Sensibilidade dentinária associada ao clareamento dental em dentes vitais - uma revisão de literatura / Tooth sensitivity related to vital teeth dental bleaching ­ a literature review

O clareamento dental pode ser realizado através da técnica caseira ou de consultório, utilizando agentes como o peróxido de carbamida (PC) e peróxido de hidrogênio (PH). Apesar de seguro, existem alguns efeitos adversos relacionados ao clareamento dental, como a sensibilidade dentinária (SD), que pode estar presente em diferentes graus dependendo da técnica utilizada. A aplicação de agentes dessensibilizantes antes, durante ou depois do clareamento dental vem sido estudada para evitar ou reduzir a sensibilidade associada ao clareamento. O estudo visa revisar a literatura em relação a aspectos e conceitos importantes do clareamento dental, discutindo seus possíveis efeitos adversos com foco na sensibilidade dentinária. Foi realizada uma pesquisa digital da base de dados Medline, via PubMed, utilizando palavras-chave relacionadas ao tema, priorizando artigos publicados há menos de 20 anos e escritos em inglês ou português. Artigos também foram buscados manualmente e foram utilizados livros de odontologias relacionados ao tema. De um total de 48 artigos, 28 foram escolhidos para a composição do trabalho, além de 2 livros de dentística que abordam o clareamento dental. Constata-se que a sensibilidade dentinária é um efeito adverso comum relacionado ao clareamento dental, que possui causa exata desconhecida, porém sabe-se que está relacionada à difusão do peróxido de hidrogênio pelos tecidos dentários. A sensibilidade dentinária é mais frequente na técnica de clareamento de consultório do que na técnica caseira, e pode ser agravada por fatores relacionados ao indivíduo e/ou ao dente. Alguns agentes como o nitrato de potássio, fosfopeptídeos de caseína-fosfato de cálcio amorfo (CPP-ACP), vidros bioativos e partículas de hidroxiapatita, se mostraram efetivos no controle da sensibilidade dentinária.

Dental bleaching can be performed in at-home or in-office techniques, using agents such as carbamide peroxide or hydrogen peroxide. Although it's safe, there are some side effects related to dental bleaching, such as tooth sensitivity, which may be present in different degrees, depending on the chosen technique. The application of desensitizing agents before, during or after dental bleaching is being studied to avoid or reduce the bleaching related sensitivity. The study aims to review the literature over important aspects and concepts of dental bleaching, discussing its possible side effects, focusing on tooth sensitivity. Methods: an online search was done on Medline's database, through PubMed, using keywords related to the theme, prioritizing articles published less than 20 years ago, written in English or Portuguese. Articles were also researched manually, and dentistry books related to the theme were used as well. Out of 48 articles, 28 were chosen to this study's composition, in addition to 2 books that approach dental bleaching. Tooth sensitivity is a common side effect related to dental bleaching, with an unknown cause, however, it is known that it's related to hydrogen peroxide's diffusion through dental tissues. Tooth sensitivity is more frequent within in-office technique than within at-home technique, and may be worsen by individual and/or dental related factors. Agents such as potassium nitrate, CPP-ACP, bioactive glasses and hydroxyapatite particles, showed up to be effective in dental sensitivity control.

Peróxido de carbamida 37% no clareamento dentário e sua atuação na efetividade clareadora e eliminação de sensibilidade: relato de caso / The usage of 37% carbamide peroxide in tooth bleaching and its effect on bleaching effectiveness and elimination of sensitivity: a case report / Peróxido de carbamida al 37% en el blanqueamiento dental y su efecto sobre la eficacia del blanqueamiento y la eliminación de la sensibilidad: informe de un caso

Introdução:A sensibilidade dentária é o efeito adverso mais comum relacionado ao clareamento dentário. Na técnica de consultório, o peróxido de carbamida a 37%, surgiu como possibilidade de clarear e não causar sensibilidade.Objetivo:trata-se deum relato de caso, que avaliou a eficácia (mudança de cor) e a presença ou não de sensibilidade dentária quando se fezo uso de um produto àbase de peróxido de hidrogênio a35% e outro de peróxido de carbamida a 37%, na técnica de clareamento dentário de consultório.Relato de caso:Paciente de25 anos, sexo masculino, submetido a estudo de boca dividida, onde no hemiarco esquerdo foi aplicado peróxido de hidrogênio a 35% e no hemiarco direito, peróxido de carbamida a 37%. Foram feitas 3 sessões, sendo Peróxido de Carbamidacom aplicação única de 45 minutos, e Peróxido de Hidrogêniocom 3 aplicações de 15 minutos, em seu respectivo lado de aplicação e intervalo de sete dias entre cada sessão. Os valores de sensibilidade foram analisados antes e depois de cada sessão por meio da escala visual analógica de dor, e a alteração de cor foi avaliada através da Escala Vita, analisando incisivos e caninos superiores, antes de cada sessão.Conclusões:O clareamento dental com o Peróxido de Hidrogênio apresentou melhor eficácia clareadora e o Peróxido de Carbamida apresentou ausência de sensibilidade durante o procedimento clareador. Sugerem-se mais estudos do tipo ensaio clínico, com o Peróxido de Carbamida, para que se possa, com uma amostra maior de pacientes, verificar suas vantagens no quesito sensibilidade, bem como sua efetividade clareadora (AU).

Introduction:Tooth sensitivity is the most common adverse effect related to tooth bleaching. In the in-office technique, 37% carbamide peroxide has emerged as a way of tooth bleaching which does not cause sensitivity.Objective:This paper consists of a case report that evaluated the efficacy (color change) and the presence or absence of tooth sensitivity when using a product based on 35% hydrogen peroxide and another product based on 37% carbamide peroxide in the in-office tooth bleaching technique.Case report:A 25-year-old male patient underwent a split-mouth study in which 35% hydrogen peroxide was applied to the left hemi-arch and 37% carbamide peroxide to the right hemi-arch. Three sessions were carried out, carbamide peroxide with a single 45-minute application, and hydrogen peroxide with three 15-minute applications, on their respective application side and with a seven-day interval between each session. Sensitivity values were analyzed before and after each session using the visual analogue pain scale, and color change was assessed using the Vita Scale, analyzing upper incisors andcanines before each session. Conclusions:Teeth bleaching with hydrogen peroxide showed better bleaching efficacy and carbamide peroxide showed no sensitivity during the bleaching procedure. Further clinical trials with carbamide peroxide are suggested inorder to verify, with a larger sample of patients, its advantages in terms of sensitivity, as well asits bleaching effectiveness (AU).

