Promoting bioengineered tooth innervation using nanostructured and hybrid scaffolds.

The innervation of teeth mediated by axons originating from the trigeminal ganglia is essential for their function and protection. Immunosuppressive therapy using Cyclosporine A (CsA) was found to accelerate the innervation of transplanted tissues and particularly that of bioengineered teeth. To avoid the CsA side effects, we report in this study the preparation of CsA loaded poly(lactic-co-glycolic acid) (PLGA) nanoparticles, their embedding on polycaprolactone (PCL)-based scaffolds and their possible use as templates for the innervation of bioengineered teeth. This PCL scaffold, approved by the FDA and capable of mimicking the extracellular matrix, was obtained by electrospinning and decorated with CsA-loaded PLGA nanoparticles to allow a local sustained action of this immunosuppressive drug. Dental re-associations were co-implanted with a trigeminal ganglion on functionalized scaffolds containing PLGA and PLGA/cyclosporine in adult ICR mice during 2weeks. Histological analyses showed that the designed scaffolds did not alter the teeth development after in vivo implantation. The study of the innervation of the dental re-associations by indirect immunofluorescence and transmission electron microscopy (TEM), showed that 88.4% of the regenerated teeth were innervated when using the CsA-loaded PLGA scaffold. The development of active implants thus allows their potential use in the context of dental engineering. STATEMENT OF SIGNIFICANCE: Tooth innervation is essential for their function and protection and this can be promoted in vivo using polymeric scaffolds functionalized with immunosuppressive drug-loaded nanoparticles. Immunosuppressive therapy using biodegradable nanoparticles loaded with Cyclosporine A was found to accelerate the innervation of bioengineered teeth after two weeks of implantation.

Cost-effectiveness of professional pharmacy services in community pharmacy: a systematic review.

INTRODUCTION: The aim was to determine whether professional pharmacy services (PPS) provided to ambulatory patients attending community pharmacy are cost-effective compared with usual care (UC). Areas covered: MEDLINE, Web of Knowledge, Scopus, Cochrane Library and Centre for Reviews and Dissemination databases were searched, and the risk of bias of randomized controlled trials, and the methodological quality of economic evaluations was assessed. A total of 17 economic evaluations of 13 studies were included. Seven studies were classified as high-, three as medium- and three as low-quality. PPS were more effective and less costly than UC in four studies; seven studies concluded that PPS were more effective and more costly and two studies concluded that the service was as effective as the UC, with higher and lower costs. Expert commentary: Although the uncertainty was variable among the studies, a general trend towards the cost-effectiveness of PPS was observed. Decision makers are encouraged to consider the feasibility of implementing PPS.

Feroxyhyte nanoflakes coupled to up-converting carbon nanodots: a highly active, magnetically recoverable, Fenton-like photocatalyst in the visible-NIR range.

We demonstrate the enhanced photocatalytic response of a novel Fenton-like heterogeneous catalyst obtained through the assembly of superparamagnetic feroxyhyte nanoflakes synthesized by continuous gas-slug microfluidics and carbon nanodots obtained by pyrolysis from a natural organic source. The novel nanohybrids enable the utilization of the visible and near-infrared ranges due to the active role of the carbon nanodots as up-converting photo-sensitizers. This novel photocatalyst is magnetically recoverable and maintains an excellent response after multiple reutilization cycles. In addition, its synthesis is based on inexpensive and abundant raw materials and its photocatalytic response is evaluated in the presence of energy efficient, affordable light-emitting diodes (LEDs), thereby providing a promising and feasible alternative to the homogeneous Fenton process.

Novel Anisotropic Magnetoelectric Effect on δ-FeO(OH)/P(VDF-TrFE) Multiferroic Composites.

The past decade has witnessed increased research effort on multiphase magnetoelectric (ME) composites. In this scope, this paper presents the application of novel materials for the development of anisotropic magnetoelectric sensors based on δ-FeO(OH)/P(VDF-TrFE) composites. The composite is able to precisely determine the amplitude and direction of the magnetic field. A new ME effect is reported in this study, as it emerges from the magnetic rotation of the δ-FeO(OH) nanosheets inside the piezoelectric P(VDF-TrFE) polymer matrix. δ-FeO(OH)/P(VDF-TrFE) composites with 1, 5, 10, and 20 δ-FeO(OH) filler weight percentage in three δ-FeO(OH) alignment states (random, transversal, and longitudinal) have been developed. Results have shown that the modulus of the piezoelectric response (10-24 pC·N(-1)) is stable at least up to three months, the shape and magnetization maximum value (3 emu·g(-1)) is dependent on δ-FeO(OH) content, and the obtained ME voltage coefficient, with a maximum of ∼0.4 mV·cm(-1)·Oe(-1), is dependent on the incident magnetic field direction and intensity. In this way, the produced materials are suitable for innovative anisotropic sensor and actuator applications.

