Reasons for Repeated General Anesthesia for Dental Treatments of Uncooperative Children

Objectives: In some cases, dental treatment of children under general anesthesia (GA) should be repeated due to treatment failures. This study evaluated the reasons leading to dental retreatment under GA in children under 12 years of age. Materials and methods:In this retrospective study, the records of all children who underwent dental treatment under GA between 2011-2021 in Tabriz Dental Faculty Hospital, Iran, were collected. The records of children treated under GA for the second time or more were analyzed. Collected data included age at first treatment, mental and/or physical disabilities, type of treatments and participation in follow-up sessions. Data were analyzed using Stata SE version 17. Results:In a group of 667 children who underwent general anesthesia for the first time (GA1), 41% (95% confidence interval [CI] 37.2%-44.9%) required retreatment. Among all age groups, 1-3-year-old children were more likely to require a second GA (GA2) compared to other age groups (all P < 0.05). Children with physical and mental disabilities were around eight times more likely to require a second GA (P < 0.05). Conclusion:Younger age, mental and physical disabilities, no or irregular participation in follow-up sessions and treatments such as composite resin restorations or pulpotomy were factors influencing repeated dental treatments under general anesthesia.

CXCL9 and its Receptor CXCR3, an Important Link Between Inflammation and Cardiovascular Risks in RA Patients

Cardiovascular disease (CVD) is the most common cause of mortality in rheumatoid arthritis (RA), and Inflammation has a decisive role in its pathogenesis. CXCL9 contributes to multi aspects of inflammatory reactions associated with the pathogenesis of CVD. In the current study, we evaluated the association of plasma CXCL9 and CXCR3 gene expression with Cardiovascular risk factors in RA patients for the first time. Thirty newly diagnosed, 30 on-treatment RA patients, and 30 healthy subjects were recruited in this study. The plasma concentration of CXCL9 and CXCR3 gene expression were measured using ELISA and Real-Time PCR, respectively. The CVD risk was evaluated using Framingham Risk Score (FRS) and Systematic Coronary Risk Evaluation (SCORE). The plasma levels of CXCL9 were significantly higher in the newly diagnosed and on-treatment RA patients compared to the control group (P < 0.0001 and P < 0.001, respectively). Also, The CXCR3 gene expression was strongly elevated in newly diagnosed and on-treatment patients (P < 0.001 and P < 0.01, respectively). The CXCL9 and CXCR3 were significantly associated with RA disease activity (P = 0.0005, r = 0.436; P = 0.0002, r = 0.463, respectively). The FRS was remarkably higher in newly diagnosed and on-treatment patients (P = 0.014 and P = 0.035, respectively). The CXCR3 gene expression significantly correlated with age, systolic blood pressure, FRS, and SCORE (P = 0.020, r = 0.298; P = 0.006, r = 0.346; P = 0.006, r = 0.349; P = 0.007, r = 0.341, respectively). The CXCL9 plasma concentration had a significant negative correlation with plasma HDL and LDL levels (P = 0.033, r = -0.275; P = 0.021, r = -0.296, respectively). CXCL9 and CXCR3 correlates with different variables of CVD in RA.

Effects of topical fluoride treatment on the bond strength of pit and fissure sealants: A systematic review

Background

This systematic review aimed to evaluate the available scientific evidence concerning the effects of topical fluoride treatment on the bond strength of pit and fissure sealants. Prevention of dental caries is one of the crucial issues in pediatric dentistry. Pit and fissure sealant and fluoride therapies are two caries prevention procedures that may be performed in one session. However, fluoride therapy may affect the bond strength of pit and fissure sealants.

Methods

An electronic search for in vitro studies published in English and Persian on topical fluoride therapy and the bond strength of pit and fissure sealants was performed via PubMed/ Medline, Web of Science, Google Scholar, Embase, and Scopus databases until May 2022. The articles were independently reviewed for quality by two reviewers. Textual data were analyzed manually, and the bond strength of sealants placed after fluoride application was compared with control groups.

Results

A total of 8482 articles were initially identified and reviewed by two independent reviewers, and 13 were selected for full-text evaluation. Finally, six articles were included in the systematic review. A total of 250 teeth were studied, 148 of which were in the case group (fluoride group) and 102 in the control group. Tensile and shear bond strengths were compared between groups in the studies.

Conclusion

In the studies in which the tooth surfaces were washed after applying fluoride, there was no change in the fissure sealant bond strength. However, in studies in which fluoride was not washed, the bond strength decreased significantly, independent of the fluoride type.

Mini-Review: Role of Drugs Affecting Renin-Angiotensin System (RAS) in Traumatic Brain Injury (TBI): What We Know and What We Should Know

Traumatic brain injuries (TBIs) are among the most important clinical and research areas in neurosurgery, owing to their devastating effects and high prevalence. Over the last few decades, there has been increasing research on the complex pathophysiology of TBI and secondary injuries following TBI. A growing body of evidence has shown that the renin-angiotensin system (RAS), a well-known cardiovascular regulatory pathway, plays a role in TBI pathophysiology. Acknowledging these complex and poorly understood pathways and their role in TBI could help design new clinical trials involving drugs that alter the RAS network, most notably angiotensin receptor blockers and angiotensin-converting enzyme inhibitors. This study aimed to briefly review the molecular, animal, and human studies on these drugs in TBI and provide a clear vision for researchers to fill knowledge gaps in the future.

Mechanisms accounting for gendered differences in mental health status among young Canadians: A novel quantitative analysis

Adolescent girls consistently report worse mental health than boys. This study used reports from a 2018 national health promotion survey (n = 11,373) to quantitatively explore why such gender-based differences exist among young Canadians. Using mediation analyses and contemporary social theory, we explored mechanisms that may explain differences in mental health between adolescents who identify as boys versus girls. The potential mediators tested were social supports within family and friends, engagement in addictive social media use, and overt risk-taking. Analyses were performed with the full sample and in specific high-risk groups, such as adolescents who report lower family affluence. Higher levels of addictive social media use and lower perceived levels of family support among girls mediated a significant proportion of the difference between boys and girls for each of the three mental health outcomes (depressive symptoms, frequent health complaints, and diagnosis of mental illness). Observed mediation effects were similar in high-risk subgroups; however, among those with low affluence, effects of family support were somewhat more pronounced. Study findings point to deeper, root causes of gender-based mental health inequalities that emerge during childhood. Interventions designed to reduce girls' addictive social media use or increase their perceived family support, to be more in line with their male peers, could help to reduce differences in mental health between boys and girls. Contemporary focus on social media use and social supports among girls, especially those with low affluence, warrant study as the basis for public health and clinical interventions.

The efficacy of intrathecal methyl-prednisolone for acute spinal cord injury: A pilot study

Study design

Randomized clinical trial.

Objectives

To evaluate the safety and effectiveness of intrathecal methyl-prednisolone compared to intravenous methyl-prednisolone in acute spinal cord injuries.

Setting

Imam Reza Hospital, Tabriz University of Medical Sciences.

