Prospective observational study to validate a next-generation sequencing blood RNA signature to predict early kidney transplant rejection.

The objective of this study was to validate the performance of Tutivia, a peripheral blood gene expression signature, in predicting early acute rejection (AR) post-kidney transplant. Recipients of living or deceased donor kidney transplants were enrolled in a nonrandomized, prospective, global, and observational study (NCT04727788). The main outcome was validation of the area under the curve (AUC) of Tutivia vs serum creatinine at biopsy alone, or Tutivia + serum creatinine at biopsy. Of the 151 kidney transplant recipients, the mean cohort age was 53 years old, and 64% were male. There were 71% (107/151) surveillance/protocol biopsies and 29% (44/151) for-cause biopsies, with a 31% (47/151) overall rejection rate. Tutivia (AUC 0.69 [95% CI: 0.59-0.77]) and AUC of Tutivia + creatinine at biopsy (0.68 [95% CI: 0.59-0.77]) were greater than the AUC of creatinine at biopsy alone (0.51.4 [95% CI: 0.43-0.60]). Applying a model cut-off of 50 (scale 0-100) generated a high- and low-risk category for AR with a negative predictive value of 0.79 (95% CI: 0.71-0.86), a positive predictive value of 0.60 (95% CI: 0.45-0.74), and an odds ratio of 5.74 (95% CI: 2.63-12.54). Tutivia represents a validated noninvasive approach for clinicians to accurately predict early AR, beyond the current standard of care.

Wound related complications and the anterior rectus sheath versus Gibson approach to kidney transplantation: A single center randomized controlled trial.

INTRODUCTION: Wound related complications (WRC) are a significant source of morbidity in kidney transplant recipients, and may be mitigated by surgical approach. We hypothesize that the anterior rectus sheath approach (ARS) may decrease WRC and inpatient opiate use compared to the Gibson Approach (GA). METHODS: This double-blinded randomized controlled trial allocated kidney transplant recipients aged 18 or older, exclusive of other procedures, 1:1 to ARS or GA at a single hospital. The ARS involves a muscle-splitting paramedian approach to the iliopsoas fossa, compared to the muscle-cutting GA. Patients and data analysts were blinded to randomization. RESULTS: Seventy five patients were randomized to each group between August 27, 2019 and September 18, 2020 with a minimum 12 month follow-up. There was no difference in WRC between groups (p = .23). Nine (12%) and three patients (4%) experienced any WRC in the ARS and GA groups, respectively. Three and one Clavien IIIb complications occurred in the ARS and GA groups, respectively. In a multiple linear regression model, ARS was associated with decreased inpatient opioid use (ß = -58, 95% CI: -105 to -12, p = .016). CONCLUSIONS: The ARS did not provide a WRC benefit in kidney transplant recipients, but may be associated with decreased inpatient opioid use.

Color and translucency of enamel in vital maxillary central incisors.

STATEMENT OF PROBLEM: Limited data, especially in vivo data, exist regarding translucency parameter (TP) values for vital anterior nonrestored dentition. Additionally, published information on the CIELab values of vital enamel at a theoretical infinite thickness is lacking. Obtaining TP and CIELab values in a population that varies in terms of ethnicity, age, and sex would be useful to inform the development and placement of esthetic dental restorations that more accurately capture the complex optical qualities of enamel. PURPOSE: The purpose of this clinical study was to investigate in vivo the TP and CIELab values of vital anterior incisor enamel at a theoretical infinite thickness in a diverse pool of participants who varied in age, ethnicity, and sex. MATERIAL AND METHODS: Spectral reflectance measurements (380 to 780 nm at 2-nm intervals) of the mid-incisal region of vital, unrestored maxillary anterior teeth were made in 120 participants, equally divided into 2 sexes, 4 racial or ethnic groups, and 5 age ranges. Instruments were oriented to achieve 0-degree observation and 45-degree illumination, and spectral measurements were made with white and black silicone backgrounds. Reflectance spectra of the incisal enamel from both the black and white silicone backing were used to fit to the Kubelka-Munk (K-M) reflectance theory. The CIEDE2000 color difference formula was used to determine TP, and data were compared among participant demographics. CIELab color coordinate values for enamel at an infinite thickness were calculated by using a D65 illumination and CIE standard human (2-degree) observer. To determine value ranges and significant differences among participant groups, CIELab values were analyzed with a 4-way ANOVA, and TP values were analyzed with a generalized linear mixed model. Pairwise comparisons of interest were evaluated with Bonferroni-corrected Student t tests. RESULTS: For maxillary central incisor enamel, the average TP was 10.1 ±3.6, and the average CIELab color coordinates were L∗=73.5 ±7.6, a∗=2.2 ±1.8, b∗=11.9 ±8.4. TP values of incisal enamel significantly differed among specific age and ethnic groups, with general significant interactions of age and sex (P=.009), as well as ethnicity and age (P=.042). CIE color coordinates of enamel at an infinite thickness were found in the L∗ coordinate among different age groups with the same sex and ethnicity, specifically when comparing CIELab direction with the population characteristics of age (P=.011) and the interaction between age, sex, and ethnicity (P=.035). CONCLUSIONS: In vivo L∗ values and TP values of incisal enamel differed significantly among groups determined by ethnicity, age, and sex.

