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Immediate access to the patient in crisis situations, such as cardiac arrest during robotic surgery, can be challenging. We aimed to present a full immersion simulation module to train robotic surgical teams to manage a crisis scenario, enhance teamwork, establish clear lines of communication, improve coordination and speed of response. Start time of cardiopulmonary resuscitation (CPR), first defibrillator shock and robotic de-docking time from the first 'cardiac arrest call' were recorded. Observational Teamwork Assessment for Surgery (OTAS) scores were used in control and test simulations to assess performance along with a participant survey. Repeat scenarios and assessment were conducted at a 6-month interval for the same team to validate knowledge retention and an additional scenario was run with a new anaesthetic team to validate modular design. OTAS scores improved across all specialty teams after training with emergency algorithm and at retention validity re-test (p = 0.0181; p = 0.0063). There was an overall reduction in time to CPR (101-48 s), first defibrillator shock (> 302 s to 86 s) and robot de dock time (86-25 s) Improvement remained constant at retention validity re-test. Replacing the anaesthetic team showed improvement in time to CPR, first shock and robotic de-dock times and did not affect OTAS scores (p = 0.1588). The module was rated highly for realism and crisis training by all teams. This high-fidelity simulation training module is realistic and feasible to deliver. Its modular design allows for efficient assessment and feedback, optimising staff training time and making it a valuable addition to robotic team training., (© 2023. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Purpose: The purpose of this study was to compare student performance in removable partial denture (RPD) design during a pre-clinical RPD course with and without using a recently developed computer software named AiDental. Additionally, student perceptions associated with the use of this software were assessed., Methods: The AiDental software consists of a learning environment containing an RPD design system that automatically designs RPDs based on the user's input. The software also contains an RPD game component that compares the user's RPD Design to an automatically generated RPD ideal design. The study was conducted in two phases. In phase one, pre-clinical second-year dental students who participated in the study were randomly divided into two groups: The AiDental group with AiDental software access (n = 36), and the conventional group without software access (n = 37). Both groups received conventional RPD instruction and practice, however, the AiDental group had additional access to the AiDental software. After 2 weeks, both groups took a mock practical test, which was collected and graded by the principal investigator (PI). The PI was blinded from group assignment and no identifying information was used in the mock practical. In phase two, all students were granted access to the AiDental software for the remainder of the pre-clinical course duration. At the conclusion of the course, all students were given a survey to evaluate their perceptions of the AiDental software. Descriptive statistics were calculated and analyzed. Variables related to perceptions of both the AiDental designer and game were assessed using Spearman's rank correlation test, the chi-square test, Fisher's exact test, and the non-parametric Wilcoxon rank-sum test as appropriate. In addition, a thematic analysis of the responses to the optional comments section was conducted using the Braun and Clarke method., Results: Phase one results showed that subjects in the AiDental group were more likely than subjects in the conventional group to receive a final grade of A or B. Phase two results showed generally favorable student perceptions towards the software, and additionally, the results showed that age was significantly negatively correlated with ease of use of the software, improving decision-making, and critical thinking relative to RPD design choices. However, no correlation between age and using the software as a reference were noted., Conclusions: The use of AiDental's automated feedback and gamification techniques in RPD education had a positive effect on student grades and it was well-liked by students. Thus, the results suggest that AiDental has the potential to be a useful adjunct to pre-clinical teaching., (© 2023 The Authors. Journal of Dental Education published by Wiley Periodicals LLC on behalf of American Dental Education Association.)

Conceptualizing: The next patient interaction is logical, essential, and largely done intuitively., Main Purpose: To design and test a succinct learning guide for student guidance and student-faculty interaction in conceptualizing the next patient interaction., Methods: In 2021 and 2022, faculty scored questions from 1-5: Recognize deviation from the ideal? Articulate how and how much the situation deviated? Gage consequences of the situation? Assess own capabilities? To what extent does the student have a clear grasp of the procedural outcome? Faculty were also given open-ended questions., Results: Forty-eight reports were completed, 25 D3 and 23 D4. Three hundred thirty-five faculty entries were made in the questions calling for a 1-5 response out of a possible 336 responses. Statistically significant differences were noted. Students were better able to recognize the situation as different from ideal than to articulate how and how much the situation deviated. Students were better able to grasp how and how much this situation differs from the ideal than to assess own capabilities. D4 students were better able to recognize deviation from the ideal and to articulate how and how much the situation deviated than were D3 students. For open-ended questions, more students were scored as "Prepared" than were scored as "Unsure" and "Missed" combined., Conclusions: The exercise is seen as a succinct and constructive (nonjudgmental) path to guide the student's conceptualization of the next patient encounter before the encounter begins. Next steps will be incremental for wider use in a clinical teaching environment., (© 2022 The Authors. Journal of Dental Education published by Wiley Periodicals LLC on behalf of American Dental Education Association.)

