Improving Inpatient Colonoscopy Bowel Preparation: A Successful Quality Improvement Project.

Inadequate inpatient bowel preparation can lead to repeat procedures, prolonged hospital stays, and increased financial burden. In this quality improvement project, the authors developed an electronic medical record (EMR)-based order set with precise instructions and anticipatory guidance for inpatient bowel preparation before colonoscopy. The current study is a nonrandomized intervention study. The authors compared 2 groups: an intervention group using a newly developed, consensus-based, standardized EMR bowel preparation order set and a control group using previously existing EMR bowel preparation orders. Bowel preparation outcomes were followed over the course of 16 months. The aim was to improve inpatient colonoscopy bowel preparation, as evaluated by the Boston Bowel Preparation Scale, procedure delays, and length of hospital stay. We additionally evaluated the groups' demographics and patient-level factors. A total of 459 inpatient colonoscopies were evaluated over a 16-month period. The intervention group consisted of 227 inpatient colonoscopies, while the control group consisted of 232. The intervention group showed superior Boston Bowel Preparation Scale score and decreased length of hospital stay. The number of adequate bowel preparations increased in the intervention group when compared to the control group from 77% to 86%. The creation of an EMR-based order set is a low-cost and sustainable action that can be easily implemented throughout a hospital system.

Development of the Japanese version of the stroke stigma scale: a validity and reliability assessment.

BACKGROUND: The stigma perceived by many post-stroke persons hinders their social lives. A scale to measure stigma is needed to identify social problems related to stigma, and to evaluate effectiveness of interventions. OBJECTIVES: This study aimed to develop a Japanese version of the Stroke Stigma Scale (SSS-J), and confirm its utility by examining reliability and validity. METHODS: Eighty community-dwelling post-stroke individuals were enrolled at six sites. After translating the scale into Japanese using back translation methods, psychometric properties of the rating scale, internal scale validity, and reliability were examined to fit the Rasch model. Criterion-related validity, construct validity, and test-retest reliability were examined using total scores transformed to logit. For test-retest reliability, 30 participants completed the SSS-J twice, one week apart. RESULTS: Rasch analysis showed that the SSS-J had the best fit with 15 items on a 3-category rating scale. Item difficulty logits were -2.01 to 2.21, person ability logits were -4.69 to 0.62 (mean, -1.41), person reliability coefficient was 0.71 (separation index, 1.58), and item reliability coefficient was 0.96 (separation index, 5.04). For criterion validity, Spearman's rank correlation coefficient with the Center for Epidemiologic Studies Depression Scale was 0.51 (p < 0.001). For construct validity, Spearman's rank correlation coefficients with each subscale of the Stroke Impact Scale ranged from -0.36 to -0.16 (p = 0.002-0.126). For test-retest reliability, the intra-class correlation coefficient was 0.64 (p < 0.001). CONCLUSIONS: The SSS-J adapted to the Rasch model was reliable and valid. This scale can be used to quantitatively measure stigma among community-dwelling post-stroke persons in Japan.

Generating PET Attenuation Maps via Sim2Real Deep Learning-Based Tissue Composition Estimation Combined with MLACF.

Deep learning (DL) has recently attracted attention for data processing in positron emission tomography (PET). Attenuation correction (AC) without computed tomography (CT) data is one of the interests. Here, we present, to our knowledge, the first attempt to generate an attenuation map of the human head via Sim2Real DL-based tissue composition estimation from model training using only the simulated PET dataset. The DL model accepts a two-dimensional non-attenuation-corrected PET image as input and outputs a four-channel tissue-composition map of soft tissue, bone, cavity, and background. Then, an attenuation map is generated by a linear combination of the tissue composition maps and, finally, used as input for scatter+random estimation and as an initial estimate for attenuation map reconstruction by the maximum likelihood attenuation correction factor (MLACF), i.e., the DL estimate is refined by the MLACF. Preliminary results using clinical brain PET data showed that the proposed DL model tended to estimate anatomical details inaccurately, especially in the neck-side slices. However, it succeeded in estimating overall anatomical structures, and the PET quantitative accuracy with DL-based AC was comparable to that with CT-based AC. Thus, the proposed DL-based approach combined with the MLACF is also a promising CT-less AC approach.

