Gastrostomy Tube Placement in Neonates Undergoing Congenital Heart Surgery: A Novel Assessment for Improving Utilization and Timing of Placement.

BACKGROUND: Neonates undergoing congenital heart defect repair require optimized nutritional support in the perioperative period. Utilization of a gastrostomy tube is not infrequent, yet optimal timing for placement is ill-defined. The objective of this study was to identify characteristics of patients whose postoperative course included gastrostomy tube placement to facilitate supplemental tube feeding following neonatal repair of congenital heart defects. METHODS: A single-institution, retrospective chart review identified 64 consecutive neonates who underwent cardiac operations from 2012 to 2016. Perioperative variables were evaluated for significance in relation to gastrostomy tube placement. RESULTS: A total of 27 (42%) underwent gastrostomy tube placement. Diagnosis of a genetic syndrome was associated with the likelihood of placement of gastrostomy tube (P = .032), as were patients with single ventricle physiology (P = .0013) compared to those felt to be amenable to eventual biventricular repair. Aortic arch reconstruction (P = .029), as well as the need for delayed sternal closure (P = .05), was associated with increased frequency of gastrostomy tube placement. Postoperative outcomes including the number of days intubated (P = .0026) and the presence of significant dysphagia (P = .0034) were associated with gastrostomy placement. Additionally, genetic syndrome (P = .003), aortic arch reconstruction (P = .01), and postoperative intubation duration (P = .0024) correlated with increased length of stay, where increased length of stay was associated with gastrostomy tube placement (P = .0004). DISCUSSION: Patient characteristics that were associated with a high likelihood of eventual gastrostomy placement were identified in this study. Early recognition of such characteristics in future patients may allow for reduced time to gastrostomy tube placement, which in turn may improve perioperative growth and outcomes.

Evaluation of healing at molar extraction sites with ridge preservation using a non-resorbable dense polytetrafluoroethylene membrane: A four-arm cohort prospective study.

OBJECTIVES: To examine ridge dimensional changes and histologic parameters of healing when ridge preservation (RP) was performed at molar sites using dense polytetrafluoroethylene (dPTFE) membrane alone, without a bone graft. MATERIAL AND METHODS: Eighteen patients had molar extraction and RP using dPTFE membrane alone. Ridge dimensions were measured using two standardized cone beam computerized tomography (CBCT) scans taken within 72 h and 3 months following extraction. Following a 3-month healing period, an implant osteotomy was prepared using a trephine drill and bone cores were collected for histological analysis. Four-arm analyses were performed using data from three previously published study arms of the same research group. RESULTS: There was a significant change in the buccal ridge height between the four groups at all aspects of the socket. Alveolar ridge width reduction at 3 mm from crest for all aspects (mesial, midpoint, distal) of the socket showed statistically significant difference for dPTFE alone group compared to the other three groups. Percentage of vital bone formation (62.10%) was significantly greater in dPTFE alone group compared to the other groups. CONCLUSIONS: RP using dPTFE membrane alone in molar sites with intact socket walls showed successful outcomes in maintaining ridge dimensions and in histologic wound healing.

Impact of different surgical protocols on dimensional changes of free soft tissue autografts: A randomized controlled trial.

BACKGROUND: To determine if there is a difference in the amount of shrinkage during healing of free soft tissue autografts (FSTAs) using different surgical techniques-suturing the vestibular flap margin apically to the base of the recipient bed versus leaving the flap margin free and unsutured. METHODS: Twenty-eight patients with mucogingival defects requiring FSTAs were recruited and enrolled in the study. Patients were randomized into test and control groups (14 per group) and received ≥1 FSTAs on non-molar mandibular teeth. In the test group the mucosal flap margin was sutured apically to the periosteum at the base of the graft; whereas, the mucosal flap margin in the control group was left free. Graft dimensional measurements were taken at time of surgery, then at 1, 3, and 6 months post-surgery. RESULTS: Thirty-five grafts were performed (15 test, 20 control). All FSTAs experienced vertical shrinkage after 6 months, but there was no significant difference (P = 0.51) in the mean amount of shrinkage after 6 months between the test (23.20% ± 20.88%) and control (21.10% ± 21.88%) groups. There was significantly greater horizontal shrinkage in the test (loss of 7.59% ± 10.20%) compared with the control (small gain of 0.32% ± 4.20%) group (P = 0.01). CONCLUSIONS: The findings suggest that there is similar vertical shrinkage when performing FSTA surgery when the mucosal flap margin is left free and unsutured when compared with leaving the flap margin free.

