Erratum: Author correction to "TMEM16A inhibits angiotensin II-induced basilar artery smooth muscle cell migration in a WNK1-dependent manner" Acta Pharm Sin B 11(12) (2021) 3994-4007

[This corrects the article DOI: 10.1016/j.apsb.2021.04.013.].

Effects of sarcopenia on the occurrence of overt hepatic encephalopathy in patients with liver cirrhosis / 中华消化杂志

Objective:To investigate the risk factors of overt hepatic encephalopathy (OHE) in patients with liver cirrhosis, and to clarify the effect of sarcopenia on OHE.Methods:Based on the liver cirrhosis cohort established by our research group, from January 1, 2013 to December 31, 2017, 480 patients diagnosed with liver cirrhosis and underwent upper abdominal computed tomography were selected from 3 centers, including the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai East Hospital Affiliated to Tongji University, and Shandong Provincial Hospital. The L3 skeletal muscle index (L3-SMI) <44.77 cm 2/m 2 for males and L3-SMI <32.50 cm 2/m 2 for females were used as the diagnostic criterion for sarcopenia. The clinical data of all the patients were collected, including baseline medical history, age, serum total bilirubin, serum levels of aspartate aminotransferase (AST), γ-glutamyl transpeptidase (GGT), albumin, sodium, prothrombin time (PT), international normalized ratio (INR), hemoglobin, platelet count, etc, as well as Child-Pugh classification of liver function, and model for end-stage liver disease (MELD) score. Independent sample t test, rank sum test, and chi-square test were used for statistical analysis. Binary logistic regression analysis was used to analyze the independent risk factors for OHE in patients with liver cirrhosis, and Kaplan-Meier method was used to analyze the effect of sarcopenia on the incidence of OHE in patients with liver cirrhosis. Results:After 2 years of follow-up, the incidence of OHE was 16.2% (78/480). The age, serum total bilirubin level, AST, GGT, PT, INR, Child-Pugh score, and MELD score of OHE patients were all higher than those of non-OHE patients ((59.67±10.30) years old vs. (53.41±12.06) years old, 35.25 μmol/L(20.10 μmol/L, 60.53 μmol/L) vs. 22.70 μmol/L(15.10 μmol/L, 35.20 μmol/L), 40.00 U/L(27.25 U/L, 61.00 U/L) vs. 33.00 U/L(24.75 U/L, 47.00 U/L), 52.50 U/L(26.25 U/L, 86.75 U/L) vs. 34.50 U/L(22.00 U/L, 73.00 U/L), (17.71±3.52) s vs. (15.50±2.98) s, 1.50±0.34 vs. 1.31±0.29, 8.95±2.19 vs.7.20±1.94, 13.56±4.42 vs.11.42±3.92), while serum albumin, serum sodium and platelet count of OHE patients were all lower than those of non-OHE patients ((29.72±5.55) g/L vs. (33.19±5.89) g/L, 139.00 mmol/L(136.00 mmol/L, 142.00 mmol/L)vs.140.00 mmol/L (138.00 mmol/L, 142.00 mmol/L), 60.00×10 9/L(43.75×10 9/L, 90.25×10 9/L) vs. 80.00×10 9/L(56.00×10 9/L, 131.00×10 9/L)), and the differences were statistically significant ( t=-4.77; Z=-4.10, -3.13, -2.24; t=-5.19, -4.71, -6.57, -3.98, 4.99; and Z=2.44 and 3.48; all P<0.05). The proportions of ascites, hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis at baseline, and the incidence of sarcopenia in OHE patients were all higher than those in non-OHE patients (82.1%, 64/78 vs. 63.7%, 256/402; 41.0%, 32/78 vs. 3.5%, 14/402; 5.1%, 4/78 vs. 1.0%, 4/402; 14.1%, 11/78 vs. 2.5%, 10/402; 37.2%, 29/78 vs. 19.7%, 79/402), and the L3-SMI of OHE patients was lower than that of non-OHE patients ((43.14±8.97) cm 2/m 2 vs. (46.29±8.49) cm 2/m 2), and the differences were statistically significant ( χ2=9.11, 101.97, 4.52, 18.38, 10.53; t=2.86; all P<0.05). The results of binary logistic regression analysis indicated that platelet count ( OR=0.995, 95% confidence interval (95% CI) 0.991 to 1.000, P=0.038), L3-SMI ( OR=0.959, 95% CI 0.922 to 0.997, P=0.035) and hepatic encephalopathy ( OR=14.724, 95% CI 6.741 to 32.161, P<0.001) were independent influencing factors for OHE in patients with liver cirrhosis. The incidence of OHE in patients with sarcopenia was higher than that of patients without sarcopenia (26.9%, 29/108 vs. 13.2%, 49/372), and the difference was statistically significant ( χ2=10.53, P=0.001). The results of Kaplan-Meier analysis demonstrated that patients with sarcopenia were more likely to develop OHE ( P<0.001). Conclusion:Sarcopenia is closely correlated to OHE and is an independent predictor of OHE in patients with liver cirrhosis.

