Publications by authors named "Caroline Nguyen"

55 Publications

Functional Connectivity Correlates of Perceived Financial Exploitation in Older Adults.

Front Aging Neurosci 2020 12;12:583433. Epub 2020 Nov 12.

Department of Family Medicine, USC Keck School of Medicine, Alhambra, CA, United States.

Financial exploitation (FE) in old age is devastating and common; however, the neural correlates of FE are poorly understood. Previous studies of FE in older adults have implicated declines in decision making and social cognition as two risk factors for FE in later life. Here we examined whether functional connectivity among brain regions implicated in decision making and social cognition differed for those with an experience of FE vs. those without. Participants included 16 older adults without cognitive impairment who reported FE (Mean age = 70.5, 62.5% female, Mean education = 16.0 years) and 16 demographically and cognitively matched adults who denied a history of FE (Mean age = 65.1, 37.5% female, Mean education = 15.1 years). Measures of whole-brain resting-state functional connectivity in the hippocampus, insula, and medial frontal cortex were derived for each group. Compared to the non-FE group, FE was associated with greater functional connectivity between the right hippocampus and bilateral temporal regions, and less functional connectivity between the right hippocampus and the right cerebellum and bilateral lingual gyri. The FE group showed less connectivity between the right and left insula and cingulate cortex, and between the right insula and regions of the left lateral temporal gyrus and dorsolateral prefrontal cortex. Finally, the FE group showed greater functional connectivity between the medial frontal cortex and the right lateral temporal gyrus and orbitofrontal cortex, and less functional connectivity with the right pre- and postcentral gyri. Results suggest that perceived FE in old age is associated with whole-brain functional connectivity differences involving the hippocampus, insula, and medial frontal cortex, consistent with models implicating age-associated changes in decision making and social cognition in FE.
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http://dx.doi.org/10.3389/fnagi.2020.583433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693621PMC
November 2020

Management of an Imminent Pathological Fracture of a Fibular Neomandible Via a Minimally Invasive Approach-A Case Report.

J Prosthodont 2020 Dec 26;29(9):746-750. Epub 2020 Sep 26.

Department of Oral Oncology and Dentistry, Vancouver Center, British Columbia Cancer, Vancouver, BC, Canada.

Fibular free flap reconstruction remains the workhorse of postmandibulectomy reconstruction. Dental implantation to support a dental prosthesis is a sought-after outcome when the area of resection involves tooth-bearing zones. Chronic perisoft tissue pedicle hyperplasia with secondary infection leading to gradual bone loss is a simple complication to manage in the general population, but it becomes a serious issue in the fibula mandibular reconstruction patient in that it can lead to pathological fracture of the fibula. A case of a patient with a near fracture of his fibula mandibular reconstruction, and its management via a minimally invasive approach is presented.
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http://dx.doi.org/10.1111/jopr.13262DOI Listing
December 2020

Technical Protocol for Presenting Maxillofacial Prosthetics Concepts to Dental Students using Interactive 3D Virtual Models within a Portable Document Format.

J Prosthodont 2020 Jul 26;29(6):546-549. Epub 2020 Jun 26.

Prosthodontics Department, School of Dentistry, University of Bordeaux, Bordeaux, France.

An appropriate presentation of maxillofacial defects and their prosthetic rehabilitation concepts using traditional two-dimensional educational materials is challenging for dental students and prosthodontics residents. This technique article introduces a simple approach to visualize and communicate three-dimensional (3D) virtual models embedded into a portable document format (PDF) file for presenting maxillofacial prosthetics concepts and enhancing students' spatial ability when learning maxillofacial prosthetics. MeVisLab software was used to combine various maxillofacial models and save them as a single 3D model. Adobe Acrobat Pro DC software was used to import the 3D model and create interactive visualization PDF documents. Adobe reader software was then used to visualize the content of the PDF documents. This approach allows educators to develop PDF files with multiple 3D models for teaching maxillofacial prosthetics concepts and communicate them with their students. Students can simply open the PDF file, activate the 3D mode, and interactively manipulate the 3D models to enhance their spatial ability for learning maxillofacial prosthetics.
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http://dx.doi.org/10.1111/jopr.13210DOI Listing
July 2020

Managing Excessive Gingival Display Using a Digital Workflow.

J Prosthodont 2020 Jun 6;29(5):443-447. Epub 2020 May 6.

Faculty of Dentistry, The University of British Columbia, Vancouver, BC, Canada.

This technique article describes an approach to managing excessive gingival display by lengthening of the clinical crowns using a digital workflow. An intraoral scanner was used to obtain a template to be used for the crown lengthening surgical procedure considering the patient-desired diagnostic setups while fully seating the template on the patient's teeth during surgery. Using a digital approach for lengthening the clinical crowns decreased the likelihood of the need for postsurgical modifications, thus shortening the treatment duration. After the crown lengthening healed for 12 weeks, full-mouth reconstruction proceeded. Maxillary and mandibular preparation reduction guides were digitally designed and printed to facilitate conservative crown preparations. An intraoral scanner was used to make full-arch scans and interocclusal records for the fabrication of provisional and final crowns. Fully guided implant planning and placement were also executed.
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http://dx.doi.org/10.1111/jopr.13181DOI Listing
June 2020

Graves' hyperthyroidism in pregnancy.

