Reproducibility and speed of landmarking process in cephalometric analysis using two input devices: mouse-driven cursor versus pen

To define if the new portable appliances, like smartphone, iPad, small laptop and tablet can be used in cephalometric tracing without dropping out the validity of any measurement. METHODS:We investigated and compared the reproducibility and the speed of landmarks identification process on lateral X-rays in two input devices: a mouse-driven cursor and a pen used as input means in mobile devices. One expert located 22 landmarks on 15 lateral X-rays in a repeated measure design two times, at time T1 and T2, after at least one month. The Intraclass Correlation coefficient was used to evaluate the reproducibility for each landmark tracing and the agreement between the value derived from both input devices. Also, the mean errors in measurements, the standard deviation and the Friedman Test significans (P < 0.05) between both input were statistically evaluated. RESULTS:All landmarks had a high agreement and the Friedman Test indicated statistically significant differences (P<0.05) for the identification of Na, Po, Pt, PNS, Ba, Pg, Gn, UIE, UIA, APOcc and PPOcc landmarks. CONCLUSIONS:Even if the mouse input give higher agreement for landmark tracing the differences are really minimal and they can be ignored in private practice. We suggest the adequacy of pen input in clinical setting

An Evaluation of Cellular Neural Networks for the Automatic Identification of Cephalometric Landmarks on Digital Images

Several efforts have been made to completely automate cephalometric analysis by automatic landmark search. However, accuracy obtained was worse than manual identification in every study. The analogue-to-digital conversion of X-ray has been claimed to be the main problem. Therefore the aim of this investigation was to evaluate the accuracy of the Cellular Neural Networks approach for automatic location of cephalometric landmarks on softcopy of direct digital cephalometric X-rays. Forty-one, direct-digital lateral cephalometric radiographs were obtained by a Siemens Orthophos DS Ceph and were used in this study and 10 landmarks (N, A Point, Ba, Po, Pt, B Point, Pg, PM, UIE, LIE) were the object of automatic landmark identification. The mean errors and standard deviations from the best estimate of cephalometric points were calculated for each landmark. Differences in the mean errors of automatic and manual landmarking were compared with a 1-way analysis of variance. The analyses indicated that the differences were very small, and they were found at most within 0.59 mm. Furthermore, only few of these differences were statistically significant, but differences were so small to be in most instances clinically meaningless. Therefore the use of X-ray files with respect to scanned X-ray improved landmark accuracy of automatic detection. Investigations on softcopy of digital cephalometric X-rays, to search more landmarks in order to enable a complete automatic cephalometric analysis, are strongly encouraged

Subcutaneous Cavernous Angiolipoma: a New Soft-tissue Entity

No Abstract available</p

Microinvasive radial growth phase of cutaneous melanoma: A histopathological and immunohistochemical study with diagnostic implications

Cutaneous melanoma (M) can develop through two progression phases: the radial growth phase of M (RGPM) and the vertical one. This distinction has a practical relevance in defining lesions with potential for a metastatic course. We analyzed the morphological attributes (intraepidermal proliferation type, inflammatory infiltrate, mitogenicity, Breslow thickness, Clark level, ulceration) and the immunohistochemical profile (S100, Melan A, HMB45, p16INK4a, CD117, Ki67, Cyclin D1, E Cadherin, Podoplanin) of 12 microinvasive RGPMs in absence of regression, with almost 10 years of follow-up. Immunohistochemistry (IHC) revealed that S100, Melan A, and HMB45 maintain a high expression in M cells in both epidermal and dermal compartments. Interestingly, an overexpression of p16INK4a in the nests of dermal microinvasion has been ascertained in all our cases. On the other hand, we found an attenuation of expression for CD117, Ki67, Cyclin D1, and E Cadherin in the migration phase from the epidermis to dermis. Each phase in M progression appears characterized by a specific immunohistochemical profile, as a result of molecular alterations. The long-term follow-up of our case series showed that microinvasive RGPM without regression is not tumori-genic and is devoid of metastatic potential; therefore, its accurate categorization is important. Conversely, microinvasive RGPM with regression should be classified as melanocytic tumor with uncertain biological potential. IHC for p16INK4a can be helpful in the diagnosis of microinvasive M on challenging cutaneous biopsies. Moreover, it can be applied as an immunohistochemical discriminator to distinguish microinvasive RGPM from in situ RGPM and microinvasive RGPM from dysplastic nevi

Densitometria ossea: una breve guida per il nefrologo:

DXA: a beginner's guideStudies in patients with chronic kidney disease have definitively shown that "dual-energy X-ray absorptiometry" (DXA) may be helpful in assessing fracture risk. Moreover, it is essential to diagnose osteoporosis and evaluate response to treatment. In order to obtain the best utility from DXA, nephrologists need to know the fundamentals of this technique, its indications in clinical practice, and the potential pitfalls in the interpretation of its results. This review will provide an overview of the fundamentals, methodology, and current clinical applications of DXA with special focus on the nephrologist's perspective

