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Biomedical subjects

M Tonetti

Publications and source records attributed to M Tonetti.

At least 37 records · Page 2Linked to original sources

The metabolism of 6-deoxyhexoses in bacterial and animal cells.

L-fucose and L-rhamnose are two 6-deoxyhexoses naturally occurring in several complex carbohydrates. In prokaryotes both of them are found in polysaccharides of the cell wall, while in animals only L-fucose has been described, which mainly participates to the structure of glycoconjugates, either in the cell membrane or secreted in biological fluids, such as ABH blood groups and Lewis system antigens. L-fucose and L-rhamnose are synthesized by two de novo biosynthetic pathways starting from GDP-D-mannose and dTDP-D-glucose, respectively, which share several common features. The first step for both pathways is a dehydration reaction catalyzed by specific nucleotide-sugar dehydratases. This leads to the formation of unstable 4-keto-6-deoxy intermediates, which undergo a subsequent epimerization reaction responsible for the change from D- to L-conformation, and then a NADPH-dependent reduction of the 4-keto group, with the consequent formation of either GDP-L-fucose or dTDP-L-rhamnose. These compounds are then the substrates of specific glycosyltransferases which are responsible for insertion of either L-fucose or L-rhamnose in the corresponding glycoconjugates. The enzyme involved in the first step of GDP-L-fucose biosynthesis in E. coli, i.e., GDP-D-mannose 4,6 dehydratase, has been recently expressed as recombinant protein and characterized in our laboratory. We have also cloned and fully characterized a human protein, formerly named FX, and an E. coli protein, WcaG, which display both the epimerase and the reductase activities, thus indicating that only two enzymes are required for GDP-L-fucose production. Fucosylated complex glycoconjugates at the cell surface can then be recognized by specific counter-receptors in interacting cells, these mechanisms initiating important processes including inflammation and metastasis. The second pathway starting from dTDP-D-glucose leads to the synthesis of antibiotic glycosides or, alternatively, to the production of dTDP-L-rhamnose. While several sets of data are available on the first enzyme of the pathway, i.e., dTDP-D-glucose dehydratase, the enzymes involved in the following steps still need to be identified and characterized.

Animals↗

Expression, purification and characterization of GDP-D-mannose 4,6-dehydratase from Escherichia coli.

GDP-D-mannose dehydratase (GMD) catalyzes the first step of the pathway that converts GDP-D-mannose to GDP-L-fucose in bacteria, plants and mammals. Recently, the gene coding for GMD has been identified and sequenced in E. coli. Based on this sequence, we have expressed and purified GMD in E. coli as a glutathione transferase (GST) fusion protein. The fused GST-GMD protein and the thrombin-cleaved GMD were then characterized. The catalytically active form of both enzyme species seems to be a hexamer of 410 and 250 kDa, respectively. The GST-GMD fusion protein has a Km of 0.22 +/- 0.04 mM and a specific activity of 2.3 +/- 0.2 micromol/h/mg. Ca2+ and Mg2+ activate GMD, while GDP-L-beta-fucose, the end-product of the pathway, inhibits it specifically. The GST-GMD fusion protein contains one mole of tightly bound NADP+ per mole of hexamer. Apparently, this NADP+ is involved in the catalytic mechanism of GMD.

Chromatography, Gel↗

Effects of the murine L929 and L1210 cell lines on nitric oxide and TNF-alpha production by RAW 264.7 murine macrophages.

Co-cultures of the murine macrophagic cell line RAW 264.7 with the L929 fibrosarcoma cell line, but not with the leukemia L1210 cell line, showed enhanced NO production over control RAW 264.7 cells. This potentiating effect, which was observed in detectably mycoplasma-free conditions and required low concentrations of recombinant murine IFN-gamma, was due to soluble factors released from L929 cells and not to physical contact between the two cell types. The soluble factors were able to induce TNF-alpha in the macrophages and to potentiate the TNF-alpha release induced by IFN-gamma. Increased generation of NO in RAW 264.7 cells co-cultured with L929 cells was prevented by a neutralizing anti-TNF-alpha antibody, suggesting that TNF-alpha is an autocrine factor for iNOS expression in these conditions. Also the L929 cell line showed a 4- to 5-fold enhanced NO production following co-culture with RAW 264.7 cells, thus indicating that exposure of tumor cells to macrophages can lead to an increased iNOS expression in tumor cells themselves.