Purpose: To compare the axial and nonaxial retention forces of different milled bar attachment designs for maxillary implant overdentures., Materials and Methods: Four implants were placed in the canine and second premolar areas of an edentulous maxillary ridge model and connected to a cobalt-chromium milled bar either with or without Locator attachments. According to the type of bar and overlying housing, the following groups (n = 10 each) were investigated: group 1 (MWM) = milled bar without attachments and metal housing; group 2 (MWP) = milled bar without attachments and PEEK housing; group 3 (MAM) = milled bar with Locator attachments and metal housing; and group 4 (MAP) = milled bar with Locator attachments and PEEK housing. Axial and nonaxial (anterior, posterior, and lateral) retention forces were measured both at baseline and after wear simulation, then compared between groups and dislodging directions., Results: MAM showed the highest axial (53.20 ± 2.28 N) and nonaxial (anterior [33.80 ± 1.48 N], posterior [37.60 ± 2.07 N], and lateral [34.40 ± 1.67 N]) retention forces at baseline, followed by MAP, then MWM, and MWP (P < .001). MAP showed the highest axial (42.80 ± 2.28 N) and nonaxial (anterior [24.00 ± 1.58 N], posterior [29.40 ± 2.07 N], and lateral [27.80 ± 1.64 N]) retention forces after wear simulation, followed by MAM, then MWP, and finally MWM (P < .001). MAM showed the highest axial (25.25 ± 2.45 N) and nonaxial (anterior [28.29 ± 4.03 N], posterior [24.40 ± 3.25 N], and lateral [25.55 ± 1.65 N]) retention loss, followed by MWM, then MAP, and finally MWP (P < .001). For all groups, the highest retention forces were noted with axial dislodging, followed by posterior dislodging, then lateral dislodging, and finally vertical dislodging (P < .001)., Conclusion: Milled bars with PEEK housings and Locator attachments for maxillary implant overdentures were associated with the highest axial and nonaxial retention forces after wear simulation, while milled bars with metal housing and no attachments showed the lowest forces. Milled bars with metal housing and attachments showed the highest retention loss, while milled bars with PEEK housing with no attachments showed retention gain.

Artificial intelligence (AI) and Augmented Intelligence (AuI) have existed for decades but have only recently been applied to dentistry and incorporated into higher education for dental professionals. Early examples of the incorporation of AI into dental education suggest it can enhance students' learning and can be applied in pre-clinical and clinical instruction. AI can be used to support clinical decision-making for dental professionals, making radiographic interpretation more precise and consistent. This paper provides a brief overview of AI, highlights opportunities to improve higher education and provides brief case studies of individuals and organizations working to advance the quality of dental education using AI. Opportunities for the application of AI in dental education include the adoption of clinical decision support that can improve patient outcomes and overall quality of patient care; development of courses that assist students in learning enhanced radiographic interpretation, diagnosis and treatment planning; research collaborations with industry for product evaluation and future product developments; and practice administration in understanding the quality of the care being delivered at the school.

Purpose: To evaluate strain around resilient stud and bar attachments for inclined implants supporting mandibular overdentures during loading and dislodging., Materials and Methods: A mandibular edentulous model was printed using the laser sintering technique. Two vertical implants and two 30-degree distally inclined implants were placed in canine and premolar areas, respectively. Overdentures were attached to the implants with either a resilient stud (Locator, group 1) or a bar/clip (group 2) attachment. Three strain gauges were mounted at the buccal, lingual, and proximal surfaces of each implant. Microstrains were registered during vertical loading and dislodging force applications and compared between attachments (resilient stud and bar) and implant positions (vertical and inclined)., Results: For canine implants, bar overdentures recorded significantly higher microstrains than Locator overdentures during vertical loading. For premolar (inclined) implants, Locator overdentures recorded significantly higher microstrains than bar overdentures during vertical dislodging. For both groups (during loading) and the bar overdenture group (during dislodging), canine (vertical) implants showed significantly higher microstrains than premolar (inclined) implants., Conclusion: Within the limitations of this in vitro study, canine (vertical) implants may be at risk of increased stresses during loading if bar attachments are used for vertical and inclined implants supporting mandibular overdentures, and premolar (inclined) implants may be at risk of increased stresses during dislodging if Locator attachments are used. For both attachments, canine implants showed significantly higher microstrains than premolar implants during loading and dislodging.

