Comparative evaluation of cervical pulpotomy and pulpectomy for primary molars with irreversible pulpitis: a multicentre randomised controlled trial.

PURPOSE: The objective of this multicentre randomised controlled trial was to compare the clinical/radiographic outcomes of cervical pulpotomy using calcium-enriched mixture cement (PCEM) and pulpectomy using Metapex (PM) in primary molars with irreversible pulpitis (IP). METHODS: A total of 134 primary molars from 94 children were randomly assigned to two intervention groups: the PCEM group (n = 74) and the PM group (n = 60). Baseline characteristics including age/gender/molar type/tooth type/jaw were recorded. The primary outcome measures were clinical/radiographic success rates assessed at the first and second follow-up appointments. Secondary outcomes included reasons for clinical/radiographic failures. Multiple logistic regression analysis was performed to determine the impact of various factors on the success rates. RESULTS: The mean age of the participants in both groups was similar (PCEM group: 5.4 years, PM group: 5.5 years). Gender distribution, molar type, tooth type, jaw, and number of practitioners were comparable between the groups. The clinical success rate at the first follow-up was 98.6% in the PCEM group and 96.4% in the PM group. At the second follow-up, the clinical success rate was 97.1% in the PCEM group and 91.1% in the PM group. The radiographic success rates at the first and second follow-up were 98.6% and 96.4% in the PCEM group and 96.4% and 91.1% in the PM group, respectively. Multiple logistic regression analysis did not reveal any significant association between the success rates and age/gender/molar type/jaw, or treatment groups (P > 0.05). CONCLUSION: In primary molars with IP, both simple/conservative cervical pulpotomy using calcium-enriched mixture cement and pulpectomy using Metapex demonstrated high clinical/radiographic success rates. No significant differences were observed between the two treatment modalities. These findings suggest that both techniques can be considered effective treatment options for managing primary molars with IP. TRIAL REGISTRATION NUMBER: Trial registration number: IRCT20201226049838N1, retrospectively registered on 12 January 2021.

Teaching Minimally Invasive Interventions in Paediatric Dentistry: A Cross-Sectional Survey of Dental Schools in Iran.

BACKGROUND: Dental caries is a significant public health problem in Iran. Teaching  minimally invasive interventions in paediatric dentistry may facilitate the provision of treatment for untreated dental caries in children. We evaluated the teaching of such interventions in both undergraduate dental curriculum and Paediatric Dentistry Specialty Training Programme (PDSTP) in Iran. METHODS: This was a cross-sectional questionnaire-based survey. Participants in this study were the directors of 40 undergraduate programmes and 15 PDSTPs in all Iranian dental schools (response rate = 100%). Descriptive statistics were reported. RESULTS: The most commonly taught methods were preventive fissure sealant and preventive resin restoration (PRR), which were taught 'both didactically and clinically' in all undergraduate dental programmes. The least commonly taught methods were silver diamine fluoride (SDF), the Hall technique and resin infiltration, which were taught 'both didactically and clinically' in less than 5% of dental schools. The same three methods were the least commonly approaches taught in PDSTP, further, they were less often perceived to be 'essential'. CONCLUSIONS: There was a notable variation in the teaching of the management of dental caries in Iran's dental education. Some minimally invasive approaches including SDF, the Hall technique and resin infiltration are not being commonly taught in Iranian dental schools despite the evidence base for these techniques.

When Should a Brain MRI Be Performed in Children with New-Onset Seizures? Results of a Large Prospective Trial.

