Posterior Instrumentation of the Cervical Spine with a Versatile Modular Fixation System

OBJECT

To study the feasibility/suitability of posterior instrumentation of the entire cervical and upper thoracic spine (C0-Th5) for a broad spectrum of indications in a predominantly old-aged and co-morbid patient population using a novel occipito-cervico-thoracic system.

METHODS

54 consecutive patients (m=31, f=23, median age 63) with degenerative, neoplastic, traumatic, or infectious diseases were treated over a period of 29 months. Primary posterior as well as secondary posterior approaches after anterior instrumentation were used. Clinical and radiographic data was acquired prospectively using standard scales at pre-defined time intervals.

RESULTS

On average 3 segments (range: 1-6) were bridged without significant intraoperative complications. In 30 cases a posterior decompression was additionally performed. Nine of 315 implanted screws were defined as suboptimal, leading to operative revision in 5 cases. During the follow-up interval (9+/-1.1 months, range: 3-25) patients showed a statistically significant improved mobility (Karnofsky score: 58+/-3 [pre] compared to 75+/-3 [post]) with improved mental and physical health (SF-36 health survey: mental component 44 [pre] to 51 [post], physical component 34 [pre] to 44 [post]) and less subjective pain (VAS: 3.9+/-0.3 [pre] to 0.5+/-0.1 [post]). All patients remained neurologically stable or improved after operation except two, who transiently deteriorated by one Nurick grade. Only one dislocation and no breakages of the implanted hardware were seen, and no significant secondary loss of spinal alignment was observed.

CONCLUSIONS

Posterior instrumentation of the entire cervical and upper thoracic spine with the novel occipito-cervico-thoracic system has been shown to be safe, convenient and effective. The anterior approach in high-risk patients can thus be avoided, and the approach provides substantial additional stability to multi-level anterior constructs.

[Pregnant woman and road safety: a numerical approach. Application to a restrained third trimester pregnant woman in frontal impact]

OBJECTIVES

The goal of our work is the development of a numerical model of pregnant woman in driving position. We present an application to the study of injury mechanisms during a frontal car crash for a seat belt restrained pregnant woman in driving position.

MATERIALS AND METHODS

We integrated a digital representation of a pregnant uterus, foetus and placenta in a previous existing numerical model of non pregnant Human body in driving position, the Humos model. The realization of a numerical simulation of a frontal car crash enabled us to analyze the part played by the safety belt in the organic traumatisms.

RESULTS

Three phases were highlighted. The first phase consists of a translation forwards of the pregnant uterus during the impact. The second phase is a rotation forwards in the sagittal plan of the pregnant uterus with for axis of rotation the posterior wall of the pubis. The third phase is a vertical adjustment coupled to a translation of the uterus towards the back. This translation leads the uterus to impact the spine.

CONCLUSION

The development of a pregnant numerical model in the field of accidentology allows the analysis of organic traumatisms. That makes it possible to study the role played by the existing safety systems. This model might make it possible to develop safety systems specific to the pregnant woman.

The influence of electron beam irradiation on the shear bond strength of glass-reinforced frameworks and veneer composites

The bond between glass fibre framework and veneer composite can be achieved by silane coupling agents or by monomers that penetrate into a polymer network. However, it has been clinically demonstrated that his bond can fail. This study investigated whether electron beam irradiation improved the bond strength of fibre-frameworks and veneer composite with and without additional coupling agents.

The influence of electron beam irradiation on fibre-reinforced composite specimens

This study investigated whether glass fibre-reinforced composite (FRC) specimens can benefit from post-curing using electron beam irradiation. Twenty-four frameworks of the Vectris and 24 of the Stick glass fibre-reinforced system were veneered with their correspondent veneer materials. Eight specimens of both systems were post-cured using electron beam irradiation (3 x 33 kGy, 10 MeV). The specimens were fixed in a restrained-end apparatus and inserted in an artificial mouth. With the exception of controls (n = 8 each) all other groups were thermally cycled and mechanically loaded (TCML). Finally, all samples were loaded to fracture using a universal testing machine. In two of eight non-irradiated Vectris/Targis specimens facing fracture occurred during TCML. Irradiation avoided these failures. No Stick/Sinfony facing fractured. However, Stick frameworks showed considerable torsions. Post-curing with electron beam irradiation made Stick frameworks stiffer. The fracture load of irradiated Stick/Sinfony specimens reached 520 +/- 31 N; control (without TCML and irradiation) 396 +/- 14 N, TCML-group without irradiation 362 +/- 41 N. Irradiated Vectris/Targis had a fracture resistance of 575 +/- 57 N; the control 556 +/- 36 N and the TCML group without irradiation 383 +/- 51 N. This investigation demonstrated that different types of FRC systems could considerably benefit from electron beam irradiation. The reconstructions became stiffer and resisted higher load.

