This paper reviewed the development history of doctor-patient shared decision-making （SDM） at home and abroad， emphasizing the importance of cross-cultural analysis in constructing a Chinese doctor-patient SDM model. It also delved into the relationship between Western “individualistic” sociocultural values and doctor-patient SDM， as well as the influence of China’s “collectivist” sociocultural values on doctor-patient SDM， revealing significant disparities in doctor-patient SDM models under distinct sociocultural contexts. Although the doctor-patient SDM theory in China originated from the West， this theory requires profound “collision” and adaptation with local Chinese culture to form a localized theory suited to China’s national conditions. Through cross-cultural adaptation and integrating China’s familism tradition and medical ethics concepts， the future construction of the doctor-patient SDM model in China should emphasize family members’ involvement and seek cultural balance to facilitate its widespread application in clinical practice.

Piezo1 is a Ca²⁺-permeable mechanosensitive ion channel that plays a central role in mechanosensing and signal transduction in dental and periodontal tissues. In tooth tissue, Piezo1 is a key factor mediating dentin sensitive pain. The flow of dentinal tubule fluid induced by external stimulation can activate the Piezo1 channel on odontoblasts, triggering neuronal signals through the pannexin-1-purinergic 2X3 receptor (PANX-1-P2X3) receptor axis, resulting in pain perception. In addition, Piezo1 has a dual regulatory role in the process of pulp inflammation and repair : on the one hand, its expression is up-regulated in an inflammatory environment, which may aggravate pain sensitivity ; on the other hand, it activates the migration, proliferation and odontogenic differentiation of dental pulp stem cells by mediating Ca²⁺influx, ATP release and downstream purinergic 2X7 receptor (P2X7R), MEK / ERK signaling pathways, thereby promoting reparative dentin formation. In periodontal tissue, Piezo1 plays a central role in maintaining periodontal tissue homeostasis and regulating alveolar bone remodeling by sensing mechanical stimuli such as bite force. During orthodontic tooth movement, Piezo1 promotes osteogenic differentiation by activating Wnt / Ca²⁺, Notch and other pathways on the tension side. It affects osteoclast activity by regulating receptor activator of nuclear factor-κB ligand/osteoprotegerin (RANKL/OPG) balance on the pressure side. At the same time, Piezo1 is also a key regulator of periodontal immune microenvironment. It is expressed in immune cells such as macrophages, neutrophils and dendritic cells. Its activation can promote the polarization of macrophages to pro-inflammatory M1 type, enhance the release of pro-inflammatory factors and matrix metalloproteinases, and thus aggravate the inflammatory destruction of periodontal tissue.In view of its multiple functions, Piezo1 has become a potential therapeutic target, including local or systemic application of its inhibitors, mechanical intervention, physical therapy, gene therapy and stem cell therapy, showing a broad clinical transformation prospect in the treatment of oral diseases. In this paper, the structural characteristics, signal transduction mechanism of Piezo1 and its expression distribution, function and regulatory network in tooth tissue and periodontal tissue are reviewed, so as to provide ideas for the development of oral disease treatment strategies targeting Piezo1.

OBJECTIVE: This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction (MI) in patients with both coronary heart disease (CHD) and type 2 diabetes (T2D). METHODS: We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen, China. Patients were categorized into 6 groups based on baseline fasting plasma glucose (FPG) levels and diabetes duration (from the date of diabetes diagnosis to the baseline date) to examine their combined effects on subsequent MI. Cox proportional hazards regression models were used, with further stratification by age, sex, and comorbidities to assess potential interactions. RESULTS: Over a median follow-up of 2.4 years, 2,110 patients experienced MI. Compared to those with optimal glycemic control (FPG < 6.1 mmol/L) and shorter diabetes duration (< 10 years), the fully-adjusted hazard ratio ( HR) (95% Confidence Interval [95% CI]) for those with a diabetes duration of ≥ 10 years and FPG > 8.0 mmol/L was 1.93 (95% CI: 1.59, 2.36). The combined effects of FPG and diabetes duration on MI were largely similar across different age, sex, and comorbidity groups, although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation. CONCLUSION Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D. Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.
Humans ; Diabetes Mellitus, Type 2/blood* ; Male ; Female ; Middle Aged ; Aged ; Coronary Disease/complications* ; Myocardial Infarction/etiology* ; Retrospective Studies ; China/epidemiology* ; Glycemic Control ; Blood Glucose ; Adult ; Risk Factors ; Time Factors

