[The effect of glycopyrrolate on intestinal spasm and hemodynamics in painless colonoscopy].

Objective: To investigate the effects of glycopyrrolate on intestinal spasm and hemodynamics in painless colonoscopy. Methods: A total of 100 patients who were scheduled to undergo painless colonoscopy were selected as the study subjects and randomly divided into two groups by a computerized number method. Ten patients in both groups dropped out because of disruption of the study protocol, and 45 patients from each group were included in the final analysis. Before anesthesia induction, patients in group glycopyrrolate (group G) were injected with 0.2 mg glycopyrrolate, while those in congtrol group (group C) were injected with an equal amount of saline. The heart rate, systolic blood pressure, and diastolic blood pressure were recorded at T0 (baseline period), T1 (after anesthesia induction), T2 (colonoscopy over sigmoid colon), T3 (colonoscopy over the liver region), T4 (after the end of examination), and T5 (at the awakening phase), and the degree of intestinal spasm was assessed intraoperatively using the Likert's four-point scale. The numerical rating scale (NRS) was used to assess preoperative and postoperative pain. The incidence of adverse events was recorded. Results: The general data at baseline were not statistically different between the two groups (P>0.05). During the procedure, patients in group G had lower intraoperative intestinal spasm scores than those in group C (P=0.028). Intraoperative hypotension and bradycardia occurrence were lower in group G than in group C (P<0.05), and intraoperative norepinephrine use was also lower than in the group C (P=0.034). Postoperative visual analog scale pain scores were lower in group G (P=0.047), but patients who used glycopyrrolate had a higher proportion of dry mouth (P=0.035). Conclusion: During painless colonoscopy, preoperative administration of glycopyrrolate significantly improved intraoperative hemodynamic fluctuations, reduced the incidence of hypotension and bradycardia, and relieved postoperative pain. However, glycopyrrolate use resulted in the risk of dry mouth.

Effect of glazing technique and firing on surface roughness and flexural strength of an advanced lithium disilicate.

OBJECTIVE: The objective of this study was to investigate the effects of glazing technique and firing on the surface roughness and flexural strength of an advanced lithium disilicate (ALD) and lithium disilicate (LD). METHODS: Eight groups of bar-shaped specimens (1 mm × 1 mm × 12 mm, N=160, 20/group) were manufactured from ALD (CEREC Tessera, Dentsply Sirona) and LD (IPS e.max CAD, Ivoclar). The specimens were then submitted to various posttreatments: crystallization (c), crystallization followed by a second firing (c-r), crystallization with glaze in one step (cg), and crystallization followed by a glaze layer firing (c-g). Surface roughness was measured by means of a profilometer, and flexural strength was determined using a three-point bending test. Surface morphology, fractography, and crack healing analysis were conducted using scanning electron microscopy. RESULTS: Refiring (c-r) did not affect the surface roughness (Ra) while applying glaze at both cg and c-g procedures increased the roughness. ALDc-g (442.3 ± 92.5 MPa) promoted higher strength than ALDcg (282.1 ± 64.4 MPa), whereas LDcg (402.9 ± 78.4 MPa) was stronger than LDc-g (255.5 ± 68.7 MPa). Refiring completely closed the crack in ALD, but it had a limited effect on LD. CONCLUSIONS: Two-step crystallization and glazing improved ALD strength compared to the one-step protocol. Refiring and one-step glazing do not increase LD's strength, while two-step glazing has a negative effect. CLINICAL RELEVANCE: Besides both materials being lithium-disilicate glass ceramics, the glazing technique and firing protocol affected their roughness and flexural strength differently. A two-step crystallization and glazing should be the first choice for ALD, while for LD, glazing is optional and when necessary, should be applied in one-step.

[Surgical treatment strategy for difficult-reducible atlantoaxial dislocation].

Objective: To discuss the surgical strategy for difficult-reducible atlantoaxial dislocation. Methods: Clinical data of 82 patients with difficult-reducible atlantoaxial dislocation underwent surgical treatment in the Department of Neurosurgery, Xuanwu Hospital from January 2018 to February 2019 were retrospectively reviewed. Total of 32 men and 50 women were included, with a mean age of (41.8±12.9) years. Most cases (n=80) were treated with one-staged posterior atlantoaxial joint distraction and cage implantation, a few (n=2) underwent ventral decompression. All cases were followed up, postoperative improvement of clinical symptoms and radiology parameters were analyzed. Results: Of the patients, 80 cases (97.6%) received one-staged posterior atlantoaxial joint distraction and cage implantation; lateral facet joint bony fusion was found in 4 patients and was cut off with an osteotome. Transoral odontoidectomy was performed in 2 cases (2.4%) with fused atlanto-odontoid joint. All the patients were followed-up for (18.6±7.3) months. Postoperative CT showed complete reduction of ADI was achieved in 60 patients (75.0%). The ADI decreased significantly after the operation [(2.1±1.4) mm vs (5.0±1.5) mm, P<0.05]. The postoperative vertical distance between odontoid process and the Chamberlain line decreased significantly when compared with that before the operation [(3.9±3.8) mm vs (10.2±5.2) mm, P<0.05]. The mean JOA score at 6 months post operation improved significantly than that before the operation (13.7±1.5 vs 11.2±1.7, P<0.05). Seventy-five patients (93.8%) had atlantoaxial intra-articular bony fusion at 1 year follow-up. Conclusion: Most difficult-reducible atlantoaxial dislocations can be managed well by posterior one-staged atlantoaxial joint distraction and Cage implantation.