Introducción: La sensibilidad de la dentina es el efecto adverso más común relacionado con el blanqueamiento dental. En la técnica en clínica, el peróxido de carbamida al 37% ha surgido como una posibilidad de blanqueamiento sin causar sensibilidad.Objetivo: Se tratade un informe de caso que evaluó la eficacia (cambio de color) y la presencia o ausencia de sensibilidad de la denina al utilizar un producto a base de peróxido de hidrógeno al 35% y otro a base de peróxido de carbamida al 37% en la técnica de blanqueamiento dental en clínica.Informe de caso:Un paciente del sexo maculino de 25 años fue sometido a un estudio de boca dividida en el que se aplicó peróxido de hidrógeno al 35% en la hemiarcada izquierda y peróxido de carbamida al 37% en la hemiarcada derecha.Se realizaron tres sesiones, la peróxido de carbamida con una única aplicación de 45 minutos, y la peróxido de hidrógeno con tres aplicaciones de 15 minutos, en sus respectivos lados de aplicación y con un intervalo de siete días entre cada sesión. Se analizaron los valores de sensibilidad antes y después de cada sesión mediante la escala analógica visual del dolor, y se evaluó el cambio de color mediante la Escala Vita, analizando los incisivos superiores y los caninos antes de cada sesión. Conclusiones: El blanqueamiento dental con peróxido de hidrógeno demostró una mayor eficacia blanqueadora y el peróxido de carbamida no manifestó sensibilidad durante el procedimiento de blanqueamiento. Se sugiere realizar más ensayos clínicos con peróxido de carbamidaparapoder utilizar una muestra mayor de pacientes y verificar sus ventajas en términos de sensibilidad, así como su eficacia blanqueadora (AU).

Evaluación del desempeño de tres puntajes no invasivos para el diagnóstico de fibrosis avanzada en una población con hígado graso no alcohólico / Evaluation of the performance of three non-invasive scores for the diagnosis of advanced fibrosis in a population with non-alcoholic fatty liver disease

Introducción. La enfermedad hepática grasa no alcohólica (EHGNA) es la hepatopatía crónica más común en el mundo, y en aproximadamente el 10 % de los casos progresará a cirrosis o a carcinoma hepatocelular. La presencia de fibrosis hepática es el mejor predictor de esta progresión, pero su diagnóstico mediante biopsia hepática es invasivo y con riesgo de complicaciones (alrededor del 2,5 %). Existen puntajes no invasivos que se han desarrollado y validado para estadificar la fibrosis, pero no conocemos su rendimiento en la población colombiana. El objetivo de este estudio fue evaluar el desempeño de los puntajes fibrosis-4 (FIB-4), la relación AST/ALT y el índice AST/plaquetas (APRI) para la detección de fibrosis avanzada en pacientes colombianos con EHGNA. Metodología. Estudio observacional tipo transversal de pacientes con EHGNA, que entre 2008 y 2022 tuvieran disponible el resultado de una biopsia hepática. Se hizo una descripción demográfica básica y se calculó el FIB-4, la relación AST/ALT y el APRI con los laboratorios más recientes previos al procedimiento. Posteriormente se calcularon valores de sensibilidad, especificidad, valores predictivos, razones de verosimilitud y área bajo la curva-característica operativa del receptor (AUC-ROC) para los puntos de corte evaluados previamente en la literatura. Resultados. Se incluyeron 176 pacientes, de los cuales el 14,3 % tenían fibrosis avanzada. El FIB-4 presentó el mejor rendimiento con un valor AUC-ROC de 0,74 para el punto de corte de 1,30 y 2,67. En segundo lugar, estuvo la relación AST/ALT con un valor AUC-ROC de 0,68 con el punto de corte de 0,8, y finalmente el APRI con valor AUC-ROC 0,62 con el punto de corte de 1. Conclusión. En la población analizada los tres puntajes tienen menor rendimiento diagnóstico comparado a los resultados reportados en Europa y Japón. El FIB-4 es el único que alcanza una AUC-ROC con rendimiento razonable, con la limitación que 27,4 % obtuvieron un resultado indeterminado.

Introduction. Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide, with approximately 10% of cases progressing to cirrhosis or hepatocellular carcinoma. Liver fibrosis presence is the best predictor of this progression, yet its diagnosis through liver biopsy is invasive and poses risk of complications. Although non-invasive scoring systems have been developed and validated for fibrosis staging, their performance remains unexplored in the Colombian population. This study aims to assess the efficacy of the fibrosis-4 (FIB-4) score, AST/ALT ratio, and AST to platelet ratio index (APRI) in detecting advanced fibrosis among Colombian NAFLD patients. Methods. This cross-sectional observational study included NAFLD patients with available liver biopsy results from 2008 to 2022. Basic demographic characteristics were described, and FIB-4, APRI, and AST/ALT ratio were calculated using the latest laboratory data before the procedure. Subsequently, sensitivity, specificity, predictive values, likelihood ratios, and the area under the receiver operating characteristic curve (AUC-ROC) were computed for previously assessed cutoff points. Results. A total of 176 patients were included, among whom 14.3% had advanced fibrosis. FIB-4 demonstrated superior performance with an AUC-ROC value of 0.74 for cutoff points of 1.30 and 2.67. Following was the AST/ALT ratio with an AUC-ROC value of 0.68 for cutoff point of 0.8, and finally, APRI with an AUC-ROC of 0.62 for the cutoff point of 1. Conclusion. All three scores have lower diagnostic efficacy compared to results reported in Europe and Japan. FIB-4 is the only one that achieves an acceptable AUC-ROC performance with the limitation that an indeterminate result was obtained in 27,4% of the sample.

