[Effect of Twin-block in adolescents with mandibular retrusion and normal anterior overjet].

PURPOSE: To investigate the therapeutic effect of modified fixed Twin-block on patients whose mandible was retruded and anterior overjet was normal. METHODS: Thirty-six adolescents with mandibular retrusion and normal anterior overjet were selected. The goal of occlusal reconstruction was to move the soft tissue pogonion forward to the zero meridian(0°). Fixed Twin-block combined with the mini-implants on the mandibular buccal shelf was used to promote mandibular growth. After 12 months, the appliances were removed step by step to observe the stability of the jaw relationship. Fixed orthodontic treatment was performed to achieve ideal occlusion and coordinated profile. SPSS 13.0 software package was used for Student's t test. RESULTS: The length of mandibular body increased significantly which facilitated the forward movement of the soft tissue pogonion, and the profile changed from convex to straight. Comparison of the results before and after Twin-block treatment showed that Co-Gn, SNB, U1-SN, U6-0°, U1-0°, U1-L1, anterior overbite, anterior overjet, Pog's-0°, L1-0° and lower anterior facial height changed significantly (P＜0.05). Comparison of the results before and after fixed orthodontic treatment showed that PP-MP, SN-MP, U6-0°, IMPA, L1-0°,U1-SN, U1-L1, anterior overbite and overjet changed significantly(P＜0.05). CONCLUSIONS: Modified fixed Twin-block combined with mini-implants on the mandibular buccal shelf can effectively stimulate the mandibular growth and improve the lateral profile of patients with mandibular retrusion and normal overjet.

[Study on digital models of normal deciduous dentition in 189 children from Shanghai].

PURPOSE: To study the gender difference and the regulation of growth and development in normal deciduous dentition． METHODS: A total of 189 children with normal deciduous dentition aged 3 to 6 years in several kindergartens in Xuhui District in Shanghai were selected. The three-dimensional(3D) digital dental models were reconstructed by intraoral scanning. Geomagic Studio, a 3D reverse engineering software, was employed to extract the data, such as the dental arc perimeter of C(APC), the dental arc perimeter of E(APE), the dental arc length of C(LC), the dental arc length of E(LE), the dental arc width of C(C-C), the dental arc width of E(E-E), the mesiodistal width of the deciduous crown, the maxillary and mandibular space. SPSS 22.0 software package was used for data analysis. RESULTS: Parameters of deciduous dentition in boys were significantly elevated than in girls(P＜0.05). All the boys and girls were divided into 4 groups by age. In 3-year-old group, significant differences were observed in maxillary APC, C-C, E-E(P＜0.05) between boys and girls. In 4-year-old group, all boys' parameters were significantly greater than girls'(P＜0.05) except maxillary LC. In 5-year-old group, there were significant differences in all the parameters between boys and girl(P＜0.05) except maxillary APE and mandibular APC, LC, LE, C-C. No significant difference was observed in all the parameters except mandibular APE in 6-year old group. The significant difference between boys and girls were observed in the mesiodistal width of each deciduous crown except that of the maxillary lateral incisor and mandibular central incisor (P＜0.05). There were significant differences in maxillary LE and E-E among children of different ages(P＜0.05).The maxillary space was significantly greater than the mandibular space(P＜0.01). CONCLUSIONS: There was gender difference in children's normal deciduous dentition, especially when they were 4 years old.

Buccal rotation for wholly impacted maxillary third molar extraction.

BACKGROUND: Extracting wholly impacted maxillary 3rd molars faces difficulty due to the narrow surgical field, adjacent teeth resistances and risk of oroantral communication. This study is designed to introduce and evaluate the applicability of a novel method-buccal rotation to extract maxillary 3rd molars. MATERIALS AND METHODS: In this cohort study, from October 1st 2020 to September 30th 2021, 72 wholly impacted maxillary 3rd molars were included. Based on the crowns with coronal 1/3, middle 1/3, apical 1/3 of the adjacent teeth roots, teeth were classified into position I, II, III. Based on the angles < 30°, ≥ 30°but < 60°, ≥ 60° to the adjacent teeth, teeth were classified into angulation A, B, C. Traditional method and novel method-buccal rotation were applied based on the surgical simulations. Surgical results were recorded. To analyze the data, Chi-square test was applied. RESULTS: 82.00% of teeth in position I and 50.00% in position II were designed to use traditional method, 83.33% in position III were using the novel method (p < 0.05). 81.25% of teeth in angulation A and 52.63% in angulation B were designed to use traditional method, 80.00% in angulation C were using the novel method (p < 0.05). Four cases got temporary complications. CONCLUSION: Buccal rotation was applicable to extract the deep impacted maxillary third molars with large angles towards the adjacent teeth.

