Pattern Deviation Research Articles

Retinal Nerve Fiber Layer Optical Texture Analysis: Involvement of the Papillomacular Bundle and Papillofoveal Bundle in Early Glaucoma

To apply retinal nerve fiber layer (RNFL) optical texture analysis (ROTA) in eyes with early glaucoma to investigate (1) the pattern of RNFL defects, (2) how often the papillomacular bundle and papillofoveal bundles are involved, and (3) the association between papillomacular and papillofoveal bundle defects and visual field (VF) sensitivity abnormalities. Cross-sectional study. Two hundred four eyes with early glaucoma (VF mean deviation, ≥ -6 dB) with RNFL defects from 171 consecutively enrolled patients with glaucoma. All eyes underwent 24-2 VF testing and OCT for ROTA. The borders of RNFL defects were delineated from ROTA, and the involvement of the arcuate bundle, papillomacular bundle (i.e., bundles from the macula, excluding the fovea), and papillofoveal bundle (i.e., bundles from the fovea) was determined for each eye. Multilevel logistic regression analysis was applied to evaluate the structure-function association. Proportions of eyes with papillomacular or papillofoveal bundle defects. Of the 204 eyes, 71.6% and 17.2% demonstrated RNFL defects involving the papillomacular and papillofoveal bundles, respectively; 25.0% showed arcuate bundle defects without involvement of papillomacular or papillofoveal bundles. The pattern of RNFL defects was diverse; the most common was concomitant involvement of the inferior arcuate bundle and the inferior papillomacular bundle (20.6%). Papillomacular or papillofoveal bundle defects were not associated with VF defects (i.e., with ≥ 3 contiguous locations with abnormal VF sensitivity in the pattern deviation probability plot) in the corresponding hemifield, although VF sensitivity of any 1 of the central 4 VF locations of the 24-2 test, which were within the macula, was more likely to be abnormal (P < 0.05 in the pattern deviation probability plot; odds ratio, 12.5; 95% confidence interval, 7.0-22.5) when the VF stimulus was projected onto a papillomacular or papillofoveal bundle defect than that projected onto an intact papillomacular or papillofoveal bundle. Contrary to the conventional notion that the fovea and macula are not affected until the late stages of glaucoma, papillofoveal and papillomacular bundle defects were common in early glaucoma, and they were associated with central VF sensitivity loss at the corresponding VF test locations.

Clinical Evaluations of Macular Structure-Function Concordance With and Without Drasdo Displacement.

PurposeThe purpose of this study was to compare concordance between ganglion cell-inner plexiform layer (GCIPL) data from the Cirrus optical coherence tomographer (OCT) Ganglion Cell Analysis (GCA) and visual fields (VFs), with and without Drasdo displacement.MethodsFrom 296 open-angle glaucoma participants, GCIPL deviation and raw thickness data were extracted over locations per the 10-2 VF test grid, with and without application of Drasdo displacement, with global and eccentricity-dependent sensitivities and specificities calculated for both. With OCT and VF data classified as within or outside normative limits, pattern deviation values were compared using paired t-tests and Spearman correlations. Regression models were applied to pattern deviation values as a function of GCIPL thickness, and differences in model performance with and without displacement were compared using extra sums-of-squares F tests.ResultsThere were small but significant improvements in global specificity without displacement (0.58–0.59 with displacement and 0.61 without displacement), without notable differences in sensitivity (0.77–0.78 with displacement and 0.76–0.78 without displacement). At abnormal VF locations and without displacement, a higher proportion of correct OCT classifications (P = 0.0008) and significant correlation with worsening pattern deviation values were observed (r = 0.50, P = 0.002). Regression models indicated significantly steeper slopes with Drasdo displacement centrally (P = 0.002–0.04).ConclusionsWith GCA deviation maps, small improvements in structure-function concordance were observed without displacement, which are unlikely to be clinically meaningful. Using GCIPL thickness data, significantly better structure-function concordance was observed centrally with Drasdo displacement.Translational RelevanceApplying Drasdo displacement on probability-based reports is unlikely to alter clinical impressions of structure-function concordance, but applying displacement with GCIPL thickness data may improve detection of structure-function concordance.

Macular sector-wise decision tree model for the prediction of parafoveal scotoma not detected by 24-2 visual field test.

