Closure of Large Tracheocutaneous Fistula Using Modified Hinge Flap and Deltopectral Flap.

BACKGROUND: Various methods for closing tracheocutaneous fistulas have been reported; however, there is no established consensus. This study reports the successful closure of a large tracheocutaneous fistula using a Modified Hinge Flap and DP flap. METHODS: Between July 2014 and December 2023, four patients underwent a modified hinge flap and DP flap for tracheocutaneous fistula at a single center. RESULTS: The maximum diameter of the fistula was 10-33 mm, the cartilage defect was 1/4-1/2 of the total circumference of the trachea, and no radiation was administered to the neck during the perioperative period. In all cases, postoperative speech and swallowing improved, and none of the patients complained of cosmetic appearance. CONCLUSIONS: The method in this study is simple and allows reliable closure of relatively large tracheocutaneous fistula of 10 mm or more, and we believe that it can be a new treatment method for tracheocutaneous fistula closure.

Evaluating the Effectiveness of a Structural Allograft in Medial Open Wedge High Tibial Osteotomy in Patients With and Without a Lateral Hinge Fracture.

Background: A lateral hinge fracture is a common complication in medial open wedge high tibial osteotomy (MOWHTO) and is associated with delayed union or nonunion. A comparison of outcomes between patients with or without a lateral hinge fracture after MOWHTO with a structural allograft has not been investigated. Purpose: To validate the outcomes of MOWHTO with a structural allograft, especially in the presence of a lateral hinge fracture. Study Design: Case series; Level of evidence, 4. Methods: We conducted a single-surgeon cohort study at a tertiary referral hospital between April 2017 and August 2022 and included patients who had undergone MOWHTO with a structural allograft for isolated medial compartment osteoarthritis with genu varum. We compared the incidence of delayed union or nonunion events and functional scores between patients with a lateral hinge fracture and those without using the Fisher exact test and independent t test. Results: A total of 88 MOWHTO procedures (77 patients) were analyzed. The overall incidence of lateral hinge fractures was 29.5% (n = 26), including type I (n = 20 [22.7%]) and type II (n = 6 [6.8%]). Notably, 42.3% (n = 11) of these fractures had not been detected intraoperatively but during the follow-up visits. The overall Knee Society Score (KSS), Knee Society Score-Function (KSS-F), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were 90.0 ± 10.0, 93.4 ± 10.8, and 93.8 ± 7.1 points, respectively. None of the patients had delayed union or nonunion, and none underwent a reoperation because of bony union problems. The functional scores (KSS, KSS-F, and WOMAC) were not different between patients who had a lateral hinge fracture and those who did not (P > .05). Conclusion: The routine use of a structural allograft was associated with satisfactory outcomes after MOWHTO, regardless of whether there was a lateral hinge fracture.

The Effectiveness of Temporary Hemiepiphysiodesis for Non-idiopathic Coronal Angular Deformity of the Knee in Children: A Comparison of Hinge Eight-Plate and Traditional Eight-Plate.

