Diagnostic criteria and dose limiting approaches for image modalities in odontology

Objectives: Technical innovations in radiography enable the development of new approaches to reduce the dose to patients. The aim of this thesis was to explore dose optimization approaches for the most frequently used radiographic modalities in dentistry. Material and Methods. Intraoral radiography: The performance of the Automatic exposure control function (AEC) was tested on dry mandibles with soft tissue equivalent of different thicknesses. Furthermore the image quality was compared between images exposed manually and with AEC function. Two different generations of direct digital intraoral sensors, based on charged couple device (CCD) and complementary metal oxide semi-conductor (CMOS) were compared in terms of dose response function, minimal perceptible contrast details and minimal perceptible exposure difference. Panoramic radiography: Effective doses obtained from panoramic examinations with ten different collimation features were assessed using the metal-oxide semiconductor field-effect transistor (MOSFET) method. In addition, the applicability of the collimation function under clinical situations was evaluated. Cone Beam Computed Tomography: Optimized exposure protocols for temporomandibular joint (TMJ) examinations on a phantom were obtained for CBCT and MSCT through subjective image quality analysis. Effective doses, before and after, optimization were compared for CBCT and MSCT using thermoluminescent dosimeter (TLD) technique. Results: The exposure times using AEC were adjusted automatically according to the thickness of the objects and the resulting image quality was considered adequate by observers. The CMOS sensor was more sensitive to radiation and presented better image quality on low contrast details perception compared to the CCD sensor. The calculated effective dose of a full size panoramic radiograph was 17.6 μSv at 8mA and 66kV. In 61% of the studied referrals, a collimation including the dental alveolar region was applicable, providing a dose reduction by 40.3%. The effective doses for bilateral TMJ examination was 92 μSv for CBCT and 124 μSv for MSCT. The image quality of CBCT was considered better than that of MSCT. Conclusions: AEC might be a feasible approach for acquiring intraoral digital radiographs with good image quality. ProSensor with CMOS technique was preferred in comparison to Dixi sensor with CCD technique due to lower exposure and better detectability of low contrast details. Collimating panoramic radiographs was an effective approach to reduce radiation dose to patients when clinical indication allowed. For TMJ examination CBCT was preferred to MSCT due to better image quality at comparable effective doses

Paraplegia with lumbar artery compression by the diaphragmatic crus

The authors report three cases of transient and recurrent paraplegia due to compression of the second right lumbar artery by the diaphragmatic crus. Circumstances of appearance are suggestive when paraplegia occurs in dorsolumbar hyperlordosis and low cardiac output is an associated hemodynamic risk factor. Selective medullary arteriography is indispensable for diagnosis and can demonstrate three signs: an anterior spinal dorsolumbar artery (artery of Adamkiewicz) that does not descend to the conus medullaris; posterior spinal arteries arising from the second lumbar arteries that vascularize the conus medullaris; existence of a tight stenosis on the second right lumbar artery that is aggravated during dynamic maneuvers. Section of the right diaphragmatic crus and release of the second right lumbar artery from the aorta to the fibrous arcade of the psoas permits definitive cure of symptoms

Pre-surgical radiographic and clinical features as predictors for temporomandibular joint discectomy prognosis

Objectives This study aimed to identify potential clinical and radiological predictors associated with the outcome of discectomies. Methods In this retrospective observational study, the material comprised preoperative CBCT images and medical records of 62 patients with disc derangement disorders, who had undergone discectomy because of disc displacement with reduction (DDwR), disc displacement without reduction (DDwoR), systemic arthritis (SA), or joint hypermobility. Clinical and radiographic variables were analysed in relation to success rate determined by subjective, objective and combined outcomes. Results The success odds ratio was 11 times higher in patients with painful DDwR versus that of SA (p = 0.03), and even 25.9 times higher when considering solely objective outcome (p = 0.03). In the absence of subchondral pseudocyst, there were 5.2 times higher odds to have a successful subjective outcome (p = 0.04). Extensive bone apposition on the temporal joint component indicated a 9.3 times higher likelihood of a failed objective outcome (p = 0.04). Conclusions There is a significant higher risk for combined outcome failure for the diagnosis SA involving the TMJ compared with DDwR. Predictors of importance based on CBCT findings related to the objective outcome failure were extensive bone apposition on the temporal joint component and condylar subchondral pseudocysts for the subjective outcome failure.publishedVersio

