1.Comparative Study on the Effects of Qingchang Wenzhong Decoction (清肠温中方) on the Intestinal Mucus Barrier in Conventional and Pseudo-Germ-Free Model Mice of Acute Ulcerative Colitis
Mingxu GAO ; Leilei LIU ; Lijie LU ; Jiali WANG ; Juncong HU ; Yangzhe LIN ; Qirui LIU ; Yue DONG ; Luyue WANG ; Zeyu XUE ; Junxiang LI ; Lei SHI
Journal of Traditional Chinese Medicine 2026;67(14):1528-1537
ObjectiveTo explore the mechanisms of Qingchang Wenzhong Decoction (清肠温中方, QWD) in treating ulcerative colitis (UC). MethodsA total of 100 male C57BL/6J mice were assigned to a pseudo-germ-free group (n=45) and a conventional group (n=55) using a random number table. Pseudo-germ-free model was established by giving antibiotic treatment and subsequently subjected to acute UC induction. After the model was successfully established, the 45 pseudo-germ-free acute UC mice were randomly allocated to a pseudo-germ-free model group, a pseudo-germ-free QWD group, and a pseudo-germ-free mesalazine group, with 15 mice in each group. The 55 conventional mice were randomly divided into a normal control group (n=10), as well as a conventional model group, a conventional QWD group, and a conventional mesalazine group, with 15 mice in each group. Except for the normal control group, acute UC models were established in all other groups. Mice in the control group received no intervention. From day 32 of the experiment, mice in the pseudo-germ-free QWD group and the conventional QWD group were administered with QWD granules at a dose of 9.71 g/(kg·d) by gavage with deionized water, while those in the pseudo-germ-free mesalazine group and the conventional mesalazine group were given mesalazine enteric-coated tablets at a dose of 151.67 mg/(kg·d) by gavage. Mice in the remaining groups received an equal volume of deionized water once daily for 7 consecutive days. On day 25 of the experiment, six mice were randomly selected from both the pseudo-germ-free group and the conventional group to measure body weight, and fecal samples were collected for 16S rDNA sequencing to compare differences in gut microbiota, including operational taxonomic units (OTUs), Shannon index, Observed_species index, and phylogenetic diversity (PD whole tree). On day 39, body weight was measured in all groups, and the disease activity index (DAI) was evaluated. Colon length and colon wet weight were recorded. Histopathological changes in colonic tissues were assessed by hematoxylin and eosin (HE) staining, and histological injury scores were determined. In addition, the expression levels of mucopolysaccharides and mucin 2 (MUC2) in colonic tissues were measured. ResultsOn day 25, there was no significant difference in body weight between the pseudo-germ-free group and the conventional microbiota group (P>0.05). Compared to the conventional microbiota group, the pseudo-germ-free group showed significantly reduced OTUs, Shannon index, Observed_species index, and PD whole tree (P<0.01). On day 39, compared to the normal control group, mice in the conventional model group showed a significant decrease in the body weight and an increase in DAI, along with increased colon wet weight, shortened colon length, markedly elevated histopathological scores, and reduced expression of mucopolysaccharides and MUC2 (P<0.01). In contrast, no significant differences were observed in these parameters in the pseudo-germ-free model group (P>0.05). Compared to the conventional model group, the conventional QWD group showed significant improvement in all measured parameters, whereas the conventional mesalazine group showed reductions only in DAI scores and colon wet weight (P<0.01). No statistically significant differences were observed among the pseudo-germ-free model group, the pseudo-germ-free QWD group, and the pseudo-germ-free mesalazine group (P>0.05). ConclusionQWD may promote the reconstruction of the intestinal mucus barrier by regulating the intestinal flora, thereby exerting a therapeutic effect on acute UC.