[Oral health behavior and parental cognition of first-grade children in urban and suburban areas of Shanghai].

PURPOSE: To investigate oral health behaviors of first-grade school children and parents' cognition of oral health in urban and suburban areas of Shanghai, and to analyze and compare the differences between the two areas, so as to provide reference for formulating oral health intervention measures and oral health education. METHODS: A total of 3 312 first-grade school-aged children in Shanghai were included by cluster random sampling method. Relevant data were collected through questionnaire survey of parents' oral health and clinical oral examination of children. Chi-square test was used to compare the differences in oral health behaviors of children and parents' oral health cognition between urban and suburban area with SAS 9.4 software package. RESULTS: The proportion of children who brush their teeth more than twice a day in urban and suburban areas was 72.55% and 44.26%, and the proportion of children who brushed their teeth with fluoride toothpaste was 53.25% and 44.79%, respectively. Compared with the suburban area, the brushing habits of school-aged children in urban area were better, the difference was statistically significant(P＜0.05). In terms of medical habits, the proportion of children with no dental experience in urban and suburban areas was 26.99% and 44.08%, and the proportion of children with toothache in the past year was lower than that in the last dental visit, the difference was statistically significant (P＜0.05). In terms of parents' cognition and attitude towards oral health knowledge, parents in urban areas were more correct than those in suburban areas, with the average correct rate being 82.56% and 70.42%, and the difference was statistically significant (P＜0.05). CONCLUSIONS: There are regional differences in oral health behaviors of first-grade school children and parents' oral health knowledge between urban and suburban area in Shanghai. It is suggested that relevant government departments should strengthen oral health education and oral health behavior guidance for parents, and strengthen oral health investment in non-central urban areas.

20 abnormal metabolites of Stage IV Grade C periodontitis was discovered by CPSI-MS.

Saliva is a noninvasive biofluid that contains the metabolic signature of severe periodontitis (SP, Stage IV and Grade C). Conductive polymer spray ionization mass spectrometry (CPSI-MS) was used to record a wide range of metabolites within a few seconds, making this technique a promising point-of-care method for the early detection of SP (Stage IV and Grade C). Saliva samples from 31 volunteers, consisting of 16 healthy controls (HC) and 15 patients with SP (Stage IV and Grade C), were collected to identify dysregulated metabolites. Twenty metabolites were screened out, including seven amino acids. Moreover, the results showed that amino acid metabolism is closely related to the development of periodontitis. The present study further confirmed that salivary metabolites in the oral cavity were significantly altered after plaque removal. These results suggest that the combination of CPSI-MS is a feasible tool for preclinical screening of SP (Stage IV and Grade C).

[Clinical efficacy of the combination of miniscrew with clear aligner in controlling the roller coaster effect].

PURPOSE: To investigate the clinical efficacy of miniscrew in controlling the roller coaster effect in long-distance space closure with clear aligner. METHODS: Sixteen adult patients with bimaxillary protrusion were selected. All cases were treated with clear aligner and their four first premolars were extracted. G6 was designed in all cases. In the experimental group, four miniscrews were inserted at the beginning of treatment to control the teeth in three dimensions; while in the control group, the miniscrews were not applied until obvious roller coaster effect appeared. Paired t test was used to analyze the data with Graphpad Prism 6.0 software package. RESULTS: All the extraction space was closed successfully and the lateral profile was improved significantly. The torque of the upper incisor was under well control and no roller coaster effect happened in the experimental group; while in the control group, the lingual inclination of the upper incisors and open bite of the posterior teeth developed(P＜0.05). After the miniscrews intrusion of the upper anterior teeth, the occlusion relationship improved significantly. CONCLUSIONS: Miniscrews effectively prevents and eliminates the roller coaster effect in the process of long-distance space closure with clear aligner.

Influence of different base materials and thicknesses on the fracture resistance of endocrown: A three-dimensional finite element analysis.