Adição da Troponina Ultrassensível à Avaliação de Risco Perioperatório Melhora a Capacidade Preditiva de Morte em Pacientes Submetidos à Cirurgia Não Cardíaca / Addition of High-Sensitivity Troponin to Perioperative Risk Assessment Improves the Predictive Ability of Death in Non-Cardiac Surgery Patients

Resumo Fundamento A estratificação ode risco é uma importante etapa na avaliação perioperatória. No entanto, os principais escores de risco não incorporam biomarcadores em seus conjuntos de variáveis. Objetivo Avaliar o poder incremental da troponina à estratificação de risco tradicional. Métodos Um total de 2230 pacientes admitidos na unidade de terapia intensiva após cirurgia não cardíaca foram classificados de acordo com três tipos de risco: Risco Cardiovascular (RCV), Índice de Risco Cardíaco Revisado (IRCR), e Risco Inerente da Cirurgia (RIC). O principal desfecho foi mortalidade por todas as causas. A regressão de Cox foi usada, assim como a estatística C antes e após a adição de troponina ultrassensível (pelo menos uma medida até três dias após a cirurgia). Finalmente, o índice de reclassificação líquida e a melhoria de discriminação integrada foram usadas para avaliar o poder incremental da troponina para a estratificação de risco. O nível de significância usado foi de 0,05. Resultados A idade média dos pacientes foi 63,8 anos e 55,6% eram do sexo feminino. A prevalência de lesão miocárdica após cirurgia não cardíaca (MINS) foi 9,4%. Pacientes com um RCV elevado apresentaram uma maior ocorrência de MINS (40,1% x 24,8%, p<0,001), bem como pacientes com alto RIC (21,3 x 13,9%, p=0,004) e aqueles com IRCR≥3 (3,0 x 0,7%, p=0,009). Pacientes sem MINS, independentemente do risco avaliado, apresentaram taxa de mortalidade similar. A adição de troponina à avaliação de risco melhorou a capacidade preditiva de mortalidade em 30 dias e de mortalidade em um ano em todas as avaliações de risco. Conclusão A prevalência de MINS é mais alta na população de alto risco. No entanto, sua prevalência na população de risco mais baixo não é desprezível e causa um maior risco de morte. A adição da troponina ultrassensível melhorou a capacidade preditiva da avaliação de risco em todos os grupos.

Abstract Background Risk stratification is an important step in perioperative evaluation. However, the main risk scores do not incorporate biomarkers in their set of variables. Objective Evaluate the incremental power of troponin to the usual risk stratification Methods A total of 2,230 patients admitted to the intensive care unit after non-cardiac surgery were classified according to three types of risk: cardiovascular risk (CVR), Revised Cardiac Risk Index (RCRI); and inherent risk of surgery (IRS). The main outcome was all-cause mortality. Cox regression was used as well as c-statistics before and after addition of high-sensitivity troponin (at least one measurement up to three days after surgery). Finally, net reclassification index and integrated discrimination improvement were used to assess the incremental power of troponin for risk stratification. Significance level was set at 0.05. Results Mean age of patients was 63.8 years and 55.6% were women. The prevalence of myocardial injury after non-cardiac surgery (MINS) was 9.4%. High CVR-patients had a higher occurrence of MINS (40.1 x 24.8%, p<0.001), as well as high IRS-patients (21.3 x 13.9%, p=0.004) and those with a RCRI≥3 (3.0 x 0.7%, p=0.009). Patients without MINS, regardless of the assessed risk, had similar mortality rate. The addition of troponin to the risk assessment improved the predictive ability of death at 30 days and at 1 year in all risk assessments. Conclusion The prevalence of MINS is higher in the high-risk population. However, its prevalence in lower-risk population is not negligible and causes a higher risk of death. The addition of high-sensitivity troponin increased the predictive ability of risk assessment in all groups.

O uso do laser de alta e baixa intensidade para o tratamento de hipersensibilidade dentinária: uma revisão integrativa

Objetivo: Determinar as evidências científicas sobre a influência do uso de lasers de baixa e alta intensidade no tratamento da hipersensibilidade da dentina. Revisão de literatura: Foram realizadas buscas na Biblioteca Virtual em Saúde (BVS), incluindo as bases de dados: Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS); Bibliografia Brasileira de Odontologia (BBO); e National Library of Medicine (MEDLINE). A maioria dos estudos destacam a eficácia dos lasers na redução da HD, com o laser Nd:YAG mostrando-se eficaz na obliteração dos túbulos dentinários e proporcionando alívio a longo prazo. Apesar dos benefícios, alguns estudos alertam para possíveis danos à polpa dentária, especialmente com lasers de alta potência. Considerações finais: Embora os lasers tenham se mostrado eficazes na redução da HD, a escolha do laser deve ser personalizada para cada paciente, destacando a necessidade de aprimorar os protocolos clínicos e adquirir experiência relevante por parte dos profissionais especialistas.

Objective: To determine the scientific evidence on the influence of the use of low and high intensity lasers in the treatment of dentin hypersensitivity. Literature review: Searches were carried out in the Virtual Health Library (VHL), including the databases: Latin American and Caribbean Literature in Health Sciences (LILACS); Brazilian Bibliography of Dentistry (BBO); and National Library of Medicine (MEDLINE). Most studies highlight the effectiveness of lasers in reducing HD, with the Nd:YAG laser proving effective in obliterating dentinal tubules and providing long-term relief. Despite the benefits, some studies warn of possible damage to the dental pulp, especially with high-power lasers. Final considerations: Although lasers have been shown to be effective in reducing HD, the choice of laser must be personalized for each patient, highlighting the need to improve clinical protocols and acquire relevant experience on the part of specialist professionals.

