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PubMed2000

An evaluation of active shape models for the automatic identification of cephalometric landmarks.

This paper describes an evaluation of the application of active shape models to cephalometric landmarking. Permissible deformations of a template were established from a training set of hand-annotated images and the resulting model was used to fit to unseen images. An evaluation of this technique in comparison to the accuracy achieved by previous methods is presented. Sixty-three randomly selected cephalograms were tested using a drop-one-out method. On average, 13 per cent of 16 landmarks were within 1 mm, 35 per cent within 2 mm, and 74 per cent within 5 mm. It was concluded that the current implementation does not give sufficient accuracy for completely automated landmarking, but could be used as a time-saving tool to provide a first-estimate location of the landmarks. The method is also of interest because it provides a framework for a range of future improvements.

Adolescent↗
PubMed2003

To beat or not to beat: roles of cilia in development and disease.

Cilia and flagella appeared very early in evolution to provide unicellular organisms with motility in water. Adaptation to non-aquatic life in plants resulted in the almost complete elimination of these organelles, except for gametic transport in some phylogenetic groups. In contrast, cilia and flagella were retained and employed for a wide variety of functions requiring fluid movement in complex multicellular animals. The functions of cilia in diverse processes such as left-right axis pattern formation, cerebrospinal fluid flow, sensory reception, mucociliary clearance and renal physiology indicate that cilia have been adapted as versatile tools for many biological processes. In this review, we discuss recent discoveries that have extended knowledge of the roles of cilia in normal development, and the pathological consequences caused by their dysfunction in mammals. We also consider evolutionary relationships between cilia from lower and higher eukaryotes, outline the ciliary components required for assembly and motility, and review the terminology of axonemal heavy chain dynein genes.

Animals↗
PubMed2003

Pathogenesis of split-hand/split-foot malformation.

Split-hand/split-foot malformation (SHFM), also known as ectrodactyly, is a congenital limb malformation, characterized by a deep median cleft of the hand and/or foot due to the absence of the central rays. SHFM may occur as an isolated entity or as part of a syndrome. Both forms are frequently found in association with chromosomal rearrangements such as deletions or translocations. Detailed studies of a number of mouse models for ectrodactyly have revealed that a failure to maintain median apical ectodermal ridge (AER) signalling is the main pathogenic mechanism. A number of factors complicate the identification of the genetic defects underlying human ectrodactyly: the limited number of families linked to each SHFM locus, the large number of morphogens involved in limb development, the complex interactions between these morphogens, the involvement of modifier genes, and the presumed involvement of multiple genes or long-range regulatory elements in some cases of ectrodactyly. So far, the only mutations known to underlie SHFM in humans have been found in the TP63 gene. The identification of novel human and mouse mutations for ectrodactyly will enhance our understanding of AER functions and the pathogenesis of ectrodactyly.

Abnormalities, Multiple↗
PubMed2003

Does articulating study casts make a difference to treatment planning?

OBJECTIVE: To assess whether articulating casts in centric relation (CR) compared with intercuspal position (ICP) makes a difference to treatment planning. DESIGN: Reliability analysis. SUBJECTS: Ten orthodontists. METHODS: Twenty case vignettes were examined on three occasions: twice with the casts in ICP and once in CR. A series of dichotomous decisions were made relating to the treatment need and treatment mechanics. MAIN OUTCOME MEASURES: The changes in treatment decisions were examined. Intra-examiner agreement between the two hand-held cast assessments (H1 v. H2) and between the first set of hand-held casts compared with the articulated casts (H1 v. A1) were evaluated using the kappa statistic. The differences between the kappa statistics for H1 v. H2 and H1 v. A1 were then tested with the Wilcoxon matched pairs signed rank sum test. RESULTS: The only statistically significant change in the kappa score between H1 v. H2 and H1 v. A1 was for the extraction decision (P= 0.007). No other statistically significant differences were found for the other treatment decisions, although trends were identified for orthognathic surgery and anchorage support decisions. CONCLUSION: Routine articulation of study models for all orthodontic patients is not supported by the results of this study. Articulation of the study models did not affect the treatment planning decisions in a meaningful manner. Further work with selected samples is required to determine if articulation is helpful for specific malocclusions.

