A Novel Intervention Technology for Cerebral Palsy: Brain Stimulation.

A common pediatric disorder with posture and motor dysfunction in neurological diseases is known as cerebral palsy (CP). Recently, a series of effective techniques have been developed for treatment of CP. These promising methods need high-tech equipment for brain stimulation and mainly classified into invasive and no-invasive approaches. This study aimed to introduce these techniques for treatment of patients who suffer from CP. The potential and performance of currently available brain stimulation techniques have been mentioned in detail. Moreover, the clinical application, safety, efficacy and challenges of these methods have been discussed. Here we review the recent advances in the CP treatment with an emphasis on brain stimulation techniques.

The effect of adding fentanyl to epinephrine-containing lidocaine on the anesthesia of maxillary teeth with irreversible pulpitis: a randomized clinical trial.

INTRODUCTION: Deep and long-lasting anesthesia is essential throughout endodontic treatment. This study was conducted to compare the effect of adding fentanyl to epinephrine-containing lidocaine on depth and duration of local anesthesia in painful maxillary molars with irreversible pulpitis (IRP). METHODS AND MATERIALS: This randomized double-blind, clinical trial with parallel design was conducted on 61 healthy volunteers; the control group received a mixture of normal saline and 2% lidocaine with 1:80000 epinephrine and the experimental group received a mixture of fentanyl and 2% lidocaine with 1:80000 epinephrine. The depth and duration of pulpal anesthesia were evaluated by means of electric pulp testing in 5-min intervals during a period of 60 min. Pain intensity was recorded five times: before injection, after injection, during access cavity preparation, initial file placement and pulpectomy using visual analog scale (VAS). All data were analyzed and compared using the chi-square and Mann-Whitney tests. RESULTS: Except for one patient in the control group, all others had deep and long-lasting anesthesia. The difference between pain intensity of the control and experimental groups was not statistically significant (P>0.05). CONCLUSION: Addition of fentanyl to conventional local anesthetic solution did not increase the effectiveness of infiltration in patients diagnosed with IRP.

Evaluation of isthmus prevalence, location, and types in mesial roots of mandibular molars in the Iranian Population.

BACKGROUND: Management of canal isthmus is considered as an important factor for successful endodontic treatment. Accordingly, this study was designed to determine the prevalence, location, and types of isthmus in mesial root canals of extracted mandibular molars in a sample of Iranian population. MATERIALS AND METHODS: In this cross-sectional descriptive study, 60 extracted molars with two mesial canals were included. The samples were initially decoronated and then, roots were sectioned horizontally at 2, 4, and 6 mm levels from the apex via a low-speed handpiece with a thin metallic disk and finally prepared and stained with Indian ink. All sections were examined using a stereomicroscope at a magnification of ×30. Prevalence, location, and types of isthmus were evaluated based on the classifications by Kim and Teixeira and all data were statistically analyzed by the chi-squared test. The statistical significance level was established at 0.05. RESULTS: Eighty-three percent of extracted mandibular molars had an isthmus at the mesial root. This prevalence increased with distance from the apex, that is, 92% at 6 mm from the apex and 70% at 2 mm from the apex. A statistically significant difference was found between the sections at 2 and 6 mm from the apex (P < 0.05), but no other significant differences between other levels (P > 0.05). CONCLUSION: Isthmus is very common in the mesial roots of the mandibular permanent molars in the Iranian population, with the highest prevalence in the 6 mm distance from the root apex. Therefore, detection, cleaning, and filling of these apical 6 mm isthmuses are of great benefit in modern endodontics.

The best time for EEG recording in febrile seizure.

OBJECTIVE: Some studies suggest that detection of epileptic discharge is unusual during the first postictal week of febrile seizure and others believe that EEGs carried out on the day of the seizure are abnormal in as many as 88% of the patients. In this study, we intend to compare early and late EEG abnormalities in febrile seizure. MATERIALS & METHODS: EEG was recorded during daytime sleep, 24-48 hours (early EEG) and 2 weeks (late EEG) after the seizure in 36 children with febrile seizure (FS), aged between 3 months and 6 years. EEGs that showed generalized or focal spikes, sharp, spike wave complex, and slowing were considered as abnormal EEG. Abnormalities of the first EEG were compared with those of second EEG. RESULTS: The most common abnormal epileptiform discharges recorded in the early EEG were slow waves (27.6%) and sharp waves in late EEG (36%). Distribution of abnormalities in early and late EEG showed no significant statistical difference. CONCLUSION: The early and late EEG recording had the same results in patient with febrile seizure.

