Postoperative pain of minimally invasive root canal treatment:a randomized clinical trial.

This randomized clinical trial compared postoperative pain between a minimally invasive (MP) and conventional root canal treatment protocol (CP). A total of 170 mature permanent teeth (either with vital or necrotic pulp), were randomly assigned into two groups. In the CP group, ProTaper Gold (Dentsply Sirona, Ballaigues, Switzerland) and a continuous wave of condensation technique were used, whereas, in the MP group, TruNatomy (Dentsply Sirona), ultrasonic-assisted irrigation (UI), calcium hydroxide, and a sealer-based obturation technique were used. Patients recorded preoperative and postoperative pain using a 0-10 numerical rating scale (NRS) at 4 h, 1, 2, 3, 4, 5, 6, and 7 days after instrumentation and 1 day after canal obturation, respectively. There were no significant differences in pain intensity at any time points assessed between the two groups (p > 0.05). The occurrence of moderate/intense pain after instrumentation was significantly associated with preoperative periapical index (PAI) (p = 0.017) and NRS scores (p < 0.001). Preoperative pulp status (p = 0.009) and NRS score (p = 0.006) were identified as significant factors in the occurrence of moderate/intense pain after obturation. Instrumentation unequivocally reduced pain severity for both groups. The post-endodontic pain associated with the use of MP, combined with UI, Ca(OH)2, and calcium-silicate cement, did not differ from that of CP. Preoperative pain score, PAI, and preoperative pulp status were determined to be prognostic factors for postoperative pain.

Pharmacologic management of trigeminal nerve injury after endodontic treatment: A retrospective analysis.

BACKGROUND: Trigeminal nerve injury following endodontic treatment, leading to unpleasant sensations or partial sensory loss in the face or oral mucosa, is uncommon but significant when it occurs. OBJECTIVE: This study analysed the pharmacological management of trigeminal nerve injuries (TNI) in a university-based hospital. METHODS: We conducted a retrospective analysis of 47 patients who visited the Department of Orofacial Pain and Oral Medicine at Yonsei University Dental Hospital, Seoul, Korea, after TNI following endodontic procedures in primary clinics. Both objective tests and subjective evaluations, assessed the extent and duration of sensory injury during the initial visit. The patient's initial symptoms, presumed cause of TNI, referral delay (time interval between TNI and the first visit to our clinic), and medications were analysed to determine whether these factors affected the outcomes. RESULTS: Most patients with TNI experienced dysesthesia with hypoesthesia (70.2%). The mandibular molars were predominantly affected (72.3%), with the inferior alveolar nerve (IAN), lingual nerve (LN), both IAN and LN, and maxillary nerve compromised in 83.0, 12.8, 2.1, and 2.1% of cases, respectively. Causes of TNI included local anaesthesia (29.8%), overfilling/over-instrumentation (25.5%), endodontic surgery (17.0%), and unknown factors (27.7%). A shorter referral delay was associated with better outcomes, with an average delay of 8.6 weeks for symptom improvement compared with 44.1 weeks for no change. The medication regimens included steroids, NSAIDs, topical lidocaine, vitamin B complex, Adenosine Triphosphate (ATP), antiepileptics, antidepressants, and opioids administered alone or in combination, with a mean duration of 20.7 weeks. 53.2% of the patients reported improvement in their symptoms, 27.7% experienced no significant change, and 19.1% had unknown outcomes. CONCLUSIONS: Swift referral to an orofacial pain specialist is recommended for effective recovery in cases of TNI arising from endodontic treatment.

Healthcare-associated infection after spinal cord injury in a tertiary rehabilitation center in South Korea: a retrospective chart audit.

