Journals
2025 EN
Ackermans Leanne L. G. C. · Stokroos Jasper C. · Van Dijk David P. J.
+7 more
ABSTRACT Background Polytrauma patients with an Injury Severity Score (ISS) ≥ 16 have a high mortality rate. Early identification of patients at risk of mortality is key. Different risk stratification models are available; however, body composition on third lumbar computed tomography (L3 CT) is not routinely used. The aim of this study is to determine the effect of CT body composition on 1‐year mortality in adult polytrauma patients. Methods Body composition analysis (L3 CT) was performed on 593 adult polytrauma patients. The associations with 1‐year mortality were assessed using uni‐ and multivariable logistic regression analysis. As a sensitivity analysis, 1‐year mortality was analysed using Kaplan–Meier survival curves, log‐rank tests and Cox regression. Results The study population was predominantly male (69.5%), with a mean age of 55 (±20) years and an average BMI of 25.34 kg/m 2 (±4.07). Comorbidities were present in 327 (55.4%) patients, with an average Charlson Comorbidity Index (CCI) of 2.07 points (±2.1). The mean ISS score was 27.59 (±11.06); 323 (54.5%) patients had an ISS ≥ 25 points. Age, CCI, ISS, skeletal muscle index and skeletal muscle radiation attenuation (OR 1.053, 5.713, 3.711, 0. 563 and 0.533, respectively; p < 0.001), subcutaneous adipose tissue radiation attenuation (SATRA OR 1.253, p = 0.028) and visceral adipose tissue index (OR 1.242, p = 0.038) were significantly associated with 1‐year mortality. In multivariable logistic regression, age, ISS and SATRA remained statistically significantly associated with 1‐year mortality (OR 1.062, p < 0.001; OR 4.761, p < 0.001; OR 1.396, p = 0.009). Conclusions This study demonstrated that subcutaneous adipose tissue radiation attenuation on emergency trauma CT scans is significantly associated with 1‐year mortality in adult polytrauma patients. Additionally, we found a significant effect of age and ISS on 1‐year mortality. Incorporating body composition analysis could lead to a better selection of patients at risk for 1‐year mortality and aid in treatment decision‐making.
Journals
2025 EN
Haehling Stephan · Langer Henning T. · Heymsfield Steven B.
+2 more
ABSTRACT In December 2024, the Society on Cachexia and Wasting Disorders (SCWD) hosted a Regulatory and Trial Update Workshop in Washington, D.C., bringing together experts from academia, industry, and the US Food and Drug Administration (FDA). This article summarizes key topics discussed during the meeting, including diagnostic challenges, emerging assessment methods, and trial endpoints. The D 3 ‐creatine dilution technique was highlighted as a promising tool for evaluating muscle mass. Additionally, the workshop addressed variability in computed tomography‐based lumbar skeletal muscle index measurements, emphasizing sources of variation at the instrument, imaging, and reader levels, as well as biological and clinical fluctuations. Discussions also focused on clinical trial endpoints for sarcopenia, particularly validated physical performance measures such as the Short Physical Performance Battery (SPPB), habitual gait speed, stair‐climb tests, and the 6‐min walk test. Furthermore, novel therapeutic approaches were explored, including 20‐hydroxyecdysone, enobosarm, anamorelin, ponsegromab, and nutritional supplementation, alongside broader strategies targeting myostatin‐activin signalling inhibition and Akt pathway activation. During the meeting, it was made clear that from a regulatory treatment development standpoint, clinically meaningful changes in patient‐reported outcomes, physical function and/or morbidity/mortality need to be shown. If the latter is not an efficacy endpoint, safety needs to be documented. Given that the population that may be addressed in aging associated sarcopenia is vast, the safety requirement standards applied for studies may be equivalent to those of studies in type 2 diabetes mellitus. Some argued at the meeting that this would make study programs so large that from an economic standpoint only therapies that significantly impact on morbidity/mortality outcomes have a chance to be considered commercially feasible for development.
Journals
2025 EN
Nie Xin · Sun Yan · Dijk David P. J.
