The Comparison of Midazolam and Propofol in Gastrointestinal Endoscopy: A Systematic Review and Meta-analysis.

INTRODUCTION: Midazolam and propofol are both used for sedation in gastrointestinal endoscopy. We conducted a systematic review and meta-analysis to compare the efficacy and safety of midazolam and propofol in gastrointestinal endoscopy. MATERIALS AND METHODS: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials assessing the effect of midazolam versus propofol on sedation in gastrointestinal endoscopy are included. Two investigators have independently searched for articles, extracted data, and assessed the quality of included studies. This meta-analysis was performed using the random-effect model. RESULTS: Five randomized controlled trials involving 552 patients were included in the meta-analysis. Overall, compared with midazolam sedation during gastrointestinal endoscopy, propofol sedation results in higher endoscopist satisfaction scores during gastrointestinal endoscopy than midazolam [standard mean difference (Std. MD)=-0.71; 95% confidence interval (CI)=-1.05 to -0.37; P<0.0001), but the comparison shows no remarkable influence on patient satisfaction scores between midazolam and propofol (Std. MD=-0.34; 95% CI=-0.88 to 0.20; P=0.21), procedure time (Std. MD=0.14; 95% CI=-0.13 to 0.42; P=0.31), hypoxia [risk ratio (RR)=0.86; 95% CI=0.53-1.38; P=0.53), and bradycardia (RR=1.05; 95% CI=0.54-2.06; P=0.89). In addition, propofol shows higher incidence of hypotension than midazolam (RR=0.58; 95% CI=0.34-0.99; P=0.04). CONCLUSIONS: When compared with midazolam sedation for gastrointestinal endoscopy, propofol sedation results in higher endoscopist satisfaction scores, but may increase the incidence of hypotension.

Root and canal morphology of maxillary second molars by cone-beam computed tomography in a native Chinese population.

Objective To evaluate the root and root canal morphology of the maxillary second molars (MSMs) in a native Chinese population by cone-beam computed tomography. Methods Cone-beam computed tomography images of 2412 MSMs from 1294 Chinese patients were analyzed to determine the number and morphology of the roots, the root canal morphology, the bilateral symmetry, and the correlations of these parameters with sex and age. Results The percentage of fused roots increased with age, while the percentage of fused roots in women was higher than that in men. The percentage of second mesiobuccal (MB2) canals in MSMs with three separate roots was higher in men than women. Patients aged 31 to 40 years showed a higher prevalence of MB2 canals, while those aged ≥51 years showed the lowest prevalence of MB2 canals among both men and women. There was a significant difference in bilateral symmetry of MSMs between men and women. Conclusion Root fusion of MSMs increased with age, while the root canal morphology was more complex in patients of intermediate ages.

A Gold Nanoparticle Platform for the Delivery of Functional TGF-ß1 siRNA Into Cancer Cells.

Nanoparticles, especially gold nanoparticles (AuNPs), have been shown to be an efficient carrier to deliver small RNAs into cancer cells. In this study, we used cysteamine-functionalized AuNPs to effectively deliver TGF-ß1 siRNA into hepatoma HepG2 cells in vitro and in vivo. We found that, compared with AuNPs-mediated NC siRNA (AuNP-siNC), AuNPs-delivered TGF-ß1 siRNA (AuNP-siTGFß1) efficiently decreased the level of TGF-ß1, increased cell apoptosis, and significantly inhibited the proliferation of recipient tumour cells. Systemic administration of the AuNP-siTGFß1 complexes into human HepG2 xenografted mice likewise reduced TGF-ß1 expression and downstream TGF-ß1 signalling. Functionally, AuNP-siTGFß1 strongly inhibited tumour growth and improved the survival rate of tumour-bearing mice compared with the control groups. In conclusion, our results demonstrate that the siRNA delivery system with AuNP described here appears to be a highly effective method to deliver RNAi therapeutics into tumour cells for oncotherapy.

Bilateral maxillary fused second and third molars: a rare occurrence.

This case report describes the diagnosis and endodontic therapy of maxillary fused second and third molars, using cone-beam computed tomography (CBCT). A 31-year-old Chinese male, with no contributory medical or family/social history, presented with throbbing pain in the maxillary right molar area following an unsuccessful attempted tooth extraction. Clinical examination revealed what appeared initially to be a damaged large extra cusp on the buccal aspect of the distobuccal cusp of the second molar. However, CBCT revealed that a third molar was fused to the second molar. Unexpectedly, the maxillary left third molar also was fused to the second molar, and the crown of an unerupted supernumerary fourth molar was possibly also fused to the apical root region of the second molar. Operative procedures should not be attempted without adequate radiographic investigation. CBCT allowed the precise location of the root canals of the right maxillary fused molar teeth to permit successful endodontic therapy, confirmed after 6 months.

The clinical treatment of complicated root canal therapy with the aid of a dental operating microscope.