Curr Opin Endocrinol Diabetes Obes 2019 10;26(5):232-240

Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine and Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

Purpose Of Review: Graves' hyperthyroidism is associated with significant obstetric, maternal, fetal, and neonatal complications. Early diagnosis and an understanding of the management of Graves' hyperthyroidism in pregnancy can help to prevent these complications. Antithyroid drugs (ATD) should be avoided in early pregnancy, given their association with congenital malformations.

Recent Findings: TSH-receptor antibodies (TRAb) are integral in the management of Graves' hyperthyroidism in pregnancy and in the preconception period. TRAb are indicative of the current activity of Graves' hyperthyroidism and the likelihood of relapse. Furthermore, TRAb predicts the risk of fetal and neonatal hyperthyroidism.The incidence of congenital malformations is roughly the same for propylthiouracil (PTU) and methimazole (MMZ). Exposure to both ATDs in early pregnancy has been associated with increased incidence of congenital malformations compared with exposure to either ATD alone.

Summary: The goal of the physician is maintaining euthyroidism throughout pregnancy and delivery of a healthy, euthyroid baby. An understanding of the natural progression of Graves' hyperthyroidism in pregnancy and the proper utilization of TRAb enables the physician to minimize the risks associated with Graves' hyperthyroidism and side effects of ATDs unique to pregnancy. The physician should prioritize preconception counseling in women with Graves' hyperthyroidism in order to avoid hyperthyroidism and having to use ATDs in pregnancy.
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http://dx.doi.org/10.1097/MED.0000000000000492DOI Listing
October 2019

Elder Abuse Characteristics Based on Calls to the National Center on Elder Abuse Resource Line.

J Appl Gerontol 2020 10 31;39(10):1078-1087. Epub 2019 Jul 31.

Keck School of Medicine of USC, Alhambra, USA.

Characterizing the types of elder abuse and identifying the characteristics of perpetrators are critically important. This study examined the types of elder abuse reported to the National Center on Elder Abuse (NCEA) resource line. Calls were coded with regard to whether abuse was reported, types of abuse alleged, whether multiple abuse subtypes occurred, and who perpetrated the alleged abuse. Of the 1,939 calls, 818 (42.2%) alleged abuse, with financial abuse being the most commonly reported (449 calls, 54.9%). A subset of calls identified multiple abuse types (188, 23.0%) and multiple abusers (149, 18.2%). Physical abuse was most likely to co-occur with another abuse type (61/93 calls, 65.6%). Family members were the most commonly identified perpetrators (309 calls, 46.8%). This study reports the characteristics of elder abuse from a unique source of frontline data, the NCEA resource line. Findings point to the importance of supportive resources for elder abuse victims and loved ones.
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http://dx.doi.org/10.1177/0733464819865685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6992470PMC
October 2020

The Fabrication of an Acrylic Repositioning Stent for Use During Intensity Modulated Radiation Therapy: A Feasibility Study.

J Prosthodont 2019 Jul 11;28(6):643-648. Epub 2019 Jun 11.

Department of Radiation Oncology, Faculty of Medicine, University of British Columbia, BC Cancer, Vancouver, BC, Canada.

Purpose: Radiotherapy is one of the main treatment modalities for head and neck cancers. To minimize damage to normal tissues during radiotherapy, various methods of stabilization have been used, including thermoplastic facemasks and repositioning stents. The goal is to assess the effect of using a customized oral repositioning stent on patient positioning during the course of radiotherapy.

Materials And Methods: Ten consecutive patients scheduled to undergo intensity modulated radiation therapy (IMRT) for cancers of the maxillary sinus, nasal cavity, or oral cavity were recruited to participate in the study (ST group). These patients were matched to 2 retrospective cohorts, one using the original repositioning stent design (OB group), and the other with no stabilization stent (NB group). Hard baseplate wax was used to create a customized wax pattern of the proposed acrylic stent chairside, and processed in heat-cured clear hard acrylic. Relative stability of the daily patient setup was assessed by comparing measurements from surrogate bony landmarks to radiation isocentres obtained from the initial reconstructed planning computed tomograph (CT) to each daily KeV image.

Results: There was no stent fracture or distortion throughout treatments, and no patients' treatments were required to be aborted, delayed, or replanned. Mean 3D deviations for the ST, OB, and NB groups were 0.29 ± 0.10 cm, 0.32 ± 0.14 cm, and 0.31 ± 0.13 cm, respectively. The ANOVA test revealed no significant difference in triangulated variations between the treatment groups (F = 0.18, p = 0.84). Patient stability data demonstrated mean vertical, longitudinal, and lateral variations that did not appear different when compared to 2 retrospective cohorts. Although the deviations were not statistically significant between matched cohorts, the added durability of the stent and comfort for patients, without affecting IMRT timeline, are considered clinically significant.

Conclusion: By using a customized repositioning stent, it is possible to maintain patient stability comparable to prior protocols and within the range of clinical guidelines, while providing superior comfort and ease of insertion to the patients.
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http://dx.doi.org/10.1111/jopr.13074DOI Listing
July 2019

Digital Workflow of Auricular Rehabilitation: A Technical Report Using an Intraoral Scanner.

J Prosthodont 2019 Jun 28;28(5):596-600. Epub 2019 Mar 28.

Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada.

Prosthodontic rehabilitation of a congenital or acquired defect of the ear is considered a challenging and skill-dependent procedure. This technical report describes a novel approach for direct digital scanning of the unaffected contralateral ear using an intraoral scanner and external markers. The obtained digital data of the ear was exported, digitally mirrored, and successfully positioned to a virtual model of a human head with a missing ear. This technique demonstrates the potential application of CAD/CAM in the design and fabrication of an auricular prosthesis for patients with a unilateral ear defect.
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http://dx.doi.org/10.1111/jopr.13057DOI Listing
June 2019

Postpartum Thyroiditis.

