Efficiency of Near-Infrared Technology in the Clinical Detection of Carious Lesions: A Systematic Review.

The field of dentistry has seen various technological advances regarding caries detection, some lesions still prove to be difficult to detect. A reasonably new detection method, near-infrared (NIR), has shown good results in caries detection. This systematic review aims to compare NIR with conventional methods in terms of caries detection. Online databases (PubMed, Scopus, ScienceDirect, EBSCO, and ProQuest) were used for the literature search. The search was performed from January 2015 till December-2020. A total of 770 articles were selected, of that 17 articles qualified for the final analysis as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The articles were assessed according to a modified Critical Appraisal Skills Programme checklist, and then synthesis of the review started. The inclusion criteria were clinical trials done in vivo on teeth with active caries of vital or nonvital teeth. This review excluded nonpeer reviewed articles, case reports, case series, opinions, abstracts, non-English written articles, studies of subjects with arrested caries, or teeth with developmental defects of tooth structure and teeth having environmental defects of tooth structure, as well as in-vitro studies. The review compared near-infrared technology with radiography, visual inspection, and laser fluorescence in terms of caries detection, sensitivity, specificity, and accuracy. The sensitivity of NIR ranged from 99.1 to 29.1%. Studies showed that NIR exhibited higher sensitivity for occlusal enamel and dentin caries. The specificity of NIR ranged from 94.1 to 20.0%. In enamel and dentinal occlusal caries, NIR demonstrated lower specificity than that of radiograph. The specificity of NIR in early proximal caries was low. Accuracy was determined in 5 out of 17 studies where the values ranged from 97.1 to 29.1%. The accuracy of NIR was the highest for dentinal occlusal caries. NIR shows promising evidence as an adjunct in caries examination due to its high sensitivity and specificity; however, more studies are required to determine its full potential in different situations.

Gait Trajectory Prediction on an Embedded Microcontroller Using Deep Learning.

Achieving a normal gait trajectory for an amputee's active prosthesis is challenging due to its kinematic complexity. Accordingly, lower limb gait trajectory kinematics and gait phase segmentation are essential parameters in controlling an active prosthesis. Recently, the most practiced algorithm in gait trajectory generation is the neural network. Deploying such a complex Artificial Neural Network (ANN) algorithm on an embedded system requires performing the calculations on an external computational device; however, this approach lacks mobility and reliability. In this paper, more simple and reliable ANNs are investigated to be deployed on a single low-cost Microcontroller (MC) and hence provide system mobility. Two neural network configurations were studied: Multi-Layered Perceptron (MLP) and Convolutional Neural Network (CNN); the models were trained on shank and foot IMU data. The data were collected from four subjects and tested on a fifth to predict the trajectory of 200 ms ahead. The prediction was made for two cases: with and without providing the current phase of the gait. Then, the models were deployed on a low-cost microcontroller (ESP32). It was found that with fewer data (excluding the current gait phase), CNN achieved a better correlation coefficient of 0.973 when compared to 0.945 for MLP; when including the current phase, both network configurations achieved better correlation coefficients of nearly 0.98. However, when comparing the execution time required for the prediction on the intended MC, MLP was much faster than CNN, with an execution time of 2.4 ms and 142 ms, respectively. In summary, it was found that when training data are scarce, CNN is more efficient within the acceptable execution time, while MLP achieves relative accuracy with low execution time with enough data.

Decompressive Craniotomy for Malignant Middle Cerebral Artery Infarction: Optimal Timing and Literature Review.

