Faculty Bibliography

Localized treatment of oligometastatic liver disease can improve both local control and survival. The liver is a frequent site of metastases from colorectal, breast, and lung cancers, but most patients are not eligible for surgical resection due to lesion number, location, or comorbidities. For these patients, non-surgical ablative methods such as radiofrequency ablation (RFA) and stereotactic body radiotherapy (SBRT) and increasingly microwave ablation (MWA) are used. RFA was used as the primary comparator in this review because it represents the most historically established and widely reported ablative modality in the comparative radiotherapy literature. While RFA has been the traditional approach, SBRT is emerging as a promising alternative, offering precise, non-invasive treatment. SBRT may be especially useful for larger lesions or tumors in locations where RFA is difficult to perform. However, high-quality evidence and large-scale trials are still needed to confirm its efficacy and define its role. This review compares the strengths and limitations of both methods and provides practical guidance for clinical decision-making in the treatment of patients with inoperable liver metastases.

PURPOSE/OBJECTIVE:Evidence-based dentistry has progressed from case reports and series to best evidence consensus statements; to non-randomized and randomized controlled studies; to systematic reviews (SRs), which analyze individual studies; and to umbrella reviews (URs), which now evaluate SRs. The purpose of this article is to review and summarize the findings of recent dental URs selected by the authors because they analyzed the quality of SRs, identified their strengths and weaknesses, and represented multiple disciplines of dentistry and diverse journals. MATERIALS AND METHODS/METHODS:A PubMed search was completed using the keywords "umbrella review, dentistry" and the filters "meta-analysis" and "systematic review" along with the years 2022-2024. There were 93 URs listed, with 56 being dental-related. The 56 URs were reviewed, and 15 were collectively selected by the authors to be summarized as examples of multiple dental disciplines and dental-related treatments published in a diverse group of dental journals. RESULTS:The 15 selected URs exhibited similar formats with findings based on the included SRs. The results of the 15 URs are summarized and presented along with the strengths and weaknesses noted in the SRs. CONCLUSIONS:The URs included in this article assessed the quality of SRs based on AMSTAR 2 (AMSTAR 2 is a critical appraisal tool used to assess the methodological quality of systematic reviews, particularly those focusing on healthcare interventions), ROBIS (ROBIS is the first rigorously developed tool designed specifically to assess the risk of bias in systematic reviews), and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Deficiencies were reported relative to the following items: failure to register the protocol before starting the review; incomplete literature search; absence of a list of excluded studies and lack of justification for the exclusions; inadequate review methods; lack of reporting the sources of funding; failing to assess risk of bias (ROB) or an unsatisfactory technique to assess ROB; not listing potential sources of conflict of interest; and lack of homogeneity in the study design, which prevented performing a meta-analysis. These findings indicate the need for careful study of SR and UR guidelines related to design and review, assessment of bias risk, and review reporting before applying the conclusion to clinical practice. Clinicians need to be aware of the deficiencies present in SRs and URs. Also, it is important to recognize that reviews are based on only those studies that met the inclusion criteria of the authors, and the exclusion of studies is fraught with potential bias.

BACKGROUND:Early detection of oral potentially malignant disorders (OPMDs) and oral cavity cancer can improve patient prognosis. In this guideline, the authors address the use of vital staining, specifically toluidine blue, as an adjunct to screen adults without mucosal abnormalities and to determine the need for biopsy among adults with mucosal abnormalities in the oral cavity. TYPES OF STUDIES REVIEWED/METHODS:The authors conducted systematic searches to identify evidence on the benefits and harms of using vital staining as an adjunct as well as patient and clinician values and preferences regarding the use of this adjunct. The guideline panel used the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework to formulate recommendations. As part of the framework, the panel also considered the resources required, equity, acceptability, and feasibility when formulating recommendations. RESULTS:The panel formulated 2 recommendations and 2 good practice statements. For adults with and without mucosal abnormalities, the panel recommend against the use of vital staining as an adjunct (conditional recommendation, very low certainty). The good practice statements encourage clinicians to perform a clinical oral examination in all adult patients. CONCLUSIONS AND PRACTICAL IMPLICATIONS/CONCLUSIONS:Biopsy remains the first choice for obtaining a definitive diagnosis of an OPMD and oral squamous cell carcinoma. Clinical oral examination should be performed in all asymptomatic adults with no clinically evident mucosal abnormality. When implementing or adapting these recommendations, local contexts should be taken into account to ensure equitable access to early detection.

