Influence of cross-infection control methods on performance of pen-type laser fluorescence in detecting occlusal caries lesions in primary teeth

The aim of this in vitro study was to determine the influence of cross-infection control methods, as probe tip autoclaving and polyvinyl chloride (PVC) wrapping, on the performance of laser fluorescence device (DIAGNOdent pen—LFpen) on occlusal surfaces of primary molars. One experienced examiner carried out all examinations (n?=?78). For the probe tip autoclaving study, 62 sites (sample A, 40 teeth) were used. The sites were assessed with LFpen using tips in six different conditions: without autoclaving and after autoclaving for 10, 20, 30, 40, and 50 cycles of 10 min. For the PVC wrapping study, we selected other 58 sites (sample B, 38 teeth). The sites were assessed with the LFpen device in two conditions: with and without PVC wrapping. The teeth were sectioned and histologically assessed for caries depth. LFpen values, sensitivity, and specificity were compared among the different conditions. The LF readings were slightly higher after successive examinations, independently of autoclaving. In both studies, no statistical differences in the sensitivity and specificity were observed for all conditions. In conclusion, probe tip autoclaving and PVC wrapping do not influence the performance of LFpen device on occlusal surfaces of primary molars.     

The reporting quality of studies investigating the diagnostic accuracy of anti-CCP antibody in rheumatoid arthritis and its impact on diagnostic estimates

ABSTRACT: BACKGROUND: Recently anti-CCP testing has become popular in the diagnosis of rheumatoid arthritis (RA). However, the inadequate reporting of the relevant diagnostic studies may overestimate and bias the results, directing scientists into making false decisions. The aim of the present study was to evaluate the reporting quality of studies used anti-CCP2 for the diagnosis of RA and to explore the impact of reporting quality on pooled estimates of diagnostic measures. METHODS: PubMed was searched for clinical studies investigated the diagnostic accuracy of anti-CCP. The studies were evaluated for their reporting quality according to STARD statement. The overall reporting quality and the differences between high and low quality studies were explored. The effect of reporting quality on pooled estimates of diagnostic accuracy was also examined. RESULTS: The overall reporting quality was relatively good but there are some essential methodological aspects of the studies that are seldom reported making the assessment of study validity difficult. Comparing the quality of reporting in high versus low quality articles, significant differences were seen in a relatively large number of methodological items. Overall, the STARD score (high/low) has no effect on the pooled sensitivities and specificities. However, the reporting of specific STARD items (e.g. reporting sufficiently the methods used in calculating the measures of diagnostic accuracy and reporting of demographic and clinical characteristics/features of the study population) has an effect on sensitivity and specificity. CONCLUSIONS: The reporting quality of the diagnostic studies needs further improvement since the study quality may bias the estimates of diagnostic accuracy.     

In vivo comparison of laser fluorescence measurements with conventional methods for occlusal caries detection

The purpose of this study was to evaluate the efficiency of the laser fluorescence (LF) (DIAGNOdent) measurements comparing with visual examination and conventional bitewing radiography for occlusal caries detection. The study comprised 44 occlusal surfaces. Three examiners independently evaluated the teeth by visual examination, LF measurements, and bitewing radiographs. After the evaluations, the teeth were opened, and the clinical lesion depth was determined. One-way variance analysis (ANOVA) was performed for comparison of observers. The diagnostic performance of three methods was assessed by using non-parametric tests (Kruskal-Wallis, Mann-Whitney U, and Spearman rank correlation). No statistically significant difference was found between observers (p > 0.05), and statistically significant difference was found between diagnostic systems (p < 0.01). The correlation of LF measurements with the clinical lesion depth was better than visual examination and bitewing radiography. This result concluded that LF may be a useful adjunct to visual examination, and the diagnostic performance of this device seems to be good for occlusal caries detection.     

Axillary plexus block using a peripheral nerve stimulator: single or multiple injections

This prospective, randomized, double-blind study was undertaken to evaluate the success rates of axillary brachial plexus block performed with the help of a peripheral nerve stimulator when either one, two or four of the major nerves of the brachial plexus were located. Seventy-five patients undergoing upper limb surgery were randomly allocated to one of the following five groups according to the nerve and number of nerves to be located; G-1: musculo-cutaneous, radial, median and ulnar nerves; G-2: musculo-cutaneous plus one of the other three nerves; G-3: radial nerve; G-4: median nerve; G-5: ulnar nerve. The sensory block was evaluated before surgery and cutaneous anaesthesia was considered to be present when the needles of a Wartenberg Pinwheel were no longer felt in all the dermatomes of the nerves implicated in the surgical site. Otherwise, the block was considered to need completion before surgery. Only one out of the 15 patients in G-1 and G-2 needed completion of their block before surgery whereas seven out of 15 for G-3 and eight out of 15 for G-4 and G-5 needed completion of their block (P less than 0.01). We conclude that when performing an axillary block with the help of a peripheral nerve stimulator, stimulation of the musculo-cutaneous nerve and one other nerve or stimulation of all four major nerves of the brachial plexus gives a higher success rate than stimulation of only one nerve, whether the stimulated nerve is the median, radial or ulnar.     

