Smart healthcare plays an important role in easing the strain on medical resources and improving the continuity of chronic disease management. This study analysed the iatrogenic risks from the intrinsic attributes and the external environment of smart healthcare, including doctor-patient conflict risk, technical operation risk, information leakage risk, humanistic absence risk, legal risk, regulatory risk and ethical risk. Based on the " structure process result" model, suggestions were proposed to optimize the construction of a smart healthcare platform for chronic diseases, improve the legal system and industry standards, strengthen talent cultivation and capacity building, establish an integrated regulatory system, and regularly evaluate the effectiveness of chronic disease management. These suggestions provided references for creating a healthy, orderly, and safe smart healthcare environment for chronic disease patients.

Objective:To analyze change trend of disease burden of chronic kidney disease (CKD) mortality between 2012 and 2023 in Chongqing, and provide suggestion for CKD prevention.Methods:The mortality data of CKD were collected from Chongqing death registration between 2012 and 2023 according to International Classification of Diseases 10 th. The data were analyzed to calculate mortality rate, standardized mortality rate, age specific mortality rate, and the rate of years of life lost (YLL) and proportion by using software SPSS 26.0. The mortality rate of CKD between men and women, urban area and rural area were compared by χ2 test. The change trend was described by average annual percent of change (AAPC). Results:The mortality rate and standardized mortality rate of CKD were 7.94/100 000 and 4.63/100 000 respectively in 2012 and 6.70/100 000 and 2.79/100 000 respectively in 2023 in Chongqing. The difference in change of CKD mortality rate was not significant (AAPC=-0.79%, t=-1.60, P=0.273). However, the standardized mortality rate of CKD decreased by 3.59% ( t=-3.98, P=0.003) from 2012 to 2023. The mortality rate of CKD was higher in men than in women in 2014 and 2022, the differences were significant (all P<0.05). The standardized mortality rate of CKD in men and women decreased by 3.17% and 4.11% respectively between 2012 and 2023, the difference was significant (all P<0.05). The mortality rate of CKD had been higher in urban area than in rural area since 2016 (all P<0.05). During this period, the mortality rate and standardized mortality rate of CKD in urban area remained stable, but the mortality rate and standardized mortality rate of CKD in rural area showed average annual decreases of 2.21% and 4.90%, the differences were significant (all P<0.05). The proportion of CKD due to hypertension decreased, but the proportion of CKD due to diabetes and other causes increased. The rate of age standardized YLL of CKD showed an average annual decrease of 2.83%, the differences were significant ( P=0.011). Conclusions:The standardized mortality rate and age standardized YLL of CKD decreased from 2012 to 2023 in Chongqing. Men, urban residents and the elderly are key populations in CKD prevention.

Objective·To explore the diagnostic and treatment methods for patients with cystic fibrosis(CF)complicated by allergic bronchopulmonary aspergillosis(ABPA),and to enhance clinicians'understanding of these two diseases.Methods·A retrospectively analysis was conducted on the clinical data of 5 patients with CF complicated by ABPA admitted to the Department of Respiratory Medicine,Shanghai Children's Hospital,Shanghai Jiao Tong University School of Medicine,from July 2023 to August 2024.A literature search was performed in PubMed,Web of Science,Cochrane Library,and CNKI for studies published in the past 10 years regarding the co-existence of these diseases.Clinical manifestations,treatment courses,and current epidemiological research were summarized and analyzed.Results·Common symptoms of patients with CF complicated by ABPA included aggravated cough and expectoration,wheezing,fever,and dyspnea.Whole-exome aequencing indicated mutations in the cystic fibrosis transmembrane conductance regulator(CFTR)gene,and an increase in the concentration of chloride ions in sweat.The levels of total serum immunoglobulin E(IgE)and Aspergillus fumigatus-specific IgE increased,and chest computed tomography(CT)showed bronchiectasis and mucus plugging.CF complicated by ABPA is often missed or misdiagnosed for asthma.In China,ABPA is often diagnosed before CF,whereas in Caucasian populations CF is typically diagnosed first.Initial treatment usually involves long-term oral administration of antifungal drugs such as voriconazole combined with glucocorticoids such as prednisone.For patients with frequent relapses or severe side effects,alternative antifungal agents or omalizumab therapy may be considered.Co-infection with Pseudomonas aeruginosa is common,often requiring intravenous antibiotics such as cefoperazone-sulbactam.Current epidemiological research focuses mainly on clinical characteristics,treatment regimens,and novel diagnostic methods.Conclusion·ABPA and CF have overlapping symptoms.Accurate diagnosis of CF complicated by ABPA requires genetic testing,sweat chloride measurement,chest CT,and serological tests.The coexistence of these diseases often leads to missed,delayed,or incorrect diagnosis,increasing patient burden.Present epidemiological studies mainly address clinical characteristics with a lack of targeted clinical drug trials for this patient population.

