Hysteroscopic Transillumination as a Guide for Laparoscopic Excision of Rudimentary Uterine Horn: A Winning Duo.

STUDY OBJECTIVE: Anatomic anomalies of the female reproductive genital tract affect approximately 5.5% of women [1]. The hemiuterus or class U4 by the European Society of Human Reproduction and Embryology / European Society for Gynaecological Endoscopy 2013 classification is a rare congenital malformation defined as a unilateral uterine development, with a contralateral part that could be either incompletely formed or absent. This class is divided into 2 subclasses depending on the presence or not of a functional rudimentary cavity (U4a/U4b) [2]. This work aimed to share our experience performing an hysteroscopic and laparoscopic combined technique to surgically manage this uterine malformation exploiting the hysteroscopic transillumination. DESIGN: A step-by-step explanation of surgical technique with narrated video footage. SETTING: Tertiary Level Academic Hospital "IRCCS Azienda Ospedaliero - Universitaria di Bologna" Bologna, Italy. INTERVENTIONS: A 32-year-old woman with a symptomatic (severe dysmenorrhea and chronic pelvic pain) suspected U4a uterine malformation diagnosed at our center was scheduled for laparoscopic removal of the right uterine horn and ipsilateral salpingectomy exploiting the contemporary hysteroscopic transillumination guidance. We selected this approach to avoid possible complications owing to the anatomic anomalies that are very common in these cases [3,4]. After coagulation and section of the right round ligament at the uterine angle and opening of the right broad ligament, access to the retroperitoneum was obtained to directly visualize the entire course of ureter and the uterine artery. The right uterine artery was coagulated and sectioned at the uterus. Then, the hysteroscope was introduced to the uterine fundus and the light source brightness was increased up to 100% to allow an adequate transmural visualization of the uterine defect from the laparoscope. Once the defect edge was well highlighted, the right uterine horn was isolated and removed using a monopolar hook, taking care to preserve an adequate amount of myometrium. A double layer running suture with barbed absorbable thread (V-Loc) for reconstructive purposes was performed. The specimen was retrieved inside an endobag to allow a safe extraction. Right salpingectomy was then performed. CONCLUSION: Considering the great anatomic variability of this condition, this type of surgery is not always simple. Indeed, the borders between the uterus and the rudimentary uterine horn are often not perfectly recognizable; this can lead to accidental removal of healthy myometrium and increase the risk of perioperative bleeding [5]. In our experience, the combined hysteroscopic and laparoscopic combined technique allows the surgeon to better delimit the borders of the hemiuterus, providing a more conservative and safer surgery. Hysteroscopic transillumination offers the possibility to modulate the radicality in the resection of the rudimentary horn and in the final treatment of dysmorphism.

Caries detection and characterization in pediatric patients using iTero 5D near-infrared technology.

INTRODUCTION: Near-infrared imaging (NIRI) has been proposed as an alternative to radiographs and uses nonionizing radiation in the near-infrared spectrum to differentially scatter light off tooth surfaces and generate images allowing interproximal caries detection. The new iTero 5D Element Scanner (Align Technology, Santa Clara, Calif) has integrated NIRI capture and viewing technology but has not been specifically studied in a pediatric population. Therefore, this study aimed to assess clinicians' abilities to detect and characterize caries in pediatric patients using this instrument. METHODS: Bitewing (BW) radiographs and an intraoral scan were captured on 17 pediatric patients (344 surfaces were analyzed). Data were randomized and graded by 5 calibrated clinicians individually with 2 different rounds of grading. RESULTS: The reliability of lesion characterization (ie, grade) among examiners was poor to fair in both systems, whereas the reliability of caries detection was moderate. Both systems had a high specificity and low sensitivity. The reliability of the characterization of the combined dataset was moderate to substantial, whereas, for detection, it was substantial. CONCLUSIONS: When using either BW or NIRI analysis, reliability is relatively poor, and clinicians are more likely to correctly identify a healthy tooth surface when compared with a carious surface. There is a small difference in error rate between BW and NIRI systems that is not likely to be clinically significant. When NIRI and BW data are combined, clinician agreement for both lesion characterization and detection increases significantly.

Effect of resin composite shade on digital fiber-optic transillumination imaging in vitro.

