This case report describes a simple technique using clear aligners to intrude overerupted molars. A 27-year-old woman presented with missing mandibular left first and second molars, with the left third molar present in the arch. However, the prosthetic rehabilitation was limited by the opposing overerupted molars. Clear aligner therapy (CAT) was used to regain the necessary interocclusal space. After initial molar distalization, subsequent 2.14 and 1.3 mm of intrusion for the maxillary left first and second molars, respectively, was designed to solve the door-wedge effect dilemma. Without miniscrews, considerable intrusion (1.9 and 0.9 mm for maxillary left first and second molars, respectively) was achieved within 6 months with minimal discomfort. Radiologic and clinical examinations revealed a favorable occlusal relationship and improved alignment for both arches. Outcomes in the case revealed that intruding overerupted molars via CAT may be an effective approach.

OBJECTIVES:This study aimed to investigate the effect of acetylation of α-tubulin induced by ATP-citrate lyase (ACLY) activation on pyroptosis process in mouse bone marrow derived macrophages (BMDMs). MATERIALS AND METHODS:Level of phospho-ACLY was assessed in normal and inflamed gingiva. Mouse BMDMs were harvested and infected with Porphyromonas gingivalis. The mRNA and protein levels of genes were analyzed by real-time quantitative PCR and western blotting, respectively. Polymerization and acetylation of microtubules were detected with immunofluorescence. Lactate dehydrogenase (LDH) activity assay, immunofluorescence, and ELISA were performed to determine pyroptosis in P.gingivalis-induced BMDMs. RESULTS:Elevated expression of phospho-ACLY was observed in the inflamed gingiva. P. gingivalis infection was shown to promote pyroptosis in mouse BMDMs. Moreover, P. gingivalis-induced BMDMs showed increased phospho-ACLY, as well as polymerization and acetylation of microtubules. Inhibition and knockdown of ACLY showed depolymerization and decreased acetylation of microtubules, thus resulting in reduced P. gingivalis-induced pyroptosis in BMDMs. CONCLUSIONS:Our findings suggest that ACLY-mediated dynamics of microtubules participate in the progress of periodontitis. P. gingvalis-triggered phospho-ACLY target the microtubule cytoskeleton by influencing acetylation of tubulin, facilitating NLRP3 inflammasome activation and pyroptosis.

In clear aligner therapy (CAT), Class II elastics are widely used to reinforce the anchorage during the distalization of upper molars, however, their association with alveolar bone dehiscences (ABDs) and fenestrations (ABFs) in the anterior region remains unclear. The aim of this research is to assess the incidence of ABDs/ABFs in adult patients undergoing non-extraction CAT with Class II elastics, and to explore risk factors associated with the occurrence of ABDs/ABFs. Thirty adult patients with Class II malocclusion who underwent non-extraction CAT with Class II intermaxillary elastics were enrolled in this study. Cone-beam computed tomography (CBCT) images were obtained before (T0) and immediately after (T1) CAT to assess the occurrence of ABDs/ABFs on the labial and lingual sides of anterior teeth. Chi-square tests were used to compare the incidence of ABDs/ABFs at T0 and T1, meanwhile, binary logistic regression was utilized to analyze the risk factors associated with ABDs/ABFs at T1. On the labial side, the incidence of ABDs increased significantly in the mandibular central incisors (from 36.7 to 62.8

Objectives:To evaluate the accuracy of Invisalign ClinCheck in predicting open gingival embrasures (OGEs) and to identify predictors of OGEs in adult extraction cases. Materials and Methods:Fifty-seven adult patients treated with Invisalign and four first premolar extractions were included in this retrospective study. OGEs were measured in maxillary and mandibular anterior regions using posttreatment intraoral photographs (actual OGEs) and the final step from the first treatment plan in ClinCheck (predicted OGEs). Prediction performance indicators including precision, sensitivity, specificity, false positive rate, false negative rate, and accuracy were evaluated at each tooth site. Predictors of OGEs (age, crowding, crown morphology, tooth movement, tooth site, treatment duration, and attachment design) were analyzed using binary logistic regression. Results:Incidence of actual OGEs was like that of the ClinCheck predicted OGEs in the maxillary and mandibular anterior regions. The predictability of ClinCheck was satisfactory in both the maxilla and mandible, with accuracy rates of 94.0% and 86.0%, respectively. The most accurate prediction was for the maxillary central incisors, achieving a precision of 100% and an accuracy of 96.6%. The most significant predictors of OGEs included patient age at initial consultation, anterior crowding, tooth crown morphology, and type of tooth movement. Conclusions:Invisalign ClinCheck predicted OGEs in adult patients treated with four premolar extractions. The accuracy of the prediction was satisfactory, 94% in the maxilla and 86% in the mandible, demonstrating great potential for clinical application.

