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1.
Zhongguo Gu Shang ; 32(7): 677-682, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31382729

RESUMO

At present, artificial vertebral implants have proven to be effective in the treatment of spinal tumors, infections, fractures and other diseases. However, the fusion artificial vertebral body can cause adjacent intervertebral joint degeneration and loss of original physiological curvature and activity. The movable artificial vertebral body can, to some extent, restore the normal physiological movement and reduce biomechanical changes of the spine, reducing the occurrence of complication. The design of movable artificial vertebral body is to equip movable device when the basis of reliable stability is obtained. According to its principle it can be divided into ball socket joint or elastic deformation. However the overall design of movable artificial vertebral body needs further improvement. Traditional mechanical processing methods are difficult to process complex prostheses and the agreement rate between traditional produced prostheses and lesions was low. While the emerging 3D printing technology can achieve individualized improvement of prosthesis, its slow rate and high cost need to be improved. The materials of movable artificial vertebral body includes metal, ceramics, biomaterials, high polymer materials and so on. Titanium alloy is the main material in metal materials, which is widely used, but its modulus of elasticity is still far from that of human bone and it lacks ideal bone fusion. Ceramic materials are rich in variety but fragile and poor in wear resistance. Biomaterials include autogenous bone, allogeneic bone, etc., with limited source and complicated operation. There are many kinds of polymer and biodegradable materials which obtain excellent and ideal properties. But their properties and applications need to be further studied. The movable artificial vertebral body still needs to be promoted and developed. The clinical experimental data is still insufficient, and long-term curative effect needs to be further observed and studied. This paper reviews the development, advantages, design, processing and materials of movable artificial vertebral bodies and provides useful reference for optimization design, processing and clinical application of movable artificial vertebral bodies.


Assuntos
Coluna Vertebral , Materiais Biocompatíveis , Fenômenos Biomecânicos , Humanos , Próteses e Implantes , Neoplasias da Coluna Vertebral , Titânio
2.
Rev Med Suisse ; 15(657): 1340-1349, 2019 07 10.
Artigo em Francês | MEDLINE | ID: mdl-31290630

RESUMO

This article aims to present the principles of rehabilitation following anatomical and reverse total shoulder arthroplasties. The rehabilitation consist of three phases: wound healing and movement initiation (weeks 0-6), movement recovery (7-12), strengthening and return to activity (13-18). At 6 to 12 months follow-up, most patients report a substantial decrease in pain and a return to light to moderate activity level. The rehabilitation of the reverse arthroplasty specifically requires deltoid muscle strengthening and dislocation prevention. The functional outcome is slightly inferior for reverse arthroplasty, which is indicated when musculotendinous lesions are associated to bone lesions, but satisfaction rates are comparable between the two types of implants. The durability of total shoulder arthroplasties is globally satisfying, though shorter in young active patients.


Assuntos
Artroplastia do Ombro , Articulação do Ombro , Artroplastia , Humanos , Próteses e Implantes , Amplitude de Movimento Articular , Articulação do Ombro/cirurgia , Resultado do Tratamento
3.
Zhongguo Ying Yong Sheng Li Xue Za Zhi ; 35(3): 250-255, 2019 May 28.
Artigo em Chinês | MEDLINE | ID: mdl-31257808

RESUMO

OBJECTIVE: To investigate the protective effects of procyanidin on periprosthetic osteolysis caused by tricalcium phosphate (TCP) wear particles in the mouse calvaria and its mechanism. METHODS: Forty-eight male ICR mice were randomly divided into sham group, TCP group, and procyanidin (0.2 mg/kg, 1 mg/kg, 5 mg/kg)-treated group (n=12). A periprosthetic osteolysis model in the mouse calvaria was established by implanting 30 mg of TCP wear particles onto the surface of bilateral parietal bones following removal of the periosteum. On the 2nd day post-operation, procyanidin (1 mg/kg, 5 mg/kg) was locally injected to the calvaria under the periosteum every other day. After 2 weeks, all the mice were sacrificed to collect the blood samples and the calvaria. Periprosthetic osteolysis and osteoclastogenesis in the mouse calvaria were observed by tartrate resistant acid phosphatase (TRAP) staining and HE staining. mRNA levels of TRAP, capthesin K, c-Fos and NFATc1 in the periprosthestic bone tissue were examined by real-time fluorescence quantitative PCR. Serum contents of total anti-oxidation capacity (T-AOC) and MDA, and superoxide dismutase (SOD) activity were determined by chemical colorimetry. Protein expressions of autophagic biomarkers such as Beclin-1 and LC-3 in periprosthetic bone tissue of the calvaria were examined by Western blot. RESULTS: Compared with sham group, periprosthetic osteolysis, osteoclastogenesis, mRNA levels of TRAP, capthesin K, c-Fos and NFATc1, and serum MDA content were increased significantly in the TCP group (P<0.05), whereas serum T-AOC level and SOD activity were decreased. The protein expressions of Beclin-1 and LC-3, and the conversion of LC3-II from LC3-I were both up-regulated markedly in the mouse calvaria of TCP group (P<0.05). Compared with TCP group, osteolysis, osteoclastogenesis, mRNA levels of TRAP, capthesin K, c-Fos and NFATc1 and serum MDA content were decreased obviously in the procyanidine group (P<0.05), serum T-AOC level and SOD activity were increased, the expressions of Beclin-1 and LC-3, and the conversion of LC3-II from LC3-I were down-regulated obviously in the mouse calvaria of procyanidin group (P<0.05). CONCLUSION: Procyanidin has a protective effect of periprosthetic osteolysis caused by TCP wear particles in the mouse calvaia, its mechanism may be mediated by inhibition of oxidative stress and autophagy.


