Biocompatible dressing for pediatric hypospadias repair.

PURPOSE: The search for an ideal Hypospadias repair dressing continues. We aimed to develop a hypoallergenic optimized biocompatible dressing (BD). METHOD: BD with a multi-layered structure of hydrophilic treated Polypropylene with three-layered technologies; Absorbent-spunlaced hydroentangled polyester/viscose blend, outer Polypropylene, Polyester, Acrylic, and Spandex, with super Absorbent Polymer and Acrylic adhesive. Wistar rat abdominal wound model was divided into two groups: control (normal gauze dressing with adhesive) and Study (BD). The physical properties and wound characteristics were compared. RESULTS: Average mass: thickness of BD was 626.7 ± 5.6 g m-2: 2.6 ± 0.015 mm. Absorption was 1425.2 ± 127.6%. Percentage desorption of solution A from dressings at 24:40 h was 1249 ± 150%:1417 ± 230%. BD was hydrophilic with no particles/residue after immersion and pH neutral. The average air permeability was 11.6 ± 1.6 cm3/cm2/sec. The tensile force was 200N-220N with an extension on the breaking point at 24 mm. BD was superior for ease of removability on Day 6 (p = 0.012) and sticking quality (p = 0.036), absorption (p = 0.036), ease of removability(p = 0.036), and sustenance (p = 0.030) on Day 10. BD dressing demonstrated better wound healing (p = 0.015) and decreased redness (p = 0.002) on Day 10. Histopathological healing was better with BD on Day 14(p = 0.025) and Day 20 (p = 0.034). CONCLUSION: BD demonstrated better desirable physical and wound healing qualities with less inflammation compared with control normal dressing.

Anesthetic management of right brachiocephalic artery aneurysm causing tracheal compression.

The airway compression poses a challenge for the anesthesiologist in airway management during aneurysm repair surgery.

Imaging application and radiosensitivity enhancement of pectin decorated multifunctional magnetic nanoparticles in cancer therapy.

In this contribution, we report the fabrication of multifunctional nanoparticles with gold shell over an iron oxide nanoparticles (INPs) core. The fabricated system combines the magnetic property of INPs and the surface plasmon resonance of gold. The developed nanoparticles are coated with thiolated pectin (TPGINs), which provides stability to the nanoparticles dispersion and allows the loading of hydrophobic anticancer drugs. Curcumin (Cur) is used as the model drug and an encapsulation efficiency of approximately 80% in TPGINs is observed. Cytotoxicity study with HeLa cells shows that Cur-loaded TPGINs have better viability percent (~30%) than Cur alone (~40%) at a dose of 30 µg of TPGINs. Further, annexin V-PI assay demonstrated the enhanced anticancer activity of Cur-loaded TPGINs via induction of apoptosis. The use of TPGINs leads to a significant enhancement in generating reactive oxygen species (ROS) in HeLa cells through improved radiosensitization by gamma irradiation (0.5 Gy). TPGINs are further evaluated for imparting contrast in magnetic resonance imaging (MRI) with the r2 relaxivity in the range of 11.06-13.94 s-1 µg-1 mL when measured at 7 Tesla. These experimental results indicate the potential of TPGINs for drug delivery and MR imaging.

Graphene nanofiber composites for enhanced neuronal differentiation of human mesenchymal stem cells.

Aim: To differentiate mesenchymal stem cells into functional dopaminergic neurons using an electrospun polycaprolactone (PCL) and graphene (G) nanocomposite. Methods: A one-step approach was used to electrospin the PCL nanocomposite, with varying G concentrations, followed by evaluating their biocompatibility and neuronal differentiation. Results: PCL with exiguous graphene demonstrated an ideal nanotopography with an unprecedented combination of guidance stimuli and substrate cues, aiding the enhanced differentiation of mesenchymal stem cells into dopaminergic neurons. These newly differentiated neurons were seen to exhibit unique neuronal arborization, enhanced intracellular Ca2+ influx and dopamine secretion. Conclusion: Having cost-effective fabrication and room-temperature storage, the PCL-G nanocomposites could pave the way for enhanced neuronal differentiation, thereby opening a new horizon for an array of applications in neural regenerative medicine.

Accuracy of computer navigation in total knee arthroplasty: A prospective computed tomography-based study.

