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 explore the value of systemic immune-inflammation index(SⅡ)in differentiating acute and chronic cholecystitis.Methods A total of 297 patients with cholecystitis who underwent cholecystectomy in Jinshan Hospital,Fudan University from August 2020 to November 2023 were selected,and were divided into acute cholecystitis group(n=192)and chronic cholecystitis group(n=105).The patients in acute cholecystitis group were further divided into severe subgroup(n=114)and mild subgroup(n=78).The differential diagnosis values of SⅡ and neutrophil-to-lymphocyte ratio(NLR)in acute and chronic cholecystitis were evaluated by ROC curve.Results Compared with chronic cholecystitis group,males were more,older,the incidence of hypertension was higher,drainage volume increased,drainage time,hospital time,and surgical duration were all longer,blood cells,neutrophil count,monocyte count increased,total bilirubin,direct bilirubin,and creatinine were higher,SⅡ and NLR increased in the acute cholecystitis group(P＜0.05).Compared with the severe subgroup,the drainage volume decreased,drainage time,hospital stay,and surgical duration were shorter,white blood cell count,neutrophil count,monocyte count,and total bilirubin decreased,while lymphocyte count increased,SⅡ and NLR decreased in the mild subgroup(P＜0.05).The optimal cutoff values of SⅡ and NLR for distinguishing acute cholecystitis from chronic cholecystitis were 797.96 and 3.65,and the AUC were 0.847 and 0.869,with 73.2％and 74.2％of sensitivity,and 86.7％and 89.5％of specificity.The optimal cutoff values of SⅡ and NLR for distinguishing acute severe cholecystitis from mild cholecystitis were 1 056.59 and 4.65,the AUC were 0.768 and 0.779,with 77.0％and 82.3％of sensitivity,and 67.5％and 62.3％of specificity.There was no statistically significant difference between the values of SⅡ and NLR for distinguishing acute severe and acute cholecystitis.Conclusion SⅡ is a good hematological indicator for distinguishing acute cholecystitis from chronic cholecystitis with similar value to NLR.

Monoclonal gammopathy of undetermined significance combined with renal damage is named monoclonal gammopathy of renal significance. There are few reports about IgA vasculitis in patients with monoclonal gammopathy of undetermined significance. Here, we report a case of monoclonal gammopathy of renal significance, who had manifestations of IgA vasculitis, including purpura, gastrointestinal bleeding and joint pain. The patient had elevated serum creatinine levels, prompting further investigation through immunofixation electrophoresis and bone marrow aspiration biopsy. Immunofixation electrophoresis showed IgA-λ-type monoclonal immunoglobulin, while the bone marrow aspiration biopsy suggested plasmacytosis. Kidney biopsy indicated membranous hyperplastic glomerulonephritis, light and heavy chain deposition, IgA-λ. The patient was diagnosed with monoclonal gammopathy of renal significance. In light of the elevated serum creatinine, the patient was treated with chemotherapy regimen (bortezomib +cyclophosphamide +dexamethasone). After chemotherapy, there was no significant improvement in the patient's renal function. Subsequently, the patient experienced abdominal pain, skin purpura, joint pain and severe gastrointestinal bleeding. Gastroenteroscopy did not find the exact bleeding position. Angiography revealed hyperplasia of left jejunal artery. Surgical operation found that the bleeding site was located between the jejunum and ileum, where scattered hemorrhagic spots and multiple ulcers were present on the surface of the small intestine, with the deepest ulcers reaching the serosal layer. And the damaged intestine was removed during the operation. Intestinal pathology showed multiple intestinal submucosal arteritis, rusulting in intestinal wall necrosis and multiple ulcers. Considering intestinal lesions as gastrointestinal involvement of IgA vasculitis, methylprednisolone was used continually after the operation, and the patient's condition was improved. However, after half a year, the patient suffered a severe respiratory infection and experienced a recurrence of serious gastrointestinal bleeding. It was considered that the infection triggered the activity of IgA vasculitis, accompanied by gastrointestinal involvement. Finally, the patient died from gastrointestinal bleeding. The present case represented a patient with monoclonal gammopathy of renal significance and IgA vasculitis, prominently presenting with renal insufficiency and severe gastrointestinal bleeding, making the diagnosis and treatment process complex. Patients with IgA monoclonal gammopathy who presented with abdominal pain, purpura, and arthralgia should be vigilant for the possibility of concomitant IgA vasculitis. The treatment of cases with IgA vasculitis combined with monoclonal gammopathy of renal significance was rather challenging. Plasma cell targeting therapy might be an effective regimen for IgA vasculitis with monoclonal gammopathy. However, patients with poor renal response to the treatment indicated poor prognosis.
Humans ; Cyclophosphamide/administration & dosage* ; Gastrointestinal Hemorrhage/etiology* ; IgA Vasculitis/complications* ; Immunoglobulin A ; Intestine, Small/pathology* ; Kidney/pathology* ; Kidney Diseases/pathology* ; Monoclonal Gammopathy of Undetermined Significance/complications* ; Necrosis ; Paraproteinemias/complications* ; Vasculitis/etiology*

