Response accuracy of ChatGPT 3.5 Copilot and Gemini in interpreting biochemical laboratory data a pilot study.

With the release of ChatGPT at the end of 2022, a new era of thinking and technology use has begun. Artificial intelligence models (AIs) like Gemini (Bard), Copilot (Bing), and ChatGPT-3.5 have the potential to impact every aspect of our lives, including laboratory data interpretation. To assess the accuracy of ChatGPT-3.5, Copilot, and Gemini responses in evaluating biochemical data. Ten simulated patients' biochemical laboratory data, including serum urea, creatinine, glucose, cholesterol, triglycerides, low-density lipoprotein (LDL-c), and high-density lipoprotein (HDL-c), in addition to HbA1c, were interpreted by three AIs: Copilot, Gemini, and ChatGPT-3.5, followed by evaluation with three raters. The study was carried out using two approaches. The first encompassed all biochemical data. The second contained only kidney function data. The first approach indicated Copilot to have the highest level of accuracy, followed by Gemini and ChatGPT-3.5. Friedman and Dunn's post-hoc test revealed that Copilot had the highest mean rank; the pairwise comparisons revealed significant differences for Copilot vs. ChatGPT-3.5 (P = 0.002) and Gemini (P = 0.008). The second approach exhibited Copilot to have the highest accuracy of performance. The Friedman test with Dunn's post-hoc analysis showed Copilot to have the highest mean rank. The Wilcoxon Signed-Rank Test demonstrated an indistinguishable response (P = 0.5) of Copilot when all laboratory data were applied vs. the application of only kidney function data. Copilot is more accurate in interpreting biochemical data than Gemini and ChatGPT-3.5. Its consistent responses across different data subsets highlight its reliability in this context.

Enhancing Oral Hygiene in Children With Hearing Impairment: The Impact of Skit Video Interventions -A Randomized Controlled Trial.

Aim. This study aimed to assess the effectiveness of 3 interventions-skit video, pictorial, and sign language-in improving the oral hygiene of children with hearing impairment. Materials and Methods. Sixty children randomly divided into 3 groups: Skit video, Pictorial, and Sign language. The mean gingival and Oral Hygiene Index scores were recorded before and after interventions. A 1-way ANOVA was used for statistically significant difference between pre and post intervention scores. Results. A significant difference in mean oral hygiene and gingival index scores before and after interventions was found in Group A (P < .005). A statistically significant difference was also found between group A and B in inter group comparison of OHI and GI scores post intervention (P < .004). Conclusion. Skit video and pictorial intervention effectively improves oral health resulting in reduced mean oral hygiene and gingival scores.

Smile aesthetics in Pakistani population: dentist preferences and perceptions of anterior teeth proportion and harmony.

BACKGROUND: This study aimed to evaluate dentist perceptions of attractive smiles in the Pakistani population, considering different dental proportions. METHODS: Maxillary casts and digital images were used to create symmetrical representations of anterior teeth. dentists' preferences for good and bad teeth proportions, width/height ratios, and various dental proportions (golden, recurring esthetic dental (RED), golden percentage, Preston, and local/observed) were assessed using one sample and paired t-test. The Chi-square test was used to determine the gender disparities and factors affecting smile attractiveness. A p-value of ≤ 0.05 was taken as significant. RESULTS: The RED proportion emerged as the preferred choice for normal-sized teeth, with specialists and general dentists favoring it over the golden proportion. For tall teeth, the golden proportion was predominantly preferred. The golden percentage received limited preference for aesthetic smile construction. CONCLUSIONS: The smiles created using the principles of RED proportion were opted as the most attractive by local dentists. Factors such as tooth arrangement, color, and midline were highlighted as essential considerations in aesthetic smile construction.

The Analysis of Intermolar Width and Skeletal Base Class as a Predictor of Potential Maxillary Canine Impaction in Permanent Dentition: A Cross-Sectional Study.