OBJECTIVES: This study aimed to analyze the correlations and proportional relationships between maxillary anterior teeth (MAT) and facial measurements in Han Chinese individuals with the most attractive smiles, as evaluated by dental professionals. METHODS: Ten dentists with more than 5 years of clinical experience from different professional directions in a tertiary stomatological hospital were selected to evaluate the smile attractiveness of volunteers by visual analogue scale (VAS). Eighty-eight Han volunteers with the most attractive smile were selected. The perceived width of the MAT, the dimensions (height and width) of the maxillary central incisors (MCI), and the facial dimensions (intercanthal distance, interzygomatic distance, interalar distance, facial height and lower facial height) of the volunteers were measured on the frontal photos of the smile, digital oral model, and 3D face model. Pearson correlation analysis was performed to analyze linear correlations, and regression analysis was carried out to explore the proportional relationships. Reliability analysis using the intraclass correlation coefficient verified the stability of these proportional relationships. In addition, the correlations between MAT perceived width and the proportional relationships of (MCI) height to width ratio, with facial dimensions were explored and their reliability was verified. RESULTS: In Han Chinese individuals with the most attractive smiles, as evaluated by dental professionals, the Pearson correlation coefficients among MAT perceived widths were 0.813, 0.389, and 0.560. A proportional relationship existed between the lateral incisor and central incisor, and the ratio was 0.729. No significant correlations were found between MCI and the inner canthal distance, zygomatic distance, interalar distance, facial height, or the lower one-third facial height except for a negative correlation (r=-0.357) between MCI height and facial height in males and a positive correlation (r=0.249) between MCI width and interalar width when genders were combined. CONCLUSIONS Correlations exist among MAT perceived widths in Han Chinese individuals with the most attractive smiles, as evaluated by dental professionals. Partial correlations are observed between MCI height and width and facial measurements. The perceived width of the lateral incisor can serve as a reference indicator for predicting the perceived width of the central incisor, providing a reference for the aesthetic restoration of MAT in the Han ethnicity population.
Adult ; Female ; Humans ; Male ; China ; Esthetics, Dental ; Face/anatomy & histology* ; Incisor/anatomy & histology* ; Maxilla/anatomy & histology* ; Smiling ; East Asian People

The aim of this research was to investigate the mechanism of chelidonine on H2 O2-in-duced inflammatory injury in porcine intestinal epithelial cells(IPEC-J2)through transcriptome sequencing.IPEC-J2 cells in the logarithmic growth phase were divided into the blank group(K group),H2O2 group(S group)and chelidonine group(L group),with three replicates in each group.Total RNA was isolated from each group for the purpose of constructing a sequencing li-brary.The assembled data underwent functional annotation,differential gene analysis,as well as GO and KEGG enrichment analyses.qPCR was used to confirm the expression of key differentially expressed genes(DEGs),and ELISA was utilized to assess the effect of chelidonine on the permea-bility of IPEC-J2 cells.The results indicated that the sequencing data met the necessary criteria and demonstrated a strong correlation between samples.The GO functional annotation results suggest that the intervention effects of chelidonine involve biological processes such as oxidative stress re-sponse and G2/M phase transition regulation of the mitotic cycle,and are closely associated with molecular functions,such as transmembrane transport activity.The KEGG enrichment analysis indicates that following H2 O2 treatment,DEGs in IPEC-J2 cells are predominantly enriched in the p53 signaling pathway,the coagulation cascade,the FoxO signaling pathway,and various other sig-naling pathways.Following pretreatment with chelidonine,the DEGs exhibit significant enrichment in several signaling pathways related to inflammation,including the TNF signaling pathway,syn-aptic vesicle cycle,and IL-17 signaling pathway.The results of qPCR were consistent with the se-quencing results.Chelidonine has also been found to effectively inhibit LDH release,elevate GLN content,and decrease DOA content.In conclusion,it can be seen that chelidonine can reduce cell permeability and alleviate H2 O2-induced inflammatory injury in IPEC-J2 cells by modulating in-flammation-related pathways such as the TNF signaling pathway.

