Objective: This study aims to explore the influencing factors, formation mechanisms, and treatment methods of labial protuberance in the anterior maxilla during orthodontic treatment, providing a reference for clinical practice. Method: This study reports a case where the absence of upper anterior teeth 11 and 21, and the retraction tilting movement of teeth 12 and 22, resulted in labial protuberance and gingival hyperplasia. Alveolar osteoplasty and gingivoplasty were performed. The specific changes in the alveolar bone during the retraction of the anterior teeth and the characteristics of its remodeling were analyzed. Combined with relevant literature, the factors influencing the formation of labial protuberance in orthodontic patients, mechanisms, and methods for prevention and treatment were summarized. Results: After periodental surgery follow-up for 6 months, the gingival color and shape of teeth 12 and 22 were good, the labial alveolar bone was normal, and the overall condition was stable. A review of the literature showed that labial protuberance is more common in adult orthodontic patients, and the distance (>4 mm) and speed of retraction of anterior teeth are related to its formation, with the main mechanism likely being differential remodeling of the alveolar bone. In adult patients, the number of active osteoblasts and osteoclasts in the alveolar bone decreases, along with a reduction in metabolic activity and overall cellular activity, which diminishes the reactivity of the alveolar bone. After treatment of anterior teeth retraction, there is insufficient labial bone resorption. Moreover, the lack of mechanical stress-mediated periodontal ligament in the interdental space leads to reduced bone remodeling stimulation in this area, resulting in thickening of the labial alveolar bone of the upper anterior teeth. The remodeling rates of cortical and trabecular bone differ, with active trabecular bone proliferation near the tooth root surface and slow cortical bone resorption near the outer surface, which ultimately results in increased bone thickness at the labial cervical region. Specific case analysis indicates that the retraction distance of the upper anterior teeth in this case was about 6 mm. The alveolar bone at the missing sites of teeth 11 and 21, lacking periodontal ligament stimulation, showed less remodeling and absorption, likely appearing as hyperplasia. The prevention of labial bone protrusion mainly involves controlling the speed and distance of retraction of anterior teeth. Smaller labial protuberances generally do not require treatment, but those affecting function and aesthetics can be addressed with periodontal alveolar osteoplasty. Conclusion After the retraction of anterior teeth in orthodontics, a prominent, hard bone protuberance on the labial side can sometimes occur, which may be due to differential remodeling efficiency in different regions of the alveolar bone. For bone protuberance that influences aesthetics or function, periodontal alveolar osteoplasty can be a reliable option.

Objective: To explore the relationship between sleep characteristics, physical activity patterns, with depressive and anxiety symptoms in college students, so as to provide reference for student mental health promotion. Methods: From September to November 2023, a convenience sampling method was used to select 7 954 college students aged 18-22 years from 9 universities in Shanghai, Hubei, and Jiangxi. Assessments were conducted using the International Physical Activity Questionnaire Short-Form (IPAQ-SF), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and Pittsburgh Sleep Quality Index (PSQI) to evaluate physical activity, depressive and anxiety symptoms, and sleep quality, respectively. Logistic regression analysis was employed to explore the impact of sleep characteristics and physical activity patterns on depressive and anxiety symptoms and their comorbidity among college students. Results: The detection rates for depressive symptoms, anxiety symptoms, and comorbid depression and anxiety symptoms were 25.67%, 35.39%, and 23.15%, respectively. Factors such as gender, grade, household registration, parental education level, annual family income, family structure, and dietary habits were all associated with the detection rates of depressive and anxiety symptoms and their comorbidity (χ2=4.41-118.39, P<0.05). Physical activity patterns, sleep duration, sleep quality, and sleepwake characteristics were also associated with the occurrence of depressive and anxiety symptoms and their comorbidity (χ2=9.66-627.70, P<0.05). Logistic regression analysis showed that college students who stayed up late and slept less than 7 had the highest risk of depressive and anxiety symptoms and their comorbidity (OR=1.93, 1.85, 1.88, P<0.05). Compared to regular physical activity patterns, insufficient physical activity patterns were associated with an increased risk of depressive and anxiety symptoms (all OR=1.18, P<0.05). Further stratified analysis results showed that the risk of depression, anxiety and their comorbidity increased in college students who stayed up late and slept less than 7 h, went to bed before midnight and slept less than 7 h, or went to bed before midnight and slept more than 7 h but did not have sufficient physical activity (P<0.05). Conclusions Sleep characteristics and physical activity patterns significantly affect depressive and anxiety symptoms in college students. Universities should strengthen sleep management and implement flexible physical activity interventions to help students establish healthy lifestyles.

