PR Group Research Articles

The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial

Objective: To investigate whether inspiratory muscle training would contribute to the improvement of exercise capacity, dyspnea perception and respiratory functions in lung transplantation candidates. Design: Prospective randomized controlled trial. Setting: Pulmonary Rehabilitation center. Subjects: A total of 34 patients with severe lung disease requiring lung transplantation were randomly allocated to either pulmonary rehabilitation plus inspiratory muscle training group (PR + IMT group, n = 17) or pulmonary rehabilitation group (PR group, n = 17) before any lung transplantation operation. Methods: All patients underwent supervised pulmonary rehabilitation program on two days per week for three months. The PR + IMT group received inspiratory muscle training in addition to the standard pulmonary rehabilitation program. The 6-minute walk test, maximal inspiratory pressure, modified Medical Research Concile dyspnea scores and spirometric parameters were measured for each patient. Results: The PR + IMT group had statistically significantly increased in walking distance (100 m, P = 0.03), maximum inspiratory pressure (26 cmH2O, P = 0.001) and alveolar volume ratio of carbonmonoxide diffusion capacity (9%, P = 0.02) than PR group. Although both groups demonstrated a statistically significant decrease in the dyspnea score, no significant differences were found between the groups (P = 0.075). There was no change in spirometric variables in both groups. Conclusion: A greater increase in exercise capacity was observed in the PR + IMT group. Our study showed that inspiratory muscle training improved exercise capacity even further and increased the benefits provided by pulmonary rehabilitation.

Mechanical and Surface Properties of Monolithic Zirconia

This study compared monolithic zirconia with conventional ones based on mean roughness (Ra), Vickers hardness (VHN), topography, transmittance, grain size, flexural strength (FS), Weibull modulus, and fractographic behavior. One monolithic (Prettau Zircon [PR group]) and two conventional (ICE Zirkon Transluzent [IZ group] and BloomZir [BL group]) zirconias were used. Specimens were tested using a profilometer, a microhardness tester, a scanning electron microscope, a spectrophotometer, and a Universal Testing Machine (EMIC DL 2000). Ra, VHN, grain size, and transmittance were analyzed using the Kruskal-Wallis test associated with Dunn test (α=0.05). FS was analyzed using one-way analysis of variance with the Tukey honestly significant difference test (α=0.05). Means and standard deviations of roughness, after sintering (Ra, in μm) and VHN, were, respectively, 0.11 ± 0.01, 1452.16 ± 79.49, for the PR group; 0.12 ± 0.02, 1466.72 ± 91.76, for the IZ group; and 0.21 ± 0.08, 1516.06 ± 104.02, for the BL group. BL was statistically rougher ( p<0.01) than PR and IZ. Hardness was statistically similar ( p=0.30) for all groups. Means and standard deviations of FS (in MPa) were 846.65 ± 81.97 for the PR group, 808.88 ± 117.99 for the IZ group, and 771.81 ± 114.43 for the BL group, with no statistical difference ( p>0.05). Weibull moduli were 12.47 for the PR group, 7.24 for the IZ group, and 6.31 for the BL group, with no statistical differences. The PR and BL groups had higher transmittance values and grain sizes than the IZ group ( p<0.05). Although the BL group had some fractures that originated in the center of the tensile surface, fractographic analyses showed the same fracture pattern. All tested zirconia showed similar VHN, and the monolithic zirconia had similar roughness compared to one of the conventional zirconias. In addition, the monolithic zirconia showed similar flexural strength and Weibull modulus compared to the others even though its mean grain size was larger. The total transmittance of monolithic zirconia was higher than only one of the conventional zirconias tested.

Prognostic analysis of stage Ⅰb2 andⅡa2 cervical squamous cancer without high risk factors treated with neo-adjuvant chemotherapy and radical hysterectomy

