Objective:To explore the correlation between anxiety, depression, and inflammatory markers in the body fluids of patients with burning mouth syndrome (BMS), creating a preliminary assessment model based on clinical data.Methods:Forty-one BMS patients were recruited according to the predefined inclusion criteria and exclusion criteria from the Department of Oral Medicine, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine between December 2021 and September 2023, along with 12 healthy controls. The pain intensity of the 41 patients was assessed using the visual analog scale (VAS). Meanwhile, anxiety and depression were assessed using the Zung self-rating anxiety scale (SAS) and the Zung self-rating depression scale (SDS). The concentrations of brain-derived neurotrophic factor (BDNF), interferon-γ (IFN-γ), interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor-alpha (TNF-α) in saliva and serum were measured using the Luminex 200 TM system and enzyme-linked immunosorbent assay. Statistical analyses were performed using the Chi-square test, independent samples t-test, ANOVA, Spearman′s correlation analysis, and multiple linear regression, respectively. Results:The VAS score for the 41 BMS patients was (3.56±1.90), with 48.8% (20/41) and 41.5% (17/41) of patients experiencing mild and moderate pain, respectively. Only 7.3% (3/41) of patients had severe pain. Among the 41 BMS patients, 61.0% (25/41) exhibited anxiety and/or depression, in whom 39.0% (16/41) had both anxiety and depression, 9.8% (4/41) experienced anxiety without depression, and 12.2% (5/41) had depression without anxiety. The concentrations of IFN-γ and TNF-α in the serum and saliva of BMS patients were significantly higher than those in healthy controls (all P<0.05). In contrast, the BDNF concentration in serum was significantly lower in BMS patients than in healthy participants ( P<0.01), but was significantly higher in saliva ( P<0.001). Serum TNF-α was positively correlated with IFN-γ, IL-1β, and IL-6 (β=0.803, β=0.812, β=0.592; all P<0.01), while saliva TNF-α was negatively correlated with both anxiety and depression (β=-0.325, β=-0.321; all P<0.05). SAS scores were linearly correlated with saliva TNF-α concentrations (SAS=51.374-1.154×saliva TNF-α); saliva TNF-α concentrations were linearly correlated with saliva IFN-γ and IL-1β (saliva TNF-α=2.408+0.281×saliva IFN-γ+0.002×saliva IL-1β). Conclusions:This study provides a preliminary exploration of a clinical assessment model for BMS based on inflammatory markers and psychological scores, offering an exploratory framework for further research and optimization of the model.

Objective:To explore the correlation between anxiety, depression, and inflammatory markers in the body fluids of patients with burning mouth syndrome (BMS), creating a preliminary assessment model based on clinical data.Methods:Forty-one BMS patients were recruited according to the predefined inclusion criteria and exclusion criteria from the Department of Oral Medicine, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine between December 2021 and September 2023, along with 12 healthy controls. The pain intensity of the 41 patients was assessed using the visual analog scale (VAS). Meanwhile, anxiety and depression were assessed using the Zung self-rating anxiety scale (SAS) and the Zung self-rating depression scale (SDS). The concentrations of brain-derived neurotrophic factor (BDNF), interferon-γ (IFN-γ), interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor-alpha (TNF-α) in saliva and serum were measured using the Luminex 200 TM system and enzyme-linked immunosorbent assay. Statistical analyses were performed using the Chi-square test, independent samples t-test, ANOVA, Spearman′s correlation analysis, and multiple linear regression, respectively. Results:The VAS score for the 41 BMS patients was (3.56±1.90), with 48.8% (20/41) and 41.5% (17/41) of patients experiencing mild and moderate pain, respectively. Only 7.3% (3/41) of patients had severe pain. Among the 41 BMS patients, 61.0% (25/41) exhibited anxiety and/or depression, in whom 39.0% (16/41) had both anxiety and depression, 9.8% (4/41) experienced anxiety without depression, and 12.2% (5/41) had depression without anxiety. The concentrations of IFN-γ and TNF-α in the serum and saliva of BMS patients were significantly higher than those in healthy controls (all P<0.05). In contrast, the BDNF concentration in serum was significantly lower in BMS patients than in healthy participants ( P<0.01), but was significantly higher in saliva ( P<0.001). Serum TNF-α was positively correlated with IFN-γ, IL-1β, and IL-6 (β=0.803, β=0.812, β=0.592; all P<0.01), while saliva TNF-α was negatively correlated with both anxiety and depression (β=-0.325, β=-0.321; all P<0.05). SAS scores were linearly correlated with saliva TNF-α concentrations (SAS=51.374-1.154×saliva TNF-α); saliva TNF-α concentrations were linearly correlated with saliva IFN-γ and IL-1β (saliva TNF-α=2.408+0.281×saliva IFN-γ+0.002×saliva IL-1β). Conclusions:This study provides a preliminary exploration of a clinical assessment model for BMS based on inflammatory markers and psychological scores, offering an exploratory framework for further research and optimization of the model.