Development of a macular sector-wise decision tree model (DTM) for the prediction of parafoveal scotoma. This prospective study enrolled 126 patients with early-stage open-angle glaucoma (mean deviation ≥-6 decibels) without the signs of parafoveal scotoma on the 24-2 visual field (VF) test (i.e., any abnormalities at the four innermost points). Based on the central 36 points of the 10-2 pattern deviation plot, patients were classified as being with or without 10-2 parafoveal scotoma. For the discrimination of patients from those without 10-2 parafoveal scotoma, a macular ganglion cell-inner plexiform layer (mGCIPL) sector-wise DTM analysis was performed. Among 126 eyes without 24-2 parafoveal scotoma, 10-2 parafoveal scotoma was detected in 77 (61.1%) eyes. The balanced accuracy of DTM was best in the inferotemporal sector (0.9286; 95% CI, 0.7458-0.9697) and worst in the inferior sector (0.8373; 0.6484-0.9204). DTM revealed that even in the absence of VF abnormalities at the innermost 4 points on the 24-2 test, (1) 10-2 parafoveal scotoma should be strongly suspected when the adjacent 24-2 perifoveal point in the correlated sector is abnormal; (2) if the 24-2 perifoveal point is normal, and if the probability colour codes of the correlated mGCIPL sector are green, the probability of 10-2 parafoveal scotoma is very low. In clinical practice, the evaluation of the 24-2 perifoveal test points along with the probability colour codes of mGCIPL can be a useful decision-support tool in determining whether 10-2 tests are needed for a given patient.

Cluster Formation for Analyses of Glaucomatous Visual Field Defects in Central 10-2 Visual Field in Normal Tension Glaucoma Eyes.

PurposeTo develop a cluster system to analyze the retinal sensitivity loss of 68 test points in the central 10 degrees of standard automated perimetry (SAP) in eyes with normal tension glaucoma (NTG).Patients and MethodsPatients with NTG who met the following criteria were included: visual acuity ≥0.7, SAP-derived mean deviation ≥−15 dB, and pattern deviation probability plots with at least one point with a probability of <0.5% and/or two or more contiguous points with a probability of <1% that did not cross the horizontal meridian in the central 12 points of the 24-2 test points. SAP with the Swedish Interactive Threshold Algorithm Standard (SITA-S) 10-2 program (10-2) was performed within 6 months of the SITA-S 24-2. The averaged total deviation (TD) for each of the 68 test points in the 10-2 was calculated. Hierarchical cluster analyses were performed based on the deviation of the TDs of the test points, and a dendrogram was created. The number of clusters was determined following the Sturges’ rule.ResultsOne hundred and twenty-six eyes of 126 patients (61.9±11.4 years) were studied. Hierarchical cluster analysis of the TD values statistically obtained a dendrogram that divided the 68 test points into 7 clusters. Of these 7 clusters, 21 points belonging to the clusters in the papillomacular region included cluster 5. Cluster 5 was distributed above and below the horizontal meridian, which does not agree with the course of the retinal nerve fiber layer (RNFL).ConclusionThe hierarchical cluster analysis of the TD values stratified the 68 test points of the 10-2 into seven clusters. Considering the course of the RNFL, cluster 5 was divided into clusters of 5a and 5b, and consequently eight clusters were considered to be appropriate for detecting glaucomatous visual field defects in the central 10 degrees in NTG eyes.

Menstrual characteristics and associated physical activity in some school adolescent girls in Taiz city, Yemen

Background: Onset of menstruation is the most marked physical change in an adolescent girl. Besides secondary sexual characters, other physical changes such as weight gain, acne etc. may be problematic to young girls. This study was carried out to study the characteristics of menstrual cycles and associated physical problems among the in some adolescent school girls.&#x0D; Methods: A predesigned questionnaire was administered to students of classes 6 to 12 at one urban schools (Saba primary and secondary school for girls) during the period from 1st January 2021 to 1st of march 2021 in Taiz. SPSS v 23 was used for date analysis.&#x0D; Results: 500 students were enrolled in this study, 67.7% (338) of them were in primary school while the rest of them 32.4% (162) were from secondary school. The mean age of the girls was 16.4 years [range: 12-25; SD: 1.3]. Of these, the mean age of menarche being 13.2 years [range: 9-18; SD: 1.2]. The majority (71.2%) of them had regular menstrual pattern. Most of them suffered from moderate dysmenorrhoea (41%); nearly 34.2% reported severe dysmenorrhoea while 4.2% girls reported absence of dysmenorrhea.&#x0D; Only 8.6% of adolescent girls had consulted a doctor for symptoms related to menstrual. Among other physical changes besides secondary sexual characters, 58% suffered from acne, 24.2% reported weight gain and 21.6% had excessive hair growth.&#x0D; Conclusions: A good proportion of school going adolescent girls experience menstrual pattern deviation from normal and all so other problems such as acne, weight gain and excessive body hair. However, only a minority of them approach doctors for alleviation of these problems