Objective: To analyze the prognosis of Ⅰb2 and Ⅱa2 cervical squamous cancer without high risk factors treated with neo-adjuvant chemotherapy (NACT) and radical hysterectomy. Methods: This retrospective study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰ b2 and Ⅱ a2 cervical squamous cancer without high risk factors who underwent platinum-based NACT followed by radical surgery from January 2008 to January 2015. The responses of NACT were observed and compared in their effect on postoperative pathologic risk factors. Kaplan-Meier method and Cox regression analysis were performed to analyze survival status. Results: This study was recruited 282 patients with the average age of (44.4±6.7) years old. After NACT, 42 patients achieved complete response [CR, 14.9% (42/282) ], while 138 patients achieved partial response [PR, 48.9% (138/282) ] and 102 stable disease [SD, 36.2% (102/282) ]. The rate of pathologic diameter ≥4 cm, deep stromal invasion (DSI) positive and lymph-vascular space invasion (LVSI) positive rate decreased significantly in CR and PR group compared with SD group (P<0.05) . The number of postoperative risk factors in CR, PR and SD groups varied significantly (χ(2)=64.869, P=0.000) . Besides, the rate of multiple intermediate risk factors was respectively 0 vs 13.8% vs 45.1% (χ(2)=7.107, P=0.008) . The disease relapsed in 23 patients, and 12 died. On the whole series, 5-year overall survival rate was 91.7%, and 5-year recurrence-free survival rate was 88.9%. The rate of recurrence (P=0.002) and mortality (P=0.036) were higher in LVSI positive patients compared with LVSI negative. And the rate of recurrence was higher in patients with multiple intermediate risk factors, compared with no or one intermediate risk factors (P=0.002) . Univariate analysis revealed that LVSI positive and multiple intermediate risk factors were the factors predicted recurrence and mortality (P<0.05) , and no significance in age, stage, tumor grade, tumor diameter before or after NACT, response to NACT, or DSI positive factors (all P>0.05) . The multivariate analysis showed that, the factor of primary tumor diameter ≥6 cm (P=0.022) and multiple intermediate risk factors (P=0.001) were independent prognostic variables for recurrent-free survival. Besides, multiple intermediate risk factors was independent prognostic variable for overall survival (P=0.034) . After surgery, 107 patients did not receive adjuvant therapy, while 175 patients received adjuvant therapy with 26 radiotherapy, 46 chemotherapy and 103 concurrent radiochemotherapy. On survival analysis of postoperative adjuvant treatment, 5-year recurrence-free survival rate of radiotherapy group was significantly lower in patients with the factor of SD response to NACT (P=0.011) and multiple intermediate risk factors (P=0.008) , while overall no significance in overall survival rate (P>0.05) . Conclusions: NACT may be play beneficial role in relieving the status of intermediate risk factors for stage Ⅰ b2 and Ⅱ a2 cervical squamous cancer without high risk factors. The status of multiple intermediate risk factors is independent prognostic factors for recurrence and mortality. For patients with multiple intermediate risk factors, postoperative adjuvant chemotherapy or concurrent radiochemotherapy might be the better choice to prevent relapse.

Distribution and reduction magnitude of HIV-DNA burden in CD4+ T cell subsets depend on art initiation timing.

The aim of our study was to analyze the dynamics of HIV-DNA levels in CD4 T-cell subsets in individuals starting successful dolutegravir-based regimens. Twenty-seven individuals with acute infection (AI, n = 8) or chronic infection (CI, n = 5) and patients in virological success (VS, n = 10) or virological failure (VF, n = 4) on antiretroviral therapy (ART) who initiated a dolutegravir-based regimen were enrolled (NCT02557997). CD4 T-cells from baseline and week 48 of successful treatment were sorted into effector memory (TEM), transitional memory (TTM), central memory (TCM) and naïve (TN) cell groups for total HIV-DNA measurements by qPCR. Bayesian methods were used to estimate the posterior probability of a HIV-DNA decrease more than 0.25 log copies/10 cells at week 48. All patients achieved HIV-RNA suppression at 48 weeks. At baseline and week 48, the highest contributions to the HIV-DNA-infected pool from CD4 T cells were observed in TTM cells in the AI group (62.4 and 60.2%, respectively), but in TCM cells for the CI, VS and VF groups (54.6 and 59.4%, 58.2 and 62.9%, 62.4 and 67.2%), respectively. HIV-DNA burden declined in all subsets after 48 weeks of treatment in the AI (probability (Pr) > 91%), CI (Pr > 52%) and VF (Pr > 52%) groups, but only in TEM cells in the VS group (Pr = 95%). Our study showed that dolutegravir-based treatment reduced the HIV-DNA cellular burden in individuals from the AI, CI and VF groups, though the reduction levels differed between the patient subgroups. Early treated patients had the highest probability of HIV-DNA reduction. Interestingly, in the aviremic VS group, HIV-DNA reduction was limited to TEM cells.

Pulmonary rehabilitation and oropharyngeal exercises as an adjunct therapy in obstructive sleep apnea: a randomized controlled trial

ObjectiveIt is well recognized that the most effective treatment for obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). Different treatment possibilities comprise surgery, mandibular advancement, pulmonary rehabilitation, and oropharyngeal and facial exercises (PR program). However, these treatments showed inconsistent results. The purpose of the study was to compare the short-term effects of CPAP and the combination of PR program with CPAP on OSA severity, ventilatory functions, and changes in body characteristics in a newly diagnosed patient. MethodsThis study was a single-center, two-arm, parallel, randomized, controlled, open-label trial. Forty patients with OSA (20 men, 20 women, aged 54.2 ± 6.8 years) with moderate to severe obstructive sleep apnea were randomized to CPAP and CPAP + PR. The PR group underwent six weeks of 60-min twice-weekly individual PR programs. The primary outcome measure was apnea/hypopnea index, oxygen desaturation index, and Epworth Sleepiness Scale. The secondary outcome measures were a percentage of total sleep time with oxygen saturation below 90%, body mass index (BMI), vital capacity and forced expiratory volume in 1 s (% of predicted), neck, waist, and hip circumferences. ResultsFive patients with OSA did not complete the program. The comparison between baseline and final assessment was made in 15 patients in the CPAP + PR group and 20 patients in the control group with CPAP only. Although OSA severity was controlled with CPAP treatment in both groups, a significant reduction of neck, waist, and hip circumferences, BMI, and improvement of pulmonary function were confirmed only in the CPAP + PR group after treatment. ConclusionTreatment with CPAP combined with the PR program improved OSA patients to a greater extent than only CPAP.

