Deep Learning-Based Nystagmus Detection for BPPV Diagnosis.

In this study, we propose a deep learning-based nystagmus detection algorithm using video oculography (VOG) data to diagnose benign paroxysmal positional vertigo (BPPV). Various deep learning architectures were utilized to develop and evaluate nystagmus detection models. Among the four deep learning architectures used in this study, the CNN1D model proposed as a nystagmus detection model demonstrated the best performance, exhibiting a sensitivity of 94.06 ± 0.78%, specificity of 86.39 ± 1.31%, precision of 91.34 ± 0.84%, accuracy of 91.02 ± 0.66%, and an F1-score of 92.68 ± 0.55%. These results indicate the high accuracy and generalizability of the proposed nystagmus diagnosis algorithm. In conclusion, this study validates the practicality of deep learning in diagnosing BPPV and offers avenues for numerous potential applications of deep learning in the medical diagnostic sector. The findings of this research underscore its importance in enhancing diagnostic accuracy and efficiency in healthcare.

Fully digital workflow for the fabrication of a tooth-colored space maintainer for a young patient.

OBJECTIVES: Preventive orthodontic therapy with a band and loop is recommended to reduce the prevalence and severity of malocclusion on premature loss of a primary molar. However, when young patients are less cooperative and have a severe gag reflex, using traditional impression methods may be challenging. The use of a conventional metal space maintainer (SM) requires manual laboratory procedures and does not provide optimal esthetics. Moreover, gingival submergence of the wire and gingivitis caused by metal structures may occur. This clinical report describes a complete digital workflow for the fabrication of a zirconia SM to overcome these limitations. CLINICAL CONSIDERATIONS: An 8-year-old boy with a band and loop SM for a missing primary mandibular right second molar presented with plaque accumulation around the band, soft tissue impingement by the loop, and loss of cement. A reverse band and loop SM had been proposed for the restoration of the primary mandibular right first molar. After conservative tooth preparation, a digital impression procedure was performed. A customized band and loop SM was designed using a computer-aided design software and milled out of the zirconia block. After sintering, the SM was luted with adhesive resin cement. CONCLUSIONS: Using an intraoral scanner, computer-aided design, and computer-aided manufacturing technology, the limitations of traditional impression procedures were overcome, and a zirconia SM with mechanical, biological, and esthetic advantages was fabricated. CLINICAL SIGNIFICANCE: Advancements in dental materials and digital technologies allow for the efficient fabrication of a tooth-colored SM with an improved patient satisfaction and reduced human error.

Predictive values of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and other prognostic factors in pediatric vestibular neuritis patients.

OBJECTIVE: To analyze the relationship between severity and hemodynamic factor in pediatric vestibular neuritis patients and find out their effectiveness as a prognostic factor. STUDY DESIGN: Retrospective review. SETTING: Tertiary medical center. PATIENTS: Pediatric patients diagnosed between January 2010 and December 2019 at a tertiary medical institution who were hospitalized with dizziness. MAIN OUTCOME MEASURE: A study of the duration of spontaneous nystagmus loss and the severity of the disease using questionnaires (PVSQ, DHI) in pediatric patients admitted to Vestibular neuritis (VN) and correlation with NLR, PLR, MPV and RDW conducted at the time of admission. RESULT: This study was conducted on 22 children with VN and 30 children in control group. For the evaluate of the severity of the symptoms of VN patients, two group were classified based on the period from the onset of the symptom to the loss of the spontaneous nystagmus.: mild VN and severe VN, and the PVSQ and DHI questionnaires were used to assess the degree of improvement. PVSQ and DHI score generally improved during spontaneous nystagmus loss, and comparing the severity of the symptoms with the values of NLR, PLR, MPV and RDW showed a positive correlation between the severity of the symptoms and the value of the NLR and PLR value. CONCLUSION: NLR, PLR value is thought to be an efficient indicator of pediatric VN patents and could be a clue to the current unknown cause of childhood VN disease.

Digital approach to fabricating a retrofitted abutment for reuse of an existing implant-supported fixed partial denture after the failure of an implant.

The failure of an implant that supports an implant-supported fixed partial denture (ISFPD) may result in a failure of the prosthesis. Although fabricating a new ISFPD after replacing the implant is ideal, patients may hope to reuse the existing ISFPD because of financial constraints. A technique for rescuing a 6-unit metal-ceramic ISFPD with computer-aided design and computer-aided manufacturing (CAD-CAM) technology is described.

Digital Workflow for Establishing the Posterior Palatal Seal on a Digital Complete Denture.

