Faculty Bibliography

BACKGROUND:Biofilms represent a complex milieu of matrix-enclosed microorganisms, which can significantly contribute to the pathology of chronic wounds. In this study, we compare the activity of 3 commercial antimicrobial wound care solutions, Vashe (HOCl based), PhaseOne (HOCl based), and Sulfamylon (mafenide acetate), for their in vitro activity against bacterial and fungal biofilms. METHODS:Reference and clinical isolates of 6 Gram-negative bacterial species (36 total strains), 3 Gram-positive bacteria (21 strains), and 3 Candida species (9 strains) were used to create biofilms. Various working concentrations of the 3 antiseptic agents were incubated with the biofilms in microwell plates; they were monitored from 1 minute to 24 hours to compare bacterial and fungal viability through colony forming unit analysis. RESULTS:Vashe and PhaseOne displayed excellent bactericidal and fungicidal activity, whereas Sulfamylon demonstrated minimal activity against the biofilms tested. With the exception of Candida albicans, all biofilms were eliminated at either 1 or 10 minutes using Vashe and PhaseOne solutions. In most cases, mafenide was unable to eliminate both bacterial and fungal biofilms, even with 24 hours of treatment. CONCLUSIONS:Biofilms represent a major clinical challenge, with no clear consensus for treatment of chronic wounds or prosthetic devices. Our results suggest that hypochlorous acid-based wound solutions such as Vashe and PhaseOne are more efficacious than mafenide in eliminating bacterial and fungal biofilms. Further studies are necessary to investigate and compare the in vivo efficacy of these products in clinical care.

BACKGROUND: The pectoralis major muscle flap is a versatile reconstructive option for deep sternal wound infections (DSWI). The timing and surgical technique of bilateral pectoralis major muscle advancement flaps versus unilateral pectoralis major muscle turnover and unilateral pectoralis major muscle advancement flap on patient outcomes remain to be elucidated. The purpose of this investigation was to compare timing, immediate versus delayed reconstruction, and the surgical technique in patients with deep sternal wounds infections on patient outcomes. METHODS: A retrospective review of patients who underwent sternal reconstruction with pectoralis major muscle was conducted. Patients diagnosed with DSWI after undergoing cardiac surgery were included for analysis. Patients were divided by flap timing and flap type for analyses. Bivariate tests were performed to compare patient clinical characteristics. Outcomes of interest were rates of postoperative complications, same admission mortality, reoperation, readmission, operating room time, and length of stay. RESULTS: = 0.019). CONCLUSION/CONCLUSIONS: Patients who underwent pectoralis major muscle advancement flaps had lower incidence of tissue necrosis. Furthermore, the timing of immediate sternal reconstruction was associated with a decreased hospital length of stay.

Treatment of large bone defects is a challenging clinical situation that may be benefited from cell therapies based on regenerative medicine. This study was conducted to evaluate the effect of local injection of bone marrow-derived mesenchymal stromal cells (BM-MSCs) or adipose tissue-derived MSCs (AT-MSCs) on the regeneration of rat calvarial defects. BM-MSCs and AT-MSCs were characterized based on their expression of specific surface markers; cell viability was evaluated after injection with a 21-G needle. Defects measuring 5 mm that were created in rat calvaria were injected with BM-MSCs, AT-MSCs, or vehicle-phosphate-buffered saline (Control) 2 weeks post-defect creation. Cells were tracked by bioluminescence, and 4 weeks post-injection, the newly formed bone was evaluated by µCT, histology, nanoindentation, and gene expression of bone markers. BM-MSCs and AT-MSCs exhibited the characteristics of MSCs and maintained their viability after passing through the 21-G needle. Injection of both BM-MSCs and AT-MSCs resulted in increased bone formation compared to that in Control and with similar mechanical properties as those of native bone. The expression of genes associated with bone formation was higher in the newly formed bone induced by BM-MSCs, whereas the expression of genes involved in bone resorption was higher in the AT-MSC group. Cell therapy based on local injection of BM-MSCs or AT-MSCs is effective in delivering cells that induced a significant improvement in bone healing. Despite differences observed in molecular cues between BM-MSCs and AT-MSCs, both cells had the ability to induce bone tissue formation at comparable amounts and properties. These results may drive new cell therapy approaches toward complete bone regeneration.

