High-Precision Implant Cavity Fabrication Using Femtosecond Lasers.

Objective: This study aims to enhance the precision of implant cavity preparation, addressing a notable challenge in the current state of the field by utilizing femtosecond lasers. Background: The application of femtosecond lasers in implant cavity preparation heralds a noninvasive and efficient technique, characterized by diminished thermal damage and high biocompatibility. Despite these promising attributes, the realization of precise cavity preparation remains a significant challenge in the contemporary domain. Materials and Methods: Our research group devised a specialized femtosecond laser microsurgery robotic system tailored for sophisticated implant cavity preparation. This system facilitated the meticulous analysis of sheep shank bone samples, enabling precise three-dimensional cutting. The analysis included an extensive examination of ablation effects, using a laser scanning microscope and VK Analyzer software. This investigation spanned the phases of laser flux calibration and experimental validation, offering a critical evaluation of the automated preparation process. Results: The study delineated that at the focus position of our custom-made oral clinical femtosecond laser microsurgery robotic system, the laser spot diameter is 75.69 µm, and ascertained the ablation threshold for sheep shank cortical bone to be 1.47 J/cm2. Utilizing low laser flux with minimal ablation craters overlap compromised the sidewall precision of the implant cavity, whereas employing high laser flux with extensive ablation craters overlap resulted in an enlarged ablation angle. At a laser energy setting of 2.2362 J/cm2 and a 50% ablation crater overlap, an implant cavity was successfully crafted featuring a top diameter of 4.41 mm, a bottom diameter of 3.98 mm, and a depth of 3 mm, devoid of any adverse thermal effects such as cracking or carbonization. Conclusions: The oral clinical femtosecond laser microsurgery robotic system can achieve automated and precise implant cavity preparation. This advancement promotes the broader application of femtosecond lasers in the field of orthopedics.

The effect of telerehabilitation on balance in stroke patients: is it more effective than the traditional rehabilitation model? A meta-analysis of randomized controlled trials published during the COVID-19 pandemic.

Objective: Telerehabilitation and telemedicine have gradually gained popularity. In 2019, the outbreak of COVID-19 started in Wuhan and then spread across the world. To date, most countries have opted to coexist with the virus. However, patients, especially those who have suffered a stroke, should take measures to avoid being infected with any disease as much as possible since any infectious disease can lead to adverse events for them. Telerehabilitation can be beneficial to stroke patients as they are less likely to be infected by the virus. In recent years, several studies on telerehabilitation have been conducted globally. This meta-analysis aimed to investigate the effects of telerehabilitation on the balance ability of stroke patients, compare the efficacy of conventional rehabilitation with telerehabilitation, explore the characteristics of telerehabilitation and conventional rehabilitation, and provide recommendations for rehabilitation programs in the context of the global pandemic. Methods: We searched Pubmed, Embase, the Web of Science, and The Cochrane Library databases from 1 January 2020 to 31 December 2022 for randomized controlled trials published in English that evaluated the improvement of balance function in stroke patients after telerehabilitation and compared the differences between telerehabilitation (TR) and conventional rehabilitation (CR). The random-effects model was utilized to calculate mean differences (MDs) with 95% confidence intervals (CIs) to estimate intervention effects. Statistical heterogeneity was assessed according to the I2 values. The risk of bias was measured using the Cochrane risk-of-bias assessment tool. Results: We included nine studies in the system evaluation, all of which were included in the pooled analysis. All outcomes in the experimental and control groups improved over time. The comparison between groups concluded that people who received the telerehabilitation intervention had a significant improvement in the Berg Balance Scale (MD = 2.80; 95% CI 0.61, 4.98, P < 0.05, I2 = 51.90%) and the Fugl-Meyer Assessment (MD = 8.12; 95% CI 6.35, 9.88, P < 0.05, I2 = 0) compared to controls. The Timed Up and Go test (MD = -4.59; 95% CI -5.93, -.25, P < 0.05, I2 = 0) and Tinetti Performance-Oriented Mobility Assessment-Balance (MD = 2.50; 95% CI 0.39, 4.61, P < 0.05) scored better in the control group than in the experimental group. There were no significant differences in other outcomes between the two groups. Conclusion: Studies on changes in medical conditions during the COVID-19 pandemic also demonstrated that, for stroke patients, telerehabilitation achieves similar effects as the conventional rehabilitation model and can act as a continuation of the conventional rehabilitation model. Owing to the different equipment and intervention programs of telerehabilitation, its curative effect on the static balance and reactive balance of stroke patients may be different. Currently, telerehabilitation may be more conducive to the rehabilitation of patients' static balance abilities, while conventional rehabilitation is more effective for the rehabilitation of patients' reactive balance. Therefore, further studies are needed for investigating the difference in efficacy between varied devices and telerehabilitation programs. Further research is needed on static and reactive balance. In addition, such research should have a large body of literature and a large sample size to support more definitive findings based on the context of the COVID-19 pandemic. Systematic review registration: CRD42023389456.

