Objective To investigate the incidence and severity of enamel demineralization during clear aligner treatment and provide reference for clinical medical nursing work.Methods A total of 151 patients(3 507 teeth)undergoing clear aligner treatment in our hospital from 2015 to 2022 were collected.The enamel demineralization before and after treatment was compared,and the enamel demi-neralization index(EDI)was calculated to evaluate the severity of demineralization.The incidence and severity of enamel demineraliza-tion were analyzed statistically,and the differences among different genders,ages and dental positions were compared.Results Enam-el demineralization occurred in 84 patients during treatment,with an incidence rate of 55.63%.Gender and treatment time had no effect on the incidence,and the incidence of adolescent patients was higher than that of adult patients.Among the investigated 3 507 teeth,601 teeth had enamel demineralization,and the incidence rate was 17.14%.The incidence of maxillary anterior teeth and mandibular posterior teeth was higher;the incidence of right teeth was significantly higher than that of left teeth,and the incidence of teeth with ad-hesive attachments was also significantly increased.88%of the enamel demineralization lesions were 1－2 degrees,and the degree of enamel demineralization was similar in male and female patients.But the degree in adolescents was significantly higher than that in adult patients.The average EDI value of maxillary anterior teeth was significantly higher than that of mandible,but that of maxillary posterior teeth was significantly lower than that of mandible.The average EDI value of right teeth was significantly higher than that of left.Conclusion The incidence of enamel demineralization is high in the process of clear aligner treatment,and teenagers are suscep-tible to it.The demineralization of teeth is significantly different among different tooth positions,and adhesive attachments will increase the risk of enamel demineralization.Therefore,medical staff should take active and effective measures in the prevention and treatment of enamel demineralization.

Objective:To explore the value of transrectal multimodal ultrasound parameters in monitoring and evaluating the efficacy of endocrine therapy for prostate cancer.Methods:Thirty patients with prostate cancer confirmed by pathology and treated with endocrine therapy in Inner Mongolia Autonomous Region People′s Hospital from November 2019 to May 2021 were selected. The levels of serum prostate specific antigen (PSA), prostate volume, color Doppler parameters, elasticity index and contrast-enhanced ultrasound parameters were measured and recorded before treatment, 1 month and 3 months after treatment. The parameters before and after treatment were statistically analyzed. The correlation between the changes of each index and PSA was analyzed by Spearman correlation analysis.Results:Total prostate specific antigen, free prostate specific antigen, and prostate volume were significantly different before treatment, and 1 month and 3 months after treatment( P<0.05), and the values showed a downward trend with increase of treatment time. There was no significant difference in resistance index before and 1 month after treatment( P>0.05), but decreased significantly 3 months after treatment( P<0.05). The values of elasticity index, peak intensity, area under curve and gradient at 1 month and 3 months after treatment were lower than those before treatment, while the arrival time and rising time at 1 month and 3 months after treatment were significantly higher than those before treatment( P<0.05). Spearman correlation analysis showed that there was no correlation between the changes of quantitative parameters and PSA value before and after treatment( P>0.05). Conclusions:Prostate volume, color Doppler parameters, elasticity index, and contrast-enhanced ultrasound parameters change in the early stage of endocrine therapy for prostate cancer, which can be used as a useful supplement to PSA for prostate cancer, and can be used to evaluate the efficacy of clinical prostate cancer endocrine therapy.

Objective:To investigate the role of coupler perfusion in transrectal ultrasound in the diagnosis of preoperative T staging of rectal cancer.Methods:A retrospective analysis of the preoperative clinical data of 132 patients with rectal cancer in the People′s Hospital of Inner Mongolia Autonomous Region from June 2015 to November 2020. According to whether or not the patients agreed to coupler perfusion before ultrasound examination, they were divided into 2 groups, namely the perfusion group 69 cases and the non-perfusion group of 63 cases, with postoperative pathology as the gold standard, and compared with magnetic resonance imaging(MRI) to evaluate the accuracy of the 2 groups and MRI in the T staging of rectal cancer.Results:The total coincidence rates of the coupling agent perfusion group, non-perfusion group and MRI group for the diagnosis of rectal cancer T staging were 89.9%, 76.2% and 87.9%, respectively, and the difference among the three methods was statistically significant (χ 2=6.096, P=0.047). The diagnostic sensitivity of the coupling agent perfusion group for T1 stage was 96.0%, which was higher than 61.5% of the non-perfusion group and 92.3% of the MRI ( P=0.010). The specificity of the perfusion group for the diagnosis of T2 stage was 95.7%, higher than the non-perfusion group and MRI ( P=0.037), the positive predictive value of the perfusion group for T2 stage was 90.9%, which was higher than the non-perfusion group and MRI ( P=0.035). The diagnostic accuracy of the perfusion group for T2 stage was 94.2%, higher than the non-perfusion group and MRI (χ 2=7.070, P=0.029). There were no statistically significant differences in diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy among the perfusion group and the non-perfusion group and the MRI for T3 and T4 (all P>0.05). Conclusions:Coupled-agent perfusion makes it convenient and fast for intracavity ultrasound to diagnose T staging of rectal cancer, and the diagnostic efficiency is comparable to MRI. In particular, it can be used as a highly reliable imaging method for T1 and T2 rectal cancer.

