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Teng F, Jin Q. Evaluation of cytokine expressions in patients with recurrent aphthous stomatitis: A systematic review and meta-analysis. PLoS One 2024; 19:e0305355. [PMID: 38861558 PMCID: PMC11166324 DOI: 10.1371/journal.pone.0305355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024] Open
Abstract
This systematic review and meta-analysis aimed to evaluate the expression levels of various T helper (Th) cell-secreted cytokines in recurrent aphthous stomatitis (RAS). Case-control studies comparing the serum or salivary levels of cytokines between RAS patients and healthy controls were searched in PubMed, EMBASE, Web of Science, and Google Scholar prior to September 30, 2023. Cytokines produced by Th1 (interleukin [IL]-1, IL-2, IL-8, IL-12, tumor necrosis factor alpha [TNF-α], interferon gamma [IFN-γ]), Th2 (IL-4, IL-5, IL-6, IL-10, IL-13), and Th17 (IL-17A) cells were investigated. The standard mean difference (SMD) with 95% confidence interval (CI) was calculated to detect the difference. A total of 20 studies comprising 1070 RAS patients and 536 healthy controls were included. RAS patients had significantly higher salivary levels of IL-2 (SMD = 4.15, 95%CI 0.83-7.48), IL-5 (SMD = 0.53, 95%CI 0.05-1.00), IL-6 (SMD = 0.48, 95%CI 0.12-0.84), IL-12 (SMD = 0.94, 95%CI 0.18-1.71), and TNF-α (SMD = 1.31, 95%CI 0.44-2.18) compared to healthy controls. Serum levels of IL-6 (SMD = 0.48, 95%CI 0.30-0.66), TNF-α (SMD = 0.70, 95%CI 0.22-1.17), and IFN-γ (SMD = 0.72, 95%CI 0.17-1.28) were significantly increased, while serum IL-10 levels (SMD = -2.25, 95%CI -3.99 to -0.52) were reduced in RAS patients. Patients diagnosed with major RAS had markedly elevated serum IL-8 levels (SMD = 0.39, 95%CI 0.07-0.71) and a trend toward higher serum IL-6 levels (SMD = 0.51, 95%CI -0.02 to 1.04) than those with minor RAS. In conclusion, Th1/Th2-related cytokines, especially IL-2, IL-6, and TNF-α, are involved in the pathogenesis of RAS development and progression and are potential therapeutic targets for RAS.
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Affiliation(s)
- Fangjun Teng
- Department of Stomatology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qiuchen Jin
- Department of Stomatology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Wei W, Deng Y, Wang Y, Yao H, Du G, Tang G. Dynamic salivary cytokine profile of recurrent aphthous stomatitis patients in thalidomide maintenance treatment. Clin Oral Investig 2024; 28:140. [PMID: 38334890 DOI: 10.1007/s00784-024-05531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To dynamically compare the longitudinal (time axis) and transverse (between groups) differences of the salivary cytokines during thalidomide maintenance treatment of recurrent aphthous stomatitis. METHODS A randomized, controlled, clinical trial was performed. After the initial prednisone treatment, thalidomide (50 mg/d vs. 25 mg/d) was used as a maintenance drug for 4 or 8 weeks. The salivary IL-4, 5, 6, 10, TNF-α, and IFN-γ were dynamically detected with a cytometric bead array. RESULTS Overall, the level of six elevated salivary cytokines after prednisone treatment was significantly downregulated, remained low during thalidomide maintenance, and rebounded at recurrence. The effect of 50 mg/d thalidomide on the salivary cytokines was not superior to 25 mg/d medication. The relapse-free period following drug withdrawal was the longest in the subgroup using 25 mg/d thalidomide for 8 weeks. The order of magnitude of IL-6 was the most obvious, and at week 8, only the level of IL-6 in the group (25 mg/d thalidomide for 8 weeks) continued to decline compared with the other groups. CONCLUSION Thalidomide maintenance treatment can effectively sustain low levels of salivary IL-4, 5, 6, 10, TNF-α, and IFN-γ of recurrent aphthous stomatitis patients. IL-6 displayed a good correlation with the disease and is expected to become an index for diagnosis and follow-up. CLINICAL RELEVANCE Low-dose long-term thalidomide maintenance treatment was supported for recurrent aphthous stomatitis. TRIAL REGISTRATION Trial registration number of ChiCTR-IPR-16009759 at http://www.chictr.org/index.aspx .