The effectiveness of virtual reality for rehabilitation of Parkinson disease: an overview of systematic reviews with meta-analyses.

BACKGROUND: An increasing number of systematic reviews (SRs) and meta-analyses (MAs) of clinical trials have begun to investigate the effects of virtual reality (VR) in patients with Parkinson disease (PD). The aim of this overview was to systematically summarize the current best evidence for the effectiveness of VR therapy for the rehabilitation of people with PD. METHODS: We searched SR-MAs based on randomized controlled trials (RCTs) for relevant literature in PubMed, Embase, and Cochrane library databases for systematic reviews from inception to December 5, 2020, and updated to January 26, 2022. The methodological quality of included SR-MAs was evaluated with the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), and the certainty of evidence for outcomes with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). We created an evidence map using a bubble plot format to represent the evidence base in 5 dimensions: effect size of VR therapy versus active intervention (AT), clinical outcome area, number of trials, statistical significance, and certainty of evidence. RESULTS: From a total of 585 reports, 12 reviews were identified, of which only one was rated moderate quality, three were rated low quality, and eight were rated critically low quality by AMSTAR 2. Compared with AT, VR therapy induced increased benefits on stride/step length, balance, and neuropsychiatric symptoms. Compared with passive intervention (PT), VR therapy had greater effects on gait speed, stride/step length, balance, activities of daily living, and postural control in people with PD. Certainty of evidence varied from very low to moderate. CONCLUSIONS: We found the methodological quality of the reviews was poor, and certainty of the most evidence within them was low to very low. We were therefore unable to conclude with any confidence that, in people with PD, VR therapy is harmful or beneficial for gait, balance, motor function, quality of life, activities of daily living, cognitive function, neuropsychiatric symptoms, and postural control. In the future, rigorous-designed, high-quality RCTs with larger sample sizes are needed to further verify the effectiveness of VR therapy in the treatment of PD.

Whether cognitive behavioral therapy is effective for Alzheimer's disease: A protocol for systematic review and network meta-analysis.

BACKGROUND: Alzheimer disease (AD) is a progressive neurodegenerative disease characterized by impaired memory and cognitive judgment. It is the leading cause of dementia in the elderly, and its high morbidity and mortality have also brought a significant social burden. So far, there is no method can completely cure Alzheimer's dementia, but there are many non-drug treatments that have been praised by people, especially the cognitive behavioral therapy proposed in recent years. The main purpose of this article is to evaluate the effect of cognitive behavioral therapy on the cognitive function improvement of patients with Alzheimer's dementia. METHODS: We did a network meta-analysis to identify both direct and indirect evidence in relevant studies. A systematic literature search will be performed in the Cochrane Library, PubMed, and EMBASE from inception to October 2020. We extracted the relevant information from these trials with a predefined data extraction sheet and assessed the risk of bias with the Cochrane risk of bias tool.The outcomes investigated were Mini-Mental State Examination and AD Assessment Scale-Cognitive section scores. We did a pair-wise meta-analysis using the fixed-effects model and then did a random-effects network meta-analysis within a Bayesian framework. The = the Assessment of Multiple Systematic Reviews-2 scale, Preferred Reporting Items for Systematic Reviews and Meta-Analyses scale and Grading of Recommendations Assessment, Development and Evaluation were used to assess the quality and evidence grade of the literature. General characteristics of the eligible randomized controlled trials will be summarized and described. Meanwhile, The ADDIS software will be used to perform the network meta-analysis, and the result figures will be generated by STATA 15.0 software. RESULTS: Using the draft search strategy of databases and after screening,7 randomized controlled trials met the a priori criteria and were included. This network mate-analysis will be published in a peer-reviewed journal. CONCLUSION: Our study will provide evidence for cognitive behavioral intervention in AD patients. And provide recommendations and guidelines for the clinic. PROTOCOL REGISTRATION: INPLASY2020110052.

