Cumulative suppressive index as a predictor of relapse free survival and overall survival in Human Papilloma Virus-negative oral squamous cell carcinomas with negative resection margins.

BACKGROUND: This study aimed to analyze margin status and the impact of the immune elements on recurrence in patients with oral squamous cell carcinoma (OSCC), employing a prognostic biomarker, cumulative suppressive index (CSI), which reflects FoxP3+, PD-L1+, and CD8+ cell spatial relationships in the tumor microenvironment. METHODS: Cox proportional hazards regression was used to evaluate the interactive effect of the margin by CSI discrepancy (high, 3-4 vs low, 0-2) on recurrence free survival (RFS) and overall survival (OS) in 119 patients with stage I to IVA OSCC. RESULTS: In cases with negative margins, multivariable analysis showed high CSI was significantly associated with worse RFS (HR = 2.59, 95% CI [1.03, 6.49], P = .04) and OS (HR = 5.49, 95% CI [1.48, 20.35], P = .01) compared to low CSI. However, high CSI was not significantly associated with recurrence in cases with positive margins. CONCLUSIONS: Immune architecture analysis can augment our current histopathological risk assessment of margin status.

Training to Care for Limited English Proficient Patients and Provision of Interpreter Services at U.S. Dental School Clinics.

Legal protections in the United States mandate that individuals with limited English proficiency (LEP) have equal access to health care. However, LEP populations are at higher risk of poor health. Dental school clinics offer lower cost care by supervised dental students and often provide care for LEP patients. The aims of this study were to survey dental students about their clinical experience with LEP patients, the interpreter resources available at their dental school clinics, and the extent of instruction on these topics. Academic deans at 19 dental schools (30.6% of 62 invited schools) distributed the survey to their students, and the survey was completed by 325 students (4.2% of students at the 19 participating schools). Among the responding students, 44% reported their dental school clinic lacked formal interpreter services, and most of the respondents reported receiving minimal instruction on caring for LEP patients. Only 54% of the responding students reported feeling adequately prepared to manage LEP patients following graduation. These results suggest there is limited access to interpreter services for students while in dental school. A large proportion of these dental students thus reported feeling unprepared to treat LEP patients after graduation.

Impact on Junior Faculty of Teaching Opportunities During Predoctoral Education: A Survey-Based Study.

Dental schools have addressed full-time faculty shortages by utilizing part-time faculty and postdoctoral students as teachers. Studies have also shown that peer tutors in dental schools can be used effectively in addition to or in place of faculty, but there has been little research on whether the peer tutoring experience influences tutors to pursue academic careers. This study surveyed junior faculty at 60 U.S. dental schools about their predoctoral tutoring and teaching experiences. Data from 122 respondents were analyzed. The results indicated that more recent graduates had more peer tutoring opportunities available than those who graduated prior to the 1980s and that the teaching experiences influenced the respondents' decisions to pursue academic careers. Additionally, those peer tutoring programs that placed more responsibility on the peer tutors, signifying trust from the institution, were the most successful in influencing respondents' decisions to pursue academia. Finally, when comparing their predoctoral teaching experiences to faculty development of teaching skills at their current institutions, the majority of the respondents reported that the faculty development was better. However, the peer tutoring programs considered equal to or better than faculty development were more influential in stimulating participants' academic career interest. These results suggest that dental schools can look to peer tutoring and teaching programs to stimulate students' interest in academia that can help reduce faculty shortages in the long term, but only if programs are developed that place greater responsibility and trust in students and that equal the quality of faculty development programs.

The effect of regenerative periodontal therapy in preventing periodontal defects after the extraction of third molars: A systematic review and meta-analysis.

