Development and validation of artificial neural networks model for detection of Barrett's neoplasia: a multicenter pragmatic nonrandomized trial (with video).

BACKGROUND AND AIMS: The aim of this study was to develop and externally validate a computer-aided detection (CAD) system for the detection and localization of Barrett's neoplasia and assess its performance compared with that of general endoscopists in a statistically powered multicenter study by using real-time video sequences. METHODS: In phase 1, the hybrid visual geometry group 16-SegNet model was trained by the use of 75,198 images and videos (96 patients) of neoplastic and 1,014,973 images and videos (65 patients) of nonneoplastic Barrett's esophagus. In phase 2, image-based validation was performed on a separate dataset of 107 images (20 patients) of neoplastic and 364 images (14 patients) of nonneoplastic Barrett's esophagus. In phase 3 (video-based external validation) we designed a real-time video-based study with 32 videos (32 patients) of neoplastic and 43 videos (43 patients) of nonneoplastic Barrett's esophagus from 4 European centers to compare the performance of the CAD model with that of 6 nonexpert endoscopists. The primary endpoint was the sensitivity of CAD diagnosis of Barrett's neoplasia. RESULTS: In phase 2, CAD detected Barrett's neoplasia with sensitivity, specificity, and accuracy of 95.3%, 94.5%, and 94.7%, respectively. In phase 3, the CAD system detected Barrett's neoplasia with sensitivity, specificity, negative predictive value, and accuracy of 93.8%, 90.7%, 95.1%, and 92.0%, respectively, compared with the endoscopists' performance of 63.5%, 77.9%, 74.2%, and 71.8%, respectively (P < .05 in all parameters). The CAD system localized neoplastic lesions with accuracy, mean precision, and mean intersection over union of 100%, 0.62, and 0.54, respectively, when compared with at least 1 of the expert markings. The processing speed of the CAD detection and localization were 5 ms/image and 33 ms/image, respectively. CONCLUSION: To our knowledge, this is the first study describing external (multicenter) validation of AI algorithms for the detection of Barrett's neoplasia on real-time endoscopic videos. The CAD system in this study significantly outperformed nonexpert endoscopists on real-time video-based assessment, achieving >90% sensitivity for neoplasia detection. This result needs to be validated during real-time endoscopic assessment.

Early Stage Forest Fire Detection from Himawari-8 AHI Images Using a Modified MOD14 Algorithm Combined with Machine Learning.

The early detection and rapid extinguishing of forest fires are effective in reducing their spread. Based on the MODIS Thermal Anomaly (MOD14) algorithm, we propose an early stage fire detection method from low-spatial-resolution but high-temporal-resolution images, observed by the Advanced Himawari Imager (AHI) onboard the geostationary meteorological satellite Himawari-8. In order to not miss early stage forest fire pixels with low temperature, we omit the potential fire pixel detection from the MOD14 algorithm and parameterize four contextual conditions included in the MOD14 algorithm as features. The proposed method detects fire pixels from forest areas using a random forest classifier taking these contextual parameters, nine AHI band values, solar zenith angle, and five meteorological values as inputs. To evaluate the proposed method, we trained the random forest classifier using an early stage forest fire data set generated by a time-reversal approach with MOD14 products and time-series AHI images in Australia. The results demonstrate that the proposed method with all parameters can detect fire pixels with about 90% precision and recall, and that the contribution of contextual parameters is particularly significant in the random forest classifier. The proposed method is applicable to other geostationary and polar-orbiting satellite sensors, and it is expected to be used as an effective method for forest fire detection.

Switching from entecavir to tenofovir disoproxil fumarate for HBeAg-positive chronic hepatitis B patients: a phase 4, prospective study.

