Electronic periodontal tool integration to enrich clinical diagnosis.

PURPOSE/OBJECTIVES: The objective of this study was to evaluate the effectiveness of an Electronic-Periodontal-Diagnosis-Tool (EPDT) to facilitate the formulation of a correct periodontal diagnosis and analyze students' perceptions of the use of the EPDT. METHODS: Fifty Year-3 students who recently started their clinical training, were randomly assigned to two groups. Two clinical scenarios involving challenging periodontal diagnoses, each one with unique components, variables, and categories were distributed with specific instructions. The cases were analyzed to determine the correct periodontal diagnosis-half without the use of the EPDT and half with the use of the EPDT. A post-exercise discussion conducted by the faculty explained the answer rationales. The students completed an anonymous/voluntary survey to evaluate their perceptions. Statistical analysis using likelihood ratio chi-square tests and a generalized linear model evaluated whether the use of the EPDT resulted in higher percentages of correct diagnoses. RESULTS: EPDT use resulted in a three times higher percentage of correct classifications than no tool use (48% versus 16%), which the investigators considered an important effect of the EPDT. The generalized-linear-model assessment confirmed that EPDT resulted in better classifications (p < 0.0001). The feedback about the perceptions of the EPDT was favorable. CONCLUSION: Students using the EPDT resulted in higher percentages of correct diagnoses. The EPDT provided students with a useful framework to determine the correct periodontal diagnoses, which is essential in providing appropriate treatments.

A literature review of local and systemic considerations for endodontic treatments in older adults.

OBJECTIVES: The aim of this literature review was to summarise the clinical important findings on the endodontic treatment outcome in older patients (≥60 years old) with pulpal/periapical disease considering local and systemic factors from a body of knowledge that is heterogeneous in methods or disciplines. BACKGROUND: Due to the increasing number of older patients in the endodontic practice, and the current trend for tooth preservation, the need for clinicians to have a better understanding of age-related implications that may influence the required endodontic treatment in older adults to retain their natural dentition is indispensable. METHODS: PubMed/Medline and Embase was searched by a medical librarian using specific terms based on inclusion/exclusion criteria. The reference list was hand-seached for additional relevant publications between 2005-2020. A combination of these terms was performed uing Boolean operators and MeSH terms. RESULTS: Of the 1577 publications identified manually and electronically, 25 were included to be fully reviewed by the examiners. The data was derived from three systematic reviews, one systematic and meta-analysis, three case series, four prospective and 14 retrospective cohorts. Overall, there was heterogeneity in reporting as well as limitations in most studies. CONCLUSIONS: The outcome of endodontic treatment (ET) either nonsurgical or surgical or combination of these is not affected by older age. ET can be the treatment of choice in older patients wiht pulpal/periapical disease. There is no evidence that older age per se affects the outcome of any type of endodontic treatment.

Pain Relief with Combination Acetaminophen/Codeine or Ibuprofen following Third-Molar Extraction: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of our study was to perform a systematic review and meta-analysis of randomized, blinded, placebo-controlled studies that, following third-molar extraction, utilized either a combination of acetaminophen (600 mg) with codeine (60 mg) or ibuprofen (400 mg) for pain management. DESIGN: We searched PubMed, and the trial registry ClinicalTrials.gov databases with the keywords "molar or molars," "tooth or teeth," "extraction," and "pain." Selected studies were: (1) randomized, blinded, placebo controlled, (2) utilized either a single-dose combination acetaminophen (600 mg) with codeine (60 mg) (A/C) or ibuprofen, and (3) recorded standardized pain relief (PR) at 6 hours, or summed total pain relief over 6 hours (TOTPAR6). Of the 2,949 articles that were identified, 79 were retrieved for full-text analysis, and 20 of these studies met our inclusion criteria. RESULTS: For A/C, the weighted, standardized mean difference (SMD) for TOTPAR6 was 0.796 (95% confidence interval [CI], 0.597-0.995), P < .001, and for PR at 6 hours, the SMD was 0.0186 (0.007 to 0.378; P = .059), whereas for ibuprofen the SMD for TOTPAR6 was 3.009 (1.283 to 4.735; P = .001), and for PR at 6 hours, the SMD was 0.854 (95% CI, 0.712-0.996; P < .001). A SMD of 0.8 or larger is indicative of a large effect. CONCLUSIONS: Our data indicate that single dose of ibuprofen (400 mg) is an effective pain reducer for post third molar extraction pain.