OBJECTIVE: Temporary hemiepiphysiodesis (TH) is a very common technique for coronal angular deformity of the knee in children, especially non-idiopathic. However, there is currently a dearth of comparative research on the hinge eight-plate (HEP) and traditional eight-plate (TEP). This study aimed to assess the clinical effectiveness and implant-related complication rates of TH using TEP and HEP for non-idiopathic coronal angular deformity, as well as to identify clinical factors affecting correction velocity. METHODS: We retrospectively observed a consecutive series of patients with non-idiopathic coronal angular deformity of the knee who underwent TH using HEP or TEP and completed the deformity correction process from July 2016 to July 2022. According to the kind of eight plates, we divided those patients into the HEP group and the TEP treatment group. Relevant clinical factors, including the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), screw divergence angle (SDA), angle of plate and screw (APS), hinge angle of HEP (HA), and the knee zone location of the lower extremity mechanical axis, were documented. Additionally, deformity correction velocity, complications, and clinical efficacy were assessed. Categorical variables were analyzed using the chi-squared test, Fisher exact test, or Wilcoxon test, while continuous variables were evaluated using the t-test or analysis of variance (ANOVA). RESULTS: There were 29 patients in the HEP treatment group (seven girls and 22 boys) and 33 patients (12 girls and 21 boys) in the TEP treatment group. In all, 91.86% (79/86 knees) of the genu angular deformities were completely corrected, 6.98% (6/86 knees) had the overcorrection condition, and 10.47% (9/86 knees) had screw loosening. The swayback HEP rate was 11.29% (7/62 HEPs), which was related to the screw loosening in the HEP group (p < 0.001). The overall correction velocities and screw divergence angle change speeds in the HEP group were all significantly faster than those in the TEP group (p < 0.05). The initial APS of the HEP implanted was higher than that of TEP (p < 0.01), and multisite changes of APS during deformity correction of the HEP group were smaller than that of the TEP group. CONCLUSION: HEP proved to be an appropriate device for TH for non-idiopathic coronal angular deformities of the knee with high correction velocity in children. Avoiding the occurrence of the swayback phenomenon may reduce the complications of HEP.

Plasmonic Hinge Modes in Metal-Coated Nanolasers.

Plasmonic lasers have traditionally been built on flat metal substrates. Here, we introduce substrate-free plasmonic lasers created by coating semiconductor particles with an optically thin layer of noble metal. This architecture supports plasmonic "hinge" modes highly localized along the particle's edges and corners, exhibiting Purcell factors exceeding 100 and Q-factors of 15-20 near the plasmon resonance frequency. We demonstrate hinge-mode lasing in submicron CsPbBr3 perovskite cubes encapsulated with conformal 15-nm-thick gold shells. The lasing is achieved with 480-nm nanosecond pumping at 10 pJ/µm2 through the translucent gold layer, producing a line width of 0.6 at 538 nm. Their rapidly decaying evanescent fields outside the gold coating show distinct sensitivities to long- and short-range external perturbations. Our results suggest the potential of these novel laser modes for sensing and imaging applications.

Influence of varus-producing distal femur osteotomy correction and hinge width in relation to hinge fractures: Biomechanical study on porcine femora.

BACKGROUND: Hinge fractures in varus-producing distal femoral osteotomies (DFOs) lead to decreased axial and torsional stability. The purpose of this study was to assess (1) which hinge width has a high risk of hinge fracture in DFO for lateral opening wedge (LOW) and medial closing wedge (MCW) osteotomies, (2) which osteotomies allow for greater correction before risking a fracture, (3) whether patient-specific instrumentation (PSI) allows accurate hinge width planning. METHODS: Thirty porcine femoral bones were divided into two groups: LOW, MCW with hinge widths of 5 mm, 7.5 mm, and 10 mm as subgroups. Osteotomies were performed in a PSI-navigated fashion. A force parallel to the longitudinal bone axis was applied in a uniaxial testing machine until a fracture occurred. RESULTS: The maximum correction was 6.7 ± 1.1° for LOW and 13.4 ± 1.9° for MCW (ß0 < 0.001, ß1 = 0.002, ß2 = 0.02, ß3 = 0.005). The relative error of the planned hinge width compared with the actual hinge width was -3.7 ± 12.3% for LOW (P = 0.25) and 12.3 ± 13.1% for MCW (P = 0.003). CONCLUSIONS: Increasing the hinge width allows for greater correction in MCW osteotomies. For LOW osteotomies, a smaller hinge width seems to be advantageous because it allows a greater correction without the risk of hinge fracture. With PSI-guided LOW osteotomies, the planned hinge width could be achieved intraoperatively with greater accuracy than with MCW osteotomies. However, the MCW osteotomy appears to be the preferred option when larger corrections are desired because a larger correction angle can be achieved without the risk of intraoperative hinge fracture.

Improving mass lumping and stiffness parameters of bar and hinge model for accurate modal dynamics of origami structures.