Objective To investigate the effect of different modes of administration of dexmedeto-midine pre-nasal spray combined with pumping and conventional pumping on remifentanil and heart rate var-iability(HRV)in patients undergoing oral and maxillofacial surgery.Methods Ninety patients undergoing elective oral and maxillofacial surgery,43 males and 47 females,aged 18-64 years,BMI 18-25 kg/m2,ASA physical status Ⅰ or Ⅱ,were selected.The patients were divided into three groups by random number table method:pre-nasal spray combined with pump injection group(group PP),conventional pump injection group(group CP),and control group(group C),30 cases in each group.Patients in group PP were given a nasal spray of dexmedetomidine at a dose of 0.5 μg/kg,group CP and group C were given the same amount of normal saline by the same method 45 minutes before entering the room on the day of surgery.Dexmedetomidine was injected intravenously in group PP at doses of 0.5 μg/kg and in group CP at dose of 1 μg/kg for 10 minutes,and group C was given the same amount of normal saline 10 minutes before induc-tion of anesthesia.Ramsay sedation score on admission,duration of surgery,the dose of remifentanil during induction and maintenance of anesthesia,room admission(T1),induction intubation(T2),10 minutes after skin incision(T3),and extubation(T4),RMSSD,SDNN,LF,HF,TP,LF/HF ratio and other HRV analysis indicators,HR,MAP,and BIS values were recorded.The incidence of PONV and the use of analgesics within 24 hours after operation were recorded.Results Compared with group C,the MAP was significantly reduced,RMSSD,SDNN,and logTP were significantly increased,and LF/HF was significantly decreased in group PP at T,(P＜0.05),the LF/HF were significantly reduced in groups PP and CP at T2-T4(P＜0.05),the dosage of remifentanil during the anesthesia induction,the incidence of PONV,and the use rate of analgesic drugs in 24 hours were significantly reduced in groups PP and CP(P＜0.05).Compared with group CP,the RMSSD,SDNN,logLF,logHF,and logTP were increased sig-nificantly in group PP at T,(P＜0.05),the logHF were increased significantly in group PP at T2 and T4(P＜0.05),the Ramsay sedative evaluation was increased significantly,the dosage of remifentanil was sig-nificantly reduced during the maintenance of anesthesia in group PP(P＜0.05).Conclusion After the use of dexmedetomidine,the indicators related to stress level in HRV analysis were significantly reduced,and the dosage of opioids was significantly reduced.The use of dexmedetomidine pre-nasal spray combined with pump injection can further reduce the dosage of opioids during the anesthesia maintenance phase.

Objective To investigate the syndrome differentiation characteristics of children with atopic dermatitis(AD)and the immune imbalance status in children with different syndrome types of AD.Methods A total of 159 AD children and 100 normal control children were enrolled.The peripheral blood eosinophil(Eo)count was measured by impedance method,total serum immunoglobulin E(IgE)by immunoturbidimetric assay,and interferon-gamma(IFN-γ),interleukin-4(IL-4),interleukin-5(IL-5)and interleukin-17(IL-17)were measured by multiple microspheres flow immunofluorescence assay.Results Among 159 AD children,syndrome of heart-fire and spleen-deficiency was most commom,accounting for 38.4%,followed by syndrome of blood-deficiency and wind-dryness(22.0%),syndrome of heat accumulation in heart and spleen(20.1%)and syndrome of spleen-deficiency and dampness-accumulation(19.5%).Compared with normal control group,there was no significant difference in serum IFN-γ level among different syndrome types of AD.The levels of peripheral blood Eo,serum total IgE,IL-4 and IL-17 in AD with heart-fire and spleen-deficiency syndrome were significantly increased(P<0.05).The levels of peripheral blood Eo,IL-4,IL-5 and IL-17 in AD with blood-deficiency and wind-dryness syndrome were significantly increased(P<0.05).The levels of IL-4,IL-5 and IL-17 in AD with heat accumulation in heart and spleen syndrome were significantly increased(P<0.05).The levels of peripheral blood Eo and serum IL-4 in AD with spleen-deficiency and dampness-accumulation syndrome were significantly increased(P<0.05).Conclusion Heart-fire and spleen-deficiency syndrome is the most common type in children with AD,however,the main type under 3 years old is heat accumulation in heart and spleen syndrome.Th2/Th17 immune imbalance are the main pathogenesis in heart-fire and spleen-deficiency syndrome,blood-deficiency and wind-dryness syndrome and heat accumulation in heart and spleen syndrome,and Th2 immune imbalance is the main pathogenesis of spleen-deficiency and dampness-accumulation syndrome.

