The use of integrated text mining and protein-protein interaction approach to evaluate the effects of combined chemotherapeutic and chemopreventive agents in cancer therapy.

Combining chemotherapeutic (CT) and chemopreventive (CP) agents for cancer treatment is controversial, and the issue has not yet been conclusively resolved. In this study, by integrating text mining and protein-protein interaction (PPI), the combined effects of these two kinds of agents in cancer treatment were investigated. First, text mining was performed by the Pathway Studio database to study the effects of various agents (CP and CT) on cancer-related processes. Then, each group's most important hub genes were obtained by calculating different centralities. Finally, the results of in silico analysis were validated by examining the combined effects of hesperetin (Hst) and vincristine (VCR) on MCF-7 cells. In general, the results of the in silico analysis revealed that the combination of these two kinds of agents could be useful for treating cancer. However, the PPI analysis revealed that there were a few important proteins that could be targeted for intelligent therapy while giving treatment with these agents. In vitro experiments confirmed the results of the in silico analysis. Also, Hst and VCR had good harmony in modulating the hub genes obtained from the in silico analysis and inducing apoptosis in the MCF-7 cell line.

CNN-LSTM Based Multimodal MRI and Clinical Data Fusion for Predicting Functional Outcome in Stroke Patients.

Clinical outcome prediction plays an important role in stroke patient management. From a machine learning point-of-view, one of the main challenges is dealing with heterogeneous data at patient admission, i.e. the image data which are multidimensional and the clinical data which are scalars. In this paper, a multimodal convolutional neural network - long short-term memory (CNN-LSTM) based ensemble model is proposed. For each MR image module, a dedicated network provides preliminary prediction of the clinical outcome using the modified Rankin scale (mRS). The final mRS score is obtained by merging the preliminary probabilities of each module dedicated to a specific type of MR image weighted by the clinical metadata, here age or the National Institutes of Health Stroke Scale (NIHSS). The experimental results demonstrate that the proposed model surpasses the baselines and offers an original way to automatically encode the spatio-temporal context of MR images in a deep learning architecture. The highest AUC (0.77) was achieved for the proposed model with NIHSS. Clinical Relevance- - We present the first deep learning approach predicting the clinical outcome of stroke patients treated by mechanical thrombectomy which integrates imaging data at the voxel level with key clinical metadata. Combining clinical and imaging data to evaluate the potential benefit from therapy closely mirrors the clinical decision process. Our promising results suggest our predictive model could assist in acute stroke management.

Clinical, radiological, and histological correlation in diagnosis of pulpitis.

Background: To establish an endodontic diagnosis, a clinician should consider a variety of factors. Various studies have failed to demonstrate a strong correlation between histological findings with clinical and radiographic assessments. This study sought to evaluate the histopathological features of reversible and irreversible pulpitis diseases and their correlation with clinical diagnosis in extracted human molar teeth. Materials and Methods: In this experimental ex vivo study, 75 molars with caries and three intact molars were used. According to the radiographic findings and clinical criteria and the need for root canal therapy, samples were categorized as having normal/reversible pulpitis and irreversible pulpitis. Immediately after extraction, an exposure was made at 2 mm below the cementoenamel junction. Formalin-fixed specimens were decalcified, sectioned and stained with hematoxylin and eosin for histological examinations using light microscopy. Variables including the type and severity of the inflammation, hyperemia, necrosis, fibrosis and the existence of an odontoblastic layer and dentin bridge were evaluated. The Fisher's exact test and the Chi-squared test were used for statistical analysis. P <0.05 was considered as significant. Results: Acute inflammation, hyperemia and pulp exposure were significantly more common among subjects with irreversible pulpitis (P < 0/005). However, fibrosis was significantly higher in the reversible group (P < 0/005). There were no statistically significant differences between the groups regarding the other variables. Conclusion: Some discrepancies between clinical, radiographic and histological findings were observed in our experimental study. Indeed, effective clinical practice requires consideration of all discrepancies found.

Evaluation of Relationship between Sever Early Childhood Caries and Breast Milk`s Lactose among 12- to 24-month-old Children.