Minocycline, but not doxycycline attenuates NMDA-induced [Ca2+]i and excitotoxicity.

Minocycline and doxycycline, two semisynthetic second-generation tetracyclines, are reported to provide neuroprotection against brain injury and glutamate-induced neurotoxicity in neuronal cultures. Doxycycline has been postulated as the potential ideal candidate for further therapeutic development as it has fewer adverse effects than minocycline. In this study, we determined whether minocycline and doxycycline could similarly protect neurons against excitotoxic insults. We treated cultured rat cortical neurons and cerebellar granule neurons (CGN) with excitotoxic concentrations of NMDA or glutamate in the presence or absence of minocycline or doxycycline. Intracellular Ca concentration ([Ca]i) was also measured using a Fluorescent Light Imaging Plate Reader (FLIPR; Molecular Devices) with the calcium sensitive dye Fluo-3 AM. We found that minocycline and tetracycline markedly protected neurons against NMDA- and glutamate-induced neuronal death. In contrast, the structurally related tetracycline, doxycycline, was ineffective at concentrations up to 100 µM. Furthermore, minocycline, but not doxycycline, also significantly attenuated NMDA- or glutamate-induced [Ca]i in both cortical neurons and CGN. Our results suggest that minocycline but not doxycycline is able to directly block NMDA- or glutamate-induced excitotoxicity in neurons most likely by inhibiting NMDA- and glutamate-induced [Ca]i. This finding may contribute to our understanding of the molecular mechanisms underlying doxycycline- and minocycline-induced neuroprotection.

MicroRNA-342-5p protects against myocardial ischemia-reperfusion injury by targeting the GPRC5A pathway.

Myocardial ischemia/reperfusion (MI/R) injury usually occurs in patients with cardiovascular disease. However, myocardial reperfusion insult often induces apoptosis. It is assumed that that microRNAs (miRNAs) are involved in the pathological and physiological processes associated with myocardial ischemia/reperfusion (MI/R). In the present study, we found decreased expression of miR-342-5p in hypoxia/reoxygenation (H/R) cardiomyocyte model (H9C2 cells) and MI/R mouse model. Alternatively, overexpression of miR-342-5p was found to ameliorate myocardial cell damage in both in vivo and in vitro. In addition, G protein-coupled receptor, family C, group 5, member A (GPRC5A) was identified as a direct target of miR-342-5p. The up-regulation of GPRC5A functioned to inhibit the previously observed protective effect of miR-342-5p in the H9C2 H/R model. Our results revealed that miR-342-5p may be a potential target for MI/R injury prevention and therapy of MI/R injury.

Geniposide attenuates epilepsy symptoms in a mouse model through the PI3K/Akt/GSK-3ß signaling pathway.

Previous reports on the pharmacological actions of geniposide have indicated that it has anti-asthmatic, anti-inflammatory and analgesic effects in the liver and gallbladder, and therapeutic effects in neurological, cardiovascular and cerebrovascular diseases. The results of the current study demonstrate that geniposide attenuates epilepsy in a mouse model through the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt)/glycogen synthase kinase-3ß (GSK-3ß) signaling pathway. A mouse model of epilepsy was induced by maximal electric shock (50 mA, 50 Hz, 1 sec). Epilepsy mice were intragastrically administered with 0, 5, 10 or 20 mg/kg geniposide. Geniposide significantly reduced the incidence and significantly increased the latency of clonic seizures in epileptic mice compared with non-treated epileptic mice (both P<0.01). Geniposide treatment significantly inhibited cyclooxygenase-2 mRNA expression in epilepsy mice (P<0.01). Furthermore, geniposide significantly suppressed the protein expression of activator protein 1, increased the activation of Akt and increased the protein expression of GSK-3ß and PI3K in epilepsy mice (all P<0.01). These results suggest that geniposide attenuates epilepsy in mice through the PI3K/Akt/GSK-3ß signaling pathway.

