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1.
Medicina (Kaunas) ; 57(8)2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34440965

RESUMO

Background and objectives: In oral and maxillofacial operations, the iliac crest is a commonly used donor site from which to harvest bone for augmentation prior to dental implantation or for reconstruction of jaw defects caused by trauma or pathological lesions. In an aging society, the proportion of elderly patients undergoing iliac crest bone grafting for oral augmentation is growing. Although postoperative morbidity is usually moderate to low, the age and health of the patient should be considered as risk factors for complications and delayed mobilization after the operation. The aim of this retrospective study was to evaluate the postoperative morbidity and complications in elderly patients after the harvesting of iliac crest bone grafts for oral surgery. Material and Methods: Data were collected from a total of 486 patients (aged 7-85) who had a surgical procedure that included the harvesting of iliac crest bone grafts for intraoral transplantation. All patients were operated on between 2005 and 2021 in the Department for Oral and Maxillofacial Surgery of the University Hospital in Aachen, Germany. As parameters for postoperative morbidity and complications, gait disturbances, hypesthesia of cutaneous nerves, incision hernias, iliac crest fractures, delayed wound healing, and unfavorable scar formation at the donor site were all evaluated. Results: The study was performed with 485 patients due to the exclusion of one patient as the only one from whom grafts were taken from both sides. When younger and older patients were compared, neither gait disturbances (p = 0.420), nor hernias (p = 0.239), nor fractures (p = 0.239), nor hypesthesia (p = 0.297), nor wound healing delay (p = 0.294), nor scar problems (p = 0.586) were significantly different. However, the volume of the graft was significantly correlated with the duration of the hospital stay (ρ = 0.30; p < 0.01) but not with gait disturbances (ρ = 0.60; p = 0.597). Additionally, when controlling for age (p = 0.841), sex (p = 0.031), ASA class (p = 0.699), preexisting orthopedic handicaps (p = 0.9828), and the volume of the bone graft (p = 0.770), only male sex was associated with the likelihood of suffering gait disturbances (p = 0.031). Conclusions: In conclusion, harvesting bone grafts from the anterior iliac crest for intraoral augmentation is a safe procedure for both young and elderly patients. Although there is some postoperative morbidity, such as gait disturbances, hypesthesia, scar formation, or delayed wound healing at the donor site, rates for these minor complications are low and mostly of short duration. Major complications, such as fractures or incision hernias, are very rare. However, in our study, the volume of the bone graft was associated with a longer stay in hospital, and this should be considered in the planning of iliac crest bone graft procedures.


Assuntos
Ílio , Coleta de Tecidos e Órgãos , Idoso , Transplante Ósseo , Humanos , Masculino , Morbidade , Dor Pós-Operatória , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
2.
Int J Med Robot ; : e2318, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34328700

RESUMO

BACKGROUND: Defects of the facial skeleton often require complex reconstruction with vascularized grafts. This trial elucidated the usability, visual perception and accuracy of a markerless augmented reality (AR)-guided navigation for harvesting iliac crest transplants. METHODS: Random CT scans were used to virtually plan two common transplant configurations on 10 iliac crest models, each printed four times. The transplants were harvested using projected AR and cutting guides. The duration and accuracies of the angulation, distance and volume between the planned and executed osteotomies were measured. RESULTS: AR was characterized by the efficient use of time and accurate rendition of preoperatively planned geometries. However, vertical osteotomies and complex anatomical settings displayed significant inferiority of AR guidance compared to cutting guides. CONCLUSIONS: This study demonstrated the usability of a markerless AR setup for harvesting iliac crest transplants. The visual perception and accuracy of the AR-guided osteotomies constituted remaining weaknesses against cutting guide technology.

3.
Sci Rep ; 11(1): 13598, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193930

RESUMO

Conventional anastomoses with interrupted sutures are challenging and inevitably associated with trauma to the vessel walls. The goal of this study was to evaluate a novel alternative adhesive-based suture-free anastomosis technique that uses an intraluminal stent. Overall, 120 porcine coronary vessels were analyzed in an ex vivo model and were examined for their mechanical (n = 20 per cohort) and hydrostatic strength (n = 20 per cohort). Anastomoses were made using the novel VIVO adhesive with an additional intraluminal nitinol stent and was compared to interrupted suture anastomosis and to native vessels. Sutureless anastomoses withstood pressures 299 ± 4.47 [mmHg] comparable to native vessels. They were performed significantly faster 553.8 ± 82.44 [sec] (p ≤ 0.001) and withstood significantly higher pressures (p ≤ 0.001) than sutured anastomoses. We demonstrate that the adhesive-based anastomosis can also resist unphysiologically high longitudinal tensile forces with a mean of 1.33 [N]. Within the limitations of an in vitro study adhesive-based suture-free anastomosis technique has the biomechanical potential to offer a seamless alternative to sutured anastomosis because of its stability, and faster handling. In vivo animal studies are needed to validate outcomes and confirm safety.