2.Comparative Study on the Effects of Qingchang Wenzhong Decoction (清肠温中方) on the Intestinal Mucus Barrier in Conventional and Pseudo-Germ-Free Model Mice of Acute Ulcerative Colitis
Mingxu GAO ; Leilei LIU ; Lijie LU ; Jiali WANG ; Juncong HU ; Yangzhe LIN ; Qirui LIU ; Yue DONG ; Luyue WANG ; Zeyu XUE ; Junxiang LI ; Lei SHI
Journal of Traditional Chinese Medicine 2026;67(14):1528-1537
ObjectiveTo explore the mechanisms of Qingchang Wenzhong Decoction (清肠温中方, QWD) in treating ulcerative colitis (UC). MethodsA total of 100 male C57BL/6J mice were assigned to a pseudo-germ-free group (n=45) and a conventional group (n=55) using a random number table. Pseudo-germ-free model was established by giving antibiotic treatment and subsequently subjected to acute UC induction. After the model was successfully established, the 45 pseudo-germ-free acute UC mice were randomly allocated to a pseudo-germ-free model group, a pseudo-germ-free QWD group, and a pseudo-germ-free mesalazine group, with 15 mice in each group. The 55 conventional mice were randomly divided into a normal control group (n=10), as well as a conventional model group, a conventional QWD group, and a conventional mesalazine group, with 15 mice in each group. Except for the normal control group, acute UC models were established in all other groups. Mice in the control group received no intervention. From day 32 of the experiment, mice in the pseudo-germ-free QWD group and the conventional QWD group were administered with QWD granules at a dose of 9.71 g/(kg·d) by gavage with deionized water, while those in the pseudo-germ-free mesalazine group and the conventional mesalazine group were given mesalazine enteric-coated tablets at a dose of 151.67 mg/(kg·d) by gavage. Mice in the remaining groups received an equal volume of deionized water once daily for 7 consecutive days. On day 25 of the experiment, six mice were randomly selected from both the pseudo-germ-free group and the conventional group to measure body weight, and fecal samples were collected for 16S rDNA sequencing to compare differences in gut microbiota, including operational taxonomic units (OTUs), Shannon index, Observed_species index, and phylogenetic diversity (PD whole tree). On day 39, body weight was measured in all groups, and the disease activity index (DAI) was evaluated. Colon length and colon wet weight were recorded. Histopathological changes in colonic tissues were assessed by hematoxylin and eosin (HE) staining, and histological injury scores were determined. In addition, the expression levels of mucopolysaccharides and mucin 2 (MUC2) in colonic tissues were measured. ResultsOn day 25, there was no significant difference in body weight between the pseudo-germ-free group and the conventional microbiota group (P>0.05). Compared to the conventional microbiota group, the pseudo-germ-free group showed significantly reduced OTUs, Shannon index, Observed_species index, and PD whole tree (P<0.01). On day 39, compared to the normal control group, mice in the conventional model group showed a significant decrease in the body weight and an increase in DAI, along with increased colon wet weight, shortened colon length, markedly elevated histopathological scores, and reduced expression of mucopolysaccharides and MUC2 (P<0.01). In contrast, no significant differences were observed in these parameters in the pseudo-germ-free model group (P>0.05). Compared to the conventional model group, the conventional QWD group showed significant improvement in all measured parameters, whereas the conventional mesalazine group showed reductions only in DAI scores and colon wet weight (P<0.01). No statistically significant differences were observed among the pseudo-germ-free model group, the pseudo-germ-free QWD group, and the pseudo-germ-free mesalazine group (P>0.05). ConclusionQWD may promote the reconstruction of the intestinal mucus barrier by regulating the intestinal flora, thereby exerting a therapeutic effect on acute UC.
3.Association between ambient particulate matter exposure and risk of benign prostatic hyperplasia in middle-aged and older men: A longitudinal cohort study based on CHARLS
Hanxiao HU ; Chuchu LIU ; Yuyuan HU ; Jiali CHEN ; Lingyi WANG ; Xiaobo LIU ; Yue WU
Journal of Environmental and Occupational Medicine 2026;43(5):630-636
Background Benign prostatic hyperplasia (BPH) is a common chronic urinary disease in middle-aged and older men, yet the impact of long-term exposure to atmospheric particulate matter (PM) on its pathogenesis remains unclear. Objective To investigate the association between PM exposure and the risk of incident BPH in middle-aged and older men. Methods Based on four waves of follow-up data (2011–2018) from the China Health and Retirement Longitudinal Study (CHARLS), 4766 participants were enrolled. Robust Poisson regression models were employed to assess the association between exposure to PM (PM1, PM2.5, and PM10) and the risk of incident BPH. Relative risks (RR) and their corresponding 95% confidence intervals (95%CI) were calculated. Dose-response relationships were fitted using restricted cubic splines (RCS). Subgroup analyses were performed to explore potential effect modifications, and multiple imputation was used to handle missing data. Results Over a mean follow-up of 6 years, 914 incident BPH cases were identified among the4766 participants (cumulative incidence: 19.18%). After adjusting for confounders, each 10 μg·m−3 increase in PM1, PM2.5, and PM10 concentrations was associated with a 13.1% (RR=1.131, 95%CI: 1.063, 1.203), 8.5% (RR=1.085, 95%CI: 1.050, 1.122), and 5.1% (RR=1.051, 95%CI: 1.034, 1.069) increased risk of BPH, respectively. RCS analysis showed that no nonlinear relationship was found between PM1 and PM2.5 and the risk of BPH (P>0.05); however, a nonlinear association was observed for PM10 (P=0.03), with the risk increment slowing beyond 100 μg·m−3. Subgroup and sensitivity analyses confirmed the robustness of these findings. Conclusion Long-term exposure to ambient particulate matter may be associated with an increased risk of incident BPH in middle-aged and older men.
