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1.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 924-930, 2020 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-33047731

RESUMO

OBJECTIVE: To explore the applicability of integration between three-dimensional (3D) facial and dental data to evaluate the nasolabial morphology variation before and after the cross-arch fixed restoration of the maxillary implant-supported prostheses. METHODS: Twelve patients (4 women and 8 men), mean age (54.82±5.50) years (from 45 to 62 years) referred to the Department of Oral Implan-tology, Peking University School and Hospital of Stomatology, were selected and diagnosed with edentulous maxilla. For all the patients, 4 to 6 implants were inserted into the maxilla. Six months later, the final cross-arch fixed prostheses were delivered. The 3D facial images were collected before and after the final restoration. The 3D data of prostheses were also captured. All the 3D data were registered and measured in the same coordinate system. Then the displacement of all the landmarks [cheilion left (CHL), cheilion right (CHR), crista philtri left (CPHL), crista philtri right (CPHR), labrale supe-rius (LS), subnasale (SN), stomion (STO), upper incisor (UI), upper flange border of the prostheses (F-point, F)], and the variation of the distances between these landmarks (SN-LS, CPHR-CPHL, CHR-CHL, LS-STO) were analyzed and compared. RESULTS: The consistency test among three measurements of the length of F-SN indicated that the integration method of the dental prostheses and soft tissue had the good repetitiveness, ICC=0.983 (95%CI: 0.957-0.995). After wearing the final cross-arch maxillary implant-supported prostheses, all the landmarks on the soft tissue moved forward. The nasal base area changed minimally, and the shift of SN in the sagittal direction was only (0.61±0.44) mm. But the sagittal shift of LS was (3.12±1.38) mm. In the vertical direction, SN, LS, CPHL, and CPHR moved upward. But STO, CHL, and CHR moved downward a little. Except for the slight decrease of the length of philtrum (SN-LS), the length of CHL-CHR, CPHL-CPHR, and the height of upper lip were increased together (P < 0.01). In the direction of Z axis, the strong correlations were found not only between the movements of SN and F (r=0.904 3) but also between the movements of LS and UI (r=0.958 4). CONCLUSION: The integration method of 3D facial and dental data showed good repetitiveness. And the strong correlations between the landmarks of prostheses and nasolabial soft tissue in the sagittal direction were found by this new method.


Assuntos
Maxila , Boca Edêntula , Feminino , Humanos , Incisivo , Lábio , Masculino , Maxila/cirurgia , Pessoa de Meia-Idade , Próteses e Implantes
2.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 964-970, 2020 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-33047738

RESUMO

OBJECTIVE: To evaluate the digital workflow coupling conic retention for the immediate restoration of adjacent posterior implants. METHODS: The patients with adjacent teeth missing in the posterior jaw seeking for implant restoration in the Department of Implantology, Peking University School and Hospital of Stomatology from March, 2017 to February, 2018 were recruited. After implant placement and commercial conic retention coping delivery, the patient had an intraoral scan for digital impression, and the computer-assisted design/computer-assisted manufacturing (CAD/CAM) technology was used for the fabrication of the immediate splinted prosthesis, which was made of polymethyl methacrylate (PMMA) and loaded immediately after delivery. Six months later, all the temporary prostheses were replaced by the permanent ones made of monolithic zirconia with CAD/CAM technology as well. The parallel periapical films were taken for the temporary and permanent prostheses post-delivery. The clinical effect of this workflow was evaluated by indices including the survival rates of implants and prostheses, the change of marginal bone level, and the implant-related and prosthesis-related complications; before the final restoration, the Visual Analogue Score (VAS) was used to evaluate the satisfaction of the patients. RESULTS: Ten patients (4 males and 6 females, 55.5 years old for average) were recruited. Totally 34 implants were placed; 14 prostheses were fabricated, temporary and permanent, respectively. After an observation period from 4 to 14 months, the survival rate for implants and prostheses were both 100%; the marginal bone level of the implants were (1.06±0.97) mm and (0.96±0.82) mm, immediate post-operation and 6 months later, respectively. The difference was not statistically significant (P>0.05). Neither implant- nor prostheses- related complications were observed. And the VAS of the patients' satisfaction was 87.2. CONCLUSION: For the adjacent posterior implants, the immediate prostheses manufactured by digital workflow, coupling conic retention, were clinically feasible and patient-satisfactory.


