Temporomandibular Joint Disorders in Patients with Rheumatoid Arthritis

BackgroundTemporomandibular joint disorders (TMD) are not uncommon in patients with rheumatoid arthritis (RA). However, the extent of involvement and its clinical relevance have not been well characterized. This study evaluated the correlation between the severity of RA-related TMD and RA, as well as determined the potential predictors for early identification and management of TMD in RA patients.MethodsWe sequentially recruited 56 adult RA patients from our Arthritis Clinic. TMD and RA were surveyed, clinically by questionnaires and physical examinations, and radiologically by tomography in TMD and conventional radiography in RA. The patients were stratified into no, mild and severe TMD groups according to the physical and tomographic examinations. The correlation of the severity of TMD and RA were evaluated. The relative importance of relevant predictors of severe TMD was analyzed by a logistic regression model.ResultsPhysical and radiologic temporomandibular joint abnormalities were found to be highly prevalent (85.7% and 74.5%) in these patients, and the occurrence increased to as much as 92.9% when the 2 data sets were combined. More than half of the patients had severe TMD presenting with debilitating symptoms or with a significant degree of bony destruction. The severity of TMD was variably correlated with RA severity. The score of hand-joint space narrowing was found to be the most influential predictor of severe TMD by logistic regression analysis.ConclusionThere was a high prevalence of TMD in RA patients. The severity of TMD variably correlated with RA severity. Clinically, a high score of hand-joint space narrowing may serve as an early indicator of RA patients at risk of severe TMD. This may facilitate early management and prevent the functional impairment of the temporomandibular joint

Clinical meaning of age-related expression of fecal cytokeratin 19 in colorectal malignancy

<p>Abstract</p> <p>Background</p> <p>Colorectal cancer (CRC) is one of the leading causes of malignant death worldwide. Because young age of onset is often considered a poor prognostic factor for CRC, it is important to identify the poor outcomes of CRC in a younger population and to consider an aggressive approach by implementing early treatment. Our aim was to specifically quantify the fecal cytokeratin 19 (CK19) transcript from CRC patients and investigate its correlation with clinical stage, tumor malignancy, and age.</p> <p>Methods</p> <p>The quantitation of fecal CK19 transcript was determined by a quantitative real-time reverse transcription polymerase chain in 129 CRC patients (45 younger than 60 years at diagnosis) and 85 healthy controls. The levels of CK19 protein were examined both in colonic cell lines and tissues.</p> <p>Results</p> <p>The analysis of 45 younger CRC patients (age ≤ 60 years) revealed that patients at the M1 stage had significantly higher expression levels of fecal CK19 mRNA when compared with healthy controls (<it>p </it>< 0.001) and patients at the M0 stage (<it>p </it>= 0.004). Additionally, the degree of consistency between the mean level of fecal CK19 mRNA and the distant metastatic rate in each age interval was up to 89% (<it>p </it>= 0.042).</p> <p>Conclusion</p> <p>These results indicate that high levels of fecal CK19 mRNA represent a potential marker for colorectal malignancy and for aggressive treatment of younger CRC patients.</p

Potential of Core-Collapse Supernova Neutrino Detection at JUNO

JUNO is an underground neutrino observatory under construction in Jiangmen, China. It uses 20kton liquid scintillator as target, which enables it to detect supernova burst neutrinos of a large statistics for the next galactic core-collapse supernova (CCSN) and also pre-supernova neutrinos from the nearby CCSN progenitors. All flavors of supernova burst neutrinos can be detected by JUNO via several interaction channels, including inverse beta decay, elastic scattering on electron and proton, interactions on C12 nuclei, etc. This retains the possibility for JUNO to reconstruct the energy spectra of supernova burst neutrinos of all flavors. The real time monitoring systems based on FPGA and DAQ are under development in JUNO, which allow prompt alert and trigger-less data acquisition of CCSN events. The alert performances of both monitoring systems have been thoroughly studied using simulations. Moreover, once a CCSN is tagged, the system can give fast characterizations, such as directionality and light curve

Detection of the Diffuse Supernova Neutrino Background with JUNO

As an underground multi-purpose neutrino detector with 20 kton liquid scintillator, Jiangmen Underground Neutrino Observatory (JUNO) is competitive with and complementary to the water-Cherenkov detectors on the search for the diffuse supernova neutrino background (DSNB). Typical supernova models predict 2-4 events per year within the optimal observation window in the JUNO detector. The dominant background is from the neutral-current (NC) interaction of atmospheric neutrinos with 12C nuclei, which surpasses the DSNB by more than one order of magnitude. We evaluated the systematic uncertainty of NC background from the spread of a variety of data-driven models and further developed a method to determine NC background within 15\% with {\it{in}} {\it{situ}} measurements after ten years of running. Besides, the NC-like backgrounds can be effectively suppressed by the intrinsic pulse-shape discrimination (PSD) capabilities of liquid scintillators. In this talk, I will present in detail the improvements on NC background uncertainty evaluation, PSD discriminator development, and finally, the potential of DSNB sensitivity in JUNO

