Faculty Bibliography

BACKGROUND: Multiple physiologic impairments are responsible for chronic wounds. A cell line grown which retains its phenotype from patient wounds would provide means of testing new therapies. Clinical information on patients from whom cells were grown can provide insights into mechanisms of specific disease such as diabetes or biological processes such as aging. The objective of this study was 1) To culture human cells derived from patients with chronic wounds and to test the effects of putative therapies, Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) on these cells. 2) To describe a methodology to create fibroblast cell lines from patients with chronic wounds. METHODS: Patient biopsies were obtained from 3 distinct locations on venous ulcers. Fibroblasts derived from different wound locations were tested for their migration capacities without stimulators and in response to GM-CSF. Another portion of the patient biopsy was used to develop primary fibroblast cultures after rigorous passage and antimicrobial testing. RESULTS: Fibroblasts from the non-healing edge had almost no migration capacity, wound base fibroblasts were intermediate, and fibroblasts derived from the healing edge had a capacity to migrate similar to healthy, normal, primary dermal fibroblasts. Non-healing edge fibroblasts did not respond to GM-CSF. Six fibroblast cell lines are currently available at the National Institute on Aging (NIA) Cell Repository. CONCLUSION: We conclude that primary cells from chronic ulcers can be established in culture and that they maintain their in vivo phenotype. These cells can be utilized for evaluating the effects of wound healing stimulators in vitro

BACKGROUND: The superficial temporal fascia merits its popularity in reconstructive surgery for its large number of clinical applications. In this report, the authors present their experience with different uses of the superficial temporal fascial flap in facial reanimation. METHODS: Seventeen cases are presented. In 10 patients, the fascial flap provided a vascularized lining at the interface between the free muscle flap for smile restoration and the overlying skin. In six cases, it was utilized to correct small or moderate contour deficits in the paretic hemiface, using either the fascial flap alone or in combination with free adipose tissue. One patient presented with facial paralysis and Frey syndrome following parotidectomy, and the fascial flap was used to control gustatory sweating. Five independent observers graded aesthetic and functional outcomes on a scale from poor to excellent. Three patients were lost to follow-up, so 14 cases were evaluated. RESULTS: Follow-up ranged from 1 to 216 months (47 +/- 60.49 months). The specific reconstructive goal for each patient was achieved and the overall symmetry was greatly improved, with all patients being granted higher scores by the panel of observers following the superficial fascia flap (Wilcoxon matched-pairs signed ranks, p < 0.0001). Transient or permanent alopecia along the temporal incision was the main complication observed. CONCLUSIONS: Transfer of the superficial temporal fascia flap is a valuable technique with several potential applications in facial paralysis management and reconstructive surgery in general. The advantages of this highly vascularized, gliding, and pliable flap far outweigh the associated minimal complications

This study sought to evaluate the sealing capability of the implant abutment connection of different dental implant systems. Five Nobel Replace select, Straumann and Intra-lock implants of approximately 4.5 mm diameter with their respective abutments were provided by the manufacturers. A calibration curve was determined by placing toluidine blue (TB) increments of 0.1 microL into 1.5 mL of distilled water and recording its absorbance in a spectrophotometer until reaching 0.7 microL. Then, 0.7 microL of TB was placed in the deepest portion of each implant's internal screw, the abutments were adapted to the implant according to the manufacturer's instructions and the specimens were placed in vials with 1.5 mL of distilled water. Spectrophotometric analysis was performed at 1, 3, 6, 24, 48, 72, 96 and 144 h. Statistical analysis was performed by One-way anova at 95% level of significance. The calibration curve was linear with respect to the TB amount in 1.5 microL distilled water (R(2) = 0.9961). All implant abutment systems presented an increase in absorbance as a function of time. As time elapsed in vitro, significantly higher amounts of TB was released from the Straumann and Nobel Replace Select connection systems (P < 0.0001). Leakage was significant between the groups. Despite controlled torquing, the seal between the implant body and the abutment could not be maintained in all three of the systems tested.

BACKGROUND: In managing late facial paralysis, association of cross-facial nerve grafting and free muscle transfer proves superior to any other method of mid-face reanimation. Nevertheless, predicting functional recovery remains a struggle, and in a minority of patients, results are deceiving. In this study, cases of fair or moderate outcomes from a free muscle transfer received a segmental temporalis transposition to upgrade the functional and aesthetic results. METHODS: From 1981 to 2007, 153 patients received a free muscle transfer for smile restoration in the authors' center. Of all patients, 72 percent (110 patients) required a third stage of revisions. In 41 cases, mini-temporalis transfer was used to augment moderate outcomes of a free muscle transfer. The exclusion criterion was less than 3 months' follow-up; thus, six patients were not evaluated. Each patient was videotaped at three successive time points (preoperatively, following free muscle transfer, and following mini-temporalis transfer). Five independent observers graded patients' videos using a five-category scale from poor to excellent. RESULTS: In all of the patients, the averaged scores were higher after free muscle transfer in comparison with the preoperative scores (Wilcoxon signed rank test, p < 0.0001). After mini-temporalis transfer, 97.1 percent of the patients had scores that were increased further and 2.8 percent had the same scores. Alopecia along the coronal incision was seen in four patients, and hollowing of the infratemporal fossa was seen in five. CONCLUSION: Analysis of these clinical data supports the use of mini-temporalis transfer as a safe and reliable method of correcting imperfect outcomes following a free muscle transfer for smile restoration

PURPOSE: To perform methylation array analysis of 807 cancer-associated genes using tissue and saliva of oral squamous cell carcinoma (OSCC) patients with the objective of identifying highly methylated gene loci that hold diagnostic and predictive value as a biomarker. Experimental Design: We did the methylation array on DNA extracted from preoperative saliva, postoperative saliva, and tissue of 13 patients with OSCC, and saliva of 10 normal subjects. We identified sites that were highly methylated in the tissue and preoperative saliva samples but not methylated in the postoperative saliva samples or in normal subjects. RESULTS: High quality DNA was obtained and the methylation array was successfully run on all samples. We identified significant differences in methylation patterns between the preoperative and postoperative saliva from cancer patients. We established a gene classifier consisting of 41 gene loci from 34 genes that showed methylation in preoperative saliva and tissue but were not methylated in postoperative saliva or normal subjects. Gene panels of 4 to 10 genes were constructed from genes in the classifier. The panels had a sensitivity of 62% to 77% and a specificity of 83% to 100% for OSCC. CONCLUSIONS: We report methylation array analysis of 807 cancer-associated genes in the saliva of oral cancer patients before and after oral cancer resection. Our methylation biomarker approach shows the proof of principle that methylation array analysis of saliva can produce a set of cancer-related genes that are specific and can be used as a composite biomarker for the early detection of oral cancer