早期骨性关节炎客观诊断方法的评价

骨性关节炎(Osteoarthritis,OA)是一种以关节软骨破坏,软骨下骨和滑膜反应为特征的慢性进行性骨性关节疾病.关节软骨的稳定而复杂的耐压框架结构在破坏后,自身的修复能力很弱.因此,早期诊断成为治疗骨性关节炎的重点,本文就相关客观诊断方法在诊断OA中的特点作一综述.     

The diagnostic accuracy of a laser fluorescence device and digital radiography in detecting approximal caries lesions in posterior permanent teeth: an in vivo study

The aim of this in vivo study was to test the diagnostic accuracy of a pen-type laser fluorescence (LFpen) device in detecting approximal caries lesions, in posterior permanent teeth, at the cavitation and non-cavitation thresholds, and compare it with that of digital bitewing radiography. Thirty patients (aged 18–37), who attended the Faculty of Dentistry at Damascus University for a dental examination, were consecutively screened. Ninety approximal surfaces of posterior permanent teeth without frank cavitations, enamel hypoplasia or restorations were selected and examined using the LFpen (DIAGNOdent pen) and digital bitewing radiography. The reference standard was the visual-tactile inspection, after performing temporary tooth separation, using orthodontic rubber rings, placed for 7 days. The status of included approximal surfaces was recorded as intact/sound, with white/brown spots or cavitated. One trained examiner performed all examinations. There were statistically significant differences in LFpen readings between the three types of approximal surface status (P?<?0.001). The optimal cut-off values for detecting approximal caries lesions in posterior permanent teeth were >16 and 8 at the cavitation and non-cavitation thresholds respectively. The sensitivity, specificity and accuracy (measured by the area under the receiver-operating characteristic curve) were 100, 85 and 95 and 92, 90 and 95% at the cavitation and non-cavitation thresholds respectively. The intra-class correlation coefficient for intra-examiner reliability was 0.95. The diagnostic accuracy of the LFpen was significantly higher than that of digital bitewing radiography (P?<?0.001). The LFpen’s diagnostic performance was accurate and significantly better than digital bitewing radiography in detecting approximal caries lesions, in posterior permanent teeth.     

In vivo evaluation of laser fluorescence performance using different cut-off limits for occlusal caries detection

The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparing different cut-off limits for occlusal caries detection. One hundred and thirty first permanent molars were selected. Visual examination and LF assessments were performed independently. The extent of caries was assessed after operative intervention. New cut-off limits were established and compared with those proposed by the manufacturer and by Lussi et al. (Eur J Oral Sci 109:14–19, 2001). Similar sensitivity and higher specificity was found at D₂ (considering as disease only dentin caries) when the LF cut-off limits proposed by Lussi et al. and the new one were compared. At the D₃ threshold (considering as disease only deep dentin caries), no statistically significant difference among the cut-off limits for sensitivity was found. However, the new cut-off limits showed higher specificity. The LF device provided good ability to detect dentin caries lesions. Furthermore, the new cut-off limits and the values proposed by Lussi et al. could be suggested for the in vivo detection of occlusal caries. An erratum to this article can be found at     

The contribution of work-up or additional views to the accuracy of diagnostic mammography

This study examines the influence of work-up on the accuracy of diagnostic mammography in symptomatic women. Subjects were sampled from all women consecutively attending a symptomatic breast clinic and aged 25-55 years (240 women shown to have breast cancer and 240 age-matched women shown not to have cancer). Mammography films were prospectively reported by two radiologists independently of each other and in a blinded manner using two phases of film reading: initially only baseline films were read, then mammography was re-read with work-up films. The accuracy of reporting mammography with and without work-up was compared using sensitivity and specificity, likelihood ratios, and receiver operating characteristic (ROC) curves. Reporting the mammogram with work-up (compared to without any work-up films) improved sensitivity (75.3% vs 69.0%, P=0.059) for one radiologist, with a non-significant gain in specificity (84.5% vs 79.4%, P=0.38). For the other radiologist, it resulted in a non-significant decrease in sensitivity (79.5% vs 83.7%, P=0.14) with a significant increase in specificity (85.6% vs 61.9%, P=0.00001). ROC curves for both radiologists showed that reporting mammography with work-up resulted in significant improvement (4.5% for R1, 6.8% for R2) in overall test accuracy. Our findings support the use of work-up mammography in the diagnostic setting.     

