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 analyze the characteristics of HIV-1 pretreatment drug resistance(PDR)and molecular transmission networks in Yubei District,Chongqing,providing evidence for targeted interventions.Methods Using a cross-sectional design,plasma samples were collected from HIV/AIDS patients receiving antiretroviral therapy(ART)in Yubei District from January 2022 to December 2023.Pol gene fragments were extracted and amplified for HIV-1 genotyping and drug resistance analysis.Molecular transmission networks were constructed based on genetic distance calculations.Results Among 478 HIV-1 pol sequences,eight geno-types were identified:with CRF07_BC(60.4%,289/478),CRF08_BC(15.5%,74/478),CRF01_AE(11.7%,56/478),and CRF85_BC(5.9%,28/478).The overall PDR rate was 6.3%(30/478),with resistance to nucleoside reverse transcriptase inhibitors(NRTIs)and non-nucleoside reverse transcriptase inhibitors(NNRTIs)at 1.7%(8/478)and 5.2%(25/478),respectively.No protease inhibitor(PI)resistance was de-tected.The molecular network included 177 cases(37.0%network entry rate),forming 53 clusters with 198 connections.Cluster sizes ranged from 2 to 17 nodes,and 75.3%(149/198)of connections were associated with five subdistricts/towns:Shuanglonghu Street,Huixing Street,Luoqi Town,Gulu Town,and Baoshenghu Street.Conclusion HIV-1 genotypes in Yubei District exhibit diversity and complexity,with moderate PDR prevalence.Regional clustering of transmission networks suggests the need for enhanced molecular surveil-lance and targeted interventions based on analytical findings.

Objective To investigate the expression patterns of Gli1,Gli2 and Gli3 genes and proteins in hepatocellular carcinoma(HCC)tissue and their correlation with prognosis.Methods Gli gene expression in 315 HCC samples were analyzed using the cBioportal database,and Gli protein expression was examined in 40 HCC and other liver tissue samples through immunohistochemistry.Results Gli gene alterations were found in 57 cases(18.1%)of HCC samples,with alteration frequencies of 19 cases(6.0%),13 cases(4.1%)and 25 cases(7.9%)for Gli1,Gli2 and Gli3,respectively.Gli1 showed significant co-occurrence with both Gli2 and Gli3(P＜0.05),while Gli2 and Gli3 exhibited a tendency toward mutual exclusivity.Increased Gli1 gene expression significantly correlated with decreased disease-free survival(P＜0.01).Immunohistochemical analysis demonstrated that Gli1 protein expression was significantly higher in HCC tissue than that in normal liver tissue,adjacent tissue,hepatitis and cirrhotic tissue(P＜0.05).In HCC tissue,strong positive correlation was observed between the three Gli proteins(Gli1 vs.Gli2:rs=0.796;Gli1 vs.Gli3:rs=0.759;Gli2 vs.Gli3:rs=0.891,all P＜0.01).High expression levels of all three Gli proteins were detected in 53.3%(8/15)of HCC samples,compared to only 11.8%(2/17)in non-cancerous liver tissue.Conclusion Gli1,Gli2 and Gli3 proteins commonly exhibit synergistic high expression and significant positive correlation in HCC tissue,with Gli1 showing a special expression pattern of independent high expression.

Objective Under the operation background of Diagnosis-Intervention Packet(DIP),whether there is interaction between reducing medical cost and average length of stay combined with pre-hospitalization mode,and whether there is difference between different departments and diseases in interaction.Methods Based on real-world data from 71 453 patients admitted to Guizhou Provincial People's Hospital from July to December 2021,a two-way analysis of variance was employed.When the interaction effect was statistically significant,parameter estimation was used to determine the magnitude and direction of the interaction effect,followed by subgroup analyses by department and disease.Results Without adjustment,both total medical costs and average length of stay exhibited a negative interaction effect(P＜0.05).Subgroup analyses revealed that in terms of total medical costs,the effect size for the surgical system was 0.18％,lower than that for the internal medicine system(0.70％);for core diseases,it was 6.62％,lower than that for comprehensive diseases(7.71％).Regarding average length of stay,the effect size for the surgical system was 0.55％,better than that for the internal medicine system(0.22％);for core diseases,it was 8.70％,higher than that for comprehensive diseases(2.90％).Conclusion The combination of DIP payment reform and pre-admission management model demonstrates a synergistic effect,effectively reducing patients' medical costs and length of stay.This effect is influenced by disease complexity and the standardization of diagnostic and treatment processes.

