Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.
Humans ; Consensus ; Dental Caries/etiology* ; Dental Enamel/pathology* ; Tooth Demineralization/etiology* ; Tooth Remineralization

Objective Exploring the influencing factors of organ dysfunction following postpartum hemorrhage.Methods A retrospective study was conducted on 140 patients with postpartum hemorrhage admitted to the department of critical care medicine at the Women's Hospital School of Medicine Zhejiang University between January 2020 and December 2023.Based on the sequential organ failure assessment(SOFA)score within 24 hours of ICU admission,patients were categorized into an observation group(SOFA≥2,54 cases)and a control group(SOFA<2,86 cases).Clinical data collected for both groups included age,prenatal body mass index(BMI),postpartum hemorrhage volume,obstetric and induced abortion history,use of assisted reproductive technology,and pre-delivery prophylactic iliac artery balloon,the differences in the above data between the two groups of patients to determine whether there was any organ damage were compared,and variables showing statistically significant differences were subsequently included in a multivariate Logistic regression analysis.Receiver operator characteristic curve(ROC curve)were plotted,and area under the curve(AUC)was calculated to evaluate the predictive performance of each influencing factor.Results The univariate analysis revealed no statistically significant differences in age,prenatal BMI,obstetric history,induced abortion history,or use of assisted reproductive technology between the two groups(all P>0.05).Compared with the control group,the observation group had significantly higher postpartum hemorrhage volume[mL:1850(1500,2500)vs.1500(1000,2 000),P<0.05]and a significantly lower proportion of patients with prophylactic iliac artery balloon[13.0%(7/54)vs.32.6%(28/86),P<0.05].Multivariate Logistic regression analysis of the two statistically significant factors from the univariate analysis showed that postpartum hemorrhage volume>1 000 mL was a risk factor for organ dysfunction[odds ratio(OR)=5.602,95%confidence interval(95%CI)was 1.569-20.002,P=0.008],while prophylactic placement of an iliac artery balloon was a protective factor against organ dysfunction(OR=0.377,95%CI was 0.147-0.971,P=0.043).ROC curve analysis demonstrated that postpartum hemorrhage volume had the highest predictive value for organ dysfunction,with an AUC=0.704 95%CI was 0.618-0.790,P<0.001.At the optimal cut-off value of 1 400 mL,the sensitivity was 48.8%and the specificity was 81.5%.The combination of a postpartum hemorrhage volume>1000 mL and pre-delivery prophylactic iliac artery balloon showed the next highest predictive value(AUC=0.666,95%CI was 0.577-0.755,P=0.001).Conclusions Postpartum hemorrhage volume>1 000 mL is a risk factor for organ dysfunction following postpartum hemorrhage and demonstrates certain predictive value,while the pre-delivery prophylactic iliac artery balloon can reduce the incidence of organ dysfunction and serves as a protective factor.

This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.

Objective:To develop an artificial intelligence（AI）-based sequential ultrasound-magnetic resonance imaging（US-MRI）diagnostic strategy to optimize the imaging workflow for ovarian masses.Methods:A total of 1 120 patients with pathologically confirmed ovarian masses who underwent both preoperative pelvic ultrasound and MRI between January 2021 and December 2023 at Women's Hospital，Zhejiang University School of Medicine were retrospectively included. Patients were randomly divided into the training（ n=672）and internal test set（ n=448）at a ratio of 6∶4. An external test set（ n=128）was established at the Forth Affiliated Hospital of School of Medicine. Deep learning was used for automated segmentation of MRI lesions，followed by radiomic feature extraction and machine learning classification to construct both a US-MRI multimodal model and sequential US-MRI strategy. Diagnostic performance and potential healthcare cost-saving effects were evaluated across strategies. Results:In the internal test set（ n=448），the AI-based sequential US-MRI strategy achieved a F1 score of 0.863 and a diagnostic accuracy of 82.14%，with no significant difference compared to the US-MRI multi-modal model（ P>0.05）. The sequential strategy identified 82 cases（18.30%，82/448）of patients as low-risk true negatives during initial ultrasound screening，suggesting a potential to reduce the need for MRI examinations in future clinical practice. In the external test set（ n=128），the strategy achieved an F1 score of 0.800 and a confirmed diagnosis rate of 85.94%，with a theoretical reduction of 26.56%（34 cases）in MRI utilization while maintaining a diagnostic accuracy rate higher than that of the multi-modal model（82.18%）. Conclusions:The AI-based US-MRI sequential diagnostic strategy demonstrates favorable diagnostic accuracy while offering the potential to optimize MRI utilization. This approach may enhance the efficiency of imaging resource allocation and reduce healthcare burden in the management of ovarian masses.

