Factors in uterus may be important in the aetiology of type 2 diabetes.Malnutrition during early life can affect insulin secretion and result in insulin resistance,and such effects are markedly exaggerated when facing over-nutrition in later life.This paper gives a review about the population evidence and epigenetic mechanism in the generational susceptibility to type 2 diabetes.

Objective To explore the related factors that might had effect on orthodontic patients' esthetic evaluation of axial dental midline angulation from three aspects which are ideal value,detectable value and tolerable value.Methods Photographs of a smiling woman was digitally manipulated to produce models with left or right maxillary axial dental midline angulations in 2° increments.These digital photographs models were used to develop an electronic questionnaire in combination with corresponding guidance for each question.The electronic questionnaire was applied to investigate the esthetic evaluation of axial dental midline angulation from 222 orthodontic patients who complied with the inclusion criteria.Esthetic evaluation included three aspects,the ideal value,the detectable value and the tolerable value,which represented the degrees of maxillary axial dental midline angulations the patients considered to be ideal,detectable and tolerable,respectively.The patients' personal information and clinical orthodontic examination results were collected as well.Results The mean detectable value and tolerable value were 4.9° and 9.7°,the median of detectable value and tolerable value were 5°and 9.5°.Logistic regression analysis was applied to explore the influence of seven factors on each evaluator's ideal value,detectable value and tolerable value.The seven factors were gender,marriage condition,education level,orthodontic treatment condition,malocclusion index,dental esthetic rating from others and from themselves.The statistical analysis indicated education level and orthodontic treatment condition were the influential factors of detectable values,while the tolerable values were influenced by the education level and gender.The ideal value converged to 0° and none of the factors had effect on it.Conclusions The education level,orthodontic treatment condition and gender are considered to be the influential factors of the esthetic evaluation of axial dental midline angulation.

Objective To study clinical features and mechanism in patients suffered from chronic hepatitis B achieving seroconversion of HBsAg by combination treatment with interferon (IFN) and nucleoside analogue (NA). Methods Thirty-two cases with chronic HBV hepatitis were enrolled into this retrospective study. All of them received combination treatment with IFN and Lamivudine/Adefovir, as well as achieved seroconversion of HBsAg from June, 2001 to May, 2007. All the cases in this study were followed up. Results Generally, serum HBV DNA fell below the detection limit 3 to 6 months after starting combination treatment. Virological breakthrough/relapse or new clinical resistant had not been found in all enrolments after combination treatment, including patients with previous resistant to Lamivudine, although the average length of treatment was over 2 years. The average period of following up after seroconversion of HBsAg was 13.2 months. Two cases transfered back to HBsAg positive, one of them achieved seroconversion of HBsAg again by the anti-virus treatment, and the other one gave up treatment and remained anti-HBe positive and HBeAg negative.The other 30 eases kept at the stage of seroconversion of HBsAg. Seven patients underwent liver biopsy after seroconversion of HBsAg, and 3 of them had taken liver biopsy before combination therapy too. Biopsy specimens were scored for fibrosis and neeroinflammation according to the Knodell histological activity index. Six cases showed HBsAg and HBcAg negative by immunohistochemistry,and only 1 case with HBsAg positive in liver tissue experienced relapse. Inflammation and fibrosis grade of the 3 cases who had taken liver biopsy twice were lowered after HBsAg seroconversion,although the ALT level of 1 case who had turned from G2S4 to GIS2-3 remained abnormal after HBsAg seroconversion. According to the sequence and character of HBsAg seroconversion, there were three models of HBsAg conversion. The sequence of transition was HBV DNA→HBeAg→HBsAg,which was dominant one, accounting for 59%(19/32 cases). HBV DNA negative, and the titer of HBeAg wandering at a low level, after then HBeAg and HBsAg change to negative in the same time,31% (10/32 cases). The titer of HBsAg decreased rapidly after the HBV DNA clearance, and the HBsAg clearance was earlier than HBeAg, 9% (3/32 cases). After 1 year of combination therapy,there were 15 of 21 cases (71.4%) whose titer HBsAg showed less than 100 COI by agent from Roche, and 7 of 11 cases (63.6%) whose titer HBsAg showed less than 250 IU/L by agent from Abbott. The frequency of adverse reaction was similar with that induced by IFN monotherapy, and no new adverse reaction was found. Conclusions Combination therapy and long course treatment might be the key to achieve the HBsAg seroconversion. Those with HBsAg in liver tissue and (or) low serum anti-HBs are more likely to relapse. The titer of HbsAg<100 COI (Roche, Germany) or<250 IU/L (Abbott, USA) after one year treatment may be regarded as a predict index of HBsAg seroconversion.

