ObjectiveTo investigate the liver histopathological features of HBeAg-negative patients in the indeterminate phase of low-viral-load chronic hepatitis B virus （HBV） infection. MethodsA total of 271 patients with low-viral-load HBeAg-negative chronic HBV infection who underwent liver biopsy in Department of Infectious Diseases， Affiliated Hospital of Yan’an University， from September 2013 to June 2021 were enrolled as subjects， and the degree of liver injury was compared between patients based on age， sex， presence or absence of the family history of hepatitis B， HBsAg， and alanine aminotransferase （ALT） level. The chi-square test was used for comparison of categorical data between two groups. ResultsAmong the 271 patients with HBeAg-negative chronic HBV infection， 86 patients （31.73%） grade≥A2 liver inflammatory activity， 72 （26.57%） had a liver fibrosis stage of ive， and 112 （41.33%） had moderate or severe liver histological injury. The proportion of patients with grade≥A2 liver inflammatory activity in the patients with ALT>20 U/L was significantly higher than that in the patients with ALT≤20 U/L （χ²=3.938， P=0.047）. There were no significant differences in the proportion of patients with grade≥A2 liver inflammatory activity between the patients with different ages， sexes， family history of hepatitis B， HBsAg levels （all P>0.05），there were no significant differences in the proportion of patients with a liver fibrosis stage of ≥F2 between the patients with different ages， sexes， family history of hepatitis B， HBsAg， and ALT levels （all P>0.05）， and the stratified analysis of patients aged≤30 years and patients without the family history of hepatitis B showed no statistical significance between groups （all P>0.05）. There was no significant difference in the degree of liver histological injury between the patients with different ages， sexes， family history of hepatitis B， HBsAg， and ALT levels （all P>0.05）. ConclusionSignificant liver injury is observed in more than 40% of the patients with low-viral-load HBeAg-negative chronic HBV infection， and there is no significant difference in the degree of liver histological injury between the patients with different ages， sexes， family history of hepatitis B， HBsAg， and ALT levels. Even for the patients aged≤30 years who deny the family history of hepatitis B， there is still a considerable proportion of patients with liver injury， which should be taken seriously by clinicians.

Objective : To reveal the role of periodontal ligament stem cell-derived exosomes (PDLSC-Exos) in orthodontic bone remodeling, in order to provide new therapeutic strategies for orthodontic tooth movement (OTM). Methods : This study has been reviewed and approved by the Ethics Committee. Healthy periodontal ligament tissues from clinical orthodontic reduction extractions were collected, and periodontal ligament stem cells (PDLSCs) were isolated and cultured. When cultured to the third generation, their self-renewal ability and multidirectional differentiation potential were detected. PDLSC-Exos were isolated and purified by gradient centrifugation and identified by transmission electron microscopy, immunofluorescence, ZetaView, and nanoflow cytometry. The co-culture of 10 μg/mL PDLSC-Exos and PDLSCs (PDLSCs+Exos) induced osteogenic differentiation to evaluate the effect of osteogenesis. Bone marrow-mononuclear cells (BMMs), promoted by osteoclast differentiation [30 ng/mL macrophage colony stimulating factor (M-CSF) + 50 ng/mL receptor activator of nuclear factor-κ B ligand (RANKL)], and then were treated with 10 μg/mL PDLSC-Exos to assess the effect on osteoclasts. We established a rat model of OTM, and 50 μg/mL PDLSC-Exos was injected locally into the periodontal ligament before we established the model (OTM + Exos), every 2 days for 14 days. Alveolar bone remodeling was analyzed by micro-CT, and alveolar bone osteoclasts were analyzed by immunohistochemistry and immunofluorescence. Results: The isolated and purified PDLSCs met the basic characteristics of mesenchymal stem cells, and PDLSC-Exos had typical characteristics of extracellular vesicles. PDLSCs-Exos significantly promoted the osteogenic differentiation of PDLSCs, and promoted the osteoclast differentiation and bone resorption activity of BMMs (P < 0.05). The rate of alveolar bone remodeling in rats with local periodontal injection of PDLSC-Exos was significantly accelerated, and the tooth movement distance was significantly increased (P < 0.05); immunohistochemistry results showed that PDLSC-Exos promoted the differentiation of osteoclasts (P < 0.05). In addition, immunofluorescence showed that PDLSC-Exos co-localized with osteoclasts, indicating that PDLSC-Exos may promote osteoclast differentiation in vivo. Conclusion PDLSC-Exos accelerate the rate of orthodontic bone remodeling by promoting osteogenic differentiation of PDLSCs and osteoclast differentiation of BMMs, thereby accelerating OTM.

