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Orbital fractures are common, but their management remains controversial. The aim of the present study was to assess the accuracy of an advanced artificial intelligence (AI) model, ChatGPT-4, in surgical decision-making, with a focus on orbital fracture diagnosis and management. A retrospective observational analysis was conducted by involving a sample of 30 orbital fracture cases diagnosed and managed at the Geneva University Hospital, Switzerland. The process involved creating patient vignettes from anonymised medical records and presenting them to ChatGPT-4 in three stages: initial diagnosis, refinement with radiological reports and surgical intervention decisions. The performance of ChatGPT-4 in providing the appropriate surgical strategy was evaluated through measures of sensitivity, specificity, positive predictive value and negative predictive value, with the actual management used as the benchmark for accuracy. The AI model could correctly diagnose the fracture in 100 % of the cases. It demonstrated a specificity of 100 % and sensitivity of 57 % for treatment recommendation, indicating its effectiveness in recognising patients who truly required an intervention; however, it demonstrated a moderate performance in correctly identifying cases that were better suited for conservative treatment. Cohen's Kappa statistic for interrater reliability of the choice of treatment was 0.44, indicating a weak level of agreement between ChatGPT and the physician's choice of treatment. The study demonstrates that AI tools such as ChatGPT-4 can offer a high degree of accuracy in diagnosing orbital fractures and recognising patients requiring surgical intervention; however, it performed less satisfactorily in correctly identifying patients who were better suited for non-surgical treatment., Competing Interests: None., (© 2024 The Author(s).)

Purpose: To determine whether odontogenic maxillary sinusitis, either alone (OMSw/oFB) or in combination with fungus ball (OMSwFB), is associated with specific clinical characteristics and treatment outcomes compared to non-odontogenic maxillary sinusitis., Materials and Methods: A retrospective cohort study was performed on patients who underwent surgical treatment for chronic maxillary sinusitis between 2013 and 2021. OMSw/oFB and OMSwFB patients, were selected as the study group, while patients diagnosed with non-odontogenic maxillary sinusitis (non-OMS) were enrolled as the control group. Predictor variables were OMSw/oFB and OMSwFB. Outcomes were clinical presentation, postoperative complications, and treatment outcome. Descriptive, bivariate, and multiple logistic regression statistics were calculated, and the significance level was set at P ≤ 0.05., Results: The sample included 200 patients with a mean age of 49.6 ± 20.1 years and 57.5 % were men. Of the 200 patients, 123 (61.5 %) had non-OMS, 55 (27.5 %) had OMSw/oFB, and 22 (11 %) had OMSwFB. Multivariate analysis showed that OMSw/oFB was associated with more successful treatment rates (OR = 8.19, p < 0.01), whereas OMSwFB was associated with a less favorable outcome (OR = 0.27, p = 0.03). Age was associated with an unfavorable outcome in both OMS groups (OR: 0.98, p = 0.03 and p = 0.03, respectively), but no significant associations with other outcomes were found., Conclusion: This study suggests that OMSwFB is a recalcitrant form of OMS associated with a higher risk of persistent symptoms and less favorable outcome. These patients should be informed about the challenging nature of the disease and closely monitored., Competing Interests: Declaration of competing interest 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. The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for [Journal of Stomatology, Oral and Maxillofacial Surgery] and was not involved in the editorial review or the decision to publish this article., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

