Comparative evaluation of anxiety level during restorative treatment using no music, monaural beats, and binaural auditory beats as audio distraction behavior guidance technique in children aged 6-12 years: A randomized clinical trial.

Background: Binaural auditory beat is an auditory illusion perceived when two different pure-tone sine waves with less than a 30 Hz difference are presented to a listener dichotically. Monaural beat stimulation is achieved by the superposition of amplitude-modulated signals of nearby frequencies to both ears simultaneously. Aim: The study aims to evaluate and compare anxiety level during restorative treatment using no music, monaural beats, and binaural auditory beats as audio distraction behavior guidance techniques in children aged 6-12 years. Settings and Design: Three-arm, parallel-group randomized study was conducted in the department of pediatric and preventive dentistry. Materials and Methods: The sample size of 45 participants was calculated and allocated into three groups as no music, monaural beats, and binaural auditory beats group. Teeth with Class I cavity in primary or permanent molars were prepared and restored. Anxiety was measured pre and postintervention using pulse oximeter and Venham's picture test. Statistical Analysis Used: Data obtained were analyzed with SPSS software version 20.0 and were carried out using one-way analysis of variance and dependent t-test and significance value < 0.05 was considered. Results: Binaural auditory beats and monaural beats showed a better reduction in anxiety levels as per Venham's picture test scores with statistically significant "P" value 0.0001 and 0.064, respectively. Likewise, binaural auditory beats showed better reduction in anxiety levels as per pulse rate scores with statistically significant "P" value 0.0001 as compared to conventional treatment technique. Conclusion: Binaural auditory beat was found to be the most effective followed by the monaural beat compared to the control group. Thus, binaural auditory beats and monaural beats can be used effectively as an essential aid to reduce anxiety in children.

Lactoferrin for the postoperative management of term neonates after gastrointestinal surgery.

BACKGROUND: Neonates who have undergone gastrointestinal surgery are particularly susceptible to infectious complications in the postoperative period. This may be due in part to disruption of the integrity of the gut and its altered intestinal microflora. Lactoferrin is a whey protein found in milk and is an important innate mammalian defence mechanism. Lactoferrin has been reported to have antimicrobial and anti-inflammatory properties. It has also been reported to help establish a healthy gut microflora and aid in the intestinal immune system. Lactoferrin supplementation has been reported to decrease sepsis in preterm infants. There may be a role for lactoferrin to reduce the incidence of sepsis, thus reducing morbidity and mortality and improving enteral feeding in postoperative term neonates. OBJECTIVES: The primary objective of this review was to evaluate the efficacy of administering lactoferrin on the incidence of sepsis and mortality in term neonates after gastrointestinal surgery. The secondary objective was to assess the impact of administering lactoferrin on time to full enteral feeds, the intestinal microflora, duration of hospital stay, and mortality before discharge in the same population. SEARCH METHODS: The Cochrane Neonatal Information Specialist searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase Ovid, CINAHL, the WHO ICTRP and ClinicalTrials.gov trials registries. The date of the last search was February 2023. There were no restrictions to language, publication year or publication type. We checked references of potentially relevant studies and systematic reviews. SELECTION CRITERIA: We planned to include randomised controlled trials that studied infants born at 37 or more weeks of gestation who had one or more episodes of gastrointestinal surgery within 28 days of birth, and compared administration of lactoferrin with a placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. We planned to use the GRADE approach to assess the certainty of evidence for each outcome. MAIN RESULTS: We identified no published randomised controlled studies that assessed the efficacy of lactoferrin for the postoperative management of term neonates following gastrointestinal surgery. AUTHORS' CONCLUSIONS: There is currently no evidence available from randomised controlled trials to show whether lactoferrin is effective or ineffective for the postoperative management of term neonates after gastrointestinal surgery. There is a need for randomised controlled trials to be performed to assess the role of lactoferrin in this setting.