Right ventricular energetics and power in pulmonary regurgitation vs. stenosis using four dimensional phase contrast magnetic resonance

ObjectiveWe investigated a full energetic profile of pressure and volume loaded right ventricle (RV) in porcine models by evaluating kinetic energy (KE), stroke power, power output and power loss across pulmonary valves with stenosis (PS) or with regurgitation (PR). MethodsFifteen pigs (6 PS and 6 PR, 3 unoperated controls) were studied. Phase-contrast 4D-flow MRI was performed in models of PS and PR at baseline and at 10–12 weeks, in conjunction with cardiac catheterization. Phase contrast velocities over 1 cardiac cycle were registered with a dynamic mask of the RV segmented from cine images. Mean KE and KE curve profiles were measured, normalized for RV volumes and compared between groups. Right heart catheterization pressures were used to calculate RV stroke power and power output, from which pulmonary valve power loss and RV power output ratio were calculated, and compared between groups. ResultsPS and PR groups had similar KE pre procedure but significant changes in KE post procedure. The PR group had higher RV power output ratio and KE (72.1% ± 11.4%; 20.6 ± 6.1) than PS group (25.6% ± 4.7%; 13.8 ± 5.0) post procedure. Volume loaded RV from PR had higher KE and power output ratio compared to pressure load from PS. ConclusionsIn porcine models of PS and PR, the RV presents altered systolic and diastolic energetic profiles. Pulmonary valve efficiency appeared to decrease in the medium term with somatic growth, with increased power loss in all groups studied, and greatly within the PS group.

Intra-articular viscosupplementation of hyaluronic acids in an experimental osteoarthritis model

ObjectiveTo analyze, from the immunohistochemical perspective, the effects of hyaluronic acid of different molecular weights in an experimental model of osteoarthritis in rabbits. MethodsForty-four male California rabbits were randomly assigned to three different groups (PR, S, and P) and submitted to the resection of the anterior cruciate ligament of the right knee. Three weeks after the surgical procedure, three intra-articular weekly injections were carried out with low-molecular-weight native hyaluronic acid (Hyalgan®) to PR group, high molecular weight branched chain hyaluronic acid (Synvisc®) to group S, and saline solution 0.9% to group P. All animals were sacrificed 12 weeks after the surgical procedure, and the tibial plateaus of the infiltrated knees were then dissected. Histological sections of cartilage from the tibial plateau support areas were stained with immunohistochemical markers in order to investigate the amount of metalloproteases (MMPs 3 and 13) and their inhibitors (TIMPs 1 and 3). The staining intensity was quantified on a Zeiss Imager.Z2 Metasystems microscope and analyzed by Metafer4 Msearch software. ResultsThe chondroprotective effect of the hyaluronic acids used in the study was demonstrated when compared to the control group. However, the comparison between them presented no significant statistical difference regarding chondroprotection. ConclusionThe injection of saline solution demonstrated signs of OA development, while adding native hyaluronic acid of low molecular weight (Hyalgan®) and hyaluronic acid of high molecular weight (Synvisc®) protected the articular cartilage in this model of OA.

Pyruvate in reduced osmolarity oral rehydration salt corrected lactic acidosis in sever scald rats

BackgroundA novel pyruvate-based oral rehydration salt (Pyr-ORS) was demonstrated of superiority over bicarbonate- or citrate-based one to preserve organ function and correct lactic acidosis in rehydration of lethal shock in animals. This study further compared these effects between low-osmolar Pyr-ORS and equimolar citrate-based counterpart. MethodsEighty rats, using a fatal burn shock model, were randomized into four groups (two subgroups per group: n = 10): the sham group (group SR), Pyr-ORS group (group PR), WHO-ORS III group (group CR), and no rehydration group. ORS was delivered by manual gavage during 24 h following burns. Oral administration consisted of half of counted volume in the initial 8 h plus the rest in the later 16 h. Systemic hemodynamics, visceral organ surface blood flow, organ function, and metabolic acidosis were determined at 8 h and 24 h after burn. Another set of rats with identical surgical procedures without tests was observed for survival. ResultsSurvival was markedly improved in the groups PR and CR; the former showed a higher survival rate than the latter at 24 h (40% versus 20%, P < 0.05). Systemic hemodynamics, visceral blood flow, and function of heart, liver, and kidney were greatly restored in group PR, compared with group CR (all P < 0.05). Hypoxic lactic acidosis was efficiently reversed in group PR, instead of group CR, (pH 7.36 versus 7.11, base excess 2.1 versus −9.1 mmol/L, lactate 4.28 versus 8.18 mmol/L; all P < 0.05) at 24 h after injury. ConclusionsPyruvate was advantageous over citrate in low-osmolar ORS for protection of organs and survival; pyruvate, but not citrate, in the ORS corrected hypoxic lactic acidosis in rats subjected to lethal burn shock in 24 h.