BACKGROUND AND PURPOSE: There is a paucity of data regarding the incidence of structural brain lesions in children with new-onset unprovoked seizures. Our aim was to determine the frequencies and types of epileptogenic lesions detected on a dedicated epilepsy protocol MR imaging according to age group, the presence of developmental delay, and the number and types of seizures. MATERIALS AND METHODS: Consecutive children between 6 months and 18 years of age with new-onset unprovoked seizures were included. The frequencies and types of epileptogenic lesions were determined and then stratified according to sex, age groups, the presence of developmental delay, and the number and types of seizures at presentation. Multivariate analysis was used to identify variables significantly associated with the presence of epileptogenic lesions. RESULTS: One thousand children were included. An epileptogenic lesion was identified in 26%, with malformations of cortical development being the most common lesion (32%), followed by hypoxic-ischemic injury (20%) and vascular etiologies (16%). Univariate analysis showed a significant increase in the frequency of epileptogenic lesions with decreasing age, the presence of developmental delay, and the number and types of seizures at presentation. The presence of developmental delay and seizure type at presentation remained significant in a multivariate analysis. CONCLUSIONS: We documented a relatively high rate of epileptogenic lesions in children with new-onset seizures, with the presence of developmental delay and specific seizure types being associated with a higher likelihood of detecting an epileptogenic lesion on neuroimaging. This study fulfills the requirements of the study design recommended by the Practice Committee of the American Academy of Neurology, and we hope that our results will assist the relevant societies and committees in formulating neuroimaging guidelines for children with new-onset seizures.

Eficacia y seguridad de tres esquemas para la preparación del colon para colonoscopia (polietilenglicol (PEG) 4 litros (4 L) (dosis única) vs. PEG 4 L dividido (2 L + 2 L) vs. PEG 2 L dividido de volumen bajo (1 L + 1 L): ensayo clínico controlado aleatorizado / A randomized controlled clinical trial of the efficacy and safety of colonoscopy preparation using a single four liter dose of polyethylene glycol (PEG) vs. two 2 liter doses of PEG vs. two low volume (1L + 1L) doses of PEG

Resumen Introducción: la colonoscopia es el examen estándar de oro para evaluar la mucosa del colon. De la limpieza del colon en la preparación intestinal para colonoscopia depende el hallazgo de pólipos, que pueden ser adenomatosos con potencial maligno y con la posibilidad de degenerarse en cáncer de colon. Objetivo: comparar la eficacia y la seguridad de tres tipos de preparaciones para la limpieza del colon: dosis única de polietilenglicol (PEG) 4 litros (4 L) y dosis divididas: PEG 4 L dividido (2 L + 2 L) y PEG 2 L dividido (1 L + 1 L) de volumen bajo. Métodos: en pacientes con una colonoscopia electiva de una clínica universitaria, se realizó un ensayo clínico controlado aleatorizado y ciego (para el médico que evaluó la limpieza del colon). Se asignaron 74 pacientes para cada grupo. El parámetro principal de eficacia fue la preparación integral de calidad adecuada medida con la escala de Boston, y los parámetros secundarios fueron el porcentaje de eventos adversos, la tolerabilidad y la tasa de detección de pólipos. Resultados: la preparación completa de todo el colon fue significativamente de mayor la calidad en la alternativa de 4 L divididos (2 L + 2 L), seguida de la otra alternativa dividida (1 L + 1 L) y menor en la dosis única (79,7 %, 75,7 % y 63,5 %, respectivamente, p = 0,019); también se encontraron diferencias en la detección de pólipos (13,5 %, 24,3 % y 9,5 %, p = 0,037) y sin diferencias en la presentación de al menos un evento adverso (p = 0,254) ni en la tolerabilidad (p = 0,640). Conclusiones: las dos preparaciones de dosis dividida tienen una mayor eficacia en la limpieza del colon en comparación con la dosis única de 4 L y en la detección de pólipos, mientras que no se evidencian diferencias en las preparaciones para la ocurrencia de eventos adversos y la tolerabilidad. La dosis de PEG 2 L dividido puede ser una muy buena opción para las preparaciones de colonoscopia electiva.