Pasting properties of A- and B-type wheat starch granules and annealed starches in relation to swelling and solubility.

Wheat starch contains two distinct groups of granules, A-type and B-type, which have different compositions and properties. The aim of this study was to investigate the differences in pasting properties of A- and B-type wheat starch granules and their annealed starches, and to relate them to swelling properties and solubility. A- and B-type wheat starch granules were fractionated. The differences in pasting properties between A- and B-type wheat starch granules depended on starch solids content. The A-type starch had a higher pasting viscosity at ≥8 % solids content, but the trend was reversed at a lower solids content (5 %). This cross-over phenomenon in the pasting viscosity can be explained because A-type wheat starch granules have more starch molecules leached out, while swelled less at high temperatures and are probably more rigid than B-type wheat starch granules. This is the first study to show the cross-over in the pasting viscosity-starch concentration between A-type and B-type wheat starches and that B-type wheat starch has higher pasting viscosity than A-type at a low solids content. When annealed in warm water, both annealed A- and B-type wheat starch granules had higher pasting viscosities than untreated counterparts by altering the swelling of starch.

Cold-blooded vertebrates evolved organized germinal center-like structures.

Germinal centers (GCs) or analogous secondary lymphoid microstructures (SLMs) are thought to have evolved in endothermic species. However, living representatives of their ectothermic ancestors can mount potent secondary antibody responses upon infection or immunization, despite the apparent lack of SLMs in these cold-blooded vertebrates. How and where adaptive immune responses are induced in ectothermic species in the absence of GCs or analogous SLMs remain poorly understood. Here, we infected a teleost fish (trout) with the parasite Ichthyophthirius multifiliis (Ich) and identified the formation of large aggregates of highly proliferating IgM+ B cells and CD4+ T cells, contiguous to splenic melanomacrophage centers (MMCs). Most of these MMC-associated lymphoid aggregates (M-LAs) contained numerous antigen (Ag)-specific B cells. Analysis of the IgM heavy chain CDR3 repertoire of microdissected splenic M-LAs and non-M-LA areas revealed that the most frequent B cell clones induced after Ich infection were highly shared only within the M-LAs of infected animals. These M-LAs represented highly polyclonal SLMs in which Ag-specific B cell clonal expansion occurred. M-LA-associated B cells expressed high levels of activation-induced cytidine deaminase and underwent significant apoptosis, and somatic hypermutation of Igµ genes occurred prevalently in these cells. Our findings demonstrate that ectotherms evolved organized SLMs with GC-like roles. Moreover, our results also point to primordially conserved mechanisms by which M-LAs and mammalian polyclonal GCs develop and function.

Effects of Two Electron-Donating and/or -Withdrawing Substituents on Two-Photon Absorption for Diphenylacetylene Derivatives.

Two-photon absorption for diphenylacetylene (DPA) derivatives with two substituents (-OMe and/or -NO2) at the 4,4'-position was investigated experimentally and theoretically. The two-photon absorption spectra and the two-photon absorption cross-sections σ(2) for DPA derivatives were obtained by optical-probing photoacoustic spectroscopy (OPPAS). The simulated two-photon absorption spectra of the DPA derivatives, obtained with the time-dependent density functional theory within the Tamm-Dancoff approximation, agreed well with the experimental ones. The mechanisms for enhancement of the σ(2) for centrosymmetric and non-centrosymmetric DPA derivatives were found to be different. The large σ(2) for centrosymmetric molecules (DPA-OMeOMe and DPA-NO2NO2) results from the magnitude of the transition dipole moment, while for non-centrosymmetric molecules (DPA-OMeNO2), it is enhanced by the smaller detuning energy. Information on two-photon absorption properties of DPA derivatives obtained in this study will be important for the molecular design of two-photon absorption materials.

Noise reduction performance of a deep learning-based reconstruction in brain computed tomography images acquired with organ-based tube current modulation.