STUDY DESIGN: A retrospective observational study. OBJECTIVE: To identify the difference between patients with and without healthcare-associated infection (HAI) after spinal cord injury (SCI), changes in the quantity of rehabilitation after HAI, and resistance to and application of empirical antibiotics. SETTING: University hospital-affiliated rehabilitation center. METHODS: Altogether, 338 patients with SCI receiving inpatient rehabilitation from January 2015 to March 2018 were categorized into two groups based on the presence or absence of HAI. Demographic and clinical characteristics, amount of rehabilitation performance between before and after HAI, resistance to antibiotics, and empirical antibiotic change rates were investigated. RESULTS: In 79 patients, 117 HAI cases occurred, with an overall incidence of 34.6%. Male sex, complete SCI, and trauma history were more frequent in the HAI group than in the non-HAI group. Length of stay (LOS) was longer at 28.9 days in the HAI group. The incidence of lower respiratory tract infections (LRIs) and urinary tract infections (UTIs) was 5.0 and 16.9%, respectively. The rehabilitation loss rates due to LRIs and UTIs were 40.0 and 20.2%, respectively, which were not statistically significant. The rates of resistance to recommended empirical antibiotics for LRIs and UTIs were 26.9-57.7% and 54.2-67.8%, respectively. The rates of empirical antibiotic changes for LRIs and UTIs were 35.3 and 43.9%, respectively. CONCLUSIONS: HAI after SCI was more common in men, complete SCI and trauma history. LOS was prolonged in the HAI group. A quantitative reduction of rehabilitation treatment after HAI was observed, but further research is needed for validation.

Electrophysiological Changes in the Peripheral Nervous System After Subacute Spinal Cord Injury.

OBJECTIVE: To assess factors affecting electrophysiological changes in the peripheral nervous system below the neurologic level of injury (NLI) in patients with subacute spinal cord injury (SCI). DESIGN: Retrospective observational study. SETTING: An inpatient rehabilitation center of a university hospital. PARTICIPANTS: Through reviewing the medical records of 151 subjects with SCI, 42 without any other disease inducing peripheral neurologic abnormalities were included. They were classified into 2 groups, with or without denervation potentials in electromyography (EMG) below NLI. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Demographics and clinical characteristics including NLI, American Spinal Injury Association Impairment Scale (AIS), and Lower Extremity Motor Score were compared. Results of electrophysiological study including nerve conduction study, somatosensory-evoked potential (SSEP), and motor-evoked potential (MEP) were compared. RESULTS: Denervation potentials in EMG below NLI were observed in 20 subjects, and 10 of them were AIS A or B, but there was none in subjects without denervation potentials (P<.001). The lower extremity motor score was 4.35±7.74 in the group with denervation potentials, lower than 33.64±13.60 of the opposite group (P<.001). In the analysis of electrophysiological study, patients with denervation potentials showed a higher proportion of no response than patients without denervation potentials (60.0% vs 11.4% in peroneal nerve conduction study, 35.0% vs 2.3% in tibial nerve conduction study, 80.0% vs 18.2% in SSEP, 87.5% vs 22.7% in MEP; P<.001, respectively). Additionally, greater axonal loss, based on decrease of amplitude without delayed latency on nerve conduction study, was observed in the group with denervation potentials than the opposite group (P<.001). CONCLUSION: Among subjects with subacute SCI, cases of peripheral nervous dysfunction below the injury site occur, possibly associated with the severity of SCI.

An integrated humanities-social sciences course in health sciences education: proposed design, effectiveness, and associated factors.

BACKGROUND: Previous research has not provided enough direction regarding effective content design of courses integrating the humanities and social sciences in medical and dental education. This study aims at exploring how an Integrated Medical/Dental Humanities-Social Medicine/Dentistry course may be designed; how effective it may be in terms of student growth in knowledge, attitudes, skills, and aspirations; and associated factors. METHODS: The course was designed by distilling commonalities in the international standards for medical/dental education proposed by seven major health organizations. This analysis resulted in a curriculum covering nine major topics: history, professionalism, communication, ethics, management, policy, insurance, law, and research methodology. During the 2017 calendar year, data was collected and statistically analyzed from 68 third-year pre-doctoral students enrolled in the resulting MDHS 13-week course. RESULTS: Participants showed growth in skills, aspirations, knowledge, and attitudes, with the greatest change occurring in skills, then aspirations, knowledge, and attitudes. Knowledge growth was the only variable significantly related to student achievement of course objectives (ß = 0.635, t (63) = 3.394, p = 0.001). The topics that students perceived as most critical were insurance, policy, management, and law. The perceived importance of research was most common among participants and was significantly related to all learning outcomes (For knowledge, ß = 0.213, t (63) = 2.203, p = 0.031; for attitudes, ß = 0.784, t (63) = 10.257, p = 0.000; for skills, ß = 0.769, t (63) = 9.772, p = 0.000; and aspirations ß = 0.639, t (63) = 7.595, p = 0.000). CONCLUSIONS: This study proposed a framework for humanities-social sciences education in health sciences education and analyzed its implementation. The empirical evaluation of its effectiveness and factors related to successful outcomes found that students perceived gains in their knowledge, attitudes, skills, and aspirations for humanistic and social aspects of dentistry/medicine. In addition, their recognition of the importance of research was associated with the greatest growth in all four learning outcomes. This study may contribute to the improved design of integrated humanities-social sciences courses.

