Final Impression Research Articles

Prosthetic Rehabilitation of a Patient after Hemimaxillectomy due to Squamous Cell Carcinoma in the Maxillary Sinus: Case Report

AbstractRehabilitation of uncontrolled diabetics with impairments due to acquired defects is complex. More significant defects are more challenging to treat than smaller ones, which can often be corrected surgically. When surgical reconstruction is not possible, the preferred treatment method for facial defects is prosthetic reconstruction. An obturator prosthesis is a standard and efficient method for treating such maxillary defects. This case report aims to evaluate patients' satisfaction with uncontrolled diabetes with improved speech, swallowing, and articulation, and achieving acceptable aesthetics after rehabilitation.This case report details the ultimate obturator prosthesis therapy for an elderly male patient who had a hemimaxillectomy because of squamous cell cancer of the maxillary air sinus. The patient had uncontrolled diabetes and mobility grade 1 of the remaining upper teeth. A gauze coated with Vaseline blocked a significant medial undercut in the defect. The primary, final impression, and jaw relationships were recorded to aid postoperative speech and deglutition. Normal palatal contours were replicated to ensure functional outcomes. The obturator portion was hollowed to reduce its weight and prevent unnecessary strain on the supporting teeth and tissues. The obturator was fabricated using heat-cured acrylic resin to allow future additions in the event of tooth extraction and relining.A well-made and constructed obturator for diabetic patients can offer high adaptability and functionality. Multidisciplinary planning is essential for effective dental care and functional rehabilitation, and avoiding oroantral communication. This will significantly improve the patient's quality of life.

Navigating the Social Environment: Linking Motivations, Impressions, and Behaviors Via a Sampling Approach to Trustworthiness.

Our understanding of impression formation comes from experiments constraining participants' control over information sampling. This limits our understanding of how people sample information when forming impressions as well as the effects of self-generated samples on impressions. Our paradigm allows participants to actively collect information samples. This work investigates how people explore the social environment and how sampled information informs resulting impressions. Four experiments tested theoretically-driven predictions regarding information sampling patterns under interested and disinterested information search. Under interested search, participants truncated the sampling of social targets showing early untrustworthy behavior. Under disinterested search, participants sampled extensively and systematically, avoiding small-sample biases. The sampled information, once obtained, accurately determines final impressions. Moreover, we documented a direct link between sampled information and subsequent behaviors (partner selection in trust games, trustworthiness expectations). By investigating sampling-based trustworthiness impressions, the present research informs the origins of trustworthiness and sampling accounts of judgment and decision-making.

Constructing a Large Language Model to Generate Impressions from Findings in Radiology Reports.

Background The specialization and complexity of radiology makes the automatic generation of radiologic impressions (ie, a diagnosis with differential diagnosis and management recommendations) challenging. Purpose To develop a large language model (LLM) that generates impressions based on imaging findings and to evaluate its performance in professional and linguistic dimensions. Materials and Methods Six radiologists recorded imaging examination findings from August 2 to 31, 2023, at Shanghai General Hospital and used the developed LLM before routinely writing report impressions for multiple radiologic modalities (CT, MRI, radiography, mammography) and anatomic sites (cranium and face, neck, chest, upper abdomen, lower abdomen, vessels, bone and joint, spine, breast), making necessary corrections and completing the radiologic impression. A subset was defined to investigate cases where the LLM-generated impressions differed from the final radiologist impressions by excluding identical and highly similar cases. An expert panel scored the LLM-generated impressions on a five-point Likert scale (5 = strongly agree) based on scientific terminology, coherence, specific diagnosis, differential diagnosis, management recommendations, correctness, comprehensiveness, harmlessness, and lack of bias. Results In this retrospective study, an LLM was pretrained using 20 GB of medical and general-purpose text data. The fine-tuning data set comprised 1.5 GB of data, including 800 radiology reports with paired instructions (describing the output task in natural language) and outputs. Test set 2 included data from 3988 patients (median age, 56 years [IQR, 40-68 years]; 2159 male). The median recall, precision, and F1 score of LLM-generated impressions were 0.775 (IQR, 0.56-1), 0.84 (IQR, 0.611-1), and 0.772 (IQR, 0.578-0.957), respectively, using the final impressions as the reference standard. In a subset of 1014 patients (median age, 57 years [IQR, 42-69 years]; 528 male), the overall median expert panel score for LLM-generated impressions was 5 (IQR, 5-5), ranging from 4 (IQR, 3-5) to 5 (IQR, 5-5). Conclusion The developed LLM generated radiologic impressions that were professionally and linguistically appropriate for a full spectrum of radiology examinations. © RSNA, 2024 Supplemental material is available for this article.

