Long-term assessment of systemic microcirculatory function and plasma cytokines after coronavirus disease 2019 (COVID-19)

Abstract Systemic microvascular dysfunction has been shown to be present in COVID-19, and serum cytokines are known to be involved in the regulation of vascular function. We sought to evaluate systemic microvascular endothelial function, with laser doppler perfusion monitoring (LDPM), and plasma levels of cytokines after acute COVID-19. Individuals admitted to a Cardiology hospital with acute COVID-19 and followed for 12-15 months after recovery underwent noninvasive evaluation of systemic endothelium-dependent microvascular reactivity by cutaneous LDPM with local thermal hyperemia (LTH). A multiplex biometric immunoassay panel was used to assess 48 serum cytokines and chemokines. Twenty patients and 14 control volunteers were enrolled. The areas under the curves of vasodilation induced by LTH were significantly increased after recovery (P=0.009) and were not different from values obtained in healthy volunteers (P= 0.85). The peak microvascular flow during LTH did also significantly increase (P= 0.02), and was not different form values obtained in healthy volunteers (P= 0.55). Several cytokines displayed significantly reduced serum concentrations after recovery from COVID-19. In conclusion, endothelium-dependent systemic microvascular reactivity improved after recovery from COVID-19 in patients with cardiovascular diseases, in parallel with a reduction in the levels of several serum cytokines and chemokines involved in the regulation of vascular function and inflammation.

Effects of regular physical exercise on skin blood flow and cardiovascular risk factors in overweight and obese subjects / Efeitos do exercício físico regular sobre o fluxo sanguíneo da pele e nos fatores de risco cardiovascular em indivíduos com sobrepeso e obesidade

Objective: it is well known that low omentin levels and reduced bioavailability of nitric oxide (NO) are outgrowth of obesity. Besides, in obese subjects, microvascular dysfunction can be an initial stage of cardiovascular diseases. This situation can be evaluated with skin laser­Doppler flowmetry (LDF). Methods: in this study we investigated the effects of 12 weeks moderate physical exercise on microvascular reactivity and plasma levels of omentin and NO in 25 overweight and obese subjects. Control group was composed of 28 sedentary participants who were neither obese nor overweight. Microvascular reactivity was handled by measurement of skin blood flow from the ring finger of the right hand with LDF, which is a non­invasive method for evaluation. With this method, it was aimed to examine the post­occlusive reactive hyperemia response of the patients. None of the participants in both groups have never followed a regular exercise schedule in their life span. Results: with regular exercise, there was a statistically significant decrease in glucose (p=0.008), cholesterol (p=0.05), and triglyceride (p=0.048) levels, while body mass index, high­density lipoprotein, and low­density lipoprotein levels did not change significantly in overweight/obese group. Also, the omentin level significantly increased (p=0.01), but NO level did not change significantly. Moreover, the amount of change in omentin and NO levels measured before and after the physical exercise were significantly correlated (r=0.57). Considering the microcirculation, rest flow (p=0.001) and peak flow value of LDF (p=0.001) increased after the physical exercise. Conclusion: our study shows that moderate physical exercise affects microvascular reactivity and plasma levels of omentin in overweight and obese subjects.

Objetivo: sabe-se que níveis baixos de omentina e a reduzida biodisponibilidade de óxido nítrico (NO) são consequências da obesidade. Além disso, a disfunção microvascular pode ser um estágio inicial de doenças cardiovasculares em indivíduos obesos. Essa situação pode ser avaliada com a fluxometria de pele laser-Doppler (LDF). Métodos: foram investigados os efeitos do exercício físico moderado por 12 semanas na reatividade microvascular e nos níveis plasmáticos de omentina e NO em 25 indivíduos com sobrepeso e obesidade. O grupo controle foi composto por 28 participantes sedentários que não eram obesos nem com sobrepeso. A reatividade microvascular foi obtida pela medida do fluxo sanguíneo da pele do dedo anelar da mão direita com LDF, que é um método não invasivo de avaliação. Com este método, objetivou-se examinar a resposta da hiperemia reativa pós-oclusiva dos pacientes. Os participantes de ambos os grupos nunca seguiram um cronograma regular de exercícios em sua vida. Resultados: com o exercício regular houve diminuição estatisticamente significativa dos níveis de glicose (p=0,008), de colesterol (p=0,05) e de triglicerídeos (p=0,048), enquanto o índice de massa corporal e os níveis de lipoproteínas de alta e baixa densidade não se alteraram significativamente no grupo com sobrepeso/obesidade. Além disso, o nível de omentina aumentou significativamente (p=0,01), mas o nível de NO não apresentou modificações significas. Observou-se, também, que as modificações nos níveis de omentina e NO mensurados antes e após o exercício físico foram significativamente correlacionados (r=0,57). Em relação à microcirculação, os valores do fluxo de repouso (p=0,001) e do valor de fluxo de pico e da LDF (p=0,001) aumentaram após o exercício físico. Conclusão: nosso estudo mostra que o exercício físico moderado afeta a reatividade microvascular e os níveis plasmáticos de omentina em indivíduos com sobrepeso e obesidade.

