scholarly journals Lateral cephalometric diagnosis of asymmetry in Angle Class II subdivision compared to Class I and II

2014 ◽  
Vol 19 (4) ◽  
pp. 80-88 ◽  
Author(s):  
Aparecida Fernanda Meloti ◽  
Renata de Cássia Gonçalves ◽  
Ertty Silva ◽  
Lídia Parsekian Martins ◽  
Ary dos Santos-Pinto
Keyword(s):  
Class Ii ◽  
Diagnostic Methods ◽  
Class I ◽  
Linear Measurements ◽  
Morphological Alterations ◽  
Mandibular Asymmetry ◽  
Study Results ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

INTRODUCTION: Lateral cephalometric radiographs are traditionally required for orthodontic treatment, yet rarely used to assess asymmetries. OBJECTIVE: The objective of the present study was to use lateral cephalometric radiographs to identify existing skeletal and dentoalveolar morphological alterations in Class II subdivision and to compare them with the existing morphology in Class I and II relationship. MATERIAL AND METHODS: Ninety initial lateral cephalometric radiographs of male and female Brazilian children aged between 12 to 15 years old were randomly and proportionally divided into three groups: Group 1 (Class I), Group 2 (Class II) and Group 3 (Class II subdivision). Analysis of lateral cephalometric radiographs included angular measurements, horizontal linear measurements and two indexes of asymmetry that were prepared for this study. RESULTS: In accordance with an Index of Dental Asymmetry (IDA), greater mandibular dental asymmetry was identified in Group 3. An Index of Mandibular Asymmetry (IMA) revealed less skeletal and dental mandibular asymmetry in Group 2, greater skeletal mandibular asymmetry in Group 1, and greater mandibular dental asymmetry in Group 3. CONCLUSION: Both IDA and IMA revealed greater mandibular dental asymmetry for Group 3 in comparison to Groups 1 and 2. These results are in accordance with those found by other diagnostic methods, showing that lateral cephalometric radiography is an acceptable method to identify existing skeletal and dentoalveolar morphological alterations in malocclusions.

scholarly journals Maxillary anterior alignment stability in Class I and Class II malocclusions treated with or without extraction

2015 ◽  
Vol 86 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Willian Juarez Granucci Guirro ◽  
Karina Maria Salvatore Freitas ◽  
Guilherme Janson ◽  
Marcos Roberto de Freitas ◽  
Camila Leite Quaglio
Keyword(s):  
Class Ii ◽  
Class I ◽  
Maxillary Incisor ◽  
Class Ii Malocclusion ◽  
Group 4 ◽  
Posttreatment Period ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

ABSTRACT Objective:  To compare the postretention stability of maxillary incisors alignment in subjects with Class I and II malocclusion treated with or without extractions. Materials and Methods:  The sample comprised 103 subjects with initial maxillary anterior irregularity greater than 3 mm and was divided into four groups: group 1 comprised 19 patients with Class I malocclusion treated with nonextraction (mean initial age = 13.06 years); group 2 comprised 19 patients with Class II malocclusion treated with nonextraction (mean initial age = 12.54 years); group 3 comprised 30 patients with Class I malocclusion treated with extractions (mean initial age = 13.16 years); group 4 comprised 35 patients with Class II malocclusion treated with extractions (mean initial age = 12.99 years). Dental casts were obtained at three different stages: pretreatment (T1), posttreatment (T2), and long-term posttreatment (T3). Maxillary incisor irregularity and arch dimensions were evaluated. Intergroup comparisons were performed by one-way analysis of variance followed by Tukey tests. Results:  In the long-term posttreatment period, relapse of maxillary crowding and arch dimensions was similar in all groups. Conclusion:  Changes in maxillary anterior alignment in Class I and Class II malocclusions treated with nonextractions and with extractions were similar in the long-term posttreatment period.

scholarly journals Evaluation of Gingival Microleakage in Class II Composite Restorations with Different Lining Techniques: An In Vitro Study