High-Dose Propranolol for Severe and Chronic Aggression in Autism Spectrum Disorder: A Pilot, Double-Blind, Placebo-Controlled, Randomized Crossover Study.

Despite the use of behavioral interventions and psychotropic medications, many individuals with autism spectrum disorder (ASD) who engage in severe aggression remain refractory to conventional treatment. Propranolol, a beta-blocker, has accumulated much anecdotal evidence as a promising option. However, well-designed studies are rare, and the apprehension about cardiovascular side effects from large doses continues to exist. The aims of this study were (1) to demonstrate the feasibility of treating aggression with high-dose propranolol using telehealth study visits and (2) to document cardiac safety. This study utilized a randomized, double-blind, placebo-controlled, crossover design. Dosing was titrated up in a flexible but stepwise fashion until therapeutic response was obtained or up to 200 mg tid. Following washout, those who were assigned propranolol were crossed over to placebo and vice versa. Six participants between the ages 12-19 participated. The primary outcome measures were the final Clinical Global Impression Improvement Scale (CGI-I) and the Aberrant Behavior Checklist-Community Irritability (ABC-C/I) scores at 200 mg tid. The CGI-I indicated a 50% reduction in symptoms in the propranolol phase, while the ABC-I indicated a 37% reduction in comparison to placebo. The effect sizes ( r ) for the CGI-I and the ABC-C/I were large, -0.74 and -0.64, respectively. The average blood pressure was 122/68 during the placebo phase and 109/72 during the propranolol phase. All Holter monitor exams were unremarkable. These results suggest that propranolol is an effective option in decreasing aggression in individuals with ASD. As this was a small study, a larger clinical trial is needed.

Does delayed phase imaging in CT angiography provide additional information in patients with suspected active bleeding?

We hypothesize that delayed phase imaging does not provide additional diagnostic information in patients who undergo multi-phasic CTA for suspected active bleeding. Data on patients who underwent multiphasic CTA (pre-contrast, arterial, porto-venous, and delayed phases) for suspected acute bleed were retrospectively collected between January 2019 and November 2021. CTA images were reviewed by a general radiologist, an interventional radiologist, and a body imaging radiologist independently. Each reader evaluated if delayed phase images provided additional information that would change the final impression of the CTA report. Additional information regarding bleeding location, time needed for delayed image acquisition, and radiation exposure were also obtained. A total of 104 patients with CTAs were analyzed with an average age of 58 years ± 22. Studies rated with absent additional findings on delayed images were 102 (98.1%) by the interventional radiologist, 101 (97.1%) by the body imaging radiologist, and 100 (96.1%) by the general radiologist with percent agreement of 96.15% (kappa 0.54, p < 0.001). All the findings were characterized as unlikely to be clinically significant. Mean time added to complete a delayed phase images was 3.61 ± 3.4min. The average CT dose length product (DLP) for the total exam was 3621.78 ± 2129.57 mGy.cm with delayed acquisition adding a mean DLP of 847.75 ± 508.8 mGy.cm. Delayed phase imaging does not provide significant additional diagnostic information in evaluating patients with suspected active bleeding but is associated with increased examination time and radiation exposure.