Objective To mine and analyze adverse drug events(ADEs)of novel agents for multi-drug-resistant tuberculosis(MDR-TB)based on the FDA Adverse Event Reporting System(FAERS)database,to explore the signals of ADEs,and to provide reference for clinical use.Methods The FAERS database was searched and extracted from Q1 of 2015 to Q4 of 2023,and the ADE reports about bedaquiline,delamanid,and pretomanid were collected.Data mining and analysis were carried out on relevant reports of the drug using the reporting odds ratio(ROR),proportional reporting ratio(PRR),medicines and healthcare products regulatory agency(MHRA),and the Bayesian confidence progressive neural network(BCPNN).Results The number of ADE reports for the target drugs bedaquiline,delamanid,and pretomanid were 2 477,1 630,and 173,respectively.ADE of the target drugs involved multiple organ systems.Positive signals detected by the ROR,PRR,MHRA,and BCPNN methods were 246,246,215,204 for bedaquiline;251,251,224,200 for delamanid;and 25,25,24,22 for pretomanid.Clinically significant high-risk signals include prolonged QT interval on ECG,anemia,liver toxicity,peripheral neuropathy,etc.Conclusions The signal mining of ADEs based on the FAERS database indicates that close attention should be paid to risks such as prolonged QT interval on ECG,anemia,liver toxicity,and peripheral neuropathy during the clinical use of bedaquiline,delamanid,and pretomanid.In addition,monitoring of new potential ADE signals(such as acute heart failure,respiratory failure,acute kidney injury,etc.)should be strengthened,and timely intervention measures should be taken to ensure medication safety.

Objective:Dehydrated hereditary stomatocytosis (DHS), a rare condition caused by pathogenic PIEZO1 or KCNN4 mutations, remains under-recognized. This study aimed to improve the diagnosis and management of DHS in China by retrospectively analyzing clinical and genetic characteristics.Methods:Patients diagnosed with DHS at Peking Union Medical College Hospital between 2018 and 2024 were included. All had suspected congenital hemolytic anemia and were confirmed by next-generation sequencing to harbor pathogenic PIEZO1 or KCNN4 mutations. Clinical features, genotypes, iron overload, and treatment outcomes were collected and analyzed.Results:Twenty-three DHS patients were identified, including 21 with PIEZO1 and 2 with KCNN4 mutations. Common manifestations were splenomegaly, jaundice, cholelithiasis, and secondary iron overload. Mild and moderate anemia occurred in 8.7% and 17.4% of patients, respectively, and stomatocytes were present in only 17.4%. The median time from symptom onset to diagnosis was 11 years. The predominant PIEZO1 variants were c.7367G > A and c.6328C > T, with nine novel mutations identified. Both KCNN4 mutations involved c.1055G > A. No clear genotype–phenotype correlation was observed. Secondary hepatic iron overload was found in 21.7% of patients.Conclusion:DHS is often underdiagnosed or misdiagnosed. Genetic testing enables accurate identification, and regular monitoring for secondary hepatic iron overload is crucial for long-term management.