Scientifica ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Vedavathi Bore Gowda ◽  
B. V. Sreenivasa Murthy ◽  
Swaroop Hegde ◽  
Swapna Devarasanahalli Venkataramanaswamy ◽  
Veena Suresh Pai ◽  
...  
Keyword(s):  
Study Groups ◽  
Class Ii ◽  
Composite Liner ◽  
Flowable Composite ◽  
Composite Restorations ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aim. To compare the microleakage in class II composite restorations without a liner/with resin modified glass ionomer and flowable composite liner.Method. Forty standardized MO cavities were prepared on human permanent mandibular molars extracted for periodontal reasons and then divided into 4 groups of ten specimens. The cavity preparations were etched, rinsed, blot dried, and light cured and Adper Single Bond 2 is applied. Group 1 is restored with Filtek P60 packable composite in 2 mm oblique increments. Group 2 is precure group where 1 mm Filtek Z350 flowable liner is applied and light cured for 20 sec. Group 3 is the same as Group 2, but the liner was cocured with packable composite. In Group 4, 1 mm RMGIC, Fuji Lining LC is applied and cured for 20 sec. All the teeth were restored as in Group 1. The specimens were coated with nail varnish leaving 1 mm around the restoration, subjected to thermocycling, basic fuchsin dye penetration, sectioned mesiodistally, and observed under a stereomicroscope.Results. The mean leakage scores of the individual study groups were Group 1 (33.40), Group 2 (7.85), Group 3 (16.40), and Group 4 (24.35). Group 1 without a liner showed maximum leakage. Flowable composite liner precured was the best.

scholarly journals FE-SEM Evaluation of Dental Specimens Prepared by Different Methods forIn VitroContamination

2012 ◽  
Vol 2012 ◽  
pp. 1-5
Author(s):  
Vitor Cesar Nakamura ◽  
Simony Hidee Hamoy Kataoka ◽  
Giulio Gavini ◽  
Patrícia Helena Ferrari ◽  
Silvana Cai
Keyword(s):  
Control Group ◽  
Buffer Solution ◽  
Morphological Alterations ◽  
Ultrasonic Bath ◽  
Group 4 ◽  
Cement Removal ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

Objective. To evaluate through FE-SEM the cleanliness and dentinal alterations promoted by different methods of dental sample preparation.Methods. Twenty-five human single-rooted teeth were used. The teeth were cleaned and autoclaved in wet medium and randomly divided into 5 groups (), according to the preparation methods employed—control group: no solutions applied; group 1: cement removal and irrigation with 5.25% % EDTA for 4 minutes each; group 2: 17%  % NaOCl (4 minutes ultrasonic bath); group 3: cement removal and 17%     buffer solution + distilled water (10 minutes ultrasonic); group 4: 17%   NaOCl (3 minutes ultrasonic bath). Specimens were analyzed by field emission scanning electron microscope (FE-SEM), at 1500x magnification. Data were submitted to qualitative analysis according to a scoring system and submitted to Kruskal-Wallis test.Results. In ascending order, as to bind parameters, (i) cleanliness: control, group 2, group 3, group 5, and group 4, (ii) dentinal alterations: group 1, group 5, group 2, group 3, and group 4.Conclusion. The proposed protocol was suitable for subsequent microbiological contamination, because it showed less dentinal morphological alterations with increased removal of organic waste.

scholarly journals Analysis of the bactericidal effect of ozone pneumoperitoneum

2009 ◽  
Vol 24 (2) ◽  
pp. 124-127 ◽  
Author(s):  
Rodrigo Altenfelder Silva ◽  
José Eduardo Rosseto Garotti ◽  
Renata Santos Bittencourt Silva ◽  
Alessandra Navarini ◽  
Adhemar Monteiro Pacheco Jr
Keyword(s):  
Wistar Rats ◽  
Bactericidal Effect ◽  
Bactericidal Action ◽  
Co2 Pneumoperitoneum ◽  
E Coli ◽  
Carbon Dioxide Gas ◽  
Study Results ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