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Affiliation(s)
- Wei Wei
- Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University School of Medicine Ear Institute, Shanghai Key Laboratory of Translational Medicine On Ear and Nose Diseases, Shanghai, 200092, China
| | - Yiwen Deng
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Yufeng Wang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Hui Yao
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Guanhuan Du
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China.
| | - Guoyao Tang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China.
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Assiri K, Hosmani J, Chalikkandy SN, Alkahtani AM, Alhanif RM, Alsarh SA, Patil S, Reda R, Testarelli L. Correlating Salivary Levels of Immunoglobin E and Human Eosinophil Cationic Protein in the Aseer Cohort with Recurrent Apthous Stomatitis. Int J Gen Med 2023; 16:2923-2931. [PMID: 37457753 PMCID: PMC10348369 DOI: 10.2147/ijgm.s410061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
Background Repeated Aphthous Stomatitis (RAS) is the most prevalent inflammatory disorder of the oral mucosa, characterized by recurrent emergence of single or numerous painful ulcers. RAS usually affects healthy people without systemic illnesses. There is evidence linking atopy to the progression of this illness. Immunoglobulin E (IgE) and human eosinophil cationic protein (HECP) levels in the saliva of individuals with aphthous stomatitis were assessed as allergy-related indicators. Materials and Methods Sixty people were assessed for this study. 30 patients with RAS were included in the patient group, while 30 healthy individuals made up for the control group. Sixty participants' non-stimulated saliva was taken and IgE and HECP were evaluated using enzyme-linked immunosorbent assay (ELISA). Data were analyzed in SPSS 20 through the Mann-Whitney test and p<0.05 was considered significant. Results The salivary level of HECP was significantly (p 0.05) higher among cases (0.83 0.70) compared to controls (0.170 0.15), whereas the salivary level of IgE was not significantly (p = 0.41) higher among cases (35.60 11.19) compared to controls (67.42 18.34). Conclusion Even though this study found a positive correlation between elevated HECP levels and RAS, additional research with larger sample sizes is required to identify the biological mechanisms responsible for the observed associations and to include salivary HECP levels in the RAS patient's evaluation.
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Affiliation(s)
- Khalil Assiri
- Department of Diagnostic Dental Sciences, College of Dentistry, King Khalid University, Abha, 62529, Saudi Arabia
| | - Jagadish Hosmani
- Department of Diagnostic Dental Sciences, College of Dentistry, King Khalid University, Abha, 62529, Saudi Arabia
| | | | - Abdullah M Alkahtani
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | | | - Shankargouda Patil
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT, 84095, USA
| | - Rodolfo Reda
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, 00161, Italy
| | - Luca Testarelli
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, 00161, Italy
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Surboyo MDC, Boedi RM, Hariyani N, Santosh ABR, Manuaba IBPP, Cecilia PH, Ambarawati IGAD, Parmadiati AE, Ernawati DS. The expression of TNF-α in recurrent aphthous stomatitis: A systematic review and meta-analysis. Cytokine 2022; 157:155946. [PMID: 35728503 DOI: 10.1016/j.cyto.2022.155946] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The pathogenesis of recurrent aphthous stomatitis (RAS) is related to an increase of pro-inflammatory cytokine, namely tumor necrosis factor α (TNF-α). This cytokine plays an important role in the development of ulcer lesions, both in saliva, tissues and blood. This systematic review analyzed the differences of TNF-α in lesions, salivary and blood and can be used as a reliable method of diagnosis for RAS. METHODS A comprehensive search of PubMed, Scopus databases, Web of Science, Scielo, Google Scholar and Embase with keywords. The inclusion criteria were studies that assessed the saliva, serum, and RAS lesion, with the outcome reporting the mean of saliva, serum and tissue expression of TNF-α. The risk of bias was also assessed. RESULT Healthy individuals showed significantly lower TNF-α than RAS (SMD = -1.517, 95% CI [-2.25, -0.78]). Although there is a significant difference between sample (i.e., saliva, serum) and detection type (i.e., cytometry bead array, ELISA), both methods can detect a significant difference in TNF-α between healthy individuals and RAS patients. CONCLUSIONS The TNF-α is a useful diagnostic marker for RAS. We encourage saliva to detect changes in TNF-α during ulceration as it provides accuracy, reliability, and non-invasive procedure compared to a blood draw.