Profile of prosthodontics program directors in North America.

PURPOSE: To develop a current profile of prosthodontics program directors (PPDs) in United States dental schools and describe the current challenges and responsibilities of those serving in the position and assess the professional needs of the program directors (PDs) to better support them in their roles. MATERIALS AND METHODS: A survey was sent to 51 participants who were identified as PPDs in North America via Qualtrics in 2019 to assess the professional needs of PDs to better support their roles. The survey consisted of 29 items organized into six sections: (1) demographic information; (2) hours and time spent in various areas of the job; (3) greatest challenges; (4) perceived importance of specific competencies; (5) opinions on the greatest rewards of the position; (6) their needs for support from the American College of Prosthodontists and advice for the future PD. RESULTS: The response rate for this survey was 88.3%. Of the 45 respondents, the majority were white/non-Hispanic, followed by Asian/Pacific Islanders. The two largest and equal numbers of participants who worked for more than 10 years and between 1 and 3 years were observed with approximately 29% each, and PDs who worked less than a year occupied the least amount. Overall, 34% of PDs are on the tenure track and 80% of those are tenured. Teaching and clinical services took away the greatest time with approximately 42% and 22.1%, respectively. Thirty-five (78%) PDs listed the greatest challenge they encountered was the workload of the role. Skills listed in leadership and personnel competencies were all rated more important than most of the skills listed in management. CONCLUSIONS: There is a wide gender gap and a lack of racial diversity among the PPDs. The biggest challenge faced by them is the amount of workload followed by budget and fiscal constraints. And for their improved efficiency, they gave emphasis on learning time management and continuous clinical training of newer advances.

Influence of interdental spaces and the palate on the accuracy of maxillary scans acquired using different intraoral scanners.

PURPOSE: To assess the influence of interdental spaces and scanning the palate on the accuracy of maxillary scans acquired using three intraoral scanners (IOSs). MATERIALS AND METHODS: A virtual completely dentate maxillary cast without interdental spaces was obtained and modified to create 1, 2, and 3 mm of interdental spacing between the anterior teeth. These three files (reference standard tessellation language files) were used to print three reference casts. The reference casts were scanned using three IOSs: TRIOS4, iTero Element 5D, and Aoralscan2. Three groups were created based on the interdental spaces: 0, 1, 2, and 3 mm (n = 10). The groups were subdivided into two subgroups: no palate (NP subgroup) and palate (P subgroup). The reference STL files were used to measure the discrepancy with the experimental scans by calculating the root mean square (RMS) error. Three-way analysis of variance (ANOVA) and post hoc Tukey pairwise comparison tests were used to analyze trueness. The Levene test was used to analyze precision (α = 0.05). RESULTS: Trueness ranged from 91 to 139 µm and precision ranged from 5 to 23 µm among the subgroups tested. A significant correlation was found between IOS*group (p<0.001) and IOS*subgroup ( p<0.001). Tukey test showed significant trueness differences among the interdental spaces tested (p<0.001). The 1- and 2-mm groups obtained better trueness than the 0- and 3-mm groups (p<0.001). An 11 µm mean trueness discrepancy was measured among the different interdental space groups tested. The P subgroups demonstrated significantly higher trueness when compared to the NP subgroups (p<0.001). The discrepancy between the maxillary scans with and without the palate was 4 µm. Significant precision discrepancies were found (p = 0.008), with the iTero group showing the lowest precision. CONCLUSION: Interdental spaces and incorporation of the palate on maxillary intraoral scans influenced trueness and precision of the three IOSs tested. However, the scanning discrepancy measured may be of no clinical relevance.