Objective To analyse the efficacy of Gao Mo therapy in the treatment of aromatase inhibitor-related osteoarticular symptoms in breast cancer patients.Methods A total of 80 breast cancer patients with aromatase inhibitor-related osteoarticular symptoms were selected from the breast clinic of a Tier-IIIA hospital in Guangdong Province between January and August 2024.The patients were divided into an intervention group and a control group according to the random number table,with 40 patients per group.Patients in the control group received routine nursing care,while the patients in the intervention group received Gao Mo therapy for 4 weeks based on the intervention of the control group.The two groups were compared with in terms of pain level,index of knee osteoarthritis,and quality of life of the patients with breast cancer before intervention and at 1st,2nd and 4th weeks after intervention.Results Before the intervention,the two groups presented no significant differences in scores of pain assessment,knee osteoarthritis index and quality of life(P>0.05).Analysis of variance for repeated measures showed that the main effects of time and group as well as the interaction effect,were statistically significant in scores of pain assessments in both groups(both P<0.05).The main effects of time and the interaction effect were statistically significant in scores of knee osteoarthritis index and quality of life assessments at different time points(both P<0.05),but there was no statistically significant difference in the main effect between groups(both P>0.05).After 4 weeks of intervention,the intervention group demonstrated significantly lower scores in knee function and pain assessments with a significantly higher scores in the total quality of life assessment in comparison with those of the control group(all P<0.05).Conclusion Gao Mo therapy can mitigate the aromatase inhibitor-related osteoarticular symptoms in breast cancer patients,enhance the function of knees,and improve the quality of life of the patients with breast cancer.

Objective:To develop and validate a predictive model for septic shock using noninvasive left ventricular pressure-strain loop myocardial work parameters combined with clinical indicators.Methods:In this retrospective study, 105 septic patients admitted to the intensive care unit of Zhangzhou Hospital between January and December 2023 were analyzed after screening (initial cohort: 124 patients). Participants were stratified into non-shock ( n=38) and shock ( n=67) groups based on septic shock occurrence within 48 hours of admission. Demographic characteristics, laboratory parameters, clinical variables, and myocardial work indices were compared between groups. Independent risk factors were identified through multivariate logistic regression, and a predictive model was constructed. Results:Five independent predictors of septic shock were identified: Left ventricular global longitudinal strain (GLS) ≥ -16% (X 1).Global work index (GWI) <1 196.5 mmHg% (X 2).Brain natriuretic peptide (BNP) ≥299.81 pg/mL (X 3).Lactate (Lac) ≥4.75 mmol/L (X 4).Mean arterial pressure (MAP) <68.5 mmHg (X 5).The derived model equation was:Y = -21.104 + 3.517×X 1 + 2.066×X 2 + 1.941×X 3 + 3.440×X 4 + 3.526×X 5.ROC analysis determined an optimal diagnostic cutoff of -13.6185 points (rounded to -14 for clinical practicality). Scores≥-14 indicated high septic shock risk. The model demonstrated excellent discrimination (AUC=0.960, 95% CI=0.919-0.998) and goodness-of-fit (Hosmer-Lemeshow test, P=0.804). Conclusions:This novel predictive model integrating myocardial work parameters and clinical indicators exhibits outstanding diagnostic performance for early septic shock detection, potentially enabling timely therapeutic intervention.

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

The rapid screening of bioactive constituents within traditional Chinese medicine (TCM) presents a significant challenge to researchers. Prevailing strategies for the screening of active components in TCM often overlook trace components owing to their concealment by more abundant constituents. To address this limitation, a fishing strategy based on offline two-dimensional liquid chromatography (2D-LC) combined with surface plasmon resonance (SPR) was utilized to screen bioactive trace components targeting peroxiredoxin 3 (PRDX3), using Uncaria alkaloids (UAs) as a case study. Initially, an orthogonal preparative offline 2D-LC system combining a positively charged C₁₈ column and a conventional C₁₈ column under disparate mobile phase conditions was constructed. To fully reveal the trace alkaloids, 13 2D fractions of UAs were prepared, and their components were characterized using mass spectrometry (MS). Subsequently, employing PRDX3 as the targeting protein, a SPR-based screening approach was established and rigorously validated with geissoschizine methyl ether (GSM) serving as a positive control for binding. Employing this refined strategy, 29 candidate binding alkaloids were fished from the 13 2D fractions. Notably, combining offline 2D-LC with SPR increased the yield of candidate binding components from 10 to 29 when compared to SPR-based screening alone. Subsequent binding affinity assays confirmed that PRDX3 was a direct binding target for the 12 fished alkaloids, with isovallesiachotamine (IV), corynoxeine N-oxide (CO-N), and cadambine (CAD) demonstrating the highest affinity for PRDX3. Their interactions were further validated through molecular docking analysis. Subsequent intracellular H₂O₂ measurement assays and transfection experiments confirmed that these three trace alkaloids enhanced PRDX3-mediated H₂O₂ clearance. In conclusion, this study introduced an innovative strategy for the identification of active trace components in TCM. This approach holds promise for accelerating research on medicinal components within this field.