Faculty Bibliography

Chronic wounds, especially in diabetic patients, pose a significant clinical challenge due to impaired microvasculature and delayed healing. This study presents Exo-Q, a novel thermoresponsive hydrogel formed by co-gelation of engineered Q protein nanofibers with exosomes, a class of vesicular intercellular communication mediators. Exo-Q transitions from a gel to a viscoelastic solution at physiological temperature, enabling localized, topical delivery of exosomes with an initial burst release followed by sustained release. In a diabetic mouse wound model, Exo-Q effectively delivered human bone marrow multipotent stromal cell-derived exosomes directly to the wound bed, where they accumulated in endothelial cells of granulation tissue without detectable systemic distribution. Exosomes produced under stringent and replicable cell culture conditions consistently carried biomacromolecular cargo enriched for miRNAs with validated targets in angiogenesis-associated genes, indicative of their therapeutic potential. Topical application of Exo-Q resulted in extensive neovascularized granulation tissue, significantly accelerating wound closure to levels comparable to non-diabetic wounds. Importantly, the hydrogel's modular design maintained the functional integrity of Q protein nanofibers and exosomes, demonstrating compatibility with full-thickness human wounds. This platform allows for tailored customization to address critical stages of diabetic wound healing while ensuring efficacy at low dosages, potentially enabling patient-administered treatment. By leveraging advanced biomaterials, Exo-Q advances the therapeutic efficacy of exosome-based interventions for diabetic wounds, offering a localized, non-invasive solution to chronic, non-healing wounds. This innovative hydrogel platform represents a modular therapeutic strategy with significant potential for clinical applications in regenerative medicine.

Exosomes, nanoscale extracellular vesicles, have garnered substantial interest in biomedical research owing to their critical roles in intercellular communication, diagnostics, and regenerative therapeutics. Among biomolecules investigated in regenerative medicine, exosomes are one of the most intensively researched. While no clinical trials have yet been conducted to assess their regenerative efficacy in human dental applications, a rapidly growing body of preclinical research highlights their therapeutic potential in oral and maxillofacial regeneration. Dental tissue-derived exosomes, most notably from dental pulp stem cells, periodontal ligament stem cells, gingival fibroblasts, and stem cells from exfoliated deciduous teeth, have shown the ability to promote regeneration of bone, the periodontal ligament and other supporting tissues. Moreover, these exosomes have demonstrated potential roles in modulating orthodontic tooth movement and alleviating temporomandibular joint disorders. Preclinical studies included in this review consistently reported improved bone regeneration outcomes, such as increased bone volume, mineralization, and osteogenic marker expression following exosome application. Importantly, exosomes have also exhibited potent immunomodulatory effects, notably through inhibition of inflammation in bone defects and periodontitis models. The therapeutic versatility of exosomes is further reflected in their application across several fields of dentistry, such as periodontitis therapy, pulp regeneration, alveolar bone regeneration, and immune regulation. The majority of the studies highlighted the anti-inflammatory, pro-angiogenic, and osteoinductive features of exosomes, derived from diverse cellular sources. These promising preclinical outcomes collectively indicate that exosome-based therapies hold strong potential for translation into clinical dental practice, offering a novel, cell-free, and biologically targeted strategy to craniofacial tissue regeneration.

OBJECTIVES/OBJECTIVE:This study aims to explore the application of Fused Deposition Modeling (FDM) as a 3D printing technique for developing endosseous Polyetheretherketone (PEEK) dental implants. Specifically, the primary aim of the study is to systematically investigate the effects of key FDM processing parameters, including thermal conditions, print speed, layer height, build orientation, and post-processing heat treatments, on the mechanical and thermal properties of PEEK implants. By conducting an in-depth analysis, this study aims to establish optimized processing guidelines for the reliable manufacturing of high-performance, clinically viable PEEK dental implants. METHODS:PEEK dental implants were fabricated using FDM with variations in thermal conditions (nozzle, bedplate, and chamber temperatures), print speed, layer height, build orientation, and post-print heat treatments. Mechanical testing (compression and fatigue), detailed thermal characterization using Differential Scanning Calorimetry (DSC), and fractographic analysis were performed. Finite Element Analysis (FEA) was also conducted to understand the implant's load-bearing performance. RESULTS:Nozzle temperature dictates implant resolution, while chamber temperature is a key determinant of implant crystallinity. Interestingly, for PEEK dental implants, all the FDM thermal processing conditions play a crucial role in influencing the part's thermal properties. Moreover, print speed plays an essential role in developing dimensionally accurate high-strength implants. Notably, the fractographic analysis of the failed implants revealed interesting multimodal fracture behavior specific to 3D-printed threaded implants. FEA demonstrates that the implants tend to buckle under load and break at the implant-abutment interface, consistent with experimental results. Furthermore, fatigue testing reveals that PEEK implants, fabricated at a specific build orientation with respect to the bedplate, suffice the Food and Drug Administration durability requirements. SIGNIFICANCE/CONCLUSIONS:These findings underscore the clinical potential of FDM-developed PEEK as a customizable, lightweight, and durable alternative to conventional metallic implants, paving the way for next-generation patient-specific lightweight dental implant solutions.