A preliminary study of buccal and lingual alveolar bone thickness of posterior teeth in patients with skeletal Class III malocclusion and mandibular asymmetry

The purposes of this retrospective study were to investigate the buccal and lingual alveolar bone thickness values of the posterior teeth in patients with asymmetrical skeletal Class III malocclusion and compare them with patients with symmetrical skeletal Class III and Class I malocclusion. Seventy-eight cone-beam computed tomography scans were classified into 3 groups according to the sagittal pattern and menton deviation: asymmetrical Class III (n= 26), symmetrical Class III (n= 26), and symmetrical Class I (n= 26). The buccal and lingual alveolar bone thickness of the first molar and premolars in the maxilla and mandible were measured at 3, 6, and 8 mm apical to the cementoenamel junction and the apical and middle levels of the root. Measurements were compared among the 3 groups. In the asymmetrical Class III group, the buccal alveolar bone along the distobuccal root of the maxillary first molar on the deviated side was thinner by 1.07 to 1.10 mm than that in the symmetrical Class I group at 6-mm, 8-mm, and middle-level planes (P<0.001, P<0.01, and P<0.001). The buccal alveolar bone thickness along the distal and mesial roots of the mandibular first molar on the deviated side was thinner by 1.28 to 1.85 mm, and by 0.72 to 1.21 mm, respectively (P <0.001 and P <0.01), than that in the symmetrical Class I group at 6-mm, 8-mm, apical and middle-level planes. In this preliminary study, patients with skeletal Class III malocclusion showed thinner buccal and lingual alveolar bone in the posterior teeth than subjects with Class I malocclusion. Particular attention should be paid to buccal alveolar bone thickness along the distobuccal root of the maxillary and distal root of the mandibular first molar to prevent periodontal complications in decompensation. Future studies should involve larger sample sizes, more repeatable and comprehensive measuring and statistical methods.

Comparison of one-jaw and two-jaw orthognathic surgery in patients with skeletal Class III malocclusion using data from 10 multi-centers in Korea: Part I. Demographic and skeletodental characteristics.

ObjectiveTo investigate demographic and skeletodental characteristics of one-jaw (1J-OGS) and two-jaw orthognathic surgery (2J-OGS) in patients with skeletal Class III malocclusion.Methods750 skeletal Class III patients who underwent OGS at 10 university hospitals in Korea between 2015 and 2019 were investigated; after dividing them into the 1J-OGS (n = 186) and 2J-OGS groups (n = 564), demographic and skeletodental characteristics were statistically analyzed.Results2J-OGS was more frequently performed than 1J-OGS (75.2 vs. 24.8%), despite regional differences (capital area vs. provinces, 86.6 vs. 30.7%, p < 0.001). Males outnumbered females, and their mean operation age was older in both groups. Regarding dental patterns, the most frequent maxillary arch length discrepancy (ALD) was crowding in the 1J-OGS group (52.7%, p < 0.001) and spacing in the 2J-OGS group (40.4%, p < 0.001). However, the distribution of skeletal pattern was not significantly different between the two groups (all p > 0.05). The most prevalent skeletal patterns in both groups were hyper-divergent pattern (50.0 and 54.4%, respectively) and left-side chin point deviation (both 49.5%). Maxillary spacing (odds ratio [OR], 3.645; p < 0.001) increased the probability of 2J-OGS, while maxillary crowding (OR, 0.672; p < 0.05) and normo-divergent pattern (OR, 0.615; p < 0.05) decreased the probability of 2J-OGS.ConclusionsIn both groups, males outnumbered females, and their mean operation age was older. The most frequent ALD was crowding in the 1J-OGS group, and spacing in the 2J-OGS group, while skeletal characteristics were not significantly different between the two groups.

UWHVF: A Real-World, Open Source Dataset of Perimetry Tests From the Humphrey Field Analyzer at the University of Washington.