Quantitative Gradient Echo MRI Identifies Dark Matter as a New Imaging Biomarker of Neurodegeneration that Precedes Tisssue Atrophy in Early Alzheimer's Disease.

BACKGROUND: Currently, brain tissue atrophy serves as an in vivo MRI biomarker of neurodegeneration in Alzheimer's disease (AD). However, postmortem histopathological studies show that neuronal loss in AD exceeds volumetric loss of tissue and that loss of memory in AD begins when neurons and synapses are lost. Therefore, in vivo detection of neuronal loss prior to detectable atrophy in MRI is essential for early AD diagnosis. OBJECTIVE: To apply a recently developed quantitative Gradient Recalled Echo (qGRE) MRI technique for in vivo evaluation of neuronal loss in human hippocampus. METHODS: Seventy participants were recruited from the Knight Alzheimer Disease Research Center, representing three groups: Healthy controls [Clinical Dementia Rating® (CDR®) = 0, amyloid ß (Aß)-negative, n = 34]; Preclinical AD (CDR = 0, Aß-positive, n = 19); and mild AD (CDR = 0.5 or 1, Aß-positive, n = 17). RESULTS: In hippocampal tissue, qGRE identified two types of regions: one, practically devoid of neurons, we designate as "Dark Matter", and the other, with relatively preserved neurons, "Viable Tissue". Data showed a greater loss of neurons than defined by atrophy in the mild AD group compared with the healthy control group; neuronal loss ranged between 31% and 43%, while volume loss ranged only between 10% and 19%. The concept of Dark Matter was confirmed with histopathological study of one participant who underwent in vivo qGRE 14 months prior to expiration. CONCLUSION: In vivo qGRE method identifies neuronal loss that is associated with impaired AD-related cognition but is not recognized by MRI measurements of tissue atrophy, therefore providing new biomarkers for early AD detection.

Nicotine-related misperceptions among faculty and students at a Midwestern dental school.

PURPOSE/OBJECTIVES: To determine the perceptions about the ill-effects of nicotine in students and faculty at a Midwestern dental school. This information will help inform the school and improve teaching on this subject during a time when electronic nicotine delivery systems are increasingly popular. METHODS: An online survey of dental students and faculty of a Midwestern dental school was deployed in November, 2020 to determine their level of misperception about the ill effects of nicotine. An online Qualtrics survey was administered to approximately 212 predoctoral students at a dental institution and approximately 100 part- and full-time faculty at the same school. RESULTS: The response rate for faculty was 55.1% and that for students was 37.5%. The majority of faculty and students "agreed" or "strongly agreed" that nicotine causes cancer, birth defects, cardiovascular disease, oral inflammation, and Chronic Obstructive Pulmonary Disease. CONCLUSIONS: Dental school faculty and students linked the risks of smoking tobacco to nicotine. Based on the results of this study, we feel our institution's curriculum should consider including information specific to nicotine in addition to tobacco in general.

Deteriorated regional calf microcirculation measured by contrast-free MRI in patients with diabetes mellitus and relation with physical activity.