OBJECTIVE:The aims of this pilot study were to determine whether (1) a modified version of the Robinson-Ho Skin Type Color Bar would identify early, subtle skin tone variations in patients with dark skin tones because of injury, and (2) if the tool was reliable between clinicians. METHODS:This was a prospective, observational cohort study in a surgical intensive care/acute care unit located in an urban, academic hospital. Patients who were ≥18 years old without a skin injury, but with a confirmed dark skin tone based on the modified Robinson-Ho Skin Type Color Bar, were included in the pilot study. RESULTS:The first aim could not be supported because of the lack of patients who developed subtle skin tone changes indicative of a skin injury. Two patients developed a skin injury (deep tissue pressure injury, trauma). These wounds did not manifest as subtle changes, therefore rendering the tool ineffective for these cases. The second aim was supported as inter-rater reliability of the Robinson-Ho Skin Type Color Bar showed moderate agreement between multiple raters. It was also noted that race/ethnicity was not an objective marker for determining skin tone per the tool. CONCLUSIONS:Although the modified Robinson-Ho Skin Type Color Bar was not an effective method to detect subtle skin tone changes indicative of injury because of the 2 wounds that did occur, it was reliable to use between multiple users. The tool also served as an objective marker for determining baseline skin tone.

BACKGROUND:Intestinal ultrasonography (IUS) is increasingly utilised for diagnosing and monitoring IBD. Despite its cost-effectiveness, patient tolerance and suitability for serial bedside assessments, broad adoption has been limited by knowledge gaps in evidence, training and standardisation. AIMS/OBJECTIVE:To summarise key knowledge gaps in the assessment of luminal disease activity, postoperative recurrence, complications, pouch-related disorders and the use of IUS in paediatrics, contrast enhancement, elastography, as well as education, training and future applications involving artificial intelligence. METHODS:We conducted a systematic umbrella review, following PRISMA guidelines, to map the current landscape of high-quality evidence and identify gaps in IUS research relevant to IBD. We searched MEDLINE from inception to February 2025 for systematic reviews, meta-analyses and consensus statements. We extracted data from eligible studies on design, outcomes and identified research gaps. Gaps were categorised by insufficient information, bias, inconsistency or lack of relevant data. RESULTS:Sixty of 507 studies met inclusion criteria. Key gaps included lack of validated and standardised IUS activity indices for Crohn's disease and ulcerative colitis, limited evidence for IUS in post-operative recurrence, paediatric populations and perianal or pouch disease. Data on the use of contrast-enhanced ultrasound and elastography were sparse. Small sample sizes, heterogeneous designs and inadequate follow-up limited most studies. Training, competency assessment and integration of artificial intelligence remain underexplored. CONCLUSIONS:Sizable gaps persist in the evidence base for IUS in IBD. Addressing these gaps through robust, multicentre studies and consensus-driven frameworks is essential to optimise the clinical and research utility of IUS in IBD management.

Full facial vascularized composite allotransplantation (VCA) offers a reconstructive option for patients with severe facial disfigurement who cannot be treated with conventional methods. This article details a surgical protocol for donor procurement of a full facial allograft, focusing on soft tissue with limited bony harvest restricted to the nasal framework, and emphasizes key anatomical landmarks and technical considerations for safe and efficient harvest. The procedure involves dissection of the entire facial soft tissues while preserving the external carotid artery, internal jugular veins and subsequent thyro-linguofacial, and branches of the facial and maxillary nerves to maximize pedicle length for later neurorrhaphy. The protocol describes systematic exposure of the vascular pedicles at their origin in the neck, subperiosteal elevation of the scalp, identification and division of the supraorbital and infraorbital nerves, and preparation of the facial nerve at its root to achieve optimal length. Strategies to minimize ischemia time and ensure allograft integrity are highlighted. This article provides a comprehensive visual guide to the procurement phase of a full soft tissue face allograft and aims to standardize the technique for research application and surgical training in advanced vascularized composite allotransplantation.

BACKGROUND:Whole eye transplantation (WET) has long been looked to as a potential solution for the aesthetic and functional deficits caused by severe ocular pathology and trauma. Here, we describe the first successful combined face and whole eye transplantation (FT/WET), highlighting the logistical, ethical, and technical considerations that enabled this milestone. METHODS:A 46-year-old male with severe facial and ocular deficits underwent multidisciplinary evaluation and was deemed a candidate for FT/WET. Subsequently, a surgical algorithm was developed through rigorous preoperative planning and team based surgical simulations. This process focused on techniques that would allow for efficient graft procurement and inset, while simultaneously limiting trauma to the globe and its adnexa. RESULTS:Longitudinal monitoring demonstrated maintained graft viability throughout the postoperative period. Fluorescein angiography and ICG angiography confirmed robust retinal and choroidal perfusion. Diffusion-weighted MRI revealed structural preservation of the optic tracts, despite inner retinal atrophy. The patient has also experienced significant improvement in facial aesthetics and functionality with no episodes of graft rejection to date. CONCLUSIONS:This case demonstrates the feasibility of addressing deficits once deemed irreparable through advanced surgical techniques, preoperative planning, and multidisciplinary collaboration. Although functional vision recovery has not been observed, this innovation expands the reconstructive options available for patients with severe facial and ocular deficits, paving the way for future advancements in vascularized composite allotransplantation.