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Objectives Pain management during endodontic therapy is an important issue in clinical practice. The objective of this systematic review and meta-analysis was to evaluate the efficacy of occlusal reduction to control the post-operative endodontic pain in adults undergoing root canal therapy. Materials and methods Electronic database and manual searches of English papers were conducted up to August 2019 to identify randomised placebo-controlled trials. The MeSH terms used were (endodontics OR root canal therapy) AND (postoperative pain) AND (occlusal reduction). The primary outcome measure was the post-operative pain intensity up to 72 hours. Pooled standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using random-effects inverse variance method. The statistical heterogeneity was assessed using the Cochrane Q test. The significance level was set at P Results In total, six randomised controlled trials including 344 participants were included. Our meta-analyses showed that relief of occlusal surface did not significantly reduce the pain intensity scores at 12- (SMD = -0.46; 95% CI = -1.24, 0.30; P = .239), 24- (SMD = -0.17; 95% CI = -0.73, 0.38; P = .533) and 48- (SMD = -0.67; 95% CI = -1.38, 0.03; P = .063) when compared to placebo. However, at 72 hours, patients received intervention showed significant more pain reduction than placebo groups (SMD = -1.07; 95% CI = -1.81, -0.32; P = .005). Conclusion Based on this meta-analysis, the efficacy of occlusal reduction in post-endodontic pain control for up to 2 days is not supported. However, on day three, it had a positive influence on the control of post-endodontic pain.

Objectives The current systematic review and meta-analysis aimed to assess the efficacy of prophylactic oral antibiotics in the management of post-operative endodontic symptoms in adults with necrotic pulp. Materials and methods A systematic search up to April 2020 was performed to find all randomised controlled trials (RTCs) comparing oral antibiotics with placebo to manage post-endodontic symptoms. The outcome measures were post-operative pain, swelling and/or the combined pain and swelling at different follow-ups. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were estimated using random-effect inverse-variance method. Additional analysis was performed if heterogeneity existed (P Results For post-endodontic pain, 8 RCTs (n = 690) were included. Antibiotic prescription had no significant effect on endodontic pain at 6 (SMD = -0.008, 95% CI -0.279 - 0.264, P = .95), 12 (SMD = -0.080, 95% CI -1.39 - 1.23, P = .90), 24 (SMD = -0.044, 95% CI -0.29 - 0.20, P = .72), 48 (SMD = 0.18, 95% CI -0.26 - 0.62, P = .42) and 72 h (SMD= -0.050, 95% CI -0.33 - 0.23, P = .723) post-operatively. For post-endodontic swelling, 4 RCTs (n = 149) were included. Antibiotic prescription had no significant effect on endodontic swelling at 24 (SMD = 0.29, 95% CI -0.72 - 1.32, P = .56), 48 (SMD = -0.23, 95% CI -0.98 - 0.51, P = .54) and 72 hours (SMD= -0.03, 95% CI -1.25 - 1.33, P = .96), post-operatively. For combined pain and swelling, no meta-analysis was performed. Conclusion The administration of prophylactic antibiotics to prevent post-operative endodontic symptoms is not supported by the current evidence.

In late December 2019, a new type of coronavirus, called novel coronavirus disease 2019 (COVID-19), caused a major outbreak of severe pneumonia in Wuhan (Huanan seafood market) and then, across China. As of 31 March 2020, COVID-19 has spread in 200 countries, including Iran, and imposed serious health-related threats to the public worldwide. Fever, dry (non-productive) cough, myalgia, and pneumonia seem to be the symptoms of COVID-19 disease. To date, and despite various studies and investigations, except for chloroquine and hydroxychloroquine, which have recently been temporarily approved by FDA, no other vaccines and/or antiviral agents have been clinically endorsed for the treatment of COVID-19 disease. Nevertheless, prevention of the disease and control of the infection is deemed a top priority for the general public. Owing to the characteristics of different dental treatments and settings, the risk of virus transmission can be considered high between patients and dental practitioners. Therefore, the need for strict and tough effective infection control protocols in dental practice is of great importance, namely for the dental centers in the potentially affected areas with COVID-19. This study, based on relevant evidence, aimed to review the basic knowledge of COVID-19 and address the recommended protocols of infection control for the dental practitioners and treatments in hypothetically stricken areas.

