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

Oral lichen planus (OLP) is a chronic inflammatory disease of the oral mucosa. The pathogenesis of OLP is still unclear. Immune abnormalities mediated by T cells and related cytokines play a crucial role in the pathogenesis of OLP. In recent years, glycolytic metabolism-related transporters, enzymes and regulators, such as glucose transporter-1 (Glut1), glyceraldehyde 3-phosphate dehydrogenase (GAPDH), lactate dehydrogenase A (LDHA), mammalian target of rapamycin (mTOR) and hypoxia inducible factor-1α (HIF-1a), have attracted an increasing amount of attention in OLP by regulating the proliferation and differentiation of T cells and the secretion of inflammatory factors. It has been shown that 2-deoxy-D-glucose (2-DG) or rapamycin (RAPA) inhibits the glycolytic metabolism of T cells and then inhibits OLP. This article reviews the research progress of glycolytic metabolism-related transporters, enzymes and regulatory factors in OLP in recent years.

Objective:To investigate the clinical characteristics of influenza A and influenza B pneumonia and the risk factors of severe influenza pneumonia in children.Methods:The epidemiology, clinical characteristics, laboratory tests and pathogens of co-infection in children with pneumonia caused by influenza A virus and influenza B virus, and the risk factors of severe influenza pneumonia were retrospectively analyzed.Results:(1) The cases of influenza A infection accounted for 65.1% and those with influenza B infection accounted for 32.9% among the 711 children with influenza pneumonia.The dominant strain was Influenza B Victoria virus in spring and summer, influenza A(H 3N 2) virus in autumn, and influenza A(H1N1) virus in winter.The dominant strain was influenza A virus at the age of < 1 year and ~3 years, influenza A virus and influenza B virus at the age of ~6 years, and influenza B virus at the age of &ge;6 years.(2) The gastrointestinal symptoms were more common in children with influenza B pneumonia compared with those with influenza A pneumonia(53.4% vs 44.7%, χ2=4.728, P=0.030), but crackles and wheezing were more common in children with influenza A pneumonia compared with those with influenza B pneumonia(80.1% vs 70.5%, 36.9% vs 25.6%, χ2=8.945, 8.093, all P<0.05). (3) The percentage of decreased lymphocyte count in children with influenza B pneumonia was higher than those with influenza A pneumonia(5.6% vs 1.9%, χ2=6.633, P=0.010). (4) Mixed Mycoplasma Pneumoniae was more common in children with influenza B pneumonia compared with those with influenza A pneumonia(23.9% vs 10.8%, χ2=20.789, P<0.001), and mixed virus and bacteria were more common in children with influenza A pneumonia compared with those with influenza B pneumonia(15.8% vs 8.1%, 50.1% vs 41.9%, χ2=7.934, 4.221, all P<0.05). (5) Multivariate logistic regression analysis showed that age <2 years( OR=1.886, 95% CI 1.149~3.096, P=0.012), increased LDH( OR=1.736, 95% CI 1.080~2.790, P=0.023), the percentage of lymphocyte decreased( OR=2.762, 95% CI 1.669~4.571, P<0.001) and the percentage of CD3 + decreased ( OR=6.019, 95% CI 3.993~9.331, P<0.001)were risk factors for severe influenza pneumonia. Conclusion:Among hospitalized children with influenza pneumonia, there were some differences in the age of infection, clinical characteristics, laboratory tests and pathogens of co-infection between the cases caused by influenza B and influenza A, and clinicians should remain vigilant for the occurrence of severe influenza pneumonia.