Assuntos
Biflavonoides/farmacologia , Fosfatos de Cálcio/efeitos adversos , Catequina/farmacologia , Osteólise , Proantocianidinas/farmacologia , Próteses e Implantes/efeitos adversos , Animais , Autofagia , Masculino , Camundongos , Camundongos Endogâmicos ICR , Estresse Oxidativo , Distribuição Aleatória , Crânio
4.
J Photochem Photobiol B ; 197: 111515, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31255939

RESUMO

An extraordinary arrangement of research is as yet going on in the area of orthopedic implants advancement to determine different issues being looked by the engineering today. In spite of a few detriments of the orthopedic metallic inserts, they keep on being utilized, essentially as a result of their unrivaled mechanical properties. We investigated the conceivable utilization of silicon carbide (SiC) as a nano-ceramic covering material of titanium (Ti)-based all out femoral substitution implants. The thought is to keep wear garbage arrangement from the delicate titanium exterior. Silicon carbide is a hard and firmly holding bio-ceramic surface substance, and in light of these physico-chemical properties, it isn't actually degradable, just like the case with apatite (HA). To improve cytocompatibility and osseous-integration, we deposited anodized titanium nanotubes (TiO2) inserts, by electrochemical deposition method (EDM), with silicon carbide (SiC) with apatite (SiC@HA). The deposition was affirmed by SEM, while phase composition properties were assessed by XRD. Calcium affidavit, osteocalcin creation, and articulation of bone genes were essentially higher in rodent osteoblast cell culture on SiC@HA-covered anodized titanium nanotubes than in cells cultured on uncoated anodized titanium nanotubes. Implantation into rodent femurs likewise demonstrated that the SiC@HA-covered substance had unrivaled osseous-integration movement in correlation with that of customary inserts, as evaluated by in vivo tomography and histology. Therefore, anodized titanium nanotubes covered with SiC@HA holds guarantee as an orthopedic implant substance.


Assuntos
Regeneração Óssea , Compostos Inorgânicos de Carbono/química , Materiais Revestidos Biocompatíveis/química , Durapatita/química , Nanopartículas/química , Compostos de Silício/química , Titânio/química , Animais , Regeneração Óssea/efeitos dos fármacos , Osso e Ossos/metabolismo , Osso e Ossos/patologia , Adesão Celular/efeitos dos fármacos , Materiais Revestidos Biocompatíveis/farmacologia , Materiais Revestidos Biocompatíveis/uso terapêutico , Subunidade alfa 1 de Fator de Ligação ao Core/genética , Subunidade alfa 1 de Fator de Ligação ao Core/metabolismo , Fraturas do Fêmur/terapia , Regulação da Expressão Gênica/efeitos dos fármacos , Masculino , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/efeitos dos fármacos , Células-Tronco Mesenquimais/metabolismo , Osteoblastos/citologia , Osteoblastos/efeitos dos fármacos , Osteocalcina/metabolismo , Próteses e Implantes , Ratos
5.
Arq. bras. cardiol ; 113(1 supl.2): 7-7, jul., 2019.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1015679