Objective To explore the prevalence of uremic pruritus(UP)in patients with maintenance hemodialy-sis(MHD)in Anhui Province and its influential factors.Methods Patients with MHD were enrolled in 27 hemo-dialysis centers in Anhui Province.Clinical data were compared.Results A total of 3 025 patients with MHD were included.The prevalence of UP was 63.3%,among them,mild UP 55.9%and moderate to severe UP 7.4%.The prevalence rates of UP in southern Anhui,central Anhui and northern Anhui were 75.4%,63.6%and 57.9%.The prevalence of total UP in≤30 years,31-50 years,51-70 years and≥71 years was 53.5%,59.8%,65.4%and 65.9%.The prevalence of total UP and moderate to severe UP increased with age(P<0.01).Age,age of dialysis,proportion of hypertension,25(hydroxy)vitamin D3[25(OH)D3],proportion of low flux dialyzer usage and proportion of calcium-phosphorus binder usage in UP group were higher than those in the group without UP.However,the levels of diastolic blood pressure,hemoglobin(Hb)and hemodialysis filtration ratio in the UP group were lower than those in the non-UP group(P<0.05).By comparison,the age,hyperten-sion and diabetes of patients in moderate and severe UP group were higher than those in mild UP group,while the proportion of non-calcium-phosphorus binding was lower than that in mild UP group(P<0.05).Binary Logistic regression analysis showed that high 25(OH)D3 was associated with a higher risk of UP in MHD patients,and high throughput dialyzer use was associated with a lower risk of UP in MHD patients(P<0.05).Conclusion The prevalence rate of UP in maintenance hemodialysis patients in Anhui province is 63.3%.The prevalence of UP is the highest in southern Anhui,and the prevalence of total UP and moderate to severe UP increases with age.High 25(OH)D3 levels are a risk factor for UP in MHD patients,and the use of high-throughput dialyzers can reduce the risk of UP in MHD patients.

Objective:To investigate the current situation and influence factors of prehospital thrombolysis treatment for ST segment elevation myocardial infarction (STEMI) in China, to analyze the main factors affecting prehospital thrombolysis implementation, and optimize the pre-hospital thrombolysis strategy for STEMI to reduce mortality.Methods:A multicenter cross-sectional survey was conducted. 21 cities from six major geographical regions in China were selected by using convenient sampling method. An anonymous online electronic questionnaire was used to investigate the current situation and influence factors of prehospital emergency physicians and grassroots physicians implementing prehospital thrombolysis treatment for STEMI patients. Chi-square test was used to analyze the differences in count data between groups, and multivariate logistic regression was used to analyze the factors affecting prehospital thrombolysis in STEMI.Results:A total of 5 163 prehospital emergency physicians and physicians from grassroots township health centers/community health service centers or village clinics participated in this survey. Among them, 3208 (62.13%) have never implemtent thrombolysis, and 1 955 (37.87%) have did it before. The results of the multivariate logistic regression analysis indicated that physicians with 5-10 years of experience ( OR=1.41, 95% CI: 1.18-1.69, P<0.01), 11-20 years of experience ( OR=1.25, 95% CI: 1.03-1.52, P=0.02), those working in village clinics ( OR=1.30, 95% CI: 1.05-1.61, P=0.02), those in pre-hospital emergency medical institutions/departments ( OR=3.19, 95% CI: 2.80-3.64, P<0.01), those whose units are equipped with remote ECG transmission capabilities ( OR=1.72, 95% CI: 1.50-1.96, P<0.01), or ECG AI-assisted diagnostic tools ( OR=1.31, 95% CI: 1.15-1.49, P<0.01), and those who believe that thrombolysis is highly effective and should be widely adopted ( OR=2.55, 95% CI: 2.09-3.12, P<0.01) or consider it somewhat effective but warranting caution ( OR=2.11, 95% CI: 1.73-2.59, P<0.001), were more likely to make pre-hospital thrombolysis decisions for STEMI patients. To improve the current situation of pre-hospital thrombolysis for STEMI, the top four measures prioritized by pre-hospital emergency and grassroots physicians were enhancing the rescue capabilities of primary care doctors (92.22%), strengthening guidance from higherlevel hospitals (84.99%), increasing support for information technology (83.37%), and improving public health education (74.75%). Conclusions:The implementation rate of prehospital thrombolysis for STEMI in China still needs to be improved. Optimizing the prehospital thrombolysis strategy for STEMI, strengthening the allocation of basic medical resources and information technology support, and improving the referral mechanism are conducive to the implementation of prehospital thrombolysis for STEMI.

