Assessment of gait spatio-temporal parameters in neurological disorders using wearable inertial sensors

Movement analysis carried out in laboratory settings is a powerful, but costly solution since it requires dedicated instrumentation, space and personnel. Recently, new technologies such as the magnetic and inertial measurement units (MIMU) are becoming widely accepted as tools for the assessment of human motion in clinical and research settings. They are relatively easy-to-use and potentially suitable for estimating gait kinematic features, including spatio-temporal parameters. The objective of this thesis regards the development and testing in clinical contexts of robust MIMUs based methods for assessing gait spatio-temporal parameters applicable across a number of different pathological gait patterns. First, considering the need of a solution the least obtrusive as possible, the validity of the single unit based approach was explored. A comparative evaluation of the performance of various methods reported in the literature for estimating gait temporal parameters using a single unit attached to the trunk first in normal gait and then in different pathological gait conditions was performed. Then, the second part of the research headed towards the development of new methods for estimating gait spatio-temporal parameters using shank worn MIMUs on different pathological subjects groups. In addition to the conventional gait parameters, new methods for estimating the changes of the direction of progression were explored. Finally, a new hardware solution and relevant methodology for estimating inter-feet distance during walking was proposed. Results of the technical validation of the proposed methods at different walking speeds and along different paths against a gold standard were reported and showed that the use of two MIMUs attached to the lower limbs associated with a robust method guarantee a much higher accuracy in determining gait spatio-temporal parameters. In conclusion, the proposed methods could be reliably applied to various abnormal gaits obtaining in some cases a comparable level of accuracy with respect to normal gait.

Detektion von Nickel- und Cobaltspezies in einzelnen lebenden Zellen mit hoher lateraler Auflösung

