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The periodontal disease and gingival bleeding are highly prevalent in the adult population worldwide. The World Health Organization (WHO) data shows that 90–100% of the 34-year-old adults present gingival inflammation. Therefore, an investigation method is required to allow the assessment of the periodontal disease as well as the monitoring of the evolution of the gingival inflammation after periodontal treatments. Non-invasive and operator-independent methods for periodontal examination are necessary for diagnosing and monitoring the periodontal disease. The periodontal ultrasonography is a reliable technique for visualizing the anatomical elements which are necessary to diagnose the periodontal status. Using this imaging technique the dentino-enamel junction, the cortical bone, the radicular surface from the crown to the alveolar bone, the gingival tissue can be seen without interfering with those elements during the examination. Also, calculus visualization is possible before and after scaling in order to evaluate the quality of the treatment. Using 2D ultrasonography is not feasible in dental practice as it requires extensive experience and is also time consuming. The reproducibility of the 2D slices is very difficult in order to have the possibility to compare different investigations efficiently. 3D reconstructions of the periodontal tissue can be a very good alternative to eliminate the operator dependence. Ultrasonography allows the practitioner to visualize the anatomic elements involved in making a periodontal diagnosis. It also allows tracking of subsequent changes. This method is not commonly used for periodontal examination and further studies are required. Previous studies show that ultrasonography can be a reliable non-invasive method to diagnose and monitor the periodontal disease.

The study evaluates the effect of adding graphene-Ag nanoparticles (G-AgNp) to a PMMA auto-polymerizing resin, with focus on antibacterial activity, cytotoxicity, monomer release, and mechanical properties. Auto-polymerizing acrylic resin (M) was loaded with 1 wt% G-AgNp (P1) and 2 wt% G-AgNp (P2). Methyl methacrylate monomer release (MMA) was measured after immersion of the samples in chloroform and cell medium respectively. Cell viability was assessed on dysplastic oral keratinocytes (DOK) and dental pulp stem cells. Oxidative stress and inflammatory response following exposure of dysplastic oral keratinocytes to the experimental resins was evaluated. Antibacterial activity against Staphylococcus aureus, Streptococcus mutans and Escherichia coli and also flexural strength of the resins were assessed. Residual monomer: For samples immersed in chloroform, MMA concentration reached high levels, 10.27 μg/g for sample P1; MMA increased at higher G-AgNp loading; 0.63 μg/g MMA was found in medium for P1, and less for sample P2. Cell viability: Both cell lines displayed a viability decrease, but remained above 75%, compared to controls, when exposed to undiluted samples. Inflammation: proinflammatory molecule TNF-α decreased when DOK cultures were exposed to G-AgNp samples. MDA levels indicated increased oxidative stress damage in cells treated with PMMA, confirmed by the antioxidant mechanism activation, while samples containing G-AgNp induced an antioxidant effect. All tested samples showed antibacterial properties against Gram-positive bacteria. Samples containing G-AgNp also exhibited bactericide action on E. coli. Mechanical properties: both samples containing G-AgNp improved flexural strength compared to the sample resin, measured through elastic strength parameters. PMMA resin loaded with G-AgNp presents promising antibacterial activity associated with minimal toxicity to human cells, in vitro, as well as improved flexural properties. These encouraging results obtained in vitro support further in vivo investigation, to thoroughly check whether the PMMA loaded with graphene-silver nanoparticles constitute an improvement over current denture materials.

Aim : To demonstrate the feasibility of the 3D ultrasound periodontal tissue reconstruction of the lateral area of a porcine mandible using standard 2D ultrasound equipment and spatial positioning reading sensors. Material and method : Periodontal 3D reconstructions were performed using a free-hand prototype based on a 2D US scanner and a spatial positioning reading sensor. For automated data processing, deep learning algorithms were implemented and trained using semi-automatically seg- mented images by highly specialized imaging professionals. Results : US probe movement analysis showed that non-parallel 2D frames were acquired during the scanning procedure. Comparing 3 different 3D periodontal reconstructions of the same porcine mandible, the accuracy ranged between 0.179 mm and 0.235 mm. Conclusion : The present study demonstrated the diagnostic potential of 3D reconstruction using a free-hand 2D US scanner with spatial positioning readings. The use of auto- mated data processing with deep learning algorithms makes the process practical in the clinical environment for assessment of periodontal soft tissues.