Progenitor-derived endothelin controls dermal sheath contraction for hair follicle regression.

Substantial follicle remodelling during the regression phase of the hair growth cycle is coordinated by the contraction of the dermal sheath smooth muscle, but how dermal-sheath-generated forces are regulated is unclear. Here, we identify spatiotemporally controlled endothelin signalling-a potent vasoconstriction-regulating pathway-as the key activating mechanism of dermal sheath contraction. Pharmacological blocking or genetic ablation of both endothelin receptors, ETA and ETB, impedes dermal sheath contraction and halts follicle regression. Epithelial progenitors at the club hair-epithelial strand bottleneck produce the endothelin ligand ET-1, which is required for follicle regression. ET signalling in dermal sheath cells and downstream contraction is dynamically regulated by cytoplasmic Ca2+ levels through cell membrane and sarcoplasmic reticulum calcium channels. Together, these findings illuminate an epithelial-mesenchymal interaction paradigm in which progenitors-destined to undergo programmed cell death-control the contraction of the surrounding sheath smooth muscle to orchestrate homeostatic tissue regression and reorganization for the next stem cell activation and regeneration cycle.

Psychological behavior management techniques to alleviate dental fear and anxiety in 4-14-year-old children in pediatric dentistry: A systematic review and meta-analysis.

Child's uncooperative behavior can impede the efficient delivery of dental care. Therefore, in spite of exceeding availability of behavior management techniques there is a need to search for a psychological behavior management technique that effectively reduces fear and anxiety during dental treatment and instill a change in child's attitude toward the treatment and is also acceptable by the parents. The aim of our systematic review is to determine the efficacy of various psychological behavior management techniques in managing a child's behavior in pediatric dentistry by assessing the fear and anxiety levels, ease of use by the clinician, application in various operative procedures, and parental acceptance. A systematic search was conducted by two reviewers in databases PubMed, Google Scholar, Scopus, Web of Science, and Cochrane for the studies published from January 1, 2011, to December 31, 2020. Studies included were clinical studies which evaluated the efficacy of various psychological behavior management techniques by evaluating the fear and anxiety levels and the changes in behavior during dental treatment in children aged between 4 and 14 years. The studies selected were then assessed for quality with the help of predetermined criteria which categorized the studies into high, medium, and low. Through search strategy, 7147 articles were yielded. After screening through titles and abstracts, 60 nonduplicated articles were selected which were further screened for full text. At the end, 15 articles were included in systematic review and 3 articles for meta-analysis. It was concluded that all the psychological behavior management techniques aided in reduction of fear and anxiety. In noninvasive procedures, conventional psychological behavior management techniques can be effective but in invasive procedures other newer psychological behavior management techniques showed better results. The aspect of parental acceptance regarding various techniques was not discussed in any of the included studies.

Evaluation of the Treatment Protocols in the Management of Pulpally Involved Young Permanent Teeth in Children: A Systematic Review and Meta-analysis.

Background: In children with young permanent teeth, dental caries and traumatic injuries are the most common problems leading to pulp necrosis. Since, root development is completed in two to three years after eruption of the tooth into the oral cavity, loss of pulp vitality in young permanent tooth creates distinctive problems. In spite of exceeding availability of treatment procedures there is a need to search for a substantial procedure to treat young permanent teeth effectively. Aim: The aim of this systematic review was to evaluate the treatment protocols in the management of pulpally involved young permanent teeth in children. Method: Systematic search was conducted on databases PubMed, Cochrane, and Google Scholar among studies published from 1st January 2010 till 31st May 2020. Studies meeting the inclusion criteria were included in the review and were then assessed for quality with the help of predetermined criteria which categorized studies into high, medium, and low. Results: Search strategy yielded 4,846 articles. After screening through titles and abstracts, 33 articles remained which were further screened for full text. At the end, 14 articles were included in systematic review. Furthermore, the included articles were statistically evaluated by meta-analysis. Conclusion: In apexogenesis and apexification procedures, newer biomimetic materials like mineral trioxide aggregate and biodentine have more success rate than conventionally used calcium hydroxide. Among regenerative endodontic procedures platelet-rich plasma and platelet- rich fibrin showed better results. Clinical significance: To amend clinician perceptions towards acceptance of the newer regenerative procedures and their effectiveness in management of young permanent tooth. How to cite this article: Saxena N, Hugar SM, Soneta SP, et al. Evaluation of the Treatment Protocols in the Management of Pulpally Involved Young Permanent Teeth in Children: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2022;15(S-1):S103-S113.