Übergangsmetallen wie Nickel und Cobalt kommt meist eine große Bedeutung als Cofaktor in Enzymen oder Metallkomplexen im Metabolismus von Lebewesen zu. Da eine sehr geringe Konzentration dieser Übergangsmetalle in einer Zelle für deren Funktionalität ausreicht, ist eine konstante Konzentration der Spurenelemente in einer Zelle angestrebt. Durch meist anthropogene Einflüsse sind Pflanzen und Menschen zunehmend hohen Konzentrationen von Übergangsmetallen ausgesetzt, die in Abhängigkeit von ihrer Spezies, der Konzentration und der Lokalisation unterschiedliche Toxizitäten aufweisen können. Die Speziation von Metallen wurde bisher mittels gängiger Analyseverfahren, wie der ICP-MS und ähnlicher Verfahren, anhand von bulk-Material durchgeführt. Durch die Entwicklung von optischen Sensoren für Metallionen war es möglich, diese Metalle auch in lebenden Zellen mittels Fluoreszenzmikroskopie zu lokalisieren. Ke und Kollegen (2006, 2007) nutzten einen solchen optischen Sensor - Newport Green DCF, um die Aufnahme von Nickel in humane A543 Lungenbronchialepithelzellen nach Inkubation mit dem wasserlöslichen NiCl2 (0,5 mM und 1 mM) sowie den wasserunlöslichen Verbindungen Ni3S2 (0,5 µg/cm2 und 1 µg/cm2) und NiS (2,5 µg/cm2) nachzuweisen und zu lokalisieren und konnten damit eine Akkumulation von Nickel im Zytoplasma und im Zellkern aufzeigen. Dabei war bei wasserlöslichen und wasserunlöslichen Nickelverbindungen Nickel nach 24 h im Zytoplasma und erst nach 48 h im Zellkern zu beobachten.rnrnDa Nickel und Cobalt keine detektierbare Eigenfluoreszenz unter den gegebenen Bedingungen zeigten, wurde für den optischen Nachweis von Nickel und Cobalt mit dem konfokalen Laser-Raster Mikroskop (CLSM) nach der Zugabe der verschiedenen wasserlöslichen und wasserunlöslichen Metallverbindungen NiCl2, NiSO4, Ni3S2 und CoCl2 in einzelnen lebenden humanen Gingiva-Fibroblasten, sowie in Pflanzenzellen in dieser Arbeit ebenfalls der optische Sensor Newport Green DCF genutzt. Korrespondierend zu den Ergebnissen früherer Arbeiten von Ke et al. (2006, 2007), in denen die Nickelaufnahme bei Konzentrationen von >0,5 mM NiCl2 bzw. >0,5 µg/cm2 Ni3S2 gezeigt wurde, wurde Nickel in Fibroblasten in Abhängigkeit von der Spezies mit steigender Metallkonzentration von 100 µM bis 500 µM nach 16 h im Zytoplasma und zunehmend nach 24 h bis 48 h im Zellkern detektiert. Bei der wasserunlöslichen Verbindung Ni3S2 war der Nachweis von Nickel im Zellkern bereits nach 16 h bis 24 h erfolgreich. Zusätzlich wurden weitere Strukturen wie das Endoplasmatische Retikulum, die Mitochondrien und die Nukleoli durch eine starke Fluoreszenz des optischen Sensors bei Colokalisationsexperimenten mit Organell-spezifischen Fluoreszenzfarbstoffen als target für die Nickelbindung vermutet. Die Lokalisation von Cobalt in den Fibroblasten entsprach weitgehend der Lokalisation von Nickel. Im Zellkern war die Cobaltlokalisation jedoch auf die Nukleoli beschränkt. Weiterführende Versuche an humanen Gingiva-Fibroblasten zeigten, dass die Aufnahme der Metalle in die Fibroblasten pH-Wert abhängig war. Niedrige pH-Werte im sauren pH-Bereich verringerten die Aufnahme der Metalle in die Zellen, wobei ein pH-Wert im basischen Bereich keinen bedeutenden Unterschied zum neutralen pH-Bereich aufwies. Im Vergleich zu den Fibroblasten war in Pflanzenzellen zu jedem Zeitpunkt, auch bei geringen Konzentrationen der Metallverbindungen sowie des optischen Sensors, Nickel und Cobalt in den Zellkernen detektierbar. Durch die Eigenschaft der Pflanzenzellen eine Vakuole zu besitzen, war Nickel und Cobalt hauptsächlich in den Vakuolen lokalisiert. Weitere Strukturen wie das Endoplasmatische Retikulum, die Mitochondrien oder auch die Zellwand kamen bei Pflanzenzellen als target in Frage.rnrnDie Fluoreszenz und Lokalisation der Metalle in den Fibroblasten waren unabhängig von der Spezies sehr ähnlich, sodass in den Zellen die Spezies anhand der fluoreszenzmikroskopischen Aufnahmen kaum unterschieden werden konnten. Lambda-Scans in verschiedenen regions of interest (ROI) wurden durchgeführt, um durch die Fluoreszenzspektren Hinweise auf eine charakteristische Beeinflussung der Bindungspartner von Nickel und Cobalt oder dieser Metalle selbst in den Zellen auf den optischen Sensor zu bekommen und diese dadurch identifizieren zu können. Das Ziel der parallelen Detektion bzw. Lokalisation und gleichzeitigen Speziation bestimmter Nickel- und Cobaltpezies in einzelnen lebenden Zellen konnte in dieser Arbeit durch den optischen Sensor Newport Green DCF nicht erreicht werden.