Biomass properties and permeability in an immersed hollow fibre membrane bioreactor at high sludge concentrations.

This study aimed to investigate the influence of biomass properties and high mixed liquor suspended solids (MLSS) concentrations on membrane permeability in a pilot-scale hollow fibre membrane bioreactor treating domestic wastewater. Auxiliary molasses solution was added to maintain system operation at constant food-to-microorganisms ratio (F/M = 0.13). Various physicochemical and biological biomass parameters were measured throughout the trial, comprising pre-thickening, thickening and post-thickening periods with reference to the sludge concentration and with aerobic biotreatment continuing throughout. Correlations between dynamic changes in biomass characteristics and membrane permeability decline as well as permeability recovery were further assessed by statistical analyses. Results showed the MLSS concentration to exert the greatest influence on sustainable membrane permeability, with a weaker correlation with particle size distribution. The strong dependence of absolute recovered permeability on wet accumulated solids (WACS) concentration, or clogging propensity, revealed clogging to deleteriously affect membrane permeability decline and recovery (from mechanical declogging and chemical cleaning), with WACS levels increasing with increasing MLSS. Evidence from the study indicated clogging may permanently reduce membrane permeability post declogging and chemical cleaning, corroborating previously reported findings.

Biological treatment and thickening with a hollow fibre membrane bioreactor.

Aerobic operation of an immersed hollow fibre membrane bioreactor, treating municipal wastewater supplemented with molasses solution, has been studied across mixed liquor suspended solids (MLSS) concentrations between 8 and 32 g L(-1), the higher concentrations being normally associated with thickening operations. Only a marginal loss in membrane permeability was noted between 8 and 18 g L(-1) when operation was conducted without clogging. The sustainable operational flux attainable above 18 g L(-1) was highly dependent upon both the MLSS concentration and the state of the membrane. A temperature-corrected flux of 28 L m(-2) h(-1) (LMH) was sustained for 18 h at an MLSS of 8 g L(-1) using membranes close to initial their virgin-state permeability. This value decreased to around 14 LMH at 20 g L(-1) and 5 LMH at 32 g L(-1) MLSS for an aged membrane whose permeability had been recovered following clogging. Below the threshold flux operation without significant clogging was possible, such that the membrane permeability could be recovered with a chemically enhanced backflush (CEB). Above this flux clogging took place at a rate of around 7-14 g solids per m(2) membrane per m(3) permeate volume passed irrespective of the MLSS concentration. The permeability of the unclogged membrane was depressed and could not be recovered using a standard CEB, indicative of irrecoverable pore clogging. The outcomes corroborated previously reported observations concerning the deleterious long-term impacts of clogging, and confirmed the critical importance of operation at a sustainable flux value.

Optimizing and modelling nitrogen removal in a new configuration of the moving-bed biofilm reactor process.

A new configuration of the moving-bed biofilm reactor process with pre-denitrification and nitrification was investigated in a pilot plant, which is fed with urban raw wastewater, the primary settler is located between the anoxic and the aerobic reactors, and primary sludge is recycled to the anoxic reactor as a hybrid pre-denitrification. The carriers used in the experiments are made of high-density polyethylene, with a diameter of 10 mm and a specific surface area of 400 m(2)/m(3). The new process was compared with conventional pre-denitrification-nitrification using in-series reactors fed with settled wastewater. The new configuration achieved an increase of 45% for the denitrification rate and of 30% for the nitrification rate when compared with conventional configuration. These results were analysed in light of the calibration study of the mixed-culture biofilm (MCB) model and simulations in AQUASIM 2.1 platform. Regarding denitrification, the high values obtained in the new configuration were attributed to a higher removal of the slowly biodegradable substrate (Xs) in the anoxic reactor due to the use of raw wastewater and sludge recycle. Accordingly, the amounts of heterotrophic biomass (XH) and Xs obtained in simulations were higher in both the biofilm and the bulk liquid. Regarding nitrification, the higher values were attributed to a lower removal of Xs in the aerobic reactors and accordingly, a lower accumulation of heterotrophic biomass in the biofilm was found in the simulations.

Bloodless surgery in a patient with thalassemia minor. Usefulness of erythropoietin, preoperative blood donation and intraoperative blood salvage.