+6 more
ABSTRACT Background Body composition alterations such as skeletal muscle (SM) loss in cancer patients are associated with poor survival. In turn, immune cell‐driven pathways have been linked to muscle wasting. We aimed to investigate the relationship between body composition, tumour‐infiltrating lymphocytes and survival in patients with advanced lung cancer. Methods We studied 200 patients with advanced lung cancer receiving immunotherapy ( n = 81) or non‐immunotherapy regimens ( n = 119). Body composition including SM index (SMI) at baseline and longitudinal changes were assessed using computed tomography (CT) scans at the third lumbar vertebra. Associations between body composition parameters and overall survival (OS) were evaluated using Cox regression analysis. The median value of SMI, stratified by sex, was used as the cut‐off to define groups with high and low baseline SMI. Stable SMI was defined by any increase or < 2% decrease per 100 days; loss of SMI was defined by ≥ 2% decrease per 100 days. Logistic regression analysis was applied to investigate the association between SMI and peripheral circulating immune cells. Tumour‐infiltrating lymphocytes were identified by immunohistochemistry, and their relationship with SMI was evaluated. Results SMI loss was associated with shorter OS (whole cohort: HR = 2.314, 95% CI = 1.388–3.858, p = 0.001; immunotherapy cohort: HR = 3.028, 95% CI = 1.113–8.236, p = 0.03; non‐immunotherapy cohort: HR = 2.298, 95% CI = 1.191–4.435, p = 0.013). Low baseline SMI was associated with higher CD3 + T cell abundance (OR = 1.240, 95% CI = 1.080–1.424, p = 0.002) but lower CD3 + CD8 + T cell abundance (OR = 0.862, 95% CI = 0.762–0.974, p = 0.018) in peripheral blood. Subsequent SMI loss during treatment was also significantly associated with higher CD3 + T cell counts (OR = 3.414, 95% CI = 1.301–8.961, p = 0.013) and lower CD3 + CD8 + T cell abundance (OR = 0.666, 95% CI = 0.459–0.968, p = 0.033). Patients with stable SMI had a higher number of CD8 + tumour‐infiltrating lymphocytes than patients with SMI loss (15.4% vs. 7.9%, p = 0.036). Conclusion SM loss is an independent predictor for survival in patients with advanced lung cancer and is associated with reduced peripheral and tumour‐infiltrating cytotoxic T cell abundance. An inadequate antitumour immune response may contribute to metabolic tissue wasting in cancer.
Journals
2025 EN
Haehling Stephan · Sato Ryosuke · Langer Henning
+5 more
ABSTRACT The Society on Cachexia and Wasting Disorders (SCWD) convened a Regulatory and Trial Update Workshop in Washington, D.C., in December 2024, assembling experts from academic institutions, the pharmaceutical industry and the US Food and Drug Administration (FDA) for focused discussions. This article summarizes the latter half of the meeting, which primarily focused on novel anti‐obesity therapies based on incretin pathway alteration. Discussions highlighted the impact of glucagon‐like peptide‐1 (GLP‐1) receptor agonists or GLP‐1/glucose‐dependent insulinotropic polypeptide (i.e., GLP‐1/GIP) agonists on body composition and muscle health; the challenges of distinguishing ‘true’ skeletal muscle from fat‐free tissue; the impact of treatment discontinuation and weight regain; advances in imaging and quantitative assessment of lean body mass; as well as insights from emerging muscle‐preserving therapies (e.g., bimagrumab, pemvidutide and enobosarm). There are significant challenges in defining meaningful structural, functional and patient‐reported endpoints for the use of muscle‐‘protective’ drug therapies in the context of weight loss therapies. These also involve significant regulatory considerations for future drug development and approval pathways, for instance related to the very large number of individuals that may be considered for these therapeutic approaches as well as from the potential long (or life‐long) duration of therapy considered with these drugs. Together, these discussions highlight the growing importance of integrating body composition and functional assessments in future clinical trials.