The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of corticosteroids on postoperative endodontic pain and to determine/adjust between-trial heterogeneity using meta-regression analysis.A systematic literature search was conducted to identify randomized clinical trials using corticosteroids to manage postoperative endodontic pain in adults. The outcome measure was pain intensity scores at 6, 12, and 24 hours postoperatively. Standardized mean differences (SMDs) with their 95% confidence intervals (CIs) were estimated using the random effect inverse variance method. The level of significance was set at P .05. Meta-regression analysis was also performed to examine the associations between effect sizes and study-level covariates.Eighteen randomized clinical trials, comprising 1088 patients, were included. Corticosteroids significantly reduced the incidence of postoperative pain in endodontic patients at 6 hours (SMD = -1.03; 95% CI, -1.55 to -0.51; P = .000), 12 hours (SMD = -1.089; 95% CI, -1.71 to -0.46; P = .001), and 24 hours (SMD = -0.957; 95% CI, -1.34 to -0.56; P = .000). Meta-regression analysis showed that the type and dose of drug, performing intention-to-treat analysis, and using rescue medication could significantly influence the effect size at different time points.Corticosteroids had a postoperative pain-reducing effect in endodontic patients, and the choice of drug regimens could be an important predictor of pain reduction.

Summary The objective of this review was to evaluate the efficacy of non-narcotic analgesics including non-steroidal anti-inflammatory drugs (NSAIDs) and/or paracetamol in the treatment of post-operative endodontic pain. Additionally, we aimed to examine the possible association of study covariates on the pain scores using meta-regression analysis. An electronic search was performed in 2016. After data extraction and quality assessment of the included studies (n = 27, representing 2188 patients), meta-analysis was performed using a random-effect inverse variance method. Meta-regression analysis was conducted to examine the associations between effect sizes and study-level covariates (P

Deep neural networks have proven themselves as a strong approach in image classification and object detection with high accuracy. However, they are computationally demanding and the trained networks contain millions of active parameters and connections. Two recent trends of having deeper and dense architectures and the deployment of trained networks on resource-constrained devices such as smart phones and portable tablets bring new challenges. Instead of deploying an ensemble of smaller networks, we propose a pruning methodology on a trained network so that a smaller version of a fully trained network has the same and even better accuracy in comparison to the original one. We achieve two objectives with the pruning scheme. First, we have a smaller network with a better accuracy level, and we make the trained model avoids overfitting. Accordingly, an evolutionary based framework including three steps is defined to perform further tuning on trained deep network using dropping nodes and connections. This study shows that implementing genetic algorithm, after preprocessing and training stages, not only results in partially connected networks, but also increases performance and reduces overfitting specially when the depth and width of fully connected networks are investigated in small datasets.

To assess the effect of light irradiation and different immersion media on discoloration of white mineral trioxide aggregate (WMTA) and calcium enriched mixture (CEM) cement at different time intervals.Enamel sections of 12 teeth were removed and six cavities were prepared in each tooth. The cavities were filled randomly either with WMTA or CEM and covered with transparent sealant. Half the specimens were irradiated for 160 sec (eight exposures of 20 sec each) and the remaining were irradiated for 40 sec (two exposures of 20 sec each); digital images were taken after each exposure. The teeth were stored in phosphate buffer saline, oxygen-rich medium and glycerin (n = 4). Digital images were obtained after 1, 3, 7, 14, and 28 days. Commission Internationale de I'E'clairage (CIE) color space system and Photoshop CS5 software were used to evaluate the discoloration. The color change (ΔE) and lightness (ΔL) values was analyzed using repeated measures anova and Tukey's Tukey's honest significant difference (HSD) test.The materials tested showed significant discoloration over time (WMT CEM; P 0.001). ΔE increased significantly while ΔL decreased in three media over time (P 0.001). Greater duration of light curing caused a significant decrease in ΔL and ΔE values in both materials (WMTA CEM; P 0.001).Color stability of WMTA was inferior to CEM samples after exposure to different duration of irradiation and media over time.