OBJECTIVE: To compare the results of early or delayed decompressive craniotomy for patients with malignant middle cerebral artery infarction. METHODS: A prospective randomized study was carried out of a series of 46 consecutive patients with malignant middle cerebral artery territory infarction. Patients were divided randomly into 2 groups: group I, 27 patients who were followed until obvious deterioration of level of consciousness; group II, 19 patients who were operated on prophylactically in 6 hours of presentation even with no clear deterioration of level of consciousness or radiologic findings. Patients were assessed clinically using the Glasgow Coma Scale, motor power by the United Kingdom Medical Research Council, and functionally by the National Institutes of Health Stroke Scale and modified Rankin Scale. Radiologically, patients had primary magnetic resonance imaging on admission, followed by computed tomography scan. Infarction behavior including volume of infarct area, midline shift, and secondary hemorrhage were calculated. RESULTS: At final follow-up, both groups showed good improvement in level of consciousness, motor power, and functional outcome; however, statistically significant neurologic improvement was shown in group II. Functional outcome also showed statistically significant improvement (P < 0.05) in this ultraearly decompression group (group II). There was a significant difference in mortality in both groups; more than half (52%) of group I died as a result of delay in surgery or its other consequences. Another significant difference was in the progression of infarction volume, which was observed more in group I (statistically insignificant). CONCLUSIONS: Despite the possible complications from surgery, early decompressive craniotomy (within 6 hours of ictus without waiting for neurologic deterioration) has a significant impact on prognosis. Delay in transferring the patient, diagnosing the condition, or taking the decision of surgery significantly affects mortality and overall outcome.

Surgical excision of symptomatic sacral perineurial Tarlov cyst: case series and review of the literature.

OBJECT: Symptomatic sacral perineural cysts are extremely rare. The aim of this retrospective study is to investigate the outcome of 15 consecutive patients treated by microsurgical resection of the cyst and to review the literature. METHODS: The authors retrospectively reviewed their clinical data archive from 2002 to 2014. Fifteen patients who were operated on due to symptomatic sacral perineural cysts were enrolled in the study. Patients' symptoms, radiographs, intra-operative findings, and clinical results were evaluated. All 15 patients underwent microsurgical excision of the cyst. The literature on this topic available in PubMed was also reviewed. RESULTS: There were 5 men and 10 women included in the study, with a mean age of 31 years (range 7-60 years). Preoperative symptoms include low back pain, coccydynia, buttock pain, perianal pain and radicular pain. All of the patients underwent surgical resection. The mean follow-up was 54 months (range 3-160 months). All the patients experienced complete or substantial resolution of the preoperative local and radicular pain after surgery. CONCLUSIONS: Cyst excision is an effective and safe technique for symptomatic sacral perineural (Tarlov) cysts. Careful patient selection is vital to the management and treatment of this difficult and controversial pathology.

Outcome of surgical versus conservative management of cervical spine myelopathy secondary to cervical tuberculosis.

Cervical spine tuberculosis is a rare infectious disease that is not yet discussed well regarding the optimal method of its management. This is a prospective study of a total of 29 patients with cervical spine tuberculosis with a mean follow-up of 14 months (range, 10-21); they were classified randomly into two groups: group I, patients who underwent anterior cervical decompression and fixation and followed by the anti-tuberculous medications (16 patients) and group II, patients who had conservative anti-tuberculous medications only without surgical intervention (13 patients). All patients had complete clinical assessments using Nurick scale and the modified Japanese Orthopaedic Association score for myelopathy and the visual analogue scale for assessment of cervical pain. We had also neuro-radiographic assessment (cervical spine X-ray and MRI) at the first presentation and at 3, 6, and 12 months later. At final follow-up, significant neurological improvement was demonstrated in both management approaches, more obvious in the surgical group. Cervical pain showed a statistically significant improvement (P < 0.05) in surgical group rather than in conservatively treated group. In the surgical group, the mean Cobb angle showed a significant change from a preoperative mean of -3.1 ± 1.6° to postoperative mean of 16.6 ± 5.4°, significantly correlated to the improvement of cervical pain (P = 0.004), while it was changed from a mean of -0.8 ± 2.2 to a mean of 9.2 ± 3.8 1 year after starting of medical treatment in group II. In spite of the conservative trend in the management of Pott's disease, surgical management of cervical spine myelopathy secondary to cervical tuberculosis could be the optimal treatment even in an early stage of the disease.

