[The spring of artificial intelligence: AI vs. expert for internal medicine cases]. / Les Printemps de la Médecine Interne : l'intelligence artificielle face aux experts internistes.

INTRODUCTION: The "Printemps de la Médecine Interne" are training days for Francophone internists. The clinical cases presented during these days are complex. This study aims to evaluate the diagnostic capabilities of non-specialized artificial intelligence (language models) ChatGPT-4 and Bard by confronting them with the puzzles of the "Printemps de la Médecine Interne". METHOD: Clinical cases from the "Printemps de la Médecine Interne" 2021 and 2022 were submitted to two language models: ChatGPT-4 and Bard. In case of a wrong answer, a second attempt was offered. We then compared the responses of human internist experts to those of artificial intelligence. RESULTS: Of the 12 clinical cases submitted, human internist experts diagnosed nine, ChatGPT-4 diagnosed three, and Bard diagnosed one. One of the cases solved by ChatGPT-4 was not solved by the internist expert. The artificial intelligence had a response time of a few seconds. CONCLUSIONS: Currently, the diagnostic skills of ChatGPT-4 and Bard are inferior to those of human experts in solving complex clinical cases but are very promising. Recently made available to the general public, they already have impressive capabilities, questioning the role of the diagnostic physician. It would be advisable to adapt the rules or subjects of future "Printemps de la Médecine Interne" so that they are not solved by a public language model.

Oral health in Alzheimer's disease: a multicenter case-control study.

OBJECTIVES: The aim of this case-control study was to carry out an oral health assessment on a group of Alzheimer's patients and to establish a hypothesis regarding the implication of the characteristics of the disease and the treatment of oral health. MATERIALS AND METHODS: A total of 70 Alzheimer's patients, residents at the Alzheimer Center Reina Sofia Foundation (Madrid, Spain) and at the Alzheimer State Reference Center (Salamanca, Spain), and 36 controls (companions/acquaintances), were studied by oral examination and saliva sampling. The oral health indices DMFT/DMFS, CPI, the prosthetic condition, oral hygiene, saliva volume, and pH, as well as the specific microbiological parameters governing the risk of developing caries were assessed. RESULTS: Alzheimer's patients exhibited, as compared to the control group, (1) fewer teeth (10.9 ± 10.5 vs 23.7 ± 6.5), (2) fewer obturations (2.2 ± 3.4 vs 6.6 ± 5.6), (3) fewer periodontally healthy sextants (0.1 ± 0.4 vs 1.4 ± 2.2), (4) worse oral hygiene (43.1 vs 72.2% brushed), (5) greater use of removable prostheses (47.8 vs 8.4%), (6) higher incidence of candida infection (11.8 vs 0.0%) and cheilitis (15.9 vs 0.0%), (7) lower salivary flow (0.6 ± 0.6 vs 1.1 ± 0.6), and (8) lower buffering capacity (46 vs 80%). CONCLUSIONS: After taking into account the influence of age, Alzheimer's patients had worse oral health (caries and periodontal disease), more mucosal lesions (cheilitis and candidiasis), and worse saliva quantity and quality. CLINICAL RELEVANCE: Clinicians should be aware of the implications of Alzheimer's disease in oral health, in order to stablish the effective preventive measures and the optimal treatment plan.

The role of personality traits in self-rated oral health and preferences for different types of flawed smiles.

