Langerhans Cell Histiocytosis of the Pediatric Thoracic Spine with Development of Neurological Compromise: A Case Report.

CASE: This report describes a 7-year-old girl with Langerhans cell histiocytosis (LCH) of the thoracic spine who developed neurological deterioration during nonsurgical management. She was treated with decompression and instrumented fusion followed by chemotherapy, recovered completely after surgery, and was doing well at 6-year follow-up. CONCLUSIONS: The best treatment of LCH of the spine is not clear, but in the setting of neurologic compromise after failing conservative management, surgical decompression with adjuvant chemotherapy should be considered.

Effect of Ultrasound Frequency and Treatment Duration on Antibiotic Elution from Polymethylmethacrylate Bone Cement.

INTRODUCTION: The objective of this study was to evaluate the effect of ultrasound frequency and treatment duration on antibiotic-impregnated polymethylmethacrylate (PMMA) antibiotic elution rates and mechanical strength. METHODS: Two batches of PMMA were prepared: one with five grams of vancomycin powder and one without. Each batch was divided into two frequency groups: kHz and MHz. Each frequency group was divided into two duration groups: two minutes and ten minutes. Elution samples were measured daily using flow injection analysis. After one week of elution, ultrasound treatments were done daily until each group's average concentration fell below those of non-ultrasound control groups. After elution testing, compression testing determined mechanical properties. Paired t-tests were used to compare daily elution amounts to baseline values. Univariate ANOVAs were used to test for effects of both frequency and treatment duration on antibiotic elution amounts and on mechanical properties. RESULTS: All ultrasound treatments resulted in significant increases in antibiotic elution. Frequency and duration had significant effects of increasing antibiotic elution (p < 0.001). The kHz group produced significantly greater antibiotic elution than the MHz group (p < 0.001). The 10-minute duration produced significantly greater antibiotic elution than the two-minute duration (both p < 0.001). Frequency and duration did not have significant effects on yield stress (p = 0.841 and p = 0.179, respectively). Frequency had a significant effect (p = 0.024) on modulus, but duration did not (p = 0.136). CONCLUSIONS: Ultrasound frequency and treatment duration significantly affect antibiotic elution from PMMA which may be helpful for treatment of periprosthetic joint infections during revision arthroplasty.

Antibiotic Elution and Mechanical Strength of PMMA Bone Cement Loaded With Borate Bioactive Glass.

Introduction: Local delivery of antibiotics using bone cement as the delivery vehicle is an established method of managing implant-associated orthopedic infections. Various fillers have been added to cement to increase antibiotic elution, but they often do so at the expense of strength. This study evaluated the effect of adding a borate bioactive glass, previously shown to promote bone formation, on vancomycin elution from PMMA bone cement. Methods: Five cement composites were made: three loaded with borate bioactive glass along with 0, 1, and 5 grams of vancomycin and two without any glass but with 1 and 5 grams vancomycin to serve as controls. The specimens were soaked in PBS. Eluate of vancomycin was collected every 24 hours and analyzed by HPLC. Orthopedic-relevant mechanical properties of each composite were tested over time. Results: The addition of borate bioactive glass provided an increase in vancomycin release at Day 1 and an increase in sustained vancomycin release throughout the treatment period. An 87.6% and 21.1% increase in cumulative vancomycin release was seen for both 1g and 5g loading groups, respectively. Compressive strength of all composites remained above the weight-bearing threshold of 70 MPa throughout the duration of the study with the glass-containing composites showing comparable strength to their respective controls. Conclusion: The incorporation of borate bioactive glass into commercial PMMA bone cement can significantly increase the elution of vancomycin. The mechanical strength of the cement-glass composites remained above 70 MPa even after soaking for 8 weeks, suggesting their suitability for orthopedic weight-bearing applications.

Thermoresponsive Nanocomposite Hydrogels: Transparency, Rapid Deswelling and Cell Release.

Thermal modulation reversibly switches poly(N-isopropylacrylamide) (PNIPAAm) hydrogels between a water-swollen and a deswollen state which is useful for a variety of biomedical applications. The utility and efficiency of PNIPAAm hydrogels requires tailoring their rate of deswelling/reswelling, mechanical properties and/or optical clarity. In the current work, we prepared novel thermoresponsive nanocomposite hydrogels comprised of a PNIPAAm hydrogel matrix and polysiloxane colloidal nanoparticles (~54 nm ave. diameter) via in situ photopolymerization of aqueous solutions of NIPAAm monomer, N,N'-methylenebisacrylamide (BIS, crosslinker), photoinitiator and 0.5-4.0 wt% polysiloxane nanoparticles (wt% solids of nanoparticles with respect to NIPAAm weight) at ~7 °C. At these nanoparticle concentrations, the nanocomposite hydrogels were more optically transparent versus those prepared with analogous larger nanoparticles (~219 nm ave. diameter). The volume phase transition temperature (VPTT) of the nanocomposite hydrogels was conveniently unaltered versus that of the pure PNIPAAm hydrogel. Incorporation of nanoparticles caused enhancement in modulus as well as the extent and rate of deswelling. When cooled from 37 °C to 25 °C, mouse smooth muscle precursor cells (10T1/2) were effectively detached from nanocomposite hydrogel surfaces due to hydrogel swelling.