Objective Under the operation background of Diagnosis-Intervention Packet(DIP),whether there is interaction between reducing medical cost and average length of stay combined with pre-hospitalization mode,and whether there is difference between different departments and diseases in interaction.Methods Based on real-world data from 71 453 patients admitted to Guizhou Provincial People's Hospital from July to December 2021,a two-way analysis of variance was employed.When the interaction effect was statistically significant,parameter estimation was used to determine the magnitude and direction of the interaction effect,followed by subgroup analyses by department and disease.Results Without adjustment,both total medical costs and average length of stay exhibited a negative interaction effect(P＜0.05).Subgroup analyses revealed that in terms of total medical costs,the effect size for the surgical system was 0.18％,lower than that for the internal medicine system(0.70％);for core diseases,it was 6.62％,lower than that for comprehensive diseases(7.71％).Regarding average length of stay,the effect size for the surgical system was 0.55％,better than that for the internal medicine system(0.22％);for core diseases,it was 8.70％,higher than that for comprehensive diseases(2.90％).Conclusion The combination of DIP payment reform and pre-admission management model demonstrates a synergistic effect,effectively reducing patients' medical costs and length of stay.This effect is influenced by disease complexity and the standardization of diagnostic and treatment processes.

Objective To investigate the expression patterns of Gli1,Gli2 and Gli3 genes and proteins in hepatocellular carcinoma(HCC)tissue and their correlation with prognosis.Methods Gli gene expression in 315 HCC samples were analyzed using the cBioportal database,and Gli protein expression was examined in 40 HCC and other liver tissue samples through immunohistochemistry.Results Gli gene alterations were found in 57 cases(18.1%)of HCC samples,with alteration frequencies of 19 cases(6.0%),13 cases(4.1%)and 25 cases(7.9%)for Gli1,Gli2 and Gli3,respectively.Gli1 showed significant co-occurrence with both Gli2 and Gli3(P＜0.05),while Gli2 and Gli3 exhibited a tendency toward mutual exclusivity.Increased Gli1 gene expression significantly correlated with decreased disease-free survival(P＜0.01).Immunohistochemical analysis demonstrated that Gli1 protein expression was significantly higher in HCC tissue than that in normal liver tissue,adjacent tissue,hepatitis and cirrhotic tissue(P＜0.05).In HCC tissue,strong positive correlation was observed between the three Gli proteins(Gli1 vs.Gli2:rs=0.796;Gli1 vs.Gli3:rs=0.759;Gli2 vs.Gli3:rs=0.891,all P＜0.01).High expression levels of all three Gli proteins were detected in 53.3%(8/15)of HCC samples,compared to only 11.8%(2/17)in non-cancerous liver tissue.Conclusion Gli1,Gli2 and Gli3 proteins commonly exhibit synergistic high expression and significant positive correlation in HCC tissue,with Gli1 showing a special expression pattern of independent high expression.

With the development of modern medical standards,autoimmune diseases and their associ-ated successive osteoporosis have received increasing attention in recent years.Patients with autoimmune diseases,due to the characteristics of the disease and the prolonged use of glucocorticoid hormone thera-py,may affect the bone formation and bone absorption of the patient,followed by severe successive osteo-porosis,thereby increasing the risk of osteoporotic vertebral fractures.Vertebral compression fractures of the spine are common fracture types in patients with osteoporotic fractures.Osteoporosis is a common complication after glucocorticoid therapy in patients with autoimmune diseases.Percutaneous vertebro-plasty(PVP)and percutaneous kyphoplasty(PKP)are minimally invasive operation and are commonly used surgical methods for the treatment of osteoporotic vertebral compression fractures.However,due to the operation of spinal puncture during the operation,there are serious surgical risks such as bone cement leakage,spinal epidural hemorrhage,subdural hemorrhage,and subarachnoid hemorrhage in both PVP and PKP.As a result,it is necessary to evaluate the patient's body before surgery carefully,especially in the case of blood coagulation.This article reports a case of autoimmune disease patient admitted to Peking University People's Hospital due to lumbar 4 vertebral compression fracture combined with Sj?gren's syn-drome.The patient's preoperative examination showed that the activated partial thromboplastin time(APTT)was significantly prolonged.After completing the APTT extended screening experiment and lu-pus anticoagulant factor testing,the multi-disciplinary team(MDT)of Peking University People's Hospi-tal jointly discussed the conclusion that the patient's test results were caused by an abnormal self-immuni-ty anti-copulant lupus(LAC).Based on the results of the laboratory examination,the patient was con-sidered to be diagnosed with combined antiphospholipid syndrome(APS).For such patients,compared with the patient's tendency to bleed,we should pay more attention to the risk of high blood clotting in the lower limbs of the patient,pulmonary clots and so on.With timely anti-coagulation treatment,the patient safely passed the peripheral period and was successfully discharged from the hospital.Therefore,for pa-tients with autoimmune diseases with prolonged APTT in the perioperative period,doctors need to careful-ly identify the actual cause and carry out targeted treatment in order to minimize the risk of surgical and perioperative complications and bring satisfactory treatment results to the patients.