Digital imaging fiber-optic transillumination (DIFOTI) devices have been used to detect caries, a technique without using X-rays. However, the effects of resin composites (RCs) shades on the images acquired with DIFOTI devices have not been investigated. Thus, this study aimed to elucidate the influence of RC shade on the images obtained with DIFOTI technique. Three shades (A1, A3, and Opaque) for each of four flowable RCs were filled on a cavity prepared in a left mandibular first premolar obtained from a donated body. Then, transmission images with a DIFOTI device (DIAGNOcam; KaVo, Biberach, Germany) were acquired, and the average lightness values of the images in the RC and enamel were used to calculate differences between those areas. To clarify the influence of the optical translucency and color on DIFOTI images, the color parameters (L*, a* and b*) of each RC were obtained with black and white backgrounds. The color differences between the backgrounds were calculated as transparency parameter (TP) values. The number of repetitions was set to 10. Differences in the lightness value of the shades varied in each RC. The difference in lightness was significantly associated with the TP value and color parameters of L* (p < 0.01), with negative (R = - 0.81) and positive (R = 0.84) correlations, respectively. In conclusion, DIFOTI images of RCs with high optical translucency resembled those of the natural tooth structure.

A Novel Method for Transillumination.

PURPOSE: To introduce a cost-efficient device for transillumination in the management of uveal melanoma. METHODS: Todorich Illuminated Depressor is a ball-point depressor, designed to work with the 23-, 25- and 27-gauge Alcon Constellation endoillumination. It was invented to allow indentation and peripheral vitreous visualization for vitrectomy. RESULTS: Todorich depressor combined with endoillumination can also work as a device for transillumination for tumor localization. We started using this method of transillumination for the management of uveal melanomas since September 2020 and have successfully performed Ru-106 plaque brachytherapy for 10 cases of uveal melanoma. Three were large choroidal melanoma cases, and en bloc tumor resection by partial lamellar sclerouvectomy was successfully performed after precise localization of tumors using this method. CONCLUSION: Alcon Constellation endoillumination capped with Todorich Illuminated Depressor is an affordable and viable alternative for transillumination of intraocular tumors.

Reconstructing a Deblurred 3D Structure in a Turbid Medium from a Single Blurred 2D Image-For Near-Infrared Transillumination Imaging of a Human Body.

To provide another modality for three-dimensional (3D) medical imaging, new techniques were developed to reconstruct a 3D structure in a turbid medium from a single blurred 2D image obtained using near-infrared transillumination imaging. One technique uses 1D information of a curvilinear absorber, or the intensity profile across the absorber image. Profiles in different conditions are calculated by convolution with the depth-dependent point spread function (PSF) of the transillumination image. In databanks, profiles are stored as lookup tables to connect the contrast and spread of the profile to the absorber depth. One-to-one correspondence from the contrast and spread to the absorber depth and thickness were newly found. Another technique uses 2D information of the transillumination image of a volumetric absorber. A blurred 2D image is deconvolved with the depth-dependent PSF, thereby producing many images with points of focus on different parts. The depth of the image part can be estimated by searching the deconvolved images for the image part in the best focus. To suppress difficulties of high-spatial-frequency noise, we applied a noise-robust focus stacking method. Experimentation verified the feasibility of the proposed techniques, and suggested their applicability to curvilinear and volumetric absorbers such as blood vessel networks and cancerous lesions in tissues.

Penlight versus Smartphone: Diagnostic Efficacy of Transillumination.

Background: The purpose of this study was to compare the diagnostic accuracy of a smartphone flashlight to a conventional penlight with regards to transillumination of simulated soft tissue masses of the hand and wrist. Methods: Eight participants performed transillumination assessments in a fresh frozen cadaver upper extremity model. Spheres measuring 9.5 mm were used to simulate fluid-filled or solid soft tissue masses. Two spheres were placed on the volar aspect and two on the dorsal aspect of the wrist. These were then evaluated with either a smartphone flashlight or penlight. Participants noted whether each sphere did or did not transilluminate. Each participant performed two evaluations at an interval of 3 weeks. Results: The overall sensitivity, specificity and accuracy of the smartphone were 100%, 44% and 72%, respectively. The overall sensitivity, specificity and accuracy of the penlight were 100%, 75% and 88%, respectively. The difference in accuracy between the smartphone group and penlight group was statistically significant (p = 0.029). The kappa value, indicating intra-observer agreement, for the smartphone group and penlight group was 0.76 and 0.76, respectively. Conclusion: In conclusion, transillumination with a penlight is a viable adjunct to the examination of soft tissue masses of the hand and wrist. The use of a smartphone flashlight, while convenient, is less accurate than a penlight and can lead the examiners to misinterpret the composition of soft tissue masses. Level of Evidence: Level IV (Diagnostic).