Methods

Patients meeting our inclusion and exclusion criteria were enrolled in the study and divided randomly into two treatment arms: intrathecal and intravenous. Standard spinal cord injury care (including surgery) was given to each patient based on our institutional policy. Patients were then assessed for neurological status (based on ASIA scores, Frankel scores) and complications for six months and compared to baseline status after injury. To better understand the biological bases of methyl-prednisolone on spinal cord injuries, we measured two biomarkers for oxidative stress (serum malondialdehyde and total antioxidant capacity) in these patients at arrival and day three after injury.

Results

The present study showed no significant difference between the treatment arms in neurological status (sensory scores or motor scores) or complications. However, the within-group analysis showed improvement in neurological status in each treatment arm within six months. Serum malondialdehyde and total antioxidant capacity were analyzed, and no significant difference between the groups was seen.

Conclusion

This is the first known clinical trial investigating the effect of intrathecal MP in acute SCI patients. Our finding did not show any significant differences in complication rates and neurological outcomes between the two study arms. Further studies should be conducted to define the positive and negative effects of this somehow novel technique in different populations as well.

Accuracy of Teledentistry for Diagnosis and Treatment Planning of Pediatric Patients during COVID-19 Pandemic

Teledentistry is a new technology in the dentistry field, which has great benefits during pandemic such as the coronavirus disease 2019 (COVID-19). The overall purpose of the study was to assess the diagnostic sensitivity and specificity of virtual (mobile phone teledentistry) compared with clinical examinations during COVID-19. The basic design of the study was based on the comparison treatment plans by the students and the gold standard (clinical treatment plan of an expert pedodontist with 10 years of clinical experience). This double-blind clinical trial was conducted on 20 children (aged 6 to 12 years) with a chief complaint of dental caries with or without pain. An appropriate radiograph and five standard intraoral photographs (frontal view occlusion, maxillary occlusal view, mandibular occlusal view, right lateral view, and left lateral view) were prescribed for each patient according to the guidelines of the American Association of Pediatric Dentistry. Then, the treatment plan for the carious teeth was recorded for each patient. Each patient underwent a clinical examination at first and was followed randomly by a virtual examination by two dental students. Then, the clinical and virtual treatment plans were compared with each other, and also with the gold standard. The sensitivity and specificity values were calculated for each group. The accuracy of the diagnosis was measured by applying Cohen's kappa. Interexaminer reliability was measured using the intraclass correlation coefficient (ICC) and Cronbach's alpha. The mean kappa coefficient for the interexaminer agreement (for 24 teeth) was 0.62 in clinical and 0.69 in virtual examinations. The results showed no significant difference in the treatment plans of students and the gold standard (P > 0.05). The diagnostic sensitivity and specificity were 73.22% and 95.8% for clinical and 76.44% and 92.9% for virtual treatment plans showing no significant differences between virtual (mobile phone teledentistry) and clinical examinations (P > 0.05). The intraexaminer reliability of the examiners was found to be 0.92 by calculating the ICC. Then, teledentistry can be considered as a supplement to clinical examinations of pediatric dentistry, finally resulting in better patient management. However, more studies are necessary for teledentistry.

Factors Affecting the Duration of Fixed Orthodontic Treatment in Patients Treated in a University Department between 2016 and 2020

Objective:The aim of this study was to assess the effect of possible influential factors on duration of fixed orthodontic treatment. Methods:This cross-sectional retrospective study included 505 female and 183 male orthodontic patients (a total of 688 persons) referring to a university department of orthodontics during 2016-2020. The study population included only those who had undergone fixed orthodontic treatment of both maxillary and mandibular arches. Information including age, gender, total treatment duration, number of missed treatment sessions, incidences of bracket debonding, and type of treatment plan were collected from patient records. Data were analyzed using SPSS software version 21 at 0.05 significance level. Results:The mean duration of orthodontic treatment was significantly longer in men than women (19.09±5.6 versus 18.22±4.56 months, respectively; P=0.040). The treatment duration was also longer in patients with a treatment plan including teeth extraction compared to non-extraction treatment plans (19.85±4.30 versus 17.56±5.02 months, respectively; P<0.001). Duration of treatment in patients with more than one missed treatment appointment was significantly longer than those who had . one missed session (P<0.001). Duration of treatment in patients with bracket debonding was significantly longer (P=0.030). Also, the duration of treatment had a significant correlation with the frequency of both missed sessions (r=0.365, P<0.001) and bracket debonding (r=0.098, P=0.01). Conclusion:Based on the results of the present study, missed sessions, treatment plan, and bracket debonding have the greatest effect on the duration of fixed orthodontic treatment.

Vital pulp therapy following pulpotomy in immature first permanent molars with deep caries using novel fast-setting calcium silicate cement: A retrospective clinical study

OBJECTIVES

To compare the success rate of vital pulp therapy following complete pulpotomy in immature first permanent molars, during caries treatment, using novel fast-setting calcium silicate cement (Novel CSC) versus MTA.

METHODS

Six- to eight- years old children, who received pulpotomy of first immature permanent molar using one layer novel CSC (Protooth) or two layers slow-setting MTA (MTA Angelus) covered with glass ionomer were recalled for radiographic and clinical evaluation after two years. The effects of cement type, age, gender, jaw, anesthesia type, and restoration type were assessed on the clinical success of pulpotomy and continued root formation (apexogenesis) as the treatment outcome.

RESULTS

Out of 366 included teeth in the study, 316 teeth were available for statistical analysis. The mean observation time was 28.2 ± 2.7 months. Novel CSC showed significantly higher clinical success rate (93.1%) compared to MTA (84.5%). Restored teeth with stainless steel crowns after pulpotomy and treatments performed under general anesthesia had a statistically significant effect on treatment outcome in contrast to age, gender, and jaw type.

CONCLUSION

The observations of this retrospective study suggested that the success rate of vital pulp therapy following complete pulpotomy using one layer fast-setting novel CSC was significantly higher than slow-setting MTA covered with glass ionomer. Treatment under general anesthesia and restoration using stainless steel crowns influenced the treatment outcome.

CLINICAL SIGNIFICANCE

Novel fast-setting calcium silicate cement is a promising new biomaterial for vital pulp therapy in immature permanent molars that allows complete root formation overtime with apexogenesis. Clinicians must also be aware of the importance of immediate definitive restoration and proper sealing and isolation in vital pulp therapy.

A novel application of a data mining technique to study intersections in the social determinants of mental health among young Canadians

Objectives

Adolescent mental health is an emergent clinical and public health priority in Canada. Gender-based differences in mental health are well established. The objective of this study was to evaluate a new data mining technique to identify social locations of young Canadians where differences in mental health between adolescent males and females were most pronounced.

Methods

We examined reports from 21,221 young Canadians aged 11-15 years (10,349 males, 10,872 females) who had responded to a 2018 national health and health behaviours survey. Using recursive partitioning for subgroup identification (SIDES), we identified social locations that were associated with the strongest differences between males and females for three reported mental health outcomes: positive psychosomatic health, symptoms of depression, and having a diagnosed mental illness.

