Oral health educators' reflections on teaching 2022 and beyond

INTRODUCTION

The global pandemic prompted changes in health science education affecting both teaching and learning. This multi-institutional study assesses the near-term implications of these changes on faculty and faculty development. The project goals were to: (1) describe faculty experiences of teaching during the pandemic; (2) identify ways to sustain new pedagogical approaches, (3) describe the types of support faculty members need, and (4) offer recommendations to enhance oral health professions education.

METHODS

A mixed-method approach using exploratory sequential design was conducted in two phases collecting qualitative and quantitative data. Focus group participants included didactic, pre-clinical, and clinical faculty in dental school (DMD/DDS), dental hygiene and dental therapy programs, and also faculty members serving in administrative roles in these programs (N = 37). One hundred forty-four faculty participated in the multi-institutional follow-up survey.

RESULTS

Focus group and survey results led to 14 recommendations (nine structural and five individual) for oral health profession institutions and educators.

CONCLUSION

Oral health profession education faculty were dramatically impacted by the pandemic and new faculty development needs were identified. Traditional faculty development topics and practices may be no longer applicable in the post-COVID-19 environment. Additionally, the pandemic stimulated creative approaches for curriculum design, teaching, and assessment in oral health profession education. Strategies need to be implemented to sustain these innovations.

A phase II open-label trial of avelumab plus axitinib in previously treated non-small-cell lung cancer or treatment-naïve, cisplatin-ineligible urothelial cancer

BACKGROUND

We hypothesized that avelumab plus axitinib could improve clinical outcomes in patients with advanced non-small-cell lung cancer (NSCLC) or urothelial carcinoma (UC).

PATIENTS AND METHODS

We enrolled previously treated patients with advanced or metastatic NSCLC, or untreated, cisplatin-ineligible patients with advanced or metastatic UC. Patients received avelumab 800 mg every 2 weeks (Q2W) and axitinib 5 mg orally two times daily. The primary endpoint was objective response rate (ORR). Immunohistochemistry was used to assess programmed death-ligand 1 (PD-L1) expression (SP263 assay) and the presence of CD8+ T cells (clone C8/144B). Tumor mutational burden (TMB) was assessed by whole-exome sequencing.

RESULTS

A total of 61 patients were enrolled and treated (NSCLC, n = 41; UC, n = 20); 5 remained on treatment at data cut-off (26 February 2021). The confirmed ORR was 31.7% in the NSCLC cohort and 10.0% in the UC cohort (all partial responses). Antitumor activity was observed irrespective of PD-L1 expression. In exploratory subgroups, ORRs were higher in patients with higher (≥median) CD8+ T cells in the tumor. ORRs were higher in patients with lower TMB (<median) in the NSCLC cohort and higher TMB (≥median) in the UC cohort. Treatment-related adverse events (TRAEs) occurred in 93.4% of patients, including grade ≥3 TRAEs in 55.7%. Avelumab exposures with 800 mg Q2W dosing were similar to those observed with 10 mg/kg Q2W dosing.

CONCLUSIONS

In previously treated patients with advanced/metastatic NSCLC, ORR appeared to be superior to anti-PD-L1 or anti-programmed cell death protein 1 monotherapy, irrespective of PD-L1 status, whereas in untreated, cisplatin-ineligible patients with advanced/metastatic UC, ORR was lower than expected, potentially limited by small patient numbers.

TRIAL REGISTRATION

Clinicaltrial.gov NCT03472560; https://clinicaltrials.gov/ct2/show/NCT03472560.

How to Teach Medical Students About Pain and Dementia: E-Learning, Experiential Learning, or Both?

OBJECTIVE

Pain management in persons with mild to moderate dementia poses unique challenges because of altered pain modulation and the tendency of some individuals to perseverate. We aimed to test the impact of an e-learning module about pain in communicative people with dementia on third-year medical students who had or had not completed an experiential geriatrics course.

DESIGN

Analysis of pre- to postlearning changes and comparison of the same across the student group.

SETTING

University of Pittsburgh School of Medicine and Saint Louis University School of Medicine.

SUBJECTS

One hundred four University of Pittsburgh and 57 Saint Louis University medical students.

METHODS

University of Pittsburgh students were randomized to view either the pain and dementia module or a control module on pain during a five-day geriatrics course. Saint Louis University students were asked to complete either of the two modules without the context of a geriatrics course. A 10-item multiple choice knowledge test and three-item attitudes and confidence questionnaires were administered before viewing the module and up to seven days later.

RESULTS

Knowledge increase was significantly greater among students who viewed the dementia module while participating in the geriatrics course than among students who viewed the module without engaging in the course (P < 0.001). The modules did not improve attitudes in any group, while student confidence improved in all groups.

CONCLUSIONS

Medical students exposed to e-learning or experiential learning demonstrated improved confidence in evaluating and managing pain in patients with dementia. Those exposed to both educational methods also significantly improved their knowledge.

