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Umadevi K, Sundeep D, Varadharaj EK, Sastry CC, Shankaralingappa A, Chary RN, Vighnesh AR. Precision Detection of Fungal Co-Infections for Enhanced COVID-19 Treatment Strategies Using FESEM Imaging. Indian J Microbiol 2024; 64:1084-1098. [PMID: 39282206 PMCID: PMC11399527 DOI: 10.1007/s12088-024-01246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/28/2024] [Indexed: 09/18/2024] Open
Abstract
The treatment of fungal infections presents significant challenges due to the lack of standardized diagnostic procedures, a restricted range of antifungal treatments, and the risk of harmful interactions between antifungal medications and the immunosuppressive drugs used in anti-inflammatory treatment for critically ill patients with COVID-19. Mucormycosis and aspergillosis are the primary invasive fungal infections in patients with severe COVID-19, occurring singly or in combination. Histopathological examination is a vital diagnostic technique that details the presence and invasion of fungi within tissues and blood vessels, and the body's response to the infection. However, the pathology report omits information on the most common fungi associated with the observed morphology, as well as other potential fungi and parasites that ought to be included in the differential diagnosis. This research marks significance in diagnosing fungal infections, such as mucormycosis and aspergillosis associated to COVID-19 by field emission scanning electron microscopy (FESEM) imaging to examine unstained histopathology slides, allowing for a detailed morphological analysis of the fungus. FESEM provides an unprecedented resolution and detail, surpassing traditional Hematoxylin & Eosin (H&E) and Grocott's Methenamine Silver (GMS) staining methods in identifying and differentiating dual fungal infections and diverse fungal species. The findings underscore the critical need for individualized treatment plans for patients severely affected by COVID-19 and compounded by secondary fungal infections. The high-magnification micrographs reveal specific fungal morphology and reproductive patterns. Current treatment protocols largely depend on broad-spectrum antifungal therapies. However this FESEM guided diagnostic approach can help in targeted patient specific anti fungal therapies. Such precision could lead to more effective early interventions, addressing the complex management required for severe COVID-19 cases with coexisting fungal infections. This approach significantly advances disease management and patient recovery, advocating for personalized, precision medicine in tackling this multifaceted clinical challenge. Graphical Abstract
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Affiliation(s)
- Kovuri Umadevi
- Department of Pathology, Government Medical College and Hospital, Khaleelwadi, Nizamabad, Telangana 503001 India
| | - Dola Sundeep
- Biomedical Research Laboratory, Department of Electronics and Communication Engineering, Indian Institute of Information Technology Design and Manufacturing, Jagannathagattu Hill, Kurnool, Andhra Pradesh 518008 India
| | - Eswaramoorthy K Varadharaj
- Biomedical Research Laboratory, Department of Electronics and Communication Engineering, Indian Institute of Information Technology Design and Manufacturing, Jagannathagattu Hill, Kurnool, Andhra Pradesh 518008 India
| | - Chebbiyam Chandrasekhara Sastry
- Biomedical Research Laboratory, Department of Mechanical Engineering, Indian Institute of Information Technology Design and Manufacturing, Jagannathagattu Hill, Kurnool, Andhra Pradesh 518008 India
| | | | - Rajarikam Nagarjuna Chary
- Department of Pathology, Government Medical College and Hospital, Khaleelwadi, Nizamabad, Telangana 503001 India
| | - Alluru Raghavendra Vighnesh
- Department of Mechanical Engineering, Indian Institute of Technology (IIT-BHU), Varanasi, Uttar Pradesh 221005 India
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2
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Fokter SK, Ledinek Ž, Kljaić Dujić M, Novak I. Extreme Serum Titanium Concentration Induced by Acetabular Cup Failure: Unveiling a Unique Scenario of Titanium Alloy Debris Accumulation. Bioengineering (Basel) 2024; 11:235. [PMID: 38534509 DOI: 10.3390/bioengineering11030235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
The majority of contemporary total hip arthroplasty (THA) implants are constructed from Ti alloys, which are generally believed to generate fewer adverse local tissue reactions (ALTRs) compared to CoCr alloys. This study presents a case of unusual primary THA failure where a substantial release of Ti alloy debris was observed. A 52-year-old active male underwent THA after post-traumatic aseptic necrosis of the femoral head in 2006. Seventeen years after the procedure, the patient presented with groin pain and a restricted range of motion. X-rays revealed the protrusion of the alumina ceramic head through the Ti6Al4V acetabular cup. Trace element analysis indicated significantly elevated levels of serum Ti, Al, and V. CT and MRI confirmed Ti alloy cup failure and a severe ALTR. During revision surgery, it was found that the worn-out ceramic head was in direct contact with the acetabular cup, having protruded through a central hole it had created over time. No acetabular liner was found. Histological analysis of his tissue samples showed wear-induced synovitis with areas of multinucleated foreign body giant cells and the accumulation of numerous metal particles but no acute inflammatory response. Six months after the revision THA, the patient has experienced favourable outcomes. This case provides an instructive illustration for studying the consequences of the substantial release of Ti alloy debris from orthopedic implants.
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Affiliation(s)
- Samo K Fokter
- Clinical Department of Orthopedic Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Slomškov trg 15, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia
| | - Živa Ledinek
- Department of Pathology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Milka Kljaić Dujić
- Department of Radiology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Igor Novak
- Clinical Department of Orthopedic Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
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3
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Kasai T, Hirai S, Furukawa Y, Misumi K, Takeda T, Goto Y, Takanobu K, Yoneyama K, Yamano S, Senoh H, Umeda Y. Lung carcinogenicity by whole body inhalation exposure to Anatase-type Nano-titanium Dioxide in rats. J Toxicol Sci 2024; 49:359-383. [PMID: 39098045 DOI: 10.2131/jts.49.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
To investigate the carcinogenicity of anatase-type nano-titanium dioxide (aNTiO2), F344/DuCrlCrlj rats were exposed to aNTiO2 aerosol at concentrations of 0, 0.5, 2, and 8 mg/m3. The rats were divided into 2 groups: carcinogenicity study groups were exposed for two years, and satellite study groups were exposed for one year followed by recovery for 1 day, 26 weeks, and 52 weeks after the end of exposure. In the carcinogenicity groups, bronchiolo-alveolar carcinomas were observed in two 8 mg/m3-exposed males, showing an increasing trend by Peto's test. However, this incidence was at the upper limit of JBRC's historical control data. Bronchiolo-alveolar adenomas were observed in 1, 2, 3, and 4 rats of the 0, 0.5, 2, and 8 mg/m3-exposed females and were not statistically significant. However, the incidence in the 8 mg/m3-exposed females exceeded JBRC's historical control data. Therefore, we conclude there is equivocal evidence for the carcinogenicity of aNTiO2 in rats. No lung tumors were observed in the satellite groups. Particle-induced non-neoplastic lesions (alveolar epithelial hyperplasia and focal fibrosis) were observed in exposed males and females in both the carcinogenicity and satellite groups. Increased lung weight and neutrophils of bronchoalveolar lavage fluid were observed in the 8 mg/m3-exposed carcinogenicity groups. The aNTiO2 deposited in the lungs of the satellite group rats was decreased at 26 weeks after the end of exposure compared to 1 day after the end of exposure. At 52 weeks after the end of exposure, the decreased level was the same at 26 weeks after the end of exposure.
