The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.

The dental operative microscope has been widely employed in the field of dentistry, particularly in endodontics and operative dentistry, resulting in significant advancements in the effectiveness of root canal therapy, endodontic surgery, and dental restoration. However, the improper use of this microscope continues to be common in clinical settings, primarily due to operators' insufficient understanding and proficiency in both the features and established operating procedures of this equipment. In October 2019, Professor Jingping Liang, Vice Chairman of the Society of Cariology and Endodontology, Chinese Stomatological Association, organized a consensus meeting with Chinese experts in endodontics and operative dentistry. The objective of this meeting was to establish a standard operation procedure for the dental operative microscope. Subsequently, a consensus was reached and officially issued. Over the span of about four years, the content of this consensus has been further developed and improved through practical experience.
Humans ; Dentistry, Operative ; Consensus ; Endodontics ; Root Canal Therapy ; Dental Care

Background Global warming may increase the frequency of compound hot extreme (CHE).However, there is still a lack of studies assessing the associations between CHE and preterm birth (PTB), and the underlying biological mechanisms remain unclear. Objective To estimate the association of exposure to CHE during pregnancy with PTB, and to explore the roles of inflammatory, endothelial dysfunction, and oxidative stress in the association between CHE and PTB. Methods All participants were selected from the Prenatal Environments and Offspring Health (PEOH), a prospective birth cohort conducted in Guangzhou. In this study, a total of 2449 participants who gave birth from May to October in 2014 to 2017 were enrolled, and among them blood samples were collected from 311 preterm (n=43) and full-term (n=268) pregnant women at the time of delivery. A hot day/night was identified as a day when the daily maximum temperature/minimum temperature was higher than its 90th percentile in the study period, and a CHE was defined as having both a hot night and a following hot day. The meteorological data were obtained from the China Meteorological Data Sharing Service System. Anusplin was used to assess the daily maximum temperature, daily minimum temperature, and relative humidity of the participant residence. Enzyme-linked immunosorbent assay (ELISA) was used to measure C reactive protein (CRP), endothelin-1 (ET-1), and malondialdehyde (MDA) levels in maternal serum, and their results were transformed by natural logarithm. A distributed lag nonlinear model was used to investigate the associations of exposures to hot day, hot night, and CHE during pregnancy with PTB at different lag days, and a logistic regression model was used to investigate the associations of CRP, ET-1, and MDA with PTB. Results The incidence rate of PTB was 6.2% in all selected participants. Compared with the non-hot day, the RRs (95%CIs) of CHE in lag 3, 7, and 14 days on PTB were 1.43 (1.12-1.84), 1.24 (1.08-1.43), and 1.17 (1.05-1.30), respectively, and the cumulative effects (% difference) (95%CI) of CHE in lag 14 days on maternal serum CRP, ET-1, and MDA were 0.33% (−0.45%-1.12%), 0.59% (0.11%-1.07%), and 0.57% (0.09%-1.05%), respectively. Compared with the Q1 (lowest quartile) for CRP, ET-1 and MDA, the RRs (95%CIs) of Q4 (highest quartile) for PTB were 1.27 (0.50-3.22), 1.51 (0.61-3.72), and 2.07(0.81-5.27), respectively. Conclusion Maternal exposure to CHE during pregnancy might be associated with an increased risk of PTB. Prenatal exposure to CHE is positively associated with maternal serum CRP, ET-1, and MDA, and the three biochemical indicators are also positively associated with PTB. However, the above conclusions still need further confirmation.