The bar and hinge framework uses truss elements and rotational springs to efficiently model the structural behaviour of origami. The framework is especially useful to investigate origami metamaterials as they have repeating geometry, which makes conventional finite element simulations very expensive due to a large number of degrees of freedom. This work proposes improvements to the parameters of bar and hinge model within the context of structural dynamics, specifically modal analysis under small deformations, which has not been carried out previously in the literature. A range of low-frequency modes involving origami folding and panel bending deformations that can be accurately captured by the bar and hinge framework are identified. Within this range, bar and hinge parameters like the lumped masses and the rotational spring stiffness values are derived using conservation laws and finite element tests. The best among the proposed schemes is found to predict natural frequencies of the considered origami structures to within 10% maximum error, improving the accuracy by more than three times from existing schemes. In most cases, the errors in natural frequencies are less than 5%. This article is part of the theme issue 'Origami/Kirigami-inspired structures: from fundamentals to applications'.

Hypothyroidism Induced by a TSH Receptor Peptide-Implications for Thyroid Autoimmunity.

Background: The "neutral" thyrotropin receptor autoantibodies (N-TSHR-Ab) directed at the TSHR ectodomain's hinge region have been shown to induce thyroid cell damage in vitro. During these earlier studies, we developed a mouse monoclonal antibody (MC1) specific for a peptide (amino acid 322-340) in the region (MC1-Mab) which was able to induce thyroid cell stress and apoptosis when administered in vivo. Methods: In order to examine the effect of in vivo generated N-TSHR-Abs, rather than an acutely administered monoclonal antibody, we immunized Balb/c mice with the hinge region peptide over 18 weeks. Serum TSHR antibodies, specific TSHR hinge region antibodies, serum thyroglobulin (TG) and anti-TG as well as thyroxine and thyrotropin (TSH) levels were examined to evaluate the response to the immunization. Histological examination of the thyroid glands and flow cytometry of spleen T cells, B cells and macrophages were also performed to explore the underlying mechanisms. Results: We found that TSHR-peptide immunized mice developed N-TSHR-Abs against the peptide which resulted in thyroid damage shown by thyroid follicular destruction with follicular cell apoptosis, M1 macrophage infiltration, thyroglobulin release, and induction of thyroglobulin antibodies. This resulted in hypothyroidism with increased TSH levels. Conclusion: This study demonstrated that endogenous neutral antibodies to the TSHR could induce thyroid cell damage from apoptosis and M1 macrophage infiltration and resulted in hypothyroidism.

Real Topological Phonons in 3D Carbon Allotropes.

There has been a significant focus on real topological systems that enjoy space-time inversion symmetry and lack spin-orbit coupling. While the theoretical classification of the real topology has been established, more progress has yet to be made in the materials realization of real topological phononic states in 3D. To address this crucial issue, high-throughput computing is performed to inspect the real topology in the phonon spectrums of the 3D carbon allotropes. Among 1661 carbon allotropes listed in the Samara Carbon Allotrope Database (SACADA), 79 candidates host a phononic real Chern insulating (PRCI) state, 2 candidates host a phononic real nodal line (PRNL) state, 12 candidates host a phononic real Dirac point (PRDP) state, and 10 candidates host a phononic real triple-point pair (PRTPP) state. The PRCI, PRNL, PRTPP, and PRDP states of 27-SG. 166-pcu-h, 1081-SG. 194-42T13-CA, 52-SG. 141-gis, and 132-SG. 191-3,4T157 are exhibited as illustrative examples, and the second-order phononic hinge modes are explored. This study broadens the understanding of 3D topological phonons and expands the material candidates with phononic hinge modes and phononic real topology.

High Rates of Early Septic Failure, but Low Rates of Aseptic Loosening After Revision Total Knee Arthroplasty With Contemporary Rotating-Hinge Prostheses.

