Accuracy of three cone-beam CT devices and two software systems in the detection of vertical root fractures

OBJECTIVES

The aim of this study was to compare the accuracy of vertical root fracture (VRF) detection using three tomography devices and two software systems in teeth with different endodontic fillings.

METHODS

The sample consisted of 45 premolars divided into 3 groups: No filling (NF, n=15); Gutta percha (GP, n=15) and Metallic Post (MP, n=15). Cone-beam computed tomography (CBCT) images were acquired in Kodak 9000 3D, Orthopantomography 300 (OP300) and PreXion 3D devices, before and after induced root fractures. Two oral radiologists analyzed all images using InVivoDental and e-Vol DX software systems. The analysis was repeated after 15 days in 30% of the sample. Data analysis compared receiver operating characteristic (ROC) curves, as well the areas under the ROC curves. Accuracy, sensitivity, specificity, positive and negative predictive value were calculated according to each tomographic device and software. Intra- and interexaminer reliability were tested using the Kappa coefficient.

RESULTS

The highest accuracy was seen in the image set from the PreXion 3D, using InVivo (0.96) or e-Vol DX (0.92) in image analysis. The OP300 device presented a similar performance of the PreXion 3D in teeth with different endodontic fillings. When using e-Vol DX, the accuracy of Kodak 9000 3D improved from 0.62 to 0.74.

CONCLUSIONS

The PreXion 3D device is the most accurate when detecting VRF, with a performance similar to the OP300 in endodontic filled teeth. Kodak 9000 3D is indicated for teeth without fillings, with better accuracy using e-Vol DX software.

[Pilot study for the inclusion of the portfolio of the family medicine specialist book in training]

BACKGROUND

The Spanish Family Medicine National Commission is proposing a new portfolio-type Specialist Training Book (STB).

OBJECTIVE

To pilot its contents, structure, and implementation strategies.

DESIGN

Cross-sectional, descriptive study.

SETTING

A Provincial Family Medicine Teaching Unit.

PARTICIPANTS

Twenty-eight tutors and 36 residents.

METHODS

For 9 months the participants conducted a training assessment on diverse areas of competence by means of tasks at work. Tutors recorded information on the quality of reflection achieved by residents and the tasks they performed by means of the card model proposed in the STB. Residents filled in an ad hoc survey. A univariate analysis of quantitative data was conducted.

RESULTS

Thirty-three surveys were received from residents; 21 tutors handed in 67 evaluation reports (average: 3 per tutor). They dealt with all the areas of competence, particularly those of communication, teaching, and ethics. Tasks most used were clinical sessions, critical incidents and video-recording. Both tutors and residents thought that the new method could be useful for reflecting on clinical practice, understanding their own areas of competence better and for strengthening the tutor-trainee relationship, especially if some suggestions to improve its practical use and reduce time and effort involved were taken into account.

CONCLUSIONS

The new STB in its current version or with some modifications is a useful tool for residents' training assessment and is probably accepted well in our ambit.

Spatially resolved polarization properties for in vitro corneas

Spatially resolved polarization properties of in vitro mammalian corneas have been studied by using a Mueller-matrix imaging polarimeter in transmission mode. Sixteen images corresponding to independent combinations of polarization states in the illumination and analyzing pathways are recorded. Spatially resolved Mueller matrices of the samples are calculated from them. Results show that the birefringence of the cornea is almost linear. Although the magnitude of retardation depends on the sample, it is approximately constant at the center and increases towards the periphery. Dichroism and polarizing power are negligible. Maps of the degree of polarization indicate that the cornea basically does not depolarize the totally polarized incident light.

Depolarization effects in the human eye

We have studied the effects of depolarization in the living human eye by using a spatially resolved Mueller-matrix polarimeter [Opt. Lett. 24 (1999) 64]. Results show that the degree of polarization for the central part of double-pass images is about 0.85 and 0.70 for 2 mm and 5 mm of pupil, respectively. This parameter decreases towards the tails of the image. In the plane of the pupil, the degree of polarization also depends on the analyzed area, and it has been related to the different components of the light coming back from the retina. Values of polarizance suggest that the eye presents a slight polarizing power mainly due to the existence of both circular birefringence and dichroic properties. Polarizance is also larger at the central part of double-pass images (about 0.25 on average) and decreases along the radius. In addition, it has been shown that the major retinal layer where the light is reflected does not depend on the state of polarization of the incident light.

Polarization and retinal image quality estimates in the human eye

We have previously studied how polarization affects the double-pass estimates of the retinal image quality by using an imaging polarimeter [Opt. Lett. 24, 64 (1999)]. A series of 16 images for independent combinations of polarization states in the polarimeter were recorded to obtain the spatially resolved Mueller matrices of the eye. From these matrices, double-pass images of a point source for light with different combinations of incoming (first-pass) and outcoming (second-pass) polarization states were reconstructed and their corresponding modulation transfer functions were calculated. We found that the retinal image or, alternatively, the ocular aberrations, are nearly independent of the state of polarization of the incident light (in the first pass). This means that a significant improvement in the ocular optics by using a specific type of polarized light could not be achieved. However, quite different estimates of the retinal image quality are obtained for combinations of polarization states in both the first and the second passes in the double-pass apparatus.