A patient with thalassemia minor and idiopathic scoliosis was scheduled for posterior vertebral arthrodesis. The diagnosis of thalassemia minor was made during the preoperative assessment. Preoperative blood cell count displayed the following data: red blood count 5.4 x 106/microL, haemoglobin 11.6 g/dL and hematocrit 36.9%. As corrective surgery for scoliosis is associated with major blood loss, the patient was scheduled for preoperative treatment with human recombinant erythropoietin (rHuEPO), autologous blood donation, intraoperative blood cell salvage and administration of tranexamic acid. The use of rHuEPO was intended to increase hemoglobin (12.1 g/dL) levels at the moment of surgery following the donation of 2 autologous blood units. 1000 mL of salvaged blood were processed. The output line of the blood cell salvage machine did not show any sign of increased red cell haemolysis. The postoperative course was uneventful and the patient was discharged from the postoperative intensive care unit on day 7 after surgery with no allogenic blood transfusion. No references detailing the use of rHuEPO and autologous blood donation preoperatively in patients with thalassemia minor and only one case report discussed the utility of intraoperative blood cell salvage in a patient with thalassemia intermedia. Although further experience is needed, this case report suggests that even for patients with thalassemia minor, methods focused on allogenic blood salvage can be used safely.

Dolor en el trauma térmico / Pain in thermal trauma

La máxima agresión física que puede sufrir un ser humano son las quemaduras. Actualmente, en Chile se hospitalizan alrededor de 9.000 personas al año por quemaduras, con una tasa de mortalidad que ha ido en disminución en los últimos 20 años, por lo tanto la cantidad de pacientes sobrevivientes va en aumento. La IASP (Internacional Association for Study of Pain) definió el dolor en quemados como: "un dolor agudo y grave, que se produce al sufrir una quemadura y luego continuo con exacerbaciones que declinan gradualmente". El dolor en el trauma térmico está siempre presente, es de intensidad severa y prolongada en el tiempo, con una alta prevalencia de dolor crónico. Se sabe que el aumento en la intensidad se debe a que las quemaduras dañan gran cantidad de nociceptores, produciéndose una amplificación de la respuesta al dolor. Los opioides son el principal pilar en el tratamiento farmacológico. Es fundamental el buen manejo del dolor, para evitar el dolor patológico que aumentará el dolor crónico y con ello el desmedro de la vida personal de nuestros pacientes. Desafortunadamente el subtratamiento es una realidad, produciendo directamente un retraso en la recuperación de sus quemaduras y en la inserción social y laboral.

Burns are the greatest physical aggression that a human being can experience. In Chile, approximately 9000 patients are hospitalized annually due to burns, with a mortality rate that has decreased progressively in the last 20 years, which means that the amount of survivors is increasing. The IASP (International Association for Study of Pain) has defined pain in the burn patient as "an acute and severe pain produced by a burn that later continues with exacerbations that gradually decline". Pain in thermal trauna is always present, of severe intensity and prolonged in time, with a high prevalence of chronic pain. It is Known that the increase in intensity of pain is due to the damage of a great number of nociceptors, that produces an amplification of the response to pain. Opioids are the mainstay of pharmacologic treatment. Appropriate management of pain is fundamental to avoid pathologic pain that will increase the chronic pain and deteriorate the quality of life of our patients. Unfortunately undertreatment is a reality, retarding the healing of the burn wound, and the social and workplace reintegration.

[Migration and psychiatric diseases]. / Patología psiquiátrica en el inmigrante.

Immigration is an emergent social phenomenon with a great impact on health systems. Psychiatric disorders are said to be universal phenomenon, but their clinical expression may be determined by cultural factors. Indeed, immigration acts as a risk factor for the development of mental diseases, as it works as a stress generating factor. The adaptability process for both the immigrants and the receptor environment, involves a social and cultural effort that modifies interindividual relationships, mainly at the therapeutic level. Psychiatry faces up to a new therapeutic and diagnostic challenge, where ethnocultural barriers (either individual or collective) and social and biological barriers need to be got over. Barriers to access to Mental Health Services or social resources and language differences mean an important obstacle which has to be got over by health systems providing special mental health programs, either segregationist or integrative. This review tries to summarize the different issues that limit or interfere with daily clinical practice when treating the immigrant population, meaningful both in quantitative and qualitative psychiatric terms.

Patterns of symptoms in neuroleptic-naive patients with schizophrenia and related psychotic disorders before and after treatment.

A three-factor structure of schizophrenic symptoms has received considerable support, but there are no data on the factor structure of symptoms in neuroleptic-naive patients and how symptoms evolve after the inception of antipsychotic treatment. Seventy neuroleptic-naive patients with schizophrenia or related psychotic disorders were assessed with the Scales for the Assessment of Positive and Negative Symptoms before and after neuroleptic treatment. Ten global ratings of symptoms were subjected to factor analysis at the two time points and the factor solutions compared. A three-factor structure composed of psychotic, disorganization, and negative dimensions was found at the two assessment points. The negative and disorganization factors were highly correlated at each assessment and across assessments. While the symptom composition of the factors at the neuroleptic-naive assessment fitted that described in most previous studies, the composition of the negative and disorganization factors after neuroleptic treatment was somewhat different in that attention and inappropriate affect loaded on the negative factor instead of the disorganization factor. It is concluded that caution is warranted when using the three-factor model of schizophrenic symptoms as it may not be stable at different phases of the illness.

