Efficacy of ibuprofen gargle for postoperative pain after mandibular third molar extraction: a phase II, placebo-controlled, double-blind, randomized crossover trial (Preprint)

BACKGROUND Extraction of mandibular third molars is one of the most commonly performed oral surgical procedures, and non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management. Oral administration of NSAIDs can produce various adverse events such as gastrointestinal disorders, renal and hepatic dysfunction, and platelet dysfunction. Topical use of analgesics has been proposed as an alternative to oral and injectable medications to safely improve postoperative pain relief. We will conduct a single-center, placebo-controlled, double-blind, randomized crossover trial to assess the pain-relieving effect of an ibuprofen-containing gargle in patients undergoing extraction of mandibular third molars in comparison with a placebo gargle. OBJECTIVE This will be the first clinical study to evaluate the efficacy of ibuprofen gargle for relieving postoperative pain after extraction of mandibular third molars. METHODS This study will be performed at Kobe University Hospital. Participants (n = 40) will be randomized equally to one of two groups. The IP group will receive ibuprofen gargle on postoperative day (POD) 1 and placebo gargle on POD 2. The PI group will receive placebo gargle on POD 1 and ibuprofen gargle on POD 2. Both groups will receive ibuprofen gargle on PODs 3 to 5 at least once daily. The primary objective is to estimate the within-subject difference in a visual analogue scale (VAS) before and 5 minutes after use of ibuprofen or placebo gargle on PODs 1 and 2. The secondary objectives are to estimate the within-subject difference in ΔVAS before and 15 minutes after use of ibuprofen or placebo gargle on PODs 1 and 2, the ΔVAS before and after 5 or 15 minutes of use of ibuprofen gargle on PODs 3 to 5, the overall effectiveness (self-completion, five scales) on PODs 1 to 5, the daily frequency of use (ibuprofen or placebo gargle and analgesics) on PODs 1 to 7, and the occurrence of adverse events. RESULTS The Kobe university Certified Review Board approved the study. The intervention was implemented in May 2021. CONCLUSIONS This trial will provide exploratory evidence of the efficacy and safety of ibuprofen gargle for pain reduction after mandibular third molar extraction. CLINICALTRIAL Japan Registry of Clinical Trials (jRCT) identifier: jRCTs051210022. Registered on 10 May 2021.

The Comparison and Exploration of the Subject Difference between Lamentations and Lament of Capital Ying

Lamentations and lament of capital Ying are models of city lament in ancient Hebrew-and Chinese classical literary traditions respectively. A comparative study shows that there are significant subject difference between lamentations and lament of capital Ying . Lamentations is the collective works, and its compilation and inheritance function as emotional expression of sufferings of the past, present and future of the Jewish people, reflecting their infinite belief of transcendent God . In contrast, lament of capital Ying is the creation of Qu Yuan, and under the influence of the sage's commitment to the mandate of heaven by his individual virtue. The poetry expresses Qu Yuan’s personal grief through a special literary technique and its succession and experience in later generations are mainly individual. The subject difference of two poetry is a reflection of different development trajectories of the humans-transcendent relationship in Hebrew- and the Chinese civilizations of the Axial Age.

Response Bias Reflects Individual Differences in Sensory Encoding

Humans exhibit substantial biases in their decision making even in simple two-choice tasks, but the origin of these biases remains unclear. I hypothesized that one source of bias could be individual differences in sensory encoding. Specifically, if one stimulus category gives rise to an internal-evidence distribution with higher variability, then responses should optimally be biased against that stimulus category. Therefore, response bias may reflect a previously unappreciated subject-to-subject difference in the variance of the internal-evidence distributions. I tested this possibility by analyzing data from three different two-choice tasks ( ns = 443, 443, and 498). For all three tasks, response bias moved in the direction of the optimal criterion determined by each subject’s idiosyncratic internal-evidence variability. These results demonstrate that seemingly random variations in response bias can be driven by individual differences in sensory encoding and are thus partly explained by normative strategies.