Utilization and outcomes of deceased donor SARS-CoV-2-positive organs for solid organ transplantation in the United States.

Coronavirus disease-19 has had a marked impact on the transplant population and processes of care for transplant centers and organ allocation. Several single-center studies have reported successful utilization of deceased donors with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests. Our aims were to characterize testing, organ utilization, and transplant outcomes with donor SARS-CoV-2 status in the United States. We used Scientific Registry of Transplant Recipients data from March 12, 2020 to August 31, 2021 including a custom file with SARS-CoV-2 testing data. There were 35 347 donor specimen SARS-CoV-2 tests, 77.5% upper respiratory samples, 94.6% polymerase chain reaction tests, and 1.2% SARS-CoV-2-positive tests. Donor age, gender, history of hypertension, and diabetes were similar by SARS-CoV-2 status, while positive SARS-CoV-2 donors were more likely African-American, Hispanic, and donors after cardiac death (p-values <.01). Recipient demographic characteristics were similar by donor SARS CoV-2 status. Adjusted donor kidney discard (odds ratio = 2.08, 95% confidence interval [CI] 1.66-2.61) was higher for SARS-CoV-2-positive donors while donor liver (odds ratio = 0.44, 95% CI 0.33-0.60) and heart recovery (odds ratio = 0.44, 95% CI 0.31-0.63) were significantly reduced. Overall post-transplant graft survival for kidney, liver, and heart recipients was comparable by donor SARS-CoV-2 status. Cumulatively, there has been significantly lower utilization of SARS-CoV-2 donors with no evidence of reduced recipient graft survival with variations in practice over time.

Comparative outcomes for over 100 deceased donor kidney transplants from SARS-CoV-2 positive donors: A single-center experience.

Emerging data support the safety of transplantation of extra-pulmonary organs from donors with SARS-CoV-2-detection. Our center offered kidney transplantation (KT) from deceased donors (DD) with SARS-CoV-2 with and without COVID-19 as a cause of death (CoV + COD and CoV+) to consenting candidates. No pre-emptive antiviral therapies were given. We retrospectively compared outcomes to contemporaneous DDKTs with negative SARS-CoV-2 testing (CoVneg). From February 1, 2021 to January 31, 2022, there were 220 adult KTs, including 115 (52%) from 35 CoV+ and 33 CoV + COD donors. Compared to CoVneg and CoV+, CoV + COD were more often DCD (100% vs. 40% and 46%, p < .01) with longer cold ischemia times (25.2 h vs. 22.9 h and 22.2 h, p = .02). At median follow-up of 5.7 months, recipients of CoV+, CoV + COD and CoVneg kidneys had similar rates of delayed graft function (10.3%, 21.8% and 21.9%, p = .16), rejection (5.1%, 0% and 8.5%, p = .07), graft failure (1.7%, 0% and 0%, p = .35), mortality (0.9%, 0% and 3.7%; p = .29), and COVID-19 diagnoses (13.6%, 7.1%, and 15.2%, p = .33). Though follow-up was shorter, CoV + COD was associated with lower but acceptable eGFR on multivariable analysis. KT from DDs at various stages of SARS-CoV-2 infection appears safe and successful. Extended follow-up is required to assess the impact of CoV + COD donors on longer term graft function.

Predicting GFR after radical nephrectomy: the importance of split renal function.