Dwellings, crowding, and tuberculosis in Montreal

The association of tuberculosis (TB) with poverty has long been recognized, yet it may reflect not only characteristics of poor individuals, but also housing and neighborhood features which promote airborne spread. We sought to determine whether dwelling and building features, residential density and crowding are independently associated with TB occurrence in a low-incidence setting. We used residential addresses to geocode active TB cases reported in Montreal in 1996-2000. These "case dwellings" were linked to the municipal dwelling geodatabase from 2000, and to Canadian census data from 1996. We compared them with randomly selected Montreal dwellings ("controls," in a 1:10 ratio), using the same data sources. From multivariate logistic regression, the 595 case dwellings were more likely than the 5950 control dwellings to be in buildings >5 stories tall (adjusted odds ratios [OR] 1.6; 95% CI: 1.0-2.5), constructed since 1970 (adjusted OR 2.5; 1.8-3.6), in the lowest quartile for resale valuation (adjusted OR 1.3; 1.0-1.6), and on blocks where lot coverage exceeded the median value (adjusted OR 1.3; 1.0-1.6). Case dwellings were also more often found in census tracts with more persons per room, and a higher proportion of inhabitants who had arrived in Canada within the last 5 years. We conclude that dwelling and building features-notably dwellings in taller and new buildings, with lower resale value, and dwellings on blocks with high residential density-as well as crowding, were associated with TB occurrence, after adjustment for sociodemographic factors.

Influence of stress simulation parameters on the fracture strength of all-ceramic fixed-partial dentures

OBJECTIVES

This in vitro study tested the influence of diverse stress simulation parameters on the fracture strength of all-ceramic three-unit fixed partial dentures (FPDs).

METHODS

All-ceramic FPDs made of Empress 2 (Ivoclar-Vivadent, FL) were exposed to thermal cycling and mechanical loading (TCML) with varying loading parameters such as chewing force (amount, frequency), thermal loading, lateral jaw motion, abutment material, artificial periodontium or antagonistic denture. To investigate the influence of the abutment material, human teeth, polymer abutments and alloy abutments were used. Two different TCML devices with pneumatic or weight loading were compared. FPDs without aging were used as a control.

RESULTS AND SIGNIFICANCE

Combined thermal and mechanical loading significantly reduced the FPD fracture resistance from 1832N to 410N. Duplication of chewing frequency, phase load increase or additional lateral movement did not effect the results. Increasing chewing force, artificial periodontium, and antagonist or abutment material reduced the fracture resistance of the tested FPDs. Different devices with weight or pneumatic loading had no significant influence on the loading capacity of the FPDs. Artificial aging should be performed combining thermal cycling with mechanical loading. Simulation of the artificial periodontium, human antagonists and abutments should be included to achieve a significant aging.

Pedestrian lower limb injury criteria evaluation: a finite element approach

OBJECTIVE

In pedestrian traumas, lower limb injuries occur under lateral shearing and bending at the knee joint level. One way to improve injury mechanisms description and consequently knee joint safety is to evaluate the ultimate shearing and bending levels at which ligaments start being injured.

METHODS

As such data cannot easily and accurately be recorded clinically or during experiments, we show in this article how numerical simulation can be used to estimate such thresholds. This work was performed with the Lower Limb Model for Safety (LLMS) in pure lateral bending and shearing conditions, with an extended range of impact velocities.

RESULTS

One result concerns the ultimate knee lateral bending angle and shearing displacement measurements for potential failure of ligaments (posterior cruciate, medial collateral, anterior cruciates and tibial collateral). They were evaluated to be close to 16 degrees and 15 mm, respectively.

