Precisão dos escaneamentos intraorais e modelos 3D, com diferentes escâneres e softwares: revisão sistemática / Accuracy of intraoral scanning and 3D models, with different scanners and software: systematic review

Objetivo: Esta revisão sistemática investigou se a precisão dos escaneamentos intraorais e modelos 3D com diferentes escâneres e softwares, é suficiente para os clínicos aceitarem e implementarem as novas tecnologias como critério de diagnóstico e planejamentos dos tratamentos. Material e métodos: Protocolo PROSPERO número CRD42020218151. Duas revisoras realizaram uma pesquisa avançada de banco de dados eletrônico, sem restrição de idioma ou data, no MEDLINE/PubMed; Embase; BVS/LILACS; Scopus; Cochrane Library; Google Scholar e Web of Science até janeiro de 2021. Os estudos foram escolhidos por título e resumo para triagem, de acordo com os seguintes critérios de inclusão: Estudos Clínicos in vivo e in vitro (pacientes, modelos de gesso de pacientes e manequins simulando bocas humanas) com os diferentes softwares e técnicas de escaneamento intraoral comparando a acurácia, fidelidade e/ou precisão como desfecho dos escaneamentos intraorais, dos modelos virtuais em 3D com modelos de gesso; com um mínimo de 5 pacientes escaneados sem limite de idade ou gênero; texto completo acessível; nos estudos de coorte, transversais e caso-controle. Após a leitura do texto completo os artigos foram excluídos de acordo com os seguintes critérios: 1) estudos com menos de 5 pacientes; 2) estudos em animais; 3) revisão sistemática, descrição de técnica, intervenções, protocolos; 4) escaneamentos por Ressonância Magnética ou Tomografia computadorizada; 5) estudos em que não foram utilizados scanners intraorais. Resultados. Dos 4410 estudos inicialmente identificados, 16 preencheram os critérios de inclusão. O guia PRISMA foi utilizado para redação da revisão e a ferramenta ROBINS-1 da Cochrane foi utilizada para análise de viés. Os estudos incluídos na sua maioria mostraram diferenças estatisticamente significativas entre os resultados das moldagens convencionais e digitais, porém também demonstraram que as diferenças não têm significância clínica. Conclusões: Esta revisão sistemática permitiu levantar dados que demonstraram que os escaneamentos intraorais não são superiores às moldagens convencionais, mas de acurácia equivalente com confiabilidade para o uso das imagens digitais conseguidas por escaneamento intraoral e dos modelos digitais provenientes destes escaneamentos.

Accuracy of tooth-implant impressions: Comparison of five different techniques.

PURPOSE: To compare the accuracy of five different tooth-implant impression techniques. MATERIALS AND METHODS: In this in vitro, experimental study, an acrylic model containing one bone-level Straumann dental implant at the site of maxillary first molar and an adjacent second premolar prepared for a porcelain fused to metal restoration was used. Impressions were made from the model using five different one-step tooth-implant impression techniques including scanning with an intraoral scanner, occlusal matrix, wax relief, closed-tray, and open-tray techniques. Each technique was repeated 15 times. The impressions were poured with dental stone, and the obtained casts were scanned by a laboratory scanner. The scan file of each technique was compared with the scan file of the original acrylic model by Geomagic Design X software. Data were analyzed by one-way analysis of variance, and Tamhane's post-hoc test (α = 0.05). RESULTS: For dental implant, intraoral scanning had the highest accuracy (0.1004 mm2 ) followed by open-tray (0.1914 mm2 ), occlusal matrix (0.2101 mm2 ), closed-tray (0.2422 mm2 ), and wax relief (0.2585 mm2 ) techniques (p < 0.05). For the prepared tooth, wax relief (0.0988 mm2 ) had the highest accuracy followed by occlusal matrix (0.1211 mm2 ), open-tray (0.1663 mm2 ), closed-tray (0.1737 mm2 ), and intraoral scanning (0.4903 mm2 ) technique (p < 0.05). For both dental implant and prepared tooth, occlusal matrix (0.2431 mm2 ) had the highest accuracy followed by open-tray (0.2574 mm2 ), wax relief (0.2693 mm2 ), closed-tray (0.2862 mm2 ), and intraoral scanning (0.3192 mm2 ) technique (p > 0.05). CONCLUSION: The compared simultaneous tooth-implant impression techniques had comparable accuracy with no significant difference.