The posterior palatal seal (PPS) plays important roles in improving denture retention, preventing food and debris from entering under the denture base, reducing the gag reflex, providing more strength across the denture, and making the distal border less noticeable to the tongue. Digital dentures have become popular, owing to the use of computer-aided design and computer-aided manufacturing and rapid prototyping technologies. However, limited research has been conducted on a digital workflow to establish the PPS. This article presents a technique to establish the PPS by using digital technologies for providing the advantages of the PPS to patients wearing digital dentures.

Fabricating a custom tray for an impression of multiple abutment teeth by using an open-source software program.

Although intraoral scanners have gained in popularity, the traditional impression technique with a custom tray is still useful, particularly when making a definitive impression of multiple abutment teeth. A custom tray can be fabricated with a dental software program, avoiding the disadvantages of the manual laboratory procedures. However, additional module purchasing is necessary. This article presents a digital workflow for designing a custom tray by using an open-source software program.

Predictive Values of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Other Prognostic Factors in Pediatric Patients With Bell's Palsy.

BACKGROUND AND OBJECTIVES: Bell's palsy (BP) is the most frequent cause of unilateral facial paralysis, and inflammation is believed to play an important role in pathogenesis. Due to its rarity, however, no consensus has been reached regarding optimum treatment or factors affecting prognosis. In the present study, treatment outcomes and prognostic factors of BP were investigated in pediatric patients who underwent steroid therapy. The goal was to investigate the relationship between BP and inflammation using multiple inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW). MATERIALS AND METHODS: In all, 54 patients diagnosed with BP and 39 healthy randomly selected controls were enrolled in this retrospective study. Demographic characteristics and complete blood cell count test results were compared. In addition, prognostic factors were sought by dividing the 54 patients with BP into 2 groups according to the House-Brackmann grading system: low grade BP (grades II and III) and high grade BP (grades IV and V). Serum samples were analyzed retrospectively on initial presentation and 6 months after the symptom begins. Meaningful hematological parameters include NLR, PLR, MPV, and RDW. RESULTS: The NLR values in the BP group were significantly higher than in the control group. The NLR value in the 2 groups of patients with BP differed significantly. The mean PLR value in the BP group was higher than in the control group; however, there were no significant differences between the low-grade and high-grade BP groups nor were there any statically significant differences in the other characteristics. CONCLUSION: The NLR and PLR values are readily accessible parameters that may be useful prognostic markers in pediatric patients with BP. Further studies are required to confirm these results and their utility in predicting prognosis and treating pediatric patients with BP.

A completely digital approach to scanning dental implants placed in a limited space or with an adverse angulation.

Unfavorable implant placement may cause difficulties in making implant impressions or scans. If the impression posts or scan bodies cannot be properly seated on the implants because of contact between them, adjustment with a rotary instrument or the use of gold cylinders is necessary. This article introduces a technique for obviating the clinical difficulties without the need to adjust the impression posts or scan bodies or the use of gold cylinders.

Digital approach to fabricating an implant indexing device for dental implant abutments.

When dental implant abutments are fabricated, the use of an implant indexing device (IID) is recommended to evaluate the accuracy of a definitive cast. An IID is also useful to position multiple implant abutments on implants. Several methods have been used to fabricate an IID. However, the existing methods are labor-intensive. This article presents a digital workflow for fabricating an IID using computer-aided design and computer-aided manufacturing (CAD-CAM) technology with minimal human error.

Design concept for preventing aspiration or ingestion of CAD-CAM crowns: A dental technique.

Accidental aspiration or ingestion of a crown is a risk during dental treatment. To prevent this, dental floss can be tied to a loop attached to the lingual surface of the crown. However, the method needs an additional laboratory procedure and is applicable only to cast crowns. This article introduces a technique for fabricating a zirconia crown with a loop using computer-aided design and computer-aided manufacturing (CAD-CAM) technology.

Fabricating a crown under an existing removable partial denture with impression scanning and CAD-CAM technology.

Retrofitting a new crown to an existing removable partial denture (RPD) is a challenging procedure. Recently, intraoral scanners (IOSs) have been successfully used to solve this issue. However, purchase of IOSs is necessary, and most clinicians still use the conventional impression technique. This article describes a combined conventional and digital approach to fabricating a new crown under an RPD without an IOS.

Predictive values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and other prognostic factors in pediatric idiopathic sudden sensorineural hearing loss.

