Objective To investigate the prevalence and influencing factors of thyroid enlargement in school-age children in Tianjin. Methods School-age children were randomly selected in Tianjin to undergo thyroid ultrasound examination, and salt iodine, urine iodine, height, and weight tests. A questionnaire survey was conducted. Univariate and multivariate regression models were used to analyze the risk factors for thyroid enlargement. Results A total of 917 children aged 7-13 years in Tianjin were surveyed, with a thyroid enlargement rate of 4.03% and a median thyroid volume of 2.60 ml. There was a non-linear relationship between children's body mass index (BMI) and the incidence of thyroid enlargement in children (P=0.008), and a linear relationship between children's body surface area (BSA) and the incidence of thyroid enlargement in children (P<0.001). Being 9 years old (OR=3.728, 95%CI: 1.343-10.343, P=0.012), obesity (OR=3.886, 95%CI: 1.801-8.384, P=0.001), having lunch at school (OR=3.157, 95%CI: 1.497-6.658, P=0.003) and frequent consumption of preserved foods (OR=4.611, 95%CI: 1.643-12.945, P=0.004) were risk factors for goiter in children. Regular consumption of seaweed (OR=0.305, 95%CI: 0.100-0.927, P=0.036) was a protective factor for goiter in children. Conclusion The incidence of thyroid enlargement in children in Tianjin meets national standards. Obesity, eating lunch at school, frequently consuming pickled foods, and being 9 years old may be risk factors for thyroid enlargement in children. Eating seaweed or kelp regularly is a protective factor. At the same time, attention should be paid to the relationship between BMI, BSA, and thyroid enlargement rate in children..

Objective To explore the association between different levels of fluoride exposure and dyslipidemia in elderly people, and to analyze the influencing factors and their interactions. Methods A total of 1 143 elderly people over 60 years old were randomly selected from historical high water fluorosis areas and control areas in Tianjin. Logistic regression model and classification tree model were used to analyze the influencing factors of dyslipidemia, and to analyze the interaction between high fluoride exposure and relevant influencing factors on dyslipidemia. Results The prevalence of elevated low density lipoprotein cholesterol (LDL-C) was 5.69% (65/1 143). There was a significant difference in the prevalence of high LDL-C in different fluoride-exposed areas (2 = 0.092，P = 0.762). Multivariate logistic analysis showed that high fluoride exposure (OR=2.306，95%CI：1.185-4.491) and abdominal obesity (OR=2.274，95%CI：1.299-3.978) were risk factors for high LDL-C, while type B personality (OR=0.529，95%CI：0.308-0.908) was a protective factor for high LDL-C. The results of classification tree model showed that abdominal obesity contributed the most to the prevalence of high LDL-C in the elderly, followed by high fluoride exposure and hyperglycemia. There was a significant multiplicative interaction between high fluoride exposure and abdominal obesity on dyslipidemia (OR=5.191,95%CI：1.609-16.745，P=0.006). Conclusion High fluoride exposure may increase the risk of high LDL-C, and there is a multiplicative interaction between high fluoride exposure and abdominal obesity on dyslipidemia.

Objective　To analyze the monitoring data of SARS-CoV-2 variants from local cases in Hainan Province between January 2023 and March 2024, and to understand the predominant variants epidemic situation and population characteristics of SARS-CoV-2 in Hainan Province, providing scientific guidance for the prevention and control strategies formulation, early warning of the risk of SARS-CoV-2 infection. Methods　The variation surveillance data submitted by five sentinel monitoring hospitals in Hainan Province from January 2023 to March 2024 were collected, and general descriptive analysis was conducted on the dynamic epidemic trend of the dominant clade, population characteristics, and disease severity. Results　From January 2023 to March 2024, a total of 2 600 local cases clade information in Hainan Province were collected, all of which were Omicron variant strains involving 115 evolutionary branches. The three phases identified include: the co-dominance of BA.5.2.48 and BF.7 from the first week of 2023 to the 13th week of 2024; the prevalence of XBB and its subclades from the 16th to the 52nd week of 2023; and the predominance of BA.2.86 and its subclades from the first to the 13th week of 2024, with Omicron BA.2.75 causing small-scale sporadic outbreaks. Among all the age groups of branch infection cases, individuals aged >18~60 years constituted the largest group, while those under 4 years were the smallest, with no significant gender differences. The severity of the clinical disease was mainly asymptomatic and mild. Conclusions　Different dominant evolutionary clades of SARS-CoV-2 showed sequential replacement characteristics, and the clinical severity of illnesses has gradually decreased. In the future, the focus should be on individuals aged >60 years and above and those aged >18~60 years with underlying conditions, along with continuous enhancement of variant monitoring and analysis. This will ensure a timely understanding of the dynamic epidemic trend of dominant evolutionary clades in time, and focus on the immunogenicity of the new variant branch and changes in immunogenicity and vaccine protection of new variant clades, providing scientific guidance for the vaccine research, clinical treatment, and immunization strategy formulation.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Peri-implantitis is a pathologic condition associated with dental plaque that occurs in the implant tissue and is characterized by inflammation of the mucous membrane surrounding the implant, followed by the progressive loss of supporting bone. In this study, a case of guided bone regeneration therapy based on plaque control of peri-implant inflammation was reported. Four years after surgery for the left second premolar implant, the patient presented with "left lower posterior tooth swelling and discomfort for more than 2 years". The X-ray periapical film showed a decrease in distal bone mineral density of implant, and the clinical diagnosis was peri-implantitis of the left second premolar. Implants underwent guided bone regeneration and regular periodontal maintenance treatment. Re-examination at 3.5 months, 11 months, 18 months, and 7 years showed that the alveolar bone height and bone mineral density were stable, and the periodontal depth became shallow. However, the gingival recession was mild. In the present case, follow-up at 7 years demonstrated that the clinical periodontal indexes could be remarkably improved after complete periodontal treatment for peri-implantitis, and the alveolar bone could be well restored and regenerated.
Humans ; Peri-Implantitis/etiology* ; Follow-Up Studies ; Bone Regeneration ; Guided Tissue Regeneration, Periodontal/methods* ; Dental Plaque/prevention & control* ; Male ; Female ; Dental Implants/adverse effects*