Objective:To analyze the occupational health monitoring data of workers in Zhoushan City, and provide scientific basis for health monitoring and the formulation of occupational disease prevention measures.Methods:From January 2016 to November 2019, the occupational health examination data of 37826 workers in Zhoushan City were collected to analyze the change trend of the detection rate of suspected occupational diseases and occupational contraindications, and to compare the health monitoring status of workers with different social characteristics such as enterprise scale and economic type.Results:From 2016 to 2019, the detection rate of suspected occupational diseases showed a downward trend (χ 2trend=21.09, P<0.05) . The occupational health examination of on-the-job workers in Zhoushan were mainly small enterprises (59.72%, 22591/37826) , private economic enterprises (65.32%, 24707/37826) , male (82.03%, 31028/37826) , 30-49 years old (59.11%, 22359/37826) , and exposed to noise (67.06%, 25365/37826) . The detection rates of occupational contraindications and suspected occupational diseases were higher in micro enterprise, male, over 60 years old, exposed to occupational hazards for more than 49 months, and exposed to chemical and physical hazards at the same time. The detection rates of occupational contraindications and suspected occupational diseases were significantly different among different enterprise scale, economic type, gender, age and occupational hazard factors ( P<0.05) . Among benzene workers with occupational contraindications and suspected occupational diseases, the detection rate of A/G abnormality in female workers was higher than that in male workers ( P=0.04) , and there was no significant difference in other genders ( P>0.05) . Conclusion:It is necessary to pay more attention to the workers working in small and private enterprises in Zhoushan City, strengthen the occupational health supervision of male workers who are over 60 years old who are exposed to benzene, noise and other occupational hazards, standardize the occupational health inspection, and effectively protect the health of the occupational population.

Objective:To analyze the occupational health monitoring data of workers in Zhoushan City, and provide scientific basis for health monitoring and the formulation of occupational disease prevention measures.Methods:From January 2016 to November 2019, the occupational health examination data of 37826 workers in Zhoushan City were collected to analyze the change trend of the detection rate of suspected occupational diseases and occupational contraindications, and to compare the health monitoring status of workers with different social characteristics such as enterprise scale and economic type.Results:From 2016 to 2019, the detection rate of suspected occupational diseases showed a downward trend (χ 2trend=21.09, P<0.05) . The occupational health examination of on-the-job workers in Zhoushan were mainly small enterprises (59.72%, 22591/37826) , private economic enterprises (65.32%, 24707/37826) , male (82.03%, 31028/37826) , 30-49 years old (59.11%, 22359/37826) , and exposed to noise (67.06%, 25365/37826) . The detection rates of occupational contraindications and suspected occupational diseases were higher in micro enterprise, male, over 60 years old, exposed to occupational hazards for more than 49 months, and exposed to chemical and physical hazards at the same time. The detection rates of occupational contraindications and suspected occupational diseases were significantly different among different enterprise scale, economic type, gender, age and occupational hazard factors ( P<0.05) . Among benzene workers with occupational contraindications and suspected occupational diseases, the detection rate of A/G abnormality in female workers was higher than that in male workers ( P=0.04) , and there was no significant difference in other genders ( P>0.05) . Conclusion:It is necessary to pay more attention to the workers working in small and private enterprises in Zhoushan City, strengthen the occupational health supervision of male workers who are over 60 years old who are exposed to benzene, noise and other occupational hazards, standardize the occupational health inspection, and effectively protect the health of the occupational population.

Based on the data from the -, the bibliometric analysis was applied to analyze and evaluate the literature regarding clinical research of acupuncture for ophthalmopathy published between 1954 to 2016, hoping to objectively reflect the disease spectrum and indication of acupuncture for ophthalmopathy. The results showed that the disease spectrum of acupuncture for ophthalmopathy involved 47 specific diseases in 13 types of diseases. The total number of cases was 176 469, and the number of effective cases was 160 662, and the effective rate was 91.0%. The indication of acupuncture for ophthalmopathy included myopia, blepharoptosis and conjunctivitis. The commonly used indications were strabismus, dry eye and ophthalmoplegia, and the secondary indications were optic atrophy, blepharoptosis, oculomotor paralysis, blepharospasm, amblyopia. The most commonly used acupuncture points for ophthalmopathy were Cuanzhu (BL 2), Jingming (BL 1), Taiyang (EX-HN 5), and the most commonly used auricular points were yan (LO), gan (CO) and shen (CO). As for the methods of acupoint combination, local acupoints were mainly selected, combined with distal acupoint to assist treatment.