OBJECTIVE: To evaluate regional calf muscle microcirculation in people with diabetes mellitus (DM) with and without foot ulcers, compared to healthy control people without DM, using contrast-free magnetic resonance imaging methods. METHODS: Three groups of subjects were recruited: non-DM controls, DM, and DM with foot ulcers (DM + ulcer), all with ankle brachial index (ABI) > 0.9. Skeletal muscle blood flow (SMBF) and oxygen extraction fraction (SMOEF) in calf muscle were measured at rest and during a 5-min isometric ankle plantarflexion exercise. Subjects completed the Yale physical activity survey. RESULTS: The exercise SMBF (ml/min/100 g) of the medial gastrocnemius muscle were progressively impaired: 63.7 ± 18.9 for controls, 42.9 ± 6.7 for DM, and 36.2 ± 6.2 for DM + ulcer, p < 0.001. Corresponding exercise SMOEF was the lowest in DM + ulcers (0.48 ± 0.09). Exercise SMBF in the soleus muscle was correlated moderately with the Yale physical activity survey (r = 0.39, p < 0.01). CONCLUSIONS: Contrast-free MR imaging identified progressively impaired regional microcirculation in medial gastrocnemius muscles of people with DM with and without foot ulcers. Exercise SMBF in the medial gastrocnemius muscle was the most sensitive index and was associated with HbA1c. Lower exercise SMBF in the soleus muscle was associated with lower Yale score.

The periodontal senior case clinical challenge: Students' opinions of a formative virtual assessment during the COVID-19 emergency.

INTRODUCTION: Due to COVID-19, innovative, virtual educational methods are being developed to provide students with learning experiences comparable to established clinical practices. Our objective was to produce the Periodontal Senior Case Clinical Challenge (PSCCC) that would provide fourth-year students an alternative for senior case presentations and would be a formative assessment for which student opinions would be provided and analysed. The PSCCC would utilise an online, case-based, written, clinical assessment and follow-up, structured discussion to challenge students to demonstrate ability to apply didactic periodontal knowledge to patient-based experiences. We hypothesised the PSCCC would provide effective learning and a formative assessment. MATERIAL AND METHODS: Relevant didactic resources were distributed to 48 students for independent review. The PSCCC was delivered in two sections, (1) a case-based assessment via a virtual classroom with written student responses, and (2) oral discussions conducted via virtual meetings that were moderated and assessed by ten periodontists, with the collaboration of nine residents. A voluntary six-statement survey was used to evaluate the students' opinions of the PSCCC. The scores for 75% (36/48) of students who participated were evaluated for statistical and clinical importance. RESULTS: The value of our PSCCC was supported by 91.7% (33/36) of the analyses (p < .0008). DISCUSSION: The PSCCC was a successful alternative pathway to assess students' clinical and didactic integrated knowledge in periodontics. It provided a unified vision of treatment of the selected case, building on all aspects of the students' periodontal education whilst allowing interaction in a simultaneous, three-tiered educational approach, involving dental students, periodontal residents and faculty. CONCLUSION: In support of our hypothesis, for each of the 6 statements, ≥94.44% (34/36) of the scores given by the students were considered exceptionally strong clinical support for our pedagogical strategy that combines educational resources and can be successfully implemented in other programmes.

Quantitative Variable Assessment of Patellar Instability: An MRI-Based Study.

OBJECTIVE. The purpose of this study was to investigate the reproducibility of three quantitative MRI parameters associated with patellar instability and to determine whether they measure anatomic predisposition to patellar instability individually or in combination with the other parameters. MATERIALS AND METHODS. In this retrospective study, 100 patients diagnosed with a patellar dislocation injury and 100 age- and sex-matched control patients were examined using MRI. The distance between the tibial tubercle and posterior cruciate ligament (TT-PCL), distance between the tibial tubercle and trochlear groove (TT-TG), and TG depth (trochlear dysplasia) were measured independently by three fellowship-trained musculoskeletal radiologists. Intraclass correlation coefficient (ICC) was used to assess intraobserver and interobserver reliability. The parameters in both groups were tested for interdependence on each other and were compared for prevalence and association with patellar instability. RESULTS. All three parameters showed almost perfect intraobserver (TT-PCL ICC, ≥ 0.88; TT-TG ICC, 0.96; trochlear dysplasia ICC, ≥ 0.92) and interobserver (TT-PCL ICC, 0.82; TT-TG ICC, 0.94; trochlear dysplasia ICC, 0.91) reliability and were significantly more common in the patellar instability group. Trochlear dysplasia had the highest association with patellar instability, both as a unique parameter and in pairwise combination with an abnormal TT-TG. Optimal cutoff thresholds for normal TT-TG and TT-PCL were 15.00 mm or less and 21.30 mm or less, respectively. The optimal normal cutoff threshold for evaluating trochlear dysplasia via trochlear depth was 4.95 mm or more. CONCLUSION. Patellar instability is multifactorial. Highly reproducible parameters derived from MRI reveal both unique and overlapping anatomic predispositions, and considering all parameters together may help individualize patient management when selecting orthopedic procedures.