Anesthetic efficacy of an inferior alveolar nerve block in soft tissue and correlation between soft tissue and pulpal anesthesia.

OBJECTIVES: This study was aimed at evaluating the anesthetic success rates in various regions of soft tissue after inferior alveolar nerve (IAN) block and comparing the success rates of soft tissue anesthesia with those of pulpal anesthesia to find correlations. MATERIALS AND METHODS: Fifty-nine dental students received an IAN block injection. A total of four test sites were used for soft tissue anesthesia using a pressure algometer (PA): the corner of the lower lip vermilion border (LL); the buccal-attached gingiva of the lateral incisor (BGI), the molar (BGM), and the lingual gingiva (LG). The lateral incisor (LI) and the first molar (M1) were evaluated for pulpal anesthesia using an electric pulp tester. To evaluate whether soft tissue anesthesia can be an indicator of pulpal anesthesia, the positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS: The highest success rate for soft tissue anesthesia was seen on the LG (93.9%), followed by LL (79.6%), BGI (53.1%), and BGM (14.3%). The PPVs of LL for the M1 and Ll were 74.4 and 59.0%. The NPVs for the M1 and LI were much higher in the LL (90.0 and 100%, respectively) than in the BGI (56.5 and 69.6%, respectively). CONCLUSIONS: The highest success rate was found in the LG. Lip numbness was not an indicator of pulpal anesthesia of M1 and LI. However, if the LL was not anesthetized, the probabilities of failed pulpal anesthesia were very high in the LI and M1. CLINICAL RELEVANCE: The clinicians need to consider not doing an additional lingual nerve block after IAN block.

Oligonucleotide-based biosensors for in vitro diagnostics and environmental hazard detection.

Oligonucleotide-based biosensors have drawn much attention because of their broad applications in in vitro diagnostics and environmental hazard detection. They are particularly of interest to many researchers because of their high specificity as well as excellent sensitivity. Recently, oligonucleotide-based biosensors have been used to achieve not only genetic detection of targets but also the detection of small molecules, peptides, and proteins. This has further broadened the applications of these sensors in the medical and health care industry. In this review, we highlight various examples of oligonucleotide-based biosensors for the detection of diseases, drugs, and environmentally hazardous chemicals. Each example is provided with detailed schematics of the detection mechanism in addition to the supporting experimental results. Furthermore, future perspectives and new challenges in oligonucleotide-based biosensors are discussed.

Randomized clinical trial of pulpotomy using a premixed injectable calcium silicate cement on mature permanent teeth with reversible pulpitis.

The aim of this two-center randomized controlled trial was to assess the outcomes and relative factors associated with pulpotomies performed using a premixed injectable calcium silicate cement, as compared to mineral trioxide aggregate in mature permanent premolar and molar teeth with reversible pulpitis. Included teeth were randomly divided into two groups according to pulpotomy material (ProRoot MTA [PMTA] group, Endocem MTA Premixed [EPM] group). After pulp exposure, the superficial pulp was either removed to a depth of 2 mm (partial pulpotomy) or completely amputated to the level of the root canal orifice (full pulpotomy). A 3-mm layer of either material was randomly placed over the pulp wound, followed by the application of a thin layer of a light-cured glass ionomer composite liner. The restoration procedure was then carried out during the same visit. After one year of treatment, the pulpotomy success rate was 94.4% (67/71), with no significant difference between the PMTA and EPM groups. The success rate was 93.9% in the PMTA group and 97.1% in the EPM group. There were no significant factors related to the procedures. EPM is a viable alternative to PMTA for single-visit pulpotomies of permanent premolars and molars.

Feasibility of Mobile Health App-Based Home Aerobic Exercise for Physical Performance in Healthy Young Adults.