PurposeThis article describes the Humphrey field analyzer (HFA) dataset from the Department of Ophthalmology at the University of Washington.MethodsPointwise sensitivities were extracted from HFA 24-2, stimulus III visual fields (VF). Total deviation (TD), mean TD (MTD), pattern deviation, and pattern standard deviation (PSD) were calculated. Progression analysis was performed with simple linear regression on global, regional, and pointwise values for VF series with greater than four tests spanning at least four months. VF data were extracted independently of clinical information except for patient age, gender, and lateralityResultsThis dataset includes 28,943 VFs from 7248 eyes of 3871 patients. Progression was calculated for 2985 eyes from 1579 patients. Median [interquartile range] age was 64 years [54, 73], and follow-up was 2.49 years [1.11, 5.03]. Baseline MTD was −4.51 dB [−8.01, −2.65], and baseline PSD was 2.41 dB [1.7, 5.34].ConclusionMTD was found to decrease by −0.10 dB/yr [−0.40, 0.11] in eyes for which progression analysis was able to be performed. VFs with deep localized defects, PSD > 12 dB and MTD −15 dB to −25 dB, were plotted, visually inspected, and found to be consistent with neurologic or glaucomatous VFs from patients. For a small number of tests, extracted sensitivity values were compared to corresponding printouts and confirmed to match.Translational RelevanceThis open access pointwise VF dataset serves as a source of raw data for investigation such as VF behavior, clinical comparisons to trials, and development of new machine learning algorithms.

Preservative free travoprost and timolol fixed combination in the initial treatment of primary glaucoma: an assessment of hypotensive efficiency and safety

Purpose. To evaluate the efficacy and safety of Travapress Duo with respect to hypotensive results, changes in functional parameters, and adverse reactions. Material and methods. 30 patients aged 65–75 (averagely 71.3 ± 3.2 years) with a newly diagnosed primary open-angle glaucoma (POAG) received Travapress Duo in the evening, once a day. Goldman tonometry was performed during the screening, then 1 week, 1 month and 3 months from the treatment start. Static perimetry and optical coherence tomography (OCT) were performed before treatment and at the end of the 3rd month since the treatment start. Adverse events were recorded at each stage of the study.Results. As a result of a 3 month long therapy with Travapress Duo, a significant decrease in IOP was noted starting from the 1st week of instillations (by 34 %), after 1 month, by 35 % and after 3 months of observation by 36 %. By the end of the 3rd month of treatment, we noted an insignificant increase in visual acuity, a positive dynamic of the standard deviation and the standard deviation pattern, as well as OCT indicators, such as average thickness of the layer of retinal nerve fibers and the layer of retinal ganglion cells in the macula, stabilization of the thickness of the retinal ganglion cell complex layer and the size of the inner plexiform layer. One patient complained of discomfort and hyperemia by the end of the 1st week of drug instillation. No systemic side effects were noted during the follow-up, and in no case drug withdrawal was require. Conclusion. The preservative-free Travapress Duo drug displayed a high hypotensive efficacy, reducing the IOP to 36% of the initial value. The hypotensive effect was accompanied by indirect neuroprotection, which manifested itself in the positive changes observable in the results of functional studies with varying degrees of reliability. Travapress Duo is characterized by a low level of local side effects and can be recommended for both for the initial and long-term therapy of primary glaucoma of developed and advanced stages.

Initial hypotensive therapy of primary glaucoma with the domestic latanoprost generic: efficacy and safety

Purpose: a comparative study of the efficacy and safety of the Latanoprost-Optic drug and the original latanoprost drug administered to previously untreated patients with primary open-angle glaucoma (POAG). Material and methods. A double-blind, randomized, parallel-group study involved 60 patients (70 eyes) with newly diagnosed POAG, who were randomly divided into 2 groups of equal size. The patients of the main group (34 eyes) received Latanoprost-Optic, whilst the control group received the original preparation of latanoprost, 1 instillation in the evening. The reference points were the values of intraocular pressure, visual acuity, perimetric indices (standard deviation, standard deviation pattern), the average thickness of the retinal nerve fiber layer, the minimum width of the neuroretinal girdle, the thickness of the retinal nerve fiber layer in the macula, the thickness of the ganglion cell layer in the macula, the thickness of the inner plexiform layer, and the safety (adverse events). The observation period was 12 weeks. Results. After 2 weeks, both groups showed a statistically significant decrease in intraocular pressure, which remained stable after 6 and 12 weeks. The average decrease in intraocular pressure of those receiving Latanoprost-Optic was 30% and at no control point a statistically significant difference from the original drug was revealed. A positive dynamic of visual acuity, static perimetry indices and optical coherence tomography was registered, showing n significant intergroup differences. This may indicate that the drugs have an indirect neuroprotective effect. The adverse events included discomfort and redness of the bulbar conjunctiva, which were recorded in 7 out of 30 patients in the study group and in 6 out of 30 patients in the control group. All of them were mild and completely reversible. No serious or systemic adverse events were reported. Conclusion. Latanoprost-Optic has an efficacy comparable to that of the original latanoprost drug and has a comparable favorable safety profile.

