Research Spotlight

Gach, R., Triano, S., Ogola, G.O., da Graca, B., Shannon, J., El-Ansary, D., Bilbrey, T., Cortelli, M. and Adams, J. (2021). “”Keep Your Move in the Tube” safely increases discharge home following cardiac surgery.” Pm r Feb 1. [Epub ahead of print].

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INTRODUCTION: Restrictive sternal precautions intended to prevent cardiac surgery patients from damaging healing sternotomies lack supporting evidence and may decrease independence and increase post-acute care utilization. Data regarding the impact of alternative approaches on safety and outcomes are needed to guide evidence-based best practices. OBJECTIVE: To examine whether an approach allowing greater freedom during activities of daily living than permitted under commonly-used restrictive sternal precautions can safely decrease post-acute care utilization. DESIGN: Before-and-after study, using propensity score adjustment to account for differences in patient clinical and demographic characteristics, surgery type, and surgeon. SETTING: 600-bed acute care hospital. INTERVENTION: Beginning March 2016, our institution replaced traditional weight- and time-based precautions given to patients who underwent median sternotomy with the “Keep Your Move in the Tube” (KMIT) approach for mindfully performing movements involved in the activities of daily living, guided by pain. MAIN OUTCOME MEASURES: We compared sternal wound complications, discharge disposition, 30-day readmission, and functional status between consecutive cardiac surgery patients with “independent” or “modified independent” preoperative functional status who underwent median sternotomy in the 1.5 years before (n = 627, standard precautions group) and after (n = 477, KMIT group) KMIT implementation. RESULTS: The odds of discharge to home, vs to inpatient rehabilitation or skilled nursing facility, was ~3 times higher for KMIT than standard precautions patients (risk-adjusted odds ratio [rOR], 95% confidence interval [CI] = 2.90, 1.95-4.32, and 3.03, 1.57-5.86, respectively). KMIT patients also had significantly higher odds of demonstrating “independent” or “modified independent” functional status on final inpatient physical therapy treatment for bed mobility (rOR, 95%CI = 7.51, 5.48-10.30) and transfers (rOR, 95%CI = 3.40, 2.62-4.42). No significant difference was observed in sternal wound complications (in-hospital or causing readmission) (rOR, 95%CI = 1.27, 0.52-3.09) or all-cause 30-day readmissions (rOR, 95%CI = 0.55, 0.23-1.33). CONCLUSIONS: KMIT increases discharge-to-home for cardiac surgery patients without increasing risk for adverse events and reducing utilization of expensive institutional post-acute care.

Wang, L., Yang, H., Huang, J., Pei, S., Wang, L., Feng, J.Q., Jing, D., Zhao, H., Kronenberg, H.M., Moore, D.C. and Yang, W. (2021). “Targeted Ptpn11 deletion in mice reveals the essential role of SHP2 in osteoblast differentiation and skeletal homeostasis.” Bone Res 9(1): 6.

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The maturation and function of osteoblasts (OBs) rely heavily on the reversible phosphorylation of signaling proteins. To date, most of the work in OBs has focused on phosphorylation by tyrosyl kinases, but little has been revealed about dephosphorylation by protein tyrosine phosphatases (PTPases). SHP2 (encoded by PTPN11) is a ubiquitously expressed PTPase. PTPN11 mutations are associated with both bone and cartilage manifestations in patients with Noonan syndrome (NS) and metachondromatosis (MC), although the underlying mechanisms remain elusive. Here, we report that SHP2 deletion in bone gamma-carboxyglutamate protein-expressing (Bglap(+)) bone cells leads to massive osteopenia in both trabecular and cortical bones due to the failure of bone cell maturation and enhanced osteoclast activity, and its deletion in Bglap(+) chondrocytes results in the onset of enchondroma and osteochondroma in aged mice with increased tubular bone length. Mechanistically, SHP2 was found to be required for osteoblastic differentiation by promoting RUNX2/OSTERIX signaling and for the suppression of osteoclastogenesis by inhibiting STAT3-mediated RANKL production by osteoblasts and osteocytes. These findings are likely to explain the compromised skeletal system in NS and MC patients and to inform the development of novel therapeutics to combat skeletal disorders.

Revilla-León, M., Abaei, D.S., Tittle, A. and Zandinejad, A. (2021). “Additively manufactured implant abutment screw-access guide to remove a cement-retained implant crown: A technique.” J Prosthet Dent.

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A complete digital workflow to remove a cement-retained implant-supported crown by using an additively manufactured implant abutment screw-access guide is described. The existing cone beam computed tomography (CBCT) scan was superimposed on the digital scans of the patient, which facilitated the visualization of the implant abutment screw access and guided the design of the device. Advantages of the technique described include the precise translation of the implant abutment screw access, safe removal of the implant crown, and conservative clinical intervention.

Aljadeff, L., Shrestha, M., Kim, R.Y., Schlieve, T., Williams, F., Wright, J. and Hammer, D. (2021). “A slow-growing anterior maxillary mass.” Oral Surg Oral Med Oral Pathol Oral Radiol.

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A 43-year-old-male with no medical conditions presented to his dentist with a left maxillary swelling present for 1 year. His physical exam revealed a 2-cm × 2-cm, poorly demarcated, firm mass in the left anterior maxilla causing mobility of the associated teeth. He had a bluish discoloration of the anterior maxillary mucosa. A computed tomographic scan demonstrated a homogeneous and uniformly radiolucent, well-defined mass in the left anterior maxilla primarily involving the alveolus and the roots of teeth 7-12. The mass caused expansion and tooth displacement. An incisional biopsy was done and MUC 4 staining was diffusely positive so the diagnosis of low-grade fibromyxoid sarcoma (LGFMS) was made. He underwent wide local excision and reconstruction with a fibula free flap and a three-dimensionally printed, implant-retained prosthesis. The final pathology confirmed the diagnosis of LGFMS, stage pT4aN0M0, with negative margins. The patient had no evidence of recurrence at 1-year follow-up.

Nalliah Bds Mhcm, R.P., Ramaswamy Ph, D.V. and Timothé Dds Mph, P. (2021). “Coaching that helps International Dentists successfully matriculate into Advanced Standing programs in the US.” J Dent Educ.

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One pathway to licensure for Internationally trained Dentists (ITD) in the United States is to complete an Advanced Standing (AS) program. Such programs are competitive—at the University of Michigan, only 2% of applicants are accepted. ITDs also face other barriers to licensure, including high tuition cost, immigration barriers, and cultural differences. [No abstract; excerpt from article].