Objective:To carry out carrier screening among people of childbearing age, detect the pathogenic genes of monogenic genetic diseases and analyze the carrier status of pathogenic variants, so as to provide fertility guidance and intervention measures for high-risk families.Methods:From August 2022 to August 2023, 1 533 families of childbearing age who met the criteria were recruited in the Chinese PLA General Hospital, including a total of 3 044 subjects. According to the standard enrollment procedure, 223 genes (197 autosomal recessive genes and 26 X-linked genes) of the subjects were tested. According to the screening results, genetic counseling and fertility guidance were provided to the subjects. Invasive prenatal diagnosis was performed for high-risk couples (both couples being carriers of the same autosomal recessive disease gene or the woman was a carrier of X-linked disease gene), and their pregnancy pattern, outcome and offspring phenotype were followed up.Results:(1) A total of 3 044 cases from 1 511 couples and women of childbearing age from 22 families were included for carrier screening. Totally 1 503 families chose simultaneous screening and 30 families chose sequential screening out of the 1 533 families. Among the 3 044 subjects, 1 603 individuals carried at least one pathogenic or likely pathogenic variant, and the overall carrier rate was 52.66% (1 603/3 044). A total of 2 292 pathogenic or likely pathogenic variants were detected, and 0.75 variants (2 292/3 044) were detected per capita. (2) The three genes with the highest carrier rates were GJB2 (8.67%, 264/3 044), CYP21A2 (3.19%, 97/3 044) and PAH (3.09%, 94/3 044). There were 32 genes with a carrier rate ≥1/200, 17 genes with a carrier rate ≥1/100, and 7 genes with a carrier rate ≥1/50. (3) Thirty-eight high-risk families were identified. After excluding G6PD gene mutation, there were 33 high-risk families, of which 25 couples were carriers of the same autosomal recessive gene, 9 women were carriers of X-linked gene, and 1 family was double high-risk couple with both autosomal recessive and X-linked gene. After further excluding the GJB2 c.109G>A mutation, 21 high-risk families were identified. Preimplantation genetic testing for monogenic disease was performed in 12 families after genetic counseling. Prenatal diagnosis was completed in 4 out of 5 high-risk families who conceived naturally. Two fetuses carried the parental variants and terminated the pregnancy, one fetus did not carry the parental variants but was induced due to trisomy 21 syndrome, and one fetus was a carrier of congenital disorders of glycosylation type 1a.Conclusions:Carrier screening effectively identifies high-risk genetic disease families and provides reproductive guidance to prevent the birth of affected children. However, establishing multidisciplinary team is essential for managing complex cases. Implementation should prioritize prenatal institutions with genetic counseling or diagnostic expertise for monogenic disorders or established referral networks.