Pesquisa de novos pontos craniométricos para aumento da precisão em reconstrução facial forense / Ressearch of new craniometric points for more accurate facial reconstruction

A estimativa de aparência da face de uma pessoa, partindo de um crânio seco, é chamada de Reconstrução Facial Forense (RFF). Pode ser realizada de maneira digital ou manual, a partir da marcação de pontos cranianos, que possuem diferentes médias de espessura de tecido mole sobreposto. Nas reconstruções digitais o uso de tomografias computadorizadas de feixe cônico (TCFC), que nos permite obter o volume de pacientes sentados, possibilitou um avanço significativo na mensuração das médias de volume dos tecidos moles faciais. Foi desenvolvido um protocolo para medições de tecidos moles a partir de 32 pontos craniométricos (10 sagitais e 11 bilaterais). Este trabalho propõe a inserção de cinco novos pontos cranianos ao protocolo, com medidas a partir dos pontos Mentual (Ml), Supra Canino (sC), Fronto-zigomático (Fz), Ptério (Pt) e Posterior do Ramo Mandibular (prM), com o intuito de aumentar a acurácia das reconstruções. As TCFC foram manipuladas no software Horus® (LGPL 3.0) e mensuradas conforme protocolo adaptado de Beaini et al. (1), obtidas as espessuras de tecido mole a partir dos pontos craniométricos propostos. Foram estudadas 100 TCFC de brasileiros adultos (maiores de 18 anos) que disponibilizaram seus exames para utilização em pesquisas de maneira anônima e que compõe um banco de dados já estruturado e utilizado em pesquisas anteriores. Esse banco de dados contém exames de 50 indivíduos do sexo feminino e 50 do sexo masculino, separados em grupos por sexo e idade. Estatisticamente, foram aplicados testes de normalidade e a diferença entre cada grupo foi testada para obtenção das espessuras médias referentes a cada ponto craniano. Para o ponto Fz, as médias de espessura de tecidos moles foram de 4.56mm para mulheres e 5.14mm para homens. Para o ponto Ml, as médias de ETMF foram de 12.88mm para mulheres e 14.74mm para homens. No ponto prM, as médias de ETMF foram de 18.30mm para homens e 19.69mm para mulheres. No ponto Pt, as médias de ETMF foram de 11.01mm para mulheres e 13.09mm para homens. No ponto sC, as médias de ETMF foram de 10.99mm para mulheres e 12.71mm para homens. A divisão de ETMFs por sexo é justificada, concordando com parcela significativa da literatura, uma vez que quatro 10 dos cinco pontos estudados apresentaram diferenças estatísticas significativas, com as espessuras de indivíduos do sexo masculino sendo maiores que de indivíduos do sexo feminino.

The accuracy of widal test for typhoid fever diagnosis in Ethiopia: Systematic review and meta-analysis

Introduction: Widal agglutination test is a serologic investigation that is used to diagnose typhoidfever. This is an easy, fairly inexpensive, and readily available test it'ith questionable reliability. The test performance differs from setting to setting depending on the technique used and otherfactors. The accuracy ofthis test in Ethiopia is poorly understood. So, the aim of this scientific work was to analyze the accuracy of Widal agglutination in diagnosing typhoidfever in Ethiopia. Methods: We performed a systematic review and meta-analysis. Two electronic databases (PubMed/Medline and Google scholar) were searched using preset search strategv to find relevant studies. The methodological quality of the studies included was evaluated "'ith a QUADAS-2. We extracted important variables from the eligible articles. Statistical analysis was conducted using STATA version 14. The protocol of our systematic review and metaanalysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the record number CRD42020194252. Results: The electronic quests yielded 42 papers of which 8 "'ere eligible for analysis. The quality of these studies was rated to be moderate based on the QUADAS-2. The pooled sensitivity, specificity, and negative, andpositive predicthe values ofthe Widal test were 80.8%, 53.0%, 98.5%, and 2.1% respecth'ely. Conclusion: The "'idal agglutination test has average specificity, ven good negative predicth'e value, and ven poor positive predictive value for the diagnosis of typhoidfever. Depending on Widal to diagnose typhoid fever may lead to over-diagnosis of typhoid fever and related complications including inappropriate use of antibiotics. There is an urgent needfor quick and dependable tests for diagnosing typhoidfever, particularly in settings like Ethiopia M'here doing timely culture is notfeasible.

Acurácia da detecção do antígeno galactomanana no soro para o diagnóstico precoce de aspergilose pulmonar invasiva: uma revisão rápida / Accuracy of serum galactomannan antigen detection for the early diagnosis of invasive pulmonary aspergillosis: a rapid review

Tecnologia: Detecção do antígeno galactomanana no soro. Contexto: A aspergilose pulmonar invasiva (API) é uma infecção fúngica oportunista de grande risco para pacientes imunocomprometidos. A detecção do antígeno galactomanana no soro por meio de um imunoensaio (ELISA) pode ser um teste não invasivo que auxilie no diagnóstico precoce da doença nestes pacientes. Objetivo: Avaliar a acurácia da detecção do antígeno galactomana no soro para o diagnóstico precoce de aspergilose pulmonar invasiva. Métodos: Revisão rápida sistematizada sobre acurácia de diagnóstico. As bases de dados utilizadas na pesquisa foram: PUBMED, EMBASE, SCOPUS, BVS e Cochrane Library. A avaliação da qualidade metodológica dos estudos incluídos foi realizada por meio da ferramenta AMSTAR-2. Resultados: Foram selecionadas três revisões sistemáticas que atendiam aos critérios de elegibilidade com as quais foi realizada uma análise descritiva dos dados encontrados. A avaliação da qualidade metodológica demonstrou que duas das revisões sistemáticas (RS) apresentaram qualidade criticamente baixa e uma das RS apresentou qualidade alta. Conclusão: A detecção da galactomanana sérica por ELISA pode ser um teste auxiliar no diagnóstico de API, entretanto, possui várias limitações e deve ser utilizado juntamente com outros critérios diagnósticos do consenso do EORTC/MSG. Novas pesquisas devem ser fomentadas para avaliar a utilização do teste no tempo do diagnóstico e no monitoramento da API