4.
Ann Anat ; 238: 151782, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34144156

RESUMO

BACKGROUND: Sutured anastomosis remains the gold standard in microvascular surgery. The procedure is not free of complications and is a time-consuming operation requiring a high level of experience. The aim of this study was to develop new methods for a stable, faster, and safer anastomosis using a novel biodegradable adhesive, VIVO, and a custom-made microvascular stent. METHODS: The VIVO medical adhesive was used for a total of 30 anastomoses in rats in the right carotid artery: 15 anastomoses were performed with a temporary intraluminal catheter, VIVO, and reduced sutures (VIVO + TC). A further 15 anastomoses were performed with nitinol stents, VIVO, and reduced sutures (VIVO + SM). Sutured anastomoses served as controls (C) and were performed on the left carotid arteries of the 30 rats. Operation and bleeding times were assessed, and patency was evaluated by Doppler flowmetry and indocyanine green (ICG) angiography. Subsequently, the anastomoses were evaluated histopathological. RESULTS: The overall patency was recorded as 100% in all groups. No thrombosis or circulatory disturbance was found. Compared to C and VIVO + SM, VIVO + TC proved to be significantly less traumatic, less demanding, and time-saving. The sealing properties of VIVO lead to shorter bleeding times and less oozing. In contrast, VIVO + SM proved to be the most technically demanding and time-consuming procedure. CONCLUSION: The success of a microvascular sutured anastomosis is determined by a short ischemic interval. Compared to sutured anastomosis, VIVO + TC showed ease of use as well as shorter time taken for anastomosis, less trauma, and lower blood loss. More long-term studies on the functions, biological interactions, and survival rates of glue-based anastomoses need to be initiated.

5.
Ann Anat ; 236: 151713, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33675947

RESUMO

BACKGROUND: The aim of the present investigation was to develop a new cleft model in rats that allows alveolar cleft repair and subsequent tooth movement. METHODS: A complete continuity-interrupting alveolar cleft was performed on the left-side maxillae of 33 rats through ultrasonic surgery. The clefts were filled with bone wax, and microCT scans were done to analyze the cleft size. After four weeks, the cleft repair was completed using autologous, xenogeneic (human), or synthetic bone substitute. After an additional four weeks, the orthodontic tooth movement was initiated. RESULTS: Fourteen rats died during the research, and the study design was constantly adapted accordingly. The main reasons for death included breathing problems during or immediately after the experimental activities (eight animals), followed by two deaths due to circulatory failures. In the remaining 19 animals, the average cleft size was about 2.70 ± 0.46 × 2.01 ± 0.25 × 1.18 ± 0.20 mm, and the mean velocity of orthodontic tooth movement after seven days was between 0.21 ± 0.08 mm in the autologous group and 0.50 ± 0.54 mm in the xenogeneic group. After 56 days, the mean values ranged between 0.67 ± 0.27 mm in the autologous group and 0.82 ± 0.72 mm in the synthetic group. CONCLUSIONS: Surgical interventions in the oral cavity of rats requires a stronger anesthesia and lead to increased risk of coolant and coagulated blood aspiration. The new alveolar cleft model in rats allows for subsequent orthodontic tooth movement after cleft repair, but only in the mesial root of the first molar.

6.
Materials (Basel) ; 13(19)2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33007841

RESUMO

AIM: This in vitro study aimed to evaluate the effects of implant designs on primary stability in different bone densities and bony defects. METHODS: Five implant types (tapered-tissue-level, tissue-level, zirconia-tissue-level, bone-level, and BLX implants) were used in this assessment. The implants were inserted into four different artificial bone blocks representing varying bone-density groups: D1, D2, D3, and D4. Aside from the control group, three different types of defects were prepared. Using resonance frequency analysis and torque-in and -out values, the primary stability of each implant was evaluated. RESULTS: With an increased defect size, all implant types presented reduced implant stability values measured by the implant stability quotient (ISQ) values. Loss of stability was the most pronounced around circular defects. Zirconia and bone-level implants showed the highest ISQ values, whereas tissue level titanium implants presented the lowest stability parameters. The implant insertion without any thread cut led to a small improvement in primary implant stability in all bone densities. CONCLUSIONS: Compared with implants with no peri-implant defects, the three-wall and one-wall defect usually did not provide significant loss of primary stability. A significant loss of stability should be expected when inserting implants into circular defects. Implants with a more aggressive thread distance could increase primary stability.