Symmetric, aligned and luminous smiles are usually classified as 'beautiful' and aesthetic. However, smile perception is not strictly governed by standardised rules. Personal traits may influence the perception of non-ideal smiles. We aimed to determine the influence of personality traits in self-rated oral health and satisfaction and in the aesthetic preference for different strategically flawed smiles shown in photographs. Smiles with dark teeth, with uneven teeth, with lip asymmetry and dental asymmetry were ordered from 1 to 4 as a function of the degree of beauty by 548 participants, of which 50·7% were females with a mean age of 41·5 ± 17·6 years (range: 16-89 years). Self-assessment and oral satisfaction were recorded on a Likert scale. Personality was measured by means of the Big Five Inventory (extraversion, agreeableness, conscientiousness, neuroticism and openness), and the Life Orientation Test was used to measure optimism and pessimism. Of the four photographs with imperfect smiles, dental asymmetry was the most highly assessed in 63% of the sample, and the worst was lip asymmetry, in 43·7% of the sample. Some personality traits (above all conscientiousness and openness) were significantly correlated with the position assigned to the photographs with dental and lip asymmetry or with misaligned teeth. The extraversion, agreeableness and openness traits were correlated with the self-perceptions of oral health and aesthetics of the participants. Dental asymmetry seems to be better tolerated than lip asymmetry. Personality traits are weakly but significantly correlated with the aesthetic preference and oral health values, conscientiousness and openness being the most relevant domains in this sense.

Ultrashort pulsed laser conditioning of human enamel: in vitro study of the influence of geometrical processing parameters on shear bond strength of orthodontic brackets.

The surfaces of 63 extracted premolar teeth were processed with intense ultrashort laser pulses (λ = 795 nm; pulse duration, 120 fs; repetition rate, 1 kHz) to produce cross patterns with different pitches (s) in the micrometer range in order to evaluate the influence of such microstructures on the shear bond strengths of orthodontic brackets to enamel. The samples were classified in nine groups corresponding to the control group (raw samples) and eight different laser-processed groups (cross patterns with s increasing from 15 to 180 µm). Brackets were luted with Transbond(TM) XT adhesive resin to all the samples; after 72 h, they all were submitted to strength test in a universal testing machine. Additionally, a third of the samples underwent morphological analysis of the debonded surface by means of scanning electron microscope microscopy and an analysis of the failure mode based on the adhesive remnant index. The results showed that enamel microstructuring with ultrashort laser pulses remarkably increase the bond strength of brackets. Dense cross patterns (s < 90 µm) produce the highest increase of bond strengths as compared to control group whereas light ones (s > 90 µm) give rise to smaller improvements of the bond strength. A strong correlation of this behavior with the predominant failure mode in both scenarios was found. So far, the best compromise between suitable adhesive efficiency, processing time minimization, and enamel surface preservation suggests the performance of cross patterns with pitches in the order of 90 µm.

Influence of Er:YAG and Ti:sapphire laser irradiation on the microtensile bond strength of several adhesives to dentin.

The aim of the present study was to evaluate the influence of erbium:yttrium-aluminum-garnet (Er:YAG) and Ti:sapphire laser irradiation on the microtensile bond strength (MTBS) of three different adhesive systems to dentin. Flat dentin surfaces from 27 molars were divided into three groups according to laser irradiation: control, Er:YAG (2,940 nm, 100 µs, 2.7 W, 9 Hz) and Ti:sapphire laser (795 nm, 120 fs, 1 W, 1 kHz). Each group was divided into three subgroups according to the adhesive system used: two-step total-etching adhesive (Adper Scotchbond 1 XT, from now on XT), two-step self-etching adhesive (Clearfil SE Bond, from now on CSE), and all-in-one self-etching adhesive (Optibond All-in-One, from now on OAO). After 24 h of water storage, beams of section at 1 mm(2) were longitudinally cut from the samples. Each beam underwent traction test in an Instron machine. Fifteen polished dentin specimens were used for the surface morphology analysis by scanning electron microscopy (SEM). Failure modes of representative debonded microbars were SEM-assessed. Data were analyzed by ANOVA, chi-square test, and multiple linear regression (p < 0.05). In the control group, XT obtained higher MTBS than that of laser groups that performed equally. CSE showed higher MTBS without laser than that with laser groups, where Er:YAG attained higher MTBS than ultrashort laser. When OAO was used, MTBS values were equal in the three treatments. CSE obtained the highest MTBS regardless of the surface treatment applied. The Er:YAG and ultrashort laser irradiation reduce the bonding effectiveness when a two-step total-etching adhesive or a two-step self-etching adhesive are used and do not affect their effectiveness when an all-in-one self-etching adhesive is applied.