Rod-shaped plasmonic sensors

Plasmonic nanoparticles exhibit strong light scattering efficiency due to the oscillations of their conductive electrons (plasmon), which are excited by light. For rod-shaped nanoparticles, the resonance position is highly tunable by the aspect ratio (length/width) and the sensitivity to changes in the refractive index in the local environment depends on their diameter, hence, their volume. Therefore, rod-shaped nanoparticles are highly suitable as plasmonic sensors.rnWithin this thesis, I study the formation of gold nanorods and nanorods from a gold-copper alloy using a combination of small-angle X-ray scattering and optical extinction spectroscopy. The latter represents one of the first metal alloy nanoparticle synthesis protocols for producing rod-shaped single crystalline gold-copper (AuxCu(1-x)) alloyed nanoparticles. I find that both length and width independently follow an exponential growth behavior with different time-constants, which intrinsically leads to a switch between positive and negative aspect ratio growth during the course of the synthesis. In a parameter study, I find linear relations for the rate constants as a function of [HAuCl4]/[CTAB] ratio and [HAuCl4]/[seed] ratio. Furthermore, I find a correlation of final aspect ratio and ratio of rate constants for length and width growth rate for different [AgNO3]/[HAuCl4] ratios. I identify ascorbic acid as the yield limiting species in the reaction by the use of spectroscopic monitoring and TEM. Finally, I present the use of plasmonic nanorods that absorb light at 1064nm as contrast agents for photoacoustic imaging (BMBF project Polysound). rnIn the physics part, I present my automated dark-field microscope that is capable of collecting spectra in the range of 450nm to 1750 nm. I show the characteristics of that setup for the spectra acquisition in the UV-VIS range and how I use this information to simulate measurements. I show the major noise sources of the measurements and ways to reduce the noise and how the combination of setup charactersitics and simulations of sensitivity and sensing volume can be used to select appropriate gold rods for single unlabeled protein detection. Using my setup, I show how to estimate the size of gold nano-rods directly from the plasmon linewidth measured from optical single particle spectra. Then, I use this information to reduce the distribution (between particles) of the measured plasmonic sensitivity S by 30% by correcting for the systematic error introduced from the variation in particle size. I investigate the single particle scattering of bowtie structures — structures consisting of two (mostly) equilateral triangles pointing one tip at each other. I simulate the spectra of the structures considering the oblique illumination angle in my setup, which leads to additional plasmon modes in the spectra. The simulations agree well with the measurements form a qualitative point of view.rn

Implementation of a VLSI amplifier interfaced with biomedical sensors for ultra wide band data transmission

This thesis presents a CMOS Amplifier with High Common Mode rejection designed in UMC 130nm technology. The goal is to achieve a high amplification factor for a wide range of biological signals (with frequencies in the range of 10Hz-1KHz) and to reject the common-mode noise signal. It is here presented a Data Acquisition System, composed of a Delta-Sigma-like Modulator and an antenna, that is the core of a portable low-complexity radio system; the amplifier is designed in order to interface the data acquisition system with a sensor that acquires the electrical signal. The Modulator asynchronously acquires and samples human muscle activity, by sending a Quasi-Digital pattern that encodes the acquired signal. There is only a minor loss of information translating the muscle activity using this pattern, compared to an encoding technique which uses astandard digital signal via Impulse-Radio Ultra-Wide Band (IR-UWB). The biological signals, needed for Electromyographic analysis, have an amplitude of 10-100μV and need to be highly amplified and separated from the overwhelming 50mV common mode noise signal. Various tests of the firmness of the concept are presented, as well the proof that the design works even with different sensors, such as Radiation measurement for Dosimetry studies.

Diffusion in heterogeneous systems studied by laser scanning confocal microscopy and fluorescence correlation spectroscopy

Understanding and controlling the mechanism of the diffusion of small molecules, macromolecules and nanoparticles in heterogeneous environments is of paramount fundamental and technological importance. The aim of the thesis is to show, how by studying the tracer diffusion in complex systems, one can obtain information about the tracer itself, and the system where the tracer is diffusing. rnIn the first part of my thesis I will introduce the Fluorescence Correlation Spectroscopy (FCS) which is a powerful tool to investigate the diffusion of fluorescent species in various environments. By using the main advantage of FCS namely the very small probing volume (<1µm3) I was able to track the kinetics of phase separation in polymer blends at late stages by looking on the molecular tracer diffusion in individual domains of the heterogeneous structure of the blend. The phase separation process at intermediate stages was monitored with laser scanning confocal microscopy (LSCM) in real time providing images of droplet coalescence and growth. rnIn a further project described in my thesis I will show that even when the length scale of the heterogeneities becomes smaller than the FCS probing volume one can still obtain important microscopic information by studying small tracer diffusion. To do so, I will introduce a system of star shaped polymer solutions and will demonstrate that the mobility of small molecular tracers on microscopic level is nearly not affected by the transition of the polymer system to a “glassy” macroscopic state. rnIn the last part of the thesis I will introduce and describe a new stimuli responsive system which I have developed, that combines two levels of nanoporosity. The system is based on poly-N-isopropylacrylamide (PNIPAM) and silica inverse opals (iOpals), and allows controlling the diffusion of tracer molecules. rn