PURPOSE: To assess the bactericidal action of ozone pneumoperitonium, and to compare the results with CO2. METHODS: It was used 36 Wistar rats. The animals, under anesthesia, were inoculated with 2ml of E. coli ATCC at a concentration of 10(10)UFC, and 1ml of BaSO4, into the peritoneal cavity. They were divided into three groups: Group 1, CO2 pneumoperitoneum was performed for 15 minutes; Group 2, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 42µg/ml, and Group 3, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 62µg/ml. Six animals from each group were sacrificed after the experiment, and the remaining 6 observed for 24 hours. Material was collected from the cavity of all animals for microbiological study. RESULTS: Ozone presented a greater bactericidal effect than CO2 in those animals sacrificed immediately after pneumoperitoneum. In the animals studied 24 hours after pneumoperitoneum evidenced no difference in bactericidal effect between the two gases. Moreover, no difference in mortality was observed. CONCLUSION: Ozone has a more potent bactericidal effect than carbon dioxide gas, although this did not influence survival of the animals.

scholarly journals Effects of orthodontic treatment after adenoidectomy on jaw relations in the sagittal plane

2005 ◽  
Vol 62 (4) ◽  
pp. 287-292 ◽  
Author(s):  
Jasmina Milic
Keyword(s):  
Orthodontic Treatment ◽  
Treatment Effects ◽  
Sagittal Plane ◽  
Class Ii ◽  
Open Bite ◽  
Class I ◽  
Group 2 ◽  
One Year ◽  
Group 1

Aim. To evaluate the orthodontic treatment effects, performed immediately after adenoidectomy, on lips relation, overjet and class (Angle). Methods. Three groups of patients, aged 6?17 years, were observed: group K - patients with oral respiration caused by adenoidal enlargement; group 1 - patients with adenoidectomy performed five and more years previously; group 2 - patients with one year of orthodontic treatment performed immediately after adenoidectomy. Lips and overjet status and class (Angle) was measured in the examined patients. Results. In all of the three examined groups, there was a statistically highly significant increase (p<0.01) of competent lips. In the patients of group K, the overjet values ranged from 1 mm up to 12 mm where 90% of them had overjet > 4 mm and 6% < 1 mm. The front open bite, low overbite and reversed overjet was found in the patients with low overjet in this group, as well. Overjet values in the patients of group 1 ranged from -2 mm up to 12 mm where 86% had overjet > 4 mm and 10% < 1 mm. Significantly higher increase (p<0.01) of overjet values (1?4 mm in 94% of patients) was observed in the patients of group 2 in comparison to the values found in the patients from groups 0 and 1. Class II (Angle) was recorded in 81% of the patients in group 0, and 79% in group 1, while class I (Angle) was observed 100% only in the patients of group 2. Conclusion. Orthodontic treatment immediately after adenoidectomy was necessary for achieving the competition lips relation, normal overjet and class I (Angle).

scholarly journals A TEN-YEAR ANALYSIS OF CHANGES IN THE SENSITIVITY OF THE LEADING UROPATHOGEN TO ANTIBACTERIAL AGENTS IN CHILDREN WITH URINARY TRACT INFECTION IN THE NEPHROLOGY DEPARTMENT