Managing Acute Pain and Opioid Risks Following Wisdom Teeth Extraction: An Illustrative Case

Introduction

The opioid epidemic has awakened educators to the insufficiency of training in the areas of pain management and substance use disorders within the curricula of health sciences schools. The University of Pittsburgh Center of Excellence in Pain Education created an online educational module focusing on factors contributing to the opioid epidemic and the role of robust interprofessional communication in avoiding common practitioner errors.

Methods

The 1-hour module created by an interprofessional team comprised a pretest, video presentation featuring case vignettes, posttest, and learner satisfaction survey. The content of the module focused on four core concepts: (1) managing acute perioperative pain, (2) maximizing opioid safety, and (3) identifying and (4) managing suspected opioid abuse and diversion.

Results

Data were obtained from 250 dental, pharmacy, and nursing students from the University of Pittsburgh who completed the module as part of their respective profession-specific curricula. Results collapsed across the three school-specific implementations indicated an average increase in knowledge test scores from pre- to posttest (Z = -8.82, p < .001). In addition, the learner satisfaction data revealed an overall positive response to the module, with students commenting that they enjoyed the module and felt it provided them with a valuable learning experience.

Discussion

Learner outcomes and feedback suggest that our interprofessional team was successful in creating an effective learning module applicable to several health care professions, namely, pharmacy, dentistry, and nursing. Future studies might address the application of the knowledge gained to actual patient care.

Learning and Teaching Together to Advance Evidence-Based Clinical Education: A Faculty Learning Community

Clinical teaching is a cornerstone of health sciences education; it is also the most challenging aspect. The University of Pittsburgh Schools of Dental Medicine, Nursing, and Pharmacy developed a new evidence-based interprofessional course framed as a faculty learning community (FLC) around the principles of learning in a clinical environment. The aim of this study was to assess the overall effectiveness of this two-semester FLC at four health professions schools in academic year 2014-15. The assessment included anonymous participant surveys in each session and an anonymous end-of-course survey. Thirty-five faculty members from dental, health and rehabilitation sciences, nursing, and pharmacy enrolled in the FLC, with six to 32 enrollees attending each session. All attendees at each session completed the session evaluation surveys, but the attendance rate at each session ranged from 17.1% to 91.4%. Sixteen participants (46%) completed the end-of-course survey. The results showed overall positive responses to the FLC and changes in the participants' self-reported knowledge. Session surveys showed that the participants found the FLC topics helpful and appreciated the opportunity to learn from each other and the interprofessional nature of the FLC. Responses to the end-of-course survey were in alignment with the individual session surveys and cited specific benefits as being the content, teaching materials, and structured discussions. In additional feedback, participants reported interest to continue as a cohort and to extend the peer-support system beyond the FLC. This outcomes assessment of the first round of the FLC confirmed that this cohort-based faculty development in an interprofessional setting was well received by its participants. Their feedback provided valuable insights for changes to future offerings.

Assessing the Professional Identity of Dental School Faculty: An Exploratory Study

Experts have argued that dental education needs to shift from a teacher-centered paradigm to a learner-centered paradigm. Assisting faculty members to self-identify as educators may be a key to reaching that goal. The aim of this exploratory study was to assess how dental faculty members described their professional identity (educator or clinician) and the effect of their self-defined identity on their motivation to pursue professional development as educators. A 14-question anonymous survey was distributed electronically to all 536 part-time and full-time dental faculty members at two U.S. dental schools; 114 responses were recorded for a 21.5% response rate. Just over half of the survey respondents (53.5%, n=61) self-identified as educators, and the other 46.5% (n=53) self-identified as clinicians. A lower percentage of the self-identified clinicians were full-time employees (37.3%, n=25) than the self-identified educators (60.7%, n=42); the difference was statistically significant (p=0.0143). Among respondents who self-identified as educators, 53.2% (n=25) had taken four or more courses on teaching vs. 24.2% (n=8) of those who self-identified as clinicians (p=0.0321). Also, 50% (n=30) of the self-identified educators prioritized future teaching courses as their continuing education plan vs. 20.8% (n=11) of the self-identified clinicians (p=0.0013), and 49.2% (n=30) of the self-identified educators had attended at least one ADEA Annual Session vs. 15.4% (n=8) of the self-identified clinicians (p=0.0011); both of those differences were statistically significant. This study found that only about half of the respondents from two dental schools self-identified as educators, but nearly all viewed learning about teaching concepts and techniques as very or somewhat important. Administrators can use these findings to promote their faculty training initiatives and find ways to encourage and support educator identification.

Abstract P5-11-09: Sustained efficacy of eflapegrastim in breast cancer patients in a phase 2, open-label, dose-ranging study

Background: Eflapegrastim is a distinct biologic that uses the innovative proprietary long-acting protein/peptide discovery technology (LAPSCOVERY™) and consists of a novel, modified recombinant human G-CSF conjugated to the Fc fragment of IgG4 via a polyethylene glycol linker. A Phase 2 study of 3 doses of eflapegrastim vs pegfilgrastim was conducted in breast cancer patients receiving docetaxel + cyclophosphamide (TC) chemotherapy.