A method of impressing flabby ridge

Flabby ridge remained a challenge in dental clinical practice to obtain an accurate impression for edentulous patients. During the traditional impression making process, the excessive and displaceable soft tissue are usually compressed. In this article, we presented an impression method by using a modified special stock tray, impression compound and polyvinyl siloxane impression materials.•the suitable stock tray was modified with holes about 5 mm diameter in the corresponding area to the crest of the flabby ridge.•the primary impression was made by position the modified tray with the softened compound impression on the edentulous ridge, avoiding the area of the flabby ridge.•the final accurate impression was obtained by using the light body polyvinyl siloxane impression material.

Economical Prosthodontic Management of Microstomia Patient with Hinge Denture -

Microstomia is an abnormally reduced oral aperture. In the literature, it is not classified by any particular size criteria, rather defined by its effects on function and esthetics. Prosthodontic management of edentulous patients with microstomia is a challenging task. Use of conventional methods for recording an impression and fabricating prosthesis is not effective in such patients. To fabricate well-fitting prosthesis, accuracy of impression recording important anatomic landmarks is essential. Formation of an exacting custom tray and diagnostic cast is critical for final impression accuracy. Provision of a well-fitting prosthesis in microstomia patient will restore esthetics, comfort, and function with oral and systemic patient wellbeing. This paper presents a case report of managing an edentulous microstomia patient with sectional removable prosthesis.

Clinical Performance of Computer-Aided Design (CAD)/Computer-Aided Manufacturing (CAM) Resin Nanoceramic Endocrowns in Restoring Molars: An In Vivo Study.

Background It is difficult to determine the optimal method for restoring endodontically treated teeth, as several factors affect this decision. Functional requirements and the amount of remaining coronal tissue are considered the most important factors in choosing the best restoration for those teeth. Endocrown was introduced as a conservative alternative for endodontically treated and coronally damaged teeth. Aim The aim of this study is to assess the clinical performance of the nanoceramic system for molar endocrowns by evaluating color change, gingival condition, prosthesis integrity, and the presence of secondary caries. Materials and methods The sample consisted of 20 endocrowns. The teeth were prepared with at least 2 mm of wall thickness and a cavity depth of 4 mm from the occlusal surface. The final impression was taken, and the prostheses were adhered using dual-cure resin cement. It was clinically evaluated according to clinical success criteria (United States Public Health Service) in terms of color stability, gingival indexes, integrity of the restoration, and the presence of secondary caries after a week, three months, six months, and a year. The statistical study was conducted using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, NY, USA), and the results were considered statistically significant at the 95% level of significance. The Friedman test was used to study the significance of the differences in the average values of color change, plaque index, and the integrity of the prostheses during follow-up periods. Results The study showed a gradual increase in the degree of color change with follow-up periods. Furthermore, there was no significant difference in the incidence of gingival changes, the integrity of the prosthetic margins, or the occurrence of secondary caries during the follow-up periods. Conclusions Within the limitations of this study, an endocrown made of CeraSmart nanoceramic is an acceptable option for crowning decayed and endodontic-treated molars with acceptable clinical performance.

Modified Roll Envelope Technique Combined With Apically Repositioned Flap (MRARF) for Peri-Implant Soft Tissue Augmentation-A Case Series.

In the present case series, we performed implant surgery using a modified roll envelope technique and an apically repositioned flap (MRARF). To improve patients' peri-implant soft tissue phenotypes, they underwent dental implantation following the buccal contour concavities, inadequate keratinized tissue width, and soft tissue thickness simultaneously. This case series includes 4 patients treated between July 2021 and February 2022 who received dental implants and guided bone regeneration treatment 6 months earlier and were to be taken up for second-stage surgery. They were eligible for the MRARF technique if each implant site showed a labial and buccal deficiency and a reduced keratinized mucosa width than the adjacent teeth. Sutures were removed 2 weeks after surgery, and a provisional restoration was delivered. A final impression was taken at 6 weeks to produce the definitive implant-supported restoration. All surgery sites healed uneventfully, and no postoperative pain or excessive swelling was reported. The modified flap design allowed for increasing the width and thickness of keratinized mucosa with a minimally invasive technique. A harmonious color, texture, and mucogingival junction position that matched the surrounding tissue and adjacent teeth was achieved, and all patients were satisfied with the final results. MRARF at second-stage implant surgery could obtain satisfactory results regarding vertical and horizontal aesthetic gingival contours and an adequate width and thickness of keratinized mucosa around the implants.

