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// Yabing Dong 1, 2, * , Gaoyi Wu 3, * , Ting Zhu 1, 2, * , Hongyu Chen 1, 2 , Yong Zhu 1, 2 , Guoxiong Zhu 3 , Fabin Han 4 , Huaqiang Zhao 1 1 School of Stomatology, Shandong University, Wen Hua Xi Lu, Jinan City 250012, Shandong Province, China 2 Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Wen Hua Xi Lu, Jinan City 250012, Shandong Province, China 3 Department of Stomatology, Jinan Military General Hospital, Shi Fan Lu, Jinan City 250031, Shandong Province, China 4 Center for Stem Cells and Regenerative Medicine, The Affiliated Liaocheng Hospital, Taishan Medical University, 252000, Shandong Province, China * These authors contributed equally to this work Correspondence to: Huaqiang Zhao, email: zhaohq@sdu.edu.cn Keywords: chronic sleep disturbance, angiogenesis, TMJ-OA, VEGF Received: November 22, 2016 Accepted: January 18, 2017 Published: January 28, 2017 ABSTRACT Chronic sleep disturbance (CSD) has been linked to the development of temporomandibular joint osteoarthritis (TMJ-OA). While the pathogenesis of TMJ-OA is unclear, recent studies indicate that osteochondral angiogenesis is important. We developed a rat model of CSD induced TMJ-OA to investigate the changes caused by sleep disturbance and to correlate them with vascular invasion in the TMJ. We found pathological alterations and an increased microvessel density in the rat TMJ following CSD. VEGF, Dll4 and p-ERK1/2, the expression of angiogenic factors, were highly expressed in the rat mandibular condylar cartilage and their expression increased with CSD. Furthermore, we show that VEGF-induce activation of ERK1/2, which in turn, increases Dll4 expression. Together, our results suggest that CSD can cause OA-like pathological alterations in the rat TMJ by increasing angiogenesis.

Objective To carry out a standard meta-analysis to determine if aspirin should be stopped before tooth extraction. Study Design The PubMed, ScienceDirect, EBSCOhost, and Science Citation Index databases were searched for studies published up to September 30, 2014. Eligible studies were restricted to randomized controlled trials (RCTs) and controlled, nonrandomized trials. Results Three RCTs and seven controlled trials met the inclusion criteria (covering 1752 patients: 529 on aspirin therapy and 1223 not on aspirin therapy). The results showed that the risk of postoperative hemorrhage was significantly higher in patients on aspirin therapy (relative risk [RR] = 2.46; 95% confidence interval [CI]: 1.45-4.81) but that bleeding time (BT) was not significantly different between the two groups (standardized mean difference [SMD] = 0.63; 95% CI: −0.04 to 1.31). Sensitivity analyses showed that the results were unstable. Conclusions We could reach a conclusion that BT is prolonged or hemorrhage is exacerbated by long-term use of aspirin. We recommend not stopping long-term aspirin use before tooth extraction but enhancing hemostasis methods, if necessary.