Letter to editor: Exploring complications following cranioplasty after decompressive hemicraniectomy: A retrospective bicenter assessment of autologous, PMMA and CAD implants.

This study presents a critical analysis of complications following cranioplasty (CP) after decompressive hemicraniectomy, focusing on autologous, polymethylmethacrylate (PMMA), and computer-aided design (CAD) implants. The analysis encompasses a retrospective bicenter assessment, evaluating factors influencing surgical outcomes and emphasizing the significance of material selection in minimizing postoperative complications. The study's comprehensive examination of complication rates associated with various implant materials contributes significantly to understanding CP outcomes. While polymethylmethacrylate (PMMA) and autologous bone flaps (ABFs) exhibited higher rates of surgical site infection (SSI) and explantation, a meta-analysis revealed a contrasting lower infection rate for polyether ether ketone (PEEK) implants. The study underscores the critical role of material selection in mitigating postoperative complications. Despite its strengths, the study's retrospective design, reliance on data from two centers, and limited sample size pose limitations. Future research should prioritize prospective, multicenter studies with standardized protocols to enhance diagnostic accuracy and treatment efficacy in CP procedures.

Anti-Microbial Effect of AgBr-NP@CTMAB on Streptococcus Mutans and Assessment of Surface Roughness Hardness and Flexural Strength of PMMA.

Purpose: To investigate the inhibition of Streptococcus mutans (S.mutans) and its biofilm by AgBr-nanoparticles (NP) @CTMAB (cetyltrimethyl-ammonium bromide) and evaluate the changes in Polymethyl methacrylate (PMMA)'s surface roughness (Ra), microhardness, and flexural strength during prolonged immersion in AgBr-NP@CTMAB for application in the denture cleaning industry. Patients and Methods: The antibacterial activity of AgBr-NP@CTMAB against S.mutans was measured colony formation assay, OD600 and laser confocal microscopy. Changes in the specimens' values for surface roughness, microhardness, and flexural strength (MPa) were measured after immersion solutions for 180 or 360 days. Results: The AgBr-NP@CTMAB solution exhibited a robust antibacterial effect on planktonic S. mutans, with a minimum bactericidal concentration of 5 µg/mL. The 10 µg/mL AgBr-NP@CTMAB solution efficiently inhibited S. mutans biofilm formation. (2) No significant difference in surface roughness after immersion in AgBr-NP@CTMAB (10 µg/mL and 20 µg/mL) comparing with distilled water (P > 0.05) and Polident had significantly higher than distilled water (P < 0.05). There was a significant decrease in the surface hardness of the PMMA specimens that were immersed in the Polident compared with those in distilled water (P < 0.05). While, no significant differences in surface hardness after immersion in the AgBr-NP@CTMAB (P > 0.05). The result of flexural strength suggested that there was no statistically significant difference (P < 0.05) between AgBr-NP@CTMAB as well as Polident and water. Conclusion: AgBrNP@CTMAB can efficiently inhibit the growth of plankton S.mutans and biofilm formation, without affecting the flexural strength, microhardness, or surface roughness of PMMA. Therefore, AgBrNP@CTMAB holds promise as a new denture cleaning agent.

Evaluation and assessment of the wettabilty and water contact angle of modified poly methyl methacrylate denture base materials against PEEK in cast partial denture framework: an in vitro study.

INTRODUCTION: The prevalence of adults with partially dental arches is expected to be more than imagined and patients requiring replacement of missing teeth are slowly increasing in number too. Removable partial dentures are known to provide for substantial replacement for the missing teeth with also added advantages when compared to fixed or implant prosthesis, mainly in elderly patients. Denture base material performance and durability are greatly influenced by wettability and water contact angle. In the case of dentures; adequate moisture distribution is necessary to ensure excellent wettability which has an influence on comfort and oral health. The purpose of conducting this study was to find out whether the advancements made using PEEK (Polyether ether ketone) would prove to be more beneficial than the current upgrades in the current material spectrum. MATERIALS AND METHODS: This study was performed under in vitro conditions. All the fabrication and processing was done only by one operator. The materials used were divided into three groups each comprising 20 samples. Group A was modified polymethylmethacrylate (Bredent Polyan), Group B was polyoxymethylene acetal resin (Biodentaplast) and Group C was PEEK. An Ossila Goniometer was used to measure the contact angle. The three types of liquids used for the testing included distilled water, natural saliva and mouth wetting solution (Wet Mouth Liquid, ICPA India). Human saliva was collected from an individual with no medical conditions and normal salivary secretion. RESULTS: The data was analyzed using One-way ANOVA test and a pairwise comparison using the Post Hoc Tukey's Honest Significant Difference. Table 1 consists of the mean water contact angles of the denture base materials and mean contact angles of various denture base materials. In saliva, mouth wetting solution and distilled water, the highest mean and least mean contact angle was seen in Polyan and Biodentaplast respectively. A signicant difference was seen between PEEK and Polyan and Biodentaplast and Polyan on further comparison. CONCLUSION: From the resources and the materials at our disposal, it could be concluded that Polyan, Biodentaplast and PEEK and could be used as viable options in cast partial denture framework.