A Questionnaire-based Study on Impression Materials and Techniques for Complete Denture Construction among Dentists Practicing in Central/Western Regions of Libya

Background: The success of complete dentures mainly depends on impression-making accuracy; thus, dentists need to select the proper impression materials and techniques to achieve optimal outcomes. Objective: To determine the favoured impression materials and techniques used for complete denture construction among dentists practicing in the Central/Western regions of Libya. Materials and Methods: This study was conducted between July 2023 and September 2023. The questionnaire was comprised of 30 questions, which were divided into two parts including; 11 questions for demographic and professional attitude and 19 questions focused on professional steps of complete denture fabrication for edentulous patients. Results: The response rate for this questionnaire was (66%). It was revealed that (96.1%) of respondents used only irreversible hydrocolloid (alginate) as an ideal option for primary impressions. In response to the same question for final impressions, (45.8%) of participants exhibited that polyvinylsiloxane was the favourite choice. Regarding custom trays, (41.7%) of practitioners preferred using light-cured acrylic resin as a custom tray to take definitive impressions. (87.4%) of prosthodontists border molded the custom tray in sections by (81.9%), using modelling plastic impression compound by (92.1%). The most used philosophy for final impression making was the mucostatic impression technique by (50.4%), while (37.0%) used selective pressure and (12.6%) selected muco-compressive. Implant-supported overdenture was discussed as an alternative treatment by (65.4%). The obtained data was statistically analyzed using SPSS 28. Conclusion: This study reflects a diversity of opinion among Libyan dentists during the construction of complete dentures. The most commonly used material for primary impression was irreversible hydrocolloid (alginate) and for final impression was polyvinylsiloxane, which coincides with professional practices worldwide. Modelling plastic impression compound was the most preferred material for border molding. The mucostatic technique was the predominantly used impression philosophy for final impression making.

Prosthetic Rehabilitation of a Maxillectomy Patient with Restricted Mouth Opening Using an Altered Cast Technique: A Case Report

Deformity in the maxillofacial region caused by surgical resection of a tumor have an adverse effect on the patient's ability to swallow, masticate, phonate, and psychological state. These patients may have restricted mouth opening capacity due to several surgical procedures and scar contracture resulting from radiation therapy. Therefore due to restricted access to the oral cavity prosthetic rehabilitation of these patients becomes a challenging task. A precise impression of the resection defect is necessary for accurate obturation. This is not practical for patients who have restricted mouth opening, hence this crucial first step in the making of a good prosthesis is frequently accomplished by altering the conventional impression method. This clinical report details the prosthetic rehabilitation of a patient who was diagnosed with Adenoid cystic carcinoma of the left maxillary sinus. Patient underwent maxillectomy for tumor removal, which was worsened by trismus as a result of the procedure and radiation therapy. For orofacial rehabilitation and defect obturation, the patient was restored with a removable dental prosthesis with a hollow bulb obturator. An altered cast technique was used in the final impression making. This rehabilitation approach was successful in restoring lost function and appearance of the patient. Keywords: Maxillectomy, Hollow Obturator, Altered cast technique

Challenges in Distinguishing Rectal Leiomyosarcoma from Ovarian Malignancy: A Diagnostic Conundrum