OBJECTIVE To prepare celastrol -loaded albumin nanoparticles （CLT-AN），and to investigate their activity against rheumatoid arthritis （RA）in vivo . METHODS CLT-AN was prepared by ultrasonic method . The formulation technology was optimized by single -factor test by taking particle size ，polydispersity index （PDI）and stability as indexes ，with the dosage of CLT ， the dosage of soybean oil and the ultrasonic power as factors . The physical and chemical properties of CLT -AN were investigated by transmission electron microscopy （TEM）and laser particle size analyzer ；in vitro stability and release profile were studied . A rat model of adjuvant -induced arthritis was constructed to investigate the effects of CLT -AN on joint swelling ，the levels of serum inflammatory factors [tumor necrosis factor α（TNF-α）and interleukin -1β（IL-1β）] and pathological state of joint tissue . RESULTS The optimized formulation was CLT 6.5 g，soybean oil 45 mg，ultrasonic power 490 W，ultrasonic time 8 min. CLT- AN prepared by the best formulation showed uniform and spherical morphology . Its particle size ，PDI，Zeta potential were （96.8± 1.1）nm，0.174±0.020，and（－18.6±1.7）mV，respectively. The encapsulation efficiency and drug -loading efficiency were （94.61±0.46）% and（2.42±0.21）%. There were no significant changes in particle size ，PDI，Zeta potential and encapsulation efficiency of CLT -AN within 5 days of storage at room temperature . CLT-AN was slowly released in vitro ，and the cumulative release reached 73.56% in 72 h. Compared with CLT ，CLT-AN could significantly inhibit the joint swelling of model rats ，reduced the levels of inflammatory factors TNF -α and IL -1β in serum ，and improved the pathological state of inflammatory joint tissue . CONCLUSIONS CLT-AN prepared by ultrasonic method has the appropriate particle size ，good stability ，significant sustained - release characteristics ，and excellent therapeutic efficacy against RA .

Cardio-cerebrovascular disease (CCVD) is a major comorbidity of Coronavirus disease 2019 (COVID-19). However, the clinical characteristics and outcomes remain unclear. In this study, 102 cases of COVID-19 from January 22, 2020 to March 26, 2020 in Xixi Hospital of Hangzhou were included. Twenty cases had pre-existing CCVD. Results showed that compared with non-CCVD patients, those with CCVD are more likely to develop severe disease (15% versus 1%), and the proportion of pneumonia severity index grade IV was significantly higher (25% versus 3.6%). Computed tomography images demonstrated that the proportion of multiple lobe lesion involvement was significantly higher in the CCVD group than in the non-CCVD group (90% versus 63.4%). Compared with non-CCVD group, the levels of C-reactive protein, fibrinogen, D-dimer, and serum amyloid-A were higher, whereas the total protein and arterial partial PaO
COVID-19 ; Cerebrovascular Disorders/epidemiology* ; Comorbidity ; Humans ; SARS-CoV-2 ; Tomography, X-Ray Computed

Objective:To explore the risk factors for early hematoma expansion (HE) in patients with spontaneous intracerebral hemorrhage (sICH), and construct a clinical-radiomics combined model to predict HE after sICH.Methods:From April 2014 to September 2020, 339 patients with sICH who underwent plain CT scans in Radiology Department of our hospital were recruited. Patients were divided into HE group and non-HE group according to whether HE occurred (HE was defined as an increase in hematoma volume>33% or 6 mL on the follow-up CT within 24 h). The clinical data of non-HE group and HE group were compared, and multivariate Logistic regression analysis was used to detect independent risk factors for HE. The radiomics features were extracted from the regions of interest of the hematoma in the first CT scan images; the optimal radiomics features were selected using least absolute shrinkage and selection operator (LASSO) regression model and 10-fold cross-validation method, and then, the radiomics scores (R-score) were calculated; the risk factors for HE (clinical data) and R-score (radiomics data) were used to construct the clinical model, R-score model, and clinical-radiomics combined model; receiver operating characteristic (ROC) curve was performed to evaluate the prediction performance of clinical model, R-score model, and clinical-radiomics combined model; the best model was visualized as a nomogram and a calibration curve was drawn to evaluate the prediction accuracy of this model.Results:As compared with patients in the non-HE group, patients in the HE group had shorter time from sICH onset to first CT, higher percentage of patients with diabetes, lower platelet count, lower Glasgow Coma Scale (GCS) scores, and larger baseline hematoma volume in CT image, with significant differences ( P<0.05). Multivariate Logistic regression analysis showed that baseline hematoma volume ( OR=1.015, 95%CI: 1.000-1.030, P=0.046), GCS scores ( OR=0.914, 95%CI: 0.839-0.995, P=0.039), time from sICH onset to first CT ( OR=0.855, 95%CI: 0.741-0.987, P=0.032), and diabetes ( OR=0.522, 95%CI: 0.311-0.875, P=0.014) were independent risk factors for HE. By using LASSO regression and 10-fold cross-validation method, 20 optimal radiomics features were finally selected. The area under ROC curve of clinical model, R-score model, and clinical-radiomics combined model were 0.650, 0.860, and 0.870, respectively. The calibration curve showed that the prediction accuracy of clinical-radiomics combined model in early HE had good consistency with the actual occurrence probability. Conclusion:The clinical-radiomics combined model could effectively predict early HE with good calibration, which is helpful in individualized clinical assessment of risk of early HE in SICH patients.