Lower Limb Wrapping Prevents Hypotension, but Not Hypothermia or Shivering, after the Introduction of Epidural Anesthesia for Cesarean Delivery

The decrease of arterial blood pressure and body temperature after epidural or spinal anesthesia is thought to be the result of sympathetic block, which could cause pooling and redistribution of blood into the lower extremities. Studies have demonstrated that leg wrapping with elastic bandages may reduce the incidence of hypotension after spinal anesthesia. We tried to extend these previous observations to epidural anesthesia by testing the hypothesis that leg wrapping with elastic bandages should decrease the incidence of hypotension in patients receiving epidural anesthesia. Moreover, we evaluated the effect of this maneuver as regards hypethermia and shivering. Sixty parturients were randomly allocated to receive either leg wrapping with tight elastic bandages (leg-wrapped group) or not (control group) before anesthesia. Sublingual temperature was observed at five periods: baseline, immediately after epidural anesthesia, abdominal skin disinfection, skin incision, and delivery. Hypotension and shivering during the observation periods were also recorded. The incidence of hypotension was significantly less frequent (P = 0.03) in the leg-wrapped group (23%) compared with the control group (50%). Shivering incidences were similar in both groups (70% versus 70%). Sublingual temperature decreased significantly (P < 0.001) throughout the procedure in each group. However, no differences were found between the two groups at each designated observation, even if compared by the magnitude of temperature decrease. We conclude that although leg wrapping with elastic bandages prevents maternal hypotension after epidural anesthesia, it does not reduce the incidence or magnitude of hypothermia or prevent shivering

Efficacy of oropharyngeal lidocaine instillation on hemodynamic responses to endotracheal intubation

背景：研究顯示，口咽置入局部麻醉劑lidocaine，可降低光纖內視鏡清醒插管時的循環反應。本研究嘗試將此一局部麻醉效果，延伸用於麻醉誘導插管時。 目的：本研究在探討全身麻醉誘導期，插管前給予口咽置入局部麻醉劑2% lidocaine 5 ml，能否改善血壓和心率對氣管插管的反應。 材料和方法： 56位接受常規預定手術之成年病患被隨機分成二組，實驗組病患在全身麻醉誘導後45秒，於口咽置入局部麻醉劑2% lidocaine 5 mL，造成口咽及氣管表皮麻醉；對照組病患在全身麻醉誘導後45秒，於口咽置入生理鹽水5 mL。三分鐘後，給予受試者氣管插管，期間每分鐘監測受試者之血壓 (收縮壓、舒張壓、平均血壓) 和心率。口咽置入局部麻醉劑後，連續監測受試者每分鐘之血壓和心率達六分鐘。將兩組氣管插管後一分鐘之血壓和心率，以及其與基礎值之變動，以非配對 t-試驗比較，以確定口咽置入局部麻醉劑lidocaine，對降低氣管插管時循環反應的效果。 結果：在氣管插管後一分鐘之血壓和心率，lidocaine 組均比對照組為低(P &lt; 0.05)。氣管插管後一分鐘之收縮壓、舒張壓、平均血壓與基礎值之變動差在對照組均較高 (P &lt; 0.001)，然而心率變動差兩組並無差異。 結論：氣管插管前口咽置入局部麻醉劑lidocaine，可以降低因插管時刺激造成之心率及血壓的上升的循環反應。此為一簡單又有效，可以局部麻醉上呼吸道的方法，能使麻醉誘導及氣管插管時的循環反應較為平穩。Purpose: This study attempts to determine whether oropharyngeal instillation of 5mL of 2% lidocaine for 3 min before intubation modifies changes in heart rate (HR) and blood pressure (BP) responses to the stimulation. Materials and methods: Fifty-six surgical patients were randomized to receive oropharyngeal instillation with either 5 mL of 2% lidocaine (lidocaine group) or 5 mL of normal saline (control group) 45 s after induction bolus. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and HR were recorded every min thereafter for 6 min. Laryngoscopy and intubation was attempted at 3 min after intervention. The 1-min postintubation values of HR, SBP, DBP, and MBP between the groups, and their changes from baseline were compared as a priori using the unpaired t-test. Results: The 1-min postintubation values of SBP, DBP, MBP, and HR were significantly lower in the lidocaine group as compared to the control group (P &lt; 0.05). The differences in mean values of SBP, DBP, and MBP changes from baseline were significantly greater in the control group (P ≤ 0.001), while that of HR was not significant. More patients (P &lt; 0.001) become hypertensive at 1-min postintubation in the control group than in the lidocaine group. No differences in tachycardia incidence were found. Conclusion: We conclude that oropharyngeal administration of lidocaine before intubation attenuates the cardiovascular responses to the stimulation. It is a simple and effective method for achieving anesthesia of the upper airway and rendering induction smoother with respect to cardiovascular changes.Contents Abstract p.5 中文摘要 p.7 Chapter 1. Introduction p.8 Chapter 2. Rationale and hypotheses p.11 1.Rationale of this study p.11 2.Hypothesis and specific objectives p.12 Chapter 3. Literature review p.13 1. Intravenous lidocaine and cardiovascular response to intubation p.14 2. Laryngotracheal lidocaine and cardiovascular response to intubation p.18 3.Summary p.23 Chapter 4. Materials and methods p.30 1.General study design p.30 2.Study population p.30 3.Randomization p.30 4.Methods p.31 5.Data recording p.32 6.Sample size calculation p.32 7.Statistical analysis p.33 Chapter 5. Results p.35 Chapter 6. Discussion p.40 1.Major findings 2.Comparison with previous studies p.40 3.Possible mechanism p.42 4.Methodological consideration p.42 5.Strengths p.45 6.Limitations p.45 7.Further perspectives p.46 8.Conclusion p.47 References p.48 Appendix Approval of the Institutional Review Board of Cathay General Hospital p.53 Tables and Figures List Table 3-1. Prospective studies on intravenous lidocaine and response to intubation p.25 Table 3-2. Prospective studies on laryngotracheal lidocaine and response to intubation p.27 Table 5-1. Characteristics of the patients and baseline variables p.36 Table 5-2. Hemodynamic variables at 1-min postintubation between the groups p.37 Table 5-3. Postintubation circulatory changes from baseline in each group p.38 Figure 4-1. Study design flow chart p.34 Figure 5-1. Heart rate and blood pressure changes from baseline p.3

