Comparison between Radiographic (2-dimensional and 3-dimensional) and Histologic Findings of Periapical Lesions Treated with Apical Surgery.

INTRODUCTION: The aim of this study was to evaluate the concordance of 2- and 3-dimensional radiography and histopathology in the diagnosis of periapical lesions. METHODS: Patients were consecutively enrolled in this study provided that preoperative periapical radiography (PR) and cone-beam computed tomographic imaging of the tooth to be treated with apical surgery were performed. The periapical lesional tissue was histologically analyzed by 2 blinded examiners. The final histologic diagnosis was compared with the radiographic assessments of 4 blinded observers. The initial study material included 62 teeth in the same number of patients. RESULTS: Four lesions had to be excluded during processing, resulting in a final number of 58 evaluated cases (31 women and 27 men, mean age = 55 years). The final histologic diagnosis of the periapical lesions included 55 granulomas (94.8%) and 3 cysts (5.2%). Histologic analysis of the tissue samples from the apical lesions exhibited an almost perfect agreement between the 2 experienced investigators with an overall agreement of 94.83% (kappa = 0.8011). Radiographic assessment overestimated cysts by 28.4% (cone-beam computed tomographic imaging) and 20.7% (periapical radiography), respectively. Comparing the correlation of the radiographic diagnosis of 4 observers with the final histologic diagnosis, 2-dimensional (kappa = 0.104) and 3-dimensional imaging (kappa = 0.111) provided only minimum agreement. CONCLUSIONS: To establish a final diagnosis of an apical radiolucency, the tissue specimen should be evaluated histologically and specified as a granuloma (with/without epithelium) or a cyst. Analysis of 2-dimensional and 3-dimensional radiographic images alike results only in a tentative diagnosis that should be confirmed with biopsy.

Pyörivän magneettivuon aiheuttamien tehohäviöiden mittaus sähköteräslevystä.

Kiertomagnetoinnin, eli pyörivän magneettivuon, on havaittu aiheuttavan sähkökoneiden rautapiireissä käytetyissä sähköteräslevyissä merkittävästi vaihtovuota suuremman tehohäviön. Sähkökoneet suunnitellaan käyttäen vaihtovuomittaukseen perustuvia levymateriaalin tehohäviöarvoja, vaikka pyörivien sähkökoneiden rautapiireissä on alueita, joissa esiintyy pyörivä vuontiheysjakauma. Tämän johdosta rautahäviöiden tarkka laskeminen on vaikeaa. Työssä käsitellään rautaa magneettisena materiaalina, siinä muodostuvia tehohäviöitä vaihtovuolla sekä pyörivällä magneettivuolla sekä esitetään pyörivän magneettivuon aiheuttamien tehohäviöiden mittaukseen soveltuvat mittalaitteet ja laitteiden toiminnan perusta. Pyörivän magneettivuon aiheuttamat tehohäviöt määritetään sähkö- ja magneettikentänvoimakkuuden mittaukseen perustuvalla laitteistolla, joka suunniteltiin ja valmistettiin työn yhteydessä. Mittaukset suoritettiin kidesuuntaamattomille sähköteräksille M350-50A, M600-50A ja M800-50A. Mittaustulosten perusteella laitteistoa voidaan pitää toimivana.

Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice.

Trabecular bone score (TBS) is a recently-developed analytical tool that performs novel grey-level texture measurements on lumbar spine dual X-ray absorptiometry (DXA) images, and thereby captures information relating to trabecular microarchitecture. In order for TBS to usefully add to bone mineral density (BMD) and clinical risk factors in osteoporosis risk stratification, it must be independently associated with fracture risk, readily obtainable, and ideally, present a risk which is amenable to osteoporosis treatment. This paper summarizes a review of the scientific literature performed by a Working Group of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. Low TBS is consistently associated with an increase in both prevalent and incident fractures that is partly independent of both clinical risk factors and areal BMD (aBMD) at the lumbar spine and proximal femur. More recently, TBS has been shown to have predictive value for fracture independent of fracture probabilities using the FRAX® algorithm. Although TBS changes with osteoporosis treatment, the magnitude is less than that of aBMD of the spine, and it is not clear how change in TBS relates to fracture risk reduction. TBS may also have a role in the assessment of fracture risk in some causes of secondary osteoporosis (e.g., diabetes, hyperparathyroidism and glucocorticoid-induced osteoporosis). In conclusion, there is a role for TBS in fracture risk assessment in combination with both aBMD and FRAX.