Objectives. This study aimed to analyze the inter-molar width and skeletal base class to predict maxillary canine impaction in permanent dentition. Methods. This cross-sectional study was carried out between September 2021 to March 2022. Patients aged between 13 and 20 years were recruited. These patients' cone-beam computer tomography(CBCT), lateral cephalogram, and dental casts were collected and analyzed. For statistical analysis, T-test and Chi-square tests were applied. Results. A total of 92 patients were enrolled in this study. Inter-molar width was significantly decreased in patients with impacted canine(P < .001). The skeletal base classification was statistically significant when compare with intermolar width(P < .05). The location of impaction (P = .060), type of impaction(P = .435), and side of impaction(P = .239) were determined to be statistically insignificant. Conclusion. The Inter-molar width was decreased in patients with impacted canine; therefore, it may be a potential risk factor. The skeletal classification was found to affect inter-molar width in impacted canine patients.

Analysis of shade-matching ability in dental students: a comparative study under clinical and correcting light conditions.

BACKGROUND: Selecting the ideal tooth shade is essential to the success of aesthetic dental restorations. Students' cognitive abilities are involved in the multifaceted and intricate process of shade matching. Hence, the present study aimed to assess and compare the shade-matching ability of undergraduate dental students in various years of dental education under clinical and correcting light. METHODS: This comparative cross-sectional study was instigated amongst male 4th, 5th, and 6th-year students of the dental complex of King Faisal University, Kingdom of Saudi Arabia. A total of 72 male dental students assessed the shade under clinical (fluorescent light) and correcting light (handheld Dental Base Light) by using VITA Classical shade guides. Statistical analysis was done using SPSS version 23 (Armonk, NY, USA). The Chi-square test was used to evaluate the association between correct and incorrect shade matching under correcting and clinical light. RESULTS: Out of 72 male students, 22(30.6%) were from the 4th year, 26(36.1%) were from the 5th year, and 24(33.3%) were from the 6th year, with a mean age of 22.92 ± 1.01 years. The majority of the 6th-year students selected shade of anterior tooth # 11 correctly under clinical and correcting light, and 3(12.5%) students selected incorrectly under clinical and correcting light, with a statistically significant association among them (p = 0.004). As far as the shade selection of the posterior tooth is concerned, a statistically significant difference was observed under clinical light among all clinical students (p = 0.008). CONCLUSION: The clinical performance of dental students in shade matching improved with advancing years of dental education. Additionally, the shade matching ability of all groups of dental students was superior under correcting light compared to conditions under clinical light.

Impact of high-speed handpiece noise-induced dental anxiety on heart rate: analyzing experienced and non-experienced patients - a comparative study.

BACKGROUND: Dental anxiety is very much common among the patients and could be due to different factors like the behavior of the dentist, past experiences, Needle phobia, or word of mouth from other patients. According to recent studies, a strong association between sound and anxiety has been found, so this observational study has been conducted to find out the link between the activation of anxiety with the sound of a handpiece between experienced patients, who have already gone through the dental treatments and non-experienced patients. METHODS: Total of 297 participants were part of this study. These participants were divided into 2 groups according to the experienced and non-experienced dental patients. The researcher first filled out the CORAH Dental Anxiety Scale (DAS) form to mark the anxiety level of the patients, and then noted the readings of the heart rate in 3 intervals which were before during, and after the treatment with the pulse oximeter. Later the data was analysed using the SPSS independent t-test. RESULTS: Results show that patients in group 1 who have gone through the dental treatment before were less anxious and had a lesser effect on their heart rate than the patient who were having the treatment for the first time who were in group 2. Another interesting factor was noticed that in both the groups female were found to be more anxious than male participants. Participants with younger age were found to be more anxious than older age patient in both groups CONCLUSIONS: The sound of the handpiece can provoke anxiety in the patient, affecting the heart and increasing the heart rate. Participants who were experienced were found to be less anxious than the participants who were inexperienced.

Improved ridge width with tenting screw bone augmentation using particulate and block grafts: A case report.