Sequential Multiple Assignment Randomized Treatment (SMART) for Bipolar Disorder at Any Phase of Illness and at least Mild Symptom Severity.

Objectives: To sequentially study the effectiveness of lithium and divalproex monotherapy and adjunctive therapy with quetiapine or lamotrigine in the acute and continuation treatment of bipolar I or II disorder at any phase of illness and at least mild symptom severity. Methods: From June 2011 to December 2016, patients with bipolar I or II disorder (using DSM-IV diagnostic criteria) and CGI-S (Clinical Global Impression-Severity) ⩾ 3 were randomized to receive lithium or divalproex monotherapy for 2 weeks. Patients who had CGI-S-depression ⩾ 3 for 2 weeks at any time after 2-week monotherapy were randomly assigned to receive quetiapine or lamotrigine, or remaining on monotherapy for a total of 26 weeks. Results: The rates of early termination due to lack of efficacy and side effects and changes in BISS (Bipolar Inventory of Symptoms Scale) and CGI-S total score were not significantly different between lithium and divalproex. The completion rate was significantly higher with adjunctive therapy than with monotherapy. BISS and CGI-S total scores, and their sub-scores were significantly reduced with adjunctive therapy compared to monotherapy. Adjunctive therapy significantly increased survival times compared to monotherapy (hazard ratio = 6.8), and the monotherapy group had a significantly increased risk for not reaching sustained recovery from depression (hazard ratio = 12.7). Patients who did not need the 2nd randomization and remained on monotherapy had a significantly reduced hazard for discontinuation (hazard ratio = 3.8). Conclusions: The efficacy of lithium and divalproex as monotherapy was modest. Adjunctive lamotrigine and quetiapine to either one was well-tolerated and equally effective in reducing bipolar symptomatology, but adjunctive therapy should be initiated as early as possible when depression symptoms are present.

Evaluation of healing at molar extraction sites with and without ridge preservation: A three-arm histologic analysis.

BACKGROUND: Little evidence is available regarding the benefit of ridge preservation (RP) at molar sites. The primary objective of this three-arm cohort study was to histologically compare the healing outcome between natural healing after molar tooth extraction and two different techniques of RP using freeze-dried bone allograft (FDBA) and a nonresorbable dense polytetrafluoroethylene (dPTFE) membrane, or an absorbable collagen sponge as a barrier. METHODS: Seventy-nine patients requiring extraction and delayed implant placement were placed into three groups: extraction alone (control); ridge preserved using FDBA; and either dPTFE (Test1) or collagen sponge (Test2). Bone cores were harvested from implant osteotomies at ≈3 months after extraction for histomorphometric analysis to determine the percentage of vital bone, residual graft, and connective or other tissue. Ridge dimension changes were also evaluated radiographically (cone-beam computed tomography). RESULTS: The percentage of vital bone was significantly greater in control group compared with Test1 but was not statistically different among other groups. Test2 showed significantly less connective or other tissue than control and Test1. The percentage of residual graft was significantly lower in Test1 compared with Test2. There was no significant correlation between the percentage of vital bone or residual graft and the following parameters: healing time, patient age, gender, buccal plate thickness, or radiographic changes in ridge dimensions. CONCLUSION: RP at molar sites using FDBA and an absorbable collagen sponge may be a sufficient and economic way to preserve the ridge dimension without interfering with the amount of new bone formation.

Management of Thick and Thin Periodontal Phenotypes for Immediate Dental Implants in the Esthetic Zone: A Controlled Clinical Trial.

The goal of the study was to compare the outcome of immediate single-implant placement in esthetic sites of patients with thick or thin tissue phenotypes. Forty-one patients underwent implant surgery with guided bone regeneration including peri-implant gap and overcontour grafting. A connective tissue graft was added only for patients with a thin tissue phenotype. Twenty-six patients completed the 12-month follow-up examination (thick, n = 14; thin, n = 12). The thick-phenotype group gained 0.01 ± 1.56 mm of midfacial soft tissue height, while the thin-phenotype group lost 0.20 ± 1.14 mm (P = .21). There was no significant difference in buccal plate thickness achieved at time of uncovery, pink and white esthetic scores, radiographic bone levels, and clinical parameters between the two groups. These results suggest that when the suggested treatment protocol is followed, there are no significant differences in the outcomes of immediate implant placement for patients with different soft tissue phenotypes.