Technology: Detection of galactomannan antigen in serum. Background: Invasive pulmonary aspergillosis (IPA) is an opportunistic fungal infection of serious risk for immunocompromised patients. Detection of galactomannan antigen in serum by immunoassay (ELISA) could be a noninvasive test that contributes to the early diagnosis of the disease in this group of patients. Objective: To evaluate the accuracy of serum galactomannan antigen detection for the early diagnosis of invasive pulmonary aspergillosis. Methods: Rapid review of diagnostic accuracy. Databases used in the search were: PUBMED, EMBASE, SCOPUS, BVS, and Cochrane Library. The methodological quality of the included studies was assessed using the AMSTAR-2 tool. Results: Three systematic reviews that satisfied the eligibility criteria were selected, and a descriptive analysis of the data found was performed. The methodological quality assessment showed that two of the systematic reviews (SR) presented critically low quality, and one of the SR presented high quality. Conclusion: Detection of serum galactomannan by ELISA may be a valuable test for diagnosing IPA; however, it has a series of limitations and should be used in conjunction with other diagnostic criteria of the EORTC/MSG consensus. Further research should be encouraged to evaluate the use of this assay, considering the time to diagnosis and IPA monitoring

Estabilidad dimensional de la silicona por adición: polivinilsiloxano un estudio in vitro / Dimensional stability of silicone by addition: polyvinylsiloxane in vitro study

Introducción: Se han realizado con el fin de evaluar la estabilidad dimensional, cada grupo de estudio confecciona su propio aditamento con el fin de determinar si existe o no una variación dimensional de los diferentes materiales de impresión utilizados en la rehabilitación oral. Esta variación va a depender de distintos factores como el tiempo, el material, la temperatura, la humedad entre otros.Objetivo: En este sentido, el objetivo del estudio fue evaluar la estabilidad dimensional de la silicona de adición / polivinilsiloxano (VPS) y para ello se tendrá en cuenta el tiempo.Métodos: Se trata de un estudio experimental. La muestra estuvo conformada por un total de 50 modelos, 25 para VPS Y 25 para el grupo control cuyo material fue la silicona por condensación. Para realizar el estudio se confecciono un modelo maestro teniendo en cuenta 6 localizaciones y 5 periodos de tiempo donde elprimer grupo a los 0 minutos, el segundo grupo a los 20 minutos, el tercer grupo a la 1 hora, cuarto grupo a las 6 horas y el quinto grupo a las 24 horas, después de tomada la impresión.Resultados: Después de la toma de impresión cuando se contabiliza a los 0 minutos, a los 60 minutos, a las 6 horas y a las 24 horas se obtiene el estadístico t ≥ 2,1318 y p≤ 0,05 confirmando que se encuentran diferencias significativas entre las dos siliconas respecto a la variación dimensional.Conclusiones: Se concluye que existe una variación de la estabilidad dimensional al ser comparada con el grupo control como lo es la silicona por condensación. (AU)

Introduction: They have been carried out in order to evaluate dimensional stability, a study group makes its own abutment in order to determine if there is no dimensional variation of the different impression materials used in oral rehabilitation. This variation will depend on different factors such as time, material, temperature, humidity among others.Objective: In this sense, the objective of the study was to evaluate the dimensional stability of the addition silicone / polyvinylsiloxane (VPS) and for this, time will be taken into account.Methods: We went on to an experimental study. The sample consisted of a total of 50 models, 25 for VPS and 25 for the control group whose material was silicone by condensation. To carry out the study, a master model was made taking into account 6 locations and 5 time periods where the first group at 0 minutes, the second group at 20 minutes, the third group at 1 hour, the fourth group at 6 hours and the fifth group at 24 hours, after the impression was taken.Results: After taking the impression when it is counted at 0 minutes, at 60 minutes, at 6 hours and at 24 hours, the statistic t ≥ 2.1318 and p≤ 0.05 is obtained, confirming that there are significant differences between the two silicones with respect to the dimensional variation.Conclusions: It is concluded that there is a variation in dimensional stability when compared with the control group such as silicone by condensation.. (AU)

Avaliação da acurácia dos modelos dentários digitais obtidos para cirurgia ortognática / Assessment of the accuracy of digital dental models obtained for orthognathic surgery

