3D Printing onto Textiles: A Systematic Analysis of the Adhesion Studies

The article reviews the literature focused on investigating the adhesion strength between the 3D-printed polymers and the textile substrates, and its dependence on different factors related to materials, printing parameters, and fabrics type and structure. 3D printing (3DP) onto textiles is a domain in expansion as it allows developing products with new functionalities by gathering the advantages of design freedom, tailor-fit, comfort, variety, and mass customization provided by both the textiles and the additive manufacturing technology. In this context, it becomes important to document and understand how the adherence of different 3D-printed molten polymer to diverse textiles substrates can be improved for obtaining products more resistant to specific conditions, such as washing, wear, or ironing. Following a systematic search of electronic databases, 28 articles were selected for the full-text read and data extraction. The summarized information was grouped per 3DP material and analyzed factors, and then discussed in terms of variables influencing the adherence, including pretreatments and post-treatments applied to fabrics or 3D-printed onto fabrics specimens and objects. A case study of a customized polylactic acid-cotton-elastane wrist-hand orthosis is also presented to exemplify the modality in which the information synthetized in this review can be used in the development process of a new product.

Pain Management in Pediatric Burns: A Review of the Science behind It

Pediatric burns are a significant medical issue that can have long-term effects on various aspects of a child's health and well-being. Pain management in pediatric burns is a crucial aspect of treatment to ensure the comfort and well-being of young patients. The causes and risk factors for pediatric burns vary depending on various factors, such as geographical location, socioeconomic status, and cultural practices. Assessing pain in pediatric patients, especially during burn injury treatment, poses several challenges. These challenges stem from various factors, including the age and developmental stage of the child, the nature of burn injuries, and the limitations of pain assessment tools. In pediatric pain management, various pain assessment tools and scales are used to evaluate and measure pain in children. These tools are designed to account for the unique challenges of assessing pain in pediatric patients, including their age, developmental stage, and ability to communicate effectively. Pain can have significant physical, emotional, and psychological consequences for pediatric patients. It can interfere with their ability to engage in daily activities, disrupt sleep patterns, and negatively affect their mood and behavior. Untreated pain can also lead to increased stress, anxiety, and fear, which can further exacerbate the pain experience. Acute pain, which is short-term and typically associated with injury or illness, can disrupt a child's ability to engage in physical activities and impede their overall recovery process. On the other hand, chronic pain, which persists for an extended period, can have long-lasting effects on physical functioning and quality of life in children. The psychological consequences of burns can persist long after the physical wounds have healed, leading to ongoing emotional distress and impaired functioning. Multimodal pain management, which involves the use of multiple interventions or medications targeting different aspects of the pain pathway, has gained recognition as an effective approach for managing pain in both children and adults. However, it is important to consider the specific needs and considerations of pediatric patients when developing evidence-based guidelines for multimodal pain management in this population. Over the years, there have been significant advances in pediatric pain research and technology, leading to a better understanding of pain mechanisms and the development of innovative approaches to assess and treat pain in children. Overall, pain management in pediatric burns requires a multidisciplinary approach that combines pharmacologic and nonpharmacologic interventions.

Investigations on the Fatigue Behavior of 3D-Printed and Thermoformed Polylactic Acid Wrist-Hand Orthoses

Additively manufactured wrist-hand orthoses (3DP-WHOs) offer several advantages over traditional splints and casts, but their development based on a patient's 3D scans currently requires advanced engineering skills, while also recording long manufacturing times as they are commonly built in a vertical position. A proposed alternative involves 3D printing the orthoses as a flat model base and then thermoforming them to fit the patient's forearm. This manufacturing approach is faster, cost-effective and allows easier integration of flexible sensors as an example. However, it is unknown whether these flat-shaped 3DP-WHOs offer similar mechanical resistance as the 3D-printed hand-shaped orthoses, with a lack of research in this area being revealed by the literature review. To evaluate the mechanical properties of 3DP-WHOs produced using the two approaches, three-point bending tests and flexural fatigue tests were conducted. The results showed that both types of orthoses had similar stiffness up to 50 N, but the vertically built orthoses failed at a maximum load of 120 N, while the thermoformed orthoses could withstand up to 300 N with no damages observed. The integrity of the thermoformed orthoses was maintained after 2000 cycles at 0.5 Hz and ±2.5 mm displacement. It was observed that the minimum force occurring during fatigue tests was approximately -95 N. After 1100-1200 cycles, it reached -110 N and remained constant. The outcomes of this study are expected to enhance the trust that hand therapists, orthopedists, and patients have in using thermoformable 3DP-WHOs.

