying and Wei at the microscopic level manifests as immune hyperactivation， leading to collateral malnutrition； heat-toxins traversing collaterals induce collateral hyperactivity， resulting in pathological angiogenesis； ultimately， toxin accumulation at the pivotal abnormal collateral site erodes bone， activating the receptor activator of nuclear factor kappa-B ligand （RANKL）-receptor activator of nuclear factor kappa-B （RANK） signaling pathway-driven osteoclast differentiation. This theoretical framework innovatively integrates modern findings in oral microbiology， immune-inflammation， and bone metabolism， offering a holistic and dynamic perspective to understand the complexity of multimorbidity. Given the limited efficacy of current periodontal treatments for RA and the scarcity of reported TCM compound interventions for multimorbidity， the abnormal collateral theory proposes a systematic intervention strategy centered on "governing diseases through collaterals and regulating collaterals with herbs"， along with TCM therapeutic principles such as "unblocking， clearing， and nourishing collaterals". Potential herbal treatments for multimorbidity are also highlighted. Future research should focus on refining TCM syndrome patterns in multimorbid patients and leveraging omics technologies for deeper exploration， thereby providing a theoretical foundation and research direction for TCM in addressing complex multimorbid conditions.

The multimorbidity of rheumatoid arthritis （RA） and periodontitis （PD） has drawn increasing attention， as both conditions are characterized by chronic inflammation， immune dysregulation， and progressive bone destruction. Modern research confirms that PD is a significant risk factor for RA development， and their coexistence mutually exacerbates disease progression. However， traditional Chinese medicine （TCM） currently lacks a systematic theoretical explanation for this complex multimorbid relationship. This study， based on the TCM theory of abnormal collateral， thoroughly examines the intrinsic connection between RA and PD multimorbidity， proposing "abnormal collateral as the pivot， with accumulated toxins eroding bone" as the core TCM pathogenesis. The research elucidates PD as the "origin of abnormal collateral"， where its pathogens act as toxic factors that invade the joints through collaterals， triggering RA via mechanisms such as molecular mimicry. The dynamic pathological progression of RA-PD multimorbidity can be described as follows： the displacement of Ying and Wei at the microscopic level manifests as immune hyperactivation， leading to collateral malnutrition； heat-toxins traversing collaterals induce collateral hyperactivity， resulting in pathological angiogenesis； ultimately， toxin accumulation at the pivotal abnormal collateral site erodes bone， activating the receptor activator of nuclear factor kappa-B ligand （RANKL）-receptor activator of nuclear factor kappa-B （RANK） signaling pathway-driven osteoclast differentiation. This theoretical framework innovatively integrates modern findings in oral microbiology， immune-inflammation， and bone metabolism， offering a holistic and dynamic perspective to understand the complexity of multimorbidity. Given the limited efficacy of current periodontal treatments for RA and the scarcity of reported TCM compound interventions for multimorbidity， the abnormal collateral theory proposes a systematic intervention strategy centered on "governing diseases through collaterals and regulating collaterals with herbs"， along with TCM therapeutic principles such as "unblocking， clearing， and nourishing collaterals". Potential herbal treatments for multimorbidity are also highlighted. Future research should focus on refining TCM syndrome patterns in multimorbid patients and leveraging omics technologies for deeper exploration， thereby providing a theoretical foundation and research direction for TCM in addressing complex multimorbid conditions.