CONCLUSION

The lower leg model used in this study is an advanced FE model of the lower limb, validated under various situations. Its accurate anatomical description allows a wide range of applications. According to the validity domain of the model, it offered a valuable tool for the numerical evaluation of potential injuries and the definition of injury risk criterion for knee joint.

Composite veneering of metal based fixed partial dentures

The aim of this in vitro study was to determine the thermal mechanical properties of veneering composites after polymerization with the appropriate polymerization device. Fracture tests were performed to investigate the effect on fixed partial dentures (FPDs). Dynamic mechanical thermal analysis was used to determine the temperature-dependent mechanical properties. To approximate the clinical situation, the fracture resistance of three-unit metal-based FPDs with different composite veneering was investigated after a simulated 5-year oral wearing period. The restorations were made of a high gold alloy and veneered with three different composites. To determine the influence of fabrication, one composite was used in a light-polymerizing and a heat/pressure-curing version and, in addition, a newly developed heat protection paste was used. After a 5-year simulation period, the fracture resistance was determined. The storage modulus varied between 14268 N mm(-2) (Belleglass) and 6616 N mm(-2) (Sinfony). Adoro showed no significant differences between light curing (9155 N mm(-2)) and heat curing (8184 N mm(-2)) variations. The Adoro-veneering with the heat protection paste showed the highest median fracture strength (1700 N), followed by Adoro LC (1555 N), Belleglass (1051 N), Adoro HP (1150 N) and Sinfony (909 N). The most common failure type occurring in all FPDs was a cracking of the composite, exposing the metal framework. All FPDs showed stress cracking of the composite. The heat protection paste seemed to reduce the crack formation after fabrication and increased the fracture resistance of the composite veneering. Stress cracking after thermal cycling and mechanical loading affected all composites, but all veneered three-unit alloy FPDs showed a fracture resistance sufficient for posterior application.

Electron beam irradiation of denture base materials

Electron beam irradiation can be used to influence the properties of polymers. It was the aim of this study to investigate whether PMMA denture base materials can benefit from irradiation in order to have increased fracture toughness, work of fracture or hardness. Rectangular specimens of heat-and auto-curing denture base materials were electron beam irradiated (post-cured) with 25, 100 and 200 kGy using an electron acceleration of 10 MeV or 4.5 MeV respectively. Fracture toughness, work of fracture, Vickers hardness and colour changes were measured and compared with not-irradiated specimens. The toughness, work of fracture and hardness increased using 10 MeV with a dose of 25 kGy and with 100 kGy using 4.5 MeV. However, the clinical use may not benefit from the observed small changes. Higher dosage (200 kGy) decreased the values significantly. The colour changes reached a level which was found to be not clinically acceptable.

CONCLUSION

PMMA denture base materials do not benefit from post-curing with electron beam irradiation.

Genomic analysis distinguishes Mycobacterium africanum

Mycobacterium africanum is thought to comprise a unique species within the Mycobacterium tuberculosis complex. M. africanum has traditionally been identified by phenotypic criteria, occupying an intermediate position between M. tuberculosis and M. bovis according to biochemical characteristics. Although M. africanum isolates present near-identical sequence homology to other species of the M. tuberculosis complex, several studies have uncovered large genomic regions variably deleted from certain M. africanum isolates. To further investigate the genomic characteristics of organisms characterized as M. africanum, the DNA content of 12 isolates was interrogated by using Affymetrix GeneChip. Analysis revealed genomic regions of M. tuberculosis deleted from all isolates of putative diagnostic and biological consequence. The distribution of deleted sequences suggests that M. africanum subtype II isolates are situated among strains of "modern" M. tuberculosis. In contrast, other M. africanum isolates (subtype I) constitute two distinct evolutionary branches within the M. tuberculosis complex. To test for an association between deleted sequences and biochemical attributes used for speciation, a phenotypically diverse panel of "M. africanum-like" isolates from Guinea-Bissau was tested for these deletions. These isolates clustered together within one of the M. africanum subtype I branches, irrespective of phenotype. These results indicate that convergent biochemical profiles can be independently obtained for M. tuberculosis complex members, challenging the traditional approach to M. tuberculosis complex speciation. Furthermore, the genomic results suggest a rational framework for defining M. africanum and provide tools to accurately assess its prevalence in clinical specimens.

