Electrochemical corrosion behavior and mechanical properties of Ti-Ag biomedical alloys obtained by two powder metallurgy processing routes.

Titanium is frequently used as a biomaterial and the importance of Ti-Ag alloys has increased thanks to the antibacterial behavior of silver. In this study, Ti-Ag alloys (5, 10 and 15 wt% Ag) were obtained by two different powder metallurgy routes: blended elemental (BE) and mechanical alloying (MA). The influence of the powder mixture methodology on both microstructure and electrochemical behavior was analyzed. Powders were compacted at 600 and 900 MPa, respectively, and sintered at high vacuum for 3 h at 950 °C. The obtained Ti-Ag alloys were microstructurally characterized by Scanning Electron Microscopy (SEM), Energy Dispersive X-Ray Spectroscopy (EDS) and X-Ray Diffraction (XRD), and mechanically tested by hardness and bending tests. Electrochemical tests were run using a three-electrode cell in an artificial Fusayama saliva solution. Open-Circuit Potential (OCP), polarization curves, potentiostatic tests and Electrochemical Impedance Spectroscopy (EIS) techniques were employed to evaluate the corrosion resistance of the studied Ti-Ag alloys. The initial characteristics of powders before sintering and after blend/alloying modified the electrochemical behavior of the Ti-Ag-sintered alloys and were determined. The samples obtained with the BE powders better resisted corrosion than the MA samples, and this behavior was directly related to the quantity and distribution of intermetallic Ti2Ag. A large quantity of intermetallics present on both the edge and inside grains reduced the corrosion resistance of TiAg alloys.

Psychological Interventions for Parents of Children with Cancer: A Systematic Review and Meta-analysis

This study provides a systematic review and meta-analysis of randomized controlled trials that analyzed the efficacy of psychological interventions for parents of children with cancer. The search was conducted in the databases PsycInfo, Medline, PsycArticles, and PsycTests. Fourteen studies met the inclusion criteria. Two independent researchers extracted relevant data, and the studies were assessed for methodological quality. The standardized mean difference (d) was used as the effect size index. The meta-analyses, which applied random and mixed-effects models, showed that weighted effect sizes were statistically significant for depression at posttreatment (d= 1.19). However, the methodological quality moderated the depression estimate. The weighted effect sizes for the remaining variables were not statistically significant: stress/burnout (d= 0.90), quality of life (d= 1.26), anxiety (d= 0.21), posttraumatic stress (d= 0.05), and general indicator of emotional symptoms (d= 0.33). This review also highlights several methodological limitations of the studies. Future directions for research that examines interventions targeting primary caregivers of children with cancer are discussed. In conclusion, more high-quality research is needed to establish the efficacy of psychological interventions for parents of children with cancer (AU)

Tilt testing in neurocardiogenic syncope: isosorbide versus isoproterenol.

OBJECTIVE: To compare the diagnostic value of pharmacological stimulation with sublingual isosorbide dinitrate and intravenous isoproterenol during tilt testing in patients with neurocardiogenic syncope and with a negative tilt test without pharmacological provocation. METHODS AND RESULTS: One hundred and twenty patients with a history of neurocardiogenic syncope (aged 15 to 77 years) and 50 healthy volunteers (aged 25 to 70 years) were prospectively submitted to head-up tilt (HUT). Those who did not develop syncope or presyncope during passive HUT for 30 minutes underwent repeated HUT with isoproterenol infusion at 4 microg/min (ISOP HUT), for 10 minutes, and, subsequently, were tilted after sublingual administration of 5 mg of isosorbide dinitrate (ISDN HUT) for another 12 minutes. ISDN HUT was always performed after ISOP HUT. Sensitivity and specificity of passive HUT were 41% (95% C.I. 32.9% to 51.0%) and 100%, respectively. Sensitivity of ISOP HUT was 51.4% (95% C.I. 39.2% to 63.6%) and specificity 70% (95% C.I. 55.4% to 82.1%) and for ISDN HUT were 70% (95% C.I. 57.9% to 80.4%) and 88% (95% C.I. 75.7% to 95.5%), respectively. The accuracy of ISDN HUT was significantly higher than the accuracy of ISOP HUT 77.5% (95% C.I. 68.9% to 84.6%). There were fewer side effects during ISDN HUT. CONCLUSION: Sublingual isosorbide dinitrate is at least as sensitive as isoproterenol to assess patients with suspected neurocardiogenic syncope and with a negative tilt test without provocation. The low rate of side effects and the higher accuracy of ISDN HUT, along with the simplicity of this challenge compared to ISOP HUT, suggest that sublingual isosorbide dinitrate should be preferred as a provocative agent to evaluate neurocardiogenic syncope after a negative passive tilt test.

Effects of intraventricular angiotensin II mediated by the sympathetic nervous system.

Central effects of angiotensin II were studied in rats treated with adrenalectomy, chemical sympathectomy with intravenous 6-hydroxydopamine, or a combination of both. Unrestrained, unanesthetized rats were compared before and after one of the three treatments to determine water drinking and blood pressure responses to intracerebroventricular (ivt) injections of 50 and 500 ng angiotensin II (AII). Adrenalectomy alone did not alter either drinking or pressor response to AIIivt. Peripheral sympathectomy alone resulted in a prolonged latency for pressor response but did not significantly alter drinking response to AIIivt. Results obtained by combined treatment were not significantly different from results obtained by sympathectomy alone. There remained a pressor response to AIIivt after combined treatment. The adrenals do not appear to be involved in mediating pressor response to AIIivt. Furthermore, sympathetic neural activation alone causes the early pressor response to AIIivt. Finally, some other factor(s) in addition to sympathetic neural activation must contribute to the pressor response to AIIivt.

Positive head-up tilt table test in patients with the long QT syndrome.

AIMS: Syncope in patients with the long QT syndrome is commonly attributed to a ventricular arrhythmia (torsades de pointes). The susceptibility of patients with the long QT syndrome (LQTS) to neurally mediated syncope is currently unknown. METHODS AND RESULTS: Head-up tilt table testing (70 degrees) was performed in six patients with the long QT syndrome and a history of syncope. All patients had syncope with a mixed response. The RR interval was significantly decreased 2 min before the onset of syncope (980 +/- 125 ms vs 630 +/- 91 ms, P=0.003), and significantly increased during syncope (983.17 +/- 224.71; P=0.006). Non-significant changes in QT intervals were observed. Baseline QT was 513 +/- 86 ms and decreased to 450 +/- 59 ms 2 min before the onset of syncope (P=0.11). Although not statistically significant, QT intervals during syncope were longer than at 2 min before syncope (485 +/- 85 ms vs 450 +/- 59 ms; P=0.29). CONCLUSION: Our results suggest that patients with the LQTS are susceptible to neurally mediated syncope. Whether this susceptibility differs from control populations remains unresolved. From a clinical standpoint, neurocardiogenic syncope should be considered a diagnostic alternative in patients with LQTS.