The objective of this case report is to present the use of tenting screw bone augmentation technique for the rehabilitation of narrow horizontally deficient mandibular ridges and to evaluate the feasibility and outcomes of this approach in achieving sufficient bone volume for successful implant placement and Osseointegration. A 34-year-old woman with no significant medical history presented with bilaterally missing teeth in the lower arch. A comprehensive treatment plan was developed through assessment and Cone Beam Computed Tomography (CBCT) imaging to evaluate the ridge dimensions and plan the treatment accordingly accurately. The tenting screw technique, utilizing autogenous/autologous+allograft materials, was chosen for horizontal ridge augmentation. Bone augmentations were performed simultaneously bilaterally using tenting screws. After a 20-week healing period, CBCT scans revealed favorable bone regeneration with adequate width for successful implant placements. This case report demonstrates the potential of tenting screw bone augmentation in effectively rehabilitating mandibular ridges and achieving optimal dental implant outcomes. Further research is needed to validate these findings and assess the long-term stability and success of this technique.

The efficacy of iatrosedation and music listening techniques in attenuating dental anxiety in patients undergoing dental crown preparation: A randomized clinical trial.

Dental anxiety is a common problem encountered in dental clinics that affects both patients and dentists. Adequate management of dental anxiety is critical for optimal treatment outcomes for the patient. This study aims to assess the efficacy of two anxiety-reduction techniques (iatrosedation and music listening) for dental crown preparation in adult patients. In this clinical trial, 60 patients were randomly assigned to three groups: Group 1, iatrosedation; Group 2, music listening; and Group 3, control. Patients in all three groups underwent dental crown preparation. To measure the anxiety levels of the patients, heart rate was calculated using a pulse oximeter, and verbal rating scale scores were assessed. One-way analysis of variance, post hoc analysis, and Spearman's correlation were used to compare the mean values of the three groups. Significant differences were observed in the heart rate and verbal rating scale scores among individuals in the study groups. A more substantial reduction in anxiety levels was found in patients exposed to iatrosedation (Group 1), which was followed by music listening (Group 2). Recorded heart rate and verbal rating scores were the highest in the control group patients. The iatrosedation technique significantly reduced dental anxiety for patients undergoing dental crown treatment; however, music listening was less effective than iatrosedation. Educating patients regarding the dental care they are about to receive is vital for reducing their anxiety.

The effectiveness of single antibiotic paste nitrofurantoin V/S double antibiotic paste in alleviation of post-operative pain of patients suffering from symptomatic irreversible pulpitis-A randomized controlled trial.

Objective: The present research evaluated and compared effectiveness between nitrofurantoin and double antibiotic paste in alleviating post-operative pain in patients suffering from symptomatic irreversible pulpitis. Methods: There were 60 subjects enrolled who were allotted among three groups: Group 1 - Nitrofurantoin, Group 2 - double antibiotic paste, and Group 3 - Control. Succeeding access opening and chemo mechanical preparation, intracanal medicament was placed in the root canals. Using a numerical pain scale, pain scores were measured at the following time intervals: preoperative, 12, 24, 48, and 72 h. One-way ANOVA and post hoc statistical analysis were conducted, with a p-value of ⩽ considered as statistically significant. Results: Preoperatively, most patients experienced moderate to severe pain. The patients in groups 1 and 2 reported considerable reduction in their pain scores (p ⩽ 0.001) on each time interval. However, patients in group 3 experienced a higher level of pain even at 72 h. No considerable distinction was found among participant's pain scores of groups 1 and 2 (p = 0.193). Conclusion: For effective pain-relieving, both nitrofurantoin and double antibiotic paste can be successfully used in patients suffering from symptomatic irreversible pulpitis. However, when calcium hydroxide was used, patients experience high levels of pain.

Hypofractionated Radiotherapy for Hematologic Malignancies during the COVID-19 Pandemic and Beyond.