Validity of near-infrared light transillumination for the assessment of proximal caries in permanent teeth.

PURPOSE: The aim of this study was to evaluate the performance of DIAGNOcam (DC) in diagnosing proximal caries and to compare its effectiveness with the International Caries Detection and Assessment System (ICDAS) and bitewing radiography (BWR). METHODS: 118 premolars extracted for orthodontic reasons were included and examined using three detection methods and validated by histological sections as the gold standard. The sensitivity, specificity and areas under the ROC curve (Az value) at the outer half enamel (D1), inner half enamel (D2) and dentine (D3) thresholds were compared between different methods. RESULTS: At all categories, the specificity of DC was almost as high as ICDAS and BWR. DC showed a significantly higher sensitivity (0.68) than both visual (0.33) and radiographic examination (0.47) at the D1 threshold. DC presented the highest Az value (area under the ROC curve) at the D1 and D2 threshold (0.81, 0.86), while BWR showed the greatest Az values at D3 (0.94). Furthermore, DC had the highest association strength with the gold standard (Spearman's ρ = 0.80). CONCLUSIONS: It can be concluded that DC could detect proximal caries effectively and showed comparable or even better performance than ICDAS and BWR.

Reflected near-infrared light versus bite-wing radiography for the detection of proximal caries: A multicenter prospective clinical study conducted in private practices.

OBJECTIVES: The aim of the present prospective multicenter clinical study was to compare the detection of proximal caries with near-infrared light reflection (NILR) versus bitewing radiography (BWR). MATERIALS AND METHODS: Intraoral scans were performed on 100 patients in five dental clinics using an intraoral scanner (iTero Element 5D, Align Technology, Tempe, AZ, USA) that includes a near-infrared light source (850 nm) and sensor. Reflected near-infrared light images of posterior teeth were used by the individual dentists to detect proximal caries and the results were compared to the BWRs. In a total of 3499 proximal surfaces of molars and premolars which were examined, 223 carious lesions were detected by BWR, while NILR detected 549 carious lesions. Caries detection using both methods was also done by an expert team of five dentists, highly experienced in NILR image interpretation, who used the same sets of clinically-obtained data. Sensitivity, specificity, and accuracy were calculated for caries detection by both the dentists and the expert team. Fifty-nine of the detected carious lesions were clinically treated and the observations during caries excavation were compared with those done with NILR and BWR. Statistical analysis to compare between NILR and BWR diagnosis was performed using non-parametric two-sided McNemar's Chi-Square test with the significance level set at p < 0.05. Kappa coefficients were calculated to assess the level of agreement between the two caries detection methods. RESULTS: Accuracy of NILR detection of early enamel lesions was 88% and that of carious lesions involving the dentino-enamel junction (DEJ) was 97%. Accuracy was found to be higher at 96% and 99%, respectively, when the same data were examined by the expert team. Direct observation during caries-excavation treatment suggested that NILR detected early enamel lesions that were not detectable with BWR alone. CONCLUSIONS: Within the limitations of the present study, NILR was more sensitive than BWR in detecting early enamel lesions and comparable to BWR in detecting lesions that involved the DEJ. CLINICAL RELEVANCE: Reflected near-infrared light images that are generated simultaneously with 3D intra-oral scanning may be used reliably for detection, screening, and monitoring of proximal caries, thus potentially minimizing the traditional use of ionizing radiation.

TrueVue transillumination volume rendering for three-dimensional transoesophageal echocardiography in interventional imaging.