Comparison of Type I and Type III Collagen Concentration between Oreochromis mossambicus and Oreochromis niloticus in Relation to Skin Scaffolding

Background and Objectives: Skin scaffolding can be done using allografts and autografts. As a biological allograft, the skin of Oreochromis niloticus (ON) has been used due to its high type I and III collagen content. Oreochromis mossambicus (OM) is also a member of the Oreochromis family, but not much is known regarding its collagen content. As such, this study aimed to assess and compare the collagen content of the two fish species. Materials and Methods: This is a crossover study comparing the skin collagen contents of the two fish. Young fish were chosen, as they tend to have higher collagen concentrations. The skin samples were sterilized in chlorhexidine and increasing glycerol solutions and analyzed histochemically with Sirius red picrate under polarized light microscopy. Results: 6 young ON and 4 OM specimens were used. Baseline type I collagen was higher for OM, but at maximum sterilization it was higher for ON, with no differences in between Type III collagen was higher for OM across all comparisons with the exception of the last stage of sterilization. Generally, collagen concentrations were higher in highly sterilized samples. Conclusions: OM skin harvested from young fish, with its greater collagen III content may be a better candidate for use as a biological skin scaffold in the treatment of burn wounds, compared to ON.

A systematic review of follow-up results of additively manufactured customized implants for the pelvic area

INTRODUCTION

While 3D printing of bone models for preoperative planning or customized surgical templating has been successfully implemented, the use of patient-specific additively manufactured (AM) implants is a newer application not yet well established. To fully evaluate the advantages and shortcomings of such implants, their follow-up results need to be evaluated.

AREA COVERED

This systematic review provides a survey of the reported follow-ups on AM implants used for oncologic reconstruction, total hip arthroplasty both primary and revision, acetabular fracture, and sacrum defects.

EXPERT OPINION

The review shows that Titanium alloy (Ti4AL6V) is the most common type of material system used due to its excellent biomechanical properties. Electron beam melting (EBM) is the predominant AM process for manufacturing implants. In almost all cases, porosity at the contact surface is implemented through the design of lattice or porous structures to enhance osseointegration. The follow-up evaluations show promising results, with only a small number of patients suffering from aseptic loosening, wear, or malalignment. The longest reported follow-up length was 120 months for acetabular cages and 96 months for acetabular cups. The AM implants have proven to serve as an excellent option to restore premorbid skeletal anatomy of the pelvis.

Cardiovascular Risk Assessment in Rheumatoid Arthritis: Accelerated Atherosclerosis, New Biomarkers, and the Effects of Biological Therapy

Rheumatoid arthritis (RA), one of the most common of the chronic inflammatory autoimmune diseases (CIADs), is recognized as an independent cardiovascular risk factor. Traditional risk factors such as smoking, arterial hypertension, dyslipidemia, insulin resistance, and obesity are frequently found in RA. Given the increased risk of mortality and morbidity associated with cardiovascular disease (CVD) in RA patients, screening for risk factors is important. Moreover, there is a need to identify potential predictors of subclinical atherosclerosis. Recent studies have shown that markers such as serum homocysteine, asymmetric dimethylarginine, or carotid intima-media thickness (cIMT) are correlated with cardiovascular risk. Although RA presents a cardiovascular risk comparable to that of diabetes, it is not managed as well in terms of acute cardiovascular events. The introduction of biological therapy has opened new perspectives in the understanding of this pathology, confirming the involvement and importance of the inflammatory markers, cytokines, and the immune system. In addition to effects in inducing remission and slowing disease progression, most biologics have demonstrated efficacy in reducing the risk of major cardiovascular events. Some studies have also been conducted in patients without RA, with similar results. However, early detection of atherosclerosis and the use of targeted therapies are the cornerstone for reducing cardiovascular risk in RA patients.

The Effects of Subjective Cognitive Decline on APOE Genotype Disclosure in the Butler Hospital Alzheimer's Prevention Registry

BACKGROUND

Subjective cognitive decline (SCD) and APOE genotyping are both instrumental in identifying high-risk individuals for Alzheimer's disease (AD) prevention trials.

OBJECTIVE

This study examined the relationship between SCD and the impact of APOE disclosure on the psychological and behavioral health of cognitively unimpaired individuals. Design/Setting/Participant: We recruited 189 trial volunteers (mean age 66, 65% female, 96% White), from the Butler Hospital Alzheimer's Prevention Registry. Participants completed screening for cognitive impairment and a psychological readiness assessment before learning their APOE genotype, and were followed for 6 months after.

RESULTS

SCD had a modest, temporary impact on mood and event-related distress following APOE disclosure, specifically on those who were ε4 carriers. The presence of SCD (SCD+) did not compound the AD genetic test-specific distress related to learning that one was an ε4 carrier. SCD also did not moderate changes in perceived AD risk, with all non-carriers showing a more rapid decrease in perceived risk over time than carriers. Counterintuitively, those without SCD (SCD-) reported taking more steps in future-directives than the SCD+ group at baseline and after disclosure, potentially suggesting that those with SCD may have subtle executive declines that limit future-oriented actions or fear-avoidance behaviors. Further, the SCD- group was more accurate in recalling their APOE status and the recall accuracy correlated with their broad knowledge about APOE as a risk gene for AD.

CONCLUSION

Our findings support the safety and tolerability of APOE disclosure in research volunteers regardless of their SCD statuses, but further studies are warranted to include diverse individuals and those pursuing testing through direct-to-consumer services outside of traditional research settings.

