To investigate the association between albumin-to-globulin ratio (AGR) and interstitial lung disease (ILD) in patients with primary Sjögren's syndrome (pSS), to identify high-risk clinical phenotypes for SS-ILD, and to construct an AGR-based nomogram risk stratification model. This was a single-center retrospective cohort study enrolling pSS patients who met the 2016 ACR/EULAR classification criteria between January 2014 and December 2024. Patients were divided into ILD and non-ILD groups based on the presence or absence of ILD. Propensity score matching (PSM) was applied to balance baseline characteristics. Univariable and multivariable logistic regression analyses were performed to evaluate the independent association between AGR and ILD. A nomogram risk stratification model was constructed based on predictors identified in the multivariable analysis, and its predictive performance was assessed using receiver operating characteristic (ROC) curve analysis. A total of 1,087 pSS patients were enrolled (93.6% female; mean age 58.25 ± 12.16 years; ILD group n = 69; non-ILD group n = 1,018). In the total cohort, AGR was significantly lower in the ILD group than in the non-ILD group (1.01 ± 0.30 vs. 1.18 ± 0.31), and the prevalence of documented dry eye was markedly lower in the ILD group (2.9% vs. 19.4%). Multivariable regression analysis demonstrated that AGR was independently and inversely associated with ILD risk (OR = 0.138, 95% CI 0.038-0.502); CRP was also an independent risk factor (OR = 1.009, 95% CI 1.000-1.017); and absence of documented dry eye symptoms was independently associated with ILD (OR = 0.196, 95% CI 0.047-0.821). After PSM (1:2 nearest-neighbor matching on age, sex, and BMI), 67 of 69 ILD patients were successfully matched, yielding a balanced cohort of 201 patients (ILD n = 67; non-ILD n = 134), with all covariate standardized mean differences (SMDs) < 0.1. In the matched cohort, AGR remained significantly lower in the ILD group (1.01 ± 0.30 vs. 1.19 ± 0.30) and these associations remained robust in the multivariable model (AGR: OR = 0.127, 95% CI 0.024-0.687; absence of dry eye: OR = 0.145, 95% CI 0.029-0.720). Three layers of sensitivity analysis (basic IPTW, extended-covariate IPTW with 11 covariates, and E-value analysis) confirmed the robustness of the AGR-ILD association, with the E-value point estimate of 12.30 substantially exceeding the strength of known confounders. The exploratory nomogram constructed from AGR, dry eye, age, and LDH demonstrated an AUC of 0.710 (95% CI 0.647-0.774) at an optimal cutoff of 0.096, with a sensitivity of 54.5% (95% CI 42.4%-66.7%), specificity of 81.3% (95% CI 79.0%-83.6%), PPV of 16.6% (95% CI 12.9%-20.2%), NPV of 96.3% (95% CI 95.4%-97.2%), and accuracy of 79.6% (95% CI 77.2%-81.9%). In this single-center retrospective cohort, low AGR was independently associated with the occurrence of ILD in pSS patients. Low AGR combined with absence of documented dry eye symptoms may identify a clinical subset warranting further evaluation for pulmonary involvement. Given the retrospective design, limited ILD event count, and lack of external validation, the nomogram developed in this study should be considered an exploratory tool, and the findings are hypothesis-generating, requiring prospective multicenter validation before clinical application.

Texture critically drives food acceptance or rejection, with oral processing varying widely among individuals and influencing dynamic perception and bolus formation. Adaptive strategies like tongue-palate squeezing often replace chewing in populations with masticatory or swallowing challenges (e.g., tooth loss, sarcopenia, xerostomia), yet their impact on texture perception, muscle activity, and bolus properties remain poorly evaluated, particularly in comparison to traditional chewing. This study compared chewing versus squeezing effects on texture perception, processing parameters (oro-exposure, muscle activity, salivation), and bolus properties using mashed potato (MP) enriched with psyllium (MP-psyllium) or xanthan (MP-xanthan). Twenty-six participants processed samples via chewing or squeezing until they were ready to swallow. Sensory evaluation covered textural (hardness, stickiness, cohesion) and hedonic (taste, texture, overall liking) properties. Electromyography measured masticatory muscle activity and chewing duration. Boluses were collected for saliva and texture analysis. Squeezing increased MP-psyllium hardness ratings (by 26%) and reduced MP-xanthan cohesiveness (by 45%). It prolonged oro-sensory exposure (by 22-31%), halved masseter and temporalis activity, and decreased salivation during MP-xanthan processing. Liking remained moderate (∼6/9). Both strategies softened boluses, but squeezed versions were harder or less cohesive than chewed. Oral processing strategies differentially modulate perception via sensory feedback, ensuring viscoelastic boluses for swallowing. Squeezing highlights tongue tactile sensitivity and compensatory prolonged exposure. These findings underscore texture-modified diets tailored to individual oro-sensory strategies. Rehabilitation for patients with chewing and swallowing disorders should be tailored to their specific oro-sensory processing needs.