Introduction: Rectal leiomyosarcoma is a rare malignant mesenchymal tumor accounting for &lt;0.1% of all malignant colorectal neoplasms and carries a grave prognosis. Case Presentation: A 50-year-old postmenopausal, P3L3 woman presented with complaints of abdominal pain for two months, dark-colored loose stools, 10-15 episodes per day for 2-3 months, and gradual weight loss for 4-5 months. On ultrasonography and MRI of the pelvis, a large irregular lobulated ill-defined solid lesion was seen arising from the right side of the pelvis measuring 14x8x14cm. The right ovary was not observed to be separate from the mass. There was omental thickening and peritoneal deposits with ascites. The final impression suggested a right-sided malignant ovarian mass with peritoneal dissemination (ORADS-5) with a differential leiomyosarcoma. Her tumor markers (CA- 125; CA19-9, and CEA) were raised. Given the strong dilemma between ovarian malignancy and leiomyosarcoma and the advanced stage of the disease, the patient was planned for an ultrasound-guided biopsy of the lesion. The histopathological report revealed atypical spindle cell proliferation with myoid features with the presence of multiple mitotic figures. The diagnosis of rectal leiomyosarcoma was further confirmed with immunohistochemical tests, which were positive for actin and desmin and negative for CD 117 and S100. The patient was referred to oncosurgeon for further management and was planned for surgical resection followed by chemotherapy with intravenous doxorubicin. Conclusion: Rectal leiomyosarcoma is commonly misdiagnosed as ovarian malignancy because of its exophytic growth and similar clinical features at the time of the presentation. Hence, clinicians must be aware of these differentials for the successful management of cases.

Tuberculous meningitis causing holocord longitudinally extensive transverse myelitis

ABSTRACT Longitudinally extensive transverse myelitis (LETM) is a neurological entity with characteristic inflammatory lesions in ≥3 vertebral segments of the spinal cord. It is most commonly associated with neuromyelitis optica spectrum disorder. Other causes include infections, autoimmune disorders, and neoplasms. Tuberculosis has been reported as a cause of LETM in few case reports. However, tuberculous meningitis (TBM) as a cause of LETM is extremely rare, more so with involvement of the complete spine cord from the brainstem to the conus medullaris. A 65-year-old female was admitted to our hospital with sudden-onset tetraplegia and sensory, bowel, and bladder involvement. With no significant past history, mild meningeal signs, and normal metabolic profile, cerebrospinal fluid analysis was done revealing polymerase chain reaction test positive for Mycobacterium tuberculosis. Magnetic resonance imaging of the spine was suggestive of complete spinal cord edema extending from the brainstem to the level of conus medullaris without skip lesions. A final impression of holocord LETM caused by TBM was suggested after ruling out other causes. The case highlights TBM as a potential cause of LETM especially in endemic countries, especially Asian and African countries, more so with holocord involvement without skip lesions.

Modification on Window Technique in Full Edentulous Patient with Hyperplasia

Complete denture is often used by patients that have edentulism. However, a long-term denture wearers commonly showed the hyperplastic growth of tissue called hyperplasia. This condition will present some difficulties for impression and retention. A 77 year old male patient reported to the RSGM UMY with a loose-fitting denture. He has been using it for 10 years. His old denture has suction cup on the palatal which no longer retentive and stable. The clinical examination showed the maxillary and mandibular complete edentulous ridge with flabby ridge area in the maxillary and mandibular anterior region. Patient is given treatment complete denture with acrylic resin material. In this case, window technique is used as the impression technique for a flabby ridge. Denture-induced hyperplasia is a condition of enlarged of fibrous tissue that could leads to poor denture retention, support, and stability. In the presence of hyperplasia, fabrication of as stable denture can be very arduous challenge. Special impression technique, like window technique frequently used on a case with flabby ridge. Window technique is a technique which use medium body impression material for the un-displaceable tissue whereas the flabby tissue impressed by using light body elastomer impression that must be freed from pressure. In patient with flabby ridge or hyperplasia due to denture, fabrication of impression need special technique like window technique which can be proven to ensure a final impression of the flabby ridge to improve denture stability, retention, support, and patient comfort.