Fracture behavior of UHMWPE in non-implanted, shelf-aged knee prostheses after gamma irradiation in air.

We studied non-implanted ultra-high molecular weight polyethylene (UHMWPE) knee components, that were gamma-sterilized in air and shelf-aged during 6 and 7 years, to explore fracture mechanisms in the degraded material. Prior to the fractography study, we assessed degradation through FTIR and optical density measurements in microtome sections. Then, we morphologically compared the surface fractography of degraded, oxidized UHMWPE with that of non-degraded material in specimens from the same implants, fractured after uniaxial tensile tests in standardized samples. Fractography surface analysis clearly differentiated the behavior of non-degraded and degraded UHMWPE. Failure in non-degraded samples occurred through craze formation, followed by fast crack propagation. Quantitative fracture analysis suggested a ductile behavior. This was supported by the identified local plasticity in the region close to the initial flaw. In the fractography surface analysis of degraded material, a fibrillar behavior was observed. A heterogeneous domain structure appeared, showing different coarseness with multiple void sizes. Our results, based on mechanical measurements and fracture morphology in the subsurface region, confirmed the embrittlement of oxidized UHMWPE.

Development and verification of design and operation criteria for the step feed process with nitrogen removal.

The step feed process with three stages of denitrification-nitrification reactors has been studied using simulations in order to develop criteria for the optimum selection of the design parameters and to propose efficient operational strategies. To verify the simulation results experimental studies in a pilot plant of 1100 litres were carried out. The simulation studies showed that the optimum influent flow distribution to the three anoxic reactors is in the range of 40-40-20% and 33-33-34% depending on the wastewater characteristics and effluent requirements. These two latter conditions and in turn the influent flow distribution determine the anoxic and aerobic reactor volumes. The reduction of the dissolved oxygen in the two first aerobic reactors and the use of facultative zones in the final D-N stage are proposed as operational strategy. The experimental results proved the validity of the criteria developed for design and operation. A high capacity of the IAWQ activated sludge model No. 1 to predict the performance of the step feed process was observed.

[The impact of the implementation of staying in the United Kingdom for six months or more as donor exclusion criteria on the donor base of the Basque Country]. / Repercusión de la implantación de la estancia en el Reino Unido durante seis o más meses como motivo de exclusión sobre la base de donantes de sangre en el País Vasco.

BACKGROUND: To reduce the risk of new variant Creutzfeldt-Jakob disease by blood products some countries exclude persons who have spent six months or more cumulatively in the United Kingdom as blood donors. METHOD: We asked our donors about this selection criteria to evaluate the loss of blood donors and donations in case of implementation of this measure. RESULTS: 11,681 donors and 1,648 refused persons were analyzed. 123 (1.05%) and 11 (0.66%) respectively fulfilled this criteria. CONCLUSIONS: In case of implementation of this selection criteria 1% of blood donors and 1.77% blood donations would be lost.

Differentiating primary from secondary negative symptoms in schizophrenia: a study of neuroleptic-naive patients before and after treatment.

OBJECTIVE: The study examined the primary versus secondary character of negative symptoms in a group of first-episode, neuroleptic-naive psychotic patients before and after they started neuroleptic treatment. METHOD: Forty-seven inpatients with a first episode of schizophrenia or related psychotic disorders were examined for the presence of negative symptoms, psychosis, depression, and parkinsonism at admission to an inpatient psychiatric unit, before receiving neuroleptics, and at discharge an average 3.3 weeks later, after starting neuroleptic treatment. RESULTS: Although patients' mean scores on measures of positive, negative, and depressive symptoms decreased significantly over the treatment period, the mean rating of nonakinetic parkinsonism worsened. The mean rating of akinetic parkinsonism did not change significantly over the treatment period. Negative symptoms at admission were not predicted by positive or depressive symptoms at admission. Residual negative symptoms at discharge were mainly predicted by negative symptoms at admission (i.e., primary symptoms) and to a negligible degree by residual positive and depressive symptoms. Change in negative symptoms over the observation period was predicted to a marginal degree by change in depressive symptoms. CONCLUSIONS: Negative symptoms rated during a first psychotic episode before and after starting antipsychotic treatment are mainly primary in character and should be considered as a direct manifestation of the basic dysfunctions of schizophrenia.