MRI-guided and CT-guided cervical nerve root infiltration therapy: a cost comparison

PURPOSE To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. MATERIALS AND METHODS Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40 mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. RESULTS The mean intervention time was 24.9 min. (range: 12 - 36 min.) for MRI-guided infiltration and 19.7 min. (range: 5 - 54 min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. CONCLUSION Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance.

A novel mutation in BCS1L associated with deafness, tubulopathy, growth retardation and microcephaly

We report a novel homozygous missense mutation in the ubiquinol-cytochrome c reductase synthesis-like (BCS1L) gene in two consanguineous Turkish families associated with deafness, Fanconi syndrome (tubulopathy), microcephaly, mental and growth retardation. All three patients presented with transitory metabolic acidosis in the neonatal period and development of persistent renal de Toni-Debré-Fanconi-type tubulopathy, with subsequent rachitis, short stature, microcephaly, sensorineural hearing impairment, mild mental retardation and liver dysfunction. The novel missense mutation c.142A>G (p.M48V) in BCS1L is located at a highly conserved region associated with sorting to the mitochondria. Biochemical analysis revealed an isolated complex III deficiency in skeletal muscle not detected in fibroblasts. Native polyacrylamide gel electrophoresis (PAGE) revealed normal super complex formation, but a shift in mobility of complex III most likely caused by the absence of the BCS1L-mediated insertion of Rieske Fe/S protein into complex III. These findings expand the phenotypic spectrum of BCS1L mutations, highlight the importance of biochemical analysis of different primary affected tissue and underline that neonatal lactic acidosis with multi-organ involvement may resolve after the newborn period with a relatively spared neurological outcome and survival into adulthood. CONCLUSION Mutation screening for BCS1L should be considered in the differential diagnosis of severe (proximal) tubulopathy in the newborn period. What is Known: • Mutations in BCS1L cause mitochondrial complex III deficiencies. • Phenotypic presentations of defective BCS1L range from Bjornstad to neonatal GRACILE syndrome. What is New: • Description of a novel homozygous mutation in BCS1L with transient neonatal acidosis and persistent de Toni-Debré-Fanconi-type tubulopathy. • The long survival of patients with phenotypic presentation of severe complex III deficiency is uncommon.

The Perceived Prognosis of Endodontic Treatment and Implant Therapy Among Dental Practitioners

Little data concerning the perceived success of implant therapy in comparison with endodontic treatment exists. While the criteria used to measure the outcome of each modality are not the same, it is not clear if this is appreciated by practicing dentists. The purpose of the study was to evaluate the perceived outcome of implant therapy in comparison to endodontic treatment. A 23 question Web-based survey was distributed to 648 dentists who matriculated from the University of Connecticut School Of Dental Medicine over the past 30 years. The response rate was 47%. Sixty-seven percent of respondents were general dentists. Forty-nine percent of respondents did not know different criteria exist in the literature and are used to evaluate implant and root canal treatment. Fifty-four percent of dentists felt the prognosis of implant therapy was the same as or better than endodontic treatment of teeth with vital pulps. Thirty percent of responders thought root canal treatment of teeth with necrotic pulp was superior to implants and only 16% thought retreatment was preferable. Treatment planning for implant placement vs. retreatment of a restorable tooth was 46% and 32%, respectively. A third of the respondents felt that the role of endodontics will decline in the future. Dentists’ primary source of information regarding implant therapy was continuing education; however, their primary source of information regarding endodontic treatment was their dental program. Dentists felt the prognosis of implant therapy was as good or superior to endodontic treatment of teeth with vital, necrotic or previously treated pulps.

Restauración de incisivo inferior fracturado mediante procedimientos de invasión mínima : reporte de un caso clínico