PURPOSE: To evaluate a conceptually simple model to predict new-baseline-glomerular-filtration-rate (NBGFR) after radical nephrectomy (RN) based on split-renal-function (SRF) and renal-functional-compensation (RFC), and to compare its predictive accuracy against a validated non-SRF-based model. RN should only be considered when the tumor has increased oncologic potential and/or when there is concern about perioperative morbidity with PN due to increased tumor complexity. In these circumstances, accurate prediction of NBGFR after RN can be important, with a threshold NBGFR > 45 ml/min/1.73m2 correlating with improved overall survival. METHODS: 236 RCC patients who underwent RN (2010-2012) with preoperative imaging (CT/MRI) and relevant functional data were included. NBGFR was defined as GFR 3-12 months post-RN. SRF was determined using semi-automated software that provides differential parenchymal-volume-analysis (PVA) from preoperative imaging. Our SRF-based model was: Predicted NBGFR = 1.24 (× Global GFRPre-RN) (× SRFContralateral), with 1.24 representing the mean RFC estimate from independent analyses. A non-SRF-based model was also assessed: Predicted NBGFR = 17 + preoperative GFR (× 0.65)-age (× 0.25) + 3 (if tumor > 7 cm)-2 (if diabetes). Alignment between predicted/observed NBGFR was assessed by comparing correlation coefficients and area-under-the-curve (AUC) analyses. RESULTS: The correlation-coefficients (r) were 0.87/0.72 for SRF-based/non-SRF-based models, respectively (p = 0.005). For prediction of NBGFR > 45 ml/min/1.73m2, the SRF-based/non-SRF-based models provided AUC of 0.94/0.87, respectively (p = 0.044). CONCLUSION: Previous non-SRF-based models to predict NBGFR post-RN are complex and omit two important parameters: SRF and RFC. Our proposed model prioritizes these parameters and provides a conceptually simple, accurate, and clinically implementable approach to predict NBGFR post-RN. SRF can be easily obtained using PVA software that is affordable, readily available (FUJIFILM-Medical-Systems), and more accurate than nuclear-renal-scans. The SRF-based model demonstrates greater predictive-accuracy than a non-SRF-based model, including the clinically-important predictive-threshold of NBGFR > 45 ml/min/1.73m2.

Mathematical Tooth Proportions: A Systematic Review.

PURPOSE: The aim of this systematic review was to evaluate and compare three commonly used proportions that include the golden proportion, golden percentage, and Recurring Esthetic Dental (RED) proportion to identify which of the mathematical formulas, if any, can be used to provide predictable and repeatable esthetic clinical outcomes. METHODS: A comprehensive search of electronic databases that included EBSCO, ProQuest, SCOPUS, Science Direct, Wiley, Google Scholar and PubMed was conducted using the terms: "golden proportion," "golden percentage," and "Recurring Esthetic Dental (RED) proportions" alone or in concurrence with one or both ensuing terms: "tooth proportions" and "esthetic tooth proportions." In addition, the following journals were hand searched for relevant articles: Journal of Prosthodontics, Journal of Prosthetic Dentistry and Journal of Esthetic and Restorative Dentistry. Related citations were also considered. RESULTS: Tooth proportions varied substantially in the natural dentition. No studies revealed findings that supported the use of one mathematical formula to predict esthetic success. The golden proportion is present between the central to lateral incisor in some cases, but rarely between the lateral incisor and the canine. When compared to the other proportions, the golden percentage provided better starting points for tooth shape and size, but only when values were adjusted to consider other factors such as ethnicity and/or facial proportions. CONCLUSION: Mathematical formulas did not provide consistent results that would allow for their use as a standardized guide for esthetically pleasing smiles. Although the golden percentage may be a good starting point if the percentages are adjusted on a case-by-case basis, generalized esthetic ideals cannot be determined by a mathematical formula and are open to interpretation by both the clinician and the patient.

Early success transplanting kidneys from donors with new SARS-CoV-2 RNA positivity: A report of 10 cases.

Transplantation of solid organs from donors with active SARS-CoV-2 infection has been advised against due to the possibility of disease transmission to the recipient. However, with the exception of lungs, conclusive data for productive infection of transplantable organs do not exist. While such data are awaited, the organ shortage continues to claim thousands of lives each year. In this setting, we put forth a strategy to transplant otherwise healthy extrapulmonary organs from SARS-CoV-2-infected donors. We transplanted 10 kidneys from five deceased donors with new detection of SARS-CoV-2 RNA during donor evaluation in early 2021. Kidney donor profile index ranged from 3% to 56%. All organs had been turned down by multiple other centers. Without clear signs or symptoms, the veracity of timing of SARS-CoV-2 infection could not be confirmed. With 8-16 weeks of follow-up, outcomes for all 10 patients and allografts have been excellent. All have been free of signs or symptoms of donor-derived SARS-CoV-2 infection. Our findings raise important questions about the nature of SARS-CoV-2 RNA detection in potential organ donors and suggest underutilization of exceptionally good extrapulmonary organs with low risk for disease transmission.

