[Clinical application of Chaihu Jia Longgu Muli Decoction based on modern pathophysiology mechanism].

Chaihu Jia Longgu Muli Decoction was firstly recorded in Treatise on Cold Damage(ZHANG Zhong-jing, Eastern Han dynasty). According to this medical classic, it is originally used in the treatment of the Shaoyang and Yangming syndrome. Based on the modern pathophysiological mechanism, this study interpreted the classic provisions of Chaihu Jia Longgu Muli Decoction. Original records of "chest fullness" "annoyance" "shock" "difficult urination" "delirium" "heavy body and failing to turn over" all have profound pathophysiological basis, involving disorders in cardiovascular, respiratory, nervous, and mental systems. This formula is widely used, which can be applied to treat epilepsy, cerebral arteriosclerosis, cerebral infarction, and other cerebrovascular diseases, hypertension, arrhythmia, and other cardiovascular diseases, insomnia, constipation, anxiety, depression, cardiac neurosis and other acute and chronic diseases as well as diseases in psychosomatic medicine. The clinical indications include Bupleuri Radix-targeted syndrome such as fullness and discomfort in chest and hypochondrium, bitter taste mouth, dry throat, and dizziness, the insomnia, anxiety, depression, susceptibility to fright, upset, dreamfulness and other psychiatric symptoms, red tongue, thick and yellow tongue coating, and wiry hard and powerful pulse. This formula was found to be used in combination with other formulas, such as Gualou Xiebai Decoction, Wendan Decoction, Zhizhu Pills, Juzhijiang Decoction, Suanzaoren Decoction, and Banxia Baizhu Tianma Decoction.

Convergent angles of a tapered implant referred from the root profile of premolars.

Background/purpose: Limited studies have discussed the convergent profiles regarding tapered implants based on biological considerations. This study analyzed the convergent angles (CAs) of premolar roots and imitated a tapered implant according to the anatomy of tooth roots. Materials and methods: A total of 60 single-rooted premolars were explored by micro-computed tomography. Every individual root was divided into 10 segments corono-apically, and the roots' buccolingual (BL) and mesiodistal (MD) CAs were measured by sections. To mimic a dental implant, the irregular shape of examined root cross-sections was transformed into a circular shape with equal areas. A biomimetic dental implant (BDI) was reconstructed and its CAs were compared with those of the natural roots' BL and MD at the examined levels and overall estimation. Results: In general, the maxillary and mandibular premolars demonstrated comparable CA patterns. However, significantly different CA patterns of BL, MD, and BDI were developed for both the maxillary and mandibular roots at the examined levels. The BL's CAs were greater than those CAs measured from the BDI and MD aspects, particularly for the sections at the middle and apical thirds of the roots. For overall CAs, the BDI's CAs were comparable with the average CAs of the BL and MD for both premolar groups. Conclusion: Instead of a cylindrical configuration, the BDI prototype demonstrated a tapered model with a continuous slope. The average CA of BDI was 14°-24°, serving as a biological reference for future tapered implant design and research.

Characteristics of the convergent angles of tapered implants based on a premolar root model.

STATEMENT OF PROBLEM: Developing tapered implants with the most appropriate angular characteristics requires an improved analysis of the anatomy of premolar roots. PURPOSE: The purpose of this observational study was to analyze the 3D anatomy of premolar roots by determining the tapered slope and convergent angle (TS/CA), to transform the TS/CA patterns into those in which the tapered implants mimic natural tooth roots, and to provide TS/CA references for future investigations. MATERIAL AND METHODS: A total of 73 human single-rooted premolars were surveyed and analyzed by microcomputed tomography and an associated software program. The 3D root surface area (RSA), the radius/diameter (R/D) at the planned first to tenth millimeter levels apical to the cementoenamel junction (CEJ), and the TS/CA at corresponding levels were calculated. The results were statistically analyzed by using an independent samples t test to assess the general differences of tested parameters between maxillary and mandibular premolars. A paired t test was used to examine the significant intragroup TS/CA differences between sequential coronoapical levels. One-way ANOVA was applied to study the general significance of developmental patterns in maxillary and/or mandibular groups. Two-way ANOVA was used to inspect the TS/CA significance at various measurements coronoapically between the maxillary and mandibular premolars (α=.05). RESULTS: Generally, the RSA, root length, R/D, and TS/CA parameters examined for the maxillary premolar roots differed significantly from those for the mandibular roots at the evaluated levels (P<.05). According to the measurements, the maxillary premolar roots generally exhibited nonsignificant RSA and R/D reduction patterns, with a decreasing angle of TS=13.44 degrees and CA=24.53 degrees coronoapically. However, mandibular premolar roots exhibited a significant reduction pattern, with TS=11.25 degrees and CA=21.06 degrees coronoapically according to both individual and general evaluations. CONCLUSIONS: Based on the developmental patterns of the evaluated TSs/CAs, tapered implants imitating premolar root anatomy should have a conical rather than a cylindrical shape, and the R/D of these models should be reduced to half at the apical third. However, further studies are warranted to identify more TS/CA characteristics related to the tapered implants, including the TSs/CAs of other tooth types.