Purpose: To evaluate patient satisfaction and prosthetic complications of maxillary conventional dentures and implant overdentures opposing mandibular implant overdentures with different attachments., Materials and Methods: A total of 60 patients with maxillary conventional dentures (maxillary CD) and mandibular two-implant overdentures received four implants in the maxilla. The implants were connected to the maxillary overdentures with a stud attachment (maxillary OD). The participants were classified into three groups according to the type of mandibular overdenture attachment: bar overdentures (BOD, n = 20), resilient telescopic overdentures (TOD, n = 20), and resilient stud/Locator overdentures (LOD, n = 20). Patient satisfaction (using a visual analog scale [VAS] and oral health-related quality of life (OHRQoL)] and prosthetic/soft tissue complications were evaluated for maxillary CD and maxillary OD after 1 year of insertion., Results: LOD showed higher VAS and oral health impact profile (OHIP-14) scores with maxillary CD and maxillary OD than BOD and TOD except for ease of chewing (VAS) and satisfactory diet (OHIP-7). For maxillary CD, TOD showed a significantly higher frequency of prosthetic and soft tissue complications than BOD and LOD. For all groups, maxillary OD showed significantly higher patient satisfaction regarding VAS and OHIP-14 scores, and lower prosthetic and soft tissue complications than the maxillary CD., Conclusion: Locator-retained maxillary overdentures opposing mandibular implant overdentures improved patient satisfaction and reduced prosthetic complications compared to conventional maxillary dentures. Such overdentures are best opposed by Locator-retained mandibular overdentures, as they increase patient satisfaction and reduce prosthetic and soft tissue complications compared to the bar and telescopic attachments.

Background: Clinical outcome data in the United Kingdom, Europe, and the United States have yet to facilitate appropriately specific surveillance for liposarcoma histological subtypes, despite being one of the most common soft tissue sarcomas. Therefore, this study aims to demonstrate histologic-specific differences in liposarcoma recurrence, disease progression, and survival and discuss the implications., Methods and Findings: This cohort study involves patients from a regional sarcoma service in the UK who have had a primary surgical excision of liposarcoma between October 2002 and September 2019. The median follow-up is five years. Confirmed histopathological diagnoses of liposarcoma (n = 193) are organised according to the World Health Organisation recognised subtypes: atypical lipomatous tumours (ALT), myxoid, pleomorphic, and dedifferentiated liposarcomas. In addition, retroperitoneal variants (n = 34) are included to illustrate the broader spectrum of phenotypes. The primary outcomes were local recurrence, distant disease progression, and disease-specific death, and compared using Kaplan-Meier analyses and tumour variables using Cox proportional hazard analyses. All three primary outcomes significantly differed (P < 0.0001, n = 193). There were no metastases or disease-specific death in patients with ALT (n = 92) and no metastases of their retroperitoneal counterparts (n = 17). Amongst the metastasising cases of rarer subtypes, there were pulmonary spread of pleomorphic (8/9, n = 20), dedifferentiated (4/5, n = 18), and myxoid (2/3, n = 29) liposarcomas., Conclusion: An absence of metastases of ALT should be considered alongside global evidence. Surveillance protocols could better differentiate between these subtypes and, in doing so, save patients a considerable amount of irradiation, time, fear, and anxiety., Competing Interests: Declaration of Competing Interest The authors do not have competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The purpose of this study is to assess students' perception of digital waxing software for dental anatomy education. Dental students were introduced to digital waxing during a dental anatomy course, and were requested to finish a voluntary survey. Students strongly agreed (18.2%) or agreed (48.0%) with the statement "digital waxing contributed to my learning of dental anatomy", and strongly agreed (29.9%) and agreed (55.8%) with the statement "The digital waxing software helped develop my wax-up skills". The digital waxing software may be effective for dental anatomy education, but students do not believe digital waxing can be a replacement for conventional wax-up practice.

To compare full and partial coverage crowns made with different CAD/CAM leucite reinforced ceramic blocks on fracture resistance and fractographic analysis. Full coverage and partial coverage crowns with finish line at 2 mm and 4 mm above the gingiva for molars made with IPS Empress CAD and Rosetta BM. After fatigue process, the fracture test and fractographic analysis were conducted. Although the fracture resistance of IPS Empress crowns did not show any statistical differences regardless of the design, both the partial coverage crowns fabricated using Rosetta BM showed significantly higher load at break and peak load than the full coverage crown. The crowns made with IPS Empress showed significantly higher fracture resistance than that made with Rosetta BM, regardless of the restorative design. The fracture resistance and fractographic analysis of CAD/CAM leucite reinforced full and partial coverage crowns were influenced by the restorative design of and material type.

