Faculty Bibliography

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.

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.

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.

Implant-based breast reconstruction (IBBR) remains the most common form of post-mastectomy reconstruction worldwide, offering patients a reliable and accessible option to restore breast contour. Advances in surgical technique, biomaterials, and implant technology have driven rapid evolution in the field, with the dual goals of improving aesthetic outcomes and minimizing patient morbidity. The prepectoral plane has been popularized due to the eliminated risk of animation deformity and reduced postoperative pain. Some concerns remain regarding mastectomy flap thickness and long-term oncologic and aesthetic outcomes. Concurrently, nipple-sparing mastectomy has improved aesthetic results and enabled surgeons to move beyond just restoring breast form and improve functional recovery as well, as demonstrated by surgical efforts aimed at restoring nipple-areolar complex (NAC) sensation. Adjunctive use of biologic matrices and synthetic meshes has broadened reconstructive options, while next-generation implants seek to further enhance outcomes. Balanced against these innovations are important oncologic and systemic safety concerns, including breast implant-related cancers and the ongoing debate over breast implant illness (BII). This review highlights eight current "hot topics" in implant-based breast reconstruction: (1) prepectoral reconstruction, (2) nipple-sparing mastectomy, (3) oncoplastic techniques, (4) nipple-areolar complex (NAC) neurotization, (5) biologic matrices and synthetic meshes, (6) next-generation implants, (7) optimizing aesthetic outcomes, and (8) implant-associated cancer and systemic concerns. Together, these areas define the current landscape of innovation, controversy, and future directions in implant-based reconstruction.

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.

Pancreatic ductal adenocarcinoma (PDAC) with extensive peripancreatic vessel involvement is classified as locally advanced pancreatic cancer (LAPC). For this group of patients, the current standard of care does not include considering a potentially curative oncologic resection. However, recent advances in multiagent chemotherapy and surgical techniques are challenging this paradigm. Moreover, the current determination of anatomic resectability is vague and unreliable. Here we propose a definition of local resectability, based on pre- and intra-operative assessment. This anatomic definition of resectability assumes careful patient selection based on tumor biology and patient condition. The pre-operative evaluation of vascular anatomy and tumor involvement is conducted using 3D-rendering of pancreas-protocol computed tomography. Identifying a disease-free arterial or venous segment above and below the tumor involvement ("suitable target") is the single critical factor that determines anatomic resectability. Intraoperative isolation of these target vessels confirms the feasibility of vascular reconstruction before resection. This approach, which focuses on identifying target vessels rather than circumferential involvement, offers a more straightforward and clinically relevant method for assessing surgical eligibility in LAPC patients at centers of excellence. In summary, reconstructability-based on surgical expertise and guided by tumor biology-now defines the modern paradigm of resectability in LAPC.

BACKGROUND:Body contouring surgery (BCS) is a common postoperative trajectory for adults following bariatric surgery, yet research on its application to adolescents is lacking. This scoping review aimed to map the available literature on quality of life (QoL) and potential for BCS in adolescents after bariatric surgery. METHODS:This review followed the Joanna Briggs Institute (JBI) guidance for scoping reviews and is reported in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR). Three electronic databases were queried for studies regarding QoL and BCS in adolescents following bariatric surgery within the last 20 years. A descriptive and thematic analysis was conducted. RESULTS:Twenty-three studies met inclusion criteria. A total of 19 (82.6%) evaluated QoL and 4 (17.4%) explored the role of BCS in adolescents following bariatric surgery. The most common method of data collection was prospective study (65.2%). Two themes were described: QoL after bariatric surgery, which expressed improvement in several domains within 6 months, and role for BCS, which showed high interest in addressing residual excess skin and appearance. Gaps in the literature were identified, including a need for studies exploring mediators of QoL, predictors of compliance, and outcomes of BCS. CONCLUSIONS:Studies describing residual symptoms and BCS in adolescents following bariatric surgery are lacking. BCS may complement bariatric surgery, but further research must be conducted to assess its safety in adolescents. By addressing the research gaps described in this review, physicians may have a better understanding of the needs of this population and how to counsel them. LEVEL OF EVIDENCE AND TYPE OF STUDY/UNASSIGNED:Level IV; Systematic Scoping Review.

BACKGROUND:Congenital palatal fistula (CPF), most often associated with submucous cleft palate (SMCP), is a rare clinical entity. Surgical management is challenging owing to anatomical variation and risk of persistent velopharyngeal insufficiency (VPI). We reported outcomes from a case series of 27 patients with CPF associated with SMCP managed using a standardized institutional algorithm. METHODS:A retrospective review was conducted at CLAPP Hospital, Lahore, from 2015 to 2020. Patients with CPF associated with SMCP were included; acquired fistulae and syndromic cases were excluded. Fistulae were classified using the Pakistan Comprehensive Fistula Classification Scheme. SMCP was further stratified according to the CLAPP Classification and Treatment Algorithm, guiding surgical approach (midline incision, modified Langenbeck, or standard Langenbeck with/without adjunctive procedures). Outcomes included fistula recurrence and speech results. RESULTS:The cohort comprised 27 patients (mean age 9.9 years; range 1-23 years), and 52% were female. Two patients (7.4%) developed postoperative fistula recurrence. Preoperatively, 94% of patients had severe hypernasality (G3). Postoperatively, mean composite speech scores improved by 52.3% (14.9→7.1). Fourteen patients [14/17 (82.4%)] achieved G0/G1 (normal resonance). Younger patients (<12 years) showed greater improvement (90% to G0/G1) compared to older patients (71.4%). No middle-ear sequelae were observed. CONCLUSIONS:A tailored algorithmic approach for CPF associated with SMCP yielded low recurrence (7.4%) and substantial speech improvement. Younger patients demonstrated greater postoperative speech benefit, underscoring the importance of early diagnosis and repair.