Subcutaneous Cavernous Angiolipoma: a New Soft-tissue Entity

No Abstract available</p

Automatic Cephalometric Analysis

Abstract Objective: To describe the techniques used for automatic landmarking of cephalograms, highlighting the strengths and weaknesses of each one and reviewing the percentage of success in locating each cephalometric point. Materials and Methods: The literature survey was performed by searching the Medline, the Institute of Electrical and Electronics Engineers, and the ISI Web of Science Citation Index databases. The survey covered the period from January 1966 to August 2006. Abstracts that appeared to fulfill the initial selection criteria were selected by consensus. The original articles were then retrieved. Their references were also hand-searched for possible missing articles. The search strategy resulted in 118 articles of which eight met the inclusion criteria. Many articles were rejected for different reasons; among these, the most frequent was that results of accuracy for automatic landmark recognition were presented as a percentage of success. Results: A marked difference in results was found between the included studies consisting of heterogeneity in the performance of techniques to detect the same landmark. All in all, hybrid approaches detected cephalometric points with a higher accuracy in contrast to the results for the same points obtained by the model-based, image filtering plus knowledge-based landmark search and "soft-computing" approaches. Conclusions: The systems described in the literature are not accurate enough to allow their use for clinical purposes. Errors in landmark detection were greater than those expected with manual tracing and, therefore, the scientific evidence supporting the use of automatic landmarking is low

Indoor Radon: Sources, Transport Mechanisms and Influencing Parameters

Population exposure to indoor radon has been proven to increase the risk of lung cancer, and it is considered a leading cause after tobacco smoking. Due to the relatively low outdoor activity concentration, most of the exposure to radon occurs indoors. Radon is generated mostly by the rocks that contain radium-226 either in the soil or in the building materials. Once generated, it enters the buildings directly, due to the activity concentration gradient, or indirectly via a radon carrier. The magnitude and the relative contribution of the entry patterns depend mainly on the building characteristics, the geology, and the living habits of occupants

Impact of Preventive Strategies on HPV-Related Diseases: Ten-Year Data from the Italian Hospital Admission Registry

Simple Summary HPV-related diseases are mainly represented by cancers. Furthermore, real world data with respect to the effects of primary and secondary preventive strategies are lacking. Therefore, the aim of this study is to assess the effectiveness of preventive strategies in accordance with Italian HPV-related hospital admissions. From 2008 to 2018, there was a decrease (APC = -3.8%) in all HPV-related diseases. The increase in cervical cancer screening adherence was related to a decrease in invasive cervical cancer and an increase in HPV vaccine coverage, which was found to arise from a decrease in "in situ" cervical cancer. In this study, the need to improve the acceptance of preventive strategies for HPV-related diseases, as well as the homogenous information furnished by all healthcare workers involved in their promotion (e.g., gynecologists, general practitioners, pediatricians) is highlighted. Human papillomavirus (HPV)-related diseases are still a challenge for public health. Some studies have shown the effects of preventive strategies on them, but studies at the national level are few in number. Therefore, a descriptive study through hospital discharge records (HDRs) was conducted in Italy between 2008 and 2018. Overall, 670,367 hospitalizations due to HPV-related diseases occurred among Italian subjects. In addition, a significant decrease in hospitalization rates for cervical cancer (average annual percentage change (AAPC) = -3.8%, 95% CI = -4.2, -3.5); vulval and vaginal cancer (AAPC = -1.4%, 95% CI = -2.2, -0.6); oropharyngeal cancer; and genital warts (AAPC = -4.0%, 95% CI = -4.5, -3.5) was observed during the study period. Furthermore, strong inverse correlations were found between screening adherence and invasive cervical cancer (r = -0.9, p &lt; 0.001), as well as between HPV vaccination coverage and in situ cervical cancer (r = -0.8, p = 0.005). These results indicate the positive impact of HPV vaccination coverage and cervical cancer screening on hospitalizations due to cervical cancer. Indeed, HPV vaccination also resulted in a positive impact on the decrease in hospitalization rates due to other HPV-related diseases

Determinants of inappropriate setting allocation in the care of patients with type 2 diabetes: A population-based study in Reggio Emilia province

The study aims to describe the distribution of patients with type 2 diabetes (T2D) by care plan and to highlight determinants of underuse and overuse of integrated care (IC). This cross-sectional study included all T2D patients resident in Reggio Emilia on 31/12/2015 based on the population-based diabetes registry. Eligibility for IC requires good glycaemic control, no rapid insulin, no kidney failure and no diabetes complications. We calculated the proportion of IC underuse and overuse and adjusted prevalence estimate using multivariate logistic regression. Determinants were age, sex, citizenship, district of residence and time since diagnosis. Of 29,776 patients, 15,364 (51.6%) were in diabetes clinic plan, 9851 (33.1%) in IC plan and 4561 (15.3%) not in any care plan (i.e., in Other group). There were 10,906 (36.6%) patients eligible for IC, of whom 1000 in Other group. When we adjusted for all covariates and restricted the analysis to patients included in care plans, the proportion of those eligible for IC plan but cared for in diabetes clinic plan (i.e. underuse of IC) was 28% (n = 3028/9906; 95%CI 27–29). Similarly, the proportion of those not eligible for IC but cared for in IC plan (i.e. overuse of IC) was 11% (n = 1720/11,896; 95%CI 10–11).The main determinant of both IC underuse and overuse was the district of residence. Foreign status was associated with underuse (37%; 95%CI 33–43), while old age (≥80 years) with both underuse (36%; 95%CI 0.33–0.38) and overuse (23%; 95%CI 22–25). The criterion for suspension of IC plan most frequently found was renal failure, followed by hospitalization for diabetes-related complications. Patients are more often allocated to more specialized settings than not. Healthcare provider-related factors are the main determinants of inappropriate setting allocation