The purpose of this study was to assess and compare the complication rates of single-jaw orthognathic surgery between outpatients and inpatients, and to examine their impact on the outcome of care setting. A retrospective cohort study was performed of patients who underwent single-jaw orthognathic procedures. Outpatients between 2008 and 2023 were selected as the study group, while inpatients between 1997 and 2023 were enrolled as the control group. The predictor variable was the patient care setting. The primary outcome variable was the occurrence of overall complications. Secondary outcomes included surgery-, anesthesia-, and patient-related complications. Other study variables included age, sex, surgery, and anesthetic procedures. Descriptive, bivariate, and multiple logistic regression statistics were computed and the significance level was set at p ≤ 0.05. The sample included 307 patients with a mean age of 23.1 years ±9.5 years, of whom 55% were female. The outpatient and inpatient groups consisted of 123 (40.1%) and 184 (59.9%) patients, respectively. Of the 123 outpatients, 104 (85.5%) were discharged on the day of surgery. Age (p = 0.012) and ketamine administration (p = 0.022) were significantly associated with complications among outpatients. Outpatient setting and age were significantly associated with overall complications (OR 2.48; 95% confidence interval [CI] 1.34-4.66, p = 0.003 and OR 0.94, 95% CI 0.88-0.98, p = 0.021, respectively) and anesthetic-related complications (OR 4.43, 95% CI 2.03-10.5, p = 0.0003 and OR 0.92, 95% CI 0.83-0.98, p = 0.041, respectively). The study demonstrated that outpatient orthognathic surgery had a high success rate but also identified a higher rate of anesthetic-related complications among outpatients, particularly in younger patients and in those receiving ketamine., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: This observational study compares the effectiveness of baricitinib (BARI), a targeted synthetic disease-modifying antirheumatic drug (tsDMARD), with alternative biological DMARDs (bDMARDs) in patients with rheumatoid arthritis (RA), from a prospective, longitudinal cohort., Methods: We compared patients initiating a treatment course (TC) of BARI, tumour necrosis factor inhibitors (TNFi) or bDMARDs with other modes of action (OMA), during a period when all these DMARDs were available in Switzerland. The primary outcome was drug maintenance; secondary outcomes included discontinuation rates related specifically to ineffectiveness and adverse events. We further analysed rates of low disease activity (LDA) and remission (REM) at 12 months and drug maintenance in bDMARD-naïve and tsDMARD-naïve population., Results: A total of 1053 TCs were included: 273 on BARI, 473 on TNFi and 307 on OMA. BARI was prescribed to older patients with longer disease duration and more previous treatment failures than TNFi. Compared with BARI, the adjusted drug maintenance was significantly shorter for TNFi (HR for discontinuation: 1.76; 95% CI, 1.32 to 2.35) but not compared with OMA (HR 1.27; 95% CI, 0.93 to 1.72). These results were similar in the b/tsDMARD-naïve population. The higher discontinuation of TNFi was mostly due to increased discontinuation for ineffectiveness (HR 1.49; 95% CI, 1.03 to 2.15), with no significant differences in drug discontinuation for adverse events (HR 1.46; 95% CI, 0.83 to 2.57). The LDA and REM rates at 12 months did not differ significantly between the three groups., Conclusions: BARI demonstrated a significantly higher drug maintenance compared with TNFi, mainly due to lower drug discontinuations for ineffectiveness. We found no difference in drug maintenance between BARI and OMA. Clinical outcomes did not differ between the three groups. Our results suggest that BARI is an appropriate therapeutic alternative to bDMARDs in the management of RA., Competing Interests: Competing interests: BTPG has been once a paid speaker (Eli Lilly) and participated in the advisory board (Janssen). CP is employed by Eli Lilly and holds stock options (Eli Lilly and Company). CL is employed by Eli Lilly and holds stock options (Eli Lilly and Novartis). AF has received grants or contracts (Eli Lilly, Pfizer, AbbVie, Gilead and BMS), consulting fees (AstraZeneca, AbbVie, Pfizer and Gilead) and honorary payments (BMIS, AbbVie, Eli Lilly, Pfizer and MSD) and participated in advisory boards (Astra-Zeneca, Gilead, Novartis, AbbVie, Eli Lilly, Pfizer, J&J, Mylan and UCB). DM, RA, RM and DSC have no conflicts of interest to disclose., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In a clinical trial setting, patients with rheumatoid arthritis (RA) taking the Janus kinase inhibitor (JAKi) tofacitinib demonstrated higher adverse events rates compared with those taking the tumour necrosis factor inhibitors (TNFi) adalimumab or etanercept., Objective: Compare treatment discontinuations for adverse events (AEs) among second-line therapies in an international real-world RA population., Methods: Patients initiating JAKi, TNFi or a biological with another mode of action (OMA) from 17 registers participating in the 