Group DD Research Articles

The Effect of a Subsequent Dose of Dexmedetomidine or Other Sedatives following an Initial Dose of Dexmedetomidine on Electrolytes, Acid-Base Balance, Creatinine, Glucose, and Cardiac Troponin I in Cats: Part II.

The administered dose of dexmedetomidine may occasionally fail to produce the anticipated sedative effects. Therefore, a subsequent dose or administration of another sedative may enhance sedation; however, patient safety may be affected. The safety of seven different drugs administered at the following time point after an insufficient dose of dexmedetomidine was evaluated in a crossover, blind, experimental study that included six healthy adult cats. All cats received an initial dose of dexmedetomidine and a subsequent dose of either dexmedetomidine (Group DD), NS 0.9% (DC), tramadol (DT), butorphanol (DBT), buprenorphine (DBP), ketamine (DK), or midazolam (DM). Animal safety was assessed using repeated blood gas analysis and measurement of electrolytes, glucose, cardiac troponin I, and creatinine to evaluate cardiac, respiratory, and renal function. The median values of creatinine, cardiac troponin I, pH, partial pressure of carbon dioxide, potassium, and sodium did not change significantly throughout the study. Heart rate was significantly decreased in all groups after administration of the drug combinations, except for in the DK group. Respiratory rate decreased significantly after administration of the initial dose of dexmedetomidine and in the DBP and DM groups. The partial pressure of oxygen, although normal, decreased significantly after the administration of dexmedetomidine, whereas the median concentration of glucose increased significantly following the administration of dexmedetomidine. The results of our study suggest that the drug combinations used did not alter the blood parameters above normal limits, while cardiac and renal function were not compromised. Therefore, a safe level of sedation was achieved. However, the administration of dexmedetomidine reduced the partial pressure of oxygen; thus, oxygen supplementation during sedation may be advantageous. Additionally, the increase in glucose concentration indicates that dexmedetomidine should not be used in cats with hyperglycaemia, whereas the decrease in haematocrit suggests that dexmedetomidine is not recommended in anaemic cats.

Persistent exposure to artificial light at night (ALAN) accelerates metamorphosis and colonization in larvae of marine shellfish

The ongoing course of urbanization has led to excessive use of artificial light at night (ALAN), which has rapidly become an important source of pollution in many cities. The Pacific abalone (Haliotis discus hannai) Larvae were kept under a 12/12 h light/dark photoperiod (DD) in order to determine the effects of ALAN on embryonic development. To simulate the street lighting conditions at night, the artificial light was switched on from 18:00 until midnight (AD) or until 06:00 the next day (ND). Moreover, Groups AD and ND had a considerably greater hatching success rate and metamorphosis rate than Group DD (P < 0.05), whereas Group DD had a significantly longer hatching period and course to complete the metamorphosis of the larvae (P < 0.05). Transcriptomic analyses showed that members of Groups AD and DD had considerably higher expression levels of genes involved in ribosome biogenesis, spliceosome function, and the mRNA surveillance pathway. Prostaglandin B2, L-palmitoylcarnitine, stearic acid, palmitic acid, leukotriene C4, and arachidonic acid were screened by non-targeted metabolomics as differential metabolic markers that played a vital role in the response of larvae to different ALAN conditions. Multi-omics correlation analysis suggested that five pathways related to fatty acid synthesis, catabolism, and metabolism, such as biosynthesis of unsaturated fatty acids and arachidonic acid metabolism, were enriched in each comparison. Further quantitative analysis showed that compared to Group DD, 33 out of 50 fatty acids were upregulated in Group AD, and the levels of almost all fatty acids were increased in Group ND, which in turn suggested that fatty acids played a vital role in the physiological response of larvae to illumination changes. The findings of this work were significant for the unbiased and full-scale assessment of the ecological effects of ALAN, as well as the structural stability of the marine benthic community.

Effect of low-dose propofol combined with dexamethasone on the prevention of postoperative nausea and vomiting in gynaecological day surgery under remimazolam-based general anesthesia.