PURPOSE: Radiotherapy is integral in the management of hematological malignancies (HM). Standard radiotherapy dose fractionation regimens range between 20 and 50 Gy in 10-25 fractions over 2-5 weeks. This study presents the outcomes of patients with HM treated with hypofractionation radiotherapy (HFRT) during the COVID-19 pandemic. METHODS: Patients (n = 36) were treated with HFRT between January 2020 and September 2022. The outcomes measured were the overall response rate (ORR), freedom from local progression (FFLP), and overall survival (OS). RESULTS: The median follow-up was 13.2 months. Thirty-three patients (92%) had non-Hodgkin (NHL) or Hodgkin lymphoma (HL). Eighteen patients (50%) had aggressive and nine (25%) had indolent NHL. Nineteen patients (53%) presented with stage I/II and fifteen (42%) with stage III/IV disease. Twenty-five (69.4%) and eleven (30%) received consolidative and definitive RT, respectively. Twenty patients (56%) received treatment to the neck and/or thorax and nine (25%) to the abdomen or pelvis. The total dose ranged from 18 to 42.5 Gy in 6-17 fractions/2.67-5 Gy per fraction. The median dose in 2 Gy fractions for an alpha/beta (α/ß) ratio of 10 amounted to 39 Gy (SD ± 13.86) and 43.6 Gy (SD ± 12) for an α/ß of 3. The most commonly used fractionation scheme was 39 Gy in 13 fractions. ORR was 94.4% for the entire cohort, and 100, 94.4, and 83.3% for indolent NHL, aggressive NHL, and HL patients. The two-year FFLP was 76% (95% CI: 34-93%) for the entire cohort and 100, 87 (95% CI: 56.4-96.5%), and 42% (95% CI: 1.1-84.3%) for the indolent NHL, aggressive NHL, and HL patients. Two-year OS for the entire cohort was 80% (95% CI: 59.9-90.5%) and 100, 66.1 (95% CI: 36.4-84.4%), and 100% for the indolent NHL, aggressive NHL, and HL patients. Only one patient presented with grade two pulmonary toxicity. CONCLUSIONS: HFRT in HM provides excellent local control to be validated in a larger prospective study.

Glimpse into the future of prosthodontics: The synergy of artificial intelligence.

Prosthodontics, deals in the restoration and replacement of missing and structurally compromised teeth, this field has been remarkably transformed in the last two decades. Through the integration of digital imaging and three-dimensional printing, prosthodontics has evolved to provide more durable, precise, and patient-centric outcome. However, as we stand at the convergence of technology and healthcare, a new era is emerging, one that holds immense promise for the field and that is artificial intelligence (AI). In this paper, we explored the fascinating challenges and prospects associated with the future of prosthodontics in the era of AI.

Frequency and etiological denominators of alveolar osteitis at Northern Province of Kingdom of Saudi Arabia-An observational study.

Objective: Alveolar osteitis is a painful complication that often arises after tooth extraction, presenting a significant clinical challenge. It is imperative to gain a comprehensive understanding of both its occurrence and the contributing factors to enhance the quality of dental care. The aim of this study was to assess the frequency and prevalence of alveolar osteitis among patients and compare these variables based on demographic characteristics (age and sex), the number of teeth extractions, operator experience, health status, and smoking habits in the target population. Methods: This cross-sectional observational study was conducted from May 2019 to April 2020. It included all patients above 16 years of age, of both genders, who underwent permanent tooth extraction for various reasons. Patient demographics, smoking habits, health status, operating dental surgeon's clinical experience, extraction technique, and the number of teeth extracted were recorded. Statistical analysis was performed using SPSS version 25. Chi-square test and regression analysis were used to assess differences between age, sex, smoking habit, dentist category, and the number of teeth extractions in relation to alveolar osteitis. Results: A total of 679 permanent tooth extractions were performed in 438 patients. Alveolar osteitis was observed in 107 cases (15.7%) following tooth extractions. Among these, 36 cases (33.6%) occurred in single tooth extraction cases, while 71 cases (66.4%) were present in patients with multiple extractions. Moreover, 67 cases (62.6%) of alveolar osteitis were found in cigarette smokers. In addition, 61 cases (57%) of dry sockets were reported after tooth extractions performed by dental interns, while 46 cases (43.0%) were noted in extractions performed by experienced dental surgeons and specialists. Conclusion: The study found a 15.7% incidence of alveolar osteitis in tooth extraction patients in the Al-Jouf region. Alveolar osteitis was more prevalent in males and the age group of 56-77 years. Multiple tooth extractions were associated with higher alveolar osteitis incidence, while operator inexperience increased post-extraction complication risks. In addition, a promising novel protocol and risk assessment scoring system have been devised which require further validation and future research.

Should aspirin be replaced with ADP blockers and anti-GPVI to manage thrombosis?