Contributions of dental colour to the physical attractiveness stereotype.

Dental appearance may play a key role on the way we develop a first impression of another person. To test whether relatively minor changes in the lightness of tooth colour would influence the perceived social appeal (social, intellectual, psychological and relational abilities) of an unknown male and unknown female, this cross-sectional study was performed on 555 Spanish adults. The two major independent variables related to the photograph were tooth lightness (computer-derived), divided into three levels that included lightened teeth, natural teeth and darkened teeth, and the gender of the observed face. Moreover, six independent variables related to the observer were assessed (age, gender, educational level, place of residence, frequency of brushing and self-reported health status). The dependent variables were scored on five-point Likert scales designed to quantify four domains (social, intellectual, psychological and relationship competences) of the Social Appeal Scale (SAS). Tooth lightness influences the perception of social appeal in all dimensions, as darkened smiles received significantly poorer scores than natural-colour smiles, but these were also worse than lightened smiles. A logistic regression analysis revealed that the major predictor of social appeal was tooth lightness, and for each increment in lightness (from darkened to lightened smiles), the odds ratio (OR) of positive values being perceived increased significantly in all items (from 2·3 in Popularity to 6·9 in Happiness). A perceptible change in dental lightness is the strongest factor associated with the dental attractiveness stereotype, affecting significantly the 12 traits assessed, but mainly the Happiness, Social Relations and Academic Performance.

In vitro analysis of femtosecond laser as an alternative to acid etching for achieving suitable bond strength of brackets to human enamel.

This study aims to evaluate the effect of laser irradiation and orthophosphoric acid etching on the shear bond strength (SBS) of orthodontic brackets to enamel. Three groups (n = 20) of extracted premolar teeth were randomly established depending on the laser treatment performed on the buccal surfaces: (1) no laser (control); (2) Er:YAG laser (2,940 nm, 0.8 W, 100 µs/pulse, 10 Hz) and; (3) Ti:Sapphire laser (795 nm, 1 W, 120 fs/pulse, 1 kHz). Each group was divided into two subgroups according to whether 37%-orthophosphoric acid etching was made after laser irradiation or not. Brackets were randomly luted with Transbond(TM) XT adhesive resin. After 72 h, a SBS test was developed in a universal testing machine (crosshead speed, 0.5 mm/min). Representative specimens from each experimental subgroup were examined by means of scanning electron microscopy. Cement residuals remaining on the premolar surfaces were assessed using the adhesive remnant index. ANOVA, post-hoc tests for intergroup comparisons, chi-square test and linear regression were run for data analyses (α = 0.05). After acid etching, SBS values did not differ regardless the laser treatment. When phosphoric acid was not applied, the SBS values of the femtosecond laser group were significantly higher than for the other groups. Femtosecond laser without acid seems to be the most suitable method to improve bond strengths at the bracket/enamel interface, thus avoiding the disadvantages inherent to acid etching.

Evaluation of micromorphological changes in tooth enamel after mechanical and ultrafast laser preparation of surface cavities.

The aim of this in vitro study was to evaluate the morphological changes that occur in tooth enamel after mechanical instrumentation and after femtosecond laser irradiation with different parameters via light and scanning electron microscopy (SEM). Twelve totally impacted third molars were collected and sectioned to provide several cut surfaces. These surfaces were exposed to infrared (λ = 795 nm, 120 fs, 1-kHz repetition rate, maximum mean power 1 W) laser pulses and machined by means of a conventional mechanical technique. Two very different geometrical patterns were performed with femtosecond laser pulses: shallow rectangular cavities and deep cylindrical ones. The results of both machining procedures were examined using light and scanning electron microscopy. The SEM images show the femtosecond laser ability to produce high-precision cavities in tooth enamel. No signs of collateral damage, burning, melting, or cracks were observed despite the far different laser pulse energies used (ranging from 7 to 400 µJ), unlike what is seen with conventional mechanical techniques. The femtosecond laser has the potential to become an optimal tool for the treatment of dental decay and as an alternative to the conventional drill to reduce mechanical damage during removal of the hard dental tissue.