OBJECTIVE: To investigate the feasibility and effects of a mobile app-based home cycling exercise program compared to home cycling exercise without additional monitoring system. Compared with fitness facilities or outdoor exercise, home-based exercise programs effectively improve physical performance in an indwelling community. However, a flexible, informal environment may decrease motivation and impair adherence to physical exercise. Mobile devices for aerobic exercise and mobile applications provide real-time monitoring, immediate feedback, and encouragement to increase motivation and promote physical performance. We investigated the feasibility and effects of a mobile app-based home exercise program on body composition, muscular strength, and cardiopulmonary function. METHODS: Between February and May 2023, 20 participants were randomly allocated to the intervention (mobile application with a tablet) and control groups, and they performed aerobic exercise using a stationary bicycle for ≥150 minutes per week for 6 weeks (≤30-minute exercise session, with 3-minute warm-up and 3-minute cool-down). Karvonen formula-based heartrate defined the weekly increase in exercise intensity. Outcome measures included body-composition parameters, isokinetic knee flexor and extensor strength tests, cardiopulmonary exercise test results, and rate of target heart rate (HR) achievement. Participants were assessed at baseline and after the intervention. RESULTS: Unrelated personal events led two participants to drop out. The intervention and control groups had similar baseline characteristics. Compared with the control group, in the post-intervention isokinetic strength test, bilateral knee flexor and extensor power, and time to target HR achievement significantly increased each week in the intervention group. CONCLUSION: Home-based exercise to achieve long-term cardiovascular fitness with portable electronic/mobile devices facilitates individualized exercise using real-time feedback to improve motivation and adherence.

Histologic and Electron Microscopic Characterization of a Human Immature Permanent Premolar with Chronic Apical Abscess 16 Years after Regenerative Endodontic Procedures.

Previous studies have reported successful clinical outcomes after regenerative endodontic procedures (REPs) for immature permanent teeth with pulpal infection. However, it remains unclear whether the procedures promote true regeneration or repair. This case report describes the histologic and electron microscopic characteristics of a human immature permanent premolar with a chronic apical abscess that was treated with an REP. Tooth #20 of a 9-year-old girl underwent an REP. At the 6-year follow-up, the patient was asymptomatic, and closure of the apex and thickening of the dentinal walls were observed. However, 16 years after the procedure, apical periodontitis recurred, necessitating apical surgery. The resected root fragments were obtained during the surgery and analyzed using micro-computed tomography, light microscopy, and scanning electron microscopy. Distinct dentinal tubules and interglobular dentin were observed in the regenerated hard tissue. Cementum-like tissue and a root canal were also observed in the apical fragment. The regenerated root tissue in this case exhibited a structure similar to the native root structure. Therefore, we believe that cell-free REPs possess regenerative potential for teeth diagnosed with pulp necrosis and chronic apical abscess.

Variations in the morphology of apical constriction affecting electronic readings: An in vitro investigation using 3D-printed tooth models.

We investigated the interference of apical constriction position and diameter on the accuracy of electronic apex locators using 3D-printed tooth models. Single-rooted tooth models with the same length, canal taper and major foramen, but variation in apical constriction position or size, were designed and 3D-printed. A mounting model was custom-made for precise measurement of both marks (0.5 and APEX/0.0) of two electronic apex locators. The electronic measurements of both devices were correlated significantly to the major foramen rather than apical constriction. The mean measurements of the group with 0.45 mm in apical constriction width were significantly shorter than those of the other groups for both marks of the two devices (p < 0.05). The variations in apical constriction position and width negatively affected the precision of the 0.5 mark of the tested devices. The 0.0 or APEX mark was consistently located the major foramen.

Task-residual effective connectivity of motor network in transient ischemic attack.

Transient ischemic attack (TIA) is a temporary episode of neurological dysfunction that results from focal brain ischemia. Although TIA symptoms are quickly resolved, patients with TIA have a high risk of stroke and persistent impairments in multiple domains of cognitive and motor functions. In this study, using spectral dynamic causal modeling, we investigate the changes in task-residual effective connectivity of patients with TIA during fist-closing movements. 28 healthy participants and 15 age-matched patients with TIA undergo functional magnetic resonance imaging at 7T. Here we show that during visually cued motor movement, patients with TIA have significantly higher effective connectivity toward the ipsilateral primary motor cortex and lower connectivity to the supplementary motor area than healthy controls. Our results imply that TIA patients have aberrant connections among motor regions, and these changes may reflect the decreased efficiency of primary motor function and disrupted control of voluntary movement in patients with TIA.

Evaluation of the clinical efficacy of quantitative light-induced fluorescence technology in diagnosing cracked teeth.