Abstract PD5-03: TransNEOS: Validation of the oncotype DX recurrence score (RS) testing core needle biopsy samples from NEOS as predictor of clinical response to neoadjuvant endocrine therapy for postmenopausal estrogen receptor positive (ER+), HER2 negative (HER2-) breast cancer patients

Abstract Background: Neoadjuvant therapy for locally advanced breast cancer has the potential to improve surgical therapeutic outcomes without sacrificing the survival advantages of adjuvant therapy. However, determining whether ER+ patients (pts) will respond to neoadjuvant (NA) chemotherapy (CT) or hormone therapy (HT) can be difficult. Not all ER+ pts respond to NACT, while response to NAHT can vary across ER+ pts. Thus, the ability to select pts more likely to benefit from NAHT would represent progress in clinical management of breast cancer. NEOS is a randomized phase III study assessinglong-term prognosis of ER+ primary breast cancer with/without adjuvant CT following NAHT (UMIN 000001090, http://www.umin.ac.jp/). We used archived core biopsy tumor samples from the NEOS study to validate the RS result as a predictor of clinical response and its association with successful breast conserving surgery (BCS) in pts treated with 6 months of NAHT. Methods: NEOS enrolled 904 postmenopausal pts with ER+, HER2-, clinically node negative (cN0) breast cancer to evaluate whether adjuvant CT was necessary for pts who responded to NAHT. In this current study, we enrolled pts with tumors ≥2cm from the NEOS study. Biopsy samples of 333 pts were assessed for the Oncotype DX assay. Response to NAHT was recorded as complete/partial response (CR/PR), or stable/progressive disease (SD/PD). Primary endpoint of this study was to evaluate clinical response (CR/PR) to NA letrozole between pts with low (&amp;lt;18) and high (≥31) RS result. Secondary endpoints include evaluating the relationships between clinical response and continuous RS results, and other covariates including age, tumor size, grade, Ki67 by IHC, ER and PR single gene scores, and ER and proliferation gene group scores by RT-PCR. Results: The analysis included 294 pts with median age of 63 yrs, median tumor size of 25mm, and 66% were nuclear grade 1. 156 (53.0%), 83 (28.6%) and 54(18.4%) cases were low, intermediate, and high RS groups by Oncotype DX, respectively. Six (2%), 126 (42.8%), 149 (50.3%), 13 (4.4%) cases experienced CR, PR, SD, PD as clinical response, respectively, similar to that of all NEOS pts. Clinical response rate was 54%, 42% and 22% in low, intermediate, and high RS groups, respectively. The proportion of pts with clinical response was significantly higher in the low RS group vs the high RS group (p&amp;lt;0.001). In univariate analyses, continuous RS was significantly associated with clinical response (p&amp;lt;0.001), along with ER (p=.02), PR (p&amp;lt;0.001), and ER gene group score (p&amp;lt;0.001). Other covariates were not associated with clinical response. Conclusion: The Oncotype DX RS test in core biopsy samples is validated as a predictive assay for clinical response of NAHT in postmenopausal, ER+/HER2-, cN0, primary early breast cancer pts. Further results on the association of RS results with BCS outcomes following NAHT will be presented. These results when combined with previously published data on RS in NACT studies help guide pts with ER+, HER2- breast cancer with NAHT vs NACT treatment options to maximize clinical response. Citation Format: Yamamoto Y, Iwata H, Masuda N, Fujisawa T, Toyama T, Kashiwaba M, Ohtani S, Taira N, Sakai T, Hasegawa Y, Nakamura R, Akabane H, Shibahara Y, Sasano H, Yamaguchi T, Sakamaki K, Chao C, McCullough D, Sugiyama N, Ohashi Y. TransNEOS: Validation of the oncotype DX recurrence score (RS) testing core needle biopsy samples from NEOS as predictor of clinical response to neoadjuvant endocrine therapy for postmenopausal estrogen receptor positive (ER+), HER2 negative (HER2-) breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD5-03.

Minimally Invasive Transforaminal Lumbar Interbody Fusion: An Attractive Option for Select Failed Backs.