Assessing the need for routine safety testing for patients being treated with dupilumab for moderate-to-severe atopic dermatitis.

Atopic dermatitis (also known as AD or eczema) is a common skin disease that can cause intense and persistent itching and rashes. Skin creams or ointments are not suitable or effective for some patients with moderate-to-severe AD. In these patients, oral (taken by mouth) or injected medications may be required. Some of those oral or injected treatments could be toxic and often have unwanted side effects, especially when used for a longer period of time, so patients must be regularly tested to see whether those treatments are harming their blood or organs. Dupilumab is a newer injectable drug for treating moderate-to-severe AD. Dupilumab specifically targets key molecules in the body that cause AD. Dupilumab has been tested for up to one year in more than 2000 patients enroled in placebo-controlled clinical trials. During those trials, patients provided blood and urine samples for laboratory testing while they were being treated with dupilumab or placebo (dummy drug). In this paper, the authors from Germany and the U.S.A, analysed how blood cells, blood chemistry, and urine chemistry changed during treatment, to check whether dupilumab is safe to use without the need for regular laboratory tests. After performing many routine laboratory tests on patients' blood and urine, they found that there were no clinically important changes in test results that could be linked to dupilumab. They concluded that patients using dupilumab for moderate-to-severe AD do not need routine laboratory testing. This is a summary of the study: Laboratory safety of dupilumab in moderate-to-severe atopic dermatitis: results from three phase III trials (LIBERTY AD SOLO 1, LIBERTY AD SOLO 2, LIBERTY AD CHRONOS).

Biodegradation of polyvinyl alcohol by different dominant degrading bacterial strains in a baffled anaerobic bioreactor.

Polyvinyl alcohol (PVA) is the main pollutant in printing and dyeing wastewaters. This pollutant exhibits great demand, poor biodegradability and refractory degradation. In this study, PVA wastewater treatment experiments were conducted in a stably operating baffled anaerobic bioreactor (ABR) by using simulated PVA wastewater. The PVA degradation pathway and mechanism of the mixed dominant PVA-degrading bacterial strains were identified through the analysis of their degradation products. From the results, we inferred that PVA was degraded in a stepwise process under the synergistic action of different extracellular and intracellular enzymes produced by the mixed dominant PVA-degrading bacterial strains. In this process, PVA was first degraded into ketones, fatty acids and alcohols. It was then regenerated into acetic acid, hydrogen and carbon dioxide. Finally, these substances could be further utilized by methanogens. PVA was thus degraded completely. This study may serve as a reference for future works on the degradation of PVA in the ecological environment. It may also guide the sustainable development of PVA.

Shape memory response of porous NiTi shape memory alloys fabricated by selective laser melting.

Porous NiTi scaffolds display unique bone-like properties including low stiffness and superelastic behavior which makes them promising for biomedical applications. The present article focuses on the techniques to enhance superelasticity of porous NiTi structures. Selective Laser Melting (SLM) method was employed to fabricate the dense and porous (32-58%) NiTi parts. The fabricated samples were subsequently heat-treated (solution annealing + aging at 350 °C for 15 min) and their thermo-mechanical properties were determined as functions of temperature and stress. Additionally, the mechanical behaviors of the samples were simulated and compared to the experimental results. It is shown that SLM NiTi with up to 58% porosity can display shape memory effect with full recovery under 100 MPa nominal stress. Dense SLM NiTi could show almost perfect superelasticity with strain recovery of 5.65 after 6% deformation at body temperatures. The strain recoveries were 3.5, 3.6, and 2.7% for samples with porosity levels of 32%, 45%, and 58%, respectively. Furthermore, it was shown that Young's modulus (i.e., stiffness) of NiTi parts can be tuned by adjusting the porosity levels to match the properties of the bones.

[Clinical management of 110 cases of polypropylene mesh and sling exposure after reconstructive pelvic floor surgery].

Objective: To explore the clinical management and outcomes of polypropylene mesh and sling exposure after reconstructive pelvic surgery (RPS) . Methods: A total of 110 cases of mesh and sling exposure after RPS were analyzed, who admitted between Jan. 2002 and Oct. 2017 in First Affiliated Hospital of PLA General Hospital, in which 3 cases were referred from other hospitals. Mesh and sling exposures were identified in the outpatient clinic and categorized and managed according to International Continence Society and International Urogynecology Association (ICS-IUGA) classification about category, time and site (CTS) of mesh complication. Outpatient management included observation, topical estrogen use and mesh removal. Management in hospital included surgical removal of exposed mesh and repair of the resulting defects under the anesthesia. Seventy-four cases were managed in the outpatient setting, and 36 cases required inpatient management. Follow-up was consecutively performed from 1 month to 10 years. Objective outcome included the surgeon's assessment of the healing state of the vaginal mucosa. Subjective outcome was evaluated with patient global impression of improvement questionnaire (PGI-I) . Results: One hundred and ten patients with mesh exposure were classified according to the different RPS underwent. There were 95 cases from transvaginal mesh surgery, 5 cases from anti-stress urinary incontinence sling surgery, and 10 cases from sacrocolpopxy. The outpatient group healed at an average of (3.0±1.8) months. Of the 36 patients who required inpatient management, 21 cases healed completely at an average of 7 days after one surgery. The remaining 8 cases required either two or three times surgeries or conservative management. In the outpatient group, the PGI-I scale very much better was found in 65 cases (87.8%) and much better in 9 cases (12.2%) . In the inpatient surgery group, the scale was very much better in 30 cases (83.3%) , and much better in 6 cases (16.7%) . Conclusions: Among patients with mesh exposure after mesh-augmented RPS, 2/3 of patients with a CTS classification 1-3 could be managed in the office, and remaining 1/3 with CTS classification 4-6 need operation under anesthesia in hospital. If the mesh and sling exposure could be scientifically classified, according to the size, site and accompany symptoms, as well as pain, most of the mesh complications after explosure could be resolved. Using the pelvic floor repair and polypropylene mesh sling, the majority of the patients could get a better outcome, without affecting the effect of the original operation.