INTRODUCTION: Evidence now exists advocating the use of computer navigation in total knee arthroplasty (TKA). Despite the introduction of new navigation systems into clinical practice no evidence currently exists showing independent verification of their accuracy. The aim of this study was to validate the in vivo accuracy of the Exactech Guided Personalised Surgery (GPS) computer navigation system using a validated computed tomography (CT) measurement of alignment. METHOD: Consecutive patients who underwent TKA using the GPS Navigation System at our institution were prospectively recruited. Intraoperative parameters of 3D alignment as measured by the GPS navigation system were recorded and compared against the postoperative measurements of alignment measured using the Perth CT Protocol to assess the accuracy of the GPS navigation system. RESULTS: 29 consecutive patients (13 male, 16 female) who underwent TKA were prospectively recruited. Overall, for all measures of 3D alignment the mean difference between intraoperatively recorded and postoperative CT-measured alignment was 1.55° ± 0.22° (95% confidence interval). Individual measurement differences in the femoral prosthesis were: coronal alignment 1.64° ± 0.52°; flexion 2.07° ± 0.55°; rotation 1.38° ± 0.33° Differences in the tibial prosthesis were: coronal alignment 2.03° ± 0.53°; slope 1.14° ± 0.39° The whole limb coronal alignment difference was 2.34° ± 0.83° CONCLUSION: The Exactech GPS Navigation system is very accurate with a high concordance between intraoperative and postoperative measures of alignment and prosthesis positioning. We therefore confidently validate the system and support its continued use in clinical practice. Other navigation systems should undergo a similar validation process.

How should new orthopaedic implants be introduced: an example and recommendations for best practice.

Continued advancements in orthopaedics have led to the development of many new implants; many of these are being utilized in clinical practice with little or no evidence base for their safety or effectiveness. Highly publicized failures in orthopaedic technology have led to an increased awareness of this issue in both medical and non-medical circles. In most cases, the significant harm caused to the public could have been avoided by the appropriately staged implementation of new implants. This review comments on the current literature regarding the optimal practice for the introduction of new orthopaedic technology. The authors' experience with the failed ESKA Adapter Short-stem/Modular Hip is described; the methodology used for its evaluation is used as a basis to discuss what was successful about the process and also give warning on what could be improved upon. The ideal practice requires new orthopaedic implants to be evaluated by high-volume surgeons in specialist orthopaedic hospitals. These studies should include biomechanical studies, radiostereophotometric analysis, implant retrieval and outcome assessment. Results and complications should be reported early to the appropriate joint registry and regulatory body. Once a suitable evidence base has developed, the implant can be distributed into wider clinical practice or withdrawn. These recommendations aim to protect the patient and public from harm while allowing surgical innovation to still continue.

Multifunctional gold coated iron oxide core-shell nanoparticles stabilized using thiolated sodium alginate for biomedical applications.

In this paper we report synthesis of aqueous based gold coated iron oxide nanoparticles to integrate the localized surface plasma resonance (SPR) properties of gold and magnetic properties of iron oxide in a single system. Iron oxide-gold core shell nanoparticles were stabilized by attachment of thiolated sodium alginate to the surface of nanoparticles. Transmission electron microscope (TEM) micrograph presents an average elementary particle size of 8.1±2.1nm. High resolution TEM (HR-TEM) and X-ray photon spectroscopy further confirms the presence of gold shell around iron oxide core. Gold coating is responsible for reducing saturation magnetization (Ms) value from ~41emu/g to ~24emu/g - in thiolated sodium alginate stabilized gold coated iron oxide core-shell nanoparticles. The drug (curcumin) loading efficiency for the prepared nanocomposites was estimated to be around 7.2wt% (72µgdrug/mg nanoparticles) with encapsulation efficiency of 72.8%. Gold-coated iron oxide core-shell nanoparticles could be of immense importance in the field of targeted drug delivery along with capability to be used as contrast agent for MRI & CT.

Axillary Artery Injury Associated with Proximal Humeral Fractures: Review of Long-Term Vascular, Orthopedic, and Neurologic Outcomes.

BACKGROUND: Fracture and dislocation of the proximal humerus is common. It is associated with a number of vascular, neurologic, and orthopedic complications; these include brachial plexopathy and avascular necrosis (AVN) of the humeral head. These complications are rare but can potentially cause severe disability to patients; however, they remain poorly described in the literature. To describe vascular, orthopedic, and neurologic outcomes after axillary artery repair, in patients with proximal humeral fractures or dislocations. METHODS: We conducted a retrospective review of patients admitted to 2 tertiary trauma centers in Victoria, Australia, with fracture or dislocation of the proximal humerus and associated axillary artery injury. Patients were selected according to guidelines for trauma call or alert and the presence of high-risk mechanism of injury. Data on vascular, orthopedic, and neurologic complications were collected. RESULTS: Twenty-one patients were identified. Injury to the first part of the axillary artery was noted in 11 patients (52%). Brachial plexus exploration was performed in 17 patients (81%). Four patients (19%) underwent nerve repair. Long-term neurologic recovery was universally poor. Major orthopedic complications included AVN of the humeral head, delayed union, and the need for prosthesis or arthrodesis. Eleven patients (52%) received upper limb fasciotomy. Five patients (24%) underwent delayed secondary upper limb amputation. CONCLUSIONS: There was an unusually high rate of injuries to the first part of the axillary artery. Close clinical observation is recommended for such patients. AVN of the humeral head and brachial plexopathy remain significant and debilitating complications.