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Affiliation(s)
- Tatsuya Kasai
- Japan Bioassay Research Center (JBRC), Japan Organization of Occupational Health and Safety
| | - Shigeyuki Hirai
- Japan Bioassay Research Center (JBRC), Japan Organization of Occupational Health and Safety
| | - Yuske Furukawa
- Japan Bioassay Research Center (JBRC), Japan Organization of Occupational Health and Safety
| | - Kyouhei Misumi
- Japan Bioassay Research Center (JBRC), Japan Organization of Occupational Health and Safety
| | - Tomoki Takeda
- Japan Bioassay Research Center (JBRC), Japan Organization of Occupational Health and Safety
| | - Yuko Goto
- Japan Bioassay Research Center (JBRC), Japan Organization of Occupational Health and Safety
| | - Kenji Takanobu
- Japan Bioassay Research Center (JBRC), Japan Organization of Occupational Health and Safety
| | - Kengo Yoneyama
- Japan Bioassay Research Center (JBRC), Japan Organization of Occupational Health and Safety
| | - Shotaro Yamano
- Japan Bioassay Research Center (JBRC), Japan Organization of Occupational Health and Safety
| | - Hideki Senoh
- Japan Bioassay Research Center (JBRC), Japan Organization of Occupational Health and Safety
| | - Yumi Umeda
- Japan Bioassay Research Center (JBRC), Japan Organization of Occupational Health and Safety
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4
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Matos AL, Pacheco V, Lopes R, Cardoso JC, Carvalho L, Rustemeyer T, Gonçalo M. Inflammatory lung pseudotumor possibly related to titanium hypersensitivity. Contact Dermatitis 2023; 88:419-422. [PMID: 36775858 DOI: 10.1111/cod.14292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/14/2023]
Affiliation(s)
- Ana Luísa Matos
- Dermatology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - Vânia Pacheco
- Occupational Medicine Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - Rita Lopes
- Thoracic Surgery Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - José Carlos Cardoso
- Dermatology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - Lina Carvalho
- Pathology Department, Coimbra University Hospital Center, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Thomas Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Margarida Gonçalo
- Dermatology Department, Coimbra University Hospital Center, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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5
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Yamano S, Goto Y, Takeda T, Hirai S, Furukawa Y, Kikuchi Y, Kasai T, Misumi K, Suzuki M, Takanobu K, Senoh H, Saito M, Kondo H, Umeda Y. Pulmonary dust foci as rat pneumoconiosis lesion induced by titanium dioxide nanoparticles in 13-week inhalation study. Part Fibre Toxicol 2022; 19:58. [PMID: 36100920 PMCID: PMC9472424 DOI: 10.1186/s12989-022-00498-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background Most toxicological studies on titanium dioxide (TiO2) particles to date have concentrated on carcinogenicity and acute toxicity, with few studies focusing of pneumoconiosis, which is a variety of airspace and interstitial lung diseases caused by particle-laden macrophages. The present study examined rat pulmonary lesions associated with pneumoconiosis after inhalation exposure to TiO2 nanoparticles (NPs). Methods Male and female F344 rats were exposed to 6.3, 12.5, 25, or 50 mg/m3 anatase type TiO2 NPs for 6 h/day, 5 days/week for 13 weeks using a whole-body inhalation exposure system. After the last exposure the rats were euthanized and blood, bronchoalveolar lavage fluid, and all tissues including lungs and mediastinal lymph nodes were collected and subjected to biological and histopathological analyses. Results Numerous milky white spots were present in the lungs after exposure to 25 and 50 mg/m3 TiO2 NPs. Histopathological analysis revealed that the spots were alveolar lesions, characterized predominantly by the agglomeration of particle-laden macrophages and the presence of reactive alveolar epithelial type 2 cell (AEC2) hyperplasia. We defined this characteristic lesion as pulmonary dust foci (PDF). The PDF is an inflammatory niche, with decreased vascular endothelial cells in the interstitium, and proliferating AEC2 transformed into alveolar epithelial progenitor cells. In the present study, the AEC2 in the PDF had acquired DNA damage. Based on PDF induction, the lowest observed adverse effect concentration for pulmonary disorders in male and female rats was 12.5 mg/m3 and 6.3 mg/m3, respectively. The no observed adverse effect concentration for male rats was 6.3 mg/m3. There was a sex difference in lung lesion development, with females showing more pronounced lesion parameters than males. Conclusions Inhalation exposure to TiO2 NPs caused PDF, an air-space lesion which is an alveolar inflammatory niche containing particle-laden macrophages and proliferating AEC2. These PDFs histopathologically resemble some pneumoconiosis lesions (pulmonary siderosis and hard metal pneumoconiosis) in workers and lung disease in smokers, suggesting that PDFs caused by exposure to TiO2 NPs in rats are an early pneumoconiosis lesion and may be a common alveolar reaction in mammals. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12989-022-00498-3.
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Racovita AD. Titanium Dioxide: Structure, Impact, and Toxicity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095681. [PMID: 35565075 PMCID: PMC9104107 DOI: 10.3390/ijerph19095681] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 12/27/2022]
Abstract
Titanium dioxide, first manufactured a century ago, is significant in industry due to its chemical inertness, low cost, and availability. The white mineral has a wide range of applications in photocatalysis, in the pharmaceutical industry, and in food processing sectors. Its practical uses stem from its dual feature to act as both a semiconductor and light scatterer. Optical performance is therefore of relevance in understanding how titanium dioxide impacts these industries. Recent breakthroughs are summarised herein, focusing on whether restructuring the surface properties of titanium dioxide either enhances or inhibits its reactivity, depending on the required application. Its recent exposure as a potential carcinogen to humans has been linked to controversies around titanium dioxide's toxicity; this is discussed by illustrating discrepancies between experimental protocols of toxicity assays and their results. In all, it is important to review the latest achievements in fast-growing industries where titanium dioxide prevails, while keeping in mind insights into its disputed toxicity.
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Affiliation(s)
- Anca Diana Racovita
- Department of Chemistry, Faculty of Science, University of Warwick, Coventry CV4 7AL, UK
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7
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Gilbert JD, Neubauer K, Byard RW. Macroscopic identification of visceral titanium pigment in an intravenous drug user. J Forensic Sci 2021; 66:2024-2028. [PMID: 34117775 DOI: 10.1111/1556-4029.14779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/15/2021] [Accepted: 05/20/2021] [Indexed: 12/27/2022]
Abstract
Autopsy findings in intravenous drug addicts are quite variable and may involve a number of organ systems. Reports of the macroscopic identification at autopsy of components of tablets that have been crushed and injected are, however, exceedingly rare. The case of 34-year-old man who died of zolpidem toxicity on a background of pulmonary hypertension attributed to intravenous injections of crushed tablets is described. A very unusual finding was very fine white stippling on the cut surfaces of both the liver and spleen which was shown on energy-dispersive x-ray spectroscopy (EDS) to be titanium dioxide most likely from the coating of the zolpidem tablets. This case is significant in demonstrating titanium dioxide accumulation within organs at both macroscopic and microscopic levels, with confirmation of exposure by EDS analysis. The clinical significance of exposure to such high levels of titanium dioxide is unclear.