Assessment of the Effect of Different Irrigation Protocols on the Penetration of Irrigation Solution into Simulated Lateral Canals (In Vitro Study).

OBJECTIVE: To compare the effectiveness of lateral canal irrigation penetration by conventional needle, passive ultrasonic, sonic endo activator, and Erbium laser (2780nm). METHODS: A total of 40 palatal roots of human maxillary first molars were collected and instrumented at a working length of 12 mm by an X1-X4 rotary Protaper Next system (Dentsply, Maillefer, Ballaigues, Switzerland) using the crown-down technique. Artificial lateral canals were made at 2, 4, and 6 mm from the apex on mesial and distal sides using an ISO rotary reamer (Dentsply, Maillefer, Ballaigues, Switzerland; #10 for mesial, #08 for distal). The samples were then cleared using methyl salicylate. A solution of black ink and normal saline was used as an irrigant for the root canal. The percentages of the penetration of the ink into the lateral canals were measured using a stereomicroscope (Q-Scope, Arnhem, The Netherlands) with the aid of program Image J. The Tukey test is used to assess the significant difference between intragroup and intergroup comparisons of different thirds, and the T-test is used to assess the significant difference between every two groups and for the mesial and distal sides of each group. The level of significance was set at 0.05. RESULTS: Results showed that none of the activation techniques used resulted in complete lateral canal penetrations; however, on both sides at all thirds, the Erbium laser (2780 nm) achieved the highest results with a highly significant statistical difference (p=0.05) with all other groups, and the least penetration was in the conventional needle group. CONCLUSION: The size of the lateral canal is a restricting factor for all activation methods; the best results can be achieved by laser. Conventional needles cannot be used alone to disinfect complex canal anatomy; however, passive ultrasonic and sonic endo activator activations can produce comparable results.

Exploring complications following cranioplasty after decompressive hemicraniectomy: A retrospective bicenter assessment of autologous, PMMA and CAD implants.

Cranioplasty (CP) after decompressive hemicraniectomy (DHC) is a common neurosurgical procedure with a high complication rate. The best material for the repair of large cranial defects is unclear. The aim of this study was to evaluate different implant materials regarding surgery related complications after CP. Type of materials include the autologous bone flap (ABF), polymethylmethacrylate (PMMA), calcium phosphate reinforced with titanium mesh (CaP-Ti), polyetheretherketone (PEEK) and hydroxyapatite (HA). A retrospective, descriptive, observational bicenter study was performed, medical data of all patients who underwent CP after DHC between January 1st, 2016 and December 31st, 2022 were analyzed. Follow-up was until December 31st, 2023. 139 consecutive patients with a median age of 54 years who received either PMMA (56/139; 40.3%), PEEK (35/139; 25.2%), CaP-Ti (21/139; 15.1%), ABF (25/139; 18.0%) or HA (2/139; 1.4%) cranial implant after DHC were included in the study. Median time from DHC to CP was 117 days and median follow-up period was 43 months. Surgical site infection was the most frequent surgery-related complication (13.7%; 19/139). PEEK implants were mostly affected (28.6%; 10/35), followed by ABF (20%; 5/25), CaP-Ti implants (9.5%; 2/21) and PMMA implants (1.7%, 1/56). Explantation was necessary for 9 PEEK implants (25.7%; 9/35), 6 ABFs (24.0%; 6/25), 3 CaP-Ti implants (14.3%; 3/21) and 4 PMMA implants (7.1%; 4/56). Besides infection, a postoperative hematoma was the most common cause. Median surgical time was 106 min, neither longer surgical time nor use of anticoagulation were significantly related to higher infection rates (p = 0.547; p = 0.152 respectively). Ventriculoperitoneal shunt implantation prior to CP was noted in 33.8% (47/139) and not significantly associated with surgical related complications. Perioperative lumbar drainage, due to bulging brain, inserted in 38 patients (27.3%; 38/139) before surgery was protective when it comes to explantation of the implant (p = 0.035). Based on our results, CP is still related to a relatively high number of infections and further complications. Implant material seems to have a high effect on postoperative infections, since surgical time, anticoagulation therapy and hydrocephalus did not show a statistically significant effect on postoperative complications in this study. PEEK implants and ABFs seem to possess higher risk of postoperative infection. More biocompatible implants such as CaP-Ti might be beneficial. Further, prospective studies are necessary to answer this question.