Radiochemotherapy-induced oral mucositis (OM) is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy. Erosion and ulcers are the main features of OM that seriously affect the quality of life of patients and even the progress of tumor treatment. To date, differences in clinical prevention and treatment plans for OM have been noted among doctors of various specialties, which has increased the uncertainty of treatment effects. On the basis of current research evidence, this expert consensus outlines risk factors, clinical manifestations, clinical grading, ancillary examinations, diagnostic basis, prevention and treatment strategies and efficacy indicators for OM. In addition to strategies such as basic oral care, anti-inflammatory and analgesic agents, anti-infective agents, pro-healing agents, and photobiotherapy recommended in previous guidelines, we also emphasize the role of traditional Chinese medicine in OM prevention and treatment. This expert consensus aims to provide references and guidance for dental physicians and oncologists in formulating strategies for OM prevention, diagnosis, and treatment, standardizing clinical practice, reducing OM occurrence, promoting healing, and improving the quality of life of patients.
Humans ; Chemoradiotherapy/adverse effects* ; Consensus ; Risk Factors ; Stomatitis/etiology*

Objective To compare the recurrence rates between 755 nm Q-switched alexandrite laser(QSAL)treat-ment and surgical excision of oral melanotic macules(OMM).Methods This study was reviewed and approved by the Ethics Committee,and informed consent was obtained from the patients.A retrospective cohort study was designed to collect demographic and clinical characteristics and follow-up data from patients with OMM.Patients who received QSAL or surgical excision in the Department of Oral Medicine,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from January 2019 to August 2021 were included.The one-year recurrence rate was in-vestigated as the primary outcome.Long-term adverse reaction rates were investigated as safety indicators.Kaplan-Mei-er analyses were performed to analyze the recurrence-free rates between the groups.Results A total of 57 patients were enrolled in this study.16 patients underwent surgical excision,and 41 underwent QSAL.The baseline demograph-ic and clinical characteristics between the groups were not significantly different.No recurrence(0%)of OMM was ob-served in the surgical excision group,while in the QSAL group,the macule recurred in 12 patients(29.27%).The aver-age duration of recurrence was 6.08 months after treatment.Recurrence was not found to be associated with smoking(P = 1.000),gastrointestinal polyps(P = 1.000),longitudinal melanonychia(P = 0.187),family history(P = 0.552),treat-ment sessions(P = 0.567)or multiple macule lesions(P = 0.497).Compared with treatment with surgical excision,the odds ratio of recurrence for treatment with QSAL was 4.41,with a 95%confidence interval of 1.27-15.24(P = 0.020).In the surgical excision group,3 patients(18.75%)reported depressions and scars on the lesion,while no long-term ad-verse reactions(0%)were reported in the QSAL group(P = 0.019).Conclusion Compared with surgical excision,the advantage of QSAL is the low long-term adverse reaction rate,while the disadvantage is the relatively high one-year re-currence rate.It is necessary to communicate the advantages and disadvantages of the two methods with OMM patients to assist in clinical decision-making.

Objective To investigate the classification,clinical manifestations,diagnosis,differential diagnosis and treatment of oral lichenoid lesions and provide a reference for clinical practice.Methods Hospital ethical approval and patient informed consent were obtained.We report a case of oral lichenoid lesion in children and review the diagno-sis and treatment of oral lichenoid damage in the literature.Results The patient experienced repeated rupture of the dorsal surface of the tongue with pain for more than 3 years.There was a large area of tongue back surface erosion with an irregular shape,surrounded by pearly-white lines.The left erosive area was accompanied by tissue hyperplasia,which was approximately 1.5 cm × 2.0 cm,with tough texture and broad masses.The pathological diagnosis of the pa-tient was oral lichenoid lesion.After biopsy of the dorsal surface of the tongue,the pathological diagnosis of the patient was granulomatous inflammation.The final diagnosis of lichenoid granulomatous stomatitis was made on the basis of the patient's intraoral damage features,systemic history,medication history and histopathological findings.A review of the literature suggests that oral lichenoid lesions have an unknown etiology and need to be clinically differentiated from oral lichen planus,oral lichenoid drug reactions,oral lichenoid contact damage and chronic ulcerative stomatitis.The clini-cal treatment of oral lichen planus is based on the topical and/or systemic use of glucocorticoids.Conclusion There are still no uniform criteria for the classification and diagnosis of oral lichenoid lesions.They rely mainly on history tak-ing,clinical manifestations and histopathological findings,and the treatment is mainly based on the topical and/or sys-temic use of glucocorticoids.