BACKGROUND: The purpose of this study was to determine implant survivorship and functional outcomes for revision total knee arthroplasty (rTKA) with contemporary rotating-hinge knee implants. METHODS: A retrospective review identified 115 rTKAs using contemporary rotating-hinge implants from 2014 to 2018 for the treatment of instability (34, 30%), reimplantation after periprosthetic joint infection (PJI) (33, 29%), aseptic loosening (25, 22%), arthrofibrosis (14, 12%), periprosthetic fracture (4, 3%), osteolysis (4, 3%), and femoral component fracture (1, 1%). There were 70 women (61%), and the mean age was 67 years (range, 27 to 94). The mean follow-up was 3 years (range, 2 to 6). Kaplan-Meier analysis and Cox proportional hazard models estimated survivorship. RESULTS: The re-revision rate was 20% (23 of 115) at an average of 18 months postoperatively. Re-revision indications included PJI (n = 14), aseptic loosening (n = 4), arthrofibrosis (n = 2), instability/malalignment (n = 1), femoral stem fracture (n = 1), and hinge mechanism disruption (n = 1). At 2 and 5 years, survivorship free from all-cause re-revision was 86 and 64%, and survivorship free from re-revision for aseptic loosening was 100 and 87%, respectively. Use of a rotating-hinge implant in reimplantation after PJI was a risk factor for subsequent re-revision (hazard ratio = 2.4, P = 0.046). On a radiographic review of unrevised rotating-hinges, there were major radiolucent lines around 2 femoral and 5 tibial components. The mean Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement increased from 43 preoperatively to 60 at 1 year (P < 0.001). CONCLUSIONS: In patients treated with a rotating-hinge implant for rTKA, there were relatively poor 2-year (86%) and 5-year (64%) survivorship free from all-cause re-revision, most commonly due to PJI. Midterm survivorship free from re-revision for aseptic loosening was modest (87%). There should be a goal to mitigate complications in complex rTKAs with rotating-hinge implants, namely PJI.

Rotating Hinge Revision Total Knee Arthroplasty Provides Greater Arc of Motion Gains for Patients Who Have Severe Arthrofibrosis.

BACKGROUND: Arthrofibrosis is a common postoperative total knee arthroplasty (TKA) complication that results in limited range of motion (ROM). There is limited literature on outcomes after revision TKA (rTKA) for arthrofibrosis based on preoperative ROM restriction. The aims of this study were to: (1) examine ROM trajectory after rTKA for arthrofibrosis patients who have severe versus nonsevere limitations; (2) compare ROM gains and final arc of motion (AOM) between severe and nonsevere cohorts; (2a) compare ROM gain in a severe cohort treated with a rotating hinge (RH) versus a non-RH (NRH) construct; and (3) assess the impact of arthrofibrosis severity on patient-reported outcome measures. METHODS: Patients were divided into 2 groups: group A had preoperative ROM < 70° (severe), and group B had preoperative ROM > 70° (non-severe). Patients were assessed clinically using AOM gain, absolute ROM, Knee injury and Osteoarthritis Outcomes Score for Joint Replacement, lower extremity activity scale, and pain scores. Postoperative gains in AOM were compared between both groups. RESULTS: A total of 56 rTKAs (group A (severe): n = 36, group B (non-severe): n = 20) were performed for patients who have postoperative fibrosis. Group B had better ROM at the 1-year time point (group B: 95.9 ± 22.5 degrees versus group A: 83.2 ± 25.7 degrees). Group A had significantly better improvement in absolute AOM than group B (31.1 ± 20.9 versus 11.4 ± 25.0 degrees, P < 0.01). The RH group demonstrated significantly better absolute AOM gain than the NRH group (41.3 ± 19.4 versus 18.3 ± 15.2 degrees, P < 0.001). However, there were no significant differences in patient-reported outcome measures between groups A and B or between RH and NRH groups at the final follow-up. CONCLUSIONS: Final ROM achieved between severe and nonsevere arthrofibrosis groups was similar, and patients who have severe arthrofibrosis can expect greater absolute ROM gains and similar functional outcomes than nonsevere arthrofibrosis patients. The RH rTKAs provided greater AOM gains for patients who have severe arthrofibrosis, with equivalent functional outcomes to non-RH implants. For severe arthrofibrosis patients, RH designs provided twice the overall ROM gain; however, longer follow-up is necessary to determine whether RH designs have inferior overall implant survivorship.