We aimed to evaluate the image quality of brain computed tomography (CT) images reconstructed using deep learning-based reconstruction (DLR) in organ-based tube current modulation (OB-TCM) acquisition. An anthropomorphic head phantom and a cylindrical low-contrast phantom were scanned at the standard dose level for adult brain CT in axial volume acquisition without OB-TCM. Moreover, image acquisition with OB-TCM was performed. The radiation dose on the eye lens was measured using a scintillation fibre-optic dosimeter placed on the anthropomorphic phantom's eye surface. The task transfer function (TTF), contrast-to-noise ratio (CNR), and low-contrast object specific CNR obtained from low-contrast phantom images reconstructed with filtered back projection (FBP), hybrid iterative reconstruction (HIR), and two types of DLR (DLRCTA and DLRLCD) were compared. In result, OB-TCM achieved a 32.5% dose reduction in the eye lens. Although HIR, DLRCTA, and DLRLCD showed lower TTF than FBP, the difference in TTF at the highest contributing spatial frequency corresponding to the contrast rod diameter was < 10%. Despite the OB-TCM acquisition, DLRCTA and DLRLCD achieved significantly lower noise and a higher CNR than FBP without OB-TCM (p < 0.05). However, low-contrast object specific CNR was equivalent among all reconstruction methods for the objective diameter of 5 mm and slightly improved in DLRLCD for the objective diameter of 7 mm. DLR with OB-TCM acquisition enabled dose reduction for the eye lens and high CNR image appearance, whereas the low contrast detectability evaluated by low-contrast object specific CNR did not always improve.

Treating Exudative Pleurisy Accompanied by Felty Syndrome in an Older Patient With Advanced Rheumatoid Arthritis.

Advanced rheumatoid arthritis (RA) is complicated by extra-articular manifestations such as small- and medium-sized vasculitis, pulmonary fibrosis, and pleurisy. The clinical course of the disease is refractory and critical. Treating advanced RA with multiple extra-articular manifestations is challenging. Here, we report a case of advanced RA in a 75-year-old man with exudative pleurisy and Felty syndrome. Treatment should be initiated promptly while paying attention to the possibility of infection as a differential diagnosis of exudative pleurisy because of the drastic change in the patient's condition due to disease progression. In addition, appropriate treatment is required to differentiate between Felty syndrome and malignant diseases. In older patients with RV complicated by pleurisy and Felty syndrome, starting steroids and immunosuppressive agents is crucial when conducting a thorough examination and considering the rapid progression of symptoms.

Organ-Specific Positron Emission Tomography Scanners for Breast Imaging: Comparison between the Performances of Prior and Novel Models.

The performances of photomultiplier tube (PMT)-based dedicated breast positron emission tomography (PET) and silicon photomultiplier tube (SiPM)-based time-of-flight (TOF) PET, which is applicable not only to breast imaging but also to head imaging, were compared using a phantom study. A cylindrical phantom containing four spheres (3-10 mm in diameter) filled with 18F-FDG at two signal-to-background ratios (SBRs), 4:1 and 8:1, was scanned. The phantom images, which were reconstructed using three-dimensional list-mode dynamic row-action maximum likelihood algorithm with various ß-values and post-smoothing filters, were visually and quantitatively compared. Visual evaluation showed that the 3 mm sphere was more clearly visualized with higher ß and smaller post-filters, while the background was noisier; SiPM-based TOF-PET was superior to PMT-based dbPET in sharpness, smoothness, and detectability, although the background was noisier at the SBR of 8:1. Quantitative evaluation revealed that the detection index (DI) and recovery coefficient (CRC) of SiPM-based TOF-PET images were higher than those of PMT-based PET images, despite a higher background coefficient of variation (CVBG). The two organ-specific PET systems showed that a 3 mm lesion in the breast could be visualized at the center of the detector, and there was less noise in the SiPM-based TOF-PET image.

Impact of respiratory gating and ECG gating on 18F-FDG PET/CT for cardiac sarcoidosis.