Abstract Introduction: Colonoscopy is the gold standard for evaluation of the colonic mucosa. Colon cleansing in preparation for colonoscopy depends on finding of polyps which can be adenomatous with malignant potential and the possibility of degenerating into colon cancer. Objective: This study's objective was to compare the efficacy and safety of three types of preparations for colon cleansing: a single four liter dose of polyethylene glycol (PEG) vs. two 2 liter doses of PEG vs. two low volume (1L + 1L) doses of PEG. Methods: This is a randomized controlled clinical trial of patients who underwent elective colonoscopy at a University clinic. It was blinded for the doctor who evaluated colon cleansing. Seventy four patients 74 patients were randomized into each group. The main parameter of effectiveness was integral preparation of adequate quality measured on the Boston scale. Secondary parameters were the percentage of adverse events, tolerability and detection rate of polyps. Results: Complete preparation of the entire colon was achieved significantly more often with 4 liters divided into two 2 liter doses followed by the other divided alternative (1 L + 1 L). It was achieved least frequently with in the single dose: 79.7%, 75.7% and 63.5%, respectively, p = 0.019. Differences were also found in the detection of polyps (13.5%, 24.3% and 9.5%, respectively, p = 0.037). ) There were no differences in presentation of at least one adverse event (p = 0.254) or in tolerability (p = 0.640). Conclusions: The two divided dose preparations had higher colon cleansing and polyp detection efficacies than did the single 4L dose while there were no differences in occurrence of adverse events and tolerability. The divided PEG 2L dose could be a very good option for elective colonoscopy preparation.

Differential molecular response of maize and Johnson grass against maize dwarf mosaic virus and bermuda grass southern mosaic virus.

Maize dwarf mosaic virus (MDMV) and bermuda grass southern mosaic virus (BgSMV) is the most important cereal potyvirus in Iran. Expression of some key genes in maize plants susceptible and tolerant to MDMV or BgSMV and gene expression profile of MDMV and BgSMV compatible or incompatible to Johnson grass plants were studied. Time points of 1, 9, 24 and 72 h after inoculation with both viruses were investigated as well. By analyzing the expression of the genes, it was identified that in maize infected by MDMV and BgSMV, the transcript levels of the peroxiredoxin, GLP, SAM, NPR1 and chlorophyll a-b binding genes were significantly higher in the tolerant than in susceptible plants during the entire experiment. In the BgSMV inoculated Johnson grass plants, some of the genes related to plant defense responses including NPR1, peroxiredoxin and SAM had higher expression level than the Johnson grass plants inoculated by MDMV. Important genes in maize tolerance like NPR1 and MT-LP, were analyzed by trilinear decomposition analysis and genes clustering. The upregulated expression of genes at one-hour post inoculation showed that the plant response to viruses was activated at the early stage of infection. Keywords: MDMV; BgSMV; gene expression; quantitative real-time PCR; trilinear decomposition analysis.

Clinical and radiographic outcomes of laser pulpotomy in vital primary teeth: a systematic review and meta-analysis.

AIM: This was to compare clinical and radiographic success rates of laser pulpotomy with those of other pulpotomy techniques in primary teeth. METHODS: PubMed, SCOPUS, EMBASE, Cochrane and ISI Web of Knowledge databases were searched electronically without time or language limitations. Clinical trials in which laser pulpotomy was compared with at least one other pulpotomy modality in primary teeth were selected. The bibliographic reference lists of eligible articles were also hand-searched. Odds ratios, risk differences and 95% confidence intervals were calculated with the aid of Comprehensive Meta-Analysis software (Version 2.2.050, Biostat, Englewood, NJ, USA). The methodological quality of articles included in the meta-analysis was determined using the Jadad scale. RESULTS: Twelve pulpotomy studies were selected for systematic review and underwent data extraction. Of these studies, statistical analysis was conducted on 11. All clinical trials had low to moderate risks of methodological bias. The meta-analysis showed no significant differences in clinical and radiographic pulpotomy outcomes with laser compared with other techniques (p > 0.05). Likewise, no differences were found in the outcomes at 1, 3, 6, 9, 12 or ≥ 18 months (all p > 0.05). CONCLUSIONS: For primary molar pulpotomy, the laser technique showed comparable clinical and radiographic results to other conventional pulpotomy medicaments, including formocresol and mineral trioxide aggregate.