Objective:To investigate the detection, epidemiological and clinical characteristics of human rhinovirus(HRV) in hospitalized children with respiratory tract infections.Methods:The study population comprised of 10 514 children with respiratory tract infections admitted to Department of Respiration, the Children′s Hospital of Soochow University, between January 2013 and December 2019.The nasopharyngeal aspirates and medical history were obtained by qualified medical personnel.Reverse transcription-polymerase chain reaction method was used to test HRV.Results:The total positive rate of human rhinovirus was 14.2%(1 493/10 514), and there was no significant difference between male and female( χ2=2.006, P=0.157). The positive rates from 2013 to 2019 were 9.7%, 14.6%, 19.1%, 18.6%, 18.1%, 11.0%, 11.4% respectively, and there were significant differences among these groups( χ2=116.580, P<0.001). HRV distributed throughout the year with a peak in summer and autumn(June to November), followed by spring, and the lowest in winter.The detection rates of HRV infection rates were 14.2%, 15.5%, 13.5% and 9.8% in the age group of 28 d~6 months, ~2 years, ~7 years and>7 years respectively, and there were significant differences among these age groups( χ2=16.124, P<0.001). The detection rate of HRV in children under 2 years was higher( χ2=7.711, P=0.005). The clinical characteristics of HRV infection were fever, cough, wheezing and even dyspnea.Bronchopneumonia had the highest percentage(68.9%), followed by bronchitis(13.2%). Compared with non-coinfection group, patients with coinfection with other viruses were more prone to wheezing and pulmonary rales( χ2=9.483, 10.821, P=0.024, 0.013), and coinfection with mycoplasma was more likely to cause fever and lobar pneumonia( χ2=51.585、96.060, P all<0.001); 57.8% presented leukocytosis, while 15.6% showed a higher CRP(>15 mg/ml). The increase of CRP and leukocytosis were more obvious in children under 2 years of age( χ2=26.097, 55.973, P all<0.001). Conclusion:HRV was a major viral pathogen of RTIs in recent 7 years, distributing throughout the year with a peak in summer and autumn, mainly involving children under 2 years of age.The clinical features were diverse, and the clinical symptoms were severe in childhood coinfections with other pathogens.

Objective To investigate the prevalence of feeding intolerance (FI),and to explore the FI within 7 days of ICU admission in association with clinical outcome in critically ill patients.Methods The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24h were recruited from March 2014 to August 2014,and all clinical,laboratory,and survival data were prospectively collected.The AGI (acute gastrointestinal injury) grade was daily assessed based on gastrointestinal (GI) symptoms,feeding details and organ dysfunction within the first week of ICU stay.The intra-abdominal pressures (IAP) was measured using AbViser device.Results Of 550 patients enrolled,418 were assessed in GI symptoms and feeding details within 7 days of ICU stay.The mean age and SOFA score were (65.1 ± 18.3) years and (8.96 ±4.10),respectively.Of them,355 patients (84.9％) were under mechanical ventilation support,and 37 (8.85％) received renal replacement therapy.The mean length of time for enteral feeding was (30.8 ±26.2) h,and the prevalence of FI on the 3rd and 7th day of ICU stay accounted for 39.2％ and 25.4％,respectively.Compared to those with FI within 7 days of ICU stay,the patients without FI had higher rate of successively weaning from mechanical ventilation (21.3％ vs.5.7％,P =0.003) and higher rate of withdrawal of vasoactive medication (45.5％ vs.20.0％,P =0.037),as well as lower mortality rate of 28-day (24.4％ vs.38.7％,P =0.004) and 60-day (29.6％ vs.44.3％,P =0.005).In multivariate Cox regression model with adjustment for age,sex,participant center,serum creatinine and lactate,AGI grade on the first day of ICU stay,and comorbidities,the FI within 7 days of ICU stay (x2 ≥ 7.24,P ＜ 0.01) remained to be independent predictors for 60-day mortality.After further adjusted for SOFA score,the FI within 7 days of ICU stay (HR =1.71,95％ CI:1.18-2.49;P =0.006) and AGI grade on the first day of ICU stay (HR =1.33,95 ％ CI:1.07-1.65;P =0.009) could provide independent prognostic values of 60-day mortality.Conclusions There is high rate of FI occurred within 7 days of ICU stay,and is significantly associated with worse outcome.In addition,this study also provides evidence to further support that measurement of gastrointestinal dysfunction could increase value of SOFA score in outcome prediction for the risk of 60-day mortality.

