Faculty Bibliography

Prenatal exposure to phthalates might influence the development of childhood obesity. Most previous studies used body mass index (BMI) at a specific age instead of BMI development, which might be a better indicator of later health. We aimed to assess the association of prenatal phthalate exposure with longitudinal BMI development from infancy to adolescence. Among 1,379 mother-child pairs from a population-based cohort study, phthalate concentrations were measured in maternal spot urine samples, collected during first, second and third trimester. We estimated age- and sex-adjusted BMI standard deviation scores (SDS) at 6 months and 1, 2, 3, 4, 6, 10 and 13 years. We examined the associations of maternal phthalate urine concentrations during pregnancy with repeated measures of BMI using linear mixed effects models. An interquartile range higher natural log-transformed maternal first trimester high-molecular weight phthalate and di-2-ethylhexylphthalate (DEHP) urine concentrations were associated with a -0.10 (95% confidence interval (CI) -0.15 to -0.04), and -0.09 (95% CI -0.15 to -0.04) lower age- and sex-adjusted BMI at 6 months. An interquartile range higher natural log-transformed maternal first trimester phthalic acid and low-molecular weight phthalate urine concentrations were associated with a 0.11 (95% CI 0.03 to 0.18) and 0.13 (95% CI 0.04 to 0.21) higher age- and sex-adjusted BMI at 13 years old. No significant associations were observed for maternal second and third trimester phthalate urine concentrations with BMI. Thus, higher maternal phthalate metabolites urine concentrations appear to be related to lower BMI at early ages but with higher BMI at later ages.

Bitemark recognition reliability in forensics has been criticized for lacking objectivity and empirical support. Despite doubts about classifying these injuries as bitemarks, pattern injuries must still be legally documented and analyzed. Forensic odontology can benefit from aesthetic dentistry by adopting metric analysis methods to define human dentition and objectively assess whether a pattern resembles a dental arch. In addition, past research on the challenges of individualizing bitemarks has inadvertently also defined these class characteristics. Although objectively quantifying these metrics is critical, prospective research must prove their uniqueness to the human species as well as their dependable transference to substrates such as skin. To explore and qualitatively define the mathematical characteristics of variations in the maxillary dental arch, an under-researched aspect of forensic odontology, two scanners collected digital maxilla scans from 100 participants (50% male, 50% female). The arch shape's intercuspal distance and parabolic curvature (y = ax² + bx + c) were defined, recorded, and analyzed. The mean intercuspal distance of maxillary canines was 33.8 mm (SD: 2.25 mm, 29.0-39.6 mm). The mean fitted curve created by Linear Mixed Model (LMM) for Quadratic Regression Analysis was a mean of y-mean_Total = 0.040x² - 0.0008x - 1.581, an upper limit of y-higher_Total = 0.047x² - 0.00039x + 2.593, and a lower limit of y-lower_Total = 0.032x² - 0.0012x - 5.754. In addition, sexual dimorphism using quadratic analysis was not established. Quadratic regression analysis establishes an objective framework for characterizing the maxillary dental arch. Results indicate that the arches of human dentitions share class characteristics within a narrow range, and can also offer a framework for the assessment of dentitions across species.

OBJECTIVE:To evaluate trends in telemedicine utilization overall and across clinical specialties, providing insights into its evolving role in health care delivery. STUDY DESIGN/METHODS:This retrospective cross-sectional study analyzed 1.9 million telemedicine video visits from a large academic health care system in New York City between 2020 and 2023. The data, collected from the health care system's electronic health records, included telemedicine encounters across more than 500 ambulatory locations. METHODS:We used descriptive statistics to outline telemedicine usage trends and compared telemedicine utilization rates and evaluation and management characteristics across clinical specialties. RESULTS:Telemedicine utilization peaked during the COVID-19 pandemic, then declined and stabilized. Despite an overall decline, 2 non-primary care specialties (behavioral health and psychiatry) experienced continued growth in telemedicine visits. Primary care and urgent care visits were mainly characterized by low-complexity visits, whereas non-primary care specialties witnessed a rise in moderate- and high-complexity visits, with the number of moderate-level visits surpassing those of low complexity. CONCLUSIONS:The findings highlight a dynamic shift in telemedicine utilization, with non-primary care settings witnessing an increase in the complexity of cases. To address future demands from increasingly complex medical cases managed through telemedicine in non-primary care, appropriate resource allocation is essential.

OBJECTIVE:To evaluate the safety and effectiveness of alveolar bone reconstruction simultaneous to implant removal due to peri-implantitis. MATERIAL AND METHODS/METHODS:Partial or fully dentulous patients subjected to implant removal due to advanced peri-implantitis (≥ 50% of bone loss) lesions and seeking to have the failed implant replaced for esthetic or functional reasons were consecutively included. Guided bone regeneration was performed by means of a mixture of xenograft and autogenous bone and a ribose cross-linked barrier membrane. Re-entry for implant placement was performed at 4-month follow-up. Overall, six radiographic variables were assessed before (T0) and after (T1) alveolar bone reconstruction at four levels in ridge width (RW) and height (RH). Peri-implant conditions were evaluated at latest follow-up. Simple and multiple binary logistic regression models were calculated using generalized estimation equations to evaluate the effect of baseline upon reconstructive outcomes. RESULTS: = 39) met the inclusion criteria. Alveolar RW and RH were augmented from T0 to T1 at all levels. All implants achieved primary stability. Only ~13% were subjected to ancillary bone regeneration simultaneous to implant placement. After a mean follow-up period after loading of ~2.2 years, ~70% implants demonstrated peri-implant health, while mucositis was diagnosed in the remaining implants. CONCLUSION/CONCLUSIONS:The performance of alveolar bone reconstruction in residual partially contained defects simultaneous to implant removal due to peri-implantitis lesions demonstrates being safe and effective for implant site development.