Bose-Fermi mixtures in optical lattices

Using mean field theory, we have studied Bose-Fermi mixtures in a one-dimensional optical lattice in the case of an attractive boson-fermion interaction. We consider that the fermions are in the degenerate regime and that the laser intensities are such that quantum coherence across the condensate is ensured. We discuss the effect of the optical lattice on the critical rotational frequency for vortex line creation in the Bose-Einstein condensate, as well as how it affects the stability of the boson-fermion mixture. A reduction of the critical frequency for nucleating a vortex is observed as the strength of the applied laser is increased. The onset of instability of the mixture occurs for a sizably lower number of fermions in the presence of a deep optical lattice.

Keskinopeusalueella toimivan induktiomoottori - puhallinkäytön suorituskyvyn mittaus alipainekäytössä

Keskinopeusalueella toimivaa massiiviroottorista epätahtimoottoria voidaan käyttää teollisissa puhaltimissa, joissa on tärkeää saavuttaa normaalia korkeampi pyörimisnopeus ja paine-ero. Usein tällaisella puhaltimella saavutetaan parempi hyötysuhde ja säädettävyys kuin vanhoilla volumetrisilla pumpuilla. Paperikoneiden vedenpoistossa käytetty alipaineen tuotto muodostaa erään sovelluskohteen tällaiselle puhallinkäytölle. Työssä esitellään tällaiseen sovelluskohteeseen suunnitellun puhaltimen ja sitä käyttävän massiiviroottorisen epätahtikoneen testausmenetelmät niiden ominaisuuksien määrittämiseksi, sekä siihen tarvittavan mittalaitteiston vaatimukset. Puhaltimen osalta esitetään täydellinen laskenta perustuen LTKK:ssa 20.10.2000 - 27.10.2000 välisenä aikana suoritettuun puhaltimen testiajoon.

DTC-induktiomoottorikäytön soveltaminen keskitaajuusalueelle

Työssä tarkastellaan olemassa olevan suoraa vääntömomentin säätöä käyttävän taajuudenmuuttajan soveltamista keskitaajuusalueella toimiviin induktiomoottorikäyttöihin. Keskinopeusalueen sovellusten pyörimisnopeudet ovat tyypillisesti 6000…30000rpm. Tällöin invertterin lähtötaajuuden on nelinapaista moottoria ohjattaessa ulotuttava 1000Hz:iin. ABB:n ACS600 taajuudenmuuttajan nykyinen syöttötaajuus ulottuu noin 400Hz:iin ja sen keskimääräinen kytkentätaajuus on luokkaa 3kHz. Taajuudenmuuttajan keskimääräistä kytkentätaajuutta ei haluta tästä merkittävästi nostaa, koska tällöin pääteasteen mitoitusta ja rakennetta on muutettava. Tarkastelussa keskitytään täten jännitemodulointiin, joka määrittelee invertterin lähtöjännitteen käyrämuodon ja pääteasteen tehokytkimien kytkentätaajuuden. Työssä esitetään suoran käämivuon säädön periaatetta soveltava 30-kulmainen modulointimenetelmä (30-modulointi), jolla moottorin syöttövirrasta voidaan eliminoida 5. ja 7. yliharmoninen komponentti. Yliharmonisten komponenttien eliminointi mahdollistaa passiivisilla komponenteilla toteutetun alipäästösuodattimen asentamisen invertterin lähtöön, jolloin moottorissa tapahtuvat tehohäviöt saadaan pieniksi. 30-moduloinnin ohjaukseen ja säätöön esitetään menetelmät, jotka mahdollistavat sen toteuttamisen nykyiseen taajuudenmuuttajaan ohjelmallisesti ilman suuria laitteistomuutoksia. 30-moduloinnin ominaisuuksia tarkastellaan analyyttisin menetelmin ja sen toimintaa testataan esitettyjen teorioiden perusteella simuloimalla. 30-moduloinnin ohjelmallinen implementointi nykyiseen ACS600:een mahdollistaa periaatteessa noin 600Hz:n syöttötaajuuden saavuttamisen. Tällöin invertterin keskimääräinen kytkentätaajuus voidaan säätää koko pyörimisnopeusalueella alle 4kHz:n tasolle.