Study DesignRetrospective case series.PurposeTo compare minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) outcomes in primary and revision surgeries.Overview of LiteratureRevision spinal fusion is often associated with an increased risk of approach-related complications. Patients can potentially benefit from the decreased approach-related morbidity associated with MI-TLIF.MethodsSixty consecutive MI-TLIF patients (20 failed back [Fa group], 40 primary [Pr group]) who underwent surgery between January 2011 and May 2012 were reviewed after Institutional Review Board approval to compare operative times, blood loss, complications, Oswestry Disability Index (ODI) scores, and Visual Analog Scale (VAS) scores for back and leg pain before surgery and at the last follow-up.ResultsNineteen revision surgeries were compared with 36 primary surgeries. One failed back and four primary patients were excluded because of inadequate data. The mean follow-up times were 28 months and 24 months in the Pr and Fa groups, respectively. The mean pre- and postoperative ODI scores were 53.18 and 20.23 in the Pr group and 52.01 and 25.72 in the Fa group, respectively (ODI percentage change: Pr group, 60.36%±29.73%; Fa group, 69.32%±13.72%; p=0.304, not significant). The mean pre- and postoperative VAS scores for back pain were 4.77 and 1.75 in the Pr group and 4.1 and 2.0 in the Fa group, respectively, and the percentage changes were statistically significant (VAS back pain percentage change: Pr group, 48.78±30.91; Fa group, 69.32±13.72; p=0.027). The mean pre- and postoperative VAS scores for leg pain were 6.52 and 1.27 in the Pr group and 9.5 and 1.375 in the Fa group, respectively (VAS leg pain percentage change: Pr group, 81.07±29.39; Fa group, 75.72±15.26; p=0.538, not significant). There were no statistically significant differences in operative time and estimated blood loss and no complications.ConclusionsMI-TLIF outcomes were comparable between primary and revision surgeries. The inherent technique of MI-TLIF is particularly suitable for select failed backs because it exploits the intact paramedian corridor.

Micro-CT Evaluation of Gutta-Percha Removal by Two Retreatment Systems.

Introduction:The aim of the present ex vivo research was to compare the remaining filling material and the volumes of dentine removed after retreatment of curved canals with two rotary systems naming ProTaper Universal Retreatment and Mani NRT-GPR using micro-computed tomography (micro-CT). Methods and Material: Forty mandibular molars containing two completely separated canals, with curvature angle of 25-35° and a curvature radius <10 mm were prepared to the Mtwo instrument 35/0.04 and filled with warm gutta-percha and AH-Plus sealer. The teeth were randomly divided into 2 groups (n=20), according to the retreatment system evaluated: ProTaper Universal Retreatment (PR group) or Mani NRT-GPR (MR group). Retreatment was considered complete when the working length was reached and when smooth dentinal walls were observed, with no evidence of filling material adhered to instruments or in the irrigating solution. Preoperative and postoperative micro-CT images were obtained with an isotropic voxel size of 11.88 µm to observe the volume of residual filling material in the canals and dentine removed after retreatment. Statistical analysis was performed by Student’s t-test (P<0.05). Results:The mean percentage of remaining filling material was 12.96% for PR group and 24.26% for MR group (P=0.0056). The percentage of dentin removal was greater in the PR group (5.02%) than MR group (1.36%) (P=0.0028). Both systems failed to completely remove the filling material from the canals. Conclusion: ProTaper Universal Retreatment system was more effective than Mani NRT-GPR system regarding removal of root filling material and also removed significantly more dentine after retreatment of curved mesial root canals of mandibular molars.

Remifentanil infusion versus propofol and remifentanil patient controlled sedation/analgesia for moderate sedation during interventional radiological procedures: A prospective randomized trial

Aim: The use of intravenous sedation and analgesia during interventional radiological procedures is increasing. Sedation and analgesia should minimize patients’ negative psychological reactions caused by fears and anxiety. Also they should relieve pain and provide patients a safe and comfortable environment. The aim of this study was to compare the efficacy and safety of two drugs and methods used for moderate sedation during radiological procedures. Material and Methods: Sixty patients, with American Society of Anesthesiologists scores (ASA) I-II-III, undergoing interventional radiology procedures were included in this study. The patients were administered remifentanil bolus (0.2 µg.kg-1) followed by remifentanil infusion (0.05 µg.kg-1.min-1) in Group R, 2.5mL loading dose (25 mg propofol–25 µg remifentanil) and a 1mL bolus dose (10 mg propofol–10 µg remifentanil) via patient-controlled analgesia/sedation (PCAS) device in Group PR. All the patients’ sedation levels were assessed with the Ramsey Sedation Scale (RSS), pain levels were assessed with Visual Analog Scale (VAS). Their recoveries were assessed with the modified Aldrete score (MAS) at 5 min intervals. Results: Although a significant difference was noted between the groups for RSS values at 5, 10, 20, 25, and 30th minutes during the procedure (P 0.05). Conclusion: Both propofol–remifentanil PCAS and remifentanil infusion provide sufficient moderate sedation.

