A New Simplified Autogenous Sinus Lift Technique.

Oral maxillofacial rehabilitation of the atrophic maxilla with or without pneumatization of the maxillary sinuses routinely presents limited bone availability. This indicates the need for vertical and horizontal bone augmentation. The standard and most used technique is maxillary sinus augmentation using distinct techniques. These techniques may or may not rupture the sinus membrane. Rupture of the sinus membrane increases the risk of acute or chronic contamination of the graft, implant, and maxillary sinus. The surgical procedure for maxillary sinus autograft involves two stages: removal of the autograft and preparation of the bone site for the graft. A third stage is often added to place the osseointegrated implants. This is because it was not possible to do this at the same time as the graft surgery. A new bioactive kinetic screw (BKS) bone implant model is presented that simplifies and effectively performs autogenous grafting, sinus augmentation, and implant fixation in a single step. In the absence of a minimum vertical bone height of 4 mm in the region to be implanted, an additional surgical procedure is performed to harvest bone from the retro-molar trigone region of the mandible to provide additional bone. The feasibility and simplicity of the proposed technique were demonstrated in experimental studies in synthetic maxillary bone and sinus. A digital torque meter was used to measure MIT and MRT during implant insertion and removal. The amount of bone graft was determined by weighing the bone material collected by the new BKS implant. The technique proposed here demonstrated the benefits and limitations of the new BKS implant for maxillary sinus augmentation and installation of dental implants simultaneously.

Artificial Intelligence and Capsule Endoscopy: Automatic Detection of Small Bowel Blood Content Using a Convolutional Neural Network.

Introduction: Capsule endoscopy has revolutionized the management of patients with obscure gastrointestinal bleeding. Nevertheless, reading capsule endoscopy images is time-consuming and prone to overlooking significant lesions, thus limiting its diagnostic yield. We aimed to create a deep learning algorithm for automatic detection of blood and hematic residues in the enteric lumen in capsule endoscopy exams. Methods: A convolutional neural network was developed based on a total pool of 22,095 capsule endoscopy images (13,510 images containing luminal blood and 8,585 of normal mucosa or other findings). A training dataset comprising 80% of the total pool of images was defined. The performance of the network was compared to a consensus classification provided by 2 specialists in capsule endoscopy. Subsequently, we evaluated the performance of the network using an independent validation dataset (20% of total image pool), calculating its sensitivity, specificity, accuracy, and precision. Results: Our convolutional neural network detected blood and hematic residues in the small bowel lumen with an accuracy and precision of 98.5 and 98.7%, respectively. The sensitivity and specificity were 98.6 and 98.9%, respectively. The analysis of the testing dataset was completed in 24 s (approximately 184 frames/s). Discussion/Conclusion: We have developed an artificial intelligence tool capable of effectively detecting luminal blood. The development of these tools may enhance the diagnostic accuracy of capsule endoscopy when evaluating patients presenting with obscure small bowel bleeding.

Introdução: A endoscopia por cápsula revolucionou a abordagem a doentes com hemorragia digestiva obscura. No entanto, a leitura de imagens de endoscopia por cápsula é morosa, havendo suscetibilidade para a perda de lesões significativas, limitando desta forma a sua eficácia diagnóstica. Este estudo visou a criação de um algoritmo de deep learning para deteção automática de sangue e resíduos hemáticos no lúmen entérico usando imagens de endoscopia por cápsula. Métodos: Foi desenvolvida uma rede neural convolucional com base num conjunto de 22,095 imagens de endoscopia de cápsula (13,510 imagens contendo sangue e 8,585 mucosa normal ou outros achados). Foi construído um grupo de imagens para treino, compreendendo 80% do total de imagens. O desempenho da rede foi comparado com a classificação consenso de dois especialistas em endoscopia por cápsula. Posteriormente, o desempenho da rede foi avaliado usando os restantes 20% de imagens. Foi calculada a sua sensibilidade, especificidade, exatidão e precisão. Resultados: O algoritmo detetou sangue e resíduos hemáticos no lúmen do intestino delgado com uma exatidão e precisão de 98.5% e 98.7%, respetivamente. A sensibilidade e especificidade foram 98.6% e 98.9%, respetivamente. A análise do conjunto de usado para teste da rede foi concluída em 24 segundos (aproximadamente 184 frames/s). Discussão/Conclusão: Foi desenvolvida uma ferramenta de inteligência artificial capaz de detetar efetivamente o sangue luminal. O desenvolvimento dessas ferramentas pode aumentar a precisão do diagnóstico da endoscopia por cápsula ao avaliar pacientes que apresentam sangramento obscuro do intestino delgado.

Automatic detection of tumor vessels in indeterminate biliary strictures in digital single-operator cholangioscopy.

