Sol-gel dip-coated TiO2 nanofilms reduce heat production in titanium alloy implants produced by microwave diathermy.

Objective: To verify that the TiO2 nanofilm dip-coated by sol-gel can reduce titanium alloy implants (TAI)'s heat production after microwave diathermy (MD).Methods: The effect of 40 W and 60 W MD on the titanium alloy substrate coated with TiO2 nanofilm (Experimental Group) and the titanium alloy substrate without film (Control Group) were analyzed in vitro and in vivo. Changes in the skeletal muscle around the implant were evaluated in ex vivo by histology.Results: After 20 min of MD, in vitro the temperature rise of the titanium substrate was less in the Experimental Group than in the Control Group (40 W: 1.4 °C vs. 2.6 °C, p < .01, 60 W: 2.5 °C vs. 3.7 °C, p < .01) and in vivo, the temperature rise of the muscle tissue adjacent to TAI was lower in the Experimental Group than in the Control Group (40 W: 3.29 °C vs. 4.8 °C, p < .01, 60 W: 4.16 °C vs. 6.52 °C, p < .01). Skeletal muscle thermal injury can be found in the Control Group but not in the Experimental Group.Conclusion: Sol-gel dip-coated TiO2 nanofilm can reduce the heat production of TAIs under single 40～60 W and continuous 40 W MD and protect the muscle tissue adjacent to the implants against thermal injury caused by irradiation.

Study on TiO2 Nanofilm That Reduces the Heat Production of Titanium Alloy Implant in Microwave Irradiation and Does Not Affect Fracture Healing.

Background: Metal implants can produce heat and damage adjacent tissues under microwave irradiation, which makes local metal implants in the body a contraindication for microwave therapy. However, with the wide application of titanium alloy implants which have low permeability and low conductivity, this concept has been challenged. Our team members have confirmed through previous research that continuous low-power microwave irradiation does not cause thermal damage to the surrounding tissues of the titanium alloy. Is there any other way to further increase the dose of microwave irradiation while reducing the heat production of titanium alloy implants? In this study, the effect of TiO2 nanofilm on reducing the heat production of titanium alloy implants in microwave field was verified by animal experiments, and the effect of TiO2 nanofilm on fracture healing was observed. Methods: 30 rabbits were selected. In the experiment of temperature measurement, 10 rabbits were randomly divided into experimental group (n = 5) and control group (n = 5), and the contralateral lower limb of the rabbits in experimental group was set as the sham operation group. The right femurs in the experimental group were implanted with Ti6Al4V plates coated with TiO2 nanofilm, and the right femurs in the control group were implanted with common titanium alloy plates without TiO2 nanofilm. The same surgical procedure was used in the sham operation group, but no plate was implanted. The temperature of the deep tissue above the metal implant was measured with an anti-interference thermocouple thermometer during 20 minutes of microwave irradiation. The other 20 rabbits were randomly divided into two groups, experimental group (n = 10) and control group (n = 10). The femoral shaft fracture models were established again. Ti6Al4V plates coated with TiO2 nanofilm and common titanium alloy plates were implanted in the two groups, respectively, and both groups were exposed to continuous microwave irradiation with a power of 40 W or 60 W for 30 days after operation. The fracture healing was evaluated by X-ray at 0 day, 14 days, and 30 days after microwave irradiation, respectively. The animals were sacrificed at 30 days after operation for histopathological assessment. Results: The temperature in the experimental group, control group, and sham operation group increased significantly after 40 W and 60 W microwave irradiation (2.18 ± 0.15°C~6.02 ± 0.38°C). When exposed to 40 W microwave, the temperature rise of the control group was 4.0 ± 0.34°C, which was significantly higher than that of the experimental group 2.82 ± 0.15°C (P < 0.01) and the sham operation group 2.18 ± 0.33°C (P < 0.01). There was no significant difference in temperature rise between the experimental group and the sham operation group (P = 0.21). When exposed to 60 W microwave, the temperature rise of the control group was 6.02 ± 0.38°C, which was significantly higher than that of the experimental group 3.66 ± 0.14°C (P < 0.01) and sham operation group 2.96 ± 0.22°C (P < 0.01), and there was no significant difference between the experimental group and the sham operation group (P = 0.32). X-ray evaluation showed that there was no significant difference in callus maturity between the experimental group and the control group at 14 days (P = 0.554), but there was significant difference in callus maturity between the two groups at 30 days (P = 0.041). The analysis of bone histologic and histomorphometric data at 30 days was also consistent with this. Conclusion: Under the animal experimental condition, compared with the common titanium alloy implant, the TiO2 nanofilm can reduce the heat production of the titanium alloy implant in the 2450 MHz microwave field and has no adverse effect on fracture healing. This study opens up a promising new idea for the application of microwave therapy to metal implants in human body.