Influences of Light-emitting Diode Illumination Bleaching Technique on Nanohardness of Computer-aided Design and Computer-aided Manufacturing Ceramic Restorative Materials

This study evaluated the effect of light-emitting diode (LED) illumination bleaching technique on the surface nanohardness of various computer-aided design and computer-aided manufacturing (CAD/CAM) ceramic materials. Twenty disk-shaped samples (width, length, and thickness = 10, 15, and 2 mm) were prepared from each of the ceramic materials for CAD/CAM, including Lava™ Ultimate (LV), Vita Enamic® (En) IPS e.max® CAD (Me), inCoris® TZI (IC), and Prettau® zirconia (Pr). The samples from each type of ceramic were randomly divided into two groups based on the different bleaching techniques to be used on them, using 35% hydrogen peroxide with and without LED illumination. The ceramic disk samples were bleached according to the manufacturer's instruction. Surface hardness test was performed before and after bleaching using nanohardness tester with a Berkovich diamond indenter. The respective Vickers hardness number upon no bleaching and bleaching without or with LED illumination [mean ± standard deviation (SD)] for each type of ceramic were as follows: 102.52 ± 2.09, 101.04 ± 1.18, and 98.17 ± 1.15 for LV groups; 274.96 ± 5.41, 271.29 ± 5.94, and 268.20 ± 7.02 for En groups; 640.74 ± 31.02, 631.70 ± 22.38, and 582.32 ± 33.88 for Me groups; 1,442.09 ± 35.07, 1,431.32 ± 28.80, and 1,336.51 ± 34.03 for IC groups; and 1,383.82 ± 33.87, 1,343.51 ± 38.75, and 1,295.96 ± 31.29 for Pr groups. The results indicated surface hardness reduction following the bleaching procedure of varying degrees for different ceramic materials. Analysis of variance (ANOVA) revealed a significant reduction in surface hardness due to the effect of bleaching technique, ceramic material, and the interaction between bleaching technique and ceramic material (p < 0.05). Bleaching resulted in a diminution of the surface hardness of dental ceramic for CAD/CAM. Using 35% hydrogen peroxide bleaching agent with LED illumination exhibited more reduction in surface hardness of dental ceramic than what was observed without LED illumination. Clinicians should consider protection of the existing restoration while bleaching.

Alteration of IFN-γ, IL-4, IL-17 and TGF-β levels in Serum of Patients with Chronic Lymphocytic Leukemia Treated with FCR

To investigate the alteration and clinical significance of IFN-γ, IL-4, IL-17 and TGF-β levels in serum of patients with chronic lymphocytic leukemia treated with FCR. Forty-seven CLL patients treated with FCR regimen were enrolled in CLL group, meanwhile 30 healthy persons were selected in control group. The serum levels of IFN-γ, IL-4, IL-17 and TGF-β were detected by ELISA in CLL group before and after treatment and in control group, then the differences of IFN-γ, IL-4, IL-17 and TGF-β levels as well as IFN-γ/IL-4 ratio and TGF-β/IL-17 ratio were compared between 2 groups. Before treatment with PCR regimen, the IL-4, IL-17 and TGF-β levels as well as TGF-β/IL-17 in CLL group were higher than those in control group (P<0.05), while the IFN-γ level and IFN-γ/IL-4 ratio in CLL group were lower than those in control group (P<0.05); after treatment with PCR regimen, the IL-4, IL-17 and TGF-β levels as well as TGF-β/IL-17 ratio all significantly decreased (P<0.05), while IFN-γ level and IFN-γ/IL-4 ratio significantly increased (P<0.05) as compared with those before treatment, moreover, the IL-4 and IL-17 levels as well as TGF-β/ IL-17 and IFN-γ /IL-4 ratio were no significantly different from those in control group (P>0.05), only the IFN-γ and TGF-β levels were significantly diffrent from control group (P<0.05). The analysis of Binet staging (stage A, B, C) showed that along with pregression of Binet stages, the TGF-γ/IL-17 levels as well as the IFN-γ/IL-4 ratio in CLL group negatively correlated with Binet staging (r=-0.53), while the TGF-β/IL-17 ratio positively correlated with Binet staging (r=0.46). The analysis of grouping accoraing to therapentic efficacy fonnd that the IL-4 and IL-17 levels and IFN-γ/IL-4 and TGF-β/IL-17 ratios in CR and PR groups were significantly different before and after treatment (P<0.05), while those in SD and PD groups did not showed statistical difference before and after treatment (P>0.05). Along with the progression of disease, the IFN-γ/ IL-4 ratio gradually decreases, and the TGF-β / L-17 ratio gradually increases. The treatment with FCR regimen can overcome this tread, therefore dynamically monitoring the chages of IFN-γ/ IL-4 and TGF-β / L-17 ratios may contribute to guide the clinical treatment.

