Evaluation of healing criteria for success after periapical surgery

INTRODUCTION: In periapical surgery, the absence of standardization between different studies makes it difficult to compare the outcomes. OBJECTIVE: To compare the healing classification of different authors and evaluate the prognostic criteria of periapical surgery at 12 months. MATERIAL AND METHODS: 278 patients (101 men and 177 women) with a mean age of 38.1 years (range 11 to 77) treated with periapical surgery using the ultrasound technique and a 2.6x magnifying glass, and silver amalgam as root-end filling material were included in the study. Evolution was analyzed using the clinical criteria of Mikkonen et al., 1983; radiographic criteria of Rud et al., 1972; the overall combined clinical and radiographic criteria of von Arx and Kurt, 1999; and the Friedman (2005) concept of functional tooth at 12 months of surgery. RESULTS: After 12 months, 87.2% clinical success was obtained according to the Mikkonen et al., 1983 criteria; 73.9% complete radiographic healing using Rud et al. criteria; 62.1% overall success, following the clinical and radiographic parameters of von Arx and Kurt, and 91.9% of teeth were functional. The von Arx and Kurt criteria was found to be the most reliable. CONCLUSION: Overall evolution according to von Arx and Kurt agreed most closely with the other scales.

Neoplastic invasion of laryngeal cartilage: reassessment of criteria for diagnosis at MR imaging

PURPOSE: To evaluate whether proposed diagnostic criteria applied to magnetic resonance (MR) images of patients with laryngeal and hypopharyngeal carcinoma may be used to distinguish neoplastic from inflammatory involvement of the laryngeal cartilages. MATERIALS AND METHODS: The radiologic and histopathologic data in 121 consecutive patients with primary squamous cell carcinoma of the larynx (n = 63) or hypopharynx (n = 58) who underwent MR imaging before laryngectomy formed the basis of this retrospective study. Patient consent for retrospective chart review was waived by the institutional review board. All laryngectomy specimens were processed with a dedicated histopathologic whole-organ slice technique. MR images were evaluated by two readers according to established ("old") and proposed ("new") diagnostic criteria on the basis of the signal intensity behavior of cartilage on T2-weighted images and contrast material-enhanced T1-weighted images compared with that of the adjacent tumor. Specifically, with the new criteria, T2-weighted or postcontrast T1-weighted cartilage signal intensity greater than that of the adjacent tumor was considered to indicate inflammation, and signal intensity similar to that of the adjacent tumor was considered to indicate neoplastic invasion. The results of the MR image interpretation were compared with the histologic reference standard. RESULTS: The area under the receiver operating characteristic curve for the new criteria (0.94) was nominally but significantly larger than that for the old criteria (0.92) (P = .01). Overall specificity was significantly improved (82% for new vs 74% for old criteria, P < .001) and was greatest for the thyroid cartilage (75% for new vs 54% for old criteria, P < .001) with the new criteria. The sensitivities of the established and the proposed criteria were identical. CONCLUSION: The proposed MR imaging criteria enable improved differentiation of neoplastic cartilage invasion from peritumoral inflammation.

Risk assessment for invasive exotic plants using multi-criteria risk models

Invasive exotic plants have altered natural ecosystems across much of North America. In the Midwest, the presence of invasive plants is increasing rapidly, causing changes in ecosystem patterns and processes. Early detection has become a key component in invasive plant management and in the detection of ecosystem change. Risk assessment through predictive modeling has been a useful resource for monitoring and assisting with treatment decisions for invasive plants. Predictive models were developed to assist with early detection of ten target invasive plants in the Great Lakes Network of the National Park Service and for garlic mustard throughout the Upper Peninsula of Michigan. These multi-criteria risk models utilize geographic information system (GIS) data to predict the areas at highest risk for three phases of invasion: introduction, establishment, and spread. An accuracy assessment of the models for the ten target plants in the Great Lakes Network showed an average overall accuracy of 86.3%. The model developed for garlic mustard in the Upper Peninsula resulted in an accuracy of 99.0%. Used as one of many resources, the risk maps created from the model outputs will assist with the detection of ecosystem change, the monitoring of plant invasions, and the management of invasive plants through prioritized control efforts.