O objetivo deste estudo laboratorial foi avaliar a acurácia dos modelos digitais obtidos por duas técnicas de escaneamento (escâner intraoral - Itero 5d Element® - e escâner de bancada -Straumann ®) de um modelo experimental (Nacional Ossos ®) da arcada superior confeccionada em poliuretano e do modelo de gesso obtido desta arcada. Os pontos A ­ 3mm acima do elemento 17; B ­ 3mm acima do elemento 14; C ­ 3mm acima do elemento 24; D ­ 3mm acima do elemento 27; E ­ cúspide mesiovestibular do elemento 16; F - ponto de contato mais incisal entre os elementos 11 e 21; G - Cúspide mesiovestibular do elemento 26 foram utilizados como referência para as medidas realizadas. As medidas foram realizadas em um software (Geomagic®) de simulação cirúrgica e analisadas quanto a validade e precisão das técnicas de escaneamento utilizadas em todos os grupos (1 a 5). O grupo 1 corresponde ao grupo padrão-ouro; o 2 ao grupo do escaneamento com escâner intraoral do modelo de poliuretano; o 3 ao escaneamento de bancada do modelo; o 4 ao escaneamento com escâner intraoral do modelo de gesso; e 5 ao escaneamento de bancada do modelo de gesso. Na análise da validação, todas as técnicas apresentaram-se válidas quando comparadas ao grupo controle com exceção da medida FG que apresentou diferenças estatisticamente significativas (p<0,05) entre os grupos 1 e 2. A precisão foi avaliada através do índice de correlação intraclasse (CCI) e todas as técnicas apresentaram-se altamente precisas com (CCI) próximo de 1. Desta forma, conclui-se que o escâner intraoral e o escâner de bancada utilizados neste estudo foram confiáveis quando comparados ao grupo controle e que os dois modelos de escâner utilizados se apresentaram com alta precisão (AU).

The objective of this experimental study was to evaluate the accuracy of digital models generated by two scanning techniques (intraoral scanner - Itero 5d Element® - and desktop scanner -Straumann ®) of an experimental model of the upper arch (Nacional Ossos ®) made of polyurethane and the plaster model obtained from this arch. Points A ­ 3mm above element 17; B ­ 3mm above element 14; C ­ 3mm above element 24; D ­ 3mm above element 27; E ­ mesiobuccal cusp of element 16; F - most incisal point of contact between elements 11 and 21; G - Mesiobuccal cusp of element 26 were used as a reference for the measurements performed. The measurements were performed in a surgical simulation software (Geomagic ®) and analyzed for the validity and precision of the scanning techniques used in all groups (1 to 5). Group 1 corresponds to the gold standard group; 2 to the scanning group with intraoral scanner of the polyurethane model; 3 to the desktop scan of the model; 4 to intraoral scanner scanning of the plaster model; and 5 to the desktop scan of the plaster model. In the validation analysis, all techniques showed to be valid compared to the control group, except the FG measure, which showed statistically significant differences (p<0.05) between groups 1 and 2. Precision was assessed using the intraclass correlation(ICC) index, and all techniques were highly accurate with an ICC close to 1. Thus, it is concluded that the intraoral scanner and the bench scanner used in this study were reliable compared to the control group and that the two scanner models used presented themselves with high precision (AU).

Acurácia de implantes imediatos instalados com cirurgia guiada ou convencional na região anterior de acordo com a experiência do cirurgião: estudo in vitro / Accuracy of immediate implants installed with guided or conventional surgery in the previous region according to the surgeon's experience: in vitro study

O objetivo deste estudo foi avaliar acurácia do posicionamento de implantes imediatos instalados na região anterior da maxila por meio de cirurgia guiada ou convencional de acordo com a experiência do cirurgião. Dez cirurgiões inexperientes e 10 cirurgiões experientes instalaram em modelos odontológico, um implante de forma guiada e convencional na região do dente 12 e 22, distribuídos aleatoriamente. A amostra foi composta por 4 grupos: experiente e guiado (EG), experiente e convencional (EC), inexperiente e guiado (IG) e inexperiente e convencional (IC) com 10 casos em cada grupo, totalizando 40 implantes. Foram impressos 20 modelos obtidos a partir do escaneamento de um manequim de treinamento padronizado (MOM). O modelo foi submetido a tomografia por feixe cônico e escaneado para planejamento da posição ideal do implante e obtenção das guias cirúrgicas, utilizando o software coDiagnostiX®. Após a instalação dos implantes foram obtidas novas tomografias dos modelos e a acurácia do posicionamento foi comparada ao planejamento inicial por meio da sobreposição das imagens nos sentidos global, e linear. Os dados obtidos foram tabulados e submetidos à análise estatística. Observamos diferenças estatísticas entre o tipo de cirurgia no grupo experiente no desvio angular e nos desvios lineares: plataforma tridimensional (P-3D), mesio distal (P-MD), vestíbulo palatino (P-VP),apical tridimensional (A-3D), mesio distal (A-MD), vestíbulo palatino (A-VP) e no grupodos cirurgiões inexperientes nos desvios lineares P-3D, P-MD, P-VP, A-3D, A-MD. Ao comparar a acurácia de acordo com a experiência do cirurgião, observamos diferenças significativas apenas na cirurgia convencional para os desvios de P-3D, PAC e A-AC. Concluímos que a acurácia dos implantes instalados de forma guiada foi maior independentemente do grau de experiência do cirurgião. (AU)