Adult↗
PubMed1995

The determination of volume of right ventricular casts using a conductance catheter.

Conductance catheters were used to assess the volume of right ventricular models made from post-mortem casts. Models were made from silastic rubber and filled with saline. The correlation between volume assessed by conductance catheter and real volume was investigated as saline was withdrawn from, and injected into, five models. The mean regression between real and conductance-derived volume was 1.05 (SE 0.04 mean R2 0.94 SE 0.02) with Y-intercept -0.25 ml SE 1.72. Parallel wall conductance was assessed through the tricuspid orifice sealed with human tricuspid tissue, or left open, and found to be negligible. There was no difference between volumes measured by a catheter through either the pulmonary or tricuspid orifice. We conclude that conductance catheters are suitable for the assessment of right ventricular volume, despite the complex geometry.

Adolescent↗
PubMed2001

Biology of oral mucosa and esophagus.

The mucosal lining of the oral cavity and esophagus functions to protect the underlying tissue from mechanical damage and from the entry of microorganisms and toxic materials that may be present in the oropharynx. In different regions, the mucosa shows adaptation to differing mechanical demands: Masticatory mucosa consists of a stratified squamous keratinized epithelium tightly attached to the underlying tissues by a collagenous connective tissue, whereas lining mucosa comprises a nonkeratinized epithelium supported by a more elastic and flexible connective tissue. The epithelium is constantly replaced by cell division in the deeper layers, and turnover is faster in the lining than in the masticatory regions. Chemotherapeutic agents and radiation limit proliferation of the epithelium so that it becomes thin or ulcerated; this will first occur in the lining regions. The principal patterns of epithelial differentiation are represented by keratinization and nonkeratinization. As keratinocytes enter into differentiation, they become larger and begin to flatten and to accumulate cytokeratin filaments. In addition to the keratins, the differentiating keratinocytes synthesize and retain a number of specific proteins, including profilaggrin, involucrin, and other precursors of the thickening of the cell envelope in the most superficial layers. The concept of epithelial homeostasis implies that cell production in the deeper layers will be balanced by loss of cells from the surface. There is a rapid clearance of surface cells, which acts as a protective mechanism by limiting colonization and invasion of microorganisms adherent to the mucosal surface.

Antineoplastic Agents↗
PubMed2001

Relations between tooth enamel dose and organ doses for electron spin resonance dosimetry against external photon exposure.

An analysis of doses to tooth enamel and to organs was carried out to develop a method that can predict the organ doses and the effective dose by electron spin resonance (ESR) dosimetry using tooth samples for external photon exposure. Absorbed dose to tooth enamel and organ doses were obtained by Monte Carlo calculations using the EGS4 code in combination with a mathematical human model with a newly defined teeth part. The calculations gave quantitative relations between tooth enamel dose and organ doses for some cases of external photon exposure. It was also found that tooth enamel dose depends more significantly on energy of incident photons than the other organ dose or the effective dose. The obtained data are to be useful for the assessment of individual dose in past exposure events by the ESR dosimetry using tooth enamel.

Air↗
PubMed2004

Development of numerical phantoms by MRI for RF electromagnetic dosimetry: a female model.

Numerical human models for electromagnetic dosimetry are commonly obtained by segmentation of CT or MRI images and complex permittivity values are ascribed to each issue according to literature values. The aim of this study is to provide an alternative semi-automatic method by which non-segmented images, obtained by a MRI tomographer, can be automatically related to the complex permittivity values through two frequency dependent transfer functions. In this way permittivity and conductivity vary with continuity--even in the same tissue--reflecting the intrinsic realistic spatial dispersion of such parameters. A female human model impinged by a plane wave is tested using finite-difference time-domain algorithm and the results of the total body and layer-averaged specific absorption rate are reported.