Perfil da microbiota e padrões de resistência aos antimicrobianos em uroculturas de pacientes transplantados renais / Profile of the microbiot and anti-microbain resistance patterns in urocultures of reneal transplant patients

Objetivo: analisar o perfil de micro-organismos presentes e resistência destes aos antimicrobianos em uroculturas de pacientes transplantados renais no período de 2021-2022. Métodos: trata-se de um estudo transversal com análise quantitativa dos dados de uroculturas positivas de pacientes transplantados renais, acompanhados no Hospital Geral de Fortaleza entre janeiro de 2021 a dezembro de 2022. Foi empregado um instrumento de pesquisa elaborado, contendo variáveis classificatórias, e os dados foram obtidos por meio de registros das uroculturas existentes no sistema de prontuário eletrônico utilizado pelo hospital. Resultados: das 534 uroculturas solicitadas, 36,7% apresentaram resultado positivo, sendo 60,4% de mulheres com idades entre 20 e 59 anos. A maioria dos casos foram desenvolvidos por pacientes que receberam acompanhamento ambulatorial (56,2%). Os micro-organismos isolados foram, predominantemente, enterobactérias (81,34%), com prevalência de E.coli (69,30%). Os perfis de sensibilidade antimicrobiana variaram, com a resistência da E.coli a antibióticos como ampicilina, ácido nalidíxico, norfloxacino e ciprofloxacino. Conclusões: essas descobertas fornecem informações importantes sobre métodos clínicos específicos, métodos preventivos e melhorias na qualidade de vida dos transplantados renais.

Objective: to analyze the profile of microorganisms present and their resistance to antimicrobials in urocultures of renal transplant patients in 2021-2022. Methods: it is a cross-sectional study with quantitative data analysis from positive urocultures of renal transplant patients accompanied at the General Hospital of Fortaleza between January 2021 and December 2022. An elaborate research instrument containing classification variables was employed, and the data were obtained through records of the urocultures existing in the electronic checkbook system used by the hospital. Results: of the 534 urocultures requested, 36.7% showed a positive result, of which 60.4% were women aged between 20 and 59. Most cases were developed by patients who received outpatient follow-up (56.2%). The isolated microorganisms were predominantly enterobacteria (81.34%), with the prevalence of E.coli (69.30%). Antimicrobial sensitivity profiles varied, with E.coli resistance to antibiotics such as ampicillin, nalidixic acid, norfloxacin, and ciprofloxacin. Conclusion: these findings provide important information about specific clinical methods, preventive methods, and improvements in the quality of life of renal transplant patients.

Evaluación de la prueba G8 como tamizaje para valoración geriátrica integral en pacientes adultos mayores con cáncer / Evaluation of the G-8 test as a screening tool for comprehensive geriatric assessment in elderly patients with cancer

RESUMEN Objetivo: evaluar la sensibilidad y especificidad del test G8 en el tamizaje de adultos mayores con cáncer para la realización de la valoración geriátrica integral (VGI). Materiales y métodos: el presente estudio observacional y retrospectivo se realizó en el Servicio de Geriatría del Hospital Almenara de Lima, Perú. Se revisaron los informes de VGI en las historias clínicas electrónicos de adultos mayores (> 60 años) con cáncer, ambulatorios y hospitalizados, durante noviembre de 2022 y julio de 2023. Los pacientes se clasificaron según los criterios SIOG-1 (Sociedad Internacional de Oncología Geriátrica), formando dos grupos: pacientes aptos y pacientes no aptos o unfit (vulnerables + frágiles + muy enfermos). Del test G8 se estimó la sensibilidad, especificidad y valor predictivo positivo, área bajo la curva característica operativa del receptor (AUC). Resultados: ingresaron al estudio 201 pacientes, 91 mujeres (45,3%) y 110 (54,7%) varones, la media de la edad fue de 76,2 ± 7,4 años. Las neoplasias más frecuentes fueron colorrectal, estómago, próstata y vías biliares. La prevalencia de pacientes aptos y no aptos (unfit) fue del 23,4 y 76,6%, respectivamente. Cuando el puntaje de la prueba G8 fue ≤11, la sensibilidad, especificidad, valor predictivo positivo y AUC fueron 73,4% (intervalo de confianza al 95%: 65,7-80,2%), 91,5% (79,6%-97,6%), 96,6% (91,7-98,6%) y 89% (84-93%), respectivamente. Conclusiones: el test G8 con puntaje ≤11 tendría una alta sensibilidad y especificidad, para identificar adultos con cáncer vulnerables o frágiles, que podrían beneficiarse de la VGI.

ABSTRACT Objective: To evaluate sensitivity and specificity of the G8 test in screening older adults with cancer who may benefit from a Comprehensive Geriatric Assessment (CGA). Material and methods: This observational retrospective study was carried out in the Geriatrics Service of the Guillermo Almenara Hospital in Lima, Peru. CGA reports were reviewed in the electronic medical records of older adults (> 60 years) with cancer, both outpatients and inpatients, between November 2022 and July 2023. Patients were classified according to the SIOG-1 (International Society of Geriatric Oncology) criteria into two groups: fit and non-fit patients (vulnerable + frail + too sick). Sensitivity, specificity, and positive predictive value, area under the receiver operating characteristic curve (AUC), were estimated for the G8 test. Results: 201 patients entered the study, 91 women (45.3%) and 110 (54.7%) men; their mean age was 76.2 ± 7.4 years. The most frequent neoplasms were colorectal, stomach, prostate, and bile ducts. The prevalence of eligible and unfit patients was 23.4% and 76.6%, respectively. When the G8 test score was ≤11, sensitivity, specificity, positive predictive value, and AUC were 73.4% (95% Confidence Interval: 65.7- 80.2%), 91.5% (79.6%-97.6%), 96.6% (91.7-98.6%), and 89% (84-93%), respectively. Conclusions: The G8 test with a score ≤11 would have high sensitivity and specificity for identifying vulnerable or frail patients with cancer who could benefit from the CGA.

