Painless Treatment Research Articles

One-Year Follow-up Study on Minimally Invasive Treatment of Cariogenic or Non-cariogenic White Spot Lesions

(1) Background: The current practice in dental medicine aims to perform non-invasive treatments, which preserve as many hard tissues as possible. This trend is based on the final appearance, which should be as aesthetic and as close to natural teeth as possible. The use of Icon DMG can be considered revolutionary in the treatment of white spot lesions (WSLs) caused by various factors. (2) Methods: A diagnosis was established after clinical inspection, transillumination, or based on the patient’s medical history. Icon infiltration was followed according to the producer’s indications. Chromatic stability was assessed by two examinators with Vitapan 3D Master, and gum health improvement was assessed using the gingival index (GI). (3) Results: Ten dental units were observed for one year and showed chromatic stability. Gum health was improved. No side effects occurred. (4) Conclusions: An easy, non-invasive technique and painless treatment are the desired results from the use and implementation of resin in current practice. Following the infiltration protocol offers the desired aesthetic results.

Midterm clinical outcomes of collateral ligament repair of the thumb and lesser digits: a retrospective analysis of 35 cases

BackgroundFinger collateral ligament injuries are common, and conservative treatment usually works well. However, complete ruptures that lead to instability could cause painful disability. This study presents our clinical experience and a qualitative functional evaluation following the surgical repair of the thumb and proximal interphalangeal (PIP) joint collateral ligament ruptures.MethodsThirty-five patients (22 men and 13 women), diagnosed via a physical examination and magnetic resonance imaging (MRI) with a total collateral ligament rupture in the metacarpophalangeal thumb (16) and PIP joints of the lesser digits (19) and treated surgically, were evaluated retrospectively. The limited range of motion; functional score by Saetta; disabilities of the arm, shoulder, and hand (DASH) score; pre- and post-operative pain, deformity level; and post-operative ability to grip keys, buttons, and jars were measured. The significance of the change between the pre and post-operative visual analog scale for pain (VAS) scores were evaluated using the Wilcoxon signed-rank test. The difference between the lesser digits and thumb groups by patient age was evaluated using the Mann–Whitney-U test. All data, such as the mean, range, and standard deviation, were calculated using SPSS.ResultsThe mean pre- and post-operative VAS scores were 4.8 (from 3 to 7) and 0.91 (0 to 4), respectively. The mean post-operative limitation in the range of motion was 9.78° (s = 14.47) for lesser digits and 6.87° (s = 12.29) for the thumb. According to Seatta et al., the final functional score was 62.5% excellent, 25% good, and 12.5% moderate for the thumb and 84.2% excellent, 10.5% good, and 5.3% poor for the lesser digits. The mean post-operative DASH score was 13.55 (SD: 8.77) for lesser digits and 14.22 (SD: 8.9) for the thumb. The mean contralateral (healthy) hand DASH score was 0.75 (SD: 1.05) for lesser digits and 0.75 (SD: 1.05) for the thumb. For the thumb and lesser digits, the z-scores were − 3.55 and − 3.787, respectively, and the progress of the VAS score was significant (p < 0.05).ConclusionAfter a 40-month follow-up for 35 acute, subacute, and chronic cases, the results suggest that direct and suture-anchor repairs are feasible, painless treatments associated with good finger function.

Biological evaluation of the efficacy of two different anesthetic solutions in pain control during extraction of mandibular second primary molars