[Efficacy analysis of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures].

OBJECTIVE: To evaluate the clinical results of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures. METHODS: From January 2013 to December 2014, 8 consecutive patients with postoperative deep infection after surgeries for proximal humeral fractures who were treated with two-stage reverse total shoulder arthroplasty were retrospectively reviewed after the final follow-up. There were 1 man and 7 women with a mean age of (58.5±6.4) years, of whom 3 left shoulders and 5 right shoulders were involved. There were 2 patients with periprosthetic infection after hemiarthroplasty for proximal humeral fractures, and 6 patients with humeral head necrosis as well as implant-associated infection after open reduction internal fixation for proximal humeral fractures with the locking plate. The diagnosis of postoperative deep infection was confirmed by either the preoperative cultures or the intraoperative biopsies during the first-stage surgery. At the first-stage surgery, all the patients underwent a thorough debridement, and then an antibiotic-impregnated bone cement spacer was placed after the removal of prosthesis or locking plate. During the second-stage surgery, the cement spacer was removed, and then a revision shoulder arthroplasty with the reverse shoulder prosthesis was performed in all the patients who were routinely followed up after the second-stage surgery. The visual analogue score (VAS), Constant score and University of California Los Angeles (UCLA) score were employed to evaluate the postoperative shoulder function. RESULTS: The mean follow-up time was (19.9±8.0) months (range 12 to 35 months). At the end of the follow-up, the median forward elevation [100° (60°, 140°) vs. 25° (0°, 90°), P=0.011], the median external rotation [15° (0°, 50°) vs. 5° (0°, 20°), P=0.048], and the median internal rotation [L4 (buttock, T12) vs. buttock (buttock, L3), P=0.041] were all significantly improved postoperatively. The median Constant score [53.5 (32, 74) vs. 29.0 (10, 57), P=0.012], the median UCLA score [20.5 (9, 26) vs. 9.5 (5, 15), P=0.012], and the median VAS score [1.5 (0, 5) vs. 5.0 (0, 8), P=0.018] were all significantly improved after the surgery. No recurrence of infection, prosthetic loosening or neurovascular injury was noted by the last follow-up. CONCLUSION: two-stage reverse total shoulder arthroplasty was an effective treatment for the postoperative deep infection after surgeries for proximal humeral fractures. The shoulder function was postoperatively improved to a certain degree.

Virologic responses and tolerance of peginterferon alfa plus ribavirin treatment for patients with chronic hepatitis C virus infection in different age categories.

OBJECTIVE: This study aimed to evaluate the effect of age on the treatment comprising peginterferon plus ribavirin administered to patients with chronic hepatitis C (CHC). MATERIALS AND METHODS: A total of 314 patients with CHC treated with peginterferon plus ribavirin were classified into three categories according to age. The efficacy and safety outcomes were compared between groups. RESULTS: Elderly patients yielded significantly lower rapid virological response and sustained virological response (SVR) (31.3% and 35.4%, respectively, P < 0.05) rates than younger patients. The discontinuation rate of the patients aged ≥ 60 years were significantly higher (29.2%, P = 0.004) than that of the younger patients. The elderly patients suffered from adverse events, such as fatigue (P = 0.005), neutropenia (P = 0.013), jaundice (P = 0.013), hepatocellular carcinoma (P = 0.013), and gastric cancer (P = 0.018), more frequently than the younger patients. In multivariable analysis, age was a negative factor that affected the SVR of the patients with CHC (odds ratio [OR] =0.983, 95% confidence interval [95% CI] =0.967-1.0, P = 0.05). The SVR rate of the patients with hepatitis C virus (HCV) genotype non-1 was significantly higher than that of the patients with HCV-1 (OR = 0.559, 95% CI = 0.349-0.895, P = 0.015). An early virological response could be considered as a powerful positive predictor to obtain an SVR (OR = 2.353, 95% CI = 1.411-3.922, P = 0.001). CONCLUSIONS: Increasing age negatively affected the efficacy of peginterferon and ribavirin therapy in the treatment of patients with CHC. Elderly patients experienced poorer treatment tolerance and adherence, and as a result, treatment efficacy is poor.

Nanogel-Conjugated Reverse Transcriptase Inhibitors and Their Combinations as Novel Antiviral Agents with Increased Efficacy against HIV-1 Infection.

