Purpose The objective of this multicentre randomised controlled trial was to compare the clinical/radiographic outcomes of cervical pulpotomy using calcium-enriched mixture cement (PCEM) and pulpectomy using Metapex (PM) in primary molars with irreversible pulpitis (IP). Methods A total of 134 primary molars from 94 children were randomly assigned to two intervention groups: the PCEM group ( n = 74) and the PM group ( n = 60). Baseline characteristics including age/gender/molar type/tooth type/jaw were recorded. The primary outcome measures were clinical/radiographic success rates assessed at the first and second follow-up appointments. Secondary outcomes included reasons for clinical/radiographic failures. Multiple logistic regression analysis was performed to determine the impact of various factors on the success rates. Results The mean age of the participants in both groups was similar (PCEM group: 5.4 years, PM group: 5.5 years). Gender distribution, molar type, tooth type, jaw, and number of practitioners were comparable between the groups. The clinical success rate at the first follow-up was 98.6% in the PCEM group and 96.4% in the PM group. At the second follow-up, the clinical success rate was 97.1% in the PCEM group and 91.1% in the PM group. The radiographic success rates at the first and second follow-up were 98.6% and 96.4% in the PCEM group and 96.4% and 91.1% in the PM group, respectively. Multiple logistic regression analysis did not reveal any significant association between the success rates and age/gender/molar type/jaw, or treatment groups ( P > 0.05). Conclusion In primary molars with IP, both simple/conservative cervical pulpotomy using calcium-enriched mixture cement and pulpectomy using Metapex demonstrated high clinical/radiographic success rates. No significant differences were observed between the two treatment modalities. These findings suggest that both techniques can be considered effective treatment options for managing primary molars with IP. Trial registration number Trial registration number: IRCT20201226049838N1, retrospectively registered on 12 January 2021.

Background. Low back pain (LBP) is one of the most prevalent and costly muscu-loskeletal problems. Impaired neuromuscular control and reduced use of the dorsal and abdominal muscles lead to instability in the spine and subsequent injury. Recently, vibration therapy has been proposed as an alternative method for LBP rehabilitation. Flexi-bar is a vibratory tool. When it is shaken, the core muscles are automatically activated to control the trunk against oscillatory forces created by the Flexi-bar. This study aimed to compare the efficacy of Flexi-bar and stabilization exercises in LBP rehabilitation.Methods. Thirty-eight patients were randomly assigned into Flexi-bar (n = 19) and stabilization (n = 19) groups. The Flexi-bar group received general physiotherapy and Flexi-bar exercises and the stabilization group received general physiotherapy and stabilization exercises. Both groups received treatment for 3 sessions per week, a total of 10 sessions. The outcome measures were Numeric Pain Rating Scale, Oswestry Disability Index, and Sorensen test.Results. After the intervention, both groups showed a significant improvement in pain, functional disability, and back muscles endurance (p < 0.05) however, no significant differences were found between the groups after treatment, while only back muscles endurance was significantly improved in the Flexi-bar group over the stabilization group (p < 0.001).Conclusions. Neither of the two exercise interventions wasn't superior in reduc-ing pain and functional disability. However, the Flexi-bar group showed significant improvement in back muscles endurance over the stabilization group. Flexi-bar is recommended as an effective, portable, and cheap tool in LBP rehabilitation.Study registration. This study was registered in the Clinical Trial Center with no: IRCT20191015045122N1.

Flexion-relaxation phenomenon (FRP) is a well-known phenomenon in spinal extensor muscles. According to the literature, prolonged flexed posture leads to creep phenomenon and affects the active and passive neuromuscular control of the spinal column. The purpose of this study was to investigate FRP occurrence in elite cyclists that prolonged flexion posture is an integral part of their professional life. Their muscles’ contraction pattern during forward bending was also compared. Electromyography (EMG) was recorded during flexion and extension from standing position in thoracic erector spinae (TES), lumbar erector spinae (LES) and gluteus maximus (Gluteus max) in 15 healthy male elite cyclists. In addition, the kinematic data related to the trunk angles were simultaneously recorded by a motion analysis system. Two-way ANOVA was used to assess the effects of muscle group and direction of movement on maximum amplitude of EMG activity. Among 15 cyclists, FRP was detectable in 60%, 87% and 73% of the participants in TES, LES and Gluteus max, respectively, and happened between 74% and 82% of the trunk flexion. There was no statistically significant difference in onset and offset of muscles FRP. Despite prolong hyper kyphotic posture, FRP was identifiable in TES, LES and Gluteus max muscles of elite cyclists.