AIM: To investigate the correlation of serum Silent mating-type information regulation 2 homolog 1(SIRT1)and Vasostatin-2 content with pathological changes in diabetic retinopathy(DR)patients.METHODS: A total of 104 DR patients(104 eyes)admitted to our hospital from April 2021 to April 2024 were included as the DR group. According to different disease stages, they were assigned into a non-proliferative DR(NPDR)group of 44 cases(44 eyes)and a proliferative DR(PDR)group of 60 cases(60 eyes). Meantime, 104 patients(104 eyes)with simple diabetes were treated as non-DR group. ELISA was applied to detect the levels of SIRT1 and Vasostatin-2 in serum. The diagnostic value of serum SIRT1 and Vasostatin 2 in DR was analyzed by ROC curve. Multivariate Logistic regression was applied to analyze the factors that affected the occurrence of DR. Pearson correlation was applied to analyze the relationship between the levels of SIRT1 and Vasostatin-2 in the serum of DR patients and angiogenesis indicators(VEGF, Ang-2).RESULTS: Compared with the non-DR group, the levels of SIRT1 and Vasostatin-2 in the serum of the DR group were significantly decreased(P<0.05). Compared with the NPDR group, the levels of SIRT1 and Vasostatin-2 in the serum of the PDR group were significantly decreased(P<0.05). Compared with the non-DR group, the levels of VEGF and Ang-2 in the serum of the DR group were obviously higher(P<0.05). Compared with the single detection of serum SIRT1 and Vasostatin-2 levels, combined detection significantly increased the AUC in the diagnosis of DR(Z=4.180, 5.128, all P<0.05). Multivariate Logistic regression analysis showed that HOMA-IR(OR=3.455), fasting blood glucose(OR=1.467), SIRT1(OR=0.836), Vasostatin-2(OR=0.767), VEGF(OR=2.564), and Ang-2(OR=1.834)levels were the influencing factors on the occurrence of DR(all P<0.05). Pearson correlation analysis showed that the levels of SIRT1 and Vasostatin-2 in the serum of DR patients were negatively correlated with VEGF and Ang-2(rSIRT1 vs VEGF=-0.395, rSIRT1 vs Ang-2=-0.474, rVasostatin-2 vs VEGF=-0.323, rVasostatin-2 vs Ang-2=-0.583, all P<0.001).CONCLUSION: The abnormal decrease of serum SIRT1 and Vasostatin 2 levels in DR patients is closely related to the stage of DR lesions and angiogenesis.

To analyze the clinical characteristics of acute diquat poisoning complicated by central nervous system injury (CNSI) and identify early risk factors, aiming to provide a theoretical basis for reducing mortality in diquat poisoning with CNSI.

Venous malformation is a common congenital, non-tumor vascular malformation, accounting for about 60% of all vascular malformations, of which 40% occur in the head and neck. Due to the complex anatomical structure of the oral and maxillofacial region and the diverse classification of venous malformations, their clinical treatment poses certain difficulties and challenges. This article systematically elaborates on the etiology, clinical manifestations, imaging features, and clinical treatment strategies of venous malformations in the oral and maxillofacial region. Molecular genetic studies have shown that the occurrence and development of venous malformations are closely related to abnormal activation of the ANGPT/TIE2/PI3K/AKT/mTOR signaling pathway; its clinical manifestations are gradually growing blue purple masses and its histological features are tortuous venous ducts; and clinical imaging examinations have high specificity, among which digital subtraction angiography classification has important clinical guidance value for the treatment of venous malformation sclerosis. According to different classifications, strategies, such as sclerosis treatment, surgical treatment, and laser treatment, can be applied separately or in combination. This article also explores the advantages and disadvantages of targeted therapy in the treatment of venous malformations, with a focus on improving clinical outcomes while reducing complications. At the same time, through the analysis of typical clinical cases, it summarizes the key points of diagnosis and treatment and treatment plans, in order to provide a reference for improving the clinical efficacy of venous malformation treatment and reducing treatment complications.

Tophaceous wound represent a severe complication of end-stage gout, characterized by the deposition of monosodium urate (MSU) crystals leading to localized tissue ischemia, chronic inflammation, and non-healing ulcers. The pathological mechanism involves the formation of MSU crystals under persistent hyperuricemia, inflammatory encapsulation, and mechanical compression of the vascular system due to tophus enlarge-ment, ultimately resulting in chronic non-healing ulcers. This article consolidates current evidence to outline an integrated management strategy for such wounds, combining systemic metabolic control with localized interventions. Effective treatment depends on maintaining serum uric acid levels below 300 μmol/L through urate-lowering agents, including conventional drugs and novel urate transporter 1 inhibitors such as AR882, complemented by anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs and glucocorticoids to alleviate pain and reduce inflammation. Topical agents and advanced dressings are utilized to support healing and manage exudate. Debridement, which encompasses sharp, ultrasonic, and micro-techniques, is essential for removing necrotic tissue and MSU deposits, with efficacy assessed via local uric acid monitoring. Surgical reconstructions, including skin flap grafting and tendon or ligament reconstruction, are indicated for significant tissue loss or functional impairment. Long-term management emphasizes continuous metabolic control, personalized rehabilitation, and lifestyle modification. The comprehensive treatment of tophaceous wounds requires multidisciplinary collaboration to balance local repair and systemic regulation for improved prognosis. Future research directions include gene therapy to regulate purine metabolism and artificial intelligence-assisted personalized treatment plans, to achieve precision medicine for tophaceous wounds.
Humans ; Wound Healing ; Gout/therapy* ; Uric Acid/blood* ; Debridement

