Effectiveness of training before unsedated MRI scans in young children: a randomized control trial.

BACKGROUND: Young children requiring clinical magnetic resonance imaging (MRI) may be given general anesthesia. General anesthesia has potential side effects, is costly, and introduces logistical challenges. Thus, methods that allow children to undergo awake MRI scans are desirable. OBJECTIVES: To compare the effectiveness of mock scanner training with a child life specialist, play-based training with a child life specialist, and home book and video preparation by parents to allow non-sedated clinical MRI scanning in children aged 3-7 years. MATERIALS AND METHODS: Children (3-7 years, n=122) undergoing clinical MRI scans at the Alberta Children's Hospital were invited to participate and randomized to one of three groups: home-based preparation materials, training with a child life specialist (no mock MRI), or training in a mock MRI with a child life specialist. Training occurred a few days prior to their MRI. Self- and parent-reported functioning (PedsQL VAS) were assessed pre/post-training (for the two training groups) and pre/post-MRI. Scan success was determined by a pediatric radiologist. RESULTS: Overall, 91% (111/122) of children successfully completed an awake MRI. There were no significant differences between the mock scanner (89%, 32/36), child life (88%, 34/39), and at-home (96%, 45/47) groups (P=0.34). Total functioning scores were similar across groups; however, the mock scanner group had significantly lower self-reported fear (F=3.2, P=0.04), parent-reported sadness (F=3.3, P=0.04), and worry (F=3.5, P=0.03) prior to MRI. Children with unsuccessful scans were younger (4.5 vs. 5.7 years, P<0.001). CONCLUSIONS: Most young children can tolerate awake MRI scans and do not need to be routinely anesthetized. All preparation methods tested, including at-home materials, were effective.

A radiographic assessment of the distances from the sacral hiatus to the lower lumbar spinous processes

The objective of this work is to determine whether the linear distances from the sacral hiatus to the lower lumbar spinous process are normally distributed when measured on Magnetic resonance images. In an observational study the distance from the sacral hiatus to the inferior border of the lower lumbar spinous processes was measured and analysed in sixty nine subjects on sagittal magnetic resonance images of the pelvis. Analysis of all distances with the Anderson- Darling Normality test showed the distances from the sacral hiatus to the 4th and 5th lumbar spinous processes to be normally distributed. The distances in males and females from the sacral hiatus to the fifth lumbar spinous process were 83.0 (13.7) mm and 71.0 (12.7) mm, respectively. The distances in males and females from the sacral hiatus to the fourth lumbar spinous process were 101.6 (14.2) mm and 92.2 (11.6) mm respectively. A significant inverse correlation between age and distance from the sacral hiatus to the 5th lumbar spinous processes was found in males in a magnetic resonance study. The distances from the sacral hiatus to the 4th and 5th lumbar spinous processes are normally distributed. These preliminary data may help to develop techniques to help prevent the neurological injury associated with neuraxial injections (AU)

No disponible

Long-term durability of one-step adhesive-composite systems to enamel and dentin.

This study evaluated the long-term durability of three one-step adhesive-composite systems to ground enamel and dentin. Twenty-seven teeth were randomly divided into three groups of nine. The first group had its crowns sectioned to expose superficial dentin, which was then ground with 600 grit SiC paper. One of three one-step adhesives: a trial bonding agent, OBF-2; i Bond or Adper Prompt L-Pop was applied to the dentin of three teeth and built-up with the corresponding resin composite (Estelite sigma, Venus or Filtek Supreme). The second group of nine teeth had their enamel approximal surfaces ground with wet 600-grit SiC paper, then one of the three one-step adhesives was applied and built-up with resin composite. The bonded specimens were sliced into 0.7 mm-thick slabs. After 24 hours and one year of water storage at 37 degrees C, the slabs were sectioned into beams for the microtensile bond strength test. Failure modes were observed using optical and electron scanning microscopy. The third group of nine teeth had approximal wedge-shaped cavities prepared above the CEJ into dentin. Two-to-three grains of rhodamine B were added to each of the three adhesives prior to restoring the cavities with resin composite. After 24 hours storage, the teeth were sectioned and their interfaces examined with a laser scanning confocal microscope. The bond strengths of the three adhesive-composite systems to both enamel and dentin significantly lessened after one year of water storage, however, there was no significant difference between the materials.

Self-etching primers: is prophylactic pumicing necessary? A randomized clinical trial.

The purpose of this clinical trial was to determine whether pumice prophylaxis is required before the use of a self-etching primer (SEP). A total of 30 patients undergoing treatment with full upper and lower fixed appliances were recruited into this randomized cross-mouth controlled trial. In all cases, stainless steel orthodontic brackets were bonded using Transbondtrade mark XT adhesive after pretreatment of the enamel surface using a new SEP. Diagonally opposite quadrants of the mouth were randomly assigned to have the enamel either pumiced or not pumiced before the use of a SEP. Bond failures, along with the adhesive remnant index (ARI) scores, were recorded at 6 and 12 months into treatment. The data were subsequently analyzed in terms of odds ratio and associated 95% confidence interval. Because of the very high bond failure rates of 55.5% for the no-pumice group and 33.2% for the pumice group, patient recruitment ceased at only 14 patients. Although the bond failure rates were unacceptably high in both groups, pumicing was found to have a clinically and statistically significant effect on reducing clinical bond failure rates. The ARI scores in all cases were 0, indicating that no adhesive remained on the enamel surface at bond failure. The significance of this trial is that pumicing before the use of an SEP is to be recommended, although the SEP used in this study cannot be recommended for clinical use.