Huulisuihkun homogeenisuuden vaikutus paperin rakenneominaisuuksiin

Työssä verrattiin perälaatikoilla 1 ja 2 valmistettujen papereiden rakenteellisia ominaisuuksia. Paperin rakenteessa formaatio oli tärkein ominaisuus ja sen jälkeen kuituorientaatio. Näytteiden valintaperusteena pidettiin sitä, että vertailtavilla näytteillä formaatio (pohja) oli paras kyseisellä perälaatikolla ja vetolujuussuhteet olivat samoja. Toinen valintatapa oli verrata samoissa virtausolosuhteissa valmistettuja papereita keskenään. Näytteiden formaatio mitattiin betaradiografialla. Fosforikuvalevystä skannattu kuva analysoitiin kuva-analyysillä. Mittauksen etuna oli suuri erottelukyky, joka mahdollisti monipuolisen tunnuslukujen laskennan. Näistä esimerkkeinä olivat keskihajonta, vinous ja huipukkuus. Lisäksi määritettiin flokkikokojakaumat sekä kone- että poikkisuuntaan. Kuituorientaation määrityksessä paperinäyte revittiin kerroksiin, kerrokset skannattiin ja kuvat analysoitiin kuvankäsittelyohjelmilla. Juova- ja kuituorientaatioanalyysissä määritettiin orientaatiokulma, max/min-arvo ja anisotropia. Virtaviiva-analyysin tunnusluku oli pyörrekoko. Käytettäessä tunnuslukuna variaatiokerrointa formaatio oli parempi perälaatikolla 1 ali- ja yliperällä. Tasaperän läheisyydessä formaatio oli huonompi. Keskihajonta oli pienempi perälaatikolla 1, mutta erot perälaatikoiden välillä tasaantuivat lähellä tasaperää. Flokkikoko oli koko s/v-alueella hieman suurempi perälaatikolla 1. Virtaviiva-analyysin avulla saatiin selville, että perälaatikolla 1 valmistettujen papereiden paikallinen orientaatiovaihtelu ja pintojen toispuoleisuus oli lievempää kuin perälaatikolla 2.

Diagonal ear lobe crease and atherosclerosis: a review of the medical literature and dental implications

In Spain a significant number of individuals die from atherosclerotic disease of the coronary and carotid arteries without having classic risk factors and prodromal symptoms. The diagonal ear lobe crease (DELC) has been characterized in the medical literature as a surrogate marker which can identify high risk patients having occult atherosclerosis. This topic however has not been examined in either the medical or dental literature emanating from Spain. The majority of clinical, angiography and postmortem reports support the premise that DELC is a valuable extravascular physical sign able to distinguish some patients at risk of succumbing to atherosclerosis of the coronary arteries. A minority of studies have however failed to support this hypothesis. More recently reports using B mode ultrasound have also linked DELC to atherosclerosis of the carotid artery and another report has related DELC to the presence of calcified carotid artery atheromas on panoramic radiographs. DELC is readily visible during head and neck cancer screening examinations. In conjunction with the patient"s medical history, vital signs, and panoramic radiograph, the DELC may assist in atherosclerotic risk assessment

Accuracy and Precision of Head Motion Information in Multi-Channel Free Induction Decay Navigators for Magnetic Resonance Imaging.

Free induction decay (FID) navigators were found to qualitatively detect rigid-body head movements, yet it is unknown to what extent they can provide quantitative motion estimates. Here, we acquired FID navigators at different sampling rates and simultaneously measured head movements using a highly accurate optical motion tracking system. This strategy allowed us to estimate the accuracy and precision of FID navigators for quantification of rigid-body head movements. Five subjects were scanned with a 32-channel head coil array on a clinical 3T MR scanner during several resting and guided head movement periods. For each subject we trained a linear regression model based on FID navigator and optical motion tracking signals. FID-based motion model accuracy and precision was evaluated using cross-validation. FID-based prediction of rigid-body head motion was found to be with a mean translational and rotational error of 0.14±0.21 mm and 0.08±0.13(°) , respectively. Robust model training with sub-millimeter and sub-degree accuracy could be achieved using 100 data points with motion magnitudes of ±2 mm and ±1(°) for translation and rotation. The obtained linear models appeared to be subject-specific as inter-subject application of a "universal" FID-based motion model resulted in poor prediction accuracy. The results show that substantial rigid-body motion information is encoded in FID navigator signal time courses. Although, the applied method currently requires the simultaneous acquisition of FID signals and optical tracking data, the findings suggest that multi-channel FID navigators have a potential to complement existing tracking technologies for accurate rigid-body motion detection and correction in MRI.