Assuntos
Desenho Assistido por Computador , Fluxo de Trabalho , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Próteses e Implantes , Implantação de Prótese
3.
Khirurgiia (Mosk) ; (9): 116-122, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030012

RESUMO

IPOM intraperitoneal hernia repair, in comparison with other abdominal wall reconstruction methods, has a number of significant advantages. Among them are a reduction in operative time, low rate of surgical site infections, quick rehabilitation, and good cosmetic results. At the same time, one of the main constraining factors for its widespread use is the rather high frequency of adhesion formation between the implant and the abdominal organs. The first way to solve this serious problem is to improve the structure of the implant itself, and in the first place, its anti-adhesive layer. The second is the search for adjuvant tools that work in «problematic¼ areas, prone to adhesions formation, such as the points of implant fixation, its edges, or the areas of damage to antiadhesive layer due to a violation of the operative technique. It is desirable that they could exert their effect also in other parts of the abdominal cavity, which, despite the absence of a zone of «active¼ intervention, can also undergo adhesions. Based on this, the purpose of this review was to summarize modern data on the anti-adhesive activity of both composite implants and specialized membranes and liquid agents.


Assuntos
Cavidade Abdominal , Hérnia Abdominal , Herniorrafia , Humanos , Próteses e Implantes , Aderências Teciduais
4.
Dtsch Arztebl Int ; 117(24): 405-411, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32865491

RESUMO

BACKGROUND: Many people have leg-length discrepancies of greater or lesser severity. No evidence-based studies on the need for treatment are currently available. METHODS: This review is based on publications retrieved by a selective search in the PubMed database, as well as on published recommendations from Germany and abroad and on the authors' own clinical experience. RESULTS: If the two legs are of different lengths, this is generally because one leg is too short. It is debated whether leg-length discrepancy causes pain or long-term musculoskeletal disturbances. A direct connection to back pain is questionable, but a mildly elevated incidence of knee arthritis seems likely. The evidence base on the indications for treatment of leg-length discrepancy is poor; only informal consensus recommendations are available. There are a wide variety of conservative and surgical treatment options. The final extent of a leg-length discrepancy first noted during the growing years can be estimated with predictive algorithms to within 2 cm. The treatments that can be considered include a shoe insert, a high shoe, or an orthosis, surgically induced slowing of growth by blockade of the epiphyseal plates around the knee joint, or leg lengthening with osteotomy and subsequent distraction of the bone callus with fully implanted or external apparatus. Changes in leg length exert marked mechanical stress on the soft tissues. If the predicted leg-length discrepancy exceeds 5 cm, initial leg-lengthening treatment can already be considered during the patient's growing years. CONCLUSION: It must be discussed with each patient individually whether the treatment should be conservative or surgical. The extent of the discrepancy is not the sole determining factor for the mode of treatment. The decision to treat is always elective.


Assuntos
Desigualdade de Membros Inferiores , Perna (Membro) , Alemanha , Humanos , Perna (Membro)/anatomia & histologia , Próteses e Implantes , Resultado do Tratamento
5.
Nat Commun ; 11(1): 4465, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32901012

RESUMO

Titanium implants have been widely used in bone tissue engineering for decades. However, orthopedic implant-associated infections increase the risk of implant failure and even lead to amputation in severe cases. Although TiO2 has photocatalytic activity to produce reactive oxygen species (ROS), the recombination of generated electrons and holes limits its antibacterial ability. Here, we describe a graphdiyne (GDY) composite TiO2 nanofiber that combats implant infections through enhanced photocatalysis and prolonged antibacterial ability. In addition, GDY-modified TiO2 nanofibers exert superior biocompatibility and osteoinductive abilities for cell adhesion and differentiation, thus contributing to the bone tissue regeneration process in drug-resistant bacteria-induced implant infection.