BACKGROUND: The aim of this study was to estimate the impact of respiratory and electrocardiogram (ECG)-gated FDG positron emission tomography (PET)/computed tomography (CT) on the diagnosis of cardiac sarcoidosis (CS). METHODS AND RESULTS: Imaging from thirty-one patients was acquired on a PET/CT scanner equipped with a respiratory- and ECG-gating system. Non-gated PET images and three kinds of gated PET/CT images were created from identical list-mode clinical PET data: respiratory-gated PET during expiration (EX), ECG-gated PET at end diastole (ED), and ECG-gated PET at end systole (ES). The maximum standardized uptake value (SUVmax) and cardiac metabolic volume (CMV) were measured, and the locations of FDG accumulation were analyzed using a polar map. The mean SUVmax of the subjects was significantly higher after application of either respiratory-gated or ECG-gated reconstruction. Conversely, the mean CMV was significantly lower following the application of respiratory-gated or ECG-gated reconstruction. The segment showing maximum accumulation was shifted to the adjacent segment in 25.8%, 38.7%, and 41.9% of cases in EX, ED, and ES images, respectively. CONCLUSION: In FDG PET/CT scanning for the diagnosis of CS, gated scanning is likely to increase quantitative accuracy, but the effect depends on the location and synchronization method.

High-Resolution Silicon Photomultiplier Time-of-Flight Dedicated Head PET System for Clinical Brain Studies.

We acquired brain 18F-FDG and 18F-flutemetamol PET images using a time-of-flight system dedicated to the head (dhPET) and a conventional whole-body PET/CT (wbPET) system and evaluated the clinical superiority of dhPET over wbPET. Methods: There were 18 subjects for the 18F-FDG PET study and 17 subjects for the 18F-flutemetamol PET study. 18F-FDG PET images were first obtained using wbPET, followed by dhPET. 18F-flutemetamol PET images were first obtained using wbPET, followed by dhPET. Images acquired using dhPET and wbPET were compared by visual inspection, voxelwise analysis, and SUV ratio (SUVR). Results: All 18F-FDG and 18F-flutemetamol images acquired using dhPET were judged as visually better than those acquired using wbPET. The voxelwise analysis demonstrated that accumulations in the cerebellum, in the lateral occipital cortices, and around the central sulcus area in dhPET 18F-FDG images were lower than those in wbPET 18F-FDG images, whereas accumulations around the ventricle systems were higher in dhPET 18F-FDG images than those in wbPET 18F-FDG images. Accumulations in the cerebellar dentate nucleus, in the midbrain, in the lateral occipital cortices, and around the central sulcus area in dhPET images were lower than those in wbPET images, whereas accumulations around the ventricle systems were higher in dhPET 18F-flutemetamol images than those in wbPET 18F-flutemetamol images. The mean cortical SUVRs of 18F-FDG and 18F-flutemetamol dhPET images were significantly higher than those of 18F-FDG and 18F-flutemetamol wbPET images, respectively. Conclusion: The dhPET images had better image quality by visual inspection and higher SUVRs than wbPET images. Although there were several regional accumulation differences between dhPET and wbPET images, understanding this phenomenon will enable full use of the features of this dhPET system in clinical practice.

Implant deformation and implant-abutment fracture resistance after standardized artificial aging: An in vitro study.

BACKGROUND AND PURPOSE: Zirconia abutments have been widely adopted in clinical implant practice. The unique mechanical properties of zirconia may significantly affect the long-term prognosis of implant treatments. The purpose of this study was to investigate the influence of abutment material on implant deformation and fracture resistance of internal conical connection implant-abutment complexes of two diameters after standardized artificial aging. MATERIALS AND METHODS: Thirty original abutments (one-piece titanium, one-piece zirconia, zirconia with alloy base) with two diameters (regular, narrow) were connected to internal conical connection implants and subjected to a standardized artificial aging process consisting of thermal cycling and mechanical cyclic loading. Microcomputed tomography (µCT) scans of implant bodies were performed before and after aging. 3-dimensional images of implant bodies were generated from the µCT scans and aligned for before and after aging to calculate the volumetric deformation amount. Finally, fracture resistance was measured using a mechanical static loading test for the surviving aged and 30 brand-new specimens. RESULTS: All specimens survived artificial aging. No significant difference in implant deformation was found in the regular groups (p = 0.095). In narrow groups, the one-piece zirconia group showed significantly less deformation (p < 0.0001). For fracture resistance, no significant decrease was observed after aging in any group (p > 0.05). One-piece zirconia abutments showed significantly lower strength than the other two materials for both diameters (p < 0.0001). CONCLUSIONS: In the regular diameter system, abutment material had no significant influence on the tested mechanical property degradation after simulated long-term oral use. The mechanical performance of narrow diameter one-piece zirconia abutments differed from the other two materials. For optimal performance, one-piece zirconia abutments should be adopted only in anterior regions.