Objectives: This study compared the prognostic value of a noncontrast CMR risk score for the composite of all-cause death, nonfatal myocardial infarction, and new congestive heart failure., Background: A cardiovascular magnetic resonance (CMR) risk score including left ventricular ejection fraction (LVEF), myocardial infarct (MI) size, and microvascular obstruction (MVO) was recently proposed to risk-stratify patients with ST-segment elevation myocardial infarction (STEMI)., Methods: The Eitel CMR risk score and GRACE (Global Registry of Acute Coronary Events) score were used as a reference (Score 1: acute MI size ≥19% LV, LVEF ≤47%, MVO >1.4% LV and GRACE score). MVO was replaced by intramyocardial hemorrhage (IMH) in Score 2 (acute MI size ≥19% LV, LVEF ≤47%, IMH, and GRACE score). Score 3 included only LVEF ≤45%, IMH, and GRACE score., Results: There were 370 patients in the derivation cohort and 234 patients in the validation cohort. In the derivation cohort, the 3 scores performed similarly and better than GRACE score to predict the 1-year composite endpoint with C-statistics of 0.83, 0.83, 0.82, and 0.74, respectively. In the validation cohort, there was good discrimination and calibration of score 3, with a C-statistic of 0.87 and P = 0.71 in a Hosmer-Lemeshow test for goodness of fit, on the 1-year composite outcome. Kaplan-Meier curves for 5-year composite outcome showed that those with LVEF ≤45% (high-risk) and LVEF >45% and IMH (intermediate-risk) had significantly higher cumulative events than those with LVEF >45% and no IMH (low-risk), log-rank tests: P = 0.02 and P = 0.03, respectively. The HR for the high-risk group was 2.3 (95% CI: 1.1-4.7) and for the intermediate-risk group was 2.0 (95% CI: 1.0-3.8), and these remained significant after adjusting for the GRACE score., Conclusions: This noncontrast CMR risk score has performance comparable to an established risk score, and patients with STEMI could be stratified into low risk (LVEF >45% and no IMH), intermediate risk (LVEF >45% and IMH), and high risk (LVEF ≤45%). (A Trial of Low-dose Adjunctive alTeplase During prIMary PCI [T-TIME]; NCT02257294) (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850)., Competing Interests: Funding Support and Author Disclosures Funding was provided by a British Heart Foundation Grant (RE/18/6134217; PG/11/2/28474) and the Chief Scientist Office. Dr Berry was supported by a Senior Fellowship from the Scottish Funding Council. The T-TIME trial was funded by the Efficacy and Mechanism Evaluation program of the National Institute for Health Research. Boehringer Ingelheim United Kingdom Ltd provided the study drugs and matched placebo. Part of this project was supported by a research agreement with Siemens Healthcare. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: This study analyzed the stress distribution of restored principal abutments in free-end saddle partial dentures., Materials and Methods: The mandibular second premolar was modeled with class II cavity restored with composite resins (Tetric N Ceram and Charisma Smile). Finite element analysis (FEA) was used to examine the stresses under 200-N static load vertically and horizontally and the results were graphically illustrated in the form of von Mises stresses., Results: The von Mises stress distribution patterns of two different composite resins (Tetric N Ceram and Charisma Smile) were very similar in all modes of loading., Conclusion: Composite resins with a similar modulus of elasticity in class II cavities with occlusal rest seat preparation had similar stress distributions., Clinical Significance: Nanohybrid composite resin restorations may be a possible method for preparing abutments for receiving elements of the removable partial denture (RPD)., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Mahrous et al.)