Background and study aims Indeterminate biliary strictures pose a significative clinical challenge. Dilated, irregular, and tortuous vessels, often described as tumor vessels, are frequently reported in biliary strictures with high malignancy potential during digital single-operator cholangioscopy (D-SOC). In recent years, the development of artificial intelligence (AI) algorithms for application to endoscopic practice has been intensely studied. We aimed to develop an AI algorithm for automatic detection of tumor vessels (TVs) in D-SOC images. Patients and methods A convolutional neural network (CNN) was developed. A total of 6475 images from 85 patients who underwent D-SOC (Spyglass, Boston Scientific, Marlborough, Massachusetts, United States) were included. Each frame was evaluated for the presence of TVs. The performance of the CNN was measured by calculating the area under the curve (AUC), sensitivity, specificity, positive and negative predictive values. Results The sensitivity, specificity, positive predictive value, and negative predictive value were 99.3 %, 99.4 %, 99.6% and 98.7 %, respectively. The AUC was 1.00. Conclusions Our CNN was able to detect TVs with high accuracy. Development of AI algorithms may enhance the detection of macroscopic characteristics associated with high probability of biliary malignancy, thus optimizing the diagnostic workup of patients with indeterminate biliary strictures.

Deep learning and colon capsule endoscopy: automatic detection of blood and colonic mucosal lesions using a convolutional neural network.

Background and study aims Colon capsule endoscopy (CCE) is a minimally invasive alternative to conventional colonoscopy. However, CCE produces long videos, making its analysis time-consuming and prone to errors. Convolutional neural networks (CNN) are artificial intelligence (AI) algorithms with high performance levels in image analysis. We aimed to develop a deep learning model for automatic identification and differentiation of significant colonic mucosal lesions and blood in CCE images. Patients and methods A retrospective multicenter study including 124 CCE examinations was conducted for development of a CNN model, using a database of CCE images including anonymized images of patients with normal colon mucosa, several mucosal lesions (erosions, ulcers, vascular lesions and protruding lesions) and luminal blood. For CNN development, 9005 images (3,075 normal mucosa, 3,115 blood and 2,815 mucosal lesions) were ultimately extracted. Two image datasets were created and used for CNN training and validation. Results The mean (standard deviation) sensitivity and specificity of the CNN were 96.3 % (3.9 %) and 98.2 % (1.8 %) Mucosal lesions were detected with a sensitivity of 92.0 % and a specificity of 98.5 %. Blood was detected with a sensitivity and specificity of 97.2 % and 99.9 %, respectively. The algorithm was 99.2 % sensitive and 99.6 % specific in distinguishing blood from mucosal lesions. The CNN processed 65 frames per second. Conclusions This is the first CNN-based algorithm to accurately detect and distinguish colonic mucosal lesions and luminal blood in CCE images. AI may improve diagnostic and time efficiency of CCE exams, thus facilitating CCE adoption to routine clinical practice.

Automated detection of ulcers and erosions in capsule endoscopy images using a convolutional neural network.

Capsule endoscopy (CE) is an important tool in the management of patients with known or suspected inflammatory bowel disease. Ulcers and erosions of the enteric mucosa are prevalent findings in these patients. They frequently occur together, and their identification in CE is crucial for an accurate evaluation of disease severity. Nevertheless, reviewing CE images is a time-consuming task, and the risk of overlooking lesions is significant.Over the last decade, artificial intelligence (AI) has emerged as a means for overcoming these pitfalls. Of all AI methods, convolutional neural networks (CNN), due to their complex multilayer architecture present the best results in medical image analysis, particularly capsule endoscopy. Therefore, we aimed to develop a CNN for the automatic identification of ulcers and erosions in the small bowel mucosa. A total of 1483 CE exams (PillCam SB3®) performed at a single center between 2015 and 2020 were analysed. From these exams, a total of 6130 frames of the enteric mucosa were obtained, 4233 containing enteric ulcers and erosions, and the remaining containing normal mucosa or other findings. Ulcers and erosions were stratified according to Saurin's classification for bleeding potential: P1E-erosions with intermediate bleeding risk; P1U-ulcers with intermediate bleeding risk; P2U-ulcers with high bleeding risk. For automatic identification of these lesions, these images were inserted into a CNN model with transfer learning. The pool of images was divided for constitution of training and validation datasets, comprising 80% and 20% of the total number of images, respectively. The output provided by the CNN was compared to the classification provided by a consensus of specialists. After optimizing the neural architecture of the algorithm, our model was able to automatically detect and distinguish ulcers and erosions (any bleeding potential) in the small intestine mucosa with an accuracy of 95.6%, sensitivity of 90.8%, and a specificity of 97.1%. We believe that our study lays the foundation for the development and application of effective AI tools to CE. These techniques should improve diagnostic accuracy and reading efficiency. Schematic representation of the workflow and summary of the results.