Efficacy of Ibuprofen Gargle for Postoperative Pain After Mandibular Third Molar Extraction: A Phase II, Placebo-Controlled, Double-Blind, Randomized Crossover Trial

BackgroundExtraction of mandibular third molars is one of the most commonly performed oral surgical procedures, and non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management. Oral administration of NSAIDs produces various adverse events such as gastrointestinal disorders, renal and hepatic dysfunction, and platelet dysfunction. Topical use of analgesics has been proposed as an alternative to oral and injectable medications to safely improve postoperative pain relief. We will conduct a single-center, placebo-controlled, double-blind, randomized crossover trial to assess the pain-relieving effect of an ibuprofen-containing gargle in patients undergoing extraction of mandibular third molars in comparison with a placebo gargle.MethodsThis study will be performed at Kobe University Hospital. Participants (n = 40) will be randomized equally to one of two groups. The IP group will receive ibuprofen gargle on postoperative day (POD) 1 and placebo gargle on POD 2. The PI group will receive placebo gargle on POD 1 and ibuprofen gargle on POD 2. Both groups will receive ibuprofen gargle on PODs 3 to 5 at least once daily. The primary objective is to estimate the within-subject difference in a visual analogue scale (VAS) before and 5 minutes after use of ibuprofen or placebo gargle on PODs 1 and 2. The secondary objectives are to estimate the within-subject difference in ΔVAS before and 15 minutes after use of ibuprofen or placebo gargle on PODs 1 and 2, the ΔVAS before and after 5 or 15 minutes of use of ibuprofen gargle on PODs 3 to 5, the overall effectiveness (self-completion, five scales) on PODs 1 to 5, the daily frequency of use (ibuprofen or placebo gargle and analgesics) on PODs 1 to 7, and the occurrence of adverse events.DiscussionThis will be the first well-designed clinical study to evaluate the efficacy of ibuprofen gargle for relieving postoperative pain after extraction of mandibular third molars. This trial will provide exploratory evidence of the efficacy and safety of ibuprofen gargle for pain reduction after mandibular third molar extraction.Trial registrationJapan Registry of Clinical Trials (jRCT) identifier: jRCTs051210022. Registered on 10 May 2021.

Response bias reflects individual differences in sensory encoding

Humans exhibit substantial biases in their decision making even in simple 2-choice tasks but the origin of these biases remains unclear. We hypothesized that one source of bias could be individual differences in sensory encoding. Specifically, if one stimulus category gives rise to an internal evidence distribution with higher variability, then responses should optimally be biased against that stimulus category. Therefore, response bias may reflect a previously unappreciated subject-to-subject difference in the shape of the internal evidence distributions. We tested this possibility by analyzing data from three different 2-choice tasks (N = 443, 443, 498). We found that, for all three tasks, response bias moved in the direction of the optimal criterion determined by each subject’s idiosyncratic internal evidence variability. These results demonstrate that seemingly random variations in response bias can be driven by individual differences in sensory encoding and are thus partly explained by normative strategies.

Tissue Factor and Tissue Factor Pathway Inhibitor in the Wound-Healing Process After Neurosurgery

Objectives: The aim of the study was to assess the concentrations of tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in the blood of patients with a postoperative wound after neurosurgery. Method: Participants included 20 adult patients who underwent neurosurgery because of degenerative spine changes. The concentration of TF and TFPI in the patients’ blood serum was measured 3 times: before surgery, during the first 24 hr after surgery, and between the 5th and 7th days after surgery. The control group comprised 20 healthy volunteers similar to the patient group with respect to gender and age. Results: A statistically significant difference was observed between TF concentration at all three measurement time points in the research group and TF concentration in the control group ( p = .018, p = .010, p = .001). A statistically significant difference was found between TFPI concentration at the second time point in the research group and TFPI concentration in the control group ( p = .041). No statistically significant within-subject difference was found between TF concentrations before and after surgery. A statistically significant within-subject difference was found between TFPI concentrations within 24 hr after surgery and 5–7 days after surgery ( p = .004). Conclusion: High perioperative concentrations of TF indicate not only the presence of thrombophilia but also the importance of TF in the wound-healing process. Perioperative changes in TFPI concentrations are related to its compensatory influence on hemostasis in thrombophilic conditions.

Inhaled smoke volume, puffing indices and carbon monoxide uptake in asymptomatic cigarette smokers

1. Nine asymptomatic smokers each smoked one cigarette of their usual brand on four separate occasions. 2. The inhaled smoke volume was measured by tracing the smoke with the inert gas 81Krm. Puffing indices were recorded by using an electronic smoking analyser and flowhead/cigarette holder. The expired air carbon monoxide concentration was measured immediately before and within 5 min of finishing smoking. 3. The inhaled smoke percentage (total inhaled smoke volume/total puff volume) averaged 46% to 85% in different subjects. 4. Neither the mean inhaled smoke volume per puff nor the total inhaled smoke volume per cigarette was significantly correlated with any of the puffing indices. 5. Smokers took significantly smaller and shorter puffs, left longer between puffs and inhaled less smoke as the cigarette was smoked (P < 0.01), although the proportion of the puff which was subsequently inhaled did not change significantly. 6. There was no significant intra-subject difference in any index from one visit to another.