This consensus was developed by the Orthodontic Society of the Chinese Stomatological Association to provide a systematic, scientific, and practical guideline for informed consent in orthodontic care. Orthodontic treatment is typically lengthy, highly individualized, and involves multiple factors such as growth and development, occlusal function, and facial esthetics. Rapid technological advances and diverse risk profiles make the traditional reliance on orthodontist experience or institutional templates insufficient to ensure patients′ full understanding and autonomous decision-making. To address this, the expert panel conducted extensive reviews of domestic and international guidelines, analyzed representative dispute cases, and performed multicenter patient-clinician surveys. Using a multi-round Delphi method, the group established a standardized informed consent framework covering the initial consultation, treatment, and retention phases. The consensus emphasizes that informed consent is not only a fundamental legal and ethical requirement but also a key step in building trust, improving patient compliance, and enhancing treatment satisfaction. Orthodontists should clearly and comprehensively explain treatment plans, potential risks, uncertainties, and associated costs, while respecting the autonomy of patients or guardians, and maintain continuous communication and dynamic evaluation throughout the treatment process. The release of this consensus provides unified and authoritative guidance for clinical orthodontics, helping to standardize informed consent, enhance its transparency, safeguard patient rights, reduce medical risks, and promote high-quality, sustainable development of orthodontic practice.

Objective Exploring the influencing factors of organ dysfunction following postpartum hemorrhage.Methods A retrospective study was conducted on 140 patients with postpartum hemorrhage admitted to the department of critical care medicine at the Women's Hospital School of Medicine Zhejiang University between January 2020 and December 2023.Based on the sequential organ failure assessment(SOFA)score within 24 hours of ICU admission,patients were categorized into an observation group(SOFA≥2,54 cases)and a control group(SOFA<2,86 cases).Clinical data collected for both groups included age,prenatal body mass index(BMI),postpartum hemorrhage volume,obstetric and induced abortion history,use of assisted reproductive technology,and pre-delivery prophylactic iliac artery balloon,the differences in the above data between the two groups of patients to determine whether there was any organ damage were compared,and variables showing statistically significant differences were subsequently included in a multivariate Logistic regression analysis.Receiver operator characteristic curve(ROC curve)were plotted,and area under the curve(AUC)was calculated to evaluate the predictive performance of each influencing factor.Results The univariate analysis revealed no statistically significant differences in age,prenatal BMI,obstetric history,induced abortion history,or use of assisted reproductive technology between the two groups(all P>0.05).Compared with the control group,the observation group had significantly higher postpartum hemorrhage volume[mL:1850(1500,2500)vs.1500(1000,2 000),P<0.05]and a significantly lower proportion of patients with prophylactic iliac artery balloon[13.0%(7/54)vs.32.6%(28/86),P<0.05].Multivariate Logistic regression analysis of the two statistically significant factors from the univariate analysis showed that postpartum hemorrhage volume>1 000 mL was a risk factor for organ dysfunction[odds ratio(OR)=5.602,95%confidence interval(95%CI)was 1.569-20.002,P=0.008],while prophylactic placement of an iliac artery balloon was a protective factor against organ dysfunction(OR=0.377,95%CI was 0.147-0.971,P=0.043).ROC curve analysis demonstrated that postpartum hemorrhage volume had the highest predictive value for organ dysfunction,with an AUC=0.704 95%CI was 0.618-0.790,P<0.001.At the optimal cut-off value of 1 400 mL,the sensitivity was 48.8%and the specificity was 81.5%.The combination of a postpartum hemorrhage volume>1000 mL and pre-delivery prophylactic iliac artery balloon showed the next highest predictive value(AUC=0.666,95%CI was 0.577-0.755,P=0.001).Conclusions Postpartum hemorrhage volume>1 000 mL is a risk factor for organ dysfunction following postpartum hemorrhage and demonstrates certain predictive value,while the pre-delivery prophylactic iliac artery balloon can reduce the incidence of organ dysfunction and serves as a protective factor.