RESUMO

INTRODUÇÃO: O restabelecimento da função valvar pulmonar com implante percutâneo de próteses atualmente é realizado somente nos pacientes portadores de biopróteses, condutos ou homoenxertos posicionados na via de saída do VD. Próteses dedicadas para tratos de saída nativo estão sendo estudadas e implantadas com sucesso em diversos centros mundiais. OBJETIVOS: Apresentar a experiência inicial do implante percutâneo da VENUS-P Valve® em trato de saída nativo pulmonar. Materiais e métodos: A prótese VENUS-P Valve® (Venus Medtech, Shanghai) é um stent autoexpansível com uma valva de pericárdio porcino. Os pacientes são avaliados com ecocardiografia transtorácica, angiotomografia, ressonância magnética e cateterismo cardíaco. São critérios de inclusão a presença de regurgitação pulmonar importante, com volumes diastólicos do VD>130 ml/m2, sem estenoses na VSVD ou ramos pulmonares e trato de saída com no máximo 35 mm de diâmetro após insuflação de cateter-balão medidor. O ecotranstorácico é o método padrão de escolha da prótese. Os pacientes realizaram ecocardiografia transtorácica e avaliação clínica 24 horas e 30 dias após os procedimentos. RESULTADOS: Quatro pacientes (3 homens) foram submetidos ao implante percutâneo das valvas pulmonares. O peso e idade médio foi de 62,2 kg e 25,8 anos. A via de saída teve 30 mm em média e a prótese utilizada apresentou diâmetro médio de 32 mm. Três próteses tinham 25 mm de comprimento e a última 30 mm. Houve sucesso no implante de todos os dispositivos com restabelecimento imediato da função valvar pulmonar. Uma prótese foi considerada em posição mais baixa no trato de saída porém sem interferência em estruturas cardíacas. Ao ecocardiograma de controle todos os dispositivos encontravam-se sem refluxo significativo, com fluxo preservado para as artérias pulmonares bilaterais e sem complicações relacionadas. Não houve complicações ou óbitos relacionados aos procedimentos. CONCLUSÕES: O restabelecimento da função valvar pulmonar em pacientes com trato de saída nativo com o implante percutâneo da VENUS-P Valve® mostrou-se uma excelente alternativa nesta experiência inicial. Os procedimentos são factíveis e seguros. Por tratar-se de experiência inicial, acreditamos que um maior número de implantes e análise dos resultados tardios devem ser realizadas para incorporação definitiva destes dispositivos neste grupo selecionado de pacientes. (AU)


Assuntos
Humanos , Próteses e Implantes , Substituição da Valva Aórtica Transcateter
6.
Bone Joint J ; 101-B(7_Supple_C): 108-114, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256654

RESUMO

AIMS: It is increasingly appreciated that coordinated regulation of angiogenesis and osteogenesis is needed for bone formation. How this regulation is achieved during peri-implant bone healing, such as osseointegration, is largely unclear. This study examined the relationship between angiogenesis and osteogenesis in a unique model of osseointegration of a mouse tibial implant by pharmacologically blocking the vascular endothelial growth factor (VEGF) pathway. MATERIALS AND METHODS: An implant was inserted into the right tibia of 16-week-old female C57BL/6 mice (n = 38). Mice received anti-VEGF receptor-1 (VEGFR-1) antibody (25 mg/kg) and VEGF receptor-2 (VEGFR-2) antibody (25 mg/kg; n = 19) or an isotype control antibody (n = 19). Flow cytometric (n = 4/group) and immunofluorescent (n = 3/group) analyses were performed at two weeks post-implantation to detect the distribution and density of CD31hiEMCNhi endothelium. RNA sequencing analysis was performed using sorted CD31hiEMCNhi endothelial cells (n = 2/group). Osteoblast lineage cells expressing osterix (OSX) and osteopontin (OPN) were also detected with immunofluorescence. Mechanical pull-out testing (n = 12/group) was used at four weeks post-implantation to determine the strength of the bone-implant interface. After pull-out testing, the tissue attached to the implant surface was harvested. Whole mount immunofluorescent staining of OSX and OPN was performed to determine the amount of osteoblast lineage cells. RESULTS: Flow cytometry revealed that anti-VEGFR treatment decreased CD31hiEMCNhi vascular endothelium in the peri-implant bone versus controls at two weeks post-implantation. This was confirmed by the decrease of CD31 and endomucin (EMCN) double-positive cells detected with immunofluorescence. In addition, treated mice had more OPN-positive cells in both peri-implant bone and tissue on the implant surface at two weeks and four weeks, respectively. More OSX-positive cells were present in peri-implant bone at two weeks. More importantly, anti-VEGFR treatment decreased the maximum load of pull-out testing compared with the control. CONCLUSION: VEGF pathway controls the coupling of angiogenesis and osteogenesis in orthopaedic implant osseointegration by affecting the formation of CD31hiEMCNhi endothelium. Cite this article: Bone Joint J 2019;101-B(7 Supple C):108-114.