Healing at Molar Extraction Sites Using Freeze-Dried Bone Allograft and Collagen Wound Dressing: Case Series and Three-Arm Analyses.

PURPOSE: Ridge preservation limits dimensional changes after tooth extraction. However, it is still unclear if using a membrane may be advantageous over a collagen wound dressing. Therefore, the goal of this report was to evaluate the outcomes of ridge preservation using freeze-dried bone allograft with a collagen wound dressing. MATERIALS AND METHODS: This study included 21 patients who had one molar extracted, and the site received ridge preservation using freeze-dried bone allograft and a collagen wound dressing (test 2 group). Patients had two standardized cone beam computed tomography (CBCT) scans, taken within 72 hours and 3 months after extraction, to measure changes in ridge height and width, and buccal and lingual plate thicknesses. Changes in keratinized tissue width were recorded. Three-arm analyses were performed using historic data from a previous randomized controlled trial by the same study group, in which 20 molar sites received a collagen wound dressing alone (control) and 20 received ridge preservation with freeze-dried bone allograft and a dense polytetrafluoroethylene membrane (test 1) using the same methodology. RESULTS: There was a statistically significant difference in mean buccal ridge height changes between the control group (2.6 ± 2.06 mm) and test 2 group (1.55 ± 0.93 mm) but no difference in ridge and keratinized tissue width changes between groups. No correlation was found between buccal plate thickness and ridge width change. CONCLUSION: Freeze-dried bone allograft with collagen wound dressing as a barrier was used successfully for ridge preservation in intact molar extraction sites (< 50% bone loss) and can be considered as a treatment alternative to freeze-dried bone allograft with a dense polytetrafluoroethylene membrane.

Funding Source, Quality of Publications and Outcome in Genetic Damage in Mammalian Cells Exposed to Non-Ionizing Radiofrequency Fields.

There has been ongoing debate and discussion concerning whether the funding source influenced the outcome of research on human health effects from exposure to radiofrequency fields (RF, electromagnetic waves that carry energy as they propagate in air and dense media). In a study of 225 publications, in which we sought to determine a possible association between the funding source(s), quality and outcome in a total of 2,160 genetic damage assessment tests of mammalian cells exposed to RF energy, we made several observations. One finding was that a great majority of researchers had acknowledged government agencies as the funding source (53%, 120 of 225 publications), while a small number of scientists mentioned mobile phone industry as the financial source (9%, 20 of 225 publications). Numerous investigators did not mention the funding source (26%, 58 of 225 publications). Secondly, industry-funded investigations were of better quality and utilized quality control measures, i.e., blind evaluation, adequate description of dosimetry, positive controls and/or sham-exposed controls, compared to those funded by the government. Another observation was that in industry-funded studies, the d values (effect size or standardized mean difference between the cells exposed to RF energy and sham-exposed controls) were consistently lower than in government-funded studies. In addition, compared to government-funded studies, a higher percentage of industry-funded studies reported no difference in genetic damage between RF- and sham-exposed cells (80% for industry-funded studies versus 49% for government-funded studies). Finally, we observed that industry-funded studies were less likely to report an increase in genetic damage in cells exposed to RF energy (10%) compared to government-funded studies (23%). In view of the large difference between the percentage of publications funded by government and industry (53% or 122 of 225 publications for government, compared to 9% or 29 of 225 publications for industry), caution should be used when debating and discussing the above observations. Overall, it is important to include the quality control measures in the investigations, and also mention the funding source in published studies.

Esthetic, clinical, and radiographic outcomes of two surgical approaches for single implant in the esthetic area: 1-year results of a randomized controlled trial with parallel design.