Adult↗
PubMed2005

A Simulator for X-ray images.

A simulator for X-ray images is presented based on a virtual X-ray source and a virtual human body obtained from tomographic slices. In the simulator it is possible to modify the tube potential, the anodic current, the exposure time, the filtration and some geometric parameters such as source-skin distance, orientation and field size. The virtual body consists of a three-dimensional voxel matrix in which CT numbers for each point of the body are stored. The interactions of X rays passing through the body are evaluated using the pencil beam technique. The image is obtained by computing the dose absorbed by the detector and converting it into optical density using a proper response function. The image spatial resolution is limited by the voxel size. The influence of each parameter on the image quality can be observed interactively. The dose absorbed in each point of the body is an important parameter obtained as output of the simulator.

Computer Simulation↗
PubMed1981

Positioning the right atrial catheter: a model for reappraisal.

A flexible Silastic casting of the human right atrium was developed to correspond to some in vivo human right atrium hemodynamic characteristics including chamber pressures, pulsatility, fluid output, and flow velocity. Using an infusion pump, air was introduced (10 ml in 30 s) into the superior vena cava of the model and aspirated via a catheter from different positions within the model atrial chamber. The tests were carried out at atrial inclinations of 60 degrees, 80 degrees, and 90 degrees from the horizontal and compared the aspiration efficiency of a single-orificed 16-gauge catheter to a 16-gauge multiorified (5 aperatures) catheter. Optimal air aspiration occurred with the multiorificed catheter tip positioned within the area 2.0 cm below the junction of the superior vena cava (SVC) and the atrial chamber at an inclination of 80 degrees. As much as 80 per cent of the incoming air could be aspirated under these conditions. At its optimal position the single-orificed catheter gave a maximal yield of 45 to 50 per cent aspiration when the tip was positioned 3.0 cm above the SVC and atrial chamber junction. Aspiration of air from mid right atrium (4.5 cm below the SVC-atrial junction) was poor regardless of the type of catheter used or atrial inclination. These data suggest a need for reappraisal of catheter design and placement.

Cardiac Catheterization↗
PubMed2003

Laryngoscopic intubation: learning and performance.

BACKGROUND: Many healthcare professionals are trained in direct laryngoscopic tracheal intubation (LEI), which is a potentially lifesaving procedure. This study attempts to determine the number of successful LEI exposures required during training to assure competent performance, with special emphasis on defining competence itself. METHODS: Analyses were based on a longitudinal study of novices under training conditions in the operating room. The progress of 438 LEIs performed by the 20 nonanesthesia trainees was monitored by observation and videotape analysis. Eighteen additional LEIs were performed by experienced anesthesiologists to define the standard. A generalized linear, mixed-modelling approach was used to identify key aspects of effective training and performance. The number of tracheal intubations that the trainees were required to perform before acquiring expertise in LEI was estimated. RESULTS: Subjects performed between 18 and 35 laryngoscopic intubations. However, statistical modeling indicates that a 90% probability of a "good intubation" required 47 attempts. Proper insertion and lifting of the laryngoscope were crucial to "good" or "competent" performance of LEI. Traditional features, such as proper head and neck positions, were found to be less important under the study conditions. CONCLUSIONS: This study determined that traditional LEI teaching for nonanesthesia personnel using manikin alone is inadequate. A reevaluation of current standards in LEI teaching for nonanesthesia is required.

Adult↗
PubMed2003

Sources of error in noninvasive pulmonary blood flow measurements by partial rebreathing: a computer model study.