Comparing the reliability of a new fluorescence camera with conventional laser fluorescence devices in detecting caries lesions in occlusal and smooth surfaces of primary teeth

The aims of this in vitro study were (1) to compare the reliability of a new fluorescence camera (FC; VistaProof) with that of two other laser fluorescence devices (DIAGNOdent and DIAGNOdent pen) in assessing smooth and occlusal caries lesions in primary teeth and (2) to determine the influence of the spacer, the protective cover and air drying on the FC readings. We selected 129 primary molars which were divided into two groups: smooth surfaces (n=68) and occlusal surfaces (n=61). Two trained examiners performed the evaluations using the FC and the other laser fluorescence devices separately. One examiner repeated all assessments after 1 week. Inter- and intraexaminer reproducibility was calculated from the absolute values derived from the devices using intraclass correlation coefficient (ICC) and Bland-Altman analysis. Pearson correlation was performed among the values obtained with the different devices. For aim 2, only teeth from the occlusal surface group were used. Another examiner performed measurements with the FC, varying the size of the spacer, the use of the plastic protective cover and the drying time (0, 3 and 15 s). Wilcoxon’s test was used to compare these measurements. High values of interexaminer ICC were observed with the FC in both experiments. However, the highest intraexaminer ICC for smooth surfaces was found for the DIAGNOdent (ICC 0.918). A positive correlation between all methods was observed in both studies. Only drying for 15 s significantly increased the FC readings. In conclusion, the FC showed high reliability for occlusal and smooth surfaces, similar to the other fluorescence methods tested. Additionally, prolonged air drying increased the FC measurements.     

Pre-surgical radiologic identification of peri-prosthetic osteolytic lesions around TKRs: a pre-clinical investigation of diagnostic accuracy

Background  

Emerging longitudinal data appear to demonstrate an alarming trend towards an increasing prevalence of osteolysis-induced mechanical failure, following total knee replacement (TKR). Even with high-quality multi-plane X-rays, accurate pre-surgical evaluation of osteolytic lesions is often difficult. This is likely to have an impact on surgical management and provides reasonable indication for the development of a model allowing more reliable lesion assessment. The aim of this study, using a simulated cadaver model, was to explore the accuracy of rapid spiral computed tomography (CT) examination in the non-invasive evaluation of peri-prosthetic osteolytic lesions, secondary to TKR, and to compare this to conventional X-ray standards.     

Impact of age on glomerular filtration estimates

Background. Glomerular filtration decreases progressively withage in adults. Predictive equation should have proper modellingto adequately account for normal senescence. Methods. Corrected 24-h creatinine clearances (CCLs) were measuredin a cohort of 773 outpatients from 18 to 90 years old. Multiplelinear regression was used to model the effect of age on glomerularfiltration. Comparisons were made with the simplified MDRD andthe MAYO equations. Impact of the derived equation was testedin a second cohort of 7551 patients with normal serum creatinine. Results. While all equations show declining function with age,our results suggest that the GFR reduction is progressive afterthe age of 30 and continue to decline steadily after the ageof 60. This leads to a convex curve in the multiple regressionanalysis that is best fitted by an equation including the quadraticterm (age²). In contrast, the MDRD equation produces a fasterdecrease in early adulthood and a flatter curve after the ageof 60 while the MAYO equation produces a more linear effect.MDRD results in the normal range are lower than those estimatedby the MAYO equation. These equations, as applied on an independentcohort of 7551 normal outpatients from 18 to 102 years, producedifferent profile of evolution of GFR with age. Conclusions. Inclusion of a quadratic term for age in the formulaestimating GFR results in better modelling of the natural declineof renal function associated with ageing. Furthermore, as GFRsteadily declines after the age of 30, a single cut-off valueof GFR normality for all ages leads to underdiagnosis of youngadults and over diagnosis of elderly individuals. Guidelinesshould take into account the observed reduction of kidney functionwith age in normal population for optimal evaluation of eGFR.     

影响CT引导下胸膜病变同轴活检诊断准确率及相关并发症的因素分析

目的探讨影响CT引导下同轴活检诊断胸膜恶性病变的准确率和相关并发症的因素。方法分析88例接受CT引导下胸膜病变穿刺活检的病例资料,最终诊断结果依据病理诊断或临床随访。采用单因素及多因素分析CT引导下影响穿刺活检诊断胸膜恶性病变的准确率及相关并发症发生的主要因素。结果 88例患者中CT引导下同轴活检诊断胸膜恶性病变56例,良性病变28,性质待定4例;其诊断胸膜恶性病变的准确率、敏感度、特异度分别为89.29%(75/84)、86.15%(56/65)、100%(19/19)。穿刺活检过程中发生气胸14例,单因素分析提示无影响CT引导下胸膜病变同轴活检诊断准确率的相关因素;多因素分析提示穿刺部位病变大小/胸膜厚度是气胸发生的危险因素(OR:8.744),而胸腔积液是气胸发生的保护因素(OR:0.171)。结论 CT引导下胸膜病变同轴活检是相对安全的技术并且诊断准确率较高,值得临床推广应用。     

Impact of using the ultradistal radius region of interest on diagnostic classification.