Objectives: To establish SD rat model with type 2 diabetes mellitus (DM) and concomitant chronic periodontitis (CP) and to evaluate the influence of periodontitis on the vascular lesions of type 2 diabetes rats. Methods: Totally 241 clean level SD rats were randomly divided into four groups, group A (normal control, NC, n=27), group B (DM, n=34), group C (CP, n=90) and group D (DM+CP, n=90). The rats of DM group were fed with high-fat and high-sugar diet for 8 to 10 weeks, and then were multiply injected with small dose streptozotocin under the condition of ice bath. Blood sugar levels after the injection were dynamically monitored at 72 h, 1 week, 2 weeks and 4 weeks, respectively. The CP model was established by means of ligation. Bilateral maxillary first and second molars were selected and ligated using 0.2 mm orthodontic wires binding with 4-0 surgical suture soaked with Porphyromonas gingivalis (Pg) suspension. After a period of 14 weeks, all the rats were put to death. Maxillary samples were subjected to methylene blue staining to observe alveolar bone loss. Bilateral carotid artery specimens were collected. The left carotid artery specimens were used to detect the prevalence of Pg using quantitative real-time PCR. The right carotid artery specimens were used to observe pathological changes. Results: Blood sugar levels of rats in group B and D increased and changed sharply after Streptozotocin injection with in 1 week. Symptoms of 'more drink, more food and body weight loss’ appeared. The fasting blood glucose (FBG) was more than 7.8 mmol/L and (or) the random blood glucose (RBG) was more than 17.8 mmol/L. Both FBG and RBG became stable after 2 to 3 weeks. Levels of HbA1C in group B and D ([7.32±0.45]%, [9.41±0.45]%) were significantly higher than that of group A ([4.02±0.45]%) (P<0.01). Rats of group D were observed the most severe bone loss showing wider interdental space and furcation involvement. Pathological results of carotid artery tissues of group D showed the worst lesions including thinning and calcification of vessel walls, and breaking down or disappearance of elastic fibers. The prevalences of DNA of Pg in groups of A, B, C and D were 3/7, 3/7, 6/7 and 7/7, respectively. The bacteria numbers detected by quantitative real-time PCR in groups C and D were significantly higher than that of groups A and B (P<0.01). Conclusions Rat model of type 2 DM with periodontitis was successfully established in the present study. Carotid artery specimens from DM+CP model rats showed typical vascular lesions such as calcification and fiber disorders. Pg was found in all carotid specimens and the highest bacteria numbers were detected in the composite model rats. The Pg might play a role in the progress of diabetes vascular lesions.

Objective To investigate the effect of tooth extraction with antibiotics on atherosclerosis, and to examine the expression of serum interleukin 6(IL-6) and the pathological changes of the carotid artery in chronic periodontitis(CP) rats with or without atherosclerosis(As).Methods A total of 44 SD rats were randomly divided into four groups, group A(normal control), group B(As), group C(CP),group D(CP+As).After model establishment, group C and group D were randomly divided into group C1/D1 (tooth extraction) and group C2/D2(tooth extraction with antibiotics) according to random number table and received the corresponding oral intervention treatment respectively.Serum IL-6 levels were determined by enzyme linked immunosorbent assay(ELISA) respectively one week before the intervention, one week after the first intervention, one, three, five weeks after the second intervention.The pathological changes of the carotid artery were accessed under light microscope.Results At all sampling time points, the levels of serum IL-6 in group B, C, D were higher than that of group A, with group D 1 being increased most obviously,significantly higher than that of group A(P＜ 0.001).One week after the second intervention, the content of IL-6 in group C and group D peaked[C1(127.0±29.9) ng/L, C2: (120.6±23.1) ng/L, D1: (175.1±50.8) ng/L,D2: (160.5±37.7) ng/L], and was significantly higher than that of group B[B: (43.4±7.5) ng/L, P＜0.001].Then they all had varying degrees of decline, 5 weeks after the second intervention, group C1 and D1 were still higher than that of group B, but group C2 and D2 were lower than that of group B.At all sampling time points, the levels of serum IL-6 in group C2/D2 were lower than those in group C1/D1, 5 weeks after the second intervention the difference was most obvious and statistically significant(P＜0.001).Pathology showed that the carotid artery wall in group A was normal.The carotid artery wall was thickened in group B,inflammatory cells and foam cells could be seen, and elastic fibers disordered.The carotid artery wall in group C 1 was uneven, foam cells and a small amount of inflammatory cells were visible, and elastic fiber disordered.Obvious thickening was not seen in the carotid artery wall of group C2, a small amount of foam cells and inflammatory cells were found, and elastic fiber mildly disordered.The carotid artery wall in group D1 was obviously uneven, calcium salt deposits were visible in the artery wall, a large amount of inflammatory cells and foam cells could be found, and elastic fiber disordered.Obvious thickening was not seen in the carotid artery wall of group D2, a small amount of inflammatory cells and a large amount of foam cells could be seen, and elastic fiber disordered.Conclusions Periodontitis and hyperlipidemia could increase the level of serum IL-6 and the risk of the As.In chronic periodontitis rats with or without atherosclerosis, when periodontal inflammation was not controlled, tooth extraction may increase the risk of the As.At the time of tooth extraction, giving the anti-inflammatory treatment can reduce the risk to a certain extent.

OBJECTIVETo prepare the oral solution of egg yolk hepatitis B virus (HBV)-specific transfer factor (EYHBV-TF) and evaluate its immunological activity as an immune regulator against hepatitis B.