To compare efficacy and safety of topiramate (TPM) and propranolol for migraine prophylaxis in children. In a parallel single-blinded randomized clinical trial, 5–15 y-old referred migraineurs to Pediatric Neurology Clinic of Shahid Sadoughi Medical Sciences University, Yazd, Iran from May through October 2011, were evaluated. Patients were distributed into two groups, 50 of whom were treated with 3 mg/kg/d of topiramate (TPM) and another group of 50, were treated with 1 mg/kg of propranolol for 3 mo. Primary endpoints were efficacy in reduction of monthly frequency, severity, duration and headache related disability. Secondary outcome was clinical side effects. Fifty two girls and 48 boys with mean age of 10.34 ± 2.31 y were evaluated. Monthly frequency, severity and duration of headache decreased with TPM, from 13.88 ± 8.4 to 4.13 ± 2.26 attacks, from 6.32 ± 1.93 to 2.8 ± 2.12, and from 2.36 ± 1.72 to 0.56 ± 0.5 h, respectively. Monthly frequency, severity and duration of headache also decreased with propranolol from 16.2 ± 6.74 to 8.8 ± 4.55 attacks, from 6.1 ± 1.54 to 4.8 ± 1.6 and from 2.26 ± 1.26 to 1.35 ± 1.08 h, respectively. Pediatric Migraine Disability Assessment score reduced from 31.88 ± 9.72 to 9.26 ± 7.21 with TPM and from 33.08 ± 8.98 to 23.64 ± 9.88 with propranolol. Transient mild side effects were seen in 18 % of TPM and in 10 % of propranolol (P = 0.249) groups. Topiramate is more effective than propranolol for pediatric migraine prophylaxis.

This paper attempted to examine the earnings management in the initial public offerings of corporate shares at Tehran Stock Exchange (TSE). Using a sample 47 companies listed on Tehran Stock Exchange during 2000 to 2009, this research analyzes the model for discretionary current accruals. The results showed managers manipulated the corporate earnings through the discretionary current accruals three years before admission to the Stock Exchange manage. Additionally, the results revealed that managers tended to manipulate the earnings during the year prior to the public offerings though the discretionary current accruals, even though there was no evidence suggesting that managers manipulated the earnings at the IPO year. DOI: 10.5901/mjss.2015.v6n6s6p92

The objectives of this study were to assess the efficacy of preemptive oral administration of single dose of non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen on the local anesthetic success in adults with irreversible pulpitis and to find the possible covariates that could predict treatment effect. A systematic search using electronic databases up to March 2015 was conducted. Odds ratio (OR) and 95% confidence intervals (CIs) were estimated using random and fixed-effect inverse variance method. Subgroup and meta-regression analyses were conducted to assess the potential source of heterogeneity. Results showed that preemptive analgesics are more effective than placebo in increasing anesthetic success (OR = 0.30, CI% 0.24–0.39, p = 0.000) [Q = 55.860 (p = 0.001)]. In the subgroup analysis, administration of NSAIDs as monotherapy, ibuprofen as mono- vs. combination therapy, oxicam type drugs as monotherapy, and acetaminophen as combination therapy were significantly more effective in increasing anesthetic success OR = 0.25, CI% 0.16–0.38, p = 0.00, Q = 40.539 (p = 0.003); OR = 0.44, CI% 0.26–0.75, p = 0.00, Q = 12.833 (p = 0.011); OR = 0.48, CI% 0.30–0.74, p = 0.002, Q = 15.898 (p = 0.14); OR = 0.30, CI% 0.16–0.38, p = 0.001, Q = 7.506 (p = 0.02); OR = 0.10, CI% 0.16 0.38, p = 0.001, Q = 5.075 (p = 0.07), respectively. However, there was no significant difference in increasing anesthetic success between treatment and placebo arms when acetaminophen was administrated alone. In meta-regression analysis, an association between different types of NSAIDs (indomethacin, diclofenac potassium, and oxicam-type drugs) and articaine with treatment effect was observed. The administration of preemptive analgesics can induce superior intraoperative analgesia for patients with irreversible pulpitis. However, strategies such as co-administration of certain types of analgesics and anesthetic solution might be predictors of treatment effect. Additionally, there was no association between different timing and dosage of analgesics and treatment effect. When compared to placebo, preemptive oral analgesics are superior in achieving anesthetic success in inflamed pulp.

Today traffic is one of the chief concerns in many countries and large cities. Development of public transportation is one of the key and vital solutions to this concern. Without paying enough attention to proper public transportation it becomes almost impossible to solve this issue. As a result, transportation is considered to be a development index throughout the world, and railway transportation is considered to be one of its most important and vital forms. Easy access, short waiting times, fast and comfortable trips, high safety and artistic design are all important factors in attracting more passengers to use public transportation. Recent public transportation systems move toward fully automatic operations with the least possible human interferences, so that a safer and more economic system is provided for passengers. Automatic Train Operation (ATO) plays an important role in this.