Efficacy of Oropharyngeal Lidocaine Instillation on Hemodynamic Responses to Orotracheal Intubation

Study Objective: To determine whether oropharyngeal instillation of lidocaine after anesthetic induction modifies the hemodynamic response to intubation. Design: Prospective, randomized, double-blind, placebo- controlled study. Setting: Operating room of a university hospital. Patients: 56 ASA physical status I and II adult patients scheduled for elective surgery requiring orotracheal intubation and general anesthesia. Interventions: Patients were randomized to receive oropharyngeal instillation with either 5 mL 2% lidocaine (n = 28, lidocaine group) or 5 mL normal saline (n = 28, control group) 45 seconds after anesthetic induction bolus. Orotracheal intubation was attempted three minutes later. Measurements: Systolic (SBP), diastolic (DBP), mean arterial pressure ( MAP), and heart rate (HR) were recorded at baseline, just before intubation, and for three minutes postintubation at one-minute intervals. Occurrence of adverse events such as arrhythmias, ischemic changes in electrocardiography, and bronchospasm after intubation were also documented. Main Results: All postintubation values of SBP, DBP, MAP, and HR were significantly lower in the lidocaine group than the control group (P < 0.01). In both groups, postintubation HRs were significantly higher than baseline values (P < 0.05). More patients (P < 0.001) became hypertensive postintubation in the control group (14/28, 50%) than the lidocaine group (2/ 28, 7%). Conclusion: Oropharyngeal instillation of lidocaine for three minutes before intubation attenuates the cardiovascular responses to intubation

Metalenses : advances and applications

Metasurfaces, the 2D counterpart of artificial metamaterials, have attracted much attention because of their exceptional ability to manipulate the electromagnetic wave such as amplitude, phase, polarization, propagation direction, and so on. Different from conventional lenses, metalenses based on the metasurface optics are truly flat and compact and exhibit superior performance. In this report, recent progress in the development of metalenses is explored. First, the working principle and characteristics of metalenses are discussed. Then, it is described how the dispersion aberration in metalenses can be eliminated to make them suitable for being employed in a range of applications that are difficult or impossible for traditional lenses. In addition, various metalens‐based applications are introduced, including imaging, high spectral resolution spectroscopy, and multiplex color routing. Furthermore, a survey of reconfigurable and tunable metalenses is conducted. Finally, the report concludes by addressing future prospects of metalenses