CD19 CAR T cells for B cell malignancies: a systematic review and meta-analysis focused on clinical impacts of CAR structural domains, manufacturing conditions, cellular product, doses, patient's age, and tumor types.

CD19-targeted chimeric antigen receptors (CAR) T cells are one of the most remarkable cellular therapies for managing B cell malignancies. However, long-term disease-free survival is still a challenge to overcome. Here, we evaluated the influence of different hinge, transmembrane (TM), and costimulatory CAR domains, as well as manufacturing conditions, cellular product type, doses, patient's age, and tumor types on the clinical outcomes of patients with B cell cancers treated with CD19 CAR T cells. The primary outcome was defined as the best complete response (BCR), and the secondary outcomes were the best objective response (BOR) and 12-month overall survival (OS). The covariates considered were the type of hinge, TM, and costimulatory domains in the CAR, CAR T cell manufacturing conditions, cell population transduced with the CAR, the number of CAR T cell infusions, amount of CAR T cells injected/Kg, CD19 CAR type (name), tumor type, and age. Fifty-six studies (3493 patients) were included in the systematic review and 46 (3421 patients) in the meta-analysis. The overall BCR rate was 56%, with 60% OS and 75% BOR. Younger patients displayed remarkably higher BCR prevalence without differences in OS. The presence of CD28 in the CAR's hinge, TM, and costimulatory domains improved all outcomes evaluated. Doses from one to 4.9 million cells/kg resulted in better clinical outcomes. Our data also suggest that regardless of whether patients have had high objective responses, they might have survival benefits from CD19 CAR T therapy. This meta-analysis is a critical hypothesis-generating instrument, capturing effects in the CD19 CAR T cells literature lacking randomized clinical trials and large observational studies.

Development of a Fast Positioning Platform with a Large Stroke Based on a Piezoelectric Actuator for Precision Machining.

In this paper, a fast positioning platform (FPP) is proposed, able to meet simultaneously the requirements of large stroke and high frequency response, developed based on a PZT (piezoelectric actuator) and a quad-parallel flexible mechanism, for application in precision machining. The FPP is driven by a high-stiffness PZT and guided by a flexible hinge-based mechanism with a quad-parallel flexible hinge. The proposed quad-parallel flexible hinge mechanism can provide excellent planar motion capability with high stiffness and good guiding performance, thus guaranteeing outstanding dynamics characteristics. The mechanical model was established, the input and output characteristics of the FPP were analyzed, and the working range (output displacement and frequency) of the FPP was determined. Based on the mechanical model and the input and output characteristics of the FPP, the design method is described for of the proposed FPP, which is capable of achieving a large stroke while responding at a high frequency. The characteristics of the FPP were investigated using finite element analysis (FEA). Experiments were conducted to examine the performance of the FPP; the natural frequency of the FPP was 1315.6 Hz, while the maximum output displacement and the motion resolution of the FPP in a static state were 53.13 µm and 5 nm, respectively. Step response testing showed that under a step magnitude of 50 µm, the stabilization times for the falling and rising edges of the moving platform were 37 ms and 26 ms, respectively. The tracking errors were about ±1.96 µm and ±0.59 µm when the amplitude and frequency of the signal were 50 µm, 50 Hz and 10 µm, 200 Hz, respectively. The FPP showed excellent performance in terms of fast response and output displacement. The cutting test results indicated that compared with the uncontrolled condition, the values of surface roughness under controlled conditions decreased by 23.9% and 12.7% when the cutting depths were 5 µm and 10 µm, respectively. The developed FPP device has excellent precision machining performance.

The hinge-1 domain of Flna is not necessary for diverse physiological functions in mice.