Fish contaminants through the tribal perspective : an ethnography of the Keweenaw Bay Indian Community's tribal fish harvest

It has been well documented that many tribal populations and minority groups across the nation have been identified as being at high risk of the adverse health effects created by consuming fish that have been contaminated with mercury, PCBs, DDT, dioxins, and other chemicals. Although fish consumption advisories are intended to inform fish consumers of risks associated with specific species and water bodies, advisories have been the subject of both environmental injustices and treaty rights’ injustices. This means that understanding fish contaminants, through community perspectives is essential to good environmental policy. This study examined the fish contaminant knowledge, impacts on fishing and fish consumption, and the factors that contribute to harvesting decisions and behaviors in one tribal nation in the Upper Peninsula of Michigan, the Keweenaw Bay Indian Community. Using ethnographic methods, participant observation and semi-structured interviewing, fieldnotes were kept and all interviews were fully transcribed for data analysis. Among seventeen fishermen and women, contaminants are poorly understood, have had a limited impact on subsistence fishing but have had a substantial impact on commercial fishing activity. But ultimately, all decisions and behaviors are based on their own criteria and within a larger context of knowledge and understanding: the historical and cultural context. The historical context revealed that advisories are viewed as another attack on tribal fishing. The cultural context revealed that it is the fundamental guidance and essential framework associated with all harvesting beliefs, values, and traditional lifeways. These results have implications for advisories. ‘Fish’ and ‘contaminants’ appear differently based on the perceptions and priorities of those who encounter them.

CRITERIA FOR SUSTAINABLE PRODUCT DESIGN WITH 3D PRINTING IN THE DEVELOPING WORLD

The demand for consumer goods in the developing world continues to rise as populations and economies grow. As designers, manufacturers, and consumers look for ways to address this growing demand, many are considering the possibilities of 3D printing. Due to 3D printing’s flexibility and relative mobility, it is speculated that 3D printing could help to meet the growing demands of the developing world. While the merits and challenges of distributed manufacturing with 3D printing have been presented, little work has been done to determine the types of products that would be appropriate for such manufacturing. Inspired by the author’s two years of Peace Corps service in the Tanzania and the need for specialty equipment for various projects during that time, an in-depth literature search is undertaken to better understand and summarize the process and capabilities of 3D printing. Human-centered design considerations are developed to focus on the product desirability, the technical feasibility, and the financial viability of using 3D printing within Tanzania. Beginning with concerns of what Tanzanian consumers desire, many concerns later arise in regards to the feasibility of creating products that would be sufficient in strength and quality for the demands of developing world consumers. It is only after these concerns are addressed that the viability of products can be evaluated from an economic perspective. The larger impacts of a product beyond its use are vital in determining how it will affect the social, economic, and environmental well-being of a developing nation such as Tanzania. Thus technology specific criteria are necessary for assessing and quantifying the broader impacts that a 3D-printed product can have within its ecosystem, and appropriate criteria are developed for this purpose. Both sets of criteria are then demonstrated and tested while evaluating the desirability, feasibility, viability, and sustainability of printing a piece of equipment required for the author’s Peace Corps service: a set of Vernier calipers. Required for science educators throughout the country, specialty equipment such as calipers initially appear to be an ideal candidate for 3D printing, though ultimately the printing of calipers is not recommended due to current restrictions in the technology. By examining more specific challenges and opportunities of the products 3D printing can produce, it can be better determined what place 3D printing will have in manufacturing for the developing world. Furthermore, the considerations outlined in this paper could be adapted for other manufacturing technologies and regions of the world, as human centered design and sustainability will be critical in determining how to supply the developing world with the consumer goods it demands.