Enfermedad inflamatoria intestinal: características de fenotipo y tratamiento en un hospital universitario de Bogotá, Colombia / Phenotypic characteristics and treatment of inflammatory bowel disease at a university hospital in Bogotá, Colombia

Resumen Introducción: la enfermedad inflamatoria intestinal (EII) (colitis ulcerativa [CU], enfermedad de Crohn [EC]) es una patología inflamatoria crónica y recurrente del tracto digestivo, de causa aún incierta. La incidencia y prevalencia de esta enfermedad están en aumento a nivel mundial, especialmente en los países en vías de desarrollo. Objetivo: describir las características del fenotipo y el tipo de tratamiento administrado a 165 pacientes con diagnóstico de EII que consultaron durante el período comprendido entre el 5 de julio del 2013 y el 31 de diciembre del 2016 en un hospital universitario de la ciudad de Bogotá, Colombia. Materiales y métodos: se realizó un estudio descriptivo basado en frecuencias y proporciones de los pacientes con diagnóstico de EII atendidos en la Clínica Universitaria Colombia (Bogotá) entre el 5 de julio del 2013 y el 31 de diciembre del 2016. Resultados: el 75,8% de los casos correspondió a CU y el 24,2% a EC, con un leve predominio del sexo femenino en ambas (56% y 55%, respectivamente); la forma de presentación más frecuente de la CU fue la pancolitis en el 46,4%. Los pacientes con EC tuvieron un compromiso más frecuentemente ileocolónico (52,5%) e inflamatorio no estenosante ni fistulizante (60%), un mayor porcentaje de manifestaciones extraintestinales (35%), de uso de medicamentos biológicos (35%) y requirieron un mayor número de cirugías (27,5%) en comparación con los pacientes con CU.

Abstract Inflammatory bowel disease (IBD) includes ulcerative colitis and Crohn's disease which are chronic and recurrent inflammatory pathologies of the digestive tract whose causes are still uncertain. IBD's incidence and prevalence are increasing worldwide, especially in developing countries. Objectives: The objective of this study was to describe phenotypic characteristics and types of treatment of 165 patients diagnosed with IBD treated between July 5, 2013 and December 31, 2016 at a university hospital in Bogotá, Colombia. Methods: This is a descriptive study based on frequencies and proportions of patients diagnosed with IBD at the University Clinic Colombia in Bogotá between July 5, 2013 and December 31, 2016. Results: UC accounted for 75.8% of the cases while CD accounted for 24.2% of these cases. Women accounted for a slightly larger proportion of patients than did men: 56% of UC cases and 55% of CD cases. UC's most frequent form of presentation was pancolitis which was found 46.4% of the patients. Frequent forms of CD presentation were ileocolonic (52.5%) and inflammatory non-stenosing or fistulizing (60%). CD patients had a greater percentage of extraintestinal manifestations (35%), greater use of biological medications (35%) and required a greater number of surgeries (27.5%) than did UC patients.

Simultaneous feedback control of plasma rotation and stored energy on NSTX-U using neoclassical toroidal viscosity and neutral beam injection.

A model-based feedback system is presented enabling the simultaneous control of the stored energy through ßn and the toroidal rotation profile of the plasma in National Spherical Torus eXperiment Upgrade device. Actuation is obtained using the momentum from six injected neutral beams and the neoclassical toroidal viscosity generated by applying three-dimensional magnetic fields. Based on a model of the momentum diffusion and torque balance, a feedback controller is designed and tested in closed-loop simulations using TRANSP, a time dependent transport analysis code, in predictive mode. Promising results for the ongoing experimental implementation of controllers are obtained.