Journals
2025 EN
Carlson Steven R. · Klein Gregg R. · Cherian Chris
ABSTRACT Patellar clunk syndrome (PCS) is a complication of total knee arthroplasty (TKA) leading to audible and palpable clunking of the patellofemoral joint as the knee is extended out of deep flexion. While historically a clinical diagnosis, some cases require further workup and imaging. Here, we demonstrated the utility of dynamic ultrasound assessment for a patient with clunking after TKA and identified a variant of PCS that is not well described in the literature. Therefore, this case provides considerations for the workup of post‐TKA knee clunking while illustrating unique findings that may contribute to a more challenging diagnosis.
Journals
2025 EN
Irwin Scott P. · Durning Steven J. · Dong Ting
Abstract Purpose To examine the perceived self‐efficacy of dentists who recently completed Graduate Dental Education (GDE) programs and identify how closely it aligns with their supervisors’ assessments of them. Self‐efficacy has been associated with academic pursuits, motivation, and engagement, which may affect how dental providers practice, seek continuing education, and pursue future opportunities. Methods Recent graduates of military GDE programs rated their self‐efficacy on specific tasks within each of the seven domains of dental competencies. Their supervisors completed a similar survey, rating the graduate's performance in the same tasks. Graduates’ mean ratings were calculated for each domain, spearman correlations were calculated for all graduate‐supervisor task ratings, and the magnitude of differences between graduate and supervisor domain means were examined. Results Graduates’ perceived self‐efficacy ranged from 3.57 to 4.41 out of 5.0. Correlations for each task were universally weak (ρ = ‐0.04–0.27). Correlations for domain means were also weak (ρ = 0.06–0.14). Overall, graduates rated themselves lower than their supervisors, with mean differences ranging from ‐0.17 ( p = 0.003, Cohen's d = 0.20) for Professionalism to ‐0.95 ( p < 0.001, Cohen's d = 0.90) for Health Promotion . Conclusions Overall, graduates’ perceived self‐efficacy was moderate to high for 26 tasks across seven domains. However, in aggregate, graduates underestimated their abilities compared to performance measures from their current supervisors, although effect sizes were small. The accuracy of graduates’ self‐efficacy varied by program length and the clinical specialty of their supervisors. High‐performing graduates always underestimated themselves while low‐performing graduates often overestimated themselves.
Journals
2025 EN
Smith Carlos S. · English Shelvia · Quock Ryan L.
+1 more
Abstract The American Dental Education Association (ADEA) embarked upon a path to broadly assess the clinical and learning environments across dental school and allied oral health programs. Assessing clinical learning environments has provided an important opportunity for gaining feedback from learners and team members about their experiences, responding to their needs on an intentional basis and forming context‐specific understanding of and evidence for the impact of curriculum, pedagogical, and even patient care practices. This article presents key highlights of the overall usefulness of climate studies across higher education, corporate environments and health professions education. Moving from dialogue to action, it presents clear recommendations for moving forward and maximizing change efforts toward optimally inclusive, equitable, and ethically‐centered oral health professions education clinical and learning environments.
Journals
2025 EN
Xu Jin · Wang Steven · Yu Wenjing
+4 more
Abstract Objectives With the development of three‐dimensional (3D) image, the 3D virtual surgical planning (VSP) system has been broadly used in the treatment planning of orthodontic–orthognathic cases. This study aimed to understand the current education status regarding the use of orthodontic–orthognathic surgical planning tools in the postgraduate orthodontic and oral and maxillofacial surgery (OMFS) programs in North America. Methods An electronic multiple‐choice survey was sent via email with 2‐week and 1‐month follow‐ups, requesting anonymous participation of program directors/department chairs from all postgraduate orthodontic and OMFS programs in North America. Responses were collected directly on Qualtrics for analysis. Results The response rate was 25.68% for orthodontic and 34.34% for OMFS programs. Two‐dimensional traditional surgical planning (TSP) at initial treatment planning and 3D VSP right before surgery were most commonly utilized in both specialty programs. All responded postgraduate OMFS programs utilized VSP, yet 26.32% of responded orthodontic programs did not utilize VSP. For the surgical outcomes, fewer orthodontic programs were highly satisfied than OMFS programs. More orthodontic programs warranted secondary surgery at a higher rate due to the unsatisfied outcome. Additionally, the orthodontic programs that did not use VSP showed higher unsatisfied surgical outcomes than the programs that used VSP. Moreover, there were discrepancies between orthodontic and OMFS programs regarding the perceived level of collaboration of each other on the surgical planning for the patients. Conclusion There were discrepancies between orthodontic and OMFS programs regarding the utilization of VSP, treatment outcomes satisfaction, and perceived level of collaboration on surgical planning for the patients.