To observe the effect of low-dose propofol combined with dexamethasone on the prevention of postoperative nausea and vomiting (PONV) in gynaecological day surgery under remimazolam-based general anesthesia. A total of 120 patients, aged from 18 to 65 years old, American Society of Anesthesiologists grade I or II, were scheduled to undergo hysteroscopy under total intravenous anesthesia. The patients were divided into 3 groups (n = 40 each): dexamethasone plus saline group (DC group), dexamethasone plus droperidol group (DD group) and dexamethasone plus propofol group (DP group). Dexamethasone 5 mg and flurbiprofen axetil 50 mg were given intravenously before induction of general anesthesia. Anesthesia induction: remimazolam 6 mg/kg/hours was continuously pumped until sleep and slow intravenous injection of alfentanil 20 ug/kg and mivacurium chloride 0.2 mg/kg was given. Anesthesia maintenance: remimazolam 1 mg/kg/hour and alfentanil 40 ug/kg/hours were continuously pumped. After the start of surgery, DC group was given 2 mL saline, DD group was given droperidol 1 mg, and DP group was given propofol 20 mg. Primary outcome: incidence of PONV in the postanesthesia care unit (PACU). Secondary outcome: incidence of PONV in patients within 24 hours after surgery, as well as general patient data, duration of anesthesia, the recovery time of patients, dose of remimazolam and alfentanil, etc. In PACU, patients of group DD and DP showed less PONV than those in group DC (P < .05). Within 24 hours after operation, there was no significant difference in the incidence of PONV among the 3 groups (P > .05), but the incidence of vomiting in DD group and DP group was significantly lower than that in DC group (P < .05). There was no significant difference in general data, anesthesia time, the recovery time of patients and dosage of remimazolam and alfentanil among the 3 groups (P > .05). The effect of low-dose propofol combined with dexamethasone to prevent PONV under remimazolam-based general anesthesia was similar to that of droperidol combined with dexamethasone, both of which significantly reduced the incidence of PONV in the PACU compared to dexamethasone alone. However, low-dose propofol combined with dexamethasone had little effect on the incidence of PONV within 24 hours compared to dexamethasone alone and only reduced the incidence of postoperative vomiting in patients.

Oral Health-Related Quality of Life in Patients with Temporomandibular Disorders and Effect of Anxiety: A Retrospective Case-Control Study.

To evaluate oral health-related quality of life (OHRQoL) in patients with temporomandibular disorders (TMDs) involving masticatory muscle pain, disc displacement with reduction, or both and to determine the associations of these disorders with anxiety. This study consisted of 150 patients with TMDs and 50 healthy controls. Patients were diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I and then divided into three diagnostic groups: masticatory muscle pain (group MP), disc displacement with reduction (group DD), or both (group MPDD). The participants completed the Oral Health Impact Profile-14 (OHIP-14) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires for assessment of OHRQoL and anxiety, respectively. Statistical analyses were performed using Kruskal-Wallis test and Mann-Whitney U post hoc paired-comparison tests. A total of 121 of the patients (60.25%) were female and 79 (39.75%) were male, ranging from ages 18 to 68 years (mean age: 37.32 ± 13.62). Gender distribution, mean age, educational status, and occupational status were similar among groups. The OHIP-14 global and domain scores and distribution of GAD-7 levels were significantly different among groups (P < .001). For psychologic discomfort and disability domains, group MPDD statistically scored the highest, followed by group MP, group DD, and then the control group (P < .05). According to correlation analyses, there were positive correlations between the GAD-7 and all OHIP-14 scores (r = 0.438, P < .001) within group MPDD. OHRQoL is negatively affected by TMDs and worsens as the severity of anxiety increases. Therefore, physical conditions and anxiety levels in TMD patients should be simultaneously considered for treatment and maintenance. Int J Prosthodont 2023;36:148-154. doi: 10.11607/ijp.7587.

Association of angiotensin converting enzyme gene polymorphism with diabetic nephropathy in patients using lisinopril

Angiotensin Converting Enzyme (ACE) plays an important role in the development and progression of Diabetic nephropathy (DN). The present study was designed to determine the possible association between ACE gene polymorphism and DN. The study included 242 samples: DN (n = 121), type 2 Diabetes mellitus (DM2) (n = 60) and control (n = 61). The blood samples were collected from the subjects, followed by DNA extraction. Insertion deletion polymorphism of ACE gene studied using specific primers. Patients using Lisinopril were followed for two months. The ACE genotype distribution in DN patients was as follows: DD (n = 47; 38.84%), II (n = 17; 14.04%) and DI (n = 57; 47.10%). In DM group the genotype distribution was DD (n = 4; 6.66%), II (n = 25; 41.66%) and DI (n = 31; 51.66%) while in control group DD (n = 38; 62.29%), II (n = 1; 1.63%) and DI (n = 22; 36.06%). The comparison of II genotype to DD genotype was reflected by p-value =0.0001, OR=17.28 and 95% CI 5.313-49.58. The percent decrease of micro-albuminuria after two months with the use of Lisinopril 10 mg twice a day in DD, II and DI genotype of DN were 31.27%, 12.37% and 16.81%, respectively. Our findings revealed that DD genotype has strong association with DN but not a risk factor for development of disease.