BACKGROUND:Taxes on sugar-sweetened beverages can improve public health. We aimed to characterise the extent and types of sugar-sweetened beverage taxes implemented worldwide and the national characteristics predicting implementation, such as sugar-sweetened beverage intake amounts, disease rates, or economic development. METHODS:This longitudinal analysis aggregated serial global datasets (including the Global Dietary Database, Non-Communicable Diseases Risk Factor Collaboration, Global Burden of Disease study, and World Bank data) from 1990 to 2024 in 183 countries to assess sugar-sweetened beverage tax characteristics and national predictors of policy adoption. Sugar-sweetened beverage taxes for public health purposes were identified and characterised, including amounts, fiscal instruments, structures, and covered beverages. Sugar-sweetened beverage consumption, obesity and diabetes prevalence, gross domestic product (GDP), and sociodemographic index (SDI) were assessed as predictors of tax implementation using Cox proportional hazards models with time-varying covariates. FINDINGS/RESULTS:From 1990 to 2024, 64 countries implemented sugar-sweetened beverage taxes, accelerating over time and covering 3·5 billion people globally. South Asia led in adoption (50% of countries; median tax rate 7·5%), followed by southeast and east Asia (47·8%; 5·0%), the Middle East and North Africa (30·0%; 17·0%), and Latin America and the Caribbean (31·3%; 7·0%). Taxes were ad valorem (ie, based on price; 45%), volume-based (44%), sugar-content-based (5%), or mixed (6%), and 13% of countries earmarked revenue for public health. Multivariable-adjusted predictors of tax implementation included diabetes prevalence (hazard ratio [HR]=1·22 [95% CI 1·05-1·43]), obesity prevalence (1·14 [1·00-1·29]), GDP per capita (HR per $10 000: 1·19 [1·06-1·34]), and SDI (0·70 [0·57-0·86]), but not sugar-sweetened beverage intake (0·77 [0·42-1·39]). INTERPRETATION/CONCLUSIONS:Global adoption of sugar-sweetened beverage taxes has rapidly accelerated since 1990; however, there is important heterogeneity by region and tax structure, and the taxes are shaped by a country's economic capacity, social development, and health conditions. FUNDING/BACKGROUND:This work was supported by the National Institutes of Health (R01HL115189).

OBJECTIVES/OBJECTIVE:This study aimed to develop and validate the Knowledge Related to Oral Health Literacy Spanish (KROHL- S) instrument to assess oral health knowledge among Spanish-speaking adults in the United States, a population facing significant oral health disparities. DESIGN/METHODS:A cross-sectional study was conducted at NYU College of Dentistry. A convenience sample of 175 self-identified Spanish-speaking adults (70% female, mean age 49. 79 years) completed the orally administered KROHL- S questionnaire. Participants, mainly born outside the US (91. 9%), also completed the Comprehensive Measure of Oral Health Knowledge (CMOHK) and a single-item literacy screening tool in Spanish (SILS). Psychometric properties of the KROHL- S, including internal consistency (Cronbach's alpha), discriminant validity (correlation with CMOHK), and known-group validity (comparison across education levels), were evaluated. Confirmatory factor analysis was used to test the original factor structure. RESULTS:The mean KROHL- S score was 8.34 (SD = 5.82), indicating a low level of oral health knowledge in the sample. Internal consistency for the overall KROHL- S was good (Cronbach's alpha = 0.75), and interrater agreement was high. A moderate positive correlation was found between KROHL- S and CMOHK scores (r = 0.49, p < .0001). Participants with higher education levels showed significantly greater oral health knowledge on the KROHL- S. Confirmatory factor analysis suggested an average fit to the data (RMSEA = 0.064, CFI = 0.86, TLI = 0.83). CONCLUSION/CONCLUSIONS:The KROHL- S could be used to assess oral health knowledge among Spanish-speaking adults and incorporates cultural and linguistic aspects, making it suitable for a wider range of individuals. KROHL-S offers a valuable tool for healthcare providers by not only helping identify individuals' knowledge gaps to guide customized educational interventions but also helping enhance patient-provider communications.