Comparison of efficacy of anesthetics for removal of palatal and buccal miniscrews

ObjectiveEven though published literature exists, it is still unclear about the best pain control method while miniscrew removal is performed. The aim of this research was to investigate the efficacy of local anesthetics while removing buccal and palatal miniscrews. Materials and methodsFifty-five patients were selected in this randomized, double-blind, prospective study, of which 25 patients were recruited for palatal miniscrew removal (PR group) and 30 for buccal miniscrew removal (BR group). Each patient in the PR group received topical anesthesia on one side and an injection of local anesthetic on the other before palatal miniscrew removal. Each patient in the BR group received topical anesthesia on one side and topical placebo gel on the other before buccal mini-implant removal. Patients were asked to complete a visual analog pain scale (VAS) at different time points. A factorial repeated-measures analysis of variance was used to determine any statistically significant difference, if any. ResultsIn the PR group, there were significant differences in mean VAS scores at A2 and A3 for the topical anesthetic in comparison with needle anesthetic. In the BR group, there were significant differences in mean VAS scores at A2 and A3 for the placebo anesthetic in comparison with the topical gel anesthetic. No significant associations were found between age and sex versus VAS measurements at any time point in both the groups. ConclusionTopical anesthesia cannot be considered an adequate and comfortable alternative to the injection of local anesthesia for pain control while palatal miniscrew removal is performed; however, using a topical benzocaine gel, when removing buccal interradicular mini-implants, is effective in controlling patient discomfort.

Effects of rosuvastatin on inducible nitric oxide synthase in rats with hyperlipidaemia and periodontitis.

Nitric oxide is a free radical that is synthesized from l-arginine by nitric oxide synthase (NOS). The level of inducible NOS (iNOS) in gingiva with periodontitis is higher than that in healthy gingiva. The aim of this study was to evaluate the effects of rosuvastatin administration on alveolar bone loss (ABL) and iNOS(+) cell counts in gingival tissues in rats with ligature-induced experimental periodontitis with/without hyperlipidaemia. The rats were randomly divided into seven groups: Hy (cholesterol-added diet/water administration); HyP (cholesterol-added diet/periodontitis/water administration); HyPR (cholesterol-added diet/periodontitis/rosuvastatin administration); P (standard diet/periodontitis/water administration); PR (standard diet/periodontitis/rosuvastatin administration); C (standard diet/water administration); and R (standard diet/rosuvastatin administration). Experimental periodontitis was induced with silk ligatures, and rosuvastatin/water was administered to rats by oral gavage for the last 2weeks of the 8-week study. After the rats were killed in week 8, histomorphometric and histological analyses were performed. Immunostained iNOS(+) cells were counted in the gingival samples and the Mann-Whitney U-test was used for statistical analysis. The experimental groups exhibited increases in total cholesterol and low-density lipoprotein, except for Groups C and R. The cholesterol-added diet induced ABL in Group Hy. Of the periodontitis groups, the lowest ABL was found in Group PR. While there was a significant difference in ABL between Groups P (0.82±0.15mm) and PR (0.70±0.21mm) receiving a standard diet (P<.05), no difference was observed between Groups HyP (0.77±0.07mm) and HyPR (0.76±0.11mm) receiving a cholesterol-added diet (P˃.05). Rosuvastatin significantly reduced expression of iNOS in Groups PR (18.40±2.31%) and HyPR (24.00±4.83%) compared with Group P (30.90±2.42%; P<.001). However, a larger number of iNOS(+) cells was found in Group HyPR than in Group PR (P<.001). Administration of rosuvastatin reduced gingival iNOS expression in ligature-induced periodontitis with/without hyperlipidaemia. It also led to significant differences in ABL in rats with periodontitis, except when periodontitis was associated with hyperlipidaemia. These findings could provide an important contribution in further studies to evaluate the role of rosuvastatin as a host modulatory agent in the pathogenesis of periodontal diseases.

Maternal ophthalmic artery Doppler ultrasonography in preeclampsia and pregnancy outcomes.

To examine the association of ophthalmic artery (OA) Doppler measure - the ratio of velocity peaks (PR) - to adverse pregnancy outcomes in preeclampsia. Prospective cohort study of 56 women with preeclampsia that underwent Doppler measurements of OA flow, medial to optic nerve. PR results were classified as normal (PR < 0.78), abnormal (PR 0.78-0.98), or highly abnormal (PR ≥ 0.99). Attending clinicians were blinded to OA Doppler results. The primary endpoints were (1) a composite of adverse maternal outcomes-central nervous system injury (eclampsia or posterior reversible encephalopathy syndrome), HELLP syndrome, hypertensive crisis, maternal admission to the intensive care unit, and maternal death-and (2) a composite of adverse perinatal outcomes-birth weight <10th percentile for gestational age, neonatal acidemia, 5-min Apgar score <7, admission of infants weighing >2500 g to the neonatal intensive care, preterm birth <32 weeks, fetal or neonatal death. Adverse maternal outcomes became more frequent as the PR values increased (p=.005). The occurrence of hypertensive crisis after hospital admission (secondary endpoint) was also positively associated with PR values (p=.001). Adverse perinatal outcomes were not associated with PR values (p=.551), but women in the highly abnormal PR group (PR ≥ 0.99) had the earliest deliveries (p=.001) and the smallest newborns (p=.004). All women in the highly abnormal PR group (n=16) had an adverse outcome. Maternal OA Doppler PR ≥ 0.99 in preeclampsia may identify women at increased risk of adverse maternal outcomes and pregnancies at the greatest risk of preterm birth.