Myocardial Ischemia Related to Common Cancer Therapy-Prevention Insights

Modern antineoplastic therapy improves survival and quality of life in cancer patients, but its indisputable benefits are accompanied by multiple and major side effects, such as cardiovascular ones. Endothelial dysfunction, arterial spasm, intravascular thrombosis, and accelerated atherosclerosis affect the coronary arteries, leading to acute and chronic coronary syndromes that negatively interfere with the oncologic treatment. The cardiac toxicity of antineoplastic agents may be mitigated by using adequate prophylactic measures. In the absence of dedicated guidelines, our work provides the most comprehensive, systematized, structured, and up-to-date analyses of the available literature focusing on measures aiming to protect the coronary arteries from the toxicity of cancer therapy. Our work facilitates the implementation of these measures in daily practice. The ultimate goal is to offer clinicians the necessary data for a personalized therapeutic approach for cancer patients receiving evidence-based oncology treatments with potential cardiovascular toxicity.

Current Therapeutic Approach to Atrial Fibrillation in Patients with Congenital Hemophilia

Cardiovascular disease in hemophiliacs has an increasing prevalence due to the aging of this population. Hemophiliacs are perceived as having a high bleeding risk due to the coagulation factor VIII/IX deficiency, but it is currently acknowledged that they also have an important ischemic risk. The treatment of atrial fibrillation (AF) is particularly challenging since it usually requires anticoagulant treatment. The CHA2DS2-VASc score is used to estimate the risk of stroke and peripheral embolism, and along with the severity of hemophilia, guide the therapeutic strategy. Our work provides the most complete, structured, and updated analysis of the current therapeutic approach of AF in hemophiliacs, emphasizing that there is a growing interest in therapeutic strategies that allow for short-term anticoagulant therapy. Catheter ablation and left atrial appendage occlusion have proven to be efficient and safe procedures in hemophiliacs, if appropriate replacement therapy can be provided.

Osteonecrosis of the Jaws in Patients with Hereditary Thrombophilia/Hypofibrinolysis-From Pathophysiology to Therapeutic Implications

Osteonecrosis of the jaws (ONJ) usually has a clear etiology. Local infection or trauma, radiotherapy and drugs that disrupt the vascular supply or bone turnover in the jaws are its major contributors. The thrombotic occlusion of the bone’s venous outflow that occurs in individuals with hereditary thrombophilia and/or hypofibrinolysis has a less known impact on jaw health and healing capability. Our research provides the most comprehensive, up-to-date and systematized information on the prevalence and significance of hereditary thrombophilia and/or hypofibrinolysis states in ONJ. We found that hereditary prothrombotic abnormalities are common in patients with ONJ refractory to conventional medical and dental treatments. Thrombophilia traits usually coexist with hypofibrinolysis traits. We also found that frequently acquired prothrombotic abnormalities coexist with hereditary ones and enhance their negative effect on the bone. Therefore, we recommend a personalized therapeutic approach that addresses, in particular, the modifiable risk factors of ONJ. Patients will have clear benefits, as they will be relieved of persistent pain and repeated dental procedures.

Aging of 3D Printed Polymers under Sterilizing UV-C Radiation

In the context of the COVID-19 pandemic, shortwave ultraviolet radiation with wavelengths between 200 nm and 280 nm (UV-C) is seeing increased usage in the sterilization of medical equipment, appliances, and spaces due to its antimicrobial effect. During the first weeks of the pandemic, healthcare facilities experienced a shortage of personal protective equipment. This led to hospital technicians, private companies, and even members of the public to resort to 3D printing in order to produce fast, on-demand resources. This paper analyzes the effect of accelerated aging through prolonged exposure to UV-C on mechanical properties of parts 3D printed by material extrusion (MEX) from common polymers, such as polylactic acid (PLA) and polyethylene terephthalate-glycol (PETG). Samples 3D printed from these materials went through a 24-h UV-C exposure aging cycle and were then tested versus a control group for changes in mechanical properties. Both tensile and compressive strength were determined, as well as changes in material creep properties. Prolonged UV-C exposure reduced the mechanical properties of PLA by 6-8% and of PETG by over 30%. These findings are of practical importance for those interested in producing functional MEX parts intended to be sterilized using UV-C. Scanning electron microscopy (SEM) was performed in order to assess any changes in material structure.

The Effect of Disinfectants Absorption and Medical Decontamination on the Mechanical Performance of 3D-Printed ABS Parts

Producing parts by 3D printing based on the material extrusion process determines the formation of air gaps within layers even at full infill density, while external pores can appear between adjacent layers making prints permeable. For the 3D-printed medical devices, this open porosity leads to the infiltration of disinfectant solutions and body fluids, which might pose safety issues. In this context, this research purpose is threefold. It investigates which 3D printing parameter settings are able to block or reduce permeation, and it experimentally analyzes if the disinfectants and the medical decontamination procedure degrade the mechanical properties of 3D-printed parts. Then, it studies acetone surface treatment as a solution to avoid disinfectants infiltration. The absorption tests results indicate the necessity of applying post-processing operations for the reusable 3D-printed medical devices as no manufacturing settings can ensure enough protection against fluid intake. However, some parameter settings were proven to enhance the sealing, in this sense the layer thickness being the most important factor. The experimental outcomes also show a decrease in the mechanical performance of 3D-printed ABS (acrylonitrile butadiene styrene) instruments treated by acetone cold vapors and then medical decontaminated (disinfected, cleaned, and sterilized by hydrogen peroxide gas plasma sterilization) in comparison to the control prints. These results should be acknowledged when designing and 3D printing medical instruments.

