Faculty Bibliography

OBJECTIVE:At the New York University College of Dentistry, we are faced with the challenge of teaching Head and Neck Anatomy to a class of approximately 380 first-year students. We have developed an innovative anatomy curriculum that has proven effective in facilitating students' learning and long-term retention of the material. It has the added benefit of being time- and cost-efficient. Here, we share the structure of our curriculum and examine the student outcomes and student feedback. MATERIALS AND METHODS/METHODS:In this paper, we describe the evidence-based methods used in our course and present measures of student success. We also surveyed students about aspects of the anatomy curriculum. RESULTS:Our curriculum efficiently manages cost, instructional time, and classroom space, while promoting student success. Over the last 9 years, NYU Dentistry students have achieved a mean first-time pass rate of 98.6% and an average anatomy score of 1.74 standard deviations above the national mean on the National Board Dental Examination Part I. Students agree with instructor assessments of which features of the curriculum are valuable and state that the course helps them prepare for clinical courses. CONCLUSION/CONCLUSIONS:We believe that the main factors in the success of our course are the small group setting, the benefits of spaced repetition and frequent quizzes, and the use of plastinated specimens in place of wet cadavers.

Parathyroid hormone (PTH) was the first osteoanabolic hormone for treating osteoporosis. We have previously shown that PTH acts through PTHR1 and protein kinase A (PKA) activation to regulate osteoblastic gene expression. Our study aimed to elucidate the effects of increased PKA activity and better understand the actions of PTH (1-34) in bone. Tamoxifen (1mg/10g) was injected weekly to 1 or 5 month-old C57Bl/6J male col1CRE^ERT/Prkar1a^fl/fl mice or Prkar1a^fl/fl mice as controls for 3-4 weeks to delete the PKA regulatory subunit 1A in osteoblasts and increase PKA activity. At both ages, col1CRE^ERT/Prkar1a^fl/fl mice demonstrated bone pathologies in their skulls, femurs and vertebrae and tumors in their tails (Figure 1). MicroCT showed cortical bone breakdown with apparent trabecular bone in the cortical area in femurs and vertebrae and expansion of bone in skulls. Deletion of Prkar1a increased bone turnover with a huge increase in osteoblast activity shown by serum-P1NP levels (6.5-13 fold), only single fluorescent labeling and a substantial increase in osteoclast activity shown by CTX levels (4.4-12 fold) and TRAP staining. Surprisingly, the col1CRE^ERT/Prkar1a^fl/fl skulls showed thicker calvariae, shown by alizarin red staining and muCT but no changes in mandibles or teeth. Col1CRE^ERT/Prkar1a^fl/fl mice had tumors in their tails evident by an invasion of stromal and osteoclastic cells but with intact growth plate, cartilage and intervertebral discs. In conclusion, high PKA activity in osteoblasts appears to be involved with high bone turnover and pathological events mimicking hyperparathyroidism, Jansen's metaphyseal chondrodysplasia or McCune-Albright syndrome. [Formula presented]
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Abaloparatide, a novel analog of parathyroid hormone-related protein (PTHrP 1-34) became, in 2017, the second osteoanabolic therapy for the treatment of osteoporosis. This study aims to compare the effects of PTH (1-34), PTHrP (1-36), and abaloparatide on bone remodeling in male mice. Intermittent daily subcutaneous injections of 80 μg/kg/day were administered to four-month-old C57Bl/6J male mice for six weeks. During treatment, mice were followed by DEXA-Piximus to assess changes in bone mineral density (BMD) in the whole body, femur and tibia. At either four or eighteen hours after the final injection, femurs were harvested for μCT analyses and histomorphometry, sera were assayed for bone turnover marker levels, and tibiae were separated into cortical, trabecular, and bone marrow fractions for gene expression analyses. Our results showed that, compared with PTH (1-34), abaloparatide resulted in a similar increase in BMD at all sites, while no changes were seen with PTHrP (1-36). With both PTH (1-34) and abaloparatide, μCT and histomorphometry analyses revealed similar increases in bone volume associated with an increased trabecular thickness, in bone formation rate as shown by P1NP serum level and in vivo double labeling, and in bone resorption as shown by CTX levels and osteoclast number. Gene expression analyses of trabecular and cortical bone showed that PTH (1-34) and abaloparatide led to different actions in osteoblast differentiation and activity, with increased Runx2, Col1A1, Alpl, Bsp, Ocn, Sost, Rankl/Opg and c-fos at different time points. Abaloparatide seems to generate a faster response on osteoblastic gene expression than PTH (1-34). Taken together, abaloparatide at the same dose is as effective as PTH (1-34) as an osteoanabolic, with an increase in bone formation but also an increase in bone resorption in male mice. This article is protected by copyright. All rights reserved.