Smartphone as a tool for evaluating oblique muscle dysfunction.

The aim of this study was to describe a simple, accessible, and reliable method using a smartphone for evaluating oblique muscle dysfunctions. The photograph rotation tool in the iPhone PHOTO app was used by 75 examiners to evaluate 22 photographs from only 9 patients, captured in infra- and supra-dextroversion, and infra- and supra-levoversion, as not all the patients were photographed in the 4 positions mentioned. Each patient received a score for the superior and inferior oblique muscle functions, ranging from -4 (hypofunction) to 4 (hyperfunction) or 0 (normal function), using preediting and postediting photographs. These values were compared with the scores previously given by trained personnel in strabismus screening. The difference in score between the two groups was expressed in natural (whole and non-negative) numbers. The mean and pattern deviation were then calculated. The scores of most of the edited photos showed a lower mean than those of the unedited ones, except for a patient with left superior oblique hyperfunction. The patients with no oblique dysfunction and those with right superior oblique hyperfunction demonstrated (after editing the photograph) scores with greater similarity with their initial scores (p<0.05 and p<0.01, respectively). Similar results were found in the patients with oblique hypofunctions and right inferior oblique hyperfunction (p<0.01). The proposed method for assessing muscular function in vertical strabismus is reproducible, accessible, simple, and reliable, and provides better consistency to the admeasurement.

Experimental Study on the Size Effect on the Probability Distribution of Concrete Compressive Strength

Understanding the size effect on the probability distribution of concrete compressive strength is critical to accurately determining its probability distribution and to correctly calculating reliability. Compressive strength tests were performed on concrete cubic specimens with side lengths of 70 mm, 100 mm, and 150 mm, respectively. The Kolmogorov‐Smirnov test results revealed that concrete compressive strength of each specimen size followed a normal probability distribution; that is, a change in specimen size did not affect the type of probability distribution. The point and interval estimates of the mean and standard deviation of concrete compressive strength showed that both the mean and standard deviation decreased, and the latter decreased to a greater extent with an increase in specimen size. The calculation results show that the standard value of concrete compressive strength also has a significant size effect, but the standard value increases with an increase in specimen size, which is opposite to the change pattern of concrete compressive strength mean and standard deviation. Finally, a reliability analysis was carried out using the compressive strength of a cubic concrete specimen with a size of 150 mm as an example, and the probability distributions for different specimen sizes were found to have a great influence on the reliability of the calculation results. Therefore, it is important to account for the size effect on the probability distribution of concrete compressive strength in practical engineering.

Influence of Different Fabrication Techniques on the Accuracy of Radiographic Scan Templates in Cases of Full-Arch Computer-Guided Implant Placement: An In Vitro Study.

To evaluate the influence of using different fabrication techniques, including intraoral scans, CBCT scans of patients' existing dentures, or denture duplicates, on the accuracy of radiographic scan templates. The influence of selecting different segmentation threshold values during reconstruction of CBCT data was also evaluated. A reference model was obtained by scanning five pairs of maxillary and mandibular acrylic complete dentures using a desktop laboratory laser scanner (DWOS 7Series, Dental Wings). Test scans were obtained from intraoral scans of dentures, CBCT scans of dentures and denture duplicates reconstructed at different grayscale segmentation thresholds, and a laboratory scan of denture duplicates. The resultant STL scan files were imported to an open source and cloud storage software (Medit Link) for the accuracy measurements by calculating root mean square estimate (RMSE) between reference and test scans. Collected data were then analyzed. Qualitative analysis was also performed using 3D color maps. The lowest RMSE (352.7) was found with intraoral denture scans. The highest RMSE (1,336.3) was found with the CBCT scans of the denture duplicates at segmentation threshold of -700 grayscale level. Qualitative analysis revealed that the intraoral denture scans exhibited the most homogenous deviation pattern relative to reference lab scans. Within the limitations of this study, the intraoral scans of the patients' existing dentures resulted in the fabrication of the most accurate radiographic scan templates. The improved accuracy of scan templates fabricated using the intraoral scanners can eliminate the possible laboratory errors associated with the conventional technical procedures as well as reduce the inaccuracies resulting from the image processing and segmentation of CBCT data.