Evaluating anxiety levels and pain perception while administering local anesthesia using conventional, insulin, and deception syringes in 6-12-year-olds.

Background: Injections are one of the most fear-provoking stimuli in dentistry. Painless administration of an injection is a vital step in alleviating anxiety, which in turn leads to good behavior in children. The aim is to evaluate and compare anxiety levels and pain perception using conventional, insulin, and deception syringes during the administration of local anesthesia in children. Methods: Forty-five children aged 6-12 were selected using a standard sample size formula and equally divided into three groups. Local anesthesia was administered using a conventional syringe to Group A participants and an insulin syringe for Group B participants. Group C participants were administered local anesthesia using a deception syringe by showing the patient disposable obturation tips, and eventually a conventional syringe was used for administration of local anesthesia after hiding them from the patient. Anxiety levels were assessed using Venham's Picture Scale and pulse rate at baseline and after administration of local anesthesia. The Wong-Baker Faces Pain Rating Scale was used to assess pain perception after the administration of local anesthesia. Results: Insulin and deception syringes showed better reduction in anxiety levels and pain perception than conventional syringes, demonstrating a high statistically significant difference. Conclusion: The use of insulin and deception syringes for administration of anesthesia was demonstrated to be effective in alleviating anxiety in children and is therefore recommended as an alternative to conventional syringes.

Assessment of Knowledge, Attitude, and Practices about Dental Home among Healthcare Professionals of Belagavi City: A Cross-sectional Study.

Aim and objective: The aim and objective of the study was to assess the knowledge, attitude, and practices about dental home among healthcare professionals of Belagavi city. Materials and methods: A sample of 400 participants was divided into four groups (Ayurveda, Homeopathy, Nursing, and Medical) based on their healthcare specialty. A 20 item validated questionnaire containing four domains was distributed among the participants. The data was statistically analyzed. Results: Descriptive analysis was used followed by Chi-square for association and one-way ANOVA for comparison followed by Karl Pearson correlation coefficient for determining the correlation between knowledge, attitude, and practices of healthcare professionals. The results of the study showed that the knowledge and practices were statistically not significant among all healthcare professionals (p > 0.05). However, the results were found to be statistically highly significant when correlation was done between knowledge, attitude, and practices (p < 0.0001). Conclusion: The study concludes that there is a need to increase the level of knowledge, attitude, and practices among healthcare professionals about the concept of dental home. Clinical Significance: The clinical significance of our study is the implementation of the dental home concept in India, which can prove to be a source of coordinated care that emphasizes overall patient health and aids in rendering quality treatment. Through this initiative oral health can be incorporated as a primary healthcare entity. This can also provide an opportunity for dental professionals to take the lead in applying successful strategies to improve the provision of dental care. Moreover, treatment needs if taken care at the preliminary stages itself, can reduce a major oral healthcare burden from extensive debilitating oral pathologies in the pediatric population. How to cite this article: Saxena N, Hugar SM, Patil V, et al. Assessment of Knowledge, Attitude, and Practices about Dental Home among Healthcare Professionals of Belagavi City: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(2):164-167.

Assessment of knowledge and attitude toward informed consent and assent for biomedical research involving children among health-care professionals in Belagavi city: A questionnaire study.