BACKGROUND AND OBJECTIVES: No consensus has been reached regarding the optimum treatment or factors affecting prognosis in pediatric idiopathic sudden sensorineural hearing loss (ISSNHL) due to its rarity. In the present study, treatment outcomes and prognostic factors of ISSNHL were investigated in pediatric patients who underwent steroid therapy. SUBJECTS: and Methods: Forty-two patients diagnosed with ISSNHL were enrolled in this retrospective study and compared with 39 normal healthy controls with respect to demography and complete blood cell count test results. In addition, prognosis factors were sought by dividing the 42 ISSNHL patients to 3 groups according to their response to the treatment. RESULTS: Neutrophil-to-lymphocyte ratio (NLR) value in the ISSNHL group were significantly higher than in the control group. NLR value in the three treatment response groups differed significantly. Early treatment with steroid and accompanying tinnitus were positive prognostic factor for hearing recovery. Other characteristics were not significant. CONCLUSION: The results of this study suggest that good hearing recovery in children may be associated with early time of initial treatment and accompanying tinnitus. Also, NLR value might be useful readily accessible prognostic markers in pediatric ISSNHL patients. Further studies are required to confirm prognostic factors useful to predict prognosis and treat ISSNHL in pediatric patients.

A Digital Approach to Retrofitting a Post and Core Restoration to an Existing Crown.

One problem that may arise in full-coverage restorations is clinical crown fracture. Fracture of an endodontically treated and crowned tooth in the esthetic zone may be embarrassing to both the patient and clinician. If a completely sound margin and at least 2 mm of coronal structure remain, a fractured tooth may possibly be retreated by a repair. Several methods have been introduced to reproduce the original contour of the tooth for retrofitting an existing crown. If an existing crown is used as a template, excessive core material may remain over the margin, as loading the proper amount of core material is difficult, and making vent holes on the existing crown is not feasible. This article presents a repair technique to reuse an existing crown with computer-aided design and computer-aided manufacturing (CAD/CAM) technology. By using a milled poly(methylmethacrylate) matrix, the mentioned limitations are eliminated, and the original contour of the tooth can be effectively restored with minimal intervention. As an existing crown is reused, the issues of additional time and cost for repreparation, reimpression, and new crown are eliminated.

Fabricating a reduction guide for parallel guiding planes with computer-aided design and computer-aided manufacturing technology.

Preparing appropriate guiding planes is essential for the success of a removable partial denture. Owing to the difficulty of determining the location and dimension of proximal reduction, establishing optimal guiding planes may challenge even skilled clinicians. This article introduces a digital workflow for fabricating a reduction guide to establish parallel guiding planes.

GM1 Induced the inflammatory response related to the Raf-1/MEK1/2/ERK1/2 pathway in co-culture of pig mesenchymal stem cells with RAW264.7.

Pig-human xenotransplantation can trigger cell-mediated immune responses. We explored the role of gangliosides in inflammation related to immune rejection in xenotransplantation. Co-culture of xenogeneic cells (pig-MSCs and RAW264.7) was used to emulate xenotransplantation conditions. MTT assay results indicated that cell viability was significantly decreased in pADMSCs co-cultured with RAW264.7 cells. GM1 and GM3 were highly expressed in pADMSCs co-cultured with RAW264.7 cells. pADMSCs co-cultured with RAW264.7 cells strongly expressed pro-inflammatory proteins such as COX-2, iNOS, p50, p65, pIκBα, and TNF-α. GM1-knockdown pADMSCs co-cultured with RAW 264.7 cells did not show significantly altered cell viability, but pro-inflammatory proteins were markedly inhibited. Co-culture of pADMSCs with RAW264.7 cells induced significant phosphorylation (p) of JNK1/2 and pERK1/2. However, pERK1/2 and pJNK1/2 were decreased and MEK1/2 and Raf1 were suppressed in GM1-knockdown pADMSCs co-cultured with RAW264.7 cells. Thus, the Raf-1/MEK1/2/ERK1/2 and JNK1/2 pathways were significantly upregulated in response to increases of GM1 in co-cultured xenogeneic cells. However, the inflammatory response was suppressed in co-culture of GM1-knockdown pADMSCs with RAW264.7 cells via down-regulation of the Raf-1/MEK1/2/ERK1/2 and JNK1/2 pathways. Therefore, the ganglioside GM1 appears to play a major role in the inflammatory response in xenotransplantation via the Raf-1/MEK1/2/ERK1/2 and JNK1/2 pathways.

Fabricating a custom zirconia post-and-core without a post-and-core pattern or a scan post.

Due to the increased esthetic demands, custom zirconia post-and-cores have recently become popular. A post-and-core pattern with acrylic resin or wax is scanned using a laboratory scanner for the design of a definitive post-and-core restoration. This procedure requires additional time and material handling experience. If a scan post is used for an intracanal digital scan, substantial initial investments for hardware and software are required. This article introduces an alternative technique for fabricating a custom zirconia post-and-core with a conventional impression. By using this technique, a properly fitted zirconia post-and-core is quickly and easily fabricated with less human error.