AIM: The objectives of this study were to compare (a) esthetic, (b) clinical, (c) radiographic, and (d) patient-centered outcomes following immediate (Type 1) and early implant placement (Type 2). MATERIAL AND METHODS: Forty-six subjects needing a single extraction (premolar to premolar) were randomly allocated to Type 1 or Type 2 implant placement. One year following permanent restoration, evaluation of (a) Esthetics using soft tissue positions, and the pink and white esthetic scores (PES/WES), (b) Clinical performance using probing depth, modified plaque index, and sulcus bleeding index (c) Radiographic bone level, and (d) Patient satisfaction by means of visual analogue scales (VAS) was recorded. RESULTS: Thirty-five patients completed the one-year examination (Type 1, n = 20; Type 2, n = 15). Type 1 implants lost 1.03 ± 0.24 mm (mean ± SE) of mid-facial soft tissue height while Type 2 implants lost 1.37 ± 0.28 mm (p = 0.17). The papillae height on the mesial and distal was reduced about 1 mm following both procedures. Frequency of clinical acceptability as defined by PES ≥ 6 (Type 1: 55% vs. Type 2 40%), WES ≥ 6 (Type 1: 45% vs. Type 2 27%) was not significantly different between groups (p > 0.05). Clinical and radiographic were indicative of peri-implant health. Patient-centered outcomes failed to demonstrate significant differences between the two cohorts. CONCLUSION: One year after final restoration, there were no significant differences in esthetic, clinical, radiographic, and patient-centered outcomes following Type 1 and Type 2 implant placement. At one year, patient satisfaction may be achieved irrespective of the two placement protocols.

Extent of Elder Abuse Training in Dental Hygiene Curricula and Program Directors' Perceptions of Importance of and Barriers to Implementation.

Research published in 2002 reported limited elder abuse training in U.S. dental hygiene curricula although its importance has increased with an aging population. The aims of this study were to determine the current extent of elder abuse training in U.S. dental hygiene curricula and to explore dental hygiene program directors' perspectives on the topic. A 25-item online survey was distributed to all 361 program directors, coordinators, and/or department chairs of Commission on Dental Accreditation (CODA)-accredited dental hygiene programs via email in August 2017. A response rate of 27.2% (n=98) was achieved. A large percentage of the respondents (83.3%) included elder abuse training in their program curricula; for most (58.7%), one to three curriculum hours were spent on the topic. A large percentage (89%) agreed the topic was at least somewhat important to include, and 29.5% said a personal or professional elder abuse experience influenced the depth of instruction at their program. Various barriers to inclusion were identified. At least 40% of these educators perceived their graduates to be appropriately competent in their ability to recognize elders' oral neglect (63.5%) and general neglect (48.7%) and to document potential signs of elder abuse (43.8%). Lower percentages perceived that their graduates were competent in the areas of communication regarding elder abuse (21.9%) and reporting suspected abuse (32.4%). Despite rising awareness about elder abuse among dental hygienists and widespread incorporation of the subject in dental hygiene curricula, these results suggest that there are still deficiencies in training. To prepare dental hygiene graduates to confidently recognize and respond to elder abuse, educators should seek to overcome barriers by modifying instruction and embracing interprofessional collaboration.

Comprehensive Review of Quality of Publications and Meta-analysis of Genetic Damage in Mammalian Cells Exposed to Non-Ionizing Radiofrequency Fields.

There have been numerous published studies reporting on the extent of genetic damage observed in animal and human cells exposed in vitro and in vivo to non-ionizing radiofrequency fields (RF, electromagnetic waves that carry energy as they propagate in air and dense media). Overall, the data are inconsistent; while some studies have suggested significantly increased damage in cells exposed to RF energy compared to unexposed and/or sham-exposed control cells, others have not. Several variables in exposure conditions used in the experiments might have contributed to the controversy. In this comprehensive review, four specific quality control measures were used to determine the quality of 225 published studies in animal and human cells exposed in vitro and in vivo to RF energy, and the results from 2,160 tests with different sample sizes were analyzed. The four specific quality control measures were as follows: 1. "Blind" collection/analysis of the data to eliminate individual/observer "bias"; 2. Adequate description of "dosimetry" for independent replication/confirmation; 3. Inclusion of "positive controls" to confirm the outcomes; and 4. Inclusion of "sham-exposed controls" which are more appropriate to compare the data with those in RF exposure conditions. In addition, meta-analysis of the genetic damage in cells exposed to RF energy and control cells, thus far available in the RF literature database, was performed to obtain the "d" values, i.e., standardized mean difference between these two types of cells or the effect size. The relationship between d values and the above-mentioned quality control measures was ascertained. In addition, the correlation between the quality control measures and the conclusions reported in the publications (no significant difference between the cells exposed to RF energy and control cells; increased damage in former cells compared to the latter; increased, no significant difference and decreased damage in cells exposed to RF energy in the same experiment; or decreased damage in cells exposed to RF energy) was examined. The overall conclusions were as follows: 1. When all four quality control measures were mentioned in the publication, the d values were smaller compared to those when one or more quality control measures were not mentioned in the investigation; 2. Based on the inclusion of quality control measures, the weighted outcome in cells exposed to RF energy (d values) indicated a very small effect, if any; 3. The number of published studies reporting no significant difference in genetic damage of cells exposed to RF energy, compared to that of control cells, increased with increased number of quality control measures employed in investigations; 4. The number of published studies reporting increased genetic damage in cells exposed to RF energy decreased with increased number of quality control measures; and 5. There was a "bias" towards the publications reporting increased genetic damage in cells exposed to RF energy even with very small sample size. Overall, the results from this study underscore the importance of including quality control measures in investigations so that the resulting data are useful, nationally and internationally, in evaluating "potential" health risks from exposure to RF energy.