ObjectiveTo explore the effectiveness and potential mechanism of Shugan Jianpi Granules （疏肝健脾颗粒） combined with Chushi Zhiyang Ointment （除湿止痒软膏） in the treatment of atopic dermatitis with sleep disturbance of liver constraint and spleen deficiency syndrome. MethodsSixty-six patients with atopic dermatitis combined with sleep disturbance of liver constraint and spleen deficiency syndrome were randomly divided into 33 cases each in the treatment group and the control group. Both groups were treated with Chushi Zhiyang Ointment for external use. The treatment group additionally received Shugan Jianpi Granules orally， one dose per day； and the control group received cetirizine hydrochloride tablets orally， 10mg per day， taken before bedtime. Both groups were under the treatment for 4 weeks. Clinical effectiveness was evaluated after treatment， and the SCORing Atopic Dermatitis （SCORAD） index， pruritus visual analog scale （VAS） score， Insomnia Severity Index （ISI） score， and Pittsburgh Sleep Quality Index （PSQI） score were recorded before and after treatment， and serum levels of melatonin （MLT）， interleukin-4 （IL-4）， interleukin-6 （IL-6）， interleukin-13 （IL-13）， and tumor necrosis factor-α （TNF-α） were measured. The patients were also tested for blood routine， liver function and kidney function before and after treatment， and the occurrence of adverse events was also observed. ResultsThe total effective rate in the treatment group （90.63%， 29/32） was significantly higher than that in the control group （66.67%， 20/30， P＜0.05）. After the interventions， the scores for SCORAD， VAS， ISI， and PSQI， as well as the levels of IL-4， IL-6， IL-13， and TNF-α， were significantly reduced in both groups. In contrast， the MLT levels in treatment group significantly elevated compared to that before treatment （P＜0.05）. Comparing between the two groups after treatment， the scores of SCORAD， ISI， PSQI， and VAS， as well as the levels of serum IL-4 and IL-13 in the treatment group were significantly lower than those in the control group， while the MLT levels were markedly higher than that in the control group （P＜0.05 or P＜0.01）. There was no obvious abnormality in blood routine， liver function and kidney function in both groups when compared before and after treatment. The incidence rate of adverse reactions was 9.38% （3/32） in the treatment group and 13.33% （4/30） in the control group， and the difference between groups showed no statistical difference （P＞0.05）. ConclusionOn the basis of topical application of Chushi Zhiyang Ointment， the combined application of Shugan Jianpi Granules can significantly alleviate the degree of skin lesions and itching， and improve the quality of sleep in atopic dermatitis patients with sleep disturbance of liver constraint and spleen deficiency syndrome， and its mechanism may be related to regulating the immune balance， reducing the secretion of inflammatory factors， and elevating the level of MLT.

Congenital median cleft lip caused by all kinds of reasons is the most basic presentation of facial median cleft. Although a wide array of options is available, the technique employed will largely depend on the surgeon preference and experience, and lack of uniform standards. The basic surgical treatments of midline cleft lip and nose deformities include exposure of abnormal anatomy, repair soft tissue and skin, anatomic approximation of cartilaginous elements, orbicularis oris muscle repair and craniofacial osteotomy. However, there is still no common classification system to stratify the wide variations of midline cleft lip and nasal deformity, which is important to formulate specific surgical method for different types. This article summarized various classifications, recommended to use the Kolker’s classification by which the treatment options were summarized and proposed research prospects to provide ideas for further study.