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Affiliation(s)
| | - Ken Neubauer
- Adelaide Microscopy, The University of Adelaide, Adelaide, SA, Australia
| | - Roger W Byard
- Forensic Science SA, Adelaide, SA, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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8
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Analysis using the finite element method of a novel modular system of additively manufactured osteofixation plates for mandibular fractures - A preclinical study. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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9
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Markowska-Szczupak A, Endo-Kimura M, Paszkiewicz O, Kowalska E. Are Titania Photocatalysts and Titanium Implants Safe? Review on the Toxicity of Titanium Compounds. NANOMATERIALS 2020; 10:nano10102065. [PMID: 33086609 PMCID: PMC7603142 DOI: 10.3390/nano10102065] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022]
Abstract
Titanium and its compounds are broadly used in both industrial and domestic products, including jet engines, missiles, prostheses, implants, pigments, cosmetics, food, and photocatalysts for environmental purification and solar energy conversion. Although titanium/titania-containing materials are usually safe for human, animals and environment, increasing concerns on their negative impacts have been postulated. Accordingly, this review covers current knowledge on the toxicity of titania and titanium, in which the behaviour, bioavailability, mechanisms of action, and environmental impacts have been discussed in detail, considering both light and dark conditions. Consequently, the following conclusions have been drawn: (i) titania photocatalysts rarely cause health and environmental problems; (ii) despite the lack of proof, the possible carcinogenicity of titania powders to humans is considered by some authorities; (iii) titanium alloys, commonly applied as implant materials, possess a relatively low health risk; (iv) titania microparticles are less toxic than nanoparticles, independent of the means of exposure; (v) excessive accumulation of titanium in the environment cannot be ignored; (vi) titanium/titania-containing products should be clearly marked with health warning labels, especially for pregnant women and young children; (vi) a key knowledge gap is the lack of comprehensive data about the environmental content and the influence of titania/titanium on biodiversity and the ecological functioning of terrestrial and aquatic ecosystems.
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Affiliation(s)
- Agata Markowska-Szczupak
- Department of Chemical and Process Engineering, West Pomeranian University of Technology in Szczecin, Al. Piastów 42, 71-065 Szczecin, Poland;
- Correspondence: (A.M.-S.); (E.K.)
| | - Maya Endo-Kimura
- Institute for Catalysis, Hokkaido University, N21, W10, Sapporo 001-0021, Japan;
| | - Oliwia Paszkiewicz
- Department of Chemical and Process Engineering, West Pomeranian University of Technology in Szczecin, Al. Piastów 42, 71-065 Szczecin, Poland;
| | - Ewa Kowalska
- Institute for Catalysis, Hokkaido University, N21, W10, Sapporo 001-0021, Japan;
- Correspondence: (A.M.-S.); (E.K.)
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10
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Swiatkowska I, Martin N, Hart AJ. Blood titanium level as a biomarker of orthopaedic implant wear. J Trace Elem Med Biol 2019; 53:120-128. [PMID: 30910194 DOI: 10.1016/j.jtemb.2019.02.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/18/2019] [Accepted: 02/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Joint replacement implants are usually manufactured from cobalt-chromium or titanium alloys. After the device is implanted, wear and corrosion generate metal particles and ions, which are released into local tissue and blood. The metal debris can cause a range of adverse local and systemic effects in patients. RESEARCH PROBLEM In the case of cobalt and chromium, a blood level exceeding 7 μg L-1 indicates potential for local toxicity, and a failing implant. It has been repeatedly suggested in the literature that measurement of titanium could also be used to assess implant function. Despite an increasing interest in this biomarker, and growing use of titanium in orthopaedics, it is unclear what blood concentrations should raise concerns. This is partly due to the technical challenges involved in the measurement of titanium in biological samples. AIM This Review summarises blood/serum titanium levels associated with well-functioning and malfunctioning prostheses, so that the prospects of using titanium measurements to gain insights into implant performance can be evaluated. CONCLUSION Due to inter-laboratory analytical differences, reliable conclusions regarding "normal" and "abnormal" titanium levels in patients with orthopaedic implants are difficult to draw. Diagnosis of symptomatic patients should be based on radiographic evidence combined with blood/serum metal levels.
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Affiliation(s)
- Ilona Swiatkowska
- Institute of Orthopaedics and Musculoskeletal Science, University College London, HA7 4LP, Stanmore, UK.
| | - Nicholas Martin
- Trace Element Laboratory, Clinical Biochemistry, Charing Cross Hospital, W6 8RF, London, UK
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, HA7 4LP, Stanmore, UK; Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
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11
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Pierini G, Fini M, Giavaresi G, Dallari S, Brayda Bruno M, Rocca M, Nicoli Aldini N, Giardino R. Atomic Absorption Spectrophotometry (AAS) for the Evaluation of Metallosis in Prostheses and Artificial Organs: A New Approach. Int J Artif Organs 2018. [DOI: 10.1177/039139889902200712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To study the presence of metals in body fluids and tissues after implantation of metallic biomaterials and possible related diseases, a new approach in Atomic Absorption Spectrophotometry (AAS) was developed. This technique was compared to three traditional methods: mineralisation with acid digestion (method A) also known as “wet method”, dry ashing (with or without oxygen) (method B); classic Kjeldaal (method C). The new approach (method D) modifies the mineralisation phase and the instrument operating instructions. Al, Na, Cr, K, Ni, Co, Ti, Fe, Hg, Pb, V, Sb and Cu levels were tested with the four methods on bone, muscle, cartilage, skin, brain, lymph nodes, blood, urine, and hair. Test results were checked by the addition method. Results demonstrated a significantly higher percentage of Al, Cr, Ni, Ti and Hg recovery with the new approach. The advantages of method D are no residue, no redox reaction, insignificant loss of analytes and enhanced sensitivity (at ppb level vs ppm of the other methods). This approach should be considered especially when testing heavy metals and complex matrices. Its disadvantages are that it is more time consuming and requires the presence of an operator.
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Affiliation(s)
- G. Pierini
- Forensic Medicine Department, University of Bologna, Bologna
| | - M. Fini
- Experimental Surgery, Research Institute Codivilla-Putti, Rizzoli Orthopaedic Institutes, Bologna
| | - G. Giavaresi
- Experimental Surgery, Research Institute Codivilla-Putti, Rizzoli Orthopaedic Institutes, Bologna
| | - S. Dallari
- Forensic Medicine Department, University of Bologna, Bologna
| | | | - M. Rocca
- Experimental Surgery, Research Institute Codivilla-Putti, Rizzoli Orthopaedic Institutes, Bologna
| | - N. Nicoli Aldini
- Experimental Surgery, Research Institute Codivilla-Putti, Rizzoli Orthopaedic Institutes, Bologna
| | - R. Giardino
- Experimental Surgery, Research Institute Codivilla-Putti, Rizzoli Orthopaedic Institutes, Bologna
- Surgical Pathophysiology, Medical School, University of Bologna, Bologna - Italy
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12
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Swiatkowska I, Mosselmans JFW, Geraki T, Wyles CC, Maleszewski JJ, Henckel J, Sampson B, Potter DB, Osman I, Trousdale RT, Hart AJ. Synchrotron analysis of human organ tissue exposed to implant material. J Trace Elem Med Biol 2018; 46:128-137. [PMID: 29413102 DOI: 10.1016/j.jtemb.2017.12.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Orthopaedic implants made of cobalt-chromium alloy undergo wear and corrosion that can lead to deposition of cobalt and chromium in vital organs. Elevated cardiac tissue cobalt levels are associated with myocardial injury while chromium is a well-established genotoxin. Though metal composition of tissues surrounding hip implants has been established, few investigators attempted to characterize the metal deposits in systemic tissues of total joint arthroplasty patients. METHODS We report the first use of micro-X-ray fluorescence coupled with micro-X-ray absorption spectroscopy to probe distribution and chemical form of cobalt, chromium and titanium in postmortem samples of splenic, hepatic and cardiac tissue of patients with metal-on-polyethylene hip implants (n = 5). RESULTS Majority of the cobalt was in the 2+ oxidation state, while titanium was present exclusively as titanium dioxide, in either rutile or anatase crystal structure. Chromium was found in a range of forms including a highly oxidised, carcinogenic species (CrV/VI), which has never been identified in human tissue before. CONCLUSIONS Carcinogenic forms of chromium might arise in vital organs of total joint arthroplasty patients. Further studies are warranted with patients with metal-on-metal implants, which tend to have an increased release of cobalt and chromium compared to metal-on-polyethylene hips.