This study sought to compare patient demographics, operative course, and peri-operative outcomes between unilateral and bilateral cleft patients. Primary cleft lip repairs were isolated from the National Surgical Quality Improvement Program Pediatric Database (NSQIP-P). Unilateral and bilateral cases of primary cleft lip were identified by ICD codes. Demographics, comorbidities, and post-operative outcomes were compared between cohorts. Patients were propensity matched to control for differences before repeating the analysis. About 4550 cleft lip repairs were evaluated over the 5-year period. Of the cases where the cleft type was identifiable, 75.5% were unilateral clefts and 24.5% were bilateral clefts. The bilateral cleft population had significantly more comorbidities including higher rates of ventilator dependence (1.0% versus 0.4%, p = 0.02), asthma (1.6% versus 0.7%, p = 0.011), tracheostomy (1.6% versus 0.5%, p < 0.001), gastrointestinal disease (16.9% versus 12.7%, p < 0.001), previous cardiac surgery (3.6% versus 2.2%, p = 0.015), developmental delay (9.9% versus 4.6%, p < 0.001), structural central nervous system abnormalities (5.0% versus 2.5%, p < 0.001), and nutritional support (8.0% versus 3.2%, p < 0.001). Following propensity matching, there were no significant differences in complications, readmissions, or reoperations between the cohorts. Patients with bilateral cleft lip have significantly more comorbidities than unilateral cleft lip patients. However, peri-operative outcomes are comparable between the groups.

Neutrophil elastase is a serine protease that has been implicated in the pathogenesis of inflammatory bowel disease. Due to post-translational control of its activation and high expression of its inhibitors in the gut, measurements of total expression poorly reflect the pool of active, functional neutrophil elastase. Fluorogenic substrate probes have been used to measure neutrophil elastase activity, though these tools lack specificity and traceability. PK105 is a recently described fluorescent activity-based probe, which binds to neutrophil elastase in an activity-dependent manner. The irreversible nature of this probe allows for accurate identification of its targets in complex protein mixtures. We describe the reactivity profile of PK105b, a new analogue of PK105, against recombinant serine proteases and in tissue extracts from healthy mice and from models of inflammation induced by oral cancer and Legionella pneumophila infection. We apply PK105b to measure neutrophil elastase activation in an acute model of experimental colitis. Neutrophil elastase activity is detected in inflamed, but not healthy, colons. We corroborate this finding in mucosal biopsies from patients with ulcerative colitis. Thus, PK105b facilitates detection of neutrophil elastase activity in tissue lysates, and we have applied it to demonstrate that this protease is unequivocally activated during colitis.

Surgical site infections represent one of the most common postoperative complications in patients undergoing aesthetic surgery. As with other postoperative complications, the incidence of these infections may be influenced by many factors, and varies depending on the specific operation performed. Understanding of the risk factors for the development of these infections is critical since careful patient selection and appropriate perioperative counselling will set the right expectations, and can ultimately improve patient outcomes and satisfaction. Various perioperative prevention measures may also be employed to minimize the incidence of these infections. Once the infection occurs, prompt diagnosis will allow management of the infection and any associated complications in a timely manner to ensure patient safety, optimize the postoperative course and avoid long-term sequelae.

OBJECTIVE/UNASSIGNED:To determine, for intervention development, the psychosocial needs of adolescents diagnosed with a craniofacial condition who attended focus group sessions. DESIGN/UNASSIGNED:A mixed-methods design combining qualitative focus groups with quantitative measures. SETTING/UNASSIGNED:An outpatient clinic at a major medical center in Manhattan, New York. PARTICIPANTS/UNASSIGNED:Fourteen adolescents, aged 14 to 18, with craniofacial conditions. MAIN MEASURES/UNASSIGNED:Participants completed measures assessing a range of psychological constructs. Average scores were compared to clinical cutoff scores and normative data for adolescents. The 2 focus groups were coded using an inductive approach to assess pertinent themes. Additionally, the acceptability and feasibility of a proposed intervention was measured. RESULTS/UNASSIGNED:Adolescents with craniofacial conditions were within normal ranges for quality of life, self-esteem, and body image and they reported higher resiliency. They were above cutoff scores for perceived stress and post-traumatic stress disorder symptoms and below cutoff scores for mindfulness. When compared to normative samples, they displayed higher perceived social support, but lower coping. Based on qualitative analyses, 6 themes emerged: stress, bullying, coping, resiliency, mindfulness, and social support. Both qualitative and quantitative analyses revealed most participants were supportive of a future intervention for this population. CONCLUSIONS/UNASSIGNED:The present study identified several factors associated with psychological well-being of adolescents with craniofacial diagnoses and demonstrates the importance of creating interventions to target specific psychosocial needs. Findings from this study may guide researchers in developing and refining a specific program for this population and provide information to help those with craniofacial conditions who are experiencing psychosocial challenges.