We conducted this single blind randomized clinical trial to compare the efficacy and safety of oral chloral hydrate and intranasal midazolam for induction of sedation for computerized tomography scan of brain in children. Participants aged 1-10 years (n=60) were randomized to receive 100 mg/kg chloral hydrate orally with intra nasal normal saline OR intranasal midazolam 0.2 mg/kg with oral normal saline. Adequate sedation (Ramsay sedation score of four) was obtained and CT scan completed successfully in 76.7% of chloral hydrate group and in 40% of midazolam group (P=0.004). No significant difference was seen for side effects frequency between the two drugs (10% in chloral hydrate, 3.3% in midazolam group; P=0.34). We conclude that oral chloral hydrate can be considered as a safe and effective drug for sedation in children undergoing CT scan of brain.

Complete androgen insensitivity syndrome (AIS) is an X-linked disorder of sex development. Surgical management entails timely gonadectomy given the risk of malignant transformation. Our patient presented at age 15 years with primary amenorrhea. Initial laboratory testing showed elevated testosterone, luteinizing hormone, anti-Müllerian hormone levels, and 46,XY karyotype. Imaging studies showed no uterus, ovaries, and identified two candidate gonads. She underwent bilateral gonadectomy. Pathology reports revealed Sertoli cell and intratubular germ cell tumors located in separate gonads. Our case is the first report of the youngest patient with AIS with bilateral gonadal tumors derived from different histological origins. We also review literature for reports of AIS patients with gonadal tumors. Currently, there is no consensus for the timing of gonadectomy in AIS patients. However, given the varying potential for malignant transformation of gonads in AIS patients with different phenotypes, development of a standardized treatment guideline is indicated.

Four patients with Down syndrome and midtracheal stenosis, three with proven absence of the midtracheal pars membranacea ("hourglass trachea"), are reported. Five previously reported patients who had Down syndrome and tracheal stenosis of this type are summarized. Respiratory difficulty and stridor were the reported clinical features of all but one of the patients whose clinical story is available. That approximately half the patients with tracheal stenosis with hourglass trachea and midtracheal absence of the tracheal pars membranacea reported had Down syndrome suggests that the association of this pattern of congenital tracheal stenosis with Down syndrome is, although infrequent, significant.

Gastroesophageal reflux (GER) is well documented in premature infants with bronchopulmonary dysplasia (BPD).1–3 When medical management is inadequate or no longer effective in improving reflux, Nissen fundoplication is the therapy most often used.4 However, it has been our experience that these patients often continue to have gastrointestinal (GI) motility problems after surgery, and a variety of sequelae of fundoplication possibly related to abnormal intestinal motility, including persistent retching5 and dumping syndrome,6,7 have been reported in such patients. Whether gastric overdistension severe enough to cause gastric or visceral infarction occurs in the absence of other causes of intestinal obstruction such as adhesions8 or volvulus9 in infants who have had fundoplication is not known. This study demonstrates by a microdissection flat-mount preparation technique the structural abnormalities of the MEP of the small intestine and colon of premature infants with BPD who had gastroesophageal reflux treated by Nissen fundoplication. The abnormalities may explain continuing gastrointestinal tract dysmotility in such patients.

Immunoperoxidase localization of prostatic tissue antigens has become useful in identifying the prostate as the origin of metastatic disease. Much research has been aimed at investigating the presence of these antigens in the adult prostate gland in benign and neoplastic states. Few studies have been done to determine the presence of these markers before puberty. We studied the prostate gland of 42 children of varying ages to determine the presence of these antigens at all age ranges to puberty. Sequential sections of the prostate were cut for prostate specific antigen, prostatic acid phosphatase, and hematoxylin and eosin staining. The degree of immunoperoxidase stain was graded from 0 to 4. The results showed that staining levels of prostate specific antigen and prostatic acid phosphatase were high at birth, decreased by age 6 months, reappeared by age 10 years and increased to puberty. Thus, the levels of prostate specific antigen and prostatic acid phosphatase appear to follow the testosterone levels, suggesting a hormonal dependence.