Genomic characterization of an endemic Mycobacterium tuberculosis strain: evolutionary and epidemiologic implications

In a study of 302 Mycobacterium tuberculosis clinical isolates from the low-incidence Canadian-born population of Quebec, we characterized a large endemic strain family by using genomic deletions. The DS6(Quebec) deleted region (11.4 kb) defined a strain family of 143 isolates encompassing two subgroups: one characterized by pyrazinamide (PZA) susceptibility and the other marked by a PZA-monoresistant phenotype. A second deletion (8 bp) in the pncA gene was shared by all 76 isolates with the PZA resistance phenotype, whereas a third DRv0961 deletion (970 bp) defined a further subset of 15 isolates. From their deletion profiles, we derived a most parsimonious evolutionary scenario and compared multiple standard genotyping modalities (using IS6110 restriction fragment length polymorphism [RFLP], spoligotyping, and mycobacterial interspersed repetitive units [MIRU]) across the deletion-based subgroups. The use of a single genotyping modality yielded an unexpectedly high proportion of clustered isolates for a high IS6110 copy strain (27% by IS6110 RFLP, 61% by MIRU, and 77% by spoligotyping). By combining all three modalities, only 14% were genotypically clustered overall, a result more congruent with the epidemiologic profile of reactivation tuberculosis, as suggested by the older age (mean age, 60 years), rural setting, and low proportion of epidemiologic links. These results provide insight into the evolution of genotypes in endemic strains and the potential for false clustering in molecular epidemiologic studies.

In vitro fracture resistance and marginal adaptation of metallic and tooth-coloured post systems

The aim of this in vitro study was to compare the fracture resistance and marginal adaptation of all-ceramic incisor crowns with all-ceramic posts, glass-fibre-reinforced posts and titanium posts as well as a control without any post. Three groups of eight maxillary incisors were restored with an all-ceramic post, a fibre-reinforced composite (FRC) post, a titanium post and a further group was restored without posts. Composite cores were provided and all-ceramic crowns were adhesively luted. After artificial ageing, the fracture resistance of the restored teeth was determined. The marginal adaptation of the restorations at the interfaces between cement-tooth and cement-crown was evaluated with scanning electron microscopy using replica specimen before and after ageing. The restored teeth without posts [270N (235/335)] showed no significantly different fracture strength compared with teeth with the titanium system [340N (310/445)]. The all-ceramic posts [580N (425/820)] and the FRC posts [505N (500/610)] both provided a significant higher fracture resistance than the teeth without posts. Prior to ageing, all materials showed <5% separation at the margins cement-tooth or cement-crown ('marginal gap'). After ageing, the interfaces of all systems deteriorated to values between 6 and 14% marginal gap. The greatest marginal gap was found with the titanium system (14%) at the interface cement-crown and with the all-ceramic posts (12%) at the transition between cement-tooth. Regarding fracture resistance and the marginal adaptation, the all-ceramic and FRC posts may be considered as an alternative to the commonly used titanium post restorations.

Prevention of Laboratory-Acquired Brucellosis

Brucellosis is one of the most common laboratory-acquired infections, mostly because aerosolization is a mechanism of transmission in this setting. We report an exposure to Brucella melitensis that occurred in a large microbiology laboratory and describe the strategy chosen for antibiotic prophylaxis and serological follow-up of exposed workers.