Background: Pharmaceutical firms are striving to find potential treatments to prevent and treat COVID-19. One of the gold standards to evaluate treatment is a clinical trial; however, the difficulty in patient recruitment could act as a determinant. It is evident from the registry data that very few studies have been conducted involving the population of the Middle East and North Africa (MENA) region., Aim: To document knowledge, perception, and attitude of the public from Two large countries in the MENA region (Egypt and Saudi Arabia) towards participation in clinical trials focused on evaluating potential COVID-19 treatments., Method: A cross-sectional study was conducted that used a snowball sampling strategy for recruitment. General population 18 years old or older, who lived in Saudi Arabia or Egypt were invited. The survey was adopted from literature and was approved by an ethics committee., Results: Out of 800 participants in the survey, 407 participants were from Egypt, and 393 were from Saudi Arabia. Most participants (48%) had moderate knowledge, i.e., > 60% < 80%. The results revealed poor attitude (88.5%) and poor perceptions (45.8%) regarding participation in COVID-19 clinical trials. Education and residence were identified as determinants of participants' knowledge, attitude, and perceptions. Participants' knowledge and understanding of COVID-19 trials did not impact their willingness to participate. This coupled with a poor attitude and perception among the masses drastically affects any potential for participation in future clinical trials. Conclusion: A relatively small proportion of participants were interested in enrolling in COVID-19 studies. Increased collective engagement through social media and healthcare professionals can help improve attitudes and perceptions toward trial participation., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Purpose/objectives: To assess student perceptions on learning dental anatomy using natural extracted teeth, 3D printed models, 3D virtual models, and augmented reality (AR) technology.  METHODS: Eighty first-year dental students enrolled in the dental anatomy course were instructed to examine four stations. The stations included four versions of a mandibular first molar: an extracted natural tooth, a 3D printed model, a 3D virtual model, and a model displayed on a novel AR device. After examining all stations, the students were asked to complete an electronic survey. Bivariate analysis was performed to determine whether students' perceptions are related to their demographic characteristics and technological experience with computer use, 3D modeling, and video games.  RESULTS: Seventy students completed the survey (87.5% response rate). Students rated natural teeth to have the highest educational value, the 3D printed tooth to be the most accessible, and the AR application to be the most interesting modality. Students who played little to no video games were more likely to rate AR as high educational value (48.8% vs. 10.3%; p < 0.001), while students with little 3D modeling experience were more likely to rate high accessibility of the 3D Model (78.1% vs. 48.3%; p < 0.001). No statistically significant associations between the perceptions and students' demographic characteristics or use of computer were noted., Conclusion: The natural extracted tooth was rated highest in educational value, while the 3D printed model was rated easiest to use, and the AR model was the most interesting to the students., (© 2021 American Dental Education Association.)

COVID-19 has resulted in the deferral of major surgery for genitourinary (GU) cancers with the exception of cancers with a high risk of progression. We report outcomes for major GU cancer operations, namely radical prostatectomy (RP), radical cystectomy (RC), radical nephrectomy (RN), partial nephrectomy (PN), and nephroureterectomy performed at 13 major GU cancer centres across the UK between March 1 and May 5, 2020. A total of 598 such operations were performed. Four patients (0.7%) developed COVID-19 postoperatively. There was no COVID-19-related mortality at 30 d. A minimally invasive approach was used in 499 cases (83.4%). A total of 228 cases (38.1%) were described as training procedures. Training case status was not associated with a higher American Society of Anesthesiologists (ASA) score ( p  =  0.194) or hospital length of stay (LOS; p  >  0.05 for all operation types). The risk of contracting COVID-19 was not associated with longer hospital LOS ( p  =  0.146), training case status ( p  =  0.588), higher ASA score ( p  =  0.295), or type of hospital site ( p  =  0.303). Our results suggest that major surgery for urological cancers remains safe and training should be encouraged during the ongoing COVID-19 pandemic provided appropriate countermeasures are taken. These real-life data are important for policy-makers and clinicians when counselling patients during the current pandemic., Patient Summary: We collected outcome data for major operations for prostate, bladder, and kidney cancers during the COVID-19 pandemic. These surgeries remain safe and training should be encouraged during the ongoing pandemic provided appropriate countermeasures are taken. Our real-life results are important for policy-makers and clinicians when counselling patients during the COVID-19 pandemic., (© 2021 The Author(s).)

Global disruptions caused by coronavirus disease 2019 (COVID-19) affects all walks of life, and dentistry and dental education are no exceptions. Dental education uniquely blends didactic courses and hands-on clinical training seamlessly to prepare oral healthcare providers of the future. Apart from economical and access to care implications, closure of all the dental institutions in the United States affects their educational mission greatly, equally disturbing pre-doctoral and graduate training. Efforts are ongoing to continue the educational mission in dental institutions by delivering scheduled course content remotely using multiple online tools. In spite of those efforts, since clinical experiences cannot be completely replaced by any available alternative method of instruction that is delivered remotely, students are missing out on valuable patient-based clinical experiences. In this perspective article, we briefly discuss the several implications of COVID-19, in the context of dental education. We then highlight some of the lessons we can learn from this pandemic which we hope will have several positive implications, including curricular changes, increased public health awareness and preparedness for future public health emergencies., (© 2020 American Dental Education Association.)