Current Therapeutic Approach to Acute Myocardial Infarction in Patients with Congenital Hemophilia

Advances in the treatment of hemophilia have made the life expectancy of hemophiliacs similar to that of the general population. Physicians have begun to face age-related diseases not previously encountered in individuals with hemophilia. Treatment of acute myocardial infarction (AMI) is particularly challenging because the therapeutic strategies influence both the patient's thrombotic and hemorrhagic risk. As progress has been made in the treatment of AMI over the last decade, we performed an in-depth analysis of the available literature, highlighting the latest advances in the therapy of AMI in hemophiliacs. It is generally accepted that after the optimal substitution therapy has been provided, patients with hemophilia should be treated in the same way as those in the general population. New-generation stents that allow short dual antiplatelet therapy and potent P2Y12 receptor inhibitors have begun to be successfully used. At a time when specific recommendations and relevant data are scarce, our study provides up-to-date information to physicians involved in the treatment of AMI in hemophiliacs.

Current Knowledge of MicroRNAs (miRNAs) in Acute Coronary Syndrome (ACS): ST-Elevation Myocardial Infarction (STEMI)

Regardless of the newly diagnostic and therapeutic advances, coronary artery disease (CAD) and more explicitly, ST-elevation myocardial infarction (STEMI), remains one of the leading causes of morbidity and mortality worldwide. Thus, early and prompt diagnosis of cardiac dysfunction is pivotal in STEMI patients for a better prognosis and outcome. In recent years, microRNAs (miRNAs) gained attention as potential biomarkers in myocardial infarction (MI) and acute coronary syndromes (ACS), as they have key roles in heart development, various cardiac processes, and act as indicators of cardiac damage. In this review, we describe the current available knowledge about cardiac miRNAs and their functions, and focus mainly on their potential use as novel circulating diagnostic and prognostic biomarkers in STEMI.

Immune thrombocytopenia, severe hematological consequence in a patient with COVID-19: A case report

Since the first appearance of coronavirus disease 2019 (COVID-19), multiple studies have focused on this novel coronavirus. Within a few months, the clinical and paraclinical manifestations and the mechanisms by which these changes are induced were elaborated. Clinically, the virus mainly causes the common cold, but can also result in severe or fatal pneumonia/acute respiratory syndrome. Regarding the biological changes, similar to any other virus, it can lead to a reduced lymphocyte count. The second most common change is represented by a reduced thrombocyte count. Furthermore, most patients have blood clotting abnormalities, inflammatory syndrome, raised D-dimer and lactate dehydrogenase levels. Detection of immune thrombocytopenia in asymptomatic patients who tested positive for COVID-19 justifies the need to perform differential diagnosis and testing for COVID-19. Typically, patients with severe forms of COVID-19 develop mild thrombocytopenia, while severe thrombocytopenia is rarely reported. The aim of this case report was to present the situation in which one asymptomatic patient who tested positive for COVID-19 developed severe immune thrombocytopenia.

DICOM 3D viewers, virtual reality or 3D printing - a pilot usability study for assessing the preference of orthopedic surgeons

As standard practice in orthopedic surgery, the information gathered by analyzing Computer Tomography (CT) 2D images is used for patient diagnosis and planning surgery. Lately, these virtual slices are the input for generating 3D virtual models using DICOM viewers, facilitating spatial orientation, and diagnosis. Virtual Reality (VR) and 3D printing (3DP) technologies are also reported for use in anatomy visualization, medical training, and diagnosis. However, it has not been yet investigated whether the surgeons consider that the advantages offered by 3DP and VR outweigh their development efforts. Moreover, no comparative evaluation for understanding surgeon's preference in using these investigation tools has been performed so far. Therefore, in this paper, a pilot usability test was conducted for collecting surgeons' opinions. 3D models of knee, hip and foot were displayed using DICOM 3D viewer, two VR environments and as 3D-printed replicas. These tools adequacy for diagnosis was comparatively assessed in three cases scenarios, the time for completing the diagnosis tasks was recorded and questionnaires filled in. The time for preparing the models for VR and 3DP, the resources needed and the associated costs were presented in order to provide surgeons with the whole context. Results showed a preference in using desktop DICOM viewer with 3D capabilities along with the information provided by Unity-based VR solution for visualizing the virtual model from various angles challenging to analyze on the computer screen. 3D-printed replicas were considered more useful for physically simulating the surgery than for diagnosis. For the VR and 3DP models, the lack of information on bone quality was considered an important drawback. The following order of using the tools was preferred: DICOM viewer, followed by Unity VR and 3DP.