Assesment of radiotherapy effects on the blood flow in gingiva and dental pulp - a laser Doppler flowmetry study

Abstract Objective This study aims to determine and compare the dental pulp and gingival blood flow in patients referred for oropharyngeal radiotherapy (RT) at three different time points: before the start, immediately after, and six months following the completion of RT. The aim is also to evaluate the dependence of the pulp and gingival blood flow on the radiation dose. Methodology A prospective study included 10 patients referred for intensity-modulated RT (IMRT) in the oropharyngeal region, with at least one intact tooth surrounded by a healthy gingiva. The dose received by each selected tooth and adjacent gingiva was determined according to the map of treatment planning and computer systems. The blood flow measurements were performed using the laser Doppler flowmetry (LDF) method. Results Comparing vascular flows at three different time points, the median blood flow in the dental pulp showed no statistically significant difference (p=0.325), contrary to gingiva (p=0.011). Immediately after RT completion, the gingival flow significantly increased compared to its starting point (p=0.012). The pulp flow correlated negatively with the radiation dose, whereas a strong correlation was noted 6 months following the RT completion. Conclusions RT caused a significant acute gingival blood flow increase, followed by a long-term (over six months) tendency to return to the starting levels. The dental pulp blood flow is differently affected by higher radiation doses (over 50Gy) in comparison to lower doses (below 50Gy). During RT planning, considering the possibility of protecting the teeth localized near the Gross Tumor Volume as a sensitive organ is recommended.

Study of pulp blood flow in normal adult first molars detected by laser Doppler flowmetry / 口腔疾病防治

Objective @#To explore the "clinical normal reference range" of pulpal blood flow (PBF) in the physiological state in an effort to provide a reference for clinical diagnosis and treatment.@* Methods@# According to the working principle and operational considerations of laser Doppler flowmetry (LDF), the PBF blood flow value of the first molars of the upper and lower mandibles of normal adults was detected by LDF, and the clinical reference value range under physiological conditions was analyzed and calculated. The differences in PBF values by sex, dental position and location (left and right side, upper and lower jaw) were analyzed. @*Results @#A total of 200 normal adult participants with an average age of (22.76 ± 3.26) years were included. The cohort included 95 males and 105 females, with a total of 800 first molars. Neither the PBF values of the left and right first molars nor the PBF values of the upper and lower first molars in males or females significantly differed (P>0.05). The PBF value for females was higher than that of males. Specifically, the clinical reference PBF values for males and females were (8.56 ± 3.25) PU and (9.51 ± 3.47) PU, respectively.@*Conclusion @#The PBF values of normal adult first molars in healthy subjects were higher in females than in males, and in the PBF values of first molars of the same sex did not significantly differ between the left side and right side or upper and lower jaw; these values could be used as a reference for the selection of control teeth.

Guía de manejo obstétrico y del recién nacido en madre aloinmunizada / Guidelines for the obstetric management of an alloimmune mother and her newborn / Guia de manejo obstétrico e neonatal em mães aloimunizadas

Resumen: La aloinmunización es una respuesta biológica frente a la exposición de antígenos no propios. La gestación, las transfusiones de hemocomponentes, los trasplantes de órganos sólidos y células hematopoyéticas, así como el consumo de drogas intravenosas exponen a las pacientes al desarrollo de aloanticuerpos antieritrocitarios. El hallazgo de los mismos debe cumplir con las instancias diagnósticas para identificar la probabilidad de estar asociados a enfermedad hemolítica feto neonatal (EHFN) y su oportuna derivación a policlínica de alto riesgo obstétrico (ARO) para su correcto seguimiento. Es fundamental que sean los laboratorios de inmunohematología de los servicios de hemoterapia y medicina transfusional los encargados de los estudios diagnósticos de aloinmunización eritrocitaria(1). En este sentido hemos elaborado esta guía con el objetivo de protocolizar de manera multidisciplinaria el manejo de las embarazadas aloinmunizadas y sus recién nacidos.

Abstract: Alloimmunization is the biological response to exposure to non-HLA antigens. Pregnancy, transfusion of blood components, solid organ and hematopoietic cell transplantation, as well as intravenous drug use expose patients to the development of anti-erythrocyte antibodies. When the latter are found, they must match diagnostic criteria to identify the potential association to hemolytic disease of the fetus and newborn (HDFN) and its timely referral to the high-risk obstetric risk polyclinic for due follow-up. It is of the essence for erythrocyte alloimmunization diagnostic tests to be carried out by the immunohematology laboratories of the Hemotherapy and Transfusional Medicine services. To that end, we have prepared these guidelines with the purpose of providing a multidisciplinary protocol for the handling of maternal alloimmunization and alloimmunization of the newborn.

Resumo: A aloimunização é uma resposta biológica à exposição a antígenos não próprios. A gravidez, as transfusões de hemocomponentes, os transplantes de órgãos sólidos e células hematopoiéticas, bem como o uso de drogas intravenosas expõem os pacientes ao desenvolvimento de anticorpos antieritrocitários. O achado destes deve obedecer a critérios diagnósticos para identificar a doença e a probabilidade de estarem associados a doença hemolítica feto neonatal (DHPN) e seu encaminhamento oportuno para uma unidade de alto risco obstétrico para acompanhamento adequado. É fundamental que os laboratórios de imuno-hematologia dos serviços de Hemoterapia e Medicina Transfusional se encarreguem dos estudos diagnósticos da aloimunização eritrocitária. Elaboramos este guia com o objetivo de estabelecer um protocolo multidisciplinar para o manejo de gestantes aloimunizadas e seus recém-nascidos.