Science has shown that there are two sustainable alternatives to providing energy needs: renewable energy resources and fuel cells-hydrogen-based energy, which will play a complementary role in securing global energy resources. By promoting the use of hydrogen-based energy technologies, as clean energy technologies for stationary applications, at the level of local communities, industrial and commercial communities, research topics in this field will help the practical development of sustainable and clean energy systems. This chapter provides an overview of fuel cells highlighting aspects related to fuel cell short history, the main components and operating principles of fuel cells, the main constructive fuel cell types, and the main ways of powering stationary applications through the hydrogen fuel cell technologies.

Aim: To evaluate the effectiveness of SonoVue urethrosonography in diagnosing the adult male anterior urethral strictures pathology in comparison with retrograde urethrography.Material and method: We standardised the method and performed a comparative study evaluating the diagnosis of urethral strictures using retrograde urethrography and retrograde ultrasonographic exploration with SonoVue on 6 male patients.Results: In all patients, the existence of urethral stricture, localization and its extension were confirmed. Contrast-enhanced ultrasonographic exploration brought additional categories of information: the degree of spongiofibrosis, the elasticity of the urethral walls and the presence of urethral lithiasis. There were no periprocedural incidents.Conclusion: This pilot study demonstrates the feasibility and innocuity of urethral ultrasound with SonoVue. Real-time ultrasound exploration highlights aspects that are not seen in radiological examination, so the method can be complementary or alternative to this procedure.

Abdominal ultrasound (US) performed as a “primary imaging procedure” is an important diagnostic tool in gastroenterol-ogy. Expanding the routine investigation to the lower thoracic region might sometimes accelerate the diagnosis in inconclusive manifestations such as pulmonary pathology.US is a valuable tool in evaluating patients with breathing difficulties, chest pain, hypoxia, or chest trauma. This paper presents the particular situation of a patient hospitalized in the gastroenterology depart-ment, where the US identified significant pulmonary alterations and changed the final diagnosis from a gastrointestinal disease to pleuro-pulmonary tuberculosis. A brief review of literature is also included, in relation to chest US.

Point-of-care ultrasound has become of utmost importance in the management of critically ill patients, changing everyday clinical practice. With this case report, we highlight the role of abdominal ultrasound in the management of elderly patientswith gallstone ileus (a rare cause of intestinal obstructions caused by a cholecysto-duodenal fistula) and with contraindications for contrast-enhanced CT scan.

Objectives: The purpose of the study is to identify and validate ultrasound criteria for parotid tumors evaluation, as well as to elaborate a multimodal, multi-criteria and integrative ultrasound approach for allowing tumor discrimination in a noninvasive manner. Material and method: Twenty patients with solid parotid tumors (12 benign, 8 malignant) were examined by ultrasound: real-time “grey scale” ultrasound, Doppler ultrasound, elastography, harmonic ultrasound imaging with i.v. contrast (CEUS). The study focused on tumor morphology and circulation. The analysis of the results was observational, enhanced by statistical methods and artificial intelligence (decision trees). Results: All malignant tumors showed increased hypoechogenicity, tumoral cervical adenopathies, increased stiffness and „in block” mobility with the parotid gland upon palpation with the transducer, uneven distribution of the contrast material during the arterial phase (8/8). To varying degrees, they showed imprecise delineation (7/8), structural heterogeneity (6/8) and disorganized flow pattern (6/8). All cases of benign tumors showed heterogeneous echostructure, clear delineation and no capsule (12). They also showed moderate hypoechogenicity (9/12), no cervical lymph nodes (11/12) and variable rigidity (increased 6/12; low 3/12). A selection and ranking of relevant ultrasound parameters was also made. Some of them were included in a transparent and easy-to-use decision tree model with 100% data accuracy. Conclusions: The characterization and discrimination of solid parotid tumors require a multimodal and multicriteria approach. Ultrasound criteria can be divided into criteria of certainty and criteria of diagnosis probability. CEUS examination of parotid tumors did not reveal significant differences between benign and malignant circulatory bed. Decision trees discovered by artificial intelligence from the data may represent intelligent diagnosis support systems with very high accuracy, up to 100%.