Hepatotoxicidad por isoniazida en un paciente con enfermedad de Crohn: Reporte de caso y revisión de la literatura / Hepatotoxicity due to Isoniazide in a Patient with Crohn’s Disease: Case Report and Literature Review

La isoniazida se utiliza para el tratamiento o profilaxis de la tuberculosis; sin embargo, su uso puede asociarse con reacciones hepáticas adversas. La hepatitis clínicamente manifiesta sucede en 0,5%-1% de los pacientes que reciben isoniazida como monoterapia. En este artículo se describe el caso de un paciente con enfermedad de Crohn que cursó con hepatotoxicidad grave por isoniazida, y se hace una revisión de la literatura al respecto

Isoniazid is used for treatment or prophylaxis of tuberculosis but may be associated with adverse hepatic reactions. Clinically manifest hepatitis occurs in 0.5%-1% of patients who receive isoniazid as monotherapy. This article describes the case of a patient with Crohn’s disease who experienced severe hepatotoxicity due to isoniazid. It also reviews the literature.

Boundary displacement measurements using multi-energy soft x-rays.

The Multi-Energy Soft X-ray (ME-SXR) system on NSTX provides radial profiles of soft X-ray emission, measured through a set of filters with varying thickness, which have been used to reconstruct the electron temperature on fast time scales (∼10 kHz). In addition to this functionality, here we show that the ME-SXR system can be used to measure the boundary displacement of the NSTX plasma with a few mm spatial resolution during magnetohydrodyamic (MHD) activity. Boundary displacement measurements can serve to inform theoretical predictions of neoclassical toroidal viscosity, and will be used to investigate other edge phenomena on NSTX-U. For example, boundary measurements using filtered SXR measurements can provide information on pedestal steepness and dynamic evolution leading up to and during edge localized modes (ELMs). Future applications include an assessment of a simplified, filtered SXR edge detection system as well as its suitability for real-time non-magnetic boundary feedback for ELMs, MHD, and equilibrium position control.

Toroidal mode number estimation of the edge-localized modes using the KSTAR 3-D electron cyclotron emission imaging system.

A new and more accurate technique is presented for determining the toroidal mode number n of edge-localized modes (ELMs) using two independent electron cyclotron emission imaging (ECEI) systems in the Korea Superconducting Tokamak Advanced Research (KSTAR) device. The technique involves the measurement of the poloidal spacing between adjacent ELM filaments, and of the pitch angle α* of filaments at the plasma outboard midplane. Equilibrium reconstruction verifies that α* is nearly constant and thus well-defined at the midplane edge. Estimates of n obtained using two ECEI systems agree well with n measured by the conventional technique employing an array of Mirnov coils.

Report on a patient with a 12q24.31 microdeletion inherited from an insulin-dependent diabetes mellitus father.

We report a 2.3-year-old female patient with global developmental delay, infantile spasms, hypotonia, microcephaly, flat face, full cheeks, macroglossia, highly arched palate, retro-gnathia, narrow ear orifices, and café-au-lait spots. Molecular karyotyping revealed approximately a 1-Mb interstitial deletion of the long arm of one chromosome 12, del(12)(q24.31). The same deletion was identified in her father who presents insulin-dependent diabetes mellitus (IDDM) diagnosed at 14 years. Only one other patient with a similar de novo deletion has been reported previously [Mol Syndromol 2010;1:42-45]. A phenotype-genotype correlation is discussed, and the description of a novel rare microdeletion entity is raised.

High-harmonic fast-wave power flow along magnetic field lines in the scrape-off layer of NSTX.

A significant fraction of high-harmonic fast-wave (HHFW) power applied to NSTX can be lost to the scrape-off layer (SOL) and deposited in bright and hot spirals on the divertor rather than in the core plasma. We show that the HHFW power flows to these spirals along magnetic field lines passing through the SOL in front of the antenna, implying that the HHFW power couples across the entire width of the SOL rather than mostly at the antenna face. This result will help guide future efforts to understand and minimize these edge losses in order to maximize fast-wave heating and current drive.