7.
Ann Anat ; 228: 151435, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31678402

RESUMO

BACKGROUND: One surgical objective is creating an aesthetically satisfying outcome. The morbidity increases with age. Standard values for areas of the face, which are frequently surgically treated, are needed for the surgeon. METHODS: 240 Caucasians aged 21-65 were divided into six subgroups by gender and age. They were scanned by a three-dimensional (3D) scanner. Distances and angles in faces between landmarks were evaluated. RESULTS: During aging, the relation of the eye's width to the eye's height became significantly smaller (M: p=0.001, F: p≤0.0001). The outer contour of the nose became significantly sharper with increasing age (M: p=0.001, F: p=0.0021). Seen from caudal, the nose formed an isosceles triangle with the base between the left and right alar curvature and the base had an average length of 31.35mm±2.97mm. The leg of this triangle had an average length of 33.67mm±2.09mm. The nose got longer and wider during aging; the age-dependent changes between the different groups of males (p≤0.0001) and the difference between females and males were significant (p≤0.0001). The thickness of the nasal wings remained the same size during a lifetime. Females had significantly greater heights for both lips (p≤0.0001, p=0.027). In males and females, the heights decreased with increasing age. CONCLUSION: This study provided a database of measurements of parts of the face, especially those parts that can underlie various surgical treatments.


Assuntos
Envelhecimento/patologia , Face/anatomia & histologia , Face/cirurgia , Adulto , Idoso , Análise de Variância , Reabsorção Óssea , Olho/anatomia & histologia , Ossos Faciais/anatomia & histologia , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Boca/anatomia & histologia , Nariz/anatomia & histologia , Adulto Jovem
9.
Mol Neurobiol ; 54(10): 8429-8443, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27957680

RESUMO

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease manifested by the progressive loss of upper and lower motoneurons. The pathomechanism of ALS is complex and not yet fully understood. Neuroinflammation is believed to significantly contribute to disease progression. Inflammasome activation was recently shown in the spinal cord of human sporadic ALS patients and in the SOD1(G93A) mouse model for ALS. In the present study, we investigated the neuroprotective and anti-inflammatory effects of 17ß-estradiol (E2) treatment in pre-symptomatic and symptomatic male SOD1(G93A) mice. Symptomatic mice with E2 substitution exhibited improved motor performance correlating with an increased survival of motoneurons in the lumbar spinal cord. Expression of NLRP3 inflammasome proteins and levels of activated caspase 1 and mature interleukin 1 beta were significantly reduced in SOD1(G93A) mice supplemented with E2.


Assuntos
Esclerose Amiotrófica Lateral/metabolismo , Regulação para Baixo/fisiologia , Estradiol/farmacologia , Inflamassomos/metabolismo , Neurônios Motores/metabolismo , Superóxido Dismutase-1/metabolismo , Esclerose Amiotrófica Lateral/genética , Animais , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/fisiologia , Regulação para Baixo/efeitos dos fármacos , Estradiol/uso terapêutico , Feminino , Humanos , Inflamassomos/antagonistas & inibidores , Inflamassomos/genética , Masculino , Camundongos , Camundongos Transgênicos , Neurônios Motores/efeitos dos fármacos , Superóxido Dismutase-1/genética
10.
Glia ; 63(12): 2260-73, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26200799

RESUMO

Amyotrophic lateral sclerosis (ALS) is characterized by the degeneration of motoneurons in the cerebral cortex, brainstem and spinal cord. Neuroinflammation plays an important role in the pathogenesis of ALS and involves the activation of microglia and astrocytes. Intracellular inflammasome complexes are part of the innate immunity as they sense and execute host inflammatory responses. The best characterized component is the NLRP3 inflammasome comprised of the NLR protein NLRP3, the adaptor ASC and pro-caspase 1. The NLRP3 inflammasome is critical for the activation of caspase 1 and the processing and release of IL1ß and IL18. In this study, we investigated the expression, activation and co-localization of the NLRP3 inflammasome in the spinal cord of male SOD1(G93A) mice carrying a mutant human superoxide dismutase 1 (SOD1) variant and regarded as an animal model for ALS as well as in post-mortem tissue of ALS patients. NLRP3 and its molecular components as well as IL1ß were already detectable in SOD1 mice at a pre-symptomatic stage after 9 weeks and further increased in 14 week old animals. Spinal cord astrocytes were identified as the major cell type expressing NLRP3 components. In human ALS tissue, we also found increased NLRP3, ASC, IL18 and active caspase 1 levels compared to control patients. Our findings suggest that astroglial NLRP3 inflammasome complexes are critically involved in neuroinflammation in ALS.


Assuntos
Esclerose Amiotrófica Lateral/metabolismo , Astrócitos/metabolismo , Proteínas de Transporte/metabolismo , Esclerose Amiotrófica Lateral/patologia , Animais , Astrócitos/patologia , Caspase 1/metabolismo , Células Cultivadas , Modelos Animais de Doenças , Humanos , Interleucina-18/metabolismo , Interleucina-1beta/metabolismo , Masculino , Camundongos Transgênicos , Neurônios Motores/metabolismo , Neurônios Motores/patologia , Proteína 3 que Contém Domínio de Pirina da Família NLR , RNA Mensageiro/metabolismo , Medula Espinal/metabolismo , Medula Espinal/patologia , Superóxido Dismutase/genética , Superóxido Dismutase/metabolismo , Superóxido Dismutase-1
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