Objective To construct an NZB/W(F1)mouse model of systemic lupus erythematosus and evaluate the effects of nicotinamide on each index of lupus nephritis pathogenesis of NZB/W(F1)mice in order to provide data for research on the role of nicotinamide in the treatment of lupus nephritis.Methods Female NZB/W(F1)mice were obtained by crossing male NZW mice with female NZB ones.Urine samples were collected using metabolic cages and proteinuria test strips were used to detect proteinuria.Blood samples were collected through the orbital venous plexus in mice.Enzyme-linked immunosorbent assay(ELISA)was used to detect the level of anti-dsDNA antibody.Levels of serum creatinine and urea nitrogen and liver function indexes were detected using an automatic blood analyzer.Hematoxylin-eosin staining and immunofluorescence technique were used to detect the pathological state of the kidney.Results The levels of proteinuria,double-stranded DNA antibodies,serum creatinine,and urea nitrogen were gradually increased during the natural course of the disease in female NZB/W(F1)mice,indicating that the lupus nephritis disease model was constructed in female NZB/W(F1)mice.Compared to the control group,nicotinamide feeding could obviously decrease the level of proteinuria(P=0.0070),inhibit the production of double-stranded DNA antibodies(P=0.0325),and retard the progression of serum creatinine(P=0.0067)and urea nitrogen indexes(P=0.0166)in serum.In addition,the pathological state of the kidney in the nicotinamide feeding group was significantly alleviated compared with the control group.Conclusion A lupus nephritis disease model is constructed in NZB/W(F1)mice.Nicotinamide feeding can obviously alleviate the disease state of lupus nephritis in NZB/W(F1)mice.

Objective:To investigate the effect of teaching practice under the concept of narrative medicine on improving the empathy level of interns in oral mucosal diseases.Methods:The interns of stomatology in the class of 2018 in School of Stomatology, Shanghai Jiao Tong University, were divided into narrative medicine teaching group (27 interns receiving narrative medicine concepts and methods before and during internship) and traditional teaching group (21 interns received patients directly under the guidance of teachers without the addition of narrative medicine concepts and methods). A questionnaire was used to collect the general information of students, and the Chinese version of Jefferson Scale of Physician Empathy (JSPE) (the version for medical students) was used to measure the empathy level of students. After the end of internship, a statistical analysis was performed for the scores of both groups, and a questionnaire survey was conducted to investigate the acceptance of internship under the guidance of narrative medicine among the students in the narrative medicine teaching group. GraphPad Prism 9.3.0 was used to perform the t-test and the rank sum test. Results:There was a significant difference in JSPE score between the traditional teaching group and the narrative medicine teaching group (92.26±8.23 vs. 104.20±15.65, t=2.70, P=0.005), and in addition, 88.89% (24/27) of the students in the narrative medicine teaching group were interested in participating in internship under the guidance of narrative medicine. However, there was no significant difference in the score of internship between the narrative medicine teaching group and the traditional teaching group (87.28±2.77 vs. 85.47±4.31, t=1.68, P=0.100). Conclusions:Incorporating the concepts and methods of narrative medicine into clinical teaching of oral mucosal diseases can significantly improve the empathy ability of interns and raise the awareness that empathy is as important as scientific literacy among students.

The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists. The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers, based on factors such as detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening. Not only it can provide a standardized procedure of oral ulceration, but also it can improve the diagnostic efficiency, in order to avoid misdiagnosis and missed diagnosis.
Consensus ; Humans ; Oral Ulcer/therapy*