Pulpal blood flow changes and pain scores related to using Superelastic 0. 018-inch Nickel Titanium as the first orthodontic alignment archwire: a prospective clinical trial

Abstract Background Optimal orthodontic force results in maximum rate of tooth movement without tissue damage. Even though starting orthodontic treatment with a thicker archwire may shorten treatment duration, the evidence on the effect of using 0.018-inch NiTi as the first alignment archwire on pulpal blood flow (PBF) status is still scarce. Objectives to record PBF changes and pain scores associated with using 0.018-inch NiTi as the first alignment archwire during fixed orthodontic treatment. Methodology Patients were selected from subjects attending postgraduate orthodontic teaching clinics at Jordan University of Science and Technology. In total, forty healthy patients who exhibited mild lower arch crowding were included. A split-mouth trial design was used. Each patient received two archwire sizes at one time joined in the midline by crimpable hook and applied in the lower arch. Patients were assigned into one of two groups based on archwire sizes used. Group 1: 0.014-inch and 0.018-inch NiTi (Six males, 14 females aged 19.4±1.33 years) and Group 2: 0.016-inch and 0.018-inch NiTi (Seven males, 13 females aged 19.6±1.45 years). The archwire size group was randomly allocated with a 1:1 allocation ratio. A Laser Doppler Flowmeter was used to measure PBF at different time intervals (T0-T5). Pain scores were recorded using a visual analogue scale (VAS). A repeated measures ANOVA and a post-hoc Bonferroni comparison tests were conducted to examine differences at the different time points before and during orthodontic alignment. Results For all studied archwire sizes, PBF decreased 20 minutes after their placement. Most PBF changes occurred within 24hours and continued to decrease until 72 hours after archwire placement where the maximum reduction was reached. Eventually, normal values were reverted within 1 month. PBF changes were similar between all alignment - groups. Conclusions Initial orthodontic alignment with 0.018-inch NiTi does not cause irreversible changes to pulpal vasculature or produces higher pain scores.

Antilipoperoxidative and anti-inflammatory efficacy of multifunctional sunscreens containing ferulic acid

Unprotected chronic exposure to ultraviolet radiation generates many harmful effects to human skin and UV filters are essential to health, however, traditional sunscreens do not provide enough protection against cutaneous oxidative stress, a process amplified by UV radiation. Therefore, is been proposed the development of multifunctional photoprotective formulations, acting in the absorption/reflection of UV radiation and assisting in cutaneous homeostasis. In the present study, ferulic acid is used in conjunction with two sunscreens, bemotrizinol and ethylhexyl triazone, for the determination of biosafety and efficacy methods, using techniques that better elucidate the effects of ferulic acid. Skin permeation assays were performed by applying a formulation containing the three substances in the stratum corneum of volunteers, which were removed by the tape stripping method (ex vivo) with follow quantification by high performance liquid chromatography (HPLC). The test was able to evaluate the penetration depth of the substances, characterizing them. In addition, the simultaneous quantification of the three substances was performed by a single and fast method, facilitating their analysis and improving the technique. Also, TBARS (thiobarbituric acid reactive substances) assays were performed in stratum corneum removed by tape stripping (ex vivo), evaluating the potential of cutaneous lipid peroxidation, with or without ferulic acid. To date, it is the first time that TBARS method is used to characterize the stratum corneum (ex vivo) and quantified by HPLC. The protocol developed may aid in the efficacy of antioxidant agents in studies aimed at elucidating the level of lipid peroxidation caused by drugs and cosmetics, and even in carrying out baseline studies characterizing different ethnicities and genders. As last, an anti-inflammatory in vivo assay with Laser Doppler flowmetry equipment was used to compare the sunscreen formulation with or without ferulic acid. Data indicated that the antioxidant reduced the angular coefficient of the perfusion units, mitigating the inflammatory effects. Furthermore, a significant difference was found between the genders, suggesting a more pronounced inflammatory reaction in women. Ferulic acid proved to be a valuable resource, besides being safe and raise the SPF of sunscreens, it also mitigates the effects of inflammation