Detection of molecular affecting sensitivity to local glucocorticoid therapy in oral lichen planus through transcriptome sequencing / 北京大学学报(医学版)

Objective:To detect key genes of local glucocorticoid therapy in oral lichen planus(OLP)through transcriptome sequencing.Methods:The study prospectively enrolled 28 symptomatic patients who visitied Department of Oral Mucosa,Peking University Hospital of Stomatology from November 2019 to March 2023.Topical inunction of 0.1 g/L of dexamethasone was applied for 1 min,3 times daily for 4 weeks.The patients'signs and pain symptoms were recorded and they were classified as effective group and ineffective group according to the treatment outcome.Their mucosa samples were collected before treatment.After isolating total RNA,transcriptome sequencing was performed.The gene expression data obtained by sequencing were analyzed differently using the DESeq2 package in R software,and the Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis was performed on the basis of the hypergeometric distribution algorithm to describe the biological function of differentially expressed genes(DEGs),accordingly detecting sensitivity related molecular affecting therapeutic effect of dexamethasone.Results:After 4 weeks treatment by topical dexamethasone,13 cases of the 28 OLP pa-tients responding well with the sign score reducing from 7.0(4.5,9.0)to 5.0(3.0,6.3),pain score decreasing from 5.0(2.0,5.5)to 2.0(0.0,3.5),oral health impact profile lessening from 5.0(3.5,9.0)to 1.0(0.0,5.0)significantly(P＜0.01)were classified as effective group and 15 cases with poor response to the drug were sorted as ineffective group.There were no significant differences of demographic and baseline levels of clinical features,especially disease severity between these two groups.A total of 499 DEGs including 274 upregulated and 225 downregulated genes were identified between ef-fective group and ineffective group.KEGG enrichment analysis showed that upregulated genes in effective group compared with ineffective group including CLDN8,CTNNA3,MYL2 and MYLPF were associated with leukocyte transendothelial migration,while downregulated genes were significantly enriched in tumor necrosis factor(TNF),interleukin-17(IL-17),nuclear factor kappa B(NF-κB)signaling pathways,and cortisol synthesis and secretory.Conclusion:High expressions of CLDN8,CTNNA3,MYL2 and MYLPF genes in patients with oral lichen planus have a good clinical response to topical dexamethasone,while patients with high expression genes of inflammation pathway such as TNF,IL-17,NF-κB and corti-sol synthesis and secretion received poor effect.

Improved effect and mechanism of propofol on vascular hyporeactivity in septic rats / 陆军军医大学学报

Objective To observe the improved effect of propofol on vascular hyporeactivity in septic rats and its underlying mechanism.Methods A total of 96 SD rats(12 weeks old,both genders,weighing 200～220 g)were randomly divided into sham group(n=16),sepsis group(n=16,cecal ligation and puncture),propofol group(n=16),propofol+ROCK inhibitor Y-27632 group(n=16),propofol+PKCαinhibitor GO6976 group(n=16),propofol+IP3 inhibitor 2-APB group(n=8)and propofol+gap junction inhibitor metoclopramide sodium(Movens)group(n=8).In vitro vascular ring reactivity and vascular calcium sensitivity were measured to observe the improved effects of propofol on vascular hyporeactivity in septic rats and its relationships with RhoA/ROCK,PKCα,IP3 and cell gap junction.Results Determination of in vitro vascular ring and calcium sensitivity showed that the contractile reactivity to norepinephrine(NE)and to calcium sensitivity were significantly decreased in the arterial rings isolated from the septic rats compared with those from the sham group,with the dose-response curve shifting to the right,and most significant decrease by 51.42％in the superior mesenteric artery(SMA,P＜0.05).Propofol treatment significantly improved the hyporeactivity and calcium sensitivity of the vessels isolated from the septic rats,especially those of the femoral artery with a recovery rate of 89.57％(P＜0.05).In comparison with the propofol group,the dose-response curves of the propofol+Y-27632 group and the propofol+GO6976 group were shifting to right,indicating that Y-27632 and GO6976 could significantly inhibit the amelioration of propofol on calcium sensitivity of SMA in severely septic rats with an inhibitory rate of 146.95％and 88.63％(P＜0.05),respectively.Isolated vascular reactivity measurement demonstrated that Y-27632 and Movens treatment significantly antagonized the ameliorated role of propofol on hyporeactivity of blood vessels from the septic rats with an inhibitory rate of 40.79％and 169.90％(P＜0.05),separately,while no such effect was observed in the propofol+GO6976 and propofol+2-APB groups.Conclusion Propofol treatment can significantly improve vascular hyporeactivity of septic rats,which may attribute to the increase of vascular calcium sensitivity through RhoA/ROCK pathway.

Evaluation of 99m Tc-HYNIC-TOC and 131 I-MIBG imaging in diagnosis of pheochromocytoma and paraganglioma / 基础医学与临床

Objective To evaluate 99mTc-HYNIC-TOC somatostatin receptor and 131 I-MIBG imaging in clinical diag-nostic of pheochromocytoma and paraganglioma(PPGL).Methods This was a retrospective study.359 PPGL pa-tients diagnosed by pathology microscopy were included.The diagnostic sensitivity and influencing factors on 99mTc-HYNIC-TOC somatostatin receptor and 131 I-MIBG imaging were analyzed.Results The positive rate of 99mTc-HYN-IC-TOC somatostatin receptor scintigraphy was 57.7%(184/319)and 131I-MIBG imaging was 83.2%(232/279).The positive rates of 99m Tc-HYNIC-TOC somatostatin receptor imaging in the adrenal glands,retroperitoneum,head and neck,heart and mediastinum,pelvis and bladder were 53.3%,62.5%,95.0%,66.7%,50.0%and 11.0%respec-tively and the positive rates of 131I-MIBG imaging were 86.7%,88.5%,45.4%,50.0%,75.0%and 33.3%respec-tively.The positive rate of the two imaging did not showed difference among patients with different genetic back-grounds(SDH,VHL,RET mutations).The median maximum diameter of tumors was 4.4(3.0,6.1)cm.and the diag-nostic sensitivity of somatostatin receptor imaging and 131 I-MIBG imaging for larger tumors(≥4.4 cm)was signifi-cantly higher than those for the smaller tumor group(＜4.4 cm)(64.0%vs.51.3%;92.3%vs.74.1%)(P＜0.01).Tumors in 19 patients(5.3%)failed to uptake neither imaging method.Conclusions This is the largest PPGL cohort in China concerning 99m Tc-HYNIC-TOC somatostatin receptor imaging and 131 I-MIBG imaging.The sensitivity of 131 I-MIBG imaging is higher than that of 99m Tc-HYNIC-TOC somatostatin receptor imaging,but for some tumors,such as head and neck paraganglioma,the latter has obvious advantages.These two imagings technol-ogies are complementary and the choice of them should depend the individual situation of patients.