'JAK-pot' collaboration were included. The primary outcome was the rate of treatment discontinuation due to AEs. We used unadjusted and adjusted cause-specific Cox proportional hazard models to compare treatment discontinuations for AEs among treatment groups by class, but also evaluating separately the specific type of JAKi., Results: Of the 46 913 treatment courses included, 12 523 were JAKi (43% baricitinib, 40% tofacitinib, 15% upadacitinib, 2% filgotinib), 23 391 TNFi and 10 999 OMA. The adjusted cause-specific hazard rate of treatment discontinuation for AEs was similar for TNFi versus JAKi (1.00, 95% CI 0.92 to 1.10) and higher for OMA versus JAKi (1.11, 95% CI 1.01 to 1.23), lower with TNFi compared with tofacitinib (0.81, 95% CI 0.71 to 0.90), but higher for TNFi versus baricitinib (1.15, 95% CI 1.01 to 1.30) and lower for TNFi versus JAKi in patients 65 or older with at least one cardiovascular risk factor (0.79, 95% CI 0.65 to 0.97)., Conclusion: While JAKi overall were not associated with more treatment discontinuations for AEs, subgroup analyses suggest varying patterns with specific JAKi, such as tofacitinib, compared with TNFi. However, these observations should be interpreted cautiously, given the observational study design., Competing Interests: Competing interests: RA has nothing to disclose. DM has nothing to disclose. SAB reports grants from Pfizer outside of this work and speaker fees from Benecke. DC has nothing to disclose. CC reports reports personal fees from AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis, Pfizer outside the submitted work. DDC has nothing to disclose. LD reports contract with BMS outside the present work. OE reports consulting and speaker fees from AbbVie, Pfizer, Eli Lilly, Novartis and Jansen. DH has nothing to disclose. KLH reports grant support from Pfizer and Bristol Myers Squibb and speaking fees from AbbVie. FI reports consulting fees from AbbVie, Janssen, UCB, Galapagos and speaker fees from AbbVie, Galapagos, Eli Lilly, Pfizer and UCB. NI reports consulting and speaking fees from AbbVie, Novartis, UCB, Eli Lilly, Pfizer and Celltrion. LKF has nothing to disclose. SSK has nothing to disclose. TKK reports grants from AbbVie, BMS, Galapagos, Novartis, Pfizer and UCB, consulting fees from AbbVie, Gilead, Janssen, Novartis, Pfizer, Sandoz, UCB Grünenthal, Sandoz and speaker fees from Grünenthal, Sandoz. BFL reports consulting fees from Eli Lilly, Pfizer and AbbVie, and speaking fees from Sandoz. GL has nothing to disclose. DN reports grants from MSD, consulting fees from BMS, Lilly, Novartis, Pfizer, UCB and speaker fees from Pfizer and UCB. KP reports speaker fees from Novartis, Eli Lilly, Roche, Pfizer, Sobi, AbbVie, Pfizer and MSD. MPS has nothing to disclose. AR reports grants from Amgen, AstraZeneca, Novartis, AbbVie, Pfizer, MSD, Lilly, Boehringer Ingelheim, speaker fees from Amgen, AbbVie and Novartis. ZR reports consulting fees from AbbVie, Pfizer, Janssen, AstraZeneca, Novartis, Boehringer Ingelheim, Eli Lilly and speaker fees from AbbVie, Pfizer, Janssen, AstraZeneca, Novartis, Boehringer Ingelheim, Eli Lilly, SOBI, Lek (Sandoz). AS reports speaker fees from AbbVie, BMC, MSD, Pfizer and Roche. PV reports grants from Pfizer and Galapagos, consulting fees from Galapagos, Gilead, Pfizer, Sidekick Health, speaking fees from Eli Lilly, Galapagos and Roularta. RW has nothing to disclose. JZ reports speaking fees from AbbVie, Sobi, Pfizer and Eli Lilly. DSC reports consulting fees from Medela AG. AF reports grants from AbbVie, Pfizer, Galapagos and Eli Lilly, consulting fees from Eli Lilly, Pfizer, AbbVie, speaker fees from Pfizer, Eli Lilly, AbbVie, MSD and BMS. KL has received consultancy and/or speaker fees from Pfizer, Viatris, Celltrion and Galapagos paid to her institution., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To assess the relationship between self-reported and serologic evidence of prior chlamydial infection, rheumatoid arthritis (RA)-related autoantibodies and risk of RA-development., Methods: This is a nested study within a prospective Swiss-based cohort including all first-degree relatives of RA patients (RA-FDR) who answered a question on past chlamydial infections. Primary outcome was systemic autoimmunity associated with RA (RA-autoimmunity) defined as positivity for anti-citrullinated peptide antibodies (ACPA) and/or rheumatoid factor (RF). Secondary outcomes were high levels of RA-autoimmunity, RA-associated symptoms and RA-autoimmunity, and subsequent seropositive RA diagnosis. We conducted a