Root canal filling materials for endodontic treatment of necrotic primary teeth: a network meta-analysis

PURPOSE

To investigate the effect of different root canal filling materials on the change of failure of the endodontic treatment of necrotic primary teeth.

METHODS

A literature search was carried out in PubMed/MEDLINE, CENTRAL, Scopus databases, and grey literature up to July 2022 selecting randomised clinical trials related to research question. Two reviewers independently selected the studies, extracted the data, and assessed the bias risk. Root canal filling materials were grouped according to the main component [iodoform (IOD), calcium hydroxide (CAOH), zinc oxide (ZO) or mix (IOD plus CAOH plus ZO) pastes]. Pairwise and network meta-analyses using the mixed treatment comparisons method were performed to compare the number of events (failure) among treatments. Odds ratio and 95% confidence intervals (CI) for calculated. Post-probabilities among treatments were also calculated and interpreted.

RESULTS

From 1186 potentially relevant studies, 17 were selected for full-text analysis, and 7 were included in the meta-analysis, totalizing 263 teeth. In the direct evidence, ZO pastes resulted in a higher chance of failure than IOD pastes (OR 7.07 95% CI 1.02, 62.59). In the indirect evidence, there was no difference between the materials. The IOD pastes presented a high probability (81%) of being the treatment associated to lowest number of failures among all treatments. The CAOH pastes presented the highest probability of being the worst option. Studies showed high bias risk.

CONCLUSION

There is currently no scientific evidence of the superiority of any one root canal filling material for endodontic treatment of necrotic primary teeth.

Intestinal absorption of long-chain polyunsaturated fatty acids in preterm infants fed breast milk or formula

The importance of long-chain polyunsaturated fatty acids (LCPs) in the development of preterm infants is now well accepted but the source of dietary LCPs to be added to infant formulas remains controversial. We measured dietary intakes, fecal output, and percentages of intestinal absorption of n-6 and n-3 LCPs in healthy preterm infants fed exclusively preterm breast milk (PBM; n = 20), formula without LCPs added (NLCPs; n = 19), formula with LCPs derived from phospholipids (PL-LCPs; n = 19), or formula with LCPs from triacylglycerols (TG-LCPs; n = 19). Intestinal absorption of arachidonic acid was not different in the four groups but docosahexaenoic acid was better absorbed from PL-LCPs than from PBM (88.3 +/- 1.8% compared with 78.4 +/- 4.0%, P < 0.05) Total absorption of n-6 LCPs was not different between groups but total n-3 LCPs were better absorbed from PL-LCPs than from PBM or TG-LCPs (88.7 +/- 1.9%, 79.2 +/- 4.4%, and 80.4 +/- 2.2%, respectively). In conclusion, docosahexaenoic acid and arachidonic acid were absorbed as efficiently from TG-LCPs formula as from breast milk fat. Absorption of docosahexaenoic acid and n-3 LCPs was greater from PL-LCPs formula than from PBM or TG-LCPs formula.

Plasma and red blood cell fatty acid of very low birth weight infants fed exclusively with expressed preterm human milk

The fatty acid composition of plasma phospholipids, triglycerides, sterol esters, and red blood cell phospholipids were determined at birth and again on d 7, 14, and 28 of life in 22 very low birth weight infants (birth weight 1180 +/- 290 g, gestational age 29.8 +/- 2.4 wk) fed exclusively with preterm human milk starting from the first hours postpartum. Milk intake was recorded daily, and intakes of fat and individual fatty acids were measured weekly. The intakes of linoleic acid and linolenic acid rose significantly during the study period, so did their incorporation into plasma and red blood cell lipids. The intakes of arachidonic acid (29.2 +/- 2.4 versus 30.4 +/- 2.1 mg.kg-1.day-1) and docosahexaenoic acid (18.8 +/- 1.7 versus 17.0 +/- 1.2 mg.kg-1.day-1) on d 14 and 28, respectively, were not different; however, their plasma levels declined significantly. The percentages of arachidonic acid declined in all plasma and red blood cell lipids, whereas the fall of docosahexaenoic acid was more notable in triglycerides and sterol esters, intermediate in plasma phospholipids, and less pronounced in red blood cell phospholipids. We conclude that very low birth weight infants fed exclusively with preterm milk, which unlike most preterm formulas contains long chain polyunsaturated fatty acids, exhibit declining levels of arachidonic acid and docosahexaenoic acid from birth up to 28 d of life.

[Interdisciplinary communication in neonatology]

An efficient and rational neonatal intensive care should be regionalized. Interdepartmental communication among obstetricians, neonatologists, pediatricians, neurologists should be planned and stirred between the reference centre and the outside hospitals, as well as in the catchment area. In this way only, such important goals as in-utero and neonatal transfer, training of obstetric neonatal teams, regionalized epidemiology and care evaluation can be achieved. In the same way, communication inside the hospital among doctors, nurses and parents is basic to humanize medical care.

Development of a screening system for cystic fibrosis: meconium or blood spot trypsin assay or both?

High blood trypsin levels during early days of life are found in newborns subsequently diagnosed to be affected by cystic fibrosis. The authors compared the validity of the traditional meconium test with the blood immunoreactive trypsin (IRT) assay, carried out in parallel on 113,302 neonates from three regions of North-eastern Italy. The meconium test showed a sensitivity of 57.7%. The sensitivity of the IRT test was higher (96.1%). It was possible to identify by IRT 10 out of 11 false negative CFs at the meconium test. A shortcoming of neonatal IRT, however, is its low specificity; 1.6% of the newborns had to be retested. A new screening policy was therefore proposed and carried out on 69,640 newborns: the Lactase test (LACT) on meconium was introduced as a complementary assay in IRT positive newborns. If LACT exceeded 2 U/g dry meconium, a confirmatory sweat test was immediately requested; if LACT test was negative and IRT exceeded 85 micrograms/l, IRT was repeated. Postneonatal retesting values above 25 micrograms/l required a sweat test. As a result, the estimated prevalence of CF was 1:4,352, the sensitivity was 93.3%; the specificity turned out to be 99.6%, considering all false positive newborns investigated with retesting and/or direct sweat test.

[Feeding sick neonates separated from their mothers with maternal milk]

In the 3 years between 1983 and 1985, 70.5% of the 833 newborns hospitalized and discharged from the Neonatal Intensive Care Unit in Trento were successfully breast-fed (in the same period 83.4% of newborn babies discharged from the ten hospitals of the Province of Trento were breast-fed). All the pathological newborns were separated from their mothers: also Trento's delivery room is 3 km from the NICU. 436 were of very low birth weight and of these 76.2% were partly or totally breast-fed (261, or 60.0%, were born outside Trento.

A liveborn 69,XXX triploid. Origin, X chromosome activity and gene dosage

A 69,XXX female liveborn triploid survived 45 days. The phenotype was consistent with the average clinical picture of liveborn triploids. Autopsy revealed slight atrophy of cerebral cortex and corpus callosum and severe adrenal hypoplasia. Chromosome polymorphisms indicated that the origin of this triploid was dispermy. Replication studies of the X chromosome performed on lymphocytes and fibroblasts showed that the majority of cells had two late replicating X chromosomes. X chromosome inactivation in spontaneous abortuses and liveborn triploids is discussed. Nine enzymes encoded by autosomal genes were tested, five had normal, three increased, and one reduced levels of activity. The reduced activity of alpha-galactosidase, an X-linked enzyme, is in agreement with cytogenetic findings and demonstrated a gene dosage effect.