BACKGROUND: Tenofovir disoproxil fumarate (TDF) is widely used and recommended as first-line treatment for patients infected with the hepatitis B virus (HBV). However, current data are limited regarding the efficacy and safety of switching to TDF for the treatment of chronic hepatitis B in hepatitis B e-antigen (HBeAg)-positive patients who are virologically suppressed with another nucleos(t)ide analogue. The primary objective of this study was to evaluate the hepatitis B surface antigen (HBsAg) reduction potential of switching from entecavir (ETV) to TDF at week 48 in HBeAg-positive chronic hepatitis B patients with undetectable serum HBV-DNA. METHODS: In this multicenter, single-arm, open-label, phase 4 clinical study, 75 participants currently treated with ETV 0.5 mg once daily were switched to TDF 300 mg once daily for 96 weeks. RESULTS: At week 48, 3/74 participants (4%) achieved 0.25 log10 reduction of HBsAg levels from baseline (the primary endpoint). Mean HBsAg reduction was -0.14 log10 IU/mL and 12% (9/74) achieved 0.25 log10 reduction by 96 weeks. No participants achieved HBsAg seroclearance. HBsAg reduction at weeks 48 and 96 was numerically greater in participants with higher alanine aminotransferase levels (≥ 60 U/L). Seventeen participants (25%) achieved HBeAg seroclearance up to week 96. No participants experienced viral breakthrough. All drug-related adverse events (18 participants [24%]) were mild in intensity, including an increase in urine beta-2-microglobulin (15 participants [20%]). CONCLUSIONS: In conclusion, HBsAg reduction was limited after switching from ETV to TDF in this study population. Further investigation is warranted to better understand the clinical impact of switching from ETV to TDF. ClinicalTrials.gov: NCT03258710 registered August 21, 2017. https://clinicaltrials.gov/ct2/show/NCT03258710?term=NCT03258710&draw=2&rank=1.

Characteristics of Grouped Discharge Waveforms Observed in Long-term Masseter Muscle Electromyographic Recording: A Preliminary Study.

We investigated the characteristics of grouped discharge (GD) waveforms obtained from long-term masseter electromyogram (EMG) recording in 6 female temporomandibular disorder (TMD) patients with myofascial pain and 6 healthy females. The EMG measurement was performed from the morning of the experiment day until the subject woke up the next day. We observed a significantly larger number of GD waveforms in the TMD group compared to the control group (p=0.002). Our results indicate that the existence of GD waveforms in masseter EMGs might be a predictor of future TMD with myofascial pain.

Effect of food properties and chewing condition on the electromyographic activity of the posterior tongue.

BACKGROUND: Retraction of the posterior tongue facilitates bolus formation, food transfer and Stage II transport in chewing and swallowing. Surface electromyography of the neck region (N-EMG) enabled the evaluation of muscle function at the posterior tongue. Although previous studies showed that food hardness increased masticatory muscles EMG activity and volitional chewing altered swallowing, the effect of food properties and chewing condition on N-EMG activity has not yet been elucidated. OBJECTIVE: To investigate the effect of food properties and chewing conditions on N-EMG. METHODS: Twelve healthy adults (six men and six women, mean age 28.1 ± 2.7) participated in this study. Three test foods were used: a cookie (solid food), crushed cookies adjusted using agar and water (semisolid food) and crushed cookies adjusted using thickening agent and water (soft food). Masseter and submental muscle EMG and N-EMG activity were recorded while chewing the three test foods. Participants were instructed to masticate the three test foods in three chewing conditions: (a) chewing freely, (b) chewing test foods with the same number of chewing cycles as when chewing solid food and (c) chewing with a maximum effort. RESULTS: Total N-EMG activity when chewing solid food was higher than that in the other two test foods regardless of the chewing condition. In soft food and semisolid food, the total N-EMG activity was increased by increasing the number of chewing cycles. CONCLUSION: The total N-EMG activity was increased while chewing hard food, which indicates the positive effect of chewing hard food on rehabilitation at the posterior tongue.

Quantitative chiral analysis of amino acids in solution using enantiomer-selective photodissociation of cold gas-phase tryptophan via chiral recognition.