Continuous improvement of H-mode discharge performance with progressively increasing lithium coatings in the National Spherical Torus Experiment.

Lithium wall coatings have been shown to reduce recycling, improve energy confinement, and suppress edge localized modes in the National Spherical Torus Experiment. Here, we show that these effects depend continuously on the amount of predischarge lithium evaporation. We observed a nearly monotonic reduction in recycling, decrease in electron transport, and modification of the edge profiles and stability with increasing lithium. These correlations challenge basic expectations, given that even the smallest coatings exceeded that needed for a nominal thickness of the order of the implantation range.

Evidence for the importance of trapped particle resonances for resistive wall mode stability in high beta tokamak plasmas.

Active measurements of the plasma stability in tokamak plasmas reveal the importance of kinetic resonances for resistive wall mode stability. The rotation dependence of the magnetic plasma response to externally applied quasistatic n=1 magnetic fields clearly shows the signatures of an interaction between the resistive wall mode and the precession and bounce motions of trapped thermal ions, as predicted by a perturbative model of plasma stability including kinetic effects. The identification of the stabilization mechanism is an essential step towards quantitative predictions for the prospects of "passive" resistive wall mode stabilization, i.e., without the use of an "active" feedback system, in fusion-alpha heated plasmas.

Effect of collisionality on kinetic stability of the resistive wall mode.

The impact of collisionless, energy-independent, and energy-dependent collisionality models on the kinetic stability of the resistive wall mode is examined for high pressure plasmas in the National Spherical Torus Experiment. Future devices will have decreased collisionality, which previous stability models predict to be universally destabilizing. In contrast, in kinetic theory reduced ion-ion collisions are shown to lead to a significant stability increase when the plasma rotation frequency is in a stabilizing resonance with the ion precession drift frequency. When the plasma is in a reduced stability state with rotation in between resonances, collisionality will have little effect on stability.

Simulation of a tangential soft x-ray imaging system.

Tangentially viewing soft x-ray (SXR) cameras are capable of detecting nonaxisymmetric plasma structures in magnetically confined plasmas. They are particularly useful for studying stationary perturbations or phenomenon that occur on a timescale faster than the plasma rotation period. Tangential SXR camera diagnostics are planned for the DIII-D and NSTX tokamaks to elucidate the static edge magnetic structure during the application of 3D perturbations. To support the design of the proposed diagnostics, a synthetic diagnostic model was developed using the CHIANTI database to estimate the SXR emission. The model is shown to be in good agreement with the measurements from an existing tangential SXR camera diagnostic on NSTX.

Resistive wall mode instability at intermediate plasma rotation.

Experimental observation of resistive wall mode (RWM) instability in the National Spherical Torus Experiment (NSTX) at plasma rotation levels intermediate to the ion precession drift and ion bounce frequencies suggests that low critical rotation threshold models are insufficient. Kinetic modifications to the ideal stability criterion yield a more complex relationship between plasma rotation and RWM stability. Good agreement is found between an experimental RWM instability at intermediate plasma rotation and the RWM marginal point calculated with kinetic effects included, by the MISK code. By self-similarly scaling the experimental plasma rotation profile and the collisionality in the calculation, resonances of the mode with the precession drift and bounce frequencies are explored. Experimentally, RWMs go unstable when the plasma rotation is between the stabilizing precession drift and bounce resonances.

On demand triggering of edge localized instabilities using external nonaxisymmetric magnetic perturbations in toroidal plasmas.

The application of nonaxisymmetric magnetic fields is shown to destabilize edge-localized modes (ELMs) during otherwise ELM-free periods of discharges in the National Spherical Torus Experiment (NSTX). Profile analysis shows the applied fields increased the temperature and pressure gradients, decreasing edge stability. This robust effect was exploited for a new form of ELM control: the triggering of ELMs at will in high performance H mode plasmas enabled by lithium conditioning, yielding high time-averaged energy confinement with reduced core impurity density and radiated power.