Oral mucosal lesions with transient self-healing of Langerhans cell histiocytosis: a case report / 华西口腔医学杂志

Langerhans cell histiocytosis (LCH) is a group of unexplainable abnormal proliferation and aggregation of Langerhans cell. LCH can be classified into four clinical variants: Letterer-Siwe disease, Hand-Schüller-Christian disease, eosinophilic granuloma, and congenital self-healing LCH. LCH is most prevalent in children. Lesions can be localized in a single system or multiple organs, and clinical manifestations vary depending on the affected organs. The skin and mucocutaneous tissues are the starting point of the affected tissue. This study presents a LCH case characterized by transient self-healing. This case can further provide references for the clinical diagnosis and treatment of LCH.

Interpretation of the Chinese Consensus on Clinical Diagnosis and Management of Covert Hepatic Encephalopathy / 胃肠病学

Recently,Chinese Society of Gastroenterology of Chinese Medical Association organized the experts to formulate the Chinese consensus on clinical diagnosis and management of covert hepatic encephalopathy.The consensus was developed based on a review of recent domestic and foreign guidelines,a summary of the new achievements in the field,and a consideration of the practice of China.The consensus updated the concept and epidemiological characteristics,explained the risk factors,pathogenesis,and hazards of covert hepatic encephalopathy,and provided recommendations for its diagnosis,treatment,and chronic disease management.This paper interpreted the key points of this consensus,to provide reference and guidance for clinical practice.

Analysis of risk factors of sarcopenia in maintenance hemodialysis patients / 中华肾脏病杂志

Objective:To explore the prevalence and risk factors of sarcopenia in patients with maintenance dialysis (MHD).Methods:It was a cross-sectional study. Patients who received MHD treatment in the Blood Purification Center of Hainan Provincial People's Hospital in October 2019 were included as study subjects. The patients were divided into sarcopenia group and non-sarcopenia group according to whether they had sarcopenia or not. Chest CT imaging and laboratory examination data were collected. Dual-energy X-ray absorptiometry was used to measure the skeletal muscle mass. Chi-square test or Mantel-Haenszel trend chi-square test was used to compare the clinical data of patients with and without sarcopenia. Multivariate logistic regression equation was used to analyze the risk factors of sarcopenia.Results:A total of 182 MHD patients were enrolled in the study, and the prevalence of sarcopenia was 33.5% (61/182). The proportions of age ≥60 years old, diabetic nephropathy, tunneled-cuffed catheter, body mass index <18 kg/m 2, serum albumin <40 g/L, low density lipoprotein cholesterol ≥3.37 mmol/L, left ventricular ejection fraction <50%, chest CT-suspected pulmonary tuberculosis (PTB) and PTB in sarcopenia group were higher than those in non-sarcopenia group (all P<0.05). Multivariate logistic regression analysis results showed that left ventricular ejection fraction <50% (≥50% as a reference, OR=3.250, 95% CI 1.035-10.206, P=0.044), low-density lipoprotein cholesterol ≥3.37 mmol/L (<3.37 mmol/L as a reference, OR=6.354 ,95% CI 1.675-24.108, P=0.007), chest CT-suspected PTB (normal as a reference, OR=7.433, 95% CI 1.531-36.083, P=0.013), and PTB (normal as a reference, OR=28.871, 95% CI 3.208-259.872, P=0.030) were independent influencing factors of sarcopenia in MHD patients. Conclusions:The prevalence of sarcopenia is higher in MHD patients. Blood low-density lipoprotein cholesterol ≥3.37 mmol/L, ejection fraction <50%, chest CT-PTB and suspected PTB are independent risk factors of sarcopenia in MHD patients. Correcting left ventricular systolic function, regulating blood lipids and preventing PTB as early as possible can reduce the prevalence of sarcopenia in MHD patients.