INTRODUCTION: To analyze the stress distribution of the all-ceramic endocrown with different base materials and thicknesses using three-dimensional finite element analysis. METHODS: A endodontically treated maxillary premolar was scanned by micro-CT, a three-dimensional finite element model of the endocrown with fluid resin as the base material was divided into control (0 mm), 1 mm, 2 mm, and 3 mm groups according to base thickness. Three kinds of conventional base materials were used and divided into glass ion group (A), fluid resin group (B), and nanocomposite resin group (C), and a three-dimensional finite element model of the endocrown with 1.0 mm thickness of base was established. A static loading with axial and 45° direction was applied to each model, the stress distribution of each part of the endocrown was analyzed under different base materials and thicknesses. RESULTS: The different thickness of the base layer has an influence on the components of the restoration and the tooth. The stress in the control group was the largest. The stress was the lowest when the thickness of the base layer was 1 mm; The maximum of the equivalent stress, the first, second, and third principal stress in the endocrown, abutment, and alveolar bone, are basically the same with the different base materials. The stress on the base layer increases with the elastic modulus of base materials increases. CONCLUSIONS: The base layer played a force buffering effect on the dental body restored with endocrowns, and the effect was the best at 1 mm; The selection of base material has little influence on the whole, but in order to protect the weak tissues of the cavity bottom, the base material with lower elastic modulus can be used.

[Enhanced mechanical properties and cytocompatibility of GelMA hydrogels by incorporating graphene oxide].

PURPOSE: To construct graphene oxide/methacrylated gelatin(GO/GelMA) hydrogel and to investigate its mechanical property and biocompatibility. METHODS: 50, 100, 200 µg/mL GO was added to GelMA and mixed thoroughly. The micromorphology of hydrogels was observed under scanning electron microscope(SEM). Compression text was used to assess lastic modulus, CCK-8 and live/dead cell staining was conducted to assess the viability of rat bone marrow-derived mesenchymal stem cells (rBMSCs). The data were analyzed using SPSS 23.0 software package. RESULTS: SEM showed a highly porous structure of the hydrogel. After adding GO, the elastic modulous increased (100, 200 µg/mL), swelling ratio increased(100 µg/mL) and expansion ratio decreased(200 µg/mL). The viability increased in 50 µg/mL GO and decreased in 100 and 200 µg/mL GO. CONCLUSIONS: Proper concentration of GO can increase the mechanical property and biocompatibility. 50 µg/mL GO/GelMA was suggested in bone tissue engineering given priority to biocompatibility.

[Consistency of the landmark identification on two types of cephalograms from cone-beam CT].

PURPOSE: To study the landmark consistency on two types of cephalograms reconstructed from the data of cone-beam CT(CBCT). METHODS: CBCT data of 56 patients without teeth missing were uploaded into Dolphin software and transferred to the cephalograms. In the control group, the right half projection was taken while in the experimental group, the images achieved after 6 individual projections were managed to achieve the synthesized cephalograms. One experienced orthodontists traced the 23 frequently-used landmarks and the consistency was compared by means of Hotelling T2 test with SPSS 13.0 software package. RESULTS: The tracing of anterior nasal ridge, posterior nasal ridge, upper incisor root tip, lower incisor edge, lower incisor root tip and condyle showed significant difference(P<0.05). CONCLUSIONS: The synthesized cephalograms in the experimental group show the anatomical structure more precisely which is more beneficial to landmark identification.

[Clinical study of the effect of fixed Twin-block on adolescent skeletal Class â ¡ malocclusion].

PURPOSE: To evaluate the retention ability of fixed Twin-block appliance and its clinical effect on adolescent skeletal ClassⅡmalocclusion. METHODS: Twenty-six skeletal ClassⅡdivision 1 adolescents (M:12, F: 14; age:11~13 years, average: 11.8 years) were chosen and fixed Twin-block appliance was used to guide the mandibular protrusion for one year. Before and after treatment, cephalometric films were taken to observe the skeletal, dental and soft tissue changes. Graphpad Prism 6.0 software was used for Student's t test. RESULTS: There was no loosening or destruction of the appliance during the treatment and the profile of all cases was improved significantly. The indexes that showed significant difference(P<0.05) included the mandibular length and position (Co-Gn, SNB, ANB, Pog-VL, Pos-VL) , the inclination and position of the maxillary incisors(U1-VL, U1-SN), the sagittal position of the mandibular dentition(L1-VL, L6-VL). The indexes that showed insignificant difference(P>0.05) included the mandibular plane(MP-SN), the length and position of the maxilla (SNA, A-VL) , the vertical position of the maxillary incisor(U1-HL), the position of the maxillary posterior teeth(U6-VL, U6-HL), the mandibular incisor inclination(IMPA) and the vertical position of the mandibular dentition(L6-MP,L1-MP). CONCLUSIONS: Fixed Twin-block appliance can enhance the mandibular anchorage, effectively promote the mandibular growth and improve the facial profile.