AIMS: The aim of the present article is to address the advantages of real-time TrueVue transillumination rendering for three-dimensional transoesophageal echocardiography in the context of echocardiographic procedural guidance for structural interventions for several procedural concerns. METHODS: Procedures in which transillumination imaging was used during at least one step of the whole intervention were retrospectively collected; the loops were reviewed by an experienced imaging specialist and the most important concerns imaged in the loops were listed. The apparent added value of transillumination for each of these concerns was scored independently by two imager specialists, and their agreement was derived. RESULTS: Between January and June 2019, 50 procedures were performed in our centre. Transillumination imaging was used in 64% of these cases. Considering all the loops the added value of transillumination compared with the conventional rendering was scored greater than 3 in a Likert scale in 87% of analysed loops by both the operators with a good agreement (κ  = 0.47, P  = 0.001). A different level of perceived advantage and agreement was observed between three image features that improved: substantial agreement (κ  = 0.652, P  = 0.001) for enhancing the contrast between structures and cavities (n  = 24 loops); good agreement for the contrast between different structures (κ  = 0.588, P  = 0.002) (n  = 37 loops); moderate agreement for the perception of interaction between the device and structures (κ  = 0.3, P  = 0.027) (n  = 7 loops). CONCLUSION: The use of new volume-rendering techniques in interventional imaging may be useful especially for solving the concerns regarding the cavity-structure contrast.

Capacidad de sellado de los conductos laterales con distintas técnicas de obturación del conducto radicular / Sealing capacity of lateral canals with different root canal obturation techniques

Objetivo: Estimar y comparar la eficacia de diferentes técnicas de obturación para impedir el flujo de colorante a través de los conductos laterales. Materiales y métodos: Se emplearon 50 premolares inferiores extraídos y conservados en formol neutro al 5% hasta el momento de su uso, a los cuales se les realizaron conductos laterales artificiales. Una vez instrumentados los conductos principales, los dientes fueron divididos al azar en 5 grupos (n=10) para ser obturados con cuatro técnicas distintas: A) System B + inyección de gutapercha termoplástica del sistema Elements, Extruder; B) obturadores de Thermafil, ProTaper Universal; C) técnica híbrida y D) obturación con inyección de gutapercha termoplástica del sistema Elements, Extruder. Inmersos en tinta china y diafanizadas las raíces, se evaluó la longitud de penetración de la tinta en los conductos laterales. Se empleó el análisis de la varianza para detectar diferencias significativas (P<0,05) entre los niveles medios de penetración del colorante según las técnicas de obturación y las zonas del diente, y se efectuaron pruebas de rango múltiple (HSD de Tukey) para realizar comparaciones dos a dos, manteniendo fija la tasa de error por familia. Resultados: A la técnica B le correspondió el valor medio más bajo (30,63%) de penetración de tinta china. Los valores medios más elevados (54,52% y 51,74%) correspondieron a las técnicas A y C, respectivamente. Conclusión: Ninguna de las técnicas de obturación del conducto radicular empleadas ha sido capaz de impedir la filtración del colorante en los conductos laterales (AU)

Aim: To estimate and compare the different obturation techniques to avoid the flow of colorant through lateral canals. Materials and methods: 50 extracted lower premolars preserved in 5% neutral formol until the moment of use, had artificial lateral canals made. Once canals were instrumented, the teeth were randomly divided into 5 groups (n=10) to be filled with four different techniques: A) System B + injection of thermoplastic gutta-percha, Elements system, Extruder; B) Thermafil, ProTaper Universal obturators; C) hybrid technique, and D) injection of thermoplastic gutta-percha, Elements system, Extruder. Having immersed the premolars in India ink and diaphanized the roots, the penetration length of the India ink inside the canals was assessed. Analysis of variance was used to detect significant differences (P<0.05) between the mean levels of dye penetration according to the filling techniques and tooth areas, and multiple range tests (Tukey's HSD) were performed for two-to-two comparisons, keeping the error rate per family fixed. Results: Technique B had the lowest mean value (30.63%) of penetration. The highest mean values (54.52% and 51.74%) corresponded to techniques A and C, respectively. Conclusion: No obturation technique of the root canal used was able to avoid filtration of colourant in the lateral canals (AU)

Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries.