In this paper, the artificial intelligence is employed to design a Fault-Tolerant Controller (FTC) for structural vibrations. The FTC is designed to reduce the probability of damage considering sensor fault. For this purpose, Neural Networks (NNs) are used as fault detection and accommodation and fuzzy logic is used as a controller. This control strategy requires two groups of neural networks. The first group of neural networks finds the faulty sensor by estimating the structural responses and comparing them with the responses obtained from the sensors. The second group has the task of estimating the response of the faulty sensor using data obtained from healthy sensors. To evaluate this method, the time history analysis of a 3-story benchmark building equipped with accelerometers and active actuators has been used. This evaluation is based on determining the probability of structural damage and the generation of fragility curves under forty ground motions. To develop fragility curves, the criteria specified in the FIMA 356 (IO, LS and CP) for the moment frame based on the inter-story drift are used. This study show that in the absence of the neural networks, sensor fault reduces the performance of the fuzzy controller and it is even possible to increase the structural responses compared to the structure without the controller. In addition, results demonstrate that the proposed control strategy can rectify the deterioration of sensor faults and decrease the probability of failure.

BACKGROUND AND OBJECTIVE: Ocular thyroid disease is a common complication associated with Graves' disease and hyperthyroidism, which in severe cases there is a risk of irreversible loss of vision. The aim of this study was to compare the visual acuity, refractive errors, proptosis and ocular deviation of these patients with healthy individuals. METHODS: In this historical cohort study, 65 patients with history of thyroid disease were compared with 65 healthy subjects. Patients in the age range of 24 to 60 years with a history of thyroid disease and healthy individuals were selected from those who referred to the eye clinic who did not have thyroid disease. The proptosis of the eyes was measured with Hertel exophthalmometer. Visual acuity of the patients was measured with Snellen chart and refractive error measurement was done with an auto-refractometer. FINDINGS: Of the patients, 53 (81.5%) were males and 12 (18.5%) were females. Sphere refractive error in patients and healthy individuals was -0.85±2.44 diopters and -0.46±1.26 diopters, respectively. The mean visual acuity in the patient and healthy groups was 0.91±0.13 and 0.96±0.08 in Snellen unit (p≤0.0001), respectively. The mean proptosis in patient and healthy individuals was 17.7±2.55 mm and 16.05±1.86 mm (p≤0.0001), respectively. The mean of total eye astigmatism in patient and healthy individuals was -1.11±1.19 diopters and -0.6±0.66 diopters, respectively (p≤0.0001). CONCLUSION: Higher astigmatism and proptosis and decreased visual acuity in the patients, indicating thyroid disease has affected on the involved eye.

Objective: The P21(waf) is a tumor-suppressor protein encoded by CDKN1A gene. In this study, we evaluated P21(waf) expression and CDKN1A exon 2 mutation and their relationships with clinicopathological parameters and cancer development in salivary adenoid cystic carcinoma (ACC). Patient and Methods: Forty paraffin blocks from patients with salivary ACC were collected. Immunohistochemical staining was performed using P21 antibody. Genomic DNAs were extracted from the deparaffinized sections of the embedded tissue. Exon 2 of CDKN1A gene was amplified by PCR and the PCR products were sequenced. Spearman's correlation coefficient, Fisher's exact test, and Kruskal-Wallis test were used for data analysis. Results: A significant inverse correlation was observed between P21 expression and histologic grade (p=0.033, r=-0.338). The correlation of tumor size with recurrence (p=0.048) and tumor stage (p=0.046) was also evidenced. No mutation was detected in the exon 2 of CDKN1A gene. Conclusions: Regarding the association of P21 expression and histologic grade as a major prognostic indicator of ACC, P21 may be a useful prognostic indicator in ACC. On the other hand, CDKN1A exon 2 mutation seems inapplicable as a risk factor for ACC development.

Background and Aims: To develop a Persian version of the diagnostic criteria for temporomandibular disorders (DC/TMD) Axis I and to assess its content validity Methods: The present study is a cross-sectional survey. To cross-culturally adapt the instrument, the DC/TMD Axis I was translated using a forward-backward method. Translation quality and cultural adaptation were assessed by a panel of five experts on a scale of 0 to 100. Then, the content validity of the Persian version was quantitatively evaluated by a panel of 10 experts calculating content validity index (CVI) and content validity ratio (CVR). Results: Average values of translation quality were less than 90% in 7 items, which were rephrased. Average values of cultural adaptation of 2 items were less than 90% and they were omitted according to the experts' opinion. CVR values in all items of the questionnaire were between 0.8 1 and for the total instrument, the CVR values was obtained to be 0.94. All of the items of the questionnaire in terms of relevancy earned values higher than 0.75. CVI values in terms of clarity for 13 items and in terms of simplicity for 10 items were less than 0.75, which were candidates for revision in the second round. All these items received values higher than 0.75 in the second round. Conclusions: Evaluating content validity of the Persian version of DC/TMD Axis I can be an introduction for assessing other psychometric properties of the questionnaire and will pave the way for including Iran in international studies on TMD.