OBJECTIVES: To evaluate the clinical application of the dental operating microscope (DOM) in the management of complicated root canal therapy. METHODS: 345 teeth with 546 root canals which could not be successfully managed by conventional methods received therapy under the DOM with ultrasonic instruments by the same endodontists. The aetiology of the canals included calcification, broken instrument, missed canal and canal perforation. The teeth and canals successfully managed were then calculated. RESULTS: 406 canals were successfully managed with a rate of 74.4%; 246 teeth were successfully managed with a rate of 71.3%. The rates in each category of the complicated root canals were: 74.0% for calcified canals, 72.3% for canals blocked by broken instruments, 82.5% for missed canals and 72.7% for canal perforations. CONCLUSIONS: The clinical application of the DOM is an effective way of managing complicated root canal therapy.

[Report and analysis of periodicals of oral science in China].

OBJECTIVE: To review and analyze the history and current situation of stomatological journals in China from 1949 to 2009. METHODS: The data from journal database, web sites and yearbooks were collected, and the information on Chinese dental journals, national economic indicators and the development in dental disciplines from 1949 to 2009 were obtained. RESULTS: The dental journals numbered one kind, four issues in 1949 and 32 kinds, 204 issues in 2009. China's gross domestic product (GDP) was from 67.9 billion Yuan in 1949 to 30.067 trillion Yuan in 2008. CONCLUSIONS: The quantity of stomatological journals in China has increased remarkably over the past 60 years.

Identifying and reducing risks for potential fractures in endodontically treated teeth.

INTRODUCTION: Although long-term functional survival rates can be high for initial endodontically treated permanent teeth, they are generally more susceptible to fracture than teeth with vital pulps. Tooth extraction is often the consequence of an unfavorable prognosis after coronal and root fractures, but their occurrence in endodontically treated teeth might be reduced by identifying the risks for fracture associated with various operative procedures. METHODS: This article presents an overview of the risk factors for potential tooth fractures in endodontically treated teeth on the basis of literature retrieved from PubMed and selected journal searches. RESULTS: Postendodontic tooth fractures might occur because of the loss of tooth structure and induced stresses caused by endodontic and restorative procedures such as access cavity preparation, instrumentation and irrigation of the root canal, obturation of the instrumented root canal, post-space preparation, post selection, and coronal restoration and from inappropriate selection of tooth abutments for prostheses. CONCLUSIONS: Potential tooth fractures might be reduced by practitioners being aware during dental treatments of controllable and noncontrollable risks.

[Shear bond strength of anterior teeth fragment reattachment using two different adhesive materials].

OBJECTIVE: To compare the shear bond strength of the fractured anterior teeth reattached by two different adhesive materials. METHODS: Forty crown fractured anterior modes were divided into two groups randomly, with 20 in each group. Group A were reattached by Clearfil SE Bond and Clearfil AP-X, while group B were reattached by Clearfil S3 Bond and Clearfil AP-X. Then the specimens were submitted to an axial compression test in a universal testing machine until tooth fractured. The strength was recorded. RESULTS: The mean shear bond strength of group A and group B was (324.32 +/- 65.91) N and (263.08 +/- 55.88) N, separately. The mean shear bond strength of group A was statistically higher than group B(t = 3.17, P = 0.000). CONCLUSION: The shear bond strength of two-step adhesive Clearfil SE Bond is higher than one-step adhesive Clearfil S3 Bond for the reattachment of fractured anterior teeth.

Fracture resistance and pattern of the upper premolars with obturated canals and restored endodontic occlusal access cavities.

We studied whether obturing canals and restoring endodontic occlusal access cavities on upper premolars could provide acceptable resistance and pattern to fracture. Eighteen upper premolars were divided equally into 3 groups. Group 1 consisted of intact controls; group 2 had access cavities and root canal preparations; group 3 as in group 2 but obturated with gutta-percha and AH26, and the access cavity restored with glass ionomer and composite. Specimens were submitted to compressive strength testing using the Hounsfield Universal H50KM testing machine with a load cell of 2000 Newtons and a crosshead speed set at 1.0 mm/min until fracture. The results from the compressive strength tests showed that intact controls (1105.83±90.93 MPa) and restored premolars (936.67±44.67 MPa) were significantly different from premolars with unrestored access cavities 568.33±105.49 MPa. There was no significant difference between intact controls and restored premolars. The predominant fracture pattern for intact teeth was an oblique fracture. For premolars that had endodontic access cavities, restored or unrestored, the most common fracture pattern was a vertical fracture. The restoration of occlusal access cavities with glass ionomer and composite provided fracture resistance close to that of intact controls, but when restored teeth fractured, they were predominantly non-restorable.

[Diagnostic test study of dental operating microscope used for locating the second mesiobuccal canal orifice in maxillary first molars].

