Standardization of the Punch Technique for the Implantation of Bone Anchored Auditory Devices: Evaluation of the MIPS Surgical Set.

OBJECTIVE: To describe and assess intraoperative and postoperative outcomes in the insertion of osseointegrated auditory implants with a newly designed surgical instrumentation set through a punch type technique. STUDY DESIGN: Retrospective case series. METHODS: Patients who underwent bone anchored auditory implant surgery using the Minimally Invasive Ponto Surgery (Oticon Medical, Somerset, NJ) surgical set through a punch technique at nine neurotology tertiary referral based practices were identified. Demographic data, skin thickness at implant site, implant used, duration of surgery, adverse intraoperative events, and postoperative outcomes were recorded. RESULTS: Seventy-five patients comprised the study cohort (32 males, 43 females). Most patients (57. 3%) were aged 51 to 75 years while 30.7% of the cohort comprised those aged 18 to 50 years and 12% were over 75 years. All but two patients received 4 mm fixtured implants and 68% received the Oticon Medical BioHelix implant. Two patients received 3 mm fixture implants and 32% received the Oticon Medical Wide Ponto implant. Mean surgical time was 12.2 minutes (6-45 min, standard deviation of 6.88 min). In three instances, surgery was converted to a linear incision to control brisk bleeding. Skin condition was Holgers 0 to 1 in 91.8%, while 5.5% had Holgers 2, and 2.7% had Holgers 3 at the first postoperative visit. At second postoperative visit, 94.3% had Holgers 0 to 1, 4.3% had Holgers 2, and 1.4% had Holgers 3. All instances of adverse skin reactions were treated with topical or systemic antibiotics and/or local debridement. There were no instances of implant loss. One patient had his implant traumatically displaced to a 45-degree angle necessitating implant replacement at a second site. CONCLUSION: Punch technique placement of osseointegrated auditory implants using the Minimally Invasive Ponto Surgery surgical set represents a safe technique that further simplifies a progressively minimally invasive surgery.

Infection Control Programs and Antibiotic Control Programs to Limit Transmission of Multi-Drug Resistant Acinetobacter baumannii Infections: Evolution of Old Problems and New Challenges for Institutes.

BACKGROUND: Acinetobacter baumannii complex (A. baumannii) has been isolated worldwide. The rapid spread of multidrug-resistant A. baumannii complex (MDRAB) in clinical settings has made choosing an appropriate antibiotic to treat these infections and executing contact precautions difficult for clinicians. Although controlling the transmission of MDRAB is a high priority for institutions, there is little information about MDRAB control. Therefore, this study evaluated infection control measures for A. baumannii infections, clusters and outbreaks in the literature. METHODS: We performed a review of OVID Medline (from 1980 to 2015), and analyzed the literature. RESULTS: We propose that both infection control programs and antibiotic control programs are essential for control of MDRAB. The first, effective control of MDRAB infections, requires compliance with a series of infection control methods including strict environmental cleaning, effective sterilization of reusable medical equipment, concentration on proper hand hygiene practices, and use of contact precautions, together with appropriate administrative guidance. The second strategy, effective antibiotic control programs to decrease A. baumannii, is also of paramount importance. CONCLUSION: We believe that both infection control programs and antibiotics stewardship programs are essential for control of MDRAB infections.

Photoheterotrophic growth of Chlorella vulgaris ESP6 on organic acids from dark hydrogen fermentation effluents.

In this work, Chlorella vulgaris ESP6 was used to assimilate the soluble metabolites in the hydrogen fermentation broth of Clostridium butyricum CGS5 to obtain valuable microalgae biomass. The results show that C. vulgaris ESP6 could grow on the 4-fold diluted dark fermentation broth. Acetate was efficiently utilized during the growth of C. vulgaris ESP6, whereas the microalgae growth was inhibited by lactate, butyrate, and HCO3(-) when their concentrations were higher than 0.5, 0.1, and 2.72 g/L, respectively. C. vulgaris ESP6 could completely consume butyrate (the most abundant dark fermentation metabolite) when it was grown on Tris-Acetate-Phosphate medium under a food to microorganism (F/M) ratio of 1.11.

Hierarchical superstructures with control of helicity from the self-assembly of chiral bent-core molecules.

Herein, two asymmetric chiral bent-core molecules, 3-[(4-{[4-(heptyloxy)benzoyl]oxy}benzoyl)oxy]-phenyl-4-[(4-{[(1R)-1-methylheptyl]oxy}benzoyl)oxy] benzoate (BC7R) and 3-[(4-{[4-(heptyloxy)benzoyl]oxy}benzoyl)oxy]-phenyl-4-[(4-{[(1S)-1-methylheptyl]oxy}benzoyl)oxy] benzoate (BC7S), were synthesized to demonstrate control of the helicity of their self-assembled hierarchical superstructures. Mirror-imaged CD spectra showed a split-type Cotton effect after the formation of self-assembled aggregates of BC7R and BC7S, thereby suggesting the formation of intermolecular exciton couplets with opposite optical activities. Both twisted and helical ribbons with preferential helicity that corresponded to the twisting character of the intermolecular exciton couplet were found in the aggregates. The formation of helical ribbons was attributed to the merging of twisted ribbons through an increase in width to improve morphological stability. As a result, control of the helicity of hierarchical superstructures from the self-assembly of bent-core molecules could be achieved by taking advantage of the transfer of chiral information from the molecular level onto the hierarchical scale.

Donor-acceptor polymers based on multi-fused heptacyclic structures: synthesis, characterization and photovoltaic applications.

We report here two novel 2,7-fluorene- and 2,7-carbazole-based conjugated polymers PFDCTBT and PCDCTBT containing ladder-type heptacyclic structures with forced planarity. PCDTBT shows excellent solubility, low band gap and high hole mobility, leading to a power conversion efficiency of 3.7%.