Results

The SIDES algorithm identified both established and new intersections of social factors that were associated with gender-based differences in mental health experiences, most favouring males.

Discussion

This analysis represents a novel proof-of-concept to demonstrate the utility of a subgroup identification algorithm to reveal important differences in mental health experiences between adolescent males and females. The algorithm detected new social locations (i.e., where gender intersected with other characteristics) associated with poor mental health outcomes. These findings set the stage for further intersectional research, involving both quantitative and qualitative analyses, to explore how axes of discrimination may intersect to shape potential gender-based health inequalities that emerge during childhood.

Chronically altered NMDAR signaling in epilepsy mediates comorbid depression

Depression is the most common psychiatric comorbidity of epilepsy. However, the molecular pathways underlying this association remain unclear. The NMDA receptor (NMDAR) may play a role in this association, as its downstream signaling has been shown to undergo long-term changes following excitotoxic neuronal damage. To study this pathway, we used an animal model of fluoxetine-resistant epilepsy-associated depression (EAD). We determined the molecular changes associated with the development of depressive symptoms and examined their response to various combinations of fluoxetine and a selective neuronal nitric oxide synthase inhibitor, 7-nitroindazole (NI). Depressive symptoms were determined using the forced swim test. Furthermore, expression and phosphorylation levels of markers in the ERK/CREB/ELK1/BDNF/cFOS pathway were measured to determine the molecular changes associated with these symptoms. Finally, oxidative stress markers were measured to more clearly determine the individual contributions of each treatment. While chronic fluoxetine (Flxc) and NI were ineffective alone, their combination had a statistically significant synergistic effect in reducing depressive symptoms. The development of depressive symptoms in epileptic rats was associated with the downregulation of ERK2 expression and ELK1 and CREB phosphorylation. These changes were exactly reversed upon Flxc + NI treatment, which led to increased BDNF and cFOS expression as well. Interestingly, ERK1 did not seem to play a role in these experiments. NI seemed to have augmented Flxc’s antidepressant activity by reducing oxidative stress. Our findings suggest NMDAR signaling alterations are a major contributor to EAD development and a potential target for treating conditions associated with underlying excitotoxic neuronal damage.

Comparison of Effects Exerted by 4% Articaine Buccal Infiltration and 2% Lidocaine Inferior Alveolar Nerve Block on Pain Perception and Behavioral Feedback of Children during Pulp Treatment of Mandibular Second Primary Molars

Background: One of the most impressive factors discouraging many people from seeking dental treatment is the fear of experiencing pain during dental procedures. Thus, the use of an effective method for pain control is vital in this regard. Articaine, which has an additional ester and thiophene groups that increase its biosolubility and permeability compared to older anesthetic agents, can be more effective on inducing anesthesia during dental treatment. Given the inconsistent currently available information on this concept, the present study was designed to compare the efficacy of articaine with that of lidocaine on pain control during pulp treatment of deciduous molar. Methods and materials: In this cross-sectional study, 38 patients who needed pulpotomy in both mandibular second molar of primary teeth were randomly divided into two groups, using the Randlist software. In the first meeting, infiltration with articaine 4% (epinephrine 1/100 000) was performed for all patients in group 1 on the left side of the mandible. At the next appointment, inferior alveolar nerve block was done with lidocaine 2% on the right side of the mandible (epinephrine 1/80 000). Notably, for all patients in the second group, the first injection was performed on the right second primary molar with articaine 4% (epinephrine 1/100 000), and inferior alveolar nerve block was also done with lidocaine 2% on the left side of the mandible (epinephrine 1/80 000). Results:Of the 38 patients included in the current study, 10 (26.3%) subjects in the lidocaine group and nine (23.6%) in the articaine group complained of pain during their dental treatment procedures, but this difference was not statistically significant. Conclusion: According to the findings of this study, buccal infiltration of 4% articaine had a comparable anesthetic outcome to that of 2% lidocaine for inferior alveolar nerve block in pulp treatment of the second primary mandibular molars.

Complications of dual growing rod with all-pedicle screw instrumentation in the treatment of early-onset scoliosis

BACKGROUND

Treatment of early-onset scoliosis (EOS) is still a challenge to patients, families, and surgeons. Previous studies have indicated that EOS patients are at high risk for complications following growth-friendly surgery. This study was performed to evaluate the results and complications of all-pedicle screw dual growing rod instrumentation in the treatment of EOS.

METHODS

In an IRB-approved retrospective study, we searched the electronic medical records of our institution for all patients who underwent posterior spinal instrumentation for scoliosis between March 2014 and March 2017. Patients under the age of 10 at the time of surgery who were treated with a growth-friendly technique were then selected. Patients with incomplete records and less than 2 years of follow-up were excluded. Charts, operative notes, clinic visits, and radiographs were extracted. Radiographs were reviewed, and the main curve Cobb angle, thoracic kyphosis, pelvic tilt, pelvic incidence, sacral slope, and proximal junctional angles were measured. We specifically looked for any intra-operative or post-operative complications. Statistical analysis was performed to determine the risk factors of complications.

RESULTS

A total of 42 patients with a mean age of 4.8 ± 2.1 years (range, 1.5-8 years) were included in the final analysis. Patients were followed for a median of 34 months (range, 24-55). The major curve was corrected from a mean of 42.9° ± 10.7° to 28.8° ± 9.6° at the latest follow-up. Proximal junctional angles and thoracic kyphosis increased significantly during the follow-up period (both P values < 0.001). A total of 7 complications (17%) were observed. Four patients (10%) developed superficial surgical site infections, all of which resolved with antibiotics and one round of surgical debridement. Three cases (7%) of proximal junctional kyphosis (PJK) were encountered during the study period, none of which required revision surgery. Pre-operative thoracic kyphosis was the only significant risk factor for the development of PJK.

CONCLUSIONS

Our findings suggest that in settings without access to magnetically controlled growing rods, dual growing rods with all-pedicle screw instrumentation is still a viable treatment strategy with comparable results and complications. The most common complications are infection and PJK, with the latter being associated with a larger pre-operative thoracic kyphosis.

Resilience factors associated with physical function in vulnerable older adults from four countries

Background

Adverse childhood experiences (ACEs) include an array of maltreatment and they have been shown to confer higher risks of early mobility loss and ultimately disablement in older ages. This study aims to identify resilience factors associated with physical function in a diverse sample of older adults (65-74 years) from the 2012 International Mobility in Aging Study (IMIAS) who reported ACEs.

Methods

2002 participants were recruited from Kingston, Ontario; St. Hyacinthe, Quebec; Tirana, Albania; Manizales, Colombia; and Natal, Brazil. Economic ACEs were classified by self-report of at least one-poor childhood economic status, childhood hunger, parental unemployment-before the age of 15 years. The Short Physical Performance Battery was used to measure physical function; a score of &lt; 8 was considered poor. Associations between hypothesized resilience factors (education, social support, expressed gender roles) and physical function were identified via bivariate analysis and logistic regression; after adjusting for sex, age, and sample site.

