Comparison of digital systems and conventional dental film for the detection of approximal enamel caries

Objectives

The aims of this study were (1) to compare the accuracy of the detection of approximal enamel caries lesions using three intraoral storage phosphor plate digital systems and one conventional film-based radiographic system; and (2) to determine whether there is a correlation between the histological and radiographic measurements of enamel caries.

Methods

160 approximal surfaces were radiographed under standardized conditions using three storage phosphor stimulable systems (DenOptix and Digora FMX with white and blue plates), and one film system (Insight film). 17 observers scored the images for the presence and depth of caries using a 4-point scale. The presence of caries was validated histologically (gold standard). Two-way analysis of variance was used to test the differences in sensitivity, specificity and overall accuracy (TP + TN). The data from the radiographic and histological measurements were statistically analysed by Spearman’s rank correlation coefficient.

Results

Two-way analysis of variance and the post hoc t-test demonstrated that Digora (white plate) had higher specificity and overall accuracy values than DenOptix (P = 0.021); there was no statistically significant difference among the other imaging modalities (P > 0.05). There was no significant correlation between the histological depth measurements and the radiographic measurements from Digora (blue plate) (P = 0.43), Digora (white plate) (P = 0.15), DenOptix (P = 0.17) and Insight film (P = 0.06).

Conclusions

The results suggest that (1) the performance of the three storage phosphor image plate systems was similar to that of the Insight film for detection of approximal enamel caries, and (2) the increase in histological depth of enamel caries was not significantly correlated with radiographic measurements.     

Educating and Training a Workforce for Nutrition in a Post-2015 World

Nearly all countries in the world today are burdened with malnutrition, manifesting as undernutrition, micronutrient deficiencies, and/or overweight and obesity. Despite some progress, efforts to alleviate malnutrition are hampered by a shortage in number, skills, and geographic coverage, of a workforce for nutrition. Here, we report the findings of the Castel Gandolfo workshop, a convening of experts from diverse fields in March 2014 to consider how to develop the capacity of a global cadre of nutrition professionals for the post-2015 development era. Workshop participants identified several requirements for developing a workforce for nutrition, including an ability to work as part of a multisectoral team; communication, advocacy, and leadership skills to engage decision makers; and a set of technical skills to address future challenges for nutrition. Other opportunities were highlighted that could immediately contribute to capacity development, including the creation of a consortium to link global North and South universities, online training modules for middle managers, and practical, hands-on experiences for frontline nutrition workers. Institutional and organizational support is needed to enable workshop recommendations on education and training to be effectively implemented and sustained. The findings from the Castel Gandolfo workshop can contribute to the delivery of successful nutrition-relevant actions in the face of mounting external pressures and informing and attaining the forthcoming Sustainable Development Goals.     

Randomized, Evaluator-Blind, Split-Face Comparison Study of Single Cross-linked versus Double Cross-linked Hyaluronic Acid in the Treatment of Glabellar Lines

BACKGROUND At present, various hyaluronic acids are being used to rejuvenate facial skin. There is no comparative study of single cross-linked hyaluronic acid (SCHA) versus double cross-linked hyaluronic acid (DCHA). The objective of our study is to compare the effectiveness and complications of SCHA versus DCHA in the treatment of glabellar lines.
METHODS Ten female patients were enrolled in this randomized, evaluator-blind study. One side (left vs. right) of each patient's glabellar lines was treated with SCHA and the other side was treated with DCHA. Two independent blinded observers reviewed the clinical photographs at 3, 6, 9, and 12 months after the treatment and assessed for degree of improvement as well as complications.
RESULTS The two products were equally effective in producing an optimal cosmetic result, although at 6, 9, and 12 months posttreatment, a higher proportion of patients showed over 50% improvement with DCHA than with SCHA. At 12 months posttreatment, DCHA was considered superior in 70% of patients, whereas SCHA was superior in 10% of patients.
CONCLUSIONS Both SCHA and DCHA are equally effective in producing an optimal cosmetic result. DCHA provides a more durable esthetic improvement when compared to SCHA in the treatment of glabellar lines.     

Preliminary Validation of an Optimally Weighted Patient-Based Utility Index by Application to Randomized Trials in Breast Cancer

ObjectivesTo optimize, apply, and validate a scoring algorithm that provides a utility index from a cancer-specific quality of life questionnaire called the Utility-Based Questionnaire-Cancer (UBQ-C) using data sets from randomized trials in breast cancer. The index is designed to reflect the perspective of cancer patients in a specific clinical context so as to best inform clinical decisions.MethodsWe applied the UBQ-C scoring algorithm to trials of chemotherapy for advanced (n = 325) and early (n = 126) breast cancer. The algorithm converts UBQ-C subscales into a subset index, and combines it with a global health status item into an overall HRQL index, which is then converted to a utility index using a power transformation. The optimal subscale weights were determined by their correlations with the global scale in the relevant data set. The validity of the utility index was tested against other patient characteristics.ResultsOptimal weights (range 0–1) for the subset index in advanced (early) breast cancer were: physical function 0.20 (0.09); social/usual activities 0.23 (0.25); self-care 0.04 (0.01); and distresses 0.53 (0.64). Weights for the overall HRQL index were health status 0.66 (0.63) and subset index 0.34 (0.37). The utility index discriminated between breast cancer that was advanced rather than early (means 0.88 vs. 0.94, P < 0.0001) and was responsive to the toxic effects of chemotherapy in early breast cancer (mean change 0.07, P < 0.0001).ConclusionsThe scoring algorithm for the UBQ-C utility index can be optimized in different clinical contexts to reflect the relative importance of different aspects of quality of life to the patients in a trial. It can be used to generate sensitive and responsive utility scores, and quality-adjusted life-years that can be used within a trial to compare the net benefit of treatments and inform clinical decision-making.     