Cone beam computed tomography indications for interdisciplinary therapy planning of impacted canines

Objective: To investigate how cone beam computed tomography (CBCT) affects the therapeutic planning of impacted maxillary canines. Study Design: A total of 132 impacted canines from 89 pediatric patients were collected from 3 specialist clinics in Stockholm, Sweden. An interdisciplinary therapy planning team consisting of 5 dental specialists evaluated each case and chose their preferred treatment alternative, initially without and later with CBCT images, to decide whether CBCT was justified for therapy planning. Predefined variables measurable using only 2-dimensional (2D) assessments were analyzed using stepwise logistic regression analyses. Results: The CBCT was considered indicated in 47% of the cases. Additional information from CBCT led to a treatment decision change in 9.8%. Significant 2D predictors for CBCT justification were horizontal canine angulation compared with vertical angulation (odds ratio [OR] = 10.9), extraction strategy involvement (OR = 6.7), and buccally positioned canines compared with palatal (OR = 5.3), central (OR = 25.0), and distal or uncertain positions (OR = 7.7). Conclusions: The benefit-risk assessment of CBCT for impacted canines may be reinforced by performing and applying justification decisions for CBCT acquisition at the therapeutic thinking level. If preliminary treatment planning motivates further in-depth investigation of either root status or tooth location, a CBCT is indicated.publishedVersio

ESTUDO DA SECAGEM E EXTRAÇÃO DE SEMENTES DE MAMÃO (CARICA PAPAYA L.)

http://dx.doi.org/10.5902/223611704640http://dx.doi.org/10.5902/223611704640Em virtude de características como o alto teor em óleo, quantidade expressivas de glucosinolatos, fonte de pectina, entre outros, buscou-se através desse trabalho avaliar as melhores condições de secagem e extração do óleo das sementes de mamão do tipo Caricapapaya L. Para o desenvolvimento deste, as sementes foram secas em estufa de esterilização nas temperaturas de 60 e 70°C e, em seguida, foram realizadas extrações via sonicação de amostras com diâmetros médio de 1,200 mm, 0,780mm e inferior a 0,655mm. Com os dados obtidos, curvas de secagem foram construídas e ajustadas segundo modelos matemáticos. Espectros de absorbância em função do comprimento de onda também foram construídos e analisados

Small bowel involvement is a prognostic factor in colorectal carcinomatosis treated with complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy

<p>Abstract</p> <p>Background</p> <p>Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising treatment for patients with peritoneal carcinomatosis (PC). Our objective was to identify new prognostic factors in patients with PC from colorectal cancer treated with this procedure.</p> <p>Methods</p> <p>All patients with PC from colorectal cancer treated by HIPEC from January 2000 to December 2007 were prospectively included. The tumor extension was assessed by the Peritoneal Cancer Index (PCI) and the residual disease was recorded using the completeness cytoreductive score (CCs). All clinical and treatment data were computed in univariate and multivariable analyses using survival as primary end point.</p> <p>Results</p> <p>We carried out 51 complete procedures in 49 consecutive patients. The mean PCI was 10. The allocation of CCs was: CC-0 = 37, CC-1 = 14. The five-year overall and progression-free survival rate were 40% and 20%, respectively. Several prognostic factors for survival were identified by univariate analysis: PCI < 9 (<it>P </it>< 0.001), CC-0 vs. CC-1 (<it>P </it>< 0.01) and involvement of area 4 (<it>P </it>= 0.06), area 5 (<it>P </it>= 0.031), area 7 (<it>P </it>= 0.014), area 8 (<it>P </it>= 0.022), area 10 (<it>P </it>< 0.0001), and area 11 (<it>P </it>= 0.02). Only the involvement of the distal jejunum (area 10) was significant in the multivariable analysis (<it>P </it>= 0.027).</p> <p>Conclusions</p> <p>We demonstrated that the involvement of area 10 (distal jejunum of the PCI score) was an independent factor associated with poor prognosis.</p