Diversity of Mycobacterium tuberculosis isolates in an immigrant population: evidence against a founder effect

Population-based studies have used DNA typing of Mycobacterium tuberculosis organisms to estimate the extent of ongoing tuberculosis transmission in various communities and to characterize associated risk factors. The finding of matched DNA "fingerprints" among isolates from an immigrant subgroup may reflect transmission in the adopted country but could also reflect limited diversity among M. tuberculosis organisms within that immigrant community. The authors sought to determine which hypothesis is more likely to explain the high frequency of matched isolates among Haitian-born tuberculosis patients in Montreal, Quebec, Canada. The authors determined the number of different bacterial genotypes in this community as compared with other foreign-born tuberculosis patients and applied a recently described measure of genetic similarity between M. tuberculosis organisms ("genetic distance"). Among 76 Haitian-born tuberculosis patients diagnosed during 1996-1998, the authors identified 47 distinct genotypes on the basis of standard IS6110 DNA typing and categorical analysis. In genetic distance analysis, these 47 genotypes showed as great a genetic diversity as that observed among the 191 distinct genotypes identified in 216 other foreign-born tuberculosis patients. A mycobacterial "founder effect" is unlikely to account for the high proportion of shared isolates among Haitian-born Montrealers. Recent transmission remains the most likely explanation.

Marginal adaptation in dentin of a self-adhesive universal resin cement compared with well-tried systems

OBJECTIVES

This study compares the marginal adaptation of a new self-adhesive universal resin cement with only one application step, to the marginal adaptation of established cements and their corresponding adhesive systems.

METHODS

All-ceramic crowns were inserted on human molars using a new self-adhesive universal resin cement without and with one pre-treatment step, a resin cement with a smear-layer removing and a compomer cement with a smear-layer dissolving adhesive system. After simulation of five years oral stress, the marginal adaptation was evaluated by dye penetration and scanning electronic microscope analysis using the replica technique.

RESULTS

Scanning electron microscopy: all investigated luting agents showed comparable amounts of 'perfect margin' ranging between 88-98% (median). Dye penetration: the self-adhesive system had significantly lower dye penetration (18-25%, median).

SIGNIFICANCE

The results indicate that a self-adhesive universal resin cement without pre-treatment can provide a marginal adaptation at dentin which is comparable to established luting agents.

Marginal adaptation and fracture resistance of adhesively luted glass fibre-composite reinforced molar crowns with different inner crown surfaces

OBJECTIVES

This study compared the influence of different inner crown surfaces on the fracture resistance and marginal adaptation of adhesively fixed glass fibre-reinforced molar crowns.

MATERIALS AND METHODS

Vectris/Targis crowns were constructed with an inner framework of glass fibres (directly on the tooth) or an inner veneering composite layer between the fibre-framework and the tooth-substance. Both groups were sandblasted inside using Al(2)O(3); 50 microm grain size (200 kPa, 20 s) and silane coated. A control group had the inner fibre framework, but was neither sandblasted nor silane coated. The crowns were adhesively cemented on extracted human teeth, and thermally cycled and mechanically loaded (TCML: 6000 x 5 degrees C/55 degrees C; 1.2 x 10(6) x 50 N, 1.66 Hz). The marginal adaptation before and after TCML was evaluated and the fracture resistance was investigated using a Zwick universal testing machine.

RESULTS

After TCML the proportion of 'perfect margin' of the control group decreased significantly at the interface crown/cement. For the variations with an inner fibre framework or inner composite layer the marginal adaptation or fracture resistance did not decrease significantly after ageing. The fracture resistance values were control: 1509N+/-486; inner fibre framework: 1896N+/-342; inner composite layer: 1754N+/-340.

CONCLUSIONS

In the case of the investigated fibre framework and veneering composite, the inner surface of glass fibre-reinforced molar crowns can be covered with a composite layer or with a glass fibre framework. Both methods achieve comparable high fracture strengths and reliable marginal adaptation.

Fracture resistance of fiber-reinforced vs. non-fiber-reinforced composite molar crowns

This study compared fracture resistance of fiber-reinforced and non-fiber-reinforced composite molar crowns under simulated oral stress conditions. Three groups of fiber-reinforced composite crowns were constructed using one polyethylene fiber (belleGlass/Connect) and two glass fiber reinforcement systems (Sculpture/FiberKor, Targis/Vectris). The non-fiber-reinforced crowns based on the facing material alone: Sculpture, Targis or belleGlass. Additionally, crowns were made of the non-reinforced composite Artglass. Each group consisted of eight crowns. All crowns were luted to human molars and exposed to thermal cycling and mechanical loading (6000 x 5 degrees C/55 degrees C; 1.2 x 10(6x)50 N; 1.66 Hz). The fracture resistance was measured using a Zwick universal testing machine.