Pathologies associated with the mandibular third molar impaction.

To evaluate the associations of impaction patterns of mandibular third molars (M3Ms) with pathologies caused by them. In this study, 262 patients with 432 impacted M3Ms who referred in Shanghai Xuhui District Center were reviewed. The pathologies include pericoronitis, mandibular second molar (M2M) caries, and M2M distal periodontal pathology. The impaction patterns of M3Ms and the pathologies were examined, while the M2M outcomes after surgeries were evaluated. A χ2 test was used to analyze the data, with a p value of <0.05 being considered statistically significant. Pericoronitis was the major symptom in all patients, whereas the propensities of M2M distal caries and periodontal pathologies increased in older patients. Soft tissue impacted and vertically angulated teeth were more associated with pericoronitis (p < 0.05); mesio-angular impacted teeth in less deep positions had greater risks of M2Ms distal caries (p < 0.05); mesio-angular and horizontal impacted teeth in relative deep positions were more likely to cause M2Ms distal periodontal pathologies (p < 0.05). Extractions of soft tissue impacted teeth in vertical angulations should be considered, while removals of mesially and horizontally angulated or bony impacted teeth could be delayed.

[The effect of fluoride varnish Duraphat in preventing deciduous dental caries in preschool children].

PURPOSE: To evaluate the effect of fluoride varnish Duraphat on preventing caries of primary teeth caries, and provide scientific basis for the establishment of oral health care. METHODS: 1140 preschool children aged 3~4 years old were chosen from 25 public kindergartens in Xuhui district of Shanghai by cluster sampling method, they were divided into 2 groups on a voluntary basis with the informed consent of the child's parents. 762 preschool children in Fluoride Varnish group were taken oral examination and used fluoride varnishes every 6 months, 378 preschool children in the control group were without treatment. Oral health instruction was given to all the children. The data of caries prevalence, mean dmft, caries incidence and mean increments of dmft (decayed, missing and filled teeth) of 2 groups were compared. The results were analyzed using SAS 9.4 software package. RESULTS: After 2 years, caries prevalence, mean dmft, caries incidence and mean increments of dmft of fluoride varnish groups were lower than those of control group and the difference was statistically significant (P＜0.05). CONCLUSIONS: Fluoride varnish Duraphat is effective in decreasing caries incidence and mean dmft increments of primary teeth in preschool children and is worthy to be used widely in Xuhui district.

[In vitro study of apical negative pressure irrigation on apical extrusion and E. faecalis elimination].

PURPOSE: To compare the efficiency of negative pressure irrigation and conventional syringe irrigation and evaluate the possibility as a new way of irrigation. METHODS: In vitro silicone socket model was used to simulate the resistance of apical flow by apical surrounding tissues. The in vitro efficacy on apical extrusion and E.faecalis elimination between negative pressure irrigation and conventional syringe irrigation was compared. SPSS 17.0 software package was used for statistical analysis. RESULTS: Negative pressure irrigation extruded less (P<0.05), and was more effective in E.faecalis elimination(P<0.05) than conventional syringe. CONCLUSIONS: Negative pressure irrigation is a promising irrigation technique during root canal therapy.

[Combination of NITI cantilever arm and casting frame in correcting lingually inclined mandibular molar].

PURPOSE: To study the effect of NITI cantilever arm in correcting lingually inclined mandibular molar. METHODS: Sixteen patients whose single mandibular second molar was lingually inclined were chosen. The intra-mandibular anchorage was achieved by means of cast frame which connected the bilateral mandibular posterior teeth. The splint disoccluded the lingually inclined second molar with the antagonist. The cantilever arm of 0.018 inch×0.025 inch or 0.019 inch×0.025 inch NITI wire was used to provide buccal rotation moment and intrusion force. Graphpad Prism 6.0 software was applied for data analysis. RESULTS: All the lingually inclined second molars were uprighted, the axial change relative to the sagittal plane was 24°±1.2°(P<0.01).The change of the distance from the mesial lingual cusp of the lingually inclined second molar to the sagittal plane was 3 mm±0.8 mm (P<0.05). The anterior overbite was almost unchanged and the periodontal condition was healthy. CONCLUSIONS: Combination of casting frame with NITI cantilever arm can provide effective mechanics to correct lingually inclined mandibular molars.