International assessment of inter- and intrarater reliability of the International Frontal Sinus Anatomy Classification system.

BACKGROUND: Inconsistencies in the nomenclature of structures of the frontal sinus have impeded the development of a validated "reference standard" classification system that surgeons can reliably agree upon. The International Frontal Sinus Anatomy Classification (IFAC) system was developed as a consensus document, based on expert opinion, attempting to address this issue. The purposes of this study are to: establish the reliability of the IFAC as a tool for classifying cells in the frontal recess among an international group of rhinologists; and improve communication and teaching of frontal endoscopic sinus surgery (ESS). METHODS: Forty-two computed tomography (CT) scans, each with a marked frontal cell, were reviewed by 15 international fellowship-trained rhinologists. Each marked cell was classified into 1 of 7 categories described in the IFAC, on 2 occasions separated by 2 weeks. Inter- and intrarater reliability were evaluated using Light's kappa (κ), the interclass correlation coefficient (ICC), and simple proportion of agreement. RESULTS: Interrater reliability showed pairwise κ values ranging from 0.7248 to 1.0, with a mean of 0.9162 (SD, 0.0537). The ICC was 0.98. Intrarater reliability showed κ values ranging from 0.8613 to 1.0, with a mean of 0.9407 (SD, 0.0376). The within-rater ICC was 0.98. CONCLUSION: Among a diverse sample of rhinologists (raters), there was substantial to almost perfect agreement between raters, and among individual raters at different timepoints. The IFAC is a reliable tool for classification of cells in the frontal sinus. Further outcome studies are still needed to determine the validity of the IFAC.

Endothelial cell-specific overexpression of endothelial nitric oxide synthase in Ins2Akita mice exacerbates diabetic nephropathy.

Previous studies demonstrated that global deficiency of eNOS in diabetic mice exacerbated renal lesions and that overexpression of eNOS may protect against tissue injury. Our study revealed for the first time overexpression of eNOS leads to disease progression rather than protection. Transgenic mice selectively expressing eNOS in endothelial cells (eNOSTg) were cross bred with Ins2Akita type-1 (AK) diabetic mice to generate eNOS overexpressing eNOSTg/AK mice. Wild type, eNOSTg, AK and eNOSTg/AK mice were assessed for kidney function and blood glucose levels. Remarkably, overexpressing eNOSTg mice showed evidence of unpredicted glomerular injury with segmental mesangiolysis and occasional microaneurysms. Notably, in eNOSTg/AK mice overexpression of eNOS led to increased glomerular/endothelial injury that was associated with increased superoxide levels and renal dysfunction. Results indicate for the first time that overexpressing eNOS in endothelial cells cannot ameliorate diabetic lesions, but paradoxically leads to progression of nephropathy likely due to eNOS uncoupling and superoxide upsurge. This novel finding has a significant impact on current therapeutic strategies to improve endothelial function and prevent progression of diabetic renal disease. Further, the eNOSTg/AK model developed in this study has significant translational potentials for elucidating the underlying mechanism implicated in the deflected function of eNOS in diabetic nephropathy.

Construct validity of a low-cost medium-fidelity endoscopic sinus surgery simulation model.