Clin Obstet Gynecol 2019 06;62(2):359-364

Medicine and Obstetrics and Gynecology, Division of Endocrinology, Diabetes & Metabolism, Keck School of Medicine, University of Southern California, Los Angeles, California.

Postpartum thyroiditis (PPT) is an autoimmune-mediated destructive thyroiditis that occurs in the first year postpartum with a prevalence of 5%. In order to appropriately counsel and treat the patient, physicians need to recognize the signs and symptoms of PPT and distinguish PPT from Graves hyperthyroidism. This review of PPT will discuss the etiology, clinical course, risk factors, prognosis, and treatment of PPT. Understanding PPT is important for all physicians taking care of women in the peripartum period as women who have had PPT are at an increased risk of subsequent episodes of PP and at risk of permanent hypothyroidism.
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http://dx.doi.org/10.1097/GRF.0000000000000430DOI Listing
June 2019

Physical and mental health correlates of perceived financial exploitation in older adults: Preliminary findings from the Finance, Cognition, and Health in Elders Study (FINCHES).

Aging Ment Health 2020 05 10;24(5):740-746. Epub 2019 Feb 10.

Department of Family Medicine, USC Keck School of Medicine, Alhambra, CA, USA.

Financial exploitation (FE) in old age is poorly understood, particularly among those without significant cognitive impairment. The Finance, Cognition, and Health in Elders Study (FINCHES) aims to identify factors associated with FE among cognitively-healthy older adults. Preliminary findings regarding physical and mental health correlates in the pilot phase of FINCHES are reported. Sixteen older adults who self-reported FE were demographically-matched on age, education, sex, and race/ethnicity to eighteen older adults who did not report past FE. Those who believed they were exploited endorsed significantly greater symptoms of depression ( = 0.014) and marginally greater symptoms of anxiety ( = 0.062). Participants trended towards lower perceived successful aging ( = 0.094). Perceived FE participants also endorsed greater medical conditions ( = 0.047), but follow-up individual item analyses suggest that this was driven by problems with sleep ( = 0.030). These preliminary findings from the pilot phase of FINCHES highlight negative mental health factors associated with perceived FE among cognitively-intact older adults.
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http://dx.doi.org/10.1080/13607863.2019.1571020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6933096PMC
May 2020

An unusual presentation of post gastric bypass hypoglycemia with both postprandial and fasting hypoglycemia

Endocrinol Diabetes Metab Case Rep 2018 Oct 31;2018:18-0089. Epub 2018 Oct 31.

Division of Endocrinology, Diabetes, and Metabolism, Keck School of Medicine, LAC+USC Medical Center, University of Southern California, Los Angeles, California, USA.

There has been an increasing awareness of post gastric bypass hypoglycemia (PGBH). Histopathologic findings from such patients who underwent partial/total pancreatomy, however, can vary widely from minimal changes to classic nesidioblastosis, making the pathologic diagnosis challenging. PGBH typically presents as postprandial hypoglycemia, as opposed to insulinoma, which presents as fasting hypoglycemia. Herein, we describe an unusual case of a patient with PGBH who initially presented with postprandial hypoglycemia three years after surgery, but later developed fasting hyperinsulinemic hypoglycemia as the disease progressed. Our hypothesis for this phenomenon is that this disease is progressive, and later in its course, the insulin release becomes dissociated from food stimulation and is increased at baseline. Future studies are needed to investigate the prevalence as well as etiology of this progression from postprandial to fasting hypoglycemia. Learning points: •• There has been an increasing awareness of post gastric bypass hypoglycemia (PGBH). •• Histopathologically, PGBH can vary from minimal changes to nesidioblastosis. •• Although uncommon, patients with PGBH after Roux-en-Y gastric bypass may present with both postprandial and fasting hyperinsulinemic hypoglycemia as disease progresses. •• Our hypothesis for this phenomenon is that the insulin release becomes dissociated from food stimulation and is increased at baseline with disease progression.
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http://dx.doi.org/10.1530/EDM-18-0089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215949PMC
October 2018

Neuropsychological case report of MCI reversion at one-year follow-up.

Appl Neuropsychol Adult 2020 May-Jun;27(3):284-293. Epub 2018 Oct 23.

Family Medicine, University of Southern California, Alhambra, CA, USA.

This report presents the neuropsychological profile of an older gentleman diagnosed with single-domain mild cognitive impairment (MCI) at baseline who reverted to normal cognitive functioning at 1-year follow-up. The case highlights important considerations for assessing and diagnosing MCI in clinical settings in the context of sizeable reversion rates that have been reported extensively in the literature. A 72-year-old gentleman presented to our Neuropsychology Clinic with subjective memory complaints. Per recommendation, the patient returned for follow-up testing 1-year later. A clinical interview, comprehensive battery of neuropsychological tests, and mood questionnaires were administered during both evaluations. At baseline, DSM-5 Mild Neurocognitive Disorder consistent with single-domain amnestic MCI was diagnosed based on several impaired scores on the California Verbal Learning Test, 2nd version (CVLT-II) and collateral report of subtle decline in functioning. At follow-up, all cognitive performances fell within normal limits. The patient no longer met criteria for Mild Neurocognitive Disorder. The present case study highlights important considerations when assessing and diagnosing MCI in the clinical setting. Repeat testing in clinical settings is underscored by the sizeable rate of MCI reversion reported in the literature. Important diagnostic and feedback considerations are discussed.
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http://dx.doi.org/10.1080/23279095.2018.1519510DOI Listing
December 2020

Meta-analysis of cognitive ability differences by apolipoprotein e genotype in young humans.