28Assessment of thermal variations in the pulpal chamber during fabrication of provisionals using two different techniques and three materials.

BACKGROUND: The issue of an increase in pulpal temperature affects direct and indirect techniques, where the fabricating material will come in direct contact with the prepared teeth. OBJECTIVE: The aim of this study was to assess the pulpal thermal variations during provisional fabrication using direct and indirect-direct techniques, with three commonly commercially available provisional fabricating materials. METHOD: In this vitro analytical study, 120 extracted human teeth were placed in a dentulous mould and dental stone was poured, to create a working model with an embedded natural right maxillary central incisor. Recording of thermal changes in the pulp chamber during provisionalization with direct (technique 1) and indirect-direct (technique 2) using three common types of provisional crown materials. 120 provisional crowns were fabricated using polymethyl methacrylate (DPI) (Group 1), Bis-acryl composite (Protemp 4) (Group 2) and Visible-light polymerizing (VLP) Urethane Dimethacrylate (Revotek LC) (Group 3) by two techniques and recording of peak temperature changes were done. Temperature rise in the pulp chamber was recorded using a thermocouple. RESULTS: The mean initial and final temperature of the pulp chamber recorded for Groups 1, 2 and 3 was 31.52, 32.56; 31.01, 32.34; 32.29, 34.47 for technique 1 and 29.13, 30.5; 29.29, 31.11; 30.31, 32.65 for technique 2. The mean change in temperature was higher in Group 3 compared to the other groups. CONCLUSION: The temperature rise detected according to this study was within the safer pulpal health limits with all the investigated materials and techniques. The resin material recommended for clinical use when the direct technique is employed for the fabrication of provisional crowns is bis-acryl composite resin (Protemp-4) as it caused minimal temperature rise in the pulpal chamber.

A simplified low-cost phantom for image quality assessment of dental cone beam computed tomography unit.

INTRODUCTION: A standardised testing protocol for evaluation of a wide range of dental cone beam computed tomography (CBCT) performance and image quality (IQ) parameters is still limited and commercially available testing tool is unaffordable by some centres. This study aims to assess the performance of a low-cost fabricated phantom for image quality assessment (IQA) of digital CBCT unit. METHODS: A customised polymethyl methacrylate (PMMA) cylindrical phantom was developed for performance evaluation of Planmeca ProMax 3D Mid digital dental CBCT unit. The fabricated phantom consists of four different layers for testing specific IQ parameters such as CT number accuracy and uniformity, noise and CT number linearity. The phantom was scanned using common scanning protocols in clinical routine (90.0 kV, 8.0 mA and 13.6 s). In region-of-interest (ROI) analysis, the mean CT numbers (in Hounsfield unit, HU) and noise for water and air were determined and compared with the reference values (0 HU for water and -1000 HU for air). For linearity test, the correlation between the measured HU of different inserts with their density was studied. RESULTS: The average CT number were -994.1 HU and -2.4 HU, for air and water, respectively and the differences were within the recommended acceptable limit. The linearity test showed a strong positive correlation (R2 = 0.9693) between the measured HU and their densities. CONCLUSION: The fabricated IQ phantom serves as a simple and affordable testing tool for digital dental CBCT imaging.

Predictive metabolomic signatures for safety assessment of three plastic nanoparticles using intestinal organoids.

Nanoplastic particles are pervasive environmental contaminants with potential health risks, while mouse intestinal organoids provide accurate in vitro models for studying these interactions. Metabolomics, especially through LC-MS, enables detailed cellular response studies, and there's a novel interest in comparing metabolic changes across nanoparticle species using gut organoids. This study used a mouse intestinal organoid combined with cell model to explore the differences in metabolites and toxicity mechanisms induced by exposure to three nanoplastics (PS, PTFE, and PMMA). The results showed that PS, PTFE, and PMMA exposure reduced mitochondrial membrane potential, intracellular ROS accumulation and oxidative stress, and inhibited the AKT/mTOR signaling pathway. Non-targeted metabolomics results confirmed that three types of nanoplastic particles regulate cellular status by regulating fatty acid metabolism, nucleotide metabolism, necroptosis and autophagy pathways. More importantly, these representative metabolites were further validated in model groups after mouse intestinal organoids and HCT116 cells were exposed to the respective NPs, indicating that organoid metabolomics results can be used to effectively predict toxicity. Untargeted metabolomics is sensitive enough to detect subtle metabolomic changes when functional cellular analysis shows no significant differences. Overall, our study reveals the underlying metabolic mechanism of NPs-induced intestinal organoid toxicity and provides new insights into the possible adverse consequences of NPs.