Objectives: Evaluation of Acoustic Radiation Force Impulse Imaging (ARFI) elastography performance in predicting the elasticity of the submandibular glands in normal situations and after radiation therapy. Material and method: A number of 54 normal submandibular glands from 27 voluntary subjects and 33 pathological submandibular glands (radiation submaxillities) from 18 patients who had undergone radiation therapy for various cervical and facial oncological conditions were included in study. All the patients had undergone a B mode ultrasonography (Tissue Harmonic Imaging, 8-14 MHz) while the submandibular volume was determined and subsequently an ARFI examination while the shear wave velocity (SWV) was measured (in the central, peripheral and subcapsular areas, with the results expressed in m/s). Results: In the volunteers’ group the mean value of the SWV of the left submandibular gland was 1.68 ± 0.46 m/s, determined in the centre of the gland, 1.88 ± 0.4 m/s in the periphery (corresponding to the subcapsular parenchyma) and the SWV of the right submandibular gland was 1.74 ± 0.35 m/s (centrally) and 1.84 ± 0.43 m/s in the periphery. The mean value of all measurements was 1.82 ± 0.41 m/s. The mean volume of the glands was 7.97 ± 2.63 cm3. In the group of patients who had underwent radiation therapy (at least 35Gy), the mean value of the SWV was 2.24 ± 0.49 m/s centrally and 2.1 ± 0.58 m/s in the periphery on the left and 1.99 ± 0.5 m/s centrally and 2.21 ± 0.52 m/s in the periphery on the right. The mean value of all the measurements was 2.13 ± 0.52 m/s and the mean volume of the gland was 5.95 ± 4.16 cm3. Conclusions: Elastography using ARFI technique is a valid examination in the evaluation of the normal and pathological submandibular gland stiffness. The values of the shear wave velocities that correspond to a normal stiffness, determined through the ARFI technique, are similar in the two glands. After cervical and facial radiation therapy the values of the SWV are increased, indicating a change in the consistency of the gland thus implying a structural transformation. The ARFI technique can be used in the evaluation of the salivary glands pathology.

Starting from the Kryptofix 22 azacrown compound, mono- and di-branched derivatives have been synthesized, by coupling with one or two 4-chloro-3,5-dinitrobenzoyl chloride units and then substituting the chlorine(s) on the aromatic ring(s) with methoxyamine. The two new compounds were characterized by IR, NMR, and UV-Vis spectra; they are soluble in organic solvents, yielding a yellow color, which is changing to blue in the presence of a base (such as alkali metal hydroxides), thus acting as colorimetric chemosensors. The ratios of complexation and extraction constants with alkali metal cations were measured.

Starting from 4-chloro-3,5-dinitrobenzoic acid 1, compounds 2–10 (N-alkoxy-3,5-dinitro-4-aminobenzoic acid esters where alkoxy stands for methoxy, carboxymethoxy, triphenylmethoxy, or corresponding amides) have been obtained, from which compounds 3–5 and 7–10 are new, and for the known compounds 2 and 6 the synthetic procedure has been improved. The new derivatives have been characterized by appropriate means (IR, UV–Vis, 1H- and 13C-NMR, fluorescence) and their properties were studied. Thus, depending on their structure, the compounds have acid properties, fluorescence and complexing properties with alkaline cations.