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Affiliation(s)
| | - Rizky Merdietio Boedi
- Department of Dentistry, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia; Centre of Forensic and Legal Medicine and Dentistry, School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Ninuk Hariyani
- Department of Dental Public Health, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Arvind Babu Rajendra Santosh
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia; School of Dentistry, Faculty of Medical Sciences, University of The West Indies, Jamaica
| | | | - Pamela Handy Cecilia
- Graduate School of Dental Sciences Program, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | | | - Diah Savitri Ernawati
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
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Changes in Th1/Th2-related cytokine expression in the saliva of patients with recurrent aphthous stomatitis before and after prednisone treatment. Clin Oral Investig 2022; 26:1089-1093. [DOI: 10.1007/s00784-021-04349-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/18/2021] [Indexed: 12/15/2022]
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Luo K, Zhao H, Bian B, Wei X, Si N, Brantner A, Fan X, Gu X, Zhou Y, Wang H. Huanglian Jiedu Decoction in the Treatment of the Traditional Chinese Medicine Syndrome "Shanghuo"-An Intervention Study. Front Pharmacol 2021; 12:616318. [PMID: 33995016 PMCID: PMC8120301 DOI: 10.3389/fphar.2021.616318] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/05/2021] [Indexed: 01/16/2023] Open
Abstract
“Shanghuo” (“excessive internal heat”) is caused by exuberant endogenous fire, which does not have a comprehensive and systematic traditional Chinese medicine theory. In previous study, we had evaluated the therapeutic effect of Huanglian Jiedu Decoction (HLJDD) (granule) on patients with “Shanghuo”, however, the specific mechanism was not clear, which need further exploration. To explain its intervention mechanism, we select 57 patients with oral diseases caused by “Shanghuo” and 20 health volunteers to divide into oral disease group, HLJDD intervention group and healthy control group. Firstly, biochemical indicators before and after HLJDD intervention are detected, such as inflammatory factors, oxidative stress factors and energy metabolism factors. The results exhibit that HLJDD significantly decreases indicators succinic acid (p < 0.001); tumor necrosis factor-alpha, adenosine triphosphate, citric acid (p < 0.01); interleukin-8 (IL-8), 4-hydroxynonenal, pyruvic acid, lactate dehydrogenase (p < 0.05). The levels of glucocorticoid, adrenocorticotropic hormone (p < 0.01); lactic acid, IL-4, IL-10 (p < 0.05) significantly increase after HLJDD intervention. In addition, we adopt multi-omics analysis approach to investigate the potential biomarkers. Nontargeted metabolomics demonstrate that the levels of 7 differential metabolites approach that in the healthy control group after HLJDD intervention, which are correlated with histidine metabolism, beta-alanine metabolism and sphingolipid metabolism through metabolic pathway analysis. Targeted lipidomics results and receiver operating characteristic curve analysis show that 13 differential lipids are identified in the three groups mainly focuse on lysophosphatidylcholines, lysophosphatidylethanolamines. Finally, the network associations of those differential biomarkers reveal the regulation of adenosine triphosphate and tricarboxylic acid cycle play essential role in the therapeutic effect mechanism of HLJDD in “Shanghuo”. The study has laid the foundation for further revealing the mechanism and finding clinical biomarkers related to “Shanghuo”.
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Affiliation(s)
- Keke Luo
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Haiyu Zhao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Baolin Bian
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaolu Wei
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Nan Si
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Adelheid Brantner
- Institute of Pharmaceutical Sciences, University of Graz, Graz, Austria
| | - Xiaorui Fan
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinru Gu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanyan Zhou
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hongjie Wang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
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Shen C, Ye W, Gong L, Lv K, Gao B, Yao H. Serum interleukin-6, interleukin-17A, and tumor necrosis factor-alpha in patients with recurrent aphthous stomatitis. J Oral Pathol Med 2021; 50:418-423. [PMID: 33432616 DOI: 10.1111/jop.13158] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recurrent aphthous stomatitis remains the most common disease of the oral mucosa. The aim of this study was to investigate the clinical significance of serum interleukin-6, interleukin-17A, and tumor necrosis factor-alpha in recurrent aphthous stomatitis. METHODS Using flow cytometry analysis, we detect the level of serum interleukin-2, interleukin-6, interleukin-17A, tumor necrosis factor-alpha, and interferon-gamma in 127 patients with recurrent aphthous stomatitis and 20 healthy control cases; compare; and analyze the correlation of each index. RESULTS The levels of serum interleukin-2, interleukin-6, tumor necrosis factor-alpha, and interferon-gamma in the recurrent aphthous stomatitis group were higher than in the control group, and the differences were statistically significant (P < .05). There was no significant difference in interleukin-17A between the two groups. CONCLUSION The levels of serum interleukin-6 and tumor necrosis factor-alpha in recurrent aphthous stomatitis patients were significantly increased. Considering that serum TNF-α was mostly within the normal range, its role in the pathology of RAS needed to be further explored.
