Outcome of full pulpotomy in mature permanent molars using 3 calcium silicate-based materials: A parallel, double blind, randomized controlled trial.

AIM: The aim of the study was to compare the outcome of full pulpotomy using 2 calcium silicate-based materials compared with mineral trioxide aggregate (MTA) in symptomatic mature permanent teeth with carious pulp exposure. METHODOLOGY: This study was designed as a parallel, double blind, randomized controlled trial where symptomatic mature permanent teeth with carious pulp exposure meeting the inclusion criteria were randomly treated with full pulpotomy using one of 3 calcium silicate-based materials (ProRoot MTA, Biodentine and TotalFill). Full pulpotomy was performed, and haemostasis was achieved via a cotton pellet moistened with 2.5% NaOCl. A 3-mm layer of the calcium silicate-based material was randomly placed as the pulpotomy agent through a block randomization process followed by a resin-based composite restoration. Postoperative periapical radiograph was taken. Clinical and radiographic evaluation were completed after 6 months and 1 year. The patient and evaluator were blinded to the type of materials used. Pain levels were scored preoperatively and 7 days after treatment. Effect of potential prognosis factors including gender, age, diagnosis, bleeding time and type of caries were also analysed. RESULTS: One hundred and sixty-four teeth in 146 patients received full pulpotomy and were randomly assigned to either the tested or control material through block randomization technique (50 MTA, 50 Biodentine and 64 TotalFill). The age ranged from 10 to 70 years. The diagnosis was irreversible pulpitis in 112 teeth (72%) and reversible pulpitis in 28 teeth (28%). The majority of patients presented with severe pain, during the first week 96.9% reported complete relief of pain or mild pain. Four cases had immediate failure. At 6 months the overall success rate was 92.2%, over 1 year 156/164 teeth attended follow-up with 12 failures (2 restorative failures and 10 endodontic failures), the overall success of pulpotomy at 1 year was 92.3% (144/156); 91.8% in MTA, 93.3% in Biodentine and 91.9% in TotalFill with no significant difference amongst the groups and no side effects observed. No significant association was evident between outcome and the investigated variables. CONCLUSIONS: The 1-year success rate of full pulpotomy did not differ significantly between Biodentine pulpotomy, TotalFill pulpotomy, and MTA pulpotomy. The study was registered with clinical trials; registration number (NCT04345263).

Utility of Equivalence and Cognition Models in Enhancing Validity of Translated Questionnaires: A Methodological Example Using the Heart Quality-of-Life Questionnaire.

BACKGROUND: The cross-cultural adaptation of questionnaires has tenuous theoretical underpinnings that limit the rigor of data collection and the meaningful analysis of cognitive interview data. An adaptation of existing models of equivalence and cognition provides structure to the comprehensive investigation of various equivalence types in enhancing the validity of translated questionnaires. PURPOSE: In this study, a framework comprising equivalence and cognition models was used to assess and finalize the Heart Quality-of-Life (HeartQoL)-Bahasa Malaysia (BM) questionnaire, which was derived from both forward-backward (FB) and dual-panel (DP) translation methods. METHODS: Investigation and finalization of two initial versions of the questionnaire were conducted based on findings from an expert assessment (n = 3 sociolinguists blinded to translation methods) and cognitive interviews with purposively sampled patients (FB: n = 11; DP: n = 11). The equivalence model of Herdman et al. and the question-and-answer model of Collins were adapted to form a "cognition-and-equivalence" model to guide data collection and analysis through modified cognitive interviews. The final HeartQoL-BM was completed by 373 patients with ischemic heart disease from two medical centers, and the data were analyzed using confirmatory factor analysis to assess the evidence of equivalence. RESULTS: Findings from the expert assessment and cognitive interview showed the existence of semantic and item equivalence on almost all of the FB and DP items, identified some subtle potential equivalence gaps, and guided the process of item finalization. Confirmatory factor analysis, including tests of factorial invariance on the final two-factor model of HeartQoL-BM, confirmed conceptual, item, measurement, and operational equivalence, which supports functional equivalence. CONCLUSIONS: The potential use of the cognition-and-equivalence model for modified cognitive interviewing and the application of the six equivalence types of Herdman et al. were supported by the HeartQoL-BM showing functional equivalence with its source. HeartQoL-BM is a potentially valid measure of health-related quality of life for patients with ischemic heart disease independent of conditions such as angina, myocardial infarction, and heart failure.