Assuntos
Antibacterianos/química , Grafite , Nanofibras/química , Próteses e Implantes , Infecções Relacionadas à Prótese/prevenção & controle , Titânio , Células 3T3 , Animais , Materiais Biocompatíveis/química , Regeneração Óssea , Sobrevivência Celular , Modelos Animais de Doenças , Feminino , Teste de Materiais , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Camundongos , Nanocompostos/química , Osteogênese , Processos Fotoquímicos , Infecções Estafilocócicas/prevenção & controle
6.
Bone Joint J ; 102-B(10): 1375-1383, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993330

RESUMO

AIMS: To investigate metallosis in patients with magnetically controlled growing rods (MCGRs) and characterize the metal particle profile of the tissues surrounding the rod. METHODS: This was a prospective observational study of patients with early onset scoliosis (EOS) treated with MCGRs and undergoing rod exchange who were consecutively recruited between February 2019 and January 2020. Ten patients were recruited (mean age 12 years (SD 1.3); 2 M:8 F). The configurations of the MCGR were studied to reveal the distraction mechanisms, with crucial rod parts being the distractable piston rod and the magnetically driven rotor inside the barrel of the MCGR. Metal-on-metal contact in the form of ring-like wear marks on the piston was found on the distracted portion of the piston immediately outside the barrel opening (BO) through which the piston rod distracts. Biopsies of paraspinal muscles and control tissue samples were taken over and away from the wear marks, respectively. Spectral analyses of the rod alloy and biopsies were performed to reveal the metal constituents and concentrations. Histological analyses of the biopsies were performed with haematoxylin and eosin staining. RESULTS: Titanium (Ti), vanadium (V), and neodymium (Nd) concentrations in the biopsies taken near the wear marks were found to be significantly higher than those in the control tissue samples. Significantly increased Nd concentrations were also found in the tissues near the barrel of the MCGR. Chronic inflammation was revealed by the histological studies with fibrosis and macrophage infiltration. Black particles were present within the macrophages in the fibrotic tissues. CONCLUSION: Ti and V were generated mainly at the BO due to metal-on-metal contact, whereas the Nd from the rotor of the MCGR is likely released from the BO during distraction sessions. Phagocytotic immune cells with black particles inside raise concern regarding the long-term implications of metallosis. Cite this article: Bone Joint J 2020;102-B(10):1375-1383.


Assuntos
Reação a Corpo Estranho/etiologia , Próteses e Implantes/efeitos adversos , Escoliose/cirurgia , Biópsia , Criança , Feminino , Reação a Corpo Estranho/diagnóstico por imagem , Humanos , Magnetismo , Masculino , Neodímio/efeitos adversos , Estudos Prospectivos , Escoliose/diagnóstico por imagem , Titânio/efeitos adversos , Vanádio/efeitos adversos
7.
Bone Joint J ; 102-B(10): 1349-1353, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993333

RESUMO

AIMS: The hypothesis of this study was that bone peg fixation in the treatment of osteochondral lesions of the talus would show satisfactory clinical and radiological results, without complications. METHODS: Between September 2014 and July 2017, 25 patients with symptomatic osteochondritis of the talus and an osteochondral fragment, who were treated using bone peg fixation, were analyzed retrospectively. All were available for complete follow-up at a mean 22 of months (12 to 35). There were 15 males and ten females with a mean age of 19.6 years (11 to 34). The clinical results were evaluated using a visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively and at the final follow-up. The radiological results were evaluated using classification described by Hepple et al based on the MRI findings, the location of the lesion, the size of the osteochondral fragment, and the postoperative healing of the lesion. RESULTS: The mean VAS and AOFAS score improved significantly from 6.3 (4 to 8) and 70.6 (44 to 78) preoperatively to 1.6 (0 to 5) and 91.1 (77 to 100) at the final follow-up, respectively (p < 0.001). The classification on MRI was stage 2a in nine patients, stage 3 in 14, and stage 4 in two. The lesion was located on the posteromedial aspect of the dome of the talus in 19 patients, the anterolateral aspect in five, and the centrolateral aspect in one. The mean size of the fragment was 11.2 mm (5 to 20) horizontally, 10.4 mm (7 to 18) vertically, and 5.2 mm (3 to 10) deep, respectively. The postoperative healing state was good in 19 patients and fair in six. CONCLUSION: Bone peg fixation for osteochondral lesions of the talus showed satisfactory clinical and radiographic results, without complications. This technique could be a good form of treatment for patients with this condition who have an osteochondral fragment. Cite this article: Bone Joint J 2020;102-B(10):1349-1353.