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 evaluate the efficacy of radiofrequency thermocoagulation with CT-guided transforaminal puncture of intervertebral foramen through the superior margin of costotransverse joint for refractory post-herpetic neuralgia (PHN) in the upper thoracic segment.Methods:Thirty patients with PHN in the upper thoracic segment underwent radiofrequency thermocoagulation with CT-guided intervertebral foramen puncture. The visual analogue scale and self-rating depression scale were used to evaluate the degree of postoperative pain and mental state before and after treatment, and patients were followed by telephone or outpatient visit.Results:No infection occurred after radiofrequency thermocoagulation in all 31 PHN patients. After operation, all patients had hypoesthesia in skin of the original pain area, the pain was significantly relieved, and the mental state improved significantly. The VAS scores were 5.94±0.93, 2.74±0.69, 2.68±0.70 and 2.45±0.51 before and 3 hours, 1 week, 1 month after treatment( t=18.80, t=18.80, t=16.44, all P<0.01). The SDS scores were 58.6±12.2, 47.7±4.4, 48.1±4.8 before and 1 week, 1 month after treatment( t=6.75, t=5.86, all P<0.01). There were 13 patients with moderate or severe depression before treatment, while no patients with moderate or severe depression after treatment; only 5 patients had mild depression one month after surgery. There was no hypoxemia under nasal catheter during the operation. Intraoperative hypertension was found in 19 cases; after treatment with Urapidil (12.5 - 50.0 mg), the blood pressure was not higher by 20% of the basal blood pressure and<180/100 mmHg (1 mmHg=0.133 kPa). No pneumothorax, perioperative cardiovascular and cerebrovascular accidents occurred. Conclusion:Radiofrequency thermocoagulation with CT-guided intervertebral foramen puncture through the superior margin of costotransverse joint can effectively relieve refractory PHN of the upper thoracic segment with safety.