Clinical comparative study on the accuracy of palatal rugae in models obtained by different impression materials and intraoral scanning.

Palatal rugae are frequently used in the evaluation of tooth movement after treatment in orthodontics and as a stable region in superimposition. It is important to note that the impression method and material used to record the rugae region affect the accuracy of the impression. The aim of this study is to compare the accuracy of palatal rugae, in three-dimensional (3D) by employing both conventional and digital impression methods. In this study, 22 patients (12 females, 10 males) mean age of 13.5 ± 1.7years old were selected with complete permanent dentition. Three different impressions were taken from the maxillae of the patients: conventional impression using silicone rubber impression material, conventional impression using alginate impression material, and optical impression using an intraoral scanner. The impressions' digital data were analyzed by the GOM Inspect (Version 2018, Braunschweig, Germany), a 3D analysis software. The Root Mean Square (RMS) values of the total ruga region were evaluated in this software. The data were statistically analyzed using the Jamovi program. The Kruskal-Wallis test and Mann-Whitney U test were performed due to the non-normal distribution of the data. There is no statistically significant difference between the comparison points of the right and left rugae's medial and lateral points and total rugae regions' RMS values. Although there was no statistically significant difference, the total RMS values of alginate and digital scan measurements showed closer results than the RMS values of silicone and digital scan measurements. The study found that there was no statistically significant difference in the total RMS values of the ruga region between traditional and digital impression methods. The treatment period in orthodontics is long. Different impression materials and methods can be used for diagnostic, mid-treatment, and final impressions. For superimpositions and treatment and post-treatment palatal ruga evaluations, traditional and digital impression methods are clinically acceptable and can be used as alternatives to each other.

The Value of Coronary Computed Tomography Angiography in Patients with a High Calcium Score.

We aimed to assess the agreement between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) to determine whether patients with a high coronary artery calcium score (CS) would benefit from CCTA. This cross-sectional study was conducted on patients suspected of having coronary artery disease. The patients underwent calcium scoring. The total CS and the number of calcified foci were determined. The calcium score index (CSI) was defined, and coronary arteries were evaluated by CCTA. ICA was performed, and reports of ICA were extracted. All the abovementioned variables were compared. For data analysis, the κ coefficient and the ROC curve were used. The study population consisted of 195 patients: 124 men (63.6%) and 71 women (36.4%). The median (IQR) value of CS was 529 (229-1042), ranging from 17 to 4717. In all 195 patients, the concordance between the final impression of CCTA and ICA was 90.2%, while the number and type of involved territories were similar at 57.9%. The highest agreement was seen in the left main and right coronary arteries, whereas the lowest agreement was detected in the left anterior descending and the left circumflex artery. The patients were categorized into different CS groups, and in those with a high CS (>1000), the agreement between CCTA and ICA concerning final impression and involved territories was similar to the whole group of patients. CCTA in patients with a high CS, even exceeding 1000, remains beneficial as the noninvasive available method.

An Evaluation of Retention of Complete Denture Bases Made with a “Modified Single-stage Impression” Technique Using a Heat-moldable Tray