La odontología está inmersa en un nuevo paradigma: no se puede pensar en ninguna técnica restauradora sin que participen fenómenos de adhesión. El desarrollo de pernos de fibra de vidrio, sumado a los procedimientos de restauraciones adhesivas puede utilizarse como uno de los tantos recursos de la odontología de invasión mínima. Los pernos de fibra de vidrio ofrecen varias ventajas: comportamiento anisótropo, módulo de elasticidad bajo, buena resistencia mecánica, el lecho que aloja al perno de fibra requiere de una mínima preparación y se cementan con cementos adhesivos con carga, permitiendo de esta manera obtener una superficie homogénea que se interpone entre el perno de fibra y los tejidos dentales, conectándolo a los tejidos del conducto y sustituyendo mecánicamente la dentina. El caso clínico que se reporta se presentó para su resolución en la Clínica Integrada III F. O. UNCuyo durante el año lectivo 2009. El paciente presentaba una fractura amelodentinaria desde hacía cuatro años, con compromiso de la vitalidad y un proceso periapical. Durante los procedimientos endodónticos se realizó una perforación de la pared del conducto que se selló mediante la colocación de hidróxido de calcio y la obturación del mismo con conos de gutapercha. Se efectuó el seguimiento clínico y radiográfico del caso en donde se constató la reparación del proceso apical y luego se procedió a la restauración del elemento dentario con resinas compuestas con la ayuda de un poste de fibra de vidrio cementado con cemento resinoso. Dadas las características del tratamiento endodóntico realizado, se decidió dejar más porción del cono de gutapercha a pesar de lo aconsejado por numerosos autores, ya que de esta manera se aseguró el sellado de la perforación radicular para evitar de esta manera la nanofiltración hacia el interior del elemento dentario.

Markov blanket-based approach for learning multi-dimensional Bayesian network classifiers: An application to predict the European Quality of Life-5 Dimensions (EQ-5D) from the 39-item Parkinson's Disease Questionnaire (PDQ-39)

Multi-dimensional Bayesian network classifiers (MBCs) are probabilistic graphical models recently proposed to deal with multi-dimensional classification problems, where each instance in the data set has to be assigned to more than one class variable. In this paper, we propose a Markov blanket-based approach for learning MBCs from data. Basically, it consists of determining the Markov blanket around each class variable using the HITON algorithm, then specifying the directionality over the MBC subgraphs. Our approach is applied to the prediction problem of the European Quality of Life-5 Dimensions (EQ-5D) from the 39-item Parkinson’s Disease Questionnaire (PDQ-39) in order to estimate the health-related quality of life of Parkinson’s patients. Fivefold cross-validation experiments were carried out on randomly generated synthetic data sets, Yeast data set, as well as on a real-world Parkinson’s disease data set containing 488 patients. The experimental study, including comparison with additional Bayesian network-based approaches, back propagation for multi-label learning, multi-label k-nearest neighbor, multinomial logistic regression, ordinary least squares, and censored least absolute deviations, shows encouraging results in terms of predictive accuracy as well as the identification of dependence relationships among class and feature variables.

Conductivity variations of multi-walled carbon nanotubes oriented in liquid crystal cells

The control of carbon nanotubes conductivity is generating interest in several fields since it may be relevant for a number of applications. The self-organizing properties of liquid crystals may be used to impose alignment on dispersed carbon nanotubes,thus control-ling their conductivity and its anisotropy. This leads to a number of possible applications in photonic and electronic devices such as electrically controlled carbon nanotube switch- es and crossboards. In this work, cells of liquid crystals doped with multi-walled nanotubes have been prepared in different configurations. Their conductivity variations upon switching have been investigated. It turns out that conductivity evolution depends on the initial configuration (either homogeneous, homeotropic or in-plane switching), the cell thickness and the switching record. The control of these manufacturing paramenters allows the modulation of the electrical behavior of carbon nanotubes.

Preferential expression of an ammonium transporter and of two putative nitrate transporters in root hairs of tomato.

Root hairs as specialized epidermal cells represent part of the outermost interface between a plant and its soil environment. They make up to 70% of the root surface and, therefore, are likely to contribute significantly to nutrient uptake. To study uptake systems for mineral nitrogen, three genes homologous to Arabidopsis nitrate and ammonium transporters (AtNrt1 and AtAmt1) were isolated from a root hair-specific tomato cDNA library. Accumulation of LeNrt1-1, LeNrt1-2, and LeAmt1 transcripts was root-specific, with no detectable transcripts in stems or leaves. Expression was root cell type-specific and regulated by nitrogen availability. LeNrt1-2 mRNA accumulation was restricted to root hairs that had been exposed to nitrate. In contrast, LeNrt1-1 transcripts were detected in root hairs as well as other root tissues under all nitrogen treatments applied. Analogous to LeNrt1-1, the gene LeAmt1 was expressed under all nitrogen conditions tested, and root hair-specific mRNA accumulation was highest following exposure to ammonium. Expression of LeAMT1 in an ammonium uptake-deficient yeast strain restored growth on low ammonium medium, confirming its involvement in ammonium transport. Root hair specificity and characteristics of substrate regulation suggest an important role of the three genes in uptake of mineral nitrogen.