BACKGROUND: This retrospective study evaluated the clinical efficacy of quantitative light-induced fluorescence (QLF) technology for crack detection and the diagnosis of cracked teeth and assessed the possibility of a quantitative evaluation of cracks using QLF technology. METHODS: Patients who were clinically diagnosed with cracked teeth over a 1-year period were included. The QLF images of the corresponding symptomatic cracked teeth and asymptomatic contralateral teeth with crack lines were taken with Qraypen C (AIOBIO, Seoul, Korea). Fluorescence loss (ΔF), maximum fluorescence loss (ΔFmax), red fluorescence (ΔR), and maximum red fluorescence (ΔRmax) of the crack line were analyzed. The correlation between these parameters and sex, age, tooth position (1st premolar, 2nd premolar, 1st molar, 2nd molar), spontaneous pain (+/-), percussion test (+/-), cold test (++/+/-), and bite test (+/-) were statistically analyzed. RESULTS: A total of 66 patients were included. Twenty-four patients had asymptomatic contralateral teeth with apparent crack lines; thus, 90 teeth were analyzed. The crack lines in 84 teeth observed as red fluorescent lines on the QLF images showed ΔR values higher than the cut-off value set by the analysis program used. The patient's age and the ∣ΔF∣ and ΔR values were positively correlated. However, there was no statistically significant difference in the QLF parameters between the same patient's symptomatic tooth and the contralateral tooth. CONCLUSIONS: QLF technology is a useful assistive diagnostic device for diagnosing cracked teeth.

Biologically based treatment of immature permanent teeth with pulpal necrosis: a case series.

This case series reports the outcomes of 8 patients (ages 9-4 years) who presented with 9 immature permanent teeth with pulpal necrosis and apical periodontitis. During treatment, 5 of the teeth were found to have at least some residual vital tissue remaining in the root canal systems. After NaOCI irrigation and medication with ciprofloxacin, metronidazole, and minocycline, these teeth were sealed with mineral trioxide aggregate and restored. The other group of 4 teeth had no evidence of any residual vital pulp tissue. This second group of teeth was treated with NaOCl irrigation and medicated with ciprofloxacin, metronidazole, and minocycline followed by a revascularization procedure adopted from the trauma literature (bleeding evoked to form an intracanal blood clot). In both groups of patients, there was evidence of satisfactory postoperative clinical outcomes (1-5 years); the patients were asymptomatic, no sinus tracts were evident, apical periodontitis was resolved, and there was radiographic evidence of continuing thickness of dentinal walls, apical closure, or increased root length.

Relationship Between Brainstem Auditory Evoked Potentials and Clinical Function in Patients With Cerebral Infarction.

PURPOSE: The purpose of this study was to analyze the association between the brainstem auditory evoked potential (BAEP) and clinical outcomes at discharge in patients who have had subacute ischemic stroke. METHODS: A total of 210 patients who have had ischemic stroke, confirmed by MRI within 3 months after onset, were enrolled. Demographics and stroke-related clinical assessment scales, such as the modified Barthel index and National Institute of Health Stroke Scale (NIHSS), were collected. Recorded latencies of waveforms I, III, and V of BAEP were bilaterally collected and analyzed. The results of the patients with supratentorial brain lesions were further analyzed. RESULTS: The mean BAEP latencies of waveforms I, III, and V in the subjects were 1.84 ± 0.22, 4.07 ± 0.27, and 6.07 ± 0.33 ms, respectively. As the modified Barthel index and NIHSS scores at discharge functionally worsened, the latencies of all lesion-side BAEP waveforms were significantly delayed. In patients with supratentorial brain lesions only, there was a significant delay in the latency of waveform V at the lesion side as modified Barthel index severity increased ( P = 0.048). As the NIHSS score functionally worsened, BAEP latencies III and V recorded at the lesion side significantly delayed ( P = 0.023 and P = 0.003, respectively). In multivariate linear regression models, latency V was found to be a significant factor in predicting outcome at discharge, among other factors. CONCLUSIONS: In patients with ischemic stroke with the poor clinical outcome at discharge, there were delayed latencies of waveforms I, III, and V of BAEP performed in the early phase of stroke.

Correlation of Femoral Muscle Volume Using Three-Dimensional Modeling and Locomotor Function After Unilateral Trans-femoral Amputation.