Objective:To investigate the condylar resorption and influencing factors in post mandibular distraction osteogenesis of the hemifacial microsomia patients.Methods:This retrospective study investigated the clinical data of hemifacial microsomia patients who underwent mandibular distraction osteogenesis in the Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from October 2008 to August 2021. Three-dimensional models of pre-operation and pre-distractor extraction were created by the analysis of CT data via ProPlan CMF 3.0. The height and volume of the condyle were measured. Data were analyzed statistically. According to the changes of condylar height and volume pre- and post-operation, the condylar height resorption rate and volume resorption rate could be calculated. The volume resorption rate of the affected side between Type-Ⅱa and Type-Ⅱb hemifacial microsomia patients, hemifacial microsomia patients whether wearing a bite plate, prereproductive and adolescent hemifacial microsomia patients were compared with the Mann-Whitney U test. The Spearman correlation coefficient analysis was used to determine the correlations of the condylar volume resorption rate and condylar height resorption rate in the affected side with measurements of elogation distance, preoperative condylar height, patient age, and distractor remaining time in mandible. P<0.05 indicates that the difference was statistically significant. Results:Forty-seven Type-Ⅱa hemifacial microsomia patients(36 male patients, 11 female patients) were included, patient age ranged from 5 to 20 years and the mean age was (8.49±2.60) years, 36 patients were in the prereproductive age(5-<10 years old), and 11 patients were in the adolescent age(10-20 years old). Forty-six Type-Ⅱb hemifacial microsomia patients(34 male patients, 12 female patients) were included, patient age ranged from 5 to 20 years and the mean age was (8.93±3.43) years. Thirty-six patients were in the prereproductive age(5-<10 years-old), and ten patients were in the adolescent age(10-20 years-old). The follow-up period of Type-Ⅱa hemifacial microsomia patients was (8.49±2.60) months, and the follow-up period of Type-Ⅱb hemifacial microsomia patients was (9.79±2.59) months. Facial asymmetry was improved effectively. Surgical part of the bone had good osteogenesis. Mouth opening and closing, speech, and eating were all normal. The condylar volume resorption rate 34.8%(19.1%, 54.3%) in the affected side of Type-Ⅱa hemifacial microsomia was significantly associated with the elogation distance ( r=0.46, P=0.001), and it had no correlation with the height of the affected condyle ( r=-0.12, P=0.421), age of patients ( r=-0.06, P=0.691), and distractor remaining time in mandible ( r=-0.10, P=0.517). The condylar volume resorption rate 61.0%(11.2%, 95.0%) in the affected side of Type-Ⅱb hemifacial microsomia was significantly associated with the height of the affected condyle ( r=-0.45, P=0.002) and had weak correlation with the elogation distance ( r=0.29, P=0.049), and it had no correlation with age of patients ( r=0.06, P=0.705), and distractor remaining time in mandible ( r=0.21, P=0.157). However, there was no significant difference in terms of the condylar volume resorption rate of the affected side between Type-Ⅱa and Type-Ⅱb hemifacial microsomia ( z=-1.90, P=0.058). Whether the hemifacial microsomia patients wearing a bite plate following mandibular distraction osteogenesis did not affect the condylar volume resorption rate of the affected side ( z=-1.17, P=0.242 in Type-Ⅱa hemifacial microsomia, z=-0.17, P=0.869 in Type-Ⅱb hemifacial microsomia). The condylar volume resorption rate of the affected side had no significant difference between prereproductive and adolescent hemifacial microsomia patients ( z=-0.18, P=0.860 in Type Ⅱa hemifacial microsomia, z=-1.50, P=0.134 in Type-Ⅱb hemifacial microsomia). Conclusion:Condylar resorption of the affected side would happen in post mandibular distraction osteogenesis of the hemifacial microsomia patients, and the condylar resorption rate of the affected side has relationship with the elogation distance and affected preoperative condylar height.

