To investigate the implications of salivary pH for the occurrence of oral mucositis (OM) in patients with hematological diseases during consolidation chemotherapy with high-dose cyclidine, and to evaluate the effect of personalized alkalization care guided by dynamic pH monitoring on the healing of oral ulcers in acidic subgroups. The study was conducted using a two-stage design. The first phase was a prospective cohort observation, which included 100 patients who received high-dose cytiabine (≥ 2 g/m[2]/ time) consolidation chemotherapy in the hematology department of a hospital from May 2024 to May 2025. They were uniformly given basic oral care and saliva pH and OM grades were recorded daily. OM was determined based on the occurrence of WHO oral mucositis grade ≥ 2 within a 28-day cycle. In the second stage, patients who developed OM in the first stage were selected for persistent acidic microenvironment (pH < 6.0 for ≥ 3 consecutive days), and randomized controlled trials (1:1 area randomization) were conducted to compare ulcer healing time between "pH monitoring guided alkalization care" and "routine care", and to observe pH changes and pain VAS scores on the 3rd and 7th days after intervention. Statistical analysis, in addition to the conventional intergroup comparisons, supplemented multivariate models were used to adjust for outcomes (Logistic regression in the first stage, Cox regression or generalized linear model in the second stage), and effect sizes and 95% confidence intervals were reported. In the first stage, there were 53 cases of OM occurrence and 47 cases of no OM occurrence. The baseline pH difference was not statistically significant (6.32 ± 0.42 vs. 6.17 ± 0.39, P = 0.067). In the second stage, a total of 34 cases were included in the acidic subgroup, 20 in the intervention group, and 14 in the conventional group; The ulcer healing time in the intervention group was shorter than that in the conventional group (6.8 ± 1.2 d vs. 11.3 ± 2.1 d, P < 0.001), and the pH on the third day after intervention was higher than that in the conventional group (6.55 ± 0.15 vs. 6.09 ± 0.19, P < 0.001). A single baseline pH is difficult to serve as a universal early warning indicator for OM occurrence; In the persistent acidic microenvironment subgroup, personalized alkalization care guided by dynamic pH monitoring can accelerate the return of the oral microenvironment to neutrality and shorten the ulcer healing cycle.

Inflammatory skin diseases are chronic conditions characterized by persistent inflammation and disrupted skin barriers, necessitating sustained drug delivery. This study presents a long-acting hybrid dissolving microneedle (DMN) patch incorporating hyaluronic acid (HA)-based microparticle depots (TA@MDepots) for intradermal delivery of triamcinolone acetonide (TA). HA is modified to HA acetate to enhance compatibility with hydrophobic TA, enabling efficient microdepot formulation. These TA@MDepots are integrated into the DMN tip layer using mold-casting, resulting in patches with strong mechanical properties and rapid tip dissolution (<3 min) upon application. In vitro and ex vivo studies demonstrate effective skin penetration, sustained dermal retention, and prolonged TA release. The hybrid patch shows excellent cytocompatibility and significantly reduces tumor necrosis factor-alpha and interleukin-6 levels in activated macrophages. In vivo, the patch outperforms commercial TA ointment in a murine ulcer model by accelerating wound closure, reducing epidermal thickening, and lowering inflammatory cytokine expression, despite a lower TA dosage and fewer applications. Histological analyses confirm skin structure restoration and immune modulation, while systemic toxicity assessments show no adverse effects. This hybrid DMN platform offers a minimally invasive, biocompatible, and patient-friendly strategy for prolonged corticosteroid delivery in chronic inflammatory skin diseases and represents a promising alternative to conventional topical or injectable therapies.

Neisseria gonorrhoeae conjunctivitis is rare in adults but may rapidly progress to vision-threatening complications. Peripheral ulcerative keratitis (PUK) is an unusual and severe manifestation. A 42-year-old male presented with bilateral ocular pain, swelling, and profuse purulent discharge for 15 days, leading to inability to open his eyes. History revealed recent urethral discharge and multiple sexual contacts. Ocular examination showed severe conjunctival chemosis and peripheral corneal thinning with descemetocele formation. Gram stain of conjunctival swabs demonstrated intracellular gram-negative diplococci. Serology revealed positive VDRL and TPHA (late latent syphilis). HIV and Chlamydia trachomatis testing were unavailable. The patient received intravenous ceftriaxone 1 g twice daily, oral doxycycline, and topical fortified antibiotics. Due to progressive corneal thinning, bilateral amniotic membrane grafting with perilimbal conjunctival excision and bandage contact lens placement was performed. Syphilis was treated with three weekly doses of benzathine penicillin G. At 6 weeks, vision improved to 6/9 bilaterally with healed ulcers and clear corneas. Gonococcal conjunctivitis in adults can rapidly progress to peripheral ulcerative keratitis. Early diagnosis, broad STI screening, systemic therapy, and timely surgical intervention are critical for preserving vision.

With excellent anti-inflammatory and immunomodulatory performances, dexamethasone (Dex) is widely used in the treatment of skin and mucosal ulcers. However, its therapeutic efficacy for oral ulcers is limited by the unique oral environment. To address this issue, we loaded dexamethasone into polylactic acid nanoparticles (PANs) and modified them with ligands to enhance their targeted delivery efficiency. These Dex-loaded PANs (Dex-PANs) were further incorporated into gelatin hydrogel to prolong the release of the drug with a single administration. A self-synthesized bisuccinimidyl-ester was used, for the first time, as the cross-linker to covalently adhere the gelatin hydrogel to the ulcer site, thereby resisting mechanical detachment or salivary erosion. Compared to the control group, the tensile strength of the cross-linked gelatin hydrogel adhesive on skin was increased by approximately 10-fold. Moreover, the gelatin hydrogel could maintain for over 5 days in saliva, during which it slowly degraded without detachment from the skin while releasing the Dex-loaded PANs. In vitro experiments demonstrated that the Dex-PANs incorporated in gelatin hydrogel exhibited no cytotoxicity and promoted the proliferation of gingival epithelial cells, accelerating ulcer healing. In vivo studies showed that the novel Dex formulation enabled rapid healing of oral ulcers with a single administration. This approach may contribute to advancements in medical adhesives and guide the creation of nanoparticle-based buccal delivery technologies.