Results

Nearly half (46%) the participants reported economic ACES. High levels of education (OR 0.39; CI: 0.22-0.66) and social support from family (OR: 0.52; CI: 0.36-0.76), partners (OR: 0.47; CI: 0.29-0.74), and friends (OR: 0.59; CI: 0.38-0.92), as well as masculine (OR:0.49; CI: 0.29-0.83) and androgynous (0.48; CI: 0.30-0.77) gender roles, protected against poor physical function for those reporting childhood economic ACEs.

Conclusions

Despite encountering economic ACEs, those who achieved high relative levels of education, greater levels of support, as well as those characterized by masculine or androgynous gender roles, were more likely to maintain good physical performance in older ages compared to those with low education, no social support, and those classified as undifferentiated gender roles. Findings highlight critical points of intervention for those who experienced ACES.

Key messages

These findings imply that the associated negative physical health outcomes of ACEs can be delayed or eliminated via exposure to certain protective factors. Economic ACE exposure may be unavoidable, but there are resilience factors that could be promoted to foster the better health across the life course.

Protective Effects of Leukadherin1 in a Rat Model of Targeted Experimental Autoimmune Encephalomyelitis (EAE): Possible Role of P47phox and MDA Downregulation

Background

Reactive oxygen and nitrogen species (ROS and RNS) are involved in pathologic mechanisms underlying demyelination and exacerbation in multiple sclerosis (MS) lesions. P47phox is the most important subunit of an ROS-producing enzyme (NADPH oxidase) which is reportedly upregulated in MS plaques due to the intense activity of infiltrated immune cells and resident microglia. Leukadherin1 is a specific CD11b/CD18 agonist that inhibits signaling and transmigration of inflammatory cells to sites of injury. Based on this mechanism, we evaluated therapeutic effects of leukadherin1 in an animal model of targeted experimental autoimmune encephalomyelitis (EAE) through focal injection of inflammatory cytokines to the spinal cord.

Methods

For model induction, Lewis rats were first immunized with 15µg MOG 1–125 emulsion. Twenty days later, animals were subjected to stereotaxic injection of IFNγ and TNFα to the specific spinal area (T8). One day after injection, all animals presented EAE clinical signs, and their behaviors were monitored for eight days through open-field locomotion and grid-walking tests. Leukadherin1-treated animals received daily intraperitoneal injections of 1mg/kg of the drug. The specific spinal tissues were extracted on day 5 in order to measure nitric oxide (NO), malon di-aldehyde (MDA), and TNFα concentrations alongside P47phox real-time PCR analysis. In addition, spinal sections were prepared for immunohistochemical (IHC) observation of infiltrated leukocytes and activated microglia.

Results

Leukadherin1 exhibited promising improvements in EAE clinical scores and behavioral tests. Demyelination, CD45+ leukocyte infiltration, and Iba1+ microglia activation were reduced in spinal tissues of leukadherin1-treated animals. Furthermore, P47phox expression levels, MDA, and NO amounts were decreased in treated animals. However, TNFα concentrations did not differ following treatment.

Conclusion

Based on our results, we suggest that leukadherin1 may be used as a novel therapeutic agent in tackling the clinical challenge of multiple sclerosis, especially during the acute phase of the disease. This effect was possibly mediated through decreased leukocyte infiltration and oxidative stress.

A narrative review on the management of Acute Heart Failure in Emergency Medicine Department

The main urgent symptom presented to an emergency department is acute heart failure (AHF). In that considerable risksof morbidity and mortality, it is important to plan precision medicine to achieve the most suitable outcomes. The object of this review is to provide a summary of contemporary management procedures of emergency medicine in a department of acute heart failure. Heart failure could be presented with a broad range of symptoms, in particular a sudden worsening of those of Chronic Obstructive Pulmonary Disease. The treatment should focus on acute and chronic underlying disorders with instructions focusing on haemodynamics and blood pressure status. Treatment of patients suffering with worsening symptoms of AHF mainly focuses on intravenous diuretics. In emergency situations, patients suffering with AHF with low blood pressure must receive emergency consultation and a primary fluid bolus therapy (range 250-500 mL) followed by inotropic therapy with or without antihypotensive agents. For treatment of severe heart failure and cardiogenic shock in patients treated with noradrenalin, when blood pressure support is required, a direct-acting inotropic agent, dobutamine, could be applied effectively. When non-invasive positive pressure ventilation is needed, suppliers must track for any possibility of sudden worsening, i.e., for acute decompensated heart failure. When cardiac output is high the disorder could be treated with vasopressors.

Closed Antegrade/Retrograde intramedullary fixation of central metatarsal fractures: Surgical technique and clinical outcomes

BACKGROUND

Intramedullary fixation with k-wires is a surgical option in the management of fractures of the shaft and neck of central metatarsals. The current study aimed at investigating the clinical outcomes of closed antegrade/retrograde intramedullary pinning technique.

PATIENTS AND METHODS

A total of 34 patients (26 males and eight females) with 58 metatarsal neck and shaft fractures (28 shaft and 26 neck fractures) were operated using the antegrade/retrograde intramedullary fixation technique. At the final follow-up visit, pain intensity was assessed using the visual analog scale (VAS) and foot function was evaluated by the American Orthopedic Foot and Ankle Society (AOFAS) forefoot scoring system.

RESULTS

Mean follow-up period was 18 months, ranged 12 to 34. Mean time to clinical fracture healing was 6.5 weeks, ranged 5 to 9. Bony union was occurred in all the cases. No surgical site infection was noted. Mean VAS score at the final follow-up visit was 0.28, ranged 0 to 3. At the final follow-up, the mean AOFAS score was 95.2, ranged 81 to 100.

CONCLUSION

Closed antegrade/retrograde intramedullary pinning is a minimally invasive technique to manage central metatarsal fractures. Using this technique, metatarsal alignment can be restored and good clinical outcome is achieved.

Children's Pain Perception and Behavioral Feedback during Local Anesthetic Injection with Four Injection Site Preparation Methods

Introduction:An effective pain control significantly contributes to an optimal dental treatment in pediatric dentistry. This study was conducted to compare children's pain perception and behavioral feedback during local anesthetic injection accompanied with counter-irritation, refrigerant, ice precooling or topical benzocaine. Methods:This study was conducted on 99 children who needed dental treatment in bilateral maxillary primary molars by local anesthesia. Subjects were randomly assigned to three groups, in which the injection site was prepared using counter-irritation in group I, ice precooling in group II, and refrigerant spray precooling in group III. In all three groups, 20% benzocaine gel was used in the injection site of opposite quadrant as a control. The perceived pain and behavioral feedback of children during injection were evaluated using the visual analogue scale (VAS) and sound, eye, and motor (SEM) indexes. Sign and Kruskal-Wallis tests were used to analyze data at a significance level of P < 0.05. Results:The perceived pain was significantly lower when using benzocaine compared to the other three methods (P < 0.05). Behavioral feedback of children when using benzocaine was not significantly different from the counter-irritation method (P=1.00). However, behavioral feedback with counter-irritation was significantly better than precooling (P < 0.05). Counter-irritation was significantly more effective than precooling methods in reduction of pain perception and improvement of behavioral feedback (P < 0.05). Conclusions:The perceived pain was significantly lower when the benzocaine method was used. Behavioral feedback was significantly better with benzocaine and counter-irritation methods compared to precooling procedures.