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Affiliation(s)
- Chenlu Shen
- Department of Stomatology, the First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Weijia Ye
- Department of Stomatology, the First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Lijun Gong
- Department of Stomatology, the First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Kejia Lv
- Department of Stomatology, the First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Bicong Gao
- Department of Stomatology, the First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Hua Yao
- Department of Stomatology, the First Affiliated Hospital, Zhejiang University, Hangzhou, China
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Borst J, Ma L. Oral ulcerations in a patient with autosomal dominant hyper-IgE syndrome (AD-HIES). BMJ Case Rep 2020; 13:13/11/e236705. [PMID: 33139362 DOI: 10.1136/bcr-2020-236705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 23-year-old woman with autosomal dominant hyper-IgE syndrome complicated by recurrent pneumonia and sinusitis presented with 1 week of multiple painful oral ulcers unresponsive to empiric antiviral and antifungal treatment. Her ulcers progressively worsened and she required hospitalisation for intravenous hydration and pain control. PCR swab of an ulcer was positive for varicella-zoster virus. Her symptoms never fully resolved despite antiviral therapy, and within 2 weeks, she relapsed with new and worsening ulcers. Biopsy revealed chronic active inflammation with no evidence of viral inclusion bodies or fungal hyphae. She was diagnosed with recurrent aphthous stomatitis and referred to a local dentist for CO2 laser treatments with rapid resolution of her symptoms. This case highlights the broad differential for recurrent oral ulcers in people with a primary immunodeficiency. It also raises awareness of the benefits of laser therapy for aphthous stomatitis treatment and the importance of partnering with our colleagues in dentistry.
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Affiliation(s)
- Johanna Borst
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Lawrence Ma
- Department of Internal Medicine and Pediatrics, University of California San Diego, La Jolla, California, USA
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de Perosanz-Lobo D, Latour I, Ortega-Quijano D, Fernández-Guarino M, Torrelo A. Severe recurrent aphthous stomatitis treated with adalimumab: A case report in a teenage patient. Pediatr Dermatol 2019; 36:986-987. [PMID: 31588588 DOI: 10.1111/pde.14003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recurrent aphthous stomatitis (RAS) is a chronic disorder of unknown etiology characterized by recurring ulcers involving the oral mucosa in patients with no other manifestations. It is a common cause of oral ulcers in children. In its major form, RAS can be a severe and disabling disorder due to pain and scarring, and poses a therapeutic challenge. Therapies for major RAS include prednisone, thalidomide, colchicine, and dapsone. However, many patients do not achieve adequate control of the disease with them (J Clin Diagn Res, 10, 2016 and ZE08). We report a case of severe RAS in a teenager with a dramatic response to adalimumab.
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Affiliation(s)
| | - Irene Latour
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Zeng Q, Shi X, Yang J, Yang M, Zhao W, Zhao X, Shi J, Zhou H. The efficacy and safety of thalidomide on the recurrence interval of continuous recurrent aphthous ulceration: A randomized controlled clinical trial. J Oral Pathol Med 2019; 49:357-364. [PMID: 31514233 DOI: 10.1111/jop.12960] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Qingxiang Zeng
- State Key Laboratory of Oral Diseases Department of Oral Medicine West China Hospital of Stomatology Sichuan University Chengdu Sichuan China
| | - Xueke Shi
- State Key Laboratory of Oral Diseases Department of Oral Medicine West China Hospital of Stomatology Sichuan University Chengdu Sichuan China
| | - Jin Yang
- State Key Laboratory of Oral Diseases Department of Oral Medicine West China Hospital of Stomatology Sichuan University Chengdu Sichuan China
| | - Miao Yang
- State Key Laboratory of Oral Diseases Department of Oral Medicine West China Hospital of Stomatology Sichuan University Chengdu Sichuan China
| | - Wei Zhao
- State Key Laboratory of Oral Diseases Department of Oral Medicine West China Hospital of Stomatology Sichuan University Chengdu Sichuan China
| | - Xiaoyi Zhao
- Department of pharmacy West China Hospital of Stomatology Sichuan University Chengdu Sichuan China
| | - Jiahong Shi
- State Key Laboratory of Oral Diseases Department of Oral Medicine West China Hospital of Stomatology Sichuan University Chengdu Sichuan China
| | - Hongmei Zhou
- State Key Laboratory of Oral Diseases Department of Oral Medicine West China Hospital of Stomatology Sichuan University Chengdu Sichuan China
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