Mineral Trioxide Aggregate Mixed with Normal Saline, Calcium Chloride or KY Jelly as Apical Plug in Simulated Open Apices: An In vitro Microleakage Study.

INTRODUCTION: Mineral trioxide aggregate (MTA) mixed with normal saline has short working time, delayed setting time, and poor consistency when used as an apical plug. A preliminary study suggested that substituting normal saline with KY Jelly or 5% calcium chloride (CaCl2) as a vehicle expedites the setting time of MTA. The present in vitro study compared the microleakage of ProRoot MTA mixed with normal saline (MS) to that of ProRoot MTA mixed with KY Jelly and/or 5% CaCl2 in simulated canals with open apices. MATERIALS AND METHODS: Thirty six single-rooted extracted human teeth were cleaned and shaped with ProTaper rotary system to make 36 standardized artificially created open apices. Teeth were randomly divided into three experimental groups (n=10) and two control groups (n=3). In group 1, MTA was mixed with normal saline (MS) and placed into the canals to form 4 to 5 mm apical plugs. In group 2, MTA was mixed with 5% CaCl2 (MC) and in group 3, MTA was mixed with KY Jelly (MK). The other two groups served as positive and negative controls. The remaining canal spaces in the experimental groups were backfilled with thermoplasticized gutta-percha without sealer. Dye penetration and clearing was used to evaluate the sealing ability of each group. The samples were then examined under stereomicroscope to measure the microleakage of different MTA mixtures in mm. Data were statistically analyzed using One-Sample Kolmogorov-Smirnov test for determination of normal distribution and then by one-way ANOVA and Tukey's tests to detect any significance. RESULTS: Positive and negative controls responded as expected. The MS group showed the least mean dye penetration value. There was a significant difference between MS with other groups (P<0.05) but no difference was found between MC and MK groups. CONCLUSION: Within the limitations of this in vitro study, we can conclude that among these three vehicles, normal saline mixed with ProRoot MTA has the least amount of microleakage in canals with open apices.

Comparison of vaccination-related pain in infants who receive vapocoolant spray and breastfeeding during injection.

BACKGROUND: Vaccination is one of the most common painful procedures in infants. Despite the irreparable consequences and complications of acute pain in infants, and existence of pharmacological and non-pharmacological methods for pain control, pain control in infants has received less attention. Therefore, this research aimed to compare the vaccination-related pain in infants younger than 6 months who receive vapocoolant spray and breastfeeding during injection, in order to suggest a strategy to provide emotional, mental, and physical health for infants. MATERIALS AND METHODS: This is a randomized clinical trial study on 144 infants less than 6 months of age, referred to Ibn Sina Health Care Center in 2009, who were selected by convenience sampling. Forty-eight infants were allocated through systematic random sampling to each study group (i.e., breastfeeding, vapocoolant spray, and control group). Inclusion criteria were: Fully conscious infants, lack of any disease (sensory, motor abnormalities, cold, etc.), taking no medication, exclusive breastfeeding, vaccination for hepatitis B and DTP, regular visits to health care center, infants with Iranian nationality, and quiet infants who did not cry. The infant was excluded if he/she was crying and it was impossible to make him/her quiet before injection. Data were gathered by a questionnaire (six questions) and checklist [neonatal infant pain scale (NIPS)]. Data were analyzed by descriptive and inferential statistical methods through SPSS. RESULTS: The findings suggest that breastfeeding during vaccination has a more analgesic effect on vaccination pain, compared to application of vapocoolant spray before vaccination. In 64.6% of the infants, breastfeeding during vaccination caused analgesia, while 25% of the infants who received vapocoolant spray experienced analgesic effect. There was a significant difference in pain between the infants who received vapocoolant spray and those on breastfeeding during injection (P < 0.001). CONCLUSION: It seems that breastfeeding during vaccination in infants under 6 months of age is an effective, natural, safe, accessible, and inexpensive method without side effects to reduce vaccination-related pain.