Objective:To investigate the relationship between the changes of serum lipoprotein associated phospholipase A2 (Lp-PLA2), human Parkinson′s protein 7 (PARK7), erythropoietin (EPO) and neurological deficit score (NIHSS) and carotid intima-media thickness (CIMT) in patients with acute ischemic stroke (AIS).Methods:150 patients with AIS diagnosed in our hospital from January 2016 to January 2018 (AIS group) and 80 healthy subjects were selected as the control group. The Lp-PLA2, PARK7, EPO levels were compared between the two groups according to NIHSS score (mild, moderate and severe), carotid atherosclerotic plaque (unstable plaque, stable plaque, no plaque).Results:The serum level of Lp-PLA2, PARK7, EPO and CIMT values in the AIS group were significantly higher than those in the control group ( P<0.05). The Lp-PLA2 and PARK7 levels in the mild, moderate and severe AIS patients were gradually increased among the three groups, with statistically significant difference ( P<0.05). There was no significant difference in EPO levels between the different NIHSS groups ( P>0.05); The levels of Lp-PLA2, PARK7 and EPO of AIS patients in non plaque group, stable plaque group and unstable plaque group were gradually increased among the groups, and the difference between the two groups was statistically significant ( P<0.05). The level of Lp-PLA2 and PARK7 in patients with AIS and the NIHSS scores showed a significant positive correlation ( P<0.05). There was a significant positive correlation between Lp-PLA2, PARK7, EPO and CIMT in patients with AIS ( P<0.05). Conclusions:The serum levels of Lp-PLA2, PARK7 and EPO were significantly increased in AIS patients. Lp-PLA2, PARK7 were related to the aggravation of neurological deficits in potential patients. Lp-PLA2, PARK7 and EPO were related to the increase of carotid intima-media thickness in potential patients.

Objective To observe the change of retinal microstructures and the association between visual outcome with these microstructures in central serous chorioretinopathy (CSC) after laser treatment.Methods This is a retrospective study.From April 2016 to February 2017,a total of 52 eyes from 52 patients who underwent conventional laser treatment (27 eyes) or subthreshold laser treatment (25 eyes) for CSC and the sub-retinal fluid (SRF) absorbed completely were included in this study.The were 46 patients (46 eyes) and 6 males (6 eyes),with the mean age of 43.92± 8.62 years.The healthy fellow eyes (49 eyes) were selected as control.All patients were underwent BCVA and SD-OCT examination.According to the OCT images for all patients,the thickness of central foveal (CFT),outer nuclear (ONL),inner segment (IS),outer segment (OS) were measured.The status of ellipsoid zone (EZ),interdigitation zone (IZ) and RPE were also evaluated at fovea.Comparing the change of SD-OCT microstructures in two time points,the first visit after SRF absorbed and the last visit respectively.Spearman correlation analysis was used to analyze the relation between BCVA and ONL,IS,OS.Results At the first visit after SRF absorbed,compared with control eyes,the thickness of CFT (182.55 ± 24.14 μm),ONL (72.86 ± 17.39 μm),IS (41.23 ± 5.14 μm),OS (18.52 ± 10.26 μm) in CSC eyes were decreased (P＜ 0.001).Meanwhile,the mean BCVA of CSC eyes was 81.27± 6.39 letters,which was also significantly decreased comparing with control eyes (P＜ 0.001).At last visit,the thickness of CFT,ONL,IS,OS were 195.19±22.10,75.44±16.33,44.56±4.09,26.60± 11.39 μm,and the mean BCVA was 85.50±5.95 letters.All recovered significantly comparing with first visit (P＜0.05).At first visit,the BCVA of patients with integrate EZ (83.38± 5.78 letters) was significantly better than the BCVA of patients with unintegrated EZ (77.90± 5.97 letters) (P=0.003).And the BCVA of patients with smooth RPE (82.72± 5.95 letter) was also significantly better than the BCVA of patients with rough RPE (78.00± 6.31 letters) (P=0.020).The result of Spearman correlation analysis showed that the thickness of OS was positively correlated to BCVA at two time points (r=0.423,0.416;P=0.002,0.002).Conclusions In CSC,the thickness of ONL,IS,OS were decreased,and the integrality of EZ,IZ,the smooth of RPE were disrupted in different extent.After laser treatment,with retinal reattachment,those microstructures including ONL,IS,OS,EZ,IZ recovered slowly.The thickness of OS,the integrality of EZ and the smooth of RPE were associated with visual acuity.