Effect of leech-centipede medicine on improving erectile function in diabetes-induced erectile dysfunction rats via PDE5 signalling pathway-related molecules

Context The leech and centipede granules have good curative effects on many diabetic vascular diseases, including diabetes-induced erectile dysfunction (DIED). Objective To explore the effect of leech and centipede on erectile function in rats with diabetes-induced erectile dysfunction and its possible mechanism. Materials and methods Thirty male Sprague–Dawley DIED rats were randomly divided into the model group (Group M), low-dose group (Group DD), high-dose group (Group DG) and tadalafil group (Group T) (n = 6); diabetic rats were induced by streptozotocin. Apomorphine was used to induce diabetic erectile dysfunction. The ‘leech-centipede’ granules (0.15 and 0.6 g/kg) were intragastrically administered in the DD and DG groups for 8 weeks. Blood glucose, serum insulin, testosterone, cGMP levels and protein expression changes were measured in each group. Results After 8 weeks, the erectile function of rats in the DG group significantly improved (1.26 ± 0.73). Penis tissue cGMP levels were higher in the DG group (1.48 ± 0.11) than in the M group (0.58 ± 0.15). Protein and mRNA expression levels of NOS were significantly higher (0.77 ± 0.05; 0.61 ± 0.02) but those of PDE5 (0.43 ± 0.05; 0.61 ± 0.03) were lower in the DG group than in the M group (0.37 ± 0.06; 0.51 ± 0.01; 0.78 ± 0.06; 0.81 ± 0.04). Conclusion The leech-centipede can improve erectile dysfunction in DIED rats by regulating the expression of cGMP, NOS, and PDE5-related molecules in the PDE5 pathway. This study provides a potential mechanism for the treatment of DIED with leech-centipede.

Impact of sintering procedure and clinical adjustment on color stability and translucency of translucent zirconia

Statement of problemChairside and laboratory adjustments of translucent monolithic zirconia restorations sintered by short cycles are inevitable. Therefore, the optical properties of these materials should be evaluated under conditions similar to those in the oral environment. PurposeThe purpose of this in vitro study was to evaluate the color stability and the translucency changes of translucent monolithic zirconia after the sintering procedure, simulated clinical adjustment, and coffee thermocycling. Material and methodsEighty monolithic zirconia disks (diameter: 10 mm; thickness: 1 mm) were milled from 4 zirconia brands (Zolid FX Preshaded, Zolid FX White, DD Cubex2, and DD Bio ZX2). Two sintering procedures (standard or speed) were performed for each zirconia brand. The color coordinates and the translucency after sintering, clinical adjustment, and after 5000 cycles in a coffee solution were analyzed with a reflectance spectrophotometer, and the translucency parameters and contrast ratio were measured. The color differences and the translucency variations were calculated for each tested variable and statistically analyzed with 2-way ANOVA and pairwise comparison (α=.05). ResultsBoth clinical adjustment procedure and coffee thermocycling had significant influence on color differences (P<.001). For translucency, 2-way ANOVA showed a significant interaction between sintering procedure and zirconia brand after coffee thermocycling (P<.001) while no significant interaction was recorded after the clinical adjustment procedure (P=.247). For all evaluated groups, the translucency parameter values decreased after either clinical adjustment procedure or coffee thermocycling (P<.001). For tested zirconia, group DD Cubex2 showed higher translucency parameter regardless of the variables tested. ConclusionsThe color and the translucency of the translucent zirconia can be affected by the type of the zirconia brand and the sintering protocol. Furthermore, the color and the translucency were affected by both the clinical adjustment procedure and the coffee thermocycling, but not beyond the clinically acceptable limit of the color difference.Clinical Implications

Effects of various methods of dexmedetomidine administration for sedation in elderly patients undergoing spinal anesthesia: a randomized controlled study.