Intrauterine spermatic cord torsion in the newborn: sonographic and pathologic correlation

In five newborn patients with spermatic cord torsion, sonography demonstrated an enlarged and globular testis, hydrocele, and skin thickening. In four of these patients the testicular parenchyma was heterogeneous. Peripheral hypoechoic areas were seen in two of the four patients; the other two had a central hypoechoic region and a peripheral echogenic rim. The testis in the fifth patient was diffusely hyperechoic. Duplex Doppler sonography performed in two patients failed to demonstrate any signal in the spermatic cord in either the abnormal or contralateral hemiscrotum. Scintigraphic findings were positive for testicular torsion in two patients and equivocal in three patients. Surgery was performed 2-12 days after sonography and established the diagnosis of spermatic cord torsion. Pathologic examination demonstrated hemorrhagic infarction of the entire testis as well as scattered calcifications. The authors conclude that a solid globular testicular mass seen during the neonatal period is suggestive of intrauterine spermatic cord torsion.     

The PB3300 intraarterial blood gas monitoring system

Continuous intraarterial blood gas (IABG) monitoring is in clinical use both in the operating room and intensive care unit. This technology uses miniature, optically-based sensors that can be placed into a patient's artery. The arterial blood gas values are transduced into an optical signal that is measured by a bedside monitor on which the values are displayed. In this paper, we describe the operating principles of the PB3300 Intra-Arterial Blood Gas Monitoring System (Puritan-Bennett Corporation, FOxS Division, Carlsbad, CA). Topics include the principles of fluorescent determinations of pH,PCo ₂, andPO ₂; the optical path of the PB3300; system calibration; dye layer geometry; and clinical operation. The accuracy, precision, and drift of the system measuring tonometered aqueous standards are reported. The following values were noted for eight sensors sending data to eight monitors: system bias and precisions of 0.00±0.02 pH at a pH of 7.40, –2.5±1.5 mm HgPCo ₂ at aPCo ₂ of 40 mm Hg, and 3.3±1.3 mm HgPO ₂ at aPO ₂ of 80 mm Hg.

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Abstrakt Die kontinuierliche intraarterielle Blutgasüberwachung (IABG) wird klinisch sowohl im OP als auch auf der Intensivstation eingesetzt. Hierbei werden miniaturisierte, optische Sensoren angewandt, die sich direkt in der Arterie des Patienten plazieren lassen. Die Blutgaswerte werden in optische Signale umgesetzt und von einem bettseitigen Monitor gemessen und angezeigt. In dieser Arbeit beschreiben wir das Funktionsprinzip des Intra-Arteriellen Blutgasanalysesystems PB3300 (Puritan-Bennett Corporation, FOxS Division, Carlsbad, CA). Themen sind die Grundlagen der Bestimmung von pH, PCO2 und PO2 mittels Fluoreszenz; die optische Übertragung des PB3300; die Kalibrierung des Systems; die Geometrie der Farbschichten und der Einsatz in der Klinik. Die Genauigkeit, Auflösung und Drift des Systems bei der Messung von tonometrischen wässrigen Standards wird beschrieben. Die folgenden Werte ergaben sich aus einer Meßreihe mit 8 Sensoren, die an 8 Monitore angeschlossen waren (jeweils Bias, Streuung und Sollwert): 0.00±0.02 pH bei 7.40 pH, –2.5±1.5 mmHg PCO2 bei 40 mmHg PCO2 und 3.3±1.3 mmHg PO2 bei 80 mmHg PO2.

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Resumen La monitorizaciòn continua de gases intraarteriales tiene uso clinico, tanto en el pabellòn de operaciones como en la unidad de cuidados intensivos. Esta tecnologia utiliza sensores miniatura de tipo òptico que pueden ser introducidos en una arteria del paciente. Los valores de gases arteriales son transducidos en forma de señal òptica que es medida al lado de la cama del paciente por un monitor que presenta los valores numéricos. En este trabajo, describimos los principios de operaciòn del PB3300 Intra-Arterial Blood Gas Monitoring System (Puritan-Bennett Corporation, FOxS Division, Carlsbad, CA). Los temas incluyen los principios de determinaciones fluorescentes de pH, PCO₂, and PO₂; la via òptica del PB3300; calibraciòn del sistema; geometria de la capa de colorante; y la operaciòn clinica. Se presentan la exactitud, precisiòn, y deriva (drift) del sistema, midiendo soluciones acuosas de tonometrìa estàndar. Los siguientes valores fueron registrados para ocho sensores enviando informaciòn a ocho monitores: los sesgos del sistema y las precisiones fueron de 0.00±0.02 pH a pH 7.40, –2.5±1.5 mmHg PCO₂ a PCO₂ 40 mmHg, y 3.3±1.3 mmHg PO₂ a PO₂ 80 mmHg.