Interpretation of the Chinese consensus on clinical diagnosis and management of covert hepatic encephalopathy / 中华消化杂志

Recently, Chinese Society of Gastroenterology of Chinese Medical Association organized the experts to formulate the Chinese consensus on clinical diagnosis and management of covert hepatic encephalopathy. The consensus was developed based on a review of recent domestic and foreign guidelines, a summary of the new achievements in the field, and a consideration of the practice of China. The consensus updated the concept and epidemiological characteristics, explained the risk factors, pathogenesis, and hazards of covert hepatic encephalopathy, and provided recommendations for its diagnosis, treatment, and chronic disease management. This paper interpreted the key points of this consensus, to provide reference and guidance for clinical practice.

Ethanol extract of Herpetospermum caudigerum Wall ameliorates psoriasis-like skin inflammation and promotes degradation of keratinocyte-derived ICAM-1 and CXCL9 / 中西医结合学报

OBJECTIVE@#To explore whether the ethanol extract of Herpetospermum caudigerum Wall (EHC), a Xizang medicinal plant traditionally used for treating liver diseases, can improve imiquimod-induced psoriasis-like skin inflammation.@*METHODS@#Immunohistochemistry and immunofluorescence staining were used to determine the effects of topical EHC use in vivo on the skin pathology of imiquimod-induced psoriasis in mice. The protein levels of interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), and interleukin-17A (IL-17A) in mouse skin samples were examined using immunohistochemical staining. In vitro, IFN-γ-induced HaCaT cells with or without EHC treatment were used to evaluate the expression of keratinocyte-derived intercellular cell adhesion molecule-1 (ICAM-1) and chemokine CXC ligand 9 (CXCL9) using Western blotting and reverse transcription-quantitative polymerase chain reaction. The protein synthesis inhibitor cycloheximide and proteasome inhibitor MG132 were utilized to validate the EHC-mediated mechanism underlying degradation of ICAM-1 and CXCL9.@*RESULTS@#EHC improved inflammation in the imiquimod-induced psoriasis mouse model and reduced the levels of IFN-γ, TNF-α, and IL-17A in psoriatic lesions. Treatment with EHC also suppressed ICAM-1 and CXCL9 in epidermal keratinocytes. Further mechanistic studies revealed that EHC suppressed keratinocyte-derived ICAM-1 and CXCL9 by promoting ubiquitin-proteasome-mediated protein degradation rather than transcriptional repression. Seven primary compounds including ehletianol C, dehydrodiconiferyl alcohol, herpetrione, herpetin, herpetotriol, herpetetrone and herpetetrol were identified from the EHC using ultra-performance liquid chromatography-quadrupole-time of flight-mass spectrometry.@*CONCLUSION@#Topical application of EHC ameliorates psoriasis-like skin symptoms and improves the inflammation at the lesion sites. Please cite this article as: Zhong Y, Zhang BW, Li JT, Zeng X, Pei JX, Zhang YM, Yang YX, Li FL, Deng Y, Zhao Q. Ethanol extract of Herpetospermum caudigerum Wall ameliorates psoriasis-like skin inflammation and promotes degradation of keratinocyte-derived ICAM-1 and CXCL9. J Integr Med. 2023; 21(6): 584-592.

Erratum: Author correction to 'TMEM16A inhibits angiotensin II-induced basilar artery smooth muscle cell migration in a WNK1-dependent manner' Acta Pharmaceutica Sinica B 11 (2021) 3994-4007

[This corrects the article DOI: 10.1016/j.apsb.2021.04.013.].