Comparative validity of the OIDP and OHIP-14 in describing the impact of oral health on quality of life in a cross-sectional study performed in Spanish adults.

OBJECTIVES: We aimed to compare the utility and validity of two popular socio-dental indicators (OIDP and OHIP-14) for describing the impact of oral conditions on quality of life applied simultaneously. STUDY DESIGN: We recruited a consecutive sample of 270 healthy Spanish workers visiting the Employment Risk Prevention Centre for a routine medical check-up. OHIP-14 was self-completed before the oral examination and the face to face interview of the OIDP was performed. Both instruments were compared by evaluating its reliability and its validity. RESULTS AND CONCLUSIONS: The standardised Cronbach alphas for OHIP-14 and OIDP were 0.89 and 0.74 respectively. OIDP showed lower face validity but higher content validity than OHIP-14. Both indicators showed high construct and criterion validity, since individuals perceiving need for dental treatment or having any complaint about their mouth obtained significantly higher total OIDP and OHIP scores than their counterparts. The prevalence of impacts was much higher using the OHIP (80.7%) than the OIDP (27.8%).

The discovery of surgical anesthesia: discrepancies regarding its authorship.

The suppression of pain during surgical interventions has been a major achievement for humankind. Chronologically, in 1842, William E. Clarke, a chemist in Rochester (NY), provided Elijah Pope with ether for the purposes of tooth extraction. In 1844, in Boston, G.Q. Colton and the dentist Horace Wells used nitrous oxide as an anesthetic for tooth extraction. On the 16th of October, 1846, the American dentist William T.G. Morton became a pioneer within the medical community with respect to anesthesia by inhalation when he used ether as an anesthetic at the Massachusetts General Hospital. In 1847, the Scot James Young Simpson began to use chloroform as an anesthetic for obstetrics in Edinburgh. These events gave rise to several disputes among their users (who are not very well-known today), who strove to claim that they had been the discoverers of surgical anesthesia, with a view to obtaining a series of patents and state sinecures. This article attempts to clarify certain discrepancies about the authorship of surgical anesthesia. The evidence suggests that surgical anesthesia first began to be applied in the field of dentistry.

Validation of two complementary oral-health related quality of life indicators (OIDP and OSS 0-10 ) in two qualitatively distinct samples of the Spanish population.

BACKGROUND: Oral health-related quality of life can be assessed positively, by measuring satisfaction with mouth, or negatively, by measuring oral impact on the performance of daily activities. The study objective was to validate two complementary indicators, i.e., the OIDP (Oral Impacts on Daily Performances) and Oral Satisfaction 0-10 Scale (OSS), in two qualitatively different socio-demographic samples of the Spanish adult population, and to analyse the factors affecting both perspectives of well-being. METHODS: A cross-sectional study was performed, recruiting a Validation Sample from randomly selected Health Centres in Granada (Spain), representing the general population (n = 253), and a Working Sample (n = 561) randomly selected from active Regional Government staff, i.e., representing the more privileged end of the socio-demographic spectrum of this reference population. All participants were examined according to WHO methodology and completed an in-person interview on their oral impacts and oral satisfaction using the OIDP and OSS 0-10 respectively. The reliability and validity of the two indicators were assessed. An alternative method of describing the causes of oral impacts is presented. RESULTS: The reliability coefficient (Cronbach's alpha) of the OIDP was above the recommended 0.7 threshold in both Validation and Occupational samples (0.79 and 0.71 respectively). Test-retest analysis confirmed the external reliability of the OSS (Intraclass Correlation Coefficient, 0.89; p < 0.001) Some subjective factors (perceived need for dental treatment, complaints about mouth and intermediate impacts) were strongly associated with both indicators, supporting their construct and criterion validity. The main cause of oral impact was dental pain. Several socio-demographic, behavioural and clinical variables were identified as modulating factors. CONCLUSION: OIDP and OSS are valid and reliable subjective measures of oral impacts and oral satisfaction, respectively, in an adult Spanish population. Exploring simultaneously these issues may provide useful insights into how satisfaction and impact on well-being are constructed.