2020 ◽  
Vol 73 (7) ◽  
pp. 1360-1364
Author(s):  
Tetiana V. Budnik ◽  
Tetiana B. Bevzenko
Keyword(s):  
Relative Risk ◽  
High Sensitivity ◽  
Study Groups ◽  
E Coli ◽  
The Past ◽  
Study Results ◽  
Sensitivity Level ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The aim: To study the prevalence of ABR among children with UTI over the past 10 years, with an assessment of the sensitivity of E. Coli to common antibiotics in dynamics. Materials and methods: The study involved 1,044 children with UTI aged from 1 month to 18 years. Examination of patients and interpretation of the results was performed in accordance with the provisions of the Declaration of Helsinki of Human Rights. According to the design, the study included 3 comparison groups: Group 1 — children of the 2009 follow-up year (n = 337), Group 2 — of 2014 (n = 328) and Group 3 — of 2019 (n = 379). Results: Escherichia coli is recognized as the leading uropathogen in all study groups: its percentage in Group 1 was 47 % (158/337), in Group 2 — 64 % (210/328) and in Group 3 — 66.5 % (252/379). The prevalence of antibacterial resistance of E. coli strains and the high dynamics of its growth are shown. So the level of resistance of E. Coli in 2019 was 70 ± 4.06 % (176/252). This was 11 % more compared to 2014 and 18.8 % more compared to 2009. The percentage of multiresistant strains tended to increase and amounted to 28 ± 9.97 % (70/252) among patients with UTI and 40 ± 9.12 % (70/176) in the structure of resistance in 2019. The relative risk of ABR increased by 1.6 times in 2019 compared to 2014 (RR2019 = 2.208 ± 0.207 [1.473;3.310], р < 0.05 vs RR2014 = 1.375 ± 0.209 [0.913;2.063]) and by 3 times compared to 2009 (RR2009 = 0.727 ± 0.209 [0.483;1.095]). Ampicillin and amoxicillin showed an equally low sensitivity level (3.5 ± 32.14 % (9/252)). Only every second child confirmed sensitivity to cefuroxime (53.6 ± 5.76 (135/252)). Ceftazidime and ciprofloxacin showed a relatively high sensitivity level — 77.4 ± 3.34 (195/252) and 83 ± 2.81 (209/252), and at the same time the rapidly growing resistance rates — almost twice as high over the past 5 years. Furazidin K showed a high sensitivity level of 85.7 ± 2.53% (216/252), the lowest level of overall resistance of 14.3 ± 15.15 % (36/252) and a slow rate of its formation. An unfavourable prognosis of an increase in the relative risk of ABR by 2.9-3.7 times in the next 5–10 years was determined among patients with UTI, provided that the existing diagnostic and treatment approaches are maintained. Conclusions: The study results are important for understanding the clinical decision on the benefits of antibacterial therapy and optimizing its empirical choice for a patient with UTI.

scholarly journals HISTOLOGICAL STRUCTURE OF PROXIMAL METAPHYSEAL CARTILAGE OF HUMERUS IN RATS AFTER 60-DAY TARTRAZINE ADMINISTRATION