Progress of Research on Gut Mycobiome and Chronic Liver Diseases / 胃肠病学

Gut mycobiome plays an important role in host’s health, and many chronic liver diseases are accompanied by gut fungi disorder. Gut mycobiome is involved in the development of liver diseases through direct colonization or indirectly through its metabolites and various regulatory factors. Regulation of intestinal fungi may provide a new strategy for the treatment of chronic liver disease. This article reviewed research methods for gut fungi and compositional changes in fungi associated with chronic liver diseases, explored the impact of gut mycobiome on liver disease pathogenesis, assessed its potential utility as therapeutic target,and objected to provide a reference for further research on liver diseases and gut mycobiome. Future researches should further explore the characteristics of intestinal fungi and their metabolites in various liver diseases so as to provide new methods for the prevention, diagnosis, and treatment of liver diseases.

Current Status and Research Trends of Panax Between 1900-2019: A Bibliometric Analysis / 中国结合医学杂志

OBJECTIVE@#To investigate the current status and further development of Panax genus and 6 important individual species including P. notoginseng, P. quinquefolium, P. vietnamensis, P. japonicus, P. stipuleanatus and P. zingiberensis.@*METHODS@#The bibliometric analysis was based on the Web of Science core database platform from Thomson Reuters. Totally, 7,574 records of scientific research of Panax species published from 1900-2019 were analyzed. The statistical and visualization analysis was performed by CiteSpace and HistCite software.@*RESULTS@#The academic research of Panax species increase promptly. Plant science is the main research field while research and experimental medicine and agricultural engineering will be the further development tendency. Particularly, the discrimination research of P. notoginseng will be the research tendency among Panax species, especially diversity research. In addition, P. vietnamensis deserves more attention in the genus Panax.@*CONCLUSION@#This research provides a reference for further research of the genus and individual species.

Difficult and complicated oral ulceration: an expert consensus guideline for diagnosis / 国际口腔科学杂志·英文版

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.

Effect of DC vaccine sensitized with CpG ODN combined with tumor antigen on murine melanoma / 药学学报

The potential application of dendritic cells (DC) sensitized with cytosine-phosphoric acid-guanine (CpG) oligodeoxynucleotide (ODN) and tumor antigen as a vaccine against murine melanoma was investigated with freshly isolated mouse bone marrow-derived dendritic cells. For the DC vaccine preparation, DC were sensitized with the B16 tumor antigen and CpG ODN was used to promote further maturation of the DC. The immunogenic activity of the vaccine was evaluated in vitro by determining the proliferation of T lymphocytes and the killing effect of cytotoxic T lymphocytes (CTL) on B16 tumor cells. The DC vaccine was injected intraperitoneally and tumor inhibition in mice bearing B16 xenografts was examined. All mice were cared for under an approved SIMM Institutional Animal Care and Use Committee (IACUC) protocol. In vitro, this DC vaccine promoted the proliferation of T lymphocytes and showed a potent killing effect on the target B16 cells. In vivo experiments showed that after treatment or pre-immunization both the tumor volume and weight were significantly decreased. The DC vaccine with CpG ODN and tumor antigen exhibited an inhibitory effect against melanoma, providing a potential method for melanoma cancer treatment.

Establishment of a nomogram for survival rate after liver resection for primary small hepatocellular carcinoma based on SEER data and external validation / 临床肝胆病杂志