Statement of the Problem: Severe early childhood caries (S-ECC) is common among infants and toddlers. It has many problems and challenges for families as well as dentists in fields of prevention and treatment. Purpose: The study aimed to investigate the relationship between occurrence of S-ECC and level of lactose in breast milk, in infants aged 12 to 24 months. Materials and Method: This cross-sectional descriptive-analytical study was carried out from April to July 2020 on 30 children aged 12 to 24 months with or without S-ECC, who were sol-ely breastfed; their mothers answered questions about their breastfeeding habits. After the child's dental visit, the mother was asked to express 10 to 20ml of her milk as a sample and give it to the researchers. The samples were immediately kept at -4°C and then they were tested for lactose measurement. Finally, the test results were analyzed by SPSS 21 software using independent t-test. Results: The average amount of lactose in the breast milk of cases with S-ECC infant was 5.74g/100 ml and the average amount of lactose in the breast milk of cases without S-ECC infant was 4.64g/100 ml. There was no significant difference in lactose concentration between the two groups (p Value=0.64). The average number of breastfeeding times in cases with S-ECC infants was 7.87 per day while in the healthy cases this was 7.33 per day. There was no significant difference between the numbers of breastfeeding times per day in two groups. Conclusion: According to this study, the amount of lactose in breast milk of children with S-ECC was slightly higher than the amount of lactose in breast milk in children with healthy teeth.

Comparing the Efficacy of Premedication with Ibuprofen in Combination with an Inferior Alveolar Nerve Block and Primary Buccal Infiltration in Mandibular Molars with Irreversible Pulpitis: A Triple-blinded Randomized Clinical Trial.

Introduction: This study aimed to determine the success rate of the combination of buccal infiltration (BI) and inferior alveolar nerve block (IANB) injections in irreversible pulpitis in mandibular molars after premedication with ibuprofen. Materials and Methods: From 132 patients participated in the study, 120 patients were included. One hour before root canal treatment, patients with mandibular molars with symptomatic irreversible pulpitis received either a 600 mg ibuprofen capsule or a placebo. All patients received 2% lidocaine with 1:80000 epinephrine and 4% articaine with 1:100000 epinephrine for IANB and BI, respectively. Patients' pain was evaluated using the Heft-Parker visual analog scale during the preparation of access cavity, exposure of pulp, and instrumentation of root canal. The success of anesthesia was defined as the absence of pain or mild pain. The Chi-square and t-test were employed for data analysis. Results: The difference between patient age and gender in the two groups was not significant (P>0.05). The anesthesia success rate was 85% in the premedicated and 70% in the placebo group, with statistically significant results (P=0.049). Conclusion: Based on this triple-blinded randomized clinical study, mandibular molars with irreversible pulpitis were not thoroughly anesthetized by a combination of IANB+BI after premedication with ibuprofen (600 mg), even though anesthesia success was improved significantly by ibuprofen premedication.

Evaluation of the Levels of Evidence in Three Clinical Chapters in Five Editions of the Textbook Pathways of the Pulp.

Introduction: The levels of evidence (LOE) of dental education texts is critical from the educational point of view. The present study aimed to evaluate the levels of evidence of references used in three clinical chapters in the textbook Pathways of the Pulp. Material & Method: The references of three clinical chapters in the text book Pathways of the Pulp were assessed in five of its editions. The levels of evidence were ranked according to study type and the Oxford scale from 0 to 5. The chi-square test was used to compare the level of evidence between different editions of the "Retreatment," "Trauma," and "Surgery" chapters. Results: A total of 3656 references were reviewed and analyzed from the "Trauma" (928 references), "Re-treatment" (1906 references), and "Surgery" (822 references) chapters in the 1998, 2002, 2006, 2011, and 2016 editions. The percentage of the LOE 0 (no evidence) was high (>60%) in all three chapters in all editions (P<0.001). The levels of evidence had the same distribution in all editions (P=0.871). The LOE of the "Re-treatment" (P=0.044) and "Surgery" (P<0.001) chapters changed in some editions. Conclusion: The majority of references in the three clinical chapters of the book are low-level evidence. Encouragement policies for researchers to conduct studies with high LOE are necessary.

Conservative Treatment of an Infected Lateral Canal: A Case Report with a 4-Year Follow-up.