Construction and validation of a scoring model for pathogen characteristics and short-term prognosis risk prediction of candidemia / 解放军医学杂志

Objective To analyze the pathogenic characteristics and drug sensitivity of candidaemia,and construct a short-term mortality risk prediction scoring model.Methods The clinical data of patients with candidaemia admitted to the 909 Hospital of Joint Logistics Support Force from January 2011 to December 2020 were retrospectively analyzed,and the composition of pathogen composition,drug sensitivity test results and incidence of hospitalized patients were analyzed.324 cases of candidaemia were randomly divided into modeling group(190 cases)and validation group(134 cases),and the risk factors were screened by binary logistic regression.According to the odds ratio(OR)score,the 30 day mortality risk prediction scoring model was constructed,and the predictive performance of the model was verified both in modeling and validation groups.Results 356 strains of Candida including 126 strains of C.albicans(35.39%),79 strains of C.tropicalis(22.19%),74 strains of C.parapsilosis(20.79%),48 strains of C.glabrata(13.48%),14 strains of C.guilliermondii(3.93%),8 strains of C.krusei(2.25%),and 7 strains of other Candida(1.97%)were detected in 336 patients with candidemia.The incidence of candidaemia among hospitalized patients increased from 0.20 ‰ in 2011 to 0.48 ‰ in 2020.The resistance rate of candida to amphotericin B was significantly lower than that of fluconazole,voriconazole and itraconazole(P＜0.05).Among the 324 cases included in the model,95 patients died in 30 days after diagnosis,and the mortality rate was 29.32%.The proportion of males,fever,and parenteral nutrition in modeling group was significantly higher than that in validation group(P＜0.05),while the proportion of chronic lung disease and surgical history within one month were lower than those in validation group(P＜0.05).Logistic regression analysis showed that chronic renal failure,mechanical ventilation,severe neutropenia,failure to receive anti-fungal treatment within 72 hours,and APACHE Ⅱ≥20 were risk factors for short-term death of candidaemia,the OR values were 3.179,1.970,2.979,2.080,and 2.399,and the risk scores were 6,4,6,4,and 5,respectively.The area under the curve(AUC)of the risk scoring model for modeling group was 0.792(95%CI 0.721-0.862),and the result of Hosmer-Lemeshow(H-L)test was P=0.305;The AUC of validation group was 0.796(95%CI 0.735-0.898),and the H-L test result was P=0.329.A risk score≤8 indicated a low risk group for short-term mortality,a score of 9-15 indicated a medium risk group,and a score≥16 indicated a high risk group.Conclusions The incidence of candidemia in hospitalized patients is increasing and the mortality is high.The risk prediction score model can effectively predict the short-term prognosis and facilitate the early identification of the prognosis.

Research progress of high-sensitivity troponin in chronic kidney disease with acute myocardial infarction / 解放军医学杂志

The progress and clinical application of troponin detection technology have continuously improved the diagnosis rate of acute myocardial infarction(AMI),which effectively shortens the time of necrotic myocardial reperfusion.Earlier studies have found that high-sensitivity troponin(hs-cTn)is elevated to varying degrees in patients with chronic kidney disease(CKD).Therefore,when patients with CKD have AMI,the application of hs-cTn is limited to a certain extent,and with the lack of chest pain symptoms and the non-specificity of electrocardiogram performance in patients with CKD,it is particularly difficult to make a quick and accurate diagnosis of such patients.Based on this,this article will summarize the application of hs-cTn in AMI,the clinical characteristics of patients with CKD combined with AMI,how to improve the diagnostic accuracy of patients with CKD combined with AMI,and the value of hs-cTn in risk stratification and prognosis assessment of such patients to provide clinical medical staff with reference for early intervention or revascularization of patients.

Application value of multiplexed sensitivity encoding diffusion weighted imaging in neck MRI scanning / 实用放射学杂志

Objective To explore the feasibility of the multiplexed sensitivity encoding diffusion weighted imaging(MUSE-DWI)sequence in neck MRI,and to compare with traditional single-shot echo-planar imaging diffusion weighted imaging(SS-EPI-DWI)sequence.Methods Thirty healthy volunteers underwent MUSE-DWI and SS-EPI-DWI sequences scanning in neck.Two groups of images were independently scored by two radiologists for magnetic sensitivity artifact,chemical shift artifact,geometric distortion and overall image quality.The noise,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the regions of interest(ROI)of the two groups of images were measured and compared on the nasopharyngeal fossa layer,parotid gland layer,glottic layer and thyroid layer.Results Qualitative analysis showed that the image quality scores of MUSE-DWI sequence were significantly better than those of SS-EPI-DWI sequence in terms of magnetic sensitivity artifact,chemical shift artifact,geometric distortion and overall image quality(P<0.001).Quantitative analysis showed that the noise values of ROIs of MUSE-DWI sequence were significantly lower than those of SS-EPI-DWI sequence(P<0.001).The SNR and CNR of ROIs of MUSE-DWI sequence were higher than those of SS-EPI-DWI sequence(P<0.001).Conclusion MUSE-DWI sequence can significantly reduce geometric distortion,magnetic sensitivity artifact and chemical shift artifact,and SNR and CNR of images are significantly increased compared with SS-EPI-DWI sequence,which is more suitable for neck MRI scanning.

LINC00115 Targets miR-874-3p to Regulate the Biological Behavior and Paclitaxel Sensitivity of Liver Cancer Cells / 华中科技大学学报(医学版)