UK guideline on transition of adolescent and young persons with chronic digestive diseases from paediatric to adult care

The risks of poor transition include delayed and inappropriate transfer that can result in disengagement with healthcare. Structured transition care can improve control of chronic digestive diseases and long-term health-related outcomes. These are the first nationally developed guidelines on the transition of adolescent and young persons (AYP) with chronic digestive diseases from paediatric to adult care. They were commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology under the auspices of the Adolescent and Young Persons (A&YP) Section. Electronic searches for English-language articles were performed with keywords relating to digestive system diseases and transition to adult care in the Medline (via Ovid), PsycInfo (via Ovid), Web of Science and CINAHL databases for studies published from 1980 to September 2014. The quality of evidence and grading of recommendations was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The limited number of studies in gastroenterology and hepatology required the addition of relevant studies from other chronic diseases to be included. These guidelines deal specifically with the transition of AYP living with a diagnosis of chronic digestive disease and/or liver disease from paediatric to adult healthcare under the following headings; 1. Patient populations involved in AYP transition 2. Risks of failing transition or poor transition 3. Models of AYP transition 4. Patient and carer/parent perspective in AYP transition 5. Surgical perspectiv

Routinely collected data for randomized trials: promises, barriers, and implications

This work was supported by Stiftung Institut für klinische Epidemiologie. The Meta-Research Innovation Center at Stanford University is funded by a grant from the Laura and John Arnold Foundation. The funders had no role in design and conduct of the study; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript or its submission for publication.Peer reviewedPublisher PD

Metformin use and cardiovascular outcomes after acute myocardial infarction in patients with type 2 diabetes: a cohort study

Background: The use of metformin after acute myocardial infarction (AMI) has been associated with reduced mortality in people with type 2 diabetes mellitus (T2DM). However, it is not known if it is acutely cardioprotective in patients taking metformin at the time of AMI. We compared patient outcomes according to metformin status at the time of admission for fatal and non-fatal AMI in a large cohort of patients in England. Methods: This study used linked data from primary care, hospital admissions and death registry from 4.7 million inhabitants in England, as part of the CALIBER resource. The primary endpoint was a composite of acute myocardial infarction requiring hospitalisation, stroke and cardiovascular death. The secondary endpoints were heart failure (HF) hospitalisation and all-cause mortality. Results: 4,030 patients with T2DM and incident AMI recorded between January 1998 and October 2010 were included. At AMI admission, 63.9% of patients were receiving metformin and 36.1% another oral hypoglycaemic drug. Median follow-up was 343 (IQR: 1–1436) days. Adjusted analyses showed an increased hazard of the composite endpoint in metformin users compared to non-users (HR 1.09 [1.01–1.19]), but not of the secondary endpoints. The higher risk of the composite endpoint in metformin users was only observed in people taking metformin at AMI admission, whereas metformin use post-AMI was associated with a reduction in risk of all-cause mortality (0.76 [0.62–0.93], P = 0.009). Conclusions: Our study suggests that metformin use at the time of first AMI is associated with increased risk of cardiovascular disease and death in patients with T2DM, while its use post-AMI might be beneficial. Further investigation in well-designed randomised controlled trials is indicated, especially in view of emerging evidence of cardioprotection from sodium-glucose co-transporter-2 (SGLT2) inhibitors