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Affiliation(s)
- Ilona Swiatkowska
- Institute of Orthopaedics and Musculoskeletal Science, University College London, HA7 4LP Stanmore, UK.
| | - J Fred W Mosselmans
- Diamond Light Source, Harwell Science and Innovation Campus, OX11 0DE Didcot, UK
| | - Tina Geraki
- Diamond Light Source, Harwell Science and Innovation Campus, OX11 0DE Didcot, UK
| | - Cody C Wyles
- Mayo Clinic, 200 1st Street SW, Rochester, MN, USA
| | | | - Johann Henckel
- Royal National Orthopaedic Hospital, HA7 4LP Stanmore, UK
| | - Barry Sampson
- Trace Element Laboratory, Department of Clinical Chemistry, Charing Cross Hospital, Imperial College NHS Healthcare Trust, W6 8RF London, UK
| | - Dominic B Potter
- Departament of Chemistry, University College London, WC1H 0AJ London, UK
| | - Ibtisam Osman
- Trace Element Laboratory, Department of Clinical Chemistry, Charing Cross Hospital, Imperial College NHS Healthcare Trust, W6 8RF London, UK
| | | | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, HA7 4LP Stanmore, UK; Royal National Orthopaedic Hospital, HA7 4LP Stanmore, UK
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13
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Borghi SM, Mizokami SS, Pinho-Ribeiro FA, Fattori V, Crespigio J, Clemente-Napimoga JT, Napimoga MH, Pitol DL, Issa JPM, Fukada SY, Casagrande R, Verri WA. The flavonoid quercetin inhibits titanium dioxide (TiO 2)-induced chronic arthritis in mice. J Nutr Biochem 2017; 53:81-95. [PMID: 29197723 DOI: 10.1016/j.jnutbio.2017.10.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 05/31/2017] [Accepted: 10/16/2017] [Indexed: 01/14/2023]
Abstract
Titanium dioxide (TiO2) is a common component of orthopedic prosthesis. However, prosthesis wear releases TiO2, which induces inflammation and osteolysis in peri-prosthetic tissues. Quercetin is a flavonoid widely present in human diet, which presents biological activities such as antinociceptive, anti-inflammatory and antioxidant effects. Therefore, the effect of intraperitoneal treatment with quercetin in TiO2-induced arthritis model was evaluated. In the first set of experiments, mice received injection of TiO2 (0.1-3 mg/knee joint) and articular mechanical hyperalgesia, edema and histopathology analysis were performed in a 30 days protocol. The dose of 3 mg of TiO2 showed the most harmful effect, and was chosen to the following experiments. Subsequently, mice received 3 mg of TiO2 followed by post-treatment with quercetin during 30 days. Quercetin (10-100 mg/kg) inhibited in a dose-dependent manner TiO2-induced knee joint mechanical hyperalgesia, edema and leukocyte recruitment and did not induce damage in major organs such as liver, kidney and stomach. The dose of 30 mg/kg was chosen for the subsequent analysis, and reduced histopathological changes such as leukocyte infiltration, vascular proliferation and synovial hyperplasia (pannus formation) on day 30 after TiO2 challenge. The protective analgesic and anti-inflammatory mechanisms of quercetin included the inhibition of TiO2-induced neutrophil and macrophage recruitment, proteoglycan degradation, oxidative stress, cytokine production (TNF-α, IL-1β, IL-6, and IL-10), COX-2 mRNA expression, and bone resorption as well as activation of Nrf2/HO-1 signaling pathway. These results demonstrate the potential therapeutic applicability of the dietary flavonoid quercetin to reduce pain and inflammatory damages associated with prosthesis wear process-induced arthritis.
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Affiliation(s)
- Sergio M Borghi
- Department of Pathology, Center of Biological Sciences, State University of Londrina, 86057-970, Londrina, Paraná, Brazil
| | - Sandra S Mizokami
- Department of Pathology, Center of Biological Sciences, State University of Londrina, 86057-970, Londrina, Paraná, Brazil
| | - Felipe A Pinho-Ribeiro
- Department of Pathology, Center of Biological Sciences, State University of Londrina, 86057-970, Londrina, Paraná, Brazil
| | - Victor Fattori
- Department of Pathology, Center of Biological Sciences, State University of Londrina, 86057-970, Londrina, Paraná, Brazil
| | - Jefferson Crespigio
- Department of Pathology, Center of Biological Sciences, State University of Londrina, 86057-970, Londrina, Paraná, Brazil
| | - Juliana T Clemente-Napimoga
- Laboratory of Immunology and Molecular Biology, São Leopoldo Mandic Institute and Research Center, 13045-755, Campinas, São Paulo, Brazil
| | - Marcelo H Napimoga
- Laboratory of Immunology and Molecular Biology, São Leopoldo Mandic Institute and Research Center, 13045-755, Campinas, São Paulo, Brazil
| | - Dimitrius L Pitol
- Department of Morphology, Physiology and Basic Pathology, School of Dentistry, University of São Paulo, 14040-903, Ribeirão Preto, São Paulo, Brazil
| | - João P M Issa
- Department of Morphology, Physiology and Basic Pathology, School of Dentistry, University of São Paulo, 14040-903, Ribeirão Preto, São Paulo, Brazil
| | - Sandra Y Fukada
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, 14040-903, Ribeirão Preto, São Paulo, Brazil
| | - Rubia Casagrande
- Department of Pharmaceutical Sciences, University Hospital (Health Science Centre), Londrina State University, 86038-350, Londrina, Paraná, Brazil
| | - Waldiceu A Verri
- Department of Pathology, Center of Biological Sciences, State University of Londrina, 86057-970, Londrina, Paraná, Brazil.
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Rahman L, Wu D, Johnston M, William A, Halappanavar S. Toxicogenomics analysis of mouse lung responses following exposure to titanium dioxide nanomaterials reveal their disease potential at high doses. Mutagenesis 2016; 32:59-76. [PMID: 27760801 PMCID: PMC5180171 DOI: 10.1093/mutage/gew048] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Titanium dioxide nanoparticles (TiO2NPs) induce lung inflammation in experimental animals. In this study, we conducted a comprehensive toxicogenomic analysis of lung responses in mice exposed to six individual TiO2NPs exhibiting different sizes (8, 20 and 300nm), crystalline structure (anatase, rutile or anatase/rutile) and surface modifications (hydrophobic or hydrophilic) to investigate whether the mechanisms leading to TiO2NP-induced lung inflammation are property specific. A detailed histopathological analysis was conducted to investigate the long-term disease implications of acute exposure to TiO2NPs. C57BL/6 mice were exposed to 18, 54, 162 or 486 µg of TiO2NPs/mouse via single intratracheal instillation. Controls were exposed to dispersion medium only. Bronchoalveolar lavage fluid (BALF) and lung tissue were sampled on 1, 28 and 90 days post-exposure. Although all TiO2NPs induced lung inflammation as measured by the neutrophil influx in BALF, rutile-type TiO2NPs induced higher inflammation with the hydrophilic rutile TiO2NP showing the maximum increase. Accordingly, the rutile TiO2NPs induced higher number of differentially expressed genes. Histopathological analysis of lung sections on Day 90 post-exposure showed increased collagen staining and fibrosis-like changes following exposure to the rutile TiO2NPs at the highest dose tested. Among the anatase, the smallest TiO2NP of 8nm showed the maximum response. The anatase TiO2NP of 300nm was the least responsive of all. The results suggest that the severity of lung inflammation is property specific; however, the underlying mechanisms (genes and pathways perturbed) leading to inflammation were the same for all particle types. While the particle size clearly influenced the overall acute lung responses, a combination of small size, crystalline structure and hydrophilic surface contributed to the long-term pathological effects observed at the highest dose (486 µg/mouse). Although the dose at which the pathological changes were observed is considered physiologically high, the study highlights the disease potential of certain TiO2NPs of specific properties.