Objective:To develop an artificial intelligence（AI）-based sequential ultrasound-magnetic resonance imaging（US-MRI）diagnostic strategy to optimize the imaging workflow for ovarian masses.Methods:A total of 1 120 patients with pathologically confirmed ovarian masses who underwent both preoperative pelvic ultrasound and MRI between January 2021 and December 2023 at Women's Hospital，Zhejiang University School of Medicine were retrospectively included. Patients were randomly divided into the training（ n=672）and internal test set（ n=448）at a ratio of 6∶4. An external test set（ n=128）was established at the Forth Affiliated Hospital of School of Medicine. Deep learning was used for automated segmentation of MRI lesions，followed by radiomic feature extraction and machine learning classification to construct both a US-MRI multimodal model and sequential US-MRI strategy. Diagnostic performance and potential healthcare cost-saving effects were evaluated across strategies. Results:In the internal test set（ n=448），the AI-based sequential US-MRI strategy achieved a F1 score of 0.863 and a diagnostic accuracy of 82.14%，with no significant difference compared to the US-MRI multi-modal model（ P>0.05）. The sequential strategy identified 82 cases（18.30%，82/448）of patients as low-risk true negatives during initial ultrasound screening，suggesting a potential to reduce the need for MRI examinations in future clinical practice. In the external test set（ n=128），the strategy achieved an F1 score of 0.800 and a confirmed diagnosis rate of 85.94%，with a theoretical reduction of 26.56%（34 cases）in MRI utilization while maintaining a diagnostic accuracy rate higher than that of the multi-modal model（82.18%）. Conclusions:The AI-based US-MRI sequential diagnostic strategy demonstrates favorable diagnostic accuracy while offering the potential to optimize MRI utilization. This approach may enhance the efficiency of imaging resource allocation and reduce healthcare burden in the management of ovarian masses.

BACKGROUND:The light curing and fluoride light curing enamel adhesives have a certain sealing effect on the etched enamel surface.The fluoride light curing enamel adhesives can also achieve the anti-caries function by releasing fluoride ions.However,the existing researches lack the long-term tracing of fluoride release effect,especially the amount of local pathogenic bacteria after 1-3 months of local fluoride application. OBJECTIVE:To analyze the changes in the expression of Porphyromonas gingivalis and Streptococcus mutans in subgingival plaque of the upper anterior teeth adhered by different components of enamel adhesives in adolescent patients with fixed appliance. METHODS:Ninety adolescent patients who received orthodontic treatment in Shanghai Stomatological Hospital from January to December 2016 were enrolled,including 43 males and 47 females,with a mean age of(13.27±1.12)years.These patients were randomly divided into three groups(n=30 per group).In the chemical curing group,Unite? bonding resin was used to bond fixed appliances.In the light curing group,Transbond XT light curing resin was used to bond the fixed appliance.In the fluoride light curing group,GC light curing orthodontic adhesive was used to bond the fixed appliance with cement.The subgingival plaque was collected on the day of bonding,1st,2nd,and 3rd month follow-up reviews.The expressions of Porphyromonas gingivalis and Streptococcus mutans in subgingival plaque were detected by PCR. RESULTS AND CONCLUSION:(1)Intragroup comparison:With the increase of bonding time,Porphyromonas gingivalis expression increased significantly in the 3rd month in the chemical curing group(P<0.05).In the light curing group,Porphyromonas gingivalis showed a significant decrease in the 1st month(P<0.05).Porphyromonas gingivalis expression decreased significantly in the 1st and 2nd months compared with initial data in the fluoride light curing group(P<0.05).The expression of Streptococcus mutans was higher in the chemical curing group in the 1st,2nd,and 3rd months compared with the initial data(P<0.05).In the fluoride light curing group,the expression of Streptococcus mutans was lower in the 1st,2nd,and 3rd months compared with the initial data(P<0.05).There was no significant difference in the proliferation and expression of Streptococcus mutans during follow-up in the light curing group compared to the initial adhesion(P>0.05).(2)Intergroup comparison:In the 1st month,the expression of Porphyromonas gingivalis was lower in the light curing group and fluoride light curing group than that in the chemical curing group(P<0.05).In the 2nd and 3rd months,the expression of Porphyromonas gingivalis was lower in the fluoride light curing group than that in the light curing group and chemical curing group(P<0.05).In the 1st,2nd,and 3rd months,the expression of Streptococcus mutans was lower in the light curing group and fluoride light curing group than that in the chemical curing group(P<0.05).The expression of Streptococcus mutans was lower in the fluoride light curing group than that in the light curing group(P<0.05).(3)The results show that in the fixed orthodontic process,the use of different components of enamel adhesives has different effects on the proliferation and expression of oral Porphyromonas gingivalis and Streptococcus mutans in the short term.Fluoride light curing enamel adhesives at the initial stage can reduce the occurrence of enamel demineralization,caries,and periodontal inflammation.