Complex tracer mobilities in polymer networks revealed by fluorescence correlation spectroscopy

Gels are elastic porous polymer networks that are accompanied by pronounced mechanical properties. Due to their biocompatibility, ‘responsive hydrogels’ (HG) have many biomedical applications ranging from biosensors and drug delivery to tissue engineering. They respond to external stimuli such as temperature and salt by changing their dimensions. Of paramount importance is the ability to engineer penetrability and diffusion of interacting molecules in the crowded HG environment, as this would enable one to optimize a specific functionality. Even though the conditions under which biomedical devices operate are rather complex, a bottom-up approach could reduce the complexity of mutually coupled parameters influencing tracer mobility. The present thesis focuses on the interaction-induced tracer diffusion in polymer solutions and their homologous gels, probed by means of Fluorescence Correlation Spectroscopy (FCS). This is a single-molecule-sensitive technique having the advantage of optimal performance under ultralow tracer concentrations, typically employed in biosensors. Two different types of hydrogels have been investigated, a conventional one with broad polydispersity in the distance between crosslink points and a so-called ‘ideal’, with uniform mesh size distribution. The former is based on a thermoresponsive polymer, exhibiting phase separation in water at temperatures close to the human body temperature. The latter represents an optimal platform to study tracer diffusion. Mobilities of different tracers have been investigated in each network, varying in size, geometry and in terms of tracer-polymer attractive strength, as perturbed by different stimuli. The thesis constitutes a systematic effort towards elucidating the role of the strength and nature of different tracer-polymer interactions, on tracer mobilities; it outlines that interactions can still be very important even in the simplified case of dilute polymer solutions; it also demonstrates that the presence of permanent crosslinks exerts distinct tracer slowdown, depending on the tracer type and the nature of the tracer-polymer interactions, expressed differently by each tracer with regard to the selected stimulus. In aqueous polymer solutions, the tracer slowdown is found to be system-dependent and no universal trend seems to hold, in contrast to predictions from scaling theory for non-interacting nanoparticle mobility and empirical relations concerning the mesh size in polymer solutions. Complex tracer dynamics in polymer networks may be distinctly expressed by FCS, depending on the specific synergy among-at least some of - the following parameters: nature of interactions, external stimuli employed, tracer size and type, crosslink density and swelling ratio.

The oxidation capacity of the atmosphere - OH and HO 2 radical measurements in a boreal forest environment using laser induced fluorescence spectroscopy