BACKGROUND: Caries is one of the most prevalent and preventable conditions worldwide. If identified early enough then non-invasive techniques can be applied, and therefore this review focusses on early caries involving the enamel surface of the tooth. The cornerstone of caries detection and diagnosis is a visual and tactile dental examination, although alternative approaches are available. These include illumination-based devices that could potentially support the dental examination. There are three categories of illumination devices that exploit various methods of application and interpretation, each primarily defined by different wavelengths, optical coherence tomography (OCT), near-infrared (NIR), and fibre-optic technology, which incorporates more recently developed digital fibre optics (FOTI/DIFOTI). OBJECTIVES: To estimate the diagnostic test accuracy of different illumination tests for the detection and diagnosis of enamel caries in children or adults. We also planned to explore the following potential sources of heterogeneity: in vitro or in vivo studies with different reference standards; tooth surface (occlusal, proximal, smooth surface, or adjacent to a restoration); single or multiple sites of assessment on a tooth surface; and the prevalence of caries into dentine. SEARCH METHODS: Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 15 February 2019); Embase Ovid (1980 to 15 February 2019); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 15 February 2019); and the World Health Organization International Clinical Trials Registry Platform (to 15 February 2019). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA: We included diagnostic accuracy study designs that compared the use of illumination-based devices with a reference standard (histology, enhanced visual examination with or without radiographs, or operative excavation). These included prospective studies that evaluated the diagnostic accuracy of a single index test and studies that directly compared two or more index tests. Both in vitro and in vivo studies of primary and permanent teeth were eligible for inclusion. We excluded studies that explicitly recruited participants with caries into dentine or frank cavitation. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently and in duplicate using a standardised data extraction form and quality assessment based on QUADAS-2 specific to the clinical context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence regions. The comparative accuracy of different illumination devices was conducted based on indirect and direct comparisons between methods. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression. MAIN RESULTS: We included 24 datasets from 23 studies that evaluated 16,702 tooth surfaces. NIR was evaluated in 6 datasets (673 tooth surfaces), OCT in 10 datasets (1171 tooth surfaces), and FOTI/DIFOTI in 8 datasets (14,858 tooth surfaces). The participant selection domain had the largest number of studies judged at high risk of bias (16 studies). Conversely, for the index test, reference standard, and flow and timing domains the majority of studies were judged to be at low risk of bias (16, 12, and 16 studies respectively). Concerns regarding the applicability of the evidence were judged as high or unclear for all domains. Notably, 14 studies were judged to be of high concern for participant selection, due to selective participant recruitment, a lack of independent examiners, and the use of an in vitro study design. The summary estimate across all the included illumination devices was sensitivity 0.75 (95% confidence interval (CI) 0.62 to 0.85) and specificity 0.87 (95% CI 0.82 to 0.92), with a diagnostic odds ratio of 21.52 (95% CI 10.89 to 42.48). In a cohort of 1000 tooth surfaces with a prevalence of enamel caries of 57%, this would result in 142 tooth surfaces being classified as disease free when enamel caries was truly present (false negatives), and 56 tooth surfaces being classified as diseased in the absence of enamel caries (false positives). A formal comparison of the accuracy according to device type indicated a difference in sensitivity and/or specificity (Chi2(4) = 34.17, P < 0.01). Further analysis indicated a difference in the sensitivity of the different devices (Chi2(2) = 31.24, P < 0.01) with a higher sensitivity of 0.94 (95% CI 0.88 to 0.97) for OCT compared to NIR 0.58 (95% CI 0.46 to 0.68) and FOTI/DIFOTI 0.47 (95% CI 0.35 to 0.59), but no meaningful difference in specificity (Chi2(2) = 3.47, P = 0.18). In light of these results, we planned to formally assess potential sources of heterogeneity according to device type, but due to the limited number of studies for each device type we were unable to do so. For interpretation, we presented the coupled forest plots for each device type according to the potential source of heterogeneity. We rated the certainty of the evidence as low and downgraded two levels in total due to avoidable and unavoidable study limitations in the design and conduct of studies, indirectness arising from the in vitro studies, and imprecision of the estimates. AUTHORS' CONCLUSIONS: Of the devices evaluated, OCT appears to show the most potential, with superior sensitivity to NIR and fibre-optic devices. Its benefit lies as an add-on tool to support the conventional oral examination to confirm borderline cases in cases of clinical uncertainty. OCT is not currently available to the general dental practitioner, and so further research and development are necessary. FOTI and NIR are more readily available and easy to use; however, they show limitations in their ability to detect enamel caries but may be considered successful in the identification of sound teeth. Future studies should strive to avoid research waste by ensuring that recruitment is conducted in such a way as to minimise selection bias and that studies are clearly and comprehensively reported. In terms of applicability, any future studies should be undertaken in a clinical setting that is reflective of the complexities encountered in caries assessment within the oral cavity.

Application of Near-infrared Light Transillumination in Restorative Dentistry: A Review.