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Affiliation(s)
- Luna Rahman
- Environmental Health Science and Research Bureau, Health Canada, Tunney's Pasture Bldg. 8, Ottawa, Ontario K1A 0K9, Canada and
| | - Dongmei Wu
- Environmental Health Science and Research Bureau, Health Canada, Tunney's Pasture Bldg. 8, Ottawa, Ontario K1A 0K9, Canada and
| | - Michael Johnston
- Centre for Biologics Evaluation, Biologics and Genetic Therapies Directorate, Health Canada, Ottawa, Ontario K1A 0K9, Canada
| | - Andrew William
- Environmental Health Science and Research Bureau, Health Canada, Tunney's Pasture Bldg. 8, Ottawa, Ontario K1A 0K9, Canada and
| | - Sabina Halappanavar
- Environmental Health Science and Research Bureau, Health Canada, Tunney's Pasture Bldg. 8, Ottawa, Ontario K1A 0K9, Canada and
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Abstract
A large list of foreign substances may penetrate the skin and induce a foreign body granulomatous reaction. These particles can enter the skin by voluntary reasons or be caused by accidental inclusion of external substances secondary to cutaneous trauma. In these cases, foreign body granulomas are formed around such disparate substances as starch, cactus bristles, wood splinters, suture material, pencil lead, artificial hair, or insect mouthparts. The purpose of this article is to update dermatologists, pathologists, and other physicians on the most recent etiopathogenesis, clinical presentations, systemic associations, evaluation, and evidence-based management concerning foreign body granulomatous reactions of skin.
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Affiliation(s)
- Ana M Molina-Ruiz
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avda. Reyes Católicos 2, Madrid 28040, Spain.
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avda. Reyes Católicos 2, Madrid 28040, Spain
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Abstract
: The cutaneous deposition disorders are a group of unrelated conditions characterized by the accumulation of either endogenous or exogenous substances within the skin. These cutaneous deposits are substances that are not normal constituents of the skin and are laid down usually in the dermis, but also in the subcutis, in a variety of different circumstances. There are 5 broad categories of cutaneous deposits. The first group includes calcium salts, bone, and cartilage. The second category includes the hyaline deposits that may be seen in the dermis in several metabolic disorders, such as amyloidosis, gout, porphyria, and lipoid proteinosis. The third category includes various pigments, heavy metals, and complex drug pigments. The fourth category, cutaneous implants, includes substances that are inserted into the skin for cosmetic purposes. The fifth category includes miscellaneous substances, such as oxalate crystals and fiberglass. In this article, the authors review the clinicopathologic characteristics of cutaneous deposition diseases, classify the different types of cutaneous deposits, and identify all the histopathologic features that may assist in diagnosing the origin of a cutaneous deposit.
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Park JY, Shin DH, Choi JS, Kim KH. Metallic discoloration on the right shin caused by titanium alloy prostheses in a patient with right total knee replacement. Ann Dermatol 2013; 25:356-9. [PMID: 24003281 PMCID: PMC3756203 DOI: 10.5021/ad.2013.25.3.356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/29/2011] [Accepted: 09/05/2011] [Indexed: 11/16/2022] Open
Abstract
The differential diagnosis of bluish-gray pigmentation of the skin includes dermal melanocytosis, malignant melanoma and metallic discoloration. Of these disorders, metallic discoloration, which develops from deposits of fine metallic particles on the skin, is an uncommon dermatologic disease. We report a case of metallic discoloration of the right shin caused by titanium alloy prostheses in a patient with right total knee replacement. The patient had bluish-gray pigmentation on her right shin as well as pain while walking. Histopathologic findings of the skin lesion showed abundant black particles in the perivascular area of the lower dermis. Polarizing microscopy revealed refractile foreign materials in the dermis. An energy dispersive X-ray spectrophotometer unit attached to a transmission electron microscope detected titanium and aluminium peaks in the specimen.
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Affiliation(s)
- Jeong Young Park
- Department of Dermatology, College of Medicine, Yeungnam University, Daegu, Korea
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Meslemani D, Kellman RM. Recent advances in fixation of the craniomaxillofacial skeleton. Curr Opin Otolaryngol Head Neck Surg 2012; 20:304-9. [DOI: 10.1097/moo.0b013e3283543a9d] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mittal G, Dubbudu RR, Cariappa KM. Three dimensional titanium mini plates in oral & maxillofacial surgery: a prospective clinical trial. J Maxillofac Oral Surg 2012; 11:152-9. [PMID: 23730061 PMCID: PMC3386418 DOI: 10.1007/s12663-011-0267-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 07/19/2011] [Indexed: 10/17/2022] Open
Abstract
AIM The purpose of the study was to evaluate the efficacy of three dimensional titanium miniplates as treatment modality for the stabilization of the fractured or osteotomized bone fragments in maxillofacial region. PATIENTS AND METHODS 24 patients with maxillofacial trauma and one patient who underwent orthognathic surgery constituted the sample of the study. All the patients with maxillofacial injuries required open reduction internal fixation of the fractures and the orthognathic surgery patient required stabilization of the osteotomized segments. CONCLUSIONS Three dimensional plates provide good stability of bone fragments due to closed quadrangular geometric shape, and the ease of contouring and adapting. Because of better inter fragmentary stability; supplemental fixation is not necessary, thereby enhancing the overall comfort, convenience and well being of the patient.
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Affiliation(s)
- Gaurav Mittal
- Department of Dentistry, VCSGGMSRI, Pauri Garhwal, Srinagar, Uttarakhand India
| | | | - K. M. Cariappa
- Department Of Oral & Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Karnataka India
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Gilardino MS, Chen E, Bartlett SP. Choice of internal rigid fixation materials in the treatment of facial fractures. Craniomaxillofac Trauma Reconstr 2011; 2:49-60. [PMID: 22110797 DOI: 10.1055/s-0029-1202591] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Evaluation of Metal Concentrations in Hair and Nail After Orthognathic Surgery. J Craniofac Surg 2011; 22:68-72. [DOI: 10.1097/scs.0b013e3181f6c456] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Buchalska M, Kras G, Oszajca M, Łasocha W, Macyk W. Singlet oxygen generation in the presence of titanium dioxide materials used as sunscreens in suntan lotions. J Photochem Photobiol A Chem 2010. [DOI: 10.1016/j.jphotochem.2010.05.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Egusa H, Ko N, Shimazu T, Yatani H. Suspected association of an allergic reaction with titanium dental implants: a clinical report. J Prosthet Dent 2009; 100:344-7. [PMID: 18992567 DOI: 10.1016/s0022-3913(08)60233-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent reports have questioned whether metal sensitivity may occur after exposure to titanium. This clinical report demonstrates the emergence of facial eczema in association with a titanium dental implant placed for a mandibular overdenture supported by 2 implants. Complete remission was achieved by the removal of the titanium material. This clinical report raises the possibility that in rare circumstances, for some patients, the use of titanium dental implants may induce an allergic reaction.