Osteonecrosis of the Femoral Head in Patients with Hypercoagulability-From Pathophysiology to Therapeutic Implications

Osteonecrosis of the femoral head (ONFH) is a debilitating disease with major social and economic impacts. It frequently affects relatively young adults and has a predilection for rapid progression to femoral head collapse and end-stage hip arthritis. If not diagnosed and treated properly in the early stages, ONFH has devastating consequences and leads to mandatory total hip arthroplasty. The pathophysiology of non-traumatic ONFH is very complex and not fully understood. While multiple risk factors have been associated with secondary ONFH, there are still many cases in which a clear etiology cannot be established. Recognition of the prothrombotic state as part of the etiopathogeny of primary ONFH provides an opportunity for early medical intervention, with implications for both prophylaxis and therapy aimed at slowing or stopping the progression of the disease. Hereditary thrombophilia and hypofibrinolysis are associated with thrombotic occlusion of bone vessels. Anticoagulant treatment can change the natural course of the disease and improve patients' quality of life. The present work focused on highlighting the association between hereditary thrombophilia/hypofibrinolysis states and ONFH, emphasizing the importance of identifying this condition. We have also provided strong arguments to support the efficiency and safety of anticoagulant treatment in the early stages of the disease, encouraging etiological diagnosis and prompt therapeutic intervention. In the era of direct oral anticoagulants, new therapeutic options have become available, enabling better long-term compliance.

A Review on 3D-Printed Templates for Precontouring Fixation Plates in Orthopedic Surgery

This paper is a systematic review of the literature on 3D-printed anatomical replicas used as templates for precontouring the fixation plates in orthopedic surgery. Embase, PubMed, Cochrane, Scopus and Springer databases were consulted for information on design study, fracture anatomical location, number of patients, surgical technique, virtual modeling approach and 3D printing process. The initial search provided a total of 496 records. After removing the duplicates, the title and abstract screening, and applying exclusion criteria and citations searching, 30 papers were declared eligible and included in the final synthesis. Seven studies were identified as focusing on retrospective non-randomized series of clinical cases, while two papers presented randomized case control studies. Two main approaches were highlighted in developing 3D-printed anatomical models for precontouring fixation plates: (a.) medical reconstruction, virtual planning and fracture reduction followed by 3D printing the model; (b.) medical reconstruction followed by 3D printing the model of the mirrored uninjured side. Revised studies reported advantages such as surgical time and blood loss reduction, while the reduction quality is similar with that of the conventional surgery. During the last couple of years there was an increase in the number of studies focused on precontouring orthopedic plates using 3D printing technology. Three-dimensionally-printed templates for plate precontouring were mostly used for acetabular fractures. Knowledge on medical virtual modeling and reconstruction is mandatory.

Research on New Patterns of Antimicrobial Resistant in Bacterial Pathogens Identified in Healthcare-associated Infections

Knowledge of antibiotic resistance mechanisms is absolutely necessary to successfully fight against multi-resistant bacteria, the solutions to this issue being a direct consequence of understanding the mechanisms underlying its occurrence. Considering that in Romania more than 92.3% of patients have been receiving antimicrobial prophylaxis in surgery for more than one day, and empirical therapy is very common, the increasing antibiotic resistance is an important problem. The experiments were performed at the Military Medical Research Center on the 26 multiple drug resistance (MDR) bacterial strains from health care-associated infections (HAI): Escherichia coli (3), Klebsiella spp. (4), Pseudomonas aeruginosa 10), Proteus mirabilis (1), Staphylococcus aureus (7) and Enterobacter cloacae (1). They were isolated and initially identified by the Medical Analysis Laboratory of the Dr. Al. Gafencu Emergency Military Hospital, Constanta and the Microbiology Laboratory from the Military Medical National Institute for Research and Development Cantacuzino of Bucharest. Bacterial strains were reseeded on specific culture media, and identification was based on culture, morpho-tinctorial characters and biochemical properties. Antibiotic susceptibility testing was performed by the Kirby-Bauer diffusion method, following the CLSI 2016 guidelines. The results obtained lead to the idea of reconsidering the strategy for the use of antimicrobial substances by the following actions: performing in vitro sensitivity tests, close collaboration between the clinician and microbiologist, finding additional methods for assessing the effective concentrations of the antibiotic at the level of the infections. The observed percentage of antibiotic resistance in our study was 85.72%, that being much higher than the mentioned percentage by the European Antibiotic Surveillance Report (EARS-Net) for Romania in 2013 (25-50%).

Material flow design and simulation for a glass panel recycling installation

The current paper presents the design of a glass panels recycling flow and the method used for establishing the optimal processing installation architecture. In the solution provided in the current research, a novel approach centred on applying digital twinning in the design of the requested processing architecture is presented. It involves designing the virtual prototype of the diffused processing architecture and modelling the glass waste flow as a hybrid material flow. Dedicated analysis and simulation software is then used for establishing installation architecture and the specific parameters for each processing and transport capacity. The assessment of different processing scenarios by virtual modelling and simulations can also be used for exploring options to increase productivity and profit for other different recycling architectures. The main practical value of the study consists of creating the means to improve the waste recycling of automotive windshields, float glass or construction glass panels with metallic meshes, all representing categories of waste insufficiently recycled in Romania. The simulation results of the study were validated by tests made on the glass panel recycling installation. Also, a recovery glass rate of minimum 85% of the amount of waste loaded into the recycling system was achieved, obtaining a waste recycling quantity three times higher than initially anticipated.