Purpose: Currently, indications and algorithms for oral and dental clearance prior to transplant and cardiac surgeries can be cryptic for referring surgical teams. Care coordination and timing is often suboptimal. Our group has subsequently devised an algorithm for patients to receive oral health clearance prior to relevant surgical and medical therapies, streamlining the process for the patient, referring transplant team, and dental/OMFS team.
Background(s): In a multitude of health circumstances, patients are asked to receive pre-treatment oral health clearance. Related literature on efficacy and appropriate delivery is often sparse and/or inconclusive. Patients planned for cardiac surgery, solid organ transplant, bone marrow transplant, radiation therapy, and immunologic drugs are often asked to procure dental evaluation and "clearance" prior to treatment. Arguably, the most vulnerable populations include heart transplant patients, whom are also placed on postsurgical immune-suppressive therapy, and those undergoing cardiac valve replacement, at risk for subsequent endocarditis. These patient groups often present with poor dentition, notably including periodontitis and apical periodontitis, which both have been associated with postoperative infections and unfavorable surgical outcomes.
Method(s): Our group has developed a presentation to be delivered to an interdisciplinary group of physicians, nurse practitioners, and physician assistants, comprising teams of cardiothoracic surgery, transplant surgery, hematology-oncology, radiation oncology, and internal medicine. The goals are to increase knowledge about dental clearance's importance, and to expedite the process of receiving care. Additionally, the authors have developed a corresponding "dental pathway" within our hospital's electronic medical record (EMR) system to expedite clearance, as well as to increase compliance with presurgical dental clearance. Topics discussed in the presentation include pathways of transmission, the clearance process for inpatients, the separate process for clearance in outpatients, as well as a discussion on what occurs during a clearance visit.
Conclusion(s): The presentation created aims to increase interdisciplinary health care providers' background on oral health clearance. A topic that is often esoteric to other medical providers, the authors have devised a simple avenue to provide insight into the topic. Furthermore, our EMR pathway will provide coordinated collaboration between medical and dental providers, hopefully fostering effective and efficient oral health clearance prior to relevant surgical therapies. References: 1. Allareddy V, Elangovan S, Rampa S, et al. Presence of Gingivitis and Periodontitis Significantly Increases Hospital Charges in Patients Undergoing Heart Valve Surgery. J Mass Dent Soc. 2015; 63: 10-16. 2. Goldman KE. Dental Management of Patients with Bone Marrow and Solid Organ Transplantation. Dental Clinics of North America. 2006:659-676. 3. Meyur U, et al. Heart Transplants - Assessment of Dental Procedures. Clinical Oral Investigations. 1999 Jun;(3)2:79-83. 4. Souza AF, et al. Dental Management for Patients Undergoing Heart Valve Surgery. Journal of Cardiac Surgery. 2017;32:627-632. 5. Strojan P, et al. Treatment of Late Sequelae After Radiotherapy for Head and Neck Cancer. Cancer Treat Rev. 2017 September;59:79-92. 6. Smith MM, et al. Morbidity and mortality associated with dental extraction before cardiac operation. Ann Thorac Surg, 97 (2014), pp. 838-844. 7. Sollecito, Thomas P., et al. The Use of Prophylactic Antibiotics Prior to Dental Procedures in Patients with Prosthetic Joints. The Journal of the American Dental Association, vol. 146, no. 1, 2015,. [Figure presented] [Figure presented] [Figure presented]
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The technical feasibility and clinical applicability of facial transplantation (FT) have been demonstrated, yet animal models with different technical nuances and allograft compositions continue to be developed. We sought to provide a comprehensive appraisal of the current scope and value of animal models in FT.