Using Meglumine Diatrizoate to improve the accuracy of diagnosis of cracked teeth on Cone-beam CT images.

AIM: To explore in a laboratory setting the feasibility of using Meglumine Diatrizoate (MD) to improve the accuracy of diagnosis of cracked teeth on cone-beam CT (CBCT) images. METHODOLOGY: Twenty-four teeth were cracked artificially by soaking them cyclically in liquid nitrogen and hot water. The number and position of crack lines were evaluated with a dental operating microscope and used as the gold standard. The artificially cracked teeth were then examined using routine scanning (RS) and enhanced scanning (ES) modes, respectively. For the ES mode, MD was painted on the surface of the crack lines, and then, CBCT scanning with the same parameters was performed after 10 min. A radiological graduate student and an experienced radiologist evaluated the presence or absence of crack lines, respectively. The differences between the RS and ES modes were determined and assessed using McNemar's test. Inter-examiner agreement and intra-examiner agreement were assessed using kappa analysis. RESULTS: Fifty-seven crack lines were found in the 24 cracked teeth. In the RS mode, the accuracy of detection of crack lines was 23% (radiological graduate student) and 32% (experienced radiologist), whereas in the ES mode, the accuracy was 61% (radiological graduate student) and 65% (experienced radiologist). The inter-examiner agreement was 0.693 in RS mode and 0.849 in ES mode. The intra-examiner agreement was 0.872 and 0.949 for the radiological graduate student in RS and ES mode respectively; and one for the experienced radiologist both in RS and ES mode. CONCLUSIONS: Compared with routine scanning mode, more crack lines could be detected in enhanced scanning mode using Meglumine Diatrizoate as a contrast medium. MD could be a potential contrast medium to improve the accuracy of detection of crack lines on CBCT images.

[CYP2C19 genetic polymorphism and monitoring voriconazole plasma concentrations in the treatment and prevention of invasive fungal disease for hematological patients].

Objective: To evaluate the effects of CYP2C19 genetic polymorphism on the plasma concentration of voriconazole in patients with hematological disease and the value of serial monitoring plasma concentrations in the treatment and prevention of invasive fungal disease (IFD). Methods: From January 2016 to December 2016, 65 hematological patients who received voriconazole intravenous administration for the treatment of invasive fungal disease were enrolled in this study. The population CYP2C19 polymorphism of voriconazole were performed using PCR-Pyrosequencing. The trough plasma concentrations of vriconazole (Ctrough) was detected by ultra performance liquid chromatography tandem mass spectrometry. Results: Based on the genotype analysis, 65 subjects were identified as extensive metabolizers' group (30 cases) and poor metabolizers' group (35 cases). The Ctrough of the 65 patients were detected for 169 times totally, and there was a significant difference of Ctrough values between the two groups [0.98(0.38-2.08) mg/L vs 2.19(1.53-4.27) mg/L, z=10.286, P<0.001]. The medium of Ctrough in 65 hematological patients were described. Lack of response to therapy was more frequent in patients with voriconazole levels <1.5 mg/L (50.0%) than in those with voriconazole levels >1.5 mg/L (20.5%) (P=0.052). And the risk of adverse events was more frequent in patients with voriconazole levels >5.5 mg/L (80.0%) than in those with voriconazole levels ≤5.5 mg/L (8.3%) (χ2=11.689, P=0.020). Conclusion: Patients with CYP2C19 wild-type phenotype are extensive metabolizers, their Ctrough of voriconazole are significantly lower than patients with CYP2C19 non-wild-type phenotype (poor metabolizers). Appropriate concentrations of vriconazole can improve the efficacy and safety during treatment.

Differentiation of pleomorphic adenoma and Warthin's tumour of the salivary gland: is long-to-short diameter ratio a useful parameter?

AIM: To determine the utility of the long-to-short diameter ratio (L/S ratio) and other sonographic features in the differentiation of pleomorphic adenoma (PA) and Warthin's tumour (WT) of the salivary gland. MATERIAL AND METHODS: From 2003 to 2013, 100 patients with 100 PAs and WTs were included in this ethics committee-approved retrospective study. For each lesion, B-mode sonographic and colour Doppler images were obtained and the L/S ratios were calculated. Surgical excision and histopathological examination were accomplished in all cases. Differences between the L/S ratio and other sonographic features for PA and WT were evaluated. RESULTS: Of the 100 salivary tumours, 80 were located in the parotid (37 PAs and 43 WTs), and 20 were in the submandibular gland (19 PAs and one WT). In the parotid, the L/S ratio was 1.38±0.21 for PA and 1.73±0.46 for WT. The L/S ratio of the WTs was higher than that of the PAs (p<0.001). Applying a cut-off of 1.519, the sensitivity, specificity, and accuracy for differentiation of PA and WT in the parotid were 69.8%, 81.1%, and 75%, respectively; however, the accuracy dropped to 42.9% in diagnosing masses with ≥50% macroscopic cystic structures. When those masses were excluded, the accuracy rose to 78.1%. CONCLUSIONS: The L/S ratio when used with other ultrasound features aids differentiation between PA and WT in the parotid gland; however, masses with macroscopic cystic structures ≥50% should not be judged by this parameter.

Age-related changes in P2 receptor mRNA of rat cerebral arteries.

Aging alters the vascular response to extracellular nucleotides. However, the molecular mechanisms that underlie the effect of aging remain unclear. We investigated the mRNA expression of P2X(1), P2Y(1), P2Y(2) subtypes of the nucleotide receptors (P2) in the basilar artery, aorta and carotid artery from male Sprague-Dawley rats, 2-months and 19-months old. In the basilar arteries of 19-month old rats, as compared to the 2-month old rats, the P2X(1) receptor transcripts were reduced and the P2Y(1) and P2Y(2) receptor mRNA was increased. In the aorta and carotid arteries, P2Y(1) receptor mRNA was decreased in the 19-month old rats when compared to the 2-month old rats. There were no marked changes of P2X(1) and P2Y(2) receptor mRNA between the two age groups in the aorta or carotid artery. In endothelial cells, P2Y(1) and P2Y(2) receptor mRNA was reduced with age. We concluded that, down-regulation of P2X(1) and up-regulation of P2Y(1), P2Y(2) receptor mRNA in smooth muscle cells and down-regulation of P2Y(1) and P2Y(2) receptor mRNA on vascular endothelial cells might underlie the changes of cerebral vascular tone in aging.