Study of electric conduction mechanisms in bismuth silicate nanofibers.

This work represents the nature of conduction mechanism in bismuth silicate (BiSiO) nanofibers as a function of temperature and frequency. Scanning electron micrographs and X-rays diffraction patterns exhibited the formation of cubic phases of Bi4(SiO4)3 and Bi12SiO20 nanofibers respectively with an average diameter of ~200 nm. Temperature dependent (300 K-400 K) electrical characterization of fibers was carried out in frequency range of ~20 Hz-2 MHz. The complex impedance analysis showed contribution from bulk and intergranular parts of nanofibers in conduction. Moreover, analysis of the Cole-Cole plot confirmed the space charge dependent behavior of BiSiO nanofibers. Two types of relaxation phenomena were observed through Modulus analysis. In ac conductivity curve, step like feature of plateau and dispersive regions were described by Maxwell-Wagner effect while the dc part obeyed the Arrhenius law. However, frequency dependent ac conductivity revealed the presence of conduction mechanism in diverse regions that was ascribed to large polaron tunneling model. Detailed analysis of complex Impedance and ac conductivity measurement showed negative temperature coefficient of resistance for the BiSiO nanofibers. Current-voltage (IV) characteristics represented ohmic conduction; followed by space charge limited current conduction at intermediate voltages. Results from both ac and dc measurements were in good agreement with each other.

Application of a new system for classifying root canal morphology in undergraduate teaching and clinical practice: a national survey in Malaysia.

AIM: To evaluate and compare the feedback of final year undergraduate dental students in eight Malaysian dental schools on the application of a new system for classifying root canal morphology in teaching and clinical practice. METHODS: One PowerPoint presentation describing two classification systems for root canal morphology (Oral Surgery Oral Medicine Oral Pathology, 1974 38, 456 and its supplemental configurations, International Endodontic Journal 2017, 50, 761) was delivered to final year undergraduate dental students in eight dental schools in Malaysia by two presenters (each presented to four schools). To examine students' feedback on the utility of each system, printed questionnaires consisting of six questions (five multiple choice questions and one open-ended question) were distributed and collected after the lecture. The questionnaire was designed to compare the classification systems in terms of accuracy, practicability, understanding of root canal morphology and recommendation for use in pre-clinical and clinical courses. The exact test was used for statistical analysis, with the level of significance set at 0.05 (P = 0.05). RESULTS: A total of 382 (out of 447) students participated giving a response rate of 86%. More than 90% of students reported that the new system was more accurate and more practical compared with the Vertucci system (P < 0.001). Overall, 97% of students reported the new system helped their understanding of root and canal morphology compared with the Vertucci classification (P < 0.001). Over 97% of students recommended the use of the new system in teaching, pre-clinical courses and clinical practice (P < 0.001). Except for two schools, no significant difference was detected between the responses of students for all questions at the different schools (P > 0.05). The students' responses for all questions were almost similar for both presenters (P > 0.05). CONCLUSIONS: The new system of International Endodontic Journal 2017, 50, 761 for classifying root and canal morphology was favoured by final year undergraduate dental students in Malaysia. The new system has the potential to be included in the undergraduate endodontic curriculum for teaching courses related to root and canal morphology.

Experience of a rapid access falls and syncope service at a teaching hospital in Kuala Lumpur.

No abstract available.