Objective: To investigate surface properties of novel flowable composites after polishing and simulated brushing wear, compared to their pasty counterpart. Methods: Composites employed in this study were: three flowable composites (A1: Clearfil Majesty ES Flow; B1: Beautifil Flow Plus F00; C1: Filtek Bulk Fill) and three paste composites (A2: Clearfil Majesty; B2: Beautifil; C2: Filtek Z350. Eleven disk-shaped specimens were made for each material. The specimens were cured, then subjected to sandpaper finishing for 20 s, one-step polishing for 30 s, finally subjected to simulated brushing for 10 000 cycles. Surface roughness and glossiness were measured before finishing, after finishing, after polishing, after 5 000 brushing cycles and after 10 000 brushing cycles, respectively. Data obtained were analyzed using two-way ANOVA method. Scanning electron microscope was employed to examine the microscopic appearance of each material. Results: Surface roughness (0.11~0.22 μm) and glossiness (74.25~86.48 GU) of each material were similar after one-step polishing. After brushing simulation, roughness increased significantly and glossiness decreased significantly for each material (P<0.05). Group A1 presented the best gloss ([50.68±1.58] GU) after final wear (P<0.05). Flowable composites of group A1 and B1 tested in the present setup showed better surface properties compared to their pasty counterpart (group A2 and B2). Conclusions Within the limit of this study, flowable composites tested in the present research can obtain similar surface polish or even better than the paste composite counterpart.

Objective: To evaluate effects of color matching of different cavosurface margins on the resin composites in vitro.Methods:Twenty extracted human premolars with an A 2 shade buccal surface were used in this study .Rectangular shaped cavities (3.0 mm depth, 2.0 mm width, 2.0 mm length) were prepared in the center of the buccal surfaces .The gingival and occlusal cavosurface margins were prepared to be either shoulder or bevel;the other cavosurface margins remained vertical .Ten teeth were filled with Clearfil AP-X (AP), the other ten with Clearfil Majesty (MJ) and light cured.The color difference at the cavosurface margin area was measured using a spectrophotometer ( CrystalEye ) and evaluated by 3 observers subjectively .The data were statistically analyzed using repeated measures ANOVA and Chi-square test .Results:When measured by CrystalEye , the color difference between the tooth and resin composite was reduced from the center of restoration to the cavosurface margin area .Both objective and subjective evaluations showed that for AP , the color difference at the cavosurface margin area had no statistical difference among 3 types of the margins; for MJ, the color difference at bevel margin area was significantly smaller than that at the vertical margin area .Conclusion: The resin com-posite restorations produced the color matching at marginal area .The color matching of resin composites with higher diffused light transmission property is more susceptible to the type of cavosurface margins . Preparing bevels may reduce the color difference between the restoration and tooth surface .