To control structures against wind and earthquake excitations, Adaptive Neuro Fuzzy Inference Systems and Neural Networks are combined in this study. The control scheme consists of an ANFIS inverse model of the structure to assess the control force. Considering existing ANFIS controllers, which require a second controller to generate training data, the authors’ approach does not need another controller. To generate control force, active and semi-active devices could be used. Since the active ANFIS inverse controller may not guarantee a satisfactory response due to different uncertainties associated with operating conditions and noisy training data, this paper uses MR dampers as semi-active devices to provide control forces. To overcome the difficulty of tuning command voltage of MR dampers, a neural network inverse model is developed. The effectiveness of the proposed strategy is verified and illustrated using simulated response of the 3-story full-scale nonlinear benchmark building excited by several earthquake records through computer simulation. Moreover, the recommended control algorithm is validated using the wind-excited 76-story benchmark building equipped with MR and TMD dampers. Comparing results with other controllers demonstrates that the proposed method can reduce displacement, drift and acceleration, significantly.

BACKGROUND AND OBJECTIVE: Evaluating the thickness of the masseter muscle is an important determinant of the health or illness of the muscle. Investigating changes in masseter muscle thickness due to its function on the temporomandibular joint plays a significant role in detecting the cause of many disorders in this joint. The present study aims to compare the ultrasonic thickness of masseter muscle between patients with bruxism and healthy people. METHODS: This case-control study was conducted among 44 subjects in two groups (22 subjects in each group of, including 11 women and 11 men) in the age range of 18 – 30 years old in patients with bruxism and healthy people. The subjects had normal BMI, had no inflammatory disease or strike to the temporomandibular joint, and had no history of maxillofacial surgery. Ultrasound evaluation of masseter muscle was performed in a supine position, with 12 MHz linear probe along the auricle and perpendicular to mandibular ramus on muscle ventricle and the thickness of the muscle was obtained in millimeters. FINDINGS: The masseter muscle thickness was more in patients with bruxism (11.97±0.85 mm) than healthy subjects (10.76±2.2 mm) (p<0.01). The masseter muscle thickness in men (12.54±0.4 mm and 11.44±0.25 mm, respectively) was more than that of women (11.4±0.79 mm and 10.08±3.05 mm, respectively) (p=0.038). CONCLUSION: The results of this study showed that the masseter muscle thickness in people with bruxism is more than healthy people and is more in men.

Background: Forward head posture (FHP) is a forward positioning of the head relative to the trunk in the sagittal plane. This posture is one of the most prevalent poor postures in patients with head and neck pain. Rehabilitative Ultrasound Imaging (RUSI) is a reliable method to objectively evaluate muscle thickness and function. Objective: To compare thickness of cervical muscles that control both head and neck posture between asymptomatic women with and without FHP. Methods: Seventy asymptomatic women aged between 20 and 40 years, with and without FHP (35 in each group), participated in the study. The thickness of the cervical muscles (rectus capitis posterior - RCP, oblique capitis superior - OCS, semispinalis capitis - SSC, sternocleidomastoid - SCM, and longus coli - LCo) was measured using RUSI and the data was compared between the two groups. Results: The comparison of cervical muscle thickness between women with and without FHP revealed significant difference only with regard to the muscle thickness of the SCM muscle (mean difference: 0.7 mm, 95% confidence interval of the difference: 0.14, 1.26 mm, p value: 0.014). The thickness of this muscle was greater in women with FHP. Conclusion: Tonic contraction of the SCM muscle can lead to greater thickness of this muscle in subjects with FHP. (C) 2017 Published by Elsevier Editora Ltda. All rights reserved.