Neurosci Biobehav Rev 2018 11 17;94:49-58. Epub 2018 Aug 17.

Department of Family Medicine, USC Keck School of Medicine, 1000 S. Fremont Avenue, Unit 22, HSA Building A-6, 4thFloor, Room 6437A, Alhambra, CA, 91803, USA; Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, 90089, CA, USA; USC School of Gerontology, Los Angeles, CA, 90089, USA; Department of Neurology, USC Keck School of Medicine, Los Angeles, 90033, CA, USA.

The apolipoprotein (APOE) ε4 allele has been proposed as an example of an antagonistic pleiotropy gene, conferring a beneficial effect on cognition in early life and a detrimental impact on cognition during later years. However, findings on the cognitive associations of the ε4 allele in younger persons are mixed. This PRISMA conforming study aimed to investigate APOE genotype (e4/non-e4) associations across seven cognitive domains (intelligence/achievement, attention/working memory, executive functioning, memory, language, processing speed and visuospatial abilities) in younger humans using a meta-analytic approach. Of 689 records reviewed, 29 studies (34 data-points) were selected for the quantitative synthesis. Participants' ages ranged from 2-40. Results showed that young ε4 carriers did not statistically differ from non-ε4 carriers across any cognitive domains. Overall, findings do not provide compelling support for an antagonistic pleiotropic effect of the ε4 allele across the lifespan.
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http://dx.doi.org/10.1016/j.neubiorev.2018.08.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231411PMC
November 2018

An Acrylic Immobilization Bite Block for Use During Radiation Therapy: Description of a New Technique.

Int J Prosthodont 2018 Jul/Aug;31(4):338-341

Utilizing intraoral bite blocks can aid in stabilizing the mandible during radiation treatment (RT) and minimizing side effects to healthy tissues. This report describes a technique to fabricate a customized acrylic repositioning immobilization bite block that was integrated into the clinical workflow of radiation appointments with no delay in starting RT and with increased patient comfort.
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http://dx.doi.org/10.11607/ijp.5727DOI Listing
November 2018

Iodine-Induced Fetal Hypothyroidism: Diagnosis and Treatment with Intra-Amniotic Levothyroxine.

Horm Res Paediatr 2018 23;90(6):419-423. Epub 2018 May 23.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA,

Background: Iodine is necessary for fetal thyroid development. Excess maternal intake of iodine can cause fetal hypothyroidism due to the inability to escape from the Wolff-Chaikoff effect in utero.

Case Report: We report a case of fetal hypothyroid goiter secondary to inadvertent excess maternal iodine ingestion from infertility supplements. The fetus was successfully treated with intra-amniotic levothyroxine injections. Serial fetal blood sampling confirmed fetal escape from the Wolff-Chaikoff effect in the mid third trimester. Early hearing test and neurodevelopmental milestones were normal.

Conclusion: Intra-amniotic treatment of fetal hypothyroidism may decrease the rate of impaired neurodevelopment and sensorineural hearing loss.
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http://dx.doi.org/10.1159/000488776DOI Listing
August 2019

Salivary flow rate after conventional and intensity-modulated radiation therapy.

J Am Dent Assoc 2018 Jun 11;149(6):432-441. Epub 2018 Apr 11.

Background: Conventional 3-dimensional conformal radiation therapy (3DCRT) for head and neck cancer (HNC) can cause hyposalivation, leading to caries and tooth extraction-related osteoradionecrosis. Intensity-modulated radiation therapy (IMRT) delivers more focused radiation than does 3DCRT. To reduce hyposalivation, the Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) guidelines limit salivary gland radiation dose. In this study, the authors compared the salivary flow rate in patients receiving 3DCRT and those receiving IMRT and evaluated the effect of their treatment satisfying the QUANTEC guidelines on hyposalivation.

Methods: The authors evaluated findings in 96 patients with HNC who received radiation therapy (RT); 20 received unilateral 3DCRT, 17 received bilateral 3DCRT, and 59 received IMRT. The authors measured stimulated whole saliva before radiation and 3 and 12 months after radiation. The authors defined hyposalivation as stimulated whole saliva less than 3.5 grams per 5 minutes.

Results: At 12 months, 50% and 54% of patients receiving unilateral 3DCRT and IMRT, respectively, exhibited nonstatistically significant hyposalivation compared with 71% of patients receiving bilateral 3DCRT (P = .2). A lower proportion of patients receiving IMRT (27%) and unilateral 3DCRT (5%) had decreased salivary flow (< 25% of baseline) than did those receiving bilateral 3DCRT (59%; P < .004); fewer patients whose treatment satisfied the QUANTEC guidelines exhibited hyposalivation than patients whose treatment did not fullfill QUANTEC guidelines (39% versus 71%; P < .002).

Conclusions: Twelve months after RT for HNC, treatment satisfying the QUANTEC guidelines resulted in decreased hyposalivation. Unilateral 3DCRT and IMRT may result in less hyposalivation than does bilateral 3DCRT.