Effects of body mass index on kidney transplant outcomes are significantly modified by patient characteristics.

Body mass index (BMI) is a known risk factor associated with kidney transplant outcomes and is incorporated for determining transplant candidate eligibility. However, BMI is a coarse health measure and risks associated with BMI may vary by patient characteristics. We evaluated 296 807 adult (age > 17) solitary kidney transplant recipients from the Scientific Registry of Transplant Recipients (2000-2019). We examined effects of BMI using survival models and tested interactions with recipient characteristics. Overall, BMI demonstrated a "J-Shaped" risk profile with elevated risks for overall graft loss with low BMI and obesity. However, multivariable models indicated interactions between BMI with recipient age, diagnosis, gender, and race/ethnicity. Low BMI was relatively higher risk for older recipients (>60 years), people with type I diabetes, and males and demonstrated no additional risk among younger (18-39) and Hispanic recipients. High BMI was associated with elevated risk for Caucasians and attenuated risk among African Americans and people with type II diabetes. Effects of BMI had variable risks for mortality vs graft loss by recipient characteristics in competing risks models. The association of BMI with posttransplant outcomes is highly variable among kidney transplant recipients. Results are important considerations for personalized care and risk stratification. Findings suggest that transplant contraindications should not be based on absolute BMI thresholds but modified based on patient characteristics.

Three-Dimensional Accuracy of Conventional Versus Digital Complete Arch Implant Impressions.

PURPOSE: The accuracy of digital impressions is still controversial for complete arch implant cases. The aim of this study is to compare the accuracy of different intraoral scanners with the conventional technique in terms of trueness and precision in a complete arch implant model. MATERIAL AND METHODS: Eight implants were inserted asymmetrically in a polyurethane edentulous mandibular model with different angulations. A 3-dimensional (3D) reference model was obtained by scanning this polyurethane model with an optical scanner. First, digital impressions were made by using 3 different intraoral scanners: Carestream 3500 (DC), Cerec Omnicam (DO) and 3Shape Trios 3 (DT). Subsequently, a nonsplinted open tray impression technique was used for conventional impression group (C) and then the master casts were digitalized with a lab scanner. Each 10 STL files belonging to 4 different impression groups were imported to a reverse engineering program, to measure distance and angle deviations from the reference model. All statistical analyses were performed after taking absolute values of the data. After comparing the impression groups with one-way ANOVA, the trueness and precision values were analyzed by Tukey post hoc test and 0.05 was used as the level of significance. RESULTS: The mean trueness of distance was 123.06 ± 89.83 µm for DC, 229.72 ± 121.34 µm for DO, 209.75 ± 47.07 µm for DT, and 345.32 ± 75.12 µm for C group (p < 0.0001). While DC showed significantly lower deviation compared to DO and C, no significant difference was found between DC and DT. C showed the highest distance deviation significantly in all groups; and no significant difference was found between DO and DT groups. In angle measurements; the trueness was 0.26° ± 0.07° for DC, 0.53° ± 0.42° for DO, 0.33° ± 0.30° for DT, and 0.74° ± 0.65° for C group. There was no significant difference between the groups in terms of angular trueness (p = 0.074). In terms of the precision for distance, the results of DC 80.43 ± 29.69 µm, DO 94.06 ± 69.96 µm, DT 35.55 ± 28.46 µm and C 66.97 ± 36.69 µm were determined (p = 0.036). The significant difference was found only between DT and DO among all groups. Finally, angular precision was determined to be 0.19° ± 0.11° for DC, 0.30° ± 0.28° for DO, 0.22° ± 0.19° for DT, and 0.50° ± 0.38° for Group C. No significant difference was found between the groups, in terms of angular precision (p = 0.053). CONCLUSIONS: All digital impression groups yielded superior data compared to conventional technique in terms of trueness. DC formed the impression group with the highest trueness in both distance and angular measurements. The results of this in vitro study suggest the use of intraoral scanners compared to the conventional impression techniques in complete arch implant cases with high angulations.