Objective:To investigate the differences between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) and insulin resistance (IR) and the relationship between Lp-PLA2 and IR and homocysteine (Hcy) levels in patients with type H and non-type H hypertension.Methods:A total of 298 patients with essential hypertension (observation group) who visited Lu′an Hospital of Traditional Chinese Medicine in Anhui Province from January 2018 to January 2020 were selected, and 564 healthy subjects were as control group. According to age, gender and body mass index (BMI), propensity score matching was conducted, and the matching relationship was determined according to 1∶1 nearest neighbor matching method. Finally, 166 cases were included in the observation group and the control group. Type H hypertension was defined as essential hypertension with an Hcy level of > 10 mol/L.Results:The smoking proportion, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), fasting blood glucose (FPG), fasting insulin (FINS), fibrinogen (FIB), hypersensitive C reactive protein (hs-CRP), LP-PLA2, Hcy, and homeostasis model of assessment for insulin resistance index (HOMA-IR) in the observation group were higher than those in control group: 24.7% vs. 13.9%, (5.06 ± 1.65) mmol/L vs. (4.60 ± 1.42) mmol/L, (2.92 ± 0.97) mmol/L vs. (2.62 ± 0.86) mmol/L, (5.80 ± 1.03) mmol/L vs. (5.12 ± 0.94) mmol/L, (13.06 ± 5.14) U/L vs. (9.25 ± 4.67) U/L, (3.28 ± 1.16) g/L vs. (2.17 ± 1.01) g/L, (2.00 ± 1.09) mg/L vs. (0.52 ± 0.43) mg/L, (161.98 ± 86.84) mg/L vs. (126.87 ± 56.84) mg/L, (15.00 ± 5.06) mol/L vs. (11.54 ± 3.63) mol/L and 3.49 ± 1.25 vs. 2.03 ± 1.11 ( P < 0.05), and the high density lipoprotein cholesterol (HDL-C) was lower than that in control group: (1.15 ± 0.56) mmol/L vs. (1.33 ± 0.66) mmol/L ( P < 0.05). The age, BMI, smoking ratio, TC, FPG, FINS, FIB, hs-CRP and Hcy in H-type hypertension group were higher than those in non-H-type hypertension group: (56.41 ± 11.07) years old vs. (49.61 ± 10.58) years old, (27.92 ± 4.02) kg/m 2 vs. (24.23 ± 4.11) kg/m 2, 31.1% vs. 14.3, (5.32 ± 1.54) mmol/L vs. (4.63 ± 1.24) mmol/L, (5.97 ± 1.03) mmol/L vs. (5.51 ± 0.98) mmol/L, (14.29 ± 5.04) U/L vs. (11.06 ± 4.57) U/L, (3.48 ± 1.10) g/L vs. (2.95 ± 0.83) g/L, (2.48 ± 1.21) mg/L vs. (1.22 ± 1.02) mg/L, 16.13 (12.96, 23.20) mol/L vs. 7.63 (6.58, 8.35) mol/L ( P < 0.05), and the HDL-C was lower than that in non-H-type hypertension group: (1.05 ± 0.54) mmol/L vs. (1.31 ± 0.78) mmol/L ( P < 0.05). HOMA-IR was 2.27 (1.60, 3.34) and Lp-PLA2 was 61.64 (53.25, 75.47) in patients with non-H-type hypertension. HOMA-IR was 3.34 (2.63, 443) and Lp-PLA2 was 212.25 (120.35, 278.62) in patients with type H-type hypertension. Lp-PLA2 and Lp-PLA2 were higher in patients with H-type hypertension than those in patients with non-H-type hypertension ( P < 0.05). In patients with essential hypertension, there was a strong positive correlation between Hcy and HOMA-IR and Lp-PLA2 ( r = 0.655 and 0.774, P < 0.05). Age, BMI, TC, FPG, FINS, FIB, hs-CRP, HOMA-IR and LP-PLA2 were independent risk factors for Hcy increase ( P < 0.05), while HDL-C was a protective factor for Hcy increase ( P < 0.05). Conclusions:Patients with type H-hypertension have a higher HOMA-IR and an increased level of Lp-PLA2, which is correlated with an increase in Hcy.

Objective ToexploretheMRIfeaturesanddifferentialdiagnosisofgemistocyticastrocytoma(GemA).Methods The MRIfeaturesof10casesofGemAprovedbysurgeryandpathologywereinvestigatedretrospectively(thelocationoftumor,tumor shape,boundary,signalandenhancement)andtheliteraturewasreviewed.Results All10casesofGemA weresupratentorialand solitary.Ofthese10cases,7caseswerelocatedinthefrontallobe,5casesinthetemporallobe,6casesinmultiplelobesandinvaded theoppositebraintissuesthroughcorpuscallosum.8casesweresolidGcystic,8casespresentedwithunclearboundary,only2cases hadclearboundary.Therewasnoedemaormildedemain7casesandobviousedemain3cases.Thesolidpartoftumorswereisointense orslighthypointenseonT1WI,only1caseshowedhighintensityonT1WI,isointenseorslighthyperintenseonT2WI.CTsuggested calcificationin2cases.6casesweremildlyenhanced,4casesweremarkedlyenhanced.MRSshowed(n＝4)thatCHopeakwasmildly ormoderatelyincreased,NAApeakwassignificantlyreduced,theaverageratioofCho/NAA was2.91.DWIshowedhyperintenseor slighthyperintense(n＝3),theADCaveragevalueoftumorROIwasabout(1.150±0.081)×10－3 mm2/s.1caseofSWIsequence showedthickeningandcircuitousvascularshadow.Conclusion AsMRIofGemAischaracterizedbyhighandlowgradegliomas,the preoperativediagnosisisdifficult.Combiningenhancementwithfunctionalexamination,itisexpectedtoimprovetheaccuracyofpreoperative diagnosisofGemA.

Enhancement of health management capability and resource utilization efficiency of hospitals has become an imperative need to deepen the healthcare reform. The high-value consumables are subject to point-to-point accurate tracking based on code scan, relying on the hospital′s WeChat official account for WeChat-based management. The WeChat platform enables the system to automatically push the preset procurement plan to the mobile terminal of the managers via the low-inventory alarm at the departments. On the other hand, vendors can use their own mobile terminals to receive in time the plans, query product inventory, and last month invoicing information. These measures facilitate the hospital management on high-value consumables.