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1.
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
2.
Artigo em Inglês | MEDLINE | ID: mdl-32344831

RESUMO

The impact of engineered nanoparticles (ENPs) on the migration and toxicity of coexisting pollutants is still unclear, especially in soil media. This study aims to evaluate the impact of titanium dioxide nanoparticles (TiO2 NPs) on the phytotoxicity of cadmium (Cd) to Oryza sativa L., and the migration of cadmium (Cd) in the soil-rice system. Three different Cd stress groups (C1 group: 1.0 mg kg-1, C2 group: 2.5 mg kg-1 and C3 group: 5.0 mg kg-1) were set in the pot experiment, and the target concentration of TiO2 NPs in each group were 0 mg kg-1 (T0), 50 mg kg-1 (T1), 100 mg kg-1 (T2) and 500 mg kg-1 (T3). Plant height and biomass decreased with the increasing of Cd content in paddy soil. TiO2 NPs could lower the phytotoxicity of Cd in terms of the changes in the morphological and biochemical characteristics, especially in the tillering and booting stage. In the tillering stage, TiO2 NPs addition caused a significant increase in plant height, biomass and the total chlorophyll content in the leaves of Oryza saliva L. In the booting stage, TiO2 NPs addition caused a 15% to 32% and 24% to 48% reduction of malondialdehyde (MDA) content for the C2 and C3 group, respectively, compared to that of the respective control treatment (T0). TiO2-NPs addition reduced the activity of peroxidase (POD) in the leaves in the booting and heading stage, and the activity of catalase (CAT) in the tillering stage. In the C1 and C2 group, the grain Cd content in the 100 and 500 mg kg-1 TiO2 NPs treatments reached 0.47-0.84 mg kg-1, obviously higher than that of the treatment without TiO2 NPs (0.27-0.32 mg kg-1), suggesting that TiO2-NPs could promote Cd migration in the soil-rice system.


Assuntos
Bioacumulação , Cádmio/toxicidade , Nanopartículas Metálicas/análise , Oryza/química , Oryza/crescimento & desenvolvimento , Poluentes do Solo/toxicidade , Titânio/efeitos adversos , Humanos , Nanopartículas Metálicas/química , Raízes de Plantas/efeitos dos fármacos , Solo , Poluentes do Solo/análise , Titânio/administração & dosagem
3.
Orthod Craniofac Res ; 23(4): 517-522, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32301238

RESUMO

OBJECTIVE: To assess the prevalence of allergic sensitization to titanium and nickel in orthodontic patients and to evaluate alterations of smell and taste. SUBJECTS AND METHODS: A total of 250 subjects were invited to participate, 245 accepted. The age range was 11-45 years, 68% were females and 52% adolescents. An epicutaneous patch test was performed. Of the positive subjects in the patch test, 26 participated in the taste and smell testing and were matched by age and sex with 26 negative subjects. RESULTS: The prevalence of hypersensitivity to titanium and/or nickel in orthodontic patients was 15.5%. Taste and smell were more impaired in sensitized subjects (P ≤ .025), taste was more affected than smell and the tastes most affected were sour and bitter tastes, while the sweet taste was least impaired. CONCLUSION: The allergic sensitization to titanium is more uncommon than to nickel, with altered smell and taste related to those hypersensitivities.


Assuntos
Níquel , Paladar , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Níquel/efeitos adversos , Prevalência , Olfato , Titânio/efeitos adversos , Adulto Jovem
5.
PLoS One ; 15(3): e0230027, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150598