A exposição crônica desprotegida à radiação ultravioleta (UV) contribui para o desenvolvimento de câncer de pele e os filtros solares são relevantes para evitar tais efeitos prejudiciais, porém, os protetores solares tradicionais não geram proteção suficiente contra o estresse oxidativo cutâneo. Logo, espera-se o desenvolvimento de formulações fotoprotetoras multifuncionais, atuando não somente na absorção e/ou reflexão da radiação UV, mas, também, auxiliando na homeostase cutânea, com presença de agentes antioxidantes. No presente estudo foi utilizado o ácido ferúlico conjuntamente com dois filtros solares, o bemotrizinol e a triazona de octila, para determinação de métodos de segurança e eficácia, utilizando técnicas que melhor elucidem e comprovem os efeitos do ácido ferúlico. Foram realizados ensaios de permeação cutânea pela aplicação tópica de formulação contendo as três substâncias em voluntários, sendo o estrato córneo retirado pelo método de tape stripping (ex vivo) com subsequente quantificação por cromatografia líquida de alta eficiência (CLAE). O ensaio pôde avaliar a profundidade de penetração das substâncias, caracterizando-as. Ademais, a quantificação simultânea das três substâncias foi efetuada por método único e rápido, facilitando análise com aprimoramento da técnica. Em adição, foi realizado ensaios de TBARS (substâncias reativas ao ácido tiobarbitúrico) em estrato córneo removido por tape stripping (ex vivo), para avaliar o potencial de peroxidação lipídica cutânea, contendo ou não o ácido ferúlico. Até o presente momento, é a primeira vez que o método TBARS é utilizado para caracterização do estrato córneo (ex vivo) e quantificada por CLAE. O protocolo desenvolvido pode auxiliar na eficácia de agentes antioxidantes, em estudos que visam elucidar o nível de peroxidação lipídica causada por medicamentos e cosméticos e, até mesmo, na realização de estudos de base, caracterizando etnias e gêneros. Ademais, um ensaio anti-inflamatório in vivo com equipamento de fluxometria Laser Doppler foi utilizado para comparar a formulação fotoprotetora com ou sem ácido ferúlico. Os dados indicaram que o antioxidante reduziu o coeficiente angular das unidades de perfusão, mitigando os efeitos inflamatórios. Ainda, foi identificada diferença entre os gêneros, sugerindo reação inflamatória mais pronunciada em mulheres. O ácido ferúlico provou ser um recurso valioso, além de ser seguro e elevar o FPS dos fotoprotetores, também atenuando os efeitos da inflamação

Laser doppler flowmetry as a method of analysis for the evaluation of chemo - induced oral mucositis: a pilot study / Flujometría por láser doppler como método de análisis para la evaluación de la mucositis oral inducida por quimioterapia: un estudio piloto

Background: Oral mucositis (OM) is an inflammation of the oral mucosa due to cancer therapy that compromises the patient's quality of life. Laser Doppler flowmetry (LDF) is a non-invasive method to monitor microvascular blood flow (BF) in real-time. Purpose: Develop a method to evaluate BF in the genian region cheek in patients undergoing chemotherapy by LDF and compare the degrees of OM and pain with evaluation of BF. Material and methods: Evaluation of OM was performed using the World Health Organization (WHO) and Oral Mucositis Assessment Scale (OMAS) scales and the visual analog scale for pain evaluation. For flowmetry analysis, a laser Doppler flowmeter (moorVMSTM™, 780 nm wavelength and VP3 probe), fixed by an acrylic resin support was used; VP3 probe was positioned on the genian region and the patient's head was stabilized with a neck pillow for an accurate measurement. The Wilcoxon test was used to compare the flowmetry results at the studied times. The Pearson correlation coefficient was used to evaluate relationships between BF and the WHO, OMAS and visual analog scales. Results: Eleven patients of both sexes, aged between 30 and 78 years, with OM were included. An increase in cutaneous BF was observed at the initial times of OM, with progressive reduction during the chemotherapy cycle. There was a statistical difference (p<0.05) between time point T0 (first consultation) and time point T6 (last consultation). Conclusion: The method developed in this pilot study is effective, reliable, and reproducible, and allows the evaluation of BF dynamics in the genian region using LDF of patients undergoing chemotherapy at risk of developing OM.

Antecedentes: La mucositis oral (MO) es una inflamación de la mucosa oral debido a la terapia del cáncer, que compromete la calidad de vida del paciente. La flujometría láser Doppler (FLD) es un método no invasivo para monitorear el flujo sanguíneo microvascular (FS) en tiempo real. Objetivo: Desarrollar un método para evaluar la FS en la mejilla de la región geniana en pacientes sometidos a quimioterapia por FLD y comparar los grados de MO y dolor con la evaluación del FS. Material y Métodos: La evaluación de la MO se realizó utilizando las escalas de la Organización Mundial de la Salud (OMS) y la Escala de Evaluación de la Mucositis Oral (OMAS) y la escala analógica visual para la evaluación del dolor. Para el análisis de flujometría se utilizó un flujómetro láser Doppler (moorVMSTM™, longitud de onda de 780 nm y sonda VP3), fijado por un soporte de resina acrílica; La sonda VP3 se colocó en la región geniana y la cabeza del paciente se estabilizó con una almohada para el cuello para una medición precisa. Se utilizó la prueba de Wilcoxon para comparar los resultados de la flujometría en los tiempos estudiados. Se utilizó el coeficiente de correlación de Pearson para evaluar las relaciones entre FS y las escalas de la OMS, OMAS y analógicas visuales. Resultados: Se incluyeron 11 pacientes de ambos sexos, con edades comprendidas entre 30 y 78 años, con MO. Se observó un aumento del FS cutáneo en los momentos iniciales de la MO, con reducción progresiva durante el ciclo de quimioterapia. Hubo una diferencia estadística (p<0.05) entre el momento T0 (primera consulta) y el momento T6 (última consulta). Conclusión: El método desarrollado en este estudio piloto es efectivo, confiable y reproducible, y permite evaluar la dinámica del FS en la región geniana utilizando FLD de pacientes sometidos a quimioterapia con riesgo de desarrollar MO.