Objective To explore the effect of LINC00115 targeting miR-874-3p on the biological behavior and paclitaxel sensitivity of liver cancer cells.Methods The qRT-PCR was performed to detect the expression levels of LINC00115 and miR-874-3p in liver cancer tissues and cell lines.The si-NC,si-LINC00115,miR-NC,miR-874-3p,pcDNA,pcDNA-LINC00115,anti-miR-NC+si-LINC00115,anti-miR-874-3p+si-LINC00115 were transfected into liver cancer cells MHCC97H respective-ly.CCK-8 method was applied to assess cell viability and IC50 value to paclitaxel.Transwell assay was performed to detect cell migration and invasion.Dual luciferase reporter gene method was used to determine the relationship between LINC00115 and miR-874-3p.Results LINC00115 was highly expressed(P＜0.05),while miR-874-3p was lowly expressed(P＜0.05)in liver cancer tissues and cell lines.After downregulating LINC00115,the cell absorbance(A)value,the IC50 value to paclitaxel,migra-tion and invasion were significantly reduced(all P＜0.05),while miR-874-3p expression was significantly increased(P＜0.05).After upregulating miR-874-3p,the cell A value,IC50 value to paclitaxel,migration and invasion were significantly reduced(all P＜0.05).After upregulating LINC00115,miR-874-3p expression was decreased(P＜0.05).LINC00115 had a direct interaction with miR-874-3p.Downregulating miR-874-3p significantly reduced the effect of low LINC00115 expression on A value,IC50 value to paclitaxel,migration and invasion of liver cancer cells(all P＜0.05).Conclusion Downregulation of LINC00115 inhibits the prolifera-tion,migration and invasion of liver cancer cells to increase paclitaxel sensitivity by promoting miR-874-3p expression.

Effects of maternal high-fat diet and exercise intervention on insulin sensitivity and the hypothalamic arcuate nucleus in male offspring mice / 中国组织工程研究

BACKGROUND:In the offspring of obese mothers,some metabolic genes are"silent"under certain environmental influences.These"silent"genes may be"awakened"under the acquired environment and then cause metabolic regulation disorders. OBJECTIVE:In the case of offspring with different diets,to explore the metabolic genetic effects of long-term high-fat and exercise intervention in female mice. METHODS:Seventy 3-week-old female C57BL/6 mice were divided into high-fat diet(HFD)and high-at exercise groups(high-fat diet+exercise,HFD-Ex),and they gave birth naturally after 16 weeks of intervention.After 4-week lactation,16 male offspring mice from each group were randomly selected.Totally 32 offspring mice were randomly divided into 4 subgroups and given high-fat diet or standard chow diet for 6 weeks:HFD-HFD,HFD-Ex-HFD,HFD-standard chow diet,and HFD-Ex-standard chow diet.The offspring mice were subjected to glucose tolerance test and insulin tolerance test in the 10th week,followed by body composition analysis and sacrifice.Western blot was used to determine the level of p-Akt in the liver.Immunofluorescence of the hypothalamic arcuate nucleus was used to analyze the expression of neuropeptide Y and pro-opiomelanocortion. RESULTS AND CONCLUSION:Under the high-fat diet,compared with the HFD group,the offspring of the HFD-Ex group had significantly improvements in glucose metabolism,body mass,and body composition(P＜0.05).Under the standard chow diet,compared with the HFD group,the expression of neuropeptide Y in the hypothalamic arcuate nucleus of the HFD-Ex group was significantly decreased(P＜0.05),and the expression of pro-opiomelanocortion was significantly up-regulated(P＜0.05).In the case of insulin(-),the expression of phosphorylated Akt(Ser473)protein in the liver showed no significant difference between the two groups,but in the case of insulin(+),there was a significant difference between the two groups(P＜0.05).In the high-fat diet mode,the metabolic protection effect of the maternal long-term exercise may gradually weaken with the prolongation of the offspring's high-fat exposure;in the standard chow diet mode,the maternal long-term exercise can improve the central regulation of energy metabolism and insulin sensitivity of the male offspring.

Gut microbiota and drug-associated osteonecrosis:a two-sample Mendelian randomization study / 中国组织工程研究

BACKGROUND:Osteonecrosis due to drugs is a serious adverse reaction occurring after the application of such drugs.Increasing evidence suggests that the gut microbiota composition is associated with osteonecrosis due to drugs.However,the causal relationship of the gut microbiota to osteonecrosis due to drugs is still unclear. OBJECTIVE:To evaluate the potential causal relationship between the gut microbiota and the risk of osteonecrosis due to drugs using the Mendelian randomization method. METHODS:A two-sample Mendelian randomization study was performed using the summary statistics of gut microbiota from the largest available genome-wide association study meta-analysis(n=13 266)conducted by the MiBioGen consortium as well as the summary statistics of osteonecrosis due to drugs obtained from the FinnGen consortium R9 release data(264 cases and 377 013 controls).Inverse variance weighted,MR-Egger,weighted median,weighted model and simple model were used to examine the causal association between gut microbiota and osteonecrosis due to drugs.Sensitivity analysis was used to test whether the results of the Mendelian randomization analysis were reliable.Reverse Mendelian randomization analysis was performed on all the bacteria as an outcome for effect analysis and sensitivity analysis. RESULTS AND CONCLUSION:Inverse variance weighted estimates suggested that Lentisphaerae(phylum),Lentisphaeria(class),Melainabacteria(class),Gastranaerophilales(order),Rhodospirillales(order),Victivallales(order)and Bifidobacterium(genus)had protective causal effects on osteonecrosis due to drugs.Methanobacteria(class),Bacillales(order),Methanobacteriaceae(family),Lachnospiraceae(family),Methanobacteriales(order),Holdemania(genus),Holdemania(UCG010 group)(genus),Odoribacter(genus)and Tyzzerella3(genus)had negative causal effects on osteonecrosis due to drugs.According to the results of reverse Mendelian randomization analysis,Clostridiaceae1(family),Peptostreptococcaceae(family),Streptococcaceae(family),Clostridiumsensustricto1(genus)and Streptococcus(genus)showed negative causal effects on osteonecrosis due to drugs.However,Eisenbergiella(genus)showed protective causal effects on osteonecrosis due to drugs.None of the bidirectional sensitivity analysis revealed heterogeneity or horizontal pleiotropy.When gut microbiota were used as exposure and osteonecrosis due to drugs as the outcome,Mendelian randomization analysis found that seven bacterial traits were positively correlated to osteonecrosis due to drugs,nine bacterial traits were negatively related to osteonecrosis due to drugs.When osteonecrosis due to drugs were used as exposure and gut microbiota as the outcome,reverse Mendelian randomization analysis found a negative correlated relationship with five bacterial traits and a positive causal relationship with one bacterial trait.By changing the diversity and composition of gut microbiota,it is expected to improve the incidence and prognosis of osteonecrosis due to drugs,providing new ideas for the study of orthopedic diseases.