Objective To explore the relevant protective/risk factors during the development of coronary heart disease blood stasis evidence in the process of pre-existing evidence based on the macro-,meso-,and micro-health state characterization parameter system of Chinese medicine state science.Methods 253 cases of coronary heart disease to be investigated were collected from the outpatient and inpatient departments of the Department of Cardiology in the hospitals affiliated to Hunan University of Traditional Chinese Medicine,and questionnaires were formulated according to the three dimensions of macro,meso,and micro,and the collected parameters were categorized with Python software,and the patients were diagnosed as pre-coronary heart disease blood stasis evidence(150 cases)and coronary heart disease blood stasis evidence(100 cases),and statistical analyses were performed with frequency analysis,χ2 test,and Logistic regression and other methods for statistical analysis.Results ①The results of univariate analysis showed that:age,BMI,history of smoking,history of alcohol consumption,history of hypertension,history of diabetes mellitus,average monthly high temperature,air quality,season,type of occupation,social environment,coronary artery angiographic stenosis,diastolic blood pressure,systolic blood pressure,creatinine,uric acid and total cholesterol differed between patients diagnosed as pre-Coronary artery disease blood stasis evidence and those diagnosed as Coronary artery disease blood stasis evidence,and all the differences were statistically significant(P<0.05).② Binary logistic regression analysis showed that age,BMI,history of alcohol consumption,type of occupation,coronary angiographic stenosis,diastolic blood pressure,creatinine,and dark red tongue were independent risk factors.A prediction model was established:P=1/[1+exp(16.522-1.427×age-0.975×BMI-3.55×drinking history+1.982×monthly average high temperature+0.709×season-1.827×occupational type-1.1×coronary angiographic stenosis-0.072×diastolic blood pressure-0.076×creatinine+2.398×dizziness-4.108×dark red tongue+4.169×pulse asthenia)],the model prediction rate was 90.5%.Conclusion The logistic regression model of coronary heart disease with blood stasis evidence is good with clinical diagnosis,which lays the foundation for the exploration of the state between the already diseased and undiseased of coronary heart disease,and provides important basic data for the theory of subhealth.

Objective To investigate the application value of low-molecular-weight heparin calcium combined with alprostadil in the treatment of hypoparathyroidism(HP)after thyroid surgery.Methods Sixty patients with HP after thyroid surgery were randomly divided into two groups:study group(30 cases)and control group(30 cases).The study group received low-molecular-weight heparin calcium and alprostadil,along with oral calcium supplements and calcitriol or an intravenous infusion of calcium gluconate,for three consecutive days after surgery.The control group received only oral calcium supplements and calcitriol or intravenous calcium gluconate.The values and changes in parathyroid hormone(PTH),postoperative drainage volume,and postoperative complications were compared between two groups.Results There were no significant difference in PTH levels at 3 days,1 week,1 month,and 6 months after surgery between two groups(P＞0.05).The difference in PTH levels between 3 days and 1 day after surgery was(6.77±2.61)ng/L in study group and(1.29±1.12)ng/L in control group,with a significant difference(P＜0.05).The difference in PTH levels between 1 week and 1 day after surgery was(10.51±3.66)ng/L in study group and(2.65±2.17)ng/L in control group(P＜0.05).There were no significant difference in PTH levels at 1 month,6 months,and 1 day after surgery(P＞0.05).Comparison of postoperative drainage volume:The postoperative drainage volume of study group was(90.07±22.24)ml,and that of control group was(88.20±24.09)ml,with no statistical significance(P＞0.05).There was no significant difference in postoperative complications between two groups(P＞0.05).Conclusion In cases of HP after total thyroidectomy,timely use of low-molecular-weight heparin calcium and alprostadil can accelerate the recovery of PTH and reduce patient numbness,which is safe,effective,and worthy of clinical promotion.