Limited Evidence Suggests That Vitamin D May Help Prevent and Treat Periodontal Disease in Adults.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Serum vitamin D levels and chronic periodontitis in adult, Caucasian population-a systematic review. Peric M, Cavallier E, Toma S, Lasserre JF. J Periodontal Res 2018; 53:645-56. SOURCE OF FUNDING: Information not available/none declared. TYPE OF STUDY/DESIGN: Systematic review.

Comparative Evaluation of SmartMouth Clinical DDS Advanced Oral Rinse and Chlorhexidine Mouthrinse.

PURPOSE: To evaluate the efficacy of SmartMouth Clinical DDS compared with 0.12% chlorhexidine and placebo mouthrinses. MATERIALS AND METHODS: Seventy-six subjects with gingivitis or chronic periodontitis were enrolled in a double-blind, placebo-controlled, clinical study. Examinations included Gingival Index (GI), Bleeding Score (BS), Plaque Index (PI), Tooth Stain Index (TSI), and Calculus Index (CI). Subjects were given a prophylaxis and oral hygiene instructions at the time of enrolment. Subjects were assigned to one of three groups: SmartMouth Clinical DDS (SM), 0.12% chlorhexidine (CHX), or placebo (PL). Subjects were examined at 3 and 6 weeks. Data were evaluated as differences from baseline for each group. Analysis of variance (ANOVA), t tests or non-parametric alternatives were used to analyse data. RESULTS: The GI, BS and PI decreases from baseline were statistically significant at both 3 and 6 weeks for all three groups (p ≤ 0.025). Differences between groups were not statistically significant, except that the PI decrease for CHX was significantly greater than PL at 6 weeks (p = 0.048). At 6 weeks there was a statistically significant increase in TSI for CHX (p ≤ 0.001). CI decreased significantly for all groups at 3 weeks (p ≤ 0.004) and for PL at 6 weeks (p ˂ 0.001). At 3 weeks and 6 weeks, the percentages for compliance were significantly higher for SM and PL than for CHX (p ˂ 0.001). SM had less taste alteration reported than CHX (p = 0.003). CONCLUSION: While all three groups were shown to improve GI, BS and PI scores; non-prescription SM resulted in less taste alteration, less tooth stain and better compliance than CHX.

Diffusion Tensor Imaging of the Calf Muscles in Subjects With and Without Diabetes Mellitus.