[Information Management System for Rehabilitation Medicine Department of General Hospital].

OBJECTIVES: To develop a common information management system for rehabilitation medicine department of general hospital. METHODS: Based on the investigation of information requirement of several different levels hospitals, the medical information management system was designed, and it has been applied in several hospitals. RESULTS: In addition to rehabilitation treatment informatization for inpatient and outpatient, the system has highly customizable, assistant research, teaching and management features. CONCLUSIONS: The system can simplify the process of medical treatment, improve the efficiency of diagnosis and treatment, increase patient satisfaction, improve the management level. It worths popularizing.

Enhancement of Apoptosis by Titanium Alloy Internal Fixations during Microwave Treatments for Fractures: An Animal Study.

OBJECTIVE: Microwaves are used in one method of physical therapy and can increase muscle tissue temperature which is useful for improving muscle, tendon and bone injuries. In the study, we sought to determine whether titanium alloy internal fixations influence apoptosis in tissues subjected to microwave treatments at 2,450 MHz and 40 W during the healing of fractures because this issue is not yet fully understood. METHODS: In this study, titanium alloy internal fixations were used to treat 3.0-mm transverse osteotomies in the middle of New Zealand rabbits' femurs. After the operation, 30-day microwave treatments were applied to the 3.0 mm transverse osteotomies 3 days after the operation. The changes in the temperatures of the muscle tissues in front of the implants or the 3.0 mm transverse osteotomies were measured during the microwave treatments. To characterize the effects of titanium alloy internal fixations on apoptosis in the muscles after microwave treatment, we performed TUNEL assays, fluorescent real-time (quantitative) PCR, western blotting analyses, reactive oxygen species (ROS) detection and transmission electron microscopy examinations. RESULTS: The temperatures were markedly increased in the animals with the titanium alloy implants. Apoptosis in the muscle cells of the implanted group was significantly more extensive than that in the non-implanted control group at different time points. Transmission electron microscopy examinations of the skeletal muscles of the implanted groups revealed muscular mitochondrial swelling, vacuolization. ROS, Bax and Hsp70 were up-regulated, and Bcl-2 was down-regulated in the implanted group. CONCLUSION: Our results suggest that titanium alloy internal fixations caused greater muscular tissue cell apoptosis following 2,450 MHz, 40 W microwave treatments in this rabbit femur fracture models.

Thermal effects of 2450 MHz microwave exposure near a titanium alloy plate implanted in rabbit limbs.

This study aimed to examine the safety profile of microwave therapy on limbs with metal implants. New Zealand white rabbits were implanted with titanium alloy internal fixation plates. Femurs were exposed to 20, 40, 60, or 80 W of microwave radiation for 30 min (microwave applicator at 2450 MHz), and temperatures of the implants and muscles adjacent to implants were recorded. To evaluate thermal damage, nerves were electrodiagnostically assessed immediately after radiation, and histologic studies performed on nerve and muscle sections. As expected, implant temperature was highest in the exposure field. Temperatures of limbs with titanium alloy implants increased significantly at 60 and 80 W, with a significant decline in the nerve conduction velocity and acute thermal injuries in nerves and muscles adjacent to implants. However, temperature remained unchanged and no adverse effects were observed in nerves and muscles at 20 and 40 W. These findings are inconsistent with the current notion that surgical metal implants in the treatment field are contraindications for microwave therapy. Hence, we believe that a lower dose of continuous wave microwave irradiation is safe for limbs with titanium alloy implants.