Das wichtigste Oxidationsmittel für den Abbau flüchtiger Kohlenwasserstoffverbindungen (VOC, engl.: volatile organic compounds) in der Atmosphäre ist das Hydroxylradikal (OH), welches sich in einem schnellen chemischen Gleichgewicht mit dem Hydroperoxylradical (HO2) befindet. Bisherige Messungen und Modellvergleiche dieser Radikalspezies in Waldgebieten haben signifikante Lücken im Verständnis der zugrundeliegenden Prozesse aufgezeigt.rnIm Rahmen dieser Doktorarbeit wurden Messungen von OH- und HO2-Radikalen mittelsrnlaserinduzierten Fluoreszensmesstechnik (LIF, engl.: laser-induced fluorescence) in einem Nadelwald in Süd-Finnland während der Messkampagne HUMPPA–COPEC–2010 (Hyytiälä United Measurements of Photochemistry and Particles in Air – Comprehensive Organic Precursor Emission and Concentration study) im Sommer 2010 durchgeführt. Unterschiedliche Komponenten des LIF-Instruments wurden verbessert. Eine modifizierte Methode zur Bestimmung des Hintergrundsignals (engl.: InletPreInjector technique) wurde in den Messaufbaurnintegriert und erstmals zur Messung von atmosphärischem OH verwendet. Vergleichsmessungen zweier Instrumente basierend auf unterschiedlichen Methoden zur Messung von OH-Radikalen, chemische Ionisationsmassenspektrometrie (CIMS - engl.: chemical ionization mass spectrometry) und LIF-Technik, zeigten eine gute Übereinstimmung. Die Vergleichsmessungen belegen das Vermögen und die Leistungsfähigkeit des modifizierten LIF-Instruments atmosphärische OH Konzentrationen akkurat zu messen. Nachfolgend wurde das LIF-Instrument auf der obersten Plattform eines 20m hohen Turmes positioniert, um knapp oberhalb der Baumkronen die Radikal-Chemie an der Schnittstelle zwischen Ökosystem und Atmosphäre zu untersuchen. Umfangreiche Messungen - dies beinhaltet Messungen der totalen OH-Reaktivität - wurden durchgeführt und unter Verwendung von Gleichgewichtszustandsberechnungen und einem Boxmodell, in welches die gemessenen Daten als Randbedingungen eingehen, analysiert. Wenn moderate OH-Reaktivitäten(k′(OH)≤ 15 s−1) vorlagen, sind OH-Produktionsraten, die aus gemessenen Konzentrationen von OH-Vorläuferspezies berechnet wurden, konsistent mit Produktionsraten, die unter der Gleichgewichtsannahme von Messungen des totalen OH Verlustes abgeleitet wurden. Die primären photolytischen OH-Quellen tragen mit einem Anteil von bis zu einem Drittel zur Gesamt-OH-Produktion bei. Es wurde gezeigt, dass OH-Rezyklierung unter Bedingungen moderater OH-Reaktivität hauptsächlich durch die Reaktionen von HO2 mit NO oder O3 bestimmt ist. Während Zeiten hoher OH-Reaktivität (k′(OH) > 15 s−1) wurden zusätzliche Rezyklierungspfade, die nicht über die Reaktionen von HO2 mit NO oder O3, sondern direkt OH bilden, aufgezeigt.rnFür Hydroxylradikale stimmen Boxmodell-Simulationen und Messungen gut übereinrn(OHmod/OHobs=1.04±0.16), während HO2-Mischungsverhältnisse in der Simulation signifikant unterschätzt werden (HO2mod/HO2obs=0.3±0.2) und die simulierte OH-Reaktivität nicht mit der gemessenen OH-Reaktivität übereinstimmt. Die gleichzeitige Unterschätzung der HO2-Mischungsverhältnisse und der OH-Reaktivität, während OH-Konzentrationen von der Simulation gut beschrieben werden, legt nahe, dass die fehlende OH-Reaktivität in der Simulation eine noch unberücksichtigte HO2-Quelle darstellt. Zusätzliche, OH-unabhängigernRO2/HO2-Quellen, wie z.B. der thermische Zerfall von herantransportiertem peroxyacetylnitrat (PAN) und die Photolyse von Glyoxal sind indiziert.

Novel metallo-porphyrin based colourimetric amine sensors and their processing via plasma enhanced chemical vapour deposition at atmospheric pressure : synthesis, characterisation and mechanistic studies