Practical Implications: Patients with HNC treated with modern RT techniques have a lower risk of developing hyposalivation, particularly if the QUANTEC guidelines are met, which also may result in decreased dental caries, tooth extractions, and postextraction osteoradionecrosis. Management of HNC requires a multidisciplinary team, including dentists and radiation oncologists.
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http://dx.doi.org/10.1016/j.adaj.2018.01.031DOI Listing
June 2018

Graves' hyperthyroidism in pregnancy: a clinical review.

Clin Diabetes Endocrinol 2018 1;4. Epub 2018 Mar 1.

4Division of Endocrinology, Diabetes & Metabolism, Department of Medicine and Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 1540 Alcazar Street CHP 204, Los Angeles, California 90033 USA.

Background: Graves' hyperthyroidism affects 0.2% of pregnant women. Establishing the correct diagnosis and effectively managing Graves' hyperthyroidism in pregnancy remains a challenge for physicians.

Main: The goal of this paper is to review the diagnosis and management of Graves' hyperthyroidism in pregnancy. The paper will discuss preconception counseling, etiologies of hyperthyroidism, thyroid function testing, pregnancy-related complications, maternal management, including thyroid storm, anti-thyroid drugs and the complications for mother and fetus, fetal and neonatal thyroid function, neonatal management, and maternal post-partum management.

Conclusion: Establishing the diagnosis of Graves' hyperthyroidism early, maintaining euthyroidism, and achieving a serum total T4 in the upper limit of normal throughout pregnancy is key to reducing the risk of maternal, fetal, and newborn complications. The key to a successful pregnancy begins with preconception counseling.
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http://dx.doi.org/10.1186/s40842-018-0054-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831855PMC
March 2018

Dental Students' Interpretations of Digital Panoramic Radiographs on Completely Edentate Patients.

J Dent Educ 2018 Mar;82(3):313-321

Dr. Kratz is a Prosthodontist in Victoria, BC, Canada; Dr. Nguyen is Assistant Professor, Division of Prosthodontics and Dental Geriatrics, Department of Oral Health Sciences, University of British Columbia Faculty of Dentistry and Provincial Practice Leader in Prosthodontics, Department of Dentistry and Oral Oncology, BC Cancer Agency, Vancouver, Canada; Dr. Walton is Professor Emeritus, Division of Prosthodontics and Dental Geriatrics, Department of Oral Health Sciences, University of British Columbia Faculty of Dentistry; and Dr. MacDonald is Associate Professor and Chair, Division of Oral and Maxillofacial Radiology, Department of Oral, Biological, and Medical Sciences, University of British Columbia Faculty of Dentistry.

The ability of dental students to interpret digital panoramic radiographs (PANs) of edentulous patients has not been documented. The aim of this retrospective study was to compare the ability of second-year (D2) dental students with that of third- and fourth-year (D3-D4) dental students to interpret and identify positional errors in digital PANs obtained from patients with complete edentulism. A total of 169 digital PANs from edentulous patients were assessed by D2 (n=84) and D3-D4 (n=85) dental students at one Canadian dental school. The correctness of the students' interpretations was determined by comparison to a gold standard established by assessments of the same PANs by two experts (a graduate student in prosthodontics and an oral and maxillofacial radiologist). Data collected were from September 1, 2006, when digital radiography was implemented at the university, to December 31, 2012. Nearly all (95%) of the PANs were acceptable diagnostically despite a high proportion (92%) of positional errors detected. A total of 301 positional errors were identified in the sample. The D2 students identified significantly more (p=0.002) positional errors than the D3-D4 students. There was no significant difference (p=0.059) in the distribution of radiographic interpretation errors between the two student groups when compared to the gold standard. Overall, the category of extragnathic findings had the highest number of false negatives (43) reported. In this study, dental students interpreted digital PANs of edentulous patients satisfactorily, but they were more adept at identifying radiographic findings compared to positional errors. Students should be reminded to examine the entire radiograph thoroughly to ensure extragnathic findings are not missed and to recognize and report patient positional errors.
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http://dx.doi.org/10.21815/JDE.018.033DOI Listing
March 2018

Roux-en-Y Gastric-Bypass and sleeve gastrectomy induces specific shifts of the gut microbiota without altering the metabolism of bile acids in the intestinal lumen.

Int J Obes (Lond) 2019 02 30;43(2):428-431. Epub 2018 Jan 30.

Sorbonne Universités, UPMC Univ. Paris 06, École normale supérieure, PSL Research University, CNRS, INSERM, APHP, Laboratoire des Biomolécules (LBM), 27 rue de Chaligny, Paris, 75005, France.

Some shifts in the gut microbiota composition and its metabolic fingerprints have been associated to Sleeve gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB). So far, plasma bile acids have been associated with post-operative glucose improvement and weight loss, but nothing is known about their metabolism in the gut lumen. As bile acids are physiologically transformed by the microbiota into various species, the aim of this work was to study how SG and RYGB-associated dysbiosis impact the bioconversion of bile acids in the intestinal lumen. Comparing SHAM (n = 9) with our validated rat models of SG (n = 5) and RYGB (n = 6), we quantified luminal bile acids along the gut and found that the metabolic transformation of bile acids (deconjugation, dehydroxylation, and epimerization) is not different from the duodenum to the colon. However, in the cecum where the biotransformation mainly takes place, we observed deep alterations of the microbiota composition, which were specific of each type of surgery. In conclusion, despite specific dysbiosis after surgery, the bile acids metabolism in the gut lumen is highly preserved, suggesting that a resilience of the gut microbiota occurs after these procedures.
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http://dx.doi.org/10.1038/s41366-018-0015-3DOI Listing
February 2019

Correction to: Detectable Neuropsychological Differences in Early Preclinical Alzheimer's Disease: a Meta-Analysis.