Istradefylline, an adenosine A2A receptor antagonist, for patients with Parkinson's Disease: a meta-analysis.

OBJECTIVES: To assess the efficacy and safety of istradefylline as an adjunct to levodopa in patients with Parkinson's Disease (PD). METHODS: In this study, we searched the Cochrane Library, MEDLINE, Embase, China Academic Journal Full-text Database (CNKI), China Biomedical Literature Database (CBM), Chinese Scientific Journals Database (VIP), and Wanfang Database. The quality of included studies was strictly evaluated. Data analyses were performed by the Cochrane Collaboration's RevMan5.0 software. RESULTS: Five randomized controlled trials (RCTs) were included. The result showed a significant reduction of the awake time per day spent in the OFF state and improvement of the Unified Parkinson's Disease Rating Scale (UPDRS) Part III in the ON state when receiving istradefylline compared with patients receiving placebo. There was no significant difference between the istradefylline 20mg and the istradefylline 40 mg groups in the UPDRS Part III in the ON state (WMD=1.27, 95% CI [-0.40, 2.95]). The results showed significant differences in dyskinesia (RR=1.63, 95% CI [1.16, 2.29]) compared to istradefylline 40 mg with placebo. There was no significant statistical difference with regard to other adverse events. CONCLUSIONS: The present study showed that istradefylline is safe and effective as an adjunct to levodopa in patients with PD. Future large-scale, higher-quality, long-treatment, and placebo-controlled trials are needed.

Ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: a meta-analysis.

OBJECTIVE: To assess the efficacy and safety of ustekinumab for psoriasis. METHODS: In this meta-analysis study, we searched The Cochrane Library (2009, 1 issue), MEDLINE (1966 to March 2009), EMBASE (1974 to March 2009), and China Academic Journal Full-text Database (CNKI, 1994-2009/3), China Biomedical Literature Database (CBM, 1978-2009/3), Chinese Scientific Journals Database (VIP, 1989-2008/3), and Wan fang Database (1999-2009). The quality of included studies was critically evaluated. Data analyses were performed with the Cochrane Collaboration's RevMan 5.0 software. RESULTS: Three randomized controlled trials (RCTs) with a total of 2316 patients were included in the inclusion criteria. The meta-analysis showed significant improvement of the psoriasis area and severity index (PASI), dermatology life quality index (DLQI) score or physician's global assessment when receiving ustekinumab compared with patients receiving placebo, while significant differences were noted between the ustekinumab 45 mg group and the ustekinumab 90 mg group in these indexes. There was no statistical significance with regard to adverse effects. CONCLUSIONS: The present study showed ustekinumab to be safe and effective for patients with psoriasis. Future high-quality, long-treatment, placebo-controlled, double-blind trials are needed.

[Clinical observation on treatment of infantile rotavirus enteritis by umbilical application of lunxieting paste].

OBJECTIVE: To observe the clinical effect of umbilical application with Lunxieting Paste (LXT) for the treatment of infantile rotavirus enteritis (IRE). METHODS: One hundred and ninety infants with IRE were randomly assigned into three groups, 55 in Group A, 60 in Group B and 75 in Group C. All were treated with conventional therapy, mainly the dehydration and acidosis correcting, rehydration salt and antiviral therapy; but to patients in Groups B and C, an additional medication of Smecta 1.5 g, thrice a day. for infants below 1 year and 3 g, thrice a day. for those between 1-2 years old, by orally taken with 0.05 L of warm water and umbilical application with LXT (one dose per day, containing 6.0 g of crude drug) was given respectively. RESULTS: The total effective rate was 69.1% in Group A, 75% in Group B and 92% in Group C, respectively, showing significant difference (P<0.05) in comparing Group C with Groups A and B. Moreover, serum levels of TNF-alpha were decreased and IFN-gamma increased in Group C after treatment, all showed statistical significance as compared with those in the other two groups (P<0.05). No significant adverse reactions were observed in all patients. CONCLUSION: Umbilical application of LXT could effectively alleviate the diarrhea symptom in IRE patients, accelerate the negative inversion of rotavirus, and reduce the injury of intestinal membrane, showing a therapeutic efficacy more effective and quicker than that of conventional treatment with more convenience for use.