Prognosis in children with traumatic injuries referring to the emergency department

PURPOSE

Trauma may lead to serious complications in children patients. The purpose of this study was to investigate prognosis in children with traumatic injuries.

METHODS

This cross-sectional study was conducted on all of the children (<18 years old) who had suffered traumatic injuries and transferred to the emergency department of Imam Hussein Hospital by emergency medical services. After selecting the children, a checklist including information such as demographic characteristics, trauma type, consciousness level, and final outcome was recorded. Finally, the data were analyzed using t-test, Chi-square test and ANOVA.

RESULTS

In total of 564 children were investigated. Among them, 70% were males, and 33.2% were in the age range of 5-12 years. The mechanism of injuries in 97.9% of the cases was blunt trauma. The most common chief complaint among the affected children was nausea. The majority of them had stable vital signs and normal neurological tests results. However, 1.06% of them died during hospitalization. The results indicated that the final outcome in the children affected by traumatic injuries is significantly related to the type of trauma, the location of traumatic event, the vehicle used to transport them to emergency departments and their Glasgow coma scale score (p < 0.05).

CONCLUSION

Considering the young age of the child patients and over half of trauma happened at home, it is important to raise parents' awareness about the risky places and activities, which were likely to result in traumatic injuries for children.

Direct pulp capping of primary molars using a novel fast-setting calcium silicate cement: a randomized clinical trial with 12-month follow-up

Objective: Novel fast-setting calcium silicate cement with fluoride (Protooth) has been developed for potential applications in tooth crowns. The aim of this study was to evaluate the success rate of direct pulp capping in primary molars using two-layer mineral trioxide aggregate (MTA) and overlying glass ionomer cement versus one-layer novel calcium silicate cement with 4 to 10 minutes setting time. Materials and methods: Ninety bilaterally symmetrical primary molars in the same jaw in 45 patients aged 5 to 7 years were included. Exposed pulps following caries removal were randomly capped with one-layer novel calcium silicate cement or two-layer MTA and glass ionomer cement. All cavities were filled with amalgam. Clinical and radiographic evaluations were performed after six and twelve months. 41 patients were available for the evaluations at the end of the 12-month follow-up. Results: The overall success rate of direct pulp capping, in a split-mouth design, using MTA covered with glass ionomer cement or one-layer novel calcium silicate cement after 12 months were 90% (37 out of 41 cases) and 85% (35 out of 41 cases), respectively, without statistically significant differences after 6 and 12 months. Conclusion: Within the limitations of this study, clinical and radiographic evaluations suggested one-layer novel calcium silicate cement would be successfully used in direct pulp capping of primary molars as a practical alternative to two-layer MTA and overlying glass ionomer cement.

PIRO, SOFA and MEDS Scores in Predicting One-Month Mortality of Sepsis Patients; a Diagnostic Accuracy Study

INTRODUCTION

Different scoring systems based on clinical and laboratory findings are designed for prediction of short-term mortality of patients with severe sepsis and septic shock. This study aimed to compare the screening performance characteristics of PIRO, SOFA and MEDS Scores in predicting one-month mortality of sepsis patients.

METHODS

This diagnostic accuracy study was performed on septic shock and severe sepsis patients referring to emergency department of Loghmane Hakim Hospital, Tehran, Iran, from 2017 to 2018. The performance of MEDS, SOFA, and PIRO models in predicting 30-day mortality of patients was evaluated using discrimination and calibration indices.

RESULTS

200 patients with the mean age of 71.03±15.59 years were studied (61% male). During the 30 days, 66 patients died (mortality rate=33%). The area under the ROC curve of PIRO, MEDS, and SOFA scores were 0.83 (95% CI=0.78-0.89), 0.94 (95% CI=0.91-0.97) and 0.87 (95% CI=0.81-0.92), respectively. Based on Brier, Brier_Scaled and Nagelkerke's R² of the models, the best performance in predicting one-month mortality belonged to MEDS score. C-statistic showed that MEDS score had the highest value in the differentiation between the survived and non-survived cases.

CONCLUSION

This study showed that MEDS score performs better than PIRO and SOFA scores in predicting one-month mortality of patients with severe sepsis and septic shock.

Comparison of the effect of pharmacotherapy and neuro-feedback therapy on oral health of children with attention deficit hyperactivity disorder

Background

Attention deficit hyperactivity disorder (ADHD) is a chronic and progressive mental disorder related to the childhood period. This study aims to compare the oral health of two groups of ADHD children: those under pharmacotherapy and those under neuro-feedback therapy.

Material and Methods

72 ADHD children (aged 6-12) were divided into two 36 member groups: The pharmacotherapy group and the neuro-feedback therapy group. Unstimulated salivary flow (USF), DMFT, and plaque index were assessed in these children. Statistical analysis was carried out on the data with the independent t-test, which was performed using SPSS 16. The significance level of the study was p<0.05.

Results

In this study, the USF of ADHD children who used Ritalin was found to be significantly less than that of the neuro-feedback group (1.25 ± 1.21 vs. 1.91 ± 1.16 ml/min; p=0.002). Also, the plaque index (5.9 ± 3.1 vs. 3.94 ± 1.9; p=0.018) and DMFT scores (39% ± 9% vs. 31% ± 9%; p=0.018) were significantly higher for the pharmacotherapy group.

Conclusions

Neuro-feedback therapy is preferable to Ritalin treatment for ADHD children in terms of their oral health status. Key words:Attention deficit hyperactivity disorder, drug therapy, neurofeedback, oral health.

HPLC profiling of phenolics and flavonoids of Adonidia merrillii fruits and their antioxidant and cytotoxic properties

In this study the antioxidant and cytotoxicity activity of the Adonidia merrillii fruits were investigated using different solvent polarities (methanol, ethyl acetate and water). The results showed that the total phenolic and flavonoid contents of the methanolic extract was higher compare with other extract with respective values of 17.80 ± 0.45 mg gallic acid equivalents/g dry weight (DW) and 5.43 ± 0.33 mg rutin equivalents/g DW. Beside that The RP-HPLC analyses indicated the presence of gallic acid, pyrogallol, caffeic acid, vanillic acid, syringic acid, naringin and rutin. In the DPPH, NO2 and ABTS scavenging assays, the methanolic extract exhibited higher antioxidant activity as compared to the ethyl acetate and water extracts. The extracts exhibited moderate to weak cytotoxic activity in the assays using human hepatocytes (Chang liver cells) and NIH/3T3 (fibroblasts cell) cell lines. The findings showed the Adonidia merrillii fruit extracts to possess considerable antioxidant and cytotoxicity properties. The fruit, therefore, is a potential candidate for further work to discover antioxidant and cytotoxic drugs from natural sources.