PURPOSE/OBJECTIVE:The purpose of this review of occlusion for fixed partial dentures (FPD) placed on natural teeth was to determine the level of scientific evidence available regarding the occlusal scheme during eccentric mandibular movements and the scheme for occlusal contact in the maximal intercuspal position (MIP). MATERIALS AND METHODS/METHODS:A PubMed search of "natural teeth, dental occlusion, fixed partial dentures, bridges" using the filters: Case Reports, Clinical Trial, Randomized Controlled Trial, Systematic Review resulted in 7 citations, none of which were relevant. Two were on complete dentures, 2 on implants, and 1 on removable partial dentures. As a result of the literature search and review, it was determined there is a lack of compelling evidence to support a specific eccentric occlusal relationship, tooth form, or how opposing teeth interdigitate, necessitating a look back at First Principles. RESULTS:Three natural dentition eccentric occlusal relationships have been described in the dental literature: canine protected articulation (CPA), group function (GF), and balanced occlusion. There are no clinical trials focused on the differences between occlusal schemes for occlusal rehabilitation of natural teeth using FPDs. Most clinical studies of natural dentitions determined that GF occurs more commonly than CPA but there is a lack of data supporting the superiority of either of these two eccentric occlusal relationships. There were no clinical studies on occlusal contact schemes with FPDs. Two basic intercuspal schemes have been advocated, cusp-to-fossa and cusp-to-marginal ridge. There is no evidence for how many occlusal contacts are necessary for a stable occlusion with some authors having recommended buccalized or lingualized occlusion. CONCLUSIONS:With FPD occlusion involving natural teeth, there is no clinical evidence supporting the superiority of one eccentric occlusal relationship over another. During protrusive movements, guidance by only the incisors without posterior tooth contact is the most common type of relationship and it is more common in Angle's Class Type I occlusions than in Angle Class II and III occlusions. Posterior tooth contact can occur during protrusion, and it is most common in Angle Class III occlusions and least common in Angle Class II occlusions. The canines can make occlusal contact during protrusive movements. Clinicians have used both GF and CPA in the restoration of teeth with FPDs. When restoring one arch the prostheses should harmonize with the patient's existing occlusal scheme if no other pathology exists. Nonworking side (mediotrusive) contacts should not be present on posterior teeth during lateral mandibular movements. In MIP, occlusal forces should be directed along the long axis of teeth. Some clinicians prefer that occlusal forces not be present on inclined surfaces in MIP and have cuspal contact on opposing flat fossae whereas others use multiple contacts on inclined surfaces around cusps, a process known as tripodizing. There is no clinical evidence that tripodizing or cuspal contact on flat surfaces enhances positional stability of the teeth or improves masticatory function. There is a need for extensive research of excursive and MIP schemes involving fixed partial dentures attached to natural dentition.

Individuals with heritable thoracic aortic disease (HTAD) face a high risk of deadly aortic dissections, but genetic testing identifies causative variants in only a minority of cases. We explored the contribution of non-canonical splice variants (NCVAS) to thoracic aortic disease (TAD) using SpliceAI and sequencing data from diverse cohorts, including 551 early-onset sporadic dissection cases and 437 HTAD probands with exome sequencing, 57 HTAD pedigrees with whole genome sequencing, and select sporadic cases with clinical panel testing. NCVAS were identified in syndromic HTAD genes such as FBN1, SMAD3, and COL3A1, including intronic variants in FBN1 in two Marfan syndrome (MFS) families. Validation in the Penn Medicine BioBank and UK Biobank showed enrichment of NCVAS in HTAD-associated genes among dissections. These findings suggest NCVAS are an underrecognized contributor to TAD, particularly in sporadic dissection and unsolved MFS cases, highlighting the potential of advanced splice prediction tools in genetic diagnostics.

Cancer is a systemic disease with complications beyond the primary tumor site. Among them, thrombosis is the second leading cause of death in patients with certain cancers (e.g., pancreatic ductal adenocarcinoma [PDAC]) and advanced-stage disease. Here, we demonstrate that pro-thrombotic small extracellular vesicles (sEVs) are secreted by C-X-C motif chemokine 13 (CXCL13)-reprogrammed interstitial macrophages in the non-metastatic lung microenvironment of multiple cancers, a niche that we define as the pro-thrombotic niche (PTN). These sEVs package clustered integrin β₂ that dimerizes with integrin α_X and interacts with platelet-bound glycoprotein (GP)Ib to induce platelet aggregation. Blocking integrin β₂ decreases both sEV-induced thrombosis and lung metastasis. Importantly, sEV-β₂ levels are elevated in the plasma of PDAC patients prior to thrombotic events compared with patients with no history of thrombosis. We show that lung PTN establishment is a systemic consequence of cancer progression and identify sEV-β₂ as a prognostic biomarker of thrombosis risk as well as a target to prevent thrombosis and metastasis.

High-dimensional multiplexed imaging can reveal the spatial organization of tumour tissues at the molecular level. However, owing to the scale and information complexity of the imaging data, it is challenging to discover and thoroughly characterize the heterogeneity of tumour microenvironments. Here we show that self-supervised representation learning on data from imaging mass cytometry can be leveraged to distinguish morphological differences in tumour microenvironments and to precisely characterize distinct microenvironment signatures. We used self-supervised masked image modelling to train a vision transformer that directly takes high-dimensional multiplexed mass-cytometry images. In contrast with traditional spatial analyses relying on cellular segmentation, the vision transformer is segmentation-free, uses pixel-level information, and retains information on the local morphology and biomarker distribution. By applying the vision transformer to a lung-tumour dataset, we identified and validated a monocytic signature that is associated with poor prognosis.