Métodos de investigación in vitro de los factores que afectan la durabilidad de la adhesión a dentina / In vitro investigation’s methods of the factors influencing resin-dentin bond durability

La durabilidad de la adhesión resina-dentina es de crucial importancia tanto para el clínico como para el investigador, sin embargo, se sabe muy poco acerca de la estabilidad de la capa híbrida. El test de fuerzas de adhesión inmediata no puede demostrar adecuadamente los efectos que pueden tener en la durabilidad de la adhesión los poros y otros defectos internos producidos en la capa híbrida. Después del ciclado mecánico, el efecto de estas irregularidades interfaciales que alteran la durabilidad de la adhesión puede resultar más aparente. El uso combinado del ciclado mecánico con el test de fuerzas adhesivas de microtensión permite la evaluación in vitro de la durabilidad de la adhesión resina-dentina bajo unas condiciones clínicamente más relevantes de las que son usadas normalmente en la técnica de fuerzas de adhesión estáticas. El método de degradación basado en la inmersión de los especímenes en hipoclorito de sodio acuoso durante un corto periodo de tiempo resulta bastante más real que los estudios in vitro realizados con almacenamiento en agua durante un largo periodo de tiempo. La disminución de los valores de las fuerzas de adhesión obtenidas después de la inmersión es similar a los obtenidos con estudios de degradación in vivo (AU)

The durability of resin-dentin bonds between adhesive resins and coronal dentin is of critical importance and little is known regarding the stability of hybridized layers. Static bond strength tests may not adequately demonstrate the potential detrimental effects that porosities and other internal defects within the adhesive layer may have on bonding durability. After cyclic loading, the effect of these interfacial defects on long-term bonding may be more readily apparent. The combined use of mechanical loading with micro tensile bond strength testing permits the evaluation of the in vitro durability of resin-dentin bonds under more clinically-relevant conditions than are usually employed in static bond strength testing techniques. The challenging method based upon 10% Sodium hypochlorite immersion of specimens during a short period of time is much more reliable than in vitro studies based on long-term water storage of specimens and those previously reported after Sodium hypochlorite immersion are similar to the decline in bond strength obtained when in vivo degradation studies are performed (AU)

Método de preparación del espécimen para evaluar la micromorfología de la interfase adhesiva resina-dentina con un microscopio electrónico de barrido / No disponible

La infiltración con resina de las fibras de colágeno desmineralizadas permiten la formación de una capa híbrida con tags de resina y ramas laterales, creando de esta manera, retenciones micromecánicas de la resina al substrato desmineralizado. Dichas retenciones son el principal mecanismo para la adhesión resina-dentina, siendo la penetración de la resina en la dentina intertubular, el factor de mayor importancia en la obtención de unas adecuadas fuerzas de adhesión. Uno de los instrumentos más usados para estudiar los mecanismos que envuelven el proceso de adhesión ha sido el microscopio electrónico de barrido (MEB). El principio del MEB se basa en imágenes tridimensionales que se construyen punto a punto y línea a línea desde los electrones secundarios. El objetivo de este estudio es describir la preparación de los espécimenes para evaluar la formación de la capa híbrida, los tags de resina y ramas laterales (AU)

The infiltration of demineralized collagen fibers with resin permits formation of a hybrid layer with resin tags and adhesive lateral branches, thus creating micromechanical retention of the resin to the demineralized substrate. The micromechanical retention is the chief mechanism for resin bonding to dentin with resin penetration of the intertubular dentin being of major importance in bond strength. One of the first and most widely used tools to study the mechanisms involved in the process of bonding has been the scanning electron microscope (SEM). The principle of SEM is based upon a pseudo three-dimensional image that is built up point-by-point and line-by-line from secondary electrons. The objective of this study is to describe the preparation of the specimens to evaluate the hybrid layer, resin tags and adhesive lateral branches formations (AU)

Effect of cyclic loading on the microtensile bond strengths of total-etch and self-etch adhesives.