Nucleoside reverse transcriptase inhibitors (NRTIs) are an integral part of the current antiretroviral therapy (ART), which dramatically reduced the mortality from AIDS and turned the disease from lethal to chronic. The further steps in curing the HIV-1 infection must include more effective targeting of infected cells and virus sanctuaries inside the body and modification of drugs and treatment schedules to reduce common complications of the long-term treatment and increase patient compliancy. Here, we describe novel NRTI prodrugs synthesized from cholesteryl-ε-polylysine (CEPL) nanogels by conjugation with NRTI 5'-succinate derivatives (sNRTI). Biodegradability, small particle size, and high NRTI loading (30% by weight) of these conjugates; extended drug release, which would allow a weekly administration schedule; high therapeutic index (>1000) with a lower toxicity compared to NRTIs; and efficient accumulation in macrophages known as carriers for HIV-1 infection are among the most attractive properties of new nanodrugs. Nanogel conjugates of zidovudine (AZT), lamivudine (3TC), and abacavir (ABC) have been investigated individually and in formulations similar to clinical NRTI cocktails. Nanodrug formulations demonstrated 10-fold suppression of reverse transcriptase activity (EC90) in HIV-infected macrophages at 2-10, 2-4, and 1-2 µM drug levels, respectively, for single nanodrugs and dual and triple nanodrug cocktails. Nanogel conjugate of lamivudine was the most effective single nanodrug (EC90 2 µM). Nanodrugs showed a more favorable pharmacokinetics compared to free NRTIs. Infrequent iv injections of PEGylated CEPL-sAZT alone could efficiently suppress HIV-1 RT activity to background level in humanized mouse (hu-PBL) HIV model.

Upregulation of salivary α2 macroglobulin in patients with type 2 diabetes mellitus.

We investigated the expression of salivary α2-macroglobulin (α2-MG) in patients with type 2 diabetes mellitus (T2DM) to investigate its value for predicting damage to the salivary glands. A total of 116 patients with T2DM and 60 patients with impaired fasting glucose (IFG) were included in this study. Sixty health volunteers were enrolled as a control group. Unstimulated saliva was collected at 8 a.m. prior to breakfast. Expression of α2-MG was determined using an enzyme-linked immunosorbent assay. The correlation between salivary α2-MG, serum α2-MG, and concentration of fasting glucose was analyzed using Pearson correlation analysis. No significant difference was observed in the expression of serum α2-MG in the T2DM group, IFG group, and control group (P > 0.05). Compared with the control group and IFG group, a statistical difference was observed in the salivary α2-MG in the T2DM group (P < 0.01). No statistical difference was observed in the salivary α2-MG in the IFG group compared with the control group (P > 0.05). In the patients with T2DM, a close correlation was identified in the expression of serum α2-MG and salivary α2-MG (r = 0.52, P < 0.01). A poor correlation was identified between salivary α2-MG and blood sugar level (r = -0.12, P = 0.199). The expression of salivary α2-MG showed a remarkable increase in T2DM patients, which may be associated with functional disorders of the salivary gland.

Nanostructured conducting polymers and their biomedical applications.

Much attention has been paid to nanostructured conducting polymers due to their unique properties, which arise from their nanoscale size, such as their large surface area, high electrical conductivity, electrochemical stability and quantum effects. This article reviews three methods to synthesize nanostructured conducting polymers and their applications in the biomedical field, focusing specifically on neural probes, biosensors, artificial muscles or actuators and controlled drug release. Challenges and future directions of these nanostructured conducting polymer are also discussed.

UiO-66/AgNPs Coating for Dental Implants in Preventing Bacterial Infections.

Titanium (Ti)-based biomaterials lack inherent antimicrobial activities, and the dental plaque formed on the implant surface is one of the main risk factors for implant infections. Construction of an antibacterial surface can effectively prevent implant infections and enhance implant success. Silver nanoparticles (AgNPs) exhibit broad antibacterial activity and a low tendency to induce drug resistance, but AgNPs easily self-aggregate in the aqueous environment, which significantly impairs their antibacterial activity. In this study, UiO-66/AgNP (U/A) nanocomposite was prepared, where zirconium metal-organic frameworks (UiO-66) were employed as the confinement matrix to control the particle size and prevent aggregation of AgNPs. The bactericidal activity of U/A against methicillin-resistant Staphylococcus aureus and Escherichia coli increased nearly 75.51 and 484.50 times compared with individually synthesized Ag. The antibacterial mechanism can be attributed to the enhanced membrane rupture caused by the ultrafine AgNPs on UiO-66, leading to protein leakage and generation of intracellular reactive oxygen species. Then, U/A was loaded onto Ti substrates (Ti-U/A) by using self-assembly deposition methods to construct an antibacterial surface coating. Ti-U/A exhibited excellent antibacterial activities and desired biocompatibility both in vitro and in vivo. The U/A nanocomposite coating technique is thus expected to be used as a promising surface modification strategy for Ti-based dental implants for preventing dental implant infections.

[Analysis of the efficacy and safety of bone disease treatment in patients with newly diagnosed multiple myeloma treated with denosumab or zoledronic acid].