RESUMO

BACKGROUND: We described safety and functional one-year follow-up outcomes of individuals with lower limb amputation treated with bone-anchored prostheses using titanium press-fit osseointegration implants. METHODS: All consecutive individuals treated between March 2015 and June 2018 with curved osseointegration femur implant (OFI-C) indicated for a long femoral remnant, gamma osseointegration femur implant (OFI-Y) indicated for a short femoral remnant, or osseointegration tibia implant (OTI) were eligible for this study. All adverse events were evaluated, infections were graded as follows: grade 1 and 2: low- and high-grade soft tissue infection, respectively, grade 3: deep bone infection, grade 4: septic implant failure. Functional outcome measures included prosthesis wearing time (PUS), health-related quality of life (GS), and the overall situation as an amputee (GS Q3); evaluated with the Questionnaire of persons with trans-femoral amputation (Q-TFA) before surgery and at one-year follow-up. RESULTS: Ninety of 91 individuals were included (mean age: 54±14 yrs, 26 females); treated with 53, 16 and 21 OFI-C, OFI-Y and OTI, respectively. Soft tissue infections (grade 1: 11 events, grade 2: 10 events) were treated successfully with antibiotics except in two (OFI-C and OFI-Y), who required additional surgery due to recurrent stoma irritation and peri-stoma abscess drainage. One individual with dysvascular amputation (OTI) developed septic implant loosening and occlusion of the femoral artery resulting in a transfemoral amputation. No aseptic loosening's occurred. One individual (OFI-Y) required stoma surgical refashioning due to soft tissue redundancy. At baseline mean ±SD and median (25th to 75th PCTL) Q-TFA PUS and GS were 52±39, 52(7-90) and 40±19, 42(25-50) and improved significantly to 88±18, 90 (90-100) and 71±15, 75 (67-83) at one-year follow-up. The GS Q3 improved over time. CONCLUSION: Titanium osseointegration implants can be safely used within a one-year follow-up period. The performance improved compared to the use of a socket-suspended prosthesis.


Assuntos
Prótese Ancorada no Osso/efeitos adversos , Fêmur/fisiologia , Extremidade Inferior/cirurgia , Osseointegração/efeitos dos fármacos , Qualidade de Vida , Segurança , Titânio/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur/efeitos dos fármacos , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
6.
Spine Deform ; 8(1): 135-138, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31950479

RESUMO

STUDY DESIGN: Case report. OBJECTIVE: To describe the importance of preoperative halo-gravity traction and posterior vertebral column resection (PVCR) for severe proximal thoracic kyphoscoliosis associated with Desbuquois dysplasia, after breakage of a growing rod construct. Desbuquois dysplasia is a rare, autosomal recessive chondrodysplasia characterized by short stature, joint laxity, kyphoscoliosis, and characteristic facial dysmorphism. Our 8-year-old patient developed severe, progressive, infantile-onset kyphoscoliosis and had been initially treated with Vertical Expandable Prosthetic Titanium Rib (VEPTR) rods. She subsequently underwent growing rod placement, but the eventual rod fracture resulted in a severe angular kyphosis. METHODS: Clinical and radiographic case review. RESULTS: The broken implants were removed, and she was treated with 2.5 months of preoperative halo-gravity traction. She then underwent a T4 PVCR and C7-L4 instrumented posterior spinal fusion. The patient had an uneventful postoperative course without any neurologic problems. Two years postoperatively, correction was well maintained with appropriate alignment and balance without implant breakage. CONCLUSION: To our knowledge, this is the first report of treatment of spinal deformity associated with Desbuquois dysplasia. Our results suggest that preoperative halo-gravity traction and PVCR are safe and efficacious techniques for severe rigid kyphoscoliosis in the cervicothoracic region associated with broken growing rods in a patient with Desbuquois dysplasia. LEVEL OF EVIDENCE: Level IV.


Assuntos
Anormalidades Craniofaciais/cirurgia , Nanismo/cirurgia , Instabilidade Articular/cirurgia , Cifose/cirurgia , Ossificação Heterotópica/cirurgia , Polidactilia/cirurgia , Próteses e Implantes/efeitos adversos , Falha de Prótese/efeitos adversos , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Titânio/efeitos adversos , Criança , Anormalidades Craniofaciais/complicações , Remoção de Dispositivo , Nanismo/complicações , Feminino , Gravitação , Humanos , Instabilidade Articular/complicações , Cifose/complicações , Ossificação Heterotópica/complicações , Polidactilia/complicações , Escoliose/complicações , Índice de Gravidade de Doença , Tração/métodos , Resultado do Tratamento
7.
World Neurosurg ; 135: e106-e115, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31756507