Abstract Aim: Although most dental schools teach complete denture definitive impression techniques consisting of secondary impressions in border-molded custom impression trays, it has been found that later, graduates in clinical practice abandon this step because of its complexity and attempts to seek easier alternatives. To simplify two-stage techniques, single-step border molding with elastomeric impression materials and light-cured resin materials has gathered acceptance among clinicians. The study aims to evaluate the retention of record bases made with a modified single-stage impression technique that uses elastomeric impression material in a heat moldable tray with modeling compound as material for border molding. Settings and Design: This was an in vivo preliminary cohort study. Materials and Methods: Thirteen completely edentulous patients requiring complete dentures were included in the study. A traditional two-stage impression was made using custom trays fabricated over diagnostic casts and further border molding done with a modeling compound, and the final impression was made to use zinc oxide–eugenol impression material. Additionally, a modified single-stage impression technique using heat moldable impression trays was made. Master casts from each technique were made, and further record bases were made on each master cast. Wire loops were adapted on the palatal aspect of record bases. The retention of each record base was evaluated using a force gauge. Statistical Analysis: The Kolmogorov–Smirnov test was used to analyze the normality of variables and later Wilcoxon signed-rank test was applied. Results: The double-stage technique exhibited retention values in the range of 0.6–66.7 units, whereas the single-stage technique showed a range of 0.15–78.55. The tests showed no significant difference between double-stage and single-stage techniques (P &gt; 0.05). Conclusions: The single-stage technique using heat moldable trays with elastomeric impression material and modeling compound as a material for border molding can produce denture retention compared to the conventional technique that uses a two-step impression technique. The use of the modified single-stage technique can additionally save an extra appointment for patients, although it is better to use such a technique as an advanced impression technique and not as a training technique for beginners or students, as the material cost is substantially higher than the conventional two-stage technique.

Generative Pre-trained Transformer 4 analysis of cardiovascular magnetic resonance reports in suspected myocarditis: A multicenter study

PurposeDiagnosing myocarditis relies on multimodal data including magnetic resonance imaging (MRI), clinical symptoms, and blood values. The correct interpretation and integration of MRI findings requires radiological expertise and knowledge. We aimed to investigate the performance of Generative Pre-trained Transformer 4 (GPT-4), a large language model, for report-based medical decision-making in the context of cardiac MRI for suspected myocarditis. MethodsThis retrospective study includes MRI reports from 396 patients with suspected myocarditis and eight centers, respectively. MRI reports and patient data including blood values, age, and further clinical information were provided to GPT-4 and to radiologists with 1 (Resident 1), 2 (Resident 2), and 4 years (Resident 3) of experience in cardiovascular MRI and knowledge of the 2018 Lake Louise Criteria. The final impression of the report regarding the radiological assessment of whether myocarditis is present or not was not provided. The performance of GPT-4 and of the human readers were compared to a consensus reading (two board-certified radiologists with 8 and 10 years of experience in cardiovascular MRI). Sensitivity, specificity, and accuracy were calculated. ResultsGPT-4 yielded an accuracy of 83%, sensitivity of 90%, and specificity of 78%, which was comparable to the physician with 1 year of experience (R1: 86%, 90%, 84%, p=.14) and lower than that of more experienced physicians (R2: 89%, 86%, 91%, p=.007 and R3: 91%, 85%, 96%, p<.001). GPT-4 and human readers showed a higher diagnostic performance when results from T1- and T2-mapping sequences were part of the reports, for Residents 1 and Resident 3 with statistical significance (p=.004 and p=.02, respectively). ConclusionGPT-4 yielded good accuracy for diagnosing myocarditis based on MRI reports in a large dataset from multiple centers and therefore holds the potential to serve as a diagnostic decision supporting tool in this capacity, particularly for less experienced physicians. Further studies are required to explore the full potential and elucidate educational aspects of the integration of large language models in medical decision-making.

Ефективність цифрових і звичайних відбитків, що застосовуються при заміщенні дефектів твердих тканин зубів бічних зубів: оцінка сприйняття пацієнтів, комфорту лікування та витраченого часу