The correspondence of 3D supporting bone loss and crown-to-root ratio to periodontitis classification.

AIM: Assessing the application of three-dimensional clinical attachment loss (3D-CAL), 3D supporting bone loss (3D-SBL), supracrestal tissue attachment (STA), and crown-to-root ratio (CRR) in evaluating the 2017 periodontitis classification. MATERIALS AND METHODS: We analysed ninety single-rooted human premolars with micro-computed tomography. The amount of 3D-SBL, linear radiographic bone loss (RBL), and CRR corresponding to various periodontitis stages as well as the statistical significance was investigated. RESULTS: From a 3D perspective, the premolars with a 21% of 3D-SBL at 2.0 mm coronal root length (RL) and 15% RBL corresponded to the periodontitis stage I. Premolars with a 44% of 3D-SBL at coronal 4.2-4.4 mm RL and 33% RBL accorded with the periodontitis stage II. Excluding the consideration of STA, CRR = 5:6 and 4:3 were associated with the levels at 15% and 33% RBL, respectively. CONCLUSIONS: A greater percentage of 3D-CAL than that of 2D-CAL is significant at evaluated levels. It is feasible to correlate the 3D-SBL, 3D-CAL, and STA parameters to evaluate the stages of periodontitis severity. However, the current use of RBL and CAL as applied for staging in the 2017 classification might be inconsistent with the evaluated premolar roots length, when STA dimensions are considered.

Correction: Incompatible amount of 3-D and 2-D periodontal attachments on micro-CT scanned premolars.

[This corrects the article DOI: 10.1371/journal.pone.0193894.].

Incompatible amount of 3-D and 2-D periodontal attachments on micro-CT scanned premolars.

Micro-computed tomography (micro-CT) was employed to relate the root surface area (RSA) to the periodontal attachment levels (PALs) of extracted premolars to diagnose periodontitis. Single-rooted human maxillary and mandibular premolars 31 and 36, respectively, were surveyed by micro-CT and its associated software. RSA levels from the 1st to 10th mm, corono-apically, were analyzed using statistical t tests. The average root length (RL) and RSA of the maxillary and mandibular premolars were significantly different (p < 0.05). Both premolars demonstrated a non-significant RSA percentage comparison at the evaluated PALs. For the 30% coronal 2-D radiographic RL, the 3-D RSAs 3.77 mm and 3.99 mm apical to the cementoenamel junction (CEJ) were 39.48% and 40.65% for maxillary and mandibular premolars, respectively. At the 15% coronal 2-D RL, the 3-D RSA 2 mm apical to the CEJ of the premolars was approximately 21%. At the 50% coronal 2-D RL level, approximately 62% coronal 3-D RSA and 6.5 mm RL decreased. The amount of decrease of the RSA attachment is significant in every 2-mm measurement for both premolars. Sampling periodontal microbial pathogens based on the condition of 2-D radiographic bone and clinical attachment losses without considering 3-D RSA is potentially inadequate and may underestimate the severity of the periodontitis.

Inconsistency in the Crown-to-Root Ratios of Single-Rooted Premolars Measured by 2D and 3D Examinations.

