Biomechanical Behavior of Narrow Dental Implants Made with Aluminum- and Vanadium-Free Alloys: A Finite Element Analysis

Titanium (Ti) alloys used for narrow dental implants usually contain aluminum (Al) and vanadium (V) for improved resistance. However, those elements are linked to possible cytotoxic effects. Thus, this study evaluated the biomechanical behavior of narrow dental implants made with Al- and V-free Ti alloys by the finite element method. A virtual model of a partially edentulous maxilla received single implants (diameter: 2.7 and 2.9 mm; length: 10 mm) at the upper lateral incisor area, with respective abutments and porcelain-fused-to-metal crowns. Simulations were performed for each implant diameter and the following eight alloys (and elastic moduli): (1) Ti–6Al–4V (control; 110 GPa), (2) Ti–35Nb–5Sn–6Mo–3Zr (85 GPa), (3) Ti–13Nb–13Zr (77 GPa), (4) Ti–15Zr (113 GPa), (5) Ti–8Fe–5Ta (120 GPa), (6) Ti–26.88Fe–4Ta (175 GPa), (7) TNTZ–2Fe–0.4O (107 GPa), and (8) TNTZ–2Fe–0.7O (109 GPa). The implants received a labially directed total static load of 100 N at a 45° angle relative to their long axis. Parameters for analysis included the maximum and minimum principal stresses for bone, and von Mises equivalent stress for implants and abutments. Ti–26.88Fe–4Ta reaches the lowest maximum (57 MPa) and minimum (125 MPa) principal stress values, whereas Ti–35Nb–5Sn–6Mo–3Zr (183 MPa) and Ti–13Nb–13Zr (191 MPa) models result in the highest principal stresses (the 2.7 mm model surpasses the threshold for bone overload). Implant diameters affect von Mises stresses more than the constituent alloys. It can be concluded that the narrow implants made of the Ti–26.88Fe–4Ta alloy have the most favorable biomechanical behavior, mostly by mitigating stress on peri-implant bone.     

Multilayered optofluidics for sustainable buildings

Indoor climate control is among the most energy-intensive activities conducted by humans. A building facade that can achieve versatile climate control directly, through independent and multifunctional optical reconfigurations, could significantly reduce this energy footprint, and its development represents a pertinent unmet challenge toward global sustainability. Drawing from optically adaptive multilayer skins within biological organisms, we report a multilayered millifluidic interface for achieving a comprehensive suite of independent optical responses in buildings. We digitally control the flow of aqueous solutions within confined milliscale channels, demonstrating independent command over total transmitted light intensity (95% modulation between 250 and 2,500 nm), near-infrared-selective absorption (70% modulation between 740 and 2,500 nm), and dispersion (scattering). This combinatorial optical tunability enables configurable optimization of the amount, wavelength, and position of transmitted solar radiation within buildings over time, resulting in annual modeled energy reductions of more than 43% over existing technologies. Our scalable “optofluidic” platform, leveraging a versatile range of aqueous chemistries, may represent a general solution for the climate control of buildings.