Assuntos
Osteocondrite/cirurgia , Próteses e Implantes , Tálus/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Osteocondrite/diagnóstico por imagem , Estudos Retrospectivos , Tálus/diagnóstico por imagem
8.
Khirurgiia (Mosk) ; (7): 39-44, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736462

RESUMO

OBJECTIVE: To evaluate an effectiveness of light strengthened polypropylene endoprosthesis in the treatment of patients with middle and large ventral hernias. MATERIAL AND METHODS: Early and long-term outcomes of surgical treatment were analyzed in 60 patients with middle and large ventral hernias. Onlay hernia repair was performed. Patients were divided into two groups by 30 patients. Abdominal wall repair with conventional polypropylene endoprosthesis was performed in the first group, light strengthened endoprosthesis was used in the second group. RESULTS: Application of light strengthened polypropylene endoprosthesis was accompanied by reduced inflammatory response and higher intensity of reparative processes in the area of implantation in early postoperative period. Moreover, we observed better functional state of abdominal rectus muscles in long-term postoperative period in the same group. Improved physical component of health by 4.5% was found in the 2nd group. As a result, incidence of excellent outcomes increased by 13.3%, good results by 6.7%, incidence of satisfactory results decreased by 20%. Recurrent hernia was absent. CONCLUSION: Light strengthened endoprosthesis is effective and advisable in patients with middle and large ventral hernia.


Assuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Telas Cirúrgicas , Materiais Biocompatíveis , Herniorrafia/instrumentação , Humanos , Luz , Masculino , Polipropilenos , Próteses e Implantes , Recidiva
9.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(4): 302-306, 2020 Apr 08.
Artigo em Chinês | MEDLINE | ID: mdl-32762201

RESUMO

Concerning on the safety risks caused by electromagnetic interference of patients implanted with high-risk active implantable medical devices in the environment of domestic MUs, this study evaluates and focuses on the requirements of electromagnetic compatibility in domestic and international standards for rail transit vehicles, the main mechanism of risks caused by EMI, the actual measurement of environmental data in MUs and the working performance of various active implantables in the compartment. The test results shows that all kinds of active implantable medical device samples works normally in the CRH2A EMU in China, and there is still a large margin between the measured radiation emission in MU and the limit required by the standards.


Assuntos
Campos Eletromagnéticos , China , Radiação Eletromagnética , Humanos , Marca-Passo Artificial , Próteses e Implantes
10.
Nat Commun ; 11(1): 4195, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32826916

RESUMO

Realizing a clinical-grade electronic medicine for peripheral nerve disorders is challenging owing to the lack of rational material design that mimics the dynamic mechanical nature of peripheral nerves. Electronic medicine should be soft and stretchable, to feasibly allow autonomous mechanical nerve adaptation. Herein, we report a new type of neural interface platform, an adaptive self-healing electronic epineurium (A-SEE), which can form compressive stress-free and strain-insensitive electronics-nerve interfaces and enable facile biofluid-resistant self-locking owing to dynamic stress relaxation and water-proof self-bonding properties of intrinsically stretchable and self-healable insulating/conducting materials, respectively. Specifically, the A-SEE does not need to be sutured or glued when implanted, thereby significantly reducing complexity and the operation time of microneurosurgery. In addition, the autonomous mechanical adaptability of the A-SEE to peripheral nerves can significantly reduce the mechanical mismatch at electronics-nerve interfaces, which minimizes nerve compression-induced immune responses and device failure. Though a small amount of Ag leaked from the A-SEE is observed in vivo (17.03 ppm after 32 weeks of implantation), we successfully achieved a bidirectional neural signal recording and stimulation in a rat sciatic nerve model for 14 weeks. In view of our materials strategy and in vivo feasibility, the mechanically adaptive self-healing neural interface would be considered a new implantable platform for a wide range application of electronic medicine for neurological disorders in the human nervous system.