BACKGROUND: Periodontal defect on the distal aspect of mandibular second molars is a common complication after mandibular third-molar extraction. Researchers have proposed different procedures, but no evidence has shown that a single effective method can prevent or treat this complication. METHODS: The authors conducted a systematic review and meta-analysis to answer this clinical question: what is the effect of regenerative periodontal therapy on the periodontal tissue healing of the distal site of the mandibular second molar after impacted mandibular third-molar extraction compared with extraction alone without using any biomaterials during a follow-up period of at least 6 months? The authors conducted an electronic search for randomized controlled trials using MEDLINE, Embase, and other databases, and they assessed the quality of selected articles. RESULTS: Among the 1,083 eligible articles found in the initial search, 7 studies fit all of the selection criteria. All of these studies had a follow-up period lasting at least 6 months. The authors found that regenerative periodontal therapy was significantly more effective in gaining clinical attachment level or reducing probing depth at the distal site of the mandibular second molar than extraction without therapy (weighted mean difference of clinical attachment level gain, 1.94 millimeters [95% confidence interval {CI}, 1.56-2.31]; weighted mean difference of probing depth reduction, 1.67 mm [95% CI, 1.15-2.19]). CONCLUSIONS AND PRACTICAL IMPLICATIONS: The results of our systematic review and meta-analysis demonstrated that regenerative periodontal therapy effectively prevents the periodontal defect associated with impacted mandibular third-molar extraction. Clinicians should consider performing guided tissue regeneration when the defect is anticipated.

Access to Interpreter Services at U.S. Dental School Clinics.

The number of Americans with limited English proficiency (LEP) is growing, and legal protections mandate that LEP individuals have equal access to health care services. The aim of this study was to determine the availability of interpretation services in U.S. dental school clinics and the kinds of instruction dental students are given regarding treatment of LEP patients. A survey was distributed to the academic deans of all U.S. dental schools; 35 completed the survey for a response rate of 58%. Respondents were asked to report on the number of LEP patients treated in their student clinics, the resources available to students working with LEP patients, and the extent of instruction offered. Descriptive statistics were calculated. The results indicated that the proportion of LEP patients treated at U.S. dental schools was perceived to be higher than that of the general population. The availability of interpreter services and the extent of student education about LEP individuals varied widely. Among the responding schools, the most common language spoken by LEP patients was Spanish, followed by Chinese (Mandarin and Cantonese) and Russian. Most of the responding dental schools reported offering fewer than two hours of instruction to their predoctoral students on treating LEP patients. Although almost 90% of the respondents indicated believing LEP patients received care equal in quality to that of non-LEP patients in their clinics, only 61.9% indicated that their students were adequately prepared to manage LEP patients following graduation. These findings suggest that dental schools should consider curricular innovations that will prepare students to work with LEP populations and improve the ability of LEP patients to receive care in the teaching clinic setting.

Pseudomonas aeruginosa biofilm-associated homoserine lactone C12 rapidly activates apoptosis in airway epithelia.

Pseudomonas aeruginosa (PA) forms biofilms in lungs of cystic fibrosis (CF) patients, a process regulated by quorum-sensing molecules including N-(3-oxododecanoyl)-l-homoserine lactone (C12). C12 (10-100 µM) rapidly triggered events commonly associated with the intrinsic apoptotic pathway in JME (CF ΔF508CFTR, nasal surface) epithelial cells: depolarization of mitochondrial (mito) membrane potential (Δψ(mito)) and release of cytochrome C (cytoC) from mitos into cytosol and activation of caspases 3/7, 8 and 9. C12 also had novel effects on the endoplasmic reticulum (release of both Ca(2+) and ER-targeted GFP and oxidized contents into the cytosol). Effects began within 5 min and were complete in 1-2 h. C12 caused similar activation of caspases and release of cytoC from mitos in Calu-3 (wtCFTR, bronchial gland) cells, showing that C12-triggered responses occurred similarly in different airway epithelial types. C12 had nearly identical effects on three key aspects of the apoptosis response (caspase 3/7, depolarization of Δψ(mito) and reduction of redox potential in the ER) in JME and CFTR-corrected JME cells (adenoviral expression), showing that CFTR was likely not an important regulator of C12-triggered apoptosis in airway epithelia. Exposure of airway cultures to biofilms from PAO1wt caused depolarization of Δψ(mito) and increases in Ca(cyto) like 10-50 µM C12. In contrast, biofilms from PAO1ΔlasI (C12 deficient) had no effect, suggesting that C12 from P. aeruginosa biofilms may contribute to accumulation of apoptotic cells that cannot be cleared from CF lungs. A model to explain the effects of C12 is proposed.