Quality of Cardiopulmonary Resuscitation in Emergency Department Based on the AHA 2015 Guidelines; a Brief Report

INTRODUCTION

Adhering to existing guidelines on cardiopulmonary resuscitation (CPR) can increase the survival rate of the patients. The present study has been designed with the aim of determining the quality of CPR performed in the emergency department based on the latest protocol by the American heart association (AHA).

METHODS

In this prospective cross-sectional study CPR process was audited in patients above 18 years old in need of CPR presenting to the emergency departments of 3 teaching hospitals based on the AHA 2015 guidelines. Less than 60% agreement was considered as fail, 60-70% as poor, 70-80% as moderate, 80-90% as good, and 90-100% as excellent.

RESULTS

80 cases of CPR were audited (55% male). Location of arrest was the hospital in 58 (72.5%) cases and 48 (60.0%) of the cases happened during the day. 28 (35.0%) cases had orotracheal intubation before the initiation of CPR. 30 (37.5%) patients had a shockable rhythm at the initiation of CPR. Based on the findings, out of the 31 studied items, 9 (29.03%) had excellent agreement, 10 (32.25%) had good, 4 (12.90%) had moderate, 2 (6.45%) had poor, and 6 (19.35%) had fail agreement rate.

CONCLUSION

Based on the findings of the present study, the quality of applying the principles of basic and advanced CPR in the emergency department of the studied hospital had intermediate, poor and fail agreement with the recommendations of the AHA 2015 in at least one third of the cases.

Is it safe to discharge blunt abdominal trauma patients with normal initial findings?

BACKGROUND

Trauma is the leading health concern among young adults. Blunt abdominal trauma (BAT) is the most common type of blunt traumas. BAT patients may prove normal in the initial clinical assessments, but since the time required for an intra-abdominal injury to be clinically apparent is not predictable, deciding when to safely discharge these patients could be a dilemma. The purpose of this study is to determine whether follow-up of the early discharged or further diagnostic assessment of the later discharged BAT patients with normal initial findings reveals any abnormal findings.

METHODS

Totally, 389 hemodynamically-stable patients suspected of BAT who arrived at the emergency department (ED) of two university hospitals in Tehran from September 2013 to September 2014 were included in this study. Upon arrival at the ED, all subjects underwent abdominal examination and FAST, and were assessed for hematocrit and base deficit levels and presence of hematuria. These assessments were repeated in the patients who were discharged after 6 h, at 6 or 12 h post-arrival. All patients were followed-up after 24 h and one week by phone call.

RESULTS

Out of all study participants, 158 patients (40.6%) had normal findings in all initial assessments. These patients were discharged from the ED after a median of 5 h. After one week of follow-up, none of them had any symptom or complication, or had sought medical attention after being discharged from the study hospitals. Out of these patients, 78 patients (49.4%) were discharged after 6 hours by their physician's decision, and underwent the same diagnostic assessments for the second or third time. None of these assessments revealed any abnormal findings.

CONCLUSIONS

A combination of normal abdominal exam, normal FAST, normal hematocrit, normal base deficit, and absence of hematuria rules out intra-abdominal injury in BAT patients. It is safe to discharge patients after they prove normal for these assessments. Longer observation and repeated diagnostic assessment of these patients does not yield any new findings, and seems to be unnecessary.

Diagnostic Accuracy of Abdominal wall Ultrasonography and Local Wound Exploration in Predicting the Need for Laparotomy following Stab Wound

INTRODUCTION

Screening of patients with anterior abdominal penetrating trauma in need for laparotomy is an important issue in management of these cases. This study aimed to compare the accuracy of abdominal wall ultrasonography (AWU) and local wound exploration (LWE) in this regard.

METHODS

This diagnostic accuracy study was conducted on ≥ 18 year-old patients presenting to emergency department with anterior abdominal stab wound and stable hemodynamics, to compare the characteristics of AWU and LWE in screening of patients in need of laparotomy.

RESULTS

50 cases with the mean age of 28.44 ± 7.14 years were included (80% male). Sensitivity, specificity and area under the receiver operating characteristic (ROC) curve of AWU were 70.58 (95% CI: 44.04 - 88.62), 93.33 (95% CI: 76.49 - 98.83), and 81.96 (95% CI: 69.91 - 94.01), respectively. These measures were 88.23 (62.25 - 97.93), 93.33 (76.49 - 98.83), and 90.78 (95% CI: 81.67 - 99.89) for LWE, respectively. The difference in overall accuracy of the two methods was not statistically significant (p = 0.0641).

CONCLUSION

Based on the findings of the present study, AWU and LWE had the same specificity but different sensitivities in screening of anterior abdominal stab wound patients in need of laparotomy. The overall accuracy of LWE was slightly higher (91.48% versus 85.1%).

Prevalence and Associated Factors of Acute Traumatic Coagulopathy; a Cross Sectional Study

INTRODUCTION

Acute traumatic coagulopathy (ATC) is defined as having evidence of coagulopathy in patients with severe trauma. The aim of this preliminary study was to assess the prevalence and associated factors of ATC in severely traumatic patients presenting to emergency department (ED).

METHODS

In this retrospective cross sectional study, all patients with severe traumatic injury and available coagulation profile, presenting to the EDs of two major trauma centers in Tehran, Iran, during one year, were studied. Rate of ATC was determined and the associations with various variables as well as outcome were analyzed using SPSS 21.

RESULTS

246 patients with the mean age of 36.57±17.11 years were included (88.2% male). The mean injury severity score (ISS) was 21.83 ± 7.37 (16 - 54). Patients were resuscitated with 676.83 ± 452.02 (0 - 1500) ml intravenous fluid before arriving at the ED. The maximum and minimum frequencies of ATC were 31.3% based on PTT > 36s and 2.4% based on PT > 18s, respectively. There was a significant association between the occurrence of ATC (PT ratio > 1.2) and ISS > 23 (p = 0.001), abdominal abbreviated injury score (AIS) > 3 (p = 0.003), base deficit > 4 (p = 0.019), pulse rate > 90/minute (p = 0.041), and pH < 7.30 (p = 0.043).

CONCLUSION

The frequency of ATC in the present series varied from 2.4% to 31.3% based on different ATC definitions. Abdominal AIS > 3 and base deficit > 4 were among the significant independent factors related to ATC occurrence based on stepwise logistic regression analysis.

Levosimendan exerts anticonvulsant properties against PTZ-induced seizures in mice through activation of nNOS/NO pathway: Role for KATP channel

AIMS

Although approving new anticonvulsants was a major breakthrough in the field of epilepsy control, so far we have met limited success in almost one third of patients suffering from epilepsy and a definite and reliable method is yet to be found. Levosimendan demonstrated neuroprotective effects and reduced mortality in conditions in which seizure can be an etiology of death; however, the underlying neuroprotective mechanisms of levosimendan still eludes us. In the light of evidence suggesting levosimendan can be a K_ATP channel opener and nitrergic pathway activator, levosimendan may exert antiseizure effects through K_ATP channels and nitrergic pathway.

MAIN METHODS

In this study, the effects of levosimendan on seizure susceptibility was studied by PTZ-induced seizures model in mice.