Rapid prototyping for patient-specific surgical orthopaedics guides: A systematic literature review

There has been a lot of hype surrounding the advantages to be gained from rapid prototyping processes in a number of fields, including medicine. Our literature review aims objectively to assess how effective patient-specific surgical guides manufactured using rapid prototyping are in a number of orthopaedic surgical applications. To this end, we carried out a systematic review to identify and analyse clinical and experimental literature studies in which rapid prototyping patient-specific surgical guides are used, focusing especially on those that entail quantifiable outcomes and, at the same time, providing details on the guides’ design and type of manufacturing process. Here, it should be mentioned that in this field there are not yet medium- or long-term data, and no information on revisions. In the reviewed studies, the reported positive opinions on the use of rapid prototyping patient-specific surgical guides relate to the following main advantages: reduction in operating times, low costs and improvements in the accuracy of surgical interventions thanks to guides’ personalisation. However, disadvantages and sources of errors which can cause patient-specific surgical guide failures are as well discussed by authors. Stereolithography is the main rapid prototyping process employed in these applications although fused deposition modelling or selective laser sintering processes can also satisfy the requirements of these applications in terms of material properties, manufacturing accuracy and construction time. Another of our findings was that individualised drill guides for spinal surgery are currently the favourite candidates for manufacture using rapid prototyping. Other emerging applications relate to complex orthopaedic surgery of the extremities: the forearm and foot. Several procedures such as osteotomies for radius malunions or tarsal coalition could become standard, thanks to the significant assistance provided by rapid prototyping patient-specific surgical guides in planning and performing such operations.

CLASIC VERSUS NOVEL IN REDUCTION OF ACUTE ANTERIOR DISLOCATION OF THE SHOULDER: A COMPARISON OF FOUR REDUCTION TECHNIQUES

AIM

The purpose of our study is to compare four different techniques for reduction shoulder dislocation in term of efficacy, duration until reduction and pain felt by patient during the procedure.

MATERIAL AND METHODS

During 2015 year, we conducted a study on 50 chronological patients with anterior shoulder dislocation. After exclusion of four patients, the remaining 46 (74% males, mean age 44.6 +/- 20.03 years, range 18 to 89) were randomly assigned in four groups and reduced by Cunningham (C), Kocher (K), Mothes (M) and Hipocrat (H) techniques. All the patients were sedated using Midazolam (2 mg) and Fentanyl (1 microg/kgbw) except patients who underwent Cunningham technique.

RESULTS

The success rate was 76.9% in C group, 98.4% in K group, 90.2% in M group and 87.96% in H group (p>0.05). The level of pain in C group was similar to the other groups in the absence of pain medication (p<0.05).

CONCLUSIONS

Cunningham technique is a simple, single person technique, drug free, less painful and safer, comparable with other "classical" methods.

MANAGEMENT OF BILATERAL FEMORAL NECK FRACTURE IN A NONAGENARIAN PATIENT--CASE REPORT

Simultaneous bilateral femoral neck fracture is rare injury. Cases with this type of fracture have been reported in the literature since the 1950s, following the introduction of electroconvulsive therapy which generates violent hip muscle contractions. In young patients' simultaneous bilateral femoral neck fracture results from high energy trauma (car accident or fall from height) in a normal bone. Pathological changes in bone structure occurring in chronic kidney disease, vitamin D deficiency, osteomalacia, osteoporosis, metabolic imbalances and administration of corticosteroids explain the occurrence of this particular type of fracture following low-energy trauma. We present the case of a 90-year-old female patient who suffered a simple fall from her own height resulting in a Garden IV bilateral femoral neck fracture. Our therapeutic option in this patient was bilateral uncemented bipolar hemiarthroplasty in a single session using a single tray of sterile surgical instruments and two sterile drapes. Postoperative outcome was very good, allowing the initiation of functional recovery on the first postoperative day. Uncemented hemiarthroplasty proved to be a good choice in such a patient in the associated diseases may trigger the risk of cardiovascular disturbances specific to bone cement implantation syndrome.

Proximalize osteotomy of tibial tuberosity (POTT) as a treatment for stiffness secondary to patella baja in total knee arthroplasty (TKA)

INTRODUCTION

Stiffness after a total knee arthroplasty (TKA) is one of the most common post-operative complications. The purpose of this study is the evaluation of the effectiveness of TT proximalization osteotomy of improving a lack of flexion and secondary pain in patella baja (infera) post-TKA.

MATERIALS AND METHODS

Between April 2007 and July 2012, TT proximalization osteotomy was performed on 21 patients. The average preoperative flexion was 70° (in a range of 60-80). Clinical pre- and post-operative evaluations were performed with Knee Society Score, Western Ontario and McMaster Universities Arthritis Index scales and a satisfaction survey. Modified Blackburn-Peel index and Portner angle were used to evaluate patellar height.