Effect of cervical dynamics on adjacent segment degeneration after anterior cervical fusion with cages.

The objective of this study is to evaluate the effect of anterior cervical discectomy and fusion (ACDF) on the motion of the cervical spine and dynamic stress (tendency to kyphosis) on adjacent segments and on the overall spinal alignment which may predispose to symptomatic disc diseases at other levels. Twenty consecutive patients underwent ACDF with a mean follow-up of 28 months (range 13-38). Preoperative and postoperative clinical assessments were done by using the neck disability index (NDI) and the Japanese Orthopedic Association (JOA) score. In all cases, at the last follow-up control, a neuro-radiographic assessment [cervical spine static and dynamic X-ray and magnetic resonance imaging (MRI)] was done. The angle of the operated disc space, the disc space angle of contiguous segments, and their range of motion (ROM) and the kyphotic Cobb angle (C2-7) were measured by computer software. The study was done at Sant'Andrea Hospital, Rome, Italy in the period from November 2003 to November 2005. We observed that: the mean Cobb angle improved significantly (p < 0.001) from 3.4 degrees (kyphosis) to postoperative 14.5 degrees. This normalization of angle showed a direct effect on improvement of myelopathic patients, but it had a statistically nonsignificant effect on adjacent segments degeneration (ASD). The mean segmental ROM of adjacent segments did not show significant instability. The mean was 11.1 degrees at upper and 10.2 degrees at lower levels (close to normal). In six cases, the ROM was higher than normal: five of these patients demonstrated symptomatic adjacent segment pathology. Postoperative improvement of mean JOA and NDI scores was statistically significant (p < 0.001). Anyway, symptomatic ASD was observed in five patients (20%): in four of them, the higher disc spaces and in one, the lower disc spaces were involved. In four cases, the preoperative MRI showed slight and asymptomatic disc degeneration at the same levels involved subsequently. This ASD was significantly related to the increased ROM at the segments involved. Follow-up X-rays showed solid fusion with absence of movement in all but one case (at 13-month follow-up), who showed slight movement in the operated level in spite of clinical improvement. The follow-up MRI showed, in all cases, good decompression in the treated levels. Compensatory increase in ROM of the contiguous motion segments in patients subjected to ACDF may lead to ASD especially in those cases with asymptomatic adjacent subclinical degenerative disease. If these preliminary results will be confirmed by larger series, it could be reasonable in young selected patients with soft disc herniation to adopt total disc arthroplasty instead of fusion after cervical micro-discectomy.

Prevention of postoperative pain and of epidural fibrosis after lumbar microdiscectomy: pilot study in a series of forty cases treated with epidural vaseline-sterile-oil-morphine compound.