Audience and Presenter Comparison of Live Web-Based Lectures and Traditional Classroom Lectures During the COVID-19 Pandemic.

PURPOSE: The purpose of the study was to assess participants' and presenters' perceptions of a live web-based lecture series in comparison to traditional in-person lectures. MATERIALS AND METHODS: A virtual lecture series was organized by the---from March 25th until June 3rd of 2020. Twenty-five postgraduate prosthodontics programs and 81 presenters participated. Two surveys were developed and distributed to the audience (N = 330) and the presenters (N = 81). Follow-up emails were sent one week, three weeks, and four weeks after the initial email survey to encourage its completion. The data were analyzed descriptively. One-way ANOVA (p = 0.05), followed by a post hoc test, were used to compare the response percentages among the different generations of presenters and participants. RESULTS: Fifty-two percent of participants, and 65% of presenters, completed the survey. More than 96% of participants and presenters were satisfied with the lecture series. Seventy-nine percent of audience members felt that the live web-based lectures were as effective as traditional classroom lectures, or more effective; 32% of presenters agreed. Millennial audience members had significantly (p = 0.0028) more negative responses than the other generations. CONCLUSION: Participants have more positive perceptions of web-based lectures than presenters.

Management of intraoral stents for radiotherapy during COVID-19 pandemic.

Radiotherapy is being performed in many situations as a curative approach for head and neck cancer instead of surgery due to the current novel coronavirus disease (COVID-19) pandemic. A recent publication reported that even hypofractionation was being conducted in order to reduce the daily exposure of both patients and the medical staff involved in cancer therapies. As a result, dental teams may be requested more frequently than usual to fabricate intraoral stents (IOS). Given that IOS may be a potential source of COVID-19 contagion, the main purpose of the present correspondence is to offer a guide on how health professionals may be safely presented in the room, on the management of the IOS and also how to sanitize the stents.

Long-term stainability of interim prosthetic materials in acidic/staining solutions.

OBJECTIVE: To evaluate the long-term color stainability, translucency, and contrast ratio (CR) of different resins used to fabricate interim prostheses after immersion in acidic/staining solutions. MATERIALS AND METHODS: A total of 160 specimens were divided into 16 groups (n = 10) according to the material (heat-polymerized acrylic resin [HPAR], auto-polymerized acrylic resin [APR], nanoparticulated bis-acrylic resin [BR], and prefabricated poly(methyl methacrylate) block for CAD/CAM [CADR]) and immersion solutions (artificial saliva, cola beverage, coffee, and red wine). A spectrophotometer was used before and after each immersion period (7, 14, 28, 90, and 180 days). Color differences (CIEDE2000 and CIELab) were calculated. A three-way repeated-measures analysis of variance and Bonferroni test (α = .05) were used. RESULTS: After 180 days, the APR presented the highest value for coffee and the CADR presented the smallest value for the cola (P < .001). For the CR, the highest values were obtained at 180 days for BR in coffee (1.35) and wine (1.18) (P < .001). Higher translucency parameters were obtained in the BR and CADR in the initial, 14, 28, and 90 days (P < .001). CONCLUSIONS: From the greatest to the smallest staining potential, the solutions were classified as: wine > coffee > cola beverage > saliva, while for the materials as: APR > BR > HPAR > CADR. CLINICAL SIGNIFICANCE: The knowledge of the long-term optical behavior of interim prosthetic materials is important for clinicians to decide which material to use to match the dietary intake of their patients and their esthetic demands. Prefabricated blocks for CAD/CAM systems have been shown to maintaining their optical characteristics even after a long period of immersion in acidic/staining solutions.

Accuracy of complete-arch implant impression made with occlusal registration material.