This paper presents the various applications of near-infrared light transillumination (NILT) in dentistry. Untreated dental caries is considered the most prevalent health condition affecting both children and adults worldwide. Increased awareness and a paradigm shift toward utilization of minimally invasive treatment procedures and nonionizing radiation led to the discovery of newer techniques for screening and early diagnosis of demineralized lesions. Demineralized lesions detected early can be treated with minimally invasive treatment procedures such as the usage of fluoridated dentifrice to encourage remineralization and resin infiltration to arrest caries progression. NILT procedure involves noninvasive, nonionizing radiation and helps in the identification of early demineralized lesions using light transillumination. At near-infrared wavelengths, the enamel appears translucent and helps in visualizing and detecting demineralized lesions when long-wave light transilluminated against the tooth surface. The wavelength in the range of 1310 nm is considered best for the transillumination of lesions. This technique has been proven to be successful in the detection of carious and demineralized lesions. NILT can be used as a screening tool for the early detection of demineralized lesions and can be considered as an adjunct to bitewing radiographs. It can be advantageous in screening pregnant, growing adolescent patients and in cases where multiple follow-ups are needed and ionizing radiation must be avoided. Keywords: Dental caries, Early diagnosis, Ionizing radiation, Minimally invasive, Near-infrared, Occlusal caries, Transillumination.

Tests to detect and inform the diagnosis of root caries.

BACKGROUND: Root caries is a well-recognised disease, with increasing prevalence as populations age and retain more of their natural teeth into later life. Like coronal caries, root caries can be associated with pain, discomfort, tooth loss, and contribute significantly to poorer oral health-related quality of life in the elderly. Supplementing the visual-tactile examination could prove beneficial in improving the accuracy of early detection and diagnosis. The detection of root caries lesions at an early stage in the disease continuum can inform diagnosis and lead to targeted preventive therapies and lesion arrest. OBJECTIVES: To assess the diagnostic test accuracy of index tests for the detection and diagnosis of root caries in adults, used alone or in combination with other tests. SEARCH METHODS: Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 31 December 2018); Embase Ovid (1980 to 31 December 2018); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 31 December 2018); and the World Health Organization International Clinical Trials Registry Platform (to 31 December 2018). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA: We included diagnostic accuracy study designs that compared one or more index tests (laser fluorescence, radiographs, visual examination, electronic caries monitor (ECM), transillumination), either independently or in combination, with a reference standard. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. In vitro and in vivo studies were eligible for inclusion but studies that artificially created carious lesions were excluded. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently and in duplicate using a standardised data extraction and quality assessment form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) specific to the review context. Estimates of diagnostic test accuracy were expressed as sensitivity and specificity with 95% confidence intervals (CI) for each dataset. We planned to use hierarchical models for data synthesis and explore potential sources of heterogeneity through meta-regression. MAIN RESULTS: Four cross-sectional diagnostic test accuracy studies providing eight datasets with data from 4997 root surfaces were analysed. Two in vitro studies evaluated secondary root caries lesions on extracted teeth and two in vivo studies evaluated primary root caries lesions within the oral cavity. Four studies evaluated laser fluorescence and reported estimates of sensitivity ranging from 0.50 to 0.81 and specificity ranging from 0.40 to 0.80. Two studies evaluated radiographs and reported estimates of sensitivity ranging from 0.40 to 0.63 and specificity ranging from 0.31 to 0.80. One study evaluated visual examination and reported sensitivity of 0.75 (95% CI 0.48 to 0.93) and specificity of 0.38 (95% CI 0.14 to 0.68). One study evaluated the accuracy of radiograph and visual examination in combination and reported sensitivity of 0.81 (95% CI 0.54 to 0.96) and specificity of 0.54 (95% CI 0.25 to 0.81). Given the small number of studies and important differences in the clinical and methodological characteristics of the studies we were unable to pool the results. Consequently, we were unable to formally evaluate the comparative accuracy of the different tests considered in this review. Using QUADAS-2 we judged all four studies to be at overall high risk of bias, but only two to have applicability concerns (patient selection domain). Reasons included bias in the selection process, use of post hoc (data driven) positivity thresholds, use of an imperfect reference standard, and use of extracted teeth. We downgraded the certainty of the evidence due to study limitations and serious imprecision of the results (downgraded two levels), and judged the certainty of the evidence to be very low. AUTHORS' CONCLUSIONS: Visual-tactile examination is the mainstay of root caries detection and diagnosis; however, due to the paucity of the evidence base and the very low certainty of the evidence we were unable to determine the additional benefit of adjunctive diagnostic tests for the detection and diagnosis of root caries.

