Search

One of the most difficult local anesthetic blocks to master in dentistry is the inferior alveolar nerve block (IANB). Historically, dental students have practiced local anesthesia on one another. At the University of Colorado, these practice sessions have been limited to one required laboratory session. The predictability and confidence of student IANB success have not been high in the past. Therefore, the objective of this study was to investigate the impact of a novel IANB simulator, built on a three dimensional (3D)-printed mixed-reality haptic model, for second-year dental students to practice on prior to their laboratory session.Thirty-nine student participants volunteered to practice with the IANB simulator. Participants were divided into two groups, Group A and Group B. Self-reported confidence and injection-specific accuracy were measured during IANB simulator practice and the laboratory session. During lab, partner numbness was assessed as a measure of IANB success. Groups A (n = 20) and B (n = 19) practiced with the simulator before and after laboratory, respectively. Injection domains were not assessed during Group B's practice with the IANB simulator.Self-reported confidence increased for both groups (p0.001). However, for anesthetic success, Group A exhibited significantly greater success (52.6%) than Group B (17.6%) (p = 0.029).Self-reported confidence in performing an IANB improved and higher anesthetic success was achieved for Group A. Further investigation is necessary to determine the long-term impact of using the IANB simulator in dental education.

This article aims to highlight and clarify the role of the psychologist and the main functions during the interrogation of minors. The task of the work is to bring out the expediency of the specialist who should be present during the interrogation of minors as a result of theoretical analysis, which will ensure the efficiency of the work done, supporting justice, as it will not harm the juvenile. The paper presents analyzes of the views of a number of authors related to the role and activities of the psychologist during the juvenile interrogation, as well as the psychologist's involvement and the foreign experience of the juvenile interrogation. Synthesis, induction and analysis were used as a theoretical research method. Thus, the theoretical analyzes performed in the work show that some authors identify the professions of pedagogue and psychologist, while other authors prefer a specialist who has knowledge in different areas of psychology. The study of Western and Russian experience shows the importance of involving a psychologist, first of all, in order to avoid revictimization of a minor. Based on the forthcoming legislative changes, where the involvement of a psychologist in interrogations involving minors will be mandatory, the implementation of theoretical and research work necessary to clarify the role and functions of the psychologist will further clarify the role and functions of the psychologist, who will use it to solve problems.

Background: COVID-19 has impacted persons with serious illness, including those with chronic, neurodegenerative conditions. While there are several reports on COVID-19’s impact on inpatient palliative care, literature is limited about the impact on outpatient care which may be more relevant for these patients. Aim: To generate a person-centered description of the impact of COVID-19 from the perspectives of patients living with neurodegenerative disease and caregivers to improve outpatient palliative care delivery. Design: This qualitative study used rapid analysis via matrix design to identify emergent themes related to participant perspectives on the challenges of COVID-19. Data sources included semi-structured interviews, open-ended survey responses, medical record documentation and participant-researcher communications. Setting/Participants: Data was collected from 108 patients with Parkinson’s disease, Alzheimer’s disease or related disorders and 90 caregivers enrolled in a multicenter, clinical trial of community-based, outpatient palliative care between March 20, 2020 and August 8, 2020 (NCT03076671). Results: Four main themes emerged: (1) disruptions to delivery of healthcare and other supportive services; (2) increased symptomatic and psychosocial needs; (3) increased caregiver burden; (4) limitations of telecommunications when compared to in-person contact. We observed that these themes interacted and intersected. Conclusions: Patients and caregivers have unmet care needs because of the pandemic, exacerbated by social isolation. While telemedicine has helped improve access to healthcare, patients and caregivers perceive clear limitations compared to in-person services. Changes in society and healthcare delivery in response to COVID-19 highlight ongoing and novel gaps that must be addressed to optimize future outpatient palliative care for neurologic illness.