Improving input contrast estimation to an x-ray imaging system.

Objective.An appropriate parameter to study the performance of an x-ray imaging system is contrast transfer, or the system's ability to capture contrast in the radiation beam and bring it to the image. However, determining the input contrast to the system is difficult, as it is heavily affected by secondary radiation, which in turn depends on a multitude of factors. This work presents a method to improve the calculation of input contrast to the imaging system when PMMA phantoms are used.Approach.An expression to obtain input contrast from primary radiation attenuation and scatter-to-primary ratio is shown, and the approximation upon which it is based is discussed. Primary and secondary radiation emerging from the phantoms are calculated for monoenergetic pencil beams impinging on planar PMMA phantoms of different thicknesses. Monte Carlo simulations of two types of anti-scatter grids are also incorporated into the calculations.Main results.The primary and secondary components of radiant energy and grid transmission factors are presented for monoenergetic beams with energies from 10 to 150 keV. These results are then used to calculate input contrast for polyenergetic beams when using a commercial image quality phantom combined with different thicknesses of PMMA and anti-scatter grids.Significance.The information of the object contrast carried by the beam constitutes the input to the imaging system. An accurate determination of this input contrast can be carried out in a wide variety of situations from the study of a reduced number of cases, as those presented in this work for monoenergetic beams, PMMA phantoms of different thicknesses and anti-scatter grids. The relationship between the input contrast and the contrast due to primary radiation used in this work provides a good approximation for the different combinations of inserts, phantoms, grids, and energy spectra analyzed here.

Monte Carlo model of a prototype flat-panel detector for multi-energy applications in radiotherapy.

BACKGROUND: The incorporation of multi-energy capabilities into radiotherapy flat-panel detectors offers advantages including enhanced soft tissue visualization by reduction of signal from overlapping anatomy such as bone in 2D image projections; creation of virtual monoenergetic images for 3D contrast enhancement, metal artefact reduction and direct acquisition of relative electron density. A novel dual-layer on-board imager offering dual energy processing capabilities is being designed. As opposed to other dual-energy implementation techniques which require separate acquisition with two different x-ray spectra, the dual-layer detector design enables simultaneous acquisition of high and low energy images with a single exposure. A computational framework is required to optimize the design parameters and evaluate detector performance for specific clinical applications. PURPOSE: In this study, we report on the development of a Monte Carlo (MC) model of the imager including model validation. METHODS: The stack-up of the dual-layer imager (DLI) was implemented in GEANT4 Application for Tomographic Emission (GATE). The DLI model has an active area of 43×43 cm2 , with top and bottom Cesium Iodide (CsI) scintillators of 600 and 800 µm thickness, respectively. Measurement of spatial resolution and imaging of dedicated multi-material dual-energy (DE) phantoms were used to validate the model. The modulation transfer function (MTF) of the detector was calculated for a 120 kVp x-ray spectrum using a 0.5 mm thick tantalum edge rotated by 2.5o . For imaging validation, the DE phantom was imaged using a 140 kVp x-ray spectrum. For both validation simulations, corresponding measurements were done using an initial prototype of the imager. Agreement between simulations and measurement was assessed using normalized root mean square error (NRMSE) and 1D profile difference for the MTF and phantom images respectively. Further comparison between measurement and simulation was made using virtual monoenergetic images (VMIs) generated from basis material images derived using precomputed look-up tables. RESULTS: The MTF of the bottom layer of the dual-layer model shows values decreasing more quickly with spatial frequency, compared to the top layer, due to the thicker bottom scintillator thickness and scatter from the top layer. A comparison with measurement shows NRMSE of 0.013 and 0.015 as well as identical MTF50 of 0.8 mm1 and 1.0 mm1 for the top and bottom layer respectively. For the DE imaging of the DE-phantom, although a maximum deviation of 3.3% is observed for the 10 mm aluminum and Teflon inserts at the top layer, the agreement for all other inserts is less than 2.2% of the measured value at both layers. Material decomposition of simulated scatter-free DE images gives an average accuracy in PMMA and aluminum composition of 4.9% and 10.3% for 11-30 mm PMMA and 1-10 mm aluminum objects respectively. A comparison of decomposed values using scatter containing measured and simulated DE images shows good agreement within statistical uncertainty. CONCLUSION: Validation using both MTF and phantom imaging shows good agreement between simulation and measurements. With the present configuration of the digital prototype, the model can generate material decomposed images and virtual monoenergetic images.