Carpal tunnel syndrome assessment with ultrasonography: value of inlet-to-outlet median nerve area ratio in patients versus healthy volunteers.

OBJECTIVE: To evaluate the diagnostic value of the Inlet-to-outlet median nerve area ratio (IOR) in patients with clinically and electrophysiologically confirmed carpal tunnel syndrome (CTS). METHODS: Forty-six wrists in 46 consecutive patients with clinical and electrodiagnostic evidence of CTS and forty-four wrists in 44 healthy volunteers were examined with ultrasonography. The cross-sectional area (CSA) of the median nerve was measured at the carpal tunnel inlet (the level of scaphoid-pisiform) and outlet (the level of the hook of the hamate), and the IOR was calculated for each wrist. Ultrasonography and electrodiagnostic tests were performed under blinded conditions. Electrodiagnostic testing combined with clinical symptoms were considered to be the gold standard test. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic value between the inlet CSA and IOR. RESULTS: The study population included 16 men and 30 women (mean age, 45.3 years; range, 18-83 years). The control population included 18 men and 26 women (mean age, 50.4 years; range, 18-79 years). The mean inlet CSA was 8.7 mm2 in healthy controls and 14.6mm2 in CTS group (P<0.001). The mean IOR in healthy volunteers (1.0) was smaller than that in patients (1.6, P<0.001). Receiver operating characteristic analysis revealed a diagnostic advantage to using the IOR rather than the inlet CSA (P<0.01). An IOR cutoff value of ≥ 1.3 would yield 93% specificity and 91% sensitivity in the diagnosis of CTS. CONCLUSION: The IOR of median nerve area promises to be an effective means in the diagnosis of CTS. A large-scale, randomized controlled trial is required to determine how and when this parameter will be used.

Low dose of continuous-wave microwave irradiation did not cause temperature increase in muscles tissue adjacent to titanium alloy implants--an animal study.

BACKGROUND: Research studies on the influence of radiofrequency electromagnetic radiation on implants in vitro have failed to investigate temperature changes in the tissues adjacent to the implants under microwave therapy. We therefore, used a rabbit model in an effort to determine the impact of microwave therapy on temperature changes in tissues adjacent to the titanium alloy implants and the safety profile thereof. METHODS: Titanium alloy internal fixation plates were implanted in New Zealand rabbits in the middle of femur. Microwave therapy was performed by a 2450 MHz microwave generator 3 days after the surgery. Temperature changes of muscles adjacent to the implants were recorded under exposure to dose-gradient microwave radiation from 20w to 60w. RESULTS: Significant difference between control and microwave treatment group at peak temperatures (T(peak)) and temperature gap (T(gap) = T(peak)-T(vally)) were observed in deep muscles (T(peak), 41.63 ± 0.21°C vs. 44.40 ± 0.17°C, P < 0.01; T(gap), 5.33 ± 0.21°C vs. 8.10 ± 0.36°C, P < 0.01) and superficial muscles (T(peak), 41.53 ± 0.15°C vs. 42.03 ± 0.23°C, P = 0.04; T(gap), 5.23 ± 0.21°C vs. 5.80 ± 0.17°C, P = 0.013) under 60 w, and deep muscles (T(peak), 40.93 ± 0.25°C vs. 41.87 ± 0.23°C, P = 0.01; T(gap), 4.73 ± 0.20°C vs. 5.63 ± 0.35°C, P = 0.037) under 50w, but not under 20, 30 and 40w. CONCLUSION: Our results suggest that low-dose (20w-40w) continuous-wave microwave irradiation delivered by a 2450 MHz microwave generator might be a promising treatment for patients with titanium alloy internal fixation, as it did not raise temperature in muscle tissues adjacent to the titanium alloy implant.