Starting from N-hydroxyphthalimide 1 and the reactive fluoro- or chloro-nitroaryl derivatives 2, 3 and 4a-e (2-chloro-3,5-dinitropyridine; 3, NBD-chloride; 4a, 1-fluoro-2,4-dinitrobenzene; 4b, picryl chloride; 4c, 4-chloro-3,5-dinitrobenzotrifluoride; 4d, 2-chloro-3,5- dinitrobenzotrifluoride; 4e, 4-chloro-3,5-dinitrobenzoic acid) the corresponding N-(2-nitroaryloxy)-phthalimide derivatives 5a-e, or 6 and 7 were obtained and characterized by IR, UV-Vis 1H-NMR and 13C-NMR spectroscopy. The TLC behavior and the hydrophobicity of these derivatives have been experimentally evaluated by RM0 parameters (using RP-TLC). The experimental RM0 parameters were compared with the calculated partition coefficient, log P. A QSPR study was also performed to establish possible correlations between the structure and physical properties (λmax and RM0) of compounds 5a-e, 6, and 7.

Aims: The high technical demands associated with perforator flaps demand a precise preoperative identification and evaluation of perforator vessels. Color Doppler Ultrasonography (CDU) and Dynamic Infrared Thermography (DIRT) are currently used for preoperative perforator mapping. Each individual technique has advantages and disadvantages. The purpose of this paper is to analyze the value of combining the two methods in order to optimize the process of preoperative perforator mapping. Material and methods: CDU and DIRT were used for preoperative perforator mapping in 10 pigs. The results were compared to intraoperative findings. Total number of perforators, localization, and identification of the dominant perforator was analyzed for each method. The examination time was recorded for each procedure. Results: Both methods had a high sensitivity in determining the number and localization of perforators when compared to those identified during surgery. DIRT produced a higher number of false positive results. CDU accurately identified the emergence of the perforators in the fascia in all cases. Both methods correctly identified the dominant perforator. The sensitivity, positive predictive value, and accuracy of CDU were 93.56%, 97%, and 91.30% respectively and for DIRT 95.05%, 80.67%, and 77.41% respectively. The average examination was 39.76 minutes for CDU and 10.24 minutes for DIRT. The average time taken into account for the analysis of a single perforator in order to confirm DIRT findings was 1.83 minutes. Conclusions: Preoperative perforator mapping has become a compulsory step in nearly all reconstructive procedures. In our study, both CDU and DIRT correctly identified the dominant perforator in all cases. By combining the two examinations overall mapping time can be reduced significantly. A reduced examination time translates into increased patient compliance and a lower procedure cost. The combined mapping technique facilitates the selection of the ideal perforator in all cases. Correctly identifying the dominant perforator preoperatively reduces operative time, lowers complication rates and ensures an overall better result.

We report the case of a senior patient, presenting with two cutaneous tumours in which the clinical and dermoscopic examination pointed towards a basal cell carcinoma. Ultrasound revealed highly vascularised tumours and elastography showed increased rigidity. Histological examination of both lesions following complete resection was consistent with squamous cell carcinomas. The distinctive feature of this case consists of the complex non-invasive diagnostic imaging of the tumour morphology, performed in real time, revealing aspects compatible with highly proliferative malignant tumours. This case emphasises the importance of ultrasound diagnosis in a multi-disciplinary approach for better and more predictable results.

Aims: To evaluate the utility of grey scale ultrasonography (US) and contrast enhanced ultrasonography (CEUS) for characterization of malignant gastric tumors.Material and methods: The study was conducted prospectively and it included a number of 30 patients with malignant gastric tumors diagnosed through upper tract endoscopy and biopsy: 25 adenocarcinomas, 3 lymphomas, and 2 stromal tumors. All the patients were examined by US, followed immediately by CEUS, using both oral and intravenous contrast agents. CEUS assessed the dynamics of the contrast agent during the arterial phase and the venous phase. The distribution characteristics of the contrast agent inside the region of interest (ROI) were also evaluated. Twenty four patients underwent surgery.Results: Adenocarcinomas presented heterogeneous enhancement with variable pattern, followed by a delayed wash-out in almost all of the situations. Lymphomas presented a variable pattern, intensity and homogeneity of the enhancement, followed by delayed wash-out. Stromal tumors showed early arterial intense and homogenous enhancement followed by moderate wash-out in venous phase.Conclusions: Grey scale US and CEUS are useful methods in characterizing gastric tumors and contribute to a more adequate evaluation of the lesions. The dynamics of the contrast agent may be suggestive for the anatomopathological nature of the tumor. Larger studies will be necessary in order to determine thepractical value of the method.