PURPOSE: This study compared the root canal anatomy between cone-beam computed tomography (CBCT) and micro-computed tomography (micro-CT) images before and after biomechanical preparation and root canal filling. MATERIALS AND METHODS: Isthmus-containing mesial roots of mandibular molars (n=14) were scanned by micro-CT and 3 CBCT devices: 3D Accuitomo 170 (ACC), NewTom 5G (N5G) and NewTom VGi evo (NEVO). Two calibrated observers evaluated the images for 2-dimensional quantitative parameters, the presence of debris or root perforation, and filling quality in the root canal and isthmus. The kappa coefficient, analysis of variance, and the Tukey test were used for statistical analyses (α=5%). RESULTS: Substantial intra-observer agreement (κ=0.63) was found between micro-CT and ACC, N5G, and NEVO. Debris detection was difficult using ACC (42.9%), N5G (40.0%), and NEVO (40%), with no agreement between micro-CT and ACC, N5G, and NEVO (0.05

Background Olfactory dysfunction (OD) has been reported to impact social interactions. However, the relationship between OD and loneliness has received little attention. The purpose of this study was to determine the association between OD and loneliness, controlling for patient factors. Methods Subjects without otolaryngic complaints were enrolled and olfactory function was assessed using: Sniffin’ Sticks test to measure threshold, discrimination and identification (TDI), Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and 9 – item Olfactory-Visual Analogue Scale (VAS). Loneliness was assessed using the De Jong Gierveld (DJG) and University of California Los Angeles (UCLA) loneliness scales. Bivariate analysis was performed followed by regression analysis, controlling for confounders. Results In total, 221 subjects were included with a mean age of 50.5 years (range 20 to 93), 133 (60.2%) females and 161 (72.9%) white. Mean TDI score was 29.3 (7.0) and 49.5% of the cohort was dysosmic. Using DJG, 36.4% of the cohort were classified as lonely, whereas 35.0% were lonely using UCLA. Olfactory measures were significantly associated with DJG, including TDI (β = −0.03, p = 0.050), olfactory discrimination (β = −0.111, p = 0.005), QOD-NS (β = 0.058, p Conclusions In this community-based sample of older adults, both OD and loneliness were common. Those subjects with worse olfactory function were more likely to report loneliness. Further research is necessary to establish causality, as well as explore the role of depression.

The purpose of this study was to assess the accuracy of 2-dimensional morphometric parameters of root canals on different cone-beam computed tomographic (CBCT) images using 2 segmentation methods (operator dependent and Otsu's automatic), considering micro-computed tomographic (micro-CT) images as the reference standard.Ten mandibular molars were scanned by micro-CT imaging and 3 different CBCT devices: Accuitomo (J Morita Corporation, Kyoto, Japan), NewTom 5G (CEFLA, Imola, Italy), and NewTom VGi evo (CEFLA). The images were standardized and recorded using MeVisLab software (MeVis Medical Solutions AG, Bremen, Germany). Two calibrated examiners assessed the images of axial reconstructions quantitatively by 2-dimensional parameters (area, perimeter, roundness, and largest and smallest diameter). Fleiss kappa was performed to check interrater and intrarater reliability. The absolute error was calculated as the means and standard deviation. One-way analysis of variance was performed for comparison between the methods used by the operator and Otsu's automatic thresholding. To determine the accuracy of CBCT devices, the absolute error rate of each parameter was calculated using micro-CT measurements as the reference value with thresholding determined by the operator.The thresholding method performed by the operator had lower absolute error values for area, perimeter, and major and minor diameters, differing (P.05) from Otsu's automatic method, with no differences between the CBCT machines.An overestimation of area, roundness, and major and minor diameters and an underestimation of the perimeter were shown for the 3 CBCT machines evaluated. Thresholding determined by the operator is more accurate than that determined by Otsu's automatic method for the assessment of 2-dimensional morphometric parameters, which could direct influence in the diagnosis and endodontic treatment plan.

Objective Sleep apnea research cites that an oral appliance, which places the mandible in a more forward position and the genioglossus (tongue muscle) on the floor of the mouth, improves aspects of the pharyngeal opening. Exercise science research has cited improvements in airway dynamics and physiological variables with oral appliance use during exercise. Thus, the purpose of this study was to design an oral appliance that would act on the genioglossus and determine if there were effects on respiratory parameters while exercising. Materials and methods Seventeen healthy subjects ages 18–43 participated in this study. Prior to the exercise protocol, the order of the oral applicance (OA) or no oral appliance (no OA) condition was randomly assigned to subjects, with subjects completing both conditions. Respiratory parameters (respiratory rate, ventilation, oxygen, and carbon dioxide) were measured between conditions while subjects ran for 10 min at steady state. Results The results demonstrated that both respiratory rate (25.97 BPM, OA and 28.35 BPM, no OA) and ventilation (47.66 l/min, OA and 50.34 l/min, No OA) were significantly lowered (p < .01) in the OA condition. There were no differences in carbon dioxide (1.89 l/min, no OA and 1.88 l/min, OA) or oxygen outcomes (2.17 l/min, no OA and 2.17 l/min OA). Discussion The outcomes from this study suggest that the design of the oral appliance elicits an effect on the genioglossus, thereby resulting in lowered respiratory rate and ventilation with no negative effects on oxygen uptake during exercise.