Duplex sonographic criteria for measuring carotid stenoses

PURPOSE: The aim of this retrospective study was to determine optimal duplex sonographic criteria for use in our institution for diagnosing severe carotid stenoses and to correlate those findings with angiographic measurements obtained by the European Carotid Surgery Trial (ECST), North American Symptomatic Carotid Endarterectomy Trial (NASCET), and Common Carotid (CC) methods of grading carotid stenoses. METHODS: We analyzed the angiographic data using the ECST, NASCET, and CC methods and compared the results with the duplex sonographic findings. We then calculated the sensitivity, specificity, positive and negative predictive values, and accuracy of the duplex sonographic method. Taking these parameters into account, the optimal intrastenotic peak systolic velocity (PSV) and end diastolic velocity (EDV) were derived for diagnosing severe stenoses according to the 3 angiographic methods. RESULTS: Optimal PSV and EDV values for diagnosing a 70% or greater stenosis in our laboratory were as follows: with the NASCET method of angiographic grading of stenoses, PSV 220 cm/second or greater and EDV 80 cm/second or greater, and with the ECST and CC methods, PSV 190 cm/second or greater, and EDV 65 cm/second or greater. The optimal PSV and EDV for diagnosing a stenosis of 80% or greater with the ECST grading method were 215 cm/second or greater and 90 cm/second or greater, respectively. CONCLUSIONS: Duplex sonography is a sensitive and accurate tool for evaluating severe carotid stenoses. Optimal PSVs and EDVs vary according to the angiographic method used to grade the stenosis. They are similar for stenoses 70% or greater with the NASCET method and for stenoses 80% or greater with the ECST method.

Computer-aided operation planning and 3-dimensional osteotomy guidance for alveolar distraction

Objectives: In alveolar distraction, in cases of severe atrophy in particular, it is often difficult to perform osteotomies in order to make a transport segment in optimal size and shape. Moreover care must be taken, not to damage the closely locating anato- mical structures such as the maxillary sinus, the inferior alveolar nerve, and the roots of the neighboring teeth. For setting ideal osteotomy lines exactly, we have developed a CT-based preoperative planning tool. Methods: 3-dimensional visual reconstruction of the jaw is created from the preoperative CT scans (1.0-mm slice thick- ness). Using the image-processing software Mimics (Materialise, Yokohama, Japan), various procedures of virtual cutting are simulated first to determine optimal osteotomy lines and to design an ideal transport segment. After the computer planning, data from the virtual solid model are transferred to a rapid prototype model, and a guiding splint is made to transfer the planned surgical simulation to the actual surgery. Results: The method was used in a case of severe atrophy of the anterior maxilla. The patient had a large maxillary sinus requir- ing a precise osteotomy in this critical area. Using the splint allowing a 3-dimensional guidance, alveolar osteotomies were easily done to achieve a transport segment in sufficient dimen- sion as planned, and any perforation of the maxillary sinus could be avoided. Finally the alveolar distraction of 10mm has suc- cessfully been performed. Conclusion: The preoperative planning method and the guiding splint described here are useful in problematic cases requiring an extremely precise osteotomy due to lack of bony space.

Accuracy of WHO CD4 cell count criteria for virological failure of antiretroviral therapy

OBJECTIVES: To examine the accuracy of the World Health Organization immunological criteria for virological failure of antiretroviral treatment. METHODS: Analysis of 10 treatment programmes in Africa and South America that monitor both CD4 cell counts and HIV-1 viral load. Adult patients with at least two CD4 counts and viral load measurements between month 6 and 18 after starting a non-nucleoside reverse transcriptase inhibitor-based regimen were included. WHO immunological criteria include CD4 counts persistently <100 cells/microl, a fall below the baseline CD4 count, or a fall of >50% from the peak value. Virological failure was defined as two measurements > or =10 0000 copies/ml (higher threshold) or > or =500 copies/ml (lower threshold). Measures of accuracy with exact binomial 95% confidence intervals (CI) were calculated. RESULTS: A total of 2009 patients were included. During 1856 person-years of follow up 63 patients met the immunological criteria and 35 patients (higher threshold) and 95 patients (lower threshold) met the virological criteria. Sensitivity [95% confidence interval (CI)] was 17.1% (6.6-33.6%) for the higher and 12.6% (6.7-21.0%) for the lower threshold. Corresponding results for specificity were 97.1% (96.3-97.8%) and 97.3% (96.5-98.0%), for positive predictive value 9.5% (3.6-19.6%) and 19.0% (10.2-30.9%) and for negative predictive value 98.5% (97.9-99.0%) and 95.7% (94.7-96.6%). CONCLUSIONS: The positive predictive value of the WHO immunological criteria for virological failure of antiretroviral treatment in resource-limited settings is poor, but the negative predictive value is high. Immunological criteria are more appropriate for ruling out than for ruling in virological failure in resource-limited settings.