Measurement of parameters of polarization in the living human eye using imaging polarimetry

An imaging polarimeter using liquid-crystal variable retarders (Bueno, J. M., Artal, P. (1999). Double-pass imaging polarimetry in the human eye. Optics Letters, 24, 64-66) has been used to study the parameters of polarization in the living human eye. Retardation introduced by birefringent structures of the eye has been calculated by using a spatially resolved collection of Mueller matrices obtained from series of 16 double-pass retinal images. Results for images with a 2-mm pupil diameter show that although the retardation introduced by the eye in a double-pass varies among individuals, at the central cornea the slow axis is directed along the upper-temporal to lower-nasal line and the ellipticity is close to zero, which indicates the presence of linear birefringence. As pupil size increased, the measured retardation also increased, while ocular birefringence remained linear and azimuthal angle changed without a clear tendency.

[Diagnosis of dyslipidemia in primary care: a service to be improved. Results of a multicenter evaluation]

OBJECTIVE

The variability of the quality of care in the primary care procedures to diagnose lipaemia was evaluated.

DESIGN

Observation, multi-centred and retrospective study.

SETTING

Random sample of 10 primary care centres in the Murcia region.

PATIENTS AND OTHER PARTICIPANTS

Patients over 19 with lipaemia detected over the previous twelve months in the general medical clinics at health centres. 500 cases in all were studied (50 per centre).

MEASUREMENTS AND MAIN RESULTS

Compliance with criteria of good clinical practice was evaluated. These criteria were formulated by health centre doctors and included: adequate diagnosis, classification into primary or secondary, phenotype, recording of cardiovascular risk factors and assessment of cardiovascular (CV) risk. The differences between the centres studied and the effect of the centre's characteristics (teaching, location, existence of lipaemia programme) and of the patients' (age and gender) were also examined. We found that none of the cases evaluated satisfied the five quality criteria at the same time. Assessment of CV risk and the aetiopathogenic classification were the criteria least complied with (1.5% +/- 1.0). Centres varied considerably. Their characteristics affected the quality of the procedure evaluated, which in all centres had a lot of room for improvement.

CONCLUSIONS

The quality of the procedures for diagnosing lipaemia can be considerably improved. It varies a lot from centre to centre.

[The QUALI Project: a quality study of the structure of the primary care teams (PCT) of Catalonia. The Quality Improvement Commission of the Societat Catalana de Medicina Familiar i Comunitària]

OBJECTIVE

To analyse the compliance with the primary health care quality criteria of the Committee for Quality Improvement of the Catalan Society of Family and Community Medicine.

DESIGN

Cross-sectional descriptive study.

SETTING

Reformed primary care centres (PCC) in Catalonia (186), of which 73 (39.2%) filled out the disk with the results.

MEASUREMENTS AND MAIN RESULTS

A total of 202 criteria, divided into five sections (structure and material resources, human resources, work organisation, systems of recording and access, and continuity, confidentiality and participation), were self-evaluated in each PCC. These criteria were defined as basic or optimal and compliance with them was graded from 1 to 4. 72.8% of the criteria were fully complied with. In 7.4% there was partial compliance, and in 19.7% non-compliance. The basic criteria had 74% total compliance, whereas the optimal criteria had 51.9%. The groups with least compliance (sum of the total plus the partial) were records systems (68.6%) and human resources (73.5%). The organisation group had the best compliance (85.5%). By sub-groups, the greatest compliance was found in privacy (93.7%), direct care (89.2%) and recording actions (89.1%). Sub-groups with least compliance were long-term treatments (61.8%), vaccinations (46.4%) and storage (42%). Eight of the 18 criteria not complied with by 50% or more were considered responsibility of the team. There was 37.8% total compliance and 24% partial in the criteria referring to the specific training of primary care professionals. Up to 80% non-compliance was found in quality of long-term prescription records, vaccinations and storage.

CONCLUSIONS

The high level of compliance in the sections which depend most on professionals should be noted (accessibility-continuity and organisation). This study is a first approach towards understanding the quality of the structure of PC in Catalonia, and enables proposals for improvement to be set up.

[Fastrach intubation in patients with cervical disease]

The Fastrach laryngeal mask for intubation is a new device designed for blind orotracheal intubation in patients with criteria predictive of difficult airway control. The new device looks like the conventional laryngeal mask but offers a series of design changes that allow orotracheal intubation to be accomplished without visualization of the glottis. The rigid metal tube is bent and incorporates a metal handle; the two fixed bars that prevent the epiglottis from falling and blocking the opening have been replaced by a moveable bar that rises with the passage of the endotracheal tube and the exit of the V-shaped metal tube guides the endotracheal tube that was specially designed for this use. We describe three patients with cervical disease, one with advanced ankylosing spondylitis, one with traumatic luxation of the C6-C7 articulation and one diagnosed of two cervical disk hernias. All their tracheas were intubated without difficulty through the Fastrach mask with the patients' heads in neutral position. Although fiberoptic bronchoscopy is the method of choice in patients with cervical problems, the non-availability of the technique and the need for training in its use make the Fastrach mask an alternative worth considering for such patients.