To explore the origin of biomolecule homochirality in interstellar molecular clouds, enantiomer-selective photodissociation via chiral recognition between amino acids in the gas phase was examined using a tandem mass spectrometer containing an electrospray ionization source and a cold ion trap. Ultraviolet photodissociation mass spectra of cold gas-phase noncovalent complexes of sodiated l-tryptophan ion, Na+(l-Trp), with an amino acid such as serine (Ser), threonine (Thr), or alanine (Ala) were obtained by the photo-excitation of l-Trp in the noncovalent complexes. Dissociation of l-Trp via CO2 loss occurred when it was noncovalently complexed with d-Ser or d-Thr in the presence of Na+. For the l-enantiomers, the energy absorbed by l-Trp was released through evaporation of l-Ser or l-Thr, and dissociation of the amino acids was suppressed. In contrast, the enantiomer-selective phenomenon was not observed in the noncovalent complex with Ala, suggesting that a side-chain OH group plays an important role in chiral recognition and enantiomer-selective photodissociation. The enantiomer-selective photodissociation was applied to the quantitative chiral analysis of amino acids. The enantiomeric excess of Ser and Thr in solution could be determined by measuring the relative abundance ratio of the enantiomer-selective photodissociation of Trp to amino acid evaporation in a single photodissociation mass spectrum obtained by photo-excitation of l-Trp used as a chiral probe in cold gas-phase noncovalent complexes with the analyte amino acids, and by referring to the linear relationships established in this work.

Enantiomeric Excess Determination for Monosaccharides Using Chiral Transmission to Cold Gas-Phase Tryptophan in Ultraviolet Photodissociation.

Chiral transmission between monosaccharides and amino acids via photodissociation in the gas phase was examined using a tandem mass spectrometer fitted with an electrospray ionization source and a cold ion trap in order to investigate the origin of the homochirality of biomolecules in molecular clouds. Ultraviolet photodissociation mass spectra of cold gas-phase noncovalent complexes of the monosaccharide enantiomers glucose (Glc) and galactose (Gal) with protonated L-tryptophan H+(L-Trp) were obtained by photoexcitation of the indole ring of L-Trp. L-Trp dissociated via Cα-Cß bond cleavage when noncovalently complexed with D-Glc; however, no dissociation of L-Trp occurred in the homochiral H+(L-Trp)(L-Glc) noncovalent complex, where the energy absorbed by L-Trp was released through the evaporation of L-Glc. This enantioselective photodissociation of Trp was due to the transmission of chirality from Glc to Trp via photodissociation in the gas-phase noncovalent complexes, and was applied to the quantitative chiral analysis of monosaccharides. The enantiomeric excess of monosaccharides in solution could be determined by measuring the relative abundance of the two product ions in a single photodissociation mass spectrum of the cold gas-phase noncovalent complex with H+(L-Trp), and by referring to the linear relationships derived in this work. Graphical Abstract ᅟ.

Various Effects of Sandblasting of Dental Restorative Materials.

BACKGROUND: Sandblasting particles which remain on the surfaces of dental restorations are removed prior to cementation. It is probable that adhesive strength between luting material and sandblasting particle remnants might exceed that with restorative material. If that being the case, blasting particles adhere to sandblasted material surface could be instrumental to increasing adhesive strength like underlying bonding mechanism between luting material and silanized particles of tribochemical silica coating-treated surface. We hypothesize that ultrasonic cleaning of bonding surfaces, which were pretreated with sandblasting, may affect adhesive strength of a resin luting material to dental restorative materials. METHODS: We therefore observed adhesive strength of resin luting material to aluminum oxide was greater than those to zirconia ceramic and cobalt-chromium alloy beforehand. To measure the shear bond strengths of resin luting material to zirconia ceramic and cobalt-chromium alloy, forty specimens of each restorative material were prepared. Bonding surfaces were polished with silicon abrasive paper and then treated with sandblasting. For each restorative material, 40 sandblasted specimens were equally divided into two groups: ultrasonic cleaning (USC) group and non-ultrasonic cleaning (NUSC) group. After resin luting material was polymerized on bonding surface, shear test was performed to evaluate effect of ultrasonic cleaning of bonding surfaces pretreated with sandblasting on bond strength. RESULTS: For both zirconia ceramic and cobalt-chromium alloy, NUSC group showed significantly higher shear bond strength than USC group. CONCLUSIONS: Ultrasonic cleaning of dental restorations after sandblasting should be avoided to retain improved bonding between these materials.