RESUMO

OBJECTIVE: The present study investigated the risk factors for instrumentation failure (IF) after total en bloc spondylectomy (TES) of thoracic and lumbar spine tumors using a titanium mesh cage (TMC) for anterior reconstruction. METHODS: The data from patients who had undergone TES for thoracic and lumbar spine tumors in our institution were retrospectively reviewed. Anterior reconstruction was performed using a TMC filled with morcelized allograft or morcelized autograft. Posterior reconstruction was performed using pedicle fixation. Survival analysis from TES to IF was conducted. The Kaplan-Meier method was used for univariate analysis. Factors of statistical significance were included in the multivariate analysis using Cox regression analysis. RESULTS: A total of 30 patients (20 men and 10 women), with a mean age of 37.1 ± 14.3 years (range, 14-65 years) were included. The mean follow-up period was 41.8 ± 21.3 months (range, 13-120 months). Bone fusion was achieved in 23 patients (76.7%). IF occurred in 8 patients. The mean interval from TES to the first IF was 31.8 ± 15.1 months (range, 13-64 months). On univariable analysis, a body mass index >28 kg/m2, perioperative radiotherapy, and the TMC in an oblique position were associated with IF. On multivariable analysis, these 3 factors were entered into the Cox regression model and were also significant. CONCLUSIONS: The use of TES can achieve durable oncological control. However, IF, a not uncommon late complication that leads to reoperation, should be a cause for concern. We found perioperative radiotherapy, a TMC in an oblique position, and a body mass index >28 kg/m2 were significant predictive factors for IF.


Assuntos
Vértebras Lombares/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Telas Cirúrgicas , Titânio , Adulto , Feminino , Humanos , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação , Estudos Retrospectivos , Fatores de Risco , Telas Cirúrgicas/efeitos adversos , Vértebras Torácicas/cirurgia , Titânio/efeitos adversos , Adulto Jovem
8.
World Neurosurg ; 135: e116-e125, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31756509

RESUMO

OBJECTIVE: The main objective of the present study was to analyze the efficacy and feasibility of surgical management for patients with monosegmental lumbar or lumbosacral pyogenic vertebral osteomyelitis (PVO) by using one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion. METHODS: From February 2014 to May 2016, 27 patients with lumbar or lumbosacral PVO were treated by posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion. The degree of damage to the patients' vertebral bodies was one third to one half height. There were 16 male and 11 female, with a mean age of 43.5 years (range, 32-56 years) at the time of surgery. The mean follow-up time was 35.7 months (range, 26-53 months). The clinical efficacy was evaluated on average operation time, blood loss, visual analog scale, erythrocyte sedimentation rate, C-reactive protein level, and neurologic function recovery. RESULTS: PVO was completely cured and the grafted bone was fused in all 27 patients. There was no recurrent vertebral osteomyelitis infection. Erythrocyte sedimentation rate and C-reactive protein level achieved normal limits within 3 months in all patients. The American Spinal Injury Association neurologic classification was improved in all cases. Pain relief was obtained in all patients. CONCLUSIONS: Our results showed that one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion was an effective treatment for patients with one third to one half height of vertebral body damaged in monosegmental lumbar or lumbosacral PVO. The surgical method is characterized as minimum surgical trauma, good pain relief, good neurologic recovery, and good reconstruction of spinal stability.


Assuntos
Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Osteomielite/cirurgia , Telas Cirúrgicas , Adulto , Desbridamento/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes/efeitos adversos , Estudos Retrospectivos , Fusão Vertebral/métodos , Telas Cirúrgicas/efeitos adversos , Vértebras Torácicas/cirurgia , Titânio/efeitos adversos , Resultado do Tratamento , Tuberculose da Coluna Vertebral/cirurgia
9.
Front Immunol ; 10: 2714, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31849940

RESUMO

Coal is one of the most abundant and economic sources for global energy production. However, the burning of coal is widely recognized as a significant contributor to atmospheric particulate matter linked to deleterious respiratory impacts. Recently, we have discovered that burning coal generates large quantities of otherwise rare Magnéli phase titanium suboxides from TiO2 minerals naturally present in coal. These nanoscale Magnéli phases are biologically active without photostimulation and toxic to airway epithelial cells in vitro and to zebrafish in vivo. Here, we sought to determine the clinical and physiological impact of pulmonary exposure to Magnéli phases using mice as mammalian model organisms. Mice were exposed to the most frequently found Magnéli phases, Ti6O11, at 100 parts per million (ppm) via intratracheal administration. Local and systemic titanium concentrations, lung pathology, and changes in airway mechanics were assessed. Additional mechanistic studies were conducted with primary bone marrow derived macrophages. Our results indicate that macrophages are the cell type most impacted by exposure to these nanoscale particles. Following phagocytosis, macrophages fail to properly eliminate Magnéli phases, resulting in increased oxidative stress, mitochondrial dysfunction, and ultimately apoptosis. In the lungs, these nanoparticles become concentrated in macrophages, resulting in a feedback loop of reactive oxygen species production, cell death, and the initiation of gene expression profiles consistent with lung injury within 6 weeks of exposure. Chronic exposure and accumulation of Magnéli phases ultimately results in significantly reduced lung function impacting airway resistance, compliance, and elastance. Together, these studies demonstrate that Magnéli phases are toxic in the mammalian airway and are likely a significant nanoscale environmental pollutant, especially in geographic regions where coal combustion is a major contributor to atmospheric particulate matter.