Objective:To identify the genetic causes of adverse pregnancy outcomes in five families and provide a basis for rational guidance on genetic and reproductive counseling.Methods:A retrospective analysis was conducted on five families with a history of adverse pregnancy outcomes, where one partner was found to have a cryptic balanced translocation. These cases were identified among pregnant women who underwent invasive prenatal diagnosis at the Department of Medical Genetics and Prenatal Diagnosis, Wuxi Maternity and Child Health Care Hospital, from January 2016 to June 2023. Conventional G-banding karyotyping and chromosomal microarray analysis (CMA) were performed on affected children/fetus samples. Chromosome G-banding and fluorescence in situ hybridization (FISH) were used for parental tracing. Genetic counseling was provided for all cases, and the pregnancy outcomes were followed up. Descriptive analysis was applied in this study. Results:Case 1 involved an eldest son with unexplained intellectual disability, and the CMA results showed an 8.6 Mb deletion in the 4p16.3p16.1 region and a 1.0 Mb duplication in the 7q36.3 region. Unbalanced translocations were detected in the current pregnancies of the other four cases, which were a 6.1 Mb duplication in the 14q32.2q32.33 region with a 1.6 Mb deletion in the 21q22.3 region (Case 2), a 10.8 Mb duplication in the 6q25.3q27 region with a 1.2 Mb deletion in the 15q26.3 region (Case 3), a 1.0 Mb duplication in the 5p15.33 region with a 2.9 Mb deletion in the 6q27 region (Case 4), and a 3.2 Mb deletion in the 1q44 region with a 4.8 Mb duplication in the 19p13.3 region (Case 5). FISH confirmed that either the husband or the wife in each of the five families was a carrier of a cryptic balanced translocation. Further CMA testing on amniotic fluid samples from previous terminated pregnancies of Cases 3 and 4 also indicated unbalanced translocations. Both the current pregnancy of Case 1 and the subsequent pregnancy of Case 2 gave birth to healthy babies after non-abnormal prenatal diagnosis and genetic counseling. Cases 3 to 5 are currently preparing for pregnancy.Conclusion:Advances and combined application of genetic technologies will be conducive to improving the diagnosis of cryptic balanced translocations in some families with adverse pregnancy outcomes, providing a sound basis for genetic counseling in future pregnancy.

Objective:To explore the prevalence rate of restless leg syndrome (RLS) and its related influencing factors in patients with maintenance hemodialysis (MHD) in Anhui province.Methods:It was a cross-sectional study, including regular MHD patients in blood purification centers of 27 hospitals in southern, central and northern Anhui province from January to March 2020. The investigation included general demographic characteristics, primary diseases, complications, dialysis-related conditions and drug use. According to the presence or absence of RLS, the patients were divided into RLS group and non-RLS group, and the differences of clinical data between the two groups were compared. Logistic regression analysis method was used to analyze the influencing factors of RLS.Results:The study included 3 025 MHD patients, aged (54.8±12.8) years old, with 1 819 males (60.1%) and 1 206 females (39.9%). The dialysis age was (5.5±3.8) years. The prevalence rates of RLS in MHD patients were 8.8% (265/3 025), of which 13.7% (77/561), 7.7% (88/1 145) and 7.6% (100/1 319) in southern, central and northern Anhui province, respectively. The prevalence rates of RLS in MHD patients in secondary and tertiary hospitals were 9.5% (55/577) and 8.6% (210/2 448), respectively. Proportion of hypertension, dialysis age, intact parathyroid hormone, alkaline phosphatase, 25(OH)D3, and proportions of secondary hyperparathyroidism, erythropoietin use, iron supplements, active vitamin D use, calcimimetic use, dialysis blood flow <250 ml/min and low-flux dialyzers in RLS group were higher than those in non-RLS group, while hemoglobin level and proportions of non-calcium-phosphorus binders and high-flux dialyzers were lower than those in non-RLS group (all P<0.05). Multivariate logistic regression analysis results showed that long dialysis age ( OR=1.188, 95% CI 1.031-1.369, P=0.017) and high alkaline phosphatase ( OR=1.007, 95% CI 1.001-1.013, P=0.047) were correlated with a higher risk of RLS in MHD patients. Conclusions:The prevalence rate of RLS in MHD patients in Anhui province is 8.8%. The prevalence rates of RLS in MHD patients in southern, central and northern Anhui province are 13.7%, 7.7% and 7.6%, respectively. The prevalence rate of RLS in secondary and tertiary hospitals are 9.5% and 8.6%, respectively. Long dialysis age and high alkaline phosphatase are associated with a high risk of RLS in MHD patients.