Clinical study of cancer-related fatigue in patients with advanced gastric cancer

Objective To study the relationship between cancer-related fatigue (CRF) and clinicopathological features and quality of life in patients with advanced gastric cancer. Methods The clinical and pathological data of 182 patients with advanced gastric cancer were collected, The CRF level and quality of life were assessed by the brief fatigue inventory (BFI), European Organization for Research on Treatment of Cancer (EORTC) life quality scale QLQ-C30(V3.0). The correlations between CRF and clinicopathological features and quality of life were analyzed. Results One hundred twenty-two patients with advanced gastric cancer were associated with different degrees of fatigue. The CEF BFI score had correlation with the age (F= 6.637, P= 0.001), PS score (F= 15.559, P= 0.000), the World Health Organization (WHO)pathologic type (F= 7.352, P= 0.000). The CRF index of the 50-59 age group was higher than that of other age groups; the CRF BFI scores of PS score 1 and 2 were higher than that of 0 group; CRF BFI score of gastric signet ring cell carcinoma was significantly higher than that of gastric squamous cell carcinoma. The Pearson correlation analysis showed that the CRF BFI score was positively correlated with mood (r= 0.423, P= 0.008). There were significant differences in body function and mood (F=-16.254, F=-13.256, both P <0.05) and fatigue, pain and loss of appetite among 3 CRF groups (F= 12.075, F= 14.361, F= 13.837, all P <0.05). There was a significant difference in the mean CRF BFI score between the three groups before and after chemotherapy (t SD= 6.981, t PR= 6.903, t PD= 7.437, all P < 0.05). Compared with pre-chemotherapy, the mean CRF BFI score of SD and PR group decreased after 3 months follow-up, score of PD group increased, the differences were statistically significant (t= 2.371, t= 6.912, t= 18.237, all P < 0.05). Conclusions The incidence of CRF in patients with advanced gastric cancer is very high, the degree of CRF has correlation with age, PS score and pathological type. Relieve symptoms such as fatigue, pain and loss of appetite and control adverse reactions could help to reduce the degree of CRF. Key words: Stomach neoplasms; Cancer-related fatigue; Quality of life

Intravoxel incoherent motion diffusion-weighted imaging for discriminating the pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer

To investigate the usefulness of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in discriminating the pathological complete response (pCR) to neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC), 42 patients underwent preoperative IVIM-DWI before (pre-nCRT) and after nCRT (post-nCRT). The values of pre-nCRT and post-nCRT IVIM-DWI parameters (ADC, D, D* and f), together with the percentage changes (∆% parametric value) induced by nCRT, were compared between the pCR (tumour regression grade [TRG] 4) and non-pCR (TRG 0, 1, 2 or 3) groups and between the GR (TRG 3 or 4) and PR (TRG 0, 1 or 2) groups based on the Dworak TRG system. After nCRT, the ADC and D values for LARC increased significantly (all P < 0.05). The TRG score revealed a positive correlation with pref (r = 0.357, P = 0.020), postD (r = 0.551, P < 0.001) and Δ%D (r = 0.605, P < 0.001). The pCR group (n = 10) had higher preD*, pref, postD, ∆%ADC and ∆%D values than the non-pCR group (n = 32) (all P < 0.05). The GR group (n = 15) exhibited higher postD, ∆%ADC and ∆%D values than the PR group (n = 27) (all P < 0.05). Based on ROC analysis, ∆%D had a higher area under the curve value than ∆%ADC (P = 0.009) in discriminating the pCR from non-pCR groups. In conclusion, IVIM-DWI may be helpful in identifying the pCR to nCRT for LARC and is more accurate than traditional DWI.

Randomized comparison of sevoflurane versus propofol-remifentanil on the cardioprotective effects in elderly patients with coronary heart disease

BackgroundIt is skeptical about cardioprotective property of sevoflurane in patients undergoing noncardiac surgery, especially in the elderly patients with coronary heart disease. We hypothesized that long duration of sevoflurane inhalation in noncardiac surgery could ameliorate myocardial damage in such patients.MethodsThis was a randomized, prospective study. One hundred twenty-one elderly patients with coronary heart disease were randomly allocated into two groups. Maintenance of anesthesia was achieved by sevoflurane inhalation (Group S) or propofol-remifentanil respectively (Group PR). Serum cardiac troponin I (cTnI) and brain natriuretic peptide (BNP) were measured before anesthesia induction (T0), 8 h (T1) and 24 h (T2) after anesthesia respectively. The perioperative cardiac output, complications and postoperative 3-month follow-up from end of surgery were recorded.ResultsBetween the two groups, there were no statistical differences in the values of cTnI and BNP during the study. However, The area under the curve of cTnI values over 24 h after operation was less in Group S. Group PR had lower cardiac output and consumed more amount of phenylephrine during the study (P < 0.05).ConclusionsCompared with the group PR, sevoflurane had no benefit in the myocardial protection for the elderly patients with CHD. However, Sevoflurane showed advantage in maintaining hemodynamic stability during the operative period.Trial registrationChinese Clinical Trial Registry, ChiCTR-IPR-16008871, 21 July 2016.