Animals↗

Influence of surface treatments developed for oral implants on the physical and biological properties of titanium. (I) Surface characterization.

We present an investigation of the physico-chemical surface properties of commercially pure titanium coverslips which were submitted to various treatments designed to optimize their topography in view of application in oral implantology. The surface microroughness, chemical composition and water wettability were analyzed on titanium coverslips prepared by mechanical polishing, acid attack in HCl/H2SO4, after mechanical polishing or sandblasting, and titanium plasma-spray. The chemical composition has been measured by Auger electron spectroscopy. The treatments have no major influence on the surface chemical composition and all the samples display a composition approaching that of TiO2 with minor amounts of carbon, sulfur, silicon and calcium as impurities. The roughness has been measured by scanning force microscopy on an area of 20 microns x 20 microns on each sample. Polished titanium is smooth (peak-to-valley roughness 81 nm), whereas the acid-attacked surfaces exhibit a micro-roughness in the microns range (2100 nm for polished and acid attacked; 3600 nm for sandblasted and acid attacked) which is quite reproducible over large areas of the sample. The acid attacked samples present a subsurface layer which contains hydrogen below the native passivating oxide layer. Water wettability measurement shows that all surfaces are hydrophobic with a slightly higher contact angle for the acid attacked surfaces. The different treatments analyzed in this study essentially influence the surface roughness by preserving the chemical composition and the wettability properties of titanium native oxide surface layer.

Dental Polishing↗

Influence of surface treatments developed for oral implants on the physical and biological properties of titanium. (II) Adsorption isotherms and biological activity of immobilized fibronectin.

The influence of titanium surface properties on in vitro adsorption isotherms of fibronectin, promotion of Staphylococcus aureus adhesion, and binding of a monoclonal antibody to the cell-binding domain of fibronectin was examined. Treatments producing different surface roughness were applied to a single side of commercially pure titanium coverslips, which was either mechanically polished (P), or polished and then acid attacked with H2SO4/HCl (PA), or sandblasted and then acid attacked (SLA), whereas the untreated side was blocked by an albumin coating layer. Incubation of the coverslips with concentrations of soluble 3H-labelled fibronectin increasing from 1 to 16 micrograms/ml led to the saturation of all surfaces with immobilized protein from 4 to 16 micrograms/ml. Promotion of S. aureus adhesion by fibronectin adsorbed on all surfaces and binding of the monoclonal antibody to its cell-binding domain was to some extent proportional to the amount of immobilized protein but also showed some minor differences between surfaces. More important material-related differences were observed when fibronectin adsorption isotherms were expressed as a function of the effective, roughness-corrected surface area, yielding amounts of immobilized fibronectin on the rough PA and SLA titanium surfaces which were 50% lower than those adsorbed on either smooth P or polymethylmethacrylate coverslips used as controls. In conclusion, surface treatments increasing the surface roughness of titanium do not increase, but may partly decrease in vitro adsorption of fibronectin. Despite adsorbing different amounts of fibronectin, both rough and smooth titanium surfaces promote normal expression of 2 major functional domains of this protein.

Adsorption↗

Clinical response to local delivery of tetracycline in relation to overall and local periodontal conditions.

The purpose of this study was to determine the clinical response to local delivery of tetracycline in relation to clinical and microbiological conditions of the other teeth. 4 deep pockets were monitored in 19 subjects with multiple deep periodontal lesions and high counts of P. gingivalis. In 9 patients (LT) only 2 of the selected lesions were treated by placement of tetracycline fibers (Actisite), while the rest of the dentition was left untreated. In the other 10 patients, all teeth were supragingivally scaled and then treated by application of polymeric tetracycline HCl containing fibers, the whole dentition was subject to full mouth scaling and root planing, and the patients rinsed with 0.2% chlorhexidine (FT). A significant reduction in mean PPD was observed in all treated sites after two months. This reduction was maintained over the following 4 months. The magnitude of the effect was significantly greater in the FT group (1.74 mm) than in the LT group (0.88 mm). The mean attachment level changes were similar after 2 months in locally and fully treated subjects. A tendency of relapse was noted for treated sites in LT patients from month 2 to 6. A level of statistical significance was not reached for this effect. Data from measurements recorded at 6 sites around all teeth in the full mouth treated patients were analyzed using multiple linear regression. This analysis showed local changes in PPD and AL were significantly and strongly correlated with the baseline value of the respective parameter at the same site. In addition, more pocket depth reduction was noted if a site was not bleeding on probing at 6 months, if the location of a site was not approximal and if the tooth was not a second molar. Sites located on second molars showed also less AL gain than sites located on other teeth. Smokers showed significantly less reduction in PPD and significantly less AL gain. Furthermore, if subjects had a high % of pockets deeper than 4 mm at baseline they showed significantly less attachment gain.