Methods: This was an open-label, global, multicenter, dose-ranging study designed to compare the safety and efficacy of eflapegrastim relative to a fixed dose of pegfilgrastim as a concurrent active control. The study included 4 treatment arms: 3 dose levels of eflapegrastim (45 μg/kg, 135 μg/kg, and 270 μg/kg) vs pegfilgrastim (6 mg). The primary objective of the study was the Duration of Severe Neutropenia (DSN) during Cycle 1. The results for the primary objective, along with demographics and safety, were described in a previous presentation (SABCS 2015 P1-10-05). The secondary endpoints included DSN in Cycles 2-4, absolute neutrophil count (ANC) in Cycles 1-4, the overall incidences of febrile neutropenia (FN) and hospitalization rates.

Results: A total of 147 evaluable patients were enrolled. Patient and tumor characteristics were comparable across all 4 treatment arms. Median age was 59.0 years (range 32 to 77 years); most patients were &lt;65 years (68%), Female (98%), and White (95%). The DSN for the 135 µg/kg and 270 µg/kg was non-inferior to pegfilgrastim during all cycles and the DSN for patients treated with 45 µg/kg was non-inferior during Cycles 2 and 3 (Table 1). The ANC was dose proportional across all 4 cycles. The incidence of FN and hospitalization rates was low in all arms and there were no significant differences between the Eflapegrastim and Pegfilgrastim Arms (Table 2).

Table 1. Duration of Severe Neutropenia in Cycles 2 to 4 of TC Chemotherapy by Treatment ArmDSN (Days)Eflapegrastim 45 μg/kg (N=39)Eflapegrastim 135 μg/kg (N=36)Eflapegrastim 270 μg/kg (N=36)Pegfilgrastim 6 mg (N=36)Cycle 2Difference with pegfilgrastim0.380.04-0.05NANon-Inferiority p-value0.001&lt;0.001&lt;0.001NACycle 3Difference with pegfilgrastim0.310.020.01NANon-Inferiority p-value0.002&lt;0.001&lt;0.001NACycle 4Difference with pegfilgrastim0.940.07-0.02NANon-Inferiority p-value0.781&lt;0.001&lt;0.001NADSN = Duration of Severe Neutropenia; NA = Not Applicable

Table 2. Incidence of Febrile Neutropenia and Hospitalizations Eflapegrastim 45 μg/kg (N=39)Eflapegrastim 135 μg/kg (N=36)Eflapegrastim 270 μg/kg (N=36)Pegfilgrastim 6 mg (N=36)Febrile NeutropeniaIncidence (%)3 (7.7%)1 (2.8%)1 (2.8%)2 (5.6%)Difference with Pegfilgrastim2.1 %-2.8%-2.8%NAp-value1.0001.0001.000NAHospitalizationsIncidence (%)3 (7.7%)3 (8.3%)1 (2.8%)5 (13.9%)Difference with Pegfilgrastim-6.2%-5.6%-11.1%NAp-value0.4690.7100.199NA

Conclusions: In breast cancer patients treated with TC, the non-inferiority of DSN of 135 µg/kg and 270 µg/kg eflapegrastim, compared to pegfilgrastim in Cycle 1, was sustained through Cycles 2-4 and the ANC profiles were comparable in Cycles 1-4. In addition, the overall incidence of FN and hospitalizations was comparable between the eflapegrastim arms and the pegfilgrastim arm.

Citation Format: Vacirca JL, Agajanian R, Papai Z, Horvath Z, Makharadze R, Ibrahim EN, Choi MR, Song T, Tedesco KL, McGregor K, Schwartzberg LS. Sustained efficacy of eflapegrastim in breast cancer patients in a phase 2, open-label, dose-ranging study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-09.

Abstract P5-11-07: Pharmacokinetics of eflapegrastim in a phase 2 open-label dose-ranging study in breast cancer patients receiving TC regimen

Background: Eflapegrastim (SPI-2012/HM10460A) is a novel, long acting recombinant human granulocyte colony-stimulating factor (rhG-CSF). Eflapegrastim consists of an rhG-CSF conjugated to the recombinant E coli derived Fc fragment of IgG4 via a polyethylene glycol linker. Eflapegrastim is in clinical development for the treatment of chemotherapy induced neutropenia in cancer patients.

Methods: Pharmacokinetics (PK) of eflapegrastim was investigated in an open label, dose-ranging Phase 2 study in breast cancer patients receiving docetaxel + cyclophosphamide (TC) chemotherapy. The study consisted of 4 arms. Patients in Arms 1 through 3 received subcutaneous doses of 45, 135, or 270 µg /kg of eflapegrastim and patients in Arm 4 received 6 mg pegfilgrastim (Neulasta®) on Day 2 of each 21-day chemotherapy cycle. Serum samples were collected from a subset of eflapegrastim patients at pre-specified time-points and analyzed for eflapegrastim by a validated enzyme-linked immunosorption assay (ELISA). Pharmacokinetic analyses were conducted on serum concentration-time profiles after dosing in Cycle 1. The serum concentrations for samples collected in Cycle 3 were compared with the corresponding concentrations in Cycle 1. Pharmacokinetic analyses were not conducted for pegfilgrastim patients.