BackgroundThe most critical part in management of children in the dental clinic is control of pain and this can be achieved through local anesthesia. When the treatment plan includes extraction of mandibular primary molars, the nerve block technique is the technique of choice for administration of local anesthesia. However, this technique is accompanied with discomfort due to deep penetration of the needle, possibility of nerve injury, hematoma as well as risk of self-inflicted trauma. Therefore, researchers have searched for an alternative technique to facilitate providing painless dental treatment for the child with avoidance of the possible complications of the nerve block technique, and this can be achieved by using a strong and deeply penetrating type of local anesthesia like articaine 4% that can be effective when administered with infiltration technique. The aim of the current study was to compare the efficacy of infiltration anesthesia using alexadricaine 4% and Mepecaine-L 2% in control of pain during extraction of lower 2nd primary molars in children and to compare the change in the heart rate that occurs as a consequence of pain during extraction. A total of 50 children were included in the current study, pain assessment was performed through measuring physiological parameter (pulse rate), subjective parameter (Wong–Baker Facial Pain Scale) and objective parameter (Sound Eye Motor scale). Results showed that there was significant increase in the pulse rate in both groups, while extraction using alexadricaine showed significantly lower pain scores either with Wong–Baker Facial Pain Scale (WBFPS) or with Sound Eye Motor scale (SEM).ConclusionsUsing a potent anesthetic solution like alexadricaine 4% facilitates extraction of mandibular primary molars, and achieves efficient pain control, with infiltration technique only without any need for the invasive nerve block technique.

Lidocaine-Loaded Hyaluronic Acid Adhesive Microneedle Patch for Oral Mucosal Topical Anesthesia.

The pain and fear caused by direct local injection of anesthetic or the poor experience with surface anesthetic cream increase the difficulty of clinical treatment for oral diseases. To address this problem, a hyaluronic acid microneedle patch (Li-HAMNs) that consists of fast-dissolving lidocaine hydrochloride (LDC)-loaded tips and a wet-adhesive backing layer made of polyvinyl alcohol (PVA)/carboxymethylcellulose sodium (CMC-Na) was fabricated to explore its potential use in dental topical anesthesia. Li-HAMNs could puncture the stratum corneum with an insertion depth of about 279 μm in the isolated porcine oral mucosal. The fast-dissolving tips could release LDC to improve the patients’ convenience and compliance. Importantly, the backing layer, which has good adhesion ability and water-absorbing properties, could surmount the contraction and extension of oral masticatory muscles and the saliva scour. In the tail flick test, the topical anesthesia efficacy of the Li-HAMNs group was much better than clinical lidocaine cream (EMLA cream, LDC, 1.2 mg) in spite of a relatively lower LDC dose with Li-HAMNs (LDC, 0.5 mg). It is believed that the proposed adhesive microneedle patch could enhance transmucosal delivery of anesthetics and thus open a new chapter in the painless treatment of oral diseases.

Design and Investigation of Optimal Dissolving Polymeric Microneedles for Ocular Application by Using Three-Level Factorial Design

Dissolving microneedles (dis-MNs) are very attractive micro-scale technology and a minimally invasive method to be used as a tool for transdermal delivery, leading to increased bioavailability of drugs bypassing ocular tissue barrier and painless treatment method. This study aims to design and investigate the optimal dis-MNs as a potential device for ocular application using a three-level factorial design. The dis-MNs were fabricated by micromolding technique using chitosan and polyvinyl alcohol (PVA) polymer. The physical appearance of dis-MNs was observed under a digital microscope. The mechanical strength (resistance force and insertion force) was tested with a texture analyzer. The penetration depth and dissolution time at a predetermined time were tested on porcine ocular tissue. The data illustrated that the optimal dis-MNs formulation was 3%chitosan and 20%PVA in 20%PVA in a weight ratio of 1:4. The physical appearance showed pyramidal microneedles with an average 609.01±1.01 µm in height and 200.21+3.57 μm in base width. The optimal dis-MNs showed a resistance force of 40.14±2.10 N. The insertion force into the cornea tissue (1.78 N/225 arrays) was higher than sclera tissue (0.95 N/225 arrays), indicating that the optimal dis-MNs could create micro-channels on both cornea and sclera tissues. The dissolution study showed that the optimal dis-MNs formulation was completely dissolved on cornea tissue (1 min) faster than sclera tissue (3 min). In conclusion, the optimal dis-MNs presented suitable dis-MNs properties with minimally invasive device for ocular tissue, acting as an appropriate dis-MNs model for the ophthalmic drug delivery system.