Data-driven deviation generation for non-ideal surfaces of Skin Model Shapes

The digitalization techniques enable quality control as well as performance simulation of mechanical products in the Digital Twin era. In the product design process, realistic models regarding surface geometrical deviations are essential for further functional analysis. In the context of ISO standards on geometrical product specifications and verification (GPS), the Skin Model Shapes (SMSs) concept stemmed from the Skin Models paradigm is put forward to represent deviations of mechanical parts in accordance with the nature of geometric deviations on the surfaces. Contributions have been made to generate SMSs by combining both systematic deviations and random deviations on the nominal model. However, the non-ideal surface generation process is limited by the reuse of geometric deviation’s knowledge. Existing geometric deviations that are predicted or observed on the parts cannot be applied for other SMSs generation without new parameter settings using different methods. In this paper, a framework for data-driven geometric deviation generation is proposed for non-ideal surface modeling in tolerancing. A database that contains a variety of deviations generated by different methods is constructed. Deviations that are classified as systematic and random types are represented and stored as samples in the dataset. Deviation pattern identification is addressed by transfer learning using AlexNet and it is used for different types of non-ideal surface generation. Different approaches regarding both prediction and observation stage within SMS schema are included for constructing the deviation samples. The mapping process for both systematic and random deviation samples are considered. Therefore, there is no need to re-design deviations with parameters for the surfaces. A case study is used to illustrate the non-ideal surface generation process by the propose method.

A Stream Learning Approach for Real-Time Identification of False Data Injection Attacks in Cyber-Physical Power Systems

This paper presents a novel data-driven framework to aid in system state estimation when the power system is under unobservable false data injection attacks. The proposed framework dynamically detects and classifies false data injection attacks. Then, it retrieves the control signal using the acquired information. This process is accomplished in three main modules, with novel designs, for detection, classification, and control signal retrieval. The detection module monitors historical changes in phasor measurements and captures any deviation pattern caused by an attack on a complex plane. This approach can help to reveal characteristics of the attacks including the direction, magnitude, and ratio of the injected false data. Using this information, the signal retrieval module can easily recover the original control signal and remove the injected false data. Further information regarding the attack type can be obtained through the classifier module. The proposed ensemble learner is compatible with harsh learning conditions including the lack of labeled data, concept drift, concept evolution, recurring classes, and independence from external updates. The proposed novel classifier can dynamically learn from data and classify attacks under all these harsh learning conditions. The introduced framework is evaluated w.r.t. real-world data captured from the Central New York Power System. The obtained results indicate the efficacy and stability of the proposed framework.

Mixture toxicity prediction of substances from different origin sources in Daphnia magna

Due to several anthropogenic activities, water bodies have been heavily impacted by contaminants identified in aquatic ecosystems, including pharmaceuticals, personal care products, agricultural and industrial chemicals. Risk assessment based on chemical mixtures is still default in many monitoring studies, with decisions being based solely on a chemical-by-chemical basis. The present study aimed to improve risk assessment procedures in water bodies by focusing on mixtures of chemical substances of different origins. The goal was to analyze potential interactions occurring at different complexity levels (binary and quaternary mixtures) using standardised toxicity assays. Mixture toxicity effects were assessed using Daphnia magna as the model organism and the compounds sodium fluoride, boric acid, ammonium hydroxide and acetaminophen as general representatives of contaminants in the aquatic ecosystem. The results revealed interactions between the compounds, mainly showing antagonism but also dose level and dose ratio-dependent deviations. Overall antagonism was the dominant deviation pattern, particularly at low doses, though synergism was also detected at higher doses or specific ratios. Synergism at low doses was found for the binary mixture of ammonium hydroxide and acetaminophen, two common pollutants, which denotes an enhanced risk to aquatic ecosystems. Independent Action provided more accurate predictions for the quaternary mixture, whereas Concentration Addition overestimated the toxicity of the mixture. Regarding the environmental risk assessment of water bodies, the interaction between chemicals in a mixture should not be neglected. The complexity of the mixture interactions found in the present study highlights the importance of complementing chemical screenings of water bodies with mixture toxicity data, particularly when considering chemicals of multiple origins whose joint action remains unknown.