Assuntos
Exposição Ambiental , Pulmão/efeitos dos fármacos , Pulmão/patologia , Macrófagos/metabolismo , Titânio/efeitos adversos , Animais , Apoptose/genética , Apoptose/imunologia , Biomarcadores , Citocinas/metabolismo , Citotoxicidade Imunológica , Suscetibilidade a Doenças , Perfilação da Expressão Gênica , Humanos , L-Lactato Desidrogenase/metabolismo , Pulmão/metabolismo , Pulmão/fisiopatologia , Macrófagos/imunologia , Macrófagos/patologia , Masculino , Potencial da Membrana Mitocondrial , Camundongos , Espécies Reativas de Oxigênio/metabolismo , Testes de Função Respiratória , Transdução de Sinais
10.
Int J Mol Sci ; 20(22)2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31718064

RESUMO

The increasing need for novel bone replacement materials has been driving numerous studies on modifying their surface to stimulate osteogenic cells expansion and to accelerate bone tissue regeneration. The goal of the presented study was to optimize the production of titania-based bioactive materials with high porosity and defined nanostructure, which supports the cell viability and growth. We have chosen to our experiments TiO2 nanofibers, produced by chemical oxidation of Ti6Al4V alloy. Fibrous nanocoatings were characterized structurally (X-ray diffraction (XRD)) and morphologically (scanning electron microscopy (SEM)). The wettability of the coatings and their mechanical properties were also evaluated. We have investigated the direct influence of the modified titanium alloy surfaces on the survival and proliferation of mesenchymal stem cells derived from adipose tissue (ADSCs). In parallel, proliferation of bone tissue cells-human osteoblasts MG-63 and connective tissue cells - mouse fibroblasts L929, as well as cell viability in co-cultures (osteoblasts/ADSCs and fibroblasts/ADSCs has been studied. The results of our experiments proved that among all tested nanofibrous coatings, the amorphous titania-based ones were the most optimal scaffolds for the integration and proliferation of ADSCs, fibroblasts, and osteoblasts. Thus, we postulated these scaffolds to have the osteopromotional potential. However, from the co-culture experiments it can be concluded that ADSCs have the ability to functionalize the initially unfavorable surface, and make it suitable for more specialized and demanding cells.


Assuntos
Materiais Biocompatíveis/química , Proliferação de Células , Nanofibras/química , Tecidos Suporte/química , Titânio/química , Animais , Materiais Biocompatíveis/efeitos adversos , Linhagem Celular , Fibroblastos/efeitos dos fármacos , Fibroblastos/fisiologia , Humanos , Células-Tronco Mesenquimais/efeitos dos fármacos , Células-Tronco Mesenquimais/fisiologia , Camundongos , Nanofibras/efeitos adversos , Osseointegração , Osteoblastos/efeitos dos fármacos , Osteoblastos/fisiologia , Tecidos Suporte/efeitos adversos , Titânio/efeitos adversos
11.
Spine Deform ; 7(6): 899-909, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31732000

