Successful salvage of an infected breast prothesis by changing from continuous to intermittent suction under continuous irrigation

IntroductionImplant-based breast reconstruction is a widely performed procedure. However, prostheses are susceptible to infection and there are currently no established guidelines on treatment. In the present case, a prosthesis was salvaged by changing from continuous irrigation and suction to continuous irrigation and intermittent suction. This case report has been reported in line with the SCARE criteria [1].Presentation of caseA 50-year-old female patient underwent implant-based breast reconstruction following surgery for breast cancer. One month later, the left breast prosthesis was infected with abscesses. Surgical treatment and continuous irrigation were performed as postoperative therapy. However, recurrent infection was detected a few days after surgery. Continuous irrigation was changed to continuous irrigation with intermittent aspiration, which successfully controlled the infection.DiscussionFactors that limit the effectiveness of continuous irrigation and aspiration have not yet been identified. Inflow/discharge shunt routes may be established in continuous aspiration, and, thus, sufficient cleaning may not be possible. On the other hand, the storage of water throughout the wound in intermittent aspiration may facilitate cleaning.ConclusionIntermittent suction worked well in this patient and, thus, warrants further study.     

Immediate rehabilitation of a rheumatoid arthritis patient with single-piece implants

Introduction and importanceThe aim of this article is to report the long-term outcome of full mouth rehabilitation with single piece, smooth surface implants following immediate loading protocol on a patient suffering with RA and severe unilateral condylar resorption.Case presentationHere, we present a challenging case of a patient suffering from Rheumatoid Arthritis who was stabilized and completed successfully with a 4 year follow-up period. Prosthetic management optimized the inter-occlusal relationship to maintain both function and esthetic integrity. Single piece implants are designed to engage and take support from the cortical bone low in metabolic activities thus promoting the force transmission through apical threads that are engaged in the cortical bone.DiscussionRheumatoid Arthritis [RA] is an auto-immune inflammatory condition in which the inflamed and hypertrophic synovial membrane grows into the articulation surfaces. The Temporomandibular Joints [TM] are frequently involved in rheumatoid arthritis. According to the literature on RA, due to frequent periodontitis, decreased salivary secretion, medication, as well as decrease in bone regenerative potential, RA is often considered as a relative contraindication in the use of implants. Atrophic jaws and cases with comorbidities like osteoporosis, diabetes, rheumatoid arthritis, periodontally infected cases are restored with high success by single piece smooth surface.ConclusionTo the best of our knowledge, this may be the first case of immediate functional loading by bi-cortical single piece implants.     

基于点云数据的髋臼置钉通道全局优化

针对髋臼前后柱置钉通道多截面调控规划法的不足,该研究提出了基于大密度点云数据、相关理论、软件内置功能及自编程序的规划方法,实现了对置钉通道总长的全局优化,同时进行了基于7截面、11截面调控规划法以及点云数据的前柱最大内接圆柱体虚拟置钉实验,分析了实验结果及形成机理,验证了基于点云数据规划法的全局优化效果,但对多截面调控规划法的调控有效性表示还存有疑问,此外,还对基于点云数据的髋臼置钉通道规划方法应用的相关原理和操作技巧作了简略介绍。     

3D打印导航模板辅助椎弓根螺钉在脊柱侧弯矫形术中的置钉效果

目的:探讨3D打印导航模板辅助椎弓根螺钉在脊柱侧弯矫形术中的置钉效果。方法:回顾性分析2018年1月至2020年6月间采用椎弓根螺钉置钉法治疗的39例脊柱侧弯患者的病例资料,其中采用3D打印导航模板辅助置钉(3D组)18例,常规徒手置钉方法置钉(徒手组)21例。记录并比较2组的置钉时间、置钉出血量、置钉透视次数、置钉等级及准确率、置钉可接受率、置钉并发症和主弯矫形率。采用SPSS 19.0软件进行统计学分析。结果:39例患者均顺利完成术中置钉,术后徒手组4例出现并发症,治疗后症状消失,3D组无相关并发症出现。3D组的置钉时间、置钉出血量、置钉透视次数少于徒手组,置钉等级及准确率、置钉可接受率均优于徒手组,差异有统计学意义(P<0.05);3D组和徒手组主弯矫形率比较差异无统计学意义(P>0.05)。结论:在脊柱侧弯矫形术中采用3D打印导航模板辅助椎弓根螺钉置钉,可显著降低置钉难度、优化术中置钉操作、提升置钉效果,是一种较好的置钉方法。     

On the secondary stability of coated cementless hip replacement: parameters that affected interface strength

Unlike primary stability of coated cementless implants, their secondary stability has been poorly studied. This paper considers some theoretical aspects of the secondary stability of a coated cementless hip implant in a human femur. The bone is separated from the implant by a thin layer of microscopic peaks and troughs formed on the surface of the coating. The size of the peaks and troughs is very small compared with the macrosize of the implant stem and bone in contact. The study of the bone–stem contact by direct application of the finite element method is prohibitively costly. A two-scale asymptotic homogenisation procedure that takes into account the microgeometry of the interface layer and mechanical properties of bone and the implant material is applied to obtain effective, homogenised contact parameters. These parameters can be used in finite element analyses involving smooth interfaces, which require hundreds of times fewer finite elements. With the homogenisation technique and finite element analyses for a simplified design, two parameters were found to be most important—the normal contact stiffness and the friction coefficient. They both increase several times as bone grows into the rough surface of the implant and mineralises, thus providing a stronger interface and resulting in reduced micromotions.     

