Is diagnosing exposed dentine a suitable tool for grading erosive loss?
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ABSTRACT:
SUBMITTER: Holbrook WP
PROVIDER: S-EPMC2238781 | biostudies-other | 2008 Mar
REPOSITORIES: biostudies-other
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Project description:PurposeTo present and evaluate a remote, tool-based system and structured grading rubric for adjudicating image-based diabetic retinopathy (DR) grades.MethodsWe compared three different procedures for adjudicating DR severity assessments among retina specialist panels, including (1) in-person adjudication based on a previously described procedure (Baseline), (2) remote, tool-based adjudication for assessing DR severity alone (TA), and (3) remote, tool-based adjudication using a feature-based rubric (TA-F). We developed a system allowing graders to review images remotely and asynchronously. For both TA and TA-F approaches, images with disagreement were reviewed by all graders in a round-robin fashion until disagreements were resolved. Five panels of three retina specialists each adjudicated a set of 499 retinal fundus images (1 panel using Baseline, 2 using TA, and 2 using TA-F adjudication). Reliability was measured as grade agreement among the panels using Cohen's quadratically weighted kappa. Efficiency was measured as the number of rounds needed to reach a consensus for tool-based adjudication.ResultsThe grades from remote, tool-based adjudication showed high agreement with the Baseline procedure, with Cohen's kappa scores of 0.948 and 0.943 for the two TA panels, and 0.921 and 0.963 for the two TA-F panels. Cases adjudicated using TA-F were resolved in fewer rounds compared with TA (P < 0.001; standard permutation test).ConclusionsRemote, tool-based adjudication presents a flexible and reliable alternative to in-person adjudication for DR diagnosis. Feature-based rubrics can help accelerate consensus for tool-based adjudication of DR without compromising label quality.Translational relevanceThis approach can generate reference standards to validate automated methods, and resolve ambiguous diagnoses by integrating into existing telemedical workflows.
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Project description:Erosion of dentin results in a complex multi-layered lesion. Several methods have been used to measure erosive substance loss of dentin, but were found to have only limited agreement, in parts because they assess different structural parameters. The present study compared the agreement of four different methods (transversal microradiography [TMR], Confocal Laser Scanning Microscopy [CLSM], Laser Profilometry [LPM] and modified Knoop Hardness measurement [KHM]) to measure erosive substance loss in vitro. Ninety-six dentin specimens were prepared from bovine roots, embedded, ground, polished and covered with nail-varnish except for an experimental window. Erosion was performed for 1 h using citric acid concentrations of 0.00% (control), 0.07%, 0.25% and 1.00% (n=24/group). Adjacent surfaces served as sound reference. Two examiners independently determined the substance loss. After 1 h erosion with 1% citric acid solution, substance losses (mean ± SD) of 12.0 ± 1.3 µm (TMR), 2.9 ± 1.3 µm (LPM), 3.9 ± 1.3 µm (KHM) and 17.0 ± 2.6 µm (CLSM) were detected. ROC curve analysis found all methods to have high accuracy for discriminating different degrees of erosive substance loss (AUC 0.83-1.00). Stepwise discriminatory analysis found TMR and CLSM to have the highest discriminatory power. All methods showed significant relative and proportional bias (p<0.001). The smallest albeit significant disagreement was found between LPM and KHM. No significant inter-rater bias was detected except for KHM. LPM is prone to underestimate erosive loss, possibly due to detection of the organic surface layer. KHM was not found suitable to measure erosive loss in dentin. TMR and CLSM detected the loss of mineralised tissue, showed high reliability, and had the highest discriminatory power. Different methods might be suitable to measure different structural parameters.
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Project description:AimsPulmonary congestion remains a diagnostic challenge in patients with heart failure (HF). The recommended method, chest X-ray (CXR), lacks in accuracy, whereas quantitative tomographic lung scintigraphy [ventilation/perfusion single-photon emission computed tomography (V/P SPECT)] has shown promising results but needs independent validation. The aim of this study is to evaluate V/P SPECT as a non-invasive method to assess and quantify pulmonary congestion in HF patients, using right heart catheterization as reference method. The secondary objective was to investigate the performance of V/P SPECT in the clinical setting compared with CXR.Methods and resultsForty-six consecutive patients with HF that were under consideration for heart transplantation were studied prospectively. All participants were examined with V/P SPECT, CXR, and right heart catheterization. Pulmonary artery wedge pressure served as reference method. Quantitative perfusion gradients were derived from V/P SPECT images. Ventilation/perfusion single-photon emission computed tomography images were also assessed both by expert readers and clinical nuclear medicine physicians. Expert readers correctly identified 87% of all patients with an elevated pulmonary artery wedge pressure > 15 mmHg. The average sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for V/P SPECT assessed by the expert readers were 87%, 72%, 85%, and 75%, respectively. In the clinical nuclear medicine setting, V/P SPECT had 87% sensitivity, 63% specificity, 81% PPV, and 71% NPV. Clinically, V/P SPECT outperformed CXR, which had 27% sensitivity, 75% specificity, 67% PPV, and 35% NPV.ConclusionsVentilation/perfusion single-photon emission computed tomography can be used as a non-invasive method to diagnose and quantify pulmonary congestion in patients with HF and is more accurate than CXR in diagnosing pulmonary congestion in the clinical setting.