Assuntos
Inibidores da Angiogênese/farmacologia , Interface Osso-Implante/patologia , Osseointegração/efeitos dos fármacos , Próteses e Implantes , Tíbia/cirurgia , Titânio , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Animais , Modelos Animais de Doenças , Feminino , Camundongos , Camundongos Endogâmicos C57BL , Tíbia/efeitos dos fármacos , Tíbia/metabolismo , Tíbia/patologia
7.
Bone Joint J ; 101-B(7): 880-888, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256665

RESUMO

AIMS: The aim of this study was to describe the use of 3D-printed sacral endoprostheses to reconstruct the pelvic ring and re-establish spinopelvic stability after total en bloc sacrectomy (TES) and to review its outcome. PATIENTS AND METHODS: We retrospectively reviewed 32 patients who underwent TES in our hospital between January 2015 and December 2017. We divided the patients into three groups on the basis of the method of reconstruction: an endoprosthesis group (n = 10); a combined reconstruction group (n = 14), who underwent non-endoprosthetic combined reconstruction, including anterior spinal column fixation; and a spinopelvic fixation (SPF) group (n = 8), who underwent only SPF. Spinopelvic stability, implant survival (IS), intraoperative haemorrhage rate, and perioperative complication rate in the endoprosthesis group were documented and compared with those of other two groups. RESULTS: The mean overall follow-up was 22.1 months (9 to 44). In the endoprosthesis group, the mean intraoperative hemorrhage was 3530 ml (1600 to 8100). Perioperative complications occurred in two patients; both had problems with wound healing. After a mean follow-up of 17.7 months (12 to 38), 9/10 patients could walk without aids and 8/10 patients were not using analgesics. Imaging evidence of implant failure was found in three patients, all of whom had breakage of screws and/or rods. Only one of these, who had a local recurrence, underwent re-operation, at which solid bone-endoprosthetic osseointegration was found. The mean IS using re-operation as the endpoint was 32.5 months (95% confidence interval 23.2 to 41.8). Compared with the other two groups, the endoprosthesis group had significantly better spinopelvic stability and IS with no greater intraoperative haemorrhage or perioperative complications. CONCLUSION: The use of 3D-printed endoprostheses for reconstruction after TES provides reliable spinopelvic stability and IS by facilitating osseointegration at the bone-implant interfaces, with acceptable levels of haemorrhage and complications. Cite this article: Bone Joint J 2019;101-B:880-888.


Assuntos
Procedimentos Ortopédicos/métodos , Ossos Pélvicos/fisiologia , Impressão Tridimensional , Próteses e Implantes , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sacro/cirurgia , Coluna Vertebral/fisiologia , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osseointegração , Avaliação de Resultados (Cuidados de Saúde) , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Recuperação de Função Fisiológica , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
8.
Zhongguo Gu Shang ; 32(6): 564-568, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31277543

RESUMO

OBJECTIVE: To introduce the design of customized pelvic prosthesis, to evaluate the biomechanical property under three load conditions of customized pelvic prosthesis under three load cinditions. METHODS: A titanium alloy prosthesis for reconstruction of pelvic tumors was designed by CAD software. The strength and stiffness of the custom prosthesis under static and slow gait conditions were analyzed and evaluated by finite element method. RESULTS: The results of the finite element analysis suggested that the maximum von Mises stress in the pelvic under three load conditions were 39.0, 202.8 and 42.4 MPa; the maximum displacement were 0.199, 0.766 and 0.847 mm. The maximum von Mises stress in the prosthesis under three load conditions were 62.3, 318 and 468 MPa. The maximum Von Mises stress in the Ti-alloy prosthesis and pelvic was far smaller than the yield strength of Ti-alloy. CONCLUSIONS: The study can design the size and shape of prosthesis accurately according to patient's condition. The finite element method can reduce the bone stress level and fracture risk, prolong the service life of prostheses, and ensure the safety and stability of the postoperative patients under normal gait.


Assuntos
Fraturas Ósseas , Próteses e Implantes , Fenômenos Biomecânicos , Análise de Elementos Finitos , Marcha , Humanos , Desenho de Prótese , Estresse Mecânico
9.
Urol Clin North Am ; 46(3): 333-339, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277728

RESUMO

In any man with a solid testicular mass, cancer should be considered until proven otherwise. Radical inguinal orchiectomy is the treatment of choice in patients with testis mass. Placement of a testicular prosthesis is safe with a very low complication rate and should be offered to all patients undergoing radical orchiectomy. In patients with widespread or life-threatening advanced disease, delayed orchiectomy following chemotherapy is recommended. Testis-sparing surgery can be performed in highly selected patients with solitary testicle mass, bilateral testicular tumors, or strong suspicion of a benign lesion.