RESUMO

STUDY DESIGN: Prospective longitudinal study of growth modulation system for early adolescent idiopathic scoliosis (AIS), consecutive case series from first human use to skeletal maturity, fusion, or five years postoperation. OBJECTIVES: Determine adverse events and curvature changes to end of study; examine factors most likely to explain variability in curve changes. SUMMARY OF BACKGROUND: Pilot clinical safety study was performed under US Food and Drug Administration (FDA) Investigational Device Exemption (IDE). Safety and radiographic results were previously reported to 24 months postoperation. METHODS: Subjects with early AIS underwent thoracoscopic placement of titanium clip-screw devices designed to modify growth asymmetrically. Eligibility was based on high risk of progression to 50°: single major thoracic curve 25°-40°, Risser 0, open triradiate cartilages, and premenarchal if female. Six subjects, the maximum allowed, enrolled. Adverse events (AEs), clinical outcomes, and curvatures were systematically collected. Disc heights, vertebral heights, and implant-bone contact areas were assessed. RESULTS: Consecutive subjects enrolled, aged 12.1 years (±1.7), three were female. AEs from two to five years postoperation included deformity changes leading to a second surgery in three patients: two for posterior spinal fusion, and one for thoracoscopic removal of half the implants for overcorrection. In the latter case, overcorrection appeared halted for duration of study. One patient, whose curve exceeded 50° at age 18 years, did not choose fusion. Major thoracic curves were 34° (±3°) preoperatively and 42° (±20°) at end of study. CONCLUSIONS: In a study of spine growth modulation in patients with early AIS with high risk of progression, at skeletal maturity or five years postoperation, major thoracic curves of half progressed to >50°, whereas curves of the other half remained <40°, below fusion indications. Removal of selected implants may halt overcorrection. The next, pivotal, study phase was approved by FDA. LEVEL OF EVIDENCE: Level IV, prospective case series under stringent regulatory controls.


Assuntos
Parafusos Ósseos/efeitos adversos , Escoliose/cirurgia , Coluna Vertebral/crescimento & desenvolvimento , Toracoscopia/instrumentação , Titânio/efeitos adversos , Adolescente , Determinação da Idade pelo Esqueleto , Parafusos Ósseos/normas , Criança , Progressão da Doença , Feminino , Humanos , Masculino , Cuidados Pós-Operatórios/estatística & dados numéricos , Estudos Prospectivos , Radiografia/métodos , Escoliose/diagnóstico por imagem , Curvaturas da Coluna Vertebral/classificação , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral/métodos , Fusão Vertebral/tendências , Coluna Vertebral/fisiologia , Instrumentos Cirúrgicos/efeitos adversos , Instrumentos Cirúrgicos/normas , Toracoscopia/métodos , Titânio/normas , Resultado do Tratamento , Estados Unidos , United States Food and Drug Administration
12.
J Eur Acad Dermatol Venereol ; 33 Suppl 7: 34-46, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31588611

RESUMO

Titanium dioxide (TiO2 ) is widely used in a variety of products including cosmetics. TiO2 in its nanoparticle form (nano-TiO2 ) is now the only form used as an ultraviolet (UV) filter in sunscreens, but also in some day creams, foundations and lip balms. While its efficacy as a UV filter is proven in the prevention of skin cancers and sunburns, some concerns have been raised about its safety. Indeed, considering its small size, nano-TiO2 is suspected to penetrate dermal, respiratory or gastrointestinal barriers, disseminate in the body and therefore constitute a potential risk to the consumer. At the skin level, most studies performed in humans or animals showed that nano-TiO2 did not penetrate beyond the outer layers of stratum corneum to viable cells and did not reach the general circulation, either in healthy or in compromised skin. The Scientific Committee on Consumer Safety (SCCS) considers nano-TiO2 as a non-sensitizer and as mild- or non-irritant to skin and concludes in no evidence of carcinogenicity (supported by the European Chemicals Agency), mutagenicity or reproductive toxicity after dermal exposure to nano-TiO2 . According to the SCCS, nano-TiO2 from sunscreens does not present any health risk when applied on the skin at a concentration up to 25%. However, the SCCS does not recommend the use of nano-TiO2 in formulations that may lead to exposure of the consumer's lungs by inhalation (sprayable products and powders). Indeed, even if human data are sparse and inconsistent, lung inflammation was reported in animals. In 2016, the EU Cosmetic Regulation made nano-TiO2 as an authorized UV filter, except in products that could lead to exposure of the lungs. After oral exposure, nano-TiO2 absorption and toxicity are limited. The incidental oral exposure to nano-TiO2 contained in lip balms is thus not expected to induce adverse health effects.