RESULTS

After an average follow-up of 35 months (range 18-48), an average flexion of 100° (range 90-100) and an overall satisfaction were obtained. Clinical scores improved significantly. The Blackburn-Peel index and Portner angle improved significantly from 0.3 (range 0.1-0.5) to 0.4 (0.3-0.5) and from 9 (3-15) to 12 (9-18), respectively. Three patients showed no signs of osteotomy consolidation. However, this was not linked to a lack of extension or an increase in local pain.

CONCLUSION

TT proximalization osteotomy provides satisfactory results in improving a lack of flexion and pain in patella baja post-TKR.

The benefits of using Sentinel WebDashboard in medicine: IT solution for monitoring and treatment of patient with liver cirrhosis

The global assessment of the evolution of a disease in a certain geographical area or a specific domain is useful in the medical research for the preparation of practice guidelines/protocols used in the hospitals. Cirrhosis is one of the most common disorders seen today, occupying a significant place in the gastrointestinal pathology. The disease is the final stage of various affections in terms of etiology and morphology. The most frequent subjects treated on this topic are those related to the etiopathology and early diagnosis. Given the current interest in this matter and considering that UGS (upper gastrointestinal bleeding) in liver cirrhosis is a common complication and potentially fatal, the medical research found some very useful conducting retrospective studies in this area. The purpose of our study was to create an IT system implemented with Sentinel WebDashboard, which could increase the medical performances in diagnosis, monitoring and treatment of a disease. We tested our solution on a medical data set containing information about the patients with liver cirrhosis. The solution facilitates the access of the physicians to the databases containing complete information about the patients, offers the possibility to monitor the evaluation of their health and also aids physicians in optimizing the medical procedures and improve the diagnostic methods. It also offers the advantages of a web application: it does not require the installation on the client side, being accessible anytime, anywhere via a web browser, laptop, Smartphone or tablet.

Low complications after minimally invasive fixation of calcaneus fracture

Calcaneus fractures are still a delicate point regarding the indication for osteosynthesis. Knowing the skin's poor vascularisation of the back foot, the purpose of this study is to present the benefits of proper surgical options between an open and invasive osteosynthesis with anatomical reduction and internal fixation or minimally invasive approach preserving the quality of the soft parts. 66 interventions that targeted reduction and internal fixation of calcaneus fractures were performed between 2009-2012, in the Orthopaedic and Traumatology Department of Bucharest Emergency University Hospital. 29 cases underwent open reduction and internal fixation with plates and screws or Kirschner wires, and 37 cases underwent a minimally invasive reduction and Essex Lopresti osteosynthesis technique. No patient who underwent a minimally invasive reduction had skin lesions, but showed pain due to osteoarthritis lesions that appeared in the subtalar joint. 4 of them, who underwent open reduction and internal fixation had postoperative wound infections and skin necrosis.

[Use of trabecular metal in total knee arthroplasty in severely and morbidly obese patients (BMI > 35 kg/m2)]

The use of trabecular metal in the tibial surface may increase prosthetic survival in the population with severe or morbid obesity (BMI > 35 kg/m2). A prospective, descriptive study was conducted of patients with a BMI > 35 kg/m2 who underwent total knee replacement with a prosthesis with trabecular metal. Minimal follow-up was two years. The statistical analysis was done with Student's t test; the Knee Society Score and the Western Ontario and McMaster Universities Osteoarthritis Index were applied preoperatively and postoperatively. The chi2 test was applied to the BMI values relating them with more or less radiolucent images. The total number of patients was 39, but three were excluded for not having the radiographic follow-up. Mean follow-up was 34 months (25-43); 35 were females, mean age was 69.4 years (57-81), mean BMI was 39.43 kg/m2 (35-55). All patients had grades 3 and 4 tricompartmental arthrosis. The KSS (R and F) and WOMAC scales, with a 95% confidence interval, showed a statistically significant improvement in the assessment of preoperative results and at the end of the followup. Only a few studies measure long-term implant survival. Most authors define survival as the absence of the need to revise prosthetic implants. The end point of survival is the removal or exchange of prosthetic components. Trabecular metal (TM) is currently used in orthopedic surgery and its clinical applications are increasing more and more with good results.

Secondary patellar resurfacing in the treatment of patellofemoral pain after total knee arthroplasty

PURPOSE

This paper reports a prospective review of patients who, between 2004 and 2007, underwent secondary patellar resurfacing (SPR) due to anterior knee pain after a primary total knee arthroplasty (TKA). The aim was to evaluate the clinical outcomes obtained with the SPR and to compare them with radiological findings.

METHODS

A total of twenty-seven consecutive patients met the inclusion criteria. There were twenty-three (85%) women and four (15%) men with a median age of 70 years. The patients were evaluated before and after the surgery with the same functional scores and radiological parameters. Bone scintigraphy was also used in the assessment, and a CT-scan was performed in order to evaluate the femoral component rotation. The median time between TKA and SPR was 18 months.

RESULTS

With a median follow-up of 23 months, seventeen patients (63%) reported a clear subjective improvement after SPR, and patellofemoral scores (primary outcome measure), KSS and WOMAC (secondary outcome measures) showed a statistically significant improvement following the procedure. There were no significant changes after SPR in the Insall-Salvati ratio, the lateral patellar displacement or the lateral patellar tilt. The mean time between TKA and SPR had no statistically significant effect on outcome. The bone scintigraphy revealed increased patellar uptake in seven cases, but this was not related to subsequent improvement after SPR. Rotational computed tomography showed a median internal rotation of the femoral component of 1º. The complications observed were a patellar component loosening and an acute post-infection.