Adult↗

Composition of plaque-associated lesions in the gingiva and the peri-implant mucosa in partially edentulous subjects.

The purpose of the present investigation was to study characteristics of the plaque associated lesions in the gingiva and the adjacent periimplant mucosa sampled from the same subjects. 20 partially edentulous patients (12 female and 8 male, 30-60 years of age) volunteered to participate in the study. They had all been treated for moderate to advanced periodontal disease. Edentulous regions had been restored with implants. The restorative therapy had been completed 6-24 months prior to soft tissue biopsy. Samples of gingival tissue (GM) and periimplant mucosa (PIM) from an "interproximal surface" of one tooth site and one implant site of the same jaw were harvested. One portion of the biopsy was embedded in EPON, stained in PAS and toluidine blue and used for histometric and morphometric analyses. The 2nd portion of the biopsy was snap frozen in liquid nitrogen. 15 sections, about 5 microns thick, were prepared in a cryostat and used for immune histochemical staining. The analysis of the sections included determination of the size of the lesions as well as assessments of various cells and cell markers. In all samples of both PIM and GM discrete infiltrates of inflammatory cells (ICT) were found in the connective tissue lateral to the junctional epithelium. The ICT of PIM occupied on the average 0.17 +/- 0.14 mm2 of the soft tissue, while the corresponding lesion in GM occupied an area that was 0.25 mm2 +/- 0.21 mm2 large. The density of CD19 positive cells was 7 times higher in GM than in PIM (3.7 versus 0.5) while the densities of CD3 positive cells were 7.5 (GM) and 4.7 (PM) respectively. The density of PMN elastase positive cells was about 3 times higher in GM than in PIM (3.7 versus 1.2). Care must be exercised when these differences are interpreted. It is possible that a prolonged exposure of the implant site to the oral environment may induce both qualitative and quantitative changes of the infiltrate in PIM.

Adult↗

Clinical trials on implants in regenerated bone.

The lack of a sufficient volume of healthy jaw bone was the most important local contraindication for the placement of dental implants in the 1980s. Thus, several attempts have been made in the past 10 years to develop new surgical methods for the reconstruction of lost jaw bone in potential implant patients. At present, methods such as guided bone regeneration utilizing barrier membranes or sinus lift procedures are widely used in dental offices. There are, however, some concerns about the efficacy and predictability of these procedures. There is a need to determine how new bone regenerative procedures should be properly evaluated. The goal of the present paper is to establish some guidelines for clinical trials on implants in regenerated bone. It is proposed that such trials should be conducted in two main phases according to predetermined endpoints. The first main phase evaluates the new bone regenerative procedure. This almost always requires an initial development period including step-by-step modifications to identify essential surgical factors for the achievement of successful treatment outcomes. At the end, the surgical protocol will be established in detail. This is followed by the validation period to evaluate efficacy and predictability of this surgical protocol in a clinical study with consecutively treated patients. After successful bone regeneration has been properly documented, the second main phase evaluates the implants inserted in regenerated bone in a prospective clinical study utilizing the same protocol as for implants in pristine, non-regenerated bone. This documentation allows the evaluation of tissue integration of these implants and their 5-year success rates.

Alveolar Ridge Augmentation↗

Synthesis of GDP-L-fucose by the human FX protein.