Objective:To investigate the prenatal ultrasound findings and clinical prognosis in fetal closed spina bifida without subcutaneous mass.Methods:This retrospective study included nine fetuses diagnosed with closed spina bifida without subcutaneous mass by prenatal ultrasound in Women's Hospital of Jiangnan University from October 2016 to February 2022. Descriptive analysis was used to summarize the ultrasonographic features, MRI findings, genetic testing results, pregnancy outcomes and follow-up data.Results:The diagnosis of fetal closed spina bifida without subcutaneous mass was confirmed in all cases by MRI, X-ray examination or ultrasound after termination or neonatal surgery. Four cases presenting with various degrees of sacral vertebra defects had caudal regression syndrome complicated by other malformations. Two cases had dermal sinus, presenting with subcutaneous hypoechoic sinus tract connecting to the spinal canal. Lipoma terminalis were found in two fetuses who presented with intraspinal hyperechoic mass. One fetus with diastematomyelia showed short linear strong echoes and double spinal cord echoes in the spinal canal with butterfly vertebrae. The location of the conus medullaris was lower in seven cases and normal in one fetus. The other one case had unclear position of the conus medullaris. No postoperative complications occurred in the two cases (one with dermal sinus and one with lipoma terminalis) receiving postnatal surgery and both infants grew and developed normally. Fetal death occurred in one case and six pregnancies were terminated.Conclusions:Closed spina bifida without subcutaneous mass typically has ultrasonographic features. Detection of spinal cord echoes in the spinal canal can improve the prenatal detection rate. Whether it is complicated with malformation affects its prognosis. Prenatal ultrasound diagnosis may provide information for prognosis consultation and postpartum treatment.

Objective: To compare the efficacy and safety of combining diosmin with Jiuhua hemorrhoid suppository versus diosmin alone for the treatment of hemorrhoid hemorrhage. Methods: The Jiuhua hemorrhoid suppository study was conducted in 10 medical centers across China from April 1, 2019 to June 30, 2020. Patients with hemorrhoid bleeding were randomized in a ratio of 1 : 1 to either receive Jiuhua hemorrhoid suppository and diosmin tablets (the study group) or diosmin tablets alone (the control group). The suppository was used once a day after defecation or at bedtime after rinsing the anus with warm water. Diosmin tablets were administered only once a day (0.9 g). The primary endpoint of the study was the assessment of hemorrhoid bleeding relief 7 ± 2 days after treatment, classified as “very effective” “effective” and “ineffective”. The secondary endpoint included the evaluation of pain alleviation using the visual analogue scale (VAS, with scores ranging from 0 to 10) and edema (with scores ranging from 0 to 3). The safety of the two treatment regimens was evaluated 14 ± 2 days after drug administration. Results: The full analysis set (FAS) comprised 107 participants in the study group and 111 in the control group, while the per-protocol set (PPS) included 106 participants in the study group and 111 in the control group. In terms of hemorrhoid bleeding, the proportion of very effective and effective cases in the study group were significantly higher than that in the control group [106 (99.06%) vs. 91 (81.98%), P < 0.0001] in the FAS, and the PPS results [105 (99.06%) vs. 91 (81.98%), P < 0.0001] were comparable to the FAS results. The pain VAS scores at day 7 after treatment were comparable between the two groups (0.80 ± 1.17 vs. 0.80 ± 1.20, P = 0.2177). The majority of the participants in both groups had an edema score of 0 at day 7 after treatment [96 (89.72%) vs. 99 (91.67%), P = 0.370 5]. Adverse events (AEs) occurred in 9 patients (8.4%) in the study group and 3 patients (2.7%) in the control group. In addition, 5 AEs in the study group and 1 AE in the control group were possibly in association with the study drug. Conclusion Compared with the administration of diosmin oral tablets alone, the addition of Jiuhua hemorrhoid suppository to the tablets demonstrates enhanced efficacy in addressing hemorrhoid bleeding, with satisfactory patient adherence and acceptable safety.