Implementation and evaluation of the AAPM TG 111 for radiation dosimetry in a state-of-the-art C-arm cone beam CT system.

The aim of this study was to assess the dosimetric characteristics of a state-of-the-art C-arm cone beam computed tomography (CBCT) system using the methodology proposed by the American Association of Physicists in Medicine (AAPM) Task Group (TG) 111. The dose measurement methodology described in AAPM TG 111 for wide cone beam acquisitions without table translation was employed to estimate equilibrium beam length (αeq‾) and equilibrium dose (feq‾) in various interventional task-specific protocols with different tube arc projection geometries. Dose profiles were derived from point dose measurements in the centre and peripheral locations of the ICRU/AAPM and standard polymethyl methacrylate (PMMA) body phantom. Dose measurements were performed in phantom and free-in-air using a solid-state point detector. Monte Carlo (MC) based simulation dosimetry was performed to quantify the inhomogeneous dose patterns imparted in the phantoms. Estimatedαeq‾andfeq‾on the ICRU/AAPM phantom was up to 49.4 cm and 6.17 mGy/100 mAs, respectively. Corresponding values determined on the PMMA phantom were 139 cm and 8.8 mGy/100 mAs, respectively. Free-in-air dose measurement ranged from 1.43 mGy/100 mAs to 5.93 mGy/100 mAs. Per cent difference inαeq‾andfeq‾between MC simulation and solid-state point detector measurement methods in the ICRU/AAPM phantom were within 16% and 18%, respectively. Manufacturers can use the presented methodology to characterize the dosimetric properties of C-arm CBCT systems. Clinical medical physicists may follow this methodology to verify corresponding data provided by the manufacturer and check for C-arm CBCT system performance dosimetric consistency.

In vitro assessment of inflammatory skin potential of poly(methyl methacrylate) at non-cytotoxic concentrations.

Poly(methyl methacrylate) (PMMA) is considered an attractive substrate material for fabricating wearable skin sensors such as fitness bands and microfluidic devices. Despite its widespread use, inflammatory and allergic responses have been attributed to the use of this material. Therefore, the main objective of this study was to obtain a comprehensive understanding of potential biological effects triggered by PMMA at non-cytotoxic concentrations using in vitro models of NIH3T3 fibroblasts and reconstructed human epidermis (RhE). It was hypothesized that concentrations that do not reduce cell viability are sufficient to activate pathways of inflammatory processes in the skin. The study included cytotoxicity, cell metabolism, cytokine quantification, histopathological, and gene expression analyses. The NIH3T3 cell line was used as a testbed for screening cell toxicity levels associated with the concentration of PMMA with different molecular weights (MWs) (i.e., MW ~5,000 and ~15,000 g/mol). The lower MW of PMMA had a half-maximal inhibitory concentration (IC50 ) value of 5.7 mg/cm2 , indicating greater detrimental effects than the higher MW (IC50 = 14.0 mg/cm2 ). Non-cytotoxic concentrations of 3.0 mg/cm2 for MW ~15,000 g/mol and 0.9 mg/cm2 for MW ~5,000 g/mol) induced negative metabolic changes in NIH3T3 cells. Cell viability was severely reduced to 7% after the exposure to degradation by-products generated after thermal and photodegradation degradation of PMMA. PMMA at non-cytotoxic concentrations still induced overexpression of pro-inflammatory cytokines, chemokines, and growth factors (IL1B, CXCL10, CCL5, IL1R1, IL7, IL17A, VEGFA, FGF2, IFNG, IL15) on the RhE model. The inflammatory response was also supported by histopathological and gene expression analyses of PMMA-treated RhE, indicating tissue damage and gene overexpression. Results suggested that non-cytotoxic concentrations of PMMA (3.0 to 5.6 mg/cm2 for MW ~15,000 g/mol and 0.9 to 2.1 mg/cm2 for MW ~5,000 g/mol) were sufficient to negatively alter NIH3T3 cells metabolism and activate inflammatory events in the RhE skin.

Evaluating the induced photon contamination by different breast IOERT shields using Monte Carlo simulation.