Micro-computed tomography (micro-CT) was applied to elucidate the relationship between the three-dimensional (3D) root surface area (RSA) and two-dimensional (2D) crown-to-root ratio (CRR) of extracted teeth to classify the periodontitis and assign a periodontal/prosthetic prognosis. A total of 31 maxillary and 35 mandibular single-rooted human premolars were examined. The amount of periodontal support on the basis of 3D RSA and 2D root length (RL) at CRRs of 1:1, 5:4, 3:2, and 2:1 were analyzed. Both maxillary and mandibular premolars demonstrated a nonsignificant RSA percentage at the evaluated CRRs. The coronal 21%-22% 2D RL and the 26%-28% 3D RSA bone loss apical to the cemento-enamel junction corresponded to a CRR of 1:1, relating to mild-moderate periodontitis. The coronal 30%-31% 2D RL and the 41%-42% 3D RSA bone loss corresponded to a CRR of 5:4, correlating to severe periodontitis. More severe clinical attachment loss (CAL) was observed in the 3D RSA measurement than in the 2D RL measurement at the evaluated CRRs. The amount of CAL at the CRR of 1:1 was inadequate to assess the severity of periodontitis on the basis of the 2D RL and 3D RSA measurements.

Decreased Amount of Supporting Alveolar Bone at Single-Rooted Premolars Is Under Estimated by 2D Examinations.

The purpose of this study was to relate the proportions of bone-supported root length of a 2D view into the amount of a 3D bone-attached root surface area (BA-RSA) by using a dental laser scanner examination. White-light 3D scanning technology was used to probe 36 maxillary and 35 mandibular single-rooted premolars. The bone-supported height (BSH) and BA-RSA at designated levels (95-25%) were compared using statistical t tests. The 100% BSH and BA-RSA of the maxillary/mandibular premolars were 12.6 ± 1.60 mm/13.45 ± 1.47 mm (p < 0.05) and 220.78 ± 35.31 mm2/199.51 ± 26.33 mm2 (p < 0.01), respectively. Approximately 79-80%, 59-60%, and 35-36% premolars 2D BSH remained in comparison to 75%, 50%, and 25% 3D BA-RSA preservation, respectively. However, corresponding to a 75%, 50%, and 25% 2D BSH reserve, premolars retained 67-68%, 39-41%, and 15-17% 3D BA-RSA, respectively. When taking 1.0 mm connective tissue attachment into account, 60% 3D BA-RSA and 50% 2D BSH loss were noted at the 5.1-5.4 mm clinical attachment level. Assigning a periodontal prognosis and determining the severity of periodontitis for premolars with alveolar bone loss based on 3D's or 2D's measurement is inconsistent.

Impact of Admission Glucose on Non-Diabetic Patients with ST-Segment Elevation Myocardial Infarction Treated with Percutaneous Coronary Intervention: A Meta-Analysis.

BACKGROUND: Impaired admission glucose (AG) is thought to significantly increase the risk of both early and late death with ST-segment elevation myocardial infarction (STEMI), especially for non-diabetic patients. However, several earlier studies contradict these relationships. Through our meta-analysis, we aimed to evaluate such a relation between impaired AG, the risk of death and STEMI. METHODS: We accessed PubMed, EMBASE, Web of Science, and the Cochrane Library and systematically searched their databases to identify all related prospective cohort studies. The relative risks (RRs) with their 95% confidence interval (CI) were pooled quantitatively. RESULTS: The pooled, unadjusted relative risks of early outcome events indicated that patients who had glucose concentrations ≥ the range of 6.1-11.1 mmol/L, had a 4.38-fold (95% CI, 3.23-5.94) higher early mortality. For late outcome events, the pooled unadjusted RR indicated patients who had glucose concentrations ≥ the range 7.8-11.1 mmol/L, and had a 2.69-fold (95% CI, 2.16-3.34) higher late mortality based on full participants, whereas patients had a 1.65-fold (95% CI, 1.33-2.04) higher late mortality based on based on in-hospital or 30-day survivors. CONCLUSIONS: In conclusion, the present meta-analysis demonstrated that impaired admission glucose may be an effective prognostic marker for significantly increased risk of early death. Regarding the long-term outcomes based on full population or early survival, high admission glucose also has a distinct but poorer prognostic impact on long-term mortality than early mortality. KEY WORDS: Admission glucose • Meta-analysis • Myocardial infarction • Non-diabetic.