Introduction: The present study was aimed to assess the amount and direction of growth in cranial base, jaws, and soft tissue of airway structures by cephalometric analysis in 9–11-years-old Iranian girls and boys. Materials and Methods: Thirty-four Iranian children with normal occlusion and class I molar relationships were recruited, and 2 lateral cephalograms were obtained from 9 and 11-year-old children Cephalometric variables included variables defining cranial base length and angle, maxillomandibular length and height, dental relationship, head and cervical position, soft palate and tongue, vallecula and hyoid position, and pharyngeal dimension. Normal distribution was confirmed by Kolmogorov–Smirnov analysis (P>0.05). Paired t-test was used for assessing growth changes. P value was set at 0.05. Results: Anterior, posterior, and total cranial base length were increased significantly. The increase in total and upper anterior, total and lower posterior facial heights, ramus height, and palatal inclination were statistically significant. Maxillomandibular length increased significantly with insignificant change in their position. Dental relationship and head and cervical posture were stable. Oropharyngeal and nasopharyngeal anteroposterior dimension did not change. However, hypopharynx sagittal length increased significantly. Nasopharyngeal vertical dimension increased and hyoid moved anteriorly and inferiorly. Conclusion: The results of the present study showed that cranial base and jaws grow anteriorly and inferiorly while maintaining dental occlusion and head posture. Most of the airway structures grow simultaneously with craniofacial components.

Aims Exclusive breastfeeding plays an important role in the growth and promotion of children’s health in the first six months of their life. The exclusive breastfeeding has been decreasing in Iran in recent years. The objective of this study was to investigate the factors associated with the exclusive breastfeeding in Isfahan province, Iran. Materials & This cross-sectional study was conducted on women with infants less than 6 months of age who referred to the urban and rural health centers of Golpayegan, Isfahan and Falavarjan counties (561 people) of Isfahan province between 2007 and 2008. The data were collected using a questionnaire and interview. Statistical analyses were performed using SPSS 15 software and logistic regression model. Findings Most of the infants (85.6%) fed colostrum. The exclusive breastfeeding levels in the urban and rural regions were found as 25.9% and 32.4%, respectively. Delayed onset of lactation (p<0.05) and cesarean section (p<0.05) were associated with reduction in exclusive breastfeeding, while having a female gender (p<0.01) and receiving postpartum lactation training (p<0.001) showed a positive association with exclusive breastfeeding. Conclusion Delayed onset of lactation and cesarean section reduce the level of exclusive breastfeeding in infants less than 6 months of age in urban and rural communities of Isfahan. However, having a female gender and receiving postpartum lactation training increase the level of exclusive breastfeeding.

Objective: The purpose of the present study was to investigate the effect of Positional Release Therapy (PRT) in computer users via latent trigger points (LTrPs) of the upper trapezius muscle.Materials and methods: Twenty-eight women with the upper trapezius MTrPs participated in this study. Subjects were randomly classified into two groups (14 in each group): the subjects in the Group 1 received PRT in shortened position while those in the group 2 received sham control in the neutral position of the upper trapezius muscle. They received three therapy sessions every other day for one week. The local pain intensity and Pressure pain threshold (PPT) were measured via Visual Analogue Scale (VAS) and algometry, respectively, before interventions and repeated 5 min after the first and third treatment sessions in each group.Results: One-way ANOVA was used for data analysis. After treatment, between groups comparison revealed that for PPT and VAS, there were significant differences between the two groups (VAS and PPT; P < 0.05).Conclusion: Both groups (PRT and sham control) showed alleviation of pain and increase in PPT during three sessions of therapy although PRT showed to be more effective in these patients. (C) 2016 Elsevier Ltd. All rights reserved.

In this study, the effect of active and semi active fuzzy logic controllers (FLC) on the damage imposed on steel structures considering structural uncertainties are investigated. Two FLCs are designed for controlling the actuators and controllable viscous dampers, as active and semi active devices, respectively. Fragility curves are used to show the probability of damage imposed on uncontrolled and controlled structures. They are developed in consideration with three performance levels specified in FEMA 356, including Immediate Occupancy (IO), Life Safety (LS) and Collapse Prevention (CP). For investigating the effect of structural uncertainties on the damage, fragility curves are generated separately considering deterministic and probabilistic parameters for the structure. To simulate the structure including the probabilistic parameters, Latin hypercube sampling is employed. Effectiveness of the controllers are illustrated and verified using the simulated response of a 3-story nonlinear benchmark building excited by several ground motions. To compare the performance of fuzzy controllers, fragility curves are also generated for the structure controlled by LQG and clipped-optimal controllers. Results show that FLCs can reduce the probability of damage significantly. Moreover, it is observed that the uncertainty in mass and yield strength have the greatest effect on the maximum drift of structure.