The objective of this study was to evaluate the accuracy of the positioning of immediate implants installed in the anterior region of the maxilla through guided or conventional surgery, according to the surgeon's experience. Ten inexperienced surgeons and 10 experienced surgeons installed, in dental models, an implant in a guided and conventional way in the region of tooth 12 and 22, randomly distributed. The sample consisted of 4 groups: experienced and guided (EG), experienced and conventional (EC), inexperienced and guided (IG) and inexperienced and conventional (IC) with 10 cases in each group, totaling 40 implants. Twenty models obtained from the scanning of a standardized training manikin (MOM) were printed. The model was submitted to cone beam tomography and scanned to plan the ideal position of the implant and obtain the surgical guides, using the coDiagnostiX® software. After implant placement, new tomography scans of the models were obtained and the positioning accuracy was compared to the initial planning by superimposing the images in the global and linear directions. The data obtained were tabulated and submitted to statistical analysis. We observed statistical differences between the type of surgery in the group experienced in angular deviation and linear deviations: three-dimensional platform (P-3D), mesiodistal (P-MD), palatal vestibule (P-VP), three-dimensional apical (A-3D), mesiodistal (A-MD), vestibule palatine (A-VP) and in the group of inexperienced surgeons in linear deviations P-3D, P-MD, P-VP, A-3D, A-MD. When comparing the accuracy according to the surgeon's experience, we observed significant differences only in conventional surgery for P-3D, P-AC and A-AC deviations. We concluded that the accuracy of guided implants was higher regardless of the surgeon's experience. (AU)

In Vivo Detection of External Apical Root Resorption Induced by Apical Periodontitis Using Periapical Radiography and Cone-Beam Computed Tomography

Abstract Objective: To compare the accuracy of periapical radiography (PR) and cone-beam computed tomography (CBCT) for the detection of external apical root resorption (EARR) due to root canal contamination. Material and Methods: Dog's teeth with experimentally induced root resorption due to root canal contamination underwent or not root canal treatment (n=62). True positives (TP), false positives (FP), true negatives (TN), and false negatives (FN) in PR and CBCT diagnoses were determined using histopathologic findings as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (TP + TN) in the diagnosis of EARR were calculated. Data were compared using chi-squared test (α=0.05). Results: EARR was detected in 35% of roots by PR, in 47% by CBCT, and in 50% of the roots by microscopy (p=0.03 PR versus microscopy; p=0.67 CBCT versus microscopy). Overall, CBCT produced more accurate diagnoses than PR (p=0.008). PR and CBCT allowed the identification of large resorption in 100% of the cases and showed the same accuracy. However, for small resorptions, PR showed an accuracy of 0.83, whereas CBCT showed an accuracy of 0.96 (p=0.003). Conclusion: Cone-beam computed tomography showed higher accuracy in detecting external apical root resorption of endodontic origin.

A Comparison of Two Widely Used Risk Stratification Systems for Thyroid Nodule Sonographic Evaluation.

BACKGROUND: The 2015 American Thyroid Association (ATA2015) and the American College of Radiology Thyroid Imaging and Reporting Data System (ACR TI-RADS) are two widely used thyroid sonographic systems. OBJECTIVES: To compare the two systems for accuracy of cancer risk prediction. METHODS: Preoperative ultrasound images from 265 patients who underwent thyroidectomy at our hospital from January 2012 to March 2019 were retrospectively categorized by the ACR TI-RADS and ATA2015 systems. Diagnostic performances were compared. RESULTS: Of 238 nodules assessed, 115 were malignant. Malignancy risks for the five ACR TI-RADS categories were 0%, 7.5%, 11.4%, 59.6%, and 90.0%. Malignancy risks for the five ATA2015 categories were 0%, 6.8%, 17.0%, 55.5%, and 92.1%. The proportion of total nodules biopsied was higher with the ATA2015 system than the ACR TI-RADS system: 88.7% vs. 66.3%. Proportions of malignant nodules and benign nodules biopsied were higher with ATA2015 than with ACR TI-RADS: 93.3% vs. 87.8% and 84.4% vs. 46.3%, respectively. Specificity and sensitivity rates were 53.6% and 84.3%, respectively, for ACR TI-RADS, and 15.5% and 93.3%, respectively, for ATA2015. The two systems showed similarly accurate diagnostic performance (AUC > 0.88). False negative rates for ACR TI-RADS and ATA2015 were 15.6% and 6.6%, respectively. Rates of missed aggressive cancer were similar for the two systems: 3.4% and 3.7%, respectively. CONCLUSIONS: ACR TI-RADS was superior to ATA2015 in specificity and avoiding unnecessary biopsies. ATA2015 yielded better sensitivity and a lower false negative rate. Identification of aggressive cancers was identical in the two systems.