CONCLUSION

No clinical or radiological parameter was found to be related to the final outcome after SPR. There was a discrepancy between functional scale scores and the patient's subjective satisfaction.

Resurfacing total hip replacement--a therapeutical approach in postmenopausal women with osteoporosis and hip arthrosis

AIM

Patients with incipient hip arthrosis may benefit from a relatively new therapeutical approach using resurfacing total hip replacement, but in those with associated osteoporosis, this type of surgical intervention is contraindicated, given the poor quality of osteoporotic bones. We assessed the efficacy of the antiosteoporotic pharmacological therapy to improve bone quality and bone strength in postmenopausal women diagnosed with hip arthrosis and osteoporosis thus facilitating the hip surgical intervention.

METHODS

We evaluated 20 postmenopausal women aged between 53-60 years diagnosed with osteoporosis according to the WHO criteria, by using dual-energy X-ray absorptiometry (DXA) for bone mineral density measurements. All these patients had low hip T score (osteopenia/ osteoporosis) and also incipient hip arthrosis. The surgical approach was delayed for 12 months and all the patients received bisphosphonate therapy with calcium and vitamin D supplements. DXA scans were performed after 12 months of therapy in all the patients.

RESULTS

A surgical intervention with resurfacing total hip replacement was performed in 12 of the 16 patients presenting with increasing BMD, 4 of them showing elements of rapidly advancing hip arthrosis to a stage that made this type of intervention impossible. We chose not to use this technique in the group with stable BMD (4 patients). All 12 women surgically treated had a favorable post-operative outcome without experiencing a femoral neck fracture during the surgical intervention or during the twelve-month follow-up. All 20 patients continued to receive bisphosphonate therapy.

CONCLUSION

In postmenopausal women with osteoporosis and associated hip arthrosis, improving bone mass and bone quality with bisphosphonate therapy is necessary and important in order to allow hip arthroplasty, by using the technique of resurfacing, avoiding the risk of intra-operative fractures and with a favorable post-operative long-term outcome.

Long-standing pain in a 25-year-old patient with a non-diagnosed cervical osteoblastoma: a case report

Benign osteoblastomas are infrequent tumors, representing less than 1% of all bone tumors. The spinal location accounts for 40-50% of all osteoblastomas from which only 20% are located in the cervical spine. The majority of the spinal osteoblastomas arise from the posterior elements: pedicles, laminas, transverse or spinous processes. We present a case report of a young male that due to the lack of specific symptoms was diagnosed of a cervical osteoblastoma 14 months after the first symptoms. The tumor was located in the right C7 pedicle. We then operated, resected the tumor and a posterior C6-T1 bilateral instrumentation was performed to stabilize the spine. Nowadays, this delay in diagnosis may be avoided by the routine use of MRI or CT for unspecific cervical symptoms. The treatment of this lesion is the complete surgical resection based on a correct preoperative planning with CT and MRI in order to define precisely the location, size and extension of the tumor. Currently, percutaneous or minimally invasive surgery is not commonly used in the treatment of this lesion.

Usefulness of teicoplanin for preventing methicillin-resistant Staphylococcus aureus infections in orthopedic surgery

In order to gather more data on the use of teicoplanin for reducing MRSA infections in high-risk populations, the present study was conducted. At a hospital in Barcelona, Spain, there was a high prevalence of MRSA infections among patients who underwent surgery for femoral neck fracture during the first 5 months of 2002 (period A) when cefuroxime was the antibiotic prophylaxis. During the following 12 months (period B) 600 mg of teicoplanin was added to cefuroxime. The rates of overall and MRSA infection during period A were 5.07 and 2.73%, respectively. Pulsed-field gel electrophoresis demonstrated there was no clonal relationship among MRSA strains. No nasal carriers of MRSA were detected among health workers. During period B the rates of overall and MRSA infection were 2.36 and 0.19%, respectively. Both rates were statistically significantly lower than those in period A (p<0.05). These results suggest teicoplanin may be useful in patients undergoing orthopedic surgery when the prevalence of MRSA is high.

Intrapelvic protrusion of a dynamic hip screw

The sliding hip screw, sometimes called the dynamic hip screw (DHS) has been a successful method for treating hip fractures. Nevertheless, mechanical complications of this system have been reported from time to time. They are mainly the result of instability of the fracture, bone quality and technical errors occurring during surgery. We report a case of an intrapelvic protrusion of a sliding screw after a basicervical fracture was treated with a DHS and a 6.5 mm cannulated screw, and its surgical solution using a hybrid total hip arthroplasty. In our case we think the mechanical failure was due mainly to technical errors during surgery. Despite that, we believe the sliding hip screw is the implant of choice for basicervical fractures. Using an additional K-wire during the technique is sufficient to avoid rotation of the proximal fragment and no additional fixation is necessary.;