BACKGROUND: Most of the nations have proposed research regulations to protect the rights and welfare of the research participants. Among such regulations are the informed consent and assent. In the present world, informed consent and assent is the cornerstone in health practice. AIMS AND OBJECTIVES: To compare and evaluate the knowledge and attitude toward informed consent and assent for biomedical research involving children among health-care professionals in Belagavi city. MATERIALS AND METHODS: A cross-sectional questionnaire study was conducted among 300 house surgeons divided into four groups of Medical, Dental, Nursing, and Ayurveda faculty of Belagavi city. A self-administered multiple choice questions were used to evaluate the knowledge and a five-point Likert scale was used to asses attitude regarding informed consent and assent for research involving children. Statistical analysis was done using SPSS version 20. RESULTS: There was statistically significant difference in mean knowledge and attitude among all four groups (P < 0.05), and there was no significant correlation between knowledge and attitude as a whole in each group of professionals (P > 0.05). CONCLUSION: Emphasis on additional training is the need of the hour for all the faculty participants and also incorporation of study material regarding informed consent and assent for research involving children by the policy makers.

Dermal sheath contraction powers stem cell niche relocation during hair cycle regression.

Tissue homeostasis requires the balance of growth by cell production and regression through cell loss. In the hair cycle, during follicle regression, the niche traverses the skin through an unknown mechanism to reach the stem cell reservoir and trigger new growth. Here, we identify the dermal sheath that lines the follicle as the key driver of tissue regression and niche relocation through the smooth muscle contractile machinery that generates centripetal constriction force. We reveal that the calcium-calmodulin-myosin light chain kinase pathway controls sheath contraction. When this pathway is blocked, sheath contraction is inhibited, impeding follicle regression and niche relocation. Thus, our study identifies the dermal sheath as smooth muscle that drives follicle regression for reuniting niche and stem cells in order to regenerate tissue structure during homeostasis.

Author Correction: Gene correction for SCID-X1 in long-term hematopoietic stem cells.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Author Correction: Gene correction for SCID-X1 in long-term hematopoietic stem cells.

The original version of this Article omitted the following from the Acknowledgements: "G.B. acknowledges the support from the Cancer Prevention and Research Institute of Texas (RR140081 and RR170721)."This has now been corrected in both the PDF and HTML versions of the Article.

Gene correction for SCID-X1 in long-term hematopoietic stem cells.

Gene correction in human long-term hematopoietic stem cells (LT-HSCs) could be an effective therapy for monogenic diseases of the blood and immune system. Here we describe an approach for X-linked sSevere cCombined iImmunodeficiency (SCID-X1) using targeted integration of a cDNA into the endogenous start codon to functionally correct disease-causing mutations throughout the gene. Using a CRISPR-Cas9/AAV6 based strategy, we achieve up to 20% targeted integration frequencies in LT-HSCs. As measures of the lack of toxicity we observe no evidence of abnormal hematopoiesis following transplantation and no evidence of off-target mutations using a high-fidelity Cas9 as a ribonucleoprotein complex. We achieve high levels of targeting frequencies (median 45%) in CD34+ HSPCs from six SCID-X1 patients and demonstrate rescue of lymphopoietic defect in a patient derived HSPC population in vitro and in vivo. In sum, our study provides specificity, toxicity and efficacy data supportive of clinical development of genome editing to treat SCID-Xl.

An updated classification of hair follicle morphogenesis.