Artificial intelligence for automatic diagnosis of biliary stricture malignancy status in single-operator cholangioscopy: a pilot study.

BACKGROUND AND AIMS: The diagnosis and characterization of biliary strictures (BSs) is challenging. The introduction of digital single-operator cholangioscopy (DSOC) that allows direct visual inspection of the lesion and targeted biopsy sampling significantly improved the diagnostic yield in patients with indeterminate BSs. However, the diagnostic efficiency of DSOC remains suboptimal. Convolutional neural networks (CNNs) have shown great potential for the interpretation of medical images. We aimed to develop a CNN-based system for automatic detection of malignant BSs in DSOC images. METHODS: We developed, trained, and validated a CNN-based on DSOC images. Each frame was labeled as a normal/benign finding or as a malignant lesion if histopathologic evidence of biliary malignancy was available. The entire dataset was split for 5-fold cross-validation. In addition, the image dataset was split for constitution of training and validation datasets. The performance of the CNN was measured by calculating the area under the receiving operating characteristic curve (AUC), sensitivity, specificity, and positive and negative predictive values. RESULTS: A total of 11,855 images from 85 patients were included (9695 malignant strictures and 2160 benign findings). The model had an overall accuracy of 94.9%, sensitivity of 94.7%, specificity of 92.1%, and AUC of .988 in cross-validation analysis. The image processing speed of the CNN was 7 ms per frame. CONCLUSIONS: The developed deep learning algorithm accurately detected and differentiated malignant strictures from benign biliary conditions. The introduction of artificial intelligence algorithms to DSOC systems may significantly increase its diagnostic yield for malignant strictures.

Automatic Identification of Papillary Projections in Indeterminate Biliary Strictures Using Digital Single-Operator Cholangioscopy.

INTRODUCTION: Characterization of biliary strictures is challenging. Papillary projections (PP) are often reported in biliary strictures with high malignancy potential during digital single-operator cholangioscopy. In recent years, the development of artificial intelligence (AI) algorithms for application to endoscopic practice has been intensely studied. We aimed to develop an AI algorithm for automatic detection of PP in digital single-operator cholangioscopy images. METHODS: A convolutional neural network (CNN) was developed. Each frame was evaluated for the presence of PP. The CNN's performance was measured by the area under the curve, sensitivity, specificity, and positive and negative predictive values. RESULTS: A total of 3,920 images from 85 patients were included. Our model had a sensitivity and specificity 99.7% and 97.1%, respectively. The area under the curve was 1.00. DISCUSSION: Our CNN was able to detect PP with high accuracy. Future development of AI tools may optimize the macroscopic characterization of biliary strictures.

Artificial intelligence and colon capsule endoscopy: automatic detection of blood in colon capsule endoscopy using a convolutional neural network.

Colon capsule endoscopy (CCE) is a minimally invasive alternative to conventional colonoscopy. Most studies on CCE focus on colorectal neoplasia detection. The development of automated tools may address some of the limitations of this diagnostic tool and widen its indications for different clinical settings. We developed an artificial intelligence model based on a convolutional neural network (CNN) for the automatic detection of blood content in CCE images. Training and validation datasets were constructed for the development and testing of the CNN. The CNN detected blood with a sensitivity, specificity, and positive and negative predictive values of 99.8 %, 93.2 %, 93.8 %, and 99.8 %, respectively. The area under the receiver operating characteristic curve for blood detection was 1.00. We developed a deep learning algorithm capable of accurately detecting blood or hematic residues within the lumen of the colon based on colon CCE images.

An alternative 3D numerical method to study the biomechanical behaviour of the human inner ear semicircular canal.

PURPOSE: The vestibular system is the part of the inner ear responsible for balance. Vertigo and dizziness are generally caused by vestibular disorders and are very common symptoms in people over 60 years old. One of the most efficient treatments at the moment is vestibular rehabilitation, permitting to improve the symptoms. However, this rehabilitation therapy is a highly empirical process, which needs to be enhanced and better understood. METHODS: This work studies the vestibular system using an alternative computational approach. Thus, part of the vestibular system is simulated with a three dimensional numerical model. Then, for the first time using a combination of two discretization techniques (the finite element method and the smoothed particle hydrodynamics method), it is possible to simulate the transient behavior of the fluid inside one of the canals of the vestibular system. RESULTS: The obtained numerical results are presented and compared with the available literature. The fluid/solid interaction in the model occurs as expected with the methods applied. The results obtained with the semicircular canal model, with the same boundary conditions, are similar to the solutions obtained by other authors. CONCLUSIONS: The numerical technique presented here represents a step forward in the biomechanical study of the vestibular system, which in the future will allow the existing rehabilitation techniques to be improved.