Enantioselective photolysis and quantitative chiral analysis of tryptophan complexed with alkali-metalized L-serine in the gas phase.

The enantioselective photolysis of a cold gas-phase noncovalent complex of tryptophan with alkali-metalized L-serine, M(+) (L-Ser)(Trp) (M = Na and Li), was examined using a tandem mass spectrometer containing a variable-temperature ion trap. CO2 loss from Trp in the clusters was enantiomerically selective in ultraviolet excitation with linearly polarized light. M(+) (L-Ser) promoted the enantioselective photolysis of Trp as a chiral auxiliary. The enantioselective photolysis of the D-enantiomer was applied to a quantitative chiral analysis, in which the optical purity of tryptophan could be determined by measuring the relative abundance ratio R of the enantioselective CO2 loss to the chiral-independent evaporation of L-Ser in a single photodissociation mass spectrum of M(+) (L-Ser)(Trp).

Enantiomer-selective photolysis of cold gas-phase tryptophan in L-serine clusters with linearly polarized light.

Photostability of cold gas-phase tryptophan (Trp) enantiomers in L-serine (L-Ser) clusters at 8 K as a model for interstellar molecular clouds was examined using a tandem mass spectrometer containing a cold ion trap to investigate the hypothesis that homochirality in gas-phase Ser clusters promotes the enantiomeric enrichment of other amino acids via enantiomer-selective photolysis with linearly polarized light. In the UV excitation of heterochiral H(+) (L-Ser) 3(D-Trp), the CO2-eliminated product in the cluster was observed. In contrast, the photodissociation mass spectrum of homochiral H(+)(L-Ser)3(L-Trp) showed that photolysis of amino acids in the cluster did not occur due to the evaporation of L-Ser molecules. In the spectra of the homochiral H(+)(L-Ser) (L-Trp) and heterochiral H(+)(L-Ser) (D-Trp), the evaporation of L-Ser was the primary reaction pathway, and no difference between the L- and D-enantiomers was observed. The findings confirm that when 3 L-Ser units are present in the cluster, the photolytic decomposition of Trp is enantiomerically selective.

A new posture measurement method for measuring intrinsic standing posture.

AIMS: Although body posture in relation to the dental condition has been of great interest in the dental profession, rumination bias has been a substantial obstacle to achieving a reliable objective evaluation of the intrinsic body posture. The aim of this study was to establish a posture control protocol that would minimize the effect of bias. METHODOLOGY: Fifteen healthy male volunteers (23-33 years of age) participated in this study. The posture movement was recorded for 10 seconds by a three-dimensional motion capture system. The experiment was performed on four different days. RESULTS: The posture was most stable at 4-5 seconds after the start of the front bulb gaze (the mean coefficient of variation ranged from 0.1 to 44.1). The intraclass correlation coefficients for four days were 0.871-0.975 (P < or = 0.001). CONCLUSIONS: It was concluded that the use of this measurement method helped in producing a reliable intrinsic standing posture where unbiased evaluation of the effect of any intervention on the body posture is researched.

Differential involvement of two cortical masticatory areas in submandibular salivary secretion in rats.