Objective To establish a nomogram for overall survival rate after liver resection for primary small hepatocellular carcinoma based on SEER data and external validation of Chinese data. Methods The data of 1809 patients, registered in National Cancer Institute SEER database in 2004-2015, who underwent hepatectomy for primary small hepatocellular carcinoma were extracted as modeling group, and 158 patients with small hepatocellular carcinoma who underwent hepatectomy in Affiliated Hospital of North Sichuan Medical College from 2010 to 2017 were collected as validation group. The univariate Cox risk regression analysis, lasso regression analysis, and multivariate Cox hazard regression analysis were used to investigate the influencing factors for OS after hepatectomy in patients with small hepatocellular carcinoma. A nomogram was established based on the independent influencing factors for OS, and index of concordance (C-index), calibration curves, and receiver operating characteristic (ROC) curve were used to analyze the predictive ability of the nomogram. The Kaplan-Meier survival analysis and the log-rank test were used to investigate the difference in survival between the high- and low-risk groups. Results The multivariate Cox hazard regression analysis showed that sex (hazard ratio [ HR ]=1.22, 95% confidence interval [ CI ]: 1.05-1.41, P =0.010), Seer stage ( HR =1.51, 95% CI : 1.23-1.85, P < 0.001; HR =10.31, 95% CI : 2.53-42.04, P =0.001), tumor diameter ( HR =1.22, 95% CI : 1.06-1.39, P =0.004), vascular invasion or metastasis ( HR =1.43, 95% CI : 1.24-1.65, P < 0.001), and alpha-fetoprotein ( HR =1.33, 95% CI : 1.16-1.54, P < 0.001) were independent risk factors for OS after hepatectomy for small hepatocellular carcinoma. The modeling group had a C-index of 0.621, and its area under the ROC curve at 1, 2, and 3 years was 0.666(95% CI 0.628-0.704), 0.678(95% CI 0.647-0.708), and 0.663(95% CI : 0.635-0.690), respectively; the validation group had a C-index of 0.718, and its area under the ROC curve at 1, 2, and 3 years was 0.695(95% CI : 0.593-0.797), 0.781(95% CI : 0.706-0.856), and 0.759(95% CI 0.669-0.848), respectively. Risk stratification was performed based on the nomogram, and the Kaplan-Meier survival analysis showed that for both the modeling group and the validation group, the low-risk group had a significantly better prognosis than the high-risk group ( P < 0.01). Conclusion The model established for survival rate after liver resection for primary small hepatocellular carcinoma can predict the 1-, 2-, and 3-year OS rates and can thus be used in clinical practice in China.

Recent progress in targeting degradation of FAK based on PROTAC / 药学学报

Local focal adhesion kinase (FAK) is a non-receptor intracellular tyrosine kinase that plays an important role in tumor initiation, development, metastasis and invasion, and is considered to be an important target for the development of antineoplastic drugs. It has both kinase-dependent and non-kinase-dependent scaffolding functions. However, traditional small molecular inhibitors can only inhibit its kinase-dependent activity, so it is difficult to target the kinase-independent scaffolding function. Therefore, there is an urgent need for novel strategies to enhance FAK targeting to lay the foundation for determining the druggability and discovery of FAK inhibitors. Proteolysis targeting chimera (PROTAC) is a new drug development strategy that can recruit E3 ligase to specifically ubiquitinylate target proteins for degradation through the proteasome system. The unique mechanism of action of the PROTAC system could be used to target and degrade the FAK protein, thus eliminating the scaffolding function of FAK. In this review, FAK protein, the signaling pathway, and small molecule inhibitors are briefly described, and the latest research progress in targeting the degradation of FAK using PROTAC technology is summarized.

TMEM16A inhibits angiotensin II-induced basilar artery smooth muscle cell migration in a WNK1-dependent manner

Vascular smooth muscle cell (VSMC) migration plays a critical role in the pathogenesis of many cardiovascular diseases. We recently showed that TMEM16A is involved in hypertension-induced cerebrovascular remodeling. However, it is unclear whether this effect is related to the regulation of VSMC migration. Here, we investigated whether and how TMEM16A contributes to migration in basilar artery smooth muscle cells (BASMCs). We observed that AngII increased the migration of cultured BASMCs, which was markedly inhibited by overexpression of TMEM16A. TMEM16A overexpression inhibited AngII-induced RhoA/ROCK2 activation, and myosin light chain phosphatase (MLCP) and myosin light chain (MLC20) phosphorylation. But AngII-induced myosin light chain kinase (MLCK) activation was not affected by TMEM16A. Furthermore, a suppressed activation of integrin

Application of medical magnifying loupes in diagnosis of oral mucosal diseases / 浙江大学学报·医学版

: To evaluate the application of medical magnifying loupes in diagnosis of oral mucosal diseases. Twenty-four patients with plaque-type oral lichen planus or homogeneous oral leukoplakia were inspected by naked eyes or assistance with magnifying loupes. Histopathological results were used as the gold standard to evaluate the sensitivity, specificity and accuracy of the two methods in clinical diagnosis. Questionnaires were used to evaluate the subjective effect of magnifying loupes on the diagnosis efficiency of oral mucosal diseases and to explore the most suitable parameters for application. The sensitivity, specificity and accuracy of medical magnifying loupes for the identification of plaque-type oral lichen planus and homogeneous oral leukoplakia were 94.74%, 100.00% and 95.83%, respectively, which were significantly higher than those of naked eye inspection (89.47%, 80.00% and 87.50%). The effective rate of magnifying loupes assisted diagnosis was 91.76% according to physicians' subjective evaluation. The most suitable parameters were 3.5 times magnification and working distance. The medical magnifying loupes can effectively improve the efficiency of the inspection and diagnosis of oral mucosal diseases, and have the characteristics of convenience and real-time. The recommended clinical parameters are 3.5 times magnification and working distance.