Comparison of primary coronary percutaneous coronary intervention between Diabetic Men and Women with acute myocardial infarction.

OBJECTIVE: This study aimed to explore the short-term efficacy and safety of primary percutaneous coronary intervention (PCI) in female diabetic patients complicated with acute myocardial infarction (AMI). METHODS: A total of 169 diabetic patients with AMI who underwent primary PCI were selected and divided into group A (52 females) and group B (117 males). The clinical data, characteristics of coronary artery lesions, lengths of hospital stay, and incidences of complications were then compared between two groups. RESULTS: The average age, history of hyperlipidemia, double branch lesions, triple branch lesions, and left main lesions were significantly higher in group A than in group B (P < 0.05). Smoking history, PCI history, and pre-infarction angina were distinctly lower in group A than in group B (P < 0.05). Thrombolysis in myocardial infarction 3 (TIMI3) flow and TIMI myocardial perfusion grade 3 (TMPG3) after PCI were markedly lower in group A than in group B (P < 0.001). Group A had a higher incidence of complications, such as severe arrhythmia, cardiac function Killip III/IV, cardiogenic shock, major, moderate and mild bleed event, as well as a 30-day mortality rate, compared with group B (P < 0.05). CONCLUSION: In summary, our study demonstrated that female diabetic patients with AMI had lower TIMI3 flow and TMPG3 following PCI than male patients, while there was higher incidence of complications and 30-day mortality rate. Therefore, more attention should be paid to the therapy of diabetic women with acute myocardial infarction as well as the control of risk factors.

Relation between K469E gene polymorphism of ICAM-1 and recurrence of ACS and cardiovascular mortality.

OBJECTIVE: To explore the relation between K469E gene polymorphism of intercellular adhesion molecular-1 (ICAM-1) and the recurrence of ACS and cardiovascular mortality. METHODS: A total of 185 patients with ACS hospitalized in Department of Cardiology in our hospital from Sep 2007 to Sep 2008 were selected as objectives. Polymerase chain reaction was used to analyze K469E gene polymorphism of ICAM-1. According to the genotypes, they were divided into two groups: group with K allele (KK+KE) and group without K allele (EE). The two groups were followed up prospectively for five years and blood lipid, blood pressure, blood glucose, recurrence and death of ACS were collected when the patients left hospital. The relation between ICAM-1 gene polymorphism and the recurrence of ACS and cardiovascular mortality was analyzed by Logistic regression. RESULTS: After long-term follow-up, it was found that ACS recurred on 71 cases (38.4%) and 10 cases died, among which 3 cases died of cardiovascular disease. The recurrence of ACS and cardiovascular mortality in group with K allele were remarkably higher than that in group without K allele (P<0.01). After multivariate Logistic regression adjusted ages, gender, weight indexes, TC, LDL-C, TG, smoking, drinking, family history of cardiovascular disease, history of hypertension and the severity of coronary artery disease, the risks of ACS recurrence and cardiovascular mortality in group with genotype KK+KE was 3.31 and 3.53 times of those in group with genotype EE respectively (P<0.01). When the independent variable of hypertension was introduced in regression analysis, the risks of ACS recurrence and cardiovascular mortality in group with K allele both decreased (P<0.05). When the independent variable of HDL-C was introduced, different genotypes of ICAM-1 weren't relevant with ACS recurrence and cardiovascular mortality (P>0.05). CONCLUSIONS: K469E gene polymorphism of ICAM-1 was related to ACS recurrence and cardiovascular mortality, K allele probably an independent risky factor and hypertension and to which the level of HDL-C were closely related.

Effects of Coronary Arterial Injection of Tirofiban on Diabetes Mellitus Complicated with Acute Myocardial Infarction in the Elderly.