Results: The PK profile of eflapegrastim was investigated in 11 patients, including 3 patients in the 45 µg/kg treatment arm, 4 patients in the 135 µg/kg treatment arm, and 4 patients in the 270 µg/kg treatment arm. Following single eflapegrastim doses of 45, 135, or 270 µg/kg, peak serum concentrations increased in a dose proportional manner. The summary of pharmacokinetics of eflapegrastim is presented in the Table below.

Pharmacokinetic Parameters of Eflapegrastim in Patients Following Single Subcutaneous Doses in Cycle 1ParameterEflapegrastim 45 μg/kg/Eflapegrastim 135μg/kgEflapegrastim 270 μg/kgCmax, ng/mLN = 3; Mean = 7.00; SD = 6.08N = 4; Mean = 247; SD = 276N =3; Mean = 299; SD = 329Tmax, haN =2; Mean = 58.7; SD = 46.9 - 70.5N = 4; Mean =9.00; SD = 8 - 48.1N = 3; Mean = 24.00; SD = 24 - 24.1AUC0-312, ng•hr/mLN = 0; Mean = NC; SD = NCN = 2; Mean = 16000; SD = 5850N = 3; Mean = 22900; SD = 25100t1/2, hbN = 0; Mean = NC; SD = NCN = 2; Mean = 81.0; SD = 88.4N = 1; Mean = 31.5; SD = NCAUC = area under the concentration-time curve; Cmax = maximum serum concentration; h = hour; NC = not calculated; SD = standard deviation; t1/2 = half-life; Tmax = time to maximum serum concentration; a) Expressed as median and range; b) Expressed as harmonic mean and pseudo SD

The maximum serum concentrations of eflapegrastim in Cycle 3 increased with the dose of eflapegrastim. The serum concentrations of eflapegrastim in Cycle 3 were generally lower than those in Cycle 1, but the profile was similar to Cycle 1.

Conclusions: The Cmax and AUC(0-312) of eflapegrastim increased in a dose proportional manner following subcutaneous administration. The half-life of eflapegrastim ranged from 31.5 to 81.0 hours, which is consistent with the half-life of other long-acting myeloid growth factors.

Citation Format: Vacirca JL, Papai Z, Horvath Z, Makharadze R, Reddy G, Song T, Koli P, Schwartzberg LS. Pharmacokinetics of eflapegrastim in a phase 2 open-label dose-ranging study in breast cancer patients receiving TC regimen [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-07.

Abstract P5-11-08: Immunogenicity of eflapegrastim in a phase 2 open-label dose-ranging study of eflapegrastim in breast cancer patients receiving TC regimen

Background: Eflapegrastim (SPI-2012/HM10460A) is a novel, long-acting recombinant human granulocyte colony-stimulating factor (rhG-CSF). Eflapegrastim consists of an rhG-CSF conjugated to a recombinant E. coli derived Fc fragment of IgG4 via a polyethylene glycol linker. Eflapegrastim is in clinical development for the treatment of chemotherapy induced neutropenia in cancer patients.

Methods: Immunogenicity of eflapegrastim was investigated in an open label, dose-ranging Phase 2 study in breast cancer patients receiving docetaxel + cyclophosphamide (TC) chemotherapy. The study consisted of 4 arms. Patients in Arms 1 through 3 received subcutaneous doses of 45, 135, or 270 µg/kg eflapegrastim and Arm 4 received 6 mg pegfilgrastim (Neulasta®) on Day 2 of each 21-day chemotherapy cycle. Blood samples for immunogenicity analysis were collected before the start of each chemotherapy cycle (Day 1) and at the End-of-Study Visit. Samples were tested in a screening assay for Anti-Drug Antibodies (ADA) to eflapegrastim by a validated enzyme linked immunosorption assay (ELISA). Positive samples from the screening assay were further tested in a confirmatory assay for antibodies binding to eflapegrastim or G-CSF. Samples found positive in the confirmatory assay were further tested in a validated cell based neutralizing antibody assay.

Results: Serum samples from 143 patients in the study were tested for ADA to eflapegrastim and G-CSF. Preexisting antibodies binding to eflapegrastim or G-CSF were detected in 9 out of 143 (6.3%) patients. One out of the 27 patients (3.7%) in the Pegfilgrastim Arm who was negative prior to dosing was positive for ADA in the G-CSF confirmatory assay. Two out of 100 patients (2.0%) treated with eflapegrastim, who were negative prior to dosing, demonstrated treatment-induced formation of ADA in the G-CSF confirmatory assay. However, the responses in these patients were transient (ie, not consistently positive at all the sampling times) and the assay response values were low and only slightly above the plate-specific cut points. None of the patients tested were positive for G-CSF neutralizing antibodies. A formal assessment of the impact of serum ADA on the PK of eflapegrastim was not performed since PK was examined in only a limited number of patients and all of those patients were negative for ADA both at study initiation and post-dose.

Conclusion: No neutralizing antibodies against eflapegrastim or G-CSF were detected in patients administered eflapegrastim in this study.

Citation Format: Vacirca JL, Papai Z, Agajanian R, Horvath Z, Makharadze R, Ibrahim E, Koli P, Reddy G, Tedesco KL, McGregor K, Schwartzberg LS. Immunogenicity of eflapegrastim in a phase 2 open-label dose-ranging study of eflapegrastim in breast cancer patients receiving TC regimen [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-08.