Objective: This study investigated the efficacy and safety of denosumab (DENOS) versus zoledronic acid (ZOL) in the bone disease treatment of newly diagnosed multiple myeloma. Methods: The clinical data of 80 patients with myeloma bone disease (MBD) at the Fifth Medical Center of PLA General Hospital between March 1, 2021 and June 30, 2023 were retrospectively reviewed. Eighteen patients with severe renal impairment (SRI, endogenous creatinine clearance rate<30 ml/min) were treated with DENOS, and 62 non-SRI patients were divided into DENOS (30 patients) and ZOL group (32 patients) . Results: Hypocalcemia was observed in 26 (33%) patients, and 22 patients developed hypocalcemia during the first treatment course. The incidence of hypocalcemia in the non-SRI patients of DENOS group was higher than that in the ZOL group [20% (6/30) vs 13% (4/32), P=0.028]. The incidence of hypocalcemia in SRI was 89% (16/18). Multivariate logistic regression analysis revealed that endogenous creatinine clearance rate<30 ml/min was significantly associated with hypocalcemia after DENOS administration (P<0.001). After 1 month of antiresorptive (AR) drug application, the decrease in the serum ß-C-terminal cross-linked carboxy-telopeptide of collagen type I concentrations of SRI and non-SRI patients in the DENOS group were significantly higher than that in the ZOL group (68% vs 59% vs 27%, P<0.001). The increase in serum procollagen type Ⅰ N-terminal propeptide concentrations of patients with or without SRI in the DENOS group were significantly higher than that in the ZOL group (34% vs 20% vs 11%, P<0.05). The level of intact parathyroid hormone in each group increased after AR drug treatment. None of the patients developed osteonecrosis of the jaw and renal adverse events, and no statistically significant differences in the overall response rate, complete remission and stringent complete remission rates were found among the groups (P>0.05), and the median PFS and OS time were not reached (P>0.05) . Conclusions: In the treatment of MBD, DENOS minimizes nephrotoxicity and has strong AR effect. Hypocalcemia is a common adverse event but is usually mild or moderate and manageable.

Apically extruded debris and irrigant with two Ni-Ti systems and hand files when removing root fillings: a laboratory study.

AIM: To compare the amount of apically extruded debris and irrigant produced by two Ni-Ti instruments and hand files when removing root fillings, and to compare two experimental models. METHODOLOGY: Sixty single straight root canals in human mandibular premolars were prepared with K-files and filled with gutta-percha and AH Plus sealer. The teeth were randomly divided into three groups of 20 for removal of the root filling material with Reciproc files (Group 1, RP), Mtwo retreatment files (Group 2, MR) or hand files (Group 3, H). Each group was then equally divided into experimental subgroups: A, with 1.5% agar gel model (AG); B, with empty tube model (ET). Apically extruded debris and irrigant was quantified by subtracting the initial weight of the test apparatus without a tooth from its weight after the root canal retreatment. Comparative analysis of the amount of apically extruded debris and irrigant for each of the instruments and the experimental models was performed. Time for gutta-percha removal was recorded. Data were statistically analysed using one-way analysis of variance. RESULTS: Removal of root fillings with two Ni-Ti instruments produced less apically extruded debris and irrigant than hand files in both experimental models (P < 0.05). More apically extruded debris and irrigant was produced with Reciproc files than Mtwo retreatment files using the 1.5% agar gel model (P > 0.05). Significantly more apically extruded debris and irrigant was produced with Reciproc files than Mtwo retreatment files using the empty tube model (P < 0.05). The time required to remove the root fillings followed Reciproc

De novo symptoms and their impact on life quality in patients following transvaginal reconstructive pelvic surgery with polypropylene mesh.

OBJECTIVE: To study the de novo symptoms and their impact on life quality in patients that underwent transvaginal reconstructive pelvic surgery (RPS) with polypropylene mesh. MATERIALS AND METHODS: From May 2004 to March 2011, 114 severe pelvic organ prolapse (POP) patients with Stage III-IV by POP-Q system underwent RPS with polypropylene mesh. Patients completed pelvic floor distress inventory short form (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7) preoperatively and repeated them at two and six months, and one year postoperatively. RESULTS: Ninety-six (84%, 96/114), 85 (75%, 85/114), and 77 (68%, 77/114) patients, respectively, completed the questionnaires at two months, six months, and one year postoperatively. All patients had POP-Q staging scoring < or = I at one year after surgery. Nineteen (19.8%, 19/96) patients had mesh exposure at two and six months (7.8%, 6/77) at one year follow-up. Most vaginal and pelvic symptoms, urinary and obstructive defecation bothersome symptoms improved significantly at two months postoperatively and this improvement was maintained at the one year follow-up. Mean score of PFDI-20 and PFIQ-7 all improved significantly postoperatively at two and six months and at one year follow-up (p < 0.01). Fifty percent (48/96) of patients had postoperative de novo symptoms at the two months follow-up predominantly presented with bothersome vaginal discharge (35.4%, 34/96) and pelvic muscle symptoms (20.8%, 20/96). Patients with de novo symptoms had higher postoperative mean POPDI-6 and POPIQ-7 scores (p < 0.05) than those without at the two month follow-up, but no significant difference was seen at the six month and at one year follow-ups. Patients with bothersome vaginal discharge had higher vaginal mesh exposure rate (41.2%, 14/34) than patients without (8.1%, 5/62) (p = 0.0003). One year after operation, 77 (68%) patients completed the non-validated satisfaction questionnaire. Seventy-four (96%, 74/77) patients said that they were either 'very satisfied' or 'satisfied' with the outcome of their surgery, while three (4%, 3/77) reported unsatisfactory results. CONCLUSIONS: De novo symptoms were common after transvaginal RPS with polypropylene mesh, but most of them were moderate and resolved within six months postoperatively and seldomly had a long-term negative impact on their quality of life. The impact of dyspareunia on patients' sexual function requires further research.