Double-pass imaging polarimetry in the human eye

A Mueller-matrix imaging polarimeter was developed to measure spatially resolved polarization properties in the living human eye. The apparatus is a double-pass setup that incorporates two liquid-crystal variable retarders and a slow-scan CCD camera in the recording stage. Series of 16 images for the combinations of independent polarization states in the first and second passages were recorded for two experimental conditions: with the camera conjugated either with the retina or with the eye's pupil plane. Spatially resolved collections of Mueller matrices and the degree of polarization were calculated from those images for both retinal and pupil planes.

Dearomatization of Antioxidant Rosemary Extracts by Treatment with Supercritical Carbon Dioxide

Treatment with supercritical CO(2) is proposed for deodorizing antioxidant rosemary extracts obtained by steam distillation and Soxhlet extraction. The process conditions have been optimized by applying a Taguchi experimental design with the aim of obtaining, at minimum cost, a product with acceptable antioxidant activity as well as minimum rosemary aroma. Variables were selected for their effects on the selective extraction of the compounds responsible for the residual aroma of the rosemary extract. The optimized method allowed 90% dearomatization; no detrimental effects in antioxidant activity or color of the extracts have been observed after supercritical fluid processing.

3D reconstruction of tomographic images applied to largely spaced slices

This paper presents a full reconstruction process of magnetic resonance images. The first step is to bring the acquired data from the frequency domain, using a Fast Fourier Transform algorithm. A Tomographic Image Interpolation is then used to transform a sequence of tomographic slices in an isotropic volume data set, a process also called 3D Reconstruction. This work describes an automatic method whose interpolation stage is based on a previous matching stage using Delaunay Triangulation. The reconstruction approach uses an extrapolation procedure that permits appropriate treatment of the boundaries of the object under analysis.

Human breast cancer cell metastasis to long bone and soft organs of nude mice: a quantitative assay

Bone is a common metastatic site in human breast cancer (HBC). Since bone metastasis occurs very rarely from current spontaneous or experimental metastasis models of HBC cells in nude mice, an arterial seeding model involving the direct injection of the cells into the left ventricle has been developed to better understand the mechanisms involved in this process. We present here a sensitive polymerase chain reaction (PCR) method to detect and quantitate bone and soft organ metastasis in nude mice which have been intracardially inoculated with Lac Z transduced HBC cells. Amplification of genomically incorporated Lac Z sequences in MDA-MB-231-BAG HBC cells enables us to specifically detect these cells in mouse organs and bones. We have also created a competitive template to use as an internal standard in the PCR reactions, allowing us to better quantitate levels of HBC metastasis. The results of this PCR detection method correlate well with cell culture detection from alternate long bones from the same mice, and are more sensitive than gross Lac Z staining with X-gal or routine histology. Comparable qualitative results were obtained with PCR and culture in a titration experiment in which mice were inoculated with increasing numbers of cells, but PCR is more quantifiable, less time consuming, and less expensive. This assay can be employed to study the molecular and cellular aspects of bone metastasis, and could easily be used in conjunction with RT-PCR-based analyses of gene products which may be involved with HBC metastasis.

[An evaluation study of a scale of diabetological education in primary care]

OBJECTIVE

To devise and evaluate a scale of measurement which would permit evaluation at primary care level, of the knowledge that diabetic patients have of diabetes. Secondly, to ascertain the level of knowledge of the sample of diabetic patients attending the Xixona Health Centre.

DESIGN

Non-longitudinal, observational, descriptive study.

SETTING

Primary health care (health centre).

MEASUREMENTS AND MAIN RESULTS

The degree of internal consistency of the diabetes scale of knowledge (DISK) attained a Cronbach Alpha value of 0.87. The coefficients of correlation of each of the factors--defined a priori (general knowledge, diet, exercise, hygiene and self-regulation)--oscillated between 0.77 and 0.83. The Garret index of corrected difficulty was at 0.64. The homogeneity of each item with the questionnaire showed values above 0.31. The reliability measured by means of the KR20 index was 0.86. The odd-even coefficient of reliability was at 0.89. The mean level of correct answers was 70%. A relation was found between the level of knowledge and the variables age and years the patient had been subject to the condition. No relation was found with the treatment, sex, glycaemia or HbA1C level, nor educational level.

CONCLUSIONS

The indices obtained by the scale can be considered to be judiciously acceptable, both in terms of their internal consistency and their ability to characterise. The DISK (ECODI) is, then, a valuable tool in the field of primary health care.