OBJECTIVE: To evaluate the relationship between femoral muscle volume (FMV) and physiological outcomes after trans-femoral amputations (TFAs) affecting overall locomotor function in patients. METHODS: Seven individuals who underwent TFA and had been using a prosthesis participated in this cross-sectional study. Gait and balance were assessed using clinical tests, such as 10-m walk test, 6-minute walk test, Berg Balance Scale, and automatic balance system. Respiratory gas analysis was performed to check oxygen consumption rate. Five participants were evaluated for bilateral FMV by MR imaging and FMV was reconstructed using three-dimentional remodeling. RESULTS: In five participants, significant differences were found between the non-involved and involved sides in femur length, total FMV, and functional muscle volume (all p<0.01) in all groups except for the hip adductor volume. The %mean difference between the non-involved and involved sides was 30% for femur length, 52.55% for hip flexor volume, 26.55% for hip adductor volume, 51.86% for hip extensor volume, and 60.21% for knee extensor volume. The hip flexor volume to hip extensor volume ratio in the involved limb and oxygen consumption rate during comfortable gait were negatively correlated (r=-0.96, p=0.04). CONCLUSION: In individuals who underwent unilateral TFA, hip girdle muscle imbalance in the involved limbs may be associated with oxygen consumption rate while using a prosthesis.

Clinical Efficacy of Sealer-based Obturation Using Calcium Silicate Sealers: A Randomized Clinical Trial.

INTRODUCTION: This randomized controlled clinical trial compared the clinical efficacy and outcome of a sealer-based obturation technique (SBO) with calcium silicate sealers and a continuous wave of condensation technique (CWC) with a resin-based sealer. METHODS: Root canals were prepared using rotary instruments and 2.5% sodium hypochlorite. At the next visit, patients were enrolled and randomly assigned into 2 groups on the basis of the obturation protocol: CWC with AH Plus sealer and SBO with Endoseal TCS. Patients were assessed for the level of postoperative pain using a numeric rating scale. The quality of root canal obturation was evaluated in terms of the sealer extrusion, root-filling voids, and level of root filling. The participants were recalled after at least 6 months. Healing of the teeth was determined as a decrease in Periapical Index score and resolution of symptoms. The results were statistically compared by using the χ2 test or Fisher exact test, followed by multivariate analysis with logistic regression. RESULTS: A total of 74 teeth were included in the analysis (79% recalls), and the mean follow-up period was 17 months (6-29 months). Two groups expressed identical distribution of postoperative pain (P = .973) and similar quality of root canal obturation. The total success rates were 93.2% (CWC 92.3%, SBO 94.3%) by loose criteria and 60.8% (CWC 51.3%, SBO 71.4%) by strict criteria, with no significant differences between the 2 groups. The success rate by loose criteria in teeth with sealer extrusion was significantly lower than those in teeth without sealer extrusion (P = .049). CONCLUSIONS: SBO using an Endoseal TCS could be a possible alternative to CWC using AH Plus. Sealer extrusion and postoperative pain were found to negatively impact prognosis of the endodontic treatment.

Effects of Hydrodilatation With Corticosteroid Injection and Biomechanical Properties in Patients With Adhesive Capsulitis After Breast Cancer Surgery.

OBJECTIVE: To compare the biomechanical properties of the glenohumeral joint capsule between adhesive capsulitis (AC) after breast cancer surgery and idiopathic AC and demonstrate the effects of hydrodilatation (HD) with corticosteroid injection for AC after breast cancer surgery. METHODS: Twenty-three prospective patients with AC after breast cancer surgery (BC group) and 44 retrospective patients with idiopathic AC without breast cancer (CON group) underwent HD with corticosteroid injection and home exercise training. We compared their biomechanical characteristics (capsular capacity, maximal pressure, and capsular stiffness). In the BC group, the passive range of motion (ROM) of the affected shoulder and a questionnaire (Shoulder Pain and Disability Index [SPADI]) were evaluated at baseline and 2 and 4 weeks after treatment. RESULTS: The BC group showed higher biomechanical characteristics (maximal pressure and capsular stiffness) than did the CON group. The mean maximal pressure and capsular stiffness were 519.67±120.90 mmHg and 19.69±10.58 mmHg/mL in the BC group and 424.78±104.42 mmHg and 11.55±7.77 mmHg/mL in the CON group (p=0.002 and p=0.001, respectively). And, the BC group showed significant improvements in all ROMs (abduction, flexion, and external rotation) and the SPADI pain and disability sub-scores following the treatment. CONCLUSION: The glenohumeral joint capsular stiffness was greater in the patients with AC after breast cancer surgery than in those with idiopathic AC. HD with corticosteroid injection was effective in treating AC after breast cancer surgery.

