Control of wakefulness by lateral hypothalamic glutamatergic neurons in male mice.

The lateral hypothalamus (LH) plays a key role in the maintenance of cortical activation and wakefulness. In the LH, the two main neuronal cell populations consist of excitatory glutamatergic neurons and inhibitory GABAergic neurons. Recent studies have shown that inhibitory LH GABAergic neurons are wake-promoting. However, the mechanism by which excitatory LH glutamatergic neurons contribute to sleep-wake regulation remains unclear. Using fiber photometry in male mice, we demonstrated that LH glutamatergic neurons exhibited high activities during both wakefulness and rapid eye movement sleep. Chemogenetic activation of LH glutamatergic neurons induced an increase in wakefulness that lasted for 6 hr, whereas suppression of LH glutamatergic neuronal activity caused a reduction in wakefulness. Brief optogenetic activation of LH glutamatergic neurons induced an immediate transition from slow-wave sleep to wakefulness, and long-lasting optogenetic stimulation of these neurons maintained wakefulness. Moreover, we found that LH-locus coeruleus/parabrachial nucleus and LH-basal forebrain projections mediated the wake-promoting effects of LH glutamatergic neurons. Taken together, our data indicate that LH glutamatergic neurons are essential for the induction and maintenance of wakefulness. The results presented here may advance our understanding of the role of LH in the control of wakefulness.

Glutamatergic lateral hypothalamus promotes defensive behaviors.

The glutamatergic lateral hypothalamus (LH) has been implicated in a variety of behaviors, such as evasion and feeding, while its role in defensive behaviors and relevant neurocircuits remains unclear. Here, we demonstrated that the glutamatergic LH is a critical structure regulating defensive behaviors. Trimethylthiazole (TMT), the odor of mice predator, significantly increased c-Fos expression in the LH. Using fiber photometry technology, we found that TMT exposure increased the activity of LH glutamatergic neurons. Selective activation of LH glutamatergic neurons with optogenetics and chemogenetics promoted a series of defense-related behaviors, including fleeing, avoidance, and hiding, while selective inhibition of LH glutamatergic neurons suppressed the avoidance provoked by TMT. Activation of both the glutamatergic LH terminals in the hypothalamic paraventricular nucleus (PVN) and the glutamatergic projection from the basolateral amygdala (BLA) to the LH elicited defensive behaviors. Finally, by combining the viral-mediated retrograde tracing with anterograde activation, we found that PVN-projecting glutamatergic neurons in the LH were activated by BLA glutamatergic inputs. Taken together, our results illustrate that the glutamatergic LH is a pivotal relay of defensive behaviors and possibly promotes these behaviors through the BLA→LH→PVN pathway.

Treating severe periodontitis with staged load applied implant restoration: A case report.

BACKGROUND: Because immediate implant surgery is not recommended for patients who have been diagnosed with periodontitis, researchers have treated these patients with a variety of methods, including combining orthodontic and periodontal surgeries as well as implantation. However, these treatments cost time and money for the patient. Although it has been reported that temporary implants released a severe gag reflex in 1 case, only a few studies have documented using temporary implants to treat patients diagnosed with severe periodontitis. CASE SUMMARY: The patient was a 49-year-old female who was missing the majority of her teeth and had gingival atrophy and severe alveolar bone atrophy. After being diagnosed with severe periodontitis, the patient underwent staged load applied implant restoration therapy. The first load-bearing stage was carried out immediately by inserting temporary Osstem mini implants. Maxillary teeth were extracted by using the guided bone regeneration technique, and lateral maxillary sinus lifting was conducted on both sides. During the second load-bearing stage, temporary implants were removed, and permanent implants were placed. The resin bridge was segmented during the third load-bearing stage. During the fourth load-bearing stage, the permanent prosthesis was positioned in the patient's mouth. CONCLUSION: By conducting the load-bearing treatment in stages, the patient's mouth contained restorations throughout the procedure, thus guaranteeing basic function and appearance.

[Clinical evaluation of modified free gingival transplantation technique].