Volatile amines are prominent indicators of food freshness, as they are produced during many microbiological food degradation processes. Monitoring and indicating the volatile amine concentration within the food package by intelligent packaging solutions might therefore be a simple yet powerful way to control food safety throughout the distribution chain.rnrnIn this context, this work aims to the formation of colourimetric amine sensing surfaces on different substrates, especially transparent PET packaging foil. The colour change of the deposited layers should ideally be discernible by the human eye to facilitate the determination by the end-user. rnrnDifferent tailored zinc(II) and chromium(III) metalloporphyrins have been used as chromophores for the colourimetric detection of volatile amines. A new concept to increase the porphyrins absorbance change upon exposure to amines is introduced. Moreover, the novel porphyrins’ processability during the deposition process is increased by their enhanced solubility in non-polar solvents.rnrnThe porphyrin chromophores have successfully been incorporated into polysiloxane matrices on different substrates via a dielectric barrier discharge enhanced chemical vapour deposition. This process allows the use of nitrogen as a cheap and abundant plasma gas, produces minor amounts of waste and by-products and can be easily introduced into (existing) roll-to-roll production lines. The formed hybrid sensing layers tightly incorporate the porphyrins and moreover form a porous structure to facilitate the amines diffusion to and interaction with the chromophores.rnrnThe work is completed with the thorough analysis of the porphyrins’ amine sensing performance in solution as well as in the hybrid coatings . To reveal the underlying interaction mechanisms, the experimental results are supported by DFT calculations. The deposited layers could be used for the detection of NEt3 concentrations below 10 ppm in the gas phase. Moreover, the coated foils have been tested in preliminary food storage experiments. rnrnThe mechanistic investigations on the interaction of amines with chromium(III) porphyrins revealed a novel pathway to the formation of chromium(IV) oxido porphyrins. This has been used for electrochemical epoxidation reactions with dioxygen as the formal terminal oxidant.rn

Monitoring kinetic processes in polymeric colloids by fluorescence correlation spectroscopy

Polymerbasierte Kolloide mit Groen im Nanometerbereich werden als aussichts- reiche Kandidaten fur die Verkapselung und den Transport von pharmazeutischen Wirkstoen angesehen. Daher ist es wichtig die physikalischen Prozesse, die die Bil- dung, Struktur und kinetische Stabilitat der polymerbasierten Kolloide beein ussen, besser zu verstehen. Allerdings ist die Untersuchung dieser Prozesse fur nanome- tergroe Objekte kompliziert und erfordert fortgeschrittene Techniken. In dieser Arbeit beschreibe ich Untersuchungen, bei denen Zwei-Farben-Fluoreszenzkreuz- korrelationsspektroskopie (DC FCCS) genutzt wurde, um Informationen uber die Wechselwirkung und den Austausch von dispergierten, nanometergroen Kolloiden zu bekommen. Zunachst habe ich den Prozess der Polymernanopartikelherstellung aus Emul- sionstropfen untersucht, welcher einen der am haugsten angewendeten Prozesse der Nanopartikelformulierung darstellt. Ich konnte zeigen, dass mit DC FCCS eindeutig und direkt Koaleszenz zwischen Emulsionstropfen gemessen werden kann. Dies ist von Interesse, da Koaleszenz als Hauptgrund fur die breite Groenverteilung der nalen Nanopartikel angesehen wird. Weiterhin habe ich den Austausch von Mizellen bildenden Molekulen zwischen amphiphilen Diblock Kopolymermizellen untersucht. Als Modellsystem diente ein Linear-Burste Block Kopolymer, welches Mizellen mit einer dichten und kurzen Korona bildet. Mit Hilfe von DC FCCS konnte der Austausch in verschiedenen Losungsmitteln und bei verschiedenen Temperaturen beobachtet werden. Ich habe herausgefunden, dass in Abhangigkeit der Qualitat des Losungsmittels die Zeit des Austausches um Groenordnungen verschoben werden kann, was eine weitreichende Einstellung der Austauschkinetik ermoglicht. Eine Eigenschaft die all diese Kolloide gemeinsam haben ist ihre Polydispersitat. Im letzten Teil meiner Arbeit habe ich am Beispiel von Polymeren als Modellsystem untersucht, welchen Eekt Polydispersitat und die Art der Fluoreszenzmarkierung auf FCS Experimente haben. Eine Anpassung des klassischen FCS Modells kann die FCS Korrelationskurven dieser Systeme beschreiben. Die Richtigkeit meines Ansatzes habe ich mit dem Vergleich zur Gel-Permeations-Chromatographie und Brownschen Molekulardynamiksimulationen bestatigt.