Ecografía doppler de la arteria pulmonar como indicador de madurez pulmonar fetal, Cuenca ­ Ecuador / Doppler ultrasound of the pulmonary artery as fetal lung maturity indicator, Cuenca - Ecuador

Introducción: la flujometría de la arteria pulmonar en fetos sanos puede ser un estudio predictor de la madurez pulmonar, lo que conlleva a un impacto en la disminución de la mortalidad perinatal.Objetivo: establecer el índice de tiempo de aceleración/tiempo de eyección de la arteria pulmonar (TA/TE) como un indicador de madurez pulmonar fetal en gestantes entre 26 y 40 semanas de gestación (SG), usuarias del Hospital Especializado Fundación Humanitaria Pablo Jaramillo Crespo, periodo 2017.Métodos: estudio de validación de prueba diagnóstica. Se evaluó la flujometría de la arteria pulmonar por ecografía doppler en 300 fetos sanos de gestantes entre 15 y 45 años de edad. Para la recolección de datos se utilizó encuestas y para la determinación de la validez se usó los estadísticos sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Resultados: el valor del índice TA/TE de la arteria pulmonar fue 0.216 para las gestantes entre 26-28 SG; de 0.253 entre 29-31 SG; de 0.279 entre 32-34 SG; de 0.315 para las gestantes entre 35-37 SG y de 0.349 entre 38-40 SG. Las 37 SG en punto de corte fue de 0.320; el área ROC fue 0.98 con una S: 95.2%, E: 97.2%. VPP 93.0% y VPN 98.1%.Conclusiones: el índice TA/TE de la arteria pulmonar demostró correlación con la edad gestacional. Un índice TA/TE de 0.320, como punto de corte, predice madurez pulmonar fetal (AU);

Introduction: pulmonary artery flow metric in healthy fetuses can be a predictive study of lung maturity, which leads to an impact on the decrease in perinatal mortality.Objective: to establish the ratio of pulmonary artery acceleration time to ejection time (AT/ET) as an indicator of fetal lung maturity in pregnant women from 26 to 40 weeks of gestation (WG), users of the "Hospital Especializado Fundación Humanitaria Pablo Jaramillo Crespo", period 2017.Methods: A validity study of diagnostic tests was carried out. Pulmonary artery flow metric was evaluated by Doppler ultrasound in 300 healthy fetuses of pregnant women between 15 to 45 years old. Surveys were used to collect data. Sensitivity (S), specificity (E), positive predictive value (PPV) and negative predictive value (NPV) were used to determine validity.Results: the value of the TA / TE index of the pulmonary artery was 0.216 for pregnant women between 26-28 WG; of 0.253 between 29-31 WG; 0.279 between 32-34 WG; 0.315 for pregnant women between 35-37 WG and 0.349 between 38-40 WG. The 37 WG at the cut-off point was 0.320; the ROC area was 0.98 with a S: 95.2%, E: 97.2%. The PPV 93.0% and NPV 98.1%.Conclusions: the AT/ET ratio of pulmonary artery showed correlation with gestational age. An AT/ET ratio of 0.320, as a cut-off point, predicts fetal lung maturity (AU);

Microcirculation changes in gingival tissue after ultrasonic tooth preparation in beagle dogs

Abstract Ultrasonic wave technology is widely used during dental treatments. We previously demonstrated that this method protects the gingival tissue. However, the physiological change on the gingival microvasculature caused by this method remains unclear. Objective The aim of this study was to investigate the relationship between the morphological and physiological effects on gingival microcirculation when preparing teeth, using the conventional dental turbine or ultrasonic method. Methodology The lower premolar teeth of beagle dogs were prepared along the gingival margin by using a dental turbine or ultrasonic wave instrument. Gingival vasculature changes were investigated using scanning electron microscopy for corrosion resin casts. Gingival blood flow at the preparation site was determined simultaneously by laser Doppler flowmetry. These assessments were performed immediately (Day 0), at 7 days and 30 days after tooth preparation. Results At day 0, in the turbine group, blood vessels were destroyed and some resin leaked. Furthermore, gingival blood flow at the site was significantly increased. In contrast, the ultrasonic group demonstrated nearly normal vasculature and gingival blood flow similar to the non-prepared group for 30 days after preparation. No significant alterations occurred in gingival circulation 30 days after either preparation; however, the turbine group revealed obvious morphological changes. Conclusions Based on multiple approach analyses, this study demonstrated that ultrasonic waves are useful for microvascular protection in tooth preparation. Compared with a dental turbine, ultrasonic wave instruments caused minimal damage to gingival microcirculation. Tooth preparation using ultrasonic wave instruments could be valuable for protecting periodontal tissue.