BACKGROUND AND OBJECTIVE: Avoiding the underlying healthy tissue over-exposure during breast intraoperative electron radiotherapy (IOERT) is owing to the use of some dedicated radioprotection disks during patient irradiation. The originated contaminant photons from some widely used double-layered shielding disks including PMMA+Cu, PTFE+steel, and Al+Pb configurations during the breast IOERT have been evaluated through a Monte Carlo (MC) simulation approach. METHODS: Produced electron beam with energies of 6, 8, 10, and 12 MeV by a validated MC model of Liac12 dedicated IOERT accelerator was used for disk irradiations. Each of above-mentioned radioprotection disks was simulated inside a water phantom, so that the upper disk surface was positioned at R90 depth of each considered electron energy. Simulations were performed by MCNPX (version 2.6.0) MC code. Then, the energy spectra of the contaminant photons at different disk surfaces (upper, middle, and lower one) and relevant contaminant dose beneath the studied disks were determined and compared. RESULTS: None of studied shielding disks show significant photon contamination up to 10 MeV electron energy, so that the induced photon dose by the contaminant X-rays was lower than those observed in the disk absence under the same conditions. In return, the induced photon dose at a close distance to the lower disk surface exceeded from calculated values in the disk absence at 12 MeV electron energy. The best performance in contaminant dose reduction at the energy range of 6-10 MeV belonged to the Al+Pb disk, while the PMMA+Cu configuration showed the best performance in this regard at 12 MeV energy. CONCLUSION: Finally, it can be concluded that all studied shielding disks not only don't produce considerable photon contamination but also absorb the originated X-rays from electron interactions with water at the electron energy range of 6-10 MeV. The only concern is related to 12 MeV energy where the induced photon dose exceeds the dose values in the disk absence. Nevertheless, the administered dose by contaminant photons to underlying healthy tissues remains beneath the tolerance dose level by these organs at the entire range of studied electron energies.

The first PET glimpse of a proton FLASH beam.

We demonstrate the first ever recorded positron-emission tomography (PET) imaging and dosimetry of a FLASH proton beam at the Proton Center of the MD Anderson Cancer Center. Two scintillating LYSO crystal arrays, read out by silicon photomultipliers, were configured with a partial field of view of a cylindrical poly-methyl methacrylate (PMMA) phantom irradiated by a FLASH proton beam. The proton beam had a kinetic energy of 75.8 MeV and an intensity of about 3.5 × 1010protons that were extracted over 101.5 ms-long spills. The radiation environment was characterized by cadmium-zinc-telluride and plastic scintillator counters. Preliminary results indicate that the PET technology used in our tests can efficiently record FLASH beam events. The instrument yielded informative and quantitative imaging and dosimetry of beam-activated isotopes in a PMMA phantom, as supported by Monte Carlo simulations. These studies open a new PET modality that can lead to improved imaging and monitoring of FLASH proton therapy.

Low-Cost 3-D-Printer-Assisted Personalized Cranioplasty Treatment: A Case Series of 14 Consecutive Patients.

OBJECTIVE: The current study used polylactic acid molds [developed locally using three-dimensional printers and our software] and polymethyl methacrylate (PMMA) to perform cranioplasty of bone defects in technically demanding areas of the skull while ensuring ideal cosmetic results and functional recovery. The overall aim was to identify the ideal method for standard cranioplasty procedures METHODS: Polylactic acid duplicates of the skull defects were created for eligible patients, after which a two-part negative mold composed of plaster and silicone was used to form artificial bone with PMMA. Thereafter, cranioplasty was performed and the treatment success was assessed by evaluating the percentage of similarity objectively and the body image scale subjectively. RESULTS: No surgical complications were seen to occur in the 14 patients included in the current study. Furthermore, the subjective and objective evaluation revealed a significant improvement in outcomes (p < 0.05). No postoperative complications were observed over a follow-up period of 6 months, except in 1 patient who exhibited late infection. CONCLUSIONS: Cranioplasty operations were performed at an economical price of approximately US$50 dollars, suggesting that this method can be applied widely. Furthermore, preoperative preparation of the PMMA models can help reduce the duration of anesthesia and surgery which, in turn, will minimize the risk of surgical complications. Based on current knowledge in the field, we believe that this method represents the ideal technique.

Toxicity assessment of core-shell and superabsorbent polymers in cell-based systems.