Assuntos
Neoplasias Testiculares/cirurgia , Humanos , Masculino , Orquiectomia , Tratamentos com Preservação do Órgão , Próteses e Implantes , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia
10.
J Craniofac Surg ; 30(4): e308-e311, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31166275

RESUMO

This study was planned to evaluate the improvement in mandibular function, facial esthetics and quality of life after reconstruction of complex mandibular defects using patient-specific three-dimensional (3D) titanium implant. A total of 7 patients, who visited our outpatient clinic for reconstruction of mandibular defects after removal of their primary mandibular lesion and refused treatment with autologous bone grafts were treated with patient-specific implant for reconstruction of mandible. Three-dimensional virtual treatment planning was carried out using their 3D computed-tomographic data. The unaffected contralateral side of mandible was superimposed on the defect side and a customized implant was designed in the desired size and shape on the virtual model using computer aided designing and milled in titanium using selective laser melting, for precise anatomic mandibular reconstruction. There was significant improvement in their esthetics, function, and quality of life. The symmetry of the face and occlusion was restored with adequate mouth opening, closing, and lateral movements of the mandible with no deviation of jaw during movements. The patient specific implants appear to be very useful for precise reconstruction of mandible with greater accuracy. The concept of using customized implant with the help of 3D virtual treatment planning, stereolithographic models and computer aided designing greatly improves mandibular restoration and helps to achieve good facial profile, aesthetics and dental rehabilitation preventing severe complications related to autologous grafts.


Assuntos
Transplante Ósseo/métodos , Doenças Mandibulares/cirurgia , Reconstrução Mandibular/métodos , Próteses e Implantes , Adulto , Projeto Auxiliado por Computador , Estética Dentária , Feminino , Humanos , Imagem Tridimensional/métodos , Masculino , Mandíbula/cirurgia , Desenho de Prótese , Qualidade de Vida , Estudos Retrospectivos , Titânio/uso terapêutico , Tomografia Computadorizada por Raios X
11.
Cornea ; 38(9): 1111-1116, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31232746

RESUMO

PURPOSE: To determine the spectrum of retinal complications (RCs) in a cohort of eyes with a type 1 Boston keratoprosthesis (KPro). METHODS: All patients (36 eyes of 31 patients) who received a type 1 Boston KPro from January 2004 to December 2015 at the University of California, Davis, were included. Electronic medical records were reviewed for relevant clinical data. Demographic information, initial corneal diagnosis, postoperative course, posterior segment complications, preoperative and final visual acuity were tabulated and analyzed. RESULTS: Posterior segment complications after type 1 Boston KPro were identified in 56% of eyes (n = 20). They included retinal detachment (n = 11; 31%), retroprosthetic membrane (n = 10; 28%), endophthalmitis (n = 7; 19%), cystoid macular edema (n = 5; 14%), epiretinal membrane (n = 4; 11%), vitreous hemorrhage (n = 2; 6%), choroidal detachment (n = 2; 6%), retinal vein occlusion (n = 1; 3%), and macular hole (n = 1; 3%). During the average follow-up period of 53.8 months (median, 57.1 months; range, 1.8-108.7 months) after type 1 Boston KPro, final best-corrected visual acuity improved by a mean of 0.12 logarithm of the minimum angle of resolution (LogMAR) units (range, -2.26 to +2.26) overall. The proportion of eyes with final best-corrected visual acuity better than 20/200 was 2 of 20 (10%) in the group with RCs, in contrast to 7 of 16 eyes (44%) noted among eyes without RCs. CONCLUSIONS: Long-term visual outcomes in eyes after type 1 Boston KPro may depend, in part, on maintaining a healthy posterior pole. Retinal detachment, in particular, may represent a threat to ultimate visual functioning. Regular examination of the peripheral fundus is recommended.


Assuntos
Órgãos Artificiais , Doenças da Coroide/etiologia , Doenças da Córnea/cirurgia , Segmento Posterior do Olho/patologia , Complicações Pós-Operatórias/etiologia , Próteses e Implantes/efeitos adversos , Implantação de Prótese/efeitos adversos , Doenças Retinianas/etiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acuidade Visual , Adulto Jovem
12.
J Laryngol Otol ; 133(8): 719-722, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31239001

RESUMO

BACKGROUND: The Bonebridge is an active transcutaneous bone conduction implant recommended as a surgical option for adults and children (aged 5-18 years). Successful implantation of the Bonebridge is often restricted by an insufficient amount of temporal bone to house the transducer in the paediatric patient. METHOD AND RESULTS: In this unique paediatric case, bilateral Bonebridge devices were implanted simultaneously in the right sinodural angle and the left middle cranial fossa. CONCLUSION: The simultaneous implantation of bilateral Bonebridge devices was well tolerated in this paediatric patient, with significant improvement in her hearing. The middle cranial fossa is a viable option for housing the transducer.