Contrast enhanced ultrasonography, using IV and/or oral/rectal contrast agents, represents a technical development of the US method, which has proved its applicability in the qualitative and quantitative assessment of the normal and pathological circulatory bed, as well as of the digestive lumen. The use of microbubbles and harmonics opens a new horizon in the detection and characterization of the inflammatory and tumoral conditions of the digestive tract. The interpretation of the data requires corroboration with the grey scale aspect of the examined lesion/area, as well as with the clinical context of the case and the results of other diagnosis techniques. The purpose of this paper is to review the main applications of CEUS in digestive tract pathology by analyzing the significant literature and guidelines in the light of our personal experience and demonstrating it through suggestive images.

The aim of this study is to identify the US features of skin tumors, especially morphological and vascular, in order to develop an integrative and differentiating imaging model for benign and malignant skin tumors. Material and method : Twenty three patients with solid skin tumors were included in the study. The diagnostic procedures were clinical examination, dermoscopy, multimodal ultrasonography (US), using high frequency and conventional US, contact elastography, and i.v. contrast enhanced ultrasound (CEUS). Results : The US characteristics of the basal cell carcinomas were: hypoechoic, inhomogeneous masses, with hyperechoic or anechoic areas, depending on the histological differentiation, increased rigidity, uneven vascularization at Doppler examination, central or mixed type circulatory model, with 1-2 supply vessels, velocity >2 cm/s, intensely inhomogeneous load of the contrast agent ( CA) and quick wash out time. The benign tumors were hypoechoic or echoic masses, with inhomogeneous structure, Doppler signal present only in dermofibromas, peripheral circulation model, velocities < 2.00 cm/s, a weak and uneven loading of the CA in the vascular bed, and a slow wash out time. Analysis of the CA dynamics evidenced a significantly higher value for the wash out time in the malignant tumors (38.2s± 15.15) as compared to the benign ones (54.2s ± 8.5). Particularly the tumor thickness examination by HFUS evidences an ultrasound index that may be considered as a statistically significant predictive factor (p

Aim: The aims of this study are the development of a contrast enhanced ultrasonography (CEUS) protocol for rats’ evaluation and the assessment of the potential benefits of CEUS in Walker 256 tumor rats. Material and method: In the study were used 36 albino Wistar rats grafted subcutaneously with Walker 256 tumor. The implementation of the ultrasound (US) guided injection technique (30 subjects – group A) was performed between 4 to 8 weeks after implantation. The contrast agent (CA) Sono Vue (Bracco) – was administered either into the lateral vein of the tail or directly into the heart under US guidance. The US validation, focusing on CEUS (6 subjects – group B) was realized at 4 to 6 weeks after implantation. The US procedures aimed to obtain morphological (2D), vascular (color Doppler and pulsed Doppler) and angiospecific functional data (CEUS). The Vevo 2100 equipment was used for US and Time Intensity Curves (TIC) were analyzed with Sonoliver (TomTec). The tumor specimens which were resected after the last study underwent a pathology exam. Results: A number of 23 successfully CEUS explorations were performed in 17 subjects (11 in group A and 6 in group B). Nineteen rats could not be evaluated (in 8 cases the tumor was not viable; 4 subjects died during CA administration; in 4 cases the administration line could not be obtained). In group B, CEUS was performed in 6 subjects at 4 weeks after implantation and in 5 subjects at 6 weeks. The statistical analysis of the TIC parameters identified significant differences between the Time to Peak, mean Transit Time and Rise Time parameters of the muscles and those of the tumor. Conclusions: CEUS was easily implemented on the studied tumor model and is adequate for the evaluation of tumor vascularity. US guided intracardiac administration of the CA is an easy and reproducible procedure. If the examination is performed at defined time intervals it detects the alterations within the tumor circulatory bed.