Introduction: The conventional method for teaching removable partial denture (RPD) design using a pencil drawing on a solid cast has always been the basis for teaching RPD design in most dental schools at both the undergraduate and graduate levels. This does not apply to RPD fabrication technology, as more laboratories have recently adopted more efficient and versatile digital techniques to design and fabricate RPD frameworks., Methods: At the University of Iowa College of Dentistry, we created a pilot workshop to assess the efficiency of a new approach to teaching RPD design utilizing this new digital RPD technology as a teaching tool for graduate prosthodontics residents. Three first-year prosthodontics residents were enrolled in the workshop, which involved learning the new digital workflow of designing RPD., Results: This new teaching approach very successfully achieved its educational goals. The residents reported that the digital RPD teaching approach enriched their knowledge and deepened their understanding of RPD design., Discussion: The technique garnered significant interest from the students and seemed to also increase their understanding of the steps involved in RPD fabrication as well as the different components of the RPD., (© 2020 Mahrous and El-Kerdani.)

Critical thinking is ubiquitous in patient care. One track for critical thinking develops skillsets emulating the thought process of the master clinician using probing questions and has been offered in treatment planning, literature search, and critique, risk assessment in caries and geriatrics, technology decision-making, EBD, and IPP. This paper offers 2 additional critical thinking skillsets following this emulation model in social work and ethics. Conceptualization, another form of critical thinking, is also ubiquitous in health care, yet almost no literature exists to guide learning and assess performance on conceptualization. This paper introduces for discussion 2 examples of conceptualization-"How and how much does this situation differ from the ideal?" and "How does the student/practitioner conceptualize the outcome prior to the imminent procedure?" -used continually by the practitioner in patient care situations. The result is 4 additional critical thinking skillsets at different stages of development in the armamentarium for the teacher., (© 2020 The Authors. Journal of Dental Education published by Wiley Periodicals LLC on behalf of American Dental Education Association.)

In order to provide restorations and dental prostheses that are esthetically pleasing, functional and in harmony with a patient's occlusion, practitioners must have a thorough knowledge of dental anatomy. Recent studies have shown that virtual three-dimensional (3D) models greatly enhance educational outcomes in dental anatomy courses. This article describes a novel educational technique and uses videos and web-based portals to demonstrate how to create a virtual 3D tooth model from a scan of a natural tooth for use in dental anatomy courses., (© 2020 by the American College of Prosthodontists.)

Purpose To investigate the prognostic value of circumferential left ventricular (LV) strain measured by using cardiac MRI for prediction of major adverse cardiac events (MACE) following an acute ST-segment-elevation myocardial infarction (STEMI). Materials and Methods Participants with acute STEMI were prospectively enrolled from May 11, 2011, to November 22, 2012. Cardiac MRI was performed at 1.5 T during the index hospitalization. Displacement encoding with stimulated echoes (DENSE) and feature tracking of cine cardiac MRI was used to assess circumferential LV strain. MACE that occurred after discharge were independently assessed by cardiologists blinded to the baseline observations. Results A total of 259 participants (mean age, 58 years ± 11 [standard deviation]; 198 men [mean age, 58 years ± 11] and 61 women [mean age, 58 years ± 12]) underwent cardiac MRI 2.2 days ± 1.9 after STEMI. Average infarct size was 18% ± 13 of LV mass and circumferential strain was -13% ± 3 (DENSE method) and -24% ± 7 (feature- tracking method). Fifty-one percent (131 of 259 participants) had presence of microvascular obstruction. During a median follow-up period of 4 years, 8% (21 of 259) experienced MACE. Area under the curve (AUC) for DENSE was different from that of feature tracking (AUC, 0.76 vs 0.62; P = .03). AUC for DENSE was similar to that of initial infarct size (P = .06) and extent of microvascular obstruction (P = .08). DENSE-derived strain provided incremental prognostic benefit over infarct size for prediction of MACE (hazard ratio, 1.3; P < .01). Conclusion Circumferential strain has independent prognostic importance in study participants with acute ST-segment-elevation myocardial infarction. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Kramer in this issue.