METHODSFrom hens immunized with the Hepatitis B vaccine the egg yolk was isolated to extract the specific transfer factor EYHBV-TF, and its physicochemical properties were examined. Leukocyte adhesion inhibition test (LAI) was performed to detect the immunogenic activity of EYHBV-TF. The solution of EYHBV-TF was then administered orally in normal mice, and the specific cellular immune activity induced was assayed with delayed type skin hypersensitivity test (DTH), with the non-specific immune activity assessed with immune organ index. The immune responses induced by oral EYHBV-STF solution were compared with those by EYHBV-STF injection and by different dosages (injection and oral) of porcine spleen HBV-specific transfer factor (PSHBV-STF), porcine spleen nonspecific transfer factor, and egg yolk extracts from non-immunized hens.

RESULTSThe prepared EYHBV-STF oral solution, which met the standards for biological products, could inhibit leukocyte adhesion in vitro and significantly enhance mouse foot pad swelling, demonstrating its capability of transferring antigen-specific delayed type hypersensitivity reactions to naive recipient. EYHBV-STF oral solution also significantly improved the immune organ index in mice (P<0 01) with similar effects to those caused by EYHBV-STF injections and by PSHBV-STF injection and oral solution.

CONCLUSIONOrally administered EYHBV-STF and EYHBV-STF injection both possess hepatitis B antigen-specific cellular immune activity and can significantly enhance specific cellular immune responses.

Animals ; Chickens ; Egg Yolk ; chemistry ; Hepatitis B ; drug therapy ; Hepatitis B Antigens ; Hepatitis B virus ; drug effects ; Immunity, Cellular ; Immunization ; Mice ; Swine ; Transfer Factor ; administration & dosage ; pharmacology

Objective To construct the secretory expression vector of recombinant human C-reactive protein(rhCRP) for its se-cretory expression in Pichia pastoris ,rhCRP was expressed as a secretory protein and purified ,and the immunity reactivity of the purified protein was identified .Methods The DNA fragment of rhCRP which was designed and synthesized was cloned into pPICZαA vector .Recombinant plasmid pPICZαA/rhCRP was linearized by SacⅠand transformed into Pichia pastoris X-33 by elec-trotransformation .The rhCRP was secreted into the medium under the methanol induction .RhCRP was purified by Histamine affin-ity chromatography .The purified rhCRP was identified by SDS-PAGE and Western blotting ,and its immunity reactivity and stabili-ty was identified by indirect ELISA .Results The pPICZαA/rhCRP expression vector was successfully constructed .The rhCRP of 23 × 103 was inducted and successfully expressed as a secretory protein by the recombinant Pichia pastoris strains .The rhCRP was purified by one step up to 90 .42% purity ,and it was showed good immunity and stability by indirect ELISA .Conclusion The rh-CRP with higher purity and immunoreactivity was successfully obtained by using the Pichia pastoris expression system ,which pro-vided an important experimental basis for producing anti-human CRP antibodies and developing testing CRP reagent .

Objective To prepare the oral solution of egg yolk hepatitis B virus (HBV)-specific transfer factor (EYHBV-TF) and evaluate its immunological activity as an immune regulator against hepatitis B. Methods From hens immunized with the Hepatitis B vaccine the egg yolk was isolated to extract the specific transfer factor EYHBV-TF, and its physicochemical properties were examined. Leukocyte adhesion inhibition test (LAI) was performed to detect the immunogenic activity of EYHBV-TF. The solution of EYHBV-TF was then administered orally in normal mice, and the specific cellular immune activity induced was assayed with delayed type skin hypersensitivity test (DTH), with the non-specific immune activity assessed with immune organ index. The immune responses induced by oral EYHBV-STF solution were compared with those by EYHBV-STF injection and by different dosages (injection and oral) of porcine spleen HBV-specific transfer factor (PSHBV-STF), porcine spleen nonspecific transfer factor, and egg yolk extracts from non-immunized hens. Results The prepared EYHBV-STF oral solution, which met the standards for biological products, could inhibit leukocyte adhesion in vitro and significantly enhance mouse foot pad swelling, demonstrating its capability of transferring antigen-specific delayed type hypersensitivity reactions to naive recipient. EYHBV-STF oral solution also significantly improved the immune organ index in mice (P<0 01) with similar effects to those caused by EYHBV-STF injections and by PSHBV-STF injection and oral solution. Conclusion Orally administered EYHBV-STF and EYHBV-STF injection both possess hepatitis B antigen-specific cellular immune activity and can significantly enhance specific cellular immune responses.