Observation and Analysis of the Postoperative Analgesic Effect of Subanaesthetic Dose of Ketamine in Kashin-Beck Disease Patients after Total Knee Arthroplasty.

With the transformation of modern medical models, the medical needs of patients have changed from treatment to safe, comfortable, and painless treatment. Therefore, it is clinically important to find an ideal analgesia model to reduce the pain after total knee arthroplasty and minimize the impact of surgical trauma on the body pressure. This article aims to study the effects of lower limb nerve block combined with local infiltration analgesia of the joint cavity on the hemodynamics and postoperative analgesia effects of knee joint replacement in elderly patients by comparing the effects of the subanaesthetic dose of ketamine on the hemodynamics and postoperative analgesia effect of knee joint replacement in elderly patients' intraoperative analgesia program. This article proposes that 90 patients requiring unilateral total knee replacement were randomly divided into 3 groups, with 30 patients in each group, age 65–85 years, average age 75 years, ASA I ∼ II grade, and body mass index 13.89 ∼ 37.26. Use a multifunctional monitor to monitor the patient's continuous blood pressure (SBP/DBP) and mean arterial pressure (MAP), heart rate (HR), electrocardiogram (ECG), intraoperative pulse oxygen saturation (SpO2), and end-tidal carbon dioxide (PETCO2). The following are monitored: record the heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure before induction of anesthesia (T0), before the upper tourniquet (T1), and after the upper tourniquet (T2), before tourniquet withdrawal (T3), and after tourniquet withdrawal (T4), mean arterial pressure (MAP). The three groups of patients had different degrees of itching, vomiting, nausea, and other adverse reactions. The experimental results in this article show that, in elderly patients with epidural anesthesia, the use of propofol and dexmedetomidine to maintain the patient's BIS value between 60 and 70 can meet the depth of sedation required for surgery without important surgical operation knowledge.

Design of Transcranial Magnetic Stimulation Coils for Mouse With Improved Stimulus Focus and Intensity

Transcranial magnetic stimulation (TMS) is a noninvasive and painless treatment for some neurological or psychiatric disorders. The rodent model of TMS provides the possibility to reveal the mechanism of TMS at cellular and molecular levels. However, their application has been hampered by lack of stimulation coils with appropriate focus and intensity. In this study, we analyzed various forms of coils and proposed conductive shield and iron core materials to improve the coil performance. The results showed that the combination of “Halo” coil and “Figure of Eight” coil with shield and iron core could generate better stimulus focus (30.44 mm <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> ) and intensity (87.6 V/m).

Application of a Remotely Controlled Artificial Intelligence Analgesic Pump Device in Painless Treatment of Children.

In order to effectively improve the application of analgesic pump devices in the treatment of children, a method based on remote control artificial intelligence is proposed. 100 children with dental pulpitis who were treated in a hospital from December 2018 to December 2020 were selected as the research subjects; they were randomly divided into control group and observation group by an equidistant sampling method, with 50 cases in each group. Children in the control group were given articaine and adrenaline anesthesia, and the observation group was treated with articaine and adrenaline combined with a computer-controlled anesthesia system, the anesthesia pain degree and satisfaction degree of the two groups of children were observed and compared. The results showed that the pain score in anesthesia and intraoperative pain score in the observation group was significantly lower than that in the control group, and the differences were statistically significant (P < 0.05). The total satisfaction of 96.6% patients in the observation group was significantly higher than that in the control group (84.7%) and the difference was statistically significant (P < 0.05). There were no serious complications in both groups. The application of the computer anesthesia system combined with articaine adrenaline in the painless treatment of children's dental pulp proved to have better effects, the treatment compliance is higher, and it is worthy of clinical promotion.