Objective To investigate the characteristics of neonatal methylmalonic aciduria (MMA)regarding clinical manifestations,laboratory findings,gene mutations,treatments and prognosis.Methods Acylcamitine levels in blood samples of 207 308 neonates born from January 2016 to December 2017 in Xuzhou were detected by liquid chromatography tandem mass spectrometry and the abnormal results were further confirmed by detecting organic acids in urine samples with gas chromatography-mass spectrometry and gene sequencing analysis.Patients with isolated MMA were treated with dietary control and levocarnitine,while those complicated by homocysteinemia were treated with vitamin B12,levocarnitine,glycine betaine and calcium folinate.Clinical manifestations,laboratory findings,imaging features,genotypes,treatments and prognosis of patients with MMA were retrospectively analyzed.Paired sample t-test was applied for statistical analysis.Results MMA was eventually diagnosed in 12 patients,among which three were isolated MMA and nine were complicated by homocysteinemia.The three isolated MMA cases failed to response to vitamin B12 treatment without any symptoms on diagnosis.However,vitamin B12 was effective for the other nine patients,among which four had no clinical symptoms on diagnosis and five had manifestations such as slow response,recurrent vomiting,poor feeding,dyspnea,anemia and jaundice.Abnormal results of cranial MRI included bilateral basal ganglia damage,enlarged extracranial space,ventriculomegaly and changes in white matter.All patients underwent genetic analysis and three were found with MUT gene mutations and nine with MMACHC gene mutations.MUT gene mutations were classified into five types,including c.I106G＞A,c.1880A＞G,c.441T＞A,c.581C＞T and c.1741C＞T.Eight types of MMACHC gene mutations were identified,including c.609G＞A,c.658_660delAAG,c.482G＞A,c.1A＞G,c.567dupT,c.80A＞G,c.276+1G＞A and c.228_23 l delTGAC.Two mutations,c.276+lG＞A and c.228 23 ldelTGAC,were novel mutations.The most common mutation in MMACHC gene was c.609G＞A,followed by c.658_660delAAG and c.482G＞A.One of the isolated MMA patients died after refusing treatments and the other two showed significant decrease in serum propionylcarnitine,propionylcarnitine to acetylcarnitine ratio,serum homocysteine and methylmalonic acid and methylcitric acid in urine after treatment.Moreover,of the two patients who were alive at follow-up,one experienced normal growth and development and the other suffered from growth retardation.The ratio of propionylcamitine to acetylcarnitine and the levels of serum propionylcarnitine,serum homocysteine and methylmalonic acid and methylcitric acid in urine were significantly decreased in the nine patients with MMA complicated by homocystinuria after one month of treatment [0.88±0.35 vs 0.13±0.05,(7.12±1.90) μ mol/L vs (3.18±1.08) μ mol/L,(136.48±38.14) μ mol/L vs (34.41±17.33) μmol/L,103.51±69.62vs 5.35±2.15 and 7.95±6.88 vs 1.02±0.48,t=-6.166,-6.687,-12.941,-4.208 and-3.015,respectively,all P＜0.05].Two deaths,three asymptomatic and four psychomotor retardation patients were reported during follow-up.Conclusions Newborn screening with liquid chromatography tandem mass spectrometry is important for early diagnosis of MMA.MMACHC gene defects are the main causes of MMA in Xuzhou area and the predominant one is c.609G＞A mutation.Prognosis of MMA might be related to disease type,age of onset and patient's reactivity to vitamin B12.