The rationale for our study was to investigate the pathophysiology of microvascular injury in patients with acute ST-segment-elevation myocardial infarction in relation to a history of hypertension. We undertook a cohort study using invasive and noninvasive measures of microvascular injury, cardiac magnetic resonance imaging at 2 days and 6 months, and assessed health outcomes in the longer term. Three hundred twenty-four patients with acute myocardial infarction (mean age, 59 [12] years; blood pressure, 135 [25] / 79 [14] mm Hg; 237 [73%] male, 105 [32%] with antecedent hypertension) were prospectively enrolled during emergency percutaneous coronary intervention. Compared with patients without antecedent hypertension, patients with hypertension were older (63 [12] years versus 57 [11] years; P<0.001) and a lower proportion were cigarette smokers (52 [50%] versus 144 [66%]; P=0.007). Coronary blood flow, microvascular resistance within the culprit artery, infarct pathologies, inflammation (C-reactive protein and interleukin-6) were not associated with hypertension. Compared with patients without antecedent hypertension, patients with hypertension had less improvement in left ventricular ejection fraction at 6 months from baseline (5.3 [8.2]% versus 7.4 [7.6]%; P=0.040). Antecedent hypertension was a multivariable associate of incident myocardial hemorrhage 2-day post-MI (1.81 [0.98-3.34]; P=0.059) and all-cause death or heart failure (n=47 events, n=24 with hypertension; 2.53 [1.28-4.98]; P=0.007) postdischarge (median follow-up 4 years). Severe progressive microvascular injury is implicated in the pathophysiology and prognosis of patients with a history of hypertension and acute myocardial infarction. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02072850.

Moebius/Mӧbius Syndrome (MS) is an extremely rare congenital disorder characterized by uni- or bilateral palsy of the abducens (VI) and the facial (VII) nerves, causing facial paralysis. Dysfunction of cranial nerves III through XII is common, most often the glossopharyngeal (IX) and hypoglossus (XII). Afflicted individuals seeking prosthodontic care, particularly removable prosthetics, present multiple challenges related to inherent facial and tongue muscle weakness and microstomia. Other extraoral anomalies may include congenital multiple arthrogryposis and malformations of the upper and lower limbs. This clinical report describes the rehabilitation of a patient with Moebius Syndrome using a maxillary 2-implant retained overdenture and mandibular partial removable denture prosthesis., (© 2017 by the American College of Prosthodontists.)

Unlabelled: The natural history and pathophysiological significance of tissue remodeling in the myocardial remote zone after acute ST-elevation myocardial infarction (STEMI) is incompletely understood. Extracellular volume (ECV) in myocardial regions of interest can now be measured with cardiac magnetic resonance imaging. Patients who sustained an acute STEMI were enrolled in a cohort study (BHF MR-MI [British Heart Foundation Magnetic Resonance Imaging in Acute ST-Segment Elevation Myocardial Infarction study]). Cardiac magnetic resonance was performed at 1.5 Tesla at 2 days and 6 months post STEMI. T1 modified Look-Locker inversion recovery mapping was performed before and 15 minutes after contrast (0.15 mmol/kg gadoterate meglumine) in 140 patients at 2 days post STEMI (mean age: 59 years, 76% male) and in 131 patients at 6 months post STEMI. Remote zone ECV was lower than infarct zone ECV (25.6±2.8% versus 51.4±8.9%; P<0.001). In multivariable regression, left ventricular ejection fraction was inversely associated with remote zone ECV (P<0.001), and diabetes mellitus was positively associated with remote zone ECV (P=0.010). No ST-segment resolution (P=0.034) and extent of ischemic area at risk (P<0.001) were multivariable associates of the change in remote zone ECV at 6 months (ΔECV). ΔECV was a multivariable associate of the change in left ventricular end-diastolic volume at 6 months (regression coefficient [95% confidence interval]: 1.43 (0.10-2.76); P=0.036). ΔECV is implicated in the pathophysiology of left ventricular remodeling post STEMI, but because the effect size is small, ΔECV has limited use as a clinical biomarker of remodeling., Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02072850., (© 2016 The Authors.)