Platelets have a pivotal role in maintaining cardiovascular homeostasis. They are kept docile by endothelial-derived mediators. Aberration in haemostatic balance predisposes an individual to an elevated risk of a prothrombotic environment. Anti-platelet therapy has been a key component to reduce this risk. However, understanding how these medications affect the balance between the activation and inhibition of platelets is critical. There is no evidence that a key anti-platelet therapy - aspirin, may not be the most efficacious medicine of choice, as it can compromise both platelet inhibition and activation pathways. In this review, the rationale of aspirin as an anti-thrombotic drug has been critically discussed. This review looks at how recently published trials are raising key questions about the efficacy and safety of aspirin in countering cardiovascular diseases. There is an increasing portfolio of evidence that identifies that although aspirin is a very cheap and accessible drug, it may be used in a manner that is not always beneficial to a patient, and a more nuanced and targeted use of aspirin may increase its clinical benefit and maximize patient response. The questions about the use of aspirin raise the potential for changes in its clinical use for dual anti-platelet therapy. This highlights the need to ensure that treatment is targeted in the most effective manner and that other anti-platelet therapies may well be more efficacious and beneficial for CVD patients in their standard and personalized approaches.

Parental Knowledge, Attitude and Practices Toward Dental Sealants as Preventive Strategy for Dental Caries in Children: A Cross Sectional Study.

Aim. This study aimed to evaluate the knowledge, attitude, and practices of parents residing in Pakistan toward pits and fissure sealants in children. Materials and Methods. This descriptive, cross-sectional study was carried out between November 2022 to March 2023. An online questionnaire was distributed through various social media platforms. Independent t-test and Multiple Linear Regression analysis were performed. Results. A total of 570 participants were recruited. For protection against tooth decay, most of the participants 456(80%) believed that fissure sealants should be placed to protect teeth from decay. Placement of fissure sealants was considered to be a cost-effective measure by majority of the 480 (84.2%) respondents. Conclusion. Fissure sealants are one of the most effective preventive measures against tooth decay. The knowledge, attitude and practice of parents were some being aware of fissure sealants and some were not. It appeared to support the placement of fissure sealants for their children.

Comparison of triamcinolone with pentoxifylline and vitamin E efficacy in the treatment of stage 2 and 3 oral submucous fibrosis: A randomized clinical trial.

Objective: The objective of this study was to assess the effectiveness of triamcinolone in combination with pentoxifylline and vitamin E in the treatment of patients with level two and three oral submucous fibrosis. Methods: The study aimed to compare the efficacy of corticosteroid injections (triamcinolone) versus pentoxifylline and vitamin E in the therapy of patients with stage two and three oral submucous fibrosis. A total of 42 participants with indications and features of oral submucous fibrosis were enrolled between January 2020 and September 2021. The patients' age and mouth opening were evaluated, and descriptive statistics and paired t-test were used for analytical investigation. Results: The study showed a statistically significant improvement in both treatment groups (p = 0.001) concerning pre- and post-treatment deviations. However, when comparing the standard differences in treatment outcomes between the two study groups, only mouth opening exhibited a statistically significant difference (p = 0.001). Conclusions: The findings indicate that a treatment regimen combining pentoxifylline and triamcinolone can significantly alleviate oral submucous fibrosis symptoms, including mouth opening, pain, and flaring agitation, thereby enhancing the affected individual's quality of life.

An insight into perceptions of general pathologists about the need for oral pathology services: An observational study.