Shoulder impingement syndrome (SIS) is the common cause of shoulder pain and disability and the individuals suffering from it are usually in different levels of physical activity covering an extensive age range. In spite of limited scientific evidence for an altered motor pattern in the shoulder muscles of patients with SIS, they are frequently referred to physiotherapists in an attempt to optimize coordination and strength of the affected muscles. The aim of this study was to compare scapular muscle activity in a general population of subjects with and without SIS during an arm elevation task executed at different speeds in two load conditions. The study is that of a comparative observational using a simple convenience sampling method, comprising 8 females (31.63 ± 9.39) with SIS and 10 females (29.10 ± 6.57) without SIS, matched in terms of age, body mass index (BMI) and levels of physical activity. The surface EMG (SEMG) of all the trapezius muscles, i.e., -upper fibers (UT), middle fibers (MT), and lower fibers (LT) serratus anterior (SA), and middle deltoid were recorded during shoulder elevation in a scapular plane at three speeds (slow, moderate, and fast) and two load conditions (with and without load). Data were analyzed using independent t-tests and three-factor repeated measures analysis of variance and Bonferroni method for paired comparisons. The EMG tests results in muscle activities revealed no significant differences between the two groups at three speeds, and with and without load. The findings do not support the claim that SIS necessarily accompanies changes in scapula thoracic and glenohumeral muscle activity.

Aims: The precise changes in postures of each part of the spine of primigravid women are still ambiguous. This study aimed to find out the spinal curvature and pelvic tilt changes during the first pregnancy. Study Design: Observational longitudinal study (Cohort study). Place and Duration of Study: The study was conducted at a hospital clinic in Iran, between April 2014 and December 2014. Methodology: Thirty primigravid women at the first, second and third trimesters of pregnancy were recruited in this cohort study and their lumbar and thoracic curves changes and pelvic inclination angles were studied and compared with 18 age-BMI matched non-pregnant women. The curves were measured by use of a flexible ruler and the pelvic inclination angle was measured by a pelvic inclinometer device. Before starting the main study, the reliability and repeatability of the measuring tools were confirmed in this study (ICC>0.87). A one-way ANOVA and independent tOriginal Research Article Kouhkan et al.; BJMMR, 7(9): 744-753, 2015; Article no.BJMMR.2015.384 745 test were used for statistical analysis. Results: Marked increased curvature and inclination angles were revealed as pregnancy advanced (P<0.05). The lumbar lordosis significantly increased when the first trimester was compared with the second and third ones. The thoracic curvature showed significantly increased curvature between the first and third and between the second and third trimesters. None of the lumbar or thoracic curve showed significantly difference between the control group and pregnant women during the first trimester of pregnancy. Although ten weeks pregnancy increased lumbar lordosis and thoracic kyphosis (4.2%, 8%, respectively), but it was not significant when compared with no pregnant women. The pelvic inclination angle showed to be more sensitive than spinal curvatures as it showed significant increase within all trimesters and when compared to the control group. Interestingly, it increased nearly 2.5 times more at the end of pregnancy (236%). Conclusion: The present study showed a significant increase in most variables that became higher as the months of pregnancy increased. The results might help clinicians for prescribing suitable exercises or spinal orthoses during pregnancy. More research is recommended in this area in women intending to get pregnant.

Purpose: The discharge process begins upon the admission of the infant in neonatal intensive care unit and continues to even after the infant is discharged and taken home. The survival of premature infants with very low birth weight and congenital malformations has increased with development of technology and new drugs and the increase in knowledge of neonatal physiology. This study was conducted to audit the process of infant discharge from the neonatal intensive care unit of a selected center in Shahid Beheshti University of Medical Sciences and Health Services. Study Design and methods: In this study, 90 infants admitted to the neonatal intensive care unit were selected using convenience sampling method. The data were collected using demographic information of the nurses, infants, and parents; and a checklist formulated on the basis of existing standards for infant discharge process. The checklist consisted of six parts: 1- available evidence-based guidelines to support the clinic and treatment, 2- documentation, 3- an available plan for individual discharge of every infant simultaneous to the admission according to the ward’s guidelines, 4- training the parents, 5- the plan of the discharge day, and 6- parent questionnaire. The validity and reliability of the checklist was examined using content and face validity (94%) and the inter-rater correlation coefficient (ICC=95%). Results: The results of the study showed that the implementation rate of the discharge process in the first, second, third, fourth, fifth, and sixth part were weak, moderate, moderate, weak, moderate, and weak, respectively. The discharge process cares in all the studied areas were moderate. The entire provided care was of a moderate level. Regarding the importance of the neonatal intensive care unit and also the comparison made between results of this study and those of other studies performed in other countries, the provided care were not qualified and there was a need to more attempts for improving the quality of discharge process in Iranian hospitals, especially in neonatal intensive care units.