Assuntos
Cosméticos/efeitos adversos , Exposição por Inalação/efeitos adversos , Nanopartículas/efeitos adversos , Protetores Solares/efeitos adversos , Titânio/efeitos adversos , Administração Cutânea , Administração Oral , Animais , Carcinogênese , Cosméticos/química , Cosméticos/farmacocinética , Humanos , Pulmão/efeitos dos fármacos , Reprodução/efeitos dos fármacos , Pele/efeitos dos fármacos , Absorção Cutânea , Protetores Solares/farmacocinética , Protetores Solares/toxicidade , Titânio/farmacocinética , Titânio/toxicidade
13.
BMC Musculoskelet Disord ; 20(1): 437, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554516

RESUMO

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1-1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. CASE PRESENTATION: Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient's deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. CONCLUSIONS: This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.


Assuntos
Abscesso/terapia , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Fusão Vertebral/efeitos adversos , Abscesso/etiologia , Antibacterianos/uso terapêutico , Vértebras Cervicais/microbiologia , Desbridamento , Remoção de Dispositivo/efeitos adversos , Drenagem , Quimioterapia Combinada/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Aparelhos Ortopédicos , Próteses e Implantes/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Fusão Vertebral/instrumentação , Staphylococcus aureus/isolamento & purificação , Fatores de Tempo , Titânio/efeitos adversos , Resultado do Tratamento
14.
Plast Reconstr Surg ; 144(3): 433e-443e, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461029

RESUMO

BACKGROUND: Pediatric calvarial reconstruction is challenging because of the unique anatomical and growth considerations in this population. Comparative studies evaluating current cranioplasty materials are lacking. This review addresses the knowledge gap in pediatric cranioplasty outcomes with emphasis on current materials used. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome data comparing fresh bone, banked bone, titanium, poly(methyl methacrylate), and polyetheretherketone were abstracted. RESULTS: Twenty studies met the authors' selection criteria. The mean patient age ranged from 4 to 17.4 years. Autologous cranioplasty was performed in 439 patients, and 201 patients underwent alloplastic reconstruction. Fresh bone grafts and titanium mesh were associated with the lowest infection rates (0.4 percent and 3.3 percent, respectively; p < 0.001), graft failures (2.9 percent and 3.3 percent, respectively; p < 0.001), and surgical-site occurrence rates (8.8 percent and 6.7 percent, respectively; p < 0.001). Banked bone flaps had the highest overall complication rates (51 percent; p < 0.001), bone resorption (39.7 percent; p < 0.001), and failure rates (40.2 percent; p < 0.001), whereas polyetherether ketone had the highest rates of infection (16.1 percent; p < 0.001). CONCLUSIONS: Based on the available evidence to date, fresh bone grafts and titanium mesh demonstrated the lowest surgical-site infection, surgical-site occurrence, and graft failure rates. Banked bone flaps had the highest overall surgical-site complications and graft failures. Pediatric cranioplasty outcomes studies are needed to evaluate current and novel cranioplasty materials.


Assuntos
Transplante Ósseo/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Próteses e Implantes/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adolescente , Fatores Etários , Transplante Ósseo/métodos , Criança , Pré-Escolar , Craniotomia , Humanos , Cetonas/efeitos adversos , Polietilenoglicóis/efeitos adversos , Polimetil Metacrilato/efeitos adversos , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Titânio/efeitos adversos , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
15.
BMC Musculoskelet Disord ; 20(1): 357, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31387574

RESUMO

BACKGROUND: Scaphoid fractures are the most common carpal fractures. They often need to be treated by surgery, where the use of a compression screw is the globally accepted gold standard. Surgeons may choose between different implant materials including titanium alloys, which remain in the body or are removed after healing. An alternative are biodegradable magnesium-based implants. Properties of magnesium alloys include high stability, osteoconductivity, potential reduction of infections and few artifacts in magnetic resonance imaging (MRI). The aim of this trial is to demonstrate non-inferiority of magnesium-based compression screws compared with titanium Herbert screws for scaphoid fractures. METHODS: The trial is designed as a multicenter, blinded observer, randomized controlled parallel two-group post market trial. Approximately 190 patients will be randomized (1:1) with stratification by center either to titanium or magnesium-based compression screws. Follow-up is 1 year per patient. Surgical procedures and aftercare will be performed according to the German treatment guideline for scaphoid fractures. The first primary endpoint is the patient-rated wrist evaluation (PRWE) score after 6 months. The second primary endpoint is a composite safety endpoint including bone union until 6 months, no adverse device effect (ADE) during surgery or wound healing and no serious ADE or reoperation within 1 year. The third primary endpoint is the difference in change MRI artifacts over time. Non-inferiority will be investigated for primary endpoints 1 (t-test confidence interval) and 2 (Wilson's score interval) using both the full analysis set (FAS) and the per protocol population at the one-sided 2.5% test-level. Superiority of magnesium over titanium screws will be established using the FAS at the two-sided 5% test-level (Welch test) only if non-inferiority has been established for both primary endpoints. Secondary endpoints include quality of life. DISCUSSION: This study will inform care providers whether biodegradable magnesium-based implants are non-inferior to standard titanium Herbert screws for the treatment of scaphoid fractures in terms of wrist function and safety. Furthermore, superiority of magnesium-based implants may be demonstrated using MRI, which is used as surrogate endpoint for screw degradation. TRIAL REGISTRATION: DRKS, DRKS00013368 . Registered Dec 04, 2017.