Introduction. The accuracy of the final impressions significantly affects the quality of the manufactured prosthesis. The transfer of perfect impressions to dental laboratories is always performed by dentists as part of the daily work of manufacturing prostheses in fixed prosthodontics. The accuracy of the impression depends on the materials themselves, the types of impression spoons and the impression technique. Various materials and printing techniques are used to obtain high-precision impressions. Goal. To conduct a comparative evaluation of the effectiveness of digital and conventional impressions used in the replacement of hard tissue defects of teeth of lateral teeth: assessment of patient perception, treatment comfort and time spent. To investigate the level of stress perceived by the patient at the stages of orthopedic treatment. Research material and methods. The study involved 46 patients aged 25-60 years (22 men and 24 women) who applied for orthopedic treatment of 57 defects of hard tissues of lateral teeth and had no previous experience of using conventional or digital impressions. The patient’s perceived source of stress was assessed using a modified version of the Norman Core test. Dental arch impressions were taken using polyester impression material, and bite registration was performed using polysiloxane bite registration material. Two weeks later, digital impressions and bite scans were performed on the same patients using an intraoral scanner. Both procedures were evaluated by the patients’ perception using a visual analogue scale (VAS). Patients’ perception of various impression-taking techniques was assessed using a standardized questionnaire. The stages of print processing (tray selection, working time, etc.) were recorded in seconds. The results. We found gender variations in psychoemotional reactions to specific dental interventions, highlighting potential psychological and emotional differences between male and female participants. the prevalence of strong and very strong fear of orthopedic surgery was slightly higher among female participants than among male participants. The average total time of obtaining a print using the traditional technique was 831.11 ± 5.56 s. It took half as much time to obtain prints using the digital method - 396.07 ± 7.98 seconds. In women, when receiving digital and conventional prints, the VAS indicators were lower than in men, which indicates a worse perception of the procedure by them. However, with the use of digital impressions, both women and men felt significantly higher VAS scores, which proved the advantage of using a digital method of obtaining impressions. The digital impression technique was most acceptable to both male and female patients and was preferred by all subjects. However, it is necessary to note the difference in the distribution of preferences between men and women. Conclusion. The results of the conducted study indicate that the effectiveness of the digital impression technique was higher than the traditional impression technique in terms of time spent on treatment, occurrence of adverse reactions, comfort and perception of subjects. Therefore, intraoral scanners are a clear advantage for patients visiting the dentist. Key words: defects of hard dental tissues, digital and standard impressions, patients’ feelings, stress level.

The Patient's Clinical Profile From a Neuro-Ophthalmology Center in Brazil: A Retrospective Study

Background: Neuro-ophthalmology (NO) is a subspeciality of Ophthalmology, which represents more than an intersection of Neurology and Ophthalmology. The present report highlights the increasing importance of the subspeciality in Brazil and provides a unique retrospective study of the patient's clinical profile of a NO reference center. Methods: Our study was retrospectively planned aiming to identify all neuro-ophthalmic cases of Instituto de Olhos of the Medical School Faculdade Ciências Médicas de Minas Gerais from August 2013 to March 2022.The first clinical diagnostic impression was selected from a predetermined list of 18 neuro-ophthalmologic conditions. Some NO conditions were eventually reclassified during the follow-up as the final clinical diagnosis impression. The concordance between the first and final clinical impressions was also investigated, as well as the patient's referral source. Results: The sample comprised 903 patients from which 56.4% were female. The mean age was 51.48 ± 20.93 years. Males were more frequent in lower age groups &lt;1 year (n = 3, 100%) and 1–9 years (n = 19/37, 51.4%). An external referral source represented 23.1%, and patients referred after basic ophthalmic consultation and from glaucoma service were 30.3% and 23.2%, respectively. The most encountered first clinical diagnostic impressions were isolated optic atrophy (13.1%), non–neuro-ophthalmic disease (11.7%), optic disc abnormalities (10.4%), ischemic optic neuropathies/retinal vascular occlusions (10.2%), and other visual field defects (9.0%). The kappa concordance coefficient among the first and final clinical diagnostic impressions was 0.53 (95% CI 0.48–0.59), indicating a moderate concordance level. The concordance among the most frequent diagnoses was lower in isolated optic atrophy (33%), other visual field defects (41%), and idiopathic optic neuritis (40%). Conclusions: Due to the limited number of epidemiology studies in neuro-ophthalmology, we highlight the importance of a NO service in the public health system in Brazil. It may certainly contribute to better strategy plan assistance among professionals and health care managers. This report should seemingly stimulate other studies regarding the relevant and unique features of this subspeciality, which is undoubtedly increasing its importance among patients, and in the scientific community worldwide.