Theoretical design of an absorption hologram-based sensor for dose quantification in daylight photodynamic therapy.

Daylight photodynamic therapy (D-PDT) is an effective and almost painless treatment for many skin conditions, where successful treatment relies on daylight activation of a topical photosensitizer. Optimization of D-PDT requires accurate assessment of light dose received. There is a requirement for a small-area sensor that can be placed adjacent to the treatment site to facilitate accurate dose quantification. Here, a novel, to the best of our knowledge, configuration for a D-PDT dose sensor, consisting of a holographic absorption grating fabricated in a photosensitive film, is presented. Theoretical modeling of the sensor's response (i.e., change in grating diffraction efficiency due to change in grating absorption modulation, α1, on exposure to daylight) was conducted using Kogelnik's coupled-wave theory. The influence of the different grating parameters (initial film absorption, thickness, spatial frequency, and reconstruction wavelength) on the sensor response was examined and revealed that the initial absorption and grating thickness values have a large impact on both the magnitude and rate of the D-PDT sensor response. The optimum design for an absorption grating-based D-PDT sensor is described.

Застосування анальгоседації в дорослих зі зниженим порогом болю в стоматології

Мета — підвищення ефективності стоматологічного лікування пацієнтів, які виявляли ознаки надмірного хвилювання та страху перед лікуванням, шляхом впровадження комбінованого методу анальгоседації і місцевої анестезії для знеболювання зубів. Матеріали та методи. Клінічні особливості запропонованого методу описано на підставі записів у медичних картах 42 пацієнтів із високим рівнем хвилювання від майбутніх стоматологічних маніпуляцій через недостатнє знеболювання в анамнезі, яким було проведено стоматологічне лікування зубів із поєднаним застосуванням анальгоседації на основі пропофолу і фентанілу та місцевої анестезії. Ефективність анестезії пацієнти оцінювали за візуально-аналоговою шкалою (ВАШ), візуальними та слуховими спогадами. Результати. Опрацьований алгоритм взаємних клінічних дій із застосуванням комбінованого методу анальгоседації та місцевої анестезії дозволив провести повноцінне нехірургічне лікування запланованого обсягу у всіх пацієнтів досліджуваної групи за один візит. Вихід з анальгоседації до моменту виписки з клініки тривав 50 ± 30 хвилин. Рівень болю в цій групі за ВАШ становив 0–1, в 1-шу добу після лікування — 1–2, на 3-тю добу після лікування — 0–1. Висновки. Застосування методу поєднання анальгоседації на основі пропофолу і фентанілу та місцевої анестезії дає змогу надати безболісну стоматологічну допомогу пацієнтам із недостатньою анестезією зубів в анамнезі та фобією стоматологічного лікування.

Os efeitos fisiológicos do led vermelho no tegumento

Dentre as novas tecnologias, o LED (sigla de Light Emiting Diode, em português: Diodo Emissor de Luz) é um recurso fototerápico que tem sido amplamente utilizado nas alterações cutâneas. Os diferentes comprimentos de onda são absorvidos por células específicas e esse processo recebe o nome de Fotobiomodulação, promovendo um tratamento seguro, não invasivo e indolor. A Luz na faixa do vermelho possui comprimento de onda de 610-760nm e é utilizada para acelerar o processo de cicatrização de feridas, possui poder de analgesia e anti-inflamatório. Entender os efeitos fisiológicos da Luz Vermelha de LED na pele é o objetivo principal desse trabalho de revisão da literatura e verificar se a Led Terapia tem a mesma eficácia do LASER de baixa potência, no mesmo comprimento de onda do vermelho, é um objetivo específico. A pesquisa se realiza em torno da discussão de cinco artigos científicos sendo possível verificar que, nos casos apresentados pelos autores, os resultados sobre os efeitos no tegumento, em especial o de cicatrização, analgesia e efeitos anti-inflamatórios foram positivos. O presente estudo acena ainda para a importância na continuidade de novas pesquisas para a utilização do LED, em especial, do LED Vermelho, uma vez que seus resultados benéficos foram efetivos para a pele.