STATEMENT OF PROBLEM: Which impression material, impression tray type, and implant impression technique combination produces the most accurate complete-arch impression is unclear. PURPOSE: The purpose of this in vitro study was to compare the implant impression accuracy of a completely edentulous arch made with addition silicone occlusal registration material and an open tray with the implant impression accuracy of other conventional impression techniques. MATERIAL AND METHODS: A master cast was fabricated from Type IV gypsum with four 3.8-mm diameter implants with internal hexagon located in the area of mandibular canines and first molars. Impressions (N=60) were made from the master cast using the 6 techniques investigated: group B-OC-N with occlusal registration impression material (B), open custom tray (OC), and nonsplinted impression pins (N); group B-OS-N with occlusal registration impression material (B), open plastic perforated stock tray (OS), and nonsplinted impression pins (N); group PE-OC-N with polyether medium-body impression material (PE), open custom tray (OC), and nonsplinted impression pins (N); group PE-OC-S with polyether medium-body impression material (PE), open custom tray (OC), and impression pins splinted (S) with autopolymerizing resin cut after 17 minutes and reconnected; group PE-CC-N with polyether medium-body impression material (PE), closed custom tray (CC), and nonsplinted impression pins (N); group PVS-CS-N with simultaneous double-mix polyvinyl siloxane impression material (PVS), closed stock perforated metal tray (CS), and nonsplinted impression pins (N). Type IV gypsum casts were fabricated 24 hours after making the impressions. A computerized numerical control 3D coordinate measuring machine was used to measure the absolute differences of the distances between the centroids of the 4 implants among the casts produced and the distances measured at the master cast. The Kruskal-Wallis test was used to determine differences among the experimental groups (α=.05). The Mann-Whitney U post hoc analysis was used for all group combinations. RESULTS: No significant differences were found between the test groups B-OC-N and PE-OC-S, which were more accurate than the other groups. Group B-OS-N resulted in the least accurate impressions of all experimental groups. Group PE-OC-S resulted in more accurate impressions than the PE-OC-N group. No statistically significant differences were found between groups PE-OC-N and PE-CC-N or between groups PVS-CS-N and PE-CC-N. CONCLUSIONS: For complete edentulism, the use of silicone occlusal registration material with an open custom tray and nonsplinted impression pins resulted in impressions as accurate as those produced with PE open custom tray with splinted impression pins. These 2 techniques resulted in more accurate impressions than the other 4 techniques studied.

Prosthodontic Resident Selection by Postdoctoral Dental Matching Program: A National Survey by Participating Program Director.

PURPOSE: The purpose of this study was to obtain information about the resident selection and Match process that occurred for the Commission on Dental Accreditation (CODA)-accredited Advanced Education in Prosthodontics program in North America from the program directors' perspective, after the first year of implementation. MATERIALS AND METHODS: The list of Advanced Education in Prosthodontics program in CODA-accredited North American institutions was obtained from the ACP central office, and the directors of each program were identified. The surveys were distributed to 48 program directors online and results were compiled. RESULTS: Out of 48 programs, 43 directors responded to and completed the survey (90.0%), where 35 programs participated in the Match process, 5 did not, and 3 were omitted due to incomplete surveys. While the majority of programs did not see any changes in their applicant pool or their quality, 10 programs (25.0%) observed a number of increases in the application and 13 programs (32.5%) observed an increase in the quality of the applications. Among the 35 programs that participated in the Match process, the main reasons for their participation were "fairness" (48.2%), "did not want to keep moving up interview dates" (23.2%), and "have applicants come to interview as planned" (21.4%). Thirty-three programs reported that 75% to 100% of the invited applicants came to the interview (76.7%). The majority of programs that participated in Match expressed satisfaction with the process (29/33, 80.6%). Sixteen programs (45.7%) reported that they matched with 100% of their first selections. CONCLUSION: Overall response of reintroduction of the Match process for advanced prosthodontic resident selection was very positive for majority of the program directors.

Status of Sleep Apnea and Snoring Disorder Curriculum in U.S. Advanced Education Prosthodontic Programs.