Background Olfactory loss is a common problem that significantly impacts quality of life. Olfactory training (OT) has been used most commonly for viral and traumatic olfactory dysfunction (OD) in younger subjects with hopes of neural regeneration, improved olfactory function, and subjective well-being. The objective of this study was to investigate the impact of a novel form of OT using 12 odors in participants over 45 years of age with objective OD. Methods Twenty-nine participants underwent OT using 12 standardized odor pens for a duration of 6 months. Objective OT of Threshold, Discrimination, and Identification and patient-reported outcomes were assessed at baseline and after 6 months of OT. Results Of the 29 participants who entered the protocol, only 16 subjects completed all 6 months of OT. Significant improvements were seen in overall Threshold Discrimination Identification (TDI; mean 4.40 points, P = .007), Discrimination (mean 1.44 points, P = .019), and Identification (mean 2.02 points, P = .011). Forty-four percent of subjects who completed OT achieved a mean clinically important difference of at least 5.5 points on TDI. Conclusion There was no significant change in patient-reported outcome measures, and no baseline factors were associated with change in olfaction. In this study, OT with 12 odors improves objective olfaction in nearly half of the older adults with OD. Further investigation is necessary to determine the impact of improved olfaction on overall health outcomes.

Background Olfactory dysfunction (OD) is common, affecting an estimated 13 million adults in the United States. Prior studies may underestimate OD prevalence due to use of brief smell identification tests or age-adjusted cutoff values, which concede that it is acceptable for older people to have a decreased sense of smell. Objective To determine OD prevalence in the healthy community when the goal and expectation is ideal olfactory function, rather than age-based population norms. Secondary goals were to explore factors associated with OD. Methods Subjects without otolaryngic complaints were recruited from the community surrounding the Medical University of South Carolina. Olfactory-specific information was collected, and olfactory function was assessed using the Sniffin’ Sticks test (Burghardt, Wedel, Germany) to measure threshold, discrimination, and identification (TDI). OD was defined as a TDI score Results In total, 176 subjects were included with mean age of 52 years (range: 20–93), 111 (63%) female, and 127 (72%) white. Mean TDI score was 28.8 (6.9) and OD was present in 94 (53%) subjects. Multivariate linear regression revealed that TDI decreased an average of 1 point every 5 years. TDI was also associated with Mini-Mental Status Examination (MMSE) score, asthma, and gastroesophageal reflux disease. Threshold was associated with age, heart problems, and gastroesophageal reflux disease. Discrimination was associated with age and MMSE scores. Identification was associated with age, heart problems, and anxiety. Conclusions In a community-based sample, OD affects greater than 50% of subjects. Aging impacts all aspects of olfaction, while the effects of factors such as asthma, MMSE scores, gastroesophageal reflux disease, heart problems, and anxiety may only be evident in specific olfactory subtests.

Background Olfactory dysfunction (OD) is a common problem, affecting up to 20% of the general population. Previous studies identified olfactory cleft mucus proteins associated with OD in chronic rhinosinusitis (CRS) but not in a healthy population. In this study we aimed to identify olfactory cleft mucus proteins associated with olfaction in individuals without sinus disease. Methods Subjects free of sinus disease completed medical history questionnaires that collected data regarding demographics, comorbidities, and past exposures. Olfactory testing was performed using Sniffin' Sticks, evaluating threshold, discrimination, and identification. Olfactory cleft mucus (OC) and, in select cases, inferior turbinate mucus (IT) were collected with Leukosorb paper and assays performed for 17 proteins, including growth factors, cytokines/chemokines, cell-cycle regulators, and odorant-binding protein (OBP). Results Fifty-six subjects were enrolled in the study, with an average age of 47.8 (standard deviation [SD], 17.6) years, including 33 females (58.9%). The average threshold/discrimination/identification (TDI) score was 30.3 (SD, 6.4). In localization studies, OBP concentrations were significantly higher in OC than IT mucus (p = 0.006). Cyclin-dependent kinase inhibitor 2A (CDKN2A/p16INK4a), basic fibroblast growth factor (bFGF), chemokine ligand 2 (CCL2/MCP-1), granulocyte macrophage colony-stimulating factor (GM-CSF), and chemokine ligand 20 (CCL20/MIP-3a) all inversely correlated with overall TDI (all rho ≥ -0.479, p ≤ 0.004). Stem cell factor (SCF) correlated positively with overall TDI (rho = 0.510, p = 0.002). Conclusion Placement of Leukosorb paper is relatively site-specific for olfactory proteins and it is feasible to collect a variety of olfactory cleft proteins that correlate with olfactory function. Further study is required to determine mechanisms of OD in non-CRS subjects.