Panic provocation tests have been widely used to investigate the biological underpinnings of panic disorder (PD). However, their diagnostic specificity remains uncertain, as several agents can also induce panic-like reactions in healthy individuals. This meta-analysis estimated and compared diagnostic odds ratios (DORs) across different provocation methods. Random-effects meta-analyses were conducted using the Hartung-Knapp adjustment. Based on 123 studies including 5693 participants, sodium lactate infusion showed the highest pooled DOR (24.77, 95% CI 19.03-32.25, GRADE certainty = High), followed by isoproterenol (18.85, 95% CI 12.39-28.66, GRADE certainty = Moderate), cholecystokinin tetrapeptide (CCK-4; 15.03, 95% CI 7.83-28.84, GRADE certainty = Moderate), meta-chlorophenyl piperazine (m-CPP; 14.51, 95% CI 4.67-45.07, GRADE certainty = Low), caffeine (14.11, 95% CI 4.79-41.54, GRADE certainty = Moderate), hyperventilation (11.89, 95% CI 6.51-21.73, GRADE certainty = High), carbon dioxide inhalation (CO₂; 11.12, 95% CI 8.63-14.32, GRADE certainty = High), and yohimbine (7.87, 95% CI 1.12-55.13, GRADE certainty = Very low). Breath holding, fenfluramine and flumazenil did not demonstrate statistically significant discriminative ability. Meta-regression analysis confirmed that sodium lactate yielded significantly higher DORs than m-CPP, hyperventilation, CO₂, fenfluramine, flumazenil, and yohimbine. No substantial between-study heterogeneity or publication bias was identified across the pooled analyses. These findings suggest that provocation methods targeting acid-base balance, especially sodium lactate infusion, are associated with superior diagnostic discrimination between individuals with PD and healthy controls.

Although mandibular implant-supported overdentures demonstrate high survival rates, uncertainty remains regarding their long-term biologic stability and maintenance burden, particularly across different attachment systems. Sixty edentulous patients were fitted with two-implant mandibular overdentures either by locator-type or ball retainers and followed up to a 5 years. At last follow-up, the survival rate of implants was 98.3% and 93.3% in terms of prostheses success; mean change of marginal bone was low. Maintenance requirements were frequent and mostly minor including insert/ matrix replacement and relines. Hence, long-term success is to be measured not just by survival.

BACKGROUND:Identifying oral potentially malignant disorders and oral cavity cancer early can lead to better patient outcomes. The guideline panel evaluated the usefulness of light-based adjuncts for screening adults without mucosal abnormalities and for determining the need for biopsy among adults with mucosal abnormalities in the oral cavity or on the lip. TYPES OF STUDIES REVIEWED/METHODS:The authors conducted a living systematic review to evaluate evidence on the benefits and harms of light-based adjuncts and a scoping review to assess people and clinician values and preferences regarding the use of light-based adjuncts and biopsy of mucosal abnormalities. The guideline panel used this evidence to formulate recommendations according to the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework. The framework also guided the panel's consideration of required resources, equity, acceptability, and feasibility in shaping the final recommendations. RESULTS:The guideline panel formulated 2 recommendations and 2 good practice statements. For adults with and without mucosal abnormalities, they formulated conditional recommendations against the use of light-based adjuncts on the basis of very low certainty evidence. The good practice statements urge clinicians to perform a clinical oral examination in all adult patients. CONCLUSIONS AND PRACTICAL IMPLICATIONS/CONCLUSIONS:Biopsy remains the reference standard for establishing a definitive diagnosis of an oral potentially malignant disorder and oral squamous cell carcinoma. All adults should undergo a clinical oral examination in primary care settings. When implementing or adapting these recommendations, local contexts should be considered to promote equitable access to early detection.

As the population ages, the incidence and prevalence of musculoskeletal degeneration, such as osteoarthritis, increase. While the currently accepted treatment options provide symptomatic and functional improvement, they do not halt the progression of osteoarthritis. This results in the eventual need for surgery for many patients with advanced osteoarthritis. Due to the seemingly inevitable progression of OA, many clinicians and researchers have shifted their focus to regenerative therapies. Orthobiologics, a specific type of regenerative therapy designed to treat orthopedic conditions, has been gaining traction in recent years due to the utilization of autologous biological substances and synthetic peptides in healing musculoskeletal injuries and degenerative conditions. Orthobiologics can be distinguished into one of four classes: cell-based, biologic fluids-based, matrix-based, molecular-based, and based on their composition. In this review, key examples of each class, mechanism of action, and current clinical data for each agent are examined. Limitations of current orthobiologics involve a lack of standardization in the preparation and administration of each agent, as well as uniformity in assessment endpoints across different clinical studies. Lastly, we will discuss future directions of orthobiologics as a therapy for the treatment of osteoarthritis.