Buildings are the costliest energy sinks on the planet (1, 2). For their daily operation, which largely entails trying to heat, cool, and light the indoor environment as exterior conditions change, buildings require 32% (32.4 PWh) of the energy and 50% of the electricity consumed globally (2), corresponding to about 25% (9.18 GtCO₂) of our greenhouse gas emissions (1).Moreover, the emissions associated with buildings may double or triple by mid-century with increased urbanization (1). Global air conditioning demand is set to triple by 2050 (3). Heating and cooling energy use is expected to grow by 79% and 84% in the same timeframe (1). In addition, electricity-based emissions from residential and commercial buildings have already quintupled and quadruped, respectively, in the last four decades (1).Underpinning this alarming and growing footprint is a fundamental unmet challenge in building design: existing facades cannot achieve selective, reconfigurable responses to their solar environment; no window, sunshade, or chromogenic technology is able to independently tune the amount (intensity), wavelength (spectrum), and dispersion (scattering) of incident sunlight as solar conditions change (a comprehensive review of available technologies and their optical properties is provided in SI Appendix, Table S1).Static windows, with or without permanent reflective coatings, for instance, cannot dynamically modulate solar intensity, spectrum, nor scattering (4–6). Manual or automated venetian blinds, on the other hand, can partially control intensity and scattering (with changing slat angle), but not independently (7). Adjustable window shades, which can be bent, rotated, or otherwise translated under mechanical (6, 8–12), electrical (13), hygroscopic (14, 15), or thermal (16) stimuli, can usually tune only total intensity (17), while more experimental chromogenic windows, including reorientable liquid crystal (18–20), suspended particle (21–23), as well as electro- (24–34), photo- (26, 28, 29, 31, 35), and thermochromic (26, 28, 29, 31, 35–37) devices, can generally only regulate total sunlight intensity or spectrum (32–34, 38).At the building interface, independent, synergistic control over transmitted light intensity, spectrum, and scattering is necessary to achieve optimized and climate-responsive functions (4, 6, 31, 39). Control of total light intensity would enable modulation of solar heat gain and illumination; control of spectrum and, in particular, switchable transmission of near-infrared-selective (NIR) sunlight would decouple infrared heating from visible daylighting (38, 40); while control of scattering would allow for the spatial tuning of transmitted photons within a room. In the current absence of a building material with this combinatorial functionality, interior heating, cooling, and lighting systems must bear the brunt of temperature and illumination control, compensating entirely for exterior environmental fluctuations and interior occupant changes, and by themselves consume more than 25% of the energy used in the developed world (4, 6, 31, 39, 41).To alter this energy-intensive paradigm (41), buildings would benefit from independent, switchable control over total transmittance, NIR-selective absorption, and scattering by the outer facade. Developing this scalable, combinatorial optical platform, with the ability to separately tune each of these three properties, might be considered the “holy grail” for building material design (42).Multilayered Optical Mechanisms in Biology.As a possible source of inspiration, certain biological organisms have evolved multilayered mechanisms within their skin to tune independent optical properties at their interface. In a few species of squid (e.g., Loligo plei), for instance, active camouflage is achieved through the independent and cooperative action of a pigmentary layer of chromatophore organs and a structural layer of protein cells (43–45), mediating surface color, spectral reflectance, and spatial patterning (46–50) (Fig. 1B). Large shifts in spectral reflection peaks occur along surface regions where both pigmentary and structural layers are overlaid (SI Appendix, Fig. S3 C–J), enabling combinatorial, additive, optical responses. The panther chameleon has also evolved a multilayered infrastructure within its skin, leveraging a two-tiered system of photonic crystals, each with an independent morphology and function (51) (Fig. 1A). Color change is regulated through the uppermost photonic layer, as chameleons actively manipulate the periodicity of guanine nanocrystals to selectively reflect light. Thermoregulation, on the other hand, is achieved through the lowermost photonic layer, where populations of regularly arranged iridophore cells strongly reflect radiation in the NIR region.Open in a separate windowFig. 1.Biological inspiration for fluidic multilayer. (A) Color change in the panther chameleon, achieved using a multilayer architecture of active photonic crystals. (B) Color change in the squid, achieved using coordinated actuations within a multilayer of pigmentary and structural elements. The top images are of Sepioteuthis lessoniana, whereas the bottom images are of Loligo pealeii. (C and D) Schematic for achieving independent multilayered switchable responses in building facades, where switchable fluid flow within distinct layers can enable multiple distinct optical functions. (E) Schematic exemplifying several functional or multifunctional states, achieved through coordinated fluid injections within a bilayer. The fluid multilayer acts as an additive light filter for incoming light. Scale bars: (A) white, 20 μm; black, 200 nm; (B) 1 mm; (D) 1 cm. Images in (A) reproduced from ref. 51, published under a Creative Commons license (http://creativecommons.org/licenses/by/4.0/). Images in (B) reproduced with permission from ref. 48, and under license from refs. 52 and 53.Independently tunable and multifunctional multilayer interfaces enable combinatorial physiological responses in organisms. We hypothesize that building-scale analogues of these multilayered, multifunctional biological systems might be capable of similarly dynamic optical behaviors (SI Appendix, Fig. S3). To achieve a scalable and sustainable material platform with general optical tunability, we propose moving away from traditional solid-state approaches and instead suggest the integration of confined aqueous fluids: a class of replenishable, recyclable, nontoxic materials with remarkable spatial configurability (54–57) and broadly tailorable optical programmability (58, 59). Conventional microfluidic devices are typically applied to chemical (60, 61), diagnostic (62, 63), and computational (64, 65) “lab on a chip” applications, but few examples take advantage of the optical characteristics of confined fluids, and over large planar dimensions. We suggest that a system of stacked channeled layers capable of confining a selectively designed collection of fluids can achieve versatile, multifunctional, and combinatorial optical functionality.Here, we demonstrate a large-area “optofluidic” platform for buildings, capable of achieving independent and combinatorial control of total light transmission, spectrally selective light absorption, and spatially directable light dispersion through coordinated digital fluid flows therein (Fig. 1 C–E). In simulation, we show that independent control over three sequential aqueous fluid layers within a building facade—to regulate optimal degrees of total light transmission, NIR light transmission, and visible light scattering in response to fluctuating solar conditions—can accomplish savings of 75% on heating energy, 20% on electric lighting energy, and 43% on total operational energy, compared with the best available electrochromic technology. These results point toward an exciting design paradigm for buildings, where confined, switchable fluid layers within a facade can behave in concert as functionally programmable optical and solar filters. Dynamic control of this versatile fluidic platform could significantly improve the way we build, operate, and interact with buildings.     