4.Association between ambient particulate matter exposure and risk of benign prostatic hyperplasia in middle-aged and older men: A longitudinal cohort study based on CHARLS
Hanxiao HU ; Chuchu LIU ; Yuyuan HU ; Jiali CHEN ; Lingyi WANG ; Xiaobo LIU ; Yue WU
Journal of Environmental and Occupational Medicine 2026;43(5):630-636
Background Benign prostatic hyperplasia (BPH) is a common chronic urinary disease in middle-aged and older men, yet the impact of long-term exposure to atmospheric particulate matter (PM) on its pathogenesis remains unclear. Objective To investigate the association between PM exposure and the risk of incident BPH in middle-aged and older men. Methods Based on four waves of follow-up data (2011–2018) from the China Health and Retirement Longitudinal Study (CHARLS), 4766 participants were enrolled. Robust Poisson regression models were employed to assess the association between exposure to PM (PM1, PM2.5, and PM10) and the risk of incident BPH. Relative risks (RR) and their corresponding 95% confidence intervals (95%CI) were calculated. Dose-response relationships were fitted using restricted cubic splines (RCS). Subgroup analyses were performed to explore potential effect modifications, and multiple imputation was used to handle missing data. Results Over a mean follow-up of 6 years, 914 incident BPH cases were identified among the4766 participants (cumulative incidence: 19.18%). After adjusting for confounders, each 10 μg·m−3 increase in PM1, PM2.5, and PM10 concentrations was associated with a 13.1% (RR=1.131, 95%CI: 1.063, 1.203), 8.5% (RR=1.085, 95%CI: 1.050, 1.122), and 5.1% (RR=1.051, 95%CI: 1.034, 1.069) increased risk of BPH, respectively. RCS analysis showed that no nonlinear relationship was found between PM1 and PM2.5 and the risk of BPH (P>0.05); however, a nonlinear association was observed for PM10 (P=0.03), with the risk increment slowing beyond 100 μg·m−3. Subgroup and sensitivity analyses confirmed the robustness of these findings. Conclusion Long-term exposure to ambient particulate matter may be associated with an increased risk of incident BPH in middle-aged and older men.