BACKGROUND: Diffusion tensor imaging (DTI) has been used to characterize calf skeletal muscle architecture. PURPOSE: To assess the diffusional properties of the calf muscles of subjects with and without diabetes, at rest and during isometric plantarflexion exercise. STUDY TYPE: Prospective. SUBJECTS: Twenty-six subjects in two groups: 13 healthy and 13 subjects with type 2 diabetes (DM); each group consisted of seven females and six males. FIELD STRENGTH/SEQUENCE: 3T/2D single-shot spin echo planar imaging. ASSESSMENT: Fractional anisotropy (FA), mean diffusivity (MD), diffusion eigenvalues, and fiber tracking indices were obtained from the medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) muscles of the calf at rest and during isometric plantarflexion exercise. STATISTICAL TESTS: We used a combination of nonparametric (Wilcoxon) and parametric (t-test) statistical assessments. RESULTS: The medial gastrocnemius muscle had more indices with significant differences between the two groups (six indices with P < 0.05) than did the lateral gastrocnemius (three indices with P < 0.05) and soleus muscles (only one index with P < 0.05). While the healthy group showed elevated MD values from rest to exercise (MG = 5.83%, LG = 13.45%, and SOL = 11.68%), the diabetic MD showed higher increases (MG = 19.74%, LG = 29.31%, and SOL = 20.84%) that were different between groups (MG: P = 0.009, LG: P = 0.037, and SOL: P = 0.049). DATA CONCLUSION: Our results indicate considerable diffusional changes between healthy subjects and subjects with diabetes at rest and during isometric plantarflexion exercise in the calf muscles. The medial gastrocnemius muscle displayed the most diffusion sensitivity to diabetes-related microstructural changes. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1285-1295.

Intravenous contrast-free standardized exercise perfusion imaging in diabetic feet with ulcers.

BACKGROUND: Impaired foot perfusion is a primary contributor to foot ulcer formation. There is no existing device nor method that can be used to measure local foot perfusion during standardized foot muscle exercise in an MRI environment. PURPOSE: To develop a new MRI-compatible foot dynamometer and MRI methods to characterize local perfusion in diabetic feet with ulcers. STUDY TYPE: Prospective. POPULATION/SUBJECTS: Seven participants without diabetes and 10 participants with diabetic foot ulcers. FIELD STRENGTH/SEQUENCE: 3.0T, arterial spin labeling (ASL). ASSESSMENTS: Using a new MRI-compatible foot dynamometer, all participants underwent MRI ASL perfusion assessment at rest and during a standardized toe-flexion exercise. The participants without diabetes were scanned twice to assess the reproducibility of perfusion measurements. The absolute perfusion and perfusion reserve values were compared between two groups and between regions near ulcers (peri-ulcer) and away from ulcers (away-ulcer). STATISTICAL TESTS: Bland-Altman methods for the calculation of coefficient of repeatability (CR) and two-sided and unpaired Student's t-test to compare multiple differences. RESULTS: The perfusion reserves measured had the best reproducibility (CR in medial region: 1.6, lateral region: 0.9). The foot perfusion reserve was significantly lower in the participants with diabetes compared with the participants without diabetes (1.34 ± 0.32, 95% confidence interval [CI]: 1.1, 1.58 vs. 1.76 ± 0.31, 95% CI: 1.53, 1.98, P = 0.02). Both peri-ulcer exercise perfusion (8.7 ± 3.9 ml/min/100g) and perfusion reserve (1.07 ± 0.39, 95% CI: 0.78, 1.35) were significantly lower than away-ulcer exercise perfusion (12.7 ± 3.8 ml/min/100g, P = 0.02) and perfusion reserve (1.39 ± 0.37, 95% CI: 1.11, 1.66, P = 0.03), respectively. DATA CONCLUSION: This study demonstrates intravenous contrast-free methods for local perfusion in feet with ulcers by standardized exercise-based MRI. Ischemia regions around foot ulcers can be quantitatively distinguished from normal perfused muscle regions. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:474-480.

Using Correlative Properties of Neighboring Pixels to Enhance Contrast-to-Noise Ratio of Abnormal Hippocampus in Patients With Intractable Epilepsy and Mesial Temporal Sclerosis.