OBJECTIVE: Assess construct validity of a low-cost medium-fidelity silicone injection molded model task trainer for endoscopic sinus surgery (ESS) training. METHODS: Fellowship-trained rhinologists, otolaryngology attendings, and otolaryngology residents at various levels of training performed sinus endoscopy and seven procedures on the model. Construct validity was evaluated by comparing novice to various levels of experienced performance using a validated checklist. RESULTS: Thirty-two subjects participated in this study. Otolaryngology attendings and postgraduate year (PGY) 3 to 5 otolaryngology residents significantly outperformed PGY 1 to 2 otolaryngology residents on most tasks in the task-specific checklist. CONCLUSIONS: This study demonstrated the construct validity of the low-cost medium-fidelity ESS model. LEVEL OF EVIDENCE: NA Laryngoscope, 129:1505-1509, 2019.

Critical Thinking in Dental Students and Experienced Practitioners Assessed by the Health Sciences Reasoning Test.

To date, there has been a lack of published studies examining the validity of the Health Sciences Reasoning Test (HSRT) to assess critical thinking among dental students. The aim of this study was to examine the construct validity of the HSRT using a novice-expert model consisting of first-year dental students as novices and experienced general dentists as experts. Novice cohort subjects were recruited from all 105 students in the first-year dental school class at the University of Texas Health Science Center at San Antonio during a regularly scheduled course in August 2015. A total of 83 students participated, for a 79% response rate. Thirty individuals personally recruited from the same school's faculty and from private practitioners made up the expert cohort. The results showed that the adjusted mean overall score for the expert cohort (25.31) was significantly higher than that of the novice cohort (22.64) (p=0.04). The expert cohort achieved higher adjusted mean scores in all scales (Induction, Deduction, Analysis, Inference, and Evaluation), with the difference in the Analysis scale being significant (p=0.02). In this study, experienced general dentists achieved significantly better overall scores on the HSRT as compared to first-year dental students, suggesting the instrument was able to measure differences between novice and expert. Further efforts to validate the instrument in a dental education setting and to understand its correlation with strategies and practices aimed at developing critical thinking in dental students are warranted.

Comparison of two Manual Toothbrushes in Effectiveness of Plaque Removal: A pilot study.

Purpose: This pilot study compared the effectiveness of plaque removal of two manual toothbrushes; a novel toothbrush design and a control reference toothbrush.Methods: Thirty-eight individuals meeting specific criteria consented to participate and were randomly assigned to one of two groups. Subjects were given both study toothbrushes eight days prior to data collection to use on alternate days for two minutes twice daily for familiarization. Subjects refrained from any oral hygiene procedures for twenty-four hours prior to data collection at which time a baseline plaque score was recorded using the O'Leary Plaque Control Record. Following the baseline plaque score recording, timed brushing was supervised by a research assistant, using a split mouth design, followed by a post-brushing plaque score. All plaque scores were recorded by the same examiner blinded to group assignment. Pre- and post-brushing scores were compared using t-tests and analysis of variance (ANOVA) to determine differences. Subjects also completed a qualitative survey on the two brushes.Results: When compared to overall plaque scores, no significant differences were shown between the two brushes or when compared to all interproximal surfaces, all smooth surfaces and left vs. right sides. Both brushes performed better on the left side. The control brush was slightly more effective than the novel brush in the mandible (p=0.0222) and on lingual (p=0.0169) surfaces. Results of the survey showed that the subjects significantly favored the novel brush.Conclusion: Both brushes were effective, although the reference brush was slightly more effective in plaque removal than the novel design brush in the mandible and on lingual surfaces; however, the novel brush was preferred by participants.

Osseous Healing Around Immediate Implants Placed Using Contour Augmentation: A Prospective Case Series.

The purpose of this study was to prospectively evaluate the dimensional bone changes around implants placed immediately with buccal contour augmentation. Patients with hopeless maxillary anterior teeth were treated with extraction, immediate implant placement, and simultaneous buccal contour augmentation. Hard tissue measurements were recorded at the time of implant placement and after 3 months of healing. All implants (N = 18) successfully osseointegrated with a mean buccal bone thickness of 2.94 ± 0.21 mm (mean ± SE) at the implant platform. This was significantly greater compared to previous data on immediate implants placed without contour augmentation (2.32 ± 0.17 mm). Buccal contour augmentation in conjunction with immediate implant placement significantly increased peri-implant buccal bone thickness after 3 months of healing.