Temporomandibular joint (TMJ) diseases are common clinical conditions. The number of patients with TMJ diseases is large, and the etiology, epidemiology, disease spectrum, and treatment of the disease remain controversial and unknown. To understand and master the current situation of the occurrence, development and prevention of TMJ diseases, as well as to identify the patterns in etiology, incidence, drug sensitivity, and prognosis is crucial for alleviating patients′suffering.This will facilitate in-depth medical research, effective disease prevention measures, and the formulation of corresponding health policies. Cohort construction and research has an irreplaceable role in precise disease prevention and significant improvement in diagnosis and treatment levels. Large-scale cohort studies are needed to explore the relationship between potential risk factors and outcomes of TMJ diseases, and to observe disease prognoses through long-term follw-ups. The consensus aims to establish a standard conceptual frame work for a cohort study on patients with TMJ disease while providing ideas for cohort data standards to this condition. TMJ disease cohort data consists of both common data standards applicable to all specific disease cohorts as well as disease-specific data standards. Common data were available for each specific disease cohort. By integrating different cohort research resources, standard problems or study variables can be unified. Long-term follow-up can be performed using consistent definitions and criteria across different projects for better core data collection. It is hoped that this consensus will be facilitate the development cohort studies of TMJ diseases.

Objective To investigate the morphological changes in the upper airway after bimaxillary surgery in patients with skeletal Class Ⅲ malocclusion and the relationship between jaw movement and airway changes using CBCT.Methods This study involved 44 individuals(21 males and 23 females)receiving Class Ⅲ bimaxillary surgery.Preoperative and 3-6-month postoperative CBCT data were examined using Dophin3D 11.95 software.The alterations before and after upper airway surgery were analysed using paired t-test and non-parametric Wilcoxon rank sum test.The association between airway alterations and jaw movement was examined using Pearson's correlation coefficient.Results Patients who underwent Class Ⅲ bimaxillary surgery had significantly reduced upper airway volume,sagittal cross-sectional area,and minimum cross-sectional area(P＜0.01).A correlation exists between oropharyngeal volume change and point B change(P＜0.05).When B point recession was＞7 mm,the decrease in upper airway volume increased significantly(P＜0.01),as did the risk of minimum cross-sectional area of the patient's airway(P＜0.01).Conclusion ClassⅢbimaxillary surgery re-duces upper airway capacity.Postoperative reduction in upper airway capacity coincides with mandibular recession.Mandibular reces-sion(＞7 mm)may reduce postoperative upper airway capacity and increase the risk of OSAHS.Patients at risk of upper airway stenosis should have their protocol modified to reduce airway risk.

Objective To explore the teaching effect of case-integrated scenario simulation instruction model on proba-tionary instruction of acute upper gastrointestinal bleeding.Methods A total of 40 medical students of grade 2021 majoring in clinical medicine,namely,Nanshan Class,from Guangzhou Medical University were selected as participants.The students were randomly divided into two groups,with 22 as an experimental group and 18 as a control group.The former group received the case-integrated based scenario simulation teaching model,while the latter adopted the traditional bedside teaching model.The teaching content was on acute non-variceal upper gastrointestinal bleeding.Results There was no statistically significant differ-ence in the total score of gastroenterology between the experimental group and the control group(P＞0.05).The experimental group scored significantly higher in the gastrointestinal bleeding-related contents compared to the control group(P＜0.05).The post-class survey revealed that the majority of the students in the research group expressed their high-level satisfaction with the new instruction model and demonstrated their greater interests in participation in the new instruction model.Conclusion The case-integrated scenario simulation instruction model demonstrates significant superiority to the traditional bedside teaching model in terms of stimulating learning interests,cultivating medical professionalism,and enlivening classroom atmosphere.It is suitable for practical teaching in gastroenterology and can be widely adopted as routine probationary teaching for undergraduate students.