Therapeutic efficacy and safety of three different modalities in pediatric patients with plantar warts.

Human papillomavirus infection is relatively common in communities. Thus, determining an effective and painless treatment method, especially in pediatric patients is of utmost importance. This study aimed to compare the outcomes of three different methods of treating plantar warts in pediatric patients. Children with verruca plantaris treated with a salicylic acid-lactic acid combination once daily (SA/LA 1), a salicylic acid-lactic acid combination applied in three to seven layers under occlusion every 3 days (SA/LA 2), or a combination of 5-fluorouracil (0.5%) and salicylic acid (10%) (SA/5-FU) were evaluated retrospectively. Treatment responses and recurrence rates were also evaluated after a minimum of 4months. Among the 98 children with verruca plantaris, 19 were treated with SA/LA 1, 53 were treated with SA/LA 2, and 18 were treated with SA/5-FU; the eight patients who received cryotherapy were excluded. The mean treatment duration was significantly shorter in the SA/LA 2 group than in the SA/LA 1 group and the SA/5-FU group. (p =0.000 for both) Application of a salicylic acid-lactic acid combination in multiple layers under occlusion is a safe, painless, and effective treatment method for plantar warts in children.

Women\u2019s experiences in a community-based screen-and-treat cervical cancer prevention program in rural Malawi: a qualitative study

BackgroundMalawi has the world’s highest cervical cancer incidence and mortality due to high rate of HIV coupled with inadequate screening and treatment services. The country’s cervical cancer control program uses visual inspection with acetic acid (VIA) and cryotherapy, but screening is largely limited by poor access to facilities, high cost of cryotherapy gas, and high loss-to-follow-up. To overcome these limitations, we implemented a community-based screen-and-treat pilot program with VIA and thermocoagulation. Through a qualitative study, we explore the experiences of women who underwent this community-based pilot screening program.MethodsWe implemented our pilot program in rural Malawi and conducted an exploratory qualitative sub-study. We conducted in-depth interviews with women who were treated with thermocoagulation during the program. We used semi-structured interviews to explore screen-and-treat experience, acceptability of the program and attitudes towards self-sampling for HPV testing as an alternative screening method. Content analysis was conducted using NVIVO v12.ResultsBetween July – August 2017, 408 participants eligible for screening underwent VIA screening. Thirty participants had VIA positive results, of whom 28 underwent same day thermocoagulation. We interviewed 17 of the 28 women who received thermocoagulation. Thematic saturation was reached at 17 interviews. All participants reported an overall positive experience with the community-based screen-and-treat program. Common themes were appreciation for bringing screening directly to their villages, surprise at the lack of discomfort, and the benefits of access to same day treatment immediately following abnormal screening. Negative experiences were rare and included discomfort during speculum exam, long duration of screening and challenges with complying with postprocedural abstinence. Most participants felt that utilizing self-collected HPV testing could be acceptable for screening in their community.ConclusionsOur exploratory qualitative sub-study demonstrated that the community-based screen-and-treat with VIA and thermocoagulation was widely accepted. Participants valued the accessible, timely, and painless thermocoagulation treatment and reported minimal side effects. Future considerations for reaching rural women can include community-based follow-up, cervical cancer education for male partners and self-sampling for HPV testing.

A Perspective on Imiquimod Microneedles for Treating Warts.