Objective To explore the safety and feasibility of intravenous dexmedetomidine(Dex)combined with targeted infusion of remifentanil in endoscopic retrograde cholangiopancreatography(ERCP)anesthesia in older adult patients.Methods From January to August 2021,98 older adult patients(≥65 years old)undergoing ERCP were randomly divided into TRP and TRD groups.The TRP group was anesthetized with target-controlled infusion of propofol and remifentanil and the TRD group was treated with Dex combined with target-controlled infusion of remifentanil.mean arterial pressure(MAP),heart rate(HR),electrocardiogram(ECG),respiratory rate(RR),pulse oxygen saturation(SpO2),bispectral index(BIS)before anesthesia induction(T0),immediately after induction of anesthesia(T1),endoscopic introduction(T2),duodenal papilla intubation(T3),endoscopy withdrawal(T4)and postoperative awakening(T5)were observed.Arterial blood gas analysis at different time points(T0,every 15 min after anesthesia induction and T5),PaO2,and PaCO2,were recorded at the above mentioned time points;and the remifentanil concentration in target-controlled infusion,operation time,recovery time(from infusion of remifentanil to consciousness recovery),anesthesia recovery time(from consciousness recovery to leaving the operating room),intraoperative body movement,Aldrete scores out of the room,Visual Analogue Scale(VAS)at 60 min after surgery,occurrence of post-operative adverse reactions,as well as the satisfaction of anesthesiologists,endoscopists,and patients were recorded.Results Compared with the TRP group,MAP at T1 and T3,SpO2 and RR at T1,T2,T3,and T4,and BIS at T2,T3,T4,and T5 increased,whereas HR at T1,T2,T3,and T4 decreased;the number of mandibular rests,incidence of hypoxemia,Aldrete score,and satisfaction increased,whereas the VAS score at 60 min after surgery decreased in the TRD group(P<0.05).There were no statistically significant differences in postoperative adverse reactions,PaO2 and PaCO2,target-controlled infusion remifentanil concentration,operation time,recovery time,and anesthesia recovery time between the two groups.Conclusion Compared with the target-controlled infusion of propofol-remifentanil,intravenous infusion of Dex combined with target-controlled infusion of remifentanil can reduce the incidence of hypoxemia in older adult patients during ERCP surgery,and the anesthesia regimen can meet the anesthesia needs of ERCP surgery,which is safe and feasible.

Objective To investigate the clinical effect of Mudan Granules combined with pentoxifylline in the treatment of type 2 diabetes mellitus (T2DM) with early renal disease and analyze its impact on the Toll-like receptor 4 (TLR4)/nuclear factor-κB (NF-κB) signaling pathway. Methods A total of 164 patients with T2DM and early renal disease admitted to the Second People's Hospital of Hunan Province between May 2022 and October 2023 were enrolled and randomly divided into observation group(n=82) and control group (n=82) using a random number table in a 1-to-1 ratio. The control group received pentoxifylline treatment, while the observation group received Mudan granules combined with pentoxifylline. The clinical effects and changes in renal function indicators[serum creatinine (SCr), urea nitrogen, urinary albumin-to-creatinine ratio (UACR)], TLR4/NF-κB signaling pathway indicators (TLR4, MyD88, NF-κB mRNA), and inflammation and oxidative stress indicators [C-reactive protein (CRP), glutathione peroxidase (GSH-PX), malondialdehyde (MDA), total antioxidant capacity (TAC), and transforming growth factor β1 (TGF-β1)] before and after treatment were compared between the two groups. Results The total effective rate in the observation group was 97.56%, which was higher than 89.02% in the control group (P<0.05). At 6 and 12 weeks after treatment, the levels of SCr, urea nitrogen, and UACR in both groups decreased compared with those before treatment, and the levels of these indicators in the observation group were lower than those in the control group (P<0.05). At 6 and 12 weeks after treatment, the levels of TLR4, MyD88, and NF-κB mRNA in both groups decreased compared with those before treatment, and the levels of these indicators in the observation group were lower than those in the control group (P<0.05). At 6 and 12 weeks after treatment, the levels of GSH-PX and TAC in both groups increased, while the levels of CRP, MDA, and TGF-β1 decreased compared with those before treatment. The levels of GSH-PX and TAC in the observation group were higher than those in the control group, while the levels of CRP and MDA were lower (P<0.05). Conclusion Mudan Granules combined with pentoxifylline in the treatment of T2DM with early renal disease can improve renal function to a certain extent, regulate the TLR4/NF-κB signaling pathway, and reduce inflammation and oxidative stress responses, which is beneficial for disease control.