Case report and literature review of vital pulp preservation by endodontic microsurgery at the distal buccal root of maxillary molar / 口腔疾病防治

Objective@#To investigate the diagnosis, treatment and prognosis of nonodontogenic periapical lesions and to provide a reference for clinical diagnosis and treatment.@*Methods@# A case of a patient with right upper molar pulp with apical penetration and local occlusion admitted to the West China Stomatological Hospital of Sichuan University was retrospectively analyzed, and the curative effect of microapical surgery and pith preservation was also analyzed.@*Results @#The imaging features of tooth 16 showed periradicular radiolucency combined with local radiopaque lesions around the distal buccal apical area. Endodontic microsurgery was performed under local anesthesia. Soft tissue coverage was observed in the distal buccal apical area during the surgery, and no radiopaque tissue was detected. The distal buccal root apex was cut by 3 mm, and mineral trioxide aggregate was used for root-end backfilling. The postoperative pathological results revealed fibrous connective tissue. One-week recall X-ray examination showed tight root-end backfilling and no periradicular radiolucency; an electrical test of pulp vitality showed positive results. The four-year follow-up showed that there was no discoloration in tooth 16 and no significant difference in thermal and electrical tests of pulp vitality compared with control teeth. Combining the clinical manifestations, imaging features, surgical exploration results and pathological reports, the case was most likely to be cemental hypoplasia. Through the literature review, the treatment and healthy pulp preservation of such cases by endodontic microsurgery under the premise of preserving teeth has not been reported.@*Conclusion@#For maxillary posterior teeth with periapical lesions but healthy pulp, accurate estimation of pulp status, endodontic microsurgical exploration and application of bioactive materials can achieve vital pulp preservation while removing the lesions.

Protective Effect of Dandeng Tongnao Capsule (DDTN) on Cerebral Ischemia Reperfusion Rats / 中国药学杂志

OBJECTIVE: To observe the protective effects of Dandeng Tongnao capsule (DDTN) on cerebral ischemia reperfusion injury in rat and explore its mechanism so as to reevaluation the clinical efficacy of DDTN. METHODS: Middle cerebral artery occlusion (MCAO) model in rats was established using filament method and reperfusion was processed with filament removed 2 h later. Therefore, the MCAO models were established to observe the effect of DDTN-L group (0.21 g•kg-1) and DDTN-H group (0.84 g•kg-1) on infract volume via TTC staining. Regional cerebral blood flow(rCBF) of corpus striatum of the side of cerebral infraction was measured by using laser doppler flow (LDF). Pathological changes of neuron in hippocampuses were observed via hematoxylin and eosin (HE) staining and transmission electron microscopy (TEM).The changes of amino acid in cerebral ischemia were detected by microdialysis system. The level of Ca2+ was evaluated by flow cytometer (FCM). RESULTS: The results showed that the cerebral blood flow increased and infract volume reduced at 7, 14 d in DDTN group. Analysis of HE staining and TEM scan suggested that DDTN (0.21, 0.84 g•kg-1) remarkably alleviated neuronal injury of hippocampal CA1 area during I/R. The contents of Ca2+ and excitatory amino acids were significantly decreased in DDTN group. CONCLUSION: DDTN could prevent cerebral injury of MCAO rats via decreasing the intracellular Ca2+ concentration, and inhibiting the release of excitatory amino acids.

Total nasal reconstruction based on three-dimensional technology combined with hemodynamics monitoring after operation / 中华整形外科杂志

Objective@#The purpose is to explore the method and clinical effects of total nasal reconstruction with the assistance of three-dimensional (3D) scanning, 3D printing and monitoring the blood circulation after operation.@*Methods@#3D scanning: Artex Eva 3D scanner was used to record the nose data of 500 volunteers from Xuzhou Medical University and its affiliated hospital from September 2016 to February 2017. A nose database of normal individuals was established, of which male was 138 and female was 362. In addition, 3D facial scanning was performed in patients wish to total nasal reconstruction. 3D printing: The individualized nasal structure was designed, with the assistant of patients′facial characteristics, combined with the normal nose database and the opinion of the patients. Anactual nose model was used as guidance during the operation. Postoperative monitoring: The blood flow and the retraction rate of forehead flap after surgery were measured using Laser Doppler Flowmeter and Geomagic Qualify software. The blood flow values, the temperature and the surface area of the flap were recorded and analyzed.@*Results@#The nasal database of normal people in the Huaihai region successfully established. Overall, the width of the nose takes up a quarter of the width of the faces, and the length is 1/3 of the distance from the hairline to the chin. From February 2017 to June 2018, 7 cases underwent total nasal reconstruction operations were performed by this procedure. The nasal models were all successfully printed out, as the guide of flap taken during the operation. The mean operation time of the cases was (2.45±0.75) h, and the follow-up time was 5-15 months, with an average of 12.5 months. After the operations, the retraction rate of the forehead flap were (21.8±2.72)% in one month, and (29.1±1.82)% in six months. All patients are satisfied with the nasal appearance.@*Conclusions@#Nasal reconstruction with forehead flap based on 3D scanning and 3D printing, provides objective targets for nasal fine-structure in a noninvasive way. The postoperative monitoring of the blood flow promotes the successful completion of the total nose reconstruction.