Assuntos
Fossa Craniana Média/cirurgia , Perda Auditiva Condutiva/cirurgia , Condução Óssea , Criança , Feminino , Humanos , Próteses e Implantes , Resultado do Tratamento
13.
J Photochem Photobiol B ; 197: 111504, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31228687

RESUMO

High disappointment rate of the ligament to hard tissue mending after the medical procedure has dependably been a testing issue in rotator cuff repair. Considering the elasticity of carbon dot decorated polyethylene (f-CDs-PE) and osteogenic movement of gold substituted hydroxyapatite (Au@HA) bioceramic, f-CDs-PE-Au@HA biocomposite coatings were created by an electrophoretic deposition method (EPD), the in vivo and in vitro bioactivity and cytocompatibility were researched. The physico-chemical properties of f-CDs-PE-Au@HA biocomposite coatings were characterized using fourier transform infra-red (FTIR) and X-Ray diffractometery (XRD). The morphology of the fabricated biocomposites was analyses via scanning electron microscopy (SEM) and transmission electron microscopy (TEM) methods. With a gamma-irradiation of f-CDs-PE-Au@HA biocomposite coating (BC2), the bond and multiplication of cells on biocomposite coating were improved. The specimen with a f-CDs-PE-Au@HA biocomposite (BC2) demonstrated a most noteworthy alkaline phosphatase activity articulation. The animal model consequences additionally show that the f-CDs-PE-Au@HA biocomposite (BC2) had great bioactive and cytocompatibility, which could develop the association of collagen and the arrangement of ligament and hard tissue. Expansion of the gamma-ray irradiation with f-CDs-PE-Au@HA biocomposite coating (BC2) at the tendon- hard tissue crossing point was exhibited to reinforce the mending entheses, increment hard tissue and tendon development and progress collagen association contrasted and control. The above outcomes have recommended that the progressive, implantable and solid stringy platforms built utilizing EPD extraordinary potential for enlargement of rotator cuff tears-recuperating.


Assuntos
Materiais Revestidos Biocompatíveis/química , Durapatita/química , Raios gama , Pontos Quânticos/química , Articulação do Ombro/patologia , Titânio/química , Artroplastia de Substituição , Densidade Óssea/efeitos da radiação , Carbono/química , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/efeitos da radiação , Materiais Revestidos Biocompatíveis/farmacologia , Colágeno Tipo I/metabolismo , Ouro/química , Humanos , Polietileno/química , Próteses e Implantes , Articulação do Ombro/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
Bone Joint J ; 101-B(6): 724-731, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31154850

RESUMO

AIMS: Aseptic loosening is a major cause of failure in cemented endoprosthetic reconstructions. This paper presents the long-term outcomes of a custom-designed cross-pin fixation construct designed to minimize rotational stress and subsequent aseptic loosening in selected patients. The paper will also examine the long-term survivorship and modes of failure when using this technique. PATIENTS AND METHODS: A review of 658 consecutive, prospectively collected cemented endoprosthetic reconstructions for oncological diagnoses at a single centre between 1980 and 2017 was performed. A total of 51 patients were identified with 56 endoprosthetic implants with cross-pin fixation, 21 of which were implanted following primary resection of tumour. Locations included distal femoral (n = 36), proximal femoral (n = 7), intercalary (n = 6), proximal humeral (n = 3), proximal tibial (n = 3), and distal humeral (n = 1). RESULTS: The median follow-up was 132 months (interquartile range (IQR) 44 to 189). In all, 20 stems required revision: eight for infection, five for structural failure, five for aseptic loosening, and two for tumour progression. Mechanical survivorship at five, ten, and 15 years was 84%, 78%, and 78%, respectively. Mechanical failure rate varied by location, with no mechanical failures of proximal femoral constructs and distal femoral survivorship of 82%, 77%, and 77% at five, ten, and 15 years. The survivorship of primary constructs at five years was 74%, with no failure after 40 months, while the survivorship for revision constructs was 89%, 80%, and 80% at five, ten, and 15 years. CONCLUSION: The rate of mechanical survivorship in our series is similar to those reported for other methods of reconstruction for short diaphyseal segments, such as compressive osseointegration. The mechanical failure rate differed by location, while there was no substantial difference in long-term survival between primary and revision reconstructions. Overall, custom cross-pin fixation is a viable option for endoprosthetic reconstruction of short metaphyseal segments with an acceptable rate of mechanical failure. Cite this article: Bone Joint J 2019;101-B:724-731.


Assuntos
Pinos Ortopédicos , Neoplasias Ósseas/cirurgia , Salvamento de Membro/métodos , Próteses e Implantes , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Feminino , Neoplasias Femorais/diagnóstico por imagem , Neoplasias Femorais/patologia , Neoplasias Femorais/cirurgia , Seguimentos , Humanos , Úmero/diagnóstico por imagem , Úmero/patologia , Úmero/cirurgia , Masculino , Estudos Prospectivos , Falha de Prótese , Tíbia/diagnóstico por imagem , Tíbia/patologia , Tíbia/cirurgia , Resultado do Tratamento
15.
Bone Joint J ; 101-B(6_Supple_B): 62-67, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31146557