Objective:To investigate the condylar resorption and influencing factors in post mandibular distraction osteogenesis of the hemifacial microsomia patients.Methods:This retrospective study investigated the clinical data of hemifacial microsomia patients who underwent mandibular distraction osteogenesis in the Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from October 2008 to August 2021. Three-dimensional models of pre-operation and pre-distractor extraction were created by the analysis of CT data via ProPlan CMF 3.0. The height and volume of the condyle were measured. Data were analyzed statistically. According to the changes of condylar height and volume pre- and post-operation, the condylar height resorption rate and volume resorption rate could be calculated. The volume resorption rate of the affected side between Type-Ⅱa and Type-Ⅱb hemifacial microsomia patients, hemifacial microsomia patients whether wearing a bite plate, prereproductive and adolescent hemifacial microsomia patients were compared with the Mann-Whitney U test. The Spearman correlation coefficient analysis was used to determine the correlations of the condylar volume resorption rate and condylar height resorption rate in the affected side with measurements of elogation distance, preoperative condylar height, patient age, and distractor remaining time in mandible. P<0.05 indicates that the difference was statistically significant. Results:Forty-seven Type-Ⅱa hemifacial microsomia patients(36 male patients, 11 female patients) were included, patient age ranged from 5 to 20 years and the mean age was (8.49±2.60) years, 36 patients were in the prereproductive age(5-<10 years old), and 11 patients were in the adolescent age(10-20 years old). Forty-six Type-Ⅱb hemifacial microsomia patients(34 male patients, 12 female patients) were included, patient age ranged from 5 to 20 years and the mean age was (8.93±3.43) years. Thirty-six patients were in the prereproductive age(5-<10 years-old), and ten patients were in the adolescent age(10-20 years-old). The follow-up period of Type-Ⅱa hemifacial microsomia patients was (8.49±2.60) months, and the follow-up period of Type-Ⅱb hemifacial microsomia patients was (9.79±2.59) months. Facial asymmetry was improved effectively. Surgical part of the bone had good osteogenesis. Mouth opening and closing, speech, and eating were all normal. The condylar volume resorption rate 34.8%(19.1%, 54.3%) in the affected side of Type-Ⅱa hemifacial microsomia was significantly associated with the elogation distance ( r=0.46, P=0.001), and it had no correlation with the height of the affected condyle ( r=-0.12, P=0.421), age of patients ( r=-0.06, P=0.691), and distractor remaining time in mandible ( r=-0.10, P=0.517). The condylar volume resorption rate 61.0%(11.2%, 95.0%) in the affected side of Type-Ⅱb hemifacial microsomia was significantly associated with the height of the affected condyle ( r=-0.45, P=0.002) and had weak correlation with the elogation distance ( r=0.29, P=0.049), and it had no correlation with age of patients ( r=0.06, P=0.705), and distractor remaining time in mandible ( r=0.21, P=0.157). However, there was no significant difference in terms of the condylar volume resorption rate of the affected side between Type-Ⅱa and Type-Ⅱb hemifacial microsomia ( z=-1.90, P=0.058). Whether the hemifacial microsomia patients wearing a bite plate following mandibular distraction osteogenesis did not affect the condylar volume resorption rate of the affected side ( z=-1.17, P=0.242 in Type-Ⅱa hemifacial microsomia, z=-0.17, P=0.869 in Type-Ⅱb hemifacial microsomia). The condylar volume resorption rate of the affected side had no significant difference between prereproductive and adolescent hemifacial microsomia patients ( z=-0.18, P=0.860 in Type Ⅱa hemifacial microsomia, z=-1.50, P=0.134 in Type-Ⅱb hemifacial microsomia). Conclusion:Condylar resorption of the affected side would happen in post mandibular distraction osteogenesis of the hemifacial microsomia patients, and the condylar resorption rate of the affected side has relationship with the elogation distance and affected preoperative condylar height.

Objective:Analyzing the morphological and functional changes of the temporomandibular joint (TMJ) post L-shaped reduction malarplasty. And evaluating the surgical safety.Methods:The female cosmetic patients who underwent L-shaped reduction malarplasty in the Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from December 2015 to March 2019 were recruited as the study object. Three-dimension models of pre-operation and post-operation were created by the analysis of computed tomography (CT) data via Materialise ProPlan CMF 3.0. Seventeen groups of data relating to the length and angle of the TMJ were measured in the axial plane, coronal plane and sagittal plane. These measurements included condylar anteroposterior diameter in the axial plane and condylar anterior space, superior space and posterior space in the sagittal plane. Data were analyzed via SPSS 22.0 statistical software.Results:Thirty female cosmetic patients who underwent L-shaped reduction malarplasty were included. Patient age ranged from 21 to 36 years and the mean age was (26.19±4.08) years. Fifteen patients were less than 25 years old, and other fifteen patients were more than or at least 25 years old. The condylar anteroposterior diameter post-operation was significantly longer than pre-operation in the axial plane [(9.406±1.241) mm vs.(9.259±1.276) mm], and the difference was (0.146±0.388) mm. The condylar anterior space, superior space and posterior space post-operation were all significantly smaller than pre-operation in the sagittal plane [(1.080±0.537) mm vs.(1.193±0.533) mm/(1.598±0.591) mm vs.(1.907±0.755) mm/(1.239±0.568) mm vs.(1.670±0.926)mm], and the differences were (0.113±0.409) mm, (0.309±0.711) mm, and(0.431±0.786) mm, respectively. Other thirteen measurements showed none significant differences when compared to pre-operation and post-operation ( P>0.05). Conclusions:L-shaped reduction malarplasty could trigger slight morphological changes to the TMJ. However the TMJ could adapt these changes and reach to a new balance due to compensated adaptation. The normal physiological function would not be impacted. Surgery itself could be considered as a safe contour cosmetic surgery.