Objectives: To assess the prevalence of degenerative disease of the temporomandibular joint in anterior open bite patients with different molar relationships. Methods: 246 anterior open bite adult orthodontic patients were divided into Class I group (n=65), Class II group (n=116) and Class III group (n=65) based on their sagittal molar relationships, meanwhile, 70 normal subjects were selected as control group. The occurrence of degenerative joint disease was detected by cone beam computed tomography, and the prevalence of degenerative joint disease among groups was compared. Mandibular plane angle and the vertical distance between the upper and lower incisors were also measured. Results: The overall prevalence of degenerative joint disease in anterior open bite patients and control group was 30.28% and 5.00%, respectively. Class II group showed the significantly highest prevalence of degenerative joint disease (50.43%, P＜0.001), highest frequency of bilateral degenerative joint disease (43.95%，P＜0.001) and highest mandibular plane angle. Among the anterior open bite groups, Class III group exhibited the highest vertical distance between the upper and lower incisors (3.35 ±1.86mm, P＜0.05) but the lowest prevalence of degenerative joint disease(10.77%). Conclusions: For Class II anterior open bite patients, condylar resorption in degenerative diseases of TMJ may be an important cause of malocclusion.

The aims of this retrospective study were to assess changes of vertical dimension and alveolar bone remodeling in cases with second molar scissors bite (SB) before and after intermaxillary cross-elastics (ICE) treatment. 36 patients with unilateral SB (SB group) and 36 subjects with normal occlusion (Control group) were included. CBCT records were taken before (SB-T0) and after orthodontic treatment (SB-T1). Alveolar bone height (ABH) and thickness (ABT), tooth and alveolar bone inclination, molar and facial height were measured. No changes on the vertical dimension were observed during treatment. Surrounding alveolar bone displayed synchronous changes in the inclination with molars for both arches. After ICE, the maxillary alveolar bone was found thinner at buccal side (P < 0.05), while no difference was found at the palatal side. The mandibular alveolar bone was found thicker at buccal side and thinner at lingual side (P < 0.05). Nevertheless, no difference in the alveolar bone thickness was observed between SB-T1 group and Control group. ICE is a safe method to correct SB with stability of vertical dimension and safety of periodontal bone. Buccolingual inclination of the alveolar bone changes with the molar tooth movement, showing a bone bending tendency during SB correction.

This study aimed to investigate correlation between mitochondrial reactive oxygen species and Porphyromonas gingivalis in the process of cementoblast pyroptosis. Lactate dehydrogenase activity assay, enzyme-linked immunosorbent assay, western blotting and flow cytometry analysis were utilized to explore whether Porphyromonas gingivalis triggered pyroptosis in cementoblasts. Reactive oxygen species and mitochondrial reactive oxygen species were detected using flow cytometry and fluorescence staining. The effect of mitochondrial reactive oxygen species on the Porphyromonas gingivalis-induced pyroptosis of cementoblasts was assessed by Mito-Tempo, mitochondrion-targeted superoxide dismutase mimetic. Phosphorylation levels of p65 were measured by western blotting. SC75741, a nuclear factor-kappa B inhibitor, was added to block the nuclear factor-kappa B in the Porphyromonas gingivalis-infected cementoblasts. Porphyromonas gingivalis triggered pyroptosis of cementoblasts, and an elevation in reactive oxygen species generation in the mitochondria was observed. Inhibition of mitochondrial reactive oxygen species reduced pyroptosis and nuclear factor-kappa B signaling pathway mediated the pyroptotic cell death in Porphyromonas gingivalis-infected cementoblasts. Together, our findings demonstrate that mitochondrial reactive oxygen species increased by Porphyromonas gingivalis participated in the pyroptosis of cementoblasts. Targeting mitochondrial reactive oxygen species may offer therapeutic strategies for root surface remodeling or periodontal regeneration.