Objective To explore the influential factors of esthetic evaluation of mandibular prominence by orthodontic patients from two dimensions (ideal value and tolerance range).Methods 226 orthodontic patients were investigated by an electronic questionnaire of esthetic evaluation of mandibular prominence.Binary logistic regression was adopted to analyze the influential factors.Results The tolerable boundary value for female mandibular retrognathism was affected by age (OR1.360) and orthodontic history (OR2.849).The tolerable boundary value for female mandibular prognathism and male mandibular retrognathism were found to be affected by orthodontic history (OR2.557 and 2.845,respectively).The tolerable boundary value for male mandibular prognathism was affected by age (OR1.347) and orthodontic history (OR2.310).The ideal value of male mandibular prominence was affected by age (OR1.420).Conclusions Orthodontic patients' esthetic evaluation of mandibular prominence is influenced by age and treatment condition,but not by sex,education level,marital status and personal profile.

Objective:To evaluate the effect of tutorial system for medical undergraduates in a non-affiliated hospital of a medical university in Jiangsu.Methods:32 senior medical undergraduates in non-affiliated hospitals were divided into two groups. The experimental group adopted tutor-guided teaching, and the control group adopted traditional teaching. Professional theoretical knowledge, clinical ability, operational ability, foreign language level, basic research ability and participation of scientific research activities of students in the two groups were evaluated. SPSS 19.0 was used for t test, chi-square test and U test. Results:The results of operational ability ( t=3.537, P=0.000), the number of papers that had been read ( t=6.961, P=0.000), quality of these ( U=68.000, P=0.017), the number of literature reviews that had been written and reading notes ( χ2=4.747, P=0.000), participation in scientific research activities ( t=6.788, P=0.009) of students in the experimental group were better and higher than those in the control group. In the same period, there was no significant difference between the two groups in the scores of theoretical exam, clinical competence and foreign language tests. Conclusion:The implementation of tutorial system for medical students in non-affiliated hospitals is an effective measure to improve the quality of training. We should make full use of the short intership, to improve the comprehensive quality of students by establishing perfect rules, regulations and teaching evaluation system, and educate students in accordance with their own ability.

Chronic Urticaria(CU)is a common skin disease involving autoimmunity and allergies,which brings a heavy burden to patients and society.The theory of traditional Chinese medicine"the Lung is combined with the Large Intestine,and the symptoms of large intestine can be reflected from the skin"has long shown that there is a close physiological and pathological relationship between the function of the Large Intestine and the skin.With the modern advancement of the"gut-skin axis"theory,the correlation between gut microbiome and CU has gradually become an emerging focus of research.Adjusting the imbalance of gut microbiome would be a new trend in the clinical treatment of CU.Acupuncture has a beneficial effect of regulating the gut microbiome,and the definite curative effect on CU.Therefore,this article summarized the research progress between the gut microbiome and CU in recent years,in order to discuss the feasibility of acupuncture to treat CU by regulating the gut microbiome,and provide a new idea for the mechanism research of acupuncture in the treatment of CU from the perspective of"treating skin from intestine".

Objective To explore the application of fuzzy mathematics theory in the evaluation of medical students' comprehensive mental quality. Methods A total of 80 medical undergraduates studying in the Affiliated Huai'an No.1 People’s Hospital of Nanjing Medical University from October to December 2017 were randomly selected to conduct a questionnaire survey on medical students' mental quality. The questionnaires were designed by the study group, containing 3 first-level items (learning pressure, life stress and interpersonal stress), and 19 secondary items, with the recovery rate as 95%. Fuzzy comprehensive evaluation method was used for data processing and analysis. Results By comparing the data obtained from the comprehensive evaluation of the secondary factors with those of the pre-set evaluation set, the study concluded that 25.00% of the medical students need to adjust the future pressure, 41.70% the family health status pressure and 26.79% the appearance pressure according to the principle of maximum mem-bership degree. The comprehensive evaluation of the first four factors (0.249 7, 0.268 9, 0.270 2, and 0.211 2) showed that the comprehensive mental quality of medical students was "good". The quantitative analysis results showed that 27.02% of the medical students had good comprehensive mental quality, 24.97% need the mental quality adjustments, 26.89% had the average mental quality, and 21.12% had outstanding mental quality. Fuzzy comprehensive evaluation indicated that it is necessary to adjust the learning pressure and life stress of medical students, while the interpersonal stress had little effect on the mental quality of medical students. Conclusion The fuzzy comprehensive evaluation adopts the quantitative method to deal with the qualitative indicators uniformly, being scientific and reasonable. The corresponding data of each indicator can be easily identified with the help of the indicator system built up in the evaluation, which provides evidence for distinguishing and improving the corresponding decision-making for improving the medical students' mental quality. This evaluation method has strong applicability and provides new methods and ideas for objectively evaluating the comprehensive mental quality of medical students.