The objective of this study was to evaluate the oral health, late oral complications, and oral symptoms in patients who underwent radiotherapy in the head and neck region during childhood and adolescence. Data were collected from a specialized pediatric oncology and hematology hospital; to assess oral health, measurements were taken of stimulated and unstimulated salivary flow, gingival bleeding index, visible plaque index, and caries activity index. Clinical data such as neoplasm type, treatment administered, and total radiation dose were collected. Additionally, the Vanderbilt Head and Neck Symptom Survey questionnaire was utilized to assess oral symptoms. A total of 52 patients were evaluated, with 53.8% being male and 46.2% female. The most frequent diagnosis was Hodgkin's Lymphoma (69.2%), and the most common late-onset alterations observed were trismus, prolonged retention of primary teeth, agenesis, and microdontia. Regarding salivary flow, 19.6% of patients exhibited hyposalivation with stimulated saliva, and 1.9% with unstimulated saliva. The mean visible plaque index was 7.8%, and the mean gingival bleeding index was 2.3%. In relation to the International Caries Detection and Assessment System score, 91.4% of the sample scored 0. In terms of oral symptom assessment, the domain labeled "dry mouth" was the most affected, with 18.9% of patients experiencing some degree of xerostomia. Patients who received radiotherapy for tumors in the head and neck during childhood and adolescence may develop late oral changes, which impact their oral symptoms.

Sjögren's disease (SjD), a chronic autoimmune disorder affecting exocrine glands, faces significant diagnostic challenges due to its highly heterogeneous symptoms, subjective interpretation of imaging findings, and reliance on invasive biopsies, often resulting in delayed diagnosis by 3-7 years. This review posits that the integration of diverse data streams-from medical imaging to molecular omics-is the pivotal key to overcoming diagnostic heterogeneity, and that AI serves as the indispensable engine to power this integration. We systematically synthesize evidence showing that deep learning models, such as Fully Convolutional Dense Network (FCN-DenseNet), can automate salivary gland ultrasound segmentation; computed tomography (CT)-based AlexNet may achieve diagnostic performance comparable to radiologists; and AI-driven analyses of pathology, metabolomics, and genomics have revealed potential biomarker patterns, including metabolomic and immune-clustering models with reported AUC values of 1.00. However, these findings should be interpreted cautiously because many studies were conducted in small, retrospective, single-center cohorts or relied mainly on internal validation, limiting their clinical robustness and generalizability. We thus critically advocate for a future paradigm centered on causally-aware, multimodal fusion frameworks-moving beyond mere correlation to model disease mechanisms-and the adoption of federated learning to navigate data privacy while leveraging large-scale genomics. The forthcoming challenge is not merely technical but conceptual: to develop interpretable AI that can deconstruct SjD into mechanistically defined subtypes, thereby bridging the critical gap between algorithmic prowess and clinically actionable insights for definitive early intervention and personalized treatment strategies.

Background/Objectives: Menopause is a complex physiological transition characterized by progressive estrogen deficiency and systemic biological changes that can affect multiple organs and tissues, including the oral cavity. Growing evidence suggests that hormonal fluctuations during the menopausal transition may influence periodontal health, salivary function, oral sensory perception, and overall oral health-related quality of life. Objective: This narrative review aims to provide a comprehensive overview of the biological mechanisms and clinical manifestations associated with the relationship between menopause and oral health, with particular attention to periodontal outcomes, salivary changes, oral discomfort, dental status, and the potential role of hormone replacement therapy (HRT). Methods: This narrative review was based on a structured literature search conducted in PubMed/MEDLINE and Scopus to identify studies published between January 2005 and May 2026. Predefined eligibility criteria were applied to identify relevant human studies. The retrieved evidence was synthesized narratively according to major oral health domains and menopausal phenotypes. Results: Fifty studies met the inclusion criteria. Overall, menopause was associated with poorer periodontal parameters, including increased probing depth, clinical attachment loss, and periodontal inflammation. Reduced salivary flow, dry mouth, altered salivary composition, burning symptoms, and taste disturbances were frequently reported in peri- and postmenopausal women. A higher prevalence of caries and tooth loss was also reported, although the contribution of age and other confounding factors varied across studies. New evidence suggests that estrogen deficiency may influence oral health through interconnected pathways involving immune regulation, bone metabolism, salivary gland function, and host-microbiome interactions. Evidence regarding the effects of HRT has been mixed, although several studies have reported improvements in salivary function and periodontal outcomes among treated women. Conclusions: Menopause appears to act as an important systemic modifier of oral health through multifactorial biological mechanisms. Menopause-associated oral manifestations go beyond local tissue changes and reflect broader interactions between hormonal status, inflammation, bone metabolism, and microbial ecology. Increased awareness among dental and medical professionals and a multidisciplinary approach could improve the prevention, diagnosis, and management of oral diseases in postmenopausal women. Further, well-designed longitudinal studies are needed to clarify causal relationships and identify effective therapeutic strategies.