World Health Organization (WHO) criteria using T-scores for classifying patients as normal, osteopenic, or osteoporotic are based on bone mineral density (BMD, g/cm2) of the lumbar spine and hip and bone mineral content (BMC) (BMC, g) at the distal and midradius. There is no consensus on whether other forearm regions of interest (ROIs) can be used with the WHO criteria. Because the ultradistal radius region of interest (UDR) has a greater ratio of trabecular to cortical bone than midshaft portions of the radius, it is possible that more patients would be classified as osteoporotic if the UDR is measured. The objective of this study was to determine the prevalence of osteoporosis when using T-scores from the UDR in addition to PA lumbar spine, proximal femur (hip), and the radius 33% ROI. Retrospective data were obtained from three centers with differing patient demographics, thus reducing bias as a result of patient characteristics. Data were used only from patients who had a spine, hip, and forearm scan on the same day. Central dual-energy X-ray absorptiometry (DXA) systems included a GE Lunar DPX-L, DPX IQ, and Prodigy and a Hologic Delphi. Hologic data were for the ultradistal radius + ulna ROI (UDRU). Diagnostic classification (using the WHO T-score criteria) was made excluding and including the UDR and UDRU T-scores, in addition to lumbar spine (L2-L4 or L1-L4), hip (femoral neck, greater trochanter, or total), and the radius 33% ROI. The lowest T-score from any ROI determined the classification. For all GE Lunar patients (n = 409 women; age range: 20-96 yr), the distribution of normal, osteopenic, osteoporotic not using the UDR was 94 (23%), 170 (42%), and 145 (36%), respectively. The distribution when using the UDR was 67 (16%), 137 (33%), and 205 (50%), respectively. The difference in the ratio of normal + osteopenic versus osteoporotic when excluding and including the UDR T-scores was significant (p < 0.0001; two-tailed Fisher's exact test). For all Hologic patients (n = 153 women; age range: 44-93 yr), the distributions were 32 (21%), 66 (43%), and 55 (36%) not using and 31 (20%), 64 (42%), and 58 (38%), respectively, using the UDRU (not statistically significantly different). The group mean T-scores were lowest for the UDR compared to the spine and hip with GE Lunar but not Hologic patients.     

Impact of modern diagnostic methods on the management of active rectal bleeding: Ten year experience

We analyzed 178 patients admitted with a diagnosis of lower gastrointestinal hemorrhage from 1970 to 1979. Fifty-four percent had a subsequent or previous episode of bleeding and 78 percent required transfusions. One hundred eighteen patients had rigid sigmoidoscopy, with positive findings in 10 (8.5 percent); 98 underwent angiography, with positive findings in 41 percent; and 58 underwent colonoscopy, with positive findings in 48 percent. Comparison of these tests when the patient had active bleeding revealed the rates of positive findings for angiography and colonoscopy to be 42 and 85 percent, respectively. Sixty-five patients underwent operation and 16 eventually died, for a mortality rate of 25 percent. There was a higher percentage of deaths among patients with nondirected than in those with directed operations (32 versus 22 percent). Patients with lower gastrointestinal bleeding should undergo aggressive diagnostic evaluation utilizing sigmoidoscopy, angiography, and colonoscopy to increase the number of directed operations and decrease mortality and operative morbidity.     

Impact of multiple lymphatic channel drainage to a single nodal basin on outcomes in melanoma

OBJECTIVE: To determine the impact of multiple lymphatic channels (MLCs) on outcome in melanoma. DESIGN: Retrospective cohort study. SETTING: Academic tertiary care center. PATIENTS: Of 1198 consecutive selective sentinel lymphadenectomies performed from 1995 to 2000 for primary invasive melanoma, 502 patients were identified with extremity or truncal melanoma that drained to a single nodal basin. Three cohorts were formed based on lymphatic channels (none, single, and multiple). Tumors with drainage to multiple nodal basins as well as all head and neck tumors were excluded. MAIN OUTCOME MEASURES: Multiple variables, including patterns of lymphatic drainage, were analyzed for impact on disease-free and overall survival. RESULTS: Demographics were similar among groups, with a median follow-up of 5.6 years. Univariate analysis revealed MLCs as an independent risk factor for both disease-free (P = .04) and overall survival (P = .003). Multivariate analysis confirmed that tumor depth, sentinel lymph node status, and MLCs were risk factors for both disease-free and overall survival. Kaplan-Meier analysis showed worse survival in the MLCs group. CONCLUSIONS: Our study reveals that MLCs are an independent risk factor for recurrence and mortality in melanoma. Multiple lymphatic channels may facilitate the process of metastasis.