Abutment removal torque and implant conical surface morphological changes after standardized artificial aging: An in vitro study.

STATEMENT OF PROBLEM: Zirconia abutments have become popular as they provide favorable esthetic outcomes. However, studies investigating how abutment material affects abutment screw torque performance and implant conical surface morphological changes in internal conical connection systems are scarce. PURPOSE: The purpose of this in vitro study was to investigate the influence of abutment material on abutment removal torque and implant conical surface morphological changes in internal conical connection implant-abutment assemblies of 2 diameters after simulated long-term oral use. MATERIAL AND METHODS: Thirty abutments of 3 materials (1-piece titanium, 1-piece zirconia, zirconia with alloy base) and 2 diameters (regular, narrow) made by the original manufacturer were connected to internal conical connection implants and subjected to a standardized artificial aging process consisting of thermal cycling and mechanical cyclic loading with parameters corresponding to anterior and posterior mastication scenarios simulating long-term oral use. An abutment removal torque test was done before and after aging. Morphological changes in the implant conical contact surface were observed with a scanning electron microscope (SEM). Initial and after-aging torque loss values were calculated and analyzed separately with 1-way ANOVA and Tukey HSD post hoc tests (α=.05). RESULTS: All specimens survived artificial aging. For initial and after-aging torque loss, the 1-piece zirconia groups showed significantly greater values (P<.001) for both diameters. In the SEM observation, the 1-piece zirconia groups showed distinct widespread surface damage while the other groups exhibited only minor damages. CONCLUSIONS: Regardless of diameter, 1-piece zirconia abutments tend to induce more abutment removal torque loss and implant conical surface morphological changes than those with metal connections, both initially and after simulated long-term oral use. Zirconia abutments with an alloy base performed similarly to 1-piece titanium abutments.

Evaluation of the performance of a high-resolution time-of-flight PET system dedicated to the head and breast according to NEMA NU 2-2012 standard.

BACKGROUND: This study evaluated the physical performance of a positron emission tomography (PET) system dedicated to the head and breast according to the National Electrical Manufacturers Association (NEMA) NU2-2012 standard. METHODS: The spatial resolution, sensitivity, scatter fraction, count rate characteristics, corrections for count losses and randoms, and image quality of the system were determined. All measurements were performed according to the NEMA NU2-2012 acquisition protocols, but image quality was assessed using a brain-sized phantom. Furthermore, scans of the three-dimensional (3D) Hoffmann brain phantom and mini-Derenzo phantom were acquired to allow visual evaluation of the imaging performance for small structures. RESULTS: The tangential, radial, and axial full width at half maximum (FWHM) at a 10-mm offset in half the axial field of view were measured as 2.3, 2.5, and 2.9 mm, respectively. The average system sensitivity at the center of the field of view and at a 10-cm radial offset was 7.18 and 8.65 cps/kBq, respectively. The peak noise-equivalent counting rate was 35.2 kcps at 4.8 kBq/ml. The corresponding scatter fraction at the peak noise-equivalent counting rate was 46.8%. The peak true rate and scatter fraction at 8.6 kBq/ml were 127.8 kcps and 54.3%, respectively. The percent contrast value for a 10-mm sphere was approximately 50%. On the 3D Hoffman brain phantom image, the structures of the thin layers composing the phantom were visualized on the sagittal and coronal images. On the mini-Derenzo phantom, each of the 1.6-mm rods was clearly visualized. CONCLUSION: Taken together, these results indicate that the head- and breast-dedicated PET system has high resolution and is well suited for clinical PET imaging.

Pulmonary nodule volumetric accuracy of a deep learning-based reconstruction algorithm in low-dose computed tomography: A phantom study.