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Affiliation(s)
- Hiroshi Egusa
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka, Japan
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Piozzi R, Ribeiro DA, Padovan LEM, Filho HN, Matsumoto MA. Genotoxicity and cytotoxicity in multiple organs induced by titanium miniplates in Wistar rats. J Biomed Mater Res A 2009; 88:342-7. [DOI: 10.1002/jbm.a.31876] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Olmedo D, Duffó G, Cabrini R, Guglielmotti M. Local effect of titanium implant corrosion: an experimental study in rats. Int J Oral Maxillofac Surg 2008; 37:1032-8. [DOI: 10.1016/j.ijom.2008.05.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2007] [Revised: 12/28/2007] [Accepted: 05/21/2008] [Indexed: 10/21/2022]
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Blake DM, Maness PC, Huang Z, Wolfrum EJ, Huang J, Jacoby WA. Application of the Photocatalytic Chemistry of Titanium Dioxide to Disinfection and the Killing of Cancer Cells. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/03602549909351643] [Citation(s) in RCA: 336] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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30
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Inorganic and organic UV filters: Their role and efficacy in sunscreens and suncare products. Inorganica Chim Acta 2007. [DOI: 10.1016/j.ica.2005.12.057] [Citation(s) in RCA: 451] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Flatebø RS, Johannessen AC, Grønningsaeter AG, Bøe OE, Gjerdet NR, Grung B, Leknes KN. Host Response to Titanium Dental Implant Placement Evaluated in a Human Oral Model. J Periodontol 2006; 77:1201-10. [PMID: 16805683 DOI: 10.1902/jop.2006.050406] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recent reports have questioned if metal sensitivity may arise from exposure to titanium. The objective of this study was to histologically evaluate non-perforated mucosa covering submerged maxillary titanium implants with regard to induced tissue reactions. METHODS Thirteen patients, 21 to 69 years of age, without previous implants were included. After initial examination, the bone crest areas destined for dental implant placement were exposed, and threaded external hex dental implants were inserted. Prior to wound closure, a full mucosal tissue slice was biopsied from the edge of the mucoperiosteal flap (baseline). The patients were monitored monthly for 6 months. At the abutment connection, biopsies were taken by a 6-mm punch, altogether yielding 26 specimens. Tissue reactions were analyzed by coded histometric analysis at four defined areas at increasing distance from the oral epithelium, including ratios of inflammatory cells (IC)/epithelial cells, IC/fibroblasts, and number of dense particles. RESULTS The stained sections portrayed gingival tissue with intact oral epithelium and connective tissue with variable accumulation of IC. Experimental biopsies demonstrated mineralized areas and dense particles of different sizes. Analysis of variance revealed a higher IC/fibroblast ratio for level 3 at baseline compared to level 3 at 6 months (P<0.01). Furthermore, a significant decrease in IC/fibroblast ratio was observed between levels 2 and 3 and 2 and 4 at 6 months (P<0.001). The connective tissue level facing the cover screw contained the highest number of dense particles (P<0.01). CONCLUSIONS Tissue sensitivity reactions to titanium implants were not disclosed. All 6-month biopsies contained dense particles that were most likely metals.
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Affiliation(s)
- Rigmor S Flatebø
- Department of Oral Sciences - Periodontology, Faculty of Dentistry, University of Bergen, Bergen, and Department of Oral and Maxillofacial Surgery, Stavanger University Hospital, Stavanger, Norway
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Serpone N, Salinaro A, Horikoshi S, Hidaka H. Beneficial effects of photo-inactive titanium dioxide specimens on plasmid DNA, human cells and yeast cells exposed to UVA/UVB simulated sunlight. J Photochem Photobiol A Chem 2006. [DOI: 10.1016/j.jphotochem.2005.08.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zaffe D, Bertoldi C, Consolo U. Element release from titanium devices used in oral and maxillofacial surgery. Biomaterials 2003; 24:1093-9. [PMID: 12504532 DOI: 10.1016/s0142-9612(02)00424-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Optical microscopy, scanning electron microscopy and X-ray microanalysis (EDS system) were used on c.p. titanium devices (21 grids and 10 plates) removed from 28 patients without signs of inflammation 6-24 months after surgery. Plates, grids and surrounding tissue were investigated to evaluate the titanium release and accumulation. Titanium was only present in the interfacial bone, probably due to fretting, and in all fibrous tissue surrounding the devices. Titanium content followed a decreasing gradient extending from the device surface and was not detected at a distance greater than 1mm. High titanium levels were found in blood cells in the connective tissue. In conclusion, titanium release from the devices stops only after bone is laid down on the titanium surfaces. Titanium release does not seem to interfere with the osteogenic process but perhaps may interact with it.
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Affiliation(s)
- Davide Zaffe
- Department of Anatomy and Histology, Section of Human Anatomy, University of Modena and, Reggio Emilia, Italy.
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Levine KE, Fernando RA, Lang M, Essader A, Wong BA. Development and Validation of a High- Throughput Method for the Determination of Titanium Dioxide in Rodent Lung and Lung-Associated Lymph Node Tissues. ANAL LETT 2003. [DOI: 10.1081/al-120018244] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hirai H, Okumura A, Goto M, Katsuki T. Histologic study of the bone adjacent to titanium bone screws used for mandibular fracture treatment. J Oral Maxillofac Surg 2001; 59:531-7; discussion 537-8. [PMID: 11326378 DOI: 10.1053/joms.2001.22686] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Titanium miniplates have been widely used in mandibular fracture fixation because of their strength and excellent biocompatibility. However, the condition of the bone adjacent to titanium bone screws has not been clarified. This study histologically examined the bone-screw interface in patients treated for mandibular fractures. PATIENTS AND MATERIALS Specimens were obtained from 14 patients, and the undecalcified sections were stained by the toluidine blue and Levai Laczko methods and examined with light microscopy. The mean ratio of direct contact between the bone and the titanium bone screw surface was also analyzed using a computer-aided image analyzer. RESULTS The formation of new bone was observed around the titanium bone screws in all cases. In areas of cortical bone, partial interposition of soft tissues was rarely observed. However, in areas of cancellous bone, partial interposition of soft tissues was seen, and bone resorption between the bone and soft tissues was noted. The mean ratio of direct contact between all of the adjacent bone and the surface of the titanium bone screws was 64.4%. The mean ratio of direct contact between cortical bone and the titanium bone screws was 82.4%. Black particles were observed in the bone and soft tissues around the titanium bone screws, and multinuclear giant cells resembling macrophages were observed near these particles. CONCLUSION Titanium bone screws used for mandibular fracture fixation develop almost complete contact with new bone. Some metalosis is present.