KEY FINDINGS

Administration of a single effective dose of levosimendan significantly increased seizures threshold and the nitrite level in the hippocampus and temporal cortex. Pretreatment with noneffective doses of glibenclamide (a K_ATP channel blocker) and L-NAME (a non-selective NOS inhibitor) neutralize the anticonvulsant and nitrite elevating effects of levosimendan. While 7-NI (a neural NOS inhibitor) blocked the anticonvulsant effect of levosimendan, Aminoguanidine (an inducible NOS inhibitor) failed to affect the anticonvulsant effects of levosimendan. Cromakalim (a K_ATP channel opener) or l-arginine (an NO precursor) augmented the anticonvulsant effects of a subeffective dose of levosimendan. Moreover, co-administration of noneffective doses of Glibenclamide and L-NAME demonstrated a synergistic effect in blocking the anticonvulsant effects of levosimendan.

SIGNIFICANCE

Levosimendan has anticonvulsant effects possibly via K_ATP/nNOS/NO pathway activation in the hippocampus and temporal cortex.

Survival of Composite Resin Restorations of severely Decayed Primary Anterior Teeth retained by Glass Fiber Posts or Reversed-orientated Metal Posts

Aim: The aim of this study was to compare the survival of composite resin restorations retained by glass fiber posts or reversed-orientated (upside-down) metal posts in severely decayed primary anterior teeth after 6, 12, and 18 months.

Materials and methods: A total of forty-four 3- to 5-year-old children with bilateral severely decayed primary maxillary canines were included. Patients were treated under general anesthesia. After pulpectomy, an intracanal post was seated in the primary maxillary canine on each side: either a glass fiber post or a metallic post in reversed orientation and teeth restored with light-cured composite. Survival rate of each technique was evaluated at predetermined follow-ups and data were analyzed with McNemar’s test (α = 0.05).

Results: The difference in survival of restorations retained by two types of posts was not statistically significant in clinical and radiographical evaluations after 6, 12, and 18 months. The survival rate of reversed-orientated metal and glass fiber posts after 18 months was 81.1 and 67.6% respectively (p = 0.14).

Conclusion: Reversed-orientated metal post did not show lower clinical survival compared with glass fiber posts in 18-month follow-up. Hence, reversed-orientated metal post can be considered as a potential method to obtain retention for composite restorations in severely decayed primary anterior teeth.

How to cite this article: Vafaei A, Ranjkesh B, L0vschall H, Erfanparast L, Jafarabadi MA, Oskouei SG, Isidor F. Survival of Composite Resin Restorations of severely Decayed Primary Anterior Teeth retained by Glass Fiber Posts or Reversed-orientated Metal Posts. Int J Clin Pediatr Dent 2016;9(2):109-113.

Diagnostic Accuracy of Ultrasonography and Radiography in Initial Evaluation of Chest Trauma Patients

INTRODUCTION

Application of chest radiography for all multiple trauma patients is associated with a significant increase in total costs, exposure to radiation, and overcrowding of the emergency department. Ultrasound has been introduced as an alternative diagnostic tool in this regard. The aim of the present study is to compare the diagnostic accuracy of chest ultrasonography and radiography in detection of traumatic intrathoracic injuries.

METHODS

In the present prospective cross-sectional study, patients with traumatic intrathoracic injuries, who were referred to the emergency department from December 2013 to December 2014, were assessed. The patients underwent bedside ultrasound, radiographic and computed tomography (CT) scan examinations based on ATLS recommendations. Screening performance characteristics of ultrasonography and radiography were compared using SPSS 21.0. Chest CT scan was considered as gold standard.

RESULTS

152 chest trauma patients with a mean age of 31.4 ± 13.8 years (range: 4 ‒ 67), were enrolled (77.6% male). Chest CT scan showed pulmonary contusion in 48 (31.6%) patients, hemothorax in 29 (19.1%), and pneumothorax in 55 (36.2%) cases. Area under the ROC curve of ultrasonography in detection of pneumothorax, hemothorax, and pulmonary contusion were 0.91 (95% CI: 0.86‒0.96), 0.86 (95% CI: 0.78‒0.94), and 0.80 (95% CI: 0.736‒0.88), respectively. Area under the ROC curve of radiography was 0.80 (95% CI: 0.736‒0.87) for detection of pneumothorax, 0.77 (95% CI: 0.68‒0.86) for hemothorax, and 0.58 (95% CI: 0.5‒0.67) for pulmonary contusion. Comparison of areas under the ROC curve declared the significant superiority of ultrasonography in detection of pneumothorax (p = 0.02) and pulmonary contusion (p < 0.001). However, the diagnostic value of the two tests was equal in detection of hemothorax (p = 0.08).

CONCLUSION

The results of the present study showed that ultrasonography is preferable to radiography in the initial evaluation of patients with traumatic injuries to the thoracic cavity.

Impact of Self-concept on Preschoolers' Dental Anxiety and Behavior

Background and aims . Different factors affect children's behavior during dental treatment, including psychological and behavioral characteristics. The aim of this study was to evaluate the correlation of self-concept on child's anxiety and behavior during dental treatment in 4 to 6-year-old children. Materials and methods. A total of 235 preschoolers aged 4 to 6 years were included in this descriptive analytic study. Total self-concept score for each child was assessed according to Primary Self-concept Scale before dental treatment. Child's anxiety and child's behavior were assessed, during the restoration of mandibular primary molar, using clinical anxiety rating scale and Frankl Scale, respectively. Spearman's correlation coefficient was used to evaluate the correlation between the total self-concept score with the results of clinical anxiety rating scale and Frankl Scale. Results. There was a moderate inverse correlation between the self-concept and clinical anxiety rating scale scores (r = -0.545, P < 0.001), and a moderate correlation between the self-concept and child's behavior scores (r = 0.491, P < 0.001). A strong inverse relation was also found between the anxiety and behavior scores (r = -0.91, P < 0.001). Conclusion. Children with higher self-concept had lower anxiety level and better behavioral feedback during dental treatment.

A hybrid artificial neural network and particle swarm optimization for prediction of removal of hazardous dye brilliant green from aqueous solution using zinc sulfide nanoparticle loaded on activated carbon

In the present study, zinc sulfide nanoparticle loaded on activated carbon (ZnS-NP-AC) simply was synthesized in the presence of ultrasound and characterized using different techniques such as SEM and BET analysis. Then, this material was used for brilliant green (BG) removal. To dependency of BG removal percentage toward various parameters including pH, adsorbent dosage, initial dye concentration and contact time were examined and optimized. The mechanism and rate of adsorption was ascertained by analyzing experimental data at various time to conventional kinetic models such as pseudo-first-order and second order, Elovich and intra-particle diffusion models. Comparison according to general criterion such as relative error in adsorption capacity and correlation coefficient confirm the usability of pseudo-second-order kinetic model for explanation of data. The Langmuir models is efficiently can explained the behavior of adsorption system to give full information about interaction of BG with ZnS-NP-AC. A multiple linear regression (MLR) and a hybrid of artificial neural network and partial swarm optimization (ANN-PSO) model were used for prediction of brilliant green adsorption onto ZnS-NP-AC. Comparison of the results obtained using offered models confirm higher ability of ANN model compare to the MLR model for prediction of BG adsorption onto ZnS-NP-AC. Using the optimal ANN-PSO model the coefficient of determination (R(2)) were 0.9610 and 0.9506; mean squared error (MSE) values were 0.0020 and 0.0022 for the training and testing data set, respectively.