FX is a homodimeric NADP(H)-binding protein of 68 kDa, first identified in human erythrocytes, from which it was purified to homogeneity. Its function has been unrecognized despite partial structural and genetic characterization. Recently, on the basis of partial amino acid sequence, it proved to be the human homolog of the murine protein P35B, a tumor rejection antigen. In order to address the biochemical role of FX, its primary structure was completed by cDNA sequencing. This sequence revealed a significant homology with many proteins from different organisms. Specifically, FX showed a remarkable similarity with a putative Escherichia coli protein, named Yefb, whose gene maps in a region of E. coli chromosome coding for enzymes involved in synthesis and utilization of GDP-D-mannose. Accordingly, a possible role of FX in this metabolism was investigated. The data obtained indicate FX as the enzyme responsible for the last step of the major metabolic pathway resulting in GDP-L-fucose synthesis from GDP-D-mannose in procaryotic and eucaryotic cells. Specifically, purified FX apparently catalyzes a combined epimerase and NADPH-dependent reductase reaction, converting GDP-4-keto-6-D-deoxymannose to GDP-L-fucose. This is the substrate of several fucosyltranferases involved in the correct expression of many glyconjugates, including blood groups and developmental antigens.

Amino Acid Sequence↗

Topographic distribution of black-pigmenting anaerobes before and after periodontal treatment by local delivery of tetracycline.

The purpose of this study was to determine the distribution of black-pigmenting Gram-negative bacteria in the dentition of 10 adult periodontitis patients before and after treatment by local delivery of tetracycline. The subjects were selected based on a screening for high counts of Porphyromonas gingivalis and multiple deep pockets. Subgingival microbial samples were taken from the mesial and distal aspect of every tooth (44 to 56 sites per patient) before treatment, and after one and two months. Therapy included full mouth scaling and root planing, chlorhexidine mouth rinsing and placement of tetracycline HCl fibers (Actisite) on all teeth. 63.4% of 524 baseline samples yielded total anaerobic viable counts > or = 10(6) CFU/ml; P. gingivalis was found in 59.2% and Prevotella intermedia in 56.9%. One month after treatment, the % of samples with > or = 10(6) CFU/ml was reduced to 9.4%, 5.3% were P. gingivalis- and 5.1% P. intermedia- positive. After 2 months, 9.6% samples yielded > or = 10(6) CFU/ml, 5.2% were P. gingivalis- and 9.4% P. intermedia- positive. 20 of the 39 sites with a persistence of P. gingivalis were located on second molars. Logistic regression models were utilized to explain the persistence of P. gingivalis, using site location and other clinical parameters as independent variables. These analyses indicated a strong association of site location, pocket depth and bleeding on sampling with persistence of P. gingivalis. The study shows that local delivery of tetracycline is highly effective in reducing the prevalence and proportions of black-pigmenting anaerobes within a dentition. Bleeding deep pockets of second molars have an increased risk for persistence of these anaerobes.

Administration, Topical↗

Some characteristics of the ridge mucosa before and after implant installation. A prospective study in humans.

The aim of the present investigation was to study some tissue characteristics of the ridge mucosa before and after implant installation. 9 partially edentulous patients were included in the study. At the time of fixture installation, 1 recipient site in each patient was selected for soft tissue biopsy. Abutment connection and restorative therapy were performed after 3-6 months. When the implants had been in function for about 6 months, a soft tissue sample was obtained from the keratinized peri-implant mucosa at the 1 implant site from which the first biopsy was obtained. Each biopsy was divided into 1 mesial and 1 distal portion. The mesial tissue portion was fixed in a buffered fixative and embedded in EPON. Sections were produced, stained in PAS and toluidine blue and used for histometric and morphometric analyses. The distal portion of the biopsies were embedded, snap frozen in liquid nitrogen and stored in a freezer at -70 degrees C. From each tissue portion, 15 sections were prepared in a cryostat and exposed to immunohistochemical staining. A panel of monoclonal antibodies was used and the avidin-biotin method for staining was applied. The sections were examined morphometrically. Both tissues harbored a well keratinized oral epithelium and a connective tissue, the composition of which was close to identical in terms of collagen, cells and vascular structures. The peri-implant mucosa, however, also included a junctional epithelium which evidently allowed the penetration of products from the oral cavity. As a consequence, the periimplant mucosa in comparison to the masticatory mucosa was found to contain significantly enhanced numbers of different inflammatory cells.

Adult↗

Extracellular ATP enhances mRNA levels of nitric oxide synthase and TNF-alpha in lipopolysaccharide-treated RAW 264.7 murine macrophages.

