Comparison of dexmedetomidine and a dexmedetomidine-esketamine combination for reducing dental anxiety in preschool children undergoing dental treatment under general anesthesia: A randomized controlled trial.

BACKGROUND: Dental anxiety is a widespread complication occurring in pediatric patients during dental visits and may lead to undesirable complications. Esketamine may be effective in anxiety. OBJECTIVE: The objective of this study was to investigate the effect of premedication with a dexmedetomidine-esketamine combination compared with dexmedetomidine alone on dental anxiety in preschool children undergoing dental treatment under general anesthesia. METHODS: This is a prospective, double-blinded, randomized controlled trial. A total of 84 patients were scheduled for elective outpatient dental caries treatment under general anesthesia. Patients were randomly premedicated with intranasal dexmedetomidine (group D) or intranasal dexmedetomidine-esketamine (group DS). The primary outcome was the level of dental anxiety assessed by the Modified Child Dental Anxiety Scale (MCDAS) at 2 h after surgery. Secondary outcomes included level of dental anxiety at 1 day and 7 days after surgery, the incidence of dental anxiety at 2 h, 1 day, and 7 days after surgery, sedation onset time, overall success of sedation, acceptance of mask induction, postoperative pain intensity, incidence of emergence agitation in PACU, adverse reactions, HR, and SpO2 before premedication (baseline) and at 10, 20, and 30 min after the end of study drug delivery. RESULTS: The dental anxiety in group DS was lower than that in group D at 2 h, 1 day, and 7 days postoperatively (P = 0.04, 0.004, and 0.006, respectively). The incidences of dental anxiety in group DS were lower than those in group D at 2 h (53 % vs 76 %, P = 0.03), 1 day (47 % vs 71 %, P = 0.04), and 7 days (44 % vs 71 %, P = 0.02) after surgery. Group DS had a higher success rate of sedation (P = 0.03) but showed a lower MAS score (P = 0.005) and smoother hemodynamics (P < 0.01) after drug administration than group D. Group DS showed a significantly lower incidence rate of emergence agitation (P = 0.03) and postoperative pain intensity (P = 0.006) than that in group D during the anesthesia recovery time. The occurrence of adverse reactions was similar in both groups (P > 0.05). LIMITATIONS: We did not analyze and correct for the learning effect caused by repeated applications of the MCDAS and MCDAS scores on the 1 day after surgery were obtained by telephone follow-up. CONCLUSIONS: Compared to premedication with dexmedetomidine alone, premedication with intranasal dexmedetomidine combined with esketamine could significantly improve dental anxiety in preschool children undergoing dental treatment under general anesthesia.

NLRP2 in health and disease.

NLR family pyrin domain containing 2 (NLRP2) is a novel member of the Nod-like receptor (NLR) family. However, our understanding of NLRP2 has long been ambiguous. NLRP2 may have a role in the innate immune response, but its 'specific' functions remain controversial. Although NLRP2 can initiate inflammasome and promote inflammation, it can also downregulate inflammatory signals. Additionally, NLRP2 has been reported to function in the reproductive system and shows high expression in the placenta. However, the exact role of NLRP2 in the reproductive system is unclear. Here, we highlight the most current progress on NLRP2 in inflammasome activation, effector function and regulation of nuclear factor-κB. And we discuss functions of NLRP2 in inflammatory diseases, reproductive disorders and the potential implication of NLRP2 in human diseases.

Role polarization and its effects in the spatial ultimatum game.

Human society is believed to be becoming increasingly polarized, yet it remains unclear how role polarization influences the evolution of fairness. In addition, little is known about role adaptation, despite the fact that altering the roles of players can often change the outcome of the ultimatum game. Unlike earlier static, random, symmetric role assignment, here I suggest a succeed-reinforce-fail-slacken role adaptation rule that encourages successful proposers in the present round to propose again in the next round and vice versa. The results demonstrate that this simple rule can tip the scales in favor of fair strategies when it comes to the proposer advantage, and therein lies the key to promoting fairness. Depending on its pace, notably, role adaptation can direct the system to equilibrium states that bear variable degrees of role polarization, with two consequences incidentally. Not only does it favor fairness, it also fosters empathy. Noise associated with role adaptation often reduces role polarization and thus has a negative impact on fairness and empathy. The comparison of experiments with various networks validates the substantial resilience of role polarization to structural changes. These findings add to the evidence for role polarization and highlight the centrality of role adaptation in the evolution of fairness.

Rapid deep-learning-assisted design method for 2-bit coding metasurfaces.