RESUMO

AIMS: The purpose of this study was to evaluate the biological fixation of a 3D printed porous implant, with and without different hydroxyapatite (HA) coatings, in a canine model. MATERIALS AND METHODS: A canine transcortical model was used to evaluate the characteristics of bone ingrowth of Ti6Al4V cylindrical implants fabricated using laser rapid manufacturing (LRM). At four and 12 weeks post-implantation, we performed histological analysis and mechanical push-out testing on three groups of implants: a HA-free control (LRM), LRM with precipitated HA (LRM-PA), and LRM with plasma-sprayed HA (LRM-PSHA). RESULTS: Substantial bone ingrowth was observed in all LRM implants, with and without HA, at both time periods. Bone ingrowth increased from 42% to 52% at four weeks, to 60% to 65% at 12 weeks. Mechanical tests indicated a minimum shear fixation strength of 20 MPa to 24 MPa at four weeks, and 34 MPa to 40 MPa at 12 weeks. There was no significant difference in the amount of bone ingrowth or in the shear strength between the three implant types at either time period. CONCLUSION: At four and 12 weeks, the 3D printed porous implants exhibited consistent bone ingrowth and high mechanical shear strength. Based on the results of this study, we confirmed the suitability of this novel new additive manufacturing porous material for biological fixation by bone ingrowth. Cite this article: Bone Joint J 2019;101-B(6 Supple B):62-67.


Assuntos
Fêmur/fisiologia , Osseointegração/fisiologia , Próteses e Implantes , Animais , Materiais Biocompatíveis/farmacologia , Fenômenos Biomecânicos/fisiologia , Cães , Durapatita/farmacologia , Fêmur/ultraestrutura , Masculino , Microscopia Eletrônica de Varredura , Porosidade , Impressão Tridimensional
16.
Curr Opin Ophthalmol ; 30(4): 220-228, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31170100

RESUMO

PURPOSE OF REVIEW: To review the efficacy of intrastromal corneal ring segments (ICRS) for keratoconus and with other interventions such as contacts lens, keratoplasty, and corneal collagen cross-linking. RECENT FINDINGS: Changes in ICRS thickness and size, combination of procedures, and the adaptation of a more sophisticated classification system have broadened our application of ICRS. Recent studies have shown the long-term efficacy of ICRS in visual acuity, keratometry, and astigmatism. SUMMARY: Studies have demonstrated the short-term and long-term efficacy of ICRS implantation in patients with keratoconus.


Assuntos
Substância Própria/cirurgia , Ceratocone/cirurgia , Próteses e Implantes , Implantação de Prótese/métodos , Colágeno/metabolismo , Lentes de Contato , Substância Própria/metabolismo , Reagentes para Ligações Cruzadas/uso terapêutico , Humanos , Ceratocone/metabolismo , Fotoquimioterapia/métodos , Resultado do Tratamento , Acuidade Visual/fisiologia
17.
Cornea ; 38(7): 840-846, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31170102

RESUMO

PURPOSE: To evaluate efficacy, safety, and stability of Ferrara-type intrastromal corneal ring segment (ICRS) implantation for visual rehabilitation in pediatric patients with keratoconus. METHODS: This study included patients with keratoconus aged 18 years or younger who had received Ferrara-type ICRS implantation. The uncorrected and corrected distance visual acuities, residual refractive errors, and root mean square for coma-like aberration were recorded preoperatively and at 6 months, 1, 3, and 5 years postoperatively. RESULTS: One hundred eighteen eyes of 88 patients (mean age 16.1 ± 1.89; range 10-18) were studied. All patients were examined at a 6-month follow-up after ICRS implantation, and at the 12-, 36-, and 60-month follow-ups, 97, 71, and 23 eyes were evaluated, respectively. Mean uncorrected distance visual acuity (logarithm of minimum angle of resolution) changed from 0.67 ± 0.37 preoperatively to 0.37 ± 0.30, 6 months after ICRS implantation (P < 0.0001). Mean corrected distance visual acuity increased in turn from 0.19 ± 0.15 to 0.10 ± 0.12 (P < 0.0001). The percentage of eyes with a refractive cylinder ≤2.00 D increased from 30.5% before surgery to 70.3% 6 months later, and the root mean square for corneal coma-like aberration showed a statistically significant decrease (P < 0.001). At the follow-up visits, refractive and visual values remained stable compared with those of the 6-month visit. CONCLUSIONS: Our long-term results suggest that Ferrara-type ICRS implantation is a safe, effective, and stable procedure for restoring vision in pediatric patients with keratoconus.