OBJECTIVE: This work aims to explore the short-term efficacy and safety of coronary arterial injection of tirofiban in elderly diabetic patients complicated with acute myocardial infarction (AMI) who underwent emergency percutaneous coronary intervention (PCI). METHODS: Ninety-seven elderly diabetic patients complicated with ST-elevation myocardial infarction (STEMI) who underwent emergency PCI were selected and randomized into control (group A, 49 cases) and tirofiban (group B, 48 cases) groups. Another 129 nonelderly diabetic patients (group C) complicated with STEMI who underwent emergency PCI and tirofiban treatment in the corresponding period were also involved for comparison. RESULTS: Thrombolysis in myocardial infarction 3 (TIMI3) flow was significantly higher in groups B and C than in group A after PCI (p < 0.01). TIMI myocardial perfusion grades (TMPG) 0 to 1 and 2 were distinctly lower (p < 0.01, p < 0.05) and TMPG3 was obviously higher (p < 0.01) in groups B and C than in group A. The average length of hospital stay, post-infarction angina pectoris, severe arrhythmia, and cardiac function Killip III to IV were markedly lower in groups B and C than in group A (p < 0.01, p < 0.05). Meanwhile, mucocutaneous hemorrhage was significantly higher in groups B and C than in group A (p < 0.01). CONCLUSIONS: Tirofiban effectively improved TIMI flow and TMPG perfusion in elderly diabetic patients complicated with AMI and reduced the incidence of serious complications without increasing the occurrence of severe hemorrhage. KEY WORDS: Acute myocardial infarction; Diabetes mellitus; Emergency percutaneous coronary intervention; Tirofiban.

Development of high-throughput perfusion-based microbioreactor platform capable of providing tunable dynamic tensile loading to cells and its application for the study of bovine articular chondrocytes.

Mammalian cells are sensitive to extracellular microenvironments. In order to precisely explore the physiological responses of cells to tensile loading, a stable and well-defined culture condition is required. In this study, a high-throughput perfusion-based microbioreactor platform capable of providing dynamic equibiaxial tensile loading to the cultured cells under a steady culture condition was proposed. The mechanism of generating tensile stimulation to cells is based on the pneumatically-driven deformation of an elastic polydimethylsiloxan (PDMS) membrane which exerts tensile loading to the attached cells. By modulating the magnitude and frequency of the applied pneumatic pressure, various tensile loading can be generated in a controllable manner. In this study, the microbioreactor platform was designed with the aid of the experimentally-validated finite element (FE) analysis to ensure the loading of tensile strain to cells is uniform and definable. Based on this design, the quantitative relationship between the applied pneumatic pressure and the generated tensile strain on the PDMS membrane was established via FE analysis. Results demonstrated that the proposed device was able to generate the tensile strain range (0~0.12), which covers the physiological condition that articular chondrocytes experience tensile strain under human walking condition. In this study, moreover, the effect of tensile loading on the metabolic, biosynthetic and proliferation activities of articular chondrocytes was investigated. Results disclosed that the dynamic tensile loading of 0.12 strain at 1 Hz might significantly up-regulate the synthesis of glycosaminoglycans while such stimulation was found no significant influence on the metabolic activity, the synthesis of collagen, and the proliferation of chondrocytes. Overall, this study has presented a high throughput perfusion micro cell culture device that is suitable for precisely exploring the effect of tensile loading on cell physiology.

Evaluation of contributions of orthodontic mini-screw design factors based on FE analysis and the Taguchi method.

This study determines the relative effects of changes in bone/mini-screw osseointegration and mini-screw design factors (length, diameter, thread shape, thread depth, material, head diameter and head exposure length) on the biomechanical response of a single mini-screw insertion. Eighteen CAD and finite element (FE) models corresponding to a Taguchi L(18) array were constructed to perform numerical simulations to simulate mechanical responses of a mini-screw placed in a cylindrical bone. The Taguchi method was employed to determine the significance of each design factor in controlling strain. Simulation results indicated that mini-screw material, screw exposure length and screw diameter were the major factors affecting bone strain, with percentage contributions of 63%, 24% and 7%, respectively. Bone strain decreased obviously when screw material had the high elastic modulus of stainless/titanium alloys, a small exposure length and a large diameter. Other factors had no significant on bone strain. The FE analysis combined with the Taguchi method efficiently identified the relative contributions of several mini-screw design factors, indicating that using a strong stainless/titanium alloys as screw material is advantageous, and increase in mechanical stability can be achieved by reducing the screw exposure length. Simulation results also revealed that mini-screw and bone surface contact can provide sufficient mechanical retention to perform immediately load in clinical treatment.