To evaluate the role of the masticatory area in the cerebral cortex in the masticatory-salivary reflex, we investigated submandibular salivary secretion, jaw-movement trajectory and electromyographic activity of the jaw-opener (digastric) and jaw-closer (masseter) muscles evoked by repetitive electrical stimulation of the cortical masticatory area in anesthetized rats. Rats have two cortical masticatory areas: the anterior area (A-area) in the orofacial motor cortex, and the posterior area (P-area) in the insular cortex. Our defined P-area extended more caudally than the previous reported one. P-area stimulation induced vigorous salivary secretion (about 20 µl/min) and rhythmical jaw movements (3-4 Hz) resembling masticatory movements. Salivary flow persisted even after minimizing jaw movements by curarization. A-area stimulation induced small and fast rhythmical jaw movements (6-8 Hz) resembling licking of solutions, but not salivary secretion. These findings suggest that P-area controls salivary secretion as well as mastication, and may be involved in the masticatory-salivary reflex.

Study on a practical robotic follower to support home oxygen therapy patients--questionnaire-based concept evaluation by the patients-.

Home oxygen therapy (HOT) is a medical treatment for the patients suffering from severe lung diseases. Although walking outdoors is recommended for the patients to maintain physical strength, the patients always have to carry a portable oxygen supplier which is not sufficiently light weight for this purpose. Our ultimate goal is to develop a mobile robot to carry an oxygen tank and follow a patient in an urban outdoor environment. We have proposed a mobile robot with a tether interface to detect the relative position of the foregoing patient. In this paper, we report the questionnaire-based evaluation about the two developed prototypes by the HOT patients. We conduct maneuvering experiments, and then obtained questionnaire-based evaluations from the 20 patients. The results show that the basic following performance is sufficient and the pulling force of the tether is sufficiently small for the patients. Moreover, the patients prefer the small-sized prototype for compactness and light weight to the middle-sized prototype which can carry larger payload. We also obtained detailed requests to improve the robots. Finally the results show the general concept of the robot is favorably received by the patients.

Dependence of psychophysical threshold on rate of applied force to the upper first molar in humans.

OBJECTIVE: The study aims to investigate the dynamic perception of a force applied to the upper first molar for different rates of force increase. DESIGN: Six volunteers (four male and two female; mean age, 27.2±2.4 years) with full natural dentition (except for the third molars) participated in this study. The psychophysical threshold for a force applied to the right maxillary first molar and the reaction time corresponding to each threshold were measured for rate of force increase of 103.74, 236.23, 354.58, 478.22 and 584.63 mNs(-1). The physical impulse, which is the integral of force over time, was calculated for each threshold. RESULTS: Psychophysical thresholds in the upper first molar increased with the rate of force increase. The reaction time corresponding to each threshold decreased with increasing force rate. Impulses corresponding to each threshold were independent of force rate. CONCLUSIONS: In the present study, the psychophysical threshold for a force applied to a molar tooth was shown to change depending on the rate of increase of the exerted force. From the viewpoint of the impulse, the dissipated energy necessary to reach the psychophysical sensation threshold was almost constant, regardless of the rate of force increase.

Effect of transient occlusal loading on the threshold of tooth tactile sensation perception for tapping like the impulsive stimulation.

The objectives of this study were (1) to establish a reliable method for detecting the force threshold of the tooth tactile sensation while avoiding experimenter bias and (2) to examine the effect of occlusal force loading on the threshold for impulsive force stimulation in subjects with normal dentition. Twenty volunteers participated in this study (10 males and 10 females; mean age, 26.6 ± 2.9 years). To simulate the bite force during occlusal tapping, a force-loading device was designed to exert impulsive force to the occlusal surface in the direction parallel to the tooth axis. The impulsive force detection threshold of the periodontal sensation was measured before and after loading 98 N of occlusal force on the left upper first molar for 1 min. Transient mechanical loading of the upper first molar caused an increase in the absolute threshold for impulsive force. This increase did not vanish immediately, and the increment of the threshold was maintained during the remainder of the experiment. A computer-controlled method for the evaluation of tooth tactile sensation using impulsive stimulation was established. Transient occlusal force loading parallel to the tooth axis increases the threshold of periodontal sensation for mechanical impulsive stimulation.