Causal relationship between trunk and lower limb fat mass and intervertebral disc degeneration based on a Mendelian randomization analysis / 中国组织工程研究

BACKGROUND:It has been found in recent observational studies that assessing localized fat mass is crucial in the evaluation of disc degeneration.Although obesity has been recognized as a risk factor for disc degeneration,the causal relationship between fat mass,which is a key factor in obesity,and intervertebral disc degeneration has been unclear in previous studies. OBJECTIVE:To investigate the causal risk factors of intervertebral disc degeneration associated with different distributions of fat mass,thereby enhancing the understanding of the pathogenesis of intervertebral disc degeneration and contributing to the development of preventive,therapeutic,and prognostic strategies. METHODS:Genetic markers associated with trunk and lower limb fat mass were extracted as instrumental variables from the publicly available IEU Open GWAS under the conditions of strong correlation and fulfillment of linkage disequilibrium.These markers were combined with the Mendelian randomization analysis to investigate the relationship between body fat and intervertebral disc degeneration.We used the latest version 9 database of FinnGen and assessed the results using several regression models,including inverse variance weighting,MR-Egger regression,simple mode,weighted mode,and weighted median estimator.We also assessed the heterogeneity of the genetic markers using Cochran's Q test,and multiplicity was assessed using the MR-Egger intercept test.Additionally,we used the leave-one-out method to determine the sensitivity of individual genetic markers to the causal effect of the exposure and outcome.The results were presented as odds ratios(OR)and 95%confidence intervals(CI). RESULTS AND CONCLUSION:The results from the inverse variance weighting method revealed that there was a positive causal relationship between trunk fat mass and the risk of developing intervertebral disc degeneration(OR=1.25,95%CI:1.15-1.35,P＜0.001).Additionally,there was an inverse causal relationship between bilateral lower limb fat mass and the risk of developing intervertebral disc degeneration(OR=0.7,95%CI:0.63-0.78,P＜0.001;OR=0.69,95%CI:0.62-0.76,P＜0.001).Furthermore,the MR-Egger intercept analysis did not detect any potential horizontal pleiotropy.No bias single nucleotide polymorphisms were detected,while heterogeneity tests were present,and the leave-one-out sensitivity analysis suggested reliable results.The results above demonstrate a positive causal relationship between trunk fat mass and intervertebral disc degeneration.As trunk fat mass increases,the risk of intervertebral disc degeneration rises.With an increase in both lower limb fat mass,the risk of intervertebral disc degeneration decreases.Fat content and distribution affects the risk of developing intervertebral disc degeneration and should be given more attention.

Sensitivity factor analysis of asymmetric gait quality evaluation model based on random forest algorithm / 中国组织工程研究

BACKGROUND:The assessment of asymmetric gait quality plays a pivotal role in guiding rehabilitation training;however,the link between gait quality and kinematic-kinetic gait parameters remains ambiguous. OBJECTIVE:To formulate a machine-learning model for evaluating gait quality based on gait parameters,identify factors sensitive to gait quality from asymmetric gait parameters,investigate the relationship between gait indicators and gait quality,and provide guidance for asymmetric gait training and rehabilitation. METHODS:An asymmetric gait database was established through the creation of asymmetric conditions.Kinematic and kinetic data were collected from 8 young and 8 elderly subjects(all male,right dominant population)during gait tests.Gait quality for each test data set was assessed using symmetry indices,resulting in the creation of a gait parameter-gait quality dataset.Utilizing the Random Forest algorithm,a gait quality evaluation model was developed and key quality parameter factors were identified through differential analysis.This model was iteratively refined.The model's performance was evaluated through 10-fold cross-validation,and its effectiveness was verified using the cross-validation dataset. RESULTS AND CONCLUSION:(1)A gradient test was designed to categorize gait quality into optimal,suboptimal,intermediate,and poor groups,with 759,329,133,and 125 instances,respectively.(2)The application of the Random Forest algorithm in gait quality assessment was explored.A relationship model was established between gait indicators and gait quality,yielding a predictive model accuracy of 95.99%.(3)The 13 main parameters significantly influencing asymmetric gait quality were identified through the Random Forest model's feature importance ranking.(4)An analysis of gait quality sensitivity factors using the 13 important parameters led to the identification of five key sensitivity indexes.The Random Forest model utilizing these sensitivity factors achieved a predictive accuracy of 94.20%.

Research on the macular microcirculation status and visual function changes of normal tension glaucoma patients / 眼科新进展

Objective To explore the changes in macular microcirculation status and visual function in patients with normal tension glaucoma(NTG)using the optical coherence tomography angiography(OCTA)and microperimeter MP-3 and analyze the correlation between the two.Methods In this cross-sectional observational study,17 NTG patients(30 eyes)were collected as the NTG group and then divided into mild,moderate and severe NTG subgroups according to the severity of the disease.During the same period,13 healthy subjects(23 eyes)with the same age and gender distribution were selected as the control group.OCTA was used to obtain linear density(LD)and perfusion density(PD)of superficial retinal vessels in the macular area.The microperimeter MP-3 was used to measure retinal sensitivity(RS)within 10° and fixation rate at 2° and 4° of the macular area.The OCTA parameters and microperimeter MP-3 parameters were compared among all groups,and the correlation between OCTA parameters and microperimeter MP-3 parameters in NTG patients was analyzed.Results There were no significant differences in LD and PD between the control group and the mild NTG sub-group in the central and nasal sides of the macula;the LD and PD in the remaining regions and overall average LD and PD showed a gradual downward trend in the control group and the mild,moderate and severe NTG subgroups.Compared with the control group,the RS of the mild NTG subgroup was lower in the inferior and temporal regions of the macular area.The RS of each region and overall average RS in the macular area decreased with the aggravation of the NTG.In the NTG group,LD and PD were significantly positively correlated with RS in each region and overall average RS in the macular area(all P＜0.05).In the NTG group,LD and PD were positively correlated with P2 in some regions of the macular area.Con-clusion Compared with the control group,the macular microcirculation status and visual function of NTG patients signif-icantly decreased with the progression of the disease;there is a significant correlation between macular LD and RS in NTG patients.