BackgroundThe purpose of this study was to investigate the degree of sedation and the incidence of adverse effects resulting from various methods of administering the initial dose followed by continuous infusion of dexmedetomidine (DEX) for sedation in elderly patients undergoing spinal anesthesia.MethodsIn total, 72 patients aged over 65 years who were to be administered spinal anesthesia were randomly allocated into three groups. The initial doses were injected to the groups as follows: group DD, DEX 0.5 μg/kg for 10 min; group MD, midazolam 0.02 mg/kg; and group D, no initial dose. This was followed immediately by infusing a maintenance dose of DEX 0.5 μg/kg/h to all groups.ResultsThe Bispectral index (BIS) in the D group was significantly higher than in the other two groups. There were no significant differences in the Ramsay sedation scale (RSS) among the groups. The RSS 3 level was reached in 10 min from the start of sedation in MD and DD groups and in 20 min from the start of sedation in D group. Neither bradycardia nor hypotension was observed in any of the groups.ConclusionsPatients in all three groups reached the RSS 3 sedating-effect level. However, the group that received continuous infusion only without the initial dose showed higher BIS than the other two groups and reached the RSS 3 later. No adverse events were observed in any of the groups.

The efficacy of dexmedetomidine on lung injury induced by renal ischemia/reperfusion indiabetic rats

Ischemia-reperfusion injury is a complex, which causes cell damage. In this study, we aimed to investigate the protective effects of dexmedetomidine on lung in the renal IR model in diabetic rats.&#x0D; After approval of the ethics committee, diabetes was induced by streptozocin (55 mg/kg) and then 24 Wistar Albino rats were randomly divided into 4 groups. Diabetic control group (group DC), diabetic dexmedetomidine (group DD), diabetic ischemia-reperfusion (group DIR), diabetic ischemia-reperfusion - dexmedetomidine (group DIR-D).

To study the effect of iv dexmedetomidine versus iv labetalol for the suppression of sympathoadrenal response to extubation

Tracheal extubation evokes various degrees of disturbances in the autonomic nervous system in the form of tachycardia, hypertension which can cause deleterious consequences in susceptible patients.Hence this study was conducted between iv Dexmedetomidine and iv Labetalol to compare their effectiveness in the suppression of haemodynamic response to tracheal extubation.60 participants aged between 18-55 yrs belonging to ASA 1 or 2 were randomly allocated into 2 groups. Group Dd received injection Dexmedetomidine 0.6mcg/kg iv and Group Ll received injection Labetalol 0.25mg/kg body weight. Heart rate, systolic and diastolic blood pressure were recorded at baseline, 2,5,8 minutes after drug infusion, at extubation and 1,3,5,8,10 and 15 minutes post extubation.Group Dd showed a better decrease in heart rate, systolic and diastolic blood pressure at extubation, and 15 minutes post extubation compared to Group Ll.Injection Dexmedetomidine 0.6µg/kg showed a better attenuation of sympathoadrenal response to extubation compared to injection Labetalol 0.25mg/kg.

Hemodynamic Response to Acute Volume Load in Heart Transplant Recipients

A mean pulmonary wedge pressure (mPAP) ≥ 25 mm Hg following volume load or exercise has been proposed as a partition value for detection of HfpEF. However, the hemodynamic response to volume challenge in heart transplant (Tx) recipients has never been studied. 36 heart Tx recipients (Age: 65 years) with normal LV function (EF: 55 ± 7 %) and without rejection and graft vasculopathy underwent right heart catheterization to measure hemodynamic response to volume loading before and after a rapid saline infusion of 7mL/kg over 10 min. PCWP, right atrial pressure (RAP), mean pulmonary artery pressure(PA) were obtained and the PCWP and indexed(i) stroke volume(SV) data were used to construct Starling (SVindex/PCWP) curves. Pts were categorized in those with elevated filling pressures (Group DD, n=10 pts) defined by a PCWP ≥ 15 mm Hg at rest or ≥ 25 mm Hg following volume loading vs those without (Controls, n=26 pts). No difference in age of donor and transplant, baseline hemodynamics and EF was noted between both groups. Saline infusion significantly increased PCWP and mean PA in both Groups without any significant change in BP and heart rate. Interestingly saline infusion was associated with a significant rise in SV and SVi in Controls not in DD pts(Fig 1). Moreover, in DD pts the Starling curves revealed a larger SVi at any give PCWP compared to Controls pts. In the transplanted heart volume loading increases filling pressures and is able to unmask left ventricular diastolic dysfunction. Interestingly, those with DD are characterized by a blunted Frank Starling response as evidenced by higher PCWP and failure to increase SV for any given PCWP. Further prospective studies are warranted to unravel the underlying mechanisms.