Background: Failed myocardial reperfusion is common and prognostically important after acute ST-elevation myocardial infarction (STEMI). The purpose of this study was to investigate coronary flow reserve (CFR), a measure of vasodilator capacity, and the index of microvascular resistance (IMR; mmHg × s) in the culprit artery of STEMI survivors., Methods: IMR ( n = 288) and CFR ( n = 283; mean age [SD], 60 [12] years) were measured acutely using guide wire-based thermodilution. Cardiac MRI disclosed left ventricular pathology, function, and volumes at 2 days ( n = 281) and 6 months after STEMI ( n = 264). All-cause death or first heart failure hospitalization was independently adjudicated (median follow-up 845 days)., Results: Myocardial hemorrhage and microvascular obstruction occurred in 89 (42%) and 114 (54%) patients with evaluable T2*-MRI maps. IMR and CFR were associated with microvascular pathology (none vs. microvascular obstruction only vs. microvascular obstruction and myocardial hemorrhage) (median [interquartile range], IMR: 17 [12.0-33.0] vs. 17 [13.0-39.0] vs. 37 [21.0-63.0], P < 0.001; CFR: 1.7 [1.4-2.5] vs. 1.5 [1.1-1.8] vs. 1.4 [1.0-1.8], P < 0.001), whereas thrombolysis in myocardial infarction blush grade was not. IMR was a multivariable associate of changes in left ventricular end-diastolic volume (regression coefficient [95% CI] 0.13 [0.01, 0.24]; P = 0.036), whereas CFR was not ( P = 0.160). IMR (5 units) was a multivariable associate of all-cause death or heart failure hospitalization ( n = 30 events; hazard ratio [95% CI], 1.09 [1.04, 1.14]; P < 0.001), whereas CFR ( P = 0.124) and thrombolysis in myocardial infarction blush grade ( P = 0.613) were not. IMR had similar prognostic value for these outcomes as <50% ST-segment resolution on the ECG., Conclusions: IMR is more closely associated with microvascular pathology, left ventricular remodeling, and health outcomes than the angiogram or CFR., Trial Registration: NCT02072850., Funding: A British Heart Foundation Project Grant (PG/11/2/28474), the National Health Service, the Chief Scientist Office, a Scottish Funding Council Senior Fellowship, a British Heart Foundation Intermediate Fellowship (FS/12/62/29889), and a nonfinancial research agreement with Siemens Healthcare.

Aims: To assess the prognostic significance of infarct core tissue characteristics using cardiac magnetic resonance (CMR) imaging in survivors of acute ST-elevation myocardial infarction (STEMI)., Methods and Results: We performed an observational prospective single centre cohort study in 300 reperfused STEMI patients (mean ± SD age 59 ± 12 years, 74% male) who underwent CMR 2 days and 6 months post-myocardial infarction (n = 267). Native T1 was measured in myocardial regions of interest (n = 288). Adverse remodelling was defined as an increase in left ventricular (LV) end-diastolic volume ≥20% at 6 months. All-cause death or first heart failure hospitalization was a pre-specified outcome that was assessed during follow-up (median duration 845 days). One hundred and sixty (56%) patients had a hypo-intense infarct core disclosed by native T1. In multivariable regression, infarct core native T1 was inversely associated with adverse remodelling [odds ratio (95% confidence interval (CI)] per 10 ms reduction in native T1: 0.91 (0.82, 0.00); P = 0.061). Thirty (10.4%) of 288 patients died or experienced a heart failure event and 13 of these events occurred post-discharge. Native T1 values (ms) within the hypo-intense infarct core (n = 160 STEMI patients) were inversely associated with the risk of all-cause death or first hospitalization for heart failure post-discharge (for a 10 ms increase in native T1: hazard ratio 0.730, 95% CI 0.617, 0.863; P < 0.001) including after adjustment for left ventricular ejection fraction, infarct core T2 and myocardial haemorrhage. The prognostic results for microvascular obstruction were similar., Conclusion: Infarct core native T1 represents a novel non-contrast CMR biomarker with potential for infarct characterization and prognostication in STEMI survivors. Confirmatory studies are warranted. CLINICALTRIALS., Gov Identifier: NCT02072850., (© The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Aims: To establish a clinical registry for adult patients with congenital heart disease (CHD) managed in Cairo University Hospitals, aiming at description of the pattern and clinical profile of such patients., Methods: Patients were recruited from both Cardiovascular Medicine Department Outpatient Clinic and inpatient wards of Cairo University Hospitals. Clinical data were collected from hospital records and directly from patients by treating cardiologists. Collected data were then registered in a dedicated database system and subsequently analyzed., Results: Patients (49% males) ranged in age from 16 to 63 years, with a median of 25 years. Fifty-one patients were in the age-group from 20 to 30 years, with only 9% aged 50 years or older. Seventy-eight patients had acyanotic lesions, with atrial septal defect being the most common primary diagnosis (20% of total lesions). The remaining 22 patients had cyanotic heart disease, with tetralogy of Fallot being the predominant diagnosis (45% of cyanotic lesions). Six patients presented with infective endocarditis in the setting of CHD. Four women (8% of females) presented during pregnancy. Forty-six patients were sent for surgical correction/repair, while percutaneous intervention was planned in 20 patients., Conclusions: A new registry of adult patients with CHD managed in Cairo University Hospitals provides useful information, including the extent to which congenital heart defects are underdiagnosed and undertreated during infancy and childhood. In addition, those who were previously treated early in life require long-term follow-up in specialized centers. Establishment of a multidisciplinary team with expert physicians (cardiologists, dentists, obstetricians, and psychiatrists), cardiac surgeons, and nurses may be facilitated by development of a dedicated database system. Continuous financial support is a major challenge., (© The Author(s) 2014.)