The identification of health risks arising from occupational exposure to submicron/nanoscale materials is of particular interest and toxicological investigations designed to assess their hazardous properties can provide valuable insights. The core-shell polymers poly (methyl methacrylate)@poly (methacrylic acid-co-ethylene glycol dimethacrylate) [PMMA@P (MAA-co-EGDMA)] and poly (n-butyl methacrylate-co-ethylene glycol dimethacrylate)@poly (methyl methacrylate) [P (nBMA-co-EGDMA)@PMMA] could be utilized for the debonding of coatings and for the encapsulation and targeted delivery of various compounds. The hybrid superabsorbent core-shell polymers poly (methacrylic acid-co-ethylene glycol dimethacrylate)@silicon dioxide [P (MAA-co-EGDMA)@SiO2] could be utilized as internal curing agents in cementitious materials. Therefore, the characterization of their toxicological profile is essential to ensure their safety throughout manufacturing and the life cycle of the final products. Based on the above, the purpose of the present study was to assess the acute toxic effects of the above mentioned polymers on cell viability and on cellular redox state in EA. hy926 human endothelial cells and in RAW264.7 mouse macrophages. According to our results, the examined polymers did not cause any acute toxic effects on cell viability after any administration. However, the thorough evaluation of a panel of redox biomarkers revealed that they affected cellular redox state in a cell-specific manner. As regards EA. hy926 cells, the polymers disrupted redox homeostasis and promoted protein carbonylation. Concerning RAW264.7 cells, P (nBMA-co-EGDMA)@PMMA caused disturbances in redox equilibrium and special emphasis was placed on the triphasic dose-response effect detected in lipid peroxidation. Finally, P (MAA-co-EGDMA)@SiO2 activated cellular adaptive mechanisms in order to prevent from oxidative damage.

Use of a Single Standard Skull Model for Preparation of PMMA-Based Cranioplasty Flap: A Novel Low-Cost Technique.

AIM: To introduce a novel, low-cost technique for cranioplasty using a single standard polyvinyl chloride plastic skull model as a guide for cranioplasty flap development; to observe and to compare the functional and cosmetic outcomes. MATERIAL AND METHODS: We conducted an observational, retrospective, cohort study that included 20 patients who underwent cranioplasty at the Department of Neurosurgery, RMLIMS, Lucknow from September 2020 to September 2021. The patients were evaluated based on postoperative cosmesis and symptomatic relief. RESULTS: A total of 20 patients were included in this study. All procedures were performed without any intraoperative or long-term complications noted on follow-up. None of the patients required reoperation. We observed no evidence of bleeding, infection, or poor scar formation. The patients and their families were satisfied with the cosmetic results of the procedure. CONCLUSION: Our technique provided excellent functional outcomes, cosmetic appearance, and improved clinical symptoms. This technique is currently the most cost-effective alternative available.

Antibiotic release from PMMA spacers and PMMA beads measured with ELISA: Assessment of in vitro samples and drain fluid samples of patients.

For prosthetic joint infections, antibiotic loaded poly methyl methacrylate (PMMA) spacer or beads can be used to release high concentrations of antibiotics locally at the infection site, while minimizing systemic toxicity. The aim of this study is to determine in vitro and in vivo pharmacokinetic release profile of antibiotics from PMMA spacers and PMMA beads. For the in vitro experiment, the PMMA spacers or beads were submerged in phosphate-buffered saline and gentamicin concentrations were determined from collected specimen at several times points, measured with enzyme-linked immunosorbent assays (ELISA). To assess the in vivo antibiotic release profile of different spacers, wound drainage fluid samples were collected after implantation of a spacer over a period of maximum 14 days. After 48 h, the burst gentamicin concentration elution was 9862 ± 1782 ng/ml (mean ± SD) from spacers versus 38,394 ± 7071 ng/ml (mean ± SD) for beads. Over 35 days, spacers had eluted a cumulative mean concentration of 13,812 ± 3548 versus 55,048 ± 12,006 ng/ml for beads (p < 0.001). Clinical samples of patients with a Vancogenx® spacer showed higher gentamicin release than Refobacin™ spacers (p < 0.001). This is the first study that measured the release data of local antibiotics with ELISA. Compare to spacers, the exact release values of gentamicin from PMMA beads are more than 10 times higher and reached a maximum much later than spacers. This makes the use of PMMA beads more preferable to use for treatment of the infection itself.

Design and performance evaluation of a slit-slat camera for 2D prompt gamma imaging in proton therapy monitoring: A Monte Carlo simulation study.