Modest Amounts of Voluntary Exercise Reduce Pain- and Stress-Related Outcomes in a Rat Model of Persistent Hind Limb Inflammation.

Aerobic exercise improves outcomes in a variety of chronic health conditions, yet the support for exercise-induced effects on chronic pain in humans is mixed. Although many rodent studies have examined the effects of exercise on persistent hypersensitivity, the most used forced exercise paradigms that are known to be highly stressful. Because stress can also produce analgesic effects, we studied how voluntary exercise, known to reduce stress in healthy subjects, alters hypersensitivity, stress, and swelling in a rat model of persistent hind paw inflammation. Our data indicate that voluntary exercise rapidly and effectively reduces hypersensitivity as well as stress-related outcomes without altering swelling. Moreover, the level of exercise is unrelated to the analgesic and stress-reducing effects, suggesting that even modest amounts of exercise may impart significant benefit in persistent inflammatory pain states. PERSPECTIVE: Modest levels of voluntary exercise reduce pain- and stress-related outcomes in a rat model of persistent inflammatory pain, independently of the amount of exercise. As such, consistent, self-regulated activity levels may be more relevant to health improvement in persistent pain states than standardized exercise goals.

Evaluation of Two New Indices of Blood Pressure Variability Using Postural Change in Older Fallers.

To evaluate the utility of blood pressure variability (BPV) calculated using previously published and newly introduced indices using the variables falls and age as comparators.While postural hypotension has long been considered a risk factor for falls, there is currently no documented evidence on the relationship between BPV and falls.A case-controlled study involving 25 fallers and 25 nonfallers was conducted. Systolic (SBPV) and diastolic blood pressure variability (DBPV) were assessed using 5 indices: standard deviation (SD), standard deviation of most stable continuous 120 beats (staSD), average real variability (ARV), root mean square of real variability (RMSRV), and standard deviation of real variability (SDRV). Continuous beat-to-beat blood pressure was recorded during 10 minutes' supine rest and 3 minutes' standing.Standing SBPV was significantly higher than supine SBPV using 4 indices in both groups. The standing-to-supine-BPV ratio (SSR) was then computed for each subject (staSD, ARV, RMSRV, and SDRV). Standing-to-supine ratio for SBPV was significantly higher among fallers compared to nonfallers using RMSRV and SDRV (P = 0.034 and P = 0.025). Using linear discriminant analysis (LDA), 3 indices (ARV, RMSRV, and SDRV) of SSR SBPV provided accuracies of 61.6%, 61.2%, and 60.0% for the prediction of falls which is comparable with timed-up and go (TUG), 64.4%.This study suggests that SSR SBPV using RMSRV and SDRV is a potential predictor for falls among older patients, and deserves further evaluation in larger prospective studies.

Investigation of change in surface area and grain size of cadmium titanate nanofibers upon annealing and their effect on oxygen sensing.

We have investigated the phase changes in CdTiO3 nanofibers as the annealing temperature of nanofibers was increased from 600 to 1200 °C. The nanofibers annealed at 600 °C were ilmenite with a very small amount of CdO. Upon annealing at 950 °C, CdO was completely removed. Annealing at 1000 °C yielded pure perovskite nanofibers, and at temperatures above 1100 °C rutile TiO2 nanofibers were obtained. Brunauer-Emmett-Teller (BET) analysis showed that with increase in annealing temperature the surface area of nanofibers was decreased. The nanofibers annealed at 600 °C have the higher surface area of ∼9.41 m(2)/g. Then oxygen sensors using CdTiO3 nanofibers annealed at 600 °C (ilmenite) and 1000 °C (perovskite) were fabricated. The sensitivity of the ilmenite nanofibers sensor was 2 times than that of the perovskite nanofibers sensor. The response and recovery times were 120 and 23 s, respectively, for the ilmenite nanofibers sensor, whereas response and recovery times were 156 and 50 s, respectively, for the perovskite nanofibers sensor. Better oxygen characteristics of ilmenite nanofibers are attributed to their large surface area and porosity. Therefore, we believe that ilmenite CdTiO3 nanofibers are potential candidates to develop practical oxygen sensors.