Diagnostic strategies for oral manifestations of infectious diseases / 浙江大学学报·医学版

Infectious diseases are caused by infection of organism with pathogenic agents, which may lead to epidemics. Many infectious diseases such as syphilis, diphtheria, measles, and acquired immunodeficiency syndrome have specific and non-specific manifestations in the oral cavity. However, the same disease may have different oral manifestations in different patients clinically. We can apply the strategy of "three unusuals and one change" in clinical reasoning for diagnosis of infectious diseases with oral manifestations. The so-called "three unusuals" refer to unusual age, unusual location and unusual effect, and "one change" means the change from rare to common. In this article, we will give a comprehensive introduction about the oral manifestations of common communicable diseases and their diagnostic strategies.

Research progress on Melkersson-Rosenthal syndrome / 浙江大学学报·医学版

Melkersson-Rosenthal syndrome (MRS) is a rare neuro-muco-cutaneous syndrome, which is characterized by recurrent orofacial swelling, recurrent facial paralysis and fissured tongue. It has a high prevalence in young adults. Up to now, the etiology of MRS is still not clear, it may related to infection, immune deficiency and hereditary factors. The pharmacological therapy and surgery are the main treatment. Corticosteroids seems to be the drug of choice for MRS patient, but the specific dosage and therapeutic effect have not yet been determined. Surgeries of lips provide excellent results in persistentlip edema MRS cases. This article reviews the research progress on MRS, focusing on its epidemiology, etiology, histopathological characteristics, clinical manifestations, classification, diagnostic criteria, differential diagnosis and treatment, to provide information for its early diagnosis and appropriate treatment.

Pathogenic role of NDUFA13 inactivation in spontaneous hepatitis in mice and the mechanism / 南方医科大学学报

OBJECTIVE@#To investigate the role of NDUFA13 inactivation in the pathogenesis of spontaneous hepatitis in mice and explore the possible mechanisms.@*METHODS@#Hepatocyte-specific NDUFA13 knockout (NDUFA13@*RESULTS@#Liver-specific NDUFA13 heterozygous knockout mice were successfully constructed as verified by PCR results. HE staining revealed severe liver damage in both 4- week-old and 2-year-old NDUFA13@*CONCLUSIONS@#Hepatocytes-specific NDUFA13 ablation can trigger spontaneous hepatitis in mice possibly mediated by the activation of ROS/NF-κB/NLRP3 signaling.

Investigation and analysis of children's choice of environment in oral clinics / 华西口腔医学杂志

OBJECTIVES@#To investigate and analyze children,s choice of environment in oral clinics so as to provide evidence for improving the oral clinic environment.@*METHODS@#A total of 110 children in the Pediatric Dentistry of Qingdao Stomatological Hospital Affiliated to Qingdao University were selected as the research subjects from September to December 2019 to conduct a questionnaire survey, and the results were statistically analyzed by using a Chi-square test.@*RESULTS@#A total of 107 effective questionnaires were collected. The children surveyed liked the room with pink and blue walls (61.68%), cartoon murals (57.94%), and arranged toys (61.68%). Most of them did not dislike the special smell in the room (62.62%) and liked the smell of orange essential oil (52.34%). During treatment, the children liked watching cartoons the best (61.68%), expected doctors to be dressed in white (51.40%), and expected doctors to be treated by female doctors (68.22%). Most children wanted to be accompanied by family members during treatment (62.62%). The Chi-square test showed statistically significant differences in seven questions between preschool and school-age children: the environment of the clinic room, the color of the walls, the clinic decoration, the entertainment during treatment, color of the doctors' dress and gender, and company of the family members during treatment (@*CONCLUSIONS@#Children have their own preferences for the environment in the oral clinic. For preschool children, we need to create a soothing and warm atmosphere with warm colors liked by children. For school-age children, a calm and relaxed clinic atmosphere with cold colors should be created.