Hair follicle (HF) formation in developing embryonic skin requires stepwise signalling between the epithelial epidermis and mesenchymal dermis, and their specialized derivatives, the placode/germ/peg and dermal condensate/papilla, respectively. Classically, distinct stages of HF morphogenesis have been defined, in the mouse model, based on (a) changes in cell morphology and aggregation; (b) expression of few known molecular markers; (c) the extent of follicle downgrowth; and (d) the presence of differentiating cell types. Refined genetic strategies and recent emerging technologies, such as live imaging and transcriptome analyses of isolated cell populations or single cells, have enabled a closer dissection of the signalling requirements at different stages of HF formation, particularly early on. They have also led to the discovery of precursor cells for placode, dermal condensate and future bulge stem cells that, combined with molecular insights into their fate specification and subsequent formation, serve as novel landmarks for early HF morphogenetic events and studies of the signalling networks mediating these processes. In this review, we integrate the emergence of HF precursor cell states and novel molecular markers of fate and formation to update the widely used 20-year-old seminal classification guide of HF morphogenetic stages by Paus et al. We then temporally describe the latest insights into the early cellular and molecular events and signalling requirements for HF morphogenesis in relation to one another in a holistic manner.

Dermal Condensate Niche Fate Specification Occurs Prior to Formation and Is Placode Progenitor Dependent.

Cell fate transitions are essential for specification of stem cells and their niches, but the precise timing and sequence of molecular events during embryonic development are largely unknown. Here, we identify, with 3D and 4D microscopy, unclustered precursors of dermal condensates (DC), signaling niches for epithelial progenitors in hair placodes. With population-based and single-cell transcriptomics, we define a molecular time-lapse from pre-DC fate specification through DC niche formation and establish the developmental trajectory as the DC lineage emerges from fibroblasts. Co-expression of downregulated fibroblast and upregulated DC genes in niche precursors reveals a transitory molecular state following a proliferation shutdown. Waves of transcription factor and signaling molecule expression then coincide with DC formation. Finally, ablation of epidermal Wnt signaling and placode-derived FGF20 demonstrates their requirement for pre-DC specification. These findings uncover a progenitor-dependent niche precursor fate and the transitory molecular events controlling niche formation and function.

Aplasia Cutis Congenita with Ischemic Cortical Change and Normal Array Cytogenetic Analysis with a Fetus Papyraceus Twin.

BACKGROUND: Aplasia cutis congenita (ACC) is a heterogeneous condition that can be associated with fetus papyraceus. Few reports exist documenting genetic investigations in ACC or determining the etiology and recurrence risks. OBJECTIVE: We present a Frieden group 5 ACC with fetus papyraceus along with molecular studies. RESULTS: The newborn had multifocal aplasia cutis congenita involving the head, trunk, and limbs with cerebral ischemic changes demonstrated by imaging. The newborn had a monochorionic twin fetus papyraceus. The array cytogenetic analysis was normal. CONCLUSION: Supported by the ischemic cerebral damage, a monochorionic twin fetus papyraceus (monochorionic twins often have vascular anastomoses), and a normal cytogenetic array, this ACC with Frieden group 5 may have resulted from rapid but non-fatal exsanguination of the surviving twin into the dead twin. This type of ACC may have a low recurrence risk.

More Than the Sum of Its Parts: Single-Cell Transcriptomics Reveals Epidermal Cell States.

Compared to mouse models, less is known about human epidermal cell states and differentiation. In this issue of Cell Reports, Cheng et al. (2018) dissect the cell states and heterogeneity in human epidermis with large-scale transcriptomics of 92,889 single epidermal cells from normal and inflamed skin.

Advancing insights into stem cell niche complexities with next-generation technologies.

Adult tissue-specific stem cells are essential for homeostatic tissue maintenance and key to regeneration during injury repair or disease. Many critical stem cell functions rely on the presence of well-timed cues from the microenvironment or niche, which includes a diverse range of components, including neuronal, circulating and extracellular matrix inputs as well as an array of neighboring niche cells directly interacting with the stem cells. However, studies of stem cells and their niche have been challenging due to the complexity of adult stem cell functions, their intrinsic controls and the multiple regulatory niche components. Here, we review recent major advances in our understanding of the complex interplay between stem cells and their niche that were enabled by the tremendous technological leaps in single-cell transcriptome analyses, 3D in vitro cultures and 4D in vivo microscopy of stem cell niches.