Connective tissues in lateral canals mostly remain vital even after pulp necrosis of the main canals. However, lateral canals may become necrotic following the pulp necrosis of the main root canal or after root canal therapy. This case report presents a maxillary central incisor with a necrotic lateral canal and a sinus tract that initially showed healing following the primary endodontic treatment but showed infection after fiber-post placement and permanent restoration with composite resin. Tracing the sinus tract did not reveal the reason for the infection; however, cone beam computed tomography (CBCT) confirmed a lateral radiolucency of the maxillary right central incisor as the only reason for the return of the infection. A conservative re-treatment approach was performed, replacing the fiber post with gutta-percha and root canal sealer. Successful outcome was achieved with a conservative approach; however, it took some time for the sinus tract to heal. In the case of lateral canal infection, sealing the main root canal space could heal the lesion even without lateral canal negotiation. If the main root canal seal is disturbed, re-cleaning and obturating the main root canal could be successful.

Comparison of Canal Transportation, Separation Rate, and Preparation Time between One Shape and Neoniti (Neolix): An In Vitro CBCT Study.

PURPOSE: This in vitro study compared root canal preparation in curved mesiobuccal canals of molar teeth using either the One Shape™ or the Neoniti (Neolix) rotary NiTi single-file systems, assessing canal transportation, instrument separation and time required for preparation. Methods. Extracted maxillary and mandibular human molar teeth with mesiobuccal canals having apical angles of curvature between 25 and 35o were selected and embedded in acrylic resin blocks, and an initial CBCT was taken. The teeth were divided into two equal groups (n = 20), and the canals were cleaned and shaped using either Neoniti™ or One Shape™ engine-driven NiTi rotary files. Each individual instrument was used to prepare 5 canals. The time required for the preparation of each canal was recorded. Postpreparation CBCT scans were taken and used to determine the extent of canal transportation at levels of 2, 4, 6, and 8 mm from the apex. The Kolmogorov-Smirnov test for normality was applied, and then, datasets were compared using independent t-tests, with a threshold of P < 0.05. RESULTS: Neoniti rotary files caused significantly less canal transportation of the curved canals (P=0.0001). On the other hand, the time required for canal preparation was significantly shorter for One Shape (P=0.0001). No instrument separation was recorded in both groups. CONCLUSION: Based on these results, the Neoniti™ rotary file system is preferred because it maintains the original shape of curved root canals better than One Shape™; even though this benefit comes at the cost of an increase in preparation time in clinical practice, the better technical performance may be more important than a difference in procedural time.

A long-lasting emerging epidemic of anthroponotic cutaneous leishmaniasis in southeastern Iran: population movement and peri-urban settlements as a major risk factor.

BACKGROUND: Epidemics of cutaneous leishmaniasis (CL) are occurring more frequently and spreading faster and farther than before in many areas of the world. The present study aimed to assess a long-lasting emerging epidemic (2005-2019) of 5532 cases with anthroponotic CL (ACL) in peri-urban areas of Kerman city in southeastern Iran. METHODS: This descriptive-analytical study was carried out for 15 years in Kerman province, southeastern Iran. The data were passively obtained through the health surveillance system and the Kerman Leishmaniasis Research Center. Every subject was diagnosed using direct smear microscopy. The representative causative agent was further examined by ITS1-PCR, PCR-RFLP, 7SL RNA gene sequencing and phylogenetic analyses. For each subject, a case report form designating demographic and clinical data was recorded. RESULTS: A different pattern of ACL incidence was found in peri-urban areas compared to that in the city of Kerman. The incidence rate of ACL cases has significantly increased (P < 0.001) from 2005 to 2016 in new settlements with a gradual decline after that. The overall average risk of contracting the disease was 7.6 times higher in peri-urban areas compared to Kerman city, an old endemic focus. All isolates consisting of six variants were confirmed to be Leishmania tropica. The overall pattern of the ACL infection indicates that the etiological agent of ACL is propagated and transmitted by the bite of female Phlebotomus sergenti sandflies from person to person from dissimilar clones as reflected by the complexity of the migrants' backgrounds in the province. CONCLUSIONS: The movement of populations and establishment of new settlements in peri-urban areas close to endemic areas are major risk factors for and are directly linked to CL. The underlying factors of this emerging ACL epidemic caused by L. tropica were disasters and droughts, among others. A robust commitment to a multilateral approach is crucial to make improvements in this area. This will require decisive coordinated actions through all governmental factions and non-governmental organizations. Furthermore, active and passive case detection strategies, early diagnosis, and effective treatment could help control the disease.