Not Different Enough: Avoiding Representation as “Balkan” and the Constrained Appeal of Macedonian Ethno Music

Since the early 1990s, interest in various forms of traditional music among middle-class urban ethnic Macedonians has grown. Known by some as the “Ethno Renaissance”, this trend initially grew in the context of educational ensembles in Skopje and gained momentum due to the soundtrack of the internationally acclaimed Macedonian film Before the Rain (1994) and the formation of the group DD Synthesis by musician and pedagogue Dragan Dautovski. This article traces the development of this multifaceted musical practice, which became known as “ethno music” (etno muzika) and now typically features combinations of various traditional music styles with one another and with other musical styles. Ethno music articulates dynamic changes in Macedonian politics and wider global trends in the “world music” market, which valorizes musical hybridity as “authentic” and continues to prioritize performers perceived as exotic and different. This article discusses the rhetoric, representation, and musical styles of ethno music in the 1990s and in a second wave of “ethno bands” (etno bendovi) that began around 2005. Drawing on ethnography conducted between 2011 and 2018 and on experience as a musician performing and recording in Macedonia periodically since 2003, I argue that, while these bands and their multi-layered musical projects resonate with middle-class, cosmopolitan audiences in Macedonia and its diaspora, their avoidance of the term “Balkan” and associated stereotypes constrains their popularity to Macedonian audiences and prevents them from participating widely in world music festival networks and related markets.

Transient effect of single or repeated acute deoxynivalenol and zearalenone dietary challenge on fecal microbiota composition in female finishing pigs

Mycotoxins are a major contaminant of pig feed and have negative effects on health and performance. The present study investigated the impact of single or repeated acute challenges with a diet naturally contaminated with deoxynivalenol (DON) and zearalenone (ZEN) on growth performances of finishing pigs and their fecal microbiota composition. A total of 160 pigs (castrated males and females) in two successive batches were randomly divided into four experimental groups of 40 pigs each. The control group received a control finisher diet from 99 to 154 days of age. Challenged groups were subjected to a 7-day acute challenge by being fed a DON- and ZEN-contaminated diet (3.02 mg DON/kg feed and 0.76 mg ZEN/kg feed) at 113 days (group DC), 134 days (group CD) or both 113 and 134 days (group DD). Microbiota composition was analyzed via 16S rRNA sequencing from fecal samples collected from the 80 females at 99, 119, 140 and 154 days. Challenged pigs (i.e. groups DC, CD and DD) reduced their average daily feed intake by 25% and 27% (P < 0.001) and feed efficiency by 34% and 28% (P < 0.05) during the first and second mycotoxin exposure, respectively. Microbiota composition was affected by mycotoxin exposure (P = 0.07 during the first exposure and P = 0.01 during the second exposure). At the family level, mycotoxin exposure significantly (P < 0.05) decreased the relative abundances of Ruminococcaceae, Streptococcaceae and Veillonellaceae and increased that of Erysipelotrichaceae at both 119 and 140 days of age. After the 7-day DON/ZEN challenge, the relative abundance of 6 to 148 operational taxonomic units (OTUs) differed among the treatment groups. However, none of these OTUs changed in all treatment groups. Using 27 functional pathways, pigs exposed to DON/ZEN challenges could be distinguished from control pigs using sparse partial least squares discriminant analysis, with a 15% misclassification rate. Regarding the functionality of these predictors, two pathways were involved in detoxifying mycotoxins: drug metabolism and xenobiotic metabolism by cytochrome P450. In challenged pigs, microbiota composition returned to the initial state within 3 weeks after the end of a single or repeated DON/ZEN challenge, highlighting the resilience of the gut microbiome. The feeding and growth performances of the pigs during challenge periods were significantly correlated with biological pathways related to health problems and modifications in host metabolism. To conclude, short-term DON/ZEN challenges resulted in transient modifications in the composition and functions of fecal microbiota.

The preoperative predictors for subsequent degeneration in L5-S1 disc after long fusion arthrodesis terminating at L5 in patients with adult scoliosis: focus on spinopelvic parameters