Outcome evaluation of early placed maxillary anterior single-tooth implants using objective esthetic criteria: a cross-sectional, retrospective study in 45 patients with a 2- to 4-year follow-up using pink and white esthetic scores

BACKGROUND: To validate the concept of early implant placement for use in the esthetically sensitive anterior maxilla, clinical trials should ideally include objective esthetic criteria when assessing outcome parameters. METHODS: In this cross-sectional, retrospective 2- to 4-year study involving 45 patients treated with maxillary anterior single-tooth implants according to the concept of early implant placement, a novel comprehensive index, comprising pink esthetic score and white esthetic score (PES/WES; the highest possible combined score is 20), was applied for the objective esthetic outcome assessment of anterior single-tooth implants. RESULTS: All 45 anterior maxillary single-tooth implants fulfilled strict success criteria for dental implants with regard to osseointegration, including the absence of peri-implant radiolucency, implant mobility, suppuration, and pain. The mean total PES/WES was 14.7 +/- 1.18 (range: 11 to 18). The mean total PES of 7.8 +/- 0.88 (range: 6 to 9) documents favorable overall peri-implant soft tissue conditions. The two PES variables facial mucosa curvature (1.9 +/- 0.29) and facial mucosa level (1.8 +/- 0.42) had the highest mean values, whereas the combination variable root convexity/soft tissue color and texture (1.2 +/- 0.53) proved to be the most difficult to fully satisfy. Mean scores were 1.6 +/- 0.5 for the mesial papilla and 1.3 +/- 0.5 for the distal papilla. A mean value of 6.9 +/- 1.47 (range: 4 to 10) was calculated for WES. CONCLUSIONS: This study demonstrated that anterior maxillary single-tooth replacement, according to the concept of early implant placement, is a successful and predictable treatment modality, in general, and from an esthetic point of view, in particular. The suitability of the PES/WES index for the objective outcome assessment of the esthetic dimension of anterior single-tooth implants was confirmed. However, prospective clinical trials are needed to further validate and refine this index.

Life-threatening versus non-life-threatening manual strangulation: are there appropriate criteria for MR imaging of the neck?

The aim of the study was to determine objective radiological signs of danger to life in survivors of manual strangulation and to establish a radiological scoring system for the differentiation between life-threatening and non-life-threatening strangulation by dividing the cross section of the neck into three zones (superficial, middle and deep zone). Forensic pathologists classified 56 survivors of strangulation into life-threatening and non-life-threatening cases by history and clinical examination alone, and two blinded radiologists evaluated the MRIs of the neck. In 15 cases, strangulation was life-threatening (27%), compared with 41 cases in which strangulation was non-life-threatening (73%). The best radiological signs on MRI to differentiate between the two groups were intramuscular haemorrhage/oedema, swelling of platysma and intracutaneous bleeding (all p = 0.02) followed by subcutaneous bleeding (p = 0.034) and haemorrhagic lymph nodes (p = 0.04), all indicating life-threatening strangulation. The radiological scoring system showed a sensitivity and specificity of approximately 70% for life-threatening strangulation, when at least two neck zones were affected. MRI is not only helpful in assessing the severity of strangulation, but is also an excellent documentation tool that is even admissible in court.

A synchronic lexical study of the Ede language continuum of West Africa: The effects of different similarity judgment criteria

In the context of a synchronic lexical study of the Ede varieties of West Africa, this paper investigates whether the use of different criteria sets to judge the similarity of lexical features in different language varieties yields matching conclusions regarding the relative relationships and clustering of the investigated varieties and thus leads to similar recommendations for further sociolinguistic research. Word lists elicited in 28 Ede varieties were analyzed with the inspection method. To explore the effects of different similarity judgment criteria, two different similarity judgment criteria sets were applied to the elicited data to identify similar lexical items. The quantification of these similarity decisions led to the computation of two similarity matrices which were subsequently analyzed by means of correlation analysis and multidimensional scaling. The findings of this analysis suggest compatible conclusions regarding the relative relationships and clustering of the investigated Ede varieties. However, the matching clustering results do not necessarily lead to the same recommendations for more in-depth sociolinguistic research, when interpreted in terms of an absolute lexical similarity threshold. The indicated ambiguities suggest the usefulness of focusing on the relative, rather than absolute in establishing recommendations for further sociolinguistic research.