Assuntos
Implantes Absorvíveis/efeitos adversos , Parafusos Ósseos/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Osso Escafoide/lesões , Traumatismos do Punho/cirurgia , Adolescente , Adulto , Ensaios Clínicos Fase IV como Assunto , Estudos de Equivalência como Asunto , Fixação Interna de Fraturas/efeitos adversos , Humanos , Magnésio/efeitos adversos , Imagem por Ressonância Magnética , Masculino , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/estatística & dados numéricos , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia , Titânio/efeitos adversos , Resultado do Tratamento , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/fisiopatologia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Adulto Jovem
16.
Biomed Res Int ; 2019: 2519205, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31360706

RESUMO

Dental implants are often made of titanium alloys. Implant therapy currently promises a good long-term result without impacting health; however, its success depends on many factors. In this article, the authors focus on the most common risk factors associated with metallic surgical implants. Titanium-induced hypersensitivity can lead to symptoms of implant rejection. Corrosion and biofilm formation are additional situations in which these symptoms may occur. For medical purposes, it is important to define and discuss the characteristics of metals used in implantable devices and to ensure their biocompatibility. To avoid hypersensitivity reactions to metallic dental implants, precautionary principles for primary prevention should be established.


Assuntos
Materiais Biocompatíveis/efeitos adversos , Implantes Dentários/efeitos adversos , Metais/efeitos adversos , Materiais Biocompatíveis/uso terapêutico , Corrosão , Ligas Dentárias/efeitos adversos , Ligas Dentárias/uso terapêutico , Humanos , Metais/uso terapêutico , Fatores de Risco , Titânio/efeitos adversos , Titânio/uso terapêutico
17.
Integr Environ Assess Manag ; 15(6): 1000-1011, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31286652

RESUMO

Titanium dioxide (TiO2 ) is in the process of being classified as a suspected carcinogenic substance (Carc 2). The present case study probes the outcomes of this potential classification in terms of the reduction of hazardous exposure to TiO2 due to its classification. Furthermore, the case study examines the elements that are causing ambiguity during the classification process. This study was conducted by walking through the process from the present exposure to TiO2 to the hazard assessment associated with TiO2 exposure, to the regulatory classification process, and to practical outcomes affecting TiO2 usage. Finally, the impact of the classification on exposure, which was originally considered potentially hazardous, is evaluated. The case study shows that TiO2 classification as a carcinogen will not directly reduce respiratory exposure to TiO2 , which was the original reason for the classification. Instead, the classification will lead to restrictions on recycling. Moreover, the classification will have an impact on certain solid artifacts and liquid mixtures for which hazardous exposure was not detected. Altogether, the present case raises questions concerning hazard communications associated with the Carc 2 classification; treatment of poorly soluble low toxicity (PSLT) particles and nanoparticles in the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) and the Classification, Labelling and Packaging (CLP) classifications; and use of human exposure studies for the purposes of chemical regulations. Based on the present study, the following recommendations are made: the final decision on the TiO2 classification should be reconsidered together with those of other PSLT particles and take into account extensive developments in the field of nanoscience. Furthermore, the European Chemicals Agency (ECHA) should develop state-of-the-art guidance on how to use the available human exposure data. Finally, the authorities that are in charge of European Union chemicals management are advised to further develop the regulatory network to utilize the information generated in REACH processes as efficiently as possible and to verify that the connections between the regulations result in the intended outcome. Integr Environ Assess Manag 2019;00:1-12. © 2019 SETAC.