BackgroundThe subsequent L5-S1 disc degeneration associated with long fusion arthrodesis terminating at L5 in patients with adult scoliosis has been a common concern. However, few studies paid attention to its preoperative predictors, especially in spinopelvic parameters. The purpose of the present study was to clarify the preoperative predictors of subsequent L5-S1 disc degeneration after long fusion arthrodesis terminating at L5 in patients with adult scoliosis on spinopelvic parameters.MethodsIn this retrospective study, we enrolled 67 patients with adult scoliosis, and the patients were divided into disc degeneration group (DD) and no disc degeneration group (NDD), based on the presence or absence of subsequent L5-S1 disc degeneration. The status of L5-S1 disc was evaluated by a modified version of radiographic classification. Characteristics and spinopelvic parameters of preoperative patients were collected as potential predictors for subsequent lumbosacral disc degeneration after long fusion arthrodesis terminating at L5 in patients with adult scoliosis. Multivariate logistic regression analysis and the receiver operating characteristic curve were used to identify the preoperative predictors, with an adjusted odds ratio (OR) and 95% confidence intervals (CI).ResultsThirty-six patients (53.73%) with subsequent L5-S1 disc degeneration were divided into group DD (preoperative score 0.81 ± 0.57, last follow-up score 1.83 ± 0.60, P < 0.001), and the other 31 patients were divided into group NDD (preoperative and last follow-up score 0.87 ± 0.49). There was no statistical difference in preoperative score (P = 0.583) of lumbosacral disc between two groups; however, significant statistical difference showed in last follow-up score (P < 0.001). Multivariate logistic regression identified three preoperative predictors: pelvic incidence (PI) (P = 0.018), sagittal vertical axis (SVA) (P = 0.024), and sacrum-femoral distance (SFD) (P = 0.023). PI < 48.5° (OR = 0.911, 95% CI = 0.843–0.984), SVA > 4.43 cm (OR = 1.308, 95% CI = 1.036–1.649), and SFD > 5.65 cm (OR = 1.337, 95% CI = 1.041–1.718) showed satisfied accuracy for predicting subsequent L5-S1 disc degeneration.ConclusionThe prevalence of the subsequent L5-S1 disc degeneration after long fusion arthrodesis terminating at L5 in patients with adult scoliosis was 57.3% (36 of 67 patients). PI < 48.5°, SVA > 4.43 cm, and SFD > 5.65 cm were preoperative predictors for the subsequent L5-S1 disc degeneration. More attention should be paid to prevent the L5-S1 disc from degeneration when these preoperative predictors exist, especially with two or more.

Health care utilization and overall costs based on opioid dependence in patients undergoing surgery for degenerative spondylolisthesis.

OBJECTIVE Opioid abuse is highly prevalent in patients with back pain. The aim of this study was to identify health care utilization and overall costs associated with opioid dependence in patients undergoing surgery for degenerative spondylolisthesis (DS). METHODS The authors queried the MarketScan database using ICD-9 and CPT-4 codes from 2000 to 2012. Opioid dependency was defined as having a diagnosis of opioid use disorder, having a prescription for opioid use disorder, or having 10 or more opioid prescriptions. Opioid dependency was evaluated in 12-month period leading to surgery and in the period 3-15 months following the procedure. Patients were segregated into 4 groups based on opioid dependence before and after surgery: group NDND (prior nondependent who remain nondependent), group NDD (prior nondependent who become dependent), group DND (prior dependent who become nondependent), and group DD (prior dependent who remain dependent). The outcomes of interest were discharge disposition, hospital length of stay (LOS), complications, and health care resource costs. The 4 groups were compared using the Kruskal-Wallis test and linear contrasts built from generalized regression models. RESULTS A total of 10,708 patients were identified, with 81.57%, 3.58%, 8.54%, and 6.32% of patients in groups NDND, NDD, DND, and DD, respectively. In group DD, 96.31% of patients had decompression with fusion, compared with 93.59% in group NDND. Patients in group NDD, DND, and DD had longer hospital LOS compared with those in group NDND. Patients in group DD were less likely to be discharged home compared with those in group NDND (odds ratio 0.639, 95% confidence interval 0.52-0.785). At 3-15 months postdischarge, patients in group DD incurred 21% higher hospital readmission costs compared with those in group NDND. However, patients in groups NDD and DD were likely to incur 2.8 times the overall costs compared with patients in group NDND (p < 0.001) at 3-15 months after surgery (median overall payments: group NDD $20,033 and group DD $19,654, vs group NDND $7994). CONCLUSIONS Patients who continued to be opioid dependent or became opioid dependent following surgery for DS incurred significantly higher health care utilization and costs within 3 months and in the period 3-15 months after discharge from surgery.

Effect of number of pontics and impression technique on the accuracy of four-unit monolithic zirconia fixed dental prostheses