Journals
2025 EN
Inglehart Marita R. · West Karen P. · Stolberg Rebecca
+14 more
ABSTRACT Objectives From January 2020 to the end of August 2020, preliminary research gathered data about the need for and the feasibility of an ADEA‐led joint Climate Study of dental schools and allied dental programs in the United States and Canada. Informed by these findings, the first ever ADEA‐led joint Climate Study took place in 2022. The objectives of this manuscript were to describe the timeline of this climate study and provide information about its methodology, specifically about (a) who participated in this research, (b) what was assessed, (c) how the study was conducted, and (d) how the results were communicated. Methods In 2021, the consulting company Nonprofit HR, members of the ADEA Collaborative on Dental Education Climate Assessment and campus liaisons collaborated on designing the 2022 ADEA‐led Climate Study. Results Between January 1 and March 31, 2022, survey data were collected in the United States ( N = 16,518), Canada ( N = 1042), and Puerto Rico ( N = 145) from 10,281 students, 2591 staff, 4026 faculty, 359 administrators, and 443 administrators with faculty positions in dental schools and allied dental programs. Social identity information about the respondents’ gender identity, ethnicity/race, sexual orientation, and ability status was assessed. Survey questions focused on assessing respondents’ perceptions/experiences with their own institutions’ climate and the degree to which it was inclusive. The questionnaire collected information about their well‐being, sense of belonging and cultural competence, their perceptions/experiences with harassment and discrimination, with their institutions’ diversity, equity, and inclusion‐related programming, activities, and leadership practices. Careful attention was given to how the data were collected and how the results were shared with the participating academic institutions and the dental education community at large. Conclusions Institution‐specific results of this 2022 ADEA Climate Study were shared with the participating dental schools and allied dental programs to provide them with a better understanding of their own cultural climate. This special issue of the Journal of Dental Education provides dental educators with an overview of the results of this first ever ADEA‐led Climate Study of U.S. and Canadian dental schools and allied dental programs.
Journals
2025 EN
TougerDecker Riva · Sabato Emily · Singer Steven R.
+4 more
ABSTRACT Purpose/Objective The prevalence of food insecurity (FI) on university campuses is increasing. This study explored the prevalence of food and nutrition insecurity (NI) among dental students and barriers and interventions to address them. Methods A cross‐sectional web‐based survey was conducted. Validated tools were used to assess FI and NI. Univariate binary logistic regressions and a multivariable logistic regression model identified factors independently associated with FI. Results The response rate was 11.9% ( n = 67). The mean age was 28.4 years; 67% were D1/D2 students; 53.7% were female, 15.2% identified as Hispanic, and 50.7% as White. Forty percent experienced FI; 24.2% had low nutrition security (NS), and 26.9% reported partial or full responsibility for others' living expenses. Twenty‐four percent were married, 25.8% used a food pantry; 11.1% had unsuccessfully applied for Supplemental Nutrition Assistance Program benefits. In the adjusted model, low NS, nonmarried status, and food pantry use increased the likelihood of FI (odds ratios of 16.854, 10.182, and 9.123, respectively). Common barriers and potential interventions to address FI and NI were explored. Conclusions The prevalence of FI in this sample was greater than the national average. Those who were unmarried, had low NS, and used a food pantry were significantly more likely to have FI. Proposed interventions include student services enhancements and curriculum modifications on nutrition and wellness. Further research is necessary with a larger sample to understand factors contributing to NI and FI among dental students.