VARIABILITY IN THYROID CANCER MANAGEMENT AND PROGNOSIS AMONG HISPANIC VERSUS NON-HISPANIC PATIENTS : 17 YEARS DATA FROM UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AND UNIVERSITY HEALTH SYSTEM AT SAN ANTONIO.

Abstracts: Objective : Given the increase in the incidence of thyroid cancer in the United States, and it's potential public health implications, patient studies assessing ethnic, disparity and health care access are important. In this study, we retrospectively examined the variability in stage of thyroid cancer at presentation and final outcome among Hispanic vs non-Hispanic patients. METHOD: After obtaining IRB approval, we retrospectively reviewed the medical records of 220 adult patients with papillary thyroid carcinoma(PTC) who were treated at UT Health Science Center San Antonio between1996 and 2013. At disease presentation, patients were staged and risk stratified according to the 2009 American Thyroid Association (ATA) and TNM staging system. Clinical data obtained during the first 6-18 months was used to identify the initial response to therapy and clinical data from the last follow up visit was used to identify the "final" outcome. We examined the effect of insurance and ethnicity on initial response to therapy and final outcome using Chi-square test and one way ANOVA. RESULT: Our patient population's ATA risk at diagnosis, initial response to therapy and final outcome did not differ by ethnicity (P=0.5, 0.3 &0.4) and insurance coverage(P=0.7, 0.3 & 0.4) . CONCLUSION: Insurance coverage and ethnicity may not be independent factors since ethnic minority individuals are more likely to be uninsured.

An Open Trial of Iloperidone for Mixed Episodes in Bipolar Disorder.

BACKGROUND: Mixed mood states in bipolar disorder are difficult to treat and when present indicate worse illness trajectories. Several medications are US Food and Drug Administration approved to treat mixed episodes; however, the clinical trials have been short term and rarely reported depression response. METHODS: We conducted a 5-month open-label trial examining the tolerability and efficacy of iloperidone for bipolar disorder mixed episodes. RESULTS: Mania and depression scores significantly improved over the course of the study for study completers (ie, 60%-68% improvement for manic symptoms and 41%-49% for depression symptoms). Improvements were observed early in the trial and after adjusting for concomitant medication effects. The average daily dose in completers was 15 mg. Thirty-nine percent (12/31) of the eligible sample discontinued early because of adverse effects. The adverse events most commonly associated with withdrawal were increased heart rate/palpitations (n = 5 of 12) and urinary incontinence/intense urge to urinate (n = 3 of 12). CONCLUSIONS: In a subset of patients, iloperidone provides relief for classic manic, depression, and irritability symptoms associated with mixed episodes in a long-term trial. Adverse effect profiles are likely to be a major factor contributing to individualized medication use.

Adaptive response in mouse bone marrow stromal cells exposed to 900MHz radiofrequency fields: Impact of poly (ADP-ribose) polymerase (PARP).

This study examined whether non-ionizing radiofrequency fields (RF) exposure is capable of inducing poly (ADP-ribose) polymerase-1 (PARP-1) in bone marrow stromal cells (BMSCs) and whether it plays a role in RF-induced adaptive response (AR). Bone marrow stromal cells (BMSCs) were exposed to 900MHz RF at 120µW/cm2 power flux density for 3h/day for 5days and then challenged with a genotoxic dose of 1.5Gy gamma-radiation (GR). Some cells were also treated with 3-aminobenzamide (3-AB, 2mM final concentration), a potent inhibitor of PARP-1. Un-exposed and sham (SH)-exposed control cells as well as positive control cells exposed to gamma radiation (GR) were included in the experiments. The expression of PARP-1 mRNA and its protein levels as well as single strand breaks in the DNA and the kinetics of their repair were evaluated at several times after exposures. The results indicated the following. (a) Cells exposed to RF alone showed significantly increased PARP-1 mRNA expression and its protein levels compared with those exposed to SH- and GR alone. (b) Treatment of RF-exposed cells with 3-AB had diminished such increase in PARP-1. (c) Cells exposed to RF+GR showed significantly decreased genetic damage as well as faster kinetics of repair compared with those exposed to GR alone. (d) Cells exposed to RF+3-AB+GR showed no such decrease in genetic damage. Thus, the overall date suggested that non-ionizing RF exposure was capable of inducing PARP-1 which has a role in RF-induced AR.