Análise biomecânica de resistência à fratura em dentes caninos artificiais de cães, com restauração metálica fundida e retentores intrarradiculares retos e curvos com núcleo - Estudo comparativo com análise por elementos finitos

Os cães, por fatores diversos, acabam por apresentar dentes fraturados com ou sem exposição de polpa. Estas fraturas basicamente são identificadas como fraturas recuperáveis não complicadas, recuperáveis complicadas ou irrecuperáveis. As fraturas recuperáveis (localizadas apenas no esmalte e dentina) são tratadas com dentística restauradora. As recuperáveis complicadas (com lesões em esmalte, dentina e exposição do canal radicular) passam por tratamento endodôntico, podendo ser seguidas de restaurações metálicas. Os dentes mais comumente acometidos são os dentes caninos, superiores ou inferiores. Este trabalho em dentes artificiais simulando considerável destruição de sua porção coronal objetivou testar, após a adaptação da restauração metálica fundida, a resistência às fraturas no dente canino. Os dentes artificiais foram padronizados com uma técnica de replicação de raízes artificiais em molde de resina acrílica quimicamente ativada. Oitenta réplicas iguais de resina composta fotopolimerizável, padronizadas em tamanho e forma, foram construídas a partir desta técnica. Antes da reconstrução protética, aplicou-se o tratamento endodôntico, desobturação, preparo do canal radicular e moldagem. Proteticamente, um pino intrarradicular reto e outro curvo, ambos com núcleo para sustentar a coroa metálica fundida foram cimentados na porção coronal de cada raiz-réplica. Os núcleos e coroa metálica foram ambos ferulados ou estojados. Avaliou-se os dois tipos de restauração com pino intrarradicular curvos ou retos cimentados com cimento de fosfato de zinco ou resinoso para identificar o melhor conjunto restaurador. Os testes de resistência biomecânica de 80 raízes-réplicas foram divididos em 4 grupos com 20 corpos de prova para cada um dos grupos. Grupo 1: das raízes-réplicas com pino intrarradicular curvo cimentados com cimento resinoso. Grupo 2: das raízes-réplicas com pino intrarradicular curvo cimentados com cimento de fosfato de zinco. Grupo 3: das raízes-réplicas com pino intrarradicular reto cimentados com cimento resinoso. Grupo 4: das raízes-réplicas com pino intrarradicular reto cimentados com cimento de fosfato de zinco. Estes grupos foram submetidos a teste de força com pré-carga de 1,5 N, com velocidade de avanço constante de 0,05 mm por minuto em ponto pré- determinado (mésio-lateral vestibularizada) até ocorrência de fratura do conjunto ou parte dele em uma Máquina Universal Kratos. Com a avaliação biomecânica e estudo estatístico de Kruskall-Wallis, identificou-se que os dados obtidos não seguiram distribuição normal. Esta diferença mostrou-se com o p<0,05 na interpretação do teste. No caso de dados não paramétricos o post-hoc do Kruskal-Wallis foi o teste de U de Mann-Withney. Paralelamente, um estudo com análise de elementos finitos comparou os resultados obtidos. Não houve diferença significativa sobre o tipo de cimento utilizado ou que favorecesse o uso do pino reto ou do pino curvo, recaindo a escolha para o operador decidir de acordo com a melhor indicação para cada caso clínico

Therapeutic drug monitoring of cefepime with micellar electrokinetic capillary chromatography: Assay improvement, quality assurance, and impact on patient drug levels

The improvement and performance of a micellar electrokinetic capillary chromatography assay for cefepime in human serum and plasma with a 50 μm id fused-silica capillary elongated from 40 to 60 cm is reported. Sample preparation with dodecylsulfate protein precipitation at pH 4.5, the pH 9.1 separation medium and the applied voltage were as reported previously[16]. The change resulted in a significant lower current, higher resolution and increased detection time intervals. The performance of the assay with multi-level internal calibration was assessed with calibration and control samples. Quality assurance data of a two year period assessed under the new conditions demonstrated the robustness of the assay. In serum samples of patients who received both cefepime and sulfamethoxazole, cefepime could not be detected due to the inseparability of the two compounds. The presence of an interference can be recognized by an increased peak width (width > 0.2 min), the appearance of a shoulder or an unresolved double peak. The patient data gathered during a three year period reveal that introduction of therapeutic drug monitoring led to a 50% reduction of the median drug level. The data suggest that therapeutic drug monitoring can help to minimize the risk of major adverse reactions and to increase drug safety on an individual basis. This article is protected by copyright. All rights reserved.