Study of niacin skin flushing response for the diagnosis of major depressive disorder / 中国神经精神疾病杂志

Objective To investigate the difference of niacin skin flush response between patients with major depressive disorder (MDD) and healthy controls (HCs), and its sensitivity and specificity for the diagnosis of MDD. Methods Twenty-one untreated patients with MDD and 28 age- and gender-matched HCs were enrolled in this study. The severity of depressive symptoms was assessed mainly by using the 17-item Hamilton Depression Rating Scale (HDRS-17). Methyl Nicotinate (MN) solution at 8 different concentrations (10-5 mol/L, 10-4 mol/L, 10-3.5 mol/L, 10-3 mol/L, 10-2.5 mol/L, 10-2 mol/L, 10-1.5 mol/L, 10-1 mol/L) were applied on subjects' forearms. Signals of blood flow were collected using the Doppler Laser Flowmetry to detect the skin flushing of the test. Results Under the concentrations of 10-2.5 mol/L, 10-2 mol/L, 10-1.5 mol/L and 10-1 mol/L MN solution, the blood flow was significantly higher in depressive patients than in HCs (P<0.01). The MN sensitivity (logEC50) was inversely correlated to the severity of depressive symptoms (r=-0.57, P<0.05). ROC curve analysis implied that the maximum blood flow (MBF) caused by the niacin skin flush response, could efficiently discriminate MDD from HCs (AUC=0.90, P<0.01). Conclusion The presence of enhanced niacin skin flush response may be helpful in the diagnosis of MDD.

A preliminary study on the determination of reference values of pulp viability in young incisors detected by laser doppler flowmetry / 实用口腔医学杂志

Objective: To study the clinical reference pulpal blood flow(PBF) values detected by laser doppler flowmetry(LDF) in healthy young population and to analyze their possible affected factors. Methods: Undergraduate students at the age of 17-23 years were enrolled. PBF of 12-22 were detected by LDF based on the standard procedure. Difference of the test results between different sex was analyzed by T test and variance homogeneity test, and the correlation with age was analyzed by the chi-square test, and the difference between the different teeth was analyzed by the random group analysis. Results: 400 students(250 males and 150 females with the average age of 19. 83 years) met the inclusion criteria. The clinical reference values of PBF of different anterior teeth were obtained by the detection of LDF. For the same tooth, PBF values of females were higher than that of males (P＜ 0. 05). PBF values of different ages shared no statistical significance(P＞ 0. 05). For the same gender, PBF values of middle incisor were higher than that of lateral incisors(P＜ 0. 05). Conclusion: The determination of the clinical reference values of PBF detected by LDF may promote the clinical use of this technology.

Confusion and solution for vital pulp therapy / 华西口腔医学杂志

Dental pulp tissue plays a role in forming dentin, providing nutrition, conducting pain, and generating protective responses to environmental stimuli. Bacterial infection is the main cause of pulp disease, where histopathological changes are the histological basis for determining the choice of treatment and the evaluation of therapeutic effect. Thus, particular attention should be given to eliminate infection, as well as preserve and maintain pulpal health in teeth that show reversible or limited pulpal injuries. Vital pulp therapy, especially its indications and prognostic factors, has been a research hotspot that often causes confusion among clinicians. In this paper, we briefly introduce the confusion and solution for vital pulp therapy in terms of indications, pulp condition assessment, infection elimination, and capping material selection. In addition, we develop a clinical pathway and an operation normalization of vital pulp therapy to better perform the therapy.

Study on using laser Doppler flowmetry to determine the pulpal blood flow of immature maxillary incisors / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aimed to evaluate the influence of age on the pulpal blood flow (PBF) of immature maxillary incisors of maxillary incisors, which was detected by laser Doppler flowmetry (LDF).</p><p><b>METHODS</b>LDF was used to detect the PBF value of maxillary central and lateral incisors of a child group (aged 7-13 years old) and a positive control group (aged 18-25 years old), as well as the central incisor of a negative control group (the central incisor had undergone endodontic treatment). We then compared the features of PBF in all groups with the influence of gender and position on PBF. The relation of maxillary central incisor and lateral incisor, age, and maxillary incisor were analyzed.</p><p><b>RESULTS</b>The PBF value of the negative control group was (2.08±0.73) PU. The PBF values in the positive control group in central and lateral incisors were (8.49±1.88) and (7.52±1.82) PU. In the child group, PBF values in central incisors and lateral incisors were (11.31±2.21) and (12.18±2.65) PU. A significant difference was observed between different groups and between central and lateral incisors (P<0.01). Meanwhile, no significant difference was found in the PBF values between the right and the left parts in both males and females (P>0.05). Age had a linearity negative correlation with the PBF value of incisors in the child group. A linear negative correlation existed between the age and PBF of central and lateral incisors (r=-0.310 and r=-0.510, respectively) (P<
0.01).</p><p><b>CONCLUSIONS</b>PBF value decreased with increased age in children aged 7-13 years old.</p>