Warts are a common skin problem and are caused by infection with a virus. Warts are currently mainly treated by therapies involving ablating tissue or interrupting cellular division. However, all these existing treatments are either invasive or cause skin pain and tissue destruction. Imiquimod is a synthetic compound that belongs to the imidazoquinolinone family. It has been successfully used as a topical drug to treat external anogenital warts. However, topical imiquimod cream for warts is restricted by low skin permeability, and several side effects such as itching, pain, and erosions occur most frequently following topical treatment. Microneedle technology, a minimally invasive drug delivery system, has the potential to overcome the barrier of the stratum corneum. This technique would also offer a painless treatment choice and provide personalized therapies. In the study, we loaded imiquimod within dissolving microneedles using the molding method. Gelatin was used as a structural material for microneedle formation without adding a crosslinker. To our knowledge, this is the first study of using dissolving microneedles and exploring their utilization with imiquimod for the treatment of warts. First, we added fluorescent dye and trypan blue into the microneedles to evaluate the status of drugs in the microneedles and the degradation property of microneedles made of gelatin, respectively. Here we also prove the strength of the imiquimod microneedles and study their capability to penetrate the skin. The results show no apparent differences in mechanical failure after an additional imiquimod-loaded. Besides, we provide evidence that imiquimod microneedles induce secreted embryonic alkaline phosphatase (SEAP) in the RAW 264.7 macrophages. Gelatin does not affect the imiquimod in microneedles; a similar immune response was affected by the imiquimod alone or imiquimod complexed with gelatin. Our research demonstrates a proof of concept of using imiquimod microneedles for future warts treatment.

Stumbling block for inferior alveolar nerve block in predoctoral students: An analytical observational study and review of literature of mandibular nerve block techniques.

Introduction:Dentists earnestly try to practice painless treatment. Conventional inferior alveolar nerve block technique is preferred by most of the dentists despite its various modifications.However its failure rate as per literature is quite high. Inexperienced dentists face difficulty in obtaining effective anesthesia. This may be due to limited access to inferior alveolar nerve,greater density of alveolar bone,bulky soft tissues,damage to nerve or due to risk of intravascular injection.Aim:The aim of this study is to review and clinically assess the factors causing difficulty or failure of inferior alveolar nerve block in predoctoral students and to review the mandibular nervve blocks.Material and methods:Dental interns of riyadh elm university were monitored during administration of inferior alveolar nerve block for difficulty factors influencing inferior alveolar nerve block. Onset of anesthesia, efficacy anesthesia of inferior alveolar nerve, lingual nerve and long buccal nerve were ascertained. Difficulty index was used to assess the “item difficulty” with a score of 0.0 which indicates that none of the dental interns anesthetised correctly to 1.0 suggesting all the dental interns anesthetised correctly.Results:Complete failure of inferior alveolar nerve block was noticed in 2.4% of predoctoral students. The most common cause for inferior alveolar nerve block failure was attributed to the difficulty in palpating the landmarks (77%), 22% of the patients refused multiple needle penetrations,and 19% of inferior alveolar nerve block failure was due to the fear of potential complications by the predoctoral students.Conclusion:Clinical skill of predoctoral students need adequate training in nerve blocks. Revising the current literature on alternative inferior alveolar nerve block techniques or use of evidence based dentistry to update and practice alternative nerve block techniques would aid in improving the clinical skills and treatment outcome which would therefore enable to remove the stumbling blocks in successful anesthesia.