Objective: The objective of this study was to identify the degree of perception of oral pathology as a specialty among the general pathologists and the need of utilizing oral pathologists in assisting to identify oral lesions in diagnostic challenges. Methods: A questionnaire-based survey was conducted among qualified general pathologists to collect the data. The survey items focused on various aspects, including the analysis of oral pathology as a specialty, the importance of employing oral pathologists for identifying oral lesions in diagnostic challenges, and the difficulties encountered in managing such lesions. The data collected was analyzed using descriptive and inferential statistics. For comparing the relationship between work experience and the referral of odontogenic cysts and tumors cases, a Chi-square test was employed. A significance level of p ⩽ 0.05 was deemed as statistically significant. Results: Two hundred and fifty general pathologists responded to the questionnaire. Two hundred and thirty two (92.8%) participants showed awareness of oral pathology as a specialty. For the diagnosis of oral, jaws, and salivary glands pathologic lesions, the majority 198 (79.2%) respondents believed that oral pathologists are required for the diagnosis. Regarding the referrals of lesions to oral pathologists, 137 (54.8%), participants did not refer. In terms of training in oral pathology, all of the participants agreed that they would undertake short-term posting in oral pathology. For challenging cases, all the general pathologists believed that oral pathologists should be part of the team. Conclusion: The general pathologists recognized oral pathology as a specialty and feel the need for an oral pathologist opinion in diagnosis. However, most of the general pathologists did not refer the complex cases to oral pathologists. Therefore, it is of paramount importance to encourage oral pathologists and their hiring at histopathology laboratories that are diagnosing complex head and neck cases.

Taguchi-TOPSIS based optimization of comfort in compression stockings for vascular disorders.

Compression stockings/socks are one of the most essential materials to treat vascular disorders in veins. However, the comfort of wearing such stockings over prolonged period of time is a major problem. There is limited research in the area of comfort optimization while retaining the compressional performance. The current work is carried out with an aim to determine the optimum level of the input factors e.g., knitting structure, plaiting yarn linear density and main yarn linear density for achieving desired stretch recovery percentage and thermo-physiological comfort properties of compression socks used in treatment of vascular disorders. Their optimum combination was determined by using Taguchi based techniques for order of preference by similarity to ideal solution i.e., TOPIS. In this study, thickness, areal density, air permeability, thermal resistance, over all moisture management capacity (OMMC), stretch and recovery % were optimized simultaneously by using Taguchi-TOPSIS method. The results showed that linear density of plaiting and main yarn has significant influence on all the comfort related properties for compression stockings/socks. The optimum sample had linear density 20 denier for Lycra covered by 70 denier of nylon 66 in the plaiting yarn. It also suggested 120 denier nylon 66 in the main yarn knitted into a plain single jersey structure. The percentage contribution of the factors i.e., structure, plaiting yarn linear density and main yarn linear density was obtained by using ANOVA which are 7%, 31% and 42% respectively. It is worth mentioning that in case of compression stockings, the main yarn linear density has more significant effect on comfort properties as compared to other independent parameters. The results were verified by experiment, and the accuracy was relatively high (maximum error 8.533%). This study helped to select suitable knit structure with the change of linear densities of plaiting yarn and main yarn for comfortable compression stocking/sock and will fulfill the potential requirement for treatment of venous/vascular disorders. The novel methodology involving TOPSIS method helped in analyzing the cumulative contribution of the input parameters to achieve optimum compression as well as comfort performance. This modern approach is based on contemporary scientific principles and statistical approximations. This study may provide benchmark solutions to complex problems involving multiple interdependent criteria.

Current Trends in Fixed Prosthodontics Education in Undergraduate Dental Colleges.

OBJECTIVES: The objective of this study was to explore current trends in undergraduate fixed prosthodontics teaching at undergraduate dental level education. METHODS: This cross-sectional descriptive study included close-ended questions to inquire about the teaching practices of fixed prosthodontics at Bachelor of Dental Surgery level education. Electronic copies of the survey forms were sent to the heads or directors of department of prosthodontics responsible for undergraduate dental students teaching and learning in various institutes of Sindh by the help of Google forms in December 2020. The form included questions on sociodemographic details and questions inquiring the theoretical and clinical teaching practices in undergraduate fixed prosthodontics course. Data was entered and analyzed using SPSS 25. Frequency distribution and percentages of categorical variables were recorded. RESULTS: Out of total 18 dental institutes of Sindh, 15 returned the completely filled form, giving a response rate of 83.3%. Seven (46.7%) schools teach various fixed prosthesis in the preclinical years to their students. All 15 colleges carry out didactic teaching and provide exposure by live clinical demonstrations for various fixed prosthesis. Faculty of 12 (80%) dental colleges where fixed prostheses are being constructed in the dental outpatient department mentioned that their students observe or assist the clinical procedures during their clinical rotation; but none of the students fabricate any type of fixed prosthesis in the clinical setting during their undergraduate years. CONCLUSION: Didactic teaching and live clinical demonstrations of fixed prosthodontics is being carried out in all dental colleges of Sindh. Almost half of the dental schools teach crown preparation on phantom teeth during their preclinical course. Contrary to this, none of the students fabricate any type of fixed prosthesis in the clinical setting during their undergraduate years. As these procedures are not included in the current undergraduate curriculum, recommendations should be forwarded to governing educational body of the country to include cases of fixed prosthesis in their skill set prior to their graduation.