RATIONALE AND OBJECTIVES: To test whether an image-processing algorithm can aid in visualization of mesial temporal sclerosis on magnetic resonance imaging by selectively increasing contrast-to-noise ratio (CNR) between abnormal hippocampus and normal brain. MATERIALS AND METHODS: In this Institutional Review Board-approved and Health Insurance Portability and Accountability Act-compliant study, baseline coronal fluid-attenuated inversion recovery images of 18 adults (10 females, eight males; mean age 41.2 years) with proven mesial temporal sclerosis were processed using a custom algorithm to produce corresponding enhanced images. Average (Hmean) and maximum (Hmax) CNR for abnormal hippocampus were calculated relative to normal ipsilateral white matter. CNR values for normal gray matter (GM) were similarly calculated using ipsilateral cingulate gyrus as the internal control. To evaluate effect of image processing on visual conspicuity of hippocampal signal alteration, a neuroradiologist masked to the side of hippocampal abnormality rated signal intensity (SI) of hippocampi on baseline and enhanced images using a five-point scale (definitely abnormal to definitely normal). Differences in Hmean, Hmax, GM, and SI ratings for abnormal hippocampi on baseline and enhanced images were assessed for statistical significance. RESULTS: Both Hmean and Hmax were significantly higher in enhanced images as compared to baseline images (p < 0.0001 for both). There was no significant difference in the GM between baseline and enhanced images (p = 0.9375). SI ratings showed a more confident identification of abnormality on enhanced images (p = 0.0001). CONCLUSION: Image-processing resulted in increased CNR of abnormal hippocampus without affecting the CNR of normal gray matter. This selective increase in conspicuity of abnormal hippocampus was associated with more confident identification of hippocampal signal alteration.

Enhancing contrast to noise ratio of hippocampi affected with mesial temporal sclerosis: A case-control study in children undergoing epilepsy surgeries.

OBJECTIVE: Detection of mesial temporal sclerosis (MTS) in children with epilepsy is important. We assessed whether an image-processing algorithm (Correlative Image Enhancement, CIE) could facilitate recognition of hippocampal signal abnormality in the presence of MTS by increasing contrast to noise ratio between affected hippocampus and normal gray matter. PATIENTS AND METHODS: Baseline coronal FLAIR images from brain MRIs of 27 children with epilepsy who underwent hippocampal resection were processed using CIE. These included 19 hippocampi with biopsy proven MTS and 8 biopsy proven normal hippocampi resected in conjunction with hemispherotomy. We assessed the effect of processing on contrast to noise ratio (CNR) between hippocampus and normal insular gray matter, and on assessment of hippocampal signal abnormality by two masked neuroradiologists. RESULTS: Processing resulted in a significant increase in mean CNR (from 3.9 ± 5.3 to 25.3 ± 25.8; P < 0.01) for hippocampi with MTS, with a substantial (>100%) increase from baseline seen in 15/19 (78.9%) cases. Baseline CNR of 1.7 ± 5.3 for normal hippocampi did not change significantly after processing (1.8 ± 5.3; P = 1.00). For one reader, baseline sensitivity (14/19; 73.6%) was unaffected but the specificity improved from 62.5% (5/8) to 100%. An increase in both sensitivity (from 73.6% to 78.9%) and specificity (from 62.5% to 75%) was seen for the second reader. CONCLUSION: By enhancing CNR for diseased hippocampi while leaving normal hippocampi relatively unaffected, CIE may improve the diagnostic accuracies of radiologists in detecting MTS-related signal alteration within the affected hippocampus.

A Candidate Imaging Marker for Early Detection of Charcot Neuroarthropathy.

Inflammation-mediated foot osteopenia may play a pivotal role in the etiogenesis, pathogenesis, and therapeutic outcomes in individuals with diabetes mellitus (DM), peripheral neuropathy (PN), and Charcot neuroarthropathy (CN). Our objective was to establish a volumetric quantitative computed tomography-derived foot bone measurement as a candidate prognostic imaging marker to identify individuals with DMPN who were at risk of developing CN. We studied 3 groups: 16 young controls (27 ± 5 years), 20 with DMPN (57 ± 11 years), and 20 with DMPN and CN (55 ± 9 years). Computed tomography image analysis was used to measure metatarsal and tarsal bone mineral density in both feet. The mean of 12 right (7 tarsals and 5 metatarsals) and 12 left foot bone mineral densities, maximum percent difference in bone mineral density between paired bones of the right and the left feet, and the mean difference of the 12 right and the 12 left bone mineral density measurements were used as input variables in different classification analysis methods to determine the best classifier. Classification tree analysis produced no misclassification of the young controls and individuals with DMPN and CN. The tree classifier found 7 of 20 (35%) individuals with DMPN to be classified as CN (1 participant developed CN during follow-up) and 13 (65%) to be classified as healthy. These results indicate that a decision tree employing 3 measurements derived from volumetric quantitative computed tomography foot bone mineral density defines a candidate prognostic imaging marker to identify individuals with diabetes and PN who are at risk of developing CN.