Comparison of Dentinal Wall Thickness in the Furcation Area (Danger Zone) in the First and Second Mesiobuccal Canals in the Maxillary First and Second Molars Using Cone-Beam Computed Tomography.

Objective: Differences in the morphology of the root canal system might result in favorable or adverse treatment outcomes. The present study compared the thickness of the dentinal wall in the danger zone (furcation area) of the first and second mesiobuccal canals in the maxillary first and second molars using cone beam computed tomography. Methods: In this cross-sectional study, 50 CBCT images of maxillary first and second molars were evaluated from one of the specialized radiology centers in Kerman, Iran. The images were prepared by a Planmeca Promax 3D Max machine (Planmeca, Helsinki, Finland), with a field of view (FOV) of 8×8 cm and a resolution of 0.1 mm and analyzed with Romexis Viewer software version 3.1.1 (Planmeca, Helsinki, Finland). In the 0.1-mm-thick axial cross-sections with a distance of 1 mm, the distances from the center of the MB1 and MB2 root canals to the furcation area were measured in three areas: A) furcation area, B) 2 mm below the furcation area, and C) 4 mm below the furcation area (at a magnification of ×10). The data were then analyzed with paired t-test. Results: The thickness of the dentinal wall in the MB2 root canal was significantly less than that in the MB1 root canal in all the specimens (P<0.05). In both maxillary first and second molars, the thicknesses of the MB1 and MB2 root canals were significantly different in the furcation area and 4 mm below the furcation area (P=0.001). There was no significant difference between the maxillary first and second molars 2 mm below the furcation area; however, the difference was marginal (P=0.07). Conclusion: Considering the low thickness of the dentinal wall in the MB2 root canal compared with the MB1 root canal in the maxillary first and second molars, the anti-curvature techniques away from the furcation should be used to prepare this root canal to reduce the risk of strip perforation. On the other hand, it might indicate that highly tapered instruments and other aggressive instruments, such as Gates-Glidden drills, should be used with caution in these root canals.

Prevalence and Associated-Factors for Entamoeba gingivalis in Adolescents in Southeastern Iran by Culture and PCR, 2017.

BACKGROUND: This study aimed to identify the prevalence and potential factors associated with Entamoeba gingivalis in adolescents in the city of Kerman, southeastern Iran, 2017. METHODS: In this descriptive cross-sectional study, 315 adolescents (mean age; 15 yr) consisting of 189 males and 126 females were randomly selected. For each adolescent, two specimens were collected for culturing and examination by polymerase chain reaction (PCR). Univariate and multivariate logistic regression models were performed to explore any association with demographic and clinical variables. RESULTS: The prevalence of E. gingivalis was 11.7%. Totally, 30 (15.9%) males and 7 (5.6%) females were infected with E. gingivalis. The rate of infection in males was 2.8 times higher than that in females (P<0.001). Statistical analysis identified 4 major factors including sex (OR=4.12, P<0.001), gingival index with severe inflammation (OR = 50, P<0.001), Candida spp. infection (OR=4.41, P<0.001) and decay-missing-filled teeth [DMFT (OR=3.27, P<0.001)]. In contrast to the aforementioned factors, adolescents with history of antibiotic consumption were significantly protected from E. gingivalis infection (OR= 3.24, P<0.001). Culture media detected 9.2% (n= 29), whilst PCR identified 11.4% (n= 36) of infection. CONCLUSION: The present findings clearly demonstrate a positive association between E. gingivalis and distinct demographic and clinical risk determinants. Therefore, dental practitioners and health surveillance personnel should be aware of these confounding factors to rigorously detect and critically manage oral health issues in school-age children in order to prevent or at least minimize the eventual periodontal complications in later life.

Treatment of a Maxillary Second Molar with One Buccal and Two Palatal Roots Confirmed with Cone-Beam Computed Tomography.

Root canal configuration is an important subject in endodontic practice and dentists should be familiar with all possible types of root canal configuration. A forty-three year old male was referred for root canal treatment of his maxillary left second molar tooth with symptomatic irreversible pulpitis. Pre-operative radiographs showed a three rooted molar. However, after access cavity preparation two palatal and one buccal orifices were detected. The patient was informed of the unusual root canal anatomy and cone-beam computed tomography (CBCT) was ordered for precise evaluation of the anatomy. CBCT image confirmed the presence of one buccal and two palatal root canals; an exceptionally rare condition.