PURPOSE: We investigated the design of a prompt gamma camera for real-time dose delivery verification and the partial mitigation of range uncertainties. METHODS: A slit slat (SS) camera was optimized using the trade-off between the signal-to-noise ratio and spatial resolution. Then, using the GATE Monte Carlo package, the camera performances were estimated by means of target shifts, beam position quantification, changing the camera distance from the beam, and air cavity inserting. A homogeneous PMMA phantom and the air gaps induced PMMA phantom were used. The air gaps ranged from 5 mm to 30 mm by 5 mm increments were positioned in the middle of the beam range. To reduce the simulation time, phase space scoring was used. The batch method with five realizations was used for stochastic error calculations. RESULTS: The system's detection efficiency was 1.1 × 10 - 4 PGs Emitted PGs ( 1.8 × 10 - 5 $1.1 \times {10}^{-4}\frac{{\rm PGs}}{{\rm Emitted}\ {\rm PGs}}\ (1.8 \times {10}^{-5}$ PGs/proton) for a 10 × 20 cm2 detector (source-to-collimator distance = 15.0 cm). Axial and transaxial resolutions were 23 mm and 18 mm, respectively. The SS camera estimated the range as 69.0 ± 3.4 (relative stochastic error 1-sigma is 5%) and 67.6 ± 1.8 mm (2.6%) for the real range of 67.0 mm for 107 and 108 protons of 100 MeV, respectively. Considering 160 MeV, these values are 155.5 ± 3.1 (2%) and 152.2 ± 2.0 mm (1.3%) for the real range of 152.0 mm for 107 and 108 protons, respectively. Considering phantom shift, for a 100 MeV beam, the precision of the quantification (1-sigma) in the axial and lateral phantom shift estimation is 2.6 mm and 1 mm, respectively. Accordingly, the axial and lateral quantification precisions were 1.3 mm and 1 mm for a 160 MeV beam, respectively. Furthermore, the quantification of an air gap formulated as gap d e t = 0.98 × gap real ${{\rm gap}}_{det}=0.98 \times {{\rm gap}}_{{\rm real}}$ , where gap d e t ${{\rm gap}}_{det}$ and gapreal are the estimated and real air gap, respectively. The precision of the air gap quantification is 1.6 mm (1 sigma). Moreover, 2D PG images show the trajectory of the proton beam through the phantom. CONCLUSION: The proposed slit-slat imaging systems can potentially provide a real-time, in-vivo, and non-invasive treatment monitoring method for proton therapy.

An assessment of the passivity of the fit of multiunit screw-retained implant frameworks manufactured by using additive and subtractive technologies.

STATEMENT OF PROBLEM: The lack of passive fit in implant-supported restorations can lead to mechanical and biological complications and compromise the longevity of the prosthesis. The manufacturing technique and evaluation site are factors that may affect the passive fit of multiunit screw-retained implant frameworks. However, scientific information regarding this issue is lacking. PURPOSE: The purpose of this in vitro study was to investigate the effect of manufacturing technique and evaluation site on the passive fit of multiunit screw-retained implant frameworks. MATERIAL AND METHODS: Two multiunit implant analogs were placed into the right second premolar and second molar sites of a mandibular typodont model. A total of 50 3-unit Co-Cr frameworks were fabricated with 3 indirect (conventional technique, polymethyl methacrylate milling, stereolithography) and 2 direct techniques (selective laser melting and soft alloy milling). The patterns obtained by indirect techniques were subsequently cast. The Sheffield test was used for the assessment. Digital images of the sites were obtained by using a stereomicroscope at ×40 magnification, and the measurement points (n=10 for each site) were examined to record the vertical marginal discrepancy values (µm) with the aid of a measuring software program. The collected data were subjected to the 2-way ANOVA and Tukey honestly significant difference test (α=.05). RESULTS: The influence of the manufacturing technique (variable 1) on the vertical marginal discrepancy values was statistically significant (P<.001). However, the evaluation site (variable 2) (P=.097) and the interaction of the variables (P=.960) were not statistically significant. The lowest misfit values were observed for selective laser melting (74.2 ±20.5 µm) followed by stereolithography (92.8 ±23.9 µm), soft alloy milling (108.4 ±12.0 µm), polymethyl methacrylate milling (116.7 ±17.0 µm), and conventional technique (137.5 ±18.9 µm). The vertical marginal discrepancy values of the selective laser melting group were significantly lower than those of all other groups (P<.05). CONCLUSIONS: The manufacturing technique significantly affected the passive fit. selective laser melting-fabricated frameworks demonstrated superior fitting accuracy. Among the indirect techniques, stereolithography-fabricated frameworks revealed the lowest misfit values. The vertical marginal discrepancy values of all manufacturing groups were within the range of clinical acceptability (<150 µm).