Comparison of near infrared spectroscopy (NIRS) and near-infrared transillumination-backscattering sounding (NIR-T/BSS) methods.

The aim of the study was to compare simultaneously recorded a NIR-T/BSS and NIRS signals from healthy volunteers. NIR-T/BSS is a device which give an ability to non-invasively detect and monitor changes in the subarachnoid space width (SAS). Experiments were performed on a group of 30 healthy volunteers (28 males and 2 females, age 30.8 ± 13.4 years, BMI = 24.5 ± 2.3 kg/m2). We analysed recorded signals using analysis methods based on wavelet transform (WT) for the wide frequency range from 0.0095 to 2 Hz. Despite the fact that both devices use a similar radiation source both signals are distinct from each other. We found statistically significant differences for WT amplitude spectra between both signals. Additionally, we showed different relationships of both signals to blood pressure. Collectively, based on the present findings and those of previous studies, we can conclude that the combination of NIR-T/BSS or NIRS signals and time-frequency analysis opens new frontiers in science, and give possibility to understand and diagnosis of various neurodegenerative and ageing related diseases to improve diagnostic procedures and patient prognosis.

Digital diaphanoscopy of the maxillary sinuses: A revival of optical diagnosis for rhinosinusitis.

PURPOSE: The non-invasive diagnosis of acute rhinosinusitis (ARS) remains an unresolved problem of modern otolaryngology. Analog diaphanoscopy of reduced transillumination (shading) could be enhanced by a digital image processing of the maxillary sinuses. By this means, the limited ergonomics of this safe and low-cost method can be overcome, and merits renewed the investigation. Here, we compared the diagnostic sensitivity and specificity of digital diaphanoscopy and computed tomography (CT) in detecting shading in the maxillary sinus. MATERIALS AND METHODS: We examined 103 adults using both digital diaphanoscopy of the maxillary sinus and native-phase cranial CT. We developed a scoring system for investigation of shading in the maxillary sinus using diaphanoscopy and compared the sensitivity and specificity with that of CT. Also, we documented a follow-up of acute rhinosinusitis. RESULTS: In diagnosing shading in the maxillary sinus, digital diaphanoscopy had a sensitivity of 86% and a specificity of 88%. Digital diaphanoscopy can be used not only in the screening of ARS but also for documentation of its course. CONCLUSION: This study supports the role of modern digital diaphanoscopy in the diagnosis of shading in the maxillary sinus, especially in patients with ARS when CT imaging is not recommended. The ergonomics of analog diaphanoscopy could be significantly improved for physicians and patients by the implementation of modern hardware and software components. Further development of the technique and the use of several discrete wavelengths will improve this method's sensitivity and specificity.

Near-infrared transillumination imaging combined with aperture photometry for the quantification of melanin in the iris pigment epithelium.

Near-infrared transillumination is used in the diagnosis and the management of different eye diseases. In particular, it enables the visualization of melanin in the pigment epithelium of the iris. This technique is valuable in such conditions as pigment dispersion syndrome and Adie's tonic pupil. Thus, objective quantification of the amount of melanin shedded from the iris pigment epithelium may help in the management of these conditions. By combining aperture photometry with near-infrared iris transillumination this can be achieved. A total of 4 patients (7 eyes) were examined. Three patients were diagnosed with pigment dispersion syndrome in both eyes. One patient had Adie's tonic pupil in one eye. Near-infrared iris transillumination was performed by using a prototype apparatus. Aperture photometry measurements were carried out through specially developed software. The signal-to-noise ratio of the prototype apparatus was 52 dB (399:1). Each pixel within the near-infrared transillumination image corresponded with an area size of the iris of 85 µm x 83 µm. Measurements were taken from several points of the iris in all patients. The average aperture photometry value of transillumination defects was 1321.53 (ADU) ± 501.08 SD, while the average aperture photometry value of the papillary ruff was 90.83 (ADU) ± 53.4. On average transillumination defects transmit 14.55 times more near-infrared light than the papillary ruff. A prototype apparatus for the capture of near-infrared iris transillumination images and custom software enabling aperture photometry measurements of the obtained images has been developed for the purpose of this study. This study demonstrates a potential application of this technique in the diagnosis and management of patients with such conditions as pigment dispersion syndrome and Adie's tonic pupil.