Statement of problemBecause of their relatively small scanning area, intraoral scanners may result in less accurate fixed dental prostheses (FDPs) than do laboratory scanners. PurposeThe purpose of this in vitro study was to evaluate the accuracy of monolithic zirconia FDPs with different numbers of pontics fabricated with different impression techniques. Material and methodsThe mandibular right premolars and molars of an acrylic resin model were prepared to receive 4-unit FDPs. Three master models were fabricated with epoxy resin: model NP, no pontic; model 1P, 1 pontic; and model 2P, 2 pontics. Each master model was scanned by using direct (DD) and indirect digitalization (ID). Four-unit monolithic zirconia FDPs were fabricated and divided into 3 groups (groups NP, 1P, and 2P) and then subdivided according to the digitalization technique (group DD and ID; n=10). The FDPs were also evaluated based on the presence (Po) or absence (NPo) of an adjacent pontic. The marginal, axial, and occlusal gap widths of each FDP were measured, and statistical analyses were performed to evaluate and compare the amount of gap present (α=.05). ResultsFor direct digitalization, group 2P had significantly greater marginal (69.4 μm versus 60.9 μm or 62.3 μm; P<.001) and axial gap widths (127.1 μm versus 108.9 μm or 110.4 μm; P<.001) than group NP or 1P. Group DD resulted in significantly smaller gaps compared with group ID at marginal (64.8 μm versus 73.6 μm), axial (114.8 μm versus 124.3 μm), and occlusal (172.6 μm versus 184.1 μm) measurement locations (P<.001). Greater marginal and axial gaps were noted in group Po than NPo (P<.001). ConclusionsThe length of the edentulous area significantly influenced the extent of the marginal and internal gap with the use of direct digitalization. Direct digitalization resulted in significantly smaller gap widths in all measurement areas than indirect digitalization; however, the mean differences were less than 12 μm, which is considered clinically insignificant. The presence of an adjacent pontic had a significant effect on the adjacent marginal and axial gap widths.

Nonplanar Organic Sensitizers Featuring a Tetraphenylethene Structure and Double Electron-Withdrawing Anchoring Groups.

Two metal-free organic sensitizers containing two N,N-diethylaniline (DEA) moieties and a twisted 1,1,2,2-tetraphenylethene (TPE) structure, dye SD with one anchoring group and dye DD with two anchoring groups, were synthesized and applied in dye-sensitized solar cells (DSSCs). The introduction of a nonplanar TPE structure was used to form a series of propeller-like structures and reduce the tendency of dyes to randomly aggregate on TiO2 surface, but without importing an aggregation-induced emission (AIE) property. The thermal stabilities, UV-vis absorption spectra, electrochemical properties, and photovoltaic parameters of DSSCs with these two dyes were systematically studied and compared with each other. The overall conversion efficiencies (η) of 4.56% for dye SD and 6.08% for dye DD were obtained under AM 1.5 G irradiation.

Role of spinal MCP-1-ERK-KIF17/NR2B signaling pathway in maintenance of type 2 diabetic neuropathic pain in rats

Objective To explore the role of spinal monocyte chemoattractant protein-1 (MCP-1) -extracellular signal-regulated protein kinase (ERK) -kinesin superfamily motor protein 17 (KIF17) /N-methyl-D-aspartate receptor subunit 2B (NR2B) signaling pathway in the maintenance of type 2 diabetic neuropathic pain (DNP) in rats. Methods Type 2 diabetes mellitus was induced by a high-fat and high-sucrose diet and intraperitoneal streptozotocin (STZ) 35 mg/kg, and confirmed by fasting blood glucose level≥16.7 mmol/L 3 days later in male Sprague-Dawley rats aged 6 weeks.Type 2 DNP was confirmed when the mechanical paw withdrawal threshold (MWT) and thermal paw withdrawl latency (TWL) measured on day 14 after STZ administration decreased to < 80% of the baseline value.The rats with type 2 DNP were randomly divided into 4 groups (n=36 each) using a random number table: type 2 DNP group (group DNP) , type 2 DNP + MCP-1 neutralizing antibody group (group DM) , type 2 DNP + ERK inhibitor group (group DE) and type 2 DNP + dimethyl sulfoxide group (group DD) . In DM, DE and DD groups, 0.1 ng/μl MCP-1 neutralizing antibody 10 μl, 0.5 μg/μl U0126 10 μl and 5 % dimethyl sulfoxide 10 μl were injected intrathecally, respectively, once a day for 14 consecutive days starting from 14 days after administration of STZ.Another 36 normal rats fed a common forage diet were adopted as control group (group C) . MWT and TWL were measured before STZ injection and at 1, 3, 7 and 14 days after STZ injection (T0-4) . Nine rats were sacrificed after measurement of pain thresholds at T1-4, and the lumbar segments (L4-6) of the spinal cord were removed for determination of the expression of phosphorylated ERK (p-ERK) , KIF17 and phosphorylated NR2B (p-NR2B) by Western blot. Results Compared with group C, the MWT was significantly decreased, the TWL was shortened, and the expression of p-ERK, KIF17 and p-NR2B was up-regulated at T1-4 in DNP, DM, DE and DD groups.Compared with group DNP, the MWT at T3-4 in group DM and at T2-4 in group DE was significantly increased, the TWL at T3-4 in group DM and at T2-4 in group DE was prolonged, and the expression of p-ERK, KIF17 and p-NR2B was down-regulated at T2-4 in DM and DE groups, and no significant changes were found in the parameters mentioned above in group DD. Conclusion Spinal MCP-1-ERK-KIF17/NR2B signaling pathway is involved in the maintenance of type 2 DNP in rats. Key words: Diabetes mellitus, type 2; Neuropathic pain; Chemokine CCL2; Extracellular Signal-Regulated MAP Kinases; Receptors, N-Methyl-D-Aspartate; Kinesin; Spinal cord