Extracellular ATP potentiates, by activation of P2y-type purinergic receptors, the production of NO induced by low doses of lipopolysaccharide (LPS) in the murine macrophagic cell line RAW 264.7 (Tonetti et al. (1994) Biochem. Biophys. Res. Commun. 203, 430-434). Release of TNF-alpha, known to be an autocrine factor for iNOS expression, was enhanced, too, following exposure of either LPS-induced or uninduced cells to externally added micromolar ATP. Reverse transcription-PCR experiments showed that extracellular ATP increases mRNA levels of both inducible NO synthase (iNOS) and of TNF-alpha to extents comparable to those of enzymatic and biological activities, respectively. These data demonstrate that activation of purinergic receptors by extracellular ATP results in an enhanced expression of the iNOS and TNF-alpha genes.

Adenosine Triphosphate↗

Glucose 6-phosphate dehydrogenase from human erythrocytes: identification of N-acetyl-alanine at the N-terminus of the mature protein.

Glucose 6-phosphate dehydrogenase from human erythrocytes has a blocked amino-terminus and no information could be obtained by direct sequencing of the intact protein. The peptide corresponding to the amino-terminal region was isolated from a tryptic digest of the whole protein and identified on the basis of its amino acid composition and of the failure to obtain Edman degradation. Determination of peptide mass by fast atom bombardment mass spectrometry allowed identification of the blocked amino-terminal residue as N-acetyl-alanine.

Alanine↗

Copper(II) complexes encapsulated in human red blood cells.

Copper(II) complexes were encapsulated in human red blood cells in order to test their possible use as antioxidant drugs by virtue of their labile character. ESR spectroscopy was used to verify whether encapsulation in red blood cells leads to the modification of such complexes. With copper(II) complexes bound to dipeptides or tripeptides, an interaction with hemoglobin was found to be present, the hemoglobin having a strong coordinative site formed by four nitrogen donor atoms. Instead, with copper(II) complexes with TAD or PheANN3, which have the greatest stability. ESR spectra always showed the original species. Only the copper(II) complex with GHL gave rise to a complicated behavior, which contained signals from iron(III) species probably coming from oxidative processes. Encapsulation of all copper(II) complexes in erythrocytes caused a slight oxidative stress, compared to the unloaded and to the native cells. However, no significant differences were observed in the major metabolic properties (GSH, glycolytic rate, hexose monophosphate shunt, Ca(2+)-ATPase) of erythrocytes loaded with different copper(II) complexes, with the exception of methemoglobin levels, which were markedly increased in the case of [Cu(GHL)H-1] compared to [Cu(TAD)]. This latter finding suggests that methemoglobin formation can be affected by the type of complex used for encapsulation, depending on the direct interaction of the copper(II) complex with hemoglobin.

Antioxidants↗

A novel dimeric fluoropyrimidine molecule behaves as a remote precursor of 5-fluoro-2'-deoxyuridine in human erythrocytes.

A new dimeric fluoropyrimidine molecule (5-fluoro-2'-deoxyuridilyl-(5'-->3')-5-fluoro-2'-deoxy-5'-uridylic acid, Compound 1) was chemically synthesized from two separately deblocked 5-fluoro-2'-deoxyuridine mononucleotide moieties. Other structurally related nucleotides, 5-fluoro-2'-deoxyuridine-5'-diphosphate (FdUDP), 5-fluoro-2'-deoxyuridine-5'-triphosphate (FdUTP) and 5-fluoro-2'-deoxyuridine-3',5'-bisphosphate were also synthesized. The structures of all synthesized molecules were verified by mass spectrometric analyses and were consistent with expected molecular mass values. The metabolic patterns of conversion of Compound 1 were investigated both in human erythrocyte lysates and in intact erythrocytes previously loaded with this molecule according to a highly conservative encapsulation procedure. In hemolysates, Compound 1 was transformed to 5-fluoro-2'-deoxyuridine (FUdR) and to 5-fluorouracil (FU) through the intermediate formation of 5-fluoro-2'-deoxyuridine-5'-monophosphate (FdUMP). In intact red cells, Compound 1 still generated FUdR (and to a lesser extent FU), that was then released outside. The conversion pathway involves a phosphodiesterase-catalysed hydrolysis of Compound 1 into two FdUMP molecules, followed by further dephosphorylation to FUdR and by partial conversion to FU. Unlike hemolysates, Compound 1-loaded intact erythrocytes featured transient formation of FdUDP and FdUTP, both metabolites representing storage compounds for the final and sustained production of FUdR and FU. Therefore, human erythrocytes can behave as bioreactors ensuring the time-controlled production and delivery of the two powerful antitumor drugs FUdR and FU from encapsulated Compound 1. This new molecule and other compounds as well (e.g. FdUDP and FdUTP) can be viewed as useful pre-prodrugs, exploitable for intraerythrocytic bioconversion reactions.