5.Exploring Effect of Traditional Chinese Medicine Interventions on Mitochondrial Quality Control in Chronic Heart Failure Based on Theory of "Mingmen Dongqi"
Yubin ZHANG ; Kun LIAN ; Jiahao YE ; Junyu ZHANG ; Weijun LI ; Jiali ZHANG ; Zhixi HU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(20):269-280
Chronic heart failure (CHF), as the terminal stage of various cardiovascular diseases, is characterized by a prolonged course and a high mortality rate, posing a serious threat to human health and life. According to physician Sun Yikui's theory of "Mingmen Dongqi" (dynamic Qi of life gate) in the Ming Dynasty and the modern medicine concept of mitochondrial quality control (MQC), this paper systematically explores the pathogenic mechanisms and evolutionary patterns of CHF, as well as its intrinsic connection with microstructural homeostasis, and further proposes potential traditional Chinese medicine (TCM) intervention strategies. CHF is often caused by damage to the heart Qi at the early stage. As the disease progresses, prolonged illness affects the kidneys, leading to the dynamic Qi decline of life gate. Further, it results in the failure of the functions of sustaining and consolidating, causing the disintegration of the physical form, which corresponds to mitochondrial kinetic disorders. The deficiency in primary driving force results in impaired Qi transformation, corresponding to mitochondrial autophagy dysfunction, forming a pathological transmission chain of "life gate-mitochondrion" that ultimately leads to myocardial structural disintegration and energy metabolism failure. Modern research indicates that patients with CHF exhibit significant MQC imbalance. Disrupted mitochondrial dynamics lead to network fragmentation, and impaired autophagy causes metabolic blockage, constituting the key microscopic mechanisms underlying ventricular remodeling and pump failure. Chinese herbal medicines, such as those with the effects of warming and tonifying kidney Yang or reinforcing healthy Qi, can intervene in multiple signaling pathways-including PTEN-inducible kinase 1 (PINK1)/Parkin and AMP-activated protein kinase/dynamin-related protein 1 (AMPK/Drp1)-to regulate mitochondrial dynamics and autophagy activity. This repairs damaged MQC networks and improves the microenvironment of myocardial energy metabolism. These intervention strategies align closely with the TCM therapeutic principles of warming and tonifying life gate, replenishing Qi, and activating blood, demonstrating the advantages of holistic regulation based on kidney-centered treatment and mitochondrial-targeted approaches. By integrating the "Mingmen Dongqi" theory with the MQC mechanism, this paper establishes a theoretical framework for the integrated prevention and treatment of CHF, offering new perspectives and insights for clinical practice and future research.
6.Exploring Effect of Traditional Chinese Medicine Interventions on Mitochondrial Quality Control in Chronic Heart Failure Based on Theory of "Mingmen Dongqi"
Yubin ZHANG ; Kun LIAN ; Jiahao YE ; Junyu ZHANG ; Weijun LI ; Jiali ZHANG ; Zhixi HU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(20):269-280
Chronic heart failure (CHF), as the terminal stage of various cardiovascular diseases, is characterized by a prolonged course and a high mortality rate, posing a serious threat to human health and life. According to physician Sun Yikui's theory of "Mingmen Dongqi" (dynamic Qi of life gate) in the Ming Dynasty and the modern medicine concept of mitochondrial quality control (MQC), this paper systematically explores the pathogenic mechanisms and evolutionary patterns of CHF, as well as its intrinsic connection with microstructural homeostasis, and further proposes potential traditional Chinese medicine (TCM) intervention strategies. CHF is often caused by damage to the heart Qi at the early stage. As the disease progresses, prolonged illness affects the kidneys, leading to the dynamic Qi decline of life gate. Further, it results in the failure of the functions of sustaining and consolidating, causing the disintegration of the physical form, which corresponds to mitochondrial kinetic disorders. The deficiency in primary driving force results in impaired Qi transformation, corresponding to mitochondrial autophagy dysfunction, forming a pathological transmission chain of "life gate-mitochondrion" that ultimately leads to myocardial structural disintegration and energy metabolism failure. Modern research indicates that patients with CHF exhibit significant MQC imbalance. Disrupted mitochondrial dynamics lead to network fragmentation, and impaired autophagy causes metabolic blockage, constituting the key microscopic mechanisms underlying ventricular remodeling and pump failure. Chinese herbal medicines, such as those with the effects of warming and tonifying kidney Yang or reinforcing healthy Qi, can intervene in multiple signaling pathways-including PTEN-inducible kinase 1 (PINK1)/Parkin and AMP-activated protein kinase/dynamin-related protein 1 (AMPK/Drp1)-to regulate mitochondrial dynamics and autophagy activity. This repairs damaged MQC networks and improves the microenvironment of myocardial energy metabolism. These intervention strategies align closely with the TCM therapeutic principles of warming and tonifying life gate, replenishing Qi, and activating blood, demonstrating the advantages of holistic regulation based on kidney-centered treatment and mitochondrial-targeted approaches. By integrating the "Mingmen Dongqi" theory with the MQC mechanism, this paper establishes a theoretical framework for the integrated prevention and treatment of CHF, offering new perspectives and insights for clinical practice and future research.