Objective:To investigate the risk factors for abdominal infection after liver transplantation (LT).Methods:The retrospective case-control study was conducted. The clinical data of 356 patients who underwent LT in the First Affiliated Hospital of Xi′an Jiaotong University from January 2015 to December 2018 were collected. There were 273 males and 83 females, aged from 21 to 67 years, with the median age of 46 years. Observation indications: (1) abdominal infec-tion after LT and distribution of pathogens; (2) analysis of risk factors for abdominal infection after LT; (3) follow-up and survival. Follow-up was performed using outpatient examination and tele-phone interview to detect postoperative 1-year survival rate and cases of death up to June 2020. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were described as M(range). Count data were expressed as absolute numbers or percentages. Univariate analysis was conducted using the chi-square test, t test, Mann-Whitney U test and Fisher exact probability. Multivariate analysis was done using the Logistic regression model. The Kaplan-Meier method was used to calculate sruvival time and survival rates. Log-Rank test was used for survival analysis. Results:(1) Abdominal infection after LT and distribution of pathogens: 63 of 356 recipients had abdominal infection after LT, with the overall incidence of 17.70%(63/356). Of the 63 recipients, 41 cases had abdominal infection within postoperative 2 weeks, 17 cases had multi-drug resistant organism infection. A total of 116 strains of bacteria were isolated from 63 recipients with abdominal infection, 52 of which were gram-negative bacteria, 48 were gram-positive bacteria, 16 were fungi. (2) Analysis of risk factors for abdominal infection after LT: results of univariate analysis showed that preoperative model for end-stage liver disease (MELD) score, preoperative serum albumin, preoperative leukocytes, preoperative prothrombin time, preoperative alanine aminotransferase, preoperative aspartate aminotransferase, operation time, volume of intraoperative blood loss, days of postoperative antibiotic use, postoperative renal failure, postoperative delayed graft function,duration of postoperative intensive care unit stay were related factors for abdominal infection after LT ( Z=-2.456, t=-1.982, Z=-3.193, -2.802, -2.336, -2.276, -2.116, -3.217, χ2=15.807, 10.395, 6.750, Z=-4.468, P<0.05). Liver retransplantaiton and postoperative bile leakage were related factors for abdominal infection after LT ( P<0.05). Results of multivariate analysis showed that preoperative MELD score>20 and liver retransplantation were independent risk factors for abdominal infection after LT ( odds ratio=2.871, 12.875, 95% confidence interval as 1.106-7.448, 1.290-128.521, P<0.05). (3) Follow-up and survival: 356 recipients were followed up for 1-66 months, with a median follow-up time of 32 months. The postoperative 1-year overall survival rate of 63 recipients with abdominal infection and 293 recipients without abdominal infection were 84.60% and 97.03%, respectively, showing a significant difference ( χ2=11.660, P<0.05). During the follow-up, 58 recipients died. Conclusion:Preoperative MELD score>20 and liver retransplantation are independent risk factors for abdominal infection after LT.

Objective:To study the effect of MYD88 L265P mutation on the expression of PD-L1 in tumor cells and tumor microenvironment in diffuse large B-cell lymphoma (DLBCL), and to provide theoretical basis for immunotherapy for patients.Methods:Multiplex ligation-dependent probe amplification (MLPA) was used to detect the frequency of MYD88 L265P mutation in 72 cases of DLBCL diagnosed by pathologists in Cancer Hospital of Chinese Academy of Medical Sciences from August 2008 to May 2010. Expression of PD-L1 in tumor cells and tumor microenvironment in all samples was evaluated using PD-L1 (22C3) and PD-L1 (SP142) with Ventana automatic immunohistochemical (IHC) platform. The relationship between MYD88 L265P mutation and the expression of PD-L1 in DLBCL tumor cells and tumor microenvironment was assessed.Results:Of the 72 cases of DLBCL, MYD88 L265P mutation was detected in 15 (20.8%) cases. Nine cases with JAK2 amplification were excluded, and the remaining 63 cases of DLBCL were divided into MYD88 L265P mutant group ( n=14) and MYD88 L265P wild-type group ( n=49). IHC results showed that among the 14 cases of MYD88 L265P mutant groups, PD-L1 (22C3) was positive in 7 cases (7/14) of tumor cells and PD-L1 (SP142) was positive in 4 cases (4/14) of tumor microenvironment. Among the 49 cases of MYD88 L265P wild-type group, 9 cases (18.4%) were positive for PD-L1 (22C3) in tumor cells, and 38 cases (77.6%) were positive for PD-L1(SP142) in tumor microenvironment. In addition, among the 16 cases with PD-L1(22C3) expression in tumor cells, only 2 of the 7 cases with MYD88 L265P mutation were positive for PD-L1 (SP142) in tumor microenvironment. All 9 cases with wild-type MYD88 L265P were positive for PD-L1 (SP142) in tumor microenvironment. Statistical analysis showed that the expression level of PD-L1 (22C3) in tumor cells in the MYD88 L265P mutant group was significantly higher than that in the MYD88 L265P wild-type group ( P=0.017). The expression level of PD-L1 (SP142) in tumor microenvironment in the MYD88 L265P mutant group was significantly lower than that in the MYD88 L265P wild-type group ( P=0.001). Conclusions:MYD88 L265P mutation may play an important role in the regulation of PD-L1 expression in DLBCL tumor cells and tumor microenvironment. Further studies will provide a theoretical basis for immunotherapy of DLBCL patients with MYD88 L265P mutation.