STUDY DESIGN: At the end of lumbar microdiscectomy, we administered an emulsion of low-dose epidural morphine and vaseline sterile-oil as carrier for morphine delivery. OBJECTIVE: To evaluate safety and analgesic efficacy of this compound and the impact on long-term epidural scar production. SUMMARY OF BACKGROUND DATA: Epidural analgesia has been used with lumbar microdiscectomy for facilitating management of postoperative pain, shortening patients' hospital stay and recovery time, and increasing the satisfaction rate. Several products have been used as barrier against the development of epidural fibrosis after lumbar procedures, to improve long-term outcome. METHODS: Two milligrams of morphine mixed with 2 mL of vaseline sterile-oil have been epidurally administered to 40 consecutive patients undergoing lumbar microdiscectomy, evaluating safety and analgesic effectiveness of the compound and the incidence of epidural fibrosis at clinical and magnetic resonance imaging or computed tomography scan follow-up. Outcome measures included (1) visual analog scale (VAS) to assess the intensity of spontaneous low back and radicular pain, (2) straight-leg-raising maneuver to assess the degrees of leg elevation in relation to evoked-sciatic pain, (3) postoperative time to comfortable ambulation, (4) duration of postoperative hospitalization, (5) required amount of postoperative analgesics, (6) postoperative work time loss, and (7) follow-up lumbar magnetic resonance imaging or segmental computed tomography with contrast medium for quantitative evaluation of postoperative epidural fibrosis. RESULTS: Neither intraoperative nor postoperative clinically relevant adverse events, such as urinary retention, respiratory disturbances, or wound infections, were observed. At hospital discharge, patients showed a low pain intensity score (mean VAS 11.3 mm +/- 0.88; mean straight-leg-raising 64.9 degrees +/- 14.6), with low consumption of analgesics (31.2% in hospital, 35% at home). Mean hospital stay was 1.21 +/- 0.17 days; mean postoperative work time loss was 22.23 +/- 1.97 days. At 1-week and 2-week control, mean pain intensity score was 10.7 +/- 2.3 and 9.3 mm +/- 1.3, respectively. After a mean follow-up of 34.3 months (range, 24-48) 12 patients episodes of transient lumbar and/or sciatic pain. At the last neuroradiological control, according to the 5-grade scale of Ross et al (Neurol Res 1999), epidural fibrosis scored 0 in 8 cases and 1 in 32 cases. CONCLUSION: Epidural application of morphine-vaseline sterile-oil compound after lumbar microdiscectomy proved to be safe and effective, improving postoperative pain control and return to function. At clinical and neuroradiological follow-up epidural fibrosis was acceptable. To confirm the efficacy of the compound, large prospective studies are warranted.

Prognostic relevance of the postoperative evolution of intramedullary spinal cord changes in signal intensity on magnetic resonance imaging after anterior decompression for cervical spondylotic myelopathy.

OBJECT: Areas of intramedullary signal intensity changes (hypointensity on T1-weighted magnetic resonance [MR] images and hyperintensity on T2-weighted MR images) in patients with cervical spondylotic myelopathy (CSM) have been described by several investigators. The role of postoperative evolution of these alterations is still not well known. METHODS: A total of 47 patients underwent MR imaging before and at the end of the surgical procedure (intraoperative MR imaging [iMRI]) for cervical spine decompression and fusion using an anterior approach. Imaging was performed with a 1.5-tesla scanner integrated with the operative room (BrainSuite). Patients were followed clinically and evaluated using the Japanese Orthopaedic Association (JOA) and Nurick scales and also underwent MR imaging 3 and 6 months after surgery. RESULTS: Preoperative MR imaging showed an alteration (from the normal) of the intramedullary signal in 37 (78.7%) of 47 cases. In 23 cases, signal changes were altered on both T1- and T2-weighted images, and in 14 cases only on T2-weighted images. In 12 (52.2%) of the 23 cases, regression of hyperintensity on T2-weighted imaging was observed postoperatively. In 4 (17.4%) of these 23 cases, regression of hyperintensity was observed during the iMRI at the end of surgery. Residual compression on postoperative iMRI was not detected in any patients. A nonsignificant correlation was observed between postoperative expansion of the transverse diameter of the spinal cord at the level of maximal compression and the postoperative JOA score and Nurick grade. A statistically significant correlation was observed between the surgical result and the length of a patient's clinical history. A significant correlation was also observed according to the preoperative presence of intramedullary signal alteration. The best results were found in patients without spinal cord changes of signal, acceptable results were observed in the presence of changes on T2-weighted imaging only, and the worst results were observed in patients with spinal cord signal changes on both Tl- and T2-weighted imaging. Finally, a statistically significant correlation was observed between patients with postoperative spinal cord signal change regression and better outcomes. CONCLUSIONS: Intramedullary spinal cord changes in signal intensity in patients with CSM can be reversible (hyperintensity on T2-weighted imaging) or nonreversible (hypointensity on T1-weighted imaging). The regression of areas of hyperintensity on T2-weighted imaging is associated with a better prognosis, whereas the T1-weighted hypointensity is an expression of irreversible damage and, therefore, the worst prognosis. The preliminary experience with this patient series appears to exclude a relationship between the time of signal intensity recovery and outcome of CSM.