Nasolabial Flap in the Management of Oral Sub Mucous Fibrosis: A Series of Cases.

The objective of this study was to evaluate the outcomes of the nasolabial flap in the management of oral submucous fibrosis (OSMF). The descriptive case series included 75 patients diagnosed with OSMF who underwent surgical intervention under general anesthesia. Preoperative mouth opening measurements were compared with postoperative measurements taken after 2 months. Regarding mouth opening, out of the 75 patients, 4 (5.3%) had unsatisfactory results after treatment, while 22 (29.3%) experienced satisfactory outcomes. The majority of patients, 49 (65.3%), achieved normal mouth opening (more than 30 mm) following the Nasolabial flap procedure. This indicates that the Nasolabial flap yielded favorable results in terms of restoring normal mouth opening and benefiting the patients. Based on the findings of this study, the Nasolabial flap was determined to be a viable surgical option for managing oral submucous fibrosis due to its ease of operation, reliable flap vascularity, and low post-operative complication rate. The only drawback identified was the presence of a surgical scar, which can be addressed through secondary correction procedures.

Endobronchially Implanted Real-Time Electromagnetic Transponder Beacon-Guided, Respiratory-Gated SABR for Moving Lung Tumors: A Prospective Phase 1/2 Cohort Study.

Purpose: Endobronchial electromagnetic transponder beacons (EMT) provide real-time, precise positional data of moving lung tumors. We report results of a phase 1/2, prospective, single-arm cohort study evaluating the treatment planning effects of EMT-guided SABR for moving lung tumors. Methods and Materials: Eligible patients were adults, Eastern Cooperative Oncology Group 0 to 2, with T1-T2N0 non-small cell lung cancer or pulmonary metastasis ≤4 cm with motion amplitude ≥5 mm. Three EMTs were endobronchially implanted using navigational bronchoscopy. Four-dimensional free-breathing computed tomography simulation scans were obtained, and end-exhalation phases were used to define the gating window internal target volume. A 3-mm expansion of gating window internal target volume defined the planning target volume (PTV). EMT-guided, respiratory-gated (RG) SABR was delivered (54 Gy/3 fractions or 48 Gy/4 fractions) using volumetric modulated arc therapy. For each RG-SABR plan, a 10-phase image-guided SABR plan was generated for dosimetric comparison. PTV/organ-at-risk (OAR) metrics were tabulated and analyzed using the Wilcoxon signed-rank pair test. Treatment outcomes were evaluated using RECIST (Response Evaluation Criteria in Solid Tumours; version 1.1). Results: Of 41 patients screened, 17 were enrolled and 2 withdrew from the study. Median age was 73 years, with 7 women. Sixty percent had T1/T2 non-small cell lung cancer and 40% had M1 disease. Median tumor diameter was 1.9 cm with 73% of targets located peripherally. Mean respiratory tumor motion was 1.25 cm (range, 0.53-4.04 cm). Thirteen tumors were treated with EMT-guided SABR and 47% of patients received 48 Gy in 4 fractions while 53% received 54 Gy in 3 fractions. RG-SABR yielded an average PTV reduction of 46.9% (P < .005). Lung V5, V10, V20, and mean lung dose had mean relative reductions of 11.3%, 20.3%, 31.1%, and 20.3%, respectively (P < .005). Dose to OARs was significantly reduced (P < .05) except for spinal cord. At 6 months, mean radiographic tumor volume reduction was 53.5% (P < .005). Conclusions: EMT-guided RG-SABR significantly reduced PTVs of moving lung tumors compared with image-guided SABR. EMT-guided RG-SABR should be considered for tumors with large respiratory motion amplitudes or those located in close proximity to OARs.