Neuropsychol Rev 2017 12;27(4):326-327

Department of Psychology, USC Dornsife College, Los Angeles, CA, USA.

Errors were discovered in the reporting of processing speed data that do not impact the interpretation of findings.
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http://dx.doi.org/10.1007/s11065-017-9366-0DOI Listing
December 2017

Improving admission medication reconciliation with pharmacists or pharmacy technicians in the emergency department: a randomised controlled trial.

BMJ Qual Saf 2018 07 6;27(7):512-520. Epub 2017 Oct 6.

General Internal Medicine and Health Services Research, UCLA, Los Angeles, California, USA.

Background: Admission medication history (AMH) errors frequently cause medication order errors and patient harm.

Objective: To quantify AMH error reduction achieved when pharmacy staff obtain AMHs before admission medication orders (AMO) are placed.

Methods: This was a three-arm randomised controlled trial of 306 inpatients. In one intervention arm, pharmacists, and in the second intervention arm, pharmacy technicians, obtained initial AMHs prior to admission. They obtained and reconciled medication information from multiple sources. All arms, including the control arm, received usual AMH care, which included variation in several common processes. The primary outcome was severity-weighted mean AMH error score. To detect AMH errors, all patients received reference standard AMHs, which were compared with intervention and control group AMHs. AMH errors and resultant AMO errors were independently identified and rated by ≥2 investigators as significant, serious or life threatening. Each error was assigned 1, 4 or 9 points, respectively, to calculate severity-weighted AMH and AMO error scores for each patient.

Results: Patient characteristics were similar across arms (mean±SD age 72±16 years, number of medications 15±7). Analysis was limited to 278 patients (91%) with reference standard AMHs. Mean±SD AMH errors per patient in the usual care, pharmacist and technician arms were 8.0±5.6, 1.4±1.9 and 1.5±2.1, respectively (p<0.0001). Mean±SD severity-weighted AMH error scores were 23.0±16.1, 4.1±6.8 and 4.1±7.0 per patient, respectively (p<0.0001). These AMH errors led to a mean±SD of 3.2±2.9, 0.6±1.1 and 0.6±1.1 AMO errors per patient, and mean severity-weighted AMO error scores of 6.9±7.2, 1.5±2.9 and 1.2±2.5 per patient, respectively (both p<0.0001).

Conclusions: Pharmacists and technicians reduced AMH errors and resultant AMO errors by over 80%. Future research should examine other sites and patient-centred outcomes.

Trial Registration Number: NCT02026453.
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http://dx.doi.org/10.1136/bmjqs-2017-006761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5912995PMC
July 2018

Short dental implants: A scoping review of the literature for patients with head and neck cancer.

J Prosthet Dent 2018 May 18;119(5):736-742. Epub 2017 Sep 18.

Assistant Professor, Department of Oral Health Sciences, University of British Columbia; and Provincial Practice Leader in Prosthodontics, Department of Oral Oncology and Dentistry, British Columbia Cancer Agency, Vancouver, British Columbia, Canada. Electronic address:

Statement Of Problem: Dental implants can be essential in the rehabilitation of various cancer defects, but their ideal placement can be complicated by the limited dimensions of the available host bone. Surgical interventions developed to increase the amount of bone are not all predictable or successful and can sometimes be contraindicated. Short dental implants have been suggested as an alternative option in sites where longer implants are not possible. Whether they provide a successful treatment option is unclear.

Purpose: The purpose of this study was to review the literature on short dental implants and assess whether they are a viable definitive treatment option for rehabilitating cancer patients with deficient bone.

Material And Methods: A scoping review of the literature was performed, including a search of established periodontal textbooks for articles on short dental implants combined with a search of PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. A search for all literature published before June 2016 was based on the following keywords: ['dental implants' OR 'dental implantation, endosseous' OR 'dental prosthesis, implant supported'] AND [short].

Results: The minimum acceptable implant length has been considered to be 6 mm. The survival rates of short implants varied between 74% and 96% at 5 years, depending on factors such as the quality of the patient's bone, primary stability of the implant, clinician's learning curve, and implant surface. Short implants can achieve results similar to those of longer implants in augmented bone and offer a treatment alternative that could reduce the need for invasive surgery and associated morbidity and be safer and more economical.

Conclusions: Short dental implants (6 mm to 8 mm) can be used successfully to support single or multiple fixed reconstructions or overdentures in atrophic maxillae and mandibles. The use of short dental implants lessens the need for advanced and complicated surgical bone augmentation procedures, which reduces complications, costs, treatment time, and morbidity. Short implants could be an alternative in the rehabilitation of patients with cancer.
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http://dx.doi.org/10.1016/j.prosdent.2017.06.003DOI Listing
May 2018

Detectable Neuropsychological Differences in Early Preclinical Alzheimer's Disease: A Meta-Analysis.

Neuropsychol Rev 2017 12 11;27(4):305-325. Epub 2017 May 11.

Department of Psychology, USC Dornsife College, Los Angeles, CA, USA.