Parathyroid hormone (PTH) plays a central role in regulation of calcium metabolism and is an osteoanabolic treatment for osteoporosis. We hypothesized that similar to PTH (1-34) treatment, an increase in PKA activity in osteoblasts will cause an increase in bone accrual. Our study aims to elucidate the effects of increased PKA activity in bone. Weekly injections of tamoxifen were administered to 1 month-old or 5 month-old C57Bl/6 male and female col1CRE^ERT/Prkar1a^fl/fl mice, or Prkar1a^fl/fl mice as controls, for 3-4 weeks to delete the PKA regulatory subunit 1A and increase PKA activity. This resulted in a decrease of whole body (-6%), femoral (-24%), and tibial BMD (-22%) in 2 month-old col1CRE^ERT/Prkar1a^fl/fl mice. lCT showed dramatic excess trabecular area and disappearance of cortical bone in vertebrae and femurs. Surprisingly, 6 month-old mice developed tumors in their tails. By lCT, at both ages, col1CRE^ERT/Prkar1a^fl/fl mice showed decreases in cortical thickness and cortical BMD and increases in cortical porosity. Only 2 month-old col1CRE^ERT/Prkar1a^fl/fl mice showed drastically decreased BV/TV (-64%), Tb.N (-49%) and trabecular BMD(-30%). At both ages, deletion of Prkar1a dramatically increased bone turnover with a huge increase in osteoblast activity shown by serum-P1NP levels (6.5-to 13-fold) only single fluorescent labeling and a substantial increase in osteoclast activity shown by CTX levels (4.4-to 12-fold) and TRAP staining. In both age groups, cortical and trabecular bone showedasubstantial increaseinbone sialoprotein mRNA levels (3-to 6-fold) with a shutdown in osteocalcin mRNA (0.2-to 0.4-fold). Furthermore, PTH-regulated genes were also significantly changed: SOST expression (0.1-to 0.2-fold), RANKL (2-to 3-fold) and MMP13 ([3fold). The overall data showagreatincreaseintrabecular bone mass with breakdown of cortical bone. In conclusion, high PKA activity in osteoblasts appears to be involved in increasing immature trabecular bone and resorbing cortical bone and mimics hyperparathyroidism

At the New York University College of Dentistry (NYU Dentistry), we are faced with the challenge of teaching Head and Neck Anatomy to a class of approximately 380 first-year students. We have developed an innovative anatomy curriculum that has proven effective in facilitating students' learning and long-term retention of the material and has the added benefit of being time- and cost-efficient. We believe that the main factors in the success of our course are the frequent low-stakes quizzes, the small group setting, and the use of plastinated specimens in place of wet cadavers. Our anatomy course consists of lectures and laboratory sessions. Students attend 52 hours of lectures in a traditional auditorium setting. All of the lectures are recorded and archived using Mediasite, so that students can review them at their leisure. Students are then divided into 32 small groups consisting of 8 to 14 students. Each group attends 23 lab sessions (110 minutes per session) led by a faculty member. In the labs, students work together to identify anatomical structures on plastinated specimens or bones. The instructor facilitates collaboration amongst the students and leads them in a discussion of cross-sectional anatomy. Frequent low-stakes evaluations allow students to monitor their progress in the course. Students take an online 10-30 question quiz before each lab and a 5-10 question quiz at the end of each lab (together these pre-lab and exit quizzes make up 27.5% of the overall grade). The remainder of the grade in the course is determined by three written multiple-choice exams and one practical exam. We maintain a website with additional resources students can use, including practice questions, photographs of plastinates, animations, and videos. This year, we have also linked to study sets that we have created using Cerego. We have previously published about the success we had in terms of learning goals and student satisfaction after switching from cadaver dissection to plastinations (Baker et al., 2013). Our curriculum has demonstrated continued success over the last 5 years. Within this time period, on the NBDE Part I, NYU Dentistry students have achieved a mean first-time pass rate of 99.3% and an average anatomy score of 1.73 standard deviations above the national mean. We would like to share our methods with instructors at other institutions

At the New York University College of Dentistry, lab conference hours for the review of anatomy in preparation for the National Board Dental Examination Part I (NBDE Part I) were reduced due to an increase in incoming class size in 2015. Tasked with providing students an effective means to review material that could now not be covered in the given lab hours, we identified the online platform Cerego as a way to provide a self-guided anatomy study tool. Use of Cerego replaced what would otherwise have been 96 faculty hours of instruction. We initially created three anatomy topic modules in Cerego, each of which included a combination of images, identifications, associations, and short text passages. Creation of modules in Cerego was intuitive and straightforward. The platform, with algorithms based on principles of retrieval learning and spaced practice, guides the student through individualized iterations of review in multiple formats, and provides the student with prompts for the most effective timing for return to the material. In addition, both student and instructor have access to fine grained performance analytics. We found that Cerego is well suited to fact memorization, and effective as a means to learn material within the time-frame of a single semester. However, full mastery using the Cerego program - leading to long-term retention - is achieved over a more extended period. A survey after the termination of the NBDE Part I course in 2015, as well as informal discussions with students, has indicated high student satisfaction with Cerego as a study tool. In addition, results for the anatomy portion of the board exam demonstrates student success, with NYU Dentistry students as a whole achieving a 97.1-100% first-time pass rate, and performing at 1.4-2.6 standard deviations above the mean for all dental schools in anatomy in the years 2015-2017. Given the success of our initial Cerego use, we have now incorporated this platform into the Head and Neck Anatomy and Basic Tissues courses within the Department of Basic Science and Craniofacial Biology, and other departments at NYU Dentistry have also adopted the use of this tool

Pulsed electromagnetic fields (PEMFs) can be effective in promoting the healing of delayed union or nonunion fractures. We previously reported that PEMF (Spinal-Stim(R) by Orthofix, Inc., Lewisville, TX) stimulated proliferation, differentiation and mineralization of rat calvarial osteoblastic cells in culture. In the present work we investigated the effects of PEMF (Physio-Stim(R) by Orthofix, Inc., Lewisville, TX) on human bone marrow macrophages (hBMMs) differentiated to osteoclasts. PEMF had striking inhibitory effects on formation of osteoclasts from hBMMs from both younger and older women. There were significantly greater changes in gene expression as ascertained by RNAseq from cells from older women. Interestingly, all of the genes identified by RNAseq were upregulated, and all were genes of mesenchymal or osteoblastic cells and included members of the TGF-beta signaling pathway and many extracellular matrix proteins, as well as RANKL and osteoprotegerin, indicating the mixed nature of these cultures. From these results, we suggest that PEMF can inhibit osteoclast formation via action on osteoblasts. Thus, PEMF may be very effective for bone mass maintenance in subjects with osteoporosis.