nested case-control analysis by measuring the serological status against Chlamydia trachomatis' major outer membrane protein. We replicated our analysis in an independent United States-based RA-FDR cohort., Results: Among 1231 RA-FDRs, 168 (13.6%) developed RA-autoimmunity. Prevalence of self-reported chlamydial infection was significantly higher in individuals with RA-autoimmunity compared with controls (17.9% vs 9.8%, OR = 2.00, 95%CI: 1.27-3.09, p < 0.01). This association remained significant after adjustments (OR = 1.91, 95%CI: 1.20-2.95). Stronger effect sizes were observed in later stages of RA development. There was a similar trend between a positive C. trachomatis serology and high levels of RA-autoimmunity (OR = 3.05, 95% CI: 1.10-8.46, p= 0.032). In the replication cohort, there were significant associations between chlamydial infection and RF positivity and incident RA, but not anti-CCP positivity., Conclusions: Self-reported chlamydial infections are associated with elevated RA-autoimmunity in at risk individuals. The differing association of chlamydial infections and ACPA/RF between cohorts will need to be explored in future studies but is consistent with a role of mucosal origin of RA-related autoimmunity., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

The purpose of the present study was to investigate and compare craniomaxillofacial fracture (CMF) type in patients with intracranial hemorrhage (ICH) versus blunt cerebrovascular injury (BCVI). A retrospective cohort study was performed. The predictor variables were the types of CMF. The primary outcomes variables were ICH and BCVI. Secondary outcomes were death and survival with or without neurological sequelae. Descriptive, bivariate, and multiple logistic regression statistics were computed, and the significance level was set at P ≤ 0.05. The sample was composed of 1440 patients with a mean age of 46.6 years ±24 years, and 71% were men. Pure orbital wall (odds ratio [OR]), 3.62; 95% confidence interval [CI], 1.32-12.69; P < 0.022), Le Fort III (OR, 16.08; 95% CI, 5.89-43.50; P < 0.001), cranial vault (OR, 9.74; 95% CI, 3.83.24.32; P < 0.001), skull base (OR, 9.42; 95% CI, 3.86-24.02; P < 0.001) and cervical fractures (OR, 5.50; 95% CI, 1.65-15.97; P = 0.003) were significantly associated with BCVI. All of the CMFs (P < 0.001), except for Le Fort I (OR, 0.79; 95% CI, 0.18-2.63; P = 0.731), nasal (OR, 1.05; 95% CI, 0.77-1.42; P = 0.758), and mandibular (OR, 0.68; 95% CI, 0.45-1.01; P = 0.066) fractures, were significantly associated with ICH. Secondary outcomes were negatively influenced by ICH and BCVI (P < 0.001). Within the limitations of the study it seems that Le Fort I and nasal fractures could be protective of cerebrovascular injuries, by cushioning impact forces. On the other hand it seems that patients with pure orbital wall, Le Fort III and cranio-cervical fractures are more prone to having concomitant life-threatening cerebrovascular injuries. This category of patients should have an immediate and comprehensive neurological assessment and CT angiography to rule out BCVI and to determine its severity., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Despite improved knowledge regarding the diagnosis and treatment of osteomyelitis of the jaw (OMJ), it remains a clinical challenge for oral and maxillofacial surgeons. This study aimed to identify risk factors associated with severe forms of OMJ, i.e., related to the occurrence of major complications or the refractory course of the disease. A retrospective study was performed based on the medical records of all patients diagnosed with OMJ from the past 20 years. Collected data included demographic information, medical and dental history, clinical, radiological, and bacterial findings as well as treatment modalities. The main outcome variables were the onset of major complications and treatment results. Fifty-four patients were included. Our results showed that alcohol and smoking habits, as well as malnutrition, were significantly associated with the occurrence of major complications. We also established that dental implant-induced OMJ should be considered an aggressive subtype of OMJ. Finally, clinical bone exposure was significantly associated with unfavorable outcomes, whereas dental causes or radiological evidence of periosteal reaction were predictive of successful outcomes. Identifying such factors could be useful in preventing serious complications and informing patients about the refractory course of the disease based on the presence of these factors.