Wireless sensor networks for pharmaceutical lyophilization: Quantification of local gas pressure and temperature in primary drying.

Wireless sensor networks have become prolific in a wide range of industrial processes and offer several key advantages over their wired counterparts in terms of positioning flexibility, modularity, interconnectivity, and data routing. We demonstrate their utility in pharmaceutical lyophilization by developing a series of wireless devices to measure spatial variations in gas pressure and temperature during primary drying. The influence of shelf temperature, chamber pressure, excipient concentration, and dryer configuration are explored for various representative cycles using a laboratory-scale pharmaceutical lyophilizer. Pressure and temperature variations across the shelf for these cases are shown to vary up to 1.2 Pa and 10 °C, respectively. Experimental measurements are supported by computational fluid dynamics simulations to reveal the mechanisms driving the vapor flow. The measurements and simulation data are then combined to estimate the shelf-wise sublimation rate in the inverse sense to within a deviation of 3% based on comparison with gravimetric data. We then apply the sublimation rate profile to obtain the vial heat transfer coefficient and product mass transfer resistance for a 5% w/v mannitol formulation. Finally, these parameters are applied to a one-dimensional quasi-steady heat transfer model to predict the evolution of the product temperature over the course of primary drying. Thermocouple measurements of product temperature are compared directly to the simulated data and demonstrate accuracy comparable to existing published one-dimensional models.

Avaliando a redução do tamanho do conglomerado para estimar o volume de madeira em uma floresta amazônica / Assessing reduction of cluster size to estimate wood volume in an Amazonian forest

Enquanto o Inventário Florestal Nacional Brasileiro (IFN) está em andamento, há uma demanda crescente para entender o efeito da área do conglomerado sobre a exatidão e precisão da estimativa de atributos florestais. O objetivo deste estudo foi determinar a área mínima de um conglomerado para estimar o volume comercial (VC) com a mesma acurácia e precisão que as estimativas derivadas do conglomerado original de 8.000 m². A base de dados é proveniente de um inventário realizado em uma unidade florestal (Floresta Nacional do Bom Futuro) no sudoeste da Amazônia brasileira, onde 22 conglomerados foram distribuídos em um desenho amostral em dois estágios. Foram avaliados três produtos: (i) VC de árvores com diâmetro à altura do peito (DAP) ≥ 20 cm (P1); (ii) VC de árvores com DAP ≥ 50 cm (P2); e (iii) VC de espécies comerciais com DAP ≥ 50 cm e qualidade de fuste 'nível 1' ou 'nível 2' (P3). O estudo avaliou dez cenários em que a área do conglomerado foi reduzida de 8.000 a 800 m². A acurácia de P1, P2 e P3 foi significativamente menor para reduções < 2.400 m². A precisão foi mais sensível à variação no tamanho do conglomerado, sobretudo para P2 e P3. Os tamanhos mínimos de conglomerado foram ≥ 2.400 m² para estimar P1, ≥ 4.800 m² para estimar P2 e ≥ 7.200 m² para estimar P3. Concluímos que é possível reduzir a área do conglomerado sem perder acurácia e precisão do conglomerado original do IFN. Um conglomerado de 2.400 m² fornece estimativas com a mesma acurácia que o conglomerado original, independentemente do produto avaliado. (AU)

Diagnóstico de reabsorção radicular: influência da resolução espacial de captura de imagens digitais periapicais / Root resorption diagnostic: influence of periapical digital image scanning

Introdução: a detecção da reabsorção da raiz dentária é realizada por meio de exames de imagens, pois frequentemente não apresenta sinal e sintoma clínicos. Dentre os exames de imagem disponíveis, o exame radiográfico periapical, é indicado para diagnóstico, prognóstico e acompanhamento da reabsorção radicular. Objetivo: o estudo tem como objetivo investigar a relação de diferentes resoluções espaciais com o diagnóstico de reabsorção radicular. Metodologia: foram realizados desgastes simulando reabsorção externa no terço apical e vestibular de 15 (quinze) incisivos inferiores, radiografados em crânio seco, antes e depois do desgaste. A técnica radiográfica foi realizada utilizando o sistema VistaScan (Durr Dental, Bietigheim-Bissingen, Germany), aparelho CS 2200 (Carestream Dental LLC, Atlanta-GA, USA) usando tempo de exposição de 0,15 segundos e escaneadas sob diferentes protocolos de resolução espacial, a saber, 20 pares de linhas por milímetro (pl/mm) e 40 pl/mm. Posteriormente dois avaliadores experientes fizeram análises das referidas imagens sem conhecimento prévio da resolução de escaneamento. Resultados: 75% das radiografias realizadas com 20 pl/mm foram classificadas como excelentes pelos avaliadores, contra 33% com 40 pl/mm, estatisticamente significativa. Discussão: ao avaliar a reabsorção radicular, obteve-se uma acurácia diagnóstica igual para os dois protocolos sem distinção, estatisticamente significativa, entre localização ou profundidade. Conclusão: tendo em vista que para os examinadores imagens com 20 pl/mm foram satisfatórias, com percentual de qualidade maior quando comparado a imagens obtidas com 40 pl/ mm, este estudo indica o emprego de imagens com 20 pl/mm para avaliação inicial de suspeita de reabsorções nas raízes dentárias.