Objective To evaluate the association between birth weight and subsequent risk of type 2 diabetes (T2DM) across two generations in Chinese females.Methods A cross-sectional survey was conducted among 10 324 blood-related females in Shanghai from November 2012 to January 2013.A structured questionnaire was used to collect data about demographic information,birth weight,lifestyle factors and diagnosis of T2DM.Path analysis was performed to estimate the matemal effect of birth weight and diabetes status on their offspring,and mediation analysis was conducted to test whether birth weight mediates the association between maternal and daughters' diabetes status.Results A positive association was observed between maternal and daughters' birth weight.One kg increase in maternal birth weight was associated with an average of 0.335 (95％CI:0.307-0.363) kg elevated birth weight in female offspring.Maternal diabetes status was also related with an average of 0.066 (95％ CI:0.025-0.107) kg increase in birth weight and tripled risk of subsequent T2DM (OR=3.173,95％CI:1.946-5.174) in female offspring.In all subjects aged ≥20 years,no significant relationship was observed between birth weight and risk of T2DM subsequently after adjusting for age.Offspring' s birth weight,as a mediator of maternal and daughters' diabetes status,explained 2.8％ of their association.Conclusion Maternal birth weight and diabetes status may influence their female offspring' s birth weight and subsequent risk of T2DM.

Objective To assess the impact of maximal fat oxidation intensity(FATmax) exercise on arterial stiffness in overweight/obesity young men.Method Thirty two overweight/obesity young men (BMI≥25 kg/m2) without the habit of doing exercises,were divided into an exercise group (n=16) and a control group (n=16) randomly.The exercise group completed a 12-week walk/run(FATmax intensity,3-5 times/week,40-60 min/time) intervention,while the control group maintained normal life style without regular exercise.The body composition,cardiopulmonary function (VO2max),C reactive proteins (CRP) and blood hemodynamic were measured,and the brachial-ankle pulse wave velocity(baPWV) was observed to assess the arterial stiffness before and after the 12-week intervention.Results Significant decrease was observed in the average weight,body mass index,body fat mass,body fat percentage,baPWV,CRP,platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) (P＜0.05),while significant increase was found in the average VO2max and HDL-C(P＜0.05) after the training.After the intervention,the change in baPWV(△) was positively associated with △ CRP(r=0.604),△ NLR(r=0.535) and △ WBC (white blood count) (r=0.406) (P＜0.05,n=32),but negatively correlated with △ VO2max (r=-0.660,P＜0.05,n=32).Conclusion FATmax intensity aerobic exercise is effective to downregulate the inflammation,and improve aerobic fitness and vascular function.However,the potential mechanism of arterial stiffness improvement following exercise needs further study.

This paper summarized professor AI Rudi's clinical experience in treating primary cutaneous amyloidosis （PCA） from the perspective of "skin accumulation". The morphology and pathological characteristics of PCA are similar to those of accumulation diseases in traditional Chinese medicine， proposing the concept of "skin accumulation". It is believed that the core pathogenesis of PCA is the invasion of pathogenic factors while healthy qi is in deficiency， and phlegm and stasis consolidating the exterior， which can be mainly categorized into the type of root deficiency and branch excess. Depleted healthy qi and loose striae and interstices are the root， while pathogen lingering in the skin surface， fluids and blood failure to be distributed， and binding of phlegm and stasis are the branch of the disease. The main treatment principle is consolidating the root and clearing the source. For internal treatment， it is recommended to fortify the spleen and nourish kidney， dispel phlegm and dissolve stasis， soften hardness and dissipate masses， with Self-made Erxian Sishen Decoction （二仙四参汤）， Guizhi Fuling Pills （桂枝茯苓丸）， Huajian Erchen Pills （化坚二陈丸） and Modified Xiaolei Pills （加味消瘰丸）. For external treatment， it is important to dispel pathogens and disperse accumulation， scatter and unblock fluids and blood， and hot baking with self-made Ruiji Paste （润肌膏） can be used to promote softening and peeling of skin lesions， and medicinal bath with pig bile to open striae and dispel pathogen， bovine spinal cord sealing to nourish the skin.