PURPOSE: To assess the management of sleep apnea and snoring disorders in Advanced Education Programs in Prosthodontics (AEPP) in the United States. MATERIALS AND METHODS: A 51 item, online survey was sent to program directors at 48 AEPPs in the United States in 2015. Data results were analyzed descriptively. RESULTS: Thirty-five program directors responded to the survey. Twenty-four (68.6%, N = 35) programs report not having a dedicated course for the treatment of sleep apnea and snoring disorders. The majority (94.3%) of programs chose to treat sleep disordered breathing with oral appliance therapy and 80.0% (N = 35) of programs utilize customized sleep apnea oral devices. However, only 48.6% (N = 35) and 51.4% (N = 35) of programs regularly address sleep apnea and snoring disorders at initial examination during the comprehensive exam and medical history questionnaire, respectively. CONCLUSIONS: The confidence interval for this survey is 8.71 at a confidence level of 95% due to a response rate of 72.9%. This confidence interval suggests there is responder bias in the survey results. Therefore, the results of this survey provide a suggestion of how sleep disorders are managed in AEPPs. Programs appear to be consistent among each other with regards to treatment modalities for sleep disordered breathing. The results suggest that patients are not screened enough to receive treatment addressing sleep disorders.

Dramatic secular changes in prognosis for kidney transplant candidates in the United States.

Over recent decades, numerous clinical advances and policy changes have affected outcomes for candidates of kidney transplantation in the United States. We examined the national Scientific Registry for Transplant Recipients for adult (18+) solitary kidney transplant candidates placed on the waiting list for primary listing from 2001 to 2015. We evaluated rates of mortality, transplantation, and waitlist removal. Among 340 115 candidates there were significant declines in mortality (52 deaths/1000 patient years in 2001-04 vs 38 deaths/1000 patient years in 2012-15) and transplant rates (304 transplants/1000 patient years in 2001-04 vs 212 transplants/1000 patient years in 2012-15) and increases in waitlist removals (15 removals/1000 patient years in 2001-04 vs 25/1000 patient years in 2012-15) within the first year after listing. At 5 years an estimated 37% of candidates listed in 2012-15 were alive without transplant as compared to 22% in 2001-04. Declines in mortality over time were significantly more pronounced among African Americans, candidates with longer dialysis duration, and those with diabetes (P < .001). Cumulatively, results indicate dramatic changes in prognoses for adult kidney transplant candidates, likely impacted by selection criteria, donor availability, regulatory oversight, and clinical care. These trends are important considerations for prospective policy development and research, clinical and patient decision-making, and evaluating the impact on access to care.

Detection and characterization of a novel marine birnavirus isolated from Asian seabass in Singapore.

BACKGROUND: Lates calcarifer, known as seabass in Asia and barramundi in Australia, is a widely farmed species internationally and in Southeast Asia and any disease outbreak will have a great economic impact on the aquaculture industry. Through disease investigation of Asian seabass from a coastal fish farm in 2015 in Singapore, a novel birnavirus named Lates calcarifer Birnavirus (LCBV) was detected and we sought to isolate and characterize the virus through molecular and biochemical methods. METHODS: In order to propagate the novel birnavirus LCBV, the virus was inoculated into the Bluegill Fry (BF-2) cell line and similar clinical signs of disease were reproduced in an experimental fish challenge study using the virus isolate. Virus morphology was visualized using transmission electron microscopy (TEM). Biochemical analysis using chloroform and 5-Bromo-2'-deoxyuridine (BUDR) sensitivity assays were employed to characterize the virus. Next-Generation Sequencing (NGS) was also used to obtain the virus genome for genetic and phylogenetic analyses. RESULTS: The LCBV-infected BF-2 cell line showed cytopathic effects such as rounding and granulation of cells, localized cell death and detachment of cells observed at 3 to 5 days' post-infection. The propagated virus, when injected intra-peritoneally into naïve Asian seabass under experimental conditions, induced lesions similar to fish naturally infected with LCBV. Morphology of LCBV, visualized under TEM, revealed icosahedral particles around 50 nm in diameter. Chloroform and BUDR sensitivity assays confirmed the virus to be a non-enveloped RNA virus. Further genome analysis using NGS identified the virus to be a birnavirus with two genome segments. Phylogenetic analyses revealed that LCBV is more closely related to the Blosnavirus genus than to the Aquabirnavirus genus within the Birnaviridae family. CONCLUSIONS: These findings revealed the presence of a novel birnavirus that could be linked to the disease observed in the Asian seabass from the coastal fish farms in Singapore. This calls for more studies on disease transmission and enhanced surveillance programs to be carried out to understand pathogenicity and epidemiology of this novel virus. The gene sequences data obtained from the study can also pave way to the development of PCR-based diagnostic test methods that will enable quick and specific identification of the virus in future disease investigations.