Background::The calcineurin inhibitor (CNI)-based immune maintenance regimen that is commonly used after renal transplantation has greatly improved early graft survival after transplantation; however, the long-term prognosis of grafts has not been significantly improved. The nephrotoxicity of CNI drugs is one of the main risk factors for the poor long-term prognosis of grafts. Sirolimus (SRL) has been employed as an immunosuppressant in clinical practice for over 20 years and has been found to have no nephrotoxic effects on grafts. Presently, the regimen and timing of SRL application after renal transplantation vary, and clinical data are scarce. Multicenter prospective randomized controlled studies are particularly rare. This study aims to investigate the effects of early conversion to a low-dose CNI combined with SRL on the long-term prognosis of renal transplantation.Methods::Patients who receive four weeks of a standard regimen with CNI + mycophenolic acid (MPA) + glucocorticoid after renal transplantation in multiple transplant centers across China will be included in this study. At week 5, after the operation, patients in the experimental group will receive an additional administration of SRL, a reduction in the CNI drug doses, withdrawal of MPA medication, and maintenance of glucocorticoids. In addition, patients in the control group will receive the maintained standard of care. The patients’ vital signs, routine blood tests, routine urine tests, blood biochemistry, serum creatinine, BK virus (BKV)/cytomegalovirus (CMV), and trough concentrations of CNI drugs and SRL at the baseline and weeks 12, 24, 36, 48, 72, and 104 after conversion will be recorded. Patient survival, graft survival, and estimated glomerular filtration rate will be calculated, and concomitant medications and adverse events will also be recorded.Conclusion::The study data will be utilized to evaluate the efficacy and safety of early conversion to low-dose CNIs combined with SRL in renal transplant patients.Trial registration::Chinese Clinical Trial Registry, ChiCTR1800017277.

Since the first edition of ISO15189"Medical laboratories: requirements for quality and competence" was published in 2003, it has been rapidly and widely used in the world under the promotion of the International Laboratory Accreditation Cooperation Organization (ILAC), and has become the basic standard for the quality management, capacity-building and capacity attestation of medical laboratories. The Mutual Recognition Arrangement (MRA) of ILAC for ISO15189 is the most authoritative international permit for examination results, which is accepted by international organizations. Since the establishment of ISO15189 medical laboratory accreditation system in 2004 in China, more than 530 medical laboratories have been accredited, which plays an important role in improving the quality and competence of medical laboratories in China, and improves the influence of Chinese medical laboratories in the world. ISO 15189:2012 is currently being revised by the International Organization for Standardization/Technical Committee on Clinical Laboratory Testing and in vitro diagnostic test systems (ISO/TC212). This revision will bring significant changes and the medical laboratory shall pay attention to these changes. In order to help medical laboratories understand the new ideas in advance, this paper summarizes and analyses the draft of the new international standards, and provides references for users.