Trampoline related injuries in adults.

INTRODUCTION: Trampoline-related injuries in adults are uncommon. Participation in trampolining is increasing following its admission as a sport in the Olympics and the opening of local recreational trampoline centres. The aim of this study was to assess the number and outcomes of adult trampoline-related orthopaedic injuries presenting to four trauma hospitals in Victoria. METHODS: A cohort study was performed for the period 2007-2013. Adult patients registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) who had sustained a trampolining related injury were included in this study. Descriptive analyses were used to describe the patient population, the injuries sustained and their in-hospital and 6-month outcomes. RESULTS: There was an increase in trampolining injuries from 2007 (n=3) to 2012 (n=14) and 2013 (n=18). Overall, fifty patients with a median age of 25 (range 16-66) were identified. Thirty-five patients (70%) had lower limb injuries, 20 patients (40%) had spinal injuries and one patient had an upper limb injury. Thirty-nine patients (78%) required surgery. Fractures of the tibia (n=13), ankle fractures (n=12) and cervical spine injuries (n=7) were the most common injuries; all of which required surgery. Complications included death, spinal cord injuries, compartment syndrome and open fractures. At 6 months post injury, more than half (52%) of the patients had not achieved a good recovery, 32% had some form of persistent disability, 14% did not get back to work and overall physical health for the cohort was well below population norms for the SF-12. CONCLUSION: Adult trampoline-related injuries have increased in the last few years in this cohort identified through VOTOR. Lower limb and spinal injuries are most prevalent. Public awareness and education are important to reduce the risk for people participating in this activity.

The efficacy of guiding flange appliance in correcting mandibular deviation in the hemi-mandibulectomy patient. A correlative study.

PURPOSE: This report describes the efficacy of a guiding flange appliance in correcting mandibular deviation in the hemi-mandibulectomy patient and correlates the time elapsed between surgery and placement of the appliance and the extent of initial mandibular deviation to the success rate of a guiding flange appliance in correcting the deviation. MATERIALS AND METHODS: A total of 15 hemi-mandibulectomy patients participated in the study. All had various degree of mandibular shift consequent to surgery. The patients were given a guiding flange prosthesis for about 4 months, and the efficacy of the guiding flange prosthesis was calculated in terms of percentage deviation corrected after 4 months. RESULTS: Time elapsed between surgery and prosthetic rehabilitation was in inverse relation to the percentage correction in mandibular deviation at 4 months (B = -7.668; p = 0.002). The less the initial deviation postsurgery, the better the correction (B = 9.798; p = 0.008). CONCLUSION: Percentage correction of mandibular deviation is dependent on the timing of prosthetic rehabilitation. The less the initial deviation, the better the correction.

Comparative evaluation of 2.0-mm locking plate system vs. 2.0-mm nonlocking plate system for mandibular fractures--a retrospective study.

INTRODUCTION: The purpose of this retrospective study is to evaluate the efficacy of the 2.0-mm locking miniplate/screw system in comparison to the 2.0-mm nonlocking miniplate/screw system in mirror image mandibular fractures. MATERIAL AND METHOD: A retrospective clinical trial was reviewed in the Department of Oral and Maxillofacial Surgery, Government Dental College, Pt. B.D. Sharma University of Health Sciences Rohtak for a period of 30 months (June 2007 to December 2009). A total of 30 patient pairs with isolated identical mandibular fracture (single or multiple) having 88 fractures were analyzed. RESULTS: A total of 11 complications that occurred represented 12.5% of the total. Six complications occurred at angle, three in the body and two at parasymphysis. Four complications occurred in the locking group and seven in the nonlocking group, with complication rates accounting for 9% and 16%, respectively. When comparing the overall complication rates according to plates used, the chi-square test showed no statistically significant difference between the locking and nonlocking plates (p > 0.05). DISCUSSION: Mandible fractures treated with the 2.0-mm locking plates and the 2.0-mm nonlocking plates present similar short-term complication rates.