Orofacial myofunctional reeducation assisted by a prefabricated reeducation appliance: a systematic review of the literature / Rééducation myofonctionnelle orofaciale assistée par gouttière de rééducation préfabriquée : une revue systématique de la littérature

Introduction: Several cross-sectional studies have shown the association of a dysfunctional orofacial environment with a greater prevalence of malocclusions. Orofacial myofunctional reeducation (OFMR) is the rehabilitation of the muscles, functions and resting postures of the orofacial complex. It is used in the therapeutic management of orofacial dysfunction in patients of all ages and with a wide range of disorders and comorbidities. RMOF mainly uses isotonic and isometric exercises targeting the oral and oropharyngeal structures, combined with specific exercises for ventilation, swallowing and mastication. It may involve the use of prefabricated reeducation appliances (PRAs), which may also be prescribed to modify the shape and relationship of the dental arches. Objectives: The primary objective of this systematic review of the literature was to describe and evaluate the efficacy of prefabricated reeducation appliance-assisted OFMR in orthodontics, occlusodontics and dental sleep medicine. Its secondary objective was to assess whether the use of currently available PRAs is associated with adverse effects. Materials and Methods: The systematic literature review was undertaken using five electronic databases: Medline (via PubMed), Web of Science, Cochrane Library, Embase, and Google Scholar, to identify studies evaluating the efficacy of PRA-assisted OFMR in the treatment of orofacial dysfunctions and parafunctions, temporo-mandibular dysfunction (TMD) or obstructive sleep apnea (OSA) in children, adolescents and adults, published until 20 March 2023. The primary outcome of interest was the therapeutic efficacy of PRA-assisted OFMR. In patients with obstructive sleep apnoea (OSA), efficacy was assessed primarily by a decrease in the apnoea/hypopnoea index (AHI) of at least five episodes per hour from baseline, improvement in subjective sleep quality, sleep quality measured by nocturnal polysomnography and subjectively measured quality of life. In patients with orofacial dysfunctions, parafunctions or TMD, efficacy was assessed mainly by electromyography (EMG), history and clinical examination. Secondary outcomes were dentoalveolar or skeletal improvements, and possible adverse effects of the PRAs used, including adverse effects on occlusion. Results: Only fourteen studies met all inclusion criteria: two randomised controlled trials, one non-randomised controlled trial, five prospective case-control studies, two retrospective case-control studies, two prospective case series and two retrospective case series. The two randomised controlled trials were assessed as "low risk of bias" according to the Cochrane Back Review Group's 12 risk of bias criteria. The methodological quality of the remaining 12 included studies was assessed using the ROBINS-I tool, according to the recommendations of the Cochrane Handbook. One was judged to have a measured risk of bias, eight a significant risk of bias and three a critical risk of bias. Based on the available evidence, PRA-assisted OFMR results in a statistically significant (p=0.0425) reduction in AHI in children with mild to moderate obstructive sleep apnea. In children with obstructive sleep apnoea undergoing adenoid and/or tonsil surgery, postoperative OFMR combined with a flexible PRA leads to a greater reduction in AHI compared to a control group and an improvement in SaO2 at 6 months and 12 months after surgery (p<0.01). It also contributes to greater improvement in sleep disturbance, physical fitness, daytime lethargy in the treated group than in the control group 6 months and 12 months after surgery (p<0.05). PRA-assisted OFMR provides correction of atypical swallowing and improvement in orofacial muscle balance. GRPs are generally less effective than activators for the treatment of Class II Division 1 malocclusions and appear to cause more adverse effects, mainly vestibuloversion of the mandibular incisors. The use of PRA-assisted OFMR for the management of TMD is not validated by current evidence. Conclusions: Published data, albeit of uneven methodological quality, appear to show the superiority of OFMR combined with the use of a PRA, compared with the implementation of OFMR without PRA. Prospective studies with large sample sizes would be useful to better evaluate the new therapeutic possibilities brought by the combination of OFMR with a PRA. Continued attention should be paid to the monitoring of possible adverse effects of PRA-assisted OFMR on the dental arches, especially the vestibuloversion of the mandibular incisors. It might be useful to reflect on the relevance of the arguments put forward by manufacturers about the particularities of their devices and their supposed effects. PRA-assisted OFMR appears to be a necessary paradigm shift , which it seems useful to bring to our patients. Protocol registration: This protocol was registered on March 02, 2023 in the International Prospective Register of Systematic Review (PROSPERO) and received the CRD number: CRD42023400421.