Anthropometric Evaluation of Volume of Maxillary Sinus and Nasal Septum Patterns as an AID in Personal Identification Using CBCT-A Retrospective Study

Aims: To determine the reliability and accuracy of maxillary sinus volume and nasal septum patterns in personal identification in forensics using CBCT (cone beam computed tomography).&#x0D; Study Design: Retrospective Study&#x0D; Place and Duration of Study: Department of Oral Medicine and Radiology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital Nagpur, from September 2019-December 2019.&#x0D; Methodology: 110 CBCT scans of bilateral maxillary sinuses and nasal septum images were retrospectively obtained from the Oral Medicine and Radiology database (68 men and 42 females). The study was divided into two groups based on age. Group&#x0D; -I consists of 58 CBCT scans taken between the ages of 20 and 40, while Group -II consists of 52 CBCT scans taken between the ages of 41 and 80. The height, breadth, and depth of the maxillary sinus were measured linearly. The nasal septum was classed as simple deviation to the right or left, sigmoid type, reverse sigmoid type, and straight based on the septa's deviations. Each person's combined maxillary sinus and nasal septum pattern was documented.&#x0D; Results: The difference in maxillary sinus volume between two age groups was significant (P&lt;0.5). In age group I, there was a substantial change in the left deviation pattern, and there was a significant change in the reverse sigmoid pattern in males and the straight nasal septum pattern in females. With whatever nasal septum configuration, there were no volumetric alterations(P&gt;0.5).&#x0D; Conclusion: In future, further research will be needed with a larger number of images to compare in order to arrive at a definitive identification.

Association of Visual Field Pattern Reversal with Paracentral Visual Field Loss

Visual field (VF) results that show more test points outside normal limits on the pattern deviation map than on the total deviation map have been assumed to be evidence of unreliable VF results. We propose the term pattern reversal to describe this VF finding and explore its association with paracentral loss. Retrospective cohort and case-control studies. Glaucoma and glaucoma suspect patients who completed VF testing in Veteran's Affairs ophthalmology or optometry clinics. In the cohort study, VF results were included that demonstrated pattern reversal. The area of pattern reversal was categorized as peripheral, paracentral, or mixed (both peripheral and paracentral). In the case-control study, a group of patients with paracentral loss confirmed on 10-2 VF tests were compared with acontrol group whose VF results were without paracentral loss. In the cohort study, the calculated false-positive (FP) error rates were compared among groups categorized by area of pattern reversal. In the case-control study, the rates of pattern reversal were compared between patients with and without paracentral loss. Two hundred seventeen eyes of 145 patients were included in the cohort study. Visual field results with pattern reversal and mixed loss had significantly higher FP rates compared with those with paracentral or peripheral loss only (16.25% vs. 6.26% and 8.15%, respectively; P < 0.001). Fifty-five eyes of 41 patients were included in the case group and 55 eyes of 41 patients were included in the control group. Patients with paracentral loss were more likely to have history of pattern reversal compared with those without paracentral loss (58.2% vs. 29.1%; P= 0.004). Twelve eyes with paracentral loss had 24-2 VF results that showed defects on the pattern deviation map, but not on the total deviation map. Pattern reversal may be associated with paracentral VF loss and is not always associated with elevated FP rates.