2020 ◽  
pp. 150-157
Author(s):  
V.I. Luzin ◽  
O.N. Fastova ◽  
V.N. Morozov ◽  
E.N. Morozova ◽  
S.V. Zabolotnaya
Keyword(s):  
Body Weight ◽  
Male Rats ◽  
Control Group ◽  
Histological Structure ◽  
Total Width ◽  
Adult Rats ◽  
Study Results ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The aim of the research is to study the histological structure of proximal metaphysial cartilage of the humerus in adult rats after 60 days of tartrazine administration (750 mg/kg and 1500 mg/kg body weight). Materials and Methods. The study was carried out on 90 white male rats, divided into 3 groups. In Group 1 (control), animals daily intragastrically received 1ml of 0.9 % isotonic sodium chloride solution for 60 days. Rats of Groups 2 and Group 3 received intragastrically 1ml of tartrazine solution (750 mg/kg and 1500 mg/kg body weight respectively) for 60 days. The readaptation period after the last tartrazine administration was 3, 10, 15, 24, or 45 days. The area of the proximal humerus metaphysis underwent treatment according to the standard histological protocol. The obtained sections were stained with hematoxylin-eosin and subjected to a subsequent histomorphometric study. Results. On the 3rd day of the readaptation period, the total width of the proximal metaphysial cartilage of the humerus in animals of Group 2, was by 8.59 % less than the values of the control group; the width of the indifferent, proliferating and definitive cartilage was by 6.11 %, 8.85 % and 7.15 % less; the width of the destruction zone was by 11.55 % less; and the width of the osteogenesis zone was by 9.92 % less. The content of primary spongiosis in the osteogenesis zone and the number of cells on the trabeculae surface were lower than the values of Group 1 by 8.45 % and 8.42 % respectively. During the readaptation period, the authors observed similar dynamics of changes in the histomorphometric parameters of the metaphysical cartilage of the humerus with levelling by the 45th day of the experiment. In rats of Group 3, during the entire readaptation period, the histomorphometric parameters changed more significantly and their recovery to control values was slower than in animals of Group 2. Conclusion. 60-day tartrazine administration to adult rats is accompanied by inhibition of the bone formation function of the proximal metaphysial cartilage of the humerus. It is confirmed by a decrease in the width of all its zones and components of the osteogenesis zone. More pronounced in amplitude and duration changes in the parameters studied were recorded in animals treated with tartrazine, 1500 mg/kg body weight. Keywords: humerus, metaphysial cartilage, tartrazine, histomorphometry. Цель исследования. Установить, оказывает ли влияние 60-дневное введение тартразина в дозах 750 и 1500 мг/кг массы тела на гистологическое строение проксимального метафизарного хряща плечевой кости у половозрелых крыс. Материалы и методы. Исследование проведено на 90 белых крысах-самцах, распределенных на 3 группы: 1-я – контрольная, в которой животные ежедневно в течение 60 дней получали физиологический раствор через желудочный зонд; 2-ю и 3-ю группы составили крысы, которые на протяжении 60 дней получали внутрижелудочно 1 мл раствора тартразина в дозах 750 и 1500 мг/кг массы тела соответственно. Сроки периода реадаптации после окончания введения тартразина составляли 3, 10, 15, 24, 45 сут. Проксимальный метафиз плечевой кости подвергался обработке по стандартному гистологическому протоколу. Полученные срезы окрашивались гематоксилин-эозином и подвергались последующему гистоморфометрическому исследованию. Результаты. У животных 2-й группы на 3-й день периода реадаптации общая ширина проксимального метафизарного хряща плечевой кости была меньше значений контрольной группы на 8,59 %, ширина зон индифферентного, пролиферирующего и дефинитивного хряща – на 6,11, 8,85 и 7,15 % меньше, ширина зоны деструкции – на 11,55 %, а ширина зоны остеогенеза – на 9,92 %. Содержание первичной спонгиозы в зоне остеогенеза и количество клеток на поверхности трабекул были меньше значений контрольной группы на 8,45 и 8,42 %. В ходе периода реадаптации сходная динамика изменений гистоморфометрических параметров метафизарного хряща плечевой кости сохранялась с тенденцией к сглаживанию к 45-м сут эксперимента. У крыс 3-й группы в ходе всего периода реадаптации изучаемые параметры изменялись более значимо и их восстановление до контрольных величин происходило медленнее, чем во 2-й группе. Выводы. 60-дневное введение тартразина половозрелым крысам сопровождается угнетением костеобразовательной функции проксимального метафизарного хряща плечевой кости, что подтверждается снижением ширины всех его зон и объемных компонентов зоны остеогенеза. Более выраженные по амплитуде и длительности изменения изучаемых параметров зафиксированы у животных, получавших тартразин в дозе 1500 мг/кг массы тела. Ключевые слова: плечевая кость, метафизарный хрящ, тартразин, гистоморфометрия.

scholarly journals Benefits of treatment with favipiravir in hospitalized patients for COVID-19: a retrospective observational case–control study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Anıl Ucan ◽  
Pamir Cerci ◽  
Serdar Efe ◽  
Hakan Akgun ◽  
Ahmet Ozmen ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Specific Treatment ◽  
Reactive Protein ◽  
Study Results ◽  
New Finding ◽  
Group 3 ◽  
Group 2 ◽  
Positive Effect ◽  
Control Study ◽  
Group 1

Abstract Background Although more than a year past since COVID-19 was defined, there is no specific treatment yet. Since COVID-19 management differs over time, it is hard to determine which therapy is more efficacious. In this study, we aimed to evaluate the efficacy of the regimen with Favipiravir (FPV) and determine if the timing of FPV addition offers any improvement. Methods A retrospective observational case-controlled cohort study was performed between March and September 2020, including adults with COVID-19 in a single-center in Turkey. We categorized patients into age-sex matched three groups, group 1 (n = 48) and group 2 (n = 48) included patients treated with the combination of FPV plus Hydroxychloroquine (HQ) early and late, respectively. Group 3 (n = 48) consisted of patients on HQ monotherapy. In Group 2, if the respiratory or clinic condition had not improved sufficiently, FPV was added on or after day 3. Results We found that starting FPV early had an impact on PCR negativity and the progression of the disease. 'No progression' was defined as the absence of a new finding in the control radiological examination and the absence of accompanying clinical deterioration. Also, the decrease in C-reactive protein (CRP) was greater in Group 1 than Group 3 (p < 0.001). However, we found that early initiation of FPV treatment did not have a positive effect on the estimated survival time. Conclusions According to this retrospective study results, we believe that for better clinical outcomes, FPV treatment should be started promptly to enhance antiviral effects and improve clinical outcomes.