Low-density granulocytes (LDGs) have been implicated in the pathogenesis of several autoimmune diseases, yet their role in Sjögren's disease (SjD) remains poorly understood. We enrolled 90 SjD patients and 30 healthy controls (HCs) and identified LDGs as CD14[-/low]CD15[+] cells by flow cytometry, with intracellular interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) staining, and further analyzed CD16 as a maturation marker in LDGs and T helper 17 (Th17) cell frequency. LDG percentages were significantly elevated in active SjD compared with inactive patients (p < 0.001) and HCs (p < 0.0001), and correlated positively with EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) (r = 0.355, p = 0.0006), erythrocyte sedimentation rate (ESR) (r = 0.325, p = 0.0061), γ-globulin (r = 0.334, p = 0.0177), and Th17 frequency (r = 0.537, p = 0.0068). LDG expansion was accompanied by enrichment of immature CD16[-/low] cells (r = -0.798, p = 0.0100). Patients with renal or pulmonary involvement showed higher LDG levels (p = 0.0004), and in SjD -associated interstitial lung disease (SjD-ILD) patients, LDG percentage showed a positive but non-significant trend with serum Krebs von den Lungen-6 (KL-6) levels (r = 0.497, p = 0.102). LDG levels decreased following treatment in longitudinally followed patients, and LDGs from active patients exhibited higher IL-6 and TNF-α production ratios relative to monocytes than those from inactive patients. Stratification by LDG levels revealed significant associations with disease activity, laboratory parameters, and organ involvement. These findings suggest that LDGs are associated with disease activity and organ involvement, may serve as potential biomarkers, and may contribute to the pathogenesis of SjD.

Sjögren's disease (SjD) is a chronic autoimmune disease characterized by lymphocytic infiltration and dysfunction of the exocrine glands, with manifestations extending beyond glandular sicca symptoms to multiple extraglandular systems. Although the pathogenesis of SjD remains incompletely understood, growing evidence indicates that a complex cytokine network involving both innate and adaptive immune pathways plays a central role in disease development. This narrative review summarizes recent updates on cytokine signaling in SjD across three clinically relevant domains. In glandular inflammation, activation of salivary gland epithelial cells through Toll-like receptor pathways triggers type I interferon (IFN) signaling via plasmacytoid dendritic cells, while IFN-γ, Th17-related cytokines (IL-6, IL-17, IL-22), BAFF/APRIL, and chemokines (CXCL10, CXCL12, CXCL13) collectively sustain local inflammation and ectopic lymphoid organization. The BAFF/APRIL axis, a systemic type I IFN signature, and IL-21-follicular helper T cell-B cell interactions primarily drive systemic immune activation, which together underlie autoantibody production, hypergammaglobulinemia, and a lymphoma-prone phenotype. In contrast, constitutional symptoms such as fatigue, pain, and dryness frequently dissociate from classical inflammatory activity and are better explained by neuroimmune-metabolic mechanisms, including the IFN-γ-IDO-kynurenine pathway and symptom-associated proteomic signatures. Collectively, these findings underscore the heterogeneous nature of SjD, in which glandular inflammation, systemic immune activation, and constitutional symptoms are driven by distinct yet partially overlapping cytokine pathways. Recognizing this heterogeneity has direct implications for cytokine-targeted therapy, suggesting that future trials should stratify patients by disease phenotype (IFN-high, B cell-dominant, and symptom-dominant) rather than treating SjD as a uniform population.