2nd ESMO Consensus Conference in Lung Cancer: locally advanced stage III non-small-cell lung cancer.

To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The 2nd ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, first-line/second and further lines of treatment in advanced disease, early-stage disease and locally advanced disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on locally advanced disease.

Fluoroscopic-Guided Radial Endobronchial Ultrasound Without Guide Sheath For Peripheral Pulmonary Lesions: A Safe And Efficient Combination.

BACKGROUND: Several guidelines recommend computed tomography scans for populations with high-risk for lung cancer. The number of individuals evaluated for peripheral pulmonary lesions (PPL) will probably increase, and with it non-surgical biopsies. Associating a guidance method with a target confirmation technique has been shown to achieve the highest diagnostic yield, but the utility of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance without a guide sheath has not been reported. METHODS: We conducted a retrospective analysis of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy procedures for the investigation of PPL performed by experienced bronchoscopists with no specific previous training in this particular technique. Operator learning curves and radiological predictors were assessed for all consecutive patients examined during the first year of application of the technique. RESULTS: Fifty-one PPL were investigated. Diagnostic yield and visualization yield were 72.5 and 82.3% respectively. The diagnostic yield was 64.0% for PPL ≤20mm, and 80.8% for PPL>20mm. No false-positive results were recorded. The learning curve of all diagnostic tools showed a DY of 72.7% for the first sub-group of patients, 81.8% for the second, 72.7% for the third, and 81.8% for the last. CONCLUSION: Bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance is safe and simple to perform, even without specific prior training, and diagnostic yield is high for PPL>and ≤20mm. Based on these findings, this method could be introduced as a first-line procedure for the investigation of PPL, particularly in centers with limited resources.

Eye-tracking of nodule detection in lung CT volumetric data.

PURPOSE: Signal detection on 3D medical images depends on many factors, such as foveal and peripheral vision, the type of signal, and background complexity, and the speed at which the frames are displayed. In this paper, the authors focus on the speed with which radiologists and naïve observers search through medical images. Prior to the study, the authors asked the radiologists to estimate the speed at which they scrolled through CT sets. They gave a subjective estimate of 5 frames per second (fps). The aim of this paper is to measure and analyze the speed with which humans scroll through image stacks, showing a method to visually display the behavior of observers as the search is made as well as measuring the accuracy of the decisions. This information will be useful in the development of model observers, mathematical algorithms that can be used to evaluate diagnostic imaging systems. METHODS: The authors performed a series of 3D 4-alternative forced-choice lung nodule detection tasks on volumetric stacks of chest CT images iteratively reconstructed in lung algorithm. The strategy used by three radiologists and three naïve observers was assessed using an eye-tracker in order to establish where their gaze was fixed during the experiment and to verify that when a decision was made, a correct answer was not due only to chance. In a first set of experiments, the observers were restricted to read the images at three fixed speeds of image scrolling and were allowed to see each alternative once. In the second set of experiments, the subjects were allowed to scroll through the image stacks at will with no time or gaze limits. In both static-speed and free-scrolling conditions, the four image stacks were displayed simultaneously. All trials were shown at two different image contrasts. RESULTS: The authors were able to determine a histogram of scrolling speeds in frames per second. The scrolling speed of the naïve observers and the radiologists at the moment the signal was detected was measured at 25-30 fps. For the task chosen, the performance of the observers was not affected by the contrast or experience of the observer. However, the naïve observers exhibited a different pattern of scrolling than the radiologists, which included a tendency toward higher number of direction changes and number of slices viewed. CONCLUSIONS: The authors have determined a distribution of speeds for volumetric detection tasks. The speed at detection was higher than that subjectively estimated by the radiologists before the experiment. The speed information that was measured will be useful in the development of 3D model observers, especially anthropomorphic model observers which try to mimic human behavior.

Predictive ability of heel quantitative ultrasound for incident fractures: an individual-level meta-analysis.