Introduction: Plusieurs études transversales ont montré l'association d'un environnement orofacial dysfonctionnel avec une plus grande prévalence de malocclusions. La rééducation myofonctionnelle orofaciale (RMOF) est la rééducation des muscles, des fonctions et des postures de repos du complexe orofacial. Elle est utilisée dans la prise en charge thérapeutique des dysfonctionnements orofaciaux chez des patients de tous âges et présentant un large éventail de troubles et de comorbidités. La RMOF met principalement en œuvre des exercices isotoniques et isométriques ciblant les structures buccales et oropharyngées, associés à des exercices spécifiques pour optimiser la ventilation, la déglutition et la mastication. Elle peut faire appel à des gouttières de rééducation préfabriquées (GRP) dont la prescription peut également viser l'objectif d'une modification des formes et des rapports d'arcades dentaires. Objectif: L'objectif principal de cette revue systématique de la littérature était de décrire et d'évaluer l'efficacité de la RMOF assistée par gouttières de rééducation préfabriquées en orthodontie, en occlusodontie et en médecine dentaire du sommeil. Son objectif secondaire était d'évaluer si l'emploi des GRP, actuellement disponibles, s'accompagne d'effets indésirables. Matériels et méthodes: La revue systématique de la littérature fut entreprise à partir de cinq bases de données électroniques : Medline (via PubMed), Web of Science, Cochrane Library, Embase et Google Scholar, afin d'identifier les études évaluant l'efficacité de la RMOF assistée par GRP dans le traitement des dysfonctions orofaciales et des parafonctions, des dysfonctionnements temporaux-mandibulaires (DTM) ou des syndromes d'apnées obstructives du sommeil (SAOS) de l'enfant, de l'adolescent et de l'adulte, publiées jusqu'au 20 mars 2023. Le critère de jugement principal de cette revue systématique était l'efficacité thérapeutique de la RMOF assistée par GRP. Chez les patients souffrant d'apnée obstructive du sommeil (AOS), l'évaluation de l'efficacité s'appuyait principalement sur une diminution statistiquement significative de l'indice d'apnée/hypopnée (IHA) et sur une amélioration de la qualité subjective du sommeil, de la qualité du sommeil mesurée par polysomnographie nocturne et de la qualité de vie mesurée subjectivement. Chez les patients présentant des dysfonctions orofaciales, des parafonctions ou des DTM, l'évaluation de l'efficacité l'était principalement par l'électromyographie (EMG), l'anamnèse et l'examen clinique. Les critères de jugement secondaires étaient les améliorations dentoalvéolaires ou squelettiques, et les éventuels effets indésirables des GRP employées, dont des effets indésirables sur l'occlusion. Résultats: Seulement quatorze études répondaient à tous les critères d'inclusion : deux essais contrôlés randomisés, un essai contrôlé non randomisé, cinq études cas témoins prospectives, deux études cas-témoins rétrospectives, deux séries de cas prospectives et deux séries de cas rétrospectives. Les deux essais cliniques contrôlés randomisés ont été évalués à « faible risque de biais ¼ d'après les douze critères de risque de biais du Cochrane Back Review Group. La qualité méthodologique des 12 autres études incluses a été évaluée à l'aide de l'outil ROBINS-I, conformément aux recommandations du Cochrane Handbook. L'une a été jugée comme présentant un risque de biais mesuré, huit un risque de biais important et trois un risque de biais critique. D'après les données probantes disponibles, la RMOF assistée par GRP permet une réduction statistiquement significative (p = 0,0425) de l'IAH d'enfants souffrant d'apnée obstructive du sommeil légère à modérée. Chez des enfants souffrant d'apnée obstructive du sommeil et opérés des adénoïdes et/ou des amygdales, une RMOF postopératoire associée au port d'une GRP souple conduit à une plus grande réduction de l'IAH, comparativement à un groupe témoin, et une amélioration de la saturation en oxygène (SaO2), 6 mois et 12 mois après l'opération (p < 0,01). Elle contribue également à une amélioration des troubles du sommeil, de la condition physique, de la léthargie diurne plus importante dans le groupe traité que dans le groupe témoin, 6 mois et 12 mois après l'opération (p < 0,05). La RMOF assistée par GRP permet une correction jusqu'à 100 % de la déglutition atypique et une amélioration de l'équilibre musculaire orofacial. Les GRP sont généralement moins efficaces que les activateurs pour le traitement des malocclusions de classe II, division 1 et semblent entraîner davantage d'effets indésirables, principalement une vestibuloversion des incisives mandibulaires. L'utilisation de la RMOF assistée par GRP pour la prise en charge des DTM n'est pas validée par les preuves actuelles. Conclusions: Les données publiées, même de qualité méthodologique inégale, semblent montrer la supériorité d'une RMOF associée au port d'une GRP comparée à la mise en œuvre d'une RMOF sans GRP. La mise en œuvre d'études prospectives avec de grands échantillons serait utile pour mieux évaluer les nouvelles possibilités thérapeutiques apportées par l'association de la RMOF avec une GRP. Une attention constante devra être portée à la surveillance des éventuels effets indésirables sur les arcades dentaires des GRP associées à la RMOF, notamment la vestibuloversion des incisives mandibulaires. Il pourrait être utile de conduire une réflexion quant à la pertinence des arguments avancés par les fabricants sur les particularités de leurs dispositifs et leurs effets supposés. La RMOF assistée par GRP apparaît comme un nécessaire changement de paradigme, dont il semble utile de faire bénéficier nos patients. Enregistrement du protocole: Ce protocole a été enregistré le 2 mars 2023 dans l'International Prospective Register of Systematic Review (PROSPERO) et a reçu le numéro CRD : CRD42023400421.

B-Cell-Derived TGF-ß1 Inhibits Osteogenesis and Contributes to Bone Loss in Periodontitis.