BACKGROUND:Micro-implants of a small size may injure the maxillary sinus,adjacent tooth roots and mandibular nerves during implantation surgery,which requires precise positioning and accurate implant orientation.OBJECTIVE:To explore the clinical value of a cone-beam CT-based three-dimensional(3D)printing guide plate for guiding orthodontic micro-implant nail implantation.METHODS:Sixteen patients admitted to the Stomatology Hospital of Guizhou Medical University from December 2021 to December 2023 who required implantation of micro-implant anchorage were selected.The CT scan data of the patient's dental jaw from the infraorbital margin to the hyoid bone were collected and imported into Mimics 17.0 for threshold segmentation to obtain a 3D model of the crowns,roots,and bone cortex,and a digital model of the patient's intra-oral hard and soft tissues was scanned with the iTero Oral Scanner.The CT images were optimally overlapped with the intraoral scan model to design and fabricate a micro-implant guide plate.Sixteen implants were placed under the guidance of this plate.Postoperative cone-beam CT images were taken for 3D reconstruction and distance between the micro-implant and the layer closest to the tooth was measured to assess the safety of micro-implants.Cone-beam CT images were compared before and after surgery,and deviation between micro-implant crown and tip and angle deviation between micro-implant crown and tip were measured.Orthodontic follow-up was performed for 6 months to record micro-implant loosening and detachment.RESULTS AND CONCLUSION:No contact between the 16 anchorage nails and the tooth root or adjacent tissues was found in the postoperative images.Results of the comparison of preoperative and postoperative images indicated that the cap end deviation was(1.07±0.65)mm,the tip deviation was(1.51+0.47)mm,the angle deviation was(7.40+4.63)°,and the distance between the micro-implant and the layer closest to the tooth was(1.17±0.45)mm.There were 10 micro-implants of safety grade Ⅰ and 3 of safety grade Ⅱ.During the follow-up period,the 16 micro-implants did not loosen or fall off and had good stability.The orthodontic implant guide plate based on conical beam CT design can be used for implant implantation,and the preliminary study shows that the implant implantation guided by the guide plate is safe and stable.To conclude,the orthodontic micro-implant implantation guided by cone-beam CT based 3D printed guide plate has good accuracy and stability.

Nonobstructive azoospermia (NOA), one of the most severe types of male infertility, etiology often remains unclear in most cases. Therefore, this study aimed to detect four biallelic detrimental variants (0.5%) in the minichromosome maintenance domain containing 2 ( MCMDC2 ) genes in 768 NOA patients by whole-exome sequencing (WES). Hematoxylin and eosin (H&E) demonstrated that MCMDC2 deleterious variants caused meiotic arrest in three patients (c.1360G>T, c.1956G>T, and c.685C>T) and hypospermatogenesis in one patient (c.94G>T), as further confirmed through immunofluorescence (IF) staining. The single-cell RNA sequencing data indicated that MCMDC2 was substantially expressed during spermatogenesis. The variants were confirmed as deleterious and responsible for patient infertility through bioinformatics and in vitro experimental analyses. The results revealed four MCMDC2 variants related to NOA, which contributes to the current perception of the function of MCMDC2 in male fertility and presents new perspectives on the genetic etiology of NOA.
Humans ; Male ; Azoospermia/genetics* ; Meiosis/genetics* ; Spermatogenesis/genetics* ; Adult ; Exome Sequencing ; Microtubule-Associated Proteins/genetics* ; Alleles ; Infertility, Male/genetics*

