Faculty Bibliography

While intraosseous tumors of the pediatric sinonasal tract are rare and tend to be slow growing, they can be locally aggressive and have a tendency to recur. Due to the possibility of devastating outcomes secondary to mass effect, it is important for physicians to promptly diagnose and properly manage these tumors. We report an extremely rare case of a desmoplastic fibroma of the ethmoid sinus in a pediatric patient and review its clinical findings, methods of diagnosis, and treatment

Numerous studies have demonstrated that Schwann cells (SCs) play a role in nerve regeneration; however, their role in innervating a bioceramic scaffold for potential application in bone regeneration is still unknown. Here we report the cell growth and functional behavior of SCs on beta-tricalcium phosphate (beta-TCP) scaffolds arranged in 3D printed-lattice (P-beta-TCP) and randomly-porous, template-casted (N-beta-TCP) structures. Our results indicate that SCs proliferated well and expressed the phenotypic markers p75LNGFR and the S100-beta subunit of SCs as well as displayed growth morphology on both scaffolds, but SCs showed spindle-shaped morphology with a significant degree of SCs alignment on the P-beta-TCP scaffolds, seen to a lesser degree in the N-beta-TCP scaffold. The gene expressions of nerve growth factor (beta-ngf), neutrophin-3 (nt-3), platelet-derived growth factor (pdgf-bb), and vascular endothelial growth factor (vegf-a) were higher at day 7 than at day 14. While no significant differences in protein secretion were measured between these last two time points, the scaffolds promoted the protein secretion at day 3 compared to that on the cell culture plates. These results together imply that the beta-TCP scaffolds can support SC cell growth and that the 3D-printed scaffold appeared to significantly promote the alignment of SCs along the struts. Further studies are needed to investigate the early and late stage relationship between gene expression and protein secretion of SCs on the scaffolds with refined characteristics, thus better exploring the potential of SCs to support vascularization and innervation in synthetic bone grafts.

The pharmacological effect of opioids originates, at the cellular level, by their interaction with the mu-opioid receptor (mOR) resulting in the regulation of voltage-gated Ca2+ channels and inwardly rectifying K+ channels that ultimately modulate the synaptic transmission. Recently, an alternative six trans-membrane helix isoform of mOR, (6TM-mOR) has been identified, but its function and signaling are still largely unknown. Here, we present the structural and functional mechanisms of 6TM-mOR signaling activity upon binding to morphine. Our data suggest that despite the similarity of binding modes of the alternative 6TM-mOR and the dominant seven trans-membrane helix variant (7TM-mOR), the interaction with morphine generates different dynamic responses in the two receptors, thus, promoting the activation of different mOR-specific signaling pathways. We characterize a series of 6TM-mOR-specific cellular responses, and observed that they are significantly different from those for 7TM-mOR. Morphine stimulation of 6TM-mOR does not promote a cellular cAMP response, while it increases the intracellular Ca2+ concentration and reduces the cellular K+ conductance. Our findings indicate that 6TM-mOR has a unique contribution to the cellular opioid responses. Therefore, it should be considered as a relevant target for the development of novel pharmacological tools and medical protocols involving the use of opioids.

PURPOSE: Melanoma, the skin cancer with the lowest incidence, causes the majority of all skin cancer-related deaths. Early detection has led to the discovery of melanoma at less advanced stages, thus shifting the reconstructive paradigm from sole survivorship to the improvement of function and cosmesis while still maintaining an overall adequate outcome. Reconstructive approaches rely on two main factors: location of the lesion and size of the lesion. Due to the complexity of the hand, reconstructive options are quite heterogeneous. The purpose of this study is to explore the clinical data and reconstructive strategies of hand and digital cutaneous melanoma and subungual melanoma, review the current reconstructive options presented in the medical literature, and offer a reconstructive algorithm to surgically approach primary melanoma of the hand. METHODS: A retrospective chart review was conducted for all patients undergoing oncologic resection of primary melanoma of the hand at New York University Langone Medical Center (NYULMC) between April 2003 and October 2011. Variables collected included age, race, gender, type of melanoma, Breslow depth, stage, oncologic resection, reconstructive surgery, and outcomes. RESULTS: A total of 35 patients with primary melanoma of the hand comprised the study cohort. The mean age of presentation was 56 years with a total of 24 women and 11 men. The average Breslow depth of the cohort was 1.58 mm. There were 13 cases of melanoma in situ (MIS). All MIS cases were treated with wide local excision, yet the subungual group needed more extensive reconstruction including paronychial advancement flaps and full-thickness skin grafts (FTSG). Twenty-two cases presented as malignant melanoma. The majority of the patients with cutaneous melanoma underwent wide local excision with primary closure or FTSG. In the subungual group, all patients underwent amputation at the most distal interphalangeal joint or wide local excision. The reconstruction consisted of local advancement flaps, FTSG, or primary closure. CONCLUSION: Reconstructive options for primary melanoma of the hand are quite varied without strong guidelines as to which technique is superior. Location, size, and type of lesion (cutaneous or subungual) help shape which reconstructive strategies are optimal. With more conservative oncologic approaches and advanced reconstructive techniques, patients are able to maintain function with a satisfactory degree of cosmesis.

Endosteal dental implants have been utilized as anchors for dental and orthopedic rehabilitations for decades with one of the highest treatment success rates in medicine. Such success is due to the phenomenon of osseointegration where after the implant surgical placement, bone healing results into an intimate contact between bone and implant surface. While osseointegration is an established phenomenon, the route which osseointegration occurs around endosteal implants is related to various implant design factors including surgical instrumentation and implant macro, micro, and nanometer scale geometry. In an implant system where void spaces (healing chambers) are present between the implant and bone immediately after placement, its inherent bone healing pathway results in unique opportunities to accelerate the osseointegration phenomenon at the short-term and its maintenance on the long-term through a haversian-like bone morphology and mechanical properties.