B cells play a vital role in the elimination of periodontal pathogens, the regulation of the immune response, and the induction of tissue destruction. However, the role of B cells in the dysfunction of mesenchymal stem cell (MSC) differentiation to osteoblasts in periodontitis (PD) has been poorly studied. Here we show that the frequency of CD45-CD105+CD73+ MSCs in inflamed periodontal tissues is significantly decreased in patients with PD compared with that of healthy controls. CD19+ B cells dominate the infiltrated immune cells in periodontal tissues of patients with PD. Besides, B-cell depletion therapy reduces the alveolar bone loss in a ligature-induced murine PD model. B cells from PD mice express a high level of TGF-ß1 and inhibit osteoblast differentiation by upregulating p-Smad2/3 expression and downregulating Runx2 expression. The inhibitory effect of PD B cells on osteoblast differentiation is reduced by TGF-ß1 neutralization or Smad2/3 inhibitor. Importantly, B-cell-specific knockout of TGF-ß1 in PD mice significantly increases the number of CD45-CD105+Sca1+ MSCs, ALP-positive osteoblast activity, and alveolar bone volume but decreases TRAP-positive osteoclast activity compared with that from control littermates. Lastly, CD19+CD27+CD38- memory B cells dominate the B-cell infiltrates in periodontal tissues from both patients with PD and patients with PD after initial periodontal therapy. Memory B cells in periodontal tissues of patients with PD express a high level of TGF-ß1 and inhibit MSC differentiation to osteoblasts. Thus, TGF-ß1 produced by B cells may contribute to alveolar bone loss in periodontitis, in part, by suppressing osteoblast activity.

Influence of surface finishing and printing layer orientation on surface roughness and flexural strength of stereolithography-manufactured dental zirconia.

OBJECTIVE: To evaluate the effect of surface finishing and printing layer orientation on the surface roughness and flexural strength of three-dimensionally (3D) printed 3 mol% yttria-stabilized zirconia manufactured by stereolithography (SLA). METHODS: Ninety bar-shaped zirconia specimens (1 mm x 1 mm x 12 mm) were 3D-printed via SLA. After debinding and sintering, they were randomly divided according to the printing layer orientation: parallel (PR) or perpendicular (PD) to the tensile surface for bending test. Each group was submitted to a surface finishing protocol (n=15/group): unpolished (subgroup 0), with polished tensile surface (subgroup 1), and with polished lateral and tensile surfaces (subgroup 3). Roughness of tensile surface was determined using a contact sensor and surface morphology was analyzed under Scanning Electron Microscopy (SEM). Flexural strength, apparent elastic modulus, and Weibull parameters were assessed using a 3-point bending test. Fractured specimens were examined to identify failure origins. Finite element analysis was used to evaluate tensile stress peaks and failure risk. RESULTS: PR orientation exhibited higher strength, higher apparent elastic modulus, higher maximum principal stress peaks, and lower failure risk. For both layer orientations, groups with polished lateral and tensile sides (PR3 and PD3) were the strongest. SEM revealed that polishing led to changes in defect type, location, and size. SIGNIFICANCE: SLA zirconia shows different mechanical properties according to surface roughness and defects. Orienting the printed layers parallel to the tensile side improves its mechanical performance. Polishing can significantly improve its flexural strength. It is necessary to reduce the final product's surface roughness and large pores for its best performance.

[Effect of hydroxyapatite based agents on the bonding properties of universal adhesives].

Objective: To study the effect of hydroxyapatite (HA) based agents on the bonding properties of universal adhesive with different application modes, and to provide evidence for the use of adhesives after desensitization treatment. Methods: Sixty impacted third molars were extracted and selected (acquired from Department of Oral and Maxillofacial Surgery, College of Stomatology, Xi'an Jiaotong University). Four third molars were used to prepare 1 mm thick dentin disks and treated with 1% citric acid to simulate sensitive tooth models. The dentin surfaces were observed by scanning electron microscope (SEM) after treating with no desensitization (control group), desensitized by HA based toothpaste Biorepair and Dontodent Sensitive respectively (desensitizing toothpaste A group and B group), or HA paste treatment (desensitizing paste group ) (n=2 per group). The remaining teeth were selected to expose the mid-coronal dentin and establish dentin sensitivity models. Then, the specimens were divided into 4 former groups and received corresponding treatment. Each group was randomly divided into 2 subgroups, and intermediately strong universal adhesive (G-Premio Bond) was applied on the desensitized dentin by either etch-and-rinse mode or self-etch mode. Resin-dentin slice specimens (n=4 per subgroup), microtensile specimens (n=20 per subgroup) and slice specimens (n=6 per subgroup) were prepared. The microstructure and nanoleakage of the adhesive interfaces were observed by scanning electron microscopy (SEM). The microtensile strength (bond strength) and fracture mode were tested and recorded. The water permeability of the adhesive interface was observed by laser scanning confocal microscopy (LSCM). Results: SEM showed that desensitizing toothpaste and desensitizing paste could partially or entirely occlude most of the dentin tubules. For the etch-and-rinse mode, the bond strength of specimens treated with toothpaste A [(40.98±4.60) MPa], toothpaste B [(40.89±4.64) MPa] and HA paste [(41.48±3.65) MPa] was significantly higher than that of the control group [(38.58±4.28) MPa] (F=3.89,P<0.05). There was no statistically significant difference in bond strength among the 4 subgroups for self-etch modes (F=0.48,P>0.05). After desensitization, the bond strength of the control group and desensitizing groups in the self-etch mode was significantly higher than that in the etch-and-rinse mode (P<0.05). The overall fracture modes were mixed failure and interfacial failure in the control group and desensitizing groups. SEM showed speckled silver-stained particles deposited along the bottom of the hybrid layer on the bond interface of etch-and-rinse mode, and there were few silver-stained particles deposited on the bond interface of self-etch mode. LSCM showed continuous linear penetration in the hybrid layer of etch-and-rinse mode subgroups and discontinuous linear penetration in the hybrid layer of self-etch mode subgroups. Conclusions: HA based desensitizers have no adverse effect on the bond strength of intermediately strong universal adhesive and show good bonding performance accompanied with the self-etch mode.