Objective: To explore the anti-inflammatory immune mechanism in moxibustion treatment of Crohn.s disease (CD) from the perspective of c-Jun N-terminal kinase (JNK) signaling pathway, through observing the regulatory effect ofmoxibustion on colonic JNK, c-Jun, monocyte chemoattractant protein 1 (MCP-1) and cyclooxygenase 2 (COX2) in CDmodel rats. Method: Male Sprague-Dawley rats of clean grade were randomized into a normal group, a model group, amoxibustion group and a sham moxibustion group. CD model was developed by the mixture of 2, 4, 6 Trinitro-benzene-sulfonic acid (TNBS) and ethanol via enema. Hematoxylin-eosin (HE) staining was used to observe the morphologicalchanges in rat.s colon tissues for pathological scoring; enzyme-linked immunosorbent assay (ELISA) was used to detectthe contents of MCP-1, COX2, JNK, and c-Jun in colon tissues; real-time fluorescence quantitative PCR was adopted toexamine the mRNA expressions of JNK and c-Jun in rat.s colon. Result: Compared with the normal group, the modelgroup showed more significant colonic damage and thus had a higher colonic damage score (P ＜ 0.01), manifested astopical inflammation which involved the submucosa, fissuring ulcers and granuloma; the model group also showedincreased contents of protein MCP-1 and COX2, and elevated contents of JNK protein and mRNA in colon (all P ＜ 0.05), while the change in the content of c-Jun was insignificant (all P＞ 0.05) . Compared with the model group and shammoxibustion group, the colonic damage score was lower in the moxibustion group (P ＜ 0.01, P ＜ 0.05), with improvementin colonic structure and inflammation; the contents of MCP-1 and COX2 in colon tissues declined, so did the proteincontent and mRNA expression of JNK (all P ＜ 0.05), while the change in the content of c-Jun was insignificant (all P＞0.05) . There were no significant differences between the model group and sham moxibustion group comparing all theindexes (all P＞ 0.05) . Conclusion: Moxibustion down-regulates the expressions of JNK protein and mRNA in CD rat.scolon, as well as the contents of MCP-1 and COX2 in colon tissues, which is possibly one significant mechanism formoxibustion to ease intestinal inflammation and promote the repair of colon tissues in CD.

Objective To explore neonatal screening and therapeutic effects of congenital hypothyroidism (CH) in Xuzhou. Methods Data of neonatal heel blood thyroid stimulating hormone (TSH) tested with time-resolved lfuoroimmunoassay from July 2003 to July 2015 were retrospectively analyzed; The cases with positive screening tests were called back for further examination of the serum thyroid function (TSH,FT 3,FT 4 ) by chemiluminescence immunoassay method. The CH patients were given levothyroxine replacement. A total of 686 patients with CH treated routinely for 1 years later (CH group) and 650 matched healthy children (control group) were included in the study. The physical development was monitored regularly. The neurodevelopment was tested at 1 and 3 years old. Results In Xuzhou 1228289 neonates were screened during 12 years,of them 950 cases were diagnosed with CH and the incidence was 1/1293 . Among 635 CH patients who received treatment and follow-up regularly for 2 years,?488 cases ( 76 . 85%) were evaluated to have permanent hypothyroidism and 147 cases ( 23 . 15%) have transient hypothyroidism. There were no signiifcant differences in developmental quotient between the CH group and the control group at 1 and 3 years old (P?>?0 . 05 ). Conclusions Neonatal disease screening is an effective measure for early diagnosis of CH; the physical and mental development are normal in CH patients after early replacement therapy.

Objective To investigate the prevalence,clinical classification,treatment and prognosis of neonatal hyperphenylalaninemia(HPA) in Xuzhou area,China.Methods Infants born between July 1,2003 and July 1,2015 in Xuzhou area were investigated.Heel blood samples of neonates were collected at 72 hours after birth,and the concentration of blood phenylalanine(Phe) was determined by fluorescent quantitative method in Xuzhou Maternity and Child Health Care Station Neonatal Disease Screening Center.Differential diagnosis was performed in all 265 cases diagnosed as HPA by urinary pterin analysis and dihydropteridine reductase activity determination.The blood Phe concentration and mental development were followed up regularly in infants with HPA.Mutations of phenylalanine hydroxylase (PAH) gene were analyzed by gene sequencing.The relationship between blood Phe concentration and mental development was analyzed by Bivariate correlation analysis.Results (1) The prevalence of HPA in neonates in Xuzhou was 1/4 635.Among the 265 confirmed HPA cases,260 cases(98.11％) had PAH deficiency,including 90(33.96％) classical phenylketonuria(PKU),84(31.70％) mild PKU and 86(32.45％) mild HPA.The other five patients(1.89％) diagnosed with tetrahydrobiopterin (BH4) deficiency all had 6-pyruvoyl tetrahydropteim synthase(PTPS) deficiency.(2) Among the 265 HPA cases,26 cases refused any treatment,including five cases of PTPS deficiency and 21 cases of PKU.Of the five patients with PTPS deficiency,two died and the other three had normal mental and physical development.Twenty-one PKU patients who refused treatment had mental retardation of various degrees.Among 153 PKU patients who received medical treatment,three died and 12 were lost to follow-up.(3) For 138 PKU patients who received dietary treatment and follow-up,the ages at the last visit were two months to 12 years,116 of them had normal mental development,the remaining 22 patients had mental retardation,and a negative correlation was observed between mental development and the average Phe concentration.(4) Thirty-five patients with PAH deficiency underwent gene sequencing,and 22 kinds of mutations of PAH gene were detected.Conclusions The prevalence of HPA in Xuzhou area is higher than the average national level.With early diagnosis and standard treatment,most of PKU neonates can have normal mental development.Phe level control is an important factor for mental development.