Assuntos
Eletrônica Médica/instrumentação , Eletrônica Médica/métodos , Neurocirurgia/instrumentação , Neurocirurgia/métodos , Nervos Periféricos/fisiologia , Animais , Engenharia Biomédica/instrumentação , Engenharia Biomédica/métodos , Sistema Nervoso Central/fisiologia , Sistema Nervoso Central/cirurgia , Ouro , Humanos , Masculino , Teste de Materiais , Modelos Animais , Tecido Nervoso/patologia , Tecido Nervoso/cirurgia , Nervos Periféricos/patologia , Nervos Periféricos/cirurgia , Polímeros/química , Próteses e Implantes , Ratos , Nervo Isquiático , Dispositivos Eletrônicos Vestíveis
11.
Mymensingh Med J ; 29(3): 691-700, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32844813

RESUMO

The aim of the modern dentistry is to provide the predictable treatment in short duration. Replacement of missing teeth in shorter duration helps in fulfilling patient's aesthetics and functional demands. Endosseous dental implants are predictable method for replacing missing dentition. The evolution in implant surgical techniques is focused on decreasing treatment duration, e.g. implants can be placed in fresh extraction socket. Therefore, this non-randomized clinical controlled study was designed to determine that whether the treatment outcomes obtained by short treatment duration (immediate implant) are comparable with conventional treatment options (delayed implant) by evaluating the peri-implant soft and hard tissue level, clinically and radiographically {by Cone beam computed tommography (CBCT)}. Total of 30 implants were placed in 13 patients, according to Type 1 ITI protocol (Group 1; 15 implants) and Type 4 ITI protocol (Group 2; 15 implants). Implants in each group were loaded with definitive restoration after 3 months of placement. Hard tissue parameters (marginal bone width and height and probing depth) and soft tissue parameters (width of keratinised gingiva and papillary index) were evaluated at baseline, 3 months post implant insertion and 3 months post prosthetic loading. The results showed statistically significant reduction in width of marginal bone in delayed implants as compared to immediate implants. In contrast, significant reduction in marginal bone height and width of keratinised gingiva was evident in immediate implants. Significant reduction in pocket depth (after 2nd stage surgery and 3 months post prosthetic loading) was noted around delayed implants (p<0.05). Moreover, esthetic results showed regeneration of interproximal papillae in both the groups till the end of study period. This study was concluded that both the groups showed similar results but in some aspects delayed implants was superior to immediate implants. Careful evaluation of implant placement sites before implant installation promotes optimal implant esthetics and survival outcomes.


Assuntos
Próteses e Implantes , Humanos , Radiografia , Resultado do Tratamento
12.
Artigo em Chinês | MEDLINE | ID: mdl-32791603

RESUMO

Vestibular dysfunction can seriously affect patients' daily life and work. There is an urgent need for new methods to treat vestibular dysfunction. As awareness of these diseases increases, efforts are being made to improve vestibular function through a number of vestibular assistant systems. As far as current development is concerned, vestibular assistant system mainly focuses on two fields: external prosthesis and vestibular implant. This review shows the current status and future development trend of the vestibular assistant system.


Assuntos
Doenças Vestibulares , Vestíbulo do Labirinto , Humanos , Próteses e Implantes
13.
Artigo em Chinês | MEDLINE | ID: mdl-32791605

RESUMO

Objective:To reveal the response characteristics of semicircular canal neurons(SCN) in the nonlinear perceptual interval, and to establish and screen out the precise SCN information coding model and function expression, which lays a foundation for the optimization and improvement of neuromodulation strategy of multichannel vestibular prosthesis. Method:The perceptual electrophysiological information data of the SCNs during the rotational stimulation was recorded in the nonlinear perceptual interval. The nonlinear least-squares algorithm was used to fit the electrophysiological information data to establish the linear-nonlinear models. The Akaike information criterion was used to calculate the goodness of fit of each model to determine the optimal expression function. Result:In the frequency experiment, the accurate information coding model of more than 85% of SCNs is a quadratic polynomial, and the frequency has no significant effect on the linear-nonlinear selection of the SCNs information coding model(P>0.05). In the amplitude experiment, the accurate information coding model of more than 83.33% of SCNs is quadratic polynomial when the maximum angular velocity is>80 deg/s, and the amplitude has a significant effect on the linear-nonlinear selection of the SCNs information coding model(P=0.038). Conclusion:The information coding models of SCN population in the nonlinear perceptual interval have two expressions, linear and nonlinear function, which is closely related to angular velocity. The quadratic polynomial function is more accurate and more advantageous and it can be used to design the precise neuromodulation strategy of multichannel vestibular prosthesis.