Objective To investigate the status and the influencing factors of thyroid volume of children aged 8-10 years in Tianjin. Methods Among the 1-2 primary schools were randomly selected from 12 districts in Tianjin. A total of 1 090 children were selected by class cluster sampling method (half male and half female, with a balanced age distribution). A questionnaire survey was conducted. Children’s height, weight and thyroid volume were measured, and their salt iodine content and urinary iodine content were detected. Results I n this study, the median urinary iodine in children was 161.35 µg/L, the mean thyroid volume was 2.56 mL, and the goiter rate was 3.58%. Univariate analysis showed that age, BSA, salt iodine content, urinary iodine content, eating habits, food taste, eating lunch at school, father's work, anxiety and depression, pressure, and different regional grouping were the influencing factors of thyroid volume (P<0.05). Multivariate linear regression showed that BSA, age, food taste, and urinary iodine content had significant independent effects on thyroid volume (P<0.05). Conclusion In Tianjin, the iodine nutrition level of children aged 8-10 years is at an appropriate level. When evaluating the thyroid volume of children, in addition to age factors, other factors such as physical development level and iodine intake should also be considered.

Objective To understand the molecular epidemiological characteristics of Norovirus outbreaks and the genome evolution of Norovirus epidemic strains in Hainan Province from 2020 to 2022.Methods The information and samples have been collected from the norovirus outbreaks from 2020 to 2022.Norovirus was detected by using the real-time PCR in these samples,then the detected sequences were amplified the analyzed.The Norovirus se-quences of 8 strains had been amplified and analyzed.Results From 2020 to 2022,39 gastroenteritis outbreaks were reported,and 25 outbreaks caused by Norovirus which mainly occurred in childcare institutions and schools(20/25,80％).The Norovirus outbreaks were mainly concentrated in counties around Haikou(northeast),which including Ding'an(5 cases),Wenchang(4 cases),Chengmai(4 cases),and Lingao(3 cases);following by western regions which included Baisha(2 cases),Ledong(2 cases),and Dongfang(3 cases).1 case was in Wanning in the southeast.Among individuals aged 2-17,the positive proportion of Norovirus in males was higher than that in females.Among individuals aged over 55,the proportion of Norovirus positive in females was higher than that in males.The gender of positive samples among individuals aged 18-40 was related to their profession.According to RT-PCR typing and sequencing,GⅡ group Norovirus were classified in13 outbreaks.There were 4 genotypes detected.GⅡ.2[P1 6]was the main epidemic strain with 60％(9/13),and the other three genotypes were GⅡ.4 Sydney[P31](15.4％,2/13)GⅡ.4 Sydney[P16](7.7％,1/13)and GⅡ.3[P12](7.7％,1/13).Further genic analysis of 8 Norovirus strains showed that all of them were still in the same branch as the previ-ous strain,and all exhibited a certain amount of amino acid variation.Conclusion Norovirus is the main pathogen of gastroenteritis outbreaks in Hainan province,and the main epidemic strain is GⅡ.2[P16].It is necessary to continue to strengthen the monitoring that provides scientific evidence for the prevention and control of norovirus out-breaks in Hainan region.

Primary health care institutions should be the main force of China's medical and health service system and the cornerstone of the national health care system. During the COVID-19 pandemic, China's primary health care institutions played a critical role, but many deficiencies and weaknesses were also highlighted. Through systematic literature search and analysis, this article finds that China's primary health care institutions have some problems such as low demand for patient care, weak integration of the health system, weak service foundation, and insufficient emergency response capacity for public health emergencies. Accordingly, we put forward a strategy for the construction of primary health care institutions based on the "Three Forces Theory", which aims to improve the primary medical and health care service system, upgrade the capacity of primary medical and health care services, and better fulfill the strategic goal of "Healthy China 2030".