3D打印导板辅助上颈椎椎弓根置钉与徒手置钉的比较

目的 比较个体化3D打印导板辅助上颈椎椎弓根置钉与徒手置钉的精准性。方法 选择2019年6月至2022年6月在蚌埠医学院第二附属医院就诊的上颈椎疾患患者20例,获取每位患者颈椎三维CT数据,根据置钉方式不同分为导板组和对照组,分别制作20例等比例3D打印上颈椎模型,导板组使用3D打印导板辅助上颈椎模型椎弓根螺钉置入,对照组在透视辅助下徒手置钉。根据椎体是否存在骨折,将导板组内20例模型分为钉道损伤组10例（寰椎骨折与枢椎骨折病例）和钉道完整组10例（畸形与关节脱位病例）。比较导板组和对照组螺钉可接受率、单枚螺钉置入时间差异;比较导板组术前理想钉道与术后实际钉道内倾角差异,对比钉道损伤组和钉道完整组置钉结果差异。结果 导板组螺钉可接受率为93.55%,高于对照组的79.03%(P<0.05);导板组单枚螺钉置入时间短于对照组（P<0.05）;导板组术前理想螺钉内倾角与术后实际螺钉内倾角之间差异无统计学意义（P>0.05）;钉道损伤组螺钉突破椎弓根率26.7%高于钉道完整组3.1%(P<0.05)。结论 个体化3D打印导板辅助上颈椎椎弓根置钉在置钉精准度、安全性和置...     

Role of anterior retinal cryoablation in the management of neovascular glaucoma

In a prospective study, the effect of anterior retinal cryoablation (ARC) in the management of neovascular glaucoma (NVG) was evaluated over two years, in 72 patients (74 eyes). The outcome of trabeculectomy/seton surgery preceded by 360° ARC was also analysed in 12 eyes of 12 patients (6 eyes in each group). Following ARC, pain relief with dramatic regression of anterior chamber inflammatory reaction was observed in 95% of the patients (59 eyes). At the end of the follow up, as confirmed by iris fluorescein angiography, regression of neovascularization of the iris was documented in 93.5% (58 eyes) of the cases. Intraocular pressure control (22 mm Hg) was achieved in 82.3% (51 eyes) cases. IOP control of 22 mm Hg was achieved in all the 6 eyes with the seton surgery following ARC. Similarly, control of IOP was successfully achieved in all the 6 eyes of patients with NVG with trabeculectomy with post operative course of 5-fluorouracil following ARC. ARC is strongly recommended in NVG, especially in eyes with media opacities and as a preliminary procedure for filtering surgery or drainage implant surgery.Abbreviations ARC Anterior retinal cryoablation - NVG Neovascular glaucoma - NVI Neovascularization of the iris     

Embracing fixator for treating periprosthetic femoral fractures

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Study on Relevance of Endothelin to Abnormal Uterine Bleeding Associated with Long-Term Subdermal Implants Use

Objective To investigate the relationship between estradiol, progesterone and endothelin (ET) and abnormal uterine bleeding after using sub-dermal contraceptive implant Materials & methods A prospective self-control clinical trial was conducted in 29 women in the self-control group. Blood samples were obtained on four occasions across the different phases of menstrual cycle before and after using implant. A blood sample was taken for a single determination in another 59 women in the already-use implant group. Plasma of estradiol, progesterone and endothelin were determined by using radioimmunoassays (RIA) in both groups.Results The level of estradiol and progesterone had no significant differences in women before and after using implant in self-control group. The level of estradiol,progesterone had no differences between women with normal and abnormal menstrual cycle in both groups. The levels of plasma endothelin (ET) in women with abnormal bleeding pattern were higher than women with normal bleeding pattern, but difference was not significant. Women with abnormal bleeding pattern had significantly higher ET level than that in women with normal bleeding pattern before using implants,especially in early-proliferative phase and mid-proliferative phase. the level of plasma endothelin was significantly higher in women with disturbed bleeding pattern than that in normal women in the already-use group.Conclusion High serum concentrations of ET are likely to be correlated with abnormal uterine bleeding in long-term subdermal contraceptive implants users.