The development of methods for in vivo detection of cerebral beta amyloid retention and tau accumulation have been increasingly useful in characterizing preclinical Alzheimer's disease (AD). While the association between these biomarkers and eventual AD has been demonstrated among cognitively intact older adults, the link between biomarkers and neurocognitive ability remains unclear. We conducted a meta-analysis to test the hypothesis that cognitively intact older adults would show statistically discernable differences in neuropsychological performance by amyloid status (amyloid negative = A-, amyloid positive = A+). We secondarily hypothesized a third group characterized by either CSF tau pathology or neurodegeneration, in addition to amyloidosis (A+/N+ or Stage 2), would show lower neuropsychology scores than the amyloid positive group (A+/N- or Stage 1) when compared to the amyloid negative group. Pubmed, PsychINFO, and other sources were searched for relevant articles, yielding 775 total sources. After review for inclusion/exclusion criteria, duplicates, and risk of bias, 61 studies were utilized in the final meta-analysis. Results showed A+ was associated with poorer performance in the domains of global cognitive function, memory, language, visuospatial ability, processing speed, and attention/working memory/executive functions when compared to A-. A+/N+ showed lower performances on memory measures when compared to A+/N- in secondary analyses based on a smaller subset of studies. Results support the notion that neuropsychological measures are sensitive to different stages of preclinical AD among cognitively intact older adults. Further research is needed to determine what constitutes meaningful differences in neuropsychological performance among cognitively intact older adults.
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http://dx.doi.org/10.1007/s11065-017-9345-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5681895PMC
December 2017

A Time and Motion Study of Pharmacists and Pharmacy Technicians Obtaining Admission Medication Histories.

J Hosp Med 2017 03;12(3):180-183

Department of Medicine, Division of General Internal Medicine, Cedars-Sinai Health System, Los Angeles, CA USA.

Pharmacists' admission medication histories (AMHs) are known to reduce adverse drug events (ADEs). Pharmacist-supervised pharmacy technicians (PSPTs) have also been used in this role. Nonetheless, few studies estimate the costs of utilizing PSPTs to obtain AMHs. We used time and motion methodology to study the time and cost required for pharmacists and PSPTs to obtain AMHs for patients at high risk for ADEs. Pharmacists and PSPTs required 58.5 (95% confidence interval [CI], 46.9-70.1) and 79.4 (95% CI, 59.1-99.8) minutes per patient, respectively (P = 0.14). PSPT-obtained AMHs also required 26.0 (95% CI, 14.9-37.1) minutes of pharmacist supervision per patient. Based on 2015 US Bureau of Labor Statistics wage data, we estimated the cost of having pharmacists and PSPTs obtain AMHs to be $55.91 (95% CI, 44.9-67.0) and $45.00 (95% CI, 29.7-60.4), respectively, which included pharmacist supervisory cost, per patient (P = 0.32). Thus, we found no statistically significant difference in time or cost between the two provider types. Journal of Hospital Medicine 2017;12:180-183.
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http://dx.doi.org/10.12788/jhm.2702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866092PMC
March 2017

Panoramic radiographs made before complete removable dental prostheses fabrication: A retrospective study of clinical significance.

J Prosthet Dent 2017 Jul 23;118(1):26-30. Epub 2016 Dec 23.

Associate Professor and Chair, Division of Oral and Maxillofacial Radiology, Department of Oral, Biological and Medical Sciences, University of British Columbia Faculty of Dentistry, Vancouver, BC, Canada.

Statement Of Problem: The value of digital panoramic radiographs to screen for problems before fabricating conventional complete dentures is unclear.

Purpose: The purpose of this retrospective study was to examine the influence of pretreatment digital panoramic radiographs on the clinical management of patients receiving complete removable dental prostheses.

Material And Methods: The clinical records, including panoramic radiographs, of 169 patients seeking new complete removable dental prostheses over a 6-year period were interpreted independently by both a prosthodontist and an oral and maxillofacial radiologist to identify radiographic findings that influenced clinical patient management. A 95% confidence interval and an observed proportion of agreement were used to interpret the results.

Results: Sixty percent of the 169 radiographs examined had 1 or more abnormal or positive radiographic findings; however, only 6 (<4%) of 165 abnormalities detected influenced patient management, and 3 of them were identified during the clinical examination.

Conclusions: Pretreatment digital panoramic radiographs revealed very few abnormalities that influenced the treatment of patients requiring complete removable dental prostheses. Furthermore, the digital images in this study revealed positive findings at a rate similar to those found in studies assessing analog radiographs, reinforcing current guidelines that recommend against radiographic screening of patients who seek new complete removable dental prostheses.
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http://dx.doi.org/10.1016/j.prosdent.2016.09.034DOI Listing
July 2017

Got Rice? An Unusual Case of Iodine-Deficiency Hypothyroidism.

Thyroid 2016 09 17;26(9):1338-9. Epub 2016 Aug 17.

1 Department of Endocrinology, Diabetes, and Metabolism, University of Southern California , Los Angeles, California.

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http://dx.doi.org/10.1089/thy.2016.0279DOI Listing
September 2016

Pairwise antibiotic interactions in Escherichia coli: triclosan, rifampicin and aztreonam with nine other classes of antibiotics.

J Antibiot (Tokyo) 2016 Nov 9;69(11):791-797. Epub 2016 Mar 9.

Department of Ecology and Evolutionary Biology, University of California, CA, USA.