A Robotic Platform to Navigate MRI-guided Focused Ultrasound System

Focused ultrasound (FUS) technology attracts increasing interests accrediting to its non-invasive and painless treatment of tumors. Magnetic resonance imaging (MRI) guidance has been introduced to monitor this procedure, thus allowing the ultrasound foci to be precisely controlled. However, manual positioning of the FUS transducers is challenging, especially for the intra-operative (intra-op) adjustment in the MRI room. Currently, there are very few devices capable to provide robotic transducer positioning for the treatment of abdominopelvic organ diseases under MRI. The high intensity focused ultrasound (HIFU) spot would have to be “steered” to ablate large (>Ø 3.5 cm) or multiple tumors (e.g., in liver). To this end, we proposed a hydraulic-driven tele-operated robot platform that enables 5-DoF manipulation of the FUS transducer. Even operated close to the MRI iso-center, the robot can guarantee zero electromagnetic (EM) artifact to the MR image. Our proof-of-concept robot prototype can offer a large workspace (100 mm × 100 mm × 35 mm) for FUS foci steering. Accurate manipulation (0.2 mm in translation, 0.4° in rotation) of the FUS transducer holder is achieved using rolling diaphragm-sealed hydraulic actuators. The robot control responsiveness (from 0.1 to 4 Hz) is also evaluated to show the potential to compensate for the spot tracking error induced by respiratory motion. We also demonstrate the use of wireless radiofrequency (RF) markers to continuously register the robot task space in the MRI coordinates.

The Effectiveness of Intranasal Midazolam for the Treatment of Prehospital Pediatric Seizures: A Non-inferiority Study

Background: Intranasal (IN) midazolam allows for rapid, painless treatment of pediatric seizures in the prehospital setting and may be a preferred administration route if determined to be non-inferior to intravenous (IV) or intramuscular (IM) routes. We sought to evaluate the effectiveness of IN midazolam for terminating prehospital pediatric seizures compared to midazolam administered by alternate routes. Methods: We performed a retrospective, non-inferiority analysis using data from a regional Emergency Medical Services (EMS) database. We included pediatric patients ≤ 14 years treated with midazolam (0.1 mg/kg) by EMS for non-traumatic seizures. The primary outcome was the proportion of patients requiring redosing of midazolam after initial treatment with IN midazolam compared to those that received IV or IM midazolam. We established a priori a risk difference of 6.5% as the non-inferiority margin. Results: We evaluated outcomes from 2,034 patients (median age 6 years [interquartile range 3 − 10 years], 55% male). Initial administration routes were 461 (23%) IN, 547 (27%) IM, 1024 (50%) IV, and 2 (0.1%) intraosseous (IO). Midazolam redosing occurred in 116 patients (25%) who received IN midazolam versus 222 patients (14%) treated initially with midazolam via alternate routes (risk difference 11% [95%CI 7 − 15%]). The age-adjusted odds ratio for redosing midazolam after intranasal administration compared to alternate route administration was 2.0 (95% CI 1.6 − 2.6). Conclusion: Prehospital treatment of pediatric seizure with intranasal midazolam was associated with increased frequency of redosing compared to midazolam administered by other routes, suggesting that 0.1 mg/kg is a subtherapeutic dose for intranasal midazolam administration.

Pretreatment with ablative fractional carbon dioxide laser improves treatment efficacy in a synergistic PDT protocol for actinic keratoses on the head.

A recently proposed synergistic photodynamic therapy protocol (s-PDT) combining advantages of both conventional- and daylight-PDT proved to be an effective and almost painless treatment for patients with actinic keratoses (AKs). This study investigated the safety and efficacy of an additional ablative fractional CO2-laser (AFXL) pretreatment. 28 patients with AKs on the head received s-PDT using 5-aminolevulinic acid. AFXL pretreatment was conducted using the following parameters: pulse energy 8 mJ, spot density 50 spots/cm2, power 30 W, beam size 4-18 mm. Outcome was assessed by AK area and severity index (AKASI) and lesion count (LC) before and 3 months after treatment. Safety was monitored by blood pressure and pulse measurements. Intensity of pain was determined by use of a visual analog scale (VAS). Most patients (96.4 %) showed a significant AKASI reduction (P < 0.0001) 3 months after PDT (median AKASI 1.6 [0-2.4]) compared to baseline (5.3 [4-7.75]). Median reduction rate was 75.5 % (61.3 %-100 %). Eleven patients (39.3 %) achieved AKASI 100, three (10.7 %) AKASI 75 and ten (35.7 %) AKASI 50. Blood pressure and pulse did not change significantly throughout treatment. Median VAS for pain during irradiation was 0 (0-0), 0 (0-2) and 0 (0-2) at the beginning, in the meantime and at the end, respectively. Compared to data without AFXL pretreatment, this study showed significantly higher AKASI and LC reduction rates (75.5 % vs. 63.7 % [P = 0.023] and 91.3 % vs. 80.4 % [P = 0.043]). S-PDT with AFXL pretreatment represents a safe and almost painless treatment for patients with AKs on the head and improves treatment efficacy.