7.Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury (version 2025)
Aijun XU ; Shuixia LI ; Bo CHEN ; Mengyuan YE ; Lejiao LANG ; Ning NING ; Lin ZHANG ; Changqing LIU ; Zhonglan CHEN ; Weihu MA ; Weishi LI ; Xiaoning WANG ; Dongmei BIAN ; Jiancheng ZENG ; Xin WANG ; Yuan GAO ; Yaping CHEN ; Jiali CHEN ; Yun HAN ; Xiuting LI ; Yang ZHOU ; Xiaojing SU ; Qiong ZHANG ; Tianwen HUANG ; Ping ZHANG ; Hua LIN ; Xingling XIAO ; Ruifeng XU ; Fanghui DONG ; Bing HAN ; Luo FAN ; Yanling PEI ; Suyun LI ; Xiaoju TAN ; Rongchen GUO ; Yefang ZOU ; Xiaoyun HAN ; Junqin DING ; Yi WANG ; Shuhua DENG ; Jinli GUO ; Yinhua LIANG ; Yuan CEN ; Xiaoqin LIU ; Junru CHEN ; Haiyang YU ; Lunlan LI ; Ying REN ; Yunxia LI ; Jianli LU ; Ying YING ; Lan WEI ; Yin WANG ; Qinhong XU ; Yanqin ZHANG ; Yang LYU ; Shijun ZHANG ; Sui WENJIE ; Sanlian HU ; Shuhong YANG ; Guoqing LI ; Jingjing AN ; Baorong HE ; Leling FENG
Chinese Journal of Trauma 2025;41(6):530-541
Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.
8.Consensus on informed consent for orthodontic treatment
Yang CAO ; Bing FANG ; Zuolin JIN ; Hong HE ; Yuxing BAI ; Lin WANG ; Haiping LU ; Zhihe ZHAO ; Tianmin XU ; Weiran LI ; Min HU ; Jinlin SONG ; Jun WANG ; Fang JIN ; Ding BAI ; Xianglong HAN ; Yuehua LIU ; Bin YAN ; Jie GUO ; Jiejun SHI ; Yongming LI ; Zhihua LI ; Xiuping WU ; Jiangtian HU ; Linyu XU ; Lin LIU ; Yi LIU ; Yanqin LU ; Wensheng MA ; Shuixue MO ; Liling REN ; Shuxia CUI ; Yongjie FAN ; Jianguang XU ; Lulu XU ; Zhijun ZHENG ; Peijun WANG ; Rui ZOU ; Chufeng LIU ; Lunguo XIA ; Li HU ; Weicai WANG ; Liping WU ; Xiaoxing KOU ; Jiali TAN ; Yuanbo LIU ; Bowen MENG ; Yuantao HAO ; Lili CHEN
Chinese Journal of Stomatology 2025;60(12):1327-1336
This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.
9.Current status and prospects of public health nursing development at home and abroad
Chunxia HE ; Jiali ZHANG ; Jimei ZHANG ; Lingli YAN ; Jia YIN ; Qian YAO ; Xiuying HU
Chinese Journal of Modern Nursing 2025;31(31):4321-4328
This paper conducts a systematic literature review to analyze and summarize the current status, admission standards, practical scope, competency requirements, and talent cultivation of public health nursing teams both domestically and internationally, in order to provide reference for the development of public health nursing in China and assist in the improvement of the public health talent team.
10.Consensus on informed consent for orthodontic treatment
Yang CAO ; Bing FANG ; Zuolin JIN ; Hong HE ; Yuxing BAI ; Lin WANG ; Haiping LU ; Zhihe ZHAO ; Tianmin XU ; Weiran LI ; Min HU ; Jinlin SONG ; Jun WANG ; Fang JIN ; Ding BAI ; Xianglong HAN ; Yuehua LIU ; Bin YAN ; Jie GUO ; Jiejun SHI ; Yongming LI ; Zhihua LI ; Xiuping WU ; Jiangtian HU ; Linyu XU ; Lin LIU ; Yi LIU ; Yanqin LU ; Wensheng MA ; Shuixue MO ; Liling REN ; Shuxia CUI ; Yongjie FAN ; Jianguang XU ; Lulu XU ; Zhijun ZHENG ; Peijun WANG ; Rui ZOU ; Chufeng LIU ; Lunguo XIA ; Li HU ; Weicai WANG ; Liping WU ; Xiaoxing KOU ; Jiali TAN ; Yuanbo LIU ; Bowen MENG ; Yuantao HAO ; Lili CHEN
Chinese Journal of Stomatology 2025;60(12):1327-1336
This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.

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