Assuntos
Vestíbulo do Labirinto , Fenômenos Eletrofisiológicos , Neurônios , Próteses e Implantes , Canais Semicirculares
14.
Medicine (Baltimore) ; 99(34): e21812, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846819

RESUMO

BACKGROUND: Ulcerative colitis is a recurring digestive disease characterized by inflammation in the intestinal tract, which seriously affects the life of the patient. In recent years, it has played a role in obesity, osteoporosis, and gastrointestinal disorders, and has received more and more attention. However, there are no clear conclusions about its effectiveness and safety in the treatment of UC. METHOD AND ANALYSIS: This systematic review will collect 7 databases, including Web of science, Pubmed, Embase, VIP, Wanfang, CNKI, and the Chinese Biomedical Literature Database (CBM), to collect all eligible RCTs from database inception to December 31, 2019. The 2 researchers will rigorously follow the selection process, including study screening, data extraction, and quality assessment. The primary outcome is clinical effectiveness. The main software used in this study is Review Manager V5.3 software. RESULT: This study will provide a meaningful and comprehensive evaluation on the effectiveness and safety of acupoints embedding for UC. CONCLUSION: This meta-analysis was designed to provide clinicians with valid evidence regarding acupoint embedding for UC. INPLASY REGISTRATION NUMBER: INPLASY202040166.


Assuntos
Terapia por Acupuntura/métodos , Categute , Colite Ulcerativa/terapia , Terapia por Acupuntura/efeitos adversos , Colite Ulcerativa/sangue , Citocinas/sangue , Humanos , Metanálise como Assunto , Próteses e Implantes , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Índice de Gravidade de Doença , Revisões Sistemáticas como Assunto
15.
Herzschrittmacherther Elektrophysiol ; 31(3): 288-291, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32780284

RESUMO

In order to document arrhythmias, indicated due to symptoms or for prognostic purposes, both invasive and noninvasive possibilities for ECG monitoring are available. The choice of the device for monitoring depends mainly on the frequency of arrhythmias. If they occur less than once a month, long-term monitoring becomes necessary which either continuously monitors the rhythm by an implantable device (implantables) or by wearable systems (wearables) which usually register the ECG discontinuously. Because wearables, e.g. smartphones, are basically ubiquitously available, they may be used for ECG monitoring. This paper comments on the use of implantables and wearables for the detection of atrial fibrillation and the documentation of symptomatic arrhythmias in syncope or palpitations.


Assuntos
Próteses e Implantes , Dispositivos Eletrônicos Vestíveis , Fibrilação Atrial , Eletrocardiografia , Eletrocardiografia Ambulatorial , Humanos , Síncope
16.
Cancer Radiother ; 24(6-7): 658-666, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32859465

RESUMO

Radiation therapy (RT) is one of the main modalities of cancer treatment worldwide with computed tomography (CT), as the most commonly used imaging method for treatment planning system (TPS). Image reconstruction errors may greatly affect all the radiation therapy planning process, such as target delineation, dose calculation and delivery, particularly with particle therapy. Metallic implants, such as hip and spinal implants, and dental filling significantly deteriorate image quality. These hardware structures are often very complex in geometry leading to geometric complex artefacts in the clinical target volume (CTV) area, rendering the delineation of CTV challenging. In our review, we focus on the methods to overcome artefact consequences on CTV delineation: 1- medical approaches anticipating issues associated with imaging artefacts during preoperative multidisciplinary discussions while following standard recommendations; 2- common metal artefact reduction (MAR) methods such as manually override artefact regions, ballistics avoiding beam paths through implanted materials, megavoltage-CT (MVCT); 3- prospects with radiolucent implants, MAR algorithms and various methods of dual energy computed tomography (DECT). Despite substantial and broad evidence for their benefits, there is still no universal solution for cases involving implanted metallic devices. There is still a high need for research efforts to adapt technologies to our issue: "how do I accurately delineate the ideal CTV in a metal artefact area?"