Optical coherence tomography angiography is an efficient tool to assess optic nerve perfusion

Background Glaucoma is the neuropathy of the optic nerve with accelerated apoptosis of the retinal ganglion cells. Optical coherence tomography angiography provides valuable information about the optic nerve and the retinal circulation as an auxiliary tool for glaucoma diagnosis and optic nerve saving. Purpose To evaluate the performance of optical coherence tomography angiography in distinguishing primary open-angle glaucoma from healthy eyes by measuring the radial peripapillary capillary (RPC) vessel density (VD)% and macular superficial capillary plexus (SCP) VD%. Patients and methods A descriptive prospective cross-sectional case–control study was conducted on 60 participants, who were categorized into two groups: group A (30 patients with primary open-angle glaucoma and group B (30 healthy controls of matched age and sex with group A). Structural (retinal nerve fiber layer and ganglion cell complex thickness), functional (the mean deviation, and pattern standard deviation), and vascular parameters [the VD of RPC in scan 4.5×4.5 mm (in whole image, and the peripapillary region) and macular SCP in scan 6×6 mm] were compared between the two groups. Results Statistically significant decreases of VD of RPC of the whole disk, the peripapillary region, and the macular superficial plexus layer were observed in glaucoma eyes compared with controls (all P&lt;0.001). As for the VD of the RPC of the whole disk, the mean value in the healthy control was (51.83±2.31) and in the glaucoma group was (46.21±2.98). For the VD of the RPC of the peripapillary region, the mean value in the healthy control was (52.56±0.2.61), while it was (46.9±3.1) in glaucoma eyes. Regarding VD of the macular superficial plexus layer, the mean value in healthy controls was 47.53±2.1, while it was 43.91±2.81 in glaucoma eyes. Structural, regarding the comparison of the retinal nerve fiber layer thickness between the two groups, the glaucoma patients had a significant (P=0.0001) lower mean value (81.34±0.11) than healthy controls (103.85±0.6.2). Also, for comparing the ganglion cell complex thickness between the two groups, the glaucoma patients had a significant (P=0.0001) lower mean value (80.72±6.9) than healthy controls (99.67±5.8). Functional, significant statistical differences (P=0.0001) of both, the mean deviation [between healthy control (0.18±0.86) and glaucoma group (−4.2±1.9)] and the mean of pattern deviation (P=0.0001) [between healthy control (1.22±0.91) and glaucoma group (4.6±1.72)] were determined. Conclusion Quantitative assessment of the VD of RPC and superficial macular capillary plexus is a promising tool for glaucoma decision making. As compared with healthy controls, the VD of RPC and SCP in glaucoma patients is reduced.

Multimodal Machine Learning Using Visual Fields and Peripapillary Circular OCT Scans in Detection of Glaucomatous Optic Neuropathy

To develop and validate a multimodal artificial intelligence algorithm, FusionNet, using the pattern deviation probability plots from visual field (VF) reports and circular peripapillary OCT scans to detect glaucomatous optic neuropathy (GON). Cross-sectional study. Two thousand four hundred sixty-three pairs of VF and OCT images from 1083 patients. FusionNet based on bimodal input of VF and OCT paired data was developed to detect GON. Visual field data were collected using the Humphrey Field Analyzer (HFA). OCT images were collected from 3 types of devices (DRI-OCT, Cirrus OCT, and Spectralis). Two thousand four hundred sixty-three pairs of VF and OCT images were divided into 4 datasets: 1567 for training (HFA and DRI-OCT), 441 for primary validation (HFA and DRI-OCT), 255 for the internal test (HFA and Cirrus OCT), and 200 for the external test set (HFA and Spectralis). GON was defined as retinal nerve fiber layer thinning with corresponding VF defects. Diagnostic performance of FusionNet compared with that of VFNet (with VF data as input) and OCTNet (with OCT data as input). FusionNet achieved an area under the receiver operating characteristic curve (AUC) of 0.950 (0.931-0.968) and outperformed VFNet (AUC, 0.868 [95% confidence interval (CI), 0.834-0.902]), OCTNet (AUC, 0.809 [95% CI, 0.768-0.850]), and 2 glaucoma specialists (glaucoma specialist 1: AUC, 0.882 [95% CI, 0.847-0.917]; glaucoma specialist 2: AUC, 0.883 [95% CI, 0.849-0.918]) in the primary validation set. In the internal and external test sets, the performances of FusionNet were also superior to VFNet and OCTNet (FusionNet vs VFNet vs OCTNet: internal test set 0.917 vs 0.854 vs 0.811; external test set 0.873 vs 0.772 vs 0.785). No significant difference was found between the 2 glaucoma specialists and FusionNet in the internal and external test sets, except for glaucoma specialist 2 (AUC, 0.858 [95% CI, 0.805-0.912]) in the internal test set. FusionNet, developed using paired VF and OCT data, demonstrated superior performance to both VFNet and OCTNet in detecting GON, suggesting that multimodal machine learning models are valuable in detecting GON.