Is parotidectomy justified in elderly patients with pleomorphic adenoma? A decision analysis model

PurposeThe value of parotidectomy in older patients is unclear. This study presents a decision model to help resolve this question.Materials & methodsA Markov model with Monte Carlo simulation was used to compare outcomes in patients of different ages with pleomorphic adenoma of the parotid gland treated by surgery or surveillance.ResultsIn 30-year-old patients, surgery conferred a 3.5-year gain in life expectancy whereas in 75-year-olds, it was only 0.74 months. The expected rate of malignant transformation at age 30 years was 6.5% after surgery and 26.5% after surveillance; at age 65, corresponding rates were 0.8% and 10.7%. Sensitivity analysis showed that age was the only parameter that significantly contributed to life expectancy. The benefit of surgery was restricted in older patients.ConclusionOur Markov decision-analysis model suggests that patients older than 65 years with pleomorphic adenoma have a limited survival advantage with surgery compared to surveillance.     

Atezolizumab and bevacizumab-induced encephalitis in advanced hepatocellular carcinoma: Case report and literature review

Introduction:On the basis of the results of the IMBRAVE-150 trial, the combination of atezolizumab, a programmed cell death ligand 1 (PD-L1) antibody, as well as bevacizumab, a vascular endothelial growth factor (VEGF) antibody, represents a promising novel first-line therapy in patients with advanced hepatocellular carcinoma (HCC). Despite favorable safety data, serious adverse events have been described. However, central nervous system complications such as encephalitis have rarely been reported. We present the case of a 70-year-old woman with hepatitis C virus (HCV)-related liver cirrhosis and advanced HCC who developed severe encephalitis after only one cycle of atezolizumab/bevacizumab.Patient concerns:Ten days after administration, the patient presented with confusion, somnolence, and emesis. Within a few days, the patient''s condition deteriorated, and mechanical ventilation became necessary.Diagnosis:Cerebrospinal fluid (CSF) analysis showed increased cell count and elevated protein values. Further work-up revealed no signs of an infectious, paraneoplastic, or other autoimmune cause.Intervention:Suspecting an atezolizumab/bevacizumab-related encephalitis, we initiated a high-dose steroid pulse therapy as well as repeated plasmapheresis, which resulted in clinical improvement and remission of CSF abnormalities.Outcome:Despite successful weaning and transfer to a rehabilitation ward, the patient died of progressive liver cancer 76 days after initial treatment with atezolizumab/bevacizumab, showing no response.Conclusion:This case illustrates that rapid immunosuppressive treatment with prednisolone can result in remission even of severe encephalitis. We discuss this case in the context of available literature and previously reported cases of atezolizumab-induced encephalitis in different tumor entities, highlighting the diagnostic challenges in oncologic patients treated with immune checkpoint-inhibitors.     

Treating insomnia in Swiss primary care practices: A survey study based on case vignettes

Guidelines recommend cognitive behavioural therapy for insomnia (CBT‐I) as first‐line treatment for chronic insomnia, but it is not clear how many primary care physicians (PCPs) in Switzerland prescribe this treatment. We created a survey that asked PCPs how they would treat chronic insomnia and how much they knew about CBT‐I. The survey included two case vignettes that described patients with chronic insomnia, one with and one without comorbid depression. PCPs also answered general questions about treating chronic insomnia and about CBT‐I and CBT‐I providers. Of the 820 Swiss PCPs we invited, 395 (48%) completed the survey (mean age 54 years; 70% male); 87% of PCPs prescribed sleep hygiene and 65% phytopharmaceuticals for the patient who had only chronic insomnia; 95% prescribed antidepressants for the patient who had comorbid depression. In each case, 20% of PCPs prescribed benzodiazepines or benzodiazepine receptor agonists, 8% prescribed CBT‐I, 68% said they knew little about CBT‐I, and 78% did not know a CBT‐I provider. In the clinical case vignettes, most PCPs treated chronic insomnia with phytopharmaceuticals and sleep hygiene despite their lack of efficacy, but PCPs rarely prescribed CBT‐I, felt they knew little about it, and usually knew no CBT‐I providers. PCPs need more information about the benefits of CBT‐I and local CBT‐I providers and dedicated initiatives to implement CBT‐I in order to reduce the number of patients who are prescribed ineffective or potentially harmful medications.