BACKGROUND:Preeclampsia (PE) is a multisystemic syndrome which has short- and long-term risk to mothers and children and has pluralistic etiology.OBJECTIVE:This study is aimed at constructing a competitive endogenous RNA (ceRNA) network for pathways most related to PE using a data mining strategy based on weighted gene coexpression network analysis (WGCNA).METHODS:We focused on pathways involving hypoxia, angiogenesis, and epithelial mesenchymal transition according to the gene set variation analysis (GSVA) scores. The gene sets of these three pathways were enriched by gene set enrichment analysis (GSEA). WGCNA was used to study the underlying molecular mechanisms of the three pathways in the pathogenesis of PE by analyzing the relationship among pathways and genes. The soft threshold power (β) and topological overlap matrix allowed us to obtain 15 modules, among which the red module was chosen for the downstream analysis. We chose 10 hub genes that satisfied ∣log2Fold Change | >2 and had a higher degree of connectivity within the module. These candidate genes were subsequently confirmed to have higher gene significance and module membership in the red module. Coexpression networks were established for the hub genes to unfold the connection between the genes in the red module and PE. Finally, ceRNA networks were constructed to further clarify the underlying molecular mechanism involved in the occurrence of PE. 56 circRNAs, 17 lncRNAs, and 20 miRNAs participated in the regulation of the hub genes. Coagulation factor II thrombin receptor (F2R) and lumican (LUM) were considered the most relevant genes, and ceRNA networks of them were constructed.CONCLUSION:The microarray data mining process based on bioinformatics methods constructed lncRNA and miRNA networks for ten hub genes that were closely related to PE and focused on ceRNAs of F2R and LUM finally. The results of our study may provide insight into the mechanisms underlying PE occurrence.

尽管有包括疫苗接种在内的有效预防措施,HBV 感染至今仍是世界范围内尤其是亚太地区的重大公共卫生问题.乙型肝炎相关疾病的负担主要来源于围生期母婴垂直传播或婴幼儿时期水平传播.婴幼儿期HBV 感染常迁延为慢性,因此采取适当措施预防母婴垂直传播至关重要.本指南[1]旨在为医务工作者提供乙型肝炎孕妇妊娠期和产后管理的首选方案,以及婴儿出生时的最佳处理措施和随访管理方法.本指南仅提供适用于大多数患者的一般建议,对于特殊患者请临床医生根据具体情况酌情处理.指南中证据等级和推荐强度采用GRADE 系统评价方法(表1).

目的 研究非酒精性脂肪肝(NAFLD)对乙型病毒性肝炎孕妇妊娠结局和孕期抗病毒治疗效果的影响,为完善该群体孕期和围生期管理提供更多可靠证据.方法 选取2020年1月1日至2021年12月31日在南京市第二医院产检并分娩的乙型病毒性肝炎孕妇,根据有无NAFLD分为NAFLD组(35例)和non-NAFLD组(156例),通过倾向性得分匹配进行配对,对不良妊娠结局(25对患者)、抗病毒治疗效果(12对患者)进行组间差异比较.结果 与non-NAFLD组相比,NAFLD组发生母儿不良结局的风险增加(均P<0.05),对比两组不良妊娠结局的评分发现差异有统计学意义(P=0.01).妊娠期及产后42d NAFLD组的血小板计数均高于non-NAFLD组,平均血小板体积NAFLD组低于non-NAFLD组.对两组中高病毒载量乙型肝炎孕妇妊娠中期启动抗病毒治疗的效果进行对比,发现基线、抗病毒治疗4周及8周乙型肝炎病毒DNA的水平差异均无统计学意义.结论 NAFLD会增加乙型肝炎孕妇母儿不良结局发生风险,对高病毒载量乙肝孕妇妊娠中期抗病毒治疗效果无明显影响.血小板相关指标可能是合并NAFLD乙肝孕妇潜在的疾病预后预测指标.