[Application of double miniscrews for extraction of horizontally impacted wisdom tooth with high risk of injury to inferior alveolar nerve].

PURPOSE: To study the clinical effect of double miniscrews for extraction of horizontally impacted wisdom tooth adjacent to the inferior alveolar nerve canal. METHODS: Eight horizontally impacted wisdom teeth requiring extraction because of orthodontic treatment were proven to be adjacent to the inferior alveolar nerve canal by means of cone-beam CT scan. The treatment began with double miniscrews traction under the help of cantilever beam. After 6~9 months, they left the canal and then were extracted. RESULTS: After extraction, no patient developed lip numbness. CONCLUSIONS: Application of double miniscrews traction is an efficient and reliable method for extraction of horizontally impacted wisdom tooth that is adjacent to the inferior alveolar nerve canal.

[Analysis of caries and its risk factors of the first permanent molar among primary school students in Pudong, Shanghai and Lichuan, Jiangxi Province].

PURPOSE: To Investigate the current situation of caries of primary school students in Shanghai Pudong and Lichuan, Jiangxi province, and analyze the risk factors of dental caries, in order to provide scientific evidence for prevention and treatment of dental caries. METHODS: A stratified cluster sampling method was applied to choose 10 primary schools from Lichuan and 2 primary schools from Pudong area, respectively. A total of 1922 pupils aging from 6 to 12 were selected. Oral health examination was applied to each student and questionaire survey was conducted among their parents. The results were analyzed with SPASS 21.0 software package. RESULTS： Two hundred and sixty-one caries was found in Lichuan pupils, with the caries rate of 23.6% and DMFT being 0.37±0.766. 96 caries was found in Pudong pupils, with the caries rate of 11.8% and DMFT being 0.19±0.582. There was significant difference between two areas. Analysis of risk factors showed a significant correlation between children's pre-bedtime sweets and other bad habits, as well as low level of education of children's parents and dental caries. CONCLUSIONS: The caries of primary school students in rural areas are significantly worse than those in urban areas; bad living habits are risk factors of caries and the knowledge of caries prevention should be popularized in school students to enhance the awareness of oral health among pupils.

NLRP1 promotes TGF-ß1-induced myofibroblast differentiation in neonatal rat cardiac fibroblasts.

Nuclear localization leucine-rich-repeat protein 1 (NLRP1) is a member of Nod-like receptors (NLRs) family. Recent studies have reported that NLRP1 is involved in various diseases, especially in cardiovascular diseases. However, the effect of NLRP1 on cardiac fibrosis remains unclear. In this study, NLRP1 overexpression and NLRP1 silencing constructs were transfected into neonatal rat cardiac fibroblasts induced by TGF-ß1 for 48 h to investigate the effect of NLRP1 in cardiac fibrosis and its molecular mechanisms. Cardiac fibroblasts were transfected with NLRP1 and then cultured in the presence and absence of TGF-ß1and Smad3 inhibitor (SIS3). Our data indicated that NLRP1 not only promoted fibroblast activation and myofibroblast differentiation, but also upregulated the mRNA and protein levels of α-SMA in the TGF-ß1-treated neonatal rat cardiac fibroblasts. Overexpressing NLRP1 in TGF-ß1-induced cardiac fibroblasts upregulated the mRNA and protein levels of Collagen I, Collagen III, and connective tissue growth factor. Moreover, NLRP1 upregulated the protein levels of Smad2, Smad3, and Smad4 in nuclei of fibroblasts, and attenuated levels of phosphorylated Smad2 and Smad3 in the cytoplasm of fibroblasts induced by TGF-ß1. In addition, the increase in fibrotic genes and Smad proteins was significantly reduced in the presence of SIS3. Our findings illustrated that NLRP1 promoted myofibroblast differentiation and excessive ECM production in TGF-ß1-induced neonatal cardiac fibroblasts through directly targeting TGF-ß1/Smad signaling pathways.

