Anesthetic efficacy of a combination palatal and buccal infiltration of the maxillary first molar.

INTRODUCTION: The purpose of this prospective, randomized, single-blind crossover study was to evaluate the anesthetic efficacy of a combination palatal and buccal infiltration of the maxillary first molar. MATERIALS AND METHODS: Using a crossover design, 40 subjects received two sets of maxillary first molar infiltrations at two separate appointments spaced at least 1 week apart. The anesthetic used in this study was 2% lidocaine with 1:100,000 epinephrine. One set of infiltrations consisted of a buccal infiltration of 1.8 mL of anesthetic and a palatal infiltration of 0.5 mL of anesthetic. The other set consisted of a buccal infiltration of 1.8 mL of anesthetic and a mock palatal infiltration. The first molar was pulp tested in 4-minute cycles for a total of 60 minutes. Anesthetic success was defined as no subject response to two consecutive 80 readings with an electric pulp tester. RESULTS AND CONCLUSIONS: The success rates were 88% for the buccal infiltration and 95% for the buccal plus palatal infiltration. The difference was not statistically significant. The buccal plus palatal infiltration significantly increased the incidence of pulpal anesthesia from 21 minutes through 57 minutes. Although there was an increased incidence of pulpal anesthesia with the combination buccal plus palatal infiltration, anesthesia was not provided for 60 minutes.

Longitudinal analysis of immune cell phenotypes in early stage multiple sclerosis: distinctive patterns characterize MRI-active patients.

To investigate whether peripheral immune abnormalities are associated with brain inflammation in multiple sclerosis, and whether differences in MRI activity are paralleled by changes in leukocyte composition, we conducted a prospective longitudinal study in patients at their clinical onset. Twenty patients presenting a first inflammatory event in the central nervous system suggestive of multiple sclerosis underwent, every 45 days for one year, immunophenotyping of 98 blood cell subsets together with brain MRI and clinical evaluation. Six patients showed intense MRI activity, six patients did not display MRI activity, while the remaining 8 patients had low (i.e. intermediate) MRI activity during the follow-up. Our results show that MRI-active and MRI-inactive patients display significant differences in ten lymphocyte subsets. Among these, there are both effector (CCR7-CD45RA-CD4+ alphabeta T cells, CCR5+ gammadelta T cells) and regulatory (DN CD28+ alphabeta T cells and CD25+CD8+ alphabeta T cells) lymphocytes pertaining to the innate and the acquired arms of the immune system. Moreover, these differences were, upon employment of a class prediction procedure based on "support vector machines" algorithm utilizing leave-one-out cross validation procedures, able to correctly assign patients to their respective MRI activity group. All 6 MRI-active and 6 MRI-inactive patients were correctly classified, and, upon application of a class prediction model in an unsupervised manner to the 8 patients with intermediate MRI activity, 6 were predicted as MRI-active and 2 as MRI-inactive patients. Also, when the mean values of the first three time points (T0, T1 and T2) were used for the prediction of all patients, the selected lymphocyte subsets correctly classified 90% of patients. Sensitivity was 91.7% and specificity was 87.5%. These results provide evidence showing that brain inflammation in multiple sclerosis is associated with distinct changes in peripheral lymphocyte subsets, and raise the possibility that the identified subsets may, after adequate validation, assist in the prediction of MRI activity in the early stages of multiple sclerosis.