PURPOSE: To compare the image properties and pulmonary nodule volumetric accuracies among deep learning-based reconstruction (DLR), filtered back projection (FBP), and hybrid iterative reconstruction (hybrid IR) in low-dose computed tomography (LDCT). METHODS: A multipurpose chest phantom containing artificial spherical pulmonary nodules with 5-, 8-, 10-, and 12-mm diameters and Hounsfield units (HUs) of -630 and +100 HU was scanned 20 times at a standard dose, based on a low-dose screening CT trial, and at 1/2, 1/6, and 1/12 of the standard dose. To assess noise reduction performance and volumetric accuracy, the standard deviations (SDs) of the pixel values and volumetric percentage errors (PEs) were compared among FBP, hybrid IR, and DLR. The noise non-stationarity index (NNSI) was calculated from 20 image replicates and compared among FBP, hybrid IR, and DLR to evaluate noise stationarity. RESULTS: The SD reduction rates for FBP in hybrid IR and DLR were 62 %-85 % and 79 %-90 %, respectively. For the four nodules with +100 HU, the PE of all reconstruction methods was <±25 % (not clinically relevant). For the four nodules with -630 HU, the PEs were equivalent or lower for hybrid IR and DLR than for FBP, and the PE difference between hybrid IR and DLR ranged from 0 % to 7%. The NNSI was significantly higher for DLR than for FBP and hybrid IR (p < 0.01). CONCLUSIONS: Greater noise suppression was achieved with DLR than with hybrid IR without compromising nodule volumetric accuracy in LDCT despite the representative noise non-stationarity.

Attenuation correction for phantom tests: an alternative to maximum-likelihood attenuation correction factor-based correction for clinical studies in time-of-flight PET.

OBJECTIVES: This study evaluates the phantom attenuation correction (PAC) method as an alternative to maximum-likelihood attenuation correction factor (ML-ACF) correction in time-of-flight (TOF) brain positron emission tomography (PET) studies. METHODS: In the PAC algorithm, a template emission image [Formula: see text] and a template attenuation coefficient image [Formula: see text] are prepared as a data set based on phantom geometry. Position-aligned attenuation coefficient image [Formula: see text] is derived by aligning [Formula: see text] using parameters that match the template emission image [Formula: see text] to measured emission image [Formula: see text]. Then, attenuation coefficient image [Formula: see text] combined with a headrest image is used for scatter and attenuation correction in the image reconstruction. To evaluate the PAC algorithm as an alternative to ML-ACF, Hoffman 3D brain and cylindrical phantoms were measured to obtain the image quality indexes of contrast and uniformity. These phantoms were also wrapped with a radioactive sheet to obtain attenuation coefficient images using ML-ACF. Emission images were reconstructed with attenuation correction by PAC and ML-ACF, and the results were compared using contrast and uniformity as well as visual assessment. CT attenuation correction (CT-AC) was also applied as a reference. RESULTS: The contrast obtained by ML-ACF was slightly overestimated due to its unique experimental condition for applying ML-ACF in Hoffman 3D brain phantom but the uniformity was almost equivalent among ML-ACF, CT-AC, and PAC. PAC showed reasonable result without overestimation compared to ML-ACF and CT-AC. CONCLUSIONS: PAC is an attenuation correction method that can ensure the performance in phantom test, and is considered to be a reasonable alternative to clinically used ML-ACF-based attenuation correction.

Understanding the effect of scan spans on the accuracy of intraoral and desktop scanners.