Erythrocytes↗

Extracellular ATP potentiates nitric oxide synthase expression induced by lipopolysaccharide in RAW 264.7 murine macrophages.

Inducible nitric oxide synthase (iNOS) activity in the murine macrophage cell line RAW 264.7 was increased from two- to four-fold after co-exposure of the cells to low doses of bacterial lipopolysaccharide (LPS) and micromolar ATP, compared to LPS alone. Extracellular ATP and its analogs "per se", i.e. without LPS, were not able to induce iNOS activity. The stimulating effect of UTP too, the concentration range of activity (1-100 mM nucleotides) and the rank of potency (ATP-gamma-S = AMP-PNP > ATP = ADP >> AMP-CPP = UTP) seem to indicate an involvement of P2y-type purinergic receptors. GTP, CTP and adenosine were virtually ineffective. These data suggest that binding of extracellular nucleotides to purinergic receptors may increase nitric oxide production by macrophages. This effect might occur in pathological conditions (i.e. inflammation/infection or trauma) where significant amounts of intracellular ATP can be released due to cellular damage.

Adenine Nucleotides↗

Synergistic cytotoxicity of carboplatin and divicine on murine erythroleukemic cells.

Carboplatin (CBDCA) and the pyrimidine aglycone divicine displayed cytotoxic effects of murine erythroleukemic cells (MELC), with ID50 values of 158 and 37 microM, respectively. Combination of CBDCA and divicine, at a 2:1 ratio, increased cytotoxicity considerably. Under specific conditions of time schedule of administration, the association of CBDCA and divicine resulted in a clear synergistic activity. Alkaline elution studies on both unirradiated and gamma-irradiated MELC demonstrated opposite patterns of DNA damage with the two molecules. Thus, CBDCA elicited DNA interstrand crosslinks (ISC), while divicine resulted in DNA single strand breaks (SSB). Association of both molecules led in the unirradiated cells to a higher SSB frequency than recorded with divicine alone. Accordingly, intracellular activation of CDBCA by redox cycling of divicine seems not to be involved. Rather, intracellular platinum appears to enhance cytotoxicity of divicine.

Animals↗

Digital image processing. I. Evaluation of gray level correction methods in vitro.

The aims of this study were a) to assess in an in vitro model the amount of density changes measured in digitally subtracted images due to electronic noise and image alignment error, and b) to test the accuracy of different gray level correction procedures in the reduction of densitometric image mismatches. A section of a pig mandible in which a hollow cylinder ITI Bonefit implant had been placed was used to obtain pairs of standardized radiographs. Series of radiographs were obtained with different exposure times (0.34, 0.39, 0.44, 0.51, 0.58 s). The radiographs were captured through a video camera, digitized and stored in a personal computer. The same radiographic image was recorded and subtracted from itself 10 times to study the error of the method due to electronic transformations of the images and image alignment. The noise due to the analog-to-digital transformation of the radiographic images was calculated to be +/- 2 gray levels i.e., 2% of the scale of gray levels. This kind of error was reduced up to 40% by capturing the images more than once and averaging the values per pixel. The manual superimposition of the images to be subtracted caused an increase of the error to +/- 3 gray levels (2.7%). Seven methods of gray level correction based either on a linear least squares approximation or on the cumulative density function (CDF) were tested. The group based on the CDF algorithm gave significantly better results than any other method. Pixels yielding differences smaller or equal to +/- 7 gray levels (5.5% of the scale of gray levels) should be excluded from further calculations in order to eliminate (false-positive) errors due to the normalizing algorithms. Furthermore, the CDF method on an arbitrarily chosen area of the image or on the wedge seems to give to subtraction images the ability of revealing real subtle changes in tissue density (fewer false-negative errors). The use of reference structures did not futher improve the ability of the normalization methods to correct gray level mismatches between radiographic pairs.

Absorptiometry, Photon↗