PURPOSE: To evaluate the clinical effect of modified free gingival graft technique of the peri-implant. METHODS: There were 42 mandibular posterior area implant sites in 36 patients. The width of the keratinized gingiva at the midpoint of buccal gingival margin was less than 2 mm after implantation. Two months before restoration, modified free gingival graft technique was used, i.e. the donor site was treated with individualized palatal protective plate and the recipient site was treated with individualized graft pressure plate. The survival of the graft after operation was observed. The width of buccal keratinized gingiva was measured immediately, 2, 6, 12 months after operation. Visual analogue scale (VAS) was used to record postoperative pain of the patient 1, 3, 6 days after operation. SPSS 25.0 software package was used for t test and one-way variance analysis. RESULTS: All 42 implant sites survived. The average width of buccal keratinized gingiva of the preoperative implants was (0.39±0.41) mm and (4.17±0.43) mm 12 months, postoperatively; the average increase was (3.78±0.21) mm compared with preoperative measurement. The average shrinkage was (1.12±0.12) mm. CONCLUSIONS: Modified free gingival graft technique can effectively increase the width of buccal keratinized gingiva of the implants, with minimal shrinkage of the graft 1 year after operation without significant pain after operation.

[Clinical study of titanium mesh in conjunction with concentrate growth factors to rebuild severe bone defect of anterior maxilla].

PURPOSE: To evaluate the effect of overlaying titanium mesh with concentrate growth factors(CGF) for rebuilding severe buccal bone defect of anterior maxilla when used in association with dental implantation. METHODS: Twenty patients with severe buccal bone defect of maxilla were selected. A total of 25 dental implants were placed, including 5 cases in bilateral central incisor area and 15 cases in unilateral central incisor area. After implantation, the defects were treated with Bio-oss and Bio-guid in conjunction with fixation of titanium mesh and then CGF technology was used. Two-stage surgery was carried out after 6 months of submerged healing, and permanent prosthesis was used 3 months after temporary restoration. The repairs of the defect were observed at the second stage surgery. The height of margin bone around implants and the thickness of bone at implants lingual side were measured, at the time of the second stage operation, and 3, 6, 12, 18 months after permanent restoration. The differences were analyzed by SPSS 19.0 software package with multi-sample nonparametric test and Fierdman test. RESULTS: At the time of second operation, the bone plate at lingual side was completely reconstructed, and new bone was formed at the top of implants. Clinical measurements showed that the averaged thickness of bone at lingual side was (2.69±0.154) mm at that time. Three, 6, 12, 18 months after restoration, the values were (2.67±0.152) mm, (2.66±0.153) mm, (2.65±0.153) mm, (2.65±0.151) mm, respectively. Implant-abutment junction was used as a base line to assess vertical bone absorption, the marginal bone of implant neck at lingual side was all inferior to the base line, the distance was (0.02±0.048) mm, (0.69±0.085) mm，(0.87±0.019) mm, (0.87±0.013) mm, respectively. Statistical analysis showed the thickness of bone of labial side decreased significantly over time after permanent restoration (P<0.01). Likewise, the height of marginal bone was also decreased significantly (P<0.01). However, the difference between them at 12 months and 18 months was not statistically significant (P>0.05). CONCLUSIONS: The results indicate that bone augmentation at maxilla can be achieved using titanium mesh in conjunction with CGF. The height and thickness of newly formed bone at the implant neck margin will be stabilized after 1 year. This method is worthy of wide clinical application.

[Investigation of status of dental caries in children of primary school in Hangzhou city from 2009 to 2011].

PURPOSE: To investigate the status of dental caries in children of primary school in Hangzhou City from 2009 to 2011. METHODS: The status of dental caries was examined annually from 2009 to 2011, and the caries prevalence, filling rates, mean DMFT/dmft were recorded. SPSS 13.0 software package was used for statistical analysis. RESULTS: From 2009 to 2011, the caries prevalence of deciduous teeth were 49.27%, 48.09% and 48.33%, mean dmft were 2.78, 2.81 and 2.84, filling rates of deciduous teeth were 3.92%, 4.31% and 4.28%, respectively. No significant difference was found in the caries prevalence of temporary teeth, filling rates of temporary teeth, mean dmft. For the permanent teeth, the caries prevalence were 20.24%, 18.48% and 15.85%, mean DMFT were 0.46, 0.41 and 0.33, filling rates were 10.17%, 15.67% and 23.00%, respectively. From 2009 to 2011, the caries prevalence and mean DMFT of permanent teeth was decreased, while the filling rate was increased. CONCLUSIONS: In the past three years, the status of dental caries of permanent teeth shows a remarkable improving tendency in children of primary school in Hangzhou City. However, the status of dental caries of deciduous teeth presents no significant improvement.

[Clinical study on base bonding CAD/CAM customized zirconium abutment].