Artificial neural network and particle swarm optimization for removal of methyl orange by gold nanoparticles loaded on activated carbon and Tamarisk

The influence of variables, namely initial dye concentration, adsorbent dosage (g), stirrer speed (rpm) and contact time (min) on the removal of methyl orange (MO) by gold nanoparticles loaded on activated carbon (Au-NP-AC) and Tamarisk were investigated using multiple linear regression (MLR) and artificial neural network (ANN) and the variables were optimized by partial swarm optimization (PSO). Comparison of the results achieved using proposed models, showed the ANN model was better than the MLR model for prediction of methyl orange removal using Au-NP-AC and Tamarisk. Using the optimal ANN model the coefficient of determination (R2) for the test data set were 0.958 and 0.989; mean squared error (MSE) values were 0.00082 and 0.0006 for Au-NP-AC and Tamarisk adsorbent, respectively. In this study a novel and green approach were reported for the synthesis of gold nanoparticle and activated carbon by Tamarisk. This material was characterized using different techniques such as SEM, TEM, XRD and BET. The usability of Au-NP-AC and activated carbon (AC) Tamarisk for the methyl orange from aqueous solutions was investigated. The effect of variables such as pH, initial dye concentration, adsorbent dosage (g) and contact time (min) on methyl orange removal were studied. Fitting the experimental equilibrium data to various isotherm models such as Langmuir, Freundlich, Tempkin and Dubinin-Radushkevich models show the suitability and applicability of the Langmuir model. Kinetic models such as pseudo-first order, pseudo-second order, Elovich and intraparticle diffusion models indicate that the second-order equation and intraparticle diffusion models control the kinetic of the adsorption process. The small amount of proposed Au-NP-AC and activated carbon (0.015 g and 0.75 g) is applicable for successful removal of methyl orange (>98%) in short time (20 min for Au-NP-AC and 45 min for Tamarisk-AC) with high adsorption capacity 161 mg g(-1) for Au-NP-AC and 3.84 mg g(-1) for Tamarisk-AC.

Adaptive neuro-fuzzy inference system model for adsorption of 1,3,4-thiadiazole-2,5-dithiol onto gold nanoparticales-activated carbon

In this research, a novel adsorbent gold nanoparticle loaded on activated carbon (Au-NP-AC) was synthesized by ultrasound energy as a low cost routing protocol. Subsequently, this novel material characterization and identification followed by different techniques such as scanning electron microscope(SEM), Brunauer-Emmett-Teller(BET) and transmission electron microscopy (TEM) analysis. Unique properties such as high BET surface area (>1229.55m(2)/g) and low pore size (<22.46Å) and average particle size lower than 48.8Å in addition to high reactive atoms and the presence of various functional groups make it possible for efficient removal of 1,3,4-thiadiazole-2,5-dithiol (TDDT). Generally, the influence of variables, including the amount of adsorbent, initial pollutant concentration, contact time on pollutants removal percentage has great effect on the removal percentage that their influence was optimized. The optimum parameters for adsorption of 1,3,4-thiadiazole-2, 5-dithiol onto gold nanoparticales-activated carbon were 0.02g adsorbent mass, 10mgL(-1) initial 1,3,4-thiadiazole-2,5-dithiol concentration, 30min contact time and pH 7. The Adaptive neuro-fuzzy inference system (ANFIS), and multiple linear regression (MLR) models, have been applied for prediction of removal of 1,3,4-thiadiazole-2,5-dithiol using gold nanoparticales-activated carbon (Au-NP-AC) in a batch study. The input data are included adsorbent dosage (g), contact time (min) and pollutant concentration (mg/l). The coefficient of determination (R(2)) and mean squared error (MSE) for the training data set of optimal ANFIS model were achieved to be 0.9951 and 0.00017, respectively. These results show that ANFIS model is capable of predicting adsorption of 1,3,4-thiadiazole-2,5-dithiol using Au-NP-AC with high accuracy in an easy, rapid and cost effective way.

Comparing the prevalence of chronic pain after sternotomy in patients undergoing coronary artery bypass grafting using the internal mammary artery and other open heart surgeries

Background:

The prevalence of chronic postoperative pain after cardiac surgery has been reported from 17% to 56%.

Objectives:

We aimed to compare the prevalence of postoperative pain between patients who had undergone CABG using the internal mammary artery (IMA) and those who had undergone other cardiac surgeries including CABG using the saphenous vein or cardiac valvular surgeries.

Patients and Methods:

In this cohort study, medical records of 188 patients were evaluated and divided into two equal groups (94 in each group); patients who had undergone CABG using the IMA (IMA group) and those who had undergone other cardiac surgeries using the saphenous vein or other cardiac valvular surgeries (non-IMA group). The patients' data were recorded in a self-structured questionnaire and then phone interviews were performed 3 months after the operations regarding the rate of postoperative pain. The severity of chronic pain was rated based on the numerical rating pain scale.

Results:

The two groups differed significantly regarding the prevalence of pain (P = 0.023). In the IMA group, 83 (88.3%) patients experienced pain lasting for more than three months compared to 71 (75.5%) patients in non-IMA group. The two groups differed significantly with respect to the severity of chronic pain after cardiac surgery via sternotomy (P = 0.001). The groups did not differ significantly regarding the effects of chronic pain on their sleep, referral to a physician, and drug consumption to alleviate their pain. The IMA group experienced more complications at work and during their occupational activity.

Conclusions:

The rate and severity of chronic pain after cardiac surgery via sternotomy was higher in patients undergoing CABG with separation of IMA for revascularization.

Principal component analysis- adaptive neuro-fuzzy inference system modeling and genetic algorithm optimization of adsorption of methylene blue by activated carbon derived from Pistacia khinjuk

In the present study, activated carbon (AC) simply derived from Pistacia khinjuk and characterized using different techniques such as SEM and BET analysis. This new adsorbent was used for methylene blue (MB) adsorption. Fitting the experimental equilibrium data to various isotherm models shows the suitability and applicability of the Langmuir model. The adsorption mechanism and rate of processes was investigated by analyzing time dependency data to conventional kinetic models and it was found that adsorption follow the pseudo-second-order kinetic model. Principle component analysis (PCA) has been used for preprocessing of input data and genetic algorithm optimization have been used for prediction of adsorption of methylene blue using activated carbon derived from P. khinjuk. In our laboratory various activated carbon as sole adsorbent or loaded with various nanoparticles was used for removal of many pollutants (Ghaedi et al., 2012). These results indicate that the small amount of proposed adsorbent (1.0g) is applicable for successful removal of MB (RE>98%) in short time (45min) with high adsorption capacity (48-185mgg(-1)).