3D micro-crack propagation simulation at enamel/adhesive interface using FE submodeling and element death techniques.

This study investigates micro-crack propagation at the enamel/adhesive interface using finite element (FE) submodeling and element death techniques. A three-dimensional (3D) FE macro-model of the enamel/adhesive/ceramic subjected to shear bond testing was generated and analyzed. A 3D micro-model with interfacial bonding structure was constructed at the upper enamel/adhesive interface where the stress concentration was found from the macro-model results. The morphology of this interfacial bonding structure (i.e., resin tag) was assigned based on resin tag geometry and enamel rod arrangement from a scanning electron microscopy micrograph. The boundary conditions for the micro-model were determined from the macro-model results. A custom iterative code combined with the element death technique was used to calculate the micro-crack propagation. Parallel experiments were performed to validate this FE simulation. The stress concentration within the adhesive occurred mainly at the upper corner near the enamel/adhesive interface and the resin tag base. A simulated fracture path was found at the resin tag base along the enamel/adhesive interface. A morphological observation of the fracture patterns obtained from in vitro testing corresponded with the simulation results. This study shows that the FE submodeling and element death techniques could be used to simulate the 3D micro-stress pattern and the crack propagation noted at the enamel/adhesive interface.

Damage accumulation simulations in the adhesive of enamel/ceramic interface using the FE submodelling and the element deactivation approaches.

PURPOSE: To investigate the micromechanics and damage accumulation of the enamel/adhesive interface using sub-modelling and element deactivation methods. MATERIALS AND METHODS: A finite element (FE) macromodel of the enamel/adhesive/ceramic interface subjected to shear bond testing was generated for mechanical analysis. The FE micromodel was constructed at the upper enamel/adhesive interface where stress concentration was found. The morphology of the micromechanical interlockings at the bonded interface was assigned based on a scanning electron micrograph. Boundary conditions of the micromodel were determined from the macromodel's results. Furthermore, an iterative code with the element deactivation method was used to calculate the microdamage accumulation. Parallel experiments were performed to validate the simulation. RESULTS: The micromodel results demonstrated that stress concentration within the adhesive mainly occurred at the upper corner near the enamel/adhesive interface and the base of the resin tags. A simulated fracture path was found at the base of the resin tags along the enamel/adhesive interface. The morphological observation of fracture patterns obtained from in vitro testing corresponded with the simulation results. CONCLUSION: This study showed that the FE submodelling and the element deactivation approaches could better simulate the micromechanical responses and the microdamage accumulation noted at the enamel/adhesive interface.

Numerical investigation of macro- and micro-mechanics of a ceramic veneer bonded with various cement thicknesses using the typical and submodeling finite element approaches.

OBJECTIVES: This study investigates the influence of cement thickness on the macro- and micro-mechanical responses in a ceramic veneer adjacent to an incisal overlapped incisor. METHODS: Seven finite element (FE) ceramic veneer macro-models with different cement thicknesses (10-180mum) were generated. A 10N load was applied with an angulation of 60 degrees to the longitudinal tooth axis. Seven FE micro-models corresponding to the macro-models were constructed at an enamel-adhesive interface where the stress concentration was found. Based on an interfacial scanning electron microscope (SEM) micrograph, morphology of resin tags in the micro-models was generated. The micro-model boundary conditions were determined from the macro-model results. The principal stress on each node in the macro- and micro-models was calculated to investigate interfacial mechanics. A tensile test was performed to obtain an ultimate cement tensile strength to determine the material failure parameters. RESULTS: The highest stress concentration within the cement was found at the resin tag base of the enamel-adhesive interface in lingual side. Maximum stress values from 10.6 to 14.7MPa for the micro-models were higher (44-48%) than that from 7.2 to 10.0MPa for the macro-models when the cement layers increased. Based on the ultimate tensile strength (11.8MPa), bonding failure could found when the micro-models with the cement layers presented more than about 50mum. This seems to correspond with data from previous studies. CONCLUSIONS: Higher stresses develop in the adhesive as the cement thickness increases. Cement thicknesses less than 50mum might reduce the adhesive bonding failure.