The integration of multi-source data to improve the classification of remotely sensed images

The number of remote sensing platforms and sensors rises almost every year, yet much work on the interpretation of land cover is still carried out using either single images or images from the same source taken at different dates. Two questions could be asked of this proliferation of images: can the information contained in different scenes be used to improve the classification accuracy and, what is the best way to combine the different imagery? Two of these multiple image sources are MODIS on the Terra platform and ETM+ on board Landsat7, which are suitably complementary. Daily MODIS images with 36 spectral bands in 250-1000 m spatial resolution and seven spectral bands of ETM+ with 30m and 16 days spatial and temporal resolution respectively are available. In the UK, cloud cover may mean that only a few ETM+ scenes may be available for any particular year and these may not be at the time of year of most interest. The MODIS data may provide information on land cover over the growing season, such as harvest dates, that is not present in the ETM+ data. Therefore, the primary objective of this work is to develop a methodology for the integration of medium spatial resolution Landsat ETM+ image, with multi-temporal, multi-spectral, low-resolution MODIS \Terra images, with the aim of improving the classification of agricultural land. Additionally other data may also be incorporated such as field boundaries from existing maps. When classifying agricultural land cover of the type seen in the UK, where crops are largely sown in homogenous fields with clear and often mapped boundaries, the classification is greatly improved using the mapped polygons and utilising the classification of the polygon as a whole as an apriori probability in classifying each individual pixel using a Bayesian approach. When dealing with multiple images from different platforms and dates it is highly unlikely that the pixels will be exactly co-registered and these pixels will contain a mixture of different real world land covers. Similarly the different atmospheric conditions prevailing during the different days will mean that the same emission from the ground will give rise to different sensor reception. Therefore, a method is presented with a model of the instantaneous field of view and atmospheric effects to enable different remote sensed data sources to be integrated.

Nonlinear inverse synthesis technique for optical links with lumped amplification

The nonlinear inverse synthesis (NIS) method, in which information is encoded directly onto the continuous part of the nonlinear signal spectrum, has been proposed recently as a promising digital signal processing technique for combating fiber nonlinearity impairments. However, because the NIS method is based on the integrability property of the lossless nonlinear Schrödinger equation, the original approach can only be applied directly to optical links with ideal distributed Raman amplification. In this paper, we propose and assess a modified scheme of the NIS method, which can be used effectively in standard optical links with lumped amplifiers, such as, erbium-doped fiber amplifiers (EDFAs). The proposed scheme takes into account the average effect of the fiber loss to obtain an integrable model (lossless path-averaged model) to which the NIS technique is applicable. We found that the error between lossless pathaveraged and lossy models increases linearly with transmission distance and input power (measured in dB). We numerically demonstrate the feasibility of the proposed NIS scheme in a burst mode with orthogonal frequency division multiplexing (OFDM) transmission scheme with advanced modulation formats (e.g., QPSK, 16QAM, and 64QAM), showing a performance improvement up to 3.5 dB; these results are comparable to those achievable with multi-step per span digital backpropagation.

Cooperative and adaptive medium access control in multi-hop wireless networks

Due to low cost and easy deployment, multi-hop wireless networks become a very attractive communication paradigm. However, IEEE 802.11 medium access control (MAC) protocol widely used in wireless LANs was not designed for multi-hop wireless networks. Although it can support some kinds of ad hoc network architecture, it does not function efficiently in those wireless networks with multi-hop connectivity. Therefore, our research is focused on studying the medium access control in multi-hop wireless networks. The objective is to design practical MAC layer protocols for supporting multihop wireless networks. Particularly, we try to prolong the network lifetime without degrading performances with small battery-powered devices and improve the system throughput with poor quality channels. ^ In this dissertation, we design two MAC protocols. The first one is aimed at minimizing energy-consumption without deteriorating communication activities, which provides energy efficiency, latency guarantee, adaptability and scalability in one type of multi-hop wireless networks (i.e. wireless sensor network). Methodologically, inspired by the phase transition phenomena in distributed networks, we define the wake-up probability, which maintained by each node. By using this probability, we can control the number of wireless connectivity within a local area. More specifically, we can adaptively adjust the wake-up probability based on the local network conditions to reduce energy consumption without increasing transmission latency. The second one is a cooperative MAC layer protocol for multi-hop wireless networks, which leverages multi-rate capability by cooperative transmission among multiple neighboring nodes. Moreover, for bidirectional traffic, the network throughput can be further increased by using the network coding technique. It is a very helpful complement for current rate-adaptive MAC protocols under the poor channel conditions of direct link. Finally, we give an analytical model to analyze impacts of cooperative node on the system throughput. ^