BACKGROUND: Partial rebreathing is a noninvasive method for measuring pulmonary blood flow (PBF). This study examines the systematic errors produced by the partial rebreathing technique utilizing a comprehensive mathematical model of the cardiorespiratory system of a healthy, 70-kg adult male. METHODS: The model simulates tidal breathing through a branched respiratory tree and incorporates the effects on carbon dioxide dynamics of lung tissue mass, vascular transport delays, multiple body compartments, and realistic blood-gas dissociation curves. Four studies were performed: (1) errors produced under standard conditions, (2) effects of recirculation, (3) effects of alveolar-proximal airway partial pressure of carbon dioxide (Pco(2)) differences, and (4) effects of rebreathing time. RESULTS: Systematic errors are less than 10% when the simulated PBF is between 3 and 6 l/min. At 2 l/min, PBF is overestimated by approximately 35%. At 14 l/min, PBF is underestimated by approximately 40%. At PBF of greater than 6 l/min, recirculation causes approximately 60% of the systematic error, alveolar-proximal airway differences cause approximately 20%, and alveolar-arterial differences cause approximately 20%. The standard rebreathing time of 50 s is shown to be excessive for PBF of greater than 6 l/min. At PBF of less than 3 l/min, errors are caused by inadequate rebreathing time and alveolar-arterial gradients. CONCLUSIONS: Systematic errors in partial rebreathing cardiac output measurements have multiple causes. Our simulations suggest that errors can be reduced by using a variable rebreathing time, which should be increased at low PBF so that quasi-equilibrium in the alveoli can be achieved and decreased at high PBF to reduce the effects of recirculation.

Adult↗
PubMed1996

Silicone thermoplastic glue in model surgery.

A technique using thermoplastic silicone glue for stabilizing the casts for final positioning during model surgery is presented. This procedure, performed in the laboratory, allows for reassembling the separated cast segments or teeth effectively and efficiently.

Adhesives↗
PubMed2004

New internal Le Fort I distractor for the treatment of midface hypoplasia.

A new Le Fort I internal distraction device was developed by one of the authors (J. G.) and successfully used on a patient with cleft lip and palate and severe maxillary hypoplasia. The device consisted of an upper plate and a lower plate, which were installed above and below the Le Fort I osteotomy. The upper plate was shaped like a "U," and the lower plate was shaped like an inverted "U." The design of the device was unique in that the distraction screws were placed in the maxillary sinus and orientated parallel to the sagittal plane. Presurgical planning used a stereolithographic (STL) model and the CASSOS software to calculate the distraction vector. The distractors were prebent and installed on the STL model and activated to advance the maxilla 15.5 mm. Surgery was performed in a conventional manner, and distraction was started on the seventh day after surgery. At the completion of distraction, a total of 15.5 mm of distraction was achieved. The distractors were removed 3 months after surgery. Results showed that the patient's severe maxillary hypoplasia was corrected as predicted and there was excellent new bone formation between the edges of the osteotomy.

Adolescent↗
PubMed1997

Fast visual evoked potential input into human area V5.

Studies of the human visual cortex have demonstrated that an area for motion processing (V5) is located in the lateral occipito-temporal cortex. To study the timing of arrival of signals in V5 we recorded multi-channel visual evoked potentials (VEPs) to checkerboard stimuli. We then applied dipole source analysis which was computed on a grand average of 10 subjects, and on five individual subjects, respectively. We demonstrate an early VEP component with onset before 30 ms and with a peak around 45 ms, located in the vicinity of V5. This early component was independent of a second activity, which started around 50 ms and peaked around 70 ms, and was located within the striate cortex (V1). These results provide further evidence for a very fast input to V5 before activation of V1.

Adult↗
PubMed1975

A simulation laboratory for medical education.

Simulation as an instructional technique is being utilized for the learning of clinical skills in the training of health professionals. The Center for Educational Development at the University of Illinois College of Medicine has established a Learning Resource and Development Center to assist medical faculty in the development and evaluation of instructional simulations. These are not designed to replace clinical experiences but to provide additional opportunities for students to strengthen skills in patient examination. Prior to the introduction of these learning tools in 1972, a study was undertaken to validate their instructional effectiveness. After an additional two years of operation and experimentation, a revalidation study was undertaken during the fall of 1974. Improvements are continually being made in the various simulation formats as a result of feedback from students and faculty.

Chicago↗