RESULTS

The non-reinforced Artglass crowns demonstrated the highest fracture resistance, significantly higher than the resistance shown with belleGlass, belleGlass/Connect or Targis. Artglass showed an extremely wide distribution of values, however. No statistically significant differences were found between the reinforced and non-reinforced composite crowns of Vectris/Targis, FiberKor/Sculpture or Connect/belleGlass although the reinforced crowns showed a tendency towards higher values. The fracture resistance values scattered markedly more for the reinforced crowns, and their lowest fracture values also reached the level of the lowest non-reinforced crowns. The small distribution of fracture values for the non-reinforced crowns indicates that they will be less susceptible for manufacturing faults and more reliable under clinical conditions.

CONCLUSIONS

RESULTS of this study suggest that single molar composite crowns (tested in this study) do not benefit from fiber-reinforcement.

Fixed partial dentures: all-ceramics, fibre-reinforced composites and experimental systems

The aim of this in vitro study was to compare the fracture strength of three-unit FPDs (fixed partial dentures) and three-unit inlay FPDs after a simulated 5-year oral wearing period. The restorations were made of a pressable all-ceramic (Empress 2) and two specially designed, experimentally fixed partial dentures combining ceramics with dental composite. Three-unit FPDs and inlay FPDs were manufactured and were adhesively luted onto human molars. After thermal cycling and mechanical loading in an artificial environment, the fracture strength was determined. Zircon-based milled ceramic (Lava) three-unit FPDs were used as a control. The zircon ceramic and the fibre-based ceramic three-unit FPDs showed median fracture values between 1000 and 1400 N. For composite veneered zircon FPDs a fracture strength of about 800 N and for all-ceramic Empress 2 of about 350 N could be determined. The results for the inlay FPDs were between 1300 N and 1400 N for FRC/ceramic, 1000 N for zircon/composite and 500 N for all-ceramic restorations. The all-ceramic showed higher fracture resistance applied as inlay FPDs. The described hybrid techniques combining ceramics and composites could represent an interesting procedure for further investigations and, eventually, clinical implication.

A human model for road safety: from geometrical acquisition to model validation with radioss

In order to investigate injury mechanisms, and to provide directions for road safety system improvements, the HUMOS project has lead to the development of a 3D finite element model of the human body in driving position. The model geometry was obtained from a 50th percentile adult male. It includes the description of all compact and trabecular bones, ligaments, tendons, skin, muscles and internal organs. Material properties were based on literature data and specific experiments performed for the project. The validation of the HUMOS model was first achieved on isolated segments and then on the whole model in both frontal and lateral impact situations. HUMOS responses were in good agreement with the experimental data used in the model validation and offers now a wide range of applications from crash simulation, optimization of safety systems, to biomedical and ergonomics.

Helicobacter DNA in bile: correlation with hepato-biliary diseases

BACKGROUND

Helicobacter has been identified in isolated cases of hepato-biliary diseases, but its role in the pathogenesis of these conditions remains unclear.

AIM

To determine whether Helicobacter could be detected in bile obtained at endoscopic retrograde cholangiopancreatography, and to evaluate the prevalence of this infection in patients with hepato-biliary diseases.

METHODS

Bile was collected from 125 patients with various hepato-biliary diseases undergoing endoscopic retrograde cholangiopancreatography. Among them, 75 were diagnosed with biliary stones, 15 with pancreatico-biliary malignancies and four with primary sclerosing cholangitis. The detection of Helicobacter in DNA extracted from these bile samples was performed using Helicobacter genus-specific primers (capable of detecting 100-1000 organisms/mL).

RESULTS

Helicobacter was detected in all positive controls. Only three samples had polymerase chain reaction inhibitors. All remaining bile samples (122 patients with hepato-biliary diseases) were negative for Helicobacter DNA.

CONCLUSIONS

Helicobacter can be detected in bile samples using polymerase chain reaction. This infection, however, was not present in any of our patients diagnosed with gallstones or hepato-biliary malignancies, raising doubt as to the possible association between Helicobacter and these entities. Given the low sample size of patients with primary sclerosing cholangitis, more studies are required to determine whether an association exists with this condition.