This paper proposes a deep-learning-assisted design method for 2-bit coding metasurfaces. This method uses a skip connection module and the idea of an attention mechanism in squeeze-and-excitation networks based on a fully connected network and a convolutional neural network. The accuracy limit of the basic model is further improved. The convergence ability of the model increased nearly 10 times, and the mean-square error loss function converges to 0.000168. The forward prediction accuracy of the deep-learning-assisted model is 98%, and the accuracy of inverse design results is 97%. This approach offers the advantages of an automatic design process, high efficiency, and low computational cost. It can serve users who lack metasurface design experience.

Random migration with tie retention promotes cooperation in the prisoner's dilemma game.

Migration has the potential to induce outbreaks of cooperation, yet little is known about random migration. Does random migration really inhibit cooperation as often as previously thought? Besides, prior literature has often ignored the stickiness of social ties when designing migration protocols and assumed that players always immediately disconnect from their ex-neighbors once they migrate. However, this is not always true. Here, we propose a model where players can still retain some bonds with their ex-partners after they move from one place to another. The results show that maintaining a certain number of social ties, regardless of prosocial, exploitative, or punitive, can nevertheless facilitate cooperation even if migration occurs in a totally random fashion. Notably, it reflects that tie retention can help random migration, previously thought to be harmful to cooperation, restore the ability to spark bursts of cooperation. The maximum number of retained ex-neighbors plays an important role in facilitating cooperation. We analyze the impact of social diversity in terms of the maximum number of retained ex-neighbors and migration probability, and find that the former enhances cooperation while the latter often engenders an optimal dependence between cooperation and migration. Our results instantiate a scenario in which random migration yields the outbreak of cooperation and highlight the importance of social stickiness.

The continuous and discrete molecular orbital x-ray bands from Xe(q+) (12≤q≤29) +Zn collisions.

In this paper, the x-ray emissions are measured by the interaction of 1500-3500 keV Xe(q+) (q = 12, 15, 17, 19, 21, 23, 26 and 29) ions with Zn target. When q < 29, we observe Ll, Lα, Lß1, Lß2 and Lγ characteristic x-rays from Xe(q+) ions and a broad M-shell molecular orbital (MO) x-ray band from the transient quasi-molecular levels. It is found that their yields quickly increase with different rates as the incident energy increases. Besides, the widths of the broad MO x-ray bands are about 0.9-1.32 keV over the energy range studied and are proportional to v(1/2) (v = projectile velocity). Most remarkably, when the projectile charge state is 29, the broad x-ray band separates into several narrow discrete spectra, which was never observed before in this field.

Aspiration-based partner switching boosts cooperation in social dilemmas.

Most previous studies concerning linking dynamics often assumed that links pairing individuals should be identified and treated differently during topology adjusting procedure, in order to promote cooperation. A common assumption was that cooperators were expected to avoid being exploited by quickly breaking up relationships with defectors. Then the so-called prosocial links linking two cooperators (abbreviated as CC links hereafter) would be much favored by evolution, whereby cooperation was promoted. However, we suggest that this is not always necessary. Here, we developed a minimal model in which an aspiration-based partner switching mechanism was embedded to regulate the evolution of cooperation in social dilemmas. Individuals adjusted social ties in a self-questioning manner in line with the learning theory. Less game information was involved during dynamic linking and all links were tackled anonymously irrespective of their types (i.e., CD links, DD links, or CC links). The main results indicate that cooperation flourishes for a broad range of parameters. The denser the underlying network, the more difficult the evolution of cooperation. More importantly, moderate aspirations do much better in promoting the evolution of altruistic behavior and for most cases there exists the optimal aspiration level that most benefits cooperation. Too strong or too weak selection intensity turns out to be pretty conducive to the evolution of cooperation in such a dynamical system.

Effects of adaptive dynamical linking in networked games.

The role of dynamical topologies in the evolution of cooperation has received considerable attention, as some studies have demonstrated that dynamical networks are much better than static networks in terms of boosting cooperation. Here we study a dynamical model of evolution of cooperation on stochastic dynamical networks in which there are no permanent partners to each agent. Whenever a new link is created, its duration is randomly assigned without any bias or preference. We allow the agent to adaptively adjust the duration of each link during the evolution in accordance with the feedback from game interactions. By Monte Carlo simulations, we find that cooperation can be remarkably promoted by this adaptive dynamical linking mechanism both for the game of pairwise interactions, such as the Prisoner's Dilemma game (PDG), and for the game of group interactions, illustrated by the public goods game (PGG). And the faster the adjusting rate, the more successful the evolution of cooperation. We also show that in this context weak selection favors cooperation much more than strong selection does. What is particularly meaningful is that the prosperity of cooperation in this study indicates that the rationality and selfishness of a single agent in adjusting social ties can lead to the progress of altruism of the whole population.