Narcolepsy in Parkinson's disease.

Non-motor symptoms in Parkinson's disease (PD), such as excessive daytime sleepiness, 'sleep attacks', insomnia, restless legs syndrome and rapid eye movement sleep behavior disorder, are common and provide a challenge to treatment. These sleep symptoms are also described in patients suffering from the sleep/wake disorder, narcolepsy. The International Classification of Sleep Disorders (ICSD-2) narcolepsy criteria uses a number of markers for diagnosis, of which lack or deficiency of cerebrospinal fluid (CSF) hypocretin-1 levels is a key marker. Hypocretin neurons prominently located in the lateral hypothalamus and perifornical nucleus have been proposed to interact with mechanisms involving sleep and arousal. Low hypocretin-1 levels in the CSF have been shown to correlate with hypothalamic hypocretin cell loss in narcolepsy and other forms of hypersomnia; therefore, it has been proposed that degenerative damage to hypocretin neurons (such as in PD) may be detected by low CSF hypocretin-1 concentrations, and may also explain the sleep symptoms experienced by some PD patients. To date, there is mixed conflicting data describing hypocretin-1 levels in the CSF of patients with parkinsonism associated with sleep symptoms, with most studies showing no significant decrease when compared with controls. However, hypocretin-1 CSF deficiency has been shown in some studies to be more prominent in PD patients with sleep symptoms versus those without. Notably, the hypocretin system has been shown not to be selectively disrupted, with one study showing melanin concentrating hormone cell loss in the same patients with hypocretin loss. It is likely that hypocretin deficiency in PD patients occurs secondary to collateral damage caused by the neurodegenerative process involving the hypothalamus. Awareness of narcoleptic events in PD is important for driving related advice, in addition to the possible use of dopamine D3 receptor active agonists.

Clinical experience in coronary stenting with the Vivant Z Stent.

This single centre study was designed to demonstrate feasibility, safety and efficacy of the Vivant Z stent (PFM AG, Cologne, Germany). Patients with de novo lesion were recruited. Coronary angioplasty was performed with either direct stenting or after balloon predilatation. Repeated angiogram was performed 6 months later or earlier if clinically indicated. Between January to June 2003, a total of 50 patients were recruited (mean age 55.8 +/- 9 years). A total of 52 lesions were stented successfully. Mean reference diameter was 2.77 mm (+/-0.59 SD, range 2.05-4.39 mm) with mean target lesion stenosis of 65.5% (+/-11.6 SD, range 50.1-93.3%). Forty-six lesions (88.5%) were American College of Cardiologist/American Heart Association class B/C types. Direct stenting was performed in 18 (34.6%) lesions. Mean stent diameter was 3.18 mm (+/-0.41 SD, range 2.5-4 mm), and mean stent length was 14.86 mm (+/-2.72 SD, range 9-18 mm). The procedure was complicated in only one case which involved the loss of side branch with no clinical sequelae. All treated lesions achieved Thrombolysis In Myocardial Infarction 3 flow. Mean residual diameter stenosis was 12.2% (+/-7.55 SD, range 0-22.6%) with acute gain of 1.72 mm (+/-0.50 SD, range 0.5-2.8). At 6 months, there was no major adverse cardiovascular event. Repeated angiography after 6 months showed a restenosis rate of 17% (defined as >50% diameter restenosis). Mean late loss was 0.96 mm (+/-0.48 SD) with loss index of 0.61 (+/-0.38 SD). The restenosis rate of those lesions less than 3.0 mm in diameter was 22.2% compared with 6.25% in those lesions more than 3.0 mm in diameter. The Vivant Z stent was shown to be safe and efficacious with low restenosis rate in de novo coronary artery lesion.