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Project description:The hereditary dentine disorders, dentinogenesis imperfecta (DGI) and dentine dysplasia (DD), comprise a group of autosomal dominant genetic conditions characterised by abnormal dentine structure affecting either the primary or both the primary and secondary dentitions. DGI is reported to have an incidence of 1 in 6,000 to 1 in 8,000, whereas that of DD type 1 is 1 in 100,000. Clinically, the teeth are discoloured and show structural defects such as bulbous crowns and small pulp chambers radiographically. The underlying defect of mineralisation often results in shearing of the overlying enamel leaving exposed weakened dentine which is prone to wear. Currently, three sub-types of DGI and two sub-types of DD are recognised but this categorisation may change when other causative mutations are found. DGI type I is inherited with osteogenesis imperfecta and recent genetic studies have shown that mutations in the genes encoding collagen type 1, COL1A1 and COL1A2, underlie this condition. All other forms of DGI and DD, except DD-1, appear to result from mutations in the gene encoding dentine sialophosphoprotein (DSPP), suggesting that these conditions are allelic. Diagnosis is based on family history, pedigree construction and detailed clinical examination, while genetic diagnosis may become useful in the future once sufficient disease-causing mutations have been discovered. Differential diagnoses include hypocalcified forms of amelogenesis imperfecta, congenital erythropoietic porphyria, conditions leading to early tooth loss (Kostmann's disease, cyclic neutropenia, Chediak-Hegashi syndrome, histiocytosis X, Papillon-Lefevre syndrome), permanent teeth discolouration due to tetracyclines, Vitamin D-dependent and vitamin D-resistant rickets. Treatment involves removal of sources of infection or pain, improvement of aesthetics and protection of the posterior teeth from wear. Beginning in infancy, treatment usually continues into adulthood with a number of options including the use of crowns, over-dentures and dental implants depending on the age of the patient and the condition of the dentition. Where diagnosis occurs early in life and treatment follows the outlined recommendations, good aesthetics and function can be obtained.
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Project description:This in situ study investigated the ability of a CPP-ACP chewing gum in preventing erosive enamel loss. Material and Methods: During three experimental crossover phases (one phase per group) of seven days each, eight volunteers wore palatal devices with human enamel blocks. The groups were: GI - Sugar free chewing gum with CPP-ACP; GII - Conventional sugar free chewing gum; and GIII - No chewing gum (control). Erosive challenge was extraorally performed by immersion of the enamel blocks in cola drink (5 min, 4x/day). After each challenge, in groups CPP and No CPP, volunteers chewed one unit of the corresponding chewing gum for 30 minutes. Quantitative analysis of enamel loss was performed by profilometry (µm). Data were analyzed by Repeated-Measures ANOVA and Tukey's test (p<0.05).The use of chewing gum (CPP and No CPP) resulted in lower erosive enamel loss compared with the control group (p<0.05). CPP-ACP chewing gum (CPP) did not improve the protection against erosive enamel loss compared with conventional chewing gum (No CPP) (p>0.05).The CPP-ACP chewing gum was not able to enhance the anti-erosive effect of conventional chewing gum against enamel loss.
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Project description:This study investigated the effect of the period of use and location of intraoral appliances on enamel surface loss. This randomized, single blind in situ study was conducted in 2 crossover phases based on the period of use, in which maxillary and mandibular appliances were simultaneously worn. Bovine enamel blocks (n = 120) were randomly divided among the studied groups by surface hardness. In each phase, fifteen volunteers used one maxillary appliance and two mandibular appliances for 5 days. Erosive challenge was performed 4X/day by immersion in 0.01 M HCL for 2 minutes. In the continuous phase, the intraoral appliances were worn for 20 hours. In the intermittent phase the appliances were worn for 8 hours and 30 minutes. Enamel loss was determined profilometrically. The discomfort of use of the appliances were evaluated in a questionnaire. Data were analyzed by two-way ANOVA/Tukey's test and chi-square test (p<0.05). The maxillary appliance promoted higher enamel loss compared to the mandibular one (p<0.001). Intermittent use of appliances resulted in similar enamel loss to the continuous one (p = 0.686). All volunteers preferred to use the maxillary appliance in an intermittent regimen. The intermittent use of maxillary appliance is a simplified reliable protocol appropriated for in situ erosion studies in enamel.
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