Introduction: the detection of tooth root resorption is carried out by means of imaging tests, as it often does not present a clinical sign and symptom. Among the imaging tests available, the periapical radiographic examination is indicated for diagnosis, prognosis and monitoring of root resorption. Objective: the study aims to investigate the relationship of different spatial resolutions in the diagnosis of root resorption. Methods: Artificial external root resorptions were simulated using burs by drilling to the entire depth in different locations at the apical and buccal thirds of 15 (fifteen) lower incisors were worn, radiographed on a dry skull, before and after wear. The radiographic technique was performed using the VistaScan system (Durr Dental, Bietigheim-Bissingen, Germany), CS 2200 device (Carestream Dental LLC, Atlanta-GA, USA) using an exposure time of 0.15 seconds and scanned under different resolutions protocols, namely, 20 pairs of lines per millimeters (pl/mm) and 40 pl/mm. Subsequently, two experienced evaluators performed analyzes of these images without prior knowledge of the scanning resolution. Results: seventy-five percent of the radiographs taken at 20 pl/mm were rated as excellent by the evaluators, against 33% at 40 pl/mm, a statistically significant difference. Discussion: When assessing root resorption, a similar diagnostic accuracy was obtained for the two protocols without a statistically significant distinction between location or depth. Conclusions: Considering that for examiners images with 20 pl/mm were satisfactory, with a percentage of quality greater than 40 pl/mm, this study indicates the use of 20 pl/mm for initial evaluation of suspected root resorption.

Predicting the Mesiodistal Crown Dimensions of the Permanent First Molars from the Deciduous Second Molars.

BACKGROUND: This study aims to formulate regression equations that predict the mesiodistal crown widths of the permanent first molars utilizing the mesiodistal crown widths of the deciduous second molars. METHODS: Fifty pairs of study models belonging to 50 Iraqi children aged eight to nine years with sound mixed dentition were used to measure the mesiodistal crown widths of the permanent first molars and deciduous second molars using a pointed digital sliding caliper with 0.01 mm sensitivity. Side and gender differences were assessed, and the correlations between these teeth were obtained to develop the regression equations. RESULTS: The results revealed no significant side differences, so the samples were merged and analyzed for gender differences, which were found to be significant in all examined teeth except the mandibular permanent first molar. Direct, moderate, and highly significant correlations between the mesiodistal crown widths of the permanent first molars and deciduous second molars were found, which led to the development of regression equations. After applying these equations, the resultant predicted widths were compared to the actual widths, and the results revealed nonsignificant method differences. CONCLUSIONS: A new method was developed to predict the widths of permanent first molars from the adjacent primary second molars with high precision.

Dimensional measurement accuracy of 3-dimensional models from cone beam computed tomography using different voxel sizes.

OBJECTIVES: To compare the geometric accuracy and measurement reliability of 3-dimensional (3D) reconstructed models of the mandible created from cone beam computed tomography (CBCT) images obtained with 0.2-mm and 0.4-mm voxel sizes with the reference standard model and compare the accuracy of the CBCT-based models to each other. STUDY DESIGN: The reference standard 3D model of a dry human mandible was obtained using a white light scanner. The mandible was scanned with CBCT 10 times at each voxel size. The models created from the CBCT data were compared with the reference standard by using a point-based rigid registration algorithm where the distance differences between the superimposed CBCT models and the reference standard model were recorded. The measurements derived from the 2 CBCT-based scans were also compared. RESULTS: Mean deviations from the reference standard for 0.2-mm and 0.4-mm voxel scans were 0.4342 mm and 0.4580 mm, respectively (P ≥ .16). The CBCT scans with both 0.2-mm and 0.4-mm voxels produced good measurement reliability and did not significantly differ from each other (P ≥ .20). CONCLUSIONS: CBCT scans with 0.2-mm and 0.4-mm voxel sizes delivered similarly accurate models. Larger voxels can be used to minimize radiation exposure.

Home blood pressure monitoring in the diagnosis and treatment of hypertension in pregnancy: a systematic review and meta-analysis.