Development of a fluorescent-based single liposome assay for studying calcium transporter LMCA1

The morphological and functional unit of all the living organisms is the cell. The transmembrane proteins, localized in the plasma membrane of cells, play a key role in the survival of the cells themselves. These proteins perform a variety of different tasks, for example the control of the homeostasis. In order to control the homeostasis, these proteins have to regulate the concentration of chemical elements, like ions, inside and outside the cell. These regulations are fundamental for the survival of the cell and to understand them we need to understand how transmembrane proteins work. Two of the most important categories of transmembrane proteins are ion channels and transporter proteins. The ion channels have been depth studied at the single molecule level since late 1970s with the development of patch-clamp technique. It is not possible to apply this technique to study the transporter proteins so a new technique is under development in order to investigate the behavior of transporter proteins at the single molecule level. This thesis describes the development of a nanoscale single liposome assay for functional studies of transporter proteins based on quantitative fluorescence microscopy in a highly-parallel manner and in real time. The transporter of interest is the prokaryotic transporter Listeria Monocytogenes Ca2+-ATPase1 (LMCA1), a structural analogue of the eukaryotic calcium pumps SERCA and PMCA. This technique will allow the characterization of LMCA1 functionality at the single molecule level. Three systematically characterized fluorescent sensors were tested at the single liposome scale in order to investigate if their properties are suitable to study the function of the transporter of interest. Further studies will be needed in order to characterize the selected calcium sensor and pH sensor both implemented together in single liposomes and in presence of the reconstituted protein LMCA1.

Time-gated fluorescence spectroscopy improves endoscopic detection of low-grade dysplasia in ulcerative colitis

Dysplasia in ulcerative colitis is frequently missed with 4-quadrant biopsies. An experimental setup recording delayed fluorescence spectra simultaneously with white light endoscopy was recently developed.

In vitro detection of secondary caries associated with composite restorations on approximal surfaces using laser fluorescence

This study evaluated the performance of the DIAGNOdent pen laser fluorescence device (LFpen) in comparison with visual examination (VE), bitewing radiographs (BW) and visual examination combined with bitewing radiographs (VEBW) in detecting secondary approximal caries associated with composite restorations. In total, 60 approximal surfaces from 43 permanent molars with composite restorations were assessed twice by two examiners using the LFpen, VE, BW and VEBW. After histological preparation and hardness measurements, the sample was assigned to either a crown or root caries group, depending on the location of the lesions as the gold standard. For crown caries at D1, the highest values of specificity and sensitivity were observed for the LFpen at a cutoff value of 18 (1.00) and for the VEBW (0.89). At D3 (cutoff of 30), the LFpen showed the highest values of sensitivity and specificity. For root caries, the LFpen and VEBW showed the highest values of specificity (0.54), sensitivity (0.81) and accuracy (0.69). The Spearman rank correlation coefficients for crown/root caries with histology were 0.54/0.37 (LFpen), 0.29/0.10 (BW), 0.29/0.18 (VE) and 0.23/0.37 (VEBW). For the LFpen, the ICC varied from 0.80 (interexaminer) to 0.97 (intraexaminer B); the kappa value was 0.19 for BW and 0.35 for VE (interexaminer). Intraexaminer kappa values for BW were 0.25 (A) and 0.29 (B), and those for VE were 0.31 (A) and 0.32 (B). The LFpen device exhibited a performance comparable to that of conventional methods but with higher interexaminer reproducibility. Therefore, the LFpen should be considered an auxiliary method for the detection of secondary approximal caries associated with composite restorations.

