RESUMO
Objective: This study aims to investigate the therapeutic efficacy of patent foramen ovale (PFO) closure in migraine patients with a massive right-to-left shunt (RLS) and white matter lesions (WMLs). Methods: The research focused on migraine patients with a massive RLS who underwent PFO closure in our hospital from June 2020 to June 2021. The study included 51 patients without WMLs (control group, CG) and 27 patients with WMLs (observation group, OG). A 12-month postoperative follow-up survey was conducted to assess headache episodes (frequency and duration), evaluated using the Headache Impact Test-6 (HIT-6) and the Pain Intensity Visual Analog Scale (VAS). The psychological state was also evaluated using the Hamilton Anxiety and Depression Scale (HAMA, HAMD). Adverse reactions during the follow-up were recorded. Results: No significant differences in perioperative and prognostic adverse reactions were observed between OG and CG (P > .05). Both groups showed a reduction in postoperative headache episodes and pain intensity. However, the OG exhibited higher frequency and duration of headache episodes and elevated HIT-6 and VAS scores, resulting in lower clinical efficacy (P < .05). Postoperatively, both groups demonstrated reductions in HAMA and HAMD, with CG showing lower scores compared to OG (P < .05). Logistic regression analysis identified the course of the disease, HIT-6 score, and the presence of WMLs as independent risk factors for the efficacy of PFO closure (P < .05). Conclusions: PFO closure proves effective and safe in treating migraine patients with RLS. However, for those with WMLs, clinical attention should be directed toward the treatment of WMLs.
RESUMO
OBJECTIVES: The aim of this study was to investigate the molecular mechanism underlying odontoblast damage repair in dentin hypersensitivity (DH) and the role of Yes-associated protein (YAP) in this process. METHODS: The DH model was constructed in Sprague-Dawley (SD) rats, and the in vivo expression of Piezo1, Integrin αvß3, YAP, and dentin sialophosphoprotein (DSPP) was detected by immunohistochemistry. COMSOL Multiphysics software was used to simulate the dentinal tubule fluid flow velocity and corresponding fluid shear stress (FSS) on the odontoblast processes. MDPC-23 cells were cultured in vitro and loaded with a peristaltic pump for 1 hour at FSS values of 0.1, 0.3, 0.5, and 0.7 dyne/cm2. The expression of Piezo1, Integrin αvß3, and YAP was detected by immunofluorescence. Verteporfin (a YAP-specific inhibitor) was utilised to confirm the effect of YAP on the expression of dentineogenesis-related protein under FSS. RESULTS: The level and duration of external mechanical stimuli have an effect on the functional expression of odontoblasts. In DH, the harder the food that is chewed, the faster the flow of the dentinal tubule fluid and the greater the FSS on the odontoblast processes. The expression of Piezo1, Integrin αvß3, and YAP can be promoted when the FSS is less than 0.3 dyne/cm2. After YAP inhibition, the DSPP protein expression level was reduced at 0.3 dyne/cm2 FSS. CONCLUSIONS: These results suggest that appropriate FSS can enhance the expression of odontoblast-related factors in odontoblasts via the Piezo1-Integrin αvß3-YAP mechanotransduction pathway and the YAP appears to play an essential role in the response of odontoblasts to external mechanical stimuli.