Previous investigations have shown that analyzing pairwise interactions between 22 antibiotics in Escherichia coli enable the grouping of drugs into nine functional classes. Our aim is to significantly expand this drug network by adding three clinically relevant antibiotics, two of which have distinct mechanisms of action not previously represented. Here, we examine triclosan, rifampicin and aztreonam, by testing them pairwise against themselves and one antibiotic from each of the nine classes. Network analysis shows that triclosan, rifampicin and aztreonam each form distinct functional groups of their own. This is particularly surprising for aztreonam, which is a cell wall synthesis inhibitor but did not cluster with other cell wall synthesis inhibitors. Furthermore, of the 30 pairs tested, we found several previously unreported synergies that could potentially be used in multidrug therapies. The distinct functional groups suggest that there may be properties of these drugs that are different from other drugs even with similar mechanism of action, and that, when considering drug combinations, aztreonam in particular is not simply interchangeable with other cell wall synthesis inhibitors.
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http://dx.doi.org/10.1038/ja.2016.26DOI Listing
November 2016

Comparison of vascular closure devices for access site closure after transfemoral aortic valve implantation.

Eur Heart J 2015 Dec 26;36(47):3370-9. Epub 2015 Aug 26.

Department of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.

Background: The majority of transcatheter aortic valve implantation (TAVI) procedures are currently performed by percutaneous transfemoral approach. The potential contribution of the type of vascular closure device to the incidence of vascular complications is not clear.

Aim: To compare the efficacy of a Prostar XL- vs. Perclose ProGlide-based vascular closure strategy.

Methods: The ClOsure device iN TRansfemoral aOrtic vaLve implantation (CONTROL) multi-center study included 3138 consecutive percutaneous transfemoral TAVI patients, categorized according to vascular closure strategy: Prostar XL- (Prostar group) vs. Perclose ProGlide-based vascular closure strategy (ProGlide group). Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics.

Results: Propensity matching identified 944 well-matched patients (472 patient pairs). Composite primary end point of major vascular complications or in-hospital mortality occurred more frequently in Prostar group when compared with ProGlide group (9.5 vs. 5.1%, P = 0.016), and was driven by higher rates of major vascular complication (7.4 vs. 1.9%, P < 0.001) in the Prostar group. However, in-hospital mortality was similar between groups (4.9 vs. 3.5%, P = 0.2). Femoral artery stenosis occurred less frequently in the Prostar group (3.4 vs. 0.5%, P = 0.004), but overall, Prostar use was associated with higher rates of major bleeding (16.7 vs. 3.2%, P < 0.001), acute kidney injury (17.6 vs. 4.4%, P < 0.001) and with longer hospital stay (median 6 vs. 5 days, P = 0.007).

Conclusions: Prostar XL-based vascular closure in transfemoral TAVI procedures is associated with higher major vascular complication rates when compared with ProGlide; however, in-hospital mortality is similar with both devices.
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http://dx.doi.org/10.1093/eurheartj/ehv417DOI Listing
December 2015

Neonatal Serum Phosphorus Levels and Enamel Defects in Very Low Birth Weight Infants.

JPEN J Parenter Enteral Nutr 2016 08 2;40(6):835-41. Epub 2015 Mar 2.

Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA.

Background: Very low birth weight (VLBW) infants miss out on the period of greatest mineral accretion that occurs during the last trimester of pregnancy and are at higher risk of enamel defects. No studies have well described the relationship between neonatal nutrition and dental outcomes in preterm, VLBW infants. The objective of this study was to assess the differences in nutrition biomarkers, feeding intake, and comorbidities among VLBW infants with and without enamel defects.

Methods: A retrospective chart review of VLBW infants recruited for an ongoing longitudinal dental study between 2007 and 2010 was done. Participants were classified as cases and controls according to the presence/absence of developmental defects of enamel at 8 and/or 18-20 and/or 36 months. Demographics and medical and nutrition data were abstracted from 76 subjects' medical charts.

Results: Of the 76 VLBW subjects, 62% had enamel defects (hypoplasia and/or opacity). The only significant variable in the logistic regression analysis was that infants with a 1-mg/dL increase in serum phosphorus levels had a 68% reduction in the odds of having enamel hypoplasia (odds ratio, 0.322; P = .024).

Conclusion: Neonatal lower serum phosphorus levels are significantly associated with enamel hypoplasia in VLBW infants younger than 3 years.
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http://dx.doi.org/10.1177/0148607115573999DOI Listing
August 2016

Role of iron and aluminum coagulant metal residuals and lead release from drinking water pipe materials.

J Environ Sci Health A Tox Hazard Subst Environ Eng 2015 ;50(4):414-23

a Department of Civil & Resource Engineering , Dalhousie University , Halifax , Nova Scotia , Canada.

Bench-scale experiments investigated the role of iron and aluminum residuals in lead release in a low alkalinity and high (> 0.5) chloride-to-sulfate mass ratio (CSMR) in water. Lead leaching was examined for two lead-bearing plumbing materials, including harvested lead pipe and new lead: tin solder, after exposure to water with simulated aluminum sulfate, polyaluminum chloride and ferric sulfate coagulation treatments with 1-25-μM levels of iron or aluminum residuals in the water. The release of lead from systems with harvested lead pipe was highly correlated with levels of residual aluminum or iron present in samples (R(2) = 0.66-0.88), consistent with sorption of lead onto the aluminum and iron hydroxides during stagnation. The results indicate that aluminum and iron coagulant residuals, at levels complying with recommended guidelines, can sometimes play a significant role in lead mobilization from premise plumbing.
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http://dx.doi.org/10.1080/10934529.2015.987550DOI Listing
August 2015