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Affiliation(s)
- H Hirai
- Department of Oral and Maxillofacial Surgery, Saga Medical School, 5-1-1 Nabeshima, Saga 849-8501, Japan
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Shanklin DR, Stevens MV, Hall MF, Smalley DL. Environmental immunogens and T-cell-mediated responses in fibromyalgia: evidence for immune dysregulation and determinants of granuloma formation. Exp Mol Pathol 2000; 69:102-18. [PMID: 11001860 DOI: 10.1006/exmp.2000.2322] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Thirty-nine patients with fibromyalgia syndrome (FMS) according to American College of Rheumatology criteria were studied for cell-mediated sensitivity to environmental chemicals. Lymphocytes were tested by standard [(3)H]thymidine incorporation in vitro for T cell memory to 11 chemical substances. Concanavalin A (Con A) was used to demonstrate T cell proliferation. Controls were 25 contemporaneous healthy adults and 252 other concurrent standard controls without any aspect of FMS. Significantly higher (P < 0.01) stimulation indexes (SI) were found in FMS for aluminum, lead, and platinum; borderline higher (0.05 > P > 0.02) SI were found for cadmium and silicon. FMS patients showed sporadic responses to the specific substances tested, with no high-frequency result (>50%) and no obvious pattern. Mitogenic responses to Con A indicated some suppression of T cell functionality in FMS. Possible links between mitogenicity and immunogenic T cell proliferation, certain electrochemical specifics of granuloma formation, maintenance of connective tissue, and the fundamental nature of FMS are considered.
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Affiliation(s)
- D R Shanklin
- Department of Pathology, University of Tennessee, Memphis, Tennessee 38163, USA
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Acero J, Calderon J, Salmeron JI, Verdaguer JJ, Concejo C, Somacarrera ML. The behaviour of titanium as a biomaterial: microscopy study of plates and surrounding tissues in facial osteosynthesis. J Craniomaxillofac Surg 1999; 27:117-23. [PMID: 10342150 DOI: 10.1016/s1010-5182(99)80025-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Titanium has become the biomaterial of choice for facial osteosynthesis. Titanium is considered a highly biocompatible and corrosion resistant material, although the ultrastructural behaviour of titanium in human tissues after bone fixation is not well documented. A prospective scanning electron microscopy study was carried out on 37 commercially pure titanium miniplates which were removed from 23 patients who had undergone surgery for maxillofacial trauma or deformity. Twenty two cases were used as a control group. Implant-bone specimens were excised using tungsten burs and studied with a scanning electron microscope (Jeol JSM-T-300). Findings at the bone-titanium interface were analyzed, as well as the presence of contaminating bodies on the specimen surface. Biopsies were also obtained from the soft tissues adjacent to 20 miniplates, then sectioned and stained with Haematoxilin-Eosin for histological evaluation by light microscopy. The results showed good ultrastructural osseointegration of the osteosynthesis material in most cases (81.8%). Mobility was found upon removal in 80% of plates which showed clinical complications. A significant correlation was found between the degree of microscopical osseointegration and macroscopic fixation of the plate. Microscopical contamination was found in 100% of the nine plates with intraoral exposure, while only 36% of the 22 miniplates of the control group had contaminating elements (P < 0.001). Thirty-five point one percent of the plates showed hole-like substance loss images, whose size ranged from 10-25 mu. Light microscopy showed granular deposits in soft tissues surrounding the plates in 80% of the 20 specimens investigated. Our findings suggest a higher development of corrosion in titanium than previously reported. These findings are not correlated, however with the clinical complications.
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Affiliation(s)
- J Acero
- Department of Maxillofacial Surgery, Gregorio Marañón University Hospital, Madrid, Spain
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Affiliation(s)
- G M Murphy
- Department of Photobiology, Beaumont and Mater Hospitals, Dublin, Ireland
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Dunford R, Salinaro A, Cai L, Serpone N, Horikoshi S, Hidaka H, Knowland J. Chemical oxidation and DNA damage catalysed by inorganic sunscreen ingredients. FEBS Lett 1997; 418:87-90. [PMID: 9414101 DOI: 10.1016/s0014-5793(97)01356-2] [Citation(s) in RCA: 413] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Titanium dioxide (TiO2) has been noted (US Federal Register, 43FR38206, 25 August 1978) to be a safe physical sunscreen because it reflects and scatters UVB and UVA in sunlight. However, TiO2 absorbs about 70% of incident UV, and in aqueous environments this leads to the generation of hydroxyl radicals which can initiate oxidations. Using chemical methods, we show that all sunscreen TiO2 samples tested catalyse the photo-oxidation of a representative organic substrate (phenol). We also show that sunlight-illuminated TiO2 catalyses DNA damage both in vitro and in human cells. These results may be relevant to the overall effects of sunscreens.
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Affiliation(s)
- R Dunford
- University of Oxford, Department of Biochemistry, UK
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Rubin JP, Yaremchuk MJ. Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg 1997; 100:1336-53. [PMID: 9326803 DOI: 10.1097/00006534-199710000-00043] [Citation(s) in RCA: 201] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The use of implantable biomaterials has become an integral part of aesthetic and reconstructive surgery of the face. Metals are used for fracture fixation devices, whereas polymers are used primarily for bone or soft-tissue substitution. This review of the scientific literature examines the risks and complications of these materials. First, we present an overview of commonly used materials. Second, we address general considerations of toxicity relevant to all biomaterials. Third, we present data from a large number of clinical series on the incidence of complications for individual materials used in specific applications.
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Affiliation(s)
- J P Rubin
- Department of Surgery, Massachusetts General Hospital, Boston, USA
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Kim YK, Yeo HH, Lim SC. Tissue response to titanium plates: a transmitted electron microscopic study. J Oral Maxillofac Surg 1997; 55:322-6. [PMID: 9120693 DOI: 10.1016/s0278-2391(97)90115-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE This study investigated the tissue response associated with titanium plates. MATERIALS AND METHODS Titanium miniplates were used to stabilize fractured bones and a bone graft in 14 patients. At the time of plate removal, the osteosynthesis sites were carefully examined macroscopically. After the removal of the plates, biopsies of the 14 soft tissues and two bony sites surrounding the plates were performed for light microscopic and transmitted electron microscopic examination. RESULTS Macroscopically, visible pigmentation was found in the soft tissue in 14% of the patients, but none in the bone. With light microscopy, pigmentation was found in the soft tissue of 10 of 14 sites and in one of two bony sites. Transmitted electron microscopy showed suspected titanium particles in the connective tissue of all specimens. The small particles were located between the collagen fibers. In some specimens, small particles were noted within the fibroblasts and macrophages. There were degenerative changes around the minute particles in the bone matrix. CONCLUSION Local macroscopic or microscopic tissue destruction was observed in hard and soft tissue near the titanium miniplates. If the plates remain for a long time, there is a possibility that they may cause further tissue damage. These findings suggest that the titanium miniplates should be removed routinely after bone healing.
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Affiliation(s)
- Y K Kim
- Department Of Oral and Maxillofacial Surgery, College of Dentistry, Chosun University, Kwang-Ju, Korea
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Jorgenson DS, Mayer MH, Ellenbogen RG, Centeno JA, Johnson FB, Mullick FG, Manson PN. Detection of titanium in human tissues after craniofacial surgery. Plast Reconstr Surg 1997; 99:976-9; discussion 980-1. [PMID: 9091942 DOI: 10.1097/00006534-199704000-00006] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Generally, titanium fixation plates are not removed after osteosynthesis, because they have high biocompatability and high corrosion resistance characteristics. Experiments with laboratory animals, and limited studies of analyses of human tissues, have reported evidence of titanium release into local and distant tissues. This study summarizes our results of the analysis of soft tissues for titanium in four patients with titanium microfixation plates. Energy dispersive x-ray analysis, scanning electron microscopy, and electrothermal atomic absorption spectrophotometry were used to detect trace amounts of titanium in surrounding soft tissues. A single metal inclusion was detected by scanning electron microscopy and energy dispersive x-ray analysis in one patient, whereas, electrothermal atomic absorption spectrophotometry analyses revealed titanium present in three of four specimens in levels ranging from 7.92 to 31.8 micrograms/gm of dry tissue. Results from this study revealed trace amounts of titanium in tissues surrounding craniofacial plates. At the atomic level, electrothermal atomic absorption spectrophotometry appears to be a sensitive tool to quantitatively detect ultra-trace amounts of metal in human tissue.