Efficacy of transcutaneous perineal electrostimulation versus intracavitary anal electrostimulation in the treatment of urinary incontinence after a radical prostatectomy: randomized controlled trial study protocol

BackgroundRadical prostatectomy is the gold standard treatment for men with localized prostate cancer. This technique is associated with post-operative urinary incontinence. Pelvic floor physiotherapy is a conservative, painless and economical treatment for this specific situation. Kegel exercises and perineal electrostimulation are common techniques to train pelvic floor muscles. The perineal electrostimulation can be applied to the patient with surface electrodes or by an intra-cavitary anal probe. This study proposes that transcutaneous perineal electrostimulation is as effective as intra-cavitary electrostimulation in reducing urinary incontinence secondary to radical prostatectomy. The main objective is to compare the efficacy of the treatment with transcutaneous perineal electrostimulation versus the same intra-cavitary treatment to reduce the magnitude of urinary incontinence after radical prostatectomy, and the impact on the quality of life.MethodsThis single-blind equivalence randomized controlled trial will include 70 man who suffer urinary incontinence post radical prostatectomy. Participants will be randomized into surface electrodes group and intra-anal probe group. The groups will receive treatment for 10 consecutive weeks. Outcomes include changes in the 24-h Pad Test, and ICIQ-SF, SF-12 and I-QoL questionnaires. Clinical data will be collected at baseline, 6 and 10 weeks after the first session, and 6 months after the end of treatment.DiscussionThe results will allow us to prescribe the most beneficial perineal electrostimulation technique in the treatment of urinary incontinence derived from radical prostatectomy.Trial registrationClinicalTrials.gov Identifier: NCT03587402. 27/06/2018

Evaluation of the effectiveness of the compression method for infiltration anesthesia of the mandibular molars

To study the depth of analgesia and the electrical excitability dynamics of the pulp of the tooth under local anesthesia without and with compression on the depot of local anesthetics. 87 men and 93 women took part in the study, the average age of men was 36.8±5.02 and the average age of women was 30.43±2.14. According to the indications, local anesthesia of infiltration type with and without compression at the depot of local anesthetics was performed. The injection was carried out with a solution of 4% articaine with epinephrine1:100000 or 1:200000. Patients were divided into 2 groups depending on the used concentration of the vasoconstrictor with 4% articaine. The target area thermometry and electroodontometry (EOD) of the first mandibular molar were performed. The criterion for the onset of pulp analgesia was the value from 92 to 100 mA. Dynamics of change in pulp electrical excitability of the first molar with the use of 4% articaine with epinephrine 1:200000 without a compress showed that in the latter case the reduction of pulp electrical excitability to 96.6 µA, which is optimal for painless treatment, was developed by the 5th minute of the study and remained at the limit of 92.2-92.1 µA for 20 minutes. When using 4% articaine 1:100 000 it was noted that also the compression technique allowed to reach the necessary reduction of EOD indices to 93.5 µA by the 5th minute of the study, and to 97.2 µA by the 10th minute. Increased hypothermia in the injection depot area was noted thermographically, especially when high concentrations of epinephrine were used. Our own studies reflect the dynamics of change in the electrical excitability of the pulp of the first molar with the use of 4% articaine by compression method more intensively reduces the electrical reacrivity of the dental pulp depending on the concentration of the epinephrine: with the use of 1:100000, the advantage of the pressure technique is 19.3% and 1:200000 - 21.8%.