Background Data of tenofovir alafenamide (TAF) in preventing mother-to-child transmission (MTCT) of hepatitis B virus (HBV) are limited. This study aimed to evaluate the effectiveness and safety of TAF for preventing MTCT. Methods Pregnant women with chronic HBV infection, positive for HBeAg and high-level HBV DNA, received oral TAF from gestational weeks 24-28 until postpartum week 4. All infants received HBV immunoprophylaxis. All mothers and infants were followed up until postpartum seven month. The primary outcome was the rate of MTCT at seven month. Results Eighty-nine mothers delivered and 91 infants were born. All were followed up to postpartum seven month. TAF was initiated at a mean gestational age of 25.0 (+/- 1.0) weeks with the mean treatment duration of 14.3 (+/- 1.2) weeks before delivery; 92.1% (82/89) mothers discontinued TAF, the median [IQR] time was 5.9 [4.7] weeks postpartum. The HBsAg positive rate was 0% at seven months in 91 infants, no growth retardation and congenital defects. All mothers were tolerated during TAF treatment. At delivery, 82.02% (73/89) mothers achieved HBV DNA < 200,000 IU/ml, 21.35% (19/89) achieved HBV DNA < 500 IU/ml. No significant changes on the mean (+/- SD) serum phosphate between baseline (1.20 +/- 0.10 mmol/L) and at delivery (1.21 +/- 0.13 mmol/L, p > .05). Serum creatinine at delivery (52.23 +/- 8.50 mu mol/L) was higher than baseline (45.97 +/- 5.60 mu mol/L, p < .05), but within normal range. Nine of 82 mothers stopped TAF treatment after delivery had mild ALT elevation. Conclusion TAF therapy initiated during the second trimester was effective in preventing MTCT with no safety concerns for mothers and infants (ClinicalTrials.gov number, NCT04065230).

Objective:To compare the efficacy and safety of telbivudine (LDT) and tenofovir disoproxil fumarate (TDF) treatment during the second and third trimester in pregnant women with high viral load of hepatitis B virus (HBV).Methods:Totally 506 pregnancy women with HBV infection who received antiviral therapy during the second and third trimester of pregnancy in the obstetrical clinic of The Affiliated Nanjing Hospital of Nanjing University of Chinese Medicine from January 1, 2016 to December 31, 2018 were retrospectively enrolled, and the anti-viral efficacy and safety in mothers and neonates were evaluated. Pregnancy women were divided into TDF group and LDT group according the medications. The efficacies including decline and negative rate of HBV DNA, the vertical transmission (VT) rate, the normalization rate of liver function in mothers between the two groups were compared. The safeties including birth weight of neonates, congenital deformities and the rates of preterm between the two groups were also compared. Chi-square test, independent sample t test or rank sum test were used for statistical analysis. Results:There were 239 pregnant women in the LDT group and 267 in the TDF group. The maternal HBV DNA levels before treatment in the LDT and TDF groups were (7.83±0.75) lg IU/mL and (7.82±0.66) lg IU/mL, respectively, while the maternal HBV DNA levels prior to delivery were 2.91(1.20) lg IU/mL and 2.83(1.01) lg IU/mL, respectively. The normalization rates of alanine aminotransferase (ALT) of chronic hepatitis B (CHB) pregnant women prior to delivery in TDF group and LDT group were 95.00%(38/40) and 98.18%(54/55), respectively. There were all no significant differences between the two groups ( t=0.097, U=1.040 and χ2=0.767, respectively, all P>0.05). For CHB pregnant women, the HBV DNA negative rate at one month postpartum in TDF group was 85.45%(47/55) and that in LDT group was 82.50%(33/40). The normalization rate of ALT in TDF group was 94.55%(52/55), and that in LDT group was 92.50%(37/40). There were no significant differences between the two groups ( χ2=0.152 and 0.164, respectively, P=0.697 and 0.687, respectively). The VT rates were 0(0/262) in TDF group and 0.43%(1/231) in LDT group, which had no significant difference between the two groups ( χ2=1.127, P=0.288). Two patients in LDT group who continued taking LDT 11 months postpartum switched to TDF because of HBV rt204 mutation, and no one had virus mutation in TDF group. No significant increased in creatine kinase in LDT group, and no significant abnormal calcium and phosphorus metabolism in the TDF group. The preterm rate was 7.87%(21/267) in TDF group and 4.18%(10/239) in LDT group, but there was no significant difference between the two groups ( χ2=2.970, P=0.085). However, the birth weight of neonates in TDF group ((3 204.72±490.50) g) was lower than that in LDT group ((3 374.31±467.50) g), and the difference was statistically significant ( t=3.780, P<0.01). During the course of treatment, no pregnant women discontinued treatment due to drug intolerance, and no infants presented with drug-related birth defects. Safeties for mothers and neonates were both good. Conclusions:Both LDT and TDF treatment could reduce the VT rate in pregnant women with high HBV viral load. The safety is good for both mothers and neonates. However, for CHB pregnant women who continue antiviral therapy postpartum, TDF is superior to LDT because of lower virus mutation, thus to reduce the risk of drug resistance.