OBJECTIVE: To evaluate the effect of mechanical loading on the microtensile bond strength (MTBS) of five adhesive systems to dentin. METHODS: Flat dentin surfaces from human molars were divided into five groups and bonded with total-etch self-priming adhesives (Single Bond, Prime&Bond NT and Prime&Bond XP), two-step self-etching primer (Clearfil SE Bond) and an all-in-one adhesive (Etch&Prime 3.0), according to the manufacturers' instructions. Composite build-ups were constructed incrementally with Tetric Ceram. After 24 hours of water storage, half the specimens were load cycled (5000 cycles, 90 N). The teeth were then sectioned into beams of 1.0 mm2 cross-sectional area. Each beam was tested in tension in an Instron machine at 0.5 mm/minute. Data were analyzed by two-way ANOVA and Student Newman Keuls multiple comparisons tests (p<0.05). RESULTS: Clearfil SE Bond and Single Bond attained higher MTBS than the other three adhesives. Prime&Bond NT and Prime&Bond XP performed equally, and Etch&Prime 3.0 resulted in the lowest MTBS. After mechanical loading, MTBS decreased in all groups except Prime&Bond XP. Clearfil SE Bond, Single Bond and Prime&Bond XP obtained higher MTBS than Prime&Bond NT. Specimens bonded with Etch&Prime 3.0 resulted in premature failures and MTBS could not be measured. CLINICAL RELEVANCE: When using Etch&Prime 3.0, bond structures did not withstand mechanical loading, which may have an influence on the long-term success of restorations. If dentin is acid-etched, alcohol-based adhesive systems showed higher bond strength after mechanical loading.

[Ursodeoxycholic acid treatment shortens the course of cholestasis in two patients with benign recurrent intrahepatic cholestasis]. / El tratamiento con ácido ursodexosicólico parece acortar el período de colestasis en dos pacientes con colestasis intrahepática recurrente benigna.

INTRODUCTION: Benign recurrent intrahepatic cholestasis (BRIC) is a rare autosomal-crecessive or sporadic disorder, characterized by repeated episodes of unexplained cholestasis followed by prolonged asymptomatic periods. CASE REPORT: We present two male patients aged 12 and 15 years old who initially presented cholestasis and who had no family history of liver or biliary disease. Typically, alkaline phosphatase and bilirubin levels were elevated, with a slight increase in transaminases and gamma-glutamyltransferase. In both patients biliary tract disease was ruled out by endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiography while no significant abnormalities of the liver parenchyma were found on liver biopsy. Early treatment with ursodeoxycholic acid (UDCA) reduced the duration of the cholestasis episode compared with that of other episodes in which the patient had received other treatment or the treatment was late (1 or 2 months vs 4 months in patient 1 and 1-3 months vs 5 months in patient 2, respectively). DISCUSSION: Consensus is lacking on the treatment of BRIC although several treatment have been used. UDCA could be effective in increasing bile acid secretion and in reducing serum bilirubin levels. In the two patients described, the initial dosage was 15 mg/kg/day, which was subsequently maintained at 6 mg/kg/day, which was subsequently maintained 6 mg/kg/day until biochemical parameters returned to normal. Nevertheless, larger studies are required to confirm that UDA shortens episodes of cholestasis in BRIC.

Absceso amebiano hepático / Amebic liver abscess

No disponible

Enfermedad de Caroli segmentaria / Segmental Caroli's disease

No disponible