BACKGROUND: Home blood pressure monitoring is increasingly used for pregnant individuals; however, there are no guidelines on such monitoring in this population. We assessed current practices in the prescription and use of home blood pressure monitoring in pregnancy. METHODS: We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs). We conducted a structured search through the MEDLINE (from 1946), Embase (from 1974) and CENTRAL (from 2018) databases up to Oct. 19, 2020. We included trials comparing office and home blood pressure monitoring in pregnant people. Outcomes included patient education, home blood pressure device, monitoring schedule, adherence, diagnostic thresholds for home blood pressure, and comparison between home and office measurements of blood pressure. RESULTS: We included in our review 21 articles on 19 individual studies (1 RCT, 18 observational) that assessed home and office blood pressure in pregnant individuals (n = 2843). We observed variation in practice patterns in terms of how home monitoring was prescribed. Eight (42%) of the studies used validated home blood pressure devices. Across all studies, measurements were taken 3 to 36 times per week. Third-trimester home blood pressure corresponding to office blood pressure of 140/90 mm Hg after application of a conversion factor ranged from 118 to 143 mm Hg (systolic) and from 76 to 92 mm Hg (diastolic), depending on the patient population and methodology. Systolic and diastolic blood pressure values measured at home were lower than office values by 4 (95% confidence interval [CI] -6 to -3) mm Hg and 3 (95% CI -4 to -2) mm Hg, respectively. INTERPRETATION: Many issues related to home blood pressure monitoring in pregnancy are currently unresolved, including technique, monitoring schedule and target values. Future studies should prioritize the use of validated home measuring devices and standardized measurement schedules and should establish treatment targets. PROSPERO REGISTRATION: CRD42020147352.

Natural Language Processing to Identify Pulmonary Nodules and Extract Nodule Characteristics From Radiology Reports.

BACKGROUND: There is an urgent need for population-based studies on managing patients with pulmonary nodules. RESEARCH QUESTION: Is it possible to identify pulmonary nodules and associated characteristics using an automated method? STUDY DESIGN AND METHODS: We revised and refined an existing natural language processing (NLP) algorithm to identify radiology transcripts with pulmonary nodules and greatly expanded its functionality to identify the characteristics of the largest nodule, when present, including size, lobe, laterality, attenuation, calcification, and edge. We compared NLP results with a reference standard of manual transcript review in a random test sample of 200 radiology transcripts. We applied the final automated method to a larger cohort of patients who underwent chest CT scan in an integrated health care system from 2006 to 2016, and described their demographic and clinical characteristics. RESULTS: In the test sample, the NLP algorithm had very high sensitivity (98.6%; 95% CI, 95.0%-99.8%) and specificity (100%; 95% CI, 93.9%-100%) for identifying pulmonary nodules. For attenuation, edge, and calcification, the NLP algorithm achieved similar accuracies, and it correctly identified the diameter of the largest nodule in 135 of 141 cases (95.7%; 95% CI, 91.0%-98.4%). In the larger cohort, the NLP found 217,771 reports with nodules among 717,304 chest CT reports (30.4%). From 2006 to 2016, the number of reports with nodules increased by 150%, and the mean size of the largest nodule gradually decreased from 11 to 8.9 mm. Radiologists documented the laterality and lobe (90%-95%) more often than the attenuation, calcification, and edge characteristics (11%-14%). INTERPRETATION: The NLP algorithm identified pulmonary nodules and associated characteristics with high accuracy. In our community practice settings, the documentation of nodule characteristics is incomplete. Our results call for better documentation of nodule findings. The NLP algorithm can be used in population-based studies to identify pulmonary nodules, avoiding labor-intensive chart review.

A prospective multicenter validation study for a novel angiography-derived physiological assessment software: Rationale and design of the radiographic imaging validation and evaluation for Angio-iFR (ReVEAL iFR) study.

Angiography-derived physiological assessment of coronary lesions has emerged as an alternative to wire-based assessment aiming at less-invasiveness and shorter procedural time as well as cost effectiveness in physiology-guided decision making. However, current available image-derived physiology software have limitations including the requirement of multiple projections and are time consuming. METHODS/DESIGN: The ReVEAL iFR (Radiographic imaging Validation and EvALuation for Angio-iFR) trial is a multicenter, multicontinental, validation study which aims to validate the diagnostic accuracy of the Angio-iFR medical software device (Philips, San Diego, US) in patients undergoing angiography for Chronic Coronary Syndrome (CCS). The Angio-iFR will enable operators to predict both the iFR and FFR value within a few seconds from a single projection of cine angiography by using a lumped parameter fluid dynamics model. Approximately 440 patients with at least one de-novo 40% to 90% stenosis by visual angiographic assessment will be enrolled in the study. The primary endpoint is the sensitivity and specificity of the iFR and FFR for a given lesion compared to the corresponding invasive measures. The enrollment started in August 2019, and was completed in March 2021. SUMMARY: The Angio-iFR system has the potential of simplifying physiological evaluation of coronary stenosis compared with available systems, providing estimates of both FFR and iFR. The ReVEAL iFR study will investigate the predictive performance of the novel Angio-iFR software in CCS patients. Ultimately, based on its unique characteristics, the Angio-iFR system may contribute to improve adoption of functional coronary assessment and the workflow in the catheter laboratory.