UNLABELLED: The relationship between bone quantitative ultrasound (QUS) and fracture risk was estimated in an individual level data meta-analysis of 9 prospective studies of 46,124 individuals and 3018 incident fractures. Low QUS is associated with an increase in fracture risk, including hip fracture. The association with osteoporotic fracture decreases with time. INTRODUCTION: The aim of this meta-analysis was to investigate the association between parameters of QUS and risk of fracture. METHODS: In an individual-level analysis, we studied participants in nine prospective cohorts from Asia, Europe and North America. Heel broadband ultrasonic attenuation (BUA dB/MHz) and speed of sound (SOS m/s) were measured at baseline. Fractures during follow-up were collected by self-report and in some cohorts confirmed by radiography. An extension of Poisson regression was used to examine the gradient of risk (GR, hazard ratio per 1 SD decrease) between QUS and fracture risk adjusted for age and time since baseline in each cohort. Interactions between QUS and age and time since baseline were explored. RESULTS: Baseline measurements were available in 46,124 men and women, mean age 70 years (range 20-100). Three thousand and eighteen osteoporotic fractures (787 hip fractures) occurred during follow-up of 214,000 person-years. The summary GR for osteoporotic fracture was similar for both BUA (1.45, 95 % confidence intervals (CI) 1.40-1.51) and SOS (1.42, 95 % CI 1.36-1.47). For hip fracture, the respective GRs were 1.69 (95 % CI, 1.56-1.82) and 1.60 (95 % CI, 1.48-1.72). However, the GR was significantly higher for both fracture outcomes at lower baseline BUA and SOS (p < 0.001). The predictive value of QUS was the same for men and women and for all ages (p > 0.20), but the predictive value of both BUA and SOS for osteoporotic fracture decreased with time (p = 0.018 and p = 0.010, respectively). For example, the GR of BUA for osteoporotic fracture, adjusted for age, was 1.51 (95 % CI 1.42-1.61) at 1 year after baseline, but at 5 years, it was 1.36 (95 % CI 1.27-1.46). CONCLUSIONS: Our results confirm that quantitative ultrasound is an independent predictor of fracture for men and women particularly at low QUS values.

Biomarkers of Host Response Predict Primary End-Point Radiological Pneumonia in Tanzanian Children with Clinical Pneumonia: A Prospective Cohort Study.

BACKGROUND: Diagnosing pediatric pneumonia is challenging in low-resource settings. The World Health Organization (WHO) has defined primary end-point radiological pneumonia for use in epidemiological and vaccine studies. However, radiography requires expertise and is often inaccessible. We hypothesized that plasma biomarkers of inflammation and endothelial activation may be useful surrogates for end-point pneumonia, and may provide insight into its biological significance. METHODS: We studied children with WHO-defined clinical pneumonia (n = 155) within a prospective cohort of 1,005 consecutive febrile children presenting to Tanzanian outpatient clinics. Based on x-ray findings, participants were categorized as primary end-point pneumonia (n = 30), other infiltrates (n = 31), or normal chest x-ray (n = 94). Plasma levels of 7 host response biomarkers at presentation were measured by ELISA. Associations between biomarker levels and radiological findings were assessed by Kruskal-Wallis test and multivariable logistic regression. Biomarker ability to predict radiological findings was evaluated using receiver operating characteristic curve analysis and Classification and Regression Tree analysis. RESULTS: Compared to children with normal x-ray, children with end-point pneumonia had significantly higher C-reactive protein, procalcitonin and Chitinase 3-like-1, while those with other infiltrates had elevated procalcitonin and von Willebrand Factor and decreased soluble Tie-2 and endoglin. Clinical variables were not predictive of radiological findings. Classification and Regression Tree analysis generated multi-marker models with improved performance over single markers for discriminating between groups. A model based on C-reactive protein and Chitinase 3-like-1 discriminated between end-point pneumonia and non-end-point pneumonia with 93.3% sensitivity (95% confidence interval 76.5-98.8), 80.8% specificity (72.6-87.1), positive likelihood ratio 4.9 (3.4-7.1), negative likelihood ratio 0.083 (0.022-0.32), and misclassification rate 0.20 (standard error 0.038). CONCLUSIONS: In Tanzanian children with WHO-defined clinical pneumonia, combinations of host biomarkers distinguished between end-point pneumonia, other infiltrates, and normal chest x-ray, whereas clinical variables did not. These findings generate pathophysiological hypotheses and may have potential research and clinical utility.

How to Prepare a Patient for Transarterial Radioembolization? A Practical Guide.

Transarterial radioembolization consist in delivering small particles loaded with Yttrium90, a pure beta emitter, in order to treat primary and secondary liver tumors. This treatment needs precaution since inadequate delivery of these beads can lead to severe complications. Moreover, a precise radiation dosing is crucial to achieve a good clinical success and to avoid complications such as radioembolization-induced liver disease. This review describes all the precautions and highlights clinical and technical considerations that need to be taken to avoid complications.