OBJECTIVES: This study aimed to measure and compare the accuracy (trueness and precision) of intraoral scanners and desktop scanners when scanning different spans. METHODS: Three plaster models representing different spans (full arch, half arch, and three teeth) were obtained from conventional silicone impressions of a maxillary typodont and used as the scanning objects. An industrial scanner (ATOS III Triple Scan) was used to scan the three plaster models to obtain reference digital models. The plaster models were then scanned using two intraoral scanners (Trios 3 and Primescan) and two desktop scanners (LS3 and D2000) to obtain test digital models. The reference and test models were imported into professional reverse engineering software for processing and analysis. The root mean square value indicated differences between the reference and test models. Two-way ANOVA and Bonferroni multiple comparison tests were used for statistical analysis. RESULTS: Two-way ANOVA tests revealed significant differences in trueness and precision for different scan spans (p < 0.001) and different scanners (p < 0.001), which indicates that the scanner types and scan spans affect the accuracy of the scanner. There was no significant difference in the accuracy of the D2000 at three different scan spans (trueness: 23.82 ± 0.22 µm, 21.53 ± 0.18 µm, and 21.02 ± 0.27 µm respectively; precision: 7.86 ± 0.83 µm, 7.87 ± 1.11 µm, and 7.82 ± 0.84 µm respectively). For the LS3 and the two intraoral scanners, the accuracy of the full arch scan (LS 3, trueness: 33.35 ± 0.47 µm, precision:15.36 ± 3.10 µm; Trios 3, trueness: 46.92 ± 9.23 µm, precision:20.79 ± 3.08 µm; Primescan, trueness: 28.73 ± 0.77 µm, precision:15.74 ± 2.45 µm) was significantly lower than that of the half arch (LS 3, trueness: 27.27 ± 0.43 µm, precision:5.62 ± 0.88 µm; trios 3, Trueness: 22.29 ± 1.50 µm, precision:14.12 ± 2.25 µm; Primescan, trueness: 18.91 ± 0.70 µm, precision:7.94 ± 1.09 µm) and three teeth scans (LS 3, trueness: 24.68 ± 0.36 µm, precision:5.29 ± 0.62 µm; Trios 3, trueness: 16.92 ± 0.78 µm, precision:11.95 ± 2.22 µm; Primescan, trueness: 15.79 ± 0.65 µm, precision:7.68 ± 0.62 µm). CONCLUSIONS: The scan span affected the accuracy of the intraoral scanners, but not necessarily the accuracy of the desktop scanners.

IgA nephropathy relapse following COVID-19 vaccination treated with corticosteroid therapy: case report.

BACKGROUND: The flare of immune-mediated disease following coronavirus disease of 2019 (COVID-19) vaccination is a rare adverse event following immunization. De novo, as well as relapsing IgA nephropathy (IgAN) cases, have been reported following either mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) vaccination. To our knowledge, the majority of IgAN relapses did not result in severe acute kidney injury (AKI) and resolved spontaneously. CASE PRESENTATION: This is a case of a 54-year-old female with a previous diagnosis of IgAN who developed IgAN relapse following the second dose of Moderna vaccine. Gross hematuria developed 2 days after vaccination, which was accompanied by significant AKI. Kidney biopsy showed mild tubular atrophy and IgA staining in mesangium without crescent formation. Significant improvement in serum creatinine (Cr) was observed on day 10 after initiating prednisone. Cr came back to normal within 3 months after initiating corticosteroid. CONCLUSION: COVID-19 vaccination is associated with a flare of IgAN that may cause significant AKI. Steroid therapy is associated with recovery. IgAN flare after COVID-19 vaccination should be closely monitored to elucidate any adverse effect associated with the novel vaccine.

Initial evaluation of a new maximum-likelihood attenuation correction factor-based attenuation correction for time-of-flight brain PET.

AIM: The aim of this study was to evaluate an image reconstruction algorithm, including a new maximum-likelihood attenuation correction factor (ML-ACF) for time of flight (TOF) brain positron emission tomography (PET). METHODS: The implemented algorithm combines an ML-ACF method that simultaneously estimates both the emission image and attenuation sinogram from TOF emission data, and a scaling method based on anatomical features. To evaluate the algorithm's quantitative accuracy, three-dimensional brain phantom images were acquired and soft-tissue attenuation coefficients and emission values were analyzed. RESULTS: The heterogeneous distributions of attenuation coefficients in soft tissue, skull, and nasal cavity were sufficiently visualized. The attenuation coefficient of soft tissue remained within 5% of theoretical value. Attenuation-corrected emission showed no lateral differences, and significant differences among soft tissue were within the error range. CONCLUSION: The ML-ACF-based attenuation correction implemented for TOF brain PET worked well and obtained practical levels of accuracy.