Microleakage of Nanofilled Resin-modified Glass-ionomer/Silorane- or Methacrylate-based Composite Sandwich Class II Restoration: Effect of Simultaneous Bonding

2014 ◽  
Vol 39 (1) ◽  
pp. E22-E30 ◽  
Author(s):  
F Shafiei ◽  
S Akbarian
Keyword(s):  
Class Ii ◽  
Modified Technique ◽  
Sandwich Technique ◽  
Composite Sandwich ◽  
Resin Modified Glass Ionomer ◽  
Maxillary Premolars ◽  
Group 3 ◽  
Group 2 ◽  
Restoration Effect ◽  
Group 1

SUMMARY Objectives Microleakage of composite restorations at the cervical margin placed apically to the cementoenamel junction (CEJ) is still a concern. This study evaluated the effect of simultaneous bonding application on cervical sealing of nano-ionomer/silorane- or methacrylate-based composite open sandwich Class II restorations in the modified technique compared with that of conventional bonding. Methods and Materials In 60 sound maxillary premolars, two standardized Class II cavities were prepared with cervical margins 1 mm below the CEJ. The teeth were randomly divided into six groups of 10 teeth each. In the first three groups (groups 1-3), Clearfil SE Bond and Clearfil APX (Kuraray) were used for restoration in the total bonding technique (group 1), conventional open sandwich technique associated with a nano-ionomer (Ketac N100, 3M ESPE) (group 2), and modified open sandwich technique with simultaneous bonding application for both nano-ionomer and composite (group 3). In the second three groups (groups 4-6), Silorane Adhesive and Filtek Silorane composite (3M ESPE) were used in the same manner as in the first three groups, respectively. Results The simultaneous bonding application in the modified sandwich restorations (with SE Bond or Silorane Adhesive) resulted in a significant reduction of the cervical microleakage compared with that of the conventional bonding (p&lt;0.05). However, microleakage of the modified technique was similar to that of the total bonding (with SE Bond or Silorane Adhesive) (p&gt;0.05), both showing good marginal seal.

scholarly journals Comparative Evaluation of Adenoids and Airway Space in 12 to 14-Year-Old Children With Different Growth Patterns Using Cephalometric Methods Commonly Used by ENT Specialists

2021 ◽  
pp. 030157422096687
Author(s):  
Smita Mangesh Choudhari ◽  
Sunita Shrivastav
Keyword(s):  
Growth Patterns ◽  
Diagnostic Methods ◽  
Diagnostic Efficacy ◽  
Area Method ◽  
Early Evaluation ◽  
Diagnostic Protocol ◽  
Lateral Cephalograms ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Introduction: Altered airway and growth are interrelated; hence, a study was planned to develop a diagnostic protocol that may help in diagnosing difficult airway by utilizing routine radiographic assessment. Material and Methods: Lateral cephalograms of 60 children aged 12 to 14 years who were grouped based on the growth pattern into 3 groups with 20 cases each (Group 1—normodivergent cases; Group 2—hypodivergent cases; Group 3—hyperdivergent cases) were observed. The diagnostic protocol included 3 diagnostic methods (Handelman–Osborne area method, Maw et al method, and Holmberg et al method) routinely used by ENT surgeons for altered airway evaluation, and their diagnostic efficacy was correlated with McNamara’s airway analysis. Results: Highest specificity and diagnostic accuracy were found with Holmberg et al method followed by Maw et al method. Poor specificity was observed with Handelman–Osborne area method. Conclusion: The new diagnostic protocol which includes commonly used cephalometric methods by ENT surgeons can be helpful for orthodontists in early evaluation of altered airways, so that preventive and interceptive procedures can be carried out to normalize the altered craniofacial growth. Among the methods used in this diagnostic protocol, Holmberg et al and Maw et al methods had better sensitivity and specificity.

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