PURPOSE: To evaluate the clinical application of base bonding customized zirconium abutment. METHODS: A total of 141 base bonding customized zirconium abutments used in 114 implant-supported cases during 2010.6-2012.11 in Hangzhou Stomatology Hospital were involved in the study. To evaluate the efficacy, they were followed up for 3 months to 2 years. RESULTS: Among 141 abutments, 140 were successfully applied to implant prosthesis at first time. During the observation period, partial zirconia exfoliation from bases occurred in 1 abutment. All the patients and dentists were satisfied with the final esthetic outcomes. CONCLUSIONS: The clinical effect of base bonding customized zirconium abutment is acceptable. Supported by Science and Technology Development Project of Hangzhou City(20120633B20) and Science Research Fund Key Specialist of Health and Disease of Hangzhou City(20130633B35).

[Evaluation of marginal adaptation of three different copings of metal-ceramic crowns].

PURPOSE: To evaluate the marginal adaptation of three different copings of metal ceramic crowns cast in high golden, cobalt-chrome and nickel-chrome alloy. METHODS: Thirty working dies were created from a single master die and used to fabricate thirty copings in each as the following groups: A(high golden alloy, n=10), B(cobalt-chrome alloy, n=10) and C(nickel-chrome alloy, n=10). All the metal copings were fabricated using the conventional lost wax casting technique. The restorations were seated on the master die, and high-resolution digital photographs were made of the marginal area on all four sides. The vertical marginal gap was then measured using a calibrated digital software program. One-way ANOVA and LSD tests were used to determine the differences using SPSS11.5 software package. RESULTS: The mean marginal gaps were group A:(72.9±29.3)µm; group B(85.9±33.0)µm and group C(94.1±44.9)µm. There was significant difference among three groups(P(AB)<0.01,P(AC)<0.001,P(BC)<0.05). CONCLUSIONS: The marginal gaps of three different metal copings are all clinical acceptable. The high golden copings resulted in smaller marginal gaps than either cobalt-chrome or nickel-chrome copings.

[Cone-beam CT analysis of human maxillary sinus: anatomical considerations for sinus augmentation and implant insertion].

PURPOSE: To investigate the anatomy of human maxillary sinus for providing some basic anatomical parameters related to sinus floor elevation and implant insertion. METHODS: A total of 40 cone-beam CT (CBCT) adults were selected and analyzed. The length (internal wall) and width of the maxillary sinus were measured, and the incidence and distribution of septa were investigated by use of three-dimensional reconstruction technique of CBCT. SPSS 11.0 software package was used for statistical analysis. RESULTS: The mean length (internal wall) and width of the maxillary sinus were (30.1±3.9) mm and (21.4±5.0) mm, respectively. There was no significant difference either in length or in width of maxillary sinus between males and females, or between right side and left side (P>0.05). Moreover, the incidence of sinus segments with septa was 53.8%(43/80). CONCLUSIONS: Based on this study, the use of CBCT is advantageous and mandatory to avoid or reduce the incidence of surgical complications of maxillary sinus elevation.

A comparative study of influential factors correlating with early and late hypothyroidism after (131)I therapy for Graves' disease.

BACKGROUND: (131)I therapy is recognized as the simplest, safest, least expensive, and most effective treatment, and accepted by more and more patients. However its curative effect is influenced by many factors, therefore there are some difficulties for doctors to establish individual treatment strategy. The aims of this study were to determine the incidence of early and late hypothyroidism after (131)I treatment for Graves' disease (GD) and to compare their correlation, to observe and analyze the influential factors and to understand the predictabilities of them. METHODS: Five hundred GD patients (144 males, 356 females; age (41.2 +/- 12.3) years) received (131)I treatment for the first time. The therapeutic procedure was carried out as the following: undergoing (131)I uptake test to obtain maximum of thyroid uptake value and effective half-life (EHL) time; estimating the thyroid's weight by ultrasonography; determination of thyroid hormones and correlative antibodies; pre-therapy physical examination; thyroid imaging; calculating (131)I therapeutic dosage; per os uptake of the determined (131)I dosage; follow-up appraisal of curative effect. The observing parameters included age, gender, thyroid weight, GD duration, condition of onset, state of disease, course of treatment, EHL time, maximum of thyroid uptake value, (131)I dosage and titer of correlative antibodies. We sorted out the data and used both univariate and multivariate analysis to evaluate them statistically. RESULTS: The incidence rates of early and late hypothyroidism were 33.2% and 6.6% respectively after (131)I treatment and approximately 22.2% cases of late hypothyroidism developed from early hypothyroidism. The influential factors of early hypothyroidism included course of GD, the highest thyroid uptake ratio of (131)I, EHL time and thyroid microsome antibody (TMAb), etc. A multivariate analysis on late hypothyroidism showed that female patients, with recurrence after anti-thyroid drug treatment and higher thyroid weight, had lower possibility of late hypothyroidism after (131)I therapy. CONCLUSIONS: The incidence of early hypothyroidism is higher than that of late hypothyroidism. The highest thyroid uptake ratio of (131)I, EHL and TMAb will increase the possibility of early hypothyroidism, while GD course is the protective factor. Higher (131)I dosage, longer EHL and higher TMAb titer will also increase the possibility of late hypothyroidism. The multi-perspective and multi-factor analysis has the benefit to establish individualized treatment strategy.