In vivo performance of a laser fluorescence device for the approximal detection of caries in permanent molars

OBJECTIVES: The aim of this randomised clinical trial was to investigate if a laser fluorescence device is able to discriminate between sound and carious approximal sites and between enamel and dentinal lesions, as well as to find appropriate cut-off values. METHODS: One hundred and seventeen sound or uncavitated carious sites in permanent molars were visually and radiographically examined, then either opened or not, after which their laser fluorescence was measured. Forty-three lesions were opened, the caries removed and the clinically identified caries depths were registered in addition to the radiographical scoring. Seventy-four sites were radiographically deemed sound or had enamel caries and were not opened. Here, the radiographical scorings were registered. RESULTS: Taking the radiographic scoring as gold standard for all investigated approximal sites, sound sites (D(0), n=40) showed significantly lower laser fluorescence measurements than carious sites (D(1-4), n=77) (Mann-Whitney test, P<0.025) suggesting a cut-off at 7 (sensitivity=0.68, specificity=0.7). Comparing measurements of D(0-2) (n=74) and D(3,4) (n=43), the results were also different by a statistically significant amount (P<0.025) and the cut-off calculated to be 16 (sensitivity=0.6, specificity=0.84). A fair positive correlation between laser fluorescence values and radiographical scoring was found (rho=+0.47, P<0.01). Analysing the 43 opened lesions with their clinically found lesion depths as gold standard, there was a fair positive correlation to the laser fluorescence values (rho=+0.34, P=0.03) and a moderately strong correlation to the radiographic scoring (rho=+0.67, P<0.01). CONCLUSION: The device may be an adjunct tool in the approximal detection of caries along with established procedures.

Performance of laser fluorescence devices, visual and radiographic examination for the detection of occlusal caries in primary molars

The aim of this in vitro study was to compare the performance of two laser fluorescence devices (LF, LFpen), conventional visual criteria (VE), ICDAS and radiographic examination on occlusal surfaces of primary teeth. Thirty-seven primary human molars were selected from a pool of extracted teeth, which were stored frozen at -20°C until use. Teeth were assessed twice by two experienced examiners using laser fluorescence devices (LF and LFpen), conventional visual criteria, ICDAS and bitewing radiographs, with a 2-week interval between measurements. After measurement, the teeth were histologically prepared and assessed for caries extension. The highest sensitivity was observed for ICDAS at D(1) and D(3) thresholds, with no statistically significant difference when compared to the LF devices, except at the D(3) threshold. Bitewing radiographs presented the lowest values of sensitivity. Specificity at D(1) was higher for LFpen (0.90) and for VE at D(3) (0.94). When VE was combined with LFpen the post-test probabilities were the highest (94.0% and 89.2% at D(1) and D(3) thresholds, respectively). High values were observed for the combination of ICDAS and LFpen (92.0% and 80.0%, respectively). LF and LFpen showed the highest values of ICC for interexaminer reproducibility. However, regarding ICDAS, BW and VE, intraexaminer reproducibility was not the same for the two examiners. After primary visual inspection using ICDAS or not, the use of LFpen may aid in the detection of occlusal caries in primary teeth. Bitewing radiographs may be indicated only for approximal caries detection.

Integrating optical fiber force sensors into microforceps for ORL microsurgery

The delicate anatomy of the ear require surgeons to use great care when operating on its internal structures. One example for such an intervention is the stapedectomy, where a small crook shaped piston is placed in the oval window of the cochlea and connected to the incus through crimping thus bypassing the diseased stapes. Performing the crimp process with the correct force is necessary since loose crimps poorly transmit sound whereas tight crimps will eventually result in necrosis of the incus. Clinically, demand is high to reproducibly conduct the crimp process through a precise force measurement. For this reason, we have developed a fiber Bragg grating (FBG) integrated microforceps for use in such interventions. This device was calibrated, and tested in cadaver preparations. With this instrument we were able to measure for the first time forces involved in crimping a stapes prosthesis to the incus. We also discuss a method of attaching and actuating such forceps in conjunction with a robot currently under development in our group. Each component of this system can be used separately or combined to improve surgical accuracy, confidence and outcome.