Introduction La cardiopathie uremique est une entite complexe qui touche 75 % des patients dialyses. La mortalite cardiovasculaire du patient transplante reste nettement superieure a celle de la population generale. L’objectif de ce travail est d’etudier des facteurs influencant l’evolution des parametres echocardiographiques apres transplantation renale et l’impact des comorbidites pregreffe sur l’evolution cardiaque apres transplantation. Patients et methodes Cette etude monocentrique retrospective observationnelle a inclus les patients ayant beneficie d’une premiere transplantation renale entre le 1er janvier 2007 et le 31 aout 2015. Chaque patient a beneficie d’une ETT avant la greffe et au minimum 6 mois apres la greffe. Tous les parametres echocardiographiques ont ete relus par un operateur independant en aveugle des resultats de la greffe. L’impact des facteurs suspectes a ete etudie par une analyse multivariee par regression lineaire. Resultats Cinquante-six patients ont constitue notre cohorte. Il n’a pas ete observe de modification significative de la masse ventriculaire gauche indexee (MVGi) (114,0 g/m2 versus 105,9 g/m2 ; p = 0,13). Il a ete observe un gain significatif de la FEVG en postgreffe (69,6 % versus 63,9 % ; p = 0,0046). Il n’a pas ete observe de variation significative des autres parametres echocardiographiques. En analyse multivariee, le diabete etait associe a une moindre amelioration des pressions de remplissage et du remodelage ventriculaire (â = 4,15, p = 0,046 ; et â = −0,15, p = 0,06). Les coronaropathies etaient associees a une moins bonne evolution de la FEVG (β = 7,17 ; p = 0,02). Les valvulopathies etaient associees a une moins bonne evolution de la MVGi (β = −27,3, p = 0,037) Discussion Les comorbidites avant la greffe, notamment cardiovasculaire, semblent avoir un impact plus important que les parametres nephrologiques apres la greffe. Dans cette etude, on retrouvait une faible amelioration des parametres echocardiographiques et un impact modere de la transplantation renale sur l’evolution de ces parametres. Conclusion L’impact de la transplantation renale sur l’evolution des parametres echocardiographiques etait faible dans cette etude. La coexistence d’une cardiopathie diabetique et d’une cardiopathie uremique pourrait avoir un role non negligeable dans cette absence d’amelioration apres la greffe.

Cleaning and shaping of root canals are essential steps for the success of endodontic therapy. The purpose of this study was to evaluate the tissue debridement efficacy of the self-adjusting file (SAF) protocol in the apical third of oval-shaped canals of mandibular incisors in comparison with a nickel-titanium rotary system preparation.Twenty-six single-rooted human mandibular incisor teeth were selected and assigned to a control (n = 4) and 2 experimental groups (n = 11) according to 1 of 2 instrumentation techniques, SAF and nickel-titanium rotary systems. After root canal preparation, the apical thirds of the specimens were submitted to histologic processing and analyzed by optical microscopy regarding the percentage of debris and uninstrumented root canal walls. The data were statistically compared by using unpaired t test with Welch's correction, and the level of significance was set at 5%.The percentage of remaining debris and uninstrumented canal perimeter was significantly lower in SAF group (2.18 ± 2.71 and 12.33 ± 7.85, respectively) than in rotary group (13.11 ± 12.98 and 53.54 ± 15.95, respectively) (P.05). In the SAF group most of specimens were completely free of debris, whereas in the rotary group 53% of the canals presented debris.SAF had significantly more contact to the dentin walls and removed more debris than rotary instrumentation in the apical third of mandibular incisors.