Nuclear Localization Leucine-Rich-Repeat Protein 1 Deficiency Protects Against Cardiac Hypertrophy by Pressure Overload.

BACKGROUND/AIMS: Nuclear localization leucine-rich-repeat protein 1 (NLRP1) is a cytoplasmic protein, involved in autoimmune diseases, mammalian reproduction, neuronal cell death, and stroke. However, the role of NLRP1 in cardiac hypertrophy remains unclear. We used in vivo and in vitro models to investigate the effects of NLRP1 on cardiac hypertrophy. METHODS: We used NLRP1-deficient mice and cultured neonatal rat cardiomyocytes with gain and loss of NLRP1 function. Cardiac hypertrophy was estimated by echocardiographic and hemodynamic measurements, and by pathological and molecular analysis. RESULTS: Eight weeks after aortic banding (AB), NLRP1 deficiency significantly inhibited aortic banding-induced cardiac hypertrophy, inflammation, and fibrosis. Activation of MAPK, NF-κB, and TGF-ß/Smad pathways was reduced in NLRP1-knockout (KO) mice compared with that in wild-type (WT) mice. Consistent with these results, in vitro studies, performed using cultured neonatal mouse cardiomyocytes, confirmed that NLRP1 deficiency protects against cardiomyocyte hypertrophy induced by isoproterenol (PE); this protective activity was associated with the arrest of MAPK and NF-κB signaling. CONCLUSIONS: Our data illustrates that NLRP1 plays a crucial role in the development of cardiac hypertrophy via positive regulation of the MAPK, NF-κB, and TGF-ß/Smad signaling pathways.

[Clinical study on upper molar mesial movement with miniscrews in the palatal suture and casting frame].

PURPOSE: To study the clinical effect of the upper first molar space closure by mesial traction of the second and the third molar with palatal miniscrew and casting frame. METHODS: Twelve cases with the upper first molar lost and only accepting regional orthodontic treatment were chosen. Two miniscrews were inserted beside the palatal suture, individual casting frames were manufactured to help stabilize the miniscrew and the upper premolars on the same side. The force was exerted on both the buccal and lingual side. Graphpad Prism 6.0 software was used for Student's t test. RESULTS: All the spaces were closed, the average mesial movement was 5.7 mm, the tipping of the second molar and the third molar was almost normal and the occlusion of other teeth kept intact. CONCLUSIONS: Miniscrew and casting frame can accomplish the effective mesial movement of the upper second and third molar to close the first molar space.

3,3'­Diindolylmethane attenuates cardiomyocyte hypoxia by modulating autophagy in H9c2 cells.

Autophagy is activated in the ischemic heart and is a process that is essential for survival, differentiation, development and homeostasis. 3,3'­Diindolylmethane (DIM) is a natural product of the acid­catalyzed condensation of indole­3­carbinol in cruciferous vegetables. Numerous studies have suggested that DIM has various pharmacological effects, including antioxidant, antitumor, anti­angiogenic and anti­apoptotic properties. However, the function of DIM on hypoxia­induced cardiac injury remains to be elucidated. In the present study, H9c2 cells were pretreated with DIM (1, 5 and 10 µM) for 12 h and exposed to hypoxia for 12 h. It was demonstrated that DIM markedly attenuated the increased transcription of interleukin (IL)­1ß, IL­6 and tumor necrosis factor­α induced by hypoxia. In addition, the transcription of autophagy associated genes increased in the DIM pretreated group, compared with the hypoxia group. DIM additionally attenuated the increased apoptosis, as determined by terminal deoxynucleotidyl transferase dUTP nick end labeling staining, and regulated the relative protein expression level of B cell lymphoma (Bcl) 2 associated X protein, Bcl­xL and cleaved caspase 3. Furthermore, the phosphorylation of the 5' AMP­activated protein kinase a (AMPKa) was activated and the phosphorylation of c­Jun N­terminal kinase (JNK) was inhibited. The effect of DIM on hypoxia­induced apoptosis was abolished following pretreatment with JNK activator (anisomycin, 40 ng/ml). The effect of DIM on autophagy was reversed following pretreatment with AMPKa inhibitor (CpC, 20 µM) following stimulation with hypoxia. The results demonstrated that DIM prevented hypoxia­induced inflammation and apoptosis and activated cardiomyocyte autophagy, which may be mediated by activation of AMPKa and inhibition of JNK pathways.