[The effect of cervical headgear and lower utility arch on the control of vertical dimension in tooth and jaw].

PURPOSE: To evaluate the effect of cervical headgear and lower utility arch in growing skeletal Class II division 1 patients. METHODS: The patients were divided into 3 groups, the first group was treated with cervical headgear alone (n=20), the second group was treated with cervical headgear and lower utility arch (n=20), and the third group was a control group without treatment (n=20). Cephalometric radiographs were taken and analyzed with SPSS15.0 software package. Student's t test was used to determine if there was significant difference among the 3 groups. RESULTS: Anterior facial height and ramus height displayed significantly increase in the treatment groups than those in the control group; the lower utility arch produced intrusion and lingual tipping of the mandibular incisors and distal tipping without extrusion of the mandibular molars; compared with the control group, maxillary molar total extrusion produced by cervical headgear treatment was not more than 1mm at average. CONCLUSIONS: The treatment groups show significant reduction in maxillary protrusion; significant increase in the anterior descent of the PP and ramus height, as a result, mandibular plane orientation is relatively unchanged. The treatment groups have maxillary molar extrusion less than 1mm, which can be considered clinically not significant. The lower utility arch produces mandibular incisor intrusion and lingual tipping, the mandibular molars tip distally without extrusion, the lower utility arch does not influence the mandibular rotation.

[Traditional Chinese medicine Drynaria fortunei J. Smith naringin promotes proliferation and differentiation of human periodontal ligament cells].

OBJECTIVE: To investigate the effects of Drynaria fortunei J. Smith naringin (DFSN) on proliferation and differentiation of human periodontal ligament cells (hPDLC). METHODS: Cultured human periodontal ligament cells were treated with DFSN at different concentrations. Cell proliferation was determined by MTT method; cell differentiation was evaluated through the examination of alkaline phosphate (ALP) activities. RESULTS: DFSN in a concentration ranged from 0.01 mu mol/L to 10 mu mol/L showed a promoting effect on proliferation of hPDLC (P< 0.05), and it also promoted ALP activities of hPDLC (P<0.05). CONCLUSION: Drynaria fortunei J. Smith naringin can promotes the proliferation and differentiation of human periodontal ligament cells.

[Effect of ultrasonic in instrumentation on curved and obstructed root canal preparation].

PURPOSE: To investigate and evaluate the effect of ultrasonic instrumentation on curved and obstructed root canal preparation. METHODS: Ultrasonic preparation was used on 117 root canals of 92 teeth due to resinifying therapy, pulp mummification and aging which could not be reopened and treated with traditional methods. RESULTS: 108 canals were successfully reopened with a successful rate of 92.3%. Failure occurred in 9 cases. 2 of them were lateral perforation. 2 were obstructed on curving position. 2 of them were due to pulp calcification in older patients. 3 were failing after resinifying therapy. CONCLUSION: The ultrasonic treatment of root canal was an effective and safe method. It was still limited in a cases with pulp calcification and some fine root canals treated by resinifying therapy.

[Analysis of short-term pain occurrence applying different materials for root canal therapy].

OBJECTIVE: The aim of this study is to compare the occurrence of pain applying different materials of root canal therapy in vital teeth. METHODS: 288 vital teeth were divided into 4 groups, Cortisomol sealer+gutta-percha and Vitapex+gutta-percha were used respectively in 2 groups of one time method; while Cortisomol sealer+gutta-percha and Vitapex+gutta-percha were used after 24-48 hours drainage in the other 2 groups. The occurrence of pain after 1 week was recorded. RESULTS: In all treated teeth,the occurrence rate of self-healing pain after root canal therapy was 22.6%, the occurrence rate of non-self-healing was 2.08%; in the groups of one time method,the occurrence rate of pain using Cortisomol was lower than the group using Vitapex with significant difference(P<0.01); while in the groups of root canal filling after drainage,the occurrence of self-healing pain in the group using Cortisomol was lower than the group of using Vitapex without significant difference(P>0.05);the pain occurred within 72 hours in most of the teeth. CONCLUSION: Root canal treatment applying Cortisomol sealer+gutta-percha can decrease the rate of pain occurrence after root canal filling.