Pancreatic Neuroendocrine Tumors: Computed Tomography Enhancement, But Not Histological Grade, Correlates With Tumor Aggression.

OBJECTIVES: The aims of this study were to assess computed tomography enhancement of pancreatic neuroendocrine tumors (NETs), determine correlation with histological vascularity and fibrosis, and identify a biomarker for tumor aggression. METHODS: The arterial and venous enhancement of NET was calculated on computed tomography for 56 patients. Tumor size and vascularity/fibrosis were assessed. Tumor aggression was grouped by World Health Organization and Hochwald grade and the presence of metastases. Variables were assessed for correlation. Groups were compared using t test/Wilcoxon rank sum test. RESULTS: Arterial enhancement and dynamic washout (r = 0.35, P = 0.02; r = 0.34, P = 0.02, respectively) correlate with vascularity. There is inverse correlation between vascularity and fibrosis (r = -0.62, P < 0.001), but no correlation between enhancement and fibrosis. Metastatic NET had less arterial (mean, -2 [standard deviationi {SD}, 27.1] Hounsfield unit [HU]; 35.7 [SD, 57.5] HU; P = 0.01) and venous (12.6 [SD, 14.4] HU; 29.2 [SD, 38.3] HU; P = 0.04) enhancement and less washout (8.5 [SD, 18.5] HU; 26.8 [SD, 30] HU, P = 0.02) compared with nonmetastatic NET. These differences were not present when comparing by tumor grade. Arterial hypoenhancement was the only significant predictor of metastases. CONCLUSIONS: Aggressive tumors, as determined by metastases, but not histological grade, enhance less than nonmetastatic tumors.

Screening for Diabetes in a Dental School Clinic to Assess Interprofessional Communication Between Physicians and Dental Students.

If a dental student diagnoses a patient in a dental school clinic as being at high risk of prediabetes or diabetes, the patient should be referred to his or her physician for further diagnostic evaluation, and the physician should send back the evaluation results so that the dental team can optimize treatment and health care choices if the diagnosis is confirmed. The primary aim of this study was to evaluate physicians' responses to written and oral requests for information regarding follow-up diabetes testing. A secondary aim was to evaluate patients' compliance with recommendations to seek medical care after being determined to be at high risk of prediabetes or diabetes in the dental clinic. Based on at least one positive risk factor for diabetes, 74 patients in one U.S. dental school's clinic were screened by third- and fourth-year dental students for prediabetes or diabetes and underwent point of care HbA1C (glycalated hemoglobin) blood tests between June 2014 and June 2015. Patients with an HbA1C value of 5.7% or above were referred to their physicians for follow-up testing. The physician was mailed the patient's HIPAA release and a request for updates to the student regarding the patient's diabetes status. If the physician did not provide the requested information, a dental student telephoned him or her to obtain the patient's diabetes status. Of the 74 patients, 34 (46%) tested positive with HbA1C tests and were referred to their physicians. Of those 34 referred patients, 20 (59%) saw their physicians for additional evaluations within six months of referral. None of the 20 physicians responded to the written requests for information on additional diabetes testing. After one or two telephone requests, all 20 physicians provided the test results. This study found that most of the patients (59%) followed their dental practitioner's advice to seek follow-up care with their physician, supporting the value of conducting these tests in a dental clinic. However, the results also suggested that a single written request may be insufficient to prompt physicians to return those results and that follow-up communication in a phone call may be more effective.