Objective:Analyzing the morphological and functional changes of the temporomandibular joint (TMJ) post L-shaped reduction malarplasty. And evaluating the surgical safety.Methods:The female cosmetic patients who underwent L-shaped reduction malarplasty in the Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from December 2015 to March 2019 were recruited as the study object. Three-dimension models of pre-operation and post-operation were created by the analysis of computed tomography (CT) data via Materialise ProPlan CMF 3.0. Seventeen groups of data relating to the length and angle of the TMJ were measured in the axial plane, coronal plane and sagittal plane. These measurements included condylar anteroposterior diameter in the axial plane and condylar anterior space, superior space and posterior space in the sagittal plane. Data were analyzed via SPSS 22.0 statistical software.Results:Thirty female cosmetic patients who underwent L-shaped reduction malarplasty were included. Patient age ranged from 21 to 36 years and the mean age was (26.19±4.08) years. Fifteen patients were less than 25 years old, and other fifteen patients were more than or at least 25 years old. The condylar anteroposterior diameter post-operation was significantly longer than pre-operation in the axial plane [(9.406±1.241) mm vs.(9.259±1.276) mm], and the difference was (0.146±0.388) mm. The condylar anterior space, superior space and posterior space post-operation were all significantly smaller than pre-operation in the sagittal plane [(1.080±0.537) mm vs.(1.193±0.533) mm/(1.598±0.591) mm vs.(1.907±0.755) mm/(1.239±0.568) mm vs.(1.670±0.926)mm], and the differences were (0.113±0.409) mm, (0.309±0.711) mm, and(0.431±0.786) mm, respectively. Other thirteen measurements showed none significant differences when compared to pre-operation and post-operation ( P>0.05). Conclusions:L-shaped reduction malarplasty could trigger slight morphological changes to the TMJ. However the TMJ could adapt these changes and reach to a new balance due to compensated adaptation. The normal physiological function would not be impacted. Surgery itself could be considered as a safe contour cosmetic surgery.

Congenital median cleft lip caused by all kinds of reasons is the most basic presentation of facial median cleft. Although a wide array of options is available, the technique employed will largely depend on the surgeon preference and experience, and lack of uniform standards. The basic surgical treatments of midline cleft lip and nose deformities include exposure of abnormal anatomy, repair soft tissue and skin, anatomic approximation of cartilaginous elements, orbicularis oris muscle repair and craniofacial osteotomy. In addition, there still doesn’ t have a common classification system to stratify the wide variations of midline cleft lip and nasal deformity, which is important to formulate specific surgical method for different types. This article summarized various classifications, recommended to use the Kolker' s classification by which the treatment options were summarized and proposed research prospects to provide ideas for further study.

Congenital median cleft lip caused by all kinds of reasons is the most basic presentation of facial median cleft. Although a wide array of options is available, the technique employed will largely depend on the surgeon preference and experience, and lack of uniform standards. The basic surgical treatments of midline cleft lip and nose deformities include exposure of abnormal anatomy, repair soft tissue and skin, anatomic approximation of cartilaginous elements, orbicularis oris muscle repair and craniofacial osteotomy. In addition, there still doesn’ t have a common classification system to stratify the wide variations of midline cleft lip and nasal deformity, which is important to formulate specific surgical method for different types. This article summarized various classifications, recommended to use the Kolker' s classification by which the treatment options were summarized and proposed research prospects to provide ideas for further study.