Assuntos
Artefatos , Neoplasias/diagnóstico por imagem , Neoplasias/radioterapia , Próteses e Implantes , Tomografia Computadorizada por Raios X , Carga Tumoral/efeitos da radiação , Humanos , Neoplasias/patologia , Radioterapia/métodos , Dosagem Radioterapêutica
17.
Handchir Mikrochir Plast Chir ; 52(4): 330-334, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32823367

RESUMO

This case report shows the interdisciplinary treatment of a 28-year-old woman suffering from a pronounced frontal volume defect after severe craniocerebral trauma. The combination of cranioplasty using a polymethylmethacrylate (PMMA) implant, free gracilis muscle flap transfer for soft tissue coverage and serial autologous fat grafting into the muscle flap for subsequent contouring enabled both an adequate and aesthetic reconstruction. This example demonstrates the feasibility of treating increasingly complex composite defects in a multidisciplinary setting, when plastic surgeons are involved.


Assuntos
Retalhos de Tecido Biológico , Músculo Grácil , Procedimentos Cirúrgicos Reconstrutivos , Tecido Adiposo , Adulto , Autoenxertos , Feminino , Humanos , Próteses e Implantes
18.
PLoS One ; 15(8): e0237047, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745086

RESUMO

Deep prosthetic hip infection is a devastating complication of hip replacement surgery, and treatment often involves multiple revision surgeries with antibiotic chemotherapy to control the infection. The aim of this study was to explore patients' experiences of early and longer-term recovery after one-stage or two-stage revision with an excised hip, a temporary cement spacer or a custom-made articulating spacer. We interviewed 32 participants taking part in a surgical trial at two time points (2-4 months and 18 months) following one- or two-stage revision surgery. The analytic approach was inductive using the constant comparative method to generate themes from the data. Participants' early recovery after revision was characterised by a long hospital stay with burdensome antibiotics and limited physiotherapy provision. Participants undergoing two-stage revision with an excised hip or a cement spacer described severe mobility restrictions which affected all aspects of their lives, while those undergoing one-stage revision, or two-stage revision with an articulating spacer were more mobile and independent, with some limitations. Participants with a cement spacer also reported more pain than other treatment groups, while those with an articulating spacer appeared to perceive that their recovery was slow. At 18 months, participants in all groups described both improvements and losses in mobility and functional ability. Participants in all treatment groups expressed considerable emotional resilience during recovery from revision, which may be linked to opportunities to talk with the trial personnel. Participants identified the need for better information and psychological and physical support. Experience of recovery differs after one- and two-stage revision, and further in relation to the use of spacers. Mobility, function, independence and pain are important aspects of recovery which affect all aspects of day-to-day life. Increased information and more opportunities to talk and share experiences may provide psychological support during recovery.


Assuntos
Infecções Relacionadas à Prótese/psicologia , Recuperação de Função Fisiológica/fisiologia , Reoperação/psicologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artroplastia de Quadril/efeitos adversos , Cimentos para Ossos/uso terapêutico , Feminino , Humanos , Articulações/cirurgia , Masculino , Pessoa de Meia-Idade , Próteses e Implantes/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Pesquisa Qualitativa , Reoperação/efeitos adversos
20.
Wiad Lek ; 73(6): 1217-1222, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32723956

RESUMO

OBJECTIVE: The aim of the study is to compare the mesh implantation and the strength of the mesh fixation to the anterior abdominal wall by modelling the intraperitoneal onlay mesh repair (IPOM) with and without aponeurotic defect closure. PATIENTS AND METHODS: Materials and methods: The experimental animals were randomly divided into 2 groups of 6 rabbits. In experimental group IPOM was modelled without hernia defect closure, in control group - with its suturing. The macroscopic assessment of the severity of adhesions, histological examination of the removed "anterior abdominal wall - mesh" complex and strength of the mesh fixation to the anterior abdominal wall were performed on the 90th day. RESULTS: Results: In both groups, the displacement or complete separation of the mesh from the parietal peritoneum was not observed. The extent of adhesion formation in the abdominal cavity and strength of the mesh fixation are comparable in both groups (p > 0.05). In the experimental group, the mesh was surrounded by scar tissue, mesothelioma lining was not traced. There were also moderate signs of inflammation, which were not seen in the control group. CONCLUSION: Conclusions: The strength of the mesh fixation to the parietal peritoneum and its implantation into the anterior abdominal wall is comparable with or without aponeurotic defect closure during the experimental modelling of IPOM.


Assuntos
Parede Abdominal , Laparoscopia , Animais , Peritônio , Próteses e Implantes , Coelhos , Telas Cirúrgicas
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