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Affiliation(s)
- D S Jorgenson
- Division of Medicine, Walter Reed Army Institute of Research, Walter Reed Army Medical Center, Washington, D.C., USA
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Tan MH, Commens CA, Burnett L, Snitch PJ. A pilot study on the percutaneous absorption of microfine titanium dioxide from sunscreens. Australas J Dermatol 1996; 37:185-7. [PMID: 8961584 DOI: 10.1111/j.1440-0960.1996.tb01050.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Many Australians are being advised to apply microfine titanium dioxide sunscreen daily from the cradle to the grave. However, there is a surprising lack of data on the percutaneous absorption of microfine titanium dioxide. A prospective pilot study was conducted to analyse the percutaneous absorption of microfine titanium dioxide from sunscreens. Selected patients scheduled to have skin surgery, applied titanium dioxide sunscreen to the skin daily for 2-6 weeks prior to their operation. After excision, the stratum corneum of the sample was stripped and the titanium concentration of the remaining epidermis and dermis was measured by inductively coupled plasma-mass spectrometry. The results from this pilot study showed that levels of titanium in the epidermis and dermis of subjects who applied microfine titanium dioxide to their skin were higher than the levels of titanium found in controls. Studies with larger cohorts are necessary to establish if this absorption is statistically significant.
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Affiliation(s)
- M H Tan
- Department of Dermatology, Westmead Hospital, New South Wales, Australia
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Khan MA, Williams RL, Williams DF. In-vitro corrosion and wear of titanium alloys in the biological environment. Biomaterials 1996; 17:2117-26. [PMID: 8922597 DOI: 10.1016/0142-9612(96)00029-4] [Citation(s) in RCA: 254] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cyclic anodic polarization studies were undertaken for several titanium alloys of varying composition and phase structures. All materials were exposed to an accelerated corrosion test using a potentiostat and their electrochemical behaviour was analysed within a potential range of 0 to 5000 mV. The electrolyte used was a phosphate buffered saline (PBS) solution at pH = 5, 7.4 and 9. The polarization curves obtained represented both the passive and active regions of the materials and these curves were used to compare the resistance to pitting corrosion of each material. The sliding-wear of these materials was studied in both non-corrosive and corrosive environments. A simple pin-on-disc type wear apparatus was designed and built to simulate the co-joint action of corrosion and sliding-wear. Using this apparatus, it was also possible to evaluate the effect of wear-accelerated corrosion, which was also evaluated by wearing the surface of the specimens prior to corrosion. It was evident that the mixed phase alpha-beta alloys (Ti-6AI-4V and Ti-6AI-7Nb) possessed the best combination of both corrosion and wear resistance, although commercially pure titanium and the near-beta (Ti-13Nb-13Zr) and beta (Ti-15Mo) alloys displayed the best corrosion resistant properties.
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Affiliation(s)
- M A Khan
- Department of Clinical Engineering, Faculty of Medicine, University of Liverpool, UK
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Dunbar CM, Goble RR, Gregory DW, Church WC. Intraocular deposition of metallic fragments during phacoemulsification: possible causes and effects. Eye (Lond) 1995; 9 ( Pt 4):434-6. [PMID: 7498561 DOI: 10.1038/eye.1995.101] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We undertook a prospective slit lamp examination of 56 eyes which had undergone routine phacoemulsification, in order to determine the incidence of metallic intraocular foreign bodies. Characteristic small reflective particles were noted in 86%, with a mean of 5.1 particles per affected eye. No accompanying clinical problems were seen. The used phacoemulsification needles were examined with colour photography and scanning electron microscopy. A characteristic pattern of wear was observed, corresponding to an area under the plastic irrigating sleeve rather than at the tip. This suggests cavitation erosion rather than instrument contacts as the cause. Titanium alloy contains 6% aluminium, 4% vanadium and 0.25% iron. All its constituents may corrode and leach from the surface of the metal when in contact with body fluids and have been implicated in numerous adverse biological processes.
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Affiliation(s)
- C M Dunbar
- Department of Ophthalmology, Aberdeen Royal Infirmary, UK
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Titanium dioxide (rutile) particle uptake from the rat GI tract and translocation to systemic organs after oral administration. Int J Pharm 1994. [DOI: 10.1016/0378-5173(94)90461-8] [Citation(s) in RCA: 145] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Rosenberg A, Grätz KW, Sailer HF. Should titanium miniplates be removed after bone healing is complete? Int J Oral Maxillofac Surg 1993; 22:185-8. [PMID: 8340633 DOI: 10.1016/s0901-5027(05)80249-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A prospective study of 32 patients was performed to analyze black pigmentation in the soft tissue covering titanium miniplates. This soft tissue was compared with the soft tissue covering Champy stainless steel plates. All plates were removed 8 months after application. Macroscopically visible pigmentation was found in 25.6% of the soft tissue covering titanium miniplates and in none of the soft tissue covering Champy stainless steel plates. Microscopically visible pigmentation was found in 71.8% of the soft tissue covering titanium miniplates and in 65.3% of the soft tissue covering Champy stainless steel plates. Energy-dispersive x-ray analysis of the soft tissue covering titanium miniplates revealed only the presence of titanium dioxide. In the soft tissue near Champy stainless steel plates, chromium, nickel, iron, and molybdenum were found. Electron microscopy showed titanium dioxide to be mainly deposited between the collagen fibers, whereas stainless steel particles were mainly found in giant cells.
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Affiliation(s)
- A Rosenberg
- Department of Maxillo-Facial Surgery, University of Zurich, Switzerland
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Onodera K, Ooya K, Kawamura H. Titanium lymph node pigmentation in the reconstruction plate system of a mandibular bone defect. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 75:495-7. [PMID: 8464615 DOI: 10.1016/0030-4220(93)90177-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A case of titanium pigmentation that involved a submandibular lymph node is reported. A 41-year old man had been treated for ameloblastoma by partial resection of the mandible followed by reconstruction with the use of a titanium plate to bridge the mandibular defect. Titanium pigmentation occurred in the surrounding soft tissue adjacent to the plate and within a submandibular lymph node 2 years after reconstruction.
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Affiliation(s)
- K Onodera
- Department of Oral Pathology, Tohoku University School of Dentistry, Sendai, Japan
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Keen CE, Philip G, Brady K, Spencer JD, Levison DA. Histopathological and microanalytical study of zirconium dioxide and barium sulphate in bone cement. J Clin Pathol 1992; 45:984-9. [PMID: 1452794 PMCID: PMC495029 DOI: 10.1136/jcp.45.11.984] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS To report the appearances of zirconium dioxide and barium sulphate in interface membranes, synovium, and other tissues around joint prostheses. METHODS Histological sections from 23 specimens were reviewed by light microscopy and polarisation. Scanning electron microscopy and x ray microanalysis were performed on routinely processed paraffin wax sections. RESULTS Polyethylene, metals, and polymethylmethacrylate cement debris were easily recognisable. Almost all the cement remnants contained either zirconium dioxide or barium sulphate, confirmed by microanalysis. The contrast media had characteristic light microscopic appearances. Zirconium was identified in macrophages away from cement remnants. CONCLUSION The presence of radiographic contrast media in tissues around prosthetic joints is common but not widely recognised.
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Affiliation(s)
- C E Keen
- Department of Histopathology, United Medical School, London
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