BACKGROUND:Micro-implants of a small size may injure the maxillary sinus,adjacent tooth roots and mandibular nerves during implantation surgery,which requires precise positioning and accurate implant orientation.OBJECTIVE:To explore the clinical value of a cone-beam CT-based three-dimensional(3D)printing guide plate for guiding orthodontic micro-implant nail implantation.METHODS:Sixteen patients admitted to the Stomatology Hospital of Guizhou Medical University from December 2021 to December 2023 who required implantation of micro-implant anchorage were selected.The CT scan data of the patient's dental jaw from the infraorbital margin to the hyoid bone were collected and imported into Mimics 17.0 for threshold segmentation to obtain a 3D model of the crowns,roots,and bone cortex,and a digital model of the patient's intra-oral hard and soft tissues was scanned with the iTero Oral Scanner.The CT images were optimally overlapped with the intraoral scan model to design and fabricate a micro-implant guide plate.Sixteen implants were placed under the guidance of this plate.Postoperative cone-beam CT images were taken for 3D reconstruction and distance between the micro-implant and the layer closest to the tooth was measured to assess the safety of micro-implants.Cone-beam CT images were compared before and after surgery,and deviation between micro-implant crown and tip and angle deviation between micro-implant crown and tip were measured.Orthodontic follow-up was performed for 6 months to record micro-implant loosening and detachment.RESULTS AND CONCLUSION:No contact between the 16 anchorage nails and the tooth root or adjacent tissues was found in the postoperative images.Results of the comparison of preoperative and postoperative images indicated that the cap end deviation was(1.07±0.65)mm,the tip deviation was(1.51+0.47)mm,the angle deviation was(7.40+4.63)°,and the distance between the micro-implant and the layer closest to the tooth was(1.17±0.45)mm.There were 10 micro-implants of safety grade Ⅰ and 3 of safety grade Ⅱ.During the follow-up period,the 16 micro-implants did not loosen or fall off and had good stability.The orthodontic implant guide plate based on conical beam CT design can be used for implant implantation,and the preliminary study shows that the implant implantation guided by the guide plate is safe and stable.To conclude,the orthodontic micro-implant implantation guided by cone-beam CT based 3D printed guide plate has good accuracy and stability.

Objective:To describe the current status of responsive caregiving behavior of infant mothers,to analyze their influencing factors and pathways using the information-motivation-behavioral skills(IMB)model,and to provide a basis for further interventions related to responsive caregiving be-haviors and comprehensive promotion of early childhood development.Methods:This study was a cross-sectional survey using convenience sampling.Questionnaires were used to collect basic information about mothers and their infants,as well as data on mothers' responsive caregiving behavior,knowledge of re-sponsive caregiving,social support,and parenting self-efficacy.Multivariate linear regression models were employed to analyze the influencing factors of responsive caregiving behavior,and structural equa-tion modeling was used to analyze the pathways of these influencing factors.The criterion for inadequate responsive caregiving is defined as scores not exceeding the lower quartile(P25)of the total score.Results:Among 510 mothers of aged 0-12 months infants in Weifang City,the average score for respon-sive caregiving behavior was 16.41±3.99.The proportion of inadequate responsive caregiving was 25.7％.Mothers in the insufficient responsive caregiving group had lower scores in knowledge(7.70±1.41),social support(57.92±15.16),and parenting self-efficacy(30.36±6.48)compared with those in the sufficient group,with statistically significant differences(P＜0.001).Logistic regres-sion analysis indicated that the influencing factors for responsive caregiving included the level of know-ledge about responsive parenting[adjusted OR(aOR)=0.795,95％CI:0.566-0.838],social support(aOR=0.979,95％CI:0.961-0.996),and parenting self-efficacy(aOR=0.894,95％CI:0.857-0.932).Structural equation modeling revealed that knowledge of responsive caregiving(β=0.089,P=0.031),social support(β=0.153,P=0.001),and parenting self-efficacy(β=0.296,P＜0.001)were directly related to responsive caregiving behavior.Additionally,knowledge of responsive caregiving indirectly affected responsive caregiving behavior through parenting self-efficacy(β=0.095,P=0.014),and social support indirectly affected responsive caregiving behavior through parenting self-efficacy(β=0.497,P＜0.001).Conclusion:The current level of responsive caregiving behavior among mothers of 0-1-year-old infants in Weifang City is not satisfactory.Future development of responsive care-giving interventions should focus on providing caregivers with relevant knowledge of responsive caregiving based on their needs.Additionally,it is essential to offer social support from multiple aspects to enhance caregivers' parenting self-efficacy,thereby promoting improvements in responsive caregiving behavior.