Assuntos
Exposição Ambiental/efeitos adversos , Pintura/efeitos adversos , Rotulagem de Produtos , Titânio/efeitos adversos , Monitoramento Ambiental , União Europeia , Humanos , Medição de Risco
18.
Rom J Morphol Embryol ; 60(1): 233-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31263850

RESUMO

The aim of this paper is to eliminate suspicions of a titanium (Ti) allergy in a rare case of "flowered" implant in a 43-year-old female patient with metal allergies and no history of bruxism, using a histological and immunohistochemical (IHC) analysis to determine the phenotype of cells that participated in the immune response; also, to assess the prognosis of a future implant treatment and to highlight the psychological impact of osseointegrated implant failure caused by fracture, and the influence that the necessity to use extensive surgical procedures for reimplantation can have on the treatment solution chosen by the patient. The results of our IHC analysis did not indicate a clear response for a potential Ti allergy; still, due to psychological reasons, the patient rejected the replantation and considered the use of other restorative option, a three-unit bridge, as being the most appropriate for her. Considering her opinion and attitude, the fixed prosthetic denture assured the therapeutic success.


Assuntos
Prótese Dentária Fixada por Implante/métodos , Hipersensibilidade/complicações , Titânio/efeitos adversos , Adulto , Feminino , Humanos
19.
J Foot Ankle Surg ; 58(5): 974-979, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31266695

RESUMO

Because of their inert character and desired biocompatibility, titanium implants have been universally accepted as safer alternatives to the conventional stainless steel orthopedic implants; however, recent emergence of type IV hypersensitivity reactions to titanium have included eczema, contact dermatitis, a prolonged febrile state, sterile osteonecrosis, and impaired fracture and wound healing. This report presents a patient with postoperative incision dehiscence and devascularization of surfaces in contact with titanium hardware after undergoing a double calcaneal osteotomy and a first metatarsal-cuneiform arthrodesis using titanium alloy implants. Titanium hypersensitivity was confirmed in this case through standard allergy patch testing by a board-certified immunologist. Complete healing occurred after diagnosis of the titanium allergy and hardware explant. To our knowledge, this is one of a few known allergies to titanium implants after foot and ankle surgery.


Assuntos
Artrodese/efeitos adversos , Artrodese/instrumentação , Hipersensibilidade Tardia/etiologia , Ossos do Metatarso/cirurgia , Titânio/efeitos adversos , Adulto , Feminino , Pé Chato/cirurgia , Humanos , Hipersensibilidade Tardia/diagnóstico , Hipersensibilidade Tardia/terapia , Osteotomia/efeitos adversos , Ossos do Tarso/cirurgia
20.
J Med Case Rep ; 13(1): 200, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31256758

RESUMO

BACKGROUND: Yellow nail syndrome is a rare condition associated with a triad of symptoms: yellow nails, lung lesions, and lymphedema. We report a case of yellow nail syndrome caused by titanium exposure from multiple artificial joint replacements. CASE PRESENTATION: A 78-year-old Asian woman presented to our outpatient department with chief complaints of cough, fever, and nausea. The patient was hospitalized for observation because of the presence of hypoxemia and bilateral pleural effusion. Her medical history included knee joint replacement and two spinal fusion surgeries. Her physical examination conducted following hospitalization revealed yellow nails on both hands and feet. This finding, combined with the observation of bilateral pleural effusion, raised suspicion for yellow nail syndrome. Blood analysis yielded negative results, as did the tests for sputum culture, interferon liberation, pleural effusion culture, and pleural effusion cytology. Pleural histopathological analysis and imaging yielded negative results. Considering the possibility of titanium exposure from artificial joints based on the patient's medical history, we examined a chest radiograph obtained before the second spinal fusion surgery; however, no pleural effusion was observed. Pleural effusion was observed, however, following the surgery. On the basis of these findings, the patient was diagnosed with yellow nail syndrome due to titanium exposure. CONCLUSIONS: Clinicians should examine the nails of patients with unexplained pleural effusion. Moreover, they should inquire about titanium exposure when obtaining the patient's medical history.


Assuntos
Fixadores Internos/efeitos adversos , Prótese do Joelho/efeitos adversos , Titânio/efeitos adversos , Síndrome das Unhas Amareladas/induzido quimicamente , Idoso , Artroplastia do Joelho , Feminino , Humanos , Derrame Pleural/induzido quimicamente , Fusão Vertebral
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