OBJECTIVE: To estimate the diagnostic potential of the dental operating microscope used for locating the second mesiobuccal canal (MB2) orifice in maxillary first molars. METHODS: 120 extracted maxillary first molars were used, all the access cavities were prepared and fixed on the dental study model. MB2 orifices were examined with naked eye and under a dental operating microscope (DOM). The examination was repeated by another dentist with the same methods. Then Indian ink was injected into the pulp chamber and all the teeth were treated to be transparent to determine if it had a real MB2. RESULTS: The sensitivity and accuracy of the DOM group were 0.78 and 0.76, higher than 0.61 and 0.65 of the naked eye group (P<0.05). The correspondency of Kappa index between observers by naked eye and DOM was 0.701 and 0.819, respectively. CONCLUSION: The use of DOM can increase the detection rate of MB2.

[Investigation of root canal curvature of human maxillary first premolar in buccolingual directions].

OBJECTIVE: To investigate root canal curvatures of human maxillary first premolars in buccolingual directions. METHODS: One hundred extracted permanent maxillary first premolars were used. After access preparation, a K-file was inserted into the canals and gently advanced until it reached the apical foramen. Then standardized periapical radiovisiography (RVG) images were taken from mesiodistal direction. The angle of curvature was determined according to the method described by Schneider. The radiu of curvature and length of the curved part of the root canal were calculated. RESULTS: 1) The total 50.00% (88/176) of root canal curves were in buccolingual directions, and 53 curves were showed in apical 1/3 of root region. 11.93% (21/176) of S-shaped canals were detected, and the first curves were mostly showed in middle 1/3 of root region, the secondary curves were totally showed in apical 1/3 of root region. 2) There was no difference of curvatures between buccal and lingual root canals, but the secondary curves of S-shaped canals were more complicated than other root canals. 3) There was no correlation between the angle of curvature and the radius of curvature (r=0.002, P>0.05), but significantly correlation between the angle of curvature and length of the curved part of the root canal (r=0.489, P<0.01). CONCLUSION: The occurrence of curved root canals in buccolingual directions may be high in human maxillary first premolars, and the curvatures of S-shaped canals were more complicated than others.

The C-shaped root canal configuration: a review.

Recognition of unusual variations in the canal configuration is critical because it has been established that the root with a single tapering canal and apical foramen is the exception rather than the rule. The early recognition of these configurations facilitates cleaning, shaping, and obturation of the root canal system. "C" configuration, which is an important anatomic variation, presents a thin fin connecting the root canals. Because of the importance of its true diagnosis and treatment, a comprehensive review of published information and investigations about it in addition to approaches for its treatment is necessary.

[Cost-minimization analysis of two methods during the prevention of dental fear during caries filling treatments].

OBJECTIVE: To determine the economic effects on the prevention of dental fear (DF) by pre-operation-education or local anesthesia method during the process of tooth filling. METHODS: One hundred and fifty school children of age 7 to 12, participating in this study, suffered from occlusal caries on their mandibular first molars. They were divided into 3 groups, with 25 boys and 25 girls each. Group A (pre-operation-education) was showed video tape on caries to, familiarized with clinic environment, including dental chairs and instruments; Group B (local anesthesia) received injection of 1.8 ml of 2% lidocaine for local anesthesia about 15 minutes before treatment; Group C (blank) received no intervention for DF. Thereafter, all subjects received same filling treatment. During that process, each DF case was evaluated blindly based on Venham's clinical ratings of anxiety and cooperation. Cost-minimization analysis was then studied. RESULTS: Significant difference was found between groups, but not between group A and B in DF rate (5/50, 9/50 and 21/50, chi(2) = 15.503 1, P = 0.000 4). The costs of each case in 3 groups were 83.99 Yuan, 87.09 Yuan and 87.76 Yuan respectively. CONCLUSION: Between pre-operation-education and local anesthesia methods, the former was worth promoted for it's better clinical effect in DF prevention with lower cost.

Randomized controlled trial study for preventing dental fear during caries treatments.

OBJECTIVE: To determine the clinical effects of preventing dental fear (DF) by pre-operation-education or local anesthesia method during the process of tooth filling. METHODS: 150 school children, aged 7 to 12, participated present study. All of them suffered from occlusal caries on their mandibular first permanent molars. They were divided into 3 equal groups, and each had 50, 25 boys and 25 girls. Group1 (pre-operation-education): taking about 1 hour to show them science and educational video tape on caries, then, clinic environment, including machine and instruments, and answering their questions; Group2 (local anesthesia): about 15 minutes before treatment, injecting 1.8 ml of 2% lidocaine for local anesthesia; Group3 (blank): without any measurements for DF. After that, all subjects accepted same filling treatment as usual. DF of each case was evaluated by 3 evaluators blindly based on venham's clinical ratings of anxiety and cooperative. RESULTS: Significant difference was found between groups (0.57 +/- 0.59, 0.83 +/- 0.66, 1.05 +/- 0.68, H = 18.646, P = 0.0001), also in DF rate (10%, 18% and 42%, chi(2) = 15.5031, P = 0.0004). But not between groups 1 and 2. CONCLUSION: During decayed tooth filling treatment, pre-operation-education is better than that of local anesthesia method, in DF prevention.