Dynamic changes of blood flow in frontal cortex of diabetic rats / 中国药理学通报

Aim To investigate the changes of cerebral blood flow in rats with diabetic cognitive impairment by two-channel laser Doppler flowmeter,and to explore the changes of cerebral blood flow in diabetic rats with cognitive impairment and to investigate the changes of cerebral blood flow lesions and the central nervous system function changes in the study to provide pre-foundation.Methods Thirty-four male Wistar rats were randomly divided into two groups:blank control group and diabetic model group.The rats in the model group were treated with streptozotocin (STZ) 60 mg · kg-1,and the glucose oxidase method was used to determine fasting blood glucose ≥ 16.7 mmol · L-1 as the standard of the model.The Water maze was used to observe the behavioral changes of diabetic rats.Dual-channel laser doppler flowmeter was used to measure cerebral blood flow in diabetic rats with cognitive impairment.Another 34 male Wistar rats were randomly divided into two groups:control group and diabetic model group.Dual-channel laser doppler flowmeter was used to dynamically monitor cerebral blood flow on 0 d,7 d,14 d,21 d,28 d,35 d,42 d,56 d and 75 d.ELISA was applied to detect the concentration of iNOS,eNOS and ET-1 in cerebrospinal fluid.Results Morris water maze test showed that the time of the platform (latency) was significantly longer than that of the blank control group(P ＜0.05).The cerebral blood flow/100 g of diabetic rats with cognitive impairment was significantly lower than that of the control group (P ＜ O.05),and the blood flow in the model group was significantly lower than that in the model group (P ＜ 0.05).Compared with control group,iNOS and eNOS concentrations were markedly elevated,while ET-1 concentration obviously decreased.Conclusions The decrease of blood flow in the frontal cortex of diabetic rats with cognitive impairment suggests that it may be one of the factors leading to cognitive impairment in diabetes mellitus.Cerebral blood flow reduction occurs in the early stages of diabetes,followed by no significant deterioration.Cerebral blood flow may not be related to the changes of NO and ET-1,but the trend of cerebral blood flow may be related to the change of the two.

Effects of the monitoring of cerebral blood flow in the preparation of cerebral ischemia model in rats / 中国脑血管病杂志

Objective To investigate whether the monitoring of cerebral blood flow can be used to evaluate the successful preparation of rat models with focal cerebral ischemia.Methods With the line plug inserted into the left internal cerebral artery of 30 SPF Wistar Han rats at (16.0±0.5) mm,(18.0±0.5) mm and (20.0±0.5) mm respectively,three kinds of focal cerebral ischemia models (10 each) were prepared.All the rats were divided into incomplete occlusion group,complete occlusion group and deep occlusion group according to whether the blood clots were found in skull base and the infarction was appeared in the middle cerebral artery territory after the whole brain was stained with 2,3,5-triphenyl tetrazolium chloride.The cerebral blood flow in the middle cerebral artery territory of each animal was monitored by laser Doppler at the time of before and after blocking with the line plug inserted and reperfusion with the line plug pulled out and recorded for statistical analysis.The cerebral blood flow was expressed as the relative flow unit (perfusion unit,PU);The changes of the cerebral blood flow after occlusion and reperfusion were expressed as a percentage of that blood flow and those before occlusion.Results During the process of modeling,1 rats died,and the other in the incomplete occlusion group (n=9),in the complete occlusion group (n=15),and in the deep occlusion group (n=5).The depths of inserting of 8 rats in the incomplete occlusion group were about (16±0.5) mm,and the blood flow from the anterior cerebral artery to middle cerebral artery could not be prevented completely,the Longa score was evaluated 6 h after ischemia and ranged from 0 to 1,there were no blood clots in skull base and no infarction after TTC staining.The depths of inserting of 9 rats in the complete occlusion group were about (18±0.5) mm,and the anterior cerebral artery blood flow was completely blocked,the neurological dysfunction was significant after 6 h ischemia and the Longa score was ranged from 2 to 3,the blood clots in skull base were absent and the infarctions in middle cerebral artery territory were obvious after TTC staining.The depth of inserting of 5 rats in the deep occlusion group were about (20±0.5) mm,and the anterior cerebral artery blood flow was also completely blocked,the neurological dysfunction was serious after 6 h ischemia and the Longa score was ranged from 3 to 4,there existed blood clots in skull base and obvious infarctions in middle cerebral artery territory after TTC staining.The cerebral blood flows after the line plug inserted compared with those before occlusion in the incomplete occlusion group,complete occlusion group and deep occlusion group were all decreased (94±17 vs.256±36,43±9 vs.286±44,44±6 vs.294±46,respectively,all P0.05);The percentages of cerebral blood flow after occlusion and before were (36.93±0.06)%,(15.09±0.02)%,(15.52±0.04)% respectively,and the difference between groups was statistically significant (F=39.14,P<0.01).The cerebral blood flow after reperfusion were 213±31,147±17,96±14,respectively,and the difference was also statistically significant (F=50.05,P<0.01),and the cerebral blood flow in deep occlusion group was less than that in complete occlusion group(P<0.05);The percentages of cerebral blood flow after reperfusion and before occlusion were (83.10±0.02)%,(51.83±0.05)%,(33.49±0.09)% respectively,and the difference was also statistically significant (F=93.23,P<0.01).Conclusion The cerebral blood flow monitored by laser Doppler can be used as a real-time,convenient,micro invasive,objective and reliable standard to evaluate the successful preparation of rat MCAO models with line plug method.