Dental stem cells (DSCs), a distinct subset of mesenchymal stem cells (MSCs), are isolated from dental tissues, such as dental pulp, exfoliated deciduous teeth, periodontal ligament, and apical papilla. They have emerged as a promising source of stem cell therapy for tissue regeneration and autoimmune disorders. The main types of DSCs include dental pulp stem cells (DPSCs), stem cells from human exfoliated deciduous teeth (SHED), periodontal ligament stem cells (PDLSCs), and stem cells from apical papilla (SCAP). Each type exhibits distinct advantages: easy access via minimally invasive procedures, multi-lineage differentiation potential, and excellent ethical acceptability. DSCs have demonstrated outstanding clinical efficacy in oral and maxillofacial regeneration, and their long-term safety has been verified. In oral tissue regeneration, DSCs are highly effective in oral tissue regeneration for critical applications such as the restoration of dental pulp vitality and periodontal tissue repair. A defining advantage of DSCs lies in their ability to integrate with host tissues and promote physiological regeneration, which render them a better option for oral tissue regenerative therapies. Beyond oral applications, DSCs also exhibit promising potential in the treatment of systemic diseases, including type Ⅱ diabetes and autoimmune diseases due to their immunomodulatory effects. Moreover, extracellular vesicles (EVs) derived from DSCs act as critical mediators for DSCs' paracrine functions. Possessing regulatory properties similar to their parental cells, EVs are extensively utilized in research targeting tissue repair, immunomodulation, and regenerative therapy-offering a "cell-free" strategy to mitigate the limitations associated with cell-based therapies. Despite these advancements, standardizing large-scale manufacturing, maintaining strict quality control, and clarifying the molecular mechanisms underlying the interaction of DSCs and their EVs with recipient tissues remain major obstacles to the clinical translation of these treatments into broad clinical use. Addressing these barriers will be critical to enhancing their clinical applicability and therapeutic efficacy. In conclusion, DSCs and their EVs represent a transformative approach in regenerative medicine, and increasing clinical evidence supports their application in oral and systemic diseases. Continuous innovation remains essential to unlocking the widespread clinical potential of DSCs.
Humans ; Dental Pulp/cytology* ; Translational Research, Biomedical ; Mesenchymal Stem Cells/cytology* ; Periodontal Ligament/cytology* ; Stem Cells/cytology* ; Regeneration ; Tooth, Deciduous/cytology* ; Cell Differentiation ; Tissue Engineering/methods* ; Regenerative Medicine

OBJECTIVE: To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM). METHODS: This multicenter retrospective cohort study included 1,196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1, 2019 to December 4, 2023, who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM, combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation, the probability of GC discontinuation was assessed using Kaplan-Meier curve, and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis. RESULTS: Among 1,196 patients (85.4% female; median age 56.4 years), 880 (73.6%) received IM. Over a median 12-month follow-up, 34.3% (410 cases) discontinued GC, with significantly higher rates in the IM group (40.8% vs. 16.1% in WM; P<0.05). GC dose declined progressively, with IM patients demonstrating faster reductions (median 3.75 mg vs. 5.00 mg in WM at 12 months; P<0.05). Multivariate Cox analysis identified age <60 years [P<0.001, hazard ratios (HR)=2.142, 95% confidence interval (CI): 1.523-3.012], IM therapy (P=0.001, HR=2.175, 95% CI: 1.369-3.456), baseline GC dose ⩽7.5 mg (P=0.003, HR=1.637, 95% CI: 1.177-2.275), and absence of non-steroidal anti-inflammatory drugs use (P=0.001, HR=2.546, 95% CI: 1.432-4.527) as significant predictors of GC discontinuation. Sensitivity analysis (545 cases) confirmed these findings. CONCLUSIONS RA patients receiving CM face difficulties in following guideline-recommended GC discontinuation protocols. IM can promote GC discontinuation and is a promising strategy to reduce GC dependency in RA management. (Trial registration: ClinicalTrials.gov, No. NCT05219214).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Arthritis, Rheumatoid/drug therapy* ; Glucocorticoids/therapeutic use* ; Medicine, Chinese Traditional ; Retrospective Studies

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

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