Assuntos
Substância Própria/cirurgia , Ceratocone/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Próteses e Implantes , Implantação de Prótese , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino , Refração Ocular , Acuidade Visual
18.
Khirurgiia (Mosk) ; (5): 52-56, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169819

RESUMO

AIM: Experimental analysis of the strength properties of integration of muscle tissue, tendons and ligaments, bone tissue into titanium highly porous materials prepared by using of additive technologies. MATERIAL AND METHODS: The study included 9 mature rabbits of the Chinchilla breed. Both posterior paws and latissimus dorsi muscles (36 specimens) were used. Titanium models (Ti-6-Al-4-V, 'Rematitan', Germany) were made by additive technologies with preliminary prototyping, the prototypes had a highly porous mesh structure. RESULTS: It was developed experimental model of functional bone defect involving points of attachment of the muscle and ligaments. Strength of attachment of muscles to highly porous implants was 145 H vs. 31 H for standard models. Tensile strength for fixation to bone tissue was 84 H vs. 152 H in the main group. CONCLUSION: It was found integration of soft tissues and bones into highly porous titanium implants prepared with additive technologies. Fixation strength significantly exceeds that for standard models.


Assuntos
Osso e Ossos/cirurgia , Sistema Musculoesquelético/fisiopatologia , Osseointegração/fisiologia , Próteses e Implantes , Cicatrização/fisiologia , Animais , Materiais Biocompatíveis , Osso e Ossos/lesões , Osso e Ossos/fisiopatologia , Ligamentos/fisiopatologia , Ligamentos/cirurgia , Modelos Animais , Músculo Esquelético/fisiopatologia , Músculo Esquelético/cirurgia , Porosidade , Desenho de Prótese , Implantação de Prótese , Coelhos , Recuperação de Função Fisiológica , Reoperação , Telas Cirúrgicas , Tendões/fisiopatologia , Tendões/cirurgia , Titânio
19.
Rev Med Suisse ; 15(655): 1226-1230, 2019 Jun 12.
Artigo em Francês | MEDLINE | ID: mdl-31194298

RESUMO

During the last two decades, computer-assisted surgery (CAS) has drastically changed the strategy for craniofacial reconstructive surgery, especially with respect to the prediction of preoperative virtual and ideal bone repositioning for correction of developmental or post-traumatic malformations. Intraoperative navigation and computer-aided design and modeling techniques (CAD/CAM) allow for the transfer of the virtual planned reconstruction to the operating room by guaranteeing a real time assistance during the realization of the surgical task and respectively by using patient-specific implants, surgical cutting and drilling guides. This approach has thus significantly contributed to improve the clinical accuracy, predictability and patient outcome, compared to traditional techniques.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Assistida por Computador , Projeto Auxiliado por Computador , Face/cirurgia , Humanos , Imagem Tridimensional , Protetores Bucais , Próteses e Implantes
20.
Medicine (Baltimore) ; 98(25): e16094, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232951

RESUMO

AIM: To evaluate the efficacy and safety of trabeculectomy (Trab) with mitomycin-C (MMC) versus Trab with implant. METHODS: Studies published in different languages were retrieved by systematically searching Embase, PubMed, Cochrane library, China Biology Medicine disc, and Google Scholar from 1966 to April 2018, as well as manually examining the references of the original articles. The outcome measures of efficacy covered intraocular pressure, glaucoma medications reductions, and success rate. Safety evaluation was measured by relative ratio of complications. RESULTS: A total of 11 studies involving 443 participants were covered in this meta-analysis. The weighted mean difference (WMD) in the percentage of intraocular pressure (IOP) reduction (IOPR%) comparing Ologen group with MMC group was -3.69 (95% CI: -6.70 to -0.68) at 1 month, -2.69 (-5.17 to -0.21) at 3 months, -3.67 (-6.09 to -1.25)at 6 months, -3.24 (-6.08 to -0.41) at 12 months, 1.24 (-9.43 to 11.90) at 24 months, and 1.10 (-10.11 to 12.31) at 60 months, which showed that there was statistically significant difference at 1,3, 6, and12 months after the surgery. A significantly higher incidence of postsurgery hypotony (0.64 (95% Cl: 0.42 to 0.98)) and suture lysis (0.30 (95% CI: 0.10-0.93)) was observed in MMC group. However, there was no significant difference in the reduction in glaucoma medications, success rate, and incidence of other complications.Trab with 0.2 mg/mL MMC presented higher rates of complete success compared with Trab with 0.4 mg/mL MMC (P = .01). CONCLUSION: Trab with MMC was associated with a higher IOP-lowering efficacy and a higher incidence of postsurgery hypotony and suture lysis in contrast to that of Trab with Ologen.


Assuntos
Colágeno/farmacologia , Glicosaminoglicanos/farmacologia , Mitomicina/farmacologia , Próteses e Implantes/normas , Trabeculectomia/instrumentação , Colágeno/administração & dosagem , Colágeno/uso terapêutico , Glicosaminoglicanos/administração & dosagem , Glicosaminoglicanos/uso terapêutico , Humanos , Mitomicina/administração & dosagem , Mitomicina/uso terapêutico , Trabeculectomia/métodos
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