Neuronox versus BOTOX for spastic equinus gait in children with cerebral palsy: a randomized, double-blinded, controlled multicentre clinical trial.

AIM: The aim of this study was to evaluate the efficacy and safety of a newly manufactured botulinum toxin, Neuronox, compared with BOTOX for the treatment of the spastic equinus gait in children with cerebral palsy. METHOD: A total of 127 children with cerebral palsy, aged 2 to 10 years, who presented at three university hospitals with spastic equinus gait were assessed for eligibility to participate in this double-blinded, randomized, controlled trial. Of the 119 eligible participants (mean age 4.33 y; SD 2.07; 76 males and 43 females; 79 with diplegia and 40 with hemiplegia), 57 were classified as Gross Motor Function Classification System level I, 29 as level II, and 33 as level III. Participants were randomly assigned to receive an injection of Neuronox (n=60) or BOTOX (n=59) to the calf muscles at a dose of 4U/kg for those with hemiplegia and 6U/kg for those with diplegia. Assessments were performed at baseline (V1) and at 4 (V2), 12 (V3), and 24 (V4) weeks after the intervention. The primary outcome measure was response rate at V3, with a positive response being defined as at least a 2-point increase in the Physicians' Rating Scale (PRS) score. The non-inferiority margin was set as -20% for the difference in the response rate. The secondary outcome measures included PRS score, passive range of motion (PROM) of the ankle and knee, and Gross Motor Function Measure 88 (GMFM-88). Any adverse events were investigated for safety implications. RESULTS: The response rate of the Neuronox group at V3 was not inferior to that of the BOTOX group (90% lower limit=-11.58%). There were significant improvements in PRS, PROM of ankle dorsiflexion, and GMFM scores at V2, V3, and V4 in both groups. The changes in PRS score were not statistically different between the two groups in serial evaluation (p=0.96). PROM of the ankle dorsiflexion increased without any significant difference between the two groups, either overall (p=0.56) or at each visit (V2, p=0.32; V3, p=0.66; V4, p=0.90). The increase in GMFM score in serial measurements were not significantly different between the two groups (p=0.16), whereas it was larger in the BOTOX group than in the Neuronox group at V2 and V4 (p=0.03 and 0.05 respectively). The frequency of adverse events was not significantly different between the two groups (p=0.97), and drug-related complications of Neuronox treatment were not addressed. INTERPRETATION: The outcomes of Neuronox, based on PRS, proved to be as effective and safe as those of BOTOX for the treatment of spasticity in individuals with cerebral palsy.

Inhibition of the Nav1.7 Channel in the Trigeminal Ganglion Relieves Pulpitis Inflammatory Pain.

Pulpitis causes significant changes in the peripheral nervous system, which induce hyperalgesia. However, the relationship between neuronal activity and Nav1.7 expression following pulpal noxious pain has not yet been investigated in the trigeminal ganglion (TG). The aim of our study was to verify whether experimentally induced pulpitis activates the expression of Nav1.7 peripherally and the neuronal activities of the TGs can be affected by Nav1.7 channel inhibition. Acute pulpitis was induced through allyl isothiocyanate (AITC) application to the rat maxillary molar tooth pulp. Three days after AITC application, abnormal pain behaviors were recorded, and the rats were euthanized to allow for immunohistochemical, optical imaging, and western blot analyses of the Nav1.7 expression in the TG. A significant increase in AITC-induced pain-like behaviors and histological evidence of pulpitis were observed. In addition, histological and western blot data showed that Nav1.7 expressions in the TGs were significantly higher in the AITC group than in the naive and saline group rats. Optical imaging showed that the AITC group showed higher neuronal activity after electrical stimulation of the TGs. Additionally, treatment of ProTxII, selective Nav1.7 blocker, on to the TGs in the AITC group effectively suppressed the hyperpolarized activity after electrical stimulation. These findings indicate that the inhibition of the Nav1.7 channel could modulate nociceptive signal processing in the TG following pulp inflammation.