Fit of 4-unit FDPs made of zirconia and CoCr-alloy after chairside and labside digitalization – A laboratory study

ObjectivesTo analyse the marginal fit of 4-unit fixed dental prostheses (FDPs) and the accuracy of three-dimensional cast-datasets using both approaches to Computer Aided Design (CAD)/Computer Aided Manufacturing (CAM): direct and indirect digitalization. MethodsA titanium model of a 4-unit FDP was digitized by an intraoral scanning device (iTero, Align Technology, Carlstadt, US; DD, n=12). Additionally 12 conventional impressions were taken and referring master casts were digitized by a laboratory scanner (CS2, Straumann, Basel, Switzerland; ID, n=12). Frameworks were fabricated (CARES CADCAM GmbH, Straumann, Markkleeberg, Germany) from base metal alloy (coron, Straumann; DD-C: n=12; ID-C: n=12) and zirconia (zerion, Straumann; DD-Z: n=12; ID-Z: n=12) from the same datasets. The marginal fit of the resulting frameworks and the accuracy of the underlying datasets from DD and ID were evaluated. Data were analyzed by unpaired two sample Student's t-test with Levene-test (p<0.05). ResultsFrameworks from group DD-C showed significantly better marginal fit than ID-C (DD-C: 56.90±27.37μm, ID-C: 90.64±90.81μm). For zirconia frameworks no differences between both digitalization methods (DD-Z: 127.23±66.87μm, ID-Z: 141.08±193.17μm) could be observed. Base metal alloy frameworks exhibited significantly better marginal fit than zirconia frameworks (DD: p<0.001; ID: p=0.022). Regarding the accuracy group DD showed significantly higher “trueness” than ID. SignificanceDirect and indirect digitalization lead to clinically acceptable marginal fit of 4-unit FDPs from base metal alloy and zirconia. Higher accuracy of datasets from DD leads to better marginal fit of frameworks from base metal alloy but not for ones from zirconia.

Effect of angiotensin converting enzyme genetic polymorphism on cardiovascular response to endotracheal intubation in patients with hypertension

Objective To investigate the effect of angiotensin converting enzyme (ACE) genetic polymorphism on the cardiovascular response to endotracheal intubation in patients with hypertension.Methods The patients with primary hypertension,ASA Ⅱ or Ⅲ,aged 54-64 yr,weighing 50-70 kg,scheduled for elective operation under general anesthesia,were enrolled in this study.Polymerase chain reaction-restriction fragment length polymorphism was used to detect the polymorphism of ACE gene.The patients were assigned into 3 groups according to their genotypes:homozygote DD group (group DD),heterozygote ID group (group ID),and homozygote Ⅱ group (group Ⅱ).Systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR) were recorded before and after induction of anesthesia,and at 0,1.5 and 5.0 min after intubation (T0-4).The rate-pressure product (RPP) was calculated.The cardiovascular events were recorded.Results In groups DD,ID and Ⅱ,40,39 and 40 cases were included in the analysis respectively.Compared with group ID,there was no significant difference in SBP,DBP,HR and RPP at T0-4 in group DD (P ＞ 0.05).Compared with groups DD and ID,SBP,DBP,HR and RPP were significantly deceased at T2,3,and SBP,HR and RPP were significantly deceased at T4 in group Ⅱ (P ＜ 0.05).The incidences of the myocardial ischemia during intubation and cardiovascular response to intubation were significantly lower in group C than in groups DD and ID (P ＜ 0.05).Conclusion ACE genetic polymorphism exerts an effect on the cardiovascular response to endotracheal intubation in patients with hypertension,and homozygote DD and heterozygote ID have the most influence. Key words: Angiotensin converting enzyme 2; Genotype; Hypertention; Intubation, intratracheal; Intraoperative complications