The geometry of some medical images of tissues, obtained by elastography and ultrasonography, is characterized in terms of complexity parameters such as the fractal dimension (FD). It is well known that in any image there are very subtle details that are not easily detectable by the human eye. However, in many cases like medical imaging diagnosis, these details are very important since they might contain some hidden information about the possible existence of certain pathological lesions like tissue degeneration, inflammation, or tumors. Therefore, an automatic method of analysis could be an expedient tool for physicians to give a faultless diagnosis. The fractal analysis is of great importance in relation to a quantitative evaluation of “real-time” elastography, a procedure considered to be operator dependent in the current clinical practice. Mathematical analysis reveals significant discrepancies among normal and pathological image patterns. The main objective of our work is to demonstrate the clinical utility of this procedure on an ultrasound image corresponding to a submandibular diffuse pathology.

The main objective of the study was the realisation of an experimental model and evaluation to establish whether the high frequency ultrasound method can supply credible information concerning the structure of the periodontal tissues.We used a 20 MHz, 2D transducer of Dermascan C (CORTEX TECHNOLOGY l) device for examining 20 teeth on 4 healthy pig mandibles. The examination was made in the lateral area of alveolar bones at the lingual surface.On the images obtained through this type of ultrasonography we identified the cortical bone, tooth crown, tooth root and fixed mucosa. On the images obtained with Dermascan C ver. 3.0 software, very accurate measurements of periodontal space width (mean= 0.45 mm, Std. Dev=0.078) and thickness of cortical bone (mean= 0.31 mm, Std. Dev=0.134) and fixed mucosa (mean= 0.91 mm, Std. Dev=0.176) were made.Considering the non-invasive nature of the ultrasound method for patients and for medical staff during examination, but also considering the advantages generated by the possibility of making exact measurements of different areas, this method could become a reliable alternative for X-ray examinations in patients with periodontal disease. If a miniaturized transducer would be available, it could be used for ultrasound periodontal assessment in humans.

In order to design new advanced organic structures, possessing prestablished hybrid properties, the stable free radical the esters 3a-c (where: a 3-(2-phenoxathiinacetylcarbonyloxy)-2,2,5,5-tetramethyl-1-pyrrolidinyloxy; b 3-(3-phenoxathiinacetylcarbonyloxy)-2,2,5,5-tetramethyl-1-pyrrolidinyloxy; c 3-(3-hydroxy-6-methylcarbonyloxy-4H-pyran-4-one)-2,2,5,5-tetramethyl-1-pyrrolidinyloxy) were synthesized, starting from the persistent and stable nitroxide free radical 3-carboxy-2,2,5,5-tetramethyl-1-pyrrolidinyloxy, 1, (3-CARBOXY-PROXYL) and the bromoderivatives 2a-c (where: a 2-(α-bromoacetyl)-phenoxathiin; b 3-(a-bromoacetyl) phenoxathiin; c 6-bromomethyl-3-hydroxy-4H-pyran-4-one) in the presence of 18C6 and potassium hydroxide. The new compounds, bearing the phenoxathiin fluorescent fragment (3a,b) or the 3-hydroxy-4pyrone chelating structure (3c) linked to the proxyl-paramagnetic unit may be suitable labels in physico-chemical or biomedical processes. The spectral characteristics (IR, UV-VIS, fluorescence and EPR), the lipophilicities (determined by the RPTLC method) and the purities (from TLC densitometric analysis) of the synthesized compounds 3a-c are presented. The nitroxide free radical esters 3a-c were reduced, using ascorbic acid, cysteine, or glutathione, to the corresponding diamagnetic hydroxylamines 4a-c (where: a 3-(2-phenoxathiinacetylcarbonyloxy)-2,2,5,5-tetramethyl-1-hydroxypyrrolidine; b 3-(3-phenoxathiinacetylcarbonyloxy)-2,2,5,5-tetramethyl-1-hydroxypyrrolidine; c 3-(3-hydroxy-6-methylcarbonyloxy-4H-pyran-4-one)-2,2,5,5-tetramethyl-1-hydroxypyrrolidine). This process is reversible, the compounds 4a-c undergoing rapid reoxidation to the initial nitroxides 3a-c by air exposure. The hydroxylamines 4a-c were found to exhibit a greater fluorescence than the nitroxide radicalic species 3a-c.