Training Future Dentists for an Academic Career: A Three-Tiered Model

The anticipated shortage of dental faculty presents a challenge for dental education as it will greatly impact the training of the next generation of practicing dentists. One way to alleviate shortages is to identify students who are interested in an academic career at the predoctoral level and provide them with training in teaching, research, and leadership. Based on available evidence, formal programs offer the best way to introduce students to academia as a viable career path. A well-designed program can also equip interested students with the necessary skills and basic knowledge to facilitate starting an academic career. The University of Pittsburgh School of Dental Medicine has developed a three-tiered model for providing its dental students with exposure to and training in academic dentistry. The three tiers reflect differing levels of commitment: 1) a two-year academic career track program, 2) academic career track elective courses, and 3) extracurricular activities. The aim of this study was to provide an initial assessment of the program's overall effectiveness. Data were collected using student and faculty surveys and student applications for the two-year academic career track program. The data gathered included characteristics of, and feedback from, students taking the elective courses, as well as student and faculty feedback about student teacher effectiveness. The study found overall positive responses to the three-tiered program from faculty, students, and student teachers at this initial stage. Whether these students ultimately become faculty members (the ultimate goal of the program) will be assessed in the future.

Abstract P1-10-05: Randomized phase 2, open-label, dose-ranging study of a novel, long-acting G-CSF (SPI-2012) or pegfilgrastim for the management of neutropenia in patients with breast cancer (BC) treated with (Neo) adjuvant chemotherapy with docetaxel + cyclophosphamide (TC)

Background: SPI-2012 is a distinct biologic that uses the innovative proprietary long-acting protein/peptide discovery technology (LAPSCOVERY™) to enhance the activity of G-CSF. SPI-2012 consists of a novel, modified recombinant human G-CSF conjugated to the Fc fragment of IgG4 via a polyethylene glycol linker to produce a new, more potent, longer-acting G-CSF with a potentially unique distribution to areas rich in Fc receptors. To assess the effect of SPI-2012 in supporting patients with breast cancer receiving myelosuppressive chemotherapy with TC, we conducted a randomized Phase 2 study of 3 SPI-2012 doses versus pegfilgrastim.

Methods: This was an open-label, global, multicenter, dose-ranging study designed to compare the safety and efficacy of SPI-2012 relative to a fixed, standard dose of pegfilgrastim as a concurrent active control. The study included 4 treatment arms: 3 dose levels of SPI-2012 (45 μg/kg, 135 μg/kg, and 270 μg/kg) vs pegfilgrastim (6 mg,). The primary objective of the study was the Duration of Severe Neutropenia (DSN) during Cycle 1 in patients with BC who received adjuvant or neoadjuvant TC chemotherapy.

Results: A total of 147 evaluable patients were enrolled. Patient and tumor characteristics were comparable across all 4 treatment arms. Mean age was 58.2 years (range 32 to 77 years); most patients were &lt;65 years (68%), female (98%) and white (95%). The study met its primary endpoint with DSN in patients treated in the 135 µg/kg and 270 µg/kg SPI-2012 treatment arms in Cycle 1 showing non-inferiority to the DSN in patients treated with pegfilgrastim (p=0.002 and p&lt;0.001, respectively). In addition, superiority was demonstrated in patients treated with 270 µg/kg SPI-2012 compared to pegfilgrastim (p=0.023). Non-inferiority in DSN was also observed in Cycles 2 to 4 in both the 135 µg/kg and 270 µg/kg SPI-2012 treatment arms compared to pegfilgrastim.

Duration of Severe Neutropenia in Cycle 1 of TC chemotherapy by Treatment Arm  45 μg/kg SPI-2012 (N=39) 135 μg/kg SPI-2012 (N=36) 270 μg/kg SPI-2012 (N=36)Pegfilgrastim (N=36)DSN Mean (SD)(days)1.03 (1.5)0.44 (1.3)0.03 (0.2)0.31 (0.8)Difference with pegfilgrastim0.720.14-0.28NANon-inferiority p-value0.2960.002&lt;0.001NASuperiority p-value0.0060.5280.023NASD=Standard Deviation; NA=Not Applicable

The common treatment-emergent adverse events observed in ≥20% of patients were similar across all 4 study arms with similar or lower incidence in the SPI-2012 treatment arms, and included fatigue, nausea, alopecia, diarrhea, and bone pain.

Conclusions: All doses of SPI-2012 administered in this Phase 2 study were well tolerated, and no new or significant dose-related toxicities were observed. Most reported adverse events were mild and similar to those previously reported in clinical trials with filgrastim and pegfilgrastim in patients receiving myelosuppressive chemotherapy. In Cycle 1, the 135 µg/kg dose of SPI-2012 was non-inferior compared to pegfilgrastim, and the 270 µg/kg dose was superior in terms of DSN. Additional efficacy and safety data for SPI-2012 will be collected in planned Phase 3 clinical trials.

Citation Format: Vacirca JL, Chan A, Mezei K, Adoo CS, Papai Z, McGregor K, Okera M, Horvath Z, Landherr L, Hanslik J, Hager SJ, Ibrahim EN, Ghazal H, Rostom M, Bhat G, Choi MR, Allen LF, Tedesco KL, Agajanian R, Lang I. Randomized phase 2, open-label, dose-ranging study of a novel, long-acting G-CSF (SPI-2012) or pegfilgrastim for the management of neutropenia in patients with breast cancer (BC) treated with (Neo) adjuvant chemotherapy with docetaxel + cyclophosphamide (TC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-05.

Use of lecture recordings in dental education: assessment of status quo and recommendations

This research project was part of a planned initiative at the University of Pittsburgh School of Dental Medicine to incorporate lecture recordings as standard educational support technologies. The goal of an institutional survey was 1) to gather current data about how dental educators across the United States and Canada use lecture recordings; 2) determine dental educators' perceived value and outcomes of using lecture recordings; and 3) develop recommendations based on #1 and #2 for the dental education community. Of the sixty-six North American dental schools at the time of the study, forty-five schools responded to the survey, for a 68 percent response rate. Of the respondents, twenty-eight schools were found to currently conduct lecture recording; these comprised the study sample. This study focused on the dental schools' past experiences with lecture recording; thus, those not currently engaged in lecture recording were excluded from further analysis. The survey questions covered a wide range of topics, such as the scope of the lecture recording, logistics, instructional design considerations, outcomes related to student learning, evaluation and reception, barriers to lecture recording, and issues related to copyright and intellectual property. The literature review and results from the survey showed that no common guidelines for best practice were available regarding lecture recordings in dental education. The article concludes with some preliminary recommendations based on this study.

Comparison of e-mail communication skills among first- and fourth-year dental students

As e-mail and other forms of electronic communication increase in popularity, it is important for dental schools to consider a curriculum that prepares their graduates to understand and apply effective electronic communication strategies to their patients. Reflecting this shift in communication behavior, the American Medical Association has developed specific e-mail communication guidelines. Some behavioral examples in these guidelines include protecting patients' protected health information (PHI), ensuring proper record keeping, and using professional, courteous, and understandable language. In this study, a sample of first- and fourth-year dental students (n=160) at the University of Pittsburgh School of Dental Medicine participated in an assignment assessing their patient-provider e-mail communication skills. A rubric was used to evaluate and compare the data between dental student classes. The results reveal a generalized lack of compliance with several of these guidelines by both classes (e.g., failure to protect PHI), despite efforts to expose students to these concepts in the curriculum. In an effort to train emerging dentists to function in a rapidly changing technological environment, these findings suggest a need for growth and development of curricula and perhaps guidelines/recommendations for behavioral competencies regarding dental students' use of electronic communication in the patient care environment.

Incidental appendectomy--standard or unnecessary additional trauma in surgery for colorectal cancer? A retrospective analysis of histological findings in 380 specimens

BACKGROUND

Incidental appendectomy is a frequent but non-standard procedure during surgery for colorectal cancer. Incidental appendectomy during colorectal resections is performed at the discretion of the operating surgeon.

METHOD

This retrospective study used data from 1352 consecutive patients who underwent surgery for colorectal cancer between 1993 and 2009 at the Medical University of Vienna. The authors evaluated histopathological results of appendices removed incidentally. In addition, complications and costs of the additional intervention were analyzed.

RESULTS

Appendectomy had been performed in 314 (23.22%) patients because of appendicitis. Incidental appendectomy had been performed in 380 (28.11%) patients: 86 (22.63%) had a histologically completely normal appendix, a pathologic alteration was found in 289 (76.05%) and a neoplasm was found in seven (1.84%). No complications occurred from the additional surgical procedure. The costs and time effort were negligible.

CONCLUSION

Incidental appendectomy is a safe procedure and can be integrated into surgery for colorectal carcinoma to avoid future complications. Pathological findings of the appendix, including neoplasm, are frequent but the clinical relevance remains questionable.

Association of polymorphisms in the dopamine D4 receptor gene and the activity-impulsivity endophenotype in dogs

A variable number of tandem repeats (VNTR) polymorphism in exon 3 of the human dopamine D4 receptor gene (DRD4) has been associated with attention deficit hyperactivity disorder (ADHD). Rodents possess no analogous repeat sequence, whereas a similar tandem repeat polymorphism of the DRD4 gene was identified in dogs, horses and chimpanzees. Here, we present a genetic association study of the DRD4 VNTR and the activity-impulsivity dimension of the recently validated dog-ADHD Rating Scale. To avoid false positives arising from population stratification, a single breed of dogs (German shepherd) was studied. Two DRD4 alleles (referred to as 2 and 3a) were detected in this breed, and genotype frequencies were in Hardy-Weinberg equilibrium. For modelling distinct environmental conditions, 'pet' and 'police' German shepherds were characterized. Police German shepherds possessing at least one 3a allele showed significantly higher scores in the activity-impulsivity dimension of the dog-ADHD Rating Scale than dogs without this allele (P = 0.0180). This difference was not significant in pet German shepherds. To the best of our knowledge, this is the first report of an association between a candidate gene and a behaviour trait in dogs, and it reinforces the functional role of DRD4 exon 3 polymorphism.

Resveratrol, an ingredient of wine, acts synergistically with Ara-C and tiazofurin in HL-60 human promyelocytic leukemia cells

Resveratrol (RV), a naturally occurring stilbene derivative, is a potent free radical scavenger causing a number of biochemical and antineoplastic effects. It was shown to induce differentiation and apoptosis in leukemia cells and was also identified as an inhibitor of ribonucleotide reductase (RR), a key enzyme of DNA synthesis. In this study, we report about the biochemical effects of RV in HL-60 human promyelocytic leukemia cells. RV effectively inhibited in situ RR activity. Furthermore, incubation of HL-60 cells with RV significantly decreased intracellular dCTP, dTTP, dATP and dGTP concentrations. In growth inhibition and clonogenic assays, RV acted synergistically with both Ara-C and tiazofurin in HL-60 cells. We conclude that RV could become a viable candidate as one compound in the combination chemotherapy of leukemia and therefore deserves further in vitro and in vivo testing.

Antitumor effects of 3,3',4,4',5,5'-hexahydroxystilbene in HL-60 human promyelocytic leukemia cells

Resveratrol (3,4',5-trihydroxystilbene, RV) exerts remarkable cytostatic and cytotoxic effects against a multitude of human cancer cell lines. Since the introduction of additional hydroxyl groups was supposed to increase the biological activity of RV, we have synthesized a number of polyhydroxylated stilbene analogues as potential antitumor agents. In this study, the activity of 3,3',4,4',5,5'-hexahydroxystilbene (M8) was investigated in HL-60 human promyelocytic leukemia cells. Employing a growth inhibition assay, incubation with M8 and RV resulted in IC50 values of 6.25 and 12 microM, respectively. Using a specific Hoechst/propidium iodide double staining method, we found that M8 was able to induce apoptosis in concentrations significantly lower than those of RV. In addition, M8 arrested cells in the S phase and totally depleted cells in the G2-M phase of the cell cycle (143% and 0% of control after treatment with 12.5 microM M8, respectively). We therefore believe that this promising agent deserves further preclinical and in vivo testing.

Cytotoxic and apoptotic effects of novel heterodinucleoside phosphates consisting of 5-fluorodeoxyuridine and Ara-C in human cancer cell lines

In search for possible alternatives in the treatment of human malignancies we investigated several new heterodinucleoside phosphates consisting of 5-Fluorodeoxyuridine (5-FdUrd) and Arabinofuranosylcytosine (Ara-C). We show that all dimers tested inhibited the number of colonies of CCL228, CCL227, 5-FU resistant CCL227 and HT-29 human colon tumor cells with IC50 values ranging from 0.65 to 1 nM. Dimer # 2 inhibited the number of sensitive and Ara-C resistant H9 human lymphoma cells with IC50 values ranging from 200 to 230 nM. Since no significant difference in the cytotoxicity of the dimers could be observed between sensitive and resistant cells, these compounds might be used in the treatment of 5-FU and Ara-C resistant tumors.

Amidox, an inhibitor of ribonucleotide reductase, potentiates the action of Ara-C in HL-60 human promyelocytic leukemia cells

Amidox (3,4-dihydroxybenzamidoxime), a new polyhydroxy-substituted benzoic acid derivative, is a potent inhibitor of the enzyme ribonucleotide reductase (RR), which catalyses the de novo synthesis of DNA. RR is considered to be an excellent target for cancer chemotherapy. In the present study we investigated the antineoplastic effects of Amidox alone and in combination with Arabinofuranosylcytosine (Ara-C) in HL-60 human promyelocytic leukemia cells. In growth inhibition experiments Amidox yielded an IC50 of 30 microM, colony formation was inhibited at an IC50 of 20 microM as determined by a soft agar assay. Exposure of the cells to 75 and 100 microM Amidox for 24 hours was shown to significantly decrease intracellular dCTP, dGTP and dATP pools, whereas dTTP concentration increased, as determined by HPLC. The combination of Amidox with Ara-C yielded more than additive cytotoxic effects both in growth inhibition assays and in soft agar assays. We could show that--after preincubating the cells with 75 and 100 microM Amidox and subsequent exposure to Ara-C--intracellular Ara-CTP levels increased by 576% and 1143%, respectively. In conclusion, Amidox might offer an additional option for the treatment of leukemia and thus be further investigated in vitro and in vivo.

[MRI guided stereotactic thalamotomy for the treatment of the neurogenic pain]

INTRODUCTION

Medial thalamotomy is one of the first stereotactic operations to have been used for neurogenic pain, has a low complication rate and no risk of the development of iatrogenic neurogenic pain. It represents selective local relief for all types of pain, without causing somatosensorial deficit.

PATIENTS AND METHODS

We did 39 posteromedial thalamotomies in patients with persistent intractable pain due to various disorders. The pain was assessed pre- and postoperatively on the VAS (Visual Analogic Scale).

RESULTS

Half of the patients operated on had relief of pain after thalamotomy. In 84% (n = 39) of our cases this relief occurred on the second day, in 70% (n = 35) after three months, in 63% (n = 27) after six months, in 64% (n = 25) after nine months, in 62% (n = 23) of the patients after 12 months, and in 62% (n = 22) after 24 months. Three patients had temporary complications and one a permanent complication, but this did not make him an invalid.

CONCLUSION

Posteromedial stereotactic thalamotomy under MR guidance can provide safe, effective treatment for persistent, intractable pain.

Optimization of Flow Injection On-Line Microcolumn Preconcentration of Ultratrace Elements in Environmental Samples prior to Their Spectrochemical Determination

The preconcentration of some elements such as Cd, Co, Ni, and V(IV) was modeled in the presence of complexing agents such as citrate and oxalate at high Ca, Mg, and sulfate concentrations on iminodiacetic acid/ethyl cellulose (IDAEC), a chelating cellulose. The effect of the species present in the solution was studied after construction of the species distribution curves using critical, estimated, and measured stability constants. The stability constants of the IDAEC chelates were determined potentiometrically. The constants were calculated or estimated using computer programs. The diagrams calculated in homogeneous media were used for optimization of the flow injection on-line preconcentration for analysis of ultratrace metals in the highly mineralized water "Hunyadi."

Spike-and-wave epilepsy in rats: sex differences and inheritance of physiological traits

Spontaneously occurring spike-and-wave patterns were examined in seven to eight-month-old rats of the inbred Fischer 344 and Brown Norway strains and their F1 and F2 hybrids. Neocortical activity and movement were monitored for 12 night h. Spike-and-wave episodes were identified by a three-layer back-propagation neural network. The incidence, average duration and total duration of spike-and-wave episodes were significantly higher in F1 males and F2 hybrids than in the parental strains. Male rats of the Brown Norway strain had significantly more and longer episodes than females, whereas no sex differences were present in Fischer rats. The average intraepisodic frequency of spike-and-wave patterns was significantly lower in Fischer rats than in the other groups and significantly higher in males than females. Tremor (myoclonic movements) associated with spike-and-wave episodes was absent or of very small amplitude in Fischer rats but frequent and of large amplitude in Brown Norway rats and their F1 and F2 descendants. Most of the interstrain differences were limited to male rats. Spike-and-wave episodes recurred at predictable short-term (10-30 s) and long-term (15-30 min) periods. The long-term oscillation corresponded to a similar fluctuation of motor activity. The maximum probability of spike-and-wave patterns occurred at a relatively narrow range of delta power (0-3.1 Hz) of the background EEG activity. Systemic administration of the adrenergic alpha-2 agonist, clonidine, increased the incidence of spike-and-wave episodes several-fold. The total duration of spike-and-wave episodes in the clonidine sessions (15 min) and night sessions (12 h test) correlated significantly. We suggest that several genes interact with maturational, environmental and endocrine factors, resulting in sex differences, and produce the variety of EEG and behavioral findings encountered. In addition, we submit that the clonidine test may be useful in genetic investigations of human absence epilepsies. The findings of this work demonstrate that genetic manipulation of rodents is a promising method for producing analogous models for the various forms of human absence epilepsies.

Distributed changes in rat brain DNA synthesis with long-term habituation and potentiation of the perforant path-granule cell synapse

The involvement of brain deoxyribonucleic acid (DNA) synthesis in adaptive neural events was studied in the adult rat during long-term habituation (LTH) or potentiation (LTP) of the perforant path-granule cell synapse. Male Long-Evans rats were given 50 muCi [3H]thymidine intraventricularly under urethane anesthesia. Soon thereafter, field excitatory postsynaptic potential (EPSP) slope and population spike were monitored from the right dentate gyrus before and at various times (5, 10, 15, 60 min) following the delivery to the ipsilateral perforant bundle of a low frequency (LFS: 1.0 Hz, 160 s) or a high-frequency train (HFS: 400 Hz, 200 ms), repeated once after 5 min. Unstimulated implanted rats served as controls. DNA synthesis was evaluated by the incorporation of the radioactive precursor into DNA of several brain areas at the end of a 1 h incorporation period. In CA1, LTH and LTP increased DNA synthesis by 30% on the stimulated side. In the entorhinal cortex, LTH but not LTP increased DNA synthesis (by 30%) on the stimulated side. Conversely, in the frontal cortex, LTP but not LTH increased DNA synthesis (by 100%) on both sides. Long-lasting changes in synaptic efficacy covaried non-linearly with DNA synthesis in mono- and polysynaptically stimulated hippocampal regions, and in functionally associated neocortical areas. The co-variations of population spike amplitude were positive for LTH and negative for LTP in the dentate gyrus and frontal cortex of both sides, and in CA3/CA1 of the stimulated side, indicating higher DNA synthesis at lower values of LTH and LTP, and viceversa. Further, regional cross-correlation analyses revealed a high degree of synchronization among brain sites, following low- or high-frequency train pulses, indicating that (i) extra-target sites participate on the stimulated and on the contralateral side, and (ii) small distributed changes take place across the sampled neural networks. A modulatory role of information flow on brain DNA synthesis is inferred to take place in a diffuse, distributed manner.