INTRODUCTION: The filamins are cytoskeletal binding proteins that dynamically crosslink actin into orthogonal networks or bundle it into stress fibres. The domain structure of filamin proteins is very well characterised, with an N-terminal actin-binding region, followed by 24 immunoglobulin-like repeat units. The repeat domains are separated into distinct segments by two regions of low-complexity known as hinge-1 and hinge-2. The role of hinge-1 especially has been proposed to be essential for protein function as it provides flexibility to the otherwise rigid protein, and is a target for cleavage by calpain. Hinge-1 protects cells from otherwise destructive forces, and the products of calpain cleavage are involved in critical cellular signalling processes, such as survival during hypoxia. Pathogenic variants in FLNA encoding Filamin A, including those that remove the hinge-1 domain, cause a wide range of survivable developmental disorders. In contrast, complete loss of function of this gene is embryonic lethal in human and mouse. METHODS AND RESULTS: In this study, we show that removing filamin A hinge-1 from mouse (FlnaΔH1), while preserving its expression level leads to no obvious developmental phenotype. Detailed characterisation of the skeletons of FlnaΔH1 mice showed no skeletal phenotype reminiscent of that found in the FLNA-causing skeletal dysplasia. Furthermore, nuclear functions of FLNA are maintained with loss of Filamin A hinge-1. CONCLUSION: We conclude that hinge-1 is dispensable for filamin A protein function during development over the murine lifespan.

The effect of osteotomy depth and hinge axis orientation on biplanar surgical accuracy in medial opening-wedge high tibial osteotomy-a deeper understanding by 3D simulations.

Background: Not all surgical osteotomy steps have been properly investigated for their potential impact on surgical accuracy. The main study objective was to investigate the osteotomy parameters that have respectively major and minor impact on coronal and sagittal bony accuracy in medial opening-wedge high tibial osteotomy (MOWHTO). Methods: Three tibias from an existing 3D MOWHTO osteotomy database were chronologically selected based on segmentation quality, tibial plateau size and the presence of tibial varus. The study consisted of three parts: (I) translating the hinge axis in the coronal plane and switching the osteotomy starting point (30-40 mm) and depth, (II) the hinge axis was rotated stepwise by 10° to perform five simulations, (III) the hinge axis was rotated in the axial plane stepwise by 10° towards anterolateral to perform four simulations (0°, +10°, +20°, +30°). The medial proximal tibial angle (MPTA) and lateral tibial slope were the primary outcomes. Simulations were performed with 5, 10 and 15 mm gap distraction. Results: In the coronal plane, maximum difference in osteotomy depth was 10 mm which represented an MPTA difference of 0.8°-1.1° in 10 mm gap distraction and 1.2°-2.0° in 15 mm gap distraction. Tibial slope remained unchanged. Rotating the hinge axis in the sagittal plane delivered minor changes on both MPTA (<0.5°) and tibial slope (<1.5°) at 10 mm gap distraction. Per 10° of axial rotation of the hinge axis towards anterolateral, the tibial slope increased by 1.0°-1.3° in 10 mm gap distraction while the MPTA remains nearly unchanged. Conclusions: The study showed that the medio-lateral osteotomy length is the main parameter for obtaining bony accuracy in the coronal plane and maintaining a strict perpendicular axial hinge axis position is crucial in preserving the native tibial slope. Correct axial alignment of the hinge axis can be obtained by creating an equal osteotomy depth of the anterior and posterior tibial cortices in the lateral metaphyseal area.

A structural peculiarity of Antarctic fish IgM drives the generation of an engineered mAb by CRISPR/Cas9.

IgM is the major circulating Ig isotype in teleost fish, showing in Antarctic fish unique features such as an extraordinary long hinge region, which plays a crucial role in antibody structure and function. In this work, we describe the replacement of the hinge region of a murine monoclonal antibody (mAb) with the peculiar hinge from Antarctic fish IgM. We use the CRISPR/Cas9 system as a powerful tool for generating the engineered mAb. Then, we assessed its functionality by using an innovative plasmonic substrate based on bimetallic nanoislands (AgAuNIs). The affinity constant of the modified mAb was 2.5-fold higher than that obtained from wild-type mAb against the specific antigen. Here, we show the suitability of the CRISPR/Cas9 method for modifying a precise region in immunoglobulin gene loci. The overall results could open a frontier in further structural modifications of mAbs for biomedical and diagnostic purposes.

Hinge Craniotomy for Posterior Cranial Vault Expansion: Using the Keel to the Surgeon's Advantage.

Cranial vault reconstructions are a common craniofacial procedure utilized to treat chronically elevated intracranial pressure and its sequelae for children with craniosynostosis. These surgeries often involve split-thickness autologous grafts to facilitate intracranial volume expansion. The hinge craniotomy was developed by neurosurgeons in the early 2000s as an alternative to the hemicraniectomy to allow for greater space and simplified re-securing of the bone flap. In our report, we introduce a novel application of hinge craniotomy in total cranial vault reconstruction for a pediatric patient with microcephaly secondary to congenital cytomegalovirus infection. We performed bilateral barrel stave cuts to the occipital bone as well as an undercut along the midline keel to form a hinge craniotomy. Complex reconstruction followed to augment intracranial volume and restructure the cranial vault. This technique maximized intracranial volume expansion while minimizing the need for prolonged reconstruction. It also allowed for retained vascularization of the bone flap by maintaining the connection with the intact cranial base and pericranium to further support bony healing. Our study presents a novel utilization of hinge craniotomy, using the occipital keel as a natural hinge, to create ample space during cranial vault reconstruction. This technique offers potential advantages in terms of intracranial volume expansion and bony healing.

An Innovative Approach for Management of Unfavorable Bilateral Mandibular Lingual Undercuts With Collapsible Type Complete Denture: A Case Report.

Advanced and uneven residual ridge resorption in mandibular edentulous arches leads to non-retentive and unstable dentures. The hardness of traditional heat-cured acrylic resin makes extending the denture base into bilateral lingual undercuts challenging. This can cause supporting tissue damage, pain, and ulcerations during denture insertion and removal. Although clinical challenges related to limited mouth opening were addressed by modifying the impression technique, incorporating hinges, swing lock attachments, and stainless-steel posts to form collapsible denture bases, there are no documented case reports with proper follow-up regarding the use of such type dentures in cases of mandibular lingual undercuts. A 68-year-old male patient reported, with the chief complaint of missing teeth in the upper and lower jaws for five years and wanting replacement. The intraoral clinical examination yielded findings of a severely compromised mandibular ridge (ACP Class IV) and a moderately compromised maxillary ridge (ACP Class II). In the maxillary arch, the presence of anterior labial undercut, and bilateral undercuts lateral to tuberosity were evident. The patient reported pain on palpation bilaterally in the tuberosity region. Prolonged mandibular edentulism and uneven bone resorption resulted in unfavorable bilateral lingual undercuts, with class III (M.M. House) border tissue attachment in the labial and buccal aspects of the basal tissue area. After enumerating the treatment options, the patient opted for a removable prosthesis for the maxillary and mandibular arch. Pre-prosthetic surgery was done to eliminate tuberosity undercuts. Since the patient was unwilling to take up pre-prosthetic surgical corrections for the mandibular lingual undercuts, a significant challenge emerged: creating a retentive mandibular complete denture without compromising the peripheral seal and retention. A conventional complete denture was fabricated after blocking the unfavorable undercut and reducing the height of the flange. On the recall appointment, the patient complained of reduced retention and food lodgment in the intaglio surface of the denture and pain due to denture movement on mastication. In this case report, stainless steel hinges have been added to the lingual flange of the mandibular complete denture to make it collapsible. The resultant denture facilitated reduced tissue trauma and discomfort during denture removal and insertion and had satisfactory retention and stability compared to the former denture. These collapsible type dentures can be used as an alternative to flexible dentures, wherein patients can't afford surgeries or flexible dentures.

Towards Design Optimization of Compliant Mechanisms: A Hybrid Pseudo-Rigid-Body Model-Finite Element Method Approach and an Accurate Empirical Compliance Equation for Circular Flexure Hinges.

Innovative designs such as morphing wings and terrain adaptive landing systems are examples of biomimicry and innovations inspired by nature, which are actively being investigated by aerospace designers. Morphing wing designs based on Variable Geometry Truss Manipulators (VGTMs) and articulated helicopter robotic landing gear (RLG) have drawn a great deal of attention from industry. Compliant mechanisms have become increasingly popular due to their advantages over conventional rigid-body systems, and the research team led by the second author at Toronto Metropolitan University (TMU) has set their long-term goal to be exploiting these systems in the above aerospace applications. To gain a deeper insight into the design and optimization of compliant mechanisms and their potential application as alternatives to VGTM and RLG systems, this study conducted a thorough analysis of the design of flexible hinges, and single-, four-, and multi-bar configurations as a part of more complex, flexible mechanisms. The investigation highlighted the flexibility and compliance of mechanisms incorporating circular flexure hinges (CFHs), showcasing their capacity to withstand forces and moments. Despite a discrepancy between the results obtained from previously published Pseudo-Rigid-Body Model (PRBM) equations and FEM-based analyses, the mechanisms exhibited predictable linear behavior and acceptable fatigue testing results, affirming their suitability for diverse applications. While including additional linkages perpendicular to the applied force direction in a compliant mechanism with N vertical linkages led to improved factors of safety, the associated increase in system weight necessitates careful consideration. It is shown herein that, in this case, adding one vertical bar increased the safety factor by 100N percent. The present study also addressed solutions for the precise modeling of CFHs through the derivation of an empirical polynomial torsional stiffness/compliance equation related to geometric dimensions and material properties. The effectiveness of the presented empirical polynomial compliance equation was validated against FEA results, revealing a generally accurate prediction with an average error of 1.74%. It is expected that the present investigation will open new avenues to higher precision in the design of CFHs, ensuring reliability and efficiency in various practical applications, and enhancing the optimization design of compliant mechanisms comprised of such hinges. A specific focus was put on ABS plastic and aluminum alloy 7075, as they are the materials of choice for non-load-bearing and load-bearing structural components, respectively.

Required force for distraction during medial opening wedge high tibial osteotomy may serve as a predictive indicator for lateral hinge fracture.

Introduction: Medial open wedge high tibial osteotomy is a biological procedure for treating unicompartmental knee osteoarthritis. The literature repeatedly highlights the significance of preserving an intact lateral hinge during this procedure. We investigated the temporal course of distraction forces during distraction at the osteotomy site, aiming to quantitatively measure and analyse temporal changes in distraction forces at different distraction points for intact and fractured lateral hinges. Materials and Methods: This biomechanical study was conducted on 10 human cadavers, which were divided into two groups: one with preserved 1 cm intact lateral cortexes (ILCs) and the other with completely osteotomised fractured lateral cortexes (FLCs). An experimental setup was custom designed to facilitate the required force measurement during distraction. The distraction forces were recorded with a force gauge at 0.5-mm intervals throughout the distraction. Results: There was a significant difference between the ILC and FLC groups in distraction forces at all points (8-15 mm). The ILC group consistently exhibited higher distraction force values, with FLC recording values ranging from 8.8% to 13.2% of ILC's. Lateral hinge fractures caused an 86.7% reduction in the initial required force for distraction, significantly impacting the force required for distraction. The ILC group displayed a linear increase in the required distraction force up to 12.5 mm of distraction, which reached 3.7 times the initial value at 12.5 mm of distraction. The FLC group had lower baseline required distraction forces, following a relatively linear trend with more limited increases. Conclusion: FLCs in medial opening wedge osteotomy are